今泉 和良

Bronchoscopic lung volume reduction (BLVR) with endobronchial valves is an established treatment for selected patients with advanced emphysema. A 74-year-old male patient with chronic obstructive pulmonary disease and severe dyspnea was scheduled to undergo BLVR targeting the right middle lobe bronchus based on high-resolution CT findings, which showed severe emphysematous changes with hyperinflation and fissure completeness of 98% in the right middle lobe. The physician conducted preoperative virtual reality (VR)-assisted planning using the patient's imaging data, enabling comprehensive visualisation of the bronchial tree, airway measurements, and procedural simulation. The Chartis system confirmed a 'no flow' pattern, supporting the absence of collateral ventilation. During the procedure, a size 5.5 valve was placed in the right B4/5 bronchus following VR and intraoperative assessments. The patient remained stable postoperatively without complications. VR enhanced procedural planning by improving airway assessment, optimising valve sizing, and reducing cognitive load, leading to increased efficiency and operator confidence. Further research is warranted to validate the utility of VR in bronchoscopic interventions.

The purpose of this study was to evaluate how the first oral administration of suvorexant affects PSG results in patients with severe obstructive sleep apnea (OSA). Single-center, prospective study conducted in a nonrandomized, uncontrolled, unblinded fashion. Undiagnosed 64 patients with suspected OSA underwent first-night PSG, and 30 patients with severe OSA (Apnea Hypopnea Index [AHI] ≥ 30 events/h) underwent second-night PSG testing after administration of 15 mg suvorexant. The change in AHI between the first and second nights was not significant, although the upper limit of the 95% confidence interval for the mean difference in AHI was high at 5.987.The mean duration of apnea on the second night was significantly prolonged compared to that on the first night, but there were no significant differences n 3% oxygen desaturation index, saturation of percutaneous oxygen<90% time. On the second night, total sleep time was significantly prolonged, mid-night awakenings decreased, REM sleep percentage increased, and REM latency was shorter. Because the environment for PSG testing is very different from the patient's home and many patients have difficulty sleeping, there are clinical cases in which PSG is performed with sleep medication. In this study, PSG after oral administration of 15 mg of suvorexant on the second night showed no significant difference or clear trend in AHI. However, the upper limit of the 95% confidence interval for the mean difference in AHI was greater than 5, suggesting that suvorexant may exacerbate AHI, even with the first administration.

BACKGROUND: The increasing prevalence of lung cancer in the elderly population necessitates a closer evaluation of diagnostic and therapeutic approaches. This study aimed to compare the safety and diagnostic efficacy of transbronchial lung cryobiopsy (TBLC) between patients ≥ 80 years and younger patients. METHODS: A retrospective review was conducted of 96 patients diagnosed with peripheral lung cancer who underwent TBLC between April 2021 and October 2023. The patients were categorized into two groups: the elderly group (age ≥ 80 years, n = 20) and younger group (age < 80 years; n = 76). Data regarding the biopsy yield, complications, and feasibility of molecular analyses were collected and analyzed. RESULTS: The diagnostic yield of TBLC was comparable between the elderly and younger groups (95% vs. 89.5%, p = 0.679). Biomarker testing, including programmed death-ligand 1 expression and genetic mutations, were feasible in all cases diagnosed with cancer using TBLC samples. No significant differences were observed in major complications such as pneumothorax or bleeding. CONCLUSIONS: TBLC was found to be a safe and effective diagnostic tool for peripheral lung cancer in elderly patients and provided adequate samples for molecular testing. Since the complication rates did not significantly differ between the two age groups, age alone should not be considered a contraindication for the procedure.