Browsing by Author "Labarca, Gonzalo"
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Item A 37-year-old woman with dyspnea and stridor(American Thoracic Society, 2016) Gando, Sebastian; Garcia, Ana; Labarca, Gonzalo; Fernández-Bussy, SebastiánA woman with morbid obesity and a diagnosis of asthma since childhood sought medical attention because of unrelenting dyspnea and nocturnal stridor. Spirometry revealed a restrictive pattern with amputation of inspiratory and expiratory maximum flow rates. She was referred for further diagnostic evaluation.Item A Case of Interstitial Lung Disease With Apical Pleural Thickening: Idiopathic Pleuroparenchymal Fibroelastosis(Sociedad Española de Neumología y Cirugia Torácica, 2014) Labarca, Gonzalo; Cabello, Hernán; Fernández‐Bussy, Sebastián; Cabello, Francisca; Díaz, JuanIdiopathic pleuroparenchymal fibroelastosis (IPPFE) is a very rare, recently described condition, characterised by fibrotic thickening of the pleural and subpleural parenchyma, predominantly in the upper lobes.1 Clinical manifestations and lung function tests are similar to those observed in restrictive interstitial pneumonias, and in some of the cases described, there was a history of recurrent infections, such as allergic bronchopulmonary aspergillosis or cystic fibrosis.2,3 Radiological findings include intense pleural thickening associated with signs of fibrosis, particularly in the upper lobes, with loss of volume and structural distortion, as observed in the case presented here.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 Aplicaciones torácicas del ultrasonido(Sociedad Medica de Santiago, 2016) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Lanza, Mario; Folch, Erik; Majid, AdnanThe use of thoracic ultrasound as a diagnostic tool in the emergency department, intensive care unit or in patients with pulmonary diseases is increasing steadily. It is used to guide percutaneous tracheostomies, to assess pleural effusions, to rule out pneumothorax, and to guide the placement of endovascular and pleural catheters. It is also useful in the assessment of patients with dyspnea. The aim of this review is to provide the practical and technical basics for the use of this diagnostic tool among internists and specialists in pulmonary diseases.Item Bilateral lung disease, extensive and diffuse. Diagnosis of pulmonary alveolar proteinosis by bronchoscopic cryobiopsy(Elsevier, 2017) Gando, Sebastian; Dure, Roberto; Violi, Damian; Vazquez, Bibiana; Labarca, Gonzalo; Fernández‐Bussy, SebastiánPulmonary alveolar proteinosis (PAP) is a rare disease characterized by the intra-alveolar accumulation of a proteinaceous phospholipid-laden material called surfactant. Clinically, this disease should be suspected with respiratory failure in association with a crazy paving pattern on high-resolution chest computed tomography. We report a 24-year-old gentleman who was referred to us for a history of respiratory failure, treatment with invasive ventilation and tracheostomy. His blood exams and biochemistry were normal. His infectious and rheumatological panel was negative for a secondary disease. A flexible bronchoscopy with a transbronchial biopsy through a CryoProbe was performed. An anatomopathological analysis was periodic acid-Schiff positive for PAP. A CryoProbe is a recently developed diagnostic tool that improves the diagnostic yield in diffuse lung diseases compared to bronchoscopy with transbronchial biopsy. This method should be considered for patients with diffuse lung disease and PAP.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 Complicaciones asociadas a la broncoscopía flexible: análisis de registro post- procedimiento(Sociedad Médica de Santiago, 2014) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Zagolin, Mónica; Oyonarte, Maite; Isamit, Dionis; Jalilie, Alfredo; Guerra, Carlos; Chernilo, SaraBackground: Flexible bronchoscopy is a useful diagnostic tool with a relative low rate of complications. Aim: To analyze post procedure risk of complications after flexible bronchoscopy with transbronchial or bronchial biopsy. Material and Methods: The electronic database of a bronchoscopy unit at a general Hospital was analyzed. All procedures performed between 2009 and 2011 were reviewed and complications recorded. The primary outcome measure was the risk for complications defined as the percentage of procedures complicated by hemorrhage, pneumothorax, desaturation < 80% and other complications. We used a logistic regression model to explore the association between each procedure characteristic and complication. Results: One thousand seventy nine procedures were included in the analysis. Eight percent had complications. Among these, the frequency of hemorrhage was 5.9% and pneumothorax was 0.3%. Factors associated with complications were exclusive use of topical anesthesia with an odds ratio (OR) of 1.72 (confidence intervals (CI): 1.04-2.86), regular or bad intolerance to the procedure with an OR 4.70 (CI: 3.00-7.38) and performing biopsies of the upper lobes with an OR of 1.76 (CI: 1.04-2.97). Conclusions: Exclusive use of topical anesthesia, performing biopsies of the upper lobes and procedure tolerance were risk factors associated with complications following bronchoscopic biopsies.Item Compromiso multisistémico en apnea obstructiva del sueño(Sociedad Médica de Santiago, 2014) Labarca, Gonzalo; Cruz, Rodrigo; Descalzi, FernandoObstructive Sleep Apnea (OSA) is characterized by repetitive upper airway collapse with apnea/hypopnea and recurrent hypoxia during sleep, which results in fragmented sleep and intermittent drops in arterial blood oxygen saturation (hypoxemia). Several dysfunctions of neurocognitive, endocrine, cardiovascular, and metabolic systems are recognized in patients with OSA. The most commonly reported associations are with obesity, increased cardiovascular risk, dyslipidemia, diabetes mellitus 2 and liver damage. However, there is a proven relationship between OSA and other diseases, such as polycystic ovary syndrome, gastroesophageal reflux, and chronic kidney disease. The aim of this review is to analyze clinical and experimental evidence linking OSA with other diseases.Item Concomitant tracheal and subcutaneous glomus tumor: Case report and review of the literature(2015) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Rodriguez, Macarena; Mehta, Hiren J; Jantz, MichaelGlomus tumors are unusual and generally benign neoplasms mainly found in subungeal areas. We describe a case of concomitant subcutaneous and tracheal glomus tumor that underwent successful endoscopic resection. A 48-year old male with a left forearm subcutaneous mass presented with hemoptysis. A chest CT scan demonstrated a polypoid tracheal lesion. He underwent a bronchoscopic resection. A biopsy revealed a glomus tumor, which was the same type of neoplasm that was found on the forearm biopsy. Glomus tumors are rarely found in the respiratory tract. Only 49 cases have been described. The majority of the glomus tumors arise from the lower posterior tracheal wall with no extraluminal extension. Bronchoscopic resection has been successfully used. Glomus tumors should be included in the differential diagnosis of tracheobronchial lesions. Bronchoscopic resection and adjuvant radiotherapy are valid treatment options. This is the first report of concomitant subcutaneous and tracheal glomus tumor, as well as the first reported airway glomus tumor, in Latin America. As part of this study, we also perform a literature review.Item Dark Airway Pigmentation in a Copper Miner(2018) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Majid, AdnanItem 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 Endobronchial chondromas(2014) Fernández-Bussy, Sebastián; Labarca, Gonzalo; Descalzi, Fernando; Pires, Yumai; Santos, Maria; Majid, Adnan; Folch, ErikEndobronchial chondromas are rare benign tumors. They may be part of the Carney triad; however, isolated endobronchial chondromas can occur in the larynx, trachea, and bronchi. We report a case of an endobronchial chondroma in a 61-y-old man with an incidental 5-mm endobronchial polypoid lesion at the proximal left main bronchus that was later found to be an endobronchial chondroma. Flexible bronchoscopy demonstrated a pedunculated, vascularized, pink mass. An excisional biopsy revealed a well-circumscribed lesion with nodular areas of mature cartilage and myxoid tissue confirmatory of an endobronchial chondroma. We reviewed a total of 23 cases of isolated endobronchial chondromas reported in the medical literature. Despite their rarity, endobronchial chondromas should be considered in the differential diagnosis of endobronchial tumors. Prompt recognition and resection of endobronchial chondromas is important to prevent airway obstruction and its associated complications.Item Endobronchial Involvement in Idiopathic Hypereosinophilic Syndrome(2015) Fernández-Bussy, Sebastián; Antunez, Miguel; Pires, Yumay; Labarca, GonzaloParenchymal lung involvement in eosinophilic syndromes (ES) is frequent; however, it is rarely accompanied by tracheobronchial lesions. The etiologies of ES are infectious [parasites and aspergillus (allergic bronchopulmonary aspergillosis)], rheumatologic disease (antineutrophil cytoplasmic antibody–related vasculitis), drug-associated reaction, acute eosinophilic pneumonia, chronic eosinophilic pneumonia (CEP), and hypereosinophilic syndrome (HES).Item Falla de tratamiento en neumonía adquirida en la comunidad: coccidioidomicosis en un viajero(Sociedad Chilena de Infectología, 2013) Cabello, Hernán; Labarca, Gonzalo; Fernández-Bussy, Sebastián; Cabello, Francisca; Pires, Yumay; Soto, Rodrigo; Thompson, LuisLa neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.Item Fibrosis quística en el adulto: experiencia de un centro de referencia nacional(Sociedad Medica de Santiago, 2012) Fernández, Patricia; Labarca, GonzaloBackground: Although in most patients the diagnosis of cystic fibrosis (CF) is made during their first years of life, a proportion of patients is diagnosed during adulthood. Aim: To describe the features of adult patients diagnosed with CF. Materials and Methods: Analysis of medical records of patients diagnosed with CF in a public hospital devoted to respiratory diseases. Demographic, clinical, laboratory and microbiological data were recorded. Results: Fifty eight patients aged 25.4 ± 6.5 years were included. In 40% of them, CF was diagnosed after 15 years of age. The most common mutation found was AF508. Among clinical characteristics, lung involvement, mainly bronchiectasis, was found in 93%. The mean forced expiratory volume in the first second (FEV,) was 65,7 ± 27,1%. Fifteen patients were colonized with Pseudomonas aeruginosa. The main complication seen was hemoptysis, in 12% of patients. Five patients died, mostly due to respiratory distress associated with sepsis, while three were subjected to bilateral lung transplantation. Patients in whom the diagnosis of CF was made after 15 years of age, had lower frequency of AF508 mutation, were most commonly women and had a lower rate of pancreatic involvement. Conclusions: CF is a disease that is increasingly reaching adult population. CF must be suspected in adolescents and young adults who suffer chronic lung diseases such as bronchiectasis, particularly when they are colonized by Pseudomonas aeruginosa, or in patients who develop infections by uncommon organisms.Item Intracardiac metastasis of lung adenocarcinoma diagnosed by convex-probe EBUS(2014) Rey, Diana; Labarca, Gonzalo; Caviedes, Ivan; Fernández-Bussy, SebastiánConvex-probe endobronchial ultrasound (CP-EBUS) identified a vascularised 30 mm lesion, along the right pulmonary vein extending into the LA (figure 2). Needle aspiration was performed to the described mass and to the subcarinal lymph node. Both biopsies results were positive for lung adenocarcinoma, immunohistochemistry showed positive thyroid transcription factor-1(TTF-1), molecular analysis demonstrated a negative epidermal growth factor receptor (EGFR) and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK). The patient started chemotherapy, anticoagulation and localised radiotherapy in her right hip. Cardiac metastasis of lung cancer usually involves the pericardium or epicardium by direct invasion and/or lymphatic spread, however metastasis to the LA myocardium and endocardium are extremely rare.1 Lesions in the LA and proximal portions of great arteries can be visualised by CP-EBUS.Item Lavado broncoalveolar y derrame pleural con hipereosinofilia. Caso clínico y revisión de la literatura(Sociedad Medica de Santiago, 2016) Fernández-Bussy, Sebastián; Campos, Felipe; Ogueta, Isabel; Labarca, Gonzalo; Cabello, HernánChronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.Item Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis(Hindawi Publishing Corp., 2016) Labarca, Gonzalo; Aravena, Carlos; Ortega, Francisco; Arenas, Alex; Majid, Adnan; Folch, Erik; Mehta, Hiren; Jantz, Michael; Fernández-Bussy, SebastiánIntroduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89%) and the specificity was 99% (CI 98–100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.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 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.