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:

To test the hypothesis that the presence of severe chronic obstructive pulmonary disease (COPD) increases the incidence of major bronchoscopy-associated complications, 91 patients (101 procedures) with severe airway obstruction were compared with 162 patients (171 procedures) with normal pulmonary function tests. Severe airway obstruction was defined as a FEV,/FVC ratio1< 1 L with a FEV1/FVC ratio of

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The use of bronchoalveolar lavage (BAL) to investigate peripheral bronchogenic carcinomas produces a variable yield and its significance when performed without the aid of fluoroscopy has not been established. To assess the relevance of BAL in the diagnosis of peripheral lung tumors, we prospectively analyzed the outcome of 22 flexible bronchoscopies (FFB) without fluoroscopy in peripheral lung cancer patients. The FFB provided a 45.5% yield. The ancilliary procedures carried out provided the following yields: bronchial lavage, 28.6%; BAL, 36.8%; bronchial brushing, 28.6%; brush lavage, 28.6%; and postbrushing bronchial lavage, 31.2%. The diagnostic yield from BAL was not statistically better than that of the other procedures. The highest yield with the lowest number of endoscopic methods was achieved with a combination of BAL and brushing lavage. Adding other procedures to this combination did not improve the diagnostic yield.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To assess whether chemotherapeutic effect can be evaluated by flexible bronchoscopy in non-small cell lung cancer (NSCLC) patients treated with a cisplatin-containing regimen, we reviewed the bronchoscopic findings before and after chemotherapy. There were 39 patients in the study, 31 males and 8 females, with a median age of 60 years. The number of patients in clinical stages IIIA, IIIB, and IV was 18, 10, and 11, respectively; by histological type, there were 13 adenocarcinomas, 25 squamous cell carcinomas, and 1 large cell carcinoma. Chemotherapy regimens included cisplatin + vindesine (or vinblastine), cisplatin + mitomycin C + vindesine, and cisplatin + ifosfamide + vindesine, with 13 patients in each of the three regimen groups. Nineteen patients showed a partial response, 18 no change, and 2 progressive disease. Bronchoscopic findings before chemotherapy were classified into two groups: primarily mucosal type, consisting of superficial invasive, nodular protrusion, and polypoid types; and primarily submucosal type, consisting of subepithelial, intramural, and extramural types. Findings in most patients were of the subepithelial type, and nearly three-quarters of them had a combination type. Changes in bronchoscopic findings after chemotherapy were classified into four types—scar, improved, unchanged, and progressive—in comparison with the findings before chemotherapy. The number of patients in each of these categories was 4, 16, 15, and 4, respectively. There were significant relationships between bronchoscopic changes after chemotherapy and tumor response (p= 0.001, χ2test) and between bronchoscopic findings before and those after chemotherapy (p= 0.015, χ2test), as well as between bronchoscopic changes and histological changes (p= 0.002, χ2test). These findings suggest that bronchoscopic findings before chemotherapy might predict the chemotherapeutic effect, especially in cases with primarily mucosal-type, compared with other types of bronchoscopic changes.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In a prospective study (1989–1992) of pulmonary nodules/masses and/or mediastinal/hilar lesions, 329 patients underwent transbronchial needle aspiration (TBNA) using a cytology or a histology needle with or without fluoroscopy via flexible bronchoscopy as the initial procedure to sample mediastinal lesions (169) or lung lesions (160). TBNA established the diagnosis of malignant or benign disease in 68.1% (224 patients). The diagnostic yield was 89.3% (151/169) for mediastinal and 45.6% (73/160) for lung lesions without abnormal mediastinal/hilar areas. The undiagnosed patients (105) underwent transthoracic needle aspiration (TTNA) using a 19-gauge needle under fluoroscopy or computed tomography guidance. TTNA established the diagnosis in 69.5% (73). The diagnostic yield was 83.3% (15/18) for mediastinal lesions and 66.7% (58/87) for lung lesions. Benign disease was diagnosed by TBNA in 8.8% (20/224) and by TTNA in 23% (17/73). The benign disease most commonly diagnosed by TBNA was sarcoidosis, and TTNA was most useful in diagnosing various benign lung lesions. Neither TBNA nor TTNA established the diagnosis in 9.7% (32). Overall diagnostic rates for TBNA and TTNA were 68.1 and 22.2%, respectively. The combined diagnostic rate was 90.3%. There were no complications from TBNA but TTNA was complicated by pneumothorax in 20%. We suggest that TBNA should be the diagnostic procedure of choice in patients with mediastinal/hilar lesions. BNA and TTNA are complementary procedures.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although transtracheal oxygen therapy (TTOT) has been advocated because of its beneficial effects of reduced nasal irritation and decreased oxygen flow rates, available series and our earlier reported experience have demonstrated frequent, though rarely serious, complications associated with TTOT. To assess whether increasing operator and institutional experience enhances performance with TTOT, we compared the frequency of complications associated with TTOT in our previously reported initial 20 patients [who underwent 25 procedures from October 1986 to June 1988 (Group I)] versus 31 patients treated subsequently [who underwent 37 procedures from July 1988 to June 1992 (Group II)]. Complications were recorded based on initial observations and subsequent follow-up over periods of up to 59 months after TTOT placement and were categorized into four major groups: technical/procedural, symptomatic, infectious, and miscellaneous. Overall, the total number of complications was similar in Groups I and II (51 complications/25 procedures vs 68 complications/37 procedures). Analysis by type of complication showed that increased experience beyond 25 procedures was not associated with a decrease in any type of complication. When classified into the four major categories, no group of complications was noted to decrease with experience, although there was a trend toward decreased technical/procedural complications (p= 0.053). We conclude that (a) although TTOT is associated with a large number of complications, very few are serious or life-threatening; (b) bronchoscopy is occasionally required to examine the airways for mucous balls and granulation tissue; and (c) increased institutional experience beyond the first 25 procedures does not decrease the total number of complications.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A 50-year-old female patient presented with chronic productive cough, occasional wheezing, shortness of breath, and fullness in the throat of 4 years duration. Her past medical history, physical examination, and pulmonary function tests were unremarkable. Bronchoscopy revealed a normal larynx and prominent exudative inflammation in the subglottic area. Biopsies showed marked acute and chronic inflammation with granulation tissue, giant multinucleated cells, foamy macrophages, and metaplasia. The patient was started on oral ciprofloxacin and showed marked improvement of the inflammation. Scleroma is a rare chronic granulomatous disease caused byKlebsiella rhinoschleromatiswith a certain affinity for the mucosal transitional zones of the respiratory tract. The disease typically has three consecutive stages: the catarrhal and granulomatous stages are followed by sclerotic stages which ends with extensive fibrosis, narrowing of the lumen or web formation. Endoscopists should be aware of the prolonged course, typical localization, endoscopic and histopathologic findings of the disease in order to prevent the resultant anatomic destruction and stenoses in the airways.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A mail survey was carried out to ascertain the present status of bronchoscopy in India. The survey indicated the predominant use, safety and utility of flexible bronchoscopy. A relatively low percentage of respondents reported routine use of supplemental oxygen (24.6%), bronchoalveolar lavage in immunocompromised hosts (24.6%), and fluoroscopy for transbronchial lung biopsy (7.3%). The survey had its limitations: answers to some questions were based mainly on the memory of the respondents; many participants did not provide full answers; and the survey did not include questions on mortality rates, instrument maintenance, etc. Nevertheless, the survey provided useful insights, as it covered the entire country and participants with a wide range of experience. The results indicate the present trends in bronchoscopy in India but do not establish or recommend any particular standards. Establishing guidelines in India, as elsewhere, is desirable so that there will be a reasonable degree of standardization in the practice of bronchoscopy.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Airway patency is vital for the management of mechanically ventilated patients with tracheostomies. Long-term, acute-care, ventilator-dependent patients may suffer significant damage to their tracheas including tracheomalacia, tracheal stenosis, and tracheal-esophageal and tracheal-innominate artery fistulas. We present a patient who had seven cardiopulmonary arrests. Reconstruction of the events leading to the arrests led us to hypothesize the following. Partial outward displacement of the tracheostomy tube allowed the underlying tracheomalacia and granulation tissue to cause intermittent total obstruction of the expiratory airflow and partial obstruction of the inspiratory airflow. Reestablishment of the airway terminated these arrests. Diagnosis of the tracheal tube obstruction was confirmed by bronchoscopy after the most recent event. Careful attention to the upper airways may help to prevent complications in long-term, ventilator-dependent patients.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID