ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Mechanical properties of currently used airway stents were tested in excised tracheas. Stress—strain tests included measurements of area versus circumferential (pleural) pressure, area versus load (emulating tumor compression), and force as a function of compression. The Dynamic stent showed the highest stability of the tracheal stents, followed by the Nitinol, the Nova, and the Dumon stents. Factors influencing the recoil of endoprostheses are the Young's modulus, wall or wire thickness, length, caliber, and, for silicone stents. Shore A hardness. The stability depends even more on the position of the applied load. Consequently, the length of the stent should exceed the tracheobronchial stricture by 5 mm. Strecker stents and, especially, Gianturco stents show nonlinear behavior in the compression—force test, indicating a high risk of wall perforation during cough. Palmaz stents are the stiffest metal stents but their stability is shape dependent. Once laterally compressed, these nonelastic stents cannot maintain patency. Wallstents respond to cough with unacceptable changes of length. Nitinol stents have pseudoelastic properties, suggesting optimal capability to adapt to luminal changes with minimal impairment of mucosal perfusion. As epithelialization alters the dynamic properties of all naked metal stents, their feasibility for tracheobronchial application is limited.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Small-cell lung cancer (SCLC) is generally classified as either limited or extensive disease. Recently it has been recommended to use the TNM classification (UICC 1987) when treatment involves local modalities. In the present study, we investigated whether it is possible to stage SCLC according to this TNM classification by the use of chest radiography, bronchoscopy, and mediastinoscopy. Twenty patients defined as having limited-stage SCLC were randomly selected of a series of 199 patients treated in a randomized prospective trial. In 30% of the patients the tumor size and presence of regional hilus and mediastinal lymph nodes could not be assessed by the use of chest radiographs. Also, it was not possible to evaluate tumor invasion into neighboring structures in any of these patients, and a T-stage classification was possible only if these evaluation problems were not taken into account. The T-stage is therefore likely underestimated in some of the patients classified as T1/T2. By the use of radiologic examination, 15% were classified as NO. 30% as N1, 25% as N2 + N3, and 30% as NX. By the use of mediastinoscopy, 70% were classified as NO, and 30% as N-positive. Agreement between staging of lymph nodes by radiography and staging by mediastinoscopy was obtained in only 40% of the patients. Staging of patients with SCLC strictly according to the TNM classification is not possible based on chest radiography and bronchomediastinoscopy. Using computed tomography and magnetic resonance imaging scanning will not solve the staging problems, as they also have limitations in assessing tumor invasion as well as hilar and mediastinal lymph node involvement. Therefore, further advances in staging techniques are needed.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Restoration of tracheal continuity following an extensive circumferential resection is an ongoing problem, especially in cases where direct approximation of the cut ends is impossible. In the present study, we succeeded in restoring tracheal continuity in dogs, using autogenous main bronchus as a substitute conduit. There were no signs of rejection, stenosis, or necrotic disruption of the transplanted bronchus, and bronchoscopic and roentgenographic studies during follow-up examinations revealed no abnormal granulation formation at the suture lines. At schedules intervals, the dogs were killed and pathological studies of resected specimens confirmed these observations. Excellent incorporation between the transplanted bronchus and the trachea was confirmed by pathological examination. Hydrogen clearance analyses indicated that blood flow to the transplanted main bronchus resumed as early as I month after transplantation. The recent advances in tracheobronchioplastic technique may allow the present method to become a reliable alternative for restoration of tracheal continuity following tracheal resection.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

For bronchoscopic procedures in intubated infants, an external channel was attached to an ultrathin flexible bronchoscope without a built-in channel. This modified bronchoscope can be passed through a tracheal tube of 3.5-mm internal diameter and retains adequate flexibility. Thirty-seven bronchoscopic procedures including bronchial suctioning, bronchoalveolar lavage, and drug injection were performed for nine intubated infants; indications for bronchoscopy were bronchial bleeding (n = 4), tracheobronchomalacia (n = 4), pneumonia (n = 4), and atelectasis (n = 2). Bronchoscopic suctioning, which was safely performed under simultaneous ventilatory assist, significantly contributed to airway cleaning. In two cases with atelectasis, full reexpansion of the collapsed lobe was achieved immediately after bronchial toilet. In all four cases with pneumonia, specific pathogens were detected from bronchoalveolar lavage fluid. No complications were noted. We concluded that this modified ultrathin flexible bronchoscope is a safe and useful tool for airway management in intubated infants.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Our objectives were (a) to determine if routinely sending bronchoscopic biopsy (BB) for histopathology (HP) and tissue culture (CUL) increases the diagnostic yield over that obtained by bronchoalveolar lavage (BAD) and protected specimen brush (PSB), (b) to identify subsets of patients who benefit from BB (CUL), and (c) to assess the morbidity associated with BB for suspected lower respiratory infection. We used a prospective design in a single tertiary care center. Our study patients were consecutive (N= 45) inpatients or outpatients with presumed lower respiratory infection in whom a BAL. PSB, and BB were planned as the standard of care. BAL, PSB, and BB specimens were obtained from each patient by flexible bronchoscopy. The initial two BB pieces were sent for BB (CUL) and subsequent specimens (three to six) were sent for routine BB (HP) analysis. Infectious pneumonia was identified in 34 (76%) study patients. Pathogens identified were cytomegalovirus (10), bacterial (10),Pneumocystis carinii(9), mycobacterial (3), fungi (1), and respiratory syncytial virus (1). BB (CUL) solely identified only one additional pathogen. However, BB (HP) provided additional diagnostic information over BAL and PSB in 13 of 45 (29%) patients. The addition of BB (HP) to BAL and PSB significantly increased the yield for making a specific diagnosis (either infectious or noninfectious) compared to BAL and PSB alone (p< 0.004). BB (HP) increased the diagnostic yield among patients with diffuse pulmonary infiltrates (p= 0.03). Pneumothorax (N= 3) and mild bleeding (N= 3) were the complications of biopsy. Our conclusions were as follows: (a) BB (HP) in addition to BAL and PSB significantly increased the likelihood for making a specific diagnosis (infectious or noninfectious) compared to BAL and PSB alone, especially among patients with diffuse pulmonary infiltrates: (b) routine CUL of BB had a limited incremental yield; and (c) sending BB routinely for both CUL and HP may be associated with a slight increase in morbidity.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We present a patient who developed endobronchial mucormycosis and probable dissemination despite prophylactic fluconazole. Fluconazole prophylaxis in acute leukemia patients with chemotherapy-induced neutropenia has become common. The emergence of fluconazole-resistant fungi during fluconazole prophylaxis in neutropenic patients can have important clinical implications.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A pneumomediastinum developed during flexible bronchoscopy with bronchoalveolar lavage (BAL) in a woman suffering from bronchiectasis and suspected neoplasm. To our knowledge, this complication has not been reported previously. The possible pathogenesis of BAL-induced pneumomediastinum is discussed. This complication should be kept in mind when a patient develops chest pain during BAL.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We report the case of a 72-year-old Caucasian male admitted to our hospital because of a 6-month history of hematurias and prostatic syndrome. The urological examination and blood analysis (prostatic specific antigen value, 1,950 ng/ml) and prostate biopsy evidenced the presence of an adenocarcinoma of the prostate. The chest x-ray and the computed tomography scan showed multiple bilateral nodules. A flexible bronchoscopy showed bilateral endobronchial metastases, synchronously affecting both upper lobes, with a positive immunohistochemical reaction to prostatic specific antigen and prostatic specific acid phosphatase in the bronchial biopsy.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID