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Sample records for bronchoscopes

  1. [Bronchoscopic treatment of emphysema].

    Science.gov (United States)

    Fruchter, Oren; Kramer, Mordechai R

    2012-04-01

    Bronchoscopic techniques for the management of emphysema have evolved from the success of surgical treatment. Lung volume reduction surgery (LVRS) involves the removal of 20% to 30% of each lung and targets the most emphysematous segments. Patients with heterogeneous upper lobe emphysema and a low baseline exercise capacity have been identified as a subgroup within COPD in whom mortality benefits can even be achieved, along with improvements in exercise capacity and quality of life. Increased short-term mortality of approximately 5% and postoperative morbidity are the main limitations of LVRS. The extremely restrictive selection criteria for LVRS coupled with the relatively high mortality/morbidity have been the impetus for developing less invasive endoscopic modalities. Bronchoscopic lung volume reduction (BLVR) researchers have pursued various approaches using a range of modalities, such as blockers, stents, valves, sealants, and implants. BLVR appears to be safer than LVRS in terms of mortality and morbidity. This safety profile presents an attractive alternative for patients with COPD who are fragile physiologically because of the severity of their lung disease and the presence of co-morbid illnesses. The current report aims to describe the various minimally invasive modalities available for the treatment of emphysema. PMID:22616152

  2. Bronchoscopic drainage of a malignant lung abscess.

    Science.gov (United States)

    Katsenos, Stamatis; Psathakis, Konstantinos; Chatzivasiloglou, Fotini; Antonogiannaki, Elvira-Markela; Psara, Anthoula; Tsintiris, Konstantinos

    2015-04-01

    Bronchoscopic drainage of a pyogenic lung abscess is an established therapeutic approach in selected patients in whom conventional antibiotic therapy fails. This intervention has also been undertaken in patients with abscess owing to underlying lung cancer and prior combined radiochemotherapy. However, this procedure has rarely been performed in cavitary lesions of advanced tumor origin before initiating any chemotherapy/radiotherapy scheme. Herein, we describe a case of a 68-year-old woman with lung adenocarcinoma stage IIIB, who underwent bronchoscopic drainage of necrotizing tumor lesion, thus improving her initial poor clinical condition and rendering other treatment modalities, such as radiotherapy, more effective and beneficial. Bronchoscopic drainage of a symptomatic cancerous lung abscess should be considered as an alternative and palliative treatment approach in patients with advanced inoperable non-small cell lung cancer. PMID:25887013

  3. Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia

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    G C Khilnani

    2011-01-01

    Full Text Available Background: The diagnosis of ventilator associated pneumonia (VAP remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate. Aims and Objective: To study the role of various bronchoscopic and non-bronchoscopic diagnostic techniques for diagnosis of VAP. Settings and Design: This prospective comparative study was conducted in a medical ICU of a tertiary care center. Materials and Methods: Twenty-five patients, clinically diagnosed with VAP, were evaluated by bronchoscopic and non-bronchoscopic procedures for diagnosis. The sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of various bronchoscopic and non-bronchoscopic techniques were calculated, taking clinical pulmonary infection score (CPIS of ≥6 as reference standard. Results: Our study has shown that for the diagnosis of VAP, bronchoscopic brush had a sensitivity, specificity, PPV and NPV of 94.9% [confidence interval (CI: 70.6-99.7], 57.1% (CI: 13.4-86.1, 85% (CI: 61.1-96 and 80% (CI: 21.9-98.7, respectively. Bronchoscopic bronchoalveolar lavage (BAL had a sensitivity, specificity, PPV and NPV of 77.8% (CI: 51.9-92.6, 71.8% (CI: 24.1-94, 87.3% (CI: 60.4-97.8 and 55.5% (CI: 17.4-82.6, respectively. Sensitivity, specificity, PPV and NPV for non-bronchoscopic BAL (NBAL were 83.3% (CI: 57.7-95.6, 71.43% (CI: 24.1-94, 88.2% (CI: 62.3-97.4 and 62.5% (CI: 20.2-88.2, respectively. Endotracheal aspirate (ETA yield was only 52% and showed poor concordance with BAL (k-0.351; P-0.064 and NBAL (k-0.272; P-0.161. There was a good microbiologic concordance among different bronchoscopic and non-bronchoscopic distal airway sampling techniques. Conclusion: NBAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. Our findings, if verified, might simplify the approach for the diagnosis of VAP.

  4. Fibreoptic Bronchoscope for Nasogastric Tube Placement

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    Bhandari Dhiraj

    2015-09-01

    Full Text Available A patient of stage III squamous cell carcinoma of mandible with hemi-mandibulectomy, modified radical neck dissection and radiotherapy required Ryle’s Tube (RT insertion for feeding. This case report describes use of fibreoptic bronchoscope to place an endotracheal tube in oesophagus through nasal route which was then used as a conduit to pass a RT into stomach.

  5. Tracheal schwannoma: Completely resected with therapeutic bronchoscopic techniques

    OpenAIRE

    Barney Thomas Jesudason Isaac; Devasahayam Jesudasan Christopher; Balamugesh Thangakunam; Mayank Gupta

    2015-01-01

    Tracheal schwannomas are rare benign tumors of the trachea. There are only a few reported cases in the literature. Surgeons have generally resected these tumors, whereas bronchoscopists have attempted to remove them bronchoscopically. We report a case of tracheal schwannoma which was completely resected using bronchoscopic techniques.

  6. BRONCHOSCOPIC THERAPY IN PATIENTS WITH INTRALUMINAL TYPICAL BRONCHIAL CARCINOID

    NARCIS (Netherlands)

    SUTEDJA, TG; SCHREURS, AJ; VANDERSCHUEREN, RG; KWA, B; VANDERWERF, TS; POSTMUS, PE

    1995-01-01

    Objective: To study the efficacy of bronchoscopic therapy in patients with intraluminal typical bronchial carcinoid. Design: Retrospective analysis of the data of patients with bronchial carcinoid, treated primarily with bronchoscopic techniques such as Nd-YAG laser in various hospitals in the Nethe

  7. Bronchoscopic Management of Airway Obstruction in Pediatric Endobronchial Tuberculosis

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    Jeff SW Wong

    2006-01-01

    Full Text Available The present report describes a case of severe airway obstruction caused by endobronchial tuberculosis in an 11-year-old girl who was successfully treated by bronchoscopic balloon dilation. This case illustrates the insidious presentation and the increasingly important role of bronchoscopic intervention in the management of endobronchial tuberculosis. In addition, a brief literature review of the condition in the pediatric age group is included.

  8. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease.

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    Jonathan A Kropski

    Full Text Available BACKGROUND: Although in some cases clinical and radiographic features may be sufficient to establish a diagnosis of diffuse parenchymal lung disease (DPLD, surgical lung biopsy is frequently required. Recently a new technique for bronchoscopic lung biopsy has been developed using flexible cryo-probes. In this study we describe our clinical experience using bronchoscopic cryobiopsy for diagnosis of diffuse lung disease. METHODS: A retrospective study of subjects who had undergone bronchoscopic cryobiopsy for evaluation of DPLD at an academic tertiary care center from January 1, 2012 through January 15, 2013 was performed. The procedure was performed using a flexible bronchoscope to acquire biopsies of lung parenchyma. H&E stained biopsies were reviewed by an expert lung pathologist. RESULTS: Twenty-five eligible subjects were identified. With a mean area of 64.2 mm(2, cryobiopsies were larger than that typically encountered with traditional transbronchial forceps biopsy. In 19 of the 25 subjects, a specific diagnosis was obtained. In one additional subject, biopsies demonstrating normal parenchyma were felt sufficient to exclude diffuse lung disease as a cause of dyspnea. The overall diagnostic yield of bronchoscopic cryobiopsy was 80% (20/25. The most frequent diagnosis was usual interstitial pneumonia (UIP (n = 7. Three of the 25 subjects ultimately required surgical lung biopsy. There were no significant complications. CONCLUSION: In patients with suspected diffuse parenchymal lung disease, bronchoscopic cryobiopsy is a promising and minimally invasive approach to obtain lung tissue with high diagnostic yield.

  9. Clinical analysis of bronchoscopic electrocoagulation in pediatric patients.

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    Ni, Caiyun; Yu, Huafeng; Han, Xiaorong; Meng, Chen; Zhang, Yanqing

    2014-01-01

    This study is to explore the efficacy and safety of bronchoscopic electrocoagulation treatment for pediatric disease of poor ventilation. Seventy pediatric patients of airway stenosis and obstruction as well as pharyngeal and laryngeal cysts received bronchoscopic electrocoagulation treatment, including 15 cases of epiglottic cyst, 13 cases of cicatricial hyperplasia of fibrous tissue after trachea intubation, 5 cases of foreign body in bronchus and 37 cases of endobronchial tuberculosis. Before and after the last electrocoagulation treatment, treatment efficacy was evaluated by examining the patients' clinical presentations and lesions in airway under bronchoscope, examining chest CT and pulmonary function, and estimating pulmonary atelectasis and ventilation function. Seventy cases of pediatric patients were treated by bronchoscopic electrocoagulation, with the total treatment number of 106 times. Among them, 66 cases were treated with marked efficacy and 4 cases were with effective treatment. There was no invalid treatment. The treatment efficacy was 100% without complications. Bronchoscopic electrocoagulation treatment is a fast, effective and safe therapeutic method in treating airway stenosis and obstruction, such as foreign body in bronchus, granulation tissue hyperplasia, and epiglottic cysts. It is worthy of being widely applied in clinic.

  10. Evaluation of the jet injector in paediatric fibreoptic bronchoscopes.

    Science.gov (United States)

    Sloan, I A; McLeod, M E

    1985-01-01

    The use of the Sanders venturi system during bronchoscopy in adults has been studied extensively. Its use in paediatric bronchoscopy has been limited because small changes in the characteristics of the system may produce large changes in the patient. With jet ventilation, peak inflation pressures and flow rates are influenced by the driving pressure, diameter and shape of the bronchoscope, the diameter of the injector and its length and angle from the axial line of the bronchoscope. Storz 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were evaluated in a test lung with an injector of 1.5 mm internal diameter fixed in the side-arm at 20 degrees to the axial line. Pilling 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were also examined using the standard injector with a 0.89 mm orifice in the axial line. The Storz bronchoscopes produced consistently higher peak inflation pressures and flow rates at all driving pressures in spite of the relatively large angle of the injector from the axial line. Caution is advised in the use of the Storz injector system as excessively high inflation pressures may be reached.

  11. Assessing idiopathic pulmonary fibrosis (IPF) with bronchoscopic OCT (Conference Presentation)

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    Hariri, Lida P.; Adams, David C.; Colby, Thomas V.; Tager, Andrew M.; Suter, Melissa J.

    2016-03-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a 3 year survival rate of 50%. Diagnostic certainty of IPF is essential to determine the most effective therapy for patients, but often requires surgery to resect lung tissue and look for microscopic honeycombing not seen on chest computed tomography (CT). Unfortunately, surgical lung resection has high risks of associated morbidity and mortality in this patient population. We aim to determine whether bronchoscopic optical coherence tomography (OCT) can serve as a novel, low-risk paradigm for in vivo IPF diagnosis without surgery or tissue removal. OCT provides rapid 3D visualization of large tissue volumes with microscopic resolutions well beyond the capabilities of CT. We have designed bronchoscopic OCT catheters to effectively and safely access the peripheral lung, and conducted in vivo peripheral lung imaging in patients, including those with pulmonary fibrosis. We utilized these OCT catheters to perform bronchoscopic imaging in lung tissue from patients with pulmonary fibrosis to determine if bronchoscopic OCT could successfully visualize features of IPF through the peripheral airways. OCT was able to visualize characteristic features of IPF through the airway, including microscopic honeycombing (fibrosis, and spatial disease heterogeneity. These findings support the potential of bronchoscopic OCT as a minimally-invasive method for in vivo IPF diagnosis. However, future clinical studies are needed to validate these findings.

  12. Bronchoscopic topical steroid instillation in prevention of tracheal stenosis

    OpenAIRE

    Ankit Agarwal; Singh, D. K.

    2014-01-01

    Corrosive acid poisoning commonly results in chemical injuries to respiratory and upper gastrointestinal tract. Corrosive mucosal erosion of the larynx and trachea may occur if the patient aspirates acid. We successfully used local anti-inflammatory action of dexamethasone instilled through a fiber-optic bronchoscope for regression of mucosal edema and prevention of subsequent development of stricture in a young female.

  13. Assessing idiopathic pulmonary fibrosis (IPF) with bronchoscopic OCT (Conference Presentation)

    Science.gov (United States)

    Hariri, Lida P.; Adams, David C.; Colby, Thomas V.; Tager, Andrew M.; Suter, Melissa J.

    2016-03-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a significantly worse prognosis than other forms of pulmonary fibrosis (3-year survival rate of 50%). Distinguishing IPF from other fibrotic diseases is essential to patient care because it stratifies prognosis and therapeutic decision-making. However, making the diagnosis often requires invasive, high-risk surgical procedures to look for microscopic features not seen on chest CT, such as characteristic cystic honeycombing in the peripheral lung. Optical coherence tomography (OCT) provides rapid 3D visualization of large tissue volumes with microscopic resolutions well beyond the capabilities of CT. We aim to determine whether bronchoscopic OCT can provide a low-risk, non-surgical method for IPF diagnosis. We have developed bronchoscopic OCT catheters that access the peripheral lung and conducted in vivo peripheral lung imaging in patients, including those with pulmonary fibrosis. We also conducted bronchoscopic OCT in ex vivo lung from pulmonary fibrosis patients, including IPF, to determine if OCT could successfully visualize features of IPF through the peripheral airways. Our results demonstrate that OCT is able to visualize characteristic features of IPF through the airway, including microscopic honeycombing (fibrosis, and spatial disease heterogeneity. We also found that OCT has potential to distinguish mimickers of IPF honeycombing, such as traction bronchiectasis and emphysema, from true honeycombing. These findings support the potential of bronchoscopic OCT as a minimally-invasive method for in vivo IPF diagnosis. However, future clinical studies are needed to validate these findings.

  14. Exogenous lipoid pneumonia successfully treated with bronchoscopic segmental lavage therapy.

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    Nakashima, Shota; Ishimatsu, Yuji; Hara, Shintaro; Kitaichi, Masanori; Kohno, Shigeru

    2015-01-01

    A 65-y-old Japanese man was referred to the respiratory medicine department because of abnormal radiologic findings. High-resolution chest computed tomography scans revealed a geographic distribution of ground-glass opacities and associated thickening of the interlobular septa (crazy-paving patterns) in both lower lobes. He had a habit of drinking 400-500 mL of milk and 400-800 mL of canned coffee with milk every day. A swallowing function test revealed liquid dysphagia. Bronchoalveolar lavage fluid cytology findings showed multiple lipid-laden macrophages. Taken together, these findings revealed exogenous lipoid pneumonia. We performed bronchoscopic segmental lavage therapy 3 times in the left lung. After the treatment, the radiologic findings improved in both lungs. The patient has not experienced a recurrence of lipoid pneumonia in 2 y to date. In conclusion, a case of exogenous lipoid pneumonia was successfully treated with bronchoscopic segmental lavage therapy. PMID:25161297

  15. Bronchoscopic lung biopsy for diagnosis of miliary tuberculosis

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    Aggarwal A

    2005-01-01

    Full Text Available Background: Miliary tuberculosis is often treated empirically in India in the absence of a positive diagnosis based on sputum examination. We investigated the role of fiberoptic bronchoscopy for diagnosis of this disease. Methods : Records of patients undergoing fiberoptic bronchoscopy and bronchoscopic lung biopsy, and diagnosed to have miliary tuberculosis, over a four year period were evaluated. Two to four lung biopsy specimens were obtained from each patient and examined microscopically after Hematoxylin-eosin and Zeihl-Neelson staining. Results : Thirty one patients of miliary tuberculosis (19 men and 12 women underwent fiberoptic bronchoscopy during the study period. No endobronchial abnormality was noted in any patient. Bronchoscopic lung biopsy yielded adeqaute specimen in all but one patient. Granulomatous inflammation was noted in 21 (67.7% patients on histopathological evaluation of biopsy specimens; of them, acid-fast bacilli were demonstrated in one patient. One patient (3.2% had normal alveolar architecture. In the other 8 patients (25.8%, nonspecific pulmonary interstitial inflammation and/or mild fibrosis were seen. Bronchial wash specimens showed acid-fast bacilli in only one patient; this patient also had granulomatous inflammation on lung biopsy. All patients tolerated bronchoscopy well and there were no procedure-related complications. Conclusion: Bronchoscopic lung biopsy is a safe procedure and an effective method of establishing diagnosis of miliary tuberculosis in a majority of patients with this disease. Bronchial washings do not provide significant additional information in this regard.

  16. Endoscopic bronchial occlusion with silicone spigots under virtual bronchoscopic navigation

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    Sato, Shingo; Shiroyama, Takayuki; Nishida, Takuji; Nishihara, Takashi; Okamoto, Norio

    2016-01-01

    Abstract A 68‐year‐old woman with interstitial lung disease related to dermatomyositis and systemic scleroderma was admitted to our hospital with fever and dyspnoea. Although the fever was reduced after antibiotic therapy, a left pneumothorax suddenly occurred on day 27 after admission. A continuous air leak persisted despite chest drainage with three tubes and repeated pleurodesis. Chest computed tomography (CT) images showed a cavitary lesion with a pinhole in the left upper division, which was suspected to be the affected lesion with the air leak. Virtual bronchoscopic navigation images were constructed from CT data. Bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) was performed on day 52. Two medium‐sized EWSs were inserted into the left B1 + 2a and B1 + 2b, and the air leak stopped immediately. No procedure‐related adverse events occurred. All three chest tubes were successfully removed by day 60. This case demonstrates that virtual bronchoscopic navigation can improve bronchial occlusion procedures using EWSs. PMID:27512560

  17. A novel external bronchoscope tracking model beyond electromagnetic localizers: dynamic phantom validation

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    Luo, Xiongbiao; Kitasaka, Takayuki; Mori, Kensaku

    2012-02-01

    Localization of a bronchoscope and estimation of its motion is a core component for constructing a bronchoscopic navigation system that can guide physicians to perform any bronchoscopic interventions such as the transbronchial lung biopsy (TBLB) and the transbronchial needle aspiration (TBNA). To overcome the limitations of current methods, e.g., image registration (IR) and electromagnetic (EM) localizers, this study develops a new external tracking technique on the basis of an optical mouse (OM) sensor and IR augmented by sequential Monte Carlo (SMC) sampling (here called IR-SMC). We first construct an external tracking model by an OM sensor that is uded to directly measure the bronchoscope movement information including the insertion depth and the rotation of the viewing direction of the bronchoscope. To utilize OM sensor measurements, we employed IR with SMC sampling to determine the bronchoscopic camera motion parameters. The proposed method was validated on a dynamic phantom. Experimental results demonstrate that our constructed external tracking prototype is a perspective means to estimate the bronchoscope motion, compared to the start-of-the-art, especially for image-based methods, improving the tracking performance by 17.7% successfully processed video images.

  18. Effect of fiberoptic bronchoscope compared with direct laryngoscope on hemodynamic responses to orotracheal intubation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Guo-hua; XUE Fu-shan; LI Ping; SUN Hai-yan; LIU Kun-peng; XU Ya-chao; LIU Yi; SUN Hai-tao

    2007-01-01

    @@ Fiberoptic bronchoscope (FOB) is an important instrument for respiratory, disorder examination and difficult airway management.1 The fiberoptic intubation can avoid the mechanical stimulus to oropharyngolaryngeal structures thereby it is likely to attenuate hemodynamic responses during orotracheal intubation.

  19. DETECTION OF p53 GENE MUTATION OF BRONCHOSCOPIC SAMPLIES IN THE PATIENTS SUSPECTED TO LUNG CANCER

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To determine the feasibility of detecting p53 gene mutations for early diagnosis of lung cancer using the samples from bronchoscopic examination. Methods: Point mutations of the exon 5-8 of p53 gene were detected in 85 bronchoscopic samples of 35 patients suspected to be lung cancer using silver staining PCR-SSCP. Results: p53 gene mutations were founded in 10 of 35 patients(28.6%). The incidence of p53 gene mutations (14.9%) was obviously higher than the cytological positive incidence(2.9%) in samples of sputum, bronchoalveolar lavage and brush, especially for the sputum(27.7%). In the bronchoscopic biopsy specimens, the incidence of p53 gene mutations (12.5%) was lower than that of pathologic positive result (50.0%). However, in view of all the bronchoscopic samples, there was no statistically difference between cytopathologic positive results (11.8%) and the incidence of p53 gene mutations (14.1%). Although the p53 mutations were most common in the samples from the patients bronchoscopically manifested as neoplasm compared with other manifestations, there was no statistical difference. It is valuable to notice that 3 patients with p53 gene mutation merely presented as bronchial inflammation in bronchoscope. Conclusion: Results indicated that the value of detecting p53 gene mutation for the diagnosis of lung cancer using the bronchoscopic samples was more superior to cytological examination and detection of p53 gene mutations in post-bronchoscopic sputum was easy and effective, may be used as a valuable method for early diagnosis of lung cancer.

  20. Bronchoscopic procedures and lung biopsies in pediatric lung transplant recipients.

    Science.gov (United States)

    Wong, Jackson Y; Westall, Glen P; Snell, Gregory I

    2015-12-01

    Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting.

  1. Bronchoscopic removal of aspergilloma from a cavitary lesion of the lung.

    Science.gov (United States)

    Kumar P V, Kalyan; G S, Gaude; R, Kannan; Begum R, Atharunissa; Aiyappan, Senthil Kumar

    2014-11-01

    We report a 62-year-old diabetic male who had recurrent episodes of haemoptysis, diagnosed to have Aspergilloma in the right upper lobe cavitary lesion of the lung. Bronchoscopic biopsy revealed a fungal ball (Aspergillus niger) in the right upper lobe. Since the patient did not respond to medical treatment, unfit for any surgical interventions, mechanical removal of the fungal ball was done with both rigid and flexible bronchoscopes. Patient improved symptomatically after the removal of the fungal ball; haemoptysis subsided. The patient is still under follow up without any further episodes of hemoptysis. This case report highlights a new alternative treatment option in patients with open cavitary Aspergilloma. PMID:25584256

  2. Clinical characteristics of airway foreign bodies in which bronchoscopic removal was difficult

    International Nuclear Information System (INIS)

    Airway foreign bodies may cause suffocation and pneumonia. Therefore, accurate diagnosis and expeditious removal are needed. However, we sometimes experience difficulty in removing foreign bodies from the airway by bronchoscopy. We examined the clinical characteristics of 15 cases of foreign body managed in our institute over the past 19 years, and evaluated characteristic difficulties during bronchoscopic removal. The mean age of cases was 58 years. Four patients had dementia as their underlying disease. Episodes of aspiration occurred in 10 patients. Dental foreign bodies were seen in 9 patients (60%). Chest X-ray films detected foreign bodies in 11 patients (73%), and chest computed tomography identified them in all patients. Alligator forceps and basket forceps were mainly used for removal. Fogarty forceps were also used in combination with the above in 2 patients. The foreign body was removed during the first procedure in 12 patients; however, further procedures were needed (20%) in the remaining 3 patients: using different bronchoscopic techniques, tracheotomy and surgical resection, respectively. The characteristics of these 3 cases were as follows; granulation forming around a sharp foreign body obstructing the bronchus for a prolonged period, inability of the patient to lie still due to dementia, and tracheal stenosis after tracheotomy. Characteristic difficulties during bronchoscopic removal were granulation around the foreign body, inability of the patient to lie still, and tracheal stenosis. When difficulties in bronchoscopic removal are expected, it is necessary to prepare a variety of devices in advance. (author)

  3. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia.

    Science.gov (United States)

    Davis, K Rennis; Vadakkan, D Thomas; Krishnakumar, E V; Anas, A Muhammed

    2015-01-01

    Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia. PMID:25814803

  4. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia

    OpenAIRE

    K Rennis Davis; D Thomas Vadakkan; Krishnakumar, E. V.; A Muhammed Anas

    2015-01-01

    Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia.

  5. Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration

    OpenAIRE

    Maw, Matthew; Chiu, Robert; Lim, Albert Yick Hou

    2012-01-01

    An 84-year-old woman accidentally aspirated an iron tablet. She was successfully treated with early endobronchial removal of the iron tablet remnants, oral corticosteroids and antibiotics. We describe the bronchoscopic and histological changes over time following acute iron tablet aspiration and highlight the importance of early intervention to avoid complications.

  6. Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration.

    Science.gov (United States)

    Maw, Matthew; Chiu, Robert; Lim, Albert Yick Hou

    2012-01-01

    An 84-year-old woman accidentally aspirated an iron tablet. She was successfully treated with early endobronchial removal of the iron tablet remnants, oral corticosteroids and antibiotics. We describe the bronchoscopic and histological changes over time following acute iron tablet aspiration and highlight the importance of early intervention to avoid complications. PMID:23257641

  7. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia

    Directory of Open Access Journals (Sweden)

    K Rennis Davis

    2015-01-01

    Full Text Available Pulmonary alveolar proteinosis (PAP is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia.

  8. Observation-driven adaptive differential evolution and its application to accurate and smooth bronchoscope three-dimensional motion tracking.

    Science.gov (United States)

    Luo, Xiongbiao; Wan, Ying; He, Xiangjian; Mori, Kensaku

    2015-08-01

    This paper proposes an observation-driven adaptive differential evolution algorithm that fuses bronchoscopic video sequences, electromagnetic sensor measurements, and computed tomography images for accurate and smooth bronchoscope three-dimensional motion tracking. Currently an electromagnetic tracker with a position sensor fixed at the bronchoscope tip is commonly used to estimate bronchoscope movements. The large tracking error from directly using sensor measurements, which may be deteriorated heavily by patient respiratory motion and the magnetic field distortion of the tracker, limits clinical applications. How to effectively use sensor measurements for precise and stable bronchoscope electromagnetic tracking remains challenging. We here exploit an observation-driven adaptive differential evolution framework to address such a challenge and boost the tracking accuracy and smoothness. In our framework, two advantageous points are distinguished from other adaptive differential evolution methods: (1) the current observation including sensor measurements and bronchoscopic video images is used in the mutation equation and the fitness computation, respectively and (2) the mutation factor and the crossover rate are determined adaptively on the basis of the current image observation. The experimental results demonstrate that our framework provides much more accurate and smooth bronchoscope tracking than the state-of-the-art methods. Our approach reduces the tracking error from 3.96 to 2.89 mm, improves the tracking smoothness from 4.08 to 1.62 mm, and increases the visual quality from 0.707 to 0.741. PMID:25660001

  9. Bronchoscopic resection of endobronchial inflammatory myofibroblastic tumor: A case report and systematic review of the literature

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    Animesh Ray

    2014-01-01

    Full Text Available Inflammatory myofibroblastic tumour (IMT is a rare tumour affecting the tracheo-bronchial tree in the adult population. The clinical presentation of this tumour is diverse and diagnosis can be definitively clinched by histopathological examination. Treatment of this tumour usually requires surgical resection with bronchoscopic resection being described in few cases. We describe a 32 year old male presenting with hemoptysis who was diagnosed to have IMT. Resection of the tumour was done with the help of rigid bronchoscopy. Post-resection, hemoptysis stopped and no recurrence of tumour was noted on subsequent follow-up. We also present a systematic review of literature of all the cases of tracheo-bronchial IMT treated with bronchoscopic resection and conclude it to be a useful alternative to surgery in such cases.

  10. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

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    Kundan Sandugir Gosavi

    2015-06-01

    Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

  11. Impacted Sharp Oesophageal Foreign Bodies-A Novel Technique of Removal with the Paediatric Bronchoscope.

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    Mitra, Aparajita; Bajpai, Minu

    2016-04-01

    Sharp foreign bodies in the oesophagus may present as an entirely asymptomatic child with only radiological evidence but require emergent surgical management. Safety pins, razor blades and needles are a few of the commonly ingested sharp objects in developing countries. The open safety pin is a particularly interesting clinical problem, as the management depends on its location and orientation. Many methods and instruments have been used over the years to remove them from the upper digestive tract. We present a novel method using the rigid paediatric bronchoscope and alligator forceps for the extraction of this unusual foreign body from the oesophagus of a 6 year old girl. PMID:26851436

  12. Surgical and bronchoscopic lung volume reduction in chronic obstructive pulmonary disease.

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    Meena, Manoj; Dixit, Ramakant; Singh, Mrityunjaya; Samaria, Jai Kumar; Kumar, Surendra

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient's family and country's economy. Its management continues to be a challenge to both the physician and the patient's family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR) procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date. PMID:25614834

  13. Surgical and Bronchoscopic Lung Volume Reduction in Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Manoj Meena

    2014-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient’s family and country’s economy. Its management continues to be a challenge to both the physician and the patient’s family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date.

  14. Cough quality in children: a comparison of subjective vs. bronchoscopic findings

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    Cox Nancy C

    2005-01-01

    Full Text Available Abstract Background Cough is the most common symptom presenting to doctors. The quality of cough (productive or wet vs dry is used clinically as well as in epidemiology and clinical research. There is however no data on the validity of cough quality descriptors. The study aims were to compare (1 cough quality (wet/dry and brassy/non-brassy to bronchoscopic findings of secretions and tracheomalacia respectively and, (2 parent's vs clinician's evaluation of the cough quality (wet/dry. Methods Cough quality of children (without a known underlying respiratory disease undergoing elective bronchoscopy was independently evaluated by clinicians and parents. A 'blinded' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and graded (1 to 6. Kappa (K statistics was used for agreement, and inter-rater and intra-rater agreement examined on digitally recorded cough. A receiver operating characteristic (ROC curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy. Results Median age of the 106 children (62 boys, 44 girls enrolled was 2.6 years (IQR 5.7. Parent's assessment of cough quality (wet/dry agreed with clinicians' (K = 0.75, 95%CI 0.58–0.93. When compared to bronchoscopy (bronchoscopic secretion grade 4, clinicians' cough assessment had the highest sensitivity (0.75 and specificity (0.79 and were marginally better than parent(s. The area under the ROC curve was 0.85 (95%CI 0.77–0.92. Intra-observer (K = 1.0 and inter-clinician agreement for wet/dry cough (K = 0.88, 95%CI 0.82–0.94 was very good. Weighted K for inter-rater agreement for bronchoscopic secretion grades was 0.95 (95%CI 0.87–1. Sensitivity and specificity for brassy cough (for tracheomalacia were 0.57 and 0.81 respectively. K for both intra and inter-observer clinician agreement for brassy cough was 0.79 (95%CI 0.73–0.86. Conclusions Dry and wet cough in children, as determined by clinicians and

  15. [Bronchoscopic lung volume reduction for COPD: not a real solution after all].

    Science.gov (United States)

    Wesseling, G J

    2016-01-01

    Hyperinflation is an important element in chronic obstructive pulmonary disease (COPD), contributing significantly to dyspnoea and exercise intolerance. Bronchodilators have some, albeit slight, effect on hyperinflation. Lung volume reduction surgery has been advocated in a highly select group of patients with heterogeneous, predominantly upper lobe, emphysema but morbidity and mortality associated with this intervention have hampered its widespread use in respiratory medicine. Bronchoscopic lung volume reduction has recently been introduced. Several studies have shown promising results, again in a highly select group of patients, with clinically relevant effects on symptoms, lung function and quality of life. However, for most COPD patients, prevention and slowing down of disease progression are much more important. Smoking cessation is the single most important intervention to achieve these goals. Furthermore, effective new anti-inflammatory drugs are needed since inhaled steroids, although widely used in COPD, are largely ineffective. PMID:27650026

  16. Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer

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    Punamiya Vikas

    2010-01-01

    Full Text Available Transbronchial needle aspiration (TBNA has the potential to allow adequate mediastinal staging of non-small cell lung cancer with enlarged lymph nodes in most patients without the need for mediastinoscopy. Metastasis to the mediastinal lymph nodes is one of the most important factors in determining resectability and prognosis in non-small cell lung cancer. The importance of TBNA as a tool for diagnosing intrathoracic lymphadenopathy as well as in the staging of lung cancer has been reported in various studies. We performed a literature search in PubMed and Journal of Bronchology using the keyword transbronchial needle aspiration. TBNA is a safe and effective procedure to diagnose mediastinal lymphadenopathy. Real-time bronchoscopic ultrasound-guided TBNA is the new kid on the block, which can further enhance the sensitivity of bronchoscopy in the diagnosis of mediastinal lesions.

  17. Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

    International Nuclear Information System (INIS)

    Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusions: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention at children younger than three years of age. (author)

  18. Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Miraglia, Roberto, E-mail: rmiraglia@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Vitulo, Patrizio, E-mail: pvitulo@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Maruzzelli, Luigi, E-mail: lmaruzzelli@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Burgio, Gaetano, E-mail: gburgio@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Operating Room Service, Department of Anesthesia and Intensive Care (Italy); Caruso, Settimo, E-mail: secaruso@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Bertani, Alessandro, E-mail: abertani@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Thoracic Surgery and Lung Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Callari, Adriana, E-mail: acallari@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Luca, Angelo, E-mail: aluca@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy)

    2016-03-15

    Airway stenosis is a major complication after lung transplantation that is usually managed with a combination of interventional endoscopic techniques, including endobronchial debridement, balloon dilation, and stent placement. Herein, we report a successful case of recanalization of a complete stenosis of the right middle lobe bronchus in a lung transplant patient, by using a combined percutaneous–bronchoscopic approach after the failure of endobronchial debridement.

  19. Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach

    International Nuclear Information System (INIS)

    Airway stenosis is a major complication after lung transplantation that is usually managed with a combination of interventional endoscopic techniques, including endobronchial debridement, balloon dilation, and stent placement. Herein, we report a successful case of recanalization of a complete stenosis of the right middle lobe bronchus in a lung transplant patient, by using a combined percutaneous–bronchoscopic approach after the failure of endobronchial debridement

  20. The Molecular Bronchoscope: A Tool for Measurement of Spatially Dependent CO2 Concentrations in the Lungs.

    Science.gov (United States)

    Ciaffoni, Luca; Couper, John H; Richmond, Graham; Hancock, Gus; Ritchie, Grant A D

    2016-09-01

    Respiratory physicians use bronchoscopy for visual assessment of the lungs' topography and collecting tissue samples for external analysis. We propose a novel bronchoscope tool that would enable spatially dependent measurements of the functioning of the lungs by determining local concentrations of carbon dioxide, which will be produced by healthy parts of the lung at rates that are higher than from portions where gas exchange is impaired. The gas analyzer is based on a compact laser absorption spectrometer making use of fiber optics for delivery and return of low intensity diode laser radiation to and from the measurement chamber at the distal end of a flexible conduit. The appropriate optical wavelength was chosen such that light is selectively absorbed only by gaseous CO2. The optical absorption takes place over a short path (8.8 mm) within a rigid, 12 mm long, perforated probe tip. Wavelength modulation spectroscopy was adopted as the analytical technique to reduce the noise on the optical signal and yield measurements of relative CO2 concentration every 180 ms with a precision as low as 600 part-per-million by volume. The primary objective of such a device is to see if additional spatial information about the lungs functionality can be gathered, which will complement visual observation. PMID:27487178

  1. Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: A case series of 300 patients in a tertiary care Intensive Care Unit

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    Saroj Kumar Pattnaik

    2014-01-01

    Full Text Available Introduction: Percutaneous tracheostomy (PCT is being increasingly done by intensivists for critical care unit patients requiring either prolonged ventilation and/or for airway protection. [1] Bronchoscopic guidance considered a gold standard, [2],[3] is not always possible due to logistic reasons and ventilation issues. We share our experience of Griggs PCT technique without bronchoscopic guidance with simple modifications to ensure safe execution of the procedure. Objective: The purpose of this study was to evaluate the safety issues and complications of PCT without bronchoscopic guidance in a multi-disciplinary tertiary Intensive Care Unit (ICU. Materials and Methods: A retrospective review of consecutive PCTs performed in our ICU between August 2010 and December 2013 by Griggs guide wire dilating forceps technique without bronchoscopic guidance is being presented. It is done by withdrawing endotracheal tube with inflated cuff while monitoring expired tidal volume on ventilator and ensuring the free mobility of guide wire during each step of the procedure, thereby ensuring a safe placement of the tracheostomy tube (TT in trachea. Results: Analysis of 300 PCTs showed 26 patients (8.6% had complications including 2 (0.6% patients deteriorated neurologically and 2 (0.6% deaths observed within 24 h following procedure. The median operating time was 3.5 min (range, 2.5-8 min. There were no TT placement problems in any case. Conclusion: Percutaneous tracheostomy can be safely performed without bronchoscopic guidance by adhering to simple steps as described.

  2. Bronchoscopic lung volume reduction in a single-lung transplant recipient with natal lung hyperinflation: a case report.

    Science.gov (United States)

    Pato, O; Rama, P; Allegue, M; Fernández, R; González, D; Borro, J M

    2010-06-01

    After single lung transplantation for emphysema native lung hyperinflation is a common complication that may cause respiratory failure. Herein we have reported satisfactory bronchoscopic lung volume reduction in a left single-lung transplant recipient with native lung hyperinflation, who suffered from Medical Research Council (MRC) class 3 dyspnea and chest pain. Three endobronchial valves (Zephyr; Emphasys Medical, Redwood, Calif, United States) were placed into the segmental bronchi of the right upper lobe, using videobronchoscopy under general anesthesia. Postoperative chest computed tomography revealed subsegmental atelectasis in that lobe. The clinical benefit was an improved MRC dyspnea class from 3 to 2, which was still present at 4 months after the procedure, although there were no remarkable changes in spirometric parameters.

  3. Comparison of efficacy of lignocaine anesthesia of vocal cords by spray as you go through a bronchoscope with lignocaine injection through the cricothyroid membrane

    International Nuclear Information System (INIS)

    To assess and compare the efficacy of lignocaine anesthesia of vocal cords by spray as you go through a bronchoscope with lignocaine injection through the cricothyroid membrane. Study Design: Quasi experimental study. Place and Duration of Study:This study was done in Combined Military Hospital Peshawar form May 2009 to June 2010. Material and method: Thirty patients in each group were given local anesthesia to the vocal cords. With lignocaine either via intratracheal instillation through the cricothyroid membrane or through a fibreoptic bronchoscope spray as you go. A cough score was calculated by recording the number of coughs as the bronchoscope was advanced through the cords into the trachea. A twenty point unpleasantness score was marked by the patient 2 hours after the procedure. Result: Cough score and unpleasantness score was compared among the two groups using SPSS version 19. Median unpleasantness score was 6 (Inter quartile range (IQR) 4-8) whereas median cough score was 2(IQR 0-3). The difference was statistically significant among the two groups for both cough and unpleasant scores (p< 0.001 and p< 0.001 respectively). Conclusion: Intratracheal injection of lignocaine is more comfortable for the patient. It induces much less cough and irritability to the patient than the spray as you go technique. (author)

  4. Bronchoscopic lung volume reduction

    Directory of Open Access Journals (Sweden)

    M. I. Polkey

    2006-12-01

    Full Text Available Surgical lung volume reduction can improve exercise performance and forced expiratory volume in one second in patients with emphysema. However, the procedure is associated with a 5% mortality rate and a nonresponse rate of 25%. Accordingly, interest has focused on alternative ways of reducing lung volume. Two principle approaches are used: collapse of the diseased area using blockers placed endobronchially and the creation of extrapulmonary pathways. Preliminary data from the former approach suggest that it can be successful and that the magnitude of success is related to reduction in dynamic hyperinflation.

  5. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation

    Science.gov (United States)

    Amin, Nayana; Tarwade, Pritee; Shetmahajan, Madhavi; Pramesh, C. S.; Jiwnani, Sabita; Mahajan, Abhishek; Purandare, Nilendu

    2016-01-01

    Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12-month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB. PMID:27052065

  6. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one - lung ventilation

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    Nayana Amin

    2016-01-01

    Full Text Available Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT and bronchial blockers (BBs with the pediatric fiberoptic bronchoscope (FOB is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years undergoing thoracic surgery over a 12-month period. In the study group (n = 38, measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46, DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients, preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44 to 50% (18/36 (P = 0.04. Our incidence of failed device placement at initial insertion was 4.7% (4/84. Incidence of malposition was 10% (8/80 with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36 versus 65.9% (29/44. Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.

  7. 支气管镜治疗顽固性发热的儿童大叶性肺炎%Bronchoscope in the treatment of refractory fever lobar pneumonia in children

    Institute of Scientific and Technical Information of China (English)

    王来成; 王惠丽; 赵瑜

    2015-01-01

    目的:研究经支气管镜行支气管肺泡灌洗术( baL )治疗顽固发热的儿童大叶性肺炎的疗效。方法选取2012年3月至2014年2月在开封市儿童医院呼吸科住院的顽固性发热的儿童大叶性肺炎46例,随机分为两组,支气管镜治疗组25例,常规治疗组21例。常规治疗组采用阿奇霉素联合头孢曲松抗感染,氨溴索化痰,高热时行物理或药物降温;支气管镜治疗组在常规治疗的基础上采用支气管镜行支气管肺泡灌洗术进行治疗。观察两组患者住院治疗后的退热时间。结果支气管镜治疗组和常规治疗组患者经治疗后体温均降至正常。但是,支气管镜治疗组的平均退热时间为(4.6±1.2)d,常规治疗组为(6.5±2.8)d。两组患者退热时间比较差异有统计学意义( t =3.56,p <0.05)。结论经支气管镜行支气管肺泡灌洗术,治疗顽固发热的儿童大叶性肺炎,可显著地缩短患者发热时间。%Objective to study the curative effect of bronchoscopic bronchiaL aLveoLar Lavage( baL)on persistent fever of Lobar pneumonia in chiLdren. Methods From March 20L2 to February 20L4,46 chiLdren with persistent fever of Lobar pneumonia were seLected. the cases were randomLy divided into two groups,with 25 cases in bronchoscopy group and 21 cases in routine treatment group. azithromycin and ceftriaxone were used to resist infection,and ambroxoL were used to dissoLve phLegm,physicaL or drug cooLing was given to reduce the fever in both groups. On the basis of conventionaL therapy,bronchoscopic bronchiaL aLveo-Lar Lavage( baL)were used in bronchoscopy group. after then,the fever reducing time of the two groups were observed. Results Patients’body temperature decreased to normaL after the treatments in both groups. However,the average deferves-cence time was(4. 6 ± 1. 2)days in bronchoscopy group and(6. 5 ± 2. 8)days in routine treatment group. there was significant difference

  8. Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

    Directory of Open Access Journals (Sweden)

    Andrea de Melo Alexandre Fraga

    2008-02-01

    Full Text Available OBJETIVO: Descrever manifestações clínicas e tratamento broncoscópico da aspiração de corpo estranho em crianças menores de 14 anos de idade, correlacionando com achados broncoscópicos. MÉTODOS: Estudo retrospectivo, descritivo analisando prontuários de todas as crianças menores de 14 anos de idade atendidas no Hospital das Clinicas da Universidade Estadual de Campinas de janeiro de 2000 a dezembro de 2005, submetidas à broncoscopia por suspeita clínica de aspiração de corpo estranho. RESULTADOS: Foram analisados 69 pacientes, com idade entre 8 meses e 12 anos/7 meses (75,4% abaixo de 3 anos, dos quais 62,3% eram do sexo masculino. A principal queixa foi tosse súbita (75,4%. Em 74% dos casos houve alteração de ausculta pulmonar e dispnéia foi observada em 20 crianças (29%. Um total de 88% apresentou alteração radiológica. A aspiração ocorreu predominantemente em pulmão direito (54,8%, com material de origem vegetal, destacando feijão e amendoim (30,7%. Complicações ocorreram em 29% dos pacientes, sendo pneumonia a mais comum, e foram associadas ao tempo maior de aspiração (p = 0,03. Um total de 7 pacientes (10,1% necessitaram ventilação mecânica, e 5 (7,2% foram submetidos a mais de uma broncoscopia. CONCLUSÃO: História clínica com início súbito de engasgo e tosse, anormalidades na ausculta pulmonar e na radiografia de tórax caracterizam o quadro clínico de aspiração e são indicativas de broncoscopia. Quanto maior o tempo de aspiração, maior o risco de complicações. A alta prevalência de corpos estranhos de origem vegetal alerta para a necessidade de programas preventivos dirigidos aos menores de 3 anos.OBJECTIVE: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. METHODS: A retrospective, descriptive study analyzing data related to children under 14

  9. Research progress of bronchoscopic lung volume reduction in treating end-stage emphysema%经支气管镜肺减容术治疗终末期肺气肿的研究进展

    Institute of Scientific and Technical Information of China (English)

    孙瑞琳; 金发光; 姜华; 谢永宏; 刘伟; 安琦

    2014-01-01

    Bronchoscopic lung volume reduction is a minimally invasive procedure based on the lung reduction principle,the aim is to make the far end tracheal air dispersion to pulmonary capillary circulation and the emphysematous pulmonary atelectatic,the so-called "medical resiction” dead space lung tissue in order to reduce the lung capacity.Because of the less invasive,less risk,lower cost of treatment,the wider indications compared with lung volume reduction surgery,it may have great potential clinical application to provide more choices in the treatment of end-stage emphysema.%经支气管镜肺减容术是根据肺减容原理,用微创的支气管镜下介入手术,使远端气管空气弥散到肺毛细血管循环中,近端空气不能进入而引起肺萎陷,所谓“内科切除”死腔肺组织,从而达到肺减容目的.经支气管镜肺减容术手术创伤小,安全性高,治疗费用低,较外科肺减容术适应证宽,受到越来越多的肺科医师的关注.本文拟对经支气管镜肺减容术治疗终末期肺气肿的研究进展作一综述.

  10. 纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用%The application of fiberoptic bronchoscope-guided nasal intubation and mechanical ventilation in COPD and respiratory failure in the application of

    Institute of Scientific and Technical Information of China (English)

    王峰

    2010-01-01

    Objective To explore the fiberoptic bronchoscope-guided nasal intubation and mechanical ventilation in COPD and respiratory failure in the application.Methods From January 2008 to October 2009admitted to chronic obstructive pulmonary disease (COPD)complicated by respiratory failure,120 cases of type Ⅱ fiberoptic bronchoscope intubation group was divided into 60 cases using fiberoptic bronchoscope-guided tracheal intubation through the nose,orotracheal intubation group,60 cases with orotracheal intubation,were observed.Results The fiberoptic bronchoscope fiberoptic bronchoscope intubation group under the guidance of nasal intubation All patients had an intubation success,one-time success rate of intubation was 100%,intubation time.for 1-2 min,and no case occurs when intubation heartbeat and breathing arrest,blood pressure,tracheal rupture,tracheal injury,complications such as hemoptysis.Orotracheal intubation group of patients with airway due to excessive secretion,obesity and other reasons are not fully exposed to the throat there seven cases of difficult intubation;intubation occurs when heart rate,respiratory arrest in 3 cases.Conclusion The fiberoptic bronchoscope-guided tracheal intubation through the nose is better than oral intubation with a simple operation,trauma and fewer complications,and can clear the respiratory tract,quickly correct to the obstruction and improve ventilation.%目的 探讨纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用.方法 2008年1月至2009年10月收治的慢性阻塞性肺疾病(COPD)并发Ⅱ型呼吸衰竭120例分为纤维支气管镜插管组60例采用纤维支气管镜引导下经鼻气管插管,经口气管插管组60例采用经口气管插管,进行观察.结果 纤维支气管镜插管组纤维支气管镜引导下经鼻气管插管全部病例均一次插管成功,一次性插管成功率100%,插管时间1~2 min,无一例插管时发生心跳、呼吸骤停,血压下降,气

  11. Avaliação do risco de contaminação por bactérias, no paciente submetido à broncoscopia, após o reprocessamento do broncoscópio Evaluation of the risk of bacterial contamination in the patient submitted to bronchoscopy, after reprocessing the bronchoscope

    Directory of Open Access Journals (Sweden)

    NANCY SPEKLA GRANDE

    2002-09-01

    Full Text Available Introdução: A broncoscopia é um procedimento diagnóstico e terapêutico realizado com a introdução nas vias aéreas de um tubo flexível que permite visualizar até as menores delas. Para evitar ou reduzir o risco de infecções, o broncoscópio deve ser adequadamente desinfetado com, pelo menos, desinfecção de alto nível. Objetivo: Verificar se há risco de contaminação bacteriana para os pacientes submetidos à broncoscopia do Hospital São Paulo da Unifesp, Estado de São Paulo. Métodos: No período de 1997 a 1998, o reprocessamento do broncoscópio incluiu limpeza e enxágüe com água estéril ou potável, seguida de rinsagem com glutaraldeído a 2% por 20 minutos, novo enxágüe com água estéril ou potável e rinsagem com álcool etílico a 70% e secagem com ar forçado pelo canal de sucção. Foram colhidas amostras de 65 pacientes para exames microbiológicos, instalando-se soro fisiológico estéril pelo canal de sucção do broncoscópio. Resultados: Após o reprocessamento foram encontrados nas amostras Staphylococcus epidermidis, Enterobacter sp, Acinetobacter baumanni, Streptococcus viridans, Staphylococcus aureus, Streptococcus beta hemoliticus A, Staphylococcus coagulase negativa e em cinco amostras houve crescimento de microbactéria na cultura. Conclusões: A desinfecç ão do broncoscópio com glutaraldeído a 2% não foi suficiente para garantir a desinfecção do aparelho e a presença de Staphylococcus epidermidis indica que houve contaminação do broncoscópio pela manipulação após a desinfecção.Introduction: Bronchoscopic is a diagnostic and therapeutic procedure performed by introducing a flexible tube in the airways that allows for the visualization even of the smallest airways. In order to prevent or reduce the risk of infection, the bronchoscope must be adequately disinfected with at least high level disinfection. Purpose: Check for the risk of bacterial contamination for patients submitted to

  12. Efficacy of endobronchial intubation with double-lumen tube using fiberoptic bronchoscope assisted by video laryngoscope%视频喉镜用于纤维支气管镜下双腔支气管导管插管术的辅助效果

    Institute of Scientific and Technical Information of China (English)

    张志捷; 王珊珊; 祁宾; 李法印; 苏珍; 安礼俊

    2016-01-01

    Objective To evaluate the efficacy of endobronchial intubation with double-lumen tube using fiberoptic bronchoscope assisted by video laryngoscope.Methods Thirty patients of both sexes,who underwent failed endobronchial intubation with double-lumen tube using direct laryngoscope,aged 25-64 yr,with body mass index of 23-34 kg/m2,were randomly divided into 2 groups (n=15 each) using a random number table:fiberoptic bronchoscope group (group F) and fiberoptic bronchoscope assisted by video laryngoscope group (group VF).The patients were intubated with double-lumen tube under the guide of fiberoptic bronchoscope in group F.The patients were intubated with double-lumen tube under the guide of fiberoptic bronchoscope assisted by video laryngoscope in group VF.The rate of successful intubation,intubation time,and glottis and epiglottis exposure condition when the video laryngoscope was used in group VF were recorded.The patients were followed up postoperatively,and the development of intubation-related complications (sore throat,hoarseness and swallowing difficulty) was also recorded.Results Compared with group F,the intubation time was significantly shortened,and the success rate of intubation at first attempt and second success rate of intubation were significantly increased in group VF (P<0.05).There was no statistically significant difference in the incidence of intubation-related complications between the two groups (P>0.05).Conclusion Video laryngoscope provides better efficacy for endobronchial intubation with double-lumen tube using fiberoptic bronchoscope.%目的 评价视频喉镜用于纤维支气管镜下双腔支气管导管插管术的辅助效果.方法 直接喉镜下双腔支气管导管插管失败患者30例,性别不限,年龄25 ~ 64岁,体重指数23~ 34kg/m2.采用随机数字表法分为2组(n=15):纤维支气管镜组(F组)和视频喉镜辅助纤维支气管镜组(VF组).F组患者在纤维支气管镜引导下行双腔支气管导管插

  13. 气管-支气管淋巴结瘘型结核的临床特征及经支气管镜介入治疗的研究%Features of transbronchial tuberculous mediastinal lymphadenitis and a study on bronchoscopic interventional therapy

    Institute of Scientific and Technical Information of China (English)

    苏铎华; 汤春梅; 张言斌; 方琼; 谢艺开; 肖海浩

    2014-01-01

    Objective To explore the clinical features of transbronchial tuberculous mediastinal lymph-adenitis and value of bronchoscopic interventional therapy. Methods The clinical data of 50 patients who had been diagnosed as tuberculous mediastinal lymphadenitis and had received bronchoscopic interventional therapy in our hospital during the period from January 2008 to January 2013 were retrospectively analyzed. The bronchoscopic change , improvement in symptoms , and time to sputum smear and culture conversion were used to assess the therapeutic effect. The patients were followed up for six months. Results The mean age of the patients was (35 ± 15) years and the male to female ratio was 1:1.2. The lesions occurred mostly at the right middle lobe in 24% (12/50) of the patients. The total effectiveness rate was up to 98% (49/50) after chemotherapy and bronchoscopic interventional therapy. The major complication associated with interventional therapy was hemoptysis (8%, 4/50). After follow-up of 6 months , 49 patients with active lesions were stable , with smooth bronchial mucosa and no obvious obstruction by granulation and caseous necrosis tissues. Conclusions The relavent clinical symptoms of transbronchial tuberculous mediastinal lymphadenitis is mainly caused by tuberculosis inflammation which destroys and blocks the airway. The fiber bronchoscopic therapy with forceps clip and drug infusion has a definite effect and fewer complications.%目的:探讨气管-支气管淋巴结瘘型结核的临床特征,研究经支气管镜介入治疗的效果。方法:对我院2008年1月至2013年1月住院确诊为气管-支气管淋巴结瘘型结核并接受支气管镜介入治疗的50例初治患者的临床资料进行回顾性分析,通过临床症状改善程度、支气管镜下改变及痰菌阴转时间等指标评价支气管镜介入治疗的效果,并随访6个月。结果:50例患者中,支气管瘘口分布最常见部位为右中叶,占24%(12

  14. Management of benign tracheal stenosis by intubation dilatation under flexible bronchoscopic guidance%纤维支气管镜下气管插管扩张术治疗良性气管狭窄

    Institute of Scientific and Technical Information of China (English)

    李文涛; 肖阳宝; 柳广南; 黄斯明; 凌芸; 张建全; 钟小宁

    2011-01-01

    目的 探讨纤维支气管镜(简称纤支镜)引导下气管插管扩张术治疗良性气管狭窄的效果和安全性.方法 回顾分析广西医科大学第一附属医院呼吸内科2010年3月至2011年8月采用纤支镜引导下气管插管扩张术治疗的12例不同原因所致良性气管狭窄患者的临床资料,其中男5例,女7例,年龄27 ~ 65岁,平均(37±11)岁.经纤支镜引入不同管径气管插管逐渐扩张狭窄的气管,并联合气管球囊扩张术扩张左或右主支气管,视需要临时置入金属支架,分别于术前和最后一次球囊扩张术后的当天,对患者狭窄段的气道直径、气促评分和第1秒用力呼气量(FEV1)、血气分析进行测定,并对并发症的发生情况进行评价.结果 12例患者分别接受气管插管及气管球囊扩张术1~5次后,呼吸困难迅速缓解,动脉血pH值、氧分压及血氧饱和度较治疗前明显升高,动脉血二氧化碳分压明显下降,即刻疗效达到了100%;狭窄气管,支气管的直径由治疗前的(5.7±1.2)mm增加至(12.2 +2.1)mm,FEV1由术前的(0.67±0.13)L,升高至(1.73±0.37)L,差异均有统计学意义(均P<0.01).结论 纤支镜引导下气管插管扩张术治疗良性中心性气道狭窄安全、有效.%Objective To evaluate the efficacy and safety of intubation dilatation under flexible bronchoscopic guidance in the management of benign tracheal stenosis.Methods A retrospective analysis of the clinical data was performed for 12 patients with benign tracheal stenosis from March 2010 to August 2011.There were 5 males and 7 females with a mean age of 37 ± 11 years old (range:27 -65).They were treated by intubation dilatation with different sizes under bronchoscopic guidance.And balloon dilatation was also performed for left or right main stem bronchial stenosis.And metal stents were implanted if necessary.Airway diameter,dyspnea index,complications and blood gas analysis were evaluated in all patients.And the forced

  15. ALK protein expression and gene fusion in bronchoscopic specimens of lung adenocarcinoma%检测肺腺癌活检标本间变性淋巴瘤激酶蛋白表达和基因融合

    Institute of Scientific and Technical Information of China (English)

    梁小龙; 王孟昭; 张静; 罗玉凤; 张淑英; 武莎斐; 刘媛媛; 曾瑄

    2014-01-01

    Objective To explore ALK protein expression and gene fusion in formalin-fixed and paraffin-embedded (FFPE) specimens obtained from lung cancer by bronchoscopy,and to investigate the relationship between ALK status and clinicopathological characteristics of the patients.Methods Seventyfour FFPE samples obtained from lung adenocarcinoma by bronchoscopy were tested for ALK protein expression and gene fusion respectively by immunohistochemistry (IHC) using Ventana D5F3 antibody and fluorescence in situ hybridization (FISH) using ALK break apart probe.Results sixty-five of the 74 samples were successfully tested by FISH (87.8%,65/74).There were 5 FISH-positive cases (7.7%,5/65),all with advanced stage carcinoma.Among these five FISH-positive cases,3 were IHC-positive (4.1%,3/74) and 2 IHC-negative cases.All the other 69 samples were IHC-negative,including nine FISH-uninformative samples (7 samples were less than 50 tumor cells and 2 samples with weak FISH signal).Both ALK IHC and FISH results were not correlated with age,sex,history of smoking,histological classification,differentiation and lymph node metastasis.Conclusions Bronchoscopic specimens of lung cancer can be used to detect ALK expression and gene fusion.Inmunohistochemistry in combination with FISH test may be more favorable for ALK test.%目的 探讨采用肺腺癌支气管镜活检标本检测间变性淋巴瘤激酶(ALK)蛋白表达和基因融合的可行性,及其与临床病理特征的关系.方法 74例福尔马林固定石蜡包埋的肺腺癌支气管镜活检标本,采用Bench Mark全自动免疫组化染色机和D5F3抗体试剂盒,以免疫组化法检测ALK蛋白的表达,采用Abbott ALK分离探针,以荧光原位杂交(FISH)法检测ALK基因融合.结果 74例标本中,65例成功地进行了FISH检测,成功检测率为87.8% (65/74);FISH阳性5例,阳性率为7.7%(5/65),均为中晚期低分化腺癌;其中免疫组化阳性3例,阳性率为4.1% (3/74);另2

  16. Dose-reduced 16-slice multidetector-row spiral computed tomography in children with bronchoscopically suspected vascular tracheal stenosis - initial results; Dosisreduzierte 16-Schicht-Multidetektor-Spiralcomputertomographie bei Saeuglingen und Kleinkindern mit bronchoskopischem Verdacht auf vaskulaer bedingte Trachealstenosen - erste klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Honnef, D.; Wildberger, J.E.; Das, M.; Hohl, C.; Mahnken, A.; Guenther, R.W.; Staatz, G. [Universitaetsklinikum der RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik; Schnoering, H.; Vazquez-Jimenez, J. [Universitaetsklinikum der RWTH Aachen (Germany). Klinik fuer Kinderherzchirurgie

    2006-04-15

    Purpose: To evaluate the diagnostic accuracy of contrast-enhanced dose-reduced 16-slice multidetector-row CT (MDCT) in newborns and infants with fiberoptic bronchoscopically suspected vascular-induced tracheal stenosis. Materials and Methods: 12 children (4 days to 3 years, 1.2-13.5 kg body weight) were examined using i.v. contrast-enhanced 16-slice MDCT (SOMATOM Sensation 16, Forchheim, Germany) without breath-hold and under sedation (11/12). All MDCTs were performed with a dose reduction. The beam collimation was 16 x 0.75 mm, except in the case of one child. MPRs along the tracheal axis in the x-, y- and z-directions and volume-rendering-reconstructions (VRTs) were calculated based on a secondary raw data set in addition to conventional axial slices. 2 radiologists used a three-point grade scale to evaluate the image quality, motion, and contrast media artifacts as well as the usefulness of the 2D- and 3D-reconstructions for determining the diagnosis. Statistical analysis was performed on the basis of a Kappa test. Results: In all cases the cause of the fiberoptic bronchoscopically suspected tracheal stenosis was revealed: compression due to the brachiocephalic trunk (n=7), double aortic arch (n=2), lusorian artery (n=1), vascular compression of the left main bronchus (n=2). In 3 patients further thoracic anomalies, such as tracheobronchial (n=2), and vascular (n=2) and vertebral (n=1) anomalies were found. The attenuation in the anomalous vessels was 307{+-}140 HU. The image noise was 9.8{+-}1.9 HU. The mean dose reduction was 82.7{+-}3.2% compared to a standard adult thoracic CT. All examinations were rated as diagnostically good (median 1, range 1, k=1). 3D images did not show any stair artifacts (median 2, range 1-2, k=1). The image noise was minor to moderate and hardly any motion artifacts were seen (median 1, range 1-2, k=0.8). Contrast media artifacts were rated zero to minor (median 1.5, range 1-2, k=0.676). MPRs (median 1, range 1, k=1) and VRTs

  17. 超细支气管镜在周围型肺癌诊断中的应用%Application of ultrathin fibreoptic bronchoscope in diagnosis of peripheral lung cancer

    Institute of Scientific and Technical Information of China (English)

    廉海容; 张芳; 蔡礼鸣; 游庆军

    2013-01-01

    目的 评价超细支气管镜检查在周围型肺癌诊断中的应用价值.方法 回顾性分析32例行超细支气管镜检查的周围型肺癌患者,常规支气管镜检查未发现病灶,再次行超细支气管镜检查.结果 活检25处,刷检40处.确诊16例肺癌,腺癌8例,鳞癌4例,小细胞癌2例,未分类癌2例,诊断阳性率为50.0%(16/32).其中肺内带75.0%(12/16),肺外带25.0%(4/16).超细支气管镜对肺不同部位的肿块诊断阳性率差异有统计学意义(P-0.017),其对肺内带肿块诊断阳性率较肺外带及胸膜高.常规气管镜总检查时间9~32 min,平均17.6 min;超细支气管镜总检查时间25~65 min,平均38.9 min,超细支气管镜检查时间较常规气管镜检查时间长(P=0.013).所有患者均顺利完成检查,未发生气胸和致命性大出血,且咳嗽反应较普通支气管镜检查明显小.结论 超细支气管镜作为常规气管镜的补充,能探测更远的支气管腔并获得病理,是一种有效的诊断周围型肺癌的方法,且安全微创.%Objective To evaluate the application value of ultrathin fibreoptic bronchoscopy in the diagnosis of peripheral lung cancer.Methods The data of 32 peripheral lung cancer patients who had performed ultrathin fibreoptic bronchoscopy were retrospectively analyzed.They were firstly diagnosed by conventional bronchoscope and found nothing.Secondly,ultrathin fibreoptic bronchoscopy had been done to them.Results 25 times were biopsy,40 times were brush biopsy.16 patients were identified lung cancer,eight cases were pulmonary adenocarcinoma,four cases were squamous lung carcinoma,two cases were small cell lung cancer,two cases were unclassified lung cancer,the positive rate was 50.0% (16/32).There were 12 cases (75.0%) located in inner zone of the lung,four cases (25.0%) located in outer zone of the lung.With ultrathin bronchoscopy,the positive diagnosis rate was different in different parts of the lung tumor (P =0.017).The

  18. 基于经支气管镜肺减容术治疗慢性阻塞性肺疾病的临床研究进展%Clinical advance of bronchoscopic lung volume reduction in treating chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    胡兆秋; 杨国儒

    2014-01-01

    目的 综述经支气管镜肺减容术(bronchoscopic lung volume reduction,BLVR)治疗COPD的最新临床报道和研究进展,为COPD的临床治疗和研究思路提供更多的选择.方法 对近20年来国内外发表的相关文献进行整理、分析和归纳.结果 BLVR是根据肺减容术(lung volume reduction surgery,LVRS)原理,不需行开胸术,利用支气管镜完成肺减容的微创技术.目前常用的方法有支气管封堵法和支气管开窗法.其目的都是获得LVRS益处,而减少手术创伤、风险及长期的康复过程.结论 BLVR是一种无须开胸、创伤性小的新治疗方法,在临床上大大降低了潜在的病死率和发病率,展现了巨大的临床应用前景.但由于目前还缺少大规模的随机对照临床试验结果,一些方法还处于动物实验阶段,缺乏临床研究,尚处于起步阶段.%Objective Through summarizing the clinical advance of bronchoscopic lung volume reduction (BLVR)in treating chronic obstructive pulmonary disease (COPD),to provide more choices for the clinical treatment and research idea of COPD.Methods The related references in recent 20 years at home and abroad were collected,summarized and analyzed.Results BLVR was an minimally invasive technique with bronchoscopic to achieve lung volume reduction,which was no need thoracotomy according to the lung volume reduction surgery (LVRS) principle.The commonly used methods were bronchus blocking method and bronchial fenestration.Its purpose was to obtain LVRS benefits,and reduce the surgical trauma,risk and long-term rehabilitation process.Conclusions BLVR was a new treatment method with no need thoracotomy and small surgical trauma.In clinic,it reduced greatly the potential mortality and morbidity,and showed great clinical application prospect.But due to the lack of large-scale randomized controlled clinical trials,some methods were still in the animal experiment stage and lack of clinical research,so BLVR was still in its

  19. 支气管镜下冷冻治疗儿童肉芽及瘢痕组织导致的下气道狭窄及阻塞22例%Effect of bronchoscopic cryosurgery in twenty-two children with lower airway stenosis

    Institute of Scientific and Technical Information of China (English)

    倪彩云; 孟晨; 刘霞; 马静; 陈红; 张利红; 张忠晓; 闫秀丽; 张赟; 韩晓蓉

    2012-01-01

    目的 探讨支气管镜下冷冻治疗儿童肉芽及瘢痕组织致下气道阻塞和狭窄的疗效及安全性.方法 22例包括:肺炎支原体肺炎18例,支气管内膜结核2例,支气管异物导致的肉芽组织增生,阻塞气道,引起阻塞远端肺不张1例,先天性心脏病手术气管插管后气管瘢痕引起气管重度狭窄1例.对患儿实施支气管镜下病变部位多次冷冻治疗.气管插管后导致气管狭窄的患儿,配合电凝治疗.分别于术前和最后一次冷冻治疗后,评价临床症状及支气管镜下病变部位情况,肺不张病例根据胸部CT肺不张的面积、气管重度狭窄的病例根据潮气量进行评估.结果 22例分别接受冷冻治疗1~4次.显效16例:临床症状完全改善,支气管镜下肉芽及瘢痕组织消失,灌洗治疗病变远端管腔通畅,CT见肺不张消失或基本消失.气管重度狭窄病例管腔直径由2 mm增宽为约5 mm,潮气量由3.0 ml/kg提高至8.8 ml/kg.有效5例:临床症状完全改善,支气管镜下肉芽及瘢痕组织消失,病变部位远端的部分气道变形、狭窄及闭锁,灌洗治疗不畅,CT见肺不张面积缩小1/3~ 2/3.无效1例(1/22):临床症状完全改善,支气管镜下管腔肉芽及瘢痕组织消失,但病变部位远端大部分气道管腔闭锁,灌洗治疗管腔不通畅,CT见肺不张面积未改变.总有效率95.5%.冷冻治疗术中及术后无并发症,经l~12个月随访未见病情复发.结论 支气管镜下冷冻治疗肉芽及瘢痕组织导致的儿童下气道狭窄及阻塞有效、安全.%Objective To analyze the effect and safety of bronchoscopic cryosurgery in children with lower airway stenosis caused by granulation and fiber hyperplasia.Method Twenty-two patients had undergone bronchoscopic examination and cryosurgery,18 patients with atelectasis caused by Mycoplasma pneumoniae pneumonia,2 patients with endobronchial tuberculosis (EBTB),1 patient with atelectasis caused by granulation tissue

  20. Airtraq光学可视喉镜联合 Bougie探条或纤维支气管镜在气管插管中的应用%Application of airtraq optical laryngoscope with bougie or fiberoptic bronchoscope in trache-al intubation

    Institute of Scientific and Technical Information of China (English)

    孙剑; 蔡捍东; 赵志丹

    2015-01-01

    Objective To investigate the feasibility of using alrtraq optical laryngoscope to expose glottis for tracheal intubation under general anesthesia conditions with the help of bougie or fiberoptic bronchoscopy. Method 75 adult patients with ASA ratingⅠ~Ⅱ and difficulty level of intubation ( Mallampati classification)Ⅰ~Ⅱrequiring tra-cheal intubation were selected and divided into 3 groups: the alrtraq optical laryngoscope group (25 cases), the alrtraq optical laryngoscope with the help of bougie group (25 cases), and the alrtraq optical laryngoscope with the help of fiberoptic bronchoscopy group (25 cases); the success rate, time of intubation, and the incidence rate of anesthetic complications of different intubation methods were compared. Result The success rates of the alrtraq opti-cal laryngoscope with the help of bougie and the fiberoptic bronchoscope group were significantly higher than that of the alrtraq optical laryngoscope group (P<0. 05). The intubation time of the alrtraq optical laryngoscope with the help of bougie group was significantly less than that of the alrtraq optical laryngoscope group and the alrtraq optical laryngoscope with the help of fiberoptic bronchoscope group (P<0. 05). The incidence rate of anesthetic complica-tions in the alrtraq optical laryngoscope group was significantly higher than that of the alrtraq optical laryngoscope with the help of bougie group and the fiberoptic bronchoscopy group (P<0. 05). Conclusion Due to its high success rate, short intubation time and fewer anesthetic complications, combined application of alrtraq optical laryngoscope and bougie is a favorable choice in tracheal intubation.%目的:观察全身麻醉下运用Airtraq光学可视喉镜暴露声门后,辅助使用探条或纤维支气管镜配合行气管插管的可行性。方法选取75例择期需行气管内插管手术的成年患者为研究对象, ASA 评级Ⅰ~Ⅱ级,插管困难程度分级Ⅰ~Ⅱ级,随机分为Airtraq光学

  1. Use of dexmedetomidine in intratracheal intubation with fiberoptic bronchoscope in thyroid surgeries under general anesthesia%右旋美托咪定在纤维支气管镜引导气管插管全麻甲状腺手术的应用

    Institute of Scientific and Technical Information of China (English)

    查鹏; 冯鲲鹏; 马艳辉; 张瑛; 李艳英; 刘广宇; 薛纪秀; 王天龙

    2015-01-01

    目的:研究右旋美托咪定(dexmedetomidine,Dex)对全麻甲状腺手术患者接受纤维支气管镜(fiberoptic bronchoscope,FOB)引导经口气管插管的影响.方法:拟行经口气管插管全麻甲状腺手术患者80例,美国麻醉医师协会(American Society of Anesthesiology,ASA)Ⅰ~Ⅲ级,年龄29 ~ 71岁,随机分为两组(n=40):Dex组(D组)及安慰剂组(P组).诱导前两组患者分别以Dex(1μg· kg-1,4μg·mL-1)和等量生理盐水泵入15 min,随后常规麻醉诱导,以FOB行经口气管插管,记录入室后5 min(基础值)、麻醉诱导前、气管插管前、气管插管即刻及气管插管后1,2,3,5,10 min的血压、心率和脑电双频指数(bispectral idex,BIS).观察患者气管插管的血流动力学变化及相关并发症.结果:与P组患者相比,麻醉诱导和气管插管期间,D组患者血流动力学平稳(P<0.05),并发症发生率低(但P >0.05).结论:麻醉诱导前输注Dex,可以减轻FOB引导气管插管血液动力学反应并减少其相关并发症.

  2. 支气管镜肺段灌洗联合丙种球蛋白治疗多药耐药菌肺炎的疗效研究%Study on the efficacy of lung lavage by bronchoscope combined with gamma globulin in the treatment of multi-drug resistant pneumonia

    Institute of Scientific and Technical Information of China (English)

    陈云辉; 郑利先; 罗巍; 曾博文; 陈自瑜

    2015-01-01

    OBJECTIVE To observe the efficacy of lung lavage by bronchoscope combined with gamma globulin in the treatment of multi‐drug resistant pneumonia so as to improve the curative rate of pneumonia .METHODS Total‐ly 78 cases of patients with multidrug‐resistant pneumoniae caused by K lebsiella were chosen as research objects , and all the patients were randomly divided into two groups:41 cases in the experiment group and 37 cases in the control group .Skin test was conducted to the control group to choose the suitable antibiotics for routine therapy . On the basis of this ,the observation group used lung lavage by bronchoscope combined with gamma globulin .The related indexes of Qi and blood analysis and curative effect were observed in the two groups before and after the treatments .RESULTS The effectual rate in the experimental group was 43 .9% ,significantly higher than the con‐trol group of 13 .5% .And the total effective rate in the experiment group was 90 .2% ,also significently higher than the control group of 70 .3% (P<0 .05) .After the treatments ,significant differences existed in arterial par‐tial pressure of oxygen ,carbon dioxide and arterial oxygen saturation between the two groups (P<0 .05) .No sig‐nificant differences were found between the two groups by lung functions .But after treatments ,significant differ‐ences existed in indexes like forced vital capacity ,forced expiratory volume in one second and respiratory rate in a second between the two groups (P<0 .05) .CONCLUSION Lung lavage by bronchoscope combined with gamma globulin is an effective method for curing severe pulmonary diseases with remarkable clinical efficacy and safety , hence is of high clinical value in treating multi‐drug resistant pneumonia .%目的:观察经支气管镜肺段灌洗联合丙种球蛋白治疗多药耐药菌肺炎的临床疗效,以提高肺炎的治愈率。方法选择78例多药耐药克雷伯菌属所致的肺炎患者作为研究对象,

  3. 不同类型呼吸衰竭患儿行支气管镜检查灌洗术病例对照观察%Bronchoscopic lavage in children with different types of respiratory failure: case-control analysis

    Institute of Scientific and Technical Information of China (English)

    王亚龙; 饶小春; 马渝燕; 潘跃娜; 孟辰芳; 何南; 焦安夏

    2013-01-01

    Objective To evaluate the value of bronchoscopy in children with different types of respiratory failure. Methods The clinical data of cases with respiratory failure from March 2011 to June 2012 were collected retrospectively. Changes of arterial blood gas, lung imaging and fiberoptic bronchoscopic findings were analysed. Results Finally, the results of the 60 patients were analyzed. Based on the blood gas level children were divided into group A ( ARDS Group, 11 cases) and group B (non-ARDS Group , 49 cases). Group B was divided into three subgroups; type Ⅰ respiratory failure (11 cases) , type Ⅱ respiratory failure( 17 cases) and hypercapnia alone (21cases). ① Under bronchoscope rough mucosa and edema could be found in all 60 patients. In 8/11 cases (72. 7% ) more secretion could be found in ARDS group and in 19/49 cases (38. 8% ) in non-ARDS group. Tracheostenosis could be seen in 16 cases in non-ARDS group. Hypoventilation could be seen in 2/11 cases (18. 2% ) in ARDS group and in 7/49 cases ( 14. 3% ) in non-ARDS group. Mucosal erosion could be found in 5/11 cases (45. 4% ) in ARDS group and in 2/49 cases (4. 1% ) in non-ARDS gropup. ②Etilogical diagnosis was made with bronchoscopy in 26/60 (43. 3% ) , 3/11 (27. 3% ) and 23/49 (46. 9% ) cases in ARDS and non-ARDS groups respectively.③Chest X-ray (CT) pre- and post-bronchoscopic lavage showed in ARDS group consolidation shadow, grind glass shadow and brochial aeration were the main findings, while in non-ARDS group consolidation shadow, fronchial aeration and insufficient aeration of lung were the main presentation. The efficacy rates of imaging were 87.5% (33/40) and 0% in non-ARDS and ARDS groups respectively.④ Blood gas analysis showed that improvement was found in 3/11 (27. 3% ) and 38/47 (80. 8% ) cases pre- and post-bronchoscopy in ARDS and non-ARDS groups respectively.⑤Total efficacy rates were 27. 3% (3/11) and 93.9% (46/49) in ARDS and nonARDS groups, and there was significant difference

  4. 肺泡灌洗术与纤支镜在慢阻肺合并肺不张中的诊断与治疗研究%The diagnosis and treatment study of alveolar lavage decompression and fiber bronchoscope in chronic ob- structive pulmonary disease patients complicated with pulmonary atelectasis

    Institute of Scientific and Technical Information of China (English)

    梁昆峰; 蒲晓雯; 袁钻云; 董雪宁

    2016-01-01

    目的 探讨肺泡灌洗术与纤维支气管镜在慢性阻塞性肺疾病合并肺不张的临床诊断及治疗中的价值.方法 选择80例因感染致慢阻肺合并肺不张接受治疗的患者作为研究对象,其中42例患者进行纤支镜肺泡灌洗术治疗作为试验组,38例患者采用单纯纤支镜吸痰治疗作为对照组,比较两组的正确检出率、血气分析、肺复张及转归情况.结果 病原体检测结果显示试验组细菌检出率为100%,对照组细菌检出率为86.84%,两组差异具有统计学意义(P<0.05).两组患者治疗前后血气分析指标均有明显改善,表现为PaO2升高,PaCO2降低,且差异均有统计学意义(P<0.05),但是试验组改变更明显;试验组肺复张率为88.09%,明显高于对照组(P<0.05).42例试验组总有效率为92.86%,显著高于对照组(72.32%),两组差异具有统计学意义(P<0.05).结论 对于分泌物较多致气道阻塞的慢阻肺合并肺不张患者,及时给予纤支镜吸引和肺泡灌洗,可以迅速通畅气道,使肺不张得以肺复张,加之其有安全有效、技术掌握性强的优势,值得广泛推广.%Objective To explore the value of the clinical diagnosis and treatment of the alveolar lavage op-eration and fiber bronchoscope in chronic obstructive pulmonary disease patietns complicated with atelectasis. Meth-ods 80 COPD patientscomplicated with atelectasis caused by infection were selected in this study. 42 patients were treat with alveolar lavage with bronchoscopy mirror as the experiment group, and 38 patients were treated with pure fi-ber bronchoscope sputum suction as the control group. The correct detection rate, blood gas analysis, lung recruit-ment and disease outcome were compared. Results The pathogen detection results show that the bacteria detection rate in the experiment group was 100%, while the control bacteria detection rate was 86. 84%(P <0. 05). The blood gas analysis indexes in the two groups were obviously improved

  5. Comprehensive Interventional Bronchoscopic in treatment of glottis and subglottic stenosis after intubation in 28 children%支气管镜下综合介入治疗儿童插管后声门部及声门下狭窄28例

    Institute of Scientific and Technical Information of China (English)

    刘霞; 张忠晓; 赵凤美; 马静; 李倩; 李常晓; 闫秀丽; 王玲玲; 李文刚

    2015-01-01

    Objective To discuss the effect of electronic bronchoscopy comprehensive therapy in the diagnosis and treatment of glottis and subglottic stenosis after intubation in children.Methods The records of 28 children diagnosed as glottis and subglottic stenosis after intubation by bronchoscopy in Qilu Children's Hospital of Shandong University from January 2012 to January 2015 were reviewed.They all had the neck and chest CT,bronchoscopic diagnostics,and received comprehensive treatment of laser,forceps,balloon angioplasty under electronic bronchoscopy,preoperative and postoperative evaluation was performed according to the improvement of respiratory status and endoscopic findings.All patients were followed up for 6-12 months.Results These 28 children were successfully extubated,and inspiratory dyspnea,hoarseness,and other symptoms were improved,endoscopic narrowest part was widened by 6-12 months of follow-up,including 17 cases reached clinical cure,about 6 times per patient;7 cases were successfully extubated and still in follow-up currently;2 cases of neonatal infants were extubated successfully,but they had vocal congestion,edema,glottis narrow fissure without special intervention,and were under clinical observation currently;2 cases gave up treatment because of the other problems.All patients had no serious bleeding,respiratory insufficiency or other complications.Conclusions Electronic bronchoscopic comprehensive treatment is an effective and safe method to treat glottis and subglottic stenosis after intubation in children.%目的 探讨电子支气管镜下综合治疗儿童插管后声门部及声门下狭窄的价值.方法 回顾性分析2012年1月至2015年1月山东大学齐鲁儿童医院住院的插管后声门部及声门下狭窄患儿28例临床资料.其中男13例,女15例;年龄13 d~9岁.病例均在颈部+胸部CT+支气管镜下诊断,行电子支气管镜下吸引、激光、钳夹、球囊扩张呼吸道成形术等综合治疗.根据患儿呼

  6. Bronchoscopic assessment of airway retention time of aerosolized xylitol

    OpenAIRE

    Kearney William R; Allaman Margaret M; Watt Janet L; Launspach Janice; Neelakantan Srividya; Durairaj Lakshmi; Veng-Pedersen Peter; Zabner Joseph

    2006-01-01

    Abstract Background Human airway surface liquid (ASL) has abundant antimicrobial peptides whose potency increases as the salt concentration decreases. Xylitol is a 5-carbon sugar that has the ability to lower ASL salt concentration, potentially enhancing innate immunity. Xylitol was detected for 8 hours in the ASL after application in airway epithelium in vitro. We tested the airway retention time of aerosolized iso-osmotic xylitol in healthy volunteers. Methods After a screening spirometry, ...

  7. Airway management in a bronchoscopic simulator based setting

    DEFF Research Database (Denmark)

    Graeser, Karin; Konge, Lars; Kristensen, Michael S;

    2014-01-01

    to practice on patients. OBJECTIVES: To evaluate the validity of airway simulation as an assessment tool for the acquisition of the preclinical basic skills in flexible optical intubation and to investigate anaesthetists' opinion on airway simulation. DESIGN: Observational study. SETTING: International airway...

  8. Bronchoscopic Diagnosis of Langerhans Cell Histiocytosis and Lymphangioleiomyomatosis

    OpenAIRE

    Harari, Sergio; Torre, Olga; Cassandro, Roberto; Taveira-DaSilva, Angelo M.; Moss, Joel

    2012-01-01

    Limited data are available regarding the role of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBB) as diagnostic tools in pulmonary Langerhans’ Cell Histiocytosis (LCH) and lymphangioleiomyomatosis (LAM).

  9. Successful Bronchoscopic Cryorecanalization in a Case of Endobronchial Lipoma

    Directory of Open Access Journals (Sweden)

    B. Lamprecht

    2011-01-01

    Full Text Available Endobronchial lipomas are rare benign tumors; less than 150 cases have been reported so far. Bronchial occlusion usually leads to a misdiagnosis of asthma/COPD or malignancy. We report the case of a 67-year-old man with a history of heavy smoking (100 pack years, dyspnea on exertion, cough, and malaise who was treated for pneumonia for three weeks. Due to nonresolving atelectasis of the superior segment of the right lower lobe, a malignant endobronchial tumor was suspected. Rigid bronchoscopy with cryorecanalization led to both the definite histopathological diagnosis of endobronchial lipoma and the reopening of an endoluminal airway obstruction during one procedure.

  10. Bronchoscopic assessment of airway retention time of aerosolized xylitol

    Directory of Open Access Journals (Sweden)

    Kearney William R

    2006-02-01

    Full Text Available Abstract Background Human airway surface liquid (ASL has abundant antimicrobial peptides whose potency increases as the salt concentration decreases. Xylitol is a 5-carbon sugar that has the ability to lower ASL salt concentration, potentially enhancing innate immunity. Xylitol was detected for 8 hours in the ASL after application in airway epithelium in vitro. We tested the airway retention time of aerosolized iso-osmotic xylitol in healthy volunteers. Methods After a screening spirometry, volunteers received 10 ml of nebulized 5% xylitol. Bronchoscopy was done at 20 minutes (n = 6, 90 minutes (n = 6, and 3 hours (n = 5 after nebulization and ASL was collected using microsampling probes, followed by bronchoalveolar lavage (BAL. Xylitol concentration was measured by nuclear magnetic resonance spectroscopy and corrected for dilution using urea concentration. Results All subjects tolerated nebulization and bronchoscopy well. Mean ASL volume recovered from the probes was 49 ± 23 μl. The mean ASL xylitol concentration at 20, 90, and 180 minutes was 1.6 ± 1.9 μg/μl, 0.6 ± 0.6 μg/μl, and 0.1 ± 0.1 μg/μl, respectively. Corresponding BAL concentration corrected for dilution was consistently lower at all time points. The terminal half-life of aerosolized xylitol obtained by the probes was 45 minutes with a mean residence time of 65 minutes in ASL. Corresponding BAL values were 36 and 50 minutes, respectively. Conclusion After a single dose nebulization, xylitol was detected in ASL for 3 hours, which was shorter than our in vitro measurement. The microsampling probe performed superior to BAL when sampling bronchial ASL.

  11. Ultrasonic bronchoscope guided transbronchial needle aspiration in the early diagnosis of pulmonary disease%超声支气管镜引导下经支气管针吸活检术在肺疾病中的早期诊断研究

    Institute of Scientific and Technical Information of China (English)

    杨燕; 徐大敏; 王浩凌

    2015-01-01

    目的:研究超声支气管镜引导下经支气管针吸活检术(EBUS‐TBNA )在肺疾病的早期诊断中的高效性、安全性和并发症。方法选取2013年5月至2014年5月胸部CT提示胸内包块或纵隔淋巴结肿大的28例患者行EBUS‐TBNA ,穿刺标本行病理学检查。结果28例患者中23例行EBUS‐TBNA检查,EBUS‐TBNA诊断出肺癌患者10例,转移性肿瘤4例,淋巴瘤3例,结核病3例,结节病2例,炎性患者1例。EBUS‐TBNA诊断恶性肿瘤率高达74.0%,比预期诊断率明显升高(53.2%,P<0.01)。EBUS‐TBNA诊断准确率:肺癌91.0%;淋巴瘤100.0%;转移性肿瘤75.0%;结核75.0%,结节病50.0%,炎性病变100.0%。所有行EBUS‐TBNA检查患者,仅有2例出现轻度缺氧,1例出现出血症状。结论 EBUS‐TBNA针对早期诊断呼吸疾病特别是纵隔肿块,是一种高效、微创、安全的检查手段。%Objective To research high efficiency ,safety and complications of transbronchial needle aspiration biopsy under the guidance of ultrasound bronchoscope (EBUS‐TBNA ) in the early stage diagnosis of pulmonary disease .Methods Totally 28 patients showed intrathoracic mass or mediastinal lymph nodes by chest CT treated from May 2013 to May 2014 underwent EBUS‐TBNA ,and conducted biopsy for pathological examination .Results Among all the 28 patients ,23 patients underwent EBUS‐ TB‐NA ,10 patients were diagnosed as lung cancer ,4 patients had metastatic tumors ,3 patients were diagnosed lymphoma ,3 people were tuberculosis ,2 people were sarcoidosis ,1 patients with inflammatory .The EBUS‐TBNA diagnosis rate of malignant tumor was 74 .0% ,and the diagnosis rate was significantly higher than expectation (53 .2% ,P<0 .01) .The accuracy of EBUS‐TBNA diagno‐sis was as follow :91 .0% for lung cancer ,100 .0% for lymphoma ,75 .0% for metastatic tumor;75 .0% for tuberculosis ,50 .0% for sarcoidosis ,and 100 .0

  12. Expression and Significance of NapsinA, TTF-1, CK5/6, CK7 and P63 in Biopsy Specimen by Bronchoscope of Non-small Cell Lung Cancer%NapsinA、TTF-1、CK5/6、CK7、P63在非小细胞肺癌支气管镜活检标本中的表达及意义

    Institute of Scientific and Technical Information of China (English)

    金夏祥; 俞国冰; 王爱忠; 邬丹钰; 唐晓兰

    2013-01-01

    目的 检测NapsinA、TTF-1、CK5/6、CK7及P63在非小细胞肺癌(NSCLC)支气管镜活检标本中的表达及意义.方法 采用免疫组织化学SP法检测47例NSCLC支气管镜活检标本中NapsinA、TTF-1、CK5/6、CK7及P63的表达,并结合NSCLC的临床特征病理进行分析.结果 NapsinA、TTF 1和CK7在27例肺腺癌中的阳性表达率分别为100%(27/27)、100%(27/27)和93%(25/27),表达水平明显高于CK5/6[19%(5/27)]和P63[0(0/27)](P<0.05);而CK5/6和P63在18例肺鳞癌中的阳性率均为100%(18/18),表达水平明显高于NapsinA及TTF 1[0(0/18)、0(0/18)]和CK7[11%(2/18)](P<0.05),两者差异均具有统计学意义.结论 NapsinA、TTF-1、CK7、CK5/6及P63在肺支气管镜活检标本腺癌和鳞癌鉴别诊断中具有重要意义.%Objective To detect the expression and significance of NapsinA,TTF-1 ,CK5/6.CK7 and P63 in biopsy specimen by bronchoscope of non-small cell lung cancer(NSCLC). Methods The expressions of NapsinA,TTF-l 、CK5/6、CK7 and P63 were detected by immunohistoehemical SP method in 47 NSCLC of biopsy specimen by bronchoscope,and the clinicalpathological features of NSCLC were analyzed statis tically. Results The positive rates of NapsinA. TTF-1 and CK7 were 100% (27/27), 100% (27/27) and 93%(25/27) in 27 cases of lung adenocarcinoma.respectively which was higher than CK5/6 19%(5/27) and P63 0(0/25) (P<0. 05) .respectively. The positive rates of CK5/6 and P63 were all 100% (18/1 8) in 18 cases of lung squamous cell carcinoma,respectively which was higher than NapsinA 0(0/18) , TTF-1 0 (0/18) and CK7 11 % (2/18) ( P<0. 05), respectively. Both showed significant increasing gradient. Con clusion NapsinA,TTF-1 ,CK5/6,CK7 and P63 expressions are important significance at the differential diagnosis between lung squamous cell carcinoma and adnocarcinoma in biopsy specimen by ' sonchoscope.

  13. Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

    NARCIS (Netherlands)

    Slebos, Dirk-Jan; Klooster, Karin; Ernst, Armin; Herth, Felix J. F.; Kerstjens, Huib A. M.

    2012-01-01

    Background: The lung volume reduction coil (LVR-coil), a new experimental device to achieve lung volume reduction by bronchoscopy in patients with severe emphysema, works in a manner unaffected by collateral airflow. We investigated the safety and efficacy of LVR-coil treatment in patients with hete

  14. Hyperpolarized 3He Functional Magnetic Resonance Imaging of Bronchoscopic Airway Bypass in Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Lindsay Mathew

    2012-01-01

    Full Text Available A 73-year-old exsmoker with Global initiative for chronic Obstructive Lung Disease stage III chronic obstructive pulmonary disease underwent airway bypass (AB as part of the Exhale Airway Stents for Emphysema (EASE trial, and was the only EASE subject to undergo hyperpolarized 3He magnetic resonance imaging for evaluation of lung function pre- and post-AB. 3He magnetic resonance imaging was acquired twice previously (32 and eight months pre-AB and twice post-AB (six and 12 months post-AB. Six months post-AB, his increase in forced vital capacity was <12% predicted, and he was classified as an AB nonresponder. However, post-AB, he also demonstrated improvements in quality of life scores, 6 min walk distance and improvements in 3He gas distribution in the regions of stent placement. Given the complex relationship between well-established pulmonary function and quality of life measurements, the present case provides evidence of the value-added information functional imaging may provide in chronic obstructive pulmonary disease interventional studies.

  15. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Institute of Scientific and Technical Information of China (English)

    Zhang Yu; Yu Like; Xie Haiyan; Hu Weihua; Hao Keke; Xia Ning

    2013-01-01

    Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods:The clinical features of2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results:The ratio of male/female was 4.8:1 and the peak onset age was 60~69 years old. The major pathological type was squamous cell carcinoma (44.5%), then adenocarcinoma (25.9%) and small cell lung cancer (18.3%). The incidence of squamous cell carcinoma was the highest in males (50.6%), while that of adenocarcinoma in females (56.2%). The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can signiifcantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  16. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Directory of Open Access Journals (Sweden)

    Yu Zhang

    2013-06-01

    Full Text Available Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods: The clinical features of 2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results: The ratio of male/female was 4.8:1 and the peak onset age was 60 - 69 years old. The major pathological type was squamous cell carcinoma (44.5%, then adenocarcinoma (25.9% and small cell lung cancer (18.3%. The incidence of squamous cell carcinoma was the highest in males (50.6%, while that of adenocarcinoma in females (56.2%. The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can significantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  17. Thoracoscopic detection of occult indeterminate pulmonary nodules using bronchoscopic pleural dye marking

    Directory of Open Access Journals (Sweden)

    William S. Krimsky

    2014-02-01

    Full Text Available Background: The annual incidence of a small indeterminate pulmonary nodule (IPN on computed tomography (CT scan remains high. While traditional paradigms exist, the integration of new technologies into these diagnostic and treatment algorithms can result in alternative, potentially more efficient methods of managing these findings. Methods: We report on an alternative diagnostic and therapeutic strategy for the management of an IPN. This approach combines electromagnetic navigational bronchoscopy (ENB with an updated approach to placement of a pleural dye marker. This technique lends itself to a minimally invasive wedge resection via either video-assisted thoracoscopic surgery (VATS or a robotic approach. Results: Subsequent to alterations in the procedure, a cohort of 22 patients with an IPN was reviewed. Navigation was possible in 21 out of 22 patients with one patient excluded based on airway anatomy. The remaining 21 patients underwent ENB with pleural dye marking followed by minimally invasive wedge resection. The median size of the nodules was 13.4 mm (range: 7–29. There were no complications from the ENB procedure. Indigo carmine dye was used in ten patients. Methylene blue was used in the remaining 11 patients. In 81% of cases, the visceral pleural marker was visible at the time of surgery. In one patient, there was diffuse staining of the parietal pleura. In three additional patients, no dye was identified within the hemithorax. In all cases where dye marker was present on the visceral pleural surface, it was in proximity to the IPN and part of the excised specimen. Conclusions: ENB with pleural dye marking can provide a safe and effective method to localize an IPN and can allow for subsequent minimally invasive resection. Depending on the characteristics and location of the nodule, this method may allow more rapid identification intraoperatively.

  18. Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer

    OpenAIRE

    Punamiya Vikas; Mehta Ankur; Chhajed Prashant

    2010-01-01

    Transbronchial needle aspiration (TBNA) has the potential to allow adequate mediastinal staging of non-small cell lung cancer with enlarged lymph nodes in most patients without the need for mediastinoscopy. Metastasis to the mediastinal lymph nodes is one of the most important factors in determining resectability and prognosis in non-small cell lung cancer. The importance of TBNA as a tool for diagnosing intrathoracic lymphadenopathy as well as in the staging of lung cancer has been reported ...

  19. Bronchoscopic lung volumen reduction is a treatment offered to patients with severe heterogenous emphysema

    DEFF Research Database (Denmark)

    Bendstrup, Elisabeth; Hilberg, Ole

    2014-01-01

    Idiopathic pulmonary fibrosis is a chronic, progressive interstitial pneumonia of unknown cause. It occurs primarily in older patients and is limited to the lungs. The prognosis is poor with a median survival of 2-3 years after diagnosis. The diagnosis is based on a definite pattern of usual...

  20. Bronchoscopic lung volume reduction by endobronchial valve in advanced emphysema: the first Asian report

    Directory of Open Access Journals (Sweden)

    Park TS

    2015-07-01

    Full Text Available Tai Sun Park,1 Yoonki Hong,2 Jae Seung Lee,1 Sang Young Oh,3 Sang Min Lee,3 Namkug Kim,3 Joon Beom Seo,3 Yeon-Mok Oh,1 Sang-Do Lee,1 Sei Won Lee1 1Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 2Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea; 3Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Purpose: Endobronchial valve (EBV therapy is increasingly being seen as a therapeutic option for advanced emphysema, but its clinical utility in Asian populations, who may have different phenotypes to other ethnic populations, has not been assessed.Patients and methods: This prospective open-label single-arm clinical trial examined the clinical efficacy and the safety of EBV in 43 consecutive patients (mean age 68.4±7.5, forced expiratory volume in 1 second [FEV1] 24.5%±10.7% predicted, residual volume 208.7%±47.9% predicted with severe emphysema with complete fissure and no collateral ventilation in a tertiary referral hospital in Korea.Results: Compared to baseline, the patients exhibited significant improvements 6 months after EBV therapy in terms of FEV1 (from 0.68±0.26 L to 0.92±0.40 L; P<0.001, 6-minute walk distance (from 233.5±114.8 m to 299.6±87.5 m; P=0.012, modified Medical Research Council dyspnea scale (from 3.7±0.6 to 2.4±1.2; P<0.001, and St George’s Respiratory Questionnaire (from 65.59±13.07 to 53.76±11.40; P=0.028. Nine patients (20.9% had a tuberculosis scar, but these scars did not affect target lobe volume reduction or pneumothorax frequency. Thirteen patients had adverse events, ten (23.3% developed pneumothorax, which included one death due to tension pneumothorax.Conclusion: EBV therapy was as effective and safe in Korean patients as it has been shown to be in Western countries. (Trial registration: ClinicalTrials.gov: NCT01869205. Keywords: bronchoscopy, chronic obstructive pulmonary disease, collateral ventilation, fissure integrity, treatment outcome

  1. Effect of three interventional bronchoscopic methods on tracheal stenosis and the formation of granulation tissues in dogs

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jie; WANG Ting; WANG Juan; PEI Ying-hua; XU Min; WANG Yu-ling; ZHANG Xia; WANG Chen

    2010-01-01

    Background Therapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation (APC), cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue. Methods Twelve specially bred research mongrel dogs were divided into three groups. In group 1 (four dogs) mild (procedure 1; two dogs) or moderate (procedure 2; two dogs) damage was induced mechanically. Group 2 (six dogs) received APC at different powers or durations (procedure 3:30 W, 1 amis; procedure 4:30 W, 2 cm/s; procedure 5:25 W, 3 cm/s). Group 3 (two dogs) received cryotherapy (procedure 6: two freeze-thaw cycles of 30 seconds). Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed. Results In group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4. Conclusions Lesions and stimuli from a foreign body (the stent) are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe and effective treatment method for managing tracheal stenosis caused by the formation of granulation tissue.

  2. Descriptive data on cancerous lung lesions detected by auto-fluorescence bronchoscope: A five-year study

    Directory of Open Access Journals (Sweden)

    Asmitananda Thakur

    2012-01-01

    Full Text Available Background: Auto-fluorescence bronchoscopy (AFB has been used for the identification and localization of intra-epithelial pre-neoplastic and neoplastic lesions within the bronchus. Objectives: To determine the applicability of AFB for the detection and localization of precancerous and cancerous lesions, in addition to analyzing the morphologic presentation, their association to histological type and the variation between genders. Methods: A five-year study involving 4983 patients, who underwent routine bronchoscopy [B] examination in a local tertiary teaching hospital, was done. The B examination was performed under intratracheal lidocaine, and samples were obtained using suitable approach. One thousand four hundred and eighty-five pathologically confirmed lung cancer patients were included in the study. The following parameters were studied: Morphological presentation, biopsy sites, histology. Differences between the groups were analyzed using Chi square test. Result: One thousand four hundred and eighty-five patients who had hyperplasia or neoplastic lesions were further confirmed as lung cancer pathologically. Lung cancer was more commonly found in the right lung (51.58% vs. 42.82%. The lesion occurred more frequently in the upper lobe than the lower lobe (44.17% vs. 22.42%. Male patients with squamous cell carcinoma showed upper lobe involvement more commonly, while the left main bronchus was more commonly involved in female patients. Adenocarcinoma mostly involved lesion of the upper lobe. Squamous cell carcinoma and small cell carcinoma were the major proliferative types (80.15% and 76.16% respectively. Conclusion: AFB is efficient in the detection of pre-invasive and invasive lung lesions. The morphological presentation is associated to the histological type. There is variation in the presentation and histology of cancerous lung lesions between genders.

  3. Textile fiber bronchoscope after the nose trachea intubation in ICU application%纤维支气管镜经鼻气管插管在ICU的应用

    Institute of Scientific and Technical Information of China (English)

    龙训辉

    2011-01-01

    目的:探讨纤支镜引导下经鼻气管插管在ICU患者的应用价值和意义.方法:对102例呼吸衰竭患者床边采用纤支镜引导下经鼻气管插管总结分析其临床资料.结果:102例患者全部顺利完成气管插管,成功率100%,无严重并发症发生.插管时间25s-5m.结论:纤维支气管镜引导下经鼻气管插管快速、准确、安全在ICU患者中具有很高的应用价值.

  4. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema : A Prospective Feasibility Trial

    NARCIS (Netherlands)

    Klooster, Karin; ten Hacken, Nick H. T.; Franz, Ina; Kerstjens, Huib A. M.; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction (LVR) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic LVR coil treatment has been shown to

  5. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema: A Prospective Feasibility Trial

    NARCIS (Netherlands)

    Klooster, K.; Hacken, N. Ten; Franz, I.; Kerstjens, H.; Rikxoort, E.M. van; Slebos, D.J.

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction ({LVR}) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic {LVR} coil treatment has been show

  6. 纤维支气管镜肺减容术治疗绵羊肺气肿模型的实验研究%Treatment of pulmonary emphysema sheep model through bronchoscopic lung volume reduction:an experimental study

    Institute of Scientific and Technical Information of China (English)

    冯志军; 路武杰; 滕伟; 郭俊华; 黄志昂; 王红燕; 靳建军; 王静

    2014-01-01

    目的:探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性.方法:将16只6月龄雌性绵羊随机分为A、B2组,木瓜蛋白酶方法建立肺气肿模型.A组经纤支镜射频建立气道旁路并放置支架,2组均给予内科治疗.分别测2组绵羊术前和术后24 h、4、8周的第1秒用力呼气容积(forced expiratory volume in one second,FEV10),且进行比较,A组定期行胸部CT检查,2组动物治疗8周均予以处死,行病理学检查.结果:①成功复制绵羊肺气肿动物模型16只,A组术中、术后无并发症出现;②A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;③2组不同时间点FEV10水平差异有统计学意义(F时间=1 352.409,P=0.000),2种治疗手段效果差异有统计学意义(F组间=5 004.278,P=0.000),治疗手段和时间之间有交互作用(F交互=1 325.058,P=0.000);④病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织.结论:该技术治疗绵羊肺气肿模型具有有效性及优越性.

  7. Dilation Guided by Fiberopic Bronchoscope Treating for Subglottic Stenosis in Infants%纤维支气管镜引导下气管扩张术治疗婴儿声门下狭窄

    Institute of Scientific and Technical Information of China (English)

    孙云霞; 何少茹; 梁穗新; 钟劲; 刘玉梅; 葛平江; 余宇晖

    2010-01-01

    目的 评价纤维支气管镜(FB)引导下气管扩张术治疗婴儿声门下狭窄(SGS)的效果及安全性.方法 收集本院2004年1月-2009年6月经FB检查确诊的SGS病例27例.给予保守治疗,或FB引导下,将不同型号的气管插管作为扩张器,逐渐增大管径行气管扩张术治疗.比较患儿的-般资料、首次镜检结果、气管扩张次数、扩张时不良反应、总治疗时间、随访情况等,比较不同程度SGS及不同性质SGS的扩张次数及治疗时间.结果 共23例患儿完成治疗及随访.I度SGS 5例、Ⅱ度SGS 10例、Ⅲ度SGS 8例.病例均为先天性心脏病手术麻醉气管插管后获得性SGS,4例I度SGS患儿给予观察及内科治疗,未行气管扩张术;余19例患儿因梗阻性呼吸困难立即行气管扩张术,无严重不良反应;除1例患儿人院前因在巴西手术后患SGS已行气管切开术,其余病例均未行挂戈洽切开术.所有病例扩张次数为1~6(2.17±1.59)次,I度、Ⅱ度及Ⅲ度SGS患儿扩张次数分别为(0.40±0.89)次、(2.70±1.16)次、(2.63±1.69)次,三者比较差异有统计学意义(P=0.013),但Ⅱ度与Ⅲ度比较差异无统计学意义(P=0.762).所有病例治疗时间为0.5~6.0(1.33±1.27)个月,I度、Ⅱ度及Ⅲ度SGS患儿治疗时间分别为(0.80±0.67)个月、(1.22±0.50)个月和(2.21±1.66)个月,三者比较差异有统计学意义(P = 0.007),II度与Ul度比较差异无统计学意义(P=0.395).膜状狭窄及硬疤痕并肉芽样狭窄病例的扩张次数比较差异无统计学意义(P=0.727).随访时间2~66个月,平均17.5个月.2例患儿分别于扩张术后2个月及3个月因先天性心脏病术后并发症死亡,但无梗阻性呼吸困难;其余病例均生存良好,且无明显呼吸道梗阻症状.结论 FB检查能早期诊断婴儿SGS.在FB引导下,将不同型号的气管插管作为扩张器行气管扩张术治疗SGS简单易行、安全可靠,且经济有效,可避免气管切开威胁儿童生命及造成生存质量低下.

  8. Nursing and effective assessment of Dexmedetomidine conscious sedation in the fiber bronchoscope examination%纤维支气管镜检查中右美托咪定清醒镇静的护理及其效果

    Institute of Scientific and Technical Information of China (English)

    程锐; 高丽娟; 王传光; 吴炜

    2014-01-01

    目的:评价右美托咪定用于纤维支气管镜(FB)检查患者清醒镇静治疗的护理及使用效果,以提高FB检查中患者舒适度。方法选择2011年10月~2013年12月在浙江省丽水市中心医院行FB检查的126例患者,分为A、B两组。 A组采用高氧驱动以7 L/min的速度用面罩雾化吸入2%利多卡因5 mL行表面麻醉+环甲膜穿刺局部麻醉。B组将右美托咪定针按0.6μg/kg标准在10 min内用微量注射泵匀速输完全,同时复合高氧驱动雾化吸入2%利多卡因5 mL表面麻醉。并将两组患者在检查中的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)等在入室未使用药物前(T1)、FB检查前(T2)、FB插入声门时(T3)、插入支气管后(T4)、检查结束时(T5)5个时间点进行监测,评定麻醉效果,记录检查期间的不良反应等并进行对比分析。结果两组患者在性别、年龄、体重、美国麻醉医师协会(ASA)分级上比较差异无统计学意义(P>0.05)。 A组患者检查期自T2时间点起MAP、HR监测数据开始逐步升高,不良反应增加。B组MAP、HR稍有变化,与A组比较差异有统计学意义(P 0.05). For patients of group A, MAP and HR monitoring data began to rise gradually from time point T2 during the examination period, and the adverse re action increased. Compared with group A, the changes of MAP and HR in group B were of statistically significant difference (P<0.05). Compared with group A, the examination time required for patients in group B was significantly shortened, the patients’ com-fortable level increased, the nursing work reduced and the excellent and good rate of anesthesia effect was higher, and there were significant differences (P<0.05). The incidence of adverse reations in group A of patients was 60.31%, and was 12.70%in group B, there was statistically significant difference (P< 0.05). Conclusion Under the ef-fective, reasonable and standardized nursing security, conscious sedation combined with anesthesia by intravenous slow induction of Dexmedetomidine and by inhalation surface anesthesia of 2% Lidocaine driven by high oxygen, can not only make the FB examination smoothly but also reduce the patients’suffering and the occurrence of adverse events.

  9. Tension pneumothorax during flexible bronchoscopy in a nonintubated infant.

    Science.gov (United States)

    Chan, Ian A; Gamble, Jonathan J

    2016-04-01

    We describe the case of a tension pneumothorax occurring during flexible bronchoscopy in a nonintubated infant. The pneumothorax likely occurred secondary to wall source oxygen insufflation via the bronchoscope without sufficient gas egress. The use of wall source oxygen via the bronchoscope working channel is inherently dangerous and should be avoided. PMID:26740408

  10. Observation on clinical therapy effect of tuberculose respiratory tract choke with therapeutic procedures of tiny electronic bronchoscope cut and intervention%经电子气管镜微创介入治疗结核性气道阻塞临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱春梅

    2009-01-01

    目的 探讨经电子气管镜微创介入治疗结核性气道阻塞的临床疗效.方法 对68例结核性气道阻塞的患者给予全身常规抗结核治疗的同时,加用电子气管镜微创介入治疗,镜下根据气管阻塞情况选择钳夹、刷洗、微波烧灼、激光等微创治疗后再介入抗结核药物.结果 68例中管口完全通畅44例、基本通畅22例.气道阻塞未改变2例.总有效率97%.结论 经电子气管镜微创加介入治疗可逆性结核性气道阻塞疗效肯定,并发症少,有效改善肺不张、防止进一步肺毁损.

  11. Application of bronchoscopic lung volume reduction using one-way flap device in sheep model of heterogeneous emphysema%纤维支气管镜肺减容术在绵羊肺气肿模型中的应用

    Institute of Scientific and Technical Information of China (English)

    吴琦; 李卫平; 任宝香; 武俊平; 范勇; 梁春宝; 马景良; 李萍; 华静娜; 王咏梅; 王金荣

    2006-01-01

    目的评价使用纤维支气管镜单向活瓣支架肺减容术治疗肺气肿动物模型的疗效和安全性.方法6月龄绵羊6只,全麻下经纤维支气管镜在肺段局部给予木瓜蛋白酶(75 U/kg)后,机械通气15~20 min形成肺气肿模型.通过CT确定靶区后,在X线造影定位并确定靶支气管后,经纤维支气管镜通过导丝和放送装置在肺气肿亚段放入1~2个单向活瓣支架,术后给予3 d抗炎治疗.在术前和术后8周测量肺功能残气量;术后8周处死动物取出完整肺组织,在萎陷区、非萎陷区和对侧正常肺组织分别取材,观察大体及光镜下病理学改变.结果应用纤维支气管镜肺减容术后,动物耐受性较好,术后无明显咳嗽、呼吸困难症状,术后1 h动物即可进食、行走.病理观察无肺部炎症、肺脓肿和肉芽肿形成,2只动物支架处支气管壁少量纤维母细胞和平滑肌及支气管黏膜上皮细胞增生,4只动物未见明显异常.支架远端肺组织大体标本和光镜下均证实存在肺不张,术后肺功能残气量较术前明显降低(降低49.5%),手术过程安全、操作简单易行.结论经纤维支气管镜单向活瓣支架肺减容术治疗肺气肿创伤小,支架对于气管壁的刺激小,可以达到外科肺减容术的效果;所做的动物模型为不均一肺气肿,与人类发病类型很相似,故对进一步行临床研究有一定的参考价值;因术后观察时间仅为8周,支架远期对气道的损伤及其疗效需要进一步研究.

  12. Primary study on bronchoscopic lung volume reduction using one-way flap stent made in China in sheep model of heterogeneous emphysema%国产支架支气管肺减容术在绵羊肺气肿模型中的初步应用

    Institute of Scientific and Technical Information of China (English)

    范勇; 吴琦; 梁春宝; 李萍; 马景良; 武俊平; 华静娜; 王咏梅; 王金荣; 沈淑敏; 贺能树

    2007-01-01

    目的 评价经气道国产单向活瓣支架肺减容术治疗肺气肿动物模型的放送技术和稳定性.方法 应用局部气管内滴注木瓜蛋白酶方法复制6个月龄绵羊不均一肺气肿模型,经纤维支气管镜通过导丝和放送装置在肺气肿亚段放入1、2个单向活瓣支架,术后8周处死动物取出完整肺组织,在萎陷区、非萎陷区和对侧正常肺组织分别取材,观察大体及光镜下病理学改变.结果 7只绵羊气肿模型,共放置支架10支,9支均成功植入.病理观察1只出现肺部炎症细胞浸润,2只植入支架处支气管壁有少量纤维母细胞、平滑肌细胞及支气管粘膜上皮细胞增生,4只未见明显异常.CT检查支架远端、肺组织大体标本和光镜下均证实存在肺不张.结论 经纤维支气管镜植入单向活瓣支架行肺减容术治疗肺气肿创伤小,支架对气管壁的刺激小,可以达到外科肺减容术的效果.

  13. 镜下射频置管肺减容术在肺气肿绵羊的应用%The application of establishing airway bypass by bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema

    Institute of Scientific and Technical Information of China (English)

    郭俊华; 路武杰; 冯志军; 黄志昂; 王红燕; 靳建军; 王静

    2014-01-01

    目的 探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性.方法 将16只6个月龄雌性绵羊随机分为A、B两组,木瓜蛋白酶方法建立肺气肿模型.A组经纤支镜射频建立气道旁路并放置支架,给予内科治疗,B组仅给予常规内科治疗.分别测两组绵羊术前和术后24 h、4周、8周的第1秒用力呼气容积(B超仅衔常规内科治疗,FEV10),且进行比较,A组定期行胸部CT检查,两组动物治疗8周均予以处死,行病理学检查.结果 ①成功复制绵羊肺气肿动物模型16只,A组术中、术后无明显异常;②A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;③两组不同时间点FEV1.水平差异有显著性(F时间=1 352.409,P<0.001),两种治疗手段效果差异有显著性(F组间=5 004.278,P<0.001),治疗手段和时间之间有交互作用(F交互=1 325.058,P<0.001);(④病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织.结论 该技术治疗绵羊肺气肿模型具有有效性及优越性.

  14. 经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性%The effectiveness and superiority of establishing the airway bypass through bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema

    Institute of Scientific and Technical Information of China (English)

    冯志军; 路武杰; 郭俊华; 黄志昂; 王红燕; 靳建军; 王静

    2013-01-01

    目的 探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性.方法 将16只6月龄雌性绵羊随机分为A、B两组,木瓜蛋白酶方法建立肺气肿模型.A组经纤支镜射频建立气道旁路并放置支架,同时给予内科治疗,B组仅给予内科治疗.分别测两组绵羊术前和术后24h、4周、8周的第1秒用力呼气容积(forced expiratory volume in one second,FEV1.0),且进行比较;A组定期行胸部CT检查,治疗8周处死动物,行病理学检查.结果 成功复制绵羊肺气肿动物模型16只,A组术前、术中、术后无明显异常;A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;两组不同时间点FEV1.0水平差异有统计学意义(F时间=1352.409,P<0.001),两种治疗手段效果差异有统计学意义(F组间=5004.278,P<0.001),治疗手段和时间之间有交互作用(F交互=1325.058,P<0.001);病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织.结论 该技术治疗绵羊肺气肿模型具有有效性及优越性.

  15. Diagnostic bronchoscopy: state of the art

    Directory of Open Access Journals (Sweden)

    V. Ninane

    2010-09-01

    Full Text Available Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.

  16. The effect of fibreoptic bronchoscopy in acute respiratory distress syndrome: experimental evidence from a lung model.

    Science.gov (United States)

    Nay, M-A; Mankikian, J; Auvet, A; Dequin, P-F; Guillon, A

    2016-02-01

    Flexible bronchoscopy is essential for appropriate care during mechanical ventilation, but can significantly affect mechanical ventilation of the lungs, particularly for patients with acute respiratory distress syndrome. We aimed to describe the consequences of bronchoscopy during lung-protective ventilation in a bench study, and thereby to determine the optimal diameter of the bronchoscope for avoiding disruption of the protective-ventilation strategy during the procedure. Immediately following the insertion of the bronchoscope into the tracheal tube, either minute ventilation decreased significantly, or positive end-expiratory pressure increased substantially, according to the setting of the inspiratory pressure limit. The increase in end-expiratory pressure led to an equivalent increase in the plateau pressure, and lung-protective ventilation was significantly altered during the procedure. We showed that a bronchoscope with an external diameter of 4 mm (or less) would allow safer bronchoscopic interventions in patients with severe acute respiratory distress syndrome. PMID:26559154

  17. Effect of fiberoptic intubation on myocardial ischemia and hormonal stress response in diabetics with ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Nashwa Nabil Mohamed

    2014-01-01

    Conclusion: The optimum use of fiberoptic bronchoscope with avoidance of jaw thrust maneuver attenuates the hemodynamic response to intubation which is beneficial in diabetic patients with ischemic heart disease. Stress response hormones showed no statistically significant difference between groups.

  18. Minimally Invasive Treatment for Lung Cancer

    Medline Plus

    Full Text Available ... Okay. That’s where the multidisciplinary approach a very helpful because we meet on a weekly basis and ... the multiplication of this bronchoscope, which is very helpful. This camera helps us to visualize, you know, ...

  19. Usefulness of CT virtual endoscopy in imaging a large esophagorespiratory fistula

    Energy Technology Data Exchange (ETDEWEB)

    Sonomura, Tetsuo; Kishi, Kazushi; Ishii, Seigo; Kawai, Nobuyuki; Masuda, Mitsunori; Terada, Masaki; Nakamine, Hirokazu; Sato, Morio

    2000-04-01

    A 73-year-old woman with a large esophagorespiratory fistula underwent bronchoscopy and computed tomographic (CT) virtual endoscopy before stenting. Noninvasive CT virtual endoscopy showed the large fistula, and the CT findings agreed with the bronchoscopic findings.

  20. Bronchial Anthracotic Change in South Khorasan Province (Iran), Emphasizing its Association with Tuberculosis

    OpenAIRE

    Sayyed Gholamreza Mortazavi-Moghaddam; Sayyed Alireza Saadatjoo

    2014-01-01

    Background: There are many reports on the association between anthracosis and tuberculosis. This study focuses on bronchial anthracosis and associated diseases in the province of South Khorasan-Iran. Methods: This case-series study is performed on patients referred to the Vali-e-Asre Hospital (South Khorasan-Iran) for bronchoscopic evaluations during the period of 2009-2012. Written informed consents were obtained prior to bronchoscopic evaluations. The criterion for diagnosis of bronchial...

  1. Advanced bronchoscopy for the diagnosis of peripheral pulmonary lesions.

    Science.gov (United States)

    Asano, Fumihiro

    2016-07-01

    Bronchoscopy to examine peripheral pulmonary lesions is performed using a bronchoscope with an outer diameter of 5-6mm under fluoroscopy, but the diagnostic yield can be insufficient. Problems with transbronchial biopsy include a limited range of bronchoscope insertion, difficulty in guiding a bronchoscope and biopsy instruments to lesions, and insufficient confirmation of the arrival of biopsy instruments at the target lesion; as such, new techniques have been used to overcome these individual problems. Radial-endobronchial ultrasound is used to identify peripheral pulmonary lesions and sampling sites. In a meta-analysis, the diagnostic yield, that of lesions smaller than 2cm, and complication rate were 73, 56.3, and 1.0%, respectively. Virtual bronchoscopic navigation is a method to guide a bronchoscope to peripheral lesions under direct vision using virtual bronchoscopic images of the bronchial route, and the diagnostic yield, that of 2-cm or smaller lesions, and complication rate were 73.8, 67.4, and 1.0%, respectively. Electromagnetic navigation utilizes electromagnetism; the diagnostic yield was 64.9-71%, and the pneumothorax complication rate was 4% for this modality. Ultrathin bronchoscopes can be advanced to the peripheral bronchus under direct vision in contrast to normal-size bronchoscopes, and the diagnostic yield and pneumothorax complication rates were reported to be 63 and 1.5%, respectively. The overall diagnostic yield of these new techniques on meta-analysis was 70%, a higher yield than that obtained with conventional transbronchial biopsy. Each technique has advantages and disadvantages, and the investigation of appropriate combinations corresponding to individual cases is necessary. PMID:27424820

  2. Endobronchial tuberculosis: An unusual presentation of a common disease

    Directory of Open Access Journals (Sweden)

    Aneeta S Datey

    2015-01-01

    Full Text Available Endobronchial tuberculosis (EBTB is an inflammation of the bronchial walls caused by tuberculous infection. The clinical, radiologic, and bronchoscopic presentation of EBTB is nonspecific and can be easily confused with other common pulmonary disorders. Its diagnosis requires isolation of Mycobacterium tuberculosis from bronchoscopic material. A high index of awareness of this entity and the early bronchoscopy in suspected patients are the cornerstones for establishing the diagnosis. The disease can occur in patients of all ages although it is more common in younger age group with a slight female preponderance. In recent years, a higher incidence has been reported in patients with human immunodeficiency virus infection.

  3. Percutaneous dilatational tracheostomy

    DEFF Research Database (Denmark)

    Johnsen, R.

    2015-01-01

    hospital before admission to our ICU. All 134 PDTs were performed with the Ciaglia Blue Rhino Method. No PDTs were performed with bronchoscopic guidance. In 12 cases some kind of complication due to the PDT was registered: six cases with need of surgical hemostasis, three cases of bleeding with need...

  4. Monitoring of biofilm formation on different material surfaces of medical devices using hyperspectral imaging method

    Science.gov (United States)

    Contamination of the inner surface of indwelling (implanted) medical devices by microbial biofilm is a serious problem. Some microbial bacteria such as Escherichia coli form biofilms that lead to potentially life-threatening infections. Other types of medical devices such as bronchoscopes and duod...

  5. Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail

    OpenAIRE

    Appavoo Arulvelan; Madhusudhan Soumya; Kannath Santhosh

    2015-01-01

    Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured.

  6. Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation

    NARCIS (Netherlands)

    Klooster, Karin; ten Hacken, Nick H T; Hartman, Jorine E.; Kerstjens, Huib A. M.; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2015-01-01

    BACKGROUND Bronchoscopic lung-volume reduction with the use of one-way endobronchial valves is a potential treatment for patients with severe emphysema. To date, the benefits have been modest but have been hypothesized to be much larger in patients without interlobar collateral ventilation than in t

  7. The lung volume reduction coil for the treatment of emphysema : a new therapy in development

    NARCIS (Netherlands)

    Klooster, Karin; ten Hacken, Nick H. T.; Slebos, Dirk-Jan

    2014-01-01

    Lung volume reduction (LVR) coil treatment is a novel therapy for patients with severe emphysema. In this bilateral bronchoscopic treatment, approximately 10 LVR coils per lobe are delivered under fluoroscopic guidance in two sequential procedures. The LVR coil reduces lung volume by compressing the

  8. Lung volume reduction coil treatment for patients with severe emphysema : a European multicentre trial

    NARCIS (Netherlands)

    Deslee, Gaetan; Klooster, Karin; Hetzel, Martin; Stanzel, Franz; Kessler, Romain; Marquette, Charles-Hugo; Witt, Christian; Blaas, Stefan; Gesierich, Wolfgang; Herth, Felix J. F.; Hetzel, Juergen; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial

  9. Design of the exhale airway stents for emphysema (EASE) trial : an endoscopic procedure for reducing hyperinflation

    NARCIS (Netherlands)

    Shah, Pallav L.; Slebos, Dirk-Jan; Cardoso, Paulo F. G.; Cetti, Edward J.; Sybrecht, Gerhard W.; Cooper, Joel D.

    2011-01-01

    Background: Airway Bypass is a catheter-based, bronchoscopic procedure in which new passageways are created that bypass the collapsed airways, enabling trapped air to exit the lungs. The Exhale Airway Stents for Emphysema (EASE) Trial was designed to investigate whether Exhale (R) Drug-Eluting Stent

  10. Effectiveness and Safety of Bronchial Thermoplasty in the Treatment of Severe Asthma A Multicenter, Randomized, Double-Blind, Sham-Controlled Clinical Trial

    NARCIS (Netherlands)

    Castro, Mario; Rubin, Adalberto S.; Laviolette, Michel; Fiterman, Jussara; Lima, Marina De Andrade; Shah, Pallav L.; Fiss, Elie; Olivenstein, Ronald; Thomson, Neil C.; Niven, Robert M.; Pavord, Ian D.; Simoff, Michael; Duhamel, David R.; McEvoy, Charlene; Barbers, Richard; ten Hacken, Nicolaas H. T.; Wechsler, Michael E.; Holmes, Mark; Phillips, Martin J.; Erzurum, Serpil; Lunn, William; Israel, Elliot; Jariour, Nizar; Kraft, Monica; Shargill, Narinder S.; Quiring, John; Berry, Scott M.; Cox, Gerard

    2010-01-01

    Rationale Bronchial thermoplasty (BT) is a bronchoscopic procedure in which controlled thermal energy is applied to the airway wall to decrease smooth muscle. Objectives: To evaluate the effectiveness and safety of BT versus a sham procedure in subjects with severe asthma who remain symptomatic desp

  11. Draft Genome Sequences of Four Hospital-Associated Pseudomonas putida Isolates

    Science.gov (United States)

    Marsh, Jane W.; Ezeonwuka, Chinelo D.; Pasculle, Anthony W.; Pacey, Marissa P.; Querry, Ashley M.; Muto, Carlene A.; Harrison, Lee H.

    2016-01-01

    We present here the draft genome sequences of four Pseudomonas putida isolates belonging to a single clone suspected for nosocomial transmission between patients and a bronchoscope in a tertiary hospital. The four genome sequences belong to a single lineage but contain differences in their mobile genetic elements. PMID:27688339

  12. Mineral Oil Aspiration Related Juvenile Idiopathic Arthritis.

    Science.gov (United States)

    Nelson, Andrew D; Fischer, Philip R; Reed, Ann M; Wylam, Mark E

    2015-01-01

    We describe the development of rheumatoid factor-positive migratory polyarthritis in a 5-year-old male who had been administered bidaily oral mineral oil as a laxative since birth. Minor respiratory symptoms, radiographic and bronchoscopic findings were consistent with chronic lipoid pneumonia. We speculate that immune sensitization to mineral oil promoted the clinical syndrome of juvenile idiopathic arthritis. PMID:26171269

  13. Mineral Oil Aspiration Related Juvenile Idiopathic Arthritis

    OpenAIRE

    Nelson, Andrew D.; Fischer, Philip R.; Reed, Ann M.; Wylam, Mark E

    2015-01-01

    We describe the development of rheumatoid factor-positive migratory polyarthritis in a 5-year-old male who had been administered bidaily oral mineral oil as a laxative since birth. Minor respiratory symptoms, radiographic and bronchoscopic findings were consistent with chronic lipoid pneumonia. We speculate that immune sensitization to mineral oil promoted the clinical syndrome of juvenile idiopathic arthritis.

  14. Mineral Oil Aspiration Related Juvenile Idiopathic Arthritis

    Directory of Open Access Journals (Sweden)

    Andrew D. Nelson

    2015-01-01

    Full Text Available We describe the development of rheumatoid factor-positive migratory polyarthritis in a 5-year-old male who had been administered bidaily oral mineral oil as a laxative since birth. Minor respiratory symptoms, radiographic and bronchoscopic findings were consistent with chronic lipoid pneumonia. We speculate that immune sensitization to mineral oil promoted the clinical syndrome of juvenile idiopathic arthritis.

  15. Bronchoalveolar lavage with trypsin in pulmonary alveolar proteinosis.

    OpenAIRE

    Nagasaka, Y.; Takahashi, M; Ueshima, H; Tohda, Y.; Nakajima, S.

    1996-01-01

    Two cases of pulmonary alveolar proteinosis were treated with bronchoalveolar lavage (BAL) via a fibreoptic bronchoscope. Additional clinical improvement was seen when trypsin was added to the lavage fluid. Analysis of effluents in the BAL fluid showed marked reduction of protein constituents with clinical improvement after treatment with trypsin in the lavage. BAL with trypsin was well tolerated.

  16. Intervention with flexible bronchoscopy in patiens with respiratory failure caused by tracheal stenosis

    Institute of Scientific and Technical Information of China (English)

    王继旺

    2013-01-01

    Objective To investigate the efficiency and safety of intervention with flexible bronchoscope under general anesthesia by using laryngeal mask in patients with severe tracheal stenosis induced respirtory failure.Methods A total of 16 in-patients with respiratory failure caused by

  17. Draft Genome Sequences of Four Hospital-Associated Pseudomonas putida Isolates.

    Science.gov (United States)

    Mustapha, Mustapha M; Marsh, Jane W; Ezeonwuka, Chinelo D; Pasculle, Anthony W; Pacey, Marissa P; Querry, Ashley M; Muto, Carlene A; Harrison, Lee H

    2016-01-01

    We present here the draft genome sequences of four Pseudomonas putida isolates belonging to a single clone suspected for nosocomial transmission between patients and a bronchoscope in a tertiary hospital. The four genome sequences belong to a single lineage but contain differences in their mobile genetic elements. PMID:27688339

  18. Superiority of Spacer/Mask Topical Anesthetic Compared with Conventional Spray and Gargle Method for Fibreoptic Bronchoscopy

    Directory of Open Access Journals (Sweden)

    RC Balkissoon

    1996-01-01

    Full Text Available OBJECTIVE: To compare the safety and efficacy of a new spacer-oral nasal mask device with those of the standard needle nozzle spray method for the delivery of aerosolized lidocaine to the upper airway for pre-bronchoscopic anaesthesia in a tertiary care hospital.

  19. Airway Management of Post-burn Neck Contracture with Microstomia: Age Old Technique Revisited

    Directory of Open Access Journals (Sweden)

    Chetna Jadeja;

    2012-12-01

    Full Text Available This case report describes airway management of a patient of post burn neck contracture with fixed flexion deformity and restricted mouth opening. Attempt to intubate the patient with fiberoptic bronchoscope failed so the neck contracture was released under tumescent anaesthesia. The patient was then intubated with the help of stylet.

  20. Compression evaluation of surgery video recordings retaining diagnostic credibility (compression evaluation of surgery video)

    Science.gov (United States)

    Duplaga, M.; Leszczuk, M. I.; Papir, Z.; Przelaskowski, A.

    2008-12-01

    Wider dissemination of medical digital video libraries is affected by two correlated factors, resource effective content compression that directly influences its diagnostic credibility. It has been proved that it is possible to meet these contradictory requirements halfway for long-lasting and low motion surgery recordings at compression ratios close to 100 (bronchoscopic procedures were a case study investigated). As the main supporting assumption, it has been accepted that the content can be compressed as far as clinicians are not able to sense a loss of video diagnostic fidelity (a visually lossless compression). Different market codecs were inspected by means of the combined subjective and objective tests toward their usability in medical video libraries. Subjective tests involved a panel of clinicians who had to classify compressed bronchoscopic video content according to its quality under the bubble sort algorithm. For objective tests, two metrics (hybrid vector measure and hosaka Plots) were calculated frame by frame and averaged over a whole sequence.

  1. An update on the efficacy of endobronchial valve therapy in the management of hyperinflation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Valipour, Arschang; Burghuber, Otto Chris

    2015-12-01

    Lung volume reduction surgery has been shown to be effective in patients with heterogeneous emphysema, but is also associated with a relatively high perioperative morbidity and mortality. Accordingly, several novel and potentially less invasive methods for bronchoscopic lung volume reduction have been developed. Endobronchial valve (EBV) therapy is one such therapeutic approach in patients with advanced emphysema. It has been the most widely studied technique over the past years and represents an effective treatment option for patients with severe heterogeneous upper- or lower-lobe-predominant emphysema. The choice of EBV therapy largely depends on the distribution of emphysema and the presence or absence of interlobar collateral ventilation. Adequate patient selection and technical success of valve implantation with the intention of lobar exclusion are predictive factors for positive outcomes. This review attempts to highlight the milestones in the development of bronchoscopic lung volume reduction with one-way valve implantation over the past few years.

  2. Tracheobronchopathia Osteochondroplastica

    Directory of Open Access Journals (Sweden)

    F Noorani

    2008-04-01

    Full Text Available Tracheobronchopathia Osteochondroplastica (TO is a rare disorder of large airways with unknown etiology which is characterized by cartilaginous and bony nodules lining the mucosa of the trachea and major bronchi. Generally, it is benign and asymptomatic, but it may present with cough, exertional dyspnea and wheezing. It could therefore be mistaken with asthma and chronic obstructive pulmonary disease . The diagnosis is usually made on bronchoscopy and confirmed on histology .We describe two cases of TO with characteristic bronchoscopic and histological findings. The first one had exertional dyspnea and hoarseness for more than 3 years and the second one had exertional dyspnea for more than 10 years .In both of the cases, fiber optic bronchoscopy was performed which revealed numerous white,hard,irregular nodules on trachea and main bronchi. The pathologic diagnosis of bronchoscopic biopsy was TO.

  3. An update on the efficacy of endobronchial valve therapy in the management of hyperinflation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Valipour, Arschang; Burghuber, Otto Chris

    2015-12-01

    Lung volume reduction surgery has been shown to be effective in patients with heterogeneous emphysema, but is also associated with a relatively high perioperative morbidity and mortality. Accordingly, several novel and potentially less invasive methods for bronchoscopic lung volume reduction have been developed. Endobronchial valve (EBV) therapy is one such therapeutic approach in patients with advanced emphysema. It has been the most widely studied technique over the past years and represents an effective treatment option for patients with severe heterogeneous upper- or lower-lobe-predominant emphysema. The choice of EBV therapy largely depends on the distribution of emphysema and the presence or absence of interlobar collateral ventilation. Adequate patient selection and technical success of valve implantation with the intention of lobar exclusion are predictive factors for positive outcomes. This review attempts to highlight the milestones in the development of bronchoscopic lung volume reduction with one-way valve implantation over the past few years. PMID:26294417

  4. Lobar flexible fiberoptic lung lavage: therapeutic benefit in severe respiratory failure in pulmonary alveolar proteinosis and influenza A H1N1 pneumonia

    Directory of Open Access Journals (Sweden)

    Antonello Nicolini

    2011-07-01

    Full Text Available Lobar fiberoptic lung lavage is a well-known procedure used in primary pulmonary alveolar proteinosis (PAP; the use of this procedure has increased in the recent years. This procedure has also been used in other pulmonary diseases such as desquamative interstitial pneumonia with good results. We describe a case of extremely severe respiratory failure due to concurrence of PAP and Influenza A H1N1 virus pneumonia which resolved with the help of this procedure. The patient, a 41- year-old woman, needed less mechanical ventilation after undergoing lobar fiberoptic bronchoscopic lavage. Moreover, a rapid and progressive improvement in the computed tomography of the lungs was observed. Flexibile fiberoptic bronchoscopic lobar lavage is a simple, safe procedure used not only in milder disease, but also in particular severe cases in which the physiological derangement of whole lung lavage would not be tolerated by patient or when extra-corporeal membrane oxygenation is not available.

  5. Delayed diagnosis of endobronchial mucoepidermoid carcinoma in a 29-year-old male.

    Science.gov (United States)

    Jain, Akanksha; Madan, Neha Kawatra; Arava, Sudheer; Pandey, Durgatosh; Madan, Karan

    2016-01-01

    Mucoepidermoid carcinoma (MEC) is an uncommon primary lung tumor. It usually involves large airways and presents clinically and radiologically with nonspecific features. Because of nonspecific presentation diagnosis is frequently delayed. We report the case of a 29-year-old male patient wherein a clinico-radiological consideration of tuberculosis (TB) led to a prolonged treatment with anti-TB medications without response. Flexible bronchoscopic biopsy confirmed the diagnosis of MEC following that the patient underwent curative surgical resection. PMID:27186000

  6. Difficult airway after late postoperative bleeding in a case of total thyroidectomy, tracheal resection and reconstruction

    OpenAIRE

    Mukul Chandra Kapoor; Shaloo Garg; Binita Jaiswal; Sharan Choudhri; Prashant Saxena

    2015-01-01

    Background: Airway management is a challenge in surgery involving the trachea. Methods: A lady with carcinoma thyroid infiltrating into trachea was taken up for total thyroidectomy and tracheal resection/reconstruction surgery. Airway was secured with fiber-optic bronchoscope guided tracheal intubation preventing trauma to the infiltrated lesion. Surgical and anesthetic management were unremarkable. Seven days after surgery, patient had massive hemoptysis and was taken up for an emergent r...

  7. Tracheal damage after endotracheal intubation: comparison of two types of endotracheal tubes.

    OpenAIRE

    Honeybourne, D; Costello, J C; Barham, C.

    1982-01-01

    Twenty-eight patients who required endotracheal intubation for open-heart surgery were randomly allocated to one of two types of endotracheal tube. The tracheal mucosa was examined with a fibreoptic bronchoscope at the time of extubation, usually 24 hours after operation. The degree of oedema, inflammation, and ulceration was scored by the bronchoscopist, who also photographed the whole length of the trachea. An independent observer subsequently scored any tracheal damage from these photograp...

  8. A rare complication of tracheal intubation

    OpenAIRE

    Wan Fadzlina Wan Muhd Shukeri; Wan Mohd Nazaruddin Wan Hassan; Chandran Nadarajan

    2016-01-01

    Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about ...

  9. Unexpected difficulty in ventilating the lungs after tracheal intubation -A case report-

    OpenAIRE

    Lee, Jong-Yeon; Lee, Su-Yeon; Shin, Inho; Chung, Kum-Hee; Chun, Duk-hee

    2011-01-01

    We experienced difficulty in ventilating the lungs of a patient after tracheal intubation. After intubation, an insufficient amount of tidal volume (VT) was delivered to the patient and the fiberoptic bronchoscopic examination identified partial abutment of the endotracheal tube (ETT) orifice against the tracheal wall. After various attempts to correctly place the ETT, a double-lumen endotracheal tube was placed to achieve a sufficient VT. It is important to notice that even an appropriately ...

  10. Indication for fiberoptic bronchoscopy in HIV-infected patients suspected for Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Orholm, M; Lundgren, Jens Dilling; Nielsen, T L;

    1990-01-01

    During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations...... did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed...

  11. Primary Composite Lymphoma of the Lung: a Case Report

    OpenAIRE

    Saba, Mohammadali; Ehsani, Majeed; Moosavian, Mehdi; Khooeei, Alireza

    2014-01-01

    Herein, we report a rare case of primary lung lymphoma in a 61 year-old woman with a history of 6-month nonspecific symptoms like dry cough, fever, chills and weight loss. She was admitted to a hospital and received broad-spectrum antibiotics but discharged without full recovery. In her second hospital admission, a bronchoscopic evaluation and transbronchial biopsy were performed, which were not diagnostic. Finally, an open lung biopsy was done. Immunohistochemical (IHC) staining of the speci...

  12. Endobronchial metastasis in breast cancer.

    OpenAIRE

    Albertini, R E; Ekberg, N L

    1980-01-01

    Ten patients with endobronchial metastasis from primary breast cancer were found among 1200 fibreoptic bronchoscopies. Six of these patients had radiological signs suggesting bronchial obstruction. The diagnosis was verified in nine cases by means of bronchoscopic biopsy or cytology and in one by thoracotomy. Endobronchial metastasis should be considered when symptoms or chest films suggest endobronchial disease in a patient with a history of breast cancer.

  13. Tracheobronchial foreign bodies in relation to feeding practices in young children.

    OpenAIRE

    Indudharan, R; Ram, S. P.; Sidek, D S

    1997-01-01

    Tracheobronchial foreign bodies, which are common in children, are a leading cause of accidental deaths in children under four years of age. Three cases of tracheobronchial foreign bodies in children less than two years old are described. One of the foreign bodies was unsuspected; the other two were probably related to food habits. All three cases improved without sequelae following prompt bronchoscopic intervention. Young children should not be given food containing bones or hard chitinous s...

  14. Advanced therapies for COPD—What’s on the horizon? Progress in lung volume reduction and lung transplantation

    OpenAIRE

    Trotter, Michael A.; Hopkins, Peter M.

    2014-01-01

    Advanced chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity. Treatment options beyond conventional medical therapies are limited to a minority of patients. Lung volume reduction surgery (LVRS) although effective in selected subgroups of patients is not commonly undertaken. Morbidity associated with the procedure has contributed to this low utilisation. In response to this, less invasive bronchoscopic lung volume techniques are being developed to attempt to mitiga...

  15. Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial.

    OpenAIRE

    Thomson, NC; Rubin, AS; Niven, RM; Corris, PA; Siersted, HC; Olivenstein, R.; Pavord, ID; McCormack, D.; Laviolette, M.; Shargill, NS; Cox, G.

    2011-01-01

    BACKGROUND: Bronchial thermoplasty (BT) is a bronchoscopic procedure that improves asthma control by reducing excess airway smooth muscle. Treated patients have been followed out to 5 years to evaluate long-term safety of this procedure. METHODS: Patients enrolled in the Asthma Intervention Research Trial were on inhaled corticosteroids ≥200 μg beclomethasone or equivalent + long-acting-beta2-agonists and demonstrated worsening of asthma on long-acting-β2-agonist withdrawal. Following initial...

  16. Long term (5 Year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial

    OpenAIRE

    Thomson, N C; Rubin, A.S.; Niven, R. M.; Corris, P A; Siersted, H. C.; Olivenstein, R.; Pavord, I.D.; McCormick, D.; Laviolette, M.; Shargill, N.S.; Cox, G.

    2011-01-01

    Background: Bronchial thermoplasty (BT) is a bronchoscopic procedure that improves asthma control by reducing excess airway smooth muscle. Treated patients have been followed out to 5 years to evaluate long-term safety of this procedure. Methods: Patients enrolled in the Asthma Intervention Research Trial were on inhaled corticosteroids ≥200 μg beclomethasone or equivalent + long-acting-beta2-agonists and demonstrated worsening of asthma on long-acting-β2-agonist withdrawal. ...

  17. Minimally Invasive Thoracic Surgery

    OpenAIRE

    McFadden, P. Michael

    2000-01-01

    To reduce the risk, trauma, and expense of intrathoracic surgical treatments, minimally invasive procedures performed with the assistance of fiberoptic video technology have been developed for thoracic and bronchial surgeries. The surgical treatment of nearly every intrathoracic condition can benefit from a video-assisted approach performed through a few small incisions. Video-assisted thoracoscopic and rigid-bronchoscopic surgery have improved the results of thoracic procedures by decreasing...

  18. Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006

    OpenAIRE

    Cooksley, Nathania; Judge, Daniel James; BROWN, James

    2014-01-01

    A 28-year-old woman of Laotian origin presented with dry cough, fevers, night sweats and weight loss over the preceding 6 weeks. Radiological investigations revealed large complex cavitary lesions in the middle and lower lobes of the right lung, with no mediastinal lymph node enlargement. Bronchoscopic investigations did not yield a diagnosis. CT-guided fine-needle aspiration raised the possibility of Langerhans cell histiocytosis. Open lung biopsy initially supported this, but eventually a m...

  19. Difficult airway management patterns among anesthesiologists practicing in Cairo University Hospitals

    Directory of Open Access Journals (Sweden)

    Neamat I. Abdel rahman

    2016-01-01

    Conclusion: The practice of anesthesiologists in Cairo university hospitals is close to the recommendations of the ASA guidelines for management of difficult airway. There is increased skills in fiberoptic bronchoscopes and SGA with increased frequency of difficult airway managements training courses; however, they need to improve their skills in awake fiberoptic intubations technique and they need to be trained on invasive airway management access to close the discrepancy between their theoretical choices in different situations and their actual skills.

  20. Image-based rendering method for mapping endoscopic video onto CT-based endoluminal views

    Science.gov (United States)

    Rai, Lav; Higgins, William E.

    2006-03-01

    One of the indicators of early lung cancer is a color change in airway mucosa. Bronchoscopy of the major airways can provide high-resolution color video of the airway tree's mucosal surfaces. In addition, 3D MDCT chest images provide 3D structural information of the airways. Unfortunately, the bronchoscopic video contains no explicit 3D structural and position information, and the 3D MDCT data captures no color or textural information of the mucosa. A fusion of the topographical information from the 3D CT data and the color information from the bronchoscopic video, however, enables realistic 3D visualization, navigation, localization, and quantitative color-topographic analysis of the airways. This paper presents a method for topographic airway-mucosal surface mapping from bronchoscopic video onto 3D MDCT endoluminal views. The method uses registered video images and CT-based virtual endoscopic renderings of the airways. The visibility and depth data are also generated by the renderings. Uniform sampling and over-scanning of the visible triangles are done before they are packed into a texture space. The texels are then re-projected onto video images and assigned color values based on depth and illumination data obtained from renderings. The texture map is loaded into the rendering engine to enable real-time navigation through the combined 3D CT surface and bronchoscopic video data. Tests were performed on pre-recorded bronchoscopy patient video and associated 3D MDCT scans. Results show that we can effectively accomplish mapping over a continuous sequence of airway images spanning several generations of airways.

  1. In vivo electrical bioimpedance characterization of human lung tissue during the bronchoscopy procedure. A feasibility study

    OpenAIRE

    Sánchez Terrones, Benjamín; Vandersteen, Gerd; Martín Robles, Irene; Castillo Villegas, Diego; Torrego Fernández, Alfons; Riu Costa, Pere Joan; Schoukens, Johan; Bragós Bardia, Ramon

    2013-01-01

    Lung biopsies form the basis for the diagnosis of lung cancer. However, in a significant number of cases bronchoscopic lung biopsies fail to provide useful information, especially in diffuse lung disease, so more aggressive procedures are required. Success could be improved using a guided electronic biopsy based on multisine electrical impedance spectroscopy (EIS), a technique which is evaluated in this paper. The theoretical basis of the measurement method and the instrument developed are de...

  2. [ENDOSCOPIC LUNG VOLUME REDUCTION IN PULMONARY EMPHYSEMA].

    Science.gov (United States)

    Duysinx, B; Heinen, V; Louis, R; Corhay, J-L

    2015-12-01

    Emphysema is characterized by an irreversible alveolar destruction, a progressive lung hyperinflation and a dysfunction of respiratory muscles. It induces a respiratory functional limitation and a decrease of quality of life. Endoscopic lung volume reduction represents a potential alternative to surgical treatments for advanced heterogeneous emphysema without concomitant surgical morbidity. The different bronchoscopic systems for lung volume reduction currently under evaluation are presented. PMID:26867305

  3. Atopy May Be an Important Determinant of Subepithelial Fibrosis in Subjects with Asymptomatic Airway Hyperresponsiveness

    OpenAIRE

    Sohn, Seong-Wook; Chang, Yoon-Seok; Lee, Hye-Seung; Chung, Doo-Hyun; Lee, Choon-Taek; Kim, Young-Hwan; Kim, Yoon-Keun; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon

    2008-01-01

    The bronchial pathology of asymptomatic airway hyperreponsiveness (AHR) subjects is not well understood, and the role of atopy in the development of airway remodeling is unclear. The aim of this study was to evaluate whether atopy is associated with airway remodeling in asymptomatic AHR subjects. Five groups, i.e., atopic or non-atopic subjects with asymptomatic AHR, atopic or non-atopic healthy controls, and subjects with mild atopic asthma, were evaluated by bronchoscopic biopsy. By electro...

  4. 診断時に胃転移を認めた小細胞肺癌の2 例

    OpenAIRE

    Okazaki, Akihito; Araya, Tomoyuki; Sakai, Asao; Sone, Takashi; Kasahara, Kazuo; Fujimura, Masaki

    2012-01-01

    Background. Evidence of gastric metastasis from lung cancer is rarely observed at initial diagnosis. Case 1. A 74-year-old woman with anorexia was referred to our hospital due to upper lobe atelectasis of the left lung noted on a chest X-ray film. Bronchoscopic examination revealed obstruction of the left upper bronchus by a tumor. A biopsy specimen from the mass demonstrated small cell cancer. Upper gastrointestinal endoscopy showed an elevated lesion forming a central depression ("bull's ey...

  5. Interleukin-22 is elevated in lavage from patients with lung cancer and other pulmonary diseases

    OpenAIRE

    Tufman, Amanda; Huber, Rudolf Maria; Völk, Stefanie; Aigner, Frederic; Edelmann, Martin; Gamarra, Fernando; Kiefl, Rosemarie; Kahnert, Kathrin; Tian, Fei; Boulesteix, Anne-Laure; Endres, Stefan; Kobold, Sebastian

    2016-01-01

    Background Interleukin-22 (IL-22) is involved in lung diseases such as pneumonia, asthma and lung cancer. Lavage mirrors the local environment, and may provide insights into the presence and role of IL-22 in patients. Methods Bronchoscopic lavage (BL) samples (n = 195, including bronchoalveolar lavage and bronchial washings) were analysed for IL-22 using an enzyme-linked immunosorbent assay. Clinical characteristics and parameters from lavage and serum were correlated with lavage IL-22 concen...

  6. Increased cardiac index due to terbutaline treatment aggravates capillary-alveolar macromolecular leakage in oleic acid lung injury in dogs

    OpenAIRE

    Briot, Raphael; Bayat, Sam; Anglade, Daniel; Martiel, Jean-Louis; Grimbert, Francis

    2009-01-01

    Introduction We assessed the in vivo effects of terbutaline, a beta2-agonist assumed to reduce microvascular permeability in acute lung injury. Methods We used a recently developed broncho-alveolar lavage (BAL) technique to repeatedly measure (every 15 min. for 4 hours) the time-course of capillary-alveolar leakage of a macromolecule (fluorescein-labeled dextran) in 19 oleic acid (OA) lung injured dogs. BAL was performed in a closed lung sampling site, using a bronchoscope fitted with an infl...

  7. Tracheobronchial foreign body aspiration in children: A continuing diagnostic challenge

    OpenAIRE

    Mohammad Saquib Mallick

    2014-01-01

    Background: Foreign body aspiration (FBA) is a common cause of respiratory compromise in early childhood. The objective of this study was to describe the features and outcomes of children with FBA in early and late presentations and to examine the reasons for the delay in diagnosis. Patients and Methods: This is a retrospective review of all children who were admitted with suspected FBA between July 2001 and June 2010. Patient′s characteristics, history, clinical, radiographic, bronchoscopic ...

  8. Bronchial Anthracosis: A New Diagnosis for Benign Mass Lesions of the Lung

    OpenAIRE

    Mirsadraee, Majid; Asna-Ashari, Amir; Attaran, Davood; Naghibi, Saeed; Mirsadraee, Saeed

    2013-01-01

    Background This study aimed to identify the most important new radiological presentations of anthracosis and anthracofibrosis and evaluate the risk ratio for accurate diagnosis of these conditions using computed tomography instead of bronchoscopy. Materials and Methods This prospective, case-control study evaluated three groups of 70 patients with a bronchoscopic diagnosis of simple anthracosis and anthracofibrosis and 40 patients with a non-anthracotic diagnosis (control group). Bronchoscopy...

  9. Hemoptysis: a rare cause can be related to a bronchial varix due to pulmonary venous obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Wiebe, Sheldon; Maclusky, Ian; Manson, David; Holowka, Stephanie; Yoo, Shi-Joon [The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Ontario (Canada)

    2003-12-01

    Bronchial varices, which have rarely been described in the radiology literature, can be the result of pulmonary venous obstruction and may present with hemoptysis. This case is an illustration of this rare condition, which correlates CT findings with bronchoscopic findings. We also describe the findings on phase-contrast MR that demonstrated reversed diastolic flow in the branch pulmonary artery supplying the affected lung. (orig.)

  10. Advances in bronchoscopy for lung cancer

    Directory of Open Access Journals (Sweden)

    Samjot Singh Dhillon

    2012-01-01

    Full Text Available Bronchoscopic techniques have seen significant advances in the last decade. The development and refinement of different types of endobronchial ultrasound and navigation systems have led to improved diagnostic yield and lung cancer staging capabilities. The complication rate of these minimally invasive procedures is extremely low as compared to traditional transthoracic needle biopsy and surgical sampling. These advances augment the safe array of methods utilized in the work up and management algorithms of lung cancer.

  11. Advances in bronchoscopy for lung cancer

    Science.gov (United States)

    Dhillon, Samjot Singh; Dexter, Elisabeth U.

    2012-01-01

    Bronchoscopic techniques have seen significant advances in the last decade. The development and refinement of different types of endobronchial ultrasound and navigation systems have led to improved diagnostic yield and lung cancer staging capabilities. The complication rate of these minimally invasive procedures is extremely low as compared to traditional transthoracic needle biopsy and surgical sampling. These advances augment the safe array of methods utilized in the work up and management algorithms of lung cancer. PMID:23346012

  12. Metastatic breast lump: A rare presentation of squamous cell lung cancer

    OpenAIRE

    Amitabha Sengupta; Kaushik Saha; Debraj Jash; Banerjee, Sourindra N.

    2012-01-01

    Breast metastases from extramammary neoplasm are uncommon with an incidence of 0.5% to 3% of patients with extramammary malignancy. We reported an extremely rare case of breast metastasis from squamous cell lung carcinoma. A 60-year-old woman suffered from dry cough with shortness breath for one month with simultaneous development of breast lump. The histological diagnosis, achieved by bronchoscopic lung biopsy with the aid of immunohistochemistry was squamous cell lung carcinoma. Breast lump...

  13. Automated fiducial marker planning for thoracic stereotactic body radiation therapy

    Science.gov (United States)

    Gibbs, Jason D.; Rai, Lav; Wibowo, Henky; Tsalyuk, Serge; Anderson, Eric D.

    2012-02-01

    Stereotactic body-radiation therapy (SBRT) has gained acceptance in treating lung cancer. Localization of a thoracic lesion is challenging as tumors can move significantly with breathing. Some SBRT systems compensate for tumor motion with the intrafraction tracking of targets by two stereo fluoroscopy cameras. However, many lung tumors lack a fluoroscopic signature and cannot be directly tracked. Small radiopaque fiducial markers, acting as fluoroscopically visible surrogates, are instead implanted nearby. The spacing and configuration of the fiducial markers is important to the success of the therapy as SBRT systems impose constraints on the geometry of a fiducial-marker constellation. It is difficult even for experienced physicians mentally assess the validity of a constellation a priori. To address this challenge, we present the first automated planning system for bronchoscopic fiducial-marker placement. Fiducial-marker planning is posed as a constrained combinatoric optimization problem. Constraints include requiring access from a navigable airway, having sufficient separation in the fluoroscopic imaging planes to resolve each individual marker, and avoidance of major blood vessels. Automated fiducial-marker planning takes approximately fifteen seconds, fitting within the clinical workflow. The resulting locations are integrated into a virtual bronchoscopic planning system, which provides guidance to each location during the implantation procedure. To date, we have retrospectively planned over 50 targets for treatment, and have implanted markers according to the automated plan in one patient who then underwent SBRT treatment. To our knowledge, this approach is the first to address automated bronchoscopic fiducialmarker planning for SBRT.

  14. Optical coherence tomography in conjunction with bronchoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, Ascedio Jose; Takimura, Celso Kiyochi; Lemos Neto, Pedro Alves; Figueiredo, Viviane Rossi, E-mail: ascedio@gmail.com [Servico de Endoscopia Respiratoria, Hospital das Clinicas, Universidade de Sao Paulo (FM/USP), SP (Brazil)

    2012-07-01

    To evaluate the feasibility of and the potential for using optical coherence tomography in conjunction with conventional bronchoscopy in the evaluation of the airways. Methods: This was a pilot study based on an ex vivo experimental model involving three animals: one adult New Zealand rabbit and two Landrace pigs. An optical coherence tomography imaging catheter was inserted through the working channel of a flexible bronchoscope in order to reach the distal trachea of the animals. Images of the walls of the trachea were systematically taken along its entire length, from the distal to the proximal portion. Results: The imaging catheter was easily adapted to the working channel of the bronchoscope. High-resolution images of cross sections of the trachea were taken in real time, precisely delineating microstructures, such as the epithelium, submucosa, and cartilage, as well as the adventitia of the anterior and lateral tracheal walls. The corresponding layers of the epithelium, mucosa, and cartilage were clearly differentiated. The mucosa, submucosa, and trachealis muscle were clearly identified in the posterior wall. Conclusions: It is feasible to use an optical coherence tomography imaging catheter in combination with a flexible bronchoscope. Optical coherence tomography produces high resolution images that reveal the microanatomy of the trachea, including structures that are typically seen only on images produced by conventional histology. (author)

  15. Ekstraksi Benda Asing Lampu Led di Bronkus dengan Bronkoskop Kaku

    Directory of Open Access Journals (Sweden)

    Fachzi Fitri

    2014-09-01

    Full Text Available AbstrakAspirasi benda asing adalah masalah yang relatif sering ditemukan pada anak dan merupakan masalah serius yang bisa berakibat fatal. Benda asing di traktus respiratorius harus segera dikeluarkan dalam kondisi dan peralatan optimal dan dengan trauma yang seminimal mungkin untuk mencegah komplikasi. Instrumen yang digunakan untuk tindakan ekstraksi benda asing dapat mempengaruhi morbiditas akibat komplikasi ekstraksi benda asing di traktus respiratorius. Dilaporkan satu kasus aspirasi lampu LED (Light Emitting Diode di bronkus utama kanan pada anak perempuan berumur 5 tahun, yang dua kali gagal dikeluarkan dengan bronkoskop fleksibel dan berhasil dikeluarkan dengan menggunakan bronkoskop kaku tanpa komplikasi.Kata kunci: aspirasi benda asing, lampu LED, bronkoskop kakuAbstractForeign body aspiration is a relative commonly problem in children and still a serious and sometimes fatal condition. Foreign body in respiratory tract must be removed in optimal conditions and equipment with minimal trauma to prevent complications. Instruments which being used for foreign body extraction can affect morbidity due to complications of extraction of foreign body in respiratory tract. There was reported one case of aspiration of LED (Light Emitting Diode lamp in the right main bronchus of 5 year old girl, who failed two times by flexible bronchoscope and successfully extracted by a rigid bronchoscope, without complication.Keywords: foreign body aspiration, LED lamp, rigid bronchoscope

  16. Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients.

    Directory of Open Access Journals (Sweden)

    Maddali M

    2001-04-01

    Full Text Available BACKGROUND: Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach, bronchoscopic guidance has been suggested which might not always be possible due to logistic reasons. METHODS: A retrospective study of 98 patients who had guide wire dilating forceps technique of percutaneous tracheostomy without the aid of a bronchoscope was undertaken. By ensuring the free mobility of the guide wire at each step of the procedure, a safe placement of the tracheostomy tube was achieved. RESULTS: The mean operating time was 3.05 mins [S.D:2.20]. Two patients had peristomal bleeding as an early complication. 34 patients could be decannulated with good primary approximation of the stomal tissues [mean: 3.92days, S.D: 1.46]. There were no deaths or life threatening complications attributable to this technique. CONCLUSIONS: In the absence of bronchoscopic guidance, adopting the simple but effective precaution of free movement of guide wire at each step of the procedure, a safe tracheostomy tube placement is possible.

  17. High dose rate intraluminal irradiation in recurrent endobronchial carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Seagren, S.L.; Harrell, J.H.; Horn, R.A.

    1985-12-01

    Palliative therapy for previously irradiated patients with symptomatic recurrent endobronchial malignancy is a difficult problem. We have had the opportunity to treat 20 such patients with high dose rate (50-100 rad/min) endobronchial brachytherapy. Eligible patients had received previous high dose thoracic irradiation (TDF greater than or equal to 90), a performance status of greater than or equal to 50, and symptoms caused by a bronchoscopically defined and implantable lesion. The radiation is produced by a small cobalt-60 source (0.7 Ci) remotely afterloaded by cable control. The source is fed into a 4 mm diameter catheter which is placed with bronchoscopic guidance; it may oscillate if necessary to cover the lesion. A dose of 1,000 rad at 1 cm from the source is delivered. We have performed 22 procedures in 20 patients, four following YAG laser debulking. Most had cough, some with hemoptysis. Eight had dyspnea secondary to obstruction and three had obstructive pneumonitis. In 12, symptoms recurred with a mean time to recurrence of 4.3 months (range 1-9 months). Eighteen patients were followed-up and reexamined via bronchoscope 1-2.5 months following the procedure; two were lost to follow-up. All had at least 50 percent clearance of tumor, and six had complete clearance; most regressions were documented on film or videotape. In six, the palliation was durable. The procedure has been well tolerated with no toxicity. We conclude that palliative endobronchial high dose rate brachytherapy is a useful palliative modality in patients with recurrent endobronchial symptomatic carcinoma.

  18. Bronchial Brushing Increases the Diagnostic Yield of Fiberoptic Bronchoscopy in Bronchogenic Carcinoma

    Directory of Open Access Journals (Sweden)

    Recep Bedir

    2014-07-01

    Full Text Available Background: The importance of rapid and accurate cytopathological diagnosis in bronchial cancers is increasing due to advances in treatment modalities.Aims: We evaluated the diagnostic methods and cytologic subtypes of bronchial cancers to determine the diagnostic reliability of different bronchoscopic techniques.Material and methods: Retrospective data were obtained from the hospital files and pathological specimens of the patients with diagnosis of primary lung cancer from a period of 36 months. Cytological tumor typing was determined using histopathology of bronchoscopic forceps biopsy (FB, bronchial-bronchoalveolar lavage (BL, bronchial brushing (BB, transbronchial fine-needle biopsy. Computed tomography or ultrasonography guided transthoracic biopsy and surgical biopsies were used where the other interventional methods were inadequate for diagnosis.Results: A total of 124 patients were diagnosed during study period. 119 (96% of them were male. The median age was 68, ranging between 36 and 88 years. Histopathologic subtypes were determined as non-small cell carcinoma (NSCC in 104 (83.9%, squamous cell carcinoma in 64 (51.6%, adenocarcinoma in 16 (12.9%, NSCC not otherwise specified in 24 (19.3% and small cell carcinoma in 20 (16.1% patients. The combination of FB, BL and BB established the diagnosis of bronchogenic carcinoma in most of the cases (92.6%.Conclusions: Lung cancer is seen commonly in elderly male patients with smoking history and squamous cell carcinoma is the most common cytologic type. High diagnostic accuracy can be achieved by a combination of bronchoscopic FB, BB and BL procedures. Keywords: Bronchoscopy; Lung cancer; Bronchial brushing

  19. Bronchial Anthracotic Change in South Khorasan Province (Iran, Emphasizing its Association with Tuberculosis

    Directory of Open Access Journals (Sweden)

    Sayyed Gholamreza Mortazavi-Moghaddam

    2014-09-01

    Full Text Available Background: There are many reports on the association between anthracosis and tuberculosis. This study focuses on bronchial anthracosis and associated diseases in the province of South Khorasan-Iran. Methods: This case-series study is performed on patients referred to the Vali-e-Asre Hospital (South Khorasan-Iran for bronchoscopic evaluations during the period of 2009-2012. Written informed consents were obtained prior to bronchoscopic evaluations. The criterion for diagnosis of bronchial anthracosis was black pigmentation on direct observation of bronchus. Bronchial anthracosis was classified into simple (without deformity or complicated (with deformity. Pulmonary tuberculosis (TB was diagnosed either by acid fast staining and culture of liquid samples, or histopathology examination of biopsy. Spirometry was performed to determine the obstructive or restrictive pattern. Results: Among 279 patients who underwent bronchoscopic evaluations, 89 patients, including 34 males (38.2% and 55 (61.79% females, were diagnosed with anthracosis. Simple and complicated anthracosis were observed in 42 (48.2% and 47 (52.8% cases respectively. Mean age of patients was 72.23±9.65 years. There were 43 (48.3% cases of tuberculosis (28 cases with complicated and 15 cases with simple anthracosis (P=0.021. Chest X-ray showed consolidation/infiltration, reticular/fibrotic, and mass/nodule/hilar prominence in 57 (64%, 26 (29.21% and 6 (6.74% cases, respectively. Bronchitis was reported in 42 (%59.15 out of 79 patients whose biopsy samples were taken. Spirometric patterns were obstructive, restrictive, upper airway obstruction, and normal in 45 (50.56%, 32 (35.95%, 2 (2.24%, and 10 (11.23% patients respectively. Conclusion: Tuberculosis is the most frequent disease associated with anthracosis in South Khorasan province. Consequently, patients with anthracosis must be carefully evaluated for tuberculosis.

  20. Does Airway Pressure Release Ventilation Mode Make Difference in Cardiopulmonary Function of ICU Patients?

    Directory of Open Access Journals (Sweden)

    Maziar Mahjoubifard

    2015-11-01

    Full Text Available Introduction: Tuberculosis (TB, with different types of respiratory tract involvements, has a high rate of mortality all around the world. Endobronchial involvement, which is a slightly common tuberculous infection, requires special attention due to its severe complications such as bronchostenosis. Aim of study of this study was describes, one type of pulmonary tuberculosis with less diagnosed and delayed treatment. High suspicious needs to diagnose and may be need bronchoscopy for confirmed the diagnosis. It can be associated with sever complication and early diagnosis and treatment are necessary for prevention of adverse effect. Materials and Methods: This retrospective study was conducted in a teaching hospital during 2005-2010. Patients diagnosed with endobronchial tuberculosis through bronchoscopic biopsy were included in the study. Diagnosis was confirmed by observation of caseous necrosis, bronchial lavage fluid or positive acid-fast staining in tissue samples obtained through bronchial biopsy. Moreover, demographic information, endobronchial view, lab tests, as well as clinical and radiographic findings were reviewed and evaluated retrospectively. Results: A total of 20 cases were confirmed with endobronchial tuberculosis, 75% of whom were female with the mean age of 60 years. The results showed that the most common clinical symptom was cough (80%, the most common finding in the chest X-ray was consolidation (75%, and the most common bronchoscopic feature was anthracosis (55%. Conclusion: TB is still a major concern, particularly in the developing countries. Thus, in order for early diagnosis and prevention of this disease, we need to pay meticulous attention to its clinical manifestations and bronchoscopic features.

  1. Clinical and Para-Clinical Presentations of Endobronchial Tuberculosis

    Directory of Open Access Journals (Sweden)

    Seyyed Hosein Ahmadi Hoseini

    2015-11-01

    Full Text Available Introdution: Tuberculosis (TB, with different types of respiratory tract involvements, has a high rate of mortality all around the world. Endobronchial involvement, which is a slightly common tuberculous infection, requires special attention due to its severe complications such as bronchostenosis. Aim of study of this study was describes, one type of pulmonary tuberculosis with less diagnosed and delayed treatment. High suspicious needs to diagnose and may be need bronchoscopy for confirmed the diagnosis. It can be associated with sever complication and early diagnosis and treatment are necessary for prevention of adverse effect.   Materials and Methods: This retrospective study was conducted in a teaching hospital during 2005-2010. Patients diagnosed with endobronchial tuberculosis through bronchoscopic biopsy were included in the study. Diagnosis was confirmed by observation of caseous necrosis, bronchial lavage fluid or positive acid-fast staining in tissue samples obtained through bronchial biopsy. Moreover, demographic information, endobronchial view, lab tests, as well as clinical and radiographic findings were reviewed and evaluated retrospectively. Results: A total of 20 cases were confirmed with endobronchial tuberculosis, 75% of whom were female with the mean age of 60 years. The results showed that the most common clinical symptom was cough (80%, the most common finding in the chest X-ray was consolidation (75%, and the most common bronchoscopic feature was anthracosis (55%. Conclusion: TB is still a major concern, particularly in the developing countries. Thus, in order for early diagnosis and prevention of this disease, we need to pay meticulous attention to its clinical manifestations and bronchoscopic features.

  2. Classification of pulmonary airway disease based on mucosal color analysis

    Science.gov (United States)

    Suter, Melissa; Reinhardt, Joseph M.; Riker, David; Ferguson, John Scott; McLennan, Geoffrey

    2005-04-01

    Airway mucosal color changes occur in response to the development of bronchial diseases including lung cancer, cystic fibrosis, chronic bronchitis, emphysema and asthma. These associated changes are often visualized using standard macro-optical bronchoscopy techniques. A limitation to this form of assessment is that the subtle changes that indicate early stages in disease development may often be missed as a result of this highly subjective assessment, especially in inexperienced bronchoscopists. Tri-chromatic CCD chip bronchoscopes allow for digital color analysis of the pulmonary airway mucosa. This form of analysis may facilitate a greater understanding of airway disease response. A 2-step image classification approach is employed: the first step is to distinguish between healthy and diseased bronchoscope images and the second is to classify the detected abnormal images into 1 of 4 possible disease categories. A database of airway mucosal color constructed from healthy human volunteers is used as a standard against which statistical comparisons are made from mucosa with known apparent airway abnormalities. This approach demonstrates great promise as an effective detection and diagnosis tool to highlight potentially abnormal airway mucosa identifying a region possibly suited to further analysis via airway forceps biopsy, or newly developed micro-optical biopsy strategies. Following the identification of abnormal airway images a neural network is used to distinguish between the different disease classes. We have shown that classification of potentially diseased airway mucosa is possible through comparative color analysis of digital bronchoscope images. The combination of the two strategies appears to increase the classification accuracy in addition to greatly decreasing the computational time.

  3. Epidermal Growth Factor Receptor Mutation in a Patient with Squamous Cell Carcinoma of the Lung: Who Should Be Tested

    Directory of Open Access Journals (Sweden)

    Michael Schwitter

    2013-05-01

    Full Text Available We report the case of a 64-year-old ex-smoker with metastatic poorly differentiated squamous cell carcinoma (SCC of the lung and an epidermal growth factor receptor (EGFR mutation in exon 21 (p.L858R who achieved prolonged clinical benefit from treatment with an EGFR tyrosine kinase inhibitor (TKI. The initial diagnosis of SCC of the lung obtained by bronchoscopic biopsy was based on immunohistochemical staining only with positivity for cytokeratin (CK 5/6 and p63 because morphological diagnosis was not possible. Patients with non-small cell lung cancer (NSCLC, not otherwise specified (NOS favouring SCC are usually not tested for the presence of EGFR mutations, and therefore may not receive EGFR TKI therapy. A bronchoscopic rebiopsy showed small nests of undifferentiated tumour cells with weak immunoreactivity of some tumour cells for CK5/6, p63 and no positivity of some tumour cells for thyroid transcription factor-1. These findings suggested a mixed squamous/glandular immunophenotype that has been missed at the initial biopsy. Our clinical case illustrates the problem of tumour heterogeneity encountered in small bronchoscopic biopsies and the difficulties of evaluating the histological subtype in poorly differentiated carcinomas. Initial bronchoscopy should be performed by an experienced pulmonologist who attempts to obtain sufficient material from different areas of the tumour. In the era of targeted therapy, a remote smoking history in a patient with NOS favouring SCC should also lead to EGFR mutation testing to allow highly effective therapy to be offered to mutation-positive patients.

  4. Flexible micro-OCT endobronchial probe for imaging of mucociliary transport (Conference Presentation)

    Science.gov (United States)

    Cui, Dongyao; Chu, Kengyeh K.; Unglert, Carolin I.; Ford, Tim N.; Carruth, Robert W.; Hyun, Daryl; Singh, Kanwarpal; Birket, Susan E.; Solomon, George M.; Rowe, Steve M.; Tearney, Guillermo J.

    2016-03-01

    Mucociliary clearance (MCC) plays a significant role in maintaining the health of human respiratory system by eliminating foreign particles trapped within mucus. Failure of this mechanism in diseases such as cystic fibrosis and chronic obstructive pulmonary disease (COPD) leads to airway blockage and lung infection, causing morbidity and mortality. The volume of airway mucus and the periciliary liquid encapsulating the cilia, in addition to ciliary beat frequency and velocity of mucociliary transport, are vital parameters of airway health. However, the diagnosis of disease pathogenesis and advances of novel therapeutics are hindered by the lack of tools for visualization of ciliary function in vivo. Our laboratory has previously developed a 1-µm resolution optical coherence tomography method, termed Micro-OCT, which is capable of visualizing mucociliary transport and quantitatively capturing epithelial functional metrics. We have also miniaturized Micro-OCT optics in a first-generation rigid 4mm Micro-OCT endoscope utilizing a common-path design and an apodizing prism configuration to produce an annular profile sample beam, and reported the first in vivo visualization of mucociliary transport in swine. We now demonstrate a flexible 2.5 mm Micro-OCT probe that can be inserted through the instrument channel of standard flexible bronchoscopes, allowing bronchoscopic navigation to smaller airways and greatly improving clinical utility. Longitudinal scanning over a field of view of more than 400 µm at a frame rate of 40 Hz was accomplished with a driveshaft transduced by a piezo-electric stack motor. We present characterization and imaging results from the flexible micro-OCT probe and progress towards clinical translation. The ability of the bronchoscope-compatible micro-OCT probe to image mucus clearance and epithelial function will enable studies of cystic fibrosis pathogenesis in small airways, provide diagnosis of mucociliary clearance disorders, and allow

  5. Diagnostic imaging in COPD

    International Nuclear Information System (INIS)

    COPD is a heterogeneous disease defined by expiratory airflow limitation. Airflow limitation is caused by a variable combination of emphysematous destruction of lung parenchyma and small airway obstruction. Only advanced emphysema can be diagnosed by chest X-ray. Less severe emphysema and changes in small airways are commonly diagnosed by computed tomography. Typical visual appearance of pathologic changes in lung parenchyma and airways of COPD patients are presented, furthermore methods for quantitative assessment of these changes and the crucial role of imaging for surgical and bronchoscopic treatment in COPD are discussed. (orig.)

  6. [Anomalous systemic arterial supply to left basal lung with anomalous return of V6].

    Science.gov (United States)

    Yabuki, Hiroshi; Shibuya, Jotaro; Handa, Masashi; Yamada, Takehiro

    2014-11-01

    The patient was 52-year-old woman. Her chief compliant was bloody sputum. The computed tomography revealed an anomalous artery from descending aorta running into left lung basal segment and anomalous left V6 return to superior pulmonary vein. The bronchoscopic examination showed normal bronchial branches. Under the diagnosis of anomalous systemic arterial supply to left basal lung without sequestration, left lower lobectomy was performed. Microscopically, the pulmonary artery showed intimal thickening and alveolar collapse with interstitial fibrosis were seen. The postoperative course was uneventful and she discharged at 6th postoperative day. PMID:25391467

  7. Recurrent lower respiratory tract infections in a 14-year-old boy with tracheobronchomegaly (Mounier-Kuhn syndrome).

    Science.gov (United States)

    Benesch, M; Eber, E; Pfleger, A; Zach, M S

    2000-06-01

    Tracheobronchomegaly (Mounier-Kuhn syndrome) is characterized by dilatation of the central airways, tracheobronchial outpouchings, and chronic tracheobronchitis. Most cases are diagnosed in adulthood. We report the clinical, radiographic, and bronchoscopic findings in a 14-year-old boy with tracheobronchomegaly, ptosis of the right eyelid, and redundant skin and mucosa of the upper lip, who presented with a 2-year history of recurrent lower respiratory tract infections. Pediatricians should be aware of the possibility that tracheobronchomegaly may cause clinical symptoms in childhood and adolescence. Pediatr Pulmonol. 2000; 29: 476-479. PMID:10821730

  8. Solitary Fibrous Tumor of the Trachea: CT Findings with a Pathological Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Young Sup; Choi, Soo Jin; Kim, Hyung Sik; Lee, Jae Ik [Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2008-06-15

    We present the multidetector CT findings with a pathologic correlation for the case of a solitary fibrous tumor located in the trachea. The MDCT revealed a well circumscribed intraluminal mass arising from the trachea, with strong nodular enhancement in the periphery of the mass. The enhancement pattern of the mass corresponded histopathologically to a focal hypocellular area in the center and prominent blood vessels along the periphery of the mass. We also present volume-rendered and virtual bronchoscopic images of this rare submucosal tracheal tumor.

  9. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2011-03-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  10. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2012-02-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  11. Indication for fiberoptic bronchoscopy in HIV-infected patients suspected for Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Orholm, M; Lundgren, Jens Dilling; Nielsen, T L;

    1990-01-01

    During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations...... did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed, it is...

  12. Pseudomembranous necrotizing tracheobronchial aspergillosis:an analysis of 16 cases

    Institute of Scientific and Technical Information of China (English)

    HUANG Hai-dong; LI Qiang; HUANG Yi; BAI Chong; WU Ning; WANG Qing; YAO Xiao-peng; CHEN Bin

    2012-01-01

    Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis (PNTA).In this study we analyzed the clinical data from patients with PNTA,so as to guide the diagnosis and treatment of the disease.@@Methods A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 to January 2009.Their clinical data,including the demographic information,clinical symptoms,imaging findings,bronchoscopy findings,treatment strategies and efficacy,and prognosis,were retrospectively analyzed.@@Results All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways.Nine patients (9/16,56.3%) had pulmonary and tracheobronchial tumors,5/16 (31.3%) had tracheobronchial involvement secondary to non-pulmonary tumors,and 2/16 (12.5%) had lung transplantation.The most common causes of PNTA included local radiotherapy (10/16,62.5%),repeated chemotherapy (7/16,43.8%) and recurrent intervention therapy by bronchoscope (4/16,25.0%).Aspergillus fumigatus was the most frequent pathogen (62.5%,10/16).The main clinical manifestations included progressive dyspnea (14/16,87.5%) and irritable cough (12/16,75.0%).The trachea was involved in 9/16 patients (56.3%),right main bronchus in 10/16 (62.5%).All 16 patients were treated with systemic anti-aspergillosis agents,local anti-aspergillosis agents with amphotedcin B inhalation and direct perfusion of amphotericin B by bronchoscope,and interventional treatment by bronchoscope to ensure an unobstructed airway.The total efficiency was 31.3%.@@Conclusions PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea,primary bronchus and segmental bronchus.A.fumigatus is the most common pathogen.PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency and

  13. Airway Management in a Patient with Severe Ankylosing Spondylitis Causing Bamboo Spine: Use of Aintree Intubation Catheter.

    Science.gov (United States)

    Ul Haq, Muhammad Irfan; Shamim, Faisal; Lal, Shankar; Shafiq, Faraz

    2015-12-01

    Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope. PMID:26691367

  14. Primary small cell cancer of cervical trachea: a case report and literature review

    OpenAIRE

    Qiu, Jun; Lin, Wei; Zhou, Min-Li; ZHOU, SHUI-HONG; Wang, Qin-Ying; Bao, Yang-Yang

    2015-01-01

    Primary small cell carcinoma of trachea is even more uncommon and only a few cases have been reported. Our search revealed only 90 cases in the English-language literatures. Case report: we report a case of cervical tracheal small cell cancer. A 67-year-old male presented with over 2-month history of cough and dyspnea. CT and MRI revealed a 1.0 cm × 2.5 cm intraluminal, irregular soft tissue mass in the upper trachea, approximately 2.5 cm below the glottis. A bronchoscopic examination disclos...

  15. Implantable microwave radiators for clinical hyperthermia

    Science.gov (United States)

    Taylor, Leonard S.; Samaras, George M.; Cheung, Augustine Y.; Salcman, Michael; Scott, Ralph M.

    1982-01-01

    We describe the design of coaxial microwave radiators suitable for localized hyperthermia of neoplasia in the esophagus, brain, and other organs which are accessible through body orifices. These radiators can be implanted surgically and are small enough to be passed through such devices as nasogastric tubes and bronchoscopes. The radiators consist of combinations of cross-switched half-wavelength coaxial sections and/or needle antenna terminations. The performance of these radiators, as determined by thermogram recordings in tissue phantoms and the results of in vivo animal tests, is described.

  16. Adult Henoch-Schönlein purpura associated with small cell lung cancer: A case report and review of the literature

    OpenAIRE

    Zhang, Xue-De; YANG, SHUAN-YING; Li, Wei; Ming, Zong-Juan; Hou, Yan-Li; Niu, Ze-Qun; Zhang, Yu-ping

    2013-01-01

    The present study reports the case of a 53-year-old male who had been suffering from coughing and the presence of a blood-streaked sputum for >1 month. Chest computed tomography (CT) and a bronchoscopic brush smear were performed. The patient was subsequently diagnosed with small cell lung cancer (limited stage). The patient developed polyarthritis, abdominal pain, diarrhea and a purpuric rash at 14 days post thoracotomy surgery for lung cancer. Henoch-Schönlein purpura (HSP) was diagnosed ba...

  17. Congenital lobar emphysema in an adult

    Directory of Open Access Journals (Sweden)

    Mir Sadaqat

    2011-01-01

    Full Text Available Congenital lobar emphysema (CLE is a clinico-radiological diagnosis, seen usually by four-six weeks of age (50% of patients and rarely (<5% of patients after the age of six months. Here, we report a young male with gradual onset of mild exertional breathlessness and physical examination revealing the features of right sided pneumothorax. X-ray of chest, with subsequent CT of chest, leads to the diagnosis of CLE. The pulmonary function tests, bronchoscopic examination and a1 -antitrypsin level are normal. Patient is managed conservatively.

  18. Diagnostic value of diffuse and peripheral lung lesions by transbronchial lung biopsy

    Institute of Scientific and Technical Information of China (English)

    石志红; 魏霞; 卫小红; 朱柏

    2008-01-01

    Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions.Results Eighty-nine final diagnosis cases via TBLB only once,the diagnostic rate of double lung diffuse lesions was the highest,[51.06%(24/47)],local non-nodule lesions,nodule lesions,cavity lesions were 33.33...

  19. Protein losing enteropathy secondary to a pulmonary artery stent

    International Nuclear Information System (INIS)

    A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE). He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE

  20. Subglottic tracheal stenosis

    Science.gov (United States)

    Venuta, Federico; Rendina, Erino Angelo

    2016-01-01

    Benign subglottic stenosis represents a major therapeutic challenge. Interventional bronchoscopic treatment has a limited role in this setting due to anatomical and technical reasons. The benefit with these techniques is generally temporary, due to frequent recurrences, need for repeated procedures and risk of extending the area of damage. Laryngotracheal resection is at present the curative treatment of choice. Literature data show that surgical treatment may allow very high success rates at long term with low perioperative morbidity and mortality. Technical aspects and results are reported and discussed. PMID:26981264

  1. Foreign bodies in the lactant airway, Report of a case

    International Nuclear Information System (INIS)

    We report the case of a lactant who aspired (popcorn) fragments of popcorn into his airway. Immediately the patient developed respiratory difficulty, he was remitted to a specialized hospital until 72 hours after. In this hospital the fragments of popcorn were removed by bronchoscopic procedure with posterior improvement. The aspiration of foreign bodies into the airway is a frequent accident in the early childhood. The clinical picture may be confounded specially with asthma attacks or simple acute respiratory infections. It is very important to recognize this condition because of the foreign bodies can cause severe complications and sequels, and occasionally the death

  2. Syndrome of iron pill inhalation in four patients with accidental tablet aspiration: Severe airway complications are described

    Directory of Open Access Journals (Sweden)

    U. Caterino

    2015-01-01

    Full Text Available Iron pill inhalation represents a uncommon cause of syntomatic endobronchial foreign bodies. Unlike foreign body, the direct contact of iron tablet onto the bronchial mucosa results in severe bronchial damage in addition to obstruction and local irritation. Four patients with Iron Pill Inhalation Syndrome are described. All but one patient developed irreversible bronchial stenosis as late post inflammatory complication. Bronchoscopic features and clinical evolution are described in order to reduce the risk of severe side-effects in patients highly suspected for iron pill aspiration.

  3. Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006.

    Science.gov (United States)

    Cooksley, Nathania; Judge, Daniel James; Brown, James

    2014-01-01

    A 28-year-old woman of Laotian origin presented with dry cough, fevers, night sweats and weight loss over the preceding 6 weeks. Radiological investigations revealed large complex cavitary lesions in the middle and lower lobes of the right lung, with no mediastinal lymph node enlargement. Bronchoscopic investigations did not yield a diagnosis. CT-guided fine-needle aspiration raised the possibility of Langerhans cell histiocytosis. Open lung biopsy initially supported this, but eventually a microscopic and immunohistochemical diagnosis of Hodgkin's lymphoma was made. The final diagnosis was primary pulmonary Hodgkin's lymphoma. We present a new case as well as a literature review of reported cases published since 2006. PMID:24711477

  4. Radiological-pathological findings of central sclerosing hemangioma initially misdiagnosed as papillary adenoma by bronchoscopicbiopsy: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Hyun; Seon, Hyun Ju; Song, Jang Hyeon; Park, Seo Yeon; Kim, Yun Hyeon; Choi, Yoo Duk; Song, Sang Yun [Chonnam National University Hospital, Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2013-10-15

    Sclerosing hemangioma is relatively rare, the second most common benign pulmonary neoplasm, which usually presents the peripheral location. Central location of this neoplasm is extremely rare with only a few reports. Herein, we would like to report an extremely rare case of central sclerosing hemangioma with descriptions of radiological characteristics. It was initially misdiagnosed as a papillary adenoma by bronchoscopic biopsy and mimicked central lung malignancies such as carcinoid tumors on non-invasive image evaluations. However the patient was finally confirmed with surgery.

  5. Fractured Tracheostomy Tube in Left Main Bronchus with No Mouth Opening: An Anaesthetic Challenge

    Directory of Open Access Journals (Sweden)

    Arghya Mukherjee

    2014-10-01

    Full Text Available Foreign body aspiration is a serious medical condition that demands prompt diagnosis and treatment to prevent fatal complications. This is a case report of a 42 year male with history of surgery for carcinoma tongue, hemiglossectomy and tracheostomy. He presented with dislodged fractured metallic tracheostomy tube in left main bronchus. Patient was breathing through stenosed tracheostomy stoma with bilateral normal air entry in chest. He was haemodynamically stable. Rigid bronchoscopic removal was impossible due to no mouth opening. After securing airway, general anaesthesia was induced and thoracotomy was performed to remove dislodged tube. Proper planning and coordinated team work resulted in good outcome.

  6. Protein losing enteropathy secondary to a pulmonary artery stent

    Directory of Open Access Journals (Sweden)

    Narayanswami Sreeram

    2012-01-01

    Full Text Available A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE. He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE.

  7. Post-traumatic bronchial mucus plug leading to pneumonectomy

    Directory of Open Access Journals (Sweden)

    Khan M.S

    2012-01-01

    Full Text Available Background: Blunt trauma of the chest is not uncommon these days. By far, the most important cause of significant blunt chest trauma is motor vehicle accidents. Pedestrians struck by vehicles, falls from height, blast injuries and acts of violence are other causative mechanisms. Most of the blunt trauma cases need no operative intervention and can be managed by supportive procedures. Aim: We present a case of a 10-year old boy who had blunt trauma to chest due to fall from height. Findings: The patient was in respiratory distress and developed surgical emphysema and pneumothorax on the left side. He was managed by putting in a chest drain on the left side. Patient improved and was discharged .He again developed respiratory distress 15 days later. On bronchoscopic examination, an obstruction was found just distal to the carina in the left bronchus. Several futile attempts were made to retrieve the obstructing material. Hence, mucus plug was removed through left bronchotomy. There was no improvement in the ventilation of the left lung for 7 days. Bronchoscopic suction was done. All the measures failed and the lung remained collapsed. Patient underwent pneumonectomy as the last treatment option available in our hospital. At the time of reporting this case, patient was doing well. Conclusion: Chest physiotherapy helps in reducing lung collapse. If patient is reluctant to chest physiotherapy and coughing, it can lead to accumulation of respiratory secretions and formation of mucus plug. This mucus plug can cause collapse of the lung and ill consequences.

  8. Hands-Free System for Bronchoscopy Planning and Guidance.

    Science.gov (United States)

    Khare, Rahul; Bascom, Rebecca; Higgins, William E

    2015-12-01

    Bronchoscopy is a commonly used minimally invasive procedure for lung-cancer staging. In standard practice, however, physicians differ greatly in their levels of performance. To address this concern, image-guided intervention (IGI) systems have been devised to improve procedure success. Current IGI bronchoscopy systems based on virtual bronchoscopic navigation (VBN), however, require involvement from the attending technician. This lessens physician control and hinders the overall acceptance of such systems. We propose a hands-free VBN system for planning and guiding bronchoscopy. The system introduces two major contributions. First, it incorporates a new procedure-planning method that automatically computes airway navigation plans conforming to the physician's bronchoscopy training and manual dexterity. Second, it incorporates a guidance strategy for bronchoscope navigation that enables user-friendly system control via a foot switch, coupled with a novel position-verification mechanism. Phantom studies verified that the system enables smooth operation under physician control, while also enabling faster navigation than an existing technician-assisted VBN system. In a clinical human study, we noted a 97% bronchoscopy navigation success rate, in line with existing VBN systems, and a mean guidance time per diagnostic site = 52 s. This represents a guidance time often nearly 3 min faster per diagnostic site than guidance times reported for other technician-assisted VBN systems. Finally, an ergonomic study further asserts the system's acceptability to the physician and long-term potential.

  9. [Application of Interventional Bronchoscopy in Pulmonary Peripheral Lesions].

    Science.gov (United States)

    Wang, Hui; Huang, Linian

    2016-08-20

    Lung cancer is the leading cause of cancer-related mortality worldwide. A low cure rate of lung cancer is not only attributed to intrinsic aggressive biological behavior, but also little attention to lung cancer screening. With lung screening methods continuous progress, peripheral pulmonary lesions detection rate gradually increased. Currently, a transbronchial approach using a bronchoscope or computed tompgraphy (CT) guided transthoracic needle aspiration/biopsy have been the most generally accepted methods for diagnosing peripheral pulmonary lesions. However, conventional bronchoscopy has a poor diagnostic yield and CT-guided approach has high rates of pneumothorax for such peripheral pulmonary lesions. Therefore, clinicians will be challenged with the task of providing the means to provide a safe and minimally invasive method of obtaining accurate tissue diagnostics for the pulmonary peripheral lesions. New bronchoscopic interventional diagnosis technologies have recommended in clinical gradually. They can effectively improve the peripheral pulmonary lesions diagnosis rate, shorten the time of diagnosis, and make the patients get timely and effective treatment. In this paper, we reviewed briefly available technologies to aid clinicians in attempts at minimally invasive techniques. PMID:27561808

  10. Fluoroscopic image-guided intervention system for transbronchial localization

    Science.gov (United States)

    Rai, Lav; Keast, Thomas M.; Wibowo, Henky; Yu, Kun-Chang; Draper, Jeffrey W.; Gibbs, Jason D.

    2012-02-01

    Reliable transbronchial access of peripheral lung lesions is desirable for the diagnosis and potential treatment of lung cancer. This procedure can be difficult, however, because accessory devices (e.g., needle or forceps) cannot be reliably localized while deployed. We present a fluoroscopic image-guided intervention (IGI) system for tracking such bronchoscopic accessories. Fluoroscopy, an imaging technology currently utilized by many bronchoscopists, has a fundamental shortcoming - many lung lesions are invisible in its images. Our IGI system aligns a digitally reconstructed radiograph (DRR) defined from a pre-operative computed tomography (CT) scan with live fluoroscopic images. Radiopaque accessory devices are readily apparent in fluoroscopic video, while lesions lacking a fluoroscopic signature but identifiable in the CT scan are superimposed in the scene. The IGI system processing steps consist of: (1) calibrating the fluoroscopic imaging system; (2) registering the CT anatomy with its depiction in the fluoroscopic scene; (3) optical tracking to continually update the DRR and target positions as the fluoroscope is moved about the patient. The end result is a continuous correlation of the DRR and projected targets with the anatomy depicted in the live fluoroscopic video feed. Because both targets and bronchoscopic devices are readily apparent in arbitrary fluoroscopic orientations, multiplane guidance is straightforward. The system tracks in real-time with no computational lag. We have measured a mean projected tracking accuracy of 1.0 mm in a phantom and present results from an in vivo animal study.

  11. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated newborns.

    Science.gov (United States)

    Rigal, E; Roze, J C; Villers, D; Derriennic, M; David-Melon, V; Lacroix-Mechinaud, F; Mouzard, A

    1990-01-01

    The precise diagnosis of lower respiratory tract infection in the critically ill newborn remains a difficult challenge. The bronchoscopic protected specimen brush (PSB) is a reliable method in intubated adults. Because the bronchoscopic procedure is not generally available for young children, Zucker proposed a blind technique for introducing the PSB into the distal airways. His results were promising but were not compared with any bacteriologic reference method. Therefore, we wanted to evaluate this technique in comparison with the open lung biopsy (OLB) when it could be ethically accomplished. Eleven PSB were collected simultaneously with an OLB. The sensitivity of the PSB procedure was 100%, its specificity 88%, its positive predictive value 66%, and its negative predictive value 100%. There were no complications secondary to the PSB procedure. In this short study, the PSB procedure using a blind technique is safe and feasible to obtain uncontaminated specimens in intubated and ventilated newborns, and is largely accurate in identifying the bacterial etiologic agent of lower respiratory tract infection. PMID:2371075

  12. A study to evaluate asbestos fiber burden in lung and pleural malignancies

    Directory of Open Access Journals (Sweden)

    S K Verma

    2010-01-01

    Full Text Available Background: There is scarcity of data on asbestos fiber burden in lung and pleural malignancies. Aim: To evaluate asbestos fiber burden in biopsy samples of suspected lung and pleural malignancies. Study Design: This was a single-centre, observational study. Study Period: From August 2010 to July 2010. Setting: Department of Pulmonary Medicine, CSMMU, UP, Lucknow, a tertiary care hospital in India. Study Population: Suspected cases of lung and pleural malignancy. Materials and Methods: Biopsy tissues taken by computed tomography (CT-guided biopsy, bronchoscopic biopsy, and pleural biopsy by Cope′s needle were analyzed for histopathology and asbestos burden by Haq et al.′s method. Results: 20 patients were studied. Mean fiber burden was 9.25 × 10 >4 fibers/g. Average burden in lung malignancies (11 patients was 9.178 × 10 >4 fibers/g and in pleural tissue (9 patients was 9.332 × 10 >4fibers/g. Among the different cell types, mean fiber burden in squamous cell carcinoma was 8.99 × 10 >4 fibers/g, in adenocarcinoma was 9.71 × 10 >4 fibers/g, and in small cell carcinoma was 7.54 × 10 >4 fibers/g. Mean fiber burden in bronchoscopic endobronchial biopsy tissue was 10.69 × 10 >4 fibers/g, while in CT-guided biopsy was 8.60× 10 >4fibers/g. Conclusion: Maximum number of fibers was found in adenocarcinoma.

  13. Emphysema: coiling up the lungs, trick or treat?

    Science.gov (United States)

    Bezzi, M; Mondoni, M; Sorino, C; Solidoro, P

    2015-08-01

    Lung volume reduction coil (LVRC) treatment is a minimally-invasive technique planned to achieve an improvement of exercise capacity and pulmonary function in subjects with advanced emphysema and hyperinflation. It has been proposed together with other bronchoscopic lung volume reduction approaches to reduce lung hyperinflation in emphysema as less invasive alternatives to LVRS and are currently under clinical investigation. Following the successful early experiences in previous pilot trials, recent studies allow further investigation into the feasibility, safety and efficacy of LVR coil treatment in a multi-center setting in a larger group of patients. According to this studies we can state that LVR coil treatment results in significant clinical improvements in patients with severe emphysema, in multicenter analysis, with a good safety profile and sustained results for up to 1 year. The literature on endobronchial coils continues to look promising with an acceptable safety profile, and positive long-term follow-up data are certainly more and more available. However, further well-designed, blinded, placebo (or sham) controlled trials, and even randomized trials against LVRS (lung volume reduction surgery), are needed before routine clinical use can be recommended. This is true not only for endobronchial coils, but also for the whole field of bronchoscopic lung volume reduction. PMID:27427120

  14. An preliminary clinical study of transbronchoscopic interventional treatment for severe emphysema with local made one-way valvular stents

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety and efficiency of bronchoscopic interventional lung volume reduction with domestic-made stents. Methods: The target areas of 7 patients with severe emphysema for valvular stenting form May 2006 to Aug. 2007 were prospectively selected on the basis of CT scan. Under general anesthesia, one-way valvular stenting were carried out over a guidewire under flexible bronchoscopy and fluoroscopic control. The symptom, pulmonary function, blood gas analysis, B-ultrasonic wave, 6 minute walk distance and thoracic CT were undertaken. Results: 4-6 stents per patient took place in 136 ± 72.3 min to obstruct the upper-lobe segments unilaterally but without obvious atelectasis under imaging. The patients could walk 2 hours after the operation with relief of dyspnea. No major change in radiologic findings and lung function occurred in 2 weeks, only bronchi distal to the stents gathered together. 6-min walk distance, Borg dyspnea scale fell and the pulmonary arterial pressure showed significant (P<0.05)statistical discrepancy. No major life-threatening complications were noted in the 15-day study period and no conspicuous change in lung function, blood gas analysis and lung volume. Lower-lobe pneumonia of nontarget area developed in 1 patient and acute episode of COPD occurred in another. Conclusions: Bronchoscopic interventional lung volume reduction may improve dyspnea and quality of life, as a rather safety therapeutic measure. (authors)

  15. BILATERAL PNEUMOTHORAX AS A COMPLICATION OF PERCUTANEOUS TRACHEOSTOMY: CASE REPORT.

    Science.gov (United States)

    Klancir, Tino; Adam, Višnja Nesek; Mršić, Viviana; Marin, Damjan; Goranović, Tatjana

    2016-03-01

    Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.

  16. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis.

    Science.gov (United States)

    You, Kicheol; Yang, Hyeong-Tae; Kym, Dohern; Yoon, Jaechul; HaejunYim; Cho, Yong-Suk; Hur, Jun; Chun, Wook; Kim, Jong-Hyun

    2014-12-01

    This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1±13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24h of sustaining the burn. The bronchoscopic findings were classified as normal, mild, moderate, and severe. Mechanical ventilation was administered, when required. Age, percentage of TBSA burned, ABSI score, requirement of mechanical ventilation and PF ratio, but not inhalation injury, COHb level, and bronchoscopic grades, significantly differed between the survivors and non-survivors (pburns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.

  17. Tracheal reconstruction using chondrocytes seeded on a poly(L-lactic-co-glycolic acid)-fibrin/hyaluronan.

    Science.gov (United States)

    Hong, Hyun Jun; Chang, Jae Won; Park, Ju-Kyeong; Choi, Jae Won; Kim, Yoo Suk; Shin, Yoo Seob; Kim, Chul-Ho; Choi, Eun Chang

    2014-11-01

    Reconstruction of trachea is still a clinical dilemma. Tissue engineering is a recent and promising concept to resolve this problem. This study evaluated the feasibility of allogeneic chondrocytes cultured with fibrin/hyaluronic acid (HA) hydrogel and degradable porous poly(L-lactic-co-glycolic acid) (PLGA) scaffold for partial tracheal reconstruction. Chondrocytes from rabbit articular cartilage were expanded and cultured with fibrin/HA hydrogel and injected into a 5 × 10 mm-sized, curved patch-shape PLGA scaffold. After 4 weeks in vitro culture, the scaffold was implanted on a tracheal defect in eight rabbits. Six and 10 weeks postoperatively, the implanted sites were evaluated by bronchoscope and radiologic and histologic analyses. Ciliary beat frequency (CBF) of regenerated epithelium was also evaluated. None of the eight rabbits showed any sign of respiratory distress. Bronchoscopic examination did not reveal stenosis of the reconstructed trachea and the defects were completely recovered with respiratory epithelium. Computed tomography scan showed good luminal contour of trachea. Histologic data showed that the implanted chondrocytes successfully formed neocartilage with minimal granulation tissue. CBF of regenerated epithelium was similar to that of normal epithelium. Partial tracheal defect was successfully reconstructed anatomically and functionally using allogeneic chondrocytes cultured with PLGA-fibrin/HA composite scaffold.

  18. Navigation systems based on registration of endoscopic and CT-derived virtual images for bronchofiberoscopic procedures.

    Science.gov (United States)

    Turcza, Paweł; Duplaga, Mariusz

    2004-01-01

    Bronchofiberoscopy is an essential diagnostic procedure in patients with lung cancer. Sampling methods employed during endoscopy of the respiratory tract are performed with the aim of diagnosis confirmation and staging. Transbronchial needle aspiration may be used for evaluation of lymph nodes neighbouring with trachea and bronchi. Many efforts have been undertaken to increase the sensitivity of this procedure including the application of endobronchial ultrasonography. In recent years several research groups have proposed models of navigating systems to provide computer assistance during bronchoscopic interventions. Although they have used different techniques, their objective was the same - enabling tracking location and movement of bronchofiberoscope tip with reference to previously-acquired computed tomography (CT) images. Since a fiber-optic bronchoscope is a rather long and flexible device, determination of its tip location is not an easy task. The adoption of optical tracking methods used in neurosurgery or laparoscopic surgery to endoscopy of the tracheobronchial tree is usually not possible. Another obstacle is related to the fact that bronchofiberoscopes usually have only one operational channel. This feature considerably limits the feasibility of navigation systems based on the use of small electromagnetic sensing devices or USG probes. The sources of positioning errors in such systems are respiratory movements and the lack of external referential coordinate system associated with the tracheobronchial tree.A promising option for development of a bronchoscopic guidance system is the application of image registration algorithms. Such an approach encompasses registration of endoscopic images to views derived from advanced imaging methods, e.g. CT. In the first step, reconstruction of a three-dimensional, endoluminal views is performed. Next, the position of the virtual camera in a CT-derived virtual model is determined using a complex multi-level image

  19. 重度肺气肿的内镜下肺减容治疗技术%Application of endoscopic lung volume reduction technique in severe emphysema

    Institute of Scientific and Technical Information of China (English)

    迟晶; 郭述良; 贾晋伟; 李一诗

    2013-01-01

    慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)在世界范围的发病率和死亡率占主要因素.COPD发展至重度肺气肿阶段时严重影响患者生活质量.内镜肺减容术(endoscopic lung volume reduction,ELVR)是通过支气管镜技术使过度充气的肺叶产生不张,疗效较传统的内科治疗更为确切,与外科肺减容术相比,ELVR以其微创,操作相对简单,并发症和死亡率降低等优点,引起了世界医学界的广泛研究.目前国内外研究较多的内镜下肺减容技术主要包括支气管内单向活瓣技术(one-way endobronchial valves,EBV)、气道旁路支架(airway bypass stents,ABS)、聚合物肺减容术(polymeric lung volume reduction,PLVR)、经支气管镜热蒸汽消融术(bronchoscopic thermal vapor ablation,BTVA)和肺减容弹簧圈(lung volume reduction coil,LVRC)等5种.本文将就上述内镜肺减容技术作一综述.%Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide.Once the disease develops into severe emphysema,it seriously affects the patients' life quality.Endoscopic lung volume reduction(ELVR) with bronchoscopic techniques to bring about atelectasis of the hyperinflated lobe has been developed and studied widely over the past decade,because it has a better clinical effect than the traditional medicine treatment.The techniques have the advantages of minimally invasive and simple with less complications and lower mortality compared to the open surgical approach.Nowadays the most commonly used ELVR techniques include one-way endobronchial valves (EBV),airway bypass stents (ABS),polymeric lung volume reduction (PLVR),bronchoscopic thermal vapor ablation (BTVA) and lung volume reduction coil (LVRC).In this paper the ELVR techniques are reviewed.

  20. Clinical and pathological features and imaging manifestations of bronchial anthracofibrosis: the findings in 15 patients

    Institute of Scientific and Technical Information of China (English)

    HAN Feng-feng; YANG Tian-yun; SONG Lin; ZHANG Yue; LI Hui-min; GUAN Wen-bin; LIU Qian

    2013-01-01

    Background Bronchial anthracofibrosis (BAF) has been defined as a luminal narrowing associated with anthracotic pigmentation on bronchoscopy without a relevant history of pneumoconiosis or smoking.The aim of the study is to study the clinical features and imaging manifestations of BAF,and to promote the awareness of this disease.Method Between October 2006 and January 2012,15 patients were diagnosed at our department as BAF that showed a narrowing or obliteration of lobar or segmental bronchi with anthracotic pigmentation in the overlying mucosa on bronchoscopy.The medical records including clinical features,imaging manifestations,electronic bronchoscopic findings,and pathological features were analysed,and the literature was reviewed.Results A total of 15 patients were analyzed; 13 were female (86.7%) and two were male (13.3%) and the age range was from 62 to 86 years with a mean age of 74.5 years.Three cases (20.0%) had a history of tuberculosis.The most common clinical symptoms of BAF were cough (100%),expectoration (73.3%),dyspnea (60.0%),and fever (46.7%).Twelve cases displayed mild to moderate obstructive ventilatory dysfunction.In the electronic bronchoscopic evaluation,the most common findings were black bronchial mucosal pigmentation,bronchial stenosis,bronchial occlusion,and bronchial mucosal folds.Pathological evaluation revealed chronic inflammation of the bronchial mucosa,submucosal carbon particle deposition,and mucosal or submucosal fibrosis.Chest CT scans showed that 15 patients had bronchial stenosis or obstruction (direct signs) with the right middle lobe being the most common site (11 cases,73.3%).The indirect sign was mainly the presence of bronchial obstructive diseases (including secondary infection),represented by 11 cases of pulmonary consolidation (73.3%),seven cases of atelectasis (46.7%),and five cases of nodules (33.3%).The CT mediastinal window showed bronchial lymph node lesions,mediastinal lymph node

  1. Non-resolving pneumonia: A rare presentation of progressive disseminated histoplasmosis

    Directory of Open Access Journals (Sweden)

    Supriya Sarkar

    2014-01-01

    Full Text Available Histoplasmosis, a fungal disease caused by Histoplasma capsulatum, is endemic in North and South America. Except few scattered cases, the disease is considered to be a non-entity in India. Furthermore, disseminated histoplasmosis is rare in the immunocompetent individuals. We report an adolescent boy presenting as middle lobe consolidation which did not respond to antibiotics. His condition deteriorated with the development of mediastinal lymphadenopathy, pleural effusion and hepatosplenomegaly. A diagnosis of progressive disseminated histoplasmosis was established by his clinical findings as well as bronchoscopic biopsy, transbronchial needle aspiration cytology and bronchoalveolar lavage culture demonstrating Histoplasma capsulatum. The case represents a unique example of progressive disseminated histoplasmosis in an immunocompetent individual in India.

  2. Large Cell Neuroendocrine Carcinoma of the Lung

    Directory of Open Access Journals (Sweden)

    Yusuf Aydemir

    2015-11-01

    Full Text Available Large-cell neuroendocrine carcinomas of the lung are extremely rare. There are difficulties related to the diagnosis and treatment and there are no consensus because of the small number of studies. 65-year-old male patient presented with hemoptysis. Chest X-ray and thoracic computorized tomography scan showed a mass lesion and it could not be diagnosed by bronchoscopic biopsy and lavage. Lobectomy was performed due to the high value of standardized uptake value in positron emission tomography. Large cell neuroendocrine carcinoma was diagnosed with pathological evaluation and immunohistochemical study and after 20-month follow-up there was no recurrence. The diagnosis, treatment, and prognosis of large cell neuroendocrine carcinoma in the light of the literature is presented.

  3. Organising pneumonia due to dronedarone.

    Science.gov (United States)

    Thornton, D; Avery, S; Edey, A J; Medford, A R L

    2015-01-01

    Organising pneumonia is one of the responses of the lung to injury and can mimic bacterial pneumonia but importantly it does not respond to antibiotic therapy. We present the case of a 67-year-old male who was diagnosed with organising pneumonia secondary to dronedarone. Drug reactions are a common cause and early identification of the culprit is mandatory to prevent further morbidity and ensure a favourable outcome. On chest radiography there may be fleeting peripheral consolidation, while computed tomography can show a range of stereotyped patterns including perilobular consolidation. Bronchoscopic biopsy may not always be possible but response to steroids is often rapid following removal of the culprit drug. Dronedarone should be included in the list of possible drugs and the Pneumotox database remains a useful resource for the clinician when acute drug-related pneumotoxicity is suspected. PMID:26517101

  4. The detection of sleep apnea in the awake patient. The 'saw-tooth' sign.

    Science.gov (United States)

    Sanders, M H; Martin, R J; Pennock, B E; Rogers, R M

    1981-06-19

    We studied 21 subjects, 13 of whom had the sleep apnea hypersomnolence syndrome associated with upper airway obstruction during sleep (SAHS-UAO) to determine if "saw-toothing" on the flow-volume loop was significantly associated with the phenomenon of airway occlusion during sleep. A "saw-tooth" pattern was present on the flow-volume loop in 11 of 13 subjects with SAHS-UAO. The presence of saw-toothing correlated with fluttering of tissue that was visualized in the upper airway via the fiberoptic bronchoscope. The specificity of the saw-tooth pattern for SAHS-UAO was 100%. Generalized obesity may indirectly influence the presence of saw-toothing due to deposition of what appeared to be adipose tissue in the pharyngeal walls. Although the number of subjects in this study is small, saw-toothing on the flow-volume loop appears to be an important aid in the diagnosis of SAHS-UAO.

  5. Bronchography in patients with persistent cough

    International Nuclear Information System (INIS)

    Bronchography was performed together with a fibre-optic bronchoscopic study in 98 patients with persistent cough, 33 of whom also had haemoptysis. Finally there were chronic bronchitis in 62 patients, bronchiectasis in 21, subacute bronchitis in 9, inflammatory residuals in 3, pulmonary tuberculosis in 2 patients and metastases in one. In chronic bronchitis, the value of plain chest radiography was low. It was normal in 34 of 62 cases (55%), bronchography in 12 cases (19%). Mild cases of bronchitis were more numerous in bronchography than seen by scopist. Bronchiectasis was found in 21 patients, four of these unexpectedly (two in a tbc scar). Additionally, three cases were overdiagnosed by the radiologist on chest films and eight cases by the scopist with bronchoscopy. In patients with persistent cough and haemoptysis, bronchography mainly revealed alterations of bronchitis. (orig.)

  6. Primary pulmonary Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Two cases of primary pulmonary Hodgkin's lymphoma (PPHL) are presented, a male aged 21, and a female aged 32 years. Symptoms included non-productive cough, shortness of breath, low grade fever, wheezing and weight loss. Duration of illness varied between 6 weeks in the male patient to female patient. Both patients were given an empirical trial of antibiotics and anti-cough measures with no response. Radiological studies carried out after failure to respond to medical treatment, revealed the presence of pulmonary parenchymal masses in both patients. Cytology, bronchoscopic and transbronchial biopsies were not diagnostic, which led to opened wedge resections. Finally, the diagnosis of primary pulmonary Hodgkin's disease was reached after supportive immunohistochemical staining (CD 30 and CD 15 both positive in Rs cells). Both patients were regarded as stage I extranodal (IE) after exhaustive measures failed to demonstrate involvement of other body cites. (author)

  7. Magnetic Navigation System for Thoracoscopic Surgery: a Partial Lung Resection with Transbronchial Marking

    Science.gov (United States)

    Shimada, Junichi; Itoh, Kazuhiro; Terauchi, Kunihiko; Yanada, Masashi; Shimomura, Masanori; Nishikawa, Atsushi

    In order to detect and track a small magnet embedded in the vicinity of a target tumor during surgery, we have developed a magnetic navigation system based on three-dimensional measurements with micro-fluxgate magnetic sensors. In this paper, we present an image overlay method for superimposing the embedded magnetic marker through a bronchoscope. To evaluate the performance of the proposed system and its applicability in clinical use, we set up an in vivo experiment, in which surgeons used this system to perform thoracoscopic surgery on a pig with transbronchial marking and oblique-viewing, and we succeeded in a partial resection of the pig lung including the target area. Next, we tried a wedge resection for a lung tumor in a clinical case. We successfully performed the partial resection of the lung including the target area, which corresponded to the tumor lesion, under the guidance of the magnetic navigation system.

  8. Achieving competency in bronchoscopy: challenges and opportunities.

    Science.gov (United States)

    Fielding, David I; Maldonado, Fabien; Murgu, Septimiu

    2014-05-01

    Bronchoscopy education is undergoing significant changes in step with other medical and surgical specialties that seek to incorporate simulation-based training and objective measurement of procedural skills into training programmes. Low- and high-fidelity simulators are now available and allow learners to gain fundamental bronchoscopy skills in a zero-risk environment. Testing trainees on simulators is currently possible by using validated assessment tools for both essential bronchoscopy and endobronchial ultrasound skills, and more tools are under development for other bronchoscopic techniques. Educational concepts including the 'flipped classroom' model and problem-based learning exercises are increasingly used in bronchoscopy training programmes. These learner-centric teaching modalities require well-trained educators, which is possible thorough the expansion of existing faculty development programmes. PMID:24689877

  9. PULMONARY LEIOMYOSARCOMA——REPORT OF THREE CASES

    Institute of Scientific and Technical Information of China (English)

    苗齐; 崔全才; 张志庸; 徐乐天; 于洪泉; 任华

    1996-01-01

    Three cases of pulmonary leiomyosarcoma were presented.The characteristic clinical features were described with review of literature.In comparison with bronchogenic carcinoma,the leiomyosarcoma has some characteristics;1)On chest X-ray,it usually appears as a sharply demarcated,even density round mass,growing rapidly within the lung,it rarely accompanies with hilar or mediastinal lymph node merastasis.2)The preoperative cytological or pathological diagnosis is difficult either by sputum smear or by bronchoscopic biopsy or by fine needle percutaneous aspiration biopsy.3)Pathological differential diagnosis of leiomyosarcoma of lung from apaplastic lung cancer is difficult.In conclusion,the primary pulmonary leioyosarcoma is a rare malignant tumor,detecting the present illness seriously,paying attention to the chest X-ray films characterise,early surgical resection is the only way to get diagnosis and effective treatment method.

  10. Bronchial leiomyoma, a case report and review of literature

    Directory of Open Access Journals (Sweden)

    José Cárdenas-García, MD

    2014-01-01

    Full Text Available A 44 year old male former smoker from Ecuador presented with productive cough for 3 weeks, positive tuberculin skin test, 40 lbs weight loss and right lower lobe collapse. He denied wheezing or hemoptysis. He was treated with antibiotics and ruled out for tuberculosis with negative sputum smear. Bronchoscopy showed an endobronchial lesion at the distal end of bronchus intermedius as cause of the collapse. Endobronchial biopsy of the lesion revealed an endobronchial leiomyoma, a rare cause of endobronchial tumor. The patient underwent bilobectomy as definite therapy for the leiomyoma due to its large size and possible extra-luminal extension, which made it not amenable to bronchoscopic resection or bronchoplasty. Differential diagnoses of endobronchial lesions are discussed along with clinical, radiographic, pathologic characteristics and various treatment modalities for endobronchial leiomyomas.

  11. Image-guided bronchoscopy for histopathologic diagnosis of pure ground glass opacity: a case report.

    Science.gov (United States)

    Chavez, Christine; Sasada, Shinji; Izumo, Takehiro; Nakamura, Yukiko; Tsuta, Koji; Tsuchida, Takaaki

    2014-06-01

    Guided bronchoscopy has been found to be useful for the diagnosis of solid peripheral pulmonary lesions (PPLs) but more evidence on ground glass opacities (GGOs), especially those without a solid component, are lacking. A 69-year-old male, asymptomatic, heavy smoker was referred to our department for non-surgical diagnosis of a focal pure GGO in the right upper lobe that was found incidentally on computed tomography (CT). Transbronchial biopsy (TBB) with the aide of endobronchial ultrasound with a guide sheath (EBUS-GS), virtual bronchoscopic navigation (VBN), and fluoroscopy was performed for sampling. There were no complications after the procedure. The diagnosis of adenocarcinoma with lepidic growth pattern was established from the fourth and fifth TBB specimens and was confirmed on subsequent surgical resection. Image-guided bronchoscopy with TBB was successful for the diagnosis of a pure GGO. Use of a larger biopsy device may be helpful for the histopathologic diagnosis of lung adenocarcinoma with lepidic growth. PMID:24977033

  12. [Analysis of mediastinal lymphadenopathy in sarcoidosis with transesophageal ultrasonic endoscopy; influences on cardiovascular system].

    Science.gov (United States)

    Dambara, T; Ueki, J; Aiba, M; Tamaki, S; Saito, H; Matsuda, K; Nukiwa, T; Kira, S

    1989-01-01

    We studied influences of mediastinal lymphadenopathy on cardiovascular system in nine cases of sarcoidosis with transesophageal ultrasonic endoscopy. Chest x-ray films revealed bilateral hilar lymphadenopathy in all cases, whose diagnoses were made histologically with biopsies of peripheral lung through flexible fiber optic bronchoscope and/or of lymph nodes. These findings were typical in this disease. Many compartments of cardiovascular system in mediastinal and hilar regions were visible with this technique in all subjects. And enlarged lymph nodes changed dimensions in these compartments, especially in main pulmonary arteries, left atria, pulmonary veins and aorta. Furthermore, these phenomena were seen in azygos vein and superior caval vein in some cases. It is suggested that these lymph nodes may influence hemodynamics in above-mentioned compartments of cardiovascular system, if this phenomenon deteriorates more progressively. PMID:2657139

  13. Lung volume reduction for severe emphysema: do we need a scalpel or a scope?

    Directory of Open Access Journals (Sweden)

    D. Van Raemdonck

    2010-09-01

    Full Text Available Resectional lung volume reduction has proven to be superior to medical treatment in reducing dyspnoea and in increasing lung function, survival and quality of life in a very well selected, low risk group of hyperinflated patients with heterogeneous emphysema predominantly in the upper lobe. Nevertheless, this intervention is hampered by an important pulmonary (30% and cardiovascular (20% morbidity, mainly as a result of prolonged (>7 days air leak, and a 5% risk of death as a result of the surgical intervention. Results from ongoing randomised trials are awaited in order to determine whether less invasive, non-resectional lung volume treatment of emphysema via the bronchoscope using endobronchial valves, airway bypass stents or biological adhesives/heated water vapour will yield similar improvement with less morbidity and reduced mortality, compared with surgical resection. Furthermore, it is hoped that endoscopic lung volume reduction techniques may help patients with homogeneous emphysema currently excluded by most teams for the resectional procedure.

  14. Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse

    Science.gov (United States)

    Siddiqui, Nauman; Javaid, Toseef

    2016-01-01

    Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications. PMID:27525149

  15. Airway management in Escobar syndrome: A formidable challenge

    Directory of Open Access Journals (Sweden)

    Shaji Mathew

    2013-01-01

    Full Text Available Escobar syndrome is a rare autosomal recessive disorder characterized by flexion joint and digit contractures, skin webbing, cleft palate, deformity of spine and cervical spine fusion. Associated difficult airway is mainly due to micrognathia, retrognathia, webbing of neck and limitation of the mouth opening and neck extension. We report a case of a 1 year old child with Escobar syndrome posted for bilateral hamstrings to quadriceps transfer. The child had adequate mouth opening with no evidence of cervical spine fusion, yet we faced difficulty in intubation which was ultimately overcome by securing a proseal laryngeal mask airway (PLMA and then by intubating with an endotracheal tube railroaded over a paediatric fibreoptic bronchoscope passed through the lumen of a PLMA.

  16. Successful treatment of Bronchiolitis obliterans with organizing pneumonia in dialysis patient

    Directory of Open Access Journals (Sweden)

    Vivek B Kute

    2012-01-01

    Full Text Available A 42-year-old end stage renal disease (ESRD patient was admitted with fever, anorexia, malaise, non-productive cough, and dyspnea, of one-week duration. Multiple cultures of the blood, sputum, and urine were negative for microorganisms. The possibility of bronchiolitis obliterans with organizing pneumonia (BOOP was considered when patient with pulmonary infiltrate did not respond to conventional antibiotic therapy and frequent hemodyalisis. High-resolution computed tomography of the chest revealed patchy air-space consolidation, ground-glass opacities, and small nodular opacities, predominantly located at the peripheral part of the lungs. Cultures and stains of bronchoalveolar lavage (BAL specimen and bronchoscopic biopsy of lung tissue were negative for organisms [bacteria, mycobacterium tuberculosis, PCP, fungus, and atypical organism] and showed evidence of BOOP. Patient recovered completely with early diagnosis and treatment with steroids and underwent successful renal transplantation with wife as donor without postoperative complication and relapse.

  17. A case of primary pulmonary NK/T cell lymphoma presenting as pneumonia.

    Science.gov (United States)

    Lee, Sangho; Shin, Bongkyung; Yoon, Hyungseok; Lee, Jung Yeon; Chon, Gyu Rak

    2016-01-01

    Primary pulmonary lymphoma, particularly non-B cell lymphomas involving lung parenchyma, is very rare. A 46-year-old male was admitted to the hospital with fever and cough. Chest X-ray showed left lower lobe consolidation, which was considered pneumonia. However, because the patient showed no response to empirical antibiotic therapy, bronchoscopic biopsy was performed for proper diagnosis. The biopsied specimen showed infiltrated atypical lymphocytes with angiocentric appearance. On immunohistochemical staining, these atypical cells were positive for CD3, CD30, CD56, MUM-1, and granzyme B, and labeled for Epstein-Barr virus encoded RNA in situ hybridization. These findings were consistent with NK/T cell lymphoma. We report on a case of primary pulmonary NK/T cell lymphoma presenting as pneumonic symptoms and review the literature on the subject.

  18. [Prevention and treatment of intraoperative complications of thoracic surgery].

    Science.gov (United States)

    Lampl, L

    2015-05-01

    In order to achieve a minimal complication rate there is a need for a comprehensive strategy. This means in the first line preventive steps which include patient positioning, suitable approaches and access, an appropriately qualified surgical team as well as a carefully planned dissection and preparation. Furthermore, a supply of additional instrumentation, such as thrombectomy catheters, special vascular clamps and even extracorporeal membrane oxygenation (ECMO) and a heart-lung machine (HLM) in cases of centrally located lesions should be on stand-by. Control instruments, such as a bronchoscope and esophagoscope should not be forgotten. In selected cases a preoperative embolization (vascular malformation) or cream swallow (thoracic duct injury) can be helpful. Special interventions to overcome complications arising are described for the chest wall, lung parenchyma, pulmonary vessels, great vessels, bronchial arteries, trachea and bronchi, esophagus, thoracic duct, heart, vertebral column and sternum corresponding to the topography. PMID:25691227

  19. A RARE CASE OF FOREIGN BODY (DETA CHED PORTEX TRACHEOSTOMY TUBE IN THE BRONCHUS : CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ravi Kishore

    2014-01-01

    Full Text Available Tracheostomy is a common airway procedure for life support. Fractured/ detached and hence aspiration of a tracheostomy tube in the tracheobronchial tree is a rare late complication which can be life threatening sometimes. Published reports of a fractured metallic tracheostomy tube presenting as a foreign body in the tracheobronchial tree are rare and detached portex tracheostomy tube are even rarer. Here we are reporting a rare case of detached part of portex tracheostomy tube presenting as a foreign body in the right bronchus. Therapeutic rigid bronchoscopic removal is the mainstay o f treatment. A periodic review of the techniques of tracheostomy care including timely checkups for signs of wear and tear can possibly eliminate such avoidable late complications.

  20. Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer

    Directory of Open Access Journals (Sweden)

    John Schweiger

    2013-01-01

    Full Text Available Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the position and depth of the ulcer, a reinforced endotracheal tube (ETT was placed via the tracheostomy. Four days later, the reinforced ETT was replaced with a Shiley distal extended tracheostomy tube to bypass the ulceration. Careful inspection and evaluation of the tracheostomy site before PCT prevented a potentially life-threatening issue in our patient.

  1. Safe intubation in Morquio-Brailsford syndrome: A challenge for the anesthesiologist.

    Science.gov (United States)

    Chaudhuri, Souvik; Duggappa, Arun Kumar Handigodu; Mathew, Shaji; Venkatesh, Sandeep

    2013-04-01

    Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position. PMID:23878456

  2. [Fiberoptic tracheal intubation through a laryngeal mask airway in a pediatric patient with treacher collins syndrome].

    Science.gov (United States)

    Ogata, Tokiko; Saito, Tomoyuki; Tachikawa, Mayumi; Arai, Takero; Okuda, Yasuhisa

    2013-12-01

    A 6-month-old girl with Treacher Collins syndrome was scheduled for tracheotomy because of severe airway obstruction. During slow induction of anesthesia with inhalation of sevoflurane, assisted mask ventilation was successfully performed using oropharyngeal airway. Either direct laryngoscope or GlideScope Video Laryngoscope could not reveal any part of the epiglottis (Cormack and Lehane grade 4). Even fiberoptic bronchoscopic examination assisted by GlideScope Video Laryngoscope gave a poor view of the pharynx on the video monitor. Laryngeal mask airway (LMA) was inserted easily and allowed adequate ventilation, through which fiberoptic intubation was successfully achieved. We cut the LMA short in order to pass the 3 mm tracheal tube until the glottis through it.

  3. Co-existence of Pulmonary, Tonsillar and Laryngeal Tuberculosis

    Directory of Open Access Journals (Sweden)

    Erkan Ceylan

    2013-10-01

    Full Text Available    A 56-year old man applied to otorhinolaryngology clinic with sore throat, dysphagia. During direct examination, left palatine tonsil and tonsil plicas ulcerovegetative lesions were found. In the indirect laryngoscopy, in some regions of the larynx and epiglottis, ulcerovegetative lesions were observed too. Because of suspicion of laryngeal carcinoma and metastasis, punch biopsy of the left palatine tonsil was performed. Chest x-ray and computerized tomography of the thorax revealed two adjacent cavitations in the apicoposterior segment of the left upper lobe. In the histopathologic examination of biopsies, granulomatous structures that proved tuberculosis were observed. In the fiberoptic bronchoscopic analysis, endobronchial lesion was not detected. Acid-fast bacilli were determined in sputum and bronchial lavage in microscopy and culture. The case of this middle aged male patient with co-existence of tonsillar, laryngeal and pulmonary tuberculosis presents the clinical significance of upper airway tuberculosis in terms of its infectiousness and rare occurrence.

  4. Ventilation and perfusion scintiscanning in unresectable bronchial carcinomas under radiotherapy

    International Nuclear Information System (INIS)

    Ventilation and perfusion scintiscanning using Kr-81m-gas and Tc-99m microspheres in addition to X-ray thorax control examination were performed in patients with inoperable bronchoscopically confirmed bronchial carcinoma prior to radiotherapy, during irradiation after 30 Gy and at the scheduled end of treatment. Compared with the static-morphological X-ray picture, lung scintigraphy provides additional information about regional lung functions. Perfusion scintiscanning shows to be more sensitive and more accurate a method than ventilation scintiscanning. In follow-up under radiotherapy, valuable suggestions concerning determination of target volume and final dose are supplied when aiming at a palliative objective. Early detection and confirmation of pulmonary metastases or of a lymphangiosis carcinomatosa allow to revise an originally curative objective. (orig.)

  5. Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse.

    Science.gov (United States)

    Dasa, Osama; Siddiqui, Nauman; Ruzieh, Mohammed; Javaid, Toseef

    2016-01-01

    Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications. PMID:27525149

  6. A two-stage approach to induction and intubation of two infants with Pierre Robin Sequence using a LMA Classic™ and Air-Q®: two cases report.

    Science.gov (United States)

    Templeton, T Wesley; Bryan, Yvon F

    2016-08-01

    The laryngeal mask airway (LMA) Classic™ and Air-Q® are supralaryngeal devices used for airway management in routine and difficult pediatric airways. We describe a novel two-stage technique of insertion of the LMA Classic™ awake prior to induction of anesthesia, to assure oxygenation and ventilation, and after induction removal and placement of the Air-Q® for intubation using the flexible fiberoptic bronchoscope. The LMA Classic's™ pliable design and relatively small size allow it to be easily placed in awake infants. In contrast, the Air-Q® is an excellent device for intubation because of its larger internal diameter and removable 9 mm adapter. Our goal was to reduce unpredictability and potentially increase the safety of induction of anesthesia and intubation in infants with Pierre Robin sequence. By using these devices in a two-stage approach we created a technique for consistent oxygenation, ventilation, and intubation in these infants.

  7. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2014-05-15

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  8. The Hopkins rod-lens system.

    Science.gov (United States)

    Ellis, Harold

    2007-06-01

    Surgeons have always been ready to adapt advances in technology into their practice. The discovery by Wilhelm Roentgen of X-rays in 1885 was applied within weeks of its publication to the diagnosis of fractures and the location of foreign bodies. The development of the electric light bulb by Edison enabled Max Nitze, Professor of Urology in Berlin, to develop the electrically illuminated cystoscope, which he patented in 1877. By 1911, Hugh Young used a cystoscope with a punch device to perform transurethral prostatectomy. Rapidly other electrically lit 'scopes' were introduced--the gastroscope, bronchoscope, thoracoscope and so on. All had two problems: they were rigid instruments and lacked really brilliant illumination. PMID:17598677

  9. Perfusion of lung periphery: effects of local exposures to ozone and pressure

    Energy Technology Data Exchange (ETDEWEB)

    Freed, A.N.; Scheffel, U.A.; Kelly, L.J.; Bromberger-Barnea, B.; Menkes, H.A.

    1986-08-01

    Following ozone (O/sub 3/) exposure, airways reactivity increases. We investigated the possibility that exposure to O/sub 3/ causes a decrease in pulmonary perfusion, and that this decrease is associated with the increase in reactivity. Perfusion was measured with radiolabeled microspheres. A wedged bronchoscope was used to isolate sublobar segments in the middle and lower lobes of anesthetized dogs. Isolated segments were exposed to either O/sub 3/ or an elevated alveolar pressure. Although increased alveolar pressure decreased microsphere density, exposure to 1 ppm O/sub 3/ did not. Collateral system resistance rose significantly following exposure to O/sub 3/ and to high pressure. These studies do not support the hypothesis that pulmonary perfusion is decreased following O/sub 3/ exposure and is associated with subsequent increases in reactivity.

  10. Diffuse Cystic Lung Diseases: Diagnostic Considerations.

    Science.gov (United States)

    Xu, Kai-Feng; Feng, Ruie; Cui, Han; Tian, Xinlun; Wang, Hanping; Zhao, Jing; Huang, Hui; Zhang, Weihong; Lo, Bee Hong

    2016-06-01

    Diffuse cystic lung disease (DCLD) is a group of heterogeneous diseases that present as diffuse cystic changes in the lung on computed tomography of the chest. Most DCLD diseases are rare, although they might resemble common diseases such as emphysema and bronchiectasis. Main causes of DCLD include lymphangioleiomyomatosis, Birt-Hogg-Dubé syndrome, pulmonary Langerhans cell histiocytosis, lymphoid interstitial pneumonia, amyloidosis, light-chain deposition disease, Sjögren syndrome, and primary or metastatic neoplasm. We discuss clinical factors that are helpful in the differential diagnosis of DCLDsuch as sex and age, symptoms and signs, extrapulmonary presentations, cigarette smoking, and family history. Investigations for DCLD include high-resolution computed tomography, biochemical and histopathological studies, genetic tests, pulmonary function tests, and bronchoscopic and video-assisted thoracoscopic biopsies. A proposed diagnostic algorithm would enhance ease of diagnosing most cases of DCLD. PMID:27231867

  11. A rare cause of stridor: Isolated tracheal amyloidosis

    Directory of Open Access Journals (Sweden)

    Numbere K Numbere

    2014-01-01

    Full Text Available A 50-year-old man presented to clinic with a two-year history of progressive exertional dyspnea and voice hoarseness. This history suggested upper airways obstruction, which was confirmed on computed tomography imaging that revealed extensive thickening of the proximal tracheal wall causing severe luminal narrowing. Bronchoscopic debulking was then performed and the samples obtained confirmed tracheal amyloidoisis. Extensive investigation confirmed that disease was localized solely to the trachea. Ultimately, after multiple discussions, the chosen treatment modality was radiotherapy, which proceeded relatively uneventfully and achieved excellent radiological and clinical response. Although tracheal amyloidosis is rare, it is most commonly observed as part of a multisystem presentation. The present report describes the even more uncommon diagnosis of isolated tracheal amyloidosis and highlights the role of radiotherapy in its management.

  12. Pulmonary Mycobacterium avium infection demonstrating unusual lobar caseous pneumonia.

    Science.gov (United States)

    Okuzumi, Shinichi; Minematsu, Naoto; Sasaki, Mamoru; Ohsawa, Kazuma; Murakami, Marohito

    2016-09-01

    Mycobacterium avium complex (MAC) infection is a major medical concern in Japan because of its increased prevalence and associated mortality. A common radiological feature in pulmonary MAC infection is a mixture of two basic patterns: fibrocavitary and nodular bronchiectatic; however, lobar consolidation is rare. We report an 83-year-old man with lobar caseous pneumonia caused by pulmonary MAC infection. Radiological findings were predominantly composed of dense lobar consolidation and ground-glass opacity. A diagnosis was made in accordance with the clinical and microbiological criteria set by the American Thoracic Society. A histological examination of lung specimens obtained by using a bronchoscope revealed a caseous granulomatous inflammation with an appearance of Langhans cells. The patient was treated using combined mycobacterium chemotherapy with an initial positive response for 6 months; however, the disease progressed later. We suggest that an awareness of lobar pneumonic consolidation as a rare radiological finding in pulmonary MAC infection is important. PMID:27516892

  13. Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient

    Science.gov (United States)

    Çetinkaya, Erdoğan; Gül, Şule; Mert, Ali; Boyacı, Hilal; Çam, Ertan; Dincer, H. Erhan

    2016-01-01

    Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp.) are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved. PMID:27418930

  14. Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Erdoğan Çetinkaya

    2016-01-01

    Full Text Available Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp. are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved.

  15. Ultrathin bronchoscopy in the diagnosis of peripheral cavitary lung lesions.

    Science.gov (United States)

    Bose, Sonali; Ghatol, Abhijeet; Eberlein, Michael; Yung, Rex C

    2013-04-01

    Ultrathin (UT) bronchoscopy has emerged as a useful tool to diagnose peripheral solid lung lesions of a malignant nature. This technology is superior to standard bronchoscopic techniques, which have low yield in identifying small lesions, especially as they extend further out along the bronchial tree. UT bronchoscopy can prevent the need to pursue more invasive open lung strategies to diagnose suspicious lesions. In this report, we present 3 distinct clinical scenarios where UT bronchoscopy was successful in diagnosing benign peripheral cavitary lesions after standard techniques failed. The use of UT bronchoscopy in each case was instrumental in allowing rapid initiation of appropriate therapy without need for more invasive surgical biopsies in the setting of a benign condition. PMID:23609255

  16. Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient.

    Science.gov (United States)

    Çetinkaya, Erdoğan; Çörtük, Mustafa; Gül, Şule; Mert, Ali; Boyacı, Hilal; Çam, Ertan; Dincer, H Erhan

    2016-01-01

    Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp.) are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved. PMID:27418930

  17. Clinical application of radiofrequency ablation combined with bronchial artery infusion of docetaxel in treating non-small cell lung cancer

    International Nuclear Information System (INIS)

    Objective: To discuss the clinical application of radiofrequency ablation combined with bronchial artery infusion of docetaxel in treating non-small cell lung cancer and to summarize the experience of using this therapy in clinical practice. Methods: Radiofrequency ablation was performed in twenty-one patients with lung cancer. The diagnosis was confirmed by CT-guided percutaneous needle biopsy or bronchoscopic biopsy in all patients. One week after radiofrequency ablation treatment, bronchial artery infusion of docetaxel was conducted. The therapeutic results were observed and evaluated. Results: After the treatment, the lesion's size was markedly reduced and the clinical symptoms were dramatically improved in all patients. Conclusion: Radiofrequency ablation combined with bronchial artery infusion of docetaxel is a safe, effective and simple technique with excellent therapeutic results for the treatment of non-small cell lung cancer. It is really worth popularizing this technique in clinical practice. (authors)

  18. Potassium permanganate toxicity: A rare case with difficult airway management and hepatic damage

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Agrawal

    2014-01-01

    Full Text Available Potassium permanganate (KMnO 4 is rarely used for suicidal attempt. Its ingestion can lead to local as well as systemic toxicities due to coagulation necrosis and damage, caused by free radicals of permanganate. We recently managed a case of suicidal ingestion of KMnO 4 in a lethal dose. She had significant narrowing of upper airway leading to difficult intubation as well as hepatic dysfunction and coagulopathy as systemic manifestation. We suggest to keep ourselves ready to handle difficult airway with the aid of fiber optic bronchoscope or surgical airway management in such patients. Upper gastrointestinal (GI endoscopy should be done at the earliest to determine the extent of upper GI injury and further nutrition planning.

  19. [Lung Volume Reduction Surgery - State of the Art 2016].

    Science.gov (United States)

    Caviezel, C; Franzen, D; Inci, I; Weder, W

    2016-09-01

    In a number of large case series in the mid-1990s, lung volume reduction surgery (LVRS) was shown to reduce dyspnoea and improve pulmonary function and quality of life in patients with advanced pulmonary emphysema. The large randomised National Emphysema Treatment Trial (NETT) confirmed this in the early 2000s and also demonstrated that selected patients live longer after surgery. Patient selection is crucial to the success of the procedure and should be performed at a specialised experienced centre with a multidisciplinary team approach on emphysema treatment. The upper-lobe predominant heterogeneous type of emphysema is the best indication, but there are other types of emphysema morphology that are also eligible for surgery, if ideally chosen. Nowadays there is also growing evidence for positive effects after different types of bronchoscopic lung volume reduction (BLVR) with increasing quality. These methods add to the range of multimodal emphysema treatment. PMID:27607886

  20. Integration of interventional bronchoscopy in the management of lung cancer.

    Science.gov (United States)

    Guibert, Nicolas; Mazieres, Julien; Marquette, Charles-Hugo; Rouviere, Damien; Didier, Alain; Hermant, Christophe

    2015-09-01

    Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).

  1. Integration of interventional bronchoscopy in the management of lung cancer

    Directory of Open Access Journals (Sweden)

    Nicolas Guibert

    2015-09-01

    Full Text Available Tracheal or bronchial proximal stenoses occur as complications in 20–30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as “thermal” techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1 the available methods for assessing the characteristics of stenoses before treatment, 2 the various techniques available including their preferred indications, outcomes and complications, and 3 the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy.

  2. 经支气管镜针吸活检术对纵隔及肺部疾病的诊断意义%Diagnostic Significance of Transbronchial Needle Aspiration in Mediastinal and Lung Diseases

    Institute of Scientific and Technical Information of China (English)

    杨俊勇; 严兴海

    2015-01-01

    目的:探讨经气管镜针吸活检术(TBNA)对纵隔及肺部疾病的诊断意义。方法对61例影像学检查有纵隔淋巴结肿大或支气管腔外新生物,而气管镜检查未见管腔内明显病变的患者,进行TBNA。包括胸部CT检查示单纯纵隔淋巴结肿大13例,肺部病变合并纵隔淋巴结肿大32例,支气管管腔外压性狭窄16例。对其进行经气管镜针吸活检术和电子支气管镜常规检查,包括刷检及病变处活检,对各组患者的诊断阳性率进行观察分析。结果61例患者中,经电子支气管镜常规检查确诊者为18例,包括支气管镜黏膜活检及刷检,诊断阳性率为29.51%(18/61);经气管镜针吸活检术检查确诊者为48例,诊断阳性率为78.69%(48/61);两种方法联合确诊者53例,诊断阳性率为86.89%(53/61)。经气管镜针吸活检术及联合检查,其诊断阳性率均明显高于电子支气管镜常规检查,差异具有统计学意义(P<0.001)。结论经气管镜针吸活检术创伤性较小,安全性较好,且诊断阳性率较高,在纵隔及肺部疾病的诊断中具有重要意义。%Objective To investigate The Diagnostic significance of Transbronchial needle aspiration in mediastinal and lung disease (TBNA). Methods 61 patients imaging mediastinal lymph nodes or neoplasms outside the bronchial , and bronchoscopy in patients with no obvious lesions in the lumen were TBNA.Including chest CT examination revealed 13 cases of simple mediastinal lymph nodes,lung disease mediastinal lymph nodes in 32 cases, external pressure bronchial lumenstenosis in 16 patients.Carry on Transbronchial needle aspiration and electronic bronchoscope examination for patients ,including brushing and biopsy of the lesion, the positive rate of diagnosis of patients in each group were observed and analyzed. Results In 61 patients, by electronic bronchoscope routine examination diagnosed 18 cases, including

  3. Novel use of laryngeal mask airway classic excel™ for bronchoscopy and tracheal intubation

    Directory of Open Access Journals (Sweden)

    Anusha Kannan

    2013-01-01

    Full Text Available The usage frequency and scope of supraglottic airway devices in anesthesia has expanded since the original laryngeal mask airway (LMA prototype was invented by Dr Archie Brain in the early 1980s. Today, anesthesiologists are spoilt-for-choice with more than thirty options. The LMA Classic Excel™ was introduced to anesthesia practice in 2009; designed with an epiglottic elevating bar and a removable airway connector to facilitate tracheal intubation using the LMA as a conduit. We present a case report of a women diagnosed with papillary carcinoma of thyroid, who underwent bronchoscopic assessment of the trachea and subsequent intubation for an en-bloc dissection and removal of thyroid gland through the LMA Classic Excel™.

  4. [Diagnosis and surgical treatment for small-sized peripheral lung cancer].

    Science.gov (United States)

    Iyoda, A; Fujisawa, T; Moriya, Y

    2004-01-01

    Small-sized peripheral lung cancers have been detected more frequently as a result of recent developments in diagnostic imaging including high-resolution computed tomography (HRCT). Although the diagnosis of small-sized peripheral lung cancers is difficult, it makes an adequate diagnosis possible using transbronchial fine needle aspiration cytology or a new thin-type bronchoscope. Surgical treatment using mini-thoracotomy or video-assisted thoracic surgery is effective for early stage small-sized peripheral lung cancers. Lesser resection of lung cancer may provide many benefits to patients, such as preserving vital lung tissue and providing the chance for further resection if a second primary lung cancer develops, however, lobectomy with systematic hilar and mediastinal lymph node dissection should remain the standard surgical treatment, and an intentional limited resection should be adopted for very limited patients with a definitive early stage because of recurrence rates. PMID:14733091

  5. Accidental aspiration of head scarf pin in left bronchus piercing the lung parenchyma: A rare case in a child

    Science.gov (United States)

    Parvez, Yusuf; Kandath, Mohammed Ashraf

    2016-01-01

    Foreign body (FB) aspiration is commonly seen in children but less commonly in adolescents. Headscarf pin aspiration is common in Muslim girls, who inappropriately place the pins between their lips while securing the scarf on the head. Bronchoscopy is the treatment modality of choice, and surgery is rarely required. An 11-year-old girl was admitted as a case of accidental aspiration of headscarf pin. X-ray chest showed a radiopaque object in the left bronchus piercing the lung parenchyma. Computed tomography (CT) chest confirmed the diagnosis. The headscarf pin was removed by flexible bronchoscopy as the ear, nose, and throat (ENT) surgeon failed to remove it by rigid bronchoscopy. The FB was removed successfully and the patient was discharged home. Removal of a sharp pin by bronchoscopy is difficult, especially if it pierces the lung parenchyma. In our case, the pin was bent by forceps and then removed by a flexible bronchoscope, which requires a highly skilled professional. PMID:27578937

  6. Late Development of a Bronchocutaneous Fistula due to an Epicardial Cardioverter-Defibrillator Lead

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    Vasileios Patris

    2015-10-01

    Full Text Available Cutaneous complications caused by a pacemaker or defibrillator are widely documented, but the development of a bronchocutaneous fistula has never been described before. We report the case of a 79-year-old man who was admitted to our hospital because of a seemingly superficial cutaneous infection, externalized defibrillator leads, and hemoptysis. Bronchoscopical investigation proved the existence of the fistula, which connected the epicardium, the left main bronchus, and the aforementioned site of skin infection. The patient refused an operation for the complete removal of the epicardial defibrillator and was treated conservatively. This case demonstrated that the long-term presence of foreign bodies in the epicardium may cause serious complications

  7. A retrospective study of anaesthetic management of foreign bodies in airway- a two & half years experience

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    Jyoti V Kulkarni

    2007-01-01

    In 17 % patients foreign body was located in subglottic region, in 59 % patients FB was in right main bronchus and in 24% patients it was in left main bronchus. In 33 % patients bronchoscopy was done within 72 hours of appearance of symptoms while in 51% patients bronchoscopy was done after 72 hours to one week of appearance of symptoms. In 16% patients bronchoscopy was done after one week. Twenty percent patients required tracheostomy and 3% patients required bronchodilators, nebuliza-tion and ventilatory support in immediate post operative period. All patients were managed under general anaesthesia using ketamine, suxamethonium, oxygen and halothane. All patients were ventilated through side arm of ventilating bronchoscope.All patients were discharged from hospital & no death was reported.

  8. Metastatic breast lump: A rare presentation of squamous cell lung cancer

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    Amitabha Sengupta

    2012-01-01

    Full Text Available Breast metastases from extramammary neoplasm are uncommon with an incidence of 0.5% to 3% of patients with extramammary malignancy. We reported an extremely rare case of breast metastasis from squamous cell lung carcinoma. A 60-year-old woman suffered from dry cough with shortness breath for one month with simultaneous development of breast lump. The histological diagnosis, achieved by bronchoscopic lung biopsy with the aid of immunohistochemistry was squamous cell lung carcinoma. Breast lump was a metastasis from lung, confirmed by histopathology and immunohistochemistry after core needle biopsy. Secondary malignancy metastatic to the breast is uncommon, yet this entity does exist. In view of the therapeutic implication, a metastatic breast lesion should not be mistaken for a primary breast carcinoma. Only with the awareness of such a possibility can prompt diagnosis and optimal treatment be achieved.

  9. Upper airway obstruction in infants and children: evaluation by tracheobronchography with a non-ionic contrast agent

    International Nuclear Information System (INIS)

    The clinical benefits of tracheobronchograms using nonionic contrast medium were evaluated prospectively in ten infants and children with suspected airway obstruction who could not be weaned from endotracheal intubation and were in incubators. All patients were examined usedated. The contrast agent was injected via the intubation tube, pumped with an Ambu-bag (Manual Resuscitator, Formosa-CJ Health Business Corporation, Taiwan), and then a chest radiograph was obtained immediately in both anteroposterior and lateral views using portable equipment. Imaging results were correct in eight of ten cases as judged from bronchoscopic, surgical, and clinical data. No complications occurred during or after these examinations. This method provides an easy, safe, and helpful technique for diagnosis of the airway in nonsedated infants and children whose condition is critical. (orig.)

  10. HAEMODYNAMIC CHANGES DURING NASOTRACHEAL INTUBATION: A COMPARISION BETWEEN DIRECT LARYNGOSCOPIC AND FIBREOPTIC TECHNIQUE

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    Omprakash

    2015-05-01

    Full Text Available Nasotracheal intubation is a skill greatly appreciated by anaesthetists and surgeons in head and neck specialities. The introduction of fibreoptic intubation has revolutionized the anaesthetic management of difficult airway and its increasing use in clinical anaesthesia has drawn attention to the circulatory responses during fibreoptic intubation. The aim of this study was to compare chang es in Heart rate, Systolic and Diastolic blood pressures, SpO 2 and EtCO 2 levels, associated complications and time required to achieve successful nasotracheal intubation with fibreoptic and laryngoscopic technique. 100 patients of ASA grade I & II between 18 - 50 yrs of age undergoing elective surgeries requiring nasotracheal intubation were allocated into two groups. Group I was intubated in the conventional manner using a Macintosh laryngoscope and Group II was intubated using a fibreoptic bronchoscope. Vit al parameters like heart rate, blood pressure ( S ystolic and diastolic, ECG, oxygen saturation, EtCO 2 and N 2 O/Isoflurane % with O 2 were continuously monitored and recorded preoperatively, immediately after induction, at intubation and every 1min for furthe r 5 min. Intubation time was also recorded. Incidence of epistaxis and post - operative sore throat were noted. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to post induction values in both group s but there was no significant difference between the two groups. SpO 2 and EtCO 2 were maintained within normal range during both of intubation procedures, although the time required for intubation was longer in fibreoptic bronchoscope group. There was no s ignificant difference in the incidence of epistaxis between the two groups. It was concluded that s t ress response to fibreoptic nasotracheal intubation in similar to nasotracheal intubation facilitated by Macintosh laryngoscope.

  11. Ventilator Associated Pneumonia in Critically-Ill Neonates Admitted To Neonatal Intensive Care Unit, Zagazig University Hospitals

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    Ehab A M Albanna

    2011-12-01

    Full Text Available Objective: ventilator associated pneumonia (VAP is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in intensive care unit. We studied the characteristics and risk factors of VAP in critically-ill neonates.Methods: Fifty six consecutive neonates with different diagnosis admitted from January to October 2010 to neonatal intensive care unit (NICU, Zagazig University Hospitals who needed mechanical ventilation were included in the study. There were 32 neonates, 18 males and 14 females with proven diagnosis of VAP, and 24 neonates, 11 males and 13 females without VAP served as control group. All studied neonates were subjected to history taking, clinical examination, routine investigations (Complete blood count, C-reactive protein, arterial blood gases, blood culture and liver and kidney function tests, and chest X-ray daily as well as non-bronchoscopic alveolar lavage culture for VAP group only.Findings: Of 56 neonates who needed mechanical ventilation, 57.1% developed VAP. Prematurity, low birth weight and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leucocytic count, CRP and hypoalbuminemia were significantly presented in VAP-group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO2 and PaO2. Microorganisms associated with blood stream infection in VAP diagnosed group were Klebsiella (15.6%, S. aureus (12.5%, Pseudomonas (9.4%, E. coli (6.2%, Candida (3.1%; 53.1% of obtained blood cultures were sterile. Of non-bronchoscopic alveolar lavage cultures obtained from VAP patients, 68.6% showed gram negative infection, 21.8% showed gram positive organisms and 9.3% revealed Candida infection.Conclusion: The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation

  12. Argon Plasma Coagulation Combined with Covered Stent Placement for Management of Tracheobronchial Stenoses/occlusions as well as Esophagorespiratory Fistulas

    Directory of Open Access Journals (Sweden)

    Hongwu WANG

    2010-09-01

    Full Text Available Background and objective It is a complex problem and difficult treatment for tracheobronchial stenoses/occlusions involving in carina. The aim of this study is to investigate the feasibility and efficiency of argon plasma coagulation (APC and bifurcated covered Z-type stents (CZTS placement for the treatment of tracheobronchus stenoses and esophagorespiratory fistula (ERF. Methods Thirty-two cases with airway disorders were retrospectively reviewed for the treatment of APC and CZTS placement. Under the bronchoscopic guidance, APC was first given in patients with airway stenoses, then CZTS was placed under the fluoroscopic and flexible bronchoscopic guidance either with airway stenoses or ERF. Results APC was first given in 19 patients with airway stenoses. Airway structures were significantly improved after APC procedure (57.4%-72.1% before APC vs 12.8%-25.8% after APC. Thirty-two CZTS were technically successfully placed in 30 out of 32 cases involving in carinal bifurcation. After APC and stent placement, short breath index was significantly reduced and karnofsky physical score (KPS increased obviously. The endobronchial defects were successfully palliated with bifurcated CZTS placed under fluoroscopy and flexible bronchoscopy in 12 out of 13 patients with ERFs. There is no bleeding introprocedure. Mucous retention was very common in all types of the stents less than 2 weeks after stenting, which required debridement by bronchoscopy and could be prevented by normal saline solution nebulizations. Granuloma developed at the ends of stents after 1 month of stenting which all of them were treated successfully with APC and CO2 cryosurgery. Conclusion Utilization of APC and retrieval bifurcated CZTS placement is a simple and safe protocol for the management of airway complex stenoses involving the tracheal carina and ERF.

  13. Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT: a non-surgical method of lung volume reduction

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    Noppen Marc

    2007-07-01

    Full Text Available Abstract Background Lung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently, less invasive bronchoscopic approaches have been designed to utilize these principles while avoiding the associated perioperative risks. The Endobronchial Valve for Emphysema PalliatioN Trial (VENT posits that occlusion of a single pulmonary lobe through bronchoscopically placed Zephyr® endobronchial valves will effect significant improvements in lung function and exercise tolerance with an acceptable risk profile in advanced emphysema. Methods The trial design posted on Clinical trials.gov, on August 10, 2005 proposed an enrollment of 270 subjects. Inclusion criteria included: diagnosis of emphysema with forced expiratory volume in one second (FEV1 100%; residual volume > 150% predicted, and heterogeneous emphysema defined using a quantitative chest computed tomography algorithm. Following standardized pulmonary rehabilitation, patients were randomized 2:1 to receive unilateral lobar placement of endobronchial valves plus optimal medical management or optimal medical management alone. The co-primary endpoint was the mean percent change in FEV1 and six minute walk distance at 180 days. Secondary end-points included mean percent change in St. George's Respiratory Questionnaire score and the mean absolute changes in the maximal work load measured by cycle ergometry, dyspnea (mMRC score, and total oxygen use per day. Per patient response rates in clinically significant improvement/maintenance of FEV1 and six minute walk distance and technical success rates of valve placement were recorded. Apriori response predictors based on quantitative CT and lung physiology were defined. Conclusion If endobronchial valves improve FEV1 and health status with an acceptable safety profile in advanced emphysema, they would offer a novel intervention for this progressive and

  14. Endobronchial metastases from extrathoracic malignancies.

    Science.gov (United States)

    Akoglu, Sebahat; Uçan, Eyüp S; Celik, Gülperi; Sener, Gülper; Sevinç, Can; Kilinç, Oğuz; Itil, Oya

    2005-01-01

    Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient. PMID:16475029

  15. Diagnosis of invasive aspergillus tracheobronchitis facilitated by endobronchial ultrasound-guided transbronchial needle aspiration: a case report

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    Casal Roberto F

    2009-11-01

    Full Text Available Abstract Introduction Invasive pulmonary aspergillosis is the most common form of infection by Aspergillus species among immunocompromised patients. Although this infection frequently involves the lung parenchyma, it is unusual to find it limited to the tracheobronchial tree, a condition known as invasive aspergillus tracheobronchitis. Case presentation A 65 year-old Hispanic man from Bolivia with a history of chronic lymphocytic leukemia developed cough and malaise eight months after having an allogenic stem cell transplant. A computed tomography of the chest revealed an area of diffuse soft tissue thickening around the left main stem bronchus, which was intensely fluorodeoxyglucose-avid on positron emission tomography scanning. An initial bronchoscopic exam revealed circumferential narrowing of the entire left main stem bronchus with necrotic and friable material on the medial wall. Neither aspirates from this necrotic area nor bronchial washing were diagnostic. A second bronchoscopy with endobronchial ultrasound evidenced a soft tissue thickening on the medial aspect of the left main stem bronchus underlying the area of necrosis visible endoluminally. Endobronchial ultrasound-guided transbronchial needle aspiration performed in this area revealed multiple fungal elements suggestive of Aspergillus species. Conclusion We describe the first case of invasive aspergillus tracheobronchitis in which the diagnosis was facilitated by the use of endobronchial ultrasound guided trans-bronchial needle aspiration. To the best of our knowledge, we are also presenting the first positron emission tomography scan images of this condition in the literature. We cautiously suggest that endobronchial ultrasound imaging may be a useful tool to evaluate the degree of invasion and the involvement of vascular structures in these patients prior to bronchoscopic manipulation of the affected areas in an effort to avoid potentially fatal hemorrhage.

  16. Endoscopic anatomy and map of the equine bronchial tree.

    Science.gov (United States)

    Smith, B L; Aguilera-Tejero, E; Tyler, W S; Jones, J H; Hornof, W J; Pascoe, J R

    1994-07-01

    To develop a bronchoscopic map of the equine respiratory tree, the major airways of the lungs of 6 healthy Thoroughbred horses were systematically explored with a flexible fibreoptic endoscope through a tracheostomy while the horses were sedated in stocks. With the carina as the reference point, measurements were made of distances to the branches of the major airways using markers on the shaft of the endoscope. All branches were explored until the narrowing of their diameters prevented further advancement of the endoscope. Positions of origins of branches from the parent bronchus were recorded in relation to a 12 h clock. Branching patterns of the right and left lungs were similar. Seventeen branches of the principal and caudal lobar bronchi of the left lung, and 18 branches of the principal and caudal lobar bronchi of the right lung were identified. Mean explorable distances from the carina to the ends of the right and left caudal lobar bronchi were 34.0 +/- 3.5 (sd) and 34.5 +/- 3.0 cm, respectively. Generally, smaller horses had shorter explorable bronchial lengths. Branching patterns of the parent bronchi were fairly consistent among horses, particularly the branches closest to the carina. After endoscopy and euthanasia, the lungs were removed, and dried with pressurised air flowing through them for 7-10 days. Attempts to explore the airways of the dried lungs endoscopically were relatively unsuccessful, because airways were much smaller in the dried lungs, and many of the branches were distorted when compared with their antemortem appearances. However, having a dried lung specimen as a reference during the bronchoscopic procedure was useful for maintaining orientation in the lungs. Radiographs were used to estimate the location of the origin and destination of each airway branch in relation to the nearest intercostal space. This makes the airway map useful when lesions identified radiographically are to be lavaged. PMID:8575395

  17. Comparison of streamlined liner of the pharynx airway (SLIPA TM with the laryngeal mask airway Proseal TM for lower abdominal laparoscopic surgeries in paralyzed, anesthetized patients

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    Ashraf Abualhassan Abdellatif

    2011-01-01

    Full Text Available Context: Supraglottic airway devices have been used as an alternative to tracheal intubation during laparoscopic surgery. Aims: The study was designed to compare the efficacy of Streamlined Liner of the Pharynx Airway (SLIPA for positive pressure ventilation and postoperative complications with the Laryngeal Mask Airway ProSeal (PLMA for patients undergoing lower abdominal laparoscopies under general anesthesia with controlled ventilation. Settings and Design: Prospective, crossover randomized controlled trial performed on patients undergoing lower abdominal laparoscopic surgeries. Methods: A total of 120 patients undergoing lower abdominal laparoscopic surgeries were randomly allocated into two equal groups; PLMA and SLIPA groups. Number of intubation attempts, insertion time, ease of insertion, and fiberoptic bronchoscopic view were recorded. Lung mechanics data were collected 5 minutes after securing the airway, then after abdominal insufflation. Blood traces and regurgitation were checked for; postoperative sore throat and other complications were recorded. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test for noncontinuous variables. P value <0.05 was considered significant. Results: Insertion time, first insertion success rate, and ease of insertion were comparable in both groups. Fiberoptic bronchoscopic view was significantly better and epiglottic downfolding was significantly lower in SLIPA group. Sealing pressure and lung mechanics were similar. Gastric distension was not observed in both groups. Postoperative sore throat was significantly higher in PACU in PLMA group. Blood traces on the device were significantly more in SLIPA group. Conclusions: SLIPA can be used as a useful alternative to PLMA in patients undergoing lower

  18. Endobronchial metastases from extrathoracic malignancies.

    Science.gov (United States)

    Akoglu, Sebahat; Uçan, Eyüp S; Celik, Gülperi; Sener, Gülper; Sevinç, Can; Kilinç, Oğuz; Itil, Oya

    2005-01-01

    Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient.

  19. Significance of upper airway influence among patients of vocal cord dysfunction for its diagnosis: Role of impulse oscillometry

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    Hira H

    2009-01-01

    Full Text Available Background: To identify the patients of bronchial asthma (suspected or proven, not responding to optimal therapy, for the presence of vocal cord dysfunction (VCD and to compare the diagnostic ability of flow volume (FV loop and impulse oscillometry (IOS. Materials and Methods: Fifty one patients of suspected/proven bronchial asthma not responding to optimal therapy were included for the study. Each patient was subjected to both FV loop and IOS studies. Direct visualization of the vocal cords with flexible fiberoptic bronchoscope for the presence of inspiratory vocal cord adduction during quiet respiration, with speech, and while performing provocative maneuvers was carried out. All patients were subjected to simple pulmonary function tests and recording of FV loop. IOS was performed on each patient to look for the site of obstruction and upper airway influence. The observations of both FV loop and IO studies were compared. Results: Among 51 patients participated, 12 (23.53% had bronchoscopical evidence of VCD and were labeled as VCD-positive group and rest 39 were designated VCD negative. No statistically significant difference in pulmonary function test (prereversibility results between the VCD-positive and VCD-negative patients was found. Reversible airway obstruction was observed in 75% of the patients of VCD-positive group and 67.65% of the patients in the VCD-negative group. Only one patient in the VCD-positive and none in VCD-negative group had inspiratory limb flattening of FV loop. Upper airway influence was evident by IOS in 58.3% of patients in the VCD-positive group and in 15.4% of patients in the VCD-negative group. This difference was statistically significant (P < 0.005. Conclusion: VCD was a common finding in patients with symptoms suggestive of asthma and frequently coexists with asthma. IOS was found to be a useful screening test for VCD and was more sensitive than FV loop.

  20. A modified scoring system to describe gross pathology in the rabbit model of tuberculosis

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    Osborne Jonathan

    2011-03-01

    Full Text Available Abstract Background The rabbit model is an ideal means to study the pathogenesis of tuberculosis due to its semblance to the disease in humans. We have previously described the results using a bronchoscopic route of infection with live bacilli as a reliable means of generating lung cavities in sensitized rabbits. The role of sensitization in the development of disease outcomes has been well established in several animal models. We have described here the varying gross pathology that result from lack of sensitization with heat-killed M. bovis prior to high-dose bronchoscopic infection with live bacilli. Results Rabbits lacking sensitization did not generate lung cavities, but instead formed solely a tuberculoid pneumonia that replaced the normal lung parenchyma in the area of infection. Extrapulmonary dissemination was seen in approximately equal frequency and distribution in both rabbit populations. Notable differences include the lack of intestinal lesions in non-sensitized rabbits likely due to the lack of ingestion of expectorated bacilli from cavitary lesions. The experiment also employed a modified scoring system developed initially in the primate model of tuberculosis to allow for the quantification of findings observed at necropsy. Conclusions To date, no such scoring system has been employed in the rabbit model to describe gross pathology. The quantitative methodology would allow for rapid comparative analyses and standardization of thoracic and extrapulmonary pathology that could be evaluated for statistical significance. The aim is to use such a scoring system as the foundation for all future rabbit studies describing gross pathology at all stages in TB pathogenesis.

  1. Bronchoscopy in some tertiary grade A hospitals in China: two years' development

    Institute of Scientific and Technical Information of China (English)

    NIE Xiao-meng; CAI Gang; SHEN Xian; YAO Xiao-peng; ZHAO Li-jun; HUANG Yi; HAN Yi-ping; BAI Chong; LI Qiang

    2012-01-01

    Background Although bronchoscopy has been widely performed in China,little has been known about its current state and development.In order to investigate the clinical application of bronchoscopy and make instructions for future education and development,the Chinese Society of Respiratory Diseases conducted postal surveys in both 2008 and 2010 in China.Method Questionnaires were sent to 40 tertiary grade A hospitals in 2008 and 58 tediary grade A hospitals in 2010 to investigate bronchoscopies performed in 2007 and 2009 respectively.Results Thirty (75%) hospitals returned the completed questionnaires in 2008 and forty-one (71%) hospitals in 2010.All the respondents possessed flexible bmnchoscopes.Fifty percent of the respondents had less than five in 2007,while more than 50% of the respondents had 5-9 bronchoscopes in 2009.All the respondents performed a radiograph or CT scan before bronchoscopy.Percentage of general anesthesia and no pre-medication before bronchoscopy increased,while atropine usage decreased in 2009 compared to 2007.Dudng bronchoscopy,pulse oximetry was the most widely used monitoring method.Most respondents used the nasal route to perform routine bronchoscopy.After the procedure,they used sinks to wash and glutaraldehyde to disinfect the bronchoscopes.The total number of flexible bronchoscopies performed during 2007 was 37 874 and the average was 1262.Whereas in 2009,the total number was 60 178 and the average was 1468.Diagnostic bronchoscopy was more widely used than therapeutic bronchoscopy.The mortality rate was 0.076% in 2007 and 0.032% in 2009.Conclusions The two surveys,to some extent,reflected the current status and development of bronchoscopy in China.The results are worthy of future education and developing of new guidelines.Regular surveys and monitoring of bronchoscopies across China are needed.

  2. Microbiological pattern of ventilator associated pneumonia

    International Nuclear Information System (INIS)

    Ventilator associated pneumonia (VAP) is an important and common complication of mechanically ventilated patients. It is the leading cause of morbidity and mortality in Intensive Care Units (ICU) worldwide. The aim of study was to determine the pattern of bacteria involved in VAP in intensive care unit of Jinnah hospital Lahore. Methods: It was descriptive case series study, conducted over a period of one year on mechanically ventilated 50 patients. American Thoracic Society (ATS) guidelines recommend quantitative/semi-quantitative culture of endotracheal aspirates (ETA) or bronchoscopic aspirates/washing from the infected lung segments for the diagnosis of VAP. Hence this study was conducted to identify the types of bacteria involved in VAP in our ICU. Patients enrolled were clinically and radiologically suspected VAP, admitted in the ICU of Jinnah Hospital/Allama Iqbal Medical College (AIMC) Lahore. Bronchial washings were taken with the help of Fiber optic bronchoscope. Wherever bronchoscopy was not possible, subglottic secretions were collected with the help of sterilized catheter and sucker. Collected samples were sent to the Pathology laboratory of AIMC for aerobic culture and sensitivity. Results: Major pathogenic bacteria isolated were Gram negative (74%). Among this group E. coli, Pseudomonas, Klebsiella and Acinetobacter were the commonest organisms. Gram positive bacteria were 20%, Staphylococcus aureus (MRSA) and haemolyticus streptococci were the major isolate. In 4% cases mixed growth and in 2% cases no growth was reported. Conclusion: Major pathogenic organisms of VAP in our ICU are Gram negative bacteria. The Bacteriological culture of endobroncheal aspirates is helpful in the diagnosis and management of VAP. Emperic antibiotic therapy for VAP should cover Gram negative organisms. (author)

  3. Respiratory manifestations in amyloidosis

    Institute of Scientific and Technical Information of China (English)

    XU Ling; CAI Bai-qiang; ZHONG Xu; ZHU Yuan-jue

    2005-01-01

    Background Amyloidosis is a collection of diseases in which different proteins are deposited. Amyloid deposits occur in systemic and organ-limited forms. In both systemic and localized forms of the disease, lung can be involved. The aim of this study was to explore the different respiratory manifestations of amyloidosis. Methods Chest radiology, clinical presentations, bronchoscopic/laryngoscopic findings and lung function data of 59 patients with amyloidosis involving respiratory tract collected during January 1986 to March 2005, were analysed.Results Of the 16 cases with localized respiratory tract amyloidosis, 8 had the lesions in the trachea and the bronchi, 2 in the larynx and the trachea, 5 in the larynx and/or the pharynx, and 1 in the lung parenchyma. Of 43 systemic amyloidosis with respiratory tract involvement, 3 had the lesions in bronchi, 13 in lung parenchyma, 33 in pleura, 8 in mediastina, 1 in nose and 1 in pharynx. Chest X-rays were normal in most cases of tracheobronchial amyloidosis. CT, unlike chest X-rays, showed irregular luminal narrowing, airway wall thickening with calcifications and soft tissue shadows in airway lumen. Localized lung parenchymal amyloidosis presented as multiple nodules. Multiple nodular opacities, patch shadows and reticular opacities were the main radiological findings in systemic amyloidosis with lung parenchymal involvement. In pleural amyloidosis, pleural effusions and pleural thickening were detected. Mediastinal and/or hilar adenopathy were also a form of lung involvement in systemic amyloidosis. The major bronchoscopic findings of tracheobronchial amyloidosis were narrowing of airway lumen, while nodular, 'tumour like' or 'bubble like' masses, with missing or vague cartilaginous rings, were detected in about half of the patients.Conclusions Localized respiratory tract amyloidosis mostly affects the trachea and the bronchi. Chest X-rays are not sensitive to detect these lesions. Systemic amyloidosis often involves

  4. Bronchoscopy auxiliary experience for the treatment of lung cancer complicated with lung infection after the operation%支气管镜治疗肺癌术后并发肺部感染42例临床观察

    Institute of Scientific and Technical Information of China (English)

    周子平; 冯家宁; 陆剑豪; 查健; 廖裕彬

    2015-01-01

    目的:分析和研究支气管镜辅助治疗肺癌手术后并发肺部感染的临床疗效。方法:选取肺癌术后并发肺部感染患者84例,将其按投币法随机分为观察组与对照组,每组各42例。对照组给予常规对症治疗;观察组患者在常规治疗基础上采用支气管镜行辅助治疗,治疗7天后,进行两组疗效比较。结果:观察组治疗总有效率高于对照组(P <0.05);观察组症状与体征恢复至正常时间及住院治疗时间均短于对照组(P <0.05);观察组治疗后的血氧分压、二氧化碳分压、氧饱合度均优于对照组(P <0.05)。结论:将支气管镜应用于肺癌手术后并发肺部感染患者辅助治疗中,能够将气道内的分泌物彻底清除干净,有效改善患者通气功能,并且局部给药,可提高靶器官药物浓度,对提高治疗效果及改善患者预后均具有重要作用,值得临床推广。%Objective To analyze and research bronchoscope auxiliary treatment the clinical curative effect of lung cancer complicat-ed with lung infection after the operation.Methods 84 patients with lung cancer and pulmonary infection according to its will pay method randomly divided into observation group and control group,each group of 42 patients with all have.The control group given conventional treatment;Observation group of patients on the basis of conventional treatment using bronchoscope adjuvant therapy,the two groups of patients were compared the curative effect of treatment in 7 days.Results The total effective rate of two groups of patients compared:ob-servation group is higher than the control group (P <0.05).Two groups of patients with symptoms and signs back to normal time and hospitalization time compared indicators such as:observation group of patients are shorter than the control group (P <0.05).Compared two groups after treatment in patients with blood gas index:observation group of patients

  5. 支气管镜肺减容现状和展望%Current status and prospects of lung volume reduction surgery

    Institute of Scientific and Technical Information of China (English)

    孙沁莹; 林冰

    2013-01-01

    The application of lung volume reduction surgery (LVRS) in clinical practice is limited by high postoperative morbidity and stringent selection criteria. Bronchoscopic lung-volume reduction has recently been explored as safer alternatives to LVRS for treating advanced emphysema. The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive and subjective benefit in dyspnoea scores,6MWT distance (6MWD) ,quality of life (SCRQ) are more frequent findings than improvements on spirometry or exercise tolerance. Safety data are more promising with rare procedure-related mortality, short hospital length of stay and few complications such as COPD exacerbation, peumonia, pneumo-thorax. The field of bronrhoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials build on earlier feasibility data to clarify the true efficacy of such techniques.%外科肺减容手术治疗重度肺气肿术后病死率较高,适应证少,不适宜临床推广.支气管镜肺减容术通过支气管镜下的技术操作,简便、安全,有望替代外科肺减容术治疗重度肺气肿.目前研究比较有效的方法有支气管腔内单向阀、生物胶、蒸汽消融和肺减容线圈.支气管镜肺减容术治疗重度肺气肿,可以明显改善气促指数、6 min步行距离及生活质量(SGRQ)评分等主观指标,但对于评价该项技术有效性的客观指标如肺功能指标及运动耐力仅有部分改善.采用该项技术安全性好,住院时间短,极少出现危及生命的严重并发症,可能出现的并发症包括慢性阻塞性肺疾病急性加重、肺炎和气胸.下一步需开展前瞻性的随机对照研究,证实支气管镜肺减容术的确切疗效.

  6. Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases

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    Chetan B Raval

    2011-01-01

    Full Text Available Background: Airway management in maxillofacial injuries presents with a unique set of problems. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Maxillofacial injuries are the result of high-velocity trauma arising from road traffic accidents, sport injuries, falls and gunshot wounds. Any flaw in airway management may lead to grave morbidity and mortality in prehospital or hospital settings and as well as for reconstruction of fractures subsequently. Methods: One hundred and seventy-seven patients of maxillofacial injuries, operated over a period of one and half years during July 2008 to December 2009 in Al-Nahdha hospital were reviewed. All patients were reviewed in depth with age related type of injury, etiology and techniques of difficult airway management. Results: The major etiology of injuries were road traffic accidents (67% followed by sport (15% and fall (15%. Majority of patients were young in the age group of 11-30 years (71 %. Fracture mandible (53% was the most common injury, followed by fracture maxilla (21%, fracture zygoma (19% and pan-facial fractures (6%. Maxillofacial injuries compromise mask ventilation and difficult airway due to facial fractures, tissue edema and deranged anatomy. Shared airway with the surgeon needs special attention due to restrictions imposed during surgery. Several methods available for securing the airway, both decision-making and performance, are important in such circumstances. Airway secured by nasal intubation with direct visualization of vocal cords was the most common (57%, followed by oral intubation (17%. Other methods like tracheostomy and blind nasal intubation was avoided by fiberoptic bronchoscopic nasal intubation in 26% of patients. Conclusion: The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the

  7. Application Value of Liquid Based Cytology Test in the Diagnosis of Lung Cancer%液基细胞学检测在肺癌支气管刷片诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    杨波; 房新志; 白合尼莎·阿不都热西提; 倪良凤

    2014-01-01

    目的:探讨纤维支气管镜刷片(bronchofiberscopic (BFS) washing cytology,BWC)液基细胞学检测(Liquid-based Cytology test,LCT)在肺癌诊断中的价值。方法:收集同时进行LCT和传统涂片检查的纤支镜刷片的病例543例,分析LCT和传统涂片对肺癌诊断的敏感度,特异性和分型的准确性。结果:LCT和传统涂片法诊断肺癌的敏感度分别为87.2%和81.8%,差异有统计学意义(P<0.05)。特异性分别为91.2%和94.8%,差异无统计学意义(P>0.05)。细胞学分型诊断与组织学的符合率,在LCT中,鳞癌为94.4%,腺癌95.7%,小细胞癌90.9%,总符合率为93.4%。结论:LCT是在支气管刷检制片,染色等方面便于实施质量控制的一项新技术,在肺癌诊断中具有较高的敏感度和分型诊断符合率。%Objective: To explore the diagnostic value of Liquid-based cytology test ( LCT) for lung cancer in bronchoscopically biopsied specimens.Methods 543 cases of bronchoscopically biopsied specimens were identified for lung cancer with LCT as well as conventional smear test .The results were analyzed for the sensitivity,specificity and concordance with pathology in the two methods. Results The sensitivity of LCT and conventional smear for lung cancer identification were 87.2% and 81.8%,respectively,the difference was significant (P <0.05), whereas the specificity were 91.2%and 94.8%,respectively.Analysis for the concordance between cytology and pathology in 289 specimens revealed that the identity rate of LCT was 94.4%in squamous carcinoma,95.7%in adenocarcinoma and 90.9%in small cell carcinoma. Conclusion LCT was an effective and practicable method for the identification of lung cancer with higher sensitivity and specificity comparable with conventional smear test.

  8. Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery

    Science.gov (United States)

    Byun, Sung Hye; Kang, Su Hwang; Kim, Jong Hae; Ryu, Taeha; Kim, Baek Jin; Jung, Jin Yong

    2016-01-01

    Abstract Background: Double-lumen endotracheal tubes (DLTs) are often displaced during change from the supine to the lateral decubitus position. The aim of this study was to determine whether Rescuefix, a recently developed tube-holder device, is more effective than the traditional tape-tying method for tube security during lateral positioning. Methods: Patients were randomly assigned to a Rescuefix (R) group (n = 22) or a tape (T) group (n = 22). After intubation with a left-sided DLT and adjustment of the appropriate DLT position using a fiberoptic bronchoscope, the DLT was fixed firmly at the side of the mouth by either Rescuefix or Durapore tape. “Tracheal depth” (from the tracheal carina to the elbow connector of the DLT) and “bronchial depth” (from the left bronchial carina to the elbow connector of the DLT) were measured in the supine position using the fiberoptic bronchoscope. After positional change, tracheal and bronchial depths were measured as described above. As the primary endpoint, displacement of the DLT during positional change was evaluated by obtaining the difference in depths measured when the patient was in the supine and lateral decubitus positions. In addition, after lateral positioning of the patient, any requirement for repositioning the DLT was recorded. Results: After lateral positioning, there were no significant differences in changes in tracheal and bronchial depths between the groups (tracheal depth 6.1 ± 4.4 mm [R group] and 9.1 ± 5.6 mm [T group], P = 0.058; bronchial depth 6.5 ± 4.4 mm [R group], and 8.5 ± 4.6 mm [T group], P = 0.132). Although the amount of change in tracheal and bronchial depths was not different between the groups, the need to reposition the DLT was significantly lower in the R group than in the T group (32% vs 68%, P = 0.016). Conclusion: This study demonstrated that use of Rescuefix did not reduce the amount of DLT displacement, but it did significantly

  9. Safety And Efficacy Of Proseal Laryngeal Mask Airway Versus Classic Laryngeal Mask Airway And Endo Tracheal Tube During Elective surgery

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    Soad A. Mansour , Wafaa G.Ahmed , Kawthar A. Azzam ,Tarek M. EL said

    2005-12-01

    Full Text Available The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway (PLMA, classic Laryngeal mask airway (LMA and cuffed Endo Tracheal Tube (ETT as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA(groupI,classic LMA (groupIIand ETT (group III . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation ­ Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2

  10. 免疫组化在肺小细胞癌活检诊断中的重要性%An analysis on the significance of immunohistochemistry in the biopsy of small cell lung carcinoma

    Institute of Scientific and Technical Information of China (English)

    万辉; 戴一菲

    2014-01-01

    目的:通过肺穿刺及支气管镜获得的组织极易因挤压过甚而结构不清,使肺小细胞癌与低分化鳞癌、淋巴瘤间会出现形态学上的重叠,我们通过免疫组化探讨肺小细胞癌活检标本的诊断及鉴别诊断。方法收集肺穿刺及支气管镜活检病例46例,病理组织形态学均诊断为肺癌,倾向于肺小细胞癌,每个病例均进行CgA、Syn、Sclc、TTF-1、ki67、CK5/6、P63、34βE12、LCA免疫组化诊断。结果46例诊断为肺癌,倾向于肺小细胞癌的活检标本经免疫组化证实:43例为肺小细胞癌、2例低分化鳞癌、1例非何杰金氏淋巴瘤。结论免疫组化在肺小细胞癌的诊断与鉴别诊断中具有十分重要的意义。%Objective To explore the diagnosis and differential diagnosis of biopsy specimens of small cell lung carcinoma via immunohistochemistry,considering the tissues acquired via pneumocentesis and bronchoscope are easily to be squeezed so much so that their structures become unclear, which lead to morphological overlaps between small cell lung carcinoma, poorly differentiated squamous carcinoma and lymphoma. Methods 46 patients who were received biopsy of pneumocentesis and bronchoscope were selected and were diagnosed of lung cancer both pathologically and morphologically.The diagnosed cancer tended to be small cell lung carcinoma.Each patients were received immunohistochemistry of CgA,Syn,Sclc,TTF-1, ki67,CK5/7,P63,34βE12 and LCA. Results Among the 46 patients diagnosed of lung cancer,biopsy specimens which tended to be small cell lung carcinoma were confirmed by immunohistochemistry: 43 patients were infected by small cell lung carcinoma,2 lower differentiated squamous carcinoma and 1 non-Hodgkin's lymphoma. Conclusion Immunohistochemistry is of great significance in the diagnosis and differential diagnosis of small cell lung carcinoma.

  11. 儿童气管性支气管20例临床分析%Clinical of tracheal bronchus in 20 children

    Institute of Scientific and Technical Information of China (English)

    包玉玲; 唐珩; 赵德育; 田曼; 梁慧; 韩青

    2012-01-01

    目的 分析经支气管镜检查诊断的气管性支气管患儿的临床特征.方法 回顾分析20例接受支气管镜检查而确诊的气管性支气管患儿的镜下结果、临床表现、治疗与转归.结果 先天性气管性支气管患儿20例,右侧气管性支气管19例,移位型18例,其中6例为2种或2种以上气道异常;左侧气管性支气管1例,为移位型.20例患儿的临床症状包括持续或反复的喘息,持续性局限性肺炎、肺不张,局限性肺气肿.大部分患儿经临床对症治疗后症状缓解.结论 气管性支气管异常在临床上并不少见,其临床表现为治疗反应不佳的反复喘息、肺炎、肺不张以及肺气肿等,对可疑患儿应及时进行支气管镜检查以明确诊断.%Objective To investigate the clinical features in 20 patients diagnosed with tracheal bronchus by bronchoscope. Methods Clinical manifestation, diagnosis and treatment of the 20 patients receiving diagnostic bron-choscope procedures and diagnosed of tracheal bronchus were retrospectively analyzed. All procedures were performed under general intravenous anesthesia. Results Totally 20 patients were identified as having tracheal bronchus, among whom 19 patients were right tracheal bronchus, 18 patients were shift type and 6 patients had more than two types of tracheo bronchial anomalies. Difficult-to-control wheeze, localized persistent pneumonia, atelectasis, localized hyperinflation were the most common symptoms in the patients with tracheal bronchus. The symptoms in most of the patients were relieved through the symptomatic treatment. Conclusions Tracheal bronchus is not unusual in pediatric patients, and its clinical features were difficult-to-control wheeze, localized persistent pneumonia, atelectasis, localized hyperinflation. The bronchoscopy should be performed early in the suspected patients for definite diagnosis.

  12. Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

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    Alka Chandra

    2011-01-01

    Full Text Available Aim: The aim of the study was to compare transcricoid injection with "spray as you go" technique for diagnostic fibreoptic bronchoscopy, to perform the procedure without sedation and to record any complication or side effects. Methods: Sixty patients belonging to the age group 20-70 years, undergoing diagnostic bronchoscopy over a period of 6 months, were randomly selected and divided into two groups alternatively to receive 3 ml of 4% lignocaine by a single transcricoid puncture (group I or 2 ml of 4% lignocaine instilled through the bronchoscope on to the vocal cords and further 1 ml of 2% lignocaine into each main bronchus (group II. Additional dose of lignocaine as required was given in both the groups. All patients were given intramuscular atropine 0.6 mg, 20 min before the procedure. Nebulisation with 3 ml of 4% lignocaine was given to all patients. The time from nasal insertion of the bronchoscope to reach the carina was recorded, and the total dose of lignocaine required in both the groups was calculated and compared. The cough episodes during the procedure, systolic blood pressure, and pulse rate were compared before the procedure and 5 min after the procedure in both the groups. A 0-10 visual analogue scale (VAS was used to assess discomfort 30 min after the procedure. Results: The time to reach carina was more in group II (P<0.02, and cough episodes were also more in group II (P<0.05 than in group I. The vitals before the procedure were comparable in both the groups, but 5 min after the procedure the vitals were more stable in group I than in group II, and the total dose of lignocaine required in group II was more than in group I (P<0.001. However, the VAS score was comparable in both the groups. Conclusion: Transcricoid puncture for diagnostic bronchoscopies without sedation was associated with no complication and discomfort and required lesser dose of local anaesthetic with more stable vitals and good conditions for bronchoscopists.

  13. Safe intubation in Morquio-Brailsford syndrome: A challenge for the anesthesiologist

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    Souvik Chaudhuri

    2013-01-01

    Full Text Available Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position.

  14. Management of Difficult Airway With Laryngeal Mask in a Child With Mucopolysaccharidosis and Mitral Regurgitation: A Case Report

    Science.gov (United States)

    Ziyaeifard, Mohsen; Azarfarin, Rasoul; Ferasatkish, Rasoul; Dashti, Majid

    2014-01-01

    Introduction: Mucopolysaccharidoses (MPSs) are a group of heredity storage diseases, transmitted in an autosomal recessive manner, associated with the accumulation of glycosaminoglycans (GAGs) in various tissues and organs. The concerned patients have multiple concomitant hereditary anomalies. Considering the craniofacial abnormality in these patients, airway management may be difficult for anesthesiologists. In these patients, preanesthetic assessment is necessary and performed with the accurate assessment of airways, consisting of the physical exam and radiography, MRI or CT of head and neck. An anesthesiologist should set up a “difficult intubation set” with a flexible fiber-optic bronchoscope and also, it may be necessary to discuss with an ear-nose and throat (ENT) specialist if required, for unpredicted emergency situations. Case Presentation: In this case-report we presented a 2-year-old boy with known MPSs with psychomotor retardation, bilateral corneal opacities, impaired hearing and vision, inguinal hernia, severe mitral regurgitation, micrognathia, coarse facial feature, stiff and short neck and restricted mouth opening. He scheduled for left inguinal hernia repair surgery. Discussion: The patient’s difficult airway was managed successfully and the anesthesia of his surgical procedure had an uneventful course. PMID:25478534

  15. Desquamative interstitial pneumonia: A case report

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    Lovrenski Aleksandra

    2014-01-01

    Full Text Available Introduction. Desquamative interstitial pneumonia is one of the rarest idiopathic interstitial pneumonias and the rarest form of smoking-related interstitial lung diseases. It was first described by Liebow in 1965. Histologically, it is characterized by the presence of eosinophilic macrophages uniformly filling airspaces which often contain a finely granular light-brown pigment that does not stain for hemosiderin. The alveolar walls are usually mildly thickened by fibrous tissue and infiltrated by a moderate number of lymphocytes. Case Outline. Our patient was a 56-year-old male, heavy smoker, with bilateral lung infiltrations of unknown etiology and several months of discomfort in the form of dry cough and shortness of breath. Lung function tests showed a moderate restrictive ventilation disorder and a severe reduction of diffusing capacity. Since bronchoscopic specimens did not reveal lung lesion etiology, an open lung biopsy of the lower left pulmonary lobe was performed, and based on the obtained surgical material the pathohistologically diagnosis of desquamative interstitial pneumonia was established. The patient was started on corticosteroid and immunosuppressive therapy, and he ceased smoking. At the last control examination, two years after the onset of symptoms, the patient was feeling well, and high-resolution computed tomography (HRCT scan of the thorax showed regression of pathological changes. Conclusion. Although, as in our case, the majority of DIP patients improve on treatment, some patients still develop progressive irreversible fibrosis despite therapy.

  16. [Right tracheal bronchus with anomalous ramification of the bronchial artery disclosed during an episode of hemoptysis].

    Science.gov (United States)

    Kyo, S; Maeda, H; Yahata, T; Kawashima, T; Takada, T; Ohnishi, K; Adachi, K

    2000-01-01

    A 63-year-old woman was referred to our hospital on June 18th, 1998 during an episode of hemoptysis that had lasted for 6 days. She had no hemorrhagic diathesis and no history of pulmonary disease. Chest X-ray films disclosed a ground-glass opacity in the right upper lung field. Bronchoscopic examination revealed bleeding from an anomalous ectopic orifice on the right lateral trachea, about 1 cm above the carina. Chest computed tomographic examinations by conventional and spiral methods readily disclosed an ectopic bronchus. Bronchial arteriography showed that the tracheal bronchus was fed by a branched vessel of the thyrocervical artery arising from the brachiocephalic artery. Atypical mycobacterium was detected in bronchoalveolar lavage fluid from the ectopic bronchus. A shunt had formed with the pulmonary artery and peripheral parts of the bronchial artery that fed the tracheal bronchus. It was speculated that the hemoptysis in this case might be due to the combined phenomena of infection and abnormal vessel formation in the tracheal bronchus. In our patient, the system of blood supply to the tracheal bronchus may have been a manifestation of atavism because it closely resembled the circulatory structure of the tracheal bronchi normally observed in sheep and giraffes. The tracheal bronchus should be taken into consideration as a potential cause of hemoptysis, inflammatory changes, and atelectasis during intubation. PMID:10723948

  17. Automated lobar quantification of emphysema in patients with severe COPD

    International Nuclear Information System (INIS)

    Automated lobar quantification of emphysema has not yet been evaluated. Unenhanced 64-slice MDCT was performed in 47 patients evaluated before bronchoscopic lung-volume reduction. CT images reconstructed with a standard (B20) and high-frequency (B50) kernel were analyzed using a dedicated prototype software (MevisPULMO) allowing lobar quantification of emphysema extent. Lobar quantification was obtained following (a) a fully automatic delineation of the lobar limits by the software and (b) a semiautomatic delineation with manual correction of the lobar limits when necessary and was compared with the visual scoring of emphysema severity per lobe. No statistically significant difference existed between automated and semiautomated lobar quantification (p>0.05 in the five lobes), with differences ranging from 0.4 to 3.9%. The agreement between the two methods (intraclass correlation coefficient, ICC) was excellent for left upper lobe (ICC=0.94), left lower lobe (ICC=0.98), and right lower lobe (ICC=0.80). The agreement was good for right upper lobe (ICC=0.68) and moderate for middle lobe (IC=0.53). The Bland and Altman plots confirmed these results. A good agreement was observed between the software and visually assessed lobar predominance of emphysema (kappa 0.78; 95% CI 0.64-0.92). Automated and semiautomated lobar quantifications of emphysema are concordant and show good agreement with visual scoring. (orig.)

  18. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

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    Gonzalo Labarca

    2016-01-01

    Full Text Available Introduction. Endobronchial ultrasound (EBUS is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients were included; two were randomized controlled trials (RCTs and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89% and the specificity was 99% (CI 98–100%. For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4% and specificity improved to 100% (CI 99-100%. Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.

  19. [Technology on Partial Resection and Segmentectomy for Early-stage Lung Cancer].

    Science.gov (United States)

    Sonobe, Makoto; Date, Hiroshi

    2016-07-01

    Recently, lung cancer patients who cannot undergo lobectomy because of impaired pulmonary function, co-morbidity, and/or advanced age are increasing. And patients whose lung cancer is small in size, peripherally located, and assumed to be N0 disease are also increasing. Therefore, we have a greater opportunity to perform sublobar lung resection for these patients. For sublobar resection, several surgical technologies have been developed. Virtual-assisted lung mapping (VAL-MAP) is bronchoscopic multiple dye-marking technique under support of 3-dimensional virtual images to provide geometric information on the lung surface. This technic is effective to show the location of hardly palpable small lung cancer for thoracoscopic partial lung resection and to visualize the intersegmental / intersubsegmental planes for segmentectomy. Selective segmental inflation technic is to inflate the segment which includes lung cancer in order to make an intersegmental plane, so-called inflation-deflation line, to be cut. Using this technic, we can recognize the real margin from the tumor edge to the resected plane under thoracoscopic approach. PMID:27440032

  20. A follow up study on interstitial alveolitis

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    Kamat S

    2004-01-01

    Full Text Available Objective : To study the benefits of steroid therapy in interstitial alveolitis. Method and Materials : One hundred five adult clinic patients were studied with clinical evaluation, chest radiography, CT scan, bronchoscopic lavage, pulmonary function studies and a regular follow up. They were put on daily prednisolone (in 19 on intravenous methyl prednisolone, for several months. Results: Only a few had no cough or dypnoea; 91 cases had atleast gr. III exertional breathlessness; 61(58% had been given steroids earlier and 32(31% were on a prior antitubercular treatment. Only 16% had GERD symptoms. On radiography, interstitial deposits were seen in 102 cases. While 53 cases belonged to idiopathic variety, 41 were sarcoidosis. A majority had poor lung function with a restrictive disability; but 50% showed a significant response (10%+ to bronchodilators. On follow up in 92 cases, 14 died, 8 went in remission; 32 had a fluctuating course. At some stage 66 had showed improvement. Conclusion : A large majority of our interstitial alveolitis cases are very disabled. They show clinical, functional, and radiographic improvement to long term oral prednisolone. In nonresponsive cases, intravenous steroids show an objective response.

  1. Pulmonary infiltration with eosinophils in 14 dogs

    International Nuclear Information System (INIS)

    Pulmonary infiltration with eosinophils was diagnosed in 14 dogs, whose age ranged from three months to 13 years. The predominant clinical sign was coughing. Dyspnoea, tachypnoea and pruritus were also observed. An absolute circulating eosinophilia was seen in eight dogs and basophilia in five dogs. Thoracic radiographic changes were variable and were not diagnostic. Bronchoscopic evidence of mild to severe bronchitis was present in 12 dogs. Abnormal numbers of eosinophils were found in bronchoalveolar lavage samples and, or, bronchial washings in all 14 cases, but no significant bacteria were recovered. Respiratory compliance was measured in five dogs and was abnormal in three. Faecal examination for helminth parasites was carried out in four cases, a large ascarid burden being identified in one. Intradermal skin testing was carried out in three dogs but was negative in all cases. Complete remission of signs was achieved with prednisolone in 12 cases with six dogs requiring continuous or repeated treatment. Three dogs died as a direct consequence of progression of the disease

  2. Comparison of intravenous and topical lidocaine as a suppressant of coughing after bronchoscopy during general anesthesia.

    Science.gov (United States)

    Jakobsen, C J; Ahlburg, P; Holdgård, H O; Olsen, K H; Thomsen, A

    1991-04-01

    Twenty-four consecutive patients scheduled for fiberbronchoscopy were randomized to receive double-blind either intravenous (1.5 mg/kg) or laryngotracheal (3 mg/kg) lidocaine to evaluate the influence on post-bronchoscopic laryngospasm, pain in the throat and coughing. Plasma lidocaine concentrations were analyzed 5, 15, 30 and 60 min after administration. None of the patients demonstrated laryngospasm or pain in the throat during the first hour after bronchoscopy. Patients receiving topical lidocaine coughed significantly more than patients receiving intravenous lidocaine, with a median number of coughs of 20 compared to 4, during the first hour (P less than 0.01). The plasma lidocaine concentrations were significantly higher after intravenous than after topical administration (P less than 0.001). After intravenous administration the plasma lidocaine concentrations exceeded the accepted level for potential toxicity in five out of 11 patients, but none of the patients developed toxic symptoms and no side-effects were observed. PMID:2038931

  3. Sequential fluctuating paraneoplastic ocular flutter-opsoclonus-myoclonus syndrome and Lambert-Eaton myasthenic syndrome in small-cell lung cancer.

    LENUS (Irish Health Repository)

    Simister, Robert J

    2011-03-01

    Paraneoplastic cerebellar degeneration may occur in association with Lambert-Eaton myasthenic syndrome (LEMS), but to our knowledge, the co-occurrence of paraneoplastic opsoclonus-myoclonus syndrome and LEMS has not been previously reported. A 67-year-old woman presented with a complex partial seizure and evolving ocular flutter, opsoclonus, myoclonus and \\'cerebellar\\' signs, all of which improved spontaneously within 6 weeks. Approximately 8 weeks after symptom onset, the patient became encephalopathic, she had a further complex partial seizure, and she became areflexic with potentiation of deep tendon reflexes. Radiological, bronchoscopic and histological investigations revealed small-cell lung cancer, and neurophysiological investigations confirmed a diagnosis of LEMS. High-titre anti-P\\/Q-type voltage-gated calcium-channel antibodies were identified in the serum, which increased as the signs of opsoclonus and myoclonus resolved. The encephalopathy and clinical features of LEMS responded dramatically to chemotherapy and radiotherapy. Spontaneous improvement of paraneoplastic opsoclonus-myoclonus syndrome may occur, and this syndrome may occur in association with LEMS. Antivoltage-gated calcium-channel antibodies are not implicated in the pathogenesis of paraneoplastic opsoclonus-myoclonus syndrome.

  4. Exogenous surfactant therapy in a patient with adult respiratory distress syndrome after near drowning.

    Science.gov (United States)

    Staudinger, T; Bankier, A; Strohmaier, W; Weiss, K; Locker, G J; Knapp, S; Röggla, M; Laczika, K; Frass, M

    1997-10-01

    A 24-year-old woman developed adult respiratory distress syndrome (ARDS) after near-drowning due to attempted suicide. Conventional mechanical ventilation together with prone positioning and inhaled nitric oxide could not provide sufficient oxygenation. Surface tension data (gamma min = 27 dyn/cm, stability index = 0.341) from a lavage sample supported the hypothesis that the surfactant function of this patient was drastically reduced due to a washout effect by aspiration of fresh water. Porcine surfactant (Curosurf, 50 mg/kg for each lung) was instilled via fibreoptic bronchoscope. The partial arterial carbon dioxide pressure (paCO2) and fraction of inspired oxygen (FiO2) ratio as well as shunt fraction (Qs/Qt) improved impressively. When respiratory situation deteriorated again, surfactant application was repeated. Altogether, six bolus instillations of surfactant (total dose 300 mg/kg = 18,000 mg) were administered until the respiratory situation had stabilized and oxygenation could be maintained by conventional mechanical ventilation. The radiological findings did not show substantial amelioration. The patient developed septic shock and died 12 days after admission. Surfactant application apparently led to a significant improvement of the respiratory function. However, the outcome could not be influenced positively. The high cost of surfactant therapy prevents the more widespread early administration in patients at risk.

  5. Cardiac arrhythmias during fiberoptic bronchoscopy and relation with oxygen saturation

    Directory of Open Access Journals (Sweden)

    Hassan G

    2005-01-01

    Full Text Available To evaluate the occurrence of electrocardiographic abnormalities during fiberoptic bronchoscopy, in relation to specific stages of the procedures, patients′ age, sex, smoking, pre-existing lung disease, premedication and oxygen saturation, a prospective study was conducted on 56 patients aged 35 to 75 (mean 62 years without pre-existing cardiovascular disease. Patients were connected to a 12-lead computerized electrocardiographic recorder and pulse oximeter. Fall of oxygen saturation from mean of 95.12% before the procedure to below 80% was observed in 12 (21.4% patients and below 75% in 5 (8.9% patients, at various stages. Statistically highly significant (p < 0.001 fall of oxygen saturation was observed during the procedures while bronchoscope was introduced into the airways and tracheobronchial tree examined. Major disturbances of cardiac rhythm (i.e. atrial, ventricular or both developed in 23 (41.07% patients. Out of these, sinus tachycardia was noted in 16 (69.5%, ventricular premature complexes in 5 (21.7% and paroxysmal supraventricular tachycardia in 2 (8.6% patients. Arrhythmias were most frequent in association with periods of maximum oxygen desaturation in 18 (78.2% of these 23 patients. Oxygen desaturation persisted for more than half an hour in 38 (67.8% of the 56 patients. However, no correlation was observed between the frequency of arrhythmias during bronchoscopy and patients′ age, sex pre-medication or pre-existing pulmonary disease.

  6. Free-breathing cine CT for the diagnosis of tracheomalacia in young children

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of)

    2013-08-15

    Tracheomalacia is characterized by excessive expiratory collapse of the trachea. To investigate the accuracy of free-breathing cine CT for diagnosis of tracheomalacia in young children with bronchoscopy as reference standard. In a retrospective study (May 2001-July 2008), a patient group (n = 27) of children with bronchoscopic evidence of tracheomalacia, and a control group (n = 320) underwent free-breathing cine CT. The tracheal shape on free-breathing cine CT was classified as round, lunate, elongated or crescentic. Cross-sectional area change of the trachea and age were compared between the groups and the diagnostic performance of free-breathing cine CT for tracheomalacia was evaluated. The patient group showed significantly greater cross-sectional area change of the trachea (57.2% {+-} 22.2% vs. 10.6% {+-} 11.2%, P < 0.001) than the control group. If a cross-sectional area change of the trachea of 31.6% was used as a cut-off value for the diagnosis of tracheomalacia, the sensitivity, specificity and accuracy of cine CT were 96.3% (26/27), 97.2% (311/320) and 97.1% (337/347), respectively. If a crescentic shape during the expiratory phase was used, the sensitivity, specificity and accuracy were 51.9% (14/27), 98.8% (316/320) and 95.1% (330/347), respectively. Free-breathing cine CT has potential to provide the diagnosis of tracheomalacia in young children. (orig.)

  7. Value of virtual tracheobronchoscopy and bronchography from 16-slice multidetector-row spiral computed tomography for assessment of suspected tracheobronchial stenosis in children

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    Honnef, Dagmar; Wildberger, Joachim E.; Das, Marco; Hohl, Christian; Mahnken, Andreas H.; Guenther, Rolf W.; Staatz, Gundula [University Hospital RWTH Aachen, Department of Diagnostic Radiology, Aachen (Germany); Barker, Michael [University Hospital RWTH Aachen, Department of Pediatrics, Aachen (Germany)

    2006-08-15

    To evaluate the value of dose-reduced 16-slice multidetector-row spiral computed tomography (16-MDCT) using virtual tracheobronchoscopy (VTB) and virtual bronchography (VBG) in children with suspected tracheobronchial stenosis. 12 children (4 d to 3 years, body weight 1.2 kg to 13.5 kg) with stridor and suspected tracheobronchial stenosis were examined by contrast-enhanced low-dose 16-MDCT. Conventional axial slices, MPRs, VTB, and VBG were calculated. Image findings were correlated with the results of fiberoptic bronchoscopy (12 out of 12) as a gold standard and subsequent surgery (8 out of 12). VTB and VBG demonstrated the fiberoptic bronchoscopically suspected tracheal stenosis in 11 of 12 children due to vascular compression because of the brachiocephalic trunk (6), a double aortic arch (2), a vascular compression of the left main bronchus (2), and a right aberrant subclavian artery (1). Eleven out of 12 stenoses were correctly depicted by conventional axial slices, MPRs, VTB, and VBG. Dose reduction was 79 to 85.8% compared to a standard adult chest CT. Dose-reduced 16-MDCT with the use of VTB and VBG is effective for the evaluation of tracheobronchial stenosis in children and correlates well with fiberoptic bronchoscopy. (orig.)

  8. [THE GENETIC EXAMINATION OF BRONCHIAL LAVAGE ENABLES THE PROMPT DIAGNOSIS OF PULMONARY MYCOBACTERIUM KANSASII--A CASE REPORT].

    Science.gov (United States)

    Mori, Masahide; Ageshio, Fumitaka; Kagawa, Hiroyuki; Oshitani, Yohei; Fujikawa, Takeya; Saito, Haruko; Sako, Hajime; Yano, Yukihiro; Kitada, Seigo; Maekura, Ryoji

    2015-08-01

    A 59-year-old man with chronic obstructive pulmonary disease and bronchial asthma presented at our hospital with an abnormal shadow on the chest radiograph, which was obtained as part of a routine medical examination. Computed tomography of the chest revealed two nodules in the right upper lung with the longest diameter measuring 29 mm and 10 mm, respectively. A granulomatous disease was strongly suspected based on the histological features of the transbronchial lung biopsy specimen. Results of smear examination for mycobacteria and genetic examination of the bronchial lavage aspirate by the transcription reverse transcription concerted (TRC) reaction method for Mycobacterium tuberculosis and M. avium complex (MAC), were both negative. However, three days after the bronchoscopic examination, an additional genetic examination by the TRC method confirmed the diagnosis of M. kansasii infection. About two weeks later, the culture results were positive and M. kansasii infection was re-confirmed with the DNA probe method. The patient responded well to treatment with a combination of isoniazid, rifampicin, and ethambutol. In Japan, among the nontuberculous mycobacterial infections, the prevalence of pulmonary M.kansasii disease is second only to infection with MAC. However, it is often difficult to distinguish this disease from pulmonary tuberculosis. In this patient, a genetic examination with the TRC method enabled a prompt diagnosis of M. kansasii infection. The TRC method appears to be a useful tool for diagnosing nontubercular mycobacterial infections. PMID:26665518

  9. Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis

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    Mitrović Mirjana

    2012-01-01

    Full Text Available Introduction. Invasive pulmonary aspergillosis (IA is the most frequent invasive fungal infection in patients with hematological malignancies. Massive hemoptysis (MH with blood loss more than 300- 600 ml in 24 hours is a rare (5-10% of IA patients but frequently fatal complication. Standard treatment of MH, such as oxygenation, a semi-sitting position with the bleeding site down, bronchoscopical suctioning, antifungal therapy, transfusion support and surgical resection might be either ineffective or not feasible in some cases. Outline of Cases. We report two patients with life threatening, non-controlled, massive hemoptysis who were successfully managed by non-standard measures. A 61-year-old male with acute myeloid leukemia developed pulmonary IA and massive hemoptysis after consolidation cure by chemotherapy. The bleeding site was localized in the VI lung segment by bronchoscopy. Local application of fibrinogen-thrombin concentrate (fibrin glue stopped the bleeding. A 22-year-old female patient with the diagnosis of severe aplastic anemia developed IA and massive hemoptysis early after application of immunosuppressive therapy (antilymphocyte globulin, cyclosporine and corticosteroids. Conventional transfusion therapy, desmopresine and antifibrinolytics were ineffective. This urgent condition was successfully treated with human activated recombinant factor VII (rFVIIa, NovoSeven®. Conclusion. Our experience together with data from the available literature suggests a potential benefit of fibrinogen-thrombin concentrate and rFVIIa in the treatment of refractory critical bleeding in hematooncological patients.

  10. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules.

    Science.gov (United States)

    Schwarz, Carsten; Schönfeld, Nicolas; Bittner, Roland C; Mairinger, Thomas; Rüssmann, Holger; Bauer, Torsten T; Kaiser, Dirk; Loddenkemper, Robert

    2013-01-01

    The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin. Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n=1, small cell lung cancer n=1, bacterial pneumonia n=2), and the surgical strategy had to be modified to bilobectomy in one patient. Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular pre-operative work-up of patients with SPN. PMID:22496316

  11. Real-time lens distortion correction: speed, accuracy and efficiency

    Science.gov (United States)

    Bax, Michael R.; Shahidi, Ramin

    2014-11-01

    Optical lens systems suffer from nonlinear geometrical distortion. Optical imaging applications such as image-enhanced endoscopy and image-based bronchoscope tracking require correction of this distortion for accurate localization, tracking, registration, and measurement of image features. Real-time capability is desirable for interactive systems and live video. The use of a texture-mapping graphics accelerator, which is standard hardware on current motherboard chipsets and add-in video graphics cards, to perform distortion correction is proposed. Mesh generation for image tessellation, an error analysis, and performance results are presented. It is shown that distortion correction using commodity graphics hardware is substantially faster than using the main processor and can be performed at video frame rates (faster than 30 frames per second), and that the polar-based method of mesh generation proposed here is more accurate than a conventional grid-based approach. Using graphics hardware to perform distortion correction is not only fast and accurate but also efficient as it frees the main processor for other tasks, which is an important issue in some real-time applications.

  12. Endoscopic bronchial valve treatment: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Eberhardt R

    2015-10-01

    Full Text Available Ralf Eberhardt,1,2 Daniela Gompelmann,1,2 Felix JF Herth,1,2 Maren Schuhmann1 1Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, 2Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany Abstract: As well as lung volume reduction surgery, different minimally invasive endoscopic techniques are available to achieve lung volume reduction in patients with severe emphysema and significant hyperinflation. Lung function parameters and comorbidities of the patient, as well as the extent and distribution of the emphysema are factors to be considered when choosing the patient and the intervention. Endoscopic bronchial valve placement with complete occlusion of one lobe in patients with heterogeneous emphysema is the preferred technique because of its reversibility. The presence of high interlobar collateral ventilation will hinder successful treatment; therefore, endoscopic coil placement, polymeric lung volume reduction, or bronchoscopic thermal vapor ablation as well as lung volume reduction surgery can be used for treating patients with incomplete fissures. The effect of endoscopic lung volume reduction in patients with a homogeneous distribution of emphysema is still unclear and this subgroup should be treated only in clinical trials. Precise patient selection is necessary for interventions and to improve the outcome and reduce the risk and possible complications. Therefore, the patients should be discussed in a multidisciplinary approach prior to determining the most appropriate treatment for lung volume reduction. Keywords: lung emphysema, valve treatment, collateral ventilation, patient selection, outcome

  13. Dynamics of human respiratory system mycoflora

    Directory of Open Access Journals (Sweden)

    Anna Biedunkiewicz

    2014-08-01

    Full Text Available The study aimed at determing the prevalence of individual species of fungi in the respiratory systems of women and men, analysis of the dynamics of the fungi in individual sections of the respiratory system as concerns their quantity and identification of phenology of the isolated fungi coupled with an attempt at identifying their possible preferences for appearing during specific seasons of thc year. During 10 years of studies (1989- 1998. 29 species of fungi belonging: Candida, Geolrichum, Saccharomyces, Saccharomycopsis, Schizosaccharomyces, Torulopsis, Trichosporon and Aspergillus were isolated from the ontocenoses of the respiratory systems of patients at the Independent Public Center for Pulmonology and Oncology in Olsztyn. Candida albicans was a clearly dominating fungus. Individual species appeared individually, in twos or threes in a single patient, they were isolated more frequently in the spring and autumn, less frequently during the winter and summer. The largest number of fungi species were isolated from sputum (29 species, bronchoscopic material (23 species and pharyngeal swabs (15 species. Sacchoromycopsis capsularis and Trichosporon beigelii should be treated as new for the respiratory system. Biodiversity of fungi, their numbers and continous fluctuations in frequency indicate that the respiratory system ontocenose offers the optimum conditions for growth and development of the majority of the majority of yeasts - like fungi.

  14. A case of multifocal skin metastases from lung cancer presenting with vasculitic-type cutaneous nodule

    Directory of Open Access Journals (Sweden)

    Nalan Akgul Babacan

    2015-01-01

    Full Text Available Although cutaneous metastasis occurs usually at the terminal stage of the disease, it may be rarely concurrent with the diagnosis and may also present as the first sign of the illness. A 55-year-old male patient presented with vasculitic-type cutaneous nodular lesions and a necrotic distal phalangeal lesion developed over the last month. He was a tradesman and smoked 40 packets year. On physical examination, he was found to have multiple cutaneous lesions on the skin of the face, limbs, neck, scalp, dorsal side, fingers, subungual side, right leg, and feet. A skin lesion punch biopsy was performed and squamous cell carcinoma metastasis was detected. He was diagnosed as having squamous cell lung cancer with bronchoscopic biopsy. Although it is very rare, cutaneous metastases that is concurrent with the diagnosis of lung cancer may be the first sign of the disease. In patients with suspicious skin lesions, the patient′s age, smoking history, and other symptoms should be evaluated and a biopsy should be performed.

  15. A Case of Multifocal Skin Metastases from Lung Cancer Presenting with Vasculitic-type Cutaneous Nodule

    Science.gov (United States)

    Babacan, Nalan Akgul; Kiliçkap, Saadettin; Sene, Soner; Kacan, Turgut; Yucel, Birsen; Eren, Mehmet Fuat; Cihan, Sener

    2015-01-01

    Although cutaneous metastasis occurs usually at the terminal stage of the disease, it may be rarely concurrent with the diagnosis and may also present as the first sign of the illness. A 55-year-old male patient presented with vasculitic-type cutaneous nodular lesions and a necrotic distal phalangeal lesion developed over the last month. He was a tradesman and smoked 40 packets year. On physical examination, he was found to have multiple cutaneous lesions on the skin of the face, limbs, neck, scalp, dorsal side, fingers, subungual side, right leg, and feet. A skin lesion punch biopsy was performed and squamous cell carcinoma metastasis was detected. He was diagnosed as having squamous cell lung cancer with bronchoscopic biopsy. Although it is very rare, cutaneous metastases that is concurrent with the diagnosis of lung cancer may be the first sign of the disease. In patients with suspicious skin lesions, the patient's age, smoking history, and other symptoms should be evaluated and a biopsy should be performed. PMID:25814739

  16. The Efficacy of Bronchial Thermoplasty for Severe Persistent Asthma– the First National Experience

    LENUS (Irish Health Repository)

    Watchorn, DC

    2016-05-01

    There is an unmet need for new therapies in severe persistent asthma. Bronchial thermoplasty is a bronchoscopic procedure which employs radiofrequency energy to reduce airway smooth muscle and has been demonstrated to improve symptomatic control in severe persistent asthma in other populations. Seven patients have completed bronchial thermoplasty at a tertiary referral centre in Ireland. Asthma Control Test scores and data on hospitalisations, exacerbations, maintenance corticosteroid requirements, rescue bronchodilator use and peak expiratory flow rate (PEFR) were compared one year before and one year post treatment. Significant improvements were demonstrated in mean Asthma Control Test scores, from 8.9 to 14.7 (p = 0.036). Trends towards improvement were seen in mean hospitalisations (respective values for total in 12 month period 5.0, 0.9; p = 0.059) and PEFR (181.4 l\\/min, 280 l\\/min respectively; p = 0.059). These data support the use of bronchial thermoplasty in severe persistent asthma in the Irish population.

  17. A novel technique of differential lung ventilation in the critical care setting

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    Kuwagata Yasuyuki

    2011-05-01

    Full Text Available Abstract Background Differential lung ventilation (DLV is used to salvage ventilatory support in severe unilateral lung disease in the critical care setting. However, DLV with a double-lumen tube is associated with serious complications such as tube displacement during ventilatory management. Thus, long-term ventilatory management with this method may be associated with high risk of respiratory incidents in the critical care setting. Findings We devised a novel DLV technique using two single-lumen tubes and applied it to five patients, two with severe unilateral pneumonia and three with thoracic trauma, in a critical care setting. In this novel technique, we perform the usual tracheotomy and insert two single-lumen tubes under bronchoscopic guidance into the main bronchus of each lung. We tie the two single-lumen tubes together and suture them directly to the skin. The described technique was successfully performed in all five patients. Pulmonary oxygenation improved rapidly after DLV induction in all cases, and the three patients with thoracic trauma were managed by DLV without undergoing surgery. Tube displacement was not observed during DLV management. No airway complications occured in either the acute or late phase regardless of the length of DLV management (range 2-23 days. Conclusions This novel DLV technique appears to be efficacious and safe in the critical care setting.

  18. Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma

    Directory of Open Access Journals (Sweden)

    Sergio Nicola Forti Parri

    2014-01-01

    Full Text Available We reported the case of a 36 years old woman involved in a car accident and admitted to the Emergency Room with critical conditions. A CT scan showed hemopericardium, pneumomediastinum and D2 unstable vertebral fracture; then a sternotomy was promptly performed. After admittance to Intensive Care Unit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption of the left main bronchus with a 2 cm gap beetwen two consecutive cartilage rings. D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture. On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy. The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope. Postoperative course was uneventful and the patient was transferred to the Physical Rehabilitation Unit after 23 d. The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions. The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption.

  19. Accurate airway segmentation based on intensity structure analysis and graph-cut

    Science.gov (United States)

    Meng, Qier; Kitsaka, Takayuki; Nimura, Yukitaka; Oda, Masahiro; Mori, Kensaku

    2016-03-01

    This paper presents a novel airway segmentation method based on intensity structure analysis and graph-cut. Airway segmentation is an important step in analyzing chest CT volumes for computerized lung cancer detection, emphysema diagnosis, asthma diagnosis, and pre- and intra-operative bronchoscope navigation. However, obtaining a complete 3-D airway tree structure from a CT volume is quite challenging. Several researchers have proposed automated algorithms basically based on region growing and machine learning techniques. However these methods failed to detect the peripheral bronchi branches. They caused a large amount of leakage. This paper presents a novel approach that permits more accurate extraction of complex bronchial airway region. Our method are composed of three steps. First, the Hessian analysis is utilized for enhancing the line-like structure in CT volumes, then a multiscale cavity-enhancement filter is employed to detect the cavity-like structure from the previous enhanced result. In the second step, we utilize the support vector machine (SVM) to construct a classifier for removing the FP regions generated. Finally, the graph-cut algorithm is utilized to connect all of the candidate voxels to form an integrated airway tree. We applied this method to sixteen cases of 3D chest CT volumes. The results showed that the branch detection rate of this method can reach about 77.7% without leaking into the lung parenchyma areas.

  20. Primary Sjogren’s Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome

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    Abidullah Khan

    2016-01-01

    Full Text Available A previously well, 45-year-old Pakistani lady was admitted to the medical unit on-call of Khyber Teaching Hospital (KTH Peshawar with a 5-day history of fever, productive cough with copious mucoid sputum, dyspnea, and pleuritic chest pain. She also complained of dry eyes, mouth, and vagina. Her chest X-ray showed diffuse alveolar shadowing and arterial gas analysis confirmed type 1 respiratory failure. Over the next few days, she deteriorated rapidly making an urgent transfer to the medical intensive care unit (MICU necessary, where she was mechanically ventilated. An HRCT followed by bronchoscopic biopsies made a diagnosis of acute interstitial pneumonitis (AIP, formerly known as Hamman-Rich syndrome. She also turned out to be positive for both anti-SS-A/Ro and anti-SS-B/La antibodies along with a positive Schirmer’s test and lower lip biopsy. She received intravenous steroids and supportive care. The patient had a complete recovery after approximately three weeks’ stay in the hospital with lung function returning back to normal. This is most probably the first ever case of primary Sjogren syndrome (pSjS presenting as AIP, recovering completely in less than a month time.

  1. Advanced therapies for COPD-What's on the horizon? Progress in lung volume reduction and lung transplantation.

    Science.gov (United States)

    Trotter, Michael A; Hopkins, Peter M

    2014-11-01

    Advanced chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity. Treatment options beyond conventional medical therapies are limited to a minority of patients. Lung volume reduction surgery (LVRS) although effective in selected subgroups of patients is not commonly undertaken. Morbidity associated with the procedure has contributed to this low utilisation. In response to this, less invasive bronchoscopic lung volume techniques are being developed to attempt to mitigate some of the risks and costs associated with surgery. Of these, endobronchial valve therapy is the most comprehensively studied although the presence of collateral ventilation in a significant proportion of patients has compromised its widespread utility. Bronchial thermal vapour ablation and lung volume reduction (LVR) coils are not dependent on collateral ventilation. These techniques have shown promise in early clinical trials; ongoing work will establish whether they have a role in the management of advanced COPD. Lung transplantation, although effective in selected patients for palliation of symptoms and improving survival, is limited by donor organ availability and economic constraint. Reconditioning marginal organs previously declined for transplantation with ex vivo lung perfusion (EVLP) is one potential strategy in improving the utilisation of donor organs. By increasing the donor pool, it is hoped lung transplantation might be more accessible for patients with advanced COPD into the future. PMID:25478204

  2. The lung cancer breath signature: a comparative analysis of exhaled breath and air sampled from inside the lungs

    Science.gov (United States)

    Capuano, Rosamaria; Santonico, Marco; Pennazza, Giorgio; Ghezzi, Silvia; Martinelli, Eugenio; Roscioni, Claudio; Lucantoni, Gabriele; Galluccio, Giovanni; Paolesse, Roberto; di Natale, Corrado; D'Amico, Arnaldo

    2015-11-01

    Results collected in more than 20 years of studies suggest a relationship between the volatile organic compounds exhaled in breath and lung cancer. However, the origin of these compounds is still not completely elucidated. In spite of the simplistic vision that cancerous tissues in lungs directly emit the volatile metabolites into the airways, some papers point out that metabolites are collected by the blood and then exchanged at the air-blood interface in the lung. To shed light on this subject we performed an experiment collecting both the breath and the air inside both the lungs with a modified bronchoscopic probe. The samples were measured with a gas chromatography-mass spectrometer (GC-MS) and an electronic nose. We found that the diagnostic capability of the electronic nose does not depend on the presence of cancer in the sampled lung, reaching in both cases an above 90% correct classification rate between cancer and non-cancer samples. On the other hand, multivariate analysis of GC-MS achieved a correct classification rate between the two lungs of only 76%. GC-MS analysis of breath and air sampled from the lungs demonstrates a substantial preservation of the VOCs pattern from inside the lung to the exhaled breath.

  3. CD8 positive T cells express IL-17 in patients with chronic obstructive pulmonary disease

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    Eidelman David H

    2011-04-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a progressive and irreversible chronic inflammatory disease of the lung. The nature of the immune reaction in COPD raises the possibility that IL-17 and related cytokines may contribute to this disorder. This study analyzed the expression of IL-17A and IL-17F as well as the phenotype of cells producing them in bronchial biopsies from COPD patients. Methods Bronchoscopic biopsies of the airway were obtained from 16 COPD subjects (GOLD stage 1-4 and 15 control subjects. Paraffin sections were used for the investigation of IL-17A and IL-17F expression in the airways by immunohistochemistry, and frozen sections were used for the immunofluorescence double staining of IL-17A or IL-17F paired with CD4 or CD8. In order to confirm the expression of IL-17A and IL-17F at the mRNA level, a quantitative RT-PCR was performed on the total mRNA extracted from entire section or CD8 positive cells selected by laser capture microdissection. Results IL-17F immunoreactivity was significantly higher in the bronchial biopsies of COPD patients compared to control subjects (P P P P Conclusion These findings support the notion that Th17 cytokines could play important roles in the pathogenesis of COPD, raising the possibility of using this mechanism as the basis for novel therapeutic approaches.

  4. [Lipoid pneumonia - an underestimated syndrome].

    Science.gov (United States)

    Schwaiblmair, M; Berghaus, T; Haeckel, T; Wagner, T; Scheidt, W von

    2010-01-01

    Lipoid pneumonia, first described by Laughlen 1925 may be classified as endogenous or exogenous. The endogenous form is seen when fat is deposited into the lung tissue. It is usually associated with proximal obstructive lesions, necrotic tissue after radio- or chemotherapy, with lipid storage disease or hyperlipidemia . Exogenous lipoid pneumonia results from inhaling or aspirating animal, vegetable or mineral oil. There are usually some underlying neurological defects or esophageal abnormalities. Patients may present with cough, sputum, hemoptysis and chest pain or may be asymptomatic. There is no classic chest film appearance: it may appear as diffuse airspace infiltration or localized consolidation simulating tumour. Computed tomography is diagnostically helpful and shows hypodense areas measuring from -100 to - 30 Hounsfield units. Bronchoscopic biopsies are mandatory for histological confirmation of the diagnosis. Treatment of exogenous lipoid pneumonia has always been conservative by discontinuing the use of oil, correction of underlying defects that may favor aspiration and treatment of intercurrent pneumonia. Other measures, for example corticosteroid therapy, are of uncertain benefit. Complications of lipoid pneumonia that worsen prognosis are recurrent bacterial pneumonias including nontuberculous mycobacteria or aspergillus, or lung cancer that has developed in areas of pre-existing exogenous lipoid pneumonia. PMID:20024881

  5. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis.

    Science.gov (United States)

    Zhao, Xue Hong; Zhang, Yun; Liang, Zhong Yan; Zhang, Shao Yang; Yu, Wen Qiao; Huang, Fang-Fang

    2015-12-01

    The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.

  6. Tracheal reconstructions.

    Science.gov (United States)

    Srikrishna, S V; Shekar, P S; Shetty, N

    1998-12-01

    Surgical reconstruction of the trachea is a relatively complex procedure. We had 20 cases of tracheal stenosis. We have a modest experience of 16 tracheal reconstructions for acquired tracheal stenosis. Two patients underwent laser treatment while another two died before any intervention. The majority of these cases were a result of prolonged ventilation (14 cases), following organophosphorous poisoning (11 cases), Guillain-Barré syndrome, bullet injury, fat embolism and surprisingly only one tumor, a case of mucoepidermoid carcinoma, who had a very unusual presentation. There were 12 males and 4 females in this series, age ranging from 12-35 years. The duration of ventilation ranged from 1-21 days and the interval from decannulation to development of stridor was between 5-34 days. Six of them were approached by the cervical route, 5 by thoracotomy and cervical approach, 2 via median sternotomy and 3 by thoracotomy alone. Five of them required an additional laryngeal drop and 1 required pericardiotomy and release of pulmonary veins to gain additional length. The excised segments of trachea measured 3 to 5 cms in length. All were end to end anastomosis with interrupted Vicryl sutures. We have had no experience with stents or prosthetic tubes. Three patients developed anastomotic leaks which were controlled conservatively. Almost all of them required postoperative tracheo-bronchial suctioning with fibreoptic bronchoscope. We had one death in this series due to sepsis. PMID:9914459

  7. Medical devices for the anesthetist: current perspectives

    Directory of Open Access Journals (Sweden)

    Ingrande J

    2014-03-01

    Full Text Available Jerry Ingrande, Hendrikus JM LemmensDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USAAbstract: Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools, ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use.Keywords: catheters, echocardiography, ultrasound, fiberoptic bronchoscope, laryngeal mask airway, closed-loop anesthesia

  8. Interventional bronchoscopy in the management of thoracic malignancy.

    Science.gov (United States)

    Hardavella, Georgia; George, Jeremy

    2015-09-01

    Interventional bronchoscopy is a rapidly expanding field in respiratory medicine offering minimally invasive therapeutic and palliative procedures for all types of lung neoplasms. This field has progressed over the last couple of decades with the application of new technology. The HERMES European curriculum recommendations include interventional bronchoscopy skills in the modules of thoracic tumours and bronchoscopy [1]. However, interventional bronchoscopy is not available in all training centres and consequently, not all trainees will obtain experience unless they rotate to centres specifically offering such training. In this review, we give an overview of interventional bronchoscopic procedures used for the treatment and palliation of thoracic malignancy. These can be applied either with flexible or rigid bronchoscopy or a combination of both depending on the anatomical location of the tumour, the complexity of the case, bleeding risk, the operator's expertise and preference as well as local availability. Specialised anaesthetic support and appropriately trained endoscopy staff are essential, allowing a multimodality approach to meet the high complexity of these cases. PMID:26632425

  9. Interventional bronchoscopy in the management of thoracic malignancy

    Directory of Open Access Journals (Sweden)

    Georgia Hardavella

    2015-09-01

    Interventional bronchoscopy is a rapidly expanding field in respiratory medicine offering minimally invasive therapeutic and palliative procedures for all types of lung neoplasms. This field has progressed over the last couple of decades with the application of new technology. The HERMES European curriculum recommendations include interventional bronchoscopy skills in the modules of thoracic tumours and bronchoscopy [1]. However, interventional bronchoscopy is not available in all training centres and consequently, not all trainees will obtain experience unless they rotate to centres specifically offering such training. In this review, we give an overview of interventional bronchoscopic procedures used for the treatment and palliation of thoracic malignancy. These can be applied either with flexible or rigid bronchoscopy or a combination of both depending on the anatomical location of the tumour, the complexity of the case, bleeding risk, the operator’s expertise and preference as well as local availability. Specialised anaesthetic support and appropriately trained endoscopy staff are essential, allowing a multimodality approach to meet the high complexity of these cases.

  10. Acute Respiratory Failure Caused by Hepatopulmonary Fistula in a Patient with Hepatocellular Carcinoma.

    Science.gov (United States)

    Lee, Jungsil; Kim, Yoon Jun; Kim, Hyung-Jun; Kim, Jee-Min; Kim, Young-Chan; Choi, Sun Mi

    2016-07-01

    A 59-year-old man presented with acute dyspnea following sudden productive cough and expectoration of a full cup of "blood-tinged" sputum. He had been diagnosed with hepatitis B virus-related hepatocellular carcinoma and had received transarterial chemoembolization 5 years ago for a 20-cm hepatic mass; he denied any history of hematemesis and the last esophagogastroduodenoscopy from a year ago showed absence of varix. Chest computed tomography (CT) with angiography showed new appearance of right basal lung consolidation but no bleeding focus. Despite the use of systemic antibiotics, the patient developed respiratory failure on day 7 of hospitalization. After intubation, a massive amount of brown sputum with anchovy-paste-like consistency was suctioned via the endotracheal tube. Bronchoscopic toileting was performed and the patient was extubated. In the ward, he continued to expectorate the brown sputum. On day 25 of hospitalization, a repeat CT scan showed simultaneous disappearance of the pneumonic consolidation and the necrotic fluid within the hepatic mass, suggesting the presence of a fistula. He has continued to receive systemic antibiotics, sorafenib, and entecavir, and follow up by respiratory and hepato-oncology specialists. PMID:27433178

  11. Dynamics of eosinophil infiltration in the bronchial mucosa before and after the late asthmatic reaction.

    Science.gov (United States)

    Aalbers, R; de Monchy, J G; Kauffman, H F; Smith, M; Hoekstra, Y; Vrugt, B; Timens, W

    1993-06-01

    We wanted to determine whether changes in bronchial hyperresponsiveness (BHR) following allergen challenge show a time relationship with inflammatory events in the airways of allergic asthmatic subjects. Lavage was performed and endobronchial biopsies were taken via the fiberoptic bronchoscope, before, and 3 and 24 h after, allergen challenge, on separate occasions, in nine dual asthmatic responders. The numbers of activated eosinophils, identified by immunohistochemistry, using the monoclonal anti-eosinophil cationic protein antibody, EG2, were significantly increased both at 3 h and at 24 h in the submucosa and bronchial lavage. A significant negative correlation was found between the number of EG2+ cells in the submucosa and in the bronchial lavage 24 h after the allergen challenge (r = -0.70). At 24 h, the amount of eosinophil cationic protein (ECP) was increased in the bronchial lavage. A significant correlation was observed between the amount of ECP at 3 h and the log provocative dose of house dust mite producing a 20% fall in forced expiratory volume in one second (PD20 HDM) (r = -0.63). The results suggest a recruitment of activated eosinophils to the submucosa and, further, to the epithelial lining, followed by degranulation. This process has already started 3 h after allergen challenge, and lasts for at least 24 h, which may result in mucosal damage and subsequent allergen-induced increase in BHR, before and after the late asthmatic reaction. PMID:8339804

  12. Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management:a challenging thoracic politrauma

    Institute of Scientific and Technical Information of China (English)

    Sergio Nicola Forti Parri; Gian Marco Guiducci; Kenji Kawamukai; Carlo Coniglio; Giovanni Gordini; Federico De Iure; Rocco Trisolini; Salomone Di Saverio; Gregorio Tugnoli

    2014-01-01

    We reported the case of a36 years old woman involved in a car accident and admitted to theEmergencyRoom with critical conditions.ACT scan showed hemopericardium, pneumomediastinum andD2 unstable vertebral fracture; then a sternotomy was promptly performed.After admittance toIntensiveCareUnit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption ofthe left main bronchus with a2 cm gap beetwen two consecutive cartilage rings.D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture.On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy.The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope.Postoperative course was uneventful and the patient was transferred to thePhysicalRehabilitationUnit after23 d.The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions.The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption.

  13. CT of the pulmonary parenchyma: Current clinical applications

    International Nuclear Information System (INIS)

    CT is playing an increasingly important role in the evaluation of patients with complex pulmonary parenchymal pathology. This course reviews the general principles of pulmonary CT and examines current methods of optimizing studies of the pulmonary parenchyma, including high-resolution CT. The basic CT signs of focal and diffuse parenchymal pathology are described. CT permits a more effective characterization of pulmonary processes. The clinical applications derived from the effective use of parenchymal CT are illustrated. Emphasis is placed on the various uses of parenchyman CT in the immunocompromised population, the group that will benefit most from the integration of CT with clinical management. The ability of CT to detect pulmonary pathology before it becomes apparent on plain radiographs is a major asset in this patient group. In addition, CT can serve as a road map for bronchoscopic or percutaneous tissue sampling procedures and can also e used to monitor response to therapy for the various pulmonary processes encountered in these patients. The various roles of CT - early detection, monitoring, characterization, and guidance of percutaenous or endoscopic procedures - in the diagnosis and management of various clinical entities are stressed

  14. A Case—Contrl Study of Dietary Factors in Patients with Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    HUANGCHENGYU; ZHANGXIUQUAN; 等

    1992-01-01

    A case-control study was designed to investigate association of dietary factors with the risk of lung cancer in Sichuan,China.The cases consisted of 135 patients with preinvasive lung cancer which had been confirmed with histopathology,fiber bronchoscope,CT and X-ray film in three provincial hospitals in the recent one year.Controls were healthy subjects who went to one of these hospitals for health check-up;patients with pulmonary diseases was exluded.Controls were matched to cases for sex and age with a ratio of 1:1.Nutrient intakes, the eating habit and other relevant factors were investigated.The data analyzed with the conditional logistic regression model indicated,that dietary beta-carotene intakes had a significantly inverse association with the risk of lung cancer.Vitamin Chad a less significantly inverse association with the risk.Association of protein,fat,energy,retinol intakes of dietbalance index with the risk was not significant.Association of tea,alcohol,garlic or mushroom,respectively,with the risk was also not observed.Consumption of more processed foods and deep-fried foods were found to be risk factors.Smoking and air pollution from coal burning stoves were also observed as independent risk factors of lung cancer in the present study.The mental stress incidence in the case was significantly higher than that in the control.

  15. Lung cancer screening beyond low-dose computed tomography: the role of novel biomarkers.

    Science.gov (United States)

    Hasan, Naveed; Kumar, Rohit; Kavuru, Mani S

    2014-10-01

    Lung cancer is the most common and lethal malignancy in the world. The landmark National lung screening trial (NLST) showed a 20% relative reduction in mortality in high-risk individuals with screening low-dose computed tomography. However, the poor specificity and low prevalence of lung cancer in the NLST provide major limitations to its widespread use. Furthermore, a lung nodule on CT scan requires a nuanced and individualized approach towards management. In this regard, advances in high through-put technology (molecular diagnostics, multi-gene chips, proteomics, and bronchoscopic techniques) have led to discovery of lung cancer biomarkers that have shown potential to complement the current screening standards. Early detection of lung cancer can be achieved by analysis of biomarkers from tissue samples within the respiratory tract such as sputum, saliva, nasal/bronchial airway epithelial cells and exhaled breath condensate or through peripheral biofluids such as blood, serum and urine. Autofluorescence bronchoscopy has been employed in research setting to identify pre-invasive lesions not identified on CT scan. Although these modalities are not yet commercially available in clinic setting, they will be available in the near future and clinicians who care for patients with lung cancer should be aware. In this review, we present up-to-date state of biomarker development, discuss their clinical relevance and predict their future role in lung cancer management.

  16. Multifocal Extranodal Involvement of Diffuse Large B-Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Devrim Cabuk

    2013-01-01

    Full Text Available Endobronchial involvement of extrapulmonary malignant tumors is uncommon and mostly associated with breast, kidney, colon, and rectum carcinomas. A 68-year-old male with a prior diagnosis of colon non-Hodgkin lymphoma (NHL was admitted to the hospital with a complaint of cough, sputum, and dyspnea. The chest radiograph showed right hilar enlargement and opacity at the right middle zone suggestive of a mass lesion. Computed tomography of thorax revealed a right-sided mass lesion extending to thoracic wall with the destruction of the third and the fourth ribs and a right hilar mass lesion. Fiberoptic bronchoscopy was performed in order to evaluate endobronchial involvement and showed stenosis with mucosal tumor infiltration in right upper lobe bronchus. The pathological examination of bronchoscopic biopsy specimen reported diffuse large B-cell lymphoma and the patient was accepted as the endobronchial recurrence of sigmoid colon NHL. The patient is still under treatment of R-ICE (rituximab-ifosfamide-carboplatin-etoposide chemotherapy and partial regression of pulmonary lesions was noted after 3 courses of treatment.

  17. Scintigraphic results in patients with lung transplants. A prospective comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Humplik, B.I.; Sandrock, D.; Aurisch, R.; Richter, W.S.; Munz, D.L. [Charite Univ. Medicine, Berlin (Germany); Ewert, R. [German Heart Center, Berlin (Germany)

    2005-04-01

    We addressed the feasibility of scintigraphy in the postoperative monitoring of lung transplants. Method: 37 patients (22 women, 15 men, 37 {+-} 15 years) in good clinical conditions were examined after lung transplantation. Scintigraphic procedures for assessing ventilation ({sup 133}Xe), perfusion ({sup 99m}Tc microspheres) and aerosol-inhalation ({sup 99m}Tc aerosol) were performed for all patients. The findings were compared with those of established diagnostic modalities. Results: All lung transplants showed homogeneous ventilation but with a non-physiologic difference of over 20% between both pulmonary lobes in one-third of the cases. There was a difference between the impairment of perfusion and ventilation in the presence of an impaired Euler-Liljestrand reflex in 14/37 (38%) patients. Furthermore, bronchoscopy and aerosol-inhalation scans often did not correlate, e.g. a bronchoscopically evident stenosis was not necessarily associated with an increased activity, and vice versa. Although peripheral mucociliary clearance was preserved after transplantation, stasis in central airways resulted in significantly impaired global clearance. Conclusion: Ventilation and perfusion scintigraphy reveal in a significant number of lung recipients pathologic findings and therefore can be recommended for postoperative monitoring. From a clinical point of view aerosol-inhalation scintigraphy (clearance) is not of any additional value. (orig.)

  18. Haemophilia, AIDS and lung epithelial permeability

    Energy Technology Data Exchange (ETDEWEB)

    O' Doherty, M.J.; Page, C.J.; Harrington, C.; Nunan, T.; Savidge, G. (Haemophilia Centre and Coagulation Research Unit, Department of Nuclear Medicine, Rayne Institute, St. Thomas' Hospital, London (United Kingdom))

    1990-01-01

    Lung {sup 99m}Tc DTPA transfer was measured in HIV antibodypositive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP)). Lung {sup 99m}Tc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compred to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung basis in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of {sup 99m}Tc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs. (au).

  19. Endoscopic bronchial valve treatment: patient selection and special considerations.

    Science.gov (United States)

    Eberhardt, Ralf; Gompelmann, Daniela; Herth, Felix J F; Schuhmann, Maren

    2015-01-01

    As well as lung volume reduction surgery, different minimally invasive endoscopic techniques are available to achieve lung volume reduction in patients with severe emphysema and significant hyperinflation. Lung function parameters and comorbidities of the patient, as well as the extent and distribution of the emphysema are factors to be considered when choosing the patient and the intervention. Endoscopic bronchial valve placement with complete occlusion of one lobe in patients with heterogeneous emphysema is the preferred technique because of its reversibility. The presence of high interlobar collateral ventilation will hinder successful treatment; therefore, endoscopic coil placement, polymeric lung volume reduction, or bronchoscopic thermal vapor ablation as well as lung volume reduction surgery can be used for treating patients with incomplete fissures. The effect of endoscopic lung volume reduction in patients with a homogeneous distribution of emphysema is still unclear and this subgroup should be treated only in clinical trials. Precise patient selection is necessary for interventions and to improve the outcome and reduce the risk and possible complications. Therefore, the patients should be discussed in a multidisciplinary approach prior to determining the most appropriate treatment for lung volume reduction. PMID:26504379

  20. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2016-01-01

    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  1. 48. The value of CT scan and detection of telomerase activity in biopsy specimens for early diagnosis of lung carcinoma

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To evaluate the diagnostic value of telomerase activity in the specimens of biopsy with bronchoscopy or cutting needle. Methods: Telomerase activity was measured in the biopsy apecimens taken from 52 patients suspected of having early lung cancer by CT scan. The PCR based silver staining telomeric repeat amplification protocol (TRAP) was used for detection of telomerase activity in 22 patients with early lung cancer (T1N0M0). Control study was made on the specimens taken from 24 patients with benign disease (cyst 3, TB 6, pseudtumor 5, pneumonjia 10). Results: The positive rates of telomerase activity were 86.45% (19/22) and 4.2% (1/24) in early lung cancers and benign lesions respectively (P<0.01). It was significantly higher in early lung cancers than in benign disease. All cases were diagnosed with surgical pathology and following for 2 years. Conclusion: Detecting telomerase activity in preoperative bronchoscope and cutting needle biopsy specimens may contribute to diagnosis of early lung cancer.

  2. Interfractional Positional Variability of Fiducial Markers and Primary Tumors in Locally Advanced Non-Small-Cell Lung Cancer During Audiovisual Biofeedback Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Roman, Nicholas O., E-mail: nroman@mcvh-vcu.edu [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Shepherd, Wes [Department of Pulmonology, Virginia Commonwealth University, Richmond, VA (United States); Mukhopadhyay, Nitai [Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (United States); Hugo, Geoffrey D.; Weiss, Elisabeth [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States)

    2012-08-01

    Purpose: To evaluate implanted markers as a surrogate for tumor-based setup during image-guided lung cancer radiotherapy with audiovisual biofeedback. Methods and Materials: Seven patients with locally advanced non-small-cell lung cancer were implanted bronchoscopically with gold coils. Markers, tumor, and a reference bony structure (vertebra) were contoured for all 10 phases of the four-dimensional respiration-correlated fan-beam computed tomography and weekly four-dimensional cone-beam computed tomography. Results: The systematic/random interfractional marker-to-tumor centroid displacements were 2/3, 2/2, and 3/3 mm in the x (lateral), y (anterior-posterior), and z (superior-inferior) directions, respectively. The systematic/random interfractional marker-to-bone displacements were 2/3, 2/3, and 2/3 mm in the x, y, and z directions, respectively. The systematic/random tumor-to-bone displacements were 2/3, 2/4, and 4/4 mm in the x, y, and z directions, respectively. All displacements changed significantly over time (p < 0.0001). Conclusions: Although marker-based image guidance may decrease the risk for geometric miss compared with bony anatomy-based positioning, the observed displacements between markers and tumor centroids indicate the need for repeated soft tissue imaging, particularly in situations with large tumor volume change and large initial marker-to-tumor centroid distance.

  3. Thoracoscopic CO laser coagulation shrinkage of blebs in treatment of spontaneous pneumothorax

    Science.gov (United States)

    Sensaki, Koji; Arai, Tsunenori; Kikuchi, Keiichi; Takagi, Keigo; Tanaka, Susumu; Kikuchi, Makoto

    1992-06-01

    Spontaneous pneumothorax is a common disease in young people. Operative intervention has been done in most of the recurrent cases. Recently thoracoscopic treatment has been tested as a less invasive treatment modarity. We adopted carbon monoxide (CO) laser for thoracoscopic treatment of recurrent spontaneous pneumothorax. CO laser (wavelength; 5.4 micrometers ) could be delivered by chalcogenide glass (As - S) covered with a teflon sheath and ZnSe fiber tip. The sterilized flexible bronchoscope was inserted through the thoracoscopic outer sheath under local anesthesia. Shrinkage of blebs was obtained by non-contact method of CO laser irradiation. Laser power at the tip was 2.5 - 5 W and irradiation duration was 0.5 s each. Excellent shrinkage of bleb and bulla could be obtained by CO laser without perforation complication. Advantages of CO laser as a thoracoscopic treatment were: (1) capability of fiber delivery (flexible thoracoscopy was easy to operate and clear to visualize the blebs which were frequently found at the apical portion of the lung, and (2) shallow extinction length (good shrinkage of blebs, low risk of perforation, and thin layer of carbonization). In conclusion, our new technique of thoracoscopic CO laser irradiation was found to be a safe and effective treatment of spontaneous pneumothorax.

  4. Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Matthew S.; Kim, Hyun J.; Abtin, Fereidoun G.; Galperin-Aizenberg, Maya; Pais, Richard; Da Costa, Irene G.; Ordookhani, Arash; Chong, Daniel; Ni, Chiayi; McNitt-Gray, Michael F.; Goldin, Jonathan G. [David Geffen School of Medicine at UCLA, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, Los Angeles, CA (United States); Strange, Charlie [Medical University of South Carolina, Department of Pulmonary and Critical Care Medicine, Columbia, SC (United States); Tashkin, Donald P. [David Geffen School of Medicine at UCLA, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA (United States)

    2012-07-15

    To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe. The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearman's rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes. The target lobe volume at full inspiration in the treatment group had a mean reduction of -0.45 L (SE = 0.034, P < 0.0001), and was associated with volume increases in the ipsilateral lobe (rho = -0.68, P < 0.0001) and contralateral lung (rho = -0.16, P = 0.006), and overall reductions in expiratory RA (rho = 0.31, P < 0.0001) and residual volume (RV)/total lung capacity (TLC) (rho = 0.13, P = 0.03). When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung. (orig.)

  5. Image-guided endobronchial ultrasound

    Science.gov (United States)

    Higgins, William E.; Zang, Xiaonan; Cheirsilp, Ronnarit; Byrnes, Patrick; Kuhlengel, Trevor; Bascom, Rebecca; Toth, Jennifer

    2016-03-01

    Endobronchial ultrasound (EBUS) is now recommended as a standard procedure for in vivo verification of extraluminal diagnostic sites during cancer-staging bronchoscopy. Yet, physicians vary considerably in their skills at using EBUS effectively. Regarding existing bronchoscopy guidance systems, studies have shown their effectiveness in the lung-cancer management process. With such a system, a patient's X-ray computed tomography (CT) scan is used to plan a procedure to regions of interest (ROIs). This plan is then used during follow-on guided bronchoscopy. Recent clinical guidelines for lung cancer, however, also dictate using positron emission tomography (PET) imaging for identifying suspicious ROIs and aiding in the cancer-staging process. While researchers have attempted to use guided bronchoscopy systems in tandem with PET imaging and EBUS, no true EBUS-centric guidance system exists. We now propose a full multimodal image-based methodology for guiding EBUS. The complete methodology involves two components: 1) a procedure planning protocol that gives bronchoscope movements appropriate for live EBUS positioning; and 2) a guidance strategy and associated system graphical user interface (GUI) designed for image-guided EBUS. We present results demonstrating the operation of the system.

  6. Lung vasculature imaging using speckle variance optical coherence tomography

    Science.gov (United States)

    Cua, Michelle; Lee, Anthony M. D.; Lane, Pierre M.; McWilliams, Annette; Shaipanich, Tawimas; MacAulay, Calum E.; Yang, Victor X. D.; Lam, Stephen

    2012-02-01

    Architectural changes in and remodeling of the bronchial and pulmonary vasculature are important pathways in diseases such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. However, there is a lack of methods that can find and examine small bronchial vasculature in vivo. Structural lung airway imaging using optical coherence tomography (OCT) has previously been shown to be of great utility in examining bronchial lesions during lung cancer screening under the guidance of autofluorescence bronchoscopy. Using a fiber optic endoscopic OCT probe, we acquire OCT images from in vivo human subjects. The side-looking, circumferentially-scanning probe is inserted down the instrument channel of a standard bronchoscope and manually guided to the imaging location. Multiple images are collected with the probe spinning proximally at 100Hz. Due to friction, the distal end of the probe does not spin perfectly synchronous with the proximal end, resulting in non-uniform rotational distortion (NURD) of the images. First, we apply a correction algorithm to remove NURD. We then use a speckle variance algorithm to identify vasculature. The initial data show a vascaulture density in small human airways similar to what would be expected.

  7. An Uncommon Procedure for a Rare Ailment: Massive Bronchoalveolar Lavage in a Patient with Pulmonary Alveolar Proteinosis

    Directory of Open Access Journals (Sweden)

    Belgin Samurkaşoğlu

    2012-09-01

    Full Text Available As a rare procedure, massive bronchoalveolar lavage (MBAL is a large-volume lavage which necessitates general anesthesia and one-lung ventilation (OLV. During MBAL isotonic saline is instilled into one lung and drained through one lumen of a double-lumen tube. MBAL is the most effective treatment for symptomatic pulmonary alveolar proteinosis (PAP. A 27-year-old male with PAP was scheduled for therapeutic MBALs. After standard preoxygenation, monitoring and anesthesia induction, a double-lumen tube was placed. Tube position was verified by a fiberoptic bronchoscope. The internal jugular vein, radial and pulmonary arteries were cannulated. A temperature probe and foley catheter were inserted. The nonventilated lung was filled with 1000 mL saline and then drained in each session. The left and right lung were lavaged with an interval of 2 weeks. A total of 20 L saline was used in each MBAL without retention. MBALs were terminated after the effluent became clear. Duration of the left and right MBALs were 325 and 275 minutes, respectively. Despite increased shunt fraction, oxygenation was within acceptable limits during OLV. The trachea was extubated in the operating room uneventfully after each MBAL. The patient’s clinical and laboratory findings were evidently improved. Consequently, if proper conditions are provided, MBAL is safe and beneficial despite its risks and the long duration.

  8. Pulmonary alveolar proteinosis

    Directory of Open Access Journals (Sweden)

    Hadice Selimoğlu Şen

    2011-06-01

    Full Text Available Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of lipoproteinosis material within the alveoli. A 36 age male patient applied to our hospital with dyspnea that began 5 months ago. Bilateral diffuse infiltration on postero-anterior chest graphy was seen. Arterial blood gas measurements (ABG was: pH:7.44, pCO2: 36 mmHg, pO2: 49 mmHg, SaO2: 85%, HCO3: 24 mmol/L. High resolution computed tomography (HRCT reported as bilateral diffuse ground glass areas and interlobuler septal thickening on this areas. Asido resistant bacillus was negative in sputum at three times and was also negative in post bronchoscopic sputum and bronchoalveoler lavage material. Wedge resection was made by video-assisted thoracoscopic surgery. Histopathology report of biopsy material revealed “Pulmonary alveolar proteinosis (PAP”. Massive lung lavage under general anesthesia was planned for patient. Clinical improvement was seen in patient beginning from admission and ABG measurements entered the recovery trend in follow-up. Partial pressure of oxygen was increased to 65 mmHg and patient was followed without lung lavage. Control chest radiography and HRCT showed significant radiological improvement. After three months, radiological lesions had completely regressed at control HRCT. As a result, in patients with symptoms and radiologically bilateral diffuse infiltration physicians should consider PAP as a rare disease in the differential diagnosis.

  9. Clinical spectrum of pulmonary hamartoma diagnosed by surgical resection

    International Nuclear Information System (INIS)

    We retrospectively reviewed our institutional experience of pulmonary hamartomas. We analyzed the records of 23 patients with pulmonary hamartomas which were diagnosed by surgical resection. There were 12 males and 11 females. Their mean age was 53.5 years old (range: 28 to 71 years). Twenty patients were asymptomatic, 2 had chest pain and 1 had a cough. Twenty-two patients had solitary and only 1 patient had multiple lesions. The tumor sizes ranged from 0.5 to 3.0 cm (mean: 1.5 cm). Graphically, 6 patients had calcification which was not popcorn-like. We could not diagnose nodules by bronchoscopic biopsy, which was preoperatively performed in 17 patients. Surgery was performed because we could not rule out malignancy in all patients. Surgical procedures consisted of 6 enucleation, 16 wedge resection and 1 lobectomy. Video-assisted thoracic surgery was performed in 17 patients. To diagnose pulmonary nodule, whose malignancy is difficult to determine, surgical resection should be considered. (author)

  10. Haemophilia, AIDS and lung epithelial permeability

    International Nuclear Information System (INIS)

    Lung 99mTc DTPA transfer was measured in HIV antibodypositive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP)). Lung 99mTc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compred to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung basis in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of 99mTc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs. (au)

  11. An approach to interstitial lung disease in India

    Directory of Open Access Journals (Sweden)

    J N Pande

    2014-07-01

    Full Text Available Interstitial lung diseases are common and have varied etiology, clinical presentation, clinical course and outcome. They pose a diagnostic challenge to physicians and pulmonologists. Patients present with dry cough, exertional dyspnoea, interstitial lesions on X-ray of the chest and restrictive ventilatory defect on spirometry. A sharp decline in oxygen saturation with exercise is characteristic. Careful evaluation of the history of the patient and physical examination help in narrowing down diagnostic probabilities. HRCT of the chest has emerged as an important tool in the evaluation of these disorders. Idiopathic Interstitial Pneumonias (IIP are a group of conditions which are classified into several types based on pathological features. Bronchoscopic procedures are helpful in diagnosis of certain disorders but are of limited value in classification of IIP which requires surgical biopsy. Usual Interstitial Pneumonia (UIP, also referred to as Idiopathic Pulmonary Fibrosis, has a progressive course and an unfavourable outcome. Certain new drugs have recently become available for treatment of UIP. Our approach towards diagnosis and management of interstitial lung diseases based on personal experience over the past three decades is reported here. Key words: Usual interstitial pneumonia – sarcoidosis – pneumoconiosis – bronchoscopy – lung biopsy 

  12. Successful transgene expression with serial doses of aerosolized rAAV2 vectors in rhesus macaques.

    Science.gov (United States)

    Fischer, Anne C; Beck, Suzanne E; Smith, Carolina I; Laube, Beth L; Askin, Frederic B; Guggino, Sandra E; Adams, Robert J; Flotte, Terence R; Guggino, William B

    2003-12-01

    Bronchoscopic microspraying of recombinant adeno-associated viral (rAAV) vectors targets high doses of vector directly to pulmonary epithelium. Single-dose endobronchial gene therapy trials have been accomplished in cystic fibrosis patients; however, repeated dosing strategies are likely essential for lifetime correction. These studies address whether serial redosing with rAAV2 vectors results in an antiserotypic response and, furthermore, whether it triggers an inflammatory response prohibitive to transgene expression. Serial redosing of 9 x 10(11) infectious units of aerosolized rAAV2 vectors to rhesus macaques resulted in successful gene transfer by quantitative PCR (1.43 x 10(9) copies/g tissue) and transgene expression. Additionally, confocal microscopy and immunohistochemical analysis demonstrated in situ expression localized to the pulmonary epithelium. Although serial redosing did induce a heightened anti-neutralizing antibody response in sera, gene transfer prevailed with resultant expression. This study is the first to demonstrate successful gene transfer subsequent to repeated aerosolized doses of rAAV2 in immunocompetent nonhuman primates without associated inflammatory responses prohibitive to transgene expression. PMID:14664794

  13. Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient.

    Science.gov (United States)

    Abdel-Rahman, Nader; Izhakian, Shimon; Wasser, Walter G; Fruchter, Oren; Kramer, Mordechai R

    2015-01-01

    Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual. PMID:26819795

  14. The impact on diagnosis of lung cancer by endoscopic technology development%内镜技术发展对肺癌诊断的影响

    Institute of Scientific and Technical Information of China (English)

    傅毅立; 李辉

    2009-01-01

    近年来,一些新技术在支气管镜下的应用得以实现.例如支气管内超声(EBUS)技术、自动荧光支气管镜(AFB)技术、电磁导航支气管镜技术(ENB)、荧光共聚焦显微镜(FCFM)技术及光干涉断层扫描(OCT)技术等,均从不同角度和层面解决了以往传统技术手段存在的缺陷.虽然目前这些技术手段还有待进一步完善和临床验证,但其必然会对肺癌的诊断和治疗产生巨大的影响.%In recent years, with the development of some new techniques based on bronchoscopic skills, such as endobronchial ultrasonography, autofluorescence bronchoscopy, electromagnetic navigation bronchoscopy, fibered confocal fluorescence microendoscopy and optic coherence tomography of the advent of technology, which solved the shortcomings of traditional technology from different areas and dimensions. Although these techniques need to be improved and clinical verified further, it was believed that the great impact on diagnosis and treatment of lung cancer should be made by them.

  15. Methods to Improve Success With the GlideScope Video Laryngoscope.

    Science.gov (United States)

    Nemec, Darrell; Austin, Paul N; Silvestro, Loraine S

    2015-12-01

    Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. A literature search revealed 253 potential sources, with 25 meeting search criteria: 7 randomized controlled trials, 4 descriptive studies, 8 case series, and 6 case reports. Findings from the randomized controlled trials suggested that using a flexible-tipped endotracheal tube with a rigid stylet (GlideRite, Verathon Medical) improved intubation success, whereas other methods did not, such as using a forceps-guided endotracheal tube exchanger. If a malleable stylet was used, a 90 degrees bend above the endotracheal tube cuff was preferable to a 60 degrees bend. Evidence from lower-level sources suggested that several interventions were helpful, including using a controllable stylet, a fiberoptic bronchoscope in conjunction with the GlideScope, or an intubation guide, and twisting the endotracheal tube to facilitate passage into the trachea. Providers must consider the risks and benefits of any technique, particularly if the device manufacturer does not recommend the technique. Further rigorous investigations should be conducted examining methods to increase success. PMID:26742332

  16. Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis

    International Nuclear Information System (INIS)

    The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways

  17. Successful treatment of laryngomalacia and bilateral vocal cord paralysis with continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Sovtić Aleksandar

    2010-01-01

    Full Text Available Introduction Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. Case report In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA. The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP for a year. The level of pressure had to be set at 7cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement. Discussion In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement. Conclusion In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.

  18. Therapeutic bronchoscopy for malignant airway stenoses: Choice of modality and survival

    Directory of Open Access Journals (Sweden)

    Chhajed Prashant

    2010-01-01

    Full Text Available Background: There are no data regarding the factors influencing the choice of therapeutic bronchoscopic modality in the management of malignant airway stenoses. Objectives: To assess the choice of therapeutic bronchoscopy modality and analyze factors influencing survival in patients with malignant central airway obstruction. Materials and Methods: We performed 167 procedures in 130 consecutive patients, for malignant central airway obstruction, over six years. Results: Laser was used either alone or in combination with stent insertion in 76% procedures. Laser only was used in 53% procedures for lesions below the main bronchi. Stents alone were used for extrinsic compression or stump insufficiency. Combined laser and stent insertion was most frequently used for lesions involving the trachea plus both main bronchi or only the main bronchi. The Dumon stent was preferred in lesions of the trachea and the right bronchial tree, the Ultraflex stent for lesions on the left side and stenoses below the main bronchi. Survival was better in patients with lung cancer, lesions restricted to one lung and when laser alone was used compared to esophageal cancer, metastases and tracheal involvement. Conclusion: The choice of different airway stents can be made based on the nature and site of the lesion. Dumon stents are suited for lesions in trachea and right main bronchus and the Ultraflex stents on the left side and stenoses beyond the main bronchi. Survival can be estimated based on the diagnosis, site of the lesion and treatment modality used.

  19. Laryngeal structure and function in dogs with cough.

    Science.gov (United States)

    Johnson, Lynelle R

    2016-07-15

    OBJECTIVE To investigate the prevalence and type of laryngeal abnormalities in dogs examined because of cough that did not have signs of upper airway disease and to compare the prevalence of those abnormalities among dogs with various respiratory tract diseases. DESIGN Prospective study. ANIMALS 138 dogs with cough that did not have signs of upper airway disease. PROCEDURES The study was conducted between July 2001 and October 2014 and included dogs examined for cough that had laryngoscopic and bronchoscopic examinations performed by 1 examiner. Laryngeal hyperemia and swelling were recorded, and laryngeal function was assessed before and after doxapram stimulation when indicated. Results were compared among dogs on the basis of cough duration (acute [ 2 months]) and disease diagnosed (inflammatory airway disease, airway collapse, lower respiratory tract infection, and eosinophilic bronchopneumopathy). RESULTS Laryngeal hyperemia was detected in 73 of 134 (54%) dogs with cough of subacute or chronic duration, and its prevalence did not vary significantly among dogs with various diseases. Thirteen dogs had laryngeal paresis, and 13 dogs had laryngeal paralysis; dysphonia (n = 2) and stridor (1) were uncommon findings in those dogs. The prevalence of laryngeal dysfunction (paresis or paralysis) did not differ significantly among diseases. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that 26 of 138 (19%) dogs examined because of cough alone had laryngeal dysfunction, which suggested that a complete laryngoscopic examination should be included in the diagnostic evaluation of dogs with cough. PMID:27379595

  20. Evaluation of dynamic tumour tracking radiotherapy with real-time monitoring for lung tumours using a gimbal mounted linac

    International Nuclear Information System (INIS)

    Purpose: To evaluate feasibility and acute toxicities after dynamic tumour tracking (DTT) irradiation with real-time monitoring for lung tumours using a gimbal mounted linac. Materials and methods: Spherical gold markers were placed around the tumour using a bronchoscope prior to treatment planning. Prescription dose at the isocentre was 56 Gy in 4 fractions for T2a lung cancer and metastatic tumour, and 48 Gy in 4 fractions for the others. Dose-volume metrics were compared between DTT and conventional static irradiation using in-house developed software. Results: Of twenty-two patients enrolled, DTT radiotherapy was successfully performed for 16 patients, except 4 patients who coughed out the gold markers, one who showed spontaneous tumour regression, and one where the abdominal wall motion did not correlate with the tumour motion. Dose covering 95% volume of GTV was not different between the two techniques, while normal lung volume receiving 20 Gy or more was reduced by 20%. A mean treatment time per fraction was 36 min using DTT. With a median follow-up period of 13.2 months, no severe toxicity grade 3 or worse was observed. Conclusions: DTT radiotherapy using a gimbal mounted linac was clinically feasible for lung treatment without any severe acute toxicity

  1. Decision making in patients with pulmonary nodules.

    Science.gov (United States)

    Ost, David E; Gould, Michael K

    2012-02-15

    Integrating current evidence with fundamental concepts from decision analysis suggests that management of patients with pulmonary nodules should begin with estimating the pretest probability of cancer from the patient's clinical risk factors and computed tomography characteristics. Then, the consequences of treatment should be considered, by comparing the benefits of surgery if the patient has lung cancer with the potential harm if the patient does not have cancer. This analysis determines the "treatment threshold," which is the point around which the decision centers. This varies widely among patients depending on their cardiopulmonary reserve, comorbidities, and individual preferences. For patients with a very low probability of cancer, careful observation with serial computed tomography is warranted. For those with a high probability of cancer, surgical diagnosis is warranted. For patients in the intermediate range of probabilities, either computed tomography-guided fine-needle aspiration biopsy or positron emission tomography, possibly followed by computed tomography-guided fine-needle aspiration biopsy, is best. Patient preferences should be considered because the absolute difference in outcome between strategies may be small. The optimal approach to the management of patients with pulmonary nodules is evolving as technologies develop. Areas of uncertainty include quantifying the hazard of delayed diagnosis; determining the optimal duration of follow-up for ground-glass and semisolid opacities; establishing the roles of volumetric imaging, advanced bronchoscopic technologies, and limited surgical resections; and calculating the cost-effectiveness of different strategies. PMID:21980032

  2. Transbronchial lung biopsy without fluoroscopic guide in Tehran Imam Khomeini’s Hospital (1999

    Directory of Open Access Journals (Sweden)

    "Firoozbakhsh S

    2002-08-01

    Full Text Available Background: Transbronchial lung biopsy (TBLB is an attractive alternative to open lung biopsy as an initial diagnostic procedure for patients with diffuse parenchymal disease or localized densities beyond direct endoscopic vision. TBLB can be carried out safely without fluoroscopy in patients with diffuse lung disease. Since in our bronchoscopic department fluoroscopy is not available, we planned to evaluate the blind (without fluoroscopic guide TBLB being performed in our department to determine the success rate in obtaining lung tissue, the sensitivity of the procedure and the risk of complications. Materials and Methods: Sixty-Four TBLB were done in our department during a 6 month period (March-September 1999. Results: Lung tissue wasn’t detected in two (3.1 percent samples. Pathological results were helpful in 46 (71.9 percent cases. No evidence of hemoptysis was found after the procedure. Three (4.68 percent cases of pneumothorax was detected. Only one of them required chest tube (1.51 percent. Conclusion: We concluded that blind TBLB was successful in our department with rates of complications comparable to other approved centers.

  3. Novel use of an exchange catheter to facilitate intubation with an Aintree catheter in a tall patient with a predicted difficult airway: a case report

    Directory of Open Access Journals (Sweden)

    Gruenbaum Shaun E

    2012-04-01

    Full Text Available Abstract Introduction The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has been shown to successfully facilitate difficult intubations when other methods have failed. The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has a fixed length of 56 cm, and it has been suggested in the literature that it may be too short for safe use in patients who are tall. Case presentation We present the case of a 32-year-old, 180 cm tall Caucasian woman with a predicted difficult airway who presented to our facility for an emergency cesarean section. After several failed intubation attempts via direct laryngoscopy, an airway was established with a laryngeal mask airway. After delivery of a healthy baby, our patient's condition necessitated tracheal intubation. A fiber-optic bronchoscope loaded with an Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was passed through the laryngeal mask airway into the trachea until just above the carina, but was too short to safely allow for the passage of an endotracheal tube. Conclusions We present a novel technique in which the Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was replaced with a longer (100 cm exchange catheter, over which an endotracheal tube was passed successfully into the trachea.

  4. 鼻咽癌放疗后困难气道1例报道%A case of radiation-induced difficult airway in a patient with nasopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Deke Li; Staying Wang; Kun Chen

    2012-01-01

    In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.

  5. Using a Bedside Video-assisted Test Tube Test to Assess Stoma Viability: A Report of 4 Cases.

    Science.gov (United States)

    Ahmad, Sarwat; Turner, Keli; Shah, Paulesh; Diaz, Jose

    2016-07-01

    Mucosal discoloration of an intestinal stoma may indicate self-limited venous congestion or necrosis necessitating operative revision. A common bedside technique to assess stoma viability is the "test tube test". A clear tube is inserted into the stoma and a hand-held light is used to assess the color of the stoma. A technique (video-assisted test tube test [VATTT]) developed by the authors utilizes a standard video bronchoscope inserted into a clear plastic blood collection tube to visually inspect and assess the mucosa. This technique was evaluated in 4 patients (age range 49-72 years, all critically ill) with a discolored stoma after emergency surgery. In each case, physical exam revealed ischemic mucosa at the surface either immediately after surgery or after worsening hypotension weeks later. Serial test tube test assessments were ambiguous when trying to assess deeper mucosa. The VATTT assessment showed viable pink mucosa beneath the surface and until the fascia was revealed in 3 patients. One (1) patient had mucosal ischemia down to the fascia, which prompted operative revision of the stoma. The new stoma was assessed with a VATTT and was viable for the entire length of the stoma. VATTT provided an enhanced, magnified, and clearer way to visually assess stoma viability in the postoperative period that can be performed at the bedside with no adverse events. It may prevent unnecessary relaparotomy or enable earlier diagnosis of deep ostomy necrosis. Validity and reliability studies are warranted. PMID:27428565

  6. Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Nader Abdel-Rahman

    2015-01-01

    Full Text Available Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual.

  7. Diagnostic value of diffuse and peripheral lung lesions by transbronchial lung biopsy

    Institute of Scientific and Technical Information of China (English)

    Shi Zhihong; Wei Xia; Wei Xiaohong; Zhu Bo

    2008-01-01

    Objective To evaluate the diagnostic value of transbronchial lung biopsy (TBLB) via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions. Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions. Results Eighty-nine final diagnosis cases via TBLB only once, the diagnostic rate of double lung diffuse lesions was the highest, [51.06% (24/47)], local non-nodule lesions, nodule lesions, cavity lesions were 33.33%(23/69), 29.91%(35/117), and 28.57%(4/14), respectively. Among 24 diagnostic cases of double lung diffuse lesions, there were 6 cases of pneumonia of pulmonary tuberculosis, 9 cases of lung carcinoma, 7 cases of adenecarcinoma; 6 cases of pneumonia, 2 cases of fungous infection, and 1 case of lung hemosiderusis. The diagnostic yield about 58 cases of local lesions was low, among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%. In 89 cases of peripheral lung lesions with histological diagnosis, lung carcinoma and pulmonary tuberculosis were frequent diseases, which accounted for 86.52%. Conclusion TBLB is a reliable, safe, effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.

  8. In vivo imaging of pulmonary nodule and vasculature using endoscopic co-registered optical coherence tomography and autofluorescence imaging (Conference Presentation)

    Science.gov (United States)

    Pahlevaninezhad, Hamid; Lee, Anthony; Hohert, Geoffrey; Schwartz, Carely; Shaipanich, Tawimas; Ritchie, Alexander J.; Zhang, Wei; MacAulay, Calum E.; Lam, Stephen; Lane, Pierre M.

    2016-03-01

    Peripheral lung nodules found by CT-scans are difficult to localize and biopsy bronchoscopically particularly for those ≤ 2 cm in diameter. In this work, we present the results of endoscopic co-registered optical coherence tomography and autofluorescence imaging (OCT-AFI) of normal and abnormal peripheral airways from 40 patients using 0.9 mm diameter fiber optic rotary pullback catheter. Optical coherence tomography (OCT) can visualize detailed airway morphology endoscopically in the lung periphery. Autofluorescence imaging (AFI) can visualize fluorescing tissue components such as collagen and elastin, enabling the detection of airway lesions with high sensitivity. Results indicate that AFI of abnormal airways is different from that of normal airways, suggesting that AFI can provide a sensitive visual presentation for rapidly identifying possible sites of pulmonary nodules. AFI can also rapidly visualize in vivo vascular networks using fast scanning parameters resulting in vascular-sensitive imaging with less breathing/cardiac motion artifacts compared to Doppler OCT imaging. It is known that tumor vasculature is structurally and functionally different from normal vessels. Thus, AFI can be potentially used for differentiating normal and abnormal lung vasculature for studying vascular remodeling.

  9. Learning curves and effect of high-fidelity simulation-based training with virtual reality simulator in flexible fiberoptic intubation%高仿真模拟训练在纤维支气管镜插管教学中的应用及学习曲线研究

    Institute of Scientific and Technical Information of China (English)

    姜柏林; 赵莹; 鞠辉; 姚兰; 冯艺

    2016-01-01

    residents).A stand-ard didactic teaching session which consisted of a short film and a performance by instructor,was given to all participants in both groups.The simulator group then trained for 25 times on virtual reality simulator (Simbionix GI-Bronch Mentor),while the control group skipped this process.After training,participants in both groups had their performance assessed with the fiberoptic bronchoscope evaluated through the oral route using a simulation manikin.Participants were instructed to attempt to advance the fiberoptic broncho-scope 5 consecutive times to view the carina in the shortest amount of time.The time required to view the carina of each practice on simulator in the simulator group was recorded as pooled data to construct a group learning curve.The procedure time and global rating scale (GRS)of fiberoptic bronchoscope manipulation ability were compared between groups,so did the participant’s confidencebefore and after the training in the simulator group.Results The best fit value of the learning curve for the expert time was 9.3 (8.7, 10.0)s,the saturation of learning from the simulator can be achieved after 19 (15,26)practice ses-sions.The procedure time and GRS in the simulator group were better than the control group (F =24.993,P <0.001;F =107.357,P <0.001).The participant’s confidences in simulator group were increased after training (1.9 ±0.7 vs 4.0 ±0.6,t =10.708,P <0.001).Conclusions The simulation-based training with high-fidelity virtual reality simulator can assist novices in quick achieving a proficiency standard of basic bronchoscopic competence.The combined applications of the two criterions,that 19 times practices have been performed and the procedure time has been stabilized at about 9 s,could form a rational basis for the design of fireoptic training programmes.

  10. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2010-01-01

    Full Text Available Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7% and two patients had postoperative hoarseness of voice (5.4%. All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve ′just seal′, with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

  11. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion.

    Science.gov (United States)

    Garg, Rakesh; Rath, Girija P; Bithal, Parmod K; Prabhakar, Hemanshu; Marda, Manish K

    2010-07-01

    Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values) and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7%) and two patients had postoperative hoarseness of voice (5.4%). All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve 'just seal', with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

  12. Method for endobronchial video parsing

    Science.gov (United States)

    Byrnes, Patrick D.; Higgins, William E.

    2016-03-01

    Endoscopic examination of the lungs during bronchoscopy produces a considerable amount of endobronchial video. A physician uses the video stream as a guide to navigate the airway tree for various purposes such as general airway examinations, collecting tissue samples, or administering disease treatment. Aside from its intraoperative utility, the recorded video provides high-resolution detail of the airway mucosal surfaces and a record of the endoscopic procedure. Unfortunately, due to a lack of robust automatic video-analysis methods to summarize this immense data source, it is essentially discarded after the procedure. To address this problem, we present a fully-automatic method for parsing endobronchial video for the purpose of summarization. Endoscopic- shot segmentation is first performed to parse the video sequence into structurally similar groups according to a geometric model. Bronchoscope-motion analysis then identifies motion sequences performed during bronchoscopy and extracts relevant information. Finally, representative key frames are selected based on the derived motion information to present a drastically reduced summary of the processed video. The potential of our method is demonstrated on four endobronchial video sequences from both phantom and human data. Preliminary tests show that, on average, our method reduces the number of frames required to represent an input video sequence by approximately 96% and consistently selects salient key frames appropriately distributed throughout the video sequence, enabling quick and accurate post-operative review of the endoscopic examination.

  13. Clinical analysis of bronchial foreign bodies in 580 children%580例小儿气管支气管异物临床特点与诊治分析

    Institute of Scientific and Technical Information of China (English)

    梁军; 王晋; 徐幼; 臧丽格; 余晓燕

    2012-01-01

    Objective To analyze the characters of bronchial foreign bodies in children and the utilization of bfon-choscope in the treatment of bronchial Foreign bodies. Methods A total of 580 children were diagnosed with bronchial foreign bodies at our hospital during April 2001 until April 2011. Under local mucosal anesthesia,a bronchoscope was inserted through oral cavity into bronchi. After identifying the site of foreign body, grasping forceps was guided through bronchoscope to remove the foreign body from airway. Results CAmong 580 cases,hard nut and skin of melon seed were found(517,89. 3%). Most common site of foreign body was in fight lower lobe bronchi(318,54. 8%). Average operative frequency Was 1. 1 and one-time extraction ratio 94. 5%. The after treatment of children with cough, dyspnea, pneumoni-a, emphysema, unilateral breathing sounds disappeared, wheezing, atelectasis, mediastinal swing significantly improved (P<0. 05). Conclusion Rapid diagnosis, preoperative evaluation, and implementation of timely and effective surgical and perioperative treatment, Pediatric tracheobronchial foreign body can effectively reduce the complication rate and reduce mortality.%目的 探讨儿童支气管异物的临床特点以及支气管镜在诊断治疗儿童支气管异物中的作用,总结气管异物诊治规律.方法 经支气管镜诊断和手术的支气管异物患儿580例,均在全麻条件下经口腔插入支气管镜逐级观察支气管结构,使用花生米异物钳或鳄鱼齿状钳钳取异物,并对治疗前后临床症状改善情况进行对比分析.结果 580例患儿中,支气管异物以果仁或果壳类最为常见[517例(89.3%)],异物嵌顿位置以右下叶支气管开口为最多[318例(54.8%)].钳取异物手术次数平均1.1次,一次取出率为94.5%.治疗后患儿咳嗽、呼吸困难、肺炎、肺气肿、单侧呼吸音消失、喘鸣、肺不张、纵膈摆动等有明显改善(P<0.05).结论 快速诊断,术前评估,实施

  14. 胸部透视、胸部平片和MSCT对小儿气管、支气管异物的诊断价值分析%The Analysis of Diagnostic Value of Fluoroscopy of Chest, the Chest X-ray and Multislice Computed Tomography (MSCT) to the Foreign Bodies in the Trachea and Bronchi of the Children

    Institute of Scientific and Technical Information of China (English)

    魏相磊; 武玉丽

    2014-01-01

    Objective To explore the diagnostic value of fluoroscopy of chest, the chest X-ray and multislice computed tomography (MSCT) to the foreign bodies in the trachea and bronchi of the children, and compare the results and diagnosis accuracy to the foreign bodies in the trachea and bronchi. Methods 18 cases of suspected bronchial foreign body all given lfuoroscopy of chest, the chest X-ray and MSCT, even through axis scan images mutiplane restructuring (MPR), curved planar reformation (CPR), minimum density projection method (MinP) and CT virtual endoscopy (CTVE) etc. Image post-processing technology, and compare the images results with what be found by video bronchoscope examination. Results All cases are found foreign bodies by video bronchoscope examination. 1 case directly observed positive foreign body and 10 cases observed typical signs of indirect negative foreign body by lfuoroscopy of chest. 1 case directly observed positive foreign body and 9 cases observed typical signs of indirect negative foreign body by chest X-ray examination .meanwhile 17 cases directly observed positive foreign body by MSCT scan. Conclusion MSCT and image post-processing technology has important value in diagnosing trachea bronchial foreign body in children.%目的:探讨胸部X线透视、胸部平片和MSCT对气管支气管异物的诊断价值,比较三种方法对诊断支气管异物的正确率。方法对18例怀疑支气管异物的病例全部行胸透、胸部平片和MSCT检查,通过图像后处理工作站将MSCT轴位扫描图像进行多平面重组(MPR)、曲面重组(CPR)、最小密度投影法(MinP)和CT仿真内镜(CTVE)等图像重组,检查结果分别与支气管镜对照。结果18例经纤维支气管镜检查均发现异物。胸透直接观察到阳性异物1例,具有典型间接征象的阴性异物10例;胸部平片直接观察到阳性异物1例,具有典型间接征象的阴性异物9例;MSCT诊断支气管异物17

  15. Airway Segmentation and Centerline Extraction from Thoracic CT - Comparison of a New Method to State of the Art Commercialized Methods.

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    Pall Jens Reynisson

    Full Text Available Our motivation is increased bronchoscopic diagnostic yield and optimized preparation, for navigated bronchoscopy. In navigated bronchoscopy, virtual 3D airway visualization is often used to guide a bronchoscopic tool to peripheral lesions, synchronized with the real time video bronchoscopy. Visualization during navigated bronchoscopy, the segmentation time and methods, differs. Time consumption and logistics are two essential aspects that need to be optimized when integrating such technologies in the interventional room. We compared three different approaches to obtain airway centerlines and surface.CT lung dataset of 17 patients were processed in Mimics (Materialize, Leuven, Belgium, which provides a Basic module and a Pulmonology module (beta version (MPM, OsiriX (Pixmeo, Geneva, Switzerland and our Tube Segmentation Framework (TSF method. Both MPM and TSF were evaluated with reference segmentation. Automatic and manual settings allowed us to segment the airways and obtain 3D models as well as the centrelines in all datasets. We compared the different procedures by user interactions such as number of clicks needed to process the data and quantitative measures concerning the quality of the segmentation and centrelines such as total length of the branches, number of branches, number of generations, and volume of the 3D model.The TSF method was the most automatic, while the Mimics Pulmonology Module (MPM and the Mimics Basic Module (MBM resulted in the highest number of branches. MPM is the software which demands the least number of clicks to process the data. We found that the freely available OsiriX was less accurate compared to the other methods regarding segmentation results. However, the TSF method provided results fastest regarding number of clicks. The MPM was able to find the highest number of branches and generations. On the other hand, the TSF is fully automatic and it provides the user with both segmentation of the airways and the

  16. Air-Q laryngeal airway for rescue and tracheal intubation.

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    Ads, Ayman; Auerbach, Frederic; Ryan, Kelly; El-Ganzouri, Abdel R

    2016-08-01

    We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report. All personal identifiers that could lead to his identification have been removed from this report. A 59-year-old man was scheduled for a flexible and rigid bronchoscopy with possible laser excision of tracheal stenosis. He had a history of hypertension, atrial fibrillation, and diabetes. Assessment of airway revealed a thyromental distance of 6.5 cm, Mallampati class II, and body weight of 110 kg. He had hoarseness and audible inspiratory/expiratory stridor with Spo2 90% breathing room air. After induction and muscle relaxation, tracheal intubation and flexible bronchoscopy were achieved without incident. The patient was then extubated and a rigid bronchoscopy was attempted but failed with Spo2 dropping to 92%; rocuronium 60 mg was given, and reintubation was accomplished with a 7.5-mm endotracheal tube. A second rigid bronchoscopy attempt failed, with Spo2 dropping to 63%. Subsequent direct laryngoscopy revealed a bloody hypopharynx. A size 4.5 Air-Q LA was placed successfully and confirmed with capnography, and Spo2 returned to 100%. The airway was suctioned through the Air-Q LA device, and the airway was secured using a fiberoptic bronchoscope to place an endotracheal tube of 7.5-mm internal diameter. The case was canceled because of edema of the upper airway from multiple attempts with rigid bronchoscopy. The patient was transported

  17. Clinical diagnosis and treatment of 110 cases of pulmonary ground-glass nodule in Shanghai pulmonary hos-pital%上海肺科医院110例肺部磨玻璃样结节临床诊治分析

    Institute of Scientific and Technical Information of China (English)

    蒋慧; 武春燕

    2016-01-01

    目的:观察肺部磨玻璃样结节( ground-glass nodule ,GGN)的影像学特点、病理类型和手术效果。方法收集上海肺科医院因为GGN住院手术的完整病历110例。观察病人的性别、年龄、入院方式、平均住院时间、胸部X线片及胸部CT影像学特点、肿瘤标志物检查情况、气管镜检查情况、手术方式、病理类型分布、手术并发症等。结果 GGN( ground-glass nodule 磨玻璃样结节)患者多无呼吸道症状和体征,肿瘤标志物检查阳性率低,气管镜检查阳性低,胸片检查漏诊率高,胸部CT可有效发现肺部隐蔽病灶,病理检查恶性率高,以腺癌为主,电视辅助胸腔镜手术创伤小,手术并发症少。结论胸部CT可作为常规体检项目,肺部高度疑癌磨玻璃样结节要尽早行电视辅助胸腔镜手术,以提高早期肺癌的治愈率。%Objective To observe the imaging features, pathological types and surgical effect of pulmonary ground-glass nodule ( GGN) . Methods The complete clinical record of 110 GGN cases was collect in Shanghai pul-monary hospital to analyze their gender, age, hospital way, the results of the average duration of hospital stay, chest X-ray, chest CT, tumor markers, bronchoscope examination results, way of operation and pathological type, and sur-gical complications. Results The patients with GGN had no obvious respiratory symptoms and body signs, and their postive rate of tumor standards test and bronchoscope examination was low. The missed diagnostic rate of chest X-ray was high. But chest CT could effectively find the hidden lung lesion. The results of pathologic examination were ma-lignant, mainly including adenocarcinoma. The trauma of tele-assisted thoracoscope surgery was small, with less com-plications. Conclusion Chest CT can be used a common physical exam for highly suspected lung cancer GGN, and tele-assisted thoracoscope surgery should be applied as soon as possible.

  18. The effectiveness of an endotracheal tube holder

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    Byung Gun Lim

    2016-01-01

    Full Text Available The security of the endotracheal tube (ETT is important in the anesthesia and intensive care settings. Recently, an ETT holder instead of an adhesive tape is frequently used to provide the fixation of the ETT. There are some studies that focused on the effectiveness of the ETT holder in preventing displacement of ETT compared to an adhesive tape (1, 2. I have experienced the use of an ETT holder (E-holder, KS medical, Bucheon, Korea in many different anesthesia settings and recognized its usefulness and convenience other than ETT security in the following specific settings. Firstly, the ETT holder is definitely effective for patients undergoing procedures that frequently require the adjustment of ETT (or double lumen tube location including thoracic surgery. The location of double lumen tube needed for lung separation can be modified for effective ventilation during anesthetic induction or surgery, and after position changes. The tube can be easily relocated to the proper place for lung separation and effective ventilation by unlocking/relocking the button of the ETT holder under flexible bronchoscopic guidance (Fig. 1A, which can facilitate the operative procedure to be performed easily and quickly.Secondly, the ETT holder can be useful in procedures requiring the prone position (3. Especially, it is useful in all circumstances requiring the adjustment of ETT in the prone position. For instance, it is definitely useful for patients with Duchene muscular dystrophy undergoing scoliosis surgery under prone position. Adolescent patients with Duchene muscular dystrophy frequently have tracheobronchial malacia. If so, the airway pressure can be elevated due to the narrowing of the lesion of malacia when changed to the prone position (4. To overcome this problem, a reinforced ETT should be relocated so that it passes the narrowed tracheal lesion under flexible bronchoscopic guidance (Fig. 1B. However, the approach for this management is somewhat

  19. Treatment of intrathoracic grass awn migration with video-assisted thoracic surgery in two dogs.

    Science.gov (United States)

    Shamir, Shelly; Mayhew, Philipp D; Zwingenberger, Allison; Johnson, Lynelle R

    2016-07-15

    CASE DESCRIPTION A 17-month-old sexually intact male Vizsla and a 2-year-old spayed female mixed-breed dog were examined because of suspected intrathoracic grass awn migration. CLINICAL FINDINGS Thoracic CT revealed focal areas of pulmonary infiltration in the right caudal lung lobe in one dog and in the left caudal lung lobe in the other. In 1 patient, bronchoscopy revealed 2 grass awns in the bronchi. Results of thoracic radiography and bronchoscopy were unremarkable in the second patient; however, a grass awn was recovered from the tonsillar crypt during oropharyngeal examination. TREATMENT AND OUTCOME In both dogs, grass awns were successfully retrieved from the pleural cavity by means of video-assisted thoracic surgery during 1-lung ventilation. In one patient, a grass awn was recovered bronchoscopically from the left caudal lung lobe bronchus and another was visualized distally in an accessory lung lobe bronchus but could not be retrieved. This dog underwent accessory lung lobectomy. The second dog underwent left caudal lung lobectomy. Both patients recovered uneventfully from surgery, were discharged from the hospital, and had no apparent recurrence of clinical signs at telephone follow-up 31 months and 18 months after surgery. CLINICAL RELEVANCE With careful case selection, successful management of intrathoracic grass awn migration in dogs can be achieved by means of video-assisted thoracic surgery. Comprehensive preoperative evaluation including both computed tomography and bronchoscopy is suggested. Further investigation is necessary to evaluate whether treatment of this condition with video-assisted thoracic surgery is as effective as with traditional open thoracotomy. PMID:27379598

  20. Development and preliminary results of an in vivo Raman probe for early lung cancer detection

    Science.gov (United States)

    Short, Michael A.; Lam, Stephen; McWilliams, Annette; Zhao, Jianhua; Lui, Harvey; Zeng, Haishan

    2008-02-01

    Our previous results from Raman spectroscopy studies on ex vivo lung tissue showed the technique had great potential to differentiate between samples with different pathologies. In this work, a fast dispersive-type near-infrared (NIR) Raman spectroscopy system was developed to collect real-time, noninvasive, in vivo human lung spectra. The 785 nm excitation, and the collection of tissue emission were accomplished by using a reusable fiber optic catheter which passed down the instrument channel of a bronchoscope. Filters in two stages blocked laser emission other than 785 nm from reaching the tissue surface, and reduced fiber fluorescence and elastically scattered excitation light from being passed to the spectrometer. The spectrometer itself consisted of one of two holographic gratings with usable frequency ranges of: 700 to 2000 cm -1 and 1500 to 3400 cm -1. The dispersed light was detected by a cooled CCD array consisting of 400 by 1340 pixels. To increase the resolution of the system, while maximizing the throughput, a second fiber bundle, consisting of 54×100 μm diameter fibers connected the catheter to the spectrometer. The fibers in this second bundle were spread out to form a parabolic arc which replaced the conventional entrance slit. This geometry corrected for image aberrations, permitting complete CCD vertical binning, thereby yielding up to a 20-fold improvement in signal-to-noise ratio. The estimated spectral resolution of the system was 9 cm -1 for both gratings. So far we have measured spectra from 20 patients and have seen clear differences between spectra from tumor and normal tissue.

  1. Tracheobronchopathia Osteochondroplastica

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    Wang, Na; Long, Fei; Jiang, Shujuan

    2016-01-01

    Abstract Tracheobronchopathia osteochondroplastica (TO) is a relatively rare and benign disease of unknown etiology that is characterized by the accumulation of diffuse cartilaginous and osseous nodules protruding into the anterolateral walls of the trachea and bronchus. However, TO is easy to ignore or misdiagnose due to its nonspecific clinical manifestation. A chest computed tomography (CT) scan with a fiber bronchoscope and pathological biopsy shows the clinical features supporting the ultimate diagnosis. Here, we report 2 misdiagnosed cases of TO and review the literature to further define the diagnosis for clinicians. The first case was a 34-year-old male admitted to the hospital because of recurrent cough and intermittent fever for 10 years. CT scans showed irregular stenosis of the main bronchus and bronchofibroscope showed multiple nodules producing into the lumen. He was initially misdiagnosed of bronchial tuberculosis and received antitubercular agents for nearly half year. Symptoms got no relief and another bronchofibroscope with biopsy tests in our hospital exactly diagnosed of TO. Symptoms were significantly relieved after receiving budesonide associated with antibiotics, etc. Another case was a 46-year-old woman presenting with a history of repeated hoarseness for 8 years and a 2-month exacerbation. She underwent an electronic laryngoscopy 3 times and was diagnosed of laryngitis. Symptoms got no relief after antiinflammatory. CT scan indicated variable degrees of stenosis and calcification of the distal trachea and main bronchi and bronchofibroscope showed dozens of white nodules extruding into the lumen. Histopathologic findings revealed the ultimate diagnosis of TO and antiinflammatories, spasm relievers, and inhaled corticosteroids, showed apparent effects. Poor specificity of TO is observed in clinical manifestation and laboratory inspection. However, a CT scan associated with a bronchoscopy and histopathologic examination greatly contributes to

  2. Invasive procedure for clarification of pulmonary nodules; Invasive Verfahren zur Abklaerung pulmonaler Rundherde

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    Mahnken, A.H. [Universitaetsklinikum, Philipps-Universitaet Marburg, Klinik fuer Diagnostische und Interventionelle Radiologie, Marburg (Germany)

    2014-05-15

    The management of solitary lung nodules poses a common clinical problem and biopsy is often required. Several guidelines provide slightly different recommendations and there are no uniform recommendations regarding the ideal technique of puncture guidance (e.g. percutaneous versus bronchoscopic or thoracoscopic). Fine needle aspiration biopsy (FNA) and core biopsy are well established techniques. Both can be performed under CT and to some extent ultrasound guidance. Diagnostic accuracies of FNA and core biopsy for malignant lesions are around 95 %. Core biopsy is superior to FNA for establishing a specific diagnosis with a diagnostic yield of 81-88 % versus 17-21 %. In clinical routine practice core biopsy is the superior tool when compared to FNA. Central lesions in close proximity to bronchi may be biopsied with endobronchial ultrasound (EBUS)-guided bronchoscopy. In all other lesions percutaneous, ideally CT-guided biopsy should be the method of first choice. (orig.) [German] Solitaere Lungenrundherde stellen ein haeufiges differenzialdiagnostisches Problem dar, das oftmals mit der Bildgebung alleine nicht endgueltig zu loesen ist und eine Biopsie erfordert. Die Indikation zur Biopsie variiert zwischen den Leitlinien, und die beste Technik der Biopsie (perkutan vs. bronchoskopisch vs. thorakoskopisch) ist oftmals nicht eindeutig. Feinnadelaspirations- (FNA) und Stanzbiopsie stehen als lange etablierte Standardtechniken zur Verfuegung. Beide koennen CT- und bedingt ultraschallgesteuert durchgefuehrt werden. Die diagnostische Aussagekraft fuer die Diagnose maligner Tumoren liegt fuer beide Techniken bei 95 %. Die Stanzbiopsie ist jedoch der FNA fuer die spezifische Diagnose benigner Prozesse mit einer Genauigkeit von 82-88 vs. 17-21 % ueberlegen. Die Stanzbiopsie ist gegenueber der FNA das in der klinischen Routine ueberlegene Werkzeug. Bei sehr zentralen Herden in Nachbarschaft zu einem Bronchus kann primaer eine bronchoskopische EBUS-gesteuerte (endobronchialer

  3. Lung adenocarcinoma with Lambert–Eaton myasthenic syndrome indicated by voltage-gated calcium channel: a case report

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    Arai Hiromasa

    2012-09-01

    Full Text Available Abstract Introduction Lambert–Eaton myasthenic syndrome is a rare disorder and it is known as a paraneoplastic neurological syndrome. Small cell lung cancer often accompanies this syndrome. Lambert–Eaton myasthenic syndrome associated with lung adenocarcinoma is extremely rare; there are only a few reported cases worldwide. Case presentation A 75-year-old Japanese man with a past history of chronic rheumatoid arthritis and Sjögren syndrome was diagnosed with Lambert–Eaton myasthenic syndrome by electromyography and serum anti-P/Q-type voltage-gated calcium channel antibody level preceding the diagnosis of lung cancer. A chest computed tomography to screen for malignant lesions revealed an abnormal shadow in the lung. Although a histopathological examination by bronchoscopic study could not reveal the malignancy, lung cancer was mostly suspected after the results of a chest computed tomography and [18F]-fluorodeoxyglucose positron emission tomography. An intraoperative diagnosis based on the frozen section obtained by tumor biopsy was adenocarcinoma so the patient underwent a lobectomy of the right lower lobe and lymph node dissection with video-assisted thoracoscopic surgery. The permanent pathological examination was the same as the frozen diagnosis (pT2aN1M0: Stage IIa: TNM staging 7th edition. Immunohistochemistry revealed that most of the cancer cells were positive for P/Q-type voltage-gated calcium channel. Conclusions Our case is a rare combination of Lambert–Eaton myasthenic syndrome associated with lung adenocarcinoma, rheumatoid arthritis and Sjögren syndrome, and to the best of our knowledge it is the first report that indicates the presence of voltage-gated calcium channel in lung adenocarcinoma by immunostaining.

  4. Hemorrhagic small intestine cancer with solitary pulmonary metastasis initially presented as suspected primary lung cancer: an autopsy report.

    Science.gov (United States)

    Iwata, Takashi; Inoue, Kiyotoshi; Kiriike, Sachiko; Izumi, Nobuhiro; Mizuguchi, Shinjiro; Tsukioka, Takuma; Morita, Ryuhei; Nishiyama, Noritoshi; Takemura, Masashi; Osugi, Harusi; Wakasa, Kenichi; Suehiro, Shigefumi

    2007-12-01

    Cancer of the small intestine presenting with a solitary pulmonary metastasis is rare. Diagnosis and treatment of hemorrhagic small intestinal disease is clinically problematic due to its anatomic aspect, especially after multiple laparotomies. The case that we present here was a 79-year-old man who was initially diagnosed with suspected T2N2M0 lung cancer. After non-diagnostic results on two bronchoscopic biopsies and computed tomography-guided needle biopsy, he was admitted for thoracoscopic biopsy and possible curative operation. The patient had a history of multiple laparotomies for gastric ulcer and had no abdominal symptoms. A fecal occult blood test was positive; this was thought to be because of persistent bloody sputum. During the preoperative evaluation period, massive intestinal hemorrhage occurred. Intestinal tumor was identified by double-balloon enteroscopy and emergency laparotomy was performed to control the bleeding. The histopathological diagnosis was metastatic adenocarcinoma. However, intestinal bleeding started again. His systemic status deteriorated progressively, resulting in death. Autopsy revealed a large polypoid tumor with hemorrhagic necrosis in the jejunum that was histologically and immunohistochemically diagnosed as primary poorly differentiated adenocarcinoma in the small intestine. Multiple small submucosal tumors with central ulceration were confirmed as intramural metastases. A lung mass in the right lower lobe was diagnosed as a metastatic lesion. In the diagnosis and treatment of the disease, we faced several clinically difficult problems. We here describe in detail the clinical course and the diagnostic and therapeutic difficulties of this rare case, with some references to the literature. PMID:18432067

  5. Impact of endoscopic lung volume reduction on right ventricular myocardial function.

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    Carmen Pizarro

    Full Text Available Endoscopic lung volume reduction (ELVR provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (RtV function is undefined, we examined the extent of RtV functional changes following ELVR, as assessed by use of speckle tracking-based RtV deformation analysis.We enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc., comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval.Patients were predominantly of late middle-age (65.8 ± 8.7 yrs, male (62.5% and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively. After ELVR, RtV apical longitudinal strain improved significantly in the total study cohort (-7.96 ± 7.02% vs. -13.35 ± 11.48%, p = 0.04, whereas there were no significant changes in other parameters of RtV function such as RtV global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p = 0.03. However, clinical non-responders did not exhibit any RtV functional improvement.ELVR beneficially impacts RtV functional parameters. Speckle tracking-based RtV apical longitudinal strain analysis allows early determination of RtV contractile gain and identification of clinical responsiveness.

  6. Clinical course and spectrum of intensive care unit patients reactivating herpes simplex-1 virus: A retrospective analysis

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    Sundar Krishna

    2008-01-01

    Full Text Available Background : Herpes simplex-1 virus (HSV-1 reactivation in the respiratory tract is common in intensive care unit (ICU patients. However, susceptible ICU populations are poorly defined. Clinical recognition of HSV infection of the respiratory tract is difficult and the impact of such reactivation is not understood. Materials and Methods : A retrospective analysis of HSV-1 positive patients encountered over a 5-year period at a multispecialty ICU was carried out. HSV-1 was identified in respiratory secretions using a qualitative polymerase chain reaction (PCR technique. Patient charts were reviewed for clinical features that would typify HSV-1 respiratory involvement, and the morbidity and mortality risks found with HSV-1 respiratory involvement. Results : A review of 48 HSV-1 positive ICU patients showed that patients reactivating HSV in the respiratory tract fell into one of the three categories: (1 septic elderly patients with and without ARDS, (2 immunosuppressed patients, especially those receiving high-dose steroids, and (3 post-thoracotomy patients. Abnormalities suggestive of HSV-1 reactivation in the respiratory tract included, haemorrhagic or excessive respiratory secretions, concomitant orofacial herpes (42%, and bronchoscopic abnormalities (hemorrhagic ulcers and mucosal friability (83%. Twenty eight percent of the HSV-1 infected patients experienced postextubation stridor. HSV-1 reactivation was associated with extended ventilator stays, significant mortality (42%, and ventilator-associated pneumonias (52%. Conclusions : Identification of susceptible populations and definition of clinical features of HSV-1 related respiratory disease can enable diagnosis of HSV-1 infection in ICU patients. Although detection by a PCR technique can rapidly diagnose HSV-1 reactivation, prospective studies are required to clarify HSV disease versus mere shedding, and understand the impact of HSV-1 reactivation in hospitalized patients.

  7. Lung donor selection criteria.

    Science.gov (United States)

    Chaney, John; Suzuki, Yoshikazu; Cantu, Edward; van Berkel, Victor

    2014-08-01

    The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant. PMID:25132970

  8. An Analysis of Inhalation Injury Diagnostic Methods and Patient Outcomes.

    Science.gov (United States)

    Ching, Jessica A; Ching, Yiu-Hei; Shivers, Steven C; Karlnoski, Rachel A; Payne, Wyatt G; Smith, David J

    2016-01-01

    The purpose of this study was to compare patient outcomes according to the method of diagnosing burn inhalation injury. After approval from the American Burn Association, the National Burn Repository Dataset Version 8.0 was queried for patients with a diagnosis of burn inhalation injury. Subgroups were analyzed by diagnostic method as defined by the National Burn Repository. All diagnostic methods listed for each patient were included, comparing mortality, hospital days, intensive care unit (ICU) days, and ventilator days (VDs). Z-tests, t-tests, and linear regression were used with a statistical significance of P value of less than .05. The database query yielded 9775 patients diagnosed with inhalation injury. The greatest increase in mortality was associated with diagnosis by bronchoscopy or carbon monoxide poisoning. A relative increase in hospital days was noted with diagnosis by bronchoscopy (9 days) or history (2 days). A relative increase in ICU days was associated with diagnosis according to bronchoscopy (8 days), clinical findings (2 days), or history (2 days). A relative increase in VDs was associated with diagnosis by bronchoscopy (6 days) or carbon monoxide poisoning (3 days). The combination of diagnosis by bronchoscopy and clinical findings increased the relative difference across all comparison measures. The combination of diagnosis by bronchoscopy and carbon monoxide poisoning exhibited decreased relative differences when compared with bronchoscopy alone. Diagnosis by laryngoscopy showed no mortality or association with poor outcomes. Bronchoscopic evidence of inhalation injury proved most useful, predicting increased mortality, hospital, ICU, and VDs. A combined diagnosis determined by clinical findings and bronchoscopy should be considered for clinical practice. PMID:26594867

  9. Simultaneous dual scope endotherapy of esophago-airway fistulas and obstructions.

    Science.gov (United States)

    Zori, A G; Jantz, M A; Forsmark, C E; Wagh, M S

    2014-07-01

    Management of esophago-airway fistulas (EAF) and obstructions often involves therapy with esophageal and/or airway stents. We present a unique approach for the management of EAF and obstructions with simultaneous upper endoscopy and bronchoscopy (two scopes inserted simultaneously through the mouth). The aim is to assess the efficacy and safety of a simultaneous dual scope approach for management of EAF and obstructions. The endoscopy database at the University of Florida was reviewed from October 2007 to April 2012 to identify adult patients who had undergone simultaneous upper endoscopy and bronchoscopy for EAF and obstructions. Medical records were reviewed for demographics, indication, pathology, imaging, simultaneous endoscopic and bronchoscopic findings/maneuvers, outcomes, and adverse events. Outcomes assessed included: (i) technical success, (ii) fistula occlusion, (iii) dysphagia score, and (iv) adverse events. Thirteen patients with EAF and/or obstruction underwent simultaneous dual scope endoscopy. Dual scope procedures were technically successful in 12/13 (92%) patients. Dysphagia score improved from three to one in both patients with dysphagia without EAF. Fistula occlusion was observed in 7/10 patients (70%) with EAF. With this technique, stents were placed accurately without airway compression, migrated esophageal stents extracted from the tracheal lumen without trauma, and tracheal stents not displaced during esophageal manipulations. EAF not otherwise apparent were identified in two patients. Adverse events occurred in 2/13 (15%) patients, and 5/13 (38%) patients died from advanced cancer during follow up (mean 4.1 months, range 1-8 months). Simultaneous dual scope (two scopes inserted through the mouth at the same time) therapy of EAF and obstructions is feasible, effective, and safe, and may develop to be the preferred approach for the management of complex esophago-airway diseases.

  10. Impact of Cardiopulmonary Bypass on Respiratory Mucociliary Function in an Experimental Porcine Model.

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    Rodrigo Sánchez-Véliz

    Full Text Available The impact of cardiac surgery using cardiopulmonary bypass (CPB on the respiratory mucociliary function is unknown. This study evaluated the effects of CPB and interruption of mechanical ventilation on the respiratory mucociliary system.Twenty-two pigs were randomly assigned to the control (n = 10 or CPB group (n = 12. After the induction of anesthesia, a tracheostomy was performed, and tracheal tissue samples were excised (T0 from both groups. All animals underwent thoracotomy. In the CPB group, an aorto-bicaval CPB was installed and maintained for 90 minutes. During the CPB, mechanical ventilation was interrupted, and the tracheal tube was disconnected. A second tracheal tissue sample was obtained 180 minutes after the tracheostomy (T180. Mucus samples were collected from the trachea using a bronchoscope at T0, T90 and T180. Ciliary beat frequency (CBF and in situ mucociliary transport (MCT were studied in ex vivo tracheal epithelium. Mucus viscosity (MV was assessed using a cone-plate viscometer. Qualitative tracheal histological analysis was performed at T180 tissue samples.CBF decreased in the CPB group (13.1 ± 1.9 Hz vs. 11.1 ± 2.1 Hz, p < 0.05 but not in the control group (13.1 ± 1 Hz vs. 13 ± 2.9 Hz. At T90, viscosity was increased in the CPB group compared to the control (p < 0.05. No significant differences were observed in in situ MCT. Tracheal histology in the CPB group showed areas of ciliated epithelium loss, submucosal edema and infiltration of inflammatory cells.CPB acutely contributed to alterations in tracheal mucocilliary function.

  11. Aerodigestive Foreign Bodies in Adult Ethiopian Patients: A Prospective Study at Tikur Anbessa Hospital, Ethiopia

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    Abebe Bekele

    2014-01-01

    Full Text Available Introduction. Foreign bodies (FBs in the aerodigestive tract are important causes of morbidity and mortality and pose diagnostic and therapeutic challenges. The best method of removal of an esophageal and tracheobronchial FB is endoscopic guided extraction. Objective. To present our experience of the removal of aerodigestive FBs in adult Ethiopian patients using rigid endoscopes. Methods. A hospital-based prospective study, at Tikur Anbessa Referral and Teaching Hospital, from January 2011 to December 2012 (over two years. Results. A total of 32 patients (18 males and 14 females with a mean age of 28.0±12.74 years were treated for FB ingestion and aspiration at Tikur Anbessa Hospital. The FBs were impacted at the esophagus in 18 (56.2% patients, at the pharynx in 7 (21.8%, and at the air way in 7 (21.8% patients. Pieces of bones were the commonest objects found in the esophagus (17/18 of the cases and the pharynx (4/7, while fractured tracheostomy tubes and needles were frequently seen in the air way (3/7 cases each. The foreign bodies were visible in plain radiographs of 26 (81.2% patients. Successful extraction of FBs was achieved by using Mc gill forceps in 11 cases, rigid esophagoscopes in 9 patients, and bronchoscopes in 4 cases. Four cases required open surgery to remove the foreign bodies. Two complications (one pneumothorax and one esophageal perforation occurred. All patients were discharged cured. Discussion and Recommendations. Aerodigestive FBs are not so rare in the hospital and timely diagnosis and removal of accidentally ingested and aspirated foreign body should be performed so as to avoid the potentially lethal complications associated. Rigid esophagoscopy requires general anesthesia and is associated with its own complications, but our experience and outcome of its use are encouraging.

  12. Metallic Stents for Tracheobronchial Pathology Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Serrano, Carolina, E-mail: carolina.serrano@unizar.es [University of Zaragoza, Surgical Pathology Unit, Animal Pathology Department (Spain); Laborda, Alicia, E-mail: alaborda@unizar.es [University of Zaragoza, Minimally Invasive Techniques Research Group (GITMI) (Spain); Lozano, Juan M., E-mail: juamauloz@gmail.com [Marly Clinic, Radiology Department (Colombia); Caballero, Hugo, E-mail: hugocaballero2007@gmail.com [Marly Clinic, Pulmonology Department (Colombia); Sebastian, Antonio, E-mail: antonio.sebastian@ono.es [Lozano Blesa Clinical University Hospital, Pulmonology Department (Spain); Lopera, Jorge, E-mail: lopera@uthscsa.edu [Health Science Center, Interventional Radiology Deparment (United States); Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [University of Zaragoza, Minimally Invasive Techniques Research Group (GITMI) (Spain)

    2013-12-15

    Purpose: To present the 7-year experience of the treatment of benign and malignant tracheobronchial stenoses using metallic stents. Patients and Methods: One hundred twenty-three stents were inserted in 86 patients (74 benign and 12 malignant stenoses). Ninety-seven stents were placed in the trachea and 26 in the bronchi. The procedures were performed under fluoroscopic and flexible bronchoscopic guidance with the patient under light sedation. In cases of severe stenotic lesions or obstructions, laser resection was performed before stent placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. Results: The technical success was 100 %. Dyspnea disappearance, forced expiratory volume in the first second, and pulmonary functional data improvement was observed in all patients (p < 0.001). Complications were detected in 23 patients (26.7 %). Mean follow-up time was 6.3 {+-} 1.2 months in patients with malignant lesions and 76.2 {+-} 2.3 months patients with in benign lesions. By the end of the study, 100 % of patients with malignant pathology and 6.7 % of patients with benign lesions had died. Conclusion: Endoluminal treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients who are poor candidates for surgery. In unresectable malignant lesions, the benefit of metallic stenting is unquestionable. In benign lesions, the results are satisfactory, but sometimes other interventions are required to treat complications. New stent technology may improve these results.

  13. Usefulness of conventional transbronchial needle aspiration in the diagnosis, staging and molecular characterization of pulmonary neoplasias by thin-prep based cytology: experience of a single oncological institute

    Science.gov (United States)

    Ramieri, Maria Teresa; Marandino, Ferdinando; Visca, Paolo; Salvitti, Tommaso; Gallo, Enzo; Casini, Beatrice; Giordano, Francesca Romana; Frigieri, Claudia; Caterino, Mauro; Carlini, Sandro; Rinaldi, Massimo; Ceribelli, Anna; Pennetti, Annarita; Alò, Pier Luigi; Pescarmona, Edoardo; Filippetti, Massimo

    2016-01-01

    Background Conventional transbronchial needle aspiration (c-TBNA) contributed to improve the bronchoscopic examination, allowing to sample lesions located even outside the tracheo-bronchial tree and in the hilo-mediastinal district, both for diagnostic and staging purposes. Methods We have evaluated the sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the c-TBNA performed during the 2005–2015 period for suspicious lung neoplasia and/or hilar and mediastinal lymphadenopathy at the Thoracic endoscopy of the Thoracic Surgery Department of the Regina Elena National Cancer Institute, Rome. Data from 273 consecutive patients (205 males and 68 females) were analyzed. Results Among 158 (58%) adequate specimens, 112 (41%) were neoplastic or contained atypical cells, 46 (17%) were negative or not diagnostic. We considered in the analysis first the overall period; then we compared the findings of the first [2005–2011] and second period [2012–2015] and, finally, only those of adequate specimens. During the overall period, sensibility and accuracy values were respectively of 53% and 63%, in the first period they reached 41% and 53% respectively; in the second period sensibility and accuracy reached 60% and 68%. Considering only the adequate specimens, sensibility and accuracy during the overall period were respectively of 80% and 82%; the values obtained for the first period were 68% and 72%. Finally, in the second period, sensibility reached 86% and accuracy 89%. Carcinoma-subtyping was possible in 112 cases, adenocarcinomas being diagnosed in 50 cases; further, in 30 cases molecular predictive data could be obtained. Conclusions The c-TBNA proved to be an efficient method for the diagnosis/staging of lung neoplasms and for the diagnosis of mediastinal lymphadenopathy. Endoscopist’s skill and technical development, associated to thin-prep cytology and to a rapid on site examination (ROSE), were able to provide by c-TBNA a

  14. Inhaled nedocromil sodium reduces histamine release from isolated large airway segments of asthmatic subjects in vivo.

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    Maxwell, D L; Hawksworth, R J; Lee, T H

    1993-09-01

    Placement of an intrabronchial single balloon catheter provides the possibility of measuring histamine release in isolated large airway segments in vivo. We wanted to assess the protective effect of nedocromil sodium on intrabronchial histamine release after hyperosmolar challenge. Six mild asthmatics were bronchoscoped 30 min after inhalation of 4 mg nedocromil sodium or placebo, given via a metered dose inhaler in a randomized, double-blind, cross-over study. Lavage of the left main bronchus was carried out proximal to a balloon catheter inflated at its bifurcation, and specimens were assayed for histamine and prostaglandin D2 (PGD2) by radioimmunoassay. The rise in histamine concentration in bronchial epithelial fluid following hyperosmolar saline challenge was significantly greater following placebo than following nedocromil sodium (mean +/- SEM prechallenge histamine concentration on placebo day 6.9 +/- 2.9 nM; post-challenge: 25.3 +/- 8.0 nM; mean +/- SEM prechallenge histamine concentration on the day nedocromil sodium was given: 3.7 +/- 0.7 nM; post-challenge 5.8 +/- 1.7 nM). Changes in PGD2 levels reflected the changes in histamine, but the variability of response was large, and there were no significant differences between the effects of placebo and nedocromil sodium. The procedure caused significantly greater falls in peak expiratory flow rates following placebo (mean +/- SEM percentage fall 20.2 +/- 4.4%) than following nedocromil sodium (0.9 +/- 5.8%, p airways, and that nedocromil sodium inhibits histamine release from mediator cells in vivo. PMID:7693506

  15. Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients

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    Manu Varshney

    2011-01-01

    Full Text Available Background: Optimal depth of endotracheal tube (ET placement has been a serious concern because of the complications associated with its malposition. Aims: To find the optimal depth of placement of oral ET in Indian adult patients and its possible determinants viz. height, weight, arm span and vertebral column length. Settings and Design: This study was conducted in 200 ASA I and II patients requiring general anaesthesia and orotracheal intubation. Methods: After placing the ET with the designated black mark at vocal cords, various airway distances were measured from the right angle of mouth using a fibre optic bronchoscope. Statistical Analysis: The power of the study is 0.9. Mean (SD and median (range of various parameters and Pearson correlation coefficient was calculated. Results: The mean (SD lip-carina distance, i.e., total airway length was 24.32 (1.81 cm and 21.62 (1.34 cm in males and females, respectively. With black mark of ET between vocal cords, the mean (SD ET tip-carina distance of 3.69 (1.65 cm in males and 2.28 (1.55 cm females was found to be considerably less than the recommended safe distance. Conclusions: Fixing the tube at recommended 23 cm in males and 21 cm in females will lead to carinal stimulation or endobronchial placement in many Indian patients. The lip to carina distance best correlates with patient′s height. Positioning the ET tip 4 cm above carina as recommended will result in placement of tube cuff inside cricoid ring with currently available tubes. Optimal depth of ET placement can be estimated by the formula "(Height in cm/7-2.5."

  16. [Successful One-lung Ventilation with a Right-sided Double-lumen Tube in a Patient with a Right Upper Tracheal Bronchus, who Underwent Left Pneumonectomy for Left Hilar Lung Cancer].

    Science.gov (United States)

    Kawagoe, Izumi; Kohchiyama, Tsukasa; Hayashida, Masakazu; Satoh, Daizoh; Suzuki, Kenji; Inada, Eiichi

    2016-06-01

    A 60-year-old male patient with left hilar lung cancer was scheduled to undergo left pneumonectomy or left sleeve lower lobectomy. Preoperative computer tomographic and bronchoscopic examinations revealed that the bronchus (B1) to the right apical segment (S1) was a tracheal bronchus (TB) originating from the trachea approximately 10 mm above the carina. Because the left main bronchus was to be dissected, a right-sided double-lumen tube (DLT) was selected to completely protect the right lung from spillage of secretions or cancer cells from the left lung. The right-sided DLT was placed so as to fit its lateral opening of the bronchial lumen to normal upper branches (B2, B3), while sacrificing ventilation of S1 with an abnormal branch (B1). However, one-lung ventilation (OLV) of the right lung could not be achieved, since a gas leakage from the opened tracheal lumen occurred, most probably due to intra-lobar micro-airway communications between S1 and S2/S3. The DLT was withdrawn until the blue bronchial cuff occluded the orifice of the TB (B1). Although the upper half of the blue bronchial cuff appeared above the tracheal carina, OLV through the two bronchial lumen openings could be achieved due to a specific, slanted doughnut shape of the blue bronchial cuff and the location of the abnormal branch (B1) approximate to the carina. Left pneumonectomy using successful OLV was completed safely without hypoxemia or hypercapnea. Our experience indicates that management of OLV for patients with a thoracheal bronchus needs special considerations of the exact location of the TB and intra-lobar micro-airway communications, in addition to types of scheduled surgical procedures. PMID:27483653

  17. 13[C]-urea breath test as a novel point-of-care biomarker for tuberculosis treatment and diagnosis.

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    Mandeep S Jassal

    Full Text Available BACKGROUND: Pathogen-specific metabolic pathways may be detected by breath tests based on introduction of stable isotopically-labeled substrates and detection of labeled products in exhaled breath using portable infrared spectrometers. METHODOLOGY/PRINCIPAL FINDINGS: We tested whether mycobacterial urease activity could be utilized in such a breath test format as the basis of a novel biomarker and diagnostic for pulmonary TB. Sensitized New-Zealand White Rabbits underwent bronchoscopic infection with either Mycobacterium bovis or Mycobacterium tuberculosis. Rabbits were treated with 25 mg/kg of isoniazid (INH approximately 2 months after infection when significant cavitary lung pathology was present. [(13C] urea was instilled directly into the lungs of intubated rabbits at selected time points, exhaled air samples analyzed, and the kinetics of delta(13CO(2 formation were determined. Samples obtained prior to inoculation served as control samples for background (13CO(2 conversion in the rabbit model. (13CO(2, from metabolic conversion of [(13C]-urea by mycobacterial urease activity, was readily detectable in the exhaled breath of infected rabbits within 15 minutes of administration. Analyses showed a rapid increase in the rate of (13CO(2 formation both early in disease and prior to treatment with INH. Following INH treatment, all evaluable rabbits showed a decrease in the rate of (13CO(2 formation. CONCLUSIONS/SIGNIFICANCE: Urea breath testing may provide a useful diagnostic and biomarker assay for tuberculosis and for treatment response. Future work will test specificity for M. tuberculosis using lung-targeted dry powder inhalation formulations, combined with co-administering oral urease inhibitors together with a saturating oral dose of unlabeled urea, which would prevent the delta(13CO(2 signal from urease-positive gastrointestinal organisms.

  18. Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

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    Sugiura Yasoo

    2013-02-01

    Full Text Available Abstract Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA. When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at Conclusion We experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

  19. Pulmonary tuberculosis mimicking lung cancer on radiological findings: Evaluation of chest CT findings in pathologically proven 76 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Daun; Shin, Sang Soo; Kim, Yun Hyeon [Chonnam National Univ. Hospital, Gwangju, (Korea, Republic of); Kim, Hyoung Ook; Seon, Hyun Ju; Kang, Heoung Keun [Chonnam National Univ. Hwasun Hospital, Hwasun (Korea, Republic of)

    2012-09-15

    To evaluate chest CT features of pulmonary tuberculosis mimicking lung malignancy. We retrospectively reviewed chest CT findings for 76 consecutive patients (21-84 years, average: 63 years; M : F = 30 : 46) who underwent an invasive diagnostic procedure under the suspicion of lung cancer and were pathologically diagnosed as pulmonary tuberculosis by bronchoscopic biopsy (n = 49), transthoracic needle biopsy (n = 17), and surgical resection (n = 10). We categorized the chest CT patterns of those lesions as follows: bronchial narrowing or obstruction without a central mass like lesion (pattern 1), central mass-like lesion with distal atelectasis or obstructive pneumonia (pattern 2), peripheral nodule or mass including mass-like consolidation (pattern 3), and cavitary lesion (pattern 4). CT findings were reviewed with respect to the patterns and the locations of the lesions, parenchymal abnormalities adjacent to the lesions, the size, the border and pattern of enhancement for the peripheral nodule or mass and the thickness of the cavitary wall in the cavitary lesion. We also evaluated the abnormalities regarding the lymph node and pleura. Pattern 1 was the most common finding (n = 34), followed by pattern 3 (n = 23), pattern 2 (n = 11) and finally, pattern 4 (n = 8). The most frequently involving site in pattern 1 and 2 was the right middle lobe (n = 14/45). However, in pattern 3 and 4, the superior segment of right lower lobe (n = 5/31) was most frequently involved. Ill-defined small nodules and/or larger confluent nodules were found in the adjacent lung and at the other segment of the lung in 31 patients (40.8%). Enlarged lymph nodes were most commonly detected in the right paratracheal area (n = 9/18). Pleural effusion was demonstrated in 10 patients. On the CT, pulmonary tuberculosis mimicking lung cancer most commonly presented with bronchial narrowing or obstruction without a central mass-like lesion, which resulted in distal atelectasis and obstructive

  20. Tracheobronchial foreign body aspiration in children: A continuing diagnostic challenge

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    Mohammad Saquib Mallick

    2014-01-01

    Full Text Available Background: Foreign body aspiration (FBA is a common cause of respiratory compromise in early childhood. The objective of this study was to describe the features and outcomes of children with FBA in early and late presentations and to examine the reasons for the delay in diagnosis. Patients and Methods: This is a retrospective review of all children who were admitted with suspected FBA between July 2001 and June 2010. Patient′s characteristics, history, clinical, radiographic, bronchoscopic findings, reason for delay presentation, and complications were noted. Results: A total of 158 children admitted to the hospital with suspected FBA were included in this study. The average age was 3.28 years. Forty-eight (30.3% children were presented late (more than 14 days after FBA and 110 (69.7% children were presented early (0-14 days. The common clinical manifestations of FBA were persistent cough (100% and choking (72%. The most frequent radiological finding observed was air trapping (40% followed by atelectasis (14%. Chest radiographs were normal in 32.2% patients. Ten children in early diagnosis group and 29 children in late diagnosis group presented with complications. The diagnosis delay was mainly attributed to physician misdiagnosis (41.6%. Rigid bronchoscopy was performed in all patients. Foreign body was found in all of the cases except six. Watermelon seeds and peanuts accounted for 80% of the aspiration. Conclusion: FBA is difficult to diagnose in children. Delay in diagnosis appears to result from a failure to give serious consideration to the diagnosis. Early diagnosis and removal of foreign bodies must be achieved to avoid complications.

  1. Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

    International Nuclear Information System (INIS)

    The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs

  2. Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jong Woong; Jung, Gyoo Sik; Kim, Seong Min; Lee, Seung Ryong; Kim, Hyun Sook; Huh, Jin Do; Joh, Young Duk [Kosin Medical College, Pusan (Korea, Republic of)

    1998-05-01

    The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs.

  3. Pulmonary tuberculosis with airspace consolidation vs mycoplasma pneumonia in adults: high-resolution CT findings

    International Nuclear Information System (INIS)

    To analyse and compare high-resolution CT findings of pulmonary tuberculosis with consolidation and mycoplasma pneumonia. Twenty patients with pulmonary tuberculosis [confirmed by sputum culture (n=9) and bronchoscopic biopsy (n=11)] and airspace consolidation on high-resolution CT and 17 patients with mycoplasma pneumonia, confirmed by serologic test, were included in this study. High-resolution CT findings were analyzed in terms of ground-glass opacities, distribution of consolidation, type of nodules, cavities, interlobular septal thickening, bronchial dilatations, bronchial wall thickening and pleural effusion. In patients with tuberculosis, average age was 33.5 years (range, 20-67); in those with mycoplasma pneumonia it was 32.5 years (range, 17-74). Segmental and subsegmental distributions were most common in both diseases; the preferred site of consolidation was different, however; for tuberculosis it was the upper lobes (13 cases, 65%; bilateral involvement, 7 cases); for mycoplasma pneumonia it was the lower lobes (11 cases, 64.7%). Non-segmental (diffuse and random) distribution of ground-glass opacities were seen in two patients(11.8%) with mycoplasma pneumonia. Centrilobular nodules, branching linear opacities and alveolar nodules were not different in both diseases, but there were nodules above 10mm in 14 cases of tuberculosis and in only one case of mycoplasma pneumonia. Tree-in-bud appearances were seen in five cases of tuberculosis. Cavities without air-fluid level were noted in ten cases of tuberculosis. Other interlobular septal thickening, bronchial wall thickening, bronchial dilatation and pleural effusion were not different in both diseases. There was considerable overlap between high resolution CT findings of tuberculosis with airspace consolidation and those of mycoplasma pneumonia. The location of consolidation, type of nodules, and the presence of tree-in-bud appearance and cavities help in the differentiation of the two diseases, however

  4. Real-Time Tumor Tracking in the Lung Using an Electromagnetic Tracking System

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Amish P., E-mail: Amish.Shah@orlandohealth.com [Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida (United States); Kupelian, Patrick A.; Waghorn, Benjamin J.; Willoughby, Twyla R.; Rineer, Justin M.; Mañon, Rafael R.; Vollenweider, Mark A.; Meeks, Sanford L. [Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida (United States)

    2013-07-01

    Purpose: To describe the first use of the commercially available Calypso 4D Localization System in the lung. Methods and Materials: Under an institutional review board-approved protocol and an investigational device exemption from the US Food and Drug Administration, the Calypso system was used with nonclinical methods to acquire real-time 4-dimensional lung tumor tracks for 7 lung cancer patients. The aims of the study were to investigate (1) the potential for bronchoscopic implantation; (2) the stability of smooth-surface beacon transponders (transponders) after implantation; and (3) the ability to acquire tracking information within the lung. Electromagnetic tracking was not used for any clinical decision making and could only be performed before any radiation delivery in a research setting. All motion tracks for each patient were reviewed, and values of the average displacement, amplitude of motion, period, and associated correlation to a sinusoidal model (R{sup 2}) were tabulated for all 42 tracks. Results: For all 7 patients at least 1 transponder was successfully implanted. To assist in securing the transponder at the tumor site, it was necessary to implant a secondary fiducial for most transponders owing to the transponder's smooth surface. For 3 patients, insertion into the lung proved difficult, with only 1 transponder remaining fixed during implantation. One patient developed a pneumothorax after implantation of the secondary fiducial. Once implanted, 13 of 14 transponders remained stable within the lung and were successfully tracked with the tracking system. Conclusions: Our initial experience with electromagnetic guidance within the lung demonstrates that transponder implantation and tracking is achievable though not clinically available. This research investigation proved that lung tumor motion exhibits large variations from fraction to fraction within a single patient and that improvements to both transponder and tracking system are still

  5. [A case of obstructive ventilatory disturbance caused by bronchial wall granulation due to a fish bone].

    Science.gov (United States)

    Kimura, M; Hara, H; Matsushima, T; Kobori, M

    1992-11-01

    A 62-year-old man was admitted to Kawasaki Medical School Kawasaki Hospital after suffering from wheezing for one year. His chest X-ray film showed no significant findings in the lung fields and mediastinum. A chest CT film showed a small protrusion at the posterior wall of the right main bronchus. Bronchofiberscopy disclosed a polypoid tumor with a smooth surface in the right main bronchus, confirming the finding of the chest CT, and a restiform eminence at the truncus intermedius. The restiform eminence was revealed to be a fish bone after removal from the bronchus using the forceps of a bronchofiberscope. Histological examination of a bronchoscopic biopsy specimen from the tumor of the right main bronchus showed inflammatory granulation tissue. We confirm subsequently questioned the patient who revealed that he had aspirated another fish bone two months earlier, and we presumed that the tumor of the right main bronchus might be granulation tissue secondary to the impaction of a fish bone. The patient was not aware that he had aspirated a foreign body, but it was presumed that he had aspirated the fish bone one year earlier, coinciding with the onset of wheezing. Immediately after removal, his wheezing disappeared. Comparison of the results of pulmonary function tests after removal with those before showed improvement of V25/predicted V25 ratio from 24% to 72%, and improvement of V50/V25 ratio from 3.7 to 2.4. This is considered to be a rare case of bronchial granulation due to a foreign body, which was recognized as a small polypoid tumor by chest CT. PMID:1484442

  6. Clinical characteristics of sarcoidosis patients diagnosed in a university hospital

    Directory of Open Access Journals (Sweden)

    Özlem Abakay

    2012-09-01

    Full Text Available Objectives: The clinical characteristics and treatment resultsof patients diagnosed with sarcoidosis was investigatedin Dicle University Medical Faculty Hospital.Materials and methods: A total of 39 patients were includeddiagnosed with sarcoidosis between 01 January2008 and31 December 2011.Demographic data, laboratoryfindings, spirometric test data, diagnostic methodsand treatment regimens for the study were recorded form.According to pulmonary function test results of patients,61.5% were normal pattern, 30.8% were restrictive patternand 7.7% were obstructive pattern.Results: Of the 39 patients 15.4% male, 84.6% werefemale. The mean age was 39.5±13.1 years for males,females 44.8±14.0 years. All patients of was 17.9%stage 1, 66.7% stage 2, 10.3% stage 3 and 5.1% stage4. 61.5% were symptomatic, 38.5% were asymptomatic.Methods of diagnosis of the patients examined, 25.6% ofpatients bronchoscopic biopsy procedures, 74.4% of patientssurgical biopsy procedures. Of the 56.4% patientshad received corticosteroid treatment, 5.1% patients hadreceived corticosteroid + methotrexate treatment, 38.5%were followed up without the pharmacological treatment.Pharmacological treatment in the group complete at thetime of the study 20.5% concluded the treatment of theperson. Patients who treatment ending 8.4 months hadused pharmacological treatment.Conclusions: Interstitial lung diseases which are prevalentamong patients with sarcoidosis diagnosed by examiningthe clinical features, differential diagnosis and treatmentmay be possible detection of potential problems. JClin Exp Invest 2012; 3 (3: 363-367Key words: Sarcoidosis diagnosis, treatment

  7. Pulmonary tuberculosis mimicking lung cancer on radiological findings: Evaluation of chest CT findings in pathologically proven 76 patients

    International Nuclear Information System (INIS)

    To evaluate chest CT features of pulmonary tuberculosis mimicking lung malignancy. We retrospectively reviewed chest CT findings for 76 consecutive patients (21-84 years, average: 63 years; M : F = 30 : 46) who underwent an invasive diagnostic procedure under the suspicion of lung cancer and were pathologically diagnosed as pulmonary tuberculosis by bronchoscopic biopsy (n = 49), transthoracic needle biopsy (n = 17), and surgical resection (n = 10). We categorized the chest CT patterns of those lesions as follows: bronchial narrowing or obstruction without a central mass like lesion (pattern 1), central mass-like lesion with distal atelectasis or obstructive pneumonia (pattern 2), peripheral nodule or mass including mass-like consolidation (pattern 3), and cavitary lesion (pattern 4). CT findings were reviewed with respect to the patterns and the locations of the lesions, parenchymal abnormalities adjacent to the lesions, the size, the border and pattern of enhancement for the peripheral nodule or mass and the thickness of the cavitary wall in the cavitary lesion. We also evaluated the abnormalities regarding the lymph node and pleura. Pattern 1 was the most common finding (n = 34), followed by pattern 3 (n = 23), pattern 2 (n = 11) and finally, pattern 4 (n = 8). The most frequently involving site in pattern 1 and 2 was the right middle lobe (n = 14/45). However, in pattern 3 and 4, the superior segment of right lower lobe (n = 5/31) was most frequently involved. Ill-defined small nodules and/or larger confluent nodules were found in the adjacent lung and at the other segment of the lung in 31 patients (40.8%). Enlarged lymph nodes were most commonly detected in the right paratracheal area (n = 9/18). Pleural effusion was demonstrated in 10 patients. On the CT, pulmonary tuberculosis mimicking lung cancer most commonly presented with bronchial narrowing or obstruction without a central mass-like lesion, which resulted in distal atelectasis and obstructive

  8. Human in vivo fluorescence microimaging of the alveolar ducts and sacs during bronchoscopy.

    Science.gov (United States)

    Thiberville, L; Salaün, M; Lachkar, S; Dominique, S; Moreno-Swirc, S; Vever-Bizet, C; Bourg-Heckly, G

    2009-05-01

    The aim of the present study was to assess fibred confocal fluorescence microscopy (FCFM) as a tool for imaging the alveolar respiratory system in vivo during bronchoscopy. A 488-nm excitation wavelength FCFM device was used in 41 healthy subjects including 17 active smokers. After topical anaesthesia, the 1.4-mm miniprobe was introduced into the bronchoscope working channel and advanced distally to the alveoli. Morphometric and cellular analyses were performed on selected frames harbouring a minimal compression effect. In vivo acinar microimaging was obtained from each lung segment except for the apical and posterior segments of both upper lobes. Reproducible patterns, corresponding to the elastic framework of the axial and peripheral interstitial systems, were recorded from 192 separate acini. The mean+/-sd thickness of the acinar elastic fibres was 10+/-2.7 microm. Alveolar mouth diameters (mean+/-sd 278+/-53 microm) were normally distributed but appeared smaller in the right upper lobe and right medial basal segment. Lobular microvessels (median diameter 90 microm) were equally distributed throughout the lungs. Alveolar macrophages were not detectable in nonsmokers, whereas a specific tobacco-tar-induced fluorescence was observed in smoking subjects, providing fine details of the alveolar walls and macrophages. A strong correlation was found between the number of cigarettes smoked per day and the amount of large and mobile macrophages observed in vivo, as well as with the intensity of the macrophage alveolitis. Fibred confocal fluorescence microscopy enables accurate exploration of the peripheral lung in vivo in both smokers and nonsmokers. PMID:19213792

  9. Pneumomediastino espontâneo associado a lesões laríngeas e úlceras traqueais na dermatomiosite Spontaneous pneumomediastinum associated with laryngeal lesions and tracheal ulcer in dermatomyositis

    Directory of Open Access Journals (Sweden)

    Ascedio Jose Rodrigues

    2012-10-01

    Full Text Available O presente estudo descreve uma paciente de 41 anos de idade com dermatomiosite, doença pulmonar intersticial e vasculopatia cutânea que desenvolveu pneumomediastino. Durante exame de broncoscopia foram encontradas lesões pálidas na laringe, que se estendiam para a árvore traqueobrônquica, e úlceras profundas na parede membranácea da traqueia. O exame histopatológico revelou presença de processo inflamatório secundário à vasculite, mas sem sinais de infecção. Lesões nas vias aéreas superiores e inferiores em paciente com dermatomiosite são raríssimas. A associação de dermatomiosite com úlceras profundas de mucosa e pneumomediastino não está bem esclarecida, mas a broncoscopia é um exame que deve ser utilizado para aperfeiçoar a avaliação.We described a 41-year-old woman with dermatomyositis, interstitial lung disease, and cutaneous vasculopathy who developed a pneumomediastinum. The routine bronchoscopy investigation found pale lesions in the larynx, that extended to the tracheobronchial tree, and deep ulcers in the membranous wall of the trachea. The histopathology examination revealed an inflammatory process that was diagnosed secondary to the vasculitis, but no infections. Superior and inferior airway lesions in the same patient with dermatomyositis is a very rare condition. The association of dermatomyositis with deep mucosal ulcers and pneumomediastinum is not clear, but a bronchoscopic examination should be used to improve evaluation.

  10. A study of usefulness of washes and brush cytology with respect to histopathology in diagnosis of lung malignancy by using fiberoptic bronchoscopy

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    Abhishek Bandyopadhyay

    2016-01-01

    Full Text Available Background: Examination of specimens obtained through flexible fiberoptic bronchoscope is important and often the initial diagnostic technique performed in patients with suspected malignant lung lesion. Aims: To evaluate the usefulness of cytological findings of bronchial washings (pre-and post-bronchoscopy and bronchial brushing in the diagnosis of lung malignancy with histopathology of bronchial biopsy, taking the latter as the confirmatory diagnostic test. Settings and Design: It was a cross-sectional observational study conducted in a tertiary care center. Subjects and Methods: A total of fifty patients with suspected lung malignancy (clinically and radiologically were included in this nonrandomized cross-sectional study. Bronchial brushings were obtained from all fifty cases. Prebiopsy bronchial washing (washing collected before the brushing and biopsy procedure and postbiopsy washing (washing at the end of the procedure were collected. Results: Prebiopsy (prebrushing and postbiopsy washing showed high specificity of 92.31%, but a very low sensitivity of 32.43% and 35.14%, respectively. Sensitivity and specificity of brushing were found to be 74.36% and 81.82%, respectively. Positive predictive value of prebiopsy (prebrushing washing, postbiopsy washing and brushing are 92.31%, 93.55%, and 92.86%, respectively. There was no significant difference in sensitivity between prebiopsy (prebrushing and postbiopsy washing (Fisher exact probability test; PA= 0.99. However, there was statistically significant difference between sensitivity of brushing with prebiopsy (prebrushing washing (Fisher exact probability test; PA = 0.0012793 and postbiopsy washing (Fisher exact probability test; PA = 0.00310282. Conclusions: Bronchial washing cytology in combination with brush cytology aids in the early diagnosis of lung malignancy in addition to histopathology.

  11. Transbronchial needle aspiration "by the books"

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    Kupeli Elif

    2011-01-01

    Full Text Available Background : Training for advanced bronchoscopic procedures is acquired during the interventional pulmonology (IP Fellowship. Unfortunately a number of such programs are small, limiting dissemination of formal training. Objective : We studied success of conventional transbronchial needle aspiration (C-TBNA in the hands of physicians without formal IP training. Methods : A technique of C-TBNA was learned solely from the literature, videos and practicing on inanimate models at "Hands-On" courses. Conventional TBNA with 21 and/or 19 gauge Smooth Shot Needles (Olympus® , Japan was performed on consecutive patients with undiagnosed mediastinal lymphadenopathy. Results : Thirty-four patients (male 23, mean age 54.9 ± 11.8 years underwent C-TBNA. Twenty-two patients had nodes larger than 20 mms. Suspected diagnoses were malignancy in 20 and nonmalignant conditions in 14. Final diagnoses were malignancy 17, sarcoidosis 4, reactive lymph nodes 12, and tuberculosis 1. Final diagnosis was established by C-TBNA in 14 (11 malignancy, 3 sarcoidosis; yield 41.1%, mediastinoscopy in 14, transthoracic needle aspiration in 3, peripheral lymph node biopsies in 2 and by endobronchial biopsy in 1. Nodal size had an impact on outcome (P = 0.000 while location did not (P = 0.33. C-TBNA was positive in 11/20 when malignancy was suspected (yield 55%, while 3/14 when benign diagnosis was suspected (yield 21.4% (P = 0.05. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 66.6%, 100%, 100%, 65%, and 79.4%, respectively. There were no complications or scope damage. Conclusion : Conventional-TBNA can be learned by the books and by practicing on inanimate models without formal training and results similar to those published in the literature could be achieved.

  12. Exhaled breath analysis for lung cancer detection using ion mobility spectrometry.

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    Hiroshi Handa

    Full Text Available Conventional methods for lung cancer detection including computed tomography (CT and bronchoscopy are expensive and invasive. Thus, there is still a need for an optimal lung cancer detection technique.The exhaled breath of 50 patients with lung cancer histologically proven by bronchoscopic biopsy samples (32 adenocarcinomas, 10 squamous cell carcinomas, 8 small cell carcinomas, were analyzed using ion mobility spectrometry (IMS and compared with 39 healthy volunteers. As a secondary assessment, we compared adenocarcinoma patients with and without epidermal growth factor receptor (EGFR mutation.A decision tree algorithm could separate patients with lung cancer including adenocarcinoma, squamous cell carcinoma and small cell carcinoma. One hundred-fifteen separated volatile organic compound (VOC peaks were analyzed. Peak-2 noted as n-Dodecane using the IMS database was able to separate values with a sensitivity of 70.0% and a specificity of 89.7%. Incorporating a decision tree algorithm starting with n-Dodecane, a sensitivity of 76% and specificity of 100% was achieved. Comparing VOC peaks between adenocarcinoma and healthy subjects, n-Dodecane was able to separate values with a sensitivity of 81.3% and a specificity of 89.7%. Fourteen patients positive for EGFR mutation displayed a significantly higher n-Dodecane than for the 14 patients negative for EGFR (p<0.01, with a sensitivity of 85.7% and a specificity of 78.6%.In this prospective study, VOC peak patterns using a decision tree algorithm were useful in the detection of lung cancer. Moreover, n-Dodecane analysis from adenocarcinoma patients might be useful to discriminate the EGFR mutation.

  13. Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery

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    Giovani de Figueiredo Locks

    2015-10-01

    Full Text Available ABSTRACTOBJECTIVE: To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty.METHODS: 60 patients undergoing bariatric surgery by two techniques: open (G1 or videolaparoscopic (G2 gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2.RESULTS: G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13 in the group of patients undergoing open gastroplasty and in -0.42 cm (95% CI -0.56 to -1.4 in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients undergoing open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery.CONCLUSIONS: There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation.

  14. Isolation of human β-defensin-4 in lung tissue and its increase in lower respiratory tract infection

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    Mukae Hiroshi

    2005-11-01

    Full Text Available Abstract Background Human β-defensin-4 (hBD-4, a new member of the β-defensin family, was discovered by an analysis of the genomic sequence. The objective of this study was to clarify hBD-4 expression in human lung tissue, along with the inducible expression in response to infectious stimuli, localization, and antimicrobial activities of hBD-4 peptides. We also investigated the participation of hBD-4 in chronic lower respiratory tract infections (LRTI by measuring the concentrations of hBD-4 peptides in human bronchial epithelial lining fluid (ELF. Methods The antimicrobial activity of synthetic hBD-4 peptides against E. coli and P. aeruginosa was measured by radial diffusion and colony count assays. We identified hBD-4 in homogenated human lung tissue by reverse-phase high-performance liquid chromatography coupled with a radioimmunoassay (RIA. Localization of hBD-4 was studied through immunohistochemical analysis (IHC. We investigated the effects of lipopolysaccharide (LPS on hBD-4 expression and its release from small airway epithelial cells (SAEC. We collected ELF from patients with chronic LRTI using bronchoscopic microsampling to measure hBD-4 concentrations by RIA. Results hBD-4 exhibited salt-sensitive antimicrobial activity against P. aeruginosa. We detected the presence of hBD-4 peptides in human lung tissue. IHC demonstrated the localization of hBD-4-producing cells in bronchial and bronchiolar epithelium. The levels of hBD-4 peptides released from LPS-treated SAECs were higher than those of untreated control cells. ELF hBD-4 was detectable in 4 of 6 patients with chronic LRTI, while the amounts in controls were all below the detectable level. Conclusion This study suggested that hBD-4 plays a significant role in the innate immunity of the lower respiratory tract.

  15. 儿童支气管异物246例临床分析%Clinical analysis of bronchial foreign bodies in 246 children

    Institute of Scientific and Technical Information of China (English)

    马渝燕; 焦安夏; 江沁波; 饶小春; 潘跃娜; 刘玺诚

    2010-01-01

    目的 回顾性研究儿童支气管异物的临床特点以及电子支气管镜在诊断治疗儿童支气管异物中的作用.方法 2000年1月至2009年8月北京儿童医院经支气管镜诊断治疗的支气管异物患儿246例,应用Olympus电子支气管镜,在局部黏膜麻醉下经鼻插入支气管镜逐级观察支气管结构,使用篮状异物钳或齿状异物钳钳取异物.结果 246例患儿中,支气管异物以果仁或果壳类(230例,占93.5%)最为常见,异物嵌顿位置以右下叶支气管开口(98例,占39.8%)为最多.钳取异物手术次数平均为(1.9±1.3)次,一次取出率为58.5%(144例).阻塞于左右主支气管、右中叶和右下叶支气管的异物一次取出率较高,分别为91.1%、60.0%和55.1%.篮状异物钳钳取所需次数(1.4±0.9)明显低于齿状异物钳所需次数(2.1±1.4),差异有统计学意义(P=0.000).结论 儿童支气管异物种类以果仁或果壳类植物性异物为主,阻塞部位以右下支气管为多见.位于左右主支气管异物一次取出率明显高于其他部位.用篮状异物钳钳取异物所需手术次数明显少于使用齿状异物钳.%Objective To analyze the characters of bronchial foreign bodies in children and the utilization of bronchoscope in the treatment of bronchial foreign bodies. Methods A total of 246 children were diagnosed with bronchial foreign bodies at our hospital during January 2000 until August 2009. Under local mucosal anesthesia, a bronchoscope was inserted through nasal cavity into bronchi. After identifying the site of foreign body, grasping forceps was guided through bronchoscope to remove the foreign body from airway. Results Among 246 cases, hard nut and skin of melon seed were found ( n = 230, 93.5% ). The most common site of foreign body was in right lower lobe bronchi ( n =98, 38.9% ). The average operative frequency was 1.9 ± 1.3 and one-time extraction ratio 58.5% ( n = 144). The one-time extraction ratio of patients with foreign

  16. Interventional bronchoscopy with the use of mechanical ventilation by larynx mask or tracheal intubation under general anesthesia%经喉罩或气管插管连接行常规机械通气在全身麻醉介入治疗手术中的安全性

    Institute of Scientific and Technical Information of China (English)

    王婷; 张杰; 王娟; 党斌温; 徐敏; 裴迎华; 张晨阳

    2011-01-01

    Objective To explore and evaluate the technique of performing interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia.Methods From July 2009 to January 2010,29 patients received interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia.Airway pressure and tidal volume before and after bronchoscope insertion,arterial blood gas analysis during interventional bronchoscopy,complications and operation time were recorded.The factors influencing ventilation effects were evaluated.Results All the patients' condition were kept stable during interventional bronchoscopy and no severe complications occurred.Tidal volume was reduced by 27.1%,while peak airway pressure,plateau pressure and mean airway pressure were increased by 63.1%,43.7% and 32.4% following insertion of the bronchoscope respectively.Patients using tracheal intubation had their peak pressure increased by 79.3%,which was higher than that of patients using larynx mask (55.3%).Conclusions Interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia was safe and reliable.Although peak airway pressure increased following insertion of bronchoscope,the mean airway pressure was maintained in a low level.When performing interventional bronchoscopy during mechanical ventilation,the inside diameter of larynx mask and tracheal intubation should be as large as possible to minimize airway pressure and auto-PEEP.%目的 探索并评价使用喉罩或气管插管联合常规机械通气在介入治疗手术中的应用价值.方法 纳入2009年7月至2010年1月收入首都医科大学附属北京天坛医院呼吸科在全身麻醉下经喉罩或气管插管联合常规机械通气条件下接受气管镜介入治疗的患者29例,其中男19例,女10例,年龄19 ~74岁,平均(47±18)岁.观察手术前后的气

  17. 支气管结核临床分析%Clinical Analysis of Endobronchial Tuberculosis

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    何朝文; 李党育; 刘立义; 李柏完

    2011-01-01

    目的 对支气管结核( EBTB)的临床特点和支气管镜下形态进行分析,探讨其临床诊断要点.方法 回顾性分析我院2005年3月~2010年2月收治的102例EBTB的临床表现、影像学征象和内镜下形态等临床资料.结果 本组临床表现为咳嗽95例,咳痰84例,盗汗56例,发热54例,乏力、消瘦52例,咯血45例,咳血痰32例及胸痛24例.X线胸片示肺结核影像征象26例,肺过度充气24例,阻塞性肺炎23例,肺不张21例,支气管扩张16例,肺充气不良12例,气管狭窄5例;肺部CT表现为管腔狭窄36例,管壁局部增厚32例,肺结核征象30例,管腔闭塞23例,肺不张21例,管腔内肿物15例,管壁棘状突起12例.支气管镜下表现为炎症浸润型18例,溃疡坏死型28例,肉芽增殖型25例,瘢痕狭窄型15例,管壁软化型6例,混合型10例.本组漏诊23例,误诊56例,漏误诊率达77.4%.治愈96例,失访6例.结论 EBTB的临床和影像学征象无特异性,易误诊.提高临床医师对EBTB的警惕性和支气管镜下表现形态的认识,结合内镜下组织活检、刷检以及镜后的痰检,能有效减少EBTB漏误诊.%Objective To investigate clinical characteristics and the bronchoscopy features of endobronchial tuberculosis (EBTB)and investigate the main key points in diagnosis. Methods The clinical manifestations, imaging signs and bronchoscopic features of 102 EBTB patients admitted into our hospital during Mary 2005 and February 2010 were analyzed retrospectively. Results 93 patients had a cough, 84 had expectoration, 56 had night sweat, 54 had a fever, 52 had fatigue weight loss,45 had hemoptysis, 32 had hemoptysis sputum and 24 had chest pain. Chest X-ray showed that 26 patients had the imaging signs of tuberculosis, 24 had lung hyperinflation, 23 had obstructive pneumonia, 21 had atelectasis, 16 had bronchiecta-sis, 12 had poor lung inflation and 5 had tracheal stenosis in the performance. The CT results showed that 36 had stenosis, 32 had local

  18. The value of immunochemistry staining of TTF1, CK7, P63 and CK5/6 in the differential diagnosis of non-small cell lung cancer%TTF-1、CK7、P63、CK5/6免疫组织化学染色在非小细胞肺癌鉴别诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    方强; 刘宁

    2015-01-01

    目的:评估支气管镜活检组织中甲状腺转录因子-1(TTF-1)、细胞角蛋白7(CK7)、P63、细胞角蛋白5/6( CK5/6)免疫组织化学染色在非小细胞肺癌鉴别诊断中的价值。方法收集本院2012年11月至2014年1月经病理学证实的非小细胞肺癌患者143例,计算支气管镜活检组织免疫组织化学染色中TTF-1、CK7、P63、CK5/6对肺腺癌和肺鳞癌诊断敏感度和特异度,评估上述指标在非小细胞肺癌鉴别诊断中的应用价值。结果 TTF-1、CK7在肺腺癌中的表达高于在肺鳞癌中的表达( P <0.01),而P63、CK5/6在肺鳞癌的表达高于肺腺癌( P <0.01);TTF-1在肺腺癌诊断中的敏感度为85.1%(63/74),特异度为98.6%(68/69);CK7在肺腺癌诊断中的敏感度为82.4%(61/74),特异度为91.3%(63/69)。 P63在肺鳞癌诊断中的敏感度97.1%(67/69),特异度89.2%(66/74);CK5/6在肺鳞癌诊断中的敏感度79.7%(55/69),特异度89.2%(66/74)。肺腺癌患者中CK7(+)/TTF-1(+)的比例明显高于肺鳞癌患者( P <0.01);肺鳞癌患者中P63(+)/CK5/6(+)的阳性率明显高于肺腺癌患者( P <0.01)。结论支气管镜活检组织进行TTF-1、CK7、P63、CK5/6联合免疫组织化学染色有助于肺腺癌与肺鳞癌的鉴别。%Objective To evaluate the clinical value of the immunochemistry staining of thyroid transcription factor-1 (TTF-1), cytokeratin7 (CK7), P63, and cytokeratin5/6 (CK5/6) in the bronchoscop-ic forceps biopsy specimen in the differential diagnosis of non-small cell lung cancers.Methods Totally 143 cases of non-small cell lung cancers from Department of Respiratory and Department of Oncology from Nov 2012 to Jan 2014 were diagnosed with pathological examinations of the bronchoscopic forceps biospy.The sen-sitivity and specificity of TTF-1, CK7

  19. Differentiation of tuberculous pneumonia and community-acquired pneumonia; usefulness of chest radiography and serum CA-125

    International Nuclear Information System (INIS)

    To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. Forty-five patients with a high fever (>38 .deg. C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung volume (p < 0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3-1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3-114.8) U/ml (p < 0.005). Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125

  20. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

    Directory of Open Access Journals (Sweden)

    Johnson KN

    2015-12-01

    difficulty associated with ventilating the patient, the patient’s risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic bronchoscope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population.Keywords: intubation, ventilation, oxygenation, aspiration, elderly, anesthesia

  1. 神经外科重症监护室 MRSA 医院感染暴发分析%Healthcare-associated methicillin-resistant Staphylococcus aureus infec-tion outbreak in neurosurgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    范珊红; 许文; 戈伟; 慕彩妮; 李颖; 曹小琴; 许鹏

    2015-01-01

    Objective To investigate the causes of an outbreak of healthcare-associated infection with methicillin-resist-ant Staphylococcus aureus (MRSA)in a neurosurgical intensive care unit(NSICU).Methods Epidemiological investigation on 8 patients with lower respiratory tract infection (LRTI)in a NSICU between June 15 and June 28,2104 were performed by combination methods of prospective and retrospective survey.Results The attack rate of MRSA LRTI in NSICU patients was 22.86%,a total of 16 MRSA isolates were detected from patients’clinical specimens,nasal vestibule,as well as hospital surroundings during the period,pulsed-field gel electrophoresis (PFGE)result revealed that infection outbreak was caused by two subtypes of MRSA;risk factors analysis showed that long length of stay in ICU and aspiration of spu-tum through bronchoscopy were risk factors for MRSA LRTI.Conclusion Contamination of bronchoscope was the key factor for this epidemic spread of healthcare-associated MRSA infection.%目的:调查某院神经外科重症监护室(NSICU)耐甲氧西林金黄色葡萄球菌(MRSA)医院感染暴发的原因。方法采用前瞻性和回顾性调查相结合的方法,对2014年6月15—28日某院 NSICU 发生的8例下呼吸道MRSA感染患者进行流行病学调查。结果2014年6月15—28日该院 NSICU 患者医院 MRSA 下呼吸道感染罹患率为22.86%,该期间住院患者临床标本、鼻前庭标本及环境卫生学标本共分离 MRSA 16株,脉冲场凝胶电泳(PFGE)结果证实此次暴发为2个 MRSA 亚型感染;危险因素分析显示,住 ICU 时间长及使用支气管镜吸痰是 MRSA 下呼吸道感染的危险因素。结论推断 NSICU 支气管镜污染是此次 MRSA 医院感染暴发传播的关键因素。

  2. 视频喉镜下鼻插管在非急症气道中的应用

    Institute of Scientific and Technical Information of China (English)

    温顺; 叶宏伟; 冯玉峰

    2015-01-01

    目的观察对比在成人非急症气道患者中视频喉镜(glidescope videolaryngoscope)下鼻插管和纤支镜(fiberoptic bronchoscope)下鼻插管的临床效果。方法选取2010年6年~2014年5年随机收住在我院重症医学科的符合非急症气道的患者44例,按随机数字法分成两组,视频喉镜(贝格--康奈尔(上海)能源技术有限公司生产的型号为CEL-100的电子视频喉镜)组22例,纤支镜组22例,以下简称G组(n=22)和F组(n=22),插管前均留置血流动力学监测唯捷流技术(Vigileo Edawards Lifesciences, CA, USA),充分镇痛镇静,预充氧3min,分别记录镇痛镇静前(基础值),镇痛镇静达到目标评分后,插管即刻,插管后第1、3min的收缩压(SBP)、心率(HR)、每搏量(SV)、心输出量(CO)以及一次性气管插管成功例数,插管时间,鼻出血情况等。结果与镇静后比较,插管时两组的HR、SAP、CO均升高,其中G组0.05);插管时间G组

  3. Left mainstem bronchial narrowing: a vascular compression syndrome? Evaluation by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hungate, R.G.; Newman, B.; Meza, M.P. [Department of Radiology, Children`s Hospital of Pittsburgh and University of Pittsburgh Medical Center, 3705 Fifth Avenue, Pittsburgh, PA 15213 (United States)

    1998-07-01

    Background and objective. Vascular compression of the left mainstem bronchus (LMSB) between the descending aorta (DA) and pulmonary artery (PA) has been suggested as a cause for LMSB narrowing in children. These anatomic relationships have not been compared with those in children with a normal LMSB. Materials and methods. We undertook a retrospective review of the medical and radiologic records of 10 symptomatic young children (1-19 months, 5 boys, 5 girls) with MR demonstration of LMSB narrowing and compared them to 40 young children without great vessel or bronchial abnormality on MR (1 week-19 months, 28 boys, 12 girls). Chest MR evaluation included assessment of airway and great vessel anatomy with specific attention to the course of the LMSB and its relationship to the adjacent DA and PA. The position of the DA in relation to the spine was carefully evaluated. Results. Five children had focal and five had diffuse LMSB narrowing. DA position at the level of the crossing LMSB: in 40 % of symptomatic children the DA was located in front of the adjacent vertebral body; in 40 %, {sup 1}/{sub 2}-{sup 3}/{sub 4} and in 20 % {sup 1}/{sub 4}-{sup 1}/{sub 2} of the circumference of the DA was located anterior to the spine. In the control group, the DA was prespinal in 10 %, with a trend toward a more paraspinal location of the DA. The trend toward a difference in position of the DA between symptomatic and control patients was statistically significant (P < 0.05). DA position was not related to age (up to 19 months). At the level where the LMSB crossed the DA, a segment of the PA was located anterior to the LMSB, more often the right PA (RPA) or pulmonary bifurcation in symptomatic children and the left PA (LPA) in controls. No correlation was apparent between length of LMSB narrowing and DA or PA position. Chest radiographic abnormalities, when present, were subtle. Excellent MR/bronchoscopic correlation of LMSB narrowing was found in nine of the ten symptomatic

  4. Clinical application of multicolor fluorescence in situ hybridization on early diagnosis of lung cancer%多色荧光原位杂交(M-FISH)在肺癌早期诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    姚汉清; 朱慕云; 姜正华; 朱湘平; 刘娟; 秦艳; 王正东

    2012-01-01

    目的 探讨多色荧光原位杂交(M-FISH)在肺癌早期诊断中的临床意义.方法 通过苏北人民医院2007年1月至2011年1月89例肺癌患者支气管镜活检组织及刷检细胞标本作为观察组.结果 89份标本中61份标本中有X染色体数目的增多,其中男性45份,女性16份.具有异常X染色体数目的细胞比例为15.1%~93.2%.26例Y染色体异常,占29.21%,其中8例Y染色体增多的标本均为男性患者,占8.99%,另18例男性患者发生Y染色体数目减少,占20.22%.结论 原位荧光杂交技术对肺癌组织细胞进行检测,有助于肺癌的早期诊断,同时对于判断治疗效果、预后及有无复发等均有辅助作用.%Objective To explore the clinical significance of multicolor fluorescence in situ hybridization ( M - FISH) in the early diagnosis of lung cancer. Methods The hospital from January 2007 to 2011 in January, 89 cases of lung cancer patients with bronchoscopic biopsy and brush biopsy cell samples as the observation group. Results Totally 89 specimens, 61 specimens, the increase in the number of X chromosomes, including 45 men and 16 women were. The proportion of cells with abnormal X - chromosome number was 15. 1% to 93. 2% . 26 cases of Y chromosome abnormalities, accounting for 29.21% , 8 cases of Y chromosome number of specimens of patients were male, accounting for 8. 99% , another 18 cases of male patients with Y chromosome reduction in the number, accounting for 20. 22%. Conclusions Fluorescence in situ hybridization for detection of lung carcinoma cells, contribute to the early diagnosis of lung cancer, determine treatment, prognosis, and with or without recurrence have a supporting role.

  5. Animal study of improved percutaneous airway dilator%一种改良经皮气管扩张器的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    冯清亮; 姜万富; 黄润全; 吴建; 江勇豪

    2014-01-01

    Objective To demonstrate the feasibility and safety of the new percutaneous tracheal dilator for percutaneous dilatational tracheostomy (PDT).Methods PDT was performed by using new and old percutaneous tracheal dilator in 35 mongrel dogs under monitoring by fiberoptic bronchoscope (10 old,25 new).Disposable tracheal tube was intubated and the whole procession of expansion,ostomy and catheter were observed.Results Disposable tracheal tubes were successfully intubated in all the 25 dogs.The average operation time was (3.0±0.7) min [old (3.7±0.8) min,P<0.05].The blood loss volume was (2.0±0.6) ml [old (3.2±0.5)ml,P<0.05].No severe complications such as pneumothorax,high blood occurred after operation.Conclusions The new percutaneous tracheal dilator can be used in PDT,and the operation is safe and peomormed quickly.%目的 论证新型经皮气管扩张器的可行性及安全性.方法 使用传统和新型经皮气管扩张器对35例杂交犬在纤支镜监视下行经皮气管扩张造口(传统扩张器10例,新型扩张器25例),置入一次性气管套管,观察扩张、造口、置管等全过程.结果 25例新型经皮气管扩张器均成功置入一次性气管套管,手术时间(3.0±0.7)min[传统(3.7±0.8) min,P<0.05],出血(2.0±0.6)ml[传统(3.2±0.5)ml,P<0.05],未出现气胸、大出血等严重并发症.结论 新型经皮扩张器能顺利实施经皮气管切开,手术快速安全.

  6. Lung cancer screening with low-dose computed tomography: Canadian experience

    International Nuclear Information System (INIS)

    In 2003, the department of medical imaging at the University Health Network in Toronto, Ontario, became the first Canadian site of the International Early Lung Cancer Action Program (I-ELCAP). We report the results from the first 1000 baseline studies. Between June 2003 and December 2005, we enrolled 1000 high-risk smokers (that is, smokers with a history of a least 10 pack years, or the equivalent of one pack daily for 10 years), aged 55 years or older. A low-dose helical computed tomography (CT) (40 to 60 mA, 120 kV) was performed with 1.0mm to 1.25 collimation. Nodules found at baseline were followed according to the I-ELCAP protocol: 1) no noncalcified nodules (NCNs) or NCNs ≤ 4 mm or nonsolid nodules < 8 mm, annual repeat: 2) NCNs ≥ 5mm or nonsolid nodules ≥ 8 mm, 3-month follow up: or 3) nonsolid nodules ≥ 15 mm, antibiotics and 1-month follow-up. The first 100 study participants were aged 63 years, standard deviation (SD) 6 years, with a smoking history of 38 pack years, SD 22 pack years; 662 (66%) were former smokers, and 338 (34%) were current smokers; 453 (45%) were men, and 547 (55%) were women. Of the participants, 256 (26%) had a positive baseline low-dose computed tomography (LCDT) scan; 227 (23%) were followed after 3 months and 15 (1.6%) after 1 month; 7 (0.7%) received a contrast-enhanced CT and 6 (0.6%) an immediate CT-guided biopsy. Twenty-six invasive procedures were performed: 22 CT-guided biopsies, 1 ultrasound-guided lymph node metastasis biopsy, 1 bronchoscopic biopsy and 2 surgeries. The malignancy rate of the invasive procedures was 85%. Overall, the malignancy prevalence is 2.2%. Of the malignancies, 20 are lung carcinomas: 19 non-small-cell lung carcinomas (NSCLCs) (14 adenocarcinoma or bronchioalveolar carcinoma [BAC], 4 squamous carcinoma, and 1 large-cell carcinoma) and 1 small-cell carcinoma; 15 (78%) of the NSCLCs are Stage 1. Fourteen patients underwent surgery (1 pneumonectomy, 9 lobectomies, and 4 segmentectomies). Our

  7. The value and limit of multislice CT in the diagnosis of tracheobronchial foreign body%气管、支气管异物的多层CT诊断价值及限度

    Institute of Scientific and Technical Information of China (English)

    胡晓峰; 吕维富; 邓克学; 孙一兵

    2011-01-01

    Objective:To evaluate the clinical application of multi-slice CT(MSCT) in the diagnosis of foreign body of trachea or bronchus. Methods:135 cases with foreign body in trachea or bronchus proved by clinic history and bronchoscopic forceps were collected in the study and all cases were examined with MSCT. The post-processing reconstruction included multiple planar reconstruction (MPR). curve multiple planar reconstruction (CMPR), minimum intensity projection ( MinIP) . Results:The foreign body was showed direcrly in 120 cases (88. 9 % ). The foreign body was showed indirectly in 9 cases and the total positive rate was (95. 6%). In addition, 6 cases showed false negative image, 135 cases were confirmed with fiberoptic bronchoscopy, in which 131 cases were foreign body in traches and bronchi and 4 cases were purulent sputum in bronchus. Radiation dose of CT was much higher than radiation dose of chest X-ray. Conclusion: MSCT scanning is a significant diagnostic technique in detecting the foreign body in trachca or bronchus, but, we should make use of it carefully.%目的:探讨多层CT在气管、支气管异物诊断中的价值.方法:搜集临床怀疑气管、支气管异物135例.所有病例行多层CT检查,原始图像重建采用多平面重组(MPR)、曲面多平面重组(CMPR)、最小密度投影(MinIP),135患者均进行支气管镜检查.结果:135例患者,129例检查结果为阳性,阳性率(129/135)95.6%,CT直接发现异物120例,占(120/135)88.9%,9例患者通过间接征象判断异物存在,6例患者假阴性.135例患者均经纤维支气管镜检查证实,发现误吸异物131例,4例为支气管内浓痰;另外CT辐射量远大于胸片.结论:多层CT是一种很有价值的诊断气管,支气管异物的检查方法,但亦有其限度,我们应该积极审慎应用多层CT.

  8. 电子支气管镜在Ⅲ型食管闭锁术后气管食管瘘复发诊断中的应用%Application of electronic bronchoscopy in diagnosis of recurrent tracheoesophageal fistula of type Ⅲ esophageal atresia

    Institute of Scientific and Technical Information of China (English)

    冯翠竹; 万灝; 陈快; 陶俊锋; 黄金狮

    2016-01-01

    目的 探讨电子支气管镜在Ⅲ型食管闭锁术后气管食管瘘复发诊断中的应用.方法 回顾分析江西省儿童医院自2010年1月-2014年8月收治的5例Ⅲ型食管闭锁术后怀疑气管食管瘘复发的病例,均采用电子支气管镜结合胃管注入美兰方法进行检查.其中,男4例,女1例,检查年龄为2~15个月,平均7.4个月.结果 5例患儿均在电子支气管镜下见到气管膜部瘘口,胃管内注入美兰后可见美兰自气管膜部瘘口溢出,气管食管瘘复发诊断成立.检查时间为3~7 min,平均为4.2 min.此5例患儿均通过手术证实.结论 使用电子支气管镜结合胃管注入美兰的检查方法,用来诊断食管闭锁术后气管食管瘘复发安全可行,检查时间短,确诊率高.%Objective To investigate the application of electronic bronchoscopy in diagnosis of recurrent tracheoe-sophageal fistula of type Ⅲ esophageal atresia. Methods 5 patients were reviewed who were suspected postopera-tive tracheoesophageal fistula recurrence of type Ⅲ esophageal atresia and examined through electronic bron-choscopy combined with injecting Methylene blue into stomach tube from Jan 2010 to Aug 2014. Male to female ra-tio was 4:1. The age was 2~15 months, median age was 7.4 months. Results The 5 cases were found trachea mem-brane fistula by electronic bronchoscope, recurrent tracheoesophageal fistula was diagnosed with Methylene blue in-jected into stomach tube and overflowed from trachea membrane fistula. Examination time is 3~7 minutes, the aver-age is 4.2 minutes. The 5 cases were confirmed by operation. Conclusion Electronic bronchoscopy combined with injecting Methylene blue into stomach tube to diagnose recurrent tracheoesophageal fistula is safe and feasible, the time is short and the diagnosis rate is high.

  9. Radial probe endobronchial ultrasound scanning assessing invasive depth of central lesions in tracheobronchial wall

    Institute of Scientific and Technical Information of China (English)

    LI Jing; CHEN Ping-ping; HUANG Yu; CHEN Zheng-xian

    2012-01-01

    Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques,such as laser,afterloading radiotherapy,cryotherapy,photodynamics treatment,radiofrequency ablation and stenting,etc.The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan.This study used radial probe endobronchial ultrasound (RP-EBUS) scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall,and the influence of RP-EBUS scanning in treatment plan making and guidance.Methods This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy.We performed EBUS scanning after common bronchoscopy under local anesthesia.A radial ultrasonic probe (2.0 mm in diameter with 20-MHz frequency) with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope.The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control.The circular image of EBUS,which revealed the layered structure of the tracheobronchial wall,could be achieved.Results Total of 125 patients were enrolled in the study.Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90% (27/30),sensitivity and specificity were 88.89% (24/27) and 100% (3/3),respectively.In response to EBUS images,40 approaches were altered or guided:lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration (TBNA) (n=8); Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility (n=13),stents size were changed (n=14),operation was canceled (n=3) and foreign body was removed (n=2

  10. Diagnosis and Treatment of Acute EosinophiIic Pneumonia:One Case Report%急性嗜酸粒细胞性肺炎一例诊治分析

    Institute of Scientific and Technical Information of China (English)

    毕贞水

    2015-01-01

    Acute eosinophilic pneumonia( AEP) is a rare type of low incidence of eosinophilic pneumonia diseases, which have various manifestations. The delayed increase of peripheral blood eosinophilic granulocytes is one of its main features and the main reason of its uneasy diagnosis. This paper analyzes the diagnostic process of an AEP patient,who failed to get a definite diagnosis after a number of examinations and was diagnosed as AEP after percutaneous lung biopsy. At this point, peripheral blood eosinophils increased significantly. Its acute onset manifests cough, sputum clinically. In patients with inconspicuous systemic symptoms, chest X - ray or lung CT presented real shadow. The peripheral blood cells should be rechecked for several times and if necessary,electronic bronchoscope combined with bronchialveolar lavage fluid can be used to carry out eosinophilic granulocyte counts in order to make a diagnosis as early as possible.%急性嗜酸粒细胞性肺炎是嗜酸粒细胞性肺疾病的一种少见类型,发病率较低,临床表现多样,外周血嗜酸粒细胞迟发性增高是其主要特点之一,也是早期不易确诊的主要原因。本文报道1例急性嗜酸粒细胞性肺炎患者,其早期经多项检查未能确诊,后行经皮肺穿刺活检术诊断为急性嗜酸粒细胞性肺炎。此时,患者外周血嗜酸粒细胞增高明显。建议对于急性发病,临床主要表现为咳嗽、咳痰,全身症状不明显,而胸片或双肺CT呈实变性阴影者,应多次复查外周血细胞,必要时可采用电子支气管镜结合支气管肺泡灌洗液行嗜酸粒细胞计数检查,以尽早确诊。

  11. 纤维支气管镜检查和经皮肺穿刺活检对菌阴不典型肺结核的诊断价值%Diagnostic value of fiberoptic bronchoscopy and trans-thoracic needle lung biopsy in atypical pulmonary tuberculosis with negative sputum smear

    Institute of Scientific and Technical Information of China (English)

    常占平; 王洪芬; 彭勋; 李艳静; 徐东波; 王晋生; 李站领; 冷学艳

    2012-01-01

    目的 探讨纤维支气管镜检查和CT引导下经皮肺穿刺2种途径对菌阴不典型肺结核的诊断价值.方法 行纤维支气管镜检查516例,根据胸部X线片或CT确定病变部位,在纤维支气管镜下经支气管黏膜活检和肺活检(TBLB) 192例.行CT引导下经皮肺穿刺活检(PNLB)147例,包括纤维支气管镜检查未能确诊71例及直接行PNLB检查76例.结果 516例经纤维支气管镜检查肺结核确诊445例,阳性率86.2%,147例经皮肺穿刺活检肺结核确诊140例,阳性率95.2%,两者差异有统计学意义(P<0.01).2种方法均未出现严重不良反应.结论 纤维支气管镜检查和PNLB对菌阴不典型肺结核的诊断均有很重要的价值,合理地选用这2种方法可提高其确诊率.%Objective To evaluate the diagnostic value of fiberoptic bronchoscopy and CT-guided percutaneous needle lung biopsy ( PNLB ) in atypical pulmonary tuberculosis with negative sputum smear. Methods According to the lesion location on chest X ray or CT images, 516 patients were selected to operate the fiberoptic bronchoscopy and 192 with trans-bronchial mucosa tissue biopsy and trans-bronchial lung biopsy ( TBLB ); 147 patients were selected to operate the CT-guided percutaneous needle biopsy, including 71 patients who failed to make a definite diagnosis by fiberoptic bronchoscopic. Results The positive rates of fiberoptic bronchoscopy and PNLB were 86. 2% ( 445/516 ) and 95. 2% ( 140/147 ), there was statistically significant between them ( P < 0. 01 ). No severe adverse effect was encountered. Conclusion Diagnostic rate could be improved by using two methods rationally which are both important to the diagnosis of atypical pulmonary tuberculosis with negative sputum smear.

  12. SU-C-BRA-07: Virtual Bronchoscopy-Guided IMRT Planning for Mapping and Avoiding Radiation Injury to the Airway Tree in Lung SAbR

    International Nuclear Information System (INIS)

    Purpose: Post-treatment radiation injury to central and peripheral airways is a potentially important, yet under-investigated determinant of toxicity in lung stereotactic ablative radiotherapy (SAbR). We integrate virtual bronchoscopy technology into the radiotherapy planning process to spatially map and quantify the radiosensitivity of bronchial segments, and propose novel IMRT planning that limits airway dose through non-isotropic intermediate- and low-dose spillage. Methods: Pre- and ∼8.5 months post-SAbR diagnostic-quality CT scans were retrospectively collected from six NSCLC patients (50–60Gy in 3–5 fractions). From each scan, ∼5 branching levels of the bronchial tree were segmented using LungPoint, a virtual bronchoscopic navigation system. The pre-SAbR CT and the segmented bronchial tree were imported into the Eclipse treatment planning system and deformably registered to the planning CT. The five-fraction equivalent dose from the clinically-delivered plan was calculated for each segment using the Universal Survival Curve model. The pre- and post-SAbR CTs were used to evaluate radiation-induced segmental collapse. Two of six patients exhibited significant segmental collapse with associated atelectasis and fibrosis, and were re-planned using IMRT. Results: Multivariate stepwise logistic regression over six patients (81 segments) showed that D0.01cc (minimum point dose within the 0.01cc receiving highest dose) was a significant independent factor associated with collapse (odds-ratio=1.17, p=0.010). The D0.01cc threshold for collapse was 57Gy, above which, collapse rate was 45%. In the two patients exhibiting segmental collapse, 22 out of 32 segments showed D0.01cc >57Gy. IMRT re-planning reduced D0.01cc below 57Gy in 15 of the 22 segments (68%) while simultaneously achieving the original clinical plan objectives for PTV coverage and OAR-sparing. Conclusion: Our results indicate that the administration of lung SAbR can Result in significant injury to

  13. Application of different methods of tracheal intubation in patients undergoing cervical vertebra surgery%不同气管插管方法在颈椎手术中的应用

    Institute of Scientific and Technical Information of China (English)

    谢言虎; 柴小青; 音樱; 章蔚; 耿擎天

    2012-01-01

    Objective To compare the outcomes of tracheal intubation with different tecniques of maintain axis stability ( MILS), fiberoptic bronchoscope ( FOB) and blind tracheal intubation instrument (BT1I) in the patients undergoing cervical spine surgery. Methods Ninety patients undergoing selective cervical spine surgery were equally randomized into 3 groups of A (intubation with MILS) ,B (intubation with FOB) and CCintubation with BTII). The events related to intubation were compared among three groups. Results The time spent for intubation in group A was the least among three groups. The success rates of intubation in groups of B and C were 100% and 96. 7%, respectively, which were higher than 80% in group A(P<0. 05). There were no severe complications related to intubation in three groups. Conclusion To reduce the risk for cervical spine injury and increase the success rate of intubation, tracheal intubation in the patients undergoing cervical spine surgery is better to be guided by FOR BTII can provide a new intubation technique for the patients with cervical vertebrae injury.%目的 比较不同气管插管方法在颈椎手术中的应用效果.方法 90例颈椎择期手术患者按插管方法随机均分为三组:A组采用手法保持轴线稳定性(MILS);B组采用纤维支气管镜(FOB);C组采用盲探气管插管装置(BTⅡ).比较三组患者的气管插管相关资料.结果 A组插管费时最少.B、C组插管成功率分别为100%和96.7%,均明显高于A组的80%(P<0.05).三组患者均无严重并发症发生.结论 颈椎手术麻醉宜在FOB引导等技术下实施气管插管,以减少颈椎损伤机率,提高插管成功率.BTⅡ技术可为颈椎损伤患者插管提供了一种新的方法.

  14. 005. History of the recently established bronchoscopy unit of the pulmonology clinic of lamia’s general hospital

    Science.gov (United States)

    Manos, Emmanouil; Gkika, Dimitrs; Kolovos, Dimitrios; Giannakou, Georgia; Pathiaki, Eirini; Mavromati, Evagelia; Divani, Smaroula; Vardouli, Anna; Tsiligrou, Vaina; Karkanis, Konstantinos; Angel, Jacob

    2015-01-01

    Objective The Bronchoscopy Unit of General Hospital of Lamia provides the necessity of six counties in Thessalia and Central Greece. The first bronchoscopy was performed during Christmas of 2012 while from the opening (February 14th, 2014), the unit is presenting an increasing activity (in number and variety of medical practice). Methods From December 21st in 2012 to September 15th in 2014, were performed 158 bronchoscopic examinations in 152 patients (hospitalized and outpatients), 130 men and 28 women, with an average age 72.4 (29 to 89) years old. There were accomplished 80 biopsies (bronchial, transbronchial), 83 brushing, collected 57 cultures for common bacteria and 86 for och-bacilli (acid-fast microscopy in 12), 20 conventional transbronchial needle aspiration (TBNA), two transbronchial biopsies, seven BAL, 25 bronchial toilets in elderly patients and were removed two foreign bodies (one bone segment surrounding by granulomatous tissue and one segment of animal bowel-“kokoretsi”). Results We observed gradual increase of the incoming patients [Quarterly: 5(1st-3rd/2013), 14(4th-6th/2013), 17(7th-9th/2013), 21(10th-12th/2013), 32(1st-3rd/2014), 38(4th-6th/2014), 31(6th-Middle 9th/2014)]. There were diagnosed 70 cases of lung cancer in 93 patients (75.3%) {12 small cell lung carcinoma (SCLC), 57 non-small cell lung carcinoma (NSCLC) [28 squamous, 25 adenocarcinomas, one combo (adeno- and squamous carcinoma), one BAC και two suspicious samples for cancer]}. 49/49 were diagnosed in evident endobronchial lesion (100%) and 21/44 in non-revealing bronchoscopy (47.8%). Biopsy confirmed diagnosis in 52/93, brushing in 31/93, ΤΒΝΑ alone in 4/8 while washing alone in 3/93 patients. Five cases of active tuberculosis were diagnosed (4 M. Τuberculosis, 1 M. Smegmatis), two cases of sarcoidosis, one metastatic (uroepithelial) carcinoma, four cases of granulomatic tissue, one lipoid pneumonia, one sarcomatoid carcinoma of the lung, while the cultures isolated

  15. 原发性肺淋巴瘤3例并文献复习%Three cases of primary pulmonary lymphoma and literature review

    Institute of Scientific and Technical Information of China (English)

    张金梅; 谷伟; 杨振华; 闫海军

    2016-01-01

    目的:探讨原发性肺淋巴瘤的临床特点、诊断和治疗方法,以提高临床医师对该病的认识,减少误诊率。方法对2014年3月至2015年2月在我科确诊的3例原发性肺淋巴瘤患者的临床表现、影像学特点、诊断及治疗方法进行总结。结果原发性肺淋巴瘤的临床表现无特异性,影像学易误诊为肺炎、肺癌等。确诊主要靠经皮肺穿刺、胸腔镜或开胸肺活检获取组织,结合病理学和免疫组化检查。纤维支气管镜检查病理阳性率低。主要治疗手段为化疗。预后与淋巴瘤的恶性程度有关。结论原发性肺淋巴瘤临床表现特异性差,容易误诊,及时进行有创检查有利于其早期诊断。%Objective To study the clinical characteristics,diagnosis and treatment of primary pulmonary lymphoma to improve the clinician awareness of the disease and reduce the misdiagnosis rate. Methods A retrospective analysis of three cases of primary pulmonary lymphoma from March 2014 to February 201 5 was performed,and relevant literatures were reviewed.Results Primary pulmonary lymphoma was difficult to diagnose because of the lack of specific characteristics.Imaging was easily misdiagnosed as pneumonia,lung cancer and so on.Definite diagnosis was made by pathologic and immunohistochemical examinations.The positive rate of bronchoscope examination was low.The reco-mmended first-line therapy was chemotherapy.Prognosis was related to the degree of lymphoma. Conclusions Primary pulmonary lymphoma in clinical specificity is poor,easily misdiagnosed.Appropriate invasive biopsy is necessary for early diagnosis of primary pulmonary lymphoma.

  16. Clinical characteristics of lung cancer confirmed by bronchoscopy:An analysis of 516 patients%516例肺癌支气管镜下特征及临床特点分析

    Institute of Scientific and Technical Information of China (English)

    张令晖; 王慧霜; 朱宝华; 余秉翔; 陈良安

    2011-01-01

    目的 探讨肺癌支气管镜下特征及临床特点.方法 对516例经支气管镜确诊肺癌患者进行回顾性分析.结果 516例肺癌患者中男性384例,女性132例,男女比例2.91:1.其中鳞癌237例(45.93%),小细胞癌158例(30.62%),腺癌llO例(21.32%),其他11例(2.13%).老年组与中年组比较,鳞癌检出率上升、小细胞癌检出率下降.肺癌好发于右肺,双肺上叶多于双肺下叶.支气管镜下表现以直接征象为主占89.15%;鳞癌、小细胞癌以增生性改变为主,分别占68.78%、53.16%;腺癌以浸润性改变为主占48.62%.结论 肺癌临床表现缺乏特异性,气管镜检查是诊断肺癌的重要手段.%Objective To study the clinical characteristics of lung cancer under bronchoscope. Methods Clinical characteristics of 516 patients with lung cancer confirmed by bronchoscopy were retrospectively analyzed. Results Of the 516 patients with lung cancer, 384 were male and 132 were female (2.91:1), 237(45.93%)had squamous cell carcinoma, 158(30.62%) had small cell carcinoma, 110(21.32%)had adenocarcinoma, and 11(2.13%) had other tumors. The detection rate of squamous cell carcinoma was higher while that of small cell carcinoma was lower in old-aged group than in middle-aged group. The lung cancer was mainly located in the right lung and its incidence was higher in upper lobes than in lower lobes. Bronchoscopy showed direct signs of lung cancer in 89.15% patients, proliferative squamous cell carcinoma in 68.78% patients, proliferative small cell carcinoma in 53.16% patients, and infiltrative adenocarcinoma in 48.62% patients, respectively. Conclusion The clinical features of lung cancer are non-specific. Bronchoscopy is an important approach in diagnosis of lung cancer.

  17. 免疫组化在肺小细胞癌和肺非小细胞癌活检标本中的鉴别诊断价值%Application of immunohistochemistry in biopsy specimen for differential diagnosis of small cell lung carcinoma and non-small cell lung carcinoma

    Institute of Scientific and Technical Information of China (English)

    丁岚; 姚晨; 梅霞; 管蕾; 姜纯国; 吴迎春

    2014-01-01

    目的:探讨免疫组化在肺小细胞癌(SCLC)和肺非小细胞癌(NSCLC)鉴别诊断中的作用。方法应用免疫组化SP法,选择肺穿刺及支气管镜活检标本,病理形态疑似SCLC 共72例,检测CD56、Syn、TTF1、CK5/6、CK14、P63、CK7及NapsinA的蛋白表达,分析SCLC的病理形态特征和免疫表型特点及其与NSCLC的鉴别。结果72例肺癌患者中,SCLC共27例,低分化鳞状细胞癌(SCC)共17例,低分化腺癌(ADC)共28例。结论 SCLC和NSCLC在临床治疗上方法不同,充分应用免疫组化可以进行诊断和鉴别诊断,从而可以减少误诊,同时给临床治疗方案的选择提供重要依据。%Objective To investigate the role of immunohistochemistry in the differential diagnosis between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC).Methods The protein expressions of CD56, Syn, TTF1, CK5/6, CK14, P63, CK7, and NapsinA in percutaneous lung biopsy and bronchoscopic biopsy specimens which were suspected as SCLC were examined by immunohistological streptavidin-peroxidase ( SP) method to analyze the pathological characteristics , immunological pheno-typical features , and differential diagnosis between SCLC and NSCLC .Results Among 72 cases of lung cancer patients ,there were 27 cases of SCLC,17 cases of low differentiated squamous cell carcinoma ( SCC) and 28 cases of low differentiated adenocarcinoma ( ADC) .Conclusions It is the different therapy between SCLC and NSCLC , immunohistochemistry analysis of biopsy can provide ac-curate diagnosis of SCLC and NSCLC , which will result in less misdiagnosis and provide an important valuable in the selection of clini -cal treatment protocols for lung cancer patients .

  18. To evaluate the role of sputum in the diagnosis of lung cancer in south Indian population

    Directory of Open Access Journals (Sweden)

    Muniyappa M

    2014-04-01

    the centrally located squamous cell carcinoma rather than the peripherally located adenocarcinoma. Properly collected, simple sputum examination alone can give results similar to other highly expensive methods like bronchoscopic material for the diagnosis of lung cancer. [Int J Res Med Sci 2014; 2(2.000: 545-550

  19. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in intrapulmonary lesions

    Institute of Scientific and Technical Information of China (English)

    ZHAO Hui; XIE Zhen; ZHOU Zu-li; SUI Xi-zhao; WANG Jun

    2013-01-01

    Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered to have high value in the staging of mediastinal lymph nodes in lung cancer.The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway.Methods From September 2009 to March 2013,66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA.Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases.If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy,patients were subsequently referred for a surgical procedure.Results Among the 66 cases,59 were confirmed as pulmonary malignancies by EBUS-TBNA,of which 48 cases were non-small cell lung cancer,nine were small cell lung cancer,and two were metastatic lung tumors.No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases.Thoracoscopy or thoracotomy was subsequently undergone for them.Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung,one case of lymphoma,two cases of sclerosing hemangioma,and one case of pulmonary tuberculoma.The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%.The sensitivity,specificity,and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%,100.0%,and 93.9%,respectively.The positive and negative predictive values were 100.0% and 42.9%,respectively.The EBUS-TBNA procedures were well-tolerated by all patients.No associated complications were observed.Conclusions For intrapulmonary lesions near the central airway highly suspected of cancer,EBUS-TBNA has satisfactory diagnostic value.However,the negative predictive value of this technique is low,so negative results obtained by EBUS-TBNA should be confirmed by other

  20. Differentiation of tuberculous pneumonia and community-acquired pneumonia; usefulness of chest radiography and serum CA-125

    Energy Technology Data Exchange (ETDEWEB)

    Park, Dong Man; Kim, Jeong Sook; Kim, Young Hwan; Kim, Su Young; Hur, Gham; Choi, Soo Jeon [Inje Univ. College of Medicine, Pusan (Korea, Republic of)

    2000-11-01

    To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. Forty-five patients with a high fever (>38 .deg. C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung volume (p < 0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3-1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3-114.8) U/ml (p < 0.005). Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125

  1. Rate of tumor sterilisation of lung cancer by external beam irradiation; Lokale Effizienz der perkutanen Radiotherapie beim Lungenkrebs. Analyse von 215 Rebronchoskopien in Abhaengigkeit von der applizierten Bestrahlungsdosis

    Energy Technology Data Exchange (ETDEWEB)

    Schwegler, N. [Abt. Strahlentherapie, Kantonsspital, Aarau (Switzerland); Vrh, T. [Abt. Strahlentherapie, Kantonsspital, Aarau (Switzerland); Kern, T. [Abt. Strahlentherapie, Kantonsspital, Aarau (Switzerland); Notter, M. [Abt. Strahlentherapie, Kantonsspital, Aarau (Switzerland); Frey, M. [Abt. Pneumologie, Klinik Barmelweid (Switzerland); Grossenbacher, M. [Abt. Pneumologie, Kantonsspital, Aarau (Switzerland); Hausmann, M. [Abt. Pneumologie, Klinik Barmelweid (Switzerland); Pfenninger, T. [Abt. Pneumologie, Kantonsspital, Olten (Switzerland); Ragaz, A. [Abt. Pneumologie, Kantonsspital, Aarau (Switzerland); Schmid, R. [Abt. Innere Medizin, Regionalspital, Muri (Switzerland); Siebenschein, R. [Abt. Pneumologie, Kantonsspital, Baden (Switzerland); Keller, R. [Abt. Pneumologie, Klinik Barmelweid (Switzerland)

    1996-02-01

    The prospective, together with the pneumologists, defined treatment concept included the repetition of bronchoscopic evaluations after the application of 60 Gy and 80 Gy. These radiation doses from 60 Gy up to 80 Gy have been given with a shrinking-field technique to the mediastinum and the primary. In order to record statistically the optical tumor changements we were urged to create a so-called bT-score. The structure of this score was orientated towards the periphery of the tracheobronchial tree. Hundred and forty-four patients with endoscopically and histologically verified bronchogenic carcinomas were treated. On the subjects 215 re-bronchoscopies accomplished with biopsies were performed and allowed to analyze the macro- and microscopical behavior under treatment. A histological/cytological elimination of tumor was achieved after 60 Gy in 35.1%, after 80 Gy in 62.3%. Macroscopically no tumor was visible after 60 Gy in 43.6%, after 80 Gy in 82%. A correlation between identical micro- and macroscopical observations was only seen in 61%, respectively in 71%. The escalation of the radiation dose from 60 Gy up to 80 Gy with shrinked fields could increase the local tumor sterilization rate by 1.8 times from 35.1% to 62.3%. (orig./MG) [Deutsch] Im Rahmen eines mit den Pneumonologen prospektiv festgelegten Behandlungsschemas applizierten wir 60 Gy bis 80 Gy unter progredienter Feldverkleinerung auf Primaertumor und Mediastinum und strebten endoskopische und histologische Untersuchungen nach 60 Gy und 80 Gy an. Um die optisch festgestellten Tumorveraenderungen statistisch erfassen zu koennen, waren wir gezwungen, einen sogenannten bT-Score zu schaffen, dessen Gliederung sich an die Verjuengung des Tracheobronchialbaumes nach peripher orientierte. An 144 endoskopisch und histologisch gesicherten Bronchuskarzinomen wurden 215 Rebronchoskopien - ergaenzt durch Gewebsentnahmen - durchgefuehrt. Die ausgewerteten Resultate gestatteten, das makroskopische und mikroskopische

  2. SU-C-BRA-07: Virtual Bronchoscopy-Guided IMRT Planning for Mapping and Avoiding Radiation Injury to the Airway Tree in Lung SAbR

    Energy Technology Data Exchange (ETDEWEB)

    Sawant, A; Modiri, A; Bland, R; Yan, Y; Ahn, C; Timmerman, R [University of Texas SouthWestern Medical Center, Dallas, TX (United States)

    2015-06-15

    Purpose: Post-treatment radiation injury to central and peripheral airways is a potentially important, yet under-investigated determinant of toxicity in lung stereotactic ablative radiotherapy (SAbR). We integrate virtual bronchoscopy technology into the radiotherapy planning process to spatially map and quantify the radiosensitivity of bronchial segments, and propose novel IMRT planning that limits airway dose through non-isotropic intermediate- and low-dose spillage. Methods: Pre- and ∼8.5 months post-SAbR diagnostic-quality CT scans were retrospectively collected from six NSCLC patients (50–60Gy in 3–5 fractions). From each scan, ∼5 branching levels of the bronchial tree were segmented using LungPoint, a virtual bronchoscopic navigation system. The pre-SAbR CT and the segmented bronchial tree were imported into the Eclipse treatment planning system and deformably registered to the planning CT. The five-fraction equivalent dose from the clinically-delivered plan was calculated for each segment using the Universal Survival Curve model. The pre- and post-SAbR CTs were used to evaluate radiation-induced segmental collapse. Two of six patients exhibited significant segmental collapse with associated atelectasis and fibrosis, and were re-planned using IMRT. Results: Multivariate stepwise logistic regression over six patients (81 segments) showed that D0.01cc (minimum point dose within the 0.01cc receiving highest dose) was a significant independent factor associated with collapse (odds-ratio=1.17, p=0.010). The D0.01cc threshold for collapse was 57Gy, above which, collapse rate was 45%. In the two patients exhibiting segmental collapse, 22 out of 32 segments showed D0.01cc >57Gy. IMRT re-planning reduced D0.01cc below 57Gy in 15 of the 22 segments (68%) while simultaneously achieving the original clinical plan objectives for PTV coverage and OAR-sparing. Conclusion: Our results indicate that the administration of lung SAbR can Result in significant injury to

  3. Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study

    Institute of Scientific and Technical Information of China (English)

    WANG Zhen; WANG Chen; TONG Zhao-hui; LI Hong-jie; ZHAO Ting-ting; LI Xu-yan; XU Li-li; LUO Jing; JIN Mu-lan; LI Rui-sheng

    2008-01-01

    Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy (namely medical thoracoscopy) under local anesthesia for undiagnosed exudative pleural effusions was evaluated.Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups.Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin's lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% (25/27). Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups (P=0.114). Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and

  4. Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的对比应用%Comparison of the Airtraq laryngoscopes and Macintosh laryngoscopes in patients with difficult tracheal intubation

    Institute of Scientific and Technical Information of China (English)

    杨改生; 薛晓东; 夏舒萌; 黄俊梅; 张晋东

    2012-01-01

    laryngoscope ( A group). ECG, non - invasive blood pressure ( NIBP) , SpO2 and end - tidalcarbon dioxide ( ETCO2 ) were monitored. Before induction of anesthesia, all patients were given sufentanil (0. 3 μg/kg) , propofol TCI (4 μg /ml, blood plasma target level) , vecuronium bromide 0. 03 mg/kg to produce loss of verbal response. All patients were administered with suxa-methonium (2 mg/kg). If tracheal intubation failed for two times with the Macintosh or Airtraq laryngoscopes, it should be combined Macintosh laryngoscopes with fiberoptic bronchoscope to complish tracheal intubation. The time of intubation, the number of unsuccessful intubation attempts, changes of haemodynamics, complications during and after laryngoscopy and intubation were documented and compared between the groups. Results In the Macintosh laryngoscope group, 16 patients' tracheal intubation were successfully carried out in one time, 12 patients were successfully carried out in two times, 6 patients failed and required combining Macintosh laryngoscopes with fiberoptic bronchoscope to complish tracheal intubation. Intubation with the Airtraq laryngoscope was quicker ( 35 ± 16 ) s than with the Macintosh laryngoscope ( 82 ± 38) s ( P < 0. 01 ). The changes of blood pressure and heart rate were less in Airtraq group than in Macintosh group (P < 0. 01 ) . Conclusions The Airtraq laryngoscope can raise a-chievement ratio, shorten the duration of trachealintubation, reduce stress reactionand and prevent some complica-tions in difficult airway patients.

  5. Study on tracheal intubation related severe subglottic stenosis under laryngeal mask by using holmium laser combined with argon plasma coagulation and cryotherapy through bronchoscopy%喉罩下经支气管镜钬激光联合氩气刀和二氧化碳冷冻治疗儿童获得性重度声门下狭窄

    Institute of Scientific and Technical Information of China (English)

    许煊; 祝彬; 石苗茜; 任海丽; 封志纯

    2015-01-01

    目的:探讨2例气管插管相关性重度声门下狭窄喉罩下支气管镜诊断及介入治疗的操作方法、有效性及安全性。方法2例男性患儿,年龄分别为4和11个月,因气管插管后出现脱机困难及呼吸困难,经CT及支气管镜检查,诊断为气管插管相关的重度声门下狭窄,在对家长进行详细告知支气管镜下介入手术不可预知情况并由家长签字同意后,遂对2例患儿进行经喉罩支气管镜下钬激光联合氩气刀和二氧化碳( CO2)冷冻治疗,分析患儿的临床资料、并发症及术后转归、随访情况。结果2例手术过程顺利,例1术后紧贴声门下的肉芽组织被完全清除,2例患儿声门下环形狭窄完全解除,治疗前呼吸道狭窄处周长约2.5 mm,治疗后,周长达5.2 mm,4.0 mm支气管镜进出无障碍,术后气管导管均成功拔除,呼吸困难均明显改善。2例患儿治疗后即刻、7 d、30 d和90 d镜下检查结果示狭窄处开放良好。术中有血氧饱和度下降及心率增快或减慢,暂停操作及恢复给氧后立即恢复,术中及术后未见异常血流动力学改变,2例目前仍在随访中。结论经喉罩钬激光、氩气刀及CO2冷冻治疗可用于后天性肉芽组织增生引起的声门下狭窄,方法安全、有效,近期效果显著,远期仍在进一步随访评估。%Objective To explore the operating methods,the effectiveness and safety for 2 cases of tracheal in-tubation related severe subglottic stenosis under laryngeal mask by using bronchoscopy in the diagnosis and interven-tional treatment. Methods Two male patients ( age at 4 and 11 months) both had difficulty breathing and weaning failure after endotracheal intubation,who were diagnosed with severe subglottic stenosis through CT and bronchoscopy examination. All parents signed their consent after being fully informed of treatment risks. Two cases were treated under bronchoscopic holmium laser combined with argon plasma coagulation and

  6. 儿童气管性支气管46例%Clinical analysis of tracheal bronchus in 46 children

    Institute of Scientific and Technical Information of China (English)

    杨泽玉; 王玉; 王彦; 刘文君; 郑兰; 王汉久

    2015-01-01

    Objective To investigate changes in tracheal bronchus (TB) under bronchoscopy and its clinical features in children.Methods The bronchoscopy datum,clinical manifestations and treatments of 46 children with TB from Department of Respiratory Medicine,Anhui Provincial Children's Hospital,were retrospectively analyzed.Results Among 46 cases,31 patients had displaced TB,13 patients had supernumerary TB,and 2 patients had trachea diverticulum.Meanwhile,in 45 cases was located at the right tracheal wall and 1 case was located at the posterior tracheal wall.Besides,20 cases were found accompanied with one type of tracheo bronchial anomalies,and the other 3 patients had 2 types of anomalies.Luminal stenosis,mucous membrane longitudinal fold and/or mucous plug were mostly revealed by bronchoscopy.Clinically,the main symptom s included recurrent or persistent cough,wheezing,refractory pneumonia,atelectasis or hyperinflation in the right upper lobe.Some cases showed no symptoms and were found accidentally by using chest CT or bronchoscope to check other diseases.Through anti-inflammatory and bronchoalveolar lavage (BAL) treatment,symptoms were improved or disappeared in 38 cases,the efficient rate was 82.6%.Conclusions TB is not unusual in pediatric patients,and mainly be found at the right wall of the trachea.Displaced TB is the most common type and frequently accompanied with the other anomalies.TB should be considered when recurrent or persistent cough,wheezing,or refractory pneumonia,atelectasis or hyperinflation in the right upper lobe occurred.Bronchoscopic technology is an important tool in the diagnosis and treatment of children with TB and may be used widely in pediatric diseases clinically.%目的 探讨儿童气管性支气管(TB)的镜下改变及临床特征.方法 对安徽省儿童医院呼吸科46例经支气管镜检查确诊的TB患儿的支气管镜资料、临床表现、治疗及转归情况进行回顾性分析.结果 在46例TB患儿中,移位型31

  7. 喉罩下经支气管镜钬激光联合氩气刀和二氧化碳冷冻治疗儿童获得性重度声门下狭窄%Study on tracheal intubation related severe subglottic stenosis under laryngeal mask by using holmium laser combined with argon plasma coagulation and cryotherapy through bronchoscopy

    Institute of Scientific and Technical Information of China (English)

    许煊; 祝彬; 石苗茜; 任海丽; 封志纯

    2015-01-01

    目的:探讨2例气管插管相关性重度声门下狭窄喉罩下支气管镜诊断及介入治疗的操作方法、有效性及安全性。方法2例男性患儿,年龄分别为4和11个月,因气管插管后出现脱机困难及呼吸困难,经CT及支气管镜检查,诊断为气管插管相关的重度声门下狭窄,在对家长进行详细告知支气管镜下介入手术不可预知情况并由家长签字同意后,遂对2例患儿进行经喉罩支气管镜下钬激光联合氩气刀和二氧化碳( CO2)冷冻治疗,分析患儿的临床资料、并发症及术后转归、随访情况。结果2例手术过程顺利,例1术后紧贴声门下的肉芽组织被完全清除,2例患儿声门下环形狭窄完全解除,治疗前呼吸道狭窄处周长约2.5 mm,治疗后,周长达5.2 mm,4.0 mm支气管镜进出无障碍,术后气管导管均成功拔除,呼吸困难均明显改善。2例患儿治疗后即刻、7 d、30 d和90 d镜下检查结果示狭窄处开放良好。术中有血氧饱和度下降及心率增快或减慢,暂停操作及恢复给氧后立即恢复,术中及术后未见异常血流动力学改变,2例目前仍在随访中。结论经喉罩钬激光、氩气刀及CO2冷冻治疗可用于后天性肉芽组织增生引起的声门下狭窄,方法安全、有效,近期效果显著,远期仍在进一步随访评估。%Objective To explore the operating methods,the effectiveness and safety for 2 cases of tracheal in-tubation related severe subglottic stenosis under laryngeal mask by using bronchoscopy in the diagnosis and interven-tional treatment. Methods Two male patients ( age at 4 and 11 months) both had difficulty breathing and weaning failure after endotracheal intubation,who were diagnosed with severe subglottic stenosis through CT and bronchoscopy examination. All parents signed their consent after being fully informed of treatment risks. Two cases were treated under bronchoscopic holmium laser combined with argon plasma coagulation and

  8. Propofol Combined with Remifentanil on Tracheal and Bronchial Foreign Body Removal in Children%异丙酚联合瑞芬太尼在小儿气管异物取出术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    温晓娟

    2015-01-01

    Objective:To investigate the effect of propofol combined with remifentanil on tracheal and bronchial foreign body removal in children .Methods:In 86 cases of tracheal and bronchial foreign body removal in children .Using the method of random number table ,the cases were randomly divided into the observation group and control group .Obser-vation group:1 .0μg/kg remifentanil ,1 .5mg/kg propofol intravenous pumping anesthesia ,control group:1 .0mg/kg of ketamine ,1 .0mg/kg propofol intravenous pumping anesthesia .The two groups were spontaneously breathing ,to start operation after sleeping .Anesthesia maintain , the observation group:remifentanil to 0 .2 ~ 0 .5mg/kg per minute , propofol 2 .0~3 .0mg/kg per minute doses of continuous intravenous pumping ;the control group according to individu-al children with additional ketamine .1% tetracaine throat and trachea surface anesthesia .High frequency jet ventilation was applied in two groups .Record the operation time ,wake up of time ,and during the operation ,adverse reactions oc-curred in the operation situation;observe conditions and frequency of bronchoscope .Results:There was statistic signifi-cance in the operation time ,recovery time ,conditions and frequency of bronchoscope ,the adverse reaction of the patients with the incidence (P<0 .05) ,the observation group were better than the control group .Conclusion:Propofol combined with remifentanil on tracheal and bronchial foreign body removal in children ,satisfactory anesthesia effect ,less adverse reaction .%目的:探讨异丙酚联合瑞芬太尼在小儿气管异物取出术中的临床应用效果.方法:纳入86例气管异物患儿 ,按照随机数字表法分为观察组和对照组 ,每组43例.观察组:1 .0μg/kg瑞芬太尼、1 .5mg/kg异丙酚静脉泵入麻醉 ,对照组:1 .0mg/kg氯胺酮、1 .0mg/kg异丙酚静脉泵入麻醉.两组均保留自主呼吸 ,待患儿熟睡后手术开始.术中麻醉维持 ,观察组:瑞芬太尼以每分钟0

  9. High dose-rate brachytherapy as a treatment option in primary tracheal tumors Braquiterapia de alta taxa de dose como opção terapêutica nos tumores primários da traquéia

    Directory of Open Access Journals (Sweden)

    Heloisa de Andrade Carvalho

    2005-08-01

    Full Text Available PURPOSE: To present experience with high dose-rate endobronchial brachytherapy in the treatment of primary tracheal tumors. PATIENTS AND METHODS: Four patients with nonresected primary tracheal tumors are presented: 2 cases of squamous cell carcinoma of the trachea, 1 of recurrent adenoid cystic carcinoma, and 1 with recurrent plasmacytoma. All received brachytherapy, alone or as a boost for primary irradiation, in 3 or 4 fractions of 7.5 Gy, calculated at a depth of 1 cm. Follow-up was considered to start from the end of brachytherapy. RESULTS: Local control was achieved in all cases at the time of first bronchoscopic evaluation. Two patients with squamous cell carcinoma died at 6th and 33rd months after brachytherapy, respectively. The first had no evidence of disease, and the latter had local recurrence. The other 2 patients were alive after 64 and 110 months of follow-up, respectively, both with no evidence of disease. Tracheal stenosis developed in these 2 cases, 22 and 69 months after brachytherapy. Tracheal stent placement was needed only for the patient with an adenoid cystic carcinoma. CONCLUSIONS: Endobronchial high dose-rate brachytherapy may be used for tracheal tumors, even as a boost for external beam irradiation, or in recurrences. Local control in 3 out of 4 patients indicates that individual cases may benefit from the treatment. Long-term survival may also be expected, mainly for tumors with adenoid cystic histology.OBJETIVO: Apresentar a experiência do tratamento de 4 pacientes com tumores primários de traquéia, não operados, submetidos à braquiterapia endobrônquica de alta taxa de dose. PACIENTES E MÉTODOS: Dois casos de carcinoma espinocelular, uma recidiva de carcinoma adenóide cístico e uma recidiva de plasmocitoma primário da traquéia. Todos receberam braquiterapia endobrônquica, exclusiva ou como reforço de dose da radioterapia externa. Foram administradas 3 ou 4 frações de 7,5 Gy cada, calculados a 1 cm de

  10. Does high dose rate irradiation of obstructive intrabronchial malignancy justify the high cost? A study of 83 patients

    International Nuclear Information System (INIS)

    Purpose: Over a 6 year period, 1989 through 1994, 83 patients (pts) (76 pts with primary lung carcinoma (ca) and 7 pts with a solitary metastic lesion to the lung) and with bronchoscopically identified obstructive tumor, causing symptoms (sx's) of cough, hemoptysis and/or shortness of breath (SOB) were treated with high dose rate (HDR) Ir-192 intrabronchial irradiation (XRT), and are the basis of this study. The purpose of this retrospective study is to determine the survival and relief of sx's, compare our results to those in the classic radiation oncology lung ca literature, and determine if the improvement is sufficient to justify the high cost of adding HDR XRT to standard external beam XRT. Methods and Materials: 44 pts presented with de novo disease and initially received a course of external beam XRT (5000 - 6000 cGy, standard fractionation) followed by 3 HDR tx's of 800 cGy per treatment (tx) calculated at one cm depth, separated by one week intervals, for a total HDR dose of 2400 cGy. 39 pts presented with locally recurrent disease following prior tx with external beam XRT, and they received 3 HDR tx's, 1000 cGy per tx, one cm from the center of the catheter, separated by one week intervals, for a total dose to the tumor of 3000 cGy. All patients presented with one or more obstructive sx's. Relief of these sx's were determined at last follow-up (FU) or until death. All patients have been followed for a minimum of 6 months (mos). Results: Our results show overall median survivals of 13 mos since initial diagnosis and 6 mos since treatment. In light of these results, we attempted to determine a subgroup of patients who might have a statistically significant increase in survival. The subgroups we analyzed were 1) pts with recurrent disease, 2) those treated in later years of the study, surmising we were more selective as our experience increased, 3) squamous histology with its natural history to remain localized, and 4) younger patients, age below 50. Our

  11. 原发性支气管肺淀粉样变9例临床分析%Primary bronchial and pulmonary amyloidosis:A clinical analysis of 9 cases

    Institute of Scientific and Technical Information of China (English)

    张丽娜; 孙军平; 张明月; 刘玉霞; 杨冰; 薛新颖; 汪建新

    2014-01-01

    shadows in diffuse pulmonary interstitial parenchymal amyloidosis patients. The prognosis of pulmonary nodular parenchymal amyloidosis patients was usually good. Tracheobronchial amyloidosis usually exacerbated due to repeated infections and required bronchoscopic interventional therapy, anti-inflammation therapy, and cough-suppressing or phlegm-resolving therapy. The prognosis of diffuse pulmonary interstitial amyloidosis patients was usually poor. Conclusion Primary bronchial and pulmonary amyloidosis has no specific clinical and imaging manifestations, and is diagnosed according to its pathology. Expectant treatments such as anti-inflammation therapy can alleviate its symptoms.

  12. Achados de fibrobroncoscopia em pacientes com diagnóstico de neoplasia pulmonar Fiberoptic bronchoscopy findings in patients diagnosed with lung cancer

    Directory of Open Access Journals (Sweden)

    Marcelo Fouad Rabahi

    2012-08-01

    involving 212 patients with a confirmed diagnosis of lung cancer by cytological evaluation of BAL specimens or by histopathological evaluation of endobronchial or transbronchial biopsy specimens. The data were collected at the Respiratory Endoscopy Sector of Hospital São Salvador, located in the city of Goiânia, Brazil, between 2005 and 2010. The endoscopic findings were classified as endoscopically visible tumor, endoscopically invisible tumor, mucosal injury, as well as being classified by the presence/type of secretion. The visible tumors were also classified according to their location in the tracheobronchial tree. RESULTS: Endobronchial mass (64% and mucosal infiltration (35% were the main endoscopic findings. The histological type was determined in 199 cases, the most prevalent types being squamous carcinoma, in 78 (39%, adenocarcinoma, in 42 (21% small cell carcinoma, in 24 (12%, and large cell carcinoma, in 2 (1%. More than 45% of the visible tumors were at the upper bronchi. Squamous carcinoma (n = 78 was most commonly visualized as an endobronchial mass (in 74%, mucosal infiltration (in 36%, luminal narrowing (in 10%, or external compression (in 6%. CONCLUSIONS: Our results show that the endobronchial mass is the most common bronchoscopic finding that is suggestive of malignancy. Proportionally, mucosal infiltration is the most common finding in small cell carcinoma. In adenocarcinoma, luminal narrowing, external compression, mucosal injury, and endobronchial secretion prevail.

  13. Clinical value of virtual bronchoscopy in early diagnosis of central malignant lung neoplasm in high risk patients

    International Nuclear Information System (INIS)

    Virtual bronchoscopy (CT-VB) is a recently developed 3D visualization technique that employs thin-section spiral computed tomographic data of the thorax for non-invasive evaluation of the tracheo-bronchial tree. The purpose of this study was to compare the efficacy of multislice-CT virtual bronchoscopy in detecting early endobronchial manifestation of central lung cancer with that of flexible fiberoptic bronchoscopy. For this purpose, a group of 50 high risk patients (cigarette pack-years, long standing history of COLD) underwent both FOB and CT-VB investigation. Multislice CT was performed using the following parameters: collimation, 1 mm; pitch factor, 0.937-1.375; reconstruction interval, 0.8 mm and postprocessing was based on volume rendering technique. Images of eight standard tracheo-bronchial sections were obtained from each patient both during FOB and CT-VB and were independently interpreted respectively by a pneumologist and a bronchiseptica. Airway evaluation was based on the analysis of changes in the mucosal architecture, the shape of the ostia and of the carinae and on the presence of secretion deposits as early signs of tumor onset. The sensitivity of virtual bronchoscopy in discriminating diseased from healthy patients was 94 % and its specificity 65 %. Its positive predictive value 56 % and its negative predictive value 96 %. According to the ROC analysis, except for the assessment of the secretion deposits, the other three criteria evaluated separately during virtual bronchoscopic assessment of the airways contributed equally in discriminating diseased from disease-free patients (areas under curve ranging between 0,797 and 0,845). The best AUC was associated with the evaluation of the sum of all three parameters together (0,858). Nevertheless, FOB and CT-VB results in the evaluation of the shape of the ostia resulted to agree moderately while just a fair agreement was observed with respect to the evaluation of the mucosal architecture and of the

  14. 经支气管镜确诊的2168例肺癌的临床特点分析%Analysis of Clinical Features of 2 168 Confirmed Cases of Lung Cancer Diagnosed by Bronchoscopy

    Institute of Scientific and Technical Information of China (English)

    张宇; 于力克; 谢海燕; 胡韦华; 郝可可; 夏宁

    2011-01-01

    Objective To investigate the clinical characteristics of confirmed cases of lung cancer diagnosed by bronchoscopy. Methods A retrospective analysis was conducted to study the clinical features such as gender,age,pathologic type,lesion location,bronchoscopic image and sampling method of 2,168 confirmed cases of lung cancer diagnosed by bronchoscopy. Results The sex ratio (M/F) was 4.8 : 1 and the peak incidence was between 60 to 69 years of age. The most common pathologic type was squamous cell carcinoma (44.56%),followed by adenocarcinoma (25.92%) and small cell lung cancer (18.27%). Squamous cell carcinoma had the highest incidence rate (50.61%) a-mong men,while adenocarcinoma had the highest rate among women (56.18%). The positive rates diagnosed by forceps biopsy,brush biopsy,bronchial alveolar lavage and transbronchial needle aspiration were 81.60%,49.37%, 18.24% and 62.65% respectively. The positive rate by forceps biopsy combined with brush was 89.06%. Conclusion Bronchoscopy is an important approach in the diagnosis of lung cancer. The incidence and pathologic type of lung cancer vary depending on age and gender. Bronchoscopy and improving biopsy technique can markedly increase the diagnostic rate and help in early diagnosis of lung cancer.%分析经支气管镜确诊肺癌的临床特点.方法 回顾性分析经支气管镜确诊为肺癌的2 168例患者的性别、年龄、病理类型、病变部位、镜下表现、取材方法等特点.结果 该组患者男女比例为4.8:1,60~69岁为发病年龄高峰.鳞癌是最主要的病理类型(占44.56%),其次为腺癌(占25.92%)和小细胞癌(占18.27%).男性鳞癌发病率最高(占50.61%),女性腺癌发病率最高(占56.18%).钳检、刷检、支气管肺泡灌洗、经支气管镜针吸的诊断阳性率分别为81.60%、49.37%、18.24%和62.65%,钳检联合刷检阳性率为89.06%.结论 支气管镜检查是诊断肺癌的重要手段.不同年龄、不同性别的肺癌患者发病不同,病

  15. Clinicopathological features of a squamous cell carcinoma of the lung harboring ALK rearrangement and with crizotinib responsivity%ALK阳性并克唑替尼治疗有效肺鳞状细胞癌临床病理分析

    Institute of Scientific and Technical Information of China (English)

    穆晶; 吴卫华; 蔡毅然; 苏丹; 张海青

    2015-01-01

    Objective To observe the clinicopathological characteristics of the patient with ALK rearrangement in squamous cell carcinoma of the lung(SCCL)and analyze the responsivity of clinical therapy and prognosis of the patient. To explore the necessity of ALK testing in SCCL. Methods A 54-year-old woman was involved in this observation. The clinical records,computerized tomographic checkup,pathological morphol-ogy and immunohistochemistry of the case were discussed. ALK rearrangement was screened by using immunohistochemistry on Benchmark XT au-tostainer. Results A 54-year-old,female,never-smoking patient presented with left back pain and cough,expectoration for two months. Com-puted tomography revealed a mass in left hilar area with bronchial stenosis in superior lobe of the left lung. Bronchoscopic exploration showed that a mass prominent to the cavity of left upper lobe bronchus and blocked airway. MRI scanning of the brain and bone scanning verified the presence of metastasis. She was diagnosed as squamous cell carcinoma without EGFR mutation. Ventana immunohistochemistry showed positive ALK expression. This case was administrated gemcitabine combined with cisplatin as first-line chemotherapy for 2 cycles,but tumor still got progression;however, when she received crizotinib therapy,the primary tumor shrank. Progression-free survival was 6 months. Conclusion ALK rearrangement in SCCL is uncommon,crizotinib showed effective in ALK-positive SCCL. So it is necessary for SCCL to screen ALK rearrangement.%目的:观察间变性淋巴瘤激酶( ALK)融合基因阳性肺鳞状细胞癌( SCCL)临床病理特征、临床治疗效果,探讨对肺鳞癌患者进行ALK融合基因检测的必要性。方法 Ventana全自动免疫组化染色检测l例ALK蛋白阳性肺鳞状细胞癌患者,结合临床及影像学资料,观察组织学形态和常规免疫组化染色,分析患者临床治疗及预后。结果患者女性,54岁,不吸烟,因左背

  16. Experience of donation after citizens death for lung transplant: report of 19 cases%公民逝世后器官捐献供肺的评估及获取经验19例报告

    Institute of Scientific and Technical Information of China (English)

    徐海英; 毛文君; 陈静瑜; 刘筱凌; 周文娟

    2014-01-01

    Objective To summarize the experience of harvesting and using the lungs from donation after citizens death.Method From November 2007 to December 2013,19 cases of potential donation after brain death (DBD) and donation after cardiac death (DCD) were evaluated,including 9 cases of DCD and 10 cases of DBD.All the patients received the tests of sputum culture,bedside bronchoscopes,chest X rays,and blood gas analysis.After clear evaluation,3 cases of DCD and 3 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and the rest one case of DCD was precluded due to long warm ischemic time (>60 min).The donor lungs from remaining 12 cases were harvested successfully after the declaration of brain death or cardiac death.The donors suitable for the transplant procedure were transported to our transplant center.Result Twelve lung transplants were performed successfully,including 10 cases of bilateral lung transplantation and 2 cases of right single lung transplantation.Two patients was complicated with severe infection and died of sepsis postoperatively,and the remaining 10 patients all recovered uneventfully with dramatic improvement of pulmonary function.During the follow-up period,all the patients lived an active life style with high quality of life.The mean survival time was 34.7 months (4-60 months).Conclusion Lung transplantation using DCD and DBD can be successfully performed after adequate preoperative evaluation of donor lung and abundant preparation for donor harvesting.%目的 总结公民逝世后器官捐献供肺的评估及获取经验.方法 回顾总结2007年11月至2013年12月19例潜在器官捐献者的资料.对所有供者进行了术前评估,均行痰培养、床旁支气管镜、胸部X线片及血液气体分析等检查.19例供者中,9例为心脏死亡器官捐献(DCD)供者,10例为脑死亡器官捐献(DBD)供者.经评估7例供肺无法利用,其中3例DCD和3例DBD供者因两肺广

  17. Root cause analysis on poor position of Supreme laryngeal mask airway%Supreme喉罩对位不良的原因观察

    Institute of Scientific and Technical Information of China (English)

    吴玥; 金孝岠; 姚卫东; 鲁美静; 喻君

    2014-01-01

    目的:本研究旨在观察分析Supreme喉罩( SLMA)对位不良的原因。方法:对SLMA置入时出现对位不良的患者,利用纤支镜观察和超声实时成像检查的方法明确SLMA对位不良时的位置、原因。结果:22例初次置入对位不良的SLMA应用患者纳入观察。12例患者经再次尝试后置入成功,其余患者经其他器械辅助后成功。对位良好时SLMA位置:喉罩的食管引流管尖端已入食道入口,气囊位于甲状软骨及会厌软骨的背侧。对位不良时SLMA位置:喉罩的食管引流管尖端尚未进入食道入口,止于声门联合后缘、杓状软骨上方,气囊位于会厌软骨及舌根的背侧。结论:SLMA置入深度不足,喉罩前端不能进入食管入口,是SLMA对位不良的主要原因;而阻隔喉罩前端进一步置入食管入口的障碍主要是喉的背侧结构,如声门联合后缘或杓状软骨。%Objective:To conduct a root cause analysis on the deficient position of Supreme laryngeal mask airway ( SLMA) .Methods:Poor position of the SLMA in patients was corrected under assistance of fiber-optic bronchoscope (FOB) and portable ultrasound system,and the root causes were analyzed. Results:Totally,poor position occurred in 22 cases by initial attempt.Position was successful by second try in 12 cases,and the remaining were managed with auxiliary equipments.Perfect SLMA position relied on access of the suction tube tip to the entry point of esophagus ,and the airbag was maintained at the dorsal thyroid cartilage and epiglottis,whereas deficient position was associated with a gap between the suction tube tip and entry point of the esopha-gus,and the tube tip being just kept over the joint of vocal cords and arytenoids cartilage as well as the airbag was stuck at the back of tongue root and epi-glottis.Conclusion:Poor position of the SLMA is primarily involved in deficient insertion of the tube into the esophagus ,and the insertion

  18. Reseach of the Value of three-dimensional reconstruction technique with spiral CT in detection of tracheobronchial foreign bodies in children%浅析螺旋 CT 三维重建技术在儿童气道阴性异物诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    冯坤鹏

    2014-01-01

    objective: to investigate the Value of three-dimensional reconstruction technigues with spiral ct in detection of tracheobronchial foreign bodies in children.Methods from february 2014 to august 2014 in our hospital, 34 children cases of tracheobronchial foreign bodies were referred to spiral ct scanning and three-dimensional reconstruction,and compared the results with the bronchoscope.Results 34 patients were gained clear images.27 foreign bodies were found by spiral ct .25 foreign bodies were found at the same place by spiral ct and bronchoscopy.2 cases shown false-negative image by spiral ct,and it turns to be sputum block,after removed by suction no foreign body was found by spiral ct , spiral ct and bronchoscopy results meet the rate of 92.6%.7 cases were shown no foreign bodies by spiral CT, after anti-inflammatory treatment 7 cases both discharged.Conclusion spiral ct reconstruction techniques is a non-invasive, accurate, rapid diagnostic method to evaluate the airway foreign body, so it is valuable to judge tracheobronchial foreign bodies in children.%目的:探讨螺旋 ct 三维重建技术在儿童气道阴性异物诊断中的应用。方法对2014年2月至2014年8月于我院收治的34例疑为气道阴性异物的患者进行螺旋 ct 扫描及三维重建,并与气管镜结果对比。结果34例患者均获得清晰的图像,其中27例患儿经螺旋 ct 三维重建诊断为气道异物,25例与支气管镜检查结果一致,假阴性患者2例,支气管镜检查为痰痂块,吸除后未见异物,螺旋 ct 三维重建与气管镜结果符合率为92.6%。7例患者经螺旋 ct 三维重建显示无异物,经抗炎治疗好转后出院。结论螺旋 ct 三维重建技术可准确评价气道异物,是无创、快速的诊断方法,在诊断气道阴性异物中具有重要的应用价值。

  19. STUDY OF TIME LAPSE IN FOREIGN BODY ASPIRATION IN RELATION TO CHEST X - RAY AND TYPE OF FOREIGN BODY

    Directory of Open Access Journals (Sweden)

    Salma

    2015-10-01

    Full Text Available INTRODUCTI ON: Foreign body aspiration in pediatrics is a potentially fatal accident which will continue until children explore their surroundings with their hand and mouth. Pediatric aspirations will persist until mankind exists. Not all foreign body aspirations are witnessed hence chances of delay in diagnosing an aspiration are high. Delay in diagnosis depends on site and character of foreign body aspirated. The chest x - ray findings and type of foreign body extracted vary depending on the duration the foreign body remains in airway . OBJECTIVE: To study the X - ray finding in pediatric airway aspiration and its relation to time lapse, the type and site of lodgment of foreign body extracted via bronchoscopy. The type of foreign body in relation to time lapse in aspiration. MATERIAL AND METHODS: This was a prospective study done in Bapuji child health institute and research center, JJM Medical College, Davangere . History and pre bronchoscopy x - Ray finding were noted for 65 children who were posted for suspicious bronchoscopy from August 2011 to September 2013. 11 children were excluded from study as they showed no foreign body on bronchoscopy. Time lapse in aspir ation and seeking medical care was noted. The bronchoscopic findings regarding site of foreign body lodgment and type of foreign body were recorded. The type of foreign body and variation of x - ray picture in relation to time lapse in aspiration were noted. Data collected was analyzed using descriptive statistics. RESULT: It was observed that mean age was 28 months. About 80% of the cases were between 1 to 3 years age. 82% (n=53/54 were radio lucent foreign body, only 1.5% (n=1/54 were radio o paque. Site of lodgment of foreign body was right main bronchus in 48% (n=26/54, left main bronchus 46% (n=25/54 , tracheal 1.85% (n=1/54, subglottic 1.85% (n=1/54, carinal 1.85% (n=1/54, multiple site i.e. left bronchus +right bronchus+ carinal 1.85% (n=1/54. Groundnut was most common

  20. 氩气刀配合分叉型被膜金属支架置入治疗气管隆突处狭窄16例%Argon plasma coagulation combined with bifurcated metal stents for treatment of airway stenosis in the carinal region A 16-case analysis

    Institute of Scientific and Technical Information of China (English)

    王洪武; 周云芝; 马洪明; 罗凌飞; 李晶; 邹珩; 李冬妹

    2009-01-01

    纳入16例气管隆突处气道狭窄患者,其中良性病变4例,恶件病变12例.对气道内病变先用氩等离子体凝固清除,随后放置气道分叉型金属支架.所选支架均为国产Z型不锈钢被膜支架.L型及I型支架均在软质气管镜引导下放置,Y型支架在气管镜和透视结合下放置.氩等离子体凝固治疗前气管、左、右主支气管的阻塞程度分别为(58.8±9.1)%,(67.4±7.4)%及(69.6±8.9)%,氩等离子体凝固首次消融后的阻塞程度分别为(7.5±2.4)%,(19.4±4.1)%及(27.6±5.4)%.所有患者胸闷、气憋症状均有明显改善,气促指数降低,体能状况Kamofsky评分增高.12例患者一次成功放置支架,其中9例为Y型:4例放置失败,其中2例肺癌患者隆突较宽,Y型支架难以置入,改用L型+I型.患者中位生存时间为10个月,平均生存时间为13个月.结果提示,氩等离子体凝固结合分叉型被膜金属支架置入治疗气管隆突处狭窄可以改善患者梗阻症状,提高生活质量.%A total of 16 patients with airway stenosis including benign lesion (n=4) and malignant disease (n=12) were treated with argon plasma coagulation (APC) and Z-type covered retrievable metallic stent.L-and I-type stents were placed by guidance of brenchoscope,while Y-type stent was placed by the guidance of both bronchoscope and fluoroscope.Airway stenosis was from (58.8 +9.1)% before APC to (7.5±2.4)% after APC in tracheal,from (67.4±7.4)% to (19.4±4.1)% in left main bronchus,from (69.6±8.9)% to (27.6±5.4)% in right main bronchus.Symptoms of chest distress and breathlessness were improved remarkably,tachypnea indexes were decreased,but Kamofsky performance scope were increased.Twelve stents were successfully installed by the first time,including 9 Y-shape;otherwise,4 stents failed to be installed because the carinal was too wide to insert the Y-shape stent in two patients with lung cancer,finally,L+I type stents were used.Median survival time after successful

  1. 催眠镇痛肌松下选择性患侧肺控压吹张治疗术后顽固性肺不张的疗效%Effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperatively intractable atelectasis in hypo-analgesia and muscle relaxation

    Institute of Scientific and Technical Information of China (English)

    陆雅萍; 方向明; 胡奕; 黄冰; 孙建良; 施谷平

    2011-01-01

    Objective To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis. Methods For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning,closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day. Results Collapsed lung tissue were examined in 15 patients (83.3%) after the first treatment and in 2 patients ( 11. 1% ) after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred. Conclusion Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.%目的 探讨选择性患侧肺支气管插管控压吹张治疗术后顽固性肺不张的临床效果.方法 将嘉兴市第一医院2005年1月至2010年5月18例接受纤维支气管镜吸痰、胸腔闭式负压引流、拍背、吹气球等常规综合治疗7 d仍不能使患肺复张者在催眠镇痛术下行支气管插管选择性患侧肺控压吹张治疗,由胸部听诊及次日胸部X线片评判疗效.结果 术后第2天复查X线胸片,15例患者(83.3%)萎陷肺已全部复张,3例患者萎陷侧肺复张不完全,经第2次控压膨肺治疗后2例复张成功(11.1%,总有效率94.4%),另1例患者经3次膨肺治疗仍无效(5.6%).期间患者生命体征稳定,无插管损伤及其他并发症发生.结论 在催眠镇痛肌松下由纤维支气管镜引导选择性支气管插管控压吹张治疗术后顽固性肺不张是切实可行的.

  2. 氧瞬得可视喉镜用于意外困难气管插管20例临床分析%The use of airtraq oPtical laryngoscoPe in unanticiPated difficult tracheal intubation of 20 Patients

    Institute of Scientific and Technical Information of China (English)

    李光元; 李明强

    2014-01-01

    Objective To summarize the experiences usinG the Airtraq optical larynGoscope( AL)in the manaGement of unanticipated difficult endotracheal intubation. Methods Twenty surGical patients with General anesthesia usinG tracheal intubation were induced with propofol-remifentanyl and injected with atracuriun (0. 5 mG/kG). And then,larynGoscope with Macintosh directly throuGh oral tracheal intubation,and located the tracheal intubation by end tidal carbon dioxide detection method. AttemptinG oral tracheal intubation with Macintosh larynGoscope were failed for twice time,the AL was used to accomplish tracheal intubation. Results In all the patients,tracheal intubations with AL as a rescue intubation device Got clear GradeⅠCormack-Lehane Glottis exposure,with once-time successful intubation attemptinG in l8 patients. But in other 2 patients,tracheal intubations were accomplished by combined use of a fibreoptic bronchoscope which GuidinG tracheal tube into the Glottis throuGh AL after tracheal tube slidinG backward into the esophaGus repeatedly. DurinG the intubation attempts,interval mask ventilation were Given maintaininG SaO2≥90% in all patients. Conclusion AL offers an new effective technique as a rescue airway device in deal with unanticipated difficult tracheal intubation.%目的:总结应用氧瞬得可视喉镜处理意外困难气管插管的临床经验。方法20例拟在气管插管全身麻醉下手术的患者,以丙泊酚-瑞芬太尼静脉诱导,阿曲库铵0.5 mG/kG 静脉注射后以Macintosh 直接喉镜行经口明视下气管插管术,以呼气末二氧化碳检测法确定气管导管位置。直接喉镜试插2次未能成功,改用氧瞬得可视喉镜引导插管。结果20例患者改用氧瞬得喉镜气管插管后,声门显露完整清楚,C-L分级均为l级,l8例气管插管l 次成功,2例通过喉镜观察到导管向后反复滑入食道,经联合使用纤维支气管镜引导,气管导管插入成功;插管过程

  3. A correção das estenoses traqueobrônquicas mediante o emprego de órteses Therapeutic management of tracheobronchial stenosis with stent application

    Directory of Open Access Journals (Sweden)

    MAURÍCIO GUIDI SAUERESSIG

    2002-04-01

    Full Text Available O tratamento cirúrgico do paciente com estenose traqueobrônquica exige uma avaliação individualizada em razão da complexidade de sua origem, sendo a traqueoplastia considerada a modalidade ideal. As causas mais comuns de estenose são devidas à intubação traqueal e ao desenvolvimento de neoplasias e estas condições são justamente as que mais se beneficiam com o tratamento endoscópico quando a correção cirúrgica não está indicada. Na atualidade, os meios endoscópicos incluem a aplicação de diversos tipos de laser e sondas de dilatação, habitualmente com o uso de broncoscópio rígido, e emprego de radioterapia e órteses, separadamente ou em associação. Basicamente, as órteses são de dois tipos: metálicas e de silicone. As metálicas têm sua indicação mais freqüente para os casos de traqueomalacia e estenoses por compressão neoplásica extrínseca. Nos casos de obstrução da via aérea por inflamação aguda, restrita à sua luz ou sem envolvimento mais profundo da parede traqueobrônquica, ou em presença de neoplasia endoluminal, é recomendável a órtese de silicone. Embora em algumas situações essas diversas formas de tratamento possam ser intercambiáveis, não costumam ser a regra. Portanto, a estratégia terapêutica visando à resolução mais eficaz da estenose traqueobrônquica baseia-se na seleção dos métodos empregados desde o primeiro tratamento.The surgical treatment of patients with tracheobronchial stenosis requires individualized attention due to the complexity of its origin though tracheoplasty is considered to be the ideal procedure. The most common causes of stenosis are tracheal intubation and the development of neoplasias. These are the very conditions that most benefit from endoscopic treatment when surgical correction is not indicated. Today, endoscopic procedures include the application of different kinds of laser and dilators usually delivered with a rigid bronchoscope, as well as

  4. 平扫液体衰减反转恢复及增强T1WI序列对脑转移瘤的综合诊断价值%Synthetic diagnostic value of plain FLAIR combined with contrast-enhanced T1WI sequence in intracranial metastatic tumor

    Institute of Scientific and Technical Information of China (English)

    刘金来; 常慧贤; 金艳; 徐焱

    2010-01-01

    Objective To investigate the synthetic diagnostic value of plain FLAIR combined with contrast-enhanced T1WI sequence in intracranial metastatic tumor. Methods Retrospective analysis of 48 patients with intracranial metastatic tumor, the primary tumor have been confirmed by fiber bronchoscope biopsy or surgical biopsy. All the patients were performed MRI scans with plain FLAIR and contrast-enhanced T1WI sequence. Contrast-enhanced FLAIR scans for suspicious lesions in plain FLAIR but negative in contrast-enhanced T1WI. Comparative analysis the appearances of 192 lesions in plain FLAIR and contrast-enhanced T1WI sequence, and analyze the synthetic diagnostic value of both sequence. Results One hundred and two lesions were detected in plain FLAIR sequence, and 56 lesions with the clear border.One hundred and eighty-three lesions were detected in contrast-enhanced T1WI sequence, and 181 lesions with the clear border. And 192 lesions were detected with plain FLAIR combined with contrast-enhanced T1WI sequence. Conclusions Plain FLAIR scans are useful to detect edema of the metastatic tumor, and have higher sensitivity of the cortex region lesions. Contrast-enhanced T1WI scans are useful to detect the negative lesions in plain MRI scans, and have a higher diagnostic specificity. A combination scans of both sequence can improve the diagnostic accuracy.%目的 探讨平扫液体衰减反转恢复(FLAIR)与增强T1WI序列结合后对脑转移瘤的综合诊断价值.方法 48例脑转移瘤患者原发灶均经过纤维支气管镜活检或手术活检病理证实,所有患者均进行了FLAIR平扫及增强T1WI扫描,对于FLAIR平扫发现可疑病变而增强T1WI扫描表现阴性的患者,加扫增强FLAIR序列.对比分析192处脑转移瘤病灶在平扫FLAIR及增强T1WI序列的显示情况,进一步分析其综合诊断价值. 结果 192处脑转移瘤病灶中,平扫FLAIR序列检出可疑病灶102个,能够明确瘤灶边界的有56个;增强T1WI

  5. Cáncer de pulmón, una revisión sobre el conocimiento actual, métodos diagnósticos y perspectivas terapéuticas Lung cancer: a review of current knowledge, diagnostic methods and therapeutic perspectives

    Directory of Open Access Journals (Sweden)

    Edgar Amorín Kajatt

    2013-03-01

    diagnosis include positron emission tomography (PET with computed-tomography fusion, and transesophageal and bronchoscopic ultrasound, as the most relevant. Among the early detection techniques, the low-dose helical tomography stands out. However, it has not been able to prove to be useful as a screening tool. Conventional methods for diagnostic confirmation of lung cancer are bronchoscopy and percutaneous needle aspiration biopsy. The most common histologic type is the adenocarcinoma, being clinical stages III and IV being the most frequently found. At early clinical stages, surgical treatment has proven to be effective, and there is a good 5-year survival rate. In late stages, chemotherapy and radiotherapy are the most useful treatment methods to control the disease and palliate cancer signs and symptoms. Research in genomic analysis may provide a better understanding of cancer genetics , and therefore, new therapeutic strategies in the future

  6. 玉林市红十字会医院消毒质量监测分析研究%Analysis on monitoring of disinfection quality of Yulin Red Cross Hospital

    Institute of Scientific and Technical Information of China (English)

    陈燕红; 李劲锋; 李远

    2012-01-01

    目的 为进一步提高我院消毒灭菌质量,预防和控制医院感染.方法 按GB15982 - 1995《医院消毒卫生标准》和卫生部2002版《消毒技术规范》对医院供应室、手术室、产房、注射室、治疗室、换药室、内镜室的物体表面及医护人员手、内镜(腹腔镜、胃镜、支气管镜、结肠镜)、压力蒸汽灭菌器和使用中消毒剂等进行随机抽样检测.结果2009-2011年我院总共抽检样品8 918件,合格8 844件,总合格率99.17%,各年合格率分别为98.53%、99.09%、99.87%.灭菌锅、消毒灭菌物品、物体表面、消毒剂、空气分别为100.00%、100.00%、98.91%、99.85%、99.64%,医护人员手合格率最低为96.66%,外部监测机构显示相同的结果.结论 该医院消毒总体质量较好,但医护人员手消毒效果合格率相对较低,应采取进一步提高措施.%Objective To furtherly improve the quality of disinfection and sterilization in hospital, and prevent and control hospital infection. Method Conduct random sampling test for supply room, operation room, delivery room, therapeutic room, dressing room, injection room, objects' surfaces in endoscope room, hands of medical staff, endoscopes (laparoscope, gastroscope, bronchoscope and colonoscope) , pressure steam sterilizer and disinfectants in use according to Hospital Disinfecting Sanitation Standard (GB15982 - 1995) and Technical Standards for Disinfection (Edition 2002) of Ministry of Health. Results 8 918 samples were tested in our hospital during 2009 -2011, of which, 8 844 were qualified and the qualified rate was 99. 17%. The qualified rates in die three years were 98. 53% , 99. 09% , 99. 87% respectively, the qualified rates of autoclave, sterilization articles, object surface, disinfectant and air were 100%, 100%, 98.91%, 99.85%, 99. 64% respectively, and the qualified rate of hands of staff was more than 96. 66%. External monitoring a-gency also showed the same results

  7. Comprometimento da árvore respiratória na granulomatose de Wegener Laryngeal and tracheobronchial involvement in Wegener's granulomatosis

    Directory of Open Access Journals (Sweden)

    Ascedio Jose Rodrigues

    2012-04-01

    managing those changes. OBJECTIVES: To describe the endoscopic abnormalities found in the airway mucosa of a group of patients with WG undergoing bronchoscopy at Hospital das Clínicas of the Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP, and to report the therapeutic bronchoscopic interventions used in some cases. METHODS: The study assessed 15 patients diagnosed with GW from the Vasculitis Outpatient Clinic of the Department of Pulmonology, HC-FMUSP, referred for bronchoscopy at the Service of Respiratory Endoscopy, HC-FMUSP, from 2003 to 2007. RESULTS: Fifteen patients were studied [11 females (73.33%]; mean age, 34 ± 11.5 years. Airway changes were found in 80% of the patients, and the most frequent endoscopic finding was subglottic stenosis (n = 6. Therapeutic bronchoscopy was performed in three patients with subglottic stenosis and in other three patients with bronchial stenosis, all showing good results. CONCLUSION: Bronchoscopy allows for diagnosing, monitoring, and treating the airway lesions in WG, being a minimally invasive therapeutic option in selected cases.

  8. 支气管镜检查在儿科临床中的应用%Use of flexible fiberoptic bronchoscopy in pediatric clinical practice

    Institute of Scientific and Technical Information of China (English)

    Peter J. Mogayzel, Jr.; 张倩倩; 赵顺英; 刘玺诚

    2010-01-01

    The role of flexible fiberoptic bronchoscopy (FFB) in the evaluation of pediatric lung disease has expanded dramatically since the original description of the procedure by Wood and Fink in 1978.FFB can be used to evaluate airway anatomy, obtain secretions for culture and biochemical analysis and obtain airway cells or parenchymal tissues for evaluation. Both the upper and lower airway can be examined during FFB. Visual examination can diagnose a variety of congenital abnormalities ( Table 1 ). During FFB a dynamic evaluation of the airways, including the movement of the glottis, vocal cords and lower airways during the respiratory cycle can be performed. These observations can diagnose airway collapse due to malacia or obstruction due to external compression. Additionally, the diameter of the airway lumen and character of the airway mucosa can easily be evaluated. FFB can also identify airway obstruction by secretions and mucus plugs, blood, foreign bodies or masses. Bronchoalveolar lavage (BAL) allows collection of airway and alveolar secretions for evaluation of cellular and immunologic components, evidence of infection and cytology. Therapeutic lavage can be used to treat atelectasis by removing secretions obstructing airways. This approach can be helpful in children with inspissated secretions obstructing both large and small airways ( Figure 1 ). Therapeutic lavage has also been used in the treatment of alveolar proteinosis. Bronchial brushing can add information to bronchoscopic examination by obtaining airway epithelial cells for cytology, to identify intracellular pathogens and to evaluate cilia. Studies have demonstrated the utility of bronchial brushings for the isolation, characterization and culture of primary epithelial cells from children with asthma. Endobronchial biopsies are used for histopathological and immunocytochemical analysis and microbiological culture. Biopsies are often performed to assess cilia function and architecture. In addition

  9. 非小细胞肺癌患者体外诱导的肿瘤细胞老化与化疗客观疗效关系的研究%Studies on the relationship of objective response by chemotherapy and senescence induced in vitro for non-small cells lung cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To investigate the relationship between the objective response to combination chemotherapy of taxanes plus cisplatin in non-small cell lung cancer (NSCLC) and docetaxel plus cisplatin (DC regime) induced senescence of tumor cells in vitro. And its relation to mutant P53 protein (m-P53) was also to be evaluated. Methods: Sixty-seven specimen obtained from NSCLC patients from January 1, 2003 to June 30, 2006. The patients consisted of 48 males and 19 females,ranging in age from 54 to 82 years (mean, 67.5 years), 41 cases were diagnosed as pathological stage Ⅲb, 26 cases were diagnosed as stage Ⅳ. Thirty-nine tumors were confirmed to be adenocarcinomas, 28 were confirmed to be squamous cell carcinomas. All patients accepted 2-6 cycles combination chemotherapy of Taxanes (docetaxel 40 mg/m2, d1; d8, or paclitaxel 175 mg/m2, d1) plus cisplatin (CDDP, 25 mg/m2, d2-4). Patients were divided into chemoresponsive (CR + PR) and chemoresistant (SD + PD) groups according to objective response status which was evaluated by RECIST system. Tumor cells from specimens of bronchoscopic, surgical biopsy and pleural effusion cell collection had been cultured and treated with DC in vitro. The m-P53 of culture supematant was measured by ABC-ELISA kit before DC treatment. The telomerase activity was determined by the telomeric repeat amplification protocol (TRAP) based PCR-ELISA kit and apoptosis was determined by TdT-mediated d-UTP-X nick-end labeling (TUNEL) assay. Data represent as both actual detected and positive value. The senescence of tumor cells defined as that, apoptosis rate increased more than 50% to control, and telomerase activity decreased less than 50% to control. Results: There was no significant difference between clinical treatment response and sex,pathological type, specimen origin, or m-P53 status in cultured cell supematant. Telomerase activity and apoptosis rate was positive in 61.1% (41/67) and 25.4%(17/67) of all samples respectively. A significant

  10. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

    Institute of Scientific and Technical Information of China (English)

    Lawrence; F; Muscarella

    2014-01-01

    . The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospi-tal X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer’s labeling, supplemented as needed with professional organizations’ published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including broncho-scopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endos-copy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind andnear the forceps elevator located at the distal end othe ERCP endoscope, are recommended. If the ERCPendoscope features a narrow and exposed channel thathouses a wire connecting the GI endoscope’s controhead to this forceps elevator, then this channel’s com-plete reprocessing, including its flushing with a deter-gent using a procedure validated for effectiveness, is also emphasized.

  11. Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results

    Directory of Open Access Journals (Sweden)

    Márcia Jacomelli

    2012-04-01

    bronchoscopy-BAL and transbronchial biopsy (TBB. The BAL specimens were submitted to direct testing and culture for AFB and fungi, whereas the TBB specimens were submitted to histopathological examination. RESULTS: Of the 286 patients studied, 225 (79% were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 127 (44%; nonspecific chronic inflammation, in 51 (18%; pneumocystis, fungal infections, or nocardiosis, in 20 (7%; bronchiolitis obliterans organizing pneumonia, alveolites, or pneumoconiosis, in 14 (5%; lung or metastatic neoplasms, in 7 (2%; and nontuberculous mycobacterium infections, in 6 (2%. For the diagnosis of tuberculosis, BAL showed a sensitivity and a specificity of 60% and 100%, respectively. Adding the TBB findings significantly increased this sensitivity (to 84%, as did adding the post-bronchoscopy sputum smear microscopy results (total sensitivity, 94%. Minor post-procedure complications occurred in 5.6% of the cases. CONCLUSIONS: Bronchoscopy is a reliable method for the diagnosis of pulmonary tuberculosis, with low complication rates. The combination of TBB and BAL increases the sensitivity of the method and facilitates the differential diagnosis with other diseases.

  12. Curative effects of cryosurgery combined with argon plasma coagulation therapy for advanced central lung cancer by artificial trachea%经人工气道冷冻联合氩等离子电凝治疗晚期中央型肺癌的疗效分析

    Institute of Scientific and Technical Information of China (English)

    邱容; 肖昌武; 何正光; 文富强

    2013-01-01

    Objective To assess the feasibility,safety and clinical practicality value of cryosurgery combined with argon plasma coagulation(APC) therapy via bronchofibroscope for advanced central lung cancer by artificial trachea.Methods The clinical data of 41 cases of cryosurgery combined with argon plasma coagulation therapy via bronchofibroscope for advanced central lung cancer by artificial trachea from February 2011 to December 2012 were retrospectively analyzed.The curative effects were assessed before and after treatment.There were following evaluation indicators including preoperative,postoperative cough,hemoptysis,fever,dyspnea index,imaging examination,review of airway stenosis bronchoscopy etc.Results The research showed patients with cough relieving were 13 cases (31.7%),hemoptysis remission in 14 cases (34.1%),fever ease in 9 cases (22.0%),preoperative dyspnea index 3.5 ± 0.42,postoperative 1.8 ± 0.33,imaging suggestive of obstructive pneumonia and atelectasis disappeared in 12 cases (29.3%),27 cases (65.9%)improved,39 cases effective,2 cases no changes; bronchoscope checks completely effect in 17 cases (41.5%),partially effect in 21 cases (51.2%),invalid in 3 cases (7.3%).Conclusions cryosurgery combined with argon plasma coagulation therapy via bronchofibroscope for advanced central lung cancer by artificial trachea is feasible,safe and practical.It has the advantages of relieving cough,hemoptysis,fever,dyspnea,fewer complications etc,fewer complications and high security,which should be developed extensively in clinic.%目的 探讨经人工气道支气管镜下冷冻联合氩等离子电凝(APC)治疗晚期中央型肺癌的可行性、安全性.方法 回顾分析我院2011年2月至2012年12月经人工气道在支气管镜下对41例晚期中央型肺癌,行冷冻,并联合APC治疗的临床资料进行分析,术后一周评价疗效.评价指标包括术前、术后咳嗽、咯血、发热症状,呼吸困难指数、影像学检查、

  13. 支气管内超声引导针吸活检术在肺癌诊断中的应用价值%The value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in the diagnosis of lung cancer*

    Institute of Scientific and Technical Information of China (English)

    赵辉; 姜冠潮; 刘军; 王俊; 李剑锋; 李运; 周足力; 卜梁; 隋锡朝; 杨帆; 刘彦国

    2011-01-01

    [Objective]To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of lung cancer.[Methods]A total of 56 patients who underwent EBUS-TBNA to diagnose radiologically highly suspected lung cancer between September 2009 and June 2010 was retrospectively reviewed.Conventional bronchoscopic biopsy before EBUSTBNA was non-diagnostic in all patients.[Results]Of the 56 patients, 45 patients were detected lung mass and enlarged mediastinal/hilar lymph nodes on radiographic examination of the chest (≥ 1.0 cm), EBUS-TBNA was performed to obtain samples from mediastinal or hilar enlarged lymph nodes, 36 cases were confirmed lung cancers, nine cases were diagnosed by other methods (3 lung cancer, 1 metastatic lung tumor, and 5 benign eases).11 patients with pulmonary masses located close to the central airways were accessed by EBUS-TBNA, lung cancer was confirmed in 9 cases, pneumonia in one.One case that was not confirmed by EBUS-TBNA was diagnosed lung cancer through thoracoscopic biopsy.The sensitivity and diagnostic accuracy of EBUS-TBNA in the diagnosis of lung cancer were 91.8% (45/49) and 92.9% (52/56), respectively.The procedure was uneventful without complications.[Conclusions]EBUS-TBNA targeting lymph nodes or masses highly suspicious for malignancy demonstrated high diagnostic value in the diagnosis of lung cancer.EBUS-TBNA is recommended for these cases, especially when other diagnostic methods have failed or are difficult.%目的 探讨支气管内超声引导针吸活检术(EBUS-TBNA)在肺癌诊断中的应用价值.方法 2009年9月~2010年6月共56例影像学高度可疑肺癌患者,为明确诊断接受EBUS-TBMA.所有患者术前均接受了常规气管镜等检查,未能明确诊断.结果 该组56例患者.其中,影像学怀疑肺癌伴纵隔淋巴结和(或)肺门琳巴结肿大(短径>1cm)45例,经EBUS-TBNA行肿大淋巴结穿刺活检后确诊肺癌36例,9例EBUS-TBNA未能明确

  14. Desenvolvimento de uma órtese de Dumon modificada para aplicações traqueais: um estudo experimental em cães Development of a modified Dumon stent for tracheal applications: an experimental study in dogs

    Directory of Open Access Journals (Sweden)

    Rogério Gastal Xavier

    2008-01-01

    : Four different densities were tested in order to obtain the silicone prototypes. The pressure required for compression considering a contact area of 1 cm2, and a 30% reduction in diameter was calculated for each density. The best density was 70-75 Shore A hardness. Powdered barium sulfate was added to the silicone to make the stent radiopaque and easily identifiable in radiological imaging. This novel stent presents a corrugated external surface with discontinuous and protruding arcs resembling the tracheobronchial rings (for intercalation and fixation in the lumen of the lower airways, a highly polished inner surface and smooth extremities (to prevent friction-related damage. The prototype considered most appropriate in terms of rigidity and flexibility was bronchoscopically implanted in normal canine tracheas. After eight weeks, the animals were euthanized, and the tracheas were removed for anatomopathological analysis. RESULTS: There were no postimplantation complications, and none had to be removed. After eight weeks, the devices were found to be well-positioned. Histopathology revealed a well-preserved epithelial basal membrane, foci of denuded epithelium, mild submucosal inflammatory infiltrate with scattered granulation tissue, vascular neoformation, and no microorganisms. CONCLUSIONS: The stent developed proved resistant to mechanical stress, biocompatible in the canine trachea and well-preserved at the study endpoint.

  15. Punção aspirativa transbrônquica por agulha no diagnóstico e estadiamento do câncer de pulmão Transbronchial needle aspiration in the diagnosis and staging of lung cancer

    Directory of Open Access Journals (Sweden)

    Mauro Zamboni

    2004-04-01

    Full Text Available INTRODUÇÃO: Nos últimos anos, a punção aspirativa transbrônquica por agulha vem sendo utilizada cada vez com maior freqüência no diagnóstico e estadiamento do câncer de pulmão, principalmente nos EUA. Entretanto, muito pouco se tem publicado a respeito do método em nosso país. OBJETIVO: Avaliar a efetividade da punção aspirativa transbrônquica por agulha no diagnóstico e estadiamento do câncer de pulmão. MÉTODO: Setenta e quatro punções aspirativas transbrônquicas por agulha, realizadas no Hospital do Câncer-INCA/MS, foram revistas retrospectivamente. Todos os pacientes realizaram tomografia computadorizada do tórax previamente ao procedimento. RESULTADOS: Onze (15% pacientes tinham massas mediastinais e 63 (85% massas hilares. Foram encontradas 76 alterações endoscópicas: alargamento da carina principal em 44 (59% pacientes, alargamento de carina secundária em 12 (16%, compressão paratraqueal em 5 (7%, compressão da parede posterior da traquéia em 3 (4%, e compressão de brônquio principal em 5 (7% pacientes. O material foi satisfatório para o diagnóstico em 42 (57% pacientes e em 34 (46% o diagnóstico foi confirmado. O diagnóstico de doença maligna foi confirmado em 30/34 (88% pacientes: carcinoma indiferenciado de pequenas células em 10/30 (33%, carcinoma escamoso em 7/30 (23%, adenocarcinoma em 7/30 (23%, e carcinoma não pequenas células em 6/30 (20% pacientes. Em 4/30 (12% pacientes foram diagnosticadas patologias benignas: tuberculose em 2/4 (50% e sarcoidose em 2/4 (50% pacientes. Não observamos nenhuma complicação com o método. CONCLUSÃO: Nossa experiência em 74 pacientes mostrou que o procedimento é seguro, rápido em sua realização, com mínimas complicações e de utilidade no diagnóstico e estadiamento de pacientes com neoplasia pulmonar.BACKGROUND: Transbronchial needle aspiration (TBNA with a flexible bronchoscope has been used to diagnose bronchogenic carcinoma for many years in

  16. 三维CT在气管狭窄诊断中的应用%The Application of Three-Dimensional CT on the Diagnosis of Tracheal Stenoses

    Institute of Scientific and Technical Information of China (English)

    辛衍忠; 闫宇博; 张翔宇; 李吉尧; 崔键

    2011-01-01

    Objective: We evaluated the ability of three-dimensional CT to estimate tracheal stenoses in comparison to conventional fiberoptic bronchoscopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures. Methods: Spiral CT was performed in 64 patients with suspected tracheal stenoses and in 20 normal subjects. Tracheal stenoses due to an endolu-minal neoplasm were detected in 52 patients, whilst traumatic tracheal stricture was observed in the other 12 patients. Multiplanar reformatting (MPR), volume rendering techniques (VRT) and virtual endoscopy (VE) for trachea evaluation were applied and findings were compared to fiberoptic bronchoscopy. The accuracy of the procedure in describing the localization and degree of stenosis was tested by two radiologists in a blinded controlled trial. Results: The imaging modalities tested showed the same stenoses as the ones detected by flexible bronchoscopy and achieved accurate and non-invasive morphological characterization of the strictures, as well as additional information about the extraluminal extent of the disease. No statistically significant differences were observed between bronchoscopic findings and the MPR, VRT and VE image evaluations (P = 0.715, 0.413 and 0.417 respectively). Conclusion: Three-dimensional CT may provide a high fidelity, noninvasive and reproducible evaluation of the trachea compared to bronchoscopy. They may play a role in assessment of airway patency distal to high-grade stenoses, and represent a reliable alternative method for patients not amenable to conventional bronchoscopy.%目的:我们检测三维CT在气管狭窄的诊断中的作用和纤维支气管镜相比较,用以帮助临床胸外科医生判断气管结构的解剖学特征.方法:对怀疑气管狭窄的患者64例及20例正常病例检查螺旋CT,其中52例发现腔内新生物造成狭窄,另外12例为外伤后狭窄,应用多平面重建(MPR)、容积重建技术(VRT)、仿

  17. Infiltrados pulmonares en pacientes con cáncer Pulmonary infiltrates in cancer patients

    Directory of Open Access Journals (Sweden)

    Fernando A. Díaz Couselo

    2008-10-01

    remain as a diagnostic and therapeutic challenge in cancer patients. In order to evaluate the etiology, diagnostic methods used, Intensive Care Unit admission and in-hospital mortality, we conduced an observational, prospective study which included all patients with cancer and recent pulmonary infiltrates admitted to the Instituto Alexander Fleming between August 2003 and March 2006. Diagnostic methods were categorized in sequential steps of complexity: 1st step: radiological pattern of the pulmonary infiltrates, blood and sputum cultures, serological tests and empirical treatment response; 2nd step: bronchoalveolar lavage (BAL, non bronchoscopic tracheal aspirate and mini-BAL; 3rd step: pulmonary or extrapulmonary biopsies. Pulmonary infiltrate etiology was classified as: infection, treatment complication, disease progression, cardiovascular or mixed. Diagnosis was classified as proved or probable. A total of 106 samples from 103 patients were included. The etiologies were infection in 61 cases, disease progression in 4, treatment complication in 6, cardiovascular in 6 and mixed in 7. Proved diagnosis was obtained in 33 cases and probable diagnosis in 51 while 22 cases could not be diagnosed. Nine of the 10 diagnoses of mycoses were in oncohematologic cases. Seventy cases did not go further than procedures included in the 1st step. Thirty two cases stopped after diagnostic procedures of the 2nd step and 4 required biopsies. Forty four cases required Intensive Care Unit admission. In-hospital mortality was 30.2%. In our study, infection was the most frequent etiology. Mycoses were more frequent in oncohematologic cases. A proved or probable diagnosis was obtained in 84 (79.2% cases. In 53.7% of the cases only non-invasive diagnostic methods were required.

  18. Volume software measuring pulmonary volume of lung volume reduction in animal experiment%应用Volume软件测定肺减容动物实验中肺容积变化的研究

    Institute of Scientific and Technical Information of China (English)

    李文涛; 郑厚文; 黎雨; 傅钰雁; 柳广南

    2013-01-01

    [Objective] To evaluate the value of volume software of multi-slice spiral CT in measuring pulmonary volume of lung volume reduction in animal experiment.[Methods] Eight young pigs (16~22 kg) were randomly divided into experimental group and control group.Each pig was treated with biological lung volume reduction under fiberoptic bronchoscope guide before operation and one week after,one month and three month after the operation,its lung volume was measured respectively by volume software,then relation with its morphology and histopathology was analyzed and the effectiveness of lung volume reduction was evaluated.[Result] The control group with 4 young pigs whose right lung volume / total lung declined from (48.9±4.7)% to (48.2±5.7)% after three months were no significant differences (P >0.05).But there were straightly reduced from (57.9±1.6)% to (49.6± 2.65)% in experimental group with other 4 young pigs (P <0.05).Meanwhile three months later its volume of target lung dramatically decreased,following pulmonary fibrosis in varying degrees,which extremely consisted with the imaging changes.Yet the control group with 4 pigs had no significant changes in morphology and histopathology,even preoperative and postoperative CT scans.[Conclusion] It is a simple,rapid,accurate and no trauma method estimated by volume software supplied by multi-slice spiral CT for measuring pulmonary volume of lung volume reduction in animal experiments.%目的 探讨多层螺旋CT定量分析Volume软件在肺减容术动物实验中肺容积测定的应用价值.方法 8头健康约克幼猪,随机分为实验组、对照组各4头,经纤维支气管镜行生物性肺减容术,采用多层螺旋CT扫描,Volume软件动态监测术前、术后1周,术后1,3个月肺容积变化,分析其与术后3个月取出的动物肺脏其形态学,组织病理学的关联性 结果 对照组4头幼猪,右肺容积/总肺容积平均比值由术前(48.9±4.7)%到术后3个月减至(48

  19. Peripheral primitive neuroectodermal tumor of trachea: a case report and review of literatures%气管外周原始神经外胚层瘤一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    郑冠英; 谢宝松; 岳文香; 李瑞慧; 陈小岩; 何毅辉

    2012-01-01

    primitive neuroectodermal tumor”,“peripheral” as the search terms in Wanfang med online and PubMed database by September 2011.Results A case of 63 year-old female patient,who had been misdiagnosed as having chronic pharyngitis,chronic bronchitis and bronchial asthma,was admitted to the hospital because of cough and sputum production for 50 days,and anhelation for 1 month.After admission,the chest computerized tomography showed a space-occupying lesion in the middle of the trachea.Bronchoscopy showed a pedicle neoplasm 4 cm under the subglottic,with integral capsule,smooth surface and rich vascellum.Subsequently,tumor resection under bronchoscope was performed.Pathology report after operation showed infiltration of flake small round malignant cells under bronchial mucosa.Immunohistochemistry showed CD99 (+),Syn (+)and S-100 (+).EWS-FLI-1 fusion transcript was detected by RT-PCR.Accordingly,it was diagnosed as PNET.The symptoms of cough and anhelation were disappeared after operation.So far,there was no local recurrence and distant metastasis with 14 months follow-up.A total of 111 literatures were received in Pubmed,including one of prospective study,one of review,22 of retrospective study and 87 of case report.Forty literatures and 187 cases in all were received in Wanfang Med Online,including 24 of retrospective study and 16 of case report.But,there were no reports about tracheal PNET.Conclusions PNET can occur in the trachea and is easy to be misdiagnosed.To make a definite diagnosis,histopathology and immunohistochemistry are needed and detection of EWS-FLI-1 fusion transcript is a reliable marker for molecular diagnosis.The tracheal pPNET may be different with the pPNETs in other parts,and has a lowergrade invasion and less distant metastasis.

  20. 内镜清洗消毒过程中污染因素及预防措施研究%Risk factors for contamination during cleaning and disinfection of endoscopes and prevention measures

    Institute of Scientific and Technical Information of China (English)

    强明珠; 陶爱女; 周明娟

    2015-01-01

    OBJECTIVE To explore the risk factors for iatrogenic infections during the cleaning and disinfection of endoscopes and put forward corresponding prevention countermeasures so as to reduce the incidence of infections due to the use of endoscopes .METHODS The risk factors for the iatrogenic infections were observed through onsite examination during the cleaning and disinfection of endoscopes ,totally 184 endoscopes in use were randomly ex‐tracted .The quality of cleaning and disinfection of the endoscopes was determined through the sampling of lumens and surfaces of the endoscopes .RESULTS Of 184 samples ,169 were qualified with the qualified rate of 91 .85% ;the qualified rates of the gastroscopes ,bronchoscopes ,colonoscopes ,and laryngoscopes were 86 .00% ,95 .56% , 89 .36% ,and 97 .62% ,respectively .The bacterial colony counts of 15 samples exceeded the standard .A total of 26 strains of pathogens have been isolated ,including 14 strains of Helicobacter pylori ,8 strains of Escherichia coli ,2 strains of Pseudomonas aeruginosa ,1 strain of Staphylococcus aureus ,and 1 strain of Mycobacterium tu‐berculosis .Among the causes of unqualified cleaning and disinfection of the 15 samples ,the incomplete cleaning ac‐counted for 40 .00% ,the inappropriate use of disinfectants 40 .00% ,the inappropriate self‐protection 13 .33% , not taking special treatment for patients with special infections 6 .67% .CONCLUSION The risk factors for the iat‐rogenic infections during the cleaning and disinfection of endoscopes are complicated .It is necessary for the hospital to strengthen the cleaning of endoscopes ,education of disinfection staff ,and culture ,standardize the cleaning and disinfection procedure ,and establish scientific surveillance mode so as to prevent the iatrogenic infections .%目的:研究内镜清洗消毒过程中发生医源性感染的危险因素,并提出相对的预防策略,降低内镜使用引发的感染率。方法通过现场检查总

  1. Application of information technology in registration and management of endoscope ’ s cleaning and sterilization%信息技术在内镜清洗消毒登记管理中的应用

    Institute of Scientific and Technical Information of China (English)

    贾彩莲

    2014-01-01

    Objective To explore the clinical application effect of information technology in registration and management of endoscope ’s cleaning and sterilization.Methods Between January 2011 and January 2013, using endoscope cleaning program in computer information system to conduct scientific management for registration of endoscope cleaning and sterilization , then comparing the effect of endoscope cleaning and sterilization with manual registration .Results After adopting computer records , various endoscope ’ s cleaning and sterilization time were significantly less than those adopting manual records ,gastroscope [(8.73 ±0.35) vs (23.79 ±1.92)], colonoscopy [(8.26 ±0.47) vs (23.57 ±1.89)], laryngoscope [(8.56 ±0.51) vs (23.85 ±1.32)], bronchoscope [(8.13 ±0.68) vs (23.61 ±1.56)], duodenoscope [(8.35 ±0.84) vs (23.89 ±1.68)],with statistically significant differences (t=15.38,14.77,15.02,15.28,15.13, respectively;P<0.01), and the data integrity reached 100.00%, which was significantly higher than 77.33% with manual record, with a statistically significant difference (χ2 =38.34,P<0.05).Conclusions Information technology applied in the endoscope ’ s cleaning and sterilization work for registration and management is not only scientific , standardized and convenient , but also save time and human resources .%目的:探讨信息技术在内镜清洗消毒登记管理中的临床应用效果。方法2011年1月-2013年1月期间使用内镜洗消程序计算机信息系统对内镜清洗消毒登记进行科学的管理,并与采用手工登记内镜清洗消毒的情况进行对比分析。结果计算机记录胃镜、肠镜、喉镜、支气管镜及十二指肠镜所用时间分别为(8.73±0.35),(8.26±0.47),(8.56±0.51),(8.13±0.68),(8.35±0.84)min,少于手工记录的(23.79±1.92),(23.57±1.89),(23.85±1.32),(23.61±1.56),(23.89±1.68)min,两种记

  2. Two-level management of application of endoscope%医院内镜使用的两级管理

    Institute of Scientific and Technical Information of China (English)

    王靖; 李莉; 周辉

    2012-01-01

    OBJECTIVE To strengthen the standardized management of endoscope to avoid the iatrogenic infections due to the poor cleaning and disinfection of endoscope so as to ensure the safety of the patients and medical staff. METHODS Through the nosocomial infection administration office and the nosocomial infection monitoring team, by means of the on site inspection in combination with sampling testing, the management system, equiping facilities, disinfection procedure, the use of disinfectants,and the disinfection effect were examined; the inspection records of using endoscopes from Jan 2010 to Jun 2011 were respectively reviewed. RESULTS There was difference in the qualified rate of the sterilization of endoscopes by the two-level of hospital and department, the qualified rate of the sterilization of bronchoscope by the hospital-level inspection was 14. 3% lower than that by the department-level inspection, 15. 9% lower of the laryngoscope, 10. 4% lower of the gastroscope, 11. 2% lower of the colonoscope, 2. 1 % lower of the arthroscope, 1. 6% lower of the laparoscope, 3. 1% lower of the cystoscope, 5. 2% lower of the disinfectant, 4. 6% lower of the air, 14. 9% lower of the object surface and 11. 8% lower of the staffs hands. CONCLUSION Only as the nosocomial infections control office establishes the sound regulations and systems, standardizes the operation procedure and regularly supervise the disinfection effect can eliminate the iatrogenic infections due to lax sterilization of endoscope.%目的 加强内镜医院感染规范化管理,避免因内镜清洗消毒缺陷引起医源性感染,保证患者及医务人员安全.方法 通过医院感染管理办公室和科室医院感染监控小组两级管理组织,采用现场查看及抽样检测相结合的方法,分别对全院使用中的各种内镜检查其管理制度、消毒设施的配备、消毒程序的规范、消毒剂的使用方法及消毒效果;回顾性分析2010年1月-2011年6月使用

  3. 支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较%Contrast in respiratory mechanics and blood gas between bronchial blocker and double lumen tube in one lung ventilation

    Institute of Scientific and Technical Information of China (English)

    傅志玲; 陈卫民

    2011-01-01

    Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P<0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P < 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P> 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.%目的 比较支气管堵塞器(BB)与双腔气管导管(DLT)在单肺通气中对呼吸力学和血气的影响.方法 将36例择期行肺叶切除术和食管癌根治术患者按投硬币法随机分为BB组(17例)和DLT组(19例).BB组完成单腔管插管后在纤维支气管镜引导下置入BB,DLT组完成插管后用纤维支气管

  4. IMP3 can predict aggressive behaviour of lung adenocarcinoma

    Science.gov (United States)

    2012-01-01

    Background Lung cancer most often presents as an inoperable tumour and the diagnosis is usually performed on a small biopsy/cytology specimen. In the group of non small cell lung cancer - not otherwise specified, adenocarcinoma phenotype can be determined immunohistochemically using TTF-1 and Napsin A. Expression of oncofetal protein IMP3 in human cancer is associated with poor differentiation and aggressive behaviour. In the present study expression of IMP3 was correlated with expression of TTF-1 and Napsin A, histological subtype and clinical stage of lung adenocarcinoma. We were interested whether distant metastases are associated with IMP3 overexpression, regardless of the histologic subtype of adenocarcinoma. Methods In retrospective study, consecutive series of 105 patients with advanced lung adenocarcinoma diagnosed from 2006 to 2009 in Clinical Hospital Center Split, Croatia, were analysed. Clinical data were collected from the Pulmology Department and time of death from the Mortality Registry. Paraffin blocks of bronchoscopic biopsies were collected from the Institute of Pathology and 15 cases excluded from the analysis due to insufficient material. Expression of IMP3, Napsin A and TTF-1 were analysed by indirect enzyme immunohistochemistry. Statistical analysis was performed and P values less than 0.05 considered significant. Results Of 90 patients, 71 (78%) were males and 19 (22%) females. Median age for males was 61.5 years (min-max 43–83) and for females 61 years (min-max 44–86). Pleural effusion was found in 15 (16.6%) and distant metastases in 45 (50%) cases. According to histological subtypes, there were 34 acinar, 2 lepidic, 2 papillary and 52 solid subtypes. IMP3 overexpression was found in 63 cases (70%) and was correlated with solid subtype (P = 0.002) and negative/weak Napsin A expression (P = 0.004). Strong Napsin A expression correlated with TTF-1 expression (P = 0.003) and lower histological grades (P = 0.031). Patients

  5. 异种脱细胞真皮基质修复膜在口腔黏膜下纤维性变手术治疗中的应用%Clinical application of heterogeneous acellular dermal matrix in the surgical treatment of oral submucous fibrosis

    Institute of Scientific and Technical Information of China (English)

    蒋灿华; 李超; 石芳琼; 陈新群; 唐瞻贵; 翦新春

    2011-01-01

    目的:评价异种脱细胞真皮基质修复膜在口腔黏膜下纤维性变手术治疗中的应用效果.方法:8例重度口腔黏膜下纤维性变患者,经鼻腔气管捕管全麻下切除双侧颊部翼下颌韧带前方区域纵行的纤维条索,术中被动开口度达正常范围后,剪取相应大小的异种脱细胞真皮基质修复膜覆盖黏膜缺损创面,间断缝合后,碘纺纱包加压固定.术后10~14d拆除纱包与缝线后开始开口训练,定期随访并进行类固醇皮质激素黏膜下局部注射等辅助治疗,通过伤口愈合、瘢痕软化及开口度改善等指标评价手术效果.采用SPSS16.0软件包对数据进行单因素方差分析.结果:8例患者双侧颊部纤维条索切除后形成的手术创面,采用异种脱细胞真皮基质修复膜进行修复均获得成功.无感染或排异等并发症发生.术后随访6~18个月,患者颊部原手术区黏膜红润,质地柔软,开口困难明显改善.术前开口度为(12.04±2.93)mm,术中开口度为(35.46±3.17)mm,术后6个月时的开口度为(29.33±4.28)mm,经统计学分析,差异具有显著性(P<0.05).结论:应用异种脱细胞真皮基质修复膜修复重度口腔黏膜下纤维性变手术治疗中的黏膜缺损创面,能够起到促进创面早期愈合、减轻瘢痕形成与改善开口困难的作用,其操作简单易行,值得临床推广应用.%PURPOSE: The aim of this study was to evaluate the clinical effect of heterogeneous acellular dermal matrix in the surgical treatment of advanced oral submucous fibrosis (OSF). METHODS: There were eight patients who had undergone surgical treatment of trismus caused by OSF. Surgery was performed under general anaesthesia given through a nasoendotracheal tube using a fibreoptic bronchoscope. All the fibrous bands on the buccal mucosa were incised and bluntly dissected to stretch the mouth opening. Based on the defect, heterogeneous acellular dermal matrix graft was applied direcdy on the

  6. Comparisons of airway establishment among four surgical methods%四种外科气道技术的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈犹白; 张海钟; 陈聪慧; 韩岩

    2016-01-01

    Objective To compare efficacy, time consumed and complications among cricothyroid membrane puncture guided tracheostomy ( CMPGT ) , surgical tracheostomy ( ST ) , surgical cricothyroidotomy ( SC) , and percutaneous tracheostomy using Griggs'guide wire dilating forceps ( GWDF) for the establishment of airway in urgent need of medical attention.Methods Twenty miniature swine were randomly ( random number) divided into four groups.The procedures of CMPGT, ST, SC and GWDF were carried out when patients'SpO2 ( oxygen saturation of blood ) declined to 80% by suspension of oxygen supply after general anesthesia. Procedure performed time, ventilation resumed time, SpO2 and electrocardiograph ( ECG) and arterial blood gases ( ABG) analysis including SaO2 , PaO2 , PaCO2 , blood pH, and heart rate, blood pressure were recorded.Fiberoptic bronchoscope was used to assess any damage to the tracheal wall.Complications were noted and scored in a two-month follow-up period.Results Airways were successfully established in all swine.The times consumed for SC, GWDF, CMPGT, and ST were (86 ±12) s, (165 ±63) s, (174 ±34) s, and (519 ±128) s, respectively, however a shorter time for ventilation resumed was found in CMPGT procedure (23 ±4) s, P<0.01.ECG showed that SpO2 and T-wave decreased and Q-T shortened after oxygen suspension and recovered to normal level rapidly after ventilation.There were significant differences in ECG and ABG between pre-and post-operative periods ( P<0.05) in all groups.Minimal intra-operative bleeding was found in two swine of each group.In ST group, moderate intra-operative bleeding was encountered in three swine.Three pigs were suffered from hypotension owing to prolonged hypoxemia.There was minimal postoperative bleeding occurred in one swine, thus leading to stoma infection.In SC group, moderate intra-operative bleeding was noticed in one swine. One miniature swine had slight injury at laryngeal cartilage resulting in difficult decannulation happened

  7. 颈脊髓损伤气管切开术后拔管指征及延迟、失败原因探讨%Indications,Causes of Delay and Failure of Decannulation after Tracheostomy in Treatment of Cervical Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    赵唯; 李想; 张军卫; 洪毅

    2014-01-01

    Objective To investigate the indications,delay and failure causes of decannulation after tracheostomy in treatment of cervical spinal cord injury. Methods Clinical data of 63 patients with cervical spinal cord injury after tracheosto-my was reviewed,and self-designed indications guidance for decannulation was used to choose the time of removing tubes. The delay and failure causes of decannulation were analyzed. Results The patients′oxygenation,expectoration and swallowing a-bilities were recoveried,the pulmonary infection was controlled,and there were no laryngeal edema by laryngoscope and bron-choscopes examinations and no obvious airway constriction in distal cannula. All above conditions were used as decannulation indications. Fifty four patients(85. 7%)underwent removal surgery of the tracheostomy tubes successfully within 3 months af-ter injury. The mean interval between incision of tracheal and decannulation was 43. 2 d. Seven patients(11%)had delayed decannulation,and the causes including repeated pulmonary infection in 3 patients,granulation tissue hyperplasia in distal tra-cheostomy tube in 2 patients,drinking bucking induced by recurrent laryngeal nerve injury after anterior cervical fusion in 1 patient and psychologic factor in 1 patient. Decannulation failure occurred in 2 patients and one received tracheostomy again and was discharged with the tracheostomy tubes,the other one died of acute respiratory failure. Conclusion Self-designed indication for decannulation may guide the time of removing the tracheostomy tubes safely for patients with cervical spinal cord injury after tracheostomy. Repeated pulmonary infection is the main cause of delayed and failed decannulation. Incidence rates of tracheal stenosis and tracheomalacia are low,but the complications may be life threatening,which should be given much more attention.%目的:探讨颈脊髓损伤患者气管切开术后拔管指征及延迟、失败的原因。方法对我科收治的63例气管

  8. Analysis of the clinical characteristics of Kartagener syndrome in Chinese and foreign children%中外儿童Kartagener综合征的诊断特点分析

    Institute of Scientific and Technical Information of China (English)

    靳雨婷; 陈星; 王金荣; 郭春艳; 孙立锋

    2015-01-01

    hospital were analyzed with literature review.The differences between Chinese and foreign children in clinical manifestations and diagnosis were compared.Result All of the cases had the following clinical manifestations: recurrent productive cough, nasosinusitis, dextrocardia, total situs inversus and bronchiectasia.Situs inversus of the airway structure was visible under the bronchoscope, and electron microscopy of the respiratory mucosa showed an abnormal ciliary ultrastructure.By using "Kartagener syndrome" and "child" as the key words,reports on 55 Chinese cases and 61 foreign cases in children were retrieved from CNKI and PubMed databases.The average age of diagnosis was 9.16 ± 3.67 years in China, which was significantly later than 7.07 ± 4.92 years in foreign countries (t =2.642, P < 0.01).The main clinical manifestations were recurrent productive cough, nasosinusitis or rhinopolyp, recurrent pulmonary infection, recurrent wheezing and otitis media.Sinus imaging showed maxillary sinusitis.Dextrocardia, total situs inversus and bronchiectasia were found on thoracic and abdominal CT.The ciliary ultrastructural analysis showed shorter and missing dynein arm (6/6 cases in China and 25/27 cases in foreign).Conclusion The clinical manifestations are recurrent upper and lower respiratory tract infection combined with dextrocardia or other situs inversus in both China and other countries.The diagnosis abroad relied more on abnormal ciliary ultrastructure observed under electron microscopy, but in China mainly relied on its typical clinical manifestations.

  9. Clinical characteristics of primary ciliary dyskinesia in children%儿童原发性纤毛运动障碍的临床研究

    Institute of Scientific and Technical Information of China (English)

    徐保平; 申昆玲; 胡英惠; 冯雪莉; 李惠民; 郎志奇

    2008-01-01

    children.Methods Patients were all chosen from the inpatient department of Beijing Children's Hospital,Capital Medical University between 1990-2006.The tunics mucosa bronchiorum and/or nasal mucous membrane were gained through bronchoscope in children suspected to have PCD.The ciliary uhrnstructures were analyzed through the electron microscope.The clinical features and procedures of the diagnosis and differential diagnosis in children with PCD were analyzed.Results There were totally 26 children diagnosed as PCD with 10 (38.5%) Kartagener syndrome. All Kartagener syndrome children had mirror image dextrocardia with normal cardiac structure and situs inversus viscerurn- The broncheseopy performed in eight of 10 Kartagener syndrome children showed bronchus transposition. Twenty-six children came from twenty-five families.Although the siblings of four prohanda also had the symptoms of chronic cough with sputum,running nose and recurrent respiratory infections,only a boy and his sis~r were diagnosed as Kartagener syndrome simultaneously.Their parents and the other family members were healthy.Of the 26 patients,11 were boys and 15 were girls.The median age at diagnosis was 8.7 years.The age of onset was between the second day after dilivery and fifteen years old,median age was 3 years.The course of disease before diagnosis was eleven days to twelve years ( median 3.5 years).All the children had the symptom of cough,24 of which had productive cough.Seven cases were found to have clubbing fingers.Dynein arm defect was found in 10 children,6 of them had total absence of dynein arms and 4 had decreased dynein arm numbers.Microtube derangements were found in 8 children. One Kartngener syndrome child had a normal cilia structure.Bronchieetasis,consolidation and increased lung markings were found in 8,6 and 7 patients separately on the radiographic study.Twenty patients had sinusitis.Nine of sixteen children had decreased PEF,FEV1 and/or FEF25-75 on the pulmonary function test

  10. Basic pulmonary function tests in pig farmers

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    Đuričić Slaviša M.

    2004-01-01

    pulmonary function tests are shown in table 2. The values of FEV1 and FVC in each groups were between 92% and 97% of predicted values, and FEV1/FVCx100 was not lower than 82%. There were no differences in the average values of FEV1 (p=0.574 and FEV1 % predicted (p=0.653 between pig farmers and control subjects. Pearson coefficient of correlation and Spearman nonparametric correlation test revealed a high level of correlation of FEV1 values with sex and age and no correlation of pig farming exposure with cigarette smoking as predictor variables (Table 3. The analysis by linear regression method showed that all examined predictor variables had the effect on the value of FEV1 (Table 4. After the elimination of the two least significant predictor variables it was possible to make the equation for prediction of FEV1 values. DISCUSSION In the present study there are no significant alterations in the values of the basic pulmonary function tests in pig farmers. In the majority of previous similar studies the differences in the average values of FEV1 and FVC between pig farmers and control subjects were also not found. However, in some studies the alterations in several more specific lung function parameters were registered. The decreased values of FEV1 during workshift were also found and they are probably connected to the bronchial hyper reactivity registered in many studies in pig farmers. Longer exposure to swine confinement environment caused more decline in FEV1 and FVC and accelerated mean age-related annual decline in FEV1 was observed reaching to 44 ml/yrs more than expected. The correlations between values of FEV, with pig farming exposure and cigarette smoking in this study were not found. However, the analysis by linear regression method showed that all examined predictor variables had the effect on the value of FEV1. In a few previous bronchoscopic, BAL, and sputum studies some signs of inflammation and morphological changes of the respiratory tract were observed. The

  11. CT in the study of thoracic-pulmonary complications after liver transplantation; La Tomografia Computerizzata nello studio delle complicanze toraco-polmonari dopo trapianto del fegato

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    Robiati, S.; Veltri, A.; Martina, M. C.; Gariazzo, G.; Gandini, G. [Azienda Ospedaliera Sanitaria Giovanni Battista, Ist. di Radiologia dell' Universita' , Turin (Italy); Cerutti, E. [Turin Univ., Turin (Italy). Centro Trapianti Epatici; Ottobrelli, A. [Turin Univ., Turin (Italy). Dipt. di Gastroenterologia

    2000-12-01

    In this article is reviewed the role of Computed Tomography (CT) in thoracic complications following ortho topic liver transplantation (OLT). In a post-OLT population of 567 patients transplanted in the Italian institutions, 100 patients (17.6%) were examined with chest CT. It was reviewed data relative to the total number of examinations, clinical and/or radiographic indications, the CT technique-i.e., conventional (with (out) intravenous, i.v., contrast material) or high-resolution (HRCT). It also reviewed the radiologic patterns and their correlation with the other clinical, bronchoscopic and/or laboratory results. Of 152 chest CT examinations, 45 (29.6%) were performed because of clinical indications, 31 (20.4%) because of a radiographic abnormality, 64 (42.1%) because of clinical and radiographic abnormality, 64 (42.1%) because of clinical and radiographic indications, while in 12 cases (7.9%) the reasons were unknown; 133/152 (87.5%) examinations had been performed with conventional CT scanning (100 with i.v. contrast agent and 33 without) and 19/152 (12.5%) with HRCT. Twenty of 152 (13.2%) examinations, in 16 patients were normal; in the other 84 patients, 132/152 (86.8%) CT/HRCT studies showed 247 pathological findings (99 pleural effusions, 3 pericardial effusions, 62 cases of atelectasis, 1 pulmonary calcification, 70 suspected inflammatory parenchymal consolidations, 64 of them alveolar and 6 interstitial, 4 cases of interstitial edema and finally 8 neoplastic infiltrates). Correlated with clinical data, CT findings are very useful in detailing clinical-radiographic screening findings, despite the limitations in typifying pleural effusions, in differentiating atelectasis from inflammatory parenchymal consolidations and in assessing pneumonia etiology. Also, despite its high sensitivity (94.1%) and specificity (92.8%), CT was not accurate enough in the differential diagnosis of pneumonia. History data were necessary to characterize the histology of

  12. 气管支气管异物1125例患儿呼吸道分泌物病原菌分布及药敏分析%Distribution and drug resistance of the pathogenic bacteria from sputum specimens of 1125 children with tracheo bronchial foreign bodies

    Institute of Scientific and Technical Information of China (English)

    温鑫; 苏金柱; 崔莉; 王娟; 左路杰

    2015-01-01

    Objective To analyze the distribution and drug susceptibility of the pathogenic bacteria in the airway secretions in children with tracheobronchial foreign bodies so as to assist physicians in clinical prescription.Methods Sputum specimens of 1 125 children with tracheobronchial foreign bodies were collected in removal of the foreign bodies by rigid bronchoscope,and the drug susceptibility test was performed.Results Pathogenic bacteria were detected in 218 (19.4%) of 1 125 sputum specimens.Among the pathogenic bacteria,126 (57.79%) strains were gram-negative bacilli,consisting of 76 (34.86%) strains of Haemophilus influenzae,10 (4.59%) strains of Escherichia coli,7 (3.21%) strains of Sewer enterobacter,7 (3.21%) strains of Pseudomonas aeruginosa,and 6 (2.75%) strains of Klebsiella bacillus; and 92 (42.21%) strains were gram-positive bacilli,consisting of 80 (36.69%) strains of Streptococcus pneumonia and 10(4.59%)strains of Escherichia coli.Most of detected gram-negative bacilli were highly sensitive to cefepime,ceftazidine,imipenem and amikacin,no strains were resistant to meropenem and ciprofloxacin.None of the detected gram-positive bacilli were resistant to cefepime,vancomycin,levofloxacin and teicoplanin.Conclusions The Haemophilus influenzae of gram-negative bacilli and the Streptococcus pneumonia of gram-positive bacilli are the main pathogenic bacteria existing in the airway secretions of children with tracheobronchial foreign bodies.The Haemophilus influenzae were highly sensitive to cephalosporin,imipenem and amikacin,and the Streptococcus pneumonia to cefepime,vancomycin,levofloxacin and teicoplanin.%目的 分析气管支气管异物患儿气道内分泌物的病原菌分布及药敏结果,为临床用药提供依据.方法 收集1 125例气管支气管异物取出术时异物所在气管支气管分泌物,行细菌培养及药敏实验,收集阳性结果并进行分析.结果 1 125例标本有218例检出病原菌,阳性率19.38

  13. Study of Cytological Classification and pathogenic bacteria screening of bronchoalveolar lavage fluid in patients with refractory asthma%难治性哮喘患者支气管肺泡灌洗液细胞分类及病原菌筛查研究

    Institute of Scientific and Technical Information of China (English)

    张翠翠; 温明春; 杜秀伟; 王寒; 蔺兴娟; 张淑萍; 魏春华

    2013-01-01

    Objective To seek the cytological classification and airway pathogenic bacteria colonization,infection situation of bronchoalveolar lavage fluid (BALF) in patients with refractoryasthma.Methods Select 138 inpatients with refractory asthma which measure upto national standard,to test the BALF cells classification and bacterial culture through the bronchoscope alveolar lavage.Results ① The inflammatory cells classification of BALF:Neutrophile granulocyte 63.78 ± 30.02,Eosinophilic granulocyte 2.70 ± 4.04,Lymphocyte 5.93 ± 6.48,Alveolarmacrophages 27.21 ± 31.87,display neutrophils increased obviously.② Influence of pathogens on airway inflammation:the mean value of Neutrophils in patients with positive pathogens are an increase compared with patients with negative,but no statistically significant differences,Eosinophils mean value are low compared wiht patients with negative,the differences was statically significant (P < 0.01).③ The inflammatory cells classification of BALF:Classification standard by airway inflammation,138 cases of 24 cases of all the 138 cases are Eosinophil asthma,account for 17.38%,46 cases with Neutrophilic asthma,account for 33.33%,26 cases of Myeloid less asthma,18.84%,42 case with Mixed grain cell asthma,30.43%.General status in the group,Neutrophils group and few cell group have a longer course of disease,older ages,lower cortisol,smoking rateis higher in Neutrophils group.④Previous treatment condition of each inflammation type:patients in Neutrophils groupwith used much more systemic hormones are higher than the Eosinophils group,while the volume of inhaled steroids used less than eosinophils group.⑤Etiology test results:23 cases of pathogenic bacteria were checked out in 138 patients,account for 16.7%,Gram negative bacilli isolated from most of them,a total of 16 cases,percent of total pathogen detection 69.6%.Conclusions ① There is a special table types of airway inflammation cells in patients with refractory

  14. Value of liquid-based cytology of brushing specimens obtained via fiberoptic bronchoscopy for the diagnosis of lung cancer%纤维支气管镜下刷取标本液基细胞学检查在肺癌临床诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    赵焕; 郭会芹; 张传欣; 赵琳琳; 曹箭; 潘秦镜

    2015-01-01

    Objective To investigate the value of the liquid⁃based cytology ( LBC ) of brushing specimens obtained via fiberoptic bronchoscopy for clinical diagnosis of lung cancer. Methods We retrospectively analyzed the LBC cases in our hospital from January 2011 to May 2012, and evaluate its role in the diagnosis of lung cancer. Results The clinical data of a total of 4 380 cases were reviewed and 3 763 of them had histopathological or clinical follow⁃up results ( including 3 306 lung cancer cases and 457 benign lesion cases) . The sensitivity, specificity, and accuracy of LBC diagnosis for lung cancer were 72. 4%(2 392/3 306), 99.3%(454/457) and 75.6%(2 846/3 763), respectively. Of the 1 992 lung cancer cases diagnosed by brushing LBC, 528 cases(26.5%) were failed to take forceps biopsy and 113 cases(5.7%) showed negative forceps biopsy results. The accurate rate of subtyping of LBC for non⁃small cell carcinoma and small cell carcinoma was 99.0% (1 487/1 502) (P0.05). Conclusions Fiberoptic bronchoscopic brushing liquid⁃based cytology can significantly improve the detection rate of lung cancer, and have a high specificity and accurate rate of subtyping. It is an effective tool for the diagnosis and subtyping of lung cancer.%目的:探讨纤维支气管镜( FOB)下刷取标本液基细胞学检查对临床诊断肺癌的价值。方法回顾性分析2011年1月至2012年5月中国医学科学院肿瘤医院收治的FOB下刷取标本液基细胞学病例资料,评价其在肺癌诊断中的意义。结果共收集4380例,其中3763例有组织病理学及临床随访结果(肺癌3306例,良性病变457例)。刷取标本液基细胞学诊断肺癌的敏感性、特异性和准确性分别为72.4%(2392/3306)、99.3%(454/457)和75.6%(2846/3763)。在液基细胞学诊断为癌的1992例病例中,528例(26.5%)未取到活检,113例(5.7%)活检阴性。液基细胞学对非小细胞癌和小细胞癌

  15. 气管腺样囊性癌表皮生长因子受体基因突变的检测%Detection of epidermal growth factor receptor in tracheal adenoid cystic carcinoma

    Institute of Scientific and Technical Information of China (English)

    李冬妹; 王洪武

    2014-01-01

    目的 了解气管腺样囊性癌肿瘤组织表皮生长因子受体(EGFR) 18、19、20、21位点基因突变情况,为气管腺样囊性癌的分子靶向治疗奠定基础.方法 将自2004年至2013年在煤炭总医院经气管镜下取出的气管腺样囊性癌共36例蜡块标本,提取肿瘤细胞DNA,采用ARMS法进行EGFR18、19、20、21位点基因突变检测.采用Fisher精确概率法比较两组之间阳性率的差别.P<0.05为差异有统计学意义.结果 36例气管腺样囊性癌蜡块包埋标本中,EGFR基因突变阳性率为31% (11/36).14%(5/36)存在双突变(19外显子缺失突变及21外显子突变),0%(0/36)出现EGFR基因20外显子突变.临床分期为Ⅳ期的标本EGFR基因突变率为63%(5/8),临床分期为Ⅱ~Ⅲ期的标本中EGFR基因突变率为21%(6/28),两组间有明显差异(P<0.05).结论 气管腺样囊性癌EGFR基因突变率介于肺腺癌与鳞癌之间.气管腺样囊性癌EGFR基因突变在已有血行转移的患者中阳性率明显高于无血行转移者,晚期气管腺样囊性癌患者可能从EGFR-酪氨酸激酶抑制剂治疗中获益.%Objective To investigate the status of epidermal growth factor receptor (EGFR) gene mutations in exon 18,19,20,and 21 in tracheal adenoid cystic carcinoma,to experimentally explore the potentiality of molecularly targeted therapy in this disease.Methods The tumor cell DNA was harvested for EGFR gene mutation detection in exon 18,19,20,and 21 by ARMS method,which was extracted from paraffin embedded bronchoscopic biopsy specimens in 36 patients with adenoid cystic carcinoma at Meitan General Hospital from 2004 to 2013.The difference of mutation rate between groups was compared using Fisher's exact probability test.P <0.05 was considered as statistical significance.Results The gene mutation rate of EGFR was 31% (11/36) in the 36 paraffin embedded specimens of tracheal adenoid cystic carcinoma.Among them,14% (5/36) expressed double mutation

  16. Microbiologic profile of flexible endoscope disinfection in two Brazilian hospitals Estudo microbiológico da desinfecção de endoscópios flexíveis em dois hospitais brasileiros

    Directory of Open Access Journals (Sweden)

    Alexandre P. Machado

    2006-12-01

    Full Text Available BACKGROUD: Endoscopes are routinely used in hospitals and clinics of the world and they can be potential sources of cross-infection when the decontamination process is unsuitable AIM: The routines of flexible endoscope (bronchoscopes, esophagogastroduodenoscopes and colonoscopes disinfection procedures used in two Brazilian university hospitals were evaluated during a 3-year period METHODS: Aleatory samples from internal channels of endoscopes were collected after patient examination and after cleaning/disinfection procedures RESULTS: A contamination >3 log10 was achieved in samples recovered from endoscopes after patient examination. These samples yielded gram-negative bacilli (n = 142: 56%, gram-positive cocci (n = 43: 17%, yeast cells (n = 43: 17%, and gram-positive bacilli (n = 26: 10%. Approximately, 72 out of 149 samples (48.32% collected after undergoing the cleaning and disinfection procedures disclosed gram-negative bacilli (n = 55: 61%, gram-positive cocci (n = 21: 23%, gram-positive bacilli (n = 8: 9% and yeast cells (n = 6: 7%. Esophagogastroduodenoscopes and colonoscopes were the most frequently contaminated devices. Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter spp, Serratia marcescens, Proteus mirabilis, Citrobacter freundii, Staphylococcus aureus, Staphylococcus coagulase negative, Micrococcus luteus, Candida albicans, C. tropicalis, C. glabrata, C. guilliermondii, Bacillus spp and Corynebacterium spp were predominantly identified CONCLUSION: Inappropriate cleaning and low times of disinfection were respectively the major factors associated with the presence of microorganisms in colonoscopes and esophagogastroduodenoscopes. By analyzing the identified germs, hospital disinfection was considered of either intermediate or poor level. After this investigation, both university centers improved their previous protocols for disinfection and conditions for reprocessing endoscopes.RACIONAL: Endoscópios s

  17. IMP3 can predict aggressive behaviour of lung adenocarcinoma

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    Beljan Perak Renata

    2012-11-01

    Full Text Available Abstract Background Lung cancer most often presents as an inoperable tumour and the diagnosis is usually performed on a small biopsy/cytology specimen. In the group of non small cell lung cancer - not otherwise specified, adenocarcinoma phenotype can be determined immunohistochemically using TTF-1 and Napsin A. Expression of oncofetal protein IMP3 in human cancer is associated with poor differentiation and aggressive behaviour. In the present study expression of IMP3 was correlated with expression of TTF-1 and Napsin A, histological subtype and clinical stage of lung adenocarcinoma. We were interested whether distant metastases are associated with IMP3 overexpression, regardless of the histologic subtype of adenocarcinoma. Methods In retrospective study, consecutive series of 105 patients with advanced lung adenocarcinoma diagnosed from 2006 to 2009 in Clinical Hospital Center Split, Croatia, were analysed. Clinical data were collected from the Pulmology Department and time of death from the Mortality Registry. Paraffin blocks of bronchoscopic biopsies were collected from the Institute of Pathology and 15 cases excluded from the analysis due to insufficient material. Expression of IMP3, Napsin A and TTF-1 were analysed by indirect enzyme immunohistochemistry. Statistical analysis was performed and P values less than 0.05 considered significant. Results Of 90 patients, 71 (78% were males and 19 (22% females. Median age for males was 61.5 years (min-max 43–83 and for females 61 years (min-max 44–86. Pleural effusion was found in 15 (16.6% and distant metastases in 45 (50% cases. According to histological subtypes, there were 34 acinar, 2 lepidic, 2 papillary and 52 solid subtypes. IMP3 overexpression was found in 63 cases (70% and was correlated with solid subtype (P = 0.002 and negative/weak Napsin A expression (P = 0.004. Strong Napsin A expression correlated with TTF-1 expression (P = 0.003 and lower histological grades (P

  18. Etiology and imaging analysis of 59 patients with pulmonary fungal disease%肺真菌病59例病原学和影像学分析

    Institute of Scientific and Technical Information of China (English)

    梁大华; 秦志强; 韦海明; 莫祥兰

    2014-01-01

    目的:探讨肺真菌病的病原学分布和影像学特征。方法收集肺真菌病59例,均经支气管镜、经皮肺穿刺活检或手术切除送病理学确诊,分析其病原学分布和影像学特征。结果59例病理学确诊肺真菌病患者中,肺曲霉病24例(40.7%),肺隐球菌病24例(40.7%),肺毛霉病5例(8.5%),肺念珠菌病4例(6.8%),组织胞浆菌病2例(3.4%),合并放线菌肺炎1例(1.7%)。胸部影像学改变包括肺部肿块23例(39.0%),渗出性病变23例(39.0%),结节8例(13.6%),支气管肿物3例(5.1%),空洞病变1例(1.7%),弥漫性病变1例(1.7%)。误诊为肺炎12例(20.3%),肺结核7例(11.9%),肺癌4例(6.8%)。结论病理学确诊的肺真菌病以肺曲霉病和肺隐球菌病为多见,影像学表现主要以肺部肿块影和渗出性病变为主。肺真菌病影像学表现多种多样、缺乏特征性,诊断应尽早取得病理学依据。%Objective To observe the etiological distribution and imaging features of pulmonary fungal dis -ease that was diagnosed by pathology in the People′s Hospital of Guangxi Zhuang Autonomous Region .Methods Fif-ty-night patients with pulmonary fungal disease were collected and analyzed in the People ′s Hospital of Guangxi Zhuang Autonomous Region from June 2004 to March 2013 .The diagnosis of all the patients was confirmed by patho-logical examination ,of lung or bronchi tissue that was obtained by bronchoscope , percutaneous lung puncture biopsy or operation.Results Of the 59 patients who were diagnosed having pulmonary fungal disease by pathology , 24 pa-tients(40.7%) suffered from pulmonary aspergillosis ,24 patients(40.7%) suffered from pulmonary cryptococcosis , 5 patients(8.5%) suffered from pulmonary mucormycosis , 4 patients(6.8%) suffered from pulmonary candidiasis , 2 patients(3.4%) suffered from

  19. Management of airway for scoliosis patients associated with arthrogryposis multiplex congenita%先天性多发性关节挛缩症伴脊柱侧凸患者气道管理

    Institute of Scientific and Technical Information of China (English)

    刘延军; 马正良; 顾小萍

    2015-01-01

    Objective To summarize the experience of management of airway in scoliosis patients associated with arthrogryposis multiplex congenita (AMC).Methods The medical records of twenty scoliosis patients associated with AMC undergoing spinal corrective surgery in our hospital were retrospectively reviewed.There were twelve male patients and eight female patients in our study.The age of patients averaged at (14.9±3.7) years, ranging from 9 to 24 years.The median degree of preoperative Cobb angle was 90 degrees, with the maximum Cobb angle of 147 degrees.The following data were recorded: the grade of Mallampati,the results of pulmonary function tests, whether it was difficult airway or not, the special instrument for intubation, whether it was admitted to intensive care unit (ICU) or not after surgery, and the time from end of surgery to tracheal extubation.Results The cases of Mallampati Ⅰ , Ⅱ, Ⅲ, and Ⅳ grade was 3 (15%), 9(45%), 5(25%), and 3(15%), respectively.All patients suffered from pulmonary dysfunction.The cases of mild, moderate and severe preoperative pulmonary dysfunction was 1 (5%), 4 (20%) and 15 (75%), respectively.Five patients with anticipated difficult airway were successfully intubated via fiber bronchoscope.After surgery,seven patients with difficult tracheal extubation caused by lung ventilation dysfunction were admitted to ICU to monitor vital signs closely.The time from end of surgery to tracheal extubation varied greatly, ranging from 10 min to 1 115 min.Conclusions The patient's airway should be thoroughly examined by the attending anesthesiologists during preoperative interview, whose attention should be focused on assessing difficult airway, especially for difficult intubation.The anesthetists should make well preparations for difficult airway, especially for difficult intubation, including emergency drugs, and special instruments for intubation.%目的 总结先天性多发性关节挛缩症(arthrogryposis multiplex

  20. Clinical observation of dexmedetomidine for intubation in patients with potential difficult airways%右美托咪定用于困难气道患者纤维支气管镜清醒气管插管的临床观察

    Institute of Scientific and Technical Information of China (English)

    王前; 王天龙; 吴岚; 薛纪秀

    2013-01-01

    目的 观察右美托咪定用于困难气道患者纤维支气管镜清醒气管插管的临床效果.方法 选择MallampattiⅢ~Ⅳ级择期手术的患者40例,采用随机数字表法分为2组,右美托咪定组(DEX组,20例)和咪唑安定联合芬太尼组(C组,20例).DEX组给予右美托咪定1μg/kg,15 min输注完毕.C组给予咪唑安定1 mg、芬太尼0.1~0.15 mg.两组患者均采用1%丁卡因实施上呼吸道表面麻醉,随后纤维支气管镜引导经口气管插管.气管插管成功后立即给予镇静、镇痛及肌松药,连接麻醉机行机械通气.记录患者入室(T1)、药物输注完毕(T2)、置入纤维支气管镜前(T3)、气管插管即刻(T4)的BP、HR、SpO2、BIS及OAA/S评分.术后1d随访,记录患者对气管插管的记忆情况.结果 DEX组BP无明显变化,T2时HR明显低于T1、T4(P<0.05).C组T3时SBP明显低于T1(P <0.05),T4时HR高于T3(P <0.05).DEX组T2、T3时SBP高于C组(P<0.05),T2、T4时HR低于C组(P<0.05).两组患者SpO2、BIS及OAA/S评分比较差异无统计学意义(P>0.05).DEX组气管插管的记忆率高于C组(P<0.05).结论 清醒气管插管前静脉缓慢给予右美托咪定镇静血流动力学平稳,无呼吸抑制的风险,可以安全用于困难气道患者清醒气管插管.%Objective To evaluate the efficacy of dexmedetomidine for awake intubation in patients with potential difficult airways.Methods 40 patients with mallampatti grade of Ⅲ~ Ⅳ were randomly divided into two groups:dexmedetomidine group (group D,n =20) and control group (group C,n =20).In group D,dexmedetomidine 1 μg/kg was infused during 15 min.In group C,patients received midazolam 1 mg and fentanyl 0.05 ~0.1 mg.All patients were given enough topical anesthetics with 1% dicaine in upper respiratory tract.Then awake intubation with fiberoptic bronchoscope was conducted.BP,HR,SpO2,BIS and OAA/S were recorded before drug infusion(T1),at the end of infusion (T2),before intubation (T3)and

  1. Analysis of allergic bronchopulmonary aspergillosis in 8 children%儿童变应性支气管肺曲霉病8例

    Institute of Scientific and Technical Information of China (English)

    陈兰勤; 殷菊; 徐保平; 胡英惠; 申昆玲

    2015-01-01

    Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University from March 2010 to December 2013.The clinical features,laboratory results,image characteristics and the prognosis information were reviewed.Results Eight ABPA cases met the diagnostic criterion.All patients were school-age children (7 years and 2 months to 13 years and 8 months old).Cough (8 cases),productive sputum (8 cases),wheezing (5 cases),fever (4 cases) and hemoptysis (3 cases) were the main clinical features.Six of the 8 patients showed eosinophilia.IgE level was elevated in 7 patients (1.000-5.000 IU/L).All 8 patients were allergic to aspergillus fumigatus,while only 2 cases were positive in sputum culture for aspergillus fumigatus.CT scans showed pulmonary opacities in all 8 cases,while 7 patients had typical central bronchiectasis.Seven patients were treated with the regimen,which included glucocorticosteroid,antifungal agents (voriconazole or itraconazole) and regular bronchoscope.The symptoms of all treated patients relieved,the total serum IgE level and eosinophil cell count decreased spontaneously after the therapy.Conclusions ABPA is rare in children and the clinical features are non-specific.If the patient has elevated total IgE level in serum and eosinophilia,especially in patients with underling diseases,ABPA should be suspected.The positive result of specific antibodies to aspergillus fumigatus and central bronchiectasis on the radiology may give the suggestive diagnosis.ABPA patients generally have good response to the therapy of glucocorticosteroid and antifungal agents.

  2. 免疫过滤法、平板双向扩散法、酶联免疫吸附试验法血清学检验技术对农民肺诊断价值的Meta分析%Electrosyneresis、ouchterlony double diffusion、ELISA in diagnosing of farmer's lung with Meta analysis

    Institute of Scientific and Technical Information of China (English)

    王群; 许蕾; 刘军; 赵明静; 王笑歌

    2011-01-01

    Objective To investigate the value of electrosyneresis ,ouchterlony double diffusion ,ELISA in diagnosing of farm er' s lung with Meta analysis.Methods Articles of electrosyneresis、 ouchterlony double diffision、 ELISA on farm er' s lung published in English or Chinese from 1960 to Decem ber 2010 were collected . took clinical manfestation , physical exam ination , iconography and lung function ,fiberoptic bronchoscope as golden standards .The software of Revm an 5 .0 and Meta-disc 1 .4 were used for calculated the sensitivity ,specificity ,sum mary receiver operating characteristic curves ,area under the curve and the heterogenerty .Results 5 articles accord with the internalize standard .The sensitivity [0 .78 (0 .59 -0 .90 ) ] and D0R [23 .56 (4 .62 -120 .01 ) ] of ouchterlony double diffusion is higher than the electrosyneresis and elisa the electrosyneresis had the highestAUC (0 .9044 ) and Q * (0 .8360) .Conclusion The electrosyneresis and ouchterlony double diffusion are two useful serum diagnostic toll for detecting barm er' s lung .[英文关键词]electrosyneresis ; ouchterlony double diffusion ; ELISA ; farm er's lung ;Meta analysis%目的 通过Meta分析评价免疫过滤法、平板双向扩散法、酶联免疫吸附试验法对农民肺的诊断价值.方法 收集1960年1月至2010年12月国内外以临床表现、体格检查、影像学及肺功能改变、纤维支气管镜检查为金标准确诊农民肺,并以血清学检验技术免疫过滤法、平板双向扩散法、酶联免疫吸附试验法诊断农民肺的相关文献.采用Review Manager 5.0、Meta-Disc 1.4软件,检验异质性,根据异质性结果选择相应效应模型,计算合并灵敏度和合并特异度,合并阳性似然比、合并阴性似然比、DOR值及其95%CI.绘制综合受试者工作特征曲线、计算曲线下面积综合评价各血清学方法的诊断效能.结果 5篇文献符合纳入标准.合并敏感性和特异性后,免疫过滤

  3. Diagnostic Value of Transbronchial Needle Aspiration for Lesions of the Lung and the Mediastina with Enlarged Mediastinal Lymph Nodes%经支气管针吸活检术在伴有纵隔淋巴结肿大的肺及纵隔病变中的诊断价值研究

    Institute of Scientific and Technical Information of China (English)

    侯刚; 王玮; 李振华; 康健

    2011-01-01

    Objective To explore the diagnostic value of transbronchial needle aspiration ( TBNA ) for pulmonary or mediastinal lesions.Methods Fifty - six patients with enlarged mediastinal lymph nodes underwent routine fiberoptic bronchoscope examinations, which revealed no ohvious lumps inside the cavity nor pressure from outside the bronchial cavity.Transbronchial needle aspiration was carried out in these patients, with subsequent brush cytology performed at the TBNA site.Additional biopsy were carried out when thickened local mucosa, congestion or edema were seen.Positive rates of diagnosis of TBNA and bronchoscopy brush cytology combined with mucosa biopsy were compared to evaluate the validity and safety of TBNA,with its possible influencing factors analyzed.Results Of the 56 cases with mediastinal lymphonode enlargement, 34 were diagnosed by TBNA, with the diagnostic rate ( 60.7% ) higher than that of hronchoscopy hrush cytology comhined with mucosa hiopsy ( 16.1% )( P <0.01 ).The influencing factors included size and site of the examined lymph nodes.Lymph nodes larger than 2 cm in diameter delivered higher positive rates of TBNA diagnosis ( P < 0.01 ).Mediastinal lymph nodes in group seven delivered higher positive rates than those in the other groups ( 76.9% vs.46.7% ) ( P < 0.05 ).Complications of TBNA were rare,mostly slight bleeding of the puncture site.Conclusion TBNA is a safe and effective method in the diagnosis of lesions outside the bronchial cavity or enlargement of mediastinal lymph nodes and lymph nodes within the hilum of the lungs , especially when the bronchi are unobstructed.%目的 探讨经支气管针吸活检术(transbronchial needle aspiration,TBNA)在肺及纵隔病变诊断中的临床价值.方法 对56例常规纤维支气管镜检查支气管,管腔内未见肿物及明显外压但伴有纵隔淋巴结肿大的患者进行纵隔淋巴结针吸活检,直接涂片后送检.TBNA完成后,再以毛刷在穿刺点处刷检,

  4. Application of Dexmedetomidine in the Surgery of Obstructive Sleep Apnea Hypopnea Syndrome%右美托咪啶用于阻塞性睡眠呼吸低通气暂停综合征患者手术的麻醉效果

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    龚华渠; 叶占勇; 侯景利; 代雪梅

    2012-01-01

    continuously during operation. Results: All the patients were intuba-ted successfully. Among them, 15 patients were inserted blindly through nose, 3 patients were inserted through mouth by laryngoscope , and 3 patients were inserted by bronchoscope. The levels of SpO2 of them were above 92%. There were 18 patients who could be extubated smoothly and they entered wards with nasopharyngeal airway consciously, 3 patients entered intensive care unit (ICU )with tubes because of inaccurate hemostasis and then they were obverved for 12 - 24h and extubated consciously. Conclusions: For OSAS patients, dexmedetomidine can not only provide favourable insertion in anesthesia induction, it can also keep the vital signs of the patients more stable during operation and make patients more peaceful after operation.

  5. Lesão brônquica e pneumotórax após reintubação usando um cateter para troca da via aérea Lesión brónquica y neumotórax posterior a la reintubación usando un catéter para el cambio de la vía aérea Bronchial injury and pneumothorax after reintubation using an airway exchange catheter

    Directory of Open Access Journals (Sweden)

    Juliano P. de Almeida

    2013-02-01

    pneumothorax caused by a bronchial perforation during a reintubation using an airway exchange catheter (AEC in a patient with a head and neck cancer. CASE REPORT: A 53 year old man with oropharynx carcinoma was admitted to ICU for severe pneumonia and severe acute respiratory distress syndrome (ARDS. The patient was recognized as a difficult-to-intubate patient and an endotracheal tube (ETT was inserted through a bronchoscope. After one week of treatment, it was observed an endotracheal cuff perforation. Exchanging the endotracheal tube was necessary to achieve satisfactory pulmonary ventilation. An AEC Cook 14 was used to perform the reintubation. After reintubation, the patient presented a worsening in oxygen saturation and a chest radiography (CXR revealed a large pneumothorax. A chest tube was inserted and we observed immediate improvement in oxygen saturation. A repeat CXR confirmed correct positioning of the chest tube and reexpansion of the right lung. A bronchoscopy performed showed a posterior laceration in the right main bronchus. The patient was extubated the following day. After four days, the chest tube was removed. A CXR performed a day after chest tube removal revealed a small right upper pneumothorax, but the patient remained asymptomatic. CONCLUSIONS: Airway exchange catheter is a valuable tool to handle with difficult-to-intubate patients. Although the physicians generally focus their attention in avoid barotrauma - caused by oxygen supplement or jet ventilation through AEC - concern for insertion technique can minimize life threatening complications and increase the safety of AEC.

  6. A clinical analysis of 32 patients with diffuse alveolar hemorrhage in diffuse connective tissue diseases%弥漫性结缔组织病并发弥漫性肺泡出血32例临床分析

    Institute of Scientific and Technical Information of China (English)

    陈光星; 董怡; 鞠中斌

    2008-01-01

    .8%)patients with microscopic polyangiitis(MPA),19 of the 1267(1.5%)patients with systemic lupus erythematosus(SLE),2 of the 56(3.6%)patients with Wegener's granulomatosis(WG)and 1 of the 570(0.2%)patients with rheumatoid arthritis(RA)were consistent with the diagnosis of DAH.DAH in SLE occurred in younger patients(mean age at the time of diagnosis 27.3±13.1 years)and early in the course of disease(median duration of SLE from onset was 16.7±18.3 months),while these figures in MPA patients with DAH were 50.1±20.7 years and 10.6±18.7 months.At the time of DAH in SLE.the median systemic lupus erythematosus disease activity index(SLEDAI)score was 17.1±6.7 and anti-ds-DNA antibody titer elevated markedly,while the median C3 level was low.The levels of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)of patients with DAH in MPA,WG and RA showed marked elevation.The titer of antieutrophil cytoplasmic antibody(ANCA,MPO/PR3)in patients with MPA and WG was highly positive.The main clinical manifestations of DAH were hemoptysis,dyspnea and rapid decrease of hemoglobulin and hematoerit(HCT)in peripheral blood.Most patients presented with difluse alveolar infiltration on chest X-ray and hish resolution CT.DAH could be confirmed by bloody bronchoscopic lavage.20 patients(62.5%)had secondary pulmonary infections at the time of DAH;fungus and combined bacterial infection were most frequently seen.The mortalitv 0f CTD with DAH was 59.4%(19 out of 32).12 patients (63.2%)with SLE,5 patients(50%)with MPA and both of the 2 patients with WG died.12 of the lethal cases(63.2%)died of respiratory failure.Conclusions CTD patients presenting with hemoptysis and dyspnea with rapid decrease of hemoglobulin,and diffuse alveolar infiltration on chest X-ray or high resolution CT should be seriously considered to be suffering from DAH.A bloody BAL may confirm the diagnosis of DAH.DAH in CTD is an acute,serious and frequently life-threatening situation resulting in respiratory hilure and

  7. 亚甲蓝盐水定位气胸与支气管瘘相关支气管的临床研究%Clinical investigation of detecting the bronchi responsible for pulmonary air leakage by injecting methylene blue saline in 27 cases with intractable pneumothorax and bronchial fistula

    Institute of Scientific and Technical Information of China (English)

    金普乐; 葛晖; 彭乱顺; 王国军; 胡文霞; 宋姗

    2014-01-01

    in cases with intractable pneumothorax and bronchial fistula.Methods From January 2006 to October 2013,a total of 19 cases of intractable spontaneous pneumothorax and 8 cases of bronchial fistula were recruited in the study at the Fourth Hospital affiliated to Hebei Medical University.Of all the cases,15 were diagnosed as having tension pneumothorax and 12 as having communicating pneumothorax.All the cases failed to respond to continuous pleural suction for more than 5 days and consented to the proposed treatment.Before procedure,chest suction was established to allow sustained airflow through the drainage tube while the patients breathed normally.Under direct vision through fiberoptic bronchoscope,injection catheter was inserted into the bronchoscopy channel,and methylene blue saline was slowly injected into the potentially leaking segmental or sub-segmental bronchi.When a steady decline or disappearance in the amount of methylene blue saline in the airways was observed,or methylthionine-tainted saline was detected within the chest drainage tube,the bronchus responsible for air leakage was indicated.Beforc blocking the target bronchus,the negative pressure level of pleural suction should be reduced or stopped,and then porcine fibrin glue or acyanoacrylate was used for sealing the bronchi associated with air leakage.When the air was absent from the drainage tube,and lung recruitment was indicated in the chest Ⅹ-ray for 5 days,and bronchial blockade of air leakage was proved successful.Results The bronchi responsible for air leakage were successfully located in all 27 cases,among them segmental bronchi were located in 16,subsegmental bronchi in 10,and small subsegmental bronchus in only one.Multiple adjacent segmental involvement occurred in 3,and multiple adjacent subsegmental involvement in 5 cases.The average time for locating the target bronchi was (51 ±9) s,among them the average time for tension pneumothorax was(48 ± 15) s compared with(53 ±16) s for

  8. 伴胸部受累的淋巴瘤25例临床分析%Clinical analysis of lymphoma with chest involvement: report of 25 cases

    Institute of Scientific and Technical Information of China (English)

    周庆涛; 朱红; 贺蓓

    2009-01-01

    膜和肺组织确诊率低.%Objective To study clinical characteristics and diagnostic methods of lymphoma with chest invovement. Methods Twenty-five lymphoma patients with chest involvement were retrospectively analysed, they were all diagnosed in Peking University Third Hospital during 2000 to 2007. The data were collected including clinical manifestations, blood examinations, chest X-ray and CT scan, diagnostic methods and pathologic diagnosis. Results The median age of the 25 patients was 46 years old. Pyrexia(13 cases), weight loss over 10 percent in 6 months(11 cases), cough(10 cases), shortness of breath(9 cases) and painless enlargement of the peripheral lymph nodes(16 cases) were common manifestations. Erythrocyte sedimentation rate and serum lactate dehydrogenase(LDH) level were increased in 72.7% and 81% patients, respectively. The enlargement of mediastinum lymph nodes(16 cases, 64%) was the most common presentation of chest radiography, followed by pulmonary involvement(15 cases, 60%) including infiltration or pulmonary consolidation, mass, multiple nodules, diffuse ground-glass shadow, miliary lesion. There were also presentations of pleural effusion(10 cases, 40%), pericardial effusion(4 cases, 16%), chest wall mass(2 cases, 8%). Eighteen patients(72%) had at least two kinds of these presentations. The appearance of pleural effusion were yellow turbid, bloody or chyliform. Rivaha tests were all positive. The median value of plearal effusion examinations were listed as follows: specific gravity 1.031, total cells 9800×10~6/L, WBC 6.72×10~9/L, lymphocyte 86%, neutrophil 14%, protein 31.4 g/L, LDH 296 U/L,adenosine deaminase (ADA) 67.4 U/L Most patients(16 cases) were diagnosed by surgical biopsy,especialy peripheral lymph nodes biopsy (12 cases). Other patients were diagnosed by ultrasound or CT-guided biopsy (5 cases), video-assisted thoracoscopic pleural biopsy (1 case), video-mediastinoscopic mediastinum lesion biopsy(1 case), bronchial mucosa biopsy through bronchoscope(1 case

  9. Effect of bronchoalveolar lavage on the heart rhythm and conduction of the children with severe pneumonia%支气管肺泡灌洗术对重度肺炎患儿心脏节律及传导的影响

    Institute of Scientific and Technical Information of China (English)

    高明磊; 崔振泽

    2014-01-01

    Objective To observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage,for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology.Method From July 2011 to March 2012,30 patients who were hospitalized in pneumology department of Dalian Children's Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen.They were 3 to 12 years old,the average age was 5.3 years,including 17 boys and 13 girls,the ratio of boys and girls is 1.3∶ 1.Continuous sampling the electrocardiogram before and duriug the process including anesthesia,entering into glottis,lavage,aspiration,and revive,and recording the heart rate,rhythm amplitude and width of P wave,the PR interval,the form and width of QRS complex were also measured.The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology.Result The incidence of heart rate increase was 100.0%,26 (86.7%) patients began to emerge after anesthesia,the rest of the patients also developed heart rate increase after the start of bronchoscopic operation.All patients had sinus tachycardia,and were most obvious in the progress of lavage and revive.In the process of entering into glottis,lavage,aspiration,13 (43.3%)patients had arrhythmia episodes.Types of arrhythmia included sinus bradycardia,atrioventricular block and premature beat.Incidences of intraoperative arrhythmia compared with the preand post-operation were all statistically significantly different (P =0.00).The most common arrhythmia were premature beat,in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction.Two patients had Ⅲ ° atrioventricular block accompanied by serious sinus bradycardia

  10. Emergency treatment of endobronchial stent placement for serious main bronchial stenosis following high-risk orthotopic heart allotransplantation: One case report%高风险原位同种异体心脏移植术后支气管狭窄的急诊支架置入治疗:1例报告

    Institute of Scientific and Technical Information of China (English)

    赵永祥; 欧阳文; 朱岳; 赵玲玲; 单忠贵; 唐琪; 阳玲; 范钦明; 易波; 廖崇先; 周志明

    2007-01-01

    , which resulted in the aggravation of illness. In order to improve the post-transplant cardiac function, to relieve bronchial collapse and stenosis, and correct the obstructive type of ventilation, an emergency bronchial stent placement surgery was carried out on the sixth day after heart transplantation. Under monitoring of electrocardiogram (EGG) and percutaneaous oxygen saturation (SpO2), patient was awake and in supine to relieve left main bronchial stenosis with a nickel-titanium shape memory alloy stent (Diameter: 12 mm; length: 20 mm) by D20 fiberoptic bronchoscope. Fibrobronchoscopy was used to observe the proximal end of bronchostenosis and set the proximate location mark by using video fluoroscopy; the patency of distal end was explored by stricture, and set the distal location mark; guidewire was inserted into working path of bronchofibroscope and led through the stricture; then loaded the Ni-Ti stent on a special placement apparatus, and led in bronchial stent implantation apparatus along guidewire. When targeting well, the stent was slowly released and adjusted properly. When it was completely released, the stent implantation apparatus was drawn out. Bronchofibroscope was performed postoperatively to observe the adherence of stent; immediately photographed to observe its unfolding. Synchronized intermittent mandatory ventilation (SIMV) was given postoperatively as supportive treatment.MAIN OUTCOME MEASURES: Ameliorations of the cardiac and pulmonary functions of the patient.RESULTS: ①Carbon dioxide retention and hypercapnia were remarkably improved as compared with those preoperatively; hypertensive pulmonary vascular disease was alleviated gradually, and MPAP reduced to 30 mm Hg. One week later, re-examination of bronchofibroscopy was carried out, and the results showed that bronchi of left upper lobe, lingual lobe as well as left lower lobe could be seen distinctly, mucous membrane had slightly congested edema, and lumens were unobstructed