The Effects of Long-term Macrolide Therapy in COPD Patients with Frequent Exacerbations

Exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on lung function, morbidity and mortality. Macrolide antibiotics have been successfully used as maintenance treatment in several chronic inflammatory pulmonary diseases. We demonstrated that a regimen of azithromycin treatment 500 mg three times a week during one year compared to placebo, leads to a larger reduction in exacerbation frequency in COPD patients with a minimum of three exacerbations in the previous year. We investigated the role of viral infections. We found a viral infection in a quarter of exacerbations. It was found that human rhinovirus (HRV) was most prevalent with a peak in July. COPD patients with frequent exacerbations showed the best response to maintenance treatment with azithromycin in patients with the following characteristics: baseline blood eosinophil count ≥ 2.0% (compared to an eosinophil count < 2.0%), GOLD stage 1-2 (versus GOLD stage 4) and GOLD group C (compared to group D). We determined the effect of azithromycin maintenance therapy on the dynamics of macrolide resistance genes in the pharyngeal microbiota. It was shown that the acquisition of macrolide resistance genes was limited but the relative abundance of macrolide resistance genes increased significantly over time compared to placebo

Endoscopic Ultrasound Fine Needle Aspiration in the Diagnosis of Lymphoma

In recent years, endoscopic ultrasound techniques with Fine Needle Aspiration (FNA) have become an increasingly used diagnostic aid in the differentiation of mediastinal lymphadenopathy. Endobronchial ultrasound (EBUS) and endoesophageal ultrasound (EUS) are now available for clinicians to reach mediastinal and paramediastinal masses using a minimally invasive approach. These techniques are an established component for diagnosing and staging lung cancer and their benefit in the diagnosis of lymphoma's has been highlighted in a number of case studies. However, the lack of tissue architecture obtained by cytological FNA specimens decreases the diagnostic accuracy for benign causes of thoracic lymphadenopathies, lymphomas, and histopathological subtyping of lung cancer. Accordingly, our study group have adapted the FNA sampling technique, resulting in tissue fragments that can be used for histopathological examinations. As an illustration, we report a case of follicular non-Hodgkin lymphoma, diagnosed on tissue fragments obtained by adjusted EUS FNA. We believe that this relatively simple adjustment to routine FNA sampling can help to overcome the diagnostic limitations inherent in cytology obtained by routine FNA

Characterization of Mediastinal Lymph Node Physiology In Vivo by Optical Spectroscopy during Endoscopic Ultrasound-Guided Fine Needle Aspiration

Introduction: Esophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a minimally invasive staging procedure for mediastinal lymph nodes in patients diagnosed with lung cancer. But, a substantial false negative rate necessitates that patients returning a negative EUS-FNA result must undergo a subsequent surgical staging procedure. This study incorporates a fiberoptic reflectance spectroscopy device into the EUS-FNA procedure to asses the vascular physiology within the sampled lymph node. The aims of this pilot study were to determine the feasibility of incorporating a reflectance spectroscopy device into the EUS-FNA clinical procedure and to gather preliminary information about the vascular physiology within the center of normal and metastatic lymph nodes. Methods: This study included 10 patients with proven or suspected lung cancer and an indication for EUS-FNA. The procedure was performed on seven normal (unenlarged, positron emission tomography negative) nodes and seven suspicious (enlarged, positron emission tomography positive), with the malignant status of all nodes cytologically confirmed. Reflectance spectra were acquired using a single optical fiber that fits through the end of the EUS-FNA biopsy needle, with an outer fiber diameter of 0.38 mm. Results: The procedure was successfully performed and did not introduce complications. Model-based analysis of single fiber reflectance spectra provided quantitative information about the vascular physiology within the sampled lymph node. We observed that metastatic lymph nodes were characterized by lower microvascular oxygen saturation (50% versus 84%, p < 0.01) and lower blood volume fraction (5.6% versus 13.5%, p < 0.01) than normal nodes. Conclusions: Single fiber reflectance spectroscopy has the potential to detect abnormal lymph node physiology

Occurrence of virus-induced COPD exacerbations during four seasons

In this study, we investigated the occurrence of viral infections in acute exacerbations of chronic obstructive pulmonary disease (COPD) during four seasons. Viral infections were detected by the use of real-time reverse transcriptase polymerase chain reaction on pharyngeal swabs. During a 12-month period pharyngeal swabs were obtained in 136 exacerbations of 63 patients. In 35 exacerbations (25.7%) a viral infection was detected. Most viral infections occurred in the winter ( n = 14, 40.0%), followed by summer ( n = 9, 25.7%), autumn ( n = 6, 17.1%), and spring ( n = 6, 17.1%). Rhinovirus was the most frequently isolated virus ( n = 19, 51.4%), followed by respiratory syncytial virus ( n = 6, 16.2%), human metapneumovirus ( n = 5, 13.5%), influenza A ( n = 4, 10.8%), parainfluenza 4 ( n = 2, 5.4%), and parainfluenza 3 ( n = 1, 2.7%). This study showed that virus-induced COPD exacerbations occur in all four seasons with a peak in the winter months. However, the distribution of rhinovirus infections showed a different pattern, with most infections occurring in July