Seminars in respiratory and critical care medicine
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Convex probe endobronchial ultrasound (EBUS) is a minimally invasive diagnostic technique that allows real-time sampling of mediastinal and hilar lymph nodes and central pulmonary lesions. Its utility in diagnosing both malignant and nonmalignant diseases has led to an increased uptake and use by pulmonologists over the past decade. ⋯ It has also a role in providing tissue for molecular analysis, thereby guiding in the selection of agents in the new era of personalized chemotherapies in the treatment of NSCLC. The following review highlights the evidence for EBUS in diagnosing mediastinal pathology and addresses technique, training, and competency and future directions for this technology.
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Semin Respir Crit Care Med · Dec 2014
ReviewInterventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction.
Emphysema and asthma are responsible for economic and social burden. Altering the natural course of these diseases is a field of intense research. The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly reduce both morbidity and mortality in properly selected patients. ⋯ In patients suffering from asthma who cannot achieve control with standard medical care, BT has been shown to be safe and improves symptoms, with long lasting benefit. BT does not seem to affect traditional markers of asthma severity such as forced expiratory volume in 1 second and questions remain regarding proper patient selection for this therapy and its true physiologic effects. This article is a review of bronchoscopic modalities for emphysema and asthma.
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Semin Respir Crit Care Med · Dec 2014
ReviewInterventional pulmonology in the pediatric population.
Endoscopic airway interventions within pediatric populations vary considerably. Some of this variance may be related to institutional experience, however, may also be limited by operator experience and available equipment. Previous reports of pediatric bronchoscopic interventional procedures have been identified within the surgical literature; however, newer reports have identified other specialties participating in the care of these patients. Here, we will provide a review of the current relevant medical literature, including an evidence-based review of advanced diagnostic and therapeutic bronchoscopic treatments within the pediatric population.
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Pneumothorax refers to the presence of air within the pleural cavity, which may arise from a spontaneous defect in the visceral pleural surface, or through iatrogenic or other thoracic trauma. The most common cause in the developed world is iatrogenic pneumothorax. Most frequently, it can be managed conservatively or through simple pleural aspiration or drainage. ⋯ Following assessment of the site of the air leak within the bronchial tree, techniques are described for the sealing of leak using tissue or fibrin glues, endobronchial devices of various kinds, and combination approaches. Bronchoscopic sealing of air leaks can often avoid the requirement for thoracic surgical intervention. They may prove life-saving in patients who are difficult to wean from mechanical ventilation or extracorporeal membrane oxygenation because of catastrophic air leaks.
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The burden of pleural diseases continues to rise and affects an increasingly complex and aging patient population. As such, thoracentesis is one of the most common procedures performed by respiratory physicians, as pleural fluid analysis can establish the diagnosis of pleural effusions in approximately 75% of the cases. ⋯ Medical thoracoscopy addresses some of the limitations of these techniques, allows a comprehensive pleural examination and targeted pleural biopsies, and offers the possibility of treatment of recurrence in the same setting. As such, medical thoracoscopy is ideally positioned as a valuable tool in the diagnosis of unexplained exudative pleural effusions.