RICARDO MINGARINI TERRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
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bookPart Punção pleural(2012) TERRA, Ricardo Mingarini; JATENE, Fabio Biscegli- Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?(2012) TERRA, Ricardo Mingarini; WAISBERG, Daniel Reis; ALMEIDA, Jose Luiz Jesus de; DEVIDO, Marcela Santana; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio BiscegliOBJECTIVE: We aimed to evaluate whether the inclusion of videothoracoscopy in a pleural empyema treatment algorithm would change the clinical outcome of such patients. METHODS: This study performed quality-improvement research. We conducted a retrospective review of patients who underwent pleural decortication for pleural empyema at our institution from 2002 to 2008. With the old algorithm (January 2002 to September 2005), open decortication was the procedure of choice, and videothoracoscopy was only performed in certain sporadic mid-stage cases. With the new algorithm (October 2005 to December 2008), videothoracoscopy became the first-line treatment option, whereas open decortication was only performed in patients with a thick pleural peel (>2 cm) observed by chest scan. The patients were divided into an old algorithm (n = 93) and new algorithm (n = 113) group and compared. The main outcome variables assessed included treatment failure (pleural space reintervention or death up to 60 days after medical discharge) and the occurrence of complications. RESULTS: Videothoracoscopy and open decortication were performed in 13 and 80 patients from the old algorithm group and in 81 and 32 patients from the new algorithm group, respectively (p < 0.01). The patients in the new algorithm group were older (41 +/- 1 vs. 46.3 +/- 16.7 years, p=0.014) and had higher Charlson Comorbidity Index scores [0(0-3) vs. 2(0-4), p = 0.032]. The occurrence of treatment failure was similar in both groups (19.35% vs. 24.77%, p= 0.35), although the complication rate was lower in the new algorithm group (48.3% vs. 33.6%, p = 0.04). CONCLUSIONS: The wider use of videothoracoscopy in pleural empyema treatment was associated with fewer complications and unaltered rates of mortality and reoperation even though more severely ill patients were subjected to videothoracoscopic surgery.
- Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil(2012) TEDDE, Miguel Lia; FIGUEIREDO, Viviane Rossi; TERRA, Ricardo Mingarini; MINAMOTO, Helio; JATENE, Fabio BiscegliObjective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of mediastinal lymph nodes. The objective of this study was to evaluate the preliminary results obtained with EBUS-TBNA in the diagnosis of lesions and mediastinal lymph node staging. Methods: We evaluated patients with tumors or mediastinal adenopathy, diagnosed with or suspected of having lung cancer. The procedures were performed with the patients under sedation or under general anesthesia. Material was collected by EBUS-TBNA, after which it was prepared on slides, fixed in either absolute alcohol (for cytology) or formalin (for cell-block analysis). Results: We included 50 patients (30 males). The mean age was 58.3 +/- 13.5 years. We performed 201 biopsies of 81 lymph nodes or mediastinal masses (mean of 2.5 punctures/biopsy). The quantity of material was considered sufficient for cytology in 37 patients (74%), 21 (57%) of whom were thus diagnosed with malignancy. Of the remaining 16 patients, 1 was diagnosed with tuberculosis, 6 entered clinical follow-up, and 9 underwent further investigation (2 diagnosed with neoplasm-false-negative results). The yield was higher when the procedure was performed for diagnostic purposes, as well as being higher in patients with lesions in multiple stations and in biopsies involving the subcarinal lymph node station. One patient had endobronchial bleeding, which was resolved with local measures. There were no deaths among the patients evaluated. Conclusions: This preliminary experience shows that EBUS-TBNA is a safe procedure. Our diagnostic yield, although lower than that reported in the literature, was consistent with the learning curve for the method.
bookPart Drenagem pleural(2012) TERRA, Ricardo Mingarini; JATENE, Fabio Biscegliarticle 6 Citação(ões) na Scopus Hemangioma subglótico e mediastinal em criança: tratamento com propranolol(2011) TAMAGNO, Mauro; BIBAS, Benoit Jacques; MINAMOTO, Helio; ALFINITO, Fernanda Sobreiro; TERRA, Ricardo Mingarini; JATENE, Fabio Biscegli- Decannulation in Tracheal Stenosis Deemed Inoperable Is Possible After Long-Term Airway Stenting(2013) TERRA, Ricardo Mingarini; BIBAS, Benoit Jacques; MINAMOTO, Helio; WAISBERG, Daniel Reis; TAMAGNO, Mauro Federico Luis; TEDDE, Miguel Lia; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio BiscegliBackground. Decannulation is the ultimate therapeutic goal for patients who undergo stenting because of inoperable benign tracheal stenosis. In this study, our objectives were to evaluate whether long-term airway stenting allows decannulation in patients with benign tracheal stenosis who were deemed inoperable and to identify possible predictive factors for successful decannulation (SD). Methods. Retrospective cohort study including all patients with inoperable benign tracheal stenosis who underwent tracheal stenting in our tertiary-care university-based institution from 1998 to 2008. For benign stenosis, we use only silicone stents (T tubes, Dumon stents, and Y stents). The main outcome was SD, which was defined as removal of the tracheal stent followed by absence of respiratory symptoms and no requirement for new dilation procedures for at least 6 months. A Kaplan-Meier curve was built to evaluate SD in 5 years, and we used a Cox model to evaluate predictors for a SD. Results. Ninety-two patients were included, and during the study period 21 were decannulated. However, 2 of them had to undergo new airway procedures and were considered to represent failure. Therefore, 19 patients were successfully decannulated. According to the Kaplan-Meier estimate, the SD rate in 5 years was 27.5%. The mean follow-up time after SD was 34.3 +/- 33.9 months (range, 6 to 108 months). Cox regression showed only 1 significant factor: tracheostomy before stent insertion caused a threefold increase in the likelihood of the patient remaining with a tracheal stent (p = 0.048). Conclusions. Tracheal stenting may be considered a curative therapeutic approach in as many as 27.5% of patients with inoperable benign tracheal stenosis. (Ann Thorac Surg 2013;95:440-4) (c) 2013 by The Society of Thoracic Surgeons
bookPart Tumores Mediastinais(2013) TERRA, Ricardo Mingarini; JATENE, Fabio Biscegli- Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status(2011) TERRA, Ricardo Mingarini; TEIXEIRA, Lisete Ribeiro; BIBAS, Benoit Jacques; PEGO-FERNANDES, Paulo Manuel; VARGAS, Francisco Suso; JATENE, Fabio BiscegliOBJECTIVES: To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. METHODS: This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <= 70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was <100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. RESULTS: During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post- pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. CONCLUSION: In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.
- Surgically-challenging chondrosarcomas of the chest wall: five-year follow-up at a single institution(2011) WAISBERG, Daniel Reis; ABRAO, Fernando Conrado; FERNANDEZ, Angelo; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio Biscegli
- Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting?(2011) TERRA, Ricardo Mingarini; KIM, So Yeon; PEGO-FERNANDES, Paulo Manuel; TEIXEIRA, Lisete Ribeiro; VARGAS, Francisco Suso; JATENE, Fabio BiscegliThe purpose of this study was to analyze the effectiveness and safety of silver nitrate pleurodesis (SNP) in patients with recurrent malignant pleural effusion (RMPE) when performed in an outpatient setting. Prospective study including patients with RMPE recruited in a tertiary university-based hospital from February 2008 to June 2009. Elected patients underwent pleural catheter insertion (Day 1) followed by 0.5% SNP (Day 2), and on 7th day the drain was removed. All procedures were performed in an outpatient facility. Pleurodesis was considered successful when no additional pleural procedure was necessary by the 30th day. Complications were registered and graded according to the CTCAE3.0. Quality of life was evaluated before and 30 days after SNP. A total of 68 patients (54 female, 14 male, mean age: 57.3 years) were included. In addition, 7 had bilateral pleural effusions; therefore, 75 hemithoraces were drained. Also, 5 were excluded, and 70 hemithoraces (63 patients) underwent SNP. During the period of 30 days postpleurodesis, 8 deaths not related to the procedure occurred, and we lost contact with 10 patients who were followed elsewhere. At the 30th day, 48 hemithoraces (45 patients) were reevaluated, and 2 recurrences observed. The most frequent complication was pain-graded as 3 or more in 7 patients; infection occurred in 2 patients. Physical and environmental aspects of quality of life improved significantly after pleurodesis. In this study, SNP could be performed safely in an outpatient setting, with pain the most frequent complication. Recurrences occurred in 4% of the patients.