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Wannes Daou A, Wallace C, Barker M, Ambrosino T, Towe C, Morales DLS, Wikenheiser-Brokamp KA, Hayes D, Burg G. Flexible bronchoscopy in pediatric lung transplantation. Pediatr Transplant 2024; 28:e14757. [PMID: 38695266 DOI: 10.1111/petr.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/09/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024]
Abstract
Pediatric lung transplantation represents a treatment option for children with advanced lung disease or pulmonary vascular disorders who are deemed an appropriate candidate. Pediatric flexible bronchoscopy is an important and evolving field that is highly relevant in the pediatric lung transplant population. It is thus important to advance our knowledge to better understand how care for children after lung transplant can be maximally optimized using pediatric bronchoscopy. Our goals are to continually improve procedural skills when performing bronchoscopy and to decrease the complication rate while acquiring adequate samples for diagnostic evaluation. Attainment of these goals is critical since allograft assessment by bronchoscopic biopsy is required for histological diagnosis of acute cellular rejection and is an important contributor to establishing chronic lung allograft dysfunction, a common complication after lung transplant. Flexible bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy plays a key role in lung transplant graft assessment. In this article, we discuss the application of bronchoscopy in pediatric lung transplant evaluation including historical approaches, our experience, and future directions not only in bronchoscopy but also in the evolving pediatric lung transplantation field. Pediatric flexible bronchoscopy has become a vital modality for diagnosing lung transplant complications in children as well as assessing therapeutic responses. Herein, we review the value of flexible bronchoscopy in the management of children after lung transplant and discuss the application of novel techniques to improve care for this complex pediatric patient population and we provide a brief update about new diagnostic techniques applied in the growing lung transplantation field.
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Affiliation(s)
- Antoinette Wannes Daou
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carolyn Wallace
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mitzi Barker
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teresa Ambrosino
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Towe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David L S Morales
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathryn A Wikenheiser-Brokamp
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pulmonary Biology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory Burg
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Brown M, Nguyen P. Strength in data and collaboration: The EpiGETIF registry. Respirology 2024; 29:447-448. [PMID: 38539036 DOI: 10.1111/resp.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 05/18/2024]
Abstract
See related article
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Affiliation(s)
- Michael Brown
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Phan Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Wang Y, Zhang Y, Tong R. Case report: Successful bronchoscopic interventional treatment of endobronchial leiomyomas. Open Life Sci 2024; 19:20220845. [PMID: 38737105 PMCID: PMC11087738 DOI: 10.1515/biol-2022-0845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 05/14/2024] Open
Abstract
Endobronchial leiomyomas are rare benign neoplasms of the lungs that arise from the smooth muscle cells of the bronchi and bronchioles. While surgical resection is the mainstay of treatment for these tumors, bronchoscopic interventional therapies are also effective and can help preserve lung function in certain cases. A 40-year-old male patient presented with a persistent cough and sputum production for over 4 months. A chest computed tomography scan revealed nodular lesions in the lower lobe bronchus, later confirmed as an endobronchial leiomyoma. The patient refused surgical intervention and opted for minimally invasive bronchoscopic treatments, including electric snare resection, argon plasma coagulation, and balloon dilation, resulting in a successful outcome with no recurrence during follow-up. Clinicians should consider bronchoscopic interventions as a viable treatment option for endobronchial leiomyomas patients who are either ineligible for surgical resection or opt not to undergo surgery.
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Affiliation(s)
- Yinfeng Wang
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, No. 34, North Zhongshan Road, Licheng District, Quanzhou362000, Fujian, China
| | - Yixiang Zhang
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, No. 34, North Zhongshan Road, Licheng District, Quanzhou362000, Fujian, China
| | - Ruirui Tong
- Department of Pathology, Second Affiliated Hospital of Fujian Medical University, Quanzhou362000, Fujian, China
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Jain K, Wainwright CE, Smyth AR. Bronchoscopy-guided antimicrobial therapy for cystic fibrosis. Cochrane Database Syst Rev 2024; 5:CD009530. [PMID: 38700027 PMCID: PMC11066959 DOI: 10.1002/14651858.cd009530.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND Early diagnosis and treatment of lower respiratory tract infections is the mainstay of management of lung disease in cystic fibrosis (CF). When sputum samples are unavailable, diagnosis relies mainly on cultures from oropharyngeal specimens; however, there are concerns about whether this approach is sensitive enough to identify lower respiratory organisms. Bronchoscopy and related procedures such as bronchoalveolar lavage (BAL) are invasive but allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may increase the accuracy of diagnosis of lower respiratory tract infections and improve the selection of antimicrobials, which may lead to clinical benefits. This is an update of a previous review that was first published in 2013 and was updated in 2016 and in 2018. OBJECTIVES To evaluate the use of bronchoscopy-guided (also known as bronchoscopy-directed) antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched three registries of ongoing studies and the reference lists of relevant articles and reviews. The date of the most recent searches was 1 November 2023. SELECTION CRITERIA We included randomised controlled studies involving people of any age with CF that compared the outcomes of antimicrobial therapies guided by the results of bronchoscopy (and related procedures) versus those guided by any other type of sampling (e.g. cultures from sputum, throat swab and cough swab). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information when required. We assessed the certainty of the evidence using the GRADE criteria. MAIN RESULTS We included two studies in this updated review. One study enrolled 170 infants under six months of age who had been diagnosed with CF through newborn screening. Participants were followed until they were five years old, and data were available for 157 children. The study compared outcomes for pulmonary exacerbations following treatment directed by BAL versus standard treatment based on clinical features and oropharyngeal cultures. The second study enrolled 30 children with CF aged between five and 18 years and randomised participants to receive treatment based on microbiological results of BAL triggered by an increase in lung clearance index (LCI) of at least one unit above baseline or to receive standard treatment based on microbiological results of oropharyngeal samples collected when participants were symptomatic. We judged both studies to have a low risk of bias across most domains, although the risk of bias for allocation concealment and selective reporting was unclear in the smaller study. In the larger study, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was low because Pseudomonas aeruginosa isolation in BAL samples at five years of age in both groups were much lower than the expected rate that was used for the power calculation. We graded the certainty of evidence for the key outcomes as low, other than for high-resolution computed tomography scoring and cost-of-care analysis, which we graded as moderate certainty. Both studies reported similar outcomes, but meta-analysis was not possible due to different ways of measuring the outcomes and different indications for the use of BAL. Whether antimicrobial therapy is directed by the use of BAL or standard care may make little or no difference in lung function z scores after two years (n = 29) as measured by the change from baseline in LCI and forced expiratory volume in one second (FEV1) (low-certainty evidence). At five years, the larger study found little or no difference between groups in absolute FEV1 z score or forced vital capacity (FVC) (low-certainty evidence). BAL-directed therapy probably makes little or no difference to any measure of chest scores assessed by computed tomography (CT) scan at either two or five years (different measures used in the two studies; moderate-certainty evidence). BAL-directed therapy may make little or no difference in nutritional parameters or in the number of positive isolates of P aeruginosa per participant per year, but may lead to more hospitalisations per year (1 study, 157 participants; low-certainty evidence). There is probably no difference in average cost of care per participant (either for hospitalisations or total costs) at five years between BAL-directed therapy and standard care (1 study, 157 participants; moderate-certainty evidence). We found no difference in health-related quality of life between BAL-directed therapy and standard care at either two or five years, and the larger study found no difference in the number of isolates of Pseudomonas aeruginosa per child per year. The eradication rate following one or two courses of eradication treatment and the number of pulmonary exacerbations were comparable in the two groups. Mild adverse events, when reported, were generally well tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of BAL in 4.8% of procedures. AUTHORS' CONCLUSIONS This review, limited to two well-designed randomised controlled studies, shows no evidence to support the routine use of BAL for the diagnosis and management of pulmonary infection in preschool children with CF compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence is available for adults.
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Affiliation(s)
- Kamini Jain
- Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Claire E Wainwright
- Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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Jiao Y, Tian S, Liu J, Shen X, Wang Q, Li X, Zhang W, Dong Y, Li Y, Bai C, Huang H. A preclinical animal study to evaluate the operability and safety of domestic one-way endobronchial valves. Front Med (Lausanne) 2024; 11:1293940. [PMID: 38751979 PMCID: PMC11094200 DOI: 10.3389/fmed.2024.1293940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose To evaluate the operability and safety of bronchoscopic domestic one-way endobronchial valves (EBV) on animals. Methods Nine pigs were randomly assigned (2:1) to receive domestic one-way EBV (the experimental group, n = 6) and Zephyr® EBV (the control group, n = 3). Routine blood tests, arterial blood gases, and CT scans of the lungs were performed 1 day pre-procedure in addition to 1 week and 1 month post-procedure to assess changes in blood markers and lung volumes. At 1 month post-procedure, the animals were sacrificed, followed by removal of all valves via bronchoscopy. Pathological examinations of critical organs were subsequently performed. Results A total of 15 valves were placed in the experimental group and 6 valves were placed in the control group, without serious complications. Routine blood tests and arterial blood gas examinations at 1 day pre-procedure, 1 week post-procedure, and 1 month post-procedure did not differ significantly in both groups. No EBV displacement was noted under bronchoscopy, and the valve was smoothly removable by bronchoscope at 1 month post-procedure. At 1 week post-procedure, varying degrees of target lung lobe volume reduction were observed on lung CT in both groups. Lung volume reduction was achieved at 1 month post-procedure in both groups, without significant statistical difference. Although 3 cases in the experimental group and 1 case in the control group developed varying degrees of pneumonia, the inflammatory response did not increase over time during the experimental period. Pathological examination revealed no significant abnormal changes in the critical organs for both groups. Conclusion Our results demonstrate that domestic EBV is safe and reliable for endobronchial application in general-grade laboratory white pigs. The safety of domestic EBV is similar to that of Zephyr® EBV, with good ease of use and operability. This kind of domestic EBV can meet the safety evaluation requirements for animal testing.
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Affiliation(s)
- Yang Jiao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Jian Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaping Shen
- Department of Radiology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qin Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yuchao Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yonghua Li
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Nakai T, Matsumoto Y, Ueda T, Kuwae Y, Tanaka S, Miyamoto A, Matsumoto Y, Sawa K, Sato K, Yamada K, Watanabe T, Asai K, Furuse H, Uchimura K, Imabayashi T, Uenishi R, Fukui M, Tanaka H, Ohsawa M, Kawaguchi T, Tsuchida T. Comparison of the specimen quality of endobronchial ultrasound-guided intranodal forceps biopsy using standard-sized forceps versus mini forceps for lung cancer: A prospective study. Respirology 2024; 29:396-404. [PMID: 38246887 DOI: 10.1111/resp.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic procedure with adequate performance; however, its ability to provide specimens of sufficient quality and quantity for treatment decision-making in advanced-stage lung cancer may be limited, primarily due to blood contamination. The use of a 0.96-mm miniforceps biopsy (MFB) permits true histological sampling, but the resulting small specimens are unsuitable for the intended applications. Therefore, we introduced a 1.9-mm standard-sized forceps biopsy (SFB) and compared its utility to that of MFB. METHODS We prospectively enrolled patients from three institutions who presented with hilar/mediastinal lymphadenopathy and suspected advanced-stage lung cancer, or those who were already diagnosed but required additional tissue specimens for biomarker analysis. Each patient underwent MFB followed by SFB three or four times through the tract created by TBNA using a 22-gauge needle on the same lymph node (LN). Two pathologists assessed the quality and size of each specimen using a virtual slide system, and diagnostic performance was compared between the MFB and SFB groups. RESULTS Among the 60 enrolled patients, 70.0% were diagnosed with adenocarcinoma. The most frequently targeted sites were the lower paratracheal LNs, followed by the interlobar LNs. The diagnostic yields of TBNA, MFB and SFB were 91.7%, 93.3% and 96.7%, respectively. The sampling rate of high-quality specimens was significantly higher in the SFB group. Moreover, the mean specimen size for SFB was three times larger than for MFB. CONCLUSION SFB is useful for obtaining sufficient qualitative and quantitative specimens.
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Affiliation(s)
- Toshiyuki Nakai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Ueda
- Department of Respiratory Medicine, Izumi City General Hospital, Osaka, Japan
| | - Yuko Kuwae
- Department of Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Sayaka Tanaka
- Department of Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kanako Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhiro Yamada
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hideaki Furuse
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Riki Uenishi
- Department of Respiratory Medicine, Izumi City General Hospital, Osaka, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hidenori Tanaka
- Department of Respiratory Medicine, Izumi City General Hospital, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Vakil E, Dumoulin E, Stollery D, Gillson AM, MacEachern P, Dhaliwal I, Mitchell M, Li P, Schieman C, Romatowski N, Chee AC, Tyan CC, Fortin M, Hergott CA, Tremblay A. Molecular analysis of endobronchial ultrasound needle aspirates in patients with non-small cell lung cancer: Results from the SCOPE database. Cytopathology 2024; 35:378-382. [PMID: 38349229 DOI: 10.1111/cyt.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Molecular subtyping of non-small cell lung cancer (NSCLC) is critical in the diagnostic evaluation of patients with advanced disease. This study aimed to examine whether samples from endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of intrathoracic lymph nodes and/or lung lesions are adequate for molecular analysis across various institutions. METHODS We retrospectively reviewed all cases of linear EBUS-TBNA with a final bronchoscopic diagnosis of NSCLC entered in the Stather Canadian Outcomes registry for chest ProcEdures database. The primary outcome was specimen inadequacy rate for each molecular target, as defined by the local laboratory or pathologist. RESULTS A total of 866 EBUS-TBNA procedures for NSCLC were identified. Specimen inadequacy rates were 3.8% for EGFR, 2.5% for ALK-1 and 3.5% for PD-L1. Largest target size was not different between adequate and inadequate specimens, and rapid onsite evaluation did not increase specimen adequacy rates. One centre using next-generation sequencing for EGFR had lower adequacy rates than 2 others using matrix-assisted laser desorption/ionization time-of-flight mass spectrophotometry. CONCLUSION EBUS-TBNA specimens have a very low-specimen inadequacy rate for molecular subtyping of non-small cell lung cancer.
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Affiliation(s)
- Erik Vakil
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Dumoulin
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Stollery
- Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley-Mae Gillson
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paul MacEachern
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael Mitchell
- Division of Respirology, Western University, London, Ontario, Canada
| | - Pen Li
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Alex C Chee
- Division of Respirology, Alberta Health Services, Calgary, Alberta, Canada
| | - Chung Chun Tyan
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Fortin
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Alain Tremblay
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
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Feng Y, Wang L, Jia R, Zhang X, Wang X, Yuan Y, Yang H, Xie L, Li N, Wang X, Bibas BJ, Kim H, Schweipert J, Ren Y. Tracheobronchopathia osteochondroplastica concurrent with peripheral lung cancer: a case report and perioperative considerations. Transl Cancer Res 2024; 13:2064-2072. [PMID: 38737686 PMCID: PMC11082660 DOI: 10.21037/tcr-24-410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Background Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign, chronic disorder of unknown etiology. It is characterized by submucosal nodules, often calcified, which predominantly affect the anterolateral aspects of the trachea and main bronchi, while sparing the posterior bronchial wall. The co-occurrence of TPO and lung cancer is exceedingly rare. This report presents a case of TPO association with early-stage lung cancer, which was managed through surgical intervention. No active treatment was undertaken for the TPO. Case Description A patient presented with a nodule in the right upper lobe, which was identified during a computed tomography (CT) scan of the chest, suggestive of early-stage lung cancer. Concurrently, multiple calcifications in the cartilaginous rings of the trachea were noted. Bronchoscopy revealed distinctive "pebblestone" nodules along the anterior and lateral tracheal walls, indicative of extensive TPO. The patient underwent bronchofiberscopy, which showed patency in the bronchial lumen of the right lung's upper lobe. A biopsy was not undertaken during this procedure. Comprehensive preoperative tests, including a blood biochemical examination, tumor-marker tests, lung-function tests, head-enhanced magnetic resonance imaging, abdominal ultrasound, and whole-body bone emission CT revealed no significant abnormalities. Despite this, the patient declined a whole-body positron emission tomography (PET)-CT scan. Given the potential malignancy of nodules in the right lung's upper lobe, the lobectomy for lung cancer was carried out, a procedure that would have proceeded irrespective of the presence or absence of TPO. Preoperative planning for potential tracheal intubation difficulties involved consultation with the anesthesiologist, resulting in a smooth intraoperative process. The pathology confirmed invasive adenocarcinoma. Post-surgery, the patient developed an infection in the right lung's lower lobe, identified as pseudomonas aeruginosa and Klebsiella pneumoniae through sputum culture and bronchoscopic lavage. Treatment with meropenem for 2 weeks, as guided by drug sensitivity results and respiratory advice, led to an improvement, allowing for discharge. A follow-up lung CT four months post-operation showed inflammation absorption in the right lower lobe. Conclusions Surgical resection in cases of TPO association with lung cancer may have an increased risk of postoperative pulmonary infection. Proactive intraoperative sputum aspiration by anesthesiologists and the postoperative reinforcement of anti-infection measures, guided by drug sensitivity results, are recommended.
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Affiliation(s)
- Yong Feng
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Renxiang Jia
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Xiangchao Zhang
- Department of Anesthesiology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Xiaohan Wang
- Department of Endoscopic Therapy Center, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Yana Yuan
- Department of Pathology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Hong Yang
- Department of Pathology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Liwei Xie
- Department of Radiology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Na Li
- Department of Pharmacy, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Xiaoge Wang
- Department of Respiratory Medicine, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Benoit Jacques Bibas
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Johannes Schweipert
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
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Bessone V, Roppenecker DB, Adamsen S. Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review. Healthcare (Basel) 2024; 12:885. [PMID: 38727442 PMCID: PMC11083686 DOI: 10.3390/healthcare12090885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence.
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Affiliation(s)
- Veronica Bessone
- Ambu Innovation GmbH, Karl-Drais-Strasse 4B, DE-86159 Augsburg, Germany
| | | | - Sven Adamsen
- Ambu A/S, Baltorpbakken 13, DK-2750 Ballerup, Denmark
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
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10
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Young A, Patel K, Allen K, Ghadersohi S, Rowland M, Hazkani I. Flexible and Rigid Bronchoscopy for Critically Ill Children on Extracorporeal Membrane Oxygenation. Laryngoscope 2024. [PMID: 38651446 DOI: 10.1002/lary.31460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support. METHODS A retrospective cohort study of children on ECMO between 1/2018 and 12/2022. RESULTS A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not. CONCLUSION Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Ashley Young
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Krupa Patel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Kiona Allen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Saied Ghadersohi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Matthew Rowland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
- Department of Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
- Division of Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Inbal Hazkani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
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11
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Li Q, Lafrance D, Liberman M, Leduc C, Charbonney E, Titova P, Manganas H, Chassé M. Transbronchial Lung Cryobiopsies, Transbronchial Forceps Lung Biopsies, and Surgical Lung Biopsies in Mechanically Ventilated Patients with Acute Hypoxemic Respiratory Failure: A Retrospective Cohort Study. J Intensive Care Med 2024:8850666241247145. [PMID: 38646814 DOI: 10.1177/08850666241247145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
IMPORTANCE Lung biopsies are sometimes performed in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) of unknown etiology to guide patient management. While surgical lung biopsies (SLB) offer high diagnostic rates, they may also cause significant complications. Transbronchial forceps lung biopsies (TBLB) are less invasive but often produce non-contributive specimens. Transbronchial lung cryobiopsies (TBLC) yield specimens of potentially better quality than TBLB, but due to their novel implementation in the intensive care unit (ICU), their accuracy and safety are still unclear. OBJECTIVES Our main objective was to evaluate the risk of adverse events in patients with AHRF following the three biopsy techniques. Our secondary objectives were to assess the diagnostic yield and associated modifications of patient management of each technique. DESIGN, SETTINGS AND PARTICIPANTS We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with at least one complication, and secondary outcomes included complication rates, diagnostic yields, treatment modifications, and mortality. RESULTS Of the 26 patients who underwent lung biopsies from 2018 to 2022, all TBLC and SLB patients and 60% of TBLB patients had at least one complication. TBLC patients had higher unadjusted numbers of total and severe complications, but also worse Sequential Organ Failure Assessment scores and P/F ratios. A total of 25 biopsies (25/26, 96%) provided histopathological diagnoses, 88% (22/25) of which contributed to patient management. ICU mortality was high for all modalities (63% for TBLC, 60% for TBLB and 50% for SLB). CONCLUSIONS AND RELEVANCE All biopsy methods had high diagnostic yields and the great majority contributed to patient management; however, complication rates were elevated. Further research is needed to determine which patients may benefit from lung biopsies and to determine the best biopsy modality.
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Affiliation(s)
- Qi Li
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Dominique Lafrance
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Charles Leduc
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Emmanuel Charbonney
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Polina Titova
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montréal, Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
- Division of Pulmonology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
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12
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Goussard P, Gie A, Venkatakrishna S, Andronikou S, Ebert L, Verster J, Schubert PT, Opperman J, Janson J. Mucoepidermoid bronchial tumor in a child masquerading as tuberculosis. Pediatr Pulmonol 2024. [PMID: 38634736 DOI: 10.1002/ppul.27021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - André Gie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lars Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Janette Verster
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and Forensic Pathology Service, Cape Town, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Johan Opperman
- Division of Oral and Maxillofacial Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Dentistry, University of Western Cape, Cape Town, South Africa
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
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13
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Sigaut S, Roine P, Moyer JD, Cipriani F, De La Jonquire C, Rousseau MA, Weiss E. Evolution of airway management in patients with unstable cervical spine trauma: a retrospective cohort study. Can J Anaesth 2024; 71:553-554. [PMID: 38347313 DOI: 10.1007/s12630-024-02694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Stéphanie Sigaut
- Department of Anesthesiology and Intensive Care, Hôpital Beaujon, DMU Parabol, AP-HP. Nord, Clichy, France.
- Inserm, Neurodiderot, Paris, France.
| | - Pauline Roine
- Department of Anesthesiology and Intensive Care, Hôpital Beaujon, DMU Parabol, AP-HP. Nord, Clichy, France
| | - Jean Denis Moyer
- Department of Anesthesiology and Intensive Care, Hôpital Beaujon, DMU Parabol, AP-HP. Nord, Clichy, France
| | - Flora Cipriani
- Department of Anesthesiology and Intensive Care, Hôpital Beaujon, DMU Parabol, AP-HP. Nord, Clichy, France
| | - Christophe De La Jonquire
- Department of Anesthesiology and Intensive Care, Hôpital Beaujon, DMU Parabol, AP-HP. Nord, Clichy, France
| | - Marc Antoine Rousseau
- Department of Orthopaedic and Traumatological Surgery, Hôpital Beaujon, AP-HP, Clichy, France
- Université Paris Cité, Paris, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Intensive Care, Hôpital Beaujon, DMU Parabol, AP-HP. Nord, Clichy, France
- Inserm, Centre for Research on Inflammation, Paris, France
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14
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Lau KK, Lau RW, Baranowski R, Krzykowski J, Ng CS. Transbronchial Microwave Ablation of Peripheral Lung Tumors: The NAVABLATE Study. J Bronchology Interv Pulmonol 2024; 31:165-174. [PMID: 37747275 PMCID: PMC10984635 DOI: 10.1097/lbr.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Image-guided thermal ablation is a minimally invasive local therapy for lung malignancies. NAVABLATE characterized the safety and performance of transbronchial microwave ablation (MWA) in the lung. METHODS The prospective, single-arm, 2-center NAVABLATE study (NCT03569111) evaluated transbronchial MWA in patients with histologically confirmed lung malignancies ≤30 mm in maximum diameter who were not candidates for, or who declined, both surgery and stereotactic body radiation therapy. Ablation of 1 nodule was allowed per subject. The nodule was reached with electromagnetic navigation bronchoscopy. Cone-beam computed tomography was used to verify the ablation catheter position and to evaluate the ablation zone postprocedure. The primary end point was composite adverse events related to the transbronchial MWA device through 1-month follow-up. Secondary end points included technical success (nodule reached and ablated according to the study protocol) and technique efficacy (satisfactory ablation based on 1-month follow-up imaging). RESULTS Thirty subjects (30 nodules; 66.7% primary lung, 33.3% oligometastatic) were enrolled from February 2019 to September 2020. The pre-procedure median nodule size was 12.5 mm (range 5 to 27 mm). Procedure-day technical success was 100% (30/30), with a mean ablative margin of 9.9±2.7 mm. One-month imaging showed 100% (30/30) technique efficacy. The composite adverse event rate related to the transbronchial MWA device through 1-month follow-up was 3.3% (1 subject, mild hemoptysis). No deaths or pneumothoraces occurred. Four subjects (13.3%) experienced grade 3 complications; none had grade 4 or 5. CONCLUSION Transbronchial microwave ablation is an alternative treatment modality for malignant lung nodules ≤30 mm. There were no deaths or pneumothorax. In all, 13.3% of patients developed grade 3 or above complications.
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Affiliation(s)
- Kelvin K.W. Lau
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Rainbow W.H. Lau
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ralitsa Baranowski
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | - Calvin S.H. Ng
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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15
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Kuo FH, Elliott RA, Watkins SC, Shieh HF, Smithers CJ, Jennings RW, Munoz-San Julian C. Negative pressure suction test: An intraoperative airway maneuver to assess effectiveness of surgical correction of tracheobronchomalacia. Paediatr Anaesth 2024; 34:289-292. [PMID: 38130114 DOI: 10.1111/pan.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/15/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Surgical correction of tracheobronchomalacia (TBM) has evolved greatly over the past decade, with select pediatric institutions establishing dedicated surgery and anesthesia teams to navigate the complexities and challenges of surgical airway repairs. Although anesthetic techniques have evolved internally over many years to improve patient safety and outcomes, many of these methods remain undescribed in literature. TECHNIQUE In this article, we describe the intraoperative negative pressure suction test. This simulates the negative pressure seen in awake and spontaneously breathing patients, including the higher pressures seen during coughing which induce airway collapse in patients with TBM. Also known as the Munoz maneuver in surgical literature, this test has been performed on over 300 patients since 2015. DISCUSSION The negative pressure suction test allows for controlled intraoperative assessment of surgical airway repairs, replaces the need for risky intraoperative wake-up tests, increases the chances of a successful surgical repair, and improves anesthetic management for emergence and extubation. We provide a guide on how to perform the test and videos demonstrating its efficacy in intraoperative airway evaluation. CONCLUSIONS As surgeries to repair TBM become more prevalent in other pediatric institutions, we believe that pediatric patients and anesthesia providers will benefit from the insights and methods described here.
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Affiliation(s)
- Frederick H Kuo
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Richard A Elliott
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Scott C Watkins
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Charles J Smithers
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Russell W Jennings
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Carlos Munoz-San Julian
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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16
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Georgakopoulou VE, Tarantinos K, Mermigkis D. Foreign Body in the Tracheobronchial Tree as a Cause of Hemoptysis in an Adult Without Risk Factors for Aspiration: A Case Report. Cureus 2024; 16:e57596. [PMID: 38707010 PMCID: PMC11069630 DOI: 10.7759/cureus.57596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Although aspiration of a foreign body into the trachea and bronchi can occur in all age groups, it is more common in infants and young children. Foreign bodies in the tracheobronchial tree are uncommon in adults and mainly present in patients with dysphagia and an altered level of consciousness. The identification of foreign bodies in the tracheobronchial tree is frequently overlooked or delayed, leading patients to present later with chronic symptoms and potential complications. These complications may include persistent coughing, wheezing, obstructive pneumonitis, bronchiectasis, and abscess formation secondary to recurrent pulmonary infections. This article aims to present the case of a 27-year-old patient without risk factors for aspiration who has experienced recurrent self-limiting hemoptysis episodes for five years. Bronchoscopy revealed a foreign body at the entrance to the middle lobe bronchus. The presence of a foreign body in the tracheobronchial tree should be considered in any patient with recurrent hemoptysis. Bronchoscopy leads to accurate diagnosis, treatment, and prevention of complications.
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17
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Cao M, Yi J, Bao H, Sun J, Chen Y. Complex bronchopleural fistulas: a case report. J Int Med Res 2024; 52:3000605241245269. [PMID: 38635897 PMCID: PMC11032051 DOI: 10.1177/03000605241245269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. Concomitant problems, such as pulmonary infection and respiratory failure, are typically the main contributors to mortality from BPF because of improper contact between the bronchial and pleural cavity. We present the case of a 75-year-old male patient with a history of right upper lobe lung cancer resection who developed complex BPFs. Following appropriate antibiotic therapy and chest tube drainage, we treated the fistulas using endobronchial valve EBV placement and local argon gas spray stimulation. Bronchoscopic treatment is the preferred method for patients who cannot tolerate a second surgery because it can help to maximize their quality of life. Our treatment method may be a useful reference for treating complex BPF.
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Affiliation(s)
| | | | - Hongjie Bao
- Department of Pulmonary Medicine, Shaoxing People’s Hospital, Shaoxing, China
| | - Jian Sun
- Department of Pulmonary Medicine, Shaoxing People’s Hospital, Shaoxing, China
| | - Yefeng Chen
- Department of Pulmonary Medicine, Shaoxing People’s Hospital, Shaoxing, China
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18
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Shimanuki Y, Sakamoto S, Yoshida H, Iizuka N, Miyoshi S, Sonobe S, Tochigi N, Kishi K. Endobronchial cryptococcosis without pulmonary parenchymal involvement caused by Cryptococcus neoformans in an immunocompetent host. Respirol Case Rep 2024; 12:e01343. [PMID: 38571723 PMCID: PMC10990678 DOI: 10.1002/rcr2.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Cryptococcus is a yeast-like fungus. Pulmonary lesions caused by Cryptococcus neoformans typically present as single or multiple nodules or infiltrative lesions in the lungs; however, endobronchial lesions are rare. A 40-year-old previously healthy Japanese man was referred to our hospital due to an abnormality detected on chest computed tomography. The analysis revealed focal bronchiectasis and bronchial wall thickening in the right upper lobe, which persisted for 6 months. Bronchoscopy showed reddish and edematous mucosa, stenosed bronchi (right B1 and B3), and white moss at the bifurcation of the right upper bronchus. Transbronchial biopsy revealed numerous yeast-like fungi and an encapsulated body. Bronchial washing for fungus culture identified Cryptococcus neoformans. Although analysis for serum cryptococcal antigen was negative, bronchoscopy led to a definitive diagnosis. Antifungal treatment improved the bronchial wall thickening. This is a rare case of endobronchial cryptococcosis caused by Cryptococcus neoformans without pulmonary parenchymal involvement in an immunocompetent host.
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Affiliation(s)
- Yui Shimanuki
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Susumu Sakamoto
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Hiromichi Yoshida
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Noboru Iizuka
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Shion Miyoshi
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Satoshi Sonobe
- Department of Surgical PathologyToho University Omori Medical CenterTokyoJapan
| | - Naobumi Tochigi
- Department of Surgical PathologyToho University Omori Medical CenterTokyoJapan
| | - Kazuma Kishi
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
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19
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Huan N, Lee WL, Ramarmuty HY, Nyanti LE, Tsen MSL, Yunus D. The utility of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) for the diagnosis of mediastinal lymphoma. Respirol Case Rep 2024; 12:e01342. [PMID: 38576853 PMCID: PMC10990922 DOI: 10.1002/rcr2.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a revolutionary tool for the diagnosis and staging of mediastinal disorders. Nevertheless, its diagnostic capability is reduced in certain disorders such as lymphoproliferative diseases. EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) is a novel technique that can provide larger samples with preserved tissue architecture, with an acceptable safety profile. In this case report, we present a middle-aged gentleman with a huge anterior mediastinal mass and bilateral mediastinal and hilar lymphadenopathy. He underwent EBUS-TBNA with rapid on-site evaluation (ROSE) followed by EBUS-TBMC, all under general anaesthesia. Histopathological analysis showed discordance between EBUS-TBNA and EBUS-TBMC in which only TBMC samples provided adequate tissue to attain a diagnosis of primary mediastinal large B-cell lymphoma. This case report reinforced the diagnostic role of EBUS-TBMC in the diagnosis of lymphoproliferative diseases.
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Affiliation(s)
- Nai‐Chien Huan
- Department of Respiratory MedicineQueen Elizabeth HospitalKota KinabaluMalaysia
| | - Wei Lun Lee
- Department of Respiratory MedicineQueen Elizabeth HospitalKota KinabaluMalaysia
- Department of MedicineQueen Elizabeth HospitalKota KinabaluMalaysia
| | | | - Larry Ellee Nyanti
- Department of Respiratory MedicineQueen Elizabeth HospitalKota KinabaluMalaysia
- Medical Department, Faculty of Medicine and Health SciencesUniversiti Malaysia SabahKota KinabaluMalaysia
| | | | - Dahziela Yunus
- Department of PathologyQueen Elizabeth HospitalKota KinabaluMalaysia
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20
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Friedman DZP, Theel ES, Walker RC, Vikram HR, Razonable RR, Vergidis P. Serial Bronchoalveolar Lavage Fluid Aspergillus Galactomannan and Treatment Response in Invasive Pulmonary Aspergillosis. Open Forum Infect Dis 2024; 11:ofae114. [PMID: 38560609 PMCID: PMC10977621 DOI: 10.1093/ofid/ofae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
We studied patients diagnosed with aspergillosis based on positive bronchoalveolar lavage (BAL) Aspergillus galactomannan (GM) who had follow-up BAL sampling within 180 days. GM trend and clinical outcome were concordant in only 60% (30/50). While useful for the initial diagnosis, BAL GM trending does not always correlate with treatment response.
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Affiliation(s)
- Daniel Z P Friedman
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases and Public Health, University of Chicago, Chicago, Illinois, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Randall C Walker
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Raymund R Razonable
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Paschalis Vergidis
- Section of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
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21
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Aurangabadkar GM, Choudhary SS, Khan SM. Lipoid Pneumonia Secondary to Diesel Aspiration: An Occupational Hazard. Cureus 2024; 16:e58509. [PMID: 38765374 PMCID: PMC11101980 DOI: 10.7759/cureus.58509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Lipoid pneumonia is defined as a type of pneumonia that occurs as a result of inhalation of either endogenous or exogenous lipid-containing products in the lungs. We present the case of a 55-year-old male patient who presented with chief complaints of cough with blood-tinged sputum, right-sided chest pain, dyspnea, and fever for two days. The patient gave a history of working as a mechanic in an automobile garage and reported an episode of accidental aspiration of diesel during diesel siphoning at the workplace. A chest X-ray and computed tomography (CT) scan of the chest were done, which revealed right-sided lower lobe consolidation. The patient was admitted and started on intravenous antibiotics, corticosteroids, and inhaled bronchodilators, along with oxygen support. A bronchoscopy was done, which revealed the presence of thick mucoid secretions in the right lower lobe bronchus. The patient was discharged after 10 days with stable vitals and was advised to have regular follow-ups to monitor for any long-term pulmonary complications.
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Affiliation(s)
- Gaurang M Aurangabadkar
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Sumer S Choudhary
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Shafee M Khan
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
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22
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Šimon R, Šimonová J, Čuchrač L, Klimčík R, Vašková J. Foreign Body in the Airway Mimicking Tumour in an Adult: A Case Report. Cureus 2024; 16:e58584. [PMID: 38765362 PMCID: PMC11102659 DOI: 10.7759/cureus.58584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol addiction, neuromuscular diseases, and mental health issues and illnesses are the main risk factors. The authors present an atypical clinical presentation of a 3-week-lasting foreign body aspiration mimicking a tumour that led to severe acute respiratory insufficiency and required aggressive artificial lung ventilation. Diagnosis of FB was based on the results of the chest computed tomography (CT) scans and flexible bronchoscopy, which, however, initially assumed a neoplastic disease in the right main bronchus. During FB extraction via flexible fiberoptic bronchoscopy inserted through an 8.5 mm endotracheal tube high-frequency ventilation through a catheter placed between the vocal cords was used to ensure adequate alveolar ventilation and maintain sufficient oxygenation. After extraction of the FB, thoracosurgical intervention was performed to resolve empyema as a septic complication of the FB aspiration. After this therapy, a complete resolution of pleural empyema and lung atelectasis was observed.
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Affiliation(s)
- Róbert Šimon
- 1st Department of Surgery, Pavol Jozef Šafarik University, Košice, SVK
| | - Jana Šimonová
- 1st Department of Anaesthesiology and Intensive Medicine, Pavol Jozef Šafarik University, Košice, SVK
| | - Lukáš Čuchrač
- 1st Department of Anaesthesiology and Intensive Medicine, Pavol Jozef Šafarik University, Košice, SVK
| | - Roman Klimčík
- Department of Pneumology and Phthiseology, Pavol Jozef Šafarik University, Košice, SVK
| | - Janka Vašková
- Department of Medical and Clinical Biochemistry, Pavol Jozef Šafarik University, Košice, SVK
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23
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Maruyama S, Takahashi T, Kobayashi D, Hayase Y, Sugiyama Y. Interstitial Lung Disease With Respiratory Failure After COVID-19 mRNA Vaccination. Cureus 2024; 16:e58491. [PMID: 38765336 PMCID: PMC11101300 DOI: 10.7759/cureus.58491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
A septuagenarian woman developed dyspnea on the day following a fifth vaccination. Just before vaccination, a chest X-ray showed no abnormalities, but after the fifth vaccination, bilateral diffuse ground-glass opacities were detected. Bronchoalveolar lavage revealed a lymphocyte predominance and transbronchial lung biopsy revealed growth of the alveolar epithelium, along with organized polypoid granulation tissues in the alveolar ducts and bronchioles. Despite the administration of corticosteroids, imaging revealed persistent fibrosis, and she required long-term oxygen therapy. Although recent reports indicated that corticosteroids are effective for drug-induced interstitial lung disease related to COVID-19 mRNA vaccination, this case presented a somewhat different clinical manifestation.
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Affiliation(s)
- Soichi Maruyama
- Department of Respiratory Medicine, Nerima Hikarigaoka Hospital, Tokyo, JPN
| | - Taro Takahashi
- Department of Respiratory Medicine, Nerima Hikarigaoka Hospital, Tokyo, JPN
| | | | - Yoneko Hayase
- Department of Pathology, Nerima Hikarigaoka Hospital, Tokyo, JPN
| | - Yukihiko Sugiyama
- Department of Respiratory Medicine, Nerima Hikarigaoka Hospital, Tokyo, JPN
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24
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Bhadra K, Setser RM, Condra W, Bader BA, David S. A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions. J Bronchology Interv Pulmonol 2024; 31:117-125. [PMID: 37450607 PMCID: PMC10984630 DOI: 10.1097/lbr.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 05/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Compared with the standard cryoprobe, the novel ultrathin 1.1 mm cryoprobe (UTCP) has improved ergonomics, shape memory, and flexibility. The performance of UTCP has demonstrated promising results in several small trials. METHODS In this single-center, retrospective review, we examine 200 (N=200) consecutive patients referred for cone beam CT bronchoscopic biopsy of peripheral lung lesions. We utilized an extended multimodality approach, including transbronchial needle aspirate, brush, traditional forces biopsies, UTCP biopsies, and BAL. We analyzed tool in lesion, tool touch lesion, center strike rates, and diagnostic yield. We assessed for molecular adequacy and analyzed safety. RESULTS A total of 222 lesions were biopsied. We achieved a tool in lesion or tool touch lesion confirmation for all biopsy attempts (100%) and a center strike rate of 68%. AQuIRE diagnostic yield was 90%, with 60% malignant, 30% benign lung nodules, and 10% nondiagnostic. UTCP was diagnostic in 3.6 % of peripheral lung lesions biopsies when all other modalities were nondiagnostic; thus, raising our overall diagnostic yield from 86.4% to 90.1%. Our analysis demonstrates superior adequacy for molecular analysis for histologic samples (TBBX or UTCP) versus cytologic samples (FNA) ( P <0.001). Three patients (1.5%) had a pneumothorax, and 1 patient (0.5%) had moderate bleeding. CONCLUSION UTCP was diagnostic in 3.6% of peripheral lung lesions when all other modalities were nondiagnostic. In the setting of CBCT guidance, UTCP has a similar safety profile to standard biopsy tools. Future trials are warranted to assess UTCP and its impact on peripheral lung lesion biopsies.
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Affiliation(s)
- Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN
| | | | - William Condra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN
| | | | - Stephanie David
- Diagnostic Pathology Services, CHI Memorial Hospital, Chattanooga, TN
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25
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Magarinos J, Egelko A, Criner GJ, Abbas A, Enofe N, Thomas J, Carney K, Friedberg J, Bakhos C. Lung volume reduction surgery is safe and leads to functional improvement in patients who fail or cannot undergo bronchoscopic lung volume reduction. JTCVS Open 2024; 18:369-375. [PMID: 38690414 PMCID: PMC11056479 DOI: 10.1016/j.xjon.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
Background Bronchoscopic lung volume reduction (BLVR) has supplanted surgery in the treatment of patients with advanced emphysema, but not all patients qualify for it. Our study aimed to investigate the outcomes of lung volume reduction surgery (LVRS) among patients who either failed BLVR or were not candidates for it. Methods We conducted a retrospective analysis of patients who underwent LVRS for upper lobe-predominant emphysema at a single tertiary center between March 2018 and December 2022. The main outcomes measures were preoperative and postoperative respiratory parameters, perioperative morbidity, and mortality. Results A total of 67 LVRS recipients were evaluated, including 10 who had failed prior valve placement. The median patient age was 69 years, and 35 (52%) were male. All procedures were performed thoracoscopically, with 36 patients (53.7%) undergoing bilateral LVRS. The median hospital length of stay was 7 days (interquartile range, 6-11 days). Prolonged air leak (>7 days) occurred in 20 patients. There was one 90-day mortality from a nosocomial pneumonia (non-COVID-related) and no further deaths at 12 months. There were mean improvements of 10.07% in forced expiratory volume in 1 second and 4.74% in diffusing capacity of the lung for carbon monoxide, along with a mean decrease 49.2% in residual volume (P < .001 for all). The modified Medical Research Council dyspnea scale was improved by 1.84 points (P < .001). Conclusions LVRS can be performed safely in patients who are not candidates for BLVR and those who fail BLVR and leads to significant functional improvement. Long-term follow-up is necessary to ensure the sustainability of LVRS benefits in this patient population.
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Affiliation(s)
- Jessica Magarinos
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa
| | - Aron Egelko
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Abbas Abbas
- Lifespan Health System, Department of Thoracic Oncology, Brown University, Providence, RI
| | - Nosayaba Enofe
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - JiJi Thomas
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Kevin Carney
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Joseph Friedberg
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Charles Bakhos
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
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26
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Kalvapudi S, Zubair HM, Kunadharaju R, Bhura S, Mengiste H, Saeed M, Saradna A, Grover H, Shafirstein G, Yendamuri S, Ivanick NM. Correlation of Bronchoscopy and CT in Characterizing Malignant Central Airway Obstruction. Cancers (Basel) 2024; 16:1258. [PMID: 38610936 PMCID: PMC11010868 DOI: 10.3390/cancers16071258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Malignant Central Airway Obstruction (MCAO) presents a significant challenge in lung cancer management, with notable morbidity and mortality implications. While bronchoscopy is the established diagnostic standard for confirming MCAO and assessing obstruction subtype (intrinsic, extrinsic, mixed) and severity, Computed Tomography (CT) serves as an initial screening tool. However, the extent of agreement between CT and bronchoscopy findings for MCAO remains unclear. METHODS To assess the correlation between bronchoscopy and CT, we conducted a retrospective review of 108 patients at Roswell Park Comprehensive Cancer Center, analyzing CT and bronchoscopy results to document MCAO presence, severity, and subtype. RESULTS CT correctly identified MCAO in 99% of cases (107/108). Agreement regarding obstruction subtype (80.8%, Cohen's κ = 0.683, p < 0.001), and severity (65%, Quadratic κ = 0.657, p < 0.001) was moderate. CT tended to equally overestimate (7/19) and underestimate (7/19) the degree of obstruction. CT was also poor in identifying mucosal involvement in mixed MCAO. CONCLUSIONS CT demonstrates reasonable agreement with bronchoscopy in detecting obstruction. Nevertheless, when CT indicates a positive finding for MCAO, it is advisable to conduct bronchoscopy. This is because CT lacks reliability in determining the severity of obstruction and identifying the mucosal component of mixed disease.
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Affiliation(s)
- Sukumar Kalvapudi
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.K.); (S.Y.)
| | - Hafiz M. Zubair
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Rajesh Kunadharaju
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Sajeer Bhura
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Hiwot Mengiste
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Musa Saeed
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Arjun Saradna
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Harshwant Grover
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Gal Shafirstein
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.K.); (S.Y.)
| | - Nathaniel M. Ivanick
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.K.); (S.Y.)
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27
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Bergin SP, Chemaly RF, Dadwal SS, Hill JA, Lee YJ, Haidar G, Luk A, Drelick A, Chin-Hong PV, Benamu E, Khawaja F, Nanayakkara D, Papanicolaou GA, Small CB, Fung M, Barron MA, Davis T, McClain MT, Maziarz EK, Madut DB, Bedoya AD, Gilstrap DL, Todd JL, Barkauskas CE, Bigelow R, Leimberger JD, Tsalik EL, Wolf O, Mughar M, Hollemon D, Duttagupta R, Lupu DS, Bercovici S, Perkins BA, Blauwkamp TA, Fowler VG, Holland TL. Plasma Microbial Cell-Free DNA Sequencing in Immunocompromised Patients With Pneumonia: A Prospective Observational Study. Clin Infect Dis 2024; 78:775-784. [PMID: 37815489 PMCID: PMC10954333 DOI: 10.1093/cid/ciad599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Pneumonia is a common cause of morbidity and mortality, yet a causative pathogen is identified in a minority of cases. Plasma microbial cell-free DNA sequencing may improve diagnostic yield in immunocompromised patients with pneumonia. METHODS In this prospective, multicenter, observational study of immunocompromised adults undergoing bronchoscopy to establish a pneumonia etiology, plasma microbial cell-free DNA sequencing was compared to standardized usual care testing. Pneumonia etiology was adjudicated by a blinded independent committee. The primary outcome, additive diagnostic value, was assessed in the Per Protocol population (patients with complete testing results and no major protocol deviations) and defined as the percent of patients with an etiology of pneumonia exclusively identified by plasma microbial cell-free DNA sequencing. Clinical additive diagnostic value was assessed in the Per Protocol subgroup with negative usual care testing. RESULTS Of 257 patients, 173 met Per Protocol criteria. A pneumonia etiology was identified by usual care in 52/173 (30.1%), plasma microbial cell-free DNA sequencing in 49/173 (28.3%) and the combination of both in 73/173 (42.2%) patients. Plasma microbial cell-free DNA sequencing exclusively identified an etiology of pneumonia in 21/173 patients (additive diagnostic value 12.1%, 95% confidence interval [CI], 7.7% to 18.0%, P < .001). In the Per Protocol subgroup with negative usual care testing, plasma microbial cell-free DNA sequencing identified a pneumonia etiology in 21/121 patients (clinical additive diagnostic value 17.4%, 95% CI, 11.1% to 25.3%). CONCLUSIONS Non-invasive plasma microbial cell-free DNA sequencing significantly increased diagnostic yield in immunocompromised patients with pneumonia undergoing bronchoscopy and extensive microbiologic and molecular testing. CLINICAL TRIALS REGISTRATION NCT04047719.
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Affiliation(s)
- Stephen P Bergin
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjeet S Dadwal
- Department of Medicine, Division of Infectious Diseases, City of Hope National Medical Center, Duarte California, California, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yeon Joo Lee
- Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, NewYork, New York, USA
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
| | - Ghady Haidar
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alfred Luk
- Section of Infectious Diseases, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Alexander Drelick
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
- Department of Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Peter V Chin-Hong
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Esther Benamu
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Deepa Nanayakkara
- Department of Medicine, Division of Infectious Diseases, City of Hope National Medical Center, Duarte California, California, USA
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, NewYork, New York, USA
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
| | - Catherine Butkus Small
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
- Department of Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Monica Fung
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Michelle A Barron
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
| | - Thomas Davis
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Micah T McClain
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen K Maziarz
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Deng B Madut
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Armando D Bedoya
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel L Gilstrap
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jamie L Todd
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christina E Barkauskas
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert Bigelow
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Ephraim L Tsalik
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Emergency Medicine Services, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VP and Chief Scientific Officer, Infectious Disease, Danaher Diagnostics, Washington, DC, USA
| | - Olivia Wolf
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Vance G Fowler
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas L Holland
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
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Yoneoka R, Takeda K, Kasai H, Sugiura T, Shikano K, Abe M, Suzuki T. A 65-Year-Old Man with Refractory Hemoptysis Associated with Chronic Progressive Pulmonary Aspergillosis Who Failed to Respond to Combined Endobronchial Occlusion and Bronchial Artery Embolization: A Case Report and Literature Review. Am J Case Rep 2024; 25:e942422. [PMID: 38527273 PMCID: PMC10946694 DOI: 10.12659/ajcr.942422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/26/2024] [Accepted: 01/12/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Hemoptysis due to airway hemorrhage is treated with hemostatic agents, bronchial artery embolization (BAE), or surgical resection. We present the case of a 65-year-old man with refractory hemoptysis associated with chronic progressive pulmonary aspergillosis (CPPA) who failed to respond to combined endobronchial occlusion (EBO) with endobronchial Watanabe spigot (EWS) and BAE. CASE REPORT A 63-year-old man was diagnosed with CPPA in the right upper lung and presented to our hospital 2 years later for hemoptysis at age 65. He developed severe hemoptysis during an outpatient visit, and was urgently admitted, intubated, and ventilated to prevent choking on blood clots. Chest computed tomography showed a large mass in the apical portion of the right lung, constituting apical pleural thickening and an encapsulated pleural effusion, and dilatation in the bronchial artery supplying the right upper lung lobe. Bronchoscopy revealed the right upper lobe B1-B3 as the bleeding source. The patient had recurrent hemoptysis that was not controlled by BAE or 6 EBO+EWS procedures, and he ultimately died of hypoxemia.In the literature review, EBO+EWS can effectively control hemoptysis in appropriate cases, without the need for BAE or surgical lung resection. It is less invasive, is associated with fewer adverse events than BAE or surgery, and can achieve temporary hemostasis for severe hemoptysis. CONCLUSIONS BAE and EBO+EWS were ineffective in controlling recurrent hemoptysis caused by CPPA in this case. However, a multidisciplinary approach such as attempting hemostasis with combined EBO+EWS and BAE may be a viable treatment option in severe cases of hemoptysis.
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Affiliation(s)
- Ryotaro Yoneoka
- Department of Medicine, School of Medicine, Chiba University, Chiba, Japan
| | - Kenichiro Takeda
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Education, School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohei Shikano
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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29
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Wang J, Tian L, Liu B. Plastic bronchitis secondary to thoracotomy in an adult: A case report. Respir Med Case Rep 2024; 48:102002. [PMID: 38510662 PMCID: PMC10950725 DOI: 10.1016/j.rmcr.2024.102002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
This study presents a rare case of plastic bronchitis (PB) in a 57-year-old adult post-lung lobectomy, a condition predominantly found in post-Fontan children. The patient exhibited progressive dyspnea and complete atelectasis on the surgical side, revealing a gray rubbery bronchial cast obstructing the right main bronchus. Treatment involved repeated bronchoscopies, glucocorticoids, acetylcysteine, physiotherapy, and a low-fat diet, leading to gradual improvement. No similar cases have been reported, highlighting PB's diagnostic challenge. This underscores the need to consider rare conditions like PB in post-lobectomy complications. Timely examinations and bronchoscopies are essential for accurate diagnosis, ensuring prompt treatment and improving patient outcomes.
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Affiliation(s)
- Jia Wang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Long Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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30
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Horio Y, Kuroda H, Masago K, Matsushita H, Sasaki E, Fujiwara Y. Current diagnosis and treatment of salivary gland-type tumors of the lung. Jpn J Clin Oncol 2024; 54:229-247. [PMID: 38018262 DOI: 10.1093/jjco/hyad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
Salivary gland-type tumors of the lung are thought to originate from the submucosal exocrine glands of the large airways. Due to their rare occurrence, reports of their study are limited to small-scale or case reports. Therefore, daily clinical practices often require a search for previous reports. In the last 20 years, several genetic rearrangements have been identified, such as MYB::NF1B rearrangements in adenoid cystic carcinoma, CRTC1::MAML2 rearrangements in mucoepidermoid carcinoma, EWSR1::ATF1 rearrangements in hyalinizing clear cell carcinoma and rearrangements of the EWSR1 locus or FUS (TLS) locus in myoepithelioma and myoepithelial carcinoma. These molecular alterations have been useful in diagnosing these tumors, although they have not yet been linked to molecularly targeted therapies. The morphologic, immunophenotypic, and molecular characteristics of these tumors are similar to those of their counterparts of extrapulmonary origin, so clinical and radiologic differential diagnosis is required to distinguish between primary and metastatic disease of other primary sites. However, these molecular alterations can be useful in differentiating them from other primary lung cancer histologic types. The management of these tumors requires broad knowledge of the latest diagnostics, surgery, radiotherapy, bronchoscopic interventions, chemotherapy, immunotherapy as well as therapeutic agents in development, including molecularly targeted agents. This review provides a comprehensive overview of the current diagnosis and treatment of pulmonary salivary gland tumors, with a focus on adenoid cystic carcinoma and mucoepidermoid carcinoma, which are the two most common subtypes.
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Affiliation(s)
- Yoshitsugu Horio
- Department of Outpatient Services, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Thoracic Surgery, Teikyo University Hospital, Mizonokuchi, Kanagawa-prefecture, Japan
| | - Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hirokazu Matsushita
- Division of Translational Oncoimmunology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Šapina M, Olujic B, Nađ T, Vinkovic H, Dupan ZK, Hamidović N, Damašek M, Milas K, Zubčić Ž, Erić I. Real-time ultrasound-guided segmental bronchoscopic insufflation in a Tay-Sachs patient with atelectasis. Pediatr Pulmonol 2024. [PMID: 38450877 DOI: 10.1002/ppul.26956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/08/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Matej Šapina
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, Osijek, Croatia
| | - Bojana Olujic
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Tihana Nađ
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Hrvoje Vinkovic
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Zdravka Krivdić Dupan
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | | | - Mia Damašek
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | | | - Željko Zubčić
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Ivan Erić
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
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Chen GJ, Chen XB, Rao WY, Pan XY, Li SY, Su ZQ. Airway necrosis and granulation tissue formation caused by Rhizopus oryzae leading to severe upper airway obstruction: a case report. Front Cell Infect Microbiol 2024; 14:1366472. [PMID: 38500502 PMCID: PMC10944989 DOI: 10.3389/fcimb.2024.1366472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Pulmonary Mucormycosis is a fatal infectious disease with high mortality rate. The occurrence of Mucormycosis is commonly related to the fungal virulence and the host's immunological defenses against pathogens. Mucormycosis infection and granulation tissue formation occurred in the upper airway was rarely reported. This patient was a 60-year-old male with diabetes mellitus, who was admitted to hospital due to progressive cough, sputum and dyspnea. High-resolution computed tomography (HRCT) and bronchoscopy revealed extensive tracheal mucosal necrosis, granulation tissue proliferation, and severe airway stenosis. The mucosal necrotic tissue was induced by the infection of Rhizopus Oryzae, confirmed by metagenomic next-generation sequencing (mNGS) in tissue biopsy. This patient was treated with the placement of a covered stent and local instillation of amphotericin B via bronchoscope. The tracheal mucosal necrosis was markedly alleviated, the symptoms of cough, shortness of breath, as well as exercise tolerance were significantly improved. The placement of airway stent and transbronchial microtube drip of amphotericin B could conduce to rapidly relieve the severe airway obstruction due to Mucormycosis infection.
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Affiliation(s)
- Geng-Jia Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Nanshan School of Medical, Guangzhou Medical University, Guangzhou, China
| | - Xiao-Bo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wan-Yuan Rao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiao-Yi Pan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shi-Yue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhu-Quan Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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New ML, Amass T, Neumeier A, Huie TJ. Massive Hemoptysis Simulation Curriculum Improves Performance. Chest 2024; 165:645-652. [PMID: 37852435 DOI: 10.1016/j.chest.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Massive hemoptysis is a rare, high-acuity presentation, which requires the integration of both cognitive and procedural skills. Simulation has been recommended to improve preparation for high-acuity, low-occurrence procedures; however, the effect of a simulation curriculum for massive hemoptysis management has never been investigated. RESEARCH QUESTION Does simulation for hemoptysis management improve competence? STUDY DESIGN AND METHODS Kern's six steps for medical education curriculum design were used iteratively to develop a simulation curriculum for the management of massive hemoptysis. Pulmonary and critical care medicine fellows from the University of Colorado participated in a local needs assessment and a massive hemoptysis simulation curriculum. Using a manikin-based massive hemoptysis simulator developed for this curriculum, the simulation session used repetitive practice, clinical variation, a range of difficulties, and directed feedback in a group practice setting. Time to management and performance were assessed for each management attempt; competence was assessed using a combined metric of management-related priorities and global entrustment. RESULTS During the needs assessment, fellows viewed massive hemoptysis management skills as important, while expressing their current confidence as low. Nineteen fellows participated in a 90-min case-based hemoptysis simulation during which each was exposed to five different cases and acted as the primary manager for two cases. There was significant improvement in performance from the first to final simulation attempts measured by time to successful management (14.24 vs 10.26 min, P = .0067) and entrustment (Global Assessment Scale, 1 [should not perform] to 5 [independent]; 4.11 vs 4.61; P = .015). Fellow self-assessed knowledge and confidence in hemoptysis management and endobronchial blocker placement improved significantly after the simulation. INTERPRETATION Hemoptysis simulation experience improves fellow confidence and skill for management of this high-acuity, low-occurrence presentation.
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Affiliation(s)
- Melissa L New
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO.
| | - Timothy Amass
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Anna Neumeier
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Tristan J Huie
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; National Jewish Health, Denver, CO
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Gwon HR, La Woo A, Yong SH, Park Y, Kim SY, Kim EY, Jung JY, Kang YA, Park MS, Park SY, Lee SH. Factors affecting accuracy of clinical staging in resectable non-small cell lung cancer in a real-world study. Thorac Cancer 2024; 15:730-737. [PMID: 38380557 PMCID: PMC10961224 DOI: 10.1111/1759-7714.15253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The clinical staging of non-small cell lung cancer (NSCLC) is well known to be related to their prognosis. However, there is usually a discrepancy between clinical staging and pathological staging. There are few analyses of clinical staging accuracy in patients with NSCLC. We compared the concordance rate between clinical and pathological staging of NSCLC and evaluated factors affecting the accuracy in real-world data. METHODS Altogether, 811 patients with primary NSCLC who had undergone curative lung resection surgery in Severance Hospital from January 2019 to December 2020 were retrospectively reviewed. We used the eighth edition of the American Joint Committee on Cancer TNM staging. RESULTS Among 811 patients, endobronchial ultrasound (EBUS) and positron emission tomography (PET-CT) were performed in 31.6% and 96.7%, respectively. The concordance rates between clinical and pathological TNM staging, T factor, and N factor, were 68.7%, 77.7%, and 85.8%, respectively. With multivariable logistic regression analysis, current smokers (OR 0.49; 95% CI: 0.32-0.76, p = 0.001) and a higher clinical stage (p < 0.001) contributed to the clinical staging inaccuracy. Additionally, the presence of a bronchoscopy specialist was significantly associated with clinical staging accuracy (OR 1.53; 95% CI: 1.10-2.13, p = 0.011). CONCLUSION Clinical staging accuracy in NSCLC improved compared to before the widespread use of PET-CT and EBUS in clinical staging work-up. Smoking history and absence of expert bronchoscopy specialists showed a meaningful correlation with the inaccuracy of clinical staging. Thus, training more bronchoscopy experts would improve the staging accuracy of NSCLC, which could positively affect the prognosis of NSCLC.
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Affiliation(s)
- Hye Ran Gwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
- Division of PulmonologyNational Cancer CenterGoyangKorea
| | - A. La Woo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Seung Hyun Yong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Song Yee Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Eun Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
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New ML, Amass T, Neumeier A, Jacobson NM, Huie TJ. Creation and Validation of a Massive Hemoptysis Simulator. Chest 2024; 165:636-644. [PMID: 37852436 DOI: 10.1016/j.chest.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Simulation for the management of massive hemoptysis is limited by the absence of a commercially available simulator to practice procedural skills necessary for management. RESEARCH QUESTION Is it feasible to create and validate a hemoptysis simulator with high functional task alignment? STUDY DESIGN AND METHODS Pulmonary and critical care medicine (PCCM) attending physicians from four academic institutions in the Denver, Colorado, area and internal medicine residents from the University of Colorado participated in this mixed-methods study. A hemoptysis simulator was constructed by connecting a 3-D-printed airway model to a manikin that may be intubated. Attending PCCM physicians evaluated the simulator through surveys and qualitative interviews. Attendings were surveyed to determine simulation content and appropriate assessment criteria for a hemoptysis simulation. Based on these criteria, expert and novice performance on the simulator was assessed. RESULTS The manikin-based hemoptysis simulator demonstrated adequate physical resemblance, high functional alignment, and strong affective fidelity. It was universally preferred over a virtual reality simulator by 10 PCCM attendings. Twenty-seven attendings provided input on assessment criteria and established that assessing management priorities (eg, airway protection) was preferred to a skills checklist for hemoptysis management. Three experts outperformed six novices in hemoptysis management on the manikin-based simulator in all management categories assessed, supporting construct validity of the simulation. INTERPRETATION Creation of a hemoptysis simulator with appropriate content, high functional task alignment, and strong affective fidelity was successful using 3-D-printed airway models and existing manikins. This approach can overcome barriers of cost and availability for simulation of high-acuity, low-occurrence procedures.
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Affiliation(s)
- Melissa L New
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO.
| | - Timothy Amass
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Anna Neumeier
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Nicholas M Jacobson
- College of Engineering, Design and Computing, University of Colorado, Aurora, CO
| | - Tristan J Huie
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; National Jewish Health, Denver, CO
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Simpson RC, Ale GB, Harris WT. Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia. Pediatr Pulmonol 2024; 59:715-723. [PMID: 38088146 DOI: 10.1002/ppul.26819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are frequently performed in children with known or suspected aspiration, however, the additive value of FB in conjunction with direct laryngoscopy and rigid bronchoscopy (DLB) has not been previously quantified. This study details the common endoscopic/cytological findings and associated management impact of FB and BAL in pediatric Aerodigestive patients undergoing combined airway evaluation (FB and DLB) for oropharyngeal dysphagia. MATERIALS AND METHODS A retrospective chart review was performed in children <3 years of age followed through a large Aerodigestive center undergoing outpatient, combined airway endoscopy for dysphagia. Patient and procedural characteristics, endoscopic and BAL findings, and management metrics were collected and analyzed. A secondary analysis evaluated the association between endoscopic findings and medication changes. RESULTS Ninety-one procedures (median patient age, 15 months) were identified. All procedures included both FB and DLB, and just over half (52.7%) included esophagogastroduodenoscopy. Common endoscopic findings included bronchitis (73.6%), adenoidal hypertrophy (31.9%), and tracheomalacia (10.8%). BAL cytology frequently identified neutrophilic inflammation (mean 39.6% neutrophils [interquartile range 6.5%-71%)]. Cultured pathogens commonly included Streptococcus viridans (46.6%), Hemophilus influenzae (36.3%), Moraxella catarrhalis (30.1%), and Streptococcus pneumoniae (25.0%). FB and BAL results contributed to clinical decisions in 65 of 91 (71.4%) patients. Endoscopically-diagnosed bronchitis (odds ratio [OR] 7.27, 95% confidence interval [CI] 2.4-21.99) and tracheomalacia (OR 5.79, 95% CI 1.20-27.85) were significantly associated with increased odds of medication adjustments following FB. CONCLUSION In pediatric Aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia, FB and BAL are high-yield and clinically impactful procedures.
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Affiliation(s)
- Ryne C Simpson
- Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Guillermo Beltran Ale
- Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Šapina M, Olujic B, Nađ T, Vinkovic H, Dupan ZK, Bartulovic I, Milas K, Kos M, Divkovic D, Zubčić Ž, Erić I. Bronchoscopic treatment of pediatric atelectasis: A modified segmental insufflation-surfactant instillation technique. Pediatr Pulmonol 2024; 59:625-631. [PMID: 38018688 DOI: 10.1002/ppul.26792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Atelectasis is a condition characterized by the collapse and nonaeration of lung regions and is considered a manifestation of an underlying disease process. The goal of atelectasis treatment is the restoration of volume loss. In the range of different treatment options, chest physiotherapy is often used as a first-line approach, and some cases require bronchoscopic interventions. METHODS In this case series, we describe a modified bronchoscopic treatment procedure using pressure-controlled bronchoscopic segmental insufflation with surfactant application. RESULTS The proposed approach resulted in significant improvement of lung volume across a range of patients including massive lobar, atypical rounded atelectasis in previously healthy patients, and in a particularly challenging case involving an infant suffering from spinal muscular atrophy type I. CONCLUSION The modified segmental insufflation-surfactant instillation technique offers a safe and promising easily implementable treatment of persistent atelectasis caused by different underlying disease processes with positive long-term outcomes.
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Affiliation(s)
- Matej Šapina
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, Osijek, Croatia
| | - Bojana Olujic
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Tihana Nađ
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Hrvoje Vinkovic
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Zdravka K Dupan
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | | | | | - Martina Kos
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Dalibor Divkovic
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Željko Zubčić
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
| | - Ivan Erić
- University Hospital Center Osijek, Osijek, Croatia
- Medical Faculty Osijek, Osijek, Croatia
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Kang J, Kim YS, Kim JY. Video-assisted thoracic surgery for an endobronchial ancient schwannoma obstructing the left main bronchus. J Surg Case Rep 2024; 2024:rjae140. [PMID: 38476456 PMCID: PMC10930187 DOI: 10.1093/jscr/rjae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
A schwannoma is a tumor that arises from the Schwann cells of the peripheral nerves. Primary pulmonary schwannomas are extremely rare, although they can occur anywhere in the body. Symptoms of endobronchial schwannoma vary depending upon the extent of bronchi blockage by the tumor. Schwannoma is a benign tumor. However, there is a risk of recurrence if a lesion that has developed extraluminal growth is incompletely resected. Here, a 76-year-old female patient presented with dyspnea and cough. An endobronchial tumor was identified originating from the left lower lobe bronchus and had collapsed the left lower lobe and grown to block most of the left main bronchus. Video-assisted thoracic surgery was performed to resect the left lower lobe. The tumor was diagnosed as an ancient schwannoma.
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Affiliation(s)
- Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juwha-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-Do 10380, South Korea
| | - Yeon Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juwha-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-Do 10380, South Korea
| | - Ji-Ye Kim
- Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juwha-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-Do 10380, South Korea
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Ahmad Fahmi AK, Habib Rahman AF, Hishamuddin AH, Arasu K, Mohan Singh AS. A Foreign Body Aspiration Leading to Pneumothorax: A Case of Airway Emergency. Cureus 2024; 16:e56489. [PMID: 38638762 PMCID: PMC11026065 DOI: 10.7759/cureus.56489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Foreign body (FB) aspiration is a matter that should not be taken lightly. The presence of a foreign object might lead to hazardous complications, particularly in the pediatric population. These complications depend on the type and location of the aspirated object as the tracheobronchial tree has a very small diameter, and foreign bodies become stuck in the upper airways of children, causing stridor and sudden difficulty in breathing. Impaction of a foreign body in the right bronchial tree is more frequent due to the relatively straighter alignment of the right mainstem of the trachea, as opposed to the left side. Herein, we present a 10-year-old Malay boy who accidentally aspirated a pencil cap. An urgent computed tomography (CT) of the thorax revealed a suspicious intraluminal FB in the bronchus leading to pneumothorax and pneumomediastinum. He underwent a right bronchoscopy and a successful FB removal.
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Affiliation(s)
| | | | | | - Kanivannen Arasu
- Otolaryngology - Head and Neck Surgery, Taiping Hospital, Taiping, MYS
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Zhang C, Xie F, Li R, Cui N, Herth FJF, Sun J. Robotic-assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Thorac Cancer 2024; 15:505-512. [PMID: 38286133 PMCID: PMC10912532 DOI: 10.1111/1759-7714.15229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
Robotic-assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta-analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta-analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%-85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%-94.7% vs. 79.0%, 95% CI: 75.8%-82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%-4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high-quality prospective studies still need to be conducted.
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Affiliation(s)
- Chunxi Zhang
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Runchang Li
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Ningxin Cui
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, ThoraxklinikUniversity of HeidelbergHeidelbergGermany
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
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Martínez Redondo M, Carpio Segura C, Zamarrón De Lucas E, Álvarez-Sala Walther R, Prados Sánchez C. Should atelectasis be considered a pulmonary complication and indicator of poor prognosis in cystic fibrosis? J Int Med Res 2024; 52:3000605241233520. [PMID: 38546237 PMCID: PMC10981250 DOI: 10.1177/03000605241233520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/29/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVE This study examined whether bronchoscopy leads to clinicoradiological improvement in cystic fibrosis (CF) and the predictive factors. The study also investigated whether pulmonary atelectasis is a poor prognostic factor in CF. METHODS This multicenter, case-control, observational, retrospective study included two groups of patients with CF: a case group (patients with persistent atelectasis who were followed-up at least for 2 years) and a control group (patients without atelectasis matched 1:1 by sex and age [±3 years]). We recorded demographic data, lung function test results, pulmonary complications, comorbidities, treatments (including bronchoscopies, surgery and transplantation), and deaths. RESULTS Each group included 55 patients (case group: 20 men, mean age 25.4 ± 10.4 years; control group: 20 men, mean age 26.1 ± 11.4 years). Bronchoscopy did not lead to clinicoradiological improvement. Allergic bronchopulmonary aspergillosis (ABPA) was more frequent in the case group. Patients in the case group more frequently used inhaled steroids, their pre-atelectasis lung function was statistically worse, and they had more exacerbations during follow-up. CONCLUSION Moderate-to-severe pulmonary disease and ABPA can favor atelectasis. Pulmonary atelectasis can be a poor prognostic factor in CF because it increases exacerbations. Despite our results, we recommend enhancing treatment, including bronchoscopy, to prevent persistent atelectasis.
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Affiliation(s)
- María Martínez Redondo
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Carlos Carpio Segura
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Ester Zamarrón De Lucas
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Rodolfo Álvarez-Sala Walther
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Concepción Prados Sánchez
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
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Truong B, Zapala M, Kammen B, Luu K. Automated Detection of Pediatric Foreign Body Aspiration from Chest X-rays Using Machine Learning. Laryngoscope 2024. [PMID: 38366768 DOI: 10.1002/lary.31338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE/HYPOTHESIS Standard chest radiographs are a poor diagnostic tool for pediatric foreign body aspiration. Machine learning may improve upon the diagnostic capabilities of chest radiographs. The objective is to develop a machine learning algorithm that improves the diagnostic capabilities of chest radiographs in pediatric foreign body aspiration. METHOD This retrospective, diagnostic study included a retrospective chart review of patients with a potential diagnosis of FBA from 2010 to 2020. Frontal view chest radiographs were extracted, processed, and uploaded to Google AutoML Vision. The developed algorithm was then evaluated against a pediatric radiologist. RESULTS The study selected 566 patients who were presented with a suspected diagnosis of foreign body aspiration. One thousand six hundred and eighty eight chest radiograph images were collected. The sensitivity and specificity of the radiologist interpretation were 50.6% (43.1-58.0) and 88.7% (85.3-91.5), respectively. The sensitivity and specificity of the algorithm were 66.7% (43.0-85.4) and 95.3% (90.6-98.1), respectively. The precision and recall of the algorithm were both 91.8% with an AuPRC of 98.3%. CONCLUSION Chest radiograph analysis augmented with machine learning can diagnose foreign body aspiration in pediatric patients at a level similar to a read performed by a pediatric radiologist despite only using single-view, fixed images. Overall, this study highlights the potential and capabilities of machine learning in diagnosing conditions with a wide range of clinical presentations. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Brandon Truong
- School of Medicine, University of California, San Francisco, California, U.S.A
| | - Matthew Zapala
- Division of Pediatric Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Bamidele Kammen
- Division of Pediatric Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Kimberly Luu
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
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KAMIO T, ODANI Y, OHTOMO W, OGUSHI A, AKUNE Y, KURITA M, OKADA A, INOSHIMA Y. Midazolam and butorphanol combination for sedating beluga whales (Delphinapterus leucas). J Vet Med Sci 2024; 86:207-210. [PMID: 38104973 PMCID: PMC10898986 DOI: 10.1292/jvms.23-0307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
Safe sedation doses for performing minor procedures such as bronchoscopy, endoscopy, and tooth extraction for beluga whales (Delphinapterus leucas) require elucidation. This study aimed to provide suggestions for determining appropriate midazolam and butorphanol doses to adequately sedate beluga whales to complete procedures and minimize the risk of side effects. We administered midazolam and butorphanol to six captive beluga whales (9-44 years old). Topical lidocaine anesthesia was administered during bronchoscopy. The sedation doses for the beluga whales varied from 0.020 to 0.122 mg/kg for midazolam and from 0.020 to 0.061 mg/kg for butorphanol. In beluga whales, optimal midazolam and butorphanol doses were lowest in old whales. These findings contribute to knowledge regarding appropriate sedation and prevention of overdose accidents during minor procedures in beluga whales.
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Affiliation(s)
- Takashi KAMIO
- Port of Nagoya Public Aquarium, Aichi, Japan
- Joint Graduate School of Veterinary Sciences, Gifu
University, Gifu, Japan
- Laboratory of Food and Environmental Hygiene, Cooperative
Department of Veterinary Medicine, Gifu University, Gifu, Japan
| | | | | | | | | | | | - Ayaka OKADA
- Laboratory of Food and Environmental Hygiene, Cooperative
Department of Veterinary Medicine, Gifu University, Gifu, Japan
| | - Yasuo INOSHIMA
- Joint Graduate School of Veterinary Sciences, Gifu
University, Gifu, Japan
- Laboratory of Food and Environmental Hygiene, Cooperative
Department of Veterinary Medicine, Gifu University, Gifu, Japan
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Yan Y, Bi J, Liu J, Tao X, Fu Y. [Analysis of the diagnosis and treatment of 10 cases of complex respiratory foreign bodies in children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:155-159. [PMID: 38297871 DOI: 10.13201/j.issn.2096-7993.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 02/02/2024]
Abstract
Objective:To explore the diagnosis and treatment experience of complex respiratory foreign bodies in children. Methods:The clinical data of 1 243 cases of respiratory foreign bodies in children were retrospectively analyzed, among which 10 cases(0.8%) were complicated respiratory foreign bodies. Results:Among the 10 cases of complex respiratory foreign bodies, 2 cases were removed by open thoracotomy, 1 case was removed by tracheotomy, 1 case was removed by lobectomy, 1 case was removed by fiberoptic bronchoscopy because of difficult airway caused by the accompanying congenital pulmonary artery sling, and the pulmonary artery sling correction was synchronized with the fiberoptic bronchoscopic removal, 3 cases were removed by fiberoptic bronchoscopic holmium laser and/or freezing method to make the foreign body deformed and fragmented and then taken out by the sound gate, and 2 cases were removed because of the In 3 cases, the foreign bodies were deformed and fragmented by fiberoptic bronchoscopy, and in 2 cases, the foreign bodies were removed through the vocal folds because of their special characteristics. Two cases were intubated and sent to ICU after surgery because of obvious vocal edema and difficulty in deoxygenation, two cases were transferred to ICU after cardiac or thoracic surgery, and the rest of them returned to ordinary wards after surgery, and all 10 cases recovered well after surgery. Conclusion:Respiratory foreign body combined with airway stenosis, when the foreign body type, shape, embedded location of special foreign body, foreign body is too large, need to rationally choose the method of foreign body removal. If necessary, a combination of methods can be used to ensure that the airway obstruction is quickly relieved with the best program.
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Affiliation(s)
- Yangyan Yan
- Department of Otolaryngology Head and Neck Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health,Hangzhou,310005,China
| | - Jing Bi
- Department of Otolaryngology Head and Neck Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health,Hangzhou,310005,China
| | - Jia Liu
- Department of Otolaryngology Head and Neck Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health,Hangzhou,310005,China
| | - Xiaofen Tao
- Department of Endoscopy Center,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health
| | - Yong Fu
- Department of Otolaryngology Head and Neck Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health,Hangzhou,310005,China
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Xu W, Chen M, Xu J, Wang L, Peng C, Mo G. A novel approach involving reversed placement of endobronchial valves combined with retrograde methylene blue instillation for the localization of multifocal bronchopleural fistula. Respirol Case Rep 2024; 12:e01292. [PMID: 38314103 PMCID: PMC10834146 DOI: 10.1002/rcr2.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
The bronchopleural fistula (BPF) is a pathological communication between the bronchus and the pleural space. Diagnosing BPF poses a significant challenge for physicians, particularly when identifying multifocal BPFs. Traditionally, retrograde instillation of methylene blue (MB) into the pleural cavity with simultaneous observation with a bronchoscope has been used to locate a BPF. However, MB instillation is not effective in identifying multifocal BPFs. In this article, we report a new method for locating multifocal BPFs which involves placing the endobronchial valve (EBV) in reverse combined with retrograde MB instillation. First, the thoracic cavity is filled with MB solution. Then, using bronchoscopy, the location of a BPF can be identified as the MB solution flows into the bronchus. Secondly, an EBV is deployed in reverse in the bronchus where the identified BPF is located. Retrograde MB instillation is then repeated to locate any additional BPFs until no new ones are found. Two cases were reported using this novel method to identify multifocal BPFs, and each case was ultimately diagnosed with 2 BPFs. After precisely locating all the BPFs, the EBVs are then removed and placed forward in the target bronchi for treating the BPFs. During the follow-up period, no recurrence of BPFs was observed. We conclude that reversed placement of EBVs combined with retrograde MB instillation appears to be an effective approach for locating multifocal BPFs.
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Affiliation(s)
- Weihua Xu
- Respiration DepartmentTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Ming Chen
- Respiration DepartmentTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Jiagan Xu
- Respiration DepartmentTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Lei Wang
- Cardiothoracic Surgery DepartmentTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Congbin Peng
- Anesthesiology DepartmentTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Guohong Mo
- Endoscopy DepartmentTongde Hospital of Zhejiang ProvinceHangzhouChina
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Nickel K, Schütz K, Carlens J, Grewendorf S, Wetzke M, Keil O, Dennhardt N, Rigterink V, Köditz H, Sasse M, Happle C, Beck CE, Schwerk N. Ten-year experience of whole lung lavage in pediatric Pulmonary Alveolar Proteinosis. Klin Padiatr 2024; 236:64-72. [PMID: 38262422 PMCID: PMC10883753 DOI: 10.1055/a-2194-3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Pulmonary Alveolar Proteinosis (PAP) is extremely rare and can be caused by hereditary dysfunction of the granulocyte macrophage colony-stimulating factor receptor (GM-CSF) receptor, autoantibodies against GM-CSF, or other diseases leading to alveolar macrophage (AM) dysfunction. This leads to protein accumulation in the lung and severe dyspnea and hypoxemia. Whole lung lavage (WLL) is the first line treatment strategy. METHODS Here, we present data from more than ten years of WLL practice in pediatric PAP. WLL performed by the use of a single lumen or double lumen tube (SLT vs. DLT) were compared for technical features, procedure time, and adverse events. RESULTS A total of n=57 procedures in six PAP patients between 3.5 and 14.3 years of age were performed. SLT based WLL in smaller children was associated with comparable rates of adverse events but with longer intervention times and postprocedural intensive care treatment when compared to DLT based procedures. DISCUSSION Our data shows that WLL is feasible even in small children. DLT based WLL seems to be more effective, and our data supports the notion that it should be considered as early as possible in pediatric PAP. CONCLUSION WLL lavage is possible in small PAP patients but should performed in close interdisciplinary cooperation and with age appropriate protocols.
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Affiliation(s)
- Katja Nickel
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Katharina Schütz
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
| | - Simon Grewendorf
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH),
Member of the German Center for Lung Research (DZL)
| | - Oliver Keil
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Nils Dennhardt
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Vanessa Rigterink
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Harald Köditz
- Department of Pediatric Cardiology and Intensive Medicine, Hannover
Medical School, Hannover, Germany
| | - Michael Sasse
- Department of Pediatric Cardiology and Intensive Medicine, Hannover
Medical School, Hannover, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH),
Member of the German Center for Lung Research (DZL)
- RESIST Cluster of Excellence Infection Research, Hannover Medical
School, Hannover, Germany
| | - Christiane E. Beck
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH),
Member of the German Center for Lung Research (DZL)
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Dress C, Silva CT, von Allmen DC, Zak S. Airway findings in trisomy 13 and trisomy 18: A 10-year retrospective review. Pediatr Pulmonol 2024; 59:342-347. [PMID: 37937891 DOI: 10.1002/ppul.26750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/12/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Trisomy 18 and trisomy 13 are the most common autosomal trisomies following trisomy 21, with overall incidence rising. Both diagnoses are characterized by multisystem involvement and were previously thought to be incompatible with life. New data suggest that prolonged survival is possible, and thus many families are opting for more aggressive medical interventions. This study aims to describe airway findings in trisomy 18 and trisomy 13, as these have not been comprehensively studied and can impact medical decision-making. We hypothesize that most children with trisomy 18 and trisomy 13 will have abnormal findings on airway endoscopy. METHODS This a 10-year retrospective analysis of children with trisomy 13 or trisomy 18 who underwent endoscopic airway evaluation at a single center between 2011 and 2021. A total of 31 patients were evaluated. RESULTS Thirty-one patients were included and underwent flexible bronchoscopy by a pediatric pulmonologist, often in conjunction with rigid bronchoscopy performed by pediatric otolaryngology. Findings were typically complimentary. All patients had at least one clinically significant finding on evaluation, and most patients had both upper and lower airway, as well as static and dynamic airway findings. The most common airway findings in children with trisomy 13 and 18 include tracheomalacia, bronchomalacia, laryngomalacia, hypopharyngeal collapse, glossoptosis, and bronchial compression. CONCLUSION These findings can have significant implications for clinical care, and thus knowledge of trends has the potential to improve counseling on expected clinical course, presurgical planning, and informed consent before interventions.
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Affiliation(s)
- Carolyn Dress
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cherie T Silva
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Douglas C von Allmen
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sara Zak
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Devi L, Verma Y, Kumar A, Khan F, Verma S, Kumar A. Understanding the Landscape of Bronchoscopy in Lung Cancer: Insights From Lesion Location, Gender, and Diagnostic Efficacy. Cureus 2024; 16:e53918. [PMID: 38465029 PMCID: PMC10924703 DOI: 10.7759/cureus.53918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Lung cancer constitutes a critical global health concern. According to the International Agency for Research on Cancer's (IARC) GLOBOCAN 2020 estimates, lung cancer is the leading cause of death in cancer patients. In areas where tuberculosis is prevalent, misdiagnosis and mistreatment frequently result from overlap, creating significant difficulties that delay diagnosis and treatment. Amid this complication, bronchoscopic techniques emerge as critical diagnostic tools, though their efficacy varies between studies. METHOD Our retrospective study, conducted from July 2021 to December 2022 at the Department of Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, examined 156 participants with malignancies. Our focus encompassed diverse lesions within the bronchial landscape, revealing intriguing findings. RESULTS Bronchoscopic examinations unravelled prevalent abnormalities: 52 (33.3%) manifested as intraluminal growth, 48 (31.6%) as mucosal irregularities, and a less frequent (16, 10.3%) as an intraluminal bulge. Transbronchial needle aspiration stood out with a 10/11 (91%) positivity rate, biopsy came in second at 38/46 (83%), and bronchoalveolar lavage showed a 44/152 (29%) positivity rate. It was interesting to see how the lesions were spread out among the different types of histology. For example, squamous cell carcinoma showed 17/37 (46%) intraluminal growth, while adenocarcinoma showed 22/60 (36.7%) intraluminal growth and 4/60 (6.7%) intraluminal bulge. Moreover, a significant absence of abnormalities was observed in various lesions, underlining the intricacies of characterising bronchial lesions. CONCLUSION Our study shows that direct tissue sampling is better and that new bronchoscopic technologies are important for diagnosing lesions that were hard to get to in the past. However, limitations in patient selection biases and the single-centre focus caution against generalised interpretations. Our research illuminates the pivotal role of bronchoscopic methods in diagnosing lung lesions, emphasising the necessity for continued advancements to enhance diagnostic accuracy and treatment efficacy in lung cancer subtypes.
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Affiliation(s)
- Laxmi Devi
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Yogendra Verma
- Pathology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Anand Kumar
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Farhan Khan
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Sanjay Verma
- Respiratory Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND
| | - Ankit Kumar
- Respiratory Medicine, King George's Medical University, Lucknow, IND
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Ahn C, Park Y, Oh Y. Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis. Acute Crit Care 2024; 39:179-185. [PMID: 38476070 PMCID: PMC11002625 DOI: 10.4266/acc.2023.01165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. METHODS A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables. RESULTS In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001). CONCLUSIONS Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoonseok Oh
- Data engineer, SciAL Tech Inc., Seoul, Korea
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Lilburn P, Williamson JP, Phillips M, Tillekeratne N, Ing A, Glanville A, Saghaie T. Tracheobronchial stents: an expanding prospect. Intern Med J 2024; 54:204-213. [PMID: 38140778 DOI: 10.1111/imj.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
The first dedicated tracheobronchial silicone stent was designed by the French pulmonologist Jean-Paul Dumon. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistulae. Silicone stents require rigid bronchoscopy for insertion; however, they are more readily repositioned and removed compared with metallic stents. Metallic stents demonstrate luminal narrowing when loads are applied to their ends, therefore stents should either be reinforced at the ends or exceed the area of stenosis by a minimum of 5 mm. Nitinol, a nickel-titanium metal alloy, is currently the preferred material used for airway stents. Airway stenting provides effective palliation for patients with severe symptomatic obstruction. Drug-eluting and three-dimensional printing of airway stents present promising solutions to the challenges of the physical and anatomical constraints of the tracheobronchial tree. Biodegradable stents could also be a solution for the treatment of nonmalignant airway obstruction.
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Affiliation(s)
- Paul Lilburn
- Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin Phillips
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nikela Tillekeratne
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Alvin Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Allan Glanville
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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