Objective
To explore the clinical value of balloon dilatation through flexible bronchoscope in the management of tracheobronchial stenosis of endobronchial tuberculosis.
Methods
From January 2005 to September 2009, 149 cases of tracheobronchial stenosis caused by endobronchial tuberculosis were examined by flexible bronchoscope and treated with balloon dilatation. Changes of the clinical features, atelectasis and airway diameters were observed and evaluated before and after the last treatment and in 12 months.
Results
The airway diameters were immediately enlarged (100%, 149/149) after the procedure, and the clinical symptoms were relieved. The average airway diameter changed from (2.7±1.4) mm before the procedure, to (6.8±2.0) mm, (6.4±1.7) mm and (6.3±2.3) mm immediately, 3 and 12 months after the treatments. Expansion of atelectasis was seen in 92% (34/37) of the cases, and the rate of restenosis was 3.4% (5/146) 12 months after treatment. There were significant differences before and after the treatments in the airway diameters, expansion rate of atelectasis and the general outcome (t=13.09-20.50, P<0.01), but there were no differences among measurements immediately, 3 and 12 months after the treatments. The final effective rate was 93.3% (139/149). Severe complications (4.0%, 6/149) were rare in these patients.
Conclusion
Balloon dilatation through flexible bronchoscope is a simple, effective and safe method for the management of tracheobronchial stenosis after endobronchial tuberculosis.
Key words:
Tuberculosis; Bronchi; Tracheal stenosis; Bronchoscopy; Balloon dilatation
Objective To investigate the risk factors of atherosclerotic renal artery stenosis (ARAS) in patients with coronary heart disease. Methods Six hundred and seventy-seven patients with suspected or certainly diagnosed as coronary heart disease consecutively underwent selective coronary angiography and non-selective renal artery angiography during May to Sep. 2016 in the Department of Cardiology of General Hospital of Shenyang Military Region. According to the degree of renal artery stenosis, the subjects were divided into renal artery normal group, renal artery slight stenosis group (renal artery stenosis <50%) and renal artery obvious stenosis group (renal artery stenosis ≥50%). Both univariate and multivariate logistic regression analysis were used to study the independent risk predictors of ARAS. Results By analysis of clinical data, it was found that age, systolic blood pressure, pulse pressure and creatinine level were higher in patients with different degrees of renal artery stenosis than in renal artery normal group (P<0.05). There were significant differences in different degrees of renal artery stenosis groups in female, hypertension, left main coronary artery (P<0.05). The proportion of coronary double vessel lesions was higher in renal artery slight stenosis group than in renal artery normal group (P<0.05). Age, pulse pressure and creatinine level were significantly higher in renal artery obvious stenosis group than in the other two groups (P<0.05). Peripheral vascular disease, left main coronary artery disease, single coronary artery and three vessel disease were significantly higher than that in other two groups (P<0.05). The incidence of renal artery obvious stenosis was 18.9% in patients with renal artery obvious stenosis, and was 16.7% in renal arteries slight stenosis group. By univariate and multivariate Logistic regression analysis, age, female, peripheral vascular disease, and multivessel coronary artery disease were independent risk factors for ARAS. Conclusion Renal artery angiography should be routinely performed for patients with coronary artery disease undergoing coronary angiography to identify ARAS, especially for elderly and female patients associated with peripheral vascular disease.
DOI: 10.11855/j.issn.0577-7402.2017.12.10
Abstract Background: Mitral stenosis (MS) is related to prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion. The objective of the current study was to investigate the correlation between the P-wave duration, P-wave dispersion (PWD), mitral stenosis (MS) and to explore the cut-off values for predicting the MS in the patients. Methods: We enrolled 62 patients with MS and sinus rhythm as test group, and 62 healthy subjects matched in age- and sex- were selected as control group. We conducted the 12-lead electrocardiogram and echocardiography for all the subjects. The maximum and the minimum P-wave duration and PWD were calculated. Univariate and multivariate logistic regression analyses were performed to demonstrate the correlation between P-wave duration and PWD and MS. The receiver operating characteristic (ROC) curve was drawn to detect the threshold of P-wave duration and PWD for predicting the MS. Results : There were significant differences in the left atrial diameter (45.00±5.78 vs. 32.31±4.24 cm 2 ), pulmonary artery pressure (46.68±17.29 vs. 32.64±2.86 mm Hg), left ventricular end-diastolic diameter (47.57±4.80 vs. 45.58±5.04 cm), ejection fraction (63.10±3.05 vs . 65.13±2.56%), aortic root inside diameter (29.60±3.50 vs . 31.58±3.58) and pulmonary trunk (24.17±2.78 vs . 22.23±1.77) values between the test group and the control group. Besides, the test subjects had significantly longer maximum P-wave duration (123.42±12.33 vs . 108.18±9.07) and larger P-wave dispersion (47.24±13.61 vs . 28.94±9.19). In the multivariate analysis, maximum P-wave duration (OR:1.221, 95% CI:1.126-1.324) and P-wave dispersion (OR:1.164, 95% CI:1.094-1.238) were correlated with the occurrence of MS. The optimal threshold for the maximum P-wave duration and PWD were 119.50ms, and 42.50ms, respectively, and the areas under the curve were 0.859 and 0.865, respectively. Conclusions: A longer P-wave duration and a higher PWD are correlated with the increased risk of MS progression.
Objective: To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis (TBTB). Methods: From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT (computer tomography), bronchial reconstructions and bronchoscopy. All patients underwent routine anti-tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council (mMRC) dyspnea scale and complications. Results: Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for (10±4) times, and then these patients received balloon dilatation through bronchoscope for (7±3) times subsequently. The total effective rates were 76.53% and 72.45% after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses (t=-15.012, P<0.01). The average of mMRC score changed from (3.8±0.5) before the procedure, to (1.1±0.7), (1.2±0.7) and (1.2±0.7) immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy (t=30.398-31.058, P<0.01), but not among the 3 scores after treatments. No serious complications were observed in all cases. Conclusions: Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronchial tuberculosis. A shorter course of disease indicated more benefits for patients.目的： 探讨经支气管镜冷冻术联合球囊扩张治疗瘢痕狭窄型支气管结核气道闭塞的有效性及安全性。 方法： 回顾性分析2008年12月至2016年5月首都医科大学附属北京胸科医院收治的98例瘢痕狭窄型支气管结核气道闭塞患者，支气管结核诊断依据支气管镜检查及细菌学或病理学检查，胸部CT、气道三维重建及支气管镜检查提示支气管结核瘢痕狭窄致气道闭塞。所有病例均接受全身抗结核药物治疗及气道闭塞处冷冻消融治疗，闭塞气道打通者后续行球囊扩张治疗，比较治疗前后的效果。观察指标包括临床疗效评估（包括治疗前后气道直径变化及肺复张情况）、呼吸困难指数及并发症等。 结果： 98例瘢痕狭窄型支气管结核气道闭塞患者经（10±4）次冷冻治疗后，87例成功打通闭塞气道，后续行（7±3）次球囊扩张治疗。扩张结束3个月及12个月后进行随访，治疗总有效率分别为76.53%（75/98）和72.45%（71/98）。统计不同治疗效果患者的病史时间发现，"治愈"患者病史的中位时间为3.0个月，"有效"患者病史的中位时间为5.0个月，"无效"患者病史的中位时间为9.0个月，治疗有效（包括治愈和有效）者与无效者的病史时间的差异有统计学意义（t=-15.012，P<0.01）。所有闭塞气道打通患者治疗后呼吸困难症状均较前明显改善，治疗结束时改良英国医学研究委员会呼吸困难指数（mMRC）评分由治疗前的3.8±0.5降为1.1±0.7，治疗结束3个月及12个月后mMRC评分分别为1.2±0.7和1.2±0.7。治疗后3个时段与治疗前比较，差异均有统计学意义（均P<0.01）；治疗后各时段比较，差异均无统计学意义（均P>0.05）。所有病例均未出现明显并发症。 结论： 经支气管镜冷冻术联合球囊扩张治疗是治疗瘢痕狭窄型支气管结核气道闭塞非常安全、有效的治疗方法，而且病史时间越短，治疗效果越好。.
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