Incidence of bacteremia following bronchoscopy with argon plasma coagulation: a prospective study.

BACKGROUND: This evaluation was undertaken to determine the incidence of bacteremia and infectious complications associated with argon plasma coagulation (APC) procedures. METHODS: Consecutive patients undergoing bronchoscopy with APC for treatment of endobronchial lesions were studied. Venesection was performed for blood cultures within 60 s of the APC procedure. APC catheter washings were cultured. Patients with positive blood cultures were reviewed immediately. All patients underwent clinical review 1 and 12 weeks after APC. RESULTS: Forty-two patients underwent 44 APC procedures. Their mean age was 66 ± 12 years. One case (2.3 %) had bacteremia with Acinetobacter lwolfii. APC catheter washing culture was positive in 14 (31.8 %) procedures. No patient had clinical features suggesting infection and there were no complications. Phone review after 1 week revealed no complications. After 3 months, 8 (18 %) had died, all related to advanced lung malignancy and not to the APC procedure. CONCLUSIONS: APC does not appear to increase the risk of bacteremia compared to airway insertion of the bronchoscope. Although contamination of the APC catheter with oropharyngeal commensal bacteria is common, clinically significant infection following the APC procedure is rare.

Long-term reflux-related symptoms after bariatric surgery: comparison of sleeve gastrectomy versus laparoscopic adjustable gastric banding.

BACKGROUND: Long-term pulmonary reflux-related symptoms following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have not been reported. METHODS: We designed a retrospective analysis of consecutive patients who underwent LAGB or LSG between January 2000 and December 2010. All patients provided detailed history and physical examination. We assessed both early and late reflux-related symptoms. All patients underwent spirometry and chest X-ray (CXR). RESULTS: The analysis included 307 patients who underwent either LAGB (n = 193) or LSG (n = 114). Mean age was 43 ± 12 and 46 ± 11 years, respectively; 144 (76.6 %) and 83 (73 %) were female, respectively. Similar rates of previous pulmonary disease were noted in both LAGB and LSG groups (10.9 vs. 10.5 %, respectively). However, more patients with sleep apnea were in the LSG group (13.2 vs. 6.2 %, p = 0.03). The mean interval between surgery and the onset of pulmonary symptoms was longer in patients who underwent LAGB (72 ± 22 months) than for those who had LSG (36 ± 24 months; p = 0.03). The overall complication rate was higher in the LAGB (7.3 %) than in LSG (4.4 %) group. LSG patients had significantly lower rates of morning cough (12.3 vs. 59.6 %, p = 0.001) and postprandial cough (10.5 vs. 58 %, p = 0.001) compared to the LAGB patients. Two cases of pneumonia occurred in each group. The mortality rate was zero in both groups. CONCLUSION: Both surgeries are considered safe and without major reflux-related symptoms. There is a lower incidence of cough with LSG than with LAGB.

Pulmonary complications following laparoscopic adjustable gastric banding.

Laparoscopic adjustable silicone banding (LAP-BAND) has rapidly gained acceptance and is now considered the most common bariatric operation. The accumulated experience with LAP-BAND has established this surgical method as safe and effective. However, no data have been issued concerning pulmonary complications following the procedure. We have recently experienced 3 cases of pulmonary complications following LAP-BAND surgery: 1 patient with pulmonary cavitation and 2 with bronchiectasis. Pulmonary physicians should be aware of the possibility of long-term pulmonary complications in patients who have undergone LAP-BAND surgery.

The role of bacterial culture by bronchoscopy in patients with lung cancer: a prospective study.

BACKGROUND: Patients with lung cancer undergoing surgical and medical treatment are at increased risk for pulmonary complications. The importance of routine bronchoscopy procedure in populations with lung cancer has rarely been defined. We aimed to determine the growth of potentially pathogenic microorganisms (PPM) among patients evaluated by bronchoscopy for lung cancer. METHODS: This prospective study included 155 consecutive patients with lung mass or radiologic findings suspicious for malignancy. Baseline demographic, clinical and radiologic features were collected. Clinical features of infection were compared to microbiologic and histologic results. RESULTS: The bacterial spectrum of lung cancer patients was similar to those without malignancy. The most frequently isolated organisms were Pseudomonas sp. and Staphylococcus aureus. Among all patients, bronchial bacterial positive PPM growth was noted in 30% (46/155). The significant PPM growth rate was three-fold higher among those with clinical signs of infection (P<0.001). Interestingly, 30 of these 46 patients (66%) did not show signs of clinical infection. CONCLUSIONS: Bronchoscopic evaluations should include bacterial cultures for direct targeted antibiotic therapy only in the symptomatic patients.

Increased hypoxemia in patients with COPD and pulmonary hypertension undergoing bronchoscopy with biopsy.

BACKGROUND AND OBJECTIVE: Patients with pulmonary hypertension (PH) are considered to be at risk for complications associated with flexible bronchoscopy (FB), but data concerning the degree of PH are often lacking. We investigated whether COPD patients with PH who undergo bronchoscopy are at greater risk for complications. METHODS: This prospective study included 207 consecutive COPD patients undergoing FB. All underwent an echo-Doppler to evaluate pulmonary artery pressure on the day of the bronchoscopy procedure. Pulmonologists were blinded to the echocardiogram results. RESULTS: A total of 167 patients (80.7%) had normal pulmonary pressure. The remaining 40 patients (19.3%) had PH: 27 (13.0%) mild, eight (3.9%) moderate, and five (2.4%) severe. Noninvasive hemodynamic parameters between groups before and after FB were similar. Two patients with normal pulmonary pressure developed supraventricular tachycardia. None developed hemodynamically significant dysrhythmia. Bleeding episodes between groups in bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) did not differ. PH patients who underwent BAL and TBB had decreased O2 saturation during the procedure compared with the non-PH group (23.5% vs 6.9%, P=0.033). No deaths were attributable to FB. CONCLUSION: PH is common among COPD patients undergoing FB. PH patients undergoing BAL and TBB are at higher risk of decreased O2 saturation than those without PH. Further studies should assess the risk among COPD patients with moderate-to-severe PH.

Pleural ELFA D-dimer assay: a surrogate marker for malignant pleural effusion.

BACKGROUND: Malignant pleural effusion is associated with enhanced fibrinolysis. However, no data are available concerning the precise role of pleural D-dimer assay in pleural effusion. We therefore assessed the role of pleural D-dimer assay in predicting malignant pleural effusion. PATIENTS AND METHODS: A prospective laboratory investigation was conducted in a tertiary care teaching hospital. The study included consecutive patients with pleural effusion who presented at the Pulmonary Department between November 2009 and May 2010. Blood and pleural D-dimer levels were measured by Enzyme Linked Fluorescent assay (ELFA). The results were correlated with the clinical, laboratory, and radiological findings, and with the final diagnosis of the pleural fluid. RESULTS: A total of 103 patients with pleural effusion were included in the study. The Pleural ELFA D-dimer results were found to be positively correlated with pleural etiology of malignancy (p=0.0001). Pleural etiology was also correlated with pleural LDH, pleural protein, pleural PH, pleural glucose, pleural and blood CRP, but not with ADA. In a binary logistic regression, only the pleural ELFA D-dimer assay was a significant predictor of the malignant pleural effusion (odds ratio 1.007; 95% confidence interval 1.002-1.012; p=0.007). The area under the receiver operating characteristics curve for malignancy was 0.79. A D-dimer level of 146mg/ml had a sensitivity of 82% and a specificity of 74%. CONCLUSIONS: We found high D-dimer levels among malignant pleural effusion. D-dimer might be useful as a simple, noninvasive, surrogate marker for malignant pleural effusion.

Clinical and radiological features of Mycobacterium kansasii and other NTM infections.

BACKGROUND: Mycobacterium kansasii infection is one of the most common causes of nontuberculous mycobacterial lung disease in the world. However, it is not possible to differentiate completely between M. kansasii and other nontuberculous mycobacteria (NTM) because of a lack of direct comparative studies. This retrospective study sought to identify their clinical and radiological features systematically. METHODS: The sample included 98 consecutive patients with a culture-positive diagnosis of NTM infection, derived from the databases of the Laboratory of Microbiology of a tertiary medical center and two outpatient tuberculosis centers. Sixty-four patients had M. kansasii infection. All patients fulfilled disease criteria for treatment. Data on patient background and clinical features were collected, and chest radiographs were evaluated. RESULTS: In the M. kansasii group, n = 27 (42%) were native-born Israelis compared to 9.4% (n = 3) of all other NTM groups (p = 0.0001). Similar rates of co-morbid diseases, including diabetes mellitus, heart disease, lung diseases, and malignancy were noted in both groups. Old TB was less common in the M. kansasii group compared to the other NTM (3.1% vs. 23.5%, p = 0.003). Clinical symptoms were significantly more common in patients with M. kansasii infection. On radiological study, M. kansasii infection was associated with more cavitations and unilaterality. Patients with M. kansasii infection had a higher likelihood of right upper lobe disease (p = 0.001). Pleural effusions and lymphadenopathy were found only in a few patients in each group. CONCLUSION: Major differences in the epidemiologic and clinical features of M. kansasii infection and other NTM have important diagnostic and clinical implications.