ABSTRACT
BACKGROUND: Bronchoscopic lung volume reduction (BLVR), using biological agents, is one of the new alternatives to lung volume reduction surgery. OBJECTIVES: To evaluate efficacy and safety of biological BLVR using low cost agents including autologous blood and fibrin glue. METHODS: Enrolled patients were divided into two groups: group A (seven patients) in which autologous blood was used and group B (eight patients) in which fibrin glue was used. The agents were injected through a triple lumen balloon catheter via fiberoptic bronchoscope. Changes in high resolution computerized tomography (HRCT) volumetry, pulmonary function tests, symptoms, and exercise capacity were evaluated at 12 weeks postprocedure as well as for complications. RESULTS: In group A, at 12 weeks postprocedure, there was significant improvement in the mean value of HRCT volumetry and residual volume/total lung capacity (% predicted) (P-value: <0.001 and 0.038, respectively). In group B, there was significant improvement in the mean value of HRCT volumetry and (residual volume/total lung capacity % predicted) (P-value: 0.005 and 0.004, respectively). All patients tolerated the procedure with no mortality. CONCLUSION: BLVR using autologous blood and locally prepared fibrin glue is a promising method for therapy of advanced emphysema in term of efficacy, safety as well as cost effectiveness.
Subject(s)
Biological Therapy/methods , Blood , Bronchoscopy/methods , Fibrin Tissue Adhesive/administration & dosage , Lung/surgery , Pulmonary Emphysema/surgery , Adult , Aged , Airway Remodeling , Biological Therapy/adverse effects , Bronchoscopy/adverse effects , Cone-Beam Computed Tomography , Egypt , Exercise Test , Exercise Tolerance , Fibrin Tissue Adhesive/adverse effects , Forced Expiratory Volume , Humans , Lung/diagnostic imaging , Lung/physiopathology , Lung Volume Measurements , Male , Middle Aged , Predictive Value of Tests , Pulmonary Emphysema/diagnosis , Pulmonary Emphysema/physiopathology , Recovery of Function , Severity of Illness Index , Time Factors , Treatment Outcome , Vital CapacityABSTRACT
Warfarin is the most commonly prescribed anticoagulant drug; however, a narrow therapeutic range and a high risk of bleeding or stroke complicate its clinical use. Warfarin resistance was defined as prolonged warfarin requirements of more than 15âmg/day to achieve therapeutic anticoagulation or failure to achieve therapeutic anticoagulation with more than 20âmg/day. The resistance is associated with polymorphisms of the vitamin K epoxide reductase-oxidase complex (VKORC1) and cytochrome P450-2C9 (CYP2C9) genes, which affect warfarin pharmacodynamics and pharmacokinetics, respectively. Identification of the VKORC1 -1639 (A/G) and CYP2C9 (*1/*2/*3) allelic variants was performed using the PGX-Thrombo Strip in 41 patients with warfarin resistance compared with 30 patients with normal warfarin response out of 352 diagnosed cases of deep vein thrombosis. In warfarin-resistant patients, the VKORC1-1639 genotype frequencies were GG 0.756, GA 0.244 and AA 0.0, whereas in warfarin responder patients, they were: GG 0.333, GA 0.400 and AA 0.276 with Pâ≤â0.001. The CYP2C9 genotype frequencies showed nonsignificant difference in both group of patients (Pâ=â0.31). Our results suggest that the VKORC1-1639 GG and the wild type CYP2C9*1*1genotypes are associated with the high-dose requirement for warfarin therapy, and that VKORC1-1639 GG is responsible for warfarin resistance and failure in Egyptian patients.