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

摘要:

Our objective was to examine the morbidity and mortality related to flexible fiberoptic bronchoscopy (FFB) and its associated procedures when performed by supervised trainees. It was a retrospective study of consecutive FFB performed over a 97-month period in a large teaching hospital (Houston Veterans Affairs Medical Center). A total of 3,572 FFB and 6,968 associated procedures were reviewed. Fifty-seven (1.60%) complications developed in 56 patients. Death occurred in six (0.17%) cases. Two patients died from massive bleeding, two had fatal dysrhythmias, and two died of refractory respiratory failure. The most common procedures performed during FFB other than bronchial washings were bronchial brushings (76.7%) and transbronchial biopsies (TBBX, 51.8%). Complications presented in 1.99% of TBBX, mainly pneumothoraces (1.13%) and significant bleeding (0.81%). Endobronchial biopsy (EBBX), brushing, transbronchial needle aspiration (TBNA), broncho-alveolar lavage (BAL), and brachy therapy were associated with complications in < 1% of cases. The low frequency of complications and mortality in this study confirms the notion that FFB is safe in the teaching setting at a large institution. This concept applies to a broad variety of bronchoscopy-associated procedures including TBBX, EBBX, TBNA, BAL, brushing, and brachytherapy.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Hypoxemia is a common complication of flexible bronchoscopy (FFB). This study compares the degree of hypoxemia produced with two approaches to FFB: nebulized lidocaine (NBL) followed by endotracheal tube (ETT) placement, and transcricoid injection of lidocaine (TCL) followed by transnasal insertion of the bronchoscope. A total of 50 patients (49 males; mean age, 48 ± 7.6 years) examined by two practitioners for diagnostic purposes was included in the study. Patients were premedicated with diazepam and atropine sulfate and examined in the supine position. According to the techniques used for local anesthesia and instrument approach, patients were randomly allocated into two groups: NBL/ oral group—27 subjects had NBL followed by peroral passage of the scope through a 9-mm-inner diameter (ID) ETT; and TCL/nasal group—23 subjects had a TCL and perinasal passage of the scope. Arterialized capillary blood from the ear lobe was sampled: (1) 15–30 min prior to FFB, (2) immediately after local anesthesia, (3) during FFB, and (4) 20–30 min after FFB. TCL initially produced more depression of PcO2than NBL, but this trend reversed after introduction of the bronchoscope and continuation of the procedure. Additional lidocaine during the procedure was given to 21 patients in the NBL/oral group, compared to 3 patients in the TCL/nasal group (p< 0.005). PcO2decreased (from 9.5 ± 1.6 to 8.2 ± 1.6 kPa;p< 0.05) during FFB in the NBL/oral group but not in the TCL/nasal group (PcO2= 8.8 ± 1.2 before and 8.6 ± 1.8 kPa during FFB; NS). No significant CO2retention during the procedure was observed in either of the groups. FFB through an orally inserted ETT using nebulized local anesthetic is associated with greater desaturation than nasal FFB with TCL. The technique used for local anesthesia and the amount of fluid applied to the airways may contribute to a greater extent to the development of hypoxemia than the introduction of a 9-mm-ID ETT in the airway.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The occurrence of laryngeal tuberculosis continues to be significant in many countries, and although it is relatively easy to identify when it coexists with pulmonary tuberculosis, it is sometimes misdiagnosed when it is present with other entities. Thirteen cases of laryngeal tuberculosis among 553 new cases seen at the Pulmonary Diseases Department of the General Hospital of Mexico City over a 2-year period are reported, along with their clinical and roentgenological characteristics, the diagnostic approach, and particularly the endoscopic findings. Three of these 13 patients also had tracheobronchial involvement. Various forms of coexisting pulmonary and extrapulmonary tuberculosis were seen. Eleven were confirmed by positive smear or culture. Two patients required surgical treatment owing to laryngeal obstruction.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Total (and differential) cell count of BAL fluids was performed by two different automatic cell analyzers. While a good correlation was obtained between the microscope counts and those obtained with the automatic analyzers, no correlation was obtained in the case of differential counts.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A 74-year-old man with a foreign body in the right upper lobe bronchus developed torsion of the lung. Lung torsion was suspected because of the characteristic findings of a chest radiogram and a discrepancy between bronchoscopic and chest roentgenographic findings. The bronchoscopy showed a foreign body in the right upper lobe bronchus, but chest radiograms disclosed a picture mimicking right middle lobe collapse. Lung torsion was further confirmed by pulmonary angiogram. The foreign body was removed by bronchotomy and the torsionallobe was corrected by surgery. This is the first reported case of lung torsion caused by an intrabronchial foreign body.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We encountered a patient with bronchial lipoma initially manifested by asthmatoid symptoms and discovered because of the findings of pulmonary atelectasis. A 74-year-old man was found to have atelectasis of the left superior segment when examined for exertional dyspnea. The patient had been treated for asthma for 8 years. Bronchoscopic examination revealed a pedunculated tumor obstructing the left superior segmental bronchus. As a result of a biopsy, the tumor was diagnosed as benign bronchial lipoma. High-frequency current excision was attempted first, but failed due to its location and broad base. Laser cautery and ethanol injection into the residual site were subsequently performed. Part of the base of the tumor remained, but the atelectasis disappeared. Subsequently, the dyspnea, cough, and gasping sound of respiration also disappeared. Ninety-six patients with bronchial lipoma, including our patient, have been reported in the English and Japanese literature, and the chief complaints were symptoms due mainly to airway closure or infection secondary to the tumor. Such tumors have frequently been treated by open-chest resection for the purpose of differentiation from malignant diseases as well; but high-frequency current excision and laser cautery are considered sufficient unless malignant findings are observed by frequent biopsies, because of advances in endoscopic surgery.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A 39-year-old man with no history of lung disease presented with massive hemoptysis and was found to have an idiopathic fistula between a bronchial artery and a segmental bronchus. Bleeding was localized by bronchoscopy, and he was successfully treated with bronchial artery embolization. This is a rare case report of a fistulous connection between bronchial artery and bronchus in the absence of significant underlying lung pathology. The causes of massive hemoptysis and their management are reviewed.

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