Journal of bronchology & interventional pulmonology
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J Bronchology Interv Pulmonol · Oct 2013
Review Case ReportsMediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique that allows lung cancer nodal staging and biopsy of parabronchial and paratracheal tissue. Its simplicity, high diagnostic yield, ability to diagnose both benign and malignant conditions, and exceedingly low complication rate has resulted in rapid widespread adoption by surgeons and physicians. EBUS-TBNA-related complications, however, do occur and need to be considered when assessing the risk-benefit profile of performing the procedure, and if the patient represents with unexpected symptoms after the procedure. ⋯ This case demonstrates the importance of considering EBUS-TBNA-related complications to guide relevant imaging decisions and antibiotic choices. We review the published literature regarding infective complications of EBUS-TBNA and propose possible pathophysiologies. These complications are likely to increase in frequency as the technique is more widely adopted.
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J Bronchology Interv Pulmonol · Oct 2013
Infections associated with tunnelled indwelling pleural catheters in patients undergoing chemotherapy.
Malignant pleural effusions are common complications of advanced malignancies and are associated with significant morbidity and reduced survival. Tunnelled indwelling pleural catheters (TIPCs) are implantable devices used for palliation of symptomatic malignant pleural effusions. Although complication rates are overall low, their use in the setting of concurrent chemotherapy has not been carefully reviewed. We report our experience with infectious complications directly attributable to TIPCs (pleural or local soft tissue infections) in those patients receiving concurrent chemotherapy. ⋯ The overall risk of infection in TIPC is low. Patients undergoing chemotherapy while the TIPC is in place do not seem to have an increased risk of infection, and therefore chemotherapy should not necessarily be viewed as a contraindication to TIPC insertion.
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J Bronchology Interv Pulmonol · Oct 2013
Foreign body aspiration in adults and in children: advantages and consequences of a dedicated protocol in our 30-year experience.
Foreign body (FB) inhalation is a potentially life-threatening emergency also in clinically stable patients as the situation could worsen at any moment. There is varying opinion regarding the urgency for removal of inhaled FBs, and there are no guidelines in the literature. The aim of our study was to present our experience with FB aspiration in children and adults from 1993, when we introduced our Thoracic Endoscopy Service with the availability "on call" of a bronchologist 24 hours a day, 7 days a week, defining a dedicated protocol together with our anaesthesiologists for prompt intervention in this situation. ⋯ We conclude that an efficient organization involving a dedicated protocol of intervention, trained staff available 24 hours a day, 7 days a week, appropriate setting, and the right instrumentation enabled us to tackle this important emergency.
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J Bronchology Interv Pulmonol · Jul 2013
ReviewMethemoglobinemia in bronchoscopy: a case series and a review of the literature.
Methemoglobinemia results from oxidation of ferrous iron to ferric iron within the hemoglobin molecule. This molecule cannot bind oxygen and increases the affinity of normal hemoglobin for oxygen, which results in decreased oxygen offloading in peripheral tissues. At elevated levels, methemoglobinemia can cause dyspnea, cyanosis, and even death. Common local anesthesia agents have been correlated with methemoglobinemia. Bronchoscopy is a commonly performed clinical procedure which uses topical application of these anesthetics to provide patient comfort. Methylene blue is an agent thought to help reverse the effects of methemoglobinemia by facilitating the methemoglobin reductase system. ⋯ Using topical anesthetic during bronchoscopy appears relatively safe. No fatalities from methemoglobinemia after bronchoscopy have been reported. A high suspicion for methemoglobinemia is required in patients who develop hypoxia or cyanosis postprocedurally. Access to CO-oximetry can confirm the diagnosis but the clinical picture is often sufficient to proceed with methylene blue treatment or observation, based on how severely the patient is affected. Patients who return to baseline can be considered for discharge home.
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J Bronchology Interv Pulmonol · Jul 2013
Case Reports"The black bronchoscopy": a case of airway soot deposition.
The term "black bronchoscopy" is used to describe the black pigmentation of the airways. It is a rare condition with multiple etiologies. ⋯ Early flexible bronchoscopy allowed for a precise diagnosis of severe inhalation injury, and bronchial lavage was carried out to remove soot casts to reduce complications. Any patient suspected of having smoke inhalation injury should undergo early bronchoscopy to allow for a precise diagnosis, staging, and more aggressive treatment measures as the mortality among patients exposed to smoke with inhalation airway injury is high.