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1.
J Laparoendosc Adv Surg Tech A ; 30(5): 477-480, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32311303

RESUMO

Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/cirurgia , Traqueotomia/métodos , Aerossóis/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Betacoronavirus/isolamento & purificação , Carcinoma de Células Escamosas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Glote , Humanos , Controle de Infecções/normas , Neoplasias Laríngeas/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Insuficiência Respiratória/etiologia , Traqueotomia/efeitos adversos , Vigília
2.
Vet J ; 253: 105391, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685136

RESUMO

Brachycephalic obstructive airway syndrome (BOAS) is a common disorder presenting enlarged soft palate, stenotic nares and abnormal turbinate growth. Surgical correction of BOAS abnormalities with caudal palatoplasty is an elective therapy. This prospective study aimed to compare the effect of an air plasma device and diode laser in dogs undergoing palatoplasty. Outcome measures were as follows: (1) intra-operative and immediate post-operative complications; (2) evaluation of thermal injury in histological tissue sections of the excised soft palate. Twenty dogs with enlarged soft palates underwent palatoplasty, using an air plasma device (n=10) and diode laser (n=10). Soft palate specimens underwent masked histopathological analysis to assess post-operative thermal injury. In this pilot study, no differences were observed in surgical times; all dogs were discharged 24h after surgery and had stable respiration. In the air plasma group, post-operative bleeding occurred in two cases and revision surgery was performed. No difference in thermal injury was observed using the two devices (P>0.05). The air-plasma device was a viable surgical option for palatoplasty in dogs with BOAS.


Assuntos
Obstrução das Vias Respiratórias/veterinária , Queimaduras/veterinária , Craniossinostoses/veterinária , Doenças do Cão/cirurgia , Lasers Semicondutores/efeitos adversos , Palato Mole/anormalidades , Obstrução das Vias Respiratórias/cirurgia , Animais , Craniossinostoses/cirurgia , Cães , Feminino , Masculino , Palato Mole/patologia , Projetos Piloto , Complicações Pós-Operatórias/veterinária , Estudos Prospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(42): e17713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626153

RESUMO

Few data are available regarding factors that impact cricothyrotomy use and outcome in general hospital setting. The aim of the present study was to determine the incidence and outcomes of the patients underwent cricothyrotomy in a "cannot intubate, cannot oxygenate" (CICO) situation at university hospitals in Korea.This was a retrospective review of the electronic medical records of consecutive patients who underwent cricothyrotomy during a CICO situation between March, 2007, and October, 2018, at 2 university hospitals in Korea. Data regarding patient characteristics and outcomes were analyzed using descriptive statistics.During the study period, a total of 10,187 tracheal intubations were attempted and 23 patients received cricothyrotomy. Hospitalwide incidence of cricothyrotomy was 2.3 per 1000 tracheal intubations (0.23%). The majority of cricothyrotomy procedures (22 cases, 95.7%) were performed in the emergency department (ED); 1 cricothyrotomy was attempted in the endoscopy room. In the ED, 5663 intubations were attempted and the incidence of cricothyrotomy was 3.9 per 1000 tracheal intubations (0.39%). Survival rate at hospital discharge was 47.8% (11 of 23 cases). Except for cardiac arrest at admission, survival rate was 62.5% (10 of 16 cases). Successful cricothyrotomy was performed in 17 patients (73.9%) and 9 patients (52.9%) were survived. Among 6 patients of failed cricothyrotomy (26.1%), 2 patients (33.3%) were survived. After failure of cricothyrotomy, various methods of securing airway were established: 3 tracheal intubations, 1 nasotracheal intubation, and 1 tracheostomy.The success rate of cricothyrotomy and survival rate in the CICO situation were not high. After failure of cricothyrotomy, various methods of securing airway were performed.


Assuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/cirurgia , Cartilagem Cricoide/cirurgia , Sistema de Registros , Cartilagem Tireóidea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/mortalidade , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
4.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570357

RESUMO

Vallecular cysts are a rare entity but can complicate the airway management due to the physical impediment and distortion of the laryngeal inlet. It can lead to fatal life-threatening airway obstruction postinduction of anaesthesia. Infancy compounds the risks due to lack of cooperation and physiological reserves. The literature review suggested most anaesthesiologists avoided muscle relaxants and aspiration of the cyst was used as a rescue technique. The present case report illustrates the successful airway management of an infant with a huge vallecular cyst using fibre-optic intubation by a 'three-person' technique after paraglossal videolaryngoscopy failed to secure the airway.


Assuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/cirurgia , Cistos/cirurgia , Tecnologia de Fibra Óptica , Doenças da Laringe/cirurgia , Laringoscopia/instrumentação , Obstrução das Vias Respiratórias/diagnóstico por imagem , Cistos/complicações , Cistos/diagnóstico por imagem , Humanos , Lactente , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico por imagem , Masculino , Resultado do Tratamento
5.
In Vivo ; 33(5): 1641-1644, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471417

RESUMO

BACKGROUND: An open-label, single-arm study was conducted to assess the safety of a cryosurgery unit named CRYO2 for debulking at the site of obstruction or stenosis. PATIENTS AND METHODS: In order to treat central airway tumor-related stenosis, debulking at the stenotic site of the airway was performed using CRYO2 under general or local anesthesia. The primary endpoint was the incidence of moderate to massive hemorrhage. RESULTS: Incidence of moderate to massive hemorrhage during surgery was 3.8% (1/26) (95% confidence interval(CI)=0.1-19.6%). Technical success was 96.2% (25/26), with a 95% confidence interval of 80.4-99.9%. CONCLUSION: CRYO2 for debulking at the site of obstruction or stenosis can be performed safely.


Assuntos
Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos de Citorredução , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Criocirurgia/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Neoplasias do Sistema Respiratório/complicações , Neoplasias do Sistema Respiratório/diagnóstico , Neoplasias do Sistema Respiratório/terapia , Resultado do Tratamento
6.
BMJ Case Rep ; 12(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488451

RESUMO

Angioedema (AE) is caused by a wide range of diseases and pharmaceuticals; it can become life-threatening when located to the airways. Patients with deficiency or malfunction of complement C1 esterase inhibitor (hereditary or acquired) experience recurrent AE due to an accumulation of the vasoactive mediator bradykinin (BK). Complement C1 inhibitor normally decreases BK production, so a reduced function hereof causes increased levels. The diagnosis of hereditary or acquired AE can be difficult due to similarities to allergic reactions (swelling, abdominal pain, rash). We describe a 35-year-old man presenting with upper-airway AE progressing rapidly and promptly required cricothyroidotomy. Complement and autoantibody screening together with sequencing of SERPING1 were performed and gave the diagnosis of acquired complement C1 esterase inhibitor deficiency. The patient is unusual to have this disease before the age of 40 years. No associated comorbidities were found. It is important to know that antiallergic medication is not effective in BK-mediated AE.


Assuntos
Proteína Inibidora do Complemento C1/genética , Angioedema Hereditário Tipos I e II/genética , Doença Aguda , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Exantema/etiologia , Angioedema Hereditário Tipos I e II/complicações , Angioedema Hereditário Tipos I e II/diagnóstico , Humanos , Masculino , Mutação , Traqueotomia
7.
Int J Pediatr Otorhinolaryngol ; 127: 109642, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479918

RESUMO

OBJECTIVE: Currently no established criteria exist to guide use of ex utero intrapartum treatment (EXIT) for fetal neck mass management. This study aims to correlate prenatal radiographic findings with incidence of ex utero intrapartum treatment and necessity of airway intervention at delivery. METHODS: We reviewed our EXIT experience between 2012 and 17. Furthermore, we performed a literature review of articles reporting incidences of fetal neck masses considered for EXIT. Articles that were included (1) discussed prenatal radiographic findings such as size, features, and evidence of compression and (2) reported extractable data on delivery outcomes and airway status. RESULTS: Ten cases at our institution were reviewed. Another 137 cases across 81 studies met inclusion criteria. These studies showed aerodigestive tract compression to be significantly associated with neck masses undergoing EXIT. Additionally, there was significantly higher incidence of airway intervention in cases where polyhydramnios, anatomic compression, and solid masses were seen on prenatal diagnostic imaging, while mass location and size did not correlate with airway intervention. CONCLUSION: With this data, we propose that any neck mass with anatomic compression on fetal imaging in the 3rd trimester should be considered for EXIT. When radiographic findings do not show compression but do display polyhydramnios or a solid neck mass (regardless of polyhydramnios), an airway surgeon should be available for perinatal airway assistance.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Período Periparto , Gravidez , Centros de Atenção Terciária , Ultrassonografia Pré-Natal
8.
Indian J Cancer ; 56(3): 236-240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389387

RESUMO

AIMS: Small cell lung cancer (SCLC) constitutes 15%-25% of all lung cancers. Their treatment approach is different from nonsmall cell lung cancer. Central airway obstruction develops at the time of diagnosis or eventually at some time as the disease progress. Quick relief of symptoms with chemotherapy will cause to postpone interventional bronchoscopy which divest patient from benefits of this procedure. There is a few data about the use of interventional bronchoscopy in SCLC. SUBJECTS AND METHODS: Between January 2005 and December 2012, rigid bronchoscopy under general anaesthesia was done in a total of 944 cases. Among them, 52 consecutive SCLC cases were evaluated retrospectively. STATISTICAL ANALYSIS: Survival was calculated from the date of application of therapeutic bronchoscopy using statistical software. RESULTS: From the 52 cases (41 males) mean age of the patients were 56,87 ± 10,16 (range 34-78). Most common obstruction areas were distal trachea and carina invasion involving both main bronchus (n: 12; 23%). Most common method used was mechanical desobstruction after coagulation with diode diode laser or APC. A total of 16 stents was applied to 15 of the cases from 52 cases (28.8%). Most common used stent was silicon Y stent (n: 11). Most common complication during the procedure was bleeding that was mild in 11 cases and massive in 1. One patient died during the procedure (1.9%). CONCLUSIONS: Multimodal interventional bronchoscopic methods seem to be a last option but may be useful in the management of advanced airway obstruction in the setting of SCLC. The choice of modality may be chosen depending upon individual patient characteristics as appropriate.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia/mortalidade , Neoplasias Pulmonares/complicações , Carcinoma de Pequenas Células do Pulmão/complicações , Adulto , Idoso , Obstrução das Vias Respiratórias/etiologia , Broncoscopia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
9.
J Craniofac Surg ; 30(8): 2486-2489, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31469743

RESUMO

We reported a 16-year-old patient with chin defect accompanying micrognathia and airway stenosis owing to a traffic accident. The treatment of this patient involved a modified genioplasty associated with orthognathic surgeries. Through data analysis, we found that the patient's facial morphology and airway space are greatly improved compared with preoperation: y-axis(T4-T1) = -4.5 degree; FCA (T4-T1) = -18 degree; CSAmin(T4-T1) = 227 mm. In conclusion, the modified genioplasty associated with orthognathic surgeries is an effective way to reshape the defected chin and treat micrognathia and airway stenosis in this case.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Queixo/cirurgia , Mentoplastia , Micrognatismo/cirurgia , Adolescente , Humanos , Masculino , Procedimentos Cirúrgicos Ortognáticos
10.
J Cardiothorac Surg ; 14(1): 155, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455391

RESUMO

BACKGROUND: This study aimed to study the clinical efficacy of argon plasma coagulation plus cryotherapy for central airway stenosis caused by lung cancer. METHODS: The clinical data of 177 patients with central airway stenosis caused by lung cancer received surgery from June, 2017 to July 2018 were retrospectively analyzed. According to different treatments, 43 patients received cryotherapy were included in the control group, while 134 patients received argon plasma coagulation plus cryotherapy were in the observation group. After propensity score matching, patients in the two groups were in a 1:1 ratio. The Karnofsky score, partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), partial pressure of arterial carbon dioxide (PaCO2) and adverse reactions in patients were analyzed one week before and after treatment. Besides, the survival rates of the two groups were compared. RESULTS: After propensity score matching, the baseline data were not significantly different between the two groups. The post-treatment Karnofsky scores in the two groups were significantly higher than those of before treatment, and the post-treatment score of the observation group was higher than that of the control group (all P < 0.05). The post-treatment PaO2 and SaO2 in the observation group were both higher than those of the control group; while the PaCO2 in the observation group was significantly lower than that of the control group (all P < 0.05). In the observation group, the levels of PaO2 and SaO2 were significantly higher, and the level of PaCO2 was significantly lower after treatment than those of before treatment (all P < 0.05). The rates of completely effective and mild effective in the observation group were significantly higher than those in the control group (both P < 0.05). The incidences of bleeding, arrhythmia and fever in the observation group were significantly lower than those in the control group (all P < 0.05). The survival rate was significantly higher in the observation group (72.09%) than in the control group (51.16%). CONCLUSIONS: Argon plasma coagulation combined with cryotherapy can significantly alleviate the central airway stenosis caused by lung cancer, reduce the incidence of adverse reactions, and improve prognosis in patients.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Coagulação com Plasma de Argônio/métodos , Crioterapia/métodos , Neoplasias Pulmonares/complicações , Adulto , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
12.
Acta otorrinolaringol. esp ; 70(4): 215-221, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185398

RESUMO

Objetivos: El objetivo de este estudio es presentar las indicaciones y resultados de la faringoplastia de expansión como tratamiento del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). En segundo lugar, comparar los hallazgos de la somnoscopia (drug-induced sleep endoscopy -DISE-) antes y después de la cirugía. Material y métodos: El diseño del estudio fue una cohorte prospectiva de pacientes tratados quirúrgicamente de 2015 a 2016. Todos los pacientes fueron diagnosticados de SAHOS leve a grave y no toleraban la CPAP. Todos tenían DISE y polisomnografía previa a la cirugía, y posterior a la misma. Los criterios de inclusión fueron la edad, entre 18 años y 70 años, amígdalas pequeñas (tamaños 1 y 2), estadio clínico de Friedman II y III, y colapso lateral mayoritario en la DISE preoperatoria. Se les realizó únicamente cirugía del paladar, usando la técnica de faringoplastia de expansión. Resultados: Se incluyeron 17 pacientes, el 52,94% eran pacientes con SAHOS grave. La edad media fue de 42 años, el índice de masa corporal media fue de 28. La tasa de éxito quirúrgico según los criterios de Sher fue del 82,35%. El 41,17% presentó un índice de apnea-hipopnea postoperatoria inferior a 10. El 75% de los pacientes lograron no tener que usar la CPAP. Conclusión: La faringoplastia de expansión es una técnica segura como tratamiento del SAHOS en pacientes con amígdalas pequeñas, grado Friedman I y II y colapso de paredes laterales en somnoscopia, en ausencia de colapso multinivel. La DISE postoperatoria demostró la mejoría del colapso lateral obtenida con la expansión


Objectives: The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery. Material and methods: The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty. Results: Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP. Conclusion: Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Músculos Faríngeos/cirurgia , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Obstrução das Vias Respiratórias/cirurgia , Endoscopia/métodos , Polissonografia , Estudos Prospectivos , Sono/efeitos da radiação , Medicamentos Indutores do Sono/farmacologia , Técnicas de Sutura , Resultado do Tratamento
13.
Orv Hetil ; 160(31): 1235-1240, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31352810

RESUMO

Laryngocele is a unilateral or bilateral dilation of the saccule or appendix of the laryngeal ventricle. It is a benign lesion, often without any specific symptom, diagnosed unintentionally, but it can cause life-threatening airway obstruction, needing emergency tracheotomy. The authors present three cases of laryngocele and the related surgical methods. Orv Hetil. 2019; 160(31): 1235-1240.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Laringocele/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Adulto , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/cirurgia , Apêndice , Feminino , Humanos , Laringocele/complicações , Laringocele/diagnóstico por imagem , Laringoscopia , Laringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Traqueotomia
14.
Otolaryngol Clin North Am ; 52(5): 891-901, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301824

RESUMO

Pediatric obstructive sleep apnea (OSA) affects 2% to 4% of American children, and is associated with metabolic, cardiovascular, and neurocognitive sequelae. The primary treatment for pediatric OSA is adenotonsillectomy. Children with obesity, craniofacial syndromes, and severe baseline OSA are at risk for persistent disease. Evaluation of persistent OSA should focus on identifying the causes of upper airway obstruction. Interventions should be tailored to address the patient's symptomatology, sites of obstruction, and preference for surgical versus medical management. Further research is needed to identify management protocols that result in improved outcomes for children with persistent OSA.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/cirurgia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/cirurgia , Adenoidectomia , Obstrução das Vias Respiratórias/etiologia , Criança , Endoscopia , Humanos , Imagem por Ressonância Magnética , Polissonografia , Apneia Obstrutiva do Sono/etiologia , Tonsilectomia
15.
Ulus Travma Acil Cerrahi Derg ; 25(4): 355-360, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297781

RESUMO

BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method-computed tomography (CT) scan. METHODS: A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted. RESULTS: The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland-Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p<0.001. The VAS scores for the palpation and US difficulty were 5.13+-1.1 and 3.32+-0.9 (p<0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US. CONCLUSION: Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Tireóidea/diagnóstico por imagem , Adulto , Idoso , Índice de Massa Corporal , Cartilagem Cricoide/anatomia & histologia , Cartilagem Cricoide/cirurgia , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palpação , Estudos Prospectivos , Fatores Sexuais , Cartilagem Tireóidea/anatomia & histologia , Cartilagem Tireóidea/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ultrassonografia
16.
Ann Otol Rhinol Laryngol ; 128(12): 1182-1188, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31319699

RESUMO

OBJECTIVES: The aim of our study is to report a case of a child with subglottic thymus that was suspected during diagnostic work-up for severe airway obstruction, excised surgically and confirmed with final histopathological examination. Moreover, we performed a narrative literature review to outline clinical and diagnostic features of this rare condition and to report suggestions for the management of subglottic masses. METHODS: We report the case of a 7-month-old boy who was admitted to our Pediatric Airway Team Unit due to a history of worsening biphasic stridor and recurrent episodes of upper airway obstruction. The successful diagnostic work-up and a narrative literature of analogous cases of subglottic thymus were reported. RESULTS: Ectopic thymus is a very rare condition in which thymic tissue is found outside the normal pathway of its embryonic migration. It usually presents as a cystic or, more rarely, solid mass, showing an indolent course toward spontaneous involution. In some cases, however, it becomes symptomatic exerting compression on surrounding vital structures. Due to its rarity, the initial diagnosis is normally mistaken with inflammatory diseases or malignancies and the definitive diagnosis is only achieved after histological examination of the excised specimen. To our knowledge, only four other cases of subglottic ectopic thymic tissue have been reported in the English literature so far and the diagnosis has never been suspected preoperatively. CONCLUSION: It is mandatory to consider ectopic thymic tissue in the differential diagnosis in children presenting with airways obstruction in order to prevent unnecessary, extensive, and exploratory surgery.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Coristoma/diagnóstico , Timo , Doenças da Traqueia/diagnóstico , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/cirurgia , Coristoma/complicações , Coristoma/cirurgia , Humanos , Lactente , Masculino , Doenças da Traqueia/complicações , Doenças da Traqueia/cirurgia
17.
Lakartidningen ; 1162019 May 15.
Artigo em Sueco | MEDLINE | ID: mdl-31192393

RESUMO

The main, but not sole, indication for an Ex-utero Intrapartum Treatment (EXIT) delivery is an airway obstruction due to either laryngeal atresia or tumors in the head and neck region. Here we present our Institution's experience with eleven cases: three teratomas, four lymphatic malformations, two laryngeal atresias and two dermoid cysts. The EXIT procedure was used to secure the fetal airway while maintaining uteroplacental gas exchange and fetal hemodynamic stability through the umbilical circulation. Five fetuses required tracheostomy. Only one fetal death occurred due to extensive growth of a teratoma preventing us from establishing an airway. No other fetal or major maternal complication occurred. The EXIT procedure is a complex procedure and these rare cases should be referred to a center with a dedicated and experienced multidisciplinary team.


Assuntos
Obstrução das Vias Respiratórias , Histerotomia/métodos , Laparotomia/métodos , Adulto , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/cirurgia , Cesárea , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Hospitais Universitários , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Laringe/anormalidades , Laringe/cirurgia , Anormalidades Linfáticas/cirurgia , Equipe de Assistência ao Paciente , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Região Sacrococcígea/patologia , Região Sacrococcígea/cirurgia , Suécia , Teratoma/congênito , Teratoma/cirurgia , Traqueotomia/métodos
18.
Adv Clin Exp Med ; 28(7): 961-965, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31199878

RESUMO

BACKGROUND: Tracheobronchomalacia is the most common cause of congenital airway obstruction in infants. An alternative for surgical approach (aortopexy) can be metallic airway stents. Usually, they are not considered as a first choice because of the relatively high risk of complications. Recent years have brought encouraging reports of biodegradable stents applied in children. OBJECTIVES: The aim of this study was to report our experience in the treatment of airway malacia using biodegradable stents. MATERIAL AND METHODS: Six polydioxanone (PDS), self-expanding custom-made stents (ELLA-CS) were implanted in 2 children: 3 in the patient with left main bronchus occlusion due to postpnemonectomy syndrome and 3 stents in the baby with tracheomalacia. RESULTS: Airway collapse was always relieved after stent expansion. Both patients needed repeated stenting because of limited stent lifespan. All the stents were implanted without complications through a rigid bronchoscope. The baby with stented main bronchus died because of irreversible lung lesion. CONCLUSIONS: This small study shows that biodegradable airway stents seem to be an attractive option in the treatment of tracheobronchomalacia in children. We consider this method to be safe, effective, repeatable, and reversible in small children with growing airways. As a time-buying procedure they can be especially useful in the treatment of tracheobronchomalacia.


Assuntos
Implantes Absorvíveis/efeitos adversos , Obstrução das Vias Respiratórias/terapia , Materiais Biocompatíveis , Stents , Traqueobroncomalácia/terapia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Materiais Biocompatíveis/efeitos adversos , Broncomalácia/terapia , Broncoscopia , Criança , Feminino , Humanos , Lactente , Masculino , Stents/efeitos adversos , Traqueobroncomalácia/diagnóstico por imagem , Resultado do Tratamento
19.
Pediatr Surg Int ; 35(8): 835-843, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31165248

RESUMO

PURPOSE: The aim of this study was to evaluate the indications and the clinical outcomes of the fetuses managed with ex utero intrapartum treatment (EXIT) procedures. METHODS: We retrospectively reviewed the medical records of all fetuses who underwent EXIT procedures between 2003 and 2018. RESULTS: EXIT procedures were performed in nine cases. The prenatal diagnosis of the neonates was congenital high airway obstruction syndrome in four cases, the neck masse in five cases. Although the airway management under the EXIT procedure was successful in eight cases, the airway management failed in one case. During the EXIT procedures, the airway was managed by endotracheal intubation in two cases, whereas six cases underwent tracheostomy. Six cases with fetal airway obstruction survived to discharge, whereas three cases died due to airway management failure or complications of the underlying disease. A case with a cervical teratoma underwent tumor resection the day after birth due to rapid enlargement of the neck mass. Long-term survival was achieved in five cases. CONCLUSIONS: We concluded that the EXIT procedure was effective and could be performed safely in the airway management of fetuses with suspected airway obstruction. The treatment strategy for the neck masses should be planned before birth.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Intubação Intratraqueal/métodos , Cuidado Pré-Natal/métodos , Traqueostomia/métodos , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/diagnóstico , Feminino , Doenças Fetais/diagnóstico , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Útero
20.
J Bronchology Interv Pulmonol ; 26(4): 254-259, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31188158

RESUMO

BACKGROUND: Central airway obstruction (CAO) is defined as obstruction of the airway lumen in the trachea or mainstem bronchi, most commonly due to primary or metastatic malignancy; and is classified as extraluminal, endoluminal, or mixed. The majority of malignant CAO are advanced stage and require a multimodality palliative approach, including stent placement. We describe a retrospective review of a novel self-expandable metallic stent, the Bonastent; a fully covered, nitinol-braided airway stent which conforms to airway tortuosity without loss of diameter in the management of CAO. METHODS: We performed a retrospective chart review of patients with CAO who underwent Bonastent placement at a single center between February 2017 and March 2018. Ease of stent placement, short-term complications (within 24 h of stent placement) and long-term complications (within 3 mo of stent placement) were recorded. RESULTS: Eleven patients were identified, reviewed and included in the study. Thirteen stents in 11 patients were placed for predominantly malignant CAO. One patient had a short-term complication of stent migration. Four patients had long-term complications; of which 3 patients had in-stent mucus impaction requiring bronchoscopy. In our study, the stent-related complication rates were comparable to the reported literature. CONCLUSION: In our experience, Bonastent is an easy to use option which adds to the armamentarium of the self-expandable metallic stent to treat malignant CAO.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Brônquios/cirurgia , Stents Metálicos Autoexpansíveis , Traqueia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Ligas , Broncoscopia , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Muco , Neoplasias/complicações , Cuidados Paliativos , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Estudos Retrospectivos
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