ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:The purpose of this study was to examine the biocombatibility of and possible adverse tissue reactions in air-ways to a bioabsorbable bronchial stent made of self-reinforced poly-l-lactide in an animal model. Both silicone and metallic internal stents are used to treat bronchial stenosis. Absorbable stents may offer some benefits as compared with other available stents. Tissue reactivity has been minimal when absorbable materials were used in other organs, and extraction of the stent is unnecessary. Bioabsorbable 15 mm long spiral stents were implanted intrabronchially through a standard left thoracotomy in 6 pigs weighing between 15 and 26 kg each. Macroscopically, the healing and tissue reactions around the stents were observed by repeated bronchoscopy. The histologic studies were performed when the pigs were killed after 6 months of follow-up. The stents were observed to be in the correct location 6 weeks postoperatively. At the time of death, all of the stents except one had disappeared. The bronchial wound had healed well in all animals and histology revealed normal scar tissue without any additional tissue reaction caused by the stent. This study showed that a bioabsorbable bronchial stent made of self-reinforced poly-l-lactide causes no adverse tissue reactions in the bronchial mucosa and should be investigated further. Intrabronchial stents made of self-reinforced poly-l-lactide could be suitable for treatment of bronchial stenosis.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:Flexible bronchoscopy (FFB) has been used widely in both immunocompromised patients, in whom opportunistic infection is the primary concern, and immunocompetent patients, in whom infection and malignancy are issues. The operating characteristics of FFB in these diverse settings have not been fully explored, prompting us to review our community's experience with the procedure. We identified patients under-going FFB for a nonresolving infiltrate over a 2-year period at four Rochester, New York hospitals. We classified the patients into 3 groups: Group I, immunocompromised other than acquired immunodeficiency syndrome (AIDS): Group II, immunocompetent with symptoms of pneumonia for at least 10 days with prior antibiotic therapy of at least a week; and Group III, immunocompetent patients suspected of having pulmonary malignancy. We determined the operating characteristics of FFB by pursuing follow-up until a diagnosis was established or for a minimum of 2 years by review of records, and by contacting the patient or attending physician as necessary. We were successful in follow-up on 159 patients (31 Group I, 64 Group II. and 64 Group III). FFB was most likely to yield a specific diagnosis in Group I patients (61%), compared to 38% and 31% for Groups II and III, respectively. The infiltrate in the immunocompetent patient was most likely to he infection when features of pneumonia were present (Group II), and neoplastic when not (Group III). We conclude the specificity and positive predictive values of FFB were excellent for all 3 groups. The sensitivity of the procedure was best for Group II patients (92%). All Group III patients with a false negative result were subsequently determined to have carcinoma. The predictive value of a negative result and hence the diagnostic value of FFB was best for immunocompetent patients, especially when features of pneumonia were present (95%). Despite a higher diagnostic yield, the value of a negative result was least for the immunoincompetent group (50%). We conclude that a patient's clinical features at presentation define the utility of FFB for those with a nonresolving infiltrate.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:There are increasingly frequent reports of contamination of flexible bronchoscopes by various microorganisms, generally gram-negative bacilli and mycobacteria. We report contamination of flexible bronchoscopes with Mycobacterium chelonae (MC) 6 months after the installation of an automated endoscope washer (Aseptoscope; Phagogéne, France) at our hospital. Between August and November 1994, 160 specimens, collected during flexible bronchoscopy (FFB) were sent for Ziehl-Neelsen staining and culture for mycobacteria. Thirty-three were contaminated with culture positive for MC. In its epidemiologic investigation, the hospital hygiene laboratory could not formally identify the source of the contamination. A possible source was the tap water, which was used without microfiltration during the initial operation of the washer. Retrospective examination of the patients records who underwent FFB during this period revealed no significant difference between the contaminated and uncontaminated specimens in terms of the FFB used, the type of sampling, the day and time of FFB, or the purpose of the examination. Various measures were implemented to try to eradicate the contamination, including instituting water microfiltration. Despite these modifications, the surveillance system instituted detected MC from washer's specimens several times. Six isolated bronchoalveolar lavages or secretions were found to be contaminated by MC for approximately 1 year afterwards, bringing the total number of contaminations to 39. The washer was removed from use in January 1997, and manual disinfection was resumed. Since then, MC has not been isolated from patients or from bronchoscopic specimens performed every two weeks. The consequences of contamination varied. In our department. no patient was colonized or infected, but unnecessary antimycobacterial treatment was instituted for six patients. Contamination some-times led to an initial erroneous diagnosis. To avoid contamination, particular care must be taken with the operation of endoscope washers, pending further investigation. The decontamination protocol must be respected (product used, duration of disinfection).

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:The aim of protected bronchoalveolar lavage (PBAL) is to improve the diagnostic yield in bacterial pneumonia by combining the high sensitivity of bronchoalveolar lavage (BAL) with the specificity of the protected specimen brush (PSB). We evaluated PBAL and PSB in patients infected with human immunodeficiency virus (HIV) known to have a high incidence of bacterial pneumonia and colonization of the tracheohronchial tree. Sixty-three consecutive episodes with symptoms suggestive of pneumonia were investigated prospeetively. A comprehensive microbiologic workup was performed, including quantitative cultures for bacterial agents. Each episode was classified as “pneumonia,” “control,” or “non-infectious infiltrates.” Fifty-one episodes were identified as pneumonia. A definite microbial etiology could be established in 34/51 (67% cases, including a bacterial etiology in 15/51 (29%). The sensitivity for definite and probable bacterial pneumonia was 13/22 (59%) for PSB and 15/22 (68%) for PBAL (p value not significant). Specificity was 8/8 (100%), but there were 4 false-positive results in cultures of PSB and in cultures of PBAL effluent in patients with infiltrates on chest radio-graphs. PBAL effluent had a significantly higher mean bacterial index and specific bacterial index than PSB (5.4 ± 4.9 vs. 3.3 ± 3.2, p < 0.01, and 5.6 ± 0.8 vs. 3.8 ± 2.1. p < 0.001). The yield for Pneumocystis carinii was 13/15 (87%). PBAL, as compared to PSB, had a similar diagnostic yield for bacterial pneumonia. Both techniques were highly specific, but the specificity may be lower in patients with abnormal chest radiographs. PBAL most accurately reflected the bacterial load of the area investigated, and also conserved the yield of BAL reported for P. carinii. PBAL is a rational technique for the diagnosis of pneumonia in patients with HIV.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:We describe four cases of small endobronchial neurilemmomas arising at the bronchial bifurcations. The endoscopic features of these neurilemmomas were similar to those of early carcinomas, but the neurilemmomas appeared to have less vascular proliferation. The cells of four neurilemmomas stained positive for S-100 protein on immunohistochemical examination. Only 20 cases of endobronchial neurilemmoma have been described in the literature, and most of these lesions were large and obstructed the bronchi. The possibility of neurilemmoma should be considered in the differential diagnosis of small sessile polypoid lesions found in the bronchi on bron-choscopic examination.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:Leiomyoma is rarely located in the bronchus. This report describes a 53-year-old woman with endobronchial leiomyoma (EBL). Right upper lobectomy was performed to remove the tumor, which arose from the posterior wall of the right upper bronchus. Complete resection and bronchoscopic management of this tumor may prevent relapses.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abstract:Tracheal stenosis (TS), tracheomalacia, and tracheo-esophageal fistula (TEF) are life-threatening complications, most often caused by long-term mechanical ventilation. We describe a 45-year-old man with combined thoracoabdominal trauma who developed symptoms of TEF and TS after a 20-day period of mechanical ventilation. The diagnostic and therapeutic modalities used are discussed. Periodic endoscopic inspection of the airways of all long-term ventilatior patients who have tracheostomies may help to prevent and/or to detect these complications.

ISSN:1070-8030    

出版商:OVID    

年代:1998

数据来源: OVID