Stefano Baglioni

Myasthenic Inspiratory Vocal Cord Dysfunction: Efficacy of Nasal Continuous Positive Airway Pressure Treatment

Myasthenic vocal cord dysfunction (VCD), presenting with severe inspiratory stridor, was successfully treated with nasal continuous positive airway pressure (nCPAP), thus giving the medical staff time to make the diagnosis and avoiding intubation or tracheostomy. An important sign leading to diagnosis was the very high MEF50/MIF50 ratio calculated from the flow-volume loop. nCPAP treatment induced prompt remission of stridor and a sharp reduction in the MEF50/MIF50 ratio from 9.90 to 1.36. A review of the literature has shown that VCD with inspiratory stridor is an unusual onset symptom of myasthenia gravis and that nCPAP treatment may avoid emergency oral/tracheal intubation and tracheostomy. After diagnosis, the patient underwent thymectomy, and today, 3 years later, he is well without any further therapy.

Diagnostic yield of fluoroscopy-guided transbronchial biopsy in peripheral lung lesion: Adequacy of transbronchial sample for tumor genotyping

INTRODUCTION The fluoroscopy-guided transbronchial lung biopsy (TBLB) is an useful technique for diagnosis of peripheral lung lesion (PLL). The diagnostic yield of TBLB is limited and variable, ranging in literature from 16-80%. Nowadays the specimens collected must be suitable for tumor genotyping and the published data for this issue are not conclusive. Aim of the study was to evaluate the diagnostic yield of fluoroscopy guided TBLB and the adequacy of sample for molecular testing in adenocarcinoma subtype. METHODS The pts. referred to our Unit in the period 2013-2015 due to peripheral lung opacities with diameter ≥ 2 cm were included in the study. We excluded pts with uncontrolled coagulopathy, pregnancy, emodinamic instability. All the pts underwent bronchoscopy and fluoroscopy-guided TBLB and TB needle aspiration (TBNA). We performed 4-6 TBLB and 4-6 TBNA for each patient. In case of histopathologic diagnosis of adenocarcinoma, genotyping for EGFR, ALK, K-RAS was done. RESULTS 263 patients have been included, 164 males, age 68.8±11, range 33-88 yrs. TBNA and TBLB allow a diagnosis in 167 patients (diagnostic yield 68%)(table 1); the false negative were 48 (18.2%). The adenocarcinoma represented the 40% of malignant lesions: in this group the sample was adequate for genotyping examination in the majority of cases (> 90%). CONCLUSIONS The fluoroscopy-guided TBLB allowed a correct diagnosis in about 70% of cases with very few adverse events. The specimen resulted adequate for genotyping of adenocarcinoma in the majority of patients.

Effect of bamiphylline on tracheobronchial mucus clearance in subjects with smokers' simple chronic bronchitis.

A double-blind study versus placebo was performed to assess the effect of bamiphylline, a new xanthylic derivative, on tracheobronchial mucus clearance (TBMC) in smokers with simple chronic bronchitis and impaired mucus clearance as compared to normal controls. Twenty patients were enrolled and divided into two randomized groups. The first group was treated with bamiphylline (600 mg b.d.) for 15 days, while the second group received placebo with the same oral dosage regimen. Complete clinical-functional examinations were made before and after the test period to establish the effects of treatment. At the end of the study, only the group treated with bamiphylline showed a net increase in mucus clearance (mean radioaerosol elimination 28 +/- 7% before treatment and 38 +/- 11% after treatment; p < 0.01) and an improvement in the clinical score and pulmonary function parameters, in particular the residual volume (RV = 3.41 +/- 0.75 liters before treatment and 2.7 +/- 0.6 after treatment; p < 0.01) and the forced expiratory volume at 1 s (FEV1 = 2.37 +/- 0.7 liters before treatment and 2.88 +/- 0.5 after treatment; p < 0.05). No side effects or adverse reactions that could be attributed to the study drug were observed.