Journal of bronchology & interventional pulmonology
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J Bronchology Interv Pulmonol · Oct 2013
Review Case ReportsMediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.
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. ⋯ 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.
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J Bronchology Interv Pulmonol · Oct 2013
Infections associated with tunnelled indwelling pleural catheters in patients undergoing chemotherapy.
Malignant pleural effusions are common complications of advanced malignancies and are associated with significant morbidity and reduced survival. Tunnelled indwelling pleural catheters (TIPCs) are implantable devices used for palliation of symptomatic malignant pleural effusions. Although complication rates are overall low, their use in the setting of concurrent chemotherapy has not been carefully reviewed. We report our experience with infectious complications directly attributable to TIPCs (pleural or local soft tissue infections) in those patients receiving concurrent chemotherapy. ⋯ The overall risk of infection in TIPC is low. Patients undergoing chemotherapy while the TIPC is in place do not seem to have an increased risk of infection, and therefore chemotherapy should not necessarily be viewed as a contraindication to TIPC insertion.
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J Bronchology Interv Pulmonol · Jul 2013
ReviewMethemoglobinemia in bronchoscopy: a case series and a review of the literature.
Methemoglobinemia results from oxidation of ferrous iron to ferric iron within the hemoglobin molecule. This molecule cannot bind oxygen and increases the affinity of normal hemoglobin for oxygen, which results in decreased oxygen offloading in peripheral tissues. At elevated levels, methemoglobinemia can cause dyspnea, cyanosis, and even death. Common local anesthesia agents have been correlated with methemoglobinemia. Bronchoscopy is a commonly performed clinical procedure which uses topical application of these anesthetics to provide patient comfort. Methylene blue is an agent thought to help reverse the effects of methemoglobinemia by facilitating the methemoglobin reductase system. ⋯ Using topical anesthetic during bronchoscopy appears relatively safe. No fatalities from methemoglobinemia after bronchoscopy have been reported. A high suspicion for methemoglobinemia is required in patients who develop hypoxia or cyanosis postprocedurally. Access to CO-oximetry can confirm the diagnosis but the clinical picture is often sufficient to proceed with methylene blue treatment or observation, based on how severely the patient is affected. Patients who return to baseline can be considered for discharge home.
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J Bronchology Interv Pulmonol · Jul 2013
The safety of medical thoracoscopy in a group at high risk for complications.
The use of medical thoracoscopy (MT) for the diagnosis and/or palliative treatment of pleural effusions is expected to become more widespread in the coming years. The aims of the present study were to establish the safety of MT in a group of patients at high risk for complications and to determine the factors that affect the development of complications. ⋯ MT is a safe method for the diagnosis of patients with pleural effusion, even in patients at high risk for complications. However, complications, found in approximately half of the patients, should also be examined in terms of cost.