Transbronchial needle aspiration "by the books"

Training for advanced bronchoscopic procedures is acquired during the interventional pulmonology [IP] Fellowship. Unfortunately a number of such programs are small, limiting dissemination of formal training. We studied success of conventional transbronchial needle aspiration [C-TBNA] in the hands of physicians without formal IP training. A technique of C-TBNA was learned solely form the literature, videos and practicing on inanimate models at "Hands-On" courses. Conventional TBNA with 21 and /or 19 gauge Smooth Shot Needles [Olympus [Registered Sign], Japan] was performed on consecutive patients with undiagnosed mediastinal lymphadenopathy. Thirty-four patients [male 23], mean age 54.9 +/- 11.8 years underwent C-TBNA. Twenty- two patients had nodes larger than 20 mms. Suspected diagnoses were malignancy in 20 and nonmalignant conditions in 14. Final diagnoses were malignancy 17, sarcoidosis 4, reactive lymph 12, and tuberculosis 1. Final diagnosis was established by C-TBNA in 14 [11 malignancy, 3 sarcoidosis; yield 41.1%], mediastinoscopy in 14, transthoracic needle aspiration in 3, peripheral lymph node biopsies in 2 and by endobronchial biopsy in 1. Nodal size had an impact on outcome [P=0.000] while location did not [P=0.33]. C-TBNA was positive in 11/20 when malignancy was suspected [yield 55%], while 3/14 when benign diagnosis was suspected [yield 21.4%] [P=0.05]. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 66.6%, 100%, 100%, 65% and 79.4%, respectively. There were no complications or scope damage. Conventional-TBNA can be learned by the books and by practicing on inanimate models without formal training and results similar to those published in the literature could be achieved

Pleural effusion following ventriculo-pleural shunt: case reports and review of the literature

Ventriculo-pleural shunt [VPLS] is an acceptable alternative in the management of hydrocephalus. Imbalance between the production and absorption of cerebrospinal fluid an lead to formation of pleural effusion in patient with VPLS and on occasion produce symptoms. Pleural effusion could be a transudate or a non-specific exudate. We report our experience with this modality in relation to formation of pleural effusion and review the literature to make recommendation for its management. Information related to patients' demographics, smoking history, prior pulmonary and occupational history, indication, duration and complications of the VPLS and their management was gathered to substantiate current recommendation with our experience