Browsing by Author "Caviedes, Iván"
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Item Airway fibroepithelial polyposis(2017) Labarca, Gonzalo; Caviedes, Iván; Vial, Macarena R; Pires, Yumay; Folch, Erik; Majid, Adnan; Fernández-Bussy, SebastiánFibroepithelial polyps are benign lesions, frequently found in the skin and genitourinary tract. Airway involvement is rare, and few case reports have been published. Our patient was a 79 y.o. male smoker, who was referred to us with a 3-month history of dry cough. At physical examination, the patient looked well, but a chest CT showed a 6-mm polyp lesion in his trachea. A flexible bronchoscopy confirmed this lesion, and forceps biopsies were performed. Argon plasma coagulation was used to completely resect and treat the lesion. Pathological analysis revealed a fibroepithelial polyp (FP). The aim of this manuscript is to report a case of FP with bronchoscopic management and to review the current literature about this condition.Item Clinical screening of oropharyngeal dysphagia: standard of care(2017) Caviedes, Iván; Fernández-Bussy, Sebastián; Labarca, Gonzalo; Herth, Félix J FWe read with interest the paper by VERIN et al. [1] related to oropharyngeal dysphagia and its importance in institutionalised neurological and head and neck patients, between others. Furthermore, this is a very common problem in the critical and intermediate care settings, and a similar situation occurs with other acute neurological diseases, such as amyotrophic lateral sclerosis, cerebral trauma, post-neurosurgical procedures and toxic metabolic encephalopathies.Item Dendriform Pulmonary Ossification(American Association of Respiratory Care, 2015) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Pires, Yumay; Díaz, Juan Carlos; Caviedes, IvánDendriform pulmonary ossification is a rare condition often diagnosed by either surgery or postmortem examination. We report a 43-y-old man with a history of nonproductive cough for 1 y. His physical examination was unremarkable. Chest computed tomography showed multiple bilateral micronodules in both lower lobes; however, the patient's pulmonary function was normal. Flexible bronchoscopy with transbronchial biopsies revealed branching ossification. Pulmonary ossification is a chronic process characterized by progressive metaplastic ossification. We reviewed a total of 42 cases of dendriform pulmonary ossification reported in the medical literature: most of these cases were diagnosed by autopsy. Despite its rarity, dendriform pulmonary ossification should be considered in the differential diagnosis of diffuse lung disease. Bronchoscopy with transbronchial biopsies must be considered as a potential diagnostic procedure.Item Non-Answered Questions in Patients with Endobronchial Valve Placement for Lung Volume Reduction(2018) Caviedes, Iván; Labarca, Gonzalo; De Oliveira, Hugo; Herth, Felix; Fernández, SebastiánEndoscopic lung volume reduction is a minimally invasive procedure performed to reduce the space occupied by the emphysemas' lobes. This procedure has been demonstrated to be beneficial for patients with advanced chronic obstructive pulmonary disease and severe hyperinflation. The use of endobronchial valves is increasing, as well as the number of reports of adverse events. The most common complications after the procedure are a pneumothorax, bleeding, infections, the need for valve removal, and valve expulsion. We have recently treated a patient who achieved immediate left upper lobe atelectasis but developed a pneumothorax on the 6th day and near-fatal kinking of the left lower lobe bronchus. This patient had asphyctic episodes probably due to a functional left pneumonectomy. We should consider this unusual complication in patients undergoing endoscopic lung volume reduction whose condition worsens after achieving complete lobar atelectasis.Item PREDICTIVE MODELS FOR PULMONARY FUNCTION CHANGES AFTER RADIOTHERAPY FOR BREAST CANCER AND LYMPHOMA(2012) Sánchez, Beatriz; Goset, Karen; Caviedes, Iván; Delgado, Iris; Córdova, AndrésPurpose: To propose multivariate predictive models for changes in pulmonary function tests (DPFTs) with respect to preradiotherapy (pre-RT) values in patients undergoing RT for breast cancer and lymphoma. Methods and Materials: A prospective study was designed to measure DPFTs of patients undergoing RT. Sixty-six patients were included. Spirometry, lung capacity (measured by helium dilution), and diffusing capacity of carbon monoxide tests were used to measure lung function. Two lung definitions were considered: paired lung vs. irradiated lung (IL). Correlation analysis of dosimetric parameters (mean lung dose and the percentage of lung volume receiving more than a threshold dose) and DPFTs was carried out to find the best dosimetric predictor. Chemotherapy, age, smoking, and the selected dose-volume parameter were considered as single and interaction terms in a multivariate analysis. Stability of results was checked by bootstrapping. Results: Both lung definitions proved to be similar. Modeling was carried out for IL. Acute and late damage showed the highest correlations with volumes irradiated above 20 Gy (maximum R2 = 0.28) and 40 Gy (maximum R2 = 0.21), respectively. RT alone induced a minor and transitory restrictive defect (p = 0.013). Doxorubicin-cyclophosphamide-paclitaxel (Taxol), when administered pre-RT, induced a late, large restrictive effect, independent of RT (p = 0.031). Bootstrap values confirmed the results. Conclusions: None of the dose-volume parameters was a perfect predictor of outcome. Thus, different predictor models for DPFTs were derived for the IL, which incorporated other nondosimetric parameters mainly through interaction terms. Late DPFTs seem to behave more serially than early ones. Large restrictive defects were demonstrated in patients pretreated with doxorubicin-cyclophosphamide-paclitaxel.Item Reducción de volumen pulmonar endoscópica en enfisema pulmonar avanzado. Casos clínicos(Sociedad Medica de Santiago, 2017) Fernández‐Bussy, Sebastián; Labarca, Gonzalo; Caviedes, Iván; Mehta, Hiren; Jantz, Michael; Majid, AdnanChronic obstructive pulmonary disease (COPD) has no curative treatment, and in moderate to advanced stages, functional parameters and quality of life are affected. Lung volume reduction improves respiratory parameters and quality of life of these patients. Endoscopic lung volume reduction is a minimally invasive procedure that uses endobronchial valves or coils. Valves are unidirectional, blocking the air from entering the target lobe during inspiration, allowing the exit of air and secretions during expiration. Complete fissure and absence of collateral ventilation are needed for an adequate functioning of endobronchial valves. Endobronchial coils cause mechanical retraction of the lung parenchyma. We report two patients who underwent endoscopic lung volume reduction by endobronchial valves. One patient was on continuous positive pressure non-invasive ventilation due to his severe emphysema.Item Rendimiento diagnóstico de la ultrasonografía endobronquial con aspiración transbronquial por aguja fina en el estudio de etapificación mediastínica en pacientes con cáncer pulmonar(Sociedade Brasileira de Pneumologia e Tisilogia, 2015) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Canals, Sofía; Caviedes, Iván; Folch, Erik; Majid, AdnanOBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. METHODS: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). RESULTS: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. CONCLUSIONS: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions.Item Tracheostomy tube placement: Early and late complications.(Journal of Bronchology & Interventional Pulmonology and Lippincott Williams & Wilkins, 2015) Fernández-Bussy, Sebastián; Mahajan, Bob; Folch, Erik; Caviedes, Iván; Guerrero, Jorge; Majid, AdnanTracheostomy tube placement is a therapeutic procedure that has gained increased favor over the past decade. Upper airway obstructions, failure to liberate from the ventilator, and debilitating neurological conditions are only a few indications for tracheostomy tube placement. Tracheostomy tubes can be placed either surgically or percutaneously. A percutaneous approach offers fewer surgical site infections and postsurgical bleeding than a surgical approach. A surgical placement posses a lower risk of injury to the posterior tracheal wall and spontaneous decannulation is less common. Late complications of both approaches include stenosis, malacia, along with tracheoesophageal, tracheoinnominate, and tracheocutaneous fistulas. This review describes the indications and methods of placement of tracheostomy tubes along with early and late complications that may occur following placement.