Publications by authors named "Paulo Francisco Guerreiro Cardoso"

Objective: The patient's journey to the medical center for an outpatient visit can often mean hours of travel in their vehicle, leading to increased expenses and greater carbon dioxide (CO2) emissions into the environment. The study demonstrates the estimated carbon emission and cost savings associated with a telemedicine program dedicated to patients with tracheal disease in the Brazilian public health system.

Methods: Cross-sectional study of telemedicine visits for patients with tracheal disease referred to a public academic hospital between August 1, 2020, and December 30, 2023.

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Article Synopsis
  • The study examined patients with tracheal or laryngotracheal stenosis who required tracheostomy, focusing on their swallowing and clinical profiles before undergoing airway interventions.
  • It involved a retrospective cohort study where patients underwent swallowing evaluations and imaging, with follow-ups at 6 and 12 months to assess progress.
  • Results showed female predominance, high rates of subglottic stenosis, and that many had significant swallowing difficulties, indicating a need for personalized care due to potential complications affecting recovery.
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To compare two different wavelengths of the surgical contact diode laser (CDL) for producing a posterior laryngofissure in in-vivo pigs. Anesthetized pigs underwent a tracheostomy and an anterior laryngofissure through a cervicotomy. They were randomly selected for the CDL wavelength and Power, according to the peak of Power set at device (980nm wavelength: Ppeak power of 10 W, 15 W, and 20 W, or 1470 nm wavelength: Ppeak 3 W, 5 W, 7 W, 10 W).

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Cilia are biological structures essential to drive the mobility of secretions and maintain the proper function of the respiratory airways. However, this motile self-cleaning process is significantly compromised in the presence of silicone tracheal prosthesis, leading to biofilm growth and impeding effective treatment. To address this challenge and enhance the performance of these devices, we propose the fabrication of magnetic silicone cilia, with the prospect of their integration onto silicone prostheses.

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Article Synopsis
  • Silicone endotracheal prostheses are good for medical use, but they often develop harmful biofilms that can cause inflammation and complications.
  • The study tested cold atmospheric plasma (CAP) to see if it could inhibit these harmful biofilms, and also assessed its effects on human bronchial cells.
  • Results showed that CAP significantly reduced biofilm viability without being harmful to the bronchial cells, suggesting it could be a useful method to prevent biofilm formation on silicone prostheses.
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Tracheal replacement with a bioengineered tracheal substitute has been developed for long-segment tracheal diseases. The decellularized tracheal scaffold is an alternative for cell seeding. It is not defined if the storage scaffold produces changes in the scaffold's biomechanical properties.

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Objective: To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay.

Methods: A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital.

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The purpose of this research was to identify risk factors that were independently related to the maintenance of a swallowing dysfunction in patients affected by critical COVID-19. We conducted a prospective observational cohort study of critical patients with COVID-19, who were admitted to a COVID-19 dedicated intensive care unit (ICU) and required prolonged orotracheal intubation (≥48 hours). Demographic and clinical data were collected at ICU admission and/or at hospital discharge or in-hospital death.

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Lobectomy for consolidation of failed endoscopic lung volume reduction for emphysema has been reported in selected patients with favorable results but with considerable morbidity. The challenging issues in such patients are frailty caused by severe emphysema itself, poor tolerance to single-lung ventilation, target lobe hyperinflation, and inability to use gas inflation for the minimally invasive resection. Careful planning, including use of a robotic platform and extracorporeal membrane oxygenation support, can circumvent such difficulties and ensure a safe, minimally invasive resection in the high-risk emphysematous patient.

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Blind-end stenosis (Myer-Cotton IV) is an extreme response to airway injury, resulting in phonatory ablation and dependence on a tracheostomy. A minimally invasive airway desobstruction and stenting can be beneficial in such cases. We present 2 cases of Myer-Cotton IV stenosis that were treated with a minimally invasive desobstruction using a hybrid (endoscopic-surgical) approach followed by the placement of a silicone T-tube.

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Tracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single-center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO).

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Article Synopsis
  • Lung cancer requires accurate mediastinal staging for better prognosis and surgical planning, with EBUS-TBNA emerging as a less invasive procedure compared to traditional mediastinoscopy.* -
  • A systematic review and meta-analysis compared the effectiveness of EBUS-TBNA versus mediastinoscopy in staging lymph nodes for non-small cell lung cancer (NSCLC), involving five studies and 532 patients.* -
  • Results showed that both procedures had similar accuracy (EBUS-TBNA sensitivity at 81% and mediastinoscopy at 75%), and while mediastinoscopy experienced slightly more complications, the differences were not statistically significant, suggesting EBUS-TBNA can be preferred for staging.*
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Objective: 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 São Paulo, Brazil.

Results: We analyzed 3,473 FBs.

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Benign airway stenosis is a multifactorial and heterogeneous disease often occurring after tracheal intubation. Despite the frequent finding of pathological gastroesophageal reflux (GER) in benign tracheal stenosis, the cause-and-effect relationship between these two entities and its impact on the outcome of the stenosis itself have not been established. The altered ventilatory dynamics caused by an increased thoracoabdominal pressure gradient in such patients has been proposed as a central cause.

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Mechanical evaluation of tracheal grafts is of great relevance for transplant research. Although there are some publications demonstrating different techniques of tracheal mechanical evaluation, there is still no definitive or preferred protocol available. Here, we present a simple image processing acquisition system that can be used for in vivo experiments.

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Objective: This study focuses on the impact of antireflux surgery in the outcome of tracheal stenosis.

Methods: We performed a retrospective study including patients with benign tracheal stenosis who underwent esophageal manometry and dual-probe 24-hour ambulatory esophageal pH study. Patients with an abnormal pH study were managed with laparoscopic modified Nissen fundoplication or medically (omeprazole 80 mg/d, orally).

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To evaluate the feasibility of a 980-nm contact diode laser (CDL) as a method for creating a posterior laryngofissure in live pigs. Twenty-eight Landrace pigs (15-20 kg) were anesthetized, intubated, ventilated, and submitted to a cervical tracheostomy. An anterior and posterior midline longitudinal laryngofissure incision was created according to randomization-control (n = 4), posterior laryngofissure with a scalpel blade; electrocautery (n = 12), posterior laryngofissure by electrocautery (10, 15, 20, 25 W powers); CDL (n = 12), posterior laryngofissure by the CDL (10, 15, 20, 25 W peak powers in pulsed mode).

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Background: The primary objective of the study was to evaluate the health-related quality of life (HRQL) of patients with benign post-intubation tracheal stenosis considered as unfit for surgical treatment. Secondary objectives were: (I) to determine if clinical variables (gender, age, total treatment time, and type of tracheal device) could influence HRQL and (II) to compare the results with a normal standardized population.

Methods: Prospective study between August-2014 and December-2016 including patients with tracheal stenosis treated with silicone stents, T-Tubes or tracheostomy.

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Benign tracheoesophageal fistula (TEF) results from an abnormal communication between the posterior wall of the trachea or bronchi and the adjacent anterior wall of the esophagus. It can be acquired or congenital. The onset of the TEF has a negative impact on the patient's health status and quality of life because of swallowing difficulties, recurrent aspiration pneumonia, and severe weight loss.

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Tracheal resections are major surgical procedures with a complication rate as high as 44%. Early detection of complications followed by a structured and expedited course of action is critical for achieving a successful outcome. The prevention of complications after tracheal resection starts with a correct indication for resection.

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