Clinics in chest medicine
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Pediatric interventional bronchoscopy includes a variety of diagnostic and therapeutic procedures. Restoration of airway patency, management of tracheoesophageal fistula, and difficult airway intubation are just a few pertinent examples. ⋯ Although no comparative studies are available, the authors compare the different techniques as reported in the literature. Respective advantages and drawbacks are discussed in light of their own practice, with particular emphasis on technical difficulties encountered in younger children.
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Although bronchoscopy technology continues to evolve at a fairly rapid pace, basic procedures, such as bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration, continue to play a paramount role in the diagnosis of bronchopulmonary diseases. Pulmonologists should be trained in these basic bronchoscopic procedures.
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Clinics in chest medicine · Sep 2013
Review Historical ArticleLung cancer screening: past, present and future.
Lung cancer is the leading cause of cancer death for men and women. Most lung cancer cases are diagnosed at an advanced stage, when cure is no longer an option; this heavily influences mortality. ⋯ However, the recent National Lung Screening Trial demonstrated that low-dose computed tomography screening for lung cancer decreases mortality. This article outlines the history of lung cancer screening, the current state of screening and possible future adjuncts to screening.
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Clinics in chest medicine · Sep 2013
ReviewQuality-of-life improvement and cost-effectiveness of interventional pulmonary procedures.
Most interventional pulmonology studies focus on the technical success of procedures without measuring validated quality-of-life (QoL) outcomes. Studies are now incorporating end points that include QoL measurements and there are examples of interventional procedures that likely improve QoL. It is vital for the interventional pulmonary literature to incorporate cost-effectiveness when introducing new technology. While not uniformly analyzed in a rigorous manner in all studies, there are examples of interventional pulmonary studies that analyze cost-effectiveness through avoidance of more expensive procedures, cost savings per day free of emergency room visit, or cost savings per day not requiring intensive care unit care.
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In the staging of mediastinal lymph nodes before lung cancer surgery, endobronchial ultrasound transbronchial needle aspirations (EBUS-TBNA) have proven to be highly sensitive and specific as well as safe. Although positron emission tomography/computed tomography (PET/CT) has been a major development in the preoperative workup of patients with lung cancer, EBUS-TBNA has superior test performance and PET/CT cannot be regarded as a substitute for tissue sampling with EBUS-TBNA. In general, EBUS-TBNA staging is needed for any patient with CT nodes greater than 1 cm in short axis, or PET-positive mediastinal nodes.