Laser-Assisted Removal of Aspirated Thumbtacks by Flexible Bronchoscopy

Background. Aspirated thumbtacks are difficult to extract as the sharp edge of the thumbtack often is well imbedded within bronchial wall and its removal is technically demanding and may cause complications such as bronchial mucosal tear and bronchial wall perforation. These sharp metal objects are commonly removed using rigid bronchoscopy since their removal through flexible bronchoscopy is considered to be dangerous. Objectives. To describe a technique for removal of sharp aspirated metal objects employing laser through flexible bronchoscopy. Methods. We report two patients in whom a new technique for removal of sharp aspirated metal objects utilizing Nd-Yag laser flexible bronchoscopy was used. Results. Successful and uncomplicated removal of the aspirated thumbpack by flexible bronchoscopy under conscious sedation was accomplished in the two patients described. Both patients were discharged within 24 hours. Conclusions. In patients with aspirated thumbtack laser-assisted breakage of the object through flexible bronchoscopy may obviate the need for rigid bronchoscopy or thoracotomy

Long-Term Follow-Up of Flexible Bronchoscopic Treatment for Bronchial Carcinoids with Curative Intent

Background. Typical pulmonary carcinoids represent less than 5% of primary lung tumors. In patients with typical bronchial carcinoid, formal surgical resection still remains the gold-standard treatment. Data regarding long-term outcome in using flexible bronchoscope-based modalities under conscious sedation is very limited. Objectives. We sought to investigate, over extended follow-up period, the effectiveness of endobronchial resection for carcinoid tumors with curative intent using flexible bronchoscopy. Methods. Nd:YAG laser photoresection using flexible bronchoscope under conscious sedation. Follow-up included repeat bronchoscopy every 6 months and chest CT every year. Results. Ten patients aged 24 to 70 years with endobronchial carcinoid were treated. The tumor location was variable: 2 left Main bronchus, 1 left upper lobe bronchus, 2 right main bronchus, 2 right middle lobe bronchus and 3 right lower lobe bronchus. No major complications were observed. The patients required between 2 and 4 procedures. Patients were followed for a median period of 29 months with no evidence of tumor recurrence. Conclusions. Endobronchial laser photoresection of typical bronchial carcinoids using flexible bronchsocopy under conscious sedation is an effective treatment modality for a subgroup of patients that provides excellent long-term results that are similar to outcome obtained by more invasive procedures

Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients

<p>Abstract</p> <p>Background</p> <p>Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment.</p> <p>Methods</p> <p>Patients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation.</p> <p>Results</p> <p>A total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions.</p> <p>Conclusions</p> <p>BTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising.</p

Removal of metallic tracheobronchial stents in lung transplantation with flexible bronchoscopy

<p>Abstract</p> <p>Background</p> <p>Airway complications are among the most challenging problems after lung transplantation, and Self-Expandable Metallic Stents (SEMS) are used to treat airway complications such as stenosis or malacia at the bronchial anastomosis sites. Several transplantation centers are reluctant to use SEMS since their removal is sometimes needed and usually requires the use of rigid bronchoscopy under general anesthesia. The objective of the current report is to describe our experience in SEMS retrieval by flexible bronchoscopy under conscious sedation.</p> <p>Methods</p> <p>A retrospective review was done of patients requiring tracheobronchial stent placement after lung transplantation in which the SEMS had to be removed. The retrieval procedure was done by flexible bronchoscopy on a day-care ambulatory basis.</p> <p>Results</p> <p>Between January 2004 and January 2010, out of 305 lung transplantation patients, 24 (7.8%) underwent SEMS placement. Indications included bronchial stenosis in 20 and bronchomalacia in 4. In six patients (25%) the SEMS had to be removed due to excessive granulation tissue formation and stent obstruction. The average time from SEMS placement to retrieval was 30 months (range 16-48 months). The stent was completely removed in five patients and partially removed in one patient; no major complications were encountered, and all patients were discharged within 3 hours of the procedure. In all procedures, new SEMS was successfully re-inserted thereafter.</p> <p>Conclusions</p> <p>The retrieval of SEMS in patients that underwent lung transplantation can be effectively and safely done under conscious sedation using flexible bronchoscopy on a day-care basis, this observation should encourage increasing usage of SEMS in highly selected patients.</p

Erratum to “Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient”

Lan istripuek eraginiko heriotzen trataera, euskal prentsaren aldetik, aztergai dugu artikulu honetan. Horretarako 2001. eta 2009. urteetan Bizkaian izandako heriotzak aintzat hartu dira. Abiapuntuko hipotesia zera da: beste heriotza bortitz batzuetan ez bezala "esate baterako ETAk burututako atentatuetan edo Genero Indarkeriagaitik sortutakoetan, non hedabideen jarreretan izandako bilakaera azken urteotan nabarmena den" lan istripuen kasuan gertaerako kazetaritzatik oso hurbil dagoen beste ikuspegi bat mantentzen da. Gure azterketa osatzeko hainbat elkarrizketa egin zaie Euskal Herriko sindikatu nagusietako ordezkariei. Testu hau Zientzi eta Berrikuntzarako Ministerioak fintzatutako Ikerkerta Proiektu batean oinarrituta dago (CSO2010-19866, erreferiantziaduana, hain zuzen).; This article explores the evolution of the Basque print media"s approach to reporting labour fatalities, beginning with an analysis of press coverage of workplacerelated deaths in the Province of Biscay during the period 2001-2009. Our initial hypothesis held that the regional press policy of treating certain types of violent death (such as deaths related to violence perpetrated by Basque separatists and gender violence) as key social issues has been in sharp contrast to its perception and handling of labour-related fatalities, which have generally been treated as undifferentiated local news events and lumped together with items such as traffic accidents. This paper is part of a wider research project financed by the Ministry of Science and Innovation titled "The evolution of newspaper coverage of violent deaths in the Basque Country" (reference CSO2010-19866).; En este artículo se analiza la evolución en el tratamiento de los accidentes laborales mortales por parte de la prensa vasca, tomando como referencia los fallecimientos ocurridos en Bizkaia en los años 2001 y 2009. Como hipótesis de partida se considera que, al contrario de lo que ha ocurrido con otras muertes violentas, como las provocadas por los atentados de ETA o por la violencia de género, en donde se puede observar una toma de postura por parte de los medios en los últimos años, en el caso de la siniestralidad laboral nos encontramos con un enfoque mucho más cercano al periodismo de sucesos, en el que los fallecimientos en el puesto de trabajo se equiparan a los accidentes de tráfico. Este texto forma parte de un proyecto de investigación más amplio sobre "La evolución en el tratamiento de las muertes violentas en la prensa del País Vasco", financiado por el Ministerio de Ciencia e Innovación (referencia CSO2010-19866)