Pierfranco Foccoli

Multicentre European study for the treatment of advanced emphysema with bronchial valves

This multicentre, blinded, sham-controlled study was performed to assess the safety and effectiveness of bronchial valve therapy using a bilateral upper lobe treatment approach without the goal of lobar atelectasis. Patients with upper lobe predominant severe emphysema were randomised to bronchoscopy with (n=37) or without (n=36) IBV Valves for a 3-month blinded phase. A positive responder was defined as having both a ≥4-point improvement in St George’s Respiratory Questionnaire (SGRQ) and a lobar volume shift as measured by quantitative computed tomography. At 3 months, there were eight (24%) positive responders in the treated group versus none (0%) in the control group (p=0.002). Also, there was a significant shift in volume in the treated group from the upper lobes (mean±sd -7.3±9.0%) to the non-treated lobes (6.7±14.5%), with minimal change in the control group (p<0.05). Mean SGRQ total score improved in both groups (treatment: -4.3±16.2; control: -3.6±10.7). The procedure and devices were well tolerated and there were no differences in adverse events reported in the treatment and control groups. Treatment with bronchial valves without complete lobar occlusion in both upper lobes was safe, but not effective in the majority of patients.

Nd: YAG Laser Therapy in Lung Cancer

ABSTRACTBetween April 1982 and March 1993, 1,585 patients with significant symptoms of malignant airway obstruction were treated with 2,253 tracheobronchial neodymium (Nd):YAG laser resections performed by the first author only: 1,274 (78%) patients had non-small cell lung cancers, 91 (6%) small cel

Xpert MTB/RIF as add-on test to microscopy in a low tuberculosis incidence setting

Tuberculosis (TB) is a major public health concern worldwide. Early diagnosis, universal access to drug susceptibility testing and prompt initiation of treatment are key elements of the End TB strategy, and should therefore be implemented in all settings [1–5]. In order to reach TB elimination goals, the World Health Organization (WHO) currently recommends the use of a rapid molecular test, Xpert MTB/Rif (Xpert; Cepheid, Sunnyvale, CA, USA), as initial diagnostic tool when TB is suspected [6–8]. Although the excellent performance of this test in high TB burden areas is already supported by strong scientific evidence, few studies have been conducted so far to assess its impact on the diagnostic work-up of TB in low burden settings, sometimes with contrasting findings [7, 9, 10–12]. For example, according to Sohn et al. [10], Xpert testing might have limited impact in the ambulatory setting in Canada, owing to lower sensitivity and limited potential to expedite diagnosis beyond what is achieved with the existing, well-performing diagnostic algorithm. Xpert MTB/Rif should be used as an alternative test for microscopy for TB diagnosis in low incidence settings http://ow.ly/JQCF30i8nO3

Patient selection and efficacy of valve bronchoscopic lung volume reduction (BLVR) in emphysema

BLVR has been proposed as an alternative to lung volume reduction surgery in patients with severe emphysema (TomaTP et al Lancet 2003; 361:931-3). There is agreement that for bronchial valves to work, fissure integrity is needed as it is associated with lobar volumetric changes which predicts efficacy of BLVR (VenutaF et al Ann Thorac Surg 2005;79:411-416). Two methods are available to evaluate fissure integrity: HRCT with direct observation of fissures and Chartis to directly assess the absence of collateral ventilation as the functional result of fissure integrity. We evaluated the response of 11 consecutive patients (FEV1 0,80L±0,25; RV 5,05L±1.3) with severe heterogeneous emphysema and complete fissure based on Chartis and CT scan analysis. Patients had valves (Olympus SVS) placed in the most diseased lobe with complete fissure (Chartis). Fissure completeness was also evaluated through quantitative CT (SeleCT by VIDA, Olympus). Lung function (FEV1, RV) showed significant improvement at 6 months. Follow up CT at 3 months showed significant volume reduction in the target lobe and a 62% responder rate as defined as ≥ 350ml volume reduction

Transanastomotic endobronchial migration of a pericardial flap.

A 36-year-old woman underwent left main bronchus sleeve resection for a typical carcinoid. The bronchial anastomosis was reinforced with a bovine pericardial flap fixed by fibrin glue. Six months after the surgery the patient presented with acute dyspnea. Flexible bronchoscopy disclosed an endoluminal migration of the pericardial flap through the anastomotic dehiscence and a cicatricial stenosis of the left upper bronchus. The migrated flap was successfully removed and the stenosis segment of the bronchus was dilated using a rigid bronchoscope. Two months after complete recovery from the bronchial dehiscence, the patient developed an anastomotic cicatricial stenosis, which was effectively treated by laser photoresection and mechanical dilatation. Eight months after the last procedure the patient remains symptom free.

La terapia radicale

La piu frequente indicazione alla broncoscopia terapeutica e rappresentata dai tumori ostruenti la trachea ed i grossi bronchi. Nella grande maggioranza dei casi si tratta di tumori maligni non operabili in cui la rimozione della componente endoluminale ostruente oppure il posizionamento di una protesi nelle compressioni estrinseche rappresentano una terapia palliativo-sintomatica.