Background
Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes.
Methods
All bronchoscopic records from the period January 1st, 2015 - December 31st, 2017 (from the Department of Respiratory Diseases, University Hospital Brno, Czech Republic) were retrospectively analyzed. Of the 3542 bronchoscopic records, 796 patients underwent TBB and were further analyzed. Basic demographic data, TBB procedure-related factors, smoking history and radiological features were analyzed. Furthermore, in patients who developed PTX, PTX onset, PTX symptoms, distribution of the abnormal radiological findings and duration of hospitalization were also analyzed.
Results
Patients who developed PTX had significantly lower body mass index (BMI) and more than 4 samples taken during procedure (all
p
< 0.05). TBB performed from the left upper pulmonary lobe was associated with a significant risk of PTX development (OR 2.27; 95% CI 1.18–4.35;
p
= 0.02). On the contrary, TBB performed from the right lower lobe was associated with a significant reduction of risk of developing PTX (OR 0.47; 95% CI 0.22–0.98;
p
= 0.04). Logistic regression analysis showed BMI (OR 1.08; 95% CI 1.02–1.16;
p
= 0.01), left upper lobe as sampling site (OR 2.15; 95% CI 1.13–4.11;
p
= 0.02) and more than 4 samples taken (OR 1.91; 95% CI 1.04–3.49;
p
= 0.04) to be significantly associated with PTX development.
Conclusions
We conclude that TBB from the left upper pulmonary lobe is associated with significantly increased risk of post-procedural PTX. The right lower pulmonary lobe seems to be the safest sampling site to perform TBB. In patients with diffuse-type pulmonary disease, TBB should be performed preferably from the right lower lobe in order to decrease the risk of post-procedural PTX.
A new approach for sweat analysis used in cystic fibrosis (CF) diagnosis is proposed. It consists of a noninvasive skin-wipe sampling followed by analysis of target ions using capillary electrophoresis with contactless conductometric detection (C4D). The skin-wipe sampling consists of wiping a defined skin area with precleaned cotton swab moistened with 100 μL deionized water. The skin-wipe sample is then extracted for 3 min into 400 μL deionized water, and the extract is analyzed directly. The developed sampling method is cheap, simple, fast, and painless, and can replace the conventional pilocarpine-induced sweat chloride test commonly applied in CF diagnosis. The aqueous extract of the skin-wipe sample content is analyzed simultaneously by capillary electrophoresis with contactless conductometric detection using a double opposite end injection. A 20 mmol/L L-histidine/2-(N-morpholino)ethanesulfonic acid and 2 mmol/L 18-crown-6 at pH 6 electrolyte can separate all the major ions in less than 7 min. Skin-wipe sample extracts from 30 study participants-ten adult patients with CF (25-50 years old), ten pediatric patients with CF (1-15 years old), and ten healthy control individuals (1-18 years old)-were obtained and analyzed. From the analyzed ions in all samples, a significant difference between chloride and potassium concentrations was found in the CF patients and healthy controls. We propose the use of the Cl/K ratio rather than the absolute Cl concentration and a cutoff value of 4 in skin-wipe sample extracts as an alternative to the conventional sweat chloride analysis. The proposed Cl/K ion ratio proved to be a more reliable indicator, is independent of the patient's age, and allows better differentiation between non-CF individuals and CF patients having intermediate values on the Cl sweat test. Figure New approach for cystic fibrosis diagnosis based on skin-wipe sampling of forearm and analysis of ionic content (Cl/K ratio) in skin-wipe extracts by capillary electrophoresis with contactless conductometric detection.
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