22 research outputs found

    Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes

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    This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion

    Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

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    ┬á INTRODUCTION: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopistÔÇÖs feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIAL AND METHODS: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. RESULTS: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ┬▒ 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. CONCLUSIONS: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.

    The influence of lung volume reduction with intrabronchial valves on the quality of life of patients with heterogeneous emphysema ÔÇö a prospective study

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    Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used ÔÇö bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single center prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ┬▒ 10 years old), all ex-smokers with tobacco exposure 38 ┬▒ 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (ÔÇô12.8; p < 0.001) and in domains and differences were for: ÔÇťsymptomsÔÇŁ (ÔÇô8.5; p < 0.001), ÔÇťactivityÔÇŁ (ÔÇô13.9; p < 0.001) and ÔÇťinfluence on lifeÔÇŁ(ÔÇô13.5; p < 0.002). Conclusions: The presented study revealed the significant improvement of the quality of life measured by SGRQ after the IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used ÔÇö bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ┬▒ 10 years), all ex-smokers with tobacco exposure 38 ┬▒ 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (ÔÇô12.8; p < 0.001) and in domains and the differences were for: ÔÇťsymptomsÔÇŁ (ÔÇô8.5; p < 0.001), ÔÇťactivityÔÇŁ (ÔÇô13.9; p < 0.001) and ÔÇťinfluence on lifeÔÇŁ(ÔÇô13.5; p < 0.002). Conclusions: The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment

    Initial Polish experience of flexible 19 gauge endobronchial ultrasound-guided transbronchial needle aspiration

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    Introduction: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopistÔÇÖs feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Material and methods: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. Results: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ┬▒ 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. Conclusions: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable

    Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases ÔÇö a multicenter prospective study

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A┬ágeneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing itÔÇÖs safety could result in wider use.Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a┬águide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5ÔÇô8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.Results: From March 2017 to September 2019 ÔÇö 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a┬áchest tube drainage and a┬áminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

    Transbronchial lung cryobiopsy guided by radial "mini-probe" endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing itÔÇÖs safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5ÔÇô8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 ÔÇö 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

    Wst─Öpne polskie do┼Ťwiadczenia z u┼╝yciem ig┼éy Flex 19G do przezoskrzelowej biopsji pod kontrol─ů ultrasonografii wewn─ůtrzoskrzelowej

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    WST─śP: EBUS (endobronchial ultrasonography) jest ma┼éoinwazyjn─ů metod─ů diagnostyczn─ů o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii ┼Ťr├│dpiersia i wn─Ök p┼éucnych. ViziShotFlex 19G needle to nowa ig┼éa przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firm─Ö Olympus w 2015 roku. Jej konstrukcja ma zapewni─ç wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz uzyskanie wi─Ökszej ilo┼Ťci materia┼éu tkankowego do analizy. Cele niniejszej pracy to ocena wydolno┼Ťci diagnostycznej procedury EBUS-TBNA (EBUS ÔÇö transbronchial needle aspiration) z zastosowaniem ig┼éy Flex 19G oraz prezentacja opinii endoskopist├│w na temat badania z jej u┼╝yciem. MATERIA┼ü I METODY: Ig┼éy Flex 19G zastosowano w diagnostyce pacjent├│w z adenopati─ů ┼Ťr├│dpiersia i/lub wn─Ök w dw├│ch o┼Ťrodkach pulmonologicznych w Polsce. Wykonywano zar├│wno rozmazy cytologiczne, jak i bloki kom├│rkowe (CB ÔÇö cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dw├│ch wybranych pacjent├│w z adenopati─ů potwierdzon─ů w tomografii komputerowej (┼Ťrednia wieku 58 ┬▒ 12 lat) podano badaniu EBUS-TBNA z u┼╝yciem igie┼é Flex 19G. Wszystkie wykonane rozmazy cytologiczne okaza┼éy si─Ö diagnostyczne (wydolno┼Ť─ç diagnostyczna 100%). Z┼éo┼Ťliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast ┼éagodn─ů adenopati─Ö u 7 pacjent├│w (31,8%). W 12 z 14 przypadk├│w raka p┼éuca wykonane CB mog┼éy by─ç u┼╝yte do oznacze┼ä immunohistochemicznych i molekularnych. Po biopsji w─Öz┼é├│w ch┼éonnych, zw┼éaszcza wn─Ökowych, nie obserwowano nasilonego krwawienia. W por├│wnaniu ze standardow─ů procedur─ů EBUS-TBNA z u┼╝yciem ig┼éy 21/22G endoskopi┼Ťci podkre┼Ťlali wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz jako┼Ť─ç bioptatu, natomiast w pozosta┼éych aspektach biopsji r├│┼╝nice by┼éy nieznacz─ůce. WNIOSKI: Pierwsze polskie do┼Ťwiadczenia z u┼╝yciem igie┼é Flex 19G okazuj─ů si─Ö by─ç podobne do standardowej techniki z u┼╝yciem igie┼é 21/22G oraz prezentuj─ů wysok─ů wydolno┼Ť─ç diagnostyczn─ů w raku p┼éuca, szczeg├│lnie z zastosowaniem CB. Profil bezpiecze┼ästwa biopsji jest akceptowalny.WST─śP: EBUS (endobronchial ultrasonography) jest ma┼éoinwazyjn─ů metod─ů diagnostyczn─ů o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii ┼Ťr├│dpiersia i wn─Ök p┼éucnych. ViziShotFlex 19G needle to nowa ig┼éa przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firm─Ö Olympus w 2015 roku. Jej konstrukcja ma zapewni─ç wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz uzyskanie wi─Ökszej ilo┼Ťci materia┼éu tkankowego do analizy. Cele niniejszej pracy to ocena wydolno┼Ťci diagnostycznej procedury EBUS-TBNA (EBUS ÔÇö transbronchial needle aspiration) z zastosowaniem ig┼éy Flex 19G oraz prezentacja opinii endoskopist├│w na temat badania z jej u┼╝yciem. MATERIA┼ü I METODY: Ig┼éy Flex 19G zastosowano w diagnostyce pacjent├│w z adenopati─ů ┼Ťr├│dpiersia i/lub wn─Ök w dw├│ch o┼Ťrodkach pulmonologicznych w Polsce. Wykonywano zar├│wno rozmazy cytologiczne, jak i bloki kom├│rkowe (CB ÔÇö cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dw├│ch wybranych pacjent├│w z adenopati─ů potwierdzon─ů w tomografii komputerowej (┼Ťrednia wieku 58 ┬▒ 12 lat) podano badaniu EBUS-TBNA z u┼╝yciem igie┼é Flex 19G. Wszystkie wykonane rozmazy cytologiczne okaza┼éy si─Ö diagnostyczne (wydolno┼Ť─ç diagnostyczna 100%). Z┼éo┼Ťliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast ┼éagodn─ů adenopati─Ö u 7 pacjent├│w (31,8%). W 12 z 14 przypadk├│w raka p┼éuca wykonane CB mog┼éy by─ç u┼╝yte do oznacze┼ä immunohistochemicznych i molekularnych. Po biopsji w─Öz┼é├│w ch┼éonnych, zw┼éaszcza wn─Ökowych, nie obserwowano nasilonego krwawienia. W por├│wnaniu ze standardow─ů procedur─ů EBUS-TBNA z u┼╝yciem ig┼éy 21/22G endoskopi┼Ťci podkre┼Ťlali wi─Öksz─ů gi─Ötko┼Ť─ç uzbrojonego endoskopu oraz jako┼Ť─ç bioptatu, natomiast w pozosta┼éych aspektach biopsji r├│┼╝nice by┼éy nieznacz─ůce. WNIOSKI: Pierwsze polskie do┼Ťwiadczenia z u┼╝yciem igie┼é Flex 19G okazuj─ů si─Ö by─ç podobne do standardowej techniki z u┼╝yciem igie┼é 21/22G oraz prezentuj─ů wysok─ů wydolno┼Ť─ç diagnostyczn─ů w raku p┼éuca, szczeg├│lnie z zastosowaniem CB. Profil bezpiecze┼ästwa biopsji jest akceptowalny
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