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Prosperi Desenzi Ciaralo P, Guerreiro Cardoso PF, Minamoto H, Bibas BJ, Ribeiro de Carvalho CR, Pego-Fernandes PM. Implementation and Results of a Dedicated Telemedicine Program ( TeleTrachea) for Patients with Tracheal Diseases. Telemed J E Health 2024; 30:1317-1324. [PMID: 38109228 DOI: 10.1089/tmj.2023.0524] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Background: Central airway diseases requiring frequent outpatient visits to a specialized medical center due to tracheal devices. Many of these patients have mobility and cognition restrictions or require specialized transport due to the need for supplemental oxygen. This study describes the implementation and results of a telemedicine program dedicated to patients with central airway diseases based in a Brazilian public health system. Methods: A retrospective study of telemedicine consultation for patients with central airway diseases referred to a public academic hospital between August 1, 2020 and August 1, 2022. The consultations occurred in a telemedicine department using the hospital's proprietary platform. Data retrieved consisted of demographics, disease characteristics, and the treatment modalities of the patients. The analysis included the savings in kilometers not traveled, the carbon footprint based on reducing CO2 emissions, and the cost savings in transportation. Results: A total of 1,153 telemedicine visits conducted in 516 patients (median age of 31.5 years). Two hundred ninety patients (56.2%) had a tracheal device (129 silicone T-Tube, 128 tracheostomy, and 33 endoprosthesis) and 159 patients (30.8%) had difficulties in transportation to the specialized medical center. Patients were served from 147 Brazilian cities from 22 states. The savings in kilometers traveled was 1,224,108.54 km, corresponding to a 250.14 ton reduction in CO2 emissions. The costs savings in transportation for the municipalities was BRL$ 1,272,283.78. Conclusions: Telemedicine consultations for patients with central airway diseases are feasible and safe. Cost savings and the possibility of disseminating specialized care make telemedicine a fundamental tool in current medical practice.
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Affiliation(s)
- Pedro Prosperi Desenzi Ciaralo
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Benoit Jacques Bibas
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Divisions of Pulmonology, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
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Tedde ML, De Carvalho RLC, Milanez De Campos JR, Gomes Da Silva DA, Okumura EM, Falavigna GG, Marchesi AC, Petrizzo P, Souto Maior BS, Pego-Fernandes PM. Randomized comparison of oblique and perpendicular stabilizers for minimally invasive repair of pectus excavatum. Interdiscip Cardiovasc Thorac Surg 2024:ivae040. [PMID: 38492558 DOI: 10.1093/icvts/ivae040] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/22/2024] [Accepted: 03/14/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Bar dislocation is one of the most feared complications of the minimally invasive repair of pectus excavatum (MIRPE). METHODS Prospective randomized parallel-group clinical trial intending to assess whether oblique stabilizers can reduce bar displacement in comparison with regular stabilizers used in MIRPE. Additionally, we evaluated pain, quality of life (QoL) and other postoperative complications. Participants were randomly assigned to surgery with perpendicular (n = 16) or oblique stabilizers (n = 14) between October 2017 and September 2018 and followed for three years. Bar displacements were evaluated with the bar displacement index (BDI). Pain scores were evaluated through visual analogue scale and QoL through the Pectus Excavatum Evaluation Questionnaire. RESULTS Control group average BDI was 17.7 (±26.7) and intervention group average BDI was 8.2 (±10.9). There was one reoperation in each group which required correction with two bars. Bar displacement was similar among groups (p = 0.12). No other complications were recorded. There was no statistically significant difference on pain score. There was a significant difference between pre and post-operative composite scores of the participants' body image domain and psycho-social aspects in both groups. The difference between the pre and postoperative participants' perception of physical difficulties was greater and statistically significant in the intervention group. CONCLUSIONS There was no statistical difference in the use of perpendicular or oblique stabilizers, but the availability of different models of stabilizers during the study suggested that this can be advantageous. The trial is registered at ClinicalTrials.gov, number NCT03087734.
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Affiliation(s)
- Miguel L Tedde
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
- Hospital Infantil Sabará, Thoracic Surgery, -São Paulo, Brazil
| | - Rafael Lucas Costa De Carvalho
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Jose Ribas Milanez De Campos
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Diego Arley Gomes Da Silva
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Erica Mie Okumura
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Gustavo Guilherme Falavigna
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Alana Cozzer Marchesi
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Paulla Petrizzo
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Barbara Siqueira Souto Maior
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Heart Institute (InCor), Hospital das Clínicas, University of Sao Paulo Medical School, Thoracic Surgery, -São Paulo, Brazil
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Guimaraes AB, Correia AT, da Silva RS, Dos Santos ES, de Souza Xavier Costa N, Dolhnikoff M, Maizato M, Cestari IA, Pego-Fernandes PM, Guerreiro Cardoso PF. Evaluation of Structural Viability of Porcine Tracheal Scaffolds after 3 and 6 Months of Storage under Three Different Protocols. Bioengineering (Basel) 2023; 10:bioengineering10050584. [PMID: 37237655 DOI: 10.3390/bioengineering10050584] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Tracheal replacement with a bioengineered tracheal substitute has been developed for long-segment tracheal diseases. The decellularized tracheal scaffold is an alternative for cell seeding. It is not defined if the storage scaffold produces changes in the scaffold's biomechanical properties. We tested three protocols for porcine tracheal scaffold preservation immersed in PBS and alcohol 70%, in the fridge and under cryopreservation. Ninety-six porcine tracheas (12 in natura, 84 decellularized) were divided into three groups (PBS, alcohol, and cryopreservation). Twelve tracheas were analyzed after three and six months. The assessment included residual DNA, cytotoxicity, collagen contents, and mechanical properties. Decellularization increased the maximum load and stress in the longitudinal axis and decreased the maximum load in the transverse axis. The decellularization of the porcine trachea produced structurally viable scaffolds, with a preserved collagen matrix suitable for further bioengineering. Despite the cyclic washings, the scaffolds remained cytotoxic. The comparison of the storage protocols (PBS at 4 °C, alcohol at 4 °C, and slow cooling cryopreservation with cryoprotectants) showed no significant differences in the amount of collagen and in the biomechanical properties of the scaffolds. Storage in PBS solution at 4 °C for six months did not change the scaffold mechanics.
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Affiliation(s)
- Alberto Bruning Guimaraes
- Organ and Tissue Laboratory, LIM 61, Division of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Aristides Tadeu Correia
- Organ and Tissue Laboratory, LIM 61, Division of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Ronaldo Soares da Silva
- Organ and Tissue Laboratory, LIM 61, Division of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Elizabete Silva Dos Santos
- Organ and Tissue Laboratory, LIM 61, Division of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Natalia de Souza Xavier Costa
- Laboratorio de Poluicao Atmosferica Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-000, Brazil
| | - Marisa Dolhnikoff
- Laboratorio de Poluicao Atmosferica Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-000, Brazil
| | - Marina Maizato
- Bioengenharia, Instituto do Coração do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Idagene Aparecida Cestari
- Bioengenharia, Instituto do Coração do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Paulo Manuel Pego-Fernandes
- Organ and Tissue Laboratory, LIM 61, Division of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Organ and Tissue Laboratory, LIM 61, Division of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 05403-904, Brazil
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Leite PHC, Mariani AW, Araujo PHXNDE, Lima CET, Braga F, Haddad R, Campos JRMDE, Pego-Fernandes PM, Terra RM. Robotic thoracic surgery for inflammatory and infectious lung disease: initial experience in Brazil. Rev Col Bras Cir 2021; 48:e20202872. [PMID: 34008797 PMCID: PMC10683415 DOI: 10.1590/0100-6991e-20202872] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. METHODS retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. RESULTS a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. CONCLUSIONS robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.
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Affiliation(s)
| | - Alessandro Wasum Mariani
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Pedro Henrique Xavier Nabuco DE Araujo
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | | | - Felipe Braga
- - Hospital Copa Star, Serviço de Cirurgia Torácica - Rio de Janeiro - RJ - Brasil
| | - Rui Haddad
- - Hospital Copa Star, Serviço de Cirurgia Torácica - Rio de Janeiro - RJ - Brasil
| | - José Ribas Milanez DE Campos
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Paulo Manuel Pego-Fernandes
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Ricardo Mingarini Terra
- - Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
- - Rede D'Or - São Luiz, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
- - Hospital Sírio Libanês, Serviço de Cirurgia Torácica - São Paulo - SP - Brasil
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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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Cardoso PFG, Minamoto H, Bibas BJ, Pego-Fernandes PM. Impact of gastroesophageal reflux in the pathogenesis of tracheal stenosis. Transl Cancer Res 2020; 9:2123-2135. [PMID: 35117568 PMCID: PMC8799195 DOI: 10.21037/tcr.2020.03.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/24/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
Benign airway stenosis is a multifactorial and heterogeneous disease often occurring after tracheal intubation. Despite the frequent finding of pathological gastroesophageal reflux (GER) in benign tracheal stenosis, the cause-and-effect relationship between these two entities and its impact on the outcome of the stenosis itself have not been established. The altered ventilatory dynamics caused by an increased thoracoabdominal pressure gradient in such patients has been proposed as a central cause. The presence of GER in a setting of microaspiration can also induce changes in the local collagen proliferation response, as well as in the local microbiome of the tracheal stenosis site, which may potentially cause and enhance the harm imposed to the already diseased tracheal wall. Diagnosis of GER remains underestimated in the general population, thus making its accurate detection and treatment in central airway stenosis a matter of investigation. The high prevalence of GER in tracheal stenosis patients often occurs in the absence of typical upper digestive signs and symptoms, therefore requiring an objective assessment using a 24-hour ambulatory esophageal pH/impedance study that has shown abnormal results in more than half the patients. The impact of the treatment of GER in patients with benign tracheal has been scarcely reported. Our group showed recently that the surgical control of GER through laparoscopic fundoplication in selected patients with tracheal stenosis can improve substantially the chance of resolution of the tracheal stenosis as opposed to the medical management with high dose proton pump inhibitors. This chapter describes the impact of GER in the pathogenesis of tracheal stenosis with a focus on its mechanisms, diagnosis and treatment strategy.
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Affiliation(s)
- Paulo Francisco Guerreiro Cardoso
- Divisao de Cirurgia Toracica, Instituto do Coracao, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Helio Minamoto
- Divisao de Cirurgia Toracica, Instituto do Coracao, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Benoit Jacques Bibas
- Divisao de Cirurgia Toracica, Instituto do Coracao, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo Manuel Pego-Fernandes
- Divisao de Cirurgia Toracica, Instituto do Coracao, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Terra RM, Lauricella LL, Haddad R, de-Campos JRM, Nabuco-de-Araujo PHX, Lima CET, Santos FCBD, Pego-Fernandes PM. Segmentectomia pulmonar anatômica robótica: aspectos técnicos e desfechos. Rev Col Bras Cir 2019; 46:e20192210. [DOI: 10.1590/0100-6991e-20192210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: relatar nossa experiência inicial com a segmentectomia robótica, descrevendo a técnica operatória, a colocação preferencial dos portais, os resultados iniciais e desfechos. Métodos: dados clínicos de pacientes submetidos à segmentectomia robótica, entre janeiro de 2017 e dezembro de 2018, foram obtidos de um banco de dados prospectivo de cirurgia robótica. Todos os pacientes tinham câncer de pulmão, primário ou secundário, ou doenças benignas, e foram operados usando o sistema Da Vinci com a técnica de três portais mais uma incisão utilitária de 3cm. As estruturas hilares foram dissecadas individualmente e as ligaduras dos ramos arteriais e venosos, dos brônquios segmentares, assim como, a transecção do parênquima, realizadas com grampeadores endoscópicos. Dissecção sistemática dos linfonodos mediastinais foi realizada para os casos de câncer de pulmão não de pequenas células (CPNPC). Resultados: quarenta e nove pacientes, dos quais 33 mulheres, foram submetidos à segmentectomia robótica. A média de idade foi de 68 anos. A maioria dos pacientes tinha CPNPC (n=34), seguido de doença metastática (n=11) e doenças benignas (n=4). Não houve conversão para cirurgia aberta ou vídeo, ou conversão para lobectomia. A mediana do tempo operatório total foi de 160 minutos e do tempo de console foi de 117 minutos. Complicações pós-operatórias ocorreram em nove pacientes (18,3%), dos quais sete (14,2%) tiveram internação prolongada (>7 dias) devido à fístula aérea persistente (n=4; 8,1%) ou complicações abdominais (n=2; 4%). Conclusão: a segmentectomia robótica é um procedimento seguro e viável, oferecendo curto período de internação e baixa morbidade.
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Affiliation(s)
| | - Leticia Leone Lauricella
- Hospital Sírio Libanês, Brasil; Universidade de São Paulo, Brasil; Hospital São Luiz Itaim - Rede D'Or, Brasil
| | - Rui Haddad
- Pontifícia Universidade Católica do Rio de Janeiro, Brasil; Hospital Copa Star, Brasil; Hospital Quinta D'Or - Rede D'Or, Brasil
| | | | | | - Carlos Eduardo Teixeira Lima
- Pontifícia Universidade Católica do Rio de Janeiro, Brasil; Hospital Copa Star, Brasil; Hospital Quinta D'Or - Rede D'Or, Brasil
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León Bueno De Camargo PC, Afonso JE, Campos SV, Carraro RM, Leite PBP, Mello LS, Braga Teixeira RHDO, Pego-Fernandes PM, Andre Nathan C. Microbial profile of donor lungs: data from 2009 to 2016. Transplantation 2017. [DOI: 10.1183/1393003.congress-2017.pa1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Terra RM, Araujo PHXND, Lauricella LL, Campos JRMD, Costa HF, Pego-Fernandes PM. Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience. J Bras Pneumol 2017; 42:185-90. [PMID: 27383931 PMCID: PMC5569613 DOI: 10.1590/s1806-37562015000000212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/01/2015] [Accepted: 02/25/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.
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Affiliation(s)
- Ricardo Mingarini Terra
- Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Leticia Leone Lauricella
- Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - José Ribas Milanez de Campos
- Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Herbert Felix Costa
- Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo Manuel Pego-Fernandes
- Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Terra RM, Antonangelo L, Mariani AW, de Oliveira RLM, Teixeira LR, Pego-Fernandes PM. Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion. Lung 2016; 194:681-6. [PMID: 27300446 DOI: 10.1007/s00408-016-9891-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/02/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion. METHODS Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival. RESULTS 156 patients (out of 196 potentially eligible) were included in this study. Most were female (72 %) and breast cancer was the most common underlying malignancy (53 %). Pleural fluid ADA level was stratified as low (<15 U/L), normal (15 ≤ ADA < 40), and high (≥40). Low and high ADA levels were associated with worse survival when compared to normal ADA (logrank: 0.0024). In multivariable analysis, abnormal ADA (<15 or ADA ≥ 40) and underlying malignancies different from lymphoma, lung, or breast cancer were associated with worse survival. Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival. CONCLUSIONS Pleural fluid Adenosine Deaminase levels (<15 or ≥40 U/L) and neoplasms other than lung, breast, or lymphoma are independent predictors of worse survival in patients with malignant pleural effusion who undergo pleurodesis.
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Affiliation(s)
- Ricardo Mingarini Terra
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil.
- Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.
| | - Leila Antonangelo
- Pathology Division, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Alessandro Wasum Mariani
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil
- Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Ricardo Lopes Moraes de Oliveira
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil
| | - Lisete Ribeiro Teixeira
- Pulmonology Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Paulo Manuel Pego-Fernandes
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil
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Andrade Neto JD, Terra RM, Teixeira RM, Pereira SV, Pego-Fernandes PM. Safety Profile of the Use of Iodopovidone for Pleurodesis in Patients with Malignant Pleural Effusion. Respiration 2015; 90:369-75. [DOI: 10.1159/000440727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022] Open
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Terra RM, Bellato RT, Teixeira LR, Chate RC, Pego-Fernandes PM. Safety and systemic consequences of pleurodesis with three different doses of silver nitrate in patients with malignant pleural effusion. Respiration 2015; 89:276-83. [PMID: 25823909 DOI: 10.1159/000371470] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Silver nitrate (SN) is an alternative to talc pleurodesis in patients with malignant pleural effusion (MPE). Nevertheless, SN complications have not been thoroughly investigated so far. OBJECTIVE To evaluate frequent adverse events (AE) of SN treatment at three different doses for pleurodesis in patients with MPE. The secondary objective was to evaluate systemic inflammation, efficacy and quality of life in these patients. METHODS A double-blind, randomized, clinical trial was conducted in patients with recurrent MPE at a tertiary university hospital. The study patients underwent pleural catheter insertion and were randomly assigned to one of the three pleurodesis groups treated with 30 ml 0.3%, 30 ml 0.5% or 60 ml 0.3% SN. Patients were discharged 3 days after the procedure, and returned to follow-up visits on days 10 and 30. During follow-up, AE, inflammatory markers, quality of life and CT scans were systematically assessed and documented. RESULTS Sixty patients (11 males and 49 females, median age 62.13 years) were included. Overall, 199 AE were observed, including 23 serious AE. Grade 1/2 metabolic AE, such as increases in creatinine and liver enzymes, were the most frequent. Grade 3/4 hypoxia was observed in 13 patients. Four patients died, 3 due to disease progression and in 1 patient death was possibly related to pleurodesis. C-reactive protein levels increased in a dose-dependent manner and peaked 48 h after pleurodesis. No significant difference was observed among groups regarding quality of life or clinical/radiological recurrence. CONCLUSION Hypoxia was the most significant AE following SN pleurodesis; mild metabolic events were very common. SN instillation causes substantial dose-dependent systemic inflammatory responses.
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Affiliation(s)
- Ricardo Mingarini Terra
- Division of Thoracic Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
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Medeiros IL, Terra RM, Choi EM, Pego-Fernandes PM, Jatene FB. Evaluation of serial C-reactive protein measurements after surgical treatment of pleural empyema. Clinics (Sao Paulo) 2012; 67:243-7. [PMID: 22473405 PMCID: PMC3297033 DOI: 10.6061/clinics/2012(03)07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 10/23/2011] [Accepted: 11/29/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Serial C-reactive protein measurements have been used to diagnose and monitor the response to therapy in patients with pneumonia and other infectious diseases. Nonetheless, the role of C-reactive protein measurement after surgical treatment for pleural empyema is not well defined. The aim of this study is to describe the behavior of C-reactive protein levels after the surgical treatment of pleural empyema and to correlate this parameter with the patient's prognosis. METHODS We retrospectively analyzed the records of patients with pleural empyema treated by either chest-tube drainage or surgery from January 2006 to December 2008. C-reactive protein levels were recorded preoperatively and 2 and 7 days postoperatively. The clinical outcome was binary: success or failure (mortality or the need for repeated pleural intervention). RESULTS The study group comprised fifty-two patients. The median C-reactive protein values were as follows: 146 mg/L (pre-operative), 134 mg/L (post-operative day 2), and 116 mg/L (post-operative day 7). There was a trend toward a decrease in these values during the first week after surgery, but this difference was only statistically significant on day 7 after surgery. Over the first week after surgery, the C-reactive protein values decreased similarly in both groups (successful and failed treatment). No correlation between the preoperative C-reactive protein level and the clinical outcome was found. CONCLUSIONS We observed that, in contrast to other medical conditions, C-reactive protein levels fall slowly during the first postoperative week in patients who have undergone surgical treatment for pleural empyema. No correlation between the perioperative C-reactive protein level and the clinical outcome was observed.
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Fiorelli AI, Stolf NAG, Pego-Fernandes PM, Oliveira Junior JL, Santos RHB, Contreras CAM, Filho DDL, Dinkhuysen JJ, Moreira MCV, Mejia JAC, Castro MCR. Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline. Transplant Proc 2011; 43:211-5. [PMID: 21335190 DOI: 10.1016/j.transproceed.2010.12.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient < 0.8 (RR = 1.3) (B), ischemia > 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor.
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Affiliation(s)
- A I Fiorelli
- Brazilian Association for Organ Transplantation, Brazil.
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Pego-Fernandes PM, Nascimbem MB, Ranzani OT, Shimoda MS, Monteiro R, Jatene FB. Videotoracoscopia como uma opção no tratamento cirúrgico do quilotórax após cirurgia cardíaca pediátrica. J Bras Pneumol 2011; 37:28-35. [DOI: 10.1590/s1806-37132011000100006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar o uso de videotoracoscopia no tratamento cirúrgico do quilotórax após cirurgia para correção de cardiopatias congênitas em crianças. MÉTODOS: Revisamos os prontuários médicos de 3.092 crianças operadas para a correção de cardiopatias congênitas no Instituto do Coração/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) entre fevereiro de 2002 e fevereiro de 2007. RESULTADOS: Das 3.092 crianças, 64 (2,2%) apresentaram quilotórax como complicação pós-operatória. Em 50 (78,1%) dessas, o tratamento clínico foi bem-sucedido, enquanto esse falhou em 14 (21,9%), as quais foram submetidas à ligação do ducto torácico por videotoracoscopia. A ligação do ducto torácico obteve sucesso em 12 pacientes (86%) e falhou em 2 casos, os quais foram resolvidos com medidas clínicas adicionais, como dieta pobre em gorduras e nutrição parenteral. Não houve morbidade ou mortalidade relacionada à operação. Dos 14 pacientes, 5 (35%) faleceram em decorrência de complicações cardíacas ou infecciosas. CONCLUSÕES: A ligadura videoassistida do ducto torácico pode ser realizada com segurança em pacientes gravemente enfermos e com doença cardíaca grave, com resultados favoráveis.
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Silva VFPE, Pazetti R, Soto SDF, Siqueira MMQ, Correia AT, Jatene FB, Pego-Fernandes PM. Effects of mycophenolate sodium on mucociliary clearance using a bronchial section and anastomosis rodent model. Clinics (Sao Paulo) 2011; 66:1451-6. [PMID: 21915499 PMCID: PMC3161227 DOI: 10.1590/s1807-59322011000800024] [Citation(s) in RCA: 13] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 05/06/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To study the effects of mycophenolate sodium on mucociliary clearance. INTRODUCTION Mycophenolate is one of the most commonly used immunosuppressive drugs in lung transplantation. Although its pharmacokinetic properties are well defined, its side effects on mucociliary clearance have not yet been studied. METHODS Sixty rats were subjected to left bronchial section and anastomosis. The right bronchus was used as a control. After surgery, the rats were assigned to two groups based on whether they received saline solution (n = 30) or mycophenolate sodium (n = 30). After 7, 15, or 30 days of treatment, 10 animals from each group were sacrificed, and in vitro mucus transportability, in situ mucociliary transport velocity and ciliary beat frequency were measured. RESULTS The analysis of mucus transportability revealed that neither mycophenolate nor bronchial section altered any transportability related property for up to 30 days of treatment after surgery (p>0.05). With regard to ciliary beat frequency, the operated left bronchi from the mycophenolate group showed a significant decrease on post-surgical day 30 (p = 0.003). In addition, we found a significant reduction in the in situ mucociliary transport velocity in the mycophenolate-treated group (p = 0.0001). DISCUSSION These data add important information regarding mucociliary clearance dysfunction following mycophenolate therapy and suggest that mycophenolate might contribute to the high incidence of respiratory tract infections in lung transplant patients. Further studies are needed to investigate the combined action of mycophenolate with other immunosuppressive drugs and to establish methods to protect and recover mucociliary clearance, an important airway defense mechanism.
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Terra RM, Teixeira LR, Bibas BJ, Pego-Fernandes PM, Vargas FS, Jatene FB. Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status. Clinics (Sao Paulo) 2011; 66:211-6. [PMID: 21484035 PMCID: PMC3059870 DOI: 10.1590/s1807-59322011000200005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 09/12/2010] [Revised: 09/24/2010] [Accepted: 11/01/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. METHODS This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. RESULTS During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. CONCLUSION In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.
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Affiliation(s)
- Ricardo Mingarini Terra
- Thoracic Surgery Division, Hospital das Clínicas, Faculdade de Mecicina, Universidade de São Paulo, São Paulo, Brazil.
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Terra RM, Kim SY, Pego-Fernandes PM, Teixeira LR, Vargas FS, Jatene FB. Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting? Ann Surg Oncol 2010; 18:1145-50. [DOI: 10.1245/s10434-010-1447-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Indexed: 11/18/2022]
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Pego-Fernandes PM, Mariani AW. Medical teaching beyond graduation: undergraduate study groups. SAO PAULO MED J 2010; 128:257-8. [PMID: 21181063 PMCID: PMC10948062 DOI: 10.1590/s1516-31802010000500002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 11/21/2022] Open
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Pego-Fernandes PM, de Serro-Azul JB, Matheus F, Maehara BS. Myocardial revascularization in a patient with situs inversus totalis. Arq Bras Cardiol 2008; 88:e103-6. [PMID: 17589612 DOI: 10.1590/s0066-782x2007000500021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 04/20/2006] [Accepted: 01/17/2007] [Indexed: 11/22/2022] Open
Abstract
We report the case of a patient with dextrocardia and situs inversus totalis associated with obstructive coronariopathy in the anterior and posterior descending arteries, right coronary artery, first diagonal branch and left marginal branch. The patient underwent coronary artery bypass grafting surgery. This surgery has been rarely reported in literature and we found only one similar case in the national medical literature. The myocardial revascularization was carried out with the right mammary artery for the anterior descending artery. The saphenous vein anastomosed the aorta to the right coronary artery, left marginal branch, fist diagonal branch and posterior descending artery. The surgery was performed with extracorporeal circulation.
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Terra RM, de Medeiros IL, Minamoto H, Nasi A, Pego-Fernandes PM, Jatene FB. Idiopathic Tracheal Stenosis: Successful Outcome With Antigastroesophageal Reflux Disease Therapy. Ann Thorac Surg 2008; 85:1438-9. [PMID: 18355548 DOI: 10.1016/j.athoracsur.2007.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Revised: 10/02/2007] [Accepted: 10/08/2007] [Indexed: 11/18/2022]
Affiliation(s)
- Ricardo Mingarini Terra
- Division of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
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Pazetti R, Pego-Fernandes PM, Ranzani OT, Parra ER, Lorenzi-Filho G, Jatene FB. Cyclosporin A reduces airway mucus secretion and mucociliary clearance in rats. Clinics (Sao Paulo) 2007; 62:345-52. [PMID: 17589677 DOI: 10.1590/s1807-59322007000300021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 02/23/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assay the effects of cyclosporin A on mucus secretion from goblet cells and on mucociliary transport in situ in rats. METHODS Twenty-one male Wistar rats were assigned to 3 groups: control (n = 5), saline (n = 8), and cyclosporin A (n = 8). After 30 days of drug therapy, the rats were killed, and the lungs were removed from the thoracic cavity. Mucus samples were collected, and the transport rate was evaluated in vitro using a bullfrog palate model. Mucociliary transport was timed in situ by direct view of particles trapped on the mucus moving across the respiratory tract. Finally, the amount of stored mucins in the goblet cells of the respiratory epithelium was measured. RESULTS Drug dosage measurements showed that cyclosporine blood concentration at the moment the rats were killed was 1246.57 +/- 563.88 ng/mL. The in vitro transport rate was significantly lower (P < .001) in the cyclosporin A-treated group. Also, the in-situ mucociliary transport rate was decreased in all cyclosporin A-treated animals when compared to the saline group (P = .02). Mucus quantity measurements showed a significant decrease on both acid (P = .01) and neutral (P = .02) mucus production from goblet cells in the animals submitted to cyclosporin A therapy. The correlation between the percentage of total mucus and in vitro transport rate was positive and significant (r = 0.706, P < .001), as was the correlation between the percentage of total mucus and the in situ mucociliary transport rate (r = 0.688, P = .001). CONCLUSION This study shows that cyclosporin A plays an important role in the impairment of the mucociliary clearance in rats by reducing both acid and neutral mucus production from goblet cells and causing a decrease in the mucociliary transport velocity.
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Affiliation(s)
- Rogerio Pazetti
- Thoracic Surgery Service, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, SP, Brazil.
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Jatene FB, Pego-Fernandes PM. Minimally invasive bypass. Ann Thorac Surg 1996; 62:1883-4. [PMID: 8957421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kioka Y, Pego-Fernandes PM, Pomerantzeff PM, Jatene AD. [Prosthetic valve endocarditis]. Kyobu Geka 1990; 43:718-23. [PMID: 2232391] [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: 12/30/2022]
Abstract
From January/1983 to March/1988, 28 patients were submitted to valve replacements for prosthetic valve endocarditis in 1,512 valve replacements. Seventeen patients were male, their mean age was 36.7 +/- 12.9 years old, and eight cases were operated under emergency condition. The blood cultures were positive in 14 (50%), the agent most commonly found being Streptococcus viridans in 5 cases. Hospital mortality was 28.5%. The causes of death were septicemia in 4 cases, low output syndrome in 2 cases, cerebrovascular accident in 1 case, and coagulopathy in 1 case. Mortality was higher with statistical significance in the cases whose blood cultures were negative, the cases in which the time from valve replacement to the onset of endocarditis was less than one year, and the cases under emergency condition.
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Affiliation(s)
- Y Kioka
- Heart Institute of São Paulo University Medical School
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