Anastomotic Airway Complications after Lung Transplantation

PURPOSE: Anastomotic airway complications are a major cause of morbidity and mortality after lung transplantation (LTx). In this study, the authors identified types and clinical outcomes of airway complications after LTx. MATERIALS AND METHODS: All bronchial anastomotic complications were analyzed in a total of 94 LTx cases involving 90 recipients who underwent surgery between July 2006 and May 2014. Fifteen LTx cases (14 recipients) with incomplete medical records for fiberoptic bronchoscopy (FBS) and three cases underwent heart-lung transplantation (HLT) were excluded. Postoperative FBS at 24-48 hours, 1, 3, 6, and 12 months, and then yearly after the transplantation were performed. RESULTS: A total of 76 LTx cases (75 recipients) were analyzed. The mean age of the recipients was 49.55 years (range, 18-71 years), and 38 (49.4%) were male. Twenty-one out of 76 cases (27.6%) experienced early anastomotic complications, and 12 (15.8%) presented late anastomotic complications. The early anastomotic airway complications presented in various forms: stenosis, 1 case; narrowing, 1; necrosis & dehiscence, 3; fistula, 4; granulation, 10; and infection, 2. Late complications almost entirely presented in the form of bronchial stenosis; five recipients showed stenosis at the anastomosis site, and one of them showed improvement after ballooning. Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site. Three of these patients showed improvement after ballooning or bronchoplasty. CONCLUSION: By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.

Asociación entre las características clínicas-epidemiológicas y estancia hospitalaria prolongada de los pacientes hospitalizados con diagnóstico de síndrome obstructivo bronquial agudo, en el Hospital Nacional Madre Niño San Bartolomé, durante el año 2013 / Association between clinical and epidemiological characteristics and prolonged hospital stay of hospitalized patients diagnosed with acute bronchial obstructive syndrome in the National Hospital Mother Child San Bartolome, in 2013

Introducción: El Síndrome Obstructivo Bronquial (SOBA) es una de las patologías más prevalentes de la práctica pediátrica habitual y es responsable de consultas frecuentes a las emergencias, ya que afecta al 5 a 10 por ciento de todos los niños menores de 3 años de edad existiendo un incremento de la morbilidad y mortalidad a pesar de los recursos terapéuticos disponibles hoy en día; es generalmente secundario a infecciones virales y su presentación clínica y evolución intra y extra hospitalaria se cree dependen de numerosos factores tanto ambientales, epidemiológicos, y clínicos Objetivos: Determinar la asociación de riesgo entre características Clínicas y Epidemiológicas presentes al ingreso de los pacientes pediátricos menores de 3 años hospitalizados con diagnóstico de Síndrome Obstructivo Bronquial Agudo; y estancia hospitalaria prolongada, en el Hospital Nacional Madre Niño San Bartolomé, durante el año 2013. Material y métodos: Estudio analítico de casos y controles; el grupo Caso (constituidos por pacientes con estancias hospitalarias prolongadas) y el grupo Control (constituidos por pacientes con estancias hospitalarias no prolongadas), donde se evaluó múltiples variables tanto clínicas, epidemiológicas y de manejo terapéutico mediante pruebas de contraste de hipótesis (Chi-Cuadrado). Resultados: Durante el año 2013 se registraron en el libro de ingresos hospitalarios 276 casos ingresados con el diagnóstico de Síndrome Obstructivo Bronquial; de los cuales 198 cumplían los criterios de inclusión, se repartieron en dos grupos, el Grupo Caso de 80 pacientes (los cuales tenían un tiempo de hospitalización mayor a cinco días, y el grupo control de 118 pacientes (los cuales tenían un tiempo de hospitalización menor a cinco días), de las variables estudiadas solo se encontró asociación de riesgo para la variable grupo etario con un Chi cuadrado menor de 0,05 y Odds ratio de 2,1 (IC 95 por ciento: 1,179-3,752); y para la variable Estado Nutricional, con...

Introduction: Bronchial Obstructive Syndrome (SOBA) is one of the most prevalent diseases in the usual pediatric practice and is responsible for frequent emergency consultations, affecting 5-10 per cent of all children under 3 years of age. There are a increased morbidity and mortality despite treatment resources available today; this is usually secondary to viral infections and their clinical presentation and intra- and extra-hospital outcome depend of numerous environmental, epidemiological and c1inical factors. Objectives: To determine the association of risk between Clinical and Epidemiological factors present on admission in pediatric patients under 3 years of age hospitalized with diagnosis of Acute Bronchial Obstructive Syndrome; and prolonged hospital stay in the National Hospital Mother Child St. Bartholome, in 2013. Methods: Analytical case control-case study. Where the case group (consisting of patients with prolonged hospital stays) and the control group (consisting of patients without prolonged hospital stays), multiple variables was evaluating by the testing hypothesis (Chi-Square). Results: During the year 2013 were registered in the book of hospital admissions 276 patients with the diagnosis of Obstructive Bronchial Syndrome; of which 198 was including in the study, they were divided into two groups: the case group with 80 patients (who had a longer than five days hospitalization), and the control group with 118 patients (who had a hospital stay less than five days) of the variables studied only the age had risk association (Chi square less than 0.05) and odds ratio of 2.1 (95 per cent CI: 1.179 to 3.752) and for the Nutritional state, with a Chi-square less than 0.05 and an odds ratio of 2.4 (95 per cent CI 1.190 to 4.76). The most common diagnosis associated with the syndrome Obstructive bronchial acute was pneumonia Viral and bronchiolitis (50 per cent). Conclusions: Obstructive bronchial syndrome occurs mostly in males, under the 12 months...

Relationship between bronchial anthracofibrosis and endobronchial tuberculosis

BACKGROUND/AIMS: Various pulmonary diseases may be associated with bronchial anthracofibrosis (BAF). Our aim was to identify a relationship between BAF and endobronchial tuberculosis (EBTB). METHODS: In total, 156 patients, diagnosed with EBTB using bronchoscopy, between June 1999 and May 2008, were included. Clinical and bronchoscopic findings between patients with BAF (n = 72, BAF group) and without BAF (n = 84, non-BAF) were analyzed retrospectively. RESULTS: The crude odds ratio (OR) of BAF for EBTB was 8.88 (95% confidence interval, 6.37 to 12.37). On multivariate analysis, adjusting for age, history of biomass smoke exposure, and comorbidities, the most significant independent factor for EBTB was a history of biomass smoke exposure (adjusted OR, 17.471; adjusted p < 0.001). EBTB was more frequent in the right lung, particularly the right middle lobar bronchus, in the BAF group. Actively caseating, edematous-hyperemic, and ulcerative were the major types, with 77 (49%), 33 (21%), and 31 cases (20%), respectively. The BAF group had more ulcerative type, while the non-BAF group had more actively caseating type. The duration of EBTB treatment was similar between the groups. No significant difference was observed in the development of complications during treatment and posttreatment bronchostenosis between the groups. CONCLUSIONS: These findings suggest that BAF may be a risk factor for EBTB and affect the location and morphological type at the time of EBTB development.

Benign superior mediastinal syndrome due to intrathoracic tuberculosis in a child-association with endobronchial tuberculosis.

A 5-year-old boy presented with fever, cough, breathlessness and facial swelling. He was pale with distended veins over neck and chest, cervical and axillary lymphadenopathy and bilateral expiratory wheeze. Chest radiographs showed superior mediastinal widening. A computed tomography scan of the chest revealed mediastinal lymph nodes compressing superior vena cava and trachea. Bronchoscopy revealed nodular lesions in trachea and bronchi and compression of trachea. Broncho-alveolar lavage revealed acid fast bacilli. Diagnosis of superior mediastinal syndrome (SMS) secondary to tuberculosis was made and child was treated with antitubercular treatment along with oral prednisolone with good response.