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Tumores do mediastino em crian as  [cached]
Fraga José Carlos,Komlós Marcia,Takamatu Eliziane,Camargo Luciano
Jornal de Pneumologia , 2003,
Abstract: INTRODU O: Os tumores mediastinais na crian a compreendem um grupo heterogêneo de les es com origem embrionária distinta. Podem apresentar-se como cistos benignos ou les es malignas. OBJETIVO: Descrever os procedimentos diagnósticos, tratamento e evolu o de uma série de crian as e adolescentes com tumores do mediastino. MéTODO: Análise retrospectiva de vinte crian as com tumores de mediastino, no período de julho de 1996 a julho de 2002 no Hospital de Clínicas de Porto Alegre. Todos os pacientes foram submetidos a algum procedimento cirúrgico, seja diagnóstico, terapêutico ou ambos. RESULTADOS: Doze meninos e oito meninas foram estudados. A idade média no momento do diagnóstico foi de seis anos e oito meses, variando entre três meses e 16 anos. Quatorze tumores (70%) ocorreram no mediastino anterior, sendo os mais comuns os linfomas de Hodgkin e n o-Hodgkin; seis tumores (30%) ocorreram no mediastino posterior, sendo o neuroblastoma o mais freqüente. Nos tumores anteriores, a abordagem cirúrgica mais comum foi a toracotomia anterior de Chamberlain; nos posteriores, a toracotomia póstero-lateral. No período de seguimento ocorreram seis óbitos, todos sem nenhuma rela o com o procedimento cirúrgico. CONCLUS O: Os tumores mediastinais em crian as s o responsáveis por morbimortalidade. No mediastino anterior foram mais comuns os linfomas; no posterior, os tumores de origem neural. A cirurgia é um passo importante no diagnóstico e tratamento dessas les es
Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum
Nan Song,Gening Jiang,Dong Xie,Peng Zhang
Jornal Brasileiro de Pneumologia , 2013,
Abstract: OBJETIVO: A cirurgia torácica vídeo-assistida (CTVA) tem sido uma interven o de escolha para o tratamento de pneumotórax espontaneo (PS) com bolha pulmonar. Nosso objetivo foi apresentar uma abordagem de CTVA uniportal unilateral para bulectomia bilateral e avaliar sua eficácia terapêutica. MéTODOS: Entre maio de 2011 e janeiro de 2012, cinco pacientes foram submetidos a bulectomia bilateral por essa abordagem. Todos apresentavam PS bilateral. A TCAR pré-operatória mostrou que todos os pacientes tinham bolhas bilaterais no pulm o apical. As indica es cirúrgicas, os procedimentos de opera o e os desfechos foram revisados. RESULTADOS: Todos os pacientes foram submetidos com sucesso a essa abordagem para bulectomia bilateral, sem complica es intraoperatórias. A mediana de tempo para a retirada do dreno torácico foi de 4,2 dias, e a mediana do tempo de hospitaliza o no pós-operatório foi de 5,2 dias. A mediana de seguimento pós-operatório foi de 11,2 meses. Um paciente teve recidiva de PE do lado esquerdo três semanas após a cirurgia e foi submetido a abras o pleural. CONCLUS ES: A bulectomia bilateral utilizando CTVA uniportal combinada com acesso contralateral ao mediastino anterior é tecnicamente confiável e promove desfechos favoráveis para pacientes com PS que desenvolvem bolhas bilaterais no pulm o apical. Entretanto, para a realiza o desse procedimento cirúrgico, s o necessários cirurgi es com experiência em CTVA, instrumentos toracoscópicos longos, entre outras exigências. OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilatera
Tratamento agressivo com retalho muscular e/ou omentopexia nas infec??es do esterno e mediastino anterior em pós-operatório de esternotomia
Moreschi, Alexandre Heitor;Macedo Neto, Amarilio Vieira de;Barbosa, Gilberto Venossi;Saueressig, Mauricio Guidi;
Jornal Brasileiro de Pneumologia , 2008, DOI: 10.1590/S1806-37132008000900004
Abstract: objective: to evaluate the impact of an aggressive treatment approach using muscle flaps or omentopexy in infections of the sternum and anterior mediastinum following sternotomy on mortality, as compared to that of a conservative treatment approach. methods: data were collected prior to, during and after the surgical procedures. group a (n = 44) included patients submitted to conservative treatment-debridement together with resuture or continuous irrigation with polyvinylpyrrolidone-iodine solutions, or even with second-intention wound healing (retrospective data). group b (n = 9) included patients in whom infection was not resolved with conservative treatment, and who therefore underwent aggressive treatment (intermediate phase). group c (n = 28) included patients primarily submitted to aggressive treatment (prospective data). results: postoperative hospital stays were shorter in the patients submitted to aggressive treatment (p < 0.046). there were 7 deaths in group a, 1 in group b, and 2 in group c. however, the classical level of significance of α = 0.05 was not reached. conclusion: aggressive treatment also proved to be effective when the infection was not resolved with conservative treatment. these findings demonstrate that the proposed treatment provides excellent results.
Tumor del mediastino anterior en hombre joven
Ruiz Pi?a, Víctor;Morales Gómez, José;Recinos Carrera, Elio Germán;Ibarra-Pérez, Carlos;
Revista del Instituto Nacional de Enfermedades Respiratorias , 2007,
Abstract: a young man presented with a solid mass in the anterosuperior mediastinum and superior vena cava syndrome. some tumor markers were elevated. diagnosis was followed by chemotherapy.
Mediastinal tumors. Report of 29 operated patients. Tumores de mediastino. Reporte de 29 pacientes operados.  [cached]
Antonio Ríos Rodríguez,Nancy Capin Sarria,Lidia Torres Aja,Arístides Sánchez Sánchez
MediSur , 2010,
Abstract: Background: Surgery is the unique possibility of cure of survival with life quality for patients with tumor or mediastinal mass. Objective: To describe the results of surgical procedures in patients with mediastinal tumor. Methods: Descriptive, retrospective study of 29 patients operated after being diagnosed with mediastinal tumor in a period of 17 years (1986-2002). Studied variables were: tumor′s locus in the mediastinum, tumor nature, histological diagnosis and strategies regarding surgical approach. Findings: There was a prevalence of benign tumors (81,8%) and the most frequent locus was anterior mediastinum. Conclusions: These findings agree with previous studies, mainly regarding tumors′ locus and nature. Fundamento: La cirugía es la única posibilidad de curación o de supervivencia con calidad de vida, de los pacientes con diagnóstico de tumor o masa mediastinal. Objetivo: Describir los resultados de los procedimientos quirúrgicos en pacientes con diagnóstico de tumor de mediastino. Métodos: Estudio descriptivo y retrospectivo de una serie de 29 pacientes operados tras el diagnóstico de tumor de mediastino, en un período de 17 a os (1986-2002). Las variables estudiadas fueron: localización de la tumoración en el mediastino, naturaleza del tumor, diagnóstico histológico y estrategias en cuanto al abordaje quirúrgico. Resultados: Predominaron los tumores benignos (81,8 %) así como la localización en el mediastino anterior. Conclusiones: Los resultados concuerdan, en gran medida, con otros estudios realizados sobre este tema, pero sobre todo en lo referente a la naturaleza y localización de los tumores.
Morbilidad de las afecciones quirúrgicas del mediastino Morbidity of mediastinum surgical affections  [cached]
Orestes Noel Mederos Curbelo,Juan Carlos Barrera Ortega,Orlando Villafranca Hernández,Lilian Gómez Guirola
Revista Cubana de Cirugía , 2011,
Abstract: Introducción: las afecciones quirúrgicas del mediastino son un tema controversial, por la variedad de las manifestaciones clínicas, compromiso de estructuras adyacentes, y complejidad de las intervenciones quirúrgicas a realizar. Objetivos: mostrar la experiencia del Hospital Universitario "Cmdte. Manuel Fajardo" en la atención a estas afecciones. Métodos: estudio descriptivo, prospectivo, de corte transversal, tipo serie de casos, de todos los pacientes atendidos por afecciones quirúrgicas del mediastino, excluyendo los tumores esofágicos, las hernias hiatales y las prolongaciones endotorácicas de la glándula tiroides. Resultados: la localización más afectada fue el mediastino medio. La enfermedad más frecuente en mediastino anterior fue el bocio endotorácico verdadero; en el medio, el derrame pericárdico agudo y crónico, con compresión del miocardio; y en el posterior, los tumores neurogénicos, las eventraciones y hernias diafragmáticas traumáticas crónicas. Las vías de acceso quirúrgico más usadas fueron la toracotomía anterior izquierda, la esternotomía media, la toracotomía posterolateral y la toracotomía vertical, en ese orden. Las complicaciones más frecuentes fueron la arritmia cardiaca, la inestabilidad tensional y los procesos inflamatorios respiratorios. Conclusiones: las afecciones mediastinales más frecuentes se localizaron en el mediastino medio, posterior y anterior. La cirugía exerética de los tumores y las resecciones del pericardio fueron las intervenciones más realizadas, y las complicaciones más presentadas fueron las cardiovasculares y las respiratorias. Introduction: the surgical affections of mediastinum are a controversial topic due to the variety of its clinical manifestations, involvement of surrounding structures and the complexity of surgical interventions to be carried out. Objectives: to show the experiences acquired by the "Commandant Manuel Fajardo" University Hospital in relation to the care of these affections. Methods: a cross-sectional, prospective, descriptive and case-series type study was conducted in all patients seen due to surgical affections of mediastinum, ruled out the esophageal tumors, hiatal hernias and endothoracic extensions of thyroid gland. Results: the more involved location was the middle mediastinum. The more frequent anterior mediastinal disease was the real endothoracic goiter; in the middle, the acute and chronic pericardial leakage with myocardium compression and in the posterior one, the neurogenic tumors, the eventrations and the chronic traumatic diaphragmatic hernias. The more used routes of
Evaluación, diagnóstico y tratamiento quirúrgico: De las neoplasias del mediastino
Fernando Guzmán Toro,Dimas Morales,Yusbelys A Guerrero Hernández
Revista Venezolana de Oncología , 2006,
Abstract: OBJETIVOS: Se presenta la experiencia en el diagnóstico y tratamiento de 36 pacientes con neoplasias mediastinales en un período de 20 a os. MéTODOS: Se evaluaron 36 pacientes con neoplasias mediastinales: 19 pacientes eran masculinos, y 17 femeninos. RESULTADOS: Las manifestaciones clínicas más frecuentes fueron: dificultad respiratoria (47,22 %), tos (36,11 %), disfagia (11,11 %). Los hallazgos radiológicos más comunes: ensanchamiento mediastinal (47,22 %), imagen densa bien definida en mediastino (16,6 %), velamiento del hemitórax (8,33 %). Las intervenciones quirúrgicas más frecuentemente realizadas fueron: mediastinostomía anterior (19,44 %), esternotomía mediana, timectomía (19,44 %) y toracotomía izquierda con resección del tumor (16,66 %). Se observó presencia de tumor en mediastino anterior en 25 pacientes (69,44 %), mediastino medio en 5 pacientes (13,88 %), mediastino posterior en 6 pacientes (16,66 %). Las neoplasias más frecuentes fueron: linfoma (16,66 %) y timoma (16,66 %). Entre las complicaciones operatorias se observaron 2 casos de lesión incidental de vena cava superior y 4 pacientes con sangrado en el posoperatorio inmediato. Conclusiones: Es importante en las neoplasias del mediastino un diagnóstico temprano que permita seleccionar la estrategia terapéutica más adecuada que permita el tratamiento ideal de los pacientes afectados con estas neoplasias. OBJECTIVES: We review the experience with the diagnosis and management of 36 patients with mediastinal neoplasms during a 20 year period. METHODS: We evaluated 36 patients with mediastinal neoplams: 19 were male and 17 were female. RESULTS: The most frequent clinical manifestations were: dyspnea (47.22 %), cough (36,11 %) and dysphagia (11.11 %). The most common radiological findings were: Mediastinal widening (47.22 %), well defined mediastinal radiodense image (16.6 %) and pleural effusion (8.33 %). The surgical procedures performed most frequently were: anterior mediastinostomy (19.44 %), median sternotomy and thymectomy (19.44 %) and left thoracotomy with tumor resection (16.66 %). The tumor was located in the anterior me-diastinum in 25 patients (69.44 %), visceral compartment in 5 patients (13,88 %) and posterior mediastinum in 6 patients (16.66 %). Lymphoma (16.66 %) and thymoma (16.66 %) were the mediastinal tumors observed most frequently. Surgical morbidity was registered in 6 patients: 2 patients had intraoperative incidental lace-ration of the superior vena cava and 4 patients had immediate postoperative bleeding. CONCLUSIONS: When managing mediastinal neoplasms, early diagn
Tumores do mediastino em crian?as
Fraga, José Carlos;Komlós, Marcia;Takamatu, Eliziane;Camargo, Luciano;Contelli, Fábio;Brunetto, Algemir;Antunes, Carlos;
Jornal de Pneumologia , 2003, DOI: 10.1590/S0102-35862003000500002
Abstract: background: mediastinal tumors in children comprise a heterogeneous group of lesions that have a range of embryonic origins. they may present as benign cysts, as well as malignant lesions. objective: to describe the diagnostic procedures, the treatments and outcomes of a group of children and adolescents with mediastinal tumors. method: a retrospective analysis of twenty children and adolescents with mediastinal tumors who were treated at the hospital de clínicas de porto alegre from july, 1996 to july, 2002. all patients were submitted to some kind of surgical procedure: diagnostic, therapeutic, or both. results: twelve boys and eight girls were studied. mean age at diagnosis was 6 years and 8 months (ranging from 3 months to 16 years). fourteen tumors (70%) were located at the anterior, and six (30%) at the posterior mediastinum. hodgkin and non-hodgkin lymphomas were the most common tumors found in anterior mediastinum, whereas neuroblastoma was the most common among posterior malignancies. the most used surgical procedure for anterior tumors was chamberlain anterior thoracotomy; posterolateral thoracotomy was usually performed for posterior tumors. six patients died during the follow-up period but none of the deaths was considered related to the surgical procedure. conclusion: mediastinal tumors in children and adolescents represent an important cause of morbidity/mortality. the most common tumors at the anterior mediastinum were lymphomas, whereas at the posterior mediastinum the most common were neurogenic tumors. surgery is an important step for the diagnosis and treatment of such lesions
Hemangioendotelioma: tumor raro de mediastino
Queiroz, Marcelo Loze de;Souza, Petrucio Arantes Sarmento de;Imaeda, Carlos Jogi;Forte, Vicente;
Jornal Brasileiro de Pneumologia , 2004, DOI: 10.1590/S1806-37132004000200012
Abstract: a 30-year-old caucasian male from s?o paulo was admited to the hospital. he had been complaining about constant, moderate pain in the anterior and lateral left hemi-thoracic region for the last three mouths as well as associatede great effort dyspnea over the last mounth. investigation with chest x-rays, ct scans and mri revealed an large vessel invasion. the patient was submitted to a left side parasternal madiastinostomy and a biopsy of the mediastinal mass which was complicated by severe bleeding. an immediate median full sternotomy was elected in addition to a left anterior-lateral thoracotomy for total tumor resection and control of the bleeding. evolution was good, with hospital discharge on the ninth postoperative day. the anatomical-pathological essay disclosed a hemangioendothelioma of the mediastinum.
A raridade histológica no cancer da tireoide The histological rarity of thyroid cancer  [cached]
Débora Modelli Vianna,Otávio Alberto Curioni,Luciano José de Lemos Fran?a,Diógenes Lopes de Paiva
Brazilian Journal of Otorhinolaryngology , 2012, DOI: 10.1590/s1808-86942012000400010
Abstract: O cancer da tireoide é a neoplasia endócrina mais comum, correspondendo a cerca de 1% de todos os tipos de cancer. Sarcomas, linfomas e metástases para a glandula tireoide s o raros e pouco descritos na literatura. OBJETIVO: Descrever tipos histológicos raros de cancer de tireoide em servi o de referência. MéTODOS: Revis o de prontuários de pacientes admitidos com diagnóstico de cancer de tireoide no período de 1977 a 2010. Foram coletadas informa es demográficas, diagnósticas, terapêuticas e histopatológicas. RESULTADOS: Foram revisados 3018 prontuários de pacientes admitidos com doen a tireoidiana. Dos casos com diagnóstico de tumores raros, predominou o tipo histológico carcinoma anaplásico, com 22 casos (0,7%), seguido por 11 casos de carcinoma medular (0,36%), dois de sarcoma (0,07%), dois de linfoma (0,07%) e um de tumor carcinoide metastático (0,03%). Houve predomínio do gênero feminino (57%) e de caucasianos (84%). A apresenta o clínica com nódulo tireoídeo palpável foi a mais frequente. Todos os casos de linfoma, sarcoma e carcinoma anaplásico evoluíram a óbito. CONCLUS O: Sarcomas, linfomas e metástases em tireoide s o incomuns e tendem à evolu o desfavorável. Thyroid cancer is the most common endocrine cancer, accounting for about 1% of all cancers. Sarcomas, lymphomas and metastases to the thyroid gland are rare and only with a handful of descriptions in the literature. OBJECTIVE: To describe rare histological types of thyroid cancer found in a reference center. METHODS: Medical chart review from admitted patients diagnosed with thyroid cancer in the period from 1977 to 2010. Demographic, diagnostic, therapeutic and histopathological information were collected. RESULTS: 3,018 records of patients admitted with thyroid disease were reviewed. Among the cases diagnosed with rare tumors there was a predominance of: anaplastic carcinoma: 22 cases (0.7%), followed by 11 cases of medullary carcinoma (0.36%); 2 cases of sarcoma (0.07%), 2 cases of lymphoma (0.07%) and one case of metastatic carcinoid tumor (0.03%). There were more females diagnosed (57%) as well as Caucasians (84%). The most frequent clinical presentation was a palpable thyroid nodule. All patients with lymphoma, sarcoma and anaplastic carcinoma died. CONCLUSION: Sarcomas, lymphomas and thyroid metastases are uncommon and tend to worse outcomes.
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