RESUMO
Introducción: La granulomatosis con poliangeítis (GPA) es una enfermedad autoinmune con múltiples manifestaciones otorrinolaringológicas. La estenosis subglótica (ESG) se reporta entre 8%-50% de los pacientes. Objetivo: Describir la presentación clínica y tratamiento de la ESG en pacientes con GPA. Material y método: Estudio descriptivo retrospectivo de los pacientes atendidos en el Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile entre 2011 y 2015 con diagnóstico de GPA y ESG. Resultados: Diez pacientes (90% mujeres) con edad promedio al diagnóstico de 44,6 años. Los síntomas fueron: disnea (9/10), disfonía (6/10) y estridor (5/10). En el 80%, la ESG fue la presentación inicial de la GPA. El 90% presentó GPA localizada y 10% GPA sistémica. El 60% presentó anticuerpos anticitoplasma de neutrófilos (ANCA) negativo. Todos los pacientes recibieron glucocorticoides sistémicos, asociados a inmunosupresores y/o anticuerpos monoclonales. Una paciente requirió traqueostomía y dos pacientes han requerido dilatación endoscópica con balón asociado a inyección local de metilprednisolona. Conclusiones: La ESG puede ser la única manifestación de GPA. Los síntomas inespecíficos y la alta probabilidad de presentar ANCA negativo hacen difícil el diagnóstico. El manejo debe ser individualizado y multidisciplinario. La mayoría de nuestros pacientes pudieron ser manejados adecuadamente con tratamiento médico.
Introduction: Granulomatosis with polyangiitis (GPA) is an autoimmune disease that presents with multiple ENT manifestations. Subglottic stenosis (SGS) has been reported in 8-50% of the patients. Aim: To describe the clinical presentation and treatment of SGS in patients with GPA. Material and method: Retrospective review of clinical data from all patients consulting in the Otolaryngology department at Pontificia Universidad Católica de Chile from 2011 to 2015 with SGS and GPA diagnosis. Results: Ten patients (90% female) with average age at diagnosis of44.6 years. The symptoms were: dyspnea (9/10), dysphonia (6/10) and stridor (5/10). SGS was the initial presenting manifestation of GPA in 80% of patients. GPA was localized in 90% and systemic in 10% of patients, and anti-neutrophilic cytoplasmic antibodies (ANCA) were negative in 60% of patients. Systemic glucocorticoids were used in every patient, associated with immunosuppressants and/or monoclonal antibodies. One patient required tracheostomy and 2 patients were treated with endoscopic balloon dilation associated with local methylprednisolone injection. Conclusions: SGS can be GPA’s initial or unique manifestation. Diagnosis is hindered due to the unspecificity ofsymptoms and the high probability of presenting with negative ANCA. Individualized and multidisciplinary treatment is required. Most patients were treated pharmacologically with an adequate response in our series.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Granulomatose com Poliangiite/complicações , Laringoestenose/diagnóstico , Laringoestenose/epidemiologia , Ensaio de Imunoadsorção Enzimática , Tomografia Computadorizada por Raios X , Granulomatose com Poliangiite/diagnóstico , Laringoestenose/terapia , Epidemiologia Descritiva , Estudos Retrospectivos , Técnica Indireta de Fluorescência para Anticorpo , Anticorpos Anticitoplasma de NeutrófilosRESUMO
OBJECTIVE: To evaluate the incidence of subglottic stenosis in children undergoing endotracheal intubation. METHODS: Children in the paediatric intensive care unit of a tertiary care hospital were considered eligible for inclusion if they received endotracheal intubation for more than 24 hours. After extubation, children underwent flexible fibre-optic nasolaryngoscopy. Based on this first evaluation, they were divided into two groups: 'acute normal', with mild laryngeal alterations or normal findings; and 'acute alterations', with moderate to severe laryngeal alterations. Further laryngoscopic follow up (7-10 days later) was undertaken for those children in the acute normal group who developed symptoms during follow up (after discharge from the intensive care unit), and for all children in the acute alterations group. Children were then classified into two final groups: 'normal final examination', with no chronic changes; and 'subglottic stenosis'. RESULTS: We included 123 children. The incidence of subglottic stenosis was 11.38 per cent (95 per cent confidence interval, 6.63-17.94 per cent). All the children who developed subglottic stenosis had had moderate to severe alterations immediately after extubation. CONCLUSION: This incidence of subglottic stenosis is quite high and needs further investigation to identify risk factors.
Assuntos
Glote/fisiopatologia , Intubação Intratraqueal/efeitos adversos , Laringoestenose/epidemiologia , Criança , Pré-Escolar , Humanos , Incidência , Laringoscopia , Laringoestenose/diagnóstico , Laringoestenose/etiologia , Masculino , Prevalência , Estudos ProspectivosAssuntos
Humanos , Laringoestenose , Laringoestenose/classificação , Laringoestenose/complicações , Laringoestenose/diagnóstico , Laringoestenose/tratamento farmacológico , Laringoestenose/epidemiologia , Laringoestenose/etiologia , Laringoestenose/mortalidade , Laringoestenose/fisiopatologia , Laringoestenose/terapia , Estenose Traqueal , Estenose Traqueal/classificação , Estenose Traqueal/complicações , Estenose Traqueal/diagnóstico , Estenose Traqueal/tratamento farmacológico , Estenose Traqueal/epidemiologia , Estenose Traqueal/etiologia , Estenose Traqueal/mortalidade , Estenose Traqueal/terapiaRESUMO
Se presenta la experiencia de 15 años en la reconstrucción de la vía aérea por lesiones cicatrizales, secundarias e intubación o traqueotomía. La misma se compone de 141 pacientes tratados. Se discuten los métodos de diagnóstico y tratamiento tanto paliativo como definitivo, haciendo hincapié en consideraciones preventivas de las mismas
Assuntos
Traqueostomia/métodos , Estenose Traqueal/cirurgia , Laringectomia/estatística & dados numéricos , Laringoestenose/cirurgia , Intubação Intratraqueal/efeitos adversos , Traqueostomia/efeitos adversos , Traqueostomia/enfermagem , Laringoestenose/diagnóstico , Laringoestenose/epidemiologia , Laringoscopia , Complicações Pós-Operatórias , Glote/lesões , Laringectomia/métodos , Reoperação , Fístula Traqueoesofágica/etiologia , Anastomose CirúrgicaRESUMO
Se presenta la experiencia de 15 años en la reconstrucción de la vía aérea por lesiones cicatrizales, secundarias e intubación o traqueotomía. La misma se compone de 141 pacientes tratados. Se discuten los métodos de diagnóstico y tratamiento tanto paliativo como definitivo, haciendo hincapié en consideraciones preventivas de las mismas
Assuntos
Intubação Intratraqueal/efeitos adversos , Laringectomia/estatística & dados numéricos , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Traqueostomia , Anastomose Cirúrgica , Fístula Traqueoesofágica/etiologia , Glote/lesões , Laringectomia , Laringoscopia , Laringoestenose/diagnóstico , Laringoestenose/epidemiologia , Complicações Pós-Operatórias , Reoperação , Traqueostomia/efeitos adversos , Traqueostomia/enfermagemRESUMO
The authors reviewed 39 cases of Laryngotracheal stenosis diagnosed in the last 15 years. Etiologic factors, management and resultas were analized. Patients age ranged from 1 month to 63 years old, 16 of them were females and 23 were males. Prolonged endotraqueal intubation was the most common cause, followed by tracheostomy. The subglottic airway was involved in the majority of the patients. Endotracheal intubation was prolonged over 5 days in 63,5% of the cases; 22.7% of the patients develped symptomatic laryngotracheal stenosis around 30 days after extubation. Surgical treatment was performed in 61.5% of the cases; a variety of techniques were used; in this group the decannulation rate was 79%. Expectant observation was the management for 11 patients, withh a decannulation rate of 40%. Endotracheal intubation, tracheostomy and laryngoytracheal stenosis management aspects were analysed