ABSTRACT
INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of lung ultrasound, conducted by pulmonologists without experience in this procedure, to tule out pneumothorax after invasive procedures. MATERIAL AND METHODS: Our prospective observational study consecutively included patients who underwent transbronchial lung biopsy (TBLB), therapeutic thoracentesis (TT) and/or transparietal pleural biopsies (PB) for whom subsequent chest radiography to rule out complications was indicated. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered in the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the "barcode" sign. RESULTS: We included 275 procedures (149 TBLBs, 36 BPs, 90 TTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Lung ultrasound performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.
Subject(s)
Pneumothorax , Pulmonologists , Humans , Iatrogenic Disease , Lung/diagnostic imaging , Pneumothorax/diagnostic imaging , UltrasonographyABSTRACT
Introducción La ecografía ha demostrado ser una herramienta útil para el diagnóstico del neumotórax en manos expertas. Tras los procedimientos broncopleurales se recomienda realizar una radiografía de tórax para descartar complicaciones. Nuestro objetivo ha sido determinar la validez de la ecografía torácica para descartar neumotórax tras procedimientos invasivos, realizada por neumólogos sin experiencia en este procedimiento. Material y métodos Estudio observacional prospectivo que incluyó pacientes consecutivos sometidos a biopsia transbronquial (BTB), toracocentesis evacuadora (TE) y/o biopsias pleurales transparietales (BPT) a los que se les indicó radiografía de tórax posterior para descartar complicaciones. En todos los casos el mismo neumólogo que hizo la técnica, realizó una ecografía inmediatamente después del procedimiento. Se consideró diagnóstica de neumotórax la presencia de punto pulmonar o la combinación de los signos: ausencia de deslizamiento pleural, ausencia de líneas B y presencia del signo de «código de barras». Resultados Se incluyeron 275 procedimientos (149 BTB, 36 BPT, 90 TE) entre los que se produjeron 14 (5,1%) neumotórax iatrogénicos. La ecografía presentó una sensibilidad de 78,5%, una especificidad de 85%, y un valor predictivo positivo y negativo de 22% y 98,6%, respectivamente. La ecografía no permitió detectar la presencia de tres neumotórax, precisando uno de ellos drenaje torácico y diagnosticó adecuadamente dos neumotórax que no se detectaban en la radiografía inicial. Conclusiones La ecografía torácica realizada por neumólogos que inician su curva de aprendizaje permite descartar neumotórax con un valor predictivo negativo (VPN) del 98,6%, evitando realizar en un número considerable de casos estudios radiográficos de control innecesarios (AU)
Introduction Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of lung ultrasound, conducted by pulmonologists without experience in this procedure, to rule out pneumothorax after invasive procedures. Material and methods Our prospective observational study consecutively included patients who underwent transbronchial lung biopsy (TBLB), therapeutic thoracentesis (TT) and/or transparietal pleural biopsies (PB) for whom subsequent chest radiography to rule out complications was indicated. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered in the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the barcode sign. Results We included 275 procedures (149 TBLBs, 36 BPs, 90 TTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. Conclusions Lung ultrasound performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Iatrogenic Disease , Pneumothorax/diagnostic imaging , Pulmonologists , Ultrasonography , Sensitivity and Specificity , Prospective Studies , Lung/diagnostic imaging , Clinical CompetenceABSTRACT
INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of thoracic ultrasonography to rule out pneumothorax after invasive procedures, conducted by pulmonologists without experience in this procedure. MATERIAL AND METHODS: Our observational prospective study consecutively included patients who underwent transbronchial biopsy (TBB), evacuating thoracentesis (ECT) and/or transparietal pleural biopsies (TPB) who were indicated subsequent chest radiography to rule out complications. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the «barcode¼ sign. RESULTS: We included 275 procedures (149 TBBs, 36 TPBs, 90 ECTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and a positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Thoracic ultrasonography performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.
ABSTRACT
INTRODUCTION: Limb Girdle Muscular Dystrophy type 2C (LGMD2C) is an autosomal recessive dystrophy due to the deficit of gamma-sarcoglycan, one of the proteins of the dystrophin-associated proteins complex (DAP). A new mutation in the gamma-sarcoglycan gene, 13q12, has been described recently and is exclusive of the gypsy community. OBJECTIVE: To describe the clinicopathological and the genetic findings of eleven cases from a Spanish gypsy family with LGMD2C and the mutation C283Y. MATERIAL AND METHODS: We describe a large gypsy family with the C283Y mutation and eleven affected patients. We have performed an extensive clinical and pathological study with immunohistochemistry and Western blot analyses in the eleven patients and a genetic study of a total of twenty-seven members of the family. RESULTS: The patients presented a severe muscular dystrophy with a dystrophic pattern in the muscle biopsy, normal immunolabeling for dystrophin, very weak for alpha-, beta- and delta-sarcoglycan and absent for gamma-sarcoglycan. These eleven patients were found to be homozygous for the mutation and twelve other members of the family, heterozygous. CONCLUSIONS: The clinical picture and the evolution of the disease herein described is similar to that observed in DMD. Two fundamental differences were found: the autosomal recessive mode of inheritance, and the normal immunohistochemistry and immunoblot for dystrophin in the skeletal muscle.
Subject(s)
Chromosomes, Human, Pair 13/genetics , Cytoskeletal Proteins/deficiency , Membrane Glycoproteins/deficiency , Muscular Dystrophies/genetics , Point Mutation , Adolescent , Adult , Biopsy , Child , Child, Preschool , Consanguinity , Cytoskeletal Proteins/genetics , Cytoskeletal Proteins/metabolism , Dystrophin/analysis , Electromyography , Female , Genes, Recessive , Genotype , Humans , Male , Membrane Glycoproteins/genetics , Membrane Glycoproteins/metabolism , Muscle, Skeletal/chemistry , Muscle, Skeletal/pathology , Muscular Dystrophies/ethnology , Muscular Dystrophies/metabolism , Muscular Dystrophies/pathology , Pedigree , Phenotype , Roma/genetics , Sarcoglycans , Scoliosis/ethnology , Scoliosis/geneticsABSTRACT
The objective of our study was to determine the safety of transbronchial biopsy (TBB) in nonhospitalized patients. The design was a prospective study of the consecutive cases from July 1987 until September 1988 in the setting of a university hospital of the third level with 1,800 beds. The patients were a consecutive sample of 169 patients who had 184 procedures of fiberoptic bronchoscopy (FOB) with TBB performed. They suffered from different diseases: lung nodules or masses, diffuse interstitial disease, alveolar condensation, etc. An FOB with TBB was performed in immunocompetent outpatients, who were kept under observation for four hours and then had a chest roentgenogram taken afterwards. We contacted them again after 72 hours to rule out delayed complications. In three cases, more than 100 ml of blood were obtained during the FOB, without significant hemoptysis being recorded in those patients during the observation period; chest pain occurred in 15 patients during the TBB; pneumothorax occurred in two patients (1 percent), one of whom required admission to the hospital, without requiring chest tube drainage. Other complications are reported (bronchospasm, parenchymal hemorrhage, and pneumonia). In conclusion, we consider the TBB to be a technique with a low incidence of complications for outpatients, so therefore we do not believe that admission to the hospital is mandatory for this type of patient, although we do recommend a longer observation period.
