News - Part 8

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Statistical Analysis

VB images were converted to 3-D endoscopic views using commercial software (Navigator; General Electric) on a workstation (Advantage Windows; General Electric). The VB was derived from the SHR-CT axial images of the thorax with no further radiation exposure necessary. The radiologist (RMS), who was blinded to the findings of the other modalities, first placed the viewpoint in the proximal trachea. Retrograde inspection of the subglottic area of the trachea was performed. Subsequent analysis consisted of sequential antegrade inspection of the trachea, mainstem bronchi, lobar bronchi, and segmental bronchi. Little additional time was needed to perform and interpret the images. For the purpose of this study, the interpretation of the VB reconstruction was kept to < 10 min for all cases. All detected abnormalities in the tracheobronchial tree were recorded in the database. All SHR-CT and VB scans and FBs were interpreted in a blinded manner. The presence or absence of obstructive lesions (ie, bronchial narrowing of > 50%), endolu-minal masses (ie, a mass protruding into the lumen with < 50% occlusion), or mucosal lesions (ie, hemorrhage, erythema, or tissue friability) were recorded. In addition, the anatomic locations of the detected lesions were noted. read
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Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Procedures

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: ProceduresThe mean (± SD) age of all patients was 52 ± 12.2 years (median, 53 years; range, 29 to 88 years). Thirty-two patients (73%) were men (mean age, 52 ± 11.3 years; median age, 54 years; age range, 29 to 73 years), 12 patients (27%) were women (mean age, 52 ± 14.8 years; median age, 51 years; age range, 38 to 88 years). Histologic diagnoses included non-small cell lung cancer (16 patients), small cell lung cancer (3 patients), metastatic renal cell cancer (12 patients), metastatic melanoma (7 patients), metastatic thyroid cancer (2 patients), sarcoma (1 patient), carcinoid (1 patient), teratoma (1 patient), and esophageal cancer (1 patient). review

For each FB, visualization and interpretation of the tracheobronchial tree were achieved under the direction of the attending thoracic surgeons (DSS and DMN) who were blinded to the radiologist’s interpretation of the imaging modalities. FB findings, which were entered into the database, included the presence or absence of obstructive lesions (ie, a bronchial narrowing of > 50%), endoluminal masses (ie, a mass protruding into the lumen with < 50% occlusion), or mucosal lesions (ie, hemorrhage, erythema, or tissue friability). Read more »

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Materials and Methods

VB (also known as CT bronchography) employs three-dimensional (3-D) reconstruction of high-resolution helical CT images of the tracheobronchial tree. The contrast between the airway lumen and wall enables the generation of a 3-D anatomic model of tracheobronchial anatomy that provides views similar to those obtained during FB. Furthermore, VB enables the visualization of the tracheobronchial anatomy from multiple angles, thereby facilitating the analysis of bronchial lesions beyond the limits of FB and the assessment of airway patency distal to high-grade obstructions. Read more »

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial MalignanciesNeoplasms involving the respiratory system cause significant morbidity and mortality. Primary lung cancers account for approximately 160,000 deaths annually in the United States. In addition, nearly one third of all patients with neoplasms of nonpulmonary origin develop life-threatening pulmonary metastases. Frequently, patients with primary or metastatic cancers involving the respiratory tract have partial or complete bronchial obstructions secondary to endoluminal tumors or extrinsic compression. Noninvasive, reproducible, and objective methods for sequentially evaluating these abnormalities may prove useful for directing therapy and assessing the treatment response in these individuals, so

Patients with suspected tracheobronchial lesions typically undergo diagnostic evaluation consisting of conventional CT scanning and fiberoptic bronchoscopy (FB). Conventional two-dimensional crosssectional CT images of the chest have a reported sensitivity and specificity of 60 to 100% for the detection of obstructive lesions in the respiratory tract. The limitations of the accuracy of conventional CT scans include suboptimal scanning techniques, inappropriately thick slices, and artifacts between sections. Currently, FB remains the best modality for the evaluation of endoluminal and mucosal lesions in the respiratory tract. However, this imaging modality frequently provides little information concerning the extent of extraluminal disease or airway patency distal to high-grade bronchial stenoses. Read more »

The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: Summary

The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: SummaryA third of patients with CSA before transplant acquired OSA after transplant. This alteration in apnea type cannot be explained by variations in body weight or dosage of prednisolone between the three patient groups after transplant, nor could we identify upper airway anatomic differences. No patient in the control group acquired OSA despite a similar medication profile. Therefore, we believe it possible that these patients may have had OSA prior to the development of CHF and CSA, which was uncovered by the eradication of CSA. This conclusion remains to be confirmed with rigorous prospective studies. read more
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The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: Discussion

This study demonstrated two unique observations: first, CHF patients with CSA who undergo heart transplantation may have persistent CSA beyond the peritransplant period (> 6 months) despite normalization of heart function and sympathetic activity. Second, CSA severity is attenuated and the cycle length plus ventilation:apnea ratio are altered in appearance, similar to that seen with idiopathic nonhypercapnic CSA, a condition characterized by normal heart function, after successful heart transplantation. Therefore, mechanisms other than heart dysfunction and heightened sympathetic activation are likely for the development or persistence of CSA.
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The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: CSA

The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: CSAOf the 13 patients with CSA before transplant, 3 patients had persistent CSA, 4 patients had OSA, and 6 patients had no SDB (AHI, 36.1 ± 10.0 to 12.3 ± 0.9/h, 18.0 ± 4.2 to 11.2 ± 7.4/h, and 31.4 ± 6.5 to 1.3 ± 0.9/h, respectively) on follow-up sleep studies. The characteristics of the CSA changed significantly with transplantation, such that cycle length shortened significantly (65 ± 14 to 31 ± 7 s, p < 0.01) [Table 3, Fig 1], and the venti-lation:apnea length ratio diminished (2.6 ± 0.9 to 0.7 ± 0.3, p < 0.01) [Table 3]. There was a tendency for greater hypocapnia in the posttransplant CSA group compared with the OSA or no-SDB groups (37.5 ± 0.7 mm Hg, 40.4 ± 4.4 mm Hg, and 38.0 ± 0.6 mm Hg, respectively), but this failed to reach statistical significance. The severity of CSA pretransplant did not predict posttransplant apnea status. In the pretransplant no-SDB control group, all patients remained free of SDB after transplantation.
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The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: Results

Between the years of 1999 and 2000, 37 patients with severe CHF underwent heart transplantation workup that included full polysomnography who subsequently received a heart transplant: 16 patients had CSA, 6 patients had OSA, and 15 patients had no SDB (control group). In the CSA group following heart transplantation, one patient was excluded due to allograft dysfunction, one patient due to failure to achieve clinical stability, and one patient refused repeat polysomnography. The 13 remaining patients agreed to follow-up polysomnography and were included in the analysis, of whom 10 patients underwent orthotopic transplantation, and 3 patients underwent heterotopic transplantation. In the control group, two patients failed to achieve clinical stability and four patients refused repeat polysomnography, leaving nine patients to act as a matched control group, each of whom had an orthotopic transplant. None of the patients studied had any clinical evidence of neurologic impairment following transplantation. Read more »

The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: UNE

The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: UNESleep was manually staged according to standard criteria. A central apnea was defined as absence of oronasal airflow during sleep for > 10 s associated with absent respiratory effort. A central hypopnea was defined as any reduction in oronasal airflow for > 10 s associated with in phase thoracoabdominal movement and > 2% fall in Spo2. Obstructive apnea was defined as cessation of oronasal airflow for > 10 s in the presence of out of phase thoracoabdominal effort. An obstructive hypopnea was defined as a fall in oronasal airflow for > 10 s with out-of-phase thoracoabdominal movement associated with > 2% fall in Spo2. A mixed apnea was defined using the above criteria, when a central apnea included or terminated with obstructive components. Mixed apneas were classified as obstructive events. Patients were described as having CSA if > 80% of all respiratory events were central in origin with total central AHI > 5/h. OSA was described as AHI > 5/h with < 20% central in type. No SDB was defined as an overall AHI < 5/h. The ventilation, apnea and cycle lengths were determined during a period of continuous cyclic central apneas in stages 1 or 2 sleep and the average taken of 10 cycles as previously described. in detail
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The Effect of Successful Heart Transplant Treatment of Heart Failure on Central Sleep Apnea: Materials and Methods

Subjects and Protocol
Patients with a diagnosis of ischemic or idiopathic cardiomyopathy, and selected for heart transplantation assessment were included in the study. Patients with congenital, valvular, or restrictive heart disease were excluded. All patients were optimally treated and considered medically stable at the time of heart transplantation assessment.
At the time of heart transplantation assessment, patients underwent Tc radionucleotide equilibrium measurement of left ventricular ejection fraction (LVEF), overnight polysomnography, and measurement of sympathetic nerve activity with overnight urinary norepinephrine excretion (UNE). Patients with plasma creatinine level of > 180 mmol/L were not included. Here
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