Made available in DSpace on 2014-08-13T14:50:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-01-21Bitstream added on 2014-08-13T18:00:24Z : No. of bitstreams: 1 000760116.pdf: 1368644 bytes, checksum: ef17764b3bb2a5fd3d84bb04ed06f8b1 (MD5) / O empiema tem sido tratado de várias formas, desde a toracocentese seriada, drenagem torácica fechada (drenagem simples), drenagem com infusão de fibrinolíticos, descorticação por toracotomia e limpeza da cavidade e drenagem através da videotoracoscopia (CTVA). Apesar de a drenagem simples ser um método bastante antigo, é muito eficaz, dependendo do estágio do empiema. Já a CTVA, mesmo sendo mais invasiva, por demandar anestesia geral, é resolutiva na maioria dos estágios do empiema. Analisar os casos de empiema pleural parapneumônico em crianças submetidas à drenagem simples ou à videotoracoscopia precoce em nosso serviço para determinar quais são os fatores determinantes na evolução favorável do tratamento. Ensaio clínico controlado avaliando idade, gênero, queixa, tempo de diagnóstico, aspecto do líquido, patógenos encontrados, tipo de tratamento (drenagem torácica simples ou videotoracoscopia precoce), tempo de drenagem, necessidade de reintervenção, troca do antibiótico e tempo de internação. Foram analisados 54 pacientes com idade de sete meses a 10 anos, tratados no Serviço de Cirurgia Torácica do HCFMB UNESP, com diagnóstico de empiema pleural. O gênero masculino foi predominante (54%), o hemitórax mais acometido foi o direito (28 pacientes) e o tempo de história clínica variou de um a 30 dias. Trinta e dois pacientes foram tratados previamente com antibióticos e em 22% dos casos a bacterioscopia ou a cultura foram positivos para Streptococcus pneumoniae. Vinte e oito crianças foram submetidas à drenagem torácica simples e 26 a CTVA. As variáveis idade, tempo de história e pH do líquido pleural, não apresentaram diferenças significativas. No entanto, o tempo de drenagem foi significativamente menor nos pacientes submetidos à CTVA (4,5 ± 1,8 dias) (p<0,001). A necessidade de abordagem cirúrgica ocorreu somente no grupo submetido à drenagem torácica simples (17,9% p=0,02). A drenagem ... / The empyema have been treated in various ways, from the serial thoracocentesis, exclusive thoracic drainage, drainage and fibrinolytics, infusion thoracotomy and decortication for cavity cleansing to drainage through videothoracoscopy (VATS). Although drainage is a quite old method, it is very effective, depending on the stage of empyema. The VATS even being more invasive, since requires general anesthesia, is resolute in most stages of empyema. To analyze cases of parapneumonic pleural empyema in children undergoing simple drainage or early VATS in our service in order to determine the conclusive factors in a favorable treatment outcome. Prospective controlled trial that evaluated age, gender, time of diagnosis, aspect of the fluid, pathogens, type of treatment (simple chest tube drainage or early VATS), drainage time, need for reintervention, need to change antibiotics and hospitalization time. Fifty-four patients aged seven months old to 10 years old with a diagnosis of empyema were analyzed. Male gender was predominant (54%), right hemithorax was the most affected (28 patients) and the duration of clinical symptoms ranged from one to 30 days. Thirty- two patients were previously treated with antibiotics and in 22% of cases bacterioscopy and / or culture were positive and the most common agent was Streptococcus pneumoniae (22%). Twenty-eight children underwent simple chest tube drainage and 26 underwent VATS. The variables age, history time and pH of the pleural fluid showed no significant differences. The drainage time was significantly lower in patients undergoing VATS (4.5 ± 1.8 days) (p < 0.001). The need for surgical approach was significantly higher in the group undergoing simple chest tube drainage (17.9%). Parapneumonic empyema chest drainage in children was more efficient in the group where there was VATS assistance, for being faster and not requiring another surgery in patient’s evolution

Orientador: Daniela Cristina Cataneo / Banca: Ricardo Mingarini Terra / Banca: Paulo Francisco Guerreiro Cardoso / Resumo: O empiema tem sido tratado de várias formas, desde a toracocentese seriada, drenagem torácica fechada (drenagem simples), drenagem com infusão de fibrinolíticos, descorticação por toracotomia e limpeza da cavidade e drenagem através da videotoracoscopia (CTVA). Apesar de a drenagem simples ser um método bastante antigo, é muito eficaz, dependendo do estágio do empiema. Já a CTVA, mesmo sendo mais invasiva, por demandar anestesia geral, é resolutiva na maioria dos estágios do empiema. Analisar os casos de empiema pleural parapneumônico em crianças submetidas à drenagem simples ou à videotoracoscopia precoce em nosso serviço para determinar quais são os fatores determinantes na evolução favorável do tratamento. Ensaio clínico controlado avaliando idade, gênero, queixa, tempo de diagnóstico, aspecto do líquido, patógenos encontrados, tipo de tratamento (drenagem torácica simples ou videotoracoscopia precoce), tempo de drenagem, necessidade de reintervenção, troca do antibiótico e tempo de internação. Foram analisados 54 pacientes com idade de sete meses a 10 anos, tratados no Serviço de Cirurgia Torácica do HCFMB UNESP, com diagnóstico de empiema pleural. O gênero masculino foi predominante (54%), o hemitórax mais acometido foi o direito (28 pacientes) e o tempo de história clínica variou de um a 30 dias. Trinta e dois pacientes foram tratados previamente com antibióticos e em 22% dos casos a bacterioscopia ou a cultura foram positivos para Streptococcus pneumoniae. Vinte e oito crianças foram submetidas à drenagem torácica simples e 26 a CTVA. As variáveis idade, tempo de história e pH do líquido pleural, não apresentaram diferenças significativas. No entanto, o tempo de drenagem foi significativamente menor nos pacientes submetidos à CTVA (4,5 ± 1,8 dias) (p<0,001). A necessidade de abordagem cirúrgica ocorreu somente no grupo submetido à drenagem torácica simples (17,9% p=0,02). A drenagem ... / Abstract: The empyema have been treated in various ways, from the serial thoracocentesis, exclusive thoracic drainage, drainage and fibrinolytics, infusion thoracotomy and decortication for cavity cleansing to drainage through videothoracoscopy (VATS). Although drainage is a quite old method, it is very effective, depending on the stage of empyema. The VATS even being more invasive, since requires general anesthesia, is resolute in most stages of empyema. To analyze cases of parapneumonic pleural empyema in children undergoing simple drainage or early VATS in our service in order to determine the conclusive factors in a favorable treatment outcome. Prospective controlled trial that evaluated age, gender, time of diagnosis, aspect of the fluid, pathogens, type of treatment (simple chest tube drainage or early VATS), drainage time, need for reintervention, need to change antibiotics and hospitalization time. Fifty-four patients aged seven months old to 10 years old with a diagnosis of empyema were analyzed. Male gender was predominant (54%), right hemithorax was the most affected (28 patients) and the duration of clinical symptoms ranged from one to 30 days. Thirty- two patients were previously treated with antibiotics and in 22% of cases bacterioscopy and / or culture were positive and the most common agent was Streptococcus pneumoniae (22%). Twenty-eight children underwent simple chest tube drainage and 26 underwent VATS. The variables age, history time and pH of the pleural fluid showed no significant differences. The drainage time was significantly lower in patients undergoing VATS (4.5 ± 1.8 days) (p < 0.001). The need for surgical approach was significantly higher in the group undergoing simple chest tube drainage (17.9%). Parapneumonic empyema chest drainage in children was more efficient in the group where there was VATS assistance, for being faster and not requiring another surgery in patient's evolution / Mestre

Thesis (PhD (Medicine. Internal medicine))--University of Stellenbosch, 2007. / 1.1. Background Tumors arising from the lung, pleura, or chest wall are a frequent problem in clinical pulmonary medicine. Most lesions are either infectious, neoplastic or granulomatous in nature, but a variety of other differential diagnoses must be considered. An accurate diagnosis is important because the available treatments differ substantially, and because any delay will impair the prognosis in potentially curable patients with lung carcinoma. The investigations involve the disciplines of radiology, pulmonology, surgery, microbiology, and anatomical pathology and consume a respectable amount of resources. The aim of the work covered in this thesis was to optimize the available diagnostic methods for the routine use in a health care setting with limited resources. 1.2. Methods The general idea of this work was to identify conventional sampling methods that could be developed further to become more useful for the diagnosis of chest tumors in a low resource health care setting. The key method was research performed: a) to revise and expand the indication for a sampling method, b) to technically improve the sampling process, and c) to optimize sample transport, preparation and analysis in collaboration with the analytical laboratory. 1.3. Results A list of invasive diagnostic procedures, imaging methods and analytical processes were developed, evaluated and integrated into clinical practice. A) transbronchial needle aspiration, B) transthoracic cutting needle biopsy, C) transthoracic fine needle aspiration, D) transthoracic ultrasound, and E) rapid on-site evaluation of needle aspirates by a cytopathologist. Five studies pertaining to this thesis were published in international peerreviewed journals: â ¢ Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists (Respiration 2004;71:519-22) This paper established that ultrasound-assisted transthoracic biopsy performed by pulmonologists is feasible, safe, practical, low-cost and has a high yield. â ¢ Utility of rapid on-site evaluation of transbronchial needle aspirates (Respiration 2005;72:182-8) This paper demonstrated the economical advantages of on-site evaluation of transbronchial specimens in a low-resource setting. â ¢ Transbronchial needle aspirates: comparison of two preparation methods (Chest 2005;127:2015-8) This paper demonstrated that preparing smears on-site has a far better yield than pooling samples into a vial. This means that the yield is improved over the current standard at no additional cost. â ¢ Transbronchial needle aspirates: how many passes per target site? (European Respiratory Journal 2007;29:112-6) This paper investigated the most economical and effective approach to serial sampling with transbronchial needle aspiration during flexible bronchoscopy. â ¢ Ultrasound assisted transthoracic biopsy: fine needle aspiration or cutting needle biopsy? (European Respiratory Journal 2007;29:357-62) This paper compared two common methods of sampling and demonstrates that the less expensive method is sufficient in the majority of cases. 1.4. Conclusion This work has impacted on current practice in multiple ways. Conventional methods have been optimized by improving technical factors and with the integration of interdisciplinary collaboration. The initiated research is ongoing with the aim to achieve continued technical and economical improvements in the diagnosis of chest tumors.