Luís Martins

Multi-Temporal Analysis of Forestry and Coastal Environments Using UASs

Due to strong improvements and developments achieved in the last decade, it is clear that applied research using remote sensing technology such as unmanned aerial vehicles (UAVs) can provide a flexible, efficient, non-destructive, and non-invasive means of acquiring geoscientific data, especially aerial imagery. Simultaneously, there has been an exponential increase in the development of sensors and instruments that can be installed in UAV platforms. By combining the aforementioned factors, unmanned aerial system (UAS) setups composed of UAVs, sensors, and ground control stations, have been increasingly used for remote sensing applications, with growing potential and abilities. This paper’s overall goal is to identify advantages and challenges related to the use of UAVs for aerial imagery acquisition in forestry and coastal environments for preservation/prevention contexts. Moreover, the importance of monitoring these environments over time will be demonstrated. To achieve these goals, two case studies using UASs were conducted. The first focuses on phytosanitary problem detection and monitoring of chestnut tree health (Padrela region, Valpacos, Portugal). The acquired high-resolution imagery allowed for the identification of tree canopy cover decline by means of multi-temporal analysis. The second case study enabled the rigorous and non-evasive registry process of topographic changes that occurred in the sandspit of Cabedelo (Douro estuary, Porto, Portugal) in different time periods. The obtained results allow us to conclude that the UAS constitutes a low-cost, rigorous, and fairly autonomous form of remote sensing technology, capable of covering large geographical areas and acquiring high precision data to aid decision support systems in forestry preservation and coastal monitoring applications. Its swift evolution makes it a potential big player in remote sensing technologies today and in the near future.

An Unusual Association in an Uncommon Disease: Two Cases of Spontaneous Pneumomediastinum Associated with Pneumorrhachis

Pneumomediastinum, the presence of free air in the mediastinum, is described as spontaneous pneumomediastinum when there is no apparent cause such as trauma, surgery, interventional procedures, or intrathoracic infections. Pneumorrhachis is a rare clinical condition, consisting of intraspinal air. The main causes are iatrogenic, traumatic, and nontraumatic. Spontaneous mediastinum is usually associated with subcutaneous emphysema and, occasionally, with pneumothorax; however, its association with pneumorrhachis is extremely rare. Here, we present two rare cases of spontaneous pneumomediastinum associated with pneumorrhachis caused by vigorous coughing.

Characterization of Chestnut Behavior with Photosynthetic Traits

European chestnut (Castanea sativa Mill.) covers in total 2.53 million hectares, of which 2.2 million hectares are forests and the remaining parts, are orchards. In Europe it is growing in an area comprised by 27o N and 53o N latitude, from sea level in seaside regions to 2000 m above sea level (a.s.l.) in the south of Europe. According to Fernandez-Lopez et al. (2005), chestnut species is characterized by the existence of some differentiation among extreme populations, which can be supposed due to its long-range distribution across the Mediterranean region, through varying climatic conditions. As reported by Heiniger (1992), chestnut is a good indicator of warm regions with oceanic climate. In spite of C. sativa Mill. be characterized as a mesophilic species, nowadays the chestnut shows many growth limitations, which partially can be ascribed to the climate changes, since they influence abiotic and biotic factors and consequently photosynthetic productivity. From abiotic factors, water and heat stress have been the most important limitations, inducing less growth, less vigor increasing susceptibility to the biotic factors such as ink and blight diseases. When compared with other hardwood species, the trees can absorb the same amount of carbon, but due to the fast-growing chestnut can store more carbon in less time. So, this agro forest system has been identified as an important way to slow climate change. Photosynthesis, according to (Givnish, 1988), provides green plants with almost all of their chemical energy, being central to their activity to compete and reproduce. So understanding

Role of bronchoscopy in foreign body aspiration management in adults: A seven year retrospective study

Foreign body aspiration (FBA), although more frequent in children, is a potentially life-threatening emergency that can occur at any age. Patients may be asymptomatic, have a choking event, cough attacks with inspiratory stridor, or symptoms may vary from trivial or chronic nonspecific symptoms (dyspnea, cough, sputum, wheezing) and mimic other lung diseases. Hence, in sub-acute and chronic respiratory infections, pulmonary abscesses, haemoptysis, asthmatiform syndrome, localized bronchiectasis or when a lung neoplasia is suspected FBA must be considered. Although it has little diagnostic value (sensitivity of 28--60%; specificity of 68%), chest radiography (CXR) is the initial test for FBA. Unless patients remember an aspiration event, diagnosis of FBA can be delayed for months even years, which increases the rate of complications. When FBA is suspected, a bronchoscopy must be performed to remove the FB (foreign body). In order to evaluate the role of bronchoscopy in FBA, we retrospectively collected data of all suspected FBA that were treated by bronchoscopy in our unit from November 2008 to October 2015 and analyzed those performed in adults aged over 18 years-old. A total of 135 bronchoscopies for FBA suspicion were performed, 69 (51.1%) in adults. The majority of adult patients were male (n = 44; 63.8%) and had a mean age of 63 ± 17 years-old. In 12 (17.3%) cases, clinical manifestations were unavailable since patients were referred to our unit from another hospital. The remaining patients reported a choking episode (n = 34; 49.3%), pneumonia (n = 10; 14.5%), dyspnea (n = 4; 5.8%), trauma (n = 3; 4.3%) or a cardiorespiratory arrest (n = 1; 1.4%). Five patients (7.2%) were asymptomatic. Mean time between aspiration and bronchoscopy was 77.7 ± 173.1 h (not known/available in 36 cases). In the 53 cases (76.8%) with an available CXR, 33 (62.3%) were abnormal, in which a condensation (n = 13), atelectasis (n = 10), visible FB (n = 9) or hyperinflation (n = 1) was identified.

Foreign body aspiration: A 7-year restrospective review

Background: Foreign body aspiration (FBA) is a potentially life threatening emergency. A correct diagnosis is essential to avoid complications. Aim: Compare FBA in children and adults. Methods: We retrospectively collected data of all suspected FBA in patients who undergone a bronchoscopy in our unit from November 2008 to October 2015. We analysed age, imaging, time between aspiration and bronchoscopy, type and location of foreign body (FB). Results: We performed 135 bronchoscopies for suspected FBA (66 children and 69 adults). The majority of the children were under 3 years old (mean age: 3,3 ± 3,3years) and adults over 55 years (mean age: 63 ± 17 years). In children, the mean aspiration time was of 299 hours (unknown in 21,2%), while it was of 77,7 hours for adults (unknown in 52,2%). When performed, chest radiography presented changes for 69,2% of children and 62,3% of adults. Most observed changes were hyperinflation (36,1% of children and 3% of adults) and hypotransparency (36,1% of children and 69,7% of adults). We removed 103 FB (75,8% of children and 76,8% of adults), most of them were organic in children (62%) and inorganic in adults (62,3%). The majority of the FB were found in the left side for children (42%) and in the right side for adults (60,4%). For 25% of children and 33,9% of adults, chest radiography was not in line with bronchoscopy result: 15,4% of children and 22,6% of adults had a FB without any radiographic change. Discussion: We didn9t find a significant difference between FBA suspicion in adults and children but there were differences regarding nature and location of FB. As radiographic changes are not always present, we recommend a bronchoscopy to be performed in all cases of suspected FBA.

Tracheobronchial injuries: Our personal experience on 19 cases

Purpose: To describe our experience in the Management of tracheobronchial injuries Introduction: Tracheobronchial injuries may be iatrogenic, low impact, longitudinal tears (laceration) or high impact, horizontal sections (rupture) caused by penetrating or blunt chest trauma. Methods and Results: Between 2001 and 2012, we have treated 19 tracheobronchial injuries. Six patients presented with tracheobronchial ruptures: two penetrating/stab wounds, two gunshot wounds and two complete sections of the main bronchus; and 13 iatrogenic lacerations: ten post-intubation and three lacerations related to bronchoscopic procedures. The extension of the lesions was 2-12 cm. The iatrogenic bronchial lacerations were all secondary to bronchoscope procedures. All tracheal iatrogenic lacerations and the four cases related to stab or gunshot wounds ruptures underwent conservative treatment. Only two patients underwent surgery (the two traumatic complete sections of the main bronchus). In the conservative treatment group, a silicon stent was inserted in four patients, in order to allow efficient mechanical ventilation and early weaning. Conclusion: In our series, conservative treatment was a safe and effective approach regardless of type of injury, location and size with no mortality related.

Bronchoscopic management of post intubation tracheal stenoses

Post intubation tracheal stenosis (PiTS) is a rare (1/1000 ICU patients) but life-threatening condition. The optimal management of PiTS is not well defined. Between 2010 and 2014 all new patients with PiTS for initial treatment were eligible for this study. All patients were submitted to diagnostic flexible bronchoscopy. Patients asymptomatic or with no criteria for “true” PiTS were excluded. Forty-four patients (25 F; 19 M; with a mean age of 55, 74 years-old) were identified: 28 complex (63,63%) and 16 (36,36%) web-like stenoses. All web-ring stenoses were successfully treated with dilation or Blade Assisted Mechanical Dilation (BAMD). In the group of complex stenoses, 2 (7,15%) required only BAMD and 26 (92,85%) required BAMD/LAMD (Laser Assisted Mechanical Dilation) and silicon stent placement: fourteen (53,84%) had the stent removed in this time period. As we think that PiTS retractile cicatricial fibrosis is time dependent, we tend to maintain the stents in place for a period of 36 months. A mean value of 2,17 per patient, bronchoscopic procedures were performed. No serious complications were observed and no patients were referred to surgery.

Thoracoscopy: Diagnostic and therapeutic applications

Introduction: The technique and clinical applications of medical thoracoscopy (MT) have substantially evolved over the last decades. Aim: We sought to evaluate the diagnostic and therapeutic yield and safety of MT at our unit. Methods: The reports of all MT undergone from 2010 to 2014 were reviewed and analysed as regards to indication, side, endoscopic findings, procedures and immediate complications. Results: In our study, 268 patients underwent MT, 8 of which were excluded because of lost data. One hundred fifty-one patients were male (58,08%) and 109 female (41,92%) with a mean age of 55,76 ± 20,4 years. Sixty of the MT (23,08%) were diagnostic, 140 (53,84%) therapeutic and 60 (23,08%) simultaneously diagnostic and therapeutic. Undiagnosed or malignant pleural effusions were the main indications (66,92%), followed by pneumothorax (26,92%), nodules and masses (4,23%), hydropneumothorax (1,15%), abscess (0,39%) and pleural thickening (0,39%). Thoracoscopic pleural biopsies were performed in 113 patients. One hundred twenty-one (69,54%) of the pleural effusions and 68 (97,14%) of the pneumothorax were submitted to talc poudrage. No death related to thoracoscopy was registered. Conclusions: The role of medical thoracoscopy in the diagnosis and treatment of pleural disease is as relevant today as it was when Jacobeus pioneered this important procedure.