1
|
Smeltz AM, Wicker AB, Belliston-Fowkes DJ, Tran LN, Smith EJ, An X, Lin BI, Teeter EG. Relationship Between Computed Tomography-Derived Left Bronchial Diameter and Double- Lumen Endotracheal Tube Size Selection. J Cardiothorac Vasc Anesth 2024; 38:1286-1287. [PMID: 38458827 DOI: 10.1053/j.jvca.2024.02.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Alan M Smeltz
- University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Ashley B Wicker
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Linh N Tran
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emmaline J Smith
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Xinming An
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Bridget I Lin
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Emily G Teeter
- University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
2
|
Atwood DT, Köhler JR, Vargas SO, Wong W, Klouda T. Identification of Irpex and Rhodotorula on surveillance bronchoscopy in a pediatric lung transplant recipient: A case report and review of literature of these atypical fungal organisms. Pediatr Transplant 2024; 28:e14759. [PMID: 38623871 DOI: 10.1111/petr.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Invasive fungal disease (IFD) is a frequent complication in pediatric lung transplant recipients, occurring in up to 12% of patients in the first year. Risk factors for infection include impaired lung defenses and intense immunosuppressive regimens. While most IFD occurs from Aspergillus, other fungal conidia are continuously inhaled, and infections with fungi on a spectrum of human pathogenicity can occur. CASE REPORT We report a case of a 17-year-old lung transplant recipient in whom Irpex lacteus and Rhodotorula species were identified during surveillance bronchoscopy. She was asymptomatic and deemed to be colonized by Irpex lacteus and Rhodotorula species following transplant. 2 years after transplantation, she developed a fever, respiratory symptoms, abnormal lung imaging, and histological evidence of acute and chronic bronchitis on transbronchial biopsy. After developing symptoms concerning for a pulmonary infection and graft dysfunction, she was treated for a presumed IFD. Unfortunately, further diagnostic testing could not be performed at this time given her tenuous clinical status. Despite the initiation of antifungal therapy, her graft function continued to decline resulting in a second lung transplantation. CONCLUSIONS This case raises the concern for IFD in lung transplant recipients from Irpex species. Further investigation is needed to understand the pathogenicity of this organism, reduce the incidence and mortality of IFD in lung transplant recipients, and refine the approach to diagnosis and manage the colonization and isolation of rare, atypical fungal pathogens in immunocompromised hosts.
Collapse
Affiliation(s)
- Daniel T Atwood
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Julia R Köhler
- Division of Infectious Disease, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Wai Wong
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Timothy Klouda
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Gulhati V, Desy J, Thornton CS. A case of hypercalcemia from Pneumocystis jirovecii in an immunosuppressed non-HIV patient. BMC Pulm Med 2024; 24:204. [PMID: 38658913 DOI: 10.1186/s12890-024-03007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The prevalence of non-HIV related Pneumocystis jirovecii pneumonia (PJP) is increasing with use of immunosuppressive therapies. There are case reports of solid organ transplant recipients on immunosuppressive therapy presenting with mild hypercalcemia, leading to a diagnosis of PJP. Recent studies have shown efficacy of PJP prophylaxis for patients treated with rituximab with a favourable adverse effect profile. CASE PRESENTATION A 78-year-old male with a history of PR3-ANCA vasculitis, chronic kidney disease and heart failure with reduced ejection fraction presented to our tertiary care hospital with a two-week history of confusion and non-productive cough. Background immunosuppression with rituximab was completed every six months. The patient was found to have hypercalcemia and new infiltrates and ground glass opacities on cross-sectional imaging. Bronchoscopy was performed that was positive for Pneumocystis jirovecii. He was treated with 21 days of trimethoprim-sulfamethoxazole and prednisone with resolution of symptoms and hypercalcemia. CONCLUSIONS Herein, we present a novel case of PJP in a non-transplant recipient preceded by hypercalcemia. Our case demonstrates the importance for a high suspicion for PJP in chronically immunosuppressed patients on rituximab presenting with PTH-independent hypercalcemia.
Collapse
Affiliation(s)
- Vishrut Gulhati
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, T2N 4N1, Calgary, AB, Canada
| | - Janeve Desy
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, T2N 4N1, Calgary, AB, Canada
| | - Christina S Thornton
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, T2N 4N1, Calgary, AB, Canada.
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
| |
Collapse
|
4
|
Zhu LM, Li CX, Gong XL, Xu ZM, Liu JL, Zhang HB. Clinical features of plastic bronchitis in children after congenital heart surgery. Ital J Pediatr 2024; 50:74. [PMID: 38637856 PMCID: PMC11027272 DOI: 10.1186/s13052-024-01650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Plastic bronchitis (PB) can occur in patients who have undergone congenital heart surgery (CHS). This study aimed to investigate the clinical features of PB in children after CHS. METHODS We conducted a retrospective cohort study using the electronic medical record system. The study population consisted of children diagnosed with PB after bronchoscopy in the cardiac intensive care unit after CHS from May 2016 to October 2021. RESULTS A total of 68 children after CHS were finally included in the study (32 in the airway abnormalities group and 36 in the right ventricular dysfunction group). All children were examined and treated with fiberoptic bronchoscopy. Pathogens were detected in the bronchoalveolar lavage fluid of 41 children, including 32 cases in the airway abnormalities group and 9 cases in the right ventricular dysfunction group. All patients were treated with antibiotics, corticosteroids (intravenous or oral), and budesonide inhalation suspension. Children with right ventricular dysfunction underwent pharmacological treatment such as reducing pulmonary arterial pressure. Clinical symptoms improved in 64 children, two of whom were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) due to recurrent PB and disease progression. CONCLUSIONS Children with airway abnormalities or right ventricular dysfunction after CHS should be alerted to the development of PB. Pharmacological treatment such as anti-infection, corticosteroids, or improvement of right ventricular function is the basis of PB treatment, while fiberoptic bronchoscopy is an essential tool for the diagnosis and treatment of PB. ECMO assistance is a vital salvage treatment for recurrent critically ill PB patients.
Collapse
Affiliation(s)
- Li-Min Zhu
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Chun-Xiang Li
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Xiao-Lei Gong
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Zhuo-Ming Xu
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Jin-Long Liu
- Institute of Pediatric Translational Medicine, Shanghai Children' s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Hai-Bo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China.
| |
Collapse
|
5
|
Irouschek A, Schmidt J, Birkholz T, Sirbu H, Moritz A. Video double-lumen tube for one lung ventilation: implementation and experience in 343 cases of routine clinical use during the first 20 months of the SARS-CoV-2 pandemic. J Cardiothorac Surg 2024; 19:218. [PMID: 38627789 PMCID: PMC11020909 DOI: 10.1186/s13019-024-02663-5] [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: 03/13/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Double-lumen tubes (DLTs) are the preferred device for lung isolation. Conventional DLTs (cDLT) need a bronchoscopic position control. Visualisation of correct DLT positioning could be facilitated by the use of a video double-lumen tube (vDLT). During the SARS-CoV-2-pandemic, avoiding aerosol-generation was suggesting using this device. In a large retrospective series, we report both general and pandemic related experiences with the device. METHODS All anesthesia records from patients aged 18 years or older undergoing surgery from April 1st, 2020 to December 31st, 2021 in the department of thoracic surgery requiring intraoperative lung isolation were analyzed retrospectively. RESULTS During the investigation period 343 left-sided vDLTs (77.4%) and 100 left-sided cDLTs (22.6%) were used for one lung ventilation. In the vDLT group bronchoscopy could be reduced by 85.4% related to the cDLT group. Additional bronchoscopy to reach or maintain correct position was needed in 11% of the cases. Other bronchoscopy indications occured in 3.6% of the cases. With cDLT, in 1% bronchoscopy for other indications than conforming position was observed. CONCLUSIONS The Ambu® VivaSight™ vDLT is an efficient, easy-to-use and safe airway device for the generation of one lung ventilation in patients undergoing thoracic surgery. The vDLT implementation was achieved easily with full interchangeability to the left-sided cDLT. Using the vDLT can reduce the need for aerosol-generating bronchoscopic interventions by 85.4%. Continuous video view to the carina enabling position monitoring of the DLT without need for bronchoscopy might be beneficial for both employee's and patient's safety.
Collapse
Affiliation(s)
- Andrea Irouschek
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
- Department of Anesthesiology, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Joachim Schmidt
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Torsten Birkholz
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Moritz
- Department of Anesthesiology, University Hospital Erlangen, Faculty of Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
6
|
Rodríguez Hidalgo LA, Cribillero Meza NC, Ruíz Caballero DC, Concepción Urteaga LA, Vega Fernández AG, Cornejo Portella JL. Osteochondroplastic tracheobronchopathy: Four case reports. Medwave 2024; 24:e2792. [PMID: 38588532 DOI: 10.5867/medwave.2024.03.2792] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Introduction Osteochondroplastic tracheobronchopathy is a rare benign chronic disease of unknown etiology. Bronchoscopy remains the gold standard for diagnosing osteochondroplastic tracheobronchopathy. Its typical findings are described as a cobblestone, rock garden, mountainscape, or stalactite cave appearance. The present work aims to show the main clinical features of this rare pathology. Clinical cases The clinical data of four middle-aged patients, three men and one woman, were analyzed. The main clinical symptoms were chronic cough, dyspnea, and dysphonia. The patient's preliminary diagnosis was made by computed axial tomography of the chest, confirmed by bronchoscopy and histopathological examination. Treatment included medication for symptoms and, in one case, cryosurgery and argon plasma coagulation. Discussion Diagnosing osteochondroplastic tracheobronchopathy was not easy, given its uncommon nature and non-specific symptoms often found in other pathologies. No case series articles on this pathology have been published in Peru. Therefore, we used the original articles published in other countries to reference our findings. Conclusion Osteochondroplastic tracheopathy is a benign disease that typically affects adults. Men are more likely to be affected. Its clinical manifestations are non-specific and frequently of pharyngeal origin, and the cause is not yet defined. Chest computed axial tomography combined with bronchoscopy are the main diagnostic procedures. There is no standard treatment with consistent therapeutic effects.
Collapse
|
7
|
Affiliation(s)
| | - Vijay Patel
- Rady Children's Hospital-San Diego, San Diego, CA
| |
Collapse
|
8
|
Trimble EJ, Stewart K, Reinersman JM. Early comparison robotic bronchoscopy versus electromagnetic navigational bronchoscopy for biopsy of pulmonary nodules in a thoracic surgery practice. J Robot Surg 2024; 18:149. [PMID: 38564059 DOI: 10.1007/s11701-024-01898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Pulmonary nodules are frequently encountered in high-risk patients. Often these require biopsy which can be challenging. We relate our experience comparing use of electromagnetic navigational bronchoscopy (ENB) to a robotic bronchoscopy system (RB). A retrospective review of patients undergoing bronchoscopic biopsy from 2015 to 2021. The timeframe overlapped with transition from ENB using Veran SPiN system to RB using Ion system by Intuitive. Patient and nodule characteristics were collected. Primary end point was overall diagnostic yield which was defined by pathologic confirmation of malignancy or benign finding. Secondary outcomes included diagnostic yield based on overall size of nodules and need for further work up and testing. 116 patients underwent ENB or RB of 134 nodules. No perioperative complications occurred. Diagnostic yield of ENB was 49.5% (41/91 nodules) versus 86.1% (37/43 nodules) for RB. Average nodule size for ENB was 2.55 cm versus 1.96 cm for RB. When divided based on size, ENB had a 30% diagnostic yield for nodules 1-2 cm (11/37 nodules, mean size 1.46 cm) and 64% yield for nodules 2-3 cm (14/22 nodules, mean size 2.38 cm). RB had an 81% yield for nodules 1-2 cm (mean size 1.41 cm) and 100% yield for nodules 2-3 cm (mean 2.3 cm). RB showed superiority over ENB in early implementation trials for biopsy of suspicious pulmonary nodules. It is a safe technology allowing for increased access to all lung fields and utilization in the thoracic surgical practice will be paramount to advancing the field.
Collapse
Affiliation(s)
- Elizabeth J Trimble
- Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Suite 9000, Oklahoma City, OK, 73104, USA
| | - Kenneth Stewart
- Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Suite 9000, Oklahoma City, OK, 73104, USA
| | - J Matthew Reinersman
- Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Suite 9000, Oklahoma City, OK, 73104, USA.
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| |
Collapse
|
9
|
Arora D, Tewari P, Shamshery C, Chandra B, Gupta A, Pal L. 3D Virtual Bronchoscopy as an Aid to Airway Management in a Patient with Anterior Mediastinal Mass. Ann Card Anaesth 2024; 27:165-168. [PMID: 38607882 DOI: 10.4103/aca.aca_133_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 04/14/2024] Open
Abstract
ABSTRACT Mediastinal masses pose one of the great challenges for any anesthesiologist during airway maintenance, underlining the need to devise a well-formulated plan to avoid perioperative complications. As a general rule, such patients are managed with spontaneous ventilation without the use of muscle relaxants and awake intubation. We report a case of a 66-year-old male with severe dyspnea, having a very large invasive anterior mediastinal mass, causing left lung collapse for urgent debulking surgery. The tracheobronchial compromise was ruled out using three-dimensional reconstruction on computed tomography imaging (virtual bronchoscopy) and that helped in using general anesthesia with muscle relaxation for subsequent endotracheal intubation and surgery.
Collapse
Affiliation(s)
- Divya Arora
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Prabhat Tewari
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Chetna Shamshery
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Bipin Chandra
- Department of Cardiovascular and Thoracic Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Archna Gupta
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Lily Pal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| |
Collapse
|
10
|
Cimenoglu B, Dogruyol T, Ozdemir A, Buz M, Ece D, Comert SS, Demirhan R. Foreign Body Reaction Mimicking Lymph Node Metastasis is Not Rare After Lung Cancer Resection. Thorac Cardiovasc Surg 2024; 72:235-241. [PMID: 37640061 DOI: 10.1055/a-2161-0690] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Mediastinal lymphadenopathies with high 18-fluorodeoxyglucose uptake in patients previously operated on for lung cancer are alarming for recurrence and necessitate invasive diagnostic procedures. Peroperative placement of oxidized cellulose to control minor bleeding may lead to a metastasis-like image through a foreign body reaction within the dissected mediastinal lymph node field at postoperative examinations. In this study, we investigated clinicopathological features and the frequency of foreign body reaction mimicking mediastinal lymph node metastasis. METHODS Patients who underwent surgery for lung cancer between January 2016 and August 2021 and who were subsequently evaluated for mediastinal recurrence with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Patients were grouped according to the results of EBUS-TBNA as metastasis, foreign body, and reactive. Clinicopathological features of these patients were compared and characteristics of patients in the foreign body group were scrutinized. RESULTS EBUS-TBNA was performed on a total of 34 patients during their postoperative follow-up due to suspicion of mediastinal recurrence. EBUS-TBNA pathological workup revealed metastasis in 18 (52.9%), foreign body reaction in 10 (29.4%) and reactive lymph nodes in 6 (17.6%) patients. Mean maximum standardized uptake value (SUVMax) for metastasis group and foreign body group were 9.39 ± 4.69 and 5.48 ± 2.54, respectively (p = 0.022). Time interval between the operation and EBUS-TBNA for the metastasis group was 23.72 ± 10.48 months, while it was 14.90 ± 12.51 months in the foreign body group (p = 0.015). CONCLUSION Foreign body reaction mimicking mediastinal lymph node metastasis is not uncommon. Iatrogenic cause of mediastinal lymphadenopathy is related to earlier presentation and lower SUVMax compared with metastatic lymphadenopathy.
Collapse
Affiliation(s)
- Berk Cimenoglu
- Thoracic Surgery Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Talha Dogruyol
- Thoracic Surgery Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Attila Ozdemir
- Thoracic Surgery Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Mesut Buz
- Thoracic Surgery Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Dilek Ece
- Pathology Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Sevda Sener Comert
- Pneumology Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Recep Demirhan
- Thoracic Surgery Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Mumtaz A, Navarrete-Welton A, Ahmed R, Minami T, Manzoor K. Black Bronchoscopy. R I Med J (2013) 2024; 107:19-20. [PMID: 38536134] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
| | | | - Rabeea Ahmed
- King Edward Medical University, Lahore, Pakistan
| | - Taro Minami
- The Warren Alpert Medical School of Brown University, Providence, RI; Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Health System, Providence, RI
| | - Kamran Manzoor
- The Warren Alpert Medical School of Brown University, Providence, RI; Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Health System, Providence, RI
| |
Collapse
|
12
|
Roller L, Lentz RJ, Maldonado F. Perceptions of the Research Coordinator Role Among Interventional Pulmonology Researchers. J Bronchology Interv Pulmonol 2024; 31:228-230. [PMID: 37988001 DOI: 10.1097/lbr.0000000000000953] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Lance Roller
- Division of Allergy, Pulmonary and Critical Care Medicine Vanderbilt University Medical Center
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine Vanderbilt University Medical Center
- Department of Thoracic Surgery, Vanderbilt University Medical Center
- Veterans Affairs Medical Center, Nashville, TN
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine Vanderbilt University Medical Center
- Department of Thoracic Surgery, Vanderbilt University Medical Center
| |
Collapse
|
13
|
Luna-Pardo C, Cruz-Chamorro DA, Martínez-Tomás R, Briones-Gómez A, Cases-Viedma E. Endoscopic Lung Volume Reduction With Vapor Ablation in Patients With Severe Emphysema. Arch Bronconeumol 2024; 60:244-245. [PMID: 38218694 DOI: 10.1016/j.arbres.2023.12.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Cristina Luna-Pardo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | | | - Andrés Briones-Gómez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Enrique Cases-Viedma
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
14
|
Wang Z, Bai J, Jiao G, Li P. Quantitative evaluation of endobronchial ultrasound elastography in the diagnosis of benign and malignant mediastinal and hilar lymph nodes. Respir Med 2024; 224:107566. [PMID: 38355018 DOI: 10.1016/j.rmed.2024.107566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/16/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To compare the diagnostic value of different quantitative methods of endobronchial ultrasound elastography in benign and malignant mediastinal and hilar lymph nodes. METHODS This retrospective study included patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal and hilar lymph node enlargement in our hospital between January 2019 and August 2022. We compared different quantitative elastography parameters [red area ratio (RAR, lymph node red area/lymph node area), green area ratio (GAR, lymph node green area/lymph node area), blue area ratio (SAR, lymph node blue area/lymph node area), mixed area ratio (MAR, lymph node green area/lymph node area), blue-green lymph node area/lymph node area), strain rate ratio (SR), strain rate in the target lymph node (LPA), ratio of blue area to total lymph node area outside the center of the target lymph node (PAR), and average grey value (MGV)], in order to find the best quantitative evaluation method. RESULTS A total of 244 patients (346 lymph nodes) were included in this study. All quantitative elastography parameters were statistically significant for the differentiation of benign and malignant lesions except the average grey value of the target lymph nodes. The area under the receiver operating characteristic curve of SAR was 0.872 (95% confidence interval: 0.83-0.91), the cutoff value was 0.409, and the sensitivity, specificity, positive and negative predictive values were 85.4%, 78.0%, 80.4%, and 83.4%, respectively. CONCLUSION Compared with other types of quantitative analysis, SAR has a higher predictive significance for benign and malignant lymph nodes.
Collapse
Affiliation(s)
- Zhen Wang
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiayu Bai
- Department of Rheumatology, The 1st Affiliated Hospital of China Medical University, Shenyang, China
| | - Guangyu Jiao
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
15
|
Kumar A, Gupta N, Bhargava T, Gupta A, Kumar V, Bharti SJ, Garg R, Mishra S, Bhatnagar S, Malhotra RK. A comparative evaluation of fibreoptic bronchoscopy versus C-MAC ® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients. Can J Anaesth 2024; 71:503-510. [PMID: 38243098 DOI: 10.1007/s12630-023-02687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/14/2023] [Accepted: 10/28/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas. METHODS We randomized a total of 100 patients with OP carcinoma and El-Ganzouri's risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications. RESULTS The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26-43] sec vs 60 [52-65] sec; difference, -20 sec [95% confidence interval (CI), -27 to -11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6-9] sec vs 22 [14-25] sec; difference, -13 sec [95% CI, -17 to -10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar. CONCLUSION Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases. TRIAL REGISTRATION CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.
Collapse
Affiliation(s)
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
- Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139, First Floor, Ansari Nagar, New Delhi, India.
| | - Tanvi Bhargava
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev K Malhotra
- Delhi Cancer Registry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
16
|
Yadav RK, Karmakar S, Raouf Wani A, V V. Pulmonary mucormycosis diagnosed by ultrasound guided percutaneous biopsy: A case series. Indian J Tuberc 2024; 71:225-231. [PMID: 38589128 DOI: 10.1016/j.ijtb.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 04/10/2024]
Abstract
Pulmonary mucormycosis is a rare but highly lethal fungal infection, usually affecting immunocompromised patients. Pulmonary mucormycosis was also a critical problem that complicated the later part of the clinical course of COVID-19 in India. Early diagnosis of the disease, combined with aggressive treatment, is crucial for patient survival. Fibreoptic bronchoscopy is a useful procedure for diagnosis of pulmonary mucormycosis, but image-guided percutaneous biopsy efficiently samples lesions abutting the chest wall. Biopsy is more yielding than cultures and imaging guided biopsy is required for lesions that cannot be microbiologically confirmed by fibreoptic bronchoscopy. We present a case series of four patients of pulmonary mucormycosis in whom ultrasound guided biopsy clinched the diagnosis. All the four patients were poor surgical candidates and underwent medical management with antifungal agents, and had successful clinical recovery and radiological resolution. Our case series illustrates the utility of ultrasound guided percutaneous biopsy as a diagnostic tool for sampling cavitatory disease due to pulmonary mucormycosis, when fibreoptic bronchoscopy failed to yield a diagnosis and the beneficial role antifungal agents as salvage therapy in poor surgical candidates.
Collapse
Affiliation(s)
- Rajesh Kumar Yadav
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India
| | - Saurabh Karmakar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India.
| | - Abdul Raouf Wani
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India
| | - Vinay V
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India
| |
Collapse
|
17
|
Torsello M, Sicuranza L, Meucci D, Salvati A, Tropiano ML, Santarsiero S, Calabrese C, D'Onghia A, Trozzi M. Foreign body aspiration in children: our pediatric tertiary care experience. Pediatr Surg Int 2024; 40:93. [PMID: 38551664 DOI: 10.1007/s00383-024-05679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. METHODS We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. RESULTS 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3 years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5 days (± 2.9). Complications such as pneumothorax were seen in two cases. CONCLUSIONS Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.
Collapse
Affiliation(s)
- Miriam Torsello
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Luana Sicuranza
- Department of Surgery, Otorhinolaryngology Unit, University of Cagliari, Cagliari, Italy
| | - Duino Meucci
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Antonio Salvati
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Maria Luisa Tropiano
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Sara Santarsiero
- Department of Otorhinolaryngology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cinzia Calabrese
- Otolaryngology Department, Verona University Hospital, Verona, Italy
| | - Alessandra D'Onghia
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marilena Trozzi
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| |
Collapse
|
18
|
Vu VG, Hoang AD, Phan TP, Nguyen ND, Nguyen TT, Nguyen DN, Dao NP, Doan TPL, Nguyen TTH, Trinh TH, Pham TLQ, Le TTT, Thi Hanh P, Pham VT, Tran VC, Vu DL, Tran VL, Nguyen TTT, Pham CP, Pham GL, Luong SB, Pham TD, Nguyen DP, Truong TKA, Nguyen QM, Tran TT, Dang TB, Ta VC, Tran QL, Le DT, Vinh LS. BM-BronchoLC - A rich bronchoscopy dataset for anatomical landmarks and lung cancer lesion recognition. Sci Data 2024; 11:321. [PMID: 38548727 PMCID: PMC10978879 DOI: 10.1038/s41597-024-03145-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/14/2024] [Indexed: 04/01/2024] Open
Abstract
Flexible bronchoscopy has revolutionized respiratory disease diagnosis. It offers direct visualization and detection of airway abnormalities, including lung cancer lesions. Accurate identification of airway lesions during flexible bronchoscopy plays an important role in the lung cancer diagnosis. The application of artificial intelligence (AI) aims to support physicians in recognizing anatomical landmarks and lung cancer lesions within bronchoscopic imagery. This work described the development of BM-BronchoLC, a rich bronchoscopy dataset encompassing 106 lung cancer and 102 non-lung cancer patients. The dataset incorporates detailed localization and categorical annotations for both anatomical landmarks and lesions, meticulously conducted by senior doctors at Bach Mai Hospital, Vietnam. To assess the dataset's quality, we evaluate two prevalent AI backbone models, namely UNet++ and ESFPNet, on the image segmentation and classification tasks with single-task and multi-task learning paradigms. We present BM-BronchoLC as a reference dataset in developing AI models to assist diagnostic accuracy for anatomical landmarks and lung cancer lesions in bronchoscopy data.
Collapse
Affiliation(s)
- Van Giap Vu
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Anh Duc Hoang
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Thu Phuong Phan
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Ngoc Du Nguyen
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Thanh Thuy Nguyen
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Duc Nghia Nguyen
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Ngoc Phu Dao
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | | | | | | | | | | | | | | | | | - Dang Luu Vu
- Bach Mai hospital, Hanoi, 10000, Vietnam
- Hanoi Medical University, Hanoi, 10000, Vietnam
| | | | | | | | - Gia Linh Pham
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Son Ba Luong
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Trung-Dung Pham
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Duy-Phuc Nguyen
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Thi Kieu Anh Truong
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Quang Minh Nguyen
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Truong-Thuy Tran
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Tran Binh Dang
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Viet-Cuong Ta
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Quoc Long Tran
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Duc-Trong Le
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam
| | - Le Sy Vinh
- University of Engineering and Technology, Vietnam National University, Hanoi, 10000, Vietnam.
| |
Collapse
|
19
|
Guo R, Zhai J, Zou YX, Wang XL, Bi Y. [Interventional bronchoscopic treatment for post-infectious bronchitis obliterans]. Zhonghua Er Ke Za Zhi 2024; 62:374-376. [PMID: 38527510 DOI: 10.3760/cma.j.cn112140-20231208-00420] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- R Guo
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University)Machang District, Tianjin Key Laboratory of Birth Defects for Prevetion and Treatment, Tianjin 300074, China
| | - J Zhai
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University)Machang District, Tianjin Key Laboratory of Birth Defects for Prevetion and Treatment, Tianjin 300074, China
| | - Y X Zou
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University)Machang District, Tianjin Key Laboratory of Birth Defects for Prevetion and Treatment, Tianjin 300074, China
| | - X L Wang
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University)Machang District, Tianjin Key Laboratory of Birth Defects for Prevetion and Treatment, Tianjin 300074, China
| | - Y Bi
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University)Machang District, Tianjin Key Laboratory of Birth Defects for Prevetion and Treatment, Tianjin 300074, China
| |
Collapse
|
20
|
Shchomak Z, Oliveira L, Saianda A, Bandeira T. Endobronchial lesion in a premature neonate. BMJ Case Rep 2024; 17:e259839. [PMID: 38508601 PMCID: PMC10952865 DOI: 10.1136/bcr-2024-259839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Endobronchial and endotracheal tumours are rare in the paediatric population, especially in neonates. The common presentation is respiratory distress with persistent lung collapse or hyperinflation. Treatment usually involves endoscopic or surgical lobar resection. This case presents a preterm neonate who developed acute respiratory distress with persistent right upper lobe atelectasis. A flexible bronchoscopy showed a pediculate violaceous endobronchial lesion in the right main bronchus. Endoscopic resection was not possible due to the patient's low weight and the decision was made to support the patient with continuous positive airway pressure (CPAP) at home, while monitoring her closely. Remarkably, the lesion spontaneously resolved, and CPAP support was discontinued successfully. The case emphasises the importance of early bronchoscopy, continuous monitoring and the possibility of using CPAP support until conditions are reunited for an eventual resection. This unique case also demonstrates the potential for spontaneous resolution in some cases.
Collapse
Affiliation(s)
- Zakhar Shchomak
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Lia Oliveira
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Saianda
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Teresa Bandeira
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| |
Collapse
|
21
|
Ng KL, Park J, Belcher E, Moore AJ. Not all wheeze is asthma. Thorax 2024; 79:378-379. [PMID: 38326024 DOI: 10.1136/thorax-2023-220953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Kher Lik Ng
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Park
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alastair J Moore
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
22
|
Wang S, Yang J, Luo S, Geng J, Ren Y, Zhao L, Liu M, Wang D, Li Y, Tian Z, Liu W, Zhou G, Dai H. The accuracy of electromagnetic navigation bronchoscopy compared to fluoroscopy in navigation of transbronchial lung cryobiopsy in patients with interstitial lung disease. BMC Pulm Med 2024; 24:108. [PMID: 38438922 PMCID: PMC10910665 DOI: 10.1186/s12890-024-02925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Safely implementing transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD) requires accurate navigation. Traditional fluoroscopy falls short in reducing the risk of post-procedure pneumothorax. The potential of electromagnetic navigation bronchoscopy (ENB) as a more precise navigation method warrants further exploration. METHODS A prospective cohort study was conducted on ILD patients undergoing TBLC. Patients were assigned either fluoroscopy or ENB for cryoprobe positioning. Navigation accuracy was evaluated using cone beam computed tomography (CBCT) images as the standard. Safety and diagnostic yield were also observed. RESULTS Seventeen patients underwent TBLC, with 10 guided by fluoroscopy and seven by ENB. Fluoroscopy-guided cryoprobe navigation required more adjustments [9/15 (60%) v.s. 1/9 (11%), p = 0.018] for subsequent TBLC compared to ENB, as confirmed by CBCT images. Clinical characteristics, post-procedure complications, and biopsy specimen size showed no significant differences between the groups. Fourteen patients obtained a pathological diagnosis, and 15 received a multidisciplinary discussion (MDD) diagnosis. In the fluoroscopy group, three patients failed to obtain a pathological diagnosis, and two failed to obtain an MDD diagnosis. CONCLUSIONS ENB demonstrates significantly superior accuracy in TBLC navigation compared to traditional fluoroscopy when CBCT images are used as a reference. Further studies are necessary to determine the value of ENB in TBLC navigation for ILD patients.
Collapse
Affiliation(s)
- Shiyao Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Jinmi Yang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, 010017, Inner Mongolia Autonomous Region, China
| | - Sa Luo
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Jing Geng
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Yanhong Ren
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Ling Zhao
- Department of Pathology, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Dan Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Ying Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Zheng Tian
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Wei Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Guowu Zhou
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China.
| | - Huaping Dai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China.
| |
Collapse
|
23
|
Romero López J, Toledo Muñoz-Cobo G, Padrón Fraysse LA. Endobronchial Ultrasound-Guided Intranodal Forceps Biopsy (EBUS-IFB) in a Case of a Mediastinal Tuberculous Lymphadenitis. Arch Bronconeumol 2024; 60:171-172. [PMID: 38052679 DOI: 10.1016/j.arbres.2023.11.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Javier Romero López
- Graduated in Medicine and Area Specialist in Pneumology at Juan Ramón Jiménez Hospital, Huelva, Spain.
| | - Gloria Toledo Muñoz-Cobo
- Graduated in Medicine and Area Specialist in Pediatrics at Juan Ramón Jiménez Hospital, Huelva, Spain
| | - Luis A Padrón Fraysse
- Graduated in Medicine and Area Specialist in Pneumology at Juan Ramón Jiménez Hospital, Huelva, Spain
| |
Collapse
|
24
|
Bondue B, Leduc D. [Electromagnetic navigation bronchoscopy guided micro-wave ablation: A new loco-regional therapy for pulmonary malignancy]. Rev Mal Respir 2024; 41:175-179. [PMID: 38429193 DOI: 10.1016/j.rmr.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Affiliation(s)
- B Bondue
- Service de pneumologie, hôpital universitaire de Bruxelles, hôpital Erasme, université libre de Bruxelles, 808 route de Lennik, 1070 Bruxelles, Belgique.
| | - D Leduc
- Service de pneumologie, hôpital universitaire de Bruxelles, hôpital Erasme, université libre de Bruxelles, 808 route de Lennik, 1070 Bruxelles, Belgique
| |
Collapse
|
25
|
van Pel R, Gan T, Daniels JMA, Ruigrok D, Hellemons ME, Klooster K, Slebos DJ. Lung transplant airway complications treated with biodegradable airway stents: The Dutch multi-center experience. Clin Transplant 2024; 38:e15289. [PMID: 38486062 DOI: 10.1111/ctr.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Treatment of post lung-transplant airway complications is challenging, and treatment with conventional airway stents is associated with adverse events. More recently, biodegradable airway stents (BDS) have been introduced and may be used to reduce these adverse events. In this study we explore the feasibility of treatment with BDS post lung transplant. METHODS All patients treated with BDS in The Netherlands were included in this retrospective multicenter study. Feasibility, life span of the stent, occurrence of adverse events, and evolution of lung function were evaluated. RESULTS Twelve patients (six malacia and six stenosis) received a total of 57 BDS, ranging from 1 to 10 BDS per patient. Six patients had been pretreated with conventional airway stents. Median stent life span was 112 days (range 66-202). No adverse events occurred during stent placement. In 5 out of 57 stent placements, a single additional bronchoscopy was necessary because of mucus accumulation (n = 4) or excessive granulation tissue (n = 1). All stent naïve patients became airway stent independent after treatment; all patients pretreated with conventional airway stents were still airway stent dependent at the end of follow up. CONCLUSION Treatment with BDS is safe and feasible. Adverse events were mild and easily treatable. All patients with initial treatment with BDS were airway stent independent at the end of follow up with a median treatment of 4 BDS.
Collapse
Affiliation(s)
- Roel van Pel
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tji Gan
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary medicine, Amsterdam university medical center, Amsterdam, The Netherlands
| | - Dieuwertje Ruigrok
- Department of Pulmonary medicine, University medical center Utrecht, Utrecht, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin Klooster
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary medicine, University medical center Groningen, Groningen, The Netherlands
| |
Collapse
|
26
|
Bøgh M, Gade S, Larsen DG, Schytte S, Pedersen U, Kjærgaard T. Predictors in the treatment of malignant central airway obstruction with silicone stents. Eur Arch Otorhinolaryngol 2024; 281:1457-1462. [PMID: 38183453 PMCID: PMC10858089 DOI: 10.1007/s00405-023-08365-3] [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: 09/10/2023] [Accepted: 11/19/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE To examine the role of the silicone stent in palliation of malignant central airway obstruction and identify potential preprocedural predictors for postprocedural outcome. METHODS Patients treated with endoscopic insertion of tracheobronchial silicone stents for malignant central airway obstruction at Aarhus University Hospital from 2012 to 2022 were identified from electronic medical records. Statistical analyses were carried out to identify factors affecting Days Alive and Out of Hospital, complications and overall survival. RESULTS 81 patients underwent a total of 90 tracheobronchial stent insertions. Days Alive and Out of Hospital (DAOH) for the first 30 days were affected negatively by urgent intervention, p < 0.001, preprocedural non-invasive respiratory support, p < 0.001, and preprocedural intubation, p = 0.02. Post-procedural oncological treatment was associated with a significant improved DAOH, p = 0.04. Symptomatology and lesion characteristics were not significantly associated with any impact on DAOH. Overall survival was poor (mean survival was 158 days), and only significantly affected by severe degree of dyspnea, p = 0.02, and postprocedural oncological treatment, p < 0.001. Complication where registered in 25.6% of cases within the first 30 days was observed. Procedure-related mortality was 3.7%. Based on chart annotations by an ENT-surgeon, 95% of the patients experienced relief of symptoms following stent insertion. CONCLUSIONS Palliative tracheobronchial airway stenting with silicone stents is found to have a beneficial impact, more research is required for identification of predictors for postprocedural outcome based on preprocedural classifications.
Collapse
Affiliation(s)
- Mads Bøgh
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Gade
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sten Schytte
- Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ulrik Pedersen
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Kjærgaard
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
| |
Collapse
|
27
|
Li D, Yang N, Dong J, Wang J, Cui X, Yu H, Liu Y. Comparison of rigid bronchoscopy and flexible bronchoscopy for the management of foreign body aspiration in children. Am J Otolaryngol 2024; 45:104092. [PMID: 38043300 DOI: 10.1016/j.amjoto.2023.104092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To compare clinical outcomes of flexible and rigid bronchoscopies for the management of foreign body aspiration (FBA) in different airway locations, especially in unilateral main bronchus, in children, so as to provide some suggestions to assist clinical decisions. METHODS The medical records of children diagnosed with FBA in Qingdao Women and Children's Hospital Affiliated to Qingdao University from January 2020 to June 2022 were retrospectively reviewed. The following information was collected: demographics, radiological findings, endoscopic findings, foreign body locations, duration of operation, operation cost, and intraoperative and postoperative complications. RESULTS 182 children were included in the study with the median age of 1.3 years (interquatile range, 1.0-1.8). Among whom, 124 cases (68.1 %) were male and 58 cases (31.9 %) were female. 11 cases (6.0 %) had the foreign bodies located in the trachea (larynx to carina), 3 cases (1.6 %) located in the trachea and lower bronchus, 1 case (0.5 %) located in bilateral main bronchus, 135 cases (74.2 %) located in unilateral main bronchus, 4 cases (2.2 %) located in main and lobar bronchus, and 28 cases (15.4 %) located in the lobar or segmental bronchus. Among all the included children, 84 cases (46.2 %) received rigid bronchoscopy (RB) and 98 cases (53.8 %) received flexible bronchoscopy (FB). 131 cases with the foreign bodies located in unilateral main bronchus received one type of bronchoscopy (RB or FB). They were divided into two groups according to the location of foreign body relative to the midpoint of main bronchus, the proximal bronchus group and the distal bronchus group. In the proximal bronchus group, duration of operation using RB and FB was 15 (12.5-27.5) min and 15 (14.5-30.0) min, respectively (Z = 0.000, P = 1.000). The intraoperative and postoperative complication rate using RB and FB was 15.4 % and 9.1 %, respectively (χ2 = 0.008, P = 0.927). Operation cost of FB was significantly higher than that of RB (t = -13.396, P = 0.000). In the distal bronchus group, duration of operation using RB was 20 (13.5-25.0) min, which was drastically shorter than that of FB (25 (20.0-35.0) min) (Z = -2.947, P=0.003). Operation cost of FB was still found to be significantly higher than RB (t = -20.456, P=0.000). No significant difference was found in complication rate of RB (14.3%) compared to FB (8.3%) (χ2=0.251, P=0.616). CONCLUSIONS When foreign bodies are lodged in unilateral main bronchus, RB could be chosen as the first-choice procedure with advantages in duration of operation and operation cost, especially for patients in China. Regardless of duration of operation and operation cost, FB is also a safe and efficient therapeutic procedure to remove inhaled foreign bodies in children, except for those located in the trachea and asphyxiating foreign bodies.
Collapse
Affiliation(s)
- Da Li
- Qingdao Women and Children's Hospital, China
| | - Nana Yang
- Qingdao Women and Children's Hospital, China
| | - Jinye Dong
- Qingdao Women and Children's Hospital, China
| | - Jinju Wang
- Qingdao Women and Children's Hospital, China
| | - Xin Cui
- Qingdao Women and Children's Hospital, China.
| | - Hailing Yu
- Qingdao Women and Children's Hospital, China
| | - Yuxin Liu
- Qingdao Women and Children's Hospital, China
| |
Collapse
|
28
|
Simpson RC, Ale GB, Harris WT. Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia. Pediatr Pulmonol 2024; 59:715-723. [PMID: 38088146 DOI: 10.1002/ppul.26819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are frequently performed in children with known or suspected aspiration, however, the additive value of FB in conjunction with direct laryngoscopy and rigid bronchoscopy (DLB) has not been previously quantified. This study details the common endoscopic/cytological findings and associated management impact of FB and BAL in pediatric Aerodigestive patients undergoing combined airway evaluation (FB and DLB) for oropharyngeal dysphagia. MATERIALS AND METHODS A retrospective chart review was performed in children <3 years of age followed through a large Aerodigestive center undergoing outpatient, combined airway endoscopy for dysphagia. Patient and procedural characteristics, endoscopic and BAL findings, and management metrics were collected and analyzed. A secondary analysis evaluated the association between endoscopic findings and medication changes. RESULTS Ninety-one procedures (median patient age, 15 months) were identified. All procedures included both FB and DLB, and just over half (52.7%) included esophagogastroduodenoscopy. Common endoscopic findings included bronchitis (73.6%), adenoidal hypertrophy (31.9%), and tracheomalacia (10.8%). BAL cytology frequently identified neutrophilic inflammation (mean 39.6% neutrophils [interquartile range 6.5%-71%)]. Cultured pathogens commonly included Streptococcus viridans (46.6%), Hemophilus influenzae (36.3%), Moraxella catarrhalis (30.1%), and Streptococcus pneumoniae (25.0%). FB and BAL results contributed to clinical decisions in 65 of 91 (71.4%) patients. Endoscopically-diagnosed bronchitis (odds ratio [OR] 7.27, 95% confidence interval [CI] 2.4-21.99) and tracheomalacia (OR 5.79, 95% CI 1.20-27.85) were significantly associated with increased odds of medication adjustments following FB. CONCLUSION In pediatric Aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia, FB and BAL are high-yield and clinically impactful procedures.
Collapse
Affiliation(s)
- Ryne C Simpson
- Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Guillermo Beltran Ale
- Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
29
|
Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
Collapse
Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
30
|
Kamga H. Comparing performance of flexible bronchoscopy with videolaryngoscopy for awake tracheal intubation: a reply. Anaesthesia 2024; 79:328. [PMID: 37816313 DOI: 10.1111/anae.16141] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/12/2023]
Affiliation(s)
- H Kamga
- Centre Hospitalier Universitaire de Caen, Caen, France
| |
Collapse
|
31
|
Koo DC, Scalise PN, Izadi SN, Kamran A, Mohammed S, Zendejas B, Demehri FR. Bronchoscopic Localization of Tracheoesophageal Fistula in Newborns with Esophageal Atresia: Intubate Above or Below the Fistula? J Pediatr Surg 2024; 59:363-367. [PMID: 37957098 DOI: 10.1016/j.jpedsurg.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE In neonates with suspected type C esophageal atresia and tracheoesophageal fistula (EA/TEF) who require preoperative intubation, some texts advocate for attempted "deep" or distal-to-fistula intubation. However, this can lead to gastric distension and ventilatory compromise if a distal fistula is accidently intubated. This study examines the distribution of tracheoesophageal fistula locations in neonates with type C EA/TEF as determined by intraoperative bronchoscopy. METHODS This was a single-center retrospective review of neonates with suspected type C EA/TEF who underwent primary repair with intraoperative bronchoscopy between 2010 and 2020. Data were collected on demographics and fistula location during bronchoscopic evaluation. Fistula location was categorized as amenable to blind deep intubation (>1.5 cm above carina) or not amenable to blind deep intubation intubation (≤1.5 cm above carina or carinal). RESULTS Sixty-nine neonates underwent primary repair of Type C EA/TEF with intraoperative bronchoscopy during the study period. Three patients did not have documented fistula locations and were excluded (n = 66). In total, 49 (74 %) of patients were found to have fistulas located ≤1.5 cm from the carina that were not amenable to blind deep intubation. Only 17 patients (26 %) had fistulas >1.5 cm above carina potentially amenable to blind deep intubation. CONCLUSIONS Most neonates with suspected type C esophageal atresia and tracheoesophageal fistula have distal tracheal and carinal fistulas that are not amenable to blind deep intubation. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Donna C Koo
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States.
| | - P Nina Scalise
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Shawn N Izadi
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States.
| |
Collapse
|
32
|
He Z, Hou J, Li Y, Li Y, Zeng W, Liu W. Analysis of clinical outcomes and prognosis of patients with early bronchogenic lung cancer after treatment of rigid bronchoscopy combining fiberoptic bronchoscopy: a single-center retrospective study. Expert Rev Med Devices 2024; 21:257-263. [PMID: 38131192 DOI: 10.1080/17434440.2023.2298711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To investigate the clinical value of rigid bronchoscopy combined with fiberoptic bronchoscopy in patients with early bronchogenic lung cancer who underwent sleeve lobectomy. METHODS A retrospective study was performed on 76 patients with early bronchogenic lung cancer admitted to our center from March 2016 to March 2017. Patients in the control group received conventional sleeve lobectomy (n = 38), while patients in the observation group underwent sleeve lobectomy by using rigid bronchoscopy combining fiberoptic bronchoscopy (n = 38). We compared perioperative period indicators and the recovery of pulmonary function indexes one month after the operation were compared in two groups. The prognosis of the patients were also analyzed. RESULTS Compared with the control group, the intraoperative blood loss, operation duration and airway reconstruction duration in the observation group were significantly reduced. The total incidence of perioperative complications was markedly lower in the observation group than in the control group. The percentage of DLCO% was significantly improved in the observation group. The relapse-free survival (RFS) in the observation group was remarkably longer than in the control group. CONCLUSION Rigid bronchoscopy combined with fiberoptic bronchoscopy is beneficial to improve the clinical outcome and prognosis of patients with early bronchogenic lung cancer more effectively.
Collapse
Affiliation(s)
- Zhengbing He
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Juhua Hou
- Department of School of Clinical Medicine, Yiyang Medical College, Yiyang, China
| | - Yong Li
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Yu Li
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Wei Zeng
- Department of General Practice, Yiyang Medical College Affiliated Hospital, Yiyang, China
| | - Wenguang Liu
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| |
Collapse
|
33
|
Xue FS, Gao X, Wan L. Comparing performance of flexible bronchoscopy with videolaryngoscopy for awake tracheal intubation. Anaesthesia 2024; 79:327. [PMID: 37720961 DOI: 10.1111/anae.16133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Affiliation(s)
- F S Xue
- Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - X Gao
- Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - L Wan
- Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
34
|
Xu F, Zhang C, Xie C. The ventilatory role of sputum suction tubes in shared airways. Asian J Surg 2024; 47:1413. [PMID: 38036361 DOI: 10.1016/j.asjsur.2023.11.107] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Fei Xu
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, China, 610031, Sichuan, PR China.
| | - Cheng Zhang
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, China, 610031, Sichuan, PR China; Department of Anesthesiology, ChengDu Xinjin District Maternal and Child Healthe Care Hospital, PR China
| | - Cheng Xie
- Department of Pediatric Respiratory, Chengdu Women's and Children's Central Hospital, Chengdu, China, 610031, Sichuan, PR China
| |
Collapse
|
35
|
Verger N, Parpet P, Bentoumi Y, Paulet R, Thyrault M, Sztrymf B. [Acute respiratory distress due to tracheostomy tube migration]. Rev Mal Respir 2024; 41:257-261. [PMID: 38388288 DOI: 10.1016/j.rmr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024]
Abstract
Tracheostomy cannula care is of paramount importance in the daily management of tracheotomized patients. While some complications are commonplace, specific events can occur, often according to type of cannula. We herein report the case of a 71-year-old patient; following a lengthy stay in the intensive care unit, she had received a Safe T-Tube cannula designed to provide support in a stenotic trachea. At home, while suctioning her tracheal secretions, she suddenly experienced respiratory distress requiring a rapid intervention. On arrival, no seeable cannula was found, either in the tracheostomy or in the patient's immediate surroundings. Following her transfer to intensive care, a new cannula was inserted into the tracheostomy opening, enabling mechanical ventilation to begin and achieving rapid relief of dyspnea and improvement of the patient's overall condition. Bronchial fibroscopy was then performed, during which the Safe T-Tube cannula was found folded on itself in a supra-carinal intra-tracheal position. It was extracted and replaced by a cannula of the same model, which was sewn to the skin. Although rare and usually limited to flexible cannulas, this complication is potentially fatal. Generally speaking, when cannula obstruction is suspected, bronchial endoscopy in an intensive care setting is a vital necessity. It is not only the cornerstone of the diagnosis, but also of paramount importance in treatment taking into full account the mechanism of obstruction.
Collapse
Affiliation(s)
- N Verger
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France.
| | - P Parpet
- SAMU-SMUR de Longjumeau, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 91160 Longjumeau, France
| | - Y Bentoumi
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| | - R Paulet
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| | - M Thyrault
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| | - B Sztrymf
- Service de réanimation polyvalente, hôpital de Longjumeau, groupe hospitalier Nord Essonne, 159, rue du Président-François-Mitterrand, 91160 Longjumeau, France
| |
Collapse
|
36
|
Beeman A, Ramaswamy M, Butler C, McIntyre D, Mann E, Hewitt R, Chippington S, Muthialu N. Pedicled pericardial patch in tracheal reconstruction in children - Novel technique to provide vascularized tissue for salvaging difficult airways. Int J Pediatr Otorhinolaryngol 2024; 178:111891. [PMID: 38368842 DOI: 10.1016/j.ijporl.2024.111891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Management of large central airway defects are often complex. Children who present with these defects have multiple co-morbidities or have had previous surgeries. Surgical options include various tissue cover for these defects without longer term benefits. Vascularized autologous pericardial patch offers a better solution to these defects by providing vascularity and potential for remodelling in future. METHODS 41 children (M:F of 24:17) were operated for large trachea-bronchial defects between January 2015 and August 2022. The median age of was 12 months with median weight of 8.9 kg (IQR 3.3 kg-17.7 kg) Causes leading to the central tracheal defect include failed repair of previous trachea-oesophageal fistula (TOF) (n = 21) and acquired fistula due to button battery injury (n = 11). Surgical repair consisted of autologous pedicled pericardial patch repair for the airway defect under cardiopulmonary bypass. RESULTS There were two operative deaths related to extensive sepsis and necrosis of reconstructed trachea. Four children had further reoperation with additional patch. Bronchoscopy was used as surveillance in all these children, with use of airway stents (biodegradable stent) in 9 children. The median ventilation time was 8 days, with tracheostomy being needed in 5 for long term support. CONCLUSIONS Autologous pericardial patch is a versatile technique and can be used to salvage large tracheal defects when other method have failed or not feasible. Tracheomalacia at the site of repair could be managed with biodegradable stents. Vascularity and ciliary function of the patch still needs to be evaluated.
Collapse
Affiliation(s)
- Arun Beeman
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Madhavan Ramaswamy
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Colin Butler
- Departments of Cardiothoracic Surgery, Ear, Nose and Throat, Great Ormond Street Hospital, London, United Kingdom
| | - Denise McIntyre
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Eloise Mann
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Richard Hewitt
- Departments of Cardiothoracic Surgery, Ear, Nose and Throat, Great Ormond Street Hospital, London, United Kingdom
| | - Sam Chippington
- Departments of Cardiothoracic Surgery, Interventional Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom.
| |
Collapse
|
37
|
Saad F, Frysch R, Saalfeld S, Kellnberger S, Schulz J, Fahrig R, Bhadra K, Nürnberger A, Rose G. Deformable 3D/3D CT-to-digital-tomosynthesis image registration in image-guided bronchoscopy interventions. Comput Biol Med 2024; 171:108199. [PMID: 38394801 DOI: 10.1016/j.compbiomed.2024.108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
Traditional navigational bronchoscopy procedures rely on preprocedural computed tomography (CT) and intraoperative chest radiography and cone-beam CT (CBCT) to biopsy peripheral lung lesions. This navigational approach is challenging due to the projective nature of radiography, and the high radiation dose, long imaging time, and large footprints of CBCT. Digital tomosynthesis (DTS) is considered an attractive alternative combining the advantages of radiography and CBCT. Only the depth resolution cannot match a full CBCT image due to the limited angle acquisition. To address this issue, preoperative CT is a good auxiliary in guiding bronchoscopy interventions. Nevertheless, CT-to-body divergence caused by anatomic changes and respiratory motion, hinders the effective use of CT imaging. To mitigate CT-to-body divergence, we propose a novel deformable 3D/3D CT-to-DTS registration algorithm employing a multistage, multiresolution approach and using affine and elastic B-spline transformation models with bone and lung mask images. A multiresolution strategy with a Gaussian image pyramid and a multigrid strategy within the B-spline model are applied. The normalized correlation coefficient is included in the cost function for the affine model and a multimetric weighted cost function is used for the B-spline model, with weights determined heuristically. Tested on simulated and real patient bronchoscopy data, the algorithm yields promising results. Assessed qualitatively by visual inspection and quantitatively by computing the Dice coefficient (DC) and the average symmetric surface distance (ASSD), the algorithm achieves mean DC of 0.82±0.05 and 0.74±0.05, and mean ASSD of 0.65±0.29mm and 0.93±0.43mm for simulated and real data, respectively. This algorithm lays the groundwork for CT-aided intraoperative DTS imaging in image-guided bronchoscopy interventions with future studies focusing on automated metric weight setting.
Collapse
Affiliation(s)
- Fatima Saad
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany.
| | - Robert Frysch
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Jessica Schulz
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Siemens Healthcare GmbH, Forchheim, Germany
| | | | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, USA
| | - Andreas Nürnberger
- Data and Knowledge Engineering Group, Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany
| | - Georg Rose
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| |
Collapse
|
38
|
Thomas R, Marchant JM, Goyal V, Masters IB, Yerkovich ST, Chang AB. Clinical utility of elective paediatric flexible bronchoscopy and impact on the quality of life: protocol for a single-centre, single-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e001704. [PMID: 38413121 PMCID: PMC10900573 DOI: 10.1136/bmjresp-2023-001704] [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: 03/07/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there are no randomised controlled trials (RCTs) that have examined its benefits (or otherwise).Our primary aim is to determine the impact of FB on the parent-proxy quality-of-life (QoL) scores. Our secondary aims are to determine if undertaking FB leads to (a) change in management and (b) improvement of other relevant patient-reported outcome measures (PROMs). We also quantified the benefits of elective FB (using 10-point Likert scale). We hypothesised that undertaking elective FB will contribute to accurate diagnosis and therefore appropriate treatment, which will in turn improve QoL and will be deemed to be beneficial from patient and doctor perspectives. METHODS AND ANALYSIS Our parallel single-centre, single-blind RCT (commenced in May 2020) has a planned sample size of 114 children (aged <18 years) recruited from respiratory clinics at Queensland Children's Hospital, Brisbane, Australia. Children are randomised (1:1 concealed allocation) within two strata: age (≤2 vs >2 years) and indication for FB (chronic cough vs other indications) to either (a) early arm (intervention where FB undertaken within 2 weeks) or (b) delayed (control, FB undertaken at usual wait time). Our primary outcome is the difference between groups in their change in QoL at the T2 timepoint when the intervention group has had the FB and the control group has not. Our secondary outcomes are change in management, change in PROMs, adverse events and the Likert scales. ETHICS AND DISSEMINATION The human research ethics committee of the Queensland Children's Hospital granted ethical clearance (HREC/20/QCHQ/62394). Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation. Results will be disseminated through conference presentations, teaching avenues, workshops, websites and publications. REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12620000610932.
Collapse
Affiliation(s)
- Rahul Thomas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Anne B Chang
- Respiratory Medicine, Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| |
Collapse
|
39
|
Singhania SVK, Raut A. Dry cough with abnormal airway connection. Thorax 2024; 79:279-280. [PMID: 38182425 DOI: 10.1136/thorax-2023-220934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Sumeet Vimal Kishor Singhania
- Respiratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Abhijit Raut
- Respiratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| |
Collapse
|
40
|
Huang BK, Elicker BM, Henry TS, Kallianos KG, Hahn LD, Tang M, Heng F, McCulloch CE, Bhakta NR, Majumdar S, Choi J, Denlinger LC, Fain SB, Hastie AT, Hoffman EA, Israel E, Jarjour NN, Levy BD, Mauger DT, Sumino K, Wenzel SE, Castro M, Woodruff PG, Fahy JV, Sarp FTNSARP. Persistent mucus plugs in proximal airways are consequential for airflow limitation in asthma. JCI Insight 2024; 9:e174124. [PMID: 38127464 DOI: 10.1172/jci.insight.174124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUNDInformation about the size, airway location, and longitudinal behavior of mucus plugs in asthma is needed to understand their role in mechanisms of airflow obstruction and to rationally design muco-active treatments.METHODSCT lung scans from 57 patients with asthma were analyzed to quantify mucus plug size and airway location, and paired CT scans obtained 3 years apart were analyzed to determine plug behavior over time. Radiologist annotations of mucus plugs were incorporated in an image-processing pipeline to generate size and location information that was related to measures of airflow.RESULTSThe length distribution of 778 annotated mucus plugs was multimodal, and a 12 mm length defined short ("stubby", ≤12 mm) and long ("stringy", >12 mm) plug phenotypes. High mucus plug burden was disproportionately attributable to stringy mucus plugs. Mucus plugs localized predominantly to airway generations 6-9, and 47% of plugs in baseline scans persisted in the same airway for 3 years and fluctuated in length and volume. Mucus plugs in larger proximal generations had greater effects on spirometry measures than plugs in smaller distal generations, and a model of airflow that estimates the increased airway resistance attributable to plugs predicted a greater effect for proximal generations and more numerous mucus plugs.CONCLUSIONPersistent mucus plugs in proximal airway generations occur in asthma and demonstrate a stochastic process of formation and resolution over time. Proximal airway mucus plugs are consequential for airflow and are in locations amenable to treatment by inhaled muco-active drugs or bronchoscopy.TRIAL REGISTRATIONClinicaltrials.gov; NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01716494, and NCT01760915.FUNDINGAstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Sanofi-Genzyme-Regeneron, and TEVA provided financial support for study activities at the Coordinating and Clinical Centers beyond the third year of patient follow-up. These companies had no role in study design or data analysis, and the only restriction on the funds was that they be used to support the SARP initiative.
Collapse
Affiliation(s)
- Brendan K Huang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
| | - Brett M Elicker
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Travis S Henry
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Kimberly G Kallianos
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Lewis D Hahn
- Department of Radiology, UCSD, San Diego, California, USA
| | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
| | | | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Nirav R Bhakta
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Loren C Denlinger
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sean B Fain
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Annette T Hastie
- Department of Internal Medicine, Section for Pulmonary, Critical Care, Allergy and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dave T Mauger
- Division of Biostatistics and Bioinformatics, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, USA
| | - Sally E Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
- Cardiovascular Research Institute and
| | - John V Fahy
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and
- Cardiovascular Research Institute and
| | | |
Collapse
|
41
|
Lin CK, Ruan SY, Fan HJ, Chang HC, Lin YT, Ho CC. Using cryoprobes of different sizes combined with cone-beam computed tomography-derived augmented fluoroscopy and endobronchial ultrasound to diagnose peripheral pulmonary lesions: a propensity-matched study. Respir Res 2024; 25:65. [PMID: 38317222 PMCID: PMC10840252 DOI: 10.1186/s12931-024-02700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) and cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) are utilized for the diagnosis of peripheral pulmonary lesions (PPLs). Combining them with transbronchial cryobiopsy (TBC) can provide sufficient tissue for genetic analysis. However, cryoprobes of different sizes have varying degrees of flexibility, which can affect their ability to access the target bronchus and potentially impact the accuracy. The aim of this study was to compare the diagnostic efficacy of cryoprobes of varying sizes in CBCT-AF and EBUS for the diagnosis of PPLs. METHODS Patients who underwent endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) and TBC combined with CBCT-AF for PPLs diagnosis between January 2021 and May 2022 were included. Propensity score matching and competing-risks regression were utilized for data analysis. Primary outcome was the diagnostic accuracy of TBC. RESULTS A total of 284 patients underwent TBC, with 172 using a 1.7-mm cryoprobe (1.7 group) and 112 using a 1.1-mm cryoprobe (1.1 group). Finally, we included 99 paired patients following propensity score matching. The diagnostic accuracy of TBC was higher in the 1.1 group (80.8% vs. 69.7%, P = 0.050), with a similar rate of complications. Subgroup analysis also revealed that the 1.1 group had better accuracy when PPLs were located in the upper lobe (85.2% vs. 66.1%, P = 0.020), when PPLs were smaller than 20 mm (78.8% vs. 48.8%, P = 0.008), and when intra-procedural CBCT was needed to be used (79.5% vs. 42.3%, P = 0.001). TBC obtained larger specimens than TBB in both groups. There is still a trend of larger sample size obtained in the 1.7 group, but there is no statistically different between our two study groups (40.8 mm2 vs. 22.0 mm2, P = 0.283). CONCLUSIONS The combination of TBC with CBCT-AF and EBUS is effective in diagnosing PPLs, and a thin cryoprobe is preferred when the PPLs located in difficult areas.
Collapse
Affiliation(s)
- Ching-Kai Lin
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hsin-Chu Hospital, Hsin-Chu 300, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No.17 Xu-Zhou Road, Taipei, 10020, Taiwan
| | - Hung-Jen Fan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu County 302, Taipei, Taiwan
| | - Hao-Chun Chang
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu County 302, Taipei, Taiwan
| | - Yen-Ting Lin
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan.
| |
Collapse
|
42
|
Huang J, Lin J, Lin Z, Li S, Zhong C. Artificial Intelligence Feedback for Bronchoscopy Training: Old Wine in a New Bottle or True Innovation? Chest 2024; 165:e60-e61. [PMID: 38336449 DOI: 10.1016/j.chest.2023.09.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Junfeng Huang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinsheng Lin
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zikai Lin
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Medical University, Guangdong, China
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changhao Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
43
|
Criner GJ, Mallea JM, Abu-Hijleh M, Sachdeva A, Kalhan R, Hergott CA, Lazarus DR, Mularski RA, Calero K, Reed MF, Nsiah-Dosu S, Himes D, Kubo H, Kinsey CM, Majid A, Hogarth DK, Kaplan PV, Case AH, Makani SS, Chen TM, Delage A, Zgoda M, Shepherd RW. Sustained Clinical Benefits of Spiration Valve System in Patients with Severe Emphysema: 24-Month Follow-Up of EMPROVE. Ann Am Thorac Soc 2024; 21:251-260. [PMID: 37948704 PMCID: PMC10848907 DOI: 10.1513/annalsats.202306-520oc] [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: 06/07/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023] Open
Abstract
Rationale: Follow-up of patients with emphysema treated with endobronchial valves is limited to 3-12 months after treatment in prior reports. To date, no comparative data exist between treatment and control subjects with a longer follow-up. Objectives: To assess the durability of the Spiration Valve System (SVS) in patients with severe heterogeneous emphysema over a 24-month period. Methods: EMPROVE, a multicenter randomized controlled trial, presents a rigorous comparison between treatment and control groups for up to 24 months. Lung function, respiratory symptoms, and quality-of-life (QOL) measures were assessed. Results: A significant improvement in forced expiratory volume in 1 second was maintained at 24 months in the SVS treatment group versus the control group. Similarly, significant improvements were maintained in several QOL measures, including the St. George's Respiratory Questionnaire and the COPD Assessment Test. Patients in the SVS treatment group experienced significantly less dyspnea than those in the control group, as indicated by the modified Medical Research Council dyspnea scale score. Adverse events at 24 months did not significantly differ between the SVS treatment and control groups. Acute chronic obstructive pulmonary disease exacerbation rates in the SVS treatment and control groups were 13.7% (14 of 102) and 15.6% (7 of 45), respectively. Pneumothorax rates in the SVS treatment and control groups were 1.0% (1 of 102) and 0.0% (0 of 45), respectively. Conclusions: SVS treatment resulted in statistically significant and clinically meaningful durable improvements in lung function, respiratory symptoms, and QOL, as well as a statistically significant reduction in dyspnea, for at least 24 months while maintaining an acceptable safety profile. Clinical trial registered with www.clinicaltrials.gov (NCT01812447).
Collapse
Affiliation(s)
- Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | | | | | - Ravi Kalhan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Karel Calero
- Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Michael F. Reed
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - David Himes
- Olympus Corporation of the Americas, Westborough, Massachusetts
| | | | | | - Adnan Majid
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Philip V. Kaplan
- Detroit Clinical Research Center, Beaumont Hospital, Farmington Hills, Michigan
| | | | - Samir S. Makani
- University of California, San Diego Medical Center, San Diego, California
| | | | - Antoine Delage
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Hôpital Laval, Quebec, Quebec, Canada
| | | | | |
Collapse
|
44
|
Januska MN, Langfelder-Schwind E, Vicencio AG, Berdella MN. Persistent lobar atelectasis in an infant with cystic fibrosis: The role for flexible bronchoscopy and poractant alfa. Pediatr Pulmonol 2024; 59:492-495. [PMID: 37975497 PMCID: PMC10842471 DOI: 10.1002/ppul.26757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Megan N Januska
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Department of Medicine, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Alfin G Vicencio
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria N Berdella
- The Cystic Fibrosis Center, Department of Medicine, Lenox Hill Hospital/Northwell Health, New York, New York, USA
- Department of Pediatrics, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| |
Collapse
|
45
|
Vu JP, Jagannath D, Spielberg DR, Chiou EH, Hosek KE, Lambert EM. Triple endoscopy and recurrent croup in children: A single aerodigestive center experience. Auris Nasus Larynx 2024; 51:125-131. [PMID: 37550113 DOI: 10.1016/j.anl.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/22/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To determine the utility of triple endoscopy (combined direct laryngoscopy, bronchoscopy (DLB), flexible bronchoscopy with bronchoalveolar lavage (FB + BAL), and esophagogastroduodenoscopy (EGD)) in the diagnosis and management of patients with recurrent croup (RC), and to identify predictors of endoscopic findings METHODS: A retrospective chart review was performed of pediatric patients (age <18 years) with RC evaluated by triple endoscopy at a tertiary care pediatric hospital from 2010 to 2021. Data including presenting symptoms, airway findings, BAL and EGD with biopsy findings were collected. RESULTS 42 patients with RC underwent triple endoscopy were included. The mean age was 4.55±2.84 years old. The most common symptom was chronic cough among 19 (45%) patients, while 23 (55%) patients had gastrointestinal (GI) symptoms. Airway findings included tracheomalacia in 19, laryngeal cleft in 17, and subglottic stenosis in 11 patients. On EGD with biopsy, abnormal gross findings were present in 6 and abnormal microscopic findings in 18 patients, including 6 with histologic findings suggestive of gastroesophageal reflux and 5 with eosinophilic esophagitis. Seventeen (40%) patients had positive culture on BAL. No findings in patient histories significantly predicted presence of lower airway malacia, subglottic stenosis, or abnormal EGD findings. CONCLUSIONS Children with recurrent croup presenting to aerodigestive centers may not have any pertinent presenting symptoms that correlate with significant findings on triple endoscopy. Further work is needed to determine which children with recurrent croup may benefit from aerodigestive evaluation. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Jennifer P Vu
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA
| | - Deepak Jagannath
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA.
| | - David R Spielberg
- Division of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eric H Chiou
- Division of Gastroenterology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kathleen E Hosek
- Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
| | - Elton M Lambert
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA
| |
Collapse
|
46
|
Sachdeva A, Sethi S. Motivation and Learning: Leveraging Artificial Intelligence to Improve Bronchoscopy Performance. Chest 2024; 165:243-245. [PMID: 38336435 DOI: 10.1016/j.chest.2023.09.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Ashutosh Sachdeva
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Sonali Sethi
- Pulmonary Department, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
47
|
Soo CI, Mak WW, Nasaruddin MZ, Ismail R, Ban AYL, Abdul Rahaman JA. Bronchial thermoplasty for severe asthmatics: a real-world clinical study from Malaysia. Singapore Med J 2024; 65:119-122. [PMID: 34617697 PMCID: PMC10942133 DOI: 10.11622/smedj.2021144] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Chun Ian Soo
- Division of Respiratory Medicine, Department of Internal Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Woh Wei Mak
- Department of Pulmonology, Serdang Hospital, Selangor, Malaysia
| | | | - Rosmadi Ismail
- Department of Pulmonology, Serdang Hospital, Selangor, Malaysia
| | - Andrea Yu-Lin Ban
- Pulmonology Unit, Department of Internal Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | |
Collapse
|
48
|
Tian L, Wu Y, Wang D, Liu W, Wei Y, Zhou Z, Zhang D. Application of fiberoptic bronchoscopy assisted local injection of budesonide in improving the prognosis of severe pneumonia. Minerva Med 2024; 115:88-89. [PMID: 34180646 DOI: 10.23736/s0026-4806.21.07609-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Linjuan Tian
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China -
| | - Yunping Wu
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China
| | - Dong Wang
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China
| | - Wei Liu
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China
| | - Yongding Wei
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China
| | - Zhihe Zhou
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China
| | - Dongyue Zhang
- Department of Respiratory and Critical Care, The First Peoples' Hospital of Lanzhou, Lanzhou, China
| |
Collapse
|
49
|
Steinfort DP. Systematic mediastinal staging in non-small cell lung cancer: Filling in the guideline evidence gap. Respirology 2024; 29:89-91. [PMID: 38143423 DOI: 10.1111/resp.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023]
Abstract
See related article
Collapse
Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
50
|
Abstract
OBJECTIVE Cross-sectional imaging allows identification of rare patients with a vascular ring and circumflex aorta. The key diagnostic feature is crossing of the transverse aortic arch from right to left posterior to the trachea and superior to the carina in a patient with a right aortic arch. We evaluated our patients who received an aortic uncrossing procedure. METHODS We reviewed all patients who underwent aortic uncrossing from 2002 to 2022. All patients received preoperative computed tomography imaging and bronchoscopy. RESULTS Eleven patients ranging in age from 1.5 to 10 years (median 4 years) underwent aortic uncrossing. Two patients had prior left ligamentum division, and 3 patients had prior left aortic arch division. All had significant clinical symptoms. Eight patients had deep hypothermic circulatory arrest (mean 34 minutes), and 3 patients had antegrade cerebral perfusion (median, 28 minutes). Patch material was not used for aortic augmentation, and no patient underwent a posterior tracheopexy or rotational esophagoplasty. Postoperative length of stay ranged from 4 to 31 days (median, 5 days). One patient required a temporary tracheostomy for bilateral recurrent laryngeal nerve paresis, which recovered. One patient required an aortic extension graft to alleviate esophageal compression from an unusual ectatic esophageal course. All patients had relief of airway symptoms and dysphagia. CONCLUSIONS In properly selected patients with a right aortic arch and circumflex aorta, aortic uncrossing is a safe and effective therapy to treat airway and esophageal compression. The procedure can be conducted with deep hypothermic circulatory arrest or antegrade cerebral perfusion. Careful attention to the location of the esophagus and recurrent laryngeal nerves is required.
Collapse
Affiliation(s)
- Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Ky; Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio.
| | - Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert J. Lurie, Children's Hospital of Chicago, Chicago, Ill; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - William J Wallen
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Ky; Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio
| | - Osama Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert J. Lurie, Children's Hospital of Chicago, Chicago, Ill; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| |
Collapse
|