Bronchoscopy For Foreign Body Removal: Where Is The Delay? [broncoscopia Para Remoção De Corpo Estranho: Onde Está O Atraso?]

This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.3411956958Zerella, J.T., Dimler, M., McGill, L.C., Pippus, K.J., Foreign body aspiration in children: Value of radiography and complications of bronchoscopy (1998) J Ped Surg, 33 (11), pp. 1651-1654Fraga, A.M., Reis, M.C., Zambon, M.P., Toro, I.C., Ribeiro, J.D., Baracat, E.C., Foreign body aspiration in children: Clinical aspects, radiological aspects and bronchoscopic treatment (2008) J Bras Pneumol, 34 (2), pp. 74-82Swanson, K.L., Prakash, U.B., Midthun, D.E., Edell, E.S., Utz, J.P., McDougall, J.C., Flexible bronchoscopic management of airway foreign bodies in children (2002) Chest, 121 (5), pp. 1695-1700Pritt, B., Harmon, M., Schwartz, M., Cooper, K., A tale of three aspirations: Foreign bodies in the airway (2003) J Clin Pathol, 56 (10), pp. 791-794Cataneo, A.J., Reibscheid, S.M., Ruiz Júnior, R.L., Ferrari, G.F., Foreign body in the tracheobronchial tree (1997) Clin Pediatr (Phila), 36 (12), pp. 701-706Applegate, K.E., Dardinger, J.T., Lieber, M.L., Herts, B.R., Davros, W.J., Obuchowski, N.A., Spiral CT scanning technique in the detection of aspiration of LEGO foreign bodies (2001) Pediatr Radiol, 31 (12), pp. 836-840Lima, J.A., Fischer, G.B., Felicetti, J.C., Flores, J.A., Penna, C.N., Ludwig, E., Aspiração de corpo estranho na árvore traqueobrônquica em crianças: Avaliação de seqüelas através de exame cintilográfico. (2000) J Pneumol, 26 (1), pp. 20-24Cassol, V., Pereira, A.M., Zorzela, L.M., Becker, M.M., Barreto, S.S., Corpo estranho na via aérea de crianças. (2003) J Pneumol, 29 (3), pp. 139-144Fraga, J.C., Nogueira, A., Palombini, B.C., Corpo estranho em via aérea de criança. (1994) J Pneumol, 20 (3), pp. 107-111Piva, J., Giugno, K., Maia, T., Mascarenhas, T., Nogueira, A., Kalil, L., Aspiração de corpo estranho: Revisão de 19 casos. (1989) J Pediat, 65 (10), pp. 399-403Inglis Jr, A.F., Wagner, D.V., Lower complication rates associated with bronchial foreign bodies over the last 20 years (1992) Ann Otol Rhinol Laryngol, 101 (1), pp. 61-66Davies, H., Gordon, I., Matthew, D.J., Helms, P., Kenney, I.J., Lutkin, J.E., Long term follow up after inhalation of foreign bodies (1990) Arch Dis Child, 65 (6), pp. 619-621Black, R.E., Choi, K.J., Syme, W.C., Johnson, D.G., Matlak, M.E., Bronchoscopic removal of aspirated foreign bodies in children (1984) Am J Surg, 148 (6), pp. 778-78

Postintubation Injuries And Open Surgical Tracheostomy: Should We Always Perform Isthmectomy? [sequelas Pós-intubação E Traqueostomia Cirúrgica Aberta: Devemos Sempre Fazer A Istmectomia?]

Objective: To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. Methods: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located in the city of Sumaré, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. Results: Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stoma complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. Conclusions: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stoma complications.353227233Maddaus, M.A., Pearson, F.G., Postintubation injury (2002) Pearson's Thoracic and Esophageal Surgery, pp. 300-314. , In: Pearson FG, Patterson GA, editors, Philadelphia: Churchill Livingstone/ElsevierStreitz Jr, J.M., Shapshay, S.M., Airway injury after tracheotomy and endotracheal intubation (1991) Surg Clin North Am, 71 (6), pp. 1211-30Park, M., Brauer, L., Sanga, R.R., Kajdacsy-Balla, A.C., Ladeira, J.P., Azevedo, L.C., Percutaneous Tracheostomy in Critically-ill Patients: The Experience of a Medical Intensive Care Unit (2004) J Bras Pneumol., 30 (3), pp. 237-242Ciaglia, P., Firsching, R., Syniec, C., Elective percutaneous dilatational tracheostomy. A new simple bedside procedurepreliminary report (1985) Chest, 87 (6), pp. 715-9Epstein, S.K., Late complications of tracheostomy (2005) Respir Care, 50 (4), pp. 542-9Pearson, F.G., Goldberg, M., da Silva, A.J., A prospective study of tracheal injury complicating tracheostomy with a cuffed tube (1968) Ann Otol Rhinol Laryngol, 77 (5), pp. 867-82Braz, J.R., Navarro, L.H., Takata, I.H., Nascimento Júnior, P., Endotracheal tube cuff pressure: Need for precise measurement (1999) Sao Paulo Med J, 117 (6), pp. 243-7Goldstraw, P., Morgam, C., Tracheostomy (2002) Pearson's Thoracic and Esophageal Surgery, pp. 375-383. , In: Pearson FG, Patterson GA, editors, Philadelphia: Churchill Livingstone/ ElsevierPutnam Jr., J.B., Traquéia (2005) Sabiston Tratado De Cirurgia, pp. 1792-1793. , In: Townsend MC, editor, Rio de Janeiro: ElsevierVianna, A., Tracheostomy in patients on mechanical ventilation: When is it indicated? (2007) J Bras Pneumol., 33 (6), pp. xxxvii-xxxviiiPerfeiro, J.A., Mata, C.A., Forte, V., Carnaghi, M., Tamura, N., Leão, L.E., Tracheostomy in the ICU: Is it worthwhile? (2007) J Bras Pneumol., 33 (6), pp. 687-90Leite, A.G., Kussler, D., Management of recurrent distal tracheal stenosis using an endoprosthesis: A case report (2008) J Bras Pneumol., 34 (2), pp. 121-5Arabi, Y., Haddad, S., Shirawi, N., Al Shimemeri, A., Early tracheostomy in intensive care trauma patients improves resource utilization: A cohort study and literature review (2004) Crit Care, 8 (5), pp. R347-52Croshaw, R., McIntyre, B., Fann, S., Nottingham, J., Bynoe, R., Tracheostomy: Timing revisited (2004) Curr Surg, 61 (1), pp. 42-8Walts, P.A., Murthy, S.C., Arroliga, A.C., Yared, J.P., Rajeswaran, J., Rice, T.W., Tracheostomy after cardiovascular surgery: An assessment of long-term outcome (2006) J Thorac Cardiovasc Surg, 131 (4), pp. 830-7Plummer, A.L., Gracey, D.R., Consensus conference on artificial airways in patients receiving mechanical ventilation (1989) Chest, 96 (1), pp. 178-80Leung, R., Macgregor, L., Campbell, D., Berkowitz, R.G., Decannulation and survival following tracheostomy in an intensive care unit (2003) Ann Otol Rhinol Laryngol., 112 (10), pp. 853-8Pinet, C., Quenee, V., Sainty, J.M., Significance of systematic endoscopic decannulation. Retrospective study on intensive care patients [Article in French] (1998) Rev Pneumol Clin., 54 (2), pp. 81-4Nouraei, S.A., Singh, A., Patel, A., Ferguson, C., Howard, D.J., Sandhu, G.S., Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis (2006) Laryngoscope., 116 (8), pp. 1417-21Coelho, M.S., Zampier, J.A., Zanin, S.A., Silva, E.M., Guimarães, P.S., Fístula traqueoesofágica como complicação tardia de traqueostomia (2001) J Pneumol., 27 (2), pp. 119-22Grillo, H.C., Mathisen, D.J., Wain, J.C., Laryngotracheal resection and reconstruction for subglottic stenosis (1992) Ann Thorac Surg., 53 (1), pp. 54-63Saueressig, M.G., Macedo-Neto, A.V., Moreschi, A.H., Xavier, R.G., Sanches, P.R., A correção das estenoses traqueobrônquicas mediante o emprego de órteses (2002) J Pneumol., 28 (2), pp. 84-93Terra, R.M., Minamoto, H., Tedde, M.L., Almeida, J.L., Jatene, F.B., Self-expanding stent made of polyester mesh with silicon coating (Polyflex®) in the treatment of inoperable tracheal stenoses (2007) J Bras Pneumol., 33 (3), pp. 241-7Gravvanis, A.I., Tsoutsos, D.A., Iconomou, T.G., Papadopoulos, S.G., Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury (2005) World J Surg., 29 (12), pp. 1571-5Karagiannidis, C., Velehorschi, V., Obertrifter, B., Macha, H.N., Linder, A., Freitag, L., High-level expression of matrix-associated transforming growth factor-beta1 in benign airway stenosis (2006) Chest., 129 (5), pp. 1298-30

Limits on decaying dark energy density models from the CMB temperature-redshift relation

The nature of the dark energy is still a mystery and several models have been proposed to explain it. Here we consider a phenomenological model for dark energy decay into photons and particles as proposed by Lima (J. Lima, Phys. Rev. D 54, 2571 (1996)). He studied the thermodynamic aspects of decaying dark energy models in particular in the case of a continuous photon creation and/or disruption. Following his approach, we derive a temperature redshift relation for the CMB which depends on the effective equation of state $w_{eff}$ and on the "adiabatic index" $\gamma$. Comparing our relation with the data on the CMB temperature as a function of the redshift obtained from Sunyaev-Zel'dovich observations and at higher redshift from quasar absorption line spectra, we find $w_{eff}=-0.97 \pm 0.034$, adopting for the adiabatic index $\gamma=4/3$, in good agreement with current estimates and still compatible with $w_{eff}=-1$, implying that the dark energy content being constant in time.Comment: 8 pages, 1 figur

Thermal behaviour of zircon/zirconia-added chemically durable borosilicate porous glass

Macroporous alkali resistant glass has been developed by making additions of zirconia (ZrO2) and zircon (ZrSiO4) to the sodium borosilicate glass system SiO2–B2O3 Na2O. The glass was made using a traditional high temperature fusion process. Differential thermal analysis (DTA) was carried out to identify the glass transition temperature (Tg) and crystallisation temperature (Tx). Based on these findings, controlled heat-treatments were implemented to separate the glass into two-phases; a silica-rich phase, and an alkali-rich borate phase. X-ray diffraction (XRD) was used to identify any crystal phases present in the asquenched and heat-treated glasses. Fourier transform infrared (FTIR) spectroscopy also proved effective in investigating phase separation and crystallisation behaviour. After leaching, a silica-rich skeleton with an interconnected pore structure and a uniform pore distribution was observed. Pore characterisation was carried out using mercury porosimetry. The size and shape of the pores largely depended on the heattreatment temperature and time. ZrO2/ZrSiO4 additions increased the alkali resistance of the porous glass 3–4 times

Brans-Dicke Theory and primordial black holes in Early Matter-Dominated Era

We show that primordial black holes can be formed in the matter-dominated era with gravity described by the Brans-Dicke theory. Considering an early matter-dominated era between inflation and reheating, we found that the primordial black holes formed during that era evaporate at a quicker than those of early radiation-dominated era. Thus, in comparison with latter case, less number of primordial black holes could exist today. Again the constraints on primordial black hole formation tend towards the larger value than their radiation-dominated era counterparts indicating a significant enhancement in the formation of primordial black holes during the matter-dominaed era.Comment: 9 page

Thermodynamics of phantom energy in the presence of a Reissner-Nordstrom black hole

In this paper, we study the validity of the generalized second law (GSL) in phantom dominated universe in the presence of a Reissner-Nordstr\"{o}m (RN) black hole. Our study is independent of the origin of the phantom like behavior of the considered universe. We also discuss the GSL in the neighborhood of transition from quintessence to phantom regime. We show that for a constant equation of state parameter, the GSL may be satisfied provided that the temperature is proportional to de Sitter temperature. It is shown that in models with (only) a transition from quintessence to phantom regime the generalized second law does not hold in the transition epoch. Next we show that if the phantom energy has a chemical potential, then the GSL will hold if the mass of black hole is above from a critical value.Comment: 5 pages, Accepted for publication in Astrophysics & Space Scienc

Unified dark energy models : a phenomenological approach

A phenomenological approach is proposed to the problem of universe accelerated expansion and of the dark energy nature. A general class of models is introduced whose energy density depends on the redshift $z$ in such a way that a smooth transition among the three main phases of the universe evolution (radiation era, matter domination, asymptotical de Sitter state) is naturally achieved. We use the estimated age of the universe, the Hubble diagram of Type Ia Supernovae and the angular size - redshift relation for compact and ultracompact radio structures to test whether the model is in agreement with astrophysical observation and to constrain its main parameters. Although phenomenologically motivated, the model may be straightforwardly interpreted as a two fluids scenario in which the quintessence is generated by a suitably chosen scalar field potential. On the other hand, the same model may also be read in the context of unified dark energy models or in the framework of modified Friedmann equation theories.Comment: 12 pages, 10 figures, accepted for publication on Physical Review

On exact solutions for quintessential (inflationary) cosmological models with exponential potentials

We first study dark energy models with a minimally-coupled scalar field and exponential potentials, admitting exact solutions for the cosmological equations: actually, it turns out that for this class of potentials the Einstein field equations exhibit alternative Lagrangians, and are completely integrable and separable (i.e. it is possible to integrate the system analytically, at least by quadratures). We analyze such solutions, especially discussing when they are compatible with a late time quintessential expansion of the universe. As a further issue, we discuss how such quintessential scalar fields can be connected to the inflationary phase, building up, for this class of potentials, a quintessential inflationary scenario: actually, it turns out that the transition from inflation toward late-time exponential quintessential tail admits a kination period, which is an indispensable ingredient of this kind of theoretical models. All such considerations have also been done by including radiation into the model.Comment: Revtex4, 10 figure

A Weyl-Dirac Cosmological Model with DM and DE

In the Weyl-Dirac (W-D) framework a spatially closed cosmological model is considered. It is assumed that the space-time of the universe has a chaotic Weylian microstructure but is described on a large scale by Riemannian geometry. Locally fields of the Weyl connection vector act as creators of massive bosons having spin 1. It is suggested that these bosons, called weylons, provide most of the dark matter in the universe. At the beginning the universe is a spherically symmetric geometric entity without matter. Primary matter is created by Dirac's gauge function very close to the beginning. In the early epoch, when the temperature of the universe achieves its maximum, chaotically oriented Weyl vector fields being localized in micro-cells create weylons. In the dust dominated period Dirac's gauge function is giving rise to dark energy, the latter causing the cosmic acceleration at present. This oscillatory universe has an initial radius identical to the Plank length = 1.616 exp (-33) cm, at present the cosmic scale factor is 3.21 exp (28) cm, while its maximum value is 8.54 exp (28) cm. All forms of matter are created by geometrically based functions of the W-D theory.Comment: 25 pages. Submitted to GR