Topical endotracheal mitomycin C as a complementary treatment for endoscopic treatment of recurrent laryngotracheal stenosis.

OBJECTIVE: To describe the preparation of topical endotracheal mitomycin C and the clinical outcomes of four patients with recurrent and severe laryngotracheal stenosis (LTS) treated with adjuvant topical mitomycin C. METHOD: Literature review to determine the concentration and method of preparation of topical mitomycin C for endotracheal use. Review of clinical histories. RESULTS: We established a concentration of 0.4 mg/ml topical mitomycin C for the treatment of laryngotracheal stenosis. In the treated cases, we applied a 0.4 mg/ml solution to the wound site following laser surgery and dilatation with bronchoscope. Three patients remain asymptomatic from a respiratory perspective, and treatment failed in one case. CONCLUSIONS: LTS treatment is complex due to the continuous development of granulation tissue and fibrosis following injury to the airways. Topical mitomycin C seems to be the ideal adjuvant agent thanks to its powerful antifibrotic effects.

[Bronchiolitis obliterans with organized pneumonia associated with measles virus]. / Bronquiolitis obliterante con neumonía organizada relacionada con virus del sarampión.

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a nonspecific form of pulmonary injury related to different etiologic agents. The disorder is not only limited to the alveoli but also affects to the alveolar ducts and distal bronchioles. This fact may differentiate this disorder of others with chronic inflammatory diffuse alveolar lesion as chronic eosinophilic pneumonia (CEP), extrinsic allergic alveolitis (EAA) or diffuse alveolar damage (DAD). It has been described an idiopathic form and other associated with connective tissue diseases, infections, organ's transplantation, drug or chemical induced reactions, irradiation pneumonitis and aspiration pneumonitis, among others. Their extremely variable clinical presentation and course, etiology, and histologic appearance and, in some way, the considerable confusion as a result to the different terminologies applied, has made difficult a clear understanding of this disease. We present two cases of BOOP related to infection by measles virus, whose diagnostic was obtained through pulmonary thoracoscopic biopsy and serological study respectively. Patients were treated with steroids (6 months) with a favorable outcome in terms of clinical symptoms, radiological findings, and a normalization of the pulmonary function tests. We suggest that in each patient with clinic and radiological study suspicious of BOOP, it seem to be useful to include measles virus in serologic study. This investigation may contribute to reduce the number of cases classified as idiopathic BOOP.