ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Healthy volunteers undergo flexible bronchoscopy in our laboratory during investigation into the mechanisms of lung injury after inhalational exposure to environmental agents, including ozone, nitrogen oxides, acidic aerosols, sulfur dioxide, air pollution particles, and in the absence of any exposure to obtain normal respiratory tract cells. One or more bronchoscopy-associated methods (bronchoalveolar lavage, brush biopsy, and endobronchial forceps biopsy) are included in the procedure. An absence of serious complications resulting from the procedure is clearly required for such studies to be pursued. However, the first death of a healthy volunteer undergoing investigative bronchoscopy has been reported recently in the public press and attributed to lidocaine toxicity. This impelled us to review our experience in 736 healthy volunteers. Significant complications have occurred in six of these subjects (0.8%) including fever (n = 5), pneumonia (n = 4), and chest pain (n = 1). We elected to continue our present protocol. With an emphasis on eliminating complications resulting from anesthesia, we suggest that the total dose of lidocaine instilled through the bronchoscope during the procedure not exceed 300 mg and that no sedative or narcotic be used. In addition, we recommend that no endotracheal tube be used and the introduction of the bronchoscope be transnasal. In our experience, this approach reduces the requirement for topical anesthesia compared with using an endotracheal tube and the transoral route.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Seventy-six patients (mean age. 64 years) with chest radiographs suggestive of lung cancer and with evidence of mediastinal adenopathy on computed tomography (CT) underwent bronchoscopy with bronchoscopic needle aspiration (BNA) of the affected mediastinal nodes. Patients with meta-static disease or other findings suggesting nonresectability were excluded from the study. Cytologic examination of BNA was positive for malignancy in 72% of patients (55/76). BNA of subcarinal nodes was positive in 74% of patients (41/55), and BNA of paratracheal nodes was positive in 67% of patients (14/21). BNA was positive in 82% of patients (49/56) whose main carina or trachea appeared abnormal on bronchoscopy, and was positive in 45% of patients (9/20) who, under bronchoscopic examination, had a normal main carina and trachea. Of 21 patients with negative BNA cytology, 10 patients had nonsmall-cell carcinoma. Those individuals underwent further surgical staging, establishing that eight aspirates were false negative and two aspirates were true negative. The sensitivity of BNA in patients with nonsmall-cell carcinoma was 78%, considering all positive aspirates as true positive. No serious complications were observed. In conclusion, BNA of the mediastinal nodes is a safe and valuable staging procedure in patients with lung cancer and evidence of mediastinal adenopathy on chest CT.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Premedication with ipratropium bromide has been reported to prevent broncho-constriction during bronchoscopy, but the potential benefits of this treatment have not been fully investigated. Thus we studied the effects of inhaled ipratropium bromide on the ease, acceptability, and complications of bronchoscopy in a randomized, placebo-controlled, double-blind study of 28 elderly male veterans. None of the patients developed tachycardia, tachyarrhythmias, oxygen desaturation, or wheezing during bronchoscopy. Premedication with ipratropium did not alter significantly the incidence of elevations in blood pressure or cough requiring interruption of the procedure, nor did it affect the total amounts of sedatives or lidocaine used during the procedure. Patient comfort during the bronchoscopy was perceived by the “blinded” physicians and nurses to be similar between ipratropium-and placebo-treated groups, and the bronchoscopists rated the procedures to be equally easy to perform in all subjects. However, patients receiving inhaled ipratropium were significantly less willing to repeat bronchoscopy, even if clinically indicated, and tended to regard the procedure as less comfortable, compared with patients receiving saline placebo. Thus we conclude that routine premedication with inhaled ipratropium bromide before bronchoscopy cannot be recommended.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Exogenous aspiration of lipids into the pulmonary alveoli may lead to lipoid pneumonia. We report three patients with exogenous lipoid pneumonia, each of whom was diagnosed via bronchoscopy. In the first two patients the development of lipoid pneumonia followed consumption of Vaseline as a laxative. Chest roentgenograms were abnormal and bronchoscopy with bronchoscopic lung biopsy (BLB) demonstrated lipoid pneumonia. The third patient, who complained of chest pain, underwent chest roentgenography and was found to have subtle infiltrates in the right upper lobe. A month later she developed right pleural effusion. It became evident that she had been using oil-based nasal drops and spray for rhinitis. A bronchoalveolar lavage demonstrated Sudan-positive macrophages and BLB exhibited necrotizing granulomas. We suggest that in patients with lipoid pneumonia, simple bronchoalveolar lavage is not enough to identify the disease. BLB is more likely to effect a correct diagnosis. Suspicion of the possibility of lipoid pneumonia will enable the clinician to establish the diagnosis.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A 27-year-old woman with advanced relapsing polychondritis and severe tracheobronchial obstruction underwent successful removal of Wallstent-associated granulation tissue using the argon plasma coagulator. Patency of the left and right distal bronchi was restored without risk of damaging the structural integrity of the metal stents themselves. The argon plasma coagulator allows monopolar, noncontact application of a controllable high-frequency electrical current for coagulation and desiccation of inflamed, fibrous scar and granulation tissue. Using the proper technique, bronchoscopic applications are safe and effective. This instrument warrants further consideration for inclusion in the therapeutic armamentarium of the interventional pulmonologist.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The covered Wallstent has been investigated extensively in a setting of malignant obstruction of the esophagus. Many of these patients had successful stent placement with improvement in dysphagia and quality of life. Metallic stents, however, have serious attendant morbidity and mortality, and after they are fully deployed they are virtually impossible to remove. When esophageal stents are used, particularly when positioned in the cervical esophagus, possible obstruction of the trachea must be considered because of close proximity of the structures at this level. A perforation of the trachea by a nonremovable esophageal device is a rare but potentially disastrous complication. Placement of an airway stent provides a treatment option in situations of airway compromise by esophageal device. The following report describes two patients with organ perforation and trachea compression following Wallstent insertion.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Fire within an endotracheal tube is a dangerous complication of carbon dioxide laser therapy. Safe use of laser therapy requires special knowledge about currently available endotracheal tubes and the management of an airway fire. We present an unusual case of ignition at the level of the endotracheal tube shaft, and review potential causes and prevention strategies for this complication. Flexible bronchoscopy is invaluable in monitoring and treating this complication.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A 67-year-old man, with a 9-year history of chronic obstructive pulmonary disease and treated with bronchodilators and intermittent corticosteroids, was admitted to our medical center for acute hypercapnic respiratory failure requiring mechanical ventilation. A bronchoscopy was performed because of two episodes of unexplained acute carbon dioxide retention. Bronchoscopy showed narrowing and collapse of the distal trachea, and narrowing of the right and left main stem bronchi with mucosal protrusion. The appearance of the mucosa of the distal trachea and bronchi suggested chronic inflammation. The mucosal biopsies showed chronic inflammation and squamous metaplasia. A diagnosis of idiopathic tracheobronchomalacia was made and he was referred for tracheobronchial stent placement. Four months after placement of tracheal silastic stents his spirometry showed an increase in forced expiratory volume, 1 second, from 0.72 to 2.26 L, and an increase in forced vital capacity from 1.31 to 3.49 L.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID