ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Recent studies have used intermittent determinations of arterial blood gases (ABGs) to characterize gas exchange during flexible fiberoptic bronchoscopy (FFB). This study evaluated the extent and rapidity of gas exchange alterations during FFB using continuous intraarterial blood gas (CIABG) monitoring. Ten mechanically ventilated, critically ill patients with CIABG probes were studied. All patients received sedation and muscle relaxation for the procedure. ABG measurements were made at 20-s intervals. Alterations in oxygenation and ventilation occurred almost immediately with insertion and removal of the bronchoscope. Mean Pao2decreased 10%, however there was marked inter individual variation. Mean Paco2increased 21.9%. Alterations in gas exchange, especially Paco2, were largely related to the length of time the bronchoscope was continuously in place within the tracheo bronchial tree. CIABG monitoring confirms previous studies of gas exchange during FFB and reinforces the importance of vigilant patient monitoring, expeditious performance of the procedure, and frequent breaks in the procedure to allow normalization of oxygenation and ventilation in high-risk patients.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

From November 1991 to May 1995, at the National Cancer Institute in Milan, 98 patients with lung tumors underwent esophageal endoscopic ultrasonography (EUS) to evaluate mediastinal lymph nodes (group 1 = 93 patients) or to assess mediastinal invasion affecting therapeutic decision (Group 2 = 5 patients). Regarding lymph node metastases, a prospective study in 65 consecutive patients, who were not expected to show large lymph nodes owing to inclusion criteria, demonstrated EUS accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as high as 76.3%, 42.3%, 85.9%, 45.8%, and 84.0%, respectively. Another subgroup of patients (N = 28) with benign or malignant lung disease required EUS as a further diagnostic investigation when conventional radiology was inconclusive on mediastinal nodal status. Results for malignancies were as follows: accuracy 62.8%, sensitivity 33.3%, specificity 85%, PPV 62.5%, and NPV 62.9%. In all patients included in group 2, EUS correctly assessed the presence or absence of local infiltration. Our data suggest that EUS should be performed to complete pre-operative staging of lung cancer, because it showed good results in determining both local spread of tumor and lymph node involvement, for which EUS was highly specific.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This study assessed the clinical and endoscopic findings of bronchial anastomotic complications after lung transplantation. A total of 33 bronchial anastomotic complications occurred in 23 (32%) of 71 lung transplant recipients during a 4-year period of study. Surgical technique, endoscopic patterns, and mortality were reviewed retrospectively. Dehiscence was the most common anastomotic complication (18 episodes in 15 patients), followed by severe stenosis (n = 11) and anastomotic infection (n = 4;Aspergillusin three and cytomegalovirus in one). Dehiscence occurred with equal frequency in end-to-end anastomoses [10 (17%) of 59] as compared with telescoped anastomoses [8 (26%) of 31; p = NS]. However, all three instances of fatal dehiscence occurred in the end-to-end anastomosis group. Severe stenosis occurred more commonly in telescoped anastomoses [9 (29%) of 31] than in end-to-end anastomoses [2 (3%) of 59; p < 0.001]. Each of the seven instances of severe stenosis after dehiscence occurred in the telescoped anastomosis group. The lowest incidence of dehiscence [1 (7%) of 15] and severe stenosis (0 of 15) was seen in the subgroup of end-to-end anastomoses buttressed with pericardium, but the limited number of such anastomoses did not achieve statistical significance for comparisons. Airway dehiscence and severe stenosis remain important clinical problems after lung transplantation. Although the telescoped anastomosis appears to protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared with the end-to-end anastomosis, and the incidence of severe stenosis is significantly higher.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Tracheobronchomegaly, also known as Mounier-Kuhn syndrome, is an uncommon disorder of the tracheobronchial tree. The etiology remains unknown. Clinically, the disease is characterized by marked dilatation of the trachea and main bronchi, and complications including bronchiectasis and recurrent lower respiratory tract infections. Herein, we describe a patient who presented with tracheobronchomegaly complicated by chronic cough, scanty hemoptysis, and respiratory failure requiring ventilatory support.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A foreign body lodged in the tracheobronchial tree can be removed using the rigid or flexible broncho-scope. A variety of catheters and forceps have been designed for this purpose, each using different techniques. We describe a simple technique, applicable if the foreign body has a lumen. An alligator forceps is threaded through the lumen of the foreign body and opened distally to anchor the foreign body between the open jaws of the forceps and the tip of the flexible bronchoscope. The flexible bronchoscope, forceps, and the foreign body are then removed simultaneously as a single unit.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We present a patient with a particularly slowly growing tracheal lipoma characterized by stable respiratory symptoms for 15 years. The tumor was removed by rigid bronchoscopy after an episode of upper airway obstruction. Our report emphasizes the role of this approach for management of benign tracheal tumors.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Tracheobronchial stenosis can arise as a congenital disorder with other associated abnormalities in infants, but it may also occur as an acquired lesion secondary to prolonged intubation and other factors. We report the preoperative radiologic and bronchofiberscopic findings of bronchial narrowing associated with cardiovascular disease in adults. In the past 2-years, 22 patients with thoracic aortic aneurysm (TAA) and one adult with patent ductus arteriosus (PDA) were admitted to our department. These 23 patients were examined preoperatively by computed tomography (CT) and magnetic resonance imaging (MRI) for evaluation of the hemodynamic condition. Of these patients, seven were found to have bronchial narrowing associated with TAA or pulmonary artery dilation caused by PDA and were examined by broncho-fiberscopy (BFS) preoperatively. In another 16 of these 23 patients, mild bronchial compression was detected retrospectively. Bronchial narrowing was evident with BFS in the left main bronchus in three of the seven patients, in the orifice of the left lower lobe bronchus in two, and in the orifice of the left superior segment bronchus (B6) in two. Preoperative CT or MRI indicated bronchial narrowing, which was clear in two of the seven cases and probable in five cases. Of these seven cases, four patients had postoperative respiratory complications (atelectasis and/ or pneumonia). We conclude that clinicians must be aware, preoperatively, of the possibility of existence of bronchial narrowing due to compression by a dilated large blood vessel.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID