RESUMO
Dentro de la práctica clínica en pediatría existen situaciones en las que el diagnóstico oportuno de una enfermedad involucra la meditación de situaciones insospechadas; en niños muy pequeños el interrogatorio indirecto bien realizado y detallado se convierte en herramienta fundamental para su tratamiento. En un evento de aspiración de cuerpo extraño existen indicadores específicos para tener sospecha de que estamos ante un caso; sin embargo, no todos los pacientes presentan signos y síntomas clásicos, por lo que la experiencia del clínico es vital. Se presenta el caso de un niño de veintiún meses de edad que broncoaspiró una corona de acero cromo en un consultorio dental; ésta no fue identificada sino hasta 60 días después del accidente. Es importante que los clínicos encargados de la salud bucal de los niños estén capacitados para auxiliar a sus pacientes ante un evento de aspiración de cuerpo extraño, tanto de forma inmediata como mediata, teniendo una conducta responsable ante la sospecha fundamentada de que ocurrió un accidente de esta naturaleza.
Within the scope of pediatric medical practice, certain situations arise where timely diagnosis of a condition implies facing unforeseen situations. Clinical history is clearly paramount for the correct and precise handling of any patient, even more so for very young patients from whom obtained data can be frequently imprecise. With respect to foreign body aspiration accidents, there are specific indicators which substantiate a suspicion of that case. Nevertheless, not all cases are typical, therefore, experience of the clinical operator is essential. The present study presents the case of a one year and nine months old patient who broncho-aspirated a chrome-steel crown in a dental practice, and the situation was only diagnosed 60 days later. The present diagnosis was emitted at once when the patient arrived at the National Pediatrics Institute. To that aim, a thorax X-ray was taken. The present case can be considered a paradigm. It supports the idea that the oral cavity of very young patients must be treated by qualified specialists, and that such care must be given in centers which can guarantee the patient's safety. A foreign body can remain in the bronchii for a long time, without directly endangering the patient's life. Nevertheless, this situation would introduce the patient into a dangerous chronicity, therefore, emergency room physicians should be aware of the possibility of a substantiated suspicion of foreign body aspiration. These cases, after suitable history research and auscultation could have been avoided, and thus avoid a serious chronic situation in these patients.
RESUMO
OBJECTIVE: To assess the capacity of high and low doses of the antimitotic drug mitomycin to prevent laryngeal stenosis in an animal model. METHODS: A prospective, randomized, double-blind, controlled study was carried out. End-to-end anastomosis was performed in 18 rabbits after tracheal annulus resection to produce inflammation. There were 3 treatment groups: topical saline (isotonic sodium chloride solution) and low-dose (0.2 mg/mL) and high-dose (0.5 mg/mL) topical mitomycin. RESULTS: A total of 107 procedures were performed: 54 surgical procedures, 35 fibrobronchoscopies, and 18 biopsies. The effect of mitomycin was dose related. In the high-dose mitomycin group, most rabbits progressed to stenosis with a percentage decrease in airway diameter that was significantly greater than in the other 2 groups (P <.001). The mean (SD) percentage of maximum stenosis in the high-dose group was 51% (22%). In the low-dose and saline groups, it was 18% (13%) and 16% (9%), respectively. No significant differences in tracheal stenosis between the low-dose mitomycin and saline groups were observed. Blinded histopathological analysis also showed no significant differences between the saline group and the low-dose mitomycin group. Compared with the other 2 groups, the high-dose mitomycin group had a significant increase in fibroproliferative tissue (P <.001). CONCLUSION: These results suggest that topical mitomycin is not effective for avoiding tracheal stenosis and may provoke the opposite effect if the dose is not carefully selected.
Assuntos
Anastomose Cirúrgica , Antimitóticos/farmacologia , Modelos Animais de Doenças , Laringoestenose/prevenção & controle , Mitomicina/farmacologia , Complicações Pós-Operatórias/prevenção & controle , Traqueia/cirurgia , Estenose Traqueal/prevenção & controle , Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/prevenção & controle , Animais , Biópsia , Broncoscopia , Relação Dose-Resposta a Droga , Laringoscopia , Laringoestenose/patologia , Laringe/patologia , Laringe/cirurgia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Coelhos , Traqueia/patologia , Estenose Traqueal/patologiaRESUMO
Se presenta el caso de un tumor subglótico en un hombre de 44 años, cuyo estudio histológico mostró un carcinoma de células pequeñas confirmado con un estudio inmunohistoquímico complementario. Se analiza el tratamiento y evolución de dicho caso. Se efectúa una revisión bibliográfica internacional de los tumores neuroendocrinos y, entre ellos, el de células pequeñas laríngeo, que si bien es poco frecuente, hoy conocemos mejor su importancia en la otorrinolaringología. El comportamiento clínico y las opciones de manejo son presentadas. Se discute, además, el rol del estudio inmunohistoquímico como apoyo para la obtención de un correcto diagnóstico histológico