ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract: Objectives: The objectives of this study were to clarify the usefulness of three-dimensional (3D) bronchial images by spiral computed tomography (CT) in tracheobronchial stent therapy. Five patients with tracheobronchial stenosis caused by lung neoplasms were examined with spinal CT before and after Dumon stent placement. Design: Retrospectively we compared the 3D bronchial images of the patients with bronchoscopic findings, conventional brochography, and conventional CT images. Results: The 3D bronchial images provided information concerning the poststenotic airway where the bronchoscope cannot reach. We could obtain an optimal viewpoint with 3D bronchial images simulating the bronchoscopic view of the tracheobronchial tree described as “virtual bron-chography.” This technique detected abnormalities of the airway before and after stent placement more precisely than the other modalities, although only bronchoscopy can provide a sample for histologic diagnosis. Conventional CT images had an advantage of displaying relationships between the lesion and surrounding structures. Conclusion: We concluded that spiral CT to obtain 3D bronchial images can completely replace conventional bronchography and contribute toward planning and evaluating stent therapy, together with flexible bronchoscopy and conventional CT.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Airway tuberculosis (TB) can result in luminal stenosis presenting months to years after completing antitubereulous therapy. Diagnosis can be difficult, and the first presentation could be an airway disaster. We analyzed the role of interventional bronchoscopy as an alternative to surgery in the management of severe airway stenosis from past TB. We reviewed the charts of seven patients, including three men and four women, who underwent bronchoscopic procedures for residual severe stenosis from TB diagnosed at a mean of 7.2 years (SD 8.2) earlier. The mean age at presentation of airway obstruction was 48 years (SD 12.5). Symptoms included cough (7), progressive dyspnea (7), and recurrent infections (3). A total of 11 lesions were detected in the trachea and the left main bronchus on bronchoscopy. All patients had at least 1 critical lesion with mean occlusion of 88% (SD 8.8) and mean length of 37 mm (SD 20.2). Out of the 11 lesions, severe tracheobronchomalacia was present in 7, and the airway was severely distorted in 6. Fibrosis was consistently present in all cases. All patients had dilatation with the balloon and the rigid bronchoscope followed by stenting, except for one patient who refused stenting and had dilatation performed via the flexible broncho scope. Nd-YAG laser was used in four out of the nine procedures. A total of nine silicone stents were easily deployed. Complications included bleeding (<100 mL) in three and transient hypoxia in one. Mean follow-up duration was 13.3 months (SD 8.7). Improvement in airway patency, symptoms, radiographic abnormalities, and spirometry were documented. Two patients had stent migration, and one had an associated granuloma. Mucous plugging occurred in one stent. Dilatation with the balloon and rigid tube, laser photoresection, and stenting are bronchoscopic techniques available for the treatment of tuberculous airway stenosis. Each technique is complimentary in yielding a better outcome of re-establishing luminal patency.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The great variability of the segmental bronchial branches has been confirmed. The pattern of standard bronchial nomenclature was found in only 954 (26.9%) among 3,540 explored individuals. The importance of uniform nomenclature in bronchology is stressed. The presence of bronchial variants make accurate the endoscopic diagnosis, therefore, they must be reported properly to ensure complete bronchial anatomical information.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There is general consensus that the optimal definitive treatment for severe essential hyperhidrosis (EH) in adults consists of (video-assisted) thoracoscopic ablation of the upper thoracic sympathetic ganglia T2 (and T3). Little is known about the definitive treatment of severe EH in children. The objective of this study is to compare a simplified minimally invasive thoracoscopic T2-T3 sympathicolysis technique (TS), performed by a pneumologist, in children and adults suffering from severe EH. Two hundred consecutive patients with severe EH. treated from August 1993 to August 1997, including 18 children (13.2 ± 2 years, range 7 to 15 years) and 182 adults (30.4 ± 10.8 years, range 16 to 67 years), were included in the study. Clinical efficacy, side effects, complications, and patient satisfaction were assessed in the group of children and adults, respectively. TS was proven equally effective in children as in adults (100% vs. 98% relief of palmar hyperhidrosis, respectively; 0% vs. 2% recurrence during a follow-up of 19 ± 12 vs. 18 ± 13 months), with a comparable incidence of side effects, a total absence of major complications, and 100% patient satisfaction. These results are better than historical data obtained after open surgical approaches and equal to those obtained by a (slightly more complicated) video-assisted thoracic surgery method using lasers. We conclude that TS is as safe and efficient in children with severe EH as in adults.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A procedure for bronehoscopy using bilateral superior laryngeal nerve blockade (BSLNB) associated with topical anesthesia of the trachea by transcricothyroid membrane puncture is presented. A prospective study of 163 patients (120 men and 43 women) having bronchoscopic examination for diagnostic or follow-up purposes was conducted over a 2-year period. One hundred twenty-eight examinations were performed with a flexible bronchoscope and 28 with a rigid bronchoscope; the other 7 patients had simultaneously both rigid and flexible bronchoscopy. Results provided from separate evaluations by the patient and the endoscopist were ranked in an analog-visual scale ranging from 0 to 10 and classified as poor (0 to 3). tolerable (4 to 6). good (6 to 8), and very good (9 to 10) according to the patients' tolerance and the level of difficulty encountered by the examiner. Bronchoscopy was successfully performed in all patients, although in 2 flexible bronchoscopies (1.2%) supplemental anesthesia with a 10% lidocaine spray into the oropharynx was required. Procedures, when evaluated by patients, were considered poor (2%). tolerable (11%). good (76%), and very good (11%). whereas the endoscopists' respective evaluations were 2.5%. 7%. 19%, 70.5%. Few complications such as small (less than 1 mL) punctiform tracheal bleeding and local hematomas were observed in 3% and 1.2%, respectively, whereas some patients complained of dysphagia (33%) and hoarseness (5%). which stopped after disappearance of anesthetic effects. We therefore conclude that BSLNB is safely achieved by this alternative procedure, technically easy to perform, and rapid, comfortable, and satisfying for both patients and endoscopists.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 32-year-old man with a history of recurrent epistaxis since childhood, microscopic hematuria, and a nodular lesion on chest radiograph presented with chest pain and dyspnea after chest trauma. Right hemothorax was detected on chest radiograph. Chest tube insertion was performed with an overall drainage of 700 mL of blood. Because of the persistence of a homogenous radio-opacity at the right lower hemithorax on the chest radiograph, he was referred to our pulmonary medicine department. On admission, physical examination showed dullness and absence of respiratory sounds at the lower third of right hemithorax. Laboratory findings showed mild anemia and hypoxemia of 57 mmHg. Chest radiograph showed a homogenous radio-opacity at the lower third of the right hemithorax, and a nodular lesion, 3.5 cm in diameter, projected over the upper border of the radio-opacity. No endobronchial lesion was observed under bronchoscopic examination. Computed tomography scan of the thorax showed a parenchymal nodular lesion at the right lower lobe and right pleural effusion.Because the nodular lesion was interpreted as a possible arte-riovenous malformation (AVM), the diagnosis of Rendu-Osler-Weber disease was considered. The patient underwent a right lateral thoracotomy. Organized right subpulmonic hemothorax, pleural thickening, and an AVM at the anterobasal segment were detected. A pathologic report described AVM with recanalized thrombosis and multiple intraparenchymal and intrapleural telangiectasias, with evidence of rupture. Rupture of pleural telangiectasias is an extremely rare cause of hemothorax; however, it must be considered when a patient with a history of bleeding or an AVM presents with hemothorax.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Atelectasis of an entire lung usually occurs in association with occlusion of a main bronchus by bronchogenic carcinoma, mucous plugging, and rarely by benign tumor or aspirated foreign body. The mucous plugging in nonintubated patients often occurs in a setting of impairment of ventilatory function, for example, in those with chronic bronchitis during the postoperative period or neuromuscular disorders. This article describes what appears to be a first-reported case of mucoid impaction of the entire main bronchus in a previously healthy patient. A 43-year-old woman presented with atelectasis of the left lung caused by obstruction of the left main bronchus by necrotic mucoid lesion. A correct diagnosis unsuspected initially was established after the lesion was removed using a rigid bronchoscope. A fungal culture showed heavy growth of Cladosporium cladosporioides, a fungus not previously known to precipitate pulmonary disease.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 48-year-old woman presented with dyspnea and complete atelectasis of the left lung. Flexible bronchoscopy showed a polypoid tumor totally occluding the left main bronchus. Nd-YAG laser photoresection was performed, and the tumor was histochemically proved to be a granulocytic sarcoma. Radiotherapy was administered, and a complete resolution was attained. Subsequent examination of the peripheral blood and bone marrow smears showed no evidence of leukemia.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID