Are flexible bronchoscopic cryoextraction practices an alternative to rigid bronchoscopy?

INTRODUCTION: We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. MATERIALS AND METHODS: The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. RESULT: The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. CONCLUSIONS: Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Current Practice of Airway Stenting in the Adult Population in Europe: A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP).

BACKGROUND: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. OBJECTIVES: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. METHODS: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. RESULTS: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. CONCLUSION: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings.

Respiratory Conditions Associated with Tracheobronchomegaly (Mounier-Kuhn Syndrome): A Study of Seventeen Cases.

BACKGROUND: Mounier-Kuhn syndrome (MKS) is a rare disorder characterized by enlargement of the trachea and main bronchi and associated with recurrent respiratory tract infections. OBJECTIVE: This multicenter, retrospective study was carried out to describe respiratory conditions associated with tracheobronchomegaly. METHODS: Nine institutions involved in the 'Groupe d'Endoscopie de Langue Française' (GELF) participated in this study. A standard form was used to record patient characteristics, treatments and follow-up from medical charts. RESULTS: Seventeen patients, 53% male, aged 58 ± 18 years at diagnosis were included. Recurrent infections revealed MKS in 88% of cases. Main comorbid conditions were diffuse bronchiectasis in 88% of patients and tracheobronchomalacia in 67% of cases. The exacerbation rate was 1.5 exacerbations/patient/year. The main non-respiratory morbid condition was gastroesophageal reflux disease in 29% of cases. Interventional bronchoscopy was performed in seven patients (41%), consisting of laser (n = 2) and tracheal stenting (n = 5). Complications related to stents were observed in 80% of cases with a mean stent duration of 8 months. Four deaths, including three due to respiratory causes, occurred during follow-up. CONCLUSIONS: This is the largest series of MKS reported in the literature, showing that bronchiectasis and tracheobronchomalacia are the main associated morbid conditions that constitute a challenge for treatment.

Endobronchial Treatment of Carcinoid Tumors of the Lung.

BACKGROUND: Bronchial carcinoid tumors are known as low-grade malignancies. Surgery has been proposed as the best treatment of choice for lung carcinoids. However, less invasive treatment approaches may be considered due to low-grade malignancy potential of such tumors. The aim of this study was to review the results of endobronchial treatments of carcinoid tumors of the lung and to compare with the outcome after surgery. METHODS: Initial complete tumor eradication with an endobronchial treatment was attempted for 29 patients. Diode laser or argon plasma coagulation was used during these treatments. Cryotherapy or laser treatments were applied consecutively in patients for whom there was good bronchoscopic visualization of the distal and basal tumor margins and no evidence of bronchial wall involvement. Surgery was performed in cases of atypical carcinoid and in cases of nonvisualization of the basal and distal part of the tumor. RESULTS: Overall, 29 patients have been included (median age 58 years; range, 23-77 years). Median follow-up has been 49 months (range, 22-94 months). A total of 24 patients (69%) had typical carcinoid tumor, 5 patients (31%) had atypical carcinoid tumor. Initial endobronchial treatment provided complete tumor eradication in 21 of 29 patients (72%). Of the eight other patients (28%), two were atypical carcinoids, and underwent surgical treatment. There was no tumor-related death and no recurrence during the follow-up in both groups. There was no difference for survival or recurrence between the surgical and the endobronchial treatment group of patients (p > 0.05). CONCLUSION: Endobronchial treatment may be considered as safe, effective treatment for typical carcinoid tumors in the central airways. Addition of initial endobronchial treatment had no negative effect on the surgical outcome.

Endobronchial Watanabe Spigot in the treatment of bronchobiliary fistula.

Bronchobiliary fistula (BBF) is a rare condition in which an abnormal communication exists between the bile ducts and the bronchial tree. Malignancy is the most common etiology of BBF, although many others are possible. A 74-year-old male patient with an inoperable Klatskin tumor presented with a complaint of yellow-green sputum and cough; the patient underwent fiber-optic bronchoscopy based on a preliminary diagnosis of bronchobiliary fistula. Using fiber-optic rigid bronchoscopy, the laterobasal segment of the lower right lung lobe was occluded using three pieces of 5-mm Endobronchial Watanabe Spigot. Bile drainage subsequently ceased. A bronchoscopic approach provides an alternative option for BBF treatment, particularly in patients who choose not to undergo surgery, or for whom surgery is not an option due to their underlying general condition.

The View of Religious Officials on Organ Donation and Transplantation in the Zeytinburnu District of Istanbul.

One of the obstacles to organ donation and transplantation in Turkey is that of religious beliefs and, at this point, religious officials constitute a key aspect of this problem. Positive or negative viewpoints held by religious officials regarding organ donation and transplantation are influential in guiding the public. This descriptive study was conducted for the purpose of describing religious officials' viewpoints on this subject. To determine the opinions of 40 religious officials from among the imams and muezzins working in Zeytinburnu District Mufti (Religious Officials Superior) Station who participated in a normal meeting in April and who fully completed the survey. A 27-question survey form was used that consisted of open-ended and closed questions, 5 of which were on socio-demographic characteristics, 13 on viewpoints on organ donation and transplantation, and 9 on the Islamic viewpoint regarding organ donation and transplantation. For the analysis of the results, Student's t test and one-way ANOVA tests were used. It was found that all of the religious officials believed in the importance of organ donation, 80 % considered donating their organs, and 5 % had made an organ donation. Of the religious officials who had not donated organs, 35 % gave an answer that there was no specific reason and 27.5 % stated that they had never considered the subject. While the number of those stating that they would donate the organs of a close associate who had died, 77.5 % of them who did not want to donate gave as their reason the idea that if it were him, he would perhaps not want to give his organs after death. Of the religious officials questioned, 92.5 % asserted that the religion of Islam looked positively on organ donation and transplantation, 55 % stated that the knowledge of religious officials in the country was inadequate regarding this subject, and 65 % said that for interest in organ donation to increase, religious officials should make speeches and raise the issue with the public in conversations, meetings, and sermons. Fully 85 % asserted that for interest in organ donation in Turkey to increase, religious officials have to lead on the subject. Of those questioned, 52.5 % considered their knowledge on organ donation and transplantation to be adequate and that they had obtained 52.5 % of such information from seminars/conferences, 50 % from television/radio, and 45 % from Directorate of Religious Affairs publications. However, 40 % expressed that they did not know where organ donations were made. One reason for inadequate organ donation in Turkey is that of incorrect religious beliefs. Thus, it is necessary that informative efforts are made by the Directorate of Religious Affairs through in-house training programs, and that healthcare, religious, and legal officials work jointly to inform the public about organ donation, organ transplantation, and brain death. Additionally, religious officials should donate organs by the way of example and, to increase their sensitivity, healthcare professionals should go more frequently to mosques and Mufti Stations.

Place of vibration response imaging in preoperative lung cancer patients.

INTRODUCTION: In this study, we aimed to investigate the role of the vibration response imaging (VRI) as the second-line test in preoperative evaluation of the patients with non-small cell lung cancer (NSCLC) and in prediction of the predicted postoperative forced expiratory volume in one second (ppo FEV1). MATERIALS AND METHODS: A total of 31 patients scheduled for surgery underwent pulmonary function tests (PFTs), VRIxp and quantitative lung perfusion scintigraphy (LPS) in order to predict postoperative lung functions. PFTs and VRI were repeated between 4th and 6th postoperative weeks and FEV1 and FEV1% values were compared with preoperative VRI and ppo-FEV1 calculated with perfusion scintigraphy. Statistical analysis of 31 patients under postoperative follow-up was performed in two parts. In the first part, two preoperative prediction methods (ppo based on perfusion and ppo calculated with VRI), and in the second part, estimated values and postoperative actual values (considering postoperative spirometric values as standard) were compared. RESULTS: An agreement rate of 52% was found between the ppo values calculated with VRI and with perfusion. This rate was low, although respective predictive values for ppo VRI and ppo perfusion were 84% and 47%, suggesting that ppo VRI was more significant than LPS for prediction of the 1st month postoperative value in the patients included in this study. CONCLUSIONS: VRIxp has a high-accuracy rate in prediction postoperative FEV1. It is seemed as an alternative to quantitative perfusion scintigraphy for preoperative evaluation, because it can be easily applied at the bedside as a radiation free and non-invasive method.

The View of Religious Officials on Organ Donation and Transplantation in the Zeytinburnu District of Istanbul.

One of the obstacles to organ donation and transplantation in Turkey is that of religious beliefs and, at this point, religious officials constitute a key aspect of this problem. Positive or negative viewpoints held by religious officials regarding organ donation and transplantation are influential in guiding the public. This descriptive study was conducted for the purpose of describing religious officials' viewpoints on this subject. To determine the opinions of 40 religious officials from among the imams and muezzins working in Zeytinburnu District Mufti (Religious Officials Superior) Station who participated in a normal meeting in April and who fully completed the survey. A 27-question survey form was used that consisted of open-ended and closed questions, 5 of which were on socio-demographic characteristics, 13 on viewpoints on organ donation and transplantation, and 9 on the Islamic viewpoint regarding organ donation and transplantation. For the analysis of the results, Student's t test and one-way ANOVA tests were used. It was found that all of the religious officials believed in the importance of organ donation, 80 % considered donating their organs, and 5 % had made an organ donation. Of the religious officials who had not donated organs, 35 % gave an answer that there was no specific reason and 27.5 % stated that they had never considered the subject. While the number of those stating that they would donate the organs of a close associate who had died, 77.5 % of them who did not want to donate gave as their reason the idea that if it were him, he would perhaps not want to give his organs after death. Of the religious officials questioned, 92.5 % asserted that the religion of Islam looked positively on organ donation and transplantation, 55 % stated that the knowledge of religious officials in the country was inadequate regarding this subject, and 65 % said that for interest in organ donation to increase, religious officials should make speeches and raise the issue with the public in conversations, meetings, and sermons. Fully 85 % asserted that for interest in organ donation in Turkey to increase, religious officials have to lead on the subject. Of those questioned, 52.5 % considered their knowledge on organ donation and transplantation to be adequate and that they had obtained 52.5 % of such information from seminars/conferences, 50 % from television/radio, and 45 % from Directorate of Religious Affairs publications. However, 40 % expressed that they did not know where organ donations were made. One reason for inadequate organ donation in Turkey is that of incorrect religious beliefs. Thus, it is necessary that informative efforts are made by the Directorate of Religious Affairs through in-house training programs, and that healthcare, religious, and legal officials work jointly to inform the public about organ donation, organ transplantation, and brain death. Additionally, religious officials should donate organs by the way of example and, to increase their sensitivity, healthcare professionals should go more frequently to mosques and Mufti Stations.

Diagnostic and Therapeutic Role of Electrocautery Snare Use in Endobronchial Polypoid Lesions.

INTRODUCTION: Electrocautery with a snare probe offers a tool for the treatment of endobronchial polyps. The aim of this study was to demonstrate the efficacy of the snare probe in patients undergoing rigid bronchoscopy due to central airway obstruction. METHODS: This retrospective descriptive study included patients who underwent rigid bronchoscopy with an electrocautery snare probe for the diagnosis and/or treatment of endobronchial polyps in an interventional pulmonology unit. RESULTS: The mean age of the 47 patients (38 men) with endobronchial polypoid lesions was 61.5 years. Six lesions (12.8%) were located in the trachea, 6 (12.8%) in the right main bronchus, 11 (23.4%) in the left main bronchus, and 24 (51.1%) in the lobar bronchi. Twenty-eight lesions (59.5%) were malignant. Prior to the procedure, 6 (12.8%) patients had grade 1 obstruction, 6 (12.8%) had grade 2 obstruction, 15 (31.9%) had grade 3 obstruction, and 20 (42.6%) had grade 4 obstruction. In terms of airway obstruction after the procedure, grade 1 was present in 46 (97.9%) patients and grade 2 was present in 1 (2.1%) patient. No major complication developed in 93.6% of the patients. During a mean follow-up period of 48 months, 85.1% of the patients did not experience recurrence. CONCLUSION: Our results demonstrate that the snare probe can be used to effectively and reliably establish airway patency in patients with central airway obstruction due to endobronchial polypoid lesions.

Pleural angiosarcoma: a rare cause of spontaneous haemothorax.

Angiosarcoma is a rare soft tissue tumour and constitutes less than 1% of all soft tissue cancers. Pleural angiosarcomas are extremely rare and have an aggressive course. We report the case of a 79-year-old female patient who presented with complaints of increasing dyspnoea on exertion and homogeneous opacification of the left hemithorax on chest radiograph. Epithelioid angiosarcoma was determined on pleural tissue obtained by video-assisted thoracoscopic surgery (VATS).