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Diaz YL, Ramos TM, Tedde ML, Gomes da Silva DA. The The Sandwich Technique For Minimally Invasive Repair Of Pectus Carinatum. Port J Card Thorac Vasc Surg 2024; 31:53-55. [PMID: 38743519 DOI: 10.48729/pjctvs.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/22/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Minimally invasive repair of pectus carinatum (MIRPC) has been performed using the Abramson technique in which the bar that compresses the sternum is fixed with steel wires on the ribs. A 14-year-old patient underwent to a MIRPC using a sandwich technique in which two metallic bars fixed with bridges were implanted below the sternum under thoracoscopic vision, and another bar in a subcutaneous tunnel was implanted above. This technique has the potential to avoid specific problems related to the original technique like loosening of support for correction (broken wire), avoidance of induction of pectus excavatum or subcutaneous tissue adhesion.
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Affiliation(s)
- Yara Lopes Diaz
- Hospital de Urgência e Emergência, Thoracic Surgery Department, Vitória, Espírito Santo, Brazil; Vitoria Apart Hospital, Vitoria, ES, Brazil
| | - Thiago Magalhaes Ramos
- Hospital de Urgência e Emergência, Thoracic Surgery Department, Vitória, Espírito Santo, Brazil; Vitoria Apart Hospital, Vitoria, ES, Brazil
| | - Miguel Lia Tedde
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery - SP, Brazil; Instituto Pensi, Hospital Infantil Sabará, São Paulo, Brazil
| | - Diego Arley Gomes da Silva
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery - SP, Brazil
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Tedde ML, de Beer SA. Correspondence on Should the Ravitch Procedure to Correct Pectus Excavatum Be Avoided in Young Children? J Chest Surg 2022; 55:252-254. [PMID: 35638124 PMCID: PMC9178302 DOI: 10.5090/jcs.22.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Miguel Lia Tedde
- Thoracic Surgery Department, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Sjoerd A. de Beer
- Pediatric Surgical Center Amsterdam (Kinderchirurgisch Centrum Amsterdam, KCCA), Amsterdam, Netherlands
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Wolosker N, de Campos JRM, Kauffman P, da Silva MFA, Faustino CB, Tedde ML, Puech-Leão P, Fernandes PMP. Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients. SAO PAULO MED J 2022; 140:284-289. [PMID: 35195234 PMCID: PMC9610237 DOI: 10.1590/1516-3180.2021.0078.r1.23072021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.
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Affiliation(s)
- Nelson Wolosker
- MD, PhD. Full Professor, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - José Ribas Milanez de Campos
- MD, PhD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Thoracic Surgery Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Kauffman
- MD, PhD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Marcelo Fiorelli Alexandrino da Silva
- MD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Carolina Brito Faustino
- MD. Surgeon, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil; and Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Miguel Lia Tedde
- MD, PhD. Surgeon, Department of Surgery, Thoracic Surgery Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Pedro Puech-Leão
- MD, PhD. Surgeon, Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Manuel Pêgo Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil; and Cardiothoracic Surgeon, Hospital Beneficência Portuguesa (BP), São Paulo (SP), Brazil.
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Yazbek G, Ishy A, Alexandrino da Silva MF, Sposato Louzada AC, de Campos JRM, Kauffman P, Tedde ML, Puech-Leão P, Pêgo-Fernandes PM, Wolosker N. Evaluation of compensatory hyperhidrosis after sympathectomy: The use of an objective method. Ann Vasc Surg 2021; 77:25-30. [PMID: 34411664 DOI: 10.1016/j.avsg.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. METHODS Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). RESULTS In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. CONCLUSIONS Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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Affiliation(s)
- Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, Rua Tamandaré, São Paulo, Brazil.
| | - Augusto Ishy
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - José Ribas Milanez de Campos
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Thoracic Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Puech-Leão
- Department of Vascular and Endovascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Thoracic Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Vascular and Endovascular Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
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de Carvalho RLC, Tedde ML, de Campos JRM, Hamilton NN, Guilherme GF, Sousa VM, Junior VFS, Savazzi FH, Pego-Fernandes PM. Quality of life outcomes after minimally invasive repair of pectus excavatum utilizing a new set of metallic bars and stabilizers. J Pediatr Surg 2021; 56:545-549. [PMID: 32711943 DOI: 10.1016/j.jpedsurg.2020.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE The aim of the study was to evaluate the postoperative quality of life (QoL) of patients who underwent minimally invasive repair of pectus excavatum (MIRPE) with a newly designed bar and bar stabilizers. METHODS We conducted a prospective randomized study in which patients were operated either with standard perpendicular stabilizers (control group) or with the newly designed oblique stabilizers (intervention group). All patients were evaluated 6 months after the operation with the Pectus Excavatum Evaluation Questionnaire (PEEQ). RESULTS There were 16 patients in the control group and 14 in the intervention group. Mean age was 17 (SD: 3.3, range 14-27) years. There were no demographic differences between groups. Two patients in the control group and one in the intervention group were repaired with two bars instead of one. There was one reoperation in each group. There was a significant difference between the pre- and postoperative scores, in both groups, in the patient body image domain (control group: 9.5 to 3; p < 0.01; intervention group 10 to 3; p < 0.01), as well as in the psychosocial domain (control group: 13.5 to 24, p < 0.01; intervention group: 15 to 24, p < 0.01). With regards to the patients' perception of physical difficulties before and after MIRPE, the difference between pre- and postoperative scores was greater in the intervention group (8 to 12, p < 0.01) than in the control group (10 to 11, p = 0.04). The mean length of stay was 4.5 and 5 days in the intervention group and the control group, respectively. CONCLUSION Our study showed that patients who underwent MIRPE with the newly designed bars and stabilizers had non-inferior outcomes than patients reported in the literature who underwent MIRPE with standard bars and stabilizers. We found slightly better outcomes in patients in the intervention group compared to the control group, but larger studies will be needed to confirm if those differences are statistically significant. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Miguel Lia Tedde
- Heart Institute (InCor), University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-000, Sao Paulo, Brazil; Hospital Alemão Oswaldo Cruz, R Treze de Maio, 1815, 01327-001, Sao Paulo, Brazil.
| | | | - Niura Noro Hamilton
- Heart Institute (InCor), University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-000, Sao Paulo, Brazil; Hospital Alemão Oswaldo Cruz, R Treze de Maio, 1815, 01327-001, Sao Paulo, Brazil
| | - Gustavo Falavigna Guilherme
- Heart Institute (InCor), University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-000, Sao Paulo, Brazil
| | - Vanessa Moreira Sousa
- Heart Institute (InCor), University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-000, Sao Paulo, Brazil
| | | | - Flavio Henrique Savazzi
- Heart Institute (InCor), University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-000, Sao Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Heart Institute (InCor), University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-000, Sao Paulo, Brazil
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Hamilton NN, Tedde ML, Wolosker N, Aguiar WWS, Ferreira HPDC, Oliveira HAD, Lima AMR, Westphal FL, Oliveira MVBD, Riuto FDO, Pereira STLF, Rezende GC, Valero CEB, Pego-Fernandes PM. A prospective controlled randomized multicenter study to evaluate the severity of compensatory sweating after one-stage bilateral thoracic sympathectomy versus unilateral thoracic sympathectomy in the dominant side. Contemp Clin Trials Commun 2020; 19:100618. [PMID: 32715152 PMCID: PMC7369506 DOI: 10.1016/j.conctc.2020.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/27/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.
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Affiliation(s)
- Niura Noro Hamilton
- Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-900, Sao Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-900, Sao Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 255, 05403-000, São Paulo, SP, Brazil
| | | | | | | | | | - Fernando Luiz Westphal
- Hospital da Universidade Federal do Amazonas, Av. Gen. Rodrigo Octávio, 6200, 69080-900, Manaus, AM, Brazil
| | - Marina Varela Braga de Oliveira
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, 30130-100, Belo Horizonte, MG, Brazil
| | - Fabio de Oliveira Riuto
- Hospital da Universidade Federal da Grande Dourados, R. Ivo Alves da Rocha, 558, 79823-501, Dourados, MS, Brazil
| | | | - Guilherme Cançado Rezende
- Hospital Universitário de Brasília, Setor de Grandes Áreas Norte, 605, 70840-040, Brasília, DF, Brazil
| | | | - Paulo M. Pego-Fernandes
- Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-900, Sao Paulo, SP, Brazil
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Tedde ML, Togoro SY, Eisinger RS, Okumura EM, Fernandes A, Pêgo-Fernandes PM, Campos JRMD. Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments. ACTA ACUST UNITED AC 2019; 45:e20170373. [PMID: 30758428 PMCID: PMC6534412 DOI: 10.1590/1806-3713/e20170373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. METHODS This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. RESULTS Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. CONCLUSIONS In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.
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Affiliation(s)
- Miguel Lia Tedde
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Silvia Yukari Togoro
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | | | - Erica Mie Okumura
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Angelo Fernandes
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Paulo Manuel Pêgo-Fernandes
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Jose Ribas Milanez de Campos
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
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Ono CR, Tedde ML, Scordamaglio PR, Buchpiguel CA. Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula. Radiol Bras 2018; 51:385-390. [PMID: 30559556 PMCID: PMC6290752 DOI: 10.1590/0100-3984.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Objective To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.
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Affiliation(s)
- Carla Rachel Ono
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Rogerio Scordamaglio
- Respiratory Endoscopy Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Wolosker N, Leiderman DBD, de Campos JRM, Kauffman P, Tedde ML, Yazbek G, Puech-Leão P. Number of Preoperative Hyperhidrosis Sites Does Not Affect the Sympathectomy Postoperative Results and Compensatory Hyperhidrosis Occurrence. Thorac Cardiovasc Surg 2018; 67:407-414. [DOI: 10.1055/s-0038-1667317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Patients with primary hyperhidrosis present with sweating in two or more sites in nearly 85% of cases. In this study, we examined whether the number of hyperhidrosis sites is related to the surgery outcomes.
Methods One hundred ninety-three hyperhidrosis patients who underwent bilateral videothoracoscopic sympathectomy after failure or dissatisfaction with clinical treatment were distributed into three groups based on the number of hyperhidrosis sites (one site, two sites, and three or more sites of hyperhidrosis). The primary endpoints in the study were as follows: quality of life prior to surgery, improvement of quality of life after surgery, clinical improvement of sweating, presence or absence of compensatory hyperhidrosis, and general satisfaction after 1 month of surgery.
Results Patients with two or more hyperhidrosis sites had worse quality of life before surgery than patients with a single hyperhidrosis site. There was an improvement in the quality of life in more than 95% of the patients, clinical improvement in more than 95% of patients, severe compensatory hyperhidrosis in less than 10%, and low general satisfaction after 1 month of surgery in only 2.60% of the patients, with no differences among the three groups.
Conclusions Patients with more than one preoperative hyperhidrosis site present worse quality of life prior to surgery than those with a single hyperhidrosis site, but the number of hyperhidrosis sites before surgery does not affect surgery outcomes.
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil
- Division of Vascular and Endovascular, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina, Pinheiros, University of São Paulo School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Jose Ribas Millanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil
- Division of Thoracic Surgery, Department of Surgery, University of São Paulo School of Medicine, University of São Paulo, Pinheiros, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil
- Division of Vascular and Endovascular, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina, Pinheiros, University of São Paulo School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Miguel Lia Tedde
- Division of Thoracic Surgery, Department of Surgery, University of São Paulo School of Medicine, University of São Paulo, Pinheiros, São Paulo, Brazil
| | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, A.C. Camargo Cancer Center, Fundação Antonio Prudente, São Paulo, Brazil
| | - Pedro Puech-Leão
- Division of Vascular and Endovascular, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina, Pinheiros, University of São Paulo School of Medicine, University of São Paulo, São Paulo, Brazil
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de Vilhena AF, das Neves Pereira JC, Parra ER, Balancin ML, Ab Saber A, Martins V, Farhat C, Abrantes MM, de Campos JRM, Tedde ML, Takagaki T, Capelozzi VL. Histomorphometric evaluation of the Ki-67 proliferation rate and CD34 microvascular and D2-40 lymphovascular densities drives the pulmonary typical carcinoid outcome. Hum Pathol 2018; 81:201-210. [PMID: 30031097 DOI: 10.1016/j.humpath.2018.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 12/16/2022]
Abstract
Ki-67 has shown promise as a prognostic factor in pulmonary carcinoids. In this study, we sought to validate the importance of Ki-67 and study the relationships between Ki-67 and other stromal biomarkers of vascular density. We examined Ki-67, CD34, and D2-40 in tumor tissues from 128 patients with surgically excised typical carcinoid of the lung. We used immunohistochemistry and morphometry to evaluate the amount of tumor staining for cellular proliferation (Ki-67), microvascular density (CD34-MVD), and D2-40 lymphovascular density. The main outcome was overall survival, considered as life expectancy until death from metastasis. Specimens from patients with central tumors showed high CD34-MVD (P = .01), which was also significantly associated with a compromised surgical margin, lymph node metastasis, and clinical stage Ib. Equally significant was high D2-40 lymphovascular density in central specimens with a compromised surgical margin and lymph node metastasis. A high Ki-67 proliferation rate was significantly associated with tumors from patients with clinical stage IIb, IIIa, and IV disease. Multivariate Cox model analysis demonstrated that tumor location and stage, surgical margin, tumor size, and N stage were significantly related to survival time (P < .05). Quantitative staining of the tumor for Ki-67 and CD34-MVD served as prognostic factors (P < .05), which were more relevant than the surgical and pathological stage. Ki-67 greater than 5% and CD34-MVD greater than 7% staining comprise a subset of patients with higher death hazard; this outcome may harbor evidence for further prospective studies of target therapy after surgical resection.
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Affiliation(s)
| | | | - Edwin Roger Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marcelo Luiz Balancin
- Laboratory of Genomic and Histomorphometry, Department of Pathology, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | - Alexandre Ab Saber
- Laboratory of Genomic and Histomorphometry, Department of Pathology, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | - Vanessa Martins
- Laboratory of Genomic and Histomorphometry, Department of Pathology, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | - Cecilia Farhat
- Laboratory of Genomic and Histomorphometry, Department of Pathology, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | | | | | - Miguel Lia Tedde
- Department of Thoracic Surgery, Heart Institute (Incor), São Paulo 05403-000, Brazil
| | - Teresa Takagaki
- Division of Pneumology, Heart Institute (Incor), Faculty of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
| | - Vera Luiza Capelozzi
- Laboratory of Genomic and Histomorphometry, Department of Pathology, University of São Paulo Medical School, São Paulo 01246-903, Brazil.
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Leiderman DBD, Milanez de Campos JR, Kauffman P, Tedde ML, Yazbek G, Teivelis MP, Wolosker N. The relation between age and outcomes of thoracic sympathectomy for hyperhidrosis: The older the better. J Thorac Cardiovasc Surg 2018; 156:1748-1756. [PMID: 30054140 DOI: 10.1016/j.jtcvs.2018.05.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of compensatory hyperhidrosis (CH), and variations in the quality of life. METHODS We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. RESULTS Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial hyperhidrosis, and level of resection). CONCLUSIONS We observed that patients with old age reported an improvement in sweating in the main site of hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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Affiliation(s)
| | - Jose Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Thoracic Surgery Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Vascular and Endovascular Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, A.C. Camargo Cancer Center, Fundação Antônio Prudente, São Paulo, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Vascular and Endovascular Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
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Scordamaglio PR, Tedde ML, Minamoto H, Assad RS, Fernandes PMP. Can total bronchopleural fistulas from complete stump dehiscence be endoscopically treated? Eur J Cardiothorac Surg 2017; 51:702-708. [PMID: 28082466 DOI: 10.1093/ejcts/ezw377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Bronchopleural fistula (BPF) is an uncommon complication following a lung resection to address various conditions. BPFs are associated with high morbidity and mortality rates. This study evaluated the endoscopic treatment of 'total' BPFs using the Occlutech-Fígulla® cardiac device at a single centre. Methods We selected nine patients with chronic and complete BPFs. Under direct bronchoscopic visualization, the BPFs were treated using the Occlutech-Fígulla device. The patients were followed up for 12 months to determine the treatment level and complications. Results The procedure had a favourable outcome in three patients, resulting in complete fistula closure. Two patients had partial closure and showed improvements in their clinical conditions. In two other cases, closure of the bronchial stump was unsuccessful using this method. Two patients died from causes unrelated to the procedure or the device. During the follow-up period, no complications related to infection or device-related injuries were reported. Conclusions In patients without clinical conditions that require surgical treatment, the Occlutech-Fígulla cardiac device can be a safe and effective method for the endoscopic treatment of large BPFs resulting from complete dehiscence of a bronchial stump. No severe events were reported.
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Affiliation(s)
- Paulo Rogério Scordamaglio
- Division of Respiratory Endoscopy, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Hélio Minamoto
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Renato Samy Assad
- Cardiovascular Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo Fernandes
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
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Abstract
The correction of deep pectus excavatum, with the Nuss procedure, frequently require a series of maneuvers that is inherently dangerous. Herein we describe 10 technical modifications to prevent potential complications. These modified techniques have certain advantages and according to the authors, with these maneuvers the risk of pericardial sac, cardiac injury, bar displacement and complications during the removal of the bar could be markedly reduced.
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Affiliation(s)
| | - Miguel Lia Tedde
- Hospital das Clinicas, University of São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Filho Pinto DR, Tedde ML, Avino AJG, Brandão SLB, Zanatta I, Hahn R. Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results. J Bras Pneumol 2015; 41:90-4. [PMID: 25750678 PMCID: PMC4350829 DOI: 10.1590/s1806-37132015000100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/04/2014] [Indexed: 12/03/2022] Open
Abstract
We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia.
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Affiliation(s)
- Darcy Ribeiro Filho Pinto
- Caxias do Sul University Foundation, Caxias do Sul General Hospital, Department of Thoracic Surgery, Caxias do Sul, Brazil. Department of Thoracic Surgery, Caxias do Sul General Hospital, Caxias do Sul University Foundation, Caxias do Sul, Brazil
| | - Miguel Lia Tedde
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Thoracic Surgery, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Alexandre José Gonçalves Avino
- Caxias do Sul University Foundation, Caxias do Sul General Hospital, Department of Thoracic Surgery, Caxias do Sul, Brazil. Department of Thoracic Surgery, Caxias do Sul General Hospital, Caxias do Sul University Foundation, Caxias do Sul, Brazil
| | - Suzan Lúcia Brancher Brandão
- Caxias do Sul University Foundation, Caxias do Sul General Hospital, Department of Thoracic Surgery, Caxias do Sul, Brazil. Department of Thoracic Surgery, Caxias do Sul General Hospital, Caxias do Sul University Foundation, Caxias do Sul, Brazil
| | - Iuri Zanatta
- Caxias do Sul University Foundation, Caxias do Sul General Hospital, Caxias do Sul, Brazil. Caxias do Sul General Hospital, Caxias do Sul University Foundation, Caxias do Sul, Brazil
| | - Rafael Hahn
- Caxias do Sul University Foundation, Caxias do Sul General Hospital, Caxias do Sul, Brazil. Caxias do Sul General Hospital, Caxias do Sul University Foundation, Caxias do Sul, Brazil
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Tedde ML, Petrere O, Pinto Filho DR, Pereira STLF, Monteiro R, Sassaki AM, Togoro SY, Trindade E, Saad R, Jatene FB. General thoracic surgery workforce: training, migration and practice profile in Brazil. Eur J Cardiothorac Surg 2014; 47:e19-24. [DOI: 10.1093/ejcts/ezu411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tedde ML, Onders RP, Teixeira MJ, Lage SG, Ballester G, Brotto MWI, Okumura EM, Jatene FB. Electric ventilation: indications for and technical aspects of diaphragm pacing stimulation surgical implantation. J Bras Pneumol 2013; 38:566-72. [PMID: 23147048 DOI: 10.1590/s1806-37132012000500005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Patients with high cervical spinal cord injury are usually dependent on mechanical ventilation support, which, albeit life saving, is associated with complications and decreased life expectancy because of respiratory infections. Diaphragm pacing stimulation (DPS), sometimes referred to as electric ventilation, induces inhalation by stimulating the inspiratory muscles. Our objective was to highlight the indications for and some aspects of the surgical technique employed in the laparoscopic insertion of the DPS electrodes, as well as to describe five cases of tetraplegic patients submitted to the technique. METHODS Patient selection involved transcutaneous phrenic nerve studies in order to determine whether the phrenic nerves were preserved. The surgical approach was traditional laparoscopy, with four ports. The initial step was electrical mapping in order to locate the "motor points" (the points at which stimulation would cause maximal contraction of the diaphragm). If the diaphragm mapping was successful, four electrodes were implanted into the abdominal surface of the diaphragm, two on each side, to stimulate the branches of the phrenic nerve. RESULTS Of the five patients, three could breathe using DPS alone for more than 24 h, one could do so for more than 6 h, and one could not do so at all. CONCLUSIONS Although a longer follow-up period is needed in order to reach definitive conclusions, the initial results have been promising. At this writing, most of our patients have been able to remain ventilator-free for long periods of time.
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Affiliation(s)
- Miguel Lia Tedde
- InCor, Heart Institute – University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
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Terra RM, Bibas BJ, Minamoto H, Waisberg DR, Tamagno MFL, Tedde ML, Pêgo-Fernandes PM, Jatene FB. Decannulation in Tracheal Stenosis Deemed Inoperable Is Possible After Long-Term Airway Stenting. Ann Thorac Surg 2013. [DOI: 10.1016/j.athoracsur.2012.09.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tedde ML, Figueiredo VR, Terra RM, Minamoto H, Jatene FB. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of mediastinal lymphadenopathy: initial experience in Brazil. J Bras Pneumol 2012; 38:33-40. [PMID: 22407038 DOI: 10.1590/s1806-37132012000100006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/21/2011] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of mediastinal lymph nodes. The objective of this study was to evaluate the preliminary results obtained with EBUS-TBNA in the diagnosis of lesions and mediastinal lymph node staging. METHODS We evaluated patients with tumors or mediastinal adenopathy, diagnosed with or suspected of having lung cancer. The procedures were performed with the patients under sedation or under general anesthesia. Material was collected by EBUS-TBNA, after which it was prepared on slides, fixed in either absolute alcohol (for cytology) or formalin (for cell-block analysis). RESULTS We included 50 patients (30 males). The mean age was 58.3 ± 13.5 years. We performed 201 biopsies of 81 lymph nodes or mediastinal masses (mean of 2.5 punctures/biopsy). The quantity of material was considered sufficient for cytology in 37 patients (74%), 21 (57%) of whom were thus diagnosed with malignancy. Of the remaining 16 patients, 1 was diagnosed with tuberculosis, 6 entered clinical follow-up, and 9 underwent further investigation (2 diagnosed with neoplasm-false-negative results). The yield was higher when the procedure was performed for diagnostic purposes, as well as being higher in patients with lesions in multiple stations and in biopsies involving the subcarinal lymph node station. One patient had endobronchial bleeding, which was resolved with local measures. There were no deaths among the patients evaluated. CONCLUSIONS This preliminary experience shows that EBUS-TBNA is a safe procedure. Our diagnostic yield, although lower than that reported in the literature, was consistent with the learning curve for the method.
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Affiliation(s)
- Miguel Lia Tedde
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Rodrigues AJ, Scordamaglio PR, Tedde ML, Minamoto H, de Moura EGH, Pedra CAC. Bronchoscopic closure of tracheoesophageal fistulas. Gastrointest Endosc 2011; 74:1173. [PMID: 22032325 DOI: 10.1016/j.gie.2011.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/01/2011] [Indexed: 02/08/2023]
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Ishy A, de Campos JRM, Wolosker N, Kauffman P, Tedde ML, Chiavoni CR, Jatene FB. Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy: T3 and T4. Interact Cardiovasc Thorac Surg 2011; 12:545-8. [PMID: 21233258 DOI: 10.1510/icvts.2010.252015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study compares the results obtained of video-assisted sympathectomy performed on two distinct ganglion levels (third vs. fourth thoracic ganglion) in the treatment of palmar hyperhidrosis (PH), through a blind randomized clinical trial. All participants were randomized into two groups of 20 patients (G3 and G4) and underwent the operation, and were followed for 12 months. We used an objective method for measuring sweat, checking the transepidermal water loss (TEWL), and evaluated the quality-of-life (QoL) before and after the operation. All patients (n=40) ceased suffering from PH after surgery, with statistical difference when we compared the values of TEWL palmar preoperatively with their respective values at one week, one month, six months and 12 months. The main side effect observed was compensatory hyperhidrosis (CH), which was most frequent in G3 after 12 months of follow-up. There was an improvement in QoL since the first evaluation of the postoperative period with no difference between groups. Both techniques were effective in the treatment of PH, generating objective reduction of TEWL regardless of the ganglion operated. Sympathectomy G3 had a higher incidence of CH, yet the improvement in QoL was similar in both groups.
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Affiliation(s)
- Augusto Ishy
- Department of Thoracic Surgery, University of São Paulo, 388 Peixoto Gomide Street, Flat 141, São Paulo, SP 01409-000, Brazil.
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Tedde ML, Campos JRMD, Das-Neves-Pereira JC, Abrāo FC, Jatene FB. The search for stability: bar displacement in three series of pectus excavatum patients treated with the Nuss technique. Clinics (Sao Paulo) 2011; 66:1743-6. [PMID: 22012046 PMCID: PMC3180147 DOI: 10.1590/s1807-59322011001000012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 06/30/2011] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ''third point fixation'' technique,and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS There were no deaths in any of the series. Minor complications occurred in six (4.9%) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5%) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation to remove the bar within the 30 days of implantation (3). All major complications occurred in the first and second series. CONCLUSION The elimination of fixation wires, the use of shorter bars and redesigned stabilizers placed in a more medial position results in a better outcome for pectus excavatum patients treated with the Nuss technique. With bar displacement and instability no longer significant postoperative risks, the Nuss technique should be considered among the available options for the surgical correction of pectus excavatum in pediatric patients.
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Affiliation(s)
- Miguel Lia Tedde
- Department of Thoracic Surgery, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Tedde ML, Rodrigues A, Scordamaglio PR, Monteiro JS. A new technique for T-tube insertion in patients with subglottic stenosis. Eur J Cardiothorac Surg 2011; 39:130-1. [DOI: 10.1016/j.ejcts.2010.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/29/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022] Open
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Scordamaglio PR, Tedde ML, Minamoto H, Pedra CAC, Jatene FB. Tratamento endoscópico de fístulas da árvore traqueobrônquica com dispositivos para a correção de defeitos do septo interatrial: resultados preliminares. J Bras Pneumol 2009; 35:1156-60. [DOI: 10.1590/s1806-37132009001100015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 08/18/2009] [Indexed: 11/22/2022] Open
Abstract
As fístulas da árvore traqueobrônquica, sejam elas broncopleurais ou traqueoesofágicas, apresentam etiologia multifatorial, com incidência variável na literatura. Em geral, apresentam alta morbidade e mortalidade, com indicação formal de correção cirúrgica. Entretanto, a condição clínica dos pacientes muitas vezes não permite uma reintervenção cirúrgica de grande porte. Além disso, as tentativas de fechamento endoscópico raramente têm sucesso, principalmente em fístulas de grande diâmetro. Relatamos os casos de três pacientes submetidos ao fechamento endoscópico de fístulas, sendo duas maiores que 10 mm, com a aplicação de dispositivos oclusores utilizados na cardiologia intervencionista, de forma minimamente invasiva e com resultados iniciais positivos. Esses dados sinalizam que essa pode ser uma técnica promissora na resolução de fístulas da árvore traqueobrônquica.
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Martins Rua JF, Jatene FB, de Campos JRM, Monteiro R, Tedde ML, Samano MN, Bernardo WM, Das-Neves-Pereira JC. Robotic versus human camera holding in video-assisted thoracic sympathectomy: a single blind randomized trial of efficacy and safety. Interact Cardiovasc Thorac Surg 2008; 8:195-9. [PMID: 19042929 DOI: 10.1510/icvts.2008.191353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Our objective is to compare surgical safety and efficacy between robotic and human camera control in video-assisted thoracic sympathectomy. A randomized-controlled-trial was performed. Surgical operation was VATS sympathectomy for hyperhidrosis. The trial compared a voice-controlled robot for holding the endoscopic camera robotic group (Ro) to human assisted group (Hu). Each group included 19 patients. Sympathectomy was achieved by electrodessication of the third ganglion. Operations were filmed and images stored. Two observers quantified the number of involuntary and inappropriate movements and how many times the camera was cleaned. Safety criteria were surgical accidents, pain and aesthetical results; efficacy criteria were: surgical and camera use duration, anhydrosis, length of hospitalization, compensatory hyperhidrosis and patient satisfaction. There was no difference between groups regarding surgical accidents, number of involuntary movements, pain, aesthetical results, general satisfaction, number of lens cleaning, anhydrosis, length of hospitalization, and compensatory hyperhidrosis. The number of contacts of the laparoscopic lens with mediastinal structures was lower in the Ro group (P<0.001), but the total and surgical length was longer in this group (P<0.001). Camera holding by a robotic arm in VATS sympathectomy for hyperhidrosis is as safe but less efficient when compared to a human camera-holding assistant.
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Affiliation(s)
- Joaquim Fernando Martins Rua
- Department of Thoracic Surgery, University of São Paulo, Medical School, Heart Institute InCor, Clinics Hospital, São Paulo, Brazil
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Tedde ML, Rodrigues AJ, Jatene FB. Interatrial sulcus opening during multiple grafts harvesting for heart and lung transplantation: anatomical study. Braz J Cardiovasc Surg 2008; 23:235-9. [PMID: 18820787 DOI: 10.1590/s0102-76382008000200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 04/25/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the interatrial sulcus opening regarding of left atrium gain when harvesting heart and lungs for transplantation. METHODS It was evaluated the left atrium dimension, from the right mediastinal side, after the interatrial sulcus dissection in fifty human cadaver. The interatrial sulcus gain was related with gender, age and ethnic group. RESULTS The gain observed through right interatrial opening was, in media, 1.31 cm (0.3 cm to 2.5 cm). When that value was related to the variable gender it was observed that in the 27 (54%) cases of the male the earnings was 1.19 cm +/- 0.6 cm and, in the 23 (46%) female, 1.21 cm +/- 0.5 cm (p = 0.895). In relation to age, it was observed that, in the 24 (48%) cases with smaller age than 50 years, the value was 1.08 cm +0.6 cm and, in the 26 (52%) with larger age or same to 50 years, 1.36 cm +/- 0.6 cm (p = 0.088). In relation to ethnic group, it was observed that the value of the earnings in the 31 (62%) cases of whites it was 1.34 cm +/- 0.5 cm and, in the 19 (38%) non white, 1.27 cm +/- 0.4 cm (p = 0.589). CONCLUSION Heart grafts and lung grafts must be harvested maintaining adequate segments of left atrium near the heart and the pulmonary veins of the lungs that will be transplanted. Although there is no correlation between the observed gain in the interatrial sulcus dissection and the variables gender, age and ethnic group, our results confirm that the interatrial sulcus opening can give access to significant extension of left atrium wall when separating heart and lungs.
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Affiliation(s)
- Miguel Lia Tedde
- Serviço de Cirurgia Torácica, Instituto do Coração, HCFMUSP, São Paulo, SP, Brasil.
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Terra RM, Minamoto H, Tedde ML, Almeida JLJD, Jatene FB. Endoprótese auto-expansível de malha de poliéster revestida por silicone (Polyflex®) no tratamento de estenoses traqueais não-cirúrgicas. J Bras Pneumol 2007; 33:241-7. [PMID: 17906783 DOI: 10.1590/s1806-37132007000300003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2006] [Accepted: 09/12/2006] [Indexed: 12/18/2022] Open
Abstract
OBJETIVO: Avaliar a prótese Polyflex® quanto à sua eficácia, facilidade de implantação e complicações em pacientes com afecções traqueobrônquicas. MÉTODOS: Foram acompanhados, prospectivamente, dezesseis pacientes com estenoses traqueais secundárias à intubação orotraqueal (n = 12), neoplasia (n = 3) e granulomatose de Wegener (n = 1), não candidatos a tratamento cirúrgico. Desses, onze eram mulheres e cinco eram homens, com idade média de 42,8 anos (intervalo de 21 a 72 anos). Os pacientes foram submetidos à implantação de um total de 21 próteses Polyflex®. Os procedimentos foram realizados no centro cirúrgico, sob anestesia geral e as próteses implantadas através de laringoscopia de suspensão e aplicador próprio. RESULTADOS: Em todos os casos foi possível implantar a prótese e observamos resolução de sintomas. Os pacientes permaneceram com a prótese por tempo médio de 7,45 meses, variando entre 2 e 18 meses. As complicações pós-operatórias imediatas observadas foram disfonia em dois pacientes (12,5%) e odinofagia em dois pacientes (12,5%). As complicações tardias foram tosse em dez pacientes (62,5%), migração em sete pacientes (43,75%), formação de granulomas em dois pacientes (12,5%) e pneumonia em um paciente (6,25%). CONCLUSÃO: A prótese Polyflex® é fácil de implantar e retirar, é bem tolerada e efetiva na resolução dos sintomas, porém, está associada a alto índice de migração, principalmente em estenoses pós-intubação orotraqueal.
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Affiliation(s)
- Ricardo Mingarini Terra
- Serviço de Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Tedde ML, Jatene FB. Procedimentos minimamente invasivos: complicações também minimizadas ou subestimadas? J Bras Pneumol 2004. [DOI: 10.1590/s1806-37132004000600019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fernandez A, Tedde ML, Filomeno LT, Suso FV. [Anesthesia for bronchoscopy]. Rev Hosp Clin Fac Med Sao Paulo 1992; 47:125-7. [PMID: 1340585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic procedure in many clinical situations and is relatively simple to perform with the proper techniques. Local anesthetic techniques are often preferable for bronchoscopy since the examination is mostly undertaken as outpatient procedure. When the topical anesthesia is supplemented with light sedation, the procedure is easier and more acceptable to the patient. We describe a very efficient technique based on the transtracheal injection of a minimal amount of lidocaine directly on the upper airway mucosa, producing adequate anaesthesia. The method is easy to perform and safe.
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Affiliation(s)
- A Fernandez
- Serviço de Endoscopia Respiratória, Instituto do Coração de São Paulo
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