<b><i>Background:</i></b> Transbronchial cryobiopsy (TBCB) is increasingly being identified as a potential alternative for the diagnosis of interstitial lung disease (ILD). The specimen size of TBCB is positively related to the freezing time. However, the proper initial freezing time for the clinical application of TBCB in ILD remains unknown. <b><i>Methods:</i></b> A prospective randomized parallel group study was employed to investigate ILD patients with unclear diagnosis, who were admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2019 to October 2020 and required TBCB. All patients were randomly divided into 4 groups according to the different freezing times of TBCB: 3 s, 4 s, 5 s, and 6 s groups. All operations were performed under intravenous anesthesia with endotracheal intubation, 60–65 bar pressure of freezing gas source, and 1.9-mm cryoprobe. Compare differences among groups in specimen size, complications, pathological diagnosis efficiency, and multidisciplinary discussion (MDD) diagnostic efficiency. <b><i>Results:</i></b> A total of 100 patients were recruited and randomly assigned into 4 groups (<i>n</i> = 25 each group). The specimen sizes of TBCB in ILD were positively correlated with the freezing time (<i>r</i> = 0.639, <i>p</i> < 0.05). None of the patients experienced Grade 3 severe bleeding. Pneumothorax occurred in 1 patient in the 4 s, 5 s, and 6 s groups, respectively. The diagnostic yield of MDD in the 3 s, 4 s, 5 s, and 6 s groups were 64%, 88%, 88%, and 96%, respectively (<i>p</i> < 0.05), but showing no significant differences among 4 s, 5 s, and 6 s groups. <b><i>Conclusions:</i></b> The specimen size and diagnostic efficiency of TBCB in ILD increased with a longer freezing time. When the freezing gas pressure is 60–65 bar, we recommended 4 s as the initial freezing time of TBCB, and this time is associated with high diagnostic efficiency and low incidence of complications.
Background: Transbronchial cryobiopsy (TBCB) is an option to surgical biopsy for the diagnosis in interstitial lung diseases. Several impact factors have received wide attention, including the freezing time, cryoprobe size, and contact pressure. However, the effect of the applied gas pressure on the specimen size has not been well elucidated. The purpose of this study is to investigate the effect of the applied gas pressure on the TBCB specimen size. Methods: Cryoprobes with a diameter of 1.9 mm were used to perform TBCB on 4 beagle canines under general anesthesia. TBCB was performed with a total of 16 time-pressure combinations that were randomly combined with 4 freezing times (3, 4, 5, and 6 s) and 4 gas pressures (40, 50, 55, and 60 bar). For each combination, 8 biopsies were performed. The size and quality of specimens, as well as complications, were evaluated. Results: A total of 128 TBCB specimens were obtained. With the same freezing time, the specimen sizes obtained by different applied gas pressures were significantly different (P<0.05) and positively correlated with the gas pressures (r: 0.797-0.867). With the same gas pressure, the size of the TBCB specimens was positively correlated with the freezing time (r: 0.503-0.752). In the 40-bar group, no tissues were obtained when the freezing times were 3-5 s. In the 50-bar and 55-bar groups, qualified specimens were obtained when the freezing times were 5 and 6 s. In the 60-bar group, qualified specimens were obtained when the freezing times were 3-6 s. Conclusions:The TBCB specimen size was positively correlated with the applied gas pressure. The applied gas pressure contributed to the sample size and quality. To obtain qualified specimens with a 1.9-mm cryoprobe during TBCB, the lowest limit of the normal working gas pressure range should be increased to greater than 50 bar.
ObjectiveTo evaluate the value of intraoperative CT scanning in the treatment of fresh thoracolumbar burst fractures .MethodThe data of patients with thoracolumbar fractures from January 2008 to January 2015 were analyzed retrospectively,79 cases were treatment group which were treated with intraoperative CT scan and decompression mode was determined according to CT scan results during the period from October 2012 to January 2015; 82 patients as the observation group were treated without intraoperative CT scan and direct laminectomy were performed during the period from January 2008 to October 2012. In the treatment group, it is no further decompression of the spinal canal when the CT showed a reduction of the fracture block into the spinal canal, If the intraoperative CT showed that the fractures still occupied the spinal dura mater according to the three-dimensional CT information, The position and the size of the fracture of the spinal canal were determined, and the unilateral laminectomy was performed corresponding to the position of the lamina and intervertebral ligamentum flavum. The operative time, bleeding volume, neurological function, height of the anterior vertebral compression and Cobb angle were compared between the two groups.ResultIn the treatment group, CT scan showed 48 cases (60.8%) entered the spinal canal fracture completely or basically reset .31 cases (39.2%) still occupied the spinal canal compression spinal dura mater. There were significant differences in the operation time and bleeding volume between the two groups. The treatment group was less than the control group. There was no infection, secondary spinal cord injury, loose fixation and other complications. There was no difference in the ASIA classification before and after operation. The anterior vertebral height and COBB angle of the two groups were significantly improved compared with those before operation. There was no significant difference between the two groups in the postoperative height and COBB angle, but after 2 years the difference was statistically significant between the two groups, to retain the rear ligament complex treatment group was significantly better than the control group.ConclusionPatients of thoracolumbar vertebral fracture in hyperextension position combined with internal fixation can achieve good correction effect. Orthopedic postoperative CT scan and according to the results of the scan precision treatment can simplify the operation, there was no difference in clinical efficacy compared with total laminectomy, but some patients avoid the spinal canal decompression and part were treated by small fenestration laminectomy decompression, which is conducive to the protection of spinouts ligament complex integrity.
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