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1.
Medicine (Baltimore) ; 99(28): e20930, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664089

RESUMO

Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA).Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months.A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn't significant between initial and final MDD (Z = -1.414, P = .157).Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.


Assuntos
Broncoscopia/métodos , Pneumonias Intersticiais Idiopáticas/classificação , Pneumonias Intersticiais Idiopáticas/patologia , Biópsia Guiada por Imagem/métodos , Idoso , Biópsia/tendências , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/efeitos adversos , Broncoscopia/tendências , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Pneumonias Intersticiais Idiopáticas/diagnóstico por imagem , Pneumonias Intersticiais Idiopáticas/tratamento farmacológico , Fibrose Pulmonar Idiopática/patologia , Comunicação Interdisciplinar , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X/métodos
2.
Arch Bronconeumol ; 56 Suppl 2: 19-26, 2020 07.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32362384

RESUMO

This consensus document has been drawn up by the Techniques and Transplantation and Nursing areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Respiratory Endoscopy (AEER) with the aim of providing information on the safe and effective use of bronchoscopy in patients with suspected or confirmed COVID-19 infection. Our priority is to ensure the safety of our patients, the health workers caring for them, and the community in general. At this stage in the pandemic, our information on the use of bronchoscopy in patients of this type is based on the experience of hospitals in other countries, and scientific publications are scarce. The objective of this document is to compile these experiences, based on recommendations from official agencies, in a document offering guidance in daily clinical practice.


Assuntos
Betacoronavirus , Broncoscopia/métodos , Consenso , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Broncoscópios/normas , Broncoscopia/efeitos adversos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Desinfecção/métodos , Pessoal de Saúde , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Roupa de Proteção/normas , Pneumologia , Sociedades Médicas , Espanha , Manejo de Espécimes/métodos
4.
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
5.
Med Sci Monit ; 25: 9721-9727, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31852880

RESUMO

BACKGROUND The aim of this study was to analyze the diagnostic value of thin bronchoscopy lung biopsy for peripheral pulmonary lesions under non-real-time guidance of radial ultrasound (RP-EBUS). MATERIAL AND METHODS We used a retrospective analysis of ultrasound images of 165 patients with peripheral pulmonary disease admitted to Suzhou Municipal Hospital Affiliated to Nanjing Medical University from February 2016 to December 2018 who were given RP-EBUS examination. Ultrasound images were obtained for all patients. There were 76 patients treated using traditional positioning method as the control group; 89 patients were treated by probe combined with bronchoscopy positioning method as the research group where the biopsy of the lesion along the path of the ultrasound probe was taken. The positive rate of the 2 methods was observed, and the factors affecting the quality of ultra-thin bronchoscopy under RP-EBUS non-real-time guidance were analyzed. RESULTS The detection rate of the study group was 77.64%, which was significantly higher than that in control group, which was 63.16% (χ²=5.238, P<0.05). The number of biopsies in the study group was 6±1.25, which was significantly lower than that of the control group which was 9±1.87 (t=4.116, P<0.05). The diagnostic positive rate of the RP-EBUS probe was significantly higher than that of the RP-EBUS probe (χ²=5.081, P<0.05). CONCLUSIONS The diagnostic positive rate of RP-EBUS non-real-time guided subtotal bronchoscopy lung biopsy for peripheral lung disease using probe combined with bronchoscopy positioning method was higher than the traditional positioning method, and the number of biopsies in the study group was significantly lower than that in the control group, which was related to the size, location, whether the probe was wrapped, or the characteristics of the ultrasound image.


Assuntos
Broncoscopia , Endossonografia , Pneumopatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Broncoscopia/efeitos adversos , Endossonografia/efeitos adversos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade
6.
Rev. patol. respir ; 22(4): 178-180, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189008

RESUMO

La hemoptisis puede representar una situación de riesgo vital que requiere de un inmediato diagnóstico y tratamiento con una gran variedad de causas subyacentes. Se recomienda una rápida intervención mediante fibrobroncoscopia para localizar e intentar controlar el sangrado. En los casos en los que no se puede controlar el sangrado, la embolización de las arterias bronquiales (EAB) es un tratamiento no quirúrgico seguro y efectivo para los pacientes con una hemoptisis masiva. Se han descrito complicaciones asociadas a la EAB, siendo la isquemia de la médula espinal la más grave. Informamos del caso de un paciente con hemoptisis masiva en contexto de una neumonía necrotizante, en el que se realizó una EAB tras no conseguir controlar el sangrado mediante fibrobroncoscopia


Hemoptysis may represent a life-threatening situation requiring immediate diagnosis and therapy and it can have a variety of underlying causes. It is recommended an early investigation with bronchoscopy for localization and control of bleeding. In those cases with non-controlled bleeding, bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. Complications of BAE have been reported, being spinal cord ischemia the most dangerous one. We report a case of a patient with massive hemoptysis in the context of necrotizing pneumonia, in whom a BAE was performed after an unsuccessful control of bleeding by bronchoscopy


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal/etiologia , Infarto/etiologia , Nefropatias/etiologia , Esplenopatias/etiologia , Hemoptise/terapia , Hemoptise/etiologia , Pneumonia Necrosante/terapia , Pneumonia Necrosante/complicações , Embolização Terapêutica , Doenças da Medula Espinal/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Infarto/diagnóstico por imagem , Broncoscopia/efeitos adversos , Tomografia Computadorizada por Raios X
7.
J Vet Intern Med ; 33(6): 2718-2724, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31663636

RESUMO

An 8-year-old 24.6 kg mixed breed dog underwent bronchoscopy for evaluation of a persistent progressive cough. Bronchoscopy documented a markedly thick and irregular, cobblestone appearance of the mucosa. A bronchoscopic biopsy was obtained; immediately after the biopsy, a large amount of hemorrhage poured from the endotracheal tube. Multiple efforts to control the hemorrhage were unsuccessful and the dog suffered a cardiopulmonary arrest and could not be revived. A necropsy was performed, which was significant for pallor, evidence of prior heartworm disease, prominent bronchial arteries, and erosion of the submucosal vessels at the site of the biopsy. The cause of death was hemorrhage associated with transbronchial biopsy of an enlarged bronchial artery associated with heartworm disease. This report describes a rare complication of a routine diagnostic procedure.


Assuntos
Broncoscopia/veterinária , Doenças do Cão/etiologia , Hemoptise/veterinária , Animais , Biópsia/efeitos adversos , Biópsia/veterinária , Broncoscopia/efeitos adversos , Doenças do Cão/patologia , Cães , Evolução Fatal , Hemoptise/etiologia , Hemoptise/patologia , Masculino , Mucosa Respiratória/patologia
8.
BMC Infect Dis ; 19(1): 905, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660864

RESUMO

BACKGROUND: Antibiotic resistance is rising at disturbing rates and contributes to the deaths of millions of people yearly. Antibiotic resistant infections disproportionately affect those with immunocompromising conditions, chronic colonization, and frequent antibiotic use such as transplant patients or those with cystic fibrosis. However, clinicians lack the diagnostic tools to confidently diagnose and treat infections, leading to widespread use of empiric broad spectrum antimicrobials, often for prolonged duration. CASE PRESENTATION: A 22 year-old Caucasian female with cystic fibrosis received a bilateral orthotopic lung transplantation 5 months prior to the index hospitalization. She underwent routine surveillance bronchoscopy and was admitted for post-procedure fever. A clear cause of infection was not identified by routine methods. Imaging and bronchoscopic lung biopsy did not identify an infectious agent or rejection. She was treated with a prolonged course of antimicrobials targeting known colonizing organisms from prior bronchoalveolar lavage cultures (Pseudomonas, Staphylococcus aureus, and Aspergillus). However, we identified Stenotrophomonas maltophilia in two independent whole blood samples using direct-pathogen sequencing, which was not identified by other methods. CONCLUSIONS: This case represents a common clinical conundrum: identification of infection in a high-risk, complex patient. Here, direct-pathogen sequencing identified a pathogen that would not otherwise have been identified by common techniques. Had results been clinically available, treatment could have been customized, avoiding a prolonged course of broad spectrum antimicrobials that would only exacerbate resistance. Direct-pathogen sequencing is poised to fill a diagnostic gap for pathogen identification, allowing early identification and customization of treatment in a culture-independent, pathogen-agnostic manner.


Assuntos
Broncoscopia/efeitos adversos , Febre/etiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/etiologia , Sequenciamento de Nucleotídeos em Larga Escala , Análise de Sequência de RNA , Stenotrophomonas maltophilia/genética , Antibacterianos/uso terapêutico , Lavagem Broncoalveolar , Tomada de Decisão Clínica , Fibrose Cística/cirurgia , Farmacorresistência Bacteriana , Feminino , Febre/tratamento farmacológico , Humanos , Transplante de Pulmão , Pseudomonas/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Adulto Jovem
9.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586955

RESUMO

Flexible bronchoscopy is a commonly performed procedure in pulmonary medicine. The common complications following bronchoscopy include minor bleeding, transient hypoxaemia, pneumothorax and others. Pneumothorax during diagnostic flexible bronchoscopy is mainly encountered after performing transbronchial lung biopsy. Iatrogenic pneumothorax is uncommon when lung biopsy is not performed. Herein, we report the unusual occurrence of pneumothorax following bronchoscopic suctioning while removing a mucus plug.


Assuntos
Aspergillus fumigatus/isolamento & purificação , Biópsia por Agulha/efeitos adversos , Broncoscopia/efeitos adversos , Pneumotórax/etiologia , Aspergilose Pulmonar/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Doença Iatrogênica , Muco , Aspergilose Pulmonar/patologia , Sucção/efeitos adversos
14.
Medicina (Kaunas) ; 55(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31546869

RESUMO

Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.


Assuntos
Broncoscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Pneumotórax Artificial/instrumentação , Idoso , Biópsia/efeitos adversos , Broncoscopia/efeitos adversos , Temperatura Baixa , Feminino , Humanos , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Pneumotórax Artificial/efeitos adversos , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Ther Adv Respir Dis ; 13: 1753466619871523, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476949

RESUMO

BACKGROUND: Thoracogastric-airway fistula (TGAF) post-thoracic surgery is a rare and challenging complication for esophagectomy. The aim of this study was to explore the effectiveness of airway stenting for TGAF patients and find related factors coupled with healing of fistula. METHODS: This is a retrospective study involving patients with TGAF who were treated with airway stentings. Based on different TGAF locations and sizes on chest computed tomography, covered metallic or silicon airway stents were implanted to cover orifices under interventional bronchoscopy. TGAF healing was defined as the primary outcome, and complete sealing of TGAF as the second outcome. The predictors for TGAF healing were analyzed in univariate and multivariate analysis. RESULTS: A total of 58 TGAF patients were included, of whom 7 received straight covered metallic stents, 5 straight silicon stents, 3 L-shaped covered metallic stents, 21 large Y-shaped covered metallic stents, 17 large Y-shaped silicon stents, and 5 with Y-shaped covered metallic stents. Healing was achieved in 20 (34.5%) patients, and complete sealing in 45 (77.6%) patients. There were no significant differences in healing rate and complete sealing rate between patients receiving metallic stents and those with silicon stents. In univariate analysis, lacking a previous history of radiotherapy or chemotherapy, nonmalignant fistulas, small fistulas, and shorter postesophagectomy duration were found associated with a higher rate of TGAF healing. Only shorter postesophagectomy duration was associated with TGAF healing in multivariate analysis. CONCLUSIONS: Both silicon and covered metallic airway stenting are effective methods to close TGAF. A shorter postesophagectomy period may predict better TGAF healing. The reviews of this paper are available via the supplemental material section.


Assuntos
Broncoscopia/instrumentação , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Fístula Gástrica/terapia , Fístula do Sistema Respiratório/terapia , Stents , Adulto , Idoso , Broncoscopia/efeitos adversos , Neoplasias Esofágicas/patologia , Feminino , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Desenho de Prótese , Fístula do Sistema Respiratório/diagnóstico por imagem , Fístula do Sistema Respiratório/etiologia , Estudos Retrospectivos , Silicones , Fatores de Tempo , Resultado do Tratamento , Cicatrização
16.
Ther Adv Respir Dis ; 13: 1753466619866101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31373259

RESUMO

BACKGROUND AND OBJECTIVE: Endoscopic valve therapy is a treatment modality in patients with advanced emphysema and absent interlobar collateral ventilation (CV). So far, long-term outcome following valve implantation has been insufficiently evaluated. The aim of this study was to investigate the real-world efficacy of this interventional therapy over 3 years. METHODS: From 2006 to 2013, 256 patients with severe emphysema in whom absent CV was confirmed underwent valve therapy. The 3-year effectiveness was evaluated by pulmonary function testing (VC, FEV1, RV, TLC), 6-minute-walk test (6-MWT) and dyspnea questionnaire (mMRC). Long-term outcome was also assessed according to the radiological outcome following valve placement. RESULTS: Of 256 patients treated with valves, 220, 200, 187, 100 and 66 patients completed the 3-month, 6-month, 1-year, 2-year and 3-year follow-up (FU) visit, respectively. All lung function parameters, 6-MWT and mMRC were significantly improved at 3- and 6-month FU. At 1-year FU, patients still experienced a significant improvement of all outcome parameters expect VC (L) and TLC (%). At 2 years, RV (L and %) and TLC (L and %) remained significantly improved compared to baseline. Three years after valve therapy, sustained significant improvement in mMRC was observed and the proportion of patients achieving a minimal clinically important difference from baseline in RV and 6-MWT was still 71% and 46%, respectively. Overall, patients with complete lobar atelectasis exhibited superior treatment outcome with 3-year responder rates to FEV1, RV and 6-MWT of 10%, 79% and 53%, respectively. CONCLUSIONS: Patients treated by valves experienced clinical improvement over 1 year following valve therapy. Afterwards, clinical benefit gradually declines more likely due to COPD progression.


Assuntos
Broncoscopia/instrumentação , Dispneia/terapia , Pulmão/fisiopatologia , Enfisema Pulmonar/terapia , Idoso , Broncoscopia/efeitos adversos , Dispneia/diagnóstico , Dispneia/fisiopatologia , Tolerância ao Exercício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
17.
Lung ; 197(5): 627-633, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31463549

RESUMO

PURPOSE: Air leaks are common after lobectomy, segmentectomy, and lung volume reduction surgery (LVRS). This can increase post-operative morbidity, cost, and hospital length of stay. The management of post-pulmonary resection air leaks remains challenging. Minimally invasive effective interventions are necessary. The Spiration Valve System (SVS, Olympus/Spiration Inc., Redmond, WA, US) is approved by the FDA under humanitarian use exemption for management of prolonged air leaks. METHODS: This is a prospective multicenter registry of 39 patients with air leaks after lobectomy, segmentectomy, and LVRS managed with an intention to use bronchoscopic SVS to resolve air leaks. RESULTS: Bronchoscopic SVS placement was feasible in 82.1% of patients (32/39 patients) and 90 valves were placed with a median of 2 valves per patient (mean of 2.7 ± 1.5 valves, range of 1 to 7 valves). Positive response to SVS placement was documented in 76.9% of all patients (30/39 patients) and in 93.8% of patients when SVS placement was feasible (30/32 patients). Air leaks ultimately resolved when SVS placement was feasible in 87.5% of patients (28/32 patients), after a median of 2.5 days (mean ± SD of 8.9 ± 12.4 days). Considering all patients with an intention to treat analysis, bronchoscopic SVS procedure likely contributed to resolution of air leaks in 71.8% of patients (28/39 patients). The post-procedure median hospital stay was 4 days (mean 6.0 ± 6.1 days). CONCLUSIONS: This prospective registry adds to the growing body of literature supporting feasible and effective management of air leaks utilizing one-way valves.


Assuntos
Broncoscopia/instrumentação , Pneumonectomia/efeitos adversos , Pneumotórax/terapia , Idoso , Broncoscopia/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonectomia/instrumentação , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
18.
Indian Pediatr ; 56(7): 560-562, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333209

RESUMO

OBJECTIVE: To report our experience of tracheobronchial foreign body removal in children using flexible bronchoscopy as the primary mode. METHODS: Hospital records of tracheobronchial foreign body extractions between January, 2006 and January, 2018 were reviewed. Clinical presentations, radiological findings, location and types of tracheobronchial foreign bodies, types of bronchoscopes, complications and outcome of the procedures were analyzed. RESULTS: 283 extractions in children with median (range) age of 18 (5-168) months were reviewed. Extraction by flexible bronchoscope, using wire baskets or grasping forceps, was successful in 260 cases. No major complications were encountered. Mean (SD) time for the procedure was 31 (6.3) minutes. CONCLUSION: Airway foreign bodies can safely be removed by flexible bronchoscopy with minimal complications. This procedure can be considered the primary mode for removal of airway foreign bodies by a trained and experienced person.


Assuntos
Manuseio das Vias Aéreas/métodos , Brônquios/diagnóstico por imagem , Broncoscopia , Corpos Estranhos , Traqueia/diagnóstico por imagem , Broncoscópios , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/etiologia , Corpos Estranhos/terapia , Humanos , Índia/epidemiologia , Lactente , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Instrumentos Cirúrgicos
19.
Indian Pediatr ; 56(7): 587-593, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333214

RESUMO

Flexible fiberoptic bronchoscopy a vital diagnostic and therapeutic procedure for assessing the airway. Its logistics, clinical indications and utility need to be elucidated in pediatric context. Pediatric flexible fibreoptic bronchoscopy is useful for diagnosis of airway anomalies, bronchoalveolar lavage for diagnostic and therapeutic purposes, and interventions like foreign body removal. Newer ultra-thin bronchoscopes can be used to perform this procedure in children of all ages. Pediatric flexible bronchoscopy is a valuable diagnostic and therapeutic tool in the hands of skilled personnel when used judiciously.


Assuntos
Manuseio das Vias Aéreas , Broncoscópios , Broncoscopia , Pediatria/instrumentação , Sistema Respiratório , Doenças Respiratórias , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Criança , Humanos , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/cirurgia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/terapia , Ultrassonografia de Intervenção/métodos
20.
Rev Mal Respir ; 36(7): 880-888, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31208885

RESUMO

Lung hyperinflation which is a hallmark of advanced emphysema plays a major role in the exertional dyspnoea experienced by patients. This has led to the development of surgical lung volume reduction which, though effective, is also associated with significant morbidity and mortality. The goal of endoscopic lung volume reduction which has developed over several years is to decrease hyperinflation without exposing patients to the risks of surgery. Several endoscopic techniques have been assessed by high quality controlled studies: airway by-pass, instillation of glue, insertion of coils or unidirectional valves, vapour ablation. The aim of this review is to present the results of these studies in terms of functional benefit and side effects. Based on these studies, an algorithm for the endoscopic management of advanced forms of emphysema is proposed.


Assuntos
Broncoscopia/métodos , Pneumonectomia/métodos , Enfisema Pulmonar/cirurgia , Algoritmos , Broncoscopia/efeitos adversos , Broncoscopia/mortalidade , Humanos , Seleção de Pacientes , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Enfisema Pulmonar/mortalidade
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