Filtros de veia cava inferior em pacientes com câncer: experiência em 50 casos

OBJECTIVE: To study the immediate and late results obtained from the implantation of vena cava filters in cancer patients with deep vein thrombosis concomitant with neoplasia. METHODS: This was a retrospective evaluation of 50 patients with an association of cancer and deep venous thrombosis who underwent interruption of the inferior vena cava and the insertion of permanent vena cava filters. The indications for the procedure, filter implantation technique, early and late complications related to the operation, and the clinical evolution were evaluated. RESULTS: The most frequent indication for filter implantation was the contraindication for full anticoagulant treatment (80%). The femoral vein was the preferred access route (86% of the patients). There were no complications related to the surgical procedure. During the follow-up, the following complications were observed: 1 episode of nonfatal pulmonary thromboembolism, 2 cases of occlusion of the inferior vena cava, and 1 case of thrombus retained in the device. Twenty patients (40%) died due to progression of the neoplasm. CONCLUSIONS: Interruption of the inferior cava vein using an endoluminal filter is a procedure with a low rate of complications. It is a safe and efficient measure for preventing pulmonary embolism in cancer patients who have deep vein thrombosis of the lower limbs.OBJETIVO: Estudar os resultados imediatos e tardios obtidos com a implantação de filtros de veia cava inferior em pacientes com trombose venosa profunda concomitante a neoplasia. MÉTODOS: Avaliamos retrospectivamente 50 pacientes com câncer e trombose venosa profunda associada submetidos a interrupção de veia cava inferior com filtros intraluminais definitivos. Foram estudados aspectos referentes à indicação do procedimento, à técnica de implante dos dispositivos, complicações precoces e tardias relacionadas à operação e à evolução dos pacientes. RESULTADOS: A indicação mais freqüente para o procedimento foi a impossibilidade de anticoagulação plena (80% ) e a via de acesso preferencial foi a punção da veia femoral, realizada em 86% dos pacientes. Não houve complicações relativas ao implante dos filtros. Durante a evolução ocorreram: um episódio de tromboembolia pulmonar não fatal e dois casos de oclusão da veia cava inferior; em um paciente foi demonstrada a presença de coágulo retido no dispositivo. Vinte pacientes (40%) faleceram devido à neoplasia. CONCLUSÃO: A interrupção da veia cava inferior com filtro endoluminal é um procedimento com baixo índice de complicações e eficaz na prevenção da embolia pulmonar nos pacientes com tromobose venosa profunda de membros inferiores portadores de câncer

Técnicas endovasculares para colocação de cateteres de longa permanência para quimioterapia

PURPOSE: To analyze the results from using endovascular techniques to place long-term chemotherapy catheters when advancing the catheter using the external jugular vein is difficult due to obstructions or kinking. METHODS: Between July 1997 and August 2000, 320 long-term chemotherapy catheters were placed, and in 220 cases the external jugular vein was used as the primary venous approach. In 18 of these patients, correct positioning was not achieved and several endovascular techniques were then utilized to overcome these obstacles, including manipulation of a J-wire with a moveable core, venography, and the exchange wire technique. RESULTS: In 94.5% of the patients with difficulties in obtaining the correct positioning, we were able to advance the long-term catheter to the desired position with the assistance of endovascular techniques. CONCLUSIONS: Venography and endovascular guidance techniques are useful for the placement of long-term catheters in the external jugular vein.OBJETIVO: Analisar os resultados da utilização de técnicas endovasculares na colocação de cateteres de longa permanência para quimioterapia quando a progressão do cateter através da veia jugular externa é dificultada devido a obstruções ou tortuosidades. MÉTODOS: Entre Junho de 1997 e Agosto de 2000, foram colocados 320 cateteres de longa permanência para quimioterapia, e, em 220 casos a veia jugular externa foi utilizada como acesso venoso primário. Em 18 desses pacientes, o correto posicionamento não foi conseguido sendo então utilizadas várias técnicas endovasculares para superar os obstáculos incluindo o uso de fio guia com ponta em J, flebografia e troca de cateteres. RESULTADOS: Em 94,5% dos pacientes com dificuldades para obtermos o correto posicionamento, foi conseguida a progressão do cateter de longa permanência até o posicionamento desejado com a assistência de técnicas endovasculares. CONCLUSÃO: A Flebografia e a técnica endovascular são úteis para a colocação de cateteres de longa permanência através da veia jugular extern

Reconstruções arteriais associadas à ressecção de tumores malignos

OBJECTIVE: When trunk arteries are affected by malignant neoplasia, and surgical treatment involving tumor and arterial resection is used, the vascular reconstruction must be performed immediately to avoid ischemia in the brain and large tissue masses. The objective of this study was to analyze the results obtained with the treatment of patients with malignant neoplasia who underwent tumor and vascular resection associated with arterial reconstruction. The primary patency of reconstructions, the occurrence arterial complications, and patient survival were assessed. METHODS: Thirty-six patients with cervical, abdominal, or lower limb neoplasias were followed up. These patients underwent elective operations at Hospital do Câncer A.C. Camargo, São Paulo, between September 1997 and September 2004. They were divided into 3 groups according to tumor location: Cervical (14), lower limbs (13), and Abdomen (9). Thirty-eight arterial reconstructions were performed in these 36 patients. RESULTS: There were 5 arterial complications: 2 early- and 3 late-stage. The early complications consisted of 1 symptomatic carotid occlusion with sequelae and 1 femoral graft rupture without sequelae. The late-stage complications consisted of 1 symptomatic carotid occlusion, 1 occlusion of an axillary-carotid graft, and 1 occlusion of a branch of the aortobifemoral graft, all without sequelae. There was no difference between the primary arterial patency rates. All the deaths (22) resulted from progression of neoplasic disease. CONCLUSIONS: Arterial reconstructions associated with resection of malignant neoplasia in cervical, abdominal, or lower limbs can be carried out with low rates of morbidity and mortality. There was no difference in the primary arterial patency rates among the groups studied.OBJETIVO: Quando há acometimento de artérias tronculares por neoplasias malignas e o tratamento cirúrgico é empregado para realização de ressecções tumoral e arterial, a reconstrução vascular deve ser imediata, para evitar a isquemia de tecidos nobres. O objetivo desse trabalho é analisar os resultados do tratamento de pacientes portadores de neoplasias malignas submetidos a ressecções tumoral e vascular associada à reconstrução arterial, avaliando a perviedade primária das reconstruções, as complicações arteriais e a sobrevida dos pacientes. MÉTODOS: Foram acompanhados 36 pacientes com neoplasias em regiões cervical, abdominal ou extremidades inferiores, operados eletivamente no período de setembro de 1997 a setembro de 2004 no Hospital do Câncer A.C.Camargo em São Paulo. Os pacientes foram divididos em três grupos de acordo com a localização das neoplasias: Cervical (14), Extremidade (13) e Abdome (9). Foram realizadas 38 reconstruções arteriais nos 36 pacientes. RESULTADOS: Houve cinco complicações arteriais, sendo duas precoces e três tardias. Entre as precoces, houve uma oclusão carotídea sintomática com seqüelas e uma rotura de enxerto femoral sem seqüelas. Entre as tardias, houve uma oclusão carotídea sintomática, uma oclusão de enxerto carotídeo-axilar e uma oclusão de ramo de enxerto aorto-bifemoral, todas sem sequelas. Não houve diferença entre os índices de perviedade arterial primária . Todos os óbitos (22) ocorreram devido à evolução da doença neoplásica. CONCLUSÕES: As reconstruções arteriais associadas à ressecção de neoplasias malignas em segmentos cervical, abdominal ou extremidades inferiores podem ser realizadas com baixos índices de morbi-mortalidade. Não houve diferença entre os índices de perviedade primária das reconstruções

Twenty Months of Evolution Following Sympathectomy on Patients with Palmar Hyperhidrosis: Sympathectomy at the T3 Level is Better than at the T2 Level

OBJECTIVE: To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups

Is Gender a Predictive Factor for Satisfaction among Patients Undergoing Sympathectomy to Treat Palmar Hyperhidrosis?

Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender

High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19 : first results of ReumaCoV Brasil registry

Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process

Comparison of the results obtained in the treatment of palmar hyperhidrosis through video-assisted thoracoscopic sympathectomy at the T2 and T3 denervation levels

INTRODUÇÃO: O nível ótimo de simpatectomia para a hiperidrose palmar seria aquele que resultasse na definitiva desnervação simpática da palma da mão com mínima intensidade de hiperidrose compensatória. OBJETIVOS: Comparar duas técnicas cirúrgicas (níveis de desnervação) de simpatectomia por videotoracoscopia para tratamento da hiperidrose palmar ou palmo-plantar a curto e médio prazo. MÉTODOS: De maio de 2003 a junho de 2006, 60 pacientes com hiperidrose palmar foram prospectivamente randomizados para a simpatectomia por videotoracoscopia nos níveis do gânglio T2 ou T3. Foram acompanhados pelo período médio de 20 meses avaliando-se: a resolução da hiperidrose palmar; a incidência e a intensidade da hiperidrose compensatória; sua evolução durante o estudo; e a qualidade de vida dos pacientes. RESULTADOS: 59 pacientes apresentaram resolução da hiperidrose palmar. Uma falha terapêutica ocorreu no grupo T3. A maioria dos pacientes apresentou melhora da hiperidrose plantar sem diferença entre os grupos. Após 20 meses, todos os pacientes de ambos os grupos apresentavam algum grau de hiperidrose compensatória, mas com menor intensidade no grupo T3 (p=0,007). A HC desenvolveu-se na maioria dos pacientes no primeiro mês do pós-operatório, com incidência e intensidade estáveis com o passar do tempo. Verificou-se melhora da qualidade de vida desde a primeira avaliação de pós-operatório, sem diferença em nenhum dos grupos, e assim se manteve até o fim do seguimento. CONCLUSÕES: Ambas as técnicas são efetivas para tratar a hiperidrose palmar. A complicação mais frequente foi a hiperidrose compensatória, que cronologicamente apresentou incidência e intensidade estáveis durante o estudo. A simpatectomia no nível T3 apresentou menor intensidade de HC, mas, apesar disso, a melhora da qualidade de vida foi similar em ambos os grupos.INTRODUCTION:The optimum level for sympathectomy to treat palmar hyperhidrosis would be the level that produced definitive sympathetic denervation of the palm of the hand with minimal compensatory hyperhidrosis. OBJECTIVE: To compare two surgical techniques (denervation levels) of sympathectomy using video-assisted thoracoscopy to treat palmar or palmar-plantar hyperhidrosis for short and medium-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed up for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis; incidence and severity of compensatory hyperhidrosis and its evolution over time; and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in plantar hyperhidrosis, without any difference between the groups. Twenty months later, all of the patients in both groups presented some degree of compensatory hyperhidrosis, but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen, starting from the first postoperative evaluation, but without any difference between the groups. This was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis of less severity. Nevertheless, the improvement in quality of life was similar between the groups

Máquinas do Mundo de Laura Vinci y la traducción en el proceso creativo

Este artículo parte de la afirmación de Michael Fried en "Arte y objetualidad" (1967) de que el teatro es lo que se encuentra entre las artes. Dando la vuelta a la hipótesis del crítico – que la sugirió de forma negativa –, señalamos esta característica fluida e híbrida del teatro como el camino recorrido por muchos artistas contemporáneos en obras significativas. Partiendo de esta premisa, el artículo pretende reconstituir, principalmente a partir de entrevistas, un largo proceso de creación centrado en la figura de la brasileña Laura Vinci, artista visual también involucrada en procesos teatrales. Comenzamos, entonces, con la obra Máquina do Mundo (en singular), una obra de artes visuales, llegando a las artes escénicas con Máquinas do Mundo (en plural), creada por el artista junto a la mundana companhia de teatro. Para tal reconstitución nos apoyamos principalmente en los conceptos de traducción, de Josette Féral, y work in progress, de Renato Cohen.O presente artigo parte da afirmação de Michael Fried em "Arte e objetidade" (1967) de que o teatro é o que se encontra entre as artes. Virando a hipótese do crítico – aventada em chave negativa – do avesso, apontamos tal característica fluida e híbrida do teatro como o caminho percorrido por muitos artistas contemporâneos em significativas obras. Partindo dessa premissa, o artigo tem como objetivo reconstituir – a partir de entrevistas, principalmente – um longo processo de criação centrado na figura da brasileira Laura Vinci, artista visual envolvida também em processos teatrais. Partimos, então, da obra Máquina do Mundo (no singular), obra no campo das artes visuais, chegando às artes da cena com Máquinas do Mundo (no plural), criação da artista junto a mundana companhia. Para tal reconstrução apoiamo-nos, principalmente, nos conceitos de tradução, de Josette Féral, e work in progress, de Renato Cohen.This article starts from Michael Fried's statement in "Art and objecthood" (1967) that what lies between the arts is theatre. Turning the hypothesis of the critic inside out – he suggested it in a negative way –, we point out this fluid and hybrid characteristic of theatre as the path taken by many contemporary artists in significant works. Based on this premise, the article aims to reconstitute – mainly from interviews – a long creation process centered on the figure of Brazilian artist Laura Vinci, a visual artist who is also involved in theatrical processes. We start with Máquina do Mundo (in the singular), a work in the field of visual arts, reaching the performing arts with Máquinas do Mundo (in the plural), created by the artist together with mundana companhia (a theatre company). For such reconstitution, we mainly rely on the concepts of translation, by Josette Féral, and work in progress, by Renato Cohen