Annals of Thoracic Medicine最新文献

Gastrobronchial fistula (GBF) is a rare but serious complication following esophagectomy, associated with high morbidity and mortality. The use of silicone plugs has proven effective in closing bronchial fistulas in other contexts, but its application in GBF has not been widely described. In this article, we report the successful closure of a GBF using a self-made silicone plug under bronchoscopic guidance in a patient with a history of esophagectomy for esophageal cancer. This approach offers a safe, minimally invasive alternative for managing refractory GBF.

Background: To evaluate the perioperative outcomes of hybrid multi-arm robotic-assisted uniportal thoracoscopic surgery (H-URATS) using a laparoscopic stapling device, assess the safety and feasibility of the procedure, and summarize the surgical experience.

Methods: The Department of Thoracic Surgery at Xinjiang Tumor Hospital has performed over 100 H-URATS procedures using endoscopic staplers and the robotic surgery platform. We collected the clinical data and perioperative outcomes from patients undergoing Uniportal Video-assisted Thoracoscopic Surgery (UVATS) and H-URATS between January 2023 and August 2024. Propensity score matching (PSM) was conducted based on clinical characteristics and perioperative outcomes were compared between the two groups after matching.

Results: A total of 395 patients were included, with 109 in the H-URATS group and 286 in the UVATS group. After PSM, each group consisted of 92 patients. There were no significant differences between the H-URATS and UVATS groups in terms of chest drainage duration, postoperative hospital stay, conversion to thoracotomy rate, intensive care unit admission rate, postoperative complication rate, postoperative pathological types, or tumor TNM staging (P > 0.05). The H-URATS group had less intraoperative blood loss compared to the UVATS group (P < 0.001), and more lymph nodes (LNs) and LN stations were dissected in the H-URATS group (P < 0.001).

Conclusion: In terms of short-term results, our study confirms the safety and feasibility of H-URATS as a new minimally invasive technique. It combines the advantages of uniportal thoracoscopy and robotic surgery systems and demonstrates potential benefits in oncological outcomes and complex procedures such as segmentectomies.

[This corrects the article on p. 284 in vol. 19, PMID: 39544350.].

A 32-year-old Chinese woman with a cough and bloody sputum was diagnosed with chronic eosinophilic pneumonia. After starting corticosteroid therapy, chest radiography showed improvement in the bilateral infiltrative shadow. However, chest image findings showed worsening of the bilateral infiltrative shadow and pulmonary cavities during the 20 mg/day of oral prednisolone therapy. Transbronchial lung biopsy and bronchoalveolar lavage were repeated, and the patient was diagnosed with pulmonary paragonimiasis. After starting praziquantel treatment, chest radiography findings and clinical symptoms improved. Careful follow-up during corticosteroid therapy is important to judge whether transient improvement and true deterioration of radiological findings.

The pathogenesis of cervical extension of the thymus has been postulated to be incomplete descent of the thymus in the midline of the neck, which is considered normal in children. The thymus normally extends to the neck in approximately two-thirds of children. Ectopic thymus mainly occurs in 1%-13% of the younger population. In this study, we report two cases of asymptomatic neck swelling, one due to cervical extension of the thymus and the other due to a right submandibular ectopic thymus. None of the patients required any intervention. Recurrent suprasternal swelling in children that becomes more pronounced during coughing/crying or Valsalva maneuvers can be more accurately diagnosed using neck ultrasonography and/or magnetic resonance imaging.

A 39-year-old female has postoperative empyema with bronchial stump fistula (BSF) after pneumonectomy due to ineffective tuberculosis chemotherapy. Transpleural reamputation of the right main bronchial stump with simultaneous 8-rib thoracoplasty, 6 attempts at endobronchial valve implantation and thoracostomy have failed to cure BSF and empyema. Consequently, an alternative treatment-transsternal transpericardial wedge-shaped resection of the tracheal bifurcation was performed despite its difficulty and was successful. This clinical case demonstrates the complications of BSF with tuberculosis empyema treatment in spite of there existing many alternative therapies. The need for new more effective treatments is highlighted, as well as safe and less technically difficult interventions which could assist patients with BSF.

Bronchopleural fistula (BPF) is a rare yet severe complication following lobectomy, with no standardized treatment protocol established. We present a case of a 65-year-old male with chronic obstructive pulmonary disease who developed multiple BPFs postresection of the right lower lobe due to lung cancer and with tumor recurrence and metastasis. We employed a comprehensive management strategy comprising rigorous infection control, meticulous chest drainage, antitumor treatment, and targeted deployment of bronchial stents. This approach not only resolved the BPFs but also achieved a complete response of the lung cancer, extending progression-free survival to over 3 years.

Adult patients with chronic respiratory diseases (CRDs) are considered high risk group who are more likely to experience worse clinical outcomes if they acquire viral or bacterial infections. Vaccination is the best preventive tool to reduce the risk of infection and disease occurrence and to reduce the level of severity of complications associated with the various vaccine-preventable infections. These guidelines were developed by the Saudi Thoracic Society task force to emphasize the critical importance of improving the vaccine coverage rates in adult patients with CRD. They are intended to serve as a reference for healthcare practitioners managing CRD patients. The guidelines aimed to review the current knowledge related to vaccination efficacy in adult patients with CRD, based on the recent evidence and recommendations. Integrating the administration of the recommended vaccines in routine healthcare, such as during outpatient visits or before hospital discharge, is crucial for improving the vaccination rates in high-risk patients. The key strategies to address this public health priority include simplifying vaccination guidelines to enhance their accessibility and implementation by healthcare providers, increasing awareness in both the patients and healthcare providers that vaccines are not only intended for children. Additional strategies include maintaining continuous surveillance and advance research to discover novel vaccines. This approach aims to expand the range of preventable diseases and improve overall health and well-being. Vaccine hesitancy remains a significant challenge that necessitates a clear understanding of the community concerns. Providing appropriate education and communication, as well as addressing these concerns, are the crucial steps toward improving vaccine acceptance and uptake. By implementing these guidelines and multifaceted strategies, healthcare systems can optimize vaccine coverage and protection for patients with CRD, reduce the burden of vaccine-preventable complications, and improve the clinical outcomes in this vulnerable population.

The Saudi Thoracic Society (STS) developed an updated evidence-based guideline for diagnosing and managing chronic obstructive pulmonary disease (COPD) in Saudi Arabia. This guideline aims to provide a comprehensive and unbiased review of current evidence for assessing, diagnosing, and treating COPD. While epidemiological data on COPD in Saudi Arabia are limited, the STS panel believes that the prevalence is increasing due to rising rates of tobacco smoking. The key objectives of the guidelines are to facilitate accurate diagnosis of COPD, identify the risk for COPD exacerbations, and provide recommendations for relieving and reducing COPD symptoms in stable patients and during exacerbations. A unique aspect of this guideline is its simplified, practical approach to classifying patients into three classes based on symptom severity using the COPD Assessment Test and the risk of exacerbations and hospitalizations. The guideline provides the reader with an executive summary of recommended COPD treatments based on the best available evidence and also addresses other major aspects of COPD management and comorbidities. This guideline is primarily intended for use by internists and general practitioners in Saudi Arabia.

Objective: The objective of the study was to systematically evaluate and perform a meta-analysis on the adherence to high-flow nasal cannula (HFNC) humidified oxygen therapy and its influencing factors in elderly patients with stable chronic obstructive pulmonary disease (COPD).

Methods: Relevant literature on HFNC and COPD was retrieved from PubMed, EMbase, Web of Science, and Cochrane Library databases. Cross-sectional studies, case-control studies, and cohort studies were included. Screening and quality assessment were conducted using Endnote X9 software. Quality scores were assigned using the Newcastle-Ottawa Scale and the AHRQ assessment tool. Basic information, sample size, and adherence-related factors were extracted, and heterogeneity and publication bias were assessed.

Results: A total of 321 articles were initially identified, with 8 English articles involving 325 patients included after screening. Quality assessment yielded five high-quality articles (score > 8), two medium-quality articles (score = 7), and one low-quality article (score = 6). Meta-analysis results showed a COPD patient HFNC adherence rate of 32.7%. Negative factors included the number of acute exacerbations (odds ratio [OR] =2.17), adverse reactions (OR = 4.13), regular follow-up (OR = 9.45), educational level (OR = 5.38), and concurrent medications (OR = 4.71). Positive factors included age < 70 years (OR = 0.45), duration of use (OR = 0.30), inhalation technique (OR = 0.31), treatment satisfaction (OR = 0.35), and adverse reactions (OR = 0.15). Funnel plot and Egger's test results indicated minimal publication bias.

Conclusion: Adherence to HFNC in elderly COPD patients is relatively low, influenced by negative factors such as the number of acute exacerbations, adverse reactions, regular follow-up, educational level, and concurrent medications. Positive factors include age < 70 years, duration of use, inhalation technique, treatment satisfaction, and adverse reactions.