ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The rigid bronchoscope has been the instrument of choice for removal of tracheobronchial foreign bodies in pediatric patients. Application of the flexible bronchoscope for this purpose is somewhat controversial. We report our experience with six pediatric patients with tracheobronchial foreign bodies, in all of whom foreign bodies were successfully removed using a small-caliber flexible bronchoscope and an ultrathin flexible bronchoscope supplemented with forceps and baskets normally employed for the extraction of ureteral stones. In one child, a straight pin had lodged in the periphery of the right middle lobe. Flexible bronchoscopy and ureteral stone forceps were used under fluoroscopic guidance to extract the straight pin. We believe that this approach alleviated the need for thoracotomy and should be considered in the removal of any small foreign object in the distal bronchial tree. There were no complications associated with any of the procedures. In selected patients, flexible bronchoscopic removal of even large foreign bodies is feasible provided that the bronchoscopist is prepared to manage potential complications associated with the procedure and successfully employ the rigid bronchoscope if the flexible bronchoscopic technique fails.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To determine the effectiveness of brachytherapy in the treatment of obstructive bronchial cancers, high-dose rate brachytherapy was performed on 150 occasions using a MicroSelectron delivering 15 Gy at 1.0 cm from the source axis in a single fraction. Of these treatments, 129 were available for retrospective assessment: 30 patients had predominantly endobronchial or intrinsic cancer, and 99 had predominantly submucosal/peribronchial cancer. Eighty-four percent of the patients treated had primary lung cancer; 57% of the patients had recurrent cancer following previous palliative radiotherapy and 9% following previous radical radiotherapy. Each patient was assessed prior to brachytherapy, and a follow-up assessment was attempted 4 to 6 weeks after treatment. Of the patients with intrinsic lesions, approximately 70% had symptomatic improvement; 33% had objective improvement (spirometry, arterial Po2, or atelectasis). All of the patients who underwent bronchoscopy after brachytherapy had a reduction in bronchial obstruction. Of the patients with extrinsic lesions, approximately 50% had an improvement in dyspnea and cough, but 85% had a reduction of hemoptysis. Objective improvement was seen in only approximately 20%. Thirty-six patients had con-current external radiation but not in a controlled, randomized manner. They achieved similar benefits, with no apparent increased complications. Fatal hemoptysis occurred in five patients, but whether this was a complication of treatment or a feature of the natural history is not possible to discern. Endobronchial brachytherapy given in this manner achieves palliation in a significant portion of patients. The results are comparable to those reported by others for Nd:YAG laser therapy. Of interest, some of our patients with submucosal or peribronchial tumors that would not usually be amenable to laser therapy appear to benefit from endobronchial brachytherapy.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Between April 1982 and March 1993, 1,585 patients with significant symptoms of malignant airway obstruction were treated with 2,253 tracheobronchial neodymium (Nd):YAG laser resections performed by the first author only: 1,274 (78%) patients had non-small cell lung cancers, 91 (6%) small cell lung cancers, 105 (7%) metastatic tumors, 61 (4%) rare malignant tumors, and 81 (5%) unclassifiable carcinomas. More than 90% of the Nd:YAG laser resections were performed with rigid bronchoscopy under general anesthesia (sedation plus analgesia with spontaneous ventilation). Almost all the cases (93%) showed immediate good results based on clinical, radiological, and endoscopic follow-up. Rapid regrowth of tumor is the major limitation; in our series the median time between the first and the second treatment was 100 days. Complications have been few to date: 18 hemorrhages, 6 pneumothoraxes, and 10 deaths. The mortality rate was 0.44%. Although laser resection is a palliative treatment, since 1983 we have treated 19 carcinomas in situ and none has recurred. This is also the case for some early endoluminal metastases. Finally, 17 patients with bronchogenic carcinoma that seemed inoperable did have surgery after laser therapy and another 21 underwent less extensive surgery than initially planned. Nd:YAG laser photoresection, in experienced hands, can be used safely and successfully to open airways obstructed by tumor growth while controlling bleeding. Its primary use is in the trachea and in the main bronchi.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We studied the feasibility of using selective bronchography with a newly developed isoosmolar water-soluble contrast medium (iotrolan 300) via the flexible bronchoscope to assess the nature of a focal lung opacity (FLO). The procedure was performed in 20 patients (mean age, 65.8 years) with a FLO (mean diameter, 2.5 cm) using a mean of 14.5 ml iotrolan 300. Spot films were taken throughout the administration of iotrolan at a rate of 2 films/s using a 100-mm camera. Bronchial carcinoma (seven cases) produced amputation, irregular narrowing, and underfilling of the air passages within the lesion. Hamartoma (two cases) caused only displacement of the adjacent bronchi. The main air passage within an organized pneumonia (one case) remained patent, with a normal caliber. Round atelectasis was diagnosed by the bron-chogram in one case. Seven cases with a subpleural FLO (three granuloma, two bronchial carcinoma, one lung secondary, and one lung infarction) did not display obvious diagnostic bronchographic features. In two cases the bronchial tree of the relevant lung segment was not visualized It is feasible to use bronchography with iotrolan 300 to evaluate the nature of a FLO related to the main subsegmental divisions of the bronchial tree. The subpleural opacities are difficult to assess by this technique.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

One of the major drawbacks of the transbronchial needle biopsy is its technical difficulty. It is very difficult to penetrate the bronchial wall with an 18-gauge needle, even with a protruded 21-gauge inner needle functioning as a trocar. The recommended core biopsy technique of repetitive partial withdraw of the 18-gauge needle in and out of the lesion under suction is even more cumbersome. To improve or simplify the technique, two new -kinds of needles were compared with the original 18-gauge, regular-wall, dual histology needle (MW-418). In one new needle, the distal two-thirds of the 18-gauge needle is reduced to 19-gauge (MW-418DW). The other new needle is reduced to 19-gauge in total length and made retractable (MW-319) (Mill-Rose Laboratories, Mentor, OH, U.S.A.). All three needles still have the same inner lumen, which holds a 21-gauge needle. In the first group of 10 consecutive patients studied, the most prominent mediastinal or hilar sites were aspirated once or twice with each needle. Thirty total specimens were analyzed. Specific diagnosis was made in eight patients (seven cancer, one sarcoid). The best diagnostic specimens were obtained in three patients with the MW-319, three patients with the MW-418, and two patients with the MW-418-DW needle. In the second group of 10 patients, the retractable histology needle (MW-319) and fixed histology needle (MW-418) were compared. Specific diagnostic specimens were obtained in six patients (four cancer, two sarcoid). The retractable histology needle obtained better specimens in four patients and compared favorably to the fixed histology needle. This study indicates that reducing the external diameter of the 18-gauge needle to 19-gauge makes the procedure easier, and the retractable histology needle is more efficient.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Important in the endoscopic management of the main airway stenosis is the implantation of a tracheobronchial stent. We modified the original insertion technique for a silicone stent, replacing the rigid bronchoscope with the flexible bronchoscope. Thirty-eight patients with main airway (trachea and main bronchus) stenosis were treated with silicone stent implantation. The causes of stenosis were malignant tumor (17 cases), post-intubational stenosis (19 cases), and substernal goiter (2 cases). Stent insertion with the flexible bronchoscope was performed under local anesthesia. In 25 cases implantation was preceded by either mechanical dilatation or Nd:YAG laser photocoagulation. In nine cases, we had to remove the stent because of displacement. During the follow-up time (mean, 5.00 ± 5.10 months), the patients with nontumorous stenosis showed an excellent clinical and functional improvement in ventilation. In this group two patients died. However, the cause of death was not related to stent implantation. In the group with malignant disease, we achieved a temporary improvement in ventilation (mean follow-up time, 3.44 ± 3.58 months). In patients with main airway stenosis, a silicone endobronchial prosthesis can be inserted with the flexible bronchoscope. Replacing the rigid with the flexible bronchoscope makes this implantation technique widely available.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Extrinsic trachea] compression causing dyspnea is often investigated via bronchoscopy. We present the clinical features and discuss the pathophysiology of an unusual case of acute extrinsic tracheal compression caused by a dilated esophagogastric remnant 2 years following esophagastrectomy. In this case, bronchoscopy and gastrointestinal endoscopy proved to be lifesaving components of therapy.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID