Pneumothorax after transbronchial needle biopsy.

Currently there several diagnostic techniques that re used by radiologists and pulmonary physicians for lung cancer diagnostics. In several cases pneumothorax (PNTX) is induced and immediate action is needed. Both radiologists and pulmonary physicians can insert a chest tube for symptom relief. However; only pulmonary physicians and thoracic surgeons can provide a permanent solution for the patient. The final solution would be for a patient to undergo surgery for a final solution. In our current work we will provide all those diagnostic cases where PNTX is induced and treatment from the point of view of expert radiologists and pulmonary physicians.

Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance.

Transthoracic needle biopsy (TTNB) is done with imaging guidance and most frequently by a radiologist, for the aim is to diagnose a defined mass. It is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. FNAC is a method of aspiration cytopathology, which with transthoracic biopsy ("core biopsy") is a group of percutaneous minimally invasive diagnostic procedures for exploration of lung lesions. Needle choice depends mostly upon lesion characteristics and location. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy. Both computed tomography and ultrasound may be used as imaging guidance for TTNB, with CT being more commonly utilized. Common complications of TTNB include pneumothorax and hemoptysis. The incidence of pneumothorax in patients undergoing TTNB has been reported to be from 9-54%, according to reports published in the past ten years, with an average of around 20%. Which factors statistically correlate with the frequency of pneumothorax remain controversial, but most reports have suggested that lesion size, depth and the presence of emphysema are the main factors influencing the incidence of pneumothorax after CT-guided needle biopsy. On the contrary, gender, age, and the number of pleural passes have not been shown to correlate with the incidence of pneumothorax. The problem most responsible for complicating outpatient management, after needle biopsy was performed, is not the presence of the pneumothorax per se, but an increase in the size of the pneumothorax that requires chest tube placement and patient hospitalization. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.

Influenza A (H1N1)--past season's wonder flu in Vojvodina.

BACKGROUND/AIM: Influenza A (H1N1) re-emerged in the human population during 2009. The aim of this study was to describe characteristics, laboratory findings, clinical presentation and treatment outcome among patients with influenza A (H1N1) infection. METHODS: The study was performed at the Institute for Pulmonary Diseases of Vojvodina including all the patients hospitalized at the Intensive Care Unit or High Dependency Unit with confirmed, probable or suspected Influenza A (H1N1) infection between November 6th, 2009 and April 13th, 2010. RESULTS: Among 64 patients Influenza A (H1N1) infection was confirmed by rt-PCR in 50, defined as probable in 7 and as suspected in 6 patients. There was an equal number of male and female patients. Their mean age was 46 years (SD +/- 12.1). None of the patients were vaccinated against influenza. Comorbidities were present in 37 (58%) patients. There were 29 (45%) obese patients. Three patients were pregnant. The median time from symptom onset to hospital admission was 5 days (IQR 4-7). At admission, the median Modified Early Warning Score (MEWS) was 4 (IQR 3-6). The most common presenting symptoms were cough (100%) and fever (89%). The mean oxygen saturation at admission was 85.3% (SD 9.0). Auscultatory finding of wheesing in the absence of a chronic lung disease was found in 10 (15.6%) patients. Leukopenia was noted in 23 (35.9%) patients, and thrombocytopenia in 14 (21.9%) patients. Aspartate aminotransferase values were elevated in 41 (64.1%) patients, alanine aminotransferase in 32 (50%) patients, and creatine kinase in 36 (56.2%) patients. Opacities on an initial chest radiograph were predominantly patchy and the median number of the lung fields involved was 1 (IQR = 0-3). The non-survivors had statistically significantly higher MEWS at admission (p = 0.0001), lower oxygen saturation (p = 0.001), more lung fields involved on an initial chest radiograph (p = 0.006), wheezing in the absence of chronic lung disease (p = 0.02) and elevated aspartat aminotransferase (p = 0.02) and creatine kinase (p = 0.03). Acute respiratory disstress developed in 21 (32.9%) patients, and mechanical ventilation was required in 23 (36.1%) patients. Septic shock developed in 12 (18.7%) patients, and 19 (29.7%) patients had a multi-organ dysfunction. The overall hospital mortality was high--20.3% (95% CI, 11.3%-32.2%; n = 13), and especially so among the patients who required mechanical ventilation--56.5% (95% CI, 36.8%-74.40%). CONCLUSION: Timely initiation of antiviral therapy and early recognition of critically ill are important factors for reducing mortality.