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

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To determine the incidence of fever and bacteremia following flexible bronchoscopy, we analyzed the medical records of 111 patients who had undergone flexible bronchoscopy from 1988 to 1990. Seventy-seven of these patients underwent other procedures besides biopsy at the time of flexible bronchoscopy: washing cytology in 29, brushing cytology in 23, washing and brushing cytology in 23, and bronchoalveolar lavage in 2. Twenty patients (18%) developed a fever (>37.5°C), which subsided within 24 h. No patient developed pneumonia. There was no correlation between the incidence of fever and the number of biopsies. We then prospectively studied 44 patients who underwent flexible bronchoscopy from March 1991 to October 1991. Immediately after bronchoscopic examination, venous blood was obtained for blood culture. There was only one positive culture with gram-positive rods, but the patient had neither fever nor pneumonia. Five patients had a fever >38.0°C, but it subsided within 24 h, and no patient developed infectious diseases. We conclude that the incidence of fever and bacteremia following flexible bronchoscopy is low, and there would be no benefit from the prophylactic use of antibiotics in these patients.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Between January 1, 1989, and December 31, 1991, pulmonary Kaposi's sarcoma (KS) was diagnosed in 25 patients (23 men and 2 women) with acquired immune deficiency syndrome (AIDS) in our institution. Cutaneous KS was also present in 24 cases. All patients underwent flexible bronchoscopy (FFB). The simple visualization of typical KS lesions distributed along the tracheobronchial tree was the diagnostic method exclusively in 20 (80.0%) patients. Direct biopsy of visible lesions was positive in 36.4% (4 of 11) cases. Bronchoscopic lung biopsy was performed in six patients, positive for KS in one (16.7%). Abnormal bleeding was not noted. Overall, FFB was diagnostic for pulmonary KS in 24 (96.0%) patients. Surgical lung biopsy was performed in one case with negative findings for KS on FFB. Associated simultaneous pulmonary diseases were present in nine (36.0%) cases: tuberculosis in three,Pneumocystis cariniipneumonia in three, atypical mycobacterial disease in two, and bacterial pneumonia in one. Despite chemotherapy, the 6-month survival rate was only 31.8%

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Nd-Yag laser resection is one of the most effective treatments of large airway obstruction. However, it is ineffective for extrinsic compression or malacia, and, in these cases, the insertion of a stent can be useful. We present our 2-years of experience with the Dumon silicone stents. A total of 125 prostheses have been placed in 90 patients, in most of the cases after laser treatment. Rigid bronchoscopy under general anesthesia was used in all patients. Indications were benign lesions in 41 cases (30 patients with 14 tracheal stenosis, 12 with tracheal stenosis with malacia, 4 with bronchial stenosis) and malignant lesions in 84 cases (60 patients with 54 bronchogenic carcinoma, 4 with esophageal carcinoma, 2 with thyroid carcinoma). Tolerance was excellent, except in one patient who expelled the stent twice. The most frequent complications were migration (17 cases), granuloma (11 cases), and hypersection (3 cases), granuloma (11 cases), and hypersecretion (3 cases). The rate of complications seems to be higher in benign pathology. In only one case the complication was life threatening (acute dyspnea needing tracheostomy). In 14 patients overgrowth of tumor was observed at follow-up and required repeated laser therapy. Six of these patients required a second stent. In our experience, silicone tracheobronchial stents are effective in the maintenance of airway patency and is associated with rapid relief of symptoms, good tolerance, and infrequent complications that are easily manageable and rarely life threatening.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

During a 6-year period, 268 patients underwent 419 treatments with use of a neodymium: yttrium aluminium garnet (Nd:YAG) laser for bronchostenotic lesions. The majority of patients had bronchogenic cancer and received radiotherapy before or after laser resection. In this group the mean survival was 5.9 months following initial treatment. Eighty-two patients required between 1 and 12 further treatments, and 17 also required insertion of an endobronchial stent. Pulmonary function tests proved disappointing as a determinant of the need for retreatment, and we found routine bronchoscopic examination more helpful. Serial ventilation perfusion scans were useful in selecting those patients who would not benefit from further treatment.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Endoscopic electroresection (ER) with a high-frequency cutting loop was used in 10 patients with recurrent or local extensive invading tumors. The procedures were exclusively palliative, Five patients had squamous cell carcinoma, four had adenoid-cystic carcinoma, and one adenocarcinoma. All patients had severe dyspnea and inspiratory stridor prior to ER. A total of 89 resections were performed, varying from 1 to 33 treatments for each patient. All patients experienced a significant improvement in respiratory function after ER. The complication rate was low. We consider ER to be a safe and efficient method in the palliation of patients with otherwise incurable tracheobronchial tumors.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A review of available data of a total of 149 male, heavy-smoking patients who underwent lung resection and lymph node dissection for roentgenographically occult lung cancer revealed 37 cases of exophytic squamous cell carcinoma that macroscopically protruded into the bronchial lumen. The 37 tumors were studied by both gross examination and inspection of serial blocks sectioned perpendicularly to the axis of bronchi. The macroscopic features of the exophytic tumors were classified into four types: annular constrictive (AC) in 4, polyp with superficial extension (PSE) in 14, pedunculate localized polyp (PLP) in 7, and nonpedunculate localized polyp (NLP) type in 12 cases. An AC lesion showed the annular growth narrowing the bronchus. A PSE was a lesion in which tumor protruded in the center and spread superficially in proximal and distal directions from the margin of protrusion. A PLP was a polypoid tumor that was localized in a small area with a stalk. A NLP was a polypoid tumor with a broad base that was localized in a small area without superficial invasion. Cases of each of the four types were investigated histologically and lung-saving procedures for this group of tumors were retrospectively discussed. The numbers in this series are small; however, the following hypotheses were inferred. Bronchoscopy might make it possible to differentiate these four types prior to operation. The PLP type is most suitable to lung-saving procedures, whereas lymph node dissection should be carried out for the AC type. At least 50% of patients with the AC type had extrabronchial invasion and 25% had N2 nodes. Lymph node dissection should also be carried out in patients with the NLP type, especially those with a transverse diameter ≥6 mm. For the PSE type, frozen section should be checked at the time of surgery to ensure complete resection of the tumor.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Klebsiellarhinoscleroma is a chronic granulomatous disorder of the upper respiratory tract caused by infection with the gram-negative bacillusKlebsiella rhinoscleromatis. Most commonly seen in eastern Europe, Africa, the Middle East, southeast Asia and Central America, this pathogen usually affects the nasopharynx, where chronic infection may go undiagnosed for many years. Diagnosis is often difficult because chronic inflammation causes tissue fibrosis and scarring; clinically, infection may be confused with atrophic rhinitis. Lower respiratory tract involvement is less frequent, but should be suspected when cough, dyspnea, wheezing, or hemoptysis suggest tracheobronchial obstruction. Indeed, the persistent, often indolent course of infection clinically mimics asthma, tracheal stenosis, and endobronchial spread of neoplasm.Klebsiellarhinoscleroma should be considered along with other inflammatory causes of tracheal stenosis such as Wegener's granulomatosis, tuberculosis, sarcoidosis, and fungal infections, especially in immigrants from areas of endemicity. Palliation of airway stenosis, appropriate antibiotic therapy, and close, longterm observation are the keys to successful treatment.

ISSN:1070-8030    

出版商:OVID    

年代:1994

数据来源: OVID