Background: The poor treatment outcomes of multidrug-resistant tuberculosis (TB) and the emergence of extensively drug-resistant TB and extremely and totally drug-resistant TB highlight the urgent need for new antituberculous drugs and other adjuvant treatment approaches. Objectives: We have treated cavitary tuberculosis by the application of endobronchial one-way valves (Zephyr®; Pulmonx Inc., Redwood City, Calif., USA) to induce lobar volume reduction as an adjunct to drug treatment. This report describes the feasibility, effectiveness and safety of the procedure. Methods: Patients with severe lung destruction, one or more cavities or those who were ineligible for surgical resection and showed an unsatisfactory response to standard drug treatments were enrolled. During bronchoscopy, endobronchial valves were implanted in the lobar or segmental bronchi in order to induce atelectasis and reduce the cavity size. Results: Four TB patients and 1 patient with atypical mycobacteriosis were treated. The mean patient age was 52.6 years. Complete cavity collapses were observed on CT scans in 4 of the 5 cases. All patients showed improvements in their clinical status, and sputum smears became negative within 3-5 months. There were no severe short- or long-term complications. The valves were removed in 3 of the 5 patients after 8 months on average; there was no relapse after 15 months of follow-up. Conclusion: These data suggest that endobronchial valves are likely to be useful adjuncts to the treatment of therapeutically difficult patients. More data are required to confirm our findings.
From July 1995 to February 2003, we performed 827 transbronchial needle aspiration (TBNA) on 732 patients (553 males, 179 females) between the ages of 26 and 86 (mean age 63), with mediastinal-hilar masses or lymphadenopathy. A positive diagnostic result was achieved in 315 procedures (38%), an uncertain result in 31 (4%), whereas in 481 (58%) the aspirates were negative or nondiagnostic. Out of the 1741 nodal sites tested, a positive diagnosis was reached in 510 cases (29%), a negative diagnosis in 688 (39.5%) cases, and an uncertain one in 43 (2.5%). In 500 cases (29%), the aspirates were nondiagnostic. To improve the diagnostic yield of TBNA, the following laboratory techniques were used: (1) membrane filtration; (2) cell block; (3) monolayer technique. Membrane filtration, in particular, allows very scanty samples to be correctly interpreted. In accordance with data of other authors, we can confirm that TBNA is a very useful technique for the diagnosis of hilar-mediastinal diseases and the staging of lung cancer, owing to its low invasiveness, safety, and high diagnostic yield. However, not only the operator's skill, but accurate handling of the sample is mandatory for good results.
Endobronchial ultrasound (EBUS) has revolutionized the field of bronchoscopy because it allows to observe peribronchial structures and distal peripheral lung lesions. The use of EBUS was first described by Hurte and Hanrath in 1992. EBUS technology exists in two forms: radial and convex transducer probes. The radial EBUS probe has a 20-MHZ (12-30 MHz available) rotating transducer that can be inserted together with or without a guide sheath through the working channel (2.0-2.8 mm) of a standard flexible bronchoscope. The transducer rotates and produces a 360-degree circular image around the central position of the probe. There are two types of radial EBUS probes: "peripheral" probes, used to identify parenchymal lung lesions, and "central" probes, with balloon sheaths, used for the assessment of airway walls and peribronchial lymph nodes.
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