Chest
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Clinical Trial
New dedicated bifurcated silicone stent placement for stenosis around the primary right carina.
Silicone stenting has been widely used to palliate respiratory symptoms in patients suffering from airway stenosis. Although many types and shapes of stents have been developed, there is no ideal stent for stenosis around the carina between the bronchus to the right upper lobe and the bronchus intermedius (primary right carina). The purpose of this study was to evaluate the feasibility, efficacy, and safety of a new silicone stent designed for treating airway stenosis around the primary right carina. ⋯ Stent placement with the new silicone stent designed to fit on the primary right carina is feasible, effective, and acceptably safe.
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Patients with a history of asthma-related hospitalizations are at high risk of readmission and generally consume a large amount of health-care resources. It is not clear if the secondary care provided by specialists after an episode of asthma-related hospitalization is associated with better outcomes compared with the primary care provided by general practitioners. ⋯ Compared with those who received only primary care, patients who received secondary care showed evidence of more appropriate treatment. Nevertheless, there were no differences in the costs or the risk of readmission. Adherence to asthma medication in both groups was poor, indicating the need for raising the quality of care provided by generalists and specialists alike.
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Long-term complications of therapeutic bronchoscopy include infections and airway restenosis due to tumor. No studies have compared the incidence rates of infection in patients with stents with those without stents. We hypothesized that patients with stents would have a higher incidence of lower respiratory tract infections than would patients without stents. ⋯ Therapeutic bronchoscopy with stent placement is associated with a higher risk of infection than is therapeutic bronchoscopy alone. If ablative techniques reopen the airway and there is a good chance that the tumor may respond to chemotherapy and/or radiation, a strategy of initially holding off on stenting may be warranted.
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Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. ⋯ Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefit. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.
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Unidirectional endobronchial valves, originally studied for potential treatment of emphysema, have emerged as a useful intervention for patients with persistent air leak from the lung. The procedure is accomplished via bronchoscopy in a patient who already has a chest tube in place for management of the air leak. ⋯ Specific US Food and Drug Administration-approved criteria for placement and removal of these valves via a Humanitarian Device Exemption are discussed along with reported outcomes. Current Procedural Terminology codes effective for 2013 that are specific to the procedure are reviewed.