Publications by authors named "Bruce Sabath"

Background: Computed tomography to body divergence (CTBD) is one of the main barriers to bronchoscopic techniques for the diagnosis of peripherally located lung nodules. Cone-beam CT (CBCT) guidance is being rapidly adopted to correct for this phenomenon and to potentially increase diagnostic outcomes. In this trial, we hypothesized that the addition of mobile CBCT (m-CBCT) could improve the rate of tool in lesion (TIL) and the diagnostic yield of shape-sensing robotic-assisted bronchoscopy (SS-RAB).

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Article Synopsis
  • Atelectasis is a common issue during bronchoscopy under general anesthesia and can negatively impact navigation and diagnostic results; the study aimed to assess the severity of this condition in patients.
  • The researchers developed an Atelectasis Severity Score System (ASSESS) to classify the severity of atelectasis based on specific lung zones, finding that 47% of patients had mild and moderate atelectasis, while 6% experienced severe atelectasis.
  • Results indicated that a higher Body Mass Index (BMI) increases the odds of developing greater severity of atelectasis, whereas the VESPA trial reduced these odds, highlighting the need for preventive strategies in at-risk patients, especially in specific lung zones.
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Background: Pleural infections related to indwelling pleural catheters (IPCs) are an uncommon clinical problem. However, management decisions can be complex for patients with active malignancies due to their comorbidities and limited life expectancies. There are limited studies on the management of IPC-related infections, including whether to remove the IPC or use intrapleural fibrinolytics.

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Central airway obstruction is a serious complication of various diseases, most often malignancy. Malignant etiologies include primary lung cancer as most common though metastases from various other cancers can obstruct the airways as well. Benign etiologies include inflammatory or fibrotic changes due to prior airway interventions (e.

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Background Pleural infection is a common clinical problem resulting in prolonged hospitalization and increased mortality. In patients with active malignancy, management decisions are based on the need for further immunosuppressive therapies, the ability to tolerate surgery, and consideration of the limited life expectancy. Identifying patients at risk for death or poor outcomes is very important as it will guide care.

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Laceration of an intercostal artery is a rare but potentially catastrophic complication of pleural procedures such as thoracentesis. Recognition of this problem often occurs late in the bleeding process, only after hemodynamic decompensation has occurred. Aggressive and emergent measures are usually undertaken such as angiographic embolization or thoracotomy.

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Article Synopsis
  • The study investigates whether a new ventilatory strategy called VESPA can reduce atelectasis, a condition that complicates peripheral bronchoscopy and affects imaging accuracy in patients under general anesthesia.
  • In a randomized controlled trial with 76 patients, those utilizing the VESPA strategy had a significantly lower occurrence of atelectasis (28.9%) compared to the standard ventilation group (84.2%).
  • Despite the effectiveness of VESPA in minimizing atelectasis, the study found no differences in complications between the two ventilation methods.
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Background And Objective: Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis.

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BACKGROUND Chronic cough is a common medical concern. Giant cell arteritis (GCA) is an uncommon cause of chronic cough and is not usually suspected since symptoms can be non-specific. We present a case of chronic cough due to GCA in which symptoms were subtle but imaging was remarkable and clearly disclosed the diagnosis.

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BACKGROUND As use of immune checkpoint inhibitors consistently grows, so does knowledge of immune-related adverse events. Pleural complications from PD-L1 inhibitors such as atezolizumab have never been reported. We describe the first reported case of biopsy-proven pleuritis manifesting as recurrent pleural effusion in a patient treated with atezolizumab.

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A 68-year old woman with a long smoking history underwent lung cancer screening by low-dose computed tomography. This detected a 3.0 cm spiculated mass in the left upper lobe.

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Central airway obstruction often presents with airway narrowing of differing internal diameters. Conventional straight stents do not fit these airways well and are prone to migration. We present a series of cases where hourglass-shaped silicone stents were customized intra-operatively to fit airway obstructions of both malignant and non-malignant etiologies and to improve patient performance status.

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Sending retirees to the frontlines?

J Community Hosp Intern Med Perspect

September 2020

Facing an unprecedented surge of patient volumes and acuity, institutions around the globe called for volunteer healthcare workers to aid in the effort against COVID-19. Specifically being sought out are retirees. But retired healthcare workers are taking on significant risk to themselves in answering these calls.

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Background: Despite the many advances in peripheral bronchoscopy, its diagnostic yield remains suboptimal. With the use of cone-beam CT imaging we have found atelectasis mimicking lung tumors or obscuring them when using radial-probe endobronchial ultrasound (RP-EBUS), but its incidence remains unknown.

Research Question: What are the incidence, anatomic location, and risk factors for developing atelectasis during bronchoscopy under general anesthesia?

Study Design And Methods: We performed a prospective observational study in which patients undergoing peripheral bronchoscopy under general anesthesia were subject to an atelectasis survey carried out by RP-EBUS under fluoroscopic guidance.

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A 55-year-old man presented to the ED with a 3-week history of worsening cough and shortness of breath. He had blood-tinged sputum, fever, night sweats, and a 2.7 kg weight loss within the same period.

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A 59-year old woman presented with hemoptysis of thick blood clots and fever of two days duration. Her medical history included sarcoidosis for which she was on chronic steroids. Computed tomography imaging revealed stage IV sarcoidosis with diffuse cystic and fibrotic changes bilaterally, worse in the right lung.

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Lung cancer is the leading cause of cancer-related death worldwide and lobectomy remains the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). The combination of an aging population and the implementation of low-dose CT for lung cancer screening is leading to an increase in diagnosis of early stage NSCLC in medically "inoperable" patients. The recommended treatment for this latter group of patients is stereotactic body radiation therapy (SBRT).

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Lung cancer is the world's leading cause of cancer death. Screening for lung cancer by low-dose computed tomography improves mortality. Various modalities exist for diagnosis and staging.

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