Clinics in chest medicine
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Lung volume reduction surgery has proven benefits in emphysema. However, high postoperative morbidity and stringent selection criteria for suitable candidates are limitations in clinical practice. Endoscopic approaches to lung volume reduction have used a range of different techniques such as endobronchial blockers, airway bypass, endobronchial valves, biologic sealants, and airway implants to address the limitations of surgery. ⋯ Currently available data on efficacy of bronchoscopic lung volume reduction are not consistently conclusive, and subjective benefit in dyspnea scores is a more frequent finding than improvements on spirometry or exercise tolerance. The safety data are more promising, with rare procedure-related mortality, fewer complications than lung volume reduction surgery, and short hospital length of stay. The field of bronchoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials aim to clarify the efficacy data from earlier feasibility and safety studies.
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Clinics in chest medicine · Mar 2010
ReviewInterventional bronchoscopy from bench to bedside: new techniques for central and peripheral airway obstruction.
This article discusses how basic scientific concepts, based on a greater understanding of airway physiology, support the development and dissemination of multidimensional classification systems for tracheal stenosis, expiratory central airway collapse, and innovative interventional bronchoscopic procedures for patients with asthma and chronic obstructive pulmonary disease.
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Clinics in chest medicine · Mar 2010
Biography Historical ArticleBronchoscopy: the past, the present, and the future.
This article discusses bronchoscopy: its history, including development of instruments and techniques and important historical figures; current techniques and issues; and future possibilities and potential controversies.
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Virtual bronchoscopic navigation (VBN) is a method for the guidance of a bronchoscope to peripheral lesions using virtual bronchoscopy (VB) images of the bronchial path. Irrespective of the bronchoscopist's skill level, the bronchoscope can be readily guided to the target in a short time. A system to automatically search for the bronchial path to the target has been developed and clinically applied; this system produces VB images of the path to the fourth- to twelfth- (median, sixth-) generation bronchi, and displays the VB images simultaneously with real bronchoscopic images. In this article, the author discusses VBN and the automatic VBN system, reviews the published literature, and describes its usefulness and limitations.
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Clinics in chest medicine · Dec 2009
ReviewTuberculosis-associated immune reconstitution inflammatory syndrome and unmasking of tuberculosis by antiretroviral therapy.
The tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a frequent early complication of antiretroviral therapy (ART), used to treat HIV-1 infection, especially in countries where TB is prevalent. TB-IRIS is characterized by an exaggerated inflammatory response toward the antigens of Mycobacterium tuberculosis that results in clinical deterioration in patients experiencing immune recovery during early ART. ⋯ Paradoxical TB-IRIS manifests with new or recurrent TB symptoms or signs in patients being treated for TB during early ART, and unmasking TB-IRIS is characterized by an exaggerated, unusually inflammatory initial presentation of TB during early ART. In this review the incidence, clinical features, risk factors, treatment, and prevention of TB-IRIS in adult and pediatric patients are discussed.