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  • 1
    Online Resource
    Online Resource
    Effectiveness of Immediate Video-Assisted Thoracoscopic Surgery for Empyema: A Multicentre, Retrospective Cohort Study
    S. Karger AG ; 2023
    In:  Respiration Vol. 102, No. 9 ( 2023), p. 821-832
    Details
    In: Respiration, S. Karger AG, Vol. 102, No. 9 ( 2023), p. 821-832
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Because of limitations in previous randomised controlled trials and observational studies, the effectiveness of immediate video-assisted thoracoscopic surgery (VATS) for patients with empyema in real-world settings remains unclear. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 This study aimed to evaluate whether immediate VATS improves clinical outcomes in patients with empyema. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This multicentre retrospective cohort study included 744 patients with physician-diagnosed empyema from six hospitals between 2006 and 2021. The exposure was VATS performed within 3 days of empyema diagnosis, the primary outcome was 30-day mortality, and secondary outcomes were 90-day mortality, length of hospital stay, and time from diagnosis to discharge. We used propensity score weighting to account for potential confounders. For outcome analyses, we used logistic regression for mortality outcomes and gamma regression for the number of days. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among the 744 patients, 53 (7.1%) underwent VATS within 3 days, and 691 (92.9%) initially received conservative treatment. After propensity score weighting, the differences in 30- and 90-day mortalities between the immediate VATS and initial conservative treatment groups were 1.18% (95% confidence interval [CI], −10.7 to 13.0%) and −0.08% (95% CI, −10.3 to 10.2%), respectively. The differences in length of hospital stay and time from diagnosis to discharge were −3.22 (95% CI, −6.19 to −0.25 days) and −5.04 days (95% CI, −8.19 to −1.90 days), respectively. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Our real-world study showed that immediate VATS reduced the length of hospital stay and the time from diagnosis to discharge. Considering the small sample and differences in protocols between countries, further large-scale studies are warranted.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000533439
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
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  • 2
    Online Resource
    Online Resource
    Quantitative Evaluation of Changes in Three-Dimensional CT Density Distributions in Pulmonary Alveolar Proteinosis after GM-CSF Inhalation
    S. Karger AG ; 2023
    In:  Respiration Vol. 102, No. 2 ( 2023), p. 101-109
    Details
    In: Respiration, S. Karger AG, Vol. 102, No. 2 ( 2023), p. 101-109
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 A previous clinical trial for autoimmune pulmonary alveolar proteinosis (APAP) demonstrated that granulocyte-macrophage colony-stimulating factor (GM-CSF) inhalation reduced the mean density of the lung field on computed tomography (CT) across 18 axial slice planes at a two-dimensional level. In contrast, in this study, we challenged three-dimensional analysis for changes in CT density distribution using the same datasets. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 As a sub-study of the trial, CT data of 31 and 27 patients who received GM-CSF and placebo, respectively, were analyzed. To overcome the difference between various shooting conditions, a newly developed automatic lung field segmentation algorithm was applied to CT data to extract the whole lung volume, and the accuracy of the segmentation was evaluated by five pulmonary physicians independently. For normalization, the percent pixel (PP) in a certain density range was calculated as a percentage of the total number of pixels from −1,000 to 0 HU. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The automatically segmented images revealed that the lung field was accurately extracted except for 7 patients with minor deletion or addition. Using the change in PP from baseline to week 25 (ΔPP) as the vertical axis, we created a histogram with 143 HU bins set for each patient. The most significant difference in ΔPP between GM-CSF and placebo groups was observed in two ranges: from −1,000 to −857 and −143 to 0 HU. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Whole lung extraction followed by density histogram analysis of ΔPP may be an appropriate evaluation method for assessing CT improvement in APAP.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000528038
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
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  • 3
    Online Resource
    Online Resource
    Therapeutic Effect of Direct Hemoperfusion with a Polymyxin B-Immobilized Fiber Column in the Treatment of HIV-Negative Severe Pneumocystis Pneumonia
    S. Karger AG ; 2011
    In:  Respiration Vol. 81, No. 4 ( 2011), p. 318-324
    Details
    In: Respiration, S. Karger AG, Vol. 81, No. 4 ( 2011), p. 318-324
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) has been shown to improve oxygenation in cases of diffuse alveolar damage, but little is known about its effectiveness in treating pneumocystis pneumonia (PCP) in HIV-negative immunosuppressed patients. 〈 i 〉 Objectives: 〈 /i 〉 This study was aimed at investigating the effect of PMX-DHP in treating non-HIV-related PCP. 〈 i 〉 Methods: 〈 /i 〉 Between October 2005 and September 2008, 6 patients with non-HIV-related PCP were treated with 2 sessions of PMX-DHP at an attending physician’s discretion when severe hypoxemia developed despite conventional treatments including high-dose corticosteroid, whereas 9 patients in a similar condition were treated without PMX-DHP. Changes in oxygenation and radiographic findings in the PMX-DHP group and adverse events associated with PMX-DHP were investigated retrospectively, as were the outcomes for both treatment groups. 〈 i 〉 Results: 〈 /i 〉 There was an improvement in PaO 〈 sub 〉 2 〈 /sub 〉 /FiO 〈 sub 〉 2 〈 /sub 〉 during each PMX-DHP session, from 148.8 ± 52.5 to 188.2 ± 79.3 mm Hg (p = 0.02). After 2 sessions of PMX-DHP, an improvement in PaO 〈 sub 〉 2 〈 /sub 〉 /FiO 〈 sub 〉 2 〈 /sub 〉 , from 131.8 ± 37.4 to 213.3 ± 87.3 mm Hg, was observed (p = 0.04), but no significantly different improvement was detected on the following day. The radiographic findings improved in 4 patients during PMX-DHP. The in-hospital mortality was similarly high in both groups (50% in the PMX-DHP group vs. 67% in the non-PMX-DHP group). No significant adverse events associated with PMX-DHP were observed except for advanced thrombocytopenia in 1 patient. 〈 i 〉 Conclusion: 〈 /i 〉 PMX-DHP may serve as an adjunct in the treatment of non-HIV-related PCP, temporarily alleviating severe hypoxemia even in cases refractory to conventional treatments.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000316340
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
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  • 4
    Online Resource
    Online Resource
    Clinical Features and Outcome of Acute Exacerbation of Interstitial Pneumonia: Collagen Vascular Diseases-Related versus Idiopathic
    S. Karger AG ; 2012
    In:  Respiration Vol. 83, No. 1 ( 2012), p. 20-27
    Details
    In: Respiration, S. Karger AG, Vol. 83, No. 1 ( 2012), p. 20-27
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Relatively little is known about acute exacerbation (AE) of interstitial pneumonia associated with collagen vascular diseases (CVD-IPs). 〈 i 〉 Objectives: 〈 /i 〉 This study was aimed at clarifying clinical characteristics and outcome in AE of CVD-IPs, compared with those of idiopathic interstitial pneumonias (IIPs). 〈 i 〉 Methods: 〈 /i 〉 We retrospectively reviewed 112 admission cases with suspected AE of CVD-IPs or IIPs during 2003–2009. IIPs were diagnosed with idiopathic pulmonary fibrosis (IPF) or non-IPF, mostly based on radiologic findings. Of these, 15 AEs of CVD-IPs (6 rheumatoid arthritis, 6 dermatomyositis and 3 systemic sclerosis) and 47 AEs of IIPs (13 IPF and 34 non-IPF) were included. 〈 i 〉 Results: 〈 /i 〉 The clinical characteristics in AE of CVD-IPs were similar to those of IIPs, except for younger age (63.3 ± 6.8 vs. 73.8 ± 9.1 years; p = 0.0001) and higher PaO 〈 sub 〉 2 〈 /sub 〉 /FiO 〈 sub 〉 2 〈 /sub 〉 at the onset of AE (205 ± 81.2 vs. 145 ± 53.8 mm Hg; p = 0.002) in the former. Dermatomyositis-related interstitial pneumonia (IP) showed a relatively indolent onset and was often associated with worsening control of the underlying disease, whereas AE of other CVD-IPs resembled that of IIPs. 90-day mortality of 33% in AE of CVD-IPs was similar to that of IIPs (44%; p = 0.44) or non-IPF (34%; p = 0.94), but was significantly better than that of IPF (69%; p = 0.04). 〈 i 〉 Conclusion: 〈 /i 〉 Clinical features and outcome in AE of CVD-IPs were similar, if not identical, to those of IIPs, having a significant impact on the clinical course. AE of advanced IPF with typical radiologic features seems to have higher mortality compared with other forms of IP.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000329893
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
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  • 5
    Online Resource
    Online Resource
    Detection of Herpes Viruses by Multiplex and Real-Time Polymerase Chain Reaction in Bronchoalveolar Lavage Fluid of Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome
    S. Karger AG ; 2014
    In:  Respiration Vol. 87, No. 4 ( 2014), p. 279-286
    Details
    In: Respiration, S. Karger AG, Vol. 87, No. 4 ( 2014), p. 279-286
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Human herpes viruses (HHVs) are important pathogens in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Rapid and efficient diagnostic tools are needed to detect HHVs in the lung in ALI/ARDS patients. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 This study aimed to evaluate the usefulness of multiplex and real-time polymerase chain reaction (PCR) analysis of bronchoalveolar lavage fluid (BALF) for detecting HHV reactivation in ALI/ARDS patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Between August 2008 and July 2012, eighty-seven BALF samples were obtained from ALI/ARDS patients with unknown etiology and analyzed for HHVs. The types of HHVs in the BALF samples were determined using qualitative multiplex PCR followed by quantitative real-time PCR. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Multiplex PCR identified herpes simplex virus type 1 (HSV-1) (n = 11), Epstein-Barr virus (EBV) (n = 16), cytomegalovirus (CMV) (n = 21), HHV type 6 (HHV-6) (n = 2), and HHV-7 (n = 1) genomic DNA in 35 (40%) of the BALF samples, including 14 (16%) samples containing 2 or 3 HHV types. CMV and EBV reactivation was rare in immunocompetent patients, whereas reactivation of HSV-1 was predominantly observed in intubated patients regardless of their immune status. Overall, HHVs were almost exclusively found in patients with immunosuppression or endotracheal intubation. Real-time PCR detected 0.95-1.59 × 10 〈 sup 〉 6 〈 /sup 〉 copies of viral DNA/μg human genome DNA, and HSV-1 (n = 4), CMV (n = 9), and HHV-6 (n = 1) were identified as potentially pathogenic agents. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The implementation of multiplex and real-time PCR of BALF was feasible in ALI/ARDS patients, which allowed efficient detection and quantification of HHV DNA.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000355200
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1464419-8
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