ABSTRACT
INTRODUCTION: Endobronchial tuberculosis (EBTB) can lead to bronchopulmonary complications when diagnosis is delayed. Bronchoscopic treatment in children can be challenging due to small airway size. We report our experience treating children with EBTB. METHODS: Retrospective study (2014-2020) of patients diagnosed with EBTB. Flexible bronchoscopy (FB) was performed in patients with previous diagnosis of pulmonary tuberculosis (PTB), after respiratory/radiological worsening was observed in spite of medical treatment. Treatment consisted in oral corticotherapy in all patients, and interventional bronchoscopy in selected cases. Our aim is to describe the endoscopic findings, interventional bronchoscopy alternatives, and outcome. RESULTS: Of 45 patients with PTB, 13 (28.9%, 7 M/6 F) were diagnosed with EBTB, with a mean age of 3.9 years (0.4-12.8). Four bronchoscopic patterns were observed. Endobronchial granuloma (N:9; 69.2%): Excision with rigid bronchoscopy was achieved in five (1-5 procedures per patient), while corticotherapy alone was preferred in the remaining four due to small size/distal location of the granuloma. Caseum obstruction (2; 15.4%): dense mucous molds were removed with flexible/rigid bronchoscopy (6 and 8 procedures, respectively). Bronchial stenosis (1; 7.7%): two balloon dilatations with mitomycin-C application were performed. Extrinsic compression (1; 7.7%): oral corticotherapy alone was initiated. One patient developed bronchoscopy-related complications (pneumothorax requiring thoracic tube 48 h). With a medium follow-up of 4.6 years (1.8-7.6), three patients developed bronchiectasis while the remaining 10 improved clinically and radiologically. CONCLUSION: Bronchoscopic findings in EBTB include granuloma, stenosis, caseum obstruction and external compression. In selected cases, interventional bronchoscopy can minimize long-term bronchopulmonary complications.
Subject(s)
Bronchial Diseases , Tuberculosis, Pulmonary , Tuberculosis , Bronchial Diseases/diagnosis , Bronchial Diseases/surgery , Bronchoscopy/methods , Child , Child, Preschool , Constriction, Pathologic , Humans , Mitomycin , Retrospective Studies , Tuberculosis/diagnosis , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosisABSTRACT
AIM: In the last years it has spread minimally invasive therapeutic for the treatment of pyeloureteral junction obstruction in children. Some of them have got poor outcomes in 4-year-old minor children. We show our experience in the retrograde dilatation with balloon of high pressure in infants. METHODS: It's a retrospective study of 16 infants treated in our hospital. The average follow-up after the intervention is 27.4 +/- 10.0 months. The diagnostic protocol included abdominal ultrasound, cystogram and diuretic renography. The treatment was realized by endourology retrograde balloon dilatation under fluoroscopy. The balloons were in all the cases semicompliant, with a profile of 5 mm, 6 mm 6 7 mm. After the expansion there was placed stents type double J with profile and length depending on the weight of the patient. To obtain the results, we do ultrasound scans and diuretic renography at least 1 year after the intervention. RESULTS: The mean duration of the intervention was 36.4 +/- 15.5 minutes. During the intervention, in 2 patients the placement of the stent was not possible. The time of revenue was 48 hours in all the patients except in 1 of them. The analgesic needs were exclusively non steroid antiinflammatorys. The double J stent was withdrawn with cystoscopy. In 3 patients there were postoperatory complications: a migration of the stent, a urinary infection and an urinoma. In 1 patient with worsening of hydronephrosis was needed of pyeloplasty. In the controls the disappearance of the hydronephrosis was observed in all the cases, eliminating likewise the expansion of the renal calyces. The diuretic renography improved in all babies, being the boss of the curve normal in 14 cases and semi obstructively in 2. The mean time of elimination was 9.8 +/- 2.8 minutes. CONCLUSIONS: We think that the balloon dilatation of pyeloureteral junction obstruction is a minimally aggressive technique that is possible to realize in infants with good results and scanty complications.
Subject(s)
Catheterization , Kidney Pelvis , Ureteral Obstruction/therapy , Constriction, Pathologic , Female , Humans , Infant , Male , Retrospective Studies , Time FactorsABSTRACT
Introducción: En los últimos años se han extendido terapéuticas mínimamente invasivas para el tratamiento de la estenosis pieloureteral en niños. Algunas de ellas con pobres resultados en niños menores de 4 años. Presentamos nuestra experiencia en el tratamiento mediante dilatación endourológica retrógrada con balón de alta presión en lactantes. Material y métodos: Presentamos un estudio retrospectivo de 16 pacientes menores de 1 año tratados en nuestra unidad. El seguimiento medio tras la intervención es de 27,4±10,0 meses. El protocolo diagnóstico incluyó ecografía abdominal, gammagrafía renal, cistouretrografía miccional y renograma diurético. El tratamiento se realizó mediante dilatación endoscópica retrógrada bajo control radioscópico. Los balones utilizados eran en todos los casos semicompliantes, con un perfil de 5 mm, 6 mm ó 7 mm. Tras la dilatación se colocó stents tipo doble J de calibre y longitud en función del peso del paciente. Para obtener los resultados se analizan las ecografías y los renogramas diuréticos por lo menos 1 año después de la intervención. Resultados: La duración media de la intervención fue de 36,4±15,5 minutos. Durante la intervención, en 2 pacientes no fue posible la colocación del stent, El tiempo de ingreso fue de 48 horas en todos los pacientes excepto en 1 de ellos. Las necesidades analgésicas fueron exclusivamente AINES. El stent tipo doble J fue retirado mediante cistoscopia de manera ambulatoria. En 3 pacientes hubo complicaciones postoperatorias: una migración del stent, una ITU y un urinoma. La técnica fracasó en 1 paciente que necesitó de pieloplastia desmembrada. En los controles se observó la desaparición de la hidronefrosis en todos los casos, desapareciendo así mismo la dilatación de los cálices renales. El renograma diurético MAG-3 mejoró en todos los lactantes, siendo el patrón de la curva normal en 14 casos y semiobstructivo en 2. El tiempo medio de eliminación fue de 9,8±2,8 minutos. Conclusiones: Pensamos que la dilatación con balón es una técnica mínimamente agresiva que es posible realizar en pacientes menores de 1 año con buenos resultados y escasas complicaciones (AU)
Aim: In the last years it has spread minimally invasive therapeutic for the treatment of pyeloureteral junction obstruction in children. Some of them have got poor outcomes in 4-year-old minor children. We show our experience in the retrograde dilatation with balloon of high pressure in infants. Methods: It´s a retrospective study of 16 infants treated in our hospital. The average follow-up after the intervention is 27.4±10.0months. The diagnostic protocol included abdominal ultrasound, cystogram and diuretic renography. The treatment was realized by endourology retrograde balloon dilatation under fluoroscopy. The balloons were in all the cases semicompliant, with a profile of5 mm, 6 mm ó 7 mm. After the expansion there was placed stents type double J with profile and length depending on the weight of the patient. To obtain the results, we do ultrasound scans and diuretic renography at least 1 year after the intervention. Results: The mean duration of the intervention was 36.4±15.5 minutes. During the intervention, in 2 patients the placement of thestent was not possible. The time of revenue was 48 hours in all the patients except in 1 of them. The analgesic needs were exclusively non steroid antiinflammatorys. The double J stent was withdrawn with cystoscopy. In 3 patients there were postoperatory complications: a migration of the stent, a urinary infection and an urinoma. In 1 patient with worsening of hydronephrosis was needed of pyeloplasty. In the controls the disappearance of the hydronephrosis was observed in all the cases, eliminating likewise the expansion of the renal calyces. The diuretic renography improved in all babies, being the boss of the curve normal in 14 cases and semi obstructively in 2. The mean time of elimination was 9.8±2.8 minutes. Conclusions: We think that the balloon dilatation of pyeloureteral junction obstruction is a minimally aggressive technique that is possible to realize in infants with good results and scanty complications (AU)