ABSTRACT
We describe the technique for the first robotically assisted bilateral bronchoplasty for the treatment of tracheobronchomalacia. Since 1954, this disease process has been treated with a right thoracotomy and posterior splinting of the tracheal membrane with mesh to restore the C-shape of the trachea. Traditional video-assisted thoracoscopic surgery has been of limited benefit in these cases owing to technical challenges. A robotically assisted technique offers the dual benefit of a minimally invasive port-based system while reproducing an open surgical technique.
Subject(s)
Bronchi/surgery , Robotic Surgical Procedures/methods , Thoracic Surgery, Video-Assisted/methods , Tracheobronchomalacia/surgery , Aged , Bronchoscopy/methods , Humans , Male , Minimally Invasive Surgical Procedures/methods , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/surgery , Quality of Life , Plastic Surgery Procedures/methods , Robotic Surgical Procedures/instrumentation , Thoracic Surgery, Video-Assisted/instrumentation , Thoracotomy , Tracheobronchomalacia/pathologyABSTRACT
Infliximab (Remicade), a chimeric monoclonal antibody to tumor necrosis factor-alpha (anti-TNF-alpha), is being used with increasing frequency in the treatment of Crohn's disease. Infliximab's safety profile to date has been good with reported adverse events being mild to moderate. We report a case of diffuse alveolar hemorrhage after the second infliximab infusion in a patient with Crohn's disease. The mechanism by which infliximab may have caused the observed pulmonary insult remains unknown. Physicians should be aware of the possible association between infliximab treatment and the development of alveolar hemorrhage. Future cases should be reported.
Subject(s)
Antibodies, Monoclonal/adverse effects , Crohn Disease/drug therapy , Gastrointestinal Agents/adverse effects , Hemorrhage/chemically induced , Pulmonary Alveoli , Adult , Antibodies, Monoclonal/therapeutic use , Female , Gastrointestinal Agents/therapeutic use , Humans , Infliximab , Pneumonia/chemically induced , Pneumonia/diagnosis , Pulmonary Alveoli/pathology , Tomography, X-Ray ComputedABSTRACT
We report a case of massive endobronchial hemorrhage following a fistula formation of the right pulmonary artery to the right mainstem bronchus in a 15-year-old girl. The fistula had occurred 39 days after the patient had undergone bilateral lung transplantation for cystic fibrosis. The post-transplantation course was remarkable for bronchial colonization by Aspergillus at the site of right bronchial anastomosis and an episode of spontaneous, self-limited hemoptysis on postoperative day 17. A massive endobronchial hemorrhage during surveillance bronchoscopy occurred 39 days after transplantation. Immediate intervention, including rigid bronchoscopy followed by surgery, was effective in saving the patient. The pathophysiologic hypothesis to explain the fistula of the right pulmonary artery to the right mainstem bronchus probably involves ischemia of the anastomosis with necrosis of the suture zone complicated by endobronchial infection with Aspergillus. Rigid bronchoscopic intervention associated with an excellent medical surgical collaboration was pivotal in successfully rescuing the patient.
