Iatrogenic injuries to the trachea and main bronchi

INTRODUCTION: Iatrogenic tracheobronchial injuries are rare. AIM: To analyse the mechanism of injury, symptoms and treatment of these patients. MATERIAL AND METHODS: Retrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed. RESULTS: There were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48). In 16 patients the injury occurred during tracheal intubation, in 1 during rigid bronchoscopy, in 1 during rigid oesophagoscopy, in 1 during mediastinoscopy and in 5 during open surgery. Mean length of airway tear was 3.8 cm (range: 1.5-8). In 1 patient there was an injury to the cervical trachea and in the remaining 23 in the thoracic part of the airway. The treatment included repair of the membranous part of the trachea performed via right thoracotomy in 10 patients (in 1 patient additionally coverage with a pedicled intercostal muscle flap was used), a self-expanding metallic stent in 1 patient, suture of the right main bronchus and the oesophagus in 1, left upper sleeve lobectomy in 1, right upper lobectomy in 1, implantation of a silicone Y stent in 3, mini-tracheostomy in 1, and conservative treatment in 5 patients. CONCLUSIONS: Intubation is the most frequent cause of iatrogenic main airway injuries. Patients with these life-threatening complications require an individualised approach and treatment in a reference centre

Endosonography-guided fine needle aspiration in the diagnosis of sarcoidosis : a randomized study

There are no widely accepted standards for the diagnosis of sarcoidosis. The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS‑FNA) and endoscopic ultrasound fine-needle aspiration (EUS‑FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy. This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS‑FNA) or group B (EUS‑FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS‑FNA and all patients with negative results in group B underwent EBUS‑FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed. We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134). The sensitivity and accuracy of EBUS‑FNA and EUS‑FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS‑FNA tend to be higher than those of EBUS‑FNA