Колоноскопия -«золотой стандарт» диагностики неоплазий толстой кишки. Одним из наиболее значимых критериев качества колоноскопии, согласно рекомендациям ESGE, считается показатель выявленных аденом (ADR), который должен составлять не менее 20%. Однако показатель широко варьируется, и при колоноскопии пропускается почти четверть аденом и полипов. На сегодняшний день существует широкий ряд дополнительных уточняющих методик эндоскопической диагностики, позволяющих повысить качество колоноскопии. Среди них технологии усовершенствования эндоскопических изображений (image enhanced endoscopy -IEE) и технологии увеличения поля зрения. К технологиям усовершенствования изображений относятся хромоскопия и виртуальная хромоскопия, включающая NBI, FICE, AFI, i-scan. Увеличить поле зрения позволяют специальные устройства, разглаживающие слизистую во время выведения колоноскопа (дистальный колпачок, Endocuff , Endocuff Vision, Endorings), а также эндоскопы с увеличенным углом обзора -видеоэндоскопическая система FUSE (full spectrum endoscopy). В обзоре литературы описаны указанные технологии и их влияние на показатель выявленных аденом.
An observation from practice is given – surgical treatment of mediastinal pulmonary hernia in a patient after pneumonectomy using the method of anterior mediastinal plastic surgery with a mesh implant with demonstration of long-term results.The patient I. 31 years old was ill with pulmonary tuberculosis for 3 years, treatment was carried out, against which the stenosis of the left main bronchus progressed. The patient underwent endoscopic operations: argonoplasmic destruction of the left main bronchus, balloon dilation of the left main bronchus, with a temporary effect. Due to recurrent stenosis of the left main bronchus, a pneumonectomy was performed on the left. After 7 months, she complained of severe shortness of breath at rest. Computed tomography revealed a displacement of the mediastinal organs to the left, an upper-anterior pulmonary mediastinal hernia of the right lung to the left midclavicular line at the level of the anterior I-IV intercostals on the left. The patient underwent plastic surgery of the anterior mediastinum on the right using a polymer mesh implant. As a result of treatment, after 3 years, radiologically stable restoration of the position of the only right lung in its hemithorax. The patient is functionally compensated, shortness of breath is not observed. The patient has completely returned to her usual lifestyle.
Aim: to study radiological semiotics of peripheral pulmonary lesions (PPLs) detected by CT of the chest, and establish radiological patterns, which significantly increase effectiveness of navigation bronchobiopsies. Materials and methods. A cohort retrospective study included 278 patients with PPLs with verified diagnoses established by invasive diagnostic procedures (navigation bronchoscopy with a complex of biopsies and/or diagnostic thoracic surgery). The study included 162 (58.3%) women aged 13 to 80 yrs. (average age – 46.21 ± 5.23) and 116 (41.7%) men aged 14 to 85 yrs. (average age – 46.05 ± 3.49). The patients were divided into 4 nosological groups: pulmonary TB patients – 158 (56.8%), neoplastic patients – 79 (28.4%), nontuberculous pulmonary mycobacteriosis (NTPM) patients – 21 (7.6%), and protracted course community-acquired pneumonia (CAP) patients (presentations of PPLs) – 20 (7.2%). Results. According to chest CT data, PPLs had three major radiological sings, defined as “infiltrate”, “rounded shadow”, and “focus”. Rounded shadows prevailed in NTPM patients and neoplastic patients. Statistically significant differences between the groups were as follows: the medium maximum size and contour of PPLs (focus / rounded shadow / infiltrate), the presence of bronchiectasis and the type of foci (lobular/sublobular/acinar) in the lung parenchyma surrounding PPLs, the presence of calcification, cavitation, or air bronchograms inside PPLs. The total effectiveness of bronchoscopic verification of PPLs in patients with “CT bronchus sign” was 79.4%, which significantly exceeded diagnosis verification in patients without it (17.9%) (р < 0.001). The effectiveness of diagnosis verification by bronchobiopsy in patients with PPLs less than 20 mm (CT data) achieved 50% irrespective of etiology. The most effective bronchoscopic verification of diagnoses was observed in TB and NTPM patients with PPLs ≥ 20 mm – 83.3% and 100.0% respectively, and in neoplastic patients with PPLs ≥ 30 mm it reached 93.0%. The lobar localization of the process did not affect the diagnostic effectiveness of bronchobiopsies. Conclusion. The highest effectiveness of bronchobiopsies was observed in patients with the CT bronchus sign and with PPLs ≥ 20 mm or ≥ 30 mm (CT data). The volume of diagnostic biopsies obtained by navigation bronchoscopy or surgical resection should be determined by radiological morphology of PPLs with estimation of malignancy or benign signs revealed by CT of the chest.
The objective: to analyze the effectiveness of etiological verification of pulmonary mycobacteriosis when using various biological materials at different diagnostic stages.Subjects and Methods. In Center for Diagnosis and Rehabilitation of Respiratory Diseases, CTRI, the results of stage-by-stage examinations of 142 patients (from 2018 to 2022) were analyzed. A retrospective, prospective, cohort, open study was conducted. Inclusion criteria: pulmonary mycobacteriosis etiologically verified by comprehensive microbiological examinations (molecular genetic and cultural tests) (with retrospective analysis after all stages of examination). Exclusion criteria: HIV infection. 115 women and 27 men were enrolled in the study, the age ranged from 21 to 86 years, the mean age was 57,9 years.All patients referred to CTRI for examination due to newly detected changes in the lungs (bronchiectasis, focal changes, and cavities). For etiological verification of the diagnosis, microbiological sputum testing was performed (Stage 1 of the examination); when negative results were obtained, bronchoscopy was prescribed and bronchobiopsies were used for microbiological and molecular genetic diagnostics – Stage 2. In case of negative results of Stage 2, the patient was recommended to undergo a diagnostic resection of the lung – Stage 3 of the examination. At all stages, specimens were sent for comprehensive microbiological testing: fluorescent microscopy to detect acid-fact mycobacteria, real-time polymerase chain reaction (PCR-RV) to detect NTBM DNA. Identification of NTBMB was carried out by molecular genetic methods (PCR for the presence of MTB DNA/NTBM (SYNTOL, Russia), and on DNA strips (GenoType Mycobacterium CM\AS Hain Livescience, Germany)). Specimens were cultured on a liquid medium in the ВАСТЕС MGIT960 (BD, USA).The diagnosis of mycobacteriosis was established in accordance with the diagnostic criteria proposed in the guidelines of the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) (2020): detection of NTBM in 2 sputum samples or in 1 sample of bronchobiopsy specimens or in 1 surgical specimens [15].The studied data were entered to the Microsoft Office Excel sheet (Microsoft, USA) for statistical processing; the level of statistical significance of differences was taken as 0.05.Results. It was found that slow-growing NTBM were identified as etiologically significant in 93.0%, of which 78.1% was M. avium, fast-growing NTBM were represented only by M. abscessus, 7% of observations. During X-ray examination, the bronchiectatic form – 52.1% (74/142) was detected more often compared to the abdominal – 30.9% (44/142) and focal forms – 16.9% (24/142) (p<0.001). When verifying mycobacteriosis in patients with a negative sputum test – Stage 2 of the examination – the effectiveness was 91.0% (80/88). Regardless of the radiological form of the disease and dissemination of the disease, bronchoscopy revealed pathology of the tracheobronchial tree in 85.2% of cases, mainly in the form of bronchitis with purulent secretions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.