Search

A 20-year-old woman with recurrent left-sided pneumothoraces underwent video-assisted thoracoscopic pleurectomy and wedge resection of a left apical bulla. Medical history included ABCA3 pulmonary surfactant dysfunction and subsequent interstitial lung disease with diffuse ground glass changes suggestive of a desquamative interstitial pneumonitis (DIP). She was a lifelong non-smoker. Spirometry revealed forced vital capacity 0.97 L, 32% predicted and carbon monoxide transfer factor (TLCO) 27% predicted. The operation was uneventful but there was a persistent postoperative air leak requiring prolonged pleural drainage but no other intervention. … more...

Introduction With the advent of multidisciplinary team (MDT) working and new therapies in interstitial lung disease (ILD), diagnostic accuracy is increasingly important, and international guidelines1 have reaffirmed the importance of surgical lung biopsy (SBx) where necessary. However, SBx has associated risks: to assess this further we looked at the diagnostic yield and complication rate of SBx carried out at our regional thoracic centre for patients with ILD. Methods We looked at all 104 SBxs carried out for ILD over 24 months between 2014–16, collecting data on the nature of the procedure, number of lobes sampled, complications encountered and mortality, and also whether the cases had been discussed at a regional ILD or local radiology MDT meeting prior to SBx. Results Seventy cases (67%) had been discussed prior to SBx (18 at an ILD MDT). Overall, mean age was 56 years, mean FEV1 79% predicted, FVC 84% predicted, RV 79% predicted, TLC 77% predicted, TLCO 56% predicted, and KCO 77% predicted. All but 3 procedures were carried out by VAT: the median number of lobes sampled was 2 (>1 lobe in 86%), and diagnostic specimens were obtained in 97% (UIP 29%, RB-ILD and DIP 23%, HSP 12%, Sarcoid 10%, NSIP 7%, others 19%). For complications see Table. The mean length of stay was 5.2 days (range 1–44): in-hospital mortality and 30-day mortality were 1% and 3% respectively. Conclusion Although SBx is here to stay, it has significant morbidity and mortality. Transbronchial cryobiopsy may in the future sit alongside SBx in the diagnostic pathway for ILD, but in addition to offering low morbidity and mortality it must also offer a high diagnostic yield. Reference Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society Statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013;188:733–748. more...

Introduction Burkholderia spp infection in cystic fibrosis (CF) confers a worse prognosis, with increased morbidity and mortality. Treatment can be problematic because strains are often resistant to many of the commonly available intravenous antibiotics, leading to a search for new therapies. We have studied the use of Temocillin, a derivative of Ticarcillin with promising in-vitro activitiy against Burkholderia spp, 1 in the treatment of acute exacerbations in CF patients infected with Burkholderia spp. Methods We have used Temocillin in IV form, often in combination, in acute respiratory exacerbations in CF patients attending our large adult unit who are chronically infected with Burkholderia spp. We present our two year data, looking at the subspecies treated, length of treatment, improvement in clinical parameters, and co-antibiotic use. Results Nineteen courses of IV Temocillin were administered to 7 CF patients (mean age 29 years, [range 23–42 years], 2 males, 1 infected with B Cenocepacia, 6 with B Multivorans.) All patients completed their treatment without complication. Median length of Temocillin treatment was 9.7 days (range 3–16 days), and most patients finished their therapy as outpatients (mean inpatient stay 5.2 days). All patients had clinical improvement, with all gaining weight (mean 3 kg [range 6.5 to 0.9]) and most increased spirometry (mean change in FEV1% predicted 6 [17 to -3]). As regards the efficacy of co-antibiotic use, the 11 courses accompanied by Ceftazidime had a mean 3% improvement in FEV1, 8% with Meropenem (6 courses) and 9% with Colomycin (2 courses). Discussion This clinical study has shown that Temocillin is well tolerated by CF patients and is associated with clinical improvement in those infected with Burkholderia spp when given in combination with other antibiotics. Temocillin adds to the limited antibiotic armamentarium available to treat these difficult infections in CF patients and we recommend its use to other clinicians. Reference 1 Bonacorsi S, Fitoussi F, Lhopital S, Bingen E. Comparative in vitro activities of meropenem, imipenem, temocillin, piperacillin, and ceftazidime in combination with tobramycin, rifampin or ciprofloxacin against Burkholderia cepacia isolates from patients with cystic fibrosis. Antimicrob Agents Chemother . 1999; 43 :213–217 more...