Randomized phase II trial of sulindac for lung cancer chemoprevention.

Introduction: Sulindac represents a promising candidate agent for lung cancer chemoprevention, but clinical trial data have not been previously reported. We conducted a randomized, phase II chemoprevention trial involving current or former cigarette smokers (≥30 pack-years) utilizing the multi-center, inter-disciplinary infrastructure of the Cancer Prevention Network (CPN).

Methods: At least 1 bronchial dysplastic lesion identified by fluorescence bronchoscopy was required for randomization.

Lung injury following thoracoscopic talc insufflation: experience of a single North American center.

Background: Thoracoscopic talc insufflation (TTI) has been used to obliterate the pleural space and prevent recurrent pleural effusions or pneumothorax. Reports of acute pneumonitis and ARDS after the use of talc raised concern about its safety. Differences in particle size of various talc preparations may explain the variable occurrence of pneumonitis.

Changing patterns in interventional bronchoscopy.

Background And Objective: Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach.

Methods: A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted.

Ease of use of watanabe spigot for alveolopleural fistulas.

Pulmonary fistulas are associated with a high risk of morbidity and mortality. We report 2 cases of alveolopleural fistulas, 1 in a patient with chronic hydropneumothorax and the other after wedge biopsy. In both cases, Watanabe spigot (Novatech, Grasse, France) was placed for bronchial occlusion with short-term success.

Molecular typing of Mycobacterium chelonae isolates from a pseudo-outbreak involving an automated bronchoscope washer.

We describe a pseudo-outbreak of Mycobacterium chelonae infection in bronchoalveolar lavage fluid from 9 patients that was traced to contamination of an automated bronchoscope washer. Molecular typing using repetitive extragenic palindromic polymerase chain reaction was helpful in confirming epidemiologic and clinical findings.

Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature.

Background: Severe post tracheostomy (PT) and post intubation (PI) tracheal stenosis is an uncommon clinical entity that often requires interventional bronchoscopy before surgery is considered. We present our experience with severe PI and PT stenosis in regards to patient characteristics, possible risk factors, and therapy.

Methods: We conducted a retrospective chart review of 31 patients with PI and PT stenosis treated at Lahey Clinic over the past 8 years.

Healthcare-associated pneumonia: principles and emerging concepts on management.

Healthcare-associated pneumonia (HCAP) is a relatively new entity that includes pneumonia occurring in healthcare settings other than acute-care hospitals. Many patients with HCAP are at greater risk for colonization and infection with multi-drug resistant (MDR) bacteria such as Pseudomonas aeruginosa, Gram-negative bacilli-producing extended-spectrum beta-lactamases and methicillin-resistant Staphylococcus aureus. Infections with these MDR pathogens require different empiric antibiotic therapy.

Airway epithelial gene expression in the diagnostic evaluation of smokers with suspect lung cancer.

Lung cancer is the leading cause of death from cancer in the US and the world. The high mortality rate (80-85% within 5 years) results, in part, from a lack of effective tools to diagnose the disease at an early stage. Given that cigarette smoke creates a field of injury throughout the airway, we sought to determine if gene expression in histologically normal large-airway epithelial cells obtained at bronchoscopy from smokers with suspicion of lung cancer could be used as a lung cancer biomarker.

Interventional pulmonology techniques for treating malignant large airway obstruction: an update.

Purpose Of Review: This paper reviews the recent literature on the management of malignant large airway obstruction using interventional pulmonology techniques.

Recent Findings: A number of interventional techniques have been developed during the last 25 years. Recent papers expand on this work, reaffirming the utility of laser bronchoscopy; introducing newer, less expensive technologies with similar outcomes; and attesting to the benefit of airway stenting.

A novel instrument for the evaluation of the pleural space: an experience in 34 patients.

Study Objectives: To test a novel semirigid pleuroscope to be used by pulmonologists for the diagnosis and treatment of pleural diseases.

Design: Prospective study.

Setting: Three tertiary referral centers for pulmonary diseases.