miércoles, 5 de noviembre de 2008
Non-Invasive Alternative To Bronchoscopy In Patients With Airway Stent Complications: Multidetector CT
Multidetector CT (MDCT) scans are highly accurate in detecting airway stent complications according to a recent study performed at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, MA.
MDCT correctly identified 29 (97%) of 30 complications in 21 patients, including all cases of intraluminal narrowing, migration, invasion by neoplasm and tracheal perforation; MDCT also identified three of four cases of stent fracture," according to Vandana Dialani, MD, lead author of the study.
"Our results show that MDCT is a promising alternative to bronchoscopy for surveillance of stents for complications and has the potential to assist early detection of complications while they are most amenable to treatment. MDCT has the potential to replace bronchoscopy for the routine surveillance of patients with airway stents," said Dr. Dialani.
Patient complications from airway stents are common. "Bronchoscopy is currently the reference standard for detection and treatment of stent complications, but it is an invasive test. MDCT is a non-invasive imaging alternative for the detection of airway stent complications," said Dr. Dialani.
Although the results of this study are very promising, Dr. Dialani emphasized the need for additional, larger studies in order to determine whether a negative CT result effectively excludes a stent complication and to better assess the accuracy of MDCT for detecting rare complications.
martes, 14 de octubre de 2008
Asthma is a chronic condition involving the respiratory system in which the airways occasionally constrict, become inflamed, and are lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant such as an allergen, environmental tobacco smoke, cold or warm air, perfume, pet dander, moist air, exercise or exertion, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold.
This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes.
People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. Common symptoms of asthma include:
- Coughing, especially at night
- Shortness of breath
- Chest tightness, pain, or pressure
Still, not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your asthma symptoms may also vary from one asthma attack to the next, being mild during one asthma attack and severe during another.
Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms called asthma attacks. Others might have asthma symptoms every day. In addition, some people with asthma may only have asthma during exercise or asthma with viral infections like colds.
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Our bodies need oxygen from the air we breath in order for our cells to do their work. When we breath in, air, containing oxygen, enters through the mouth or nose, and descends through the windpipe, to tubes called the bronchi. The bronchi branch out into each lung where oxygen is picked up by passing blood. The blood then carries the oxygen throughout the body.
For a variety of reasons, what happens during an asthma episode is that the bronchial tubes become narrow, or even blocked. As a result, air can't get in or out of the lungs easily, and the child begins to breathe heavily, wheeze or cough.
There are two reasons the bronchi narrow: Either because they are squeezed by muscles from the outside or because they are blocked by mucus and swelling inside the bronchial tubes.
The condition when bronchi are narrowed by squeezing, is called "Bronchoconstriction." This occurs when muscles, wrapped around the bronchi like a series of elastic bands, tighten and restrict the passage of air. It's normal for these muscles to occasionally close the airway. But in asthmatics these muscles sometimes overreact, become twitchy and constrict or block the bronchi.
For many years, bronchoconstriction was thought to be the main cause of asthma. More recently, we've become aware of another problem: Bronchial Inflammation. This occurs when the walls of the bronchi swell up and produce mucus, in reaction to some sort of irritation.
So there are two possible conditions associated with an asthmatic's airways, bronchoconstriction and bronchial inflammation. In fact it is widely believed that the more an airway is inflamed, the more likely it is that the bronchial muscles will constrict.
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Most people with persistent asthma use a combination of long-term control medications and quick-relief medications, taken with a hand-held inhaler.
If your asthma symptoms are triggered by airborne allergens, such as pollen or pet dander, you may also need allergy treatment.
You may need to try a few different medications before you find what works best.
Because asthma changes over time, you will need to work with your doctor to monitor your symptoms and learn how to make needed adjustments.
Medications used to treat asthma include long-term control medications, quick-relief (rescue) medications and medications to treat allergies. The right medication for you depends on your age and symptoms, and what seems to work best to keep your asthma under control.
Long-term control medications
In most cases, these medications need to be taken every day. Types of long-term control medications include:
Long-acting beta-2 agonists (LABAs) such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). These inhaled medications, called long-acting bronchodilators, open the airways and reduce inflammation. They are often used to treat persistent asthma in combination with inhaled corticosteroids. Long-acting bronchodilators should not be used for quick relief of asthma symptoms.
Leukotriene modifiers such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). These inhaled medications work by opening airways, reducing inflammation and decreasing mucus production.
Advair is a steroid. It prevents the release of substances in the body that cause inflammation. Salmeterol is a bronchodilator. It works by relaxing muscles in the airways to improve breathing. Advair inhalation is used to prevent asthma attacks. It will not treat an asthma attack that has already begun. Advair inhalation is also used to treat chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis
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