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El síndrome de Williams-Campbell (SWC) es una entidad clínica caracterizada por la deficiencia de cartílago en la pared bronquial de los bronquios subsegmentarios. Es una condición congénita que por lo general se diagnostica en la niñez, pero hay reportes de caso en la población adulta y se cree que esto se debe a un menor déficit de cartílago. Los síntomas principales de esta condición son la presencia de tos, disnea e infecciones respiratorias a repetición. Radiológicamente, se evidencia la presencia de bronquiectasias de pared delgada. El diagnóstico se basa en descartar otras causas más comunes de bronquiectasias, así como en la identificación de las características radiológicas y la presencia del componente congénito. Presentamos el caso de un joven con síntomas respiratorios desde la infancia, con necesidad de múltiples hospitalizaciones por procesos infecciosos de origen pulmonar a repetición, con lo cual se llega al diagnóstico de un síndrome de Williams-Campbell.

Williams-Campbell syndrome (WCS) is a clinical entity characterized by cartilage deficiency in the bronchial wall of the subsegmental bronchi. It is a congenital condition that is usually diagnosed in childhood, but there are case reports in the adult population, and it is believed that this is due to a minor cartilage deficiency. The main symptoms of this condition are the presence of cough, dyspnea and repeated respiratory infections. Radiologically, the presence of thin-walled bronchiectasis is evident. The diagnosis is based on ruling out other more common causes of bronchiectasis, as well as identifying the radiological characteristics and the presence of the congenital component. We present the case of a young man with respiratory symptoms since childhood requiring multiple hospitalizations due to repeated infectious processes of pulmonary origin, in which the diagnosis of Williams-Campbell syndrome was reached.

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El complejo ring-sling es una asociación entre el sling de la arteria pulmonar y la estenosis traqueal congénita por anillos traqueales completos. El sling de la arteria pulmonar es una forma rara de anillo vascular dentro de las cardiopatías congénitas. Se presenta el caso clínico de un niño con estridor laríngeo asociado a dificultad respiratoria evaluado en otro centro, donde se realizó endoscopia respiratoria y se observó compresión traqueal extrínseca. Ante la sospecha clínica de anillo vascular, se solicitó angiotomografía computada (angioTC) y se confirmó diagnóstico de sling de arteria pulmonar. Fue derivado a nuestro hospital y durante la intervención quirúrgica se realizó nueva endoscopia respiratoria y traqueobroncografía. Se llegó al diagnóstico de estenosis traqueal congénita con bronquio derecho accesorio (pig bronchus) y anillos vasculares completos, ambos reparados en el mismo acto quirúrgico.

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

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Abstract Objective: To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods: The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results: The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion: The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.

Resumo Objetivo: Analisar os achados na tomografia computadorizada (TC) de tórax de 23 pacientes com atresia brônquica. Materiais e Métodos: As imagens de TC foram avaliadas por dois observadores e os casos discordantes foram resolvidos por consenso. Os critérios de inclusão foram a presença de anormalidades na TC compatíveis com atresia brônquica e/ou diagnóstico confirmado por exame anatomopatológico das peças cirúrgicas para os pacientes submetidos a ressecção cirúrgica. As TCs foram avaliadas quanto aos principais achados de imagem, à distribuição das lesões, ao envolvimento pulmonar unilateral ou bilateral. Resultados: Os principais achados na TC foram a presença de broncocele, hiperinsuflação do parênquima pulmonar ou ambos. A combinação desses achados foi encontrada em todos os pacientes. Em relação à distribuição, o envolvimento foi unilateral nos 23 casos. Quando se consideraram os lobos mais acometidos, o lobo superior esquerdo foi o mais acometido, seguido do lobo inferior direito, lobo superior direito, lobo médio e lobo inferior esquerdo. Conclusão: O diagnóstico de atresia brônquica pode ser feito em presença de broncocele associada com hiperinsuflação do parênquima pulmonar adjacente.

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Conocer la morfometría en longitud, circunferencia y angulación de los bronquios principales y del bronquio intermedio pueden ser datos relevantes en procedimientos radiológicos, quirúrgicos e inclusive en eventos que amenazan la vida como la broncoaspiración. Existe poca evidencia acerca de la morfometría de los bronquios principales y del bronquio intermedio, es por ello que el presente estudio tuvo como objetivo describir la morfometría de los bronquios principales y del bronquio intermedio en una muestra de población cadavérica colombiana. Se realizó un estudio descriptivo donde se seleccionaron 29 especímenes de Cali, Colombia; 11 correspondieron a cadáveres y 18 a órganos aislados del tracto respiratorio inferior; se incluyeron los cadáveres con las estructuras debidamente disecadas y se excluyeron las muestras con estructuras anatómicas ausentes o dañadas y que afectaran la realización de las mediciones. La media de longitud del bronquio principal derecho fue de 1,69 cm IC 95 % (1,51 - 1,87) la media de la longitud del bronquio intermedio fue de IC 95 % 2,89 cm (2,66 - 3,12), la media de longitud del bronquio principal izquierdo fue de 3,34 cm IC 95 % (3,01 - 3,68); el ángulo interbronquial tiene una media de 80,17º IC 95 % (72,87 - 87,48). Las mediciones del bronquio principal derecho concuerdan con las reportadas en la literatura, lo contrario ocurre con el bronquio principal izquierdo; la medición del ángulo interbronquial muestra diferencias a la reportada por la literatura. Este estudio muestra que a pesar de que existen nomenclaturas y consensos internacionales, estos no han sido implementados correctamente por los profesionales de la salud y el término de bronquio intermedio es utilizado en la práctica diaria, por lo que se hace necesario que las Sociedades de Anatomía y Morfología vuelvan a discutir su importancia y reconocimiento en la nomenclatura.

Knowing morphometry in length, circumference and angulation of the main bronchi and the intermediate bronchus can be relevant data in radiological, surgical procedures and even in life-threatening events such as bronchoaspiration. Evidence is scarce about the morphometry of the main bronchi and the intermediate bronchus, that is why the present study aimed to describe the morphometry of the main bronchi and the intermediate bronchus in a Colombian cadaveric population sample. A descriptive study was carried out where 29 specimens were selected from Cali, Colombia; 11 corresponded to cadavers and 18 to organs isolated from the lower respiratory tract; cadavers with duly dissected structures were included and samples with anatomical structures that were absent or damaged, and that affected the performance of the measurements were excluded. Descriptive statistics was used to analyze the data. The mean length of the right main bronchus was 1.69 cm 95 % CI (1.51-1.87), the mean length of the intermediate bronchus was 2.89 cm 95 % CI (2,663,12), the mean length of the left main bronchus was 3.34 cm 95 % CI (3-3.68); the interbronchial angle had an average of 80.17º 95 % CI (72.87-87.48). The measurements of the right main bronchus agree with those reported in the literature, the opposite occurs with the left main bronchus; interbronchial angle measurement showed differences to that reported by the literature. This study shows that although there are international nomenclatures and consensus, these have not been implemented correctly by health professionals and the term intermediate bronchus is used in daily practice, it is therefore necessary that the Societies of Anatomy and Morphology again discuss their importance and recognition in the nomenclature.

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Resumen El carcinoma mucoepidermoide bronquial es una neoplasia infrecuente, representando el 0,1 a 0,2% de los tumores malignos primarios del pulmón. En general tiene un buen pronóstico, sin embargo, existe un subtipo de alto grado de pronóstico más ominoso. En este artículo se presentan dos casos clínicos de carcinoma mucoepidermoide bronquial de bajo grado, enfocado en su diagnóstico y manejo quirúrgico.

ABSTRACT Bronchopulmonary mucoepidermoid carcinoma is an uncommon neoplasm, accounting for 0.1 to 0.2% of primary malignant tumors of the lung. In general it has a good prognosis, however there is a subtype of high grade of more ominous prognosis. In this paper we present two clinical cases of low grade pulmonary mucoepidermoid carcinoma, focused on their diagnosis and surgical management.

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Background: The eosinophilic bronchopneumopathy (EBP) is characterized by pulmonary infiltration with eosinophils. The etiology of canine EBP remains unclear, although hypersensitivity to aeroallergens is suspected. Dogs affected are usually young. The persistent cough is the most common clinical sign, often associated with respiratory difficulty and exercise intolerance. The diagnosis is based on signalment, radiographic and bronchoscopic findings, and the tissue eosiphilic infiltration demonstrated by cytology of bronchoalveolar lavage (BAL). No reports were found in Brazil. The aim of this paper is report four cases of canine BPE, with emphasis on clinical aspects, diagnosis and therapy.Cases: Case 1. A 18-month-old female dog with 12 kg of body weight was presented for consultation with a 60-day history of cough, inappetence and weariness. It presented cough and tachypnea. The complementary exams demonstrated peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography, moderate amount of mucus on bronchoscopy and tissue eosinophilis infiltration on the BAL. The treatment was based on steroids, with improvement of clinical signs. Case 2. A 24-month-old female dog with 16 kg of body weight was presented for consultation with one-year history of cough, inappetence and lethargy. It presented only cough, and in complementary exams showed transitory peripheral eosinophilia, bronchointersticial pattern on radiography and predominantly eosinophilic inflammation on citology of BAL. The therapy was based on steroids, with improvement followed by worsening of signs, with need of readjustment of doses. Case 3. A 8-year-old male dog with 6.2 kg of body weight was presented for consultation with 3-weeks history of productive cough, vomiting and weight loss. The complementary exams showed peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography and eosinophils infiltration on cytology of BAL.[...]

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Background: The eosinophilic bronchopneumopathy (EBP) is characterized by pulmonary infiltration with eosinophils. The etiology of canine EBP remains unclear, although hypersensitivity to aeroallergens is suspected. Dogs affected are usually young. The persistent cough is the most common clinical sign, often associated with respiratory difficulty and exercise intolerance. The diagnosis is based on signalment, radiographic and bronchoscopic findings, and the tissue eosiphilic infiltration demonstrated by cytology of bronchoalveolar lavage (BAL). No reports were found in Brazil. The aim of this paper is report four cases of canine BPE, with emphasis on clinical aspects, diagnosis and therapy.Cases: Case 1. A 18-month-old female dog with 12 kg of body weight was presented for consultation with a 60-day history of cough, inappetence and weariness. It presented cough and tachypnea. The complementary exams demonstrated peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography, moderate amount of mucus on bronchoscopy and tissue eosinophilis infiltration on the BAL. The treatment was based on steroids, with improvement of clinical signs. Case 2. A 24-month-old female dog with 16 kg of body weight was presented for consultation with one-year history of cough, inappetence and lethargy. It presented only cough, and in complementary exams showed transitory peripheral eosinophilia, bronchointersticial pattern on radiography and predominantly eosinophilic inflammation on citology of BAL. The therapy was based on steroids, with improvement followed by worsening of signs, with need of readjustment of doses. Case 3. A 8-year-old male dog with 6.2 kg of body weight was presented for consultation with 3-weeks history of productive cough, vomiting and weight loss. The complementary exams showed peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography and eosinophils infiltration on cytology of BAL.[...](AU)

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Introducción: el diagnóstico temprano de las enfermedades que afectan el parénquima pulmonar ya sean malignas o benignas es de vital importancia para disminuir la mortalidad por estas, la cual es elevada. La biopsia de pulmón transbroncoscópica es fundamental en el diagnóstico de dichas enfermedades con una gran efectividad y un mínimo de invasividad. Objetivo: evaluar los resultados de la biopsia de pulmón transbroncoscópica en lesiones parenquimatosas y sus complicaciones. Métodos: se realizó un estudio descriptivo, de corte transversal retrospectivo, en pacientes a los cuales se les efectuó biopsia de pulmón transbroncoscópica en lesiones parenquimatosas, en el servicio de neumología del hospital Hermanos Ameijeiras, en un periodo de 10 años. Se tomaron en cuenta las variables diagnósticos definitivos, el tipo de afectación radiológica, los factores de riesgo y las complicaciones de dicho proceder. Resultados: se realizó biopsias a 154 pacientes, a 51 se le diagnosticó una enfermedad no maligna y a 78 una enfermedad neoplásica. A 25 pacientes con radiografía torácica anormal no se les estableció diagnóstico con esta técnica. Se obtuvo una muestra adecuada en 145 pacientes (94,1 por ciento) con una exactitud diagnóstica del 83,7 por ciento en enfermedad intersticial, maligna e infecciosa pulmonar. El número de complicaciones fue mínimo. Conclusiones: la biopsia de pulmón transbroncoscópica tiene un alto rendimiento diagnóstico con un número bajo de complicaciones(AU)

Introduction: The early diagnosis of diseases that affect the lung parenchyma, whether malignant or benign, is of vital importance to reduce mortality, which is high. Transbronchoscopic lung biopsy is fundamental in the diagnosis of these diseases since it is highly effective and least invasive. Objective: To evaluate the results of transbronchoscopic lung biopsy in parenchymal lesions and their complications. Methods: A descriptive, retrospective, cross-sectional study was conducted in patients who underwent transbronchoscopic lung biopsy in parenchymal lesions at Hermanos Ameijeiras Hospital Pneumology department, over 10 years. The definitive diagnoses, the type of radiological affectation, the risk factors and the complications of said procedure were taken into account as variables. Results: 154 patients were biopsied, 51 were diagnosed with a non-malignant disease and 78 with a neoplastic disease. Twenty-five patients with abnormal chest radiography were not diagnosed using this technique. An adequate sample was obtained in 145 patients (94.1 percent) with diagnostic accuracy of 83.7 percent in interstitial, malignant and infectious lung disease. The number of complications was minimal. Conclusions: Transbronchoscopic lung biopsy has high diagnostic yield with a low number of complications(AU)

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A bronquite crônica canina (BCC) é considerada uma das doenças respiratórias mais comuns em cães. Ela é caracterizada por tosse crônica e progressiva, com comprometimento da qualidade de vida do paciente. A enfermidade é causada por um processo inflamatório de origem desconhecida, sendo mais comumente observada em cães adultos a idosos de raças de pequeno porte. Casos graves da enfermidade são caracterizados por importantes alterações estruturais das vias áreas e podem evoluir para insuficiência respiratória e óbito. A despeito disso, as informações disponíveis na literatura sobre a moléstia são extremamente limitadas, e o tratamento preconizado, baseado em poucas evidências cientificas consistentes. O objetivo deste trabalho é realizar uma revisão da literatura sobre o tema, abordando os aspectos de etiopatogenia, sinais clínicos, exames subsidiários e tratamento da BCC.

Canine Chronic Bronchitis (CCB) is considered to be one of the most common chronic respiratory diseases of dogs. The hallmark of CCB is chronic and progressive cough that leads to poor life quality of the dog. Severe cases may progress to respiratory insufficiency and death. The cause is an inflammatory process of unknown origin. The disease is most common in adult and older dogs of small animal breeds. In severe cases, this chronic inflammatory process progresses to irreversible structural changes in the airways, resulting in respiratory failure. Despite this, information about the disease is extremely limited in the literature, and the recommended treatment is based on poor scientific evidence. Thus, the aim of this study is to review the subject and describe the etiology, pathophysiology, clinical features, complementary diagnosis and treatment of CCB.

La Bronquitis Crónica Canina (BCC) es considerada una de las enfermedades respiratorias más comunes en perros. Se caracteriza por la presencia de tos crónica y progresiva y afecta la calidad de vida del paciente. La enfermedad es provocada por un proceso inflamatorio de origen desconocido, y se la observa más en perros de edad media/avanzada de razas pequeñas. Los casos graves se caracterizan por alteraciones importantes en la estructura de las vías aéreas, que pueden progresar hasta la insuficiencia respiratoria y muerte. La información disponible en la literatura es limitada y el tratamiento se fundamenta en pocas evidencias científicas consistentes. El objetivo del presente trabajo fue realizar una revisión de la literatura sobre el asunto, abordando la etiopatogenia, los signos clínicos, los exámenes complementarios y el tratamiento de la BCC.

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ABSTRACT CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.

RESUMO CONTEXTO: A doença de Dieulafoy da árvore brônquica é uma condição muito rara, poucos casos foram descritos na literatura. Pode ser assintomática ou manifestar-se com hemoptise maciça. Esta doença deve ser considerada em fumadores pesados quando eles têm recorrentes hemoptises maciças sem outros achados anormais. O tratamento pode ser tanto embolização arterial como intervenção cirúrgica. RELATO DE CASO: Uma menina de 16 anos foi admitida no Serviço de Urgências devido a hemoptise com uma lesão nos brônquios de origem desconhecida. Havia sofrido hemoptise maciça e insuficiência respiratória uma semana antes da admissão. A broncoscopia de fibra óptica relevou lesão no brônquio do lobo inferior direito, com suspeita de ser lesão de Dieulafoy. Foi realizada uma segmentectomia do lobo inferior direito com excisão da lesão. O resultado da paciente foi excelente. CONCLUSÃO: A doença de Dieulafoy é uma anomalia vascular rara, sendo extremamente rara na árvore brônquica. Na doença de Dieulafoy bronquial, embolização seletiva tem sido sugerida como método para cessação do sangramento; no entanto, a habitual resseção anatômica do pulmão é uma alternativa segura e curativa.

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A bronquite crônica canina (BCC) é considerada uma das doenças respiratórias mais comuns em cães. Ela é caracterizada por tosse crônica e progressiva, com comprometimento da qualidade de vida do paciente. A enfermidade é causada por um processo inflamatório de origem desconhecida, sendo mais comumente observada em cães adultos a idosos de raças de pequeno porte. Casos graves da enfermidade são caracterizados por importantes alterações estruturais das vias áreas e podem evoluir para insuficiência respiratória e óbito. A despeito disso, as informações disponíveis na literatura sobre a moléstia são extremamente limitadas, e o tratamento preconizado, baseado em poucas evidências cientificas consistentes. O objetivo deste trabalho é realizar uma revisão da literatura sobre o tema, abordando os aspectos de etiopatogenia, sinais clínicos, exames subsidiários e tratamento da BCC.(AU)

Canine Chronic Bronchitis (CCB) is considered to be one of the most common chronic respiratory diseases of dogs. The hallmark of CCB is chronic and progressive cough that leads to poor life quality of the dog. Severe cases may progress to respiratory insufficiency and death. The cause is an inflammatory process of unknown origin. The disease is most common in adult and older dogs of small animal breeds. In severe cases, this chronic inflammatory process progresses to irreversible structural changes in the airways, resulting in respiratory failure. Despite this, information about the disease is extremely limited in the literature, and the recommended treatment is based on poor scientific evidence. Thus, the aim of this study is to review the subject and describe the etiology, pathophysiology, clinical features, complementary diagnosis and treatment of CCB.(AU)

La Bronquitis Crónica Canina (BCC) es considerada una de las enfermedades respiratorias más comunes en perros. Se caracteriza por la presencia de tos crónica y progresiva y afecta la calidad de vida del paciente. La enfermedad es provocada por un proceso inflamatorio de origen desconocido, y se la observa más en perros de edad media/avanzada de razas pequeñas. Los casos graves se caracterizan por alteraciones importantes en la estructura de las vías aéreas, que pueden progresar hasta la insuficiencia respiratoria y muerte. La información disponible en la literatura es limitada y el tratamiento se fundamenta en pocas evidencias científicas consistentes. El objetivo del presente trabajo fue realizar una revisión de la literatura sobre el asunto, abordando la etiopatogenia, los signos clínicos, los exámenes complementarios y el tratamiento de la BCC. (AU)

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ABSTRACT Objective: to discuss the clinical and therapeutic aspects of tracheobronchial lesions in victims of thoracic trauma. Methods: we analyzed the medical records of patients with tracheobronchial lesions treated at the São Paulo Holy Home from April 1991 to June 2008. We established patients' severity through physiological (RTS) and anatomical trauma indices (ISS, PTTI). We used TRISS (Trauma Revised Injury Severity Score) to evaluate the probability of survival. Results: nine patients had tracheobronchial lesions, all males, aged between 17 and 38 years. The mean values ​​of the trauma indices were: RTS - 6.8; ISS - 38; PTTI - 20.0; and TRISS - 0.78. Regarding the clinical picture, six patients displayed only emphysema of the thoracic wall or the mediastinum and three presented with hemodynamic or respiratory instability. The time interval from patient admission to diagnosis ranged from one hour to three days. Cervicotomy was performed in two patients and thoracotomy, in seven (77.7%), being bilateral in one case. Length of hospitalization ranged from nine to 60 days, mean of 21. Complications appeared in four patients (44%) and mortality was nil. Conclusion: tracheobronchial tree trauma is rare, it can evolve with few symptoms, which makes immediate diagnosis difficult, and presents a high rate of complications, although with low mortality.

RESUMO Objetivo: discutir os aspectos clínicos e terapêuticos de lesões traqueobrônquicas em vítimas de trauma torácico. Métodos: análise de dados dos prontuários de pacientes com lesões traqueobrônquicas atendidas na Santa Casa de São Paulo no período de abril de 1991 a junho de 2008. A caracterização da gravidade dos doentes foi feita por meio de índices de trauma fisiológico (RTS) e anatômicos (ISS, PTTI). O TRISS (Trauma Revised Injury Severity Score) foi utilizado para avaliar a probabilidade de sobrevida. Resultados: nove doentes tinham lesões traqueobrônquicas, todos do sexo masculino, com idades entre 17 e 38 anos. Os valores médios dos índices de trauma foram: RTS- 6,8; ISS- 38; PTTI-20,0; TRISS-0,78. Com relação ao quadro clínico, seis apresentaram apenas enfisema de parede torácica ou do mediastino e três doentes se apresentaram com instabilidade hemodinâmica ou respiratória. O intervalo de tempo necessário para se firmar o diagnóstico, desde a admissão do doente, variou de uma hora a três dias. Cervicotomia foi realizada em dois pacientes e toracotomia foi realizada em sete (77,7%), sendo bilateral em um caso. O tempo de internação variou de nove a 60 dias, média de 21 dias. Complicações apareceram em quatro pacientes (44%) e a mortalidade foi nula. Conclusão: o trauma da árvore traqueobrônquica é raro, pode evoluir com poucos sintomas, o que dificulta o diagnóstico imediato, e apresenta alto índice de complicações embora com baixa mortalidade.

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La termoplastía bronquial es un procedimiento broncoscópico que se emplea como herramienta terapéutica en pacientes con asma severa que se mantienen sintomáticos pese a un tratamiento óptimo. El procedimiento consiste en la aplicación de energía térmica controlada endobronquial para lograr la destrucción parcial del músculo liso de la vía aérea, procedimiento conocido como radiofrecuencia oblativa. El procedimiento se ha asociado a mejoría en la calidad de vida, mayores niveles de flujo espiratorio máximo, mayor cantidad de días libres de enfermedad, reducción en la frecuencia de exacerbaciones asmáticas, menor necesidad de broncodilatadores de rescate, menores visitas al servicio de urgencia y menor ausentismo laboral. El procedimiento es considerado seguro cuando se respetan las contraindicaciones, sólo existiendo una mayor tasa se exacerbaciones y hospitalizaciones en el período inmediatamente posterior al procedimiento. Los beneficios se mantienen en el seguimiento a cinco años después del procedimiento. La termoplastía bronquial es una herramienta terapéutica a tener en consideración en pacientes con asma de difícil control.

Bronchial thermoplasty is a tool used in the management of severe asthma that remain symptomatic despite adequate treatment. The procedure consist in the application of endobronchial controlled thermal energy, in order to achieve partial destruction of smooth muscle of the airway, procedure known as ablative radiofrecuency. The technique has been associated to improvement in the quality of life, higher levels of peak expiratory flow, more days free of disease, low exacerbation rates, fewer needs of rescue bronchodilators.

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Entre las variantes de la anatomía bronquial nos podemos encontrar con ramas bronquiales displásicas, ramas ausentes o ramas supernumerarias. Aunque gran parte son asintomáticas, es esencial reconocerlas porque se pueden asociar a hemoptisis, infecciones recurrentes, empiema o a complicaciones secundarias a procedimientos (por ejemplo intubaciones endotraqueales, fibrobroncoscopías, lavado broncoalveolar, biopsias, tratamientos endobronquiales, instalación de stent, braquiterapia y cirugías pulmonares entre otros). En este articulo describimos las variantes bronquiales más prevalentes en tomografia computada, incluyendo al bronquio cardíaco accesorio, bronquio traqueal y bronquio puente, entre otras.

Among the variations of bronchial anatomy, we can find dysplastic bronchial branches, an absence of bronchial branches, or supernumerary branches. Although many of them are asymptomatic, it is essential to know them because they may be associated with hemoptysis, recurrent infections, empyema, or complications secondary to various procedures (e.g. endotracheal intubation, brochoscopy, bronchoalveolar lavage, biopsy, endobronchial treatments, stent installation, brachytherapy and lung surgeries among others). In this study we used computed tomography to describe some of the most prevalent bronchial variations, including accessory cardiac bronchus, tracheal bronchus, and bridge bronchus among others.

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El cáncer de pulmón es un tumor frecuente y con alta mortalidad en países desarrolla-dos; en el tratamiento existen nuevas técnicas como la lobectomía más resección en manguito con anastomosis bronquial, que ha disminuido la mortalidad hasta en un 95% de los casos, este es un procedimiento oncológi-camente válido y a la vez comparable a una neumonectomía pero con un menor impacto funcional a nivel pulmonar; vale recalcar que es uno de los procedimientos de elección en el caso de neoplasias de los bronquios o en ocasiones de traumatismos que obstruyen los bronquios con pocos casos reportados sobre el uso de esta técnica a nivel mundial. De he-cho es la primera resección en manguito rea-lizada en el Hospital Vicente Corral Moscoso. Se presenta el caso de una paciente con presencia de una masa tumoral que causa obstrucción de la luz bronquial del pulmón derecho, diagnosticada hace dos años me-diante fibrobroncoscopía flexible por lo cual procede a ser intervenida quirúrgicamente para desobstruir la vía aérea; se realizó una lobectomía más resección en manguito, apo-yados en la literatura acerca de la validez del procedimiento realizado como cirugía oncológica, los riesgos quirúrgicos existentes y los efectos en la fisiología pulmonar.

Lung cancer is the most common tumor that causes increased mortality in developed countries, in the treatment there are new techniques such as the Lobectomy and sleeve resection with bronchial anastomosis, this technique has reduced the mortality by 95% of cases. This is an oncologically valid procedure and it is also comparable to a pneumonectomy but with a lower functional impact in the lungs; it ́s necessary to emphasize that this is one of the election procedures in the case of tumors of the bronchi or trauma sometimes obstructing the bronchi with few cases reported about using of this technique worldwide. In fact it is the first sleeve resection performed at the Vicente Corral Moscoso Hospital.The case of a patient with presence of a tumor mass obstructing the bronchial lumen of right lung is presented, it was diagnosed two years ago with flexible fibro-bronchoscopy so it proceed with surgery to unblock the airway, A lobectomy more sleeve resection was performed; supported in the literature about the validity of the procedure performed as cancer surgery, the surgical risks, and physiological effects on lung function.

Assuntos

RESUMO

Nenhuma característica dos seres vivos é tão primordial quanto a respiração, e os pulmões são os principais órgãos do sistema respiratório. Este estudo tem por objetivo descrever os aspectos macroscópicos da traqueia, dos brônquios e dos lobos pulmonares bem como os aspectos microscópicos dos brônquios pulmonares do mão-pelada e compará-los com dados da literatura de estudos realizados com mamíferos silvestres e domésticos. Utilizaram-se três exemplares de Procyon cancrivorus, que foram fixados em solução aquosa de formaldeído a 10%. Os pulmões e a traqueia foram dissecados e fotografados com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Para a identificação das características microscópicas, foram coletados fragmentos de cada brônquio seguindo as técnicas de rotina histológica. O pulmão do Procyon cancrivorus se divide em quatro lobos direito e dois lobos esquerdo e a traqueia apresenta cerca de 31 a 34 anéis. Os brônquios extrapulmonares se dividem em direito e esquerdo; o direito se subdivide em brônquios lobares cranial, médio, acessório e caudal, e o esquerdo em lobares cranial e caudal, com seus respectivos brônquios segmentares. Microscopicamente, os brônquios apresentam um epitélio prismático pseudoestratificado ciliado com células caliciformes e feixes de fibras de musculatura lisa, placas de cartilagem hialina e fibras elásticas. O conhecimento da morfologia desses órgãos nas espécies silvestres auxilia em estudos descritivos e/ou comparativos entre espécies.(AU)

No characteristic of living beings is as primal as breathing, and the lungs are the main organs in the respiratory system. This study aims to describe the macroscopic aspects of the trachea, bronchus and lung lobes and microscopic aspects of the bronchi of raccoon lungs and compare with data from the literature studies performed with wild and domestic mammals. We used three samples of Procyon cancrivorus, which were fixed in aqueous 10% formaldehyde, lungs and trachea were dissected and photographed with a digital camera (Sony a200 Camera, 10.2mpx). For the identification of microscopic characteristics, fragments were collected from each bronchus following routine histological techniques. The Procyon cancrivorus lung is divided into four lobes, with two right and left lobes. The trachea has about 31-34 rings. The extrapulmonary bronchi divides into left and right, where the right is divided into lobar bronchi cranial, middle, accessory and caudal lobes and the left in cranial and caudal, with their respective segmental bronchi. Microscopically the bronchial epithelium has prismatic pseudo-ciliated and goblet cells with bundles of smooth muscle fibers, plates of hyaline cartilage and elastic fibers. Knowledge of the morphology of these organs in wild species helps us in descriptive studies and / or comparisons between species.(AU)

Assuntos

RESUMO

Nenhuma característica dos seres vivos é tão primordial quanto a respiração, e os pulmões são os principais órgãos do sistema respiratório. Este estudo tem por objetivo descrever os aspectos macroscópicos da traqueia, dos brônquios e dos lobos pulmonares bem como os aspectos microscópicos dos brônquios pulmonares do mão-pelada e compará-los com dados da literatura de estudos realizados com mamíferos silvestres e domésticos. Utilizaram-se três exemplares de Procyon cancrivorus, que foram fixados em solução aquosa de formaldeído a 10%. Os pulmões e a traqueia foram dissecados e fotografados com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Para a identificação das características microscópicas, foram coletados fragmentos de cada brônquio seguindo as técnicas de rotina histológica. O pulmão do Procyon cancrivorus se divide em quatro lobos direito e dois lobos esquerdo e a traqueia apresenta cerca de 31 a 34 anéis. Os brônquios extrapulmonares se dividem em direito e esquerdo; o direito se subdivide em brônquios lobares cranial, médio, acessório e caudal, e o esquerdo em lobares cranial e caudal, com seus respectivos brônquios segmentares. Microscopicamente, os brônquios apresentam um epitélio prismático pseudoestratificado ciliado com células caliciformes e feixes de fibras de musculatura lisa, placas de cartilagem hialina e fibras elásticas. O conhecimento da morfologia desses órgãos nas espécies silvestres auxilia em estudos descritivos e/ou comparativos entre espécies.

No characteristic of living beings is as primal as breathing, and the lungs are the main organs in the respiratory system. This study aims to describe the macroscopic aspects of the trachea, bronchus and lung lobes and microscopic aspects of the bronchi of raccoon lungs and compare with data from the literature studies performed with wild and domestic mammals. We used three samples of Procyon cancrivorus, which were fixed in aqueous 10% formaldehyde, lungs and trachea were dissected and photographed with a digital camera (Sony a200 Camera, 10.2mpx). For the identification of microscopic characteristics, fragments were collected from each bronchus following routine histological techniques. The Procyon cancrivorus lung is divided into four lobes, with two right and left lobes. The trachea has about 31-34 rings. The extrapulmonary bronchi divides into left and right, where the right is divided into lobar bronchi cranial, middle, accessory and caudal lobes and the left in cranial and caudal, with their respective segmental bronchi. Microscopically the bronchial epithelium has prismatic pseudo-ciliated and goblet cells with bundles of smooth muscle fibers, plates of hyaline cartilage and elastic fibers. Knowledge of the morphology of these organs in wild species helps us in descriptive studies and / or comparisons between species.

Assuntos

RESUMO

Los bronquios principales son dos tubos respiratorios que se originan de la parte inferior de la tráquea y se proyectan a cada pulmón, permitiendo el paso de aire hacia y desde los bronquíolos. El objetivo de este trabajo fue verificar la inclusión como término morfológico de la pared posterior de los bronquios principales en la Terminologia Anatomica y en los textos de enseñanza de la anatomía macroscópica. Se revisó la Terminologia Anatomica y se comparó con diversos textos y artículos de enseñanza de la anatomía macroscópica, con el fin de verificar si hay descripciones de la pared posterior de los bronquios principales y si ésta se encuentra nominada. No está incluido en la Terminologia Anatomica ningún término para nominar la pared posterior de los bronquios principales, por lo que se propone incluir el término pared membranosa para tales bronquios en la Terminologia Anatomica.

There are two main bronchi breathing tubes originating from the bottom of the trachea and lung projecting to each, allowing passage of air toward and from the bronchioles. The objective of this work was to verify the morphological term inclusion as the back wall of the main bronchus in Anatomic Terminology and texts for teaching gross anatomy. Terminologia Anatomica was analyzed and compared with various texts and journals of gross anatomy teaching, in order to verify if there are descriptions of the posterior wall of the main bronchi and whether it has been nominated. In the Terminologia Anatomica the term for the back wall of the main bronchus is not included. Therefore, it is proposed that the term "membranous wall" for bronchus be included in Terminologia Anatomica.

Assuntos

RESUMO

OBJECTIVE: To experimentally compare two classic techniques described for manual suture of the bronchial stump. METHODS: We used organs of pigs, with isolated trachea and lungs, preserved by refrigeration. We dissected 30 bronchi, which were divided into three groups of ten bronchi each, of 3mm, 5mm, and 7mm, respectively. In each, we performed the suture with simple, separated, extramucosal stitches in five other bronchi, and the technique proposed by Ramirez and modified by Santos et al in the other five. Once the sutures were finished, the anastomoses were tested using compressed air ventilation, applying an endotracheal pressure of 20mmHg. RESULTS: the Ramirez Gama suture was more effective in the bronchi of 3, 5 and 7 mm, and there was no air leak even after subjecting them to a tracheal pressure of 20mmHg. The simple interrupted sutures were less effective, with extravasation in six of the 15 tested bronchi, especially in the angles of the sutures. These figures were not significant (p = 0.08). CONCLUSION: manual sutures of the bronchial stumps were more effective when the modified Ramirez Gama suture was used in the caliber bronchi arms when tested with increased endotracheal pressure. .

OBJETIVO: comparar experimentalmente duas técnicas clássicas descritas para a sutura manual do coto brônquico. MÉTODOS: foram empregadas vísceras de suínos com a traqueia e os pulmões isolados, conservados por refrigeração. Foram dissecados 30 brônquios, divididos em três grupos de dez brônquios cada, com 3mm, 5mm e 7mm, respectivamente. Em cada um dos grupos foi realizada a sutura com pontos simples separados extramucosos em cinco brônquios e nos outros cinco, foi empregada a técnica proposta por Ramirez Gama e modificada por Santos et al. Terminadas as suturas, as anastomoses foram testadas com ventilação empregando ar comprimido, submetidas a uma pressão endotraqueal de 20mmHg. RESULTADOS: os pontos de Ramirez Gama foram mais efetivos em brônquios de 3, 5 e 7 mm, e não houve extravasamento de ar mesmo após submetê-los a uma pressão endotraqueal de 20mmHg. Os pontos simples separados foram menos efetivos, havendo extravasamento em seis dos 15 brônquios testados, principalmente nos ângulos das suturas. Estes números não foram significativos (p=0,08). . CONCLUSÃO: as suturas manuais dos cotos brônquicos foram mais efetivas quando o ponto de Ramirez Gama modificado foi utilizado nos brônquios de pequeno calibre quando testados com aumento da pressão endotraqueal. .

Assuntos