Diagnostic yield of rapid on-site evaluation transbronchial needle aspiration versus conventional transbronchial needle aspiration: a single center experience.

Trans-bronchial needle aspiration allows lymph node sampling in several thoracic conditions; the ability of Rapid On-Site Evaluation (ROSE) to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective study to establish the utility of ROSE in the diagnosis of thoracic diseases with mediastinal lymph node involvement. We retrospectively reviewed 297 patients with hilar-mediastinal lymph node enlargement detected at CT scan from January 2013 to April 2016. 201 patients underwent conventional TBNA; in 96 patients, TBNA procedure was performed by on-site presence of a team of pathologists and research morphologists. Lung neoplasms, sarcoidosis, infections and lymphoma were the most common diseases diagnosed with TBNA samples. TBNA simultaneously performed in combination with ROSE produced an increase in percentage of appropriate samples compared to single cTBNA (adequate samples cTBNA vs ROSE-TBNA: 73% vs 81%; p<0.05). Our observations indicate an increase in adequacy of fine needle aspirations and increased diagnostic yield in the ROSE group. In conclusions, ROSE may serve to reduce procedure time and enhance sample triaging therefore limiting the need for further invasive diagnostic testing.

Pulmonary metastasis: very late relapse of testicular embryonal carcinoma.

Testicular carcinoma recurrences represent a rare finding (1-6% in non-seminomatous germ cell tumours). However, cases of recurrence have been described many years later. We report a case of late recurrence of embryonic testicular carcinoma, after 26 years, with pulmonary metastases. Following evidence of increase of alpha-fetoprotein (AFP), the patient underwent a total body computed tomography scan that exhibited two pulmonary nodules, one in upper left lobe and other in left hilar region with multiple mediastinal and retrocrural lymph node enlargements All consolidations showed increased sugar uptake value at PET CT. Biopsies of lung consolidations confirmed diagnosis of recurrence of testicular carcinoma.

Spirometry in elderly laryngectomized patients: A feasibility study.

BACKGROUND: Laryngeal cancer is the second most common respiratory neoplasm after lung cancer. Laryngectomy is a well established treatment for larynx cancers which involve relevant anatomic alterations. Spirometry is an essential investigation tool for diagnosis and severity of respiratory diseases, difficult to perform in laryngectomees. METHODS: 43 consecutive laryngectomized patients were enrolled from July 2014 to March 2015. Patients fulfilling inclusion criteria underwent spirometry at baseline assessment and after two days. During the examination, the spirometer was placed directly on the stoma of the patient, through mouthpiece "Spirometry Filter 74". RESULTS: At baseline, 26 eligible laryngectomees correctly performed the spirometry test with mouthpiece adhering to the stoma; 4 patients refused to perform the second spirometry after 2 days. The feasibility of spirometry examination in these patients was 100% despite difficulties in the execution of the test. The Pearson coefficient of reproducibility for FEV1, FVC and Tiffeneau Index was, respectively, 0.98, 0.94 and 0.77. DISCUSSION: Spirometry in laryngectomee patients is a feasible procedure for assessment of respiratory function; despite technical difficulties in the execution of the test, our results underline the reproducibility and repeatability of the spirometry. In conclusion, when performed within dedicated respiratory pathophysiology unit, spirometry is a reliable tool in the assessment and follow up of laryngectomees.

A case of Multiple Unilateral Pulmonary arteriovenous Malformation Relapse: Efficacy of embolization treatment.

Pulmonary arteriovenous Malformations (PAVMs) are a rare vascular alteration characterized by abnormal communications between the pulmonary arteries and veins resulting in an extracardiac right-to-left (R-L) shunt. The majority of PAVMs are associated with an autosomal dominant vascular disorder also known as Osler-Weber-Rendu Syndrome. PAVMs appearance can be both single and multiple. Clinical manifestations include hypoxemia, dyspnea cyanosis, hemoptysis and cerebrovascular ischemic events or abscesses. We report a case of an 18 year old female with severe respiratory failure caused by a relapse of multiple unilateral pulmonary arterovenous fistula. Symptoms at admission include dyspnea, cyanosis and clubbing. The patient underwent pulmonary angio-TC scan, brain CT and echocardiography. The thoracic angio-CT scan showed the presence of PAVMs of RUL and RLL; a marked increase of right bronchial artery caliber and its branches with an aneurismatic dilatation was also observed. The patient underwent percutaneous transcatheter embolization using Amplatzer Vascular Plug IV; a relevant clinical and functional improvement was subsequently recorded. Embolization is effective in the treatment of relapsing PAVMS.

Evidence of angiogenesis in bronchial biopsies of smokers with and without airway obstruction.

The involvement of bronchial vasculature in the airway remodelling occurring in symptomatic smokers with normal lung function and with chronic obstructive pulmonary disease (COPD) has been poorly investigated. An immunohistochemical study was performed on bronchial biopsies taken from 8 non-smokers and 18 smokers divided, according to global health initiative on obstructive lung diseases (GOLD) classification of COPD, into two groups, GOLD 0 and GOLD 2, each of 9 subjects. The number of vessels and the percentage of vascular area in the lamina propria were evaluated by mAb anti-collagen IV. Cellular expression of VEGF and vascular expression of alphavbeta3 integrin were evaluated by the specific monoclonal antibodies. An image processing and analysis system was used to quantify the immunohistochemical data. The number of vessels, the vascular area, the cellular expression of VEGF, the number and percentage of alphavbeta3 positive vessels were significantly higher in GOLD 0 and in GOLD 2 smokers than in non-smokers. The comparison between GOLD 0 and GOLD 2 smokers did show a weak but significantly lower number of vessels in GOLD 2, while the vascular area and the percentage of alphavbeta3 positive vessels did not differ between the two groups. A higher cellular VEGF expression was detected in the GOLD 2 than in the GOLD 0 group. Angiogenesis of bronchial vessels is a component of the airway remodelling occurring in symptomatic smokers with normal lung function and with COPD, it seems independent by the development of airway obstruction and not related to its severity.

Comparison of the bronchodilating effects of inhaled formoterol, salmeterol and salbutamol in asthmatic patients.

Ten subjects with various degrees of asthma severity underwent a three-day trial, with the aim of evaluating the bronchodilating effect of inhaled formoterol (12 micro g), in comparison with salbutamol (200 micro g) and salmeterol (50 micro g). The bronchodilation afforded by formoterol paralleled that of salbutamol in rapidity (mean percentage increases in functional measurements (FEV(1)) vs. baseline recorded 5 min after drug administration: 7.7%, 9.3%, and 0.3% for salbutamol, formoterol and salmeterol, respectively) and that of salmeterol in duration (mean percentage increases in FEV(1) vs. baseline recorded 12h after drug administration: 16.8% and 15.9% for formoterol and salmeterol, respectively). Moreover, the maximal effect of formoterol resulted to be slightly higher in comparison with salbutamol (P<0.001) and salmeterol (P<0.05); in this regard, the mean percentage increases in FEV(1) vs. baseline recorded 2h after salbutamol and formoterol, and 4h after salmeterol were 22.3%, 29.5%, and 24.6%, respectively. Therefore, these results suggest that formoterol can be used, in addition to its utilization as long-acting bronchodilator, also as an effective rescue medication for the immediate relief of asthma symptoms.