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Respiration ; : 1-5, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34515245


Guidelines have recommended endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration biopsy as initial sampling approaches of mediastinal lymph nodes for lung cancer staging. However, the small sample volume might restrict the diagnostic utility of needle aspiration in certain mediastinal diseases. We have recently shown that transbronchial mediastinal cryobiopsy, which is capable of providing larger amounts of intact tissue, improves diagnostic yield in rare tumors and benign diseases compared to EBUS-TBNA. Here, we present a case of mediastinal nodular lymphocyte predominant Hodgkin lymphoma successfully diagnosed by endoscopic transesophageal cryobiopsy.

Eur Respir J ; 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958432


BACKGROUND: Guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an initial investigation technique for mediastinal nodal staging in lung cancer. However, EBUS-TBNA can be limited by the inadequacy of intact tissues, which might restrict its diagnostic yield in mediastinal lesions of certain etiologies. We have previously shown that EBUS-guided transbronchial mediastinal cryobiopsy can provide intact samples with greater volume. METHODS: This randomised study determined the diagnostic yield and safety of transbronchial mediastinal cryobiopsy monitored by endosonography for the diagnosis of mediastinal lesions. Patients with mediastinal lesion of 1 cm or more in the short axis were recruited. Following identification of the mediastinal lesion by linear EBUS, fine-needle aspiration and cryobiopsy were sequently performed in a randomised order. Primary endpoints were diagnostic yield defined as the percentage of patients for whom mediastinal biopsy provided a definite diagnosis, and procedure-related adverse events. RESULTS: One hundred and ninety-seven patients were enrolled and randomly allocated. The overall diagnostic yield was 79.9% and 91.8% for TBNA and transbronchial mediastinal cryobiopsy, respectively (p=0.001). Diagnostic yields were similar for metastatic lymphadenopathy (94.1% versus 95.6%, p=0.58), while cryobiopsy was more sensitive than TBNA in uncommon tumors (91.7% versus 25.0%, p=0.001) and benign disorders (80.9% versus 53.2%, p=0.004). No significant differences in diagnostic yield were detected between TBNA first and cryobiopsy first groups. We observed 2 cases of pneumothorax and 1 case of pneumomediastinum. CONCLUSIONS: Transbronchial cryobiopsy performed under EBUS guidance is a safe and useful approach that offers diagnostic histological samples of mediastinal lesions.

Respiration ; 99(5): 426-430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32050197


Mediastinal biopsy is essential for the clinical diagnosis of mediastinal disease. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established approach for obtaining diagnostic samples from mediastinal masses or enlarged lymph nodes which is proven to be minimally invasive and effective. However, the insufficiency of intact samples acquired might restrict the diagnostic efficacy of EBUS-TBNA for mediastinal lesions such as rare malignancy and granulomatous disorder. We here present an EBUS-guided approach for the cryobiopsy of mediastinal diseases that is capable of providing larger amounts of intact tissue with few observed complications.

Broncoscopia/métodos , Criocirurgia/métodos , Endossonografia/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias do Mediastino/patologia , Seminoma/patologia , Adolescente , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico , Seminoma/diagnóstico , Tomografia Computadorizada por Raios X
Clin Respir J ; 13(7): 467-479, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059198


BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) results in a progressively worsening course associated with substantial morbidity and mortality. The purpose of this comprehensive study was to determine the clinical efficacy of targeted therapeutic interventions for this disease. METHODS: We searched Medline, Embase, Cochrane databases and Pubmed for relevant clinical studies. Randomized controlled trials comparing the effects of targeted treatments to control in CTEPH population were included. Pooled estimates were calculated using a random effect model. Heterogeneity was determined using the I2 statistic. RESULTS: This analysis included 6 studies with a total of 565 patients. We found that targeted treatments approved for pulmonary arterial hypertension (PAH) were associated with a larger improvement in exercise capacity, haemodynamic parameters, functional status and clinical symptom. There were no statistically significant differences associated with targeted treatments compared with control in all-cause mortality and safety outcomes. CONCLUSIONS: This is the first systematic review and meta-analysis of randomized controlled trials revealing a positive role of PAH-targeted therapies in CTEPH. Future larger randomized trials with a focus on long-term clinical outcomes are urgently needed.

Anti-Hipertensivos/uso terapêutico , Causas de Morte , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/mortalidade , Sistemas de Liberação de Medicamentos , Tolerância ao Exercício , Feminino , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/diagnóstico , Masculino , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Análise de Sobrevida
Zhonghua Nei Ke Za Zhi ; 50(8): 668-71, 2011 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-22093559


OBJECTIVE: Preliminary study of the cough reflex sensitivity test in chronic cough patients with different gender, disease duration and causes to evaluate the clinical diagnostic significance of the test and further provide some information for the treatment of chronic cough. METHODS: Totally 108 chronic cough patients in our hospital were enrolled in the study with the final diagnosis of upper airway cough syndrome (UACS), cough variant asthma (CVA) and gastroesophageal reflux cough (GERC). They all went through the cough reflex sensitivity test and the retrospective analysis of the results was made. RESULTS: In 108 patients with chronic cough (76 UACS, 19 CVA and 13 GERC), lgC5 was significantly slower in the female (1.80) than the male (2.40, P < 0.05) and in the patients with cough duration over 12 months (1.80) than those with cough duration under 12 months (2.40, P < 0.05). Cough sensitivity in patients with different causes was significantly different (P < 0.05) with lower lgC5 in GERC patients (1.49) than CVA (2.40, P < 0.05) and UACS (2.40, P < 0.05) patients. CONCLUSIONS: Cough sensitivity is different in chronic cough patients with different gender, disease duration and causes. Cough reflex sensitivity test is of great value in the etiology diagnosis of chronic cough.

Tosse/diagnóstico , Adolescente , Adulto , Idoso , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reflexo , Testes de Função Respiratória , Sensibilidade e Especificidade , Adulto Jovem