Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.827
Filtrar
1.
Zhonghua Yi Xue Za Zhi ; 100(1): 47-50, 2020 Jan 07.
Artigo em Chinês | MEDLINE | ID: mdl-31914558

RESUMO

Objective: To evaluate the clinical value of modified computed tomography angiography(CTA) in detecting bronchial artery-pulmonary artery fistula(BPF). Methods: Retrospective analysis was performed on 246 patients with hemoptysis admitted to the First Affiliated Hospital of Wenzhou Medical University from July 2017 to December 2018, who underwent modified CTA and DSA examination at the same time. CT was performed with Toshiba Aquilion one 320 row 640-slice spiral CT scanner. All modified CTA images were read blindly by two radiologists above the attending doctors. The sensitivity, specificity and accuracy of the modified CTA in diagnosing BPF were calculated with the DSA results as the reference,and the consistency of the two tests was analyzed. Results: DSA detected 186 cases of positive and 60 cases of negative, modified CTA detected 160 cases of positive and 86 cases of negative. The sensitivity,specificity and accuracy of modified CTA for BPF diagnosis was 85.5%(159/186),98.3%(59/60), 88.6%(218/246) respectively, and they were with high consistency with DSA examination results (kappa=0.73,P<0.01). Conclusion: Modified CTA has high diagnostic specificity for BPF,which can be used as the preferred method for non-invasive screening of suspected BPF patients.


Assuntos
Angiografia por Tomografia Computadorizada , Fístula , Artérias Brônquicas , Humanos , Artéria Pulmonar , Estudos Retrospectivos
2.
Kyobu Geka ; 72(12): 1042-1045, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701919

RESUMO

The patient was a 72-year-old man with a history of bronchiectasis. He was admitted to our hospital for an examination of hoarseness. Chest computed tomography (CT) showed bronchiectasis in the bilateral lungs and bronchial artery aneurysm in the mediastinum. To prevent rupture of the aneurysm, we imaged the bronchial artery aneurysm by selective bronchial artery angiography and performed bronchial artery embolization (BAE) with 19 platinum coils. Three months after successful BAE, his hoarseness had improved, and the bronchial artery aneurysm was reduced in size after 12 months. To our knowledge, this is the 1st report of BAE improving hoarseness due to bronchial artery aneurysm.


Assuntos
Aneurisma , Artérias Brônquicas , Embolização Terapêutica , Idoso , Angiografia , Rouquidão , Humanos , Masculino
3.
Medicine (Baltimore) ; 98(44): e17798, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689858

RESUMO

RATIONALE: Dieulafoy disease of the bronchus is a rare vascular deformity. To the best of our knowledge, reports of these involving both lung vascular are hitherto absent. PATIENT CONCERNS: A 67-year-old male was admitted to our department due to agnogenic hemoptysis. DIAGNOSES: Bronchoscopy was performed and some smooth, pulsatile nodular lesions were found in the middle and lower lobes, Computed tomography angiography of the bronchial artery confirmed a left bronchial artery arising from the aortic arch at T4 level, and both bronchial arteries were dilated and tortuous. INTERVENTIONS: Bronchial artery embolization was performed successfully. OUTCOMES: The patient was discharged with no hemoptysis. In addition, patient is under follow-up until today without any further incidents. LESSONS: This case reminds us that Dieulafoy disease of the bronchus could be a potential etiology for unexplained hemoptysis. The clinician should be aware of this disease when bronchoscopy revealed multiple some smooth, pulsatile nodular lesions, thereafter, bronchoscope biopsy should be avoided, as it could lead to fatal hemoptysis.


Assuntos
Artérias Brônquicas/anormalidades , Broncopatias/complicações , Hemoptise/etiologia , Malformações Vasculares/complicações , Idoso , Artérias Brônquicas/cirurgia , Broncopatias/patologia , Broncopatias/cirurgia , Broncoscopia/métodos , Angiografia por Tomografia Computadorizada , Hemoptise/cirurgia , Humanos , Pulmão/patologia , Masculino , Malformações Vasculares/patologia , Malformações Vasculares/cirurgia
4.
Kyobu Geka ; 72(11): 939-941, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31588114

RESUMO

Bronchial artery aneurysm(BAA) is quite rare, but its rupture is often lethal. Once it is found, treatments should be aggressively considered. A 67-year-old woman was diagnosed to have a 26 mm mediastinal BAA on computed tomography (CT) which was performed for screening. CT revealed a very short inflow vessel of the BAA and arteriovenous fistula at the outflow. Considering these features of the aneurysm, endovascular interventions deemed difficult and surgery was carried out. Because of the fragility, the aneurysm was resected together with the descending aorta and the graft replacement was performed under partial extracorporeal circulation. The patient has no untoward event for 1 year postoperatively. Although most recent reports advocate endovascular interventions, we think surgical treatment is a variable option in selected patients. Careful evaluation for each BAA case would be essential to determine the treatment strategy.


Assuntos
Aneurisma , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Embolização Terapêutica , Idoso , Aorta Torácica , Artérias Brônquicas , Circulação Extracorpórea , Feminino , Humanos
5.
Med Sci Monit ; 25: 6504-6511, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31467263

RESUMO

BACKGROUND Lung cancer with intracranial metastasis requires concurrent treatment of the primary lung tumor and the secondary brain tumor. This study aimed to investigate the short-term clinical efficacy of concurrent bronchial artery and posterior inferior cerebellar artery microcatheter interventional chemotherapy for the treatment of adenocarcinoma of the lung with solitary cerebellar metastasis. MATERIAL AND METHODS Seventeen patients with adenocarcinoma of the lung with solitary cerebellar metastasis received concurrent microcatheter interventional chemotherapy via the bronchial artery and posterior inferior cerebellar artery. Two cycles of treatment with teniposide (VM-26), carmustine (BCNU), carboplatin (CBP), and pirarubicin (THP) were performed every four weeks. RESULTS Four patients (23.53%) achieved a complete response (CR), five patients (29.41%) achieved a partial response (PR), seven patients (41.18%) had stable disease (SD), and only one patient (5.88%) developed progressive disease (PD). The objective response rate (ORR) and disease control rate (DCR) were 52.94% (9/17) and 94.12% (16/17), respectively. Four patients (11.76%) developed grade 1/2 chemotherapy toxicity, which included three cases (8.82%) of gastrointestinal toxicity and one case (2.84%) of granulocytopenia, but no grade 3/4 toxicity was found. During microcatheter interventional chemotherapy, three patients (8.82%) developed intracranial complications, including two cases (5.88%) of cerebrovascular spasm and one case (2.94%) of cerebral edema. CONCLUSIONS In 17 patients with adenocarcinoma of the lung with solitary cerebellar metastasis, concurrent microcatheter interventional chemotherapy via the bronchial artery and posterior inferior cerebellar artery was safe and showed short-term efficacy.


Assuntos
Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/cirurgia , Neoplasias Encefálicas/secundário , Artérias Brônquicas/cirurgia , Cateteres , Artérias Cerebrais/cirurgia , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Artérias Brônquicas/patologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Cardiovasc Intervent Radiol ; 42(10): 1449-1458, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31321481

RESUMO

OBJECTIVE: The objective of this study was to evaluate the potential benefit of a dedicated cone-beam-CT streak metal artifact removal technique (SMART) in terms of both image quality and diagnostic confidence in patients undergoing bronchial artery embolization. METHODS: A total of 17 patients were included in this retrospective study. The SMART algorithm was applied to images containing streak artifacts generated by a radiopaque intra-arterial catheter tip. Quantitative evaluation of artifact severity was performed via measurement of the Hounsfield units along a closed loop surrounding the catheter tip and was conducted in the frequency domain following the application of the discrete Fourier transform to the measured data. A high proportion of power in the low frequencies of the resulting spectrum indicated a high level of streak artifacts. Qualitative evaluation of diagnostic confidence was performed using a 4-point Likert scale. RESULTS: Both quantitative and qualitative evaluation demonstrated a significant reduction in artifact severity using the SMART algorithm. Quantitative evaluation demonstrated a mean artifact reduction of 22.5% using SMART compared to non-SMART images (p < 0.001). Qualitative evaluation demonstrated the greatest artifact reduction at the inner and outer aortic curvature, as well as immediately surrounding the tip of the catheter. In 6 of 17 cases, the use of the SMART algorithm yielded additional clinical information, increasing mean diagnostic confidence from 3.17 to 3.78 (p < 0.001). CONCLUSION: The SMART algorithm allows for efficient reduction of metal artifacts introduced by radiopaque catheter tips during cone-beam CT. Using this algorithm, diagnostic images of the aortic arch were significantly improved both quantitatively and qualitatively, yielding clinically relevant levels of enhanced diagnostic confidence. These results demonstrate that the SMART algorithm improves diagnostic and clinical characterization of the course of bronchial arteries on CBCT images, potentially improving the accuracy and clinical efficacy of bronchial artery embolization. LEVEL OF EVIDENCE: 3.


Assuntos
Artefatos , Artérias Brônquicas/diagnóstico por imagem , Broncopatias/terapia , Tomografia Computadorizada de Feixe Cônico/métodos , Embolização Terapêutica/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artérias Brônquicas/patologia , Broncopatias/diagnóstico por imagem , Broncopatias/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
BMC Pulm Med ; 19(1): 117, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248409

RESUMO

BACKGROUND: Although infections caused by nontuberculous mycobacteria (NTM) are increasing in prevalence, there are few data about hemoptysis in patients with NTM lung disease. This study investigated the characteristics and prognosis of hemoptysis secondary to NTM infection. METHODS: Following a retrospective review of cases managed between 2006 and 2016, 183 patients with NTM lung disease were enrolled and analyzed. RESULTS: Among 183 patients with NTM lung disease, Mycobacterium intracellulare (n = 64, 35%) was the major cause of NTM infection, followed by M. avium (n = 59, 32.2%) and M. abscessus complex (n = 40, 21.9%). Hemoptysis developed in 78 patients (42.6%), among whom 33 (42.3%) required bronchial artery embolization (BAE). Between patients with and without hemoptysis, there were no significant differences with respect to sex, radiographic manifestations, distribution over 3 lobes on chest computed tomography, history of pulmonary tuberculosis, antiplatelet or anticoagulation therapy, and species of NTM. However, mean age at diagnosis was significantly lower in the hemoptysis group in univariate and multivariate analyses (65.7 ± 12.8 vs. 59.7 ± 11.8, P = 0.002, odds ratio: 0.969, 95% confidence interval: 0.944-0.996). Among patients with hemoptysis, those requiring medical therapy and those requiring BAE were not significantly different in terms of demographic characteristics, radiographic manifestations, and distribution over 3 lobes. All patients who received BAE showed immediate clinical improvement, no procedure-related complications, and none of them died during the period under review. CONCLUSIONS: NTM lung disease patients commonly experienced hemoptysis without specific risk factors except for relatively young age. Although some patients with hemoptysis needed BAE, the success rate of BAE was high, and there were no serious complications associated with BAE.


Assuntos
Artérias Brônquicas , Embolização Terapêutica/métodos , Hemoptise/etiologia , Hemoptise/terapia , Infecção por Mycobacterium avium-intracellulare/complicações , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
World J Gastroenterol ; 25(17): 2144-2148, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31114140

RESUMO

BACKGROUND: Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal (GI) bleeding. It also highlights the benefits of chest computed tomography (CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery. CASE SUMMARY: A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm. CONCLUSION: We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.


Assuntos
Aneurisma Roto/diagnóstico , Fístula Esofágica/etiologia , Hemorragia Gastrointestinal/etiologia , Hematemese/etiologia , Doenças do Mediastino/etiologia , Tuberculose/complicações , Angiografia , Artérias Brônquicas/patologia , Embolização Terapêutica , Endoscopia , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/complicações , Hematemese/complicações , Humanos , Masculino , Doenças do Mediastino/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Vasc Endovascular Surg ; 53(6): 492-496, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31018831

RESUMO

Bronchial artery aneurysm (BAA) is a rare entity. Ruptured BAA can cause life-threatening hemorrhage. It is recommended that treatment should be initiated immediately after diagnosis. We present the case of a 56-year-old female with multiple BAAs and interstitial lung disease. Aortic computed tomography angiography demonstrated that the largest aneurysm at the right hilum was fed by right subclavian artery and right bronchial artery. A fistula between the pulmonary trunk and the aneurysm was also revealed. The patient underwent transcatheter embolization. Coils were placed in the feeding vessels instead of the aneurysms to avoid nontarget embolization of the pulmonary arteries through the fistula. The procedure achieved reduction in aneurysmal blood flow. The patient's cough resolved at 6-month follow-up.


Assuntos
Aneurisma/terapia , Artérias Brônquicas , Embolização Terapêutica , Procedimentos Endovasculares , Doenças Pulmonares Intersticiais/complicações , Artéria Pulmonar , Fístula do Sistema Respiratório/terapia , Fístula Vascular/terapia , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Fístula do Sistema Respiratório/complicações , Fístula do Sistema Respiratório/diagnóstico por imagem , Resultado do Tratamento , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem
12.
J Vasc Interv Radiol ; 30(3): 428-434, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819488

RESUMO

PURPOSE: To evaluate the safety and efficacy of bronchial artery embolization (BAE) in patients with primary lung cancer-related hemoptysis and to identify factors associated with hemoptysis-free survival. METHODS: Data from 84 patients with primary lung cancer (non-small cell [n = 74] and small cell [n = 10]) who underwent BAE from 1997 to 2018 for the management of hemoptysis were retrospectively reviewed. Of these, 53 patients had stage IV lung cancer. The hemoptysis volume prior to initial BAE was trivial (blood-tinged sputum) in 21 patients, moderate (< 300 mL per 24 hours) in 34 patients, and massive (> 300 mL per 24 hours) in 29 patients. RESULTS: Technical success, defined as the ability to selectively embolize the abnormal vessel, was achieved in 83 patients (98.8%), and clinical success was achieved in 69 (82.1%) patients. Polyvinyl alcohol particles were used to embolize in 51 patients, gelfoam in 15 patients, and gelfoam plus microcoils in 17 patients. Hemoptysis recurred in 20 patients (23.8%) during follow-up. The median hemoptysis-free survival and overall survival periods were both 61 days. In the clinical-success and clinical-failure groups, the median overall survival period was 99 and 9 days, respectively (P < .001). In multivariable analysis, massive hemoptysis (P = .012) and cavitary lung mass (P = .019) were predictive factors for shortened hemoptysis-free survival. CONCLUSIONS: BAE is a safe and effective approach to control hemoptysis, although the prognosis in primary lung cancer patients presenting with hemoptysis is generally poor. Massive hemoptysis and cavitary lung mass are significant predictors of shortened hemoptysis-free survival.


Assuntos
Artérias Brônquicas , Carcinoma Pulmonar de Células não Pequenas/complicações , Embolização Terapêutica/métodos , Esponja de Gelatina Absorvível/administração & dosagem , Hemoptise/terapia , Neoplasias Pulmonares/complicações , Álcool de Polivinil/administração & dosagem , Carcinoma de Pequenas Células do Pulmão/complicações , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Embolização Terapêutica/efeitos adversos , Feminino , Esponja de Gelatina Absorvível/efeitos adversos , Hemoptise/etiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Álcool de Polivinil/efeitos adversos , Intervalo Livre de Progressão , Recidiva , República da Coreia , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Carcinoma de Pequenas Células do Pulmão/patologia , Fatores de Tempo , Tomografia Computadorizada por Raios X
13.
Intern Med ; 58(11): 1593-1596, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30713314

RESUMO

Recurrence of an embolized pulmonary arteriovenous malformation (PAVM) is common after coil embolization. A 23-year-old woman who had undergone multiple instances of transcatheter coil embolization was admitted with hypoxia and hemoptysis. A PAVM in the left S6 was found to be recanalized by reperfusion through the pulmonary and bronchial arteries. The left S6 was partially resected; the specimen contained necrotic granulomas and non-tuberculous mycobacteria (NTM) around the PAVM. Clinicians should consider possible recurrence of PAVM after reperfusion of the pulmonary and bronchial arteries, as well as the risk of NTM infection during follow-up of patients who have undergone repeated coil embolization.


Assuntos
Fístula Arteriovenosa/etiologia , Embolização Terapêutica/efeitos adversos , Infecções por Micobactéria não Tuberculosa/complicações , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Artérias Brônquicas/diagnóstico por imagem , Embolização Terapêutica/métodos , Feminino , Hemoptise/etiologia , Humanos , Hipóxia/etiologia , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Radiografia Torácica , Recidiva , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Respir Investig ; 57(3): 260-267, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30692051

RESUMO

BACKGROUND: Hemoptysis is a common symptom associated with chronic pulmonary aspergillosis (CPA). While surgery is the primary choice to manage hemoptysis, it is often avoided because patients with CPA are more likely to have complications such as respiratory insufficiency and low pulmonary function. Bronchial artery embolization (BAE) may be considered one of the treatments of massive and persistent hemoptysis for such patients. METHODS: We retrospectively reviewed medical records of 41 patients, admitted to National Hospital Organization Tokyo National Hospital, Tokyo, Japan with hemoptysis arising from CPA between January 2011 to December 2016, who were considered inoperable and had undergone BAE. RESULTS: Out of the 41 cases analyzed in this study, 21 (51.2%) developed rebleeding after BAE within the mean follow-up duration of 24 months. The non-rebleeding rate of patients after BAE was 92.7% within a month and 65.8% within a year. Patients who developed rebleeding had significantly more non-bronchial systemic arteries responsible for the bleeding compared with patients who did not develop rebleeding (mean of 2.55 vs. 4.86, respectively, P = 0.011). Patients with stable or improved radiological findings demonstrated significantly lower rebleeding rates than those with radiological deterioration (P < 0.001). The non-rebleeding patients had significantly better survival than those with rebleeding (79.7% vs. 39.9% over 5 years, P = 0.046). CONCLUSIONS: Bronchial artery embolization was effective in controlling hemoptysis in patients with CPA, especially those who could not undergo surgical resection. However, disease control of CPA was important to prevent rebleeding over the long term and to improve survival after BAE.


Assuntos
Artérias Brônquicas , Embolização Terapêutica , Hemoptise/terapia , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/administração & dosagem , Doença Crônica , Progressão da Doença , Embolização Terapêutica/efeitos adversos , Feminino , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/diagnóstico por imagem , Recidiva , Estudos Retrospectivos
16.
Cancer Chemother Pharmacol ; 83(2): 387-391, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30542769

RESUMO

PURPOSE: We investigated the safety, pharmacokinetics, and efficacy of gemcitabine administered via bronchial artery infusion (BAI) and IV infusion in advanced NSCLC patients. METHODS: Patients were eligible if they had received at least two prior cytotoxic chemotherapy regimens. Gemcitabine was administered via BAI as 600 mg/m2 on day one of cycle one, followed by IV as 1000 mg/m2 on day eight of cycle one, and IV on days one and eight of all subsequent cycles. Pharmacokinetics for gemcitabine and dFdU metabolite in plasma, and dFdCTP active metabolite in peripheral blood mononuclear cells (PBMC) were evaluated. Intensive pharmacokinetic sampling was performed after BAI and IV infusions during cycle one. RESULTS: Three male patients (age range 59-68 years) were evaluated. All patients responded with stable disease or better. One PR was observed after cycle three, and the remaining had SD. Cmax (mean ± SD) following BAI for gemcitabine, dFdCTP, and dFdU were 7.71 ± 0.13, 66.5 ± 40.6, and 38 ± 6.27 µM and following IV infusion, 17 ± 2.36, 50.8 ± 3.61, and 83.2 ± 12.3 µM, respectively. The AUCinf (mean ± SD) following BAI for gemcitabine, dFdCTP, and dFdU were 6.89 ± 1.2, 791.1 ± 551.2, and 829.9 ± 217.8 µM h and following IV infusion, 12.5 ± 3.13, 584 ± 86.6, and 1394.64 ± 682.2 µM h, respectively. The AUC and Cmax of dFdCTP after BAI were higher than IV. The median OS was 6.27 months. No grade 3 or 4 toxicity was observed. The most common side effects were all grade ≤ 2 involving nausea, vomiting, rigor, thrombocytopenia, and anemia. CONCLUSIONS: Systemic exposure to dFdCTP was higher after BAI than IV in two out of three patients.


Assuntos
Antimetabólitos Antineoplásicos/farmacologia , Antimetabólitos Antineoplásicos/farmacocinética , Artérias Brônquicas , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Desoxicitidina/análogos & derivados , Floxuridina/análogos & derivados , Idoso , Antimetabólitos Antineoplásicos/administração & dosagem , Área Sob a Curva , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Desoxicitidina/administração & dosagem , Desoxicitidina/farmacocinética , Desoxicitidina/farmacologia , Feminino , Floxuridina/farmacocinética , Seguimentos , Humanos , Infusões Intravenosas , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Fosforilação , Prognóstico , Distribuição Tecidual
17.
Crit Care Med ; 47(3): e182-e189, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30531186

RESUMO

OBJECTIVES: Managing hemoptysis in chronic thromboembolic pulmonary hypertension can be challenging due to the difficulties in maintaining coagulation homeostasis in affected patients. In this study, we evaluated the efficacy and safety of bronchial artery embolization in treating hemoptysis in chronic thromboembolic pulmonary hypertension patients. DESIGN: Pilot, prospective cohort study. SETTING: A large respiratory medical institute. PATIENTS: From January 1, 2012, to December 31, 2017, hospitalized chronic thromboembolic pulmonary hypertension patients were eligible for inclusion. Patients with pulmonary hypertension caused by other conditions, or who failed to participate in the follow-up were excluded. INTERVENTIONS: Hemoptysis in chronic thromboembolic pulmonary hypertension patients was treated with or without bronchial artery embolization based on whether the bleeding could be stopped with medication alone and patient willingness for bronchial artery embolization treatment. MEASUREMENTS AND MAIN RESULTS: A total of 328 patients diagnosed with chronic thromboembolic pulmonary hypertension were consecutively collected, 317 patients were completed the follow-up. There were 15 chronic thromboembolic pulmonary hypertension patients with hemoptysis in total, and the occurrence rate of hemoptysis in chronic thromboembolic pulmonary hypertension patients was 4.7%. Among the hemoptysis chronic thromboembolic pulmonary hypertension patients, 10 (67%) underwent bronchial artery embolization, and five (33%) were treated with medication only. The median follow-up period for hemoptysis patients was 7.6 months. In patients underwent bronchial artery embolization treatment, oxygenation index and right heart function showed no significant difference between pre bronchial artery embolization and post bronchial artery embolization. Hemoptysis relapse (20% vs 80%; p = 0.025) and hemoptysis-related mortality (0% vs 40%; p = 0.032) were significantly lower, whereas the overall survival (90% vs 40%; p = 0.040) was higher in patients treated with bronchial artery embolization than in patients treated without bronchial artery embolization. CONCLUSIONS: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients.


Assuntos
Artérias Brônquicas , Embolização Terapêutica/métodos , Hemoptise/terapia , Hipertensão Pulmonar/complicações , Embolia Pulmonar/terapia , Ecocardiografia , Feminino , Hemoptise/etiologia , Hemoptise/mortalidade , Humanos , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Embolia Pulmonar/complicações , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Recidiva
18.
Eur Radiol ; 29(4): 1950-1958, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30324381

RESUMO

OBJECTIVES: To compare the average number of culprit arteries per patient, clinical success rate, and hemoptysis-free survival rate between hemoptysis patients with multidetector computed tomography (MDCT) angiography prior to bronchial artery embolization (BAE) and those without preprocedural MDCT angiography METHODS: This retrospective study was approved by the institutional review board with waiver of patient informed consent. From September 2012 to March 2017, 157 consecutive hemoptysis patients had been undergoing BAE. Among them, 106 patients received preprocedural MDCT angiography (MDCT group), while 51 patients did not receive preprocedural MDCT angiography (control group). The average number of culprit arteries per patient, clinical success rate, and hemoptysis-free survival rate were compared between the two groups. RESULTS: The average number of culprit ectopic bronchial arteries and that of non-bronchial systemic arteries originating from the subclavian and internal mammary arteries per patient in the MDCT group were both significantly higher than those in the control group (0.15 ± 0.51 vs 0.04 ± 0.20, p = 0.022, and 0.17 ± 0.56 vs 0.08 ± 0.39, p = 0.040, respectively). The clinical success rate of BAE with preprocedural MDCT angiography tended to be higher than that without MDCT angiography (97.2 vs 88.2%, p = 0.057). Importantly, patients in the MDCT group had a significantly higher hemoptysis-free early survival rate compared to those in the control group (96.1 vs 86.7%, p = 0.031). CONCLUSIONS: Preprocedural MDCT angiography helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries during BAE, and can improve the hemoptysis-free early survival rate, which could be recommended as a regular examination prior to BAE in patients with hemoptysis. KEY POINTS: • Preprocedural MDCT angiography helps detect culprit ectopic bronchial arteries and NBSAs originating from subclavian and internal mammary arteries during BAE. • Conducting MDCT angiography prior to BAE can improve hemoptysis-free early survival rate in hemoptysis patients.


Assuntos
Artérias Brônquicas/anormalidades , Embolização Terapêutica/métodos , Hemoptise/terapia , Adulto , Idoso , Brônquios/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/mortalidade , Intervalo Livre de Doença , Feminino , Hemoptise/mortalidade , Humanos , Masculino , Artéria Torácica Interna/anormalidades , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/mortalidade , Estudos Retrospectivos , Prevenção Secundária , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Taxa de Sobrevida , Resultado do Tratamento
20.
Eur Radiol ; 29(2): 707-715, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30054792

RESUMO

OBJECTIVES: In recognition of the significant impairment caused by haemoptysis on a patient's quality of life, bronchial artery embolisation has been introduced worldwide as one of the first-line treatment options. Since little evidence is available on the mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation (ssBACE), the purpose of the present study is to evaluate these. METHODS: We retrospectively evaluated the mechanisms of recurrent haemoptysis using both enhanced computed tomography and cineangiography following ssBACE by reviewing 299 haemoptysis-related arteries (HRAs) in 57 consecutive patients who underwent 2nd series ssBACE for the management of recurrent haemoptysis between April 2010 and December 2015. RESULTS: Median age of patients was 69 (interquartile range 64-74) years, and 43.9% were men. This study revealed that (1) recanalisation was the most common mechanism (45.2%) followed by development of new HRA (38.5%), bridging collaterals (14.7%) and conventional collaterals (1.7%); (2) these trends could be modified in several situations such as with antiplatelet or anticoagulant medications; (3) relatively large-diameter HRAs were more likely to recanalise compared with small-diameter HRAs and (4) recurrent haemoptysis could be managed by 2nd series ssBACE with a procedural success rate of 97.7% without any major complications. CONCLUSIONS: Recanalisation was the most common mechanism of recurrent haemoptysis after ssBACE. Our results provide interventionists with indispensable insights. KEY POINTS: • Recanalisation was the most common mechanism of recurrent haemoptysis after super-selective bronchial artery coil embolisation, followed by development of new haemoptysis-related arteries • These trends could be modified in several situations such as with antiplatelet or anticoagulant medications • Recurrent haemoptysis could be managed by 2nd series super-selective bronchial artery coil embolisation with a procedural success rate of 97.7% without any major complications.


Assuntos
Artérias Brônquicas , Embolização Terapêutica/métodos , Hemoptise/terapia , Idoso , Prótese Vascular/efeitos adversos , Artérias Brônquicas/diagnóstico por imagem , Circulação Colateral/fisiologia , Feminino , Hemoptise/diagnóstico por imagem , Hemoptise/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA