Síndrome de Williams-Campbell: reporte de caso / Williams-Campbell Syndrome: Case Report

El síndrome de Williams-Campbell (SWC) es una entidad clínica caracterizada por la deficiencia de cartílago en la pared bronquial de los bronquios subsegmentarios. Es una condición congénita que por lo general se diagnostica en la niñez, pero hay reportes de caso en la población adulta y se cree que esto se debe a un menor déficit de cartílago. Los síntomas principales de esta condición son la presencia de tos, disnea e infecciones respiratorias a repetición. Radiológicamente, se evidencia la presencia de bronquiectasias de pared delgada. El diagnóstico se basa en descartar otras causas más comunes de bronquiectasias, así como en la identificación de las características radiológicas y la presencia del componente congénito. Presentamos el caso de un joven con síntomas respiratorios desde la infancia, con necesidad de múltiples hospitalizaciones por procesos infecciosos de origen pulmonar a repetición, con lo cual se llega al diagnóstico de un síndrome de Williams-Campbell.

Williams-Campbell syndrome (WCS) is a clinical entity characterized by cartilage deficiency in the bronchial wall of the subsegmental bronchi. It is a congenital condition that is usually diagnosed in childhood, but there are case reports in the adult population, and it is believed that this is due to a minor cartilage deficiency. The main symptoms of this condition are the presence of cough, dyspnea and repeated respiratory infections. Radiologically, the presence of thin-walled bronchiectasis is evident. The diagnosis is based on ruling out other more common causes of bronchiectasis, as well as identifying the radiological characteristics and the presence of the congenital component. We present the case of a young man with respiratory symptoms since childhood requiring multiple hospitalizations due to repeated infectious processes of pulmonary origin, in which the diagnosis of Williams-Campbell syndrome was reached.

Asociación del complejo ring-sling con pig bronchus: a propósito de un caso pediátrico / Ring-sling complex association with pig bronchus: a pediatric case report

El complejo ring-sling es una asociación entre el sling de la arteria pulmonar y la estenosis traqueal congénita por anillos traqueales completos. El sling de la arteria pulmonar es una forma rara de anillo vascular dentro de las cardiopatías congénitas. Se presenta el caso clínico de un niño con estridor laríngeo asociado a dificultad respiratoria evaluado en otro centro, donde se realizó endoscopia respiratoria y se observó compresión traqueal extrínseca. Ante la sospecha clínica de anillo vascular, se solicitó angiotomografía computada (angioTC) y se confirmó diagnóstico de sling de arteria pulmonar. Fue derivado a nuestro hospital y durante la intervención quirúrgica se realizó nueva endoscopia respiratoria y traqueobroncografía. Se llegó al diagnóstico de estenosis traqueal congénita con bronquio derecho accesorio (pig bronchus) y anillos vasculares completos, ambos reparados en el mismo acto quirúrgico.

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

Tomographic findings in bronchial atresia / Achados tomográficos na atresia brônquica

Abstract Objective: To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods: The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results: The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion: The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.

Resumo Objetivo: Analisar os achados na tomografia computadorizada (TC) de tórax de 23 pacientes com atresia brônquica. Materiais e Métodos: As imagens de TC foram avaliadas por dois observadores e os casos discordantes foram resolvidos por consenso. Os critérios de inclusão foram a presença de anormalidades na TC compatíveis com atresia brônquica e/ou diagnóstico confirmado por exame anatomopatológico das peças cirúrgicas para os pacientes submetidos a ressecção cirúrgica. As TCs foram avaliadas quanto aos principais achados de imagem, à distribuição das lesões, ao envolvimento pulmonar unilateral ou bilateral. Resultados: Os principais achados na TC foram a presença de broncocele, hiperinsuflação do parênquima pulmonar ou ambos. A combinação desses achados foi encontrada em todos os pacientes. Em relação à distribuição, o envolvimento foi unilateral nos 23 casos. Quando se consideraram os lobos mais acometidos, o lobo superior esquerdo foi o mais acometido, seguido do lobo inferior direito, lobo superior direito, lobo médio e lobo inferior esquerdo. Conclusão: O diagnóstico de atresia brônquica pode ser feito em presença de broncocele associada com hiperinsuflação do parênquima pulmonar adjacente.

Estudio morfométrico de los bronquios principales y del bronquio intermedio en una muestra cadavérica colombiana / Morphometric study of the main bronchi and the intermediate bronchus in a Colombian cadaveric sample

Conocer la morfometría en longitud, circunferencia y angulación de los bronquios principales y del bronquio intermedio pueden ser datos relevantes en procedimientos radiológicos, quirúrgicos e inclusive en eventos que amenazan la vida como la broncoaspiración. Existe poca evidencia acerca de la morfometría de los bronquios principales y del bronquio intermedio, es por ello que el presente estudio tuvo como objetivo describir la morfometría de los bronquios principales y del bronquio intermedio en una muestra de población cadavérica colombiana. Se realizó un estudio descriptivo donde se seleccionaron 29 especímenes de Cali, Colombia; 11 correspondieron a cadáveres y 18 a órganos aislados del tracto respiratorio inferior; se incluyeron los cadáveres con las estructuras debidamente disecadas y se excluyeron las muestras con estructuras anatómicas ausentes o dañadas y que afectaran la realización de las mediciones. La media de longitud del bronquio principal derecho fue de 1,69 cm IC 95 % (1,51 - 1,87) la media de la longitud del bronquio intermedio fue de IC 95 % 2,89 cm (2,66 - 3,12), la media de longitud del bronquio principal izquierdo fue de 3,34 cm IC 95 % (3,01 - 3,68); el ángulo interbronquial tiene una media de 80,17º IC 95 % (72,87 - 87,48). Las mediciones del bronquio principal derecho concuerdan con las reportadas en la literatura, lo contrario ocurre con el bronquio principal izquierdo; la medición del ángulo interbronquial muestra diferencias a la reportada por la literatura. Este estudio muestra que a pesar de que existen nomenclaturas y consensos internacionales, estos no han sido implementados correctamente por los profesionales de la salud y el término de bronquio intermedio es utilizado en la práctica diaria, por lo que se hace necesario que las Sociedades de Anatomía y Morfología vuelvan a discutir su importancia y reconocimiento en la nomenclatura.

Knowing morphometry in length, circumference and angulation of the main bronchi and the intermediate bronchus can be relevant data in radiological, surgical procedures and even in life-threatening events such as bronchoaspiration. Evidence is scarce about the morphometry of the main bronchi and the intermediate bronchus, that is why the present study aimed to describe the morphometry of the main bronchi and the intermediate bronchus in a Colombian cadaveric population sample. A descriptive study was carried out where 29 specimens were selected from Cali, Colombia; 11 corresponded to cadavers and 18 to organs isolated from the lower respiratory tract; cadavers with duly dissected structures were included and samples with anatomical structures that were absent or damaged, and that affected the performance of the measurements were excluded. Descriptive statistics was used to analyze the data. The mean length of the right main bronchus was 1.69 cm 95 % CI (1.51-1.87), the mean length of the intermediate bronchus was 2.89 cm 95 % CI (2,663,12), the mean length of the left main bronchus was 3.34 cm 95 % CI (3-3.68); the interbronchial angle had an average of 80.17º 95 % CI (72.87-87.48). The measurements of the right main bronchus agree with those reported in the literature, the opposite occurs with the left main bronchus; interbronchial angle measurement showed differences to that reported by the literature. This study shows that although there are international nomenclatures and consensus, these have not been implemented correctly by health professionals and the term intermediate bronchus is used in daily practice, it is therefore necessary that the Societies of Anatomy and Morphology again discuss their importance and recognition in the nomenclature.

Carcinoma mucoepidermoide bronquial: a propósito de dos casos clínicos / Bronchopulmonary mucoepidermoid carcinoma: apropos of two clinical cases

Resumen El carcinoma mucoepidermoide bronquial es una neoplasia infrecuente, representando el 0,1 a 0,2% de los tumores malignos primarios del pulmón. En general tiene un buen pronóstico, sin embargo, existe un subtipo de alto grado de pronóstico más ominoso. En este artículo se presentan dos casos clínicos de carcinoma mucoepidermoide bronquial de bajo grado, enfocado en su diagnóstico y manejo quirúrgico.

ABSTRACT Bronchopulmonary mucoepidermoid carcinoma is an uncommon neoplasm, accounting for 0.1 to 0.2% of primary malignant tumors of the lung. In general it has a good prognosis, however there is a subtype of high grade of more ominous prognosis. In this paper we present two clinical cases of low grade pulmonary mucoepidermoid carcinoma, focused on their diagnosis and surgical management.

Biopsia de pulmón transbroncoscópica / Transbronchoscopic lung biopsy

Introducción: el diagnóstico temprano de las enfermedades que afectan el parénquima pulmonar ya sean malignas o benignas es de vital importancia para disminuir la mortalidad por estas, la cual es elevada. La biopsia de pulmón transbroncoscópica es fundamental en el diagnóstico de dichas enfermedades con una gran efectividad y un mínimo de invasividad. Objetivo: evaluar los resultados de la biopsia de pulmón transbroncoscópica en lesiones parenquimatosas y sus complicaciones. Métodos: se realizó un estudio descriptivo, de corte transversal retrospectivo, en pacientes a los cuales se les efectuó biopsia de pulmón transbroncoscópica en lesiones parenquimatosas, en el servicio de neumología del hospital Hermanos Ameijeiras, en un periodo de 10 años. Se tomaron en cuenta las variables diagnósticos definitivos, el tipo de afectación radiológica, los factores de riesgo y las complicaciones de dicho proceder. Resultados: se realizó biopsias a 154 pacientes, a 51 se le diagnosticó una enfermedad no maligna y a 78 una enfermedad neoplásica. A 25 pacientes con radiografía torácica anormal no se les estableció diagnóstico con esta técnica. Se obtuvo una muestra adecuada en 145 pacientes (94,1 por ciento) con una exactitud diagnóstica del 83,7 por ciento en enfermedad intersticial, maligna e infecciosa pulmonar. El número de complicaciones fue mínimo. Conclusiones: la biopsia de pulmón transbroncoscópica tiene un alto rendimiento diagnóstico con un número bajo de complicaciones(AU)

Introduction: The early diagnosis of diseases that affect the lung parenchyma, whether malignant or benign, is of vital importance to reduce mortality, which is high. Transbronchoscopic lung biopsy is fundamental in the diagnosis of these diseases since it is highly effective and least invasive. Objective: To evaluate the results of transbronchoscopic lung biopsy in parenchymal lesions and their complications. Methods: A descriptive, retrospective, cross-sectional study was conducted in patients who underwent transbronchoscopic lung biopsy in parenchymal lesions at Hermanos Ameijeiras Hospital Pneumology department, over 10 years. The definitive diagnoses, the type of radiological affectation, the risk factors and the complications of said procedure were taken into account as variables. Results: 154 patients were biopsied, 51 were diagnosed with a non-malignant disease and 78 with a neoplastic disease. Twenty-five patients with abnormal chest radiography were not diagnosed using this technique. An adequate sample was obtained in 145 patients (94.1 percent) with diagnostic accuracy of 83.7 percent in interstitial, malignant and infectious lung disease. The number of complications was minimal. Conclusions: Transbronchoscopic lung biopsy has high diagnostic yield with a low number of complications(AU)

Dieulafoy's disease of the bronchial tree: a case report / Doença de Dieulafoy da árvore brônquica: relato de caso

ABSTRACT CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.

RESUMO CONTEXTO: A doença de Dieulafoy da árvore brônquica é uma condição muito rara, poucos casos foram descritos na literatura. Pode ser assintomática ou manifestar-se com hemoptise maciça. Esta doença deve ser considerada em fumadores pesados quando eles têm recorrentes hemoptises maciças sem outros achados anormais. O tratamento pode ser tanto embolização arterial como intervenção cirúrgica. RELATO DE CASO: Uma menina de 16 anos foi admitida no Serviço de Urgências devido a hemoptise com uma lesão nos brônquios de origem desconhecida. Havia sofrido hemoptise maciça e insuficiência respiratória uma semana antes da admissão. A broncoscopia de fibra óptica relevou lesão no brônquio do lobo inferior direito, com suspeita de ser lesão de Dieulafoy. Foi realizada uma segmentectomia do lobo inferior direito com excisão da lesão. O resultado da paciente foi excelente. CONCLUSÃO: A doença de Dieulafoy é uma anomalia vascular rara, sendo extremamente rara na árvore brônquica. Na doença de Dieulafoy bronquial, embolização seletiva tem sido sugerida como método para cessação do sangramento; no entanto, a habitual resseção anatômica do pulmão é uma alternativa segura e curativa.

Tracheobronchial injuries in chest trauma: a 17-year experience / Lesões traqueobrônquicas no trauma torácico: experiência de 17 anos

ABSTRACT Objective: to discuss the clinical and therapeutic aspects of tracheobronchial lesions in victims of thoracic trauma. Methods: we analyzed the medical records of patients with tracheobronchial lesions treated at the São Paulo Holy Home from April 1991 to June 2008. We established patients' severity through physiological (RTS) and anatomical trauma indices (ISS, PTTI). We used TRISS (Trauma Revised Injury Severity Score) to evaluate the probability of survival. Results: nine patients had tracheobronchial lesions, all males, aged between 17 and 38 years. The mean values ​​of the trauma indices were: RTS - 6.8; ISS - 38; PTTI - 20.0; and TRISS - 0.78. Regarding the clinical picture, six patients displayed only emphysema of the thoracic wall or the mediastinum and three presented with hemodynamic or respiratory instability. The time interval from patient admission to diagnosis ranged from one hour to three days. Cervicotomy was performed in two patients and thoracotomy, in seven (77.7%), being bilateral in one case. Length of hospitalization ranged from nine to 60 days, mean of 21. Complications appeared in four patients (44%) and mortality was nil. Conclusion: tracheobronchial tree trauma is rare, it can evolve with few symptoms, which makes immediate diagnosis difficult, and presents a high rate of complications, although with low mortality.

RESUMO Objetivo: discutir os aspectos clínicos e terapêuticos de lesões traqueobrônquicas em vítimas de trauma torácico. Métodos: análise de dados dos prontuários de pacientes com lesões traqueobrônquicas atendidas na Santa Casa de São Paulo no período de abril de 1991 a junho de 2008. A caracterização da gravidade dos doentes foi feita por meio de índices de trauma fisiológico (RTS) e anatômicos (ISS, PTTI). O TRISS (Trauma Revised Injury Severity Score) foi utilizado para avaliar a probabilidade de sobrevida. Resultados: nove doentes tinham lesões traqueobrônquicas, todos do sexo masculino, com idades entre 17 e 38 anos. Os valores médios dos índices de trauma foram: RTS- 6,8; ISS- 38; PTTI-20,0; TRISS-0,78. Com relação ao quadro clínico, seis apresentaram apenas enfisema de parede torácica ou do mediastino e três doentes se apresentaram com instabilidade hemodinâmica ou respiratória. O intervalo de tempo necessário para se firmar o diagnóstico, desde a admissão do doente, variou de uma hora a três dias. Cervicotomia foi realizada em dois pacientes e toracotomia foi realizada em sete (77,7%), sendo bilateral em um caso. O tempo de internação variou de nove a 60 dias, média de 21 dias. Complicações apareceram em quatro pacientes (44%) e a mortalidade foi nula. Conclusão: o trauma da árvore traqueobrônquica é raro, pode evoluir com poucos sintomas, o que dificulta o diagnóstico imediato, e apresenta alto índice de complicações embora com baixa mortalidade.

La termoplastía bronquial: una nueva herramienta terapéutica para el asma bronquial severa / Bronchial thermoplasty: a new therapeutic tool for severe asthma

La termoplastía bronquial es un procedimiento broncoscópico que se emplea como herramienta terapéutica en pacientes con asma severa que se mantienen sintomáticos pese a un tratamiento óptimo. El procedimiento consiste en la aplicación de energía térmica controlada endobronquial para lograr la destrucción parcial del músculo liso de la vía aérea, procedimiento conocido como radiofrecuencia oblativa. El procedimiento se ha asociado a mejoría en la calidad de vida, mayores niveles de flujo espiratorio máximo, mayor cantidad de días libres de enfermedad, reducción en la frecuencia de exacerbaciones asmáticas, menor necesidad de broncodilatadores de rescate, menores visitas al servicio de urgencia y menor ausentismo laboral. El procedimiento es considerado seguro cuando se respetan las contraindicaciones, sólo existiendo una mayor tasa se exacerbaciones y hospitalizaciones en el período inmediatamente posterior al procedimiento. Los beneficios se mantienen en el seguimiento a cinco años después del procedimiento. La termoplastía bronquial es una herramienta terapéutica a tener en consideración en pacientes con asma de difícil control.

Bronchial thermoplasty is a tool used in the management of severe asthma that remain symptomatic despite adequate treatment. The procedure consist in the application of endobronchial controlled thermal energy, in order to achieve partial destruction of smooth muscle of the airway, procedure known as ablative radiofrecuency. The technique has been associated to improvement in the quality of life, higher levels of peak expiratory flow, more days free of disease, low exacerbation rates, fewer needs of rescue bronchodilators.

Bronquio cardíaco accesorio y otras variantes de la anatomía tráqueo-bronquial / Accessory cardiac bronchus and others variations of the tracheobronchial anatomy

Entre las variantes de la anatomía bronquial nos podemos encontrar con ramas bronquiales displásicas, ramas ausentes o ramas supernumerarias. Aunque gran parte son asintomáticas, es esencial reconocerlas porque se pueden asociar a hemoptisis, infecciones recurrentes, empiema o a complicaciones secundarias a procedimientos (por ejemplo intubaciones endotraqueales, fibrobroncoscopías, lavado broncoalveolar, biopsias, tratamientos endobronquiales, instalación de stent, braquiterapia y cirugías pulmonares entre otros). En este articulo describimos las variantes bronquiales más prevalentes en tomografia computada, incluyendo al bronquio cardíaco accesorio, bronquio traqueal y bronquio puente, entre otras.

Among the variations of bronchial anatomy, we can find dysplastic bronchial branches, an absence of bronchial branches, or supernumerary branches. Although many of them are asymptomatic, it is essential to know them because they may be associated with hemoptysis, recurrent infections, empyema, or complications secondary to various procedures (e.g. endotracheal intubation, brochoscopy, bronchoalveolar lavage, biopsy, endobronchial treatments, stent installation, brachytherapy and lung surgeries among others). In this study we used computed tomography to describe some of the most prevalent bronchial variations, including accessory cardiac bronchus, tracheal bronchus, and bridge bronchus among others.

Tumor Carcinoide del Pulmón. Resección en Man-Guito. Primer Caso Realizado en el Hospital Vicente Corral Moscoso. Cuenca / Carcinoid Tumor of the Lung. Man-Guito Resection. First case performed at the Vicente Corral Moscoso Hospital. Basin

El cáncer de pulmón es un tumor frecuente y con alta mortalidad en países desarrolla-dos; en el tratamiento existen nuevas técnicas como la lobectomía más resección en manguito con anastomosis bronquial, que ha disminuido la mortalidad hasta en un 95% de los casos, este es un procedimiento oncológi-camente válido y a la vez comparable a una neumonectomía pero con un menor impacto funcional a nivel pulmonar; vale recalcar que es uno de los procedimientos de elección en el caso de neoplasias de los bronquios o en ocasiones de traumatismos que obstruyen los bronquios con pocos casos reportados sobre el uso de esta técnica a nivel mundial. De he-cho es la primera resección en manguito rea-lizada en el Hospital Vicente Corral Moscoso. Se presenta el caso de una paciente con presencia de una masa tumoral que causa obstrucción de la luz bronquial del pulmón derecho, diagnosticada hace dos años me-diante fibrobroncoscopía flexible por lo cual procede a ser intervenida quirúrgicamente para desobstruir la vía aérea; se realizó una lobectomía más resección en manguito, apo-yados en la literatura acerca de la validez del procedimiento realizado como cirugía oncológica, los riesgos quirúrgicos existentes y los efectos en la fisiología pulmonar.

Lung cancer is the most common tumor that causes increased mortality in developed countries, in the treatment there are new techniques such as the Lobectomy and sleeve resection with bronchial anastomosis, this technique has reduced the mortality by 95% of cases. This is an oncologically valid procedure and it is also comparable to a pneumonectomy but with a lower functional impact in the lungs; it ́s necessary to emphasize that this is one of the election procedures in the case of tumors of the bronchi or trauma sometimes obstructing the bronchi with few cases reported about using of this technique worldwide. In fact it is the first sleeve resection performed at the Vicente Corral Moscoso Hospital.The case of a patient with presence of a tumor mass obstructing the bronchial lumen of right lung is presented, it was diagnosed two years ago with flexible fibro-bronchoscopy so it proceed with surgery to unblock the airway, A lobectomy more sleeve resection was performed; supported in the literature about the validity of the procedure performed as cancer surgery, the surgical risks, and physiological effects on lung function.

Morfo-histologia dos pulmões e árvore bronquial de Procyon cancrivorus (Carnivora: Procyonidae) / Morphohistology of the lungs and bronchial tree of the Procyon cancrivorus (Carnivora: Procyonidae)

Nenhuma característica dos seres vivos é tão primordial quanto a respiração, e os pulmões são os principais órgãos do sistema respiratório. Este estudo tem por objetivo descrever os aspectos macroscópicos da traqueia, dos brônquios e dos lobos pulmonares bem como os aspectos microscópicos dos brônquios pulmonares do mão-pelada e compará-los com dados da literatura de estudos realizados com mamíferos silvestres e domésticos. Utilizaram-se três exemplares de Procyon cancrivorus, que foram fixados em solução aquosa de formaldeído a 10%. Os pulmões e a traqueia foram dissecados e fotografados com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Para a identificação das características microscópicas, foram coletados fragmentos de cada brônquio seguindo as técnicas de rotina histológica. O pulmão do Procyon cancrivorus se divide em quatro lobos direito e dois lobos esquerdo e a traqueia apresenta cerca de 31 a 34 anéis. Os brônquios extrapulmonares se dividem em direito e esquerdo; o direito se subdivide em brônquios lobares cranial, médio, acessório e caudal, e o esquerdo em lobares cranial e caudal, com seus respectivos brônquios segmentares. Microscopicamente, os brônquios apresentam um epitélio prismático pseudoestratificado ciliado com células caliciformes e feixes de fibras de musculatura lisa, placas de cartilagem hialina e fibras elásticas. O conhecimento da morfologia desses órgãos nas espécies silvestres auxilia em estudos descritivos e/ou comparativos entre espécies.

No characteristic of living beings is as primal as breathing, and the lungs are the main organs in the respiratory system. This study aims to describe the macroscopic aspects of the trachea, bronchus and lung lobes and microscopic aspects of the bronchi of raccoon lungs and compare with data from the literature studies performed with wild and domestic mammals. We used three samples of Procyon cancrivorus, which were fixed in aqueous 10% formaldehyde, lungs and trachea were dissected and photographed with a digital camera (Sony a200 Camera, 10.2mpx). For the identification of microscopic characteristics, fragments were collected from each bronchus following routine histological techniques. The Procyon cancrivorus lung is divided into four lobes, with two right and left lobes. The trachea has about 31-34 rings. The extrapulmonary bronchi divides into left and right, where the right is divided into lobar bronchi cranial, middle, accessory and caudal lobes and the left in cranial and caudal, with their respective segmental bronchi. Microscopically the bronchial epithelium has prismatic pseudo-ciliated and goblet cells with bundles of smooth muscle fibers, plates of hyaline cartilage and elastic fibers. Knowledge of the morphology of these organs in wild species helps us in descriptive studies and / or comparisons between species.

Pared membranosa de los bronquios: propuesta de inclusión en la terminología anatómica / Membranous wall bronchus: proposal for inclusion in the terminologia anatomica

Los bronquios principales son dos tubos respiratorios que se originan de la parte inferior de la tráquea y se proyectan a cada pulmón, permitiendo el paso de aire hacia y desde los bronquíolos. El objetivo de este trabajo fue verificar la inclusión como término morfológico de la pared posterior de los bronquios principales en la Terminologia Anatomica y en los textos de enseñanza de la anatomía macroscópica. Se revisó la Terminologia Anatomica y se comparó con diversos textos y artículos de enseñanza de la anatomía macroscópica, con el fin de verificar si hay descripciones de la pared posterior de los bronquios principales y si ésta se encuentra nominada. No está incluido en la Terminologia Anatomica ningún término para nominar la pared posterior de los bronquios principales, por lo que se propone incluir el término pared membranosa para tales bronquios en la Terminologia Anatomica.

There are two main bronchi breathing tubes originating from the bottom of the trachea and lung projecting to each, allowing passage of air toward and from the bronchioles. The objective of this work was to verify the morphological term inclusion as the back wall of the main bronchus in Anatomic Terminology and texts for teaching gross anatomy. Terminologia Anatomica was analyzed and compared with various texts and journals of gross anatomy teaching, in order to verify if there are descriptions of the posterior wall of the main bronchi and whether it has been nominated. In the Terminologia Anatomica the term for the back wall of the main bronchus is not included. Therefore, it is proposed that the term "membranous wall" for bronchus be included in Terminologia Anatomica.

Modified method for bronchial suture by Ramirez Gama compared to separate stitches suture: experimental study / Sutura de brônquios pelo método de Ramirez Gama modificado comparada à sutura com pontos separados: estudo experimental

OBJECTIVE: To experimentally compare two classic techniques described for manual suture of the bronchial stump. METHODS: We used organs of pigs, with isolated trachea and lungs, preserved by refrigeration. We dissected 30 bronchi, which were divided into three groups of ten bronchi each, of 3mm, 5mm, and 7mm, respectively. In each, we performed the suture with simple, separated, extramucosal stitches in five other bronchi, and the technique proposed by Ramirez and modified by Santos et al in the other five. Once the sutures were finished, the anastomoses were tested using compressed air ventilation, applying an endotracheal pressure of 20mmHg. RESULTS: the Ramirez Gama suture was more effective in the bronchi of 3, 5 and 7 mm, and there was no air leak even after subjecting them to a tracheal pressure of 20mmHg. The simple interrupted sutures were less effective, with extravasation in six of the 15 tested bronchi, especially in the angles of the sutures. These figures were not significant (p = 0.08). CONCLUSION: manual sutures of the bronchial stumps were more effective when the modified Ramirez Gama suture was used in the caliber bronchi arms when tested with increased endotracheal pressure. .

OBJETIVO: comparar experimentalmente duas técnicas clássicas descritas para a sutura manual do coto brônquico. MÉTODOS: foram empregadas vísceras de suínos com a traqueia e os pulmões isolados, conservados por refrigeração. Foram dissecados 30 brônquios, divididos em três grupos de dez brônquios cada, com 3mm, 5mm e 7mm, respectivamente. Em cada um dos grupos foi realizada a sutura com pontos simples separados extramucosos em cinco brônquios e nos outros cinco, foi empregada a técnica proposta por Ramirez Gama e modificada por Santos et al. Terminadas as suturas, as anastomoses foram testadas com ventilação empregando ar comprimido, submetidas a uma pressão endotraqueal de 20mmHg. RESULTADOS: os pontos de Ramirez Gama foram mais efetivos em brônquios de 3, 5 e 7 mm, e não houve extravasamento de ar mesmo após submetê-los a uma pressão endotraqueal de 20mmHg. Os pontos simples separados foram menos efetivos, havendo extravasamento em seis dos 15 brônquios testados, principalmente nos ângulos das suturas. Estes números não foram significativos (p=0,08). . CONCLUSÃO: as suturas manuais dos cotos brônquicos foram mais efetivas quando o ponto de Ramirez Gama modificado foi utilizado nos brônquios de pequeno calibre quando testados com aumento da pressão endotraqueal. .

Distribuição dos brônquios lobares dos pulmões do veado-catingueiro Mazama gouazoubira / Distribution of lobar bronchi of the lungs of brown brocket deer Mazama gouazoubira

Este estudo teve como objetivo descrever a lobação do pulmão do veado-catingueiro Mazama gouazoubira. Dois animais da espécie, obtidos post mortem por atropelamento em rodovia, foram utilizados para o estudo, obedecendo aos critérios da Lei Vigente (Lei 1.153/95). Através da dissecação, a pele foi completamente removida e os animais foram fixados em solução de formaldeído a 10 porcento. Através de um acesso ventral, o bloco de vísceras foi removido e posteriormente os pulmões foram dissecados do bloco por uma secção na região torácica da traqueia e de outras estruturas do hilo pulmonar. Os pulmões e a árvore brônquica foram dissecados, fotografados, as imagens foram registradas com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Os pulmõesapresentaram-se unidos pelas estruturas que penetravam a região do hilo pulmonar, o pulmão direito do veado-catingueiro mostrou ser composto pelos lobos cranial (segmento cranial e segmento caudal), médio, caudal e acessório. O pulmão esquerdo apresentou apenas lobo cranial (segmentado em parte cranial e parte caudal) e lobo caudal. A árvore brônquica se inicia emergindo para o pulmão direito um brônquio traqueal acima da bifurcação da traqueia que sequencialmente serão denominados de brônquios principais direito e esquerdo, os quais no nível do hilo pulmonar penetram nos pulmões direito e esquerdo respectivamente. Os pulmões e árvore brônquica de M. gouazoubira apresentaram a mesma descrição anatômica de outros ruminantes, como bubalinos, ovinos e bovinos.

The study aimed to describe the lung lobation of the brown brocket deer, Mazama gouazoubira. Two animal of the species, obtained postmortem by trampling on the highway, were used for the study, according to criteria of the Governing Law (1.153/95). The skin was completely removed and the animals were fixed in 10 percent formaldehyde. The viscera were removed and the lungs were dissected by a section of the block in the thoracic trachea and other structures of the pulmonary hilum. The lungs and bronchial tree were dissected, photographed and the images were recorded with a digital camera (Sony a200 Camera, 10.2mpx). The lungs showed themselves united by structures that penetrate the region of the pulmonary hilum, the right lung was found to be composed of the cranial lobes (segment cranial and caudal segment), middle, caudal and accessory. The left lung showed only cranial lobe (segmented into the cranial and caudal part) and caudal lobe. The bronchial tree begins emerges to the right lung one tracheal bronchus above the bifurcation of the trachea that are sequentially named right and left main bronchi, which at the level of the pulmonary hilum penetrate the left and right lungs respectively. The lungs and bronchial tree of M. gouazoubira showed the same anatomical description of other ruminants, like buffaloes, sheep and cattle.

Estenosis bronquial congénita, papel de las imágenes en el diagnóstico: reporte de un caso / Congenital bronchial stenosis, the role of imaging in the diagnosis: a case report

En este artículo se reporta el caso de un lactante menor de 2 meses de edad que a los 15 días de nacido presentó estridor y dificultad respiratoria, por lo que consultó a una clínica de primer nivel en donde se le realizó radiografía de tórax, en la cual se documentó la presencia de una hiperinfiación del campo pulmonar derecho. Se realizó una fibrobroncoscopía óptica (FBO) que fue reportada como normal y una gammagrafía de ventilación/perfusión que reportó una hipoplasia pulmonar derecha. Fue manejado con oxígeno suplementario y terapias respiratorias sin mejoría clínica, motivo por el cual fue trasladado a nuestra institución para manejo especializado. Con el fin de obtener un mapa vascular pre quirúrgico, se realizó una angiografía pulmonar por tomografía (Figura 2) reconstrucciones con mínima intensidad de proyección (Figura 3) y broncoscopía virtual (BV) multicorte (Figuras 4 y 5) documentándose una estenosis del bronquio fuente derecho, producida por un repliegue de la pared bronquial y con efecto de válvula que producía una hiperinsufiación secundaria del pulmón derecho. Estos hallazgos fueron confirmados en la cirugía correctiva.

This article describes the case of an infant under 2 months old, who at 15 days of age presented stridor and respiratory distress, a chest X-ray was performed which reported the presence of a hyperinflation of the right lung field. A fiberoptic bronchoscopy (FBO) was performed which resulted normal and a ventilation/perfusion gammagraph showed a right lung hypoplasia. The infant was treated with additional oxygen and respiratory therapy without clinical. In order to obtain a pre-surgical vascular map, a multislice CT angiography and virtual bronchoscopy were performed, documenting a right bronchial stenosis produced by a fold of the bronchial wall and with valve effect which produced a secondary hyperinsufflation of the right lung. These findings were confirmed in corrective surgery.

Estenosis bronquial congénita, papel de las imágenes en el diagnóstico: presentación de un caso / The role of diagnostic imaging in congenital bronchial stenosis: A Case report

En este artículo se presenta el caso de un lactante menor de 2 meses de edad que a los 15 días de nacido presentó estridor y dificultad respiratoria, por lo que fue llevado a una clínica de primer nivel, donde se le realizó una radiografía de tórax en la cual se documentó la presencia de una hiperinflación del campo pulmonar derecho. Se le realizó una fibrobroncoscopia óptica, de resultado normal, y una gammagrafía de ventilación/perfusión que mostró una hipoplasia pulmonar derecha. Fue manejado con oxígeno suplementario y terapias respiratorias sin mejoría clínica, motivo por el cual fue trasladado a otra institución para un manejo especializado. Con el fin de obtener un mapa vascular prequirúrgico, se realizó una angiografía pulmonar por tomografía, unas reconstrucciones con mínima intensidad de proyección y una broncoscopia virtual multicorte. Con todo ello se documentó una estenosis del bronquio fuente derecho, producida por un repliegue de la pared bronquial y con efecto de válvula, que producía una hiperinsuflación secundaria del pulmón derecho. Estos hallazgos fueron confirmados en la cirugía correctiva. Este es un caso de gran interés porque, a pesar de lo inusual de la patología y la edad del paciente, fue posible establecer un diagnóstico certero mediante el uso de la TAC multidetector que permitió utilizar herramientas de reconstrucción tridimensional y navegación endoluminal, como la broncoscopia virtual.

This article reports the case of a lactating infant, 2 months old, who 15 days after birth presented gasping and respiratory difficulty. For this reason, he was taken to a first-degree clinic, where a thorax radiography was performed. This thorax radiography documented the presence of a hyper-inflation of the right lung. An optic fiber bronchoscopy was performed, with normal results, and a ventilation/perfusion scan which reported a hypoplasia of the right lung. It was treated with complementary oxygen and respiratory therapies without any clinical improvement. Therefore, the patient was sent to a different institution for more specialized treatment. A pulmonary angiography through a tomography, a minimum projection intensity reconstruction, and a multi-slice virtual bronchoscopy were performed in order to obtain a presurgical vascular map. This process showed a stenosis of the right source bronchus, caused by a fold of the bronchial wall with a valve effect, causing a secondary hyperinsuflation of the right lung. These findings were confirmed in the corrective surgery. We consider this case especially interesting because, in spite of the unusual pathology and the age of the patient, it was possible to establish a correct diagnosis through the use of the multi detector CAT scan, enabling us to use the reconstructive three-dimensional tools, as well as endoluminal navigation such as virtual bronchoscopy.

The response of bronchial associated lymphoid tissue to intratracheal administration of peste des petit ruminants virus and its Co-Infection with mannheimia hemolytica in goats / Respuesta del tejido linfoide asociado con bronquios a la administración intratraqueal del virus peste de pequeños rumiantes y su coinfección con Mannheimia hemolytica en cabras

The morphometry of bronchial associated lymphoid tissue (BALT) and its possible exploration as to the control of common viral and bacterial pneumonia and their co-infection in Sub-Saharan goats is scanty in literatures. This investigation utilizes archival tissues from study that involved 35 apparently healthy West Africa Dwarf goats which were divided into groups PPRV and PPRV+MH with 15 goats each while 5 goats served as control. PPRV goats were infected intratracheally with 1ml of pure cultured 106.5 TCID50 PPR Pestes des petit Ruminant virus (PPRV) grown in baby hamster kidney cell lines and PPRV+MH with 1 ml of PPRV and a week later 1ml of MH (Mannheimia hemolytica) A2. The BALT number, type and cellularity were determined using standard methods with the use of an image analyzer. Student t-test was used to test for significant differences. The results showed that the average number of BALT was significantly more in PPRV+MH infection than that of PPRV infection i.e. 6.20+/-3.63 for PPRV+MH and 4.11+/-2.92 for PPRV with more nodular types of BALT (8.01+/-1.83) than the aggregates type (4.3+/-1.50) while the average number of lymphocytes in the nodular, aggregate BALT significantly increased with 82.25+/-15.95, 56.00+/-7.28 in PPRV to 103.33+/-44.10, 66.00+/-7.93 in PPRV+MH respectively. There was an irregular pattern in the surface Area (SA) and Perimeter (P) of BALT following infections. The increase in average number of BALT and lymphocytes in PPRV+MH infection than that of PPRV infection showed that the development of BALT and the number of lymphocytes in BALT could be used to assess the mucosal immunity following intratracheal administration of PPRV and MH in goats. This is however the first study that described the morphometry of bronchial associated lymphoid tissue in experimental PPRV and PPRV+MH infection in Sub-Saharan goats.

Es escaso en la literatuta el conocimiento de la morfometría del tejido linfoide asociado a bronquios (BALT) y su posible exploración para el control de la neumonía viral común, pneumonia bacteriana y su co-infección en el ganado caprino subsahariano. Esta investigación utilizó tejidos archivados pertenecientes a 35 cabras enanas del oeste africano aparentemente sanas, que fueron divididas en grupos PPRV y PPRV+MH con 15 cabras cada uno, mientras que 5 cabras sirvieron como control. Las cabras PPRV fueron infectadas por vía intratraqueal con 1 ml de cultivo puro 106,5 TCID50 PPR virus Peste de Pequeños Rumiantes (PPRV) cultivados en líneas celulares renales de hámsters recien nacidos y PPRV+MH con 1 ml de PPRV y una semana después de 1 ml de MH (Mannheimia haemolytica) A2. El número de BALT, tipo y la celularidad se determinaron utilizando métodos estándar con el uso de un analizador de imágenes. Se utilizó la prueba t de Student para probar las diferencias significativas. Los resultados mostraron que el número promedio de BALT fue significativamente mayor en la infección PPRV+MH que la infección PPRV, es decir, 6,20+/-3,63 para PPRV+MH y 4,11+/-2,92 para PPRV con un BALT principalmente de tipo nodular (8,01+/-1,83) que de tipo agregado (4,3+/-1,50), mientras que el número promedio de linfocitos en el BALT nodular y agregado aumentó significativamente con 82,25+/-15,95 y 56,00+/-7,28 en PPRV y, 103,33+/-44,10 y 66,00+/-7,93 en PPRV+MH respectivamente. No hubo un patrón irregular en el área de superficie y perímetro del BALT después de las infecciones. El aumento en el número promedio de BALT y linfocitos en la infección PPRV+MH comparado con la de infección PPRV mostró que el desarrollo de BALT y el número de linfocitos en BALT podría ser utilizado para evaluar la inmunidad de la mucosa después de la administración intratraqueal de PPRV+MH en cabras. Este es el primer estudio que describe la morfometría del tejido linfoide asociado a bronquios en la...

Efetividade e segurança da técnica de higiene brônquica: hiperinsuflação manual com compressão torácica / Bronchial hygiene technique with manual hyperinflation and thoracic compression: effectiveness and safety

OBJETIVOS: Avaliar os efeitos da manobra hiperinsuflação manual com compressão torácica em termos de depuração de secreções, mecânica pulmonar, hemodinâmica e oxigenação em pacientes sob ventilação mecânica invasiva. MÉTODOS: Foi realizado estudo controlado do tipo cruzado, com vinte pacientes com mais de 48 horas em ventilação mecânica invasiva. Após 4 horas da última aspiração os pacientes foram submetidos aos procedimentos, aspiração ou hiperinsuflação manual com compressão torácica e aspiração, um após o outro, respeitando intervalo de quatro horas, em ordem estabelecida conforme randomização. As variáveis foram coletadas nos momentos pré, durante e após 5, 15, 30 e 60 minutos do término dos procedimentos. A secreção aspirada foi coletada e mensurada. RESULTADOS: Não foram encontradas alterações significativas para o volume corrente, pressão platô e complacência após os dois procedimentos durante o estudo (p>0,05). As variáveis hemodinâmicas apresentaram comportamento distinto ao longo do tempo caracterizado por aumento das pressões e frequência durante a realização dos procedimentos, com retorno aos valores basais após 5 minutos das intervenções (p≤0,001). Não foi encontrada diferença no comportamento hemodinâmico entre os procedimentos (p>0,05). A saturação de oxigênio durante todos os momentos do estudo foi 99 por cento, com exceção de dois momentos durante a realização da HMCT+ASP que foi 98 por cento (p<0,05). Não houve diferença significante entre as técnicas em relação ao peso das secreções aspiradas. CONCLUSÃO: Os resultados sugerem que a hiperinsuflação manual com compressão torácica, conforme aplicada neste estudo, embora tenha se mostrado segura hemodinamicamente, não apresentou benefícios em relação à técnica de aspiração isolada em termos de otimização da oxigenação, mecânica respiratória e depuração de secreções.

OBJECTIVES: To evaluate the effects of the manual hyperinflation with thoracic compression (MHTC) maneuver on the clearance of secretions, pulmonary mechanics, hemodynamics and oxygenation in mechanically ventilated patients. METHODS: This was a controlled, crossover study that included twenty patients who were under invasive ventilation for more than 48 hours. Four hours after the last airway suctioning procedure, the patients underwent the study interventions, Suction alone or MHTC plus Suction, in sequence at four hour intervals. The sequence order for the procedures was established by randomization. Data were collected before, during and 5, 15, 30 and 60 minutes after each intervention. The suctioned secretions were collected and weighed. RESULTS: No significant differences between the procedures were found regarding tidal volume, plateau pressure and pulmonary compliance (p>0.05). The hemodynamic variables showed increased pressures and heart rate during the procedures and returned to baseline values five minutes after the end of the procedure (p≤0.001). No significant hemodynamic differences were seen between the interventions (p>0.05). For the duration of the study, oxygen saturation was 99 percent with only two exceptions during the MHTC + Suction procedure, where saturation was 98 percent (p<0.05). No significant differences were observed between the techniques regarding the weight of the suctioned secretion. CONCLUSION: The results suggest that MHTC, as performed in this study, adds no benefit with respect to oxygenation optimization, pulmonary mechanics and clearance of secretions. However, the MHTC maneuver did not result in hemodynamic changes when compared to the suctioning procedure alone.

Anormalidades congénitas y adquiridas de la tráquea y bronquios principales en la población pediátrica: [revisión] / Congenital and adquired abnormalities of pediatric trachea and main-steam bronchi: [review]

La radiografía de tórax es la primera herramienta diagnóstica que permite sospechar alteraciones en la anatomía traqueobronquial; sin embargo, durante los últimos años la tomografía multicorte ha emergido como una modalidad diagnóstica adicional que permite identificar y caracterizar de manera precisa la patología traqueobronquial tanto congénita como adquirida, por lo que permite una mejor aproximación a sus características morfológicas y a su diagnóstico diferencial, y complementa de esta manera los hallazgos en la radiología convencional. La presente es una revisión de las principales patologías de la tráquea y de los bronquios.

Tracheobronchial tree abnormalities can be first suspected in chest radiography;nonetheless, multidetector row computed tomography imaging constitutes a complementarydiagnostic alternative for the evaluation of congenital and acquired tracheobronchial tree anomalies that allows the radiologist a closer approximation toward the correct diagnosis as well as the accurate description of its morphological features and differential diagnosis. We present a review of the main tracheobronchial tree pathology.