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Flandes J, Martinez-Muñiz FB, Cruz-Rueda JJ, Soto FJ, Majid A, Tuta-Quintero E, Giraldo-Cadavid LF. The effect of combining different sampling tools on the performance of electromagnetic navigational bronchoscopy for the evaluation of peripheral lung lesions and factors associated with its diagnostic yield. BMC Pulm Med 2023; 23:432. [PMID: 37940942 PMCID: PMC10634141 DOI: 10.1186/s12890-023-02711-1] [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: 07/06/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND We assessed the performance of Electromagnetic navigational bronchoscopy (ENB) as a standalone diagnostic technique and the performance of different sampling tools used during the procedure. METHODS We recruited 160 consecutive patients who underwent ENB for peripheral lung lesions (PLL) at a tertiary care centre. The diagnostic performance of ENB and sampling tools was assessed using a logistic regression model and a ROC-curve in which the dependent variable was diagnostic success. A multivariate model was built to predict diagnostic success before performing ENB to select the best candidates for the procedure. RESULTS Most patients with PLLs in the study were male (65%), with a mean age of 67.9 years. The yield was 66% when the most common techniques were used together as suction catheter + transbronchial biopsy forceps (TBBx) + bronchoalveolar lavage + bronchial washing (p < 0.001) and increased to 69% when transbronchial needle aspiration (TBNA) and cytology brush were added (p < 0.001). Adding diagnostic techniques such as TBBx and TBNA resulted in an increase in diagnostic performance, with a statistically significant trend (p = 0.002). The logistic model area-under the ROC-curve for diagnostic success during ENB was 0.83 (95% CI:0.75-0.90; p < 0.001), and a logit value ≥ 0.12 was associated with ≥ 50% probability of diagnostic success. CONCLUSIONS ENB, as a stand-alone diagnostic tool for the evaluation of PLLs when performed by experienced operators using a multi-modality technique, has a good diagnostic yield. The probability of having a diagnostic ENB could be assessed using the proposed model.
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Affiliation(s)
- Javier Flandes
- Chief of Bronchology and Interventional Pulmonology Unit, IIS-Fundación Jiménez Díaz, CIBERES, Avenida Reyes Catolicos No 2, 28040, Madrid, Spain
| | | | | | - Francisco J Soto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Luis F Giraldo-Cadavid
- Professor of Medicine at Facultad de Medicina, Autonorte de Bogota. Chía, Universidad de La Sabana. Address: Universidad de La Sabana, Km 7, 250001, Cundinamarca, Colombia.
- Chief of the Interventional Pulmonology Service at Fundacion Neumologica Colombiana, Cra. 13B#161 - 85, 110131, Bogotá, Colombia.
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Flandes J, Gimenez A, Alfayate J. New Bronchoscopic Treatments for Lung Peripheral Lesions. Open Respir Arch 2023; 5:100266. [PMID: 37720491 PMCID: PMC10500453 DOI: 10.1016/j.opresp.2023.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Affiliation(s)
- Javier Flandes
- Bronchoscopy and Interventional Pulmonology Unit, Respiratory Department, Fundación Jimenez Díaz University Hospital, Madrid, Spain
| | - Andres Gimenez
- Bronchoscopy and Interventional Pulmonology Unit, Respiratory Department, Fundación Jimenez Díaz University Hospital, Madrid, Spain
| | - Javier Alfayate
- Bronchoscopy and Interventional Pulmonology Unit, Respiratory Department, Fundación Jimenez Díaz University Hospital, Madrid, Spain
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Flandes J, Giraldo-Cadavid LF, Perez-Warnisher MT, Gimenez A, Fernandez-Navamuel I, Alfayate J, Naya A, Carballosa P, Cabezas E, Alvarez S, Uribe-Hernandez AM, Seijo L. Learning curves and association of pathologist's performance with the diagnostic accuracy of linear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA): a cohort study in a tertiary care reference centre. BMJ Open 2022; 12:e051257. [PMID: 36261243 PMCID: PMC9582308 DOI: 10.1136/bmjopen-2021-051257] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES We aimed to assess the learning curves and the influence of the pathologist's performance on the endobronchial ultrasound transbronchial needle aspiration's (EBUS-TBNA's) diagnostic accuracy in a real-world study. DESIGN/SETTING Cohort study conducted in a tertiary care university hospital (single centre) with patients referred for EBUS-TBNA. PARTICIPANTS/INTERVENTION We initially evaluated 376 patients (673 lymph nodes), 368 (660 lymph nodes) of whom were recruited. The inclusion criterion was EBUS-TBNA indicated for the study of mediastinal or hilar lesions. The exclusion criteria were the absence of mediastinal and hilar lesions during EBUS confirmed by a normal mediastinum and hilum on chest CT (except in cases of mediastinal staging of cancer) and lost to follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES Diagnostic accuracy and related outcomes. METHODS We included patients from a prospectively constructed database. We performed a logistic regression multivariate analysis to adjust for potential confounders of the association between pathologist performance and EBUS-TBNA accuracy. The Cumulative Summation (CUSUM) analysis was used to assess pathologists' performance and learning curves. RESULTS Most indications for EBUS were suspicion of malignancy, including intrathoracic tumours (68.3%), extrathoracic tumours (9.8%) and cancer staging (7.0%). The patients' mean age was 63.7 years, and 71.5% were male. Overall EBUS-TBNA accuracy was 80.8%. In the multivariate logistic regression model, the factors independently associated with EBUS-TBNA accuracy included certain pathologists (ORs ranging from 0.16 to 0.41; p<0.017), a lymph node short-axis diameter <1 cm (OR: 0.36; 95% CI 0.21 to 0.62; p<0.001), and the aetiology of lymph node enlargement (ORs ranging from 7 to 37; p<0.001). CUSUM analysis revealed four different learning curve patterns, ranging from almost immediate learning to a prolonged learning phase, as well as a pattern consistent with performance attrition. CONCLUSIONS Pathologists' proficiency conditioned EBUS-TBNA accuracy. This human factor is a potential source of error independent of factors conditioning tissue sample adequacy.
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Affiliation(s)
- Javier Flandes
- Interventional Pulmonology, Fundacion Jimenez Diaz-UTE, Madrid, Spain
| | - Luis Fernando Giraldo-Cadavid
- School of Medicine, Research Department, Universidad de La Sabana, Chia, Colombia
- Interventional Pulmonology, Fundacion Neumologica Colombiana, Bogota, Colombia
| | | | - Andres Gimenez
- Interventional Pulmonology, Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Javier Alfayate
- Interventional Pulmonology, Fundacion Jimenez Diaz, Madrid, Spain
| | - Alba Naya
- Pulmonary Medicine Departament, Fundacion Jimenez Diaz, Madrid, Spain
| | - Pilar Carballosa
- Pulmonary Medicine Departament, Fundacion Jimenez Diaz, Madrid, Spain
| | - Elena Cabezas
- Pulmonary Medicine Departament, Fundacion Jimenez Diaz, Madrid, Spain
| | - Susana Alvarez
- Interventional Pulmonology, Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Luis Seijo
- Pulmonary Medicine, Clínica Universidad de Navarra, Madrid, Spain
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Folch EE, Bowling MR, Pritchett MA, Murgu SD, Nead MA, Flandes J, Krimsky WS, Mahajan AK, LeMense GP, Murillo BA, Bansal S, Lau K, Gildea TR, Christensen M, Arenberg DA, Singh J, Bhadra K, Hogarth DK, Towe CW, Lamprecht B, Bezzi M, Mattingley JS, Hood KL, Lin H, Wolvers JJ, Khandhar SJ. NAVIGATE 24-Month Results: Electromagnetic navigation bronchoscopy for pulmonary lesions at 37 centers in Europe and the United States. J Thorac Oncol 2021; 17:519-531. [PMID: 34973418 DOI: 10.1016/j.jtho.2021.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 03/12/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive, image-guided approach to access lung lesions for biopsy or localization for treatment. However, no studies have reported prospective 24-month follow-up from a large, multinational, generalizable cohort. This study evaluated ENB safety, diagnostic yield, and usage patterns in an unrestricted, real-world observational design. METHODS The NAVIGATE single-arm, pragmatic cohort study (NCT02410837) enrolled subjects at 37 academic and community sites in 7 countries with prospective 24-month follow-up. Subjects underwent ENB using the superDimension navigation system versions 6.3 to 7.1. The prespecified primary endpoint was procedure-related pneumothorax requiring intervention or hospitalization. RESULTS A total of 1,388 subjects were enrolled for lung lesion biopsy (1,329; 95.7%), fiducial marker placement (272; 19.6%), dye marking (23; 1.7%), and/or lymph node biopsy (36; 2.6%). Concurrent endobronchial ultrasound-guided staging occurred in 456 subjects. General anesthesia (78.2% overall, 56.6% Europe, 81.4% US), radial endobronchial ultrasound (50.6%, 4.0%, 57.4%), fluoroscopy (85.0%, 41.7%, 91.0%), and rapid on-site evaluation use (61.7%, 17.3%, 68.5%) differed between regions. Pneumothorax and bronchopulmonary hemorrhage occurred in 4.7% and 2.7% of subjects, respectively (3.2% [primary endpoint] and 1.7% requiring intervention or hospitalization). Respiratory failure occurred in 0.6%. The diagnostic yield was 67.8% (range 61.9%-70.7%; 55.2% Europe, 69.8% US). Sensitivity for malignancy was 62.6%. Lung cancer clinical stage was I-II in 64.7% (55.3% Europe, 65.8% US). CONCLUSIONS Despite a heterogeneous cohort and regional differences in procedural techniques, ENB demonstrates low complications and a 67.8% diagnostic yield while allowing biopsy, staging, fiducial placement, and dye marking in a single procedure.
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Affiliation(s)
- Erik E Folch
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 148, Boston, MA 02114
| | - Mark R Bowling
- Brody School of Medicine, East Carolina University, 500 Moye Blvd, Greenville, NC 27834
| | - Michael A Pritchett
- FirstHealth of the Carolinas and Pinehurst Medical Clinic, 205 Page Road, Pinehurst, NC, 28374
| | - Septimiu D Murgu
- University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - Michael A Nead
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester NY 14642
| | - Javier Flandes
- Hospital Fundación Jiménez Díaz IIS-FJD Ciberes, Avda. Reyes Católicos 2, Madrid 28043, Spain
| | - William S Krimsky
- Pulmonary and Critical Care Associates of Baltimore, 9103 Franklin Square Drive, Suite 300, Baltimore, MD 21237
| | - Amit K Mahajan
- Inova Health System, Virginia Cancer Specialists, 2921 Telestar Court, Falls Church, VA, 22042
| | - Gregory P LeMense
- Blount Memorial Physicians Group(†), 266 Joule Street, Alcoa, TN 37701
| | - Boris A Murillo
- Providence Health Center and Waco Lung Associates, 340 Richland West Circle, Waco, TX 76657
| | - Sandeep Bansal
- Penn Highlands Healthcare, 100 Hospital Avenue, PO Box 447, DuBois, PA 15801
| | - Kelvin Lau
- St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Thomas R Gildea
- Cleveland Clinic, 9500 Euclid Avenue MC M2-141, Cleveland, OH 44195
| | - Merete Christensen
- Rigshospitalet, Thoraxkirurgisk klin 78ik RT 2151, Copenhagen, Denmark, Merete.Christensen
| | - Douglas A Arenberg
- University of Michigan, 1150 West Medical Center Drive, University of Michigan, Ann Arbor, MI, 48109
| | - Jaspal Singh
- Atrium Health and Levine Cancer Institute, 503B Med Ed Building, Charlotte, NC, 28203
| | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, 725 Glenwood Dr E-500, Chattanooga, TN, 37401
| | - D Kyle Hogarth
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - Christopher W Towe
- University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106
| | - Bernd Lamprecht
- Kepler Universitätsklinikum, 4021 Linz, Krankenhausstraße 9, Linz, Austria
| | - Michela Bezzi
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, 3 - 50134, Florence, Italy
| | | | - Kristin L Hood
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Haiying Lin
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Jennifer J Wolvers
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Sandeep J Khandhar
- Inova Health System, Virginia Cancer Specialists, 8503 Arlington Blvd, Fairfax, VA, 22031
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Torrego A, Herth FJ, Munoz-Fernandez AM, Puente L, Facciolongo N, Bicknell S, Novali M, Gasparini S, Bonifazi M, Dheda K, Andreo F, Votruba P, Langton D, Flandes J, Fielding D, Bonta PI, Skowasch D, Schulz C, Darwiche K, McMullen E, Grubb GM, Niven R. Bronchial Thermoplasty Global Registry (BTGR): 2-year results. BMJ Open 2021; 11:e053854. [PMID: 34916324 PMCID: PMC8679080 DOI: 10.1136/bmjopen-2021-053854] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Bronchial thermoplasty (BT) is a device-based treatment for subjects ≥18 years with severe asthma not well controlled with inhaled corticosteroids and long-acting beta-agonists. The Bronchial Thermoplasty Global Registry (BTGR) collected real-world data on subjects undergoing this procedure. DESIGN The BTGR is an all-comer, prospective, open-label, multicentre study enrolling adult subjects indicated for and treated with BT. SETTING Eighteen centres in Spain, Italy, Germany, the UK, the Netherlands, the Czech Republic, South Africa and Australia PARTICIPANTS: One hundred fifty-seven subjects aged 18 years and older who were scheduled to undergo BT treatment for asthma. Subjects diagnosed with other medical conditions which, in the investigator's opinion, made them inappropriate for BT treatment were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline characteristics collected included demographics, Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT), medication usage, forced expiratory volume in one second and forced vital capacity, medical history, comorbidities and 12-month baseline recall data (severe exacerbations (SE) and healthcare utilisation). SE incidence and healthcare utilisation were summarised at 1 and 2 years post-BT. RESULTS Subjects' baseline characteristics were representative of persons with severe asthma. A comparison of the proportion of subjects experiencing events during the 12 months prior to BT to the 2-year follow-up showed a reduction in SE (90.3% vs 56.1%, p<0.0001), emergency room visits (53.8% vs 25.5%, p<0.0001) and hospitalisations (42.9% vs 23.5 %, p=0.0019). Reductions in asthma maintenance medication dosage were also observed. AQLQ and ACT scores improved from 3.26 and 11.18 at baseline to 4.39 and 15.54 at 2 years, respectively (p<0.0001 for both AQLQ and ACT). CONCLUSIONS The BTGR demonstrates sustained improvement in clinical outcomes and reduction in asthma medication usage 2 years after BT in a real-world population. This is consistent with results from other BT randomised controlled trials and registries and further supports improvement in asthma control after BT. TRIAL REGISTRATION NUMBER NCT02104856.
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Affiliation(s)
- Alfons Torrego
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Felix J Herth
- Thoraxklinik, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | | | - Luis Puente
- Respiratory Department, Hospital General Universitario Gregorio Marañon-Facultad de Medicina Universidad Complutense, Madrid, Spain
| | - Nicola Facciolongo
- AUSL-IRCCS Reggio Emilia Pulmonology Unit, IRCCS Reggio Emilia Pulmonology Unit, Santa Maria Nuova, Italy
| | - Stephen Bicknell
- Respiratory Department, Gartnavel General Hospital, Glasgow, Glasgow, UK
| | - Mauro Novali
- Respiratory Department, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Stefano Gasparini
- Respiratory Department, Università Politecnica delle Marche, Ancona, Marche, Italy
| | - Martina Bonifazi
- Respiratory Department, Università Politecnica delle Marche, Ancona, Marche, Italy
| | - Keertan Dheda
- Respiratory Department, University of Cape Town, Cape Town, South Africa
| | - Felipe Andreo
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol-CIBERES, Badalona, Barcelona, Spain
| | - Praha Votruba
- Respiratory Department, Klinika Tuberkulozy a Respiracnich Onemocneni, Prague, Czech Republic
| | - David Langton
- Respiratory Department, Frankston Hospital Peninsula Health, Frankston, Victoria, Australia
| | - Javier Flandes
- Respiratory Department, Hospital Universitario Fundacion Jimenez Diaz-CIBERES IIS-FJD, Madrid, Spain
| | - David Fielding
- Respiratory Department, Royal Brisbane and Women's Hospital-Brisbane/AUS, Brisbane, Queensland, Australia
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dirk Skowasch
- Department of Cardiology and Pneumology, University of Bonn, Medizinische Klinik II, Bonn, Germany
| | - Christian Schulz
- Respiratory Department, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Kaid Darwiche
- Respiratory Department, Ruhrlandklinik-West German Lung Center, University Medicine Essen, Essen, Germany
| | | | - G Mark Grubb
- Boston Scientific Corp, Marlborough, Massachusetts, USA
| | - Robert Niven
- Respiratory Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
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Clemente-Moragón A, Martínez-Milla J, Oliver E, Santos A, Flandes J, Fernández I, Rodríguez-González L, Serrano Del Castillo C, Ioan AM, López-Álvarez M, Gómez-Talavera S, Galán-Arriola C, Fuster V, Pérez-Calvo C, Ibáñez B. Metoprolol in Critically Ill Patients With COVID-19. J Am Coll Cardiol 2021; 78:1001-1011. [PMID: 34474731 PMCID: PMC8404624 DOI: 10.1016/j.jacc.2021.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting. OBJECTIVES The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS. METHODS A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after metoprolol/control. The safety of metoprolol administration was evaluated by invasive hemodynamic and electrocardiogram monitoring and echocardiography. RESULTS Metoprolol administration was without side effects. At baseline, neutrophil content in BAL did not differ between groups. Conversely, patients randomized to metoprolol had significantly fewer neutrophils in BAL on day 4 (median: 14.3 neutrophils/µl [Q1, Q3: 4.63, 265 neutrophils/µl] vs median: 397 neutrophils/µl [Q1, Q3: 222, 1,346 neutrophils/µl] in the metoprolol and control groups, respectively; P = 0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment (median: 130 [Q1, Q3: 110, 162] vs median: 267 [Q1, Q3: 199, 298] at baseline and day 4, respectively; P = 0.003), whereas it remained unchanged in control subjects. Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5 ± 7.6 vs 21.9 ± 12.6 days; P = 0.17). CONCLUSIONS In this pilot trial, intravenous metoprolol administration to patients with COVID-19-associated ARDS was safe, reduced exacerbated lung inflammation, and improved oxygenation. Repurposing metoprolol for COVID-19-associated ARDS appears to be a safe and inexpensive strategy that can alleviate the burden of the COVID-19 pandemic.
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Affiliation(s)
| | - Juan Martínez-Milla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Eduardo Oliver
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Arnoldo Santos
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Javier Flandes
- Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Iker Fernández
- Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Lorena Rodríguez-González
- Pathology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; Biobank Patform-PT20/00141, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | | | - Ana-María Ioan
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - María López-Álvarez
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Sandra Gómez-Talavera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - César Pérez-Calvo
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
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Paez Vargas JJ, Vidal González A, Pérez-Calvo C, Flandes J. COVID-19 in the Critically Ill: Too Risky for High-Dose Anticoagulation? Chest 2021; 160:e249. [PMID: 34366058 PMCID: PMC8339404 DOI: 10.1016/j.chest.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Juan José Paez Vargas
- Intensive Care Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Anxela Vidal González
- Intensive Care Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - César Pérez-Calvo
- Intensive Care Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Flandes
- Interventional Pulmonology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Arenas-De Larriva M, Martín-DeLeon R, Urrutia Royo B, Fernández-Navamuel I, Gimenez Velando A, Nuñez García L, Centeno Clemente C, Andreo García F, Rafecas Codern A, Fernández-Arias C, Pajares Ruiz V, Torrego Fernández A, Rajas O, Iturricastillo G, Garcia Lujan R, Comeche Casanova L, Sánchez-Font A, Aguilar-Colindres R, Larrosa-Barrero R, García García R, Cordovilla R, Núñez-Ares A, Briones-Gómez A, Cases Viedma E, Franco J, Cosano Povedano J, Rodríguez-Perálvarez ML, Cebrian Gallardo JJ, Nuñez Delgado M, Pavón-Masa M, Valdivia Salas MDM, Flandes J. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia. ERJ Open Res 2021; 7:00165-2021. [PMID: 34258257 PMCID: PMC8183029 DOI: 10.1183/23120541.00165-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. Results A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). Conclusion Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19. Bronchoscopy is part of the armamentarium against #COVID19. It allows diagnosis, facilitates mechanical ventilation and provides prognostic information. This information could be used to refine healthcare pathways in order to improve outcomes.https://bit.ly/2QuAQOt
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Affiliation(s)
- Marisol Arenas-De Larriva
- Dept of Bronchoscopy and Interventional Pulmonology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | - Blanca Urrutia Royo
- Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Iker Fernández-Navamuel
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Andrés Gimenez Velando
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Laura Nuñez García
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Carmen Centeno Clemente
- Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain
| | - Felipe Andreo García
- Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain
| | | | | | | | | | - Olga Rajas
- Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Gorane Iturricastillo
- Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Ricardo Garcia Lujan
- Dept of Interventional Pulmonology, Hospital Universitario 12 Octubre and Hospital Univesitario Quirónsalud Madrid, Madrid, Spain
| | | | - Albert Sánchez-Font
- Pulmonology Dept, Hospital del Mar, CIBERES, UAB, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | - Ruth García García
- Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain
| | - Rosa Cordovilla
- Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain
| | - Ana Núñez-Ares
- Interventional Pulmonology Unit, Pulmonary Dept, Albacete, Spain
| | - Andrés Briones-Gómez
- Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Enrique Cases Viedma
- Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Franco
- Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Javier Cosano Povedano
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | - Manuel Nuñez Delgado
- Dept of Bronchoscopy and Interventional Pulmonology, Hospital Álvaro Cunqueiro, CHUVI, Vigo, Spain
| | - María Pavón-Masa
- Dept of Interventional Pulmonology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Javier Flandes
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundación Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
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Folch E, Arenberg D, Bansal S, Bezzi M, Bhadra K, Bowling M, Christensen M, Flandes J, Gildea T, Hogarth K, Krimsky W, Lamprecht B, Lau K, Lemense G, Mahajan A, Murgu S, Murillo B, Nead M, Pritchett M, Singh J, Towe C, Khandhar S. MA02.05 NAVIGATE 24-Month Results: Electromagnetic Navigation Bronchoscopy for Pulmonary Lesions at 37 Centers in Europe and the US. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Fernández-Bussy S, Sánchez O, Parikh M, Paton A, Kheir F, Chee A, Martínez R, Gando S, Lanza M, Canias A, Labarca G, Garcia MA, Dure R, Abia-Trujillo D, García AO, Rubinstein P, Oliveira HD, Flandes J, Folch E, Majid A. [Recommendations for performing interventions during the COVID-19 pandemic]. Rev Med Chil 2021; 148:689-696. [PMID: 33399763 DOI: 10.4067/s0034-98872020000500689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.
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Affiliation(s)
| | - Olivia Sánchez
- Instituto Enfermedades Respiratorias (INER), Universidad Autónoma de México, México
| | - Mihir Parikh
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Alichia Paton
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Alex Chee
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Rachel Martínez
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | | | - Mario Lanza
- Hospital Honduras Medical Center, Tegucigalpa, Honduras
| | - Alejandra Canias
- Hospital Universitario San Ignacio. Bogotá, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | | | | | | | | | | | - Hugo de Oliveira
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil
| | - Javier Flandes
- Unidad de Broncoscopias y Neumología Intervencionista, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
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11
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Pajares V, Núñez-Delgado M, Bonet G, Pérez-Pallarés J, Martínez R, Cubero N, Zabala T, Cordovilla R, Flandes J, Disdier C, Torrego A. Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study. PLoS One 2020; 15:e0239114. [PMID: 32956379 PMCID: PMC7505587 DOI: 10.1371/journal.pone.0239114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02464592.
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Affiliation(s)
- Virginia Pajares
- Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Gloria Bonet
- Respiratory Medicine, Hospital Universitario de Germans Trias i Pujol, Barcelona, Spain
| | - Javier Pérez-Pallarés
- Respiratory Medicine, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Raquel Martínez
- Respiratory Medicine, Hospital Universitario La Fé, Valencia, Spain
| | - Noelia Cubero
- Respiratory Medicine, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Txomin Zabala
- Respiratory Medicine, Hospital Galdakao-Usansolo, Vizcaya, Bizkaia, Spain
| | - Rosa Cordovilla
- Respiratory Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Javier Flandes
- Respiratory Medicine, Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Disdier
- Respiratory Medicine, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Alfons Torrego
- Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
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Choukri M, Giménez A, Izquierdo A, Morales M, Flandes J. SAFETY AND DIAGNOSTIC YIELD OF ECHOBRONCHOSCOPY-GUIDED TRANSVASCULAR PUNCTION. Chest 2020. [DOI: 10.1016/j.chest.2020.05.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Laso Del Hierro F, Lopez Yeste P, Giménez Velando A, Serrano Del Castillo C, Llamas Sillero P, Flandes J. USING FLOW CYTOMETRY IN EBUS-TBNA SAMPLES FOR THE DIAGNOSIS OF LUNG CANCER: EFFECTIVENESS AND SAFETY. Chest 2020. [DOI: 10.1016/j.chest.2020.05.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Cordovilla R, Álvarez S, Llanos L, Nuñez Ares A, Cases Viedma E, Díaz-Pérez D, Flandes J. SEPAR and AEER consensus recommendations on the Use of Bronchoscopy and Airway Sampling in Patients with Suspected or Confirmed COVID-19 Infection. Arch Bronconeumol 2020. [PMID: 32362384 PMCID: PMC7193137 DOI: 10.1016/j.arbres.2020.03.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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] [Indexed: 12/12/2022]
Abstract
Este documento de consenso está elaborado por el área de Técnicas y Trasplante y el área de Enfermería de la Sociedad Española de Neumología y Cirugía Torácica, así como por la Asociación Española de Endoscopia Respiratoria, con el objetivo de proporcionar conocimientos para el uso efectivo y seguro de la broncoscopia en pacientes con sospecha o con confirmación de la infección por COVID-19. Es prioritario proporcionar la mayor seguridad a nuestros pacientes, a los sanitarios que los atienden y a la comunidad en general. En este momento de pandemia, la información de la que disponemos acerca del uso de la broncoscopia en este tipo de pacientes se basa en la experiencia de otros centros y países, y las publicaciones científicas son escasas. El objetivo de este documento es recoger esas experiencias y, en base a las recomendaciones de los organismos oficiales, ofrecer un documento de ayuda para la práctica clínica diaria.
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Affiliation(s)
- Rosa Cordovilla
- Servicio de Neumología, Unidad de Broncoscopias, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER).
| | - Susana Álvarez
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Fundación Jiménez Díaz IIS-FJD CIBERES, Madrid, España; Área de Enfermería Respiratoria de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - Liliana Llanos
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España; Área de Enfermería Respiratoria de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - Ana Nuñez Ares
- Servicio de Neumología, Unidad de Broncoscopias, Complejo Hospitalario Universitario de Albacete, Albacete , España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - Enrique Cases Viedma
- Servicio de Neumología, Unidad de Endoscopias, Hospital Universitario y Politécnico La Fe, Valencia, España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - David Díaz-Pérez
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España; Área de Enfermería Respiratoria de SEPAR
| | - Javier Flandes
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Fundación Jiménez Díaz IIS-FJD CIBERES, Madrid, España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
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Folch EE, Mahajan AK, Oberg CL, Maldonado F, Toloza E, Krimsky WS, Oh S, Bowling MR, Benzaquen S, Kinsey CM, Mehta AC, Fernandez-Bussy S, Flandes J, Lau K, Krishna G, Nead MA, Herth F, Aragaki-Nakahodo AA, Barisione E, Bansal S, Zanchi D, Zgoda M, Lutz PO, Lentz RJ, Parks C, Salio M, Perret K, Keyes C, LeMense GP, Hinze JD, Majid A, Christensen M, Kazakov J, Labarca G, Waller E, Studnicka M, Teba CV, Khandhar SJ. Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group. Chest 2020; 158:393-400. [PMID: 32067944 DOI: 10.1016/j.chest.2020.01.036] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 09/22/2019] [Revised: 12/03/2019] [Accepted: 01/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created? METHODS Using the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first. RESULTS Thirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale. CONCLUSIONS The use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration.
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Affiliation(s)
- Erik E Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA.
| | | | - Catherine L Oberg
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | | | - Scott Oh
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mark R Bowling
- Division of Pulmonary, Critical Care, and Sleep Medicine, East Carolina University, Greenville, NC
| | | | | | | | | | - Javier Flandes
- Interventional Pulmonology Service, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain
| | | | | | | | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany
| | | | - Emanuela Barisione
- Interventional Pulmonology Unit, IRCCS San Martino Hospital-IST National Cancer Research Institute, Genoa, Italy
| | | | - Dragos Zanchi
- Pulmonary and Sleep of Tampa Bay Inc, Wesley Chapel, FL
| | | | | | | | | | - Mario Salio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Colleen Keyes
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | | | | | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Gonzalo Labarca
- Department of Internal Medicine, Pontifical Catholic University, Santiago, Chile
| | | | - Michael Studnicka
- Department of Pulmonary Medicine, the Paracelsus Medical University, Salzburg, Austria
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16
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Lau K, Flandes J, Christensen M, Bezzi M, Lamprecht B, Salio M, Vergnon J, Studnicka M, Trigiani M, Fernandez I, Kropfmüller R, Barisione E, Viby NE, Khandhar S, Folch E. Electromagnetic navigation bronchoscopy in the European cohort of the prospective, multicenter NAVIGATE study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Since the publication of the National Emphysema Treatment Trial study, lung volume reduction (LVR) has been considered a therapeutic alternative for patients with advanced obstructive lung disease. The high complication rate of surgical LVR has led to the development of bronchoscopic LVR (BLVR). Of the currently available BLVR alternatives, coils and unidirectional endobronchial valves lead the list. The choice of each device depends on emphysema characteristics and presence of collateral ventilation. Evaluation of these patients at centers with expertise in interventional pulmonology and management of BLVR is strongly recommended.
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Affiliation(s)
- Javier Flandes
- Bronchology and Interventional Pulmonology Unit, IIS-Fundación Jiménez Díaz, CIBERES, Avenida Reyes Catolicos No 2, Madrid 28040, Spain.
| | - Francisco J Soto
- Pulmonary and Critical Care, Department of Medicine, University of Tennessee Medical Center, 1940 Alcoa Hwy e, Knoxville, TN 37920, USA
| | - Rosa Cordovilla
- Bronchology and Interventional Pulmonology Unit, Salamanca University Hospital, Paseo de San Vicente 58, Salamanca 37007, Spain
| | - Enrique Cases
- Bronchology and Interventional Pulmonology Unit, La Fe University Hospital, Avenida Fernando Abril Martorell 106, Valencia 46026, Spain
| | - Javier Alfayate
- Bronchology and Interventional Pulmonology Unit, IIS-Fundación Jiménez Díaz, CIBERES, Avenida Reyes Catolicos No 2, Madrid 28040, Spain
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18
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Khandhar S, Murgu S, Hogarth K, Krimsky W, Flandes J, Rickman O, Wahidi M, Sztejman E, Linden P, Benzaquen S, Bansal S, Folch E. MA13.09 Electromagnetic Navigation Bronchoscopy as an Integrated Approach to Aid in Diagnosis and Treatment of Pulmonary Lesions. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Khandhar SJ, Bowling MR, Flandes J, Gildea TR, Hood KL, Krimsky WS, Minnich DJ, Murgu SD, Pritchett M, Toloza EM, Wahidi MM, Wolvers JJ, Folch EE. Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, multicenter NAVIGATE study. BMC Pulm Med 2017; 17:59. [PMID: 28399830 PMCID: PMC5387322 DOI: 10.1186/s12890-017-0403-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Electromagnetic navigation bronchoscopy (ENB) is an image-guided, minimally invasive approach that uses a flexible catheter to access pulmonary lesions. METHODS NAVIGATE is a prospective, multicenter study of the superDimension™ navigation system. A prespecified 1-month interim analysis of the first 1,000 primary cohort subjects enrolled at 29 sites in the United States and Europe is described. Enrollment and 24-month follow-up are ongoing. RESULTS ENB index procedures were conducted for lung lesion biopsy (n = 964), fiducial marker placement (n = 210), pleural dye marking (n = 17), and/or lymph node biopsy (n = 334; primarily endobronchial ultrasound-guided). Lesions were in the peripheral/middle lung thirds in 92.7%, 49.7% were <20 mm, and 48.4% had a bronchus sign. Radial EBUS was used in 54.3% (543/1,000 subjects) and general anesthesia in 79.7% (797/1,000). Among the 964 subjects (1,129 lesions) undergoing lung lesion biopsy, navigation was completed and tissue was obtained in 94.4% (910/964). Based on final pathology results, ENB-aided samples were read as malignant in 417/910 (45.8%) subjects and non-malignant in 372/910 (40.9%) subjects. An additional 121/910 (13.3%) were read as inconclusive. One-month follow-up in this interim analysis is not sufficient to calculate the true negative rate or diagnostic yield. Tissue adequacy for genetic testing was 80.0% (56 of 70 lesions sent for testing). The ENB-related pneumothorax rate was 4.9% (49/1,000) overall and 3.2% (32/1,000) CTCAE Grade ≥2 (primary endpoint). The ENB-related Grade ≥2 bronchopulmonary hemorrhage and Grade ≥4 respiratory failure rates were 1.0 and 0.6%, respectively. CONCLUSIONS One-month results of the first 1,000 subjects enrolled demonstrate low adverse event rates in a generalizable population across diverse practice settings. Continued enrollment and follow-up are required to calculate the true negative rate and delineate the patient, lesion, and procedural factors contributing to diagnostic yield. TRIAL REGISTRATION ClinicalTrials.gov NCT02410837 . Registered 31 March 2015.
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Affiliation(s)
| | | | - Javier Flandes
- Pulmonary Department, IIS-Fundacion Jimenez Diaz University Hospital, CIBERES, Madrid, Spain
| | - Thomas R Gildea
- Department of Pulmonary, Allergy, and Critical Care Medicine and Transplant Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - William S Krimsky
- Pulmonary and Critical Care Associates of Baltimore, Baltimore, MD, USA
| | - Douglas J Minnich
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Present Address: Princeton Baptist Medical Center, Birmingham, AL, USA
| | - Septimiu D Murgu
- Interventional Pulmonology Fellowship Program, The University of Chicago Medicine, Chicago, IL, USA
| | - Michael Pritchett
- Pulmonary Department, Pinehurst Medical Clinic and FirstHealth Moore Regional Hospital, Pinehurst, NC, USA
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Surgery and Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Momen M Wahidi
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Erik E Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 148, Boston, MA, 02114, USA.
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Folch E, Flandes J, Khandhar S. MA05.02 Electromagnetic Navigation Bronchoscopy: A Prospective, Global, Multicenter Analysis of 1000 Subjects with Lung Lesions. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Escarguel B, Paoli J, Monnet O, Coulmain S, Flandes J, Legodec J, Fournier C, Vergnon J. Sécurité d’un dispositif de marquage fiduciaire tumoral « 3 en 1 » : une étude pilote animale. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Arevalo-Ludeña J, Arcas-Bellas JJ, Alvarez-Rementería R, Flandes J, Morís L, Muñoz Alameda LE. A comparison of the I-Gel supraglottic device with endotracheal intubation for bronchoscopic lung volume reduction coil treatment. J Clin Anesth 2016; 31:137-41. [DOI: 10.1016/j.jclinane.2016.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 10/21/2022]
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23
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Seijo LM, Flandes J, Somiedo MV, Naya A, Manjón J, Álvarez S, Fernández-Navamuel I. A Prospective Randomized Study Comparing Manual and Wall Suction in the Performance of Bronchoalveolar Lavage. Respiration 2016; 91:480-5. [PMID: 27241670 DOI: 10.1159/000446289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction. OBJECTIVES The aim was to study BAL volume and diagnostic yields based on BAL technique. METHODS A total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients. RESULTS The mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients. CONCLUSIONS Manual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques.
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Affiliation(s)
- Luis M Seijo
- Pulmonary Department, Instituto de Investigacix00F3;n Sanitaria (IIS) - Fundacix00F3;n Jimenez Dx00ED;az University Hospital, CIBERES, Madrid, Spain
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Come CE, Kramer MR, Dransfield MT, Abu-Hijleh M, Berkowitz D, Bezzi M, Bhatt SP, Boyd MB, Cases E, Chen AC, Cooper CB, Flandes J, Gildea T, Gotfried M, Hogarth DK, Kolandaivelu K, Leeds W, Liesching T, Marchetti N, Marquette C, Mularski RA, Pinto-Plata VM, Pritchett MA, Rafeq S, Rubio ER, Slebos DJ, Stratakos G, Sy A, Tsai LW, Wahidi M, Walsh J, Wells JM, Whitten PE, Yusen R, Zulueta JJ, Criner GJ, Washko GR. A randomised trial of lung sealant versus medical therapy for advanced emphysema. Eur Respir J 2015; 46:651-62. [PMID: 25837041 DOI: 10.1183/09031936.00205614] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
Uncontrolled pilot studies demonstrated promising results of endoscopic lung volume reduction using emphysematous lung sealant (ELS) in patients with advanced, upper lobe predominant emphysema. We aimed to evaluate the safety and efficacy of ELS in a randomised controlled setting.Patients were randomised to ELS plus medical treatment or medical treatment alone. Despite early termination for business reasons and inability to assess the primary 12-month end-point, 95 out of 300 patients were successfully randomised, providing sufficient data for 3- and 6-month analysis.57 patients (34 treatment and 23 control) had efficacy results at 3 months; 34 (21 treatment and 13 control) at 6 months. In the treatment group, 3-month lung function, dyspnoea, and quality of life improved significantly from baseline when compared to control. Improvements persisted at 6 months with >50% of treated patients experiencing clinically important improvements, including some whose lung function improved by >100%. 44% of treated patients experienced adverse events requiring hospitalisation (2.5-fold more than control, p=0.01), with two deaths in the treated cohort. Treatment responders tended to be those experiencing respiratory adverse events.Despite early termination, results show that minimally invasive ELS may be efficacious, yet significant risks (probably inflammatory) limit its current utility.
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Reig JP, Sanchez E, Álvarez S, Briones A, Andreo F, Flandes J, Viedma EC. Pharmacological Conscious Sedation Techniques in Endobronchial Ultrasonography: An Observational Analysis of Five Models and Complications Associated. Chest 2014. [DOI: 10.1378/chest.1776314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ferrando J, Fernández-Navamuel I, Clemente CC, Vila P, Flandes J, Andreo F, Briones A, Viedma EC. Tolerance of the Endobronchial Ultrasound (EBUS) Using Five Different Sedation Models. Chest 2014. [DOI: 10.1378/chest.1809553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Flandes J, Heili S, Gómez Seco J, Sabillón O, Fernández I, Ortega A. Hypersensitivity Pneumonitis Caused by Esparto Dust in a Young Plaster Worker:A Case R eport and Review of the Literature. Respiration 2004; 71:421-3. [PMID: 15316220 DOI: 10.1159/000079651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 09/17/2003] [Indexed: 11/19/2022] Open
Abstract
We report a case of a 25-year-old, white, male plaster worker who started developing fever, severe dyspnea and cough during the manipulation of esparto fibers. The functional lung study showed restrictive lung disease and decreased single-breath carbon monoxide transfer lung capacity. High-resolution computed tomography revealed a diffuse 'ground-glass' pattern. The histopathological findings were interstitial inflammation with a marked predominance of lymphocytes and microgranulomas. Bronchoalveolar lavage showed a significant predominance of lymphocytes, with an increase in the level of CD8. Serum precipitins against fungal antigens confirmed that Aspergillus fumigatus was the cause of the patient's hypersensitivity pneumonitis.
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Affiliation(s)
- Javier Flandes
- Department of Pulmonology, Fundación Jiménez Díaz, Madrid, Spain
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Abstract
The case is presented of a coal miner with bilateral masses of progressive massive fibrosis, who developed acute cavitation following fibreoptic bronchoscopy and biopsies. Indeed, immediately upon bronchoscopy with transbronchial biopsy, there was expectoration of abundant melanoptysis. Three days later, the chest radiograph showed a cavity and the patient again coughed up black material, in the context of pulmonary infection. One week later, there was complete emptying of the conglomerate mass. To the authors' knowledge, this is the first reported case of a conglomerate mass of progressive massive fibrosis which cavitated as a result of bronchoscopy.
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Affiliation(s)
- M J Mena
- Servicio de Neumología, Fundación Jiménez Díaz, Madrid, Spain
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Zapatero J, Flandes J, Peñalver R, Madrigal L, Lago J, Reboiras SD, Saldaña D, Muguruza I, Candelas J. [The treatment of tracheobronchial ruptures: a review of 6 cases]. Arch Bronconeumol 1996; 32:222-4. [PMID: 8696645 DOI: 10.1016/s0300-2896(15)30767-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Tracheobronchial ruptures represent a serious pathology difficult to diagnose at the first examination. The authors review 6 cases: four as acute types with pneumomediastinum, pneumothorax and subcutaneous emphysema with a delay in diagnosis of 3.25 days, meanwhile 2 cases were chronic forms with a delay in diagnosis of 124.5 days. Diagnosis should be performed as soon as possible based in the presence of uni or bilateral pneumothorax with pneumomediastinum being confirmed by fiber bronchoscopy. The treatment is based in the resection of the fractured fragments, followed by bronchoplasty always with reabsorbable sutures the most frequent surgical technique, meanwhile in the atelectatic forms it is not possible to perform sometimes and we must practise lung resections.
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Affiliation(s)
- J Zapatero
- Servicio de Cirugía Torácica, Hospital Ramón y Cajal, Madrid
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Zapatero J, Flandes J, Ruiz-Zafra J, Fogue L, Salvatierra S, Saldaña D, Peñalver R, Candelas J. Bronchovascular mucormycosis: an urgent surgical problem. Eur J Cardiothorac Surg 1995; 9:286-8. [PMID: 7662383 DOI: 10.1016/s1010-7940(05)80164-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The case of a 70-year-old male with lymphoblastic leukemia is reviewed, who presented the rare and almost always fatal complication of pulmonary mucormycosis, but who was treated satisfactorily with amphotericin B and surgery. The risk of massive hemoptysis in the course of mucormycosis that invades the lung vessels, makes us believe that surgery is an essential part of the management of this disease. It is suggested that the patient be operated as soon as the diagnosis is obtained, as we did in our case, to avoid other risks in combined management with amphotericin B.
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Affiliation(s)
- J Zapatero
- Department of Thoracic Surgery, Hospital Ramón y Cajal, Madrid, Spain
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Máiz L, Flandes J, Perpiñá A, Fogué L, Pérez-Rodríguez E. [Bronchiolo-alveolar carcinoma: review of 14 cases]. Rev Clin Esp 1994; 194:1031-3. [PMID: 7863050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fourteen cases are revised of bronchiolalveolar carcinoma (BAC) diagnosed in our institution from 1980 to 1992. The time interval from clinical manifestations to diagnosis was 5.13 +/- 6.01 months. The incidence of smokers in the population was 42.8%. Clinical findings were non-specific, except in three cases, consisting in bronchorrhea with more than 100 ml. The most frequent site of the tumor was bilateral and diffuse (71%), mainly in nonsmokers. Endoscopic findings suggested a likely malignancy in 21% of cases. Transbronchial biopsy was the most sensitive diagnostic method. Histological confirmation was obtained in 85% of cases. To note the possible association with Epstein-Barr virus (EBV), as demonstrated by the findings of EBV genome in the cases when this study was performed.
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Affiliation(s)
- L Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid
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Zapatero J, Flandes J, Salvatierra S, Lago J, Candelas J. Thoracotomy in patients over 70 years old. Monaldi Arch Chest Dis 1994; 49:298-301. [PMID: 8000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
One hundred cases of patients aged 70 yrs or older, who had undergone surgical intervention for a thoracic pathology between 1981 and 1990, were reviewed. The mean age was 73 yrs, and bronchial cancer the most frequent aetiology (55%). A systematic detailed study before surgery is recommended in the these patients, who have the highest operative risk, and whom we should try to treat most conservatively. Although the rate of complications was higher than the normal average, mortality was only 4%, and was related to the greater or lesser aggression of the surgery. In cases of diagnosed bronchial cancer, a survival of 2 yrs was obtained in 66%, 3 yrs in 50%, and 5 yrs in 26%. We conclude that, theoretically, at the age of 70 yrs or older there is no contraindication for surgery, although it does increase the postoperative morbidity.
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Affiliation(s)
- J Zapatero
- Thoracic Surgery Department, Hospital Ramón y Cajal, Madrid, Spain
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Flandes J, Navio P, Ortiz de Saracho J, Fogue L, Pérez-Rodríguez E. [Atypical presentation of a mucinous bronchioalveolar carcinoma]. Rev Clin Esp 1994; 194:109-11. [PMID: 8008933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J Flandes
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid
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Abstract
Surgery represents the first-choice treatment to manage pulmonary metastases from colorectal cancer when the primary tumor has been controlled and there is no evidence of metastatic spreading to any other organ. In our experience on 13 patients, we obtained a survival at 5 years of 23%. The average number of metastases resected was 2.9. The increase of carcinoembryonic antigen was the first clinical sign in 10 cases (76.9%, higher or equal to 5 ng/ml) that led to its discovery. The surgical technique most frequently used was wedge resection and/or atypical segmentectomy. Intraoperative mortality was zero and morbidity low (15.3%).
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Affiliation(s)
- J Zapatero
- Department of Thoracic Surgery, Hospital Ramon y Cajal, Madrid, Spain
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Abstract
We present a case with gigantic carcinosarcoma (the largest described to date, diameter of 20.5 cm), located in the right upper lobe, in which the discordance between the brief clinical course with limited symptoms and its large size were remarkable. Preoperative diagnosis by bronchial biopsy, as used to be the case in this malignancy, was incorrect (epidermoid), and the define histological characterization was made by thoracotomy. The controversy about pathology, diagnosis and treatment of the carcinosarcoma is discussed.
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Affiliation(s)
- C Ferrando
- Servico de Neumologia, Hospital Ramón y Cajal, Madrid, España
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