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Chest ; 152(2): 450, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28797392
Chest ; 152(2): 417-423, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28267436


Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript describes these treatment options in detail, including postprocedural adverse events. Further research, including randomized controlled trials with comparison of these options, are needed, as is long-term follow-up for these interventions.

Pneumopatias/terapia , Doenças Pleurais/terapia , Fístula do Sistema Respiratório/terapia , Ar , Tubos Torácicos , Doença Crônica , Feminino , Humanos , Pneumopatias/complicações , Masculino , Doenças Pleurais/complicações , Pleurodese/instrumentação , Pleurodese/métodos , Pneumotórax/etiologia , Guias de Prática Clínica como Assunto , Fístula do Sistema Respiratório/complicações , Fatores de Risco , Fatores Sexuais
Ann Am Thorac Soc ; 12(9): 1302-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26230374


RATIONALE: Bronchial thermoplasty is an alternative treatment for patients with severe, uncontrolled asthma in which the airway smooth muscle is eliminated using radioablation. Although this emerging therapy shows promising outcomes, little is known about its effects on airway inflammation. OBJECTIVES: We examined the presence of bronchoalveolar lavage cytokines and expression of smooth muscle actin in patients with severe asthma before and in the weeks after bronchial thermoplasty. METHODS: Endobronchial biopsies and bronchoalveolar lavage samples from 11 patients with severe asthma were collected from the right lower lobe before and 3 and 6 weeks after initial bronchial thermoplasty. Samples were analyzed for cell proportions and cytokine concentrations in bronchoalveolar lavage and for the presence of α-SMA in endobronchial biopsies. MEASUREMENTS AND MAIN RESULTS: α-SMA expression was decreased in endobronchial biopsies of 7 of 11 subjects by Week 6. In bronchoalveolar lavage fluid, both transforming growth factor-ß1 and regulated upon activation, normal T-cell expressed and secreted (RANTES)/CCL5 were substantially decreased 3 and 6 weeks post bronchial thermoplasty in all patients. The cytokine tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL), which induces apoptosis in several cell types, was increased in concentration both 3 and 6 weeks post bronchial thermoplasty. CONCLUSIONS: Clinical improvement and reduction in α-SMA after bronchial thermoplasty in severe, uncontrolled asthma is associated with substantial changes in key mediators of inflammation. These data confirm the substantial elimination of airway smooth muscle post thermoplasty in the human asthmatic airway and represent the first characterization of significant changes in airway inflammation in the first weeks after thermoplasty.

Anti-Inflamatórios/administração & dosagem , Asma/cirurgia , Ablação por Cateter/métodos , Inflamação/tratamento farmacológico , Complicações Pós-Operatórias/patologia , Prednisona/administração & dosagem , Adulto , Asma/tratamento farmacológico , Biópsia , Brônquios/patologia , Líquido da Lavagem Broncoalveolar/citologia , Broncoscopia , Citocinas/análise , Feminino , Humanos , Masculino , Músculo Liso/patologia , Estudos Prospectivos , Índice de Gravidade de Doença
Org Lett ; 10(24): 5621-4, 2008 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-19053737


Diisopropylsilyl bis-enol ethers are shown to be powerful intermediates for the diastereoselective dimerization and cross-coupling of cyclic ketones. The trends observed for the oxidative coupling of a range of different dialkylsilyl bis-enol ethers derived from cyclohexanone are rationalized by invoking a stereochemical model based on a Thorpe-Ingold effect.

Cicloexanonas/química , Éteres/síntese química , Cetonas/química , Carbono/química , Ciclização , Éteres/química , Oxirredução , Estereoisomerismo