Biomedical subjects

Felix J F Herth

Publications and source records attributed to Felix J F Herth.

11 recordsLinked to original sources

PubMed2007

Actual role of endobronchial ultrasound (EBUS).

Many pathologies of the airway involve the bronchial wall and the parabronchial structures. The view of the endoscopist, however, is limited to the lumen and the internal surface of the airway. Processes within the airway wall and outside the airway can only be assessed by indirect signs. Especially in malignancies, this can be of decisive importance for the fate of the patient. Therefore, expanding the endoscopist's view beyond the airway is essential. Endobronchial ultrasound (EBUS) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) are new diagnostic tools that are available on the market. They have great potential for diagnosis of mediastinal processes and staging of lung cancer. After discovering a lung cancer without extrathoracic metastases, the preoperative mediastinal check-up is of great importance in determining operability. The investigation of a suspected malignant adenopathy justifies a complete examination by mediastinoscopy or mediastinotomy, which are considered gold standards. EBUS-TBNA constitutes the recent evolution of TBNA, a method known for 20 years now but underused. The aim of this review is to highlight to the different techniques and to discuss the results of published trials.

Biopsy, Fine-Needle↗

PubMed2007

State of the art: interventional pulmonology.

Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.

Bronchoscopy↗

PubMed2006

Molecular determinants of response to RTK-targeting agents in nonsmall cell lung cancer.

Receptor tyrosine kinases (RTKs) are essential components of the cellular signaling apparatus and are often mutated or otherwise deregulated in nonsmall cell lung cancer (NSCLC). These receptors are not solely expressed by cancer cells but also by multiple other cell types, including stromal cells that, in turn, may modulate cancer cell functions by various direct and indirect interactions. Recently, clinical studies have successfully evaluated the inhibition of RTKs by specific RTK-targeting agents, including tyrosine kinase inhibitors (TKIs). Although the response was impressive in some studies, only a limited proportion of patients benefit from these new drugs. Therefore, an intensive search for markers has started to determine which patients and tumor types are most likely to respond favorably to this new kind of treatment. Considerable attention has been focused onto molecular changes in cancer cells such as receptor expression, gene amplification, changes in intracellular signaling and receptor mutations. In this article, we explore the current data regarding molecular alterations as surrogate markers of response to specific RTK-targeting agents in NSCLC. Defined alterations may serve as key markers helping to preselect NSCLC patients for an individualized therapeutic approach in the future.

Animals↗

PubMed2006

Therapeutic bronchoscopy interventions before surgical resection of lung cancer.

BACKGROUND: Therapeutic bronchoscopy is used for endobronchial staging of lung cancer and symptomatic relief of central airway obstruction or postobstructive pneumonia. The aim of this study was to assess the utility of therapeutic bronchoscopy as a complementary tool in the combined bronchoscopic and surgical management of malignant airway lesions before curative lung surgery. METHODS: Seventy-four consecutive patients with nonsmall cell lung carcinoma undergoing a therapeutic bronchoscopy procedure followed by surgery with a curative intent were included. RESULTS: A single interventional bronchoscopic method was used in 27 patients (36%) and a combination of methods in 47 patients (64%). Median forced expiratory volume in 1 second (FEV1) before and after bronchoscopy were 1.7 L and 2.2 L, respectively, and forced vital capacity (FVC) was 2.5 L and 3.3 L, respectively. Sleeve upper lobectomy was performed in 22 patients (30%), sleeve upper bilobectomy in 16 patients (22%), lower bilobectomy in 2 patients (3%), pneumonectomy with sleeve resection in 2 patients (3%), and pneumonectomy in 28 patients (38%). The following surgeries were performed in 1 patient each: sleeve middle lobectomy, sleeve lower lobectomy, carina resection and complex reconstruction, and exploratory thoracotomy. Overall, parenchyma-sparing surgery (lobectomy or bilobectomy) could be performed in 57% patients after therapeutic bronchoscopy. There were no in-hospital deaths or deaths in the first 30 days after surgery. CONCLUSIONS: Therapeutic bronchoscopy can be used as a complementary tool in the combined bronchoscopic and surgical management of malignant airway obstruction before curative lung surgery. Therapeutic bronchoscopy might permit parenchyma-sparing surgery in patients with lung cancer.

Adenocarcinoma↗

PubMed2006

The future of bronchoscopy in diagnosing, staging and treatment of lung cancer.

Bronchoscopy is a central technique in diagnosing lung cancer, but also in different therapeutic approaches. A lot of techniques are available. The most common indication for bronchoscopy is for tissue sampling and determining the extent of lung cancer. Established diagnostic techniques are forceps biopsy, aspiration or brush cytology sampling, or needle aspiration. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement in patients with advanced stages. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound, autofluorescence bronchoscopy, and electromagnetic navigation. Other technologies, such as magnification, narrow-band imaging and confocal fluorescence microendoscopy, are in development for the use within the airways.

Biopsy, Needle↗

PubMed2006

Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans.

STUDY OBJECTIVES: Clopidogrel is often prescribed for primary or secondary prevention of cardiovascular disease and has been associated with unwanted bleeding events. After having shown that transbronchial biopsy can safely be performed in pigs receiving clopidogrel, we sought to determine whether routine clopidogrel use increases the risk of bleeding after transbronchial lung biopsy in humans. DESIGN: Prospective cohort study. PATIENTS AND INTERVENTIONS: Data were collected on 604 patients without underlying coagulation problems who underwent transbronchial lung biopsy over 13 months. Clopidogrel was not discontinued before biopsy in patients who were using it. Transbronchial biopsies were performed, and the incidence of bleeding and other complications among patients receiving clopidogrel was compared with that of other patients. RESULTS: The study was stopped early because the bleeding rate in the clopidogrel-only group (n = 18) was excessive (89% [16 of 18 patients] vs 3.4% [20 of 574 control subjects; p > 0.001] and also in the group receiving clopidogrel and aspirin (100% [12 of 12 patients] vs 3.4% among control subjects [p > 0.001]. Bleeding rates were significantly higher in the clopidogrel group for each degree of bleeding severity: mild (27% vs 1.5%), moderate (34% vs 1.5%), and severe (27% vs 0.3%; p > 0.001 for all comparisons). All 12 patients receiving both aspirin and clopidogrel had bleeding: moderate in 6 patients and severe in 6 patients. All bleeding was controlled by endoscopic means. There were no fatalities or need for blood transfusions in the patients enrolled in the trial. CONCLUSIONS: Clopidogrel use greatly increases the risk of bleeding after transbronchial lung biopsy in humans and therefore should be discontinued before bronchoscopy with biopsies. Aspirin exacerbates the effect of clopidogrel on bleeding.

Adult↗

PubMed2005

[Bronchoscopy].

Through the introduction of new techniques, bronchoscopy, a standard tool for years, has made great strides within the last years. With the introduction of endobronchial ultrasound, staging can be improved considerably in patients with lung carcinoma, thereby also leading to a better estimate of the patient's prognosis. By means of navigation techniques it is possible today to biopsy even smaller coin lesions, so that the number of diagnostic operations should decline in the next years. Also in the therapy of lung emphysema, an endoscopic technique is now available as a further treatment option. There is a good chance that broader possibilities and fields of application of bronchoscopy will emerge.

Biopsy↗

PubMed2005

Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes.

RATIONALE: Transesophageal and transbronchial, ultrasound-guided, fine-needle aspiration of enlarged mediastinal lymph nodes have become popular, but have never been compared directly. OBJECTIVES: To compare the relative diagnostic yield and ability of the transesophageal and transbronchial approaches to reach abnormal mediastinal lymph nodes. METHODS: A total of 160 patients with enlarged lymph nodes in one of eight mediastinal lymph node stations underwent transbronchial and transesophageal biopsies in a crossover design. Each of the eight stations was allocated 20 patients. Two needle punctures were done with each approach. MEASUREMENTS: Percentage of successful biopsies, percentage of patients diagnosed, and biopsy time were measured from when the lymph node was identified with ultrasound. MAIN RESULTS: Among the 106 men and 54 women (mean age 53.2 years), transbronchial aspiration was successful in 85%, and transesophageal aspiration was successful in 78% (p = 0.2). For each station, the number of positive samples for the transbronchial/transesophageal approaches was: 2R: 19/13; 2L: 16/19; 3: 17/15; 4R: 19/12; 4L: 17/20; 7: 19/20; 10R: 18/9; and 10L: 17/18. Combining both approaches produced successful biopsies in 97% and diagnoses in 94% of patients. Mean biopsy times were 3.2 minutes for the transbronchial approach and 4.1 minutes for the transesophageal approach. The transbronchial approach was superior in nodes 2R, 4R, and 10R. No complications were encountered. CONCLUSIONS: In experienced hands, enlarged mediastinal lymph nodes may be aspirated with either the transbronchial or transesophageal approach. These nonsurgical approaches have similar diagnostic yields, although the transbronchial approach is superior for right-sided lymph nodes. Combining both approaches provides results similar those of mediastinoscopy.

Adult↗

PubMed2005

Innovative bronchoscopic diagnostic techniques: endobronchial ultrasound and electromagnetic navigation.

PURPOSE OF REVIEW: Bronchoscopy is a minimally invasive method for diagnosing lung diseases, but the technique has some limitations. In case of parabronchial lesions, the view is limited to the inner surface. Therefore, endobronchial ultrasound systems were developed. For obtaining biopsies of peripheral lung lesions, a new real-time guidance system shows promising results. In this review the authors assess the most important and interesting articles in both fields. RECENT FINDINGS: In a trial it was shown that with the help of endobronchial ultrasound the diagnosing and staging of lung cancer and other pathologies could be improved. It is a safe technique and it has proved extremely useful during diagnostic and interventional procedures. With the navigation conclusive, biopsies were obtained in nearly 70% of the patients without any severe side effects. SUMMARY: Endobronchial ultrasound proved to be useful in high-resolution imaging of the multilayer structures of the bronchial wall and the adjacent mediastinal structures at a distance of as much as 4 cm. Lymph nodes could be easily localized for transbronchial needle aspiration. In many instances it was superior for staging lung cancer and other pathologies. Real-time electromagnetic-guided bronchoscopy, coupled with computed tomography is a feasible and safe method for obtaining biopsies from peripheral lung lesions.

Bronchoscopy↗

PubMed2004

Mediastinal staging--the role of endobronchial and endo-oesophageaL sonographic guided needle aspiration.

Conventional transbronchial needle aspiration (TBNA) is a valuable procedure but remains underutilised. Recently, imaging guidance such as CT fluoroscopy has created considerable interest. As CT fluoroscopy is cumbersome and exposes patients and staff to radiation, endosonographic imaging may be a better choice in providing guidance for TBNA or FNA in enlarged mediastinal Lymph nodes. Real-time imaging during the procedure is helpful and increases the yield.

Biopsy, Needle↗

PubMed2002

Aspirin does not increase bleeding complications after transbronchial biopsy.

STUDY OBJECTIVES: The present study was performed to determine whether the risk of bleeding after transbronchial lung biopsy is increased in patients taking aspirin. DESIGN: Prospective cohort study. PATIENTS AND INTERVENTIONS: After excluding patients with other coagulation problems, 1,217 patients who had undergone transbronchial lung biopsy during a prospective 1.5-year study period were included in this study. The use of aspirin was not discontinued before the procedure. Two hundred eighty-five patients (23%) had consumed aspirin within 24 h of the procedure, and most of them (82%) used aspirin on a daily basis. Transbronchial biopsies were performed, and the bleeding incidence was compared between the groups. RESULTS: A total of 57 patients (4.7%) experienced procedure-related bleeding. Minor bleeding occurred in 5 of 285 patients (1.8%) taking aspirin and in 27 of 932 control patients (2.9%; not significant). Moderate bleeding was seen in 3 of 285 patients (1.1%) in the aspirin group and in 13 of 932 patients (1.4%) in the control group (not significant). Major bleeding occurred in only 9 patients, 2 of 285 (0.9%) in the aspirin group and 7 of 932 (0.8%) in the control group (not significant). All bleeding was controlled by endoscopic means, and there were no fatalities and no need for blood transfusions. CONCLUSIONS: We conclude that the risk of severe bleeding after transbronchial lung biopsy is small (ie, < 1%) and that the use of aspirin is not associated with any increased risk of bleeding.

Adult↗