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

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Sedation is considered standard care in ambulatory flexible bronchoscopy (FFB) by most pulmonologists. Methods of sedation, however, differ from one center to another. In a prospective randomized study, we compared sedation for FFB provided by alfentanil-propofol (Group A, n = 30) with that provided by meperidine-midazolam (Group B, n = 30). These methods were compared in terms of hemodynamics, frequency of desaturation, bronchoscopist acceptability, and patient comfort. The groups were comparable in terms of patient characteristics, bronchoscopic procedures, and the total duration of the procedure. When compared with presedation values, there was a significant rise in heart rate (mean [with SE] during the procedure (82 [4]-119 [4] beats/min and 91 [3]-126 [4] beats/min) and a significant fall in oxygen saturation (96 [0.6]-90% [1%] and 96 [0.5]-90% [1.3%]), in Groups A and B, respectively. Significant elevations in systolic (142 [5]-180 [9] mmHg) and diastolic (79 [5]-93− [3] mmHg) blood pressures were observed only in patients sedated with meperidinemidazolam. The results of the questionnaire completed by the patients and the bronchoscopist indicated similar levels of satisfaction in each group. We conclude that compared to sedation with alfentanil-propofol, sedation with meperidine-midazolam gives equally good operating conditions, provides comparable levels of patient comfort and satisfaction, produces satisfactory amnesia, and is safe. Because alfentanil-propofol sedation attenuates the blood pressure response to FFB, however, it may be the most appropriate technique for use in patients with known or those at risk for coronary artery disease.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The role of bronchoscopic sampling including bronchoalveolar lavage (BAL) was assessed in patients with clinical symptoms consistent with pneumonia requiring mechanical ventilation. A total of 173 lavages were performed, with 144 patients on prior antibiotic regimens and 53 patients having human immunodeficiency virus (HIV) infection. The overall diagnostic yield was 34% (59 positive samples) with bacterial infection identified in 28 cases,Pneumocystis cariniiin 24 cases, cytomegalovirus in 10 cases, fungal infection in 5 cases, andMycobacterium tuberculosisin 2 cases. Seven patients had more than one pathogen identified. The diagnostic yield was higher in HIV-infected patients than other groups (chi-square = 17.21,P< .001). Prior antibiotics appeared to have no effect on the diagnostic yield. There was no difference in the type or sensitivity patterns of bacteria isolated from immunocompromised (19) versus immunocompetent (9) patients. We compared the bacterial sensitivities versus the American Thoracic Society recommendations for severe nosocomial pneumonia and found that up to one third of bacteria would have been resistant to the proposed treatments. The most common organisms causing failure wereStaphylococcus aureusand Le-gionella (making up 7 of the bacterial isolates). The use of BAL allowed for an accurate diagnosis of pneumonia in more than one third of patients with ventilator-associated pneumonia despite widespread use of antibiotics.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Lobar atelectasis is a common complication of lung disease in patients with cystic fibrosis (CF) that affects the overall prognosis for survival in these patients. Conventional treatment combines aggressive antibiotic therapy with increased chest physiotherapy, bronchodilators, and mucolytic agents. The exact role of flexible bronchoscopy (FFB) with bronchial lavage in the treatment of such complication is still being determined. We evaluated nine patients with CF presenting with lobar atelectasis not resolved by conventional treatment. These patients underwent FFB with bronchial lavage and direct instillation of recombinant human deoxyribonuclease (rhDNase). In patients in whom FFB failed to obtain resolution of atelectasis, a long-term rhDNase inhalation program was started. Five patients showed complete resolution of atelectasis after FFB. In three patients, atelectasis resolved after 5 to 6 months of treatment with rhDNase by inhalation. One patient with end-stage pulmonary disease died a few weeks after FFB without obtaining complete re-expansion of the collapsed lobe. We conclude that our therapeutic regimen of FFB with bronchial lavage and rhDNase instillation followed by long-term rhDNase by inhalation was effective in obtaining reexpansion of lobar collapse in eight of nine patients in whom conventional treatment failed to obtain resolution of atelectasis.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Endobronchial actinomycosis is a rare disease, caused by an anaerobic gram-positive organism, that is often difficult to diagnose. It often occurs after aspiration of material from the mouth. It can mimic the presentation of a tumor-like lesion. Material must be obtained from the deepest portion of tissue involvement because it must be cultured under anaerobic conditions to confirm the diagnosis. High-dose penicillin over a long period is the drug treatment of choice, or clindamycin can be used in cases of penicillin allergy. If medical treatment fails, surgical resection is advisable. We report the occurrence ofActinomyces odontolyticusin association with an aspirated pistachio nutshell.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 19-year-old male with severe lordosis and thoracic kyphosis developed pulmonary edema and respiratory failure after elective oral surgery. Bronchoscopy showed severe distal tracheal stenosis, which was found on computed tomography (CT) to be consistent with extrinsic compression by the posteriorly based upper thoracic vertebral bodies and a narrowed bony thoracic inlet. This is the first case reported in the literature that demonstrates that severe thoracic lordosis may be a potential risk for airway compromise from extrinsic tracheal compression in patients undergoing anesthesia for any surgery.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Erosion of and protrusion into the tracheobronchial tree by esophageal stents is a rare complication; until now, only 3 cases of bronchial erosion in patients with underlying bronchial carcinoma and esophageal tumoral involvement have been published. This is the first report of penetration of the tracheal lumen by a self-expanding metal esophageal stent in a patient with primary esophageal carcinoma.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We report a case of endobronchial hamartoma in a 64-year-old man complaining of productive cough after examination for lung cancer. Bronchoscopy revealed a smooth, round, whitish-yellow polypoid tumor protruding into the right truncus intermedius. Bronchoscopic biopsy specimens suggested endobronchial hamartoma. Therefore, we performed endobronchial resection of the tumor using an electrosurgical snare through a flexible bronchoscope.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID