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Mizumori Y, Hirano K, Hirata N, Hiraoka R, Takahashi S, Kominami R, Miyake K, Takenouchi M, Kato T, Kume S, Higashino S, Nakahara Y, Kawamura T. Precut technique using an injection needle: A retrospective study on a new ancillary procedure for pleural biopsy. Medicine (Baltimore) 2022; 101:e29377. [PMID: 35945762 PMCID: PMC9351845 DOI: 10.1097/md.0000000000029377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The effectiveness of thoracoscopic biopsy as a diagnostic method for pleural diseases has been reported; however, obtaining a sufficient specimen size is sometimes difficult. Therefore, an ancillary technique, the precut technique using an injection needle, was devised to address this problem. This study aimed to evaluate the effectiveness and safety of the novel precut technique in patients with undiagnosed pleural effusion. This retrospective study included 22 patients who underwent pleural biopsy using the precut technique to examine exudative pleural effusion of unknown etiology. Thoracoscopy was performed under local anesthesia. The biopsy procedure was performed as follows: a needle was inserted into the pleura around the lesion using a semiflexible thoracoscope; the needle was positioned to make an incision in the pleura while injecting 1% lidocaine with epinephrine and lifting the pleura from the fascia; 2 or 3 precut incision lines were arranged in a triangle; and the specimen was obtained from the parietal pleura using forceps or a cryoprobe. Patient data including age, number of biopsies, biopsy specimen size, pathological and final diagnosis, and postoperative complications were examined. All patients were male with an average age of 74 years. Pleural effusion was found on the right and left sides in 16 and 6 patients, respectively. The average major axis of the biopsy specimens was 18 mm (range, 10-30 mm), which was sufficient to establish a pathological diagnosis. Only 1 patient experienced minor temporal bleeding as a complication. The precut technique enabled the procurement of specimens sufficient in size for pleural biopsy.
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Affiliation(s)
- Yasuyuki Mizumori
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
- *Correspondence: Yasuyuki Mizumori, Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, 68 Honmachi, Himeji-shi, Hyogo 670-8520, Japan (e-mail: )
| | - Katsuya Hirano
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Nobuya Hirata
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Ryota Hiraoka
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Sayaka Takahashi
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Ryota Kominami
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Kohei Miyake
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Masaki Takenouchi
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Tomohiro Kato
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Sachie Kume
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Sachiko Higashino
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Yasuharu Nakahara
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Tetsuji Kawamura
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
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Abstract
Medical thoracoscopy is an effective and safe modality to visualize and sample contents of the pleural cavity. It is an outpatient procedure that can be performed while the patient is spontaneously breathing, with the use of local anesthesia and intravenous medications for sedation and analgesia. Medical thoracoscopy has indications in the management of a variety of pleural diseases. It is most commonly performed as a diagnostic procedure but has therapeutic applications as well. Although it has its advantages, management strategies of certain pleural diseases should take place within a multidisciplinary environment including general pulmonologists, interventional pulmonologists, and thoracic surgeons.
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Yin Y, Ma WH, Li W, Ma HF, Kang J, Herth FJF, Hou G. Hybrid Knife, a Novel Drug Delivery Tool for Treatment of Tracheal Stenosis: A Case Report. EAR, NOSE & THROAT JOURNAL 2020; 101:NP92-NP95. [PMID: 32790585 DOI: 10.1177/0145561320946649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The treatment of subglottic stenosis remains a challenge due to anatomic and technological limitations, and there is no consensus regarding treatment. Restenosis and granulation formation are the most common complications. Balloon dilatation combined with cryotherapy and adjuvant topical medication is one treatment method. However, the efficacy of adjuvant topical medication is controversial, and the lack of efficacy may be related to the effective dose of the drug delivered to the submucosal layer of the lesion. Therefore, a tool with high efficiency for delivering medications to the submucosal layer via injection may play an important role in treatment. A hybrid knife (HK) with a pressure water jet traditionally used in endoscopy submucosal dissection to inject saline into the submucosa was employed here to inject medications for subglottic stenosis, followed by electrical excision. Here, we report the case of a man with complex subglottic stenosis who underwent balloon dilatation combined with cryotherapy and an adjuvant submucosal triamcinolone injection performed with an HK. The drug was delivered more efficiently into the submucosal layer, and the lumen of the trachea was patent. Performing a submucosal injection with an HK may be a new approach to deliver medications to the submucosal layer for the treatment of tracheal stenosis.
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Affiliation(s)
- Yan Yin
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wen-Hui Ma
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Li
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Hubei Province, Wuhan, Hubei, China
| | - Hai-Feng Ma
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
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Wahidi MM, Herth FJF, Chen A, Cheng G, Yarmus L. State of the Art: Interventional Pulmonology. Chest 2019; 157:724-736. [PMID: 31678309 DOI: 10.1016/j.chest.2019.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/13/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
Interventional pulmonology (IP) has evolved over the past decade from an obscure subspecialty in pulmonary medicine to a recognized discipline offering advanced consultative and procedural services to patients with thoracic malignancy, anatomic airway disease, and pleural disease. Innovative interventions are now also available for diseases not traditionally treated procedurally, such as asthma and emphysema. The IP field has established certification examinations and training standards for IP training programs in an effort to enhance training quality and ensure competency. Validating new technology and proving its cost-effectiveness and effect on patient outcomes present the biggest challenge to IP as the health-care environment marches toward value-based health care. High-quality research is now thriving in IP and promises to elevate its practice into patient-centric evidence-based care.
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Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC.
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Chen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - George Cheng
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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Ma JW, Miao Y, Lin XY, Wang QY, Wang W, Kang J, Hou G. Endoscopic submucosal dissection of tracheal deep benign fibrous histiocytoma using hybrid knife. Onco Targets Ther 2019; 12:5609-5613. [PMID: 31371998 PMCID: PMC6628974 DOI: 10.2147/ott.s213747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
Deep benign fibrous histiocytoma (FH) is an uncommon and poorly recognized tumor that arises in subcutaneous or deep soft tissue. Deep benign FH of the trachea is even more rare. Deep benign FH recurs in approximately 20% of cases, so surgical resection is the recommended treatment for FH. However, some patients are afraid of the trauma and potential complications from the resection of tracheal tumors, so they do not accept surgical resection. With the development of interventional pulmonology, bronchoscopic intervention plays a key role in the treatment of benign tracheal tumors. Novel tools have emerged in interventional pulmonology and optimized the traditional techniques. Here, we report a case of deep benign FH of the trachea with broad base relapse after electrocautery with snare, argon plasma coagulation (APC) and radiotherapy. It was treated successfully by endobronchial resection with a hybrid knife (HK) and APC. The HK is a hybrid device that combines an electrocautery knife with a water jet in one instrument. Submucosal injection and circumferential cutting and dissection of lesions as well as coagulation of bleeding can be performed only with the HK. During the 6 months follow-up, the deep benign FH of the trachea did not relapse. In the case reported herein, the HK enabled submucosal injection and circumferential cutting and dissection of lesions as well as access to submucosal lesions to gain further adequate APC treatment, thereby allowing a better clinical response than that achieved by traditional electrocautery with snare and APC. In conclusion, the HK with a water jet is a feasible and effective endoscopic method for management for benign or low-grade malignant neoplasms of the trachea, especially those with a wide base and submucosal involvement.
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Affiliation(s)
- Jiang-Wei Ma
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yuan Miao
- Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Xu-Yong Lin
- Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Qiu-Yue Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, People's Republic of China
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