Background: The objective of this study was to compare two different techniques of bronchial anastomosis in lungtransplant, assessing differences in bronchial narrowing post-surgery.Methods: The surgical team at our center switched between simple stitches to continuous suture to anastomose the anterior bronchial wall in lung transplant procedures. CT scans of the patients obtained three months after the surgery were subject to analysis. The cross section area of the airway at the point of anastomosis was compared with an average of the cross sections of the bronchus 5mm proximal and distal to the point of anastomosis, determining the anastomotic index (AI). Data of 32 bronchi anastomosed with continuous suture from 19 patients were compared to data of 37 bronchi anastomosedwith interrupted suture from 20 patients.Results: Multivariate analysis showed significant difference in bronchial diameter reduction between patients subjected to the two techniques, with no difference between the two sides in any of the groups. The bronchi anastomosed with simple stitches had a significantly larger AI than those anastomosed with running suture (mean AI 0.98 vs 0.82, p < 0.001). A significantly larger number of bronchi subjected to this method had their AI greater than 1 comparing to bronchi anastomosed with a running suture (13 vs 1, p < 0.001).Discussion: The use of simple stitches to join the anterior bronchial wall surpasses a running suture in terms of bronchial narrowing. The interrupted suture technique seems to result in a mechanical widening at the point of anastomosis.
Uma partida de futebol representa o duelo de ideais, legados históricos, princípios, credos e uma multidão de pessoas que adotam um estilo de vida que gira em torno da modalidade que cria mais laços entre as classes sociais pelo mundo. Só um breve exemplo: a definição do time de uma pessoa é tão importante para a construção de seu caráter identitário que, por vezes, alcança o mesmo patamar da escolha do nome e da religião a ser seguida. A prova disso é que, no Brasil, há muitas pessoas que sequer acompanham futebol, porém, carregam o status de possuir um 'time do coração' .Por conta de tamanho valor, assistir um jogo de futebol é prestigiar um patrimônio imaterial de uma sociedade, de uma cidade, de um estado, de uma nação ou, até mesmo, de uma comunidade, quando se trata de clubes menores e/ou amadores. Muitas vezes, o jogo em si é uma desculpa utilizada pelas pessoas para congregarem e se reunirem. Se formos levar em conta um contexto ainda mais macro, o caso da Seleção Brasileira, em jogos de Copa do Mundo, é o maior exemplo disso. Até o trabalho para, de modo que os brasileiros possam assistir à partida.Logo, presume-se que dentro da Comunicação, transmitir um jogo de futebol tornase muito mais que a exibição de isoladas imagens, mas sim, uma experiência de vida, um relato histórico e, principalmente, a geração de emoções, que vão desde às lágrimas pela derrota (ou pela vitória mesmo) até os gritos exacerbados de gol. E por mais lamentável que seja, até mesmo as brigas de torcidas estão inseridas dentro desse contexto que envolve o futebol, no sentido de externar as mais variadas nuances existentes no ser humano.Desde as primeiras formas de interação humana até a era da web, a comunicação sempre 1 Mestrando em Comunicação da Universidade do Vale do Rio dos Sinos (Unisinos)
Cystosarcoma phyllodes is an uncommon neoplasm of the breast, constituting 0.3-0.9% of all breast tumors. The incidence of malignant phyllodes tumor is even lower. The tumor is similar to fibroadenoma in structure, but it is distinguished from it histologically by large leaf-like projections of stroma with increased stromal cellularity [1]. Although surgical removal is the mainstay of treatment, the extent of surgery required (excision vs. mastectomy) and the need for additional local therapy, such as radiotherapy, are unclear [2]. We report a case of a 35 year old married woman who presented to our out patient department with a fungating, foul smelling mass in the right breast that turned out to be a malignant phyllodes tumour. The malignant variant of the cystosarcoma phllodes tumour is indeed a very rare mammary tumour.
Introduction: Among all types of transplant complications, that related to airway anastomosis, such as stenosis is still uncertain¹². Starting by the difficulty in diagnosis, such as the low precision of bronchoscopy, high cost and invasive test. This article purpose a precise and non-invasive diagnostic method of bronchial stenosis after lung transplantation based on three measures got from a reconstruction of thorax computerized tomography (CT) using a software called TeraRecon. Objective: The anastomosis index (AI), ratio of the area of the bronchial cross-section at the site of the anastomosis to the arithmetic mean of the cross-sectional areas 5 mm upstream and 5 mm downstream, obtained from reconstruction of a thorax CT has direct correlation with the bronchoscopic and clinical diagnosis of bronchial stenosis. Methods: Were obtained all cases of clinical and bronchoscopic diagnosed bronchial stenosis after lung transplantation at Heart Institute of University of São Paulo, between 2003 and 2016 (n=8). Another 8 patients, without any signs of stenosis, were selected to the control group. After that, the closest CT from the diagnostic was obtained and reconstructed using the software Terarecon, which is capable to find the exact area of any point of a cylindrical structure chosen by the operator. Then, three areas were obtained: 5mm before, at the anastomosis and 5mm after. Were calculated the Anastomosis Index (AI), which is the ratio between the area of anastomosis, and the arithmetic average of the areas 5mm before and 5mm after the anastomosis. After that, the data was confronted to variation of best FEV1 from transplantation to chosen CT and the FEV1 closest to the chosen CT. Results: As expected, in patients without bronchial stenosis, the area of the bronchi cross- section decreases linearly as it moves from proximal to distal in the bronchial tree, the AI in these cases tends to 1. Whereas, when there is no decay linear, that is, there is bronchial stenosis at the anastomosis, the AI was less than 1. There was a significant difference between AI in stenosis group (n=8, M = 0.387, SD = 0.151) and control group (n=8, M = 0.850, SD = 0.091). t(16)= -7.893 p < 0.001. This findings were supported by mean reduction of FEV1 in 17.71% and median 19.81% on stenosis group and mean reduction of 5.45%, and median 5.35% on control group. Besides that, the values undergone in a t-test, which returned a t-value = 2.879 with a p-value = 0.0129. The result is significant at p < 0.05. Conclusion: The Anastomosis Index can be useful in diagnosis of bronchial stenosis after lung transplantation, it is harmless and subsequently may help as a basis for new studies involving treatments. It is worth mentioning that is also a rational use of resources, since lower costs are generated by the CT analysis than performing a bronchoscopy, besides not requiring hospitalization and sedation, taking into account that these patients presents greater risks by the immunosuppression and other comorbidities.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.