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1.
Medicina (Kaunas) ; 55(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31546869

RESUMO

Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.


Assuntos
Broncoscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Pneumotórax Artificial/instrumentação , Idoso , Biópsia/efeitos adversos , Broncoscopia/efeitos adversos , Temperatura Baixa , Feminino , Humanos , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Pneumotórax Artificial/efeitos adversos , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
Einstein (Sao Paulo) ; 17(3): eMD4921, 2019 Sep 05.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31508658

RESUMO

The endobronchial ultrasound is a minimally invasive technique that simultaneously associates ultrasound and bronchoscopy, to visualize lung nodule or masses, airway wall, and structures adjacent to the tracheobronchial tree. Endobronchial ultrasound has been incorporated into clinical practice all over the world because of its low risk and high diagnostic yield in neoplastic and non-neoplastic disease.


Assuntos
Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Endossonografia/métodos , Doenças do Mediastino/diagnóstico por imagem , Broncoscopia/instrumentação , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Endossonografia/instrumentação , Humanos , Pneumopatias/diagnóstico por imagem , Sensibilidade e Especificidade
3.
Medicine (Baltimore) ; 98(33): e16869, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415423

RESUMO

RATIONALE: Precise lung isolation technique with visual confirmation is essential for thoracic surgeries to create a safe and clear surgical field. However, in certain situations, such as when patients have massive pulmonary secretion or when the fiberoptic bronchoscopy (FOB) is not applicable, lung isolation has been performed blindly. PATIENT CONCERN: A 52-year-old woman, whose airway was unable to visualize with FOB due to massive pulmonary secretion, was presented for bilateral sequential lung transplantation. Extracorporeal membranous oxygenation, tracheostomy, and mechanical ventilation were applied to the patient for 39 days preoperatively as a bridge for lung transplantation. DIAGNOSIS: Patient was diagnosed with an idiopathic pulmonary fibrosis and obesity. INTERVENTION: Initially, height-based blind positioning with a conventional double-lumen endobronchial tube (DLT) failed to ventilate the patient properly, and the confirmation of DLT positioning with FOB was impossible due to massive pulmonary secretion. Therefore, a novel DLT (ANKOR DLT) that has one more cuff, located at a point between the distal opening of the tracheal lumen and the starting point of bronchial cuff, than conventional DLT was used for the lung isolation in the patient. OUTCOMES: After the completion of lung graft, FOB finding showed that the ANKOR DLT was optimally positioned at the tracheobronchial tree of the patient, and its depth was 2.5 cm shallower than that of the conventional tube. LESSONS: ANKOR DLT would be a feasible choice to achieve successful blind lung isolation when the use of FOB is impossible to achieve the optimal lung isolation.


Assuntos
Broncoscopia/instrumentação , Fibrose Pulmonar Idiopática/cirurgia , Intubação Intratraqueal/métodos , Ventilação Monopulmonar/métodos , Desenho de Equipamento , Feminino , Humanos , Fibrose Pulmonar Idiopática/complicações , Transplante de Pulmão/instrumentação , Transplante de Pulmão/métodos , Pessoa de Meia-Idade , Obesidade/complicações
4.
Int J Pediatr Otorhinolaryngol ; 127: 109651, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470204

RESUMO

OBJECTIVE: We describe the novel use of injectable carboxymethylcellulose to close a persistent bronchopleural fistula (BPF) in a neonate who underwent an ex utero intrapartum treatment (EXIT) after aborted fetoscopy. METHODS: In this case, a patient with laryngeal atresia underwent fetoscopy that was halted after concern for instruments within the mediastinum, and thus ultimately required an EXIT to establish an airway. Bilateral pneumothoraces and eventually multiple BPF were identified that continued to persist despite multiple attempts at removal of chest tubes over a four-week period. We look at the role of endoscopy and a substance often used in the larynx to help close a persistent BPF. RESULTS: At initial bronchoscopy, no BPF was identified, but at subsequent evaluation due to persistent pneumothorax, we used increased positive end expiratory pressure to help reveal the fistula. Given the bronchial location of the fistula, traditional laryngeal instruments could not be used, requiring the use of urologic cystoscopy needles to assist in accessing these challenging locations. At postoperative day 2 from the injection, the chest tube was removed and did not require replacement. CONCLUSION: There are many methods to help treat BPF. The endoscopic injection of carboxymethylcellulose adds a technique to the pediatric otolaryngologist's armamentarium.


Assuntos
Fístula Brônquica/terapia , Carboximetilcelulose Sódica/uso terapêutico , Fístula/terapia , Doenças Pleurais/terapia , Fístula Brônquica/complicações , Broncoscopia/instrumentação , Broncoscopia/métodos , Fístula/complicações , Humanos , Recém-Nascido , Injeções/instrumentação , Agulhas , Doenças Pleurais/complicações , Pneumotórax/etiologia
5.
Indian Pediatr ; 56(7): 560-562, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333209

RESUMO

OBJECTIVE: To report our experience of tracheobronchial foreign body removal in children using flexible bronchoscopy as the primary mode. METHODS: Hospital records of tracheobronchial foreign body extractions between January, 2006 and January, 2018 were reviewed. Clinical presentations, radiological findings, location and types of tracheobronchial foreign bodies, types of bronchoscopes, complications and outcome of the procedures were analyzed. RESULTS: 283 extractions in children with median (range) age of 18 (5-168) months were reviewed. Extraction by flexible bronchoscope, using wire baskets or grasping forceps, was successful in 260 cases. No major complications were encountered. Mean (SD) time for the procedure was 31 (6.3) minutes. CONCLUSION: Airway foreign bodies can safely be removed by flexible bronchoscopy with minimal complications. This procedure can be considered the primary mode for removal of airway foreign bodies by a trained and experienced person.


Assuntos
Manuseio das Vias Aéreas/métodos , Brônquios/diagnóstico por imagem , Broncoscopia , Corpos Estranhos , Traqueia/diagnóstico por imagem , Broncoscópios , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/etiologia , Corpos Estranhos/terapia , Humanos , Índia/epidemiologia , Lactente , Masculino , Instrumentos Cirúrgicos
6.
Indian Pediatr ; 56(7): 587-593, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333214

RESUMO

Flexible fiberoptic bronchoscopy a vital diagnostic and therapeutic procedure for assessing the airway. Its logistics, clinical indications and utility need to be elucidated in pediatric context. Pediatric flexible fibreoptic bronchoscopy is useful for diagnosis of airway anomalies, bronchoalveolar lavage for diagnostic and therapeutic purposes, and interventions like foreign body removal. Newer ultra-thin bronchoscopes can be used to perform this procedure in children of all ages. Pediatric flexible bronchoscopy is a valuable diagnostic and therapeutic tool in the hands of skilled personnel when used judiciously.


Assuntos
Manuseio das Vias Aéreas , Broncoscópios , Broncoscopia , Pediatria/instrumentação , Sistema Respiratório , Doenças Respiratórias , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Criança , Humanos , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/cirurgia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/terapia , Ultrassonografia de Intervenção/métodos
7.
Clin Respir J ; 13(9): 590-597, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343834

RESUMO

INTRODUCTION AND OBJECTIVES: Endosonography is increasingly used for the diagnosis of centrally located, bronchoscopically invisible intrapulmonary lesions, but data regarding its utility for molecular profiling are lacking. We aimed to assess the suitability of endosonography samples obtained from intrapulmonary lesions for cancer genotyping and programmed-death ligand 1 (PD-L1) testing. METHODS: A prospectively collected database regarding 99 consecutive patients undergoing endosonography for the diagnosis of an intrapulmonary lesion was retrospectively reviewed. Genotyping ± PD-L1 testing was carried out in the 53 patients with advanced lung cancer and was classified as complete if all clinically indicated tests could be performed, incomplete if at least one test could not be carried out, and unsuccessful if the sample was unsuitable for molecular analysis. RESULTS: All clinically indicated biomarkers could be tested in 44 (83%) patients, whereas the molecular profiling was classified as incomplete in 6 (11.3%), and unsuccessful in 3 (5.7%). Thirty-seven genetic alterations (KRAS mutation, 17; EGFR mutation, 17; ALK rearrangement, 3) and 2 cases of PD-L1 expression >50% were found in 31 (58%) patients. EGFR was successfully analysed in 94.1% of cases, KRAS in 93.9%, ALK in 89%, ROS1 in 90% and PD-L1 in 63.1%. CONCLUSION: Endosonography-derived samples from intrapulmonary lesions were suitable for a thorough molecular profiling in most patients. The few cases of incomplete accomplishment of the testing algorithm were related to the failure of PD-L1 analysis due to the exhaustion of the sample or the lack of sufficient tumour cells in the paraffin-embedded material.


Assuntos
Endossonografia/métodos , Esôfago/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Idoso , Idoso de 80 Anos ou mais , Quinase do Linfoma Anaplásico/genética , Antígeno B7-H1/genética , Broncoscopia/instrumentação , Receptores ErbB/genética , Esôfago/patologia , Feminino , Genótipo , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Proteínas Tirosina Quinases/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Estudos Retrospectivos
9.
BMJ Case Rep ; 12(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068343

RESUMO

A 64-year-old manpresented with non-productive cough and dyspnoea and was evaluated and diagnosed to have a left lung mass on CT of the chest. A transthoracic needle biopsy under CT guidance revealed necrotic tissue on histopathology and was inconclusive. Positron emission tomography scan revealed a fluoro-deoxyglucose-avid left lung mass with a left upper lobe luminal cut-off. A flexible video bronchoscopy was performed and revealed left upper lobe complete obstruction with an endoluminal plug which was removed in piecemeal fashion, and deeper biopsies were taken from the lingula. Histopathology revealed underlying adenocarcinoma colonised by aspergillosis. This case serves to remind us of the possibility of missing underlying malignancy when taking superficial biopsies of clearly visualised endobronchial necrotic tissue and the need for debulking it to a reasonable extent and to take deeper biopsies in order to not miss a possible underlying malignancy.


Assuntos
Adenocarcinoma/patologia , Broncoscopia/instrumentação , Dispneia/patologia , Biópsia Guiada por Imagem , Neoplasias Pulmonares/patologia , Tomografia por Emissão de Pósitrons , Aspergilose Pulmonar/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Biópsia por Agulha , Tosse , Dispneia/diagnóstico por imagem , Dispneia/microbiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Aspergilose Pulmonar/diagnóstico por imagem , Aspergilose Pulmonar/terapia , Recusa do Paciente ao Tratamento
10.
Zhonghua Zhong Liu Za Zhi ; 41(5): 326-330, 2019 May 23.
Artigo em Chinês | MEDLINE | ID: mdl-31137164

RESUMO

Objective: To explore the feasibility of bronchoscopic brushing liquid-based slide cytology combined with automatic immunocytochemistry (ICC) for pathological typing of lung cancer. Methods: A liquid-based thin-prep was prepared from 171 bronchoscopic brushing specimens of patients with pulmonary lesions. ICC was detected by automatic immunohistochemistry instrument while cytomorphological diagnosis was made. The results were compared with those of histopathological diagnosis. Results: Among 171 patients, 130 (76.0%) could be classified by cell morphology alone, including 31 squamous cell carcinomas, 44 adenocarcinomas and 55 small cell carcinomas; 162 (94.7%) could be classified by cell morphology combined with ICC, including 38 squamous cell carcinomas, 61 adenocarcinomas and 63 small cell carcinomas (P<0.001). According to the gold standard of histopathological diagnosis, the coincidence rate of cytomorphology combined with ICC was higher than that of cell morphology alone. The coincidence rate of squamous cell carcinoma was increased from 85.2% to 97.1% (P=0.093), adenocarcinoma from 92.5% to 98.0% (P<0.001), and small cell carcinoma from 96.1% to 98.3% (P=0.465). Conclusion: The combination of liquid-based thin-prep cytology and automatic immunohistochemistry can effectively improve the accuracy of pathological typing of brushing specimens under fiberoptic bronchoscopy, and provide more objective diagnostic results for clinical treatment.


Assuntos
Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Imuno-Histoquímica/métodos , Biópsia Líquida/métodos , Neoplasias Pulmonares/patologia , Carcinoma de Pequenas Células do Pulmão/patologia , Broncoscopia/instrumentação , Broncoscopia/métodos , Citodiagnóstico/instrumentação , Citodiagnóstico/métodos , Estudos de Viabilidade , Humanos , Biópsia Líquida/instrumentação , Neoplasias Pulmonares/classificação
11.
Pathologe ; 40(5): 529-533, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30937513

RESUMO

We report a 78-year-old male patient suffering from hairy cell leukemia, presenting clinically mainly with dyspnea. Radiology exhibited bilateral ground-glass shadows. In order to prevent pneumonia as a possible side effect due to conventional chemotherapy, it was decided to first treat the patient with rituximab; however, dyspnea persisted. Therefore, bronchoscopy was performed and specimens were sampled for both histological examination and bronchoalveolar lavage (BAL) analysis. BAL showed lymphocytosis (28.7%), and by means of immunocytochemistry a few CD79a+ B­lymphocytes as well as lymphoid cells positive for the hairy cell marker DBA44 were observed. In addition, molecular study revealed the BRAF V600E mutation. Thus, the findings of BAL were interpreted as lung infiltration by hairy cell leukemia. This result was confirmed by histology. Following a therapy switch to cladribine, a significant improvement was reached. Pulmonary infiltrates by hairy cell leukemia were rarely described. This case represents the first report of hairy cell leukemia diagnosed by means of BAL. It may be difficult to clearly separate between lymphoma infiltration of the lung and medicamentous pneumonitis, but this differential diagnosis can be supported by morphological methods.


Assuntos
Leucemia de Células Pilosas , Pneumonia , Idoso , Lavagem Broncoalveolar/métodos , Broncoscopia/instrumentação , Humanos , Pulmão
12.
Eur Respir Rev ; 28(152)2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-30996040

RESUMO

The results of the randomised controlled trials investigating the bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) are promising, and have led to their inclusion in treatment guidelines, US Food and Drug Administration approval and inclusion in routine care in an increasing number of countries. The one-way valve treatment has advanced and is now a regular treatment option. However, this new phase will lead to new challenges in terms of implementation. We believe that key issues in future research concern advanced patient selection, improved methods for target lobe selection, increased knowledge on the predictive risk of a pneumothorax, positioning of pulmonary rehabilitation in conjunction with the EBV treatment, the positioning of lung volume reduction surgery versus EBV treatment, and the long-term efficacy, adverse events, impact on exacerbations and hospitalisations, costs and survival. Hopefully, the increasing number of patients treated, the setup of (inter)national registries and future research efforts will further optimise all aspects of this treatment.


Assuntos
Broncoscopia/instrumentação , Pulmão/cirurgia , Implantação de Prótese/instrumentação , Enfisema Pulmonar/cirurgia , Broncoscopia/efeitos adversos , Humanos , Pulmão/fisiopatologia , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento
13.
Monaldi Arch Chest Dis ; 89(1)2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30996353

RESUMO

The conventional-trans bronchial needle aspiration (c-TBNA) has been the first procedure for sampling hilar/mediastinal lymph node for the diagnosis/staging of lung cancer. In the last decade the endobronchial ultrasound trans bronchial needle aspiration (EBUS-TBNA) was introduced in clinical practice and became the first-choice exam in diagnosis and staging of lung cancer. The aim of this study was to compare the diagnostic accuracy (DA), sensitivity and adequacy of c-TBNA and EBUS-TBNA. It was a retrospective and observational multicenter study. The first endpoint was diagnostic accuracy of EBUS-TBNA versus c-TBNA. The secondary end-points were sensitivity and adequacy. Two hundred and nine consecutive patients underwent the procedure, 99 EBUS-TBNA and 110 c-TBNA. When lymph nodes with short axis <2 cm the diagnostic accuracy for correct diagnosis was 94.2% in EBUS-TBNA group and 89.7% in c-TBNA group (p=0.01); the sample adequacy was 70.3% and 42%, respectively (p=0.01); the sensitivity was 93% (95% CI, 82-98%) and 86.4% (95% CI, 67.6-95.6%), respectively (p=0.002). In lymph nodes with short axis ≥2 cm the diagnostic accuracy was 95.7% in EBUS-TBNA group and 93% in c-TBNA group (p=0.939); the sample adequacy was 68.7% and 68.3%, respectively (p=0.889); the sensitivity was 95.1% (95% CI, 83-99%) and 92.1%, respectively (95% CI, 78.7-97.7%) (p=0.898). The EBUS-TBNA in patients with lymph nodes size <2 cm presented a statistically significant difference in the DA, adequacy and sensitivity compared to c-TBNA procedure, while there were no significant differences in the DA, adequacy and sensitivity between EBUS-TBNA and c-TBNA in patients with lymph node size ≥2 cm. The results of our study indicated that the EBUS-TBNA should be the first-choice procedure for the diagnosis/staging in lung cancer patients with lymph node size <2 cm. In patients with lymph node size ≥2 cm, instead, both procedures can be used for the diagnosis/staging of lung cancer.


Assuntos
Biópsia por Agulha Fina/normas , Broncoscopia/instrumentação , Linfonodos/patologia , Ultrassonografia/métodos , Idoso , Biópsia por Agulha Fina/tendências , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Padrões de Prática Médica/normas , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Int J Comput Assist Radiol Surg ; 14(7): 1137-1146, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30989504

RESUMO

PURPOSE: A laser-profiled continuum robot (CR) with a series of interlocking joints has been developed in our center to reach deeper areas of the airways. However, it deflects with constant curvature, which thus increases the difficulty of entering specific bronchi without relying on the tissue reaction forces. This paper aims to propose an optimization framework to find the best design parameters for nonconstant curvature CRs to reach distal targets while attempting to avoid the collision with the surrounding tissue. METHODS: First, the contact-aided compliant mechanisms (CCMs) are integrated with the continuum robot to achieve the nonconstant curvature. Second, forward kinematics considering CCMs is built. Third, inverse kinematics is implemented to steer the robot tip toward the desired targets within the confined anatomy. Finally, an optimization framework is proposed to find the best robot design to reach the target with the least collision to the bronchi walls. RESULTS: Experiments are carried out to verify the feasibility of CCMs to enable the nonconstant curvature deflection, and simulations demonstrate a lower cost function value to reach a target for the nonconstant curvature optimized design with respect to the standard constant curvature robot (0.11 vs. 2.66). In addition, the higher capacity of the optimized design to complete the task is validated by interventional experiments using fluoroscopy. CONCLUSION: Results demonstrate the effectiveness of the proposed framework to find an optimized CR with nonconstant curvature to perform safer interventions to reach distal targets.


Assuntos
Broncoscopia/instrumentação , Desenho de Equipamento , Procedimentos Cirúrgicos Robóticos/instrumentação , Fenômenos Biomecânicos , Humanos
15.
A A Pract ; 13(4): 130-132, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30985322

RESUMO

In this case, the novel use of high-flow nasal oxygen successfully treated severe hypoxia by delivering oxygen through a very narrow space between the bronchoscope and the tracheal wall. Removal of a foreign body from a child's lung can be associated with hypoxia and cardiorespiratory arrest. The shared airway of the bronchoscope must allow surgical instrumentation and oxygenation. This simultaneous use can compromise gas exchange, leading to hypoxia. In this case, high-flow nasal oxygen supplemented bronchoscope oxygenation to treat a severely hypoxic child and facilitate subsequent removal of a peanut without further incident.


Assuntos
Broncoscopia/instrumentação , Corpos Estranhos/cirurgia , Traqueia/cirurgia , Arachis , Humanos , Hipóxia/etiologia , Lactente , Masculino
18.
J Nepal Health Res Counc ; 16(41): 470-472, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30739923

RESUMO

Foreign body aspiration is uncommon in adults and the diagnosis may be delayed in the elderly, as many fail to provide a history of choking during initial evaluation. Flexible bronchoscopy is a useful tool for foreign body extraction from the tracheobronchial tree in selected cases. A Sixty-two year old male presented with history of cough, purulent sputum and intermittent hemoptysis. CT scan of the thorax demonstrated a radio-dense foreign body in the bronchus intermedius causing focal narrowing. Flexible fiberoptic bronchoscopy revealed a glistening white bone in the distal bronchus intermedius which was successfully grasped with the flexible forceps and extracted via the oral route with the bronchoscope. Keywords: Elderly; flexible bronchoscopy; foreign body aspiration.


Assuntos
Brônquios , Broncoscopia/métodos , Corpos Estranhos/cirurgia , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Broncoscopia/instrumentação , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Chest ; 155(5): 928-937, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30797746

RESUMO

BACKGROUND: The Lung Volume Reduction Coil Treatment in Patients With Emphysema (RENEW) trial reported improvements in quality of life, pulmonary function, and exercise performance following endobronchial coil treatment. OBJECTIVES: The purpose of this post hoc analysis was to identify baseline predictors, including quantitative CT measures, that identify patients most likely to significantly benefit from endobronchial coil therapy. METHODS: Quantitative CT analysis by an independent radiology laboratory and a qualitative evaluation by five blinded experts of the baseline thoracic CT imaging were performed. Univariate and multivariate logistic regression analyses were performed to elucidate characteristics associated with clinical response. RESULTS: In total, 125 patients underwent coil treatment and had evaluable 12-month follow-up results. Of these, 78 patients received treatment of lobes with the highest emphysematous destruction determined by quantitative CT analysis (quantitative visual match [QVM]+), and 47 received treatment in at least one lobe that was not the most destroyed (QVM-). From the 78 patients with QVM+ treatment, a subgroup of 50 patients (64%) was identified with baseline residual volume > 200% predicted, emphysema score > 20% low attenuation area, and absence of airway disease. In this subgroup, greater lobar residual volume reduction in the treated lobes was achieved, which was associated with significant mean ± SE improvement in FEV1 (15.2 ± 3.1%), St. George's Respiratory Questionnaire (-12 ± 2 points), and residual volume (-0.57 ± 0.13 L). DISCUSSION: This post hoc analysis found that both significant hyperinflation (residual volume ≥ 200% predicted) and CT analysis are critical for patient selection and treatment planning for endobronchial coil therapy. Quantitative CT analysis is important to identify optimal lobar treatment and to exclude patients with insufficient emphysema (< 20% low attenuation area), whereas visual assessment identifies patients with signs of airway disease associated with worse outcomes. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01608490; URL: www.clinicaltrials.gov.


Assuntos
Broncoscopia/métodos , Pneumonectomia/métodos , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Análise de Variância , Broncoscopia/instrumentação , Feminino , Seguimentos , Humanos , Internacionalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Análise Multivariada , Seleção de Pacientes , Valor Preditivo dos Testes , Testes de Função Respiratória , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
20.
Chest ; 155(5): 1067-1074, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30779915

RESUMO

Flexible bronchoscopy has evolved over the last few decades, allowing chest physicians to use advanced high-definition scopes to inspect the airways and perform various sampling techniques. Although the techniques of basic bronchoscopic sampling have not changed dramatically, documentation requirements, coding, and billing have become more complex and require a better understanding on the part of the proceduralists and practice administrators. Areas in need of attention include learning about the multiple endoscopy rule, appropriate use of modifiers, and recent changes to the Current Procedural Terminology codes, associated work relative value units for moderate sedation, and therapeutic aspiration of secretions. This article describes basic bronchoscopic procedures and the principles needed for their coding and billing.


Assuntos
Biópsia/instrumentação , Neoplasias Brônquicas/diagnóstico , Broncoscopia/métodos , Tecnologia de Fibra Óptica/tendências , Neoplasias Pulmonares/diagnóstico , Biópsia/métodos , Broncoscópios , Broncoscopia/instrumentação , Sedação Consciente , Desenho de Equipamento , Feminino , Previsões , Humanos , Pneumopatias/diagnóstico , Masculino , Sensibilidade e Especificidade
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