Does addition of endobronchial ultrasound improves the classification of suspicious lesions detected by autofluorescence bronchoscopy?

Autofluorescence bronchoscopy [AFB] may improve sensitivity at the cost of specificity when it is used to identify suspicious bronchial mucosal lesions not seen by conventional white light bronchoscopy. Thus, it seems useful to study these lesions additionally with endobronchial ultrasound [EBUS] for further classification of dignity of suspicious lesions aiming in improving the positive predictive value [PPV] of AFB. This study aims to answer the following question: Does addition of EBUS improves the classification of suspicious lesions detected by AFB? Fifty five subjects with suspected lung cancer referred for AFB examination for different indications were recruited for this study. Rigid and Fiberoptic bronchoscopic examination were done followed by AFB then EBUS and finally samples from suspicious sites were taken for histopathological examination. The addition of EBUS to AFB improves PPV from 72.7% in AFB alone to 100% in AFB+EBUS in case of benign suspicious lesions detected by AFB with a negative predicted value [NPV] of 60% and with a sensitivity and specificity of 75% and 100% respectively for AFB+EBUS. While EBUS addition to AFB improves PPV from 60.6% in AFB alone to 95.2% in AFB+EBUS in case of malignant suspicious lesions detected by AFB with a NPV of 100% and with a sensitivity and specificity of 100% and 92% respectively for AFB+EBUS. Thus, the addition of EBUS improves the classification of suspicious lesions detected by AFB with its great implication on further patient management and combining AFB [for tumor localization] to EBUS [for depth estimation] may provide a reliable method of staging and choice of treatment modality of lung cancer

phagocytic activity of peripheral blood macrophages in COPD patients

Macrophages numbers are elevated in the lungs of smokers and those patients with COPD, where they accumulate in the alveoli, bronchioles and small airways. The slow progression and chronicity of COPD parallels the chronic increase of macrophages that is seen in sites of tissue injury / damage and supports the concept that macrophages are at least in part responsible for the pathological consequences. The aim of this work was to study the phagocytic activity of peripheral blood macrophages in COPD patients, either in the stable and during acute exacerbation compared to the normal subjects, which might be reflected on the therapeutic intervention strategies. Prospective case - control study. Seventy subjects were enrolled in this study, divided into two groups: Group I: 50 patients with COPD and Group II: 20 healthy volunteers serving as a control group. All subjects were submitted to ABG analysis, spirometric studies and assessment of phagocytic function, namely phagocytic and lytic indices using opsonised suspension of candida of their peripheral blood macrophages. Results showed a highly significant statistical difference as regards both phagocytic and lytic indices among COPD patients [group 1] and control group [group 2] where both indices were significantly lower among the COPD group as compared to the control group indicating obvious phagocytic dysfunction among peripheral blood macrophages in COPD patients, and both indices were significantly lower in patients in exacerbation than patients in stable state. This study is directed to the evaluation of the phagocytic function of peripheral blood macrophages among COPD patients, results revealed that there is actually a phagocytic dysfunction and that it is not always positively correlating to the severity of the disease. This also draws the attention to the peripheral blood cell population in COPD disease which had not taken its share of proper assessment. Hence, it would be recommended to include the peripheral blood cell population and macrophages in particular while searching in the pathophysiology and management of COPD disease

Interventional bronchoscopy: ain Shams University Hospital experience

Bronchoscopy has evolved considerably in our hospital. During recent years, we implemented the concept of interventional bronchoscopy [IB] for the first time in Egypt. IB is defined as a diagnostic and invasive therapeutic interventions that extend beyond routine Flexible bronchoscopy. In this article, we will review our clinical experience with IB during the last five years as regards methodology requirements, available equipments, clinical applications and presentation of selected research outcomes. We retrospectively reviewed all available reports of therapeutic IB performed in our bronchoscopy unit to determine the indications, application sites, methods of disobliteration and complications of therapeutic IB. In addition, recent interesting research work done on endobronchial ultrasound, autofluorescence bronchoscopy, Nd: YAG laser bronchoscopy and endobronchial electrocautery was reviewed. In order to perform an interventional procedure, well-equipped facilities, trained personnel, preprocedure evaluation, and monitoring are mandatory. More than 500 invasive therapeutic interventions were performed in the past 5 years. The results and analysis of these IB were reviewed. We concluded from the presented data that IB has quickly gained recognition and drawn interest with its promising results. Much effort is needed to overcome challenges facing IB awareness, financial concerns, training and verification of competency in our country

Pulmonary functions in systemic lupus erythematosus

This study included fifty cases of which thirty patients had Systemic Lupus Erythrematosus [SLE], and twenty cases acted as a control group Pulmonary functions were abnormal in 22 cases out of 30 [73.3%]. Small airways affection was the commonest functional finding being detected in 20 cases [66.66]. We conclude that pulmonary functions should be routinely done in all cases having SLE for early detection of small airways affection and other abnormal pulmonary functions

Serodiagnosis of pulmonary tuberculosis by passive haemagglutination test

In this study PHT was done to detect antibodies against M. tuberculosis in three groups of Egyptians. 1st group 30 patients having active pulmonary tuberculosis 2nd group 30 patients having non tuberculous chest diseases and 3rd group 30 normal persons. It was found that 66.7% of patients with active tuberculosis gave positive PHT, 23.2% of the 2nd group and 16.6% in the 3rd group gave positive results. Also it was found that there was a high statistical significant difference between the results of PHT in the 1st group than in the other two groups. Also, there was a high statistical significant difference between the presence of tuberculous cavities and the presence of positive PHT