Browsing by Author "Calvinho, P"
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- Cirurgia do aspergiloma pulmonar: curativa?Publication . Bernardo, JE; Calvinho, P; Eugénio, L; Antunes, MJIntroduction.In lhe last few decades, there has been an increase in fungal diseases, especially in those caused by Aspergillus.The aim of this retrospective study was to confirm or ascertain whether surgical intervention to pulmonary aspergiloma can result in a cure or long term palliative treatment with improvement of quality of life. Methods and materiais. From 1989 to 2001, 23 patients with mean age of 44.1 years (18-69 years) were submitted to pulmonary surgery for excision of aspergilloma. Sixteen patients were mate (70%). The most frequent indication for surgery was haemoptysis in 16 patients (70%) followed by abundant sputum in 3 patients (3%). Four patients (17%) were asymptomatic. Old tuberculosis lesions (87%) or pulmonary abscesses (13%) were lhe basic conditions for lhe aspergilloma. Pre-operative evaluation of respiratory function showed a mean vital capacity of 69.8% (61-84% limits) and lhe mean Fevl was 66% (53-82% limits). Results. This group of patients were submitted to 18 lobectomies (82%), 2 bilobectomies (7%), 2 wedge resections and 1 pneumonectomy (4%). There was no operative mortality and lhe morbidity in lhe post-operative period was: persistent air leak in 7 patients (30%), post-operative bleeding in 2 patients (7%) and residual cavities in 2 patients (7%). The mean time of follow-up was 7.2 years (limits 1.5-14 years) and 3 deaths were registered. Two deaths were related to intestinal neoplasia and 1 related to lhe original disease, 5 years after surgery. All surviving patients referred good improvement of symptoms and quality of life. Conclusions. The resection of pulmonary aspergilloma could be performed with a low morbidity and mortality. The patients referred good improvement of symptoms and quality of life after surgery. Consequently, we suggest that surgical therapy is an option for both symptomatic and asymptomatic patients
- Current surgical management of mitral regurgitationPublication . Calvinho, P; Antunes, MJFrom Walton Lillehei, who performed the first successful open mitral valve surgery in 1956, until the advent of robotic surgery in the 21st Century, only 50 years have passed. The introduction of the first heart valve prosthesis, in 1960, was the next major step forward. However, correction of mitral disease by valvuloplasty results in better survival and ventricular performance than mitral valve replacement. However, the European Heart Survey demonstrated that only 40% of the valves are repaired. The standard procedures (Carpentier's techniques and Alfieri's edge-to-edge suture) are the surgical basis for the new technical approaches. Minimally invasive surgery led to the development of video-assisted and robotic surgery and interventional cardiology is already making the first steps on endovascular procedures, using the classical concepts in highly differentiated approaches. Correction of mitral regurgitation is a complex field that is still growing, whereas classic surgery is still under debate as the new era arises.
- Diaphragmmatic eventration: long-term follow-up and results of open-chest plicaturePublication . Calvinho, P; Bastos, C; Bernardo, JE; Eugénio, L; Antunes, MJObjective: Diaphragmmatic eventration is a relatively uncommon entity with a simple surgical correction technique - plication of the diaphragm. This study aims to assess the clinical and ventilatory impact of this technique. Materials: From April 1988 to February 2007, we operated on 20 patients (12 men) with diaphragmmatic eventration using the postero-lateral approach and correction by radial plication. The mean age of the patients studied was 56.3+/-15.6 years (range: 13-74 years). A traumatic cause was identified in 13 patients; one patient had a congenital cause and the remainder were of idiopathic origin. Chronic obstructive pulmonary disease and arterial hypertension were present in one-half of the study group, while diabetes mellitus was present in three patients. Dyspnoea was the most common complaint in 75% of the patients, and thoracic pain was present in 25%. The mean forced expiratory volume in 1s (FEV(1)) and vital capacity (VC) were 66.2+/-15.3% and 70.4+/-16% of the predicted values, respectively. Results: There was no operative mortality. Apart from a patient with moderate/severe pain and another who had pneumonia, there were no other important perioperative complications. Average drainage time was 3.3+/-1.6 days (range: 2-7 days). Hospitalisation time was 6.2+/-1.6 days (5-10 days). Follow-up was complete, for a mean of 59.6+/-55.1 months (4-206 months). There were three late deaths (one sudden, one stroke and one trauma). Eight of the 17 survivors (47%) are asymptomatic. According to the MRC/ATS grading system, the dyspnoea score was 2.06+/-0.97 preoperatively and 1.06+/-1.14 postoperatively (p=0.007). At follow-up, the FEV(1) was 76.1+/-20.1% and the VC was 78.4+/-17.3% (p>0.1). Two patients had chronic pain. Conclusion: Plication of the diaphragm is a safe and efficient procedure. Most patients experienced significant clinical improvement with enhancement of the FEV(1) and VC. Chronic surgical pain still remains a potential problem with the classical approach.