Putative Malignant Pleural Mesothelioma in situ (MPMIS) with Sequential Acquisition of Genomic Alterations on Fluorescence in situ Hybridization (FISH) Examination.

Malignant pleural mesothelioma (MPM) is a rare and deadly disease. A precursor in situ lesion, malignant pleural mesothelioma in situ (MPMIS), has recently been proposed. On cytological examination, the distinction between reactive and malignant mesothelial cells is often challenging, and sometimes even impossible without ancillary methods. Fluorescence in situ hybridization (FISH) for detection of 9p21 deletion is a powerful diagnostic tool in this context, both in histological and in cytological specimens. Here, we present a case of MPM with initial presentation as a putative MPMIS with disomic chromosomal pattern and homozygous 9p21 deletion with subsequent development of an aneuploid pattern after whole genome duplication during tumor progression.

Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018.

The Swiss National Guidelines 2013 for chronic obstructive pulmonary disease have been revised in order to acknowledge recent progress in diagnosis and management of this disease. The resulting new Swiss recommendations are based on best evidence from the literature, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report and other published national guidelines. Misdiagnosis of chronic obstructive pulmonary disease is common and means that patients do not always receive optimal treatment. To improve the management of patients with chronic obstructive pulmonary disease in Switzerland, these recommendations encourage a more comprehensive assessment of patients, based on the combined assessment of symptoms, degree of airflow limitation, risk of exacerbation and the presence of comorbidities. Recommendations for evidence-based preventive measures, as well as pharmacological and non-pharmacological strategies for the management of both stable and acute exacerbations of chronic obstructive pulmonary disease are provided in this update.

Treatment of COPD Exacerbation in Switzerland: Results and Recommendations of the European COPD Audit.

BACKGROUND: The European COPD Audit initiated by the European Respiratory Society (ERS) evaluated the management of hospital admissions due to exacerbation of chronic obstructive pulmonary disease (COPD) in several European countries. Data on the treatment of severe acute exacerbations of COPD (AECOPDs) in Switzerland are scarce. OBJECTIVES: In light of the GOLD 2010 guidelines, this work aims to examine the quality of care for AECOPD and to provide specific recommendations for the management of severe AECOPD in Switzerland. METHODS: A total of 295 patients requiring hospital admission to 19 Swiss hospitals due to exacerbation of COPD during a predefined 60 days in 2011 were included in the study. We compared the Swiss data to the official GOLD 2010 recommendations and to the results of the other European countries. RESULTS: Approximately 43% of the Swiss patients with severe AECOPD were current smokers at hospital admission, compared to 33% of the patients in other European countries (p < 0.001). In Switzerland and in Europe, spirometry data were not available for most patients at hospital admission (65 and 60%, respectively; p = 0.08). In comparison to other European countries, antibiotics were prescribed 14% less often in Switzerland (p < 0.001). Only 79% of the patients in the Swiss cohort received treatment with a short-acting bronchodilator at admission. CONCLUSIONS: Considering the overall high standard of health care in Switzerland, in light of the GOLD 2010 guidelines we are able to make 7 recommendations to improve and standardize the management of severe AECOPD for patients treated in Switzerland.

Patients' satisfaction with flexible bronchoscopy in a hospital-based community practice.

BACKGROUND: There are no data about patients' satisfaction with a first bronchoscopy in community practice. OBJECTIVES: The aim of this study was to assess the satisfaction with flexible bronchoscopy and the willingness to return for the procedure if needed in hospital-based community practice. METHODS: Prospective administration of a questionnaire before and after flexible bronchoscopy with inclusion of 126 patients in the analysis. RESULTS: The reliability analysis demonstrated a good internal consistency of the questionnaire with a mean Cronbach α of 0.7 (range 0.63-0.76). Health status and overall satisfaction with bronchoscopy were reported as poor by 31 (25%) and 0 (0%) patients, fair by 34 (27%) and 3 (2%) patients, good by 47 (37%) and 51 (40%) patients and very good by 9 (7%) and 70 (56%) patients, respectively. Overall willingness to return for a flexible bronchoscopy if necessary was 98% (123/126). Transbronchial needle aspiration (TBNA) was the most often performed diagnostic procedure (74/126, 59%). Mean duration of the bronchoscopy in patients with and without TBNA was 30 and 19 min, respectively (p < 0.001). However, TBNA did not influence patient's satisfaction. Preprocedure anxiety was reported by 26 of 51 patients (51%) and 24 of these patients (92%) rated their anxiety as unjustified after the procedure. CONCLUSIONS: Overall satisfaction and willingness to return for a flexible bronchoscopy in community practice are extremely high and these are independent of whether TBNA is undertaken or not.