Cryorecanalization: keys to success.

BACKGROUND: Symptomatic airway obstructions are common with endobronchial exophytic tumors and may result in lethal complications. Recently, a cryorecanalization procedure has emerged that plays a role in the immediate management of airway obstruction. This study was conducted to investigate the value of cryorecanalization for the immediate management of endobronchial obstructive pathology and to determine the factors that affect the success of the procedure. METHODS: We analyzed 40 patients with symptoms of airway obstruction who were admitted to our hospital from 2006 to 2010. Patients with exophytic stenosis due to primary bronchial or metastatic neoplasms who underwent cryorecanalization procedures were included. Patients were excluded if they had involvement of a major artery near the site of the intervention. The procedure was not performed on patients with coagulation abnormalities or thrombocyte count and aggregation problems. The data were collected retrospectively. RESULTS: Successful cryorecanalization was achieved in 72.5 % of patients. We found that the success rate was mainly related to the presence of the distal involvement and the older age of obstruction. Restenosis rate was 17.2 %. [corrected] The mean survival time after the cryorecanalization procedure was 11 ± 12.7 months. No complications occurred in 14 patients. No severe bleeding was observed for any patients, and moderate hemorrhaging occurred in ten patients, which was stopped with an argon plasma coagulator. We experienced no intraoperative mortality. CONCLUSIONS: Cryorecanalization is a successful and safe intervention for the immediate management of endobronchial stenosis. Appropriate patient selection and high success rates should be achieved after careful radiological assessments and with early management.

Pulmonary involvement in inflammatory bowel disease.

AIM: To determine the relationship of pulmonary abnormalities and bowel disease activity in inflammatory bowel disease (IBD). METHODS: Thirty ulcerative colitis (UC) and nine Crohn's disease patients, and 20 control subjects were enrolled in this prospective study. Detailed clinical information was obtained. Extent and activity of the bowel disease were established endoscopically. Each patient underwent pulmonary function tests and high-resolution computed tomography (HRCT). Blood samples for measurement of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), angiotensin converting enzyme and total IgE were delivered by the patients. RESULTS: Ten (25.6%) patients had respiratory symptoms. A pulmonary function abnormality was present in 22 of 39 patients. Among all patients, the most prevalent abnormalities in lung functions were a decrease in forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow (FEF) 25%-75%, transfer coefficient for carbon monoxide (DLCO), DLCO/alveolar volume. Increased respiratory symptoms score was associated with high endoscopic activity index in UC patients. Endoscopic and clinical activities in UC patients were correlated with FEV1, FEV1/FVC, and FEF 25%-75%. Smoking status, duration of disease and medication were not correlated with pulmonary physiological test results, HRCT abnormalities, clinical/endoscopic disease activity, CRP, ESR or total IgE level or body mass index. CONCLUSION: It is important that respiratory manifestations are recognized and treated early in IBD. Otherwise, they can lead to destructive and irreversible changes in the airway wall.

Prognostic significance of vascular endothelial growth factor, tumor necrosis, and mitotic activity index in malignant pleural mesothelioma.

OBJECTIVES: Tumor growth and metastasis are angiogenesis-dependent events, and several prognostic factors have been determined in malignant mesothelioma. In this study, we investigated the prognostic significance of vascular endothelial growth factor (VEGF), tumor necrosis (TN), and mitotic activity index (MAI) in malignant mesothelioma. For the first time (to our knowledge), we also demonstrated the association between VEGF staining, TN, and MAI in malignant mesothelioma. METHODS: Decortication and VATS materials of 40 patients were investigated. The routinely processed formalin-fixed, paraffin-embedded, hematoxylin-eosin-stained tumor sections that had been used for the original diagnostic purposes were retrieved. Hematoxylin-eosin sections were selected for VEGF immunostaining, TN, and mitotic count. Clinicopathologic data, stage of disease, and survival of patients were all determined. The correlations between variables were evaluated by Spearman rank correlation test. Both univariate analysis using the log-rank test and multivariate analysis using Cox regression model were performed for survival analysis. RESULTS: There was a significant correlation between VEGF staining and TN (r = 0.42, p = 0.006). In univariate analysis, both VEGF staining (p = 0.0002) and TN (p = 0.0055) showed significant correlation with short survival. Also, there was a positive correlation between VEGF and tumor stage (p = 0.046). In multivariate analysis, only VEGF was determined as an independent prognostic factor in malignant mesothelioma (p = 0.001). There was no association between MAI and survival (p = 0.504). CONCLUSIONS: VEGF, known as an important angiogenic peptide, is an independent prognostic factor in malignant pleural mesothelioma. TN stimulates angiogenesis, and we observed a significant correlation between VEGF and TN. However, further studies are needed to evaluate the prognostic significance of angiogenic properties in malignant mesothelioma.

Nutritional status of COPD patients with acute exacerbation.

The prevalence and features of nutritional status in patients with chronic obstructive pulmonary disease (COPD) have been studied extensively in stable conditions, but are poorly defined in the presence of an acute exacerbation. The aim of this study is to evaluate the nutritional status of COPD patients with acute exacerbation and possible relationship between nutritional parameters and pulmonary functions. The study group consisted of 53 COPD patients acutely admitted to the hospital for standardized medical treatment. The nutritional status of patients was assessed by anthropometric measurements, biochemical analysis, and immunologic testing. The patients were divided into two groups as having severe (FEV1 < 50%) and mild to moderate (FEV1 ? 50%) COPD and weight loss greater than 5% for the comparison of the study parameters. Ideal body weight (IBW%) was found as 104.42 +/- 4.30 in severe COPD, where as it was 115.31 +/- 7.28 in mild to moderate COPD group (p= 0.07). There was no relationship demonstrated between IBW% and FEV1. IBW% was correlated with DLCO for the total study population (r= 0.353, p= 0.035). Weight loss greater than 5% of body weight (BW) was observed in 54% of patients. Comparison of the patient's actual weight to their usual weight revealed statistically significant weight loss (p< 0.01). Mean values of serum albumin, transferrin were found in normal range. Delayed type hypersensitivity skin test revealed normal immune status. When the study parameters were compared, no any statistically significant differences in parameters related to nutritional status were detected, between severe and mild to moderate COPD groups. As a statistically significant weight loss was found between the actual and usual weights of the patients, monitoring of nutritional parameters and eventual dietetic treatment should also be included in the goals of the medical treatment of patients with COPD in acute exacerbation.

Short-term effect of nasal intermittent positive-pressure ventilation in patients with restrictive thoracic disease.

BACKGROUND: The use of nasal intermittent positive pressure ventilation (NIPPV) would be expected to ameliorate dyspnea, ventilatory capacity and exercise tolerance durability in individuals with hypercapnic respiratory failure secondary to restrictive thoracic disease. OBJECTIVES: The purpose of this study was to determine the short-term effect of NIPPV on respiratory muscle endurance, exercise capacity and respiratory functions in patients with chronic respiratory failure due to restrictive thoracic disease. METHODS: Twelve patients with chronic ventilatory failure due to restrictive thoracic disease underwent nasal bilevel positive airway pressure (BiPAP) ventilation for 2 h a day during 15 consecutive days. The effects were assessed by spirometry, arterial blood gas analysis, 6-min walking test, sensation of dyspnea according to the American Thoracic Society dyspnea scoring scales (ATS) and surface electromyogram of the diaphragm (EMGdi) before and after the study (on day 15). RESULTS: Nasal BiPAP reduced the ATS dyspnea score from 2.5 +/- 0.9 to 1.6 +/- 0.4 (p < 0.01). Distances walked in 6 min increased from 320.66 +/- 93.56 to 382.41 +/- 121.20 m (p < 0.05). Comparison of baseline with levels after nasal BiPAP ventilation showed a statistically significant improvement in PaCO(2) (p < 0.05). Forced vital capacity increased from 35 to 50% of the predicted value (p < 0.01). There were no statistically significant reductions in the amplitude of EMGdi after the therapy. CONCLUSION: These results indicate that NIPPV delivered via nasal BiPAP improves respiratory functions, exercise capacity, and reduces dyspnea in the short term in patients with chronic respiratory failure due to restrictive thoracic disease. Whether such short-term improvements can be sustained merits further study.