Background:
The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting.
Objectives:
To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients.
Methods:
During a study period of 4 years, the outcome of 44 patients who underwent intervention according to the proposal of the emphysema MDT (group A) was compared with the outcome of 44 propensity score matched patients (group B) treated without the emphysema MDT proposal.
Results:
More LVRS and less EBV insertions were performed in group A (
P
=
.009). In group B, the interventions were performed sooner than in group A (
P
=
.003). Postoperative overall morbidity and length of in-hospital stay were similar in the 2 groups (
P
=
.918 and .758, respectively). Improvement of breathing ability was reported in more patients from group A (
P
=
.012). In group B, the total number of re-interventions was higher (
P
=
.001) and the time to re-intervention had the tendency to be less (
P
=
.069). Survival was similar between the 2 groups (
P
=
.884). Intervention without discussion at the MDT and EBV as initial intervention was an independent predictor of re-intervention.
Conclusions:
Interventional treatment for patients with chronic obstructive pulmonary disease (COPD) after discussion at a dedicated MDT involved more LVRS performed, required fewer interventions for their disease, and had longer re-intervention-free intervals and better breathing improvement.
The aim of the present study was to test transrectal real-time B-mode ultrasonography for pregnancy diagnosis in ewes from the Ile de France breed on day 16, 23 and 30 after fixed-time artificial insemination. The experiment was carried out with 22 multiparous pure-bred Ile de France ewes aged 2-5 years. Diagnosis of pregnancy was based on the presence of enlarged uterine lumen with amniotic fluid and visualisation of embryo. The accuracy (Ac %), sensitivity (Se %) and specificity (Sp %) of the technique were determined. The gestational phase influenced significantly (P<0.01) the accuracy of the transrectal ultrasonography approach for pregnancy diagnosis. At day 16 the accuracy was 50.0%, whereas at day 23 and at day 30 it reached 72.73% and 90.91% respectively.
Background: The type of initial intervention i.e., endobronchial valve (EBV) implantation or lung volume reduction surgery (LVRS) to be offered as initial intervention remains vague in the treatment of emphysemachronic obstructive pulmonary disease (COPD) patients. Aim of the present study was to compare the outcomes of EBV with that of LVRS in emphysema patients who could have both offered as an initial intervention.Methods: The outcomes of 44 EBV patients were retrospectively compared to the outcomes of 44 matched LVRS patients (matched for age, gender, performance status, body mass index (BMI), lung functions, comorbidities and exercise tolerance, matching tolerance 0.2) treated in a single institute within a 5-year period. The median follow-up was 32 months (maximum duration 84 months).Results: Mean age was 61.91±9.48 years and 55 (62.5%) were male. Postoperative morbidity was similar but length of stay (LOS) was longer in the LVRS group (median 10 vs. 6 days, P=0.006). Re-interventions were more frequent in the EBV versus LVRS group (52.3% vs. 20.5%, P=0.002) and so was the overall number of re-interventions (median 2 vs. 1, P<0.01). Breathing improved in more LVRS patients (86.4% vs. 70.5%, P<0.002). The decrease of the COPD Assessment Test (CAT) score was less significant in the EBV group (P=0.034). Survival was similar between 2 groups (P=0.350).Conclusions: EBV or LVRS as initial intervention are similar in terms of morbidity and mortality. EBV showed shorter LOS whilst LVRS necessitated less but more severe re-interventions and led to better overall quality of life.
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