Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
-
Monaldi Arch Chest Dis · Feb 1997
Comparative StudyComparison of endobronchial needle aspiration with forceps and brush biopsies in the diagnosis of endobronchial lung cancer.
Endobronchial forceps biopsy (FB) specimens of lung carcinoma are not uncommonly interpreted as nondiagnostic owing to extensive crush artefact, necrosis, or insufficient tissue. FB cannot be performed in some endobronchial lung cancers (EBLCs) with massive bleeding tendency due to fragility and friability. Cytological studies from the brushings and washings may also be unproductive, increasing the bronchoscopist's frustration. ⋯ In determining cell type, no significant difference was found between EBNA (95%) and FB (97%) (p > 0.05). Regarding complications (only bleeding), there was no significant difference (p > 0.05) between EBNA (7%) and BB (13%), or between EBNA (4%) and FB (17%). We conclude that in endobronchial lung cancers: 1) the diagnostic yield of endobronchial needle aspiration is higher than brush biopsy; 2) endobronchial needle aspiration increases the yield of brush biopsy when forceps biopsy cannot be performed owing to significant bleeding; 3) endobronchial needle aspiration increases the diagnostic yield when a forceps biopsy specimen is inadequate because of crush artefact, necrosis, or tissue resistance; and 4) endobronchial needle aspiration is as safe as brush biopsy and forceps biopsy.
-
Monaldi Arch Chest Dis · Feb 1997
ReviewNoninvasive mechanical ventilation in acute on chronic respiratory failure: determinants of success and failure.
Mechanical ventilation (MV) has been indicated in the treatment of acute respiratory failure (ARF) if conservative treatment fails. The recent innovations of noninvasive methods of mechanical ventilation (NMV) make it possible to avoid the complications of invasive MV, at the same time ensuring a similar degree of efficacy. A review of the literature from 1989 to 1996 shows that use of NMV in ARF has been reported in several studies involving more than 500 patients, mostly with chronic obstructive pulmonary disease (COPD). ⋯ With these limitations, NMV in selected patients with ARF is well-tolerated and may be useful in avoiding ET intubation in most cases of COPD, and with a wide range of success rates in other diseases. This in turn has several advantages in terms of avoiding complications of invasive MV, reducing the length of stay in the Intensive Care Unit (ICU), and probably the number of ICU readmissions. Side-effects of NMV appear less severe than those induced by invasive MV.
-
Monaldi Arch Chest Dis · Feb 1997
ReviewInterstitial lung disease: basic mechanisms and genetic predisposition.
Diffuse (interstitial) lung disease comprises a wide variety of relatively uncommon conditions, which present with characteristic clusters of clinical features and often with aberrant lung function. These diseases cause major morbidity and mortality due to lung injury and fibrosis. ⋯ However, since not all individuals exposed to a common environment develop interstitial diseases, we can hypothesize that there is a genetic predisposition to their development. Therefore, if we can identify individuals who are genetically predisposed to develop diseases characterized by lung injury and fibrosis, then management strategies can be designed which will attempt to identify early disease and, in the longer term, to develop targeted genetic interventional approaches to treatment.
-
Monaldi Arch Chest Dis · Feb 1997
ReviewWhere and how must we perform noninvasive mechanical ventilation?
The classic experience of mechanical ventilation (MV) has recently been integrated with the use of devices providing noninvasive ventilatory assistance in the Intermediate Intensive Care Unit (IICU), to which patients suffering from acute on chronic respiratory insufficiency may be admitted for therapy. Noninvasive mechanical ventilation (NMV) has been demonstrated to be mandatory during severe relapses of chronic obstructive pulmonary disease (COPD). This method of ventilation can reduce mortality, morbidity and time spent in the Intensive Care Unit (ICU) when related to standard medical therapy alone. ⋯ Advanced COPD may frequently need periods of intensive treatment, monitoring and nursing. These patients may benefit from NMV which provides a specific intermediate treatment. With regard to an optimal cost/benefit ratio, the IICU is a reasonable alternative for COPD patients with less severe acute respiratory failure (ARF), reducing superfluous ICU stays.
-
Monaldi Arch Chest Dis · Feb 1997
ReviewNoninvasive pressure support ventilation: physiological and clinical results in patients with COPD and acute respiratory failure.
Noninvasive ventilation may bring considerable benefits in the treatment of acute respiratory failure, especially in patients with chronic obstructive pulmonary disease. Reduction in the need for endotracheal intubation has been well-documented. In selected groups a reduction in morbidity, mortality, and length of hospital stay have been demonstrated. The efficacy of the technique is very dependent on the skill and motivation of the team.