Indwelling Tunneled Pleural Catheters for the Management of Hepatic Hydrothorax. A Pilot Study.

RATIONALE: Hepatic hydrothorax is a complication of cirrhosis in which hydrostatic imbalances result in fluid accumulation within the pleural space. Although uncommon, this may cause significant morbidity, resulting in dyspnea requiring repeated pleural drainage procedures. Liver transplantation is curative, but it is rarely immediately available to qualified patients, presenting the clinical challenge of managing recurrent pleural effusions. Indwelling tunneled pleural catheters (ITPCs) have been used successfully to palliate dyspnea associated with recurrent malignant pleural effusions. OBJECTIVES: This study was performed to evaluate the feasibility of using ITPCs for the management of hepatic hydrothorax. METHODS: A single-center prospective feasibility study was performed to evaluate the use of ITPCs for the management of recurrent hepatic hydrothorax in patients who were eligible for liver transplant evaluation. MEASUREMENTS AND MAIN RESULTS: Twenty-five ITPCs were placed in 24 patients. The mean number of pleural drainage procedures before ITPC placement was 1.9, with no further pleural drainages required in any patient after ITPC placement. Spontaneous pleurodesis occurred in 8 of 24 patients (33%). All eight catheters were successfully removed without pleural fluid reaccumulation. Mean time to pleurodesis was 131.8 days. Pleural fluid infection occurred in 4 of 24 patients (16.7%), requiring catheter removal in 3 of the 4 patients. CONCLUSIONS: ITPCs may be successfully and safely used to control symptoms associated with hepatic hydrothorax. The rate of spontaneous pleurodesis that occurs is similar to that observed with ITPCs placed for malignant pleural effusion, although the infection rate may be higher. Clinical trial registered with www.clinicaltrials.gov (NCT02595567).

Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience.

RATIONALE: Technological advances have improved the ability of bronchoscopists to access peripheral pulmonary lesions for tissue sampling. Radial probe endobronchial ultrasound (EBUS) provides real-time feedback to guide biopsies of peripheral lesions, thereby potentially improving diagnostic yield over conventional bronchoscopy. OBJECTIVES: We assessed the overall diagnostic yield of peripheral bronchoscopy using radial probe EBUS for peripheral pulmonary lesions, as well as factors that might influence the diagnostic yield, such as radial ultrasound view, lesion size, and ability to locate the peripheral lesion. METHODS: We conducted a retrospective review of peripheral bronchoscopy cases in which radial probe EBUS was utilized to diagnose peripheral pulmonary lesions at a tertiary care university hospital. MEASUREMENTS AND MAIN RESULTS: Our study cohort comprised 496 patients who underwent bronchoscopies between January 2008 and December 2012 for the diagnosis of peripheral pulmonary lesions. Radial probe EBUS was used alone for diagnostic purposes in 467 patients. A diagnosis was made on that basis in 321 (69%) of 467 patients. A diagnosis was obtained for 83 of 144 (58%) of nodules 1-2 cm in diameter, 99 of 137 (72%) of nodules 2.1-3 cm, 54 of 70 (77%) of nodules 3.1-4 cm, 41 of 47 (87%) of nodules 4.1-5 cm, and 35 of 40 (88%) of nodules larger than 5.1 cm. Of all 467 nodules, 446 (96%) were successfully identified using radial probe EBUS. When the radial probe position was within the target lesion, the diagnostic yield was 84% compared with 48% when the probe was positioned adjacent to the lesion. CONCLUSIONS: Radial probe EBUS can be used to guide biopsy during peripheral bronchoscopy. This technique provides real-time ultrasound-based confirmation of target lesion localization prior to biopsy. Using radial probe EBUS, the vast majority of peripheral pulmonary nodules can be identified. Radial EBUS probe position relative to the target lesion significantly affects the diagnostic yield.

A prospective study of bone mass and body composition in female adolescent gymnasts.

OBJECTIVE: To examine changes in bone and body composition of adolescent female artistic gymnasts (GYM; n = 7), level 5+, compared with nongymnast controls (CON; n = 10) over 3 years. STUDY DESIGN: Areal bone mineral density (aBMD; g/cm(2)), bone mineral content (BMC; g) and bone area (cm(2)), of the total body (TB), total proximal femur (TPF), trochanter (Tr), femoral neck, lumbar spine (LS), and distal radius were measured using dual-energy X-ray absorptiometry. Fat-free soft tissue mass (FFST; g), fat mass (g), and percent body fat (%FAT) were also assessed. RESULTS: No initial differences in height or weight between GYM and CON were observed, and both groups demonstrated parallel increases in these parameters over time (P <.05; h(2) >or=0.15). At baseline, GYM possessed significantly lower %FAT and higher aBMD at all sites (except TB; P <.05; h(2) >or=0.15). Over 3 years, GYM increased more than CON (P <.05; eta (2) >or=0.15) in TB, Tr, and TPF aBMD, TB and LS BMC, and FFST. CONCLUSION: Female adolescents participating in competitive artistic gymnastics training over 3 years have enhanced rates of aBMD, BMC and FFST accrual.