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Abstract Background: Patients using immunosuppressive drugs may have unfavorable results after infections. However, there is a lack of information regarding COVID 19 in these patients, especially in patients with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the risk factors associated with COVID 19 hospitalizations in patients with RA. Methods: This multicenter, prospective cohort study is within the ReumaCoV Brazil registry and included 489 patients with RA. In this context, 269 patients who tested positive for COVID 19 were compared to 220 patients who tested negative for COVID 19 (control group). All patient data were collected from the Research Electronic Data Capture database. Results: The participants were predominantly female (90.6%) with a mean age of 53 ±12 years. Of the patients with COVID 19, 54 (20.1%) required hospitalization. After multiple adjustments, the final regression model showed that heart disease (OR =4.61, 95% CI 1.06–20.02. P < 0.001) and current use of glucocorticoids (OR =20.66, 95% CI 3.09–138. P < 0.002) were the risk factors associated with hospitalization. In addition, anosmia was associated with a lower chance of hospitalization (OR =0.26; 95% CI 0.10–0.67, P < 0.005). Conclusion: Our results demonstrated that heart disease and the use of glucocorticoids were associated with a higher number of hospital admissions for COVID 19 in patients with RA. Trial registration: Brazilian Registry of Clinical Trials RBR 33YTQC.

https://doi.org/10.1186/s42358-022-00244-5

Vacinas para covid-19 e complicações tromboembólicas
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Sobreira, Marcone Lima

; Ramacciotti, Eduardo

; Paschôa, Adilson Ferraz

; Matielo, Marcelo Fernando

; Casella, Ivan Benaduce

; Yazbek, Guilherme

; Soares, Raphael de Athayde

; Bellen, Bonno van

; Marques, Marcos Arêas

Jornal Vascular Brasileiro

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2021, Volume 20 elocation e20210167

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1677-5449.210167 1 downloads

An alternative approach to treatment of inferior vena cava filter perforation
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Krutman, Mariana

; Yazbek, Guilherme

; Nishinari, Kenji

; Pignataro, Bruno Soriano

; Bomfim, Guilherme Andre Zottele

; Cavalcante, Rafael Noronha

; Centofanti, Guilherme

; Fonseca, Igor Yoshio Imagawa

Jornal Vascular Brasileiro

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2020, Volume 19 elocation e20180131

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Relatamos um caso de perfuração de veia cava inferior imediatamente após o implante de um filtro. A complicação foi reconhecida no intraoperatório de uma laparotomia para ressecção de um câncer de ovário localmente avançado. Descrevemos uma abordagem alternativa, menos invasiva do que a remoção do filtro, consistindo na ressecção das hastes do dispositivo. Essa abordagem permitiu a manutenção do filtro e o controle efetivo do sangramento.

Abstract We report a case of inferior vena cava filter perforation immediately after filter implantation, recognized intraoperatively in a patient undergoing laparotomy for resection of locally advanced ovarian cancer. We describe an alternative approach with strut resection, less invasive than filter removal, enabling the device to be maintained and bleeding to be controlled.

https://doi.org/10.1590/1677-5449.180131 791 downloads

Brachial insertion of fully implantable venous catheters for chemotherapy: complications and quality of life assessment in 35 patients
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Fonseca, Igor Yoshio Imagawa

; Krutman, Mariana

; Nishinari, Kenji

; Yazbek, Guilherme

; Teivelis, Marcelo Passos

; Bomfim, Guilherme André Zottele

; Cavalcante, Rafael Noronha

; Wolosker, Nelson

einstein (São Paulo)

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dec 2016, Volume 14 N. 4 Pages 473 - 479

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Avaliar prospectivamente segurança perioperatória, complicações precoces e grau de satisfação de pacientes submetidos ao implante de cateteres centrais de inserção periférica pela veia basílica. Métodos Foram acompanhados prospectivamente e submetidos ao implante de cateteres de longa permanência de inserção periférica, entre novembro de 2013 e junho de 2014, 35 pacientes consecutivos com doença oncológica ativa necessitando de quimioterapia. Os procedimentos foram realizados em centro cirúrgico por uma mesma equipe composta por três cirurgiões vasculares. Os desfechos primários avaliados foram as complicações pós-operatórias precoces, ocorridas em até 30 dias após o implante. A avaliação do grau de satisfação foi realizada com base na aplicação de um questionário específico já utilizado em estudos prévios. Resultados Em todos os casos, a punção ecoguiada da veia basílica foi possível, e o procedimento foi concluído com sucesso. As complicações precoces observadas incluíram um caso de tromboflebite de basílica e um de infecção de bolsa, ambos tratados clinicamente sem necessidade de retirada do dispositivo. Dos 35 pacientes interrogados, 33 (94,3%) recomendariam o dispositivo para outras pessoas. Conclusão A implantação do port braquial é uma opção factível, com baixo risco intraoperatório e taxas semelhantes de complicações pós-operatórias imediatas quando comparada a dados já existentes da técnica convencional. Os pacientes estudados apresentaram-se satisfeitos com o dispositivo e recomendariam o procedimento para outras pessoas.

ABSTRACT Objective To prospectively evaluate the perioperative safety, early complications and satisfaction of patients who underwent the implantation of central catheters peripherally inserted via basilic vein. Methods Thirty-five consecutive patients with active oncologic disease requiring chemotherapy were prospectively followed up after undergoing peripheral implantation of indwelling venous catheters, between November 2013 and June 2014. The procedures were performed in the operating room by the same team of three vascular surgeons. The primary endpoints assessed were early postoperative complications, occurring within 30 days after implantation. The evaluation of patient satisfaction was based on a specific questionnaire used in previous studies. Results In all cases, ultrasound-guided puncture of the basilic vein was feasible and the procedure successfully completed. Early complications included one case of basilic vein thrombophlebitis and one case of pocket infection that did not require device removal. Out of 35 patients interviewed, 33 (94.3%) would recommend the device to other patients. Conclusion Implanting brachial ports is a feasible option, with low intraoperative risk and similar rates of early postoperative complications when compared to the existing data of the conventional technique. The patients studied were satisfied with the device and would recommend the procedure to others.

https://doi.org/10.1590/s1679-45082016ao3606 5064 downloads

Objective evaluation of plantar hyperhidrosis after sympathectomy
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Wolosker, Nelson

; Ishy, Augusto

; Yazbek, Guilherme

; Campos, Jose Ribas Milanez de

; Kauffman, Paulo

; Puech-Leão, Pedro

; Jatene, Fabio Biscegli

Clinics

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2013, Volume 68 N. 3 Pages 311 - 315

Abstract: En | Text: En | PDF: En

OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

https://doi.org/10.6061/clinics/2013(03)OA05 1539 downloads

Is age group a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis?
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Campos, José Ribas Milanez de

; Wolosker, Nelson

; Munia, Marco Antonio Soares

; Yazbek, Guilherme

; Kauffman, Paulo

; Puech-Leão, Pedro

; Jatene, Fábio Biscegli

Jornal Vascular Brasileiro

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dec 2011, Volume 10 N. 4 Pages 284 - 288

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: A simpatectomia torácica por videotoracoscopia é atualmente o procedimento de escolha para o tratamento definitivo da hiper-hidrose palmar, pois é um método eficaz, seguro e minimamente invasivo. Na busca de melhores índices de qualidade de vida, os pesquisadores procuram por fatores preditivos de bom resultado cirúrgico. A falência do tratamento inicial, a hiper-hidrose compensatória, o índice de massa corpóreo acima de 25, o nível de ressecção ganglionar e a extensão da ressecção são alguns dos fatores que podem influenciar negativamente os resultados. O objetivo deste estudo foi comparar a qualidade de vida dos pacientes submetidos à simpatectomia torácica, de acordo com a faixa etária, numa coorte com 1.644 pacientes. MÉTODOS: De fevereiro de 2000 a outubro de 2008, foram colhidos dados de 1.644 pacientes portadores de hiper-hidrose palmar (71%) ou axilar (29%), submetidos à simpatectomia torácica por videotoracoscopia. Os pacientes foram divididos em três grupos de acordo com a idade. O primeiro grupo foi de pacientes com até 17 anos, o segundo de 18 a 30 anos, e o terceiro com pacientes com mais de 30 anos de idade. Todos os pacientes tinham índice de massa corpóreo menor que 25. RESULTADOS: Numa avaliação 30 dias após o procedimento, a melhora da qualidade de vida foi obtida nos três grupos. Não houve diferença estatística entre as diferentes faixas etárias. Neste estudo, 91,9% dos pacientes apresentaram algum grau de hiper-hidrose compensatória, novamente sem diferença entre os grupos. CONCLUSÕES: Pacientes portadores de hiper-hidrose primária apresentam melhora da qualidade de vida após o procedimento cirúrgico independentemente de sua idade.

OBJECTIVE: Video-assisted thoracic sympathectomy is currently the procedure of choice for the definitive treatment of primary hyperhidrosis, because it is an effective, safe, and minimally invasive method. In the search for better quality of life indexes, all researchers look for predictive factors indicating better surgical outcomes. Failure in the primary treatment, postoperative compensatory hyperhidrosis, body mass index over 25, level of resection of the sympathetic chain, and extent of resection are some of the factors that may negatively influence the results. The objective of this study was to compare, according to the age group, the quality of life after bilateral thoracic sympathectomy for treatment of primary hyperhidrosis in a cohort of 1,644 patients. METHODS: From February 2000 to October 2008, data were collected from 1,644 patients with palmar (71%) or axillary (29%) hyperhidrosis who underwent video-assisted thoracic sympathectomy. The patients were divided into three groups according to their ages. The first group consisted of patients up to 17 years-old, the second from 18 to 30 years-old, and the third of over 30 years-old. All patients had a body mass index of less than 25. RESULTS: In the evaluation 30 days after surgery, improvement of the quality of life in the three groups was observed. There was no significant difference between the age groups. In the present study, 91.9% of the patients presented compensatory hyperhidrosis, with no difference between the age groups. CONCLUSIONS: Patients with primary hyperhidrosis experience quality of life improvement after thoracic sympathectomy regardless of their age.

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Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis?
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Wolosker, Nelson

; Munia, Marco Antonio Soares

; Kauffman, Paulo

; Campos, José Ribas Milanez de

; Yazbek, Guilherme

; Puech-Leão, Pedro

Clinics

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2010, Volume 65 N. 6 Pages 583 - 586

Abstract: En | Text: En | PDF: En

Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS: A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males]. RESULTS: There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION: Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.

1547 downloads Cited 11 times in SciELO

Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level
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Yazbek, Guilherme

; Wolosker, Nelson

; Kauffman, Paulo

; Campos, José Ribas Milanez de

; Puech-Leão, Pedro

; Jatene, Fábio Biscegli

Clinics

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2009, Volume 64 N. 8 Pages 743 - 749

Abstract: En | Text: En | PDF: En

OBJECTIVE: To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.

2385 downloads Cited 12 times in SciELO

10.

Abdominal aortic pseudoaneurysm associated with a metastatic germ cell tumor: a rare complication
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Zerati, Antonio Eduardo

; Nishinari, Kenji

; Yazbek, Guilherme

; Wolosker, Nelson

; Fonseca, Francisco Paulo da

Clinics

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2007, Volume 62 N. 5 Pages 657 - 660

Abstract: En | Text: En | PDF: En

2570 downloads

11.

Arterial reconstructions associated with the resection of malignant tumors
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Nishinari, Kenji

; Wolosker, Nelson

; Yazbek, Guilherme

; Zerati, Antônio Eduardo

; Nishimoto, Inês Nobuko

; Puech-Leão, Pedro

Clinics

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aug 2006, Volume 61 N. 4 Pages 339 - 344

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Quando há acometimento de artérias tronculares por neoplasias malignas e o tratamento cirúrgico é empregado para realização de ressecções tumoral e arterial, a reconstrução vascular deve ser imediata, para evitar a isquemia de tecidos nobres. O objetivo desse trabalho é analisar os resultados do tratamento de pacientes portadores de neoplasias malignas submetidos a ressecções tumoral e vascular associada à reconstrução arterial, avaliando a perviedade primária das reconstruções, as complicações arteriais e a sobrevida dos pacientes. MÉTODOS: Foram acompanhados 36 pacientes com neoplasias em regiões cervical, abdominal ou extremidades inferiores, operados eletivamente no período de setembro de 1997 a setembro de 2004 no Hospital do Câncer A.C.Camargo em São Paulo. Os pacientes foram divididos em três grupos de acordo com a localização das neoplasias: Cervical (14), Extremidade (13) e Abdome (9). Foram realizadas 38 reconstruções arteriais nos 36 pacientes. RESULTADOS: Houve cinco complicações arteriais, sendo duas precoces e três tardias. Entre as precoces, houve uma oclusão carotídea sintomática com seqüelas e uma rotura de enxerto femoral sem seqüelas. Entre as tardias, houve uma oclusão carotídea sintomática, uma oclusão de enxerto carotídeo-axilar e uma oclusão de ramo de enxerto aorto-bifemoral, todas sem sequelas. Não houve diferença entre os índices de perviedade arterial primária . Todos os óbitos (22) ocorreram devido à evolução da doença neoplásica. CONCLUSÕES: As reconstruções arteriais associadas à ressecção de neoplasias malignas em segmentos cervical, abdominal ou extremidades inferiores podem ser realizadas com baixos índices de morbi-mortalidade. Não houve diferença entre os índices de perviedade primária das reconstruções.

OBJECTIVE: When trunk arteries are affected by malignant neoplasia, and surgical treatment involving tumor and arterial resection is used, the vascular reconstruction must be performed immediately to avoid ischemia in the brain and large tissue masses. The objective of this study was to analyze the results obtained with the treatment of patients with malignant neoplasia who underwent tumor and vascular resection associated with arterial reconstruction. The primary patency of reconstructions, the occurrence arterial complications, and patient survival were assessed. METHODS: Thirty-six patients with cervical, abdominal, or lower limb neoplasias were followed up. These patients underwent elective operations at Hospital do Câncer A.C. Camargo, São Paulo, between September 1997 and September 2004. They were divided into 3 groups according to tumor location: Cervical (14), lower limbs (13), and Abdomen (9). Thirty-eight arterial reconstructions were performed in these 36 patients. RESULTS: There were 5 arterial complications: 2 early- and 3 late-stage. The early complications consisted of 1 symptomatic carotid occlusion with sequelae and 1 femoral graft rupture without sequelae. The late-stage complications consisted of 1 symptomatic carotid occlusion, 1 occlusion of an axillary-carotid graft, and 1 occlusion of a branch of the aortobifemoral graft, all without sequelae. There was no difference between the primary arterial patency rates. All the deaths (22) resulted from progression of neoplasic disease. CONCLUSIONS: Arterial reconstructions associated with resection of malignant neoplasia in cervical, abdominal, or lower limbs can be carried out with low rates of morbidity and mortality. There was no difference in the primary arterial patency rates among the groups studied.

2021 downloads

12.

Vena cava filters in cancer patients: experience with 50 patients
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Zerati, Antonio Eduardo

; Wolosker, Nelson

; Yazbek, Guilherme

; Langer, Marcel

; Nishinari, Kenji

Clinics

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oct 2005, Volume 60 N. 5 Pages 361 - 366

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Estudar os resultados imediatos e tardios obtidos com a implantação de filtros de veia cava inferior em pacientes com trombose venosa profunda concomitante a neoplasia. MÉTODOS: Avaliamos retrospectivamente 50 pacientes com câncer e trombose venosa profunda associada submetidos a interrupção de veia cava inferior com filtros intraluminais definitivos. Foram estudados aspectos referentes à indicação do procedimento, à técnica de implante dos dispositivos, complicações precoces e tardias relacionadas à operação e à evolução dos pacientes. RESULTADOS: A indicação mais freqüente para o procedimento foi a impossibilidade de anticoagulação plena (80% ) e a via de acesso preferencial foi a punção da veia femoral, realizada em 86% dos pacientes. Não houve complicações relativas ao implante dos filtros. Durante a evolução ocorreram: um episódio de tromboembolia pulmonar não fatal e dois casos de oclusão da veia cava inferior; em um paciente foi demonstrada a presença de coágulo retido no dispositivo. Vinte pacientes (40%) faleceram devido à neoplasia. CONCLUSÃO: A interrupção da veia cava inferior com filtro endoluminal é um procedimento com baixo índice de complicações e eficaz na prevenção da embolia pulmonar nos pacientes com tromobose venosa profunda de membros inferiores portadores de câncer.

OBJECTIVE: To study the immediate and late results obtained from the implantation of vena cava filters in cancer patients with deep vein thrombosis concomitant with neoplasia. METHODS: This was a retrospective evaluation of 50 patients with an association of cancer and deep venous thrombosis who underwent interruption of the inferior vena cava and the insertion of permanent vena cava filters. The indications for the procedure, filter implantation technique, early and late complications related to the operation, and the clinical evolution were evaluated. RESULTS: The most frequent indication for filter implantation was the contraindication for full anticoagulant treatment (80%). The femoral vein was the preferred access route (86% of the patients). There were no complications related to the surgical procedure. During the follow-up, the following complications were observed: 1 episode of nonfatal pulmonary thromboembolism, 2 cases of occlusion of the inferior vena cava, and 1 case of thrombus retained in the device. Twenty patients (40%) died due to progression of the neoplasm. CONCLUSIONS: Interruption of the inferior cava vein using an endoluminal filter is a procedure with a low rate of complications. It is a safe and efficient measure for preventing pulmonary embolism in cancer patients who have deep vein thrombosis of the lower limbs.

2690 downloads Cited 2 times in SciELO

13.

Totally implantable venous catheters for chemotherapy: experience in 500 patients
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Wolosker, Nelson

; Yazbek, Guilherme

; Nishinari, Kenji

; Malavolta, Luiz Caetano

; Munia, Marco Antonio

; Langer, Marcel

; Zerati, Antonio Eduardo

Sao Paulo Medical Journal

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2004, Volume 122 N. 4 Pages 147 - 151

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

CONTEXTO: Os dispositivos totalmente implantáveis vêm sendo cada vez mais utilizados para quimioterapia de pacientes oncológicos, porém poucos são os estudos em nosso meio que analisam os resultados obtidos com a implantação e utilização desses cateteres. OBJETIVO: Estudar os resultados obtidos com a implantação de cateteres totalmente implantáveis em pacientes submetidos a quimioterapia. TIPO DO ESTUDO: Prospectivo. LOCAL: Hospital do Câncer A.C. Camargo, São Paulo, Brasil. MÉTODOS: Foram colocados 519 cateteres totalmente implantáveis em 500 pacientes a serem submetidos a regime de quimioterapia preferencialmente utilizando-se a veia jugular externa direita. Foram avaliadas as complicações precoces, as tardias e a evolução até a retirada do dispositivo, morte ou fim de tratamento. RESULTADOS: A análise prospectiva mostrou duração média dos cateteres de 353 dias. Em 427 (82,2%) cateteres não se observou nenhuma complicação. Entre as complicações precoces, observamos 15 hematomas de trajeto, oito tromboflebites de coto distal de veia jugular externa e uma infecção de bolsa de subcutâneo. Entre as complicações tardias, observamos 43 complicações infecciosas (0,23/1000 dias de uso de cateter), 11 obstruções (0,06/1000 dias de uso de cateter) e 14 tromboses venosas profundas (0,07/1000 dias de uso de cateter). Foram retirados 101 cateteres, 35 devido às complicações e 66 por final de tratamento. 240 pacientes foram a óbito com o cateter funcionante e 178 pacientes ainda o utilizavam para quimioterapia. CONCLUSÃO: As baixas taxas de complicação obtidas nesse estudo confirmam a segurança e conveniência do uso dos acessos totalmente implantáveis em pacientes em regime prolongado de quimioterapia.

CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2%) catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use), 11 obstructions (0.06/1000 days of catheter use) and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use). Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.

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14.

Endovascular techniques for placement of long-term chemotherapy catheters
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Yazbek, Guilherme

; Zerati, Antonio Eduardo

; Malavolta, Luiz Caetano

; Nishinari, Kenji

; Wolosker, Nelson

Revista do Hospital das Clínicas

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2003, Volume 58 N. 4 Pages 215 - 218

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Analisar os resultados da utilização de técnicas endovasculares na colocação de cateteres de longa permanência para quimioterapia quando a progressão do cateter através da veia jugular externa é dificultada devido a obstruções ou tortuosidades. MÉTODOS: Entre Junho de 1997 e Agosto de 2000, foram colocados 320 cateteres de longa permanência para quimioterapia, e, em 220 casos a veia jugular externa foi utilizada como acesso venoso primário. Em 18 desses pacientes, o correto posicionamento não foi conseguido sendo então utilizadas várias técnicas endovasculares para superar os obstáculos incluindo o uso de fio guia com ponta em J, flebografia e troca de cateteres. RESULTADOS: Em 94,5% dos pacientes com dificuldades para obtermos o correto posicionamento, foi conseguida a progressão do cateter de longa permanência até o posicionamento desejado com a assistência de técnicas endovasculares. CONCLUSÃO: A Flebografia e a técnica endovascular são úteis para a colocação de cateteres de longa permanência através da veia jugular externa

PURPOSE: To analyze the results from using endovascular techniques to place long-term chemotherapy catheters when advancing the catheter using the external jugular vein is difficult due to obstructions or kinking. METHODS: Between July 1997 and August 2000, 320 long-term chemotherapy catheters were placed, and in 220 cases the external jugular vein was used as the primary venous approach. In 18 of these patients, correct positioning was not achieved and several endovascular techniques were then utilized to overcome these obstacles, including manipulation of a J-wire with a moveable core, venography, and the exchange wire technique. RESULTS: In 94.5% of the patients with difficulties in obtaining the correct positioning, we were able to advance the long-term catheter to the desired position with the assistance of endovascular techniques. CONCLUSIONS: Venography and endovascular guidance techniques are useful for the placement of long-term catheters in the external jugular vein.

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15.

Carotid reconstruction in patients operated for malignant head and neck neoplasia
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- SciELO Analytics

Nishinari, Kenji

; Wolosker, Nelson

; Yazbek, Guilherme

; Malavolta, Luiz Caetano

; Zerati, Antônio Eduardo

; Kowalski, Luiz Paulo

Sao Paulo Medical Journal

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jul 2002, Volume 120 N. 5 Pages 137 - 140

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

CONTEXTO: Os pacientes portadores de neoplasia maligna de cabeça e pescoço podem apresentar acometimento simultâneo de grandes vasos devido ao crescimento da massa tumoral. As opções terapêuticas são a quimioterapia, radioterapia, cirurgia ou tratamento combinado. Quando o tratamento cirúrgico é indicado e a veia jugular interna é acometida, normalmente é ressecada sem reconstrução, pois geralmente não há repercussões clínicas importantes. Porém, quando a artéria carótida interna e/ou comum são acometidas, a ressecção sem revascularização normalmente leva a índices de complicações neurológicas elevadas, motivo pelo qual deve ser realizado enxerto arterial. OBJETIVO: Analisar o resultado do tratamento cirúrgico com reconstrução carotídea dos pacientes portadores de neoplasia maligna avançada de cabeça e pescoço. TIPO DE ESTUDO: Prospectivo. LOCAL: Hospital do Câncer A.C. Camargo, São Paulo, SP, Brasil. PARTICIPANTES: 11 pacientes operados por neoplasia maligna avançada de cabeça e pescoço acometendo artéria carótida interna e/ou comum. PRINCIPAIS VARIÁVEIS: Por meio de exame clínico, seguimento ambulatorial e mapeamento dúplex, analisamos a perviedade dos enxertos carotídeos, as complicações vasculares e não-vasculares, recorrência da doença e sobrevida dos pacientes. RESULTADOS: Seis pacientes (54,5%) não apresentaram nenhum tipo de complicação. Houve uma complicação vascular representada por oclusão do enxerto carotídeo com acidente vascular cerebral hemisférico. As complicações não-vasculares ocorreram em cinco pacientes (45,5%). Durante o seguimento, oito pacientes faleceram (72,7%), sendo sete com recidiva tumoral loco-regional e um com metástases pulmonares e hepáticas (média de nove meses após a operação). Sete desses pacientes apresentavam enxerto funcionante. Os três pacientes vivos encontram-se sem recidiva tumoral e com enxertos funcionantes (média de nove meses). CONCLUSÕES: Os pacientes com neoplasia maligna avançada de cabeça e pescoço acometendo artéria carótida tratados cirurgicamente apresentam prognóstico reservado. Quando a artéria carótida interna e/ou comum é ressecada em bloco com o tumor, a reconstrução arterial deve ser realizada, sendo a veia safena magna um substituto vascular adequado.

CONTEXT: Patients with malignant head and neck neoplasia may present simultaneous involvement of large vessels due to the growth of the tumoral mass. The therapeutic options are chemotherapy, radiotherapy, surgery or combined treatments. OBJECTIVE: To analyze the result of surgical treatment with carotid reconstruction in patients with advanced malignant head and neck neoplasia. DESIGN: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. PARTICIPANTS: Eleven patients operated because of advanced malignant head and neck neoplasia that was involving the internal and/or common carotid artery. MAIN MEASUREMENTS: By means of clinical examination, outpatient follow-up and duplex scanning, we analyzed the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival of the patients. RESULTS: Six patients (54.5%) did not present any type of complication. There was one vascular complication represented by an occlusion of the carotid graft with a cerebrovascular stroke in one hemisphere. Non-vascular complications occurred in five patients (45.5%). During the follow-up, eight patients died (72.7%), of whom seven had loco-regional tumor recurrence and one had pulmonary and hepatic metastases (at an average of 9 months after the operation). Seven of these patients presented functioning grafts. The three patients still alive have no tumor recurrence and their grafts are functioning (an average of 9 months has passed since the operation). CONCLUSIONS: Patients with advanced malignant head and neck neoplasia involving the carotid artery that are treated surgically present a prognosis with reservations. When the internal and/or common carotid artery is resected en-bloc with the tumor, arterial reconstruction must be performed. The long saphenous vein is a suitable vascular substitute.

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