Interventional Pulmonology Archives - PulmCCM
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Interventional Pulmonology Articles

Jul 082014
 
Using bronchoalveolar lavage to evaluate ILD

Using BAL Cellular Analysis in Interstitial Lung Disease The role of bronchoalveolar lavage (BAL) in diagnosing and managing patients with interstitial lung disease (ILD) has always been uncertain and controversial. BAL findings are usually nonspecific, suggesting rather than proving the existence of any particular noninfectious condition (including interstitial lung disease). That said, in patients with [... read more]

Feb 042014
 
Can pulmonologists do their own on-site cytopathology during bronchoscopy?

On-site, intra-procedure cytopathologic examination of aspirated tissue during transbronchial needle aspiration (either by EBUS or “blind” approach) is probably helpful during bronchoscopy. Why wouldn’t it be? You’ve got a trained professional there to tell you when you’ve made the diagnosis and can stop taking biopsies. Diagnostic yield should go up, complications down. Randomized trials have [... read more]

Nov 062013
 
Breath tests can accurately diagnose lung cancer

Diagnosing lung cancer without a biopsy may seem like science fiction, but breath testing to identify lung cancer has made steady gains in accuracy in recent years. A study abstract presented by Peter Mazzone et al at Chest 2013 in Chicago shows just how far one of the new technologies — volatile organic compound analysis [... read more]

Jul 102013
 
EUS / EBUS beat transbronchial biopsies for diagnosis of sarcoidosis in RCT

image: Olympus EUS / EBUS Superior at Diagnosing Sarcoidosis This post has been edited from the original to reflect a correction. It originally reported that this trial suggested EBUS alone was superior to transbronchial biopsy; see below. Sarcoidosis affects tens of thousands of people in the U.S., but making the diagnosis can be tricky. A [... read more]

Jun 272013
 
Early tracheostomy does not improve survival or other outcomes (TracMan trial)

image: CUHK Early Tracheostomy Does Not Help in Large “TracMan” Trial More than 100,000 tracheostomies are performed worldwide each year for people requiring prolonged periods of mechanical ventilation. It’s generally agreed that to avoid damaging the trachea and throat, a tracheostomy should be placed within 3 weeks of mechanical ventilation. But prior to 3 weeks, [... read more]

Jun 072013
 
Managing anticoagulation for surgery and invasive procedures (Review)

Managing Anticoagulation Therapy For Surgery and Procedures (NEJM) See also: How to manage anticoagulation perioperatively (ACCP Guidelines) NOTE: This is a summary of an article in a medical journal, provided as a service to physicians. It is not medical advice. No one should ever make changes to their anticoagulation treatment except under a physician’s supervision. [... read more]

Jun 072013
 
How safe is EBUS? Complication rates <1% at experienced centers

image: Olympus EBUS Complication Rates <1% at Experienced Centers Endobronchial ultrasound (EBUS) — an ultrasound probe on the tip of a bronchoscope — allows real-time viewing of tissues beyond the bronchial wall. It enables more accurate and safer needle biopsies of lymph nodes and masses that abut the bronchial wall. EBUS is an exciting new [... read more]

Dec 302012
 
Bad news for IP guys? Incidental mediastinal lymphadenopathy may not need routine biopsy

(image: Wikipedia) With increasing use of chest CT, incidental mediastinal lymphadenopathy seems to be frequently discovered and subsequently biopsied using EBUS. The “if it’s enlarged, stick a needle in it” mantra is challenged by a paper by Stigt et al. 83 people (age ~59) with at least one incidentally discovered mediastinal lymph node > 1 [... read more]

Dec 282012
 
American Lung Association recommends CT screening for lung cancer

The American Lung Association has become the largest advisory body to recommend lung cancer screening for high-risk people, advising nearly all people aged 55-74 with a 30+ pack-year smoking history (the entry criteria for the National Lung Screening Trial, or NLST) to undergo low-dose CT scanning to detect early lung cancer. The National Comprehensive Cancer Network, [... read more]

Dec 262012
 
Pleural catheters equal to pleurodesis for dyspnea relief from malignant effusions (TIME2)

(image: Wikipedia) In the TIME2 randomized trial published in the June 13 2012 JAMA, indwelling pleural catheters and talc pleurodesis were equivalent at reducing dyspnea over the 6 weeks following the procedure among 106 patients with malignant pleural effusions. Most patients receiving pleural catheters required no hospital stays, and overall had fewer repeat procedures than those [... read more]

Dec 212012
 
Bioengineered tracheas successfully transplanted in two men

New Trachea Grown, Transplanted In Two Men Paolo Macchiarini, Philipp Jungebluth et al report in Lancet their successful bioprosthetic trachea creation and transplantation in a 36-year old man in Sweden after a distal tracheal resection for recurrent primary tracheal cancer. The same group transplanted a bioengineered trachea into a 30-year old Baltimore man, who is [... read more]

Nov 062012
 
Lung volume reduction coils improve dyspnea, FEV1 in COPD (RCT)

(image: PneumRx) ATLANTA — In a small, open-label pilot study, bronchoscopically-placed metal coils that retract emphysematous lung, creating lung volume reduction without surgery, produced functional and airflow improvements in a majority of patients with severe COPD, the lead researcher reported at CHEST 2012. Investigators randomized 47 patients with severe emphysema type COPD to undergo either [... read more]

Aug 172012
 
Advanced bronchoscopy yields are 70% in meta-analysis (Review)

(image: Wikipedia) As one after another specialty society endorses routine lung cancer screening with chest CT scans, we all know a Nodule Storm is coming to a pulmonology clinic near you. Thankfully, smart people are asking how we can systematically and successfully handle this soon-to-be-common outpatient clinical problem. Most of these many thousands of nodules [... read more]

Aug 032012
 
Non-small cell lung cancer (NSCLC): Advances in Diagnosis and Treatment (Update/Review)

Advances in Diagnosis and Treatment of Non-Small Cell Lung Cancer (NSCLC) This review document is periodically updated and reposted as new information is published. Please comment below with your suggestions for inclusion in upcoming updates of this review. (More PulmCCM topic reviews) The diagnosis and treatment of non-small cell lung cancer (NSCLC) is rapidly evolving, [... read more]

Jul 202012
 
Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?

(image: Wikipedia) There are an estimated 200,000 pleural effusions due to malignancy each year in the U.S. alone, and these represent an important cause of suffering and limitation in functional ability for people living with advanced cancer. Pleurodesis (using talc or other sclerosants) and placement of indwelling pleural catheters are both accepted, reasonable approaches to the [... read more]

Apr 242012
 
How to make $25,000 on each EBUS (Chest)

(image: flickrCC) Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), when performed by skilled physicians, reduces the need for mediastinoscopy and unnecessary thoracotomies with their associated morbidity, and is poised to permanently alter the landscape of lung cancer diagnosis and staging. Prior to 2008, Medicare seemed to recognize the potential value of EBUS by paying hospitals [... read more]

Mar 142012
 

The National Lung Screening Trial (NSLT) showed a 20% reduction in death from lung cancer, but with a number needed to screen of 320 to prevent one death, a false-positive rate of 96% and each abnormal scan generating costs of ~$45,000, the risk / benefit / cost accounts are far from settled. Few insurers (e.g. [... read more]

Feb 262012
 

I knew I smelled something fishy about this paper when I read and commented on it last year.  Now, Chest reports they’re giving this study a burial at sea, after the authors could not produce actual data supporting the trial. To help set the record straight: Chest published a retrospective study in March 2011, “Chest Tube [... read more]

Feb 192012
 

Traditional bronchoscopy with transbronchial biopsy (TBBx) has only a 34% sensitivity at diagnosing peripheral pulmonary nodules < 2 cm in size. Transthoracic needle aspiration (TTNA)’s superior sensitivity of 90% for diagnosing peripheral lesions makes it the standard of care for peripheral lesions, but TTNA carries a considerable risk for pneumothorax. A huge proportion of patients experience [... read more]

Jan 202012
 

Richard Light and friends established that parapneumonic effusions (PPE) associated with community-acquired pneumonia very rarely progress if the effusion is freely layering and less than 1 cm in height on a lateral decubitus chest film. But who orders those anymore? Chest CT use has risen 20-fold since Light’s seminal 1980 paper. Often the CT has [... read more]