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1.
Clin Transplant ; 37(10): e15056, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37354125

RESUMO

INTRODUCTION: The safety and efficacy of indwelling pleural catheters (IPCs) in lung allograft recipients is under-reported. METHODS: We performed a multicenter, retrospective analysis between 1/1/2010 and 6/1/2022 of consecutive IPCs placed in lung transplant recipients. Outcomes included incidence of infectious and non-infectious complications and rate of auto-pleurodesis. RESULTS: Seventy-one IPCs placed in 61 lung transplant patients at eight centers were included. The most common indication for IPC placement was recurrent post-operative effusion. IPCs were placed at a median of 59 days (IQR 40-203) post-transplant and remained for 43 days (IQR 25-88). There was a total of eight (11%) complications. Infection occurred in five patients (7%); four had empyema and one had a catheter tract infection. IPCs did not cause death or critical illness in our cohort. Auto-pleurodesis leading to the removal of the IPC occurred in 63 (89%) instances. None of the patients in this cohort required subsequent surgical decortication. CONCLUSIONS: The use of IPCs in lung transplant patients was associated with an infectious complication rate comparable to other populations previously studied. A high rate of auto-pleurodesis was observed. This work suggests that IPCs may be considered for the management of recurrent pleural effusions in lung allograft recipients.


Assuntos
Derrame Pleural Maligno , Humanos , Derrame Pleural Maligno/etiologia , Estudos Retrospectivos , Transplantados , Cateteres de Demora/efeitos adversos , Pulmão
2.
J Bronchology Interv Pulmonol ; 30(2): 114-121, 2023 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36192832

RESUMO

BACKGROUND: Recurrent pleural effusions are a major cause of morbidity and frequently lead to hospitalization. Indwelling pleural catheters (IPCs) are tunneled catheters that allow ambulatory intermittent drainage of pleural fluid without repeated thoracentesis. Despite the efficacy and safety of IPCs, data supporting postplacement follow-up is limited and variable. Our study aims to characterize the impact of a dedicated pleural clinic (PC) on patient outcomes as they relate to IPCs. METHODS: Patients who underwent IPC placement between 2015 and 2021 were included in this retrospective study. Differences in outcomes were analyzed between patients with an IPC placed and managed by Interventional Pulmonology (IP) through the PC and those placed by non-IP services (non-PC providers) before and after the PC implementation. RESULTS: In total, 371 patients received IPCs. Since the implementation of the PC, there was an increase in ambulatory IPC placement (31/133 pre-PC vs. 96/238 post-PC; P =0.001). There were fewer admissions before IPC placement (18/103 vs. 43/133; P =0.01), and fewer thoracenteses per patient (2.7±2.5 in PC cohort vs. 4±5.1 in non-PC cohort; P <0.01). The frequency of pleurodesis was higher in the PC cohort (40/103 vs. 41/268; P <0.001). A Fine and Gray competing risks model indicated higher likelihood of pleurodesis in the PC cohort (adjusted subhazard ratio 3.8, 95% CI: 2.5-5.87). CONCLUSION: Our experience suggests that the implementation of a dedicated PC can lead to improved patient outcomes including fewer procedures and admissions before IPC placement, and increased rates of pleurodesis with IPC removal.


Assuntos
Derrame Pleural Maligno , Humanos , Estudos Retrospectivos , Derrame Pleural Maligno/terapia , Derrame Pleural Maligno/etiologia , Cateterismo , Cateteres de Demora/efeitos adversos , Pleurodese/métodos , Drenagem/métodos
6.
J Thorac Dis ; 13(7): 4228-4235, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34422351

RESUMO

BACKGROUND: Accurate staging of newly diagnosed or recurrent malignancy is essential for effective treatment. An important first step in staging involves the use of PET/CT to identify areas of FDG avidity. PET/CT however has limitations, including false positive FDG uptake from benign causes. In this paper we characterize an uncommon yet clinically important cause of false positive PET/CTs, that of benign anthracotic lymphadenitis (BAL). We examine the clinical, radiographic and histologic characteristics of BAL in patients referred for endobronchial ultrasound (EBUS) guided biopsies and discuss its context in relation to existing literature. METHODS: We performed a retrospective observational case series of 20 patients who were referred for EBUS guided biopsies of PET positive mediastinal and hilar lymph nodes during the work-up or treatment of suspected malignancy. RESULTS: To be included, all patients received PET imaging as well as an EBUS guided biopsy of FDG avid lymph nodes which demonstrated anthracotic pigment as the only histologic abnormality. The key findings were that 90% of patients in this cohort were born outside of the US, 90% had bilateral FDG avid lymph nodes with an average standardized uptake value (SUV) of 7.9±2.2. Most patients, based on their history, had a likely exposure to biomass fuel or urban pollution. CONCLUSIONS: BAL may be an underrecognized cause for PET positive lymph nodes in patients undergoing work-up for malignancy. These findings support the importance of sampling mediastinal and hilar lymph nodes even when SUVs are highly suggestive of malignancy.

8.
Diagn Cytopathol ; 49(7): E258-E261, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33433963

RESUMO

Here we report the combined cytological and molecular diagnosis of a lung mass. The cytology and extensive immunohistochemistry on an endobronchial ultrasound-guided fine needle aspiration biopsy were inconclusive. By genomic profiling of the cell block material, we identified a MET exon 14 skipping mutation that indicated a lung origin and made the patient eligible for the tyrosine kinase inhibitor, crizotinib. This case is a prime example of complementing adequate aspiration and cell block processing techniques with molecular testing. Such an approach would augment the usability of fine needle aspiration biopsy, both as a diagnostic modality and as the first line to find therapeutic targets in the era of precision medicine.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Proteínas Proto-Oncogênicas c-met/genética , Idoso , Carcinoma Pulmonar de Células não Pequenas/genética , Citodiagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Neoplasias Pulmonares/genética , Mutação , Análise de Sequência de DNA
13.
Respiration ; 98(2): 165-170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048594

RESUMO

BACKGROUND: Despite an improved understanding of the pathophysiology of asthma, severe asthma sufferers continue to experience a poor quality of life (QOL). Bronchial thermoplasty (BT) utilizes thermal energy to reduce airway smooth muscle. In industry-sponsored trials, BT improves QOL and reduces severe exacerbations; however, the impact of BT on asthma-related QOL and medication use in non-industry-sponsored trials is less clear. OBJECTIVE: The aim of this study was to determine the impact of BT on asthma QOL measures (mini-AQLQ) and asthma controller medication use during the year following treatment with BT. METHODS: We performed a prospective study of the impact of BT in 25 patients with severe persistent asthma. Our primary outcome was change in asthma-related QOL score (mini-AQLQ) 1 year after BT treatment. Our secondary outcome was change in asthma medication use 1 year after BT. RESULTS: BT led to an improvement in mini-AQLQ score from a baseline of 3.6 ± 0.3 before therapy to 5.6 ± 0.3 1 year after the final BT procedure. Overall, 88% percent of patients showed a clinically significant improvement in mini-AQLQ at 1 year. Patients treated with BT showed a reduction in the use of montelukast and omalizumab 1 year after BT. CONCLUSION: In patients with severe persistent asthma and low asthma-related QOL scores, BT leads to an improvement in asthma-related QOL and a decrease in asthma medication use when measured 1 year after the final BT treatment.


Assuntos
Asma/cirurgia , Termoplastia Brônquica , Qualidade de Vida , Acetatos/uso terapêutico , Administração por Inalação , Administração Oral , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/fisiopatologia , Asma/psicologia , Antagonistas Colinérgicos/uso terapêutico , Ciclopropanos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Omalizumab/uso terapêutico , Estudos Prospectivos , Quinolinas/uso terapêutico , Índice de Gravidade de Doença , Sulfetos , Resultado do Tratamento , Capacidade Vital
14.
Thorac Cardiovasc Surg Rep ; 7(1): e43-e45, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30464882

RESUMO

Background Tracheal glomus tumors are rare mesenchymal neoplasms that have the potential to cause malignant, central airway obstruction. They require a thoughtful approach to safely secure the airway and definitively resect the tumor. Case Description We report the clinical course of a 25-year-old man in severe respiratory distress secondary to tracheal glomus tumor and the subsequent surgical management. Conclusion Due to their hypervascular nature, greater familiarity with tracheal glomus tumors is needed to ensure appropriate preoperative planning and intervention.

15.
Respir Med Case Rep ; 23: 18-20, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29167754

RESUMO

We report findings for a patient that underwent endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) for diagnostic purposes after an abnormal chest CT. The patient initially presented with cough and shortness of breath. Chest CT revealed a 6 cm soft tissue mass with mildly enlarged right hilar lymph nodes (LNs) and a small right sided pleural effusion. Based on these radiologic findings, the patient underwent an EBUS guided FNA of the mass. To our surprise, the mass was hypoechoic by EBUS and on aspiration, the syringe filled with yellow fluid. This finding in combination with a re-review of the CT scans with a special focus on the Hounsfield Units of the lesion confirmed the diagnosis of a mediastinal bronchogenic cyst. This case demonstrates the role of Hounsfield units in analyzing mediastinal masses and highlights the effectiveness of EBUS guided TBNA in diagnosis and treatment of bronchogenic cysts.

17.
Clin Chest Med ; 37(2): 181-9, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27229636

RESUMO

Antibiotics and fluids have been standard treatment for sepsis since World War II. Many molecular mediators of septic shock have since been identified. In models of sepsis, blocking these mediators improved organ injury and decreased mortality. Clinical trials, however, have failed. The absence of new therapies has been vexing to clinicians, clinical researchers, basic scientists, and the pharmaceutical industry. This article examines the evolution of sepsis therapy and theorizes about why so many well-reasoned therapies have not worked in human trials. We review new molecular targets for sepsis and examine trial designs that might lead to successful treatments for sepsis.


Assuntos
Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Antibacterianos/uso terapêutico , Humanos
18.
Clin Chest Med ; 37(2): xv-xvi, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27229652
19.
Sci Rep ; 6: 21642, 2016 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-26869337

RESUMO

FGF-10 can prevent or reduce lung specific inflammation due to traumatic or infectious lung injury. However, the exact mechanisms are poorly characterized. Additionally, the effect of FGF-10 on lung-resident mesenchymal stem cells (LR-MSCs) has not been studied. To better characterize the effect of FGF-10 on LR-MSCs, FGF-10 was intratracheally delivered into the lungs of rats. Three days after instillation, bronchoalveolar lavage was performed and plastic-adherent cells were cultured, characterized and then delivered therapeutically to rats after LPS intratracheal instillation. Immunophenotyping analysis of FGF-10 mobilized and cultured cells revealed expression of the MSC markers CD29, CD73, CD90, and CD105, and the absence of the hematopoietic lineage markers CD34 and CD45. Multipotency of these cells was demonstrated by their capacity to differentiate into osteocytes, adipocytes, and chondrocytes. Delivery of LR-MSCs into the lungs after LPS injury reduced the inflammatory response as evidenced by decreased wet-to-dry ratio, reduced neutrophil and leukocyte recruitment and decreased inflammatory cytokines compared to control rats. Lastly, direct delivery of FGF-10 in the lungs of rats led to an increase of LR-MSCs in the treated lungs, suggesting that the protective effect of FGF-10 might be mediated, in part, by the mobilization of LR-MSCs in lungs.


Assuntos
Lesão Pulmonar Aguda/imunologia , Fator 10 de Crescimento de Fibroblastos/imunologia , Células-Tronco Mesenquimais/imunologia , Pneumonia/imunologia , Lesão Pulmonar Aguda/induzido quimicamente , Animais , Diferenciação Celular/imunologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/imunologia , Imunofenotipagem , Lipopolissacarídeos , Masculino , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/efeitos dos fármacos , Pneumonia/induzido quimicamente , Ratos , Ratos Sprague-Dawley , Receptores de Fatores de Crescimento de Fibroblastos/imunologia
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