ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Our objective was to obtain information regarding the opinions and practice habits of pulmonary physicians who perform diagnostic and therapeutic bronchoscopy in North America. The last survey of clinical bronchoscopic practice in North America was conducted by the American College of Chest Physicians in 1989. During the past 10 years, however, bronchoscopy has evolved considerably. Numerous published clinical investigations, symposia, and training courses have accompanied a renewed interest in both advanced diagnostic and therapeutic procedures. Whether this has resulted in modifications of bronchoscopic practice, however, is unknown. To gain greater insight into practitioners' opinions and practice habits, the American Association for Bronchology conducted this survey. An eight‐page survey was mailed to 2,500 pulmonologists selected randomly from the American College of Chest Physicians (ACCP) membership roster. The survey was designed so that only bronchoscopists with experience in certain procedures addressed specific issues pertaining to those procedures. Many questions were designed intentionally to allow direct comparisons with responses from the previous ACCP survey. A total of 744 questionnaires (30% return rate) were analyzed. Respondents were similarly representative of all major regions of the United States. A total of 99% of the respondents were familiar with flexible (fiberoptic) bronchoscopy, but only 4.5% had performed stent insertions or laser resections. The majority of respondents (82 to 87%) thought that our pulmonary societies needed to prepare detailed guidelines pertaining to the practice of both flexible (82%) and therapeutic (87%) bronchoscopy. The results from this survey provide helpful information that may prompt reconsideration of existing procedure‐related training and competency issues. Overall, therapeutic procedures such as bronchoscopic stent (prosthesis) insertion or laser bronchoscopy do not appear to be practiced widely or frequently, suggesting a potential move toward development of tertiary care centers of excellence for patients who require advanced therapeutic airway procedures.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;We report a 4‐year experience using a new silicone Y‐stent characterized by highly elastic construction material, optimal inner diameter, and nonstick surface quality. Fifty patients with advanced malignant disease involving the carina were treated by rigid bronchoscopy including dilatation using laser therapy and/or mechanical dilatation followed by Y‐stent insertion using a dedicated stent applicator. Mean survival was only 109 days because of the severity of illness, but quality of life was good. Particularly good results with prolonged survival were achieved in 19 patients with esophageal cancer. For the 8 patients with esophageal carcinoma with invasion or compression of the airway without fistula, mean duration of survival was 138 days. In the 11 patients with tracheoesophageal fistulas in the vicinity of the carina, survival was only 71 days. Good life quality was directly related to good tolerance and complete reestablishment of respiratory function.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;From 1983 to 1997, we examined the usefulness of bronchoalveolar lavage (BAL) cell differential counts, with special reference to increased levels of eosinophils and lymphocytes, in patients with acute respiratory failure accompanied by diffuse shadow in chest radiographs. This study covers 118 patients with acute respiratory failure who had a Pao2of less than 60 mmHg on room air or an oxygenation index (Pao2/ Fio2) of less than 250 mmHg and diffuse shadows in chest radiographs. Pulmonary disease was evaluated on the basis of clinical findings, results from studies of specimens from bronchoscopy, transbronchial and/or open lung biopsy specimens, and other relevant examinations. Increases in the eosinophil percentage in BAL are found in several specific pulmonary diseases, especially in acute eosinophilic pneumonia and bronchitis obliterans with organized pneumonia. In addition, other specific diseases, such as miliary tuberculosis, hypersensitivity pneumonia, IIP andPneumocystis cariniipneumonia show elevated levels of increased lymphocytes in the BAL.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Percutaneous needle aspiration (PCNA) of mediastinal masses is an effective modality for the diagnosis of malignancies, especially for staging of lung cancer. Its usefulness in diagnosing benign condition has been poorly documented. This study reports the results of 65 patients with benign mediastinal masses who were subjected to PCNA after prior work‐up (including bronchial needle aspiration or mediastinoscopy in most cases) was nondiagnostic. The lesions measured from 2.3 to 10.5 cm in the largest diameter, with a mean of 4.6 cm. The following lesions were present: thymoma, 3; lipoma, 6; cyst, 12; tuberculosis, 14; nonspecific inflammation, 7; sarcoid, 4; thyroid, 5; abscess, 3; neurinoma, 3; rheumatoid inflammation, 1; aortic aneurysm, 2; Castleman's tumor, 1; osteochondroma, 1; and 3 remained undiagnosed. The patients were 13 to 75 years of age, with a mean age of 44.8 years. Forty‐four were female, and 21 were male. Most patients were asymptomatic (40) or with unspecific symptoms, such as malaise (18), substernal pain (16), low‐grade fever (12), and cough (10). There were no false‐positive aspirates for malignancy. In four patients, the cytologic diagnosis was false‐negative. PCNA resulted in introduction of chemotherapy in 11 of 14 patients with tuberculosis. Six of 12 cysts disappeared after PCNA. Contemplated surgery was abandoned in 4 of 6 patients with fatty mass and in 3 of 5 patients with mediastinal thyroid. A small pneumothorax occurred in 7 patients. PCNA is of value in the diagnosis of benign mediastinal masses. The cytologic diagnosis is reliable. PCNA may obviate the need for invasive diagnostic procedures and may lead to adequate treatment of tuberculosis.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Bronchial needle aspiration (BNA) with or without core biopsy rarely leads to clinically significant hemorrhage. We report a case of persistent bleeding after a 19‐gauge BNA core biopsy of a necrotic mediastinal lymph node that began 5 days after the procedure and the reinstitution of anticoagulation. To my knowledge, this represents the first case of nonfatal hemorrhage after BNA which was severe enough to require transfusion with fresh‐frozen plasma. The origin of the hemorrhage appears to be multifactorial. The necrotic nature of the tissue specimen, the unusually large core biopsy site, and the effects of systemic anticoagulation may all have been contributing factors.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;We describe a 73‐year‐old man who presented with an unusual combination of bronchopulmonary amyloidosis and endobronchial mass in the left bronchus, which caused atelectasis of the left lung, and a pulmonary parenchymal mass in the left lung. Nd‐YAG laser therapy was performed to photocoagulate the endobronchial lesion. Two years later, the endobronchial mass in the left bronchus caused pneumonia of the left basal segment. Left lower lobectomy was performed.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Primary pulmonary plasmacytoma is rare, and endobronchial presentation is even less common. We report a case of primary endobronchial plasmacytoma in a 45‐year‐old man who sought medical attention because of a 2‐month history of dyspnea and nonproductive cough. Chest computed tomography (CT) showed a 1.5‐cm polypoid‐appearing intraluminal lesion in the distal trachea and collapsed right lung with deviation of the mediastinum to the right. Bronchoscopy confirmed the presence of an obstructing mass lesion arising from the right mainstem bronchus with proximal extension into the distal trachea. Photocoagulation with Nd‐YAG laser was performed. Histopathology was consistent with a plasma cell tumor, and immunoperoxidase studies showed the tumor cells to be a clonal expansion of lambda light chain cells. Radiotherapy was administered for the residual tumor. The patient remains asymptomatic, and repeat bronchoscopy 9 months after the initial diagnosis did not show any recurrence. We suggest the consideration of extramedullary plasmacytoma in the differential diagnosis of obstructing tracheobronchial lesions and review the current literature.

ISSN:1070-8030    

出版商:OVID    

年代:2000

数据来源: OVID