Introduction: Transbronchial cryobiopsies (cTBB) has emerged as a new method for obtaining lung tissue biopsies in the diagnosis of interstitial lung diseases (ILDs). Until now, it has been used in a few highly specialized interventional centers and has shown promising results in obtaining a definite diagnosis of ILDs. Method: All patients undergoing a cTBB between November 2015 and June 2016 were included in this case series study. Data on patient demographics, high-resolution computed tomography patterns, size and number of biopsies, histology patterns, the contribution to a confident diagnosis and complications were registered. Results: Thirty-eight patients underwent cTBB in the period. cTBB contributed to the diagnosis in 28 (74%) of the 38 patients. Only few complications were observed; pneumothorax was the most frequent complication (10 patients, 26%). In six patients, local bleeding occurred during the procedure and was easily controlled by a Fogarty catheter balloon and in some cases tranexamic acid. Conclusion: Performing cTBB in the diagnostics of ILDs is a safe and feasible procedure. cTBB resulted in a confident diagnosis in 74% of cases.

Background: Transbronchial cryobiopsies has become increasingly used in the diagnostic workup in patients suspected of having interstitial lung disease. The procedure is associated with less complications, morbidity and mortality compared to surgical lung biopsies although with a diagnostic yield that is not as high, but close to that of surgical lung biopsies. The aim of the present study was to describe the complications and diagnostic yield and their prognostic factors. Methods: All patients undergoing transbronchial cryobiopsies at the

Mediastinitis is a rare but a serious complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). We present 3 cases of mediastinitis following these diagnostic procedures. In 2 of the patients oropharyngeal bacteria were found in the cultures from the mediastinal abscess. All 3 cases were treated successfully with thoracotomy and drainage of the abscess together with intravenous antibiotics. On the basis of these cases and an updated review of the literature we discuss the most likely etiology for mediastinitis in association with EBUS-TBNA and EUS-FNA procedures and propose how to reduce the risk for this serious complication. The possibility of mediastinitis should always be kept in mind when a patient complains of fever over a long period of time as well as chest pain and malaise after an EBUS-TBNA or EUS-FNA procedure.

Adverse effects can compromise oral voriconazole treatment of pulmonary aspergillosis. Inhaled low-dose voriconazole may be an alternative treatment. In this study, six patients inhaled 40 mg voriconazole b.i.d. for 2 days, and six patients ingested 400 and 200 mg orally b.i.d. on day one and two, respectively. Blood samples were collected after the first inhalation, and bronchial alveolar lavage fluids and blood samples were collected for measurements of voriconazole 12 hr after the last administration. The concentration of voriconazole in epithelial lining fluid (ELF) was calculated by the urea dilution method. Voriconazole concentrations were detectable in plasma 15 min. after inhalation and declined at 30 and 60 min. Twelve hours after the last dose, median (95% CI) plasma voriconazole concentration was 8 (4-26) ng/mL in the inhalation group and 1224 (535-2341) ng/mL in the oral group (p < 0.0001). In ELF, median concentration was 190 (55-318) ng/mL and 8827 (4369-35172) ng/mL, respectively (p < 0.0001). Median ELF/plasma concentration ratio was 21 (6-63) in the inhalation group and 8 (3-20) in the oral group (p = 0.2). In conclusion, voriconazole is rapidly absorbed into the systemic circulation after inhalation. There was a non-significant trend towards a higher ELF/plasma concentration ratio in the inhalation group compared to the oral group.

Clinical Therapeutics e94 Volume 39 Number 8S Results: 184 of the 1646 deaths that occurred in 2014 (11,2%) were associated with one or more drug. Drugs were the cause of death in 45% of cases and participated in it without being the single cause in 55%. The main lethal adverse reactions are hemorrhage (49%), infections (16%) in a immunosuppression setting, and respiratory diseases (13%). Antithrombotic drugs (39%), antineoplasic drugs (30%) and psycholeptic drugs were the drugs more involved in deaths. More than 30% of death were assessed as preventable or potentialy preventable. Antithrombotics and benzodiazepines are the most common medications found in avoidable deaths. 11 deaths are related to medication errors. Conclusions: Adverse drug reactions are an important cause of death in hospitalized patients. Particular attention should be paid to antithrombotic drugs because hemorrhages are the first cause of iatrogenic death. This study shows the importance of improving medication management, improving prescribing, therapeutic follow-up and therapeutic education of the patient in order to prevent drug deaths.