ADDY LIDVINA MEJIA PALOMINO
Índice h a partir de 2011
4
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
Resultados de Busca
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- Early complications in flexible bronchoscopy at a university hospital(2020) JACOMELLI, Marcia; MARGOTTO, Stephania Silva; DEMARZO, Sergio Eduardo; SCORDAMAGLIO, Paulo Rogerio; CARDOSO, Paulo Francisco Guerreiro; PALOMINO, Addy Lidvina Mejia; FIGUEIREDO, Viviane RossiObjective: To analyze the complications related to flexible bronchoscopy (FB) and its collection procedures in outpatients and inpatients with various lung and airway diseases treated at a university hospital. Methods: This was a retrospective analysis of complications occurring during or within 2 h after FB performed between January of 2012 and December of 2013, as recorded in the database of the respiratory endoscopy department of a hospital complex in the city of Sao Paulo, Brazil. Results: We analyzed 3,473 FBs. Complications occurred in 185 procedures (5.3%): moderate to severe bleeding, in 2.2%; pneumothorax, in 0.7%; severe bronchospasm, in 0.8%; general complications (hypoxemia, psychomotor agitation, arrhythmias, vomiting, or hypotension), in 1.6%; and cardiopulmonary arrest, in 0.03%. There were no deaths related to the procedures. Specifically, among the 1,728 patients undergoing biopsy, bronchial brushing, or fine-needle aspiration biopsy, bleeding occurred in 75 (4.3%). Among the 1,191 patients undergoing transbronchial biopsy, severe pneumothorax (requiring chest tube drainage) occurred in 24 (2.0%). Conclusions: In our patient sample, FB proved to be a safe method with a low rate of complications. Appropriate continuing training of specialist doctors and nursing staff, as well as the development of standardized care protocols, are important for maintaining those standards.
- Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS(2023) BARROSO, Andreia; LIN, Flavia; CARRONDO, Maria Cristina; PALOMINO, Addy; DEMARZO, Sergio Eduardo; FIGUEIREDO, Viviane Rossi; JACOMELLI, MarciaObjective: To assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). Methods: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. Results: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.0819.770; p = 0.036). Conclusions: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.
- Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil(2022) DEMARZO, Sergio Eduardo; MELO, Julia Bamberg Cunha; CARRANZA, Mariasol Ximena Martinez; OLIVEIRA, Felipe Nominando Diniz; FERREIRA, Anaregia de Pontes; PALOMINO, Addy Lidvina Mejia; FIGUEIREDO, Viviane Rossi; JACOMELLI, MarciaObjective: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. Methods: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coracao and Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, from March to August 2020. Results: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1 +/- 14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. Conclusion: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.
- Difficult Airway Intubation with Flexible Bronchoscope(2013) RODRIGUES, Ascedio Jose; SCORDAMAGLIO, Paulo Rogerio; PALOMINO, Addy Mejia; OLIVEIRA, Eduardo Quintino de; JACOMELLI, Marcia; FIGUEIREDO, Viviane RossiBackground and objective: To describe the efficacy and safety of a flexible bronchoscopy intubation (FBI) protocol in patients with difficult airway. Method: We reviewed the medical records of patients diagnosed with difficult airway who underwent flexible bronchoscopy intubation under spontaneous ventilation and sedation with midazolam and fentanyl from March 2009 to December 2010. Results: The study enrolled 102 patients, 69 (67.7%) men and 33 (32.3%) women, with a mean age of 44 years. FBI was performed in 59 patients (57.8%) with expected difficult airway in the operating room, in 39 patients (38.2%) in the Intensive Care Unit (ICU), and in 4 patients (3.9%) in the emergency room. Cough, decrease in transient oxygen saturation, and difficult progression of the cannula through the larynx were the main complications, but these factors did not prevent intubation. Conclusion: FBI according to the conscious sedation protocol with midazolam and fentanyl is effective and safe in the management of patients with difficult airway.
- Bronchoscopic techniques for removal of foreign bodies in children's airways(2012) RODRIGUES, Ascedio Jose; SCUSSIATTO, Evandro Alencar; JACOMELLI, Marcia; SCORDAMAGLIO, Paulo Rogerio; GREGORIO, Marcelo Gervilla; PALOMINO, Addy Lidvina Mejia; OLIVEIRA, Eduardo Quintino; FIGUEIREDO, Viviane RossiIntroduction The management of airway foreign bodies (AFB) can be a dramatic situation in the emergency treatment of children and different techniques have been used to improve the therapeutic success and minimize risks. Objective: to describe the bronchoscopic techniques used in the treatment of AFB in children referred to the Service of Respiratory Endoscopy of HC- FMUSP. Patients and methods: Retrospective analysis of 78 children who underwent bronchoscopy for foreign body removal, at our Service from February 2003 to April 2008. Results: 78 patients with an AFB, aged 08 months to 14 years, with 39 being organic and 39 inorganic foreign bodies. Nine foreign bodies were located in the central airway (four in the larynx and five in the trachea), 34 in the right bronchial tree and 33 in the left bronchial tree. There was bilateral aspiration in two cases. All patients were initially submitted to diagnostic flexible bronchoscopy. A rigid bronchoscope was used in 39 cases; a flexible bronchoscope in 23 and an association of techniques in 15 cases (rigid bronchoscopy, flexible bronchoscopy, suspension laryngoscopy, and fluoroscopy). Discussion: Although the rigid bronchoscopy is considered the main tool for the removal of foreign bodies from airways, other useful techniques deserve attention as part of the medical training. Conclusion: The knowledge and association of different methods in pediatric bronchoscopy add the benefits of one method to another, minimizing the chances of therapeutic failure. Pediatr Pulmonol. 2012; 47: 59- 62. (C) 2011 Wiley Periodicals, Inc.
- Radial echo-bronchoscopy for the diagnosis of peripheral lung lesions Response(2017) JACOMELLI, Marcia; DEMARZO, Sergio Eduardo; CARDOSO, Paulo Francisco Guerreiro; PALOMINO, Addy Lidvina Mejia; FIGUEIREDO, Viviane Rossi
- Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil(2015) FIGUEIREDO, Viviane Rossi; CARDOSO, Paulo Francisco Guerreiro; JACOMELLI, Marcia; DEMARZO, Sergio Eduardo; PALOMINO, Addy Lidvina Mejia; RODRIGUES, Ascedio Jose; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo Manoel; CARVALHO, Carlos Roberto RibeiroObjective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. Methods: This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Results: Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 +/- 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 670%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. Conclusions: We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.
- The role of endobronchial ultrasoundguided transbronchial needle aspiration in isolated intrathoracic lymphadenopathy in non-neoplastic patients: a common dilemma in clinical practice(2020) SANTOS, Lilia Maia; FIGUEIREDO, Viviane Rossi; DEMARZO, Sergio Eduardo; PALOMINO, Addy Lidvina Mejia; JACOMELLI, Marcia
- Bronchoscopic, laboratory and anatomopathological criteria for airway disease in patients diagnosed with granulomatosis with polyangiitis(2023) DíAZ, C. Moreno; JACOMELLI, M.; DEMARZO, S. E.; PALOMINO, A. M.; OLIVEIRA, E. P. de; ASSUNCAO, G. L. M. de; TOLEDO, A. P. de; BARBAS, C. S. V.Introduction: patients with granulomatosis with polyangiitis (GPA) may present upper airway (UA) and lower airway (LA) involvement. Objectives: we describe the endoscopic manifestations of the airways, histological findings from biopsied tissue and antineutrophilic cytoplasm antibody (ANCA) in a group of patients with GPA. Methods: retrospective study of medical records of patients with GPA undergoing bronchoscopy between 2012 and 2019. Airway findings, results of biopsies performed and ANCA results were analyzed. Results: 40 patients were included, with a mean age of 46.92±17.61 years and predominantly female (67.5%). Airway involvement was observed in 90% (n=36). The C-ANCA was reactive in 63.9%, P-ANCA in 25%, doubly reactive ANCA in 8.33% and non-reactive in 20%. The findings in upper airway (UA) were: chronic sinusitis (41.7%), destruction of the nasal septum (16.7%); and in lower airway (LA) were: tracheobronchial stenosis (38.9%) and tracheobronchitis (25%). The pathological findings most common of bronchoscopic biopsies were: polymorphonuclear inflammatory process (61.9%) and geographic necrosis (47.6%). Conclusion: the airway is involved in up to 90% of patients with GPA. Non-reactive ANCA does not rule out this possibility. Chronic sinusitis and tracheobronchial fibrostenotic processes were the most common endoscopic findings. Vasculitis in biopsies was found in a minority of cases.
- Ecobroncoscopia radial para o diagnóstico de lesões pulmonares periféricas(2016) JACOMELLI, Marcia; DEMARZO, Sergio Eduardo; CARDOSO, Paulo Francisco Guerreiro; PALOMINO, Addy Lidvina Mejia; FIGUEIREDO, Viviane RossiObjetivo: A broncoscopia convencional possui baixo rendimento diagnóstico para lesões pulmonares periféricas. A ecobroncoscopia radial (EBUS radial) emprega um transdutor ultrassonográfico rotatório na extremidade de uma sonda que é inserida no canal de trabalho do broncoscópio. O EBUS radial facilita a localização de nódulos pulmonares periféricos, aumentando assim o rendimento diagnóstico. O objetivo deste estudo foi apresentar nossa experiência inicial com o uso de EBUS radial para o diagnóstico de lesões pulmonares periféricas em um hospital terciário. Métodos: Foi realizada uma análise retrospectiva de 54 pacientes submetidos à broncoscopia guiada por EBUS radial para a investigação de nódulos ou massas pulmonares entre fevereiro de 2012 e setembro de 2013. O EBUS radial foi realizado com uma sonda flexível de 20 MHz, que foi inserida no canal de trabalho do broncoscópio até chegar à lesão-alvo. A fluoroscopia foi usada para localizar a lesão e realizar procedimentos de coleta (escovado brônquico, aspiração transbrônquica com agulha e biópsia transbrônquica). Resultados: O EBUS radial identificou 39 nódulos (média de diâmetro: 1,9 ± 0,7 cm) e 19 massas (média de diâmetro: 4,1 ± 0,9 cm). A sensibilidade global do EBUS radial foi de 66,7% (79,5% para as lesões visíveis pelo método e 25% para as lesões não visíveis pelo método). Nas lesões visíveis pelo método, a sensibilidade foi de 91,7% para massas e de 74,1% para nódulos. As complicações foram pneumotórax (3,7%) e sangramento brônquico controlado broncoscopicamente (9,3%). Conclusões: O EBUS radial apresenta bom perfil de segurança, baixo índice de complicações e alta sensibilidade para o diagnóstico de lesões pulmonares periféricas.