scholarly journals Therapeutic closure of bronchopleural fistulas using ethanol

2021 ◽  
Vol 15 ◽  
pp. 175346662110444
Author(s):  
Osheen Abramian ◽  
Justin Rosenheck ◽  
Diana Taddeo-Kolman ◽  
Francis Bowen ◽  
Ziad Boujaoude ◽  
...  
Keyword(s):  
Autologous Blood ◽  
Bronchopleural Fistula ◽  
Early Postoperative Period ◽  
Endobronchial Ultrasound ◽  
High Morbidity ◽  
Transbronchial Needle Aspiration ◽  
Surgical Interventions ◽  
Risk Of Death ◽  
Amplatzer Device ◽  
Increased Risk

Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus© 21-gauge EBUS-TBNA (endobronchial ultrasound–transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.

Errors in Transfusion Medicine: Scope of the Problem

1999 ◽  
Vol 123 (7) ◽  
pp. 563-565 ◽  
Author(s):  
Jeanne V. Linden
Keyword(s):  
Autologous Blood ◽  
Virus Transmission ◽  
Air Embolism ◽  
Transfusion Medicine ◽  
Transfusion Reaction ◽  
Risk Of Death ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Hemolytic Transfusion Reaction ◽  
Disease Risks

Abstract Error is ubiquitous whenever humans are involved in a process. Fortunately, most transfusion-related errors are benign. However, the risk of death due to acute hemolytic transfusion reaction rivals that of human immunodeficiency virus transmission and administration of the wrong blood or of blood to the wrong recipient has occurred at many facilities. Most blood misadministration errors are caused by failure to identify the recipient and blood unit adequately, although phlebotomy errors and blood bank errors also contribute. Many errors are multifactorial and may reflect underlying systems defects. Noncompliant specimen labels may be a cue to an increased risk of phlebotomy error. Autologous blood is not immune from error and poses infectious disease risks as well as the risk of hemolytic transfusion reaction; also, perioperatively recovered blood may pose a risk of air embolism if improperly handled.

scholarly journals Presence of concurrent sarcoid-like granulomas indicates better survival in cancer patients: a retrospective cohort study

2020 ◽  
Vol 6 (4) ◽  
pp. 00061-2020
Author(s):  
Mukunthan Murthi ◽  
Keiichiro Yoshioka ◽  
Jeong Hee Cho ◽  
Sixto Arias ◽  
Elio Danna ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Cancer Patients ◽  
Cancer Metastasis ◽  
Hazard Analysis ◽  
Metastatic Cancer ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Protective Mechanism ◽  
Transbronchial Needle Aspiration ◽  
Increased Risk

IntroductionAn increased risk of sarcoidosis and sarcoid-like reactions in subjects with a history of malignancy has been suggested. We assessed the incidence and clinical characteristics of cancer patients with biopsies containing sarcoid-like granulomas on cancer metastasis and patient survival.MethodsThis is a retrospective, multicentre, observational study involving endobronchial ultrasound transbronchial needle aspiration and a melanoma patient dataset at the University of Miami, USA, and a sarcoidosis patient database at Chiba University, Japan. Subjects with a confirmed diagnosis of cancer and who subsequently developed granulomas in different organs were enrolled. The study was registered at Clinicaltrials.gov (NCT03844698).Results133 patients met the study's criteria. The most common primary cancer sites were the skin (22.5%), breast (20.3%) and lymph node (12.8%). 24 (18%) patients developed sarcoid-like granulomas within 1 year of cancer diagnosis, 54 (40.6%) between 1 and 5 years and 49 (36.8%) after 5 years. Imaging showed possible sarcoid-like granulomas in lymph nodes in 51 cases (38.3%) and lung tissue and mediastinal lymph nodes in 73 cases (54.9%); some parenchymal reticular opacity and fibrosis was found in 5 (3.7%) and significant parenchymal fibrosis in 2 (1.5%) subjects. According to logistic regression analysis, the frequency of metastatic cancer was significantly lower in patients with sarcoid-like granulomas than in controls. Moreover, multivariate Cox proportional hazard analysis showed a significant survival advantage in those with sarcoid-like granuloma.ConclusionSarcoid-like granulomas are uncommon pathology findings in cancer patients. There is a significant association between the presence of granulomas and reduced metastasis and increased survival. Further study is warranted to understand the protective mechanism involved.

scholarly journals A Randomized Controlled Trial Comparing a Mapleson Circuit with Nasal Trumpet to Standard Oxygen Supplementation during EBUS Bronchoscopy under Monitored Anesthesia Care

2019 ◽  
Vol 4 (2) ◽  
pp. 1-9
Author(s):  
Wissam Abouzgheib ◽  
Talia K. Ben-Jacob ◽  
Amit Borah ◽  
Rocco Terrigno ◽  
Karla Cruz-Morel ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Patient Discharge ◽  
Standard Of Care ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Anesthesia Care ◽  
Oxygen Supplementation ◽  
Monitored Anesthesia Care ◽  
Transbronchial Needle Aspiration ◽  
Increased Risk

Background: Endobronchial ultrasound (EBUS) procedures tend to be longer than routine bronchoscopies. Increased duration and sedative dosing put patients at increased risk for ­hypoxic events. Objective: To determine whether oxygen supplementation via a nasal trumpet connected to a Mapleson B circuit (NTM) was effective in decreasing hypoxic events when compared with the standard of care, oxygen supplementation with a nasal cannula (NC). Methods: Patients referred for EBUS-guided transbronchial needle aspiration with monitored anesthesia care (MAC) were randomized 1:1 to NTM or to NC. Hypoxia-related procedural interruptions, the primary endpoint of the study, were documented for all patients. Patients in the NC group who had refractory desaturations were allowed to cross over to the NTM group. Secondary endpoints included: number of crossovers from NC to NTM, sedative dosing, total procedure times, whether procedure goals were achieved, complications apart from hypoxia, patient discharge status. Results: Fifty-two patients were randomized to NC and 48 to NTM. Baseline characteristics were comparable. The NC group had significantly more interruptions than did the NTM group (p < 0.001). Procedure duration was also significantly (p < 0.03) shorter for the NTM group. Fourteen patients were crossed over from NC to NTM because of hypoxia. Thirteen out of the 14 completed the procedure with no interruptions. All procedures were successfully completed, and all goals were achieved. All patients returned to baseline status prior to discharge. Three minor complications of epistaxis occurred. Conclusion: For patients undergoing EBUS with MAC, oxygen supplementation with NTM significantly decreased the incidence of hypoxic events when compared with NC. NTM may also be of value for other subsets of patients who are at increased risk for desaturation when undergoing bronchoscopy.

Acute pericarditis and mediastinal lymph node abscess developing after endobronchial ultrasound guided transbronchial needle aspiration

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Shingo Nishikawa ◽  
Ryo Ariyasu ◽  
Tomoaki Sonoda ◽  
Masafumi Saiki ◽  
Takahiro Yoshizawa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Mediastinal Lymph Node ◽  
Tumor Therapy ◽  
Needle Aspiration ◽  
Lymph Node Biopsy ◽  
Endobronchial Ultrasound ◽  
Tumor Treatment ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Acute Pericarditis

A 27-year-old man was diagnosed with inflammatory myofibroblastic tumor, and multiple lymph node and subcutaneous metastases. After several administrations of anti-tumor therapy, he underwent mediastinal lymph node biopsy using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to confirm tumor relapse. Five weeks later, he complained of chest pain, then rapidly developed shock due to acute pericarditis. Although he was treated with antibiotics for anaerobic bacterial infection and cardiac drainage, mediastinal lymph node abscess and pericarditis did not improve. After the surgical procedure, his physical condition dramatically improved and he was treated with another molecularly targeted therapy. Pericarditis associated with EBUS-TBNA is extremely rare. In this case, salvage was achieved by surgical drainage of the lymph node abscess and pericarditis, and long survival was obtained with further administration of anti-tumor treatment.

EFFECTS OF SMOKING ON THE DISEASE PROGNOSIS IN CANCER PATIENTS

2019 ◽  
Vol 65 (3) ◽  
pp. 321-329
Author(s):  
David Zaridze ◽  
Anush Mukeriya
Keyword(s):  
Smoking Cessation ◽  
Cancer Patients ◽  
Malignant Tumors ◽  
Scientific Data ◽  
Second Primary ◽  
Primary Tumors ◽  
Smoking Intensity ◽  
Risk Of Death ◽  
Disease Prognosis ◽  
Increased Risk

Smoking not only increases the risk of the development of malignant tumors (MT), but affects the disease prognosis, mortality and survivability of cancer patients. The link between the smoking of cancer patients and increased risk of death by all diseases and oncological causes has been established. Mortality increases with the growth of the smoking intensity, i.e. the number of cigarettes, smoked per day. Smoking is associated with the worst general and oncological survivability. The statistically trend-line between the smoking intensity and survivability was observed: each additional unit of cigarette consumption (pack/year) leads to the Overall Survival Reduction by 1% (p = 0.002). The link between smoking and the risk of developing second primary tumors has been confirmed. Smoking increases the likelihood of side effects of the antitumor therapy both drug therapy and radiation therapy and reduces the treatment efficacy. The smoking cessation leads to a significant improvement in the prognosis of a cancer patient. Scientific data on the negative effect of smoking on the prognosis of cancer patients have a major clinical importance. The treatment program for cancer patients should include science-based methods for the smoking cessation. The latter is fundamentally important, taking into account that the smoking frequency among cancer patients is much higher than in the population.

The Effect of Mianserin on Lifespan of Caenorhabditis elegans is Abolished by Glucose

2021 ◽  
Vol 13 ◽  
Author(s):  
Abdullah Almotayri ◽  
Jency Thomas ◽  
Mihiri Munasinghe ◽  
Markandeya Jois
Keyword(s):  
Caenorhabditis Elegans ◽  
Scaffolding Protein ◽  
Lifespan Extension ◽  
Wild Type ◽  
E Coli ◽  
C Elegans ◽  
Risk Of Death ◽  
Increased Risk ◽  
Antidepressant Use ◽  
Extension Effect

Background: The antidepressant mianserin has been shown to extend the lifespan of Caenorhabditis elegans (C. elegans), a well-established model organism used in aging research. The extension of lifespan in C. elegans was shown to be dependent on increased expression of the scaffolding protein (ANK3/unc-44). In contrast, antidepressant use in humans is associated with an increased risk of death. The C. elegans in the laboratory are fed Escherichia coli (E. coli), a diet high in protein and low in carbohydrate, whereas a typical human diet is high in carbohydrates. We hypothesized that dietary carbohydrates might mitigate the lifespan-extension effect of mianserin. Objective: To investigate the effect of glucose added to the diet of C. elegans on the lifespan-extension effect of mianserin. Methods: Wild-type Bristol N2 and ANK3/unc-44 inactivating mutants were cultured on agar plates containing nematode growth medium and fed E. coli. Treatment groups included (C) control, (M50) 50 μM mianserin, (G) 73 mM glucose, and (M50G) 50 μM mianserin and 73 mM glucose. Lifespan was determined by monitoring the worms until they died. Statistical analysis was performed using the Kaplan-Meier version of the log-rank test. Results: Mianserin treatment resulted in a 12% increase in lifespan (P<0.05) of wild-type Bristol N2 worms but reduced lifespan by 6% in ANK3/unc-44 mutants, consistent with previous research. The addition of glucose to the diet reduced the lifespan of both strains of worms and abolished the lifespan-extension by mianserin. Conclusion: The addition of glucose to the diet of C. elegans abolishes the lifespan-extension effects of mianserin.

scholarly journals The effect of adjuvant radiotherapy on overall survival in adults with intracranial ependymoma

2019 ◽  
Vol 7 (4) ◽  
pp. 391-399
Author(s):  
Roshan S Prabhu ◽  
Christopher D Corso ◽  
Matthew C Ward ◽  
John H Heinzerling ◽  
Reshika Dhakal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Adjuvant Radiotherapy ◽  
Subtotal Resection ◽  
National Cancer Database ◽  
Risk Of Death ◽  
Increased Risk ◽  
Intracranial Ependymoma ◽  
Male Sex ◽  
Grade 3

Abstract Background Adult intracranial ependymoma is rare, and the role for adjuvant radiotherapy (RT) is not well defined. Methods We used the National Cancer Database (NCDB) to select adults (age ≥ 22 years) with grade 2 to 3 intracranial ependymoma status postresection between 2004 and 2015 and treated with adjuvant RT vs observation. Four cohorts were generated: (1) all patients, (2) grade 2 only, (3) grade 2 status post–subtotal resection only, (4) and grade 3 only. The association between adjuvant RT use and overall survival (OS) was assessed using multivariate Cox and propensity score matched analyses. Results A total of 1787 patients were included in cohort 1, of which 856 patients (48%) received adjuvant RT and 931 (52%) were observed. Approximately two-thirds of tumors were supratentorial and 80% were grade 2. Cohorts 2, 3, and 4 included 1471, 345, and 316 patients, respectively. There was no significant association between adjuvant RT use and OS in multivariate or propensity score matched analysis in any of the cohorts. Older age, male sex, urban location, higher comorbidity score, earlier year of diagnosis, and grade 3 were associated with increased risk of death. Conclusions This large NCDB study did not demonstrate a significant association between adjuvant RT use and OS for adults with intracranial ependymoma, including for patients with grade 2 ependymoma status post–subtotal resection. The conflicting results regarding the efficacy of adjuvant RT in this patient population highlight the need for high-quality studies to guide therapy recommendations in adult ependymoma.

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