the radiomics characterization approach presented great potential to be used in a computational model to aid lung cancer histopathological subtype diagnosis as a "virtual biopsy" and metastatic prediction for therapy decision support without the necessity of a whole-body imaging scanning.

No abstract

Lung cancers may extend along or grow through the pulmonary veins to invade or lie within the left atrium (LA). A 62-year-old man, previously healthy, presented with 1-month ventilatory-independent right hemithorax back pain, dry cough and large effort dyspnea. He also referred weight loss of 12 kg in 10 months and denied hemoptysis. As antecedents, he smoked for 40 years and moderate daily alcoholism. On physical examination, the patient was in good general condition, hydrated and regular respiration at rest [blood pressure (BP) =120/80 mmHg; heart rate (HR) =90 bpm; respiratory rate (RR) =16 rpm]. Cardiac auscultation revealed two standard rhythmic sounds without murmurs. Pulmonary auscultation revealed a slightly diminished vesicular murmur in the lower 1/3 of the right hemithorax without adventitious noises. Chest radiography showed a mass over the right lower lung. A CT scan confirmed the radiography image with the mass extending along the right inferior pulmonary vein and a tumor in the LA. Transthoracic and transesophageal echocardiography revealed large mass within the LA (occupying almost the entire cavity), measuring about 10 cm × 3 cm at its largest diameter, prolapsing into the left ventricle. Bronchoscopy, head CT scan, and whole-body bone scintigraphy investigation did not show any distant metastasis. The patient was successfully operated removing the intracardiac and inferior pulmonary vein tumor with the aid of cardiopulmonary bypass, followed by a right inferior lobectomy carried out after 25 days. After 30 days from surgery presented seizures associated a brain metastasis evidenced by CT when adjuvant radio and chemotherapy was started. During the next 90 days, the clinical conditions worsened, and the patient died 4 months after the surgical treatment. The case report has two primary justifications, even considering the poor outcome: (I) rarity and (II) the possibility of the surgical treatment.

This study aimed to investigate the mobility, pain, and disability of the shoulders after different pulmonary surgical procedures.It is a cross-sectional prospective study. A total of 38 patients who underwent lung surgery via thoracotomy (mean age = 57 ± 10 years) were evaluated in the preoperative period, and first and second postoperative days were assessed for range of motion of shoulder; pain intensity; and application of the Shoulder Pain and Disability Index questionnaire. This study compared the 3 days of evaluation, and the subgroups according to the resection area (biopsy/nodulectomy, lung segmentectomy and lobectomy).There was a decrease of flexion (153° ± 16°–98° ± 23°), abduction (151° ± 20°–126° ± 38°), and increased Shoulder Pain and Disability Index (2.4–44.3) in the shoulder ipsilateral to surgery from the preoperative to the first postoperative day (P < 0.05). There was a greater loss of ipsilateral flexion and abduction in the lobectomy subgroup (P < 0.05), and decreased abduction of the contralateral shoulder in the lung segmentectomy and lobectomy subgroups (P < 0.05).After pulmonary surgery, there is bilateral impairment in shoulder range of motion, with greater limitation on ipsilateral shoulder, and larger resections.

A drenagem pleural é procedimento cirúrgico largamente utilizado na prática médica diária, que permite o restabelecimento das pressões negativas no espaço pleural. Apesar de ser considerado ato relativamente simples, poderá levar à graves complicações devido a falta de cuidados que precisam ser respeitados. Procuramos ressaltar alguns aspectos que, se não respeitados no seu conjunto, acabam determinando o insucesso dos procedimentos de drenagem de tórax. A drenagem pleural é um procedimento médico largamente empregado na prática médica diária, em situações eletivas e de emergência. Considerado como ato relativamente simples, poderá levar a severas complicações devido à falta de cuidados que precisam ser respeitados. Como o procedimento é usado em diferentes especialidades médicas, não apenas sua instalação, mas também seu controle são frequentemente, atribuições de não especialistas em cirurgia torácica. PalavrasDesta forma, procuramos, de maneira simplificada, ressaltar alguns aspectos que, se não respeitados no seu conjunto, acabam determinando o insucesso dos procedimentos de drenagem de tórax.1. Introdução 1. Introdução 1. Introdução 1. Introdução 1. Introdução O fator responsável pela entrada e saída de ar dos pulmões é o gradiente de pressão gerado pela movimentação da caixa torácica. Esse gradiente, transmitido através do espaço pleural (espaço compreendido entre as pleuras parietal e visceral) que mantém sempre uma pressão negativa, faz com que mesmo em repouso os pulmões permaneçam expandidos. E a pressão pleural que é de -4 cm de H 2 O na expiração vai a -8 cm de H 2 O na inspiração, em condições normais (Figura 1).Inúmeras causas como traumas, atos cirúrgi-cos e doenças pleurais podem provocar acumulo de gás ou líquido na cavidade pleural alterando esse sistema pressórico, determinando colapso pulmonar e insuficiência respiratória de intensidade varável (Figura 2).