Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature.

Background: Transbronchial lung biopsy (TBLB) via flexible bronchoscopy is a common procedure performed by pulmonologists. Limited scientific data exist concerning the risk of this procedure in patients with conditions that may adversely affect the rate of procedural complications.

Objectives: To evaluate the current practice pattern and attitude of pulmonologists toward the performance of TBLB in the presence of high-risk conditions.

Reducing maintenance and repair costs in an interventional pulmonology program.

Background: In the current economic climate, hospitals and academic institutions demand that medical departments function in an efficient and cost-effective manner. Detailed business plans are necessary to build new clinical programs, and institutions have learned that new programs are associated with significant costs for purchasing and maintaining equipment. We report our experience with repairs to equipment before and after starting our interventional pulmonary (IP) program, and with the effect of an educational program on reducing these costs.

Multislice CT evaluation of airway stents.

Tracheobronchial stents are playing an increasing role in the palliative treatment of large airway obstruction due to a variety of conditions, including extrinsic compression, intraluminal disease, and malacia. Computed tomography (CT) plays an important role in aiding planning of stent placement and in detecting various stent complications. In this pictorial essay, we illustrate and review the role of multislice CT in the pre- and post-stent placement settings.

Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse.

Purpose: To compare dynamic expiratory and end-expiratory computed tomography (CT) for depicting central airway collapse in patients with acquired tracheobronchomalacia (TBM).

Materials And Methods: Institutional review board approval was obtained, and informed consent was not needed. Retrospective review was performed of all patients with a CT diagnosis of TBM in a 10-month period (n = 34) who underwent evaluation of airway disease by means of three different sequences at multi-detector row CT: end inspiration, dynamic expiration, and end expiration (the latter was performed only at the levels of the aortic arch, carina, and bronchus intermedius).

Effect of clopidogrel with and without aspirin on bleeding following transbronchial lung biopsy.

Background: Clopidogrel, a potent inhibitor of platelet aggregation, is being commonly prescribed in the elderly population due to its benefits in patients with atherosclerotic diseases. It is currently unknown whether clopidogrel increases the risk of bleeding during invasive pulmonary procedures.

Methods: Pigs of the Yorkshire species were randomized to one of the following two arms: clopidogrel (75 mg/d) alone; or clopidogrel plus aspirin (75 mg/d and 325 mg/d, respectively).

The natural history of radiographically occult bronchogenic squamous cell carcinoma: a retrospective study of overdiagnosis bias.

Objective: An overdiagnosis bias occurs with the diagnosis of a disease that does not produce signs or symptoms before the patient dies from other causes. We sought to determine whether overdiagnosis bias is a factor when screening for squamous cell carcinoma of the lung.

Design: Retrospective study of the Miyagi Population-Based Lung Cancer Screening Registry for high-risk patients who were seen between January 1, 1982 (when sputum cytology tests were added for men with long smoking histories), and December 31, 1996.

Central airway obstruction.

Central airway obstruction is a problem facing all medical and surgical subspecialists caring for patients with chest diseases. The incidence of this disorder appears to be rising because of the epidemic of lung cancer; however, benign causes of central airway obstruction are being seen more frequently as well. The morbidity is significant and if left untreated, death from suffocation is a frequent outcome.

Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency.

Introduction: Training residents in medical procedures is an area of growing interest. Studies demonstrate that internal medicine residents are inadequately trained to perform common medical procedures, and program directors report residents do not master these essential skills. The American Board of Internal Medicine requires substantiation of competence in procedure skills for all internal medicine residents; however, for most procedures, standards of competence do not exist.

Frequency and severity of air trapping at dynamic expiratory CT in patients with tracheobronchomalacia.

Objective: The purpose of this study was to compare the frequency and severity of air trapping in patients with and without tracheobronchomalacia using dynamic expiratory volumetric CT.

Materials And Methods: The study group consisted of 20 subjects, including 10 patients with bronchoscopically proven tracheobronchomalacia and 10 control subjects of similar ages without tracheobronchomalacia. All 20 subjects underwent MDCT performed at the end of deep inspiration and during dynamic expiration.

Acute complications of artificial airways.

In conclusion, though there has been a dramatic reduction in the acute complications of artificial airways in the last hundred years, it remains crucial for the intensivist/anesthesiologist to have an implicit understanding of the anatomy and physiology of the process of ETI. As new techniques such as PDT are introduced, we must investigate their utility compared with the current standard of care in the most rigorous fashion. Additionally, as many of the complications of ETI can lead to increases in morbidity and mortality, prompt diagnosis and management are essential.

Ultrasound guidance for medical thoracoscopy: a novel approach.

Background: Commonly, a pneumothorax is induced before medical thoracoscopy to facilitate safe entry into the pleural space.

Objective: Evaluate the use of transthoracic ultrasound to locate a safe entry site for trocar placement during medical thoracoscopy without induction of a preprocedure pneumothorax.

Method: The study was designed as a prospective cohort study, performed in the setting of a tertiary care hospital with an active interventional pulmonology program.

2003 AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways: comparison of standard-dose and low-dose techniques.

Rationale And Objectives: Investigators in this study compared standard-dose and low-dose inspiratory and expiratory computed tomographic (CT) images with regard to their usefulness for measuring the tracheal lumen in patients with or without tracheobronchomalacia (TBM). MATERIALS AND METHODS; Hospital records were reviewed to identify 10 consecutive patients with bronchoscopically proved TBM and 10 control subjects without TBM who underwent paired volumetric inspiratory and dynamic expiratory examinations with multisection CT. A low-dose (40-80 mA) technique was used for dynamic expiratory CT in 14 (70%) of the 20 subjects, and a standard dose (240-280 mA) was used in the remaining six (30%).

The role of bronchoalveolar lavage in the immunocompromised host.

Bronchoscopy with bronchoalveolar lavage (BAL) is a frequently performed, minimally invasive endoscopic examination in patients with unclear infiltrates or pulmonary infections. It can be performed safely in patients with compromised immune systems of different etiologies. This article summarizes the experience with and efficacy of BAL in different disease states in this clinical circumstance.

Tracheobronchomalacia: evolving role of dynamic multislice helical CT.

Paired inspiratory and dynamic expiratory multislice CT imaging is a promising method for diagnosing TBM. A low-dose technique should be considered for the dynamic portion to reduce radiation exposure. Visual and quantitative analysis of the central airways provide a comprehensive assessment by allowing for the accurate diagnosis of TBM, determining its extent, assessing for predisposing conditions, and aiding selection of candidates for stent placement or tracheoplasty procedures.

Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery.

Background: There is controversy about which dialytic modality should be used for the treatment of acute renal failure (ARF) in the intensive care unit. We performed a systematic review and meta-analysis to determine the relative risks (RRs) of mortality and renal recovery associated with intermittent hemodialysis (IHD) therapy compared with continuous renal replacement therapy (CRRT) in critically ill adults with ARF.

Methods: Four databases (MEDLINE, Cochrane Library, Database of Abstracts and Reviews, and Science Citation Index), hand searching of conference proceedings and journals, manual review of bibliographies from identified articles, and contact with experts were used.