Impact of Moderate Sedation versus Monitored Anesthesia Care on Outcomes and Cost of Endobronchial Ultrasound Transbronchial Needle Aspiration.

Background And Objectives: The ideal type of sedation for endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is not known. Two previous studies comparing the diagnostic yield between moderate sedation (MS) and deep sedation/general anesthesia (DS/GA) had provided conflicting results with one study clearly favoring the latter. No study had addressed cost.

Patient-Reported Dyspnea Correlates Poorly with Aerobic Exercise Capacity Measured During Cardiopulmonary Exercise Testing.

Background: Patient-reported dyspnea plays a central role in assessing cardiopulmonary disease. There is little evidence, however, that dyspnea correlates with objective exercise capacity measurements. If the correlation is poor, dyspnea as a proxy for objective assessment may be misleading.

Pleuroscopic Pleurodesis Combined With Tunneled Pleural Catheter for Management of Malignant Pleural Effusion: A Prospective Observational Study.

Background: Malignant pleural effusion (MPE) is associated with poor prognosis and it often impinges upon quality of life; effective and efficient management is desirable. Combining pleuroscopic pleurodesis (PP) with a tunneled pleural catheter (TPC) could minimize hospitalization, effect rapid pleurodesis in most cases, and allow ongoing control of MPE for those not successfully pleurodesed.

Methods: Consecutive patients with pleural effusion associated with malignancy and with documented lung reexpansion after pleural fluid drainage were prospectively enrolled to undergo PP with TPC placement.

Transpulmonary artery needle aspiration of hilar masses with endobronchial ultrasound: a necessary evil.

The safety with regard to bleeding complications of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of hilar and mediastinal lymphadenopathy has been well established. The real-time visualization of targeted and surrounding structures allows the operator to avoid puncturing even small vessels. However, on occasions, the only way to reach the target is by traversing vessels.

Safety of ultrasound-guided small-bore chest tube insertion in patients on clopidogrel.

Background: The safety of small-bore chest tubes insertion with ultrasound (US) guidance has been well demonstrated in patients not receiving antiplatelet therapy. Given the current widespread use of these agents, pulmonologists frequently encounter patients on this therapy and requiring drainage of the pleural space. The use of these agents clearly increases the risk of bleeding, but it is not always possible to stop this therapy before the procedure, especially in patients requiring urgent drainage and those with coronary stents.

Endobronchial ultrasound with transbronchial needle aspiration in the diagnosis of bilateral hilar and mediastinal lymphadenopathy.

Background: : Bilateral hilar and/or mediastinal lymphadenopathy (BHL±ML) is an important radiographic finding. Since it was examined 38 years ago by Winterbauer and colleagues, better diagnostic techniques have been developed. The purpose of this study was to reexamine the diagnosis of BHL±ML by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

Lung abscess: update on microbiology and management.

A lung abscess is a circumscribed collection of pus in the lung as a result of a microbial infection, which leads to cavity formation and often a radiographic finding of an air fluid level. Patients with lung abscesses commonly present to their primary care physician or to the emergency department with "nonresolving pneumonia." Although, the incidence of lung abscess has declined since the introduction of antibiotic treatment, it still carries a mortality of up to 10%-20%.

An algorithmic approach to chronic dyspnea.

Question: The objective of the study was to prospectively evaluate an algorithmic approach to the cause(s) of chronic dyspnea. MATERIALS/PATIENTS/METHODS: Prospective observational study. The study group consisted of 123 patients with a chief complaint of dyspnea of unknown cause present for >8 weeks.

Clinical approach to acute cough.

Acute cough is among the most common symptoms for which patients seek medical attention. It accounts for millions of days lost from school and work and billions of dollars spent on medical care. Acute cough is defined as cough present for 3 weeks or less.

A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion.

Background: This is a prospective study to define the volume of pleural fluid adequate for maximal yield of cytologic analysis of pleural fluid.

Methods: Patients undergoing diagnostic thoracentesis with malignancy in the differential diagnosis were enrolled in the study. The first 50 mL of pleural fluid were put in a specimen cup, and subsequent fluid was collected in a drainage bag.

Cough and asthma.

Purpose Of Review: The intention of this article is to discuss and place into perspective recent articles on cough and asthma.

Recent Findings: Asthma continues to be a major diagnosis in most studies of cough. The first prospective study of sub-acute cough demonstrated an asthma incidence lower than that for chronic cough, a logical finding; upper airway cough syndrome often causes cough in the postinfectious state.

An empiric integrative approach to the management of cough: ACCP evidence-based clinical practice guidelines.

Objective: Review the literature to provide a comprehensive approach, including algorithms for the clinician to follow in evaluating and treating the patient with acute, subacute, and chronic cough.

Methods: We searched MEDLINE (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "treatment of cough," and "empiric treatment of cough." We selected case series and prospective descriptive clinical trials.

Unexplained (idiopathic) cough: ACCP evidence-based clinical practice guidelines.

Objective: To review the literature on unexplained cough, previously referred to as idiopathic cough.

Methods: Search of MEDLINE (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "unexplained cough," and "idiopathic cough." We selected case series and prospective descriptive clinical trials.

Cough and the common cold: ACCP evidence-based clinical practice guidelines.

Objective: To review the literature on cough and the common cold.

Methods: MEDLINE was searched through May 2004 for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough" and "common cold." Selected case series and prospective descriptive clinical trials were reviewed.

Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines.

Objective: To review the literature on postnasal drip syndrome (PNDS)-induced cough and the various causes of PNDS. Hereafter, PNDS will be referred to as upper airway cough syndrome (UACS).

Methods: MEDLINE search (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "causes of cough," "etiology of cough," "postnasal drip," "allergic rhinitis," "vasomotor rhinitis," and "chronic sinusitis.

Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines.

Objective: To review the literature on the most common causes of chronic cough.

Methods: MEDLINE was searched (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "causes of cough," and "etiology of cough." Case series and prospective descriptive clinical trials were selected for review.