Impact of Cough Severity on the Diagnostic Yield of Endobronchial Ultrasonography Transbronchial Biopsy with Guide Sheath: A Retrospective Observational Study.

Bronchoscopy is an invasive procedure, and patient coughing during examination has been reported to cause patient distress. This study aimed to clarify the relationship between cough severity and diagnostic yield of endobronchial ultrasonography with guide sheath transbronchial biopsy (EBUS-GS-TBB). Data of patients who underwent bronchoscopy at Kyorin University Hospital between April 2019 and March 2022 were retrospectively evaluated. Bronchoscopists assessed the cough severity upon completion of the procedure using a four-point cough scale. Cough severity was included as a predictive factor along with those reportedly involved in bronchoscopic diagnosis, and their impact on diagnostic yield was evaluated. Predictors of cough severity were also examined. A total of 275 patients were enrolled in this study. In the multivariate analysis, the diagnostic group (n = 213) had significantly more 'within' radial endobronchial ultrasound findings (odds ratio [OR] 5.900, p < 0.001), a lower cough score (cough score per point; OR 0.455, p < 0.001), and fewer bronchial generations to target lesion(s) (OR 0.686, p < 0.001) than the non-diagnostic group (n = 62). The predictive factors for severe cough include the absence of virtual bronchoscopic navigation (VBN) and prolonged examination time. Decreased cough severity was a positive predictive factor for successful EBUS-GS-TBB, which may be controlled using VBN and awareness of the procedural duration.

Analysis of predicted factors for bronchoalveolar lavage recovery failure: An observational study.

BACKGROUND: The bronchoalveolar lavage (BAL) recovery rate should generally be more than 30% for effective diagnosis. However, there have been no reports investigating a target bronchus for BAL, and the cause of BAL recovery failure is uncertain. Therefore, this study detected predictive factors for BAL recovery failure through investigations on a target bronchus for BAL by using a 3D image analysis system. Therefore, this study detected predictive factors for BAL recovery failure. MATERIALS AND METHODS: We retrospectively collected data from 338 adult patients who underwent BAL procedures at Fukujuji Hospital from June 2018-March 2022. Factors correlated with the BAL recovery rate were detected. Furthermore, the patients were divided into the failure group (recovery rate <30%; 36 patients) and the success group (recovery rate ≥30%; 302 patients), and data were compared between the two groups by analysing the target bronchus by using a 3D image analysis system. RESULTS: The patients in the failure group were older (median 74.5 years old [IQR 68.0-79.0] vs. median 70.0 years old [IQR 59.0-76.0], p = 0.016), more likely to be male (n = 27 [75.0%] vs. n = 172 [57.0%], p = 0.048), more likely to have COPD (n = 7 [19.4%] vs. n = 14 [4.6%], p = 0.003), and more likely to perform a target site of BAL other than the middle/lingual lobe (n = 11 [30.5%] vs. n = 35 [11.6%], p = 0.004) than those in the success group. The area of the bronchial wall was positively related to the recovery rate (r = 0.141, p = 0.009), and the area of the bronchial wall in the failure group was lower than that in the success group (median 10.5 mm2 [interquartile range (IQR) 8.1-14.6] vs. median 14.5 mm2 [11.4-19.0], p<0.001). CONCLUSION: The study shows that a thin bronchial wall, COPD, and a target site of BAL other than the middle/lingual lobe were identified as the predicted factors for BAL recovery failure. The weakness of the bronchial wall might cause bronchial collapse during the BAL procedure.

A rare case of COVID-19 pneumonia with severe hyperlipoproteinemia.

A 55-year-old woman was admitted to our hospital for coronavirus disease 2019 (COVID-19) pneumonia. Her symptoms improved upon treatment with steroids, remdesivir and heparin. After discharge, she consumed excessive alcohol because of taste disorder due to COVID-19; she also had chylomicronemia with a triglyceride (TG) level of 8750 mg/dl. Chylomicrons and very-low-density lipoprotein were detected by electrophoresis, and she was diagnosed with severe hyperlipoproteinemia, suspected to be Type V hyperlipoproteinemia. She did not have any symptoms of pancreatitis, and her TG levels decreased with fat intake restriction and sobriety. This is a rare case of COVID-19 with hyperlipoproteinemia, and the causes of hyperlipoproteinemia might be associated with COVID-19 complications, steroids and/or lifestyle changes during the pandemic; therefore, changes in TGs should be observed carefully after the resolution of COVID-19.

Analysis of factors predicting the application of chemical pleurodesis for pneumothorax: An observational study.

ABSTRACT: Chemical pleurodesis is performed in pneumothorax patients to treat nonresolving air leakage or prevent recurrence. However, factors that might predict the need for chemical pleurodesis remain unknown. Therefore, this study investigated predictive factors for the application of chemical pleurodesis for pneumothorax.We retrospectively analyzed 401 adult pneumothorax patients who underwent chest tube drain insertion during hospitalization at Fukujuji Hospital from January 2016 to December 2020. The patients were divided into 3 groups: the pleurodesis group, comprising 89 patients treated with chemical pleurodesis; the nonpleurodesis group, comprising 206 patients treated without chemical pleurodesis; and the surgical group, comprising 106 patients treated surgically. Data for patients in the pleurodesis group were compared to those in the nonpleurodesis or surgical group, and a predictive score of the application of chemical pleurodesis for pneumothorax was developed.Compared with the nonpleurodesis group, in the pleurodesis group, patient age was higher (P < .001), emphysema (n = 33 (37.1%) vs 70 (34.0%), P = .045), and interstitial pneumonitis (n = 19 (21.3%) vs 19 (9.2%), P = .022) were more common causes, and chest tube suction was more common (n = 78 (87.96%) vs n = 123 (59.7%), P < .001). Similar results were found between the pleurodesis and surgical groups. We developed a score for predicting the application of chemical pleurodesis for pneumothorax, including the following factors: age ≥55 years; presence of emphysema and/or interstitial pneumonitis; and use of chest tube suction. The score for the pleurodesis group showed a high area under the receiver operating characteristic curve compared with that for the nonpleurodesis group (0.776 [95% confidence interval]: 0.725-0.827). With a score of 2 as the cutoff value, the sensitivity was 91.0% and the specificity was 52.4%. In a comparison between the pleurodesis and surgical groups, the predicting score showed the high AUC of 0.904 (95% confidence interval: 0.863-0.945).This study reveals predictive factors for the application of chemical pleurodesis and provides a predictive score including 3 factors.

Mobile Cecum in a Young Woman with Ehlers-Danlos Syndrome Hypermobility type: A Case Report and Review of the Literature.

Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is unexpectedly common and is associated with a high rate of gastrointestinal manifestations. We herein report the first documented case of mobile cecum associated with EDS-HT. A 21-year-old woman with repeated right lower abdominal pain was initially diagnosed with EDS-HT. Abdominal examinations performed in the supine position, such as CT and ultrasonography, showed no gross abnormalities. In contrast, oral barium gastrointestinal transit X-ray images obtained with changes in the patient's body position revealed position-dependent cecal volvulus with mobile cecum. She was finally discharged with a dramatic resolution of her symptoms after laparoscopic cecopexy for mobile cecum.

Accuracy of CT Colonography for Detection of Polypoid and Nonpolypoid Neoplasia by Gastroenterologists and Radiologists: A Nationwide Multicenter Study in Japan.

OBJECTIVES: The objective of this study was to assess prospectively the diagnostic accuracy of computer-assisted computed tomographic colonography (CTC) in the detection of polypoid (pedunculated or sessile) and nonpolypoid neoplasms and compare the accuracy between gastroenterologists and radiologists. METHODS: This nationwide multicenter prospective controlled trial recruited 1,257 participants with average or high risk of colorectal cancer at 14 Japanese institutions. Participants had CTC and colonoscopy on the same day. CTC images were interpreted independently by trained gastroenterologists and radiologists. The main outcome was the accuracy of CTC in the detection of neoplasms ≥6 mm in diameter, with colonoscopy results as the reference standard. Detection sensitivities of polypoid vs. nonpolypoid lesions were also evaluated. RESULTS: Of the 1,257 participants, 1,177 were included in the final analysis: 42 (3.6%) were at average risk of colorectal cancer, 456 (38.7%) were at elevated risk, and 679 (57.7%) had recent positive immunochemical fecal occult blood tests. The overall per-participant sensitivity, specificity, and positive and negative predictive values for neoplasms ≥6 mm in diameter were 0.90, 0.93, 0.83, and 0.96, respectively, among gastroenterologists and 0.86, 0.90, 0.76, and 0.95 among radiologists (P<0.05 for gastroenterologists vs. radiologists). The sensitivity and specificity for neoplasms ≥10 mm in diameter were 0.93 and 0.99 among gastroenterologists and 0.91 and 0.98 among radiologists (not significant for gastroenterologists vs. radiologists). The CTC interpretation time by radiologists was shorter than that by gastroenterologists (9.97 vs. 15.8 min, P<0.05). Sensitivities for pedunculated and sessile lesions exceeded those for flat elevated lesions ≥10 mm in diameter in both groups (gastroenterologists 0.95, 0.92, and 0.68; radiologists: 0.94, 0.87, and 0.61; P<0.05 for polypoid vs. nonpolypoid), although not significant (P>0.05) for gastroenterologists vs. radiologists. CONCLUSIONS: CTC interpretation by gastroenterologists and radiologists was accurate for detection of polypoid neoplasms, but less so for nonpolypoid neoplasms. Gastroenterologists had a higher accuracy in the detection of neoplasms ≥6 mm than did radiologists, although their interpretation time was longer than that of radiologists.

[Acute gastric mucosal lesions caused by acute Helicobacter pylori infection -clinical outcomes of six cases and problems in the diagnosis of H. pylori infection].

We analyzed the ratio of positive test results in various diagnostic methods for Helicobacter pylori infection and the clinical presentations in six cases of acute gastric mucosal lesions (AGML) caused by acute H. pylori. At onset, five cases tested negative for serum antibodies; one had a positive result, but the antibody titer increased with time. Some false negative results were obtained with the following tests: urea breath test, rapid urease test, microscopy, culture, and immunostaining; however, the feces antigen test gave positive results in all five cases. These data suggest that feces antigen test should be performed in all cases suspected of acute H. pylori infection. Where progress was monitored without eradication therapy, subjective symptoms were exacerbated in some patients, and one patient developed a persistent infection. Consequently, eradication therapy should be performed at an early stage of AGML.