RESUMO Os tumores de parede torácicas são relativamente inusitados, representando 1 a 2% de todas as neoplasias, e cerca de 5% das neoplasias torácicas. Sarcomas são tumores raros e com apresentação heterogênea. São divididos em dois grandes grupos: tumores ósseos e de partes moles. A ocorrência na parede torácica é rara, representando 8% de todos os sarcomas. O tratamento de escolha é a ressecção com margens ampliadas e, quando ocorre a invasão de estruturas profundas, a toracectomia é indicada. A reconstrução do arcabouço ósseo é realizada com materiais de síntese, proporcionando estabilidade, e é seguida da reconstrução de partes moles com retalhos musculares, musculocutâneos ou locais ao acaso. Os tumores malignos primários da parede torácica correspondem a menos de 1% de todas as neoplasias e incluem grande variedade de lesões ósseas e de tecidos moles. Os condrossarcomas representam 20% dos tumores primários da parede torácica, sendo que 80% têm origem nas costelas e 20% no esterno. inusitados 2 5 heterogênea grupos rara 8 sarcomas profundas indicada síntese estabilidade musculares acaso 20 80 esterno

ABSTRACT Chest wall tumors are relatively uncommon, representing 1 to 2% of all neoplasms, and approximately 5% of thoracic neoplasms. Sarcomas are rare tumors with heterogeneous presentation. They are divided into two large groups: bone and soft tissue tumors. Occurrence in the chest wall is rare, representing 8% of all sarcomas. The treatment of choice is resection with wide margins and, when invasion of deep structures occurs, thoracotomy is indicated. The reconstruction of the bone framework is carried out with synthetic materials, providing stability, and is followed by the reconstruction of soft tissues with muscular, musculocutaneous, or random local flaps. Primary malignant tumors of the chest wall account for less than 1% of all neoplasms and include a wide variety of bone and soft tissue lesions. Chondrosarcomas represent 20% of primary tumors of the chest wall, with 80% originating in the ribs and 20% in the sternum. uncommon 2 5 presentation groups 8 sarcomas occurs indicated materials stability muscular musculocutaneous flaps lesions 20 80 sternum

RESUMO Objetivos: Avaliar os resultados precoces e tardios do tratamento cirúrgico de pacientes com bronquiectasias, comparando a Cirurgia Torácica Videoassistida (VATS) versus a toracotomia (TO). Métodos: Estudo retrospectivo observacional de pacientes submetidos à cirurgia de bronquiectasias. Os pacientes foram divididos em dois grupos de acordo com o acesso cirúrgico TO/VATS. As variáveis coletadas incluíram sexo, idade, sintomas pré-operatórios, etiologia, segmentos envolvidos, CVF e VEF1, tipo de ressecção cirúrgica, complicações, mortalidade e tempo de internação. Os resultados cirúrgicos tardios foram classificados como excelentes, remissão completa dos sintomas; bom, melhora significativa; e pobre, pouca/nenhuma melhoria. Resultados: 108 ressecções cirúrgicas (103 pacientes). Grupo TO 54 pacientes (52,4%) vs. VATS 49 (47,6%). Observou-se alto percentual de complicações, mas não foi encontrada diferença entre os grupos TO (29,6%) e VATS (24,5%). O tempo de internação pós-operatório foi menor no grupo VATS (5,4 dias) versus o grupo TO (8,7 dias) (p=0,029). 75% dos pacientes tiveram seguimento tardio; os resultados foram considerados excelentes em 71,4%, bom em 26% e ruim em 2,6%. Quanto à distribuição das bronquiectasias, o percentual excelente foi de 82,1% em pacientes com bronquiectasias localizadas e 47,5% com bronquiectasias não localizadas, p=0,003. Conclusões: VATS mostrou resultados semelhantes em relação à morbidade, comparado ao TO. No entanto, a VATS foi relacionada a internações hospitalares mais curtas, refletindo a recuperação precoce. Os resultados tardios foram excelentes na maioria dos pacientes, sendo melhores em pacientes com bronquiectasias localizadas. A VATS deve ser considerada uma abordagem preferível para a ressecção pulmonar de bronquiectasias sempre que possível. Objetivos (VATS . (TO) Métodos TOVATS TO/VATS sexo idade préoperatórios, préoperatórios pré operatórios, operatórios pré-operatórios etiologia envolvidos VEF1 VEF cirúrgica complicações significativa pobre poucanenhuma pouca nenhuma melhoria Resultados 10 103 (10 pacientes. pacientes) 5 52,4% 524 52 4 (52,4% vs 47,6%. 476 47,6% 47 6 (47,6%) Observouse Observou se 29,6% 296 29 (29,6% 24,5%. 245 24,5% 24 (24,5%) pósoperatório pós operatório 5,4 (5, dias 8,7 87 8 7 (8, p=0,029. p0029 p p=0,029 0 029 (p=0,029) 75 tardio 714 71 71,4% 26 2 2,6% 821 82 1 82,1 475 47,5 p0003 003 p=0,003 Conclusões morbidade entanto curtas precoce possível (TO (1 52,4 (52,4 47,6 (47,6% 29,6 (29,6 24,5 (24,5% 5, (5 8, (8 p002 p=0,02 02 (p=0,029 71,4 2,6 82, 47, p000 00 p=0,00 ( 52, (52, (47,6 29, (29, 24, (24,5 p00 p=0,0 (p=0,02 71, 2, (52 (47, (29 (24, p0 p=0, (p=0,0 (47 (2 (24 p=0 (p=0, (4 p= (p=0 (p= (p

ABSTRACT Objectives: To evaluate the early and late results of surgical treatment of patients with bronchiectasis, comparing the Video-Assisted Thoracic Surgery (VATS) vs. the open thoracotomy (OT). Methods: Observational retrospective study of patients who underwent surgery for bronchiectasis. Patients were divided into two groups according to surgical access OT/VATS. Variables collected included gender, age, preoperative symptoms, etiology, segments involved, FVC and FEV1, type of surgical resection, complications, mortality, and length of hospital stay. Late surgical results were classified as excellent, complete remission of symptoms; good, significative improvement; and poor, little/no improvement. Results: 108 surgical resections (103 patients). OT group 54 patients (52.4%) vs. VATS 49 (47.6%). A high percentage of complications was observed, but no difference between the OT (29.6%) and VATS (24.5%) groups was found. Post-operative hospital stay was shorter in the VATS group (5.4 days) vs. the OT group (8.7 days (p=0.029). 75% of the patients had a late follow-up; the results were considered excellent in 71.4%, good in 26%, and poor in 2.6%. Regarding bronchiectasis distribution, an excellent percentage was obtained at 82.1% in patients with localized bronchiectasis and 47.5% with non-localized bronchiectasis, p=0.003. Conclusions: VATS leads to similar results regarding morbidity, compared to OT. However, VATS was related to shorter hospital stays, reflecting the early recovery. Late results were excellent in most patients, being better in patients with localized bronchiectasis. VATS should be considered a preferable approach for bronchiectasis lung resection whenever possible. Objectives VideoAssisted Video Assisted (VATS vs . (OT) Methods OTVATS OT/VATS gender age symptoms etiology involved FEV1 FEV mortality improvement littleno little Results 10 103 (10 patients. patients) 5 52.4% 524 52 4 (52.4% 47.6%. 476 47.6% 47 6 (47.6%) observed 29.6% 296 29 (29.6% 24.5% 245 24 (24.5% found Postoperative Post operative 5.4 (5. 8.7 87 8 7 (8. p=0.029. p0029 p p=0.029 0 029 (p=0.029) 75 followup follow up follow-up 714 71 71.4% 26 26% 2 2.6% distribution 821 82 1 82.1 475 47.5 nonlocalized non p0003 003 p=0.003 Conclusions morbidity However stays recovery possible (OT (1 52.4 (52.4 47.6 (47.6% 29.6 (29.6 24.5 (24.5 5. (5 8. (8 p002 p=0.02 02 (p=0.029 71.4 2.6 82. 47. p000 00 p=0.00 ( 52. (52. (47.6 29. (29. 24. (24. p00 p=0.0 (p=0.02 71. 2. (52 (47. (29 (24 p0 p=0. (p=0.0 (47 (2 p=0 (p=0. (4 p= (p=0 (p= (p

Abstract Objective: Identify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. Methods: Retrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. Results: 56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). Conclusions: Pneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease. Objective oneyear one year Methods 1 centers analyzed demographics laterality resection 3 days Results 5 4 55%. 55 55% . (55%) 2 51% 51 (51% posttuberculosis post tuberculosis 51.8%. 518 51.8% 8 (51.8%) 286 28 6 28.6 19.2%. 192 19.2% 19 (19.2%) 363 36 36.3 pleurostomy 273 27 27.3 107 7 10.7 161 16 16.1 625 62 62.5 complication p 0.0187. 00187 0.0187 0 0187 0.0187) 30day day inhospital hospital 7.1% 71 (7.1% 92.9% 929 92 9 (92.9% 1year ( case cases) Conclusions highrisk high indications significant passed (55% (51 51.8 (51.8% 28. 19.2 (19.2% 36. 27. 10. 16. 62. 0018 0.018 018 7.1 (7.1 92.9 (92.9 (55 (5 51. (51.8 19. (19.2 001 0.01 01 7. (7. 92. (92. (51. (19. 00 0.0 (7 (92 (19 0. (9

RESUMO Objetivo: O objetivo deste estudo foi descrever os resultados de ressecções pulmonares anatômicas por videotoracoscopia no Brasil. Métodos: Cirurgiões torácicos (membros da Sociedade Brasileira de Cirurgia Torácica) foram convidados, por correio eletrônico, a participar do estudo. Dezoito cirurgiões participaram do projeto enviando seus bancos de dados retrospectivos referentes a ressecções anatômicas de pulmão por videotoracoscopia. Dados demográficos, cirúrgicos e pós-operatórios foram coletados em um instrumento padronizado e posteriormente compilados e analisados. Resultados: Dados referentes a 786 pacientes foram encaminhados (média de 43,6 ressecções por cirurgião), sendo 137 excluídos por informações incompletas. Logo, 649 pacientes constituíram nossa população estudada. A média de idade dos pacientes foi de 61,7 anos, 295 eram homens (45,5%), e a maioria - 521 (89,8%) - foi submetida à cirurgia por neoplasia, mais frequentemente classificada como estádio IA. A mediana do tempo de drenagem pleural foi de 3 dias, e a do tempo de internação, 4 dias. Dos 649 procedimentos realizados, 598 (91,2%) foram lobectomias. A taxa de conversão para toracotomia foi de 4,6% (30 casos). Complicações pós-operatórias ocorreram em 124 pacientes (19,1%), sendo pneumonia, escape aéreo prolongado e atelectasia as mais frequentes. A mortalidade em 30 dias foi de 2,0%, tendo como preditores idade avançada e diabetes. Conclusões: A casuística brasileira mostra que as ressecções pulmonares por cirurgia torácica videoassistida são factíveis e seguras, além de comparáveis àquelas de registros internacionais.

ABSTRACT Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

OBJETIVO: O objetivo foi desenvolver um modelo de tumor de pulmão em rato que permita o teste de fármacos no tratamento deste câncer. MÉTODOS: Sessenta e dois ratos Wistar fêmeas, peso médio de 208±20 g, foram anestesiados com tribromo-etanol 2,5% IP (1ml/100g de rato), traqueostomizados e intubados com cateter ultrafino para injetar células do tumor de Walker. Na 1ª etapa, estabeleceu-se a técnica do implante de células tumorais por via intrabrônquica e o índice de pega tumoral, usando-se de 10(5) a 5×10(5) células. Na 2ª, avaliou-se o volume tumoral e a correlação dos achados obtidos na tomografia computadorizada de alta resolução (TCAR) de tórax com os da necropsia e verificou-se a sobrevida. RESULTADOS: O índice de pega foi de 94,7, com o implante de 4×10(5) células do tumor; as medidas do tumor feitas na TCAR e comparadas com as da necropsia foram semelhantes (r=0, 953, p<0,0001); a sobrevida mediana foi de 11 dias; e a mortalidade cirúrgica de 4,8 %. CONCLUSÃO: O modelo mostrou-se viável, com alto índice de pega, mortalidade cirúrgica desprezível, de execução simples e fácil reprodutibilidade. A TCAR revelou alta acurácia no diagnóstico, localização e mensuração das lesões tumorais, credenciando-se para a monitorização de crescimento tumoral nesse modelo.

PURPOSE: The objective of this study was to develop a rat lung tumor model for anticancer drug testing. METHODS: Sixty-two female Wistar rats weighing 208 ± 20 g were anesthetized intraperitoneally with 2.5% tribromoethanol (1 ml/100 g live weight), tracheotomized and intubated with an ultrafine catheter for inoculation with Walker's tumor cells. In the first step of the experiment, a technique was established for intrabronchial implantation of 10(5) to 5×10(5) tumor cells, and the tumor take rate was determined. The second stage consisted of determining tumor volume, correlating findings from high-resolution computed tomography (HRCT) with findings from necropsia and determining time of survival. RESULTS: The tumor take rate was 94.7% for implants with 4×10(5) tumor cells, HRCT and necropsia findings matched closely (r=0.953; p<0.0001), the median time of survival was 11 days, and surgical mortality was 4.8%. CONCLUSION: The present rat lung tumor model was shown to be feasible: the take rate was high, surgical mortality was negligible and the procedure was simple to perform and easily reproduced. HRCT was found to be a highly accurate tool for tumor diagnosis, localization and measurement and may be recommended for monitoring tumor growth in this model.

OBJETIVO: Desenvolver um modelo de tumor pulmonar em ratos com o carcinossarcoma de Walker e verificar in vivo a presença de tumor por meio de tomografia computadorizada (TC). MÉTODOS: Ratos Wistar fêmeas (n=47) foram anestesiados com pentobarbital, intubados por traqueostomia e submetidos a toracotomia para injeção no parênquima pulmonar de células do tumor de Walker ou do veículo das mesmas. O estudo consistiu de duas etapas: na primeira desenvolveu-se a técnica de implante do tumor e estabeleceu-se o número de células necessário para um bom índice de pega tumoral. Na segunda etapa, determinou-se o volume do tumor em cm³ (Dxd²/2) através de TC e necropsia (6° dia do implante), e analizou-se a sobrevida dos animais. RESULTADOS: O índice de pega do tumor foi 93,3%, sendo 81,8% na primeira etapa e 100% na segunda. A mortalidade cirúrgica foi 17,0%. As medidas dos tumores foram semelhantes (0,099 vs. 0,111 cm³) na tomografia e na necropsia, respectivamente (r=0,993; p<0,0001) e a sobrevida mediana foi 10 dias. CONCLUSÃO: O alto índice de pega e a boa correlação dos dados de tomografia com os de necropsia permitem, por meio deste modelo, o monitoramento tomográfico do crescimento tumoral e, portanto, a avaliação da ação in vivo de drogas anti-tumorais, além da análise de sobrevida sem a necessidade do sacrifício dos animais.

OBJECTIVE: To develop a lung tumor model in rats using Walker’s carcinosarcoma and to verify the presence in vivo of tumors using computerized tomography (CT). METHODS: Female Wistar rats (n=47) were anesthetized with pentobarbital, intubated through tracheostomy and submitted to thoracotomy; subsequently a 50-70 mu L volume containing Walker’s tumor cells, or the suspension of these same cells, was injected into the lung parenchyma. The study consisted of two phases: in the first a tumor implantation technique was developed and the number of cells required to attain a satisfactory tumor development rate was established. In the second phase, the tumor volume in cm³ (Dxd²/2) was determined through CT scan and necropsis, and the survival rates were analyzed. RESULTS: The overall tumor development rate was 93.3%, or rather, 81.1% in the first phase and 100% in the second. The surgical mortality rate was 17.0%. The average tumor volume was similar (0.099 vs. 0.111 cm³) at CT scan and at necropsis, respectively (r=0.993; p<0.0001). The survival average was about 10 days. CONCLUSION: The high tumor development rate observed and the close correlation between the figures obtained through CT scan and necropsis allow for tomographical tumor growth monitoring and thereby for evaluation of the action of anti-tumor drugs in vivo as well as for analysis of survival rates without the need for sacrificing animals.

A bronquiectasia, doença rara no Primeiro Mundo, tem alta prevalência nos países em desenvolvimento. No Brasil, as principais causas são infecções respiratórias, virais ou bacterianas na infância e tuberculose. A antibioticoterapia diminui consideravelmente a morbidade, mas nos pacientes com sintomatologia persistente, a ressecção cirúrgica oferece maior possibilidade de cura ou melhor qualidade de vida. Objetivos: Avaliar prospectivamente o perfil clínico-epidemiológico de pacientes com bronquiectasia e o resultado do tratamento cirúrgico em dois hospitais da rede pública de saúde de Fortaleza (CE), na região Nordeste do Brasil. Casuística e método: Foram estudados dados demográficos, etiologia da doença e complicações e sucesso terapêutico da cirurgia de 67 portadores de bronquiectasia operados de agosto de 1989 a março de 1999. Resultados: Os pacientes, 39 mulheres e 28 homens, tinham idade média de 32,5 ± 14,1 anos e as causas mais freqüentes da bronquiectasia foram infecções bacterianas ou virais (44,8%) e tuberculose (31,3%). A doença era localizada em 46 pacientes e multissegmentar em 21, sendo bilateral em seis. Não houve óbito cirúrgico e as complicações pós-operatórias foram mais freqüentes nos pacientes com bronquiectasia multissegmentar (9/21 versus 6/46, p = 0,011). Dos 62 pacientes com seguimento, 49 foram curados, dez melhoraram e três não obtiveram benefícios. O resultado foi excelente em 39 pacientes com doença localizada e em dez com doença multissegmentar (p < 0,001). Conclusão: O resultado mostra dois grupos distintos de pacientes: os com bronquiectasia localizada, que apresentam menos complicações cirúrgicas e melhores resultados pós-operatórios, e os com bronquiectasia multissegmentar.

Bronchiectasis is a disease which is rarely found in developed countries and has a high incidence in developing countries. In Brazil, the most frequent causes are viral or bacterial respiratory infections in childhood, and tuberculosis. Antibiotic therapy considerably reduces morbidity. However, in patients with persistent symptoms, surgical resection offers greater chances of cure or better quality of life. Objectives: Prospectively evaluate the clinical-epidemiological profile of patients with bronchiectasis as well as the results of surgical treatment in patients from two public hospitals in Fortaleza (CE), northeastern Brazil. Patients and method: Sixty-seven patients with bronchiectasis submitted to surgery between August 1989 and March 1999 were evaluated, as well as demographic data, etiology of the disease, complications, and therapeutic success rate. Results: Mean age of patients (39 females e 28 males) was 32.5 ± 14.1 years. The most frequent causes of bronchiectasis were viral or bacterial infection (44.8%) and tuberculosis (31.3%). The disease was localized in 46 patients and multisegmental in 21. In six patients it was bilateral. No surgical death occurred and postoperative complications were more frequent in patients with multisegmental bronchiectasis (9/21 versus 6/46, p = 0.011). From the 62 patients who were followed up, 49 were cured, 10 showed improvement, and 3 did not obtain any benefit. Results were excellent in 39 patients with localized bronchiectasis and in 10 patients with the multisegmental form of the disease (p < 0.001). Conclusion: Results show two distinct groups of patients: those with bronchiectasis, who presented fewer surgical complications and better postoperative results, and those with multisegmental bronchiectasis.