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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 228-233, 2020 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-32164094

RESUMO

Objective: To evaluate the value of transbronchial lung cryobiopsy (TBCB) in pathological diagnosis for diffuse lung disease. Methods: The clinicopathological data of 173 patients from the first affiliated hospital of Guangzhou medical university between Jaunary 2017 and June 2019 with transbronchial lung cryobiopsy of diffuse lung disease were retrospectively analyzed and summarized with review. Among 173 cases, TBCB and conventional transbronchial lung biopsy (TBLB) were performed in 54 patients. The size of biopsy samples and diagnostic yield were compared. Results: Among 173 cases, the diagnostic yield was 85.54% (148/173) , 160 (92.49%) cases provided definite diagnosis and valuable pathological results, according to age, sex, occupation, past history, contact history, smoking history, laboratory serology and imaging findings. Among 160 cases, there were 72 cases of known etiology (45.00%), 27 cases of idiopathic interstitial pneumonia (16.88%), 7 cases of granulomatous lesions (4.38%) and 54 cases of other types (33.75%). With TBCB and TBLB in 54 patients, the specimens sizes of TBCB and TBLB were (3.3±1.3) mm(2) and (1.0±0.3) mm(2) respectively (t'=12.67 P<0.01) . The diagnostic yields of TBCB and TBLB were 81.48% (44/54) and 42.59% (23/54) respectively (χ(2)=17.33, P<0.01) . The diagnostic yields of TBCB and TBLB for interstitial lung diseases were 48.15% (26/54) and 5.56% (3/54) respectively (χ(2)=24.94, P<0.01) . However, the diagnostic yields of TBCB and TBLB for the other diffuse lung disease except interstitial lung diseases were 33.33% (18/54) and 37.04% (20/54) respectively, with no significant difference (χ(2)=0.1624, P=0.687). Conclusion: Compared with TBLB, TBCB has obvious advantages and application value in the diagnosis of diffuse pulmonary diseases, especially interstitial pulmonary diseases.


Assuntos
Broncoscopia/métodos , Doenças Pulmonares Intersticiais/diagnóstico , Pneumopatias/diagnóstico , Pulmão/patologia , Biópsia , Criopreservação , Humanos , Pneumopatias/patologia , Doenças Pulmonares Intersticiais/patologia , Estudos Retrospectivos
2.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 199-202, 2020 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-32164088

RESUMO

Infection with 2019 Novel Coronavirus (2019-nCoV) is mainly transmitted by respiratory droplets, airborne transmission and direct contact. However, conducting bronchoscopy on patients with 2019-nCoV is a high-risk procedure in which health care workers are directly exposed to the virus, and the protection and operation procedures need to be strictly regulated. According to the characteristics of bronchoscopy, it is necessary to formulate the procedure, requirements and precautions when conducting bronchoscopy in the current epidemic situation. Relevant standards for preventing from infections should be strictly implemented in the operation of bronchoscopy. It needs to emphasize that bronchoscopy should not be used as a routine means for the diagnosis of 2019-nCoV infection sampling. The indications for bronchoscopy for other diseases should be strictly mastered, and it is suggested that bronchoscopy should be postponed for those patients who is not in urgent situation.


Assuntos
Betacoronavirus , Broncoscopia/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Betacoronavirus/patogenicidade , Broncoscopia/normas , Consenso , Infecções por Coronavirus/transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto
3.
Medicine (Baltimore) ; 99(11): e19488, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176086

RESUMO

INTRODUCTION: Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. PATIENT CONCERNS: The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress. DIAGNOSIS: A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular. INTERVENTIONS: To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support. OUTCOMES: We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged. CONCLUSION: ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias da Traqueia/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Broncoscopia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Oxigenação por Membrana Extracorpórea , Fazendeiros , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/secundário , Neoplasias da Traqueia/cirurgia
4.
Medicine (Baltimore) ; 99(5): e18936, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000409

RESUMO

Bronchoscopic lung volume reduction (BLVR) offers alternative novel treatments for patients with emphysema. Comprehensive evidence for comparing different BLVR remains unclear. To estimate the effects of different BLVR on patients with emphysema. PubMed, EMBASE, Cochrane Library, and Web of Science databases from January 2001 to August 2017 were searched. Randomized clinical trials evaluated effects of BLVR on patients with emphysema. The relevant information was extracted from the published reports with a predefined data extraction sheet, and the risk of bias was assessed with the Cochrane risk of bias tools. Pair-wise metaanalyses were made using the random-effects model. A random-effects network meta-analysis was applied within a Bayesian framework. The quality of evidence contributing to primary outcomes was assessed using the GRADE framework. 13 trials were deemed eligible, including 1993 participants. The quality of evidence was rated as moderate in most comparisons. Medical care (MC)was associated with the lowest adverse events compared with intrabronchial valve (IBV)(-2.5,[-4.70 to -0.29]), endobronchial valve (EBV) (-1.73, [-2.37 to -1.09]), lung volume reduction coils (LVRC) (-0.76, [-1.24 to -0.28]), emphysematous lung sealant (ELS) (-1.53, [-2.66 to -0.39]), and airway bypass(-1.57, [-3.74 to 0.61]). Adverse events in LVRC were lower compared with ELS (-0.77,[-2.00 to 0.47]). Bronchoscopic thermal vapor ablation (BTVA) showed significant improvement in FEV1 compared with MC (0.99, [0.37 to 1.62]), IBV (1.25, [0.25 to 2.25]), and LVRC (0.72, [0.03 to 1.40] ). Six  minute walking distance (6 MWD) in ELS was significantly improved compared with other four BLVR, sham control, and MC (-1.96 to 1.99). Interestingly, MC showed less improvement in FEV1 and 6MWDcompared with EBV (-0.45, [-0.69 to -0.20] and -0.39, [-0.71 to -0.07], respectively). The mortality in MC and EBV was lower compared with LVRC alone (-0.38, [-1.16 to 0.41] and -0.50, [-1.68 to 0.68], respectively). BTVA and EBV led to significant changes in St George's respiratory questionnaire (SGRQ) compared with MC alone (-0.74, [-1.43 to -0.05] and 0.44, [0.11 to 0.78], respectively). BLVR offered a clear advantage for patients with emphysema. EBV had noticeable beneficial effects on the improvement of forced expiratory volume 1, 6MWD and SGRQ, and was associated with lower mortality compared with MC in different strategies of BLVR.


Assuntos
Broncoscopia , Enfisema Pulmonar/terapia , Broncoscopia/métodos , Humanos , Meta-Análise em Rede
5.
Medicine (Baltimore) ; 99(3): e18628, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011442

RESUMO

Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.


Assuntos
Sistema Nervoso Central/lesões , Intubação Intratraqueal/efeitos adversos , Laringoestenose/etiologia , Laringoestenose/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Broncoscopia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
7.
Niger J Clin Pract ; 23(1): 120-122, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929218

RESUMO

We present a very rare case of Sevoflurane Induced Diffuse Alveolar Haemorrhage in a young male patient with a closed tibial fracture after direct trauma to the right cruris. The patient was operated for tibial fracture, but diffuse alveolar haemorrhage developed after sevoflurane inhalation in the postoperative period following general anesthesia. Diffuse alveolar haemorrhage (DAH) is associated with inhalation injury from halogenated gases and reported as a unique entity in the literature that practicing clinicians should be aware of and consider in post-operative cases of acute respiratory distress. As DAH usually presents with symptoms the presence of hemoptysis, anemia, dyspnoea and radiological alveolar infiltrates, rapid detection of the aetiology and initiation of cause-directed treatment are of great importance on survival.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Hemoptise/induzido quimicamente , Hemorragia/induzido quimicamente , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Alvéolos Pulmonares/diagnóstico por imagem , Sevoflurano/farmacologia , Fraturas da Tíbia/cirurgia , Adulto , Anestesia Geral , Broncoscopia , Hemoptise/terapia , Humanos , Masculino , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Alvéolos Pulmonares/patologia , Tomógrafos Computadorizados , Resultado do Tratamento
8.
Pathologe ; 41(1): 32-38, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31989234

RESUMO

BACKGROUND: In addition to histological examinations, cytological samples are also being evaluated with increasing frequency for the diagnosis of lung carcinoma. OBJECTIVES: Possible applications of and techniques for cytological examinations are presented. Typical morphologies of primary lung cancer and metastatic disease are shown. MATERIAL AND METHODS: Samples were obtained during bronchoscopy, serous effusion fluid, and fine-needle aspiration cytology. Special technical features of the cytological samples are discussed. Cytomorphology of pulmonary adenocarcinoma, squamous-cell carcinoma, and small-cell lung carcinoma are shown. RESULTS: There are clear-cut diagnostic criteria for the main subtypes of primary lung carcinoma. CONCLUSIONS: Cytological examination is a valuable addition to histology for lung carcinoma diagnostics.


Assuntos
Neoplasias Pulmonares/patologia , Biópsia por Agulha Fina , Broncoscopia , Citodiagnóstico , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Sensibilidade e Especificidade
11.
Acta Cytol ; 64(1-2): 16-29, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30878997

RESUMO

Pulmonary cytology is a challenging diagnostic tool, and it is usually evaluated considering medical history and radiological findings in order to reach an accurate diagnosis. Since the majority of lung cancer patients have an advanced stage at diagnosis, a cytological specimen is frequently the only material available for diagnosis and further prognostic/predictive marker determination. Several types of specimens can be obtained from the respiratory system (including sputum, bronchoalveolar lavage, bronchial brushing, fine needle aspiration, and pleural fluid) with different technical preclinical management protocols and different diagnostic yields. Immunocytochemistry (ICC) has a pivotal role in the determination of diagnostic, prognostic, and predictive markers. Therefore, limited cytology samples are to be used with a cell-sparing approach, to allow both diagnostic ICC evaluation as well as predictive marker assessment by ICC or specific molecular assays. In this review, we describe the most common ICC markers used for the diagnosis and prognostic/predictive characterization of thoracic tumors in different cytological specimens.


Assuntos
Biomarcadores Tumorais/metabolismo , Citodiagnóstico/métodos , Imuno-Histoquímica/métodos , Neoplasias Pulmonares/metabolismo , Pulmão/metabolismo , Biópsia por Agulha Fina/métodos , Lavagem Broncoalveolar/métodos , Broncoscopia/métodos , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Escarro/metabolismo
12.
Int J Cancer ; 146(3): 781-790, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30977121

RESUMO

Bronchoscopy is the safest procedure for lung cancer diagnosis when an invasive evaluation is required after imaging procedures. However, its sensitivity is relatively low, especially for small and peripheral lesions. We assessed benefits and costs of introducing a bronchial gene-expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete-event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (i) location-based strategy-integrated the BGC to the bronchoscopy indication; (ii) simplified strategy-extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality-adjusted-life-years (QALYs), costs and incremental cost-effectiveness ratios. Compared to the standard practice, the location-based strategy (i) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (ii) reduced absolute rate of invasive procedures by 10% and improved quality-adjusted life expectancy, producing an incremental cost-effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location-based is cost-saving if the price of classifier declines.


Assuntos
Análise Custo-Benefício , Detecção Precoce de Câncer/normas , Neoplasias Pulmonares/diagnóstico , Idoso , Biomarcadores Tumorais/genética , Biópsia/efeitos adversos , Biópsia/economia , Biópsia/normas , Brônquios/diagnóstico por imagem , Brônquios/patologia , Broncoscopia/efeitos adversos , Broncoscopia/economia , Broncoscopia/normas , Simulação por Computador , Redução de Custos , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Perfilação da Expressão Gênica/economia , Perfilação da Expressão Gênica/normas , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , Padrão de Cuidado/economia , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/normas
13.
Medicine (Baltimore) ; 98(49): e18288, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804372

RESUMO

RATIONALE: The patient in this case report has been diagnosed with multidrug resistant lymph node fistula tracheobronchial tuberculosis (TBTB). The PubMed was searched using the keywords "Tuberculosis, Multidrug-Resistant", "Tuberculosis", and "Bronchial Fistula", and the results yielded no similar case reports. Therefore, this report helps us to explore more on the causes of multidrug resistance and formation of lymph node fistula, as well as associated treatment strategies. PATIENT CONCERNS: A 15-year old Tibetan girl who was previously treated in the local Hospital for Infectious Diseases for repeated TBTB demonstrated poor treatment outcomes, and so was further diagnosed in our hospital. After standard treatments, the cough and expectoration of the girl showed improvement, and mycobacterium culture showed negative results. Thoracic CT showed local compression of the right bronchus, and disappearance of stenosis. Bronchoscopy showed that the fistula was closed and healed. DIAGNOSES: Multidrug resistant lymph node fistula TBTB. INTERVENTIONS: Antituberculosis drugs such as pyrazinamide (0.75 g/time, twice per day), moxifloxacin (0.4 g per day), protionamide enteric-coated tablets (0.2 g/time, 3 times per day), pasiniazide tablets (0.3 g/time, 3 times per day), and capreomycin (0.75 g per day) were orally administered. The treatment included an 8-month intensive treatment phase and a 12-month consolidation phase. Bronchoscopic local injection combined with cryotherapy was also conducted. OUTCOMES: Bronchoscopy showed that the fistula was closed and healed, mycobacterium culture showed negative results, and thoracic CT showed local compression of the right bronchus, disappearance of stenosis after treatment. LESSONS: (1) This girl had a history of long-term oral intake of antituberculosis drugs, but the treatment effectiveness remained poor. Therefore, resistance to tuberculosis can be considered, and also mycobacterium culture and drug sensitivity tests should be considered. After these, the treatment strategies should be adjusted accordingly.(2) TBTB should be further classified by analyzing under the bronchoscope to decide the best treatment strategy accordingly.


Assuntos
Antituberculosos/uso terapêutico , Broncopatias/tratamento farmacológico , Fístula/tratamento farmacológico , Doenças da Traqueia/tratamento farmacológico , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Broncopatias/microbiologia , Broncoscopia , Quimioterapia Combinada , Feminino , Fístula/microbiologia , Humanos , Tibet , Tomografia Computadorizada por Raios X , Doenças da Traqueia/microbiologia
16.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(12): 888-894, 2019 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-31826531

RESUMO

Objective: To evaluate the diagnostic value of thin-slice CT navigation combined with radial endobronchial ultrasound in peripheral lung lesions. Methods: The clinical data of patients with peripheral lung lesions diagnosed by thin-slice CT navigation combined with radial endobronchial ultrasound in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from November 2015 to August 2018 were retrospectively analyzed. The success rate of thin-slice CT for guiding radial endobronchial ultrasound was statistically analyzed, and the diagnostic rate, sensitivity and specificity of thin-slice CT combined with radial endobronchial ultrasound were analyzed. Results: 140 consecutive patients with 145 lesions were included, 139 lesions in 136 patients were found by thin-layer CT guidance, the success rate was 95.9%; 137 lesions in 135 patients were examined by histology and/or cytology, and 106 lesions were finally diagnosed, the diagnostic rate was 77.37%; and the diagnosis sensitivity and specificity was 88.45% and 99.96%. Histological and cytological diagnostic rate, sensitivity and specificity was 72.18% versus 63.50%, 70.58% versus 66.85%, 100% versus 88.23%, respectively. Factors influencing the diagnostic rate of thin-slice CT navigation combined with radial endobronchial ultrasound include the relationship between the lesion and the target bronchus, the location of the probe and the lesion, and the size of the lesion, and the difference between the farthest generation of bronchoscopy insertion and the bronchial generation of lesions. Five patients had mild bleeding and one ultrasonic probe was damaged. Conclusion: Thin-slice CT has a higher positive rate in guiding peripheral lung lesions with radial ultrasound, and this method has a higher diagnostic value for peripheral lung lesions.


Assuntos
Endossonografia/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Broncoscopia/métodos , China , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
Zhonghua Yi Xue Za Zhi ; 99(46): 3617-3621, 2019 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-31826582

RESUMO

Objective: To summarize the clinical characteristics of pulmonary actinomycosis and analyze its diagnostic methods. Methods: The clinical symptoms, underlying diseases, imaging characteristics, preliminary diagnosis, diagnostic methods, treatment and prognosis of 30 patients with pulmonary actinomycetes admitted into the First Affiliated Hospital of Zhejiang University School of Medicine during the 10 years (January 2007 to November 2017) were retrospectively analyzed. Results: The 30 patients with pulmonary actinomycetes included were from 47 to 81 years old, with an average age of (59.5±7.8) years, with a course of disease from 5 days to 48 months, and a median course of disease of 1.5 months; 18 patients (60.0%) were complicated with underlying diseases, 10 patients (33.3%) had a history of smoking, 10 patients (33.3%) had a history of alcohol abuse. The main clinical manifestations were cough in 29 cases (96.7%), followed by sputum in 22 cases (73.3%), hemoptysis in 20 cases (66.7%), fever in 12 cases (40.0%), chest pain in 5 cases (16.7%) and shortness of breath in 3 cases (10.0%). Mass, nodules, consolidation, atelectasis can be seen by imaging, there can be a low-density lesion necrosis, formation of voids or vacuoles. Among the 25 patients (83.3%) who underwent bronchoscopy, 14 cases were abnormal, 5 cases showed endotracheal polypoid neoplasms, 9 cases showed endotracheal mucosal inflammatory changes, 2 cases of them showed bronchial foreign body, and 1 case showed broncholithiasis. All cases were diagnosed by pathology. Nine cases (30.0%) were confirmed by bronchoscopic biopsy. Two cases (6.7%) underwent CT-guided percutaneous lung biopsy, 18 cases (60.0%) underwent surgical resection of pathology, and 1 case (3.3%) was diagnosed by puncture of chest wall mass. Sufficient dose and course of penicillin were effective. Surgical excision of the lesion with antibiotics for 2-4 weeks was effective. Conclusion: The clinical manifestation of pulmonary actinomycosis is lack of specificity, obtaining positive pathological specimens is the key to the diagnosis of this disease, the first choice is bronchoscopy and percutaneous lung biopsy.


Assuntos
Actinomicose , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Broncoscopia , Humanos , Pulmão , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
BMC Infect Dis ; 19(1): 1045, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823740

RESUMO

BACKGROUND: An increased number of refractory mycoplasma pneumoniae (MP) pneumonia (MPP) cases have been reported. However the duration of MP infection in lower airway and the course of anti-MP treatment remains unclear. METHODS: We retrospectively reviewed the medical records of 94 MPP children. Patients were classified into two groups. The long-term group (Group LT) was defined as bronchoalveolar lavage fluid (BALF) remained MP-positive by PCR after 30 days of the disease course. The non-long-term group (Group NLT) was defined as BALF became MP-negative by PCR within 30 days of disease and patients who only needed one bronchoscopy lavage therapy. MP loads, clinical outcomes were analyzed along with other clinical measurements. RESULTS: The average levels of inflammatory markers such as C reactive protein and lactate dehydrogenase in Group LT were significantly higher than those in Group NLT. Airway and lung damage in Group LT were more severe than Group NLT. 28 patients developed necrotizing pneumonia and 8 patients developed pulmonary embolism in Group LT. Mean maximum MP loads in BALF were 107.46 ± 0.93 and 104.86 ± 0.93 in Groups LT and NLT, respectively. There was persistent MP DNA in Group LT, even lasted for 120 days. One severe MPP patient in Group LT had MP-associated bloodstream infection. After 3 months of follow-up, chest imaging revealed incomplete absorption of pulmonary consolidation in 33 patients of Group LT [including 13 airway obliterans (AO) patients] and in 7 patients of Group NLT (including 2 AO patients). CONCLUSION: MP loads of BALF were associated with the subsequent duration of MP DNA in lower airway. High MP loads and persistent long-term MP DNA in lower airway were associated with severity of pediatric MPP.


Assuntos
DNA Bacteriano/metabolismo , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Pulmão/microbiologia , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
Medicine (Baltimore) ; 98(50): e18262, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852095

RESUMO

INTRODUCTION: Attaining lung isolation in the infant is a challenge for anesthesia care providers. Pulmonary lobe isolation is more challenging. We describe an approach to performing selective pulmonary lobe isolation using the pediatric endobronchial blocker in an infant in the absence of appropriate auxiliary guidance tool. PATIENT CONCERNS: An 8-month-old and 9.5 kg male infant was admitted because of repeated cough with fever for 3 months and a large cyst of his right lung for 2 weeks. He had been living in a pastoral area with his parents. DIAGNOSIS: Based on the chest computed tomography (CT) and his history about long-term residence in the pastoral area, this patient's diagnosis was considered as right middle lobe hydatid cyst. INTERVENTIONS: Guided by a fiberoptic bronchoscope, a cuffed 4.0-mm inside diameter (ID) endotracheal tube was successfully placed into the right main bronchus of this infant. Then, pediatric 5-French (Fr) endobronchial blocker was placed into the right middle and lower lobes through the endotracheal tube without navigation of fiberoptic bronchoscope. OUTCOMES: Lobe isolation was successfully achieved for right middle lobectomy. This approach allows clinicians to perform lobe isolation in the absence of fiberoptic bronchoscope with very small outer diameter. CONCLUSION: This technique is relatively easy to use and less dependent on equipment with small outer diameter in the selective pulmonary lobe isolation in infants and small children.


Assuntos
Anestesia/métodos , Broncoscopia/métodos , Cistos/cirurgia , Intubação Intratraqueal/instrumentação , Pneumopatias/cirurgia , Pneumonectomia/métodos , Respiração Artificial/métodos , Cistos/diagnóstico , Desenho de Equipamento , Tecnologia de Fibra Óptica , Humanos , Lactente , Pneumopatias/diagnóstico , Masculino , Tomografia Computadorizada por Raios X
20.
BMC Infect Dis ; 19(1): 1060, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847817

RESUMO

BACKGROUND: To enhance awareness of the clinical features and prevention of endotracheal myiasis. CASE PRESENTATION: A case of intratracheal myiasis is reported. A 61-year-old male patient with a history of laryngectomy was admitted to hospital due to tracheostomal hemorrhage of 3 h duration. Intratracheal myiasis was confirmed by bronchoscopy, and the patient underwent bronchoscopic intervention, which was complicated by a tracheal-esophageal fistula and resolved by endotracheal stenting. Twenty months after stent placement, the fistula had not healed. CONCLUSION: Intratracheal myiasis has serious complications and is difficult to treat. For post-tracheostomy patients, healthcare providers and caregivers should pay attention to the care and monitoring of wounds and maintenance of a tidy, clean living environment to prevent intratracheal myiasis.


Assuntos
Eletrocoagulação/efeitos adversos , Miíase/cirurgia , Fístula Traqueoesofágica/etiologia , Animais , Broncoscopia , Cânula/parasitologia , Carcinoma de Células Escamosas/cirurgia , Seguimentos , Humanos , Larva , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Miíase/etiologia , Stents , Traqueia/parasitologia , Fístula Traqueoesofágica/terapia , Traqueostomia/efeitos adversos , Resultado do Tratamento
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