Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical ...patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. Stridor developed in three cases after extubation. In these cases, bronchoscopy revealed tracheal stenosis. Dilatation and silicone stent placement were performed using rigid bronchoscopy. The other two patients were on ventilators when they were admitted to the intensive care unit and their stenoses were also treated by rigid bronchoscopy. Hypercapnia and hypoxia resolved after intervention in three cases. Of the remaining two patients, one had the tracheostomy closed and in the other patient ventilation was stopped but the tracheostomy was maintained. Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment.
Laser therapy is a well-known technique which has been safely used for almost thirty years to treat endobronchial obstruction. Nd : YAG and Nd : YAP lasers are commonly used lasers, whose safety and ...efficacy have been investigated in several large series. Diode laser is a new laser system which has been mainly used in urology, endovascular surgery, ENT, and dermatology. In recent years it has been effectively used in endobronchial treatments.
In this study, 61 patients who underwent endobronchial treatment with a diode laser in the Interventional Pneumology Unit of our hospital were retrospectively evaluated. Fifty-one patients were male. Mean age was 54.72 ± 13.81 years, and a total of 90 laser applications were given. In 39 cases, palliation of a malign obstruction was achieved while cure was achieved in 19 cases with benign obstruction. No major complication other than minor hemorrhage in 4 cases and temporary hypoxia in 2 cases was observed.
Diode laser can be used as an effective and safe modality for endobronchial treatment.
Pulmonary tuberculosis and lung cancer are still important public health problems and can occur simultaneously. In this article, we present the case of a 38-year-old patient treated for smear ...positive pulmonary tuberculosis.
During the third month of treatment, the patient developed respiratory distress and was found to have total atelectasis of the left lung. At rigid bronchoscopy, a lesion obstructing the left main bronchus was removed with a diode laser. Oncological treatment was started following the histological diagnosis of small cell bronchial carcinoma.
Pulmonary tuberculosis and bronchial carcinoma can occur at the same time and cause diagnostic confusion. The possibility should be considered in situations where both diseases are endemic.
Drug resistance has become a major problem in the treatment of tuberculosis.
1
Resistance rates in Turkey are high because treatment approaches are often inappropriate, rates of treatment completion ...are low, and therapy is not directly observed. Despite a relatively stable number of new cases of tuberculosis each year, resistance to rifampin is growing, as is multidrug resistance.
2
We report our experience in treating patients with multidrug-resistant tuberculosis.
Methods
We conducted our study at the Sureyyapaşa Center for Chest Diseases and Thoracic Surgery, a referral center in Istanbul, Turkey, for workers and family members who receive state social and health services. . . .
Resumen Objetivo El síndrome de apnea obstructiva del sueño (SAOS) puede fomentar la hiperglucemia y la resistencia a la insulina. Nuestro objetivo es investigar el efecto del SAOS sobre la glucosa ...plasmática en ayunas, la hemoglobina glucosilada (HbA1c ) y la proteína C reactiva (PCR) en pacientes no diabéticos. Material y métodos Se determinaron los parámetros de analítica hemática de 90 pacientes no diabéticos consecutivos en los que se realizaron evaluaciones polisomnográficas en nuestro laboratorio del sueño. Un total de 61 de estos pacientes con una glucemia en ayunas normal fueron clasificados según el índice de apnea-hipopnea (IAH) como casos leves (n = 16, 26,2%), moderados (n = 18, 29,5%) o graves (n = 27, 44,2%) de SAOS. Se efectuaron determinaciones de la glucosa plasmática en ayunas, la HbA1c y la PCR. Resultados La media de edad de los pacientes fue de 47,7 ± 11,2 años, y el 72% eran varones. Los niveles de HbA1c y de glucosa en ayunas presentan una correlación positiva con el IMC (r = 0,503, p = 0,00; r = 0,258, p = 0,045). No se detectó relación alguna de la HbA1c con el índice de apnea ni con el IAH, mientras que sí se observó una correlación positiva de la glucosa en ayunas con la PCR (r = 0,262, p = 0,042; r = 0,258, p = 0,045). Los niveles de HbA1c , glucosa en ayunas y PCR muestran una correlación negativa con los valores de SpO2 mínima (con valores de r = –0,302, p = 0,018; r = –0,368, p = 0,004; r = –0,365, p = 0,004, respectivamente). Los niveles de HbA1c , glucosa en ayunas y PCR muestran una correlación positiva con el índice de desaturación medio (tiempo durante el que la SpO2 es < 90% según la pulsioximetría) (r = 0,263, p = 0,041; r = 0,311, p = 0,015; r = 0,283, p = 0,027). Conclusiones Aunque no se detectó relación alguna entre el aumento de los niveles de HbA1c o de glucosa y la gravedad del SAOS en los pacientes con SAOS no diabéticos, sí se detectó una correlación con la hipoxia nocturna. Esto podría poner de manifiesto el efecto de la hipoxia nocturna sobre el metabolismo de la glucosa en los pacientes con SAOS.
Although the responsible mechanisms are not yet fully known, obstructive sleep apnea is associated with an increased risk for cardiovascular disease and events. The aorta is not only a conduit ...delivering blood to the tissues but is also an important modulator of the entire cardiovascular system, its elastic properties also affecting left ventricular function and coronary blood flow. The aim of this study was to determine left ventricular diastolic function and aortic elastic properties in patients with obstructive sleep apnea syndrome. Fourteen male patients with obstructive sleep apnea and 14 age- and body mass index-matched healthy male controls took part in the study as a control group. All subjects underwent echocardiographic examination; left ventricular cavity dimension, standard and tissue Doppler parameters, and aortic diameter (3 cm above aortic valve) at systole and diastole were measured. While the aortic stiffness index in patients with obstructive sleep apnea was significantly higher than that of the control group (4.5 +/- 0.3 vs 2.1 +/- 0.1, P = 0.001), the aortic distensibility index was found to be lower in this group compared with controls (2.4 +/- 1.2 vs 3.9 +/- 1.5 cm2 dynes(-1) 10(-6), P = 0.009). Furthermore, peak velocity of myocardial systolic wave and peak velocities of myocardial diastolic waves in sleep apnea patients were lower than in controls. There was an association between aortic stiffness and the apnea hypopnea index (coefficient = 0.49, P = 0.002). We also found an inverse correlation between peak velocity of myocardial diastolic wave and aortic stiffness (coefficient = -0.43, P = 0.003), using multiple linear regression. Increased aortic stiffness that is associated with the severity of disease in patients with obstructive sleep apnea may lead to diastolic dysfunction of the left ventricle.
A 17-year-old patient with chronic noncirrhotic liver disease was evaluated for recent exertional dyspnea and fatigue. Physical examination revealed peripheral cyanosis and a murmur of 2/6 intensity ...at the mitral and mesocardiac areas. Blood gas analysis suggested a right-to-left shunt. Echocardiography revealed an intact septum. A perfusion lung scan with Tc-99m MAA was performed to evaluate right-to-left shunt. On the scan, in addition to the distribution of Tc-99m MAA in the brain and kidneys, intense myocardial uptake was seen. The patient had hepatopulmonary syndrome, which reflects the arterial hypoxemia that can occur in patients with chronic liver disease.
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