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Sample records for bronchoscopes

  1. 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.

  2. [The importance of bronchoscopic anatomy for anesthesiologists].

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    Hoşten, Tülay; Topçu, Salih

    2011-01-01

    One-lung ventilation (OLV) is a sine qua non of thoracic surgery and requires knowledge and talent. Close familiarity with equipments used for OLV as well as bronchoscopy and respiratory tract anatomy is important for successful OLV. We aim to outline the bronchoscopic anatomy of the tracheobronchial tree and OLV equipment for anesthetists and thoracic surgeons in this review. The recorded preoperative and intraoperative bronchoscopic applications of the patients hospitalized in our Thoracic Surgery clinic for diagnosis and treatment have been evaluated from an anesthetist's perspective. Anatomic landmarks were identified in the bronchoscopic evaluation. Optimal and misplacement images of double-lumen tubes (DLT) and bronchial blockers (BB) used for OLV in our clinic were obtained via fiber optic bronchoscopy. While left lung isolation can be made more safely due to the anatomy of the left main bronchus, placement of both DLTs and BBs to the right main bronchus requires greater care. Success in OLV procedures would increase with anesthetists being well informed about the fiber optic bronchoscopic anatomy of the tracheobronchial tree and in close cooperation with the surgical team.

  3. 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.

  4. Bronchoscopic interventions for chronic obstructive pulmonary disease

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    Mineshita, Masamichi; Slebos, Dirk-Jan

    2014-01-01

    Over the past decade, several non-surgical and minimally invasive bronchoscopic lung volume reduction (BLVR) techniques have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR can be significantly efficacious, suitable for a broad cohort of patients, and

  5. Fibreoptic Bronchoscope for Nasogastric Tube Placement

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    Bhandari Dhiraj; Garg Deepika; Chandankhede Shweta; Sharma Vaijyanti; Premendran Benhur; Tidke Sucheta

    2015-01-01

    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.

  6. Fluorescence bronchoscope for lung tumor localization

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    Profio, A.E. (Univ. of California, Santa Barbara); Doiron, D.R.; Huth, G.C.

    1977-02-01

    A fluorescence bronchoscope has been developed for localization of small bronchogenic tumors at the carcinoma in situ stage. Injected hematoporphyrin-derivative is preferentially taken up or retained by a malignant tumor, and very small amounts can be detected by the red fluorescence under excitation by violet light. The target lesion is 80 ..mu..m thick, with a mass of 250 ..mu..g, containing 250 pg of hematoporphyrin-derivative. A fiberoptic bronchoscope system with a 200W high pressure mercury arc lamp, primary filter passing 405 nm light, special violet transmitting light conductor, coherent imaging bundle, red secondary filter, and three-stage electrostatic focus image intensifier tube was designed for this application. Tumors have been visualized in animals and preparations for clinical use are underway.

  7. BRONCHOSCOPIC THERAPY IN PATIENTS WITH INTRALUMINAL TYPICAL BRONCHIAL CARCINOID

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    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

  8. 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.

  9. 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.

  10. Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion.

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    DiBardino, David M; Lanfranco, Anthony R; Haas, Andrew R

    2016-08-01

    Cryotherapy is an evolving therapeutic and diagnostic tool used during bronchoscopy. Through rapid freeze-thaw cycles, cryotherapy causes cell death and tissue necrosis or tissue adherence that can be used via the flexible or rigid bronchoscope. This extreme cold can be used through the working channel of the bronchoscope via a specialized cryoprobe or directly with the use of spray cryotherapy. These properties allow for multiple bronchoscopic techniques, each with its own equipment and procedural, safety, and efficacy considerations. Bronchoscopic cryotherapy can be used in a variety of clinical scenarios, including the treatment of malignant and benign central airway obstruction and low-grade airway malignancy, foreign body removal or cryoextraction, endobronchial biopsy, and transbronchial biopsy. The bulk of the experience with bronchoscopic cryotherapy consists of uncontrolled case series of malignant central airway obstruction. There are also controlled data supporting the use of cryoadhesion for endobronchial biopsies, albeit with an increased risk of controllable bleeding. The use of cryoadhesion for transbronchial biopsies is an active area of investigation with limited controlled data. In addition, there are promising future directions using bronchoscopic cryotherapy, including chemosensitizing malignancy with cryotherapy and capitalizing on the synergy between cryotherapy and radiation.

  11. A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers

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    Luo, Xiongbiao, E-mail: xiongbiao.luo@gmail.com [Robarts Research Institute, Western University, London, Ontario N6A 5K8 (Canada)

    2014-06-15

    Purpose: Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. Methods: The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model was designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. Results: The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0–10 min{sup −1}. The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. Conclusions: An

  12. 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.

  13. 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.

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

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    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.

  15. Heimlich's maneuver-assisted bronchoscopic removal of airway foreign body.

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    Solanki, Sohan Lal; Bansal, Shivendu; Khare, Arvind; Jain, Amit

    2011-01-01

    Aspiration of foreign bodies (FBs) by children can lead to serious illness and sometimes even death. Bronchoscopic removal of the FB is necessary to prevent from any catastrophic event. Sometimes bronchoscopic removal is not possible due to the larger size of the FB, sharp FB, or long duration FB. Tracheostomy is normally used for the removal of such FBs. The aim of this case report is to highlight the use of Heimlich maneuver for the removal of such FBs before opting invasive procedures. In the present case, a 5-year-old child was presented with history of FB aspiration 5 h back. After multiple failed bronchoscopic attempts to remove the FB it was decided to use Heimlich maneuver in the supine position. A single attempt of Heimlich maneuver expelled the FB into the oral cavity, which was removed by Magill's forceps. On repeated bronchoscope check, there was no remnant of FB. Child's further course of stay in hospital was uneventful. In conclusion, Heimlich maneuver may be useful in patient with failed bronchoscope removal of airway FBs before proceeding for tracheotomy or other invasive procedures.

  16. Heimlich's maneuver-assisted bronchoscopic removal of airway foreign body

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    Solanki, Sohan Lal; Bansal, Shivendu; Khare, Arvind; Jain, Amit

    2011-01-01

    Aspiration of foreign bodies (FBs) by children can lead to serious illness and sometimes even death. Bronchoscopic removal of the FB is necessary to prevent from any catastrophic event. Sometimes bronchoscopic removal is not possible due to the larger size of the FB, sharp FB, or long duration FB. Tracheostomy is normally used for the removal of such FBs. The aim of this case report is to highlight the use of Heimlich maneuver for the removal of such FBs before opting invasive procedures. In ...

  17. Hybrid bronchoscope tracking using a magnetic tracking sensor and image registration.

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    Mori, Kensaku; Deguchi, Daisuke; Akiyama, Kenta; Kitasaka, Takayuki; Maurer, Calvin R; Suenaga, Yasuhito; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi

    2005-01-01

    In this paper, we propose a hybrid method for tracking a bronchoscope that uses a combination of magnetic sensor tracking and image registration. The position of a magnetic sensor placed in the working channel of the bronchoscope is provided by a magnetic tracking system. Because of respiratory motion, the magnetic sensor provides only the approximate position and orientation of the bronchoscope in the coordinate system of a CT image acquired before the examination. The sensor position and orientation is used as the starting point for an intensity-based registration between real bronchoscopic video images and virtual bronchoscopic images generated from the CT image. The output transformation of the image registration process is the position and orientation of the bronchoscope in the CT image. We tested the proposed method using a bronchial phantom model. Virtual breathing motion was generated to simulate respiratory motion. The proposed hybrid method successfully tracked the bronchoscope at a rate of approximately 1 Hz.

  18. Can Bronchoscopic Airway Anatomy Be an Indicator of Autism?

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    Stewart, Barbara A.; Klar, Amar J. S.

    2013-01-01

    Bronchoscopic evaluations revealed that some children have double branching of bronchi (designated "doublets") in the lower lungs airways, rather than normal, single branching. Retrospective analyses revealed only one commonality in them: all subjects with doublets also had autism or autism spectrum disorder (ASD). That is, 49 subjects exhibited…

  19. Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis

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    Abdullah Şimşek

    Full Text Available ABSTRACT Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both. Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%. Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%. Smear microscopy of BAL fluid (BALF was performed in 16 patients and was positive for AFB in 10 (62.5%. Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%. Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%; bronchial brushing, in 7 (38.8%; fine-needle aspiration biopsy, in 2 (11.1%; and BAL, in 2 (11.1%. Bronchial anthracofibrosis was observed in 5 (27.7% of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.

  20. Laser fluorescence bronchoscope for localization of occult lung tumors

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    Profio, A.E.; Doiron, D.R.; King, E.G.

    1979-11-01

    A system for imaging occult bronchogenic carcinoma by the fluorescence of previously-injected, tumor-specific compound hematoporphyrin-derivative has been assembled and successfully used to locate a tumor l mm thick. The violet excitation source is a krypton ion laser coupled to fused quartz fiber light conductor. An electrostatic image intensifier attached to a standard flexible fiberoptic bronchoscope provides a bright image even at relatively low irradiance. A red secondary filter rejects most reflected background and autofluorescence. Sensitivity and contrast capability of the system should permit detection of a tumor less than 0.1 mm thick.

  1. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy.

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    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

  2. Technology update: bronchoscopic thermal vapor ablation for managing severe emphysema

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    Gompelmann D

    2014-09-01

    Full Text Available Daniela Gompelmann,1,2 Ralf Eberhardt,1,2 Felix JF Herth1,21Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, 2German Center for Lung Research, Heidelberg, GermanyAbstract: Bronchoscopic thermal vapor ablation (BTVA is an endoscopic lung volume reduction therapy that presents an effective treatment approach in patients with severe upper lobe-predominant emphysema. By instillation of heated water vapor, an inflammatory reaction is induced, leading to fibrosis and scarring of the lung parenchyma, resulting in lobar volume reduction. Clinical single-arm trials demonstrated great outcomes, with significant improvement of lung function, exercise capacity, and quality of life. As the BTVA-induced local inflammatory response that seems to be essential for the desired lobar volume reduction can be associated with transient clinical worsening, strict monitoring of the patients is required. In future, the balance between efficacy and safety will constitute a major challenge. This review summarizes the BTVA procedure, the mechanism of action, and the results of the clinical trials, including the efficacy and safety data.Keywords: emphysema, bronchoscopy, bronchoscopic thermal vapor ablation

  3. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

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    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

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

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    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.

  5. 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.

  6. Whole lung lavage in comparison with bronchoscopic lobar lavage using the rigid bronchoscope in patients with pulmonary alveolar proteinosis: Is it time to change strategy?

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    Hesham Alkady

    2016-12-01

    Conclusion: Whole-lung lavage is more efficient than bronchoscopic lobar lavage in treating PAP as it provides larger lavage volumes in shorter time periods and is also associated with lower rate of recurrence of symptoms and the need of relavage.

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

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    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.

  8. Efficacy of bronchoscopic lung volume reduction: a meta-analysis

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    Iftikhar IH

    2014-05-01

    Full Text Available Imran H Iftikhar,1 Franklin R McGuire,1 Ali I Musani21Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of South Carolina, Columbia, SC, USA; 2Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USABackground: Over the last several years, the morbidity, mortality, and high costs associated with lung volume reduction (LVR surgery has fuelled the development of different methods for bronchoscopic LVR (BLVR in patients with emphysema. In this meta-analysis, we sought to study and compare the efficacy of most of these methods.Methods: Eligible studies were retrieved from PubMed and Embase for the following BLVR methods: one-way valves, sealants (BioLVR, LVR coils, airway bypass stents, and bronchial thermal vapor ablation. Primary study outcomes included the mean change post-intervention in the lung function tests, the 6-minute walk distance, and the St George's Respiratory Questionnaire. Secondary outcomes included treatment-related complications.Results: Except for the airway bypass stents, all other methods of BLVR showed efficacy in primary outcomes. However, in comparison, the BioLVR method showed the most significant findings and was the least associated with major treatment-related complications. For the BioLVR method, the mean change in forced expiratory volume (in first second was 0.18 L (95% confidence interval [CI]: 0.09 to 0.26; P<0.001; in 6-minute walk distance was 23.98 m (95% CI: 12.08 to 35.88; P<0.01; and in St George's Respiratory Questionnaire was −8.88 points (95% CI: −12.12 to −5.64; P<0.001.Conclusion: The preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninferiority, if not equivalence, when compared to what is known for surgical LVR.Keyword: emphysema, endobronchial valves, sealants, stents, coils

  9. Cryorecanalization after cryosurgery for immediate treatment on central airway obstruction via flexible bronchoscope

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    Yongqun Li; Huasong Feng; Zhoushan Nie; Jiguang Meng; Xinmin Ding; Zhihai Han

    2012-01-01

    Objective: In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope. Methods: A total of 64 cases of patients in all suffered from central airway obstruction were observed and treated by applying cryorecanalization after cryosurgery via flexible bronchoscope. Divide the operation into two steps, including cryosurgery and cryorecanalization. Evaluate the therapeutic effect immediately after the treatment, wherein the evaluating indicator includes preoperative and postoperative dyspnea indexes, quality of life score, bronchoscopy, etc. The surgical safety assessment is mainly by observing the risk of bleeding in the surgery. Results: Forty cases (62.5%) has postoperative dyspnea score improved at least one level compared with preoperative dyspnea score, 24 patients (37.5%) have no significant improvement on dyspnea score. Quality of life score (Karnofsky score): preoperative 52 ± 18.7 points, postoperative 70 ± 9.2 points. Bronchoscopy review: complete success in 12 cases (18.8%), partial success in 45 cases (70.3%), no success in 7 cases (12%).89.1% overall clinical efficiency was achieved. In the surgery, the control to bleeding was satisfactory since no severe bleeding, moderate bleeding in 14 cases (21.9%) and mild bleeding in 50 cases (78.1%) were found as well as rigid bronchoscope was free. Conclusion: The central airway obstruction can be immediately relieved by cryorecanalization after cryosurgery via flexible bronchoscope with satisfactory effects and higher surgical safety.

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

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    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.

  11. Treatment of emphysema using bronchoscopic lung volume reduction coil technology : an update on efficacy and safety

    NARCIS (Netherlands)

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

    2015-01-01

    In the last decade several promising bronchoscopic lung volume reduction (BLVR) treatments were developed and investigated. One of these treatments is BLVR treatment with coils. The advantage of this specific treatment is that it works independently of collateral flow, and also shows promise for pat

  12. Bronchoscopic biopsy for diagnosis of lung cancer in the absence of visible endobronchial abnormalities

    Institute of Scientific and Technical Information of China (English)

    Hua Zheng; Baohua Lu; Qunhui Wang Co-first author; Fanbin Hu; Weimin Ding; Baolan Li

    2016-01-01

    Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and par-ticularly, malignant diseases. However, endoscopists do not normal y perform bronchoscopic biopsy in case lesions are undetected via bronchoscopy. The aim of this study was to evaluate whether performing bron-choscopic biopsy could be established in the diagnosis of lung cancer in case of endobronchial abnormali-ties undetectable to the naked eye. Methods We retrospectively analyzed 109 cases between January 2008 and December 2012. The in-clusion criteria were confirmed lung cancer diagnosis, transbronchial biopsy performed in the absence of visible endobronchial manifestations, brushing, and bronchoalveolar lavage (BAL) according to the images obtained from high-resolution computed tomography (HRCT). Data regarding age, sex, pathology, tumor stage; the method of diagnosis; location of primary lesion (central, peripheral, or intermediate); tumor size, mediastinal lymph node metastasis, and the serum carcinoembryonic antigen (CEA) value were col ected. The Pearson chi-square test or Fisher’s exact and McNemar tests were used in the univariate analysis. Results Among the 109 patients, the diagnosis of 37 (33.9%) patients was confirmed through bronchos-copy. Brushing and BAL had higher positive detection rates than biopsy (P = 0.004). There were no dif er-ences in the positive detection rates between the sex, pathology, lesion location, tumor size, lymph node metastasis, and the serum CEA value (P > 0.05 for al groups). Conclusion Despite the normal appearance of the endobronchial manifestations, lesions undetectable by bronchoscopy could be indicated. Therefore, we suggest performing bronchoscopic biopsy and that brushing and BAL might increase the positive detection rate of bronchoscopic examination.

  13. 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.

  14. Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: First case series from India

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    Hibare, Kedar Ravi; Goyal, Rajiv; Nemani, Chetan; Avinash, Rao; Ram, Bajpai; Ullas, Batra

    2017-01-01

    Background: A peripheral, bronchoscopically invisible pulmonary lesion is a diagnostic challenge. Transthoracic needle aspiration has long been the investigation of choice but runs the risk of pneumothorax (up to 44%). Newer technologies like radial endobronchial ultrasound (R-EBUS) offer a safer approach. We present our results of R-EBUS in the diagnosis of bronchoscopically invisible lesions. This is the first large case series from India. Aims: (1) To determine the yield of R-EBUS for the diagnosis of bronchoscopically invisible lesions. (2) To compare the yields of forceps versus cryobiopsies in the diagnosis of these lesions. Setting: Tertiary care cancer center. Design: Prospective study. Methods: Consecutive patients presenting between January and October 2015 with bronchoscopically invisible peripheral pulmonary lesions were included. R-EBUS was used to localize and sample the lesion and the yields were analyzed. Yields of cryo and forceps biopsy were compared where both methods had been used. Data were analyzed using SPSS version 22. Results: A definite diagnosis obtained in 67.3% (37/55) patients with no major complications. No significant difference was found in yield between: (1) small (3 cm) lesions: (46.2% versus 78.6%, P = 0.38). (2) central and adjacent lesions: 61.5% versus 70%. (3) forceps and cryobiopsy (n = 28, 75% versus 67.9% P = 0.562). Conclusions: R-EBUS is a safe procedure in our setting and its yield is comparable to that reported in literature. The yield of central and adjacent lesions and forceps or cryobiopsy appears similar. Further refinements in the technique could improve yield. PMID:28144060

  15. Comparison of haemodynamic responses to intubation: Flexible fibreoptic bronchoscope versus bonfils rigid intubation endoscope

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    Kapil Gupta

    2012-01-01

    Full Text Available Background : The flexible fibreoptic bronchoscope and bonfils rigid intubation endoscope are being widely used for difficult intubations. Methods: The haemodynamic response to intubation under general anaesthesia was studied in 60 adult female patients who were intubated using either flexible fibreoptic bronchoscope or bonfils rigid intubation endoscope (30 in each group. Non-invasive blood pressure and heart rate (HR was recorded before induction of anaesthesia, immediately after induction, at the time of intubation and, thereafter, every minute for the next 5 min. The product of HR and systolic blood pressure (rate pressure product at every point of time was also calculated. Statistical Analyses: Graph pad prism, 5.0 statistical software, independent t test and repeated measure ANOVA test were used. Results: Both bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope required a similar time (less than 1 min for orotracheal intubation. After intubation, there was a significant increase in HR, blood pressure and rate pressure product (P<0.001 in both the groups compared with the baseline and post-induction values. There was no significant difference in HR, blood pressure and rate pressure product at any of the measuring points or in their maximum values during observation between the two groups. The time required for recovery of systolic blood pressure and HR to post-induction value (±10% was not significantly different between the two groups (more than 2 min. Conclusion: In female adults under general anaesthesia, bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope require a similar time for successful orotracheal intubation and cause a similar magnitude of haemodynamic response.

  16. A pseudoepidemic of Mycobacterium chelonae infection caused by contamination of a fibreoptic bronchoscope suction channel.

    Science.gov (United States)

    Wang, H C; Liaw, Y S; Yang, P C; Kuo, S H; Luh, K T

    1995-08-01

    An unusual increase in the frequency of isolation of Mycobacterium chelonae subspecies chelonae from specimens of bronchial washings was found between September and December 1992 in National Taiwan University Hospital. During this period, a total of 123 patients underwent fibreoptic bronchoscopy with an Olympus P20. Seventy six patients had bronchial washing for bacteriological study and cytological examination. Acid-fast bacilli were found in 21 patients, in 18 of whom Mycobacterium chelonae were isolated from bronchial washing cultures. Eight patients were treated as mycobacterial infected, because of the presence of unexplained pulmonary lesion, positive acid-fast stain and culture for Mycobacterium chelonae. Diagnosis of lung cancer was delayed in one patient because of the initial negative cytological study and positive bacterial culture. The fibreoptic bronchoscope was disinfected by automated washing machine (EW-20, Olympus) using 2.3% glutaraldehyde according to a standard protocol. From a survey to search for possible sources of contamination, they were identified at the suction channel of four different bronchoscopes. This episode proved to be a pseudoepidemic. The contamination was controlled by extensive suction and rinsing of the channel with 70% alcohol immediately after disinfection by the automated bronchoscope disinfection machine. This study shows that, despite using the disinfection machine, the suction channel could still be contaminated with Mycobacterium chelonae. This may cause diagnostic confusion and unnecessary antimycobacterial treatment.

  17. Fluorescent microscopy and Ziehl-Neelsen staining of bronchoalveolar lavage, bronchial washings, bronchoscopic brushing and post bronchoscopic sputum along with cytological examination in cases of suspected tuberculosis

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    Vijay Kumar Bodal

    2015-01-01

    Full Text Available Objectives: Ever since the discovery of Mycobacterium tuberculosis in 1882, many diagnostic methods have been developed. However "The gold standard" for the diagnosis of tuberculosis (TB is still the demonstration of acid fast Bacilli (AFB by microscopic examination of smear or bacteriological confirmation by culture method. Materials and Methods: In suspected 75 patients with active pulmonary TB, the materials obtained bronchoscopically, were bronchoalveolar lavage (BAL, bronchial brushings, bronchial washings and post bronchoscopic sputum. Four smears were made from each of the specimen. Fluorescent Staining, Ziehl–Neelsen (ZN, Pap and May Grunwald-Giemsa (MGG stains were carried out for cytological examination. Results: Fluorescent stain yielded maximum AFB positivity in all the methods, that is 36 (48% in post fibre-optic bronchoscopy (FOB sputum and 19 (25.33% by fluorescence microscopy in both bronchial brushings and bronchial washings. Maximum yield of AFB with ZN staining 12 (16% was equal to the post FOB sputum and bronchial brushings samples. It was followed by 6 cases (8% in BAL and 4 (5.3% in bronchial washings. The cytological examination was suggestive of TB in only 8 (10.66% cases in bronchial washings and 6 (8% cases in post FOB collection. It was equal in BAL and Bronchial brushings each that is 5 (6.67%. Conclusion: Bronchoscopy is a useful diagnostic tool and fluorescent microscopy is more sensitive than ZN and cytology. On X-ray examination, other diseases like malignancy or fungus can also mimick TB. So apart from ZN staining or fluorescence microscopy, Pap and MGG stain will be worthwhile to identify other microorganisms.

  18. Bronchoscopic foreign body extraction in a pulmonary medicine department: a retrospective review of egyptian experience.

    Science.gov (United States)

    Korraa, Emad; Madkour, Ashraf; Wagieh, Khaled; Nafae, Ahmed

    2010-01-01

    Foreign body (FB) removal in our hospital was almost exclusively performed by surgeons through a rigid bronchoscope until the pulmonologists started getting involved in FB extraction. This study aimed to retrospectively review the results of 2 years of experience with 120 patients who presented or were referred to the Pulmonary Medicine Department, Ain Shams University Hospital in Cairo, Egypt, with clinical suspicion of FB aspiration during the period between December 2006 and December 2008. FBs were removed by either rigid and/or flexible bronchoscopy using either general or topical anesthesia. There were 54 male and 66 female patients with an age range between 3 months and 70 years and 68.5% of the patients were under the age of 10 years. Ninety patients (75%) presented with a definite history of FB aspiration, with a time interval between aspiration and presentation ranging between less than 6 hours and 12 months. The FB was visible on the chest x-ray in 42 cases. Aspirations were primarily into the right lung (53.2%). Seeds and scarf pins were the most common FB found, and were retrieved in 36 cases. Pulmonologists were successful in extracting 110 out of 111 (99.1%) bronchoscopically visualized FBs, and open thoracotomy was required in only 1 case for FB removal. In another 6 cases, only mucous plug was found to be the endogenous FB, whereas no FB could be found in 3 cases. No mortality or serious complications took place during or after the bronchoscopy. In conclusion, pulmonologists can extract FBs easily and safely either by using rigid and/or flexible bronchoscopes if they have the appropriate experience.

  19. Impacted Sharp Oesophageal Foreign Bodies—A Novel Technique of Removal with the Paediatric Bronchoscope

    Science.gov (United States)

    Bajpai, Minu

    2016-01-01

    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

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

    Science.gov (United States)

    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.

  1. [Bronchoscopic lung volume reduction is a treatment offered to patients with severe heterogenous emphysema].

    Science.gov (United States)

    Perch, Michael; Titlestad, Ingrid L; Rychwicha-Kielek, Beata A; Bendstrup, Elisabeth; Iversen, Martin; Siemsen, Mette; Jørgensen, Ole D; Haahr, Poul Erik

    2014-07-14

    Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been defined as an area of development by The Danish Health and Medicines Authority. We here present the rationale for treatment, in- and exclusion criteria, and ultimately the organization for assessment, treatment and follow-up in Denmark. The treatment aim is to lower dyspnoea. There is a national protocol for patient selection according to in- and exclusion criteria. Different commercial devices are available, but endobronchial valves have been the devices mostly applied. A national database has been established to evaluate cost-effectiveness.

  2. Interventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction.

    Science.gov (United States)

    Miller, Russell J; Murgu, Septimiu D

    2014-12-01

    Emphysema and asthma are responsible for economic and social burden. Altering the natural course of these diseases is a field of intense research. The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly reduce both morbidity and mortality in properly selected patients. LVRS is seldom performed, however, due to the high morbidity associated with the surgery. Numerous bronchoscopic interventions have been introduced with the goal of providing the clinical benefits of LVRS without the surgical complications. Thus far, these modalities have not produced the results once hoped. However, through active modification of both technique and patient selection, the role of minimally invasive modalities in the treatment of emphysema continues to evolve. Bronchial thermoplasty (BT) is a method of delivering controlled heat to airway mucosa with the goal of reducing airway smooth muscle mass and hence bronchoconstriction. In patients suffering from asthma who cannot achieve control with standard medical care, BT has been shown to be safe and improves symptoms, with long lasting benefit. BT does not seem to affect traditional markers of asthma severity such as forced expiratory volume in 1 second and questions remain regarding proper patient selection for this therapy and its true physiologic effects. This article is a review of bronchoscopic modalities for emphysema and asthma.

  3. Comparison of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar: A clinical study

    Directory of Open Access Journals (Sweden)

    Nitesh Gill

    2015-01-01

    Full Text Available Background: Device like fibreoptic bronchoscope is gold standard for difficult intubation situations. It can be performed by both orotracheal and nasotracheal route. But, through nasal route there are more chances of nasal bleeding and pressure necrosis while through oral route there is only one problem, which is clearing of upper airway for bronchoscope. Manoeuvres like jaw thrust and chin lift are very useful in clearing upper airway for bronchoscope. The aim of this study was to compare ease of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar, in terms of need of manoeuvres: Jaw thrust and Chin lift. Materials and Methods: 25 patients in age range 20-50 years, of ASA ΂ - II, and of either sex undergoing elective surgery under general anaesthesia were randomly allocated into each group. There were two groups: Group A (Rigid Cervical Collar and group B (Without Collar. Intubating condition was assessed in between these groups with need of manoeuvres like jaw thrust and chin lift. Quantitative data i.e. age, weight, thyromental distance and sternomental distance were presented as mean value and standard deviation. Intergroup comparison of quantitative data was done by t-test and probability was considered to be significant if less than <0.05. Categorical data i.e. sex, ASA grade, Mallampati grade and need of manoeuvres were presented as number and were compared among groups using Chi-square test. P < 0.05 was considered statistically significant. Results: There was significant (P < 0.05 difference between group A and group B in terms of use of manoeuvres for ease of intubation and clearing upper airway. In group B, need of jaw thrust and chin lift for clearing airway is significantly (P < 0.05 higher than collar group. Conclusion: We concluded that as far as the oral intubation with flexible fibreoptic bronchoscope is concerned, rigid cervical collar is very useful tool for making intubation easier.

  4. 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

  5. Outcomes after Bronchoscopic Procedures for Primary Tracheobronchial Amyloidosis: Retrospective Study of 6 Cases

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    Ihsan Alloubi

    2012-01-01

    Full Text Available Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion.

  6. Successful Flexible Bronchoscopic Management of Dynamic Central Airway Obstruction by a Large Tracheal Carcinoid Tumor

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    Vijay Hadda

    2014-01-01

    Full Text Available Typical carcinoid of the trachea presenting as an endoluminal polypoidal mass is a rare occurrence. Herein, we report a case of a 34-year-old female patient who presented with features of central airway obstruction. Flexible bronchoscopy demonstrated a large pedunculated growth arising from the lower end of the trachea near carina which was flopping in and out of the main tracheal lumen and the proximal right bronchus leading to dynamic airway obstruction. Successful electrosurgical excision (using a snare loop of the polypoidal growth was performed using the flexible bronchoscope itself. The patient had immediate relief of airway obstruction and histopathological examination of the polyp demonstrated features of typical carcinoid (WHO Grade I neuroendocrine tumor.

  7. Automated segmentation of lung airway wall area measurements from bronchoscopic optical coherence tomography imaging

    Science.gov (United States)

    Heydarian, Mohammadreza; Choy, Stephen; Wheatley, Andrew; McCormack, David; Coxson, Harvey O.; Lam, Stephen; Parraga, Grace

    2011-03-01

    Chronic Obstructive Pulmonary Disease (COPD) affects almost 600 million people and is currently the fourth leading cause of death worldwide. COPD is an umbrella term for respiratory symptoms that accompany destruction of the lung parenchyma and/or remodeling of the airway wall, the sum of which result in decreased expiratory flow, dyspnea and gas trapping. Currently, x-ray computed tomography (CT) is the main clinical method used for COPD imaging, providing excellent spatial resolution for quantitative tissue measurements although dose limitations and the fundamental spatial resolution of CT limit the measurement of airway dimensions beyond the 5th generation. To address this limitation, we are piloting the use of bronchoscopic Optical Coherence Tomography (OCT), by exploiting its superior spatial resolution of 5-15 micrometers for in vivo airway imaging. Currently, only manual segmentation of OCT airway lumen and wall have been reported but manual methods are time consuming and prone to observer variability. To expand the utility of bronchoscopic OCT, automatic and robust measurement methods are required. Therefore, our objective was to develop a fully automated method for segmenting OCT airway wall dimensions and here we explore several different methods of image-regeneration, voxel clustering and post-processing. Our resultant automated method used K-means or Fuzzy c-means to cluster pixel intensity and then a series of algorithms (i.e. cluster selection, artifact removal, de-noising) was applied to process the clustering results and segment airway wall dimensions. This approach provides a way to automatically and rapidly segment and reproducibly measure airway lumen and wall area.

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

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    Fraga, Andrea de Melo Alexandre; Reis, Marcelo Conrado dos; Zambon, Mariana Porto [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Pediatric Emergency Room]. E-mail: andreafrag@gmail.com; Toro, Ivan Contrera [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Thoracic Surgery; Ribeiro, Jose Dirceu; Baracat, Emilio Carlos Elias [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Pediatric Pulmonology

    2008-02-15

    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)

  9. Histopathological yield in different types of bronchoscopic biopsies in proven cases of pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Nalini Gupta

    2015-01-01

    Full Text Available Background: Diagnosis of pulmonary tuberculosis (TB is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]. Materials and Methods: The records of patients diagnosed to have pulmonary TB, over a period of 1-year were evaluated. Patients with positive acid-fast bacilli (AFB culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14 histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin-eosin and Ziehl-Neelsen staining. Results: Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each. Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%. Conclusion: Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.

  10. Poor man medical pneumoplasty: Bronchoscopic lung volume reduction with hot saline versus dissolved doxycycline as a neoteric remedy of pulmonary emphysema

    Directory of Open Access Journals (Sweden)

    A.M. Abumossalam

    2016-01-01

    Conclusion: Bronchoscopic lung volume reduction by hot saline and dissolved doxycycline comes into sight to be a safe and feasible profile with an acceptable outcome that presents an attractive substitute to COPD patients who are physiologically friable.

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

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    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.

  12. Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope.

    Science.gov (United States)

    Rajendram, R; McGuire, N

    2006-10-01

    Although tracheostomy tube displacement is uncommon, the management is often difficult and the associated mortality is high. It is important to ensure that the airway is secure and then either replace or reposition the tracheostomy tube. This case report describes the use of an Aintree intubation catheter (C-CAE-19.0-56-AIC, William Cook Europe, Denmark) mounted on an intubating fibre-optic bronchoscope (11302BD1, Karl Storz Endoskope, Germany) to reposition a partially displaced tracheostomy tube.

  13. Effete of bronchoscopic cryotherapy and injection treatment on negative sputum conversion and immune function of multi-drug resistant tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Li Li

    2016-01-01

    Objective:To analyze the effect of bronchoscopic cryotherapy and injection treatment on negative sputum conversion and immune function of multi-drug resistant tuberculosis. Methods:A total of 60 patients with multi-drug resistant tuberculosis were randomly divided into observation group and control group, control group received 3DVThAE/15DVThE treatment and observation group received bronchoscopic cryotherapy and injection + 3DVThAE/15DVThE treatment. Differences in negative sputum conversion, serum ADA and inflammatory factors, immune function index values,etc. were compared between two groups after treatment.Results: Negative sputum conversion rate of observation group 6, 12 and 18 months after treatment were higher than those of control group (P<0.05); ADA, CRP and IL-10 levels of observation group after treatment were lower than those of control group, and IFN-γ level was higher than that of control group (P<0.05); peripheral blood CD3+ and CD4+T lymphocyte levels and CD4+/CD8+ ratio were higher than those of control group, and CD8+T lymphocyte level was lower than that of control group (P<0.05); IgA, IgM and IgG levels were higher than those of control group (P<0.05).Conclusions:Bronchoscopic cryotherapy and injection therapy can improve the condition in patients with multidrug-resistant tuberculosis and optimize treatment outcome.

  14. Multimodal 3D PET/CT system for bronchoscopic procedure planning

    Science.gov (United States)

    Cheirsilp, Ronnarit; Higgins, William E.

    2013-02-01

    Integrated positron emission tomography (PET) / computed-tomography (CT) scanners give 3D multimodal data sets of the chest. Such data sets offer the potential for more complete and specific identification of suspect lesions and lymph nodes for lung-cancer assessment. This in turn enables better planning of staging bronchoscopies. The richness of the data, however, makes the visualization and planning process difficult. We present an integrated multimodal 3D PET/CT system that enables efficient region identification and bronchoscopic procedure planning. The system first invokes a series of automated 3D image-processing methods that construct a 3D chest model. Next, the user interacts with a set of interactive multimodal graphical tools that facilitate procedure planning for specific regions of interest (ROIs): 1) an interactive region candidate list that enables efficient ROI viewing in all tools; 2) a virtual PET-CT bronchoscopy rendering with SUV quantitative visualization to give a "fly through" endoluminal view of prospective ROIs; 3) transverse, sagittal, coronal multi-planar reformatted (MPR) views of the raw CT, PET, and fused CT-PET data; and 4) interactive multimodal volume/surface rendering to give a 3D perspective of the anatomy and candidate ROIs. In addition the ROI selection process is driven by a semi-automatic multimodal method for region identification. In this way, the system provides both global and local information to facilitate more specific ROI identification and procedure planning. We present results to illustrate the system's function and performance.

  15. 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.

  16. A comparison of halothane and sevoflurane for bronchoscopic removal of foreign bodies in children.

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    Batra Yatindra

    2004-01-01

    Full Text Available The present study was designed to compare induction and recovery characteristics of sevoflurane and halothane for rigid bronchoscopy for removal of foreign bodies in tracheobronchial tree in children. Forty four children (age 1-4 years were allocated randomly to two groups to receive either halothane (group H; n=22 or sevoflurane (group S; n=22 in oxygen. A graded inhalation technique was used with maximum inspiratory concentration of 5% for halothane and 8% for sevoflurane. Time for loss of consciousness and induction time in group H and group S were 2.3+/-0.4 min vs 2.2+/-0.4 min (p>0.05 and 4.6+/-0.7 min vs 4.9+/-0.6 min (p>0.05 respectively. Intubation conditions with rigid bronchoscope were similar in both groups. Fewer children in group H had vocal cord movements as compared to group S on laryngoscopy (3 vs 8, p>0.05. Six children in group H and two children in group S had disturbances of cardiac rhythm (p>0.05. Emergence time was significantly shorter in group S as compared to group H (group H - 29.6+/-10.7 min vs group S- 12.3+/-7.6 min, p<0.05. Modified Aldrete′s score of 8 was achieved significantly faster in group S as compared to group H (group H - 33.8+/-9.3 min vs group S- 17.3+/-6.8 min, p<0.05. Adverse events during induction and recovery were comparable between the two groups except for significantly high incidence of excitement in group S. In conclusion, halothane is as suitable as sevoflurane for children undergoing rigid bronchoscopy for airway foreign body retrieval, but sevoflurane has a quicker recovery.

  17. [Segmental bronchoalveolar lavage with a flexible probe via a rigid bronchoscope in the diagnosis of mediastino-pulmonary sarcoidosis].

    Science.gov (United States)

    Faina, A G

    1989-01-01

    Segmentary bronchial-alveolar lavage with flexible catheter connected to rigid bronchoscope might be used in diagnosis of mediastinal-pulmonary sarcoidosis, according to a method used by the authors. Cytologic examination of the lavage fluid shows, in the cases studied, the great abundance in cells, with lymphocytes increase to 30 +/- 12% (in agreement with other authors) making thus possible the disease diagnosis. On the other hand, polymorphonuclears increased to 20 +/- 10%. These higher values than those noticed up to now, pointed that the fibrosing process in sarcoidosis has a higher level than assumed, and appear since the onset of the disease.

  18. Comparison of endotracheal aspirate and non-bronchoscopic bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia in a pediatric intensive care unit.

    Science.gov (United States)

    Yıldız-Atıkan, Başak; Karapınar, Bülent; Aydemir, Şöhret; Vardar, Fadıl

    2015-01-01

    Ventilator-associated pneumonia (VAP) is defined as pneumonia occuring in any period of mechanical ventilation. There is no optimal diagnostic method in current use and in this study we aimed to compare two non-invasive diagnostic methods used in diagnosis of VAP in children. This prospective study was conducted in 8 bedded Pediatric Intensive Care Unit at Ege University Children´s Hospital. Endotracheal aspiration (ETA) and non-bronchoscopic bronchoalveolar lavage (BAL) were performed in case of developing VIP after 48 hours of ventilation. Quantitative cultures were examined in Ege University Department of Diagnostic Microbiology, Bacteriology Laboratory. Fourty-one patients were enrolled in the study. The mean age of study subjects was 47.2±53.6 months. A total of 28 in 82 specimens taken with both methods were negative/negative; 28 had positive result with ETA and a negative result with non-bronchoscopic BAL and both results were negative in 26 specimens. There were no patients whose respiratory specimen culture was negative with ETA and positive with non-bronchoscopic BAL. These results imply that there is a significant difference between two diagnostic methods (p ETA results were compared with this method. ETA's sensitivity, specificity, negative and positive predictive values were 100%, 50%, 100% and 48% respectively. The study revealed the ease of usability and the sensitivity of non-bronchoscopic BAL, in comparison with ETA.

  19. 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.

  20. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

    Science.gov (United States)

    Shyam, Radhey; Sachan, Pushplata; Singh, Prithvi Kumar; Singh, Gyan Prakash; Bhatia, Vinod Kumar; Chandra, Girish; Singh, Dinesh

    2017-01-01

    Introduction Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. Results All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (pmanagement of patients with difficult airways.

  1. 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.

  2. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Application of Fiber Bronchoscope in Acute Children Respiratory Infection Samples Collection%纤维支气管镜在儿童急性呼吸道感染标本采集中的应用

    Institute of Scientific and Technical Information of China (English)

    万江; 程黎

    2012-01-01

    Recently,the application of fiber bronchoscope has become more popular in the clinical practice. Traditional respiratory sample collection method is vulnerable to pollution and infants don't cooperate, while fiber bronchoscope,through irrigation,brush inspection,biopsy and so on,collects the inspection samples,which overcomes the difficulties of pollution and uncooperative children,thus provides strong help to the diagnosis and treatment. The efficacy and safety of fiber bronchoscope's has been widely affirmed in pediatric clinical application, and here is to make a review on the clinical study of fiberoptic bronchoscope applied in children's acute respiratory infection sample collection.%纤维支气管镜在临床上的应用近年来得到了进一步的普及和提高.运用传统的呼吸道标本采集方法,标本易受污染,且婴幼儿不能配合,而纤维支气管镜通过灌洗、刷检、活检等技术对呼吸道感染疾病进行标本采集,可克服标本污染及患儿不能配合等困难,对诊断与治疗提供有力的帮助.纤维支气管镜在儿科临床应用中的有效性与安全性已得到广泛肯定,现对近年来纤维支气管镜应用于儿童急性呼吸道感染标本采集的临床研究加以综述.

  5. Nursing and Cooperation of Bronchoscopic Cryotherapy to Endobronchial Tuberculosis%电子支气管镜下冷冻治疗66例支气管结核的配合与护理

    Institute of Scientific and Technical Information of China (English)

    唐静; 李盛芝; 张广宇; 王玲玲; 王睿岚

    2011-01-01

    目的:探讨冷冻治疗支气管结核治疗中的治疗配合及护理.方法:66例患者均经抗结核药物全身治疗和电子气管镜下冷冻治疗,气管镜冷冻治疗过程中,加强术中监护和心理护理,保证病人安全,观察临床疗效.结果:63例病人临床症状完全或部分改善,胸部影像学见肺不张全部或部分复张,但形成的气道狭窄较前减轻(1/2~2/3)以上,3例患者经冷冻治疗后无效.结论:冷冻治疗对支气管结核的治疗效果肯定,应用有上升趋势,关注气管镜下冷冻治疗病人实施整体优质护理.%Objective:To study nursing and cooperation of bronchoscopic cryotherapy to endobronchial tuberculosis.Methods:Bronchoscopic cryotherapy and anti-tuberculosis chemotherapy were applied to 66 endobronchial tuberculosis patients.To intensify intraoperative monitoring and psychological nursing,ensure safety of patients,observe the effect.Results:clinical symptoms were improved totally or partly in 63 patients,lung recruitment were observed and airway stenosis alleviated(1/2~2/3).No effect was observed in 3 patients.Conclusion: Bronchoscopic cryotherapy to endobronchial tuberculosis has a positive effect,increasing trend of application.Holistic nursing should be concerned in bronchoscopic cryotherapy to endobronchial tuberculosis.

  6. Comparative randomised study of GlideScope® video laryngoscope versus flexible fibre-optic bronchoscope for awake nasal intubation of oropharyngeal cancer patients with anticipated difficult intubation

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    Essam Abd El-Halim Mahran

    2016-01-01

    Full Text Available Background and Aims: Awake flexible fibre-optic bronchoscope (FFS is the standard method of intubation in difficult airway in oral cancer patients. We decided to evaluate GlideScope® video laryngoscope (GL for intubation as compared to the standard FFS for nasal intubation in such patients. Methods: After the ethical committee approval, we included 54 oropharyngeal cancer patients divided randomly into two equal groups: Group G and Group F. After pre-medication and pre-oxygenation, awake nasal intubation was performed using GL in Group G and FFS in Group F. In both groups, we compared intubation time in seconds (mean ± standard deviation (primary outcome, success rate of the first intubation attempt, percentage of Cormack and Lehane glottic score and incidence of complications. We assumed that GL could be a suitable alternative for the standard FFS in nasal intubation of patients with oropharyngeal cancer. Success rate of the first attempt and Cormack and Lehane glottic score were compared using Chi-square test. Results: Intubation time in seconds was significantly shorter in Group G (70.85 ± 8.88 S than in Group F (90.26 ± 9.41 S with (P < 0.001. The success rate of the first attempt intubation was slightly higher in Group G (81.5% than Group F (78.8%. Cormack and Lehane glottic Score I and II showed insignificant difference between both Group G (92.6% and Group F (96.3%. We detected three cases of sore throat in each group. Conclusion: GlideScope® could be a suitable alternative to FFS in nasal intubation of oropharyngeal cancer patients.

  7. Clinical study of bronchoscopic interventional cryotherapy in the treatment of bronchial tuberculosis%支气管镜介入冷冻治疗支气管结核临床研究

    Institute of Scientific and Technical Information of China (English)

    李平

    2014-01-01

    Objective To investigate the clinical efficacy of bronchoscopic interventional cryotherapy in the treatment of bronchial tu-berculosis. Method A retrospective analysis of the clinical data of 30 cases of bronchial tuberculosis patients were analyzed. Results The therapeutic effect was evaluated after six months treatment,the patients in the control group the sputum negative conversion rate was 40% in the observation group,the sputum negative conversion rate was 80%,significantly higher than that in the control group,by comparison,the difference was statistically significant( P< 0. 05 ). The observation group patients after bronchoscopic interventional cryotherapy,the total clinical effective rate was 93. 33%,significantly higher than that in the control group,by comparison,the difference was statistically signifi-cant(P< 0. 05). Conclusion The clinical efficacy of bronchoscopic interventional cryotherapy in the treatment of bronchial tuberculosis is exact,it is worthy of popularization and application.%目的:探讨支气管镜介入冷冻治疗支气管结核的临床疗效。方法:回顾性分析30例支气管结核患者的临床资料。结果:治疗半年后进行疗效评价,对照组患者痰菌转阴率为40.0%,观察组患者痰菌转阴率为80.0%,明显高于对照组,经比较,差异具有统计学意义( P<0.05)。对照组患者临床总有效率为53.33%,观察组患者经支气管镜介入冷冻治疗,临床总有效率为93.33%,明显高于对照组,经比较,差异具有统计学意义( P<0.05)。结论:支气管镜介入冷冻治疗支气管结核临床疗效确切、安全,值得推广应用。

  8. 电子支气管镜下冷冻治疗支气管结核102例分析%Bronchial Tuberculosis by Cryotherapy under Electronic Bronchoscope:Analysis of 102 Cases

    Institute of Scientific and Technical Information of China (English)

    刘福升; 徐建华; 蔡秀敏; 曹艳红

    2014-01-01

    目的:探讨电子支气管镜下冷冻治疗支气管结核的疗效。方法2010年2月~2013年7月,对102例支气管结核在常规抗结核化疗基础上,在支气管镜介入下冷冻治疗2~6次,每次间隔2~3周。冷冻术后,用抗结核药物雾化吸入治疗。结果90例溃疡坏死型及肉芽增殖型治疗后,支气管黏膜光滑、管腔通畅;7例支气管腔内遗留少量瘢痕组织,轻度管腔狭窄,不影响通气功能;5例瘢痕型经多次冷冻治疗后,支气管腔狭窄程度无明显改变。治愈率88.2%(90/102),改善率6.8%(7/102),总有效率95.1%(97/102)。结论电子支气管镜下冷冻治疗支气管结核,创伤小,无明显并发症,安全有效。%Objective To observe the cryotherapy ’ s efficacy for bronchial tuberculosis under electronic bronchoscope. Methods A total of 102 cases of bronchial tuberculosis received cryotherapy under bronchoscope on the basis of conventional antituberculosis chemotherapy, ranging from 2 -6 times per case with an interval of 2 -3 weeks.After frozen surgery, inhalation therapy with anti-TB drugs was used. Results For 90 cases with necrotizing ulceration and granulation proliferative lesions, patients’ bronchial mucosa appeared smooth and the lumen became unimpeded.A small amount of scar tissue with mild stenosis was found in 7 patients’ bronchial lumen, but the ventilatory function was unaffected.Five cases of scar-type patients’ bronchial stenosis showed no significant change after repeated cryotherapy.Totally 88.2%(90/102) of the 102 cases were cured, 6.8%(7/102) improved, and the total efficiency was 95.1%(97/102). Conclusion Cryotherapy under electronic bronchoscope for bronchial tuberculosis is a safe and effective method without significant complications.

  9. 支气管镜下常用检查方式在肺癌诊断中的意义%The Clinical Significance of Different Sampling under Bronchoscope for Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    刘倩

    2016-01-01

    Objective To investigate the clinical significance of electronic bronchoscope in the diagnosis of lung cancer. Methods Group selection a retrospective analysis Wannan Medical College Hospital August 2011 to August 2012,289 cas-es of lung cancer. The diagnostic positive rate was compared among forceps biopsy, brush biopsy and postoperative sputum cytology. Results The pathological types included squamous cell carcinoma (51.6%),adenocarcinoma (28.7%),and small cell lung cancer(13.8%).The positive rate of forceps biopsy, brush biopsy and postoperative sputum cytology was 84.0%, 26.0%and 7.0%,respectively.The combined bronchoscopic biopsy were higher than forceps biopsy (P>0.05). Conclusion Forceps biopsy was an important way of examinations. The combined bronchoscopic biopsy can increase the detectable rate of lung cancer.%目的:探讨电子支气管镜在肺癌诊断中的临床意义。方法整群选取并回顾性分析皖南医学院附属医院2011年8月―2012年8月确诊肺癌的289例患者临床资料,比较支气管镜下使用不同检查方法诊断肺癌的阳性率。结果该组最常见的为鳞癌,其次为腺癌和小细胞癌。200例联合检查患者钳检阳性率为84.0%,刷检阳性率为26.0%,支气管镜术后痰检阳性率7.0%。钳检、刷检和术后痰检3种联合检查阳性率稍高于单纯钳检,但差异无统计学意义。结论钳检为重要的取材方式,联合检查有助于肺癌的诊断。

  10. Application of collaborative nursing model in bronchial tuberculosis with cryotherapy by electronic bronchoscope%协同护理模式在支气管镜介入冷冻治疗支气管结核中的应用

    Institute of Scientific and Technical Information of China (English)

    盛莉; 林明贵; 王春梅; 于华丽; 薛娟敏

    2011-01-01

    目的 探讨经支气管镜介入冷冻治疗支气管结核的护理方法。方法 对22例经支气管镜介入局部冷冻治疗的患者实行术前宣教、术中配合、术后护理的协同护理模式,比较治疗前后患者临床症状、镜下表现及影像学检查,患者术前焦虑发生的情况,患者对支气管镜检查治疗知识的知晓程度及患者对支气管镜冷冻治疗的接受程度。结果 22例患者共进行了87次治疗,每例患者平均治疗1.5个月,平均(5±3)次,临床症状改善明显,原气管、支气管内膜病变绝大部分吸收,肺部病变明显吸收,原狭窄的管腔通畅,显效68.18%,有效31.81%,总有效率100%。未见明显不良反应。患者术前平均焦虑评分为(31.45±5.65)分,与常模(29.78±0.46)分比较,差异无统计学意义(t=1.391,P>0.05);对支气管镜冷冻治疗知识的知晓情况,比较了解以上的项目达到了96%,全部患者均愿意接受此项治疗。结论 协同护理模式在支气管镜介入冷冻治疗支气管结核的应用中起到了一定辅助作用,它也是临床上一种新的护理模式,值得临床有条件的单位推广应用及验证。%Objective To investigate collaborative nursing model in bronchial tuberculosis with cryotherapy by electronic bronchoscope. Methods Preoperative education, perioperative coordination and postoperative nursing were adopted in 22 bronchial tuberculosis patients with cryotherapy by electronic bronchoscope. Clinical symptoms, endoscope demonstrations, imaging examination, preoperative anxiety, and knowledge and acceptation degree in patients were evaluated between pre and post treatment. Results All 22 patients were treated with therapy for 87 times. Each patient was treated ( 5 ± 3 ) times, average treatment time was 1.5 months. Clinical symptom was improved, lung lesions were disappeared and lumen patency could be found after treatment. The improvement rate

  11. Application of propofol combined with midazolam in the bronchoscope of children%咪达唑仑复合丙泊酚在小儿支气管镜检查中的应用

    Institute of Scientific and Technical Information of China (English)

    卢尚亭; 李爱荣

    2008-01-01

    Objective To observe and compare the anesthesia effect of propofol combined with midazolam used in the bronchoscopes and the removal of children's intratraeheal foreign body.Methods 60 patients in hospital were choser to do the operation of bronchoscopes and the removal of children's intratracheal foreign body,the patients of selective operation were randomized into K group(n=30)related to midazolam-ketamine and P group(n=30)related to midazolam-propofol.The patients were respectively injected midazolam slowly given in a dose of 0.1~0.15mg/kg,and then offer oxygen 5~10 minutes with a face mask.After that the patients in group K were injected ketamine slowly in the dose of 2mg/kg,and 1~2mg/kg after laying the bronchoscope according as ease.The patients in group P were injected propofol slowly in the dose of 2mg/kg also,add 1~2mg/kg according as case.Observing the patients' BP,HR,SpO2,RR and if or not holding breath,bucking,postoperation laryngeal edema,glossocoma at the different periods:preoperation,laying the bronehoscope,during the operation and after the operation.Results To compare the two groups,the MAP,HR of group P are lower obviously than group K before and after laying the bmnchoscope(P<0.05).The HR,MAP of groug P descended significantly after laying bronchoscope(P<0.05),while the HR fluctuate little but MAP ascend significantly in the group K(P<0.05).After laying bronchoscope the RR descend significantly than that when patients entered operation room(P<0.05),and also lower than that ofgroup K(P<0.05).The SpO2 in the two groups have no difference.The complications as holding breath,postoperative glossocema,laryngeal edema,holding breath during reviving time,in the group K happened at a high rate than the group P(P<0.05),the awaking time is also longer in the former(P<0.05).Conclusion The anesthesia effect of midazolam-propofol is superior to that of midazdam-ketamine in the removal of children's intratraeheal foreign body.%目的 观

  12. 支气管镜在儿童支气管黏液表皮样癌诊治中的应用%Application of bronchoscope in diagnosis and treatment of bronchial mucoepidermoid carcinoma in children

    Institute of Scientific and Technical Information of China (English)

    焦安夏; 刘玺诚; 饶小春; 马渝燕; 潘跃娜; 孟辰芳; 刘芳; 周春菊; 冯雪莉

    2015-01-01

    目的 探讨支气管镜在儿童支气管黏液表皮样癌诊断及介入治疗中的应用.方法 回顾性分析2013年4月至2015年6月首都医科大学附属北京儿童医院介入肺科经病理确诊的4例儿童支气管黏液表皮样癌的临床资料,分析其临床特征、胸部CT及支气管镜表现.结果 3例为低度恶性支气管黏液表皮样癌,1例为中度恶性(中分化)支气管黏液表皮样癌.发病年龄4岁11个月~10岁9个月.患儿均无特征性临床表现,以咳嗽、喘息、运动耐受不良为主要症状,2例伴咯血,术前误诊为肺炎、支气管哮喘、支气管异物等.胸部CT提示呼吸道内类圆形肿物,2例发生于左主支气管,1例发生于右支气管中间段,1例发生于右中叶支气管,有阻塞性肺不张或肺气肿.4例患儿均在全身麻醉下行支气管镜下病灶活检,3例行支气管镜下介入治疗切除肿物,1例行肺叶切除+支气管重建术.结论 儿童黏液表皮样癌无特征性表现,常出现咳嗽、喘息等呼吸道症状.支气管镜下组织活检对确诊有重要作用,对不能手术切除的肿瘤,支气管镜下介入治疗是一种有效的姑息治疗方法.%Objective To explore the application of bronchoscope in diagnosis and treatment of bronchial mucoepidermoid carcinoma in children.Methods The clinical data of 4 cases of bronchial mucoepidermoid carcinoma treated in Department of Interventional Pulmonology,Beijing Children's Hospital Affiliated to Capital Medical University from April 2013 to June 2015,were retrospectively analyzed,and their clinical manifestations,chest computed tomography(CT),bronchoscopic manifestations were analyzed.Results Among the 4 cases of bronchial mucoepidermoid carcinoma,3 cases were low-grade bronchial mucoepidermoid carcinoma,and 1 case was intermediate grade malignant.Onset of clinical manifestations occurred from the ages of 4 years and 11 months old to 10 years and 9 months old.All patients had no

  13. 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

  14. Application of lightwand and fiberoptic bronchoscope on craniofacial burned patients with anticipated difficult airway%光棒及纤维支气管镜在头面部烧伤插管中的应用

    Institute of Scientific and Technical Information of China (English)

    宗林; 倪洋林; 王玉秀; 袁光华; 钱兆玲

    2011-01-01

    Objective To compare the success rate and time of intubation,the injuries to oral cavity and the hemodynamic changes during tracheal intubation with the lightwand and the fiberoptic bronchoscope in craniofacial burned patients. Methods Forty craniofacial burned patients,scheduled for elective surgery under general anesthesia requiring tracheal intubation were randomly allocated to either the lightwand group (group LW) or the fiberoptic bronchoscope group (group FOB). All patients were classified into class Ⅱ - Ⅳ according to Mallampati test, mouth opening and thyromental distance. Changes of hemodynamic parameters( MAP, HR, SpO2) were observed at three periods: ten minutes after entering the room, after induction of anesthesia, and three minutes after intubation. The rate of successful intubation,the time of intubation,injuries and incidence of airway complications of both groups were also observed. Results There was a little difference in successful intubation between the two groups (P > 0.05). The changes of hemodynamic parameters ( MAP, HR ) , the injuries and the incidence of airway complications weren't obvious in two groups. Conclusion Tracheal intubation u-sing light Wand and fiberoptic bronchoscope are successful, safe, valid and less injurious.%目的 比较光棒和纤维支气管镜引导下气管内插管成功率、插管时间和血流动力学的影响,评价光棒和纤维支气管镜在麻醉困难插管中的应用效果,为野战麻醉提供一种可行的通气方式.方法40例头面部烧伤、炸伤,随机分光棒组(LW组)、纤维支气管镜组(FOB组).根据综合气道评估分为Ⅱ一Ⅳ级,记录入室后、诱导后、插管后3 min的平均动脉压、心率、脉搏血氧饱和度及插管成功率、插管时间、口腔损伤、插管后并发症的发生情况.结果 两组插管成功率都在98%以上.与LW组相比,FOB组插管时间短、成功率高.血流动力学影响、口腔损伤和并发症

  15. 液基细胞制片术在纤维支气管镜抽吸物检测中的应用%Application of liquid based cytology test in detection of fiber bronchoscopic aspirates

    Institute of Scientific and Technical Information of China (English)

    万涛; 黄习臣; 粟毅; 李岱容

    2014-01-01

    Objective To study liquid based cytology test and its application values in the detection of fiber bronchoscopic aspi‐rates .Methods LBP sedimentation type of ThinPrep cell production system combined with the conventional smear were used to de‐tect 2000 specimens of fiber bronchoscopic aspirates ,and conduct microscope observation and cytological diagnosis .Results Based on liquid based cytology cell production method ,there were 614 positive cases (30 .7% ) ,267 cases of squamous cell carcinoma (13 .4% ) ,and 217 cases of adenocarcinoma(10 .9% ) ,83 cases of small cell carcinoma (4 .2% ) ,and 47 cases of undifferentiated car‐cinoma (2 .4% ) .The diagnostic sensitivity for lung cancer of liquid‐based cytology test was 64 .6% and conventional smear was 49 .2% .We also found 7 cases of fungus positive ,35 cases of typical caseous necrosis with liquid based cytology test .Conclusion The ThinPrep cell production has a more clean background ,more intact cell structure ,more efficient observation and increased posi‐tive rate of detection of cancer cells than the smears made by traditional methods .A combination of two methods can increase the accuracy of cytological detection of fiber bronchoscope aspirates and positive detection rate ,and also can assist the diagnosis of fungi and TB infections .%目的:探讨液基细胞制片技术在纤维支气管镜抽吸物检测中的应用价值。方法采用安必平(LBP)沉降式液基细胞制片系统并结合传统涂片方法处理纤维支气管镜抽吸标本2000例,制成薄片,显微镜下观察,进行细胞学诊断。结果液基细胞制片法共检出细胞学阳性病例614例(30.7%),其中鳞癌267例(13.4%),腺癌217例(10.9%),小细胞癌83例(4.2%),未定型癌47例(2.4%)。液基制片法诊断肺癌敏感度为64.6%,传统涂片法诊断肺癌敏感度为49.2%。同时发现真菌阳性7例,结核病典型的干酪样坏死35

  16. 经支气管镜介入冷冻治疗支气管结核的临床效果分析%Clinical study of bronchoscopic interventional cryotherapy in the treatment of 158 cases of ;bronchial tuberculosis

    Institute of Scientific and Technical Information of China (English)

    杜江渝; 赵懿

    2016-01-01

    Objective: This study aims to investigate the clinical effect of bronchoscopic interventional cryotherapy in the treatment of bronchial tuberculosis (BTB). Methods:158 patients admitted into our hospital from October 2012 to October 2015 were randomly divided into observation group (n=80) and control group (n=78). The control group was treated with standardized systemic chemotherapy, and the observation was treated by bronchoscopic interventional cryotherapy based on the control group in order to compare the negative rate of sputum bacteria, clinical efficacy and adverse reactions. Results: After treatment, the turn rate of the observation group was 98.75%, significantly higher than that of the control group (89.74%) (x2=5.964, P0.05). Conclusion:It has obvious clinical curative effect of bronchoscopic interventional cryotherapy in the treatment of BTB. With simple operation, it has a higher negative rate of sputum bacteria and lower incidence of adverse reactions. It also can effectively improve the pulmonary function and protect lung tissue, which is worth popularizing in clinical application.%目的:探讨经支气管镜介入冷冻治疗支气管结核(BTB)的临床疗效。方法:选取158例支气管结核患者,按照随机数表法将其分为观察组(80例)和对照组(78例)。两组均进行规范化全身化疗,而观察组在规范化全身化疗基础上联合支气管镜介入冷冻治疗。观察比较两组患者痰菌转阴率、临床疗效及不良反应发生情况。结果:治疗后观察组疾菌转阴率为98.75%,显著高于对照组的89.74%,两组相比有明显差异(x2=5.964,P<0.05);观察组临床有效率为97.50%,显著高于对照组的84.62%,两组相比有差异(x2=8.119,P<0.05);观察组不良反应发生4例(占5.00%),对照组10例(占12.82%),两组相比无差异(x2=2.236,P>0.05)。结论:经支气管镜介入冷冻治疗BTB临床疗效显著,痰菌转阴率高,不良反应发

  17. 电子支气管镜冷冻治疗支气管内膜结核支气管狭窄的护理%Nursing of electronic bronchoscopic cryotherapy for bronchial stenosis secondary to endobronchial tuberculosis

    Institute of Scientific and Technical Information of China (English)

    郑淑芳; 吴素芳; 黄钥藩

    2013-01-01

    Objective To explore nursing care of electronic bronchoscopic cryotherapy in the treatment of bronchial stenosis secondary to endobronchial tuberculosis.Methods The nursing experience on electronic bronchoscopic cryotherapy for bronchial stenosis secondary to endobronchial tuberculosis was summarized.Mental nursing and respiratory care were strengthened,preoperative preparation was done well,respiratory nursing was carefully performed to improve patient compliance,intraoperative and postoperative adverse reactions were carefully observed,and complications were effectively prevented.Results All the patients received treatment.8 patients developed postoperative blood stained sputum and were finally cured without special treatment.A minority of 28 participants had feeling of scare and accepted treatment after counseling.Correct nursing care improved patient compliance and the success rate of surgery.Conclusions Electronic bronchoscopic cryotherapy for bronchial stenosis secondary to endobronchial tuberculosis improve clinical symptoms and promote lung reexpansion.Effective perioperative nursing can improve patient compliance and success rate of surgery and reduce postoperative complications.%目的 探讨电子支气管镜冷冻治疗支气管内膜结核支气管狭窄的护理.方法 总结28例电子支气管镜冷冻治疗支气管内膜结核支气管狭窄的护理经验,重点加强心理护理和呼吸道护理,做好术前准备、注意术中不良反应、术后呼吸道护理,从而提高患者的依从性,有效预防并发症的发生.结果 本组所有患者均接受治疗,术后8例痰中带血丝,在未予特殊处理情况下均痊愈.所有参加研究的28例患者,有少数有畏惧心理,经过辅导均接受治疗,说明正确的护理,能提高患者的依从性及手术的成功率.结论 电子支气管镜冷冻治疗在治疗支气管内膜结核支气管狭窄、改善临床症状、促使肺组织复张上效果良好,通过术前、术

  18. Advances research on bronchoscopic lung volume reduction surgery for obstructive airway diseases%内科肺减容术在慢性阻塞性肺疾病最新研究进展

    Institute of Scientific and Technical Information of China (English)

    谢栓栓; 王昌惠

    2013-01-01

    阻塞性呼吸道疾病是多种疾病组成的,但它们都可因炎症导致气道狭窄,从而导致呼吸做功增加.由于其患病人数多,病死率高,严重影响患者的劳动能力和生活质量.不同群体的哮喘、慢性支气管炎和肺气肿最佳治疗策略应该是多方面的,如高危肺气肿患者应包括药物学和非药物方法以及手术治疗.回顾当前支气管镜介入水平,近十年其发展目标是更好地控制哮喘症状和缓解由于不适合肺减容手术的肺气肿患者症状,由此可见,新型支气管镜技术针对气道阻塞性疾病治疗有很大帮助.%Obstructivepulmonary disease is composed of a variety of diseases,nevertheless,they are able to induce the airway narrow and result in increase of work of breathing force.The incidence and mortality are high,which seriously influence the patients' ability to work and quality of life.There are many optimal treatment strategies of asthma,chronic bronchitis,and emphysema in different groups,such as pharmacological and non-pharmacological methods as well as surgery for high-risk patients with emphysema.In recent decades,the development objective of bronchoscopic intervention is to better control asthma symptoms and relieve symptoms of patients with emphysema who are not suitable for the lung volume reduction surgery.This demonstrates that new bronchoscopic techniques will be helpful for treatment of airway obstruction disease in future.

  19. Analysis of sedation on broncholiths through bronchoscope with holmiun laser%经支气管镜钬激光技术治疗支气管结石的疗效分析

    Institute of Scientific and Technical Information of China (English)

    郭国华; 肖建宏; 彭锦芸; 宋彬

    2016-01-01

    目的:评价经支气管镜应用钬激光技术治疗支气管结石的疗效。方法2008年1月-2015年12月,应用钬激光技术治疗支气管结石病12例,其中男7例,女5例;年龄35~64岁,中位年龄49岁。12例均因咳嗽、气促、咯血和咯石等症状就诊。支气管结石发病部位:左主气管侧6例,右中间支气管4例,主支气管2例。胸部CT检查12例,均表现为支气管腔内的高密度影,并阻塞管腔,可伴有远端支气管狭窄、扩张、阻塞性肺炎或肺门纵隔淋巴结钙化。经电子支气管镜检查12例,肉芽包裹样病灶9例,结石样病灶3例。12例患者均在右美托米定复合舒芬太尼镇静下经电子支气管钬激光技术治疗。结果全组手术顺利,手术时间45~90 min,平均60 min,术中患者心率稳定,血氧饱和度无下降,血压平稳,血流动力学稳定,患者未诉不适,无明显心肺衰竭等并发症发生,术中无大出血、气胸等并发症。术后全组病例呼吸系统症状均改善,平均术后住院(2.5±1.4)d。12例随访1~24个月,平均6个月,无结石复发及严重呼吸道感染。结论用右美托米定复合舒芬太尼镇静下经电子支气管镜用钬激光技术治疗气管结石安全、可行,治疗效果明显,为临床治疗气管结石提供了一种新的治疗手段。%Objective To evaluate the curative effect of sedation on broncholiths through bronchoscope with holmi-um laser. Methods From Jan.2008 to Dec. 2015, 12 cases with broncholiths through bronchoscope with holmium laser, male 7, female 5; the age from 35 to 64.12 cases visit a doctor when they cough, panting, haemoptysis and cough out stones. The predilection sites of bronchinal calculus: left main bronchus in 6, right middle bronchus in 4, main bronchus in 2. Thoracic computerized tomography was performed in 12 patients, which showed bronchial intra-luminal high-density shadow with distal

  20. 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

  1. 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

  2. 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

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    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

  3. 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

  4. 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

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    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

  5. 经电子支气管镜下冷冻联合化疗治疗晚期中央型肺癌的疗效观察%Curative Effect Observation of Electronic Bronchoscope Cryotherapy Combined with Chemotherapy in the Treatment of Advanced Stage Central Type Lung Cancer

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    刘旭之; 宋卓; 迟岩; 赵鑫亮; 怀丽梅; 张淑丽

    2015-01-01

    目的:应用电子支气管镜下冷冻治疗联合化疗对晚期中央型肺癌的疗效分析.方法:选取24例晚期中央型肺癌为治疗组,随机设置24例晚期中央型肺癌(拒绝行电子支气管镜介入冷冻治疗)为对照组,给予标准化疗方案.治疗组采用OLYMPS BF-260电子支气管镜冷冻介入治疗联合(多西他赛+卡铂)方案全身静脉化疗.对照组采用单纯(多西他赛+卡铂)方案全身静脉化疗.结果:治疗组24例患者中,完全缓解(CR)8例,部分缓解(PR)12例,稳定(SD)2例,疾病进展(PD)2例,有效率(CR+PR)为83.3%;对照组24例患者中, CR2例,PR11例,SD7例,PD4例,有效率为54.2%.两组有效率比较差异有统计学意义(P<0.01).治疗组和对照组平均无疾病进展时间(progression-free survival PFS)分别为183 d和92 d,差异有统计学意义(P<0.05).结论:经电子支气管镜冷冻联合化疗治疗晚期中央型肺癌有较好的疗效,可提高晚期非小细胞肺癌的生存率.%Objective:To observe the treatment efficiency of the patients with advanced stage central type lung cancer by using electronic bronchoscope cryotherapy, combined with chemotherapy.Method:24 patients with advanced stage central type lung cancer were selected the treatment group, 24 patients with advanced stage central type lung cancer were randomly selected of the control group(refused to row electronic bronchoscope in cryotherapy),who were gived the standard chemotherapy regimens.The treatment group was treated with OLYMPS BF-260 electronic bronchoscopic cryotherapy and combined intravenous chemotherapy with the Docetaxel + Carboplatin, while the control group with intravenous chemotherapy with the Docetaxel + Carboplatin.Result:In the treatment group ,complete remission(CR) was 8 cases, partial remission(PR) was 12 cases, stable disease(SD) was 2 cases,progresive disease(PD) was 2 cases.In the control group ,CR was 2 cases,PR was 11 cases,SD was 8 cases,PD was 4 cases.The effective rate

  6. 气管镜诊断气管-支气管肺低度恶性肌上皮瘤2例并文献复习%Analysis of myoepithelioma in lung diagnosed by bronchoscope:two cases report and re-view of literature

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    张晓玲; 邢荣格

    2014-01-01

    Objective:To investigate the diagnosis and treatment of myoePithelial tumour of the tracheal,bron-chus,lung by bronchoscoPe. Methods:Two cases of myoePithelial tumours and rePorted in literature of domestic and overseas were retrosPective reviewed. Results:The common clinical manifestation are cough,shortness of breath and hemoPtysis. Conclusion:MyoePithelial tumour of the tracheal,bronchus,lung is a rare tumor in the lung. Because the materials from bronchoscoPe is little,the diagnosis need careful observation of the sPecimen and immnunohistochemis-try result.%目的:探讨气管镜诊断气管-支气管肺肌上皮瘤的要点及肌上皮瘤的治疗方案。方法:回顾性分析本院2例及国内外报道的气管-支气管肺肌上皮瘤病例资料和随访记录。结果:气管-支气管肺肌上皮瘤多表现为咳嗽、气促、咯血;确诊及治疗需依靠手术。结论:气管-支气管肺低度恶性肌上皮瘤是一种非常罕见的肿瘤,气管镜标本量少,需要仔细观察标本组织形态并结合免疫组化明确诊断。

  7. 布地奈德混悬液联合纤支镜用于儿童甲型H1N1/H3N2感染合并塑型性支气管炎的病例分析%Case Analysis of Budesonide Suspension Combined with Fiber Bronchoscope for Influenza A(H1N1/H3N2) Infection Complicated with Plastic Bronchitis in Children

    Institute of Scientific and Technical Information of China (English)

    耿刚; 罗健; 罗征秀; 刘恩梅; 符州

    2015-01-01

    目的:探讨甲型H1N1/H3N2感染合并塑型性支气管炎(PB)的病理特征及诊治方法.方法:报告3例我院收治的甲型H1N1/H3N2感染合并PB儿童的病例资料,总结布地奈德混悬液雾化吸入联合纤支镜灌洗的治疗经验,并结合文献内容对该少见病种进行分析.结果:3例患儿中有2例甲型H1N1、1例甲型H3N2感染合并PB,其中2例有基础疾病,分别为支气管哮喘与原发性肾病综合征.3例患儿均诊断为重症肺炎、呼吸衰竭、肺不张,其中2例伴有纵膈气肿、皮下气肿.经纤支镜检查均取出树枝状异物,病理检查均为纤维素性渗出,伴有中性粒细胞、嗜酸性粒细胞及淋巴细胞浸润,确诊为PB.3例患儿经过辅助呼吸、呼吸道管理、抗感染等对症支持治疗,并采用布地奈德混悬液雾化吸入联合纤支镜灌洗后均痊愈出院.结论:PB是甲型流感的合并症之一,病情危重.临床上一旦考虑该病,应在布地奈德混悬液雾化治疗基础上尽快行纤支镜检查,以明确诊断并及时治疗.%OBJECTIVE:To analyze the pathological characteristics and therapy method for influenza A(H1N1/H3N2)in-fection complicated with plastic bronchitis (PB). METHODS:Clinical information of 3 children with influenza A (H1N1/H3N2) infection complicated with PB were reported to summarize the experience of aerosol inhalation of Budesonide suspen-sion combined with fiber bronchoscope lavage. Based on literatures,this rare disease were analyzed. RESULTS:Among 3 chil-dren,2 children suffered from influenza A H1N1 infection and one child influenza A H3N2 infection complicated with PB;2 of them got basic disease,i.e. bronchial asthma and primary renal syndrome. 3 children were diagnosed as severe pneumonia,re-spiratory failure and pulmonary atelectasis;2 of them suffered from mediastinal emphesema and subcutaneous emphysema. The branchlike foreign bodies,removed by fiber bronchoscope,were fibrin complicated with neutrophile

  8. 经电子支气管镜球囊扩张及冷冻联合治疗结核性支气管狭窄的疗效分析%An Analysis of Combining Electronic Bronchoscope Balloon Dilatation with Cryotherapy on Treatment of Tuberculous Bronchial Stenosis

    Institute of Scientific and Technical Information of China (English)

    梅永添; 方诗容; 刘碧翠; 李明伟; 覃仕鹤; 杨华

    2014-01-01

    目的:探讨电子支气管镜球囊扩张及冷冻联合治疗结核性支气管狭窄的临床疗效及安全性。方法结核性支气管狭窄患者32例对其进行电子支气管镜球囊扩张及冷冻联合治疗,于术前和最后一次球囊扩张及冷冻治疗后当天,对狭窄段支气管直径、FEV1进行测定并进行气促评分、随访,观察治疗效果及并发症发生情况。结果32例患者经支气管镜球囊扩张及冷冻联合治疗后胸闷、呼吸困难及痰不易咳出等症状好转;患者治疗前气道内径为(4.93±1.54)mm,治疗后为(10.03±2.14)mm;气促评分治疗前为(2.75±0.84)分,治疗后为(0.93±0.66)分;FEV1治疗前为(1.56±0.47)L,治疗后为(2.46±0.47)分;治疗前后比较差异显著(P<0.05)。32例患者均未出现气胸、大出血、支气管壁受压坏死、呼吸心跳骤停等严重并发症。结论电子支气管镜球囊扩张及冷冻联合治疗结核性支气管狭窄,方法安全、操作简便、疗效肯定,避免了大部分患者肺叶切除。%Objective To observe the effect and safety of combining electronic bronchoscopic balloon dilatation with cryotherapy on the treatment of tuberculous bronchial stenosis.Methods 32 patients with tuberculous bronchial stenosis in our department underwent the combined treatement with balloon dilatation and cryotherapy.Before operation and the last balloon dilata-tion and freezing the day after treatment, the stenosis bronchial diameter, FEV1 were meas-ured, then the follow-up score, shortness of breath,therapeutic effect and complications were observed.Results 32 patients with bronchoscopic balloon dilatation and cryotherapy after the combined treatment of chest tightness,dyspnea and difficulty in expectorating sputum and oth-er symptoms improved.The airway diameter of patients was ( 4.93+1.54 ) mm before treat-ment, after treatment it was (10.03+2.14) mm

  9. 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

  10. Clinical curative effect analysis of the treatment of granulation hyperplasia bronchial tuberculosis by cryotherapy combined with argon knife through electronic bronchoscope%电子支气管镜下冷冻及氩气序贯治疗肉芽增殖型支气管结核的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘伟; 谢永宏; 顾兴; 孙瑞琳; 李王平; 金发光

    2016-01-01

    Objective To investigate the clinical curative effect of the treatment of granulation hyperplasia bronchial tuberculosis by cryotherapy combined with argon knife. Methods A total of 328 patients with granulation hyperplasia bronchial tuberculosis were observed from January 2013 to October 2015. All patients were given antituberculosis therapy, 157 patients were treated by cryotherapy only, while 171 patients were treated by cryotherapy combined with argon knife. After four times treatment, their efficacy were assessed by symptom, imaging improvement and expression under bronchoscope. Results The total curative effect of cryotherapy combined with argon knife ( 98. 83%) was more higher than cryotherapy only ( 88. 54%) . Meanwhile, cryotherapy combined with argon knife has lower risk of bleeding. Conclusions Cryotherapy combined with argon knife are the effective methods for treating granulation hyperplasia bronchial tuberculosis.%目的:探讨冷冻及氩气序贯治疗肉芽增殖型支气管结核的临床疗效。方法回顾性分析我科2013年1月至2015年10月进行气管镜下治疗的肉芽增殖型支气管结核患者328例,所有患者均给予全身抗结核治疗,其中157例单纯进行冷冻治疗,171例行冷冻及氩气序贯治疗。通过评估局部治疗4次后对患者的症状,影像学改变及气管镜下表现等指标进行疗效分析。结果冷冻及氩气序贯治疗肉芽增殖型支气管结核的总有效率(98.83%)明显高于单纯冷冻治疗(88.54%),且出血风险明显降低。结论冷冻及氩气序贯治疗肉芽增殖型支气管结核临床疗效确切,并发症少,值得临床推广。

  11. 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

  12. Impact of ambroxol hydrochloride combined with bronchoscope lavage on level of lung function of patients with severe pulmonary infections%重症肺部感染患者盐酸氨溴索气管镜灌洗对肺功能水平的影响研究

    Institute of Scientific and Technical Information of China (English)

    尚茜; 商伟娜; 翟琳; 刘淑娟; 李娟

    2015-01-01

    目的:研究盐酸氨溴索联合气管镜灌洗对重症肺部感染患者血氧分压(PaO2)、氧合指数(PaO2/FiO2)及血液氧饱和度(SaO2)等水平的影响,为临床治疗提供参考依据。方法选取2012年10月-2013年10月收治的重症肺部感染行气管切开的患者92例,随机将其分为观察组及对照组,每组46例;对照组患者静脉滴入盐酸氨溴索治疗,观察组在对照组基础上联合纤维支气管镜对支气管肺泡进行灌洗以及吸痰治疗,对比两组患者PaO2、PaO2/FiO2及SaO2等水平变化,数据采用 SPSS 13.0软件进行统计分析。结果观察组患者治疗后 PaO2、PaO2/FiO2及SaO2等水平显著高于治疗前,及对照组治疗后,差异均有统计学意义(P<0.05);观察组患者有效率为93.48%,高于对照组的69.57%,差异有统计学意义( P<0.05)。结论盐酸氨溴索联合气管镜可有效改善重症肺部感染患者PaO2、PaO2/FiO2及SaO2等水平,并缩短各项治疗时间,提高临床治疗效果。%OBJECTIVE To study the impact of ambroxol hydrochloride combined with bronchoscope lavage on the levels of partial pressure of arterial oxygen (PaO2 ) ,the ratio of the partial pressure of oxygen to the inspired frac‐tion of oxygen (PaO2/FiO2 ) ,and arterial oxygen saturation (SaO2 ) of the patients with severe pulmonary infec‐tions so as to provide guidance for the clinical treatment .METHODS A total of 92 patients with severe pulmonary infections who underwent the tracheotomy from Oct 2012 to Oct 2013 were enrolled in the study and randomly di‐vided into the observation group and the control group ,with 46 cases in each .The control group was treated with ambroxol hydrochloride ,while the observation group was treated with ambroxol hydrochloride combined with bronchofibroscope for bronchoalveolar lavage and was treated with sputum suction ,and the statistical analysis was performed with the

  13. Airway management in a bronchoscopic simulator based setting

    DEFF Research Database (Denmark)

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

    2014-01-01

    course. PARTICIPANTS: Thirty-six consultants and residents in anaesthesiology. MAIN OUTCOME MEASURES: All participants performed one single procedure on each of the three different simulators. Their video-filmed performances were assessed by two independent, blinded experts and their opinions...... of simulation were surveyed. RESULTS: The mean score increased 0.33 points after each attempt (P = 0.021). The attitude towards simulation-based training was always more than 4 on a scale from 1 to 5. Only 25% of the procedures were performed to satisfaction with a learning-by-testing effect (P = 0.......021). Generalisability coefficient was 0.55, and there was no correlation between the number of clinical procedures performed beforehand and test scores (P = 0.93). CONCLUSION: The increase in mean score is a learning effect indicating that simulator training allows for entry of the learning curve at a higher level...

  14. Teaching and training in fibreoptic bronchoscope-guided endotracheal intubation

    Directory of Open Access Journals (Sweden)

    U S Raveendra

    2011-01-01

    Full Text Available Fibreoptic-guided endotracheal intubation skill is a strongly desirable attribute of an anaesthesiologist, essential to deal with difficult airway situations. Facilities for formal training in this crucial area are limited. Various aspects of the available and desirable training in fibreoptic endoscopic skills are discussed.

  15. 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.

  16. 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

  17. An approach towards bronchoscopic-based gene therapy using electrical field accelerated plasmid droplets.

    Science.gov (United States)

    Hradetzky, D; Boehringer, S; Geiser, Th; Gazdhar, A

    2012-01-01

    Idiopathic pulmonary fibrosis (IPF) is a devastating disease affecting the distal lung, due to failure of the alveolar epithelium to heal after micro-injuries, leading to inefficient gas exchange and resulting in death. Therapeutic options are very limited. A new therapeutic approach based on gene therapy restores the self-healing process within the lung in the experimental setup. A basic requirement of this therapy is the successful transduction of genes into the alveolar epithelium in the distal part of the lung, for which a new therapeutic instrument is required. In this paper we present the concept and first experimental results of a device which uses an electrical field to accelerate the charged droplets of plasmid suspension toward the tissue and which overcomes cell membrane with its impact energy. The aim is to develop a therapeutic device capable of being integrated into minimally invasive procedures such as bronchoscopy.

  18. 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.

  19. Novel bronchoscopic strategies for the diagnosis of peripheral lung lesions: present techniques and future directions.

    Science.gov (United States)

    Gilbert, Christopher; Akulian, Jason; Ortiz, Ricardo; Lee, Hans; Yarmus, Lonny

    2014-07-01

    The diagnosis of the peripheral lung lesion has been a long-standing clinical challenge--balancing accuracy with patient safety. With recent data revealing mortality benefits with lung cancer screening via low-dose computed tomography, now more than ever, 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 nodule. In this review, we present available technologies to aid clinicians in attempts at minimally invasive techniques and the data supporting their use. In addition, we review novel tools under investigation that may further increase yield and provide additional benefit in obtaining an early diagnosis of lung cancer.

  20. Long-Term Follow-Up of Flexible Bronchoscopic Treatment for Bronchial Carcinoids with Curative Intent

    Directory of Open Access Journals (Sweden)

    Leonardo Fuks

    2009-01-01

    sedation. Follow-up included repeat bronchoscopy every 6 months and chest CT every year. Results. Ten patients aged 24 to 70 years with endobronchial carcinoid were treated. The tumor location was variable: 2 left Main bronchus, 1 left upper lobe bronchus, 2 right main bronchus, 2 right middle lobe bronchus and 3 right lower lobe bronchus. No major complications were observed. The patients required between 2 and 4 procedures. Patients were followed for a median period of 29 months with no evidence of tumor recurrence. Conclusions. Endobronchial laser photoresection of typical bronchial carcinoids using flexible bronchsocopy under conscious sedation is an effective treatment modality for a subgroup of patients that provides excellent long-term results that are similar to outcome obtained by more invasive procedures.

  1. 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 inte...

  2. 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.

  3. 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.

  4. 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

  5. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis: A Meta-analysis

    Directory of Open Access Journals (Sweden)

    Li-Xing Hu

    2016-01-01

    Conclusions: The results of this meta-analysis suggest that EBUS-TBNA + TBLB + EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA + TBLB + EBB could be used instead.

  6. 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.

  7. 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.

  8. 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.

  9. 支气管镜下冷冻治疗气道内恶性肿瘤%Cryotherapy for malignant tumor in trachea under bronchoscope

    Institute of Scientific and Technical Information of China (English)

    郁小迎; 李强; 白冲

    2004-01-01

    目的探讨应用纤维支气管镜引导治疗晚期中央型肺癌的疗效.方法56例肺癌患者按气管镜介入治疗常规准备并插镜,将末端对准欲行冷冻治疗的病灶中央,然后将可屈式冷冻探头经内镜活检管道送入,冷冻探头的金属末端离支气管镜远端5 mm以上,探头的金属末端要尽可能置于病灶上或深入病灶内,踩动脚踏开关,时间为每次约30 s,每个点反复冻融3~5次.间隔1~7 d,可重复冷冻,平均冷冻(2.1±0.8)次.结果显微内镜下见瘤体缩小2/3,呼吸困难及咯血明显改善32例.有效内镜下见瘤体缩小1/2,呼吸困难及咯血有所改善21例,3例由于管腔外的压迫,呼吸困难未能改善.结论内镜下冷冻治疗管腔内生长的晚期中央型肺癌,能使瘤体迅速缩小,管腔得以重新疏通,使呼吸困难和咯血改善,生活质量明显提高,但总体上对生存率无明显改善.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Fiberoptic Bronchoscopic Cryotherapy in the Treatment for 39 Cases with Tracheal-bronchial Cancer%纤维支气管镜冷冻治疗气管支气管肿瘤39例

    Institute of Scientific and Technical Information of China (English)

    刘德若; 寿延宁; 石彬; 田燕雏; 郭永庆; 张海涛; 梁朝阳; 鲍彤

    2008-01-01

    [目的]探讨纤维支气管镜冷冻治疗气管支气管肿瘤的疗效.[方法]经纤维支气管镜对39例气管支气管肿瘤进行冷冻治疗.[结果]患者咳嗽症状改善76.9%,咯血91%,呼吸困难92.3%,胸痛50%,均有缓解.显妓61.5%,有效30.8%,总有效率92.3%.[结论]内镜下冷冻治疗管腔内牛长的中央型支气管肺癌,患者症状得到控制,生活质量明显提高.

  16. Nursing support on bronchoscopic interventional cryotherapy in treatment of bronchial tuberculosis%支气管镜介入冷冻治疗支气管结核的护理支持

    Institute of Scientific and Technical Information of China (English)

    向卡莉; 陈秀娟

    2014-01-01

    目的 探讨经支气管镜介入冷冻治疗支气管结核(BTB)过程中,提供护理支持的措施和效果.方法 将87例BTB患者随机分两组,观察组(45例)在舒适护理模式下,从术前准备、术中配合、术后护理三方面密切协同;对照组(42例)常规护理,比较两组患者的治疗额次、治疗时间和治疗效果.结果 观察组治疗频次和治疗时间多于对照驵,而显效率和总有效率高于对照组,患者不良反应发生率则低于对照组,对护理工作的满意度高于对照组,差异均有统计学意义(P<0.05).结论 冷冻治疗BTB需要一种新的护理模式提供支持和保障,加强护理协同,做好舒适护理能提高患者的依从性,提高手术的成功率和减少术后并发症.

  17. 支气管镜介入治疗在气道狭窄性疾病中的应用与体会%Bronchoscopic interventional therapy in airway stenosis

    Institute of Scientific and Technical Information of China (English)

    许煊

    2013-01-01

    支气管镜术和CT技术的发展,儿童气道狭窄确诊病例数逐年增多,但儿童气道狭窄的临床处理是一个很棘手的问题.本文介绍了热烧灼法、冷冻治疗术、球囊扩张气道成形术及气道支架置入技术在气道狭窄性疾病中的应用原理、适应证及方法.%Because bronchoscopy and CT technology development,the number of confirmed cases of children with airway stenosis have increased every year,but clinical management of pediatric airway constriction is a very thorny issue.This article described the application principles,indications and methods of thermal cauterization,cryotherapy,balloon dilatation airway-plasty and airway stent in airway stenosis.

  18. The diagnostic role of thoracoscope in undiagnosed pleural effusion: Rigid versus flexible

    Directory of Open Access Journals (Sweden)

    Mostafa Mahmoud Abdel Mageid Shaheen

    2014-07-01

    Conclusions: Thoracoscopy using either fibreoptic bronchoscope or rigid thoracoscope is safe and well tolerated. Rigid thoracoscope has a higher diagnostic yield, easier handling, better orientation and is less expensive. Nevertheless, fibreoptic bronchoscope is an alternative technique if rigid thoracoscopy is not available.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 电子支气管镜下覆膜气道支架置入术治疗肿瘤性食管气管瘘的护理%Nursing of electronic bronchoscope covered airway stent placement for the treatment of malignant esophageal fistula

    Institute of Scientific and Technical Information of China (English)

    杨柳

    2012-01-01

    目的:探讨在电子支气管镜下进行覆膜气道支架置入术对治疗肿瘤性食管气管瘘患者的手术前、手术中及手术后的方法,以提高肿瘤性食管气管瘘的患者的生活质量及延长生存时间,减少术后的并发症.方法:通过积极的术前护理,局部麻醉,术中配合,及术中心电、血压、指脉氧监测,注重术后护理和并发症的预防.结果:32例肿瘤性食管气管瘘患者均放置成功,覆膜气道支架置入术后,呛咳及肺部感染情况明显好转,生活质量明显提高,术后呼吸困难改善,未发生大咯血及支架移位等严重并发症.结论:积极的术前准备和心理护理,术中的严密监护和积极配合,减少并发症的发生是电子支气管镜下覆膜气道支架置入术成功的关键.%Objective: To investigate the metheds of preoperative, intraoperative, and postoperative care in the treatment of neoplastic esophagotracheal fistula surgery by the airway membrana tectoria cochleae stents, in order to improve the quality of life and prolong survival time of patients with neoplastic esophagotracheal fistula,reduce postoperative complication. Methods: We investigated the effect of nursing through positive preoperative nursing,local anesthesia,operative cooperation,monitoring with the intraoperative electrocardiogram,blood pressure,oxygen saturation,positive post -operative nursing,and the prevention of complications. Results: All 32 cases of neoplastic esophagotracheal fistula patients were successfully placed airway stents. after these operation, we found excellent nursing could markedly reduce cough and lung infections,significantly improve the quality of life,improve the postoperative respiratory difficulties , eliminate the occurrence of massive hemoptysis and stent migration. Conclusion: Through positive preoperative preparation and psychological nursing, intensive intraoperative care and actively operative cooperation,and the prevention of complications,we found that these factors are the key to the success of airway stenting.

  6. Causa morbid diagnosis and treatment value of electro-bronchoscope instead of thoracoscope for refractory or spontaneous pneumatothorax%电子支气管镜代替胸腔镜对难治性或复发性气胸病因的诊断和治疗价值

    Institute of Scientific and Technical Information of China (English)

    孙晓娟; 吴桂欣; 吕志平; 乔元秋

    2005-01-01

    目的探讨气胸的病因及持续不愈的原因,提高诊断和治疗水平.方法应用电子支气管镜代替胸腔镜对26例患者进行检查并在直视下选择合理的治疗.结果该组26例有24例中查明气胸持续不愈的原因,包括胸膜下肺大疱、肺大疱、胸膜粘连、胸膜肥厚和胸膜结核.结论该方法在探明气胸原因上有较高的临床应用价值.

  7. Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

    Directory of Open Access Journals (Sweden)

    Jayanta Medhi

    2016-01-01

    Full Text Available Purpose: To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. Materials and Methods: We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril and fluoroscopic guidance. Results: We achieved technical success in all the three patients with immediate relief of dyspnea. Conclusion: Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.

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

    DEFF Research Database (Denmark)

    Thomson, Neil C; Rubin, Adalberto S; Niven, Robert M

    2011-01-01

    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....

  9. Diffuse pulmonary infiltrates in immunocompromised patients

    NARCIS (Netherlands)

    Fijen, JW; van der Werf, TS; Ligtenberg, JJM; Tulleken, JE; Zijlstra, JG

    1999-01-01

    The differential diagnosis of bilateral interstitial pulmonary infiltrates in immunocompromised patients is very extensive. We describe two immunocompromised patients with diffuse pulmonary infiltrative changes. Bronchoscopic bronchoalveolar lavage after orotracheal intubation using topical anaesthe

  10. Foreign Body Retrieval

    Medline Plus

    Full Text Available ... long, thin, flexible or rigid tube with a light and a video camera attached. A bronchoscope is ... X-rays are a form of radiation like light or radio waves. X-rays pass through most ...

  11. 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.

  12. Pulmonary mucormycosis (Cunninghamella bertholletiae) with cavitation diagnosed using ultra-thin fibre-optic bronchoscopy.

    Science.gov (United States)

    Yagi, Shin-Ichi; Miyashita, Naoyuki; Fukuda, Minoru; Obase, Yasushi; Yoshida, Koichiro; Miyauchi, Ayaka; Kawasaki, Kouzou; Soda, Hiroshi; Oka, Mikio

    2008-03-01

    Recently, ultra-thin bronchoscopy has made it possible to observe smaller bronchi not visualized using standard techniques. We describe a case of pulmonary mucormycosis with cavitation, diagnosed using an ultra-thin bronchoscope. A 15-year-old girl with acute myeloid leukaemia had taken oral prednisolone, 60 mg/day, for graft versus host disease after haematopoietic stem cell transplantation. She was admitted to our hospital with fever and a large cavitary lesion in the right hilum. Using an ultra-thin bronchoscope, the interior of the cavity in the superior segment of the right lower lobe was observed. The bronchoscopic findings revealed debris adhering to the cavity wall with a small volume of effusion. Cunninghamella bertholletiae was isolated from the effusion specimen obtained using the bronchoscope. Pulmonary mucormycosis (C. bertholletiae) complicating an immunocompromised state was diagnosed. Ultra-thin bronchoscopy is useful to diagnose complex pulmonary infections and more research is needed to verify its clinical indications and utility.

  13. 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.

  14. Endoscopic Sealing of Bronchopleural Fistulas with Submucosal Injection of a Tissue Expander: A Novel Technique

    Directory of Open Access Journals (Sweden)

    Cayo García-Polo

    2010-01-01

    Full Text Available The occurrence of a bronchopleural fistula (BPF continues to represent a challenging management problem, and is associated with high morbidity and mortality. A novel and successful technique that uses submucosal injection of a tissue expander for bronchoscopic occlusion of BPFs has been designed. This method may be used either alone or in combination with bronchoscopic instillation of n-butyl-cyanoacrylate glue. The occlusion technique is described, with a presentation of two patients who were successfully treated with this method. The submucosal injection of a tissue expander is an effective, economical and minimally invasive technique for managing BPFs.

  15. Cryotherapy: A viable tool to remove broncholiths under flexible bronchoscopy.

    Science.gov (United States)

    Campbell, Sabrina N; Lala, Deepa; Rubio, Edmundo

    2016-12-01

    Broncholithiasis is the presence of calcific material within the tracheobronchial tree. Asymptomatic patients can be managed with observation only, whereas symptomatic disease requires surgery, rigid or flexible bronchoscopic removal. Recent reports have shown that flexible bronchoscopy can be a safe and effective option for removal of loose in addition to partially imbedded broncholiths. We present a case of a 65-yearold man with chronic cough that underwent successful cryotherapy assisted bronchoscopic removal of an imbedded broncholith. We will also review current literature regarding the management broncholithiasis.

  16. 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

  17. 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

  18. Asthma control during the year after bronchial thermoplasty

    DEFF Research Database (Denmark)

    Cox, Gerard; Thomson, Neil C.; Rubin, Adalberto S.

    2007-01-01

    BACKGROUND: Bronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma. METHODS: We randomly assigned 112 subjects who had...

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

    Science.gov (United States)

    Arulvelan, Appavoo; Soumya, Madhusudhan; Santhosh, Kannath

    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.

  20. A Case of Chronic Granulomatous Disease with a Necrotic Mass in the Bronchus: A Case Report and a Review of Literature

    Directory of Open Access Journals (Sweden)

    Ali Cheraghvandi

    2012-01-01

    Full Text Available Chronic granulomatous disease is a rare phagocytic disorder with recurrent, severe bacterial and fungal infections. We describe an unusual case of chronic granulomatous disease manifesting as an invasive pulmonary aspergillosis with an obstructive necrotic mass at the right middle bronchus. The patient was successfully treated with a bronchoscopic intervention for the removal of the obstructive mass and a medical therapy.

  1. Another STEP forward in emphysema treatment

    NARCIS (Netherlands)

    Slebos, Dirk-Jan; Klooster, Karin

    2016-01-01

    Patients with severe chronic obstructive pulmonary disease (COPD) suffer on a daily basis, despite important efforts to support this large patient population with pharmacotherapy. To potentially relieve symptoms, innovative bronchoscopic treatments have been developed in the past decade: the one-way

  2. 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

  3. [Neonatal bronchoscopy: a retrospective analysis of 67 cases and a review of their indications].

    Science.gov (United States)

    Oliveira-Santos, J A; Pereira-da-Silva, L; Clington, A; Serelha, M

    2004-01-01

    The availability of newer, more sophisticated and versatile bronchoscopes has expanded the spectrum and scope of the indications for bronchoscopy in the newborn infant both for diagnostic and therapeutic purposes. The aim of this study was to carry out a retrospective analysis of the bronchoscopies performed on newborn infants, and to review the indications of this procedure in this age group. Sixty-three patients were submitted to 67 bronchoscopies in a period of 13 years, allowing the diagnosis of 45 anomalies and malformations of the tracheo-bronchial tree, and the performance of 24 bronchoalveolar lavages. In six cases, endoscopic removal of secretions helped to resolve resistant atelectasia, while in another case, with esophageal atresia, intra-operative definition of the fistula tract was possible through catheterisation of the fistula with the bronchoscope. The flexible bronchoscope was preferred for diagnosis by direct visualisation, and the rigid bronchoscope for some diagnostic and therapeutic procedures. Stridor, unexplained cyanosis, hemoptysis, persistent or recurrent pulmonary images, difficulties in the intubation or extubation, and persistent disturbances in ventilation are among the main indications for bronchoscopy in the newborn infant. Bronchoscopy also allows the performance of subsidiary techniques, such as bronchoalveolar lavage, biopsy and laser therapy.

  4. A CASE OF ORO - PHARYNGEAL TERATOMA (EPIGNATHUS IN A NEONATE WITH DIFFICULT AIRWAY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Karthikeyan

    2015-10-01

    Full Text Available Epignathus is a midline oropharyngeal teratoma, usually presents with severe respiratory obstruction. Securing airway in these neonates is a real nightmare for a paediatric anesthesiologist. We report a case of Epignathic teratoma in a 2day old neonate with severe stridor. Awake tracheal intubation was performed because of non-availability of smaller fibre optic bronchoscope.

  5. 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

  6. 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

  7. 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...

  8. 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.

  9. 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.

  10. Utility of conventional transbronchial needle aspiration with rapid on-site evaluation (c-TBNA-ROSE at a tertiary care center with endobronchial ultrasound (EBUS facility

    Directory of Open Access Journals (Sweden)

    Neha Kawatra Madan

    2016-01-01

    Conclusion: c-TBNA with ROSE is a safe, efficacious, and cost-effective bronchoscopic modality. When it was performed by operators routinely performing EBUS-TBNA, diagnostic yields similar to that of EBUS-TBNA can be obtained. Even at the centers where EBUS facilities are available, c-TBNA should be routinely performed.

  11. 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.

  12. 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.

  13. Endobronchial Watanabe spigot embolisation in the treatment of bronchopleural fistula due to tuberculous empyema in intensive care unit.

    Science.gov (United States)

    Dalar, Levent; Kosar, Filizs; Eryuksel, Emel; Karasulu, Levent; Altin, Sedat

    2013-01-01

    Tuberculosis may be complicated with empyema and fistula in patients with cellular immune deficiency. The case presented was a 39-year-old male patient with diagnosis of rheumatoid arthritis developed hydropneumothorax while taking steroid and immunosuppressive treatment and examination of pleural fluid revealed acid-fast bacilli. The patient was admitted to the intensive care unit due to respiratory failure and underwent bronchoscopic examination due to air leakage. The right middle lobe was obliterated by using an endobronchial Watanabe Spigot (EWS), and the amount of leakage decreased considerably after the procedure. On day 7, chest tube drainage was removed, and empyema was drained with a Pezzer drain. On day 50, upon the cessation of empyema drainage, spigots were removed with rigid and flexible bronchoscope. In conclusion, EWS use in the treatment of bronchopleural fistula is an effective, safe and a reversible procedure.

  14. A novel method of airway management in a case of penetrating neck injury

    Directory of Open Access Journals (Sweden)

    Malavika Kulkarni

    2016-01-01

    Full Text Available Direct injury to airway is a rare event and also a challenge to anaesthesiologist and surgeon. We present a case report of open tracheal injury with right pneumothorax in a young male following assault with a sharp weapon. In spite of a chest tube in situ, the patient came with collapse of one lung and tachypnoea which required surgical exploration. Lower airway was evaluated by fibre-optic bronchoscopy through the open tracheal wound while he was awake and tracheal tube was passed over the bronchoscope. There was no vascular or oesophageal injury detected. Although there was a pleural tear, there were no signs of injury to lung parenchyma. After evaluation, end to end anastomosis of the trachea was planned, for which orotracheal tube was passed with surgical assistance. Patient was shifted to post-operative high dependency unit and was electively ventilated for 7 days and was later successfully extubated under fibre-optic bronchoscope guidance.

  15. 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.

  16. Testing and Evaluation of the Percussionaire Corporation Military Transporter Respirator, Model TXP

    Science.gov (United States)

    1991-10-01

    SCI’s petition to the DOT Office of Hazardous Material for approval to use the cylinder as an equipment component aboard aircraft. RESULTS Baseline...Valve Aspirator Needle/ Trocar /Bronchoscope 15 Closed circuit military/mass casualty breathing circuit Composite Oxvaen Cylinder ALT-281-1554...provisions of this Department’s Hazardous Materials Regulations to manufacture, mark, and sell non-DOT specification cylinders described in paragraph 7

  17. Aspiration-related organizing pneumonia complicating laparoscopic adjustable gastric banding: A lung cancer mimicker

    Directory of Open Access Journals (Sweden)

    Ahmed A Aljohaney

    2016-01-01

    Full Text Available There are several described pulmonary complications due to laparoscopic adjustable gastric banding. We report a rare case of a 32-year-old male who presented with pulmonary symptoms and a solitary lung mass 12 years after laparoscopic adjustable gastric banding. A bronchoscopic lung biopsy showed organizing pneumonia that was induced by aspiration pneumonia. The atypical radiological appearance of the aspiration pneumonia may pose a diagnostic challenge, and clinicians' awareness regarding such an entity is needed to avoid unnecessary intervention.

  18. Sequential unilateral lung volume reduction for emphysema - Stretching the benefit.

    Science.gov (United States)

    Khorramnia, Sadie; Holsworth, Lynda; Mestitz, Hugh; Westall, Glen P; Williams, Trevor J; Gooi, Julian H; Snell, Gregory I

    2017-01-01

    Bronchoscopic Lung Volume Reduction (BLVR) and Surgical Lung Volume Reduction (SLVR) and are two different approaches used to remodel severely emphysematous lungs to improve lung function and quality-of-life. We present a case initially referred for lung transplantation, where sequential left upper lobe BLVR and 7 years later right upper lobe SLVR, providing enduring physiological and functional improvement. The potential for sustained benefit via sequential unilateral lung volume reduction is under-appreciated.

  19. Increased Interleukin-8 in Epithelial Lining Fluid of Collapsed Lungs During One-Lung Ventilation for Thoracotomy

    OpenAIRE

    Komatsu, Yoshimichi; Yamamoto, Hiroshi; Tsushima, Kenji; Furuya, Shino; Yoshikawa, Sumiko; Yasuo, Masanori; Kubo, Keishi; Yamazaki, Yoshitaka; Hasegawa, Joh; Eguchi, Takashi; Kondo, Ryuichi; Yoshida, Kazuo; Koizumi, Tomonobu

    2012-01-01

    The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point...

  20. Failed fibreoptic intubation: 70° rigid nasendoscope and Frova introducer to the rescue

    Directory of Open Access Journals (Sweden)

    Stalin Vinayagam

    2016-01-01

    Full Text Available Endotracheal intubation was successfully accomplished with 70° rigid nasendoscope under video guidance in two patients in whom repeated attempts to secure airway with flexible fibreoptic bronchoscope were unsuccessful. Both patients had compromised airway (laryngeal papillomatosis and a huge thyroid swelling and were uncooperative. Frova intubating introducer was used along with 70° rigid nasendoscope to accomplish tracheal intubation under video guidance.

  1. Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sae Ah; Kim, Do Hyeong [Dankook University College of Medicine, Dankook University Hospital, Cheonan (Korea, Republic of); Jen, Gyeong Sik [Bundang CHA General Hospital, CHA University, Seongnam (Korea, Republic of)

    2012-07-15

    Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.

  2. 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.)

  3. 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.

  4. Foreign body in children?s airways

    Directory of Open Access Journals (Sweden)

    Cassol Vitor

    2003-01-01

    Full Text Available OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. METHOD: Time series of children who underwent bronchoscopies for foreign bodies aspirated into the airway between March 1993 and July 2002. Each patient was analyzed for age, sex, initial clinical diagnosis, nature and location of the foreign body, duration of symptoms between aspiration and bronchoscopy, radiological findings, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Thirty-four children, 20 (59% boys, ages ranging from nine months to nine years (median = 23 months. In 32 (94% children the foreign body was removed by rigid bronchoscope, and two resulted in thoracotomy. Foreign bodies were more frequent in children under three years of age (66%. A clinical history of foreign body inhalation was obtained in 27 (80% cases. Most of the foreign bodies removed were organic (65% and more frequently found in the right bronchial tree (59%. Foreign bodies were removed within 24 hours in 18 (53% cases. The most frequent radiographic findings were: unilateral air trapping, atelectasis and radiopac foreign body. Major bronchoscopy complications occurred in seven children (22%, and there were no deaths. CONCLUSIONS: More attention is necessary to the respiratory symptoms of aspirations, mainly in boys at early ages, with clinical history and compatible radiological findings. Most foreign bodies removed were of organic nature. In this case series, therapeutic rigid bronchoscopy was effective with few complications.

  5. 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.

  6. 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)

  7. 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.

  8. Pneumomediastinum Secondary to Foreign Body Aspiration: Clinical Features and Treatment Explorement in 39 Pediatric Patients

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jian Yang; Jie Zhang; Ping Chu; Yong-Li Guo; Jun Tai; Ya-Mei Zhang; Li-Xing Tang

    2016-01-01

    Background:Pneumomediastinum (PM) secondary to foreign body aspiration (FBA) is rare in children.Although it is mainly benign,some cases may be fatal.Due to the rare nature of this clinical entity,proper assessment and management have been poorly studied so far.Here,we characterized the presentation and management of this clinical entity and provided an evaluation system for the management.Methods:We retrospectively reviewed children with PM secondary to FBA,who were treated in Beijing Children's Hospital from January 2010 to December 2015.All patients were stratified according to the degree of dyspnea on admission,and interventions were given accordingly.Bronchoscopic removals of airway foreign bodies (FBs) were performed on all patients.For patients in acute respiratory distress,emergent air evacuation and/or resuscitations were performed first.Admission data,interventions,and clinical outcomes were recorded.Results:A total of 39 patients were included in this study.The clinical severity was divided into three grades (Grades Ⅰ,Ⅱ,and Ⅲ) according to the degree of dyspnea.Thirty-one patients were in Grade Ⅰ dyspnea,and they simply underwent bronchoscopic FBs removals.PM resolved spontaneously and all patients recovered uneventfully.Six patients were in Grade Ⅱ dyspnea,and emergent drainage preceded rigid bronchoscopy.They all recovered uneventfully under close observation.Two exhausted patients were in Grade Ⅲ dyspnea.They died from large PM and bilateral pneumothorax,respectively,despite of aggressive interventions in our hospital.Conclusions:PM secondary to FBA could be life-threatening in some patients.The degree of dyspnea should be evaluated immediately,and patients in different dyspnea should be treated accordingly.For patients in Grade Ⅰ dyspnea,simple bronchoscopic FBs removals could promise a good outcome.For patients in Grade Ⅱ dyspnea,emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become

  9. 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.

  10. 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.

  11. 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

  12. Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

    Science.gov (United States)

    Jacomelli, Marcia; Demarzo, Sergio Eduardo; Cardoso, Paulo Francisco Guerreiro; Palomino, Addy Lidvina Mejia; Figueiredo, Viviane Rossi

    2016-01-01

    ABSTRACT Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ∓ 0.7 cm) and 19 masses (mean diameter, 4.1 ∓ 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions. PMID:27832231

  13. 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.

  14. Therapeutic effect of argon plasma coagulation and cryotherapy combined with radiotherapy on patients with central type lung cancer%经支气管镜氩等离子体凝固及冷冻结合体外放射联合治疗中央型肺癌疗效的临床研究

    Institute of Scientific and Technical Information of China (English)

    何小鹏; 刘小伟; 党焱; 王利; 杨友文; 朱波; 陈剑辉; 马玉娟

    2013-01-01

    [Objective] To study the efficacy and safety of argon plasma coagulation (APC) and cryotherapy through bronchoscope combined with radiation on patients with central type lung cancer.[Methods] 60 patients with central type lung cancer patients were divided into two groups.35 cases in treatment group,with combined therapy.The control group 25 cases,radiation treatment.Clinical symptom,life quality scroe,airway obstruction were measured before and after treatment.[Results] After average 4 times APC and cryotherapy through bronchoscope,result compared with control group,the remission rate of clinical symptoms,airway obstruction,and improve of life quality score were markedly highter,two group had a statistically difference (P <0.05).[Conclusion] Radiation combined with APC and cryotherapy through bronchoscope is a effective and safe therapy for the patients with central type lung cancer.%目的 探讨经支气管镜氩等离子体凝固(APC)及冷冻技术结合体外放射治疗中央型肺癌的疗效.方法 对35例确诊为中心型肺癌的患者进行联合治疗,并与单纯放疗患者进行对比,以观察其疗效.结果 经平均4次的介入治疗,治疗组临床症状、生活质量评分、气道阻塞的缓解相对于对照组均有明显改善,其差异具有显著性(P<0.05).结论 经支气管镜APC及冷冻技术结合体外放疗是治疗中心型肺癌的安全有效方法.

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. Diagnostic imaging in COPD; Radiologische Diagnostik bei COPD

    Energy Technology Data Exchange (ETDEWEB)

    Owsijewitsch, Michael; Ley-Zaporozhan, Julia [Universitaetsklinik Heidelberg (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Eichinger, Monika [Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany). Abt. Radiologie

    2011-03-15

    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.)

  1. Maxillary tumor in a child: An expected case of difficult airway

    Science.gov (United States)

    Reena; Vikram, A

    2016-01-01

    Craniofacial abnormalities in pediatric population fall under the category of expected case of difficult airway. We present here a case of large maxillary tumor in a 9-year-old girl where the relative difficulty was further compounded due to her noncooperation which was again expected from a child. Local anesthetic topicalization of airway followed by slow inhalational induction with gradually increasing sevoflurane, while maintaining her spontaneous breathing, we secured her airway using fiber optic bronchoscopy. The surgery and the extubation went uneventful. In conclusion a planned airway management using fiber optic bronchoscope after airway topicalization and sevoflurane induction is the ideal technique in an expected case of difficult pediatric airway. PMID:27051379

  2. Plastic Bronchitis.

    Science.gov (United States)

    Rubin, Bruce K

    2016-09-01

    Plastic bronchitis is an uncommon and probably underrecognized disorder, diagnosed by the expectoration or bronchoscopic removal of firm, cohesive, branching casts. It should not be confused with purulent mucous plugging of the airway as seen in patients with cystic fibrosis or bronchiectasis. Few medications have been shown to be effective and some are now recognized as potentially harmful. Current research directions in plastic bronchitis research include understanding the genetics of lymphatic development and maldevelopment, determining how abnormal lymphatic malformations contribute to cast formation, and developing new treatments.

  3. Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria.

    Science.gov (United States)

    Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Ajose, Ifeoluwa; Oke, David

    2013-01-01

    Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary

  4. Endoscopic evaluation of the tracheobronchial tree and mediastinal lymph nodes.

    Science.gov (United States)

    Raymond, Daniel P; Watson, Thomas J

    2010-10-01

    Assessment of the airways and surrounding structures, including the mediastinum and pulmonary parenchyma, has been greatly facilitated by advancements in bronchoscopic techniques, both rigid and flexible. Recent years have seen an explosion in technologies that have revolutionized the ability to visualize, biopsy, or otherwise assess regions of potential pathology within the upper aerodigestive tract and adjacent structures. This article concisely and comprehensively reviews the endoscopic evaluation of the tracheobronchial tree and mediastinum with a focus on emerging technologies and their role in treatment of thoracic disease.

  5. Acquired tracheoesophageal fistula status post laryngeal neoplasm resection

    Directory of Open Access Journals (Sweden)

    Sarah Luber

    2015-04-01

    Full Text Available A tracheoesophageal fistula (TEF, albeit rare, can be a life-threatening condition that requires prompt identification and treatment. Pulmonary contamination and restriction of proper nutrition are common, unfortunate consequences of untreated TEFs and are often the causes of mortality in this population. In our patient, a history of laryngeal malignancy along with symptoms of chest pain and cough with ingestion of liquids, even without evidence of aspiration pneumonia, appropriately prompted investigation for potential TEF. Initial imaging through barium swallow identified the TEF, and the patient underwent treatment with endoclips by endoscopy with bronchoscopic assistance.

  6. 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.

  7. 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

  8. Successful removal of endobronchial lipoma by flexible bronchoscopy using electrosurgical snare.

    Science.gov (United States)

    Yun, Seong Cheol; Na, Moon Jun; Choi, Eugene; Kwon, Sun Jung; Lee, Seong Ju; Oh, Sun Hee; Cha, Eun Jung; Son, Ji Woong

    2013-02-01

    A 62-year-old man with a chronic cough presented with atelectasis of the left upper lobe on chest X-ray. Chest computed tomography showed an atelectasis in the left upper lobe with bronchial wall thickening, stenosis, dilatation, and mucoid impaction. We performed bronchoscopy and found a well-circumscribed mass on the left upper lobe bronchus. The mass was removed by flexible bronchoscopy using an electrosurgical snare and diagnosed with lipoma. An endobronchial lipoma is a rare benign tumor that can be treated by a surgical or endoscopic approach. We report the successful removal of endobronchial lipoma via flexible bronchoscopic electrosurgical snare.

  9. 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 safe, and it is highly sensitive. The advantage of an early diagnosis compensates for a rather high frequency of negative examinations....

  10. 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...

  11. 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.

  12. 3D endobronchial ultrasound reconstruction and analysis for multimodal image-guided bronchoscopy

    Science.gov (United States)

    Zang, Xiaonan; Bascom, Rebecca; Gilbert, Christopher R.; Toth, Jennifer W.; Higgins, William E.

    2014-03-01

    State-of-the-art image-guided intervention (IGI) systems for lung-cancer management draw upon high-resolution three-dimensional multi-detector computed-tomography (MDCT) images and bronchoscopic video. An MDCT scan provides a high-resolution three-dimensional (3D) image of the chest that is used for preoperative procedure planning, while bronchoscopy gives live intraoperative video of the endobronchial airway tree structure. However, because neither source provides live extraluminal information on suspect nodules or lymph nodes, endobronchial ultrasound (EBUS) is often introduced during a procedure. Unfortunately, existing IGI systems provide no direct synergistic linkage between the MDCT/video data and EBUS data. Hence, EBUS proves difficult to use and can lead to inaccurate interpretations. To address this drawback, we present a prototype of a multimodal IGI system that brings together the various image sources. The system enables 3D reconstruction and visualization of structures depicted in the 2D EBUS video stream. It also provides a set of graphical tools that link the EBUS data directly to the 3D MDCT and bronchoscopic video. Results using phantom and human data indicate that the new system could potentially enable smooth natural incorporation of EBUS into the system-level work flow of bronchoscopy.

  13. 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.

  14. 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.

  15. 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.

  16. The role of bronchoscopy in the diagnosis of early lung cancer: a review.

    Science.gov (United States)

    Andolfi, Marco; Potenza, Rossella; Capozzi, Rosanna; Liparulo, Valeria; Puma, Francesco; Yasufuku, Kazuhiro

    2016-11-01

    Lung cancer is the leading cause of cancer-related deaths worldwide with an overall 5-year survival rate of 17% after diagnoses. Indeed many patients tend to have a very poor prognosis, due to being diagnosed at an advanced stage. Conversely patients who are diagnosed at an early stage have a 5-year survival >70%, indicating that early detection of lung cancer is crucial to improve survival. Although flexible bronchoscopy is a relatively non-invasive procedure for patients suspected of having lung cancer, only 29% of carcinoma in situ (CIS) and 69% of microinvasive tumors were detectable using white light bronchoscopy (WLB) alone. As a result, in the past two decades, new bronchoscopic techniques have been developed to increase the yield and diagnostic accuracy, such as autofluorescence bronchoscopy (AFB), narrow band imaging (NBI) and high magnification bronchovideoscopy (HMB). However, due to the low specificity and the limitation to detect only proximal bronchial tree, new probe-based technologies have been introduced: radial endobronchial ultrasound (R-EBUS), optical coherence tomography (OCT), confocal laser endomicroscopy (CLE) and laser Raman spectroscopy (LRS). To date, although tissue biopsy remains the gold standard for diagnosing malignant/premalignant airway disease and some techniques are still investigational, bronchoscopic technologies can be considered the safest and most accurate tools to evaluate both central and distal airway mucosa.

  17. The effect of clonidine premedication on hemodynamic responses to microlaryngoscopy and rigid bronchoscopy.

    Science.gov (United States)

    Matot, I; Sichel, J Y; Yofe, V; Gozal, Y

    2000-10-01

    The usual hemodynamic response to laryngoscopy and bronchoscopy is an increase in heart rate and arterial blood pressure. Previous work has reported that 10%-18% of the patients develop ischemic ST segment changes during the procedure. Therefore, we performed a prospective, randomized, double-blinded study in 36 patients scheduled for elective microlaryngeal and bronchoscopic surgical procedures to evaluate the effects of 300-microg oral clonidine premedication (n = 18) or placebo (n = 18) on the hemodynamic alterations and the incidence of perioperative myocardial ischemic episodes. Myocardial ischemia was assessed by using continuous electrocardiographic monitoring, beginning 30 min before, and lasting until 24 h after the operation. During the procedure, patients receiving placebo exhibited a significant increase (mean +/- SD) in arterial blood pressure (the systolic increasing from 137+/-11 to 166+/-17 mm Hg, the diastolic increasing from 80+/-11 to 97+/-14 mm Hg) and heart rate (increasing from 79+/-15 to 97+/-12 bpm) compared with the baseline and with the clonidine group. A dose of 300-microg clonidine blunted the hemodynamic response to endoscopy. Ventricular arrhythmias were more frequent in patients who were not premedicated with clonidine. Two patients in the control group, but none in the clonidine group, had evidence of myocardial ischemia. These data should encourage routine premedication with clonidine in patients undergoing microlaryngoscopic and bronchoscopic procedures.

  18. Malignant tracheal-mediastinal-parenchymal-pleural fistula after chemoradiation plus bevacizumab: management with a Y-silicone stent inside a metallic covered stent.

    Science.gov (United States)

    Machuzak, Michael S; Santacruz, Jose F; Jaber, Wissam; Gildea, Thomas R

    2015-01-01

    Tracheal or bronchial-mediastinal fistulas are a rare entity associated to high mortality. We report a case of a 58-year-old man with an unresectable non-small cell carcinoma of the lung, treated with chemoradiation followed by bevacizumab. Approximately, 6 weeks after starting bevacizumab he developed a severe cough with copious secretions He could not lie supine due to the feeling of drowning. Investigations revealed a large tracheo-mediastinal-parenchymal-pleural fistula. Palliative management was offered with interventional bronchoscopic techniques. He was found to have a large central airway defect that obliterated almost 40% of the trachea. Under general anesthesia and positive pressure ventilation, a unique approach was used to rebuild an eroded tracheal and right main stem bronchial wall. A self-expanding metallic stent (SEMS) was placed to provide a scaffold of support, whereas a Dumon Y-stent was placed inside the SEMS. This combination allowed for a patent, stable airway; recreating the normal anatomy in a minimally invasive manner walling off the fistula. The patient was discharged 2 days after the bronchoscopic intervention, with significant palliation of his symptomatology. Eighteen months later, the upper lobe cavity persists with a stable airway and stents perfectly positioned with clinically insignificant evidence of stent related granulation in the upper trachea.

  19. 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.

  20. [The contribution of the microbiology laboratory to the diagnosis of ventilator-associated pneumonia].

    Science.gov (United States)

    Bouza, Emilio; Torres, María V; Burillo, Almudena

    2005-12-01

    The etiologic diagnosis of ventilator-associated pneumonia (VAP) should be considered as a microbiological emergency due to its impact on morbidity and mortality. Sampling of the lower respiratory tract (LRT) must be performed before starting or modifying antimicrobial therapy. Surveillance cultures in patients without criteria of VAP are not recommended. There is no evidence of any superiority of bronchoscopic over non-bronchoscopic sampling procedures, but quantitative bacterial cultures are essential to allow colonization to be differentiated from true infection of the LRT. Under these conditions, negative cultures practically rule out bacterial infection or, at least, identify patients who will not benefit from antibiotic therapy or who will require a very short course of treatment. Given that identification and antimicrobial susceptibility testing of microorganisms usually takes up to 3 or 4 days, rapid procedures that provide the clinician with useful information are essential. Rapid information, even if partial or less than perfect, is clearly better for the patient than a perfect but delayed report. Gram stain of LRT secretions is an immediate procedure that can guide management and it has a reasonable correlation with culture results. At present, new antibiogram procedures, performed on direct clinical samples, allow presumptive identification and information on susceptibility to commonly used antibiotics in less than 24 hours after sampling. The impact of using this procedure in clinical practice is currently under research.

  1. 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.

  2. Eosinophilic tracheobronchitis with cough hypersensitivity caused by Streptomyces albus antigen

    Directory of Open Access Journals (Sweden)

    Haruhiko Ogawa

    2000-01-01

    Full Text Available A 52-year-old woman is reported with atopic cough, in whom bronchoprovocation with Streptomyces albus antigen induced cough and bronchoscopic biopsy revealed eosinophilic tracheobronchitis. She was admitted for the diagnosis and treatment of severe non-productive cough. Although her induced sputum contained 8% eosinophils of nucleated cells and bronchoscopic biopsy specimens revealed eosinophil infiltration in both tracheal and bronchial wall, she did not have bronchial hyperresponsiveness to methacholine or heightened bronchomotor tone. Bronchodilator therapy was not effective for her coughing. Her symptoms worsened on returning home, suggesting the existence of some etiologic agents in her house. Streptomyces albus was isolated from her house. A high titer of anti-S. albus antibody was detected in her serum and the bronchoprovocation test with S. albus antigen was positive: development of coughing 15 min later and decrease in cough threshold to inhaled capsaicin 24 h later (3.9 μmol/L from 31.3 μmol/L prechallenge. This is the first report on eosinophilic tracheobronchitis with cough hypersensitivity caused by allergic reaction to S. albus antigen.

  3. 原发性气管肿瘤的呼吸介入治疗(附14例报告)%Interventional bronchoscopy therapy of primary tracheal tumors: report of 14 cases

    Institute of Scientific and Technical Information of China (English)

    张冬青; 陈成水; 叶民; 金旭如; 叶君如; 周颖

    2013-01-01

    tumors,especially appropriate indications and the role of interventional bronchoscopy.Methods:A retrospective analysis of the clinical data of 14 patients with primary tracheal tumors admitted to our department during the period of 2003 to 2009 was performed,all cases had detailed chest radiography,bronchoscopy and pathologic diagnosis.Results:Early clinical symptoms of all cases are unspecific,including cough and dyspnea.The majority malignant tumors included squamous cell carcinomas and adenoid cystic carcinomas; benign tumors consisted of pleiomorphic adenoma,leiomyoma,Chondroma,etc.Nine cases received surgery,and 5 of 9 received interventional bronchoscopic techniques at the same time; and the main therapy of another 5 cases were interventional bronchoscopic treatment.And the main interventional bronchoscopic techniques consisted of electrocoagulation and argon-beam coagulation.The main goal of interventional bronchoscopic treatment included benign tracheal tumors and keeping the airway open before sugery and as palliative therapy of advanced malignant tumors.Conclusion:Among primary tracheal tumors,we must pay more attention to the nonspecific symptoms.Surgery should be considered as the first choice of treatment,and interventional bronchoscopic techniques can be used in the diagnosis and provide treatment of endobronchial benign tumours,and as a way to keep the airway open until subsequent definitive resection can be done or as palliative therapy of unresectable malignant tumors.%目的:探讨原发性气管肿瘤的诊断和治疗方法,以及呼吸介入治疗的应用价值.方法:回顾性分析温州医科大学附属第一医院呼吸内科2003-2009年间原发性气管肿瘤14例的诊断和治疗经过.结果14例患者临床上均以不同程度的咳嗽、呼吸困难为主.病理组织学类型,恶性9例,以鳞癌、腺样囊性癌为主,良性肿瘤5例,包括:梭形细胞肿瘤、脂肪瘤和软骨瘤等.14例中9例患者接

  4. 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.

  5. 支气管镜介导下冷冻联合氩等离子电凝技术治疗气道狭窄

    Institute of Scientific and Technical Information of China (English)

    张丽琴; 王小伟; 赵毅超

    2014-01-01

    Objective To explore the efifcacy and safety of cryotherapy combined with argon plasma coagulation under bronchoscope for the treatment of airway stenosis. Methods The application of cryotherapy combined with argon plasma coagulation under bronchoscope in 26 patients with airway stenosis. Cryotherapy and argon plasma coagulation were taken turns during therapy. Larger lesions needed to be operated fractionally. The efficacy and safety of above treatments were evaluated after one week. Results Among twenty-six patients included 2 cases of tracheal carcinoma, 15 cases of lung cancer, 8 cases of endobronchial tuberculosis and 1 case of begin granulation. The frequencies of treatments during twenty-six patients were 41 times. 10 cases were complete response (38.5%), 15 cases were part response (57.7%), 1 case of mild response (3.8%). The overall effective rate was 96.2%. Conclusion Cryotherapy combined with argon plasma coagulation under bronchoscope for the treatment of airway stenosis are more efifcacy and safety for relieving symptoms.%目的:探讨支气管镜下冷冻联合氩等离子电凝术治疗气道狭窄的有效性和安全性。方法选取弋矶山医院26例气道狭窄患者,应用冷冻联合氩等离子凝固术治疗。术中采用冷冻、氩等离子电凝、冻切重复进行。对于较大的病变可分次手术.全部治疗结束l周后评价疗效。结果26例患者,其中2例气管癌、肺癌15例、支气管内膜结核8例、良性肉芽1例。共接受治疗41次。完全有效10例(38.5%),部分有效15例(57.7%),轻度有效1例(3.8%),临床有效率96.2%。结论在局麻下采用冷冻联合氩等离子电凝治疗气道狭窄疗效满意,可有效缓解症状,安全性较高。

  6. 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.

  7. 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

  8. 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.

  9. [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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Endobronchial Hamartoma Subtotally Occluding the Right Main Bronchus and Mimicking Bronchial Carcinoid Tumor.

    Science.gov (United States)

    Lococo, Filippo; Galeone, Carla; Lasagni, Luciano; Carbonelli, Cristiano; Tagliavini, Elena; Piro, Roberto; Zucchi, Luigi; Sgarbi, Giorgio

    2016-04-01

    Hamartomas are very rarely identified as an endobronchial lesion. Herein, we describe a peculiar case of a 55-year-old woman with persistent cough and increasing dyspnea and radiological detection of a solid lesion subtotally occluding the main right bronchus. Despite the radiological and radiometabolic (18-fluoro-2-deoxy-d-glucose positron emission tomography/computer tomography scan) features were highly suspected for bronchial carcinoid, the definitive diagnosis after endoscopic removal was indicative of an endobronchial hamartoma. When considering differential diagnosis of an endobronchial lesion, the physicians should take firmly in mind such rare entity and, accordingly, bronchoscopy and bronchoscopic biopsy should be done as first step in management of all cases presenting with endobronchial lesions.

  12. Broken tracheostomy tube: A fractured mandate

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    Arvind Krishnamurthy

    2012-01-01

    Full Text Available Tracheostomy is a common airway procedure for life support. This procedure is safe, although occasional early and late complications are known to occur. Fracture and hence aspiration of a tracheostomy tube in the tracheobronchial tree is a rare late complication, which can be potentially life threatening. Published reports of a fractured tracheostomy tube presenting as a foreign body in the tracheobronchial tree are few. The most common dislodged sites reported were the trachea and the right main bronchus, the inner flange in our patient was lodged in the trachea and the left main bronchus. Foreign-body aspiration is a serious medical emergency demanding timely recognition and prompt action as was successfully done in our patient. Therapeutic rigid bronchoscopic removal is the mainstay of treatment. A periodic review of the techniques of tracheostomy care including timely check-ups for signs of wear and tear can possibly eliminate such avoidable late complications.

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

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    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.

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

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    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.

  15. Maxillary tumor in a child: An expected case of difficult airway

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    Reena

    2016-01-01

    Full Text Available Craniofacial abnormalities in pediatric population fall under the category of expected case of difficult airway. We present here a case of large maxillary tumor in a 9-year-old girl where the relative difficulty was further compounded due to her noncooperation which was again expected from a child. Local anesthetic topicalization of airway followed by slow inhalational induction with gradually increasing sevoflurane, while maintaining her spontaneous breathing, we secured her airway using fiber optic bronchoscopy. The surgery and the extubation went uneventful. In conclusion a planned airway management using fiber optic bronchoscope after airway topicalization and sevoflurane induction is the ideal technique in an expected case of difficult pediatric airway.

  16. 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.

  17. Improved navigation for image-guided bronchoscopy

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    Khare, Rahul; Yu, Kun-Chang; Higgins, William E.

    2009-02-01

    Past work has shown that guidance systems help improve both the navigation through airways and final biopsy of regions of interest via bronchoscopy. We have previously proposed an image-based bronchoscopic guidance system. The system, however, has three issues that arise during navigation: 1) sudden disorienting changes can occur in endoluminal views; 2) more feedback could be afforded during navigation; and 3) the system's graphical user interface (GUI) lacks a convenient interface for smooth navigation between bifurcations. In order to alleviate these issues, we present an improved navigation system. The improvements offer the following: 1) an enhanced visual presentation; 2) smooth navigation; 3) an interface for handling registration errors; and 4) improved bifurcation-point identification. The improved navigation system thus provides significant ergonomic and navigational advantages over the previous system.

  18. Photodynamic therapy for the treatment of non-small cell lung cancer.

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    Simone, Charles B; Friedberg, Joseph S; Glatstein, Eli; Stevenson, James P; Sterman, Daniel H; Hahn, Stephen M; Cengel, Keith A

    2012-02-01

    Photodynamic therapy is increasingly being utilized to treat thoracic malignancies. For patients with early-stage non-small cell lung cancer, photodynamic therapy is primarily employed as an endobronchial therapy to definitely treat endobronchial, roentgenographically occult, or synchronous primary carcinomas. As definitive monotherapy, photodynamic therapy is most effective in treating bronchoscopically visible lung cancers ≤1 cm with no extracartilaginous invasion. For patients with advanced-stage non-small cell lung cancer, photodynamic therapy can be used to palliate obstructing endobronchial lesions, as a component of definitive multi-modality therapy, or to increase operability or reduce the extent of operation required. A review of the available medical literature detailing all published studies utilizing photodynamic therapy to treat at least 10 patients with non-small cell lung cancer is performed, and treatment recommendations and summaries for photodynamic therapy applications are described.

  19. [An experience with omentopexy for the repair of postoperative bronchopleural fistula].

    Science.gov (United States)

    Takenouchi, N; Shiono, T; Sekishita, Y; Fujimori, M; Sato, Y; Munemura, T; Ootake, S; Niizeki, H; Oshikiri, T

    1997-03-01

    Postoperative bronchopleural fistula has been the most troublesome complications in the thoracic surgery. In this report, we presented a case of bronchopleural fistula successfully closed by omentopexy. A 51-year-old man had undergone left upper lobectomy and S6 segmentectomy for primary lung cancer. Bronchopleural fistula due to postoperative pneumonia was developed and completion pneumonectomy with the intercostal-musclo-pexy was performed. Post-re-operative course was unsuccessful, bronchopleural fistula remained, so we tried re-closure of the bronchial stump by omentopexy without thoracoplasty or muscle flap plombage. About a half year after 3rd operation, he relapsed into bronchopleural fistula. Then fibrin gluing was performed via a flexible fiberoptic bronchoscope without hospitalization, and the omental flap was fixed completely to the bronchial stump. We believe the omentopexy a useful procedure for treating postoperative bronchopleural fistula which can't make any chest-wall deformation.

  20. Stenting of critical tracheal stenosis with adjuvant cardio-pulmonary bypass

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    Himanshu Bhardwaj

    2017-01-01

    Full Text Available Severe and critical central airway obstruction causing impaired ventilation and/or oxygenation can impose tremendous challenges on the interventional pulmonologist. Near total airway obstruction can rapidly evolve into potentially fatal complete airway occlusion during bronchoscopic airway manipulation under moderate sedation; as well as during the induction of the general anesthesia. Although there are currently interventional pulmonary procedures available to tackle the critical airway obstruction in extreme situations, cardio-pulmonary bypass should be considered prior to the intervention to maintain the adequate gas exchange during the procedure. Orotracheal intubation with mechanical ventilation in this situation can be fatal itself if the obstructing airway lesion functions as a “one way valve” allowing air to follow distally during inspiration but impeding expiratory flow leading to gas trapping, high intrathoracic pressure, tension pneumothorax, and ultimately a cardiac arrest.

  1. Tracheal granuloma because of infection with a novel mycobacterial species in an old FIV-positive cat.

    Science.gov (United States)

    De Lorenzi, D; Solano-Gallego, L

    2009-03-01

    A 15-year-old domestic shorthair feline immunodeficiency virus-positive cat was presented with a five day history of productive cough and acute respiratory distress. Physical examination revealed inspiratory dyspnoea and diffuse gingivostomatitis. Radiographs showed an intratracheal mass located at the level of the sixth and the seventh cervical vertebrae. Bronchoscopy revealed a unique intratracheal mass occluding about 85 per cent of the tracheal lumen. The tracheal mass was removed bronchoscopically. A diagnosis of pyogranulomatous inflammation referable to a mycobacterial infection was made based on cytological and histopathological findings. 16S rRNA polymerase chain reaction testing and sequence analysis identified a novel mycobacterial species, likely a slow grower, with 95 per cent identity with Mycobacterium xenopi. To our knowledge, this is the first description of a tracheal mycobacterial granuloma in a cat, and the first time, a mycobacterium with this sequence has been identified.

  2. Large Cell Neuroendocrine Carcinoma of the Lung

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    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. The Diagnosis and Management of Airway Complications Following Lung Transplantation.

    Science.gov (United States)

    Mahajan, Amit K; Folch, Erik; Khandhar, Sandeep J; Channick, Colleen L; Santacruz, Jose F; Mehta, Atul C; Nathan, Steven D

    2017-03-05

    Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2-4 percent. The incidence of lethal and non-lethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplant airway complications is anastomotic ischemia. Airway complications include development of exophytic granulation tissue, bronchial stenosis, bronchomalacia, airway fistula, endobronchial infection, and anastomotic dehiscence. The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation, and provides our expert opinion where evidence is lacking.

  4. 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.

  5. Application of peroxyacetic acid type endoscopic disinfection machine to fibre bronscope disinfection%过氧乙酸型内镜消毒机对纤维支气管镜消毒的应用观察

    Institute of Scientific and Technical Information of China (English)

    王泽琼

    2012-01-01

      目的探讨以过氧乙酸为消毒剂的全自动内镜消毒机对纤维支气管镜的消毒效果.方法将本院诊疗后污染的纤支镜380例,随机分为实验组(采用过氧乙酸为消毒剂的汇日牌WAYWIN-2000型医用全自动内镜消毒机对支气管镜消毒)和对照组(以2%戊二醛为消毒剂的传统五槽清洗消毒法),分别从内镜表面清洁度、镜身表面附着物、管道堵塞及细菌菌落检测等方面进行评价.结果实验组在内镜表面清洁度、镜身表面附着物、管道堵塞均较对照组效果好;无论是内腔采样法还是外表采样法,实验组的无菌生长例数均高于对照组;实验组≥20cfu/件的例数明显少于对照组,用内腔采样法,实验组合格率亦明显高于对照组,差异有统计学意义(P<0.05).结论应用过氧乙酸为消毒剂的全自动内镜消毒机明显提高纤维支气管镜清洗、消毒质量,同时减轻护理人员的劳动强度,提高支气管镜的应用效率,值得推广.%  Objective To investigate the disinfection effect of peroxyacetic acid for disinfectant automatic endoscopic disinfection ma-chine to fiber bronchoscope. Methods 380 contaminated fiber bronchoscope were randomly divided into experimental group (Use Huiri WAYWIN-2000 type medical automatic endoscopic disinfection machine of peroxyacetic acid as disinfectant to bronchoscopy disinfec-tion) and control group (Use traditional five tank cleaning and disinfection method of 2% glutaraldehyde as disinfectant), and evaluated the endoscopic surface cleanliness, lens barrel surface attachment, pipe blockage and bacterial colonies detected. Results Experimental group in the endoscopic surface cleanliness, lens barrel surface attachment and pipe blockage were better than those in the control group; aseptic growth number are higher than those in the control group both intracavity sampling and appearance sampling; Colony count ≥20cfu in experimental

  6. 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.

  7. Fulminant Laryngeal-tracheobronchial-pulmonary Aspergillosis: A Rare and Fatal Complication in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

    Science.gov (United States)

    Tao, Tao; Zhang, Ying-Hui; Xue, Sheng-Li; Wu, De-Pei; Chen, Feng

    2017-01-01

    A 23-year-old man who had previously undergone allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia was diagnosed with invasive laryngeal-tracheobronchial-pulmonary aspergillosis after presenting with a persistent dry cough at six months post-transplantation based on the findings of laryngoscopy and fiberoptic bronchoscopy. A fiberoptic bronchoscope was used to remove the obstructive material from the patient's airway and posaconazole plus caspofungin were administered to successfully to treat the patient. Our report suggests that laryngoscopy and fiberoptic bronchoscopy should be considered as alternative approaches to the diagnosis and treatment of allo-HSCT recipients with persistent respiratory symptoms when invasive laryngeal aspergillosis and invasive tracheobronchial aspergillosis are suspected. PMID:28154281

  8. [Value of flexible fiberoptic bronchoscopy under local anesthesia in infants].

    Science.gov (United States)

    Bodart, E; De Lange, M; Vliers, A

    1993-06-01

    From October 1991 through April 1992, 16 infants aged 5 to 25 months (mean age 14.3 months) underwent bronchoscopy with a flexible fiberoptic bronchoscope, under local anesthesia. The technique is described in detail. Reasons for bronchoscopy included recurrent or persistent pneumonia (n = 4), persistent atelectasia (n = 4), lymphadenopathy and/or airway compression (n = 2), suspected foreign body (n = 2), bronchoalveolar lavage to investigate diffuse interstitial lung disease (n = 2), and severe recurrent wheezing (n = 2). The procedure established the accurate diagnosis in 14 cases. Adverse events (32%) were minor (transient hypoxia, n = 3; moderate fever, n = 1; and laryngospasm, n = 1) and resolved completely. Flexible fiberoptic bronchoscopy under local anesthesia is a simple procedure which is safe in patients under 30 months of age when performed by a experienced operator in an adequate facility. This method is useful for the diagnosis and/or treatment of a broad spectrum of conditions.

  9. Resection of endobronchial hamartoma causing recurrent hemoptysis by electrocautery and cryotherapy

    Science.gov (United States)

    Ucar, N; Akpinar, S; Aktas, Z; Sipit, T; Ozaydin, E

    2014-01-01

    Background: Pulmonary hamartomas are rare benign tumors of the lung with an incidence of 0.025%-0.32%. Endobronchial benign lesions can cause bronchial obstruction and recurrent respiratory infections or obstructive pneumonia and recurrent hemopthysis. Case report: A 66-year-old male with recurrent hemoptysis and pneumonias for a year, was referred to our department for an endoscopic resection of an endobronchial hamartoma. Initially he refused any intervention but, as he suffered additional episodes of hemoptysis and chest infections during a year on follow up, he finally underwent interventional bronchoscopy and the lesion was cauterized using snare electrocautery probe and removed with cryoextraction. The patient has been followed for two years in our outpatient clinic, with no further problems. Conclusion: Endoscopic treatment with flexible bronchoscope, electrocautery and cryotherapy provides an excellent outcome. Surgical therapy, should be reserved for the hamartomas that cannot be approached through endoscopy. Hippokratia 2014; 18 (4): 355-356. PMID:26052204

  10. The squamous cell carcinoma case that received long-term COPD treatment

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    Figen Türk

    2013-03-01

    Full Text Available Primary tracheal tumors are rare, and composed of variousbenign and malignant pathologies. They often cansimulate obstructive pulmonary diseases, such as asthmaand chronic obstructive pulmonary disease, and patientswith malign tracheal tumors sometimes undergolong-term treatment for such diseases, without any improvement.Therefore, these tumors should be includedin the differential diagnosis in patients presenting tracheobronchialtree obstruction. We present a squamous cellendotracheal carcinoma case that had received treatmentwith a diagnosis of chronic obstructive pulmonarydisease for a long time. The recent increase in symptomshad been thought to be due to an exacerbation of the disorderbut the bronchoscopy performed after 3 months ofno improvement revealed an endotracheal mass lesion.Full recovery was obtained with bronchoscopic resectionof the tumor.Key words: Endotracheal tumor, chronic obstructive pulmonary disease, squamous cell carcinoma

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

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    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.

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

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    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.

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

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    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.

  14. 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).

  15. Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet

    Science.gov (United States)

    Lim, Sang Youn; Sohn, Sung Birm; Lee, Jung Min; Lee, Ji Ae; Chung, Sangmi; Kim, Junga; Choi, Juwhan; Kim, Sehwa; Yoo, Ah Young; Roh, Jong Ah; Park, Haein; Kim, Won Shik; Sim, Jae Kyeom; Shim, Jae Jeong

    2016-01-01

    Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation. PMID:26770233

  16. Pitfalls and Challenges of Lung Transplant in a Patient With Kartagener Syndrome and Scoliosis.

    Science.gov (United States)

    Yazicioglu, Alkin; Alici, Ibrahim Onur; Karaoglanoglu, Nurettin; Yekeler, Erdal

    2016-03-14

    We present a 22-year-old woman with Kartagener syndrome and scoliosis who died 112 days after single lung transplant. The classic thoracic involvement of situs inversus totalis and the asymmetric arrangement of the thoracic vascular structures might be a pitfall for surgeon. Anatomic obstacles have forced the surgeon to perform a single transplant. The period of primary graft dysfunction in a single transplanted lung patient was a challenge; supporting the patient with a high flow and long period of extracorporeal membrane oxygenation might lead to a vanishing bronchus. Immotile cilia, a feature of Kartagener syndrome, were another challenge and patient needed several daily aspiration bronchoscopies. Vanishing bronchus is a gradual process with high mortality rates; commonly, stenosis is at the non anastomotic bronchial tree because of insufficient nourishment of the bronchial cartilages. Several repeat bronchoscopic balloon dilatations accompanied with medical treatment were unsuccessful.

  17. 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.

  18. 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.

  19. Presence of Saccharomycopsis capsularis in the human respiratory system

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    Maria Dynowska

    2014-08-01

    Full Text Available The following paper represents a fragment of studies on the dynamics of microflora in the human respiratory system with a particular focus on new species developing in that ontocoenosis. Saccharomycopsis capsularus amounts to 6.7% of all the isolated fungi. The isolates were obtained from sputum (41.9%, bronchoscopic material (18.6% and the pharyngeal, nasal and oral swabs representing jointly 39.5% of the positive results. Almost twice as many isolates were obtained from women (66.3% as from men (33.7%. The fungi were most frequently found in the spring and autumn, more rarely in the winter, the rarest in the summer. Appearance of S. capsularis in the human body is, most probably, a consequence of its increased expansiveness in the external environment. So far it has been isolated from the soil, pollens of some tropical plants and from water reservoirs contaminated with municipal sewage.

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

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    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.

  1. 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™.

  2. Airway management in Escobar syndrome: A formidable challenge

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    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.

  3. I-gel® vs. LMA™ Supreme™ Comparison in the Prone Position

    DEFF Research Database (Denmark)

    Bisgaard, Claus Hedebo

    Baggrund: Operationer i bugleje indebærer traditionelt anæstesiinduktion og endotracheal intubation (ET) i rygleje med efterfølgende vending til bugleje, medførende potentiel risiko for accidentel extubation, hypotension og uhensigtsmæssig lejring. Studier er fremkommet hvor et alternativ......-gel Versus LMA-Fastrach Supraglottic Airway for Flexible Bronchoscope-Guided Tracheal Intubation Using a Parker (GlideRite) Endotracheal Tube: A Randomized Controlled Trial. Anesthesia and Analgesia 2015, vol 121(2), p. 430-436...... og efterfølgende ET.1 Igel LM giver mulighed for intubation gennem en allerede anlagt LM, modsat traditionel LM.2 Der er dog ingen studier af Igel anvendt i bugleje. Dette studie søger således at sammenligne en i bugleje allerede veltestet LM, LMA Supreme, med Igel for at etablere som minimum samme...

  4. Robust method for extracting the pulmonary vascular trees from 3D MDCT images

    Science.gov (United States)

    Taeprasartsit, Pinyo; Higgins, William E.

    2011-03-01

    Segmentation of pulmonary blood vessels from three-dimensional (3D) multi-detector CT (MDCT) images is important for pulmonary applications. This work presents a method for extracting the vascular trees of the pulmonary arteries and veins, applicable to both contrast-enhanced and unenhanced 3D MDCT image data. The method finds 2D elliptical cross-sections and evaluates agreement of these cross-sections in consecutive slices to find likely cross-sections. It next employs morphological multiscale analysis to separate vessels from adjoining airway walls. The method then tracks the center of the likely cross-sections to connect them to the pulmonary vessels in the mediastinum and forms connected vascular trees spanning both lungs. A ground-truth study indicates that the method was able to detect on the order of 98% of the vessel branches having diameter >= 3.0 mm. The extracted vascular trees can be utilized for the guidance of safe bronchoscopic biopsy.

  5. Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine

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    Raval Chetankumar

    2010-01-01

    Full Text Available Ankylosing spondylitis (AS patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed.

  6. A rare cause of stridor: Isolated tracheal amyloidosis

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    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.

  7. Screening and early detection of lung cancer.

    Science.gov (United States)

    Van't Westeinde, Susan C; van Klaveren, Rob J

    2011-01-01

    Lung cancer with an estimated 342,000 deaths in 2008 (20% of total) is the most common cause of death from cancer, followed by colorectal cancer (12%), breast cancer (8%), and stomach cancer (7%) in Europe. In former smokers, the absolute lung cancer risk remains higher than in never-smokers; these data therefore call for effective secondary preventive measures for lung cancer in addition to smoking cessation programs. This review presents and discusses the most recent advances in the early detection and screening of lung cancer.An overview of randomized controlled computerized tomography-screening trials is given, and the role of bronchoscopy and new techniques is discussed. Finally, the approach of (noninvasive) biomarker testing in the blood, exhaled breath, sputum, and bronchoscopic specimen is reviewed.

  8. 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

  9. Benign tracheal stenosis a case report and up to date management.

    Science.gov (United States)

    Karapantzos, Ilias; Karapantzou, Chrysa; Zarogoulidis, Paul; Tsakiridis, Kosmas; Charalampidis, Charalampos

    2016-11-01

    Benign tracheal stenosis is situation that occurs usually after stress is applied to a certain area in the trachea during the intubation of a patient or inflammation caused during an infection. In the current case report we will present a 65-year-old man with a benign tracheal stenosis due to a 15-day intubation with a high pressure and low volume intubation tube. Current methodology was applied in his case with an excellent result with a 1-year follow up. Cryotherapy, electrocautery-knife, balloon dilation and semi-rigid bronchoscopic technique were applied. Currently there are several techniques that can be used by pulmonary physicians or ear, nose and throat experts. It remains for the treating physician to choose its method based on his training, equipment and tissue damage.

  10. 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

  11. 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

  12. 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

  13. 支气管类癌的临床及影像学特点分析(附1例报告)%Clinical and Eikonic Features of Bronchial Carcinoid: A Case Report

    Institute of Scientific and Technical Information of China (English)

    王妍敏; 韩锋锋; 皮卫峰; 管雯斌; 张悦; 孙晋渊; 郭雪君

    2013-01-01

    目的 探讨支气管类癌的临床特点,减少误诊、漏诊.方法 对我院收治的1例支气管类癌的临床资料进行回顾性分析.结果 本例无明显临床症状,体检发现左肺部斑片状阴影入院.经胸部CT平扫结合支气管镜活检病理检查确诊为支气管类癌,予手术治疗,术后未行放化疗,随访6个月患者无复发.结论 支气管类癌早期临床表现缺乏特异性,诊断困难,易误、漏诊,及时行支气管镜下深部活检或外科手术活检,有利于及早确诊并治疗.%Objective To explore clinical features of bronchial carcinoid in order to avoid misdiagnosis and missed diagnosis.Methods Clinical date of one patient with bronchial carcinoid in our hospital were retrospectively analyzed.Results The patient had no clinical symptoms,and was admitted for patching shadow in left lung in physical examination.Bronchial carcinoid was confirmed by chest plain CT scan combined with bronchoscopic biopsy,and surgical therapy was performed.Chemoradiation was not given,and the patient had no recurrence within six months of follow-up.Conclusion Bronchial carcinoid is often misdiagnosed or missed diagnosed because of lack of characteristic in early period.Bronchoscopic and surgical biopsy is valuable in early diagnosis and treatment.

  14. Low cost biological lung volume reduction therapy for advanced emphysema

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    Bakeer M

    2016-08-01

    Full Text Available Mostafa Bakeer,1 Taha Taha Abdelgawad,1 Raed El-Metwaly,1 Ahmed El-Morsi,1 Mohammad Khairy El-Badrawy,1 Solafa El-Sharawy2 1Chest Medicine Department, 2Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Bronchoscopic lung volume reduction (BLVR, using biological agents, is one of the new alternatives to lung volume reduction surgery.Objectives: To evaluate efficacy and safety of biological BLVR using low cost agents including autologous blood and fibrin glue.Methods: Enrolled patients were divided into two groups: group A (seven patients in which autologous blood was used and group B (eight patients in which fibrin glue was used. The agents were injected through a triple lumen balloon catheter via fiberoptic bronchoscope. Changes in high resolution computerized tomography (HRCT volumetry, pulmonary function tests, symptoms, and exercise capacity were evaluated at 12 weeks postprocedure as well as for complications.Results: In group A, at 12 weeks postprocedure, there was significant improvement in the mean value of HRCT volumetry and residual volume/total lung capacity (% predicted (P-value: <0.001 and 0.038, respectively. In group B, there was significant improvement in the mean value of HRCT volumetry and (residual volume/total lung capacity % predicted (P-value: 0.005 and 0.004, respectively. All patients tolerated the procedure with no mortality.Conclusion: BLVR using autologous blood and locally prepared fibrin glue is a promising method for therapy of advanced emphysema in term of efficacy, safety as well as cost effectiveness. Keywords: BLVR, bronchoscopy, COPD, interventional pulmonology

  15. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors

    Science.gov (United States)

    Angrill, J; Agusti, C; de Celis, R; Rano, A; Gonzalez, J; Sole, T; Xaubet, A; Rodriguez-Roisin, R; Torres, A

    2002-01-01

    Background: A study was undertaken to investigate the incidence, diagnostic yield of non-invasive and bronchoscopic techniques, and risk factors of airway colonisation in patients with bronchiectasis in a stable clinical situation. Methods: A 2 year prospective study of 77 patients with bronchiectasis in a stable clinical condition was performed in an 800 bed tertiary university hospital. The interventions used were pharyngeal swabs, sputum cultures and quantitative protected specimen brush (PSB) bacterial cultures (cut off point ≥102 cfu/ml) and bronchoalveolar lavage (BAL) (cut off point ≥103 cfu/ml). Results: The incidence of bronchial colonisation with potential pathogenic microorganisms (PPMs) was 64%. The most frequent PPMs isolated were Haemophilus influenzae (55%) and Pseudomonas spp (26%). Resistance to antibiotics was found in 30% of the isolated pathogens. When the sample was appropriate, the operative characteristics of the sputum cultures were similar to those obtained with the PSB taken as a gold standard. Risk factors associated with bronchial colonisation by PPMs in the multivariate analysis were: (1) diagnosis of bronchiectasis before the age of 14 years (odds ratio (OR)=3.92, 95% CI 1.29 to 11.95), (2) forced expiratory volume in 1 second (FEV1) <80% predicted (OR=3.91, 95% CI 1.30 to 11.78), and (3) presence of varicose or cystic bronchiectasis (OR=4.80, 95% CI 1.11 to 21.46). Conclusions: Clinically stable patients with bronchiectasis have a high prevalence of bronchial colonisation by PPMs. Sputum culture is a good alternative to bronchoscopic procedures for evaluation of this colonisation. Early diagnosis of bronchiectasis, presence of varicose-cystic bronchiectasis, and FEV1 <80% predicted appear to be risk factors for bronchial colonisation with PPMs. PMID:11809984

  16. Comparison of three supraglottic airway devices for airway rescue in the prone position: A manikin-based study

    Directory of Open Access Journals (Sweden)

    Babita Gupta

    2015-01-01

    Full Text Available Background: Accidental extubation during surgery in prone position can be life-threatening. Supraglottic airway devices (SAD have been used successfully in such situations to rescue the airway. However, which SAD would be most appropriate in this setting has not been described in the literature. Aims: The aim of our study was to determine the most appropriate SAD for securing airway in a prone position during accidental extubation. Materials and Methods: In the study, Airway Trainer (Laerdal manikin was used for studying insertion of three SADs; I-gel, Laryngeal Mask Airway ProSeal™ (PLMA and LMA Classic™ (CLMA in the prone position. Forty anesthesia resident doctors participated in this study. The time taken for insertion; ease of insertion and ventilation; bronchoscopic view; and insertion score were compared among the three groups. Results: The time taken for I-gel insertion was significantly lesser (12.89 ± 3.94 seconds as compared to CLMA (17.07 ± 3.5 seconds and PLMA (25 + 4.78 seconds. Least resistance was encountered in the insertion of I-gel, while maximum resistance was experienced in PLMA group (22.5% vs. 90%. The maneuver required for optimal positioning was observed in 27.5% of PLMA insertion, 2.5% in CLMA while no maneuver was required in any of the I-gel insertion. Ease of ventilation was comparable in all three SADs. The bronchoscopic view and insertion score were significantly higher with I-gel as compared to CLMA and PLMA. Conclusion: All three SADs were successful as rescue devices during accidental extubation in the prone position. However, the ease of insertion was maximum with I-gel, followed by CLMA and PLMA.

  17. Bronchopulmonary infection with lophomonas blattarum: two cases report and literature review

    Institute of Scientific and Technical Information of China (English)

    Yao Guozhong

    2008-01-01

    Objective: To improve the recognition and diagnosis on the bronchopulmonary infection with Lophomonas blattarum (L. blattarum). Methods: The clinical characteristics of 2 patients diagnosed and treated in our hospital were reported, and 42 cases that had been reported from years 1993 to 2007 are analyzed. Results: In our report, the firs tpatient attacked serious asthma time after time, the second patient suffered from bronchiectasis with a protracte dinfection course. Forty-four cases all have pathogen examination and parasitic expertise. The most common symptoms are fever, cough and expectoration. 1/3 of the patients have increased acidophilic granulocyte in peripheral blood. Chest X film and CT scanning suggest changes were similar to pneumonia. Chronic cases are manifested with bronchial asthma, bronchiectasis and pulmonary abscess. L. blattarum found in phlegm or specimen collected by bronchoscopy provides the most reliable evidence for the diagnosis of this disease. Conclusion: Bronchopulmonary L. blattarum infection is a new kind of diseases. The clinical manifestations are similar to pneumonia, asthma, bronchiectasis infection or pulmonary abscess. L. blattarum found in sputum smear, bronchoscopic brush smear, bronchoscopic biopsy smear, or bronchoalceolar lavage under microscope is the foundation of the diagnosis. The pathogen species has not been finally confirmed. It is still unclear how the pathogen exists in the natural environment, how to transmit to persons and what kind of people would suffer from the disease more easily. Treatment only with antibiotics is not effective to this disease. Metronidazole with dosage of 0.5 g per time and twice per day was effective to most patients, the period of treatment need to last 14-38 d, but multidrug resistance case had been reported.

  18. Lung malignancy: Diagnostic accuracies of bronchoalveolar lavage, bronchial brushing, and fine needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    Rateesh Sareen

    2016-01-01

    Full Text Available Background: Early diagnosis of lung cancer plays a pivotal role in reducing lung cancer death rate. Cytological techniques are safer, economical and provide quick results. Bronchoscopic washing, brushing and fine needle aspirations not only complement tissue biopsies in the diagnosis of lung cancer but also comparable. Objectives: (1 To find out diagnostic yields of bronchioalveolar lavage , bronchial brushings, FNAC in diagnosis of lung malignancy. (2 To compare relative accuracy of these three cytological techniques. (3 To correlate the cytologic diagnosis with clinical, bronchoscopic and CT findings. (4 Cytological and histopathological correlation of lung lesions. Methods: All the patients who came with clinical or radiological suspicion of lung malignancy in two and a half year period were included in study. Bronchoalveolar lavage was the most common type of cytological specimen (82.36%, followed by CT guided FNAC (9.45% and bronchial brushings (8.19%. Sensitivity, specificity, positive and negative predictive value for all techniques and correlation with histopathology was done using standard formulas. Results: The most sensitive technique was CT FNAC – (87.25% followed by brushings (77.78% and BAL (72.69%. CT FNAC had highest diagnostic yield (90.38%, followed by brushings (86.67% and BAL (83.67%. Specificity and positive predictive value were 100 % each of all techniques. Lowest false negatives were obtained in CT FNAC (12.5% and highest in BAL (27.3%. Highest negative predictive value was of BAL 76.95 % followed by BB 75.59% and CT FNAC 70.59%. Conclusion: Before administering antitubercular treatment every effort should be made to rule out malignancy. CT FNAC had highest diagnostic yield among three cytological techniques. BAL is an important tool in screening central as well as in accessible lesions. It can be used at places where CT guided FNAC is not available or could not be done due to technical or financial limitations

  19. 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

  20. 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.

  1. Combination of constant-flow and continuous positive-pressure ventilation in canine pulmonary edema.

    Science.gov (United States)

    Sznajder, J I; Becker, C J; Crawford, G P; Wood, L D

    1989-08-01

    Constant-flow ventilation (CFV) maintains alveolar ventilation without tidal excursion in dogs with normal lungs, but this ventilatory mode requires high CFV and bronchoscopic guidance for effective subcarinal placement of two inflow catheters. We designed a circuit that combines CFV with continuous positive-pressure ventilation (CPPV; CFV-CPPV), which negates the need for bronchoscopic positioning of CFV cannula, and tested this system in seven dogs having oleic acid-induced pulmonary edema. Addition of positive end-expiratory pressure (PEEP, 10 cmH2O) reduced venous admixture from 44 +/- 17 to 10.4 +/- 5.4% and kept arterial CO2 tension (PaCO2) normal. With the innovative CFV-CPPV circuit at the same PEEP and respiratory rate (RR), we were able to reduce tidal volume (VT) from 437 +/- 28 to 184 +/- 18 ml (P less than 0.001) and elastic end-inspiratory pressures (PEI) from 25.6 +/- 4.6 to 17.7 +/- 2.8 cmH2O (P less than 0.001) without adverse effects on cardiac output or pulmonary exchange of O2 or CO2; indeed, PaCO2 remained at 35 +/- 4 Torr even though CFV was delivered above the carina and at lower (1.6 l.kg-1.min-1) flows than usually required to maintain eucapnia during CFV alone. At the same PEEP and RR, reduction of VT in the CPPV mode without CFV resulted in CO2 retention (PaCO2 59 +/- 8 Torr). We conclude that CFV-CPPV allows CFV to effectively mix alveolar and dead spaces by a small bulk flow bypassing the zone of increased resistance to gas mixing, thereby allowing reduction of the CFV rate, VT, and PEI for adequate gas exchange.

  2. 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.

  3. 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.

  4. Bronchoscopy-guided nasotracheal intubation in patients of gastric tube intubation%纤维支气管镜引导下经鼻气管插管患者的胃管置入

    Institute of Scientific and Technical Information of China (English)

    田芳; 王巍

    2014-01-01

    目的:探讨在纤维支气管镜引导下经鼻气管插管患者的胃管置入方法。方法选择我科2011年至2013年间收住院的在纤维支气管镜的引导下经鼻气管插管后机械通气的60例患者,随机分两组,试验组30例采用在纤维支气管镜引导下留置胃管,对照组30例采用传统的方法留置胃管。结果试验组一次性插管的成功率明显高于对照组。结论在纤维支气管镜引导下对经鼻气管插管患者的胃管留置成功率较高,可以临床推广。%Objective To study the ifberoptic bronchoscopy in patients with nasal tracheal intubation guided by stomach tube placement method.Methods Choose 2011 ~ 2011 closed under the guidance of ifber bronchoscope in hospital after nasal endotracheal intubation mechanical ventilation of 60 patients, randomly divided into two groups, treatment group 30 cases used in guided by ifber bronchoscope indwelling gastric tube, the control group 30 cases with traditional method of indwelling gastric tube.Results the experimental group one-time success rate of intubation was obviously higher than that of control group. Conclusion fiberoptic bronchoscopy in patients with nasal tracheal intubation guided by gastric tube indwelling the success rate is high, can the clinical promotion..

  5. 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.

  6. 电子支气管镜介导冷冻治疗联合放化疗治疗中晚期中央型NSCLC的临床研究%Clinical Research of Bronchoscopy Guided Cryotherapy Combined with Chemotherapy and Radiotherapy to Treat Advanced Non-Small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    李真斌; 汤晓梅; 易向军; 孙勇; 柯昌林; 李瑶; 王春福; 陈轩

    2014-01-01

    Objective:To explore the clinical value of bronchoscope-guided cryotherapy combined with chemotherapy and radiotherapy to treat patients with advanced NSCLC lung cancer.Method:50 patients with advanced lung cancer were randomized assigned to two groups, each group had 50 cases. The treatment group received bronchoscope-guided cryotherapy and chemotherapy and radiotherapy; the control group received cryotherapy and chemotherapy. The treatment effect, patient quality of life, the median survival and 1 year survival rate of the two groups were observed.Result:The response rate in the treatment group and the control groups were 73.2% and 55.8% respectively (P0.05). The median survival time was 15.2 months and 10.3 months, the one-year survival rate was 76.3% and 56.3%, there was different in two groups (P0.05);中位生存期治疗组为15.2个月,对照组10.3个月,1年生存率分别为76.3%和56.3%,两组比较差异有统计学意义(P<0.05)。结论:电子支气管镜介导冷冻治疗联合放化疗可以有效治疗中晚期NSCLC,缓解咳嗽、咯血,发热,呼吸困难等症状,提高患者的生活质量及生存期。

  7. Virtual bronchoscopy-guided transbronchial biopsy for aiding the diagnosis of peripheral lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Iwano, Shingo, E-mail: iwano45@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan); Imaizumi, Kazuyoshi [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Okada, Tohru [Research Center for Charged Particle Therapy, National Institute of Radiological Science, 4-9-1 Anagawa, Inage-ku, Chiba 2638555 (Japan); Hasegawa, Yoshinori [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Naganawa, Shinji [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan)

    2011-07-15

    Objective: The aim of this study was to evaluate the clinical value of virtual bronchoscopy (VB) in aiding diagnosis of peripheral lung cancer by transbronchial biopsy (TBB). In addition, we sought to systematically analyze the factors that affect the diagnostic sensitivity of VB-guided TBB for the evaluation of peripheral lung cancers. Materials and methods: A hundred and twenty-two peripheral lung cancers from 122 patients (82 men and 40 women, 38-84 years; median 68.5 years) who were performed VB-guided TBB were evaluated retrospectively. VB was reconstructed from 1- or 0.5-mm slice thickness images of multi-detector CT (MDCT). Experienced pulmonologists inserted the conventional and ultrathin bronchoscopes into the target bronchus under direct vision following the VB image. Results: A definitive diagnosis was established by VB-guided TBB in 96 lesions (79%). The diagnostic sensitivity of small pulmonary lesions {<=}30 mm in maximal diameter (71%) was significantly lower than that of lesions >30 mm (91%, p = 0.008). For small pulmonary lesions {<=}30 mm (n = 76), internal opacity of the lesion was the independent predictor of diagnostic sensitivity by VB-guided TBB, and the non-solid type lung cancers were significantly lower than the solid type and part-solid type lung cancers for diagnostic sensitivity (odds ratio = 0.161; 95% confidence interval = 0.033-0.780; p = 0.023). Conclusion: Use of an ultrathin bronchoscope and simulation with VB reconstructed by high quality MDCT images is thought to improve pathological diagnosis of peripheral lung cancers, especially for solid and partly solid types. For small pulmonary lesions {<=}30 mm, the lesion internal opacity is a significant factor for predicting the diagnostic sensitivity, and the sensitivity was low for small non-solid type of lung cancers.

  8. 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

  9. Application of electronic bronchoscopy in the diagnosis and treatment of children with lobar pneumonia%电子支气管镜应用于儿童大叶性肺炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    李虎; 张玲; 刘青; 华亚军

    2015-01-01

    Objective To evaluate the value of electronic bronchoscopy and bronchoalveolar lavage on pathogen diagnosis and treatment for children with lobar pneumonia. Methods The clinical data of 128 children with lobar pneumonia was retrospectively analyzed. The data about electronic bronchoscopy and bronchoalveolar lavage of these children was collected, and the efficacy of electronic bronchoscope treatment and non-electronic bronchoscope treatment was compared. Results The total fever course, time of improvement of the symptoms and signs, time of C-reactive protein level back to normal and duration of hospital stay were obviously shorter in the lavage group than in the control group (all P<0. 05). The efficiency of the lavage group was 100%, and 94. 3% of the control group (χ2=10. 395, P=0. 006). The positive observation of FQ-MP-DNA by BALF pathogen detection took up 46. 6%, and the positive observation of bacterial culture accounted for 27. 6%. Conclusion The early application of electronic bronchoscope in diagnosis and treatment can effectively promote lung recruitment and absorption of inflammation, de-fine the pathogens and shorten the course of disease, which could achieve the dual benefits of diagnosis and treat-ment.%目的 观察评估电子支气管镜检查和肺泡灌洗术对儿童大叶性肺炎的诊治效果. 方法 回顾性分析本院明确诊断为大叶性肺炎的128例患儿的临床资料,收集患儿电子支气管镜检查及支气管肺泡灌洗术资料,并对比电子支气管镜治疗与非电子支气管镜治疗的临床疗效. 结果 灌洗组患儿总热程、症状好转时间、体征消失时间、CRP恢复时间及住院天数均低于对照组( P均<0. 05 ) ,灌洗组患儿有效率100%;对照组有效率94. 3%,两组疗效比较,具有明显统计学差异(χ2 =10. 395,P=0. 006). 患儿BALF病原学检查FQ-MP-DNA检测阳性者占46. 6%,细菌培养阳性结果占27. 6%. 结论 早期进行电子支气管镜诊治,能够明确病

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

    Directory of Open Access Journals (Sweden)

    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

  11. 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

  12. 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

  13. 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.

  14. Value electronic bronchoscopy in the diagnosis of endobronchial tuberculosis.%电子支气管镜检查在痰菌阴性支气管内膜结核诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    江宏志; 张平; 欧雪珍

    2011-01-01

    Objective To explore the clinical and electronic bronchoscopic features ofendobronchial tuberculosis with negative sputum acid-fast bacillus. Methods Clinical symptoms, chest X-ray/CT manifestations and bronchoscopic findings of 69 cases with endobronchinal tuberculosis were investigated retrospectively. Results Roentgenographic appearance were exudation, atelectasis and bronchitis, 12 patients (17.2%) had clear lung fields. Under electronic bronchoscopy, exudative lesions in 28 cases, ulceration lesions in 18 cases, granulomatous lesions in 15 cases, and occlusive lesions in 8 cases. The successful detection rate of biopsy and brushing smear were 87.0% and 84.1% respectively. Conclusion The clinical manifestations and roentgenographic appearances of endebronchial tuberculosis with negative sputum acid-fast bacillus are not specific, so electronic bronchoscopy is mandatory for the prompt diagnosis, and bronchial biopsy and brushing smear examination for acid-fast bacillus are beneficial to rapid and definite diagnosis.%目的 探讨痰菌阴性支气管内膜结核的临床及电子支气管镜下特点.方法 回顾性分析本院经电子支气管镜检查后确诊痰菌阴性支气管内膜结核69例的临床、胸部影像和电子支气管镜下表现.结果 X线胸片或胸部CT片显示肺部渗出性改变、肺不张及支气管炎,23.2%的患者肺部未见异常.电子支气管镜下所见分为浸润型、溃疡型、肉芽增殖型、闭塞型.钳检病理学阳性率87.0%,刷检物涂片抗酸杆菌阳性率84.1%.结论 痰菌阴性支气管内膜结核的临床症状与X线表现无特征性,电子支气管镜检查中联合活检组织病理及刷检物涂片抗酸杆菌检测是有效的诊断手段.

  15. 支气管阻塞器用于胸腔镜下肺癌术患者单肺通气的效果%Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery

    Institute of Scientific and Technical Information of China (English)

    Lairong Sun; Lianbing Gu; Bihui Ren; Ninglei Qiu; Lijun Wang

    2011-01-01

    Objective: The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery. Methods: Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each: endobronchial blocker tube group (group 1) and double-lumen endobronchial tube group (group 2). After anesthesia was induced, in group 1, single lumen tube was intubated at first, and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary, injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily; while in group 2, the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation. Blood samples were collected before anesthesia induction, double lumen ventilation, at the one-lung ventilation of 5 min, 30 min, 60 min, 120 min and 180 min, SBP, DBP, HR, SpO2, partial pressure of end tidal carbon dioxide (PetCO2), pH, PaO2, PaCO2,PaO2/FiO2 were recorded. Results: Forty cases' intubations were all successful. There were no differences in SBP, DBP, HR, SpO2, PetCO2, pH, PaCO2 between two groups in different points (P > 0.05). Paw in group 1 was lower than group 2, PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min, 30 min, 60 min, 120 min and 180 min. Conclusion: The endobronchial blocker tube can meet the request of video-assisted thoracic surgery, with the special advantages of simple insertion, lower airway and better oxygenation. Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery.

  16. 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.

  17. 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.

  18. 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.

  19. 冷冻联合氩气刀介入治疗恶性气道狭窄的临床观察%Clinical observation of cryotherapy combined with argon knife in interventional treatment of malignant tracheobronchial stenosis

    Institute of Scientific and Technical Information of China (English)

    彭文娟

    2015-01-01

    Objective To explore the clinical effect and safety of bronchoscopic cryotherapy combined with argon knife in the treat-ment of malignant tracheobronchial stenosis. Methods Forty patients with malignant tracheobronchial stenosis in our hospital from January 2010 to December 2014 were investigated, and all the patients were divided into group A and group B. 22 cases of group A were treated with bronchoscopic interventional cryotherapy combined with Argon knife, while 18 cases of group B were treated with cryotherapy, then the clini-cal effects and complications were compared between the two groups. Results The remission rate of group A was 95. 45%, which was better than 66. 67% of group B, and there were significant differences(P<0. 05). Severe adverse effects and complications were not found in all patients of the two groups. Conclusion Cryotherapy combined with Argon knife in the interventional treatment of malignant tracheobronchial stenosis is effective and safe, so it is worth clinical promotion and application compared with single cryotherapy.%目的:探讨冷冻联合氩气刀介入治疗恶性气道狭窄的临床疗效及安全性。方法根据介入治疗方法的不同,将40例恶性气道狭窄患者分为两组。 A组(22例)使用冷冻联合氩气刀治疗,B组(18例)使用单纯冷冻治疗,评价两组治疗方法的临床疗效及并发症情况。结果 A组患者再通有效率为95.45%,明显高于B组(66.67%),差异有统计学意义( P<0.05);两组患者未见严重不良反应及并发症。结论冷冻联合氩气刀治疗恶性气道狭窄疗效可靠并安全,优于单纯冷冻治疗,值得临床推广应用。

  20. Rapid development of pulmonary cavitation as manifestation of a candida species

    Energy Technology Data Exchange (ETDEWEB)

    Rix, E.; Bickel, R.H.; Baldauf, G.

    1987-01-01

    The roentgenologic pattern of the pulmonary manifestation of candida species, resulting in a rapid development of pulmonary cavitations with mycetoma-like structures, was described in three patients. All patients, undergoing antineoplastic chemotherapy because of acute leukemia, presented with fever and expectoration, which were resistant to various antibiotic regimes. Cultures of blood and urine were sterile; but Torulopsis glabrata, a candida species, was found in multiple cultures of the sputum of all patients and also in a bronchoscopic lavage obtained from one patient after reconstitution of the granulopoesis. The roetgenologic appearance of the infiltrates was accompanied by a rise of the Ig-M immunoglobulins against candida. Following intravenous treatment with amphotericin B a reduction of the cavitation and of the infiltrates to small residues was observed. Simultaneously the body temperature and the sputum became normal and a fall in the immunoglobulin titers was found. The diagnostic problems of pulmonary cavitation and especially of pulmonary mycosis in immuosuppressed and therapy-induced granulocytopenic and thrombocytopenic patients with acute leukemia were discussed.

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. Endobronchial coils for severe emphysema are effective up to 12 months following treatment: medium term and cross-over results from a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Zaid Zoumot

    Full Text Available There is a clinical need for therapeutic options to reduce hyperinflation associated with severe emphysema. Endobronchial Coils (coils are nitinol devices implanted bronchoscopically under fluoroscopic guidance to re-tension the lung. We report the medium term effectiveness and safety of coils in a study of patients with emphysema.Forty five subjects with severe airflow obstruction and hyperinflation received bilateral sequential treatment with coils (30 day interval between treatments as part of a randomised controlled trial with a primary endpoint 90 days after the final treatment (Clinicaltrials.gov NCT01334307. Further assessments were made at 180 and 360 days and in this study the primary outcome was the effect of coil treatment on the St. George's Respiratory Questionnaire (SGRQ 360 days following treatment.At 360 days following treatment, there was an improvement in the SGRQ score of -6.1±14.0 points (p = 0.01 compared to baseline. Improvements in secondary outcomes were seen with increases in forced expiratory volume in the first second of 8.9 ±22.2% (p = 0.002 and 6-minute walking distance of 34.1±52.4m (p = 0.003. The safety profile was acceptable out to 360 days post-treatment.Statistically and clinically meaningful benefits in quality of life, exercise capacity and pulmonary function in patients treated with coils are sustained twelve months after treatment.Clinicaltrials.gov NCT01334307.

  7. Advances in Endoscope Reprocessing Technology and Its Impact on Pathogen Transmission.

    Science.gov (United States)

    Shellnutt, Cathleen

    Pathogen transmissions via flexible endoscopes have been documented in the literature and have been historically related to human error or omission of steps in the reprocessing cycle. The 2008 Centers for Disease Control and Prevention report challenged manufacturers of automated endoscope reprocessors to improve and advance technology to automate more of the reprocessing steps. A review and synthesis of the literature following the 2008 Centers for Disease Control and Prevention report was performed to evaluate whether advances in reprocessing technology have occurred and whether these have had an impact on pathogen transmission via flexible endoscopes. The Iowa Model of Evidence-Based Practice to Promote Quality Care was used to guide the project. The literature search regarding pathogen transmission related to flexible endoscopes yielded 10 documents citing infections from 2008 to 2015. A total of 353 patients were identified as having been infected with a contaminated gastroscope, bronchoscope, or duodenoscope. An evaluation of reprocessing technology identified 3 automated endoscope reprocessors with enhanced capabilities and flushing devices intended to automate portions of the manual cleaning step.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Narcoanalysis of pneumonorestion with video-assisted thoracic surgery during one-lung ventilation

    Institute of Scientific and Technical Information of China (English)

    Lairong Sun; Lianbing Gu

    2012-01-01

    Objective: The aim of our study was to analyze the anesthesia of pneumonoresection in lung cancer patients with video-assisted thoracic surgery during one-lung ventilation. Methods: After fast-speed venous induced anesthesia, double-lumen bronchial catheter or endobronchial blocker tube were intubated in 551 patients, the position of double-lumen endobronchial tube or single lumen tube + endobronchial blocker tube was confirmed with fiber-optic bronchoscope after intubation. Interstitial positive pressure ventilation were used in all patients with video-assisted thoracic surgery (VATS) interstitial positive pressure ventilation, positive end expiratory pressure and continuous positive airway pressure in collapse lobers of lung were used in one lung ventilation, and ventilation parameters were adjusted necessarily. Results: 541 cases double-tubes bronchial catheter intubation and endobronchial blocker tube used by fiberscope were located very well. The level of SPO2, PEtCO2 could be maintained normal. Ten cases were forced to converse video-assisted thoracic surgery to thoracotomy because of 4 cases pulmonary adhesion, 4 cases severe pulmonary dysfunction hard to correct hyoxemia and 2 case abnormal anatomy respectively. Conclusion: Anesthesia key of video-assisted thoracic surgery is that double lung must separated completely. Effective management of one lung ventilation could make patients to pass perioperation smoothly. Long-time one lung ventilation such as pulmonary adhesion, severe pulmonary dysfunction should be considered to be relative contraindication.

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

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    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.

  20. Increased interleukin-8 in epithelial lining fluid of collapsed lungs during one-lung ventilation for thoracotomy.

    Science.gov (United States)

    Komatsu, Yoshimichi; Yamamoto, Hiroshi; Tsushima, Kenji; Furuya, Shino; Yoshikawa, Sumiko; Yasuo, Masanori; Kubo, Keishi; Yamazaki, Yoshitaka; Hasegawa, Joh; Eguchi, Takashi; Kondo, Ryuichi; Yoshida, Kazuo; Koizumi, Tomonobu

    2012-12-01

    The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point 3), and 30 min after two-lung ventilation was restarted (point 4). The albumin and IL-8 concentrations in ELF were significantly increased at point 2 and point 3, respectively, and remained to be high, compared to the baseline. The increase in IL-8 at point 3 was correlated with the interval of one-lung ventilation; however, none developed specific acute lung injury. These findings suggest that inflammatory changes can occur on the epithelium of a collapsed lung even in patients who underwent successful and standard thoracic surgery.

  1. An approach to interstitial lung disease in India

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    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 

  2. Escherichia coli: an unknown and infrequent cause of community acquired pneumonia.

    Science.gov (United States)

    Ruiz, Luis Alberto; Zalacain, Rafael; Gómez, Ainhoa; Camino, Jesús; Jaca, Carmen; Núñez, Juan Manuel

    2008-01-01

    Our aim was to describe the incidence, clinical characteristics and outcome of community acquired pneumonia (CAP) caused by Escherichia coli through the analysis of a cohort of patients with this condition. This study includes all the patients who were admitted to our hospitals because of CAP caused by E. coli, diagnosed with highly reliable microbiological techniques, such as blood culture, bronchoscopic protected specimen brush (PSB) or transthoracic needle aspiration (TNA). 29 patients were enrolled, representing 0.4% of CAP cases admitted. Main symptoms were fever and dyspnoea. 18 patients were classified into class IV and class V of the Pneumonia Severity Index (PSI). Diagnosis was based on blood culture in 24 cases, PSB in 4 cases and by TNA in 1 case. Three of the patients died, the longer time evolution of the symptoms being the only factor related to higher mortality (p<0.05). Mean hospitalization time was 7.1+/-3.1 d, and correlated with severity at admission (r=0.43; p<0.003). This study demonstrates that CAP caused by E. coli is infrequent. It has an unspecific presentation and mortality rate is 10.3%, associated with longer time before admission to hospital.

  3. 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.

  4. A newborn with bullous pemphigoid associated with linear IgA bullous dermatosis.

    Science.gov (United States)

    Akin, M A; Gunes, T; Akýn, L; Ohyama, B; Kontas, O; Hashimoto, T

    2009-06-01

    A 16-day-old boy was admitted to our clinic with localized blisters on the neck, cheeks, earlobes, and oral cavity and with erythema on the toes, in addition to poor weight gain and respiratory distress. A physical examination revealed several erythematous plaques with tense bullae, multiple vesicles, and erosions on the left toes, neck, earlobes, and face as well as erosive lesions on the anterior part of the oral cavity, lips, and buccal mucosae. A bronchoscopic examination revealed bullous lesions in the upper respiratory tract and on the epiglottis. A skin biopsy suggested a diagnosis of bullous pemphigoid (BP). Because of the severe mucosal involvement, further investigations including various immunological techniques were performed. The case was diagnosed as BP associated with linear IgA bullous disease (LAD). Complete remission without any scarring was achieved after three weeks of oral methyl prednisolone treatment. A correct differential diagnosis of bullous diseases is important for determining the prognosis and expected response to treatment. To our knowledge, this is the first case of BP associated with LAD reported in literature.

  5. 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.

  6. 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.

  7. 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).

  8. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis.

    Science.gov (United States)

    Santacruz, Jose Fernando; Mehta, Atul C

    2009-01-15

    Overall survival rates of lung transplantation have improved since the first human lung transplantation was performed. A decline in the incidence of airway complications (AC) had been a key feature to achieve the current outcomes. Several proposed risk factors to the development of airway complications have been identified, ranging from the surgical technique to the immunosuppressive regimen. There are essentially six different airway complications post-lung transplantation. The most frequently reported complication is bronchial stenosis. Other complications include bronchial dehiscence, exophytic excessive granulation tissue formation, tracheo-bronchomalacia, bronchial fistulas, and endobronchial infections. The management of post-transplant bronchial complications needs a multispecialty team approach. Prevention of some complications may be possible by early and aggressive medical management as well as by using certain surgical techniques for transplantation. Interventional bronchoscopic procedures, including balloon bronchoplasty, cryotherapy, laser photoresection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents are among the armamentarium. Also, medical management, like antibiotic prophylaxis and therapy for endobronchial infections, or noninvasive positive-pressure ventilation in case of bronchomalacia, are used to treat an AC. In some cases, different surgical approaches are occasionally required. In this article we review the risk factors, the clinical presentation, the diagnostic methods, as well as the management options of the most common AC after lung transplantation.

  9. Primary Sjogren's Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome

    Science.gov (United States)

    Humayun, Mohammad; Haider, Iqbal; Ayub, Maimoona; Shah, Zakir; Ajmal, Fahad

    2016-01-01

    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. PMID:27818685

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

    Directory of Open Access Journals (Sweden)

    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.

  11. The role of codeine phosphate premedication in fibre-optic bronchoscopy under insufficient local anaesthesia and midazolam sedation.

    Science.gov (United States)

    Tsunezuka, Y; Sato, H; Tsukioka, T; Nakamura, Y; Watanabe, Y

    1999-06-01

    Midazolam is widely used as a sedative agent to produce amnesia in patients undergoing fibre-optic bronchoscopy. However, if a patient does not receive sufficient local anaesthesia, continuous severe cough and physical movement may interrupt the procedure and reduce its safety. We therefore examined whether codeine phosphate is a useful premedication for bronchoscopy. The study design was a randomized comparison between codeine phosphate and a placebo in patients undergoing light local anaesthesia and midazolam sedation. We used low dose local anaesthesia (5 ml of nebulized 2% xylocaine) on the assumption of insufficient local anaesthesia. Patients were allocated to receive codeine phosphate 0.4 mg kg-1 or a saline placebo 60 min before they were sedated with i.v. midazolam. If the patients exhibited severe cough during bronchoscopy, intrabronchial supplemental local anaesthesia (2% xylocaine solution in 1 ml increments) was instilled via a bronchoscope to the trachea and segmental bronchi to suppress the cough. The dose of supplemental xylocaine was assessed and the requirements were significantly lower in the codeine group compared to the placebo group: 36.4 +/- 10.2 mg vs. 95.1 +/- 24.6 mg, respectively. After bronchoscopy, patients were interviewed by a doctor to assess their willingness to undergo a repeat procedure if one was clinically indicated, but no significant difference was observed between the two groups. If local anaesthesia is insufficient, midazolam together with codeine phosphate premedication is useful for both the patient and the bronchoscopist.

  12. 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.

  13. Tendons, Concentric Tubes, and a Bevel Tip: Three Steerable Robots in One Transoral Lung Access System.

    Science.gov (United States)

    Swaney, Philip J; Mahoney, Arthur W; Remirez, Andria A; Lamers, Erik; Hartley, Bryan I; Feins, Richard H; Alterovitz, Ron; Webster, Robert J

    2015-05-01

    Lung cancer is the most deadly form of cancer, and survival depends on early-stage diagnosis and treatment. Transoral access is preferable to traditional between-the-ribs needle insertion because it is less invasive and reduces risk of lung collapse. Yet many sites in the peripheral zones of the lung or distant from the bronchi cannot currently be accessed transorally, due to the relatively large diameter and lack of sufficient steerablity of current instrumentation. To remedy this, we propose a new robotic system that uses a tendon-actuated device (bronchoscope) as a first stage for deploying a concentric tube robot, which itself is a vehicle through which a bevel steered needle can be introduced into the soft tissue of the lung outside the bronchi. In this paper we present the various components of the system and the workflow we envision for deploying the robot to a target using image guidance. We describe initial validation experiments in which we puncture ex vivo bronchial wall tissue and also target a nodule in a phantom with an average final tip error of 0.72 mm.

  14. 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.

  15. 咪达唑仑联合水合氯醛用于儿童纤维支气管镜检查50例%Application of Midazolam Combined with Chloral Hydrate in 50 Cases of Children Fiberbronchoscopic Examination

    Institute of Scientific and Technical Information of China (English)

    刘汉宏

    2015-01-01

    Objective To investigate the effect of midazolam combined with chloral hydrate used in children fiberbronchoscopic examina-tion. Methods 150 children patients undergoing bronchoscopic examination in our hospital from June 2013 to December 2014 were randomly divided into 3 groups, 50 cases in each group. The midazolam group was given midazolam, the propofol group was given propo-fol and the observation group was given midazolam combined with chloral hydrate. The anesthetic effects were observed in 3 groups. Results The systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) during examination in the observation group were in the normal range and showed no statistically significant difference compared before examination ( P > 0. 05 ); SBP and DBP during examination in the observation group were significantly lower than those in the midazolam group and the propofol group ( P 0. 05 );the excellent rate in the observation group was significantly higher than that in the mi-dazolam group and the propofol group ( P 0.05);检查中SBP和DBP水平C组显著低于A、B组( P0.05)。C组麻醉优良率显著高于A组和B组( P<0.05)。结论咪达唑仑联合水合氯醛用于儿童纤维支气管镜检查,麻醉镇痛效果明显,值得推广。

  16. Side effects of endobronchial laser treatment

    Energy Technology Data Exchange (ETDEWEB)

    Dierkesmann, R.; Huzly, A.

    1985-03-01

    Side effects that have occurred in over 250 endobronchial laser treatments are reported. The laser has been used in severe tracheal and in bronchial obstructions. In two cases significant bleeding had to be treated with tamponade. In one patient an emphysema of the mediastinum developed, in 2 further patients a small pneumothorax. Perforation of the airway was not detected and no special treatment was necessary. Three patients with life-threatening tracheal stenoses and one patient with severe stenosis of both the mainstem bronchi due to metastasis in the bifurcation lymph node had a large defect in the tracheal or bronchial wall with a deep necrosis five to twelve weeks after laser treatment; all these patients had extensive radiotherapy in addition. One patient died due to severe respiratory insufficiency, probably caused by smoke intoxication. After the laser treatment, rubber-like fibrin-rich plaques may develop, which can lead to life-threatening obstructions of the airway. It is recommended that laser bronchoscopy should be performed with the rigid bronchoscope. After treatment of tracheal lesion an endoscopic check must be performed within 24 hours. The combination of laser treatment and radiotherapy seems to involve a certain risk of large defects in the bronchial wall due to necrosis of the tumor.

  17. [Dangerous complication of transtracheal oxygen therapy with the SCOOP(R) system].

    Science.gov (United States)

    Rothe, T B; Frey, J G; Ciobanu, T D; Karrer, W

    1996-10-01

    A portable oxygen system in combination with transtracheal O2 delivery (SCOOP(R)) permits patients with respiratory failure optimal mobility and facilitates longterm oxygen therapy. This report describes a 70 year old female with COPD that developed acute respiratory distress 18 days after inserting PRESCOOP(R) and 11 days after changing to SCOOP 1 catheter. Catheter stripping had not revealed any pathology. Flexible bronchoscopy showed a mucus ball at the catheter tip leading to a 80% stenosis of the trachea. Trials to remove the ball with forceps and a loop were not successful until a rigid bronchoscop was inserted. Up to 10% of patients develop mucus ball formation with SCOOP 1 catheter which remains in situ for 6 weeks. In patients with high risk of mucus formation (high O2 flow, viscous mucus, low FEV1) the manufacturers of SCOOP recommend catheter stripping. We consider a control bronchoscopy being safer 1 week after changing from PRESCOOP to SCOOP because one patient has been reported to have died of this complication and our patient has developed a near fatal situation.

  18. Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

    Directory of Open Access Journals (Sweden)

    Sandeep Bansal

    2012-01-01

    Full Text Available Objective. To demonstrate the risk associated with blocked proximal tracheal stents when a patient presents with acute respiratory distress, with blockage of stent and what is the best management we can offer without damage to the stent and its associated complications. Case Report. A 22-yr-old, male patient, presented in severe respiratory distress. He had history of corrosive poisoning for which he was tracheotomised. A stainless steel wire mesh stent was placed in the trachea, from the subglottis, to just above the carina. One month later, he presented with a critically compromised airway with severe respiratory distress. Emergency tracheostomy was done and the metallic stent had to be cut open, in order to provide an airway. Conclusion. Management of blocked proximal stents with patient in respiratory distress remains a challenge. Formation of granulation tissue is common and fibreoptic bronchoscopic assisted intubation may not always be possible. A regular follow up of all patients with stents is essential. Placement of stents within a few centimetres of cricotracheal junction should not be encouraged for long term indications.

  19. 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.

  20. Electromagnetic navigation bronchoscopy: clinical utility in the diagnosis of lung cancer

    Directory of Open Access Journals (Sweden)

    Seijo LM

    2016-10-01

    Full Text Available Luis M Seijo Pulmonary Department, Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Madrid, Spain Abstract: Electromagnetic navigation bronchoscopy (ENB is one of several technological advances which have broadened the indications for bronchoscopy in the diagnostic workup of lung cancer. The technique facilitates bronchoscopic sampling of peripheral pulmonary nodules as well as mediastinal lymph nodes, although wide availability and expertise in endobronchial ultrasonography has limited its application in routine clinical practice to the former. ENB in this setting is quite versatile and may be considered an established alternative to more invasive techniques, especially in selected patients with underlying pulmonary disease or comorbidities at high risk for complications from computer topography-guided fine needle aspiration or surgical resection. Nodule sampling may be performed with a variety of instruments, including forceps, cytology brushes, and transbronchial needles. Although samples are generally small, they are often suitable for molecular analysis. Keywords: lung cancer, ENB, electromagnetic navigation, bronchoscopy, diagnosis, pulmonary nodule

  1. Effects of three-way laryngeal mask airway ventilation on hemodynamics and stress responses during bronchoscopy%三通喉罩通气在纤维支气管镜检查术中对血流动力学和应激激素水平的影响

    Institute of Scientific and Technical Information of China (English)

    邵丽; 杨鲜妮; 陆卫忠; 全超坤

    2014-01-01

    Objective To evaluate the effects of three-way laryngeal mask airway (TLMA ) mechanical ventilation on the hemodynamics and stress responses of patients during bronchoscopy.Methods Sixty patients with ASA class Ⅰ or Ⅱ and undergoing bronchoscopy were divided into three groups according to the stratified sampling principle (n =20 each):topical anesthesia (group A),intravenous anesthesia with endoscopic mask ventilation (group B)and intravenous anesthesia with TLMA ventilation (group C).Topical anesthesia with 20 ml 2% lidocaine was applied for the patients in all the three groups.Patients in group B and group C also received intravenous injection with fentanyl (1.0 μg/kg ) and propofol (1.5 mg/kg ),followed by sustaining anesthesia with micropump actuated continuous injection of propofol (6.0 mg/kg · h).Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure(DBP)and arterial oxygen saturation(SaO 2 )were continuously monitored during anesthesia and measured at 5 min after entering the surgery room(T0 ),just before the bronchoscope entering the glottis(T1 ),immediately after the bronchoscope entering the glottis(T2 ),3 min after the bronchoscope entering the glottis(T3 ),the time of biopsy(T4 ) and immediately after the bronchoscope extubated from the glottis(T5 ).Blood samples collected at T0 ,T1 ,T2 ,T3 ,T4 and T5 were used for the determination of plasma epinephrine(E),norepinephrine(NE)and dopamine(DA)using high performance liquid chromatography.Results SBP,DBP and HR in group A increased significantly at T2 ,T3 ,T4 and T5 as compared with those at baseline (P <0.01).They were also significantly higher than those in groups B and C at the corresponding time points (P <0.01).The levels of E,NE and DA in group A were significantly higher than those in groups B and C at T2 ,T3 ,T4 and T5 (P < 0.01 ).Conclusion TLMA is more effective in maintaining stable ventilation and stable hemodynamics and causing less stress responses during bronchoscopy.%

  2. Perforating oesophageal carcinoma presenting as necrotizing fasciitis of the neck.

    Science.gov (United States)

    Francque, S M; Van Laer, C; Struyf, N; Vermeulen, P; Corthouts, B; Jorens, P G

    2001-10-01

    A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.

  3. 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.

  4. “One-stop shop” spectral imaging for rapid on-site diagnosis of lung cancer: a future concept in nano-oncology

    Science.gov (United States)

    Darwiche, Kaid; Zarogoulidis, Paul; Krauss, Leslie; Oezkan, Filiz; Walter, Robert Fred Henry; Werner, Robert; Theegarten, Dirk; Sakkas, Leonidas; Sakkas, Antonios; Hohenforst-Scmidt, Wolfgang; Zarogoulidis, Konstantinos; Freitag, Lutz

    2013-01-01

    Background There are currently many techniques and devices available for the diagnosis of lung cancer. However, rapid on-site diagnosis is essential for early-stage lung cancer, and in the current work we investigated a new diagnostic illumination nanotechnology. Methods Tissue samples were obtained from lymph nodes, cancerous tissue, and abnormal intrapulmonary lesions at our interventional pulmonary suites. The following diagnostic techniques were used to obtain the samples: endobronchial ultrasound bronchoscopy; flexible bronchoscopy; and rigid bronchoscopy. Flexible and rigid forceps were used because several of the patients were intubated using a rigid bronchoscope. In total, 30 tissue specimens from 30 patients were prepared. CytoViva® illumination nanotechnology was subsequently applied to each of the biopsy tissue slides. Results A spectral library was created for adenocarcinoma, epidermal growth factor receptor mutation-positive adenocarcinoma, squamous cell carcinoma, usual interstitial pneumonitis, non-specific interstitial pneumonitis, typical carcinoid tumor, sarcoidosis, idiopathic pulmonary fibrosis, small cell neuroendocrine carcinoma, thymoma, epithelioid and sarcomatoid mesothelioma, cryptogenic organizing pneumonia, malt cell lymphoma, and Wegener’s granulomatosis. Conclusion The CytoViva software, once it had created a specific spectral library for each entity, was able to identify the same disease again in subsequent paired sets of slides of the same disease. Further evaluation of this technique could make this illumination nanotechnology an efficient rapid on-site diagnostic tool. PMID:24285923

  5. Desquamative interstitial pneumonia: A case report

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  7. 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.

  8. A canine model of tracheal stenosis induced by cuffed endotracheal intubation

    Science.gov (United States)

    Su, Zhuquan; Li, Shiyue; Zhou, Ziqing; Chen, Xiaobo; Gu, Yingying; Chen, Yu; Zhong, Changhao; Zhong, Minglu; Zhong, Nanshan

    2017-01-01

    Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis. PMID:28349955

  9. Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases – how to do it

    Science.gov (United States)

    Bango-Álvarez, Antonio; Torres-Rivas, Hector; Fernández-Fernández, Luis; Prieto, Amador; Sánchez, Inmaculada; Gil, Maria; Pando-Sandoval, Ana

    2017-01-01

    Transbronchial biopsy using forceps (TBB) is the first diagnostic technique performed on patients with interstitial lung disease (ILD). However, the small size of the samples and the presence of artefacts in the tissue obtained make the yield variable. Our objectives were 1) to attempt to reproduce transbronchial cryobiopsy under the same conditions with which we performed conventional TBB, that is, in the bronchoscopy unit without intubating the patient and without fluoroscopy or general anaesthesia; 2) to describe the method used for its execution; and 3) to analyse the diagnostic yield and its complications. We carried out a prospective study that included 106 patients with clinical and radiological features suggestive of ILD who underwent cryo-transbronchial lung biopsy (cryo-TBB) under moderate sedation without endotracheal intubation, general anaesthesia or use of fluoroscopy. We performed the procedure using two flexible bronchoscopes connected to two video processors, which we alternated until obtaining the number of desired samples. A definitive diagnosis was obtained in 91 patients (86%). As for complications, there were five pneumothoraces (4.7%) and in no case was there severe haemorrhage or exacerbation of the underlying interstitial disease. Cryo-TBB following our method is a minimally invasive, rapid, safe and economic technique that can be performed in a bronchoscopy suite under moderate sedation without the need for intubating the patient or using fluoroscopy and without requiring general anaesthesia. PMID:28344982

  10. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.

    Science.gov (United States)

    Pang, Lei; Feng, Yan-Hua; Ma, Hai-Chun; Dong, Su

    2015-04-01

    In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques.

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

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    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.

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

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    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.

  13. 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.

  14. Primary Malignant Melanoma of the Lung: A Case Report

    Directory of Open Access Journals (Sweden)

    Karagianni Evangelia

    2003-11-01

    Full Text Available Abstract Background Primary melanoma of the lung is an extremely rare pathological entity and sparsely reported in the literature. Case presentation A case of primary malignant melanoma of the lung in a 41-year-old female is reported. The clinical, radiological and histopathological features are discussed. The initial symptom was cough, whereas the chest radiography showed a round opacity of the right lung. The computed tomography of the chest revealed a well-demarcated mass lesion in the right upper lobe. Endobronchial mass causing obstruction of the upper lobar bronchus was the bronchoscopic finding. Patient underwent pneumonectomy. A diagnosis of melanoma was confirmed postoperatively after the immunohistochemistry. Primary nature of the tumour in the lung results from the demonstration of characteristic junctional pattern of melanoma cells beneath the bronchial epithelium on histopathology, and from exclusion of other potential primary sites in the clinical, paraclinical and laboratory examination. Conclusions Primary melanoma of the lung represents a rare pathological entity. Careful interpretation of histopathological information in correlation with all other findings from clinical and paraclinical studies can establish a diagnosis. Follow-up is necessary in order to diagnose potential dissemination or secondary sites of the disease. Due to the small number of cases reported in the literature, there is no experience on the management and the prognosis of the disease, but surgical resection remains the cornerstone of the treatment.

  15. Recurrent Respiratory Papillomatosis: A Rare Chronic Disease, Difficult to Treat, with Potential to Lung Cancer Transformation: Apropos of Two Cases and a Brief Literature Review

    Directory of Open Access Journals (Sweden)

    Stamatis Katsenos

    2011-03-01

    Full Text Available Recurrent respiratory papillomatosis (RRP, which is caused exclusively by human papilloma virus (HPV, is a rare condition characterized by recurrent growth of benign papillomata in the respiratory tract. The papillomata can occur anywhere in the aerodigestive tract but most frequently in the larynx, affecting both children and adults. The management of this entity remains still challenging since no specific definitive treatment exists. Nevertheless, novel surgical interventions as well as several adjuvant therapies have shown promising results in the long-term palliative management of this debilitating disease. Despite its mostly benign nature, RRP may cause significant morbidity and mortality because of its unpredictable clinical course and especially its tendency, albeit infrequent, for malignant transformation. In this article, we present two patients with RRP; one underwent bronchoscopic laser ablation in combination with inhaled interferon-alpha administration that led to a long-term regression of the disease while the other patient was diagnosed with transformation to squamous cell lung carcinoma with fatal outcome. We include a review of the current literature with special emphasis on RRP management and the potential role of HPV in the development of lung cancer.

  16. 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.

  17. 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.

  18. [Role of bronchoalveolar lavage and transbronchial biopsy in the diagnosis of pneumonia in patients with organ transplantation].

    Science.gov (United States)

    Arnedillo Muñoz, A; Lopez Moya, M E; de Lucas Ramos, P; Puente Maestu, L; Sanchez Juanes, M J; Rodriguez Gonzalez-Moro, J M; Garcia de Pedro, J; Rodriguez de Guzman, M C

    1996-02-01

    Pneumonia in patients with organ transplantation constitutes a very frequent cause of mortality, as a result precocious aetiologic diagnosis is indispensable. The bronchoscopic techniques, bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB), constitute fundamental procedures for these diagnoses. We begin this study with the aim of evaluating the profitability obtained with these procedures. 36 bronchoscopies were performed on 29 patients with organ transplantation, in all of them we realized BAL and in 20 TBB. We confirm the presence of pneumonia in 30 (in 15 of them we had performed TBB), the BAL was diagnostic in 20 cases (66.6%) and the TBB in 7 (46.6%). With both, BAL and TBB, we obtained a sensitivity of 80% and a specificity of 75%. We isolated 10 bacteria, 8 Citomegalovirus (CMV), 6 Pneumocystis carinii and 2 Aspergillus fumigatus. The BAL and the TBB contributed significantly in the aetiologic diagnosis of pneumonia in patients with organ transplantation, consequently we consider them basic tools in the management of these infections.

  19. APPLICATION OF CT-GUIDED BRONCHOALVEOLAR LAVAGE IN THE TREATMENT OF PATIENTS WITH SEVERE PNEUMONIA COMBINED SEPSIS SHOCK%CT 导引支气管镜肺泡灌洗对治疗重症肺炎合并脓毒症休克的效果

    Institute of Scientific and Technical Information of China (English)

    白静; 张军伟; 王建军; 程爱斌; 王红阳

    2014-01-01

    目的:探讨CT导引支气管镜肺泡灌洗对治疗肺感染合并脓毒症休克的疗效。方法对重症医学科2012年10月-2013年6月收治的47例重症肺炎合并脓毒症休克患者的临床资料进行回顾性分析。患者入选标准参照2001年国际脓毒症会议。将入选患者随机分为C T 导引支气管镜肺泡灌洗组(A组)和对照组(B组),二组均行早期目标导向治疗(EGDT ),CT 导引支气管镜肺泡灌洗组给予支气管镜肺泡灌洗连续做3d ,1次/d ,而对照组不给予支气管肺泡灌洗。记录患者年龄,性别,开始试验时、治疗后3d、7d的APACHEⅡ评分、肺感染评分、白细胞计数,乳酸降至2mmol/L的时间,机械通气时间,ICU住院时间。结果 A、B二组性别、年龄差异无统计学意义(P>0.05),开始治疗时APACHEⅡ评分、肺感染评分以及开始治疗时二组白细胞计数差异无统计学意义(P>0.05);治疗后3d和7d时 A组 APACHEⅡ评分、肺感染评分、白细胞计数明显低于B组(P<0.05);A组乳酸降至2mmol/L的时间、机械通气时间和ICU住院时间明显短于B组(P<0.05);CT 导引支气管镜肺泡灌洗操作无任何并发症的发生。结论CT导引支气管镜肺泡灌洗对治疗重症肺炎合并脓毒症休克患者安全有效,值得临床推广。%Objective To evaluate the significance of CT -guided bronchoscope alveolar lavage in severe pneumonia with sepsis shock patients .Methods The clinical experience and data of 47 patients of severe pneumonia with sepsis shock from October 2012 to June 2013 in author's hospital were retrospectively ana-lyzed .The selection criteria was in accordance with criteria set by International Conference On Sepsis in 2001 .All patients were randomly divided into treatment group(n=24)and control group(n=23) .Early goal-directed therapy(EGDT)was used in the first 6 hours of fluid resuscitation .In treatment group

  20. A new porous tracheal prosthesis sealed with collagen sponge.

    Science.gov (United States)

    Teramachi, M; Kiyotani, T; Takimoto, Y; Nakamura, T; Shimizu, Y

    1995-01-01

    We have designed a new tracheal prosthesis to overcome problems with an earlier device, which included stenosis and exposure of its constituent mesh. A polypropylene mesh cylinder, reinforced with a polypropylene spiral, is sealed with collagen sponge made from porcine dermal collagen. Using this prosthesis, we performed cervical tracheal reconstructions on 11 dogs. Three dogs died within 3 months of reconstruction. Their causes of death were anesthetic accident, diarrhea, and suffocation, respectively. Bronchoscopically, the inner surface of the prosthesis was almost covered with host tissue by 2 months. However, in one dog, a relatively large area of the mesh was exposed in the tracheal lumen at 6 months; a smaller area was exposed in two other dogs. The appearance of the inner surface rapidly became lustrous, and central stenosis was not significant, even after 12 months. Histologically, an incomplete epithelial lining at 6 months was seen on the reconstructed surface and included ciliated columnar, cuboidal, and squamous epithelium. These observations have revealed that this prosthesis has high biocompatibility and the potential to overcome problems of stenosis of the prosthesis lumen. However, because ulceration persists with this prosthesis, additional improvement is needed to reduce the incidence of mesh exposure.

  1. 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.

  2. 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.

  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. 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.

  5. 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.

  6. The effectiveness of an endotracheal tube holder

    Directory of Open Access Journals (Sweden)

    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

  7. Rocuronium combined with high-frequency ventilation for anaesthesia of tracheobronchial foreign bodies removal in children%罗库溴铵联合高频控制通气用于婴幼儿气管异物取出术

    Institute of Scientific and Technical Information of China (English)

    陈燕; 梁维斌; 黄一丹

    2010-01-01

    Objective To investigate the efficacy of rocuronium combined with high-frequency ventilation for anaesthesia of airway foreign bodies removal in children.Methods Forty-two ASA Ⅰ-Ⅱ children undergoing airway foreign bodies removal were randomly divided into rocuronium group(R)and control group(C),there were 21 cases in each group. In group R,the children were anesthetized with intravenous midazolam,ketamine,rocuronium and high-frequency mechanically ventilated after bronchoscope intubation. In group C, the children were anesthetized with midazolam,ketamine,fentanyl and assistantly ventilated after bronchoscope intubation. ECG, HR,MAP,RR,SpO2 were continuously monitored. Adverse events(hypoxia, bradycardia,cough,airway convulsion), duration of operation, the time of recovery, postoperative complications (nausea,vomiting,agitated,airway convulsion)were recorded.Results The incidence of adverse events during operation and postoperative complications were significantly lower in group R than that in group C. The duration of operation and the time of recovery were significantly shorter in group R than that in group C.Conclusions Rocuronium combined with high-frequency ventilation can reduce adverse events during operation and result in shorter duration of operation,rapid recovery and fewer postoperative complications.%目的 研究罗库溴铵联合高频控制通气用于婴幼儿气管异物取出术的麻醉效果.方法 42例ASA I~Ⅱ级行气管异物取出术的患儿,随机分为罗库溴铵组(R组)和对照组(C组),每组21例.R组静脉注射咪唑安定、氯胺酮、罗库溴铵麻醉,消除自主呼吸,插入支气管镜后经侧孔高频控制通气;C组静脉注射咪唑安定、氯胺酮、芬太尼、丙泊酚麻醉,保留自主呼吸,插入支气管镜后经侧孔辅助通气.术中连续监测心电图(ECG)、心率(HR)、呼吸(RR)、脉搏血氧饱和度(SpO2),记录低氧血症、呛咳、气道痉挛等不良反应的发生次数、手术时

  8. 气管支气管脂肪瘤误诊文献分析%Misdiagnosed Analysis of Endobronchial Lipoma:A Literature Review

    Institute of Scientific and Technical Information of China (English)

    杨翼萌; 蒲纯; 李毅; 柯会星; 许小毛; 方保民

    2012-01-01

    目的 了解气管支气管脂肪瘤临床特征,分析误诊原因,寻求早期诊断方法及合理诊治方案.方法 回顾分析我院2例气管支气管脂肪瘤及国内文献报道病理检查确诊的38例气管支气管脂肪瘤临床资料.结果 本组40例,22例误诊,误诊率55.0%.误诊为支气管哮喘7例、支气管炎6例、肺炎及肺癌各4例、支气管息肉1例,中位误诊时间12个月.经支气管镜活检病理确诊8例(20.0%),经支气管镜介入治疗后取出气管内肿物病理检查诊断3例(7.5%),行外科手术后病理检查确诊29例(72.5%).误诊原因主要与临床表现无特异性、胸部X线检查未显示气管内肿物、支气管镜活检病理诊断率低等有关.结论 气管支气管脂肪瘤临床诊断困难,胸部CT、MRI等影像学检查可发现气道内肿物,CT值测定有助于诊断.经支气管镜活检病理诊断率较低,需多点活检,必要时行手术探查.本病首选经支气管镜介入治疗.%Objective To learn clinical features of endobronchial lipoma and analyze misdiagnosed causes in order to propose appropriate treatment. Methods Clinical data of 2 patients in our hospital and 38 patients from literature reports in China with endobronchial lipoma were retrospectively analyzed. Results 22 out of 40 (55.0%) patients were misdiagnosed as having bronchial asthma (7 patients) , bronchitis (6 patients) , pneumonia (4 patients), lung cancer (4 patients) and bronchial polyps (1 patient). The middle diagnosis period was 12 months. Bronchial lipoma was definitely diagnosed by the transbronchial biopsy (TBB) specimen (8 patients, 20% ), by bronchoscopic resection and pathology (3 patients, 7.5% ) and by surgical resection and pathology (29 patients, 72.5% ). Misdiagnosis was caused due to non-specific symptoms, no goitre in trachea by chest X-ray examination and the low diagnosis rate of TBB. Conclusion Endobronchial lipoma is difficult to be defined. Chest CT and MRI can show

  9. Clinical Value of Preoperative Fiberoptic Bronchoscopy in the Diagnosis of Lung Cancer%肺癌术前纤维支气管镜检查的诊断价值

    Institute of Scientific and Technical Information of China (English)

    杨景伟; 崇文玲; 张刚; 王彬

    2013-01-01

    Objective To examine the clinical value of preoperative fiberoptic bronchoscopy in the diagnosis of lung cancer.Methods Clinical diagnosis data of 200 patients with lung cancer who received preoperative fiberoptic bronchoscopy were analyzed retrospectively from January 2007 to October 2010.Forceps holder,brushing,and bronchoalveolar lavage were used.Results 140 cases examined by fiberoptic bronchoscope were found to have goitre or abnormal signs(including 12 cases of early lung cancer which were shown normal by chest X-ray and CT examination),with a sensitivity of 70.0% ; No abnormality was found among 60 cases by fiberoptic bronchoscope examination,with a false negative rate of 30.0%.187 cases were given surgical treatments,and 13 cases gave up surgery because of abnormal bronchoscopy findings,including 3 cases of bilateral bronchial lesions,6 cases who could not tolerate total pneumonectomy due to tumor infiltration into the adjacent ipsilateral lobe bronchus,2 cases of invading carina,1 case of heterolateral bronchus invasion,and 1 case of double source of primary carcinoma.The clinical stage of the 13 cases was Ⅲ b or Ⅳ.Conclusion By preoperative fiberoptic bronchoscopy,the preoperative morphologic and pathological diagnosis of the lesions can be confirmed,and early hidden lung cancer and trachea,bronchus and other abnormalities can be detected at an early stage.It provides an important basis for early diagnosis and proper treatment of lung cancer.%目的 探讨肺癌术前纤维支气管镜检查的重要性. 方法 回顾性分析2007年1月~ 2010年10月200例肺癌患者手术前进行纤维支气管镜检查的临床资料.使用钳检、刷检、支气管肺泡灌洗3种方法. 结果 140例经纤维支气管镜检查发现肿物或异常(包括X线胸片及胸部CT检查未见异常的早期肺癌12例),敏感性70.0%;60例经纤维支气管镜检查未发现异常,假阴性率30.0%.手术187例,13例因纤维支气管镜检查发现异

  10. 三维CT对支气管异物诊断价值的临床研究%Diagnostic value of CT three-dimensional reconstruction in bronchial foreign body

    Institute of Scientific and Technical Information of China (English)

    孙欣; 宋岩; 季文樾

    2008-01-01

    目的 探讨三维CT在支气管异物诊断和鉴别诊断中的作用.方法 对37例可疑支气管异物的患儿行螺旋CT检查,并进行支气管三维CT重建,通过支气管镜检术、保守及手术治疗的结果 判断三维CT检查结果 的准确性.结果 37例可疑支气管异物的患儿中,X线胸部透视提示支气管异物8例(A组);X线胸部透视不提示支气管异物29例(B组).A组中,CT提示肺内感染5例、先天性肺发育异常-肺叶缺如2例、气管食管瘘1例.B组29例患儿中,CT提示支气管异物25例,经支气管镜检证实其中24例存在植物性异物,1例为气管内肿物;CT不提示支气管异物4例,证实为肺内感染、小儿急性喉炎各2例.手术证实存在植物性异物的24例中,CT显示气管支气管内异物影共14例次,不规则狭窄共6例次;阻塞性肺不张、肺气肿、肺炎共7例次;前两项为直接征象,占74%(20/27),后三项为间接征象,占26%(7/27).结论 三维CT检查对支气管异物的诊断及鉴别诊断有重要意义,有助于疑难病例的诊断和鉴别诊断.%Objective To investigate the role of CT three-dimensional reconstruction (3D-CT) in the diagnosis of bronchial foreign body.Methods Thirty-seven suspected pediatric cases of bronchial foreign bodies underwent CT scanning and 3D-CT reconstruction,whose accuracy was defined by bronchoscopical or surgical findings.Results For all the 37 cases,chest X-ray showed 8 cases (group A) had bronchial foreign body,while 29 cases(group B) were negative.In group A,CT findings suggested lung infection in 5 cases,congenital pulmonary dysplasia-lung lobe absence in 2 cases and tracheo-esophageal fistula in 1 case.In group B (29 patients),25 cases with bronchial foreign bodies were suspected by CT scanning and further bronchoscopical examination confirmed the existence of 24 cases of vegetable foreign body,one case of the tracheal tumor.For the four cases with negative result of bronchial foreign bodies after CT

  11. Comparison of clinical efficacy between laryngeal mask combined with new lightwand trache-al intubation and fiberoptic bronchoscopy%光棒联合新型喉罩与纤维支气管镜气管插管临床效果比较

    Institute of Scientific and Technical Information of China (English)

    罗亮

    2015-01-01

    目的:比较光棒联合新型喉罩气管插管与纤维支气管镜气管插管的临床效果。方法选择100例接受光棒联合新型喉罩气管插管全身麻醉的患者100例为观察组,同期接受纤维支气管镜气管插管患者100例为对照组。观察两组不同等级气道插管情况( Mallampati分级Ⅰ~Ⅳ级)及置管成功前后血流动力学变化,包括平均动脉压、血氧饱和度、心率、呼气末二氧化碳分压。比较两组插管时间及并发症发生情况。结果观察组Ⅳ级气道插管成功率为80.0%,显著高于对照组的36.4%,气管插管时间短于对照组,差异均有统计学意义( P<0.05)。气管插管置入后,观察组平均动脉压、心率、咽喉疼痛及口腔损伤的比例均低于对照组,差异有统计学意义( P<0.05)。两组血氧饱和度、呼气末二氧化碳分压比较差异均无统计学意义( P>0.05)。结论光棒联合新型喉罩气管插管成功率高,对血流动力学影响小,并发症少,值得临床推广应用。%Objective To compare the clinical effect of laryngeal mask combined with a new lightwand tracheal intubation to that of fiberoptic bronchoscopic endotracheal intubation.Methods One hundred patients received laryngeal mask combined with the new lightwand tracheal intubation during general anesthesia were designed as observation group,while another 100 patients received fi-beroptic bronchoscopic endotracheal intubation were designed as control group.Different grades of airway intubation( Mallampati gradeⅠ~Ⅳ) and hemodynamic changes such as mean arterial pressure,heart rate,oxygen saturation,and end tidal carbon dioxide were ob-served before and after intubation.The intubation time and complications were compared between the two groups(P>0.05).Results The successful rate ofⅣairway intubation in the observation group was 80%that was significantly higher than that in the control group (36.4%).The

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

    Science.gov (United States)

    Reynisson, Pall Jens; Scali, Marta; Smistad, Erik; Hofstad, Erlend Fagertun; Leira, Håkon Olav; Lindseth, Frank; Nagelhus Hernes, Toril Anita; Amundsen, Tore; Sorger, Hanne; Langø, Thomas

    2015-01-01

    Introduction 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. Method 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. Results 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

  13. 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

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

    Directory of Open Access Journals (Sweden)

    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

  15. 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

  16. Pneumomediastino espontâneo associado a lesões laríngeas e úlceras traqueais na dermatomiosite Spontaneous pneumomediastinum associated with laryngeal lesions and tracheal ulcer in dermatomyositis

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    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.

  17. 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.

  18. A novel rescue technique for difficult intubation and difficult ventilation.

    Science.gov (United States)

    Zestos, Maria M; Daaboul, Dima; Ahmed, Zulfiqar; Durgham, Nasser; Kaddoum, Roland

    2011-01-17

    We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit. Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation. A 13 year old patient was taken to the operating room for incision and drainage of a neck abscess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

  19. Possible Impact of Salivary Influence on Cytokine Analysis in Exhaled Breath Condensate

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    T. Ichikawa

    2007-01-01

    Full Text Available Background: Exhaled breath condensate (EBC is thought to contain substances of the lower airway epithelial lining fluid (ELF aerosolized by turbulent flow. However, contamination by saliva may affect the EBC when collected orally.Objective: The purpose of this study was to compare the cytokine expression levels in EBC with those in saliva, and to clarify the influence of saliva on cytokine measurements of EBC.Methods: EBC and saliva samples were obtained from 10 adult subjects with stable asthma. To estimate differences in the contents of substances between EBC and saliva, the total protein concentration of each sample was measured. Further, we also measured the total protein concentration of ELF obtained from another patient group with suspected lung cancer using a micro sampling probe during bronchoscopic examination and roughly estimated the dilution of EBC by comparing the total protein concentration of EBC and ELF from those two patient groups. The cytokine expression levels of EBC and saliva from asthmatic group were assessed by a cytokine protein array.Results: The mean total protein concentrations in EBC, saliva and ELF were 4.6 μg/ml, 2,398 μg/ml and 14,111 μg/ml, respectively. The dilution of EBC could be estimated as 1:3000. Forty cytokines were analyzed by a cytokine protein array and each cytokine expression level of EBC was found to be different from that of saliva. Corrected by the total protein concentration, all cytokine expression levels of EBC were significantly higher than those of saliva.Conclusion: These results suggest that the salivary influence on the cytokine assessment in EBC may be negligible.

  20. Clinical Analysis of 41 Patients with Endobronchial Tuberculosis%支气管内膜结核41例临床分析

    Institute of Scientific and Technical Information of China (English)

    陈丽娟; 吕志强; 张蔚; 陈赛娟

    2014-01-01

    目的:探讨支气管内膜结核(EBTB)的临床特征及早期诊断方法。方法:回顾性分析41例确诊的EBTB患者的临床资料。结果:纤维支气管镜(FB)检查提示增殖型病变12.5%,溃疡型病变45%,炎症浸润型病变17.5%,狭窄闭塞型病变20%,大致正常5%。结论:EBTB 缺乏特异性临床表现,联合 PPD 试验、痰 TB-DNA在EBTB初筛可提高EBTB早期诊断率,确诊主要依靠 FB 检查,联合应用刷检、支气管肺泡灌洗及活检对于EBTB诊断起着关键性作用。%Objective:To explore the clinical features and early definite diagnosis of endobronchial tubercolosis (EBTB). Methods: Clinical data of 41 patients with EBTB were analyzed retrospectively. Results: Bronchoscopic results shown exudative lesions in 12.5% of the cases,granulomatous lesions in 45%,cicatricial lesions in17.5%, ulcerative lesions in 20%,and normal-like demonstrations in 5%. Conclusions: There are no specific symptoms for EBTB. PPD、sputum TB-DNA can improved the early diagnostic rate of EBTB. Bronchoscopy plays an important role in definite diagnosis of the disease , combined use of brush inspection of acid-fast bacillus , bronchoalveolar lavage and tissue biopsy.

  1. Surgical treatment of patients with lung cancer and limited lung function: Preoperative assessment, operative mortality and morbidity

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    Subotić Dragan

    2007-01-01

    Full Text Available Introduction: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. Objective. The aim of the study was to analyze the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. Method. The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analyzed depending on preoperative radiographic and bronchoscopic aspect. Statistics: chisquare test, t-test. Results. In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1 between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairment, operative mortality was 3.1%. In the analyzed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analyzed and control groups occurred in 14.7% and 6.1% of patients respectively (p>0.05. Conclusion. Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and

  2. 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.

  3. 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.

  4. 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.

  5. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

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    Zarogoulidis P

    2012-06-01

    techniques to avoid complications and fatality.Keywords: difficult airway, bronchoscopic intubation, predictive factors, predictive scales

  6. Clinical Manifestations of Fibrosing Mediastinitis in Chinese Patients

    Institute of Scientific and Technical Information of China (English)

    Yan Hu; Jian-Xing Qiu; Ji-Ping Liao; Hong Zhang; Zhe Jin; Guang-Fa Wang

    2016-01-01

    Background:Fibrosing mediastinitis (FM) is a rare disease.FM is thought to be related to prior granulomatous mediastinal infection,such as histoplasmosis or tuberculosis.The majority of cases have been reported in endemic regions for histoplasmosis.The characteristics of cases of FM in China,where the prevalence of tuberculosis is high,have not been reported.We analyzed the clinical,imaging,and bronchoscopic features of Chinese patients with FM to promote awareness of this disease.Methods:Between January 2005 and June 2015,twenty patients were diagnosed with FM in our hospital.Medical records and follow-up data were collected.Imaging and biopsy findings were reviewed by radiologists and pathologists.Results:A total of 20 patients were analyzed (8 males and 12 females).The age ranged from 43 to 88 years with a mean age of 69.5 years.Previous or latent tuberculosis was found in 12 cases.Clinical symptoms included dyspnea (18/20),cough (17/20),expectoration (7/20),and recurrent pneumonia (3/20).Chest computed tomography scans showed a diffuse,homogeneous,soft tissue process throughout the mediastinum and hila with compression of bronchial and pulmonary vessels.Calcification was common (15/20).Pulmonary hypertension was present in 9 of 20 cases.Diffuse black pigmentation in the bronchial mucosa was frequently seen on bronchoscopy (12/13).The patients' response to antituberculosis treatment was inconsistent.Conclusions:FM in Chinese patients is most likely associated with tuberculosis.Some characteristics of FM are different from cases caused by histoplasmosis.

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

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    Pavord Ian D

    2011-02-01

    Full Text Available Abstract 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 evaluation at 1 year, subjects were invited to participate in a 4 year safety study. Adverse events (AEs and spirometry data were used to assess long-term safety out to 5 years post-BT. Results 45 of 52 treated and 24 of 49 control group subjects participated in long-term follow-up of 5 years and 3 years respectively. The rate of respiratory adverse events (AEs/subject was stable in years 2 to 5 following BT (1.2, 1.3, 1.2, and 1.1, respectively,. There was no increase in hospitalizations or emergency room visits for respiratory symptoms in Years 2, 3, 4, and 5 compared to Year 1. The FVC and FEV1 values showed no deterioration over the 5 year period in the BT group. Similar results were obtained for the Control group. Conclusions The absence of clinical complications (based on AE reporting and the maintenance of stable lung function (no deterioration of FVC and FEV1 over a 5-year period post-BT in this group of patients with moderate to severe asthma support the long-term safety of the procedure out to 5 years.

  8. Value of CT in the diagnosis of ventilator-associated pneumonia; Stellenwert der CT bei der Diagnose der Ventilator-assoziierten Pneumonie

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, U.; Pereira, P.; Laniado, M.; Claussen, C.D. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik; Heininger, A. [Tuebingen Univ. (Germany). Klinik fuer Anaesthesiologie

    1999-02-01

    Purpose: To analyse the diagnostic accuracy of computed tomography (CT) in ventilator-associated pneumonia (VAP). Materials and methods: 23 patients on mechanical ventilation with a new pulmonary abnormality on chest X-ray were examined with both spiral-CT and high-resolution CT. The diagnosis VAP was made according to prospectively defined criteria. Bronchoscopic specimen asservation with protected specimen brushing (PSB) served as gold standard. Results: With PSB, 11 of 23 patients were found to have VAP. CT showed a sensitivity and specificity of 53% and 63%, respectively. Ground glass infiltrates appeared to have a 100% specificity but were found in only 5/11 patients. Conclusions: CT is not the method of choice for diagnosing VAP. Groundglass infiltrates seeming to be highly specific are only inconstantly found. (orig.) [Deutsch] Ziel: Der diagnostische Stellenwert der Computertomographie (CT) bei der Ventilator-assoziierten Pneumonie (VAP) sollte prospektiv analysiert werden. Material und Methoden: 23 beatmete Patienten mit neu aufgetretener pneumoniesuspekter Verschattung wurden mittels Spiral-CT und High-Resolution-CT untersucht. Die Diagnose der VAP erfolgte mittels prospektiv definierter Kriterien. Als Goldstandard diente die bronchoskopische Keimgewinnung mittels Protected-Specimen-Brushing (PSB), wobei als Pneumonienachweis ein Schwellenwert von >10{sup 3} colony forming units (cfu)/ml angenommen wurde. Ergebnisse: Bei 11/23 Patienten wurde mittels PSB die Diagnose VAP gestellt. Die CT zeigte eine Sensitivitaet von 53% und ein Spezifitaet von 63%. Milchglasartige Infiltrate zeigten eine Spezifitaet von 100%, wurden jedoch nur bei 5/11 Patienten mit VAP gefunden. Schlussfolgerungen: Die CT ist zur Diagnosefindung VAP nur bedingt geeignet. Milchglasartigen Infiltraten scheint bei der VAP ein hoher diagnostischer Stellenwert zuzukommen, sie werden jedoch nur inkonstant gefunden. (orig.)

  9. Termoplastia brônquica: relato do primeiro tratamento endoscópico de asma na América Latina Bronchial thermoplasty: report on the first endoscopic treatment for asthma in Latin America

    Directory of Open Access Journals (Sweden)

    Adalberto Sperb Rubin

    2008-01-01

    Full Text Available A termoplastia brônquica é um novo procedimento broncoscópico que libera energia por radiofreqüência nas vias aéreas, com potencial redução da broncoconstrição causada pela contratura da musculatura lisa. Relatamos o caso de um homem de 48 anos, portador de asma persistente moderada, submetido à termoplastia brônquica. O tratamento aumentou o volume expiratório forçado no primeiro segundo, aumentou o número de dias livres de sintomas, reduziu o uso da medicação de resgate e melhorou o escore no questionário de Juniper Asthma Quality of Life Scale. A termoplastia brônquica foi bem tolerada e segura. Esta foi a primeira termoplastia brônquica na América Latina, com resultados estimulantes após 12 meses quanto ao seu potencial benefício em asmáticos pouco controlados.Bronchial thermoplasty is a new bronchoscopic procedure that delivers radiofrequency energy to the airway and potentially reduces the smooth muscle-mediated bronchoconstriction. We report the case of a 48-year-old man with persistent moderate asthma submitted to bronchial thermoplasty. The treatment increased the forced expiratory volume in one second, increased the number of symptom-free days, reduced the use of relief medications, and improved the Juniper Asthma Quality of Life Scale score. In this patient, bronchial thermoplasty was well tolerated and safe. This was the first bronchial thermoplasty performed in Latin America. At 12 months after the procedure, the results were encouraging in terms of its potential benefits in patients with difficult-to-control asthma.

  10. 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.

  11. 镜下冷冻术治疗气道肿瘤护理工作探讨%To Explore the Nursing of Airway Tumor Cryotherapy Treatment Under Microscope

    Institute of Scientific and Technical Information of China (English)

    林婉萍

    2015-01-01

    无论是位于气管还是支气管处的肿瘤都是比较难以处理的,但是随着科学的发展,人们研究出了使用电子支气管镜下冷冻治疗的方法用来治疗气道肿瘤.治疗过程固然重要,但是是否能够康复痊愈关键还要看对患者的护理水平.不论是术前、术中还是术后的护理都是至关重要的.通过对近几年来的36例气道肿瘤患者在镜下(包括电刀和氩气刀)治疗的护理措施,探讨在不同情境下的护理,以使得患者在治疗后减轻呼吸困难的症状,提高生存质量.%Whether in trachea or bronchus tumors are more difficult to deal with, but with the development of science, people have developed a method using electronic bronchoscopic cryotherapy for treatment of airway tumor. The treatment process is important, but whether it can recover the key depends on the level of rehabilitation nursing of patients. Whether the nursing before operation, during operation and after operation is very important. According to the recent years 36 cases of patients with airway tumor under the microscope (including electric knife and argon knife) nursing treatment, to explore the nursing in different situations, to enable patients to reduce the symptoms of dyspnea after treatment, improve the quality of life.

  12. A randomized clinical trial comparing the standard mcintosh laryngoscope and the c-mac d blade video laryngoscope™ for double lumen tube insertion for one lung ventilation in Onco surgical patients

    Directory of Open Access Journals (Sweden)

    Shagun Bhatia Shah

    2016-01-01

    Full Text Available Background and Aims: Several devices enabling double-lumen tube (DLT placement for thoracic surgeries are available, but there are no studies for D-blade video laryngoscope-guided DLT insertion. We compared the CMac D-blade videolaryngoscope™ and the Macintosh laryngoscope for DLT endobronchial intubation using parameters of time and attempts required for intubation, glottic view, incidence of complications and haemodynamic changes. Methods: Prospective, parallel group, randomised controlled clinical trial where sixty American Society of Anesthesiologists I and II patients aged 18-80 years scheduled for thoracic surgeries entailing DLT placement were randomly allocated in two groups based on the laryngoscopic device used for endobronchial intubation. Data were subjected to statistical analysis SPSS (version 17, the paired and Student′s t-test for equality of means. Nominal categorical data between the groups were compared using Chi-squared test or Fisher′s exact test as appropriate. P ˂ 0.05 was considered statistically significant. Results: Time required for intubation was comparable (37.41 ± 18.80 s in Group-M and 32.27 ± 11.13 s in Group-D. Number of attempts and incidence of complications (trauma, DLT cuff rupture, oesophageal intubation was greater in the Macintosh group, except malpositioning into the wrong bronchus (easily rectified fibre-optic bronchoscopically, which was greater with the D-blade. Greater haemodynamic changes were observed during Macintosh laryngoscopy. Conclusion: D-blade videolaryngoscope™ is a useful alternative to the standard Macintosh laryngoscope for routine DLT insertion.

  13. Tracheobronchopathia Osteochondroplastica

    Science.gov (United States)

    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

  14. 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.

  15. 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.

  16. Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

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    Babita Gupta

    2014-01-01

    Full Text Available Overview: Awake fiberoptic bronchoscope (FOB guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate.

  17. Report of 5 cases of pediatric plastic bronchitis and review of related literature%儿童塑型性支气管炎五例并文献复习

    Institute of Scientific and Technical Information of China (English)

    朱春梅; 曹玲; 常丽; 张琪; 王菲; 任晓旭

    2013-01-01

    To report the clinical course of 5 cases of pediatric plastic bronchitis and review the related literature.A total of 113 cases of pediatric plastic bronchitis occurring in China from 2000 to 2012 were retrieved through the databases of CNKI and Wanfang Med Online.Retrospective analyses were performed for the main symptoms,courses,etiologies,imaging findings,histopathological classifications,therapies and prognosis of 118 cases.Pediatric plastic bronchitis was one of critical diseases.Most of them had a rapid onset and a mortality rate.Bronchoscopy examination was essential for definite diagnosis and effective treatment.Airway management and chest physiotherapy were primary adjuvant tools.Early diagnosis and bronchoscopic treatment might result in improved prognosis.%报告5例儿童塑型性支气管炎病例的临床诊治经过,并检索中国知网(CNKI)和万方医学数据库2000年1月至2012年6月相关病例报告113例,回顾性分析118例患儿的主要临床症状、病程、病原学分布、影像学表现、病理分类、治疗和预后.儿童塑型性支气管炎属高危性疾病,多数起病急,病死率高,确诊依靠支气管镜检查,支气管镜异物取出术及灌洗是最有效的治疗方法,气道管理和胸部理疗是重要的辅助治疗手段,经早期确诊和治疗预后良好.

  18. Endobronchial mucosa invasion predicts survival in patients with small cell lung cancer.

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    Pai-Chien Chou

    Full Text Available BACKGROUND: Current staging system for small cell lung cancer (SCLC categorizes patients into limited- or extensive-stage disease groups according to anatomical localizations. Even so, a wide-range of survival times has been observed among patients in the same staging system. This study aimed to identify whether endobronchial mucosa invasion is an independent predictor for poor survival in patients with SCLC, and to compare the survival time between patients with and without endobronchial mucosa invasion. METHODS: We studied 432 consecutive patients with SCLC based on histological examination of biopsy specimens or on fine-needle aspiration cytology, and received computed tomography and bone scan for staging. All the enrolled patients were assessed for endobronchial mucosa invasion by bronchoscopic and histological examination. Survival days were compared between patients with or without endobronchial mucosa invasion and the predictors of decreased survival days were investigated. RESULTS: 84% (364/432 of SCLC patients had endobronchial mucosal invasion by cancer cells at initial diagnosis. Endobronchial mucosal involvement (Hazard ratio [HR], 2.01; 95% Confidence Interval [CI], 1.30-3.10, age (HR, 1.04; 95% CI, 1.03-1.06, and extensive stage (HR, 1.39; 95% CI, 1.06-1.84 were independent contributing factors for shorter survival time, while received chemotherapy (HR, 0.32; 95% CI, 0.25-0.42 was an independent contributing factor better outcome. The survival days of SCLC patients with endobronchial involvement were markedly decreased compared with patients without (median 145 vs. 290, p<0.0001. Among SCLC patients of either limited (median 180 vs. 460, p<0.0001 or extensive (median 125 vs. 207, p<0.0001 stages, the median survival duration for patients with endobronchial mucosal invasion was shorter than those with intact endobronchial mucosa, respectively. CONCLUSION: Endobronchial mucosal involvement is an independent prognostic factor for SCLC

  19. 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.

  20. 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."

  1. 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.

  2. 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.

  3. Evaluation of bioaerosol exposures during hospital bronchoscopy examinations.

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    Lavoie, Jacques; Marchand, Geneviève; Cloutier, Yves; Hallé, Stéphane; Nadeau, Sylvie; Duchaine, Caroline; Pichette, Gilbert

    2015-02-01

    During hospital bronchoscopy examinations, aerosols emitted from the patient's during coughing can be found suspended in the ambient air. The aerosols can contain pathogenic microorganisms. Depending on their size, these microorganisms can remain in the air for a long time. The objective of this study was to measure the sizes and concentrations of the biological and non-biological particles produced during bronchoscopy examinations, and to propose preventive or corrective measures. Two bronchoscopy rooms were studied. An aerodynamic particle sizer (UV-APS) was used to establish the concentrations of the particles present and their size distributions. This instrument determines the aerodynamic diameter of the aerosols and can distinguish fluorescent (bioaerosols) and non-fluorescent particles. Reference concentrations were measured before the start of the examinations (morning background concentrations). They were used as comparison levels for the concentrations measured during and at the end of the bronchoscopies. In parallel, computational fluid dynamics (CFD) made it possible to isolate and understand different factors that can affect the concentration levels in bronchoscopy rooms. The concentrations of the non-fluorescent and fluorescent particles (bioaerosols) were significantly higher (p ≤ 0.05) during the bronchoscopy examinations than the reference concentrations. For the investigated factors, the bioaerosol concentrations were significantly higher during bronchoscope insertion tasks. The time required at the end of the day for the bioaerosols to reach the morning reference concentrations was about fifteen minutes. The average particle sizes were 2.9 μm for the fluorescent particles (bioaerosols) and 0.9 μm for the non-fluorescent particles. Our models based on computational fluid dynamics (CFD) enabled us to observe the behaviour of aerosols for the different rooms.

  4. 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.

  5. 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.

  6. Intraflagellar transport gene expression associated with short cilia in smoking and COPD.

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    Justina Hessel

    Full Text Available Smoking and COPD are associated with decreased mucociliary clearance, and healthy smokers have shorter cilia in the large airway than nonsmokers. We hypothesized that changes in cilia length are consistent throughout the airway, and we further hypothesized that smokers with COPD have shorter cilia than healthy smokers. Because intraflagellar transport (IFT is the process by which cilia of normal length are produced and maintained, and alterations in IFT lead to short cilia in model organisms, we also hypothesized that smoking induces changes in the expression of IFT-related genes in the airway epithelium of smokers and smokers with COPD. To assess these hypotheses, airway epithelium was obtained via bronchoscopic brushing. Cilia length was assessed by measuring 100 cilia (10 cilia on each of 10 cells per subject and Affymetrix microarrays were used to evaluate IFT gene expression in nonsmokers and healthy smokers in 2 independent data sets from large and small airway as well as in COPD smokers in a data set from the small airway. In the large and small airway epithelium, cilia were significantly shorter in healthy smokers than nonsmokers, and significantly shorter in COPD smokers than in both healthy smokers and nonsmokers. The gene expression data confirmed that a set of 8 IFT genes were down-regulated in smokers in both data sets; however, no differences were seen in COPD smokers compared to healthy smokers. These results support the concept that loss of cilia length contributes to defective mucociliary clearance in COPD, and that smoking-induced changes in expression of IFT genes may be one mechanism of abnormally short cilia in smokers. Strategies to normalize cilia length may be an important avenue for novel COPD therapies.

  7. 支气管结核临床分析%Clinical Analysis of Endobronchial Tuberculosis

    Institute of Scientific and Technical Information of China (English)

    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

  8. 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

  9. 两种插管方法用于高位颈椎外伤患者经鼻气管插管的比较%Comparison of nasotracheal intubation between two methods in patients with upper cervical spine injury

    Institute of Scientific and Technical Information of China (English)

    洪英才; 麻伟青

    2013-01-01

    目的 比较使用TruviewEVO2光学喉镜与光导纤维支气管镜在高位颈椎外伤患者经鼻气管插管中的应用情况,包括气管插管时间、心率与收缩压乘积(RPP)以及两种工具插管对血流动力学的影响.方法 选择40例行颈椎手术的高位颈椎外伤(颈1~颈3)患者,随机分为TruviewEV02光学喉镜组(T组)和光导纤维支气管镜组(F组),每组20例.两组麻醉诱导方法和用药相同,分别记录两组患者入室后10 min(T1)、麻醉诱导静脉注药完毕后(T2)、气管插管即刻(T3)及气管插管后5 min(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)、心率与收缩压乘积(RPP)以及喉部结构暴露时间、气管插管时间.结果 两组均顺利完成气管内插管.组内比较,与T1相比,两组患者T2时的SBP、DBP、RPP均明显下降(P<0.01);与T2相比,两组T3时的HR、SBP、DBP、RPP均明显升高(P<0.01);组间比较,T3时T组的SBP、DBP、RPP明显低于F组(P<0.05或P<0.01);F组的喉部结构暴露时间和气管插管时间均长于T组(P<0.01),其余指标两组间无显著性差异.结论 TruviewEVO2光学喉镜与光导纤维支气管镜经鼻气管插管对患者心血管血流动力均有影响,TruviewEVO2光学喉镜的心血管反应轻,心肌氧耗少,喉部结构暴露时间和气管插管时间短,值得推广应用于高位颈椎外伤患者经鼻气管插管.%Objective To make comparison of nasotracheal intubation between TruviewEV02 optic laryngoscope and fibreoptic bronchoscope in patients with upper cervical spine injury, including intubation time, RPP, and effects of two intubation tools on hemodynamics. Methods Forty patients with upper cervical spine injury ( C1- C3 ) were selected and randomly divided intoTruviewEV02 optic laryngoscope group(T group)and fibreoptic bronchoscope group(F group) with 20 ones in each group. The two groups received the same induction of anesthesia and medication. The following parameters were recorded

  10. 阻塞性睡眠呼吸暂停低通气综合征患者行悬雍垂颚咽成形术的经鼻气管插管方式%Effects of different nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty

    Institute of Scientific and Technical Information of China (English)

    刘炜烽; 何荷番; 谢文锡; 翁培清; 李师阳

    2012-01-01

    Objective To explore the safe and effective way of nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty.Methods Upon the approval of the Ethics Committee at Second Affiliated Hospital of Fujian Medical University,from August 2008 to November 2011,90 sleep apnea hypopnea syndrome patients were randomly divided into 3 groups (n =30 each):GlideScope (G),fiberoptic bronchoscope (F) and combination of Glidescope with fiberoptic bronchoscope (G + F).The parameters of tracheal intubation time,placement of endotracheal intubation,tracheal injury and complications were recorded.Also systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) were recorded at post-induction,the moment of tracheal intubation and post-intubation 1,3,5 min.Rate pressure product (RPP) was calculated at all timepoints as the product of heart rate and SBP during observation.Results All of them underwent successful endotracheal intubation.There were 24 successful cases of intubation during the first attempt in Group G with a success rate of 80% ; 27 patients successful during the first attempt in group F with a success rate of 90% ; all in group G + F successful during the first attempt with a success rate of 100%.The rates were significantly different in 3 groups ( P < 0.05 ).Groups G and F patients with failed intubation during the first attempt were of Mallampati Ⅲ/Ⅳ-After induction,SBP,DBP,MAP and RPP were lower in 3 groups ( P < 0.05 ) while HR change was not obvious.Compared with the after induction,the moment of tracheal intubation and after intubation 1 min,3 groups of patients with SBP,DBP,MAP,HR and RPP increased ( P < 0.05 ).Groups F and G + F after intubation in intubated patients and 1 min of SBP,DBP,MAP,HR,RPP were higher than G group ( P < 0.05 ).No difference existed between groups F and G + F.Three groups showed no serious tracheal injury,laryngeal edema

  11. 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。

  12. 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.

  13. 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

  14. 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。

  15. 经纤维支气管镜沐舒坦肺泡灌洗在颈脊髓损伤并发呼吸功能衰竭患者中的应用%Fiberoptic bronchoscopy aspirating sputum and mucovent lavage in the treatment of cervical spinal cord injury with respiratory insufficiency patients

    Institute of Scientific and Technical Information of China (English)

    路闯; 袁宏伟; 刘俊杰; 代振动; 王灿亚; 田俊华; 贾会光; 赵惠强

    2011-01-01

    目的 探讨颈脊髓损伤并发呼吸功能衰竭患者经纤维支气管镜沐舒坦肺泡灌洗的疗效.方法 选择38例经常规吸氧、抗感染、解痉平喘、化痰止咳或人工通气治疗效果不佳,并具有痰液堵塞的颈脊髓损伤并发呼吸衰竭患者进行经纤支镜沐舒坦支气管肺泡灌洗治疗.结果 显效26例(68.4%),有效9例(23.7%),总有效率为92.1%,无效3例(7.9%).结论 对于分泌物较多难以排出气道的颈脊髓损伤并发呼吸衰竭患者,及时给予经纤支镜沐舒坦肺泡灌洗,有利于迅速解除气道阻塞,改善血气交换.支气管吸引灌洗技术是一种安全有效、简便经济、易被患者接受的治疗方法,应用沐舒坦肺泡灌洗治疗颈脊髓损伤并发呼吸衰竭能改善病情.%[Objective]To investigate the clinical values of aspirating sputum by bronchofibroscopy and bronchoalveolar mucovent lavage in cervical fracture with spinal cord injury patients respiratory insufficiency.[Methods]Bronchoscope was inserted into 38 patients cervical spinal cord injury with respiratory insufficiency through nose or tracheal catheter to clear the secretion, phlegm.[Results]35 lives were saved and the mission successful rate was 92.1%.[Conclusions]The clinical values of bedside fiberoptic bronchoscopy for cervical fracture with spinal cord injury patients respiratory insufficiency are grateful.

  16. 七氟醚在小儿气管异物取出术麻醉中的临床应用观察%Observation on sevoflurane for pediatric clinical effects of foreign body removal surgery

    Institute of Scientific and Technical Information of China (English)

    薛莲

    2013-01-01

    Objective:To observe the sevoflurane for pediatric clinical effects of foreign body removal surgery .Methods:Observed in our hospital,20 patients with ASAⅠ~Ⅱgrade ,sevoflurane anesthesia foreign body removal surgery tracheal foreign bodies in children with clinical data .Results:All 20 patients airway foreign body were successfully removed ,the smooth operation of the bronchoscope ,children disappear fast,rapid recovery of consciousness awakening awareness of the induction period ,surgery in children with no movement ,good postoperative spir-it ,nausea and vomiting,hoarseness and other low incidence of adverse reactions .Conclusion:Sevoflurane for children with foreign body remov-al surgery should have the ideal sedative and muscle relaxant effect ,safe and reliable ,can be used for.%目的:观察七氟醚用于小儿气管异物取出术中的临床效果。方法:观察我院收治的20例ASAⅠ~Ⅱ级、采用七氟醚吸入全麻下气管异物取出术气管异物患儿的临床资料。结果:全部20例患儿呼吸道异物均被成功取出,气管镜操作顺利,患儿在诱导期的意识消失快、苏醒时意识恢复迅速,术中患儿无体动,术后精神良好,恶心呕吐、声音嘶哑等不良反应发生率低。结论:七氟醚用于小儿气管异物取出术,具有理想的镇静及肌松效果,安全可靠,可作为小儿气管异物取出术麻醉的首选全身麻醉药。

  17. Reported Successful Treatment of Acute Critically Exogenous Lipid Pneumonia:A Case Report and Literature Review%急性重症外源性脂质性肺炎1例救治成功并文献复习

    Institute of Scientific and Technical Information of China (English)

    陈锐均; 田方; 王立军

    2015-01-01

    目的:总结急性重症外源性脂质性肺炎1例成功救治的经验,并结合文献探讨脂质性肺炎的病理生理变化及救治方法。方法:回顾性分析诊治的外源性脂质性肺炎1例的临床资料并复习有关文献。结果:患者在早期纤支镜经支气管肺泡灌洗、综合救治(气管插管呼吸机辅助呼吸、预防感染、祛痰、激素、抗氧化、清除自由基、维持内环境稳定等)后生命体征平稳,并行严重受累肺叶切除后康复出院。结论:早期纤支镜经支气管肺泡灌洗、综合救治是抢救急性重症外源性脂质性肺炎患者的关键,严重受累肺叶切除是减少并发症发生的重要手段。%Objective:To summarize the experience of of a patient with acute severe exogenous lipoid pneumonia treated successfully and to explore the pathophysiological changes and treatment of lipid pneumonia by reviewed the literatures. Method: The clinical data of 1 patient with acute critically exogenous lipid pneumonia was analyzed retrospectively and the related literatures were reviewed. Results: The case in early bronchoscopic bronchoalveolar lavaged,the signs of life restored calm after comprehensive treatment (endotracheal intubation ventilator-assisted breathing , prevention of infection , eliminating phlegm , hormone and antioxidant application , free radical scavenging , maintained a stable internal environment within the processing). At last,the case discharged from the hospital in stable condition by the lobectomy of severely affected lobi pulmonis. Conclusion: Early bronchoscopy with bronchoalveolar lavage comprehensive treatment is the key to rescue a patient with acute severe exogenous lipoid pneumonia ,the lobectomy of severely affected lobi pulmonis is an important means to reduce complications.

  18. 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

  19. Nosocomial pneumonia : rationalizing the approach to empirical therapy.

    Science.gov (United States)

    Andriesse, Gunnar I; Verhoef, Jan

    2006-01-01

    Nosocomial pneumonia or hospital-acquired pneumonia (HAP) causes considerable morbidity and mortality. It is the second most common nosocomial infection and the leading cause of death from hospital-acquired infections. In 1996 the American Thoracic Society (ATS) published guidelines for empirical therapy of HAP. This review focuses on the literature that has appeared since the ATS statement. Early diagnosis of HAP and its etiology is crucial in guiding empirical therapy. Since 1996, it has become clear that differentiating mere colonization from etiologic pathogens infecting the lower respiratory tract is best achieved by employing bronchoalveolar lavage (BAL) or protected specimen brush (PSB) in combination with quantitative culture and detection of intracellular microorganisms. Endotracheal aspirate and non-bronchoscopic BAL/PSB in combination with quantitative culture provide a good alternative in patients suspected of ventilator-associated pneumonia. Since culture results take 2-3 days, initial therapy of HAP is by definition empirical. Epidemiologic studies have identified the most frequently involved pathogens: Enterobacteriaceae, Haemophilus influenzae, Streptococcus pneumoniae and Staphylococcus aureus ('core pathogens'). Empirical therapy covering only the 'core pathogens' will suffice in patients without risk factors for resistant microorganisms. Studies that have appeared since the ATS statement issued in 1996, demonstrate several new risk factors for HAP with multiresistant pathogens. In patients with risk factors, empirical therapy should consist of antibacterials with a broader spectrum. The most important risk factors for resistant microorganisms are late onset of HAP (>/=5 days after admission), recent use of antibacterial therapy, and mechanical ventilation. Multiresistant bacteria of specific interest are methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter calcoaceticus-baumannii, Stenotrophomonas maltophilia and extended

  20. Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease.

    Directory of Open Access Journals (Sweden)

    Hyun-ju Lim

    Full Text Available Surgical or bronchoscopic lung volume reduction (BLVR techniques can be beneficial for heterogeneous emphysema. Post-processing software tools for lobar emphysema quantification are useful for patient and target lobe selection, treatment planning and post-interventional follow-up. We aimed to evaluate the inter-software variability of emphysema quantification using fully automated lobar segmentation prototypes.66 patients with moderate to severe COPD who underwent CT for planning of BLVR were included. Emphysema quantification was performed using 2 modified versions of in-house software (without and with prototype advanced lung vessel segmentation; programs 1 [YACTA v.2.3.0.2] and 2 [YACTA v.2.4.3.1], as well as 1 commercial program 3 [Pulmo3D VA30A_HF2] and 1 pre-commercial prototype 4 [CT COPD ISP ver7.0]. The following parameters were computed for each segmented anatomical lung lobe and the whole lung: lobar volume (LV, mean lobar density (MLD, 15th percentile of lobar density (15th, emphysema volume (EV and emphysema index (EI. Bland-Altman analysis (limits of agreement, LoA and linear random effects models were used for comparison between the software.Segmentation using programs 1, 3 and 4 was unsuccessful in 1 (1%, 7 (10% and 5 (7% patients, respectively. Program 2 could analyze all datasets. The 53 patients with successful segmentation by all 4 programs were included for further analysis. For LV, program 1 and 4 showed the largest mean difference of 72 ml and the widest LoA of [-356, 499 ml] (p<0.05. Program 3 and 4 showed the largest mean difference of 4% and the widest LoA of [-7, 14%] for EI (p<0.001.Only a single software program was able to successfully analyze all scheduled data-sets. Although mean bias of LV and EV were relatively low in lobar quantification, ranges of disagreement were substantial in both of them. For longitudinal emphysema monitoring, not only scanning protocol but also quantification software needs to be kept

  1. 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.

  2. 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 .

  3. 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

  4. 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

  5. Diagnostic value of fiberoptic bronchoscopy and ultrasonic atomization with gradient hypertonic saline to induce sputum for atypical pulmonary tuberculosis%梯度高渗盐水雾化导痰联合纤支镜检查对菌阴不典型肺结核的诊断价值

    Institute of Scientific and Technical Information of China (English)

    李站领; 徐东波; 彭勋; 李艳静; 赵培利; 常占平

    2012-01-01

    Objective To evaluate the diagnostic value of fiberoptic bronchoscopy and ultrasonic atomization with gradient hypertonic saline for induction sputum in bacteriological negative pulmonary tuberculosis. Methods 96 cases of atypical pulmonary tuberculosis received fiberoptic bronchoscope examination for 129 times; and 129 cases had not been diagnosed which received ultrasonic atomization to induce sputum for 149 times. Results 65 cases had been di-anosed by fiberoptic bronchoscopy,and account for 67. 70%;33 cases had been diagnosed by ultrasonic atomization to induce sputum, and account for 45. 11%; while the concordance was 75. 97% when two methods were used together. Conclusion The combination of the above two methods is worthy to be popularized and applied, which can increase the diagnosis rate of pulmonary tuberculosis obviously.%目的 探讨纤维支气管镜活检与刷检联合梯度高渗盐水雾化导痰对不典型肺结核临床诊断价值.方法 129例患者进行梯度高渗盐水雾化导痰共149次,96例痰菌阴性的不典型肺结核患者进行纤支镜肺活检并刷检共129次.结果 经纤支镜肺活检并刷检获得诊断者65例,诊断率为67.70%.经梯度高渗盐水雾化导痰诊断者33例,诊断率为45.11%,二者结合后的诊断率明显提高为75.97%.结论 上述两种方法的结合应用,可明显提高菌阴不典型肺结核的诊断率,值得临床推广应用.

  6. “One-stop shop” spectral imaging for rapid on-site diagnosis of lung cancer: a future concept in nano-oncology

    Directory of Open Access Journals (Sweden)

    Darwiche K

    2013-11-01

    Full Text Available Kaid Darwiche,1 Paul Zarogoulidis,1,2 Leslie Krauss,3 Filiz Oezkan,1 Robert Fred Henry Walter,1,4 Robert Werner,4 Dirk Theegarten,4 Leonidas Sakkas,5 Antonios Sakkas,5 Wolfgang Hohenforst-Scmidt,6 Konstantinos Zarogoulidis,1 Lutz Freitag11Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany; 2Pulmonary Department, Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3CytoViva, Inc, Auburn, AL, USA; 4Institute of Pathology and Neuropathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany; 5Pathology Department, G Papanikolaou General Hospital, Thessaloniki, Greece; 6II Medical Department, Coburg Regional Clinic, University of Wuerzburg, Coburg, GermanyBackground: There are currently many techniques and devices available for the diagnosis of lung cancer. However, rapid on-site diagnosis is essential for early-stage lung cancer, and in the current work we investigated a new diagnostic illumination nanotechnology.Methods: Tissue samples were obtained from lymph nodes, cancerous tissue, and abnormal intrapulmonary lesions at our interventional pulmonary suites. The following diagnostic techniques were used to obtain the samples: endobronchial ultrasound bronchoscopy; flexible bronchoscopy; and rigid bronchoscopy. Flexible and rigid forceps were used because several of the patients were intubated using a rigid bronchoscope. In total, 30 tissue specimens from 30 patients were prepared. CytoViva® illumination nanotechnology was subsequently applied to each of the biopsy tissue slides.Results: A spectral library was created for adenocarcinoma, epidermal growth factor receptor mutation-positive adenocarcinoma, squamous cell carcinoma, usual interstitial pneumonitis, nonspecific interstitial pneumonitis, typical carcinoid tumor, sarcoidosis, idiopathic pulmonary fibrosis, small cell

  7. 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

  8. Diagnostic Value and Effective Factors on Transbronchial Lung Biopsy Using Cup and Alligator Forceps

    Science.gov (United States)

    Eslaminejad, Alireza; Kiani, Arda; Sheikhi, Negar; Sadr, Makan; Mohammad Taheri, Zohreh

    2016-01-01

    Background: Lung biopsy through the airways by using a flexible bronchoscope (transbronchial lung biopsy: TBLB) is a suitable method for obtaining tissue specimens. This study aimed at evaluating the factors influencing TBLB results in order to increase the diagnostic power of this method. Materials and Methods: This was a prospective double blind observational study. We had a total of 44 patients with pulmonary lesions who underwent biopsy and 4 specimens were obtained from each patient. A total of 176 specimens were obtained from all patients. Biopsy specimens were taken using cup and alligator forceps alternatively. Characteristics of the obtained specimens including size, floatation, alveolarity, and bleeding were thoroughly studied. After sending to the pathologist, specimens were divided into 2 groups of diagnostic and non-diagnostic specimens. Results: Of a total of 176 specimens, 37 (21%) were diagnostic and 139 (79%) were non-diagnostic. From 88 specimens obtained by the alligator forceps, 16 were diagnostic while from the same number of specimens taken by the cup forceps 21 had diagnostic value. However, this difference was not statistically significant (P>0.05). Of the small specimens (57 cases), 12 (21.1%) were diagnostic while among the 66 medium specimens, 12 (18.2%) and from the 53 large specimens, 13 (24.5%) were diagnostic. No statistically significant difference was detected in this respect (P>0.05). Among specimens floating on the surface of the liquid (48 cases), 6 (12.5%) had diagnostic value. Of the 12 specimens suspended in the liquid, 2 (16.7%) and among the 116 specimens precipitated at the bottom, 29 (25%) were diagnostic. These differences were not significant either (P>0.05). Of the 84 specimens with more than 20 alveoli, 31 (36.9%) were diagnostic. Among 26 specimens with less than 20 alveoli 5 (19.2%) were diagnostic. This correlation was statistically significant indicating that the higher the number of alveoli in the biopsy specimen

  9. 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

  10. Early Diagnosis and Interventional Bronchoscopy of Primary Tracheal Tumors%原发性气管肿瘤的早期诊断和呼吸介入治疗

    Institute of Scientific and Technical Information of China (English)

    林晓萍

    2016-01-01

    -CT and metastatic lesions biopsy.The majority malignant tumors included squamous cell carcinomas and adenoid cystic carcinomas, and the rest were spindle cell sarcomatoid carcinoma,carcinoid,and myopericytoma.5 cases received surgery, and 3 of 5 cases received interventional bronchoscopic therapy at the same time.And the main therapy of another 7 cases were interventional bronchoscopy,which consisted of electrocautery,argon-beam coagulation and stenting.Conclusion:Primary tracheal tumors are rare and early clinical symptoms are unspecific,therefore,we must pay more attention to them.Early diagnosis can be made by neck-chest CT and bronchoscopy.Surgery should be considered as the first choice of treatment,and interventional bronchoscopic techniques have important roles in the diagnosis,treatment of benign tracheal tumors,as a way to keep the airway open before subsequent definitive resection and as palliative therapy of advanced malignant tumors.Interventional bronchoscopy to unresectable tumors can lead to symptom remission and thus improve patient’s life quality.

  11. Clinical analysis of diffusive interstitial lung diseases with positive anti-neutrophil cytoplasmic antibody%抗中性粒细胞胞浆抗体阳性的弥漫性间质性肺病的临床分析

    Institute of Scientific and Technical Information of China (English)

    丁艳芩; 朱红; 姚婉贞; 赵鸣武

    2011-01-01

    (Group B), and the ANCA negative patients (Group C), the results of syndromes, signs, radiological manifestations, pulmonary function tests, bronchoscope examinations, bronchoalveolar lavage fluid (BALF) cytology and other laboratory examinations were compared. Results: In the 122 DILD patients with ANCA results, 36 patients' ANCA (29.51%) were positive. The numbers of patients in Groups A, B, and C were 7, 29, and 86. Total lung capacity (TLC) decreased less and pleural pathological changes were more seen in Groups A and B than in Group C. Oliguria, haematuria, proteinuria, anaemia, and renal inadequacy in Group A, which were similar in Group C, appeared less than in Group B. Results of bronchoscope examination, BALF cytology, anti-nuclear antibody ( ANA), and etc. were not significantly different among the three groups. Conclusion: In DILD patients, pulmonary interstitial changes of those with positive ANCA accompany with more pleural pathological changes and TLC decreased less than those with negative ANCA. In patients with positive ANCA, non-primary vasculitis had some similar clinical manifestations as primary systematic vasculitis, however, anaemia and renal damages were less seen in the non-primary vasculitis patients.

  12. Comparison of ventilation through the laryngeal tube-suction airway and ProSeal laryngeal mask airway during gynecological laparoscopic surgery%妇科腹腔镜手术患者双管喉管和双管喉罩通气效果的比较

    Institute of Scientific and Technical Information of China (English)

    华震; 左明章; 王杨; 张宏业

    2008-01-01

    Objetive To compare the ventilation through the laryngeal tube-suction airway(LTSA)and ProSeal laryngeal mask airway(PLMA)during gynecological laparoscopic surgery.Methods Fifty ASA Ⅰ or Ⅱpatients(BMI<30 kg/m2)undergoing elective gynecological laparoscopic surgery were randomized into 2 groups (n=25 each):group Ⅰ LTSA and group Ⅱ PLMA.Anesthesia was induced with TCI of propofol(Cp=3-5 μg/ml)and remifentanyl TCI(Cp=4-6 ng/ml)and iv vecuronium 0.1 mg/kg.LTSA and PLMA were inserted when BIS was 40-60.Fiberoptic bronchoscope scores were assessed(Ⅰ=good ventilation,glottis and epiglottis are not visible;Ⅲ=good ventilation,glottis and epiglottis can be clearly seen)after successful insertion.The insertion time(from the beginning to the completion of insertion),the rate of successful insertion at first attempt and airway seal pressure were recorded.HR,BP(SP,DP,MAP),SpO2,peak airway pressure(Ppeak)and PET CO2 were continuously monitored and recorded before insertion at 1,3,5 min after insertion,at skin incision,5,10,30 min of pneumoperitoneum and 3 min after pneumoperitoneum.The duration of operation and pneumoperitoneum,recovery time,extubation time and pharyngeal adverse responses at 24 h after operation were recorded.Results The insertion time,the rate of successful insertion at fast attempt,the duration of operation and pneumoperitoneum,recovery time and extubation,airway seal pressure and pharyngeal adverse responses at 24 h after operation were comparable between the 2 groups.The hemodynamics was stable during operation in both groups.SpO2,Ppeak and PETCO2 were within normal limits and comparable between the 2 groups.The fiberoptic bronchoscopic scores were significantly higher in group PLMA.Conclusion Both laryngeal tube-suction airway and ProSeal laryngeal mask airway can be safely and effectively used in gynecological laparoscopic surgery.There is no difference in ventilatory effects between the two groups.%目的 比较双管喉管和双管喉罩

  13. Efficacy of laryngeal mask airway Supreme in patients undergoing gynecological laparoscopic surgery%Supreme喉罩用于妇科腹腔镜手术患者气道管理的效果

    Institute of Scientific and Technical Information of China (English)

    马浩南; 李恒林; 车伟

    2010-01-01

    midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 3 μg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA. The number of attempt, success rate, LMA placement time, success rate of gastric tube placement, cuff volume, peak airway pressure, and airway seal pressure, BP, HR, ECG, SpO2, PET CO2 and complications were recorded. The duration of surgery and pneumoperitoneum, and emergence time were also recorded. The fiberoptic bronchoscope scores were assessed after successful LMA placement. Results There were no significant differences in the duration of operation and pneumoperitoneum, emergence time between the two groups (P > 0.05). The BP, HR,SpO2, PET CO2 and peak pressure were within the normal range during operation in both groups. The first attempt success rates of LMA placement and gastric tube placement were significantly higher, the LMA placement time was significantly shorter, and the fiberoptic bronchoscopic scores were significantly higher in group S than in group P ( P < 0.05). Conclusion LMA Supreme is helpful for ventilation during operation with less complications and can be used effectively for gynecological laparoscopic surgery.

  14. Clinical characteristics and bronchoscopy features in elderly patients with lung cancer%老年肺癌患者的临床特点及支气管镜表现

    Institute of Scientific and Technical Information of China (English)

    高俊珍; 付秀华; 李国华; 徐常丽; 王立红

    2011-01-01

    目的:探讨老年肺癌患者的临床特点及支气管镜表现.方法:回顾分析416例经支气管镜确诊的老年肺癌患者(年龄≥60岁)的临床资料及支气管镜检查结果,并与327例非老年肺癌患者(年龄<60岁)进行对比分析.结果:老年肺癌患者男女比例是3.9:1,中位年龄是68岁,咯血症状显著多于非老年患者(P<0.05).鳞癌最多见,占50.5%,显著多于非老年(P<0.01);其次是小细胞癌,占19.7%,显著少于非老年(P<0.01).支气管镜下以增生型病变最多,占72.1%(300/416),其次是浸润型,占21.9%(91/416).老年增生型的鳞癌最多见,占42.8%(178/416),显著高于非老年患者(P<0.05).肺CT显示的病变部位与支气管镜检查结果的符合率是54.2%~77.4%.结论:老年肺癌患者的临床症状、病理分型及支气管镜下表现与非老年肺癌患者存在差异;支气管镜检查是临床上诊断老年人肺癌的重要手段.%Objective:To explore the clinical characteristics and bronchoscopy features of elderly patients with lung cancer.Methods:A total of 416 elderly patients (age over 60 years)of lung cancer diagnosed with bronchoscopy and 327 young and middle-aged patients of lung cancer were analyzed retrospectively .The correlations among the histopathologic type of lung cancer,chest CT scan,symptom,gender and the features under bronchoscope were investigated.ResuIts:Of the elderly patients,the male/female ratio was 3.9/1,and the median age was 68.The number of elderly patients with hemoptysis was higher than that of young and middle-aged group(P<0.05).The pathological types included squamous cell carcinoma(n=210,50.5%),small cell lung cancer (n=82,19.7% )and adenocarcinoma (n=71,17.1% ).Among the patients with squamous cell cancer,elder was significantly more than young and middle-aged group (P<0.01). While among the small cell lung cancer,elder was significantly lower than young and middle-aged group(P<0.01).Under bronchoscope

  15. 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

  16. 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.

  17. 不同体位保护性通气模式对误吸性急性肺损伤的影响及机制研究%Effects and mechanism of different postural protective ventilation in patients with aspiration in acute lung injury

    Institute of Scientific and Technical Information of China (English)

    陈锋; 王晨; 祝旭清; 何宗广; 郑静; 张茵

    2013-01-01

    Objective To investigate the effect of different position on the clinical prognosis of acute lung injury of inhalation and to explore the mechanism.Methods 60 patients with acute lung injury of inhalation,which visited our hospital from January 2009 to December 2012,were randomly divided into group A and group B,30 cases in each group.All cases in both groups received basic treatment of fibro-bronchoscope and low tidal volume ± positive end expiratory pressure lung protective ventilation.Cases in group A received ventilation in prone position,and cases in group B received ventilation in supine position.Respiratory function,level of interleukin-6 and tumor necrosis factor-α in both groups were detected before and 24 h after treatment,and clinical prognosis in four weeks after treatment was followed.Results Arterial partial pressure of oxygen,oxygenation index,saturation of pulse oximetry,and heart rate in group A were better than those in group B (P <0.01),and levels of interleukin-6 and tumor necrosis factor-α in group A were lower than those in group B (P <0.01).The mortality in group A (3.33%) was lower than that in group B (20.00%,P <0.05).Conclusions Prone position can improve clinical prognosis of acute lung injury of inhalation,and the mechanism is probably related to improving the respiratory function and inhibiting the inflammatory status.%目的 研究采用俯卧位和仰卧位保护性通气模式对误吸性急性肺损伤患者的影响,并探讨其机制.方法 2009年1月至2012年12月的误吸性急性肺损伤患者60例,随机分为A组和B组,每组30例.两组均采用急诊经纤维支气管镜治疗和保护性通气模式(小潮气量+呼气末正压通气)辅助通气.A组采取俯卧位,B组仰卧位.检测两组患者治疗前和治疗后24 h的呼吸功能、血流动力学指标及血清白介素6(IL 6)、肿瘤坏死因子α(TNF-α)的水平,并随访4周时两组的临床预后.结果 A组患者治疗后24 h时的动脉

  18. Comprometimento da árvore respiratória na granulomatose de Wegener Laryngeal and tracheobronchial involvement in Wegener's granulomatosis

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    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.

  19. 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

  20. 胸部CT与钡餐透视检查对食管癌诊断价值研究%Research on Value of Chest CT and Barium Meal Fluoroscopic Examination in Diagnosis of Esophagus Cancer

    Institute of Scientific and Technical Information of China (English)

    李北平

    2016-01-01

    Objective To discuss the application value of chest barium meal fluoroscopy, CT and gastroscope in diagnosis of esophagus cancer. Methods 76 cases of patients with esophagus cancer diagnosed in our hospital from January 2014 to De-cember 2015 were selected, 44 cases of patients with benign lesions of pars oesophagea treated at the same period were se-lected for comparison, the different examination methods included barium meal fluoroscopy, CT and bronchoscope, all pa-tients received the above examinations, and the diagnostic accuracy of various methods was compared and analyzed. Results The diagnostic accuracy rates of barium meal fluoroscopy, CT and gastroscope for esophagus cancer were respectively 67.11%, 90.79% and 92.11%, the diagnostic accuracy rate of CT and gastroscope for esophagus cancer was higher than that of barium meal fluoroscopic diagnosis, the diagnostic accuracy rate of CT for lesions of pars oesophagea was higher than that of barium meal fluoroscopy with statistical difference(χ2=5.37, P0.05). Conclusion Chest barium meal fluoroscopy can be in the first place in the initial diagnosis and screening of esophagus cancer in clinic, and the CT and gastroscope can be used for further examination, which is of impor-tant significance to improve the diagnosis rate of esophagus cancer in clinic.%目的:探讨胸部钡餐透视、CT和胃镜对食管癌诊断的应用价值。方法整群选取该医院2014年1月—2015年12月间就诊的76例食管癌患者作为研究对象,选取同期44例食管部良性病变患者作为对照,并根据检查方法的不同分为钡餐透视、CT、支气管镜,所有患者均进行以上检查,对比和分析各种方法在诊断中的准确性。结果钡餐透视对食管癌的诊断准确率为67.11%,CT为90.79%,胃镜为92.11%,CT与胃镜对食管癌的诊断准确率高于钡餐透视诊断,对食管部病变的诊断准确率CT高于钡餐透视,差异有统计学意义(χ2=5.37,P0.05

  1. 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.

  2. Effect of Nasotracheal Intubation Guided by Fiberbronchoscope in with Traumatic Brain Injury Patients Treatment Respiratory Insufifciency%纤支镜引导下经鼻气管插管在颅脑外伤并发呼吸功能不全中的救治效果

    Institute of Scientific and Technical Information of China (English)

    贡换龙; 陆茸; 马莹; 尹玲

    2014-01-01

    Objective:Discussion the fiberoptic nasotracheal intubation under medical treatment in craniocerebral trauma complicated with respiratory insufficiency. Methods:Choose traumatic brain injury with respiratory insufficiency patients 80 cases as research object, In the active treatment of the original diseases by fiberoptic bronchoscopy guided nasotracheal intubation mechanical ventilation, Select SIMV, A/C or PSV ventilation mode, according to the condition of adjustment of mechanical ventilation parameters. Results:80 cases of nasal trachea cannula a success, the success rate was 100%, the average (2.01 ± 0.28) min;There is no fracture, operation of sinusitis and other adverse reactions, the remaining average (8.45±3.45) d;Incidence of pulmonary infection in 5 cases, 10 cases of hoarseness, 9 cases of nasal bleeding, 5 cases of ductal incomplete resistance, 4 cases of accidental extubation;72 patients were discharged, 8 patients died, the survival rate is 90%.Conclusions:Guided by fiber bronchoscope nasotracheal intubation is one of the important measures to establish artificial airway rescue craniocerebral trauma, Has the advantages of simple, rapid, less trauma, can be repeatedly used and less complications etc.%目的:探讨纤支镜引导下经鼻气管插管在颅脑外伤并发呼吸功能不全中的救治效果。方法:选择80例颅脑外伤合并呼吸功能不全患者作为研究对象,在积极治疗原发病的同时采用经纤维支气管镜引导经鼻气管插管实施机械通气,选择SIMV、A/C或PSV通气模式,根据病情调整呼吸机参数。结果:80例经鼻气管插管一次成功,成功率100%,平均(2.01±0.28)min;操作中无骨折、鼻窦炎等不良反应发生,留管平均(8.45±3.45)d;发生肺部继发感染5例,声音嘶哑10例,鼻出血9例,导管不全阻5例,意外拔管4例;72例存活出院,死亡8例,抢救成功率90.00%。结论:纤维支气管镜引导下经鼻气管插

  3. STUDY OF TIME LAPSE IN FOREIGN BODY ASPIRATION IN RELATION TO CHEST X - RAY AND TYPE OF FOREIGN BODY

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    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

  4. Research on 2005-2012 Single Disease Misdiagnosis Document of Misdiagnosed Disease Database:Foreign Bodies in Child Trachea%误诊疾病数据库2005-2012年单病种误诊文献研究:小儿气管异物

    Institute of Scientific and Technical Information of China (English)

    国献素; 刘芳; 徐通; 王红艳

    2015-01-01

    foreign bodies in trachea who are in a critical condition need to be diagnosed as quickly as possible. For the suspected cases of foreign body in bronchus, the doctor should perform bronchoscopic examination and treatment soon in order to reduce child mortality rate.

  5. 重症新型甲型H1N1流感患儿合并塑型性支气管炎一例并文献复习%Plastic bronchitis associated with severe influenza A (H1N1) in children: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    孙德军; 杨友生; 王宝春

    2010-01-01

    Objective To improve understanding of the pathological and clinical features,diagnosis and treatment of plastic bronchitis associate with influenza A ( H1N1 ).Methods One case of plastic bronchitis associated with influenza A ( H1N1 ) diagnosed and treated in our hospital in January 2010 was reported and 19 cases of plastic bronchitis reported in the literature were reviewed.Results We describe a 5-year-old Chinese Japanese boy presenting with cough for 2 days,gasping and fever for 1 day was admitted.Left lung atelectasis and pneumothorax were found on chest X-ray examination.Pathologically,plastic bronchitis was diagnosed after the endogenous foreign body was extracted by bronchoscopy and classified as type 1 cast.In addition,influenza A (H1N1) was confirmed by the swabs which showed positive for H1N1 nucleic acid.The condition was controlled and the patient was cured and discharged after 16-days' treatment with antiviral therapy,low-dose corticosteroids,and antibiotics.Conclusion Plastic bronchitis associated with influenza A (H1N1) is a rare life-threatening disorder.The diagnosis could be made based on pathological findings of the bronchial casts as well as the positive H1N1 nucleic acid detection.Bronchoscopic extraction of casts in plastic bronchitis is not only useful for early diagnosis but an effective therapeutic modality for the disease.Influenza A( H1N1 ) may be a cause of plastic bronchitis.%目的 提高对新型甲型H1N1流感(简称甲型流感)合并塑型性支气管炎病理特点、临床特征、诊断、治疗的认识.方法 报道2010年1月厦门大学附属中山医院中心ICU收治的1例甲型流感合并塑型性支气管炎病例并进行相关文献复习.结果 患儿男,5岁,日籍华裔,咳嗽2 d加剧伴气喘,发热1 d,X线胸片示左肺不张、气胸,支气管镜检查吸出条索状异物,病理结果显示为塑型性支气管炎Ⅰ型,咽拭子甲型流感核酸检测阳性,经抗病毒、小量糖皮质激素、

  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. 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

  8. 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.

  9. Clinical treatment analysis on 36 patients with bronchiectasis complicated with asthma%支气管扩张合并哮喘36例临床治疗分析

    Institute of Scientific and Technical Information of China (English)

    刘锋; 钟丽球

    2013-01-01

    目的:观察我院收治的36例支气管扩张合并哮喘患者的临床治疗效果,并分析其治疗方案。方法选取我院2010年3月~2013年2月收治的支气管扩张并哮喘患者36例,对其使用抗菌、化痰等药物进行常规治疗,同时使用糖皮质激素静脉注射与雾化吸入联合应用,辅助以无创正压通气及纤维支气管镜下吸痰等物理治疗,观察其临床治疗效果。结果所有入组患者在治疗后临床症状及体征均有明显的缓解,痰涂片实验室检查及肺功能检测各项指标水平均有明显改善,差异有统计学意义(P<0.05)。结论支气管扩张合并哮喘患者临床治疗难度较高,我院通过对其进行多途径、多机制联合用药治疗并辅以物理治疗,能够有效的缓解其临床症状,改善患者肺功能情况与病情,具有理想的临床应用效果与价值。%Objective To observe the clinical therapeutic effect of 36 patients with bronchiectasis complicated with asthma in our hospital, and analyze its treatment plan. Methods Thirty-six patients with bronchiectasis complicated with asthma admitted into our hospital from March 2010 to February 2013 were selected. All patients were treated with antimicrobial and reducing phlegm drugs routine treatment, as well as glucocorticoid intravenous injection combined with aerosol inhalation therapy, and aided by noninvasive positive pressure ventilation and bronchoscopic suctioning phlegm physical therapy. The clinical therapeutic effect of patients was observed. Results The clinical symptoms and signs of all patients relieved obviously after the treatment, and the sputum smear laboratory examination and level of pulmonary function testing indexes improved obviously, the differences had statistical significance between before and after the treatment(P<0.05). Conclusion The clinical treatment of bronchiectasis complicated with asthma is difficult, which treated by multi ways

  10. 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

  11. Risk factors analysis of ventilator associated pneumonia and its nursing countermeasures%呼吸机相关性肺炎的危险因素分析与护理对策

    Institute of Scientific and Technical Information of China (English)

    彭丽; 蔡益民

    2014-01-01

    目的::探讨呼吸机相关性肺炎的危险因素与护理对策。方法:选取2012年1月~2013年12月我院住院的60例呼吸机相关性肺炎病例为观察组,并随机选择同时期行机械通气未发生呼吸机相关性肺炎病例60例作为对照组。单因素分析采用t检验或χ2检验,多因素分析采用logistic回归分析。结果:两组病例经单因素分析发现,年龄≥65岁、机械通气时间≥5 d、营养危险指数( NRI)≤55、急性生理和慢性健康( A-PACHE Ⅱ)评分≥15、吸痰方式、纤维支气管镜吸痰和使用抗菌药物与呼吸机相关性肺炎有关(P<0.05)。 Logistic多因素回归分析发现,年龄≥65岁(OR 7.30)、机械通气时间≥5 d(OR 4.60)、营养危险指数(IVRI)≤55(OR 3.12)和急性生理和慢性健康(APACHEⅡ)评分≥15(OR 6.13)为独立危险因素。结论:年龄≥65岁、机械通气时间≥5天、营养危险指数≤55和APACHE II评分≥15是呼吸机相关性肺炎的重要危险因素。%Objective:To explore the risk factors and nursing measures of ventilator associated pneumonia. Methods:From January 2012 to December 2013 60 cases of ventilator associated pneumonia in hospital as obervation group,and randomly selected at the same time line mechanical ventilation without venti-lator associated pneumonia 60 cases as control group. The data were treated with single factor analysis of t test andχ2 test,multiple factors analysis of logistic regression. Results:Single factor analysis found that age more than or equal to 65,mechanical ventilation time more than or equal to 5 d,nutritional risk index is less than or equal to 55,APACHEⅡscore more than or equal to 15,sucking phlegm, sputum suction fiber bronchoscope and use of antimicrobial agents related to the ventilator associated pneumonia (P<0. 05) of two groups. Logistic multifactor regression analysis found that age more than or equal to 65 (OR=7. 30),the mechanical ventilation time more

  12. 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

  13. Application of the Modified Deep Suction Methods for Patients with Severe Traumatic Brain Inj uries Undergoing Tracheotomy%改良深部吸痰法在重型颅脑损伤气管切开患者中的应用

    Institute of Scientific and Technical Information of China (English)

    毕娜; 王建荣

    2015-01-01

    Objective To discuss the application effect of modified deep suction in tracheotomy patients with severe traumatic brain injuries.Methods By convenience sampling,4 0 cases with severe traumatic brain injuries undergoing tracheotomy were selected and divided as study and control group randomly.Patients in the control group followed the routine suction methods.Patients in the study group followed the modified deep suction methods,in which the speed of insertion tube reduced as the tip over the cannula tip 0 .5 cm,until the reflection of tussis occurred or suction while feel the resistance in weasand.Bleeding and bronchoscopic status of airway mucosa,breath-hold time,patency of tracheotomy tube and CPIS were observed.Results The CPIS scores after third and seventh hour of tracheotomy were higher than them before the surgery in both groups (P0 .0 5 ).The breath hold time in study group was less than control group,and the incidence of injury of airway mucosa was less than which in control group (P 0 .0 5 ).Conclusion Modified deep suction can reduce the injury of airway mucosa and the breath-hold time,help to reduce lung infection and maintaining patency.%目的:探讨改良深部吸痰法在重型颅脑损伤后气管切开患者中的应用效果。方法采用便利抽样法选择2013年6-10月解放军第309医院神经外科 ICU收治的重型颅脑损伤后气管切开早期非机械通气患者40例,采用随机数字表法分为对照组和研究组。对照组采用常规吸痰法;研究组采取改良深部吸痰法,即在吸痰管尖端超过套管末端0.5 cm时减慢插入速度,直至患者出现呛咳反射或感觉到气管隆凸阻力时吸痰。观察两组患者气道黏膜损伤情况、吸痰时患者屏气时间、人工气道通畅程度及临床肺部感染积分(clinical pulmonary infection score,CPIS)。结果两组患者气管切开后3、7 d 时的 CPIS均高于气管切开前,差异有统计学意义(P<0.05);但3个时间点

  14. Detection of epidermal growth factor receptor mutations in small specimens of non-small cell lung cancer by amplification refractory mutation system%扩增阻滞突变系统法检测非小细胞肺癌微小标本表皮生长因子受体突变

    Institute of Scientific and Technical Information of China (English)

    任睿欣; 李嘉瑜; 李雪飞; 陈秀; 任胜祥; 周彩存

    2012-01-01

    目的:探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)微小标本代替大体标本用于扩增阻滞突变系统(amplification refractory mutation system,ARMS)法检测表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变的可行性.方法:181例NSCLC标本纳入本研究,包括157例微小标本(分别为CT引导下经皮肺穿刺活检标本、支气管内超声引导下针吸活检标本、淋巴结活检标本、支气管镜活检标本和胸腔积液)和24例大体标本.采用QIAGEN DNA提取试剂盒提取标本组织DNA,然后使用AmoyDx人类EGFR基因4种突变荧光PCR检测试剂盒检测EGFR基因的突变情况,最后采用x2检验或Fisher精确检验比较微小标本与大体标本的EGFR突变检出率.结果:181例标本中,EGFR的总突变率为39.8% (72/181);其中微小标本的EGFR突变检出率为38.9%,大体标本的EGFR突变检出率为45.8%,2者间差异无统计学意义(P=0.515).EGFR突变率在不吸烟患者(P=0.033)和腺癌患者(P<0.001)中显著增高.结论:ARMS法检测NSCLC微小标本也能获得较高的EGFR突变检出率.对于晚期难以获得大体标本的NSCLC患者,微小标本可代替大体标本应用于临床EGFR突变检测.%Objective: To explore the feasibility of the application of small specimens as alternatives of gross specimens to detect EGFR (epidermal growth factor receptor) mutation in NSCLC (non-small cell lung cancer) by ARMS (amplification refractory mutation system). Methods: Biopsy specimens from 181 cases of NSCLC were collected, in which 157 were small specimens (including specimens acquired through CT-guided percutaneous lung biopsy, endobronchial ultrasound-guided transbronchial needle aspiration, lymph node biopsy, bronchoscopic biopsy and aspiration of pleural effusion) and 24 were gross specimens. QIACEN DNA extraction kit was used to extract DNAs from NSCLC specimens. Then AmoyDx EGFR Mutation Test Kit - a highly sensitive real-time PCR

  15. 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

  16. 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

  17. 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

  18. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle – a perspective on a new tool to avoid stent migration of Dumon stents

    Directory of Open Access Journals (Sweden)

    Hohenforst-Schmidt W

    2015-05-01

    fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level, it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.Keywords: stent, airway, cone-beam computer tomography, Berci

  19. Application of muscle relaxants in pediatric anesthesia with tracheal foreign body removal%肌松药在小儿气管异物取出术的麻醉应用

    Institute of Scientific and Technical Information of China (English)

    张文斌; 石泉; 赵振海; 秦学斌

    2011-01-01

    Objective To investigate the efficacy and safety of muscle relaxant atracurium in pediatric anesthesia with tracheal foreign body removal. Methods 60 cases with foreign body in children were randomly divided into two groups: without muscle relaxant anesthesia group (A group): intravenous injection of midazolam 0.05~0.1 mg/kg,etomidate 0.2~0.3 mg/kg, fentanyl 1~2μg/kg, spontaneous respiration or mask ventilation; muscle relaxant anesthesia group (B group): A group in the method of anesthesia based on the use of atracurium O. 1~0.3 mg/kg, mask artificial ventilation; bronchoscope into two groups after the high-frequency ventilation were used. Surgery in children with breath holding record cough, SpO2<90% of the frequency and recovery time, postoperative nausea and vomiting (PONV), set to mirror the number of times and had set off glottic foreign bodies mirror the degree of difficulty. Resuits Breath-hold technique in the cough, SpO2<90% of the frequency and recovery time, PONV, home mirror the number of times over the glottis off foreign bodies in B groups were less than those in the A group (P<0.05). Conclusion In pediatric foreign body removal surgery, the application of atracurium to eliminate the choking breath-hold technique, can reduce the occurrence of hypoxia, rapid postoperative recovery.%目的 探讨肌松药阿曲库铵用于小儿气管异物取出术的麻醉效果和安全性.方法 60例气管异物患儿,随机分为两组.无肌松麻醉组:静脉注射咪达唑仑0.05~0.1 mg/kg、依托咪酯0.2~0.3 mg/kg、芬太尼1~2 μg/kg,保留自主呼吸或面罩辅助呼吸;肌松麻醉组:在无肌松麻醉组的麻醉方法基础上加用阿曲库铵0.1~0.3 mg/kg,面罩人工通气;两组置入气管镜后均采用高频通气.记录患儿术中屏气呛咳、SPO2<90%的次数和苏醒时间、术后恶心呕吐(PONV)、置镜次数、过声门异物脱落次数及置镜的难易程度.结果 术中屏气呛咳、SPO2<90%的

  20. 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.

  1. 赵氏Ⅱ型人工气管实验研究%Experimental study of type-Ⅱ ZHAO's artificial trachea

    Institute of Scientific and Technical Information of China (English)

    赵凤瑞; 陈万生; 郝雁冰; 赵轶峰; 李彦明; 马振东

    2008-01-01

    Objective To test an artificial trachea which could heal iologically with native trachea and avoid two-stage opera-tion. Methods A 5 cm-long sheep trachea pre-treated with 0.625 % glutaraldehyde, and a Sigma stainleas steel stem was positioned inside tracheal lumen, so made a type-Ⅱ ZHAO's artificial trachea. After resection of 5 cm trachea, the tracheal defect was recon-structed with ZHAO's artificial trachea. X-ray, bronchoscopic and pathologic examination took place periodically at 1, 2 weeks and 1, 3, 6, 12 months to observe the healing. Results Biological healing of artificial with native trachea was achieved in all 6 animals.The mucous membrane was alive. The animals were all long-term survivals. At 3 month the stent was in place and the lumen was well open although there was absorption of part of cartilage cells. At 6 and 12 month the artificial trachea remained well with slight granula-tion and stenosis aroundthe anastomosis. Conclusion Made from preserved homogenous trachea with Sigma stent, type-Ⅱ ZHAO's artificial trachea could be healed with native trachea biologically. Airway remained open and long-term survival was achieved in all animals.%目的 探索一种不必分期手术而且能与自体气管达到生物性愈合的人工气管.方法 用长5cm羊气管,经过0.625%戊二醛处理后,腔内缝置长6 cm Sigma不锈钢丝支架,制成赵氏Ⅱ型人工气管.实验时切除羊颈段气管5 cm,用人工气管重建.手术后1、2周、1、3、6及12个月拍颈部X线片、行支气管镜检查,然后处死实验动物检查大体和镜下病理,观察人工气管愈合情况.结果 6只实验动物人工气管与自体气管均顺利达到生物性愈合,黏膜成活,实验动物长期存活.3个月时有部分软骨细胞融解吸收,但支架位置良好,管腔通畅.6及12个月后标本显示人工气管完全成活,但吻合口处有少量肉芽增生,管腔轻度狭窄.结论 赵氏Ⅱ型人工气管可以与自体气管形成生物

  2. 人工气管移植的病理学变化%Pathological change of artificial trachea transplant

    Institute of Scientific and Technical Information of China (English)

    陈万生; 焦英华; 郝雁冰; 吴广忠; 赵轶峰; 李彦明; 王大伟; 赵凤瑞

    2013-01-01

    Objective To discuss a kind of artificial trachea which could biologically fuse with autologous trachea.Methods Firstly used allogenic fresh sheep pericardium treated by 0.625% glutaraldehyde to surround a 6cm long Sigma stainless steel wire net stents to prepare the artificial trachea.Then resected a 5cm long cervical trachea of the sheep and sutured the upper and lower end with the artificial trachea.Observed the healing of the artificial trachea by X-ray and bronchoscopic examination 50,90 and 150 days after the operation.Pathological examination was performed at regular intervals to observe the healing of the anastomotie stoma,blood circulation and the conditions in the artifical trachea and to supply theoretical bases for the clinical.Results The artificial trachea and the autolagous trachea healed together in all of the 8 animals and trachea like tissues formed to fill the defect area but the change need sufficient time.50 days after the operation there was no obvious ciliated columnar epithelium in the transplanting area.90 days after the operation there was a small quantity of ciliated columnar epithelium but the tissues were not complete.150 day after the operaiton the tissues of the trachea in the transplanting area were relatisely complete—the mucosa was covered by the ciliated columnar epithelium,the small blood vessels were abundent in the mtucosa and submucosa and the gland could be seen.Conclusion Artificial trachea can induce the receptor trachea tissues to form a complete trachea,each lay of the trachea is relatively complete and the experiment animals can be long-term survival.%目的 探讨一种能与受体气管愈合成为一体的人工气管.方法 异体新鲜(羊)心包,经过0.625%成二醛处理后,包绕长6 cm Sigma不锈钢丝网支架,预制成人工气管.实验动物(羊)切除颈段气管5 cm.用人工气管与气管上下断端吻合.手术后50、90、150天行X线片、支气管镜检查,观察人工气管愈合情况.

  3. 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.

  4. 59例支气管结石病的外科治疗%Surgical management of broncholithiasis

    Institute of Scientific and Technical Information of China (English)

    谢冬; 金宇星; 费苛; 王海峰; 周晓; 陈昶; 朱余明; 姜思明; 段亮

    2015-01-01

    patients with symptomatic improvement.Conclusion Our findings indicate that chest CT and endoscopic findings could be used for the diagnosis of broncholithiasis.Bronchoscopic therapy and surgical resection for broncholithiasis are effective methods of management for broncholithiasis.%目的 总结支气管结石的外科诊治经验.方法 1980年1月至2013年12月,手术治疗支气管结石病59例中男27例,女32例;平均年龄(54.1±6.2)岁.体检发现3例,余56例均因各种症状就诊.支气管结石发病部位:左侧22例,右侧37例;段支气管开口23例,叶支气管开口30例,右中间支气管2例,主支气管4例.胸部CT检查52例,均表现为支气管腔内的高密度斑块状影,并阻塞管腔,可伴有远端支气管狭窄、扩张、炎症或肺门纵隔淋巴结钙化.纤维支气管镜检查56例,未见明显异常18例,肉芽包裹样病灶12例,结石样病灶26例.择期手术55例,因大咯血急诊手术4例;行支气管切开取石3例,肺叶切除42例,支气管袖式切除3例,肺动脉成形术3例,右肺双叶切除3例,全肺切除4例,余肺切除1例.结果 全组手术顺利,无术中及术后死亡,7例发生并发症.平均手术(175.2 ±32.8)min,平均失血量为(271±103) ml,平均术后住院(8.2±3.4)天.53例平均随访22.8个月,49例术后无症状,4例症状改善.结论 胸部CT、内镜技术以及手术切除是诊断治疗支气管结石的有效措施.

  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. Infiltrados pulmonares en pacientes con cáncer Pulmonary infiltrates in cancer patients

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    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.

  7. 肢体缺血预处理对肺叶切除术患者肺组织水通道蛋白1表达的影响%Effect of extremity ischemic preconditioning on expression of aquaporin 1 in lung tissues of patients undergoing pulmonary lobectomy

    Institute of Scientific and Technical Information of China (English)

    韩登阳; 丛丽; 孙立新; 王明山

    2016-01-01

    Objective To evaluate the effect of extremity ischemic preconditioning on the expression of aquaporin 1 (AQP1) in the lung tissues of patients undergoing pulmonary lobectomy.Methods Forty-six American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 30-64 yr,weighing 50-80 kg,scheduled for elective pulmonary lobectomy performed via a thoracoscope,were randomly divided into 2 groups (n =23 each) using a random number table:control group (group C) and extremity ischemic preconditioning group (group R).After induction of anesthesia,the patients were intubated with the double-lumen tube.Correct position of the tube was verified with the fiberoptic bronchoscope.In group R,ischemic preconditioning was induced by 3 cycles of 5-min lower extremity ischemia followed by 5-min reperfusion after induction of anesthesia.Lung tissues were obtained when the lobe of the lung was removed during surgery for determination of AQP1 expression (by Western blot) and wet/dry lung weight ratio and for microscopic examination of pathologic changes which were scored.Immediately after onset of one-lung ventilation,at 30 and 60 min of one-lung ventilation,and at 1 h after restoration of two-lung ventilation,arterial blood samples were collected for blood gas analysis,and the oxygenation index was calculated.The development of postoperative complications and length of postoperative hospital stay were recorded.Results Compared with group C,the expression of AQP1 was significantly up-regulated,and oxygenation index at 30 and 60 min of one-lung ventilation and 1 h after restoration of two-lung ventilation were significantly increased,the pathologic score,the wet/dry lung weight ratio and incidence of postoperative pneumonia and atelectasis were significantly decreased,and the length of postoperative hospital stay was significantly shortened in group R (P< 0.05).Conclusion Extremity ischemic preconditioning can reduce lung injury through up-regulating AQP1 expression in the

  8. Clinical Observation of Single lumen endotracheal tube used for children with single lung ventilation%单腔气管导管用于儿童单肺通气的临床应用观察

    Institute of Scientific and Technical Information of China (English)

    汪俊; 汪幸; 韩芬; 夏迎静

    2014-01-01

    目的:通过观察单腔气管导管用于儿童单肺通气(OLV)的应用,探讨其在临床应用的安全性。方法:随机选取14例行胸科手术患儿,全麻诱导气管插管后,将单腔气管导管在纤维支气管镜(φ:2.8mm)引导下置入健侧主支气管,并经听诊后确定封堵效果。观察单肺通气前(T1),单肺通气5mim后(T2),单肺通气结束前(T3),单肺通气结束后(T4)的心率HR、血压BP、SpO2、动脉血气分析、气道压力(PAW)变化。结果:左侧单肺通气5例,右侧单肺通气9例,单肺通气时间40~210mim。全组病例PaO2:T2较T1明显下降(204±102.2),T3持续小幅下降(202.9±112.3);T4基本恢复至单肺通气前水平(393.6±88.3)。 PaCO2:T2上升(36±4.8),T3持续升高(39.6±5.2),T4降至术前水平(36±5.1);PAW:T2升高(22±2.9),T3维持较高水平(21.4±2.3),T4恢复术前水平(17.9±1.9)。全组病例pH值各时间点数据无明显变化。结论:单腔气管导管能够安全的用于儿童的单肺通气。%Objective:by observing the single lumen endotracheal tube application of one-lung ventilation (OLV) in children and its safety in clinical application. Methods:randomly selected 14 children with routine thoracic surgery, after endotracheal intubation of general anesthesia induction, the single lumen endotracheal tube in fiber broncho-scope (φ:2.8 mm) guided into the contralateral primary bronchus, and determine the effect after auscultation. One-lung ventilation (T1), before the observation after 5 mim one-lung ventilation (T2), before the end of single lung ventilation (T3), single lung ventilation (T4), heart rate after HR, blood pressure (BP), SpO2, arterial blood gas analysis, and airway pressure changes (PAW). One-lung ventilation in 5 cases,Results:the left the right side of the 9 cases of single lung ventilation, 40-210 mim one-lung ventilation time. Incidence

  9. 支气管封堵器与双腔支气管导管用于食管癌根治术病人单肺通气效果的比较%Comparison of bronchial blocker and double-lumen tube for one-lung ventilation in patients undergoing esophageal cancer resection

    Institute of Scientific and Technical Information of China (English)

    杨禄坤; 梁军; 苏永辉; 肖笑雨; 范东毅; 周少朋

    2013-01-01

    目的 比较支气管封堵器与双腔支气管导管用于食管癌根治术病人单肺通气的效果.方法 择期行食管癌根治术的病人40例,性别不限,年龄42 ~ 63岁,ASA分级Ⅰ~Ⅲ级,采用随机数字表法,将其分为2组(n=30):双腔支气管导管组(DLT组)和支气管封堵器组(BB组).麻醉诱导后,DLT组经口插入左侧双腔支气管导管,随后用纤维支气管镜调整导管的位置.BB组先经口插入单腔气管导管,随后在纤维支气管镜的引导下插入支气管封堵器.记录插管时间、单肺通气时间、肺萎陷时间、手术时间、拔管时间、导管移位和低氧血症的发生情况;术毕行肺萎陷评分;记录气管拔管后2d内声嘶、喉痛的发生情况和术后7d内肺部感染的发生情况.结果 与DLT组比较,BB组插管时间和肺萎陷时间延长,术后声嘶和喉痛发生率降低(P<0.05),单肺通气时间、手术时间、拔管时间、肺萎陷评分、导管移位、低氧血症和术后肺部感染的发生率差异无统计学意义(P>0.05).结论 支气管封堵器用于食管癌根治术病人单肺通气的效果与双腔支气管导管相似.%Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 42-63 yr,scheduled for elective esophageal cancer resection,were randomly divided into 2 groups (n =20 each):double-lumen endotracheal tube group (group DLT) and bronchial blocker group (group BB).After induction of anesthesia,the patients were intubated with a left-sided double-lumen endotracheal tube and correct positioning was verified by fiberoptic bronchoscopy in group DLT.After induction of anesthesia,the patients were intubated with a conventional single-lumen endotracheal tube,and then the bronchial blocker was inserted under the guidance of fiberoptic bronchoscope in group BB.The intubation

  10. Microbiologic profile of flexible endoscope disinfection in two Brazilian hospitals Estudo microbiológico da desinfecção de endoscópios flexíveis em dois hospitais brasileiros

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    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

  11. 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

  12. 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

  13. 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

  14. Secondary pulmonary tuberculosis mainly with pulmonary interstitial changes:one case report and literature review%以间质性改变为主要表现的肺结核一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    吴迪; 李学玲; 林忠惠; 翁丽珍; 陈晓红; 刘坦业

    2015-01-01

    is to get the pathological tissues by fiber bronchoscope or percutaneous lung puncture biopsy. When necessary, it is proposed to do a video assisted thoracic surgery.%目的:提高对以肺间质性改变为主要表现的肺结核的认识。方法报道1例2011年确诊的以肺间质改变为主要表现的肺结核患者的临床资料、诊治经过及随访情况,并进行相关文献复习。以“间质,肺结核”为检索词通过万方医学数据库对中文文献检索,以“interstitial,pulmonary tuberculosis”为检索词通过PubMed数据库进行检索,检索时间截至2014年5月。结果患者女,31岁,因“咳嗽6个月,加剧伴气促20余天”为主诉入院。入院前曾误诊为“慢性咽炎、慢性支气管炎、支气管哮喘”。入院查胸部CT显示双肺可见广泛性肺间质改变,并出现散在斑片影,边界模糊,部分病灶呈磨玻璃样。经纤维支气管镜于右肺下叶基底段肺活检(TBLB):肉芽肿炎伴小灶性坏死,考虑结核。异烟肼、利福平、吡嗪酰胺、乙胺丁醇(HRZE)规则抗结核治疗后,咳嗽、气促渐缓解,病灶渐吸收,随访至今29个月,未见复发。在万方医学数据库上检索到相关文献13篇,1例为个案报道,其余多为误诊分析或影像表现研究;在PubMed数据库检索,国外未见相关报道。结论以间质性改变为主要表现的肺结核好发于中青年男性,亚急性病程,临床症状不典型,以咳嗽、呼吸困难、发热最为常见,胸部CT是早期诊断的关键,网格样改变、小叶间隔增厚、小叶中心性结节、胸膜受累、树芽状是活动性间质性肺结核主要影像学表现。当与肺部弥漫性疾病难以鉴别时,经纤维支气管镜及CT引导下肺穿刺术取得组织病理学是诊断的关键,必要时可考虑行外科开胸活检术。

  15. Supreme喉罩联合Coopdech支气管阻塞器用于食道癌根治术患者气道管理效果%Effiacy of Coopdech bronchial blocker combined with a laryngeal mask airway Supreme for airway management in patients undergoing esophageal carcinoma resection

    Institute of Scientific and Technical Information of China (English)

    陈珂; 王纯辉; 李元海; 顾尔伟; 鲁显福; 邹宏运

    2014-01-01

    Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a laryngeal mask airway Supreme for airway management in patients undergoing esophageal carinoma resection.Methods Sixty patients undegoing esophageal carcinoma resection were randomly divided into 3 groups (n=20):double-lumen tube group (group DT),Coopdech bronchial blocker combined with single-lumen tube group (group TC) and Coopdech bronchial blocker combined with a laryngeal mask airway Supreme group (group SC).The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups.The first attempt success rates of intubation,the intubation time,positioning time,the number of fiberoptic bronchoscopy attempts,degree of lung collapse,postoperative atelectasis,postoperative sore throat and hoarseness were recorded.Blood pressure (BP),heart rate (HR) and bispectral index (BIS) were recorded before anesthesia(T0),immediately after intubation(T1) and at 1,3 min and 5 min after intubation (T2-4).Airway pressure (Paw) and end tidal carbon dioxide partial pressure (PETCO2) was recorded at two lung ventilation 10 min(T5) and 10 (T6),30(T7),60 min(T8) after one lung ventilation(OLV).Results Compared to group DT,The intubation time and the positioning time was significantly shorter in group TC and group SC.Compared with T1,HR,BP and BIS significantly increased in group TC and group SC group at number of patients required for tube T2-4.Compared with group group DT,there was no significant difference in SP,DP,HR,BIS,the displacement,the number of fiberoptic bronchoscopy attempts and degree of lung collapse among the three groups.Paw was significantly higher during OLV at group DT than group SC.Incidences of postoperative sore throat and hoarseness were significantly lower in group SC (20%) compared to group DT (80%) and group TC (45%).Conclusions The efficacy of the Coopdech bronchial blocker combined laryngeal mask airway Supreme is safe in patents undergoing esophageal

  16. 右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果%Efficacy of dexmedetomidine- assisted topical anesthesia in patients undergoing bronchoalveolar lavage

    Institute of Scientific and Technical Information of China (English)

    周金萍; 蔡璐; 陈公锦; 王淼; 刘冬炎; 金原野; 马连军; 袁飞

    2011-01-01

    目的 探讨右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果.方法 拟行支气管肺泡灌洗术的ICU患者24例,ASA分级Ⅱ或Ⅲ级,体重50~80 kg,年龄24~64岁,采用随机数字表法,将患者随机分为2组(n=12),A组术前30 min静脉注射0.9%生理盐水5 ml,术前5 min经气管导管或气管套管内注入2%利多卡因5~10 ml,随后按需每15~30 min经纤维支气管镜追加2%利多卡因5 ml,总量控制在20 ml以内;B组术前30 min缓慢静脉注射右美托咪啶0.5~1.0 μg/kg,随后以0.1~0.5 μg·kg-1·h-1速率维持,表面麻醉方法同A组.记录灌洗时间、不良反应及心血管不良事件的发生情况.于灌洗前20 min(T1)、灌洗开始后20 min(T2)、灌洗结束后20 min(T3)时采集血样,测定血浆儿茶酚胺浓度和血清皮质醇浓度.结果 与A组比较,B组血清皮质醇浓度、血浆儿茶酚胺浓度降低、不良反应及心血管不良事件发生率降低,操作时间缩短(P<0.05).与T1时比较,A组T2,3时血清皮质醇及血浆儿茶酚胺浓度升高,B组T2,3时血清皮质醇及血浆儿茶酚胺浓度降低(P<0.05).结论 右美托咪啶辅助表面麻醉可安全有效地用于患者支气管肺泡灌洗术.%Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was

  17. 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

  18. 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

  19. Clincal observation of lung recruitment strategy in prevention of alveolar collapse after bronchoscopy%肺复张策略对防止纤支镜治疗后肺泡塌陷的作用观察

    Institute of Scientific and Technical Information of China (English)

    谢志斌; 叶燕青

    2013-01-01

    Objective:To investigate the efficacy of lung recruitment strategy in prevention of alveolar collapse in patients after fibrobronchoscopic treatment.Methods:Sixty patients with mechanical ventilation required bronchoscopic treatment were randomly divided into treatment group (lung recruitment group) and control group (conventional mechanical ventilation group).The arterial blood gas,parameters of anaerobic metabolism and hemodynamic index were compared between the two groups.Results:PaO2 was (114.25 ± 24.75) mmHg and PaCO2 was (32.56 ± 7.73) mmHg before treatment in treatment group,while PaO2 was (112.12 ± 20.41) mmHg and PaCO2 was (31.56 ± 6.63) mmHg 30 minutes after lung recruitment.There was no significant differences at the level of PaO2 and PaCO2 before and after lung recruitment (P>0.05).PaO2 was (116.11 ±26.53) mmHg and PaCO2 was (30.12 ±5.53) mmHg in control group before fibrobronchoscopy.After 30 minutes' general mechanical ventilation,PaO2 was (86.21 ± 16.23) mmHg and PaCO2 was (31.56 ±6.63) mmHg in control group.The level of PaO2 after conventional mechanical ventilation was lower than that before conventional mechanical ventilation(P < 0.01),but there was no significant differences at level of PaCO2 (P > 0.05).Conclusions:Through lung recruitment strategy we can reexpanse the collapsed alveolars,attenuate the harm of hypoxemia,and almost not influence hemodynamic.%目的:探讨肺复张策略对防止纤支镜治疗后肺泡塌陷的效果.方法:将机械通气需纤维支气管镜检查的60例患者随机分为治疗组及对照组,治疗组采用肺复张策略,对照组行常规机械通气.比较2组动脉血气和氧代谢、血流动力学指标.结果:治疗组纤维支气管镜检查前PaO2(114.25±24.75) mmHg,PaCO2 (32.56±7.73) mmHg,肺复张30 min后PaO2(112.12±20.41) mmHg,PaCO2(31.56±6.63) mmHg,PaO2及PaCO2肺复张前后无明显差异(均P >0.05);对照组纤维支气管镜检查前PaO2(116.11±26.53) mmHg,PaCO2

  20. Pyopneumothorax caused by Salmonella choleraesuis: a case report and review of the literature%猪霍乱沙门菌致脓气胸一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    江立斌; 朱奕豪; 姚宇锋; 徐峻; 王真

    2012-01-01

    choleraesuis. Methods One case of pyopneumothorax caused by Salnonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed.As of May 2011,the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database. Results A 43 year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital.ACT scan of the chest revealed a massive shadow with mixed density in the right hemithorax,from the top of thorax to diaphragmatic surface,and there was air inside or surrounding the mass irregularly but without an air-fluid level.Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam,ceftazidime,and then imipenem-cilastatin) was ineffective.Open chest surgery was performed,and chest tube placed.Salmonella choleraesuis was isolated from the drained pleural fluid.Chest tube drainage remained in place for more than 6 weeks,and with prolonged antibiotic therapy,which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online,while 3 literatures were found in Pubmed,including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study,12 of these patients,including 9 men and 3 women,were infected with Salmonella species. The median age was 49 years,and 10 patients were immunocompromised,including malignancy,liver cirrhosis,and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis,and 4 (57%) of them died.Conclusions Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis

  1. 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.

  2. 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

  3. 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

  4. 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

  5. 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