Embolización bronquial en bronquiectasias / Bronchial artery embolization for bronchiectasias

Se presenta nuestra experiencia en el tratamiento de la hemoptisis con embolización bronquial en pacientes con bronquiectasias, desde el 2001 al 2008, en el Hospital Italiano de Buenos Aires. Veinte pacientes fueron tratados con este método: 12 mujeres y 8 hombres con una edad media de 51 años (15-83 años). Las causas de bronquiectasias fueron secundarias a infecciones inespecíficas en el 40%; otro 40% secuelas de tuberculosis y 20% por enfermedad fibroquística. La indicación de embolización fue hemoptisis mayor a 300 ml/24 hs o hemoptisis persistentes durante más de 3 días consecutivos con requerimiento de hospitalización. En el 85% de los casos se efectuó embolización bronquial y en el resto (15%) bronquial y mamaria. Este procedimiento fue bilateral en el 60% de los pacientes, 20% solo en el lado derecho y 20% del lado izquierdo. En 18 pacientes se logró oclusión vascular completa de todos los territorios pulmonares patológicos. Control agudo del sangrado fue obtenido en todos los pacientes (100%) y sólo dos presentaron nuevo sangrado a los 8 y 12 meses respectivamente. Como efecto colateral al tratamiento se observó dolor torácico leve y transitorio en dos pacientes. Concluimos que la embolización de las arterias bronquiales constituye un tratamiento adecuado y seguro para el control agudo de la hemoptisis en pacientes con bronquiectasias.

We present our experience on arterial embolization for the treatment of hemoptysis in patients with bronchiectasis between 2001 and 2008 at the Hospital Italiano in Buenos Aires. Twenty patients were treated with this method: 12 women and 8 men with a median age of 51 years (15-83 years). Bronchiectasis was secondary to bacterial infections in 40% and secondary to tuberculosis infection in 40% of the patients; 20% of the patients had cystic fibrosis. Embolization was prescribed when the hemoptysis was above 300 ml/24 hours or the hemoptysis was persistent for more than 3 consecutive days and the patient’s hospitalization was required. In 85% of the cases embolization was done only in bronchial arteries and in the remaining 15% in bronchial and mammary arteries. The procedure was bilateral in 60% of the patients, only on the right side in 20% and only on the left side in 20%. In 18 patients complete occlusion was achieved. Complete control of the bleeding was obtained in 100% of patients. Only two patients had a new bleeding, 8 and 12 months later respectively. The treatment side effects were slight and transitory thoracic pain in two patients. We concluded that the embolization of the bronchial arteries is a suitable and safe treatment to control hemoptysis in patients with bronchiectasis.

[Consensus guidelines for respiratory endoscopy issued by the Argentine Society of Bronchoesophagology]. / Normas de consenso para la realización de la endoscopia respiratoria de la Sociedad Argentina de Broncoesofagología.

The international consensus is that guidelines for respiratory endoscopy are inadequate, regarding such issues as institutional requirements, benefits, risks and limitations of the procedure, training programs and accreditation, with the result that the way or performing endoscopy varies according to how an operator was trained. The absence of precise recommendations means that practice is highly diverse and inappropriate use of the procedure has increased. The Argentine Consensus Group for Normalization of Respiratory Endoscopy was created in 1995 to unify criteria for several aspects of endoscopic practice. The official recommendations of the Group and of the Argentine Society of Bronchoesophagology define the indications (diagnostic, therapeutic and investigative) and contraindications (absolute, relative and high risk) for bronchoscopy. Required pre-bronchoscopic studies for routine and special cases are defined, as are indications for premedication, intubation and general anesthesia. Requirements for the setting, support personal and instruments are specified. Guidelines for topical anesthesia and techniques for insertion of the endoscope are suggested. The technique, indications and limitations of bronchoalveolar lavage, bronchial brushing and biopsy and transbronchial needle biopsy are defined. The utility and limitations of the various therapeutic techniques of bronchoscopy (laser, radiotherapy and stents) are defined. Norms to safeguard the patient, instruments and operator are emphasized.

[pH-metric variables in gastroesophageal reflux in asthmatic patients]. / Variables pH-métricas en el reflujo gastro-esofágico del paciente asmático.

As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Variables pH-métricas en el reflujo gastro-esofágico del paciente asmático. / [pH-metric variables in gastroesophageal reflux in asthmatic patients]

As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)