31 research outputs found
Long-Term Complications of Tracheal Intubation
Endotracheal intubation is an intervention frequently performed in the hospital setting in order to protect the central airway and provide mechanical support of ventilation. Many health care providers are expected to be able to intubate the patients for different indications. As the case in any medical intervention, endotracheal intubation can cause complications. These complications are categorized as early or late according to the time of onset of the presenting symptoms. This chapter will discuss the long term complications of endotracheal intubation that might be encountered by the treating physicians. The chapter will stress on the predisposing factors for these complications and the available methods to avoid and treat them
Therapeutic bronchoscopy for central airway diseases
Over the past century rigid bronchoscopy has been established as the main therapeutic means for central airway diseases of both benign and malignant aetiology. Its use requires general anaesthesia and mechanical ventilation usually in the form of manual or high-frequency jet ventilation. Techniques applied to regain patency of the central airways include mechanical debulking, thermal ablation (laser, electrocautery and argon plasma coagulation) and cryo-surgery. Each of these techniques have their advantages and limitations and best results can be attained by combining different modalities according to the type, location and extent of the airway blockage. If needed, deployment of airway endoprostheses (stents), as either fixed-diameter silicone or self-expandable metal stents, may preserve the airways patency often at the cost of several complications. Newer generation of customised stents either three-dimensional printed or drug-eluting stents constitute a promise for improved safety and efficacy results in the near future. Treating central disease of benign or malignant aetiology, foreign body aspiration or massive bleeding in the airways requires a structured approach with combined techniques, a dedicated team of professionals and experience to treat eventual complications. Specific training and fellowships in interventional pulmonology should therefore be offered to those who wish to specialise in this field. Therapeutic bronchoscopy modalities may effectively treat difficult central airway problems in both malignant and benign diseases. This also involves responsibility for treating related complications. Training in interventional pulmonology is warranted
Drug Eluding Stents for Malignant Airway Obstruction: A Critical Review of the Literature
Lung cancer being the most prevalent malignancy in men and the 3rd most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement
A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP)
Publisher Copyright: © Copyright 2017 S. Karger AG, Basel. All rights reserved.Background: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. Objectives: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. Methods: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. Results: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. Conclusion: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings.publishersversionpublishe
Current Practice of Airway Stenting in the Adult Population in Europe: A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP)
Background: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. Objectives: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. Methods: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. Results: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. Conclusion: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings. (C) 2017 S. Karger AG, Base
Pulmonary Hypertension, Bronchoscopy and the Big Bad Wolf! An Overestimated Risk Factor?
Lymphangioleiomyomatosis and tuberous sclerosis complex
Lymphangioleiomyomatosis (LAM) is a rare multisystemic disease of women
of child-bearing age and affects mainly the lungs, promoting cystic
destruction of lung parenchyma or leading to abdominal tumor formation
(e.g., angiomyolipomas, lymphangioleiomyomas). LAM can arise
sporadically or in association with tuberous sclerosis complex (TSC), an
autosomal inherited syndrome characterized by hamartoma-like tumor
growth and pathologic features that are distinct from manifestations of
pulmonary LAM. A substantial body of evidence has now been gathered
suggesting that the two diseases share a common genetic origin. TSC is
caused by mutations in two genes, TSC1 on chromosome 9q34 and TSC2 on
16p13. Both of these genes are tumor suppressor genes encoding hamartin
(TSC1) and tuberin (TSC2). Sporadic LAM is correlated with a mutation in
the TSC2 gene and tuberin appears to play a central role in the
pathogenesis of the disease. A TSC2 loss or mutation leads to disruption
of the tuberin-hamartin heteromer and dysregulation of S6K1 activation
leading to aberrant cell proliferation seen in LAM disease. The
extremely diverse clinical and radiologic features of the disease and
the complex therapeutic approach are reviewed in detail. Although new
therapeutic agents have been tested, to date no effective treatment has
been proposed and the prognosis of patients with LAM remains poor. As
long as newer therapeutic agents do not change this picture, lung
transplantation remains the last hope for patients with respiratory
failure at the advanced stage of the disease
THROWING PERFORMANCE AFTER RESISTANCE TRAINING AND DETRAINING
Terzis, G, Stratakos, G, Manta, P, and Georgiadis, G. Throwing
performance after resistance training and detraining. J Strength Cond
Res 22: 1198-1204, 2008-The purpose of the present study was to
investigate the effect of short-term resistance training and detraining
on shot put throwing performance. Eleven young healthy subjects with
basic shot put skills participated in 14 weeks of resistance training,
which was followed by 4 weeks of detraining. Shot put performance in
four field tests was measured before (T1) and after (T2) resistance
training and after detraining (T3). At the same time points, one
repetition maximum (1RM) was measured in squat, bench press, and leg
press. Fat-free mass (FFM) was determined with dual x-ray absorptiometry
and muscle biopsies obtained from vastus lateralis for the determination
of fiber type composition and cross-sectional area (CSA). 1RM strength
increased 22-34% (p < 0.01) at T2 and decreased 4-5% (not
significantly different) at T3. Shot put performance increased 6-12% (p
< 0.05) after training and remained unaltered after detraining. FFM
increased at T2 (p < 0.05) but remained unchanged between T2 and T3.
Muscle fiber CSA increased 12-18% (p < 0.05) at T2. Type I muscle fiber
CSA was not altered after detraining, but type IIa and IIx fiber CSA was
reduced 10-12% (p < 0.05). The percentage of type IIx muscle fibers was
reduced after training (T1 = 18.7 +/- 4, T2 = 10.4 +/- 1; p < 0.05), and
it was increased at T3 compared with T2 (T3 = 13.7 +/- 1; p < 0.05).
These results suggest that shot put performance remains unaltered after
4 weeks of complete detraining in moderately resistance-trained
subjects. This might be linked to the concomitant reduction of muscle
fiber CSA and increase in the percentage of type IIx muscle fibers