Asem Hewidy

Sequential use of cryoextraction postelectrocautery for airway recanalization using fiberoptic bronchoscopy

Background: Airway obstruction presents with dyspnea, cough, hemoptysis, and atelectasis. Removing or decreasing the size of the obstructing lesions improves patient′s symptoms and life quality. Aim: Assessing the efficacy and safety of sequential use of cryoextraction and electrocautery in achievement of airway patency using fiberoptic bronchoscopy (FOB). Patients and methods: This study was conducted at the Chest Medicine Department, Mansoura University, Egypt and included 22 patients with central airway obstruction (15 males and seven females) with a mean age of 50.5 ± 18.3 years. After etiologic diagnosis of airway obstruction, they were divided into two groups: group A (nonmalignant); eight patients and group B (malignant); 14 patients. All patients were subjected to sequential use of cryoextraction after electrocautery. Operable, unfit patients or patients with extraluminal obstruction were excluded. Clinical, radiological, functional, and bronchoscopic data were evaluated before and after FOB. Results: The improvement in performance scale was highly significant in group B (P < 0.001) and significant in group A (P = 0.001). Spirometric parameters improved in both groups but were highly significant in group B (P < 0.001). Radiological improvement occurred in four out of eight of group A and in three out of 14 of group B. FOB score improved in group B (P = 0.003) and was more significant in group A. The procedure was complicated with atrial fibrillation and hemoptysis in one case and postbronchoscopy hypoxemia in two cases with no deaths. Conclusion: Cryoextraction after electrocautery using FOB are effective, safe, easy, and cheap in achieving airway patency.

Ultrasound-guided multilevel paravertebral block versus local anesthesia for medical thoracoscopy

Background: Local anesthetic infiltration for medical thoracoscopy has an analgesic properties for short duration. Single injection thoracic paravertebral block (PVB) provides limited analgesia. Purpose: Comparison between thoracic PVB performed at two or three levels with local infiltration for anesthetic adequacy in adult medical thoracoscopy as a primary outcome and postthoracoscopic analgesia and pulmonary function as secondary outcomes for adult medical thoracoscopy. Patients and Methods: Prospective randomized control study included 63 adult patients with exudative pleural effusion randomly divided into three groups of 21 patients: 3-level PVB, 2-level PVB group, and local infiltration group. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Pain visual analog scale and spirometry were used for comparison as anesthetic adequacy in adult medical thoracoscopy as a primary outcome besides prolonged analgesia and improved pulmonary function as secondary outcomes. Results: The anesthetic adequacy was 95.3% in 3-level PVB group, 81% in 2-level PVB group, and 71.5% in local infiltration group. The mean sensory level was 1 ± 0.8 and 1 ± 0.6 segment above and 0.8 ± 0.6 and 0.7 ± 0.7 segment below the injected level in 3-level PVB group and 2-level PVB, respectively. VAS was statistically significant higher in local infiltration compared to the other two groups immediately postthoracoscopic and 1 h after. Two-hour postthoracoscopy, significant increase in forced vital capacity values in the three groups compared to their basal values whereas forced expiratory volume at 1 s (FEV1) only in both PVB groups. Conclusion: Unilateral 3-level TPVB was superior to 2-level TPVB and LA infiltration for anesthetic adequacy for patients undergoing medical thoracoscopy. Moreover, US-guided TPVB was followed by higher FEV1 values and lower pain scores during the next 12 h postthoracoscopy in comparison to local infiltration, so 3-level TPVB is an effective and relatively safe anesthetic technique for adult patients undergoing medical thoracoscopy which may replace local anesthesia.

Intralobar pulmonary sequestration: A rare presentation in adults

Introduction: Pulmonary sequestration represents a rare congenital anomaly of the lower respiratory tract. Interlobar sequestration is the most common form and usually presents in the left hemithorax during the second decade of life or earlier. Its blood supply usually arises from systemic circulation. Surgical intervention is the treatment of choice in patients with pulmonary sequestration. Case Report: We describe a late presentation of an intralobar sequestration in a 59-year-old male. It presented with recurrent attack of hemoptysis. Radiological investigations revealed pulmonary sequestration. Two unusual features were found in this case: being in the right side and having double blood supply from both systemic and pulmonary circulation. Conclusion: In this case report, we described a case of unusual presentation of ILS in old patients, right sided with double blood supply from both pulmonary artery and abdominal aorta. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 2, February 2017. ISSN – [0976-3198] Int J Case Rep Images 2017;8(2):133–137. www.ijcasereportsandimages.com Ehab et al. 133 CASE REPORT PEER REVIEWED | OPEN ACCESS Intralobar pulmonary sequestration: A rare presentation in adults Ahmed Ehab, Marwa Ghanem, Ahmed Ibrahim Twafik, Magda Abdel-salam, Nasef Abdel-Salam A. Rezk, Asem A. Hewidy

Hot saline thermoablation of peripheral non small cell lung cancer safety and efficacy; a feasibility study

Hot saline thermoablation is effective and safe for hepatoma so its application to peripheral non small cell lung cancer NSCLC may be beneficial Aim Assess the efficacy and safety of palliative transthoracic hot isotonic saline injection of peripheral inoperable NSCLC Patients and methods Randomized clinical trial done at Chest, Clinical Oncology depatments and Oncology Center Mansoura, Egypt, 2013 to 2015. 23 patients with peripheral NSCLC randomly divided to 2 groups: group A, 11 patients subjected to transthoracic hot isotonic saline injection and group B, 12 patients subjected to transthoracic injection of isotonic saline at room temperature (immediately both groups were treated with chemotherapy).Primary endpoints were clinical, functional and radiological response and tumor tissue histopathology posttreatment. Secondary endpoint was survival Results Significant decrease in chest pain and dyspnea in group A versus group B, 3 and 6 ms posttreatment. Hot saline braked deterioration in quality of life. After 6 ms, there was statistically significant increase in FEV1 and FVC in group A versus before treatment. 8 patients in group A had partial response 72.7% and 3 patients had progression 27.3% and 7 patients in group B had stable course 58.3% and 5 patients had progression 41.7% after 6 months. 10 patients in group A had coagulative necrosis while 6 patients from group B had ischemic necrosis. There were few immediate controllable complications. Survival was better in group A than group B but statistically insignificant Conclusion Hot saline thermoablation is effective, safe palliative treatment for patients with inoperable peripheral NSCLC. PACTR2016001384408.

A pilot study of chemical ablation of peripheral non-small-cell lung cancer: a novel, effective, safe, and inexpensive method

Introduction Chemical ablation with acetic acid or ethanol is effective against hepatocellular carcinoma and therefore its application in peripheral non-small-cell lung cancer (NSCLC) may be beneficial. Aim The aim of the study was to assess the efficacy and safety of percutaneous chemical ablation using acetic acid or ethanol in peripheral NSCLC cases. Patients and methods This was a prospective randomized control study conducted at the Chest and Clinical Oncology Departments, Mansoura, Egypt, from 2011 to 2014. Thirty-three patients were included with a mean age of 60 years, and were randomly divided into three groups: group A (acetic acid plus chemotherapy group) consisted of nine patients; group B (ethanol plus chemotherapy group) consisted of nine patients; and the control group C (chemotherapy alone group) consisted of 15 patients. Patients who were operable, who had tumors infiltrating the main stem bronchi or mediastinum, and those who refused to complete the study were excluded. Clinical and radiological data were evaluated before treatment and 3 and 6 months after treatment. Results There was a significant reduction in both cough score and chest pain in group A after 6 months of treatment, in the hemoptysis score in group A and group B after 6 months of treatment, and in dyspnea score in groups A and B after 3 and 6 months of treatment. There was a statistically significant difference in the tumor response results in both groups after 3 and 6 months of treatment when compared with the control group. There were one or more immediate complications but all were controllable with no mortality. Survival was better in groups A and B than in the control group. The cost of acetic acid and ethanol palliation for each patient was 10

Effect of vitamin D replacement in chronic obstructive pulmonary disease patients with vitamin D deficiency

US. Conclusion Chemical ablation is an effective and inexpensive adjuvant palliative treatment for patients with inoperable peripheral NSCLC.