Endobronchial valve to treat large bulla at right middle lobe in chronic obstructive pulmonary disease patients.

We have used endobronchial valve (EBV) to treat large bulla at right middle lobe (RML) on three chronic obstructive pulmonary disease (COPD) patients and presented the clinical datum of three COPD patients with RML bulla. The improvement of lung function was significant on two patients, whose lung parenchyma was preserved well in lobes other than RML. On one patient, whose lung function did not show improvement after EBV treatment, the parenchyma of bilateral lungs was destructed heavily by chronic inflammation of COPD, and the RML bulla did not collapse because right major and/or minor fissures are incomplete. EBV may be used to treat large RML bulla in selected patients, whose parenchyma of other parts of the lung was conserved well and right major and minor fissures are complete.

Treatment of giant emphysamous bulla with endobronchial valves in patients with chronic obstructive pulmonary disease: a case series.

BACKGROUND: Giant emphysamtous bulla (GEB) can negatively affect the pulmonary functions of chronic obstructive pulmonary diseases (COPD) patients, including decreased forced expiratory volume in 1 s (FEV1) and increased functional residual capacity (FRC). The aim of this study was to evaluate the efficacy of endobronchial valve (EBV) to treat bullae and to find efficacy predictors of successful treatment. METHODS: Five COPD patients with giant bulla were treated using EBVs. Before the EBV deployment, collateral ventilation (CV) between the targeted and adjacent lobes was evaluated with Chartis system. RESULTS: In the two patients with negative CV, the mean value of FEV1 increased from 27.1±11.4% of predicted value before EBV treatment to 32.8±12.0% (P>0.05) at 1 month after EBV treatment, than to 31.7±24.5% (P>0.05) at 6 months after EBV treatment. Only one patient, whose bulla occupied the whole right middle lung, displayed sustained improvement of FEV1 at 6 months after EBV treatment. In the three patients with positive CV, the mean value of FEV1 decreased from 28.8±19.0% of predicted value before EBV treatment to 24.8±12.6% (P>0.05) at 1 month after EBV treatment, than to 22.1±10.8% (P>0.05) at 6 months after EBV treatment. CONCLUSIONS: EBV is an effective measure to treat highly selected COPD patients with giant bulla. Although, EBV treatment can achieve transient improvement of lung function at patients with CV negative bulla, long-term benefit was merely observed at the patient with a bulla at right middle lobe (RML).

[Efficacy observation on refractory insomnia treated with the balance needling therapy].

OBJECTIVE: To observe the difference in the clinical efficacy on refractory insomnia between the balance needling therapy and the conventional acupuncture and verify the effectiveness and practicality of the balance needling therapy. METHODS: Sixty cases were randomized into a balance needling therapy group, a conventional acupuncture group and a placebo group, 20 cases in each one. In the balance needling therapy group, Shi-mian (point for insomnia) was selected with quick needling manipulation. After the arrival of qi, the technique of lifting and thrusting was applied till the radiating numbness presented in the middle or index finnger, thus the needle was removed. In the conventional acupuncture group, Sishencong (EX-HN 1), Shenmen (HT 7) and Sanyinjiao (SP 6) were punctured with the conventional technique. The treatment was given once every day, 7 treatments made one session, 2 sessions were required totally. In the placebo group, starch capsules were prescribed for oral administration before sleep every night, continuously for 14 days. The efficacy and scores of Pittsburgh sleep quality index (PSQI) beforea and after treatment were observed in three groups. RESULTS: PSQI scores were reduced after treatment in every group (both P < 0.01), the scores in the balance needling therapy group and conventional acupuncture group were reduced apparently as compared with those in the placebo group (both P < 0.01). The total effective rate were 90.0% (18/20), 85.0% (17/20) and 15.0% (3/20) in the balance needling therapy group, conventional acupuncture group and placebo group separately. The efficacy in the balance needling therapy group and the conventional acupuncture group was higher obviously than that in the placebo group (both P < 0.01), and the balance needling therapy group had the same efficacy as conventional acupuncture group (P > 0.05). CONCLUSION: The balance needling therapy is safe and effective in the treatment of refractory insomnia and achieves the same efficacy as the conventional acupuncture, which has more simple operation and less pain for the patients and much more considerable practicality in clinic.