Thoracoscopic lung biopsy or open lung biopsy for interstitial lung disease

Both traditional open lung biopsy through a limited thoracotomy and VATS lung biopsy are effective methods for obtaining parenchymal samples in patients who have respiratory insufficiency and radiographic pulmonary infiltrates. For patients with slowly progressive disease processes, who require an elective biopsy, VATS biopsy is the procedure of choice because of the ability to visualize and sample multiple areas of the lung, and because of the decreased postoperative pain. On the other hand, when patients are critically ill and already on high-level ventilatory support, the VATS method offers no advantages over the standard minimal thoracotomy.     

Analysis of small lung nodules diagnosed by open lung or thoracoscopic biopsy

We examined clinicopathologic findings in 86 cases with peripheral lung nodules less than 30 mm in size diagnosed by open lung or video-assisted thoracoscopic surgery (VATS) biopsy. Biopsies were conducted because of the new appearance or enlargement of nodules as evidenced in a comparison with retrospective chest films in 47 patients, X-ray findings of malignancy suspicion without retrospective films in 13, enlargement of nodules after the administration of antituberculosis agents in 9, and a past history of malignancy in 17. Mean tumor size was 18.1 mm in primary lung cancer (n = 29), 16.2 mm in metastatic lung cancer (n = 13), 16.3 mm in tuberculosis (n = 18), 15.3 mm in nonspecific inflammation (n = 12), 16.7 mm in benign lung tumors (n = 7), 7.5 mm in intrapulmonary lymph node (n = 2), and 19.4 mm in others (n = 5). Among primary lung cancers with a clear N-factor, the percentage of T1N0M0 cancers was up to 72%. No significant difference was observed in either of the reasons for these biopsies and the size of nodules among diseases. To detect early lung cancer and increase the rate of cure, small pulmonary nodules that could be hardly diagnosed using bronchoscopic or needle aspiration biopsy should be diagnosed positively using VATS biopsy.     

Analysis of small peripheral lung cancer diagnosed by open lung or thoracoscopic biopsy

Interferons are cytokines produced by cells in response to stimulation by certain antigens and infectious agents. In recent years, recombinant interferons have been developed, which have antiviral, antiproliferative, and immunomodulatory functions. Several cutaneous reactions have been reported, including cutaneous ulceration at injection sites. We now report three cases of cutaneous ulceration caused by interferon beta-1b injections. In addition, we review all of the previously reported cases of cutaneous ulceration caused by recombinant interferons and discuss the different mechanisms by which these substances may produce this effect.     

Needle, transbronchial, thoracoscopic, or open lung biopsy in interstitial lung disease

The specific diagnosis of interstitial lung disease has conventionally been determined by lung biopsy. Lung biopsy also is useful for assessing disease activity and prognosis, and is sometimes useful in deciding on the necessity of therapy. The availability of newer biopsy techniques and the interaction of these techniques with current generation imaging modalities has changed the role of biopsy in interstitial lung disease. This review reports on the indications, techniques, and limitations of biopsy procedures and places them in the context of the use of current imaging methods, as reflected in recent literature.     

A case of interstitial pneumonia of polymyositis-dermatomyositis with various pathological findings in open lung biopsy

A 60-year-old woman was admitted to our hospital with a two month history of dry cough and dyspnea on exertion. A chest roentgenogram revealed diffuse interstitial shadows with a reduction of lower lung volume. Laboratory examinations revealed an increase in CPK and aldolase. There was decreased proximal muscle power, and the findings of a biopsy of the right deltoid were compatible with polymyositis. Myositic symptoms were stable, but the respiratory symptoms worsened, and an open lung biopsy was performed for diagnosis and to determine the best treatment. The histological findings of biopsy materials demonstrated active interstitial pneumonia complicated by cellular interstitial pneumonia, bronchiolitis obliterans organizing pneumonia, usual interstitial pneumonia and lymphoid hyperplasia. The patient responded well to adrenocorticosteroid and immunosuppressive therapy, and is now attending as an out patient. It is well known that PM-DM can be associated with interstitial pneumonia, and this complication is an important prognostic factor clinically. The pathological patterns of interstitial pneumonia in PM-DM may be divided into usual interstitial pneumonia and bronchiolitis obliterans organizing pneumonia. Furthermore, it is well documented that these patterns are concurrent with the response to adrenocorticosteroid and prognostic factors. However, our case of PM-DM, in which various patterns such as rheumatoid arthritis (RA) were pathologically revealed, cannot be considered as having uniform pathological pattern. We consider that pulmonary pathological patterns of PM-DM are very varied, as with RA. It is a very important to evaluate the nature of these patterns and the subsequent clinical course in PM-DM with interstitial pneumonia.     

Video thoracoscopic lung biopsy in diffuse interstitial lung diseases

The present study examined the use of video thoracoscopic lung biopsy (VTLB) in diffuse interstitial lung disease, in comparison with open lung biopsy (OLB). Twenty and fifteen patients underwent VTLB and OLB, respectively, from 1987 to 1997 at the Central Chest Hospital, Thailand. Data in mean (SD). The mean age was 39 years in both groups. VTLB yielded equivalent size of lung tissues, 4.7 (2.32) cm3, and was as diagnostically useful as OLB. Estimated blood loss, 60 (37) mls, and length of pleural drainage, 2.8 (0.5) days, were comparable in either technique. As OLB had been in practice for decades, it took shorter operative time, 64 (11) mins, than VTLB, 105 (30) mins, (p = 0.005). Both VTLB and OLB approaches were safe and not associated with major postoperative complications.     

Transcutaneous needle biopsy of the lung

Spinal muscular atrophy (SMA) is a frequent autosomal recessive neurodegenerative disorder leading to weakness and atrophy of voluntary muscles. The survival motor neuron gene (SMN) is a strong candidate for SMA and present in two highly homologous copies (telSMN and cenSMN) within the SMA region (5q11.2-q13.3). More than 90% of SMA patients show homozygous deletions of at least exon 7 of telSMN, whereas absence of cenSMN seems to have no clinical consequences. In 23 non-deleted SMA patients, we searched for intragenic mutations of the SMN genes in exons 1-7 and the promotor region by single strand conformation analysis. We identified two different missense mutations, S2621 and T2741, in exon 6 of telSMN in three independent SMA families, providing further evidence for the telSMN gene as a SMA determining gene. Both mutations, as well as two previously described mutations (Y272C and G279V) are located within a highly conserved interval from codon 258 to codon 279 which seems to be an important functional domain of the telSMN protein. Recently, this region has been shown to contain a tyrosine/glycine-rich motif, which is also present in various RNA binding proteins, suggesting a potential role of SMN in RNA metabolism. Missense mutations might be useful for in vivo and transgenic experiments and further investigations on understanding the function of the telSMN protein.     

Laparoscopic vs. open wedge biopsy of the liver

The number of people smoking free-base cocaine, or "crack," has increased dramatically in recent years. Concomitantly, the literature describing complications of such use has grown as well. Adverse pulmonary effects are being increasingly noted, such as respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, and pulmonary barotrauma. These and other pulmonary effects are reviewed.     

Evaluation of transbronchial biopsy of the lung

The histo-autoradiographic study of the subfornical organ by incorporation of 3H-Leucine in normal and dehydrated rats shows the existence of a protein synthesis; this synthesis is more important in dehydrated rats. Other studies are necessary to determine the nature and role of the substance synthetized.     

Percutaneous trephine lung biopsy: evolving role

In 9 normal and 42 duodenal ulcer patients, acid and gastrin studies were performed. Basal, Oxo and Histalog stimulated acid secretion was conducted on each patient. In 24 patients post vagotomy pyloroplasty or vagotomy antrectomy, these studies were repeated within three months after surgery. Two groups of duodenal ulcer patients were identified; those who did respond and those who did not respond to Oxo stimulation. In the "responders," Oxo stimulated acid output and gastrin secretion increased significantly over basal values. Both vagotomy pyloroplasty and vagotomy antrectomy caused a similar significant decrease in Oxo and Histalog stimulated acid output. In two patients with incomplete vagotomy, antrectomy, but not pyloroplasty abolished the Oxo stimulated acid response. These data suggest that OXO stimulation test can select patients with a significant antral component in whom vagotomy and antrectomy would be the appropriate procedure. Our results also indicate that antrectomy will protect against recurrent ulceration in patients with incomplete vagotomy and may explain the lower incidence of stomal ulceration in patients with vagotomy antrectomy, compared to vagotomy pyloroplasty.     

Testicular needle biopsy, open biopsy, epididymal aspiration and intracytoplasmic sperm injection in obstructive azoospermia

Testicular or epididymal spermatozoa were obtained for in-vitro fertilization and intracytoplasmic sperm injection (ICSI) in 27 cycles out of 33 (in six men the azoospermia proved to have testicular causes). Testicular needle biopsy carried out in addition to surgical open biopsy proved to be an effective method to obtain spermatozoa for ICSI from patients with obstructive azoospermia. Thus it might be possible to replace scrotal operations by simple needle biopsies. Embryos resulting from ICSI with testicular spermatozoa were used in 19 transfers that resulted in six pregnancies. One pregnancy resulted from six embryo transfers from ICSI after microsurgical-epididymal sperm aspiration (MESA). The normal fertilization rates with testicular (37.3%) and MESA spermatozoa (53.7%) did not differ significantly from each other, but with testicular spermatozoa the rate was significantly lower than that obtained with ejaculated spermatozoa and ICSI (59.7%) in the matched couples. The abnormal fertilization of oocytes with one pronucleus was significantly higher with testicular spermatozoa than with ejaculated spermatozoa in the control couples.     

Prospective study of the value of transbronchial lung biopsy after lung transplantation

Transbronchial lung biopsy (TBB) has become the gold standard for the diagnosis of acute rejection and cytomegalovirus (CMV) pneumonia in lung transplant recipients. The aim of this study was to assess the value of regular surveillance TBB in stable asymptomatic patients and to establish the role of TBB as a follow-up procedure 1 month after a previous pathological biopsy result. We prospectively evaluated 76 TBBs performed in 17 lung transplant recipients. A definite pathological results was found in 14 of 15 TBBs performed for clinical indications: CMV pneumonia (5), acute rejection grade > or = A2 according to the criteria of the International Society for Heart and Lung Transplantation (ISHLT) (4), bronchiolitis obliterans (3), and desquamative interstitial pneumonitis (2). Fifteen of 45 surveillance TBBs performed in asymptomatic patients revealed significant abnormalities. Ten episodes of acute rejection ISHLT grade > or = A2 and three episodes of CMV pneumonia detected by TBB had direct therapeutic consequences. Nine of 16 follow-up TBBs performed 1 month after a pathological biopsy result again showed relevant pathological findings. With the exception of one severe haemorrhage, no life-threatening complications occurred. Our results suggest that transbronchial lung biopsies performed on a regular basis after lung transplantation are important for the detection of asymptomatic and/or persistent acute rejection or injection. In the long-term, this strategy might be the most effective tool in reducing the incidence of bronchiolitis obliterans, which is still the main obstacle for further improvement of long-term survival after lung transplantation.     

Different ventilatory approaches to keep the lung open

From a total of 62,858 autopsy files kept over a 30-year period (1961-1990), all cases that met the following criteria were extracted: (a) main tumor masses in the peritoneum with no evidence of origin from any adjacent organ; (b) histologic features suggestive of serous ovarian carcinoma; (c) ovaries definitely recognizable as having either no tumorous involvement or tumor confined to the surface and cortex of the ovaries; and (d) in patients with a history of abdominal operations, availability of slides and reports. From 670 stages III and IV serous carcinomas of the ovary, we retrieved 57 cases (8%) of serous surface papillary carcinoma (SSPC) of the peritoneum. All SSPCs occurred in women with an age range from 47 to 84 years (median 66 years). Eight cases (14%) were grade I, 36 (63%) were grade II, and 13 (23%) were grade III. Histologically, four cases (7%) resembled malignant epithelial mesothelioma in major parts of the tumor, and in one case endometrioid differentiation of the tumor was conspicuous. Additional histochemical and immunohistochemical examinations were performed in 30 cases of SSPC. In 14 cases (47%) neutral mucosubstances were identified by periodic acid-Schiff positivity after diastase predigestion, and in 16 cases (53%) acid mucosubstances were identified by alcian blue staining. In one of these cases the alcian blue-positive substances were abolished under predigestion by testicular hyaluronidase. Tumor cells stained positive for cytokeratin (100% of the cases), B72.3 (90%), Ber-EP4 (83%), CD 15 (57%), placental alkaline phosphatase (53%), CA 125 (43%), vimentin (23%), and carcinoembryonic antigen (10%). The survival rates at 1 year for SSPC (0%) were significantly shorter (p = 0.03) in comparison with stages III and IV ovarian carcinomas (34%). Problems of definition and differential diagnosis of SSPC are discussed.     

The role of transbronchial lung biopsy in diffuse pulmonary disease

A retrospective study of 103 patients with histologically proved cutaneous malignant melanoma was made in order to assess the validity of a simple prognostic index, based upon a multivariate analysis of weighted pathological and clinical factors, in predicting the expected outcome in a given case. The results of the study were almost identical to those observed by Cochran (1968); 16 per cent of the patients with a low prognostic index (less than 20) died or developed recurrence of melanoma during the period of follow-up, in contrast to those with a high prognostic index (greater than 25) of whom 64 per cent were similarly affected. It is concluded that the predicted outcome based upon such an index is valid for the 5 postoperative years in some 90 per cent of patients with cutaneous malignant melanoma. It is suggested that the use of such an index may be of great value in selecting patients in whom the expected outcome to surgical therapy is poor and in whom adjuvant therapy may be of value.     

The value of immediate cytologic evaluation for needle aspiration lung biopsy

RATIONALE AND OBJECTIVES: The authors evaluate the role of immediate cytologic evaluation (ICE) with fine-needle aspiration biopsy (FNAB) for lung lesions at highest risk for pneumothorax. METHODS: A prospective randomized study was conducted of 80 patients with lung lesions surrounded by aerated parenchyma undergoing FNAB with and without ICE (47 and 33 patients, respectively). An analysis of needle passes, procedure time, complications, specimen adequacy, diagnostic yield, and accuracy of procedure was made. RESULTS: There was an increased number of needle passes with ICE (> or = three passes: 23% [11 biopsies] versus 3% [1 biopsy]; P = 0.01). Fluoroscopic procedures took longer with ICE (median time: 15 versus 9 minutes; P = 0.002) with no difference in complication rates. Specimen adequacy was similar (74% and 64%) and the procedure was diagnostic in 79% (37 biopsies) with ICE and in 70% (33 biopsies) without ICE. There were no significant differences in the sensitivity, specificity, or accuracy of the biopsy. CONCLUSIONS: Immediate cytologic evaluation improved results marginally with increased procedure time and needle passes. Immediate cytologic evaluation may be most useful for lesions at lowest risk of complications to assure that a second procedure is not required.     

Bilateral pneumothorax, pneumomediastinum and pneumoperitoneum following unilateral percutaneous lung biopsy

A case of atypical varicella zoster in a 33-year-old AIDS patient is reported. The patient had had two attacks of herpes zoster within a year and was given high-dose acyclovir several times. Thereafter he developed small keratotic pellucid papules on fingers, wrists and face, which were found to contain varicella-zoster antigen by the ELISA test. Skin biopsy showed acanthosis and lack of vesication, as is usually seen in herpes infections. The atypical varicella-like lesions persisted despite repeated doses of acyclovir but cleared temporarily when the patient was given foscarnet. We believe that the prolonged therapy may have allowed selection of acyclovir-resistant varicella-zoster strains, resulting in the atypical clinical course.     

Transbronchial lung biopsy for diagnosis of infiltrative pneumonic and round lesions

The cytological and histological studies of biopsy specimens obtained from 51 patients with infiltrative pneumonic formations in the lung (Group 1) and in 30 with its round formations (Group 2) at transbronchial intrapulmonary biopsy could verify the etiology of the disease in 86.2 and 20.0% in Groups 1 and 2, respectively. Different diseases may run under the mask of tuberculosis in 36.6% of these patients.