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Bodini A, Pecoraro L, Piazza M, Piacentini G. Symptomatic vascular rings: a case misdiagnosed as difficult asthma in a school-age girl. Minerva Pediatr (Torino) 2023; 75:139-141. [PMID: 33845564 DOI: 10.23736/s2724-5276.21.06139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Bodini
- Unit of Pediatric, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Pecoraro
- Clinic of Pediatrics, ASST Mantova, Mantova, Italy - .,Department of Medicine, University of Verona, Verona, Italy
| | - Michele Piazza
- Unit of Pediatric, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Unit of Pediatric, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Natural History of Asymptomatic and Unrepaired Vascular Rings: Is Watchful Waiting a Viable Option? A New Case and Review of Previously Reported Cases. CHILDREN-BASEL 2016; 3:children3040044. [PMID: 28009833 PMCID: PMC5184819 DOI: 10.3390/children3040044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
Vascular rings are a rare form of congenital heart disease in which abnormal aortic arch anatomy leads to encircling of the esophagus and/or trachea by the aortic vasculature. Symptoms can develop from this and prompt the need for surgery. A natural history study has been done on mildly symptomatic patients but no such study has been done on asymptomatic patients. We present a case report of three children with asymptomatic vascular rings who continue to receive follow-up without intervention and review all published cases of asymptomatic or unrepaired vascular rings. Clinical observation of asymptomatic and mildly symptomatic vascular rings, regardless of aortic arch anatomy, seems to be a safe approach. Children with mild symptoms almost invariably seem to have resolution of their symptoms by four years of age.
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Murgu SD, Colt HG. Combined optical coherence tomography and endobronchial ultrasonography for laser-assisted treatment of postintubation laryngotracheal stenosis. Ann Otol Rhinol Laryngol 2013; 122:299-307. [PMID: 23815046 DOI: 10.1177/000348941312200503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We describe the use of combined optical coherence tomography (OCT) and endobronchial ultrasonography (EBUS) to identify the residual hypertrophic tissues and persistent inflammation that are known contributors to stricture recurrence after laser-assisted mechanical dilation (LAMD) oflaryngotracheal stenosis (LTS). METHODS Commercially available high-frequency EBUS (approximately 100-microm resolution) and time-domain OCT (approximately 10- to 20-microm resolution) systems were used to visualize airway wall microstructures in the area of hypertrophic tissue formation before and after LAMD in 2 patients with complex circumferential postintubation LTS. RESULTS Before LAMD, EBUS revealed a homogeneous layer consistent with hypertrophic tissue overlying a hyperechogenic layer corresponding to tracheal cartilage. OCT revealed a homogeneous light backscattering layer and an absence of layered microstructures within hypertrophic tissue. Immediately after LAMD, OCT of the laser-charred tissue showed high backscattering and shadowing artifacts; OCT of noncharred tissue showed bright light backscattering regions that suggested acute inflammation. EBUS revealed thinner but persistent hypertrophic tissue overlying the cartilage. Stenosis recurred in both patients. CONCLUSIONS Intraoperative use of EBUS and OCT could potentially identify residual hypertrophic tissues and persistent inflammation during or after LAMD. It might help physicians predict stricture recurrence, prompting alternative therapeutic strategies and avoidance of repeated endoscopic treatments for LTS.
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Affiliation(s)
- Septimiu D Murgu
- Department of Pulmonary and Critical Care Medicine, University of California, Irvine, Orange, California, USA
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Sanz-Santos J, Andreo F, Serra P, Monsó E, Ruiz-Manzano J. The role of endobronchial ultrasound in central early lung cancer. Thorac Cancer 2012; 3:139-144. [PMID: 28920286 DOI: 10.1111/j.1759-7714.2011.00102.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Central early lung cancers (CELC) are tumors arising from the central airways, roentgenographically occult, which are usually diagnosed by bronchoscopy after a positive sputum cytology. Most CELCs are undetectable for conventional white light bronchoscopy (WLB) but can be identified under autofluorescence bronchoscopy (AFB). Although AFB increases the sensitivity of WLB in detecting CELC, its low specificity remains a problem. Surgery has been the most accepted treatment for CELCs; however 20-30% of patients suffering CELC tend to have multicentricities and usually present with poor cardiopulmonary status. Therefore, surgery is not suitable in most of the cases and other therapeutic options such as bronchoscopic treatments should be considered. Because most endoscopic treatments are unlikely to be curative if the tumor has spread beyond the bronchial cartilage, accurate evaluation of CELC bronchial wall invasion is critical before selecting a bronchoscopic treatment. Endobronchial ultrasound (EBUS) is a relatively new technique that has proven to be useful in the evaluation of the normal and cancer-invaded bronchial wall. Some authors have demonstrated that after adding EBUS assessment to AFB in autofluorescence-positive lesions the specificity increases from 50 to 90%. Other studies have focused on the ability of EBUS to detect bronchial wall invasion in patients with CELCs. They compared the EBUS images with pathological findings of surgical specimens of patients that underwent surgery; in most of the cases the correlation between EBUS and pathological findings increased over 90%. Furthermore, in patients not eligible for surgery, EBUS has proven to predict patients expected response to endoscopic treatments.
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Affiliation(s)
- José Sanz-Santos
- Pulmonary Department, Hospital Germans Trias i Pujol, Badalona, Spain CiBeRes Bunyola, Balearic Islands, Spain Pulmonary Department, Hospital Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Felipe Andreo
- Pulmonary Department, Hospital Germans Trias i Pujol, Badalona, Spain CiBeRes Bunyola, Balearic Islands, Spain Pulmonary Department, Hospital Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pere Serra
- Pulmonary Department, Hospital Germans Trias i Pujol, Badalona, Spain CiBeRes Bunyola, Balearic Islands, Spain Pulmonary Department, Hospital Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eduard Monsó
- Pulmonary Department, Hospital Germans Trias i Pujol, Badalona, Spain CiBeRes Bunyola, Balearic Islands, Spain Pulmonary Department, Hospital Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Ruiz-Manzano
- Pulmonary Department, Hospital Germans Trias i Pujol, Badalona, Spain CiBeRes Bunyola, Balearic Islands, Spain Pulmonary Department, Hospital Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Colt HG, Davoudi M, Murgu S. Scientific evidence and principles for the use of endobronchial ultrasound and transbronchial needle aspiration. Expert Rev Med Devices 2011; 8:493-513. [PMID: 21728734 DOI: 10.1586/erd.11.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound (EBUS), using the radial EBUS probe and convex-probe EBUS-guided transbronchial needle aspiration, are increasingly advocated for a wide array of minimally invasive thoracic procedures. The effectiveness of EBUS-guided procedures has been demonstrated to a degree that, in many institutions, EBUS is becoming standard of practice for the diagnosis, staging and restaging of mediastinal lymphadenopathy in lung cancer, the diagnosis of sarcoidosis, and for bronchoscopic biopsy of peripheral lung lesions. Its role in other bronchoscopic procedures requires further study despite an already strong body of literature: diagnosis of lymphoma and benign infectious disease, diagnosis of early lung cancer and airway wall disorders, imaging of thoracic vascular disease such as pulmonary embolism, and therapeutic procedures such as placement of fiducial markers. In this article, we illustrate some of the principles of EBUS, describe major technical aspects pertaining to the procedure itself and provide a narrative review of original research addressing proposed roles of EBUS in a variety of indications. In closing, we describe future perspectives including new educational processes and philosophies that could favorably impact the rapid and safe dissemination of this evolving technology into clinical practice.
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Affiliation(s)
- Henri G Colt
- Pulmonary and Critical Care Medicine, University of California-Irvine, 101 The City Drive S., Orange, CA 92868, USA.
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Colt HG, Murgu SD. Interventional bronchoscopy from bench to bedside: new techniques for early lung cancer detection. Clin Chest Med 2010; 31:29-37, Table of Contents. [PMID: 20172430 DOI: 10.1016/j.ccm.2009.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lung cancer is a leading cause of cancer-related death in the world, and it accounts for more deaths than breast, colon, and prostate cancer combined in the United States. From a historical perspective, the premise behind early lung cancer detection strategy is that early detection of lung cancer is justified if early treatment improves the outcome. New optical technologies such as those presented in this article allow dynamic study of these processes at the cellular level, and it is hoped that opportunities for targeted therapy will be provided in the future. Investigators are on the verge of discovering a multidimensional bronchoscopic platform that can be used to narrow in on airway structures, explore vascular flow and angiogenesis, and discover new features of bronchogenic carcinogenesis.
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Affiliation(s)
- Henri G Colt
- Department of Medicine, Pulmonary and Critical Care Medicine, University of California School of Medicine, 101 The City Drive, Irvine, Orange, CA 92868, USA.
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Colt H, Murgu SD, Ahn YC, Brenner M. Multimodality bronchoscopic [corrected] imaging of tracheopathica osteochondroplastica. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:034035. [PMID: 19566328 DOI: 10.1117/1.3155524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Results of a commercial optical coherence tomography system used as part of a multimodality diagnostic bronchoscopy platform are presented for a 61-year-old patient with central airway obstruction from tracheopathica osteochondroplastica. Comparison to results of white-light bronchoscopy, histology, and endobronchial ultrasound examination are accompanied by a discussion of resolution, penetration depth, contrast, and field of view of these imaging modalities. White-light bronchoscopy revealed irregularly shaped, firm submucosal nodules along cartilaginous structures of the anterior and lateral walls of the trachea, sparing the muscular posterior membrane. Endobronchial ultrasound showed a hyperechoic density of 0.4 cm thickness. optical coherence tomography (OCT) was performed using a commercially available, compact time-domain OCT system (Niris System, Imalux Corp., Cleveland, Ohio) with a magnetically actuating probe (two-dimensional, front imaging, and inside actuation). Images showed epithelium, upper submucosa, and osseous submucosal nodule layers corresponding with histopathology. To our knowledge, this is the first time these commercially available systems are used as part of a multimodality bronchoscopy platform to study diagnostic imaging of a benign disease causing central airway obstruction. Further studies are needed to optimize these systems for pulmonary applications and to determine how new-generation imaging modalities will be integrated into a multimodality bronchoscopy platform.
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Affiliation(s)
- Henri Colt
- University of California School of Medicine, Pulmonary and Critical Care Medicine, Department of Medicine, 101 the City Drive South, Building 53, Room 119, Route 81 Orange, California 92868, USA.
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MURGU S, KURIMOTO N, COLT H. Endobronchial ultrasound morphology of expiratory central airway collapse. Respirology 2008; 13:315-9. [DOI: 10.1111/j.1440-1843.2007.01216.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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