Focus on quality of life.

This article aims to discuss aspects concerning Health-related to quality of life concepts. This paper presents some piece of information regarding the quality of life instruments.

Cardiothoracic Surgery League from University of São Paulo Medical School: twelve years in medical education experience.

Introduction: Academic Leagues (Academic Interest Group) are entities that belong to medical schools and their hospitals. Their goals are research, medical education and health care. The cardiothoracic Surgery League (Liga de Cirurgia Cardiotorácica--LCCT), University of São Paulo Medical School, was founded 12 years ago, aimed at providing undergraduate medical students an opportunity to expand knowledge in cardiothoracic surgery and to take part in scientific studies in the field.

Ex vivo lung evaluation and reconditioning.

Objective: Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) has been developed and can be used for evaluation and reconditioning of "marginal" and unacceptable lungs. This is a report of functional evaluation experience with ex vivo perfusion of twelve donor lungs deemed unacceptable in São Paulo, Brazil.

Recommendations for the use of extended criteria donors in lung transplantation.

Selection criteria for lung donation were based on initial experiences with lung transplantation without further studies to improve them, thereby guaranteeing the best use of donated organs. A definition of an extended criteria donor is therefore required to obtain more lungs to meet the demands of patients awaiting transplantation. Studies have been reviewed for the impact on survival and morbidity of age ranges, oxygen fraction, cause of death, smoking habits, x-ray findings, infection, hepatitis serology and non-heart-beating status, seeking to support physicians to make decisions regarding the use of marginal organs.

Hemangioma of the rib.

An asymptomatic 48-year-old woman presented to our hospital with a tumor of the rib incidentally diagnosed on a chest roentgenogram. The patient was investigated and underwent tumor resection of the chest wall. The pathologic study revealed that it was cavernous hemangioma.

Clinical and haemodynamic evaluation of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy: Is schistosomiasis hypertension an important confounding factor?

Introduction: Chronic thromboembolic pulmonary hypertension is a disease affecting approximately 4,000 people per year in the United States. The incidence rate in Brazil, however, is unknown. The estimated survival for patients with chronic thromboembolic pulmonary hypertension without treatment is approximately three years.

Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy: T3 and T4.

This study compares the results obtained of video-assisted sympathectomy performed on two distinct ganglion levels (third vs. fourth thoracic ganglion) in the treatment of palmar hyperhidrosis (PH), through a blind randomized clinical trial. All participants were randomized into two groups of 20 patients (G3 and G4) and underwent the operation, and were followed for 12 months.

Seasonal influence of the surgical outcome after thoracic sympathectomy for hyperhidrosis.

Analyze the seasonal variation of the surgical results after sympathectomy through the seasons of the year. The surgical results are better in the spring, and the sudomotor reflex is worst in summer. Comparison of surgical results of distinct techniques should be done under the same climatic conditions.

Factors affecting long-term satisfaction after thoracic sympathectomy for palmar and plantar hyperhidrosis. Is the sudomotor reflex the only villain?

The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons.

Is silver nitrate pleurodesis for patients with malignant pleural effusion feasible and safe when performed in an outpatient setting?

Background: The purpose of this study was to analyze the effectiveness and safety of silver nitrate pleurodesis (SNP) in patients with recurrent malignant pleural effusion (RMPE) when performed in an outpatient setting.

Materials And Methods: Prospective study including patients with RMPE recruited in a tertiary university-based hospital from February 2008 to June 2009. Elected patients underwent pleural catheter insertion (Day 1) followed by 0.

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short-and long-term results in ischemic cardiomyopathy.

Introduction: The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes.

Methods And Material: Patients (n = 169) with angiographic left ventricular ejection fraction of 22 ± 5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively.

Endoscopic left sympathetic blockade in the treatment for dilated cardiomyopathy.

Background: The level of sympathetic nervous activity is a major determinant of prognosis in patients with heart failure.

Objective: The purpose of this investigation was to perform a proof-of-principle trial of therapeutic endoscopic left thoracic sympathetic blockade in heart failure patients to assess safety and immediate effects.

Methods: Fifteen patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) < 40%, New York Heart Association functional class II or III, and heart rate > 65 bpm, despite either adequate betablocker use or intolerant to it, were enrolled.

Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial.

Context: Perioperative red blood cell transfusion is commonly used to address anemia, an independent risk factor for morbidity and mortality after cardiac operations; however, evidence regarding optimal blood transfusion practice in patients undergoing cardiac surgery is lacking.

Objective: To define whether a restrictive perioperative red blood cell transfusion strategy is as safe as a liberal strategy in patients undergoing elective cardiac surgery.

Design, Setting, And Patients: The Transfusion Requirements After Cardiac Surgery (TRACS) study, a prospective, randomized, controlled clinical noninferiority trial conducted between February 2009 and February 2010 in an intensive care unit at a university hospital cardiac surgery referral center in Brazil.

Atrial coronary arteries in areas involved in atrial fibrillation catheter ablation.

Background: The proximity to vascular structures is a limiting factor during radiofrequency ablation. However, little or no attention has been given to the atrial arterial circulation during the development of atrial fibrillation (AF) catheter ablation techniques.

Methods And Results: We examined the atrial arterial circulation in areas involved in AF ablation in 24 heart specimens by colored resin injection and careful dissection.

Experimental model of isolated lung perfusion in rats: technique and application in lung preservation studies.

Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail.

Robotic dissection of the right internal thoracic artery through median sternotomy.

The use of robotic systems in cardiac surgeries aims at decreasing the surgical trauma. The totally endoscopic myocardial revascularization, assisted by the DaVinci robot (Intuitive Surgical, Sunnyvale, California) is feasible and the learning process must be carried out in steps. The first step is the preparation of the left internal thoracic artery, through the totally endoscopic approach.

Thoracoscopic approach in the treatment of breast cancer relapse in the internal mammary lymph node.

Regional recurrence of breast cancer may involve the surgical site of mastectomy, axillary lymph nodes and the internal mammary lymphatic chain. Treatment of regional recurrent mammary cancer rarely requires thoracic surgery intervention, except in some selected cases of recurrence in the chest wall. Concerning lymphatic recurrence in breast cancer, the therapeutic choice rarely includes surgical lymph node excision.

Usefulness of pericardioscopy in the diagnosis of pericardial effusion.

The pericardium can be affected by infectious, neoplastic, inflammatory and metabolic diseases. Many conditions require specific treatment and, consequently, an accurate diagnosis is important. Therefore, the pericardial biopsy has an important role in the evaluation of pericardial effusions.

Azygos lobe: a difficulty in video-assisted thoracic sympathectomy.

The presence of an azygos lobe (AL) may make it difficult or even impossible to use video-assisted thoracic sympathectomy if the surgeon is unprepared to deal with this anatomical anomaly. Seven hyperhidrosis patients with an AL from a total of 1,876 individuals who underwent video-assisted thoracic sympathectomy are presented. The surgical technique and clinical evolution are described.

[Lung hyperinflation after single lung transplantation to treat emphysema].

Despite preventive measures, lung hyperinflation is a relatively common complication following single lung transplantation to treat pulmonary emphysema. The progressive compression of the graft can cause mediastinal shift and respiratory failure. In addition to therapeutic strategies such as independent ventilation, the treatment consists of the reduction of native lung volume by means of lobectomy or lung volume reduction surgery.

Evolution of cardiovascular surgery at the Instituto do Coração: analysis of 71,305 surgeries.

Background: Cardiovascular surgery has been undergoing transformations due to the advancement of percutaneous techniques, clinical treatment and primary prevention.

Objective: Evaluation of incidence and mortality of heart surgeries performed at the Instituto do Coração (InCor-HCFMUSP).

Methods: Using database from the Instituto do Coração, analysis was carried out on cardiovascular surgeries performed between 1984 and 2007, taking into consideration trends of main procedures and of mortality rates.

Cytokine profile in pleural fluid and serum after lung transplantation.

Background: Lung transplantation is the procedure of choice in several end-stage lung diseases. Despite improvements in surgical techniques and immunosuppression, early postoperative complications occur frequently.

Objective: To evaluate the pleural inflammatory response after surgery.

Impact of cytomegalovirus infection in lung transplant patients under universal prophylaxis: single-center experience in Brazil.

Introduction: Cytomegalovirus (CMV) infection, a common complication in lung transplant (LT) patients, is associated with worse outcomes. Therefore, prophylaxis and surveillance with preemptive treatment is recommended.

Objectives: Describe the epidemiology and impact on mortality of CMV infection in LT patients receiving CMV prophylaxis.

Experimental model of isolated lung perfusion in rats: first Brazilian experience using the IL-2 isolated perfused rat or guinea pig lung system.

Introduction: Lung transplantation has become the mainstay therapy for patients with end-stage lung disease refractory to medical management. However, the number of patients listed for lung transplantation largely exceeds available donors. The study of lung preservation requires accurate, cost-effective small animal models.