Journal of bronchology & interventional pulmonology
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J Bronchology Interv Pulmonol · Jul 2012
Granulomatous inflammation detected by endobronchial ultrasound-guided transbronchial needle aspiration in patients with a concurrent diagnosis of cancer: a clinical conundrum.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for evaluating mediastinal and/or hilar lymphadenopathy in patients with malignancy. Granulomatous inflammation is occasionally identified in this setting and has unclear clinical implications. Therefore, we set out to describe a cohort of patients found to have evidence of granulomatous inflammation during EBUS-TBNA done for diagnosis and/or staging of concurrent cancer. ⋯ Granulomatous inflammation is occasionally identified in mediastinal and/or hilar lymphadenopathy in patients with concurrent malignancy. Although the clinical implications of this phenomenon remain to be clarified, these findings emphasize the importance of histologic confirmation of suspected lymph node involvement and suggest that the presence of granulomatous inflammation on EBUS-TBNA may occasionally be consistent with active malignancy and prompt further investigations.
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J Bronchology Interv Pulmonol · Jul 2012
ReviewRationale for the development and the mechanism of action of endoscopic thermal vapor ablation (InterVapor) for the treatment of emphysema.
Emphysema remains a disabling disease despite current treatment. Novel approaches to the underlying physiological abnormalities responsible for symptom generation are warranted. ⋯ InterVapor induces lung volume reduction in patients with emphysema. The mechanism of action is through a thermally induced inflammatory response followed by healing with subsequent remodeling of tissue (fibrosis and distal atelectasis).
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J Bronchology Interv Pulmonol · Jul 2012
Case ReportsMesothelioma: a soon to be forgotten disease in the United States?
Malignant pleural mesothelioma is an uncommon cancer that commonly presents with a large unilateral bloody pleural effusion long after asbestos exposure. Its prevalence is decreasing with the decreasing exposure to asbestos in the United States. ⋯ The thoracoscopic evaluation revealed multiple, varied, and severe but characteristic findings of malignant pleural mesothelioma. Medical thoracoscopy is the procedure of choice for the diagnosis of pleural mesothelioma.
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J Bronchology Interv Pulmonol · Jul 2012
Comparative cost analysis of endobronchial ultrasound-guided and blind TBNA in the evaluation of hilar and mediastinal lymphadenopathy.
The superior accuracy of endobronchial ultrasound (EBUS) averts many diagnostic surgical procedures. This likely leads to significant cost savings despite an increased per procedure cost. We sought to compare the true costs of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) compared with "blind" fiberoptic bronchoscopy-transbronchial needle aspiration (FB-TBNA) factoring in the impact of diagnostic surgical procedures in the diagnosis of mediastinal lymphadenopathy. ⋯ EBUS-TBNA is less expensive than blind FB-TBNA in the evaluation of thoracic lymphadenopathy when accounting for diagnostic surgical procedures.
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J Bronchology Interv Pulmonol · Jul 2012
Case ReportsMounier-Kuhn syndrome and bilateral vocal cord paralysis.
Mounier-Kuhn syndrome is a rare disorder of unknown cause that is characterized by atrophy of the elastic and smooth muscle of the tracheobronchial tree leading to tracheobronchomegaly and bronchiectasis. The syndrome is likely underdiagnosed, because the patients usually present with common respiratory symptoms such as productive cough and usually labeled as chronic obstructive pulmonary disease. Diagnosis is established on the basis of radiologic findings. ⋯ Symptomatic patients may require endobronchial stenting if airway collapse is encountered. Here, we described a patient who presented with hoarseness and pneumonia. Further studies confirmed the diagnosis of Mounier-Kuhn syndrome with bilateral vocal cord paralysis.