Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Lung cancer in Brazil

Câncer de pulmão no Brasil

Luiz Henrique Araujo1,2,a, Clarissa Baldotto1,2,b, Gilberto de Castro Jr3,4,c, Artur Katz4,d, Carlos Gil Ferreira5,6,e, Clarissa Mathias7,f, Eldsamira Mascarenhas7,g, Gilberto de Lima Lopes8,9,h, Heloisa Carvalho4,10,i, Jaques Tabacof8, Jeovany Martínez-Mesa11,j, Luciano de Souza Viana12,k, Marcelo de Souza Cruz13,l, Mauro Zukin1,2,m, Pedro De Marchi12,n, Ricardo Mingarini Terra3,o, Ronaldo Albuquerque Ribeiro14, Vladmir Cláudio Cordeiro de Lima15,p, Gustavo Werutsky16,q, Carlos Henrique Barrios17,r; Grupo Brasileiro de Oncologia Torácica

J Bras Pneumol.2018;44(1):55-64

Abstract PDF PT PDF EN Portuguese Text

Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

 


Keywords: Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil.

 


Robotic thoracic surgery for non-small cell lung cancer: initial experience in Brazil

Cirurgia torácica robótica no tratamento do câncer de pulmão de células não pequenas: experiência inicial no Brasil

Ricardo Mingarini Terra1,2,3,4,a, Benoit Jacques Bibas1,3,4,b, Rui Haddad5,6,c, José Ribas Milanez-de-Campos1,3,d, Pedro Henrique Xavier Nabuco-de-Araujo1,2,4,e, Carlos Eduardo Teixeira-Lima5,6,f, Felipe Braga dos Santos5,6,g, Leticia Leone Lauricella1,2,4,h, Paulo Manuel Pêgo-Fernandes1,2,3,i

J Bras Pneumol.2020;46(1):e20190003-e20190003

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.

 


Keywords: Lung neoplasms/surgery; Lung neoplasms/mortality; Robotic surgical procedures.

 


Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

Cirurgia torácica robótica para ressecção de timoma e tumores tímicos: desenvolvimento técnico e experiência inicial

Ricardo Mingarini Terra1,a, José Ribas Milanez-de-Campos1,b, Rui Haddad2,c, Juliana Rocha Mol Trindade3,d, Leticia Leone Lauricella3,e, Benoit Jacques Bibas3,f, Paulo Manuel Pêgo-Fernandes1,g

J Bras Pneumol.2020;46(1):e20180315-e20180315

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperativeymoma; Thymus neoplasms; Thymectomy; Thoracic surgery; R outcomes comparable to those of other techniques.

 


Keywords: Thymoma; Thymus neoplasms; Thymectomy; Thoracic surgery; Robotic surgical procedures.

 


Pleural effusion following ovarian hyperstimulation

Derrame pleural secundário à hiperestimulação ovariana

Jader Joel Machado Junqueira, Ricardo Helbert Bammann, Ricardo Mingarini Terra, Ana Cristina Pugliesi de Castro, Augusto Ishy, Angelo Fernandez

J Bras Pneumol.2012;38(3):400-403

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Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.

 


Keywords: Fertilization in vitro; Ovarian hyperstimulation syndrome; Pleural effusion.

 


Intratracheal stent: prosthesis or orthesis?

Dispositivos intra-traqueais: próteses ou órteses?

Ricardo Mingarini Terra, Helio Minamoto, Fabio Biscegli Jatene

J Bras Pneumol.2006;32(6):606-607

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Probe-based confocal laser endomicroscopy of the airways: physiological and pathological characteristics of preneoplastic and neoplastic lesions

Endomicroscopia confocal a laser das vias aéreas: características normais e patológicas de lesões pré-neoplásicas e neoplásicas

Juliana Rocha Mol Trindade1,a, Viviane Rossi Figueiredo2,b, Paulo Manuel Pêgo-Fernandes3,c, Ricardo Mingarini Terra1,d

J Bras Pneumol.2019;45(1):e20180103-e20180103

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Self-expanding stent made of polyester mesh with silicon coating (Polyflex®) in the treatment of inoperable tracheal stenoses

Endoprótese auto-expansível de malha de poliéster revestida por silicone (Polyflex®) no tratamento de estenoses traqueais não-cirúrgicas

Ricardo Mingarini Terra, Helio Minamoto, Miguel Lia Tedde, José Luiz Jesus de Almeida, Fabio Biscegli Jatene

J Bras Pneumol.2007;33(3):241-247

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Objective: To evaluate the Polyflex® stent in terms of its efficacy, ease of implantation, and complications in patients with tracheobronchial affections. Methods: This was a prospective study, in which sixteen patients with inoperable tracheal stenosis secondary to orotracheal intubation (n = 12), neoplasia (n = 3), or Wegener's granulomatosis (n = 1) were monitored. Of these patients, eleven were women, and five were men. The mean age was 42.8 years (range, 21-72 years). Patients were submitted to implantation of a total of 21 Polyflex® stents. All procedures were carried out in the operating room under general anesthesia, and the stents were implanted via suspension laryngoscopy using the stent applicator. Results: Stents were implanted and symptoms were resolved in all cases. The stents remained in place for a mean period of 7.45 months, ranging from 2 to 18 months. The complications observed in the immediate postoperative period were dysphonia (in two patients, 12.5%) and odynophagia (in two patients, 12.5%). Late complications were cough (in ten patients, 62.5%), migration (in seven patients, 43.75%), granuloma formation (in two patients, 12.5%), and pneumonia (in one patient, 6.25%). Conclusion: The Polyflex® stent is easily implanted, easily removed, well tolerated by patients and effective in resolving symptoms. However, its use is associated with a high rate of migration, especially in patients with post-orotracheal intubation stenosis.

 


Keywords: Tracheal stenosis; Intubation, intratracheal; Prostheses and implants; Stents.

 


Video-assisted thoracoscopic thoracic duct ligation with near-infrared fluorescence imaging with indocyanine green

Fluorescência com verde de indocianina para auxiliar na ligadura do ducto torácico por videotoracoscopia

Benoit Jacques Bibas1,a, Rafael Lucas Costa-de-Carvalho1,b, Flavio Pola-dos-Reis1,c, Leticia Leone Lauricella1,d, Paulo Manoel Pêgo-Fernandes1,e, Ricardo Mingarini Terra1,f

J Bras Pneumol.2019;45(4):e20180401-e20180401

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Subglottic and mediastinal hemangioma in a child:treatment with propranolol

Hemangioma subglótico e mediastinal em criança:tratamento com propranolol

Mauro Tamagno, Benoit Jacques Bibas, Helio Minamoto,Fernanda Sobreiro Alfinito, Ricardo Mingarini Terra, Fabio Biscegli JateneCarta

J Bras Pneumol.2011;37(3):416-418

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Transdiaphragmatic intercostal hernia: imaging aspects in three cases

Hérnia intercostal transdiafragmática: aspectos de imagem em três casos

Ana Carolina Sandoval Macedo, Fernando Uliana Kay, Ricardo Mingarini Terra, José Ribas Milanez de Campos, André Galante Alencar Aranha, Marcelo Buarque de Gusmão Funari

J Bras Pneumol.2013;39(4):-

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Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.

 


Keywords: Hernia, diaphragmatic; Radiography; Ultrasonography; Tomography; Magnetic resonance imaging.

 


Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience

Lobectomia pulmonar robótica para tratamento do câncer de pulmão e de metástases pulmonares: implantação do programa e experiência inicial

Ricardo Mingarini Terra1, Pedro Henrique Xavier Nabuco de Araujo2, Leticia Leone Lauricella2, José Ribas Milanez de Campos1, Herbert Felix Costa2, Paulo Manuel Pego-Fernandes1

J Bras Pneumol.2016;42(3):185-190

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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.

 


Keywords: Pneumonectomy; Robotic surgical procedures; Thoracic surgery; Minimally invasive surgical procedures; Lung neoplasms.

 


Malignant pleural mesothelioma: multidisciplinary experience in a public tertiary hospital

Mesotelioma pleural maligno: experiência multidisciplinar em hospital público terciário

Ricardo Mingarini Terra, Lisete Ribeiro Teixeira, Ricardo Beyruti, Teresa Yae Takagaki, Francisco Suso Vargas, Fabio Biscegli Jatene

J Bras Pneumol.2008;34(1):12-20

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Objective: To evaluate the experience in diagnosing and treating malignant pleural mesothelioma (MPM) accumulated over 5 years in a tertiary public hospital. Methods: The medical charts of the patients diagnosed with MPM between January of 2000 and February of 2005 were evaluated retrospectively. Results: Of the 17 patients analyzed, 14 were male and 3 were female. The mean age was 54.1 years (range, 13-75 years). The biopsy specimens for histopathological examination were obtained through thoracoscopy in 9 patients (53%), Cope needle in 5 (29.5%), and open pleural biopsy in 3 (17.5%). The following histological types were identified: epithelial, in 14 patients (82%); sarcomatoid, in 1 (6%); and biphasic, in 2 (12%). The therapeutic approaches used were as follows: multimodal (pleuropneumonectomy and adjuvant radiotherapy and chemotherapy) in 6 patients (35%); chemotherapy and radiotherapy in 6 (35%); radiotherapy alone in 3 (17.5%); and chemotherapy alone in 2 (12%). The mean survival was 11 months (range, 1-26 months). Conclusions: In the cases studied, an integrated multidisciplinary approach was used, and a highly complex hospital infrastructure was available for the diagnosis and treatment of MPM, as recommended in the literature. However, the mean survival was only 11 months, reflecting the aggressiveness of the disease.

 


Keywords: Mesothelioma; Pleura; Surgery; Diagnosis.

 


Mini-thoracostomy with vacuum-assisted closure: a minimally invasive alternative to open-window thoracostomy

Minipleurostomia com curativo a vácuo: uma opção minimamente invasiva a pleurostomia

Alessandro Wasum Mariani1,a, João Bruno Ribeiro Machado Lisboa1,b, Guilherme de Abreu Rodrigues1,c, Ester Moraes Avila2,d, Ricardo Mingarini Terra1,e, Paulo Manuel Pêgo-Fernandes1,f

J Bras Pneumol.2018;44(3):227-230

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Thoracostomy is a common treatment option for patients with stage III pleural empyema who do not tolerate pulmonary decortication. However, thoracostomy is considered mutilating because it involves a thoracic stoma, the closure of which can take years or require further surgery. A new, minimally invasive technique that uses the vacuum-assisted closure has been proposed as an alternative to thoracostomy. This study aims to analyze the safety and effectiveness of mini-thoracostomy with vacuum-assisted closure in an initial sample of patients.

 


Keywords: Infection; Empyema, pleural; Negative-pressure wound therapy; Thoracostomy.

 


Pleurodese nos derrames pleurais malignos: Um inquérito entre médicos em países da América do Sul e Central

Pleurodese nos derrames pleurais malignos: Um inquérito entre médicos em países da América do Sul e Central

Evaldo Marchi, Francisco Suso Vargas, Bruna Affonso Madaloso, Marcus Vinicius Carvalho, Ricardo Mingarini Terra, Lisete Ribeiro Teixeira

J Bras Pneumol.2010;36(6):759-767

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Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.

 


Keywords: Pleural effusion, malignant; Pleura; Pleurodesis.

 


Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion

Posicionamento intrapleural, guiado por ultrassonografia, de cateteres pleurais: influência na expansão pulmonar imediata e na pleurodese em pacientes com derrame pleural maligno recorrente

Pedro Henrique Xavier Nabuco de Araujo1, Ricardo Mingarini Terra1, Thiago da Silva Santos1, Rodrigo Caruso Chate2, Antonio Fernando Lins de Paiva2, Paulo Manuel Pêgo-Fernandes1

J Bras Pneumol.2017;43(3):190-194

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Objective: To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). Methods: This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Results: Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: −225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Conclusions: Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE.

 


Keywords: Pleurodesis; Pleural effusion, malignant; Tomography; Catheters.

 


Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of mediastinal lymphadenopathy: initial experience in Brazil

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

Miguel Lia Tedde, Viviane Rossi Figueiredo, Ricardo Mingarini Terra, Hélio Minamoto, Fábio Biscegli Jatene

J Bras Pneumol.2012;38(1):33-40

Abstract PDF PT PDF EN Portuguese Text

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.

 


Keywords: Ultrasonography, interventional; Biopsy, fine-needle; Neoplasm staging; Lung neoplasms; Bronchoscopy.

 


Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil

Punção aspirativa por agulha guiada por ultrassom endobrônquico no estadiamento do câncer de pulmão: experiência inicial no Brasil

Viviane Rossi Figueiredo, Paulo Francisco Guerreiro Cardoso, Márcia Jacomelli, Sérgio Eduardo Demarzo, Addy Lidvina Mejia Palomino, Ascédio José Rodrigues, Ricardo Mingarini Terra, Paulo Manoel Pego-Fernandes, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2015;41(1):23-30

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Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. Methods: This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Results: Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. Conclusions: We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.

 


Keywords: Lung neoplasms; Neoplasm staging; Bronchoscopy; Endoscopic ultrasound-guided fine needle aspiration; Lymph nodes.

 


Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study)

Ressecção pulmonar anatômica por videotoracoscopia: experiência brasileira (VATS Brasil)

Ricardo Mingarini Terra1, Thamara Kazantzis1, Darcy Ribeiro Pinto-Filho2, Spencer Marcantonio Camargo3, Francisco Martins-Neto4,5, Anderson Nassar Guimarães6, Carlos Alberto Araújo7, Luis Carlos Losso8, Mario Claudio Ghefter9, Nuno Ferreira de Lima10, Antero Gomes-Neto5, Flávio Brito-Filho10, Rui Haddad11, Maurício Guidi Saueressig12, Alexandre Marcelo Rodrigues Lima13, Rafael Pontes de Siqueira5, Astunaldo Júnior de Macedo e Pinho14, Fernando Vannucci15

J Bras Pneumol.2016;42(3):215-221

Abstract PDF PT PDF EN Portuguese Text

Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

 


Keywords: Thoracic surgery, video-assisted; Thoracoscopy; Pneumonectomy.

 


Bedside tracheostomy: practical considerations

Traqueostomia à beira do leito: considerações práticas

Ricardo Mingarini Terra, Angelo Fernandez, Ricardo Helbert Bammann

J Bras Pneumol.2008;34(2):126-

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Surgical treatment of congenital tracheal stenoses

Tratamento cirúrgico das estenoses traqueais congênitas

Ricardo Mingarini Terra, Helio Minamoto, Lívia Caroline Barbosa Mariano, Angelo Fernandez, José Pinhata Otoch, Fabio Biscegli Jatene

J Bras Pneumol.2009;35(6):515-520

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Objective: To analyze the outcomes of patients undergoing repair of congenital tracheal stenosis. Methods: This was a retrospective review of congenital tracheal stenosis patients treated between 2001 and 2007 at the University of São Paulo School of Medicine Hospital das Clínicas in São Paulo, Brazil. Results: Six boys and one girl (age at diagnosis ranging from 28 days to 3 years) were included. Five of the patients also had cardiac or major vessel malformations. The stenosis length was short in three patients, medium in one and long in three. The techniques used were pericardial patch tracheoplasty in three patients, resection and anastomosis in two, slide tracheoplasty in one and vascular ring correction in one. One patient died during surgery due to hypoxia and hemodynamic instability, and one died from septic shock on postoperative day 11. Other complications included pneumonia, arrhythmia, stenosis at the anastomosis level, residual stenosis, granuloma formation and malacia. The mean follow-up period was 31 months; four patients were cured, and one required the use of a T-tube to maintain airway patency. Conclusions: Congenital tracheal stenosis is a curable disease. However, its repair is complex and is associated with high rates of morbidity and mortality.

 


Keywords: Tracheal stenosis/congenital; Tracheal diseases; Surgical procedures, operative.

 


Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery

Usos da sala híbrida em cirurgia torácica: de procedimentos multidisciplinares à cirurgia toracoscópica videoassistida guiada por imagem

Ricardo Mingarini Terra1,2, Juliano Ribeiro Andrade2, Alessandro Wasum Mariani1,2, Rodrigo Gobbo Garcia2, Jose Ernesto Succi2,3, Andrey Soares2,4, Paulo Marcelo Zimmer2

J Bras Pneumol.2016;42(5):387-390

Abstract PDF PT PDF EN Portuguese Text

The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.

 


Keywords: Thoracic surgery, video-assisted; Bronchoscopy; Thoracoscopy; Radiology, interventional.

 


 

 


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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
Secretariat of the Brazilian Journal of Pulmonology
SCS Quadra 01, Bloco K, Salas 203/204 Ed. Denasa. CEP: 70.398-900 - Brasília - DF
Fone/fax: 0800 61 6218/ (55) (61) 3245 1030/ (55) (61) 3245 6218
E-mails: jbp@jbp.org.br
jpneumo@jornaldepneumologia.com.br

Copyright 2019 - Brazilian Thoracic Association

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