RESUMEN
AIM: To determine the range of tracheal collapse at end-expiration among chronic obstructive pulmonary disease (COPD) patients and to compare the extent of tracheal collapse between static end-expiratory and dynamic forced-expiratory multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: After institutional review board approval and obtaining informed consent, 67 patients meeting the National Heart, Lung, and Blood Institute (NHLBI)/World Health Organization (WHO) Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD were sequentially imaged using a 64-detector-row CT machine at end-inspiration, during forced expiration, and at end-expiration. Standardized respiratory coaching and spirometric monitoring were employed. Mean percentage tracheal collapse at end-expiration and forced expiration were compared using correlation analysis, and the power of end-expiratory cross-sectional area to predict excessive forced-expiratory tracheal collapse was computed following construction of receiver operating characteristic (ROC) curves. RESULTS: Mean percentage expiratory collapse among COPD patients was 17 ± 18% at end-expiration compared to 62 ± 16% during forced expiration. Over the observed range of end-expiratory tracheal collapse (approximately 10-50%), the positive predictive value of end-expiratory collapse to predict excessive (≥80%) forced expiratory tracheal collapse was <0.3. CONCLUSION: COPD patients demonstrate a wide range of end-expiratory tracheal collapse. The magnitude of static end-expiratory tracheal collapse does not predict excessive dynamic expiratory tracheal collapse.
Asunto(s)
Espiración , Tomografía Computarizada Multidetector , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Pruebas de Función Respiratoria , Tráquea/fisiopatología , Traqueomalacia/fisiopatología , Anciano , Análisis de Varianza , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tráquea/diagnóstico por imagen , Traqueomalacia/diagnóstico por imagen , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Endovascular intervention for mycotic aortic aneurysms is now an alternative treatment option. CASE REPORT: An 83-year-old male presented with confusion and pyrexia of unknown origin. Acute deterioration and subsequent computed tomography scan of the abdomen revealed a contained rupture of a mycotic aortic aneurysm for which the patient had a successful endovascular repair. CONCLUSION: Endovascular management of aortic mycotic aneurysms provides an alternate and potentially safer method of intervention, particularly in patients deemed unsuitable for open repair.
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Aneurisma Infectado/cirugía , Rotura de la Aorta/cirugía , Infecciones Estreptocócicas/tratamiento farmacológico , Anciano de 80 o más Años , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/tratamiento farmacológico , Antibacterianos/uso terapéutico , Rotura de la Aorta/diagnóstico por imagen , Procedimientos Endovasculares , Humanos , Masculino , Radiografía , StentsRESUMEN
BACKGROUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.
Asunto(s)
Aneurisma de la Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Abdominal/cirugía , Elasticidad/fisiología , Microcirculación/fisiología , Anciano , Aorta Abdominal/fisiopatología , Presión Sanguínea/fisiología , Femenino , Humanos , Flujometría por Láser-Doppler , Masculino , Manometría , Trasplante de Tejidos/fisiologíaAsunto(s)
Enfermedades de la Aorta/complicaciones , Enfermedades del Ciego/etiología , Fístula Intestinal/complicaciones , Obstrucción Intestinal/etiología , Enfermedades del Yeyuno/etiología , Fístula Vascular/complicaciones , Dolor Abdominal/etiología , Anciano , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Prótesis Vascular , Enfermedades del Ciego/diagnóstico por imagen , Femenino , Humanos , Fístula Intestinal/diagnóstico por imagen , Obstrucción Intestinal/diagnóstico por imagen , Enfermedades del Yeyuno/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Tomografía Computarizada por Rayos XRESUMEN
Early diagnosis and treatment of the respiratory and gastrointestinal complications of cystic fibrosis (CF) have led to improved survival with many patients living beyond the fourth decade. Along with this increased life expectancy is the risk of further disease associated with the chronic manifestations of their condition. We report a patient with documented CF related liver disease for which he was under routine surveillance that presented with histologically proven hepatocellular carcinoma (HCC). It is important that physicians are aware of this association as increased vigilance may lead to earlier diagnosis and perhaps, a better outcome.