Novel modalities and agents in bronchoscopic lung volume reduction.

Curr Drug Targets. 2012 Dec 17;

Authors: Stratakos G, Emmanouil P, Gasparini S

Abstract
The NETT study has shown the effectiveness of lung volume reduction surgery (LVRS) in improving functional parameters and exercise tolerance in selected patients with severe pulmonary emphysema of upper lobe predominance. A number of bronchoscopic techniques have since been developed under the term "bronchoscopic lung volume reduction" (BLVR), aiming to lower the complications and the cost while facilitating the procedure of lung volume approach in patients with emphysema. These include airway bypass by creation of airway/parenchyma communications, one-way endobronchial valves occluding the airways of the targeted lobes, endobronchial coils which mechanically contract the parenchyma, hot vapour ablation thermally destroying the targeted sites and sealant which fill the alveoli with polymer material. These methods are generally simple and safe, with a favourable complications profile, requiring less infrastructure and interventional experience than the open surgical approach. Bronchial valves have produced promising results in a very narrow phenotype of emphysema patients and have the major advantage of being reversible in their action. Parenchymal interventions at the cost of producing permanent effects and a transient inflammatory syndrome, may be effective in larger group of patients regardless of the fissure integrity and the presence of collateral ventilation. New, more extensive multicentre studies are underway which aim at better selection and stratification of patients in order to further evaluate the safety and effectiveness of these techniques, before wider use of this revolutionary approach for severe lung emphysema can be advocated.

PMID: 23256722 [PubMed - as supplied by publisher]

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Patient's Perception of Symptoms Related to Morning Activity in Chronic Obstructive Pulmonary Disease: The SYMBOL Study.

Korean J Intern Med. 2012 Dec;27(4):426-35

Authors: Kim YJ, Lee BK, Jung CY, Jeon YJ, Hyun DS, Kim KC, Yu SK, Choi HS, Shin WH, Lee KH

Abstract
BACKGROUND/AIMS: Patients with chronic obstructive pulmonary disease (COPD) experience more problematic respiratory symptoms and have more trouble performing daily activities in the morning. The aim of this study was to assess the perception of COPD symptoms related to morning activities in patients with severe airflow limitation.
METHODS: Data of 133 patients with severe airflow limitation were analyzed in a prospective, non-interventional study. A clinical symptom questionnaire was completed by patients at baseline. In patients having morning symptoms, defined by at least one or more prominent or aggravating symptom during morning activities, a morning activity questionnaire was also completed at baseline and following 2 months of COPD treatment.
RESULTS: The most frequently reported COPD symptom was breathlessness (90.8%). Morning symptoms were reported in 76 (57%) patients; these had more frequent and severe clinical COPD symptoms. The most frequently reported morning activity was getting out of bed (82.9%). The long acting muscarinic antagonist (odds ratio [OR], 6.971; 95% confidence interval [CI], 1.317 to 11.905) and chest tightness (OR, 0.075; 95% CI, 0.011 to 0.518) were identified as significantly related to absence of morning symptoms. There was no significant correlation between the degree of forced expiratory volume in 1 second improvement and severity score differences of all items of morning activity after 2-month treatment.
CONCLUSIONS: Fifty-seven percent of COPD patients with severe airflow limitation have morning symptoms that limit their morning activities. These patients also have more prevalent and severe COPD symptoms. The results of this study therefore provide valuable information for the development of patient-reported outcomes in COPD.

PMID: 23269884 [PubMed - in process]

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Endobronchial treatment of complete tracheal stenosis: report of 3 cases and description of an innovative technique.

Ann Thorac Surg. 2013 Jan;95(1):351-4

Authors: Vandemoortele T, Laroumagne S, Bylicki O, Astoul P, Dutau H

Abstract
Tracheostomy is often performed in patients requiring prolonged mechanical ventilation. Complications include tracheal stenosis, more often below the stoma than suprastomal. We report 3 cases of suprastomal complete obliteration of the trachea, all of which were successfully managed endoscopically using diode laser, mechanical dilation with the rigid bronchoscope, and stent placement.

PMID: 23272862 [PubMed - in process]

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Assessment of Tumor Vascularity in Lung Cancer Using Volume Perfusion CT (VPCT) With Histopathologic Comparison: A Further Step Toward an Individualized Tumor Characterization.

J Comput Assist Tomogr. 2013 Jan;37(1):15-21

Authors: Spira D, Neumeister H, Spira SM, Hetzel J, Spengler W, von Weyhern CH, Horger M

Abstract
OBJECTIVE: To measure perfusion in different lung cancer subtypes and compare results with histopathological/immunohistochemical results.
METHODS: Seventy-two consecutive untreated patients with lung cancer (40 adenocarcinomas, 20 squamous cell, and 12 small cell lung cancers) were enrolled. A 40-second volume perfusion computed tomography of the tumor bulk was obtained. Blood flow (BF), blood volume (BV), and transit constant were determined. Tumor volume and tumor necrosis were determined on contrast-enhanced computed tomography. Pathologic specimens were assessed for microvessel density (MVD), hypoxia-induced transcription (hif-1/-2), and proliferation (Ki-67).
RESULTS: Higher MVD is associated with higher BF and BV. Higher tumor grade leads to lower BF but increased necrosis and tumor volume. Markers of hypoxia were independent from perfusion parameters, extent of necrosis or MVD. Blood flow, BV, and MVD were not significantly different among lung cancer subtypes. Transit constant was significantly reduced in small cell lung cancer versus adenocarcinoma.
CONCLUSIONS: Perfusion values are related to MVD and tumor grade but vary considerably among lung cancer subtypes.

PMID: 23321828 [PubMed - in process]