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1.
Medicine (Baltimore) ; 99(1): e18627, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895821

RESUMO

To study the safety and efficacy of fluoroscopic removal of self-expandable metallic stent for airway stenosis.We conducted a retrospective analysis of 67 consecutive patients, 39 male and 28 female, who underwent fluoroscopic stent removal from March 2011 to April 2017. The patients ranged in age from 12 to 85 years. Seventy-six airway stents were implanted, 70 covered stents and 6 bare stents, including 9 stents for second stent implantation after removal. All patients underwent chest computed tomography scans with/without bronchoscopy before stent removal. The indication of stent removal and postinterventional complications were analyzed retrospectively.Seventy-four of 76 airway stents were successfully removed, only 2 stent showed retained struts after removal, for a technical success rate of 97.4%. Two patients died of complications (1 hemorrhage and 1 respiratory failure), resulting in a clinical success rate of 94.7%. Five stents showed strut fracture and the remaining 71 stents were removed in 1 piece. Indications for stent removal include planned removal (n = 40), excessive granulation tissue (n = 15), intolerance of stenting (n = 6), inadequate expansion and deformation (n = 5), stent migration (n = 5), replacement of bare stent (n = 4), and strut fracture (n = 1). There were 17 complications of stent removal: death from massive bleeding (n = 1), restenosis requires stenting (n = 9), strut fracture or residue (n = 5), dyspnea requires mechanical ventilation (n = 2). The survival rates were 83.8%, 82.1%, and 82.1% for 0.5, 3, and 6 years.Fluoroscopic removal of airway stent is technically feasible and effective. Stents are recommended for removal within 3 months for treating airway stenosis.


Assuntos
Broncopatias/terapia , Remoção de Dispositivo/métodos , Radiografia Intervencionista/mortalidade , Stents , Estenose Traqueal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Remoção de Dispositivo/mortalidade , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
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
3.
Autoimmun Rev ; 18(9): 102353, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323366

RESUMO

Recent studies show that relapsing polychondritis patients with tracheobronchial involvement are distinct from others in terms of clinical characteristics, therapeutic management, and disease evolution. Tracheobronchial involvement affects 20 to 50% of patients and may reveal the disease. It should be sought at the time of diagnosis and at each follow-up visit. Respiratory impairment is confirmed by computed tomography (CT) of the chest, including the cervical portion of the trachea, with end-inspiratory and dynamic expiratory scans, and pulmonary function tests. These investigations should be performed, even in asymptomatic patients, at the time of diagnosis, and repeated as necessary during follow-up. Bronchoscopy and a fortiori endoscopic intervention should be considered with caution and performed only by expert endoscopists after careful evaluation of the risks and benefits of such procedures, which can lead to damage or perforation of the airways and bronchospasm. Early detection and management of tracheobronchial involvement in relapsing polychondritis has significantly improved the prognosis of patients, especially with the development of interventional fiberoptic bronchoscopy. However, relapsing polychondritis-related morbidity and mortality are still elevated, particularly in tracheobronchial disease.


Assuntos
Broncopatias/etiologia , Policondrite Recidivante/complicações , Doenças da Traqueia/etiologia , Broncopatias/diagnóstico , Broncopatias/mortalidade , Broncopatias/terapia , Broncoscopia/métodos , Diagnóstico Diferencial , Diagnóstico Precoce , Intervenção Médica Precoce/métodos , Humanos , Policondrite Recidivante/diagnóstico , Policondrite Recidivante/mortalidade , Policondrite Recidivante/terapia , Prognóstico , Sistema Respiratório/fisiopatologia , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/mortalidade , Doenças da Traqueia/terapia
5.
Ther Adv Respir Dis ; 13: 1753466619831966, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30795728

RESUMO

BACKGROUND: Balloon dilation is a primary treatment for nonmalignant tracheobronchial stenosis, but often requires multiple treatment sessions to maintain therapeutic efficacy. No guideline is available to suggest the appropriate maximum number of treatment sessions. This study aimed to investigate the relationship between the number of balloon dilation sessions and its long-term therapeutic effectiveness in Chinese patients with nonmalignant central airway stenosis. METHODS: A total of 111 patients with nonmalignant central airway stenosis treated with flexible bronchoscopic balloon dilation from January 2005 to September 2012 were included. The cumulative long-term effective rate was compared between any two adjacent sessions of balloon dilation treatment by McNemar's test. Multivariate Cox regression was performed to investigate the independent factors associated with long-term effectiveness. RESULTS: The cumulative long-term effective rate was significantly increased between any two adjacent sessions before the 6th session of treatment (all p < 0.05) but was no longer significantly increased after the 6th session. The stenosis diameter was larger in the patients receiving ⩽6 treatment sessions than those receiving ⩾6 treatment sessions. Multivariate Cox regression showed that the treatment session was an independent factor associated with long-term effectiveness (hazard ratio = 0.65, 95% confidence interval: 0.57-0.76, p < 0.001). CONCLUSION: These results suggest that the maximum number of treatment sessions of balloon dilation may be six, and patients requiring more treatment sessions were more likely to have delayed long-term effectiveness.


Assuntos
Obstrução das Vias Respiratórias/terapia , Broncopatias/terapia , Broncoscopia/métodos , Estenose Traqueal/terapia , Adulto , Obstrução das Vias Respiratórias/patologia , Broncopatias/patologia , China , Constrição Patológica/patologia , Constrição Patológica/terapia , Dilatação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Tempo , Estenose Traqueal/patologia , Resultado do Tratamento , Adulto Jovem
6.
J Bronchology Interv Pulmonol ; 26(2): 124-128, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30138251

RESUMO

BACKGROUND: Bronchial stenosis is a significant source of morbidity among lung transplant recipients, with etiologies including infection and ischemia of the airways. Current management with balloon bronchoplasty and stents is imperfect and a subset of patients requires multiple procedures to maintain airway patency. Mitomycin C (MMC) has been utilized for its antifibrotic properties in nonmalignant tracheobronchial stenosis but its application is not well studied in post-lung transplant stenosis. We performed this study to assess if MMC application decreases the need for repeated balloon bronchoplasty in lung transplant-related airway stenosis. METHODS: This is a retrospective cohort study of all lung transplant recipients who developed airway stenosis and who were treated with MMC over 4 years. MMC was injected submucosally into the stenotic airway. We compared the rate of bronchoscopic dilation at intervals of 3 and 6 months before and after MMC therapy. RESULTS: Eleven lung transplant recipients, with airway stenosis were included in our study, who required recurrent balloon dilation, despite airway stents in place in 73% of these patients. At 3 months after MMC treatment the median number of dilations decreased from 3 to 1 (P=0.023), and at 6 months from 3 to 2 dilations (P=0.004). There was a trend toward improvement in forced expiratory volume in one second and forced vital capacity, although it was not statistically significant. No adverse events related to MMC therapy was observed CONCLUSION:: Application of MMC is safe and is associated with a reduction in frequency of bronchoscopic balloon dilation in patients with post-lung transplant airway stenosis.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Broncopatias/terapia , Broncoscopia/métodos , Transplante de Pulmão , Mitomicina/uso terapêutico , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Estudos de Coortes , Constrição Patológica/terapia , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos , Stents
7.
BMC Pulm Med ; 18(1): 182, 2018 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-30497447

RESUMO

BACKGROUND: Metallic large Y stent placement has been used mainly for airway disease around the main carina. However, few studies have reported this treatment for bronchial disease around the primary right carina. METHODS: Twenty-eight patients were treated by small y stent. All stents were custom-designed and placed under fluoroscopic guidance. Clinical and imaging data were analyzed retrospectively. RESULTS: Thirty-one stents were successfully inserted in 28 patients. Twenty-five patients succeed at the first attempt (89.3%), and 3 patients needed a second attempt. Twelve complications occurred in 10 patients (35.7%). Stent restenosis and sputum retention were the most common complications. Five patients underwent successful stent removal due to complications or cure efficacy. During follow up, 17 patients died of tumors and one died of myocardial infarction. The 1-, 3-, and 5-year survival rates were 49.3, 19.6 and 19.6%, respectively. CONCLUSIONS: Metallic small y stent placement is technically feasible, effective and safe for bronchial disease around the primary right carina.


Assuntos
Broncopatias/terapia , Stents Metálicos Autoexpansíveis , Broncopatias/mortalidade , Causas de Morte , China , Constrição Patológica/cirurgia , Remoção de Dispositivo , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Zhonghua Jie He He Hu Xi Za Zhi ; 41(11): 857-862, 2018 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-30423628

RESUMO

Objective: To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis (TBTB). Methods: From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT (computer tomography), bronchial reconstructions and bronchoscopy. All patients underwent routine anti-tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council (mMRC) dyspnea scale and complications. Results: Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for (10±4) times, and then these patients received balloon dilatation through bronchoscope for (7±3) times subsequently. The total effective rates were 76.53% and 72.45% after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses (t=-15.012, P<0.01). The average of mMRC score changed from (3.8±0.5) before the procedure, to (1.1±0.7), (1.2±0.7) and (1.2±0.7) immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy (t=30.398-31.058, P<0.01), but not among the 3 scores after treatments. No serious complications were observed in all cases. Conclusions: Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronchial tuberculosis. A shorter course of disease indicated more benefits for patients.


Assuntos
Brônquios/patologia , Broncopatias/complicações , Broncoscópios , Crioterapia , Doenças da Traqueia/complicações , Tuberculose/complicações , Broncopatias/terapia , Broncoscopia/métodos , Cicatriz , Constrição Patológica , Dilatação , Humanos , Estenose Traqueal
10.
J Pediatr Surg ; 53(12): 2390-2393, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30227995

RESUMO

BACKGROUND/PURPOSE: Differences in clinical features between congenital pulmonary airway malformation (CPAM) and bronchial atresia (BA) have not yet been clearly described. METHODS: We retrospectively reviewed 112 patients with a pathological diagnosis of CPAM or BA. The clinical parameters were statistically analyzed between these diseases. RESULTS: Seventy-one patients received prenatal diagnosis and 41 received postnatal diagnosis. The percentage of prenatal diagnosis was significantly higher in CPAM patients (84% vs 50%, p < 0.001). Among patients with prenatal diagnosis, the backgrounds were not different between the two diseases except for the number of Caesarean sections (81% vs 9%, p < 0.0001). The numbers of patients that underwent fetal interventions and emergent neonatal surgery were higher in CPAM (51% vs 15%, p < 0.01 and 76% vs 12%, p < 0.0001), although there was no statistical difference in survival rate (86% vs 97%, p = 0.2). In patients receiving postnatal diagnosis, pneumonia was the primary symptom in most BA patients, whereas respiratory distress was the major symptom in patients with CPAM. Age at presentation of the primary symptom was significantly older in BA patients (4.2 years vs 1.2 years, p < 0.005). CONCLUSION: CPAM and BA have distinct clinical features in terms of therapeutic and natural history. Careful imaging evaluation and pathological analysis can lead to an accurate diagnosis of BA. TYPE OF STUDY: Prognostic study. LEVEL OF EVIDENCE: Level II. This study is categorized as a "Prognostic Study" with LEVEL III of Evidence.


Assuntos
Broncopatias/diagnóstico , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Broncopatias/congênito , Broncopatias/terapia , Malformação Adenomatoide Cística Congênita do Pulmão/terapia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos
11.
NPJ Prim Care Respir Med ; 28(1): 31, 2018 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-30108224

RESUMO

Exercise-induced bronchoconstriction (EIB) can occur in individuals with and without asthma, and is prevalent among athletes of all levels. In patients with asthma, symptoms of EIB significantly increase the proportion reporting feelings of fearfulness, frustration, isolation, depression and embarrassment compared with those without symptoms. EIB can also prevent patients with asthma from participating in exercise and negatively impact their quality of life. Diagnosis of EIB is based on symptoms and spirometry or bronchial provocation tests; owing to low awareness of EIB and lack of simple, standardised diagnostic methods, under-diagnosis and mis-diagnosis of EIB are common. To improve the rates of diagnosis of EIB in primary care, validated and widely accepted symptom-based questionnaires are needed that can accurately replicate the current diagnostic standards (forced expiratory volume in 1 s reductions observed following exercise or bronchoprovocation challenge) in patients with and without asthma. In patients without asthma, EIB can be managed by various non-pharmacological methods and the use of pre-exercise short-acting ß2-agonists (SABAs). In patients with asthma, EIB is often associated with poor asthma control but can also occur in individuals who have good control when not exercising. Inhaled corticosteroids are recommended when asthma control is suboptimal; however, pre-exercise SABAs are also widely used and are recommended as the first-line therapy. This review describes the burden, key features, diagnosis and current treatment approaches for EIB in patients with and without asthma and serves as a call to action for family physicians to be aware of EIB and consider it as a potential diagnosis.


Assuntos
Broncopatias/etiologia , Exercício , Adolescente , Asma/complicações , Asma/etiologia , Broncopatias/diagnóstico , Broncopatias/epidemiologia , Broncopatias/terapia , Criança , Constrição Patológica , Feminino , Humanos , Masculino
12.
Thorac Surg Clin ; 28(3): 365-375, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30054074

RESUMO

Airway complication (AC) after lung transplant, although rare nowadays, leads to increased costs, greater morbidity, and decreased quality of life of patients. Over the years, many risk factors have been described, ranging from surgical technique to immunosuppressive regimen. There are essentially 6 major airway complications (necrosis/dehiscence, infection, bronchial stenosis, granulomas, tracheo-bronchomalacia, and fistula) all of which require a multidisciplinary approach based on the performance status of patients. In this article, the authors review the risk factors, clinical presentation, diagnosis methods, and management options in the most common AC after lung transplantation.


Assuntos
Broncopatias/etiologia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Anastomose Cirúrgica/efeitos adversos , Brônquios/cirurgia , Broncopatias/diagnóstico , Broncopatias/terapia , Broncomalácia/etiologia , Broncoscopia , Constrição Patológica/etiologia , Feminino , Granuloma/etiologia , Humanos , Masculino , Necrose/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Qualidade de Vida , Fístula do Sistema Respiratório/etiologia , Infecções Respiratórias/etiologia , Fatores de Risco
13.
Cardiovasc Intervent Radiol ; 41(8): 1267-1273, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29687263

RESUMO

PURPOSE: This study aimed to demonstrate a transcatheter embolization strategy for bronchial artery aneurysms (BAAs) using coils for the proximal lesion and glue (n-butyl-2-cyanoacrylate [NBCA]) embolization for the distal lesion with or without the use of a microballoon occlusion catheter. MATERIALS AND METHODS: Five patients with BAAs presenting with hemoptysis were enrolled in this study. A bronchial angiogram indicated a mediastinal BAA near the orifice, accompanied by dilated distal branches with or without intrapulmonary BAA. A stepwise procedure was performed. First, the intrapulmonary branches were embolized with glue, with or without the use of a microballoon catheter depending upon the anatomical and local flow hemodynamic conditions. Second, the mediastinal BAA was tightly packed with detachable coils. RESULTS: Glue embolization of intrapulmonary abnormal branches successfully controlled hemoptysis in all patients; microballoon catheters were used in five of the 10 arteries. The volume embolization ratio of coils within the mediastinal BAA ranged from 28 to 59%, and neither coil compaction nor signs of recanalization were observed during follow-up. CONCLUSION: The stepwise embolization procedure with the sequential use of glue (with or without a microballoon occlusion system) and detachable coils may represent a possible endovascular strategy for the treatment of complex BAAs. LEVEL OF EVIDENCE IV: Level 4: Case Series.


Assuntos
Aneurisma/terapia , Oclusão com Balão/métodos , Artérias Brônquicas/fisiopatologia , Broncopatias/terapia , Embolização Terapêutica/métodos , Adesivos , Idoso , Artérias Brônquicas/diagnóstico por imagem , Broncopatias/diagnóstico por imagem , Embucrilato/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
15.
Thorac Surg Clin ; 28(2): 155-161, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29627049

RESUMO

Granulomatous diseases of the airway are challenging lesions to diagnose and effectively manage not only because they are uncommon but also because they can occur in different forms, each with unique clinical and radiological characteristics. Most such lesions can be effectively managed conservatively with repeated airway dilatation, use of intraluminal stents, and specific antimicrobial treatment. The only exception is those lesions presenting with localized airway obstruction wherein surgical resection may be indicated and beneficial.


Assuntos
Granulomatose com Poliangiite , Histoplasmose , Doenças Respiratórias , Tuberculose , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/terapia , Broncopatias/diagnóstico , Broncopatias/terapia , Granuloma/diagnóstico , Granuloma/terapia , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/terapia , Histoplasmose/diagnóstico , Histoplasmose/terapia , Humanos , Síndrome do Lobo Médio/diagnóstico , Síndrome do Lobo Médio/terapia , Sistema Respiratório/patologia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/terapia , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/terapia , Stents , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/terapia , Tuberculose/diagnóstico , Tuberculose/terapia , Tuberculose dos Linfonodos
16.
Thorac Surg Clin ; 28(2): 243-247, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29627058

RESUMO

Modern thoracic surgery requires knowledge and skill in advanced bronchoscopic techniques. Rigid bronchoscopy remains a workhorse for the management of central airway obstruction. Dilation of tracheal strictures is now much simpler with the advent of the balloon dilator, which can be passed through a therapeutic bronchoscope. Numerous adjuncts, such as laser, argon beam coagulation, electrocautery, and cryotherapy, can be used to improve airway patency. There are now numerous stenting options for strictures that require stenting to maintain airway patency.


Assuntos
Obstrução das Vias Respiratórias/terapia , Broncopatias/terapia , Doenças da Traqueia/terapia , Técnicas de Ablação , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Broncopatias/diagnóstico , Broncopatias/etiologia , Broncoscopia/métodos , Dilatação , Humanos , Stents , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/etiologia
17.
J Stroke Cerebrovasc Dis ; 27(8): e153-e155, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29571759

RESUMO

Bronchial artery embolization (BAE) is an effective treatment for massive hemoptysis. Stroke is a rare complication of BAE, with only a few cases reported in the literature. We report one such case. Posterior circulation strokes after BAE can be caused by connections between the vertebral arteries and the bronchial arteries (shunting between pulmonary and systemic circulations), backflow of embolization material from the bronchial or intercostal arteries to the subclavian artery or through backflow of emblospheres into the aortic lumen leading to subsequent embolization of the cerebral circulation. New-onset focal neurologic signs, change in mental status, or delay in recovery from anesthesia after BAE warrants brain imaging to rule out a stroke. Our case had a poor outcome, unlike the majority of previously reported cases.


Assuntos
Embolização Terapêutica/efeitos adversos , Acidente Vascular Cerebral/etiologia , Idoso , Encéfalo/diagnóstico por imagem , Artérias Brônquicas , Broncopatias/complicações , Broncopatias/terapia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/terapia , Feminino , Humanos , Acidente Vascular Cerebral/diagnóstico por imagem
18.
Cardiovasc Intervent Radiol ; 41(5): 811-815, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29344717

RESUMO

An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.


Assuntos
Aneurisma/terapia , Broncopatias/terapia , Embolização Terapêutica/métodos , Embucrilato/uso terapêutico , Hemangioma/terapia , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Broncopatias/complicações , Broncopatias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Humanos , Óleo Iodado/uso terapêutico , Masculino , Pessoa de Meia-Idade
19.
Semin Respir Crit Care Med ; 39(6): 674-684, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30641585

RESUMO

Rigid bronchoscopy is one of the oldest medical techniques used in the respiratory and thoracic fields. Even though its use declined after the development of flexible bronchoscopy, it has again gained importance with the growth of interventional pulmonology, becoming a critical technique taught as part of the training in this subspecialty. The therapeutic advantages compared to other approaches of thoracic pathologies makes rigid bronchoscopy a primary component in the present and future of interventional pulmonary medicine.


Assuntos
Obstrução das Vias Respiratórias/terapia , Broncopatias/terapia , Broncoscopia/instrumentação , Broncoscópios , Broncoscopia/história , Broncoscopia/métodos , Desenho de Equipamento , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Resultado do Tratamento
20.
In. Reichenbach, Juan Alberto. La hora de oro en pediatría. La Plata, Femeba, 2018. p.177-188.
Monografia em Espanhol | LILACS | ID: biblio-1052552

RESUMO

En la Provincia de Bs.As. la tasa de mortalidad específca por IRA ha disminuido entre los años 2001 y 2010 de 7,1 a 4,4 casos por 10.000 nacidos; siendo un rasgo distintivo el aumento de la mortalidad domiciliaria en el menor de 1 año, situación que se viene registrando desde 2007. Se presenta una situación clínica junto al Flujograma de decisión terapéutica según puntaje clínico en el menor de distintas edades para el síndrome bronquial obstructivo, como también el tratamiento


Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Broncopatias/terapia , Bronquiolite , Doenças do Recém-Nascido
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