Journal of bronchology & interventional pulmonology
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J Bronchology Interv Pulmonol · Jan 2014
Endobronchial ultrasound-guided biopsy performed under optimal conditions in patients with known or suspected lung cancer may render mediastinoscopy unnecessary.
Mediastinoscopy is the gold standard for preoperative mediastinal staging of patients with suspected or proven lung cancer. Since the development of endoscopic ultrasound-guided biopsy via the trachea (EBUS-TBNA), this status has been challenged. The purpose of the study was to examine whether mediastinoscopy is necessary, when EBUS-TBNA is performed in a center with (1) a high level of expertise, (2) "bed side" microscopy by a pathologist, (3) general anesthesia, and (4) achievement of representative tissue from station 4R, 7 and 4L, that is, the same mediastinal stations that mediastinoscopy gives access to. ⋯ When EBUS-TBNA is performed under optimal conditions including general anesthesia and "bed side" microscopy performed by a pathologist resulting in representative biopsies from station 4R, 7, and 4L, the NPV is so high that mediastinoscopy seems unnecessary.
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J Bronchology Interv Pulmonol · Jan 2014
The usefulness of endobronchial ultrasonography-guided transbronchial needle aspiration at the lobar, segmental, or subsegmental bronchus smaller than a convex-type bronchoscope.
Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for approaching the lesion adjacent to extrapulmonary bronchus. We started to use wedge insertion of a convex endobronchial ultrasound bronchoscope into bronchi narrower than the diameter of the bronchoscope itself to perform EBUS-TBNA. Our objective was to investigate the bronchus in which EBUS-TBNA was possible and safe. ⋯ EBUS-TBNA can be performed by inserting a 6.9 mm EBUS bronchoscope into airways with a mean diameter ≥ 4.5 mm as measured on computed tomography before bronchoscopy.
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J Bronchology Interv Pulmonol · Jan 2014
Case ReportsClosure of chronic bronchopleural fistula using atrial septal occluder device.
Chronic persistent bronchopleural fistulae (BPF) are challenging management problems. The management of BPF includes various surgical and medical procedures and of great value is the use of bronchoscopy and different devices. In high-risk surgical patients, bronchoscopic procedures serve as a temporary bridge until the patient's clinical condition improves, whereas in other patients bronchoscopic procedures may be the only option. We present a case of postoperative chronic BPF closed by a less invasive interventional bronchoscopic procedure using an atrial septal occluder device.
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J Bronchology Interv Pulmonol · Jan 2014
Case ReportsA painful sneeze: spontaneous thoracic lung herniation induced by vigorous sneeze.
Lung herniation, defined as the protrusion of lung tissue outside the normal boundaries of thoracic cage, is an unusual event. This most commonly occurs as a consequence of thoracic trauma. ⋯ We present a 63-year-old male who presented with spontaneously herniated lung after an episode of vigorous sneezing. The possible underlying mechanisms, important physical examination and diagnostic imaging findings, and aspects of management considerations are briefly discussed.