Angelo Gianni Casalini

Lipoid pneumonia as a complication of Lorenzo's oil therapy in a patient with adrenoleukodystrophy.

Lipoid pneumonia (LP) is a rare exogenous condition caused by inhalation or aspiration of lipid material into the lungs. It is often associated with the therapeutic use of different types of oil, and the diagnosis is based on the demonstration of lipid-laden macrophages in bronchoalveolar lavage fluid. We reported the case of a 39-year-old male with X-linked adrenoleukodystrophy who developed LP secondary to the use of Lorenzos oil. To our knowledge, the association between the use of Lorenzos oil and LP has never been reported in literature.

Toracoscopia medica: metodica e complicanze

La toracoscopia costituisce una parte importante della storia della tisiologia per il suo ruolo nella lisi delle aderenze tubercolari [1, 2]. La metodica in alcune realta pneumologiche non e mai stata abbandonata.

Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy

Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy. A consecutive series of 52 pleural TB patients observed during the period 2001–2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18–74) years, and 32 males, mean (range) age 45.75 (21–83) years, were included (28 non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately. The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples (washing, lavage or biopsy) were positive in 50% of cases (nine patients). Cultures of pleural biopsies were positive in 63% of cases (29 out of 46 patients); pleural histology was relevant in all patients. Without pleural biopsy, a diagnosis would have been reached in 15 out of 52 patients (28.6%) and in four of them only following culture at 30–40 days. An integrated diagnostic work-up that includes all the diagnostic methods of interventional pulmonology is required for a diagnosis of pleural TB. In the majority of patients, a diagnosis can be reached only with pleural biopsy. Diagnosis of tuberculous pleural effusion can be a challenge; medical thoracoscopy greatly increases accuracy http://ow.ly/EnY430gubm9

Conventional transbronchial needle aspiration with 23 gauge needle: a preliminary study.

BACKGROUND Conventional transbronchial needle aspiration (cTBNA) is a safe and minimally invasive procedure with a high yield for the diagnosis of large lymph nodes (LNs) in favourable locations (LNs >1.5 cm in stations #4R and/or #7). However, it is usually underutilized by pulmonologist. One of the main reasons given for not performing cTBNA is the risk of puncturing vascular structures of the mediastinum. Recently, with the twofold objective of minimize the risk of bleeding and reduce the cTBNA cost, a thinner and less expensive needle has been commercialized. It is a 23 gauge (G) needle that costs 34, 37 €. The aim of our study was to analyze the sample adequacy, diagnostic accuracy and safety of this needle in comparison with 21 and 22 G needles (average cost: 6,400 €). METHODS We retrospectively analysed medical records from patients who underwent bronchoscopy with cTBNA for the diagnosis of LNs >1.5 cm in stations #4R and/or #7 at the Thoracic Endoscopy Unit of the University Hospital of Parma from January 1st, 2007 to October 31(st), 2011. Five hundred patients underwent cTBNA from January 1(st), 2007 to October 31(st), 2011. In order to reduce the technical and personal bias for sampling procedure we analyzed only cases sampled by a single well-trained bronchoscopist, particularly skilful at cTBNA. RESULTS A total of 222 patients (186 men; mean age 63 years±12, range 6-89) with LNs >1.5 cm in stations #4R and/or #7 were identified. A 23 G needle was used in 84 patients (38%), a 21 G needle in 88 patients (40%) and a 22 G needle in 50 patients (22%). No statistically significant differences between the 23 G group and the 21 or 22 G group in sample adequacy (P=0.78 and P=0.12, respectively) and diagnostic accuracy (P=0.9 and P=0.4, respectively) were found. There were no intraprocedural or postprocedural complications irrespective of the size of needle used. CONCLUSIONS Transbronchial 23 G needle is as safe and effective as the 21 and 22 G needle for the sampling of LNs >1.5 cm in stations #4R and/or #7. For this reason, to obtain cytology specimens from large LNs in favourable locations, the 23 G needle may represent an alternative and less expensive choice compared to 21 and 22 G needles, even if our observation needs to be confirmed in a larger prospective study.

Inalazione di corpi estranei

L’inalazione di corpi estranei (CE) e un evento potenzialmente fatale, che costituisce una delle piu importanti indicazioni alla broncoscopia operativa in urgenza, in modo particolare in soggetti in eta pediatrica.

Il drenaggio toracico

Per drenaggio toracico si intende il posizionamento di un sondino di varie dimensioni nel cavo pleurico allo scopo di evacuare raccolte aeree o liquide ed ottenere la riespansione del polmone.

Le metodiche endoscopiche nella patologia infettiva polmonare del paziente immunocompetente

La patologia infettiva polmonare del paziente immunocompetente generalmente non richiede accertamenti particolari per la definizione dell’agente eziologico e la terapia antibiotica viene eseguita empiricamente. Esistono peraltro situazioni, legate soprattutto alle scadute condizioni del paziente, oppure alla particolarita del germe (es. sospetta TBC) e alla gravita del quadro clinico, che ne richiedono l’identificazione; la broncoscopia costituisce, in quanto metodica in grado di eseguire prelievi batteriologici mirati, una delle metodiche disponibili piu utilizzate [1].