Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Aspectos radiológicos da atresia brônquica: relato de três casos e revisão da literatura / Radiological aspects of bronchial atresia: report of three cases and review of the literature

A atresia brônquica é uma anomalia congênita rara que usualmente produz massa justa-hilar com hipertransparência distal à radiografia simples. A maioria dos pacientes é jovem e não apresenta sintomas. A tomografia computadorizada confirma o diagnóstico, permitindo o manejo conservador nos casos assintomáticos. Os autores relatam três casos de atresia brônquica. Um caso, de particular interesse, estava associado a volumosa broncocele em paciente do sexo feminino, de 45 anos de idade, que apresentou quadro sintomático de infecção respiratória. O diagnóstico foi estabelecido por meio dos achados da radiologia convencional, da tomografia computadorizada e da comparação com radiografias convencionais e tomografia linear prévios, que já demonstravam alterações. Realizou-se uma revisão sobre os achados clínicos e radiológicos dessa malformação

Bronchial atresia is a rare congenital abnormality that usually shows a juxta-hilar mass with distal radiolucency on conventional x-ray films. Most patients are young and have no symptoms. Computed tomography usually confirms the diagnosis, allowing conservative management of the asymptomatic cases. The authors report three cases of bronchial obstruction. One of the patients was of particular importance and interest, a 45-year-old female patient with symptoms of respiratory infection, due to the association with a bulky bronchocele. The diagnosis was made by analyzing the findings of conventional x-ray films and computed tomography, and the comparison with previous conventional x-ray films and linear tomography, which had already demonstrated abnormalities. A literature review on the clinical and radiological findings of this pulmonary malformation is presented.

Quiste broncogénico en el período neonatal / Bronchogenic cyst in the neonatal period

Las malformaciones congénitas del árbol traqueobronquial en el período neonatal son raras y deben ser consideradas en el diagnóstico diferencial del síndrome de dificultad respiratoria del recién nacido. Se presenta el caso de un recién nacido pretérmino con dificultad respiratoria desde el nacimiento, cuyo diagnóstico pre y postoperatorio fue de un quiste broncogénico de 3 cm de diámetro que comprimía el bronquio fuente izquierdo. La evolución fue satisfactoria, quedando una leve estenosis bronquial en el sitio de la resección del quiste

Errores en el diagnóstico y manejo del cuerpo extraño en la vía aérea / Errors in diagnosis and management of foreing bodies in the airway

En una publicación realizada en el año 1985, se encontró que la primera causa de muerte en Chile, en otorrinolaringología, fué cuerpos extraños en la vía aérea. En un servicio de ORL se reciben múltiples solicitudes de endoscopía con diagnóstico de sospecha de C.E. Después de analizar la sintomatología, diagnóstico y endoscopías de 266 casos, se recolectaron 133 casos de C.E. que fueron considerados de interés para el análisis y enseñanza, encontrando múltiples errores en el diagnóstico y manejo de estos. 79 por ciento se localizaron en el árbol bronquial, 15 por ciento en tráquea, y 6 por ciento en laringe. Se presentan algunos casos y luego se comentan los errores de diagnóstico y procedimiento, dando claves que serían de utilidad para la prevención, diagnóstico y manejo de este cuadro. Se recalca la importancia del síndrome de penetración, muchas veces subvalorado; en el examen físico se describen signos como la auscultacion esterofónica y el ruido de apertura. En la radiología, la desviación del mediastino, la atelectasia aireada y la combinación de atelectasia y enfisema en el mismo hemitorax. Algunos de estos signos no han sido descritos previamente. En la discusión y conclusiones se dan algunas recomendaciones para evitar los C.E. en especial en niños y algunas guías para el correcto diagnóstico y sospecha. También se comentan algunos hechos en relación al instrumental, anestesia, endoscopista y procedimiento. Finalmente se mencionan algunos aforismos relacionados con el tema

Síndrome da cimitarra: aspectos da endoscopia respiratória / Scimitar syndrome: endoscopic respiratory aspects

Apresenta-se o caso de uma paciente de 10 anos de idade, sexo feminino, assintomática, encaminhada ao serviço com diagnóstico de dextrocardia. A investigaçäo observou-se o sinal radiológico da cimitarra. A broncoscopia e a broncografia evidenciaram ausência de lobos superior e médio e anormalidades na segmentaçäo brônquica do lobo inferior direito. O cateterismo confirmou a drenagem anômala da veia pulmonar direita para a veia cava inferior, configurando a síndrome da cimitarra

Bronchial lability in allergic rhinitis.

The aim of this study was to assess the relationship between exercise bronchial lability and the changes in pulmonary function over a one year period in allergic rhinitis. Eighty four nonsmoking male medical students of whom twenty two were allergic rhinitics were studied. Pulmonary function status was significantly lower and exercise bronchial lability significantly higher in the allergics. Over a one year period the mean decline in the forced expiratory volume in one second (FEV1) was three times greater and in the forced expiratory flow rate in the middle half of the vital capacity (FEF 25-75%) 50% greater among the allergics. The change in FEV1 was positively related to the bronchial lability, indicating that greater bronchial lability was associated with less decline in pulmonary function in these subjects.

Effect of exercise stress on the bronchospastic response of asthmatics in remission.

Twenty asthmatics in remission phase were subjected to exercise stress by running on level ground for 6 minutes and the degree of airway obstruction was measured by a peak flowmeter. The response was compared to 20 normal healthy volunteers. The prevalence of exercise induced asthma (EIA) was observed to be 75% among the asthmatics with male preponderance. A 100% response was seen in asthmatics of more than 25 years age. EIA was more, and so was the degree of response, as the duration of illness increased. The maximal fall in PEFR from its basal value was seen in the 6th minute after stopping the exercise in majority of the cases. No positive response was observed among the healthy controls.

Changes of rabbit pulmonary elastic properties and bronchomotricity in experimentally induced chronic Chagas'disease

Com o intuito de estudar a denervaçäo brônquica na fase crônica da doença de Chagas investigaram-se as propriedades mecânicas e a motricidade brônquica de 6 coelhos chagásicos crônicos e 4 controles. Utilizou-se o método da pletismografia de corpo inteiro e todas as medidas foram feitas antes e depois da administraçäo endovenosa de cloridrato de histamina (0,11 mg/kg). No grupo chagásico crônico obteve-se um menor acréscimo da capacidade residual funcional e uma quase inalteraçäo do pico de fluxo na expiraçäo passiva após a administraçäo de histamina. Este grupo apresentou também um desvio para a direita na curva estática de pressäo transpulmonar/volume. Estes resultados sugerem uma alteraçäo na árvore brônquica, que consiste principalmente numa broncoreatividade diminuída