Biomedical subjects

Luis Marcelo Argote-Greene

Publications and source records attributed to Luis Marcelo Argote-Greene.

3 recordsLinked to original sources

PubMed2006

Thoracoscopic management of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax is defined as that which appears in patients without history of previous pathology that could explain the event. Management includes pleural drainage with or without pleurodesis and surgical resection of affected lung tissue with pleurodesis. Thoracoscopic approach has proved to be useful with low morbidity and mortality as well as low recurrence rate. This paper describes the experience with thoracoscopic management of primary spontaneous pneumothorax with pulmonary wedge resection of affected tissue, parietal pleurectomy, and pleural abrasion of remaining parietal and diaphragmatic pleura. Fifty-five patients have been submitted to this approach (24 female, 31 male). Fifty-three patients had past history of at least one previous pneumothorax (second event, n=41; third event, n=9; fourth event or more, n=3). Computed tomography was abnormal in 19 patients. Operative time was 57 minutes (+/-17). There were no transoperative complications. Macroscopic findings were presence of small type I bullae in the lung apex in 48; three more had apical pleural thickening. None of the patients presented postoperative air leak. Chest tubes were removed after 24-48 hours on average. Adequate pain control was achieved in 51 patients; 4 patients presented mild chronic intercostal pain for 3-5 months. Median follow-up was 48 months (range 6-72); no recurrence has been observed. Primary spontaneous pneumothorax can be managed thoracoscopically; management should include wedge resection of affected lung, apical pleurectomy, and pleural abrasion of remaining parietal and diaphragmatic pleura.

Adolescent↗

PubMed2001

Nonanatomic thoracoscopic wedge resection for diffuse lung disease and indeterminate pulmonary nodule.

Video technology has revolutionized thoracoscopy dramatically, considerably increasing its indications. The clinical charts of patients who underwent a video-thoracoscopic procedure during a 6-year period were reviewed. Any patient in whom lung wedge resection for diffuse disease or an indeterminate nodule was performed met the inclusion criteria. Early and long-term outcomes were analyzed. A total of 310 thoracoscopic procedures were performed in the 250 patients reviewed. Of these patients, 60 presented with diffuse lung disease and 71 with an indeterminate pulmonary nodule. The total morbidity among diffuse disease patients was 5% (one intercostal vessel hemorrhage and two air leaks). Overall mortality for this group was 11% and was related to previous respiratory status and underlying disease. Patients not requiring preoperative mechanical ventilation ended up requiring it postoperatively, for a crossover rate of 23%. There was no morbidity or mortality in patients who did not require mechanical ventilation. The therapeutic impact index (defined as the total number of patients divided by the patients in whom initiation or withdrawal of specific treatment was due to the biopsy result) for diffuse lung disease was 0.9. Regarding lung nodule resection, early morbidity was present in one patient, who developed a persistent air leak. Late morbidity was present in three patients, who developed persistent intercostal pain. Total morbidity was 5.6%. No mortality was observed for this group. Nonanatomic wedge resection via video-thoracoscopy for diffuse pulmonary disease and indeterminate lung nodule is feasible using minimally invasive methods. Morbidity and mortality are related to the underlying disease and the respiratory status; they are not necessarily due to the procedure.

Diagnosis, Differential↗

PubMedDate not supplied

[Lung transplantation].

Lung transplantation (LT) has evolved to become an important alternative in the management of patients with end-stage pulmonary disease and chronic respiratory failure. The beginnings of this technique can be traced back to the experiments of Carrel and Guthrie over a hundred years ago. However, it was not until 1963 when the first clinical experience was performed by Hardy. Clinical success did not arrive until the 1980's thanks to the works of the Toronto Lung Transplant Group. Well established criteria have been described in order to consider a patient as a potential candidate to receive a lung. Several diseases are capable of causing terminal lung damage and in general they can be classified according to their origin as obstructive (COPD, emphysema), restrictive (fibrosis), chronic infectious (cystic fibrosis, bronquiectasis), and vascular (primary pulmonary hypertension). The most frequent diagnosis is COPD. Clinically relevant modes of LT include the implant of one lung (single LT), or both lungs (bilateral sequential LT). Transplantation of the cardiopulmonary block is reserved for special situations and lobar transplantation is still considered experimental. Donor condition is essential to the success of LT. The potential donor patient frequently suffers deterioration in lung function due to edema formation or infection and both complications restrict lung's using for transplantation. Lung preservation is also limited to a short period of time which rarely exceeds 6 hours in spite of specially-designed preservative solutions such as the low potassium dextran. Outcome after LT shows current one-year survival between 65-70% with reduction to 40-45% after five years. Mortality within the first year is usually related to primary graft failure and infection. Long-term survival depends on controlling infectious problems due to immunosuppression as well as the development of bronchilitis obliterans as a manifestation of chronic rejection. LT is a therapeutic modality reserved for selected patients with chronic respiratory failure due to end-stage lung disease.

Actuarial Analysis↗