A rare case: Endobronchial solitary mixed papilloma

Endobronchial solitary papillomas are extremely rare lung neoplasms originating from the bronchial surface epithelium. They often present with cough or recurrent hemoptysis. These tumors are benign, but they should be followed closely because they may even have a low probability of malignant transformation features. It should be kept in mind that malignancy may develop especially if the patient is a smoker. Although the etiology is not known for certain, it is thought to be caused by human papillomavirus in some cases. A 43-year-old male patient was admitted with a complaint of chronic cough. Rigid bronchoscopy was performed for diagnostic and therapeutic purposes after imaging techniques revealed a lesion obstructing the lumen of the right main bronchus. The pathology result was reported as mixed bronchial papilloma. We aimed to present our case because of its rarity and to indicate that chronic cough must be further evaluated.

Management of recurrent hemoptysis: a single-center experience

BACKGROUND

A successful planning methodology for patients with hemoptysis promises overall improvement in patient care. Conducted in a reference center for chest diseases, the present study aims to analyze characteristics and predictors of interventional methods in patients with recurrent hemoptysis.

METHODS

The present study is a single-center, retrospective observational study. Between 2015 and 2018, 5973 patients with follow-up data until 2021 requiring more than one hospitalization due to recurrent hemoptysis were investigated. Patient characteristics, the amount of hemoptysis, baseline admission parameters, interventional procedures of bronchial artery embolization (BAE), fiberoptic bronchoscopy, rigid bronchoscopy, and surgical resections applied were analyzed according to number of hospitalizations and outcome.

RESULTS

: Hospital admission numbers were higher in patients with sequela of tuberculosis, bronchiectasis and lung cancer. While lung cancer was the most frequent underlying reason in recurrent admissions, it was determined that as the amount of bleeding increased, the number of admissions also increased to the hospital, and BAE and rigid bronchoscopy were performed more frequently in the groups with less frequent admissions. There was no statistically significance between the amount of bleeding, and the interventional procedure alone or in combination with another procedure (p > 0.05).

DISCUSSION

In conclusion, patients with certain diseases may experience frequent hospital admissions due to hemoptysis. Recurrent admissions may get better results with BAE and rigid bronchoscopy. We think that these procedures should be preferred in the foreground of suitable patient selection in line with available facilities and experience.

Use of airway stents to treat malignant tracheobronchial fistulas: Our six-year experience

BACKGROUND

This study aims to investigate the indications, safety, complications, and long-term outcomes of airway stenting in the treatment of malignant tracheobronchial fistulas.

METHODS

The medical records of a total of 34 patients (24 males, 10 females; mean age: 55.4+13 years; range, 23 to 76 years) with malignant tracheobronchial fistulas treated with airway stenting between February 2014 and August 2020 were retrospectively analyzed. Data including demographic features, diagnosis, symptoms, treatment, complications and outcomes were recorded.

RESULTS

Thirty-eight airway stents were inserted in 34 patients with malignant tracheobronchial fistulas, including 19 patients with malignant tracheobronchial esophageal fistulas and 15 patients with bronchopleural fistulas. The clinical success and the technical success rates were 91% and 100%, respectively. No perioperative death or severe complications occurred. Chronic complications (>24 h) occurred in eight (23%) patients with malignant tracheobronchial fistula. Median follow-up was 3.5 (range, 1.4 to 5.5) months in patients with malignant tracheobronchial esophageal fistulas and 18 (range, 9.5 to 26.5) months in patients with bronchopleural fistulas. Mortality rates were 79% and 61%, respectively.

CONCLUSION

Airway stent insertion provides a secure and effective treatment for patients with malignant tracheobronchial fistulas.

Transbronchial cryobiopsy for diagnosing parenchymal lung diseases: real-life experience from a tertiary referral center

Background and Objectives:

Transbronchial cryobiopsy (cryo-TBB) is increasingly being used in the diagnosis of diffuse parenchymal lung diseases (DPLD). Varying diagnostic success and complication rates have been reported. Herein we report our experience with cryo-TBB, focusing on diagnostic yield, factors affecting diagnosis, and safety.

Methods:

This retrospective study was conducted in a tertiary referral chest diseases hospital. Data regarding the patients, procedures, complication rates, diagnostic yield, and the final diagnosis made by a multidisciplinary committee at all diagnosis stages were evaluated.

Results:

We recruited 147 patients with suspected DPLD. The definitive diagnosis was made pathologically in 98 of 147 patients (66.6%) and using a multidisciplinary approach in 109 of 147 (74.1%) cases. The number of samples had a significant effect on diagnostic success. Histopathologic diagnostic yield and diagnostic yield with a multidisciplinary committee after a single biopsy were 50%, and histopathological diagnostic yield and diagnostic yield with multidisciplinary committee increased to 71.4% and 85.7%, respectively, with a second biopsy (p = 0.034). The incidence of mild-to-moderate hemorrhage was 31.9%; no severe hemorrhage occurred. Pneumothorax rate was 15.6%, and the mortality rate was 0.68%.

Conclusions:

Cryo-TBB has sufficient diagnostic yield in the context of a multidisciplinary diagnosis with acceptable complication rates. Performing at least 2 biopsies and from at least 2 segments increases diagnostic success.

Hydroxychloroquine plus azithromycin and early hospital admission are beneficial in COVID-19 patients: Turkish experience with real-life data

Background/aim

New treatment regimens for COVID-19, which has threatened the world recently, continue to be investigated. Although some of the treatments are promising, it is thought to be early to state that there is definitive treatment. Experiences and treatment protocol studies from treatment centers are still important. The aim of this study is to evaluate factors affecting the treatment process of the first cases followed in our clinic.

Materials and methods

The consecutive hospitalized patients with COVID-19 pneumonia were analyzed in this retrospective and cross-sectional study. Data were recorded from the electronic and written files of patients.

Results

Eighty-three patients were evaluated. The median age was 50 ± 15 years. Forty-eight (57.8%) patients had one or more comorbidities. The most common comorbidity was hypertension. The most common symptom was cough in 58 patients (70%). The overall mortality was 15%, and 85% of the patients were discharged. The time between the onset of symptoms and hospitalization was statistically significantly longer in deceased patients (P = 0.039). Age, D-Dimer, troponin, CK, CK-MB, ferritin, procalcitonin, and neutrophil to lymphocyte ratio were statistically significantly higher in deceased patients than survivor patients. In subgroup analysis, in the patients receiving azithromycin plus hydroxychloroquine and other antibiotics plus hydroxychloroquine, the duration of hospitalization was shorter in the azithromycin group (P = 0.027).

Conclusion

Early treatment and early admission to the hospital can be crucial for the better treatment process. Combination therapy with azithromycin may be preferred in the first treatment choice because it can shorten the length of hospital stay.

Is there any effect of smoking status on severity and mortality of hospitalized patients with COVID-19 pneumonia?

Introduction

The Severe Acute Respiratory Syndrome (SARS-CoV-2) virus, which emerged from China and spread all over the world, has affected the world in every aspect and will do so in the foreseeable future. This study was carried out to investigate the possible aggravating effect of smoking on the prognosis of patients with COVID-19 pneumonia presenting with pulmonary involvement.

Materials and Methods

114 adult patients who received inpatient treatment in our clinic with the diagnosis of COVID-19 pneumonia between 11 March 2020 and 30 April 2020 were retrospectively included in the study; in particular, they were evaluated in terms of smoking history, severity of disease, need for NIMV and ICU admission, and mortality during their hospitalization.

Result

The mean age of the 114 patients hospitalized with COVID-19 pneumonia was 51.14 ± 14.97 (range 16-81), and 77 (67.5%) were male. Of the patients, 19 (15.9%) were active smokers, 23 were ex-smokers (20.1%), 72 (63.1%) non-smokers. The effect of smoking on the severity of the disease, length of hospitalization, need for non-invasive mechanical ventilation (NIMV) and intensive care unit (ICU) admission and mortality were not statistically significant.

Conclusions

The rate of active smoking in patients hospitalized with COVID- 19 is lower than the population average. In this study, no correlation was observed between smoking status and the severity, prognosis and mortality of the disease. Further studies with larger number of patients and case series are needed to better elucidate the relationship between smoking and COVID-19 and the pathophysiologic mechanisms of the effects of smoking on the natural history of COVID-19 pneumonia.

Results of Tobramycin Inhalation Therapy in Patients with Noncystic Fibrosis Bronchiectasis with Pseudomonas aeruginosa Colonization: Real Life Management

Background: Inhaled antibiotics for treating bronchiectasis have been investigated in the cystic fibrosis population since 1981 and long-term clinical benefits have been reported. However, studies on noncystic fibrosis bronchiectasis (NCFB) have only been performed more recently. Owing to limited evidence, inhaled antibiotics are not currently approved for treating NCFB by the U.S. Food and Drug Administration and the European Medicines Agency. The aim of this study was to evaluate the efficacy and safety of tobramycin inhalation therapy in patients with bronchiectasis with Pseudomonas aeruginosa (PA) colonization. Methods: In this retrospective cross-sectional study, NCFB patients who were Pseudomonas positive on three consecutive cultures 1 month apart and receiving tobramycin inhalation therapy were evaluated. Evaluation of the following parameters was done in this study: age, gender, smoking history, symptoms, pulmonary function test results, sputum culture results, tobramycin treatment duration, side effects of tobramycin and response evaluation, and hospital admissions before and after treatment. Treatment with 300 mg tobramycin through nebulizer twice daily for 28 days on-off cycles for a total of 6 months was considered to be one treatment period. The approvals for the study were received by the local ethics committee and institutional review board. Results: Of the 27 patients, 21 patients completed the first period, 7 patients completed the second period, 4 patients completed the third period, and 1 patient completed the fourth period. Sputum culture was negative in 10 (47.6%) of the 21 patients who completed the first period. Decreased sputum purulence and quantity, dyspnea, and cough were observed during treatment. The frequency of hospitalizations before treatment was 1.24 ± 1.36, whereas after treatment, it decreased to 0.52 ± 0.91, this difference was statistically significant (p = 0.019). The most common side effect was increased dyspnea after nebulization in five patients. Conclusion: Tobramycin inhalation appears to be a well-tolerated treatment in patients with PA colonization with bronchiectasis. This treatment may decrease the hospitalization rates and improve the symptoms.

Real life results of coil treatment for bronchoscopic lung volume reduction in emphysema

Introduction

The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. Previous studies have reported successful outcomes in selected cases using coil for bronchoscopic lung volume reduction (BLVR). Our aim is to determine the changes in respiratory function tests, perception of dyspnea and exercise capacities after 12 months in patients treated with endobronchial coil.

Materials and Methods

The data of patients with severe emphysema and treated with coils between 2014-2017 were evaluated retrospectively. Dynamic and static lung volume capacities at baseline and 12 months, modified Medical Research Council (mMRC) questionnaire and six-minute walk test (6-MWT) results were recorded.

Result

BLVR was performed in thirty patients (one female, twenty-nine males). Five patients were treated bilaterally and twentyfive unilaterally. One patient died after 7 days and 4 patients died during follow-up. Five patients were lost to follow-up. A total of twenty patients with available data were included in the study. A statistically significant difference was found in mMRC results in pre-treatment and 12-month evaluations. There was no significant difference in FEV1, TLC and RV values at the end of 12 months. There was an increase of 18.9 meters (± 83.5 m) between the baseline and 12 months in 6-MWT. 45% of the patients improved their walking distance over 26 meters which is known as minimal clinically important difference (MCID).

Conclusions

Although no significant changes were observed in pulmonary function tests and lung volumes, the increase in exercise capacity and decreased perception of dyspnea indicate the efficacy of endobronchial coil.

Immunoglobulin G4 Related Lung Disease

Immunoglobulin G4 related disease (IgG4-RD) is a relatively newly defined disease known for multiple organ involvement. Histopathologically, the disease is characterized by lymphoplasmatic inflammation, fibrosis, and enhanced levels of IgG4-positive plasma cells in tissues. IgG4-RD has been reported in almost every organ system. With pulmonary involvement, lesions have been described in the lung parenchyma, airways, pleura, and the mediastinum. Glucocorticoids are the first choice of treatment, but additional immunosuppressive drugs may be administered in refractory patients. In this article, we report a patient with IgG4 syndrome who had lung parenchyma, mediastinum, aorta wall, and pancreatic involvement. Histopathological findings and high serum IgG4 level established the diagnosis of IgG4-related disease. The patient was treated successfully with glucocorticoids.

Evaluation of Serum Biomarkers in Patients with Sarcoidosis: Can Visfatin Be a New Biomarker for Sarcoidosis?

OBJECTIVES

Sarcoidosis is a chronic systemic inflammatory disease that affects multiple organ systems. The role of biomarkers in the diagnosis and prognosis of sarcoidosis is increasing. Interest in the role of adipose tissue-mediated inflammation in the pathogenesis of inflammatory diseases has increased in recent years. Visfatin is a proinflammatory adipocytokine that has been studied for several inflammatory diseases such as diabetes mellitus, obesity, and metabolic syndrome. We aimed to assess serum visfatin levels in sarcoidosis and its relationship with other markers of inflammation such as C-reactive protein (CRP), angiotensin-converting enzyme (ACE) and erythrocyte sedimentation rate (ESR).

MATERIALS AND METHODS

We enrolled 59 patients with sarcoidosis and 21 healthy controls and measured plasma levels of visfatin, along with serum CRP, ESR, and ACE using ELISA (enzyme-linked immunosorbent assay) kits (Blue Gene Biotech, Shanghai, China).

RESULTS

Visfatin levels did not differ significantly between the patients and control subjects (29.9±15.8 ng/mL for patients and 23.93±16.73 ng/mL for controls, p=0.15), and there was no correlation between visfatin and serum CRP, ACE, or ESR in patients with sarcoidosis.

CONCLUSION

Visfatin is recently being discussed as a biomarker for inflammatory diseases in several studies, and results are controversial. In our study, no differences were found in the serum levels of visfatin between patients with sarcoidosis and the control group.

Airway stents: a retrospective evaluation of indications, results and complications in our 10-year experience

Introduction

Tracheobronchial stents (TBS) are the principal modalities in the management of central airway obstruction with intrinsic tracheobronchial pathology and extrinsic airway compression. The aim of the study is to assess the indications, surveillance management, complications, and long-term outcomes of the TBS managed by rigid bronchoscopy (RB) in our 10-year experience.

Materials and Methods

The files of all patients who underwent stenting in two centers from November 2008 to September 2018 were reviewed for background data, type of disease, and indication for the placement of stents, symptoms, treatment, complications and outcome.

Result

305 patients were stented with 342 TBS. TBS were placed in both malignant (n= 223) and benign airway diseases (n= 82). The median length of stent stay was 88 (34-280) days in patients with malignancies and 775 (228-2085) days in benign diseases. There was no stent-related mortality. Mucostasis (19%) and granulation tissue formation (17%) were the most common stentrelated complications. Benign nature of the disease, tumors metastatic to tracheobronchial tree, lenght of stent stay, and shape of stent were associated with the development of complications.

Conclusions

TBS offer a safe and effective therapy for patients with both benign and malign tracheobronchial pathologies.

The role of interventional pulmonology in endobronchial metastasis of renal cell carcinoma

Introduction

Although metastasis of extrapulmonary solid organ malignant tumors to the lungs is very common, endobronchial metastases are very rare. The most common extrapulmonary tumors that make endobronchial metastases are breast, kidney and colorectal carcinomas.

Materials and Methods

In this study, we retrospectively examined the data of eleven renal cell carcinoma patients who underwent endobronchial metastases in an eight-year period.

Result

Ten of the patients were male and the mean age was 55 ± 1 (41-71) years. The most common symptom was cough (45.5%, n= 5), on the other hand 18.2% (n= 2) of the patients had no complaints. Right bronchial system, left bronchial system and tracheal distribution rates of endobronchial lesions were 45.5% (n= 5), 63.6% (n= 7) and 27.3% (n= 3) respectively. The mean time from diagnosis of primary renal cell carcinoma to endobronchial metastases was 47.5 ± 32 (5.2-100.5) months. A total of twenty two interventional procedures were performed. All except one patient underwent endobronchial treatment. Argon plasma coagulation was most commonly used as the endobronchial metastases option (n= 10, 100%). The mechanical resection (n= 6, 60%), laser (n= 5, 50%), cryoextraction (n= 5, 50%) and cryotherapy (n= 4, 40%) methods were used other than argon plasma coagulation. The mean survival time was 19.4 ± 15.7 (3.2-40.5) months after endobronchial metastases and 54.0 ± 40.4 (8.7-107.6) months after renal cell carcinoma diagnosis.

Conclusions

Extrathoracic malignancy that most metastasis to the airways is renal cell carcinoma. Endobronchial treatment procedures for endobronchial metastasis of renal cell carcinoma can be performed with low complication rates.

[Endobronchial metastases secondary to extrapulmonary malignancies]

Although parenchymal, pleural and mediastinal lymph node locations of metastatic Lung cancer are frequently seen, they are rarely found endobronchially. Endobronchial metastases comprise a portion of central airway obstructions that are diagnosed and treated by interventional pulmonology. Interventional procedures for endobronchial metastases (EBM) can help us reach early diagnosis, or in advanced cases with respiratory symptoms, used palliatively.

What have we learned in interventional pulmonology in the past decade?

Background/aim

The increasing number of lung diseases and particularly pulmonary malignancies has intensified the need for diverse interventions in the field of interventional pulmonology. In recent years we have seen many new developments and expanding applications in the field of interventional pulmonology. This has resulted in an increased number and variety of performed procedures and differing approaches. The purpose of the present study is to provide information on patient characteristics, range of interventions, complication rates, and the evolving approach of an experienced center for interventional pulmonology.

Materials and methods

We retrospectively examined the records of 1307 patients who underwent a total of 2029 interventional procedures in our interventional pulmonology department between January 2008 and December 2017.

Results

About half of the interventional procedures (47.2%) were performed on patients with airway stenosis due to malignant disease. Among patients with benign airway stenosis, the most frequent reason for intervention was postintubation tracheal stenosis. The number of patients who developed complications was 81 (6.2%), and the most common complication was hemorrhage (n = 31, 2.99%); 94.9% (n = 1240) of interventional procedures were performed under general anesthesia, without complications or deaths associated with anesthesia. Only one death (0.076%) occurred in the perioperative period. A total of 18 patients (1.38%) died in the 30-day perioperative and postoperative period. None of the patients with benign airway stenosis died.

Conclusion

Interventional bronchoscopy is an invasive but considerably safe and efficient procedure for selected cases and effective treatment modality for airway obstructions, massive hemoptysis, and foreign body aspiration. Interventional pulmonology is a field of pulmonary medicine that needs effort to progress and provide an opportunity to witness relevant developments, and increase the number of competent physicians and centers.

[Postintubation tracheal stenosis]

Postintubation tracheal stenosis (PITS) is an iatrogenic complication seen increasingly often as the number of intensive care unit (ICU) bed multiply, the indications for endotracheal intubation expand and disease awareness rises. PITS has a clinical severity spectrum ranging from asymptomatic cases to patients requiring urgent interventional procedures. It should therefore always be considered in the differential diagnosis in patients with a history of intubation who present with the complaint of difficult breathing. The golden standart for diagnosis is fiberoptic/rigid bronchoscopy. Even though tracheal resection and end-to-end anastomosis (TRA) is the preferred traetment, in some selected cases and in the patients who are not candidates for surgery, bronchoscopic interventions can be life saving, temporizing until surgery is possible and even be curative.

General features of patients with Pulmonary Langerhans Cell Histiocytosis followed in our instution

Introduction

Pulmonary Langerhans Cell Histiocytosis (PLCH) is a rare disease affecting young smokers. It is more common between the ages of 20-40 and equals the male/female ratio. Lung biopsy is the most useful methods for diagnosis. The first treatment is to quit smoking. Corticosteroids or chemotherapeutic agents can be used in severe progressive cases despite of quiting smoking. The patients with PLCH followed in our clinic were assessed with general clinical features in the light of the literature.

Materials and Methods

We retrospectively evaluated patients with PLCH in our clinic between January 1999 and June 2017.

Result

The female and male distribution of the 21 patients was 11/10. The average age was 35.04 ± 11.78 years. All patients were active smokers at the time of admission. The most common symptom was dyspnea. The most common finding in the pulmonary function tests was obstructive ventilatory defect. The DLCO value of the 70% patient in the carbonmonooxid diffusion test was below 80%. The most common pathologic findings detected in high-resolution chest tomography (HRCT) were cystic lesions involving bilateral upper and middle areas. There were 3 (14%) patients with pneumothorax at the time of admission and 6 (28.5%) patients with pneumothorax history before. The most common diagnostic method was open lung biopsy. All the patients quit cigarette after the diagnosis. There were 6 patients using steroid therapy, 1 patient receiving steroid and bosentan therapy, and 1 patient made pleurectomy due to recurrent pneumothorax. Lung transplantation was done to patient who received combined bosentan treatment with steroids.

Conclusions

PLCH is a rare disease and should be considered in young, smokers with spontaneous pneumothorax and cystic lung disease in the differential diagnosis. As more diffusions are affected in patients, respiratory functions for follow-up should be evaluated with diffusion tests. It is essential to quit smoking in therapy.

Efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration through the pulmonary arteries for the diagnosis of left hilar lesions

Introduction

Endobronchial ultrasonography (EBUS) is an endoscopic method that aids needle aspiration to see the bronchial wall and adjacent tissues with an ultrasound probe. Pulmonary arteries are rarely present between the bronchus wall and the tissue. In this case, it was necessary to make a selection between invasive processes and transbronchial needle aspiration (TBNA) through the pulmonary artery. There are few case reports about the safety of TBNA through the pulmonary artery. We aimed to present the results of EBUS guided TBNA through the pulmonary arteries.

Materials and Methods

The data on four cases (three men) in whom EBUS guided TBNA was performed through the pulmonary artery between August 2010 and December 2015 were reviewed retrospectively. Procedures were conducted under local anesthesia and conscious sedation. For TBNA, 22-gauge needles were used. Cases were monitored for 24 hour after the procedures. Antibiotic prophylaxis and onsite cytopathology were not used.

Result

All lesions existed were on the left hilar localization. Two of the diagnosed cases were carcinoma and one was the granulomatous lymphadenitis. We were not able to diagnose the last case. No complication was observed in any cases during the procedure.

Conclusions

EBUS guided TBNA through the pulmonary arteries at left hilar lesions is safe. The rate of diagnoses from the tissues obtained is high. No special preparation is needed for the cases have no the pulmonary hypertension.

Recovery process and determinants of adverse event occurrence in bronchoscopic procedures performed under general anaesthesia

OBJECTIVE

Regarding the fact that rigid bronchoscopy is generally performed under general anaesthesia and this patient subgroup is remarkably morbid, encountering procedure and/or anaesthesia related complications are highly likely. Here, we aimed to assess factors influencing recovery and detect possible determinants of adverse event occurrence during these operations performed in a tertiary referral centre.

METHODS

Eighty-one consecutive ASA I-IV patients were recruited for this investigation. In the operating theatre after induction of anaesthesia and advancement of the device, maintenance was provided with total intravenous anaesthesia. Neuromuscular blockage was invariably administered, and patients were ventilated manually. In addition to preoperative demographic and procedural characteristics, perioperative hemodynamic variables, recovery times and observed adverse events were noted.

RESULTS

Basic demographic properties, ASA and Mallampati scores, and procedure specific variables as lesion localization, lesion and procedure type were comparable among groups assembled with reference to event occurrence. Patients who had experienced adverse event had higher heart rates. Recovery times were comparable between Event (-) and Event (+) groups. Relationship of recovery process were individually tested with all variables and only lesion type was detected to have an effect on respiration and extubation times. Among all parameters only procedural time seemed to be associated with adverse event occurrence (mins, 22.9 ± 11.9 vs 41.6 ± 28.8, P < .001).

CONCLUSION

Recovery times related with return of spontaneous respiration were significantly lower in procedures performed for treatment of tumoral diseases in this study and procedure length was determined to be the ultimate factor which had an impact on adverse event occurrence.

A Rare Cause of Hemoptysis in Childhood: Tracheal Capillary Hemangioma

Hemangiomas are benign tumors most frequently seen in childhood and are mostly associated with cutaneous and mucosal surfaces. Tracheal capillary hemangiomas are extremely rare. The most common presenting symptom is hemoptysis, ranging from minor to major and chronic cough. We present the case of a 12-year-old boy with recurrent hemoptysis due to tracheal capillary hemangioma, who was treated with interventional bronchoscopy.

Is endobronchial ultrasound-guided transbronchial needle aspiration an effective diagnostic procedure in restaging of non-small cell lung cancer patients?

Background and Objectives:

Selecting the diagnostic procedure for mediastinal restaging after chemotherapy and/or radiotherapy in Stage IIIA-N2 non-small cell lung cancer (NSCLC) patients remains a problem. The aim of the study was to determine the efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the evaluation of mediastinal lymph nodes in the restaging of NSCLC patients.

Materials and Methods:

The present multicentric study retrospectively analyzed the results of Stage IIIA-N2 NSCLC patients who had undergone EBUS for mediastinal restaging after preoperative chemotherapy or radiotherapy or both.

Results:

In 44 patients with 73 N2 nodes, malignant cells were identified in EBUS-TBNA from 23 patients (57.5%) and 25 lymph nodes (34.2%). Twenty-one patients (42.5%) and 48 lymph nodes (65.8%) were negative for nodal metastasis. All of these patients with negative results subsequently underwent mediastinoscopy or surgery (n = 9 and n = 12, respectively). Metastasis was detected in 5 (23.8%) of 21 patients and 6 (12.5%) of 48 lymph nodes. The diagnostic sensitivity, specificity, positive predictive value, negative predicted value and accuracy of EBUS-TBNA based on number of patients were 82.1%, 100%, 100%, 76.2%, and 88.6%, respectively.

Conclusions:

EBUS-TBNA should be done before invasive procedures in restaging of the mediastinum in patients previously treated with neoadjuvant therapy because of high diagnostic accuracy rate. However, negative results should be confirmed with invasive procedures such as mediastinoscopy and thoracoscopy.

Red Blood Cell Distribution Width in Patients With Chronic Obstructive Pulmonary Disease and Healthy Subjects

BACKGROUND

Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD.

AIMS

To study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects.

METHODS

One hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared.

RESULTS

RDW values were higher in the COPD group than in controls (15±2.3% vs. 13.8±2.5%, p<0.001). In COPD patients, RDW levels positively correlated with CRP levels (r=0.27, P<.001), albumin levels (r=0.23, P=.04), right ventricular dysfunction (RVD) (r=0.24, P=.001), pulmonary hypertension (PAH) (r=0.1, P=.02), and presence of CVD (r=0.24, P=.02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3 to 11; P=.01), and presence of RVD (3.1; 95% CI: 1.7 to 8.3; P=.02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r=0.57, P<.001).

CONCLUSION

RDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status.

Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC), and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important.

Oki stent application in different indications: Six cases

INTRODUCTION

We have used Oki stents for a number of different indications. After discovering that there are limited reports in the literature on these stents, we were motivated to share our experiences in Oki stenting.

OBJECTIVES

While there is vast knowledge on double Y-stents, the Oki stent is a relatively recent development in pulmonology. Here, we demonstrate that stenting of the right secondary carina using an Oki stent should be considered for obstructions in this region.

METHODS

We placed 13 mm × 10 mm × 9 mm Oki stents in six patients under general anesthesia via rigid bronchoscopy.

RESULTS

Three cases were post-transplant patients with malacia, stenosis, and bronchopleural fistula. One case had an airway obstruction due to malignant disease, another case had a right aortic arc and aberrant left subclavian artery anomaly, and the final case had bronchopleural fistula. No serious complications were observed during stent placement.

CONCLUSIONS

Oki stents can safely be used for many clinical conditions. Patients benefit greatly from stenting; however, two of our cases died due to infection, and one case died due to malignancy.

Angiotensin-converting Enzyme as a Predictor of Extrathoracic Involvement of Sarcoidosis

BACKGROUND

Sarcoidosis is a multisystem disease, with extrathoracic involvement occurring in 25-50% of patients. Multi-organ involvement is often associated with a more chronic and severe course. The value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in diagnosing extrathoracic involvement in sarcoidosis has been demonstrated; however, because of the radiation dose and high cost, indications for its use must be well defined. Angiotensin-converting enzyme (ACE) is produced by active granuloma cells; thus, serum ACE (sACE) levels may reflect the total granuloma load.

OBJECTIVES

In this retrospective study, we evaluated the diagnostic value of sACE in the detection of extrathoracic involvement in sarcoidosis.

METHODS

43 patients with biopsy-proven sarcoidosis underwent FDG-PET/CT during the initial workup. Positive findings were classified as thoracic and/or extrathoracic. The diagnostic value of sACE was estimated using sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs).

RESULTS

Of the 43 patients studied, 17 (39.7%) had extrathoracic involvement. In this group, sACE values were higher than in patients without extrathoracic involvement (331 vs. 150, p=0.002) and correlated positively with extrathoracic involvement (R:0.532 p=0.02). Receiver operator characteristic curve analysis revealed an AUC of 0.816 [95% confidence interval: 0.669-0.963, p=0.002], 70.6% sensitivity and 80% specificity at the sACE cut-off value.

CONCLUSIONS

In sarcoidosis, extrathoracic involvement may be life threatening or indicative of poor outcome. sACE levels are easily determined and may predict extrathoracic involvement. In patients with sarcoidosis, sACE levels can be used to better define those who would benefit from FDG-PET/CT examination to detect extrathoracic involvement.

The place of YKL-40 in non-small cell lung cancer

INTRODUCTION

Despite varies treatment options, the survival rate of non-small cell lung cancer (NSCLC) is less than 1%. If biological behaviour of any cancer could be known, the information would potentially tailor the clinical work-up, assessment and treatment. The prognostic value of serum YKL-40 level has been investigated in different types of cancer and showed poor prognostic indication with more aggressive clinical course. We studied the role of serum YKL-40 levels in patients with NSCLC to determine the stage.

MATERIALS AND METHODS

Serum YKL-40 levels in venous blood samples of 55 patients was studied. 49 (89.1%) male and 6 (10.9%) female newly diagnosed NSCLC patients whom received neither cancer specific or symptom relieving treatment are enrolled. TNM staging was determined based on the findings of computerized tomography (CT), positron emission tomography (PET), cranial magnetic resonance imaging (MRI), bronchoscopy and mediastinoscopy. The patients with NSCLC were divided into two groups; Group A: stage Ia, Ib, IIa, IIb, Group B: stage IIIa, IIIb and IV.

RESULTS

There was a statistical difference in YKL-40 serum levels between groups (Group A, Group B) when compared (p< 0.05). A medium and statistical correlation was found (r= 0.48; p< 0.01) between YKL-40 levels and age.

CONCLUSION

YKL-40 levels in advanced stage NSCLC (stage III, IV) was found to be significantly high compared to early stage. It should be kept in mind that when YKL levels are high, higher stages of the disease should be suspected and future tests should be performed.

A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment

Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.

The maximum standardized FDG uptake on PETCT in patients with non-small cell lung cancer

Background: Non-small cell lung cancer (NSCLC) accounts for approximately 80% of new diagnoses of pulmonary carcinoma. This study investigated the correlation between 18 F-fluorodeoxyglucose uptake in computerized tomography integrated positron emission tomography and tumor size, lymph node metastasis, and distant metastasis in patients with NSCLC. Methods: The records of 151 NSCLC patients (139 male, 12 female; mean age 59.60 years) were evaluated retrospectively. Results: Forty-one cases were adenocarcinomas; 45 squamous cell carcinomas; and 65 unspecified NSCLC. When the cases were categorized according to tumor size (group 1, ≤ 3 cm; group 2, > 3 and ≤ 5 cm; group 3, > 5 cm), the maximum standardized uptake value (SUVmax) was significantly lower in groups 1 and 2 compared with group 3 (p = 0.006 for each). Considering all cases, tumor SUVmax was not correlated with age, gender, or histopathological type. Lymph node metastases were pathologically proven in 24 cases: 24% of these were adenocarcinomas, 6% squamous cell carcinomas, and 16% unspecified NSCLC. Neither lymph node involvement nor distant metastases were correlated with tumor SUVmax, although lymph node size was positively correlated with lymph node SUVmax (r = 0.775; p < 0.001). Conclusions: SUVmax was significantly associated with tumor size, but not with distant metastases or lymph node involvement. Therefore, SUVmax on positron emission tomography is not predictive of the presence of metastases.