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2.
Med. clín (Ed. impr.) ; 153(5): 191-195, sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183994

RESUMO

Introducción: La enfermedad pulmonar obstructiva crónica y la insuficiencia cardíaca (IC) son 2 enfermedades con una elevada morbimortalidad. La coexistencia de estas 2 enfermedades se estima que es frecuente, pero ha sido escasamente estudiada. Objetivo: Estudiar la prevalencia de limitación al flujo aéreo en una muestra de pacientes diagnosticados de IC en seguimiento en una unidad de IC y valorar las características y comorbilidades de estos pacientes. Métodos: Se trata de un estudio prospectivo observacional. Se incluyeron de forma consecutiva los pacientes visitados en la Unidad de Insuficiencia Cardíaca del Hospital Universitari Germans Trias i Pujol entre enero del 2014 y junio del 2015. Se realizaron pruebas funcionales respiratorias y se obtuvieron datos clínicos. Resultados: Se incluyeron 118 pacientes en el estudio (edad 67,2 años; DE 12,1; el 77,1% hombres). La prevalencia de limitación al flujo aéreo fue del 36,4%, con un porcentaje de infradiagnóstico del 67,4%. Los pacientes con limitación al flujo aéreo presentaban un aumento de las comorbilidades y de la mortalidad. Conclusión: La prevalencia de limitación al flujo aéreo en pacientes con IC es elevada, con un importante grado de infradiagnóstico. Sería recomendable la realización de una espirometría de cribado en estos pacientes


Background: Chronic obstructive pulmonary disease and heart failure (HF) are 2 diseases with high morbidity and mortality. The coexistence of these two diseases is estimated to be frequent, but has been poorly studied. Aim: To study the prevalence of airflow limitation in a sample of patients diagnosed with HF in follow-up in an HF unit and to assess their characteristics and comorbidities. Methods: This is a prospective observational study. The patients who visited the HF Unit of the Hospital Universitari Germans Trias i Pujol between January 2014 and June 2015 were included consecutively. Respiratory functional tests were performed and clinical data were obtained. Results: 118 patients were included in the study (age 67.2 years, 77.1% men). The prevalence of non-reversible airflow obstruction was 36.4%, with an underdiagnosis percentage of 67.4%. Patients with airflow limitation had an increase in comorbidities, but no worse prognosis. Conclusion: The prevalence of airflow limitation in patients with HF is high, with a significant degree of underdiagnosis. It seems reasonable to recommend performing a screening spirometry in these patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/complicações , Obstrução das Vias Respiratórias/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Prospectivos , Testes Respiratórios , Obstrução das Vias Respiratórias/fisiopatologia , Espirometria
3.
Georgian Med News ; (292-293): 68-71, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560666

RESUMO

The aim of our study was a comparative description of the state of bronchial sensitivity to nonspecific stimuli in respiratory asymptomatic children and children with bronchial asthma. We investigated a total of 242 children aged between 7 and 14 years. The group of respiratory asymptomatic children included 100 examined and 142 had an established diagnosis of atopic bronchial asthma at the I, II, and III stages in the phase of remission. The study was conducted in accordance with the principles of bioethics. In order to investigate the nature of the reaction, bronchoprovocation test with the acetylcholine (bronchoconstrictor) was conducted in children. The test involved monitoring the state of bronchial patency under the effect of increasing concentrations of the stimulus. The acetylcholine test showed that the state of nonspecific bronchial hypersensitivity was expressed in the most of patients with asthma and in 5% of respiratory asymptomatic children. Comparison of the results of the nonspecific bronchial sensitivity and diagnosed airway obstruction did not reveal the relationship between these characteristics. The findings suggest that the presence of nonspecific bronchial hypersensitivity is a congenital and not an acquired phenomenon.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Asma/fisiopatologia , Brônquios/fisiopatologia , Hiper-Reatividade Brônquica/fisiopatologia , Hipersensibilidade Imediata/complicações , Adolescente , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/fisiopatologia , Asma/etiologia , Hiper-Reatividade Brônquica/diagnóstico , Testes de Provocação Brônquica , Criança , Humanos
4.
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
5.
Rev. bras. cir. plást ; 34(2): 228-236, apr.-jun. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1015972

RESUMO

Introdução: Muitos pacientes portadores de sequência de Pierre Robin (micrognatia, glossoptose e obstrução de via aérea) apresentam o músculo genioglosso alterado, encurtado e retrátil, que impede a protração lingual, mantendo a parte anterior da língua verticalizada e seu volume deslocado em direção posterior. Isso pode corroborar para obstrução supraglótica, dificuldade alimentar e inversão das forças de estímulo do crescimento do corpo mandibular. Métodos: Estudo retrospectivo de pacientes com Pierre Robin tratados entre 2012 e 2017 pela equipe, com descrição da "ortoglossopelveplastia", que propõe uma modificação na glossopexia, soltando o genioglosso anômalo da sua inserção, liberando a língua para elevar seu terço anterior e avançar o volume de sua base, sendo auxiliada por ponto de tração da base lingual à sínfise mandibular. Apresentamos um algoritmo de tratamento proposto que prioriza a necessidade desta cirurgia, associada ou não à distração mandibular, de acordo com a gravidade da dificuldade respiratória e/ou alimentar. Resultados: São apresentados 12 casos de obstrução da orofaringe atendidos de 2012 a 2017, discutem-se suas prioridades, a ortoglossopelveplastia e se aplica o algoritmo proposto. Conclusão: A reorganização anatômica da musculatura em uma posição anteriorizada correta proporciona protração e funcionalidade à língua, com desobstrução da via aérea na orofaringe, melhora da função alimentar e do desenvolvimento mandibular, com baixa morbidade cirúrgica e poucas complicações.


Introduction: Several patients with the Pierre Robin sequence (micrognathia, glossoptosis, and airway obstruction) have an altered, shortened, and retractable genioglossus muscle that prevents protraction of the tongue and keeps the anterior part of the tongue vertical and its volume posteriorly displaced. This can contribute to supraglottic obstruction, feeding difficulty, and inversion of the growth stimulation forces of the mandibular body. Methods: A retrospective study of patients with the Pierre Robin sequence treated between 2012 and 2017 with "orthoglossopelveplasty," which includes modification of glossopexy, releasing the anomalous genioglossus of its insertion and releasing the tongue to raise its anterior third and advance the volume of its base using a traction suture of the tongue base to the mandible symphysis. We present a treatment algorithm that prioritizes the need for surgery associated, or not, with mandibular distraction in accordance with respiratory and/or feeding difficulty severity. Results: Twelve cases of oropharyngeal obstruction treated from 2012 to 2017 are presented, their priorities and orthoglossopleoplasty are discussed, and the proposed algorithm is applied. Conclusion: Anatomical reorganization of the musculature in a correct anterior position provides protraction and functionality to the tongue, clears the airway in the oropharynx, and improves the feeding function and mandibular development, with low surgical morbidity rates and few complications.


Assuntos
Humanos , Síndrome de Pierre Robin/cirurgia , Síndrome de Pierre Robin/complicações , Osteogênese por Distração/métodos , Doenças do Nervo Glossofaríngeo/cirurgia , Doenças do Nervo Glossofaríngeo/complicações , Obstrução das Vias Respiratórias/cirurgia , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/diagnóstico , Glossoptose/cirurgia , Glossoptose/patologia , Micrognatismo/cirurgia , Micrognatismo/complicações , Soalho Bucal/anormalidades , Soalho Bucal/cirurgia
6.
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
7.
Tuberk Toraks ; 67(1): 15-21, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31130131

RESUMO

Introduction: We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. Materials and Methods: The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. Result: The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Conclusions: Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.


Assuntos
Obstrução das Vias Respiratórias/terapia , Broncoscopia/métodos , Crioterapia/métodos , Unidades de Terapia Intensiva , Adulto , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Pediatr Ann ; 48(4): e162-e168, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986317

RESUMO

Pediatric airway disorders may be congenital (anatomical) or acquired (infectious) and may involve the upper, lower, or entire airway, with obstruction being a common feature. The pathophysiology of upper airway obstruction in infants, children, and adolescents is distinctly different due to the anatomic differences that evolve with growth. Accordingly, clinical presentation and consequences of airway obstruction vary by age. This article reviews the common upper airway disorders by age with a review of classic presentation, recommended diagnostic steps, and management considerations for the general pediatrician. [Pediatr Ann. 2019;48(4):e162-e168.].


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Sistema Respiratório/fisiopatologia , Adolescente , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Criança , Pré-Escolar , Gerenciamento Clínico , Humanos , Lactente
10.
Ann Thorac Surg ; 108(1): 203-210, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30872098

RESUMO

BACKGROUND: The flow-volume curve is a simple test for diagnosing upper airway obstruction. We evaluated its use to predict recurrence in patients undergoing endoscopic dilation for treatment of benign upper airway stenosis. METHODS: The data of 89 consecutive patients undergoing endoscopic dilation of simple upper airway stenosis were retrospectively reviewed. Morphologic distortion of flow-volume loop (visual analysis) and quantitative criteria, including maximal expiratory flow rate at 50% of the vital capacity (MEF50%)/maximal inspiratory flow rate at 50% of the vital capacity (MIF50%) of less than 0.3 or more than 1.0, forced expiratory volume in 1 second/MEF exceeding 10, and forced expiratory volume in 1 second/forced expiratory volume in .05 second exceeding 1.5, were considered predictive of recurrence. In all cases, the recurrence was confirmed by radiologic or bronchoscopic findings, or both. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual, quantitative, and aggregate criteria for detecting recurrence were computed and compared. RESULTS: Of 89 patients treated, 27 (30%) had a recurrence. Visual analysis presented a sensitivity, specificity, PPV, NPV, and accuracy of 63%, 83.9%, 63%, 83.9%, and 77.5%, respectively. Among the quantitative criterion, the MEF50%/MIF50% was the most accurate, having a sensitivity, specificity, PPV, NPV, and accuracy of 77.8%, 79%, 61.8%, and 89.1%, and 78.7%, respectively. Aggregate criterion presented the best yield compared with other criteria in sensitivity (81.5%), specificity (91.9%), PPV (81.5%), NPV (91.9%), and accuracy (88.8%). CONCLUSIONS: The flow-volume curve is a simple and noninvasive method to monitor patients undergoing endoscopic dilation of upper airway stenosis. Morphologic changes in the flow-volume loop and in the MEF50%/MIF50% ratio are suggestive of recurrence and guide the physician to implement the follow-up with further diagnostic (non)invasive examinations.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Fluxo Expiratório Forçado , Medidas de Volume Pulmonar , Idoso , Obstrução das Vias Respiratórias/fisiopatologia , Obstrução das Vias Respiratórias/terapia , Constrição Patológica/diagnóstico , Dilatação/métodos , Endoscopia , Feminino , Humanos , Pulmão/fisiologia , Masculino , Recidiva , Estudos Retrospectivos
11.
Korean J Gastroenterol ; 73(2): 105-108, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30845387

RESUMO

Achalasia is a motility disorder of the esophagus that is characterized by loss of ganglionic neurons within the myenteric plexus of the lower esophageal sphincter (LES) resulting in failure of the LES to relax. Clinically this disorder presents with simultaneous dysphagia to solids and liquids, and if left untreated, leads to esophageal dilation, which can give rise to many adverse consequences. Extrinsic compression of respiratory structures is one such consequence, and rarely, cases of tracheal compression secondary to achalasia have been reported. However, cases of extrinsic bronchial compression are yet rarer. Here, we present a case series comprised of two patients with achalasia who presented with extrinsic bronchial compression by a dilated esophagus secondary to achalasia.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Acalasia Esofágica/diagnóstico , Adulto , Obstrução das Vias Respiratórias/complicações , Asma/patologia , Endoscopia Gastrointestinal , Epilepsia/patologia , Acalasia Esofágica/etiologia , Esfíncter Esofágico Inferior/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/patologia , Tomografia Computadorizada por Raios X
12.
J Pediatr Surg ; 54(6): 1153-1158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30890267

RESUMO

PURPOSE: Congenital high airway obstruction syndrome (CHAOS) is a devastating fetal condition of complete airway discontinuity resulting in significant hydrops and extreme lung hyperplasia. It is universally fatal with survival reported only in the rare spontaneous fistulization or EXIT intervention (Ex Utero Intrapartum Treatment). Even in these cases, mortality remains high, and current investigations are targeting prenatal interventions. This report describes our experience with management and fetal interventions for CHAOS, including laser laryngotomy. METHODS: We retrospectively reviewed all patients diagnosed with CHAOS at a single academic institution between 2006 and 2017. RESULTS: Fifteen patients were identified. Eight had obstruction at the trachea and seven at the larynx. In the laryngeal obstructions, three expired shortly after birth, and one survived after spontaneous fistulization and subsequent EXIT to tracheostomy. The remaining three underwent in-utero treatment with laser laryngotomy. One had preterm premature rupture of membranes (PPROM), delivered 3 days post-operatively, and died. Two underwent EXIT to tracheostomy with one surviving to discharge and is currently 2 years old. CONCLUSION: Our study demonstrates the outcomes of a large series of patients diagnosed with CHAOS. While mortality remains high, options for fetal intervention are being explored to allow alterations in the prenatal natural history and improve postnatal outcomes. TYPE OF STUDY: Retrospective Treatment Study. LEVEL OF EVIDENCE: Level IV.


Assuntos
Obstrução das Vias Respiratórias , Doenças Fetais , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/terapia , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/terapia , Humanos , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Síndrome , Traqueostomia
13.
Clin Plast Surg ; 46(2): 249-259, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30851756

RESUMO

Pierre Robin sequence consists of clinical triad of micrognathia, glossoptosis, and airway compromise with variable inclusion of cleft palate. Evaluation of airway obstruction includes physical examination, polysomnography for obstruction events, and a combination of nasoendoscopy and bronchoscopy to search for synchronous obstructive lesions. A multidisciplinary approach is required given the high rate of syndromic disease. Management of airway obstruction and feeding starts with nonsurgical maneuvers, such as prone and lateral positioning, nasopharyngeal stenting, and continuous positive airway pressure. Surgical management includes mandibular distraction and tongue-lip adhesion. Subglottic obstruction and central sleep apnea may best be treated with tracheostomy.


Assuntos
Obstrução das Vias Respiratórias/terapia , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/cirurgia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Feminino , Humanos , Lactente , Masculino , Mandíbula/cirurgia , Boca/embriologia , Osteogênese por Distração , Síndrome de Pierre Robin/diagnóstico , Polissonografia , Traqueostomia
14.
J Coll Physicians Surg Pak ; 29(3): 258-262, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823954

RESUMO

OBJECTIVE: To describe the clinical spectrum and outcome-associated variables of pediatric malignant mediastinal masses in a resource-limited setting. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Pediatric Hematology-Oncology, The Children's Hospital, Lahore, from October 2016 to November 2017. METHODOLOGY: Children with malignant mediastinal masses were enrolled. The variables studied were median age at presentation, gender distribution, immunisation status, socio-economic background, causes of delayed presentation, presenting complaints, complications of disease, methods for mass biopsy, final diagnosis, staging, and outcome of the disease. Results were described in terms of descriptive statistics. RESULTS: The median age at diagnosis was 7.5 years with male-to-female ratio of 2:1. The commonest presenting complaint was fever (82%), respiratory distress (58%), and lymphadenopathy (51%). Seventy-eight percent patients belonged to lower socio-economic class. Eighty-six percent of patients had delayed presentation to the tertiary care hospital and the most common reason was delayed diagnosis by the medical professionals (49%). Fifty-one percent patients had weight-for-age less than 5th percentile. Common complications were airway obstruction (35%), pericardial effusion (19.6%), superior vena cava syndrome and gross pleural effusion (13.7% each). Commonest diagnosis was T-cell acute lymphoblastic leukemia (35%) followed by lymphoblastic lymphoma and Hodgkin's lymphoma (15.7% each). Fourtyfive percent patients expired, 2% defaulted treatment and 5.9% completed treatment; 25% patients were under treatment, 3.9% patients had progressive disease while outcome of 17.6% of patients could not be known. The most significant factor associated with the outcome primary diagnosis (p<0.001), delayed presentation (p=0.007) and educational status of the family. CONCLUSION: The pattern of clinical presentation, complications and diagnoses of pediatric malignant mediastinal masses showed some variation from the already reported. Low literacy rate and delay in presentation are common and contribute significantly to the poor outcome.


Assuntos
Causas de Morte , Neoplasias do Mediastino/epidemiologia , Neoplasias do Mediastino/patologia , Derrame Pleural Maligno/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Fatores Etários , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/epidemiologia , Obstrução das Vias Respiratórias/cirurgia , Criança , Pré-Escolar , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Febre/diagnóstico , Febre/etiologia , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/terapia , Humanos , Masculino , Neoplasias do Mediastino/terapia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Medição de Risco , Arábia Saudita , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida
15.
Ear Nose Throat J ; 98(2): 98-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30885002

RESUMO

The diagnosis of subglottic stenosis (SGS) is usually made by clinical assessment and definitively by a direct endoscopic examination. This study aimed to evaluate different spirometric values in relation to anatomical grading and severity of subglottic stenosis cases of upper airway obstruction. Cases of SGS that underwent dilatational procedures endoscopically at the otolaryngology department of the King Saud University Medical City, Riyadh, Saudi Arabia, from June 2015 to October 2017 were collected. Pulmonary function test (PFT) pre- and postoperative parameters and the grades of subglottic stenosis were extracted. We compared different spirometric values to the severity of SGS and compared the pre- and postoperative results for each patient. There were 19 cases with a valid PFT study within 7 days preoperatively in addition to a documented intraoperative grading according to the Myer-Cotton grading system; 7 (36.8%) were grade 1, 8 (42.1%) were grade 2, and 4 (21.1%) were grade 3. The actual preoperative ratio of forced expiratory volume (FEV1) in 1 second to peak expiratory flow (PEF) for all 19 patients ranged from 7.34 to 21.40 mL/L/min. We found a significant improvement in all spirometric parameters postdilatation including PEF ( P < .001), FEV1 ( P < .001), FEV1/PEF ( P = .001), forced expiratory flow (FEF) from 25%, 50%, and 75% of vital capacity, respectively, FEF25 ( P < .001), FEF50 ( P = .001), FEF75 ( P = .048), and maximum mid-expiratory flow ( P = .002). We did not find any correlation between the severity of stenosis and spirometric values. This study revealed that spirometry is a useful marker in following up patients with subglottic stenosis and is also a good indicator to determine postairway surgery outcomes. However, these markers do not correlate with anatomical grading and the severity of subglottic stenosis.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Laringoestenose/diagnóstico , Índice de Gravidade de Doença , Espirometria/estatística & dados numéricos , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/patologia , Biomarcadores/análise , Dilatação , Feminino , Humanos , Laringoestenose/complicações , Laringoestenose/patologia , Masculino , Período Pós-Operatório , Período Pré-Operatório , Valores de Referência
16.
Clin Respir J ; 13(4): 239-246, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30735004

RESUMO

BACKGROUND: Pulmonary function is not routinely assessed in patients without respiratory disease and symptoms before surgery, even if they are smokers. We aimed to check whether the new spirometric reference values of the worldwide Global Lung Initiative (GLI) affected the preoperative assessment of lung function in allegedly lung-healthy patients compared with the still commonly used old predicted values. METHODS: Two hundred nineteen allegedly lung-healthy non-smokers, past and current smokers were examined by spirometry before elective surgery. The obtained values of forced expiratory volume in 1 second (FEV1 ), forced vital capacity (FVC) and FEV1 /FVC were transformed into z-scores according to the GLI guidelines. A comparison between the new and old reference values was performed. FEV1 was used for the grading of airway obstruction. RESULTS: One hundred eighty-three subjects performed the ventilation manoeuvre according to the GLI recommendations and were analysed. Most non-smokers and past smokers met the new references ranges for spirometric values. Only z-scores of FEV1 /FVC distinguished among all three patient groups, FEV1 between smokers and the other two groups and FVC did not discriminate the groups, irrespective of the reference values used. Airway obstruction was identified in 24% of asymptomatic smokers by z-scores of FEV1 /FVC but in only 14% by the old predicted values. In elderly smokers (>60 years), the corresponding values rose to 50% and 30%. Old predicted values of FEV1 underestimated the degree of airway obstruction mainly in middle-aged smokers. CONCLUSION: Allegedly lung-healthy current smokers showed a higher proportion of preoperatively reduced lung function when z-scores were used, especially in elderly subjects.


Assuntos
Obstrução das Vias Respiratórias/classificação , Pulmão/fisiopatologia , Testes de Função Respiratória/métodos , Espirometria/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/diagnóstico , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Volume Expiratório Forçado/fisiologia , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/normas , Ventilação Pulmonar , Valores de Referência , Fumantes/estatística & dados numéricos , Capacidade Vital/fisiologia
17.
JAMA ; 321(5): 493-503, 2019 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-30721300

RESUMO

Importance: Recognizing patients in whom endotracheal intubation is likely to be difficult can help alert physicians to the need for assistance from a clinician with airway training and having advanced airway management equipment available. Objective: To identify risk factors and physical findings that predict difficult intubation. Data Sources: The databases of MEDLINE and EMBASE were searched from 1946 to June 2018 and from 1947 to June 2018, respectively, and the reference lists from the retrieved articles and previous reviews were searched for additional studies. Study Selection: Sixty-two studies with high (level 1-3) methodological quality that evaluated the accuracy of clinical findings for identifying difficult intubation were reviewed. Data Extraction and Synthesis: Two authors independently abstracted data. Bivariate random-effects meta-analyses were used to calculate summary positive likelihood ratios across studies or univariate random-effects models when bivariate models failed to converge. Results: Among the 62 high-quality studies involving 33 559 patients, 10% (95% CI, 8.2%-12%) of patients were difficult to intubate. The physical examination findings that best predicted a difficult intubation included a grade of class 3 on the upper lip bite test (lower incisors cannot extend to reach the upper lip; positive likelihood ratio, 14 [95% CI, 8.9-22]; specificity, 0.96 [95% CI, 0.93-0.97]), shorter hyomental distance (range of <3-5.5 cm; positive likelihood ratio, 6.4 [95% CI, 4.1-10]; specificity, 0.97 [95% CI, 0.94-0.98]), retrognathia (mandible measuring <9 cm from the angle of the jaw to the tip of the chin or subjectively short; positive likelihood ratio, 6.0 [95% CI, 3.1-11]; specificity, 0.98 [95% CI, 0.90-1.0]), and a combination of physical findings based on the Wilson score (positive likelihood ratio, 9.1 [95% CI, 5.1-16]; specificity, 0.95 [95% CI, 0.90-0.98]). The widely used modified Mallampati score (≥3) had a positive likelihood ratio of 4.1 (95% CI, 3.0-5.6; specificity, 0.87 [95% CI, 0.81-0.91]). Conclusions and Relevance: Although several simple clinical findings are useful for predicting a higher likelihood of difficult endotracheal intubation, no clinical finding reliably excludes a difficult intubation. An abnormal upper lip bite test, which is easily assessed by clinicians, raises the probability of difficult intubation from 10% to greater than 60% for the average-risk patient.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Intubação Intratraqueal , Humanos , Intubação Intratraqueal/efeitos adversos , Arcada Osseodentária/anatomia & histologia , Funções Verossimilhança , Boca/anatomia & histologia , Faringe/anatomia & histologia , Fatores de Risco , Sensibilidade e Especificidade
18.
Rev Invest Clin ; 71(1): 28-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810541

RESUMO

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cut-off point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/métodos , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/fisiopatologia , Broncodilatadores/administração & dosagem , Volume Expiratório Forçado/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Tempo
19.
Korean J Radiol ; 20(1): 50-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30627021

RESUMO

In pediatric thoracic CT, respiratory motion is generally treated as a motion artifact degrading the image quality. Conversely, respiratory motion in the thorax can be used to answer important clinical questions, that cannot be assessed adequately via conventional static thoracic CT, by utilizing four-dimensional (4D) CT. However, clinical experiences of 4D thoracic CT are quite limited. In order to use 4D thoracic CT properly, imagers should understand imaging techniques, radiation dose optimization methods, and normal as well as typical abnormal imaging appearances. In this article, the imaging techniques of pediatric thoracic 4D CT are reviewed with an emphasis on radiation dose. In addition, several clinical applications of pediatric 4D thoracic CT are addressed in various thoracic functional abnormalities, including upper airway obstruction, tracheobronchomalacia, pulmonary air trapping, abnormal diaphragmatic motion, and tumor invasion. One may further explore the clinical usefulness of 4D thoracic CT in free-breathing children, which can enrich one's clinical practice.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Traqueobroncomalácia/diagnóstico por imagem , Obstrução das Vias Respiratórias/diagnóstico , Artefatos , Criança , Diafragma/fisiologia , Humanos , Pulmão/fisiopatologia , Neoplasias Pulmonares/diagnóstico , Respiração , Tórax/diagnóstico por imagem , Traqueobroncomalácia/diagnóstico
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