ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:The diagnosis of Pneumocystis carinii pneumonia (PCP) requires the demonstration of organisms from lung-derived specimens. Adjunctive tests, including serum lactate dehydrogenase (LDH) and arterial blood gas analysis, lack adequate sensitivity and specificity when used alone. We attempted to improve the utility of these measurements in the diagnosis of PCP in patients with known or suspected human immunodeficiency virus (HIV) infection. We reveiwed the medical records of 173 consecutive inpatients in an urban teaching hospital who had an undiagnosed pulmonary disorder suggestive of PCP and who had fiberoptic bronchoscopy in 1993 and 1994. Serum LDH (international units), arterial Pao2(mmHg) on room air, and the ratio LDH/Pao2in patients with PCP was compared with patients who had another pulmonary disorder. We found that LDH/Pao2was greater than 4.5 in 84 patients, 80 patients with PCP, and 4 with other pulmonary disorders. Two of the false-positive cases had coexisting elevations in liver enzymes. LDH/Pao2was less than 4.5 in 89 patients, 43 with PCP, and 46 with other pulmonary disorders. For the diagnosis of PCP, LDH/Pao2greater than 4.5 had a sensitivity of 65% and a specificity of 92%. The positive predictive value was 95%, and the negative predictive value was 51%. In conclusion, LDH/Pao2greater than 4.5 while on room air was moderately sensitive but was highly specific and had a very high positive predictive value in the diagnosis of PCP in HIV-seropositive patients. This finding could be used to support the empiric administration of antipneumocystis therapy in HIV-infected patients suspected of having PCP.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:Although roentgenographically occult lung cancer (ROLC) has been fully studied, there have been few reports dealing with occult cancers and negative sputum cytology. From 1975 to 1994, 100 patients were diagnosed with ROLC. Of these patients, 15 who had negative sputum cytology were examined retrospectively. The clinical characteristics, bronchoscopic findings, and pathologic findings of these patients were studied. Additionally, the tumor size, location, and bronchoscopic findings were compared with those of patients who had ROLC with positive sputum cytology. There were 17 lesions in 15 patients who had ROLC with negative sputum cytology. All cases of ROLC were detected by bronchoscopy during examination for other lung or laryngeal diseases. All of the patients were men with a high smoking index. Endoscopic examination showed that 10 lesions were the superficial thickening type; 5 were the nodular type; and 2 were the polypoid type. Average longitudinal extent of the lesions was 0.52 cm, which was significantly smaller than the lesions of the positive sputum cytology group (mean diameter; 1.28 cm, p < 0.01). In patients at high risk for lung cancer, if a diagnostic bronchoscopy is performed, the bronchial tree should be carefully examined for the presence of occult early lung cancer even when the sputum cytology examination is negative.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:Eleven patients were referred to our institution for laser treatment of symptomatic localized tracheobronchial amyloidosis (LTBA) from 1983 to 1997. In 14 years we have treated approximately 2,110 new patients that received 4,624 laser sessions. Incidence of LTBA is 0.5% of all tracheobronchial lesions and 23% of all benign lesions. Symptoms at diagnosis were as follows: progressive dyspnea 54%, recurrent pneumonia 36%, stridor 18%, hoarseness 9%, dry cough 9%. Diffuse tracheobronchial infiltration and different degrees of stenosis were the most usual endoscopic finding. Extensive evaluation failed to prove systemic amyloidosis. All patients were treated with Nd-Yag laser. Profuse bleeding in 3 patients; upper respiratory insufficiency followed by orotracheal intubation for respiratory arrest and tracheotomy in 1 case; respiratory insufficiency requiring hospital admission in 1 case; and mild hemoptysis and aspiration pneumonia in 1 case were the complications associated with laser treatment. Two additional patients need tracheotomy (1 temporary and 1 permanent); stenting was used successfully in 2 cases, both complicated by granuloma formation. We have concluded that (1) progressive dyspnea was the most frequent finding before diagnosis; (2) tracheal or tracheobronchial intraluminal compromise causing concentric stenosis was the most frequent endoscopic finding; (3) laser treatment was associated with a significant number of complications; (4) LTBA caused significant morbidity in all patients; (5) and an acute, inflammatory phase followed after a variable number of years by a chronic, stable phase appears to be the course in this group of patients.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:We conducted a retrospective study to evaluate the pulmonary biopsy specimens obtained by thoracotomy and videothoracoscopy in chronic diffuse lung disease between December 1989 and August 1995. We assessed prior clinical diagnosis, preoperative lung function, histologic diagnosis, length of hospital stay, and postoperative complications. We identified 37 patients who had undergone pulmonary biopsy. Thoracotomy was performed in 15 patients (Group A). Videothoracoscopy was performed in 22 patients (Group B). The average of tissue specimens per operation was 2.4 ± 0.96 in Group A and 2.1 ± 0.67 in Group B. The average volume of tissue specimens was 3.9 ± 4.5 cm3in Group A and 6.91 ± 5.5 cm3in Group B (p < 0.05). Histologic diagnosis was obtained in 100% of the cases. The preoperative diagnosis was in agreement with the histological findings in 65% of the cases (n = 24). The average postoperative stay was 7.9 ± 1.1 days for Group A and 5.8 ± 4.5 days for Group B (p < 0.05). Two patients in Group A and 1 in Group B had persistent air leaking. In the thoracotomy group, 1 patient died from causes unrelated to the procedure during the early postoperative period. We conclude that both techniques are suitable for the diagnosis of chronic diffuse lung disease. Videothoracoscopy has become the standard procedure in our hospital when pulmonary biopsy is required to diagnose chronic diffuse lung disease.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:Mass screening program for early detection of lung cancer has been conducted in Miyagi Prefecture, Japan, and over 180,000 heavy smokers have been screened. We report a very rare case with bronchogenic adenocarcinoma detected by sputum cytology without abnormal findings on chest radiograph or computed tomography (CT). A 75-year-old man was suspected of having adenocarcinoma of the lung by sputum cytology for mass screening. Chest radiograph and CT did not show any abnormal findings. Bronchoscopic findings showed that there was no polypoidal lesion in the bronchi, but a lesion with redness and thickening of the bronchial surface stretched from the left main bronchus to subsegmental bronchi of B6, B8, and B10of the left lower lobe. Brushing cytology and transbronchial biopsy confirmed that the lesion was a bronchogenic adenocarcinoma, and left pneumonectomy was performed. Histologic examination with serial block sectioning showed that the tumor was a poorly differentiated tubular adenocarcinoma and its invasion was confined within the bronchial wall.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:A 42-year-old Army helicopter pilot presented with expectoration of small stones caused by a large calcified hilar lymph node that partially protruded through the right bronchus intermedius. The endobronchial mass that partially occluded the bronchus was composed of granulation tissue and micro-calcifications. The mass was removed using the Nd:YAG laser during three separate bronchoscopies over a 1 -year period because of regrowth of the mass after each treatment. Treatment with the Nd:YAG laser obviated the need for open thoracotomy for broncholithectomy and the resultant morbidity from potential removal of lung parenchyma.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:Cytomegalovirus is a common pathogen in organ transplant recipients. We report a case of a lung transplant recipient with cytomegalovirus disease manifesting as diffuse endobronchial lesions localized to the allograft. The consequences and response to therapy, as well as the natural progression of these lesions as monitored by serial bronchoscopy, is described.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:Despite many advances in instrumentation and anesthetic techniques, tracheobronchial foreign bodies continue to challenge even the most experienced endoscopists. In our clinic, during a period of approximately 11 years, 980 children 15 years of age or younger underwent bronchoscopy for suspected airway foreign body aspiration. Tracheostomy over ventilating bronchoscope as an open surgical procedure to facilitate removal of a foreign body was performed in 5 of these patients. The foreign bodies removed were as follows: molar tooth, plastic pen head (2), bead, and hazelnut shell. The large tracheobronchial foreign bodies can be easily removed via tracheostomy under bronchoscopic control; this combined approach may decrease the morbidity and mortality related to removal of large tracheobronchial foreign bodies.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ABSTRACT:We describe the bronchoalveolar lavage appearance in a patient presenting with chest pain, cough, shortness of breath, and diffuse interstitial infiltrates after the inhalation of crack cocaine. There was a gradual darkening of the aspirated fluid reflecting increased recovery of carbonaceous material introduced into the lung during deep inhalation of ignited crack. This emphasizes the importance of early bronchoscopy as a diagnostic tool for this entity and for the recognition of potential complications of thermal injury, a component of crack lung syndrome.

ISSN:1070-8030    

出版商:OVID    

年代:1999

数据来源: OVID