Mondor's disease in puerperium: case report

Mondor's disease is a rare entity characterized by sclerosing thrombophlebitis classically involving one or more of the subcutaneous veins of the breast and anterior chest wall. It is usually a self-limited, benign condition, despite of rare cases of association to cancer. We present the case of a 32 year-old female, breast-feeding, who went to emergency due to left mastalgia for the past week. She was taking antibiotics and non-steroidal anti-inflammatory drugs, previously prescribed for suspicious of mastitis, for three days, with no clinical improvement. Physical examination showed an enlarged left breast, an axillary lump and a painful cord-like structure in the upper outer quadrant of the same breast. Ultrasound scan showed a markedly dilated superficial vein in the upper outer quadrant of left breast. The patient was given a ventropic therapy and was kept in anti-inflammatory, with progressive pain improvement. Ultrasound control was performed after four weeks, showing reperfusion.

Respiratory mechanics and morphometric changes during anesthesia with ketamine in normal rats

Ketamine is believed to reduce airway and pulmonary tissue resistance. The aim of the present study was to determine the effects of ketamine on the resistive, elastic and viscoelastic/inhomogeneous mechanical properties of the respiratory system, lungs and chest wall, and to relate the mechanical data to findings from histological lung analysis in normal animals. Fifteen adult male Wistar rats were assigned randomly to two groups: control (N = 7) and ketamine (N = 8). All animals were sedated (diazepam, 5 mg, ip) and anesthetized with pentobarbital sodium (20 mg/kg, ip) or ketamine (30 mg/kg, ip). The rats were paralyzed and ventilated mechanically. Ketamine increased lung viscoelastic/inhomogeneous pressure (26%) compared to the control group. Dynamic and static elastances were similar in both groups, but the difference was greater in the ketamine than in the control group. Lung morphometry demonstrated dilation of alveolar ducts and increased areas of alveolar collapse in the ketamine group. In conclusion, ketamine did not act at the airway level but acted at the lung periphery increasing mechanical inhomogeneities possibly resulting from dilation of distal airways and alveolar collapse.

Three-dimensional conformal breast irradiation in the prone position

The prone position can be used for the planning of adjuvant radiotherapy after conservative breast surgery in order to deliver less irradiation to lung and cardiac tissue. In the present study, we compared the results of three-dimensional conformal radiotherapy planning for five patients irradiated in the supine and prone position. Tumor stage was T1N0M0 in four patients and T1N1M0 in one. All patients had been previously submitted to conservative breast surgery. Breast size was large in three patients and moderate in the other two. Irradiation in the prone position was performed using an immobilization foam pad with a hole cut into it to accommodate the breast so that it would hang down away from the chest wall. Dose-volume histograms showed that mean irradiation doses reaching the ipsilateral lung were 8.3 ± 3.6 Gy with the patient in the supine position and 1.4 ± 1.0 Gy with the patient in the prone position (P = 0.043). The values for the contralateral lung were 1.3 ± 0.7 and 0.3 ± 0.1 Gy (P = 0.043) and the values for cardiac tissue were 4.6 ± 1.6 and 3.0 ± 1.7 Gy (P = 0.079), respectively. Thus, the dose-volume histograms demonstrated that lung tissue irradiation was significantly lower with the patient in the prone position than in the supine position. Large-breasted women appeared to benefit most from irradiation in the prone position. Prone position breast irradiation appears to be a simple and effective alternative to the conventional supine position for patients with large breasts, since they are subjected to lower pulmonary doses which may cause less pulmonary side effects in the future.

Is Breast Asymmetry Present in Girls with Adolescent Idiopathic Scoliosis?

Study Design Cross-sectional descriptive study. Objectives To characterize breast asymmetry (BA), as defined by breast volume difference, in girls with significant adolescent idiopathic scoliosis (AIS), using magnetic resonance imaging (MRI). Summary and Background BA is a frequent concern among girls with AIS. It is commonly believed that this results from chest wall deformity. Although many women exhibit physiological BA, the prevalence is not known in adolescents and it remains unclear if it is more frequent in AIS. Breasts vary in shape and size and many ways of measuring them have been explored. MRI shows the highest precision at defining breast tissue. Methods Thirty patients were enrolled on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception on their BA. MRI acquisitions were performed in prone with a 1.5-Tesla system using a 16-channel breast coil. Segmentation was achieved using the ITK-SNAP 2.4.0 software and subsequently manually refined. Results The mean left breast volume (528.32 ± 205.96 cc) was greater compared with the mean right breast volume (495.18 ± 170.16 cc) with a significant difference between them. The mean BA was found to be 8.32% ± 6.43% (p < .0001). A weak positive correlation was observed between BA and thoracic Cobb angle (0.177, p = .349) as well as thoracic gibbosity angle (0.289, p = .122). The left breast was consistently larger in 65.5% of the patients. Twenty patients (66.7%) displayed BA ≥5%. Conclusions We have described BA in patients with significant AIS using MRI. This method is feasible, objective, and very precise. The majority of patients had a larger left breast, which could compound the apparent BA secondary to trunk rotation. In many cases, BA is present independently of thoracic deformity. This knowledge will assist in counseling AIS patients in regards to their concerns with BA.

Components Separation Technique With Limited Subcutaneous Undermining A Cadaver Study

The purpose of this study is to evaluate the influence of the undermining of the subcutaneous tissue on the tension of the abdominal wall, after the components separation of the abdominal muscles. Twenty adult cadavers were studied. The resistance of the medial advancement of both anterior and posterior recti sheaths was represented by the traction index and measured in 2 levels-3 cm above and 2 cm below the umbilicus. Traction indices were compared in the following 3 consecutive dissection situations: (1) after the subcutaneous tissue undermining laterally to the semilunaris line; (2) after the dissection of the rectus muscle from its posterior sheath associated with the release of the external oblique muscle; (3) after the subcutaneous tissue undermining laterally to the anterior axillary line. Friedman and Spearman tests were used to compare the results. There was no statistical significant difference between the subcutaneous tissue undermining laterally to the semilunaris line and that laterally to the anterior axillary line, when associated with the musculoaponeurotic dissections. In conclusion, limited subcutaneous undermining does not influence the tension of closure of the musculoaponeurotic layer after the components separation technique in cadavers.

Analgesia em pós-operatório de toratomias : estudo prospectivo e randomizado

Introdução: A dor é um importante fator de incremento da morbidade e mortalidade em pacientes submetidos a procedimentos cirúrgicos que incluem toracotomias. Diversos fatores contribuem para que esses pacientes apresentem um alto grau de dor no pós-operatório, entre os quais a secção da pele, músculos e pleura, retração dos músculos e ligamentos pelo afastador de Finochietto, irritação da pleura e nervos intercostais pelos drenos tubulares torácicos e fraturas ocasionais dos arcos costais. O aumento das taxas de morbidade e mortalidade é dado principalmente à respiração superficial decorrente da pouca mobilidade da parede torácica e conseqüente à dor e pela perda da efetividade do principal mecanismo de eliminação de secreções da árvore traqueobrônquica (tosse), resultando em atelectasias, inadequado gradiente ventilação / perfusão, hipoxemia e pneumonia. Uma vez caracterizada a necessidade de atenuação da dor como fator primordial na melhora dos índices de morbidade e mortalidade no período pós-operatório de cirurgia torácica, torna-se imperiosa uma análise das terapêuticas disponíveis na atualidade para tanto. Objetivos: Avaliar a utilização de três diferentes métodos de analgesia: 1. bloqueio peridural com morfina (BPM); 2. morfina parenteral (MP); e 3. bloqueio intercostal extrapleural contínuo com lidocaína” (BIC), em pacientes submetidos a procedimentos que incluíram toracotomias em sua execução, além de analisar o custo financeiro desses métodos. Materiais e métodos: Trata-se de um estudo prospectivo, randomizado, no qual foram analisados 79 pacientes, submetidos a toracotomias, subdivididos de forma aleatória em três grupos, de acordo com a modalidade terapêutica instituída: 25 pacientes no grupo BIC, 29 pacientes no grupo BPM e 25 pacientes no grupo MP. Cada paciente foi observado e analisado por profissionais de enfermagem previamente treinados. As variáveis analisadas foram a dor e a sedação. (quantificadas através de escores e analisadas através do método de Kruskal-Wallis com correção pelo teste de Dunn), além do custo financeiro de cada método e da necessidade de administração de opióides adicionais. Resultados: As variáveis dor e sedação foram obtidas através das seguintes medianas, respectivamente: grupos BIC (2,5 e 0); BPM (4 e 0) e MP (3,5 e 0). O custo financeiro foi de US$ 78,69 para o grupo BIC; US$ 28,61 para o grupo BPM e US$ 11,98 para o grupo MP. A necessidade adicional de opióide foi de 4,2 mg/dia para o grupo BIC; 5,7 mg/dia para o grupo BPM e 10,7 mg/dia para o grupo MP. Conclusões: A intensidade da dor foi significativamente menor no grupo BIC, quando comparado ao grupo MP. Não foram identificadas diferenças significativas de intensidade da dor quando comparados os grupos BIC versus BPM e BPM versus MP. A intensidade de sedação foi significativamente maior no grupo MP quando comparado aos grupos BIC e BPM. Não foram evidenciadas diferenças significativas quanto à sedação entre os grupos BIC e BPM. O custo financeiro do grupo MP foi sensivelmente menor quando comparado aos grupos BIC e BPM. A necessidade adicional de morfina foi significativamente maior no grupo MP, quando comparados aos grupos BIC e BPM.

Ánálise da capacidade funcional e da distribuição regional da ventilação pulmonar em pacientes com doença de chagas

INTRODUCTION: Cardiac and pulmonary manifestations of the Chagas disease (CD) affect between 20-30% of the infected subjects. The chronic Chagas cardiomyopathy (CCC) has some peculiarities such as arrhythmias and, especially heart failure (HF) and is potentially lethal due to left ventricular dysfunction. How respiratory disorders, patients get progressive loss of functional capacity, which contributes to a poor quality of life related to disease. Measurements of lung volume by the movement of the chest wall surface are an alternative evaluation of lung function and kinematics of complex thoracoabdominal for these patients. OBJECTIVE: evaluate the kinematics of the thoracoabdominal complex through the regional pulmonary volumes and to correlate with functional evaluation of the cardiorrespiratory system in patients with Chagas disease at rest. MATERIALS AND METHODS: a cross-section study with 42 subjects had been divided in 3 groups, 15 composed for patients with CCC, 12 patients with HF of different etiologies and 15 healthful presented control group. An optoelectronic plethysmography (POE), Minnesota questionnaire, six minute walk test, spirometer and manovacuometer was used. RESULTS: It was observed in the 6MWT where group CRL presented greater distance 464,93±44,63m versus Group HF with 399,58± 32,1m (p=0,005) and group CCC 404±68,24m (p=0,015), both the groups presented difference statistics with regard to Group CRL. In the manovacuometer 54,59±19,98; of the group CCC and 42,11±13,52 of group IC found group CRL presented 81,31±15,25 of the predicted versus, presenting in relation to group CRL. In the POE it observed a major contribution in abdominal compartment in patients with IC if compared like CCC and control groups. On the basis of the questionnaire of quality of life of Minessota, verified a low one groups CCC and IC 43,2±15,2 and 44,4±13,1, respectively (p<0,05) when compared with the control group (19,6±17,31). CONCLUSION: it seems that the patients with CCC possess same functional and respiratory characteristics, observed for the POE, 6MWT, manovacuometer and spirometer to the patients of group HF, being able to consider similar interventions for this complementary group as therapeutical of this neglected disease

Efeitos da perda de peso induzida pela cirurgia bariátrica sobre a função respiratória

Background: Obesity leads to alteration of lung volumes and capacities due to accumulation of fat in the chest wall and abdomen. Few studies have shown that weight loss induced by surgery improves lung function. Our objective was to evaluate the anthropometric development, pulmonary function, respiratory muscle, strength and endurance after weight loss induced by bariatric surgery. Methods: We evaluated in pre and post operative period variables of weight, BMI, NC, WHR and spirometric and respiratory pressure. Results: 39 subjects were evaluated, with age mean 35.9 ± 10.9 years, predominantly by women (76.3%). The weight mean decreased from 124.8 ± 17.5 kg to 88.8 ± 14.28 kg in post operative. The mean BMI ranged from 47,9 ± 5,6 Kg/m² to 34,3 ± 4,75 Kg/m². There was a significant increase in FVC from 3,63 ± 0,94 to 4,01±1,03, FEV1 from 3,03 ± 0,72 to 3,39 ± 0,85, FEF 25-75% from 3,41 ± 0,72 to 3,82 ± 0,94, PEF from 6,56 ± 1,47 to 7,81 ± 1,69, ERV from 0,35 ± 0,39 to 0,66 ± 0,38, MVV ranged from 103,43 ± 22,21 to 137,27 ± 29,84, all of them to p<0,01. The MIP and MEP showed no significant difference in pre and post operative. It was noted that for every centimeter reduced in neck circumference, an increase of 0.06 in FVC and 5.98 in MVV is observed. This is also observed in weight and BMI. Conclusion: We conclude that weight loss induced by bariatric surgery in obese provides a significant improvement in lung function and reduction of fat around the neck is more important in the generation of lung volume than the reduction of BMI

Avaliação da cinemática do complexo tóracoabdominal durante repouso e endurance muscular respiratória em obesos

Background: Obesity may affect the respiratory system, causing changes in respiratory function and in the pulmonary volumes and flows. Objectives: To evaluate the influence of obesity in the movement of thoracoabdominal complex at rest and during maximal voluntary ventilation (MVV), and the contribution between the different compartments of this complex and the volume changes of chest wall between obese and non-obese patients. Materials and Methods: We studied 16 patients divided into two groups: the obese group (n = 8) and group non-obese (n = 8). The two groups were homogeneous in terms of spirometric characteristics (FVC mean: 4.97 ± 0.6 L - 92.91 ± 10.17% predicted, and 4.52 ± 0.6 L - 93.59 ± 8.05%), age 25.6 ± 5.0 and 26.8 ± 4.9 years, in non-obese and obese respectively. BMI was 24.93 ± 3.0 and 39.18 ± 4.3 kg/m2 in the groups investigated. All subjects performed breathing calm and slow and maneuver MVV, during registration for optoelectronic plethysmography. Statistical analysis: we used the unpaired t test and Mann-Whitney. Results: Obese individuals had a lower percentage contribution of the rib cage abdominal (RCa) during breathing at rest and VVM. The variation of end expiratory (EELV) and end inspiratory (EILV) lung volumes were lower in obese subjects. It has been found asynchrony and higher distortion between compartments of thoracoabdominal complex in obese subjects when compared to non-obese. Conclusions: Central obesity impairs the ventilation lung, reducing to adaptation efforts and increasing the ventilatory work

Implante lobar autólogo pós pneumonectomia: modelo experimental em cães

OBJETIVO: Estudar no implante lobar autólogo a eficiência da anastomose brônquica simples, a perfusão pulmonar e as complicações devido a desproporção doador/receptor. MÉTODOS: Estudou-se 15 cães submetidos à pneumonectomia esquerda, e reimplante do lobo caudal. Estudou-se a perfusão pulmonar e a anastomose brônquica, respectivamente, por cintilografia e por broncografia. O sacrifício ocorreu aproximadamente 200 dias após a cirurgia para o estudo das anastomoses e medidas de volumes e pesos pulmonares. RESULTADOS: Quatro cães foram a óbito, um por deiscência precoce de anastomose brônquica, 1 com infecção e outros 2 por infarto pulmonar devido a oclusão da veia pulmonar no local da anastomose. A perfusão relativa do pulmão direito e esquerdo foram em média respectivamente 72,7% e 27,3%. A broncografia não mostrou nem estenose nem outras alterações na anastomose brônquica. No momento do sacrifício o lobo caudal ocupava totalmente a cavidade pleural sem que houvesse evidentes desvios do mediastino. CONCLUSÕES: O estudo mostrou que a sutura brônquica término-terminal desprotegida não levou a complicações anastomóticas. Não houve complicações pelo fato do lobo implantado ter ocupado somente metade da cavidade pleural. As complicações mais importantes foram o infarto pulmonar e deiscência total da parede torácica. Tanto a broncografia como a cintilografia se mostraram eficientes respectivamente, para o estudo da anastomose brônquica e da perfusão relativa do pulmão funcionante in vivo.

Ultrassonografia torácica extracardíaca em pequenos animais

Until recently, ultrasonography was not considered one of the prevailing imaging methods for thoracic evaluation due to its limitations in evaluating lesions located below thoracic gas collections in individuals with normal lung tissue as well as in those with pneumothorax. Nevertheless, ultrasound has an advantage over other imaging techniques. It allows not only differentiating pleural from pulmonary lesions, but also identifying and assessing peripheral pulmonary lesions. Thus, thoracic ultrasound has become more popular in Veterinary Medicine as an ancillary method in the diagnosis and treatment of several diseases of the thoracic cavity, especially in emergency settings. This review aims at providing information on the main alterations found in the chest wall, mediastinum, pleura, lung and diaphragm by means of ultrasonography.

Cloreto de sódio a 0,9%, adicionado ou não de dexametasona, intrapleural, na prevenção de aderências pulmonares após toracotomia intercostal em cães

Pulmonary adhesions in dogs are a common sequel after surgical intervention, undermining any interventions. This study aimed to determine in dogs, the efficacy of sodium chloride solution 0.9% with or without dexamethasone in order to prevent adhesions after intercostal thoracotomy. Fifteen dogs were separated into three groups of five animals, A, B and C and underwent thoracotomy in the fifth left intercostal space. Three other dogs were submitted to a previous study. In the dogs of Group A it was performed only a thoracotomy and thoracorraphy; in group B, it was performed a thoracotomy, thoracorraphy and injection into the pleural cavity of isotonic sodium chloride (10ml) and dexamethasone (1mg kg-1). In the dogs of the group C, it was performed the thoracotomy thoracorraphy and injected isotonic sodium chloride (10ml kg-1) into the pleural cavity. After 15 days of thoracotomy, it was performed transdiaphragmatic thoracocospy to determine the presence and score of adhesions between the lung and chest wall. The results demonstrated the presence of adhesions in the majority of group A and reduced or no adhesions in the other groups. For statistical evaluation, it was pplied the chi-square test with significance level of 5% (P≤0.05). The sodium chloride solution 0.9% with or without dexamethasone in the pleural space prevented or reduced lung adhesions after intercostal thoracotomy.

Uso intrapleural de solução de cloreto de sódio 0,9%, adicionada ou não de dexametasona, na prevenção de aderências pulmonares após toracotomia intercostal em cães

Pós-graduação em Cirurgia Veterinária - FCAV

Valor prognóstico da cintilografia de mamas com Sestamibi-99mTc na predição da resposta do tumor localmente avançado da mama a quimioterapia neoadjuvante

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

A new tuning fork with different vibration frequencies as an aid to bronchopulmonary hygiene physiotherapy

Background: The main function of the mucociliary system is the removal of particles or substances that are potentially harmful to the respiratory tract. The tuning fork therapeutic for the purpose of bronchial hygiene has still not been described in the literature. The optimal vibration frequency to mobilize secretions is widely debated and varies between 3 and 25 Hz. It is expected that a tuning fork is able to generate vibrations in the thorax, facilitating bronchial hygiene. The aim of the present study is to develop tuning forks with different frequencies, for use in bronchopulmonary hygiene therapy. Methods: The first tuning fork was made with a fixed frequency of 25 Hz and it was recorded in the Brazilian institution of patent registration. This device generated a frequency of 25 Hz and had a weight of 521 g, with dimensions of 600 mm in total length. The device is characterized by a bottom end containing a transducer with a diameter of 62 mm and a thickness of 5/16 mm (8''), a rod removable 148 mm, fork length of 362 mm and an extension at the upper end of sinuous shape bilaterally.The tuning forks must be applied at an angle of 90° directly on the chest wall of the patient after pulmonary auscultation for location of secretions. The tuning fork is activated by squeezing the tips of the extensions together and releasing them in a sudden movement. Results: This study shows the result of the development of others three tuning forks of different dimensions to generate different frequencies. Each equipment reaches a fixed frequency preset of 12, 15 and 20 Hz measured by digital oscilloscope. Conclusions: The tuning fork models developed in this study generated different frequencies proposed by the scientific literature as effective in the mobilization of pulmonary secretions.