Efficacy and safety of bronchoscopic diagnostic procedures of sarcoidosis: A retrospective study

Sarcoidosis is a chronic systemic granulomatous disorder of unknown etiology, which most commonly presents with bilateral hilar adenopathy and pulmonary infiltrates. Fiberoptic bronchoscopic procedures are the most important tools for the diagnosis sarcoidosis. Purpose: A retrospective study was done to evaluate the efficacy and safety of bronchoscopic diagnostic procedures in pulmonary sarcoidosis. Patients and methods: This retrospective study was done by reviewing the records of the bronchoscopic procedures and pathological reports performed between May 2012 and September 2015 to assess the diagnostic yield, and safety and bronchoscopic procedures (TBNA, EBB and TBLB) of cases of sarcoidosis done in the bronchoscopy unit of Chest Department, Mansoura University. We included adult patients with mediastinal lymphadenopathy with or without diffuse pulmonary infiltrate with suspected sarcoidosis with indicated fiberoptic bronchoscopy and excluded patients unfit for FOB with uncorrectable bleeding diathesis, patients with uncontrolled cardiac comorbidities and respiratory failure. The diagnostic yield and complications were the endpoints of our study. Results: Regarding the diagnostic yield, TBNA showed the diagnosis of 4 out of 8 patients (50%) in stage I and 3 out of 5 patients (60%) in stage II. In all the studied cases, TBNA showed the diagnosis of 7 out of 13 patients (53.8%). EBB showed the diagnosis of 2 out of 2 (100%) in stage I, 1 out of 2 patients (50%) in stage II and 1 out of 2 patients (50%) in stage III. In all the studied cases, EBB showed the diagnosis of 4 out of 6 patients (66.7%). TBLB∕EBB showed the diagnosis of 6 out of 12 patients (50%) in stage II and diagnosis of 4 out of 7 patients (57%) in stage III. In all the studied cases, TBLB∕EBB showed the diagnosis of 10 out of 19 patients (52.6%). Pneumothorax developed only in 4 patients (12%), hemoptysis developed in 5 patients (16%) and no procedure related mortality. Conclusion: The bronchoscopic diagnostic procedures (TBNA, EBB and TBLB) are effective and safe in the diagnosis of pulmonary sarcoidosis

Chemical pleurodesis by small bore catheter in hepatic hydrothorax: A feasibility study

Background: Hepatic hydrothorax treatment remains problematic, and chemical pleurodesis can be considered. Objectives: The aim of this study is to compare the efficacy and safety of chemical pleurodesis by small bore catheter to tube drainage in hepatic hydrothorax. Methods: A randomized clinical study included 30 patients with hepatic hydrothorax who were admitted to Chest Department, Mansoura University Hospital, Egypt from 2011 to 2014. Patients diagnosed with exudative effusion, renal impairment, hepatic encephalopathy were excluded. Patients were divided into 2 groups; group A (20 patients) managed by small catheter and group B (10 patients) managed by intercostal tube, chemical pleurodesis in both groups was done by Viscum. Clinical, radiological data and hospital stay duration were adopted for comparison between both groups. Results: Pleurodesis was successful in group A 65% (13 patients) and in group B 70% (7 patients). Hospital stay duration was 10 days for group A and 11 days for group B. Post procedure chest pain score was less in group A than group B which was statistically significant. No serious complications and no mortality occured. Conclusions: Small bore catheter chemical pleurodesis has successful outcome, less post procedure chest pain and minimal complications in refractory hepatic hydrothorax

Iatrogenic pneumodesis: Gelfoam flux inoculation in focal benign cavitary lung lesion

Background: Pulmonary air-space containing cavities signify major dissuade that hold gas exchange functions back and bring about recurrent suppuration. Purpose: The aim of this work is to evaluate the impact of percutaneous local inoculation of focal benign cavitary lung lesions with synthetic material (gelfoam) guided with chest computed tomography (CT) on the patient outcome based on clinical, laboratory, functional and radiological parameters. Patients and methods: A prospective simple randomized controlled trial was conducted on twenty eight patients with focal benign cavitary lung lesion less than 10 cm in diameter in whom surgical resection was contraindicated or refused. They were subdivided into two groups: group I (medically treated): 14 patients were followed up for three months with medical prophylaxis with quinolone plus clindamycin and group II (gelfoam inoculated): 14 patients percutaneous locally injected with gelfoam under CT guidance for a single session. Results: Gelfoam inoculated group (group II) presented more prevalence over medically treated group (group I) in the reduction of the frequency of infective exacerbations (71.42%), absence of leukocytosis (85.7%), functional improvement (42.85%), reduction of cavity size (57.14%) and cavitary obliteration (35.71%). Both groups were matched regarding the absence of hemoptysis and negative sputum cultures with high percentage (92.85%). However, reduction of the frequency of hospitalization predominated in group I. Significant statistical differences were present in radiological parameters only (reduction of size (0.042) and cavity obliteration (0.002). Success rate of procedure in the studied group was (35.71%). Conclusion: Percutaneous gelfoam injection may share in staged palliation and weeding out of pulmonary cavitary lesions with simple noninvasive image guided procedure

Immediate continuous positive airway pressure (CPAP) therapy after sleeve gastrectomy

Noninvasive continuous positive airway pressure ventilation may improve postoperative oxygenation, lung functions and reduce postoperative complications in morbidly obese patients undergoing sleeve gastrectomy. Aim: Evaluation of the effect of immediate postoperative CPAP therapy after sleeve gastrectomy in improving oxygenation, pulmonary functions values, reducing atelectasis and reducing postoperative pulmonary complications. Patients and methods: Single blind randomized clinical trial, was conducted in Gastroenterology Centre and Chest Department, Mansoura University Hospitals during the period from 2013 to 2015 on 46 morbidly obese patients after sleeve gastrectomy. Patients were divided into two groups; group (A) immediately placed on CPAP (8–12 cm H2O) for at least 8 h and group (B) control group, received oxygen support 4–6 L per minute via nasal catheter. The primary end points of the study were CXR, spirometric pulmonary function (FEV1, FVC, FEV1/FVC) and O2 tension and saturation measured 24 h postoperatively and the secondary endpoints were postoperative pulmonary complications during the first 2 weeks. Results: As regards FEV1 and FVC, there was a high statistically significant difference between both groups after treatment and there was a statistically significant increase in group (A) after treatment versus before treatment. As regards oxygen tension and saturation there were high statistically significant differences between both groups after treatment. There was a statistically significant decrease in atelectasis in group (A). There were statistically significant differences between both groups as regards postoperative respiratory failure and persistent atelectasis but there were no statistically significant differences in pneumonia and gastric distension. Conclusion: The use of immediate CPAP after sleeve gastrectomy in morbidly obese patients is effective in improving oxygenation, spirometric values, reducing atelectasis and decreasing postoperative pulmonary complications

Effect of vitamin D replacement in chronic obstructive pulmonary disease patients with vitamin D deficiency

Introduction: Vitamin D deficiency is prevalent among patients with chronic obstructive pulmonary disease (COPD) and comes to be more frequent with increased disease severity. We aimed to assess the role of vitamin D supplementation in patients with severe COPD. Patients and methods: We studied 30 patients with severe COPD and vitamin D deficiency. All patients received oral vitamin D3 50,000 IU once weekly for 8 weeks, followed by a daily dose of 800 IU thereafter. Pulmonary function tests, six minute walk test (6MWT), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), C-reactive protein (CRP), and serum vitamin D level were assessed at the start of the study and 1 year later. The frequency of exacerbations was recorded a year before and a year after vitamin D supplementation. Results: The mean serum vitamin D level was 11.80 ± 2.40 ng/dl and reached 55.30 ± 5.65 ng/dl a year after vitamin D intake (p < 0.001). We found a significant improvement in dyspnea scale (p < 0.003), 6MWT (p < 0.001), MVV (p < 0.001), MIP (p = 0.006), MEP (p < 0.001), coupled with a decrease in disease exacerbations (p < 0.001) and CRP (p < 0.001) a year after vitamin D replacement. However, the FEV1 and FVC did not differ significantly. Conclusion: Vitamin D replacement improved dyspnea, physical performance and decreased the frequency of exacerbation in severe COPD patients with vitamin D deficiency

Ultrasound-guided multilevel paravertebral block versus local anesthesia for medical thoracoscopy

Background: Local anesthetic infiltration for medical thoracoscopy has an analgesic properties for short duration. Single injection thoracic paravertebral block (PVB) provides limited analgesia. Purpose: Comparison between thoracic PVB performed at two or three levels with local infiltration for anesthetic adequacy in adult medical thoracoscopy as a primary outcome and postthoracoscopic analgesia and pulmonary function as secondary outcomes for adult medical thoracoscopy. Patients and Methods: Prospective randomized control study included 63 adult patients with exudative pleural effusion randomly divided into three groups of 21 patients: 3-level PVB, 2-level PVB group, and local infiltration group. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Pain visual analog scale and spirometry were used for comparison as anesthetic adequacy in adult medical thoracoscopy as a primary outcome besides prolonged analgesia and improved pulmonary function as secondary outcomes. Results: The anesthetic adequacy was 95.3% in 3-level PVB group, 81% in 2-level PVB group, and 71.5% in local infiltration group. The mean sensory level was 1 ± 0.8 and 1 ± 0.6 segment above and 0.8 ± 0.6 and 0.7 ± 0.7 segment below the injected level in 3-level PVB group and 2-level PVB, respectively. VAS was statistically significant higher in local infiltration compared to the other two groups immediately postthoracoscopic and 1 h after. Two-hour postthoracoscopy, significant increase in forced vital capacity values in the three groups compared to their basal values whereas forced expiratory volume at 1 s (FEV1) only in both PVB groups. Conclusion: Unilateral 3-level TPVB was superior to 2-level TPVB and LA infiltration for anesthetic adequacy for patients undergoing medical thoracoscopy. Moreover, US-guided TPVB was followed by higher FEV1 values and lower pain scores during the next 12 h postthoracoscopy in comparison to local infiltration, so 3-level TPVB is an effective and relatively safe anesthetic technique for adult patients undergoing medical thoracoscopy which may replace local anesthesia