Follow-up outcomes of chronic obstructive pulmonary disease patients who underwent dilatation and curettage with the Karakoca resector balloon: A 188-case series over 5 years.

We previously reported satisfactory results with the Karakoca resector balloon in 10 patients with stage IV chronic obstructive pulmonary disease (COPD) who did not respond to medical treatment. In this article, we present the outcomes of the Karakoca resector balloon dilatation and curettage technique in a larger case series (n = 188).A total of 188 COPD patients [mean age (SD): 69.2 (8.0) years; 46 females] classified as stage III to IV by the Global Initiative for Obstructive Lung Disease criteria underwent balloon desobstruction for segmental and subsegmental bronchi by therapeutic bronchoscopy. None of the patients could have achieved symptom relief even under high-dose inhaled bronchodilators and corticosteroids, oral corticosteroids, or oxygen and noninvasive mechanical ventilation therapy before the intervention. Forced expiratory volume in 1 s (FEV1) and oxygen saturation (SpO2) were measured, and modified Borg dyspnea scale (MBS) scores were determined before and 1 week and 1 month after the intervention.All patients were active smokers and 80% had concomitant chronic diseases. After the intervention, there was a notable reduction in the oxygen need of the patients. Comparison of lung function tests 1 week after the procedure with results before the procedure showed significant improvements in FEV1, MBS, and SpO2 levels (P < 0.001 for each), and the improvements were maintained for the entire postprocedural month (P < 0.001 for each). Except for 4 males, all patients were free of symptoms.These results confirmed our early observations that balloon dilatation and curettage is a safe and successful technique for medical treatment-resistant COPD.

Byssinosis and COPD rates among factory workers manufacturing hemp and jute.

OBJECTIVES: Prior studies have been performed on cotton textile plants throughout the world. This study was planned to identify the rate of byssinosis and chronic obstructive pulmonary disease (COPD) in hemp and jute workers and those who worked with both of them. MATERIAL AND METHODS: The study was realized in a factory which consecutively processed hemp and jute. The study enrollment included 266 people, 164 of whom were active workers and 102 were retired. A questionnaire, plain chest X-rays, physical examination and pulmonary function tests were performed. Dust levels were measured in various sections of the factory during 8 h work shifts. Endotoxin levels of various quality hemp fibers and dusts were measured. RESULTS: The rate of byssinosis (28.2%) was higher among the workers that who exposed to both jute and hemp dust. The frequency of chronic bronchitis in retired workers who previously smoked was higher (20%) as compared to currently smoking workers (17%). High dust levels were measured in some parts of the factory (mean (M) = 2.69 mg/m3). Working in dense dust areas, active smoking, being older than 40 years of age, being an ex-smoker, and working in the factory for a period exceeding 15 years were significantly associated with bronchitis and emphysema development. High endotoxin levels were determined for fine hemp dust (605 EU/mg), coarse hemp dust (336 EU/mg) and poor quality hemp fibers (114 EU/mg), whereas in fresh hemp stalks the level of endotoxin was determined to be lower (0.27 EU/mg). CONCLUSIONS: Because of high exposures to jute and hemp dusts that are associated with high byssinosis rates, personal protection and environmental hygiene is crucial to prevention of byssinosis.

Lung health in workers exposed to reed dust.

We conducted a cross-sectional survey in a cellulose plant among 109 reed workers, exposed to reed dust and 78 unexposed office workers, to investigate respiratory health effects of reed dust exposure. Investigations included dust measurements, serum total IgE, skin prick test, pulmonary function testing and questionnaire on respiratory symptoms. Total dust level in the reed processing unit was higher than the office (9.7 and 0.02 mg/m3, respectively). Reed workers had a higher rate of current smoking (67% and 46%, respectively). After the adjustment for smoking status and age, reed dust exposure was significantly associated with wheezing, chronic cough, dyspnea, itching eyes and itching nose. Chest tightness and ODTS symptoms were only reported by reed workers (27.5% and 23.9%, respectively). After the adjustment for pack-years of smoking, percentage of predicted FEV1, FVC, FEV1/FVC and FEF25-75 in reed workers were significantly lower than office workers. Among reed workers, wheezing was associated with older age (>40 years) and ever smoking, and cross-shift decline in FVC and FEV1 with shorter duration of work. Reed dust exposure in the workplace could provoke respiratory symptoms, possibly due to an irritating effect. Health selection bias is likely, and could have underestimated the health effects of reed dust exposure.

Use of Resector Balloon Desobstruction in Patients With Severe Chronic Obstructive Pulmonary Disease: A Pilot Feasibility Study on a Novel Desobstruction Technique.

BACKGROUND: Inflammation of the small airways (bronchiolitis) contributes to airflow limitation by narrowing and obliterating the airway lumen in patients with chronic obstructive pulmonary disease (COPD). Although currently available treatments provide satisfactory disease control in most patients, a significant number of patients do not respond. This study presents the outcomes of Karakoca resector balloon desobstruction in patients with severe COPD who did not respond to medical treatment. METHODS: Ten COPD patients classified as stage IV by the Global Initiative for Obstructive Lung Disease (GOLD) and unsuccessfully treated with high-dose bronchodilators and corticosteroids, oral corticosteroids, oxygen, and NIMV therapy underwent therapeutic bronchoscopy, including balloon desobstruction for segmental and subsegmental bronchi. Exercise capacity and SpO2 levels were measured and lung function tests and bronchoscopic biopsies performed before and after the intervention. RESULTS: After Karakoca resector balloon desobstruction, improvements were noted in the effort capacity, SpO2 and forced expiratory volume in 1 second levels of all patients. None of the patients developed preoperative complications or complication or exacerbation within the postoperative 1 to 3 months of follow-up. CONCLUSION: Satisfactory results were achieved in all patients, warranting study of Karakoca resector balloon desobstruction in larger patient cohorts.

[Therapeutic bronchoscopic treatment of postintubation tracheal stenosis: 5 cases]. / Terapötik bronkoskopi ile tedavi edilen postentübasyon trakea stenozlari: Bes olgu sunumu.

Benign airway obstruction is known as curable by therapeutic bronchoscopic methods. Compared by surgical therapies it is comfortable and has no risks for the patients. For five patients who applied our clinic after tracheostomy and endotracheal intubation stenosis we used therapeutic bronchoscopic methods; "laser-stenotic silicon stent". In two patients after vaporization of membranous stricture by Neodimum Yttrium Aliminum Pevroskite Laser (Nd-YAP laser) who were seen posttracheostomy and postentubation; stenotic stent was implanted mechanically and/or by means of baloon dilatation. Membranous stricture area was coagulated by Nd-YAP-laser in other three cases and anatomic airway diameter was achieved mechanically and by baloon dilatation. In the follow up period we applied stenotic silicon stent implantation after second laser resection in whom restenosis observed. In conclusion; patients who had stenotic silicon stent implantation and having no problems in the follow up this therapeutic method is found to be curative.

Therapeutic bronchoscopic intervention with resector balloon.

In this study a novel therapeutic bronchoscopic technique, balloon bronchoplasty with resector balloon, was used in 128 procedures for 112 consecutive patients with airway obstruction from lung cancer or granulation tissue. All procedures, except 4, were performed with a rigid bronchoscope under general anesthesia. The remainder were performed with a flexible bronchoscope under local anesthesia. In all procedures, balloon bronchoplasty was the primary method and we achieved 100% success with no major immediate or long-term complications. The technique also facilitated submucosal and distal tumor resection. We found balloon bronchoplasty using resector balloon to be a safe, effective, fast, easy, and potentially cost-effective method in the management of airway obstruction from endobronchial submucosal lesions.

A new endoluminal resection technique and device: resector balloon.

PURPOSE: We have developed a new resection technique and designed a special balloon by which resection of endoluminal airway lesions can be safely and successfully done. DESCRIPTION: From April to December 2006, 38 interventions were done in 30 patients; endobronchial tumor or granulation tissues were mechanically removed by a catheter by which the balloon was covered with a polyurethane mesh structure. Acute and long-term complications, results, advantages, and disadvantages of this new technique and device were determined. EVALUATION: Resection of endobronchial tumors and also control of bleeding and dilatations were successfully performed in 30 patients. CONCLUSIONS: As an alternative to other endobronchial treatments, this new technique and device can be used as a safe method. In addition, the utilization of this new device does not need as much experience as other techniques. On the other hand this method does not need very expensive equipment, such as a laser or cryotherapy equipment.