Science.gov

Sample records for bronchi endobronchial irradiation

  1. High dose rate intraluminal irradiation in recurrent endobronchial carcinoma

    SciTech Connect

    Seagren, S.L.; Harrell, J.H.; Horn, R.A.

    1985-12-01

    Palliative therapy for previously irradiated patients with symptomatic recurrent endobronchial malignancy is a difficult problem. We have had the opportunity to treat 20 such patients with high dose rate (50-100 rad/min) endobronchial brachytherapy. Eligible patients had received previous high dose thoracic irradiation (TDF greater than or equal to 90), a performance status of greater than or equal to 50, and symptoms caused by a bronchoscopically defined and implantable lesion. The radiation is produced by a small cobalt-60 source (0.7 Ci) remotely afterloaded by cable control. The source is fed into a 4 mm diameter catheter which is placed with bronchoscopic guidance; it may oscillate if necessary to cover the lesion. A dose of 1,000 rad at 1 cm from the source is delivered. We have performed 22 procedures in 20 patients, four following YAG laser debulking. Most had cough, some with hemoptysis. Eight had dyspnea secondary to obstruction and three had obstructive pneumonitis. In 12, symptoms recurred with a mean time to recurrence of 4.3 months (range 1-9 months). Eighteen patients were followed-up and reexamined via bronchoscope 1-2.5 months following the procedure; two were lost to follow-up. All had at least 50 percent clearance of tumor, and six had complete clearance; most regressions were documented on film or videotape. In six, the palliation was durable. The procedure has been well tolerated with no toxicity. We conclude that palliative endobronchial high dose rate brachytherapy is a useful palliative modality in patients with recurrent endobronchial symptomatic carcinoma.

  2. Endobronchial metastases of colorectal cancer.

    PubMed

    Rosado Dawid, Natalia-Zuberoa; Villegas Fernández, Francisco Ramón; Rodríguez Cruz, María Del Mar; Ramos Meca, Asunción

    2016-04-01

    Colorectal metastases affecting trachea or bronchi are highly unusual. Up to 26% of endotracheal/endobronchial metastases are due to colorectal cancer. Treatment and palliative management rely on a multidisciplinary team to improve their quality of life. PMID:26856850

  3. Dose and Volume of the Irradiated Main Bronchi and Related Side Effects in the Treatment of Central Lung Tumors With Stereotactic Radiotherapy.

    PubMed

    Duijm, Marloes; Schillemans, W; Aerts, Joachim G; Heijmen, B; Nuyttens, Joost J

    2016-04-01

    High radiation dose to the main bronchi can result in stenosis, occlusion or fistula formation, and death. Only 8 articles have reported side effects to the main bronchi from stereotactic body radiation therapy (SBRT), mostly with only one symptomatic complication per article. Therefore, we calculated the dose to the bronchial structures, such as trachea; mainstem bronchi; intermediate bronchus; upper-, middle-, and lower-lobe bronchus; and the segmental bronchi in 134 patients with central tumors and calculated the normal tissue complication probability (NTCP) for each of these structures, with toxicity determination based upon computed tomography imaging. No side effects were found in the trachea, and only stenosis occurred in the main bronchus and bronchus intermedius. Higher grades of side effects, such as occlusion and atelectasis, were only seen in the upper-, middle-, and lower bronchi and the segmental bronchi. When 0.5cc of a segmental bronchi was irradiated to 50Gy in 5 fractions, it was about 50% likely to be occluded radiographically. For grade 1 radiographically evident side effects, the 50% risk level for a 5-fraction Dmax was 55Gy for mid-bronchi and 65Gy for mainstem bronchi. To assure the relationship between clinical toxicity and side effects to the bronchi, further investigation is needed. PMID:27000511

  4. [Benign endobronchial tumors].

    PubMed

    Nikhtianov, Kh

    1980-01-01

    Endobronchial localizations of benign neoplasms are met with in 24.5 per cent of the cases. Right lung localizations are more frequent. More than half of them are broadly based (57.5 per cent). In most of the cases it is a matter of nonepithelial tumours of which a greater intensity is displayed by hamartomas /7/, vascular /4/ and neurogenic /3/ neoformations. The size of endobronchial tumours varies from 1 to 10 cm. Cases measuring 1-3 cm are the most numerous. Those of the "iceberg" type appear to be larger. The size per se has a relative importance for the clinical picture. Endobronchial tumours exhibit a clear cut clinical picture, and run a clinical course in three stages, determined by the degree of bronchial obturation and longstanding of the condition. The most common symptoms are coughing /80.7 per cent/, expectoration /50.0 per cent/, rales /57.6 per cent/, dullness /38.4 per cent/ and lacking respiration /38.4 per cent/. The nosological entity by itself is less conclusive for the clinical course. The X-ray data have orientation and by no means decisive significance for the diagnosis. The "crab pincers" sign in the bronchial lumen during bronchography has a definite importance. Bronchoscopy in conjunction with biopsy is a dependable method of preoperative diagnosing. It contributes greatly to the nosological diagnosis. Even nowadays, the diagnosis of endobronchial tumours is difficult. A rather exact diagnosis can be made intraoperatively, whereas the most accurate diagnosis is established only after histological study. The treatment of endobronchial benign neoplasms is operative. The number of medium /lobectomies/ and extensive /pulmonectomies/ pulmonary resections is considerable. In case of early diagnosis and intervention, sparing resection is the naturally indicated size of operation - mainly resection and plasty of the bronchi without lobectomy. The advantages of circular resection are substantial. Reconstructive operations of "clarinet" and

  5. Endobronchial sonography: feasibility and preliminary results.

    PubMed Central

    Hürter, T; Hanrath, P

    1992-01-01

    Endobronchial sonography, a new ultrasound technique, has been evaluated for the assessment of normal lungs and bronchial carcinomas. The procedure was performed with ultrasound catheters, which were introduced into central and peripheral bronchi through the operating channel of fibreoptic bronchoscopes. The bronchial wall is highly echogenic and laminated. The lung parenchyma appears echo rich and patchy. Pulmonary arteries can be identified by the pulsatile changes and floating echoes within the echo free lumen. Echo poor bronchial carcinomas were detected in 69 out of 74 patients with endoscopically visible tumours and in 19 out of 26 patients with peripheral carcinomas. The correct implantation of metallic stents was facilitated by endobronchial sonography in nine patients. The sonographic examination carried no particular risk and caused little discomfort. Images PMID:1412103

  6. Endobronchial Tuberculosis Mimicking Asthma

    PubMed Central

    Argun Baris, Serap; Onyilmaz, Tuğba; Basyigit, Ilknur; Boyaci, Hasim

    2015-01-01

    Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree with microbial and histopathological evidence. The clinical symptoms of the diseases are nonspecific. Chronic cough is the major symptom of the disease. The diagnosis is often delayed due to its nonspecific presentation and misdiagnosed as bronchial asthma. This case is presented to recall the notion that the endobronchial tuberculosis can mimic asthma and the importance of bronchoscopic evaluation in a patient with chronic cough and treatment resistant asthma. PMID:26798513

  7. Endobronchial lipoma: two cases and review of the literature.

    PubMed Central

    Cockcroft, D. W.; Copland, G. M.; Donevan, R. E.; Gourlay, R. H.

    1976-01-01

    Endobronchial lipoma is a benign tumour of the large bronchi occurring in middle-aged men. To the 38 successfully treated cases in the English literature a further 2 are added. The symptoms are those of obstructive pneumonitis mimicking bronchogenic carcinoma, and the result of delayed therapy may be bronchiectasis. Treatment includes local resection through a bronchoscope or a bronchotomy incision, or removal, if necessary, of the obstructed lobe or lung at thoracotomy. Smoking may be important in the pathogenesis of this tumour. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 6 PMID:953901

  8. Quick Dissection of the Segmental Bronchi

    ERIC Educational Resources Information Center

    Nakajima, Yuji

    2010-01-01

    Knowledge of the three-dimensional anatomy of the bronchopulmonary segments is essential for respiratory medicine. This report describes a quick guide for dissecting the segmental bronchi in formaldehyde-fixed human material. All segmental bronchi are easy to dissect, and thus, this exercise will help medical students to better understand the…

  9. Longstanding Endobronchial Foreign Body

    PubMed Central

    Trisolini, R.; Dore, R.; Bertolini, R.; Pasturenzi, L.; Catania, A. Fede; Gualtieri, G.; Torre, M.

    1999-01-01

    There are many circumstances in which the diagnosis of endobronchial inhalation of a foreign body (FB) can be missed. Generally, in such cases, within weeks or at most months from the event, clinical bronchopulmonary symptoms develop which allow a correct diagnosis to be made and significant complications to be avoided. We report the case of a patient in whom an endobronchial FB remained undiagnosed, because of lack of symptoms, for almost three years, and then caused signifiicant complications before being identified and removed. Problems related to diagnosis and therapy are discussed. PMID:18493510

  10. Black Endobronchial Ultrasound.

    PubMed

    Dhillon, Samjot S; Harris, Kassem; Ylagan, Lourdes

    2015-10-01

    The infrequent bronchoscopic finding of black airway pigmentation due to a variety of causes has been labeled as "Black Bronchoscopy." Black bronchioalveolar lavage has been sometimes described in tobacco, marijuana, and crack cocaine smokers. To add to this interesting panorama of bronchoscopic findings, we describe cases of black endobronchial ultrasound-guided transbronchial needle aspirates due to metastatic melanoma and anthracotic lymph nodes. PMID:26348692

  11. Endobronchial ultrasound elastography

    PubMed Central

    Dietrich, Christoph F.; Jenssen, Christian; Herth, Felix J. F.

    2016-01-01

    Elastographic techniques have recently become available as advanced diagnostic tools for tissue characterization. Strain elastography is a real-time technique used with transcutaneous ultrasound (US) and endoscopic US. Convincing evidence is available demonstrating a significant value of strain elastography for the discrimination of benign and malignant lymph nodes (LNs). This paper reviews preliminary data demonstrating the feasibility of performing real-time elastography during endobronchial US (EBUS) and a potential application of this technique for selection of LNs for EBUS-guided transbronchial needle aspiration in patients with lung cancer and extrathoracic malignancies. PMID:27503154

  12. Endobronchial occlusive disease: Nd:YAG or PDT?

    NASA Astrophysics Data System (ADS)

    Regal, Anne-Marie; Takita, Hiroshi

    1991-06-01

    Patients with endobronchial occlusion commonly experience dyspnea, cough, hemoptysis, pneumonitis, and atelectasis. If luminal patency is not re-established, obstructive symptoms may progress to sepsis and death. Although the overall survival of patients with lung cancer may not be altered by relief of airway obstruction, the prognosis for this subset of patients may be improved by eliminating the septic complications of bronchial occlusion. Techniques to treat occluded bronchi include electro-fulguration, cryotherapy, brachytherapy, laser (CO2, Nd-YAG) therapy, and photodynamic therapy (PDT). These represent local forms of treatment and are intended to be palliative. Nd-YAG and PDT are the modalities more frequently utilized in this setting. Comparison of the two treatment forms may furnish insight regarding the appropriate role for each as individual therapies and as part of the armamentarium of cancer therapies.

  13. Endobronchial radiation therapy (EBRT) in the management of lung cancer

    SciTech Connect

    Roach, M. III; Leidholdt, E.M. Jr.; Tatera, B.S.; Joseph, J. )

    1990-06-01

    Between October 1987 and November 1988, 19 endobronchial Iridium-192 line source placements were attempted in 17 patients with advanced incurable lung cancer. Approximately 30 Gy was delivered to the endobronchus using a low dose rate (LDR) afterloading technique delivering a mean dose of 70 cGy/hr at 5 mm. Improvement in subjective symptoms was noted in 67% of evaluable patients whereas objective responses defined by chest X ray and bronchoscopy were noted in 26% and 60%, respectively. No significant morbidity was observed. The radiation exposure to health care workers was low ranging from 10 to 40 mRem per treatment course with most of the staff receiving less than 10 mRem per treatment course (minimal detectable level 10 mRem). The results of this series are compared with selected series using low dose rate as well as intermediate dose rate (IDR) and high dose rate (HDR) endobronchial radiation therapy (EBRT). Based on bronchoscopic responses from the selected series reviewed, both HDR low total dose per treatment (range 7.5-10 Gy) and LDR high total dose per treatment (range 30-50 Gy) are effective in palliating the vast majority of patients with endobronchial lesions. Intermediate dose rate is also effective using fractions similar to high dose rate but total dose similar to low dose rate. The efficacy of endobronchial radiation therapy in the palliative setting suggest a possible role for endobronchial radiation therapy combined with external beam irradiation with or without chemotherapy in the initial management of localized lung cancer. Defining the optimal total dose, dose rate, and the exact role of endobronchial radiation therapy in the management of lung cancer will require large cooperative trials with standardization of techniques and definitions.

  14. Endobronchial Ultrasound Bronchoscope Damage.

    PubMed

    Patil, Monali; Harris, Kassem; Krishnan, Amita; Alraiyes, Abdul H; Dhillon, Samjot S

    2016-07-01

    Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is an effective, safe, and cost-effective diagnostic bronchoscopy technique for the work-up of mediastinal lymphadenopathy. Concern has been raised, however, about the high cost of convex-probe EBUS bronchoscope repairs. The damage is usually due to breakage of the insertion tube (the flexible part that is advanced into the airways), moisture invasion and damages to the working channel, image guide bundle, or umbilical cord. Understanding the root cause of EBUS scope damage is important for its prevention. We describe 2 unusual cases of EBUS scope damage. In the first case, the distal black rubber covering of the EBUS scope insertion tube was damaged due to friction with the edge of an endotracheal tube and in the second case, the EBUS scope insertion tube was angulating laterally instead of vertically during the flexion maneuver, probably due to scope manipulation while wedged tightly in a segmental bronchus. PMID:27077640

  15. Pathology of the Trachea and Central Bronchi.

    PubMed

    Shroff, Girish S; Ocazionez, Daniel; Vargas, Daniel; Carter, Brett W; Wu, Carol C; Nachiappan, Arun C; Gupta, Pushpender; Restrepo, Carlos S

    2016-06-01

    A wide variety of disorders can affect the trachea and central bronchi. Computed tomography is the imaging modality of choice in the evaluation of tracheobronchial disease. Tracheobronchial abnormalities are sometimes incidentally detected on routine imaging or when imaging is performed for another reason. Abnormalities of the tracheobronchial tree, however, can be easily missed because they can be subtle. Furthermore, because symptoms in patients with tracheobronchial disorders often overlap symptoms of lung disease, radiologists may focus their attention on the lungs and overlook the tracheobronchial tree. In this article, we review a wide range of tracheobronchial diseases with emphasis on their computed tomographic appearances. PMID:27261343

  16. Endobronchial mimics of primary endobronchial carcinoma: a clinical study of 25 cases.

    PubMed

    Magro, Cynthia M; Ross, Patrick

    2005-04-01

    While endobronchial lesions that present with symptoms of obstruction may be reflective of primary bronchogenic malignancy, there have been a number of reports of bronchial lesions other than primary bronchogenic carcinoma simulating primary endobronchial epithelial malignancy clinically. Twenty-five cases of symptomatic endobronchial disease were encountered with pathological assessment demonstrating an endobronchial process other than carcinoma, representing metastatic disease (breast, colon, renal, head and neck origin), fungal infection, Hodgkin's lymphoma, primary bronchogenic melanoma, lipoma, broncholith and inflammatory pseudopolyp. The present report underscores the potential pathogenetic heterogeneity encountered in lesions presenting with signs and symptoms of endobronchial obstruction, emphasizing the critical role of biopsy for establishing a definitive diagnosis. PMID:15875062

  17. Method for endobronchial video parsing

    NASA Astrophysics Data System (ADS)

    Byrnes, Patrick D.; Higgins, William E.

    2016-03-01

    Endoscopic examination of the lungs during bronchoscopy produces a considerable amount of endobronchial video. A physician uses the video stream as a guide to navigate the airway tree for various purposes such as general airway examinations, collecting tissue samples, or administering disease treatment. Aside from its intraoperative utility, the recorded video provides high-resolution detail of the airway mucosal surfaces and a record of the endoscopic procedure. Unfortunately, due to a lack of robust automatic video-analysis methods to summarize this immense data source, it is essentially discarded after the procedure. To address this problem, we present a fully-automatic method for parsing endobronchial video for the purpose of summarization. Endoscopic- shot segmentation is first performed to parse the video sequence into structurally similar groups according to a geometric model. Bronchoscope-motion analysis then identifies motion sequences performed during bronchoscopy and extracts relevant information. Finally, representative key frames are selected based on the derived motion information to present a drastically reduced summary of the processed video. The potential of our method is demonstrated on four endobronchial video sequences from both phantom and human data. Preliminary tests show that, on average, our method reduces the number of frames required to represent an input video sequence by approximately 96% and consistently selects salient key frames appropriately distributed throughout the video sequence, enabling quick and accurate post-operative review of the endoscopic examination.

  18. [Endobronchial aspergilloma revealing a bronchial carcinoma].

    PubMed

    Slimani, Hajar; Soualhi, Mouna; Sadak, Nouzha; Zahraoui, Rachida; Bourkadi, Jamal-Eddine

    2016-08-01

    Endobronchial aspergillosis is a rare presentation of pulmonary aspergillosis in immunocompetent patients; this raises questions about structural changes inducing airflow stasis in order to colonize the bronchial lumen. We present the case of a patient diagnosed with endobronchial aspergilloma covering a bronchial adenocarcinoma. PMID:27475005

  19. Surgical approaches of endobronchial neoplasms

    PubMed Central

    Li, Zhigang; Kougioumtzi, Ioanna; Darwiche, Kaid; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Stylianaki, Aikaterini; Kesisis, Georgios; Machairiotis, Nikolaos; Zarogoulidis, Konstantinos

    2013-01-01

    Endobronchial tumors are a rare entity that presents with different pathological findings. The interventional pulmonologist, but also the thoracic surgeon have at their disposal the same techniques for diagnosis, however; the two modalities differentiate in the treatment approach. Diagnosis evaluation should include lymph node evaluation. Minimal invasive techniques under local or general anesthesia are usually preferred by the interventional pulmonologists, whereas in the surgical approach of the thoracic surgeons the general anesthesia is necessary. A more extensive surgical approach either lobotomy or pneumonectomy should be performed in cases with positive intrapulmonary lymph nodes. Carinal reconstruction should be performed skillfully to get a negative proximal margin whenever needed. In the current manuscript we will present the methods of patient evaluation and surgical techniques for the management of these lesions. PMID:24102010

  20. Image-guided endobronchial ultrasound

    NASA Astrophysics Data System (ADS)

    Higgins, William E.; Zang, Xiaonan; Cheirsilp, Ronnarit; Byrnes, Patrick; Kuhlengel, Trevor; Bascom, Rebecca; Toth, Jennifer

    2016-03-01

    Endobronchial ultrasound (EBUS) is now recommended as a standard procedure for in vivo verification of extraluminal diagnostic sites during cancer-staging bronchoscopy. Yet, physicians vary considerably in their skills at using EBUS effectively. Regarding existing bronchoscopy guidance systems, studies have shown their effectiveness in the lung-cancer management process. With such a system, a patient's X-ray computed tomography (CT) scan is used to plan a procedure to regions of interest (ROIs). This plan is then used during follow-on guided bronchoscopy. Recent clinical guidelines for lung cancer, however, also dictate using positron emission tomography (PET) imaging for identifying suspicious ROIs and aiding in the cancer-staging process. While researchers have attempted to use guided bronchoscopy systems in tandem with PET imaging and EBUS, no true EBUS-centric guidance system exists. We now propose a full multimodal image-based methodology for guiding EBUS. The complete methodology involves two components: 1) a procedure planning protocol that gives bronchoscope movements appropriate for live EBUS positioning; and 2) a guidance strategy and associated system graphical user interface (GUI) designed for image-guided EBUS. We present results demonstrating the operation of the system.

  1. Endobronchial ultrasound echoic image of pulmonary hamartoma.

    PubMed

    Kajikawa, Shigehisa; Imai, Naoyuki; Takashima, Kouji; Imaizumi, Kazuyoshi; Hasegawa, Yoshinori

    2014-06-01

    A 62-year-old man with an indicated chest radiographic abnormality was referred to our hospital for more thorough examinations. Endobronchial ultrasound-guided transbronchial needle aspiration was performed because of a mass at the left hilum. Endobronchial ultrasound images showed scattered high-density spots in a low echoic and mosaic density. The pathological findings revealed pulmonary hamartoma. Subsequently, the mass was resected and comparison of ultrasound findings and pathological findings indicated that the scattered high echoic spots appeared to reflect cartilaginous tissues and bronchial epithelium inside the tumor. PMID:25473576

  2. Mechanical complication of endobronchial tuberculosis.

    PubMed

    Kizilbash, Quratulain Fatima

    2015-01-01

    A 19-year-old Vietnamese lady was diagnosed with culture positive, left upper lobe pulmonary tuberculosis for which medical treatment was initiated. Four months into treatment, she developed a 'rubber-band-like' stretching sensation in her left chest with wheezing and shortness of breath. Decreased respiratory excursion over the left lung was present on physical-examination. Chest-Xray revealed left-upper-lobe collapse with leftward deviation of the trachea and mediastinum. CT thorax revealed a long segment of stenosis in the left mainstem bronchus. FEV1 was 1.26 L (45% predicted), FVC 1.53 L (49% predicted), FEV1/FVC 82% (95% predicted) indicating airway limitation. Ventilation-perfusion scan noted 9.8% ventilation to the left lung and 92.8% to the right lung and 7.6% perfusion to the left lung and 92.4% to the right lung. Bronchoscopy was notable for pin point stenosis of the left mainstem bronchus beyond which was inflamed mucosa and abnormal cartilage rings in the left upper and middle lobe bronchi. Nine months of medical therapy for tuberculosis along with oral steroid taper was completed successfully; however the patient has required six serial bronchscopies with dilatations without stent placement at four to six week intervals due to partial restenosis, with the last bronchoscopy at four months after completion of tuberculosis therapy. PMID:26744678

  3. Endobronchial metastases from extrathoracic malignancies.

    PubMed

    Akoglu, Sebahat; Uçan, Eyüp S; Celik, Gülperi; Sener, Gülper; Sevinç, Can; Kilinç, Oğuz; Itil, Oya

    2005-01-01

    Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient. PMID:16475029

  4. Cellular morphometry of the bronchi of human and dog lungs

    SciTech Connect

    Robbins, E.S.

    1991-03-01

    One hundred and thirty-one bronchial samples from 62 patients have been dissected by generation from fixed surgical lung specimens obtained after the removal of pathological lesions. Complete patient records including occupational and smoking histories, as well as possible exposure to radon, are obtained. In addition, one hundred and sixty-two mongol dog bronchi dissected from different lobes of 23 dog lungs have also been similarly prepared. Ninety-four human samples have been completely processed for electron microscopy and have yielded 994 electron micrographs of which 532 have been entered into the Computerized Stereological Analysis System (COSAS) and been used for the measurement of the distances of basal and mucous cell nuclei to the epithelial free surface. Similarly 240 micrographs of dog epithelium from 31 bronchial samples have been entered into COSAS. We have, using the COSAS planimetry program, established data bases which describe the volume density and nuclear numbers per electron micrograph for 5 cell types of the human bronchial epithelial lining of men and women, as well as smokers, non-smokers and ex-smokers and similar parameters for the epithelial cell types of dog bronchi. The data are being used to develop weighting factors for dosimetry and radon risk analysis. 26 refs., 7 figs., 4 tabs.

  5. Endobronchial biopsies on aspirin and prasugrel.

    PubMed

    Harris, Kassem; Kebbe, Jad

    2015-06-01

    Patients are generally required to stop antiplatelet therapy prior to elective invasive procedures. Some patients receive dual antiplatelet therapy for recent vascular procedures such as drug-eluting coronary stenting, and early discontinuation of antiplatelet agents could lead to a significant risk of stent thrombosis. Most bronchoscopic procedures are performed on patients using Aspirin but not on those using Clopidogrel or Prasugrel. In this report, we describe a unique case of a patient with a recent placement of drug-eluting stents, who required endobronchial biopsies for evaluation of lung cancer recurrence. The procedure was performed successfully and safely with no complications. PMID:25697386

  6. Cellular morphometry of the bronchi of human and dog lungs

    SciTech Connect

    Robbins, E.S.

    1991-09-01

    One hundred and forty-seven bronchial samples (generations 3--6) from 66 patients (62 usable; 36 female, 26 male; median age 61) have been dissected by generation from fixed surgical lung specimens obtained after the removal of pathological lesions. In addition, one hundred and fifty-six mongol dog bronchi (generations 2--6) dissected from different lobes of 26 dog lungs have also been similarly prepared. One hundred and twenty-seven human samples have been completely processed for electron microscopy and have yielded 994 electron micrographs of which 655 have been entered into the Computerized Stereological Analysis System (COSAS) and been used for the measurement of the distances of basal and mucous cell nuclei to the epithelial free surface. Similarly 328 micrographs of dog epithelium from 33 bronchial samples have been used to measure the distances of basal and mucous cell nuclei to the epithelial free surface and have been entered into COSAS. Using the COSAS planimetry program, we continue to expand our established data bases which describe the volume density and nuclear numbers per electron micrograph for 5 cell types of the human bronchial epithelial lining of men and women, as well as smokers, non-smokers and ex-smokers and similar parameters for the same 5 epithelial cell types of dog bronchi. Our micrographs of human bronchial epithelium have allowed us to analyze the recent suggestion that the DNA of lymphocytes may be subject to significant damage from Rn progeny while within the lung. Since the last progress report three papers have been submitted for publication. 17 refs., 4 tabs.

  7. Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse

    PubMed Central

    Siddiqui, Nauman; Javaid, Toseef

    2016-01-01

    Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications. PMID:27525149

  8. Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse.

    PubMed

    Dasa, Osama; Siddiqui, Nauman; Ruzieh, Mohammed; Javaid, Toseef

    2016-01-01

    Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications. PMID:27525149

  9. Endobronchial lipoma: a rare cause of bronchial occlusion.

    PubMed

    Triviño, Ana; Mora-Cabezas, Montserrat; Vallejo-Benitez, Ana; García-Escudero, Antonio; González-Cámpora, Ricardo

    2013-11-01

    Endobronchial lipoma is a rare benign neoplasm of the tracheobronchial tree. Despite its benign nature, associated endoluminal polypoid growth can cause bronchial occlusion. In this paper, we present the consequences of a late diagnosis of this condition. PMID:23680317

  10. Two cases of endobronchial aspergilloma with lung cancer: a review the literature of endobronchial aspergilloma with underlying malignant lesions of the lung

    PubMed Central

    Jiang, Shenghua; Jiang, Luning; Shan, Fenglian; Zhang, Xiulian; Song, Ming

    2015-01-01

    Endobronchial aspergilloma is a rare disease entity with pulmonary involvement of aspergillus. Few cases of endobronchial aspergilloma associated with malignant lesions have been reported in the literature. We present 2 more cases of endobronchial aspergilloma with underlying lung cancer. And summarize the published literatures to investigate the clinical manifestations, bronchoscopic characters, imaging performances in patients with endobronchial aspergilloma with underlying malignant lesions of the lung. A review of the literature reveals 8 cases of endobronchial aspergilloma with coexisting lung malignant lesions upon presentation. The medical details of the patients including age, sex, clinical symptoms, radiological manifestations bronchoscopic characters, diagnosis and treatment are summarized. Endobronchial aspergilloma is usually incidentally detected in patients with underlying lung disease. With the increasing popularity of flexible bronchoscopy, it is being recognized as a necrotic mass causing bronchial obstruction. We should be paid more attention to prevent misdiagnosis of combined endobronchial aspergilloma and lung malignant diseases. PMID:26629257

  11. Acid-induced secretory cell metaplasia in hamster bronchi

    SciTech Connect

    Christensen, T.G.; Lucey, E.C.; Breuer, R.; Snider, G.L.

    1988-02-01

    Hamsters were exposed to an intratracheal instillation of 0.5 ml of 0.08 N nitric, hydrochloric, or sulfuric acid to determine their airway epithelial response. Three weeks after exposure, the left intrapulmonary bronchi in Alcian blue/PAS-strained paraffin sections were evaluated for the amount of secretory product in the airway epithelium as a measure of secretory cell metaplasia (SCM). Compared to saline-treated control animals, all three acids caused statistically significant SCM. In addition to the bronchial lesion, all three acids caused similar interstitial fibrosis, bronchiolectasis, and bronchiolization of alveoli that varied in individual animals from mild to severe. In a separate experiment to study the persistence of the SCM, hamsters treated with a single instillation of 0.1 N nitric acid showed significant SCM 3, 7, and 17 weeks after exposure. There was a high correlation (r = 0.96) between a subjective assessment of SCM and objective assessment using a digital image-analysis system. We conclude that protons induce SCM independently of the associated anion; the SCM persists at least 17 weeks. Sulfuric acid is an atmospheric pollutant and nitric acid may form locally on the mucosa of lungs exposed to nitrogen dioxide. These acids may contribute to the development of maintenance of the SCM seen in the conducting airways of humans with chronic obstructive pulmonary disease.

  12. Cellular morphometry of the bronchi of human and dog lungs

    SciTech Connect

    Robbins, E.S.

    1990-09-01

    One hundred and twenty one bronchial samples from 58 patients (54 useable; 32 female, 22 male; median age 61) have been dissected by generation from fixed surgical lung specimens obtained after the removal of pathological lesions. Complete patient records including occupational and smoking histories, as well as possible exposure to radon, are being kept. In addition, mongol dog bronchi dissected from different lobes of 23 dog lungs have been used to establish protocols. Ninety human samples have been completely processed for electron microscopy and have yielded 913 electron micrographs of which 471 have been entered into the Computerized Stereological Analysis System (COSAS) and used for the measurement of the distances of basal and mucous cell nuclei to the epithelial free surface. We have, using the COSAS planimetry program, established a small data base which describes the volume density and nuclear numbers per electron micrograph for 5 cell types of the human bronchial epithelial lining of men and women, as well as smokers, nonsmokers and ex-smokers. The data is being used to develop weighting factors for dosimetry and radon risk analysis. The electron micrographs of dog bronchial epithelium are unanalyzed as yet. 4 figs., 2 tabs.

  13. Endobronchial interstitial brachytherapy using a bronchofiberscope with a flexible injector system

    SciTech Connect

    Mittal, B.B.; Matuschak, G.; Culpepper, J.

    1984-07-01

    A new flexible implantation system for endobronchial brachytherapy is described. This system was used to implant Au-198 seeds in the endobronchial tumors of two patients; discomfort and morbidity were minimal. The flexible injector system may be an improvement over the rigid system for endobronchial implantation in most patients.

  14. Endobronchial Ultrasound Reliably Quantifies Airway Smooth Muscle Remodeling in an Equine Asthma Model

    PubMed Central

    Bullone, Michela; Beauchamp, Guy; Godbout, Mireille; Martin, James G.; Lavoie, Jean-Pierre

    2015-01-01

    Endobronchial ultrasonography (EBUS) revealed differences in the thickness of the layer representing subepithelial tissues (L2) between human asthmatics and controls, but whether this measurement correlates with airway smooth muscle (ASM) remodeling in asthma is unknown. In this study, we sought to determine the ability of EBUS to predict histological ASM remodeling in normal and equine asthmatic airways. We studied 109 isolated bronchi from the lungs of 13 horses. They underwent EBUS examination using a 30 MHz radial probe before being processed for histology. ASM remodeling parameters were evaluated in EBUS images (L2 thickness, L2 area, L2 area/internal perimeter [Pi] and L2 area/Pi2) and histological cuts (ASM area/Pi2), and compared. EBUS was then performed ex vivo on the lungs of 4 horses with heaves, an asthma-like condition of horses, and 7 controls to determine whether central bronchial remodeling could be detected with this technique. An optimized approach was developed based on data variability within airways, subjects, and groups, and then validated in 7 horses (3 controls, 4 with heaves) that underwent EBUS in vivo. L2 area was significantly associated to ASM area in isolated lungs (p<0.0001), in the absence of significant bias related to the airway size. Bronchial size significantly affected EBUS ASM-related parameters, except for L2 area/Pi2. L2 area/Pi2 was increased in the airways of asthmatic horses compared to controls, both ex vivo and in vivo (p<0.05). Bronchial histology confirmed our findings (AASM/Pi2 was increased in asthmatic horses compared to controls, p<0.05). In both horses with heaves and controls, L2 was composed of ASM for the outer 75% of its thickness and by ECM for the remaining inner 25%. In conclusion, EBUS reliably allows assessment of asthma-associated ASM remodeling of central airways in a non-invasive way. PMID:26348727

  15. Endobronchial Ultrasound Reliably Quantifies Airway Smooth Muscle Remodeling in an Equine Asthma Model.

    PubMed

    Bullone, Michela; Beauchamp, Guy; Godbout, Mireille; Martin, James G; Lavoie, Jean-Pierre

    2015-01-01

    Endobronchial ultrasonography (EBUS) revealed differences in the thickness of the layer representing subepithelial tissues (L2) between human asthmatics and controls, but whether this measurement correlates with airway smooth muscle (ASM) remodeling in asthma is unknown. In this study, we sought to determine the ability of EBUS to predict histological ASM remodeling in normal and equine asthmatic airways. We studied 109 isolated bronchi from the lungs of 13 horses. They underwent EBUS examination using a 30 MHz radial probe before being processed for histology. ASM remodeling parameters were evaluated in EBUS images (L2 thickness, L2 area, L2 area/internal perimeter [Pi] and L2 area/Pi2) and histological cuts (ASM area/Pi2), and compared. EBUS was then performed ex vivo on the lungs of 4 horses with heaves, an asthma-like condition of horses, and 7 controls to determine whether central bronchial remodeling could be detected with this technique. An optimized approach was developed based on data variability within airways, subjects, and groups, and then validated in 7 horses (3 controls, 4 with heaves) that underwent EBUS in vivo. L2 area was significantly associated to ASM area in isolated lungs (p<0.0001), in the absence of significant bias related to the airway size. Bronchial size significantly affected EBUS ASM-related parameters, except for L2 area/Pi2. L2 area/Pi2 was increased in the airways of asthmatic horses compared to controls, both ex vivo and in vivo (p<0.05). Bronchial histology confirmed our findings (AASM/Pi2 was increased in asthmatic horses compared to controls, p<0.05). In both horses with heaves and controls, L2 was composed of ASM for the outer 75% of its thickness and by ECM for the remaining inner 25%. In conclusion, EBUS reliably allows assessment of asthma-associated ASM remodeling of central airways in a non-invasive way. PMID:26348727

  16. Endobronchial Ultrasound Bronchoscopy to the Heart of the Matter.

    PubMed

    Palamidas, Anastasios F; Rosendahl, Ulrich; Shah, Pallav L

    2016-01-01

    Endobronchial ultrasound has been one of the success stories of the last decade, and the utility of the procedure continues to expand. Originally, it was developed for the staging and diagnosis of lung cancer, but its use rapidly expanded to other malignancies and even benign disease. We present the case of a patient originally referred with suspected endocarditis who was found to have a mass involving the right ventricle and the pulmonary outflow tract. Endobronchial ultrasound-guided biopsy was used to obtain a tissue diagnosis from the cardiac mass. PMID:27548703

  17. [Endobronchial brachytherapy: state of the art in 2013].

    PubMed

    Derhem, N; Sabila, H; Mornex, F

    2013-04-01

    Endobronchial brachytherapy is an invasive technique, which allows localizing radioactive sources at the tumour contact. Therefore, high doses are administered to tumour while healthy tissues can be spared. Initially dedicated to a palliative setting, improvements helped reaching 60 to 88% symptoms alleviation and 30 to 100% of endoscopic macroscopic response. New diagnostic techniques and early diagnosis extended the indications to a curative intent: endoluminal primitive tumour, post radiation endobronchial recurrence, inoperable patients. CT-based dosimetry is a keypoint to optimize treatment quality and to minimize potential side effects, making this treatment a safe and efficient technique for specific indications. PMID:23465785

  18. Endothelin-1 increases cholinergic nerve-mediated contraction of human bronchi via tachykinin synthesis induction

    PubMed Central

    D'Agostino, Bruno; Advenier, Charles; Falciani, Maddalena; Gallelli, Luca; Marrocco, Giuseppina; Piegari, Elena; Filippelli, Amelia; Rossi, Francesco

    2001-01-01

    In some asthmatics, muscarinic receptor antagonists are effective in limiting bronchoconstrictor response, suggesting an abnormal cholinergic drive in these subjects. There is a growing body of evidences indicating that cholinergic neurotransmission is also enhanced by endothelin-1 (ET-1) in rabbit bronchi, mouse trachea and in human isolated airway preparations.We investigated the role of secondary mediators in ET-1 induced potentiation of cholinergic nerve-mediated contraction in human bronchi, in particular the possible role of neuropeptides in this phenomenon.Bronchial tissues after endothelin treatment were exposed to a standard electrical field stimulation (EFS) (30% of EFS 30Hz)-induced contraction. In addition, in some experiments, preparations were treated with a tachykinin NK2 receptor antagonist and subsequently exposed to the same protocol. HPLC and RIA were performed on organ bath fluid samples. Moreover, the human bronchi were used for the β-PPT (preprotachykinin) mRNA extraction and semiquantitative reverse transcription polymerase chain reaction (RT – PCR), prior to and 30 – 40 min following ET-1 challenge.The selective tachykinin NK2 receptor antagonist, SR48968, was effective to reduce ET-1 potentiation of EFS mediated contraction. HPLC or RIA showed significant increased quantities of NKA in organ bath effluents after EFS stimulation in bronchi pretreated with ET-1. Finally, β-PPT mRNA level after stimulation of bronchi with ET-1 was increased about 2 fold respect to control untreated bronchi.In conclusion, this study demonstrated that, at least in part, the ET-1 potentiation of cholinergic nerve-mediated contraction is mediated by tachykinin release, suggesting that in addition to nerves, several type of cells, such as airway smooth muscle cell, may participate to neuropeptide production. PMID:11724750

  19. Acute Scedosporium apiospermum Endobronchial Infection in Cystic Fibrosis.

    PubMed

    Padoan, Rita; Poli, Piercarlo; Colombrita, Domenico; Borghi, Elisa; Timpano, Silviana; Berlucchi, Marco

    2016-06-01

    Fungi are known pathogens in cystic fibrosis patients. A boy with cystic fibrosis boy presented with acute respiratory distress. Bronchoscopy showed airways obstruction by mucus plugs and bronchial casts. Scedosporium apiospermum was identified as the only pathogen. Bronchoalveolar lavage successfully resolved the acute obstruction. Plastic bronchitis is a new clinical picture of acute Scedosporium endobronchial colonization in cystic fibrosis patients. PMID:26967814

  20. Attenuation of contractions to acetylcholine in canine bronchi by an endogenous nitric oxide-like substance.

    PubMed Central

    Gao, Y.; Vanhoutte, P. M.

    1993-01-01

    1. The involvement was assessed of an endogenous nitric oxide-like substance in contractions of canine bronchi to acetylcholine. 2. Canine third order bronchial rings, in some of which the epithelium was removed mechanically, were suspended in organ chambers and isometric tension was recorded. In some experiments, the content of guanosine 3',5'-cyclic monophosphate (cyclic GMP) of the bronchi was also measured. 3. Acetylcholine induced concentration-dependent contractions. The contractions were potentiated by nitro-L-arginine (an inhibitor of the synthesis of nitric oxide), oxyhaemoglobin (a scavenger of nitric oxide), and methylene blue (an inhibitor of soluble guanylate cyclase). The magnitude of the potentiation to acetylcholine-induced contractions by these inhibitors were not significantly different between tissues with and without epithelium. 4. Acetylcholine induced a concentration-dependent increase in intracellular content of cyclic GMP, which was similar in bronchi with and without epithelium. These increases were abolished by nitro-L-arginine and methylene blue. 5. During contractions to acetylcholine, exogenous nitric oxide relaxed the canine bronchi. The relaxations were not affected by nitro-L-arginine, but were augmented by superoxide dismutase plus catalase, and were abolished by methylene blue. 6. These observations suggest that, during contraction evoked by acetylcholine, the production of an endogenous nitric oxide-like substance increases and in turn attenuates the response of the airways to the muscarinic agonist. However, the endogenous nitric oxide-like substance does not play a major role in the epithelium-dependent attenuation of the contraction to acetylcholine in canine bronchi. PMID:8395301

  1. Convex probe endobronchial ultrasound: applications beyond conventional indications

    PubMed Central

    Li, Peng; Zheng, Wei

    2015-01-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is maturing and gaining acceptance by more and more clinicians for lymph node staging of lung cancer and diagnosis of mediastinal and hilar masses or lymph node enlargement by convex probe endobronchial ultrasound (CP-EBUS). The application of CP-EBUS, however, is not limited to conventional indications. Diagnostically, elastography is a new technology for the differentiation of benign and malignant lymph nodes before aspiration. CP-EBUS can also be used for pulmonary vascular diseases, such as pulmonary embolism (PE) and non-thrombotic endovascular lesions (NELs). Therapeutically, CP-EBUS can be used for cyst drainage and drug injections. CP-EBUS is not limited to observation and aspiration of mediastinal masses and lymph nodes, but is also suitable for exploration of other tissues external to the central airway, which necessitates unprecedented skills for the bronchoscopist. PMID:26543618

  2. Giant endobronchial hamartoma resected by fiberoptic bronchoscopy electrosurgical snaring

    PubMed Central

    2011-01-01

    Less than 1% of lung neoplasms are represented by benign tumors. Among these, hamartomas are the most common with an incidence between 0.025% and 0.32%. In relation to the localization, hamartomas are divided into intraparenchymal and endobronchial. Clinical manifestation of an endobronchial hamartoma (EH) results from tracheobronchial obstruction or bleeding. Usually, EH localizes in large diameter bronchus. Endoscopic removal is usually recommended. Bronchotomy or parenchimal resection through thoracotomy should be reserved only for cases where the hamatoma cannot be approached through endoscopy, or when irreversible lung functional impairment occurred after prolonged airflow obstruction. Generally, when endoscopic approach is used, this is through rigid bronchoscopy, laser photocoagulation or mechanical resection. Here we present a giant EH occasionally diagnosed and treated by fiberoptic bronchoscopy electrosurgical snaring. PMID:21838930

  3. A rare case of fibrostenotic endobronchial tuberculosis of trachea

    PubMed Central

    Cary, Cassiopia; Jhajj, Manjit; Cinicola, John; Evans, Richard; Cheriyath, Pramil; Gorepatti, Venaka

    2015-01-01

    Endobronchial tuberculosis (EBTB) is a sequelae of pulmonary tuberculosis (TB) that extends to the endobronchial or endotracheal wall causing inflammation, edema, ulceration, granulation or fibrosis of mucosa and submucosa. This case depicts a 20 year old foreign-born woman with a history of active pulmonary TB on anti-TB chemotherapy, who presented with worsening stridor, dyspnea, cough and weight loss. The disease state was diagnosed with multiple modalities including, spirometry, CT scan of the neck, and bronchoscopy. The biopsies of the tracheal web revealed fibrotic tissue without any granulomas or malignancy establishing the diagnosis of EBTB. Serial balloon dilations and anti-neoplastic therapy with Mitomycin C was used to accomplish sufficient airway patency to relieve her symptoms. ETBT is a rare consequence of TB, which although has a low incidence in the United States, so physicians should have a high clinical suspicion based on the need for prompt intervention. PMID:26779339

  4. Endobronchial Carcinoid Tumour with Extensive Ossification: An Unusual Case Presentation.

    PubMed

    Osmond, Allison; Filter, Emily; Joseph, Mariamma; Inculet, Richard; Kwan, Keith; McCormack, David

    2016-01-01

    Carcinoid tumour is a well-known primary endobronchial lung neoplasm. Although calcifications may be seen in up to 30% of pulmonary carcinoid tumours, near complete ossification of these tumours is an unusual finding. Such lesions can prove diagnostically challenging at the time of intraoperative frozen section as the latter technique requires thin sectioning of the lesion for microscopic assessment. We present an unusual case of endobronchial carcinoid tumour with extensive ossification in a 45-year-old male. Preliminary intraoperative diagnosis was achieved through the alternative use of cytology scrape smears. The final diagnosis was confirmed after decalcification of the tumour. The prognostic implications of heavily ossified carcinoid tumours remain elusive. Long-term clinical follow-up of these patients is recommended. PMID:27610135

  5. Endobronchial Carcinoid Tumour with Extensive Ossification: An Unusual Case Presentation

    PubMed Central

    Filter, Emily; Joseph, Mariamma; Inculet, Richard; Kwan, Keith; McCormack, David

    2016-01-01

    Carcinoid tumour is a well-known primary endobronchial lung neoplasm. Although calcifications may be seen in up to 30% of pulmonary carcinoid tumours, near complete ossification of these tumours is an unusual finding. Such lesions can prove diagnostically challenging at the time of intraoperative frozen section as the latter technique requires thin sectioning of the lesion for microscopic assessment. We present an unusual case of endobronchial carcinoid tumour with extensive ossification in a 45-year-old male. Preliminary intraoperative diagnosis was achieved through the alternative use of cytology scrape smears. The final diagnosis was confirmed after decalcification of the tumour. The prognostic implications of heavily ossified carcinoid tumours remain elusive. Long-term clinical follow-up of these patients is recommended. PMID:27610135

  6. Endobronchial ultrasound-transbronchial needle aspiration and its practical application.

    PubMed

    Currie, G P; McKean, M E; Kerr, K M; Denison, A R; Chetty, M

    2011-08-01

    Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) has emerged over the past decade as one of the most exciting and innovative developments in the field of respiratory medicine. This procedure allows sampling of mediastinal lymph nodes and masses in both malignant and benign disease and overcomes some of the disadvantages associated with mediastinoscopy and blind transbronchial needle aspiration. We describe the clinical use, indications for and limitations of EBUS-TBNA along with several illustrated clinical examples. PMID:21546452

  7. Endobronchial ultrasound for the detection of chronic pulmonary artery thrombus.

    PubMed

    Dhillon, Samjot Singh; Harris, Kassem

    2016-01-01

    Endobronchial ultrasound (EBUS) has been shown to be able to successfully identify acute/subacute pulmonary thromboembolism (PE). Most reported cases have required confirmation by computerized tomography (CT) angiography. This report demonstrates a case where CT angiography was not conclusive and the EBUS was useful in clarifying the chronic process inside the pulmonary artery compatible with clinical diagnosis of chronic pulmonary artery thrombosis. PMID:27503162

  8. Late complication of a renal calculus: fistulisation to the psoas muscle, skin and bronchi

    PubMed Central

    Snoj, Ziga; Savic, Nenad; Regvat, Jaka

    2015-01-01

    ABSTRACT Kidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention. PMID:26401876

  9. Late complication of a renal calculus: fistulisation to the psoas muscle, skin and bronchi.

    PubMed

    Snoj, Ziga; Savic, Nenad; Regvat, Jaka

    2015-01-01

    Kidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention. PMID:26401876

  10. Epithelium integrity is crucial for the relaxant activity of brain natriuretic peptide in human isolated bronchi

    PubMed Central

    Matera, Maria G; Calzetta, Luigino; Passeri, Daniela; Facciolo, Francesco; Rendina, Erino A; Page, Clive; Cazzola, Mario; Orlandi, Augusto

    2011-01-01

    BACKGROUND AND PURPOSE Brain natriuretic peptide (BNP) plays an important role in several biological functions, including bronchial relaxation. Here, we have investigated the role of BNP and its cognate receptors in human bronchial tone. EXPERIMENTAL APPROACH Effects of BNP on responses to carbachol and histamine were evaluated in non-sensitized, passively sensitized, epithelium-intact or denuded isolated bronchi and in the presence of methoctramine, Nω-nitro-L-arginine methyl ester (L-NAME) and aminoguanidine. Natriuretic peptide receptors (NPRs) were investigated by immunohistochemistry, RT-PCR and real-time PCR. Release of NO and acetylcholine from bronchial tissues and cultured BEAS-2B bronchial epithelial cells was also investigated. KEY RESULTS BNP reduced contractions mediated by carbachol and histamine, with decreased Emax (carbachol: 22.7 ± 4.7%; histamine: 59.3 ± 1.8%) and increased EC50 (carbachol: control 3.33 ± 0.88 µM, BNP 100 ± 52.9 µM; histamine: control 16.7 ± 1.7 µM, BNP 90 ± 30.6 µM); BNP was ineffective in epithelium-denuded bronchi. Among NPRs, only atrial NPR (NPR1) transcripts were detected in bronchial tissue. Bronchial NPR1 immunoreactivity was detected in epithelium and inflammatory cells but faint or absent in airway smooth muscle cells. NPR1 transcripts in bronchi increased after incubation with BNP, but not after sensitization. Methoctramine and quinine abolished BNP-induced relaxant activity. The latter was associated with increased bronchial mRNA for NO synthase and NO release, inhibited by L-NAME and aminoguanidine. In vitro, BNP increased acetylcholine release from bronchial epithelial cells, whereas NO release was unchanged. CONCLUSIONS AND IMPLICATIONS Epithelial cells mediate the BNP-induced relaxant activity in human isolated bronchi. PMID:21410689

  11. Effectiveness of a Load-Imposing Device for Cyclic Stretching of Isolated Human Bronchi: A Validation Study

    PubMed Central

    Le Guen, Morgan; Naline, Emmanuel; Grassin-Delyle, Stanislas; Devillier, Philippe; Faisy, Christophe

    2015-01-01

    Background Mechanical ventilation may induce harmful effects in the airways of critically ill patients. Nevertheless, the effects of cyclic stretching caused by repetitive inflation-deflation of the bronchial compartment have not been well characterized in humans. The objective of the present study was to assess the effectiveness of a load-imposing device for the cyclic stretching of human bronchi. Methods Intact bronchial segments were removed from 128 thoracic surgery patients. After preparation and equilibration in an organ bath, bronchi were stretched repetitively and cyclically with a motorized transducer. The peak force imposed on the bronchi was set to 80% of each individual maximum contraction in response to acetylcholine and the minimal force corresponded to the initial basal tone before stretching. A 1-min cycle (stretching for 15 sec, relaxing for 15 sec and resting for 30 sec) was applied over a time period ranging from 5 to 60 min. The device's performance level was assessed and the properties of the stretched bronchi were compared with those of paired, non-stretched bronchi. Results Despite the intrinsic capacities of the device, the targets of the tension adjustments remained variable for minimal tension (156–178%) while the peak force set point was unchanged (87–115%). In the stretched bronchi, a time-dependent rise in basal tone (P <.05 vs. non-stretched) was apparent after as little as 5 min of cyclic stretching. The stretch-induced rise in basal tone continued to increase (P <.01) after the stretching had ended. Only 60 min of cyclic stretching was associated with a significant (P <.05) increase in responsiveness to acetylcholine, relative to non-stretched bronchi. Conclusions Low-frequency, low-force, cyclic loading of human bronchi is associated with elevated basal tone and acetylcholine responsiveness. The present experimental model is likely to be a useful tool for future investigations of the bronchial response to repetitive stress

  12. Pharmacological characterization of the interaction between aclidinium bromide and formoterol fumarate on human isolated bronchi.

    PubMed

    Cazzola, Mario; Calzetta, Luigino; Page, Clive P; Rogliani, Paola; Facciolo, Francesco; Gavaldà, Amadeu; Matera, Maria Gabriella

    2014-12-15

    Long-acting muscarinic receptor antagonists (LAMAs) and long-acting β2-adrenoceptor agonists (LABAs) cause airway smooth muscle (ASM) relaxation via different signal transduction pathways, but there are limited data concerning the interaction between these two drug classes on human bronchi. The aim of this study was to investigate the potential synergistic interaction between aclidinium bromide and formoterol fumarate on the relaxation of human ASM. We evaluated the influence of aclidinium bromide and formoterol fumarate on the contractile response induced by acetylcholine or electrical field stimulation (EFS) on human isolated airways (segmental bronchi and bronchioles). We analyzed the potential synergistic interaction between the compounds when administered in combination by using Bliss independence (BI) theory. Both aclidinium bromide and formoterol fumarate completely relaxed segmental bronchi pre-contracted with acetylcholine (Emax: 97.5±2.6% and 96.4±1.1%; pEC50 8.5±0.1 and 8.8±0.1; respectively). Formoterol fumarate, but not aclidinium bromide, abolished the contraction induced by acetylcholine in bronchioles (Emax: 68.1±4.5% and 99.0±5.6%; pEC50 7.9±0.3 and 8.4±0.3; respectively). The BI analysis indicated synergistic interaction at low concentrations in segmental bronchi (+18.4±2.7%; P<0.05 versus expected effect) and from low to high concentrations in bronchioles (+19.7±0.9%; P<0.05 versus expected effect). Low concentrations of both drugs produced a synergistic relaxant interaction on isolated bronchi stimulated with EFS that was sustained for 6h post-treatment (+55.1±9.4%; P<0.05 versus expected effect). These results suggest that combining aclidinium bromide plus formoterol fumarate provides synergistic benefit on ASM relaxation of both medium and small human airways, which may have major implications for the use of this combination in the clinic. PMID:25446566

  13. Bronchoscopic debulking for endobronchial malignancy: Predictors of recanalization and recurrence

    PubMed Central

    Kuo, Scott Chih-Hsi; Lo, Yu-Lun; Chou, Chun-Liang; Chung, Fu-Tsai; Lin, Shu-Min; Liu, Chien-Ying; Kuo, Han-Pin

    2015-01-01

    Background Central airway obstruction related to endobronchial malignancy is one of the most difficult oncological complications and requires efficient palliative intervention. Methods Fifty-three consecutive patients with unresectable endobronchial malignancy receiving bronchoscopic cryotherapy as palliative treatment were retrospectively reviewed. Efficiency was evaluated by the improvement of performance status (PS), and the best achievement of tumor removal was assessed as complete or partial removal. Result Patients’ PS after cryotherapeutic tumor removal improved from the baseline PS (P = 0.006). In multivariate logistic regression analysis, the compression part of the tumor (odds ratio [OR] 0.42; 95% confidence interval [CI] 0.23∼0.75, P = 0.004) and the thin tumor stalk (OR 87.86; 95% CI 2.31∼3337.37, P = 0.016) were independent predictors of complete tumor removal. Tumors larger than 9.3 cm, including compression and invasion parts, had the highest odds of being only partially removed (positive predictive value [PPV]: 88.2%, likelihood ratio [LR]+: 10.49); tumors smaller than 9.3 cm were likely to be completely removed (negative predictive value [NPV]: 80.6%, LR−: 0.34). After cryotherapy, re-obstruction was significantly associated with non-squamous cell carcinoma (65.7 vs. 16.7%, P = 0.001) and patients who had longer overall survival (11.7 vs. 1.5 months, P < 0.001). Odds of tumor re-obstruction increased 2.28-fold (PPV: 81.6%, LR+: 2.28) beyond two months; the odds decreased by 81% (NPV: 73.3%, LR−: 0.19) within two months. Conclusion Debulking of a tumor using cryotherapy is a useful palliative treatment for endobronchial obstruction secondary to a variety of malignancies. PMID:26557910

  14. Endobronchial ultrasound for mediastinal staging in lung cancer patients.

    PubMed

    Guarize, Juliana; Pardolesi, Alessandro; Donghi, Stefano; Filippi, Niccolò; Casadio, Chiara; Midolo, Valeria; Petrella, Francesco; Spaggiari, Lorenzo

    2014-01-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has changed the way mediastinal staging is performed in lung cancer patients. EBUS-TBNA is probably the most important non-invasive procedure for mediastinal staging and the currently preferred approach in many reference cancer centres worldwide. EBUS-TBNA is a less invasive technique than mediastinoscopy with low morbidity and no mortality and can be performed in an outpatient setting with excellent results. This study describes the technical aspects of EBUS-TBNA and our personal experience with the procedure. PMID:25332380

  15. Endobronchial ultrasound: an unusual diagnostic tool for pulmonary embolism.

    PubMed

    Sariaydin, Muzaffer; Günay, Sibel; Günay, Ersin; Sarinc Ulasli, Sevinc

    2016-03-01

    Pulmonary thromboembolism (PTE) is an emergent and common pulmonary vascular disease. The most common diagnostic method for PTE is computer-aided tomography angiography. Endobronchial ultrasonography (EBUS) is used in diagnosis and staging of lung cancer via transbronchial needle aspiration from mediastinal lymphadenopathies and central masses. Diagnosis of PTE with EBUS is not common, although this technique helps to monitor pulmonary vasculature. The present case, a 60-year-old female patient to whom EBUS was applied because of mediastinal lymphadenopathy, was diagnosed as incidental PTE. PMID:26992367

  16. Induction of CD18-mediated passage of neutrophils by Pasteurella haemolytica in pulmonary bronchi and bronchioles.

    PubMed

    Ackermann, M R; Brogden, K A; Florance, A F; Kehrli, M E

    1999-02-01

    Pasteurella haemolytica is an important respiratory pathogen of cattle that incites extensive infiltrates of neutrophils into the lung. In addition to the parenchymal damage caused by factors released by P. haemolytica, neutrophils contribute to the pathologic changes in the lungs. Molecules which mediate neutrophil infiltration into the lungs during P. haemolytica pneumonia are poorly characterized. To determine whether the CD18 family (beta2-integrin) of leukocyte adhesion molecules mediates initial passage of neutrophils into the pulmonary bronchi and bronchioles of lungs infected with P. haemolytica, three Holstein calves homozygous for bovine leukocyte adhesion deficiency (BLAD) (CD18-deficient neutrophils), and three age- and breed-matched control calves (normal CD18 expression) were inoculated with P. haemolytica A1 via a fiberoptic bronchoscope and euthanized at 2 h postinoculation. Sections of lung were stained for neutrophils, and the intensity of neutrophilic infiltration was determined by computerized image analysis. Significantly fewer (P < 0.05) neutrophils infiltrated the lumen, epithelium, and adventitia of bronchioles and bronchi in lungs of calves with BLAD compared to normal calves, which had dense infiltrates within these sites at 2 h postinoculation. The reduced infiltration in calves with BLAD occurred despite the presence of an extremely large number of neutrophils in peripheral blood that is typical for these calves. The large number of neutrophils in the blood of calves with BLAD is probably a physiologic response that can occur without microbial colonization, since one calf with BLAD that was raised under germ-free conditions had large numbers of neutrophils in the blood that were similar to those in a calf with BLAD that was raised conventionally. Neutrophil counts in the germ-free and conventionally reared calves with BLAD were much higher than those in the three normal calves raised under germ-free conditions. The work in this study

  17. First Successful Surgical Reconstruction of Bilateral Transected Main Bronchi With Extracorporeal Membrane Oxygenation Support.

    PubMed

    Biancosino, Christian; Krüger, Marcus; Kühn, Christian; Zinne, Norman; Wilhelmi, Michaela; Zeckey, Christian; Krettek, Christian; Gathen, Martin

    2016-08-01

    Complex tracheobronchial injuries, especially if both main bronchi are involved, are life threatening and their diagnosis and successful treatment concerning short-term as well as long-term results are most challenging. This is the first report on a successful reconstruction of a complex bilateral bronchial injury under extracorporeal membrane oxygenation (ECMO) support. We present the course from prehospital treatment, establishment of ECMO in the emergency room to initial bronchoscopy, operative reconstruction, and intensive care therapy. Under these special circumstances ECMO provided a stable respiratory situation not only preoperatively but also intraoperatively without aggravating a compensated bronchial situation under aggressive ventilation. PMID:27449449

  18. Electron-autoradiographic study of the wall of the large bronchi in chronic inflammatory lung disease

    SciTech Connect

    Nepomnyashchikh, G.I.; Efremov, V.N.; Tumanov, V.P.

    1986-04-01

    This paper studies chronic bronchitis from the standpoint of parenchymatous-stromal interrelations, using light and electron-microscopic autoradiography. Pieces of the walls of the lobar and segmental bronchi, obtained by incision during bronchoscopy on 19 patients with chronic imflammatory lung disease were studied. From the sample of tissue obtained fragments were incubated in medium no. 199, containing either tritium-thymidine, tritium-uridine, or tritium-proline. The results of the studies present a more complete idea of the morphogenesis of chronic sclerotic changes in the human bronchii.

  19. Effects of successive tracheal resection and anastomosis on tracheal diameter and position of lobar bronchi in dogs.

    PubMed

    de Mello Souza, Carlos Henrique; Reinero, Carol R

    2016-06-01

    OBJECTIVE To evaluate the effects of successive large-segment tracheal resection and anastomosis on tracheal diameter and position of lobar bronchi in dogs. ANIMALS 5 adult Beagles. PROCEDURES Right lateral radiographs were obtained for all dogs and used to measure tracheal length. Dogs were then euthanized, and successive segmental tracheal resections (intervals of 10% from 20% to 50% of the tracheal length), each of which was followed by anastomosis, were performed in each cadaver. Tracheobronchoscopy was performed before the first tracheal resection and after each of the anastomoses to evaluate tracheal diameter and changes in position of lobar bronchi. RESULTS Tracheal diameter was minimally affected by resections up to 50% of the tracheal length. Diameter of the trachea and position of bronchi were not affected by resection of 20% of the tracheal length. Changes in the position of various lobar bronchi were detected after resection of 30% of the tracheal length. CONCLUSIONS AND CLINCIAL RELEVANCE In this study, tracheal resections of 20% of the tracheal length were accommodated, possibly as a result of stretching of the annular ligament. Resections of ≥ 30% of the tracheal length altered the position of lobar bronchi. Clinical effects, if any, attributable to these changes in bronchial position remain to be elucidated. PMID:27227506

  20. Nerve endings in bronchi of the dog that react with antibodies against neurofilament protein.

    PubMed Central

    Yamamoto, Y; Atoji, Y; Suzuki, Y

    1995-01-01

    Tree-like nerve endings in the smooth muscle layer of bronchi of the dog were examined by immunohistochemical staining with antibodies against neurofilament protein (NFP). The endings were revealed as ramified axon terminals, with arborisation at their termini. The endings were 100-300 microns in maximal length and 50-100 microns in minimal length. Most of the endings were arranged parallel to the smooth muscle strands. The endings were densely distributed in the proximal region but their density decreased towards the alveoli. In the histological sections, the endings were seen between smooth muscle cells. Terminal Schwann cells, which reacted with antibodies against glial fibrillary acidic protein and S-100 protein, and putative 'septal cells' with vimentin-like immunoreactivity were distributed near the endings. In addition, the nerve endings with NFP-like immunoreactivity were surrounded dense connective tissue that contained large amounts of fine elastic fibres. These findings indicate the nerve endings with NFP-like immunoreactivity are similar to other slowly adapting receptors (i.e. Golgi tendon organs, Ruffini endings). Some degenerated endings, which found in the unilaterally vagotomised dog, suggest the endings in the bronchi are originated from vagal nerves. Images Fig. 1 Fig. 3 Fig. 4 Fig. 5 PMID:7591986

  1. Endobronchial Hamartoma Subtotally Occluding the Right Main Bronchus and Mimicking Bronchial Carcinoid Tumor

    PubMed Central

    Lococo, Filippo; Galeone, Carla; Lasagni, Luciano; Carbonelli, Cristiano; Tagliavini, Elena; Piro, Roberto; Zucchi, Luigi; Sgarbi, Giorgio

    2016-01-01

    Abstract Hamartomas are very rarely identified as an endobronchial lesion. Herein, we describe a peculiar case of a 55-year-old woman with persistent cough and increasing dyspnea and radiological detection of a solid lesion subtotally occluding the main right bronchus. Despite the radiological and radiometabolic (18-fluoro-2-deoxy-d-glucose positron emission tomography/computer tomography scan) features were highly suspected for bronchial carcinoid, the definitive diagnosis after endoscopic removal was indicative of an endobronchial hamartoma. When considering differential diagnosis of an endobronchial lesion, the physicians should take firmly in mind such rare entity and, accordingly, bronchoscopy and bronchoscopic biopsy should be done as first step in management of all cases presenting with endobronchial lesions. PMID:27082600

  2. Intrapulmonary schwannoma diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration: case report.

    PubMed

    Watanabe, Keisuke; Shinkai, Masaharu; Shinoda, Masahiro; Ishigatsubo, Yoshiaki; Kaneko, Takeshi

    2014-11-01

    A 47-year-old woman was referred to our hospital for further examination of a lung tumor. CT of the chest revealed a round, well-defined 2.4-cm nodule in S2, adjacent to right superior lobe bronchus. Endobronchial ultrasonography showed a well-defined, hypoechoic tumor with echogenic capsule and posterior acoustic enhancement. Diagnosis of schwannoma was confirmed from the specimen obtained by endobronchial ultrasound-guided transbronchial needle aspiration. She underwent tumorectomy due to the possibility of obstructive pneumonia. Pathology diagnosis from the surgical specimen was also schwannoma. Endobronchial ultrasound-guided transbronchial needle aspiration and findings with endobronchial ultrasonography might be helpful in the diagnosis of intrapulmonary schwannoma. PMID:24907227

  3. Exercise‐induced endobronchial hemorrhage: a rare clinical presentation

    PubMed Central

    Kruavit, Anuk; Jain, Mukesh; Fielding, David

    2016-01-01

    Abstract The phenomenon of exercise‐induced hemoptysis is still relatively underrecognised in humans. We report a case of recurrent hemoptysis brought on by vigorous exercise. A 33‐year‐old male presented with several episodes of intermittent fresh small‐volume hemoptysis reproducible on vigorous exercise. There was no other significant medical history other than a past history of testicular tumor, treated with orchidectomy and adjuvant Bleomycin‐based chemotherapy 1 year prior to onset of symptoms. Computed tomography scan showed no major abnormalities other than few small bilateral non‐specific nodules. Computed tomography aortogram and pulmonary angiogram, ventilation/perfusion scan, and echocardiography yielded no significant abnormalities. Infectious, autoimmune disease, coagulopathy, vasculitis, and malignant causes were excluded. Bronchoscopy showed possible endobronchial bleeding. This phenomenon is thought to be due to vulnerability of pulmonary capillaries to stress or mechanical failure during strenuous exercise at high cardiorespiratory workload. PMID:27512564

  4. Past, present, and future of endobronchial laser photoresection.

    PubMed

    Khemasuwan, Danai; Mehta, Atul C; Wang, Ko-Pen

    2015-12-01

    Laser photoresection of central airway obstruction is a useful tool for an Interventional Pulmonologist (IP). Endobronchial therapy of the malignant airway obstruction is considered as a palliative measure or a bridge therapy to the definite treatment of cancer. Several ablative therapies such as electrocautery, argon plasma coagulation (APC), cryotherapy and laser photoresection exist in the armamentarium of IP to tackle such presentations. Besides Neodymium-Yttrium, Aluminum, Garnet (Nd:YAG) laser, there are several different types of laser that have been used by the pulmonologist with different coagulative and cutting properties. This chapter focuses on the historical perspective, current status, and potentials of lasers in the management of central airway lesions. PMID:26807285

  5. Past, present, and future of endobronchial laser photoresection

    PubMed Central

    Khemasuwan, Danai; Wang, Ko-Pen

    2015-01-01

    Laser photoresection of central airway obstruction is a useful tool for an Interventional Pulmonologist (IP). Endobronchial therapy of the malignant airway obstruction is considered as a palliative measure or a bridge therapy to the definite treatment of cancer. Several ablative therapies such as electrocautery, argon plasma coagulation (APC), cryotherapy and laser photoresection exist in the armamentarium of IP to tackle such presentations. Besides Neodymium-Yttrium, Aluminum, Garnet (Nd:YAG) laser, there are several different types of laser that have been used by the pulmonologist with different coagulative and cutting properties. This chapter focuses on the historical perspective, current status, and potentials of lasers in the management of central airway lesions. PMID:26807285

  6. 3D segmentation and reconstruction of endobronchial ultrasound

    NASA Astrophysics Data System (ADS)

    Zang, Xiaonan; Breslav, Mikhail; Higgins, William E.

    2013-03-01

    State-of-the-art practice for lung-cancer staging bronchoscopy often draws upon a combination of endobronchial ultrasound (EBUS) and multidetector computed-tomography (MDCT) imaging. While EBUS offers real-time in vivo imaging of suspicious lesions and lymph nodes, its low signal-to-noise ratio and tendency to exhibit missing region-of-interest (ROI) boundaries complicate diagnostic tasks. Furthermore, past efforts did not incorporate automated analysis of EBUS images and a subsequent fusion of the EBUS and MDCT data. To address these issues, we propose near real-time automated methods for three-dimensional (3D) EBUS segmentation and reconstruction that generate a 3D ROI model along with ROI measurements. Results derived from phantom data and lung-cancer patients show the promise of the methods. In addition, we present a preliminary image-guided intervention (IGI) system example, whereby EBUS imagery is registered to a patient's MDCT chest scan.

  7. Visceral Leishmaniasis with Endobronchial Involvement in an Immunocompetent Adult

    PubMed Central

    Kotsifas, Konstantinos; Metaxas, Eugenios; Koutsouvelis, Ioannis; Skoutelis, Athanassios; Kara, Panayiota; Tatsis, George

    2011-01-01

    Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement. PMID:21577261

  8. Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult.

    PubMed

    Kotsifas, Konstantinos; Metaxas, Eugenios; Koutsouvelis, Ioannis; Skoutelis, Athanassios; Kara, Panayiota; Tatsis, George

    2011-01-01

    Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement. PMID:21577261

  9. Exercise-induced endobronchial hemorrhage: a rare clinical presentation.

    PubMed

    Kruavit, Anuk; Jain, Mukesh; Fielding, David; Heraganahally, Subash

    2016-07-01

    The phenomenon of exercise-induced hemoptysis is still relatively underrecognised in humans. We report a case of recurrent hemoptysis brought on by vigorous exercise. A 33-year-old male presented with several episodes of intermittent fresh small-volume hemoptysis reproducible on vigorous exercise. There was no other significant medical history other than a past history of testicular tumor, treated with orchidectomy and adjuvant Bleomycin-based chemotherapy 1 year prior to onset of symptoms. Computed tomography scan showed no major abnormalities other than few small bilateral non-specific nodules. Computed tomography aortogram and pulmonary angiogram, ventilation/perfusion scan, and echocardiography yielded no significant abnormalities. Infectious, autoimmune disease, coagulopathy, vasculitis, and malignant causes were excluded. Bronchoscopy showed possible endobronchial bleeding. This phenomenon is thought to be due to vulnerability of pulmonary capillaries to stress or mechanical failure during strenuous exercise at high cardiorespiratory workload. PMID:27512564

  10. Endobronchial avium mycobacteria infection in an immunocompetent child.

    PubMed

    Perisson, Caroline; Nathan, Nadia; Thierry, Briac; Corvol, Harriet

    2013-01-01

    A 12-month-old boy, with no medical history, was admitted for dyspnoea with no cough or fever. Chest auscultation revealed an expiratory wheezing with decreased right-sided breath sounds. Chest imaging revealed subcarinal adenopathy and a nodule in the right principal bronchus (RB). Bronchoscopy showed a major obstruction of the RB by a granuloma, and a smaller granuloma in the left principal bronchus. The granulation tissue was removed by laser section. Histological examination revealed a necrotising granulomatous inflammation, culture showed a Mycobacterium avium complex (MAC). Tests to rule out tuberculosis and immunodeficiency were negative. The diagnosis of an MAC endobronchial granuloma was ascertained and a multidrug therapy associating clarithromycin, rifampin and ethambutol was started. The clinical outcome was good after 3 months of treatment and the bronchoscopy normalised after 1 year. Although rare, the frequency of MAC respiratory infections in immunocompetent children can increase. Reporting these cases should help to optimise diagnosis and treatment. PMID:24252838

  11. Endobronchial Watanabe Spigot in the treatment of bronchobiliary fistula.

    PubMed

    Özdemir, Cengiz; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altay, Sezin; Karasulu, Ahmet Levent; Dalar, Levent

    2016-01-01

    Bronchobiliary fistula (BBF) is a rare condition in which an abnormal communication exists between the bile ducts and the bronchial tree. Malignancy is the most common etiology of BBF, although many others are possible. A 74-year-old male patient with an inoperable Klatskin tumor presented with a complaint of yellow-green sputum and cough; the patient underwent fiber-optic bronchoscopy based on a preliminary diagnosis of bronchobiliary fistula. Using fiber-optic rigid bronchoscopy, the laterobasal segment of the lower right lung lobe was occluded using three pieces of 5-mm Endobronchial Watanabe Spigot. Bile drainage subsequently ceased. A bronchoscopic approach provides an alternative option for BBF treatment, particularly in patients who choose not to undergo surgery, or for whom surgery is not an option due to their underlying general condition. PMID:27374219

  12. Simulator training for endobronchial ultrasound: a randomised controlled trial.

    PubMed

    Konge, Lars; Clementsen, Paul Frost; Ringsted, Charlotte; Minddal, Valentina; Larsen, Klaus Richter; Annema, Jouke T

    2015-10-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is very operator dependent and has a long learning curve. Simulation-based training might shorten the learning curve, and an assessment tool with solid validity evidence could ensure basic competency before unsupervised performance.A total of 16 respiratory physicians, without EBUS experience, were randomised to either virtual-reality simulator training or traditional apprenticeship training on patients, and then each physician performed EBUS-TBNA procedures on three patients. Three blinded, independent assessor assessed the video recordings of the procedures using a newly developed EBUS assessment tool (EBUSAT).The internal consistency was high (Cronbach's α=0.95); the generalisability coefficient was good (0.86), and the tool had discriminatory ability (p<0.001). Procedures performed by simulator-trained novices were rated higher than procedures performed by apprenticeship-trained novices: mean±sd are 24.2±7.9 points and 20.2±9.4 points, respectively; p=0.006. A pass/fail standard of 28.9 points was established using the contrasting groups method, resulting in 16 (67%) and 20 (83%) procedures performed by simulator-trained novices and apprenticeship-trained novices failing the test, respectively; p<0.001.The endobronchial ultrasound assessment tool could be used to provide reliable and valid assessment of competence in EBUS-TBNA, and act as an aid in certification. Virtual-reality simulator training was shown to be more effective than traditional apprenticeship training. PMID:26160875

  13. Mucoid impaction of the bronchi in relation to asthma and plastic bronchitis

    PubMed Central

    Morgan, A. D.; Bogomoletz, W.

    1968-01-01

    Mucoid impaction of the bronchi is a condition which deserves wider recognition in this country. It should be considered in any asthmatic subject who may be suspected on clinical or radiological grounds to be suffering from pulmonary tuberculosis or neoplasm. Although 120 cases have been reported since 1951, there are no reports from this country in the British literature. As we have seen three cases in one hospital, we believe that mucoid impaction is being diagnosed under other headings, for example plastic bronchitis. Most of the changes in lungs removed for mucoid impaction are those of asthma, although other factors may play a part. We have compared the pathologies of mucoid impaction, asthma, and plastic bronchitis, and conclude that, while they overlap considerably, they are not identical. Mucoid impaction is an uncommon complication of asthma and certain forms of bronchitis; plastic bronchitis has a much wider aetiological background and is not a pathological entity. Images PMID:5736360

  14. Epithelial surfaces of the trachea and principal bronchi in the rat.

    PubMed Central

    Alexander, I; Ritchie, B C; Maloney, J E; Hunter, C R

    1975-01-01

    The epithelial surfaces in the trachea and principal bronchi of healthy rats were examined by scanning electron microscopy. A system of four cell types, ciliated, microvillous, brush, and goblet cells, in this order of frequency, were found and intermediate type cells were not seen. An extensive area of the surface examined was covered by densely ciliated epithelium. The presence of other cell types beneath the cilia was confirmed by transmission electron microscopy. Areas up to 1 mm in diameter and randomly distributed were observed where microvillous cells predominated and only occasional ciliated cells were found. Most ciliated cells in these areas were adjacent to glandular openings or goblet cells. The larger microvilli of the brush cells were arranged in a coronal configuration elucidated by the scanning electron microscope. Preparatory techniques recently introduced for the examination of soft tissue in the scanning electron microscope facilitated the confirmation of cell types present and the microarchitecture of the epithelial surface. Images PMID:1179314

  15. New findings on the three-dimensional anatomical relations between the bronchi and pulmonary blood vessels at the pulmonary hilum.

    PubMed

    Onuki, Takamasa; Kanzaki, Masato; Kikkawa, Takuma; Isaka, Tamami; Sakamoto, Kei; Oyama, Kunihiro; Murasugi, Masahide

    2015-05-01

    During the 1940s, considerable knowledge was acquired about the anatomy of pulmonary segments, and anatomical terms were proposed and have been widely accepted. In recent years, minimally invasive and thoracoscopic segmentectomy has been performed with a versatile sublobar resection approach on patients with early peripheral lung cancer, metastatic lung tumors, and undiagnosed nodules. The three-dimensional (3D) anatomy of the bronchi and the pulmonary vessels has also been studied in individual patients. Three-dimensional models of the bronchi and pulmonary vessels were prepared using homemade software from computed tomograms (CT) of the chests of patients scheduled to undergo surgical procedures. Using these models, the authors examined the 3D positional relationships of the segmental broncho-arterial triangle (SBAT) created by three points defined by the origins and courses of the bronchi and the pulmonary arteries, which are located apart from each other at the pulmonary hilum, and the segmental pulmonary veins (SPV), which run near the SBAT. In the left and right upper lobes, many branches of the pulmonary arteries and parallel bronchi in subsegments were widely separated at the origin of the pulmonary hilum, creating a relatively large SBAT. However, as an exceptional case, an SPV passed through an SBAT in only one of 158 patients. To our knowledge, no similar findings have been documented previously. Our findings could help to determine resection surfaces for thoracoscopic segmentectomy in the future, and provide new insights into the 3D anatomy and development of the lung. PMID:25546314

  16. Computational fluid dynamics simulation of airflow in the trachea and main bronchi for the subjects with left pulmonary artery sling

    PubMed Central

    2014-01-01

    Background Left pulmonary artery sling (LPAS) is a rare but severe congenital anomaly, in which the stenoses are formed in the trachea and/or main bronchi. Multi-detector computed tomography (MDCT) provides useful anatomical images, but does not offer functional information. The objective of the present study is to quantitatively analyze the airflow in the trachea and main bronchi of LPAS subjects through computational fluid dynamics (CFD) simulation. Methods Five subjects (four LPAS patients, one normal control) aging 6-19 months are analyzed. The geometric model of the trachea and the two main bronchi is extracted from the MDCT images. The inlet velocity is determined based on the body weight and the inlet area. Both the geometric model and personalized inflow conditions are imported into CFD software, ANSYS. The pressure drop, mass flow ratio through two bronchi, wall pressure, flow velocity and wall shear stress (WSS) are obtained, and compared to the normal control. Results Due to the tracheal and/or bronchial stenosis, the pressure drop for the LPAS patients ranges 78.9 - 914.5 Pa, much higher than for the normal control (0.7 Pa). The mass flow ratio through the two bronchi does not correlate with the sectional area ratio if the anomalous left pulmonary artery compresses the trachea or bronchi. It is suggested that the C-shaped trachea plays an important role on facilitating the air flow into the left bronchus with the inertia force. For LPAS subjects, the distributions of velocities, wall pressure and WSS are less regular than for the normal control. At the stenotic site, high velocity, low wall pressure and high WSS are observed. Conclusions Using geometric models extracted from CT images and the patient-specified inlet boundary conditions, CFD simulation can provide vital quantitative flow information for LPAS. Due to the stenosis, high pressure drops, inconsistent distributions of velocities, wall pressure and WSS are observed. The C-shaped trachea may

  17. Single-incision video-assisted anatomical segmentectomy with handsewn bronchial closure for endobronchial lipoma

    PubMed Central

    Sesma, Julio; Bolufer, Sergio; Lirio, Francisco; Navarro-Martinez, Jose; Galiana, Maria; Baschwitz, Benno; Rivera, Maria Jesus

    2016-01-01

    Endobronchial lipomas are rare benign tumors whose symptoms are usually confused with recurrent infections or even asthma diagnosis, and mostly caused by endobronquial obstructive component which also conditions severity. We report a case of a 60-year-old man with a right-lower lobe upper-segment endobronchial myxoid tumor with uncertain diagnosis. We performed a single incision video-assisted anatomical segmentectomy and wedge bronchoplasty with handsewn closure to achieve complete resection and definitive diagnosis. During the postoperative air leak was not observed and there was no complication, with low pain scores and complete recovery. Final pathological exam showed endobronchial lipoma. Single-incision (SI) anatomical segmentectomies are lung-sparing resections for benign or low-grade malignancies with diagnostic and therapeutic value, and the need for a wedge bronchoplasty is not a necessary indication for conversion to multiport or open thoracotomy. PMID:27570778

  18. The Role of Airway and Endobronchial Ultrasound in Perioperative Medicine

    PubMed Central

    Votruba, Jiri; Zemanová, Petra; Lambert, Lukas; Vesela, Michaela Michalkova

    2015-01-01

    Recent years have witnessed an increased use of ultrasound in evaluation of the airway and the lower parts of the respiratory system. Ultrasound examination is fast and reliable and can be performed at the bedside and does not carry the risk of exposure to ionizing radiation. Apart from use in diagnostics it may also provide safe guidance for invasive and semi-invasive procedures. Ultrasound examination of the oral cavity structures, epiglottis, vocal cords, and subglottic space may help in the prediction of difficult intubation. Preoperative ultrasound may diagnose vocal cord palsy or deviation or stenosis of the trachea. Ultrasonography can also be used for confirmation of endotracheal tube, double-lumen tube, or laryngeal mask placement. This can be achieved by direct examination of the tube inside the trachea or by indirect methods evaluating lung movements. Postoperative airway ultrasound may reveal laryngeal pathology or subglottic oedema. Conventional ultrasound is a reliable real-time navigational tool for emergency cricothyrotomy or percutaneous dilational tracheostomy. Endobronchial ultrasound is a combination of bronchoscopy and ultrasonography and is used for preoperative examination of lung cancer and solitary pulmonary nodules. The method is also useful for real-time navigated biopsies of such pathological structures. PMID:26788507

  19. The Role of Airway and Endobronchial Ultrasound in Perioperative Medicine.

    PubMed

    Votruba, Jiri; Zemanová, Petra; Lambert, Lukas; Vesela, Michaela Michalkova

    2015-01-01

    Recent years have witnessed an increased use of ultrasound in evaluation of the airway and the lower parts of the respiratory system. Ultrasound examination is fast and reliable and can be performed at the bedside and does not carry the risk of exposure to ionizing radiation. Apart from use in diagnostics it may also provide safe guidance for invasive and semi-invasive procedures. Ultrasound examination of the oral cavity structures, epiglottis, vocal cords, and subglottic space may help in the prediction of difficult intubation. Preoperative ultrasound may diagnose vocal cord palsy or deviation or stenosis of the trachea. Ultrasonography can also be used for confirmation of endotracheal tube, double-lumen tube, or laryngeal mask placement. This can be achieved by direct examination of the tube inside the trachea or by indirect methods evaluating lung movements. Postoperative airway ultrasound may reveal laryngeal pathology or subglottic oedema. Conventional ultrasound is a reliable real-time navigational tool for emergency cricothyrotomy or percutaneous dilational tracheostomy. Endobronchial ultrasound is a combination of bronchoscopy and ultrasonography and is used for preoperative examination of lung cancer and solitary pulmonary nodules. The method is also useful for real-time navigated biopsies of such pathological structures. PMID:26788507

  20. [Endobronchial ultrasound (EBUS): the state of the art].

    PubMed

    Douadi, Y; Dayen, C; Lachkar, S; Fournier, C; Thiberville, L; Ramon, P; François, G; Jounieaux, V

    2012-04-01

    Endobronchial ultrasound (EBUS) is a technique which allows the endoscopist to sample mediastinal and/or hilar lymph nodes for complete staging of thoracic malignancy without recourse to surgery. Originally developed at the beginning of the 21st century, EBUS has become a well developed practice within France in recent years. As the technique requires high tech, expensive and fragile equipment, it has been important to develop an approach that is appropriate for the specific features and constraints of the French health system, including access to anaesthesia, imaging modalities and costing. The first centers to adopt EBUS had to adapt quickly and develop their own practices for its use. Training seminars were carried out in order to pass on this experience. After the passage of several years, it seems helpful to give a progress report on this technique through the stages of its development, taking account of the specificities of the French system and thus to transmit this accumulated experience. In this article, the authors review the literature concerning all the essential aspects needed to apply this technique under the best conditions in the French health system. PMID:22542406

  1. The Cohen flexitip endobronchial blocker: an alternative to a double lumen tube.

    PubMed

    Cohen, Edmond

    2005-12-01

    One-lung ventilation (OLV) is usually achieved by the use of a double-lumen tubes (DLTs). With increasing need for use of OLV for video-assisted thoracoscopic procedures, the limitations of traditional DLT's, including difficult insertion and positioning, have become evident. This has led to renewed interest in devising alternative methods of achieving lung separation, such as the Univent tube or Arndt endobronchial blocker. This report describes the technical features and clinical use of a new tip-deflecting endobronchial blocker. PMID:16301278

  2. Endobronchial ultrasound EBUS--a new method for the diagnosis and staging of lung cancer.

    PubMed

    Simon, Marioara; Baldea, Luminiţa; Pop, Bogdan; Crişan, Doiniţa

    2015-01-01

    In this paper we present a new method, endobronchial ultrasound (EBUS), which appeared recently among the tools of the pulmonologist for the diagnosis and staging of lung cancer. Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) provides the opportunity for obtaining tissue samples required for the histologic and cytologic diagnosis of lung cancer. The advantages of EBUS have to be made popular as it is a minimally invasive method, safe, simple, fast, also with a superior cost/benefit ratio compared to any previously used methods. PMID:26506670

  3. The functional significance of the sympathetic innervation of mucous glands in the bronchi of man.

    PubMed Central

    Pack, R J; Richardson, P S; Smith, I C; Webb, S R

    1988-01-01

    1. Pieces of human bronchi, from lung resected for carcinoma of the bronchus, were mounted in Ussing chambers and given [35S]sulphate as radiolabelled precursor of mucous glycoproteins (mucins). The release of 35S, bound to macromolecules, into the luminal half-chamber was used as an index of mucin secretion. 2. Noradrenaline, at concentrations of 1, 10 and 100 microM, was given into both halves of the Ussing chamber. At the lowest concentration, noradrenaline failed to change mucin output, but at the two higher concentrations it stimulated output. 3. In other experiments the sympathetic nerves in the bronchial wall were labelled with 5-hydroxydopamine and examined under the electron microscope. The distances between adrenergic nerve varicosities and submucosal glands were measured; some sympathetic nerve varicosities were seen within 1 microns of gland cells. 4. A simple mathematical model for the diffusion of noradrenaline was used to predict the concentrations of the transmitter likely to result at different distances from a nerve if one or more vesicles of noradrenaline were released. 5. The model predicts that the release of a single large vesicle of noradrenaline is likely to generate an effective concentration of transmitter provided that the nerve is within 1 micron of the target cell. Images Fig. 2 PMID:3253421

  4. In vivo endoscopic autofluorescence microspectro-imaging of bronchi and alveoli

    NASA Astrophysics Data System (ADS)

    Bourg-Heckly, G.; Thiberville, L.; Vever-Bizet, C.; Viellerobe, B.

    2008-02-01

    Fibered confocal fluorescence microscopy (FCFM) is an emerging technique that can be used during bronchoscopy to analyze the nature of the human bronchial mucosa and alveolar network fluorescence microstructure. An endoscopic fibered confocal fluorescence microscopy system with spectroscopic analysis capability was developed allowing realtime, simultaneous images and emission spectra acquisition, at 488 nm excitation, using a flexible miniprobe. This flexible 1.4 mm miniprobe can be introduced into the working channel of a flexible endoscope and gently advanced through the bronchial tree up to the alveoli. FCFM in conjunction with bronchoscopy is able to image the in vivo autofluorescence microstructure of the bronchial mucosa but also the alveolar respiratory network outside of the usual field of view. In the normal bronchi, reproducible images were obtained, characterized by a highly organized fibered network. Precancerous lesions exhibited alterations of this fibered network. Microscopic and spectral analysis showed that the signal mainly originates from the elastin component of the bronchial subepithelial layer. In non smokers, the system images the elastin backbone of the aveoli. In active smokers, a strong autofluorescence signal appears from alveolar macrophages. The FCFM technique appears promising for in vivo exploration of the bronchial and alveolar extracellular matrix.

  5. Location of stretch receptors in the trachea and bronchi of the dog.

    PubMed Central

    Bartlett, D; Jeffery, P; Sant'ambrogio, G; Wise, J C

    1976-01-01

    1. Using single fibre vagal afferent recording techniques, we have investigated the longitudinal and circumferential location of slowly adapting stretch receptors in a functionally isolated, in situ segment of the trachea in dogs. 2. We have also studied the depth of these receptors within the airway wall and their response to reflex and drug induced contraction of the airway smooth muscle. 3. Thirty-four per cent of the receptors studied were in the extrathoracic trachea; calculations indicate that about 17-1% of all airway stretch receptors lie outside the thorax. 4. All the receptors were located in the membranous posterior wall of the trachea, and those tested responded more to transverse than to longitudinal stretching of the wall. 5. Receptors in the extrathoracic trachea continued to function after the regional mucosa had been widely resected; subsequent removal of histolocially proven smooth muscle tissue caused the abrupt cessation of receptor discharge. 6. Contraction of airway smooth muscle brought about an increase in receptor discharge frequency. 7. Similar results were found for a smaller number of stretch receptors located in the mainstem and lobar bronchi. 8. These findings procided evidence that stretch receptors are anatomically located within the smooth muscle layer of the airways and are functionally aranged in series with the muscle fibres. PMID:957165

  6. Smooth muscle in human bronchi is disposed to resist airway distension.

    PubMed

    Gazzola, Morgan; Henry, Cyndi; Couture, Christian; Marsolais, David; King, Gregory G; Fredberg, Jeffrey J; Bossé, Ynuk

    2016-07-15

    Studying airway smooth muscle (ASM) in conditions that emulate the in vivo environment within which the bronchi normally operate may provide important clues regarding its elusive physiological function. The present study examines the effect of lengthening and shortening of ASM on tension development in human bronchial segments. ASM from each bronchial segment was set at a length approximating in situ length (Linsitu). Bronchial tension was then measured during a slow cyclical strain (0.004Hz, from 0.7Linsitu to 1.3Linsitu) in the relaxed state and at graded levels of activation by methacholine. In all cases, tension was greater at longer ASM lengths, and greater during lengthening than shortening. The threshold of methacholine concentration that was required for ASM to account for bronchial tension across the entire range of ASM lengths tested was on average smaller by 2.8 logs during lengthening than during shortening. The length-dependency of ASM tension, together with this lower threshold of methacholine concentration during lengthening versus shortening, suggest that ASM has a greater ability to resist airway dilation during lung inflation than to narrow the airways during lung deflation. More than serving to narrow the airway, as has long been thought, these data suggest that the main function of ASM contraction is to limit airway wall distension during lung inflation. PMID:27095271

  7. Recent advances in endobronchial ultrasound-guided transbronchial needle aspiration.

    PubMed

    Nakajima, Takahiro; Yasufuku, Kazuhiro; Fujiwara, Taiki; Yoshino, Ichiro

    2016-07-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for sampling of mediastinal and hilar lymph nodes as well as pulmonary lesions adjacent to the airway. Guidelines for staging of lung cancer suggest that EBUS-TBNA should be considered the best first test of nodal staging for radiologically abnormal lymph nodes that are accessible by this approach. The application of EBUS-TBNA in pulmonary medicine and thoracic oncology is expanding with its role in the diagnosis of sarcoidosis, lymphoma, and tuberculosis. Especially for patients with early-stage sarcoidosis with adenopathy and minimal changes in the lung parenchyma, EBUS-TBNA has a significantly higher diagnostic yield compared to the conventional bronchoscopic modalities. Multidirectional analysis of samples obtained by EBUS-TBNA has allowed assessment of lymphoma and molecular analysis in lung cancer. Histological evaluation with immunohistochemistry, flow cytometry, fluorescence in situ hybridization, and chromosome analysis can be performed if good-quality samples can be obtained. Molecular analyses such as identification of epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) fusion gene detection now are being performed routinely with good sampling. One of the advantages of EBUS-TBNA is the ability to perform repeat procedures in a minimally invasive way. Restaging of the mediastinum after induction therapy can be done safely and with ease compared to repeat surgical procedures. With improvement in molecular analysis technology, comprehensive gene expression analysis will become important in the management of patients with lung cancer. Further advances in EBUS technology and needles for tissue sampling likely will help bronchoscopists to acquire ideal tissue. PMID:27424821

  8. Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation - A Phantom Study

    PubMed Central

    Hohenforst-Schmidt, Wolfgang; Banckwitz, Rosemarie; Zarogoulidis, Paul; Vogl, Thomas; Darwiche, Kaid; Goldberg, Eugene; Huang, Haidong; Simoff, Michael; Li, Qiang; Browning, Robert; Freitag, Lutz; Turner, J Francis; Pivert, Patrick Le; Yarmus, Lonny; Zarogoulidis, Konstantinos; Brachmann, Johannes

    2014-01-01

    Rationale: Cone Beam Computed Tomography imaging has become increasingly important in many fields of interventional therapies. Objective: Lung navigation study which is an uncommon soft tissue approach. Methods: As no effective organ radiation dose levels were available for this kind of Cone Beam Computed Tomography application we simulated in our DynaCT (Siemens AG, Forchheim, Germany) suite 2 measurements including 3D acquisition and again for 3D acquisition and 4 endobronchial navigation maneuvers under fluoroscopy towards a nodule after the 8th segmentation in the right upper lobe over a total period of 20 minutes (min). These figures reflect the average complexity and time in our experience. We hereby describe the first time the exact protocol of lung navigation by a Cone Beam Computed Tomography approach. Measurement: The hereby first time measured body radiation doses in that approach showed very promising numbers between 0,98-1,15mSv giving specific lung radiation doses of 0,42-0,38 mSv. Main results: These figures are comparable or even better to other lung navigation systems. Cone Beam Computed Tomography offers some unique features for lung interventionists as a realtime 1-step navigation system in an open structure feasible for endobronchial and transcutaneous approach. Conclusions: Due to this low level of radiation exposure Cone Beam Computed Tomography is expected to attract interventionists interested in using and guiding endobronchial or transcutaneous ablative procedures to peripheral endobronchial and other lung lesions. PMID:24563674

  9. Pure bronchoplastic resections of the bronchus without pulmonary resection for endobronchial carcinoid tumours†

    PubMed Central

    Nowak, Kai; Karenovics, Wolfram; Nicholson, Andrew G.; Jordan, Simon; Dusmet, Michael

    2013-01-01

    OBJECTIVES Bronchopulmonary carcinoid tumours are relatively uncommon primary lung neoplasms. A small proportion of these lesions are predominantly endobronchial and do not extend beyond the bronchial wall. Endoscopic resection can be performed, but carries around a one in three risk of local recurrence and, therefore, mandates long-term surveillance. An alternative is complete surgical resection via bronchoplastic resection. We present our experience of surgical resection in patients with endobronchial carcinoids. METHODS From 2000 to 2010, 13 patients (age 45 ± 16 years, 10 males) underwent pure bronchoplastic resection, including systematic nodal dissection, for endobronchial carcinoid tumours, without the resection of lung parenchyma. RESULTS There was no significant operative morbidity or mortality. This is a retrospective review of a consecutive case series. The last follow-up for all patients was obtained in 2011. The mean maximum tumour size was 18 ± 8 mm. No lymph node invasion was observed. The median follow-up was 6.3 ± 3.3 years, with no regional recurrence. In 1 case, a tumourlet was identified at 5 years in the contralateral airway and viewed as a metachronous new lesion. CONCLUSIONS Bronchial sleeve resection is a safe procedure for suitably located endobronchial carcinoid tumours. Endoscopic resection should be reserved for patients who decline, or are unfit, for surgery. PMID:23628650

  10. Fibrobronchoscopic cryosurgery for secondary malignant tumors of the trachea and main bronchi

    PubMed Central

    Ma, Qianli; Tian, Yanchu; Liu, Deruo

    2016-01-01

    Abstract Background Patients with secondary malignant tracheal and main bronchial tumors may suffer severe symptoms as a result of major airway obstruction. Curative surgical resection is usually not suitable because of the presence of metastatic disease and poor performance status. In this study, the use of bronchoscopic cryosurgery to reopen the airway is analyzed. Methods The clinical records of 37 patients who experienced secondary maglinancies from December 2001 to January 2013 were retrospectively reviewed. Low temperature cryotherapy (−50°C to −70°C) was delivered to the central part of the tumor by cryoprobe for four to six minutes causing destruction of the tumor mass (Cryo‐melt method). Subsequently, the edge of the tumor was frozen for 30 seconds to two minutes, followed by piecemeal removal of the frozen tumor tissue (Cryo‐resection method). Results The endpoints of the study were degree of symptomatic improvement and survival. The rates of dramatic and partial symptomatic alleviation were 57.1% and 28.6%, respectively, there were no intraoperative deaths, and median survival was 16.0 months. Prolonged survival was significantly correlated to age (under 60 years of age 22.2% vs. over 60 100%, P = 0.011), tumor location (main bronchi 0% vs. trachea 77.8%, P = 0.003), and cryorecanalization times (once 33.3% vs. twice or more 80.0%, P = 0.037). Conclusion Bronchoscopic cryorecanalization is a safe, effective, non‐invasive choice for improving the symptoms of malignant airway obstruction. In addition to achieving local‐regional control, the technique may also contribute to improved survival. PMID:27385989

  11. Conformity of bacterial growth in sputum and contamination free endobronchial samples in patients with cystic fibrosis.

    PubMed Central

    Gilljam, H; Malmborg, A S; Strandvik, B

    1986-01-01

    The use of sputum cultures to guide the antimicrobial treatment of patients with cystic fibrosis has been questioned. Bacterial growth and antibiotic susceptibility patterns of 33 culture pairs from sputum and contamination free endobronchial swabs from 14 patients with cystic fibrosis were compared. As expected, Pseudomonas aeruginosa of the mucoid and non-mucoid type, Staphylococcus aureus, and Haemophilus influenzae were the organisms most frequently found. Absolute or good agreement was found in 73% of the culture pairs. The accuracy of the sputum cultures improved with the duration of antimicrobial treatment. The extra information gained from the endobronchial culture did not change the antimicrobial strategy from that based on the sputum culture alone. It is concluded that sputum cultures provide accurate information about the bacterial colonisation of the lower respiratory tract in patients with cystic fibrosis and therefore can be trusted both at onset of treatment and during the entire treatment period. PMID:3097864

  12. Primary endobronchial myxoid leiomyoma in a child: An unusual case report and review of literature.

    PubMed

    Awasthi, Ashutosh; Dubey, Suparna; Sabhikhi, Abha K; Bal, Sabyasachi

    2016-01-01

    Primary leiomyomas are rare benign tumors of the lung and only 25 cases have been documented in children, most of which are endobronchial. Leiomyomas are benign smooth muscle neoplasms, usually diagnosed on morphological characteristics. However, immunohistochemistry plays a crucial role in the lineage differentiation when these are encountered at unusual sites or with unexpected morphological features. We report a case of endobronchial tumor of a 13-year-old male child who presented with a dry cough and hemoptysis. A mass lesion in the right main bronchus was detected by bronchoscopy and contrast-enhanced computed tomography. On histopathological examination of the resected specimen, a diagnosis of myxoid leiomyoma was made. To the best of our knowledge, this is the first case of myxoid leiomyoma to be reported in the respiratory tract. This case also demonstrates the need for a high index of suspicion and the role of immunomarkers in the diagnosis of such challenging cases. PMID:26960646

  13. Blizzard Sign as a specific endobronchial ultrasound image for ground glass opacity: A case report

    PubMed Central

    Sasada, Shinji; Izumo, Takehiro; Chavez, Christine; Tsuchida, Takaaki

    2014-01-01

    We report a case of lung adenocarcinoma presenting as pure ground glass opacity (GGO) and diagnosed by bronchoscopy with the use endobronchial ultrasound with a guide sheath (EBUS-GS). The lesion was indistinguishable by real-time fluoroscopy but simultaneous endobronchial ultrasound scanning of the involved lung segment showed a hyperechoic shadow that was subtly more intense than a typical snowstorm appearance when scanning normal alveolar tissue. Transbronchial biopsy from this area revealed adenocarcinoma with lepidic growth. On hindsight, it was the aforementioned ultrasound pattern that helped us decide the sampling site for EBUS-GS guided TBB when fluoroscopy was equivocal. We hypothesize that this pattern is specific for GGO and we name it the Blizzard Sign. PMID:26029530

  14. Endobronchial tumor in children: Unusual finding in recurrent pneumonia, report of three cases

    PubMed Central

    Madafferi, Silvia; Catania, Vincenzo D; Accinni, Antonella; Boldrini, Renata; Inserra, Alessandro

    2015-01-01

    We are reporting 3 cases of pediatric endobronchial tumors presented with recurrent pneumonia. The median age of patients, at time of presentation, was 10.6 years. All patients presented with recurrent pneumonia with a mean time to occurrence, after onset of symptoms, of 14 mo. Bronchoscopy was early performed as part of diagnostic work-up and it revealed an endobronchial mass in every case. Complete surgical resection was performed in all cases, with lung preservation in two of them. Neither post-operative chemotherapy nor radiotherapy was required. The mean duration of follow-up was 7 years and all patients are still alive and disease-free. Recurrent pneumonia, in pediatrics, should raise the suspicion of an obstructing lesion, congenital malformation or systemic disease. A systematic approach is useful for organize the clinicians initial workup. Prompt diagnosis allows parenchymal-sparing surgery, which offers the best chance of cure and reduces clinical and functional complications in these patients. PMID:26015878

  15. Peripheral pulmonary carcinoid tumor diagnosed by endobronchial-ultrasound-guided bronchoscopy.

    PubMed

    Tanaka, Ayaka; Akamatsu, Hiroaki; Kawabata, Hiroki; Ariyasu, Hiroyuki; Nakamura, Yasushi; Yamamoto, Nobuyuki

    2016-03-01

    A 45-year-old Japanese woman complained of uncontrolled hypertension and face swelling. She was diagnosed with Cushing's syndrome with secretion of adrenocorticotropic hormone. Fluorodeoxyglucose positron emission tomography-computed tomography revealed a 2 × 2 cm mass in her left lung, with high standardized maximum uptake value. She underwent bronchoscopy with endobronchial ultrasound via a guide-sheath. Surgical resection of her left upper lung was performed, and pathological examination showed a typical carcinoid tumor. After lung resection, she recovered from her subjective symptoms. Diagnosis of peripheral carcinoid tumor of the lung is generally difficult. Here, we introduce a case of peripheral pulmonary carcinoid tumor diagnosed by endobronchial-ultrasound-guided bronchoscopy. PMID:26839693

  16. Recurrent endobronchial diffuse large B-cell lymphoma. Diagnosed by cryoprobe.

    PubMed

    Pajares, Virginia; Torrego, Alfons; Granell, Miquel; Szafranska, Justyna; Mozos, Anna; Puzo, Carmen

    2013-05-01

    The bronchial involvement of diffuse large B-cell lymphoma (DLBCL) is an exceptional finding. Histological diagnosis is done with lung tissue samples. In these cases, the need for immunohistochemistry studies in order to establish the diagnosis requires obtaining tissue samples of adequate size and quality. Sometimes, endoscopic explorations may be repeated to obtain further biopsies. We present the first documented case of recurrent endobronchial DLBCL that was diagnosed from a bronchial biopsy taken with a cryoprobe. PMID:22981515

  17. A new needle on the block: EchoTip ProCore endobronchial ultrasound needle

    PubMed Central

    Dincer, H Erhan; Andrade, Rafael; Zamora, Felix; Podgaetz, Eitan

    2016-01-01

    Endobronchial ultrasound has become the first choice standard of care procedure to diagnose benign or malignant lesions involving mediastinum and lung parenchyma adjacent to the airways owing to its characteristics of being real-time and minimally invasive. Although the incidence of lung cancer has been decreasing, it is and will be the leading cause of cancer-related mortality in the next few decades. When compared to other cancers, lung cancer kills more females than breast and colon cancers combined and more males than colon and prostate cancers combined. The type of lung cancer has changed in recent decades and adenocarcinoma has become the most frequent cell type. Prognosis of lung cancer depends upon the cell type and the staging at the time of diagnosis. The cell type and molecular characteristics of adenocarcinoma may allow individualized targeted treatment. Other malignant conditions in the mediastinum and lung (eg, metastatic lung cancers and lymphoma) can be biopsied using endobronchial ultrasound needles. Endobronchial ultrasound needle biopsies provides mostly cytology specimens due to its small sizes of needles (22 gauge or larger) which may not give enough tissue to make a definitive diagnosis in malignant (eg, lymphoma) or benign conditions (eg, sarcoidosis). EchoTip ProCore endobronchial needle released in early 2014 provides histologic biopsy material. Larger tissue biopsies may potentially provide a higher diagnostic yield and it eliminates mediastinoscopy or other surgical interventions. Here we aim to review bronchoscopic approach in the diagnosis of mediastinal lesions with emphasis of EchoTip ProCore needles. PMID:27099535

  18. Endobronchial leiomyoma in an immunocompetent four-year-old female child.

    PubMed

    Gupta, Pallav; Aggarwal, Riti; Rijal, Prashant; Chugh, Krishan

    2014-03-01

    Pulmonary leiomyoma are uncommonly encountered benign mesenchymal neoplasms in children, usually found in immunosuppressed individuals in association with human immunodeficiency virus or Ebstein-Barr virus infection. We describe an interesting case of a 4-year-old immunocompetent girl who presented with pleural effusion and lung collapse secondary to endobronchial leiomyoma. She underwent a left thoracotomy and a left pneumonectomy for excision of the bronchial mass. PMID:24585919

  19. Toward endobronchial Ir-192 high-dose-rate brachytherapy therapeutic optimization

    NASA Astrophysics Data System (ADS)

    Gay, H. A.; Allison, R. R.; Downie, G. H.; Mota, H. C.; Austerlitz, C.; Jenkins, T.; Sibata, C. H.

    2007-06-01

    A number of patients with lung cancer receive either palliative or curative high-dose-rate (HDR) endobronchial brachytherapy. Up to a third of patients treated with endobronchial HDR die from hemoptysis. Rather than accept hemoptysis as an expected potential consequence of HDR, we have calculated the radial dose distribution for an Ir-192 HDR source, rigorously examined the dose and prescription points recommended by the American Brachytherapy Society (ABS), and performed a radiobiological-based analysis. The radial dose rate of a commercially available Ir-192 source was calculated with a Monte Carlo simulation. Based on the linear quadratic model, the estimated palliative, curative and blood vessel rupture radii from the center of an Ir-192 source were obtained for the ABS recommendations and a series of customized HDR prescriptions. The estimated radius at risk for blood vessel perforation for the ABS recommendations ranges from 7 to 9 mm. An optimized prescription may in some situations reduce this radius to 4 mm. The estimated blood perforation radius is generally smaller than the palliative radius. Optimized and individualized endobronchial HDR prescriptions are currently feasible based on our current understanding of tumor and normal tissue radiobiology. Individualized prescriptions could minimize complications such as fatal hemoptysis without sacrificing efficacy. Fiducial stents, HDR catheter centering or spacers and the use of CT imaging to better assess the relationship between the catheter and blood vessels promise to be useful strategies for increasing the therapeutic index of this treatment modality. Prospective trials employing treatment optimization algorithms are needed.

  20. Combination of fluorescence imaging and local spectrophotometry in fluorescence diagnostics of early cancer of larynx and bronchi

    SciTech Connect

    Sokolov, Vladimir V; Filonenko, E V; Telegina, L V; Boulgakova, N N; Smirnov, V V

    2002-11-30

    The results of comparative studies of autofluorescence and 5-ALA-induced fluorescence of protoporphyrin IX, used in the diagnostics of early cancer of larynx and bronchi, are presented. The autofluorescence and 5-ALA-induced fluorescence images of larynx and bronchial tissues are analysed during the endoscopic study. The method of local spectrophotometry is used to verify findings obtained from fluorescence images. It is shown that such a combined approach can be efficiently used to improve the diagnostics of precancer and early cancer, to detect a primary multiple tumours, as well as for the diagnostics of a residual tumour or an early recurrence after the endoscopic, surgery or X-ray treatment. The developed approach allows one to minimise the number of false-positive results and to reduce the number of biopsies, which are commonly used in the white-light bronchoscopy search for occult cancerous loci. (laser biology and medicine)

  1. Cellular morphometry of the bronchi of human and dog lungs. Progress report, April 1, 1991--October 1, 1991

    SciTech Connect

    Robbins, E.S.

    1991-09-01

    One hundred and forty-seven bronchial samples (generations 3--6) from 66 patients (62 usable; 36 female, 26 male; median age 61) have been dissected by generation from fixed surgical lung specimens obtained after the removal of pathological lesions. In addition, one hundred and fifty-six mongol dog bronchi (generations 2--6) dissected from different lobes of 26 dog lungs have also been similarly prepared. One hundred and twenty-seven human samples have been completely processed for electron microscopy and have yielded 994 electron micrographs of which 655 have been entered into the Computerized Stereological Analysis System (COSAS) and been used for the measurement of the distances of basal and mucous cell nuclei to the epithelial free surface. Similarly 328 micrographs of dog epithelium from 33 bronchial samples have been used to measure the distances of basal and mucous cell nuclei to the epithelial free surface and have been entered into COSAS. Using the COSAS planimetry program, we continue to expand our established data bases which describe the volume density and nuclear numbers per electron micrograph for 5 cell types of the human bronchial epithelial lining of men and women, as well as smokers, non-smokers and ex-smokers and similar parameters for the same 5 epithelial cell types of dog bronchi. Our micrographs of human bronchial epithelium have allowed us to analyze the recent suggestion that the DNA of lymphocytes may be subject to significant damage from Rn progeny while within the lung. Since the last progress report three papers have been submitted for publication. 17 refs., 4 tabs.

  2. Radiation bronchitis and stenosis secondary to high dose rate endobronchial irradiation

    SciTech Connect

    Speiser, B.L. ); Spratling, L.

    1993-03-15

    The purpose of the study was to describe a new clinical entity observed in follow-up bronchoscopies in patients who were treated with high dose rate and medium dose rate remote afterloading brachytherapy of the tracheobronchial tree. Patients were treated by protocol with medium dose rate, 47 patients receiving 1000 cGy at a 5 mm depth times three fractions, high dose rate 144 patients receiving 1000 cGy at a 10 mm depth for three fractions and high dose rate 151 patients receiving cGy at a 10 mm depth for three fractions followed by bronchoscopy. Incidence of this entity was 9% for the first group, 12% for the second, and 13% for the third group. Reactions were grade 1 consisting of mild inflammatory response with a partial whitish circumferential membrane in an asymptomatic patient; grade 2, thicker complete white circumferential membrane with cough and/or obstructive problems requiring intervention; grade 3, severe inflammatory response with marked membranous exudate and mild fibrotic reaction; and grade 4 a predominant fibrotic reaction with progressive stenosis. Variables associated with a slightly increased incidence of radiation bronchitis and stenosis included: large cell carcinoma histology, curative intent, prior laser photoresection, and/or concurrent external radiation. Survival was the strongest predictor of the reaction. Radiation bronchitis and stenosis is a new clinical entity that must be identified in bronchial brachytherapy patients and treated appropriately. 23 refs., 3 figs., 7 tabs.

  3. Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker

    PubMed Central

    2016-01-01

    Adult foreign body (FB) aspiration is an uncommon but potentially fatal event. Options for extraction include flexible bronchoscopy (FLXB), rigid bronchoscopy (RB), and surgical extraction. We report the case of a large, smooth aspirated rock causing airway obstruction in an elderly male. RB is generally the preferred approach for extraction of a large complex FB; however, due to its size, the FB had to be removed using FLXB combined with an endobronchial blocker. In this report, we describe the anesthetic and surgical considerations and the novel technique used to extract the FB. PMID:27274879

  4. Endobronchial polyp derived from a myxosarcoma in the lung of a dog.

    PubMed

    Hill, Richard C; Ginn, Pamela E; Thompson, Margret S; Seguin, M Alexis; Miller, Daphne; Taylor, David P

    2008-01-01

    An endobronchial polyp was visible radiographically and bronchoscopically in an 11-year-old, mixed-breed dog with a persistent cough. The polyp was removed by traction. Initial histological examination suggested it was a myxomatous fibroma. The cough resolved but recurred with polyp regrowth. Two additional lung masses became visible radiographically. The polyp was removed twice more at 6-month intervals. Euthanasia was performed 15 months after first presentation when coughing recurred soon after the final bronchoscopy. Histological examination revealed that the mass was a myxomatous sarcoma. The lung contained two other unrelated tumors: a bronchioloalveolar carcinoma and a carcinoma of unknown origin. PMID:18981198

  5. Pharmacological assessment of the onset of action of aclidinium and glycopyrronium versus tiotropium in COPD patients and human isolated bronchi.

    PubMed

    Rogliani, Paola; Calzetta, Luigino; Ora, Josuel; Lipsi, Roberto; Segreti, Andrea; Matera, Maria Gabriella; Cazzola, Mario

    2015-08-15

    Preclinical studies suggested that aclidinium and glycopyrronium might have a faster onset of action than tiotropium. In this study we assessed the onset of action of aclidinium and glycopyrronium versus tiotropium, all administered at the approved clinical doses, in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and in human isolated bronchi by using different concentrations. Sixteen COPD patients inhaled single doses of aclidinium 400µg, glycopyrronium 50μg and tiotropium 18µg and FEV1 was measured to assess their onset of action. In human isolated bronchi the time to evoke half maximal relaxation of transmural stimulation was tested from 10nM to 1µM for each drug. Nine, eight and twelve patients did not achieve 15% increase of FEV1 after inhalation of aclidinium, glycopyrronium and tiotropium, respectively. Aclidinium (15.6±7.5min) and glycopyrronium (17.9±10.4min) enhanced 15% FEV1 more rapidly than tiotropium (42.5±19.4min), with no significant difference (P>0.05). In isolated airways, glycopyrronium elicited a dose-dependent onset of action (10nM: 8.2±1.3min, 100nM: 7.1±2.1min, 1μM: 3.4±0.4min) that was faster compared to that induced by aclidinium (1μM: 6.4±0.5min) and tiotropium (1μM: 8.4±1.1min) (P<0.05), that halved the contractile tone only at the highest concentration. Bronchodilation induced by aclidinium and glycopyrronium was faster than that induced by tiotropium, but since our analysis was restricted to the acute effect of these LAMAs and the inhaled doses were not isoeffective, the real differences in their impact on the onset of bronchodilation will be definitely determined after a long-term challenge of these treatments at isoeffective doses in COPD patients. PMID:25952728

  6. [Effect of endobronchial laser therapy on the local protection system of the lungs in patients with protracted pneumonia].

    PubMed

    Efimov, V V; Gladchenko, A R; Blazhko, V I

    1989-07-01

    A study of the local pulmonary defense system in 64 patients with protracted pneumonia revealed that endobronchial low-energy laser therapy promoted activation of local defense of the lungs, increased the functional capacity of alveolar macrophages and neutrophils, lysozyme synthesis and improved rheological properties of bronchial secretion. PMID:2800500

  7. Endobronchial fibroma in a pneumoconiosis patient with a history of tuberculosis: A case report and literature review

    PubMed Central

    Wang, Meifang; Liu, Yuquan; Li, Dan; Xiong, Chang; Qian, Xin; Tang, Yijun

    2016-01-01

    Bronchial fibroma is uncommon, with only 18 cases reported since 1948. The current study presents a rare case of endobronchial fibroma, along with a relevant literature review. A 54-year-old male patient with pneumoconiosis and a history of tuberculosis was admitted to the Taihe Hospital Affiliated With Hubei University of Medicine, Shiyan, China, due to refractory dry cough. Computed tomography of the chest showed multiple nodular and confluent opacities in the lung and one cavitation in the right upper lobe region. Bronchoscopy revealed an endobronchial mass in the left main bronchus. A bronchoscopic resection was performed, and the pathological evaluation confirmed fibroma. The patient's dry cough resolved following the removal of the fibroma, and no recurrence was detected during 6 months of follow-up. Endobronchial fibroma is an extremely rare disease, for which a pathological analysis is typically required for an accurate diagnosis. Bronchoscopic treatments, including removal by forceps, argon plasma coagulation and laser or electrocautery snares, may be used to treat patients affected by endobronchial fibroma. PMID:27446391

  8. 3D endobronchial ultrasound reconstruction and analysis for multimodal image-guided bronchoscopy

    NASA Astrophysics Data System (ADS)

    Zang, Xiaonan; Bascom, Rebecca; Gilbert, Christopher R.; Toth, Jennifer W.; Higgins, William E.

    2014-03-01

    State-of-the-art image-guided intervention (IGI) systems for lung-cancer management draw upon high-resolution three-dimensional multi-detector computed-tomography (MDCT) images and bronchoscopic video. An MDCT scan provides a high-resolution three-dimensional (3D) image of the chest that is used for preoperative procedure planning, while bronchoscopy gives live intraoperative video of the endobronchial airway tree structure. However, because neither source provides live extraluminal information on suspect nodules or lymph nodes, endobronchial ultrasound (EBUS) is often introduced during a procedure. Unfortunately, existing IGI systems provide no direct synergistic linkage between the MDCT/video data and EBUS data. Hence, EBUS proves difficult to use and can lead to inaccurate interpretations. To address this drawback, we present a prototype of a multimodal IGI system that brings together the various image sources. The system enables 3D reconstruction and visualization of structures depicted in the 2D EBUS video stream. It also provides a set of graphical tools that link the EBUS data directly to the 3D MDCT and bronchoscopic video. Results using phantom and human data indicate that the new system could potentially enable smooth natural incorporation of EBUS into the system-level work flow of bronchoscopy.

  9. Delayed functional improvement after near-fatal bleeding complication following endobronchial valve therapy for emphysema.

    PubMed

    Baldi, Sergio; Coni, Francesco; Limerutti, Giorgio; Baccega, Massimo; Ruffini, Enrico; Solidoro, Paolo

    2016-01-01

    Endoscopic treatment of emphysema is supported by different methods, including valves, coils and sealants. The mechanism is mainly related to volume reduction of targeted area. Endobronchial valves (EBV) appear the most studied method. In a multicentre randomised study, placement of unidirectional endobronchial valves resulted in a statistically significant functional improvement in the treated cohort compared to the control. Adverse events, occurring post procedure, included COPD exacerbations, haemoptysis, pneumothorax and pneumonia. In our centre we treated 30 patients, between January 2009 and February 2012, with variable improvement of lung function and only mild postoperative complications. The case we report here appears very interesting for the unusual near-fatal complication (massive alveolar haemorrage) followed by delayed strong functional improvement (FEV1 +23%; RV -18%; 6MWD:+33%) six months after the valve placement. This improvement could be attributable to the EBV procedure, but an alternative explanation is that the lung volume reduction may have been enhanced by the complication itself, as an effect of alveolar collapse. PMID:27374220

  10. Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient.

    PubMed

    Abdel-Rahman, Nader; Izhakain, Shimon; Wasser, Walter G; Fruchter, Oren; Kramer, Mordechai R

    2015-01-01

    Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual. PMID:26819795

  11. Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient

    PubMed Central

    Abdel-Rahman, Nader; Izhakain, Shimon; Wasser, Walter G.; Fruchter, Oren; Kramer, Mordechai R.

    2015-01-01

    Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual. PMID:26819795

  12. High Dose Rate Brachytherapy as a Treatment Option in Endobronchial Tumors

    PubMed Central

    Hosni, Ali; Rink, Alexandra; Czarnecka, Kasia; McPartlin, Andrew; Patterson, Susan; Saibishkumar, Elantholiparameswaran

    2016-01-01

    Purpose. To report our experience with high dose rate endobronchial brachytherapy (HDR-EBBT) and to assess its efficacy and tolerability with possibility of its use in selected cases with curative intent. Method. Retrospective review of patients with endobronchial tumors treated at our institution in 2007–2013 with HDR-EBBT. Subjective response and treatment related toxicity were extracted from patients' records. Clinical response was evaluated by chest CT +/− bronchoscopy 2-3 months after treatment. Local control (LC) and overall survival (OS) were analyzed. Results. Overall 23 patients were identified. Ten patients were treated with curative intent, in 8 of them HDR-EBBT was combined with external beam radiotherapy. Short term palliation was as follows: dyspnea (13/15), cough (12/14), and hemoptysis (3/3). Seventeen patients were evaluated, of whom 9 (53%) showed complete response. Four patients developed local failure (only 1 of them treated with curative intent) and were salvaged with HDR-EBBT (n = 1), chemotherapy (n = 2), and laser (n = 1). Among patients treated with curative intent, the 2-year LC and OS were 89% and 67%, respectively, and 2 out of 4 deaths were cancer-related. Late toxicity included bronchial stenosis (n = 1). Only 1 patient had fatal hemoptysis and postmortem examination indicated local recurrence. Conclusion. HDR-EBBT is promising treatment with tolerable complication if used in properly selected patients. PMID:27493804

  13. Cellular morphometry and cycling cell populations of human and dog bronchi. Annual progress report, April 1, 1994--March 31, 1995

    SciTech Connect

    Robbins, E.S.

    1994-12-01

    Quantitative data of the human bronchial epithelial cells at possible risk for malignant transformation in lung cancer is crucial for accurate radon dosimetry and risk analysis. The nuclei of these cells may be targets for damage by {alpha} particles. Then it is important to determine the locations and other parameters of these nuclei in different airway generations, among smokers, non-smokers and ex-smokers, between men and women and in people of different ages. This proposal includes extended morphometric studies on electron micrographs of human bronchial epithelium of defined airway generations. The second part of this proposal describes the continuation of studies to quantitate the cycling tracheo-bronchial epithelial population(s) using proliferation markers and immunocytochemistry on paraffin sections. The proliferative potential of the airway mucosa of smokers, non-smokers, and ex-smokers, men and women, as well as individuals of different ages are being compared. Normal human bronchial linings are also being compared with normal adult dog bronchi and metaplastic and repairing human airways. Since cycling cells can be more sensitive to damage from carcinogens and radioactivity, the quantitative data from this project will allow the development of more accurate radon risk analysis.

  14. Particle Deposition in Human Lungs due to Varying Cross-Sectional Ellipticity of Left and Right Main Bronchi

    NASA Astrophysics Data System (ADS)

    Roth, Steven; Oakes, Jessica; Shadden, Shawn

    2015-11-01

    Particle deposition in the human lungs can occur with every breathe. Airbourne particles can range from toxic constituents (e.g. tobacco smoke and air pollution) to aerosolized particles designed for drug treatment (e.g. insulin to treat diabetes). The effect of various realistic airway geometries on complex flow structures, and thus particle deposition sites, has yet to be extensively investigated using computational fluid dynamics (CFD). In this work, we created an image-based geometric airway model of the human lung and performed CFD simulations by employing multi-domain methods. Following the flow simulations, Lagrangian particle tracking was used to study the effect of cross-sectional shape on deposition sites in the conducting airways. From a single human lung model, the cross-sectional ellipticity (the ratio of major and minor diameters) of the left and right main bronchi was varied systematically from 2:1 to 1:1. The influence of the airway ellipticity on the surrounding flow field and particle deposition was determined.

  15. The comparison of the lengths and diameters of main bronchi measured from two-dimensional and three-dimensional images in the same patients

    PubMed Central

    Lee, Jeong Woo; Choi, Jin-Wook; Han, Young-Jin; Lee, Jun-Rae

    2014-01-01

    Background Recently, multi-planar reconstruction of the three-dimensional (3D) spiral chest CT scan has demonstrated superiority in the evaluation of the tracheobronchial tree. The goal of this study was to measure the lengths of the right and left main bronchi and their anteroposterior (AP) and transverse (TR) diameters using the 3D and two-dimensional (2D) images in the same adult respectively, and to evaluate the degree of correlation between them. Methods We measured the lengths of the right and left main bronchi from the carina to the first of their branches and the AP and TR diameters at the mid-portion of the right main bronchus and 2 cm below the carina in the left main bronchus. We determined the size of the left-sided double-lumen tube (DLT) based on the measured AP diameter of the left main bronchus from the 3D and 2D images, respectively. Results There was moderate correlation between the lengths of both main bronchi obtained from the 3D images and the 2D images, and between the AP diameter of the left main bronchus obtained from the 3D images and the 2D images. Same sized DLTs were estimated in 69% of the men and 34% of the women. Conclusions The lengths of the right and left main bronchi and their AP and TR diameters obtained from 3D images were not strongly correlated with those from 2D images. Therefore, a further study is needed to verify the superiority of 3D images in selecting the appropriate size of left-sided DLT. PMID:24729839

  16. Effective Bolus Dose of Sufentanil to Attenuate Cardiovascular Responses in Laryngoscopic Double-Lumen Endobronchial Intubation

    PubMed Central

    Choi, Byung-Hee; Lee, Yong-Cheol

    2016-01-01

    Background Sufentanil is a potent opioid analgesic frequently used in clinical anesthesia. Double-lumen endobronchial intubation induces profound cardiovascular responses in comparison with ordinary endotracheal intubation because of the larger tube diameter and direct irritation of the carina. Objectives The purpose of this study was to determine the effective bolus dose of sufentanil to attenuate hemodynamic changes in response to laryngoscopic double-lumen endobronchial intubation. Patients and Methods We randomly assigned 72 patients aged 18 - 65 years and with an American Society of Anesthesiologists physical status of 1 or 2 to one of four sufentanil dose groups: NS, S0.1, S0.2, or S0.3. The respective doses for the groups were as follows: normal saline, 0.1 mcg/kg of sufentanil, 0.2 mcg/kg of sufentanil, and 0.3 mcg/kg of sufentanil. Blood pressure and heart rate were recorded during the pre-anesthesia period at baseline, pre-intubation, immediate post-intubation, and every minute during 5 minutes after intubation. Results Baseline mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 89.8 ± 12.1, 89.2 ± 10.9, 88.8 ± 13.6, and 90.7 ± 11.1, respectively. At immediate post-intubation, the mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 129.7 ± 14.7, 120.7 ± 14.2, 120.8 ± 17.2, and 96.7 ± 10.4, respectively. At immediate post-intubation, the mean arterial pressure in the NS, S0.1, and S0.2 groups significantly increased from baseline (P < 0.001), but the S0.3 group showed no difference. In the time point comparison at immediate post- intubation, the S0.3 group had a significantly lower mean arterial pressure than did the NS, S0.1, and S0.2 groups (P < 0.001). Conclusions We found that 0.3 mcg/kg of sufentanil attenuates cardiovascular responses to double-lumen endobronchial intubation without adverse effects. PMID:27252903

  17. "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA).

    PubMed

    Lococo, Filippo; Rossi, Giulio; Agostini, Lorenzo; Filice, Angelina; Paci, Massimiliano; Rapicetta, Cristian; Ricchetti, Tommaso; Tenconi, Sara; Piro, Roberto; Sgarbi, Giorgio

    2014-01-01

    The acquisition of histologic material is obligatory in order to establish the diagnosis of malignant pleural mesothelioma (MPM). In particular, tissue acquisition in cases of "dry" MPM (focal pleural thickening without pleural effusion or mediastinal lymph node involvement) is usually performed via a thoracoscopic pleural biopsy. In contrast, the techniques for performing echoendoscopic (transbronchial or transesophageal) needle aspiration of pleural lesions have only rarely been reported due to the theoretical limitations of tissue acquisition in such cases. We herein report the first case of "dry" MPM successfully diagnosed via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a 73-year-old man presenting with a pleural mass in the right costovertebral recess, adjacent to the carina. The patient underwent radical resection, and a definitive pathological examination confirmed the diagnosis of epithelioid MPM. PMID:24583437

  18. Bonfils assisted double lumen endobronchial tube placement in an anticipated difficult airway

    PubMed Central

    Subramani, Sudhakar; Poopalalingam, Ruban

    2014-01-01

    The role of various airway adjuncts in the management of difficult airway has been described in the literature. Bonfils rigid fiberscope is one of the airway assist devices widely used for endotracheal intubation in the individuals with cervical instability warranting limited neck movements. With our experience in the utilization of Bonfils for single lumen endotracheal tube placement, we are increasingly using for double lumen endobronchial (DLT) intubation as well. We would like to describe our experience in the use of Bonfils for DLT placement and outline the merits and limitations of the other suitable airway assist devices in this report. The double lumen tube has to be modified by decreasing the length of DLT to accommodate the Bonfils fiberscope and this is applicable only in certain type of double lumen tubes for e.g. Bronchocath. PMID:25425788

  19. Pulmonary artery intimal sarcoma diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration.

    PubMed

    Caraway, Nancy P; Salina, Davide; Deavers, Michael T; Morice, Rodolfo; Landon, Gene

    2015-01-01

    Intimal sarcoma of the pulmonary artery is a rare intraluminal malignant neoplasm that has an aggressive biological behavior, and early diagnosis may improve patient outcome. We describe a case of pulmonary artery intimal sarcoma diagnosed on cytologic material obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy with rapid on-site evaluation (ROSE). The aspirate showed loosely cohesive clusters of pleomorphic malignant spindled and epithelioid cells. An immunostain panel did not demonstrate any definitive mesenchymal or epithelial differentiation. The tumor's intraluminal origin was supported by radiographic imaging studies. Subsequently, the patient received preoperative chemotherapy and underwent tumor resection with reconstruction. This report describes the cytomorphologic features of this rare intravascular tumor and demonstrates how EBUS-TBNA with ROSE was instrumental in obtaining optimal cytologic sampling for ancillary studies, thus expediting the management. PMID:25745502

  20. Successful Endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm.

    PubMed

    Comer, David; Bedi, Amit; Kennedy, Peter; McManus, Kieran; McIlwaine, Werner

    2010-01-01

    A case of bronchial occlusion caused by a thoracic aortic aneurysm and the relief of this obstruction by the implantation of expandable metallic stents is described. Stent deployment provided an immediate improvement in lung ventilation and chest radiograph appearances. Stent insertion was uncomplicated, but weaning from mechanical ventilation was unsuccessful and the patient died from a ventilator-associated pneumonia, unrelated to the procedure. Endobronchial stenting should be considered as a non-invasive therapy for the treatment of bronchial obstruction, with respiratory compromise, caused by a thoracic aortic aneurysm when vascular surgery is not an option. The medium to long term survival of this patient group is poor. This can be attributed to complications related to the stent and also to the poor performance status of these patients. PMID:24946305

  1. Diagnosis of non-nodal paratracheobronchial lesions by linear endobronchial ultrasound.

    PubMed

    Lourido, Tamara; Botana, Maribel; Leiro, Virginia; Núñez, Manuel; Fernández-Villar, Alberto

    2013-08-01

    Linear endobronchial ultrasound (EBUS) allows samples of lesions close to the airways to be obtained, as it enables aspiration to be performed under visual control in real time, opening new possibilities for minimally invasive examination of the mediastinum. While there are many publications on its usefulness in the study of mediastinal or hilar lymphadenopathies, there are few that analyse the role of EBUS-guided transbronchial needle aspiration for the diagnosis of other lesions adjacent to the airways or digestive tract. We describe the characteristics and results obtained in a series of 26 cases of non-nodal lesions of different aetiologies studied by EBUS- guided transbronchial needle aspiration through the airways or oesophagus, demonstrating the usefulness and safety of this technique in the diagnosis of these types of lesions. PMID:23791245

  2. A Case of Significant Endobronchial Injury due to Recurrent Iron Pill Aspiration

    PubMed Central

    Kwak, Joo-Hee; Koo, Gun Woo; Chung, Sung Jun; Park, Dong Won; Kwak, Hyun Jung; Moon, Ji-Yong; Kim, Sang-Heon; Sohn, Jang Won; Yoon, Ho Joo; Shin, Dong Ho; Park, Sung Soo; Pyo, Ju Yeon; Oh, Young-Ha

    2015-01-01

    Gastric mucosal damage by iron pills is often reported. However, iron pill aspiration is uncommon. Oxidation of the impacted iron pill causes bronchial mucosal damage that progresses to chronic bronchial inflammation, necrosis, endobronchial stenosis and rarely, perforation. We reported a case of a 92-year-old woman with chronic productive cough and significant left-sided atelectasis. Bronchoscopy revealed substantial luminal narrowing with exudative inflammation of the left main bronchus. Bronchial washing cytology showed necroinflammatory exudate and a small amount of brown material. Mucosal biopsy showed diffuse brown pigments indicative of ferrous pigments, crystal deposition, and marked tissue degeneration. After vigorous coughing, she expectorated dark sediments and her symptoms and radiological abnormalities improved. There are a few such reports worldwide; however, this was the first case reported in Korea. Careful observation of aspiration-prone patients and early detection of iron pill aspiration may prevent iron pill-induced bronchial injury. PMID:26508942

  3. A case of endobronchial polyp mimicking congenital lobar emphysema in an infant

    PubMed Central

    Mehrain, Rahele; Hadipur, Abbas

    2011-01-01

    Background: Congenital lobar emphysema, also called infantile lobar emphysema, is a respiratory disease that occurs in infants when air enters the lungs and cannot leave easily. It results from cartilage deficiency and bronchomalacia causing distal air trapping and respiratory distress. In this study, we present a case of endobronchial polyp mimicking congenital lobar emphysema. Case presentation: An 18-month old infant was admitted to the hospital due to sudden respiratory distress. Chest x- ray showed left hemithorax lucency, mediastinal shift to the right side, left hemidiaphragm flattening, and left oblique fissure bulging to the superior. A broncoscopy showed polyp in the left lower bronchus and the biopsy of the lesion confirmed to be the polyp. Conclusion: The findings of this case emphasize the value of bronchoscopy prior to lobectomy in cases of congenital lobar emphysema. PMID:24551443

  4. High-Dose-Rate Endobronchial Brachytherapy for Recurrent Airway Obstruction From Hyperplastic Granulation Tissue

    SciTech Connect

    Tendulkar, Rahul D. Fleming, Peter A.; Reddy, Chandana A.; Gildea, Thomas R.; Machuzak, Michael; Mehta, Atul C.

    2008-03-01

    Purpose: Benign endobronchial granulation tissue causes airway obstruction in up to 20% of patients after lung transplantation or stent placement. High-dose-rate endobronchial brachytherapy (HDR-EB) has been successful in some cases refractory to standard bronchoscopic interventions. Methods and Materials: Between September 2004 and May 2005, 8 patients with refractory benign airway obstruction were treated with HDR-EB, using one to two fractions of Ir-192 prescribed to 7.1 Gy at a radius of 1 cm. Charts were retrospectively reviewed to evaluate subjective clinical response, forced expiratory volume in 1 second (FEV{sub 1}), and frequency of therapeutic bronchoscopies over 6-month periods before and after HDR-EB. Results: The median follow-up was 14.6 months, and median survival was 10.5 months. The mean number of bronchoscopic interventions improved from 3.1 procedures in the 6-month pretreatment period to 1.8 after HDR-EB. Mean FEV{sub 1} improved from 36% predicted to 46% predicted. Six patients had a good-to-excellent subjective early response, but only one maintained this response beyond 6 months, and this was the only patient treated with HDR-EB within 24 h from the most recent bronchoscopic intervention. Five patients have expired from causes related to their chronic pulmonary disease, including one from hemoptysis resulting from a bronchoarterial fistula. Conclusion: High-dose-rate-EB may be an effective treatment for select patients with refractory hyperplastic granulation tissue causing recurrent airway stenosis. Performing HDR-EB within 24-48 h after excision of obstructive granulation tissue could further improve outcomes. Careful patient selection is important to maximize therapeutic benefit and minimize toxicity. The optimal patient population, dose, and timing of HDR-EB should be investigated prospectively.

  5. An unusual endobronchial foreign body: a gauze that migrated from the mediastinum.

    PubMed

    Oztuna, Funda; Bülbül, Yilmaz; Ozlü, Tevfik

    2005-01-01

    The authors report a 48-year-old white male with lung cancer who was admitted to their clinic with a 1-year history of cough and shortness of breath. The patient was hospitalized because of progression of his complaints over 1 month. On the 3rd day of hospitalization, he expectorated a piece of gauze. The authors performed a fiber-optic bronchoscopy and saw pieces of gauze originating from granulation tissue located in the angle of the lower trachea and left main bronchi. A detailed anamnesis revealed that a mediastinoscopy had been performed 3 years ago for lung cancer staging: the gauze had migrated from the mediastinum to the endobrochial space. PMID:16210896

  6. Endobronchial ultrasound in the evaluation of lung cancer: a practical review and cost analysis for the practicing pulmonologist.

    PubMed

    Bowling, Mark R; Perry, C David; Chin, Robert; Adair, Norman; Chatterjee, Arjun; Conforti, John

    2008-05-01

    Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new technology utilized with bronchoscopy that has been shown to identify bronchial wall invasion by malignant tumors, aid in the fine needle aspiration of peripheral lung lesions and mediastinal/hilar lymph nodes, and determine the course of treatment in patients with pulmonary carcinoma in situ. The decision to invest both time and money in this technology is determined by several factors such as the cost of the equipment, reimbursement for the procedure, availability of training, the number of bronchoscopies one performs in a year, and access to endoscopic ultrasound and mediastinoscopy. This article reviews the literature to determine the utility of endobronchial ultrasound in the management of patients with lung cancer and to provide information to practicing pulmonologists that may aid in determining whether and where this technology fits into their clinical armamentarium. PMID:18414171

  7. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging.

    PubMed

    Lankarani, Ali; Wallace, Michael B

    2012-04-01

    This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease. PMID:22632944

  8. Use of radial probe endobronchial ultrasound for the diagnosis of peripheral pulmonary lesion: First report from India

    PubMed Central

    Sehgal, Inderpaul Singh; Dhooria, Sahajal; Aggarwal, Ashutosh N; Behera, Digambar; Agarwal, Ritesh

    2016-01-01

    Radial probe endobronchial ultrasound (EBUS) helps in the evaluation and sampling of peripheral pulmonary lesions (nodules, masses, consolidation), and has been demonstrated a safer alternative to computed tomography guided procedure, especially in lesions that are away from the chest wall. Although radial probe EBUS has been available for more than two decades, there is no report from the Indian subcontinent. Herein, we describe two cases of peripheral lung lesions that were successfully sampled with the use of radial probe EBUS. PMID:27051114

  9. Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction

    PubMed Central

    Strange, Charlie; Herth, Felix JF; Kovitz, Kevin L; McLennan, Geoffrey; Ernst, Armin; Goldin, Jonathan; Noppen, Marc; Criner, Gerard J; Sciurba, Frank C

    2007-01-01

    Background Lung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently, less invasive bronchoscopic approaches have been designed to utilize these principles while avoiding the associated perioperative risks. The Endobronchial Valve for Emphysema PalliatioN Trial (VENT) posits that occlusion of a single pulmonary lobe through bronchoscopically placed Zephyr® endobronchial valves will effect significant improvements in lung function and exercise tolerance with an acceptable risk profile in advanced emphysema. Methods The trial design posted on Clinical trials.gov, on August 10, 2005 proposed an enrollment of 270 subjects. Inclusion criteria included: diagnosis of emphysema with forced expiratory volume in one second (FEV1) < 45% of predicted, hyperinflation (total lung capacity measured by body plethysmography > 100%; residual volume > 150% predicted), and heterogeneous emphysema defined using a quantitative chest computed tomography algorithm. Following standardized pulmonary rehabilitation, patients were randomized 2:1 to receive unilateral lobar placement of endobronchial valves plus optimal medical management or optimal medical management alone. The co-primary endpoint was the mean percent change in FEV1 and six minute walk distance at 180 days. Secondary end-points included mean percent change in St. George's Respiratory Questionnaire score and the mean absolute changes in the maximal work load measured by cycle ergometry, dyspnea (mMRC) score, and total oxygen use per day. Per patient response rates in clinically significant improvement/maintenance of FEV1 and six minute walk distance and technical success rates of valve placement were recorded. Apriori response predictors based on quantitative CT and lung physiology were defined. Conclusion If endobronchial valves improve FEV1 and health status with an acceptable safety profile in advanced emphysema

  10. Bronchi, Bronchial Tree, & Lungs

    MedlinePlus

    ... Cells, Tissues, & Membranes Cell Structure & Function Cell Structure Cell Function Body Tissues Epithelial Tissue Connective Tissue Muscle Tissue Nervous Tissue Membranes Review Quiz Skeletal ... they are mostly air spaces surrounded by the alveolar cells and elastic connective tissue. They are separated from ...

  11. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): applications in chest disease.

    PubMed

    Medford, Andrew R L; Bennett, Jonathan A; Free, Catherine M; Agrawal, Sanjay

    2010-01-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive option for staging the mediastinum in suspect lung cancer but also in the diagnosis of mediastinal lesions accessible from the airway. This review is aimed at centres considering establishing an EBUS service that may not be so familiar with the technique. It focuses primarily on technical aspects of EBUS-TBNA, training issues, cost considerations, indications, advantages and disadvantages compared with other mediastinal sampling techniques as well as some reference to its performance in clinical studies. In summary, EBUS-TBNA is primarily used for staging non-small cell lung cancer, especially for bulky mediastinal disease and discrete N2 or N3 disease on CT, but also used for the diagnosis of unexplained mediastinal lymphadenopathy. For radical treatment staging, mediastinoscopy is still used at many centres and negative EBUS-TBNA results should be corroborated by mediastinoscopy. In the future, EBUS-TBNA may be used for staging the radiologically normal mediastinum and in re-staging. It is a procedure that can be taught with ease by an experienced operator, has numerous advantages over mediastinoscopy and is potentially cost saving by reducing the number of mediastinoscopies and associated peri-operative support required. PMID:19895387

  12. Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness.

    PubMed

    Fernández-Villar, Alberto; Mouronte-Roibás, Cecilia; Botana-Rial, Maribel; Ruano-Raviña, Alberto

    2016-02-01

    Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases. PMID:26565072

  13. Endobronchial ultrasound-guided transbronchial needle aspiration of pulmonary artery tumors: A systematic review (with video).

    PubMed

    Harris, Kassem; Modi, Kush; Kumar, Abhishek; Dhillon, Samjot Singh

    2015-01-01

    Convex probe endobronchial ultrasound (CP-EBUS) was originally introduced as a diagnostic and staging tool for lung cancer and subsequently utilized for diagnosis of other malignant and benign mediastinal diseases such as melanoma, lymphoma, and sarcoidosis. More recently, CP-EBUS has been successfully used for the visualization and diagnosis of pulmonary emboli and other vascular lesions including primary and metastatic pulmonary artery (PA) tumors. In this review, we will underline the role of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of pulmonary arterial tumors such as sarcomas and tumor emboli. We will concisely discuss the clinical applications of EBUS-TBNA and the types of pulmonary arterial tumors and their different diagnostic modalities. We searched the Cochrane Library and PubMed from 2004 to 2014 to provide the most comprehensive review. Only 10 cases of EBUS-TBNA for intravascular lesions were identified in the literature. Although many cases of EBUS and EUS-guided transvascular tumor biopsies were described in the literature, there were no reported cases of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for intravascular tumor biopsies. Except for one paper, all cases were published as case reports. PMID:26374576

  14. Atypical Endobronchial Carcinoid with Postobstructive Pneumonia Obscuring the Diagnosis of Granulomatosis with Polyangiitis.

    PubMed

    Ali, Robert; Baldeo, Candice; Onyenekwe, Jesse; Lala, Roshan; Landa, Cristian; Siddiqi, Anwer

    2015-01-01

    Granulomatosis with polyangiitis (GPA), previously termed Wegener's Granulomatosis, is an autoimmune small vessel vasculitis which is highly associated with antineutrophil cytoplasmic antibodies (ANCA) and has varied clinical manifestations. Diagnosis hinges on identifying a combination of clinical features of systemic vasculitis, positive ANCA serology, and histological evidence of necrotizing vasculitis, necrotizing glomerulonephritis, or granulomatous inflammation from a relevant organ biopsy. The American College of Rheumatology has also developed a classification criteria focusing specifically on nasal or oral inflammation, abnormal chest radiograph, and abnormal urinary sediment, along with granulomatous inflammation, which helps to distinguish GPA from other forms of systemic vasculitis. In the case presented below, the diagnosis of GPA was delayed as the patient had a concomitant atypical endobronchial carcinoid which predisposed to postobstructive pneumonia. Fortunately, the papular lesions that developed across her lower limbs prompted further investigations. The return of appropriate serology coincided with progression to alveolar hemorrhage, offering a more complete clinical picture, and when she responded to the combination of steroid, cyclophosphamide, and plasma exchange, the diagnosis of GPA was cinched. PMID:26347844

  15. Atypical Endobronchial Carcinoid with Postobstructive Pneumonia Obscuring the Diagnosis of Granulomatosis with Polyangiitis

    PubMed Central

    Ali, Robert; Baldeo, Candice; Onyenekwe, Jesse; Lala, Roshan; Landa, Cristian; Siddiqi, Anwer

    2015-01-01

    Granulomatosis with polyangiitis (GPA), previously termed Wegener's Granulomatosis, is an autoimmune small vessel vasculitis which is highly associated with antineutrophil cytoplasmic antibodies (ANCA) and has varied clinical manifestations. Diagnosis hinges on identifying a combination of clinical features of systemic vasculitis, positive ANCA serology, and histological evidence of necrotizing vasculitis, necrotizing glomerulonephritis, or granulomatous inflammation from a relevant organ biopsy. The American College of Rheumatology has also developed a classification criteria focusing specifically on nasal or oral inflammation, abnormal chest radiograph, and abnormal urinary sediment, along with granulomatous inflammation, which helps to distinguish GPA from other forms of systemic vasculitis. In the case presented below, the diagnosis of GPA was delayed as the patient had a concomitant atypical endobronchial carcinoid which predisposed to postobstructive pneumonia. Fortunately, the papular lesions that developed across her lower limbs prompted further investigations. The return of appropriate serology coincided with progression to alveolar hemorrhage, offering a more complete clinical picture, and when she responded to the combination of steroid, cyclophosphamide, and plasma exchange, the diagnosis of GPA was cinched. PMID:26347844

  16. The Role of Lobe Selection on FEV1 Response in Endobronchial Valve Therapy.

    PubMed

    Liberator, Cole; Shenoy, Kartik; Marchetti, Nathaniel; Criner, Gerard

    2016-08-01

    Endobronchial valve (EBV) therapy has shown improvement in symptoms and lung function despite limited understanding of ideal patient selection. The impact of lobe selection on EBV therapy is unclear. We performed a retrospective analysis to determine the role of lobe selection and identify preprocedure predictors of response to EBV therapy. A total of 492 patients from the USA and Europe were randomized to EBV or control therapy. Spirometry and functional measurements were taken at baseline and 12 months later. At 365 days patients undergoing EBV therapy showed improvement in FEV1 change compared to control regardless of treatment to upper or lower. There was no difference in FEV1 change between the upper and lower lobe treatment groups ( 5 .99, 7.04, p = 0.75). In addition lobe selection was not identified as a significant modifier of FEV1 change in multiple linear regression analysis. Complete lobe fissure was the only significant predictor of FEV1 change (OR 4.14 (2.29, 7.47)). Our results suggest that lobe selection does not play a major role in EBV therapy response. Complete fissure status preprocedure has the greatest influence on FEV1 improvement. These results have implications on patient selection for current treatment and in future EBV studies. PMID:26789984

  17. Efficacy of a New Blind Insertion Technique of Arndt Endobronchial Blocker for Lung Isolation

    PubMed Central

    Liang, Peng; Ni, Juan; Zhou, Cheng; Yu, Hai; Liu, Bin

    2016-01-01

    Abstract This study aimed to find other methods of blind insertion of Arndt endobronchial blocker (AEB) for lung isolation when a fiberoptic bronchoscope (FOB) is unavailable. We compared the effectiveness and safety of 3 insertion techniques of AEB: Gum elastic bougie (GEB)-, bougie combined with cricoid displacing (BCD)-, and fiberoptic bronchoscope (FOB)-guided insertion. Seventy-eight patients undergoing esophageal procedure and requiring left thoracotomy were randomly assigned to 1 of 3 groups: GEB group, BCD group, and FOB group. We recorded the successful placement of AEBs at first attempt, placement time, malposition of AEBs in supine and lateral decubitus position, the bronchus injury score, and other complications. The successful placement of AEB for the first attempt was 22/26, 25/26, and 26/26 patients in GEB, BCD, and FOB groups, respectively. The placement times in GEB and BCD groups were longer than those in the FOB group (P < 0.05). AEB malposition occurred in 1/26, 2/26, 1/26 patients after lateral decubitus position, and AEBs were repositioned in 5/26, 3/26, 1/26 patients by FOB due to poor lung isolation in GEB, BCD, and FOB groups, respectively. There was no difference for the bronchus injury scores and other complications among 3 groups (P > 0.05). Bougie and cricoid displacing-guided blind insertion of AEB seems to be a novel method, which is an effective and safe alternative when FOB was unavailable. PMID:27175708

  18. Mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.

    PubMed

    Leong, Steven C; Marshall, Henry M; Bint, Michael; Yang, Ian A; Bowman, Rayleen V; Fong, Kwun M

    2013-10-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique that allows lung cancer nodal staging and biopsy of parabronchial and paratracheal tissue. Its simplicity, high diagnostic yield, ability to diagnose both benign and malignant conditions, and exceedingly low complication rate has resulted in rapid widespread adoption by surgeons and physicians. EBUS-TBNA-related complications, however, do occur and need to be considered when assessing the risk-benefit profile of performing the procedure, and if the patient represents with unexpected symptoms after the procedure. We describe a 64-year-old woman who presented with a mediastinal abscess 5 days after EBUS-TBNA. This case demonstrates the importance of considering EBUS-TBNA-related complications to guide relevant imaging decisions and antibiotic choices. We review the published literature regarding infective complications of EBUS-TBNA and propose possible pathophysiologies. These complications are likely to increase in frequency as the technique is more widely adopted. PMID:24162119

  19. The Use of Endobronchial Ultrasound in the Diagnosis of Subacute Pulmonary Histoplasmosis

    PubMed Central

    Egressy, Katarine von Lang; Mohammed, Mohammed; Ferguson, J. Scott

    2015-01-01

    Objective. Endobronchial ultrasound (EBUS) utility in diagnosis in malignant and granulomatous mediastinal disease has been well demonstrated. We propose to examine the role of EBUS transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of subacute pulmonary histoplasmosis (SPH) with mediastinal lymphadenopathy in an area where histoplasmosis is endemic. Methods. A retrospective review was performed in a single academic institution between 2009 and 2012 of patients referred for EBUS-TBNA who had radiographic imaging and clinical symptomatology suspicious for SPH. Seven patients were reviewed. TBNA results showing granulomatous disease with areas of necrosis in the appropriate clinical setting were considered to be adequate for the diagnosis of SPH when alternative diagnosis was excluded. Patients underwent further clinical follow-up of 12 months to determine the final diagnosis. Results. All seven patients were felt to have SPH diagnosis reached by a combination of clinical presentation, EBUS-TBNA results, fungal serologies, and antigen testing. None of the patients needed further invasive procedures. Conclusions. EBUS-TBNA is a minimally invasive tool that can be used to support a diagnosis of SPH in patients with a high degree of clinical suspicion. EBUS-TBNA should be considered as an adjunctive diagnostic procedure for patients with SPH in an appropriate clinical setting. PMID:26543344

  20. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer*

    PubMed Central

    Fernández-Bussy, Sebastián; Labarca, Gonzalo; Canals, Sofia; Caviedes, Iván; Folch, Erik; Majid, Adnan

    2015-01-01

    OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. METHODS: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). RESULTS: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. CONCLUSIONS: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions. PMID:26176519

  1. Endobronchial ultrasound-guided transbronchial needle aspiration of hilar and mediastinal lymph nodes detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography

    PubMed Central

    Minami, Daisuke; Takigawa, Nagio; Oda, Naohiro; Ninomiya, Takashi; Kubo, Toshio; Ohashi, Kadoaki; Sato, Akiko; Hotta, Katsuyuki; Tabata, Masahiro; Kaji, Mitsumasa; Tanimoto, Mitsune; Kiura, Katsuyuki

    2016-01-01

    Objective Endobronchial ultrasound-guided transbronchial needle aspiration is of diagnostic value in hilar/mediastinal (N1/N2) lymph node staging. We assessed the utility of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer patients with N1/N2 lymph nodes detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Methods Fifty lung cancer patients with N1/N2 disease on 18F-fluorodeoxyglucose positron emission tomography/computed tomography underwent endobronchial ultrasound-guided transbronchial needle aspiration for pathological lymph nodes between November 2012 and April 2015. The diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration, lymph node site and size, number of needle passes and complications were evaluated retrospectively from patients' medical records. Malignancy was defined as a maximum standardized uptake value (SUVmax) >2.5. Results The median longest diameter of the 61 lymph nodes (29 subcarinal, 21 right lower paratracheal, 6 left lower paratracheal, 4 right hilar and 1 upper paratracheal) was 23.4 mm (range: 10.4–45.7); the median number of needle passes was 2 (range: 1–5). There were no severe complications. A definitive diagnosis was made by endobronchial ultrasound-guided transbronchial needle aspiration in 39 patients (31 adenocarcinomas, 3 small-cell carcinomas, 2 squamous-cell carcinomas, 3 large-cell neuroendocrine carcinomas). In the remaining 11 patients, the diagnosis was indefinite: insufficient endobronchial ultrasound-guided transbronchial needle aspiration material was collected in two patients and non-specific lymphadenopathy was confirmed by endobronchial ultrasound-guided transbronchial needle aspiration or thoracotomy in the other nine patients. The mean lymph node SUVmax was 7.09 (range: 2.90–26.9) and was significantly higher in true-positive than in false-positive nodes (P < 0.05, t-test). Non-specific lymphadenopathy was

  2. How to learn and to perform endoscopic ultrasound and endobronchial ultrasound for lung cancer staging: A structured guide and review

    PubMed Central

    Konge, Lars; Colella, Sara; Vilmann, Peter; Clementsen, Paul Frost

    2015-01-01

    The learning of transesophageal ultrasound guided fine needle aspiration (FNA) (endoscopic ultrasound-FNA), and endobronchial ultrasound guided transbronchial needle aspiration (endosonography) should be based on the following steps: Acquiring theoretical knowledge, training on simulators, and supervised performance on patients. Each step should be completed by passing a validated exam before proceeding to the next step. This approach will assure basic competency on all levels, and testing also facilitates learning and improves retention. Competence in endosonography can be based on a systematic an easy principle consisting of 2 times six anatomical landmarks. PMID:25789278

  3. Solitary endobronchial papillomas with false impression of malignant transformation: report of two cases and review of the literature

    PubMed Central

    Feng, An-Ning; Wu, Hong-Yan; Zhou, Qiang; Sun, Qi; Fan, Xiang-Shan; Zhang, Yi-Fen; Meng, Fan-Qing

    2015-01-01

    Solitary endobronchial papillomas (SEPs) are rare benign tumors of the lung, seldom transform to malignancy. This tumor had been reported occasionally manifest like carcinomas histologically. Herein we report 2 cases of SEPs; one is a squamous cell papilloma providing a false impression of interstitial micro-invasion. The other is a mixed squamous cell and glandular papilloma with massive lipid pneumonia gross appearance, and focally resembles adenocarcinoma with lepidic-like pattern on histological examination. A review of associated literatures was provided. PMID:26339442

  4. LASER BIOLOGY AND MEDICINE: Combination of fluorescence imaging and local spectrophotometry in fluorescence diagnostics of early cancer of larynx and bronchi

    NASA Astrophysics Data System (ADS)

    Sokolov, Vladimir V.; Filonenko, E. V.; Telegina, L. V.; Boulgakova, N. N.; Smirnov, V. V.

    2002-11-01

    The results of comparative studies of autofluorescence and 5-ALA-induced fluorescence of protoporphyrin IX, used in the diagnostics of early cancer of larynx and bronchi, are presented. The autofluorescence and 5-ALA-induced fluorescence images of larynx and bronchial tissues are analysed during the endoscopic study. The method of local spectrophotometry is used to verify findings obtained from fluorescence images. It is shown that such a combined approach can be efficiently used to improve the diagnostics of precancer and early cancer, to detect a primary multiple tumours, as well as for the diagnostics of a residual tumour or an early recurrence after the endoscopic, surgery or X-ray treatment. The developed approach allows one to minimise the number of false-positive results and to reduce the number of biopsies, which are commonly used in the white-light bronchoscopy search for occult cancerous loci.

  5. Endobronchial Ultrasound-Transbronchial Needle Aspiration of Mediastinal and Hilar Lymphadenopathy Learning Curve.

    PubMed

    Kheir, Fayez; Alokla, Khalid; Myers, Leann; Palomino, Jaime

    2016-01-01

    Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) has become a widely available tool that allows sampling of mediastinal and hilar lymph nodes with comparable accuracy as compared with the gold standard procedure, mediastinoscopy. The goal of this study was to evaluate the competence accuracy of this technique in academic medical center in patients with and without malignant disease. This was a retrospective chart review of the first 150 patients who underwent EBUS-TBNA at our institution with an operator not previously trained or supervised while performing the procedure. All nondiagnostic results were confirmed with mediastinoscopy. The cumulative sum analysis is a method used to continuously monitor performance against an established standard to attain competence in the procedure performed. Learning curve was assessed using cumulative sum method. Procedures were divided into sextiles (1-25, 26-50, 51-75, 76-100, 101-125, and 126-150). The technique's diagnostic accuracy was calculated for each of the 6 categories and trend toward improved accuracy was assessed using Cochran-Armitage trend test. Operator competency was achieved between 55th and 60th procedures. The diagnostic accuracy increased from 72% to 88% (from the first to third sextile) but remained stable afterwards at 88% (C-A trend test P = 0.091). The overall diagnostic accuracy was 84%. Trainees' learning rate varies while acquiring adequate knowledge. We suggest that a learning curve for each operator be used to assess competence in EBUS-TBNA procedure before physicians perform it without supervision. PMID:24621644

  6. Transcriptional Profiling of Endobronchial Ultrasound-Guided Lymph Node Samples Aids Diagnosis of Mediastinal Lymphadenopathy

    PubMed Central

    Tomlinson, Gillian S.; Thomas, Niclas; Chain, Benjamin M.; Best, Katharine; Simpson, Nandi; Hardavella, Georgia; Brown, James; Bhowmik, Angshu; Navani, Neal; Janes, Samuel M.; Miller, Robert F.; Noursadeghi, Mahdad

    2016-01-01

    Background Endobronchial ultrasound (EBUS)-guided biopsy is the mainstay for investigation of mediastinal lymphadenopathy for laboratory diagnosis of malignancy, sarcoidosis, or TB. However, improved methods for discriminating between TB and sarcoidosis and excluding malignancy are still needed. We sought to evaluate the role of genomewide transcriptional profiling to aid diagnostic processes in this setting. Methods Mediastinal lymph node samples from 88 individuals were obtained by EBUS-guided aspiration for investigation of mediastinal lymphadenopathy and subjected to transcriptional profiling in addition to conventional laboratory assessments. Computational strategies were used to evaluate the potential for using the transcriptome to distinguish between diagnostic categories. Results Molecular signatures associated with granulomas or neoplastic and metastatic processes were clearly discernible in granulomatous and malignant lymph node samples, respectively. Support vector machine (SVM) learning using differentially expressed genes showed excellent sensitivity and specificity profiles in receiver operating characteristic curve analysis with area under curve values > 0.9 for discriminating between granulomatous and nongranulomatous disease, TB and sarcoidosis, and between cancer and reactive lymphadenopathy. A two-step decision tree using SVM to distinguish granulomatous and nongranulomatous disease, then between TB and sarcoidosis in granulomatous cases, and between cancer and reactive lymphadenopathy in nongranulomatous cases, achieved > 90% specificity for each diagnosis and afforded greater sensitivity than existing tests to detect TB and cancer. In some diagnostically ambiguous cases, computational classification predicted granulomatous disease or cancer before pathologic abnormalities were evident. Conclusions Machine learning analysis of transcriptional profiling in mediastinal lymphadenopathy may significantly improve the clinical utility of EBUS

  7. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases

    PubMed Central

    Ortakoylu, Mediha Gonenc; Iliaz, Sinem; Bahadir, Ayse; Aslan, Asuman; Iliaz, Raim; Ozgul, Mehmet Akif; Urer, Halide Nur

    2015-01-01

    Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value. Methods: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up. Results: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases. Conclusions: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy. PMID:26578131

  8. Usefulness of High Suction Pressure for Sufficient Tissue Collection During Endobronchial Ultrasound Guided Transbronchial Needle Aspiration

    PubMed Central

    Shiroyama, Takayuki; Okamoto, Norio; Suzuki, Hidekazu; Tamiya, Motohiro; Yamadori, Tadahiro; Morishita, Naoko; Otsuka, Tomoyuki; Morita, Satomu; Kurata, Kanako; Okimura, Akira; Kawahara, Kunimitsu; Sasada, Shinji; Hirashima, Tomonori; Kawase, Ichiro

    2013-01-01

    Introduction The optimal suction pressure during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) remains to be determined. The aim of this study was to compare suction pressures for performance in collecting sufficient tissue specimens from mediastinal and hilar lymph nodes during EBUS-TBNA. Methods Retrospective analysis of consecutive patients with mediastinal and hilar lymphadenopathy who underwent EBUS-TBNA over a 3-year period. Results from patients who underwent EBUS-TBNA using a dedicated 20-mL VacLoc (Merit Medical Systems, Inc, South Jordan, UT) syringe (conventional method, group C) were compared with results from patients in whom a disposable 30-mL syringe (high pressure group, group H) was used. The yield for sufficient histologic specimen retrieval and amount of tissue obtained were compared between the 2 groups. Results Of 178 patients who underwent EBUS-TBNA, 131 had lung cancer confirmed by EBUS-TBNA: 35 in group C and 96 in group H. There were 7 patients in group C and 6 in group H who received final diagnoses by cytology alone. There were 28 in group C and 90 in group H who were diagnosed by both cytology and histology. There was a statistically significant difference between the groups in terms of the rate of sufficient sampling for histological specimens (p = 0.04). The H group revealed a tissue area approximately twice that of the C group (p = 0.003). There were no major procedure-related complications in either group. Conclusion Higher suction pressures with larger syringe volumes during EBUS-TBNA may be useful for safely collecting sufficient tissue specimens. PMID:24340058

  9. Characteristics of endobronchial tuberculosis patients with negative sputum acid-fast bacillus

    PubMed Central

    Yıldız, Pınar

    2013-01-01

    Objective Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence, with or without parenchymal involvement. In this study, clinical, radiological and bronchoscopic characteristics of cases diagnosed to have EBTB were evaluated. Methods Sixteen patients with at least three negative sputum examinations for acid-fast bacillus (AFB) and diagnosed as having EBTB on the histopathological examination of bronchoscopically obtained specimens showing granulomatous structures with caseation necrosis and/or positive AFB-culture on the microbiological examination of bronchoscopically obtained specimens were included in our study. Age, sex, symptoms, tuberculin skin test (TST), microbiological examination results and radiological findings were recorded. Bronchoscopical lesions were classified according to Chung classification. Results EBTB was found to be more common in females. Most common symptoms were cough (100%), sputum (75%), weight loss (62.5%), hemoptisis (37.5%), chest pain (25%) and dyspnea (12.5%). Radiological examination findings revealed consolidations/infiltrations (87.5%), nodular lesions (37.5%), cavitary lesions (25%), unilateral (43.7%) or bilateral hilar widening (31.2%) and atelectasia (25%). Middle lob syndrome was seen in three cases. Most common lesions observed bronchoscopically were active caseous lesions, granular lesions, edematous hyperemic lesions, tumorous lesions, fibrostenotic lesions respectively. In all cases “granulomatous inflammation showing caseation” was shown in the histopathological examination of biopsy specimens. Conclusions EBTB can cause various radiological and bronchoscopical findings. In most of the cases distinct response is seen to antituberculous treatment. Bronchial stenosis is an important complication. Treatment should be given as soon as possible to avoid it. PMID:24409353

  10. Endobronchial Ultrasound Changed the World of Lung Cancer Patients: A 11-Year Institutional Experience

    PubMed Central

    Wu, Biing-Ru; Chen, Chih-Yu; Chen, Wei-Chun; Hsia, Te-Chun; Cheng, Wen-Chien; Tu, Chih-Yen; Hsu, Wu-Huei

    2015-01-01

    Objectives The role of advanced bronchoscopic diagnostic techniques in the detection and staging of lung cancer has increased sharply in recent years. The development of endobronchial ultrasound (EBUS) improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions (PLLs). We investigated the impact of using EBUS as a diagnostic method for tissue acquisition in lung cancer patients. Methods In a single center observational retrospective study, 3712 subjects were diagnosed with lung cancer from 2003 to 2013 (EBUS was introduced in 2008). Thus, we divided the data into two periods: the conventional bronchoscopy period (2003 to 2007) and the EBUS period (2008 to 2013). Results A total of 3712 patients were included in the analysis. Comparing the conventional bronchoscopy period with the EBUS period data, there has been a significant reduction in the use of diagnostic modalities: CT-guided biopsy (P < 0.0001) and pleural effusion cytology (P < 0.0001). The proportion of subjects diagnosed using bronchoscopy significantly increased from 39.4% in the conventional period to 47.4% in the EBUS period (P < 0.0001). In the EBUS period, there has also been a significant increase in the proportion of patients proceeding directly to diagnostic surgery (P < 0.0001). Compared to bronchoscopy, the incidence of complications was higher in those who underwent CT guide biopsy. The incidence of iatrogenic pneumothorax significantly decreased in the EBUS period. Conclusions Advanced bronchoscopic techniques are widely used in the diagnosis of lung cancer. At our institution, the increasing use of EBUS for providing lung cancer diagnosis has led to a significant reduction in other diagnostic modalities, namely CT-guided biopsy and pleural effusion cytology. These changes in practice also led to a reduction in the incidence of complications. PMID:26545094

  11. Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer.

    PubMed

    Yasufuku, Kazuhiro; Nakajima, Takahiro; Fujiwara, Taiki; Chiyo, Masako; Iyoda, Akira; Yoshida, Shigetoshi; Suzuki, Makoto; Sekine, Yasuo; Shibuya, Kiyoshi; Yoshino, Ichiro

    2008-06-01

    Endobronchial ultrasound (EBUS) is a promising new modality first introduced during the early 1990s. The radial probe EBUS was initially developed seeking for high-resolution imaging of processes in the airway wall and outside the airways. The structure of special importance was lymph nodes, walls of the central airways, and the mediastinum. After the development of miniaturized radial probes with flexible catheters having a balloon at the tip, it has been applied to aid bronchoscopists during biopsy of patients with respiratory diseases. In particular, the role of EBUS in transbronchial needle aspiration (TBNA) has been established. Radial probe EBUS-guided TBNA has increased the yield of TBNA of mediastinal lymph nodes, although it was still not a real-time procedure with target visualization. New convex probe EBUS (CP-EBUS) with the ability to perform real-time EBUS-guided TBNA (EBUS-TBNA) has emerged to overcome these problems. Indications for EBUS-TBNA are (1) lymph node staging in lung cancer patients; (2) diagnosis of intrapulmonary tumors; (3) diagnosis of unknown hilar and/or mediastinal lymphadenopathy; and (4) diagnosis of mediastinal tumors. Case series using EBUS-TBNA for mediastinal lymph node staging in lung cancer have reported a high yield, ranging from 89% to 98% (average 94.5%). To date, there are no reports of major complications related to EBUS-TBNA. EBUS-TBNA is a novel approach with a high diagnostic yield that is safe. The aim of this article was to review the current role of EBUS-TBNA for the management of lung cancer patients. PMID:18563521

  12. Effect of Endobronchial Valve Therapy on Pulmonary Perfusion and Ventilation Distribution

    PubMed Central

    Pizarro, Carmen; Ahmadzadehfar, Hojjat; Essler, Markus; Tuleta, Izabela; Fimmers, Rolf; Nickenig, Georg; Skowasch, Dirk

    2015-01-01

    Introduction Endoscopic lung volume reduction (ELVR) is an emerging therapy for emphysematous COPD. However, any resulting changes in lung perfusion and ventilation remain undetermined. Here, we report ELVR-mediated adaptations in lung perfusion and ventilation, as investigated by means of pulmonary scintigraphy. Methods In this observational study, we enrolled 26 patients (64.9±9.4 yrs, 57.7% male) with COPD heterogeneous emphysema undergoing ELVR with endobronchial valves (Zephyr, Pulmonx, Inc.). Mean baseline FEV1 and RV were 32.9% and 253.8% predicted, respectively. Lung scintigraphy was conducted prior to ELVR and eight weeks thereafter. Analyses of perfusion and ventilation shifts were performed and complemented by correlation analyses between paired zones. Results After ELVR, target zone perfusion showed a mean relative reduction of 43.32% (p<0.001), which was associated with a significant decrease in target zone ventilation (p<0.001). Perfusion of the contralateral untreated zone and of the contralateral total lung exhibited significant increases post-ELVR (p = 0.002 and p = 0.005, respectively); both correlated significantly with the corresponding target zone perfusion adaptations. Likewise, changes in target zone ventilation correlated significantly with ventilatory changes in the contralateral untreated zone and the total contralateral lung (Pearson’s r: −0.42, p = 0.04 and Pearson’s r: −0.42, p = 0.03, respectively). These effects were observed in case of clinical responsiveness to ELVR, as assessed by changes in the six-minute walk test distance. Discussion ELVR induces a relevant decrease in perfusion and ventilation of the treated zone with compensatory perfusional and ventilatory redistribution to the contralateral lung, primarily to the non-concordant, contralateral zone. PMID:25822624

  13. Experimental Model of Tuberculosis in the Domestic Goat after Endobronchial Infection with Mycobacterium caprae ▿

    PubMed Central

    Pérez de Val, Bernat; López-Soria, Sergio; Nofrarías, Miquel; Martín, Maite; Vordermeier, H. Martin; Villarreal-Ramos, Bernardo; Romera, Nadine; Escobar, Manel; Solanes, David; Cardona, Pere-Joan; Domingo, Mariano

    2011-01-01

    Caprine tuberculosis (TB) has increased in recent years, highlighting the need to address the problem the infection poses in goats. Moreover, goats may represent a cheaper alternative for testing of prototype vaccines in large ruminants and humans. With this aim, a Mycobacterium caprae infection model has been developed in goats. Eleven 6-month-old goats were infected by the endobronchial route with 1.5 × 103 CFU, and two other goats were kept as noninfected controls. The animals were monitored for clinical and immunological parameters throughout the experiment. After 14 weeks, the goats were euthanized, and detailed postmortem analysis of lung lesions was performed by multidetector computed tomography (MDCT) and direct observation. The respiratory lymph nodes were also evaluated and cultured for bacteriological analysis. All infected animals were positive in a single intradermal comparative cervical tuberculin (SICCT) test at 12 weeks postinfection (p.i.). Gamma interferon (IFN-γ) antigen-specific responses were detected from 4 weeks p.i. until the end of the experiment. The humoral response to MPB83 was especially strong at 14 weeks p.i. (13 days after SICCT boost). All infected animals presented severe TB lesions in the lungs and associated lymph nodes. M. caprae was recovered from pulmonary lymph nodes in all inoculated goats. MDCT allowed a precise quantitative measure of TB lesions. Lesions in goats induced by M. caprae appeared to be more severe than those induced in cattle by M. bovis over a similar period of time. The present work proposes a reliable new experimental animal model for a better understanding of caprine tuberculosis and future development of vaccine trials in this and other species. PMID:21880849

  14. Elastic Deformation Properties of Implanted Endobronchial Wire Stents in Benign and Malignant Bronchial Disease: A Radiographic In Vivo Evaluation

    SciTech Connect

    Hautmann, Hubert; Rieger, Johannes; Huber, Rudolf M.; Pfeifer, Klaus J.

    1999-03-15

    Purpose: To evaluate the long-term mechanical behavior in vivo of expandable endobronchial wire stents, we imaged three different prostheses in the treatment of tracheobronchial disease. Methods: Six patients with bronchial stenoses (three benign, three malignant) underwent insertion of metallic stents. Two self-expandable Wallstents, two balloon-expandable tantalum Strecker stents and two self-expandable nitinol Accuflex stents were used. Measurements of deformation properties were performed during voluntary cough by means of fluoroscopy, at 1 month and 7-10 months after implantation. The procedures were videotaped, their images digitized and the narrowing of stent diameters calculated at intervals of 20 msec. Results: After stent implantation all patients improved with respect to ventilatory function. Radial stent narrowing during cough reached 53% (Wallstent), 59% (tantalum Strecker stent), and 52% (nitinol Accuflex stent) of the relaxed post-implantation diameter. Stent compression was more marked in benign compared with malignant stenoses. In the long term permanent deformation occurred with the tantalum Strecker stents; the other stents were unchanged. Conclusion: Endobronchial wire stents can be helpful in the treatment of major airway collapse and obstructing bronchial lesions. However, evidence of material fatigue as a possible effect of exposure to recurrent mechanical stress on the flexible mesh tube may limit their long-term use. This seems to be predominantly important in benign bronchial collapse.

  15. Effective Management of Persistent Pneumothorax Using a Thopaz(®) Digital Drainage System Combined with an Endobronchial Watanabe Spigot.

    PubMed

    Shiroyama, Takayuki; Okamoto, Norio; Tamiya, Motohiro; Hamaguchi, Masanari; Tanaka, Ayako; Nishida, Takuji; Hayama, Manabu; Nishihara, Takashi; Morishita, Naoko; Suzuki, Hidekazu; Hirashima, Tomonori

    2016-01-01

    A 72-year-old man with salivary gland cancer and multiple pulmonary metastases suffering from intractable pneumothorax was transferred to our institution; he was inoperable because of a low pulmonary function. A chest tube had been placed more than a month prior to this admission. A digital drainage system was used for 24-h monitoring of air leaks (Thopaz(®)). Using the Thopaz(®) system, we performed endoscopic bronchial occlusion using an endobronchial Watanabe spigot (EWS) to reduce air leaks. Finally, the air leaks ceased, and the chest tube was removed five days after EWS placement. We herein report a case of persistent pneumothorax that was successfully treated by endoscopic bronchial EWS placement with the aid of a Thopaz(®) system. PMID:26984087

  16. Case report of medical thoracoscopy and endobronchial ultrasound bronchoscopy in the workup of giant solitary fibrous tumor of the pleura.

    PubMed

    Dammad, Tarek; Duchesne, Joshua; Pasnick, Susan

    2016-07-01

    Solitary fibrous tumor of the pleura (SFTP) is a rare tumor of fibroblastic origin. It can be quite vascular, and its surgical management carries the risk of a major intra-operative bleed. The pre-operative use of endobronchial ultrasound (EBUS) to visualize the vascular supply of the tumor has not been reported.We report a case of a patient presenting with progressive shortness of breath and cough who was found to have a very large pleural-based tumor. We describe the use of medical thoracoscopy and EBUS to establish the diagnosis of SFTP and to characterize the blood supply of the tumor.In the future, EBUS may provide an alternative to conventional angiography for both mapping and embolizing tumor blood supply. PMID:27399107

  17. Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes

    PubMed Central

    Szlubowski, Artur; Gil, Tomasz; Kocoń, Piotr; Ziętkiewicz, Mirosław; Twardowska, Magdalena; Kużdżał, Jarosław

    2015-01-01

    This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion. PMID:26855656

  18. Mediastinal mass diagnosed by endobronchial ultrasound as recurrent hepatocellular carcinoma in a post-liver transplantation patient

    PubMed Central

    Alraiyes, Abdul Hamid; Tunsupon, Pichapong; Kheir, Fayez; Salerno, Daniel A

    2016-01-01

    Objective: We presented a rare case of recurrent hepatocellular carcinoma after liver transplant manifested as an isolated mediastinal mass. Methods: A 62-year-old man was referred for evaluation of atypical chest pain and abnormal finding of a computed tomography of the chest. He had history of chronic hepatitis C liver cirrhosis and hepatocellular carcinoma underwent orthotopic liver transplant as a curative treatment three years earlier. Results: The computed tomography of the chest demonstrated paratracheal mediastinal lymphadenopathy. He subsequently underwent endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA). The right paratracheal lymph node station 4R was sampled. Rapid on-site cytology evaluation demonstrated recurrent metastatic hepatocellular carcinoma. Conclusion: Pulmonologist should be cognizant of diagnostic utility of EBUS-TBNA in this clinical setting as more transplant patients on immunosuppressive medications with enlarged mediastinal lymphadenopathy of unknown origin will be referred for further evaluation. PMID:27489713

  19. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis: A Meta-analysis

    PubMed Central

    Hu, Li-Xing; Chen, Ru-Xuan; Huang, Hui; Shao, Chi; Wang, Ping; Liu, Yong-Zhe; Xu, Zuo-Jun

    2016-01-01

    Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods. Methods: We searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 (Nordic Cochrane Center, Copenhagen, Denmark) and Stata 12.0 software (Stata Corporation, College Station, TX, USA). The Mantel-Haenszel method was used to calculate the pooled odds ratio (OR) and 95% confidence intervals (CIs). Results: Sixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy (TBLB) for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 (95% CI, 2.20–15.79, P = 0.0004). These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA + TBLB + endobronchial biopsy (EBB) versus TBNA + TBLB + EBB was 1.54 (95% CI, 0.61–3.93, P = 0.36), implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables. Conclusions: The results of this meta-analysis suggest that EBUS-TBNA + TBLB + EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA + TBLB + EBB could be used instead. PMID:27364799

  20. Impact of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration on Diagnostic Yield of Bronchoscopy in Patients with Mediastinal Lymph Node Enlargement.

    PubMed

    Osinka, K; Zielińska-Krawczyk, M; Korczyński, P; Górnicka, B; Krenke, R

    2016-01-01

    Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) had an enormous impact on the current advancement in diagnostic bronchoscopy. The aims of the present study were: (1) to evaluate the added value of EBUS-TBNA to routine diagnostic bronchoscopy performed in patients with mediastinal lymph node enlargement and (2) to identify factors that affect the diagnostic yield of EBUS-TBNA. We retrospectively analyzed 712 EBUS-TBNA procedures out of the 4081 bronchoscopies performed in the years 2009-2014. The number of EBUS-TBNA procedures increased from 61 (8.8 % of all bronchoscopies) in 2009 to 160 (21.4 %) in 2014. In 625 (87.8 %) patients adequate cytological material was obtained. Based on cytological examination of EBUS-TBNA aspirates, specific diagnosis was made in 367 (51.5 %) patients. The forceps biopsy of endobronchial lesions provided specific diagnosis in only 204 (28.6 %) patients. The percentage of patients with EBUS-TBNA based diagnosis increased steadily from 34.4 % in 2009 to 65.0 % in 2014 (p < 0.0001). The median lymph node diameter in patients with positive EBUS-TBNA findings was 20 (IQR 15-30) mm and was significantly larger than that in patients with negative EBUS-TBNA results (15 (IQR 10-20) mm, p = 0.0001). The highest diagnostic yield (78.5 %) was found in patients with lymph node dimension between 31 mm and 40 mm. We conclude that EBUS-TBNA is a valuable diagnostic method in an unselected group of patients with mediastinal lymph node enlargement. The percentage of positive EBUS-TBNA diagnoses is related to lymph node dimensions. The overall efficacy of EBUS-TBNA improves with increasing years of experience. PMID:26987324

  1. Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions

    PubMed Central

    Ozgul, Guler; Cetinkaya, Erdogan; Ozgul, Mehmet Akif; Abul, Yasin; Gencoglu, Atayla; Kamiloglu, Emine; Gul, Sule; Dincer, H. Erhan

    2016-01-01

    Background and Objectives: Electromagnetic navigation bronchoscopy (ENB) is a promising new technology to increase the diagnostic yield of peripheral lung and mediastinal lesions. Conventional flexible bronchoscopy has a limited yield in peripheral pulmonary lesions, even in experienced hands. Radial endobronchial ultrasound (r-EBUS) with its real-time imaging capability can help to diagnose peripheral pulmonary lesions. In the present study, we aimed to investigate the diagnostic yield and safety of ENB with or without r-EBUS for peripheral lung lesions. Materials and Methods: This study was conducted in a tertiary medical center, and 56 consecutive patients who were thought to be the best candidates for bronchoscopic biopsies at a multidisciplinary meeting were enrolled. ENB was performed under conscious sedation by using an electromagnetic tracking system with multiplanar reconstruction of previously acquired computed tomography (CT) data. Sampling was performed by biopsy forceps, endobronchial brush, and bronchoalveolar lavage. Results: Fifty-six patients (50 men and 6 women; mean age, 60 ± 9 years) were studied. While an electromagnetic navigation system was used in all patients, r-EBUS was used in 26 of 56 patients. The median diameter of the lesions was 30 mm (interquartile range: 23-44 mm). Mean distance of the lesions from the pleura was 14.9 ± 14.6 mm. Mean procedure time was 20 ± 11.5 min. Mean registration error was 5.8 ± 1.5 mm. Mean navigation error was 1.2 ± 0.5 mm. The diagnostic yield of the procedure was 71.4% for peripheral lesions (non-small cell lung cancer = 23, small cell lung cancer = 3, benign diseases = 14). Pneumothorax occurred in only 1 patient (1.7%). Conclusion: ENB with or without r-EBUS is a safe, efficient, and easily applied method for sampling of peripheral lung lesions, with high diagnostic yield independent of lesion size and location. PMID:27386477

  2. A rare case of mediastinal metastasis of ovarian carcinoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

    PubMed

    Carbonari, Augusto; Camunha, Marco; Binato, Marcelo; Saieg, Mauro; Marioni, Fabio; Rossini, Lucio

    2015-10-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a minimally invasive tool with excellent diagnostic accuracy and low risk of complications in the diagnosis of thoracic diseases, including lung cancers and primary mediastinal lesions. Occasionally, EBUS-TBNA may be useful in identifying thoracic metastasis from distant tumors. Here we report an interesting and rare case of mediastinal metastasis of ovarian carcinoma diagnosed by EBUS-TBNA. PMID:26623131

  3. Reversal of IL-13-induced inflammation and Ca(2+) sensitivity by resolvin and MAG-DHA in association with ASA in human bronchi.

    PubMed

    Khaddaj-Mallat, Rayan; Sirois, Chantal; Sirois, Marco; Rizcallah, Edmond; Morin, Caroline; Rousseau, Éric

    2015-09-01

    The aim of this study was to investigate the effects of resolvin D1 (RvD1), as well as the combined treatment of docosahexaenoic acid monoglyceride (MAG-DHA) and acetylsalicylic acid (ASA), on the resolution of inflammation markers and Ca(2+) sensitivity in IL-13-pretreated human bronchi (HB). Tension measurements performed with 300 nM RvD1 largely abolished (50%) the over-reactivity triggered by 10 ng/ml IL-13 pretreatment and reversed hyper Ca(2+) sensitivity. Addition of 300 nM 17(S)-HpDoHE, the metabolic intermediate between DHA and RvD1, displayed similar effects. In the presence of 100 μM ASA (a COX inhibitor), the inhibitory effect of 1 μM MAG-DHA on muscarinic tone was further amplified, but not in the presence of Ibuprofen. Western blot analysis revealed that the combined treatment of MAG-DHA and ASA upregulated GPR-32 expression and downregulated cytosolic TNFα detection, hence preventing IκBα degradation and p65-NFκB phosphorylation. The Ca(2+) sensitivity of HB was also quantified on β-escin permeabilized preparations. The presence of ASA potentiated the inhibitory effects of MAG-DHA in reducing the Ca(2+) hypersensitivity triggered by IL-13 by decreasing the phosphorylation levels of the PKC-potentiated inhibitor protein-17 regulatory protein (CPI-17). In summary, MAG-DHA combined with ASA, as well as exogenously added RvD1, may represent valuable assets against critical AHR disorder. PMID:26159746

  4. Endobronchial ultrasound-guided sheath placement to guide transbronchial biopsy of mediastinal lymphadenopathy and lung mass: a new technique.

    PubMed

    Harris, Kassem; Bessich, Jamie; Sterman, Daniel H

    2015-04-01

    A patient with a history of lung adenocarcinoma, which was treated with chemoradiation, presented to our interventional pulmonology clinic for suspicion of recurrent lung cancer. The patient had a PET-avid right upper-lobe mass and subcarinal lymphadenopathy. We performed a curvilinear endobronchial ultrasound (CP-EBUS) with transbronchial needle aspiration (TBNA), followed by transbronchial EBUS-guided biopsies (TBB) of the subcarinal lymph node using miniforceps. The EBUS needle sheath was inserted over the needle through the bronchial wall and advanced into the lymph node. The EBUS-guided placement of the transbronchial sheath facilitated the miniforcep insertion and the performance of multiple transbronchial biopsies. Given success with this method, we further developed this technique in a second patient with a right lower-lobe mass. In an effort to obtain adequate tissue and minimize repeated efforts at miniforcep guidance into the lesion, we inserted a radial EBUS guide sheath through the curvilinear EBUS scope and guided it into the lesion using the miniforceps. We therefore used the radial sheath as a placeholder while obtaining repeated TBB using miniforceps as described. These modifications of previously described techniques allow for maximal and expeditious sampling of target lymph nodes and masses, with sufficient material obtained for histopathologic analysis. PMID:25887015

  5. Applicator for light delivery and in situ light dosimetry during endobronchial photodynamic therapy: First measurements in humans.

    PubMed

    Murrer, L H; Marijnissen, J P; Baas, P; Van Zandwijk, N; Star, W M

    1997-10-01

    This paper presents a design of an applicator for light delivery and light dosimetry during endobronchial photodynamic therapy (EB-PDT). The design incorporates a linear diffuser that is fixed in the centre of the lumen by a steel spring basket that does not block air flow. An isotropic light detector is included in this design, to measure the light fluence actually delivered to the bronchial mucosa surface. The applicator is designed for use with common bronchoscopy equipment, and can be used with bronchoscopes with a large biopsy channel ( approximately 3 mm). The first clinical measurements were performed and caused no additional discomfort to the (nonphotosensitized) patients. The data showed considerable inter-patient variability of the light fluence rate measured as a result of fixed output power of the diffuser. This fact and the expected strong dependence of the fluence rate on the lumen diameter stress the importance of in situ fluence rate measurement for a proper evaluation of the relationship between light fluence and the biological response of EB-PDT. PMID:20803333

  6. Results of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) in treatment of obstructive endobronchial non-small cell lung cancer

    NASA Astrophysics Data System (ADS)

    Weinberg, Benjamin D.; Allison, Ron R.; Sibata, Claudio; Parent, Teresa; Downie, Gordon

    2009-06-01

    We reviewed the outcome of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) for patients with symptomatic obstruction from endobronchial non-small cell lung cancer. Methods: Nine patients who received combined PDT and HDR for endobronchial cancers were identified and their charts reviewed. The patients were eight males and one female aged 52-73 at diagnosis, initially presenting with various stages of disease: stage IA (N=1), stage IIA (N=1), stage III (N=6), and stage IV (N=1). Intervention was with HDR (500 cGy to 5 mm once weekly for 3 weeks) and PDT (2 mg/kg Photofrin, followed by 200 J/cm2 illumination 48 hours post infusion). Treatment group 1 (TG-1, N=7) received HDR first; Treatment group 2 (TG-2, N=2) received PDT first. Patients were followed by regular bronchoscopies. Results: Treatments were well tolerated, all patients completed therapy, and none were lost to follow-up. In TG-1, local tumor control was achieved in six of seven patients for: 3 months (until death), 15 months, 2+ years (until death), 2+ years (ongoing), and 5+ years (ongoing, N=2). In TG-2, local control was achieved in only one patient, for 84 days. Morbidities included: stenosis and/or other reversible benign local tissue reactions (N=8); photosensitivity reaction (N=2), and self-limited pleural effusion (N=2). Conclusions: Combined HDR/PDT treatment for endobronchial tumors is well tolerated and can achieve prolonged local control with acceptable morbidity when PDT follows HDR and when the spacing between treatments is one month or less. This treatment regimen should be studied in a larger patient population.

  7. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi trial): study design and rationale.

    PubMed

    Davey, C; Zoumot, Z; Jordan, S; Carr, D H; Polkey, M I; Shah, P L; Hopkinson, N S

    2015-03-01

    Although lung volume reduction surgery improves survival in selected patients with emphysema, there has been ongoing interest in developing and evaluating bronchoscopic approaches to try to reduce lung volumes with less morbidity and mortality. The placement of endobronchial valves is one such technique, and although some patients have had a significant improvement, responses have been inconsistent because collateral ventilation prevents lobar atelectasis. We describe the protocol of a trial (ISRCTN04761234) aimed to show that a responder phenotype, patients with heterogeneous emphysema and intact interlobar fissures on CT scanning, can be identified prospectively, leading to a consistent benefit in clinical practice. PMID:24664535

  8. Yield of new versus reused endobronchial ultrasound-guided transbronchial needle aspiration needles: A retrospective analysis of 500 patients

    PubMed Central

    Dhooria, Sahajal; Sehgal, Inderpaul Singh; Gupta, Nalini; Ram, Babu; Aggarwal, Ashutosh Nath; Behera, Digambar; Agarwal, Ritesh

    2016-01-01

    Background: Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) requires a dedicated needle for aspiration of mediastinal lesions. There is no data on reuse of these needles. Methods: This is a retrospective study of patients who underwent EBUS-TBNA with either new or reused EBUS-TBNA needles. The needles were reused after thorough cleaning with filtered water and organic cleaning solution, disinfection with 2.4% glutaraldehyde solution followed by ethylene oxide sterilization. The yield of EBUS-TBNA was compared between the two groups. Results: A total of 500 EBUS-TBNA procedures (351 new, 149 reused needles) were performed. The baseline characteristics were different in the two groups with suspected granulomatous disorders (sarcoidosis or tuberculosis) being significantly more common in the new compared to the reused needle group. Similarly, the median, interquartile range number of lymph node stations sampled, and the total number of passes were significantly higher in the new versus the reused needle group. The diagnostic yield was significantly higher with new needle as compared to reused needle (65.2% vs. 53.7%, P = 0.02). On multivariate logistic regression analysis, clinical suspicion of granulomatous disorders (odds ratio 1.86 [95% confidence interval, 1.20-2.87], P = 0.005) was the only predictor of diagnostic yield, after adjusting for the type of needle (new or reused), total number of passes and the number of lymph node stations sampled. No case of mediastinitis was encountered in either group. Conclusions: The yield of EBUS-TBNA might be similar with single reuse of needles as compared to new needles. However, reuse of needle should be performed only when absolutely necessary. PMID:27578927

  9. Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer

    PubMed Central

    Shan, Hong-Bo; Zhang, Rong; Li, Yin; Gao, Xiao-Yan; Lin, Shi-Yong; Luo, Guang-Yu; Li, Jian-Jun; Xu, Guo-Liang

    2015-01-01

    Background The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer. Methods A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery. Results The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery. Conclusions EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture. PMID:26372339

  10. Usefulness of lymphoid granulomatous inflammation culture obtained by endobronchial ultrasound-guided transbronchial needle aspiration in a fungal endemic area

    PubMed Central

    Berger, John; Zamora, Felix; Podgaetz, Eitan; Andrade, Rafael; Dincer, H. Erhan

    2016-01-01

    Background and Objectives: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the procedure of choice for the evaluation of mediastinal/hilar lymph node enlargements. Granulomatous inflammation of the mediastinal/hilar lymph nodes is often identified on routine histology. In addition, mediastinal lymphadenopathy may be present with undiagnosed infection. We sought to determine the usefulness of routine cultures and histology for infectious etiologies in a fungal endemic area when granulomatous inflammation is identified. Materials and Methods: We identified 56 of 210 patients with granulomatous inflammation on EBUS-TBNA biopsies from October 2012 through October 2014. An onsite cytologist evaluated all biopsies and an additional TBNA pass for microbiologic stains and cultures were obtained in those with granulomatous inflammation. Results: Of the 56 patients with granulomatous inflammation, 20 patients had caseating (necrotizing) granulomas while noncaseating (nonnecrotizing) granulomas were detected in 36 of the remainder patients. In patients with caseating granulomas, fungal elements were identified in 6 of 20 (30%) patients (histoplasma; N = 5, blastomyces; N = 1) on Grocott methenamine silver (GMS) stain. Lymph node cultures identified 3 of 20 (20%) patients as being positive for Mycobacterium tuberculosis (N = 1), Histoplasma capsulatum (N = 1), and Blastomyces dermatitidis (N = 1). Among patients with noncaseating granulomas, only 2 out of 36 (5%) were positive for fungal elements on GMS stain, identified as Histoplasma, although the lymph node cultures remained negative. Conclusion: The incidence of granulomatous inflammation of mediastinal lymph nodes was 26.6% in our series. Of these patients, noncaseating granulomas were more common (64% vs. 36%). Infectious organisms, fungal or acid-fast bacilli (AFB), on either staining or lymph node culture were rarely identified in noncaseating granulomas, 5% and none, respectively

  11. Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer.

    PubMed

    Okachi, Shotaro; Imai, Naoyuki; Imaizumi, Kazuyoshi; Iwano, Shingo; Ando, Masahiko; Hase, Tetsunari; Aso, Hiromichi; Morise, Masahiro; Wakahara, Keiko; Ito, Satoru; Hashimoto, Naozumi; Sato, Mitsuo; Kondo, Masashi; Hasegawa, Yoshinori

    2016-01-01

    Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (≤30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT

  12. Comparison of Endobronchial Ultrasound-Guided Fine Needle Aspiration and Video-Assisted Mediastinoscopy for Mediastinal Staging of Lung Cancer.

    PubMed

    Ge, Xiahui; Guan, Wenbin; Han, Fengfeng; Guo, Xuejun; Jin, Zhichao

    2015-10-01

    Video-assisted mediastinoscopy (VAM) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are the two most commonly used invasive methods for mediastinal staging of lung cancer. The objective of this review is to assess and compare the overall diagnostic values of VAM and EBUS-TBNA. PubMed, Embase, Web of Science and the Cochrane Library were searched for studies that evaluated EBUS-TBNA or VAM accuracy. Quantitative meta-analysis was used to pool sensitivity and specificity, and study quality was evaluated. Meta-regression was applied to indirectly compare EBUS-TBNA and VAM after adjusting quality score, study design, and station number. A total of ten studies with 999 EBUS-TBNA patients and seven studies with 915 VAM patients were included. Since the pooled specificity was 100% for both modalities, sensitivity was mainly analyzed. The pooled sensitivities for EBUS-TBNA and VAM were 0.84 (95% CI 0.79-0.88) and 0.86 (95% CI 0.82-0.90), respectively. Subgroup analyses of quality score, study design, station number and rapid on-site cytologic evaluation showed no significant influence on the overall sensitivity of the two modalities. After adjusting quality score, study design, and station number, the pooled sensitivities of VAM and EBUS-TBNA were not significantly different. However, more procedural complications and fewer false negatives (FN) were found with VAM than EBUS-TBNA. VAM and EBUS exhibited equally high diagnostic accuracy for mediastinal staging of lung cancer. Due to lower morbidity with EBUS-TBNA and fewer FN with VAM, EBUS-TBNA should be performed first, followed by VAM in the case of a negative needle result. PMID:26186887

  13. Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors

    PubMed Central

    Dziedzic, Dariusz; Peryt, Adam; Szolkowska, Malgorzata; Langfort, Renata; Orlowski, Tadeusz

    2016-01-01

    Background and Objectives: The mediastinum is a relatively uncommon site of distant metastases, which typically appear as peripheral lung nodules. We chose to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of distant metastases to the mediastinum. Materials and Methods: Over the period 2008–2013, a total of 446 patients with concurrent or previously diagnosed and treated extrathoracic malignancies were evaluated. Results: Surgical treatment was carried out in 414 patients (156 women and 237 men aged 26–68 years, mean age of 56.5 years) presenting with distant metastases to the lungs: Thoracoscopic wedge resection was completed in 393 patients and lobectomy and segmentectomy were performed in 7 and 14 patients, respectively. The median time from primary tumor resection was 6.5 years (range: 4.5 months to 17 years). Thirty-two of these patients underwent EBUS-TBNA for mediastinal manifestation of the underlying disease. EBUS-TBNA specimens were aspirated from the subcarinal or right paratracheal lymph node stations in 26 (81%) patients and from the hilar lymph nodes in 6 (18.8%) patients only. Metastases to lymph nodes were confirmed in 14 of these patients (43.8%). Primary lung cancer was diagnosed in seven patients. Mediastinoscopy was performed in two patients to reveal either lymph node metastasis or sarcoidosis. Thoracotomy for pulmonary metastases resection and mediastinal lymph node biopsy was performed in nine patients. Lymph node metastasis was confirmed in five patients (15.6%). The diagnostic efficacy, sensitivity, specificity, and negative predictive value (NPV) of EBUS-TBNA were 78.8%, 93.3%, 100%, and 87.5%, respectively. Conclusion: EBUS-TBNA is a valuable diagnostic tool in a selected group of patients with secondary tumors in the mediastinum and lungs. PMID:27386474

  14. Immature myeloid cells and tolerogenic cytokine profile in lung adenocarcinoma metastatic lymph nodes assessed by endobronchial ultrasound.

    PubMed

    Bugalho, Antonio; Martins, Catarina; Silva, Zelia; Nunes, Gloria; Mendes, Andreia S; Ferreira, Inês; Videira, Paula A

    2016-01-01

    In lung cancer, the immune cell compartment of tumor-draining lymph nodes (TDLNs) dictate the response against tumors. This response is predominantly triggered by myeloid antigen-presenting cells (mAPCs) that capture antigens and, if matured, prime anti-tumor-specific T cell populations. However, the clinical role of mAPCs infiltrated in TDLN from lung cancer patients is poorly understood. The purpose of this study was to study mAPCs in TDLN from lung adenocarcinoma patients, in comparison to individuals with non-malignant diseases, using minimally invasive sampling methods. Mediastinal lymph nodes were assessed by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). mAPCs were characterized by flow cytometry and cytokine expression by quantitative polymerase chain reaction. The association with tumor burden, overall survival, and response to treatment was assessed. TDLN from lung adenocarcinoma patients (n = 24) showed a reduced immune cell compartment, but a higher level of infiltrating mAPCs, when compared with control lymph nodes (n = 17). A decreased expression of co-stimulatory molecules CD80/CD86 by TDLN and blood mAPC was observed. TDLN showed lower levels of TNF-α and IL-12 and increased levels of immunosuppressive cytokines TGF-β and IL-10. The IL-12 expression was inversely correlated with the percentage of infiltrated tumor cells, while IL-10 was directly correlated. Patients with lower expression of IL-12 in TDLN or lower expression of CD80/86 in blood mAPCs had worse overall survival and response to therapy. mAPCs of lung adenocarcinoma patients express less co-stimulatory molecules, and within TDLN, the cytokine profile is biased towards a tolerance-inducing phenotype. Patients with enhanced immune parameters have better survival and response to treatment. EBUS-TBNA allows the collection of viable specimens from TDLN that may provide further insight on relevant immunological mechanisms. PMID:26264617

  15. Protection Induced by Simultaneous Subcutaneous and Endobronchial Vaccination with BCG/BCG and BCG/Adenovirus Expressing Antigen 85A against Mycobacterium bovis in Cattle.

    PubMed

    Dean, Gillian S; Clifford, Derek; Whelan, Adam O; Tchilian, Elma Z; Beverley, Peter C L; Salguero, Francisco J; Xing, Zhou; Vordermeier, Hans M; Villarreal-Ramos, Bernardo

    2015-01-01

    The incidence of bovine tuberculosis (bTB) in the GB has been increasing since the 1980s. Immunisation, alongside current control measures, has been proposed as a sustainable measure to control bTB. Immunisation with Mycobacterium bovis bacillus Calmette-Guerin (BCG) has been shown to protect against bTB. Furthermore, much experimental data indicates that pulmonary local immunity is important for protection against respiratory infections including Mycobacterium tuberculosis and that pulmonary immunisation is highly effective. Here, we evaluated protection against M. bovis, the main causative agent of bTB, conferred by BCG delivered subcutaneously, endobronchially or by the new strategy of simultaneous immunisation by both routes. We also tested simultaneous subcutaneous immunisation with BCG and endobronchial delivery of a recombinant type 5 adenovirus expressing mycobacterial antigen 85A. There was significantly reduced visible pathology in animals receiving the simultaneous BCG/BCG or BCG/Ad85 treatment compared to naïve controls. Furthermore, there were significantly fewer advanced microscopic granulomata in animals receiving BCG/Ad85A compared to naive controls. Thus, combining local and systemic immunisation limits the development of pathology, which in turn could decrease bTB transmission. PMID:26544594

  16. A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube

    PubMed Central

    2014-01-01

    Background The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. Methods We enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded. Results Sixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p <0.0001). T2 was also significantly shorter in the TOC group than the TOE group (27.2 ± 2.5 seconds versus 34.9 ± 3.0 seconds, p <0.0001). The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The hemodynamic responses to intubation were broadly similar between the groups. Conclusion When placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick

  17. Endoscopic and endobronchial ultrasonography according to the proposed lymph node map definition in the seventh edition of the tumor, node, metastasis classification for lung cancer.

    PubMed

    Tournoy, Kurt G; Annema, Jouke T; Krasnik, Mark; Herth, Felix J F; van Meerbeeck, Jan P

    2009-12-01

    Accurate assessment of lymph node involvement is a critical step in patients with non-small cell lung cancer in the absence of distant metastases. The International Association for the Study of Lung Cancer has proposed a new lymph node map, which provides precise anatomic definitions for all intrathoracic lymph nodes. Transoesophageal endoscopic ultrasound with fine-needle aspiration and endobronchial ultrasound with transbronchial needle aspiration are two minimally invasive techniques that are increasingly implemented in the staging of non-small cell lung cancer. Therefore, recognition of the proposed anatomic borders by these techniques is very relevant for an accurate clinical staging. We here discuss the reach and limits of endoscopic ultrasound in the precise delineation and approach of the intrathoracic lymph nodes according to the new lymph node map for the seventh edition of the tumor, node, metastasis classification for lung cancer. PMID:19884852

  18. An update on the efficacy of endobronchial valve therapy in the management of hyperinflation in patients with chronic obstructive pulmonary disease.

    PubMed

    Valipour, Arschang; Burghuber, Otto Chris

    2015-12-01

    Lung volume reduction surgery has been shown to be effective in patients with heterogeneous emphysema, but is also associated with a relatively high perioperative morbidity and mortality. Accordingly, several novel and potentially less invasive methods for bronchoscopic lung volume reduction have been developed. Endobronchial valve (EBV) therapy is one such therapeutic approach in patients with advanced emphysema. It has been the most widely studied technique over the past years and represents an effective treatment option for patients with severe heterogeneous upper- or lower-lobe-predominant emphysema. The choice of EBV therapy largely depends on the distribution of emphysema and the presence or absence of interlobar collateral ventilation. Adequate patient selection and technical success of valve implantation with the intention of lobar exclusion are predictive factors for positive outcomes. This review attempts to highlight the milestones in the development of bronchoscopic lung volume reduction with one-way valve implantation over the past few years. PMID:26294417

  19. Use of endobronchial valves for native lung hyperinflation associated with respiratory failure in a single-lung transplant recipient for emphysema.

    PubMed

    Crespo, Maria M; Johnson, Bruce A; McCurry, Kenneth R; Landreneau, Rodney J; Sciurba, Frank C

    2007-01-01

    Emphysema is a common indication for adult pulmonary transplantation. Double-lung transplantation is increasingly the preferred approach because severe posttransplant native lung hyperinflation (NLH) following single-lung transplantation may compromise allograft lung function. We describe successful emergency use of bronchoscopic lung volume reduction using endobronchial valves (EBVs) [Zephyr; Emphasys Medical; Redwood, CA] in a single-lung transplant recipient who was critically ill with ventilator dependence from complications of NLH and at excessive risk for lung volume reduction surgery or pneumonectomy. Following placement of 17 valves in all segments of the native lung, atelectasis of the native lung was accompanied by volume expansion of the allograft. Immediately following valve placement, peak airway pressure decreased and alveolar ventilation increased. The patient was subsequently weaned from mechanical ventilation. This report suggests the need for clinical trials to evaluate the effectiveness of EBVs in single-lung transplant recipients with less critical functional impairment associated with NLH. PMID:17218578

  20. Photodynamic Therapy for 101 Early Cancers of the Upper Aerodigestive Tract, the Esophagus, and the Bronchi: A Single-Institution Experience

    PubMed Central

    Grosjean, P.; Fontolliet, Ch.; Wagnieres, G.; Woodtli, A.; Bergh, H. Van Den; Monnier, Ph.

    1999-01-01

    Cancer, when detected at an early stage, has a very good probability of being eradicated by surgery or radiotherapy. However, less aggressive treatments also tend to provide high rates of cure without the side effects of radical therapy. We report on the results of our clinical experience with photodynamic therapy (PDT) for the treatment of early carcinomas in the upper aerodigestive tract, the esophagus, and the tracheobronchial tree. Sixty-four patients with 101 squamous cell carcinomas were treated with three different photosensitizers: hematoporphyrin derivative (HPD), Photofrin II, and tetra (m-hydroxyphenyl)chlorin (mTHPC). Seventy-seven (76%) tumors showed a complete rsponse with no recurrence after a mean follow-up period of 27 months. There was no significant difference in terms of cure rates among the three dyes. However, mTHPC has a stronger phototoxicity and induces a shorter skin photosensitization than either of the other photosensitizers. There were eight major complications: three esophagotracheal fistulae after illumination with red light in the esophagus, two esophageal stenoses following 360° circumferential irradiation, and three bronchial stenoses. Illumination with the less penetrating green light and the use of a 180° or 240° windowed cylindrical light distributor render the risk of complications in the esophagus essentially impossible, without reducing the efficacy of the treatment. Therefore, PDT may be considered as a safe and effective treatment for early carcinomas of the upper aerodigestive tract, the esophagus, and the tracheobronchial tree. PMID:18493496

  1. [Food irradiation].

    PubMed

    Migdał, W

    1995-01-01

    A worldwide standard on food irradiation was adopted in 1983 by Codex Alimentarius Commission of the Joint Food Standard Programme of the Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO). As a result, 41 countries have approved the use of irradiation for treating one or more food items and the number is increasing. Generally, irradiation is used to: food loses, food spoilage, disinfestation, safety and hygiene. The number of countries which use irradiation for processing food for commercial purposes has been increasing steadily from 19 in 1987 to 33 today. In the frames of the national programme on the application of irradiation for food preservation and hygienization an experimental plant for electron beam processing has been established in Institute of Nuclear Chemistry and Technology. The plant is equipped with a small research accelerator Pilot (19MeV, 1 kW) and an industrial unit Elektronika (10MeV, 10 kW). On the basis of the research there were performed at different scientific institutions in Poland, health authorities have issued permission for irradiation for: spices, garlic, onions, mushrooms, potatoes, dry mushrooms and vegetables. PMID:8619113

  2. Tissue irradiator

    DOEpatents

    Hungate, F.P.; Riemath, W.F.; Bunnell, L.R.

    1975-12-16

    A tissue irradiator is provided for the in-vivo irradiation of body tissue. The irradiator comprises a radiation source material contained and completely encapsulated within vitreous carbon. An embodiment for use as an in- vivo blood irradiator comprises a cylindrical body having an axial bore therethrough. A radioisotope is contained within a first portion of vitreous carbon cylindrically surrounding the axial bore, and a containment portion of vitreous carbon surrounds the radioisotope containing portion, the two portions of vitreous carbon being integrally formed as a single unit. Connecting means are provided at each end of the cylindrical body to permit connections to blood- carrying vessels and to provide for passage of blood through the bore. In a preferred embodiment, the radioisotope is thulium-170 which is present in the irradiator in the form of thulium oxide. A method of producing the preferred blood irradiator is also provided, whereby nonradioactive thulium-169 is dispersed within a polyfurfuryl alcohol resin which is carbonized and fired to form the integral vitreous carbon body and the device is activated by neutron bombardment of the thulium-169 to produce the beta-emitting thulium-170.

  3. Irradiation subassembly

    DOEpatents

    Seim, O.S.; Filewicz, E.C.; Hutter, E.

    1973-10-23

    An irradiation subassembly for use in a nuclear reactor is described which includes a bundle of slender elongated irradiation -capsules or fuel elements enclosed by a coolant tube and having yieldable retaining liner between the irradiation capsules and the coolant tube. For a hexagonal bundle surrounded by a hexagonal tube the yieldable retaining liner may consist either of six segments corresponding to the six sides of the tube or three angular segments each corresponding in two adjacent sides of the tube. The sides of adjacent segments abut and are so cut that metal-tometal contact is retained when the volume enclosed by the retaining liner is varied and Springs are provided for urging the segments toward the center of the tube to hold the capsules in a closely packed configuration. (Official Gazette)

  4. Clinical implications of granulomatous inflammation detected by endobronchial ultrasound transbronchial needle aspiration in patients with suspected cancer recurrence in the mediastinum

    PubMed Central

    Kennedy, Marcus P; Jimenez, Carlos A; Mhatre, Ashwini D; Morice, Rodolfo C; Eapen, Georgie A

    2008-01-01

    Background Granulomatous inflammation has been previously reported in association with cancer. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a new minimally invasive test for investigating mediastinal lymphadenopathy. The identification of granulomatous inflammation by EBUS-TBNA and the clinical implications of such detection in a series of patients with previously treated cancer and new mediastinal lymphadenopathy has not previously been performed. Methods All 153 consecutive patients undergoing EBUS-TBNA in an academic cancer institution for suspected cancer in the mediastinum (mediastinal lymphadenopathy by CT imaging) were reviewed. Patients with non-caseating granuloma identified by EBUS-TBNA were included. Results EBUS-TBNA identified non-caseating granuloma in 17/153 (11%) patients. A subset of 8/153 (5.2%) had sarcoid like lymphadenopathy mimicking cancer recurrence (5/5 PET positive). Another 8/153 (5.2%) patients with new mediastinal lymphadenopathy and no prior history of cancer had a clinical syndrome consistent with sarcoidosis. One other patient with a history of breast cancer was diagnosed with non-tuberculous mycobacteria infection. No patient required mediastinoscopy and there were no complications. Conclusion In an academic cancer institute, at least 5% of patients undergoing EBUS-TBNA have sarcoid-like lymphadenopathy mimicking cancer recurrence. Further studies to define the precise etiology, natural history and prognosis of this phenomenon are warranted. PMID:18298864

  5. Ultrasound techniques in the evaluation of the mediastinum, part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques

    PubMed Central

    Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin Wu; Borst, Mathias Maximilian; Jenssen, Christian

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. PMID:26543620

  6. Rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of hilar and mediastinal lymphadenopathy in patients with lung cancer.

    PubMed

    Guo, Hongbo; Liu, Sujing; Guo, Jun; Li, Bobo; Li, Wanhu; Lu, Zuowei; Sun, Jujie; Zhang, Baijiang; Yu, Jinming

    2016-02-28

    The purpose of this study was to assess the usefulness of rapid on-site evaluation (ROSE) during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and the interpretation of its results. Based on the criterion of using ROSE or not, 236 patients with known or suspected lung cancer undergoing EBUS-TBNA were allocated into the ROSE group (122 patients with 252 lymph nodes) and non-ROSE group (114 patients with 260 lymph nodes). In the ROSE group, the percentages of the suspicious specimens on cytology and non-diagnostic specimens on pathology were both significantly lower than that in the non-ROSE group (8.7% vs. 14.6%, p = 0.038; and 0.9% vs. 4.4%, p = 0.018, respectively), and 13 out of 22 suspicious lesions on ROSE were confirmed with definite diagnoses on TBNA pathology. The diagnostic yield stratified by pathology was significantly higher in the ROSE group than that in the non-ROSE group (90.5% vs. 81.2%, p = 0.003). These results suggest that ROSE during EBUS-TBNA allows for a low rate of suspicious results and therefore improves the diagnostic yield stratified by pathology when sampling hilar or mediastinal lymphadenopathy in patients with lung cancer. PMID:26656954

  7. Endobronchial hemorrhage after intubation with double-lumen endotracheal tube in a patient with idiopathic thrombocytopenic purpura for minimally invasive cardiac surgery: a case report

    PubMed Central

    Kim, Hee Young; Kim, Kyoung Hoon; Kim, Nam Won

    2014-01-01

    Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure. PMID:24567815

  8. Irradiance gradients

    SciTech Connect

    Ward, G.J. Ecole Polytechnique Federale, Lausanne ); Heckbert, P.S. . School of Computer Science Technische Hogeschool Delft . Dept. of Technical Mathematics and Informatics)

    1992-04-01

    A new method for improving the accuracy of a diffuse interreflection calculation is introduced in a ray tracing context. The information from a hemispherical sampling of the luminous environment is interpreted in a new way to predict the change in irradiance as a function of position and surface orientation. The additional computation involved is modest and the benefit is substantial. An improved interpolation of irradiance resulting from the gradient calculation produces smoother, more accurate renderings. This result is achieved through better utilization of ray samples rather than additional samples or alternate sampling strategies. Thus, the technique is applicable to a variety of global illumination algorithms that use hemicubes or Monte Carlo sampling techniques.

  9. A follow-up study of progression from dysplasia to squamous cell carcinoma with immunohistochemical examination of p53 protein overexpression in the bronchi of ex-chromate workers.

    PubMed Central

    Satoh, Y.; Ishikawa, Y.; Nakagawa, K.; Hirano, T.; Tsuchiya, E.

    1997-01-01

    Squamous cell carcinoma (SCC) of the bronchus is considered to develop from preneoplastic 'dysplasia', but reports of sequential observation of this dysplasia-carcinoma sequence in humans are very few. We followed four dysplastic lesions found in the bronchi of three ex-chromate workers by bronchoscopy and biopsy and found that all of them progressed to SCC. Of the four lesions, three were severe dysplasias at the first biopsy which progressed to SCCs in 7-13 months. The last one was a slight dysplasia at the first biopsy and showed progression of the atypia to carcinoma in 6 years and 10 months. An immunohistochemical analysis of the chronological change in p53 protein expression in these lesions and in normal ciliated epithelium taken from the surroundings was conducted in each case. Overexpression of p53 protein was observed in two of the severe dysplasias and the one slight dysplasia, as well as their eventual SCCs. However, no such change was apparent in one case of severe dysplasia or its eventual SCC. Normal epithelium was consistently negative. Our results provide direct proof of the dysplasia-carcinoma sequence and suggest that alteration in the expression of p53 protein might be an important early event which persists. Therefore, the immunohistochemical detection of p53 overexpression in biopsy specimens of bronchial epithelium might be useful for evaluation of preneoplastic lesions in high-risk group individuals and for early diagnosis of bronchial cancer. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 PMID:9043024

  10. Irradiated foods

    MedlinePlus

    ... it reduces the risk of food poisoning . Food irradiation is used in many countries. It was first approved in the U.S. to prevent sprouts on white potatoes, and to control insects on wheat and in certain spices and seasonings.

  11. CT differentiation of enlarged mediastinal lymph node due to anthracosis from metastatic lymphadenopathy: a comparative study proven by endobronchial US-guided transbronchial needle aspiration

    PubMed Central

    Kirchner, Johannes; Broll, Michael; Müller, Phillip; Pomjanski, Natalia; Biesterfeld, Stepfan; Liermann, Dieter; Kickuth, Ralph

    2015-01-01

    PURPOSE Anthracosis often results in mediastinal nodal enlargement. The aim of this comparative study was to evaluate if it is possible to differentiate endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) proven anthracotic lymph nodes from malignant lymph node enlargement by means of multislice computed tomography (MSCT). METHODS We compared the MSCT findings of 89 enlarged lymph nodes due to anthracosis with 54 malignant lymph nodes (non-small cell lung cancer 75.9%, small cell lung cancer 18.5%, and non-Hodgkin lymphoma 5.6%). The lymph nodes were assessed for density (calcification, fat, and necrosis), shape (oval, round), contrast enhancement, and contour (sharp, ill-defined). RESULTS Malignant lymph nodes showed significantly greater axis diameters (P < 0.001). Both anthracotic and malignant nodes were most often oval (86.5% of all malignant nodes vs. 81.5% of all anthracotic nodes, P = 0.420) and showed confluence in a remarkable percentage (28.1% vs. 42.6%, P = 0.075). Anthracotic nodes showed calcifications more often (18% vs. 0%, P < 0.001). Malignant lymph nodes showed a significantly greater short and long axis diameter (P < 0.001), and they had a higher frequency of ill-defined contours (27.8% vs. 2.2%, P < 0.001) and contrast enhancement (27.8% vs. 5.6%, P < 0.001). Nodal necrosis, which appeared in one third of the malignant nodes, was not observed in anthracosis (35.2% vs. 0%, P < 0.001). Confluence of enlarged lymph nodes was seen in malignant lymph nodes (42.6%), as well as in lymph node enlargement due to anthracosis (28.1%, P = 0.075). CONCLUSION Our results show that there are significant differences in MSCT findings of malignant enlarged lymph nodes and benign lymph node enlargement due to anthracosis. PMID:25616268

  12. The utility of ROSE (rapid on-site evaluation) in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA): Is the picture rosy?

    PubMed Central

    Mallya, Varuna; Kumar, Sandeep P; Meganathan, Prabhu; Shivkumar, Swarna; Mehta, Ravindra

    2015-01-01

    Background: Mediastinal lymphadenopathy (ML) presents a diagnostic challenge. The technique to sample the lymph nodes has evolved from conventional “blind” transbronchial needle aspiration (TBNA) to the present day endobronchial ultrasound (EBUS)-guided procedure that improves the accuracy of sampling. Objective: This study was undertaken to evaluate the utility of “rapid on-site evaluation” (ROSE) in EBUS-guided TBNA (EBUS-TBNA) for the diagnosis of ML. Patients and Methods: This prospective study included 80 patients who underwent EBUS-TBNA for computed tomography/positron emission tomography (CT/PET) diagnosed ML over a 4-month period at a single tertiary care center. All 80 of these patients underwent histopathological evaluation (HPE) in addition to cytology. Three out of these 80 (3.7%) patients were excluded in view of inadequate material on EBUS-TBNA. After the sampling of nodes was done, the slides were stained with rapid hematoxylin and eosin (H&E) and then on-site evaluation was done. The tissue derived was also processed for HPE in all cases. Results: ROSE revealed granuloma in 27 patients and malignancy in 14 patients, and the remaining patients showed nonspecific inflammation. Concomitant histopathology revealed granuloma in 34 patients and malignancy in 14 patients. Considering HPE as gold standard, the overall sensitivity and specificity of EBUS-TBNA for diagnosis were 85.4% and 89.6%, respectively. For malignancy alone, the sensitivity and specificity were 100% and 98.4%, respectively. Conclusion: This novel approach is safe, has good diagnostic yield, and has an excellent potential in assisting safe and accurate diagnostic interventional bronchoscope. PMID:26811569

  13. Utility of conventional transbronchial needle aspiration with rapid on-site evaluation (c-TBNA-ROSE) at a tertiary care center with endobronchial ultrasound (EBUS) facility

    PubMed Central

    Madan, Neha Kawatra; Madan, Karan; Jain, Deepali; Walia, Ritika; Mohan, Anant; Hadda, Vijay; Mathur, Sandeep; Iyer, Venkateswaran K; Khilnani, Gopi C; Guleria, Randeep

    2016-01-01

    Background: Conventional transbronchial needle aspiration (c-TBNA) is an underutilized bronchoscopic modality. Endobronchial ultrasound (EBUS) guided-TBNA though efficacious is an expensive modality, facilities of which are available at only limited centers. c-TBNA is cost-effective and has potential for wide utilization especially in resource-limited settings. Rapid on-site evaluation (ROSE) improves the yield of c-TBNA. Materials and Methods: A retrospective review of the bronchoscopy records (May 2012 to July 2014) was performed. The patients who underwent c-TBNA with ROSE were included in the study and their clinical details were extracted. Convex probe EBUS-TBNA was being regularly performed during the study period by the operators performing c-TBNA. Results: c-TBNA with ROSE was performed in 41 patients with mean age of 42.4 (16.2) years. The most frequently sampled node stations (>90% patients) were the subcarinal and lower right paratracheal. Representative samples could be obtained in 33 out of the 41 patients (80.4%). c-TBNA was diagnostic in 32 [tuberculosis (TB)-8, sarcoidosis-9, and malignancy-15] patients out of the 41 patients. The overall diagnostic yield (sensitivity) of c-TBNA with ROSE was 78%. Mean procedure duration was 18.4 (3.1) min and there were no procedural complications. Conclusion: c-TBNA with ROSE is a safe, efficacious, and cost-effective bronchoscopic modality. When it was performed by operators routinely performing EBUS-TBNA, diagnostic yields similar to that of EBUS-TBNA can be obtained. Even at the centers where EBUS facilities are available, c-TBNA should be routinely performed. PMID:27011437

  14. Rapid on-site evaluation with BIOEVALUATOR® during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing pulmonary and mediastinal diseases

    PubMed Central

    Minami, Daisuke; Takigawa, Nagio; Inoue, Hirofumi; Hotta, Katsuyuki; Tanimoto, Mitsune; Kiura, Katsuyuki

    2014-01-01

    AIM: Rapid on-site evaluation (ROSE) is used widely during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). BIOEVALUATOR® is a device used for determining whether the tissues obtained by EBUS-TBNA are appropriate for a pathological diagnosis. This study describes our experience with ROSE using BIOEVALUATOR® during EBUS-TBNA for diagnosing pulmonary and mediastinal diseases. MATERIALS AND METHODS: We retrospectively evaluated the results of 35 patients who underwent EBUS-TBNA with BIOEVALUATOR® between December 2011 and February 2013. For the diagnosis, the tissue areas were appearing white and red through BIOEVALUATOR® are considered to be appropriate and inappropriate, respectively. We examined their medical records to obtain information concerning the examination of BIOEVALUATOR® results of the patient's materials (white/red), the diagnosis yield, site and size of lymph nodes and number of needle passes. RESULTS: The median longest diameter of 40 lymph nodes (21 #7, 13 #4R, 4 #4L and 2 #11) from 35 patients was 27.9 (range 12.4-50.6) mm and the median number of needle passes was 2 (range 1-5). The definitive diagnosis was made by EBUS-TBNA in 28 of 35 patients, by thoracotomy in one patient and BIOEVALUATOR® results were white and lymphocytes were seen in the rest six patients. The BIOEVALUATOR® results of other patients without accurate diagnosis were left indefinitive. Finally, the six patients were judged as having benign lymphadenopathy because the lymph node size on computed tomography decreased or remained stable after for at least 8 months. CONCLUSIONS: Checking aspirated samples using BIOEVALUATOR® appears useful for determining their adequacy for pathological diagnosis. PMID:24551012

  15. Impact of Endobronchial Ultrasound (EBUS) Training on the Diagnostic Yield of Conventional Transbronchial Needle Aspiration for Lymph Node Stations 4R and 7

    PubMed Central

    Sehgal, Inderpaul Singh; Dhooria, Sahajal; Gupta, Nalini; Bal, Amanjit; Ram, Babu; Aggarwal, Ashutosh Nath; Behera, Digambar; Agarwal, Ritesh

    2016-01-01

    Background There is sparse literature on whether training in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) improves the diagnostic yield of conventional TBNA (cTBNA). Objectives The aim of this study was to evaluate the diagnostic yield of cTBNA before and after the introduction of EBUS. Methods This was a retrospective analysis of patients who underwent cTBNA at our center. The study was divided into two periods, before and after the introduction of EBUS at our facility. The diagnostic yield of cTBNA was compared between the study periods. Rapid on-site cytological examination was not available. Results A total of 1,050 patients (61.6% men; mean age 45.6 years) underwent cTBNA during the study period (849 before EBUS; 201 after EBUS). Sarcoidosis (n = 527) followed by bronchogenic carcinoma (n = 222) formed the most common indications for performing cTBNA. There was a significant increase in both the success of obtaining a representative sample (from 71% to 85%), and the diagnostic yield (from 33% to 49.5%) of cTBNA, after the introduction of EBUS. The increase in the diagnostic yield of cTBNA after introduction of EBUS remained significant even after adjusting for years of performing cTBNA and the type of anesthesia (topical vs. sedation and topical) on a multivariate analysis. Conclusion The diagnostic yield of cTBNA at our facility increased after the introduction of EBUS-TBNA. However, given the retrospective nature of the study, prospective studies are required to confirm our findings. PMID:27083009

  16. Diagnostic Value of Convex Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Tuberculous Lymphadenitis: A Systematic Review and Meta-Analysis

    PubMed Central

    Li, Wei; Zhang, Ting; Chen, Yuqing; Liu, Chao; Peng, Wenjia

    2015-01-01

    Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). Material/Methods PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confidence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-effects model. Heterogeneity and publication bias were also assessed. Results A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were finally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74–86%). Significant heterogeneity (I2=77.9%) and significant publication bias were detected (Begg’s test p=0.05 and Egger’s test p=0.02). From subgroup analyses, significant differences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing different anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a significant effect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. Conclusions EBUS-TBNA appears to be an efficacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA. PMID:26177653

  17. Use of Irradiated Foods

    NASA Technical Reports Server (NTRS)

    Brynjolfsson, A.

    1985-01-01

    The safety of irradiated foods is reviewed. Guidelines and regulations for processing irradiated foods are considered. The radiolytic products formed in food when it is irradiated and its wholesomeness is discussed. It is concluded that food irradiation processing is not a panacea for all problems in food processing but when properly used will serve the space station well.

  18. Detection of irradiated liquor

    NASA Astrophysics Data System (ADS)

    Shengchu, Qi; Jilan, Wu; Rongyao, Yuan

    D-2,3-butanediol is formed by irradiation processes in irradiated liquors. This radiolytic product is not formed in unirradiated liquors and its presence can therefore be used to identify whether a liquor has been irradiated or not. The relation meso/dl≈1 for 2,3-butanediol and the amount present in irradiated liquors may therefore be used as an indication of the dose used in the irradiation.

  19. Comminuting irradiated ferritic steel

    DOEpatents

    Bauer, Roger E.; Straalsund, Jerry L.; Chin, Bryan A.

    1985-01-01

    Disclosed is a method of comminuting irradiated ferritic steel by placing the steel in a solution of a compound selected from the group consisting of sulfamic acid, bisulfate, and mixtures thereof. The ferritic steel is used as cladding on nuclear fuel rods or other irradiated components.

  20. Irradiation Creep in Graphite

    SciTech Connect

    Ubic, Rick; Butt, Darryl; Windes, William

    2014-03-13

    An understanding of the underlying mechanisms of irradiation creep in graphite material is required to correctly interpret experimental data, explain micromechanical modeling results, and predict whole-core behavior. This project will focus on experimental microscopic data to demonstrate the mechanism of irradiation creep. High-resolution transmission electron microscopy should be able to image both the dislocations in graphite and the irradiation-induced interstitial clusters that pin those dislocations. The team will first prepare and characterize nanoscale samples of virgin nuclear graphite in a transmission electron microscope. Additional samples will be irradiated to varying degrees at the Advanced Test Reactor (ATR) facility and similarly characterized. Researchers will record microstructures and crystal defects and suggest a mechanism for irradiation creep based on the results. In addition, the purchase of a tensile holder for a transmission electron microscope will allow, for the first time, in situ observation of creep behavior on the microstructure and crystallographic defects.

  1. Irradiation-Induced Nanostructures

    SciTech Connect

    Birtcher, R.C.; Ewing, R.C.; Matzke, Hj.; Meldrum, A.; Newcomer, P.P.; Wang, L.M.; Wang, S.X.; Weber, W.J.

    1999-08-09

    This paper summarizes the results of the studies of the irradiation-induced formation of nanostructures, where the injected interstitials from the source of irradiation are not major components of the nanophase. This phenomena has been observed by in situ transmission electron microscopy (TEM) in a number of intermetallic compounds and ceramics during high-energy electron or ion irradiations when the ions completely penetrate through the specimen. Beginning with single crystals, electron or ion irradiation in a certain temperature range may result in nanostructures composed of amorphous domains and nanocrystals with either the original composition and crystal structure or new nanophases formed by decomposition of the target material. The phenomenon has also been observed in natural materials which have suffered irradiation from the decay of constituent radioactive elements and in nuclear reactor fuels which have been irradiated by fission neutrons and other fission products. The mechanisms involved in the process of this nanophase formation are discussed in terms of the evolution of displacement cascades, radiation-induced defect accumulation, radiation-induced segregation and phase decomposition, as well as the competition between irradiation-induced amorphization and recrystallization.

  2. Alaskan Commodities Irradiation Project

    SciTech Connect

    Zarling, J.P.; Swanson, R.B.; Logan, R.R.; Das, D.K.; Lewis, C.E.; Workman, W.G.; Tumeo, M.A.; Hok, C.I.; Birklid, C.A.; Bennett, F.L.

    1988-12-01

    The ninety-ninth US Congress commissioned a six-state food irradiation research and development program to evaluate the commercial potential of this technology. Hawaii, Washington, Iowa, Oklahoma and Florida as well as Alaska have participated in the national program; various food products including fishery products, red meats, tropical and citrus fruits and vegetables have been studied. The purpose of the Alaskan study was to review and evaluate those factors related to the technical and economic feasibility of an irradiator in Alaska. This options analysis study will serve as a basis for determining the state's further involvement in the development of food irradiation technology. 40 refs., 50 figs., 53 tabs.

  3. The Total Irradiance Monitors

    NASA Astrophysics Data System (ADS)

    Kopp, Greg

    2015-08-01

    The first Total Irradiance Monitor (TIM) launched on NASA’s Solar Radiation and Climate Experiment in 2003 and quickly proved to be the most accurate and stable instrument on orbit for measuring the total solar irradiance (TSI). The TIM’s design improvements over the older classical radiometers helped its selection on many subsequent missions, including NASA’s Glory, NOAA’s TSI Calibration Transfer Experiment, and the series of NASA’s Total and Spectral Solar Irradiance Sensor instruments currently underway. I will summarize the status of and differences between each of the TIMs currently on-orbit or in production.

  4. Test reactor irradiation coordination

    SciTech Connect

    Heartherly, D.W.; Siman Tov, I.I.; Sparks, D.W.

    1995-10-01

    This task was established to supply and coordinate irradiation services needed by NRC contractors other than ORNL. These services include the design and assembly of irradiation capsules as well as arranging for their exposure, disassembly, and return of specimens. During this period, the final design of the facility and specimen baskets was determined through an iterative process involving the designers and thermal analysts. The resulting design should permit the irradiation of all test specimens to within 5{degrees}C of their desired temperature. Detailing of all parts is ongoing and should be completed during the next reporting period. Procurement of the facility will also be initiated during the next review period.

  5. Economics of food irradiation.

    PubMed

    Deitch, J

    1982-01-01

    This article examines the cost competitiveness of the food irradiation process. An analysis of the principal factors--the product, physical plant, irradiation source, and financing--that impact on cost is made. Equations are developed and used to calculate the size of the source for planned product throughput, efficiency factors, power requirements, and operating costs of sources, radionuclides, and accelerators. Methods of financing and capital investment are discussed. A series of tables show cost breakdowns of sources, buildings, equipment, and essential support facilities for both a cobalt-60 and a 10-MeV electron accelerator facility. Additional tables present irradiation costs as functions of a number of parameters--power input, source size, dose, and hours of annual operation. The use of the numbers in the tables are explained by examples of calculations of the irradiation costs for disinfestation of grains and radicidation of feed. PMID:6759046

  6. Food irradiation in perspective

    NASA Astrophysics Data System (ADS)

    Henon, Y. M.

    1995-02-01

    Food irradiation already has a long history of hopes and disappointments. Nowhere in the world it plays the role that it should have, including in the much needed prevention of foodborne diseases. Irradiated food sold well wherever consumers were given a chance to buy them. Differences between national regulations do not allow the international trade of irradiated foods. While in many countries food irradiation is still illegal, in most others it is regulated as a food additive and based on the knowledge of the sixties. Until 1980, wholesomeness was the big issue. Then the "prerequisite" became detection methods. Large amounts of money have been spent to design and validate tests which, in fact, aim at enforcing unjustified restrictions on the use of the process. In spite of all the difficulties, it is believed that the efforts of various UN organizations and a growing legitimate demand for food safety should in the end lead to recognition and acceptance.

  7. Irradiation of biliary carcinoma

    SciTech Connect

    Herskovic, A.; Heaston, D.; Engler, M.J.; Fishburn, R.I.; Jones, R.S.; Noell, K.T.

    1981-04-01

    External and interstitial irradiation have effected the disappearance of biliary lesions. The use of indwelling catheters in the biliary tract makes the technique more appealing. Iridium 192 implants were used.

  8. Systematic Endobronchial Ultrasound-guided Mediastinal Staging Versus Positron Emission Tomography for Comprehensive Mediastinal Staging in NSCLC Before Radical Radiotherapy of Non-small Cell Lung Cancer: A Pilot Study.

    PubMed

    Steinfort, Daniel P; Siva, Shankar; Leong, Tracy L; Rose, Morgan; Herath, Dishan; Antippa, Phillip; Ball, David L; Irving, Louis B

    2016-02-01

    Despite known limitations of positron emission tomography (PET) for mediastinal staging of non-small cell lung cancer (NSCLC), radiation treatment fields are generally based on PET-identified disease extent. However, no studies have examined the accuracy of FDG-PET/CT on a per-node basis in patients being considered for curative-intent radiotherapy in NSCLC.In a prospective trial, patients with NSCLC being considered for definitive thoracic radiotherapy (± systemic chemotherapy) underwent minimally invasive systematic mediastinal evaluation with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following noninvasive staging with integrated PET-CT.Thirty patients underwent EBUS-TBNA, with TBNA performed from a mean 2.5 lymph node (LN) stations per patient (median 3, range 1-5). Discordant findings between PET-CT and EBUS-TBNA were observed in 10 patients (33%, 95% CI 19%-51%). PET-occult LN metastases were demonstrated by EBUS in 4 patients, whereas a lesser extent of mediastinal involvement, compared with FDG-PET, was demonstrated by EBUS in 6 patients, including 2 patients downstaged from cN3 to pN2. LNs upstaged by EBUS were significantly smaller than nodes downstaged by EBUS, 7.5 mm (range 7-9) versus 12 mm (range 6-21), P = 0.005.A significant proportion of patients considered for definitive radiotherapy (+/-chemotherapy) undergoing systematic mediastinal evaluation with EBUS-TBNA in this study have an extent of mediastinal NSCLC involvement discordant with that indicated by PET-CT. Systematic EBUS-TBNA may aid in defining the extent of mediastinal involvement in NSCLC patients undergoing radiotherapy. Systematic EBUS-TBNA has the potential to contribute significantly to radiotherapy planning and delivery, by either identifying occult nodal metastases, or demonstrating FDG-avid LNs to be disease-free. PMID:26937894

  9. A comparison of ketamine-midazolam and ketamine-propofol combinations used for sedation in the endobronchial ultrasound-guided transbronchial needle aspiration: a prospective, single-blind, randomized study

    PubMed Central

    Dal, Tülay; Sazak, Hilal; Şahin, Şaziye; Yılmaz, Aydın

    2014-01-01

    Objective We aimed to compare the effectiveness and safety of ketamine-midazolam and ketamine-propofol combinations for procedural sedation in endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). Methods Sixty patients who were undergoing EBUS-TBNA were included in this study. Patients were randomly divided into two groups. Group 1 was given 0.25 mg/kg intravenous (iv) ketamine, 2 min later than 0.05 mg/kg iv midazolam. Group 2 received 0.125 mg/kg ketamine-propofol mixture (ketofol), 2 min subsequent to injection of 0.25 mg/kg each. Sedation was maintained with additional doses of ketamine 0.25 mg/kg, and ketofol 0.125 mg/kg each in Group 1 and Group 2, respectively. Blood pressure, heart rate (HR), peripheral oxygen saturation, respiratory rate (RR), Ramsay Sedation Score (RSS), and severity of cough were recorded prior to and after administration of sedation agent in the beginning of fiberoptic bronchoscopy (FOB) and every 5 min of the procedure. The consumption of the agents, the satisfactions of the bronchoscopist and the patients, and the recovery time were also recorded. Results HR in the 10th min and RSS value in the 35th min of induction in Group 1 were higher than the other group (P<0.05). The recovery time in Group 1 was statistically longer than Group 2 (P<0.05). There was no statistically significant difference between groups with respect to other parameters (P>0.05). Conclusions It was concluded that both ketamine-midazolam and ketamine-propofol combinations for sedation during EBUS-TBNA were similarly effective and safe without remarkable side effects. PMID:24976998

  10. Value of radial probe endobronchial ultrasound-guided localization of solitary pulmonary nodules with the combination of ultrathin bronchoscopy and methylene blue prior to video-assisted thoracoscopic surgery

    PubMed Central

    Xu, Chun-Hua; Yu, Li-Ke; Cao, Lan; Yang, Rusong; Yan, Jun; Liu, Zheng-Cheng; Wang, Yan

    2016-01-01

    The aim of this study was to assess the clinical value of radial probe endobronchial ultrasound (RP-EBUS)-guided localization of solitary pulmonary nodules (SPNs) with the combination of ultrathin bronchoscopy and methylene blue prior to video-assisted thoracoscopic surgery (VATS). An ultrathin bronchoscope was used to localize the lesions under RP-EBUS guidance in 48 patients (18 men and 30 women; age range, 41–72 years; mean age, 54 years), who subsequently underwent VATS resection. The lesion size, distance from the parietal pleura, localization time and complications were evaluated. The RP-EBUS-guided localization success rate was 72.9%. The lesion size ± standard deviation was 12.8±4.2 mm and the mean distance from the parietal pleura was 11.2±9.7 mm. The mean localization time was 15.7±8.3 min. The major complication of RP-EBUS-guided localization was asymptomatic hemorrhage in 4 patients (8.3%). The VATS resection success rate was 95.8%. In terms of pathological type, the 48 lesions included atypical adenomatous hyperplasia (n=4), adenocarcinoma in situ (n=5), minimally invasive adenocarcinoma (n=7), adenocarcinoma (n=18), squamous cell carcinoma (n=1), inflammation (n=6), hamartoma (n=4) and tuberculosis (n=3). Therefore, RP-EBUS-guided localization with the combination of an ultrathin bronchoscope and methylene blue prior to VATS resection is a promising technique for SPNs, it plays an important role in the accurate localization of SPNs and it is an effective and safe technique to assist VATS resection of such nodules.

  11. Precompaction irradiation of meteorites

    SciTech Connect

    Caffee, M.W.

    1986-01-01

    In the four meteorites studied, the nonirradiated grains show the nominal amount of spallogenic Ne and Ar expected from recent galactic cosmic ray exposure. Two conclusions follow from these observations: (1) the quality of spallogenic Ne and Ar in the irradiated grains is far more than can be explained by reasonable precompaction exposures to galactic cosmic rays. If the pre-compaction irradiation occurred in a regolith, the exposure to galactic cosmic rays would have to last several hundred m.y. for some of the grains. Similarly long ages would result if the source of the protons were solar flares with a particle flux similar to modern-day solar flares. These exposure durations are incompatible with current models for the pre-compaction irradiation of gas rich meteorites. (2) There is always a correlation between solar flare tracks and precompaction spallogenic Ne and Ar. This correlation is surprising, considering the difference in range of these two effects. Galactic cosmic rays have a range of meters whereas solar flare heavy ions have a range of less than a millimeter. This difference should largely decouple these two effects, as was shown in studies on lunar soil 60009, where both irradiated and non-irradiated grains contain large quantities of spallogenic Ne. If galactic cosmic rays are responsible for the spallogenic Ne and Ar in the irradiated grains, the authors would similarly expect the nonirradiated grains to contain large amounts of spallogenic Ne and Ar.

  12. Total lymphoid irradiation

    SciTech Connect

    Sutherland, D.E.; Ferguson, R.M.; Simmons, R.L.; Kim, T.H.; Slavin, S.; Najarian, J.S.

    1983-05-01

    Total lymphoid irradiation by itself can produce sufficient immunosuppression to prolong the survival of a variety of organ allografts in experimental animals. The degree of prolongation is dose-dependent and is limited by the toxicity that occurs with higher doses. Total lymphoid irradiation is more effective before transplantation than after, but when used after transplantation can be combined with pharmacologic immunosuppression to achieve a positive effect. In some animal models, total lymphoid irradiation induces an environment in which fully allogeneic bone marrow will engraft and induce permanent chimerism in the recipients who are then tolerant to organ allografts from the donor strain. If total lymphoid irradiation is ever to have clinical applicability on a large scale, it would seem that it would have to be under circumstances in which tolerance can be induced. However, in some animal models graft-versus-host disease occurs following bone marrow transplantation, and methods to obviate its occurrence probably will be needed if this approach is to be applied clinically. In recent years, patient and graft survival rates in renal allograft recipients treated with conventional immunosuppression have improved considerably, and thus the impetus to utilize total lymphoid irradiation for its immunosuppressive effect alone is less compelling. The future of total lymphoid irradiation probably lies in devising protocols in which maintenance immunosuppression can be eliminated, or nearly eliminated, altogether. Such protocols are effective in rodents. Whether they can be applied to clinical transplantation remains to be seen.

  13. Blood irradiation: Rationale and technique

    SciTech Connect

    Lewis, M.C. )

    1990-01-01

    Upon request by the local American Red Cross, the Savannah Regional Center for Cancer Care irradiates whole blood or blood components to prevent post-transfusion graft-versus-host reaction in patients who have severely depressed immune systems. The rationale for blood irradiation, the total absorbed dose, the type of patients who require irradiated blood, and the regulations that apply to irradiated blood are presented. A method of irradiating blood using a linear accelerator is described.

  14. FOOD IRRADIATION REACTOR

    DOEpatents

    Leyse, C.F.; Putnam, G.E.

    1961-05-01

    An irradiation apparatus is described. It comprises a pressure vessel, a neutronic reactor active portion having a substantially greater height than diameter in the pressure vessel, an annular tank surrounding and spaced from the pressure vessel containing an aqueous indium/sup 1//sup 1//sup 5/ sulfate solution of approximately 600 grams per liter concentration, means for circulating separate coolants through the active portion and the space between the annular tank and the pressure vessel, radiator means adapted to receive the materials to be irradiated, and means for flowing the indium/sup 1//sup 1//sup 5/ sulfate solution through the radiator means.

  15. Fuel or irradiation subassembly

    DOEpatents

    Seim, O.S.; Hutter, E.

    1975-12-23

    A subassembly for use in a nuclear reactor is described which incorporates a loose bundle of fuel or irradiation pins enclosed within an inner tube which in turn is enclosed within an outer coolant tube and includes a locking comb consisting of a head extending through one side of the inner sleeve and a plurality of teeth which extend through the other side of the inner sleeve while engaging annular undercut portions in the bottom portion of the fuel or irradiation pins to prevent movement of the pins.

  16. Irradiating insect pests

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This is a non-technical article focusing on phytosanitary uses of irradiation. In a series of interview questions, I present information on the scope of the invasive species problem and the contribution of international trade in agricultural products to the movement of invasive insects. This is foll...

  17. Update on meat irradiation

    SciTech Connect

    Olson, D.G.

    1997-12-01

    The irradiation of meat and poultry in the United States is intended to eliminate pathogenic bacteria from raw product, preferably after packaging to prevent recontamination. Irradiation will also increase the shelf life of raw meat and poultry products approximately two to three times the normal shelf life. Current clearances in the United States are for poultry (fresh or frozen) at doses from 1.5 to 3.0 kGy and for fresh pork at doses from 0.3 to 1.0 kGy. A petition for the clearance of all red meat was submitted to the Food and Drug Administration (FDA) in July 1994. The petition is for clearances of fresh meat at doses from 1.5 to 4.5 kGy and for frozen meat at {approximately}2.5 to 7.5 kGy. Clearance for red meat is expected before the end of 1997. There are 28 countries that have food irradiation clearances, of which 18 countries have clearances for meat or poultry. However, there are no uniform categories or approved doses for meat and poultry among the countries that could hamper international trade of irradiated meat and poultry.

  18. NSUF Irradiated Materials Library

    SciTech Connect

    Cole, James Irvin

    2015-09-01

    The Nuclear Science User Facilities has been in the process of establishing an innovative Irradiated Materials Library concept for maximizing the value of previous and on-going materials and nuclear fuels irradiation test campaigns, including utilization of real-world components retrieved from current and decommissioned reactors. When the ATR national scientific user facility was established in 2007 one of the goals of the program was to establish a library of irradiated samples for users to access and conduct research through competitively reviewed proposal process. As part of the initial effort, staff at the user facility identified legacy materials from previous programs that are still being stored in laboratories and hot-cell facilities at the INL. In addition other materials of interest were identified that are being stored outside the INL that the current owners have volunteered to enter into the library. Finally, over the course of the last several years, the ATR NSUF has irradiated more than 3500 specimens as part of NSUF competitively awarded research projects. The Logistics of managing this large inventory of highly radioactive poses unique challenges. This document will describe materials in the library, outline the policy for accessing these materials and put forth a strategy for making new additions to the library as well as establishing guidelines for minimum pedigree needed to be included in the library to limit the amount of material stored indefinitely without identified value.

  19. Phytosanitary applications of irradiation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Phytosanitary treatments are used to disinfest agricultural commodities of quarantine pests so the commodities can be shipped across quarantine barriers to trade. Ionizing irradiation is a promising treatment that is increasing in use. Almost 19,000 tons of sweet potatoes and several fruits, plus ...

  20. Generic phytosanitary irradiation treatments

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The history of the development of generic phytosanitary irradiation (PI) treatments is discussed beginning with its initial proposal in 1986. Generic PI treatments in use today are 150 Gy for all hosts of Tephritidae, 250 Gy for all arthropods on mango and papaya shipped from Australia to New Zeala...

  1. Nerve growth factor levels and localisation in human asthmatic bronchi.

    PubMed

    Olgart Höglund, C; de Blay, F; Oster, J P; Duvernelle, C; Kassel, O; Pauli, G; Frossard, N

    2002-11-01

    Nerve growth factor (NGF) has recently been suggested to be an important mediator of inflammation. In support of this, serum levels of NGF have been shown to be enhanced in asthmatics. However, it has not yet been shown whether the levels of NGF are also altered locally in asthmatic airways, when compared with healthy subjects, and the localisation of potential sources of NGF in the human bronchus have not yet been described. The aim of the present study was to assess NGF levels in bronchoalveolar lavage fluid (BALF) from asthmatics and to compare them to those of control subjects. Furthermore, the authors wanted to localise potential sources of NGF in bronchial tissue, and to number NGF-immunopositive infiltrating cells in the bronchial submucosa. BALF and bronchial biopsies were obtained from seven control subjects and seven asthmatic patients by fibreoptic bronchoscopy. NGF protein levels were quantified by enzyme-linked immunosorbent assay in BALF. NGF localisation was examined by immunohistochemistry on bronchial biopsy sections. The asthmatics exhibited significantly enhanced NGF levels in BALF. Intense NGF-immunoreactivity was observed in bronchial epithelium, smooth muscle cells and infiltrating inflammatory cells in the submucosa, and to a lesser extent in the connective tissue. The asthmatics exhibited a higher number of NGF-immunoreactive infiltrating cells in the bronchial submucosa than control subjects. This study provides evidence that nerve growth factor is locally produced in the airways, and shows that this production is enhanced in asthmatics. These findings suggest that nerve growth factor is produced by both structural cells and infiltrating inflammatory cells in human bronchus in vivo, and the authors suggest that the increase in nerve growth factor protein in bronchoalveolar lavage fluid observed in asthmatic patients may originate both from structural cells, producing increased nerve growth factor levels in inflammatory conditons, and from the increase in nerve growth factor-immunopositive cells determined in the bronchial submucosa. PMID:12449162

  2. Iatrogenic injuries to the trachea and main bronchi

    PubMed Central

    Warmus, Janusz; Włodarczyk, Janusz; Grochowski, Zbigniew; Bederski, Krzysztof; Kocoń, Piotr; Talar, Piotr; Kużdżał, Jarosław

    2016-01-01

    Introduction Iatrogenic tracheobronchial injuries are rare. Aim To analyse the mechanism of injury, symptoms and treatment of these patients. Material and methods Retrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed. Results There were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48). In 16 patients the injury occurred during tracheal intubation, in 1 during rigid bronchoscopy, in 1 during rigid oesophagoscopy, in 1 during mediastinoscopy and in 5 during open surgery. Mean length of airway tear was 3.8 cm (range: 1.5-8). In 1 patient there was an injury to the cervical trachea and in the remaining 23 in the thoracic part of the airway. The treatment included repair of the membranous part of the trachea performed via right thoracotomy in 10 patients (in 1 patient additionally coverage with a pedicled intercostal muscle flap was used), a self-expanding metallic stent in 1 patient, suture of the right main bronchus and the oesophagus in 1, left upper sleeve lobectomy in 1, right upper lobectomy in 1, implantation of a silicone Y stent in 3, mini-tracheostomy in 1, and conservative treatment in 5 patients. Conclusions Intubation is the most frequent cause of iatrogenic main airway injuries. Patients with these life-threatening complications require an individualised approach and treatment in a reference centre. PMID:27516782

  3. Cellular morphometry of the bronchi of human and dog lungs

    SciTech Connect

    Robbins, E.S.

    1992-09-01

    Quantitative data of the human bronchial epithelial cells at possible risk for malignant transformation in lung cancer is crucial for accurate radon dosimetry and risk analysis. The locations and other parameters of the nuclei which may be damaged by [alpha] particles must be determined and compared in different airway generations, among smokers, non-smokers and ex-smokers, between men and women and in people of different ages. This proposal includes extended morphometric studies on electron micrographs of human epithelium of defined airway generations and in parallel on electron micrographs of the dog bronchial lining. The second part of this proposal describes studies to quantitate the cycling bronchial epithelial population(s) using proliferation markers and immunocytochemistry on frozen and paraffin sections and similar labeling of isolated bronchial epithelial cells sorted flow cytometry.

  4. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

    PubMed

    Vilmann, Peter; Clementsen, Paul Frost; Colella, Sara; Siemsen, Mette; De Leyn, Paul; Dumonceau, Jean-Marc; Herth, Felix J; Larghi, Alberto; Vazquez-Sequeiros, Enrique; Vasquez-Sequeiros, Enrique; Hassan, Cesare; Crombag, Laurence; Korevaar, Daniël A; Konge, Lars; Annema, Jouke T

    2015-06-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. Recommendations 1 For mediastinal nodal staging in patients with suspected or proven non-small-cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET), endosonography is recommended over surgical staging as the initial procedure (Recommendation grade A). The combination of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic (esophageal) ultrasound with fine needle aspiration, with use of a gastrointestinal (EUS-FNA) or EBUS (EUS-B-FNA) scope, is preferred over either test alone (Recommendation grade C). If the combination of EBUS and EUS-(B) is not available, we suggest that EBUS alone is acceptable (Recommendation grade C).Subsequent surgical staging is recommended, when endosonography does not show malignant nodal involvement (Recommendation grade B). 2 For mediastinal nodal staging in patients with suspected or proven non-small-cell peripheral lung cancer without mediastinal involvement at CT or CT-PET, we suggest that EBUS-TBNA and/or EUS-(B)-FNA should be performed before therapy, provided that one or more of the following conditions is present: (i) enlarged or fluorodeoxyglucose (FDG)-PET-avid ipsilateral hilar nodes; (ii) primary tumor without FDG uptake; (iii) tumor size ≥ 3 cm (Fig. 3a

  5. ELECTRON IRRADIATION OF SOLIDS

    DOEpatents

    Damask, A.C.

    1959-11-01

    A method is presented for altering physical properties of certain solids, such as enhancing the usefulness of solids, in which atomic interchange occurs through a vacancy mechanism, electron irradiation, and temperature control. In a centain class of metals, alloys, and semiconductors, diffusion or displacement of atoms occurs through a vacancy mechanism, i.e., an atom can only move when there exists a vacant atomic or lattice site in an adjacent position. In the process of the invention highenergy electron irradiation produces additional vacancies in a solid over those normally occurring at a given temperature and allows diffusion of the component atoms of the solid to proceed at temperatures at which it would not occur under thermal means alone in any reasonable length of time. The invention offers a precise way to increase the number of vacancies and thereby, to a controlled degree, change the physical properties of some materials, such as resistivity or hardness.

  6. Irradiation direction from texture

    NASA Astrophysics Data System (ADS)

    Koenderink, Jan J.; Pont, Sylvia C.

    2003-10-01

    We present a theory of image texture resulting from the shading of corrugated (three-dimensional textured) surfaces, Lambertian on the micro scale, in the domain of geometrical optics. The derivation applies to isotropic Gaussian random surfaces, under collimated illumination, in normal view. The theory predicts the structure tensors from either the gradient or the Hessian of the image intensity and allows inferences of the direction of irradiation of the surface. Although the assumptions appear prima facie rather restrictive, even for surfaces that are not at all Gaussian, with the bidirectional reflectance distribution function far from Lambertian and vignetting and multiple scattering present, we empirically recover the direction of irradiation with an accuracy of a few degrees.

  7. BIOLOGICAL IRRADIATION FACILITY

    DOEpatents

    McCorkle, W.H.; Cern, H.S.

    1962-04-24

    A facility for irradiating biological specimens with neutrons is described. It includes a reactor wherein the core is off center in a reflector. A high-exposure room is located outside the reactor on the side nearest the core while a low-exposure room is located on the opposite side. Means for converting thermal neutrons to fast neutrons are movably disposed between the reactor core and the high and low-exposure rooms. (AEC)

  8. Post-irradiation effects in polyethylenes irradiated under various atmospheres

    NASA Astrophysics Data System (ADS)

    Suljovrujic, E.

    2013-08-01

    If a large amount of polymer free radicals remain trapped after irradiation of polymers, the post-irradiation effects may result in a significant alteration of physical properties during long-term shelf storage and use. In the case of polyethylenes (PEs) some failures are attributed to the post-irradiation oxidative degradation initiated by the reaction of residual free radicals (mainly trapped in crystal phase) with oxygen. Oxidation products such as carbonyl groups act as deep traps and introduce changes in carrier mobility and significant deterioration in the PEs electrical insulating properties. The post-irradiation behaviour of three different PEs, low density polyethylene (LDPE), linear low density polyethylene (LLDPE) and high density polyethylene (HDPE) was studied; previously, the post-irradiation behaviour of the PEs was investigated after the irradiation in air (Suljovrujic, 2010). In this paper, in order to investigate the influence of different irradiation media on the post-irradiation behaviour, the samples were irradiated in air and nitrogen gas, to an absorbed dose of 300 kGy. The annealing treatment of irradiated PEs, which can substantially reduce the concentration of free radicals, is used in this study, too. Dielectric relaxation behaviour is related to the difference in the initial structure of PEs (such as branching, crystallinity etc.), to the changes induced by irradiation in different media and to the post-irradiation changes induced by storage of the samples in air. Electron spin resonance (ESR), differential scanning calorimetry (DSC), infra-red (IR) spectroscopy and gel measurements were used to determine the changes in the free radical concentration, crystal fraction, oxidation and degree of network formation, respectively.

  9. Craniospinal irradiation techniques

    NASA Astrophysics Data System (ADS)

    Scarlatescu, Ioana; Virag, Vasile; Avram, Calin N.

    2015-12-01

    In this paper we present one treatment plan for irradiation cases which involve a complex technique with multiple beams, using the 3D conformational technique. As the main purpose of radiotherapy is to administrate a precise dose into the tumor volume and protect as much as possible all the healthy tissues around it, for a case diagnosed with a primitive neuro ectoderm tumor, we have developed a new treatment plan, by controlling one of the two adjacent fields used at spinal field, in a way that avoids the fields superposition. Therefore, the risk of overdose is reduced by eliminating the field divergence.

  10. Craniospinal irradiation techniques

    SciTech Connect

    Scarlatescu, Ioana Avram, Calin N.; Virag, Vasile

    2015-12-07

    In this paper we present one treatment plan for irradiation cases which involve a complex technique with multiple beams, using the 3D conformational technique. As the main purpose of radiotherapy is to administrate a precise dose into the tumor volume and protect as much as possible all the healthy tissues around it, for a case diagnosed with a primitive neuro ectoderm tumor, we have developed a new treatment plan, by controlling one of the two adjacent fields used at spinal field, in a way that avoids the fields superposition. Therefore, the risk of overdose is reduced by eliminating the field divergence.

  11. Irradiation of northwest agricultural products

    NASA Astrophysics Data System (ADS)

    Eakin, D. E.; Tingey, G. I.

    1985-02-01

    Irradiation of food for disinfestation and preservation is increasing in importance because of increasing restrictions on various chemical treatments. Irradiation treatment is of particular interest in the Northwest because of a growing supply of agricultural products and the need to develop new export markets. Several products have, or could potentially have, significant export markets if stringent insect ocntrol procedures are developed and followed. Due to the recognized potential benefits of irradiation, this program was conducted to evaluate the benefits of using irradiation on Northwest agricultural products. Commodities currently included in the program are cherries, apples, asparagus, spices, hay, and hides.

  12. Food irradiation and sterilization

    NASA Astrophysics Data System (ADS)

    Josephson, Edward S.

    Radiation sterilization of food (radappertization) requires exposing food in sealed containers to ionizing radiation at absorbed doses high enough (25-70 kGy) to kill all organisms of food spoilage and public health significance. Radappertization is analogous to thermal canning is achieving shelf stability (long term storage without refrigeration). Except for dry products in which autolysis is negligible, the radappertization process also requires that the food be heated to an internal temperature of 70-80°C (bacon to 53°C) to inactivate autolytic enzymes which catalyze spoilage during storage without refrigeration. To minimize the occurence of irradiation induced off-flavors and odors, undesirable color changes, and textural and nutritional losses from exposure to the high doses required for radappertization, the foods are vacuum sealed and irradiated frozen (-40°C to -20°C). Radappertozed foods have the characteristic of fresh foods prepared for eating. Radappertization can substitute in whole or in part for some chemical food additives such as ethylene oxide and nitrites which are either toxic, carcinogenic, mutagenic, or teratogenic. After 27 years of testing for "wholesomeness" (safety for consumption) of radappertized foods, no confirmed evidence has been obtained of any adverse effecys of radappertization on the "wholesomeness" characteristics of these foods.

  13. Consumer acceptance of irradiated poultry.

    PubMed

    Hashim, I B; Resurreccion, A V; McWatters, K H

    1995-08-01

    A simulated supermarket setting (SSS) test was conducted to determine whether consumers (n = 126) would purchase irradiated poultry products, and the effects of marketing strategies on consumer purchase of irradiated poultry products. Consumer preference for irradiated poultry was likewise determined using a home-use test. A slide program was the most effective educational strategy in changing consumers' purchase behavior. The number of participants who purchased irradiated boneless, skinless breasts and irradiated thighs after the educational program increased significantly from 59.5 and 61.9% to 83.3 and 85.7% for the breasts and thighs, respectively. Using a label or poster did not increase the number of participants who bought irradiated poultry products. About 84% of the participants consider it either "somewhat necessary" or "very necessary" to irradiate raw chicken and would like all chicken that was served in restaurants or fast food places to be irradiated. Fifty-eight percent of the participants would always buy irradiated chicken if available, and an additional 27% would buy it sometimes. About 44% of the participants were willing to pay the same price for irradiated chicken as for nonirradiated. About 42% of participants were willing to pay 5% or more than what they were currently paying for nonirradiated chicken. Seventy-three percent or more of consumers who participated in the home-use test (n = 74) gave the color, appearance, and aroma of the raw poultry products a minimum rating of 7 (= like moderately). After consumers participated in a home-use test, 84 and 88% selected irradiated thighs and breasts, respectively, over nonirradiated in a second SSS test. PMID:7479506

  14. Food Irradiation for Produce Safety

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A research priority for the produce industry is the development of an effective, safe and commercially applicable kill step. Irradiation is a nonthermal process that has been shown to inactivate human pathogens from fruits and vegetables. Irradiation treatment at 1.0 kGy can reduce the surface popul...

  15. Phytosanitary irradiation in south Asia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Irradiation has the potential to solve phytosanitary problems related to trade in south Asia. In general, it is the phytosanitary treatment most tolerated by fresh agricultural commodities. Irradiation technology is available in some countries of the region but is only used for phytosanitary purpos...

  16. Photoradiation Therapy Of Obstructing Endobronchial Lung Cancer

    NASA Astrophysics Data System (ADS)

    Balchum, Oscar J.; Doiron, Daniel R.

    1982-12-01

    Clinical trials of photoradiation therapy (PRT) have been carried out in 32 patients with lung cancer, 10 of which are reported here. The aim is the palliative treatment and control of cancer lesions obstructing an airway, whether in the trachea or in a large bronchus leading to a lung or to a lobe of a lung. The objective or patient benefit is the opening up of the lumen of the airway to improve ventilation to relieve shortness of breath, and to prevent the retention of secretions containing bacteria, that cause lung infections. Immediate results (one to several weeks) were uniformly good. Air passageways were opened up as revealed by subsequent bronchoscopy, after clearing away tumor debris. Short-term (several months) observations were limited in number but indicate potentially good results. Future research is directed toward better criteria for patient selection improved patient evaluation that will reveal potential cardiac and pulmonary complications, and the devising of more suitable laser light delivery techniques.

  17. Commercial implementation of food irradiation

    NASA Astrophysics Data System (ADS)

    Welt, M. A.

    In July 1981, the first specifically designed multi-purpose irradiation facility for food irradiation was put into service by the Radiation Technology, Inc. subsidiary Process Technology, Inc. in West Memphis, Arkansas. The operational experience gained, resulted in an enhanced design which was put into commercial service in Haw River, North Carolina, by another subsidiary, Process Technology (N.C.), Inc. in October 1983. These facilities have enabled the food industry to assess the commercial viability of food irradiation. Further impetus towards commercialization of food irradiation was gained in March 1981 with the filing in the Federal Register, by the FDA, of an Advanced Proposed Notice of Rulemaking for Food Irradiation. Two years later in July 1983, the FDA approved the first food additive regulation involving food irradiation in nineteen years, when they approved the Radiation Technology, Inc. petition calling for the sanitization of spices, onion powder and garlic powder at a maximum dosage of 10 kGy. Since obtaining the spice irradiation approval, the FDA has accepted four additional petitions for filing in the Federal Register. One of the petitions which extended spice irradiation to include insect disinfestation has issued into a regulation while the remaining petitions covering the sanitization of herbs, spice blends, vegetable seasonings and dry powdery enzymes as well as the petition to irradiate hog carcasses and pork products for trichinae control at 1 kGy, are expected to issue either before the end of 1984 or early in 1985. More recently, food irradiation advocates in the United States received another vote of confidence by the announcement that a joint venture food irradiation facility to be constructed in Hawaii by Radiation Technology, is backed by a contractual committment for the processing of 40 million pounds of produce per year. Another step was taken when the Port of Salem, New Jersey announced that the Radiation Technology Model RT-4104

  18. Pallet irradiators for food processing

    NASA Astrophysics Data System (ADS)

    McKinnon, R. G.; Chu, R. D. H.

    This paper looks at the various design concepts for the irradiation processing of food products, with particular emphasis on handling the products on pallets. Pallets appear to offer the most attractive method for handling foods from many considerations. Products are transported on pallets. Warehouse space is commonly designed for pallet storage and, if products are already palletized before and after irradiation, then labour could be saved by irradiating on pallets. This is also an advantage for equipment operation since a larger carrier volume means lower operation speeds. Different pallet irradiator design concepts are examined and their suitability for several applications are discussed. For example, low product holdup for fast turn around will be a consideration for those operating an irradiation "service" business; others may require a very large source where efficiency is the primary requirement and this will not be consistent with low holdup. The radiation performance characteristics and processing costs of these machines are discussed.

  19. Bronchoscopic location of bronchopleural fistula with xenon-133

    SciTech Connect

    Lillington, G.A.; Stevens, R.P.; DeNardo, G.L.

    1982-04-01

    Successful application of the technique of transbronchoscopic endobronchial occlusion of a persistent bronchopleural fistula requires an accurate determination of the segmental location of the air leak. This was achieved by injections of small boluses of Xe-133 into a number of segmental bronchi through a fiber-optic bronchoscope. Following the instillation of Xe-133 into the segmental bronchus leading to the fistula, there was a marked increase in radioactivity in the intercostal drainage tube.

  20. Nanoindentation on ion irradiated steels

    NASA Astrophysics Data System (ADS)

    Hosemann, P.; Vieh, C.; Greco, R. R.; Kabra, S.; Valdez, J. A.; Cappiello, M. J.; Maloy, S. A.

    2009-06-01

    Radiation induced mechanical property changes can cause major difficulties in designing systems operating in a radiation environment. Investigating these mechanical property changes in an irradiation environment is a costly and time consuming activity. Ion beam accelerator experiments have the advantage of allowing relatively fast and inexpensive materials irradiations without activating the sample but do in general not allow large beam penetration depth into the sample. In this study, the ferritic/martensitic steel HT-9 was processed and heat treated to produce one specimen with a large grained ferritic microstructure and further heat treated to form a second specimen with a fine tempered martensitic lath structure and exposed to an ion beam and tested after irradiation using nanoindentation to investigate the irradiation induced changes in mechanical properties. It is shown that the HT-9 in the ferritic heat treatment is more susceptible to irradiation hardening than HT-9 after the tempered martensitic heat treatment. Also at an irradiation temperature above 550 °C no detectable hardness increase due to irradiation was detected. The results are also compared to data from the literature gained from the fast flux test facility.

  1. New facility for post irradiation examination of neutron irradiated beryllium

    SciTech Connect

    Ishitsuka, Etsuo; Kawamura, Hiroshi

    1995-09-01

    Beryllium is expected as a neutron multiplier and plasma facing materials in the fusion reactor, and the neutron irradiation data on properties of beryllium up to 800{degrees}C need for the engineering design. The acquisition of data on the tritium behavior, swelling, thermal and mechanical properties are first priority in ITER design. Facility for the post irradiation examination of neutron irradiated beryllium was constructed in the hot laboratory of Japan Materials Testing Reactor to get the engineering design data mentioned above. This facility consist of the four glove boxes, dry air supplier, tritium monitoring and removal system, storage box of neutron irradiated samples. Beryllium handling are restricted by the amount of tritium;7.4 GBq/day and {sup 60}Co;7.4 MBq/day.

  2. AFIP-4 Irradiation Summary Report

    SciTech Connect

    Danielle M Perez; Misti A Lillo; Gray S. Chang; Glenn A Roth; Nicolas Woolstenhulme; Daniel M Wachs

    2012-01-01

    The Advanced Test Reactor (ATR) Full size plate In center flux trap Position (AFIP) experiment AFIP-4 was designed to evaluate the performance of monolithic uranium-molybdenum (U-Mo) fuels at a scale prototypic of research reactor fuel plates. The AFIP-4 test further examine the fuel/clad interface and its behavior under extreme conditions. After irradiation, fission gas retention measurements will be performed during post irradiation (PIE)1,2. The following report summarizes the life of the AFIP-4 experiment through end of irradiation, including a brief description of the safety analysis, as-run neutronic analysis results, hydraulic testing results, and thermal analysis results.

  3. AFIP-4 Irradiation Summary Report

    SciTech Connect

    Danielle M Perez; Misti A Lillo; Gray S. Chang; Glenn A Roth; Nicolas Woolstenhulme; Daniel M Wachs

    2011-09-01

    The Advanced Test Reactor (ATR) Full size plate In center flux trap Position (AFIP) experiment AFIP-4 was designed to evaluate the performance of monolithic uranium-molybdenum (U-Mo) fuels at a scale prototypic of research reactor fuel plates. The AFIP-4 test further examine the fuel/clad interface and its behavior under extreme conditions. After irradiation, fission gas retention measurements will be performed during post irradiation (PIE). The following report summarizes the life of the AFIP-4 experiment through end of irradiation, including a brief description of the safety analysis, as-run neutronic analysis results, hydraulic testing results, and thermal analysis results.

  4. Therapeutic postprostatectomy irradiation.

    PubMed

    Youssef, Emad; Forman, Jeffrey D; Tekyi-Mensah, Samuel; Bolton, Susan; Hart, Kim

    2002-06-01

    The purpose of this study was to determine the outcome of patients receiving external beam radiation for an elevated postprostatectomy prostate-specific antigen (PSA) level. Between December 1991 and September 1998, 108 patients received definitive radiation therapy for elevated postprostatectomy PSA levels. The median dose of irradiation was 68 Gy (range, 48-74 Gy). During treatment, the PSA levels were checked an average of 5 times (range, 3-7 times). Prostate-specific antigen values were judged to decline or increase during treatment if they changed by more than 0.2 ng/mL. After treatment, biochemical failure was defined as a measurable or rising PSA > 0.2 ng/mL. Median follow-up was 51 months (range, 3-112 months). Fifty-eight patients (54%) had evidence of biochemical failure. The 3- and 5-year actuarial biochemical relapse-free (bNED) survivals for all patients were 55% and 39%, respectively. Upon univariate analysis, intratreatment PSA and preradiation PSA were significant predictors of bNED survival. Patients with a PSA level that decreased during treatment had a 5-year bNED survival of 43% compared to 10% in patients with an increasing PSA level (P = 0.0002). Using the preradiation therapy PSA value as a continuous variable, higher preradiation therapy PSA levels were associated with an increased risk of failure (P = 0.004). Cut points of pretreatment PSA were derived at 0.9 ng/mL and 4.2 ng/mL using the Michael Leblanc recursive partitioning algorithm. The 5-year bNED rate for patients with a preradiation therapy PSA < 0.9 ng/mL was 45% versus 42% for patients with preradiation therapy PSA between 0.9 and 4.2 ng/mL and 21% for patients > or = 4.2 ng/mL (P = 0.0003). Patients with a Gleason score of < or = 7 had a 5-year bNED rate of 38% compared to 37% for patients with a Gleason score > 7 (P = 0.27). Other factors examined individually that did not reach statistical significance included time from surgery to radiation therapy, race, seminal vesicle

  5. (Irradiation creep of graphite)

    SciTech Connect

    Kennedy, C.R.

    1990-12-21

    The traveler attended the Conference, International Symposium on Carbon, to present an invited paper, Irradiation Creep of Graphite,'' and chair one of the technical sessions. There were many papers of particular interest to ORNL and HTGR technology presented by the Japanese since they do not have a particular technology embargo and are quite open in describing their work and results. In particular, a paper describing the failure of Minor's law to predict the fatigue life of graphite was presented. Although the conference had an international flavor, it was dominated by the Japanese. This was primarily a result of geography; however, the work presented by the Japanese illustrated an internal program that is very comprehensive. This conference, a result of this program, was better than all other carbon conferences attended by the traveler. This conference emphasizes the need for US participation in international conferences in order to stay abreast of the rapidly expanding HTGR and graphite technology throughout the world. The United States is no longer a leader in some emerging technologies. The traveler was surprised by the Japanese position in their HTGR development. Their reactor is licensed and the major problem in their graphite program is how to eliminate it with the least perturbation now that most of the work has been done.

  6. Generic phytosanitary irradiation treatments

    NASA Astrophysics Data System (ADS)

    Hallman, Guy J.

    2012-07-01

    The history of the development of generic phytosanitary irradiation (PI) treatments is discussed beginning with its initial proposal in 1986. Generic PI treatments in use today are 150 Gy for all hosts of Tephritidae, 250 Gy for all arthropods on mango and papaya shipped from Australia to New Zealand, 300 Gy for all arthropods on mango shipped from Australia to Malaysia, 350 Gy for all arthropods on lychee shipped from Australia to New Zealand and 400 Gy for all hosts of insects other than pupae and adult Lepidoptera shipped to the United States. Efforts to develop additional generic PI treatments and reduce the dose for the 400 Gy treatment are ongoing with a broad based 5-year, 12-nation cooperative research project coordinated by the joint Food and Agricultural Organization/International Atomic Energy Agency Program on Nuclear Techniques in Food and Agriculture. Key groups identified for further development of generic PI treatments are Lepidoptera (eggs and larvae), mealybugs and scale insects. A dose of 250 Gy may suffice for these three groups plus others, such as thrips, weevils and whiteflies.

  7. Irradiation pretreatment for coal desulfurization

    NASA Technical Reports Server (NTRS)

    Hsu, G. C.

    1979-01-01

    Process using highly-penetrating nuclear radiation (Beta and Gamma radiation) from nuclear power plant radioactive waste to irradiate coal prior to conventional desulfurization procedures increases total extraction of sulfur.

  8. Irradiation of Northwest agricultural products

    SciTech Connect

    Eakin, D.E.; Tingey, G.L.

    1985-02-01

    Irradiation of food for disinfestation and preservation is increasing in importance because of increasing restrictions on various chemical treatments. Irradiation treatment is of particular interest in the Northwest because of a growing supply of agricultural products and the need to develop new export markets. Several products have, or could potentially have, significant export markets if stringent insect control procedures are developed and followed. Due to the recognized potential benefits of irradiation, Pacific Northwest Laboratory (PNL) is conducting this program to evaluate the benefits of using irradiation on Northwest agricultural products under the US Department of Energy (DOE) Defense Byproducts Production and Utilization Program. Commodities currently included in the program are cherries, apples, asparagus, spices, hay, and hides.

  9. Consumer attitudes toward irradiated food

    SciTech Connect

    Conley, S.

    1994-12-31

    Throughout history, new methods of food preservation have been met with skepticism and fear. Such processes as pasteurization and canning were denounced as being dangerous, detrimental to nutrients, or an excuse for dirty products. Now comes irradiation, and activists argue against this new process for the same reasons. Publicly, the perception is that consumers, distrustful of nuclear power, will never buy or accept irradiated food.

  10. Slag recycling of irradiated vanadium

    SciTech Connect

    Gorman, P.K.

    1995-04-05

    An experimental inductoslag apparatus to recycle irradiated vanadium was fabricated and tested. An experimental electroslag apparatus was also used to test possible slags. The testing was carried out with slag materials that were fabricated along with impurity bearing vanadium samples. Results obtained include computer simulated thermochemical calculations and experimentally determined removal efficiencies of the transmutation impurities. Analyses of the samples before and after testing were carried out to determine if the slag did indeed remove the transmutation impurities from the irradiated vanadium.