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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(9): 784-790, 2020 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-32894913

RESUMO

Objectives: To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate. Methods: Between January 2013 to December 2016, 301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively. The methods of interventional bronchoscopy included electric knife cutting, laser cauterization, balloon dilation, cryotherapy, local drug usage and/or stenting. Airway stenosis characteristics and patients' performance status at baseline and after interventional bronchoscopy were recorded. The interval days between the first two interventional bronchoscopy treatment (maintained patency time) and the final treatment efficacy were recorded. Results: The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8% (204/301) . Stenosis sites (OR 1.548; 95% CI: 1.038-2.307, P=0.032) , dyspnea index (OR 2.140; 95% CI: 1.604-2.855, P<0.001) , and interventional method (OR 0.458; 95% CI: 0.267-0.787, P=0.005) were independent predictors associated with the efficacy of interventional bronchoscopy treatment. Stenosis sites (OR 1.508; 95% CI: 1.273-1.787, P<0.001) , stenosis grade (OR 1.581; 95% CI: 1.029-2.067, P=0.001) , anesthesia method (OR 1.581; 95% CI: 1.029-2.067, P<0.001) , and local drug usage (OR 1.304; 95% CI: 1.135-1.497, P<0.001) were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment. Conclusion: Interventional bronchoscopy is a useful treatment method for scarring airway stenosis. Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.


Assuntos
Obstrução das Vias Respiratórias , Broncoscopia , China , Cicatriz , Constrição Patológica , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhonghua Yi Xue Za Zhi ; 100(31): 2435-2440, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819059

RESUMO

Objective: To compare clinical outcomes of microsurgical bilateral decompression via unilateral approach (MBDU) between trans longissimus and iliocostalis approach, a novel lateral paraspinal approach(LPA), and classic Wiltseapproach for single level degenerative lumbar stenosis. Methods: LPA approach was researched by imaging measurement and cadaver anatomy. Retrospective analysis of a total 124 cases(male/female 75/49, aged(55±14) years) received single-level MBDU due to degenerative lumbar stenosis from 2016 to 2018 in Beijing Tiantan Hospital. Patients were categorized into two groups according to spinal canal morphology. Group A: trefoil shape (n=48), received MBDU via LPA; Group B: round & oval shape (n=76), received MBDU via Wiltse approach. Clinical parameters, including visual analogue scale (VAS) of pain, OswestryDability Index (ODI), satisfaction rate were assessed before the operation and at the latest follow-up. The internal fixation and intervertebral fusion were evaluated by X-ray and CT.The data were compared with single sample t test between the two groups. Results: The feasibility of trans longissimus and iliocostalis approach was proved by imaging measurement and anatomic study. The tube's maximum tilt angle in LPA group was 65°, and it was 40°in Wiltse group. There was no significantly difference in the operating time, bleeding and drainage volume between the two groups((120±27) min vs (115±32) min, (104±31) ml vs (110±41) ml, (50±15) ml vs (47±18) ml, respectively, t=1.246,-1.917,1.730,all P>0.05). In both groups, VAS and ODI scores significantly improved at the latest follow-up when compared with those before the operation (all P<0.05), but those were all comparable between the two groups(all P>0.05). The excellent rate of subjective satisfaction for the clinical efficacy in group A and B was 89.6%(43/48) and 86.8%(66/76) respectively (χ(2)=0.208,P>0.05). Conclusions: LPA approachfor microsurgical bilateral decompression via unilateral approach (MBDU) in degenerative lumbar stenosis is safe and effective, it has advantages in direct vison of contralateral nerve root canal decompression for trefoil shaped spinal canal.


Assuntos
Fusão Vertebral , Estenose Espinal/cirurgia , Adulto , Idoso , Constrição Patológica , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
3.
N Engl J Med ; 383(8): 733-742, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813949

RESUMO

BACKGROUND: Standard percutaneous transluminal angioplasty is the current recommended treatment for dysfunctional hemodialysis fistulas, yet long-term outcomes of this treatment are poor. Drug-coated balloons delivering the antirestenotic agent paclitaxel may improve outcomes. METHODS: In this prospective, single-blinded, 1:1 randomized trial, we enrolled 330 participants at 29 international sites. Patients with new or restenotic lesions in native upper-extremity arteriovenous fistulas were eligible for participation. After successful high-pressure percutaneous transluminal angioplasty, participants were randomly assigned to receive treatment with a drug-coated balloon or a standard balloon. The primary effectiveness end point was target-lesion primary patency, defined as freedom from clinically driven target-lesion revascularization or access-circuit thrombosis during the 6 months after the index procedure. The primary safety end point, serious adverse events involving the arteriovenous access circuit within 30 days, was assessed in a noninferiority analysis (margin of noninferiority, 7.5 percentage points). The primary analyses included all participants with available end-point data. Additional sensitivity analyses were performed to assess the effect of missing data. RESULTS: A total of 330 participants underwent randomization; 170 were assigned to receive treatment with a drug-coated balloon, and 160 were assigned to receive treatment with a standard balloon. During the 6 months after the index procedure, target-lesion primary patency was maintained more often in participants who had been treated with a drug-coated balloon than in those who had been treated with a standard balloon (82.2% [125 of 152] vs. 59.5% [88 of 148]; difference in risk, 22.8 percentage points; 95% confidence interval [CI], 12.8 to 32.8; P<0.001). Drug-coated balloons were noninferior to standard balloons with respect to the primary safety end point (4.2% [7 of 166] and 4.4% [7 of 158], respectively; difference in risk, -0.2 percentage points; 95% CI, -5.5 to 5.0; P = 0.002 for noninferiority). Sensitivity analyses confirmed the results of the primary analyses. CONCLUSIONS: Drug-coated balloon angioplasty was superior to standard angioplasty for the treatment of stenotic lesions in dysfunctional hemodialysis arteriovenous fistulas during the 6 months after the procedure and was noninferior with respect to access circuit-related serious adverse events within 30 days. (Funded by Medtronic; IN.PACT AV Access Study ClinicalTrials.gov number, NCT03041467.).


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Fármacos Cardiovasculares/administração & dosagem , Paclitaxel/administração & dosagem , Dispositivos de Acesso Vascular/efeitos adversos , Grau de Desobstrução Vascular , Idoso , Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/instrumentação , Fármacos Cardiovasculares/efeitos adversos , Materiais Revestidos Biocompatíveis , Constrição Patológica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Estudos Prospectivos , Diálise Renal/efeitos adversos , Método Simples-Cego , Extremidade Superior/irrigação sanguínea
4.
Wiad Lek ; 73(4): 789-791, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32731718

RESUMO

OBJECTIVE: The aim of the study to evaluate the peculiarities of the aortic wall structure at the place of coarctation. PATIENTS AND METHODS: Materials and methods: Studying of the aortic sections removed during operative correction at the place of constriction. 10 children at the age between 1 to 6 months were undergone the operation. Intraoperative aortic biopsy specimens were observed in 10% neutral formalin. Histologic sections were prepared in a conventional way followed by staining them with hematoxylin-eosin. RESULTS: Results: Histological examination in the areas of constriction revealed that the endothelium in all the preparations had poor expressiveness. The most significant changes were recorded in the middle layer of the aorta in the form of reduced development of elastic fibers, their fragmentation and chaotic arrangement. Angiomatosis with the formation of thin-layer small vessels by capillary type was found out. In all the preparations, areas of emptying of cells and fibers of the middle cover with the formation of cystic structures were revealed. CONCLUSION: Conclusions: The histological examination has revealed changes in the structure of the aorta wall, which may indicate the systemic nature of the lesion and make it possible to consider coarctation of the aorta to be a manifestation of systemic vasculopathy. The above-mentioned facts determine the need for a more detailed examination of children with the specified pathology at different stages of observation.


Assuntos
Coartação Aórtica , Aorta , Constrição Patológica , Técnicas Histológicas , Humanos , Lactente , Coloração e Rotulagem
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 637-641, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773792

RESUMO

OBJECTIVE: To summarize the initial clinical experience and follow-up results of the treatment for ureteroileal anastomotic stricture after radical cystectomy with Allium coated metal ureteral stent. METHODS: From September 2018 to September 2019, 8 patients with ureteroileal anastomotic stricture after radical cystectomy underwent Allium ureteral stent insertion in Peking University People's Hospital and People's Hospital of Daxing District. The preoperative renal pelvis width under ultrasound was collected to evaluate the postoperative hydronephrosis, creatinine and urea nitrogen (BUN) before and after surgery, perioperative infection, and stent-related complications. The serum creatinine and BUN, renal pelvis width under ultrasound, urography and abdominal plain film (KUB) were reviewed at the end of 1, 3, and 6 months and annually postoperatively to observe the stent position and morphology. The long-term stent patency rate, complication rate, renal function and hydronephrosis were followed up and analyzed. The t-test or rank-sum test was used to compare the measurement data of the matched sample from the preoperative to the last follow-up. RESULTS: In the study, 6 cases (7 sides) were ureteral ileal conduit stricture, and 2 cases (3 sides) ureteral orthotopic neobladder stricture. Before surgery, 5 patients underwent long-term indwelling of a single J ureteral stent, with an average indwelling time of (20.6±8.8) months and an average replacement frequency of (3.6±1.3) months/time. The mean width of renal pelvis was (26.5±9.1) mm on preoperative renal ultrasonography. Among them, 6 patients were successfully indwelled with Allium coated metal ureteral stent by retrograde approach, and 2 patients by combination of double-endoscopy and ante-retrograde approach. No surgery-related complications during perioperative period were observed. The mean follow-up period was 9.8 months and Allium stent and ureter remained unobstructed in all the patients at the last follow-up without replacement or removal. Compared with preoperative data, the mean width of renal pelvis and mean blood urea nitrogen (BUN) in the last follow-up period were significantly reduced [(26.5±9.1) mm vs. (13.4±2.5) mm, P=0.008; (11.6±2.3) mmol/L vs. (10.2±2.2) mmol/L, P=0.017], however, there were no significant differences in the average serum creatinine or hemoglobin (P>0.05). Ureteroileal anastomotic re-stricture and other stent-related complications were not observed in all the patients by antegrade urography. CONCLUSION: Allium coated metal ureteral stent could be used for the treatment for ureteroileal anastomotic stricture, which could maintain relatively long-term patency rate and protect renal function. The indwelling time was longer and it could improve quality of life of patients.


Assuntos
Ureter , Obstrução Ureteral , Derivação Urinária , Allium , Anastomose Cirúrgica , Constrição Patológica , Cistectomia , Seguimentos , Humanos , Metais , Qualidade de Vida , Stents , Resultado do Tratamento , Obstrução Ureteral/cirurgia
6.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(1): 131-136, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32621412

RESUMO

Stenting for iliac vein stenosis or compression has become a common therapeutic approach in recent years. The antithrombotic therapy after the stent deployment, however, reaches no consensus. Medications strategies and patients' prognoses differ in non-thrombotic, acute thrombotic and chronic thrombotic these three circumstances. Non-thrombotic patients usually possess satisfactory stent patency whatever antithrombotic therapy is used. Anticoagulant is the basic medication for acute thrombotic patients, benefits from additional antiplatelet drug remains to be clarified. In terms of chronic thrombotic patients, their prognoses are unsatisfactory under all antithrombotic therapies. In this review, we outlined the recent progress of antithrombotic therapy after iliac vein stenting, aiming to provide feasible medication plans for each circumstance.


Assuntos
Fibrinolíticos , Veia Ilíaca , Stents , Constrição Patológica/tratamento farmacológico , Constrição Patológica/cirurgia , Fibrinolíticos/uso terapêutico , Humanos , Veia Ilíaca/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
Am Surg ; 86(6): 621-627, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683957

RESUMO

BACKGROUND: To identify the association between the width of the gastric conduit and the benign anastomotic stricture (BAS) after esophagectomy with end-to-side cervical anastomosis for esophageal cancer. METHODS: Patients with esophageal cancer who underwent esophagectomy between July 2013 and July 2014 were included in this study. The gastric conduit was used for reconstruction in all patients and end-to-side cervical anastomosis were performed using a circular stapler. The patients were divided into a narrow group (3-5 cm) and a wide group (>5 cm) based on the gastric conduit width. Univariate and multivariate logistic regressions were used to analyze the possible factors (patients' age, gender, preoperative comorbidities, neoadjuvant chemotherapy, gastric conduit width, anastomotic leakage) that could affect the incidence of BAS. RESULTS: Two-hundred and one patients were included in this study. The median follow-up period was 29 months (17-58 months). Seven cases (3.5%) showed anastomotic leakage in the postoperative period and 38 patients (18.9%) developed BAS; all within the first year of follow-up. In univariate analysis, the width of the gastric conduit was the only risk factor for the development of BAS (odds ratio [OR] = 3.36, P = .005). In multivariate logistic regression analysis, the wide group was an independent significant risk factor for the development of BAS developing compared with the narrow group (OR = 2.84, P = .02). CONCLUSIONS: A wide gastric conduit width (>5 cm) is an independent risk factor for the development of BAS after esophagectomy and stapled cervical end-to-side anastomosis for esophageal cancer.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Constrição Patológica/etiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Esofagectomia/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estômago/cirurgia
8.
J Laryngol Otol ; 134(6): 558-561, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32618525

RESUMO

BACKGROUND: Pyriform aperture stenosis is a rare form of congenital nasal obstruction; it poses a management dilemma for otolaryngologists and physicians alike. It can result in poor weight gain and potentially life-threatening airflow obstruction. The challenge lies in the difficulty to predict which patients will require invasive operative management versus conservative therapy alone. CASE REPORT: This case demonstrates the successful use of high-flow nasal cannula therapy in a young child with pyriform aperture stenosis.


Assuntos
Cânula/efeitos adversos , Constrição Patológica/terapia , Obstrução Nasal/congênito , Doenças Nasais/congênito , Assistência ao Convalescente , Cânula/estatística & dados numéricos , Criança , Tratamento Conservador/métodos , Constrição Patológica/etiologia , Humanos , Masculino , Obstrução Nasal/diagnóstico por imagem , Obstrução Nasal/patologia , Doenças Nasais/complicações , Doenças Nasais/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
J Laryngol Otol ; 134(7): 603-609, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32713375

RESUMO

OBJECTIVE: This study aimed to evaluate the association between cochlear nerve canal dimensions and semicircular canal abnormalities and to determine the distribution of bony labyrinth anomalies in patients with cochlear nerve canal stenosis. METHOD: This was a retrospective study in which high-resolution computed tomography images of paediatric patients with severe-to-profound sensorineural hearing loss were reviewed. A cochlear nerve canal diameter of 1.5 mm or less in the axial plane was classified as stenotic. Semicircular canals and other bony labyrinth morphology and abnormality were evaluated. RESULTS: Cochlear nerve canal stenosis was detected in 65 out of 265 ears (24 per cent). Of the 65 ears, 17 ears had abnormal semicircular canals (26 per cent). Significant correlation was demonstrated between cochlear nerve canal stenosis and semicircular canal abnormalities (p < 0.01). Incomplete partition type II was the most common accompanying abnormality of cochlear nerve canal stenosis (15 out of 65, 23 per cent). CONCLUSION: Cochlear nerve canal stenosis is statistically associated with semicircular canal abnormalities. Whenever a cochlear nerve canal stenosis is present in a patient with sensorineural hearing loss, the semicircular canal should be scrutinised for presence of abnormalities.


Assuntos
Perda Auditiva Neurossensorial/etiologia , Canais Semicirculares/anormalidades , Doenças do Nervo Vestibulococlear/complicações , Adolescente , Criança , Pré-Escolar , Nervo Coclear/diagnóstico por imagem , Nervo Coclear/patologia , Constrição Patológica , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/patologia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/patologia , Tomografia Computadorizada por Raios X , Doenças do Nervo Vestibulococlear/diagnóstico por imagem , Doenças do Nervo Vestibulococlear/etiologia , Doenças do Nervo Vestibulococlear/patologia
11.
Clin Ter ; 171(4): e335-e339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614368

RESUMO

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P <0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p <0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB.


Assuntos
Obstrução das Vias Respiratórias/terapia , Intubação Intratraqueal , Nervos Laríngeos , Bloqueio Nervoso , Obstrução das Vias Respiratórias/cirurgia , Anestesia Local , Constrição Patológica , Feminino , Tecnologia de Fibra Óptica/métodos , Humanos , Intubação Intratraqueal/métodos , Lidocaína , Masculino , Pessoa de Meia-Idade , Vigília
12.
J Laryngol Otol ; 134(6): 509-518, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32508296

RESUMO

OBJECTIVE: To determine the prevalence and distribution of inner-ear malformations in congenital single-sided deafness cases, as details of malformation type are crucial for disease prognosis and management. METHODS: A retrospective study was conducted of 90 patients aged under 16 years with congenital single-sided deafness. Radiological findings were evaluated using computed tomography and magnetic resonance imaging. Inner-ear malformations were identified and cochlear nerve status was determined in affected ears. RESULTS: Out of 90 ears, 42 (46.7 per cent) were found to have inner-ear malformation. Isolated cochlear aperture stenosis was the most common anomaly (n = 18, 20 per cent), followed by isolated cochlear aperture atresia (n = 11, 12.2 per cent) and cochlear hypoplasia (n = 7, 7.8 per cent). Cochlear nerve deficiency was encountered in 41 ears (45.6 per cent). The internal auditory canal was also stenotic in 49 ears (54.4 per cent). CONCLUSION: Inner-ear malformations, especially cochlear aperture anomalies, are involved in the aetiology of single-sided deafness more than expected. The cause of single-sided deafness differs greatly between congenital and adult-onset cases. All children with single-sided deafness should undergo radiological evaluation, as the prognosis and management, as well as the aetiology, may be significantly influenced by inner-ear malformation type.


Assuntos
Cóclea/patologia , Surdez/etiologia , Orelha Interna/anormalidades , Doenças do Labirinto/congênito , Adolescente , Criança , Pré-Escolar , Cóclea/anormalidades , Cóclea/inervação , Nervo Coclear/anormalidades , Nervo Coclear/fisiopatologia , Constrição Patológica/patologia , Surdez/diagnóstico , Orelha Interna/diagnóstico por imagem , Orelha Interna/patologia , Feminino , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/epidemiologia , Humanos , Lactente , Doenças do Labirinto/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Prevalência , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Doenças do Nervo Vestibulococlear/congênito , Doenças do Nervo Vestibulococlear/epidemiologia
13.
Medicine (Baltimore) ; 99(22): e20498, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481466

RESUMO

To explore the outcome of placing a single Y-shaped tracheal self-expandable metallic stent (SEMS) to treat emergent carinal stenosis combined with stenosis of the right main and intermediate bronchi.The clinical and imaging data of 10 patients (8 males, 2 females) with carinal stenosis combined with stenosis of the right main and intermediate bronchi were retrospectively analyzed. There were 4 patients with esophageal cancer and 6 patients with lung cancer. All patients underwent treatment with a single Y-shaped tracheal SEMS. The long branch was inserted into the right main and intermediate bronchi, while the short branch was inserted into the left main bronchus. A modified Borg scale score was used as the criterion for assessing dyspnea in patients before and after stenting.A total of 10 Y-shaped tracheal SEMSs were successfully placed in 10 patients without any procedure-related complications. Compared with the score before stent placement, the mean Borg score for dyspnea after stent placement decreased from 7.6 to 0.8 (P = .04). Chest computed tomography showed that the stenosis disappeared 3 to 5 days poststenting. During the follow-up period, the most common complications were tumor ingrowth (n = 5) and granulation tissue hyperplasia (n = 7). The mean survival time after tracheal stent placement was 103 ±â€Š50 (23-172) days.The application of a single Y-shaped tracheal SEMS for emergent carinal stenosis combined with stenosis of the right main and intermediate bronchi can effectively relieve dyspnea through a simple operation.


Assuntos
Broncopatias/terapia , Stents Metálicos Autoexpansíveis , Estenose Traqueal/terapia , Idoso , Idoso de 80 Anos ou mais , Broncopatias/diagnóstico por imagem , Constrição Patológica , Neoplasias Esofágicas/complicações , Feminino , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Estenose Traqueal/diagnóstico por imagem
14.
Vestn Otorinolaringol ; 85(2): 78-83, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32476397

RESUMO

Despite the existing modern high-tech methods of examination and a variety of surgical treatment methods, the problem of diagnosis, treatment and rehabilitation of patients with chronic post-intubation cicatricial stenosis of the larynx and trachea still requires further study. Improving the understanding and correction of cellular, molecular genetic and biochemical disorders in a chronic wound is a key condition for increasing the efficiency of diagnosis, individual prognosis of the clinical course and the conduct of adequate therapeutic and preventive measures for post-intubation cicatricial laryngotracheal stenoses. In this regard, it seemed appropriate to analyze the existing etiopathogenetic factors of pathological wound healing in chronic post-intubation cicatricial stenosis of the larynx and trachea. Our attempt to summarize the available literature data demonstrated that laryngotracheal scars are a fibro-proliferative disease caused by aberrant wound healing after a damaging effect on the tissues of the larynx and trachea. The article describes the most pathogenetically significant healing, repair, and scarring factors in post-intubation laryngotracheal stenoses, including transforming growth factor ß1, vascular growth factor A, type I and III collagen, and matrix metalloproteinases. An assessment of the features of the diagnostic and prognostic significance of these markers will increase the effectiveness of the treatment of patients with chronic cicatricial stenosis of the larynx and trachea, and will also serve as a prerequisite for the development of strategies for diagnostic, treatment, prophylactic and rehabilitation measures that will improve the quality of medical care and the quality of life of patients with chronic cicatricial stenosis of the larynx and trachea.


Assuntos
Laringoestenose , Laringe , Constrição Patológica , Humanos , Intubação Intratraqueal , Qualidade de Vida , Traqueia
15.
Gan To Kagaku Ryoho ; 47(6): 870-874, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32541158

RESUMO

Superior vena cava(SVC)syndrome is a syndrome caused by impaired venous return due to stenosis of the SVC. Most of such cases are due to tumors(non-small cell lungcancer, small cell lungcancer, malignant lymphoma, etc), and the most common cause of SVC syndrome is lungcancer. Symptoms of SVC syndrome are caused by external compression of the SVC, direct invasion, internal thrombus or embolization. Increased venous pressure results in objective findings including edema of the face and neck, edema of the upper limbs, superficial precordial vein distension due to collateral circulation, and hoarseness and subjective symptoms includingcoug h, dyspnea, syncope, headache, and dizziness. SVC syndrome impair the patient's quality of life(QOL). Although there are cases of spontaneous remission, SVC syndrome is recognized as one of the oncologic emergencies because brain and laryngeal edema can be fatal and urgent care should be provided. Therapeutic modalities include radiotherapy, chemotherapy, stent placement and surgery. Treatment should be determined comprehensively based on the severity, histological type, standard therapy for the histological type and its sensitivity. It is necessary to make a definitive histopathological diagnosis as soon as possible and to cooperate with other departments to promptly select the most appropriate treatment.


Assuntos
Síndrome da Veia Cava Superior , Constrição Patológica , Humanos , Neoplasias , Qualidade de Vida , Veia Cava Superior
17.
Ann Otol Rhinol Laryngol ; 129(10): 964-968, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32441108

RESUMO

OBJECTIVE: This study was performed to evaluate the incidence, timing, and factors contributing to recurrent maxillary sinusitis due to middle meatal antrostomy (MMA) site stenosis after endoscopic sinus surgery (ESS). METHODS: The medical records and endoscopic photographs of 288 patients with chronic rhinosinusitis who underwent ESS were evaluated. Patients visited the clinic with similar schedule after ESS; recurrent maxillary sinusitis due to MMA site stenosis was investigated, including in terms of the incidence and timing. The preoperative computed tomography (CT) scans, intraoperative findings, and possible factors contributing to MMA site stenosis were examined. RESULTS: Recurrent maxillary sinusitis due to MMA site stenosis occurred in 10 patients. Most had unilateral sinusitis and stenosis was observed within 6 months postoperatively. All patients had severe inflammation, pus retention, and thick mucosal hypertrophy in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination. CONCLUSIONS: MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.


Assuntos
Endoscopia/métodos , Seio Maxilar/cirurgia , Sinusite Maxilar/cirurgia , Estomia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos
18.
Medicine (Baltimore) ; 99(19): e20209, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384517

RESUMO

To explore the clinical features and management of post-necrotizing enterocolitis strictures.Clinical data from 158 patients with post-necrotizing enterocolitis strictures were summarized retrospectively in 4 academic pediatric surgical centers between April 2014 and January 2019. All patients were treated conservatively in the internal medicine department. All patients underwent preoperative X-ray examinations, 146 patients underwent gastrointestinal contrast studies, and 138 patients underwent rectal mucosal biopsies. All of the patients were treated surgically.Of the 158 patients, 40 of them had necrotizing enterocolitis (NEC) Bell stage Ib, 104 had Bell stage IIa, and 14 had Bell stage IIb. In these patients, the clinical signs of intestinal strictures occurred at mean of 47.8 days after NEC. In 158 patients, 146 underwent barium enema examination, 116 demonstrated intestinal strictures, and 10 demonstrated microcolon and poor development. A total of 138 patients underwent rectal mucosal biopsies, and 5 patients had Hirschsprung disease. Intraoperative exploration showed that intestinal post-NEC strictures occurred in the ileal (17.7%, 28/158) and colon (82.3%, 130/158), including ascending colon, transverse colon and descending colon, and multiple strictures were detected in 36.1% (57/158) patients. Surgical resection of stricture segments in the intestine and primary end-to-end anastomosis were performed in 142 patients, and the remaining 16 patients underwent staged surgeries. In the 146 patients with complete follow-up data, 9 had postoperative adhesions: 4 of them received conservative treatment, and the others underwent a second operation. Fifteen patients were hospitalized 1 to 3 times for malnutrition and dehydration due to repeated diarrhea; these patients eventually recovered and were discharged smoothly. All the other patients had uneventful recoveries without stricture recurrence.Post-NEC strictures mostly occurred in the colon, and there were some cases of multiple strictures. A gastrointestinal contrast study was the preferred method of examination. Preoperative rectal mucosal biopsy resulted in a diagnosis of Hirschsprung disease, and then a reasonable treatment protocol was chosen. Surgical resection of stricture segments in the intestine and primary end-to-end anastomosis achieved good therapeutic effects with favorable prognoses in these patients.


Assuntos
Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Enterocolite Necrosante/complicações , Enterocolite Necrosante/terapia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/terapia , Recém-Nascido Prematuro , Estudos Retrospectivos , Índices de Gravidade do Trauma
20.
Zhongguo Gu Shang ; 33(5): 420-5, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32452178

RESUMO

OBJECTIVE: To evaluate the clinical effects of percutaneous endoscopic foraminoplasty for simple lumbar spinal lateral exit zone stenosis. METHODS: A total of 36 patients with simple lumbar spinal lateral exit zone stenosis were admitted to our hospital from January 2013 to June 2018, and received selective nerve root canal radiography and radicular block. According to the symptoms and patients' personal wills, 22 cases underwent the one-stage percutaneous foraminal surgery(the one-stage operation group), and the other 14 patients were re-admitted to the hospital for operation(the delayed operation group) because of the recurrence of symptoms after discharge. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects before therapy, 1 day after the radicular block, and 1 day, 3 months and 6 months after the operation. RESULTS: VAS and ODI of all 36 cases were obviously improved (P<0.05) at various stages after the surgery and maintained well and showed a continuous downward trend. The VAS at 6 months after the operation was improved significantly compared with that at 1 day after the operation (P<0.05).When comparing the postoperative ODI between 1 day and 3 months after the surgery, 1 day and 6 months after the surgery, 3 months and 6 months after the surgery, the differences were statistically significant (P<0.05). The VAS and ODI of the one-stage operation group at 1 day after radicular block were better than those of delayed operation group. The VAS and ODI of delayed operation group before readmission were significantly higher than those at 1 day after radicular block. There were no significant differences in VAS and ODI at each stage after operation between two groups(P>0.05), but when compared with its own pretherapy andbefore readmission results, the difference was significant (P<0.05). There was no nerve injury in all cases. Only 2 cases were presented with the outlet root stimulation symptoms, and the symptoms relieved after short term conservative treatment. CONCLUSION: The clinical effects of radicular block may be unsustainable for patients with simple lumbar spinal lateral exit zone stenosis. Instead, percutaneous endoscopic foraminoplasty was simple, safe and effective.


Assuntos
Descompressão Cirúrgica , Estenose Espinal , Constrição Patológica , Humanos , Vértebras Lombares , Neuroendoscopia , Estudos Retrospectivos , Estenose Espinal/cirurgia , Resultado do Tratamento
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