Papers by André Pedral Sena
PubMed, 2016
Background: The outpatient surgery program from our department has started in 2014 to improve pat... more Background: The outpatient surgery program from our department has started in 2014 to improve patient access to surgery and to reduce the surgical waitlist. Focused on the thoracic surgery, the most common intervention is the surgical treatment of primary hyperhidrosis by thoracic sympathectomy by video-assisted thoracoscopic surgery (VATS). It is performed according to the patient's symptoms, with section or application of surgical clips between R2-R5. Materials and methods: Retrospective study including all the patients submitted to thoracic sympathectomy by video- -assisted thoracoscopy surgery from our department's outpatient surgery program from January 2014 to January 2016. Results: In our outpatient program we performed 198 thoracic sympathectomy by VATS. The mean age of the patients was 32,8 years old. 63,6% of the patients were females and 36.4% were males. From the 198 endoscopic thoracic sympathectomy performed, 181 (91,4%) were performed bilatellary with section between R3-R5, 12 (6,1%) were performed with the application of surgical clips in R2-R4 and 3 (1.5%) could not be performed due to the presence of pleuropulmonary adhesions. One of the patients was re-operated due to recurrent symptoms and another patients had surgery to remove the surgical clips (bilaterally in R2) due to exaggerated abdominal compensatory hyperhidrosis. Three patients had pneumothorax. Conclusion: The surgical treatment of primary hyperhidrosis was the most frequent procedure in our outpatient surgery program. The procedure without the use of a thoracic drainage allowed its inclusion in the outpatient surgery program. Excluding 3 patients, all the patients were discharged within 12 hours after the surgery. The good results and the reduction of the surgical waitlist encourage the cardiothoracic outpatient surgery program.
Surgical resection, driven by good results in terms of survival, has gained an increasingly impor... more Surgical resection, driven by good results in terms of survival, has gained an increasingly important role in the approach to the patient with lung metastases. Thoracoscopy, although less invasive and permitting a faster recovery of the patient, has been the subject of some dispute due to lake of safe removal of very small nodules and detection of cold nodules (undetected on image exams). This could be surpassed by applying single port- video assisted thoracic surgery(SP-VATS). The authors present the results of SP-VATS in the treatment of 24 patients with lung metastases in terms of hospital stay, pain, number of resected nodes, lymph node dissection and pathological results. We also compared the number of nodes detected preoperatively on image exams with the number of nodes resected and the pathogical results. Of these 24 patients the vast majority were female (70.8%) with a mean age of 55.2 years. Most of the metastases originated from the digestive tract (75%). The average time of surgery was 92 minutes. In 37.5% cases (9 patients) we resected more nodes than were detected by CT and / or PET preoperatively and of these about 55% were positive in pathological examination. The use of SP-VATS allows to fill the gaps left by thoracoscopy in the treatment of lung metastases maintaining its advantages. Ensures a faster recovery and is less painful for patients. It allows the detection of cold nodules as small as 2mm and a complete lymph node dissection. In our opinion it should be the preferred technique in treating this type of pathology.
Aortic valve stenosis is the most common adult valve disease in industrialized countries. The age... more Aortic valve stenosis is the most common adult valve disease in industrialized countries. The ageing population and the increase in comorbidities urge the development of safer alternatives to the current surgical treatment. Sutureless bioprosthesis have shown promising results, especially in complex procedures and in patients requiring concomitant surgeries. Objectives: Assess the clinical and hemodynamic performance, safety, and durability of the Perceval prosthetic valve. Methods: This single center retrospective longitudinal cohort study collected data of all adult patients with aortic valve disease who underwent aortic valve replacement with a Perceval prosthetic valve between February 2015 and October 2020. Of the 196 patients included (mean age 77.20±5.08 years; 45.4% female; mean EuroSCORE II 2.91±2.20%), the majority had aortic stenosis. Results: Overall mean cross-clamp and cardiopulmonary bypass times were 33.31±14.09 and 45.55±19.04 minutes, respectively. Mean ICU and hos...
Revista de História das Ideias
Revista Fim do Mundo, 2021
Este artigo reflete sobre três eixos temáticos distintos e interligados: a pandemia de COVID-19, ... more Este artigo reflete sobre três eixos temáticos distintos e interligados: a pandemia de COVID-19, a ação do governo manifestada na implementação de políticas públicas emergenciais e o pano de fundo do racismo estrutural e da necropolítica como fatores que orientam a maneira como o Estado faz a gestão da crise sanitária. Inicialmente, este trabalho apresenta um breve panorama da pandemia e algumas reflexões das ciências sociais a respeito dela. Em seguida, discutimos a maneira como o Estado brasileiro se colocou diante da emergência de saúde pública, analisando seus investimentos e ações. Por fim, a articulação entre o racismo estrutural e a necropolítica nos permite compreender como se agravou as condições de vulnerabilidades sociais das populações negras frente ao cenário instaurado pelo coronavírus e como cada uma dessas instâncias de poder age para que elas sejam mais intensificada
Objectives: Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax without obvious u... more Objectives: Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax without obvious underlying lung disease. Definitive treatment should be offered to patients with recurrent or persistent PSP. The aim of this study was to compare the effectiveness of medical pleurodesis (MP) with video assisted thoracic surgery (VATS) on definitive treatment of PSP. Methods: 10 years' retrospective study of PSP patients that underwent VATS or MP. Baseline characteristics, perioperative and follow-up data were compared. Results: A total of 133 patients were included (MP=54; VATS=79). Baseline characteristics were similar between groups, with a male predominance (MP 83.6 vs VATS 85.5%) with a mean age of 24.78 and 25.81 years old, respectively. Post interventional length of hospital stay was similar (MP 4.94 vs VATS 4.47 days, p=0.20), but chest tube duration was longer in the VATS group (MP 2.94 vs VATS 3.56 days, p=0.03). The overall complications rate was low with no statistically ...
Background: A transient postoperative drop in platelet count is an expected finding after aortic ... more Background: A transient postoperative drop in platelet count is an expected finding after aortic valve replacement using extracorporeal circulation. The implantation of the Perceval valve has been associated with a more intense drop of platelet count compared to other bio-prostheses. This study analyses and compares the platelets progression associated with the Perceval and Intuity valves. Methods: The data was collected retrospectively for patients submitted to isolated aortic valve replacement with the Perceval valve (80 patients) and the Intuity valve (141 patients) in our institution between March 2014 and December 2018. The groups were further divided into those who receive platelet transfusion and those who did not. Results: The minimum values of platelet count were 54% and 67% of the preoperative platelet count in the patients treated with a Perceval and an Intuity valves, respectively (p<0.001). In the patients transfused with platelets, the minimum values were 52% and 79...
Leprosy Review, 2010
... especially: Arvello, Pedro de Belo, Germano Traple, Frank Duerksen, Marcos Virmond, Diltor Op... more ... especially: Arvello, Pedro de Belo, Germano Traple, Frank Duerksen, Marcos Virmond, Diltor Opromolla, Linda Lehman, Hannelore Vieth, William Woods, Elifas Cabral, Wally Hirschmann, Maria Bernadete Moreira, Geısa Campos, Carmelita R. Oliveira, Fernando Oréfice and ...
The quality, speed and volume of the information, requested by the new ones systematic of market,... more The quality, speed and volume of the information, requested by the new ones systematic of market, they affect the process of organizational decision directly. This complexity is sent to the pillars of the strategic administration, and how to model the problem, implicating, like this, in the need to discover the possibility to connect presupposed of the strategic planning, joining them to the of MCDA-C and IT. It is been, a software has enough functionality, for evaluation and control of the strategic administration. As, the strategic planning is the main used tool and with the largest satisfaction degree among the users in the world, need exists to check and control the performance, guaranteeing support to the managers' decision, with that the main focus in research will be of building an evaluation software and control on strategic administration based in the methodology MCDA-C. To solve the problem, researches will be accomplished to characterize the several evaluation models and control the strategic planning, determining their main characteristics and modeling them through a software, based on to MCDA-C, in order to check the current situation of the company front to competitive, defining with clarity which they are the strategic objectives, the internal ambient (strong / weak points) and external (Threats / Opportunities). At the end project, a system will be built, and its name will be SIMAGE.
Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular, 2018
BACKGROUND Aortic valve disease is the most common valvular heart disease. Surgical aortic valve ... more BACKGROUND Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016. RESULTS The demographic and clinical characteristics between the two groups were similar. Median surgery time was 142.5 min by limited sternotomy vs 98.15 min by conventional sternotomy (p< 0.0001). Total surgery time was 142.5 min for limited sternotomy vs 98.15 min conventional sternotomy (p< 0.0001). Aortic cross-clamping time and cardiopulmonary bypass time were ...
Desalination, Aug 30, 2017
The predatory exploitation techniques used for the supply of protein resources have been systemat... more The predatory exploitation techniques used for the supply of protein resources have been systematically causing the decrease in seafood. The solution was sought in the form of marine farms, for the purpose of production of fish and seafood. Brazil created an incentive production of seafood in order to increase seafood production. In 1998, the state governments joined the project, encouraging the creation of marine farms without an assessment of the impact on the environment. In 2005, after several records of seafood production in Santa Catarina started an epidemic of white spot shrimp, decimating several fishing farms. In Bahia came the disease lethargic crab, which simply decimated almost 90% of crabs those states. In 2010, the State Government of Bahia invested in research to combat this degradation of mangroves; the project had to in essence deal with the brown mare and help save the fishing industry of the state. It was based on these principles that Nereu project emerged, which provides for the rational and intelligent use of contaminated and hypersaline water of the marine farms from the production area of fish and seafood, in order to neutralize all pathogens and produce pure water with energy cogeneration.
Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular
Minimally invasive revascularization of the left anterior descending coronary artery has gained p... more Minimally invasive revascularization of the left anterior descending coronary artery has gained popularity. Recently, the emergence of new surgical instruments and the improvement of the technique, allowed its use by routine. Its use in Heart Team allows excellent results. Our aim is to present the results of patients undergoing this technique in our center. Retrospective study of patients submitted to minimally invasive revascularization of the left anterior descending coronary artery at our center. We identified 14 patients. The mean age was 67 years old. In the total of the procedures, 79% were elective and 21% urgent. The ventricular function was preserved in 86% of the patients. In the preoperative catheterization, 64% of the patients showed single disease of the anterior descending coronary artery, 29% had trunk lesions and 3 vessels and 7% had lesion of 2 vessels. The mean Euroscore II was 4.8%. The mean time of surgery was 103 minutes with a mean blood loss of 250mL. The mai...
Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular
Aortic valve stenosis (AS) is the most common valvular pathology in the elderly. Surgical aortic ... more Aortic valve stenosis (AS) is the most common valvular pathology in the elderly. Surgical aortic valve replacement (AVR) remains the gold-standard of treatment for AS. However, emerging transcatheter aortic valve replacement (TAVR) has become an increasing alternative to surgery. In a recent survey from the European Society of Cardiology, 9,4% of the physicians stated that age was the main reason to propose for a TAVR instead of surgery. We performed a single-center retrospective study including 353 patients (149 patients over 80 years-old, compared to 204 patients between 60-69 years-old) consecutively submitted to AVR between January 1, 2013, and December 31, 2016, to compare the results of both groups in AVR surgery and how we can improve surgery outcome in older patients. The demographic and clinical characteristics between the two groups were similar. There were no significant differences in survival between the two groups at 30 days (96,57% 60-69yo vs. 96,64% >80yo), 12 mon...
International journal of surgery case reports, 2018
The treatment of choice for mediastinal tumours is surgical, with the standard approach being ste... more The treatment of choice for mediastinal tumours is surgical, with the standard approach being sternotomy. Because of the invasive nature of this procedure, the management of these masses through mini-invasive surgery has become an alternative method. We report the case of a woman with a mediastinum tumour and a new technique used for resection, through an inframammary left incision, using a Thoratrak rib spreader and Rultract Skyhook retractor assisted by a video. This approach allows a complete visualization of the mediastinum and total dissection of the tumour safely around vascular and nervous structures. The pain is minimal because there is no real rib spread but instead an anterior displacement of the upper rib. This is the first reported case of resection of a mediastinum tumour by inframammary approach using a Thoratrak rib spreader and Rultract Skyhook.
Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular
The outpatient surgery program from our department has started in 2014 to improve patient access ... more The outpatient surgery program from our department has started in 2014 to improve patient access to surgery and to reduce the surgical waitlist. Focused on the thoracic surgery, the most common intervention is the surgical treatment of primary hyperhidrosis by thoracic sympathectomy by video-assisted thoracoscopic surgery (VATS). It is performed according to the patient's symptoms, with section or application of surgical clips between R2-R5. Retrospective study including all the patients submitted to thoracic sympathectomy by video- -assisted thoracoscopy surgery from our department's outpatient surgery program from January 2014 to January 2016. In our outpatient program we performed 198 thoracic sympathectomy by VATS. The mean age of the patients was 32,8 years old. 63,6% of the patients were females and 36.4% were males. From the 198 endoscopic thoracic sympathectomy performed, 181 (91,4%) were performed bilatellary with section between R3-R5, 12 (6,1%) were performed with...
Brazilian journal of cardiovascular surgery
Melanoma is a tumor that virtually involves any tissue and commonly metastasizes to the heart. It... more Melanoma is a tumor that virtually involves any tissue and commonly metastasizes to the heart. It is usually not diagnosed because of the absent/nonspecific cardiac signs and symptoms. Herein, we present a case of a 41-year-old man without any cardiovascular risk factor, admitted to the emergency room with chest pain, diagnosed with a myocardial infarction. Due to the presence of a mass adjacent to the mitral valve on the cardiac ultrasound examination, causing mitral regurgitation, the patient was referred to surgery. Pathological analysis of the excised specimens diagnosed the melanoma. The chemotherapy was started and achieved a partial response. Cardiac metastases usually affect the myocardium, leaving the valves unaffected. In this case, the acute coronary syndrome was the first manifestation of the malignant melanoma. We highlight the high level of suspicion needed in these cases.
International journal of surgery case reports, Jan 29, 2017
We present a case of a large thymoma with invasion to the hilum of the lung and pleural dissemina... more We present a case of a large thymoma with invasion to the hilum of the lung and pleural dissemination. A 58-year-old woman was diagnosed with a type B2 thymoma, with suspected pericardium, pulmonary artery and left lung invasion and pleural metastasis (Masaoka-Koga stage IVb). A radical resection was planned after systemic chemotherapy. Through a median sternotomy, we resected the tumour, and after confirmation of pericardium and left lung invasion, we also performed resection of the pericardium, of the lung and of the pleural metastasis. The median sternotomy allowed a safe dissection of pulmonary vessels and main bronchus.
Journal of thoracic disease, 2017
Cardiac surgery is almost universally performed through a median sternotomy, an approach which is... more Cardiac surgery is almost universally performed through a median sternotomy, an approach which is painful, unestethical, and prone to life-threatening infections. Minimally invasive cardiac surgery has tried to avoid problems associated with full sternotomy for many years. Recently, uniportal thoracic surgery was shown to be very advantageous when compared to standard thoracotomy and classical video assisted thoracic surgery (VATS). Despite very good results in lung surgery, cardiac surgery through a single thoracic port has rarely been attempted and successfully conducted. The authors present the rational, the technique, and their experience in cardiac single thoracic port surgery (CSTPS).
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Papers by André Pedral Sena