Tratamiento de la broncomalasia con malla metálica expandible / Treatment of bronchomalacia with expandable metallic stent

Desde 1987,las mallas metálicas se han utilizado en el tratamientode obstrucciones vasculares,Posteriormente éstas comenzaron a utilizarse en tráquea y bronquios.Se presenta un lactante de 2380 g,quien presentaba displasia broncoplumonar y atelectasia masiva del pulmón izquierdo que requerió asistencia respiratoria mecánica.Se reoperó en dos oportunidades para el cierre del ductusarterioso.Se diagnosticó una broncomalacia del bronquio fuente izquierdo,que se tratócon una malla metálica expandible Palmaz-Shatz colocada bajo control endoscópico,con evolución clínica satisfactoria.El uso de la malla metálica Palmaz resultó un procedimiento útil para el tratamiento primario de la broncomalacia en este paciente

Tratamiento de la broncomalasia con malla metálica expandible / Treatment of bronchomalacia with expandable metallic stent

Desde 1987,las mallas metálicas se han utilizado en el tratamientode obstrucciones vasculares,Posteriormente éstas comenzaron a utilizarse en tráquea y bronquios.Se presenta un lactante de 2380 g,quien presentaba displasia broncoplumonar y atelectasia masiva del pulmón izquierdo que requerió asistencia respiratoria mecánica.Se reoperó en dos oportunidades para el cierre del ductusarterioso.Se diagnosticó una broncomalacia del bronquio fuente izquierdo,que se tratócon una malla metálica expandible Palmaz-Shatz colocada bajo control endoscópico,con evolución clínica satisfactoria.El uso de la malla metálica Palmaz resultó un procedimiento útil para el tratamiento primario de la broncomalacia en este paciente

Taking context seriously in psychotherapy research: relating therapist interventions to patient progress in brief psychodynamic therapy.

This study examined the process of brief psychodynamic therapy in a way that preserved the context of the dialogue between therapist and patient. Data were drawn from transcripts of the complete therapies of 2 anxious and depressed women, which lasted 16 to 17 sessions. Patient utterances were rated on a psychodynamically oriented progress-stagnation scale, and all therapist interventions were rated on scales measuring (a) their compatibility with the content of a psychodynamic formulation (Plan) and (b) their quality. Within-session sequential analyses and by session and by phase-of-therapy correlational analyses were performed. Plan compatibility of therapist interventions correlated significantly with patient progress in the early and middle phases, and the quality of therapist interventions correlated significantly with patient progress in the middle phase.

Balloon pulmonary valvuloplasty in infants: a quantitative analysis of pulmonary valve-anulus-trunk structure.

OBJECTIVES: The present study was designed to establish possible predictors of unfavorable outcome in infants with pulmonary valve stenosis. BACKGROUND: Balloon pulmonary valvuloplasty is the treatment of choice for typical pulmonary valve stenosis. Patients with dysplastic valves may be less suitable candidates for this procedure because they have morphologic abnormalities of the complex valve-anulus-trunk that cause the obstructive phenomenon. METHODS: Twenty-five children (mean age +/- SD 1.1 +/- 0.7 years) with normal anulus diameter underwent balloon pulmonary valvuloplasty using a balloon/anulus ratio of 1.2 +/- 0.11. From the lateral view of a right ventricular angiogram, the following variables were quantified and scored: A, supravalvular narrowing; B, texture of the valve surface; C, diastolic deformity of the Valsalva sinuses; D, trunk/anulus ratio; E, systolic valve motion; and F, presence of a contrast jet. Paired t test, stepwise multivariate correlation with "dummy" variable methods were applied for both hemodynamic and valve-anulus-trunk determinations. RESULTS: The right ventricular-pulmonary artery gradient decreased from 66 +/- 21 (range 40 to 120) to 24 +/- 11 (range 10 to 50) mm Hg (p less than 0.001), whereas the right ventricular systolic pressure decreased from 89 +/- 20 (range 60 to 130) to 48 +/- 15 (range 30 to 80) mm Hg (p less than 0.001). Only variables A, B and D had significant influence in a percent reduction in right ventricular pulmonary artery gradient (R2 0.94, SEE 5.7; p less than 0.001). A score greater than or equal to greater than 4 obtained by adding the values from these three variables was correlated with poor outcome. CONCLUSIONS: These data show that there is an adequate relation between scores and outcome. We conclude that children less than 2 years old with pulmonary valve stenosis and a score greater than or equal to 4 should not be candidates for balloon pulmonary valvuloplasty.