Michael Machuzak - Academia.edu (original) (raw)

Papers by Michael Machuzak

Tracheal or bronchial-mediastinal fistulas are a rare entity associated to high mortality. We rep... more Tracheal or bronchial-mediastinal fistulas are a rare entity associated to high mortality. We report a case of a 58-year-old man with an unresectable non-small cell carcinoma of the lung, treated with chemoradiation followed by bevacizumab. Approximately, 6 weeks after starting bevacizumab he developed a severe cough with copious secretions He could not lie supine due to the feeling of drowning. Investigations revealed a large tracheo-mediastinal-parenchymal-pleural fistula. Palliative management was offered with interventional bronchoscopic techniques. He was found to have a large central airway defect that obliterated almost 40% of the trachea. Under general anesthesia and positive pressure ventilation, a unique approach was used to rebuild an eroded tracheal and right main stem bronchial wall. A self-expanding metallic stent (SEMS) was placed to provide a scaffold of support, whereas a Dumon Y-stent was placed inside the SEMS. This combination allowed for a patent, stable airway; recreating the normal anatomy in a minimally invasive manner walling off the fistula. The patient was discharged 2 days after the bronchoscopic intervention, with significant palliation of his symptomatology. Eighteen months later, the upper lobe cavity persists with a stable airway and stents perfectly positioned with clinically insignificant evidence of stent related granulation in the upper trachea.

Journal of bronchology & interventional pulmonology, Jan 4, 2015

Peripheral pulmonary lesions are an increasingly common finding in clinical practice. Electromagn... more Peripheral pulmonary lesions are an increasingly common finding in clinical practice. Electromagnetic navigation and radial probe endobronchial ultrasound have improved the diagnostic yield of bronchoscopy for peripheral lesions, although these techniques remain largely underutilized. One potential barrier to the adoption of these techniques may be the lack of an appropriate model to train clinicians on the various aspects of peripheral bronchoscopy. This report describes the development of a human cadaveric model with artificially implanted tumor targets designed to train physicians on aspects of peripheral bronchoscopy, including electromagnetic navigation and radial probe endobronchial ultrasound.

International Journal of Radiation Oncology Biology Physics, Jan 12, 2006

Background: Severe airway obstruction can occur in the setting of benign granulation tissue formi... more Background: Severe airway obstruction can occur in the setting of benign granulation tissue forming at bronchial anastomotic sites after lung transplantation in up to 20% of patients. Many of these benign lesions respond to stent placement, laser ablation, or balloon bronchoplasty. However, in certain cases, proliferation of granulation tissue may persist despite all therapeutic attempts. This study describes a series of refractory patients treated with high-dose-rate (HDR) brachytherapy for benign proliferation of granulation tissue, causing airway compromise. Methods and Materials: Between April 2002 and June 2005, 5 patients with significant airway compromise from recurrent granulation tissue were treated with HDR brachytherapy. All patients had previously failed to maintain a patent airway despite multiple bronchoscopic interventions. Treatment was delivered using an HDR brachytherapy afterloader with 192 Ir. Dose prescription was to a depth of 1 cm. All patients were treated weekly, with total doses ranging from 10 Gy to 21 Gy in two to three fractions. Results: The median follow-up was 12 months. All patients experienced a reduction in therapeutic bronchoscopic procedures after HDR brachytherapy compared with the pretreatment period. With the exception of possible radiation-induced bronchitis in 1 patient, there were no other treatment related complications. At the time of this report, 2 patients have died and the other 3 are alive with marked symptomatic improvement and reduced bronchoscopic procedures. Conclusion: High-dose-rate brachytherapy is an effective treatment for benign proliferation of granulation tissue causing airway obstruction. The early response to therapy is encouraging and further follow-up is necessary to determine long-term durability and late effects.

Journal of bronchology & interventional pulmonology, 2012

Journal of bronchology & interventional pulmonology, 2015

Thoracic Surgery Clinics, Jan 2, 2015

Airway complications after lung transplantation present a formidable challenge to the lung transp... more Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

The Journal of Heart and Lung Transplantation the Official Publication of the International Society For Heart Transplantation, Apr 1, 2007

Purpose: This phase 1 dose escalation study evaluated the safety and feasibility of single-dose i... more Purpose: This phase 1 dose escalation study evaluated the safety and feasibility of single-dose intrapleural IFN-h gene transfer using an adenoviral vector (Ad. IFN-h) in patients with malignant pleural mesothelioma (MPM) and metastatic pleural effusions (MPE). Experimental Design: Ad.IFN-h was administered through an indwelling pleural catheter in doses ranging from 9 Â 10 11 to 3 Â 10 12 viral particles (vp) in two cohorts of patients with MPM (7 patients) and MPE (3 patients). Subjects were evaluated for (a) toxicity, (b) gene transfer, (c) humoral, cellular, and cytokine-mediated immune responses, and (d) tumor responses via 18-fluorodeoxyglucose-positron emission tomography scans and chest computed tomography scans. Results: Intrapleural Ad.IFN-h was generally well tolerated with transient lymphopenia as the most common side effect. The maximally tolerated dose achieved was 9 Â 10 11 vp secondary to idiosyncratic dose-limiting toxicities (hypoxia and liver function abnormalities) in two patients treated at 3 Â 10 12 vp. The presence of the vector did not elicit a marked cellular infiltrate in the pleural space. Intrapleural levels of cytokines were highly variable at baseline and after response to gene transfer. Gene transfer was documented in 7 of the 10 patients by demonstration of IFN-h message or protein. Antitumor immune responses were elicited in 7 of the 10 patients and included the detection of cytotoxic T cells (1 patient), activation of circulating natural killer cells (2 patients), and humoral responses to known (Simian virus 40 largeTantigen and mesothelin) and unknown tumor antigens (7 patients). Four of 10 patients showed meaningful clinical responses defined as disease stability and/or regression on 18-fluorodeoxyglucosepositron emission tomography and computed tomography scans at day 60 after vector infusion. Conclusions: Intrapleural instillation of Ad.IFN-h is a potentially useful approach for the generation of antitumor immune responses in MPM and MPE patients and should be investigated further for overall clinical efficacy.

Annals of the American Thoracic Society, Jan 20, 2016

Rapid on-site cytologicalal examination (ROSE) of specimens collected by endobronchial ultrasound... more Rapid on-site cytologicalal examination (ROSE) of specimens collected by endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) ensures sample adequacy and triages subsequent biopsy procedures. EBUS-TBNA allows sampling of lymph nodes in granulomatous diseases; however, the ability of ROSE to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective evaluation to study the utility of ROSE in the diagnosis of granulomatous diseases as well as to establish the procedure characteristics that would optimize the concordance between ROSE and final diagnosis. Charts of patients with a cytological diagnosis of granuloma by EBUS-TBNA between 6/2008-5/2013 were reviewed. Preliminary ROSE findings and final cytological diagnosis were compared. Patient demographics and procedure variables were assessed using mean and standard deviations. The variables collected were considered in a logistic regression analysis using concordan...

Seminars in Respiratory and Critical Care Medicine, Aug 1, 2008

Malignant pleural effusions (MPEs) are commonly seen as complications of advanced malignancy, esp... more Malignant pleural effusions (MPEs) are commonly seen as complications of advanced malignancy, especially in lung cancer and breast cancer. The management will depend on the performance status of the patient, severity of the symptoms, and the primary tumor's response to systemic therapy. Thoracentesis is usually the first step for both diagnostic and therapeutic reasons. Chest tube placement with sclerotherapy is successful in 60 to 90% of cases, but it requires hospitalization for ~1 week. Alternatively, long-term tunneled pleural drainage catheters can be performed on an outpatient basis and are effective in controlling symptoms in 80 to 100% of patients. Additional advantages are the ability to treat trapped lung, large loculated effusions, and bilateral effusions simultaneously, as well as lower charges. Spontaneous pleurodesis can occur in up to 50% of the patients. Tunneled catheters should be considered in all patients with MPE and particularly those who have a reasonable expectancy of being outpatient.

Principles and Practice of Interventional Pulmonology, 2012

The Ochsner journal, 2015

Bronchogenic cysts are rare congenital anomalies that are often solitary and rarely multiple. Mos... more Bronchogenic cysts are rare congenital anomalies that are often solitary and rarely multiple. Most bronchogenic cysts are asymptomatic, and symptoms when present are usually the result of compression by the cyst on the surrounding structures. We report a case of recurrent bronchogenic cyst following a partial resection treated with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EBUS-TBNA can provide instant decompression of the cyst and relieves the pressure on the surrounding structures.

Journal of Bronchology, 2008

Endobronchial fire is a rare complication of airway ablative procedures. The long-term complicati... more Endobronchial fire is a rare complication of airway ablative procedures. The long-term complication is airway obstruction from granulation tissue, stricture and tracheobronchomalacia. A retrospective chart review from 2009 through 2013 was conducted. Four patients with endobronchial fire were identified. We present the long-term bronchoscopic management in this entity. Case 1: A 56 year old patient developed diffuse tracheobronchial stenosis after airway fire during uvuloplasty. A silicone Y-stent was placed restoring patency to the trachea and bilateral mainstem bronchi. Her functional status improved, but required multiple procedures for stent maintenance. Stent-related complications included MRSA infection and granulation tissue necessitating cryoablation, dilation and stent revision. She maintains good functional status with mild cough. Case 2: A 68 year old patient developed a complete subglottic stenosis after a prolonged recovery and tracheostomy after a cardiac procedure. An...

Techniques in Gastrointestinal Endoscopy, 2009

Hepatic hydrothorax (HH) is a troublesome pulmonary complication that can arise in end-stage live... more Hepatic hydrothorax (HH) is a troublesome pulmonary complication that can arise in end-stage liver disease patients and can significantly impair patient quality of life and functional ability. The presence of portal hypertension, the accumulation of ascites, and subsequent fluid translocation through diaphragmatic fenestrations underlies this complication. Other pleural effusion etiologies must be excluded to ensure alternative diagnoses are not the pleural effusion source. Once attributed to HH, management and an optimal patient outcome can be difficult to achieve. This review will discuss the current understanding and various approaches to HH management, with a focus on intrathoracic interventions for this vexing clinical problem.

Journal of Bronchology, 2005

ABSTRACT

COPD, 2008

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition that has frequent mo... more Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition that has frequent morbidity and mortality, with associated costs of US $ 2.5 billion annually and nearly 14,000 deaths each year. In the most advanced stages it causes debilitating breathlessness which is not improved despite maximal medical therapy including smoking cessation, bronchodilators, steroids and supplemental oxygen. Limitations of medical therapy led to the development of several surgical techniques to improve quality of life. However, surgical techniques still carry substantial morbidity even if the mortality is low at centers with larger experience; hence investigators are vigorously pursuing research into innovative, alternative methods for achieving lung volume reduction (LVR), in recent years. Endoscopic techniques for LVR are proposed, based on two main approaches, either closing of anatomical airway passages into destroyed lobe/segment of the lung to affect a collapse and reduction in vol...

Seminars in respiratory and critical care medicine, 2014

The purpose of this article is to provide an introduction to rigid bronchoscopy (RB). We will bri... more The purpose of this article is to provide an introduction to rigid bronchoscopy (RB). We will briefly discuss its history, evolution, and resurgence while we highlight its versatility and usefulness for today's interventional pulmonologist and thoracic surgeon. Despite being one of the earliest pulmonary procedures described, RB is still an important technique. Advances in thoracic medicine have made this skill critical for a fully functional interventional pulmonary program. If the interventional pulmonologist of this century is to be successful, he or she should be facile in this technique. Despite the availability of RB for decades, the invention of flexible bronchoscopy in 1966 led to a significant downturn in its usage. The growth of the interventional pulmonology field brought RB back into the spot light. Apart from the historic role of RB in treatment of central airway lesions and mechanical debulking of endobronchial lesions, RB is the key instrument that can adapt moder...

Cleveland Clinic journal of medicine, 2014

Journal of bronchology & interventional pulmonology, 2014

Endobronchial involvement is a relatively uncommon but well-described presentation in Granulomato... more Endobronchial involvement is a relatively uncommon but well-described presentation in Granulomatosis with polyangiitis (GPA). Self-expandable metallic stents (SEMs) should be reserved for the malignant airway disorder to maintain airway patency, but have been used for benign disease in specific cases. We present a case of longstanding endobronchial GPA with recurrent bronchial stenosis. Three SEMs were deployed in the distal left main bronchus 10 years prior. Two were removed in the standard manner, but the remaining stent SEM was completely embedded in the bronchial mucosa making its removal extraordinarily difficult. We placed an oversized silicone stent inside the stent leading to necrosis of the mucosa allowing for a less formidable removal of the embedded stent. Another silicone stent was temporarily placed. SEMs removal can be extremely complicated and should only be performed by experienced bronchoscopists in an institution with sufficient resources.