Lung biopsy in children: when is it useful?

AIM: To provide a further insight into the usefulness of lung biopsy in children. METHODS: Lung biopsies in children from January 2007 to December 2017 were reviewed (n=39). The histology results were categorised as: definitive diagnosis, normal lung parenchyma, inconclusive. RESULTS: Lung biopsy provided a definitive diagnosis in 25 (64%) cases. A suspected diagnosis was confirmed in 16 (41%) and a new diagnosis was found in 9 (23%) children. Histology was inconclusive in 11 (28%) cases and normal in 3 (8%). Fifteen (38%) children had treatment altered due to the biopsy result. CONCLUSION: Lung biopsy mostly confirmed the suspected diagnosis and was associated with a low procedure related morbidity (n=1) and mortality (n=0). Importantly, the biopsy result identified a pathology which altered treatment in over one third of patients. However, in a number of cases the histology was inconclusive, therefore careful patient selection is recommended to maximise diagnostic yield.

Diagnostic mini-video assisted thoracic surgery. Effectiveness and accuracy of new generation 2.0 mm instruments.

OBJECTIVE: Recently 2.0 mm mini-VATS has aroused much interest among surgeons involved with endoscopic surgery. We report our initial experience with the first first 54 patients who underwent this procedure. The aim of this study is to evaluate the effectiveness and accuracy of mini-VATS. METHODS: 54 patients were undertaken to mini-VATS for diagnostic purposes. Patients were randomly selected and the indication for operation was set by the classic VATS criteria. 35 (65%) patients were treated under general anesthesia, while 19 (35%) patients were treated under local anesthesia. RESULTS: The average length of hospital stay was 1.8 +/- 0.9 days. The days of requirement for narcotic analgesia were 1.9 +/- 1.0. Diagnostic accuracy was 100%; morbidity and mortality rates were 0%. CONCLUSIONS: The high diagnostic accuracy and low operative danger, combined with less postoperative pain, due to minor surgical trauma and faster patient recovery, has established mini-VATS as a dynamic competitor to the classic VATS procedure. Since high technology is a strong partner in endoscopic surgery, a strong potentiality for evolution exists.

Morbimortalidade em laparoscopia diagnóstica: considerações a propósito de 1.333 casos / Morbidity and mortality in diagnosis laparoscopy diagnóstica: considerations concerning 1.333 cases

Os autores reportam a morbimortalidade em 1.333 laparoscopias realizadas entre janeiro de 1985 e dezembro de 1995, parte de uma experiência de 9 mil casos submetidos ao procedimento desde 1966. Fazem também uma revisão da fisiopatologia da laparoscopia. Nos 10 anos estudados a morbidade doi de 1,28 pior cento (17 casos) e a mortalidade de 0,08 por cento (um caso), esta não-relacionada propriamente ao exame. Consideram o procedimento muito importante do ponto de vista diagnóstico, sobretudo no estadiamento de tumores, e acreditam que a sua realização, atualmente, encontra-se aquém das reais indicações.