Miguel Tedde - Academia.edu (original) (raw)

Papers by Miguel Tedde

Revista do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, 1992

Journal of Pediatric Surgery, Mar 1, 2021

Background/Purpose: The aim of the study was to evaluate the postoperative quality of life (QoL) ... more Background/Purpose: The aim of the study was to evaluate the postoperative quality of life (QoL) of patients who underwent minimally invasive repair of pectus excavatum (MIRPE) with a newly designed bar and bar stabilizers. Methods: We conducted a prospective randomized study in which patients were operated either with standard perpendicular stabilizers (control group) or with the newly designed oblique stabilizers (intervention group). All patients were evaluated 6 months after the operation with the Pectus Excavatum Evaluation Questionnaire (PEEQ). Results: There were 16 patients in the control group and 14 in the intervention group. Mean age was 17 (SD: 3.3, range 14-27) years. There were no demographic differences between groups. Two patients in the control group and one in the intervention group were repaired with two bars instead of one. There was one reoperation in each group. There was a significant difference between the pre-and postoperative scores, in both groups, in the patient body image domain (control group: 9.5 to 3; p b 0.01; intervention group 10 to 3; p b 0.01), as well as in the psychosocial domain (control group: 13.5 to 24, p b 0.01; intervention group: 15 to 24, p b 0.01). With regards to the patients' perception of physical difficulties before and after MIRPE, the difference between pre-and postoperative scores was greater in the intervention group (8 to 12, p b 0.01) than in the control group (10 to 11, p = 0.04). The mean length of stay was 4.5 and 5 days in the intervention group and the control group, respectively. Conclusion: Our study showed that patients who underwent MIRPE with the newly designed bars and stabilizers had non-inferior outcomes than patients reported in the literature who underwent MIRPE with standard bars and stabilizers. We found slightly better outcomes in patients in the intervention group compared to the control group, but larger studies will be needed to confirm if those differences are statistically significant.

Archivos De Bronconeumologia, 2012

Journal of Pediatric Surgery, Mar 1, 2018

Background: To minimize cardiac perforation during the minimally invasive repair of pectus excava... more Background: To minimize cardiac perforation during the minimally invasive repair of pectus excavatum (MIRPE), several surgeons have suggested using a suction device to intraoperatively lift the sternum. Whether or not this technique is effective for all PE patients is not yet known. As such, our aim was to quantify the extent to which a suction device is capable of lifting the sternum with a short duration of use. Methods: 30 PE patients received a low-dose CT scan as part of standard PE evaluation. A Vacuum Bell suction was then applied for only two minutes, and a repeat CT scan was obtained only at the deepest point of the chest wall deformity. We compared chest dimensions before and after Vacuum Bell suction. Results: The Vacuum Bell lifted the sternum in all 29 patients included in the analysis. The absolute change in depth ranged from 0.29 to 23.67 mm (M = 11.02, SD = 6.05). The average improvement in Haller index was 0.76. The suction was most effective for individuals with low BMI and smaller chest depths. Efficacy was not associated with gender, age, or chest morphology. Conclusions: The Vacuum Bell device effectively lifted the sternum in PE patients with different demographics and chest morphologies. Future research is needed to address whether or not the device reduces risk of cardiac perforation during MIRPE.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa po... more Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um método novo em diagnóstico e estadiamento linfonodal mediastinal. O objetivo do estudo foi avaliar os resultados preliminares obtidos com EBUS-TBNA no diagnóstico de lesões e no estadiamento linfonodal mediastinal. Métodos: Foram avaliados pacientes com tumores ou adenopatias mediastinais e com diagnóstico ou suspeita de câncer de pulmão. Os procedimentos foram realizados com os pacientes sob sedação ou anestesia geral. O material coletado foi preparado em lâminas fixadas em álcool absoluto para citologia e em formol para bloco de células. Resultados: Foram incluídos 50 pacientes (30 do sexo masculino), com média de idade de 58,3 ± 13,5 anos. Foram realizadas 201 punções em 81 linfonodos ou massas mediastinais (média de 2,5 punções). O material obtido foi considerado adequado para análise citológica em 37 pacientes (74%), dos quais 21 (57%) foram diagnosticados com malignidade. Nos 16 pacientes remanescentes, 1 teve diagnóstico de tuberculose, 6 tiveram seguimento clínico, e 9 foram submetidos a investigação adicional (2 diagnosticados com neoplasia-resultados falso-negativos). O rendimento do exame foi maior nos procedimentos com objetivo diagnóstico, em pacientes com lesões em múltiplas estações, e nas punções da estação linfonodal subcarinal. Um paciente apresentou sangramento endobrônquico resolvido com medidas locais. Não houve mortalidade na série. Conclusões: Esta experiência preliminar confirmou que o EBUS-TBNA é procedimento seguro, e que o nosso rendimento diagnóstico, inferior ao da literatura, foi compatível com a curva de aprendizado do método. Descritores: Ultrassonografia de intervenção; Biópsia por agulha fina; Estadiamento de neoplasias; Neoplasias pulmonares; Broncoscopia.

Jornal Brasileiro De Pneumologia, Feb 1, 2012

Journal of Pediatric Surgery, Nov 1, 2022

Letter to the Editor in response to: The hidden (and fatty) side of vacuum bell Dear Editor , Whe... more Letter to the Editor in response to: The hidden (and fatty) side of vacuum bell Dear Editor , When exploring the determinants of success in vacuum bell treatment, Toselli, et al., made a valuable contribution to the study of congenital chest wall deformities [1]. With 45% of patients still in follow-up, their results, in summary, are 17% of success, with a failure rate of 9.5% and dropouts of 34%. The variation in pectus depth in the group considered excellent was 0.7 (0.4;1.1) cm. In our protocol, we observed that the immediate result with the vacuum bell was encouraging, but the late results were not satisfactory [2]. These data are in line with reports from several other groups, as Toselli, et al., cite in their study [1]. However, it is in the mechanism of the so-called "success" cases on which we want to focus. In our series, we observed that the reduction in pectus depth was due to the thickening of the chest wall at the place where the vacuum bell was applied (Fig. 1). Furuta, et al., were more specific in confirming that 14 of 15 cases that were successful in treatment had no change in the Haller index [3]. In other words, the undisputed fact is that the alteration

The Annals of Thoracic Surgery, 2023

BACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currentl... more BACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum. METHODS The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion. RESULTS All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photography. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon suspicion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical examination should both be part of routine postoperative follow-up. CONCLUSIONS Through a multiround survey, international consensus was formed on multiple topics to aid standardization of pectus excavatum care.

Human pathology, Jan 18, 2018

Ki-67 has shown promise as a prognostic factor in pulmonary carcinoids. In this study, we sought ... more Ki-67 has shown promise as a prognostic factor in pulmonary carcinoids. In this study, we sought to validate the importance of Ki-67 and study the relationships between Ki-67 and other stromal biomarkers of vascular density. We examined Ki-67, CD34 and D2-40 in tumor tissues from 128 patients with surgically excised typical carcinoid of the lung. We used immunohistochemistry and morphometry to evaluate the amount of tumor staining for cellular proliferation (Ki-67), microvascular density (CD34-MVD) and lymphovascular density (D2-40-LVD). The main outcome was overall survival, considered as life expectancy until death from metastasis. Specimens from patients with central tumors showed high CD34-MVD (P=.01), which was also significantly associated with a compromised surgical margin, lymph node metastasis, and clinical stage Ib. Equally significant was high D2-40-LVD in central specimens with a compromised surgical margin and lymph node metastasis. A high Ki-67 proliferation rate was s...

The Journal of Thoracic and Cardiovascular Surgery, 2018

Objective: Several factors may potentially influence the efficacy and patient satisfaction after ... more Objective: Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of compensatory hyperhidrosis (CH), and variations in the quality of life. Methods: We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with hyperhidrosis (n ¼ 1633) who underwent bilateral sympathectomy. Results: Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial hyperhidrosis, and level of resection). Conclusions: We observed that patients with old age reported an improvement in sweating in the main site of hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.

General Thoracic and Cardiovascular Surgery, 2022

OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of p... more OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD: A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ‘‘third point fixation’ ’ technique, and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS: There were no deaths in any of the series. Minor complications occurred in six (4.9%) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5%) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation ...

Contemporary Clinical Trials Communications, 2020

To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage... more To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. Methods: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. Results: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years.

Jornal Brasileiro de Pneumologia, 2019

Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. ... more Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patie...

Rev Hosp Clin Fac Med Univ Sao Paulo, Jun 1, 1992