RCAAP Repository

The role of endobronchial ultrasound (EBUS) and trans-esophageal endobronchial ultrasound (EUS-B) in lung cancer is well established and scientifically validated. There is increasing data that endosonography is a crucial tool for the diagnosis of central lung lesions, and mediastinal staging and restaging of non-small cell lung cancer patients. The present article reviews the technical aspects of EBUS and EUS-B and focus on the last published research regarding its value in lung cancer.

Background: Ischemic ventricular septal rupture (VSR) is a lethal complication that occurs either after spontaneous or iatrogenic occlusion of one of the major epicardial coronary vessels. To the best of our knowledge, this is the first reported case of a VSD after a septal branch occlusion in a patient with patent coronary artery grafts to both the left anterior descending and posterior descending arteries. Methods: We present a rare case of anterior ischemic VSR due to the occlusion of a major septal branch. The patient had previous coronary artery bypass grafts and his left internal mammary artery conduit to the anterior descending artery was patent. The culprit lesion that resulted in the development of the VSR was the occlusion of a major septal branch. Discussion: The presence of collateral circulation in chronic coronary occlusive disease may provide a protective effect against the development of transmural myocardial necrosis which may reduce the risk of septal rupture. This case highlights the fact that patent coronary artery grafts may not protect from future ischemic VSR. Conclusion: Major septal branches with significant disease should be assessed for percutaneous options if technically feasible as dictated by the Heart Team.

No summary/description provided

A 34-year-old man was admitted for surgical treatment following traumatic posterior sternoclavicular joint dislocation and anterior mediastinum hematoma with compression of brachiocephalic vein (A, B). Intra-operative positioning consid- ered access for possible sternotomy and control of upper vena cava territory in case of bleeding from venous confluent (C). Patient was submitted to open reduction of sternoclavicular joint through an oblique supraclavicular incision (D), fixation with high strength orthopedic suture (E), mediastinal drainage and closure with absorbable suture (F).

No summary/description provided

No summary/description provided

Introduction: Ischemic mitral regurgitation (IMR) is a frequent and serious complication of coronary artery disease, associated with considerable patient increased mortality and morbidity. While the benefits of optimal medical therapy and surgical revascularization, when indicated, are uncontested in moderate to severe cases, the ideal surgical approach to the valve, if any, is yet to be established.Mitral valve repair has established benefits over replacement in primary mitral regurgitation, but its superiority in the treatment of functional regurgitation has not been replicated.Differing outcomes likely stem from the distinct IMR pathophysiology. Unlike its degenerative counterparts, IMR does not derive from direct damage to the valve leaflets, but rather from dysfunction of its sub-valvular apparatus and the left ventricular wall, in the context of acute or chronic ischaemia. Echocardiographic data points to remodelling of the left ventricle, with subsequent papillary muscle displacement, increased leaflet tethering and inefficient coaptation, as the main responsible mechanism for ischemic mitral regurgitation. Neither mitral valve repair nor replacement directly address these issues, with the appearance of the first randomized trials supporting replacement as the more durable option. However, new subvalvular procedures are improving the stability of repair techniques and the debate is long from settled.The purpose of this review is to analyse the currently available data, couple it with our understanding of IMR’s pathophysiology and compare the different outcomes for mitral valve repair and  replacement.

The extravasation of doxorubicin, a cytostatic from the anthracycline group, is a rare and feared complication of intravenous chemotherapy due to tissue toxicity of these drugs. We describe a case of a 64-year-old woman with breast cancer undergoing adjuvant chemotherapy with doxorubicin and cyclophosphamide using a tunneled central catheter. After a chemotherapy cycle, the patient developed cough, dyspnoea and chest pain, due to a pleural effusion secondary to cytostatic leakage. A pleural drainage was placed and dexrazoxone was administred with resolution of the condition. The authors wish to highlight that the use of dexrazoxone should be considered after intra-pleural extravasation of anthracyclines given its effectiveness in preventing tissue damage and long-term sequelae in peripheral extravasation.

   The tumours of the pleura are a vast and diverse field. One of the lesser known and less common tumour is the solitary fibrous tumour of the pleura, representing about 5% of these types of tumours. The authors present the case of a woman admitted to the emergency department with symptoms of dizziness and vomits. Imaging studies showed a giant thoracic mass on the left hemithorax, with a biopsy indicating a solitary fibrous tumour. The patient was referred for surgery, which was performed via thoracotomy. In the postoperative period she developed an acute pulmonary oedema secondary to lung reexpansion and fluid overload, with a good response to fluid restriction and intravenous diuretics. 

Introduction: Iliac artery aneurysms (IAA) are a rare entity with a prevalence lower than 2% in the general popula- tion involving typically the common iliac artery in 70-90%. Literature describes that bilateral common IAA may be present in approximately 50% of the affected patients. Case-report: The authors present an 88 years old male patient with an isolated giant IAA, 84mm maximum diameter, diagnosed following a four-month period of lower abdominal discomfort and pelvic hyperemic mass. The IAA was successfully excluded with an endovascular approach with an Aorto-uni-iliac endograft Endurant II (Medtronic Cardiovascular, Santa Rosa, CA, USA) followed by a femorofemoral right to left bypass. Discussion: Asymptomatic IAA are difficult to identify due to their anatomical location deep within the pelvis but once symptomatic they are associated with a high rate of morbidity and mortality. Their management has evolved toward an endovascular first approach over the past decades, nevertheless, the type of operative repair depends on patient anatomy, clinical stability and the presence of other concomitant aneurysms.

.

No summary/description provided

Aims: The aims of this study were to analyze early and late outcomes of TVS and identify predictors of short and long- term poor prognosis. Methods: Single centre retrospective study with 130 patients who underwent TVS between 2007 and 2020. Most of the patients were female (72.3%), mean age of 64.4 years; 61.1% were in New York Heart Association class III/IV, with a EuroSCORE II of 7.5%. Univariable and Multivariable analyses were undertaken to identify predictors of perioperative mortality and morbidity and long-term mortality. Results: In-hospital mortality was 10.8%, of which 7.6% were due to a cardiac cause. Diabetes Mellitus was an in- dependent predictor of increased perioperative mortality. This group had 27.7% rate of major perioperative complications. Elevated systolic pulmonary pressure and obesity were predictors of early morbidity. All-cause mortality was 43.1% for 14 years. The survival at 1, 5 and 10 years was 83%, 60% and 43%, respectively. Diabetes Mellitus was a risk factor for long-term mortality. Conclusions: Patients undergoing TVS have a high surgical risk making TVS an operation associated with high mor- tality and morbidity. This research suggests Diabetes Mellitus, pulmonary hypertension and obesity as risk factors for mortality in TVS.

Selected Oral Communications for the Manuel Machado Macedo Award and Short Oral Communications

Selected Oral Communications for the Eduardo Esteves Pinto Award and Short Oral Communications

Selected Oral Communications for the João Cid dos Santos Award and Short Oral Communications

No summary/description provided

No summary/description provided

.

Introduction: Acquired Myasthenia Gravis (MG) is a rare autoimmune neurological disorder characterized by fluctu- ating paresis of the skeletal muscle due to pathogenic antibodies against the acetylcholine receptor or other elements of the neuromuscular plaque. There is a close relation between MG and thymoma. We aimed to characterize a population of patients with Myasthenia Gravis associated thymoma (MGAT). Methods: Retrospective and longitudinal study in all patients with MGAT observed at a tertiary center between 2009 and 2020. We assessed epidemiological, clinical, laboratory and therapeutic features of both MG and thymoma. Results: We found 18 patients with an average age of 53 ± 16.2, 13 of them females. Most patients (n=15) presented the generalized MG form. Most frequent Masaoka staging was II (n=7). Regarding the WHO histopathological classification of thymoma, most patients (n=11) presented with type B2 or B3. Thirteen patients underwent extended thymectomy (12 by median sternotomy and 1 by VATS). Of the remaining 5 patients, 4 of them underwent a CT scan guided biopsy, and 1 patient did not accept further work-up. Seven patients were classified as R0 for surgical resection margins and only one of them had recurrence of thymoma. Besides surgery, oncological treatment included radiotherapy and chemotherapy. Five patients expe- rienced a myasthenic crisis during the course of the disease. Three deaths occurred in the studied population. Conclusions: This study helped to pinpoint important aspects concerning therapeutic orientation of MGAT patients, such as the clinical impact of thymectomy in the course of MGAT, the oncological prognostic value of surgical resection mar- gins, and the importance of preoperative intravenous immunoglobulin. Management of MGAT patients is only possible with a multidisciplinary approach.