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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.70-74, tab, graf.
Monography in Portuguese | LILACS | ID: biblio-1349347
2.
Rev. Col. Bras. Cir ; 49: e20223202, 2022. graf
Article in English | LILACS | ID: biblio-1365382

ABSTRACT

ABSTRACT Percutaneous tracheostomy has been considered the standard method today, the bronchoscopy-guided technique being the most frequently performed. A safe alternative is ultrasound-guided percutaneous tracheostomy, which can be carried out by the surgeon, avoiding the logistical difficulties of having a specialist in bronchoscopy. Studies prove that the efficacy and safety of the ultrasound-guided technique are similar when compared to the bronchoscopy-guided one. Thus, it is of paramount importance that surgeons have ultrasound-guided percutaneous tracheostomy as a viable and beneficial alternative to the open procedure. In this article, we describe eight main steps in performing ultrasound-guided percutaneous tracheostomy, highlighting essential technical points that can reduce the risk of complications from the procedure. Furthermore, we detail some precautions that one must observe to reduce the risk of aerosolization and contamination of the team when percutaneous tracheostomy is indicated in patients with COVID-19.


RESUMO A traqueostomia percutânea tem sido considerada o método padrão atualmente, sendo a técnica guiada por broncoscopia a mais realizada. Uma alternativa segura é a traqueostomia percutânea guiada por ultrassonografia, que pode ser feita pelo próprio cirurgião, evitando-se as dificuldades logísticas de disponibilidade de um especialista em broncoscopia. Estudos comprovam que a eficácia e a segurança da técnica guiada por ultrassonografia, comparada à guiada por broncoscopia, são semelhantes. Assim, é de suma importância que os cirurgiões tenham a traqueostomia percutânea guiada por ultrassonografia como alternativa viável e benéfica em relação ao procedimento aberto. Neste artigo, descrevemos oito passos principais da realização da traqueostomia percutânea ecoguiada, destacando pontos técnicos essenciais que podem reduzir o risco de complicações do procedimento. Ainda, detalhamos alguns cuidados que devem ser observados, com o intuito de reduzir o risco de aerolização e contaminação da equipe, quando a traqueostomia percutânea é indicada no paciente com COVID-19.


Subject(s)
Humans , Tracheostomy/methods , COVID-19 , Bronchoscopy/methods , Ultrasonography , Ultrasonography, Interventional/methods
3.
Article in Chinese | WPRIM | ID: wpr-928915

ABSTRACT

Lung volume reduction loop uses bronchoscopic lung volume reduction(BLVR) technology to compress and collapse the necrotic emphysema tissue and exhaust the internal gas to achieve the purpose of lung volume reduction to treat emphysema. After the lung volume reduction loop is implanted into the human body, the compressed part of the lung tissue tends to expand with breathing, which makes the lung volume reduction loop expand into a linear trend periodically. Fatigue resistance is one of the most important performance indexes of the lung volume reduction loop. In the paper, Z-direction vibration fatigue machine was used to simulate the changes of human respiratory cycle movement to test the fatigue performance of lung volume reduction loop, which can provide some reference for the test method of in vitro fatigue performance of lung volume reduction related products in the future.


Subject(s)
Bronchoscopy/methods , Emphysema/surgery , Humans , Lung , Pneumonectomy/methods , Pulmonary Emphysema/surgery , Treatment Outcome
4.
Chinese Journal of Lung Cancer ; (12): 118-123, 2022.
Article in Chinese | WPRIM | ID: wpr-928788

ABSTRACT

Lung cancer ranks the first cancer-related morbidity and mortality in China. With the development and penetration of imaging technology, increasing small pulmonary peripheral Nodules (SPPNs) have been detected. However, precise location and diagnosis of SPPNs is still a tough problem for clinical diagnosis and treatment in department of thoracic surgery. With the development of electromagnetic navigation bronchoscopy (ENB), it provides a novel minimally invasive method for the diagnosis and treatment of SPPNs. In this review, we summarized the application and progress of ENB in preoperative positioning, diagnosis, and local treatment, then, discussed the clinical application of ENB in the hybrid operating room.
.


Subject(s)
Bronchoscopy/methods , Electromagnetic Phenomena , Humans , Lung Neoplasms/surgery , Multiple Pulmonary Nodules/diagnosis , Thoracic Surgery
5.
Rev. cuba. med ; 60(2): e1402, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280357

ABSTRACT

Introducción: El melanoma maligno es un tumor de etiología multifactorial, cuando afecta al sistema respiratorio su origen es casi siempre metastásico, y como tumor primario es muy infrecuente, constituye el 0,07 por ciento de los tumores pulmonares malignos. Objetivo: Presentar un caso clínico con diagnóstico de melanoma maligno primario de pulmón. Presentación del caso: Se presenta el caso de una mujer de 64 años de edad, exfumadora, sin antecedentes de melanoma, que presenta tos seca asociada a disnea, los esfuerzos físicos y dolor torácico. Además de astenia y pérdida de peso. Se le realizó biopsia pulmonar mediante broncoscopia y se le diagnosticó melanoma. Conclusiones: El melanoma primario pulmonar es uno de los más raros del tipo de melanoma visceral, es una entidad neumológica infrecuente y el diagnóstico preciso requiere una investigación detallada y el cumplimiento de criterios clínicos y anatomopatológicos específicos(AU)


Introduction: Malignant melanoma is a tumor of multifactorial etiology, when it affects the respiratory system its origin is almost always metastatic, and as a primary tumor it is very infrequent, it constitutes 0.07 por ciento of malignant lung tumors. Objective: To report a clinical case with a diagnosis of primary malignant melanoma of the lung. Case report: We report the case of a 64-year-old woman, former smoker, with no history of melanoma, who had dry cough associated with dyspnea with physical exertion and chest pain. In addition to asthenia and weight loss, she had a lung biopsy by bronchoscopy and was diagnosed with melanoma. Conclusions: Primary pulmonary melanoma is one of the rarest of the visceral melanoma type, this is an infrequent pneumological entity and the precise diagnosis requires detailed investigation and the fulfillment of specific clinical and pathological criteria(AU)


Subject(s)
Humans , Female , Bronchoscopy/methods , Lung Neoplasms/diagnosis , Melanoma/diagnosis
6.
Rev. cuba. med ; 60(1): e1399, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156554

ABSTRACT

RESUMEN Introducción: El ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina es una técnica novedosa para el diagnóstico de tumores y ganglios mediastínicos e hiliares. Objetivo: Evaluar la eficacia diagnóstica de ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina como método de estudio de lesiones hiliares y mediastinales. Métodos: Se realizó un estudio descriptivo con carácter prospectivo en 49 pacientes a los que se le realizó ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina. Resultados: El diagnóstico se obtuvo mediante la histología y resultaron positivos 48 pacientes, de ellos 45 fueron positivos por el ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina y 4 negativos por este estudio. El resultado global de la investigación mostró una sensibilidad de 93,8 %, especificidad 100 %, valor predictivo positivo de 100 % y predictivo negativo 25 %. De esta manera, el índice de validez de ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina fue de 93,8 %. El número de complicaciones fue mínimo. Conclusiones: El ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina constituye un método diagnóstico eficaz y seguro en el estudio de pacientes que presentan lesiones hiliares y mediastinales con alta sospecha de cáncer de pulmón y a su vez, una alternativa de acceder al mediastino de manera no cruenta para la estadificación ganglionar.


ABSTRACT Introduction: Linear endobronchial ultrasound with transbronchial fine needle aspiration is a novel technique for the diagnosis of tumors and mediastinal and hilar lymph nodes. Objective: To evaluate the diagnostic efficacy of linear endobronchial ultrasound with transbronchial fine needle aspiration as a method of studying hila and mediastinal lesions. Methods: A prospective descriptive study was carried out in 49 patients who underwent linear endobronchial ultrasound with transbronchial fine needle aspiration. Results: The diagnosis was obtained by histology and 48 patients were positive, 45 of them resulted positive by linear endobronchial ultrasound with transbronchial fine needle aspiration and 4 resulted negative by this study. The overall result of the investigation showed a sensitivity of 93.8%, specificity 100%, a positive predictive value of 100% and a negative predictive value of 25%. Thus, the validity index of linear endobronchial ultrasound with transbronchial fine needle aspiration was 93.8%. The number of complications was minimal. Conclusions: Linear endobronchial ultrasound with transbronchial fine needle aspiration is an effective and safe diagnostic method in the study of patients with hilar and mediastinal lesions with high suspicion of lung cancer and, consecutively, it is an alternative to access the mediastinum in a non- invasive approach for lymph node staging.


Subject(s)
Humans , Male , Female , Ultrasonics/methods , Bronchoscopy/methods , Biopsy, Fine-Needle/methods , Epidemiology, Descriptive , Prospective Studies
9.
Rev. cuba. med. mil ; 48(4): e391, oct.-dic. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126653

ABSTRACT

Introducción: Las neoplasias mediastinales son tumores poco frecuentes, pueden aparecer a cualquier edad y por lo general se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Objetivo: Caracterizar a los pacientes operados por tumores de mediastino según variables clínico- epidemiológicas y diagnósticas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo, de tipo serie de casos con 37 enfermos ingresados y operados con diagnóstico de tumor mediastinal, en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante los años 2010 a 2017. Resultados: Predominó el sexo femenino con 23 pacientes y el intervalo de edad entre 31 y 40 años (11 casos). Los síntomas más comunes fueron dolor torácico, tos y disnea. El compartimiento posterior fue el mayormente afectado (11 pacientes), así como los tumores con tamaños entre 7 y 9 cm (17 enfermos). Los medios diagnósticos más utilizados fueron la tomografía computarizada, la broncoscopia y la mediastinoscopia. Primaron los tumores malignos (54,1 por ciento) en los que se identificó una amplia gama de variedades histológicas. Conclusiones: El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, aunque la tomografía computarizada asociada o no a la biopsia percutánea es la regla de oro para el diagnóstico preoperatorio. Las variedades histológicas de los tumores malignos son atribuibles a las características del órgano afectado(AU)


ABSTRACT Introduction: Mediastinal neoplasms are rare tumours; they can appear at any age and they are usually discovered incidentally on a routine chest radiograph in asymptomatic patients. Objective: To characterize patients operated on mediastinal tumours according to selected clinical, epidemiological and diagnostic variables. Methods: An observational, descriptive study of a series of cases with 37 patients admitted and operated with diagnosis of mediastinal tumour in the General Surgery Service of the Provincial Teaching "Saturnino Lora" Hospital from Santiago de Cuba, during the years 2010 to 2017. Results: The female sex predominated with 23 patients and the age interval between 31 and 40 years (11 cases). The most common symptoms were chest pain, cough and dyspnea. The posterior compartment was the most affected (11 patients), as well as the tumors with sizes between 7 and 9 cm (17 cases). The most used diagnostic means were computed tomography, bronchoscopy and mediastinoscopy. Malignant histological varieties prevailed (54.1 percent). Conclusions: The definitive diagnosis is usually established by postoperative histopathological study, although computed tomography associated or not with percutaneous biopsy is the gold standard for preoperative diagnosis. Malignant histological varieties are related with characteristics of the affected organ(AU)


Subject(s)
Humans , Adult , Middle Aged , Biopsy/methods , Bronchoscopy/methods , Mediastinal Neoplasms/diagnostic imaging , Mediastinum , Epidemiology, Descriptive , Observational Study
10.
Int. j. med. surg. sci. (Print) ; 6(2): 47-49, jun. 2019. ilus
Article in English | LILACS | ID: biblio-1247430

ABSTRACT

Rasmussen's aneurysm (RA) is a pseudoaneurysm of a pulmonary artery (AP), adjacent to or within a tuberculous cavity, appearing in 5% of these lesions. Its rupture might provoke massive hemoptysis (MH) with a near 50% mortality. The aim of this article is to report a case of massive hemoptysis following Rasmussen's aneurysm. 52-year-old man with recent history of hospita-lization due to pneumonia associated to influenza A and decompensated hyperthyroidism, pre-sents outpatient chest radiograph with signs of hyperinflation and scarring apical opacities, the patient returned to the hospital due to sharp pain of left hemi thorax during inspiration accom-panied with bloody sputum, asthenia and non-quantified weight loss. He evolves to frank MH, requiring endotracheal intubation managed in the intensive care unit (ICU). Chest computed tomography (CT) reported ground-glass opacity, nodules with a tendency to cavitation, tree-in-bud pattern in agreement with inflammation and infection, active TB is considered, and truncus of PA with vascular lesion suggestive of aneurysm dependent on pulmonary circulation, possibly RA. Fibrobronchoscopy reported signs of old and recent bleeding of left bronchial tree, probably of the lingula, blood clots in right bronchial tree. Molecular study and TB cultures was negative. Endovascular procedure with arteriography was carried out, revealing amputation of left distal segmental PA carrying the pseudoaneurysm with complete regression, discarding embolization RA It must be considered among the differential diagnoses of MH, especially on patients with pulmonary TB complications, such as the reported case. Due to its associated increased morta-lity, once RA is identified, it must be either endovascularly or surgically eradicated.


Subject(s)
Humans , Male , Middle Aged , Tuberculosis, Pulmonary/diagnostic imaging , Aneurysm, Ruptured/diagnostic imaging , Hemoptysis/diagnostic imaging , Tuberculosis, Pulmonary/complications , Bronchoscopy/methods , Tomography, X-Ray Computed/methods
11.
Rev. cuba. med ; 58(2): e1165, abr.-jun. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1139013

ABSTRACT

Introducción: El alcance de la maestría en el estudio endoscópico de las vías aéreas debe basarse en un conocimiento de la anatomía bronquial, sus divisiones, nomenclatura y los hallazgos endobronquiales normales. Objetivo: Caracterizar la anatomía del árbol bronquial derecho mediante broncoscopia flexible diagnóstica. Métodos: Se realizó un estudio descriptivo, de corte transversal prospectivo, en 2000 pacientes, en un periodo de 12 años, a los que se les realizó una revisión completa de las variantes del árbol bronquial derecho. Resultados: En el bronquio lobar superior la división más frecuente fue la bifurcación con 58,4 por ciento, el bronquio lobar medio siempre se bifurcó. En el segmento B6 predominó la bifurcación 87,7 por ciento y la más frecuente fue el tipo B6 y B6 b+c. El resto de los basales se comportaron de la manera siguiente: el segmento paracardiaco no apareció en un 8,15 por ciento, predominó la bifurcación con 89,15 por ciento y de estas, la división B8 y B9 + B10. En cuanto a las malformaciones congénitas estuvieron presentes 0,65 por ciento de bronquio traqueal, 0,15 por ciento de bronquio cardiaco accesorio y 5,15 por ciento de bronquio subsuperior. Conclusiones: El árbol bronquial derecho en la población cubana tiene características propias(AU)


Introduction: The skill scope in the airways endoscopic study should be based on the bronchial anatomy knowledge, its divisions, nomenclature and the normal endobronchial findings. Objective: To characterize the anatomy of the right bronchial tree using diagnostic flexible bronchoscopy. Methods: A descriptive, prospective cross-sectional study was carried out in 2000 patients, over a period of 12 years. A complete review of the right bronchial tree these variants was performed on these patients. Results: The most frequent division was the bifurcation with 58.4%, in the upper lobar bronchus. The middle lobar bronchus always bifurcated. In segment B6, bifurcation predominated (87.7percent), and the most frequent was type B6 and B6 b + c. The rest of the basals behaved as follows: the paracardiac segment did not appear in 8.15 percent, bifurcation predominated (89.15 percent) and out of these, B8 and B9 + B10 division. Regarding congenital malformations, we found 0.65 percent tracheal bronchus, 0.15 percent accessory cardiac bronchus and 5.15 percent subsurface bronchus. Conclusions: The right bronchial tree in the Cuban population has its own characteristics(AU)


Subject(s)
Humans , Male , Female , Bronchi/anatomy & histology , Bronchi/diagnostic imaging , Bronchoscopy/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies , Cuba
12.
Rev. Assoc. Med. Bras. (1992) ; 65(5): 589-591, May 2019. graf
Article in English | LILACS | ID: biblio-1012970

ABSTRACT

SUMMARY Our case report shows the complexity of dealing with tracheal tumors, highlighting the importance of the method used for staging. In this report, endoscopic ultrasound (EUS) was crucial to identify the involvement of the esophageal muscular propria in a tracheal tumor and change the surgical planning of the case. Staging this kind of tumor represents a challenge for physicians. There is no evidence in the literature on which methods represent the gold standard for T staging.


RESUMO Neste relato de caso mostramos a complexidade em lidar com tumores traqueais, destacando a importância do método usado para estadiamento. Neste relato, a ecoendoscopia (EUS) foi fundamental para identificar o envolvimento da camada muscular própria esofágica por um tumor traqueal e alterar o planejamento cirúrgico do caso. O estadiamento desse tipo de tumor representa um desafio para os médicos. Não há evidências na literatura sobre quais métodos representam o padrão ouro para o estadiamento T.


Subject(s)
Humans , Male , Aged , Tracheal Neoplasms , Carcinoma, Squamous Cell/diagnostic imaging , Endosonography/methods , Bronchoscopy/methods , Esophageal Neoplasms/pathology , Esophageal Neoplasms/diagnostic imaging , Tracheal Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Positron Emission Tomography Computed Tomography , Neoplasm Staging
16.
Rev. inf. cient ; 98(5): 556-565, 2019. tabs
Article in Spanish | LILACS, CUMED | ID: biblio-1024922

ABSTRACT

Introducción: La broncoscopia desde su surgimiento ha permitido ampliar las posibilidades diagnósticas de las enfermedades respiratorias, en el cáncer de pulmón permite llegar a un diagnóstico de forma rápida y segura. Objetivo: Caracterizar la broncoscopia como método diagnóstico del cáncer de pulmón, sus complicaciones y hallazgos más frecuentes, en el servicio de Neumología del Hospital General Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante los años 2016-2018. Método: Se realizó un estudio descriptivo y transversal con los datos obtenidos de los pacientes que se les realizó la fibrobroncoscopia diagnóstica durante los años 2016-2018. El universo estuvo constituido por 172 pacientes con sospecha de cáncer de pulmón y la muestra quedó constituida por los 165 pacientes que se les realizó el proceder. Se utilizaron variables como diagnóstico de malignidad, técnicas broncoscópicas, complicaciones y hallazgos broncoscópicos. Resultados: Se encontró que 103 pacientes presentaron diagnóstico de malignidad, la biopsia bronquial presentó un 61,8 por ciento de positividad, el 94,6 por ciento de los pacientes no presentaron complicaciones y el enrojecimiento de la mucosa representó un 82,4 por ciento. Conclusiones: La biopsia bronquial fue el procedimiento que mayor positividad tuvo, las complicaciones fueron mínimas con relación al número de broncoscopias realizadas y el enrojecimiento de la mucosa fue el hallazgo más frecuente(AU)


Introduction: Bronchoscopy since its emergence has allowed to expand the diagnostic possibilities of respiratory diseases, in lung cancer it allows to reach a diagnosis quickly and safely. Objective: To characterize bronchoscopy as a diagnostic method of lung cancer, its complications and most frequent findings, in the Pulmonology department of the General Hospital Dr Juan Bruno Zayas Alfonso from Santiago de Cuba during the years 2016-2018. Method: A descriptive and cross-sectional study was conducted with the data obtained from patients who underwent diagnostic fibrobronchoscopy during the years 2016-2018. The universe consisted of 172 patients with suspected lung cancer and the sample was made up of the 165 patients who underwent the procedure. Variables such as diagnosis of malignancy, bronchoscopic techniques, complications and bronchoscopic findings were used. Results: 103 patients were found to have a diagnosis of malignancy, bronchial biopsy showed 61.8per cent positivity, 94.6per cent of the patients had no complications and mucosal redness represented 82.4per cent. Conclusions: The bronchial biopsy was the procedure that had the greatest positivity, the complications were minimal in relation to the number of bronchoscopies performed and the mucosal redness was the most frequent finding(AU)


Introdução: A broncoscopia desde o seu surgimento permitiu ampliar as possibilidades diagnósticas de doenças respiratórias; no câncer de pulmão, permite chegar a um diagnóstico de forma rápida e segura. Objetivo: Caracterizar a broncoscopia como método diagnóstico de câncer de pulmão, suas complicações e achados mais frequentes, no departamento de Pneumologia do Hospital Geral Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante os anos de 2016 a 2018. Método: Foi realizado um estudo descritivo e transversal com os dados obtidos de pacientes submetidos à fibrobroncoscopia diagnóstica nos anos de 2016-2018. O universo foi composto por 172 pacientes com suspeita de câncer de pulmão e a amostra foi composta pelos 165 pacientes submetidos ao procedimento. Foram utilizadas variáveis como diagnóstico de malignidade, técnicas broncoscópicas, complicações e achados broncoscópicos. Resultados: 103 pacientes apresentaram diagnóstico de malignidade, a biópsia brônquica mostrou 61,8por cento de positividade, 94,6por cento dos pacientes não apresentaram complicações e a vermelhidão da mucosa representou 82,4por cento. Conclusões: A biópsia brônquica foi o procedimento que apresentou maior positividade, as complicações foram mínimas em relação ao número de broncoscopias realizadas e a vermelhidão da mucosa foi o achado mais frequente(AU)


Subject(s)
Humans , Bronchoscopy/methods , Lung Neoplasms/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies
17.
Einstein (Säo Paulo) ; 17(3): eMD4921, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019801

ABSTRACT

ABSTRACT The endobronchial ultrasound is a minimally invasive technique that simultaneously associates ultrasound and bronchoscopy, to visualize lung nodule or masses, airway wall, and structures adjacent to the tracheobronchial tree. Endobronchial ultrasound has been incorporated into clinical practice all over the world because of its low risk and high diagnostic yield in neoplastic and non-neoplastic disease.


RESUMO A ultrassonografia endobrônquica é uma técnica minimamente invasiva que associa simultaneamente broncoscopia à ultrassonografia, com a finalidade de visualizar nódulos ou massas pulmonares, paredes das vias aéreas, e estruturas ao redor de toda a árvore traqueobrônquica. A ultrassonografia endobrônquica foi incorporada à prática clínica em todo o mundo devido a seu baixo risco e elevado rendimento diagnóstico em doenças neoplásicas e não neoplásicas.


Subject(s)
Humans , Bronchoscopy/methods , Endosonography/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Mediastinal Diseases/diagnostic imaging , Bronchoscopy/instrumentation , Sensitivity and Specificity , Endosonography/instrumentation , Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation , Lung Diseases/diagnostic imaging
18.
Rev. bras. ter. intensiva ; 30(3): 394-397, jul.-set. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-977974

ABSTRACT

RESUMO A transfusão de concentrado de plaquetas é prática comum para prevenção de sangramento espontâneo ou decorrente de procedimentos invasivos; sabe-se que a transfusão de componentes alogênicos do sangue se associa a aumento da mortalidade e piora do desfecho clínico. A força do coágulo é avaliada por meio da tromboelastometria rotacional e determinada pela interação entre plaquetas e fibrinogênio. O efeito compensatório do incremento na concentração sérica de fibrinogênio na força do coágulo, em pacientes com trombocitopenia, tem sido demonstrado em diferentes contextos clínicos, incluindo sepse. Relatamos o caso de uma paciente com trombocitopenia grave, cujo resultado da tromboelastometria rotacional demonstrou efeito compensatório na força do coágulo determinada pelos níveis plasmáticos aumentados de fibrinogênio como reagente de fase aguda em pacientes sépticos. Relatamos o caso de uma paciente de 62 anos com diagnóstico de aplasia de medula óssea admitida a uma unidade de terapia intensiva com choque séptico e trombocitopenia grave. Nas primeiras 24 horas na unidade de terapia intensiva, ela apresentou quadro clínico de insuficiência respiratória aguda e choque. Foi necessário utilizar ventilação mecânica invasiva e fármaco vasoativo. A radiografia de tórax mostrou padrão de lesão pulmonar bilateral. Desta forma, foi solicitada broncoscopia com lavagem broncoalveolar para investigação diagnóstica. Conduziu-se uma tromboelastometria rotacional, e seu resultado mostrou perfil de coagulação normal. Apesar da trombocitopenia grave (1.000/mm3), os níveis de fibrinogênio aumentaram (1.050mg/dL) devido ao choque séptico. A broncoscopia foi realizada sem que subsequentemente ocorresse sangramento ativo. Este caso relata o uso da tromboelastometria como ferramenta diagnóstica em distúrbios da coagulação de pacientes graves, permitindo prevenir o uso desnecessário de transfusões profiláticas de concentrado de plaquetas.


ABSTRACT Platelet transfusion is a common practice to prevent spontaneous bleeding or bleeding due to invasive procedures. Transfusion of allogeneic blood components is associated with increased mortality and a worse clinical outcome. The clot strength is assessed by thromboelastometry and determined by the interaction between platelets and fibrinogen. The compensatory effect of high levels of fibrinogen on clot strength in patients with thrombocytopenia has been demonstrated in different clinical settings including sepsis. We report the case of a patient with severe thrombocytopenia whose thromboelastometry showed clot strength that was compensated for by the increase in plasma fibrinogen levels as an acute phase reactant of septic patients. Here, we report a case of a 62-year-old female diagnosed with bone marrow aplasia admitted in the intensive care unit with septic shock and severe thrombocytopenia. During the first 24 hours in the intensive care unit, she presented acute respiratory insufficiency and circulatory shock. The use of invasive mechanical ventilation and norepinephrine was required. Her chest X-ray showed bilateral lung injury. Thus, bronchoscopy with bronchoalveolar lavage was requested. Thromboelastometry was performed and resulted in a normal coagulable profile. Despite severe thrombocytopenia (1,000/mm3), fibrinogen levels were increased (1,050mg/dL) due to septic shock. Bronchoscopy was performed without any active or further bleeding. Here, we report the use of thromboelastometry in the diagnosis of coagulation disorders, preventing unnecessary prophylactic platelet transfusion.


Subject(s)
Humans , Female , Shock, Septic/complications , Thrombelastography/methods , Thrombocytopenia/physiopathology , Fibrinogen/metabolism , Thrombocytopenia/etiology , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/etiology , Bronchoscopy/methods , Bone Marrow Cells/pathology , Intensive Care Units , Middle Aged
19.
Rev. méd. Chile ; 146(9): 1033-1040, set. 2018. tab
Article in Spanish | LILACS | ID: biblio-978794

ABSTRACT

Bronchoscopy cryoprobes are used for palliative treatment of endobronchial obstructions caused by tumors and removal of granulation tissue or foreign bodies. Currently this technology is also used for diagnosis of diffuse interstitial lung disease (ILD). The multidisciplinary team that establishes the clinical, radiological and histopathological correlation in ILD, decides about performing a surgical lung biopsy when the characteristics of the interstitial disease are not similar to Idiopathic Pulmonary Fibrosis (IPF). Although surgical lung biopsy is the gold standard for diagnosis, treatment, and prognosis, transbronchial cryo-biopsy has a high diagnostic yield, low morbidity and mortality rate, low rate of complications and lower cost. It is the diagnostic method of choice in ILD when it is available. Technological improvements with greater freezing power and tensile strength of the cryo probes, allow their use in cryotherapy and cryo-recanalization for occlusive airway tumors.


Subject(s)
Humans , Bronchoscopy/methods , Lung Diseases, Interstitial/diagnosis , Cryotherapy/methods , Biopsy/methods , Tomography, X-Ray Computed , Lung Diseases, Interstitial/classification , Lung Diseases, Interstitial/physiopathology
20.
Int. arch. otorhinolaryngol. (Impr.) ; 22(3): 203-207, July-Sept. 2018. graf
Article in English | LILACS | ID: biblio-975570

ABSTRACT

Abstract Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998-2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Tracheal Stenosis/surgery , Lasers, Solid-State/therapeutic use , Postoperative Complications/epidemiology , Wounds, Gunshot/surgery , Bronchoscopy/methods , Granulomatosis with Polyangiitis/surgery , Medical Records , Retrospective Studies , Cohort Studies , Follow-Up Studies , Treatment Outcome , Granulation Tissue/surgery , Intraoperative Complications/epidemiology , Laryngoscopy/methods
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