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Diagnostic difficulties in chronic obstructive pulmonary disease exacerbations: A case report

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Case Reports in Clinical Medicine 2013年第6期2卷 370-374页

作者： Simona Stefania Bucsa Petre Iacob Calistru Department of Infectious Diseases Faculty of Medicine Carol Davila University of Medicine and Pharmacy Bucharest Romania Department of Pneumology “Dr Victor Babes” Diagnosis and Treatment Center Bucharest Romania

Exacerbations of COPD (chronic obstructive pulmonary disease) influence, by their frequency and severity, the life prognosis of patients with COPD. Most exacerbations are caused by respiratory infections with negative impact on patient quality of life. The impact of frequent exacerbation in COPD is manifested by the rapid decline of lung function, decreased quality of life increased airway inflamation and high mortality. Bronchial obstruction by foreign bodies meets frequently during childhood but can occur in adults under certain conditions of loss of consciousness (sleep, administration of tranquilizers, after anesthesia, intoxicated). The longstanding intrabronchial foreign body presents problems of diagnosis and treatment which are very different from those associated with the recently inhaled foreign body. We herein report a 77-year-old male, smoker (40 pack-year) presented to the clinic with severe dyspnoea, fever and cough with purulent sputum for about 6 months. Persistent symptoms require repeated hospitalizations for receiving different regimens of antibiotics, but they have not helped. Chest radiography showed extensive consolidation of the right lower lobe, intensity rib, heterogeneous and Chest CT scan showed metallic foreign body in right lower lobar bronchus with secondary pneumonic process in the lower right lobe. Emergency was performed bronchoscopy and extracted dental crown consists of three teeth and then the patient received combined antibiotic therapy for 14 days, in association with anti-inflammatory, mucolytics and bronchodilators. After 2 weeks he was overall in very good condition and all other complaints disappeared and Chest X-ray control showed full resorption of pneumonia opacity, without disabling signs. In this particular case, only minor symptoms are seen at the beginning and the aspirated foreign body was forgotten until later symptoms (inflammation, infection) were developed and developing clinically manifest. The diagnosis was del

关键词： Retrostenotica Secondary Pneumonia Metallic Foreign Body Aspirated Intrabronsic

Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases

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Open Journal of Thoracic Surgery 2013年第4期3卷 130-134页

作者： Bulent Aydemir Sezai Celik Oya Uncu Handan Tanrıkulu Tamer Okay Department of Thoracic Surgery Dr.Siyami Ersek Thoracic and Cardiovascular Surgery CenterIstanbulTurkey Department of Thoracic Surgery Haydarpasa Numune Training and Research HospitalIstanbulTurkey.

Objective: Iatrogenic tracheal rupture is a rare, but life-threatening complication of orotracheal intubation. In this retrospective study, etiology, and diagnostic and therapeutic approaches for iatrogenic tracheal ruptures were reviewed. Method: Eleven patients (6 males and 5 females) were diagnosed and treated for iatrogenic tracheal rupture in our clinic. The laceration occurred after orotracheal intubation in 7 cases, and during percutaneous tracheostomy and emergency tracheostomy in the other four cases, respectively. Diagnosis was made during thoracic surgery in 5 cases. The remaining cases were diagnosed in the post-operative period;the most common symptoms were mediastinal and subcutenous emphysema and pneumothorax. Results: The diagnosis was confirmed by bronchoscopy in all cases. The lacerations were longitudinal, 1-7 cm in length and were located in the distal membranous trachea. While ruptures detected intraoperatively were repaired during the surgery, the others were treated conservatively. No mortality was observed among cases treated surgically. However, three of the cases treated conservatively died (50%), and the cause of death was the underlying disease requiring intubation. Conclusion: We are in the opinion that primary disease is a determinant of patient outcome. Except cases identified during surgery, emergency surgical interventions should be preferred in patients, in whom ventilation cannot be achieved. On the other hand, bronchoscopic fibrin glue instillation should additively be applied to conservative treatment of tracheal lacerations.

关键词： Tracheal Rupture Iatrogenic Surgery Conservative Treatment

Pre-operative nasal probe tests with adrenaline and lidocaine ease insertion during flexible bronchoscopy and reduce post-operative bleeding:a randomized controlled trial

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Chinese Medical Journal 2022年第15期135卷 1808-1813页

作者： Wenjun Zhu Yuchen Zhang Jingyu Shi Xiaoqin Wang Renjiao Li Jia Liu Ping Li Dan Liu Fengming Luo Department of Pulmonary and Critical Care Medicine West China HospitalSichuan UniversityChengduSichuan 610041China Laboratory of Pulmonary Immunology and Infammation Frontiers Science Center for Disease-Related Molecular NetworkWest China HospitalSichuan UniversityChengduSichuan 610041China

Background:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy;however,the relatively narrow nasal cavity results in difficulties related to bronchoscope *** study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis,improve the first-pass success rate and patients’tolerance,and reduce postoperative ***:This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October *** hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups:control group,simple cotton bud detection group(CD group),and adrenaline+lidocaine detection group(AD group).The primary outcome was the time to pass the *** outcomes included the first-pass success rate,the patients’tolerance scores,and post-operative ***-way analysis of variance,Kruskal-WallisH test,Chi-squared test,Fisher’s exact test,and Bonferroni’s multiple comparison tests were used in this ***:In total,189 men and 111 women were enrolled in this study,with a mean age of 55.72±12.86 *** insertion time was significantly shorter in the AD group than in the control group(18.00 s[12.00–26.50 s]vs.24.00 s[14.50–45.50 s],P=0.005).Both the AD(99%vs.83%,χ2=15.62,Pbronchoscopy can significantly reduce the time to pass the glottis,improve the first-pass success rate,and reduce post-operative nasal ***-operative nasal probe tests are recommended as a

关键词： Complications Flexible bronchoscopy Nasal cavity-glottis time Nasal probe test

Key determinants of misdiagnosis of tracheobronchial tuberculosis among senile patients in contemporary clinical practice:A retrospective analysis

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World Journal of Clinical Cases 2021年第25期9卷 7330-7339页

作者： Fei Tang Lian-Jun Lin Shu-Liang Guo Wei Ye Xian-Kui Zha Yu Cheng Ying-Feng Wu Yue-Ming Wang Xiao-Mei Lyu Xiao-Yun Fan Li-Ping Lyu Department of Geriatric Respiratory and Critical Care The First Affiliated Hospital of Anhui Medical UniversityHefei 230022Anhui ProvinceChina Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment center Anhui Chest HospitalHefei 230022Anhui ProvinceChina Department of Respiratory and Critical Care Medicine Peking University First HospitalBeijing 100034China Department of Respiratory and Critical Care Medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China

BACKGROUND Tracheobronchial tuberculosis(TBTB)is a common subtype of pulmonary *** diseases often obscure the diagnosis of senile *** To characterize senile patients with TBTB and to identify the potential causes of *** One hundred twenty patients with senile TBTB who were admitted to the Anhui Chest hospital between May 2017 and May 2019 were retrospectively *** were classified as diagnosed group(n=58)and misdiagnosed group(n=62).Clinical manifestations,laboratory results,radiographic data,and endoscopic findings were compared between the two *** Patients in the misdiagnosed group were most commonly diagnosed as pulmonary tuberculosis(non-TBTB,29/62,46.8%),general pneumonia(9/62,14.5%),chronic obstructive pulmonary disease(8/62,12.9%),and tracheobronchial carcinoma(7/62,11.3%).The time elapsed between disease onset and confirmation of diagnosis was significantly longer in the misdiagnosed group[median(first quartile,third quartile):6.32(4.94,16.02)mo vs 3.73(2.37,8.52)mo].The misdiagnosed group had lower proportion of patients who underwent bronchoscopy[33.87%(21/62)vs 87.93%(51/58)],chest computed tomography(CT)scan[69.35%(43/62)vs 98.28%(57/58)],and those who showed CT signs of tuberculosis[27.91%(12/62)vs 50%(29/58)]as compared to that in the diagnosed group(P0.05).CONCLUSION Insufficient or inaccurate radiographic or bronchoscopic assessment was the predominant cause of delayed diagnosis of *** implementation and better interpretation of CT scan and early implementation of bronchoscopy can help reduce misdiagnosis of senile TBTB.

关键词： Senile tracheobronchial tuberculosis Misdiagnosis Clinical characteristics Pulmonary tuberculosis Tuberculosis

Learning curve of a robotic-assisted bronchoscopy system in sampling peripheral pulmonary nodules

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Chinese Medical Journal 2022年第22期135卷 2753-2755页

作者： Fangfang Xie Qin Zhang Shuaiyang Liu Lijun Yan Yongzheng Zhou Jiayuan Sun Department of Respiratory Endoscopy Department of Respiratory and Critical Care MedicineShanghai Chest HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200030China Shanghai Engineering Research center of Respiratory Endoscopy Shanghai 200030China

To the Editor:Computed tomography(CT)has been used for the screening of lung cancer in high-risk populations,with a subsequent reduction in lung cancer-related mortality.[1]However,it has also resulted in a considerab... 详细信息

关键词： lung mortality cancer

Cerebral air embolism complicating transbronchial lung biopsy: A case report

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World Journal of Clinical Cases 2021年第32期9卷 9911-9916页

作者： Vladimir Herout Kristian Brat Svatopluk Richter Ivan Cundrle Jr Department of Respiratory Diseases University Hospital BrnoBrno 62500Czech Republic Department of Respiratory Diseases Faculty of MedicineMasaryk UniversityBrno 62500Czech Republic International Clinical Research center Brno 60200Czech Republic Department of Radiology and Nuclear Medicine University Hospital BrnoBrno 62500Czech Republic Department of Anesthesiology and Intensive Care St.Anne's University HospitalBrno 60200Czech Republic Department of Anesthesiology and Intensive Care Faculty of MedicineMasaryk UniversityBrno 60200Czech Republic

BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described *** bronchologist should recognize this severe adverse *** recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen *** SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following *** a few cases of this rare complication were described *** patient had an incidental finding of lung tumour and pulmonary *** air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided *** timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks *** air embolism is an extremely rare complication of *** condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s *** Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after *** current gold standard for diagnosis is computed tomography scan of the *** recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.

关键词： Transbronchial lung biopsy Cerebral air embolism Ischemic stroke bronchoscopy Hyperbaric oxygen therapy Case report

介入性肺脏病学在早期非小细胞肺癌诊断及治疗中的应用

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中国胸心血管外科临床杂志 2015年第4期22卷 344-354页

作者： Ryu Peter Hambrook Tofts Peter MJ Lee Arthur Wai Sung 谭文勇 Division of Pulmonary and Critical Care Medicine Beth Israel Medical Center New York NY 10003 USA 不详

肺癌的治疗非常复杂,需要多学科联合来提供综合治疗。介入性肺脏病学是利用微创的方式为疑似肺癌的患者进行初步诊断和分期,在目前仍是一个不断发展的学科领域。支气管超声引导下的对纵隔淋巴结采样进行分期,同时进行驱动突变检测是早... 详细信息

肺癌的治疗非常复杂,需要多学科联合来提供综合治疗。介入性肺脏病学是利用微创的方式为疑似肺癌的患者进行初步诊断和分期,在目前仍是一个不断发展的学科领域。支气管超声引导下的对纵隔淋巴结采样进行分期,同时进行驱动突变检测是早期和晚期肺癌诊断及治疗的重要工具,支气管超声引导下支气管镜的进步使得可疑周围性病变的组织学采样的并发症发生率大大降低同时为立体定向放疗植入基准标记。此外,介入性肺脏病学可以缓解不可手术的癌症及晚期癌症。由于低剂量CT扫描用于肺癌的早期发现,对肺部结节的治疗有经验的肺病专科医师来说,最重要的是尽可能减少侵袭性采样,整合多学科诊治的模式进行分期。

关键词：支气管镜检查法基因表达谱多学科交流 TNM分期径向探头EBUS(RP-EBUS) 虚拟支气管镜导航(VBN) 电磁导航支气管镜检查(ENB^TM)

Survival from cardiac arrest due to sushi suffocation

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World Journal of Emergency Medicine 2014年第2期5卷 154-156页

作者： Toru Hifumi Nobuaki Kiriu Hiroshi Kato Yuichi Koido Yasuhiro Kuroda Emergency Medical center Kagawa University Hospital Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center

BACKGROUND: Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been ***: A 60-year-old man was referred to our hospital for post resuscitative intensive care. He had choked on sushi and collapsed in the dining room of a mental hospital. A nursing assistant summoned a physician who attempted to extract the sushi. External cardiac massage was initiated after 7 minutes had elapsed and followed by endotracheal intubation. Return of spontaneous circulation was achieved after 7 minutes of resuscitation. A bronchoscopy demonstrated a large amount of shari in the trachea and right bronchus, which was removed with alligator forceps and a wire ***: Neurological recovery was evident on day 2 of admission. He was transferred back to the mental hospital with no neurological ***: Emergency physicians should consider sushi suffocation, including its clinical features and management.

关键词： Food suffocation Sushi Cardiopulmonary arrest

Video-assisted thoracic surgery for ambiguous lung or mediastinal masses in response assessments for hematological malignancies

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Chinese Medical Journal 2022年第8期135卷 986-987页

作者： Runhui Zheng Guilin Peng Xin Xu Xiaodan Luo Chunyan Wang Department of Hematology First Affiliated HospitalGuangzhou Medical UniversityGuangzhouGuangdong 510230China Department of Thoracic Oncology and Surgery China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdong 510120China

To the Editor:The morbidity of thoracic lesions is very high during the treatment of malignant hematological diseases,and tumor recurrence or invasion is common,in addition to *** lung biopsy or bronchoscopy could result in severe hemoptysis,pneumothorax,or infection because of low platelets and hypo-immunity,and treatment is often ineffective due to the ambiguous *** when a patient is diagnosed with a fungal disease,it is difficult to eliminate the lesion with only antifungal medicine.

关键词： thoracic lung immunity