Brazilian Journal of Pulmonology

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

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Therapeutic application of collateral ventilation with pulmonary drainage in the treatment of diffuse emphysema: report of the first three cases

Aplicação terapêutica da ventilação colateral com drenagem pulmonar no tratamento do enfisema pulmonar difuso: relato dos três primeiros casos

Roberto Saad Junior, Vicente Dorgan Neto, Marcio Botter, Roberto Stirbulov, Jorge Henrique Rivaben, Roberto Gonçalves

J Bras Pneumol.2009;35(1):14-19

Abstract PDF PT PDF EN Portuguese Text

Objective: To report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage. Methods: Patients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were selected for the evaluation of pulmonary drainage. During the pre- and post-operative periods, patients were submitted to plethysmography and six-minute walk tests, as well as completing the following quality of life questionnaires: Medical Outcomes Study 36-item Short-Form Health Survey, Saint George's Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status and Medical Research Council Scale. In all three cases, the post-operative follow-up period was at least 300 days. The tests were performed at the following time points: during the pre-operative period; between post-operative days 30 and 40; and on post-operative day 300. Data were analyzed using profile plots of the means. Results: When the results obtained in the pre-operative period were compared to those obtained at the two post-operative time points evaluated, improvements were observed in all parameters studied. Conclusions: The results suggest that the surgical technique proposed for the treatment of patients suffering from severe diffuse emphysema successfully reduces the debilitating symptoms of these patients, improving their quality of life considerably.

 


Keywords: Pulmonary emphysema; Lung diseases, obstructive; Lung, hyperlucent.

 


Therapeutic application of collateral ventilation in diffuse pulmonary emphysema: study protocol presentation

Aplicação terapêutica da ventilação colateral no enfisema pulmonar difuso: apresentação de um protocolo

Roberto Saad Júnior, Vicente Dorgan Neto, Marcio Botter, Roberto Stirbulov, Jorge Rivaben, Roberto Gonçalves

J Bras Pneumol.2008;34(6):430-434

Abstract PDF PT PDF EN Portuguese Text

We present a protocol to test a new surgical procedure for the treatment of patients with diffuse lung emphysema who, after having received the golden standard treatment (pulmonary rehabilitation), continue to present respiratory failure with disabling dyspnea. Ten patients with severe lung hyperinflation will be evaluated. The method proposed is designed to create alternative expiratory passages for air trapped in the emphysematous lung by draining the lung parenchyma, thereby establishing communication between the alveoli and the external environment. The ten patients selected will be required to meet the inclusion criteria and to give written informed consent. Those ten patients will be included in the study pending the approval of the Ethics in Research Committee of the São Paulo Santa Casa School of Medicine, São Paulo, Brazil. The protocol we will employ in order to evaluate the proposed procedure is feasible and will show whether debilitated patients suffering from diffuse pulmonary emphysema can benefit from this procedure, which could represent an alternative to lung transplant or lung volume reduction surgery, the only options currently available.

 


Keywords: Pulmonary emphysema; Pulmonary disease, chronic obstructive; Lung, hyperlucent.

 


Evaluation of Pulmonary Function in Class I and II Obesity

Avaliação da função pulmonar na obesidade graus I e II

Zied Rasslan, Roberto Saad Junior, Roberto Stirbulov, Renato Moraes Alves Fabbri, Carlos Alberto da Conceição Lima

J Bras Pneumol.2004;30(6):508-514

Abstract PDF PT PDF EN

Background: Obesity can effect the thorax, diphragm and abdominal muscles, thereby resulting in altered respiratory function. Objective: To evaluate the effects of obesity and to determine whether body mass index (BMI) and waist circumference correlate with spirometry values in obese individuals. Method: We studied 96 non-smokers of both sexes, 48 suffering from class I and class II obesity and ranging in age rom 18 to 75. All participants presented a BMI between 30 kg/m2 and 40 kg/m2 and none had a history of morbidity. Spirometry was performed, and waist circumferences were measured. Results: No significant differences were found between the spirometric values of men with class I or II obesity and those of non-obese men. In obese women, forced vital capacity and forced expiratory volume in one second (FEV1) were significantly lower than in women who were not obese. Obese individuals of both sexes presented significantly lower expiratory reserve volume (ERV) than did non-obese individuals. Although inspiratory capacity was greater in obese men and women, the difference was significant only for the men. In obese men, there was a significant negative correlation, not seen in the women, between waist circumference and FEV1. Conclusion: Pulmonary function is altered in women suffering from class I and II obesity. In obese men, although pulmonary function is unaffected by BMI, we observed a significant negative correlation between BMI and ERV. We can conclude that pulmonary function is influenced by waist circumference in men suffering from class I and II obesity.

 


Keywords: Respiratory function tests. Spirometry. Body mass index. Obesity.

 


A rare case of pneumothorax: metastatic adamantinoma

Caso raro de pneumotórax: adamantinoma metastático

Roberto Gonçalves, Roberto Saad Júnior, Vicente Dorgan Neto, Marcio Botter

J Bras Pneumol.2008;34(6):425-429

Abstract PDF PT PDF EN Portuguese Text

Here, we describe two cases of lung metastasis of adamantinoma of long bones, a low-grade bone neoplasm that rarely metastasizes. In both cases, the clinical presentation of the metastases was characterized by spontaneous pneumothorax secondary to tumor cavitation, a phenomenon described in only three of the studies reviewed in the literature. Clinical, radiological, and anatomopathological findings, as well as the procedures adopted in the two cases, are described.

 


Keywords: Adamantinoma; Pneumothorax; Neoplasm metastasis; Medical records.

 


Mediastinal diseases: clinical and therapeutic aspects

Doenças mediastinais: aspectos clínicos e terapêuticos

Roberto Saad Júnior, Maria Elisa Ruffolo Magliari, Júlio Mott Ancona Lopez

J Bras Pneumol.2003;29(4):202-207

Abstract PDF PT

Background: Mediastinal affections are common and encompass a great number of different diagnoses. Objective: To analyze the clinical aspects and the therapeutic response of 114 patients with mediastinal diseases treated at the Thoracic Surgery Department of Santa Casa de São Paulo Hospital, from 1979 and 1997. Method: The patients were grouped according to the benign or malignant nature of the disease, and the two groups were compared regarding gender, age bracket, symptomatology, topography of the lesion, mortality, and response to treatment. Results: Sixty-three patients had neoplasia: 31 benign and 32 malignant. Fifty-one cases were not neoplastic. No difference was found between the groups regarding gender or age bracket. Half of the patients were between 20 and 49 years of age. The anterior mediastinum was the most frequently affected compartment (66 patients), followed by the upper mediastinum (18 patients), the posterior mediastinum (16 patients), and the middle mediastinum (14 patients). The most frequent histological types were: benign thymus diseases (N = 40), mesenchymal tumors (N = 17), lymphomas (N = 15), neural tumors (N = 9), and germ cell tumors (N = 8). Malignant tumors were more frequently symptomatic (91%), and benign tumors were more frequent in asymptomatic patients (92%). The most frequent symptoms were related to myastenia gravis, followed by dyspnea and chest pain. Weight loss, anorexia and fever were significantly more frequent in patients with malignant neoplasias. Conclusions: Regarding the clinical aspects we can state that benign lesions were predominant, that mediastinal diseases were more prevalent in young adults, and that benign lesions were more frequent in asymptomatic patients. Treatment (clinical/surgical) was effective in most patients, benefiting approximately 90% of the patients with benign affections and 45% of the patients with malignant tumors. In 73% of the benign affections, surgical treatment was capable of achieving the cure. Mortality resulting from complications was 1.75%.

 


Keywords: Key words - Mediastinum. Mediastinal disease/epidemiology. Mediastinal neoplasms.

 


Mediastinal liposarcoma: a case report

Lipossarcoma de mediastino: relato de caso

Roberto Saad Junior, Vicente Dorgan Neto, Roberto Gonçalves, Márcio Botter, Leticia Cristina Dalledone Siqueira

J Bras Pneumol.2008;34(1):55-58

Abstract PDF PT PDF EN Portuguese Text

Here, we describe the case of a 51-year-old female with mediastinal liposarcoma. Liposarcoma is the most common malignant mesenchymal neoplasm in adults, although a mediastinal location is extremely rare. It has a large volume and varied histologic subtypes. It is characterized by the compression of neighboring structures. Computed tomography and magnetic resonance imaging provide useful data for diagnosis. Tissue biopsy and histological typing are very important in determining the treatment and are needed for the final diagnosis. Radiotherapy and chemotherapy are ineffective treatment modalities. According to the literature, surgical resection is the treatment of choice. Long-term follow-up evaluation is indicated since there is a high rate of recurrence.

 


Keywords: Liposarcoma; Mediastinal neoplasms; Case reports [publication type].

 


Low-dose CT screening for lung cancer in Brazil: a study protocol

Rastreamento de câncer de pulmão por meio de TC de baixa dosagem no Brasil: protocolo de pesquisa

Ricardo Sales dos Santos, Juliana Franceschini, Fernando Uliana Kay, Rodrigo Caruso Chate, Altair da Silva Costa Júnior, Fernando Nunes Galvão de Oliveira, André Luiz Cavalcante Trajano, José Rodrigues Pereira, Jose Ernesto Succi, Roberto Saad Junior

J Bras Pneumol.2014;40(2):-

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Mediastinal teratoma with malignant degeneration

Teratoma de mediastino com degeneração maligna

Fabiano Alves Squeff, Eduardo Salvador Gerace, Roberto Saad Júnior, Márcio Botter, Roberto Gonçalves, Juliana Fracalossi Paes

J Bras Pneumol.2008;34(8):631-634

Abstract PDF PT PDF EN Portuguese Text

Here, we report the case of a patient with a slowly-progressing anterior mediastinal teratoma submitted to surgical resection. The anatomopathological examination of the sample revealed malignant degeneration to carcinoid tumor. Such evolution is very rare, and we have found only three related studies in the literature. We describe the clinicopathological features of the tumor and discuss the treatment administered. The evolution was satisfactory, and the patient was submitted to oncological treatment.

 


Keywords: Mediastinal neoplasms; Teratoma; Carcinoid tumor; Mediastinum/surgery.

 


Intrapulmonary teratoma

Teratoma intrapulmonar maduro

Ricardo Alexandre Faria, José Alexandre Bizon, Roberto Saad Junior, Vicente Dorgan Neto, Marcio Botter, Mauro Ajaj Saieg

J Bras Pneumol.2007;33(5):612-615

Abstract PDF PT PDF EN Portuguese Text

Case report of a 49-year-old man, presenting chest pain and bloody sputum for six months. Chest X-ray and computed tomography scan showed opacification on the left upper lobe. The bronchoscopy showed bronchial hemorrhage in the lingular bronchial segment. Due to diagnostic and therapeutic needs, this patient underwent a left inframammilary thoracotomy. The anatomopathological analysis of the surgical sample revealed an intrapulmonary teratoma. The patient presented favorable evolution and is now under outpatient follow-up treatment.

 


Keywords: Teratoma; Lung; Neoplasms.

 


Tuberculosis of the thymus

Tuberculose do timo

Mauro Tadeu Ajaj Saieg, Fabíola del Carlo Bernardi, Roberto Gonçalves, Márcio Botter, Roberto Saad Junior, Geanete Pozzan

J Bras Pneumol.2007;33(3):355-357

Abstract PDF PT PDF EN Portuguese Text

Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital, inflammatory, and neoplastic conditions. Among these lesions, the most common primary tumor of the mediastinum is thymoma, nearly followed by germ cell tumors and lymphomas. Tuberculosis of the thymus, an extremely rare condition, typically involves the mediastinal lymph nodes. We present, in this study, pathological, radiological, and clinical findings of one case of tuberculosis of the thymus in an 18-year-old patient who presented thoracic pain, dyspnea upon minimal effort, and progressive worsening of the symptoms in one week. The chest X-ray showed a large mass in the mediastinum, and computed tomography scans indicated that it was located anteriorly. The patient was submitted to surgery in order to excise the mass. Microscopy revealed a massive inflammatory response and granulomas in the thymic tissue. Ziehl-Neelsen staining for acid-fast bacilli yielded positive results, and a diagnosis of tuberculosis was made. Surgeons and pathologists should remain alert for this condition and should include it in the differential diagnosis of mediastinal masses.

 


Keywords: Thymus; Tuberculosis; Thoracic surgery; Pathology.

 


 

 


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