The search for stability: bar displacement in three series of pectus excavatum patients treated with the Nuss technique

OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD: A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ''third point fixation'' technique,and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS: There were no deaths in any of the series. Minor complications occurred in six (4.9%) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5%) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation to remove the bar within the 30 days of implantation (3). All major complications occurred in the first and second series. CONCLUSION: The elimination of fixation wires, the use of shorter bars and redesigned stabilizers placed in a more medial position results in a better outcome for pectus excavatum patients treated with the Nuss technique. With bar displacement and instability no longer significant postoperative risks, the Nuss technique should be considered among the available options for the surgical correction of pectus excavatum in pediatric patients

Spirometric Assessment of Lung Transplant Patients: One Year Follow-Up

OBJECTIVE: The purpose of this study was to compare spirometry data between patients who underwent single-lung or double-lung transplantation the first year after transplantation. INTRODUCTION: Lung transplantation, which was initially described as an experimental method in 1963, has become a therapeutic option for patients with advanced pulmonary diseases due to improvements in organ conservation, surgical technique, immunosuppressive therapy and treatment of post-operative infections. METHODS: We retrospectively reviewed the records of the 39 patients who received lung transplantation in our institution between August 2003 and August 2006. Twenty-nine patients survived one year post-transplantation, and all of them were followed. RESULTS: The increase in lung function in the double-lung transplant group was more substantial than that of the single-lung transplant group, exhibiting a statistical difference from the 1st month in both the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) in comparison to the pre-transplant values (p <0.05). Comparison between double-lung transplant and single lung-transplant groups of emphysema patients demonstrated a significant difference in lung function beginning in the 3rd month after transplantation. DISCUSSION: The analyses of the whole group of transplant recipients and the sub-group of emphysema patients suggest the superiority of bilateral transplant over the unilateral alternative. Although the pre-transplant values of lung function were worse in the double-lung group, this difference was no longer significant in the subsequent months after surgery. CONCLUSION: Although both groups demonstrated functional improvement after transplantation, there was a clear tendency to greater improvement in FVC and FEV1 in the bilateral transplant group. Among our subjects, double-lung transplantation improved lung function

Clinical outcome in patients with neoplastic pleural effusion

A proposta foi reconhecer os fatores de risco de recorrência do derrame pleural maligno (DPM) em pacientes com derrame pleural maligno (DPM) sintomático. Métodos: Através de banco de dados prospectivamente organizado de casos com derrame pleural tratados em uma única instituição, foram realizadas duas análises separadamente. A primeira análise incluiu apenas pacientes com câncer de pulmão e a segunda análise contemplou pacientes portadores de câncer de diversos tipos sítios primários. Todos os pacientes com DPM submetidos a procedimentos paliativos foram incluídos em um estudo prospectivo. Em relação a primeira análise, o grupo I continha pacientes com recidiva pleural e o grupo II sem recidiva pleural. Os fatores prognósticos para recorrência pleural foram identificados por análise univariada, utilizando o teste exato de Fisher para variáveis categóricas e o teste t de Student para variáveis quantitativas. Posteriormente, as variáveis significativas foram inseridas em uma análise de regressão logística multivariável (com P < 0,05 considerado significativo). A curva ROC (receiver operating characteristics) determinou os pontos de corte para variáveis contínuas. Em relação a segunda análise, analisamos fatores prognósticos para recorrência pleural. Esta identificação foi feita através de análise univariada pelo método de Kaplan-Meier e o teste logrank foi utilizado para comparação entre as curvas. Modelos de regressão de Cox univariados e múltiplos foram utilizados para avaliar o risco (Hazard Risk ) de recorrência. A curva ROC (receiver operating characteristics) determinou os pontos de corte para variáveis contínuas. Resultados: em relação a nossa primeira análise, 82 pacientes foram incluídos na análise. Havia 15 pacientes (18,3%) no grupo I e 67 pacientes (81,7%) no grupo II. A análise univariada dos fatores que afetam a recorrência pós-operatória foi: concentração de adenosina desaminase no líquido pleural < 16 mg / dL (p = 0,04), concentração de albumina no líquido pleural < 2,4 mg / dL (p = 0,03), administração de quimioterapia paliativa de segunda linha ( p = 0,018) e tipo de procedimento [toracocentese] (p = 0,023). Na análise multivariável, apenas o tipo de procedimento (toracocentese) (p = 0,031) foi identificado como preditor independente de recorrência. Por outro lado, quando analisamos nosso segundo subgrupo de pacientes (pacientes de diversos sítios primários), 288 pacientes foram incluídos na amostra. A sobrevida livre de recorrência foi de 76,6% em 6 meses e 73,3% aos 12 meses. Fatores positivos na análise univariada associados à recorrência pós-operatória foram: concentração de linfócitos e plaquetas no sangue periférico, procedimento pleural, linhas de quimioterapia realizadas e número de metástases. Os fatores independentes para sobrevida livre de recorrência foram procedimento pleural e linhas de quimioterapia. Pacientes submetidos à pleurodese apresentaram fator de proteção para recidiva, com HR = 0,34 (IC 95%,0,15-0,74, p = 0,007). Por outro lado, os pacientes submetidos à 1ª e 2ª linha de TC paliativa apresentaram, respectivamente, um risco de recorrência maior, HR = 2,81 (IC 95%, 1,10-7,28, p = 0,034) e HR = 3,23 (IC 95%, 1,33-7,84, p = 0,010). Concluímos que em nosso estudo, os pacientes que receberam a primeira ou a segunda linha de tratamento sistêmico têm maior risco de recorrência do DPM quando comparados aos pacientes que foram submetidos ao tratamento pleural antes de iniciar o tratamento sistêmico. O uso da toracocentese esteve associado com recorrência do DPM quando comparado a outros métodos de tratamento cirúrgicoBackground: It is known that malignant pleural effusion (MPE) recurs rapidly, in a considerable number of patients. However, some patients do not have MPE recurrence. Since MPE is associated with an average survival of 4-7 months, accurate prediction of prognosis may help recognize patients at higher risk of pleural recurrence, aiming to individualize more intensive treatment strategies.Methods: Through a prospectively organized database of cases with pleural effusion treated in a single institution, two applied analyzes were performed. The first analysis included only patients with non-small cell lung cancer (NSCLC) submitted to pleural palliative procedures. Group I contained patients who had pleural recurrence, and Group II with no pleural recurrence. Prognostic factors for pleural recurrence were identified by univariable analysis, using Fisher\'s exact test for categorical variables and Student\'s t test for quantitative variables. Afterwards the significant variables were entered into a multivariable logistic regression analysis (with p < 0.05 considered significant). Receiver operating characteristics (ROC) analysis determined the cutoff points for continuous variables. Regarding second analysis, prognostic factors for pleural recurrence were identified by univariable analysis using Kaplan-Meier method and the log-rank test was used for the comparison between the curves. Univariate and multiple Cox regression models were used to evaluate the risk (HR) of recurrence. Receiver operating characteristics (ROC) analysis also determined the cutoff points for continuous variables.Results: About our first analysis, a total of 82 patients were included in the analysis. There were 15 patients (18.3%) in Group I and 67 patients (81.7%) in Group II. Univariable analysis regarding factors affecting postoperative recurrence was: adenosine deaminase concentration in pleural fluid < 16 mg/dl (p= 0.04), albumin concentration in pleural fluid < 2.4 mg/dl (p= 0.03), administration of second-line palliative chemotherapy (p=0.018) and type of procedure [therapeutic pleural aspiration (TPA)] (p=0.023). At the multivariable analysis, only the type of procedure (TPA) (P=0.031) was identified as independent predictor of recurrence. Regarding our second analysis, A total of 288 patients were included. Recurrence-free survival was of 76.6% at 6 months and 73.3% at 12 months. Univariable analysis regarding factors affecting postoperative recurrence was: lymphocytes, platelets, pleural procedure, chemotherapy lines and number of metastases. The independent factors for recurrence-free survival were pleural procedure and chemotherapy lines. Patients who were submitted to pleurodesis had a protective factor for recurrence, with an HR =0.34 (95% CI, 0.15-0.74, p=0.007). On the other hand, patients submitted to the 1st and 2nd line of palliative CT had, respectively, an HR risk = 2.81 (95% CI, 1.10-7.28, p=0.034) and HR =3.23 (95% CI, 1.33-7.84, p=0.010). Conclusions :patients receiving the first or second line of systemic treatment have a higher risk of MPE recurrence when compared to patients who underwent MPE treatment before starting the systemic treatment. The definitive treatment of MPE, such as pleurodesis, was associated with a lower risk of MPE recurrenc