Endobronchial ultrasound guided transbronchial needle aspiration.

Abstract:

:Staging for non-small cell lung cancer (NSCLC) requires accurate assessment of the mediastinal lymph nodes which determines treatment and outcome. As radiological staging is limited by its specificity and sensitivity, it is necessary to sample the mediastinal nodes. Traditionally, mediastinoscopy has been used for evaluation of the mediastinum especially when radical treatment is contemplated, although conventional transbronchial needle aspiration (TBNA) has also been used in other situations for staging and diagnostic purposes. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive alternative to mediastinoscopy with additional access to the hilar nodes, a better safety profile, and it removes the costs and hazards of theatre time and general anaesthesia with comparable sensitivity, although the negative predictive value of mediastinoscopy (and sample size) is greater. EBUS-TBNA also obtains larger samples than conventional TBNA, has superior performance and theoretically is safer, allowing real-time sampling under direct vision. It can also have predictive value both in sonographic appearance of the nodes and histological characteristics. EBUS-TBNA is therefore indicated for NSCLC staging, diagnosis of lung cancer when there is no endobronchial lesion, and diagnosis of both benign (especially tuberculosis and sarcoidosis) and malignant mediastinal lesions. The procedure is different than for flexible bronchoscopy, takes longer, and requires more training. EBUS-TBNA is more expensive than conventional TBNA but can save costs by reducing the number of more costly mediastinoscopies. Revenue based tariff systems have been slow to reflect the innovation of techniques such as EBUS-TBNA. In the future, endobronchial ultrasound may have applications in airways disease and pulmonary vascular disease.

journal_name

Postgrad Med J

authors

Medford AR,Bennett JA,Free CM,Agrawal S

doi

10.1136/pgmj.2009.089391

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

106-15

issue

1012

eissn

0032-5473

issn

1469-0756

pii

86/1012/106

journal_volume

86

pub_type

杂志文章,评审
  • Retinal vasculitis.

    abstract::Evidence is now accumulating on both clinical and experimental grounds that the retina is an a priori source of inflammatory activity. Reactive inflammation in the retina may produce many of the clinical signs previously ascribed to uveal inflammation. Autoimmune mechanisms are probably responsible for the majority of...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.64.753.488

    authors: Sanders MD,Graham EM

    更新日期:1988-07-01 00:00:00

  • Evaluation of renal function in elderly heart failure patients on ACE inhibitors.

    abstract::A total of 187 heart failure patients aged 65-92 years, with pretreatment serum creatinine levels below 200 mumol/l, were monitored for more than 12 months on angiotensin-converting enzyme (ACE) inhibitor therapy. Optimal ACE inhibitor dosage was found in 27% of patients, while a significant deterioration in renal fun...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.75.883.275

    authors: Jolobe OM

    更新日期:1999-05-01 00:00:00

  • Simple techniques to treat medical phobias.

    abstract::Participant modelling, a behaviourally-orientated treatment technique, is an effect method of treating phobias associated with minor medical procedures or apparatus such as needles or intravenous catheters. The steps in this technique are described and two cases of severe needle phobias successfully treated with parti...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.53.615.28

    authors: Taylor CB,Ferguson JM,Wermuth BM

    更新日期:1977-01-01 00:00:00

  • Leprosy presenting as unilateral foot drop in an immigrant boy.

    abstract::This is a case report of a boy who presented with unilateral foot drop approximately 1 year after traumatic injury from skateboarding. Exploratory surgical operation was eventually performed, and histological examination of the surgical specimen revealed leprous peripheral neuropathy of the peroneal nerve. The patient...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.70.820.111

    authors: Choe W

    更新日期:1994-02-01 00:00:00

  • Spinal ganglioneuroblastoma--complete response to chemotherapy alone.

    abstract::Ganglioneuroblastoma in the spinal region is rare, the treatment of choice being surgical excision. We present a 21 year old male who was diagnosed to have this condition in the dorsolumbar spinal region. The tumour was extending intraspinally and was unresectable. Combination chemotherapy with Adriamycin (doxorubicin...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.69.815.746

    authors: Raina V,Kamble R,Tanwar R,Singh SP,Sharma S

    更新日期:1993-09-01 00:00:00

  • Missed Addisonian crisis in surgical wards.

    abstract::Three women were admitted to the surgical wards with acute gastro-intestinal symptoms and despite good clinical (pigmentation, hypotension) and biochemical (hyponatraemia, acidosis) evidence of Addisonian crisis had unnecessary investigations with delay in the diagnosis and appropriate management of this medical emerg...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.63.739.367

    authors: Small M,MacCuish AC,Thomson JA

    更新日期:1987-05-01 00:00:00

  • Familial Conn's syndrome.

    abstract::We describe the occurrence of primary hyperaldosteronism in two sisters. Although this is only the second published report of familial Conn's syndrome, it does have implications for the relatives of patients with Conn's syndrome and these are discussed. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.68.806.976

    authors: London N,Swales J,Hollinrake K,Bell P,Heagerty A

    更新日期:1992-12-01 00:00:00

  • Life-threatening acute hyponatraemia induced by low dose cyclophosphamide and indomethacin.

    abstract::We report the case of a patient with multiple myeloma who developed acute life-threatening water intoxication following treatment with oral indomethacin and low dose intravenous cyclophosphamide. We describe a possible drug interaction between these two drugs and recommend that they should only be used together with c...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.65.770.950

    authors: Webberley MJ,Murray JA

    更新日期:1989-12-01 00:00:00

  • Primary hyperparathyroidism in a patient with Conn's syndrome.

    abstract::A 61-year-old patient with treated Conn's syndrome due to multiple bilateral adrenocortical adenomata developed primary hyperparathyroidism. At operation, a parathyroid adenoma and a thyroid colloid nodule were found. Although adrenocortical adenomata and hyperplasia are common findings in multiple endocrine adenopath...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.56.651.45

    authors: Fertig A,Webley M,Lynn JA

    更新日期:1980-01-01 00:00:00

  • Prolonged survival with adrenal cortical carcinoma.

    abstract::Recurrence of adrenal cortical carcinoma 22 years after first presentation is reported in a 54-year-old woman with Cushing's syndrome. This tumour is normally associated with poor prognosis and prolonged survival is rare. Although the patient had remained well with apparent 'cure' in the intervening years, it is sugge...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.55.648.765

    authors: Shaw KM,Fisher C,Peters JL,Ross EJ

    更新日期:1979-10-01 00:00:00

  • Gentamicin-resistant enterococci and endocarditis.

    abstract::We report a case of endocarditis associated with a highly gentamicin-resistant enterococcus that failed to respond to conventional antibiotic combination therapy. Clinical resolution was achieved following cardiac surgery and antimicrobial treatment dictated by in vitro testing of the patient's organism. Laboratories ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.65.764.390

    authors: Holliman R,Smyth E

    更新日期:1989-06-01 00:00:00

  • Microvascular investigations in diabetes mellitus.

    abstract::This paper reviews the current literature concerning the different investigative modalities available to assess the microcirculation in diabetic microangiopathy. The advantages and disadvantages of the different invasive and noninvasive methods available are presented objectively. We have concentrated on the tests tha...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.69.812.419

    authors: Chittenden SJ,Shami SK

    更新日期:1993-06-01 00:00:00

  • Improving the interpretation of electrocardiographs in an accident and emergency department.

    abstract::In this study we have examined the ability of senior house officers in the Accident and Emergency (A&E) Department to interpret electrocardiographs (ECGs) and tested the value of a single seminar and guidelines on interpretation. We prospectively audited ECG interpretation taken from notes over a two-month period and ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.71.833.132

    authors: White T,Woodmansey P,Ferguson DG,Channer KS

    更新日期:1995-03-01 00:00:00

  • Non-Hodgkin's lymphoma presenting as 'chronic active toxoplasmosis'.

    abstract::We report the case of a 58 year old man in whom an unusually prolonged infection with Toxoplasma gondii was the presenting feature of an underlying non-Hodgkin's lymphoma. This case demonstrates the particular usefulness of the IgM ELISA test in monitoring disease activity. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.64.757.883

    authors: Dudley NJ,Balfour AH

    更新日期:1988-11-01 00:00:00

  • The journal club and medical education: over one hundred years of unrecorded history.

    abstract::Sir William Osler organized a journal club at McGill University in 1875, and several authors suggest that journal clubs were found in certain European countries (in particular, Germany and England) prior to that time. The evolution and development of the journal club, however, has not been recorded in the medical lite...

    journal_title:Postgraduate medical journal

    pub_type: 历史文章,杂志文章

    doi:10.1136/pgmj.63.740.475

    authors: Linzer M

    更新日期:1987-06-01 00:00:00

  • Fulminant hyperpyrexia induced by bleomycin.

    abstract::Mild and self-limiting fever following bleomycin use is common, and a fatal hyperpyrexial response occurs rarely. In previously reported cases, such hyperpyrexia occurred either after the initial administration of the drug or during subsequent therapy following an initial pyrexial response. We describe a fatal hyperpy...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.65.764.417

    authors: Leung WH,Lau JY,Chan TK,Kumana CR

    更新日期:1989-06-01 00:00:00

  • Association of serum resistin with cystatin C and urinary albumin-to-creatinine ratio in elderly Chinese men with essential hypertension.

    abstract:PURPOSE OF THE STUDY:Resistin, a recently discovered proinflammatory cytokine, has been strongly linked to kidney dysfunction. The aim of this study was to determine the relationship of serum resistin with serum cystatin C (sCysC) and albuminuria, two sensitive endogenous markers of renal function, in elderly male pati...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/postgradmedj-2013-132408

    authors: Zhang M,Cui H,Zhu BP,Fu SH

    更新日期:2015-03-01 00:00:00

  • Antibiotic prescription for patients referred to a specialist breast clinic.

    abstract::Hospital referral is indicated as an emergency for breast infections not settling with oral antibiotics. Referrals to a breast clinic over a period of 6 months were assessed for prior antibiotic prescription. A total of 1078 patients were seen during this period. 91 (8%) patients had been prescribed antibiotics, 71% o...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.2006.049296

    authors: Twine C,Gateley CA

    更新日期:2006-11-01 00:00:00

  • Early structured core training of junior trainees in ophthalmology.

    abstract::The implementation of modernizing medical careers (MMC) has resulted in some specialties being allocated very inexperienced trainees such as ophthalmology. We aim to describe the process of implementation of MMC and how it may affect the service provision in smaller specialities such as ophthalmology. A methodical app...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2007.064188

    authors: Patel N,Zia R,Dewitd D,Morris S,Ionides A

    更新日期:2007-12-01 00:00:00

  • Bone disease after jejuno-ileal bypass for morbid obesity.

    abstract::Fifteen patients who had undergone a 14 inches X 4 inches jejuno-ileal bypass operation for obesity, 3 to 4 years earlier, were investigated by iliac bone biopsy, radiology and routine biochemistry, including 25-hydroxy-vitamin D and parathyroid hormone estimations. Two patients had histological osteomalacia which was...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.59.691.299

    authors: Gilmore IT,Eastwood JB,Ellis WR,Luck VA,Fenton S,O'Grady AJ,Harris E,Murray-Lyon IM

    更新日期:1983-05-01 00:00:00

  • The challenge of providing mentorship in primary care.

    abstract::In the changing National Health Service, there is an increasing awareness of stress related problems in the medical workforce. Mentorship has been shown to help with both stress reduction and adaptation to change. There are recognised difficulties with providing mentorship for doctors but there are ways in which these...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2006.054155

    authors: MacLeod S

    更新日期:2007-05-01 00:00:00

  • Association between personality traits and future choice of specialisation among Swedish doctors: a cross-sectional study.

    abstract:BACKGROUND:Medical students' choice of their future specialty is influenced by several factors, including working conditions and type of patient relations. The aim of this study was to investigate the association between the choice of specialty and personality traits. METHODS:This is a cross-sectional questionnaire-ba...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/postgradmedj-2015-133478

    authors: Bexelius TS,Olsson C,Järnbert-Pettersson H,Parmskog M,Ponzer S,Dahlin M

    更新日期:2016-08-01 00:00:00

  • Ovarian carcinoma presenting as pyrexia of unknown origin.

    abstract::A patient with a poorly differentiated clear cell adenocarcinoma of the ovary presenting as pyrexia of unknown origin is reported. Following resection of the tumour, her pyrexia resolved completely. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.61.712.177

    authors: Schofield PM,Kirsop BA,Reginald P,Harington M

    更新日期:1985-02-01 00:00:00

  • Eosinophilic leukaemia in association with a double Philadelphia chromosome.

    abstract::A case of eosinophilic leukaemia in association with chromosomal abnormalities including a double Philadelphia chromosome is reported. Comment is also made on the cardiological problems which arise in this condition. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.56.654.268

    authors: Stockdill G,Hartley SE,Allan NC

    更新日期:1980-04-01 00:00:00

  • Complex neuromuscular disorder in a patient with chronic myeloid leukaemia.

    abstract::We report a 44 year old man who developed external ophthalmoplegia and predominantly respiratory, truncal and bulbar weakness with brisk reflexes, histological evidence of an inflammatory myopathy and a high titre of acetylcholine receptor antibodies, one month after starting hydroxyurea and allopurinol for chronic my...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.69.810.312

    authors: Bergin PS,Gale AN

    更新日期:1993-04-01 00:00:00

  • Pitfalls in the interpretation of common biochemical tests.

    abstract::This review considers some of the more common problems in the interpretation of the results of biochemical tests and, where possible, highlights ways in which errors can be identified or avoided. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.76.893.129

    authors: Ayling RM

    更新日期:2000-03-01 00:00:00

  • Interaction between the adrenergic and renin-angiotensin-aldosterone-systems.

    abstract::In congestive heart failure (CHF) both the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone-system (RAAS) are activated. Both phenomena are only of short-term benefit and inevitably detrimental with prolonged activation. There are many possibilities for interaction between the systems, in particu...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:

    authors: van Zwieten PA,de Jonge A

    更新日期:1986-01-01 00:00:00

  • Diagnosis and management of chronic persistent dry cough.

    abstract::Cough is one of the commonest symptoms of lung disease and is a frequent problem encountered in general practice as well as in hospital practice. A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. A diagnostic work-up for patients wit...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.72.852.594

    authors: Chung KF,Lalloo UG

    更新日期:1996-10-01 00:00:00

  • Strangulated femoral hernia: the persisting clinical trap.

    abstract::Five cases of strangulated femoral hernia, all with a delay in establishing the diagnosis, are reported here. These cases illustrate the continuing difficulties experienced, both in primary care and hospital practice, in making this diagnosis despite the clinical awareness of this condition. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.67.783.57

    authors: Heys SD,Brittenden J

    更新日期:1991-01-01 00:00:00

  • Morphine: myths, morality and economics.

    abstract::It is a tragedy that morphine is scarcely available for between 1.3 and 2.5 billion people whilst 3.5 million cancer patients suffer needlessly. In only 10 countries is its consumption rising, in many more only codeine consumption shows an increase, and in many areas even in the Western world prescribing is grossly li...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:

    authors: Doyle D

    更新日期:1991-01-01 00:00:00