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:

The Dumon stent (or Endoxane), designed in 1987, is a flexible, multisized, studded, silicone prosthesis. This report describes the combined results of Dumon stent placement in Marseille, France (J.F.D.), Brescia, Italy (S.C.), Saint-Etienne, France (J.M.V.), and Barcelona, Spain (P.O.). The four teams had placed 1,574 stents in 1,058 patients through September 1994. All cases involved high-grade stenosis of the tracheobronchial tree resulting from extrinsic compression or wall collapse due to loss of cartilaginous support. The locations were the trachea (54%), the left main stem bronchus (21%), the right main stem bronchus (18%), and miscellaneous (8%). The main indications were malignant tumors (677 patients, 926 stents), benign tracheal stenosis (263 patients, 419 stents), postsurgical bronchial stenosis after lung transplantation (15 patients, 36 stents), low-grade malignant tumors (21 patients, 50 stents), and miscellaneous benign stenosis lesions (82 patients, 143 stents). All stents were placed via the rigid bronchoscope. The mean number of stents per patient was 1.5 overall, 1.4 in patients with malignant lesions, and 1.6 in patients with benign tracheal stenosis. The mean duration of stenting was 14 months for benign tracheal disease (longest, 6.2 years) and 4 months for malignancy (longest, 4.7 years). Complications were uncommon, usually easily managed, and rarely life threatening. The main complications were migration (9.5%), obstruction by secretions (3.6%), and granulation (7.9%). Rare complications included airway ulceration, infection, septic shock, and aphonia. Secondary obstruction due to extrinsic compression of the prosthesis was never observed. Routine yearly evaluations are recommended, with other evaluations based on clinical indications. Based on our 7-year experience, we conclude that the Dumon stent represents an effective way to reestablish a viable airway in patients with benign and malignant tracheobronchial disease.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pulmonary hypertension (PH) has been widely stated as a relative contraindication to bronchoscopic lung biopsy (BLB) because of the potential risk of excessive bleeding. There are few data to support this contention. This risk factor was studied in an animal model of acute PH. Ten adult sheep underwent pulmonary artery (PA) catheterization followed by six BLBs of the right apical lobe and the amount of biopsy-induced bleeding was quantitated. In five of the animals, the mean PA pressure was elevated before bronchoscopy by continuous air embolization through the proximal port of the PA catheter (mean PA pressure, 32.8 ± 4.8 mm Hg). The mean PA pressure for the five control sheep was 12.2 ± 5.0 mm Hg. There was not a significant increase in blood loss for the experimental animals (mean aspirated blood, 2.6 ± 3.1 ml) compared to the controls (mean aspirated blood, 1.0 ± 1.0 ml). Histopathologic correlation supported this finding; gross and microscopic assessments of the apical lobes revealed no evidence of larger zones of hemorrhage for the experimental group. In an ovine model of acute PH, there is no increased risk of bleeding from BLB.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A postal survey was conducted in The Netherlands among pulmonary specialists in the autumn of 1993. Response was obtained from 74% of the 103 group practices, representing 210 pulmonary bronchoscopists (68% of the total number registered in our country). Eighty-eight percent of the practices comprised four or fewer pulmonologists, 74% had their own bronchoscopy room, 82% had access to fluoroscopy, 95% had day-care facilities allowing bronchoscopic interventions in outpatients, and 67% had intermediate-care facilities with electrocardiogram and pulse oximetry monitoring. Forty-three percent used video-bronchoscopy, of which 82% used the video-adapter. There was a consensus among the pulmonologists about the need for chest x-rays prior to bronchoscopy, atropine as Premedication, and local anesthesia with lidocaine spray. Flexible bronchoscopy was usually performed under local anesthesia without using midazolam. There was less consensus with regard to various other procedures prior to, during, and after bronchoscopy. About 31,000 flexible bronchoscopies were performed each year. Rigid bronchoscopy and broncho-alveolar lavage numbered < 1,500/year and 88% of the pulmonologists performed this procedure less than once a week. Pediatric bronchoscopy numbered less than 280/ year. Interventions, e.g., Nd-YAG laser, were performed only by those working in large hospitals. The majority indicated that bronchoscopic intervention should be concentrated at these institutions only and they did not plan to employ such a technique in the near-future.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Tracheobronchial stents are increasingly used for maintaining or establishing airway patency in patients with central airway obstruction due to endoluminal tumor, extrinsic tumor compression, tracheal malacia, or some benign conditions. Silicone stents (e.g., Dumon-Artemis) are often preferred over expandable metal stents, in view of their easier replacement or removal. However, spontaneous migration of silicone stents occurs at a significant frequency, especially when located in the trachea. We therefore designed a new synthetic (Tygon) tracheal prosthesis, with a screw-thread surface assuring increased stent fixation to the tracheal wall. This new stent was easily introduced in 10 patients with tracheal stenosis. Tolerance was excellent, and there was no stent migration or other complication. Besides a lower risk of spontaneous migration, this new stent offers the advantages of a substantially lower cost and an easy and simple insertion procedure. The ability for readjustment or removal of the stent is equal to that of the Dumon stent.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We prospectively evaluated a new technique of manual ambu-bag ventilation during nonbronchoscopic bronchoalveolar lavage (BAL) in critically ill premature infants dependent on mechanical ventilation. Seventeen infants underwent 34 BALs. Each patient underwent one, two, or three BALs as part of an ongoing study of the effect of dexamethasone therapy on inflammatory mediators in the lung in patients with respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD). All patients were < 30 weeks of gestational age; 11 of 17 patients were < 1 month old at the time of the first BAL. There were no major complications, such as lung abscess, pulmonary hemorrhage, or pneumothorax. Pooled results from BALs on days 0, 3, and 10 of dexamethasone therapy (n= 34), as well as results from each separate day, showed no significant difference in oxyhemoglobin saturation (Spo2), heart rate, or systolic blood pressure (SBP) before compared to after the procedure. After 10 of 34 BALs, SBP increased or decreased by ≥10 Torr and after 2 of 34 BALs, Spo2fell >5%, to a value of < 90%. After 2 of 34 BALs (6%), subjects did not return to baseline ventilator settings for >24 h. BAL sample data showed a mean of 41% macrophages in the cell count differentials. Mean BAL return was 45% of the fluid instilled. At follow-up 2 to 20 months after BAL, 16 of 17 patients were alive. One patient died of sepsis and severe RDS/BPD 6 days after BAL. We conclude that our technique of non-bronchoscopic catheter BAL using manual ambu-bag ventilation was generally well tolerated and sampled the alveolar space; however, critically ill, mechanically ventilated premature infants may require increased respiratory support after the procedure.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The technique of bronchoalveolar lavage (BAD permits the analysis of cells retrieved from the pulmonary parenchyma. While the clinical usefulness of the differential cellular analysis of BAL is controversial, utilization of newly available techniques may identify a specific etiology of the pulmonary disease. We report the case of a 50-year-old female in whom the diagnosis of recurrent non-Hodgkin's lymphoma post-bone marrow transplant was made using flow cytometry to phenotype the abnormal lymphocytes found in a BAL specimen. This case illustrates the clinical utility of immunopheno-typing abnormal or atypical lymphocytes by flow cytometry on BAL specimens, a technique that may be particularly useful in the posttransplant setting.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A male smoker presented with hemoptysis. A central endobronchial mesenchymoma was diagnosed by flexible bronchoscopy. Mesenchymomas are the most common benign tumor of the lung. They present as two distinct types: pulmonary parenchymal and central bronchial. The central type can be treated with flexible bronchoscopy techniques or surgery depending on the clinical presentation.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pulmonary aspergilloma developed in a post-tuberculosis cavity was visualized and biopsied by flexible bronchoscopy in a 53-year-old man. The patient was treated with oral itraconazole (200 mg daily) without significant side effects. After 10 months of therapy, repeat flexible bronchoscopy confirmed complete resolution of the aspergilloma.

ISSN:1070-8030    

出版商:OVID    

年代:1996

数据来源: OVID