O papel da drenagem pleural aberta no tratamento do empiema pleural

O presente trabalho tem por objetivo estudar e definir o papel da drenagem pleural aberta - pleurostornia - no tratamento do empiema pleural. O empiema pleural apresenta 3 fases evolutivas cujo reconhecimento tem fundamental importância para a escolha da terapêutica cirúrgica a ser empregada, distinta em cada fase. Este trabalho inicialmente, procura discutir a patogenia, estudar a fisiologia e caracterizar o reconhecimento destas fases bem como do fenômeno da fixação do mediastino. Os critérios que têm sido usados para o diagnóstico deste último fenômeno são igualmente estudados e discutidos. A seguir são estabelecidos os princípios fundamentais do tratamento do empiema pleural. É revisada a experiência do autor com 191 casos de pacientes tratados com drenagem pleural aberta, construída segundo uma modificação da técnica de Eloesser. São apresentados a técnica cirúrgica, o manejo pós-operatório e os resultados. Estes são discutidos procurando-se estabelecer as indicações e a vantagem do método de drenagem aberta usado nesta série

Lung cancer : changes in histology, gender, and age over the last 30 years in Brazil

Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Long time survival rate in lung carcinoma after surgical treatment: is gender a prognostic factor?

Introdução: À semelhança de resultados relatados por outros autores, anteriormente havíamos encontrado possível associação entre sexo e prognóstico em carcinoma brônquico não-pequenas células (CBNPC) em estágio I, com melhores taxas de sobrevida em mulheres. Objetivo: O objetivo do presente trabalho foi o de ampliar o estudo dos possíveis fatores prognósticos em CBNPC. Método: Em estudo de coorte retrospectivo, foi avaliada a sobrevida de 163 pacientes com CBNPC tratados cirurgicamente, com intenção curativa, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), entre 1990 e 1997, até o óbito ou o seguimento por cinco anos. Os dados foram analisados através de curvas de Kaplan-Meier e pelo teste de Mann-Whitney para comparar os tempos de sobrevida e pelo modelo de regressão de Cox para avaliar possíveis fatores de confusão. Resultados: Foram incluídos 124 (76,07%) homens e 39 (23,93%) mulheres. A sobrevida mediana foi 32,3 e 60,6 meses e a sobrevida em cinco anos de 38,0% e 55,4%, para homens e mulheres, respectivamente (p=0,030). Considerando apenas pacientes em Estágio I, as taxas de sobrevida foram 44,4% e 81,8% para homens e mulheres, respectivamente (p=0,009). O efeito do sexo persistiu após ajuste para vários fatores (idade, hemoglobina, histologia, tamanho do tumor, extensão da cirurgia e complicações pós-operatórias), realizado através da regressão de Cox. O risco relativo em mulheres foi 0,09 (IC90%:0,03-0,25, p<0,001) quando comparado com o de homens. Conclusão: Este estudo confirmou achados prévios de que as mulheres vivem por mais tempo após cirurgia para tratamento de CBNPC, quando comparadas aos homens. Esse efeito é observado apenas em estágio precoce e persiste após ajuste de vários fatores.Background: In agreement with other reported studies, wehad previously found a possible association between gender and prognosis in stage I non-small cell lung cancer (NSCLC), showing a higher survival rate among females. Objectives: The purpose of this study was to further clarify the role of gender as a possible prognostic factor in NSCLC. Method: In a retrospective cohort study, we examined the survival of 163 NSCLC patients who underwent curative surgical treatment at the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Hospital between 1990 and 1997. Data was analyzed using Kaplan-Meier plots. Additionally, we used the Mann-Whitney test for comparing group survival rates and the Cox regression model to adjust for potential confounding factors. Results: Were included 124 (76.07%) males and 39 (23.93%) females, whose median survival was of 32.3 and 60.6 months, respectively. The 5-year survival was 38.0% for men and 55.4% for women (P=0.030). Considering only stage I patients, survival rates were 44.4% and 81.8% for men and women, respectively (P=0.009). Effect of gender continued after adjustment for several factors (age, hemoglobin, histology, tumor size, type of surgery and postoperative complications). Conclusion: This study confirms our previous findings that women live longer after NSCLC surgery when compared to men. This result is only observed at an early stage and persists after adjustment of several factorsP

Long time survival rate in lung carcinoma after surgical treatment: is gender a prognostic factor?

Introdução: À semelhança de resultados relatados por outros autores, anteriormente havíamos encontrado possível associação entre sexo e prognóstico em carcinoma brônquico não-pequenas células (CBNPC) em estágio I, com melhores taxas de sobrevida em mulheres. Objetivo: O objetivo do presente trabalho foi o de ampliar o estudo dos possíveis fatores prognósticos em CBNPC. Método: Em estudo de coorte retrospectivo, foi avaliada a sobrevida de 163 pacientes com CBNPC tratados cirurgicamente, com intenção curativa, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), entre 1990 e 1997, até o óbito ou o seguimento por cinco anos. Os dados foram analisados através de curvas de Kaplan-Meier e pelo teste de Mann-Whitney para comparar os tempos de sobrevida e pelo modelo de regressão de Cox para avaliar possíveis fatores de confusão. Resultados: Foram incluídos 124 (76,07%) homens e 39 (23,93%) mulheres. A sobrevida mediana foi 32,3 e 60,6 meses e a sobrevida em cinco anos de 38,0% e 55,4%, para homens e mulheres, respectivamente (p=0,030). Considerando apenas pacientes em Estágio I, as taxas de sobrevida foram 44,4% e 81,8% para homens e mulheres, respectivamente (p=0,009). O efeito do sexo persistiu após ajuste para vários fatores (idade, hemoglobina, histologia, tamanho do tumor, extensão da cirurgia e complicações pós-operatórias), realizado através da regressão de Cox. O risco relativo em mulheres foi 0,09 (IC90%:0,03-0,25, p<0,001) quando comparado com o de homens. Conclusão: Este estudo confirmou achados prévios de que as mulheres vivem por mais tempo após cirurgia para tratamento de CBNPC, quando comparadas aos homens. Esse efeito é observado apenas em estágio precoce e persiste após ajuste de vários fatores.Background: In agreement with other reported studies, wehad previously found a possible association between gender and prognosis in stage I non-small cell lung cancer (NSCLC), showing a higher survival rate among females. Objectives: The purpose of this study was to further clarify the role of gender as a possible prognostic factor in NSCLC. Method: In a retrospective cohort study, we examined the survival of 163 NSCLC patients who underwent curative surgical treatment at the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Hospital between 1990 and 1997. Data was analyzed using Kaplan-Meier plots. Additionally, we used the Mann-Whitney test for comparing group survival rates and the Cox regression model to adjust for potential confounding factors. Results: Were included 124 (76.07%) males and 39 (23.93%) females, whose median survival was of 32.3 and 60.6 months, respectively. The 5-year survival was 38.0% for men and 55.4% for women (P=0.030). Considering only stage I patients, survival rates were 44.4% and 81.8% for men and women, respectively (P=0.009). Effect of gender continued after adjustment for several factors (age, hemoglobin, histology, tumor size, type of surgery and postoperative complications). Conclusion: This study confirms our previous findings that women live longer after NSCLC surgery when compared to men. This result is only observed at an early stage and persists after adjustment of several factorsP

Lung cancer : changes in histology, gender, and age over the last 30 years in Brazil

Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women

Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019

sem informação113344966

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data