Bronchoscopic lung volume reduction by instillation of fibrinogen and thrombin in COPD patients with homogenous emphysema.

BACKGROUND: The new endobronchial therapy called biological lung volume reduction (BioLVR) involves using a rapid polymerizing sealant to block off the most emphysematous portions of the lungs. The primary mechanism of action is resorption atelectasis, which is then followed by inflammation and remodeling of the airspace. The remodeling process will result in the formation of scars, leading to the contraction of the lung tissue. As a result, a decrease in functional lung volume is anticipated for a period of 6-8 weeks. OBJECTIVE: Assessing the safety and effectiveness of bronchoscopic installation of (fibrinogen and thrombin) in COPD patients with homogeneous emphysema in terms of radiological, physiological, and quality of life outcomes. METHODS: Between December 2017 and December 2019, 40 COPD patients with homogeneous emphysema were studied using a fiber optic bronchoscope while they were awake but sedated. Tanta University Hospitals' chest medicine department collaborated with the diagnostic radiology department of the Faculty of Medicine. RESULTS: All the following parameters were reduced from their initial values: HRCT volumetry, RV/TLC, mMRC dyspnea scale, CAT score, 6MWT, FEV1, and the FEV1/FVC ratio at the first, third, and sixth months from the beginning (p = 0.001). One individual (0.025%) had pneumonia, whereas three individuals had COPD (0.075%). Using fibrin glue produced locally, biological lung volume reduction (Bio LVR) may be an effective treatment for advanced homogenous emphysema. CONCLUSION: By using locally prepared fibrin glue the biologic lung volume reduction (Bio LVR) may be a convenient method to treat advanced homogenous emphysema.

Objective Comparison Between Spreader Grafts and Flaps for Mid-Nasal Vault Reconstruction: A Randomized Controlled Trial.

OBJECTIVE: The goal of rhinoplasty is not exclusively aesthetic and the nasal function should always be considered. Several rhinoplasty techniques can participate in nasal valve dysfunction (eg, dorsal hump reductions). Therefore, mid-nasal vault reconstruction by spreader grafts or flaps is mandatory in these cases. To date, there is a literature gap in comparing both techniques objectively. This study shows an objective comparison between spreader grafts and flaps for mid-nasal vault reconstruction. MATERIAL AND METHODS: This study was a double-blind randomized controlled trial including 40 patients who were randomly divided into 2 groups. Group 1 (20 patients) underwent spreader grafts insertion, whereas group 2 (20 patients) underwent spreader flap placement technique. Pre-operative active anterior rhinomanometry measurements were compared to 6-month post-operative measurements. Data were summarized as mean (standard deviation) for the quantitative variables. Comparisons between the 2 groups were done using unpaired t test. RESULTS: In both groups, a significant decrease in nasal resistance was noted in both the right and left sides 6 months post-operatively (P < .001). However, the comparison between the 2 both groups showed no statistical significance. CONCLUSION: Both spreader grafts and flaps, which are used for the mid-nasal vault reconstruction, have comparable and effective results in reducing the nasal resistance as evidenced by active anterior rhinomanometry measurements.

HISTORIQUE: La rhinoplastie n'a pas seulement un objectif esthétique. En effet, il faut toujours tenir compte de la fonction nasale. Plusieurs techniques de rhinoplastie peuvent entraîner une dysfonction de la valve nasale, par exemple en cas de réduction de la bosse dorsale. Dans ces situations, il faut absolument procéder à une reconstruction de la voûte nasale par greffes ou lambeaux d'extension. Jusqu'à présent, les publications scientifiques n'ont pas comparé pas objectivement les deux techniques. La présente étude contient une comparaison objective entre des greffes et des lambeaux d'extension lors de la reconstruction de la voûte nasale. OBJECTIF: La présente étude présente une comparaison objective entre les greffes et les lambeaux d'extension lors de la reconstruction de la voûte nasale. MÉTHODOLOGIE: La présente étude aléatoire et contrôlée à double insu comptait 40 patients répartis au hasard entre deux groupes. Le groupe 1 (20 patients) a subi l'insertion de greffes d'extension et le groupe 2 (20 patients), la technique d'installation de lambeaux d'extension. Les chercheurs ont comparé les mesures de rhinamométrie antérieure active obtenues avant l'opération à celles obtenues six mois après l'opération. Ils ont résumé les données relatives aux variables quantitatives à l'aide de l'écart-type moyen et standard. Ils ont comparé les deux groupes à l'aide du test de Student non apparié. RÉSULTATS: Dans les deux groupes, la résistance nasale latérale droite et gauche avait diminué considérablement six mois après l'opération (P < 0,001). Cependant, d'après la comparaison entre les deux groupes, cette différence n'était pas statistiquement significative. CONCLUSION: Les greffes et les lambeaux d'extension utilisés pour la reconstruction de la voûte nasale, donnent des résultats comparables et efficaces pour réduire la résistance nasale, tel que le démontrent les mesures de rhinamométrie antérieure active.