Endobronchial ultrasonography with a guide sheath (EBUS-GS) has recently been used for improved diagnostic yields for peripheral pulmonary lesions. This study retrospectively evaluated the factors related to the diagnostic yield of EBUS-GS for peripheral lung cancer. The medical records of 76 patients who had been diagnosed with lung cancer and had undergone bronchoscopy with EBUS-GS in our hospital between August 2014 and September 2015 were reviewed. The total diagnostic ratio of peripheral lung cancer was 71.1%. The following factors of the diagnostic yield were evaluated: location of pulmonary lesion; size; feature; bronchus sign; location of EBUS probe; EBUS detection; number of biopsies performed; procedure time; use of virtual bronchoscopic navigation; use of EBUS-guided transbronchial needle aspiration with EBUS-GS; CT slice thickness; operator's years of medical experience; and specialized training in bronchoscopy at the National Cancer Center. In all cases, lesion size ≧ 20 mm (80.8% vs. 50.0%, P = 0.006), EBUS probe location "within" (90.0% vs. 50.0%, P < 0.001), EBUS detection (80.7% vs. 28.6%, P < 0.001), number of biopsies ≧ 5 (78.0% vs. 47.1%, P = 0.013), and bronchoscopy training (81.6% vs. 60.5%, P = 0.043) significantly contributed to an increase in the diagnostic yield. Following a multivariate analysis, EBUS probe location "within" was found to be the most significant factor affecting the diagnostic yield (odds ratio 14.10, 95% CI 3.53-56.60, P < 0.001), and bronchoscopy training was the second most significant factor (odds ratio 6.93, 95% CI 1.86-25.80, P = 0.004). EBUS probe location "within" and bronchoscopy training are the most important factors for improved diagnostic yield by bronchoscopy with EBUS-GS for peripheral lung cancer.
: An 82-year-old man visited our hospital when he developed a fever of over 38°C after having consumed 5 types of health foods. He had previously been treated for chronic obstructive pulmonary disease, hypertension and hyperuricemia. Blood examination on admission revealed renal dysfunction, marked elevation of C-reactive protein, and an elevated level of serum creatine kinase. According to the laboratory data and his clinical history, rhabdomyolysis complicated by acute renal failure was suspected, but his condition improved and his fever was reduced with fluid infusion. As a drug lymphocyte stimulation test was positive for only saw palmetto in the 5 health foods, we diagnosed the case as rhabdomyolysis induced by saw palmetto. We believe that this is the first case of a health food being the cause of rhabdomyolysis.
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