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:

Brush specimens are one of several methods for establishing a diagnosis of lung cancer at the time of flexible bronchoscopy. Two acceptable methods of retrieving the brush cytology specimen are to withdraw the brush through the working channel of the bronchoscope and to withdraw the brush and bronchoscope as a unit, with the brush protruding through the distal tip of the bronchoscope. In this prospective study 53 patients with proven primary bronchogenic carcinoma underwent bronchoscopy by one senior staff pulmonary physician; there were 32 patients with peripheral tumors and 21 patients with central tumors. The sequence of sampling (withdrawn or nonwithdrawn) was assigned randomly. The specimens were interpreted by one cytopathologist in a blinded fashion and scored for both cellularity (1–4 according to the density of cells and number of quadrants involved) and presence or absence of recognizable malignant cells. Cellular yield was significantly greater for nonwithdrawn brushes [difference = 1.43 ± 1.21 for central tumors (p< 0.001), and difference = 0.65 ± 1.26 for peripheral tumors (p< 0.01)]. Malignant cells were identified in 66.7% (14/21) of withdrawn versus 71.4% (15/21) of nonwithdrawn brushes (p> 0.25; McNemar's test for matched pairs) for the central tumors. Malignant cells were identified in 53.1% (17/32) of withdrawn brushes versus 59.4% (19/32) or nonwithdrawn brushes (p> 0.25) for the peripheral tumors. This lack of a statistically significant difference could be the result of a type 2 error (inadequate sample size to detect a true difference). There were qualitative differences in the cellular preservation and nuclear details in favor of the nonwithdrawn brush specimens. We conclude, however, that withdrawing the brush through the bronchoscope decreases the cellularity of the specimen, but it does not affect the diagnostic accuracy for malignancy in either central or peripheral tumors.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Stridor is a common problem in infants and young children. While there is a variety of causes for childhood stridor, the most common is dynamic airway collapse. The purpose of this study was to determine if the incidence of surgically correctable lesions was high enough to warrant flexible bronchoscopy in all children with stridor. We reviewed the bronchoscopy reports of all children undergoing flexible bronchoscopy by the Pediatric Pulmonary Section at Phoenix Children's Hospital during 1990 and 1991. The analysis of these records provides the basis for this report. Two hundred twenty-seven flexible bronchoscopic procedures were performed in this 2-year time span, 64 primarily to evaluate stridor in 63 children. The children ranged in age from 7 days to 12 years; the mean age was 10.7 months, with a median age of 4 months. Dynamic airway collapse was the sole etiology of the stridor in 65% (41/63). Fourteen percent (9/63) had prominent dynamic airway collapse in addition to another lesion. Twenty percent (13/63) had a fixed airway lesion without a prominent component of airway collapse. Overall, 23.8% (15/63) of the patients had surgically correctable lesions. There were no serious complications from this procedure. Because of the high incidence of surgically correctable lesions in children with stridor and the low risk of undergoing the procedure, we believe that all children with stridor should be carefully evaluated by an expert in pediatric airway diseases for consideration of flexible bronchoscopy.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Bronchoscopic ultrasonography is a recently introduced technique in the diagnosis of bronchogenic carcinoma. Bronchoscopic brachytherapy is well established as a therapeutic modality in palliative therapy of advanced malignancies of the tracheobronchial tree. In an effort to combine these two modalities, we performed bronchoscopic ultrasonography in 12 patients, in all of whom bronchogenic carcinoma was histologically confirmed, although the cancers were roentgenologically occult. All 12 patients received bronchoscopic brachytherapy, and follow-up evaluations showed complete response in 11. Even though 2 patients died of other causes, the remaining 10 patients are alive at present (for an average of 6.3 months after therapy), without evidence of recurrence or distant metastases. Our experience suggests that bronchoscopic ultrasonography appears promising in the diagnosis of roentgenologically occult and bronchogenic carcinomas. The results of our study also show that in such cases bronchoscopic brachytherapy yields a high rate of therapeutic response.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The results of a questionnaire concerning pediatric bronchoscopy sent to the members of the Japan Society for Bronchology showed that experience with pediatric bronchoscopy was still limited even for accredited bronchoscopy instructors except for bronchoscopists in children's hospitals. Half of them performed pediatric bronchoscopy with flexible instruments, and the methodology was developed individually at each institute by the bronchoscopist. We evaluated the technique and safety of pediatric flexible bronchoscopy (FFB) without intubation based on our experience. A total of 14 FFB procedures without intubation was performed in patients less than 7 years of age. The youngest patient was 29 days old (3,150 g). The indications for FFB included stridor, suspicion of foreign bodies, respiratory infection, and dyspnea. Three types of bronchoscopes (Olympus BF Types P10, 4B2, and 3C10) were used. All examinations were performed under general anesthesia. There were no severe complications during or after procedures. Transnasal insertion of the FFB was felt to be better than transoral insertion because it provided a good stability and easy manipulation. It was not difficult to perform mask ventilation during examination with the BF Type 3C10 inserted into the trachea even in babies only 1 year old. When the larger-diameter instruments (BF Types P10 and 4B2) were used, a 100% oxygen supply through the bronchoscope's channel maintained adequate O2saturation. Our experience suggests that FFB without intubation in pediatric cases is useful and can be performed safely with the help of several special techniques for supporting the FFB.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Photodynamic therapy (PDT) causes selective tumor damage and has been shown to be effective in the treatment of early-stage lung cancer. Thirty patients, with 39 intraluminal cancer lesions, who were considered to be high-risk surgical candidates, were treated with PDT. A complete response after PDT was found in 23 patients (28 lesions), in 20 patients (25 lesions) after the first treatment and in 3 patients after the second treatment. Thirteen complete responders (18 tumors) are still alive, with a median survival of 10 months (range, 2–95 months). Two patients developed subsequent primaries (4 and 40 months), seven had recurrences (2–19 months), and one developed nodal disease. Therefore, the overall long-term success rate of PDT in terms of local control was 46%. Two of the partial responders achieved a complete response after external irradiation; one is still in complete-response status after 52 months. Bronchoscopic evaluation showed that partial responders had tumors located distal to a segmental bronchial bifurcation or in bronchial stumps. Our data suggest that inadequate light delivery or an insufficient light dose may account for treatment failure in this category of patients. Improvement of light dosimetry and better assessment of tumor extension may increase the efficacy of PDT.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

NecrotizingAspergillustracheobronchitis is a recently recognized entity in immunocompromised patients in which deep invasion of the tracheobronchial mucosa with the organism occurs. We report a case of a mildly immunosuppressed patient with this form of infection in whom bronchoscopy with biopsy was complicated by fatal hemorrhage. NecrotizingAspergillustracheobronchitis should be suspected in any patient at risk for invasive pulmonary disease withAspergillusand in whom compatible endobronchial lesions are visualized at bronchoscopy. Due to the risk of hemorrhage, when these conditions are present bronchoscopic biopsy should be performed with caution.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A silicone stent previously implanted into the left main stem bronchus of a patient with bronchogenic carcinoma was dislodged and floated within the trachea. The material was immediately extracted using flexible bronchoscopy alone. The technique that relies on valvuloplasty balloon equipment is described in detail. Given potential hazards of this method, it is only feasible in emergency cases when rigid bronchoscopes and/or general anesthesia are not at hand in due time.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID