ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We attempted to determine the diagnostic yield of expectorated sputum, bronchoalveolar lavage (BAL) fluid, and bronchoscopic biopsy (BB) obtained during flexible bronchoscopy (FFB) forMycobacterium tuberculosis(M.tb) in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients. The role of FFB in making a presumptive and final diagnosis of M.tb infection in the two groups was evaluated. Medical records and chest radiographs of 227 patients who had M.tb cultured from sputum or FFB specimen from July 1990 to June 1992 were reviewed. Patients were divided into HIV-infected and non-HIV-infected groups. Chest radiographs were interpreted as typical (upper lobe, miliary or cavitary infiltrates, pleural effusion, or adenopathy) and nontypical (normal chest x-ray, focal infiltrates not in the upper lobes, interstitial or diffuse, patchy infiltrates) for pulmonary tuberculosis (TB). There were no differences between HIV-infected and non-HIV-infected patients when the overall yield of sputum. BAL fluid, and BB for M.tb were compared. In patients who had both sputum and BAL fluid available for culture, spulum was as sensitive as BAL fluid for final M.tb recovery in both HIV-infected and non-HIV-infected patients. FFB was useful in making a rapid presumptive diagnosis of mycobacterial disease [presence of acid-fast bacilli (AFB) in BAL fluid or biopsy specimen or granulomas on biopsy] in 20% of HIV-infected and 40% of non-HIV-infected patients (p= ns). There were no differences between HIV-infected and non-HIV-infected groups in the presence of typical and nontypical chest radiographs for pulmonary TB. In the HIV-infected group, sputum smears were positive for AFB in 69% of patients with chest radiographs typical for pulmonary TB, compared to 41.7% in patients with non-typical chest radiographs (p= 0.01). This difference was not significant in the non-HIV-infected group. In conclusion, sputum specimens have a high yield for making a final diagnosis of pulmonary TB in both HIV-infected and non-HIV-infected patients. If patients cannot produce sputum. FFB should be performed. If sputum smears are negative in patients in whom a rapid presumptive diagnosis of pulmonary TB is required. BB in addition to BAL should be done. HIV-infected patients do not differ from non-HIV-infected patients in the presence of chest radio-graphic features typical for pulmonary TB.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Due to tremendous progress in materials and technique during the last few years, stenting of the central airways had become an almost-routine procedure as in other fields of endoscopy. But as the anatomical and physiological properties of the tracheobronchial tree are much more complex, no ideal system exists as yet. We report our experience in implanting 165 stents in 95 patients from 1989 until June 1993, their ages ranging from 2 to 90 years. In two-thirds of our patients the cause of stenosis was malignancy due to exophytic endoluminal tumor growth or extrinsic tumor compression. In the remaining patients it was of a benign origin, due mainly to cicatrical stenosis. The time of observation after stenting has been ≥ 3 years. Almost all prostheses were implanted in the central airways, mainly the trachea, followed by the larynx and the main bronchi. During the period of observation we implanted devices such as silicone stents. expandable metallic stents, and self-expanding metallic stents. Patients with different devices have been sent to our hospital from other institutions for treatment of specific complications. In our series there have been typical complications of the various stent systems that must be taken into account in the indication for this procedure. According to these experiences technical improvements have been made, and in the near-future systems will be available that may be introduced easily even under local anesthesia by visual control via flexible endoscopes.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To assess the influence of bronchoalveolar lavage (BAL) on oxygenation status, 45 subjects (36 men, 9 women; mean age. 64.4 ± 7.2 years) suffering from chronic obstructive pulmonary disease (COPD) underwent flexible bronchoscopy (FFB) as a diagnostic procedure. Thirty of them also underwent BAL to complete the investigation. This second group of patients was. further, divided into two subgroups (of 15 each) in which BALs were performed with the patient in the supine position by infusing, respectively, five aliquots of 20 ml each and two aliquots of 50 ml each of sterile saline solution at 37°C into a subsegmentary branch of both the right middle lobe and the lingula. All patients were connected to a pulse oximeter for the duration of the investigation and had an arterial blood gas (ABG) analysis immediately before the initiation of FFB and within 5 min of cessation of the bronchoscopic procedure. A significant change in arterial oxygen pressure was observed as a consequence of FFB itself (79.2 ± 4.2 vs 64.4 ± 3.8 mm Hg;p< 0.02). The negative influence of BAL on arterial oxygenation was greater, especially in those patients in whom BAL was performed with two aliquots of 50 ml each (77.0 ± 3.4 vs 59.8 ± 3.0 mm Hg;p< 0.005) rather than in those in whom BAL was done with five aliquots of 20 ml each (77.3 ± 4.0 vs. 63.2 ± 3.1 mm Hg;p< 0.01). Oxygen saturation did not differ significantly until the second pulmonary site was investigated (96.3 ± 5.6 vs 88.3 ± 3.9 and 95.8 ± 4.2 vs 87.1 ± 3.7%, respectively, for the two BAL patient groups;p< 0.005). In conclusion, our data suggest that, besides any consideration regarding practical consequences that different techniques unequivocally offer, in patients suffering from COPD, BAL must be performed with the infusion of small aliquots of fluid to protect patients from severe arterial deoxygenation.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We evaluated the images obtained from 25 patients with pulmonary disorders (cough, hemosputum, and abnormal shadows on the chest x-ray film) using a conventional flexible bronchoscope (Olympus BF type 101. an Olympus video converter (OVC-200) connected to the conventional bronchoscope, and an Olympus prototype electric endoscope. In all cases, the video converter, which contains a charge-coupled device chip, provided clear images when connected to the conventional bronchoscope. The color and contrast enhancement features facilitated the detection of indistinct findings, such as slight mucosal irregularities. The image-freezing function and computed filing system, which are the same with electric endoscopy, are very useful. Many personnel involved in the patient's health care can observe the video image simultaneously. Computer analysis of the endoscopic image may have great potential clinical application, and we consider the video converter to present advantages for bronchoscopic examinations.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The aim of this study was to test the efficiency of short-term balloon-expandable metallic stent application (Strecker device) in tumorous stenoses with subsequent irradiation and to develop a method for implanting these metallic stents using a flexible bronchoscope. Eight patients suffering from bronchial carcinoma with severe stenosis of the central airways (carina region, main stem bronchus) and dyspnea were examined. Strecker stents were applied by flexible bronchoscopy using intubation and fluoroscopic guidance. General anesthesia and muscle relaxation were used during dilatation of the stenosis and stent application. In four cases, the application of two stents was indicated (length of stenosis. >35 mm); in the other four cases, one stent was sufficient. Stent implantation was followed by immediate postoperative percutaneous irradiation in four cases and/or by afterloading in five cases. Radiotherapy has been efficient in each case and led to dilatation of the stenosis after an average irradiation dosage of 23 Gy and an average time of 39 days; thus most of the stents could be easily removed by forceps using flexible bronchoscopy. The results suggest that the implantation of metallic Strecker stents by flexible bronchoscopy is an efficient short-term therapy in patients suffering from bronchial carcinoma with severe dyspnea, if irradiation follows.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The exact indications for computed tomography (CT) of the thorax and mediastinoscopy (MS) in lung cancer (LC) still remain incompletely defined. The present study was designed to establish a standard approach to cervical MS for otolaryngologists, who in Denmark traditionally are involved in the staging of LC. Seventy-eight clinically resectable patients with LC routinely underwent CT of the chest prior to bronchoscopy and cervical MS. Sixty-four patients had non-small cell LC and 14 patients had small cell LC. Cervical MS alone established the histological diagnosis in 19% of the patients. In diagnosing metastases in the superior mediastinum, a criterion of 10 mm for abnormal enlargement of lymph node size resulted in an overall specificity and sensitivity of mediastinal CT of 85 and 81%, respectively. No clinicopathological characteristics could be identified to influence the accuracy of CT, except for the finding that the rate of false-negative mediastinal CT was significantly higher in females than in males. It was demonstrated that mediastinal lymph nodes in patients with mediastinal metastases were significantly larger than mediastinal lymph nodes in patients without metastases. It is concluded that because of the unsatisfactorily low specificity and sensitivity of mediastinal CT, cervical MS remains essential in the evaluation of patients with presumed or verified LC and that cervical MS, in experienced hands, is a safe and accurate procedure. For otolaryngologists. the strategy of routine cervical MS, performed under general anesthesia in the same stage as bronchoscopy. is advocated as a standard approach to mediastinal assessment for the staging of LC.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A 57-year-old patient presented with stridor and dyspnea. Metastases from a thyroid cancer had invaded the trachea over its whole length and eroded the fifth cervical vertebral body. Because of the possibility of transverse section, rigid bronchoscopy could not be performed. After laser photoresection a Silastic tracheal stent was inserted with a flexible bronchoscope. As this endoprosthesis did not solve the problem, it had to be removed using an inflated endotracheal tube. A 12-cm-long bifurcated Dynamic airway stent was inserted with flexible instruments under local anesthesia. Semistiff tube exchangers, fiberoptically placed into the stem bronchi. were used to guide the y-shaped Dynamic stent down until it saddled on the carina. The procedure gave the patient immediate relief from his central airway obstruction.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Central airway obstruction due to extrinsic compression and/or tracheomalacia can often be managed by insertion of tracheobronchial endoprostheses (stents). Of the various types and models of prostheses described, probably the greatest experience has been obtained with silicone Dumon-Artemis stents. for which we recently described an alternative, simplified insertion technique. We now report our experience with guide wire-assisted simplified insertion of a Dumon-Artemis stent, in a patient in whom there was no airway lumen visibility distal to the obstruction.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID