Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia.

BACKGROUND: American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. METHODS: A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. RESULTS: Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered. CONCLUSIONS: TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules.

Definite ocular sarcoidosis using endobronchial ultrasonography with transbronchial needle aspiration.

Purpose. To introduce a minimally invasive procedure, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), to obtain a pathologic evidence of a definite ocular sarcoidosis in a patient who initially presented with presumed ocular sarcoidosis with pulmonary involvement. Methods. An EBUS-TBNA procedure was performed at perihilar lymph nodes, subcarina, and right paratrachea of the patient and specimen obtained was sent for histocytopathological studies. Result. Histocytopathological findings revealed aggregates of epithelioid histiocytes forming a noncaseous granuloma, a hallmark of sarcoidosis. Conclusion. EBUS-TBNA should be considered an alternative procedure to provide cytohistopathology proven diagnosis of definite ocular sarcoidosis.

Effectiveness of activated hydrogen ions in neutralizing paraquat intoxication in rats.

OBJECTIVE: Investigate the effectiveness of H4O in preventing the paraquat's effect in rats. MATERIAL AND METHOD: Disease-free male spraque Dawley rats were used in the experiment. They were divided into two groups of 5, as the control group and the experiment group. All rats were poisoned with paraquat. The control group was fed water (H2O) while the experiment group was fed activated hydrogen ions (H4O). RESULTS: The mortality of rats was equal (40%) in both groups. The control group died earlier than the experimental group (48 hours, 96 hours). In the rats that could survive till 1 month, the pathology of the lungs in the experimental group revealed less severity than the control group. CONCLUSION: This may reflect the protective effects of activated hydrogen ions in the lungs, which are abundant in oxygen, and may offer fruitful results in humans.

Influenza viral infection in 2005-2006 in Samitivej Hospital.

OBJECTIVE: Set an alarm system for early detection of respiratory viral infection. MATERIAL AND METHOD: The authors prospectively investigated avian flu and SARS between March 2005 and April 2006. Specimens from a nasopharyngeal swab or bronchial washing were analyzed for influenza A, B, parainfluenza, adenovirus, respiratory syncytial virus and avian flu and SARS by using technique of PCR and immunofluorescence by the Department of Medical Sciences. RESULTS: Eighty-nine patients who were enrolled in the present study. Peak of the incidence was 43% on April 2005 and there was no incidence of the influenza from December 2005 till April 2006. This may be due to the mass campaign of influenza vaccination or seasonal variation. CONCLUSION: Vaccination remains the primary strategy for the prevention of influenza, and the broadened recommendations should lead to protection of a larger portion of the population.

Management of endobronchial cancer using bronchoscopic electrocautery.

From December 2004 until November 2005, 15 cases of endobronchial cancer presenting with 22 episodes of mechanical obstruction of the airway, difficulty in breathing, hemoptysis, severe coughing, obstructive pneumonia and identified recurrent atelectasis of the lungs. The cancer was removed rapidly, effectively and without complication by a technique of fiberoptic bronchoscopic electrocautery.