Respiratory failure due to insufflated talc.
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Acute Disease↗
Biomedical subjects
F B Jatene
Publications and source records attributed to F B Jatene.
A dedicated prosthesis for open thoracostomy.
Due to our dissatisfaction with the mutilation caused by the skin-lined open thoracostomy, we have developed a dedicated prosthesis that is expected to avoid or to substitute for the classic operation. The prosthesis is a corrugated silicone tube with an oval flange at one end (to fix it internally) and a mobile ring on the other (to fix it externally). It is inserted at the bottom of the empyematic cavity after 3 cm of a rib is removed. We have used it in 20 patients whose empyema was secondary to pneumonia (12) or complications of pneumonectomy (4), lobectomy (2), decortication (1), or pleuroscopy (1). Six of those patients have already been cured and their prosthesis removed after 54 to 305 days. In 1 with a persistent postpneumonectomy bronchopleural fistula the device was removed after 299 days and the patient was submitted to a limited thoracoplasty. Six other patients still have unresolved cavities and have been using the prosthesis for 63 to 302 days. Seven patients died of their underlying disease (bilateral pneumonia, 2; acquired immunodeficiency syndrome, 2; mesothelioma, 1; heart failure and pulmonary embolism, 1; unknown, 1) after using the prosthesis for 11 to 160 days. In those patients from whom the prosthesis already has been removed, the scar looks like those commonly seen after removal of an ordinary chest tube. Based on these early favorable results we feel most encouraged to persist in this research. Nevertheless, we are aware that a larger number of patients and a longer follow-up will be necessary before we may make definitive recommendations.
Empyema, Pleural↗
VATS for complete dissection of LIMA in minimally invasive coronary artery bypass grafting.
BACKGROUND: The aim of this work is to report our initial experience with minimally invasive coronary artery bypass grafting, using video-assisted thoracic surgery (VATS) to facilitate the operation and provide complete dissection of the left internal mammary artery (LIMA). METHODS: Of 44 scheduled patients, 43 patients, 30 (69.8%) male, ranging in age from 31 to 83 years (60.8 +/- 12.0 years), with a severe lesion in the anterior descending artery, were operated upon. An 8-cm left anterior minithoracotomy was performed at the fourth intercostal space. Through this incision the optical device for video-assisted thoracic surgery as well as the surgical instruments were placed to provide complete LIMA dissection. This permits dissection until the subclavian region, allowing for anastomosis without tension or distortion. Bypass circulation was not used, and the cardiac rate was decreased with the use of intravenous beta-blockers. For LIMA-to-anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was administered intravenously. RESULTS: Video-assisted thoracic surgery provided a complete dissection of LIMA. The 43 patients presented satisfactory postoperative progress, being released from the hospital between 2 and 12 days after their operation, with a mean of 4 days. The patients have remained asymptomatic during a period that ranged from 1 to 13 months (6.3 +/- 3.5 months). During the follow-up, there was one death as a result of stroke and pneumonia 2 months after the release from the hospital. CONCLUSIONS: The use of video-assisted thoracic surgery through thoracotomy allows the LIMA dissection without the necessity of other incisions. The procedure also permitted more ample dissection of LIMA when compared with minithoracotomy without video-assisted thoracic surgery.
Adult↗
Minimal pulmonary resection and minor chest procedures: is pleural drainage systematically necessary?
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Biopsy↗
Thoracoscopy in children and adolescents.
STUDY OBJECTIVES: Present the feature characteristics of the use and findings of thoracoscopy in children and adolescents. DESIGN: From February 1983 to February 1996, 77 thoracoscopic procedures were done on patients ranging in ages from 5 months to 18 years (mean, 9.8 years). Two-thirds (66.2%) were male. They were divided into three groups (1, 2, and 3) based on age (up to 2, from 2 to 8, and older than 8 years), predominance of certain diseases in these ages, and the size of the instruments utilized. They were operated on using general anesthesia with Carlens' mediastinoscope routinely used in 64 (83%) and videothoracoscopy in 13 (17%). The chief indication for therapeutic thoracoscopy was treatment of empyema, while for diagnostic thoracoscopy it was pleural biopsy and diagnosis of pleural effusions. RESULTS: In group 1, thoracoscopy was solely for the treatment of pleural disorders. In group 2, it was for the treatment of pleuropulmonary diseases. Group 3 behaved almost like adults, with broad diagnostic and therapeutic indications for thoracoscopic procedure. CONCLUSIONS: Thoracoscopy, which is a useful diagnostic and therapeutic procedure, has secured an important place in pediatric surgical practice.
Adolescent↗
Human pulmonary dirofilariasis: analysis of 24 cases from São Paulo, Brazil.
STUDY OBJECTIVE: To present the clinical, radiologic, and pathologic aspects of 24 cases of human pulmonary dirofilariasis (HPD) from São Paulo, Brazil. DESIGN: Retrospective study of 24 patients with a confirmed diagnosis of HPD over a 14-year period (from February 1982 to June 1996). SETTING: Thoracic Surgery and Pulmonary Division, University of São Paulo and Hospital Albert Einstein, São Paulo, Brazil. RESULTS: Seventeen patients were male (70.1%) and seven were female (29.9%). Their mean age was 51.4 years. Fifty-four percent of the patients were asymptomatic and 75% had a well-circumscribed noncalcified peripheral subpleural pulmonary nodule on the chest radiograph and thoracic CT scan, located preferentially in the lower lobes. The diagnosis was made after thoracotomy and wedge resections in 16 patients, by videothoracoscopy in six, after a pleural biopsy in one, and after necropsy in one. The pathologic examination of all the nodules revealed a central zone of necrosis, surrounded by a narrow granulomatous zone and peripherally by fibrous tissue. Pulmonary vessels exhibit varying degrees of endarteritis. In all cases, a dead worm, usually necrotic and fragmented, was found. CONCLUSIONS: A subpleural, noncalcified pulmonary nodule in the appropriate clinical and epidemiologic setting should alert the clinician, radiologist, or pathologist to the possibility of Dirofilaria. HPD should be considered in the differential diagnosis of pulmonary nodules.
Adolescent↗
[Minimally invasive myocardial bypass surgery using video-assisted thoracoscopy].
PURPOSE: In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. METHODS: Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered. RESULTS: All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke. CONCLUSION: MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.
Adult↗
[General thoracic surgery in cardiac patients].
PURPOSE: To analyse the main cardiac risk factors responsible for immediate and late outcomes in patients undergoing thoracic surgeries. METHODS: We performed a retrospective analysis of 90 cases of cardiac patients submitted to non-cardiac thoracic surgeries. Surgeries were divided into greater ones and others and the heart diseases into severe and mild disease. We analysed immediate and late complications, and the mortality inside these groups. RESULTS: We found a greater morbi-mortality in the greater surgeries group and a greater late mortality in the severe heart disease group. There were evidences that the degree of the heart disease does not influence immediate outcome. CONCLUSION: The heart disease was not a limiting immediate risk for surgery.
Adult↗
Hepatic and pulmonary biopsy by mini-thoracotomy and transdiaphragmatic access.
Frequently, immunodeficient patients have more than one organ or system affected by opportunistic infection or neoplasia, requiring quick and precise diagnostic investigation. In some situations, different invasive diagnostic procedures may be necessary. Open lung biopsy is sometimes necessary to clarify the pulmonary diagnosis. Laparoscopy may be useful to clarify liver or other peritoneal diseases. Some specific patients might require both procedures. In this way it is proposed that the surgeon, through a microthoracotomy used for the pulmonary biopsy, has access to the diaphragm. A small phrenotomy is performed and then a liver needle biopsy under direct vision. The described technique of simultaneous open lung and hepatic biopsy permits better handling of the needle and hemostasis of the hepatic lesion at the puncture site. This method has been used since 1994 on 16 HIV-positive patients, all having clinical and laboratory manifestations of lung disease associated with liver disease of unknown etiology. No complications related to the method were observed. It is significant that different etiologies for the lung and liver disease were found in 50% of the cases. We conclude that the presented technique is simple, useful, and safe.
AIDS-Related Opportunistic Infections↗
Minimally invasive bypass.
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Coronary Artery Bypass↗
[Video-assisted surgery for closure of persistent ductus arteriosus. Study in sheep and initial clinical experience].
PURPOSE: The aim of this study was to analyse the effectiveness of patent ductus arteriosus (PDA) closure by the video-assisted thoracic surgery (VATS). METHODS: The technique was utilized in 6 newborn lambs firstly. Three to four small incisions (3 to 10mm) were used in each animal to permit the introduction of lung retractors, video equipment, dissectors and clip appliers. The procedure was accompanied by video monitoring and after the dissection, the PDA was closed by 2 titanium clips. Seven days after, the animals were sacrificed and submitted to pathological study. Based on this initial experience seven patients (ages between 17 and 108 months) were operated on with this technique. RESULTS: In lambs, we have some difficulty to retract the lung. Despite this fact the closure of PDA was successful and proved by pathologic study. In children the dissection of PDA was easier due to manual ventilation. The interruption of PDA using the proposed method was obtained in 4 patients, those with good relation between ductus diameter and clip size and defined by echocardiography and angiographic studies. CONCLUSION: The use of VATS for interruption of PDA in both, experimental and initial clinical experiences, has showed to be an effective method.
Animals↗
[Pediatric cardiac surgery and the brain].
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Acid-Base Equilibrium↗
[Ischemic mitral valve insufficiency. Incidence, diagnosis and surgical treatment].
PURPOSE: To study the incidence of ischemic mitral regurgitation (MR) and the mortality. METHODS: One-hundred-five cases of acute myocardial infarction (AMI) with MR were reviewed. Patients were divided in two groups: group A-59 (56.2%) necropsied patients without previous surgical procedures to correlate clinical pictures with the aim to determine the cause of death; group B-46 (43.8%) patients were submitted to surgical treatment. This group was subdivided in mild, moderate and severe forms of MR, and studied comparatively the type of surgical treatment and its evolution. RESULTS: Group A-23 (39%) patients with mild forms and predominant ischemic heart disease, responsible for death; 18 (30.5%) patients without previous diagnosis, masked by myocardial failure and 18 (30.5%) with severe MR and coronary heart disease; group B-14 (30.4%) patients died at the immediate post-operatory period. Higher mortality associated to ejection fraction (EF) below 35% (47.6%; p = 0.022), severe MR (41.7%; p = 0.044) and cardiogenic shock (52.9%; p = 0.14). In 41 (89.1%), the mitral valve repair was combined to coronary artery bypass grafting operation (CABG), in 4 (8.7%) this last procedure was made without mitral repair and in the remaining patients the surgery was limited to the valve. Mitral valvuloplasty was performed in 23 (50%) patients with 3 (13%) deaths, and in 19 (42.3%) the mitral valve was replaced with 9 (47.4%) deaths. CONCLUSION: The prognosis is related to the grade of EF and to the severity of MR. In mild to moderate forms, the surgical indication is due to the associated coronary heart disease and the valvuloplasty is preferred, in this instance. In severe forms, surgical intervention must be performed as soon as possible, before cardiogenic shock appears.
Adult↗
[Posttraumatic chylothorax. Experience in the postoperative period following cardiothoracic surgery].
PURPOSE: To report the accumulated experience in the treatment of patients with postoperative chylothorax (CHT) recovery utilizing pleural drainage associated to alipoidic diet and/or intravenous nutrition. METHODS: The aim of this work is to analyse the management of 11 patients (8 males; 11 months to 70 years old) with post-operative CHT. The previous pathologies were: congenital heart disease in 7; coronary insufficiency in 2; pulmonary tumor in 1 and mediastinal tumor in 1. The diagnosis was made up to 2nd postoperative week in 6, up to 4th week in 3 and later in 2 patients. The volume through the drain ranged from 200 to 3200ml/24h (median 636ml/24h). The laboratory diagnosis was made by lipidic presence in pleural effusion. In all patients the clinical management was made by hipo or alipoidic diet. RESULTS: In 7 the response was good with a decrease of drainage progressively. In 4, it was necessary the introduction of intravenous nutrition by the insufficient response and maintenance of drainage. The reoperation was not used and lymph fistula closed in a period until 10 days in 1 patient; until 20 days in 6 and after this in 4. CONCLUSION: In conclusion, the post-operative CHT may be treated by thoracic drainage and alipoidic diet and/or intravenous nutrition with fistula closure in all patients and without need of reoperation.
Adolescent↗
Late results (50 to 182 months) of the Jatene operation.
Between May 1975 and August 1991, 184 patients with transposition of the great arteries (TGA) were operated upon by Jatene operation. One hundred and sixteen underwent corrective surgery prior to June 1987 with a follow-up period of between 50 and 182 months. The ages of these 116 patients ranged from 1 day to 84 months (11.53 +/- 15.98). Eleven percent were less than 1 month old, 38% were between 1 and 6 months, 29% between 7 and 12 months and 22% were older than this. Eighty-eight patients (76%) were boys and the weight ranged from 2.4 to 17.0 kg (6.39 +/- 3.38). Thirty-eight patients (20.7%) died in the immediate postoperative period. Of the survivors, 5 died in the late follow-up between 9 and 66 months (endocarditis at 9 and 66 months; gastroenteritis at 20 months; sudden death at 48 months; and during reoperation for relief of pulmonary stenosis (PS) at 60 months). Of the surviving 73 patients, 24 (32.9%) are anatomically normal at a mean period of 92.5 months postoperatively. Twenty-two (30.1%) have dysfunctions without clinical repercussion. Nineteen (26%) have had no recent evaluation and 8 (11%) were submitted to reoperation or angioplasty for relief of PS. Ninety-eight percent of the patients have normal left ventricular function. The majority of the patients surviving 50 to 182 months are in good clinical condition and if dysfunctions are present these show no progression or severe hemodynamic alterations.
Child↗
[Preservation of hearts by perfusion under pressure].
PURPOSE: Development of method used to fix hearts in a reduced time, with preservation of their structures and characteristics. METHODS: Fifty normal human hearts were fixed in a system with four reservoirs, a roller pump, PVC tubes and a plastic recipient. This system was used to maintain the continuous injection by pressure of formaldehyde solution, to the interior of the heart. RESULTS: The fixation was satisfactory, pré-fixation time (13.93 +/- 5.13 min) and fixation time (60.53 +/- 12.50 min) were reduced related to previously utilized methods. CONCLUSION: The method was good, with decrease of fixation time and obtention of fixed hearts, with preservation of their structures and characteristics.
Aldehydes↗
[Anatomic study of the aortic ring position in relation to the mitral ring].
PURPOSE: Evaluate the relations between aortic and mitral rings. METHODS: One hundred hearts were studied, in 84% men, 61% white and 85% were between 11 and 40 years old. The commissure between non coronary/left coronary sinus in the aortic ring and the middle point between anterior (AT) and posterior trigone (PT) in the mitral ring were used as references. When these points were coincident the position was middle; when the aortic point (AP) was closer the PT the position was posterior and when the AP was closer the AT the position was anterior or much anterior. RESULTS: Forty seven (47%) showed middle position, twenty seven (27%) much anterior, twenty two (22%) anterior and only four (4%) posterior. These aren't related to sex and age. The hearts of black people showed more posterior position than the others. CONCLUSION: Variations in aortic/mitral rings relations may be observed in normal hearts.
Adolescent↗
[Myocardial revascularization after reperfusion in the acute phase of myocardial infarction].
PURPOSE: To evaluate the coronary artery bypass grafting (CABG) after successful coronary reperfusion (CR) by streptokinase and/or percutaneous transluminal coronary angioplasty in acute myocardial infarction (AMI). PATIENTS AND METHODS: During 65-months period, 245 patients underwent CR during AMI. In 47 (19.2%) CABG were performed in the acute period due to multi-vessel disease (31%), residual lesion (20%) and post-reperfusion angina (17%). There were two distinct periods: in the first, between Jun/81 and Jun/83, 34 patients underwent CABG, 47 hours average after reperfusion; in the second, between Jul/83 and Nov/86, 13 patients underwent CABG, 7 days average after reperfusion. RESULTS: There were 7 deaths (21%) in the first period and 1 (8%) in the second one. CONCLUSION: After a multifactorial analysis the authors concluded that better results with inferior mortality (p less than 0.05) were obtained when CABG was performed later (mean 7 days) than in the immediate post-reperfusion period (mean 47 hours).
Adult↗