Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients

<p>Abstract</p> <p>Background</p> <p>Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment.</p> <p>Methods</p> <p>Patients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation.</p> <p>Results</p> <p>A total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions.</p> <p>Conclusions</p> <p>BTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising.</p

Indicativos de resiliência familiar em famílias de crianças com síndrome de Down

Resumo Este estudo objetiva caracterizar e analisar a resiliência familiar em famílias de crianças com síndrome de Down. Participaram cinco famílias compostas por pai, mãe e filhos, tendo um deles a síndrome. Os instrumentos utilizados foram o Questionário de Caracterização do Sistema Familiar, o qual foi respondido pela mãe; o Inventário de Estratégias de Coping, o qual ambos os genitores responderam separadamente; e entrevistas com genitores e filhos com desenvolvimento típico. As famílias foram visitadas em três momentos. Os resultados indicam que diante de eventos ruins, principalmente, dos problemas de saúde relacionados à síndrome de Down, as famílias apresentam capacidade de extrair sentido da adversidade, bem como de se organizar de forma cooperativa, com diálogo e estreitamento dos vínculos. Em todas as famílias foram identificados indicativos de resiliência familiar. A estratégia de coping mais utilizada é a reavaliação positiva, enquanto a menos utilizada é fuga-esquiva

Observation of Fe - H/D modes by nuclear resonant vibrational spectroscopy

Metal-hydrogen bonding is important in chemistry and catalysis, but H atoms are often difficult to observe, especially in metalloproteins. In this work we show that Fe-H interactions can be probed by nuclear resonance vibrational spectroscopy at the 14.4 keV 57Fe nuclear resonance. An important advantage of this method, compared to Raman and IR spectroscopy, is the selectivity for modes that involve 57Fe motion. We present data on the FeS4 site in rubredoxin and the [FeH(D)6]2- ion. Prospects for studying more complex systems are discussed. Copyright © 2003 American Chemical Society