A Natureza na cidade: As Áreas Verdes como uma das feições da natureza na cidade capitalista (original) (raw)
Related papers
Airway stenting for malignant and benign tracheobronchial stenosis
The Annals of Thoracic Surgery, 2003
A variety of techniques have been used to palliate the effects of large airway obstruction. Tracheobronchial stenting is the optimal endoscopic management for obstruction caused by severe extrinsic compression, intraluminal spread of malignant disease or loss of cartilaginous support. Between 1999 and 2004, 50 patients had silicone rubber stents to relieve symptomatic central airway obstruction. Stent placement was performed through a Harrel Universal rigid bronchoscope. The etiology of large airway obstruction included malignant disease in 30/50 (60%); benign disease in 17/50 (34%); and tracheoesophangeal fistula in 3/50 (17%), whilst in 6 of the 50 patients, two or more stents were required to achieve complete airway patency. There were complications in 2/50 patients (4%); however, procedure-or stent-related mortality was null. Most patients (92.5%) had successful airway obstruction palliation. Airway stenting provides immediate and reliable palliation in the majority of patients with malignant and benign central airway obstruction. Multiple stents are frequently required in order to achieve satisfactory airway patency. Pneumon 2006, 19(3):245-251.
Chest, 2012
C entral airway obstruction in patients with cancer develops secondary to intraluminal disease, extrinsic tumor compression, or both. 1 For intraluminal obstruction, ablative techniques that destroy tissue are typically used, including laser therapy, electrocautery, and mechanical coring with a rigid bronchoscope, among others. For extrinsic compression, stents are used to strengthen the bronchial wall and provide a barrier against the tumor to keep the airway open. Usually, a multimodality approach is used because fi ndings are often mixed. Although airway stenting can be a highly effective treatment of central airway obstruction, several complications have been identifi ed. 2-10 Immediate perioperative complications are rare, 11 but long-term complications are more common and more serious. 1,5 Long-term complications related to stenting include infection, granulation tissue, mucus plugging, stent migration, and stent fracture. 1,5 Of these, granulation tissue is the most common serious complication requiring bronchoscopic intervention. Management is further complicated by the diffi culty of removing metal stents. 12,13 To our knowledge, no randomized controlled studies have been performed to compare the incidence of complications between different airway stents. Background: The most serious complications of airway stenting are long term, including infection and granulation tissue formation. However, to our knowledge, no studies have quantifi ed the incidence rate of long-term complications for different stents. Methods: To compare the incidence of complications of different airway stents, we conducted a retrospective cohort study of all patients at our institution who had airway stenting for malignant airway obstruction from January 2005 to August 2010. Patients were excluded if more than one type of stent was in place at the same time. Complications recorded were lower respiratory tract infections, stent migration, granulation tissue, mucus plugging requiring intervention, tumor overgrowth, and stent fracture. Results: One hundred seventy-two patients with 195 stent procedures were included. Aero stents were associated with an increased risk of infection (hazard ratio [HR] 5 1.98; 95% CI, 1.03-3.81; P 5 .041). Dumon silicone tube stents had an increased risk of migration (HR 5 3.52; 95% CI, 1.41-8.82; P 5 .007). Silicone stents (HR 5 3.32; 95% CI, 1.59-6.93; P 5 .001) and lower respiratory tract infections (HR 5 5.69; 95% CI, 2.60-12.42; P , .001) increased the risk of granulation tissue. Lower respiratory tract infections were associated with decreased survival (HR 5 1.57; 95% CI, 1.11-2.21; P 5 .011). Conclusions: Signifi cant differences exist among airway stents in terms of infection, migration, and granulation tissue formation. These complications, in turn, are associated with signifi cant morbidity and mortality. Granulation tissue formation develops because of repetitive motion trauma and infection.
Endobronchial stent for malignant airway obstructions
The Israel Medical Association journal : IMAJ, 2006
Endobronchial stents are used to treat symptomatic patients with benign or malignant airway obstructions. To evaluate the safety and outcome of airway stent insertion for the treatment of malignant tracheobronchial narrowing. The files of all patients with malignant disease who underwent airway stent insertion in our outpatient clinic from June 1995 to August 2004 were reviewed for background data, type of disease, symptoms, treatment, complications and outcome. Airway stents were used in 34 patients, including 2 who required 2 stents at different locations, and one who required 2 adjacent stents (total, 37 stents). Ages ranged from 36 to 85 years (median 68). Primary lung cancer was noted in 35% of the patients and metastatic disease in 65%. Presenting signs and symptoms included dyspnea (82%), cough (11.7%), hemoptysis (9%), pneumonia (5.9%), and atelectasis (3%). The lesions were located in the left mainstem bronchus (31%), trachea (26%), right mainstem bronchus (26%), subglottis...
Cureus, 2023
The systematic review aims to evaluate the efficacy and safety of endobronchial stent placement for malignant airway obstruction. A comprehensive search was conducted across multiple databases to identify relevant studies. Cohort studies, randomized controlled trials, and case-control studies examining the outcomes of endobronchial stent placement in patients with malignant airway obstruction were included. Data on pre-treatment evaluation, such as pulmonary function testing, dyspnea severity scoring systems, arterial blood gas parameters, imaging, and degree of obstruction, were also collected. Primary outcomes of interest included post-procedure stenosis, pulmonary function testing evaluation, blood gas parameters, and survival outcomes. Secondary outcomes encompassed improvements in clinical status, dyspnea grade, and procedure-related complications. A total of 27 studies met the inclusion criteria and were included in the systematic review. The included studies demonstrated promising outcomes of endobronchial stent placement in managing malignant airway obstruction. Post-procedure airway diameters, pulmonary function testing, and blood gas parameters improved significantly. Survival outcomes varied among studies. Furthermore, endobronchial stent placement was associated with improvements in clinical status and dyspnea grade. Procedure-related complications ranged from pain, hemoptysis and mucus plugging to stent obstruction, migration and pneumothorax. This systematic review suggests that endobronchial stent placement is an effective and safe intervention for managing malignant airway obstruction. It offers significant improvements in post-procedure stenosis, pulmonary function testing, blood gas parameters, and clinical outcomes. However, further studies with larger sample sizes and standardized reporting are warranted to better evaluate the long-term efficacy and safety of endobronchial stent placement for malignant airway obstruction.
Journal of Vascular and Interventional Radiology, 2004
PURPOSE: This study evaluates the outcome of tracheobronchial stent placement in symptomatic patients with malignant disease. MATERIALS AND METHODS: From 1993 to 2002, 30 patients had stents placed for malignant strictures. Five of 30 patients underwent stent placement distal to the mainstem bronchi, 13 received stents in both the proximal and distal airways, and 12 received stents in only the proximal airways. Clinical response and survival were determined from the patients' medical records. A positive clinical response was judged to have occurred if the patient improved in two of these three categories: subjective symptoms (patient-reported), objective signs (clinician-reported), and postprocedural imaging. RESULTS: The condition of 29 of 30 patients improved within 4 weeks of stent placement. The mean survival duration after stent placement was 261 days (SD, . The location of stent placement was not associated with significant differences in clinical improvement or survival (P ؍ .51). Eight patients had additional airway segments that were too diffusely involved in which to place a stent or could not be recanalized. Mean survival in this group with incomplete stent placement was significantly reduced at 24.9 days (SD, 23.1 days), compared with 345.5 days (SD, 436 days) for the remaining patients who underwent complete stent placement (P < .05). Four patients lived less than 10 days after the procedure and three patients (75%) had mediastinal invasion. CONCLUSION: Tracheobronchial stent placement effectively palliates malignant airway obstruction, and clinical improvement is independent of the location in which the stent is implanted. When patients had diffuse or highly obstructive airway involvement and underwent incomplete stent placement, clinical response was also satisfactory, even though survival was worse. Patients with mediastinal invasion were poor candidates for stent placement as a result of their short survival.
Drug Eluting Stents for Malignant Airway Obstruction: A Critical Review of the Literature
Journal of Cancer, 2016
Lung cancer being the most prevalent malignancy in men and the 3 rd most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement.
Complications of tracheobronchial airway stents
Otolaryngology - Head and Neck Surgery, 2003
OBJECTIVE: Our goal was to identify and analyze airway stent complications and to devise approaches to manage stent complications. STUDY DESIGN AND SETTING: We conducted a retrospective review of patients from a tertiary medical center. METHODS: Twenty-eight airway stents were placed in 23 patients for benign (n ؍ 15) and malignant (n ؍ 13) tracheobronchial diseases. All patients were followed clinically for signs of complications. RESULTS: Nine complications (8 in those with benign disease and 1 in a patient with malignant disease) were identified and included stent migration (n ؍ 3), excessive granulation tissue (n ؍ 2), stent fracture (n ؍ 1), poor patient tolerance (n ؍ 2), and inability to place (n ؍ 1). Avoidance and management strategies for stent complications are introduced. CONCLUSION: Tracheobronchial stents provide minimally invasive therapy for significant airway obstruction. Stent complications are more frequently encountered in the long-term treatment of benign conditions. Stents can be successfully removed endoscopically if complications arise, but the longer a metallic stent is in place, the more difficult it is to remove. SIGNIFICANCE: As airway stent use increases, proper management will be required to avoid and manage complications. This is the first report to fo-cus on stent complications and their management.