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ABSTRACT: BACKGROUND: Long-term pulmonary reflux-related symptoms following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have not been reported. METHODS: We designed a retrospective analysis of consecutive patients who underwent LAGB or LSG between January 2000 and December 2010. All patients provided detailed history and physical examination. We assessed both early and late reflux-related symptoms. All patients underwent spirometry and chest X-ray (CXR). RESULTS: The analysis included 307 patients who underwent either LAGB (n = 193) or LSG (n = 114). Mean age was 43 ± 12 and 46 ± 11 years, respectively; 144 (76.6 %) and 83 (73 %) were female, respectively. Similar rates of previous pulmonary disease were noted in both LAGB and LSG groups (10.9 vs. 10.5 %, respectively). However, more patients with sleep apnea were in the LSG group (13.2 vs. 6.2 %, p = 0.03). The mean interval between surgery and the onset of pulmonary symptoms was longer in patients who underwent LAGB (72 ± 22 months) than for those who had LSG (36 ± 24 months; p = 0.03). The overall complication rate was higher in the LAGB (7.3 %) than in LSG (4.4 %) group. LSG patients had significantly lower rates of morning cough (12.3 vs. 59.6 %, p = 0.001) and postprandial cough (10.5 vs. 58 %, p = 0.001) compared to the LAGB patients. Two cases of pneumonia occurred in each group. The mortality rate was zero in both groups. CONCLUSION: Both surgeries are considered safe and without major reflux-related symptoms. There is a lower incidence of cough with LSG than with LAGB.
Beiträge zur Klinik der Tuberkulose 03/2013; · 1.90 Impact Factor
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Riva Kovjazin, David Shitrit,
Rachel Preiss,
Ilanit Haim,
Lev Triezer,
Leonardo Fuks,
Abdel Rahman Nader,
Meir Raz,
Ritta Bardenstein,
Galit Horn,
Nechama I Smorodinsky,
Lior Carmon
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ABSTRACT: Low protection of Calmette-Guérin (BCG) vaccine and drug-resistant strains require better anti-Mycobacterium tuberculosis (MTb) vaccines with a broad, long lasting, antigen-specific response. Using bioinformatics tools, we identified five 19-40mer signal peptide (SP) domain vaccine candidates (VCs) derived from MTb antigens.All VCs were predicted to have promiscuous binding to major histocompatibility complex (MHC) class I and II alleles in large geographic territories worldwide. Peripheral mononuclear cells (PBMC) from healthy naïve donors and tuberculosis patients exhibited strong proliferation that correlated positively with Th1 cytokine secretion only in healthy naïve donors. Proliferation to SP VCs was superior to antigen-matched control peptides with similar length and various MHC class I and II binding properties. T-cell lines induced to SP VCs from healthy naïve donors had increased CD44(high)/CD62L+ activation/effector memory markers and IFN-gamma, but not IL-4 production in both CD4+ and CD8+ T-cell subpopulations. T-cell lines from healthy naïve donors and tuberculosis patients also manifested strong, dose-dependent, antigen-specific cytotoxicity against autologous VC-loaded or MTb-infected macrophages. Lysis of MTb-infected targets was accompanied by high IFN-gamma secretion. Various combinations of these five VCs manifested synergic proliferation of PBMC from selected healthy naïve donors. Immunogenicity of the best three combinations, termed Mix1, Mix2 and Mix3, consisting of 2-5 of the VCs was then evaluated in mice. Each mixture manifested strong cytotoxicity against MTb-infected macrophages, while Mix3 also manifested VC-specific humoral immune response. Based on these results, we plan to evaluate the protection properties of these combinations as an improved tuberculosis subunit vaccine.
Clinical and vaccine immunology: CVI 01/2013; · 2.37 Impact Factor
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ABSTRACT: Mycobacterium kansasii infection is one of the most common causes of nontuberculous mycobacterial lung disease in the world. However, it is not possible to differentiate completely between M. kansasii and other nontuberculous mycobacteria (NTM) because of a lack of direct comparative studies. This retrospective study sought to identify their clinical and radiological features systematically.
The sample included 98 consecutive patients with a culture-positive diagnosis of NTM infection, derived from the databases of the Laboratory of Microbiology of a tertiary medical center and two outpatient tuberculosis centers. Sixty-four patients had M. kansasii infection. All patients fulfilled disease criteria for treatment. Data on patient background and clinical features were collected, and chest radiographs were evaluated.
In the M. kansasii group, n = 27 (42%) were native-born Israelis compared to 9.4% (n = 3) of all other NTM groups (p = 0.0001). Similar rates of co-morbid diseases, including diabetes mellitus, heart disease, lung diseases, and malignancy were noted in both groups. Old TB was less common in the M. kansasii group compared to the other NTM (3.1% vs. 23.5%, p = 0.003). Clinical symptoms were significantly more common in patients with M. kansasii infection. On radiological study, M. kansasii infection was associated with more cavitations and unilaterality. Patients with M. kansasii infection had a higher likelihood of right upper lobe disease (p = 0.001). Pleural effusions and lymphadenopathy were found only in a few patients in each group.
Major differences in the epidemiologic and clinical features of M. kansasii infection and other NTM have important diagnostic and clinical implications.
Respiratory medicine 07/2012; 106(10):1472-7. · 2.33 Impact Factor
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ABSTRACT: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a pathogen that emerged in the late twentieth century and was associated with significant morbidity and mortality. We report for the first time the outcomes of lung transplant recipients infected with CRKP or extended spectrum-β lactamases K. pneumoniae (ESBL-KP).
Retrospective review of 136 lung transplant recipients who underwent transplantation between 2004 and 2007 in Rabin Medical Center, Israel.
There were 52 episodes of positive cultures for K. pneumoniae (KP) in 136 recipients - of them 11 (8.1%) with CRKP, 12 (8.8%) with ESBL-KP, and 29 (21.3%) with carbapenem-sensitive ESBL-negative KP. Isolation of CRKP/ESBL-KP was associated with death in the cohort (p < 0.0001) as well as recipients' age at transplantation (p < 0.005). Time-dependent age-adjusted CRKP or ESBL-KP acquisition was an independent factor for death in patients after lung transplant, compared to patients without KP isolation or carbapenem-sensitive ESBL-negative KP (p < 0.0001).
CRKP and KP-ESBL acquisition was associated with reduced survival among lung transplant recipients.
Clinical Transplantation 07/2012; 26(4):E388-94. · 1.67 Impact Factor
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ABSTRACT: Only limited data exist regarding the incidence and outcome of surgical procedures following lung transplantation (LTX).
A retrospective analysis of surgical procedures performed in all LTX patients (n = 250) between 1997 and 2008.
Of 250 patients who underwent LTX, 68 (27.2%) required 154 surgical procedures. Mean age was 53 ± 13 yr. Mean interval between LTX and surgery was 41 ± 40 months. Mean follow-up was 21 ± 9.4 months. Fourteen (9.1%) emergency operations were performed. Sixty patients (39%) underwent general anesthesia, 12 (7.8%) regional anesthesia, and 82 (53%) local anesthesia. Two patients required a major surgical procedure, while 76 of the procedures (49.4%) were intermediate, and 76 were minor surgeries. Only two patients (0.8%) developed complications (one infectious and one bronchospasm). One patient (0.4%) died following surgery as a result of septic shock.
Minor and intermediate procedures can be performed safely in LTX patients without associated morbidity or mortality.
Clinical Transplantation 05/2012; 26(3):E242-5. · 1.67 Impact Factor
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ABSTRACT: Studies have demonstrated a link between pulmonary tuberculosis and hypercoagulable state, with reported rates of 3-10% venous thromboembolism (VTE) in all adults with tuberculosis. However, the latest research was conducted almost 18 years ago.
The present study aims to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tubercuLosis.
The study included 700 adults treated for tuberculosis from 1999 to 2007.The files were reviewed for Length of hospital stay, occurrence of VTE, site of VTE, interval from onset of tuberculosis/treatment to VTE, and outcome. To exclude primary hypercoagulable state, all patients with VTE underwent a complete hypercoagulation profile.
VTE was noted in 5 of the 700 patients (0.7%). Ages ranged from 19 to 70 years (median 53). All had pulmonary tuberculosis; median hospital stay was 28 days (range, 26-44 days). All cases of VTE occurred within the first month of treatment. All 5 patients had deep vein thrombosis, and one also subsequently developed a pulmonary embolism. All patients responded to anticoagulation treatment.
VTE occurs in 1 out of every 140 patients with acute tuberculosis. It seems to deveLop mainly in the first month of treatment, especially in those with a prolonged hospital stay. Outcome is good.
Harefuah 04/2012; 151(4):208-10, 254.
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ABSTRACT: Adenoid cystic carcinoma of the respiratory tract is a rare form of malignant neoplasm that arises from salivary glands. A surgical resection with or without radiotherapy is commonly recommended. For inoperable patients, radiotherapy and endobronchial treatment, which include laser and stent insertion, are important therapeutic modalities.
To summarize our experience in adenocystic carcinoma of the respiratory tract.
Seven patients with adenoid cystic carcinoma were diagnosed and treated in the Pulmonary Institute at Rabin Medical Center, a tertiary care hospital in central Israel in 2000-2006.
Three patients were men and four were women, with a presenting age at diagnosis ranging from 31 to 79 years. All the patients were nonsmokers. Major symptoms at presentation included dry cough, dyspnea and hemoptysis. Only two patients were operable at time of presentation and 4 patients had local and distant metastases. In 6 patients the tumor was presented in the trachea with marked obstruction of the tracheal lumen. In 4 patients coexisting lesions in the main bronchus were also found. Two patients with non-metastatic disease underwent surgical resection with external radiation. Multiple laser therapy and brachytherapy were performed in 4 patients. Two patients with severe airway stenosis that was resistant to radiotherapy were treated with laser and intratracheal stent replacement.
Endobronchial therapy that includes brachytherapy, laser and stent insertion, is a useful therapeutic modality for the treatment of patients with adenoid cystic carcinoma of the respiratory tract who are resistant to radiotherapy.
Harefuah 04/2012; 151(4):202-4, 255.
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ABSTRACT: Pleural effusions are common among patients admitted to an Intensive-Care Unit (ICU).
To retrospectively assess the role of pleural effusions in chronic obstructive pulmonary disease (COPD) patients admitted to a Medical ICU (MICU).
We reviewed records of patients admitted over 12-months to the MICU with a diagnosis of COPD. We colLected clinical and laboratory data for their entire MICU stay. A radiologist reviewed all chest radiographs to determine the presence and estimated volume of pleural effusions.
A total of 100 consecutive patients with COPD admitted to the MICU were included; 32 (32%) developed pleural effusions. COPD exacerbations were more common among patients without pleural effusion. Congestive heart failure (CHF) exacerbations were more common among patients with pleural effusions (p=0.001 and p=0.006, respectively). The length of stay was significantly longer among COPD patients with a pleural effusion (19 +/- 8 days) than those without it (14 +/- 3 days, p=0.001). The mortality rate was similar (40%) in both groups. Only patients with a large or unexplained effusion (19%) underwent thoracocentesis. In all cases, the pleural fluids were transudate and confirmed the diagnosis of CHF.
Pleural effusion is common among COPD patients admitted to a MICU. Most are due to CHF and parapneumonic effusions and respond well to treatment of the underlying problem.
Harefuah 04/2012; 151(4):198-201, 255.
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ABSTRACT: Silicosis is a progressive, fibrotic, occupational lung disease resulting from inhalation of respirable crystalline silica. This disease is preventable through appropriate workplace practices. We systematically assessed an outbreak of silicosis among patients referred to our center for lung transplant.
This retrospective cohort analysis included all patients with a diagnosis of silicosis who were referred for evaluation to the National Lung Transplantation Program in Israel from January 1997 through December 2010. We also compared the incidence of lung transplantation (LTX) due to silicosis in Israel with that of the International Society for Heart and Lung Transplantation (ISHLT) registry.
During the 14-year study period, 25 patients with silicosis were referred for evaluation, including 10 patients who went on to undergo LTX. All patients were exposed by dry cutting a relatively new, artificial, decorative stone product with high crystalline silica content used primarily for kitchen countertops and bathroom fixtures. The patients had moderate-to-severe restrictive lung disease. Two patients developed progressive massive fibrosis; none manifested acute silicosis (silicoproteinosis). Three patients died during follow-up, without LTX. Based on the ISHLT registry incidence, 0.68 silicosis cases would have been expected instead of the 10 observed (incidence ratio, 14.6; 95% CI, 7.02-26.8).
This silicosis outbreak is important because of the worldwide use of this and similar high-silica-content, artificial stone products. Further cases are likely to occur unless effective preventive measures are undertaken and existing safety practices are enforced.
Chest 03/2012; 142(2):419-24. · 5.25 Impact Factor
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ABSTRACT: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a 3-year median survival. Lung volume and diffusion capacity at rest are usually used to monitor the clinical course. Because of high mortality, identification of patients at high risk is crucial for treatment strategies such as lung transplantation (LTX). This study was designed to determine if tumor markers could accurately characterize disease severity and survival in patients with IPF.
The study population consisted of 61 patients with progressive IPF referred for LTX. Pulmonary function tests, cardiopulmonary exercise test, 6-min walk distance test, and Doppler echocardiogram were assessed at baseline and compared with tumor marker levels. Participants were prospectively followed for at least 25 months to determine the relationship between test parameters and survival. Tumor marker levels were reassessed in patients who underwent LTX. Forty-one age- and sex-matched patients (21 LTX recipients) with COPD served as control subjects.
In the IPF group, nine patients (14.7%) died during follow-up and 20 (32.8%) underwent LTX. Univariate analysis showed correlations between carbohydrate antigen (CA) 125 and FEV(1) % (P = .0001). CA 19-9 yielded the best correlations with exercise parameters and PAP. Significant correlation with survival was noted with CA 15-3 (P = .04) only. All tumor marker levels decreased significantly following LTX, except CA 125. CA 15-3 had the largest decrease (P = .001). Among the COPD group, tumor marker levels before LTX were significantly lower compared with the IPF and did not decrease following LTX. No patient in either group developed malignancy.
CA 15-3 levels may predict disease severity in IPF. Levels decreased in patients with IPF but not with COPD following LTX and were not associated with malignancy. This preliminary observation suggests that mucin has a role in the pathogenesis of IPF and possibly is a marker for disease activity.
Chest 09/2011; 141(4):1047-54. · 5.25 Impact Factor
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ABSTRACT: Malignant pleural effusion is associated with enhanced fibrinolysis. However, no data are available concerning the precise role of pleural D-dimer assay in pleural effusion. We therefore assessed the role of pleural D-dimer assay in predicting malignant pleural effusion.
A prospective laboratory investigation was conducted in a tertiary care teaching hospital. The study included consecutive patients with pleural effusion who presented at the Pulmonary Department between November 2009 and May 2010. Blood and pleural D-dimer levels were measured by Enzyme Linked Fluorescent assay (ELFA). The results were correlated with the clinical, laboratory, and radiological findings, and with the final diagnosis of the pleural fluid.
A total of 103 patients with pleural effusion were included in the study. The Pleural ELFA D-dimer results were found to be positively correlated with pleural etiology of malignancy (p=0.0001). Pleural etiology was also correlated with pleural LDH, pleural protein, pleural PH, pleural glucose, pleural and blood CRP, but not with ADA. In a binary logistic regression, only the pleural ELFA D-dimer assay was a significant predictor of the malignant pleural effusion (odds ratio 1.007; 95% confidence interval 1.002-1.012; p=0.007). The area under the receiver operating characteristics curve for malignancy was 0.79. A D-dimer level of 146mg/ml had a sensitivity of 82% and a specificity of 74%.
We found high D-dimer levels among malignant pleural effusion. D-dimer might be useful as a simple, noninvasive, surrogate marker for malignant pleural effusion.
Thrombosis Research 08/2011; 129(5):648-51. · 2.44 Impact Factor
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ABSTRACT: Lung transplantation is a viable therapy for patients with end-stage lung disease and is being increasingly performed worldwide. The incidence of lung cancer after lung transplantation has increased concomitantly, although data are still sparse.
The computerized medical records of the Pulmonary Institute of a tertiary care medical center were searched for patients who underwent lung transplantation from 1997 to 2009 and acquired lung cancer postoperatively. The prevalence, potential contributing factors, and outcome of bronchogenic cancer were determined, and the medical literature was reviewed.
Bronchogenic cancer developed in 7 of the 290 lung transplant recipients (2.4%). All had received a single lung transplant and in most cases, the cancer developed in the native lung. These findings were similar to reports in the literature. The indication for transplantation was chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis/interstitial lung disease. All had a history of smoking. The average interval from transplantation to development of lung cancer was 5 years (range 1-9). Five patients had stage 4 cancer at diagnosis and 2 had stage 1. Six patients died from 10 days to 1 year after diagnosis.
Lung transplantation is associated with a relatively high prevalence of bronchogenic cancer, particularly in the native lung, in patients with primary chronic obstructive pulmonary disease/idiopathic pulmonary fibrosis, and a history of smoking. The cancer is usually diagnosed at an advanced stage with poor outcome. Efforts to improve screening are recommended, as aggressive management and treatment may be beneficial for earlier stage disease.
Lung cancer (Amsterdam, Netherlands) 04/2011; 74(2):280-3. · 3.14 Impact Factor
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ABSTRACT: Rehabilitation is a central treatment modality for patients with chronic cardiopulmonary disease. Physical exertion for patients with pulmonary arterial hypertension (PAH) has typically been discouraged. Inpatient pulmonary rehabilitation has been shown to improve exercise capacity in patients with PAH. The present study aimed to evaluate outpatient pulmonary rehabilitation for patients with PAH.
Twenty-two patients with PAH or chronic pulmonary thromboembolic disease were allocated to ambulatory rehabilitation (n = 11) or to the control group (n = 11). All patients were stable on PAH-specific medication. The rehabilitation group underwent 24 1-hour sessions of exercise training/rehabilitation over 12 weeks. Primary end points were change in 6-minute walking distance (6MWD) and peak oxygen uptake (VO(2)) on cardiopulmonary exercise testing. All of the patients assigned to rehabilitation and 9 control subjects completed the study. In the rehabilitation group, 6MWD increased by 32 m, and in the control group 6MWD decreased by 26 meters (P = .003). Peak VO(2) increased in the rehabilitation group by 1.1 mL kg(-1) min(-1) and decreased by 0.5 mL kg(-1) min(-1) in the control group (P < .05). Peak work rate during cardiopulmonary exercise test also increased in the rehabilitation group, with borderline significance (P = .051). Echocardiography and blood N-terminal pro-brain natriuretic peptide levels were unchanged. No adverse events occurred due to the rehabilitation program.
Ambulatory rehabilitation is a safe and efficacious treatment for patients with pulmonary hypertension already on medical therapy.
clinicaltrials.gov ID: NCT00544726.
Journal of cardiac failure 03/2011; 17(3):196-200. · 3.25 Impact Factor
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ABSTRACT: Rheumatoid arthritis (RA) is a common inflammatory disease, affecting about 1% of the population. Although a major portion of the disease burden including excess mortality is due to its extra-articular manifestations, the prevalence of RA-associated lung disease is increasing. RA can affect the lung parenchyma, airways, and the pleura; and pulmonary complications are directly responsible for 10 to 20% of all mortality. Even though pulmonary infection and drug toxicity are frequent complications of RA, lung disease directly associated with the underlying RA is more common. The prevalence of a particular complication varies based on the characteristics of the population studied, the definition of lung disease used, and the sensitivity of the clinical investigations employed. An overview of lung disease associated with RA is presented here with an emphasis on parenchymal lung disease, pleural effusion, and airway involvement.
La Presse Médicale 01/2011; 40(1 Pt 2):e31-48. · 0.67 Impact Factor
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ABSTRACT: Laparoscopic adjustable silicone banding (LAP-BAND) has rapidly gained acceptance and is now considered the most common bariatric operation. The accumulated experience with LAP-BAND has established this surgical method as safe and effective. However, no data have been issued concerning pulmonary complications following the procedure. We have recently experienced 3 cases of pulmonary complications following LAP-BAND surgery: 1 patient with pulmonary cavitation and 2 with bronchiectasis. Pulmonary physicians should be aware of the possibility of long-term pulmonary complications in patients who have undergone LAP-BAND surgery.
Scandinavian Journal of Infectious Diseases 12/2010; 43(4):313-5. · 1.72 Impact Factor
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ABSTRACT: The aim of this study was to compare the extent of interaction between tacrolimus and itraconazole vs. voriconazole.
This retrospective study included 60 lung transplant recipients who were treated with a tacrolimus-based regimen; 40 received prophylactic itraconazole for the first six months following lung transplantation (LTX), and 20 were treated with voriconazole. All patients had at least 12 months of follow-up. Tacrolimus levels and dosage requirements were compared during and after azole therapy. We assessed the rejection rate, fungal infection rate, and renal function during the study period.
The mean tacrolimus dose during itraconazole treatment was 3.26 ± 2.1 mg/d compared with 5.74 ± 2.9 mg/d after itraconazole was stopped, p < 0.0001. Similarly, the mean tacrolimus dose during voriconazole treatment was 1.75 ± 0.9 mg/d compared with 4.85 ± 0.38 mg/d after voriconazole was stopped (p = 0.002). Thus, the mean increase in the total daily dose of tacrolimus after itraconazole and voriconazole withdrawal was 76% and 64%, respectively. No differences in the rejection or fungal infection rates or renal toxicity were observed during the study period, although an increase in positive fungal isolates was noted during itraconazole therapy.
The tacrolimus dose was reduced more with itraconazole than with voriconazole, without an increase in the rejection rate and with renal function preservation.
Clinical Transplantation 12/2010; 25(2):E163-7. · 1.67 Impact Factor
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ABSTRACT: Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterised by the accumulation of lung surfactant in the alveoli. In most cases it is an autoimmune disease with antibodies directed against the growth factor granulocyte-macrophage colony stimulating factor (GM-CSF). Standard of care consists of whole lung lavages in symptomatic patients. An alternative treatment is GM-CSF injections. The case history is reported of a patient with PAP and severe dyspnoea and hypoxaemia. Whole lung lavages and GM-CSF initially resulted in partial remission. However, the patient's condition deteriorated and her saturation during rest with high-flow oxygen treatment was 85%. The patient was treated with an anti-CD20 antibody rituximab which resulted in dramatic improvement. Room air saturation increased to 98% with exercise and she no longer required supplemental oxygen. The diffusion capacity for carbon monoxide increased from 27% to 48% of predicted and the chest x-rays improved. Rituximab may be useful in the treatment of patients with unresponsive PAP.
Thorax 11/2010; 65(11):1025-6. · 6.84 Impact Factor
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ABSTRACT: Lung transplantation is the recognized therapy for end-stage respiratory failure. Many serious medical complications have been described occurring from months to years after lung transplantation, often necessitating admission to an intensive care unit (ICU). We examined the factors associated with death.
All consecutive lung transplant recipients who were readmitted to the ICU > 30 days after transplantation from 2000 to 2009 were included in this retrospective study. Data were collected regarding demographic parameters, ICU stay, and outcome.
During the study period, 40 patients were admitted to the ICU. The main pre-transplant diagnosis was idiopathic pulmonary fibrosis, followed by chronic obstructive pulmonary disease. Most patients (93%) required mechanical ventilation during their ICU stay. The main reason for ICU admission was septic shock in 22 patients (55%). An organism was isolated from 19 of these patients; in 11 patients, the organism was multidrug resistant. The ICU mortality was 62.5%. Non-survivors were characterized by more frequent readmissions to hospital (p = 0.02), a higher admission Sequential Organ Failure Assessment score (p = 0.02), an admission diagnosis of sepsis (87.5% vs 37.5% for all other diagnoses, p < 0.001), and a requirement for mechanical ventilation (p = 0.02). The incidence of bronchiolitis obliterans syndrome was also significantly higher in non-survivors (p = 0.02).
Severe sepsis remains the most important factor associated with a poor outcome after readmission to ICU. New strategies are required to alter the course of this common complication of lung transplantation.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 09/2010; 30(1):54-8. · 3.54 Impact Factor
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ABSTRACT: Bronchoscopic balloon dilatation (BBD) has become a valuable tool in the treatment of tracheobronchial stenosis (TBS). The objective of this study was to assess the short- and long-term effects of BBD.
A retrospective study that included all patients with confirmed, symptomatic stenosis, who underwent BBD between 2002 and 2008. A total of 92 BBD procedures were performed in 35 patients at our institute. Lung function studies were recorded for all patients before, immediately after and 1 month following the BBD. Long-term follow-up was for a mean of 33+/-4 months.
All patients had initial success, including increased airway dimensions and symptom relief. No complications were noted related to BBD. Forced expiratory volume after one second (FEV(1)) was significantly increased after BBD (10.5%, p=0.03). These effects persisted for at least 1 month. Long-term follow-up, however, demonstrated the need for stent placement in 25 of 35 patients (71%), 210+/-91 days after BBD. Ten of 35 patients died 456+/-119 days after BBD due to progression of primary disease; all deaths were unrelated to the BBD procedures.
BBD is a safe method that offers immediate symptomatic relief in both tracheal and bronchial stenosis. However, BBD is a temporary measure, as many patients will require definitive or additional treatment with laser or stent placement.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2010; 38(2):198-202. · 2.40 Impact Factor
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ABSTRACT: Abstract
Background
Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment.
Methods
Patients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation.
Results
A total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions.
Conclusions
BTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising.
Journal of Cardiothoracic Surgery. 01/2010;
