Correlação entre Cardiomegalia pela Radiografia de Tórax e Diâmetro do Ventrículo Esquerdo pela Ecocardiografia em Pacientes com Doença de Chagas

BackgroundCardiomegaly on chest X-ray is an independent predictor of death in individuals with chronic Chagas cardiomyopathy (CCC). However, the correlation between increased cardiothoracic ratio (CTR) on chest X-ray and left ventricular end-diastolic diameter (LVEDD) on echocardiography is not well established in this population.ObjectivesTo assess the relationship between chest X-ray and LVEDD on echocardiography in patients with Chagas disease and its applicability to the Rassi score.MethodsRetrospective study on 63 Chagas disease outpatients who underwent chest X-ray and echocardiography. Cardiomegaly on chest X-ray was defined as a CTR>0.5. LVEDD was analyzed as a continuous variable. ROC curve was used to evaluate the ability of LVEDD in detecting cardiomegaly by chest X-ray, with a cut-off point defined by the highest sum of sensitivity and specificity.ResultsMedian age 61 years [interquartile range 48-68], 56% were women. CCC was detected in 58 patients, five patients had the indeterminate form of Chagas disease. Cardiomegaly was detected in 28 patients. The area under the ROC curve for LVEDD was 0.806 (95%CI: 0.692-0.919). The optimal cut-off for LVEDD was 60 mm (sensitivity = 64%, specificity = 89%). The use of LVEDD on echocardiography as a surrogate for CTR on chest X-ray changed the Rassi score values of 14 patients, with a reduction in the presumed risk in 10 of them.ConclusionLVEDD on echocardiography is an appropriate, highly specific parameter to distinguish between the presence and absence of cardiomegaly on chest X-ray in Chagas disease. (Arq Bras Cardiol. 2021; 116(1):68-74)     

Manual versus digital aspiration for first-line treatment of primary spontaneous pneumothorax. The AMVADI study: a randomized clinical trial

IntroductionThe effectiveness of needle aspiration in the initial treatment of primary spontaneous pneumothorax has been widely studied. The objective of this research was to compare digital with manual aspiration in a randomized clinical trial.MethodsWe designed a blinded parallel-group randomized clinical trial with a 1:1 allocation ratio. The clinical trial is reported in line with the guidelines of the CONSORT group. The primary outcome variables were immediate success and hospital admission, while the secondary outcome measures were relapse, re-admission and need for surgery, and length of hospital stay. A satisfaction survey was also carried out among clinicians who perform these 2 types of aspiration.ResultsA total of 67 patients were included in the study (n = 36, control group; n = 31, experimental group) with no losses to follow-up. In both groups, 58% of procedures were immediately successful, avoiding hospital admission. No differences were found in rates of relapse, re-admission, need for surgery, or length of hospital stay. Overall, 80% of clinicians who performed aspiration preferred the digital system, and this preference rose to 100% among clinicians who performed more than 5 procedures a year.ConclusionsBoth manual and digital aspiration provide good immediate results avoiding hospital admission, while digital drainage is preferred by clinicians responsible for first-line treatment of pneumothorax.     

Influencia de la presión atmosférica sobre la incidencia de neumotórax espontáneo

Background

This study analyses the relationship between the incidence of idiopathic spontaneous pneumothorax (ISP) and atmospheric pressure (AP).

Methods

A total of 288 cases of ISP were included, 229 men and 59 women. The AP of the day of diagnosis, of the 3 prior days and the monthly average was registered. The association between the incidence of ISP and AP was analyzed by calculating standardized incidence ratio (SIR) and Poisson regression.

Results

The AP on the day of admission (mean ± standard deviation) (1,017.9 ± 7 hectopascals [hPa]) was higher than the monthly average AP (1,016.9 ± 4.1 hPa) (P =.005). There was a monthly distribution pattern of ISP with the highest incidence in the months of January, February and September and the lowest in April. When AP was less than 1,014 hPa, there were fewer cases registered than what would statistically have been expected (58/72 cases). In contrast, when the pressure was higher than 1,019 hPa, the registered cases were more than expected (109/82 cases) (SIR = 1.25; 95% CI: 1.04 to 1.51). The risk of ISP increased 1.15 times (95% CI: 1.05 to 1.25, P =.001) for each hPa of AP, regardless of sex, age and monthly average AP. A dose-response relationship was observed, with progressive increases in risk (IRR = 1.06 when the AP was 1,014-1016 hPa; 1.17 hPa when the AP was 1,016-1,019 hPa and 1.69 when AP was superior to 1,019 hPa) (P for trend =.089).

Conclusion

The AP is a risk factor for the onset of idiopathic spontaneous pneumothorax.     

Cirugía toracoscópica monoportal utilizando el instrumento SILS como un método novedoso en el tratamiento quirúrgico del neumotórax

Single Incision Laparoscopic Surgery (SILS) has recently been used by general surgeons to perform cholecystectomies and pre-peritoneal hernia repairs with mesh using minimally invasive surgery, thus decreasing post-operative pain and a more cosmetic result of the surgery being obtained. We describe the first cases of video-assisted thoracic surgery (VATS) in spontaneous pneumothorax using the SILS system. There are no previous reports on the use of the SILS system in VATS for spontaneous pneumothorax. This system also allows us to obtain a more cosmetic surgical result, as well as decreasing the mean post-operative hospital stay and the need for analgesics to improve the post-operative pain.     

Neumotórax espontáneo durante la gestación

Spontaneous acute pneumothorax during pregnancy is extremely rare. A diagnosis of pneumothorax should be excluded in any pregnant women experiencing chest pain and dyspnea and must be confirmed radiographically. Treatment is the same as in non-pregnant women. Prognosis is generally good for both the mother and the fetus. We describe two cases of spontaneous pneumothorax during pregnancy with favorable maternal and perinatal outcomes.     

Neumotórax complicado en una gestante a término: tratamiento mediante cesárea y videotoracoscopia simultáneas

Spontaneous pneumothorax rarely occurs during pregnancy. The most common cause is almost always related to the presence of apical blebs or bullae. The most frequent symptoms are chest pain and dyspnea and chest radiography usually confirms the diagnosis. The treatment of choice is insertion of a chest drain and surgery should be considered in recurrent pneumothorax or persistent air leaks. The most controversial issues in spontaneous pneumothorax during pregnancy are the timing of surgery and delivery route. We describe the case of a pregnant patient in the third trimester with spontaneous pneumothorax and persistent air leaks who was successfully treated with combined elective cesarean section and videothoracoscopy in the same intervention. We believe that combined fetal extraction and videothoracoscopy in the same intervention could be a valid alternative for the definitive treatment of complicated spontaneous pneumothorax in full term pregnancies in order to avoid risks to the mother and fetus.     

Hepatotórax crônico devido à ruptura do diafragma direito: um desafio anestésico em um caso raro

Background

Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes.

Pleural Effusion and Sarcoidosis: An Unusual Combination

Pleural involvement in sarcoidosis is uncommon and appears in several forms. To document the incidence and characteristics of pleural effusion in sarcoidosis patients, a review of the cases diagnosed in our center between January 2001 and December 2012 was carried out. One hundred and ninety-five patients with sarcoidosis were identified; three (two men and one woman) presented with unilateral pleural effusion (1.5%): one in the right side and two in the left. Two were in stage II and one was in stage IV. The pleural fluid of the two patients who underwent thoracocentesis was predominantly lymphocytic. One of these patients presented chylothorax and the other had high CA-125 levels. In general, these effusions are lymphocyte-rich, paucicellular, serous exudates (sometimes chylothorax) and contain proportionally higher levels of protein than LDH. Most cases are treated with corticosteroids, although it may resolve spontaneously.     

Bilateral Chylothorax after delivery: an infrequent case treated with videothoracoscopic talc pleurodesis

Bilateral chylothorax after delivery is a highly infrequent entity. We present the case of a 28-year-old woman who developed progressive dyspnea due to bilateral milky pleural effusion several months after delivery. The effusion was found to contain chylomicrons in the biochemical analysis. Initial conservative treatment failed twice and the chylothorax was successfully treated through sequential bilateral videothoracoscopy with an interval of 6 days between the two interventions and pleurodesis with spray talc.