ABSTRACT
Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis.Methods Twenty-two cases of clinically suspected sarcoidosis underwent bronchoscopy and ultrasound bronchoscopy examination,including endobronchial biopsy (EBB),transbronchial lung biopsy (TBLB),and EBUS-TBNA.The biopsy samples of EBB,TBLB,and EBUS-TBNA were paraffin-embedded for hematoxylin eosin (HE) staining and acid-fast staining,respectively.Differences in the diagnosis of sarcoidosis were compared among EBB,TBLB,and EBUS-TBNA.The diagnostic performance of EBUS-TBNA was evaluated.Interventional pulmonology diagnostic strategy of sarcoidosis was analyzed.Results Among all the 22 patients with suspected sarcoidosis,20 cases were diagnosed as sarcoidosis,1 case was small cell lung cancer,and 1 case was lymphoma.The number of patients who were diagnosed by EBB,TBLB,and EBUS-TBNA was 6 cases,9 cases,and 16 cases,respectively;and their diagnostic yield was 30.0％,45.0％,and 80.0％,respectively.The diagnostic yield of EBUS-TBNA was significantly better than the other two (P =0.005).Combined EBB and EBUS-TBNA,the diagnostic yield was 85.0％.Combined TBLB and EBUS-TBNA,the diagnostic yield was 90.0％.Combined those three,the diagnostic yield was 95.0％.EBUS-TBNA diagnostic yield was affected by the location and size of lymph nodes.The diagnostic yield of subcarinal lymph nodes and paratracheal lymph nodes by EBUS-TBNA was significantly better than that of Hilar lymph nodes (x2 =4.29,P ＜0.05),EBUS-TBNA showed better diagnostic yield for the lymph nodes whose diameter was greater than 2cm (x2 =4.067,P ＜ 0.05).EBUS-TBNA had fewer complications.Most patients only had a little bleeding in puncture site.Conclusions EBUS-TBNA contributed to diagnose sarcoidosis,while TBLB and EBB had a complementary value in the diagnosis of sarcoidosis by EBUS-TBNA.
ABSTRACT
Os autores analisaram 16 cães mestiços, machos e fêmeas, com peso de 12 a 20Kg, hígidos, divididos em dois grupos. Um grupo (11) utilizando um pedículo de gordura mediastinal como tecido autólogo protetor e outro (I) sem proteção da anastomose. Todos os cães foram submetidos a anestesia geral inalatória em circuito valvular com absorção de CO2, mantidos com ventilação controlada manual e a toracotomia lateral esquerda, foi abordada a cavidade pleural através do 5° espaço intercostal. Com o mínimo de "stripping" peribrônquico seccionou-se a artéria brônquica, procedendo-se em seguida, à secção transversal do brônquio-fonte esquerdo à média distância entre a carina e os lobos. Após a realização da manobra de entubação seletiva foi mantida a ventilação do pulmão direito, até o término da anastomose. O grupo com proteção teve a gordura mediastinal rebatida do pericárdio, mantendo seu pedículo nutridor e fixada em forma de "flap" ao redor da anastomose. Posteriormente foi realizada a toracorrafia por planos e drenagem sub-aquática. Os cães sofreram eutanásia ao 15° dia de pós-operatório. Os segmentos de brônquios com a anastomose foram submetidos ao exame histológico. Concluiu-se que a desvascularização da anastomose brônquica é um fator de agressão ao processo cicatricial, e que a gordura mediastinal é suficiente para revascularizar a anastomose e promover um processo de cicatrização adequado.
The authors analised 16 mongrel dogs, of both sexes, with weight from 12 to 20 kg, in good health conditions, divided in 2 groups. In the control group (I) had to anastomose protection and in the other group (lI) a protective pedicle of mediastinal fat as an autolog tissue was used. Ali dogs were submitted to general volatil anesthesia. A valvuled circuit whit C02 absorption was utilized for this purpose. The animais were manteined with a manually controled ventilation. A left lateral toracotomy was performed and the pleural cavity was reached through the 5th intercostal space. The bronchial artery was seccioned with a minimún peribronchial stripping and a followed by a transversal seccion of the main left bronchius in a mediai distance between the carina and the lobules. The performance of a selective intobation permitted the maintainance of the sole right lung ventilation until the end of the anastomose. The group that had protection (11) had the mediastinic fat dissecated from the pericardic, manteined its nourishing pedicle and it was fixed in a flap from surounding the anastomose. A thoracorraphy was done per layer, anda sub-aquatic drainage was performed. The dog were submitted to euthanasia on the 15th post operative day and the bronchial segments containing the anastomose were examined histologically. lt was then concluded that the desvascularization of the bronchic anastomose is a factor of delay or impairmentt of the healing process, and that the mediastinal fat is sufficient to promove neovascularization in the anastomose area, and to promote an adquated healing process.