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Rapid On-site Evaluation of Transbronchial Aspirates in the Diagnosis of Hilar and Mediastinal Adenopathy: A Randomized Trial

Background:

Rapid on-site evaluation (ROSE) of transbronchial needle aspirates has long been used during flexible bronchoscopy, but its usefulness in the diagnosis of hilar and mediastinal adenopathy is controversial. The aim of the present study was to evaluate the extent to which ROSE can be valuable in patients undergoing transbronchial needle aspiration (TBNA) for the diagnosis of hilar and mediastinal adenopathy.

 Methods:

A total of 168 consecutive patients with enlarged lymph nodes were randomized to undergo TBNA with or without ROSE. The primary outcome measure of the study was the diagnostic yield of TBNA on a per-patient basis. Secondary outcome measures included the percentage of adequate specimens on a per-lymph node basis, the number of biopsy sites on a per-patient basis, and the complication rate of bronchoscopy on a per-patient basis.

 Results:

We found no significant difference between the TBNA group and the ROSE group in terms of diagnostic yield (75.3% vs 78.3%, respectively; P = .64), and percentage of adequate specimens (86.5% vs 78.4%, respectively; P = .11). The median (interquartile range) number of biopsy sites was significantly lower in the ROSE group (1 [1-2] vs 2 [1-2], respectively; P = .0005). The complication rate of bronchoscopy was significantly lower in patients undergoing on-site review (6% vs 20%; P = .01), whereas the complication rate of TBNA was similar among the study groups.

 Conclusions:

ROSE of transbronchial aspirates from hilar and mediastinal nodes enables avoidance of additional biopsy without loss in diagnostic yield and reduces the complication rate of bronchoscopy.

 Trial registry:

ClinicalTrials.gov; No.: NCT00915330; URL: www.clinicaltrials.gov

Behavioral and Structural Differences in Migrating Peripheral Neutrophils from Patients with COPD.

COPD neutrophils are intrinsically different than cells from other studied populations in their chemotactic behaviour and migratory structure. Differences are not due to surface expression of chemoattractant receptors, but instead appear to be due to differences in cell signaling.

Excess Ventilation During Exercise and Prognosis in Chronic Heart Failure.

Excess ventilation during exercise with accompanying dyspnea is characteristic of chronic heart failure (CHF), and these patients often exhibit increased minute ventilation (V'E) relative to the amount of carbon dioxide eliminated by the lungs (V'CO2) compared to normals. This can be measured in several ways, including using such variables as the slope of V'E vs. V'CO2, the lowest ratio of V'E/V'CO2, and the ratio of V'E/V'CO2 at the lactic acidosis threshold or peak exercise.

There is now considerable evidence that the degree of excess ventilation during exercise in patients with chronic heart failure is a robust predictor of outcome, and identifies higher-risk patients requiring aggressive treatment, including heart transplantation. The mechanism of excess ventilation...

From Intensive Care to Critical Care Medicine, A Historical Perspective.

The evolution of Critical Care Medicine is traced in relationship to its predecessors, namely Intensive Care and Intensive Therapy. This commentary documents the initial physical care rendered by professional nurses in hospitals of the 19th century in locations close to the nursing stations.

The development of life support devices to support ventilation, renal function, to reverse fatal arrhythmias, or incubators for newborns, characterized Intensive Therapy of the early 20th century. In the most recent 50 years, Critical Care evolved for comprehensive, largely electronic monitoring and automated laboratory measurements to guide intensive therapy of multi-organ failures by critical care physicians, and nurse specialists, pharmacists and respiratory therapists u...

Implications of New (Seventh) TNM Classification of Lung Cancer on General Radiologists-A Pictorial Review.

The new TNM (seventh) classification of lung cancer, published by Union Internationale Centre le Cancer, has been in use since January 2010. It is vital for general radiologists to be well versed with this system and be aware of the impact of these changes on patient management and prognosis. It is also important that radiologists appreciate the implications of the new system on reporting different imaging modalities and its limitations.

This pictorial essay outlines the proposed changes, its limitations, and implications for radiologists.

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