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ABSTRACT Introduction: measuring the severity of traumatic injuries is crucial for predicting clinical outcomes. Whereas the Injury Severity Score (ISS) has limitations in assigning scores to injuries at the same site, the New Injury Severity Score (NISS) corrects for this problem by taking into account the three most severe injuries regardless of the region of the body. This study seeks to comprehend the clinical and epidemiological profile of trauma patients while comparing the effectiveness of scales for predicting mortality. Methods: a descriptive, observational and retrospective study using records of patients who underwent thoracotomy at the Hospital das Clínicas of the Federal University of Triângulo Mineiro between 2000 and 2019. Demographic data, mechanisms of injury, affected organs, length of stay and mortality were analyzed. Injury severity was assessed using the ISS and NISS, and statistical analyses were conducted using MedCalc and SigmaPlot. Results: 101 patients were assessed, on average 29.6 years old, 86.13% of whom were men. The average duration of hospitalization was 10.9 days and the mortality rate was 28.7%. The ROC curve analysis revealed a sensitivity of 68.97%, specificity of 80.56% and area under the curve of 0.837 for the ISS, and 58.62%, 94.44% and 0.855 for the NISS, respectively. The Youden index was 0.49 for the ISS and 0.53 for the NISS. Conclusion: the study demonstrated comparable efficacy of NISS and ISS in predicting mortality. These findings hold significance in the hospital setting. Professionals must be familiar with these scales to utilize them competently for each patient.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications

Copyright of Brazilian Journal of Cardiovascular Surgery is the property of Sociedade Brasileira de Cirurgia Cardiovascular and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.

Objective: To describe the profile of patients treated in the "Red Wave", in the period of 2018-2019. Methods: It is a quantitative, cross-sectional, retrospective, descriptive and documentary research. Held at the first-aid post João XXIII Hospital, in Belo Horizonte. The universe of this study was 83 electronic medical records of patients who entered the "Red Wave" protocol. Simple frequency distributions, measures of central tendency (mean and median) and variability (standard deviation) have been performed. Results: Male, aged between 1 and 95 years old, being an average at 33,4 years old. The most frequent trauma mechanism was blunt, the means of transport was an ambulance from the Mobile Emergency Service, the causes of the trauma were an automobile accident, followed by trauma by a firearm projectile. From the performed surgeries, the most frequent ones were laparotomy, thoracotomy and craniectomy. Among the outcome, death was the most common one among patients. Conclusion: Patients arrive very seriously and death was the main outcome. Studies that allow comparative data analysis and standardization of the calculation of survival probability are suggested. It is recommended to update the red wave protocol, including other surgeries that are already performed and new inclusion criteria for patients. [ABSTRACT FROM AUTHOR]

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog. Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae. Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case. Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period. Methods: retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil. Results: a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma. Conclusion: the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.

Objective: To analyze and compare the survival of patients with pulmonary and pleural metastases in an initial thoracic surgery service. Methods: Retrospective longitudinal study of 19 patients with pulmonary and pleural metastases who underwent surgery between 2016 and 2020. Survival was analyzed using the Kaplan Meier curve. Results: Most were female, 84.2%, with a mean age of 64 years and 68.4% were non-smokers. Comorbidities were detected in 73.7% of patients, with arterial hypertension being the most prevalent. The most common primary tumors were breast and lung cancer. The most frequent approach (52.7%) was through videothoracoscopy. Chemotherapy treatment covered 84.2% of patients. Of the six patients who developed postoperative complications during hospitalization, 33.3% had pneumonia and 1 died. Overall survival at 30 months was 57.9%. Patients with pulmonary metastasis showed longer 30-month survival compared to those with pleural metastasis (75% vs. 50%; p=0.017). Regarding the primary tumor, patients with breast carcinoma had a 12-month survival of 85%, while among patients with colorectal cancer, the survival was 50%. Conclusion: According to our study, patients with pleural metastases have a worse prognosis when compared to patients with pulmonary metastases. The primary location of the tumor is associated with patient survival. [ABSTRACT FROM AUTHOR]

Abstract Background and objective: Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method: 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results: No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion: The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.

Objective: To produce and validate a manual on wound care after open-window thoracostomy for healthcare professionals. Methods: This is an experience report. Initially, articles in Portuguese, Spanish and English were selected from 2010 to 2018 in the Cochrane, SciELO, LILACS, PubMed and Google Academic databases and search sites for the development of the material. The following descriptors were used: “thoracotomy”, “thoracostomies”, “thoracic cavity”, “pleura”, “pleural cavity”, “injuries and lesions”. After consultation, the text was prepared, followed by illustrations and layout design. The completed manuscript was sent to experts for validation. The content validity index (CVI) was used to validate the manual. Results: The manual developed has thirty-six pages and seven chapters with the following themes: introduction, wound care after open-window thoracostomy, wound cleansing/debridement, dressings, care record, final considerations, and bibliography. Conclusion: It was possible to develop and validate a manual on wound care after open-window thoracostomy for the consultation of health professionals.

Abstract Female, 85 y.o., weighting 60 kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage. Bronchial blocker active suction may contribute to obtain or accelerate lung collapse, particularly in patients that do not tolerate ventilator disconnection technique or lung surgical compression. The use of bronchial blockers technology was a valuable alternative to double lumen tubes in this case of emergent thoracotomy in the context of a patient having thoracic, abdominal trauma, severe laceration of tongue and apophysis odontoid fracture associated to massive hemorrhage, despite several pitfalls that could compromise its use. The authors intend to discuss the advantages and disadvantages of bronchial blockers comparing to double-lumen tubes for lung isolation, and the risks of our approach, in this complex multitrauma case.

ABSTRACT Objective To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. Methods We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. Results The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). Conclusion Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.

With the incidence of lung cancer growing, the following pulmonary resections are increasingly indicated: segmentectomy, lobectomy with or without bronchoplasty and pneumonectomy. Thus, this study aims to perform the identification and analysis of scientific articles that address the lobectomy procedure in the treatment of lung cancer, as well as the benefits that the procedure can bring to the patient's life. An integrative review methodology was used, searching for scientific publications in the databases: Scientific Eletronic Library Online (Scielo) and Bibliographic Index Español en Ciencias de La Salud (IBECS), between 2007 and 2020. The inclusion criteria there were 11 studies selected for analysis. Lobectomy was evidenced as a surgical procedure for the removal of only one pulmonary lobe when the patient has only one area of the disabled lung and the best treatment in cases of neoplasms in early stages. It can be performed by means of thoracotomy or by videothoracoscopy, and current literature data suggest that lobectomy by video-assisted thoracic surgery (VATS) presents fewer complications and less morbidity for patients when compared to conventional lobectomy. [ABSTRACT FROM AUTHOR]

Resumo Paciente do sexo feminino, 85 anos, 60 kg, com trauma múltiplo. Após uma laparotomia inicial, uma toracotomia de emergência foi feita com um bloqueador brônquico para isolamento pulmonar (sucção inicial ativa foi aplicada). Durante a cirurgia, o balonete brônquico foi desinflado, causou um derrame hemorrágico traqueal autolimitado. Reisolamento foi tentado, mas não foi tão eficaz como inicialmente. Provavelmente, o colapso do pulmão com o mesmo bloqueador brônquico foi prejudicado na segunda tentativa devido à obstrução do lúmen do bloqueador brônquico pela hemorragia endobrônquica intraoperatória. A sucção ativa do bloqueador brônquico pode contribuir para obter ou acelerar o colapso pulmonar, particularmente em pacientes que não toleram a técnica de desconexão do ventilador ou a compressão cirúrgica pulmonar. O uso da tecnologia de bloqueadores brônquicos foi uma opção valiosa para os tubos de duplo lúmen neste caso de toracotomia de emergência em paciente com trauma torácico e abdominal, laceração grave da língua e fratura da apófise odontoide associados a hemorragia maciça, apesar de vários riscos que poderiam comprometer seu uso. Os autores pretendem discutir as vantagens e desvantagens dos bloqueadores brônquicos em comparação com os tubos de duplo lúmen para isolamento pulmonar e quais foram os riscos de nossa abordagem neste complexo caso de múltiplo trauma. Female, 85 y.o., weighting 60 kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self‐limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage. Bronchial blocker active suction may contribute to obtain or accelerate lung collapse, particularly in patients that do not tolerate ventilator disconnection technique or lung surgical compression. The use of bronchial blockers technology was a valuable alternative to double lumen tubes in this case of emergent thoracotomy in the context of a patient having thoracic, abdominal trauma, severe laceration of tongue and apophysis odontoid fracture associated to massive hemorrhage, despite several pitfalls that could compromise its use. The authors intend to discuss the advantages and disadvantages of bronchial blockers comparing to double‐lumen tubes for lung isolation, and the risks of our approach, in this complex multitrauma case. [ABSTRACT FROM AUTHOR]

Objective: To identify and analyze the factors associated with death, with a focus on performing laparotomy alone or associated with emergency thoracotomy. Method: Prospective longitudinal study of patients submitted to the "Onda Vermelha" protocol, after admission to the Risoleta Tolentino Neves Hospital, from 2011 to 2015. Descriptive analyses, Student's t-test, χ2 test, and regression multiple binary logistics were used to identify predictors of death. Results: One hundred and thirty-two patients were studied, of which 47 (35.6%) died. The average age was 28 years old. The majority was male (90.9%), with penetrating trauma predominating in the study sample (91.7%). The trauma scores were compatible with moderate severity trauma. The average time of hospitalization and stay in the intensive care unit exceeded 10 days. Laparotomy and thoracotomy occurred in 72.7 and 28% of cases, respectively. Complications were severe for 38.6% of patients, and the most common lesions were gastrointestinal (48.5%) and abdominal vessels (28.8%). Thoracotomy, severe complications and abdominal vessel injury were more frequent among patients who died (p<0.001). Factors associated to death were: emergency thoracotomy (OR=6.9, p=0.002), severe complications (OR=6.1, p=0.010), and lesions to the abdominal and pelvic vessels (OR=16.8, p<0.001). Conclusion: Emergency thoracotomy was associated with higher odds of death, regardless of other factors, as well as the mechanism of penetrating trauma, complications and injuries to the abdominal and pelvic vessels. Survival in the presence of thoracotomy was 25.7% for victims of penetrating trauma. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Ciências Veterinárias e Zoologia da Unipar is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo randomizado, duplo-cego e prospectivo foi determinar a eficácia e os efeitos colaterais da administração por via intravenosa ou epidural de morfina, bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia. MÉTODOS: Sessenta pacientes submetidos a procedimentos de toracotomia eletiva foram randomicamente alocados em quatro grupos com o uso da técnica de envelopes lacrados. Os grupos MIV, ME, MEB e MER receberam morfina controlada pelo paciente por via intravenosa, e morfina, morfina-bupivacaína e morfina- ropivacaína epidural, respectivamente. Frequência cardíaca, pressão arterial e saturação de oxigênio perioperatórias e dor pós-operatória em repouso e durante a tosse, efeitos colaterais e necessidade de analgésicos de resgate foram registrados aos 30 e 60 minutos e em duas, quatro, seis, 12, 24, 36, 48 e 72 horas. RESULTADOS: A necessidade de sódio diclofenaco durante o estudo foi menor no grupo ME. A área sob a curva de tempo na VAS foi menor no grupo ME em comparação com o Grupo MIV, mas similar aos Grupos MEB e MER. Os escores de dor em repouso foram maiores nos tempos 12, 24, 36 e 48 horas no Grupo MIV em comparação com o Grupo ME. Os escores de dor em repouso foram maiores aos 30 e 60 minutos nos Grupos ME e MIV em comparação com o Grupo MEB. Os escores de dor durante a tosse aos 30 minutos foram maiores no grupo ME em comparação com o Grupo MEB. Não houve diferença entre os Grupos MIV e MER. CONCLUSÕES: Morfina administrada por via epidural foi mais eficaz do que por via intravenosa. A eficácia foi maior no grupo EM no período pós-operatório tardio e no Grupo MEB no período pós-operatório inicial. Concluímos que morfina administrada por via epidural foi a mais eficaz e preferida.JUSTIFICATIVA Y OBJETIVOS: El objetivo de este estudio aleatorio, doble ciego y prospectivo fue determinar la eficacia y los efectos colaterales de la administración por vía intravenosa o epidural de morfina, bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía. MÉTODOS: Sesenta pacientes sometidos a procedimientos de toracotomía electiva fueron aleatoriamente ubicados en cuatro grupos con el uso de la técnica de sobres lacrados. Los grupos MIV, ME, MEB y MER recibieron morfina controlada por el paciente por vía intravenosa, epidural, morfina-bupivacaína y morfina-ropivacaína, respectivamente. La frecuencia cardíaca, presión arterial y la saturación de oxígeno perioperatorias y el dolor postoperatorio en reposo y durante la tos, los efectos colaterales y la necesidad de analgésicos de rescate fueron registrados a los 30 y 60 minutos y las 2, 4, 6, 12, 24, 36, 48 y 72 horas. RESULTADOS: La necesidad de sodio diclofenaco durante el estudio fue menor en el grupo ME. El área bajo la curva de tiempo en la VAS fue menor en el grupo ME en comparación con el Grupo MIV, pero similar al Grupo MEB y MER. Las puntuaciones de dolor en reposo fueron mayores en los tiempos 12, 24, 36 y 48 horas en el Grupo MIV en comparación con el grupo ME. Las puntuaciones de dolor en reposo fueron mayores a los 30 y 60 minutos en los Grupos ME y MIV en comparación con el Grupo MEB. Las puntuaciones de dolor durante la tos a los 30 minutos fueron mayores en el grupo ME en comparación con el Grupo MEB. No hubo diferencia entre los Grupos MIV y MER. CONCLUSIONES: La morfina administrada por vía epidural fue más eficaz que por la vía intravenosa. La eficacia fue mayor en el grupo EM en el período postoperatorio tardío y en el Grupo MEB en el período postoperatorio inicial. Concluimos entonces que la morfina administrada por vía epidural fue la más eficaz y nuestra preferida.BACKGROUND AND OBJECTIVEs: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. METHODS: Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphineropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30th and 60th minutes and the 2nd, 4th, 6th, 12th, 24th, 36th, 48th, and 72nd hour. RESULTS: Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48th hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30th and 60th minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30th minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. CONCLUSIONS: Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

FUNDAMENTO: Desde que Wilcox, em 1997, descreveu uma forma simplificada de correção do Defeito Septal Atrioventricular (DSAV) com enxerto único, diversos estudos têm sido realizados comparando-a à técnica com duplo enxerto. OBJETIVO: Relatar os resultados em médio e longo prazos da correção de DSAV completo pela técnica simplificada de enxerto único. MÉTODOS: Estudo retrospectivo de 16 casos consecutivos arrolados entre janeiro de 2001 e dezembro de 2011. A idade média foi 18,31 ± 34,19 meses (2 meses - 11 anos) e o peso 7,80 ± 6,12 Kg (3,77 - 25,0 Kg); 6 pacientes eram do sexo masculino e 14 eram portadores de Síndrome de Down. O tempo de seguimento médio foi de 54,97 ± 47,79 meses. RESULTADOS: O tempo médio de circulação extracorpórea foi 74,63 ± 18,48 min (49 - 112 min) e o de pinçamento aórtico, de 46,44 ± 11,89 min (34 - 67 min). Foram observados dois óbitos hospitalares (12,5%), ambos por causa cardiovascular. Três pacientes foram reoperados por regurgitação da valva atrioventricular (VA) esquerda e dois apresentaram bloqueio atrioventricular (BAV) completo com necessidade de implante de marca-passo definitivo. Não houve nenhum caso de obstrução da via de saída do ventrículo esquerdo. Os 14 pacientes sobreviventes permanecem assintomáticos, 10 deles com insuficiência da valva VA esquerda leve (71,42%). CONCLUSÃO: A técnica simplificada com enxerto único para correção de DSAV completo mostrou-se factível, associada à correção adequada dos defeitos e à favorável evolução clínica e ecocardiográfica nos 57,97 meses de seguimento médio avaliados.BACKGROUND: Since Wilcox's description of the simplified single-patch technique for atrioventricular septal defect (AVSD) repair in 1997, several studies have compared that technique with the two-patch technique. OBJECTIVE: To report the mid- and long-term results of the simplified single-patch technique for complete AVSD repair. METHODS: Retrospective study of 16 consecutive cases between January 2001 and December 2011. The patients' mean age was 18.31 ± 34.19 months (2 months - 11 years), and their mean weight, 7.80 ± 6.12 kg (3.77 - 25.0 kg). Six patients were males and 14 had Down syndrome. Mean follow-up duration was 54.97 ± 47.79 months. RESULTS: Mean cardiopulmonary bypass time was 74.63 ± 18.48 min (49 - 112 min), and mean aortic cross-clamp time, 46.44 ± 11.89 min (34 - 67 min). Two patients died during hospitalization (12.5%), both of cardiovascular causes. Three patients underwent reoperation due to left atrioventricular (AV) valve regurgitation, and two had third-degree VA block, requiring permanent pacemaker implantation. No patient had left ventricular outflow tract obstruction. The 14 surviving patients remain asymptomatic, ten of whom with mild left VA valve regurgitation (71.42%). CONCLUSION: The simplified single-patch technique for complete AVSD repair proved to be feasible, providing adequate correction of the defects and favorable clinical and echocardiographic outcome in the mean 57.97-month follow-up.

The occurrence of a tracheal foreign body in a three-month-old male Poodle referred to a Teaching Veterinary Hospital due to acute coughing, gagging and nausea is reported. A bronchoscopy under general anesthesia was performed in order to obtain a diagnose. During the bronchoscopy a foreign body (maize popcorn) was observed in the intrathoracic trachea. The surgeon attempted to remove it by endoscopy, but no success was achieved. Therefore, an open procedure was performed and the foreign body removed. The patient progressed satisfactorily after the thoracotomy.

OBJETIVO: Identificar os fatores de risco para complicações pulmonares em pacientes com sarcoma após serem submetidos a toracotomia para a ressecção de nódulos pulmonares. MÉTODOS: Estudo de coorte retrospectivo com 68 pacientes consecutivos com diagnóstico de sarcomas e submetidos a 174 toracotomias para a ressecção de nódulos pulmonares. A variável dependente foi definida como a ocorrência de qualquer complicação pulmonar pós-operatória. As variáveis independentes foram relacionadas com o paciente, o diagnóstico de base e o tipo de procedimento cirúrgico. Os dados foram analisados segundo um modelo multivariado de estimação de equações generalizadas, com uma função de ligação logística e uma estrutura de correlação simétrica. RESULTADOS: Houve 24 complicações (13,8%; IC95%: 9,0-19,8), incluindo um óbito. Os pacientes que apresentaram complicações pós-operatórias tiveram um tempo médio de internação duas vezes superior àqueles sem complicações (18,8 ± 10,0 dias vs. 8,6 ± 6,0 dias; p < 0,05). As variáveis que se correlacionaram com o desfecho foram o tipo de ressecção (em cunha ou anatômica; OR = 3,6; IC95%: 1,5-8,8), necessidade de transfusão sanguínea (OR = 9,8; IC95%: 1,6-60,1) e número de nódulos ressecados (OR = 1,1; IC95%: 1,0-1,1). O modelo multivariado obtido exibiu uma área sob a curva ROC de 0,75 (IC95%: 0,65-0,85). CONCLUSÕES: As complicações pulmonares pós-operatórias após a ressecção de nódulos pulmonares em pacientes com sarcoma não foram raras, ocorrendo em cerca de 10% dos procedimentos. A ocorrência dessas complicações pode ser antecipada pelo uso de ressecção não em cunha, necessidade de hemotransfusão e maior número de nódulos ressecados. Assim, já no pós-operatório imediato, é possível identificar pacientes de risco, que devem ser estritamente monitorizados durante o período pós-operatório imediato. Para esses pacientes, todas as medidas preventivas devem ser tomadas.OBJECTIVE: To identify the risk factors for pulmonary complications after thoracotomy for the resection of pulmonary nodules in patients with sarcoma. METHODS: A retrospective cohort study involving 68 consecutive patients diagnosed with sarcoma and submitted to a total of 174 thoracotomies for the resection of pulmonary nodules. The dependent variable was defined as the occurrence of any postoperative pulmonary complications. The independent variables were related to the patient, underlying diagnosis, and type of surgical procedure. We analyzed the data using a multivariate generalized estimating equations model with logistic link function and a symmetric correlation structure. RESULTS: Complications were observed in 24 patients (13.8%, 95% CI: 9.0-19.8), and there was one death. The mean length of hospital stay was twice as long in the patients with postoperative complications as in those without (18.8 ± 10.0 days vs. 8.6 ± 6.0 days; p < 0.05). The variables that correlated with the outcome measure were the type of resection (wedge vs. anatomic; OR = 3.6; 95% CI: 1.5-8.8), the need for blood transfusion (OR = 9.8; 95% CI: 1.6-60.1), and the number of nodules resected (OR = 1.1; 95% CI: 1.0-1.1). The multivariate model showed an area under the ROC curve of 0.75 (95% CI: 0.65-0.85). CONCLUSIONS: Postoperative pulmonary complications were common after pulmonary nodule resection in patients with sarcoma, occurring in approximately 10% of the procedures. The occurrence of such complications can be expected when techniques other than wedge resection are employed, when blood transfusion is required, and when a great number of nodules are resected. Therefore, it is possible to identify patients at risk for pulmonary complications, who should be closely monitored in the immediate postoperative period. In such patients, all preventive measures should be taken.

INTRODUCCIÓN: durante los últimos diez años, hemos utilizado la toracotomía posterior para abordar la porción superior del tórax en procedimientos combinados anteriores y posteriores. Actualmente hemos extendido esta indicación a toda la columna torácica en remplazo de la toracotomía convencional y toracoscopía. OBJETIVO: evaluar el rango de posibilidades y complicaciones asociadas con este nuevo abordaje, que permite combinar la cirugía vertebral torácica anterior y posterior con la misma incisión cutánea posterior. Métodos: fueron evaluados, retrospectivamente, 35 pacientes operados entre los años del 2003 y 2007. En todos se realizó doble abordaje, combinando una toracotomía posterior y abordaje posterior, mediante una sola incisión medial, para diferentes objetivos: descompresión medular, artrodesis, osteotomías o vertebrectomías. Se evaluaron los valores angulares, las etiologías, la edad, los niveles vertebrales, la cantidad de toracotomías y las complicaciones. RESULTADOS: hubo un promedio de edad de 14,1 años (1-65), diez cifosis, valor promedio 96,8 (76-131); 24 escoliosis valor promedio 80 (60-105). Etiología: síndromes genéticos, 11; escoliosis idiopática, 6; neurológicas, 5; congénitas, 4; tumores, 4; fracturas, 2; hernia discal, 1; infección, 1. Toracotomía de 1 nivel 30 doble 5. Nivel superior T3 e inferior T10. Complicaciones: 1 hemotórax y dos infecciones de herida. CONCLUSIÓN: esta vía permite acceder a todo nivel torácico en procedimientos combinados mediante una sola incisión cutánea.INTRODUÇÃO: nos últimos dez anos, foi utilizada a toracotomia posterior para a abordagem da porção superior do tórax em procedimentos combinados anteriores e posteriores. Atualmente, esta indicação tem sido estendida por toda a coluna torácica ao invés da toracotomia convencional e da toracoscopia. OBJETIVO: avaliar as possibilidades e complicações associadas a esta nova abordagem, que permite combinar cirurgias em vértebras torácicas anterior e posterior com a mesma incisão cutânea posterior. Métodos: foram avaliados, retrospectivamente, 35 pacientes operados entre 2003 e 2007. Em todos eles, realizou-se dupla abordagem combinando uma toracotomia posterior e abordagem posterior, feita só uma ferida cirúrgica, para diferentes objetivos: descompressão medular, artrodese, osteotomias, ou vertebrectomias. Foram avaliadas: as magnitudes dos ângulos, a etiologia, a idade, os níveis vertebrais, a quantidade de toracotomias e as complicações. RESULTADOS: média de idade de 14,1 anos (1-65), 10 cifoses com média de 96,8º (76-131); 24 escolioses com média de 80º (60-105). Etiologia: síndromes genéticos, 11; escolioses idiopática, 6; neurológicas, 5; congênitas, 4; tumores, 4; fraturas, 2; hérnia de disco, 1; infecção, 1; toracotomia de 1; nível 30, duplo 5; nível superior t3 e inferior t10. As complicações observadas foram um paciente com hemotórax e dois com infecções por causa da ferida. CONCLUSÃO: esta via permite o acesso a todo o nível torácico em procedimentos combinados mediante só uma ferida cirúrgica.INTRODUCTION: over the last ten years, for patients who needed a combined anterior-posterior approach, an alternative thoracotomy has been used by posterior approach using in the second step the same posterior mid-line skin incision as was used in the first step. Objective: to assess the range of possibilities and complications associated with this new approach, which allows to mix a two-step surgery through a single posterior skin incision. METHODS: thirty-five patients operated between 2003 and 2007 were evaluated. All patients underwent a two-step approach through a single posterior mid-line skin incision for spinal cord decompression, discectomy, arthrodesis, osteotomy, or vertebrectomy. The angular magnitudes, etiology, age, vertebral levels, number of thoracotomy, and complications were evaluated. RESULTS: mean age 14.1 years (1-65 years old), ten kyphosis, and 24 kyphoscoliosis. Mean scoliosis was 80.5° (60-105°), mean kyphosis was 96.8° (76°-131°). Etiology: genetic syndromes, 11; idiopathic scoliosis, 6; neurological, 5; congenital, 4; fractures, 2; disc herniation, 1; tumors, 4; infection, 1. Thoracotomy was single in 30 and double in 5, and highest at level T3 and lowest T10. The complications that occurred was one pleural hemorrhage and two infections of the posterior surgical wound (8.6%). CONCLUSION: this approach allows to accede at all the levels of thoracic previous in procedures combined through a single posterior skin incision.

BACKGROUND: Anterior access to the thoracic spine is done by open thoracotomy (OTC) or video-assisted thoracoscopic surgery (VATS). VATS is known as the method which results in lower morbidity rates, but there is little evidence of its less invasiveness. Objective: The current study yielded for outcome data concerning patients' perception of approach-related morbidity (ArM) following OTC for spinal surgery and that of a control group having a chest tube thoracotomy (CTT). METHODS: We performed a questionnaire assessment of ArM after OTC and CTT. Applying strict inclusion criteria, we compared outcomes in terms of percentage morbidity (Morbidity %) of 43 patients that underwent OTC for instrumented scoliosis correction to 30 patients that had CTT for minor thoracic pathologies (e.g., pneumothorax). RESULTS: Mean age in CTT and OTC Group was 50.2 and 16.5 years old, follow-up was of 32.2 and 58.4 months, and mean incision length was 2.5 and 25.5 cm, respectively. Mean number of levels fused in the OTC Group was 5.8. Mean morbidity (0% delineating no cases, 100% delineating highest morbidity) for the CTT Group was 10.8±15.4% (0-59.5%), 42% of patients had no morbidity. Signs of intercostal neuralgia (ICN) were present in 16.7%. A total of 35.5% had a morbidity >10% (mean: 27.5%), and 10% of morbidity cases were defined as having a chronic post-thoracotomy pain (CPP). In the OTC Group, mean morbidity was 7.0±12.7% (0-52.1%), 44% had no morbidity. Out of the sample, 18.6% had morbidity >10% (mean: 28.6%). Signs of ICN were present in 14%. In both groups, the presence of ICN had a significant impact on and showed correlation with morbidity (pINTRODUCCIÓN: el abordaje anterior de la columna torácica ha sido utilizado por medio de la toracotomía abierta o vídeo asistida. El abordaje video asistida ha sido mencionada como la menor morbilidad del procedimiento, a pesar de existir poca evidencia científica confirmando esa observación. OBJETIVO: el objetivo del presente estudio fue observar los resultados relacionados con la morbilidad de la toracotomía abierta para la corrección de la deformidad de la columna vertebral y toracotomía para la colocación de tubo de drenaje torácica, utilizando ese grupo como Control. MÉTODOS: con base en un cuestionario respondido por los pacientes; y relacionado con la evaluación de la morbilidad del abordaje anterior de la columna torácica y utilizando criterios estrictos de inclusión de los pacientes, fueron evaluados 43 pacientes sometidos a toracotomía abierta para tratamiento de la escoliosis; y 30 pacientes portadores de otras enfermedades de menor gravedad, que fueron sometidos a la toracotomía para la colocación de dreno de tórax después del procedimiento. RESULTADOS: el promedio de edad de los pacientes sometidos al procedimiento en el tórax y a la toracotomía para la colocación de dreno o toracotomía abierta para tratamiento de escoliosis fue, respectivamente: 50.2 años y 16.5 años; el seguimiento clínico fue de 32.2 meses y 54.8 meses; y la extensión de la incisión de la piel 2.5 cm y 25 cm. El promedio del número de vértebras artrosadas fue 5.8 en el grupo sometido a la toracotomía abierta para la corrección de deformidad. La morbilidad promedio (variando de 0% - ninguna morbilidad a 100% - alta morbilidad) en el grupo de pacientes sometidos a la toracotomía para colocación de dreno de tórax fue de 10.8±15.4 (0-59.5%), y un 42% de los pacientes no presentaron morbilidad. En el grupo sometido a la toracotomía abierta para la colocación del dreno de tórax fue observada neuralgia intercostal en 16.7%, y 35% de los pacientes presentaron morbilidad mayor que 10% (pormedio de un 27.5%). La morbilidad fue definida como la presencia de dolor crónico después de la toracotomía. En el grupo sometido a la toracotomía abierta para tratamiento de escoliosis el promedio de la morbilidad fue 7.0±12.7% (0-52.1%), y 44% no presentaron morbilidad. Señales de neuralgia intercostal fueron observados en 14% de los pacientes. En ambos grupos la presencia de neuralgia intercostal tuvo impacto significativo y presentó correlación con la morbilidad (pINTRODUÇÃO: A abordagem anterior da coluna torácica tem sido utilizada por meio da toracotomia aberta (TA) ou vídeo-assistida (TVA). A abordagem vídeo-assistida tem sido mencionada como a de menor morbidade do procedimento, apesar de não existir evidência científica que confirme essa observação. OBJETIVO: Observar os resultados relacionados à morbidade da toracotomia aberta para a correção de deformidade da coluna vertebral e toracotomia para a colocação de tubo de drenagem torácica, utilizando um grupo de pacientes como controle. MÉTODOS: Com base em questionário relacionado com a avaliação da morbidade da abordagem anterior da coluna torácica respondido pelos pacientes, e utilizando critérios estritos de inclusão dos pacientes, foram avaliados, em termos de porcentagem (morbidade %), 43 pacientes submetidos à toracotomia aberta para tratamento da escoliose (Grupo OTC) e 30 pacientes portadores de outras doenças de menor gravidade submetidos à toracotomia para a colocação de dreno de tórax após o procedimento (por exemplo, pneumotórax) (Grupo CTT). RESULTADOS: A média de idade dos pacientes de ambos os grupos foi 50,2 e 16,5 anos; seguimento clínico médio foi de 32,2 e 58,4 meses; e a extensão da incisão da pele 2,5 e 25,5 cm, respectivamente. A média do número de vértebras artrodesadas foi 5,8 no grupo submetido à toracotomia aberta para a correção de deformidade. A morbidade média (variando de 0%, nenhuma morbidade, a 100%, alta morbidade) no grupo de pacientes submetidos à toracotomia para colocação de dreno de tórax foi 10,8±15,4 (0-59,5%), e 42% dos pacientes não apresentavam morbidade. No grupo submetido à toracotomia aberta para a colocação do dreno de tórax, foi observada neuralgia intercostal em 16,7%, e 35,5% dos pacientes apresentavam morbidade maior que 10% (média 27,5%). A morbidade foi definida como a presença de dor crônica após toracotomia. No grupo submetido à toracotomia aberta para tratamento de escoliose, a média da morbidade foi 7,0±12,7% (0-52,1%), e 44% não apresentava morbidade. De toda a amostra, 18,6% apresentaram morbidade >10% (média: 28,6%). Sinais de neuralgia intercostal foram observados em 14% dos pacientes. Em ambos os grupos, a presença de neuralgia intercostal teve impacto significativo e apresentou correlação com a morbidade (p

OBJETIVO: descrever os resultados imediatos da aplicação da liberação anterior por videotoracoscopia, seguida de instrumentação por via posterior para correção cirúrgica da escoliose idiopática do adolescente. MÉTODOS: foram selecionados 20 pacientes, no período de agosto de 1989 a maio de 2001, com escoliose idiopática do adolescente, padrão de curva torácica direita rígida, King III. Inicialmente realizou-se a abordagem pela via anterior com liberação por videotoracoscopia e depois a via posterior para correção e fixação com instrumental de Hartshill, em um mesmo tempo cirúrgico. RESULTADOS: todos os procedimentos foram completados com sucesso com videotoracoscopia, sem necessidade de conversão para toracotomia. A média de idade dos pacientes foi de 15,7 anos (12 a 21 anos). Em relação aos dias de internação, obteve-se um tempo médio de permanência de 9,45 dias (5 a 26 dias). A média entre os valores angulares foi, no pré-operatório, de 66,25º Cobb (48º a 92º Cobb), e no pós-operatório, de 31,2º Cobb (15º a 45º Cobb). Como complicações, quatro pacientes tiveram nevralgia intercostal (20%) e um caso de atelectasia (5%). CONCLUSÕES: a discectomia por videotoracoscopia é um método efetivo e seguro para tornar flexíveis as curvas escolióticas rígidas. No entanto, trata-se de um procedimento tecnicamente difícil, que requer treinamento árduo e prolongado, com curva de aprendizado extensa.OBJETIVO: describir los resultados inmediatos de la aplicación de la liberación anterior por videotoracoscopia, seguida de instrumentación por vía posterior para corrección quirúrgica de escoliosis idiopática del adolescente. MÉTODOS: fueron seleccionados 20 pacientes, en el periodo de agosto de 1989 a mayo de 2001, con escoliosis idiopática del adolescente, con un padrón de curva torácica derecha rígida, King III. Inicialmente se realizó un abordaje por la vía anterior con liberación por videotoracoscopia y después la vía posterior para corrección y fijación con instrumental de Hartshill, en un mismo tiempo quirúrgico. RESULTADOS: todos los procedimientos fueron completados con suceso con videotoracoscopia, sin necesidad de conversión para toracotomía. El promedio de edad de los pacientes fue de 15.7 años (12 a 21 años). En relación a los días de internación, se obtuvo un tiempo promedio de permanencia de 9.45 días (5 a 26 días). El promedio entre los valores angulares fue, en el pre operatorio, de 66.25º Cobb (48º a 92º Cobb), y en el postoperatorio fue de 31.2º Cobb (15º a 45º Cobb). Como complicaciones, cuatro pacientes tenían neuralgia intercostal (20%) y había un caso de atelectasia (5%). CONCLUSIONES: la disectomía por videotoracoscopia es un método efectivo y seguro para tornar flexibles las curvas escolióticas rígidas. Sin embargo, se trata de un procedimiento técnicamente difícil, que requiere entrenamiento arduo y prolongado, con curva de aprendizaje extensa.OBJECTIVE: to describe the initial results of anterior videothoracoscopic release followed by posterior instrumentation for surgical correction of adolescent idiopathic scoliosis. METHODS: twenty patients were selected, between August 1989 and May 2001, with stiff, King III, right thoracic adolescent idiopathic scoliosis. They underwent anterior videothoracoscopic release followed by posterior correction and fixation with Hartshill instrumentation, performed in a single surgical stage. RESULTS: all procedures were successfully completed with videothoracoscopy, without need to convert to thoracotomy. The average age was 15.7 years (12 to 21 years). Concerning the length of hospital stay, there was a mean of 9.45 days (5 to 26 days). The preoperative Cobb angle average was 66.25º (48º to 92º), and the mean postoperative Cobb angle was 31.2º (15º to 45º). As complications, there were four patients with intercostal neuralgia (20%) and one with atelectasis (5%). CONCLUSIONS: the videothoracoscopic discectomy is a safe and effective method for making flexible the rigid scoliotic curves. However, this is a technically demanding procedure that requires prolonged and exhaustive training, with a steep learning curve.

Os autores relatam o caso de uma paciente de 28 anos de idade portadora de tumor de células gigantes originário da costela. O tumor de grandes dimensões (25 × 17 cm) ocupava todo o hemitórax e causava atelectasia do pulmão esquerdo. Tratava-se de uma neoplasia mesenquimal benigna, a qual raramente acomete as costelas. Foi realizada toracotomia com ressecção em bloco da parede torácica e do tumor. O objetivo deste artigo é enfatizar que, apesar da grande dimensão do tumor, ele pôde ser completamente ressecado, e o pulmão foi reabilitado.The authors report the case of a 28-year-old female patient with a giant cell tumor originating from the rib. The tumor, measuring 25 × 17 cm, occupied the entire hemithorax and caused atelectasis of the left lung. This tumor was a benign mesenchymal neoplasm, which rarely affects the ribs. A thoracotomy involving en bloc resection of the chest wall and tumor was performed. Despite the large dimensions of the tumor, complete resection was possible, and lung function was restored.

O tratamento cirúrgico da cifose de Scheuermann permanece um tópico em debate. Tratamento tradicional tem incluído liberação anterior associada à fusão dos segmentos discais apicais, seguida por instrumentação posterior. OBJETIVO: Avaliar se o uso do sistema de parafusos pedicular vertebral promove melhor estabilização e correção da deformidade, sem procedimento compressivo, diminuindo os risco de complicações. MÉTODOS: Foram avaliados 19 pacientes com cifose de Scheuermann, que foram submetidos à liberação e fusão anterior por toracotomia aberta, seguida por instrumentação posterior com sistema de parafuso pedicular vertebral posicionados pela técnica de mão livre. Pré-operatoriamente, os pacientes foram analisados pela escala analógica visual (EVA) de dor e radiografias. No pós-operatório, foi analisado o grau de correção da curva, complicações, EVA para dor e nível de satisfação com a cirurgia. A média de seguimento foi de 37,5 meses (12,6-61,7 meses). RESULTADOS: Cifose pré-operatória variou de 66° a 94°, com média de 77,6°, e média da EVA de 6,6 pontos. No pós-operatório a cifose média foi de 35,8° (variação de 23° a 50°), sendo obtida média de correção de 53,8%. A EVA foi de 0,6 ponto, com todos os pacientes, exceto um, satisfeitos com o resultado da cirurgia. Dentre as complicações: soltura de dois parafusos em um paciente, com necessidade de reintrodução e extensão da instrumentação, um paciente com infecção superficial resolvida clinicamente, uma quebra assintomática de parafuso e um paciente com infecção tardia resolvida com a retirada do implante. CONCLUSÃO: O tratamento cirúrgico da cifose de Scheuermann, usando liberação e fusão anterior por toracotomia aberta seguida por instrumentação posterior com sistema de parafuso pedicular vertebral por meio da técnica de mão livre, mostrou-se, nessa série de pacientes, segura e eficiente.Surgical treatment of Scheuermann's kyphosis is still subject to debate. Traditional treatment has included an anterior release associated to fusion of apical disk segments, followed by posterior instrumentation. OBJECTIVE: To evaluate if the vertebral pedicle screw system yields a better stabilization and correction of the deformity, without a compressive procedure, thus decreasing the risk of complications. METHODS: 19 patients with Scheuermann's kyphosis were evaluated after being submitted to anterior release and fusion by open thoracotomy followed by posterior instrumentation with a vertebral pedicle screw system with the screws positioned with the free-hand technique. Before surgery, the patients were analyzed according to the visual analogical pain scale (EVA) and using X-rays. After surgery, analysis was made of the extension of the curve correction, complications, EVA for pain, and level of satisfaction with the surgery. Mean follow-up was 37.5 months (12.6 61.7 months). RESULTS: Pre-op kyphosis varied from 66° to 94°, with a mean of 77.6° and the mean EVA was 6.6. After surgery, the mean kyphosis was 35.8° (ranging from 23° to 50°), a mean correction of 53.8% being obtained. EVA was 0.6, and all patients but one, were pleased with the result of the surgery. Complications: two screws were detached in one patient and had to be reintroduced and instrumentation had to be expanded, one patient had superficial infection that was clinically solved, a screw broke asymptomatically, and one patient had late infection that was cured with the removal of the implant. CONCLUSION: Surgical treatment of Scheuermann's kyphosis using anterior release and fusion by open thoracotomy followed by posterior instrumentation with a vertebral pedicle screw system using the free hand technique showed, in this series, to be safe and efficient.

Descriptive study that proposed to compare the qualitative and quantitative behavior of the pain in lateral posterior thoracotomy patients. The sample was consisted of 18 individuals with an average age of 44 years. The instruments used were physiotherapy evaluation form, numerical pain scale and McGill questionnaire for pain. The pain on the numerical pain scale was considered moderate(5) for both sexes. The descriptors of the McGill questionnaire choosen by the patients with higher frequency were: in the sensorial component, beat4, pointed1, shock2, final and pull2; in the afetive component, tired1, bored1, punishald1 and miserable1 and in the evaluative component was flat. The characteristics of pain in the sensorial group were more evidents on male group. No significant statistical difeferences were observed between quantitative answers concerning pain between the men and women. On the qualitative aspects , was observed an predominancy of the same descriptors of pain in afetive component for both sexes. Pain intensity was categorized as moderate. No significant statistical difference were observed between the pain on the post-operatory lateral posterior thoracotomy. These data demonstrate a necessity for an analysis with a larger study group.Estudio descriptivo que ha determinado comparar el comportamiento cualitativo y cuantitativo del dolor en pacientes sometidos a la Toracotomia Postero Lateral(TPL). La muestra fue constituida por 18 (dieciocho) individuos, siendo 10 (diez) hombres y 8 (ocho) mujeres con edad media de 44 años. Como instrumento se utilizo la ficha de evaluacion fisioterapeutica, escala numerica moderada(5) para ambos los sexos. Los descriptores de los cuestionarios para dolor McGill escogidos con mayor frecuencia por los pacientes fueron: en el componente sensorial pungente4, puntada1, choque2, fina1, tirãn2; en el componente afectivo, cansacial1, mareante1, castigante1 y miserable1 y en el componente evaluativo fue pesada1. Las caracteristicas del dolor en el grupo sensorial fueron mais evidentes en el grupo masculino. No fueron observadas diferencias estadisticas significativas entre las respuestas cuantitativas del dolor de hombres y mujeres. En relacion al aspecto cualitativo fue observado una predominancia de los mismos descriptores verbales del componente afectivo del dolor para ambos los sexos. La intensidad del dolor fue categorizada como moderada, no hubo diferencia estadistica relevante cuanto al dolor en el postoperatorio de toracotomia postero-lateral. Estos datos dan margen para una analice con casuistica mayor.Estudo descritivo que objetivou comparar o comportamento qualitativo e quantitativo da dor em pacientes submetidos à toracotomia póstero-lateral (tpl). A amostra foi constituída por 18 indivíduos, sendo 10 homens e 8 mulheres com média de idade de 44 anos. Como instrumentos, utilizou-se a ficha de avaliação fisioterapêutica, escala numérica da dor e questionário para dor McGill. A dor na escala numérica foi considerada moderada (5) para ambos os sexos. Os descritores do questionário para dor McGill, escolhidos com maior freqüência pelos pacientes, foram: no componente sensorial, latejante4, pontada1, choque2, fina1 e puxão2; no componente afetivo, cansativa1, enjoada1, castigante1 e miserável1 e no componente avaliativo foi chata1. As características da dor no grupo sensorial foram mais evidentes no grupo masculino. Não foram observadas diferenças estatísticas significantes entre as respostas quantitativas da dor de homens e mulheres. No que diz respeito ao aspecto qualitativo, observou-se predominância dos mesmos descritores verbais do componente afetivo da dor para ambos os sexos. A intensidade dolorosa foi categorizada como moderada, não houve diferença estatística significativa quanto à dor no pós-operatório de toracotomia póstero-lateral. Esses dados dão margem para a análise com casuística maior.

Introduction: Postoperative pulmonary complications may occur following lung surgery adversely affecting the clinical course and increasing the risk of morbidity and mortality. Respiratory physiotherapy operates preventing, mitigating or reversing these possible complications, and incentive spirometry is one of the techniques used. Objective: The purpose of this systematic review is to evaluate the effect of incentive spirometry practices in the postoperative period of thoracic surgery on lung function, respiratory muscle strength, pulmonary complications and length of hospital stay. Materials and Methods: The research included Medline/Pubmed, Embase and Scielo databases, besides manual search from September up to October 2015. It included randomized studies evaluating the use of incentive spirometry compared with other physical therapy methods in patients after thoracic (lung) surgery. Results: Three studies from a total of 480 articles were included. All selected studies evaluated lung function and only one study evidenced an improvement. Also, just one study showed an improvement in respiratory muscle strength. The pulmonary complications and the hospital stay was not reduced or avoided after the use of incentive spirometry. Conclusion: There are insufficient evidences to justify the recommendation of the incentive spirometry at postoperative pulmonary surgery on lung function, hospital stay, inspiratory muscle strength and pulmonary complications. [ABSTRACT FROM AUTHOR]

OBJETIVO: Verificar se existe associação entre a função muscular respiratória pré-operatória abaixo dos valores previstos e a incidência de complicações pós-operatórias e o óbito, nas laparotomias superiores e toracotomias eletivas. MÉTODOS: Estudo de coorte prospectivo, no qual 70 pacientes acima de dezoito anos foram acompanhados, em dois hospitais similares. A avaliação durante a internação pré-operatória classificou-os em não expostos (50) ou expostos (20), estes quando os valores das pressões respiratórias máximas foram abaixo de 75% dos valores previstos. O acompanhamento foi feito até a alta hospitalar, verificando-se a incidência de pneumonia, insuficiência respiratória aguda, broncoespasmo, ventilação mecânica prolongada, atelectasia, derrame pleural, pneumotórax e óbito nos dois grupos. Realizou-se análise comparativa entre os grupos e cálculo do risco relativo. RESULTADOS: A incidência total de complicações pós-operatórias da amostra foi de 22,86% (16/70); no grupo exposto foi de 55% (11/20) e no grupo não exposto de 10% (5/50). Os pacientes expostos apresentaram risco relativo de 5,5 (intervalo de confiança de 95% entre 2,19 e 13,82). CONCLUSÃO: Os resultados indicaram que a função muscular respiratória pré-operatória abaixo do valor previsto esteve associada a um risco relativo maior de complicações pós-operatórias nas cirurgias pesquisadas.OBJECTIVE: To identify any possible relation between lower than predicted preoperative respiratory muscle function and the incidence of postoperative respiratory complications and death in elective thoracotomies and laparotomies of the upper abdomen. METHODS: A prospective cohort study was conducted, in which 70 patients over the age of 18 were monitored in two similar hospitals. In the preoperative evaluation performed at admission, patients were classified as presenting respiratory muscle function (as determined by measurement of maximal respiratory pressures) > 75% of the predicted value (n = 50) or < 75% of the predicted value (n = 20). Patients were monitored until discharge. In both groups, the incidence of pneumonia was determined, as was that of acute respiratory failure, bronchospasm, prolonged mechanical ventilation, atelectasis, pleural effusion, pneumothorax and death. A comparative analysis was made between the groups, and relative risk was calculated. RESULTS: In the study sample, the overall incidence of postoperative complications was 22.86% (16/70): 55% (11/20) in the group of patients presenting < 75% of the predicted value; and 10% (5/50) in the group of patients presenting > 75% of the predicted value. Patients in the < 75% of the predicted value group presented a relative risk of 5.5 (95% confidence interval between 2.19 and 13.82). CONCLUSION: Respiratory muscle function below the predicted value was found to be related with higher relative risk of postoperative complications in the surgical procedures studied.

A síndrome de Claude Bernard-Horner apresenta várias etiologias, ocorre por interrupção do estímulo nervoso em qualquer ponto do trajeto do nervo e pode ser intra ou extratorácica. É relatado um caso dessa síndrome causado por empiema pleural septado, localizado em região paravertebral, no terço superior do hemitórax direito. O paciente foi submetido à toracotomia para drenagem da cavidade pleural. A evolução foi satisfatória, com regressão do quadro infeccioso, expansão pulmonar e remissão da síndrome.Claude Bernard-Horner syndrome presents various etiologies and occurs as the direct result of interrupted nerve signaling at any point along the nerve trajectory, be it intrathoracic or extrathoracic. Herein, we report a case of Claude Bernard-Horner syndrome caused by loculated pleural empyema located in the paravertebral region of the upper third of the right hemithorax. The patient was submitted to thoracotomy in order to drain the infected fluids. The end result was satisfactory, including resolution of the infection, pulmonary expansion, and remission of the syndrome.

A toracotomia é um procedimento cirúrgico que produz estímulo doloroso intenso. O objetivo deste estudo foi avaliar o efeito cardiovascular da associação tramadol, butorfanol e atropina na medicação pré-anestésica de gatos anestesiados com propofol e halotano. Doze animais, SRD, machos ou fêmeas, com peso médio de 2,7 ± 0,62kg receberam como medicação pré-anestésica (MPA), a associação de tramadol (2,0mg kg-1), butorfanol (0,4mg kg-1) e atropina (0,044mg kg-1), via intramuscular. Trinta minutos após MPA, a indução foi realizada com propofol (5,0mg kg-1) por via intravenosa. A manutenção anestésica foi obtida com halotano e oxigênio 100% sob ventilação artificial manual. Os gatos foram submetidos à toracotomia intercostal para implante de um segmento autólogo de pericárdio no diafragma. As variáveis avaliadas foram: freqüência cardíaca (bpm), saturação de oxigênio da hemoglobina (%), pressão arterial sistólica (mmHg) e vaporização de halotano (%). As variáveis foram mensuradas 20 minutos após a MPA (TMPA), 10 minutos após indução e a cada 10 minutos até o final do procedimento cirúrgico (T10 a T100).Os dados obtidos foram analisados estatisticamente através de ANOVA e teste de Bonferroni (pIntercostal thoracotomy is a very painful procedure that deserves proper prevention and treatment. In this study we aimed to investigate the cardiovascular effect of the association of tramadol, butorphanol and atropine in the premedication of cats anesthetised with propofol and halothane. Twelve cats of mixed breed, female and male, with mean body weight of 2.7 ± 0.62kg were premedicated with 2.0mg kg-1 tramadol and 0.4mg kg-1 butorphanol and 0.044mg kg-1 atropine combined in the same syringe intramuscularly administered. After 30 minutes of premedication, anesthetic induction was obtained with 5.0mg kg-1 propofol intravenously. Anesthetic maintenance was done with halothane and 100% oxygen with manual artificial ventilation. All cats were submitted to lateral intercostal thoracotomy for an autogenic pericardium graft implantation in the diaphragm. Variables studied were heart rate (bpm), hemoglobin oxygen saturation (%), systolic arterial pressure (mmHg), and halothane vaporization (%). Time for data collection were 20 minutes after premedication (TMPA), 10 minutes after induction and every 10 minutes up to the end of the surgical procedure (T10 to T100). Data were analyzed with ANOVA and Bonferroni's test (p

Nos trabalhos encontrados na literatura é dada pouca ênfase às conseqüências na cavidade torácica de eqüinos que são submetidos à toracotomia. Também não mencionam a ultra-sonografia como método auxiliar e de controle na avaliação pós-operatória, muitas vezes, optando-se exclusivamente pela necropsia. Neste experimento, foram utilizados seis eqüinos hígidos, sob anestesia com ventilação controlada, para a realização de acesso cirúrgico ao hemitórax direito, com o objetivo de se avaliarem através de exame clínico, mensuração de pH e gases sanguíneos, hemograma e ultra-sonografia torácica, as conse- qüências da prática de toracotomia em eqüinos. Não foram observados em nenhum dos animais transtornos respiratórios, sinais de pneumotórax ou deiscências de sutura de parede torácica. Os valores dos parâmetros fisiológicos, do pH e gases sanguíneos e do hemograma não apresentaram alterações significativas no pós-operatório. O exame ultra-sonográfico proporcionou informações sobre a quantidade e o aspecto do líquido pleural, evolução das alterações na pleura visceral, presença ou não de pneumotórax e alterações parenquimatosas subpleurais.Pertaining litterature does not usually foccus on the possible consequences in the thoracic cavity of horses subjected to thoracotomy procedures. Ultrasound is not mentioned as a method of contrai in post-operatory evaluation, which is mostiy exclusively based on post-mortem examination. Six healthy equine were used in the experiment; surgical access to the right hemitórax was assured by controiled mechanical anesthesia. The thoracotomy in the equine was further evaluated by means of a complete clinicai examination, blood gás analysis, complete blood count and thoracic ultrasonography.The suture technique aiso revealed itself efficient and the animais exbited no sings of respiratory distress, pneumotórax or thoracic wall suture dehiscense. The complete clinicai examination, pH, blood gases as well as blood cell count, did not show any significant changes at the pos-operative period. The ultrasonographic exam allowed the evaluation of pleural fluid appearance and quantity, changes of visceral pleura, presence of pneumotórax and subpleural changes.

Diversos procedimentos cirúrgicos e diagnósticos podem ser realizados através da cirurgia torácica em eqüinos. Para tanto faz-se necessária a utilização da ventilação controlada mecânica (VCM) e a compreensão dos efeitos respiratórios deste tipo de ventilação durante a toracotomia. Foram utilizados seis eqüinos hígidos, sob anestesia com ventilação controlada, para a realização de acesso cirúrgico ao hemitórax direito com o objetivo de se avaliar, através da mensuração dos parâmetros fisiológicos, ventigrafia, pH e gases sangüíneos, a eficácia da ventilação controlada em otimizar a ventilação e a oxigenação e em prevenir a atelectasia pulmonar durante manipulações intratorácicas. Verificou-se diminuição dos valores da PaCO2 e aumento dos valores de pH durante a ventilação controlada, mesmo com o pneumotórax instalado. A pressão interpleural também apresentou aumento de seus valores durante a VCM. Concluiu-se que o uso da VCM, durante a prática da toracotomia, permite a padronização da freqüência respiratória com melhora da ventilação, e subseqüente normalização das alterações da pressão parcial de dióxido de carbono e pH, bem como mantém visualmente adequada a expansão pulmonar. A VCM promove aumento da pressão interpleural, enquanto o tórax permanece fechado.Several surgical and diagnostic procedures can be performed on thoracic surgery in the equine. To carry out these procedures controlled mechanical ventilation (CMV) is necessary, as well as full understanding of the possible side effects of this type of ventilation. Six healthy equine were used under anesthesia wiith CMV to do right hemithorax approach. The goals were to evaluate efficiency of CMV in the improvement of ventilation and oxigenation as well as in the prevention of pulmonar atelectasis during intrathoracic manipulation. For such evaluation of physiologic parameters measurement, ventigraphy and blood gas analysis were performed. A decrese in PaCO2 and rise of pH values were observed, in despite of pneumothorax presence. Also the interpleural pressure showed elevated values during CMV. The use of CMV, during thoracotomy, allows padronization of respiratory rates with improvement of ventilation and for this, further normalization of alterations in PaCO2 and pH. As well as it allows visually adequate lung expansion. CMV promotes interpleural pressure elevation while the thoracic cavity remains closed.

A medição dos gases sangüíneos foi realizada em cães submetidos à técnica de toracotomia em bloco. A medicação pré-anestésica constou de acetilpromazina administrada pela via intravenosa. Com injeção intravenosa de tiopental sódico foram providas a indução, intubação orotraqueal e manutenção da anestesia cirúrgica. O traqueotubo foi conectado a um respirador mecânico pressométrico, que manteve o animal oxigenado durante a operação. Foram colhidas amostras de sangue arterial por punção da artéria femoral para determinação do pH, pressão de dióxido de carbono (PCO2), pressão de oxigênio (PO2), excesso de base (BE) e bicarbonato (HCO3-). Nos animais do grupo II, no final da cirurgia (Tempo 1) e 24 horas após (Tempo 2), foi feita anestesia local dos nervos intercostais junto das costelas seccionadas para comparação das prováveis alterações da mecânica respiratória. A técnica da toracotomia em bloco promoveu excelente exposição das vísceras do tórax, com recuperação satisfatória, sem desconforto e complicação pós-operatória.Blood gas analysis were measured in dogs submitted to en bloc thoracotomy. Preanesthetic medication consisted of acepromazine maleate injected intravenously. The animal was anesthetized with thiopental sodium intravenously, and the surgical field prepared. The trachea was intubated and mechanical ventilator was used. A radical thoracotomy was performed. Arterial samples of blood were collected from the femoral artery. Arterial blood pH value, carbon dioxide pressure (PCO2), PO2 level, base excess and standard bicarbonato level (HCO3-) were determined. Local anesthesia of intercostal nerves of the thorax, dose to the thoracotomy, were also performed on dogs in group II at end of surgery (T1) and 24 hours (T2) after the surgery. The dog recovered satisfactonly and in the following 7 days had no observable discomfort. It is anticipated that the results of this study will be useful to those using the en bloc thoracotomy, which provided excellent exposure ot the thoracic viscera with no postoperative complications.

Doze cães, sem raça definida, foram submetidos à toracotomia lateral intercostal e divididos em dois grupos de diferentes tratamentos pós-operatórios, sendo que seis animais receberam oxigenoterapia por cateterização nasal e os demais não receberam este tratamento. Os animais de ambos os grupos estiveram sob cuidados intensivos em sala de recuperação por quatro horas de período pós-operatório, quando foram monitorados o volume corrente pulmonar, a gasometria arterial, o tempo de reperfusão capilar, a coloração de mucosas ocular e oral, as frequências respiratória e cardíaca, a temperatura retal e a tolerância ao uso do cateter nasal. Os resultados obtidos demonstraram que ocorre diminuição dos valores de pressão parcial arterial de oxigênio abaixo dos índices fisiológicos. A análise estatística dos dados revelou diferença significativa entre os cães que receberam oxigênio via cateter nasal e os não tratados, no período pós-toracotomia.Lateral intercostal thoracotomy was performed in twelve mongrel dogs divided in two groups for different postoperative treatments. Six animais received oxigen by nasal catheter after surgery. Both groups were maintained in a recovery room during four hours in wich were monitored the pulmonary tidal volume, the arterial blood gas values, the capilar refil l time, the mucous membrane color, the respiratory and heart rates, the rectal temperature, and the tolerance to the nasal catheter. The results demonstrated a reduction on the arterial oxygen parcial pressure levels after the thoracotomy. The comparativo statistical analyse showed a significant diference between the group that received oxygen by nasal catheter and the group that recived no treatment.

Introduction: damage control surgery (DCS) is well recognized as a surgical strategy for patients sustaining severe abdominal trauma. Literature suggests the indications, operative times, therapeutic procedures, laboratory parameters and intraoperative findings have a direct bearing on the outcomes., Objective: to analyze the clinical profile of patients undergoing DCS and determine predictors of morbidity and mortality., Methods: a retrospective cohort study was conducted on all patients undergoing DCS following abdominal trauma from November 2015 and December 2021. Data on subjects' demographics, baseline presentation, mechanism of injury, associated injuries, injury severity scores, laboratory parameters, operative details, postoperative complications, length of stay and mortality were assessed. A binary logistic regression analysis was performed to determine potential risk factors for mortality., Results: During the study period, 696 patients underwent trauma laparotomy. Of these, 8.9% (n=62) were DCS, with more than 80% due to penetrating mechanisms. Overall mortality was 59.6%. In the logistic regression stratified by survival, several variables were significantly associated with mortality, including hypotension, and altered mental status at admission, intraoperative cardiorespiratory arrest, need for resuscitative thoracotomy, metabolic acidosis, hyperlactatemia, coagulopathy, fibrinolysis, and severity of the trauma injury scores., Conclusion: DCS may be appropriate in critically injured patients; however, it remains associated with significant morbidity and high mortality, even at specialized trauma care centers. From pre and postoperative clinical and laboratory parameters, it was possible to predict the risk of death in the studied sample.

Objective: to identify variables related to pleural complications in patients undergoing tube thoracostomies due to traumatic injuries., Method: we conducted a prospective observational study from May/2019 to January/2021 including adult trauma patients submitted to tube thoracostomies after hospital admission. Patients undergoing thoracotomies as the initial treatment were not included. We excluded patients with suspected and confirmed COVID-19 diagnosis during the hospitalization. Pleural complications were defined as clotted hemothorax, residual pneumothorax and empyema. Students t, Mann Whitneys, Chi square and Fishers exact test were used to compare variables between groups. We considered p<0.05 as significant., Results: we analyzed 68 patients. The mean age was 36.0 + 12.6 years and 91.2% were male. The mean RTS and ISS were, respectively, 7.0 ± 1.6 and 15.9 ± 7.6. The most frequent trauma mechanism was stab wounds in 50.0%, followed by blunt trauma in 38.2%. The severity of thoracic injuries was stratified (AIS) as 2 (4.4%), 3 (80.9%), 4 (13.2%), e 5 (1.5%). Pleural complications happened in 14 (20.5%) patients, being clotted / residual hemothorax (11.8%), residual pneumothorax (4.4%), empyema (2.9%) and miscellaneous (1.4%). These patients were treated by thoracoscopy (5), thoracotomy (3), chest re-drainage (3) and clinical measures alone (3). There was a significant association between pleural complications with the time of permanence (p<0,001) and the necessity of relocation (p<0,001) of the drain., Conclusion: the predictors of pleural complications in this series were time of permanence and the necessity of relocation of the drain.

A toracocentese é o método de escolha para a obtenção de amostras de líquido pleural. Embora seja considerado um procedimento pouco invasivo, é fundamental que a toracocentese obedeça a uma técnica padronizada com a finalidade de aprimorar a chance de diagnóstico e minimizar riscos. A biópsia de pleura tem por objetivo ampliar e complementar a chance de diagnóstico das doenças pleurais, sendo indicada em casos selecionados.Thoracentesis is the method of choice for obtaining samples of pleural fluid. Although it is considered a minimum invasive procedure, it is crucial to follow a standardized technique with the purpose of optimizing the chance of diagnosis and minimizing risks. The pleura biopsy may enlarge and complement the chance of diagnosis of the pleural diseases and is indicated in selected cases.

O derrame pleural neoplásico é uma complicação freqüente nos pacientes portadores de tumores avançados. A presença de células malignas no líquido pleural ou na biópsia da pleura é indicativa de disseminação da doença primária, com conseqüente redução da expectativa de vida. O diagnóstico e tratamento precoce do derrame pleural maligno são fundamentais para promover uma melhor qualidade de vida aos pacientes portadores de câncer avançado.The malignant pleural effusion is a frequent complication in patients with of advanced tumors. The presence of malignant cells in the pleural fluid or in the pleural biopsy is indicative of dissemination of the primary disease, with consequent reduction of life expectancy. The early diagnosis and treatment of the malignant effusion is pivotal in promoting a better quality of life to patients with advanced cancer.

Objective: the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period., Methods: retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil., Results: a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma., Conclusion: the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.

Objective: This study aimed to investigate the impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes., Methods: A total of 118 patients with post-thoracotomy Patient-Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 μg.kg -1 body weight] and morphine [0.48 mg.kg -1 body weight]) and the Morphine (MOR) Group (61 patients administered with morphine [0.48 mg.kg -1 ]). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared., Results: The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (p < 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (p < 0.05)., Conclusions: Dexmedetomidine combined with morphine for post-thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)