Histologic Findings of Severe/Therapy-Resistant Asthma From Video-assisted Thoracoscopic Surgery Biopsies

Bittar, Humberto E. Trejo; Doberer, Daniel; Mehrad, Mitra; Strollo, Diane C.; Leader, Joseph K.; Wenzel, Sally E.; Yousem, Samuel A.

doi:10.1097/pas.0000000000000777

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…Despite this notion, the VATS is expensive procedure for middle-income country like Pakistan and even more impractical for the low-income countries. However, imaging-guided biopsy of anterior mediastinal masses offers less complications as it is less invasiveness [ 16 - 18 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

Shazlee¹,

Ali²,

Ahmed³

et al. 2021

Cureus

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Background and objectives The high cost of video-assisted transthoracic procedures precludes their use in the diagnostics of mediastinal masses in low-and middle-income countries (LMICs). This study aims to assess the technical success rate and diagnostic yield of ultrasound-guided transthoracic mediastinal biopsies at a tertiary care hospital. Methods This descriptive cross-sectional study was conducted in patients presenting with mediastinal masses referred to radiology services at Dr. Ziauddin University Hospital. Karachi, Pakistan. Ultrasonography was performed using Toshiba Xario 200 & Aplio 500 using convex and linear probes accordingly. Biopsy was performed using a combination of 18G semiautomatic trucut and 17G co-axial needles. Complications and overall diagnostic yields were determined. Results In all 70 patients referred, the procedure was completed successfully with an overall procedural yield of 95.7%. Inconclusive biopsies due to inadequate specimen were seen in two (4.2%) patients. No postprocedure major complication or mortality was observed. Minor complications were seen in three (4.2%) out of 70, including hematoma (<3 cm) in one patient and small pneumomediastinum in two patients. Conclusion Ultrasound-guided transthoracic mediastinal biopsy may be the pragmatic technique of choice in LMICs for the diagnosis of mediastinal masses as they provide real-time visualization and is cost-effective and safe.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

Shazlee¹,

Ali²,

Ahmed³

et al. 2021

Cureus

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“…Surgical separation, stress response, pulmonary ischemia-reperfusion and anesthetics during VATS can activate immune inflammation, such as the release of inflammatory factors and the impairment of pulmonary function after operation[52]. Compared with the IGA group, NIA patients showed significantly lower levels of white blood cells, IL-6, IL-8 and CRP whileas levels of IL-10 were similar between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis

Ren

et al. 2019

PLoS ONE

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IntroductionNon-intubated anesthesia (NIA) has been proposed for video-assisted thoracoscopic surgery (VATS), although how the benefit-to-risk of NIA compares to that of intubated general anesthesia (IGA) for certain types of patients remains unclear. Therefore, the aim of the present meta-analysis was to understand whether NIA or IGA may be more beneficial for patients undergoing VATS.MethodsA systematic search of Cochrane Library, Pubmed and Embase databases from 1968 to April 2019 was performed using predefined criteria. Studies comparing the effects of NIA or IGA for adult VATS patients were considered. The primary outcome measure was hospital stay. Pooled data were meta-analyzed using a random-effects model to determine the standard mean difference (SMD) with 95% confidence intervals (CI).Results and discussionTwenty-eight studies with 2929 patients were included. The median age of participants was 56.8 years (range 21.9–76.4) and 1802 (61.5%) were male. Compared to IGA, NIA was associated with shorter hospital stay (SMD -0.57 days, 95%CI -0.78 to -0.36), lower estimated cost for hospitalization (SMD -2.83 US, 95% CI -4.33 to -1.34), shorter chest tube duration (SMD -0.32 days, 95% CI -0.47 to -0.17), and shorter postoperative fasting time (SMD, -2.76 days; 95% CI -2.98 to -2.54). NIA patients showed higher levels of total lymphocytes and natural killer cells and higher T helper/T suppressor cell ratio, but lower levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP). Moreover, NIA patients showed lower levels of fibrinogen, cortisol, procalcitonin and epinephrine.ConclusionsNIA enhances the recovery from VATS through attenuation of stress and inflammatory responses and stimulation of cellular immune function.

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“…Goblet cell hyperplasia (increased number of cells), metaplasia (change in cell phenotype) and mucus accumulation have been consistently reported in the conducting airways of patients with mild, moderate, severe, and fatal asthma (Kuyper et al, 2003;Wenzel et al, 2012;Malmström et al, 2017;Trejo Bittar et al, 2017;Elliot et al, 2018). In the epithelium of asthmatic patients, goblet cell metaplasia is the main contributor to increased numbers of goblet cells in the small airways rather than goblet cell hyperplasia (Curran and Cohn, 2010).…”

Section: Airway Epithelial Remodelingmentioning

confidence: 99%

Airway remodeling heterogeneity in asthma and its relationship to disease outcomes

Assadinia¹,

Hackett²

2023

Front. Physiol.

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Asthma affects an estimated 262 million people worldwide and caused over 461,000 deaths in 2019. The disease is characterized by chronic airway inflammation, reversible bronchoconstriction, and airway remodeling. Longitudinal studies have shown that current treatments for asthma (inhaled bronchodilators and corticosteroids) can reduce the frequency of exacerbations, but do not modify disease outcomes over time. Further, longitudinal studies in children to adulthood have shown that these treatments do not improve asthma severity or fixed airflow obstruction over time. In asthma, fixed airflow obstruction is caused by remodeling of the airway wall, but such airway remodeling also significantly contributes to airway closure during bronchoconstriction in acute asthmatic episodes. The goal of the current review is to understand what is known about the heterogeneity of airway remodeling in asthma and how this contributes to the disease process. We provide an overview of the existing knowledge on airway remodeling features observed in asthma, including loss of epithelial integrity, mucous cell metaplasia, extracellular matrix remodeling in both the airways and vessels, angiogenesis, and increased smooth muscle mass. While such studies have provided extensive knowledge on different aspects of airway remodeling, they have relied on biopsy sampling or pathological assessment of lungs from fatal asthma patients, which have limitations for understanding airway heterogeneity and the entire asthma syndrome. To further understand the heterogeneity of airway remodeling in asthma, we highlight the potential of in vivo imaging tools such as computed tomography and magnetic resonance imaging. Such volumetric imaging tools provide the opportunity to assess the heterogeneity of airway remodeling within the whole lung and have led to the novel identification of heterogenous gas trapping and mucus plugging as important predictors of patient outcomes. Lastly, we summarize the current knowledge of modification of airway remodeling with available asthma therapeutics to highlight the need for future studies that use in vivo imaging tools to assess airway remodeling outcomes.

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Histologic Findings of Severe/Therapy-Resistant Asthma From Video-assisted Thoracoscopic Surgery Biopsies

Cited by 14 publications

References 22 publications

Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis

Airway remodeling heterogeneity in asthma and its relationship to disease outcomes

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