A bleeding problem in lung cancer patients

Hematoidin crystals in sputum smears: Cytopathology and clinical associations

BACKGROUND:

There has been limited correlation of hematoidin crystals (HC) in sputum with clinical and diagnostic characteristics, partly because they are difficult to recognize. The aim of this study was, therefore, to assess these relationships in a consecutive cohort of sputum samples from patients submitted to a cytology laboratory.

METHODS:

Adequate sputum samples from 489 individuals were enrolled in this study. These were fixed in ethanol, stained by the Papanicolaou method and examined microscopically. The normality of the distribution of the continuous variable (age in years) was examined using the Shapiro–Wilk normality test. As the data were not normally distributed, Kendall rank correlation was used to correlate age with the presence of HC. The Pearson's Chi-square test was used to determine if the proportion of cases with the presence of HC was different among the categorical data variables. A univariate binary logistic regression was used to determine the variables most strongly associated with HC presence. The results include odds ratios, 95% confidence intervals, Wald χ² statistics, and corresponding P values, with statistical significance assumed at P ≤ 0.05. Analyses were performed using IBM SPSS Statistics 22.

RESULTS:

The presence of HC in sputum was associated with increasing age (P < 0.01), current smoking (P < 0.001), chronic occupational exposure to dust (P = 0.001), and hemoptysis (P < 0.001). These crystals were most prevalent in patients with a diagnosis of carcinoma (93.9%), bronchiectasis (48%), silicosis (16.0%), and chronic obstructive pulmonary disease (0.8%). Crystals were not found in patients with acute bronchitis, asthma, or lung infections, including viral and bacterial pneumonia.

CONCLUSIONS:

There are clear associations linked to the finding of HC in sputum that may be helpful in pointing to a specific diagnosis, such as the possibility of underlying carcinoma.

POSSIBILITIES OF USING MINIINVASIVE CATHETER TECHNOLOGIES IN THE TREATMENT OF LUNG BLEEDING

Aim – improve the results of the treatment of patients with pulmonary bleeding through widespread use of endovascular surgery methods for hemostasis. Materials and methods. Method of endovascular embolization of bronchial arteries is widely used in our clinic SI «Zaycev V. T. Institute of General and Emergency surgery of NAMS of Ukraine» not only as independent surgery in patients with LB, but also as way of preparation of patients with lung bleeding for planned thorax surgery. The most of the often spread nosological forms complicated by bleeding in our research were polycystic lung disease, chronic obstructive pulmonary disease, bronchiectasis disease, community-acquired pneumonia. Indications to the сatheter embolization procedure of bronchial arteries are the following: conservative treatment failure, hemoptysis in patients with bilateral inflammatory processes who was not prescribed surgical treatment for a range of reasons, absence of gross structural changes, lung resection, mainly in patients with oncologic lung injury, at massive and life-threatening profuse bleedings as a mean of temporary or constant hemostasis. Discussed treatment method is applied only in bleeding or within a 6 – 12 hour after its treatment. Successful result in embolization can be obtained in 79–99 %. Results. As a result of complete physical examination of patients with LB, it has been established that lung hemorrhage was the result of obstructive bronchitis in 14 patients (42 %), there was chronic obstructive pulmonary disease in 7 (21 %) patients and bronchiectasis was diagnosed in 6 (18 %) patients. In 2 (6 %) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12 %) patients. Conclusion. Therefore bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases, for determination of localization and source of bleeding. Endovascular occlusion of bronchial arteries in pulmonary hemorrhage permits: – to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumour; – to perform effective endovascular hemostasis; – to gain time for stabilization the patient with the aim of planned surgical treatment.