Endobronchial treatment of benign endobronchial neoplasms: Our 10 years of experience.

BACKGROUND: The aim of the study was to assess the safety, efficacy, complications, and long-term outcomes of endobronchial treatment for benign endobronchial tumors. METHODS: A total of 53 patients (39 males, 14 females; mean age: 53.7 years; range, 12 to 83 years) with the diagnosis of benign endobronchial neoplasms in our center between November 2010 and September 2019 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients and treatment outcomes were examined. RESULTS: Tumors regressed in all patients with argon plasma coagulation, diode laser and electrocautery, which was combined with cryotherapy in some cases. Complications were observed in five (9%) patients. Major complications were atrial fibrillation in two patients and respiratory failure requiring mechanical ventilation in one patient. Minor complications were minimal bleeding in two patients. The response was very good in 39 (74%) patients and good in 12 (23%) patients. There was no significant difference in the residual tissue formation requiring cryotherapy among the endobronchial treatment modalities (p>0.05). The five-year survival rate was 94%. No endobronchial treatment-related mortality was observed in any of the patients. CONCLUSION: Endobronchial treatment modalities including diode laser, electrocautery, and argon plasma coagulation combined with or without cryotherapy are effective and safe in the treatment of benign endobronchial tumors.

The impact of co-existing comorbid diseases on long-term mortality in bronchoscopic lung volume reduction.

Aim Emphysema is a lung disease in which alveolar capillary units are destroyed supporting tissue lost. Bronchoscopic lung volume reduction (BLVR) is a novel treatment for emphysema. Several comorbidities have been reported to coexist in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate comorbidities of patients with severe emphysema who underwent BLVR and association of these comorbidities with mortality. Methods Between January 2011 and December 2017 the records of severe emphysema patients who underwent endobronchial valve (EBV) or lung volume reduction coil (LVRC) placement were reviewed retrospectively. Results There were 37 patients who received EBV therapy and 29 received LVRC therapy. There were no significant differences in the demographic and clinical characteristics between two groups before the treatment. There were seven deaths (10.6%) over the period of twelve months following the BLVR treatment. All deaths occurred in patients with at least one comorbid condition. Mortality was increased in the presence of comorbidities (14.3% vs 0%, respectively; p=0.099), and it was significantly increased in the presence of multiple comorbidities (18.5% vs 0%; p=0.059). The mortality rate was higher (37.5% vs 10.5%) in the LVRC comparing to the EBV treatment group in the presence of multiple comorbid conditions, albeit not reaching statistical significance (p=0.099). Conclusion The presence of more than one comorbidity in patients who underwent the LVRC treatment are associated with significant increase of mortality. For patients with severe emphysema who have more than one comorbidity, EBV is a better choice than LVRC.

Amplitud de distribución eritrocitaria en pacientes con enfermedad pulmonar obstructiva crónica y en sujetos sanos / Red blood cell distribution width in patients with chronic obstructive pulmonary disease and healthy subjects

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) incrementa el riesgo de enfermedad cardiovascular (ECV). La amplitud de distribución eritrocitaria (ADE) se considera un potente factor de predicción de la evolución de los pacientes con ECV. Objetivos. Analizar los valores de ADE de pacientes con EPOC y compararlos en relación al estado clínico, ecocardiográfico, nutricional y analítico de los pacientes. Por otra parte, nos propusimos analizar el efecto del consumo de tabaco sobre los valores de ADE de sujetos sanos. Métodos. En el estudio se incluyeron 175 pacientes con EPOC estabilizados y 210 sujetos sanos. Se registraron y se compararon las características demográficas, clínicas, nutricionales, ecocardiográficas y analíticas, y los valores de ADE. Resultados. Los valores de ADE fueron más altos en el grupo de pacientes con EPOC que en el grupo control (15 ± 2,3% vs. 13,8 ± 2,5%, p < 0,001). Los valores de ADE de los pacientes con EPOC mostraron una correlación positiva con las concentraciones de PCR (r = 0,27, p < 0,001), las concentraciones de albúmina (r = 0,23, p = 0,04) y la presencia de disfunción ventricular derecha (DVD) (r = 0,24, p = 0,001), hipertensión pulmonar (HAP) (r = 0,1, p = 0,02) y ECV (r = 0,24, p = 0,02). El análisis de regresión logística para variables múltiples sugirió una relación independiente de la presencia de ECV (4,3; IC 95%: 1,3-11; p = 0,01) y de DVD (3,1; IC 95%: 1,7-8,3; p = 0,02) con valores elevados de ADE en los pacientes con EPOC. En la población sana, el análisis solo mostró una correlación significativa entre la ADE y la duración del consumo de tabaco (r = 0,57, p < 0,001). Conclusión. En pacientes con EPOC, la ADE se asocia de manera independiente con la ECV y la DVD. En la población sana, la ADE también se asocia con el consumo de tabaco

Background. Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. Aims. To study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. Methods. One hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. Results. RDW values were higher in the COPD group than in controls (15 ± 2.3% vs. 13.8 ± 2.5%, p < 0.001). In COPD patients, RDW levels positively correlated with CRP levels (r = 0.27, P < .001), albumin levels (r = 0.23, P = .04), right ventricular dysfunction (RVD) (r = 0.24, P = .001), pulmonary hypertension (PAH) (r = 0.1, P = .02), and presence of CVD (r = 0.24, P = .02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3 to 11; P = .01), and presence of RVD (3.1; 95% CI: 1.7 to 8.3; P = .02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r = 0.57, P < .001). Conclusion. RDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status