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ABSTRACT: Objective: In patients with malignant effusions and ECOG 3 - 4 or unexpandable lung, the PleurX® catheter system provides an effective at-home palliation of symptoms associated with recurrent pleural effusions. We investigated the clinical results of patients treated by this method in our population.Methods: All patients treated with PleurX between June 2005 and September 2010 in our clinical center were recorded using a predefined data sheet. Primary points of interest were complications associated with the insertion procedure, short- and long-term complications after insertion of the catheter, the rate of pleurodesis, the frequency of hospitalizations due to effusion-associated symptoms, time of drainage and survival time after insertion. In order to assess follow-up, a standardized questionnaire was sent to the attending practitioners.Results: Pleural effusions were most frequently due to lung cancer, breast cancer and mesothelioma. The rate of compilations associated with the insertion procedure was 7 %, and complications could easily be managed. The rate of short-term complications after insertion of the catheter was 7 %, and of long-term compilations 18 %. The rate of pleurodesis was 16 %. 78 % of patients did not need another hospitalization due to effusion-related symptoms. The mean time of drainage was 52 days. The mean survival after insertion of the drainage was 76 ± 85 days (1 - 453).Conclusions: The insertion of a PleurX catheter is associated with a low complication rate. Short-term and long-term complications are usually mild and can be readily managed. Hospitalizations due to effusion-related symptoms were not necessary in the majority of patients.
Pneumologie 11/2012; 66(11):637-44.
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ABSTRACT: To determine the diagnostic yield of EBUS guided TBB performed in routine practice with flexible bronchoscopy and under moderate sedation in ambulatory and hospitalized patients.
Bronchoscopy was performed under standard conditions in ambulatory and hospitalised patients. Bronchoscopically invisible peripheral pulmonary lesions were located with 20 MHZ-EBUS-probe and transbronchial biopsy was taken using a guiding sheath. Fluoroscopy was additionally performed as required to identify the lesion.
257 patients with peripheral pulmonal lesions were investigated, with malignancy in 70% of those with a diagnosis established. 175/257 (68.1%) of lesions were detected with EBUS. In 139/176 (79.4%) of these lesions, TBB enabled a final diagnosis. The TBB yield depended on lesion size. It was 61.3% in lesions ≤20 mm, 85.5% >20 mm/≤30 mm, and 81.2% in ≥30 mm (p<0.0001). This yield was also affected by the position of the probe (centrally 84.5%, tangentially 57.6%, p=0.01)). Operator experience did not influence the diagnostic yield but considerably shortened investigation time (4.9±3.5 vs. 6.2±4.2 min, p=0.042). Relevant complications occurred in only 1.9% (3 cases of postinterventional pneumothorax).
In an unselected population, EBUS-guided TBB has a high diagnostic yield in peripheral lesions >20 mm whereas its yield decreases considerably in smaller lesions. Complications are very rare. EBUS-guided TBB can successfully and safely be performed by flexible bronchoscopy.
Pneumologie 12/2011; 65(12):730-5.
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ABSTRACT: We report two patients admitted to our hospital suspected to suffer from cancer in the lung or mediastinum, respectively. Both patients had a diagnosis of thoracic actinomycosis. A 76 year old man revealed pulmonary and endobronchial actinomycosis associated with broncholithiasis. Diagnosis was achieved by bronchoscopy. Therapy with ampicillin/sulbactam was successful. A 36 year old patient presented with bilateral pleural effusions, extended pericardial, mediastinal and pulmonary actinomycosis with pericarditis constrictiva and superior vena cava syndrome. Diagnosis was finally made by cardiac surgery with therapeutic pericardectomy. Prolonged therapy with ampicillin/sulbactam was administered with satisfactory result. Here we discuss the importance to include actinomycosis in the differential diagnosis of pulmonary affections and mediastinal masses in order to avoid diagnostic errors and to limit invasive procedures to the necessary amount. We illustrate the need of an individualized treatment approach.
Pneumologie 03/2009; 63(2):86-92.
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ABSTRACT: A 44-year-old female patient presented with an extensive exacerbation of severe chronic obstructive lung disease (COPD) and bullous emphysema. Because of a severe type II respiratory failure, the patient was intubated and mechanically ventilated. Respiratory failure was refractory despite appropriate ventilation regimes and pCO2 values ranged from 110 mm Hg to 180 mm Hg. Chest radiography revealed hyperinflation of two giant bullae with mediastinal shifting to the left lung. We describe a successful rescue bullectomy.
Pneumologie 04/2008; 62(3):133-6.
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ABSTRACT: We report two patients with pulmonary nodules detected by chance. Histopathology of biopsies retrieved by surgical videothoracoscopy revealed benign metastasizing leiomyoma (BML). The origin of this disease as well as its dignity are not fully understood. We discuss the origin of this disease and different therapeutic options - from oophorectomy to different hormon therapies. A standardized therapeutic recommendation cannot be given.
Pneumologie 10/2007; 61(9):568-72.
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Pneumologie 11/2006; 60(10):607-10.
