Endobronchial cryobiopsy from visualised intraluminal tumour lesions may decrease the rate of diagnostic failure and shorten the time to diagnosis https://bit.ly/3NkyJ98.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Cardiopulmonary exercise testing parameters including ventilatory efficiency (VE/VCO2 slope) are used for risk assessment of lung resection candidates. However, many patients are unable or unwilling to undergo exercise. VE/VCO2 slope is closely related to the partial pressure of end-tidal carbon dioxide (PETCO2). We hypothesized PETCO2 at rest predicts postoperative pulmonary complications. METHODS: Consecutive lung resection candidates were included in this prospective multicenter study. Postoperative respiratory complications were assessed from the first 30 postoperative days or from the hospital stay. Student t test or Mann-Whitney U test was used for comparison. Multivariate stepwise logistic regression analysis was used to analyze association with the development of postoperative pulmonary complications. The De Long test was used to compare area under the curve (AUC). Data are summarized as median (interquartile range). RESULTS: Three hundred fifty-three patients were analyzed, of which 59 (17%) developed postoperative pulmonary complications. PETCO2 at rest was significantly lower (27 [24-30] vs 29 [26-32] mm Hg; P < .01) and VE/VCO2 slope during exercise significantly higher (35 [30-40] vs 29 [25-33]; P < .01) in patients who developed postoperative pulmonary complications. Both rest PETCO2 with odds ratio 0.90 (95% confidence interval [CI] 0.83-0.97); P = .01 and VE/VCO2 slope with odds ratio 1.10 (95% CI 1.05-1.16); P < .01 were independently associated with postoperative pulmonary complications by multivariate stepwise logistic regression analysis. There was no significant difference between AUC of both models (rest PETCO2: AUC = 0.79 (95% CI 0.74-0.85); VE/VCO2 slope: AUC = 0.81 (95% CI 0.75-0.86); P = .48). CONCLUSIONS: PETCO2 at rest has similar prognostic utility as VE/VCO2 slope, suggesting rest PETCO2 may be used for postoperative pulmonary complications prediction in lung resection candidates.
- MeSH
- lidé MeSH
- oxid uhličitý * MeSH
- plíce MeSH
- prospektivní studie MeSH
- spotřeba kyslíku MeSH
- srdeční selhání * MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Poor ventilatory efficiency, defined as the increase in minute ventilation relative to carbon dioxide production during exercise (VE/VCO2 slope), may be associated with dynamic hyperinflation and thereby promote the development of prolonged air leak (PAL) after lung resection. Consecutive lung lobectomy candidates (n = 96) were recruited for this prospective two-centre study. All subjects underwent pulmonary function tests and cardiopulmonary exercise testing prior to surgery. PAL was defined as the presence of air leaks from the chest tube on the 5th postoperative day and developed in 28 (29%) subjects. Subjects with PAL were not different in terms of age, sex, American Society of Anesthesiologists class, type of surgery (thoracotomy/video-assisted thoracoscopic surgery) and site of surgery (right/left lung; upper/lower lobes). Subjects with PAL had more frequent pleural adhesions (50% vs 21%; P = 0.006) and steeper VE/VCO2 slope (35 ± 7 vs 30 ± 5; P = 0.001). Stepwise logistic regression showed that only the presence of pleural adhesions [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.4-10.9; P = 0.008] and VE/VCO2 slope (OR 1.1, 95% CI 1.0-1.2; P = 0.003) were independently associated with PAL (AUC 0.74, 95% CI 0.62-0.86). We conclude that a high VE/VCO2 slope during exercise may be helpful in identifying patients at greater risk for the development of PAL after lung lobectomy. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT03498352.
- MeSH
- cvičení fyziologie MeSH
- hrudní chirurgie video-asistovaná MeSH
- hrudní trubice MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- plicní nemoci mortalita patofyziologie chirurgie MeSH
- plicní ventilace fyziologie MeSH
- pneumektomie škodlivé účinky MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- prospektivní studie MeSH
- respirační funkční testy MeSH
- senioři MeSH
- spotřeba kyslíku fyziologie MeSH
- zátěžový test MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Klíčová slova
- ALECENSA (alectinib),
- MeSH
- anaplastická lymfomová kináza antagonisté a inhibitory MeSH
- doba přežití bez progrese choroby MeSH
- endoteliální růstové faktory antagonisté a inhibitory MeSH
- inhibitory proteinkinas aplikace a dávkování farmakologie MeSH
- lidé MeSH
- nemalobuněčný karcinom plic * farmakoterapie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
BACKGROUND: Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes. METHODS: All bronchoscopic records from the period January 1st, 2015 - December 31st, 2017 (from the Department of Respiratory Diseases, University Hospital Brno, Czech Republic) were retrospectively analyzed. Of the 3542 bronchoscopic records, 796 patients underwent TBB and were further analyzed. Basic demographic data, TBB procedure-related factors, smoking history and radiological features were analyzed. Furthermore, in patients who developed PTX, PTX onset, PTX symptoms, distribution of the abnormal radiological findings and duration of hospitalization were also analyzed. RESULTS: Patients who developed PTX had significantly lower body mass index (BMI) and more than 4 samples taken during procedure (all p < 0.05). TBB performed from the left upper pulmonary lobe was associated with a significant risk of PTX development (OR 2.27; 95% CI 1.18-4.35; p = 0.02). On the contrary, TBB performed from the right lower lobe was associated with a significant reduction of risk of developing PTX (OR 0.47; 95% CI 0.22-0.98; p = 0.04). Logistic regression analysis showed BMI (OR 1.08; 95% CI 1.02-1.16; p = 0.01), left upper lobe as sampling site (OR 2.15; 95% CI 1.13-4.11; p = 0.02) and more than 4 samples taken (OR 1.91; 95% CI 1.04-3.49; p = 0.04) to be significantly associated with PTX development. CONCLUSIONS: We conclude that TBB from the left upper pulmonary lobe is associated with significantly increased risk of post-procedural PTX. The right lower pulmonary lobe seems to be the safest sampling site to perform TBB. In patients with diffuse-type pulmonary disease, TBB should be performed preferably from the right lower lobe in order to decrease the risk of post-procedural PTX.
- MeSH
- biopsie škodlivé účinky MeSH
- bronchoskopie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- plíce patologie MeSH
- pneumotorax epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- bevacizumab * aplikace a dávkování MeSH
- cytostatické látky terapeutické užití MeSH
- klinická studie jako téma MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenopatie MeSH
- míra přežití MeSH
- nádory prsu MeSH
- nemalobuněčný karcinom plic diagnostické zobrazování farmakoterapie chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- adenokarcinom * diagnóza farmakoterapie chirurgie MeSH
- bevacizumab * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- chirurgie plic metody trendy využití MeSH
- diagnostické techniky dýchacího ústrojí využití MeSH
- farmakoterapie MeSH
- humanizované monoklonální protilátky aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- klinický obraz nemoci MeSH
- kombinovaná terapie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemalobuněčný karcinom plic * diagnóza farmakoterapie chirurgie MeSH
- respirační funkční testy metody využití MeSH
- statistika jako téma MeSH
- udržovací chemoterapie metody využití MeSH
- vaskulární endoteliální růstové faktory antagonisté a inhibitory aplikace a dávkování terapeutické užití MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Příčinou ztráty části nosu je nejčastěji onkologická resekce nebo úraz. Ostatní příčiny se vyskytují marginálně. Základem diagnostiky je přesné určení rozsahu defektu jednotlivých vrstev stěny nosu - výstelky, skeletu nosu a kožního krytu. Klasifikování defektu nosu pak předurčuje následný rozsah a operační taktiku rekonstrukce. Cílem rekonstrukce je dosáhnout dobrého funkčního a estetického výsledku. Evoluce rekonstrukce nosu sledovala 3 základní proudy - indickou plastiku z čela, italskou plastiku z paže a francouzskou techniku z tváře. Z uvedených metod se nejvíce osvědčil koncept rekonstrukce paramediánním lalokem z čela. Za zakladatele moderní rekonstrukce nosu lze považovat 3 americké chirurgy - Millarda, Burgeta a Menicka. Jejich práce z konce 20. století zásadně změnily koncept rekonstrukce nosu.
The most common cause of nose loss is an oncological resection or injury. Other causes occur marginally. The basis of diagnostics is exact determination of the extent of the defect of individual nasal layers - the internal lining, the nasal framework and the skin coverage. Classification of the nose defect determines the extent and surgical tactics of reconstruction. The goal of the reconstruction is to achieve a good functional and aesthetic result. The evolution of nose reconstruction has followed three basic streams - the Indian method of the forehead, the Italian method from the arm and the French method of the lateral cheek. From these methods, the concept of paramedian forehead flap reconstruction proved to be the most successful. Three American surgeons - Millard, Burget, and Menicka are considered to be the founders of the modern reconstruction of the nose. Their work at the end of the 20th century has fundamentally changed the concept of nasal reconstruction.
