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Apoyo ventilatorio domiciliario en ni os con insuficiencia respiratoria crónica: Experiencia clínica Home ventilation in children with chronic respiratory failure: a clinical trial  [cached]
Ignacio Sánchez D.,Astrid Valenzuela S.,Pablo Bertrand N.,Cecilia Alvarez G.
Revista chilena de pediatría , 2002,
Abstract: Resumen Introducción: En los últimos a os se han desarrollado sistemas de apoyo ventilatorio en domicilio (SAVED), que han logrado tratar pacientes con insuficiencia respiratoria crónica en su hogar. Objetivo: revisar nuestra experiencia en los pacientes con SAVED. Pacientes y Método: Se revisaron las fichas de los 15 pacientes (9 mujeres) con SAVED dados de alta del Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile, entre enero de 1993 y diciembre 2000. Se describen las características del grupo y su seguimiento. Resultados: Sus edades al alta fluctuaron entre 5 meses y 15 a os; 6 tenían enfermedad neuromuscular, 4 da o pulmonar crónico, 1 deformidad torácica y 4 traqueobroncomalacia grave. Doce requirieron traqueostomía, de estos, 4 utilizaron ventilación mecánica (PLV-102, LifeCare) y 8 CPAP con generador de flujo (Downs) y válvula de PEEP, y 3 ventilación nasal a través de BiPAP. El alta fue entre 2 y 4 meses desde el ingreso y la implementación del SAVED entre 1 y 4 meses, de acuerdo a la realidad familiar y previsional. El período de seguimiento fue de 3 meses a 8 a os. La tasa de reingreso fue 2,5 y 0,4 ingresos/paciente/a o por morbilidad y por falla de sistema respectivamente; el tiempo promedio de estadía en el hospital fue de 16,5 ± 9 días/a o. Se logró la retirada del SAVED en 5 pacientes y 1 ni o falleció debido a su enfermedad neurológica. En resumen, nuestra experiencia demuestra que los SAVED son una alternativa real en el manejo de pacientes con insuficiencia respiratoria crónica grave. Esta terapia presenta escasas complicaciones, permite enviar al paciente a su casa y disminuye en forma significativa los costos del tratamiento Recently home assisted ventilation care (HAV) in children with chronic respiratory insufficiency has been developed. Objective: To report our experience about children discharged with HAV and their follow-up. Patients and methods: We reviewed the clinical notes of 15 children (9 girls) who were discharged from the Paedriatric Service of the Chilean Catholic University between january 1993 and december 2000. Patients: were aged between 5 months and 15 years, 6 had neuromuscular disease, 4 chronic lung disease, 1 thoracic deformity and 4 had severe tracheobronchomalacia. 12 required tracheostomy, mechanical ventilation was used in 4 cases (PLV-102, Lifecare), in 8 CPAP and Downs flow generator with PEEP valve, and in 3 BiPAP. The decision to use HAV was decided 2-4 months after admission, depending on the child’s condition, and was accomplished 1-4 months later, taking into
Traqueobroncomalacia en pacientes pediátricos: experiencia clínica
Castillo M,Andrés; Smith S,Jeany; Figueroa V,Valeria; Bertrand N,Pablo; Sánchez D,Ignacio;
Revista médica de Chile , 2002, DOI: 10.4067/S0034-98872002000900008
Abstract: background: tracheobronchomalacia is characterized by a deficiency in the cartilaginous support of the trachea and bronchi and hypotony in the myoelastic elements, that lead to different levels of airway obstruction. aim: to report our experience in the treatment of traqueobronchomalacia. material and methods: retrospective review of 24 patients with tracheomalacia of different levels (3 tracheobronchomalacia, 3 laryngotracheomalacia) and 8 patients with bronchomalacia. results: the age at diagnosis ranged from 9 days to 9 years. clinical presentation was recurrent wheezing in 19 patients, stridor in 6 and atelectasis in 4. the associated factors were neurological impairment in 8, congenital heart disease in 10 and prolonged mechanical ventilation in 4. the diagnosis was done by flexible bronchoscopy in all patients, using sedation and allowing spontaneous breathing. at the moment of diagnosis, treatment consisted in oxygen supply in 14 patients, physiotherapy in 21, b2 adrenergic agonists in 27, racemic epinephrine in 8, mechanical ventilation in 12, ipratropium bromide in 5 and inhaled steroids in 13. after diagnosis, 24 patients received bronchodilator therapy with ipratropium bromide, 15 received racemic epinephrine and 22 received inhaled steroids. in 21, b2 adrenergic agonists were discontinued. thirteen patients required ventilation support and home oxygen. twenty two patients showed a satisfactory clinical evolution and 6 patients died. conclusions: the clinical presentation of tracheobronchomalacia is varied and diagnosis is done by flexible bronchoscopy. treatment will depend on the severity of the disease, but b2 adrenergic agonists should be excluded (rev méd chile 2002; 130: 1014-20).
Tracheobronchomalacia and/or Excessive Dynamic Airway Collapse?  [cached]
Celal Karl?kaya,Banu Al?c?o?lu
Balkan Medical Journal , 2011,
Abstract: Expiratory airway collapse is defined as more than 50% reduction in the horizontal cross-sectional area of the airway at expiration or during coughing; and is due to pure tracheobronchomalacia (TBM) or excessive dynamic airway collapse (EDAC). It is not easy to make a clear differentiation between TBM and EDAC. These two conditions are different entities, yet they may be mistaken for each other and they may also coexist. In this paper we discuss differential diagnosis of EDAC and TBM in the light of fiberoptic and virtual bronchoscopic images according to a newly proposed FEMOS classification.
Erythema nodosum: prospective study of 32 cases
Fernandes, Nurimar C.;Maceira, Juan;Muniz, Mauro de Medeiros;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1994, DOI: 10.1590/S0036-46651994000600006
Abstract: the results of 32 cases studied lead us to the conclusion that erythema nodosum's investigation routine is very important, once in our retrospective study, the percentage of cases of unknown etiology was 69.4%, and in this prospective study it is 21.8%. in 10 cases (31.2%), more than one causing agent was suspected. infections (bacterial, helminthic, fungal, by protozoa) were diagnosed in 26 cases, streptococcal infection having predominated (12 cases). drugs-dipirone, aspirin, anovulatory - were suspected as causing agents in 13 cases. the association of erythema nodosum and histoplasmosis capsulata is described for the first time in brazil. we consider erythema nodosum to be a complex syndrome which should be regarded as a manifestation of underlying diseases. the fact that all 32 subjects were women, 26 of them during menacme, suggests that particular hormonal media may favor the action of various processes (infections and drugs), precipitating erythema nodosum's clinical picture.
Desmoid tumors: Experience of 32 cases and review of the literature  [cached]
Kumar V,Khanna S,Khanna A,Khanna R
Indian Journal of Cancer , 2009,
Abstract: Background: Desmoids are infiltrative, locally destructive, soft tissue tumors. Although they do not metastasize, the incidence of local recurrence is quite high. Aim : Present study aimed at reporting the 10-year experience of 32 desmoid cases and reviewing some facts with symptoms, investigation, and treatment of the disease. Materials and Methods : Thirty two cases of desmoid tumors were reviewed over a 10-year span. Surgical resection and adjuvant radiotherapy were the treatments of choice whenever histological margins were positive . Results : Multiparous women in reproductive age were the most commonly afflicted. The commonest site of presentation was the abdominal wall. Ninety one percent (20/22) were infraumbilical. The tumors were found in the rectus sheath in 14 patients (64%) and were laterally situated in 8 patients (36%). Local infiltration was found in six patients and the urinary bladder was most commonly involved (3/6). Locally recurrent desmoids were seen in eight patients (25%). Conclusions : In our experience, 25% of the desmoid tumors (8/32) were recurrent and postoperative radiotherapy did not seem to influence the local recurrence rate. The most important predictor for recurrence was tumors of> 5 cm.
Severe Tracheobronchomalacia after Prolonged Intubation of Multitrauma Patient
V. G. Sams,C. M. Lawson,A. B. Shibli,D. A. Taylor,P. R. Branca
Case Reports in Surgery , 2011, DOI: 10.1155/2011/627012
Abstract: Tracheobronchomalacia is a condition with significant morbidity with many etiologies including iatrogenic ones and should be considered in critically ill ventilated trauma patients. We present a case of a multitrauma patient who had difficulty weaning from the ventilator after prolonged intubation followed by tracheostomy tube placement. We describe her presentation, diagnosis, and management provide and as well a discussion of the condition.
Fósforo 32: Experiencia de 30 a os en la policitemia vera Thirty years of experience in the use of 32 phosphorus for Polycythemia Vera  [cached]
Norma Fernández Delgado,Teresa Fundora Sarraff,María Teresa Milanés Roldán
Revista Cubana de Hematolog?-a, Inmunolog?-a y Hemoterapia , 2003,
Abstract: Se realizó un estudio retrospectivo de 279 pacientes con policitemia vera (PV) de los cuales 72 (25,8 %) fueron tratados con 32P con un tiempo de seguimiento entre 4 y 28 a os. La edad promedio fue de 61 a os al recibir el primer tratamiento. El control hematológico se obtuvo en el 95,8 % de los casos (n=69). La media de duración del control hematológico fue de 27,8 meses. La media de la dosis total utilizada por paciente fue de 9.2 ± 8,9 mCi. En 34 pacientes (54,1 %) fue necesaria la administración de más de una dosis del radiofármaco durante el tiempo de evolución de la enfermedad. Del total de pacientes tratados, 5 (6,9 %) desarrollaron una leucemia aguda entre los 9 y 25 a os posteriores a la primera administración y 3 (4,1 %) desarrollaron otras malignidades después de más de 15 a os del diagnóstico. La mediana de supervivencia postratamiento fue de 10,1 a os y la causa fundamental de muerte fueron los accidentes vasculares. No hay dudas de que el 32P constituye un método terapéutico conveniente y eficaz, fundamentalmente en pacientes mayores de 60 a os, que logra una excelente calidad de vida y prolonga la supervivencia con un mínimo de reacciones adversas y un costo moderado A retrospective study of 279 patients suffering from Polycytemia Vera (PV) was made. Seventy-two of these patients (25%) were treated with 32 Phosphorus and followed-up for 4 to 28 years. The average age was 61 years on the first treatment. The hematological control was obtained in 95.8% of cases (n=69). The mean duration of the hematological control was 27.8 months. The total dose mean used per patient was 9.2±8.9 mCi. Thirty-four patients (54.1%) required the administration of more than one dose of the radioactive pharmaceutical during the evolution of the disease. Of all the treated patients, five (6.9%) developed acute leukemia 9 to 25 years after the first administration of the radiopharmaceutical and 3 (4.1%) developed other malignancies after 15 years of having been diagnosed or more. The post-treatment survival median was 10.1 years and the fundamental cause of death was vascular problems. 32 phosphorus treatment is undoubtedly a desirable effective therapeutical method for over 60 years-old patients since it assures excellent quality of life and extends the survival period, with minimum adverse reactions at a moderate cost
Técnicas en cirugía bariátrica: experiencia en 78 casos Techniques of bariatric surgery: analysis of 78 cases
B. Cánovas,J. Sastre,A. Neblett,R. López-Pardo
Nutrición Hospitalaria , 2006,
Abstract: Objetivos: La cirugía bariátrica ha demostrado su eficacia en pérdida de peso y reducción de comorbilidades en el obeso mórbido. Los objetivos de nuestro trabajo fueron: evaluar los resultados con las técnicas de Scopinaro y Bypass gástrico, mediante cirugía abierta y laparoscópica. Material y métodos: 78 pacientes con obesidad mórbida intervenidos desde el a o 2000 al 2005. 50 pacientes fueron intervenidos por cirugía abierta y 28 por laparoscopia. Se realizó bypass gástrico en 54 pacientes, la técnica Scopinaro en 20 y gastroplastia vertical anillada en 3. El tiempo de seguimiento fue desde 6 y 60 meses. Se recogieron los resultados obtenidos con las diversas técnicas y vías quirúrgicas. Resultados: El porcentaje de pacientes con pérdida de exceso de peso inferior al 50% a los dos a os fue del 5% y del 13%, y superior al 75% fue del 55% y del 40% en el bypass gástrico y el Scopiraro respectivamente. Todas las comorbilidades mejoraron significativamente. La estancia media fue inferior (p < 0,001) en el caso de laparoscopia. Las complicaciones no nutricionales fueron en su mayoría superiores en la cirugía abierta destacando las eventraciones (30%), infección de las herida (32%), y complicaciones respiratorias (16%). Las complicaciones nutricionales fueron superiores en la técnica Scopinaro destacando el déficit de vitamina D (50%), Zinc (25%), magnesio (10%) y albúmina (5%). Conclusiones: En nuestra experiencia, la realización del bypass gástrico por laparoscopia, consigue menor estancia media, menores complicaciones nutricionales y quirúrgicas, sin diferencias significativas con respecto al Scopinaro en cuanto a pérdida de peso y reducción de comorbilidades. Sin embargo, para poder defender esta técnica como de elección se requieren estudios de mayor tama o, controlados y aleatorizados y a más largo plazo, teniendo siempre en cuenta la experiencia de nuestros cirujanos. Objetives: Bariatric surgery has demonstrated its efficacy in weight loss and in reducing the comorbidities in the morbid obesity patient. The objectives of this study were to analyze the effectiveness and complication of the Scopinaro and gastric bypass techniques as well as the results from open surgery verses laparoscopy. Design: Retrospective study from 1999-2005. Subject and methods: 78 patients with morbid obesity were operated. 50 patients underwent open surgery and 28 underwent laparoscopy. Gastric bypass was performed in 54 patients, Scopinaro was performed in 20 patients and Vertical Banded Gastroplasty (VBG) was performed in 3 patients. The follow up time was between 6 and 60
SH. Hasanpour avanji,M.Ghofrani
Iranian Journal of Child Neurology , 2006,
Abstract: Objective:Pseudotumor Cerbri (PTC) is a clinical syndrome characterized byincreased Intra-Cranial Pressure (ICP) without any evidence of a masslesion or any obstructive process. The incidence is 0.9-2 per 100.000people. It is more frequent in adults in the 20-30 years age group,especially obese women, and less common in pediatric age groups;11-16 years old children may however suffer from PTC, with nodifference in the rates of occurrence in either sex.Material & Methods:In this descriptive retrospective study we reviewed the files of 32children with diagnosis of PTC admitted during the past 15 years inthe neurology ward of the Mofid Children's Hospital (25) and AliAsghar Children Hospitals (7) between the years 1988 and 2003.Results:The results of this study revealed that children in the 5-10 years agegroup, girls in particular, are more vulnerable.Conclusion: The most frequent complaints that brought these patients to physicianincluded headache, vomiting and strabismus. Common findings ofneurological examination were papilledema, abducent nerve palsyand ataxic gait. While all cases recovered with medical treatment,one did need surgical intervention.Abbreviations; Pseudotumor Cerbri = PTC; Intra Cranial pressure =ICP
Extraosseous (extramedullary) plasmacytomas: a clinicopathologic and immunophenotypic study of 32 Chinese cases
Zhuo Zuo, Yuan Tang, Cheng-Feng Bi, Wen-Yan Zhang, Sha Zhao, Xiao-Qing Wang, Qun-Pei Yang, Li-Qun Zou, Wei-Ping Liu
Diagnostic Pathology , 2011, DOI: 10.1186/1746-1596-6-123
Abstract: Thirty-two cases of EMP were investigated retrospectively by histopathology, immunophenotype, genotype and survival analysis.Clinically, the mean age of the patients was 53.4. Most of the patients received no treatment after the diagnosis was established, and the prognosis was relatively poor. Histologically, in 40% of the cases, the neoplastic cells were grade II or III. The neoplastic cells expressed one or more PC associated antigens. The immunophenotype of EMP and inflammation of sinonasal regions with numerous PC infiltrations were compared and showed some difference in expression of CD45, CD27, CD44v6 and Bcl-2 as well. Ig light chain restriction was detected in 87.5% of the cases.we described 32 Chinese cases of EMP, compare with that reported in the literature, some differences are presented, including higher percentage of grade II and III cases, clinically inconsistent treatment and management as well as poor outcome of the disease.Extraosseous plasmacytomas, so called extramedullary plasmacytomas (EMP) is defined by the updated WHO classification (2008) as localized plasma cell neoplasms that arise in tissues other than bone [1]. EMP is a rare tumor and accounts for 3~5% of all plasma cell neoplasm. Approximately 80% of them occur in the upper aerodigestive tract. EMP has also been noted to arise in other anatomic sites, including the gastrointestinal tract, lymph node, bladder, CNS, breast, thyroid, testis, parotid and skin [1,2]. There were a few reports of the tumor in large numbers in literatures, and most of those studies mainly focused on clinical features and outcome analysis of the tumor as well [3,4]. Dores GM et al [5] reviewed and analyzed the incidence and survival for plasmacytoma of bone, EMP and multiple myeloma reported in the United States in period of 1992-2004. There were 1543 cases of plasmacytomas, and EMP occupied 30.7% (474/1543). In all 474 cases of EMP, most patients were white males with advanced age, only 41 of them were Asians.
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