ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The ideal approach to diagnosis and management of patients with ventilator-associated pneumonia (VAP) has not been defined. Trauma patients with suspected VAP underwent bronchoscopy for collection of quantitative bacterial cultures and were randomized to receive either prompt empiric broad-spectrum therapy modified by culture results (intervention) or antibiotic therapy based only on results of positive cultures (control). Among 98 evaluable patients, 75 were victims of motor vehicle accidents or gunshot wounds. Seventy-two had positive bronchoscopic cultures and 18 had positive confirmatory blood or pleural fluid cultures. Among intervention patients with VAP (n = 44), the median number of days of mechanical ventilation was 17, versus 23 in control patients with VAP (n = 28; p = 0.11). Intervention patients required a median of 22 days of intensive care, while control patients required 31 (p = 0.07). Intervention patients were hospitalized a median of 37 days, control patients for 53 days (p = 0.12). Hospital charges were $106,071 in patients with VAP who received early empiric antibiotics, versus $162,413 in control patients (p = 0.06). Mortality did not differ between the two groups (18% vs. 23% overall; 21% vs. 25% in VAP patients only). Patients with VAP had a median C-reactive protein (CRP) of 24.7 mg/dL versus 18.4 mg/dL in those without VAP (p = 0.003). The receiver-operator characteristics curve area for CRP was higher than that for blood leukocyte count in predicting VAP (0.68 ± 0.06 vs. 0.45 ± 0.06; p < 0.003). Among VAP patients, serial measurements during antibiotic therapy showed a reduction of CRP from baseline to levels similar to those of patients without VAP (posttreatment level, 9.8 mg/dL; p < 0.0001). Day 14 CRP levels were lower in survivors (6.4 mg/dL vs. 14.3 mg/dL; p = 0.025). In trauma patients with suspected VAP, specific antimicrobial therapy refined by results of quantitative bronchoscopic cultures and prompt empiric antimicrobial therapy are associated with similar outcomes. CRP measurement in this setting is a potentially worthwhile marker of the presence of VAP and its response to therapy.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Massive hemoptysis is a life-threatening event that requires emergency treatment. The aim of this study was to assess the effects of bronchial artery embolization on survival in cases of massive hemoptysis. This prospective study included 24 consecutive patients with massive hemoptysis who were treated with catheterization and embolization of the bronchial arteries. Assessments at 24 hours, 30, 120, and 180 days were performed. Nine cases of multidrug-resistant tuberculosis, six of bronchiectasis, four of lung cancer, and five with diverse pathology were treated. Three patients died of hemoptysis within the following 24 hours, two at 10 days, one at 33 days, and one at 120 days; another patient died of pneumonia. Bleeding was controlled in 16 cases at 180 days. Four patients were subjected to lung resection. Kaplan-Meier survival analysis revealed an accumulative survival at 30 days of 75%, at 120 days 70.84%, and at 180 days of 66.67% (standard error of 0.0962 with 95% CI). Embolization of bronchial arteries allowed the immediate control of massive hemoptysis in the majority of cases. Operators must be skilled and experienced.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Bronchial arteriography is used mainly to visualize the bronchial arteries and their branches, and it often reveals the bleeding source in patients with hemoptysis. I report my experience with bronchial artery embolization in 280 patients with moderate to severe hemoptysis. The most common cause of bleeding was pulmonary Koch disease or posttubercular bronchiectasis. Gelfoam was used most often as the embolizing material (255 cases); however, embolizing coils were used in 23 cases, and polyvinyl alcohol was used in 2 cases. In almost all cases (91%), the immediate results were very encouraging. There was recurrent bleeding in some cases because of aspergilloma, which is a major problem in the management of hemoptysis. Bleeding recurred in 28 patients who had old tubercular lesions or posttubercular bronchiectasis. Active tubercular patients did well and had less recurrence, perhaps because simultaneous antitubercular treatment contributed to lesion regression. In this series, only 2 patients developed paraparesis, and they recovered over a 4-week period. One patient had massive hemoptysis as soon as the dye was injected in the bronchial artery, and 1 patient showed a rise in blood urea, which returned to normal in 1 week. One patient died of respiratory failure caused by extensive bilateral Koch disease 4 days after the procedure. When performed by knowledgeable and properly trained individuals, bronchial artery embolization provides successful treatment of hemoptysis.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The ability to monitor ciliary motionin vivowould help us to understand the physiological role of ciliary motion and would also be useful for the diagnosis of various disorders of the bronchi. The aim of this study was to clarify what conditions are most efficacious for the observation of ciliary motionin vivo.Lighting conditions of various combinations of the angle of the light guide fiber and objective stage were examined through a stereoscopic zoom microscope. Subsequently, a prototype bronchovideoscope that can magnify objects approximately 100 times with optimal lighting conditions similar to those found to be most efficacious was developed. The ciliary motion was visualized in the halation on the bronchial surface at magnification of 100 or more. This motion was recognized as many fine light flickers at a magnification of 100 and was recognized as many beating whips at a magnification of 500. The optimal angle of incidence to bronchial surface was found to be at 25° to 40°. Through a videoscope, many light flickers were clearly recognized on surgical specimens. Real-time observation of ciliary motionin vivowas also achieved through a flexible bronchovideoscope. This new technique holds great promise for understanding and diagnosing of the tracheobronchial disorders.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We report a patient with mucosa-associated lymphoid tissue (MALT) disease with gastric, bone marrow, and pulmonary involvement and discuss features of this condition that justify its classification and treatment as a lymphoma. The chest radiographic appearance of MALT disease is nondiagnostic and often suggests a range of pulmonary diagnoses. Additionally, while tissue histology may identify features of MALT hypertrophy, there is often difficulty establishing the disease as either benign hyperplasia or low-grade lymphoma on the basis of pathologic criteria. Even when indicators of malignancy are present, the optimal treatment approach may remain unclear. For this reason, decisions regarding treatment are often based on the biologic behavior of a particular patient's MALT disease rather than the strict histologic classification as benign or malignant.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Inflammatory pseudotumors are rare benign lung tumors. Two cases of inflammatory pseudotumors with different clinical presentations (one intrapulmonary, one endobronchial) are described. Diagnostic and therapeutic options are reviewed. Cryotherapy is proposed as a possible treatment of endobronchial inflammatory pseudotumors.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Inflammatory bowel disease (IBD) is associated with a wide variety of systemic manifestations. Yet, pulmonary involvement in Crohn's disease is rare and usually subclinical in presentation. When present, it most often occurs in the form of chronic bronchitis, alveolitis, or bronchiolitis obliterans, but rarely has tracheal or large airway involvement been described. We present a case of significant obstructive airway disease secondary to a fixed tracheal stenosis and significant right and left main bronchi narrowing secondary to Crohn's disease seen on bronchoscopy. Our patient presented in respiratory failure requiring mechanical ventilation. After Nd:YAG laser ablation and nebulized steroid therapy, the patient was successfully extubated within 48 hours. At the 4-month follow-up, the patient had normal spirometry evaluation and persistent patency of the treated airways noted on bronchoscopic evaluation.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The patient is a 74-year-old man who had been showing worsening symptoms of the cough and sputum of which he had complained for years. He had smoked 20 cigarettes a day for more than 50 years. Because his chest roentgenogram revealed right middle lobe atelectasis, bronchoscopy was performed. Four tracheal diverticula were detected on the right membranous–cartilaginous portion of the subglottic trachea, with an additional 10 bronchial diverticula on the left main bronchus, and several diverticula on other sites of the bronchi. A large amount of purulent discharge was found in the entire visible area of the tracheobronchial lumen. Bronchial toilet ameliorated atelectasis. The case presented characteristics of acquired airway pulsion diverticula, and tracheal diverticula were detectable by chest roentgenogram. An underlying disease of chronic bronchitis may have contributed to the formation of airway diverticula.

ISSN:1070-8030    

出版商:OVID    

年代:2003

数据来源: OVID