Evaldo Marchi

• Professor Livre Docente
• Professor (Associate) at Medical College of Jundiai, Sao P\ulo, Brazil

OBJECTIVES Primary hyperhidrosis is a functionally and socially limiting condition. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis. However, post-sympathectomy compensatory sweating remains a challenge in clinical practice. METHODS Record analysis of patients who underwent thoracoscopic sympathectomy between 2002 and 2020....

Background: Malignant pleural effusion (MPE) signals a disease with poor prognosis, high morbid-mortality. Studies of MPE in murine models have reproduced its formation and metastases, and have propose therapies for its control. Drugs associated with nanoparticles (nab) can reduce toxicity and increase action on the tumor cell. Our objective was to...

Introdution: To determine the role of Pleural Mesothelial Cells (PMC) and/or Neoplasic Cells (NC) in the initiation and regulation of acute inflammatory response after exposure to talc for evaluating inflammatory mediators and cellular alterations. Materials and methods: PMC cultures, human lung (A549) and breast (MCF7) adenocarcinoma cells were...

Lung-cancer screening with chest computerized tomography (CT) is not easy to introduce in low-medium resource countries due to cost issues. We investigated whether the increasing availability of chest CT exams in Brazil, in spite of no lung-cancer screening protocol, was associated with lung-cancer death rate along 10-year follow-up. We performed r...

Background: We should continually improve tools for evaluating asthma. The aim of this study was to evaluate whether the FEV1/FVC ratio in the lower range of normality is associated with worse outcomes in asthmatics without airway obstruction. Methods: We screened asthmatics at eight clinics. Subjects answered the Asthma Control Questionnaire an...

Introduction Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods 20 abdominal aorta segments of pigs were divi...

OBJECTIVES Tissue adhesives can be used to prevent pulmonary air leaks, which frequently occur after lung interventions. The objective of this study is to evaluate local and systemic effects of fibrin and cyanoacrylate tissue adhesives on lung lesions in rabbits. METHODS Eighteen rabbits were submitted to videothoracoscopy + lung incision alone (c...

Rationale Malignant pleural effusion has few options of treatment and drugs administrated by different routes can lead to a less permissive microenvironment for the development of malignant pleural disease. Objectives To analyze therapies administered intrapleurally in malignant pleural disease and to study EGFR and KRAS mutations in adenocarcinom...

O presente estudo investigou se a ventilação de ratos com cilindros de ar comprimido é possível e se esta técnica seria melhor do que o procedimento de ventilação com cilindros de oxigênio comprimido. Vinte ratos foram divididos em dois grupos de dez animais cada. Em um grupo os animais foram ventilados com ar ambiente e o outro grupo foram ventila...

Background: Matrix metalloproteinases (MMPs) are responsible for the breakdown of the extracellular matrix and play an important role in the inflammatory processes of pleural exudates. The imbalance between MMPs and their inhibitors (TIMPs) is present in various pathological processes. Objective: To evaluate the profile of MMPs and TIMPs in pleu...

Background: Pleurodesis performed either by pleurectomy or pleural abrasion is recommended in the approach of primary spontaneous pneumothorax (PSP) to avoid recurrence. However, the efficacy of parietal pleural abrasion in producing pleurodesis is questioned. This study aims to determine the efficacy of apical abrasion alone, abrasion plus fibrin...

Objective: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. Methods: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with con...

Background: Malignant pleural effusion resulting mainly from pleural metastases of lung adenocarcinoma has clinical relevance, being a sign of poor prognosis and low life expectancy. Experimental models can mimic the human condition, contributing to advances in current understanding of the mechanisms patients' pleural fluid accumulation and possib...

BACKGROUND: Even when properly performed, arterial sutures are not always absolutely hemostatic. Tissue sealants and adhesives have become available that can be used to complete sutures, preventing hemorrhage problems. OBJECTIVES: To evaluate the effectiveness of cyanoacrylate adhesive for sealing aortotomies in rabbits in a coagulopathic state, b...

Several diseases have been related to asbestos exposure, including the pleural tumor mesothelioma. The mechanism of pleural injury by asbestos fibers is not yet fully understood. The inflammatory response with release of mediators leading to a dysregulation of apoptosis may play a pivotal role in the pathophysiology of asbestos-induced pleural dise...

Talc pleurodesis is the most used method to prevent recurrence of malignant pleural effusion (MPE). Inflammatory response produced by pleural mesothelial (PMC) and neoplastic cells and its relationship to effectiveness of pleurodesis is discussed. Aim Determination of the role of PMC and neoplastic cells in initial phase and regulation of acute in...

SESSION TITLE: Pleural Disease Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM PURPOSE: Talc pleurodesis is the most used method to prevent recurrence of malignant pleural effusion. It is discussed the role of the inflammatory response produced by pleural mesothelial cells (PMC) a...

SESSION TITLE: Malignant Pleural Disease Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM PURPOSE: Malignant pleural effusion (MPE) poses a common and significant clinical problem. Its pathogenesis is still poorly understood and therapeutic options are limited. Animal models of MPE...

Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy...

In the last ten years the hemostatic agents and tissue adhesives have been frequently used and they are positive alternatives to prevent excessive blood loss. The objective of this review is to discuss the characteristics of each of these agents to facilitate the surgeon's decision when choosing the most suitable product for every type of bleeding...

Background: The mechanisms underlying pleural inflammation and pleurodesis are poorly understood. We hypothesized that the cytokines transforming growth factor β (TGFβ1) and vascular endothelial growth factor (VEGF) play a major role in pleurodesis after intrapleural silver nitrate (SN) injection. Method: Forty rabbits received intrapleurally 0....

SESSION TYPE: Pleural DiseasePRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PMPURPOSE: To describe the outcome of a series of patients with primary spontaneous pneumothorax (PSP) of large volume treated with clinical observation.METHODS: Patients with PSP (n= 101) were treated either by clinical observation, chest drainage or surgery (t...

Management of recurrent malignant pleural effusion, a common complication of malignancy, poses a challenge to clinicians. Although almost one century has elapsed since the introduction of the pleurodesis procedure, the ideal approach and best agent are still to be defined. Optimally, pleurodesis should be done at the bedside with a minimally invasi...

Boerhaave's syndrome, the spontaneous rupture of the esophagus, is associated with a 35% death rate. Perforated esophagus is a surgical emergency; it is the most serious, and frequently the most rapidly lethal, perforation of the gastro-intestinal tract. Three cases of Boerhaave's syndrome are presented, with their variants and resolutions. Treatme...

Boerhaave's syndrome, the spontaneous rupture of the esophagus, is associated with a 35% death rate. Perforated esophagus is a surgical emergency; it is the most serious, and frequently the most rapidly lethal, perforation of the gastro-intestinal tract. Three cases of Boerhaave's syndrome are presented, with their variants and resolutions. Treatme...

This study aimed to evaluate a panel of proinflammatory and antiinflammatory cytokines in noncomplicated and complicated parapneumonic pleural effusions and to correlate their levels with pleural fluid biochemical parameters. Serum and pleural effusion were collected from 60 patients with noncomplicated (n = 26) or complicated (n = 34) parapneumoni...

Chemical pleurodesis controls recurrent malignant pleural effusion. The mechanism that determines pleural symphysis involves the action of vascular endothelial growth factor (VEGF). We assessed the influence of the anti-VEGF antibody (bevacizumab) on pleurodesis induced by talc or silver nitrate and analyzed the temporal development of pleural angi...

Talc has been the most used agent worldwide for induction of pleurodesis. However, despite its popularity, wide availability, low cost, and high success rate, there is great concern about the adverse effects of intrapleural talc application. Among these, we highlight acute respiratory failure that can be potentially fatal. The mechanism by which ta...

Impairment in pulmonary capacity due to pleural effusion compromises daily activity. Removal of fluid improves symptoms, but the impact, especially on exercise capacity, has not been determined. Twenty-five patients with unilateral pleural effusion documented by chest radiograph were included. The 6-min walk test, Borg modified dyspnea score, FVC,...

Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Professionals who perform pleurodesis co...

PURPOSE: To determine if pleural fluid levels of pro- and anti-inflammatory cytokines differentiate non-complicated (NC-PPE) from complicated parapneumonic pleural effusions (C-PPE) and correlate with pleural fluid biochemical parameters. METHODS: Pleural fluid of 60 patients with NC-PPE (n= 31) or C-PPE (n= 29) was assessed by thoracentesis and sa...

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair...

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair...

Background and objective: Vascular endothelial growth factor (VEGF) is known to increase vascular permeability and promote angiogenesis. It is expressed in most types of pleural effusions. However, the exact role of VEGF in the development of pleural effusions has yet to be determined. The anti-VEGF mAb, bevacizumab, has been used in the treatment...

Introduction: Pleural Malignant Mesotheloma (PMM) is an agressive tumor with a poor prognosis, whose main etiology is the long-term exposure to asbestos fibers. The use of recently introduced electronic noses allows analysis of Volatile Organic Compounds (VOCs) spectrum by pattern recognition. We hypothesize that an electronic nose can discriminate...

Intrapleural instillation of talc has been used in the treatment of recurrent pleural effusions but can, in rare instances, result in respiratory failure. Side-effects seem to be related to composition, size and inflammatory power of talc particles. The aim of this study was to evaluate the inflammatory response to intrapleural injection of talc co...

Both talc and 0.5% silver nitrate have been shown to induce effective pleurodesis. However, acute adverse systemic inflammatory effects have been described with both agents. The aim of this study was to assess in rabbits the systemic effects associated with a new technique of pleurodesis using repeated low doses of 0.1% silver nitrate. Rabbits were...

The intrapleural instillation of a sclerosing agent produces an inflammatory process frequently followed by pain. The treatment can include the use of analgesics or anti-inflammatory drugs. Previously, it was demonstrated (experimental studies) that corticoids and nonsteroidal anti-inflammatory drugs (diclofenac) reduce the inflammation and fibrosi...

The mechanisms of the systemic response associated with talc-induced pleurodesis are poorly understood. The aim of this study was to assess the acute inflammatory response and migration of talc of small size particles injected in the pleural space. Rabbits were injected intrapleurally with talc solution containing small or mixed particles and blood...

PURPOSE: Vascular Endothelial Growth Factor (VEGF) is a cytokine known to increase vascular permeability and related to pleural effusion production. It plays along with Transforming Growth Factor Beta (TGF-β), an important role in pleural fibrosis. Bevacizumab (BZ), a recombinant antibody that prevents VEGF receptor binding and inhibits angiogenesi...

The authors describe a case of transmediastinal migration, and lodging into the right lung, of a Kirschner wire used to fix a fracture of the left clavicle. The medical literature reports cases of intrathoracic migration of Kirschner wire; however, a transmediastinal migration has not been previously described. A small right thoracotomy was perform...

Intrapleural talc is used to produce pleurodesis in malignant pleural effusions. Prior in vivo studies have documented an acute inflammatory response to talc in the pleural space but the cellular source of cytokines has not been identified. The aim of this study was to investigate the acute response of rabbit pleural mesothelial cells challenged wi...

Although reports on pleurodesis date back to the beginning of the 20th century, the search for the ideal sclerosing agent is ongoing. Several agents have been studied and used, but talc continues to be the most popular. However, potentially harmful systemic side effects have been associated with talc pleurodesis. In this article we discuss the like...

PURPOSE: We have previously demonstrated that the anti-inflammatory drugs (corticosteroids or diclofenac) diminish the efficacy of pleurodesis induced by talc (TL) but not by silver nitrate (SN). In clinical practice, anti-inflammatory cyclooxygenase-2 inhibitors (COX-2) are used to control pain and inflammation. The aim of this study was to evalua...

PURPOSE: Infectious pleural effusions (IPEs) are common clinical problems that require an adequate approach to avoid the risk of pleural thickness and pleural decortication. The imbalance between serum and pleural fluid pro- and anti-inflammatory cytokines may be important in guiding the strategies of treatment and thus influence the outcome of the...

PURPOSE: Thoracoscopic sympathectomy (TS) is the treatment of choice for primary hyperhidrosis, a condition that leads to social and psychological effects. However, it is of paramount importance the correct indication of the surgical procedure, once the ablation of the sympathetic chain is irreversible and may lead to compensatory sweating. We repo...

The experimental model of pleurodesis in rabbits has been useful in understanding the pathophysiology of the pleural inflammatory injury induced by several sclerosing agents. However, restrictions on the use of rabbits in laboratory investigation are making this model less accessible. The aim of this study was to present a new experimental model of...

Chemical pleurodesis is a therapeutic tool for the treatment of recurrent pleural effusions, mainly those of neoplastic etiology. In the past, tetracycline was the sclerosant agent of choice in clinical practice, but presently, there is no consensus about an ideal agent. The aim of this study was to evaluate the effectiveness of macrolides (azithro...

Intrapleural instillation of talc is used to produce pleurodesis in cases of recurrent malignant pleural effusions. The mechanisms by which pleurodesis is produced remain unknown but may involve either injury or activation of the mesothelium. The aim of the current study was to assess the inflammatory response of pleural mesothelial cells to talc i...

PURPOSE: Platelet-derived growth factor (PDGF) has been implicated as one of the many carcinogenic factors involved in the genesis of the tumor mesothelioma. The mechanism by which PDGF participates in the pathogenesis of the pleural inflammation due to asbestos is currently unclear. The aim of this study was to compare the expression of the recept...

O derrame pleural recidivante é uma situação clínica comum que compromete a qualidade de vida dos pacientes, em especial dos portadores de doença oncológica em estágio avançado. A abordagem terapêutica do espaço pleural é variada, incluindo procedimentos agressivos como a pleurectomia. A pleurodese é a técnica mais freqüentemente utilizada, podendo...

Recurrent pleural effusion, which is commonly seen in clinical practice, compromises patient quality of life, especially in patients with advanced malignant disease. The therapeutic approach to the pleural space involves a wide range of techniques, including aggressive procedures such as pleurectomy. Among such techniques, pleurodesis is the most f...

This study evaluated the extracellular matrix (collagen and elastic fibers) in pleurodesis induced by intrapleural talc (TL) or silver nitrate (SN). Study subjects were 420 rabbits divided into two groups and sacrificed from 15 min to 12 months after the injection of the sclerosing agents at intervals previously defined. Pleural adhesions and fibro...

The malignant pleural effusion is a frequent complication in patients with of advanced tumors. The presence of malignant cells in the pleural fluid or in the pleural biopsy is indicative of dissemination of the primary disease, with consequent reduction of life expectancy. The early diagnosis and treatment of the malignant effusion is pivotal in pr...

The infectious effusion, one of the most frequent causes of pleural effusions in the clinical practice, is a sign of complication of the pneumonic disease. The early recognition of the parapneumonic effusion is crucial to determine the best treatment form and reduce the risk of morbidity and mortality. The evolution in the diagnostic methods and th...

To determine whether the administration of antiinflammatory drugs interferes with experimental pleurodesis induced by silver nitrate or talc. Study design: Two groups of 30 white New Zealand rabbits were scheduled to receive an intrapleural injection of 0.5% silver nitrate or 400 mg/kg of talc. Each group was further classified into three subgroups...

PURPOSE: To evaluate the proteic profile of tuberculous and neoplastic pleural effusions. METHODS: Pleural fluid and pleural-serum ratio (PSR) of total protein and eletrophoretic (EF) albumin, alpha, beta and gamma globulin were analysed from 403 patients having tuberculosis (200) or malignant pleural effusions(203). Univariate analysis was applied...

PURPOSE: Primary hyperhidrosis is a condition that leads to functional disability with social and psychological effects. Although several therapeutic options are available to treat this condition, thoracoscopic symphatectomy (TS) has been the treatment of choice because of its safety and long-term control of the disease. However, the ablation of th...

PURPOSE: To evaluate the performance of laboratorial tests in diagnosing tuberculosis in patients with clinical or radiological evidence of disease but with negative sputum. METHODS: Thirty-four patients with clinical (cough, fever, weigh loss) or radiological (micronodules, consolidation, cavitation, nodules) suspicion of pulmonary tuberculosis bu...

Several systemic effects have been described after talc pleurodesis. The aim of this study was to assess the systemic response induced by low, nonpleurodesis-inducing doses of talc and silver nitrate in an experimental model in rabbits. Groups of six rabbits were injected intrapleurally with talc, 100 mg/kg or 400 mg/kg, and silver nitrate, 0.1% or...

To compare the efficacy and the safety of talc slurry and silver nitrate (SN) in the treatment of symptomatic malignant pleural effusions. Sixty patients were enrolled into the study, and all received a chest tube (26F or 28F) that was placed using local anesthesia. The patients were randomized to receive either 5 g talc diluted to a total volume o...

This study evaluated submicroscopic features of active pleural remodeling associated with chemical pleurodesis. Twenty seven rabbits received intrapleural injection of 0.5% silver nitrate (SN; N = 9) or 400 mg/kg talc slurry (N = 9) in 2 ml of saline solution; control rabbits (N = 9) received 2 ml of saline alone. The rabbits were sacrificed 15 min...

PURPOSE: Pleurodesis is frequently considered for the management of recurrent malignant pleural effusions and pneumothorax. A significant percentage of patients who are candidates for pleurodesis may be receiving anti-inflammatory drugs at the time pleurodesis is attempted. We have previously shown in rabbits that the use of corticosteroids decreas...

PURPOSE: The side effects reported in talc-induced pleurodesis may be related to migration of talc particles or reflux of inflammatory mediators to the systemic circulation. We hypothesized that different talc size particles may induce different local and systemic inflammatory response. METHODS: Sixty rabbits were injected intrapleurally with 400 m...

PURPOSE: Asbestos fibers injected into the pleural space induce pleural inflammation by activation of macrophages and neutrophils, leading to apoptosis, cell proliferation, fibrosis and eventually the tumor mesothelioma. The degree of the local inflammatory response may play a role in the overall injury induced by asbestos. We investigated if croci...

PURPOSE: We have previously shown that talc (TL) induces an acute systemic inflammatory response even in doses considered ineffective (100 mg/kg) in producing pleurodesis. Silver nitrate (SN) has been used as an effective pleurodesis agent, but its systemic effects are still unknown. The aim of this study was to determine the systemic response to S...

s: To determine whether talc (TL) and silver nitrate (SN), two effective pleurodesis agents, induce a systemic inflammatory response in the acute phase of experimental pleurodesis in rabbits. Samples of blood and pleural fluid were collected after 6, 24, and 48 h from rabbits injected intrapleurally with 3 mL saline solution, TL (400 mg/kg), or 0.5...

Pleurodesis is a useful therapeutic tool when local treatment of a recurrent malignant pleural effusion or pneumothorax is needed. We have previously demonstrated that the intrapleural injection of 0.5% silver nitrate (SN) produces a significant pleurodesis, while 0.25% SN has no sclerosing effect in a rabbit model. The objective of this study was...

PURPOSE: Talc used for pleurodesis may elicit systemic effects due to the migration of small talc particles into the systemic circulation or the absorption of inflammatory mediators from the pleural space. The aim of this study was to compare the acute systemic inflammatory response produced by talc in doses considered effective (400 mg/kg) and ine...

BACKGROUND: Inflammation is the earlier event in the multistep mechanism of pleurodesis. Several mediators may regulate the outcome of pleural inflammation, including natural endogenous mediators. OBJECTIVE: To evaluate the influence of IL-10, an anti-inflammatory cytokine, in the pleurodesis induced by talc (TS) or doxycycline (DX). METHODS: Four...

OBJECTIVE: To evaluate the pleuropulmonary alterations caused by intrapleural injection of silver nitrate or talc in an experimental model, in order to consider its use in human beings. METHOD: 112 rabbits were randomly selected to receive intrapleural 0.5% silver nitrate or 400 mg/kg talc slurry in 2 ml saline. Eight rabbits of each group were sac...

Reexpansion pulmonary edema (RPE) is a rare, but frequently lethal, clinical condition. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a pro-inflammatory status are putative mechanisms. Early diagnosis is crucial, since prognosis depends on early recogniti...

Management of recurrent malignant pleural effusion, a common complication of malignancy, poses a challenge to clinicians. Although almost one century has elapsed since the introduction of the pleurodesis procedure, the ideal approach and best agent are still to be defined. Optimally, pleurodesis should be done at the bedside with a minimally invasi...

To compare the lung damage caused by intrapleural silver nitrate (SN) with that caused by talc over a 12-month period. One hundred forty rabbits received an intrapleural injection of 0.5% SN or 400 mg/kg talc slurry in 2 mL saline solution. Groups of 10 rabbits were killed after 1, 2, 4, 6, 8, 10, or 12 months. The macroscopic pleurodesis, microsco...

The Light criteria represent the most acceptable method to separate transudates and exudates. However, approximately 10% of patients with transudates, especially those with congestive heart disease, are misdiagnosed with these criteria. To improve diagnostic accuracy, many biochemical markers have been proposed as alternatives to differentiate tran...

To compare the pleurodesis results from the intrapleural injection of silver nitrate and talc slurry over an observation period of 12 months in rabbits. Rabbits were randomized to receive 2 mL of 0.5% silver nitrate or 400 mg/kg of talc slurry in 2 mL intrapleurally. Ten rabbits in each group were killed at 1 month, 2 months, 4 months, 6 months, 8...

Apesar de estarmos completando praticamente um século desde a realização da primeira pleurodese, a metodologia não está consensualmente definida. A tendência atual de executarmos procedimentos minimamente invasivos estimulou novas pesquisas com o objetivo de reduzir a agressão, incluindo o uso de novas substâncias, a colocação de drenos mais finos...

The ideal agent for producing pleurodesis has not been identified. Although talc is the agent most commonly used at the present time, there are concerns about its safety. Silver nitrate is a possible alternative agent. The purpose of the present study was to compare the effectiveness of intrapleural silver nitrate and talc slurry in producing pleur...

Apoptosis of mesothelial cells has been demonstrated in vitro but not in vivo. To identify apoptotic pleural cells as mesothelial, we used cytokeratin as a marker and found a striking spheroid, aggregated appearance of cytokeratin in apparently apoptotic mesothelial cells. In in vitro studies, we found that the aggregated cytokeratin pattern correl...

The ideal agent for producing pleurodesis has not been identified. Talc, the most commonly used, poses several problems. Another possibility is silver nitrate, which was widely used in the past. To determine the influence of the intrapleural instillation of lidocaine in producing a pleurodesis with silver nitrate, to define the effect of lidocaine...