RESUMO
OBJECTIVE: The purpose of this study was to evaluate the use of MDCT to assess response to bronchial thermoplasty treatment for severe persistent asthma. MATERIALS AND METHODS: MDCT data from 26 patients with severe persistent asthma who underwent imaging before and after bronchial thermoplasty were analyzed retrospectively. Changes in the following parameters were assessed: total lung volume, mean lung density, airway wall thickness, CT air trapping index (attenuation < -856 HU), and expiratory-inspiratory ratio of mean lung density (E/I index). Asthma Quality of Life Questionnaire score changes were also assessed. RESULTS: Median total lung volumes before and after bronchial thermoplasty were 2668 mL (range, 2226-3096 mL) and 2399 mL (range, 1964-2802 mL; p = 0.08), respectively. Patients also showed a pattern of obstruction improvement in air trapping values (median before thermoplasty, 14.25%; median after thermoplasty, 3.65%; p < 0.001] and in mean lung density values ± SD (before thermoplasty, -702 ± 72 HU; after thermoplasty, -655 ± 66 HU; p < 0.01). Median airway wall thickness also decreased after bronchial thermoplasty (before thermoplasty, 1.5 mm; after thermoplasty, 1.1 mm; p < 0.05). There was a mean Asthma Quality of Life Questionnaire overall score change of 1.00 ± 1.35 (p < 0.001), indicating asthma clinical improvement. CONCLUSION: Our study showed improvement in CT measurements after bronchial thermoplasty, along with Asthma Quality of Life Questionnaire score changes. Thus, MDCT could be useful for imaging evaluation of patients undergoing this treatment.
Assuntos
Técnicas de Ablação , Asma/tratamento farmacológico , Asma/cirurgia , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Pulmonares/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Persistent pulmonary air leak is the most frequent complication after lung resection, resulting in an increase in postoperative morbidity and mortality. We evaluated the viability, integration, and efficacy of a free peritoneal fat graft as a method for controlling air leak in normal and emphysematous rat lungs. METHODS: Sixty Wistar rats were divided into two groups: elastase-produced lung emphysema (n=30) and control (normal) lungs (n=30). Pulmonary air leak was produced by puncture of the right lower lobe, and aerostasis was attempted by means of intrapulmonary injection of autologous free peritoneal fat graft. Rats in each group (n=6) were randomly allocated to subgroups and were sacrificed at 7, 14, 21, 30, and 60 days. Then, lungs were removed for histology, morphometry, vessel identification and counting, and immunohistochemistry for caspase 3, vascular endothelial growth factor, and factor VIII. RESULTS: Tissue integration of the free fat grafts was found in all animals in both groups. Vessels stained with India ink inside the fat grafts were present at all assessment periods in both groups. Vascular endothelial growth factor expression was significantly higher in all periods in the emphysema group compared with normal lungs (p<0.001). There was a significant increase in caspase 3 expression in the emphysema group at 7, 21, 30, and 60 days (p<0.001). Factor VIII showed a significant increase (p<0.001) at 30 and 60 days in emphysematous lungs. CONCLUSIONS: The use of free peritoneal fat graft was able to control the air leaks in normal and emphysematous rat lungs, with persisting graft viability for as long as 60 days after implantation.
Assuntos
Gordura Intra-Abdominal/transplante , Enfisema Pulmonar/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Animais , Modelos Animais de Doenças , Cavidade Peritoneal , Projetos Piloto , Pneumonectomia/efeitos adversos , Enfisema Pulmonar/etiologia , Ratos , Ratos Wistar , Transplante AutólogoRESUMO
O objetivo do presente trabalho é uma revisão do tratamento endoscópico das estenoses laringotraqueais benignas. O tratamento de eleição para este tipo de estenose é a ressecção com anastomose primária. Entretanto, nem sempre essa situação pode ser alcançada devido a natureza, extensão e localização das estenoses. O tratamento endoscópico é uma alternativa em casos nos quais a ressecção não é possível ou após complicações ou insucessos nas ressecções prévias. O tratamento endoscópico inclui dilatações, ressecção endoscópica com eletrocautério, laser, argon plasma coagulation, crioterapia, braquiterapia e a utilização de endopróteses. Todos esses métodos de dilatação mecânica produzem um resultado imediato satisfatório, com aumento da via aérea e melhora dos sintomas clínicos, mas a durabilidade da terapia continua problemática. Em poucos dias ou semanas retornam os sintomas que obrigam repetidas reintervenções. As endopróteses são divididas em: silicone rígido e metálico autoexpansível. As endopróteses de silicone são as mais utilizadas na literatura e com o maior seguimento em longo prazo. As endopróteses metálicas autoexpansíveis foram introduzidas mais recentemente, e, devido à facilidade de aplicação, ocorreram abusos na utilização com diversas complicações. Mais recentemente, as endopróteses chamadas híbridas congregam componentes metálicos autoexpansíveis com uma cobertura de silicone.
This review focuses on endoscopic treatment of benign laryngotracheal stenoses. The standard treatment for laryngotracheal stenoses is surgical resection and reconstruction of the primary airway. However, when surgical resection is not feasible due to the nature, extent, or location of the stenosis, endoscopy presents an alternative for treating complications and for the management of previous unsuccessful resections. Endoscopic treatment includes electrocauterization, laser resection, argon plasma coagulation, cryotherapy, brachytherapy,and stent placement. Although endoluminal approaches have been shown to improve luminal patency, none have produced consistent results and the durability of their effects remains problematic, resulting in a high rate of repeat interventions. There are two basic types of stents: silicon stents; and self-expandable metal stents. Silicon stents are less expensive, more widely available, and still the most often studied. However, the newer, metal stents are easier to insert and position. Therefore, metal stents have been overused, resulting in complications. Recently, hybrid stents, such as one composed of a metal scaffold and a silicon coating with self-expandable capabilities, have been introduced.
Assuntos
Humanos , Masculino , Feminino , Broncoscopia/métodos , Estenose Traqueal/diagnóstico , Estenose Traqueal/terapia , Próteses e Implantes , Stents , Técnicas e Procedimentos Diagnósticos , Endoscopia/métodosRESUMO
OBJECTIVE: To assess the safety and early clinical results of a multicenter evaluation of airway bypass with paclitaxel-eluting stents for selected patients with severe emphysema. METHODS: Airway bypass was performed with a fiberoptic bronchoscope in three steps: identification of a blood vessel-free location with a Doppler probe at the level of segmental bronchi, fenestration of the bronchial wall, and placement of a paclitaxel-eluting stent to expand and maintain the new passage between the airway and adjacent lung tissue. All adverse events were recorded, as well as 1- and 6-month pulmonary function tests and dyspnea index. RESULTS: Thirty-five patients received the airway bypass procedure with a median of 8 stents implanted per patient. At 1-month follow-up, statistically significant differences in residual volume, total lung capacity, forced vital capacity, forced expiratory volume, modified Medical Research Council scale, 6-minute walk, and St George's Respiratory Questionnaire were observed. At the 6-month follow-up, statistically significant improvements in residual volume and dyspnea were demonstrated. One death occurred after bleeding during the procedure. Retrospective analysis revealed that the degree of pretreatment hyperinflation may be an important indicator of which patients achieve the best short- and long-term results. CONCLUSIONS: The airway bypass procedure reduces hyperinflation and improves pulmonary function and dyspnea in selected patients with severe emphysema. Duration of benefit appears to correlate with the degree of pretreatment hyperinflation. These preliminary clinical results support further evaluation of the procedure.
Assuntos
Sistemas de Liberação de Medicamentos , Paclitaxel/administração & dosagem , Enfisema Pulmonar/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Broncoscopia , Desenho de Equipamento , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias , Enfisema Pulmonar/fisiopatologia , Testes de Função Respiratória , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Aortopulmonary paraganglioma is a rare tumor of the mediastinum. The only effective treatment is complete resection, which may pose a surgical challenge because of its proximity to the heart, great vessels, and trachea, often rendering a complete resection difficult to achieve. We report a case in which the tumor was excised under cardiopulmonary bypass and resulted in massive bleeding only controlled by means of packing the pleural cavity during 48 hours, known as damage control strategy. The patient survived and has been disease-free for 2 years.
Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Doenças do Mediastino/cirurgia , Paraganglioma/cirurgia , Artéria Pulmonar/cirurgia , Neoplasias Vasculares/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/patologia , Biópsia , Ponte Cardiopulmonar , Feminino , Seguimentos , Hemostasia Cirúrgica , Humanos , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/patologia , Neovascularização Patológica/cirurgia , Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologiaRESUMO
A desmoid tumor of the mediastinum was diagnosed and terated in a 35 year-old white male who presented with a right supraclavicular mass. He was treated with resection, which involved several vascular structures, requiring multiple vascular reconstructions followed by postoperative radiotherapy. The authors concluded that, when located in tha mediastinum, the invasive character of such tumors and its tendency to recur may pose a considerable surgical challenge, requiring careful preoperative planing and postoperative planning follow-up. The role of radiation therapy is limited to the control of local recurrences