WorldWideScience

Sample records for bronchoscopes

  1. [Bronchoscopic treatment of emphysema].

    Science.gov (United States)

    Fruchter, Oren; Kramer, Mordechai R

    2012-04-01

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

  2. BRONCHOSCOPIC THERAPY IN PATIENTS WITH INTRALUMINAL TYPICAL BRONCHIAL CARCINOID

    NARCIS (Netherlands)

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

    1995-01-01

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

  3. Tracheal schwannoma: Completely resected with therapeutic bronchoscopic techniques

    OpenAIRE

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

    2015-01-01

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

  4. Virtual bronchoscopic navigation in the diagnosis of peripheral pulmonary lesions with, an ultrathin bronchoscope

    International Nuclear Information System (INIS)

    Graphic data processed from thin-section chest CT images have enabled virtual bronchoscope image (VB), navigation which has also enabled short-time and accurate biopsy of small peripheral lung lesions by ultrathin bronchoscopes. However, the advantages and disadvantages of the diagnostic method have not been fully clarified. The purpose of this study was to clarify limits and problems in diagnostic procedures by virtual bronchoscopic navigation (VBN). Forty-six cases in which peripheral small lung lesions could not be recognized by conventional fluoroscopy were examined. From thin-section CT images, VB images to bronchi reaching lesions directly or as nearly as possible, were processed using workstation software (ZIO M900 Quadra). Then, transbronchial biopsy (TBB) with ultrathin bronchoscope was performed by VBN under real time CT-radiography. The correlation between diagnostic accuracy by these procedures and other factors, such as the size of the lesion, identification of the bronchus involved with the lesion on CT, and ability of forceps to biopsy the lesion were analyzed. In 27 cases, a bronchus directly involved with the lesion could be identified on CT. In 21 (77.8%), a diagnosis of lung carcinoma was established. In all cases in which the lesions were less than 10 mm, neither pulmonary artery nor the involved bronchus could be identified on CT, thus VB for the involved bronchus or accurate biopsy was not successful. Sensitivity, specificity, and diagnostic accuracy of TBB with VBN were 64.1%, 100%, and 65.9%, respectively. TBB with VBN is highly efficient for the accurate biopsy of a small lesion in the periphery of the lung, when the bronchus directly involved with the lesion is identified on CT. The existing virtual endoscopic software which has not been specified to airways is also practical for processing VB. However, this diagnostic method is limited when either the pulmonary artery or the bronchus involved with the lesion cannot be identified. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    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−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

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Science.gov (United States)

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

    2016-03-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a 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 (< 1 mm diameter) not visible by CT, dense peripheral 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.

  9. Bronchoscopic topical steroid instillation in prevention of tracheal stenosis

    OpenAIRE

    Ankit Agarwal; Singh, D. K.

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  12. Bronchoscopic lung biopsy for diagnosis of miliary tuberculosis

    Directory of Open Access Journals (Sweden)

    Aggarwal A

    2005-01-01

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

  13. Comparison of the glidescope®, flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study

    OpenAIRE

    Langley, Adrian; Mar Fan, Gabriel

    2014-01-01

    Background Smart phone technology is becoming increasingly integrated into medical care. Our study compared an iPhone modified flexible fibreoptic bronchoscope as an intubation aid and clinical teaching tool with an unmodified bronchoscope, Glidescope® and Macintosh laryngoscope in a simulated normal and difficult airway scenario. Methods Sixty three anaesthesia providers, 21 consultant anaesthetists, 21 registrars and 21 anaesthetic nurses attempted to intubate a MegaCode Kelly™ manikin, com...

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

    Science.gov (United States)

    Luo, Xiongbiao; Kitasaka, Takayuki; Mori, Kensaku

    2012-02-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  16. 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.

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

    Science.gov (United States)

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

    2015-12-01

    Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting. PMID:25940429

  18. 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

    OpenAIRE

    Vijay Kumar Bodal; Manjit S Bal; Sunita Bhagat; Jai Kishan; Deepika; Rupinder K Brar

    2015-01-01

    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 brushin...

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

    OpenAIRE

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    K Rennis Davis

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Animesh Ray

    2014-01-01

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

  6. Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate)

    OpenAIRE

    Chawla, Rakesh K.; Arun Madan; P K Bhardwaj; Kiran Chawla

    2012-01-01

    Context: Bronchopleural fistula (BPF) is a communication between the pleural space and bronchial tree. Materials and Methods: A series of 9 cases are reported where BPF was identified and managed with intrabronchial instillation of glue (N-butyl-cyanoacrylate) through a video bronchoscope. Results: Out of 9 patients the BPF was successfully sealed in 8 cases (88.88%). In 1 patient of postpneumonectomy, the fistula was big, that is >8 mm who had a recurrence after the procedure. In one case of...

  7. Bronchoscopic Implantation of a Novel Wireless Electromagnetic Transponder in the Canine Lung: A Feasibility Study

    International Nuclear Information System (INIS)

    Purpose: The success of targeted radiation therapy for lung cancer treatment is limited by tumor motion during breathing. A real-time, objective, nonionizing, electromagnetic localization system using implanted electromagnetic transponders has been developed (Beacon electromagnetic transponder, Calypso Medical Technologies, Inc., Seattle, WA). We evaluated the feasibility and fixation of electromagnetic transponders bronchoscopically implanted in small airways of canine lungs and compared to results using gold markers. Methods and Materials: After approval of the Animal Studies Committee, five mongrel dogs were anesthetized, intubated, and ventilated. Three transponders were inserted into the tip of a plastic catheter, passed through the working channel of a flexible bronchoscope, and implanted into small airways of a single lobe using fluoroscopic guidance. This procedure was repeated for three spherical gold markers in the opposite lung. One, 7, 14, 28, and 60 days postimplantation imaging was used to assess implant fixation. Results: Successful bronchoscopic implantation was possible for 15 of 15 transponders and 12 of 15 gold markers; 3 markers were deposited in the pleural space. Fixation at 1 day was 15 of 15 for transponders and 12 of 12 for gold markers. Fixation at 60 days was 6 of 15 for transponders and 7 of 12 for gold markers, p value = 0.45. Conclusions: Bronchoscopic implantation of both transponders and gold markers into the canine lung is feasible, but fixation rates are low. If fixation rates can be improved, implantable electromagnetic transponders may allow improved radiation therapy for lung cancer by providing real-time continuous target tracking. Developmental work is under way to improve the fixation rates and to reduce sensitivity to implantation technique

  8. Fluoroscopy-guided transnasal biopsy of nasopharyngeal carcinoma using a flexible bronchoscopic biopsy forcep

    International Nuclear Information System (INIS)

    Otolaryngoscopic biopsy of nasopharyngeal carcinoma is a generalized method which may be associated with inadequate sampling of tissue and patient discomfort. So, we tried fluoroscopy-guided transnasal biopsy using bronchoscopic biopsy forcep and evaluated its safety and efficacy. Prospectively we performed fluoroscopy-guided transnasal biopsy in 11 patients who were radiographically suspected of nasopharyngeal carcinoma. The posterior wall of the nasopharynx was coated with barium sulfate under fluoroscopy. A flexible bronchoscopic biopsy forcep with a steerable guiding catheter which was used in removal of intrahepatic duct stones was inserted through the nare. After localization of the tip of the biopsy forcep at tumor site with fluoroscopy, a tissue specimen was obtained. We also tried CT guided biopsy in initial 2cases. Each patient had otolaryngoscopic biopsy to compare the biopsy result and patient discomfort. We could have sufficient amount of tissue for pathological evaluation in 10 of 11 patients by the first pass with the fluoroscopic technique. Contrarily, otolaryngoscopic biopsy was successful in 7 of 11 patients on single passage. Additionally, 2 patients had complaint in our method comparing with 9 patients in otolaryngoscopic biopsy. Fluoroscopy-guided transnasal biopsy of nasopharyngeal carcinoma using the bronchoscopic biopsy forcep is safe and accurate. It can be a appropriate method competing otolaryngoscopic biopsy

  9. 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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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. PMID:26851436

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Manoj Meena

    2014-01-01

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

  13. A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy

    Directory of Open Access Journals (Sweden)

    Porpodis K

    2012-02-01

    Full Text Available Konstantinos Porpodis1, Michael Karanikas2, Paul Zarogoulidis1, Theodoros Kontakiotis1, Alexandros Mitrakas2, Agisilaos Esebidis2, Maria Konoglou3, Kalliopi Domvri1, Alkis Iordanidis4, Nikolaos Katsikogiannis5, Nikolaos Courcoutsakis4, Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece; 21st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 31st Pulmonary Department, "G Papanikolaou" General Hospital, Thessaloniki, Greece; 4Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 5Surgery Department (NHS, University General Hospital of Alexandroupolis, GreeceAbstract: Carcinoid bronchopulmonary tumors represent approximately 25% of all carcinoid tumors and 1%–2% of all lung neoplasms. The most common symptoms are: persistent cough, asthma-like wheezing, chest pain, dyspnea, hemoptysis and obstructive pneumonitis. We present a case of a young adult diagnosed with a typical carcinoid tumor. The diagnosis was established on the basis of imaging examination and bronchoscopic biopsy. The patient was treated with bronchoscopic electrocautery therapy to relieve the obstructed airway, followed by surgical lobectomy in order to entirely remove the exophytic damage. This approach was not only a palliative management to bronchial obstruction but also avoided pneumonectomy. Recent studies support the use of such interventional resection methods, as they may result in a more conservative surgical resection.Keywords: carcinoid tumor, typical lung carcinoid, therapeutic bronchoscopy, surgical resection

  14. An experience of bronchotomy and resectional procedures after failed bronchoscopic foerign body retrieval

    International Nuclear Information System (INIS)

    Foreign body bronchus is a surgical emergency and is associated with a high mortality if neglected or complicated. The objective of this study was to analyse the outcome of bronchotomy and resectional procedures after failed bronchoscopic foreign body retrieval. Methods: This study of 24 cases of bronchotomy and resectional procedures after failed bronchoscopic foreign body retrieval was done from June 2008 to June 2009 and March 2010 to Sep 2013. Patients after failed retrieval of foreign body by bronchoscopy either by ENT specialists or thoracic surgeons underwent bronchotomy or resectional procedures were included in the study. We used the posterolateral thoracotomy approach for the surgical procedures. Results: Bronchotomy and resectional procedures were done in 24 cases. Age of patients ranged from 2 years to 51 years. Most patients were children and right side was mostly involved. Bronchotomy procedures were 10 (41%) and resectional surgeries were 13 (58%). Emergency lobectomies were 3 out of 13 resectional surgeries. Right intermedius bronchus was opened up and incision was extended in the direction of foreign body in 6 cases and left bronchus intermedius was opened in 4 cases. Haemoptysis was the main symptom in late presenters. Range of objects retrieved in our study was from pins, needles to whistles. Conclusion: Retention causes endobronchial obstruction with stasis leading to irreversible damaged parenchyma. Foreign body with structural changes require resection, others can be offered bronchotomy which is a safe procedure for retained non retrievable foreign bodies. (author)

  15. Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998.

    Science.gov (United States)

    Debeljak, A; Sorli, J; Music, E; Kecelj, P

    1999-10-01

    The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy. PMID:10573222

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

    Directory of Open Access Journals (Sweden)

    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

  17. Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Rakesh K Chawla

    2012-01-01

    Full Text Available Context: Bronchopleural fistula (BPF is a communication between the pleural space and bronchial tree. Materials and Methods: A series of 9 cases are reported where BPF was identified and managed with intrabronchial instillation of glue (N-butyl-cyanoacrylate through a video bronchoscope. Results: Out of 9 patients the BPF was successfully sealed in 8 cases (88.88%. In 1 patient of postpneumonectomy, the fistula was big, that is >8 mm who had a recurrence after the procedure. In one case of pyopneumothorax the leak reduced slowly and it took us 14 days to remove the intercostal drainage tube. Rest of the patients had a favorable outcome. No complications were observed in a follow-up of 6 months. Conclusions: In our opinion, it is a cost-effective, viable, and safe alternative compared with costly, time-consuming, and high-risk surgical procedures.

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

    International Nuclear Information System (INIS)

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

  19. Solitary pulmonary nodule. Differentiating benign from malignant nodule, CT-bronchoscopic correlation, and usefulness of artificial neural networks on CT

    International Nuclear Information System (INIS)

    The objective of this study was to evaluate the useful CT finding for differentiating benign from malignant pulmonary nodule and for CT-bronchoscopic correlation, and to evaluate the usefulness of artificial neural networks (ANN). Sixty-six patients of solitary pulmonary nodule smaller than 3 cm were evaluated for differential diagnosis and CT-bronchoscopic correlation. One hundred fifty-five patients of solitary pulmonary nodule smaller than 3 cm were evaluated for ANN analysis. In lung cancers, air bronchogram/bronchiologram, grossly irregular margin, and the involvement of pulmonary vein were common, while straight or inward concave margin and satellite lesions were predominantly seen in benign nodules. The positive bronchus sign on CT was useful in predicting the success of transbronchial biopsy. The average Az value for all radiologists increased with the use of the ANN output. (author)

  20. Sealing of tracheoesophageal fistula using a Y stent through fiberoptic bronchoscope during general anesthesia under laryngeal mask airway

    OpenAIRE

    Ye, Ling; Yang, Pingliang; Zuo, Yunxia

    2014-01-01

    A 64-yr-old man was admitted because of repeated pneumonia. Both fiberoptic bronchoscopy and esophagoscopy revealed a large tracheoesophageal fistula (15 mm) in the right posterior trachea 1 cm beyond the carina. Coated nickel-titanium shape memory alloy Y shaped stent was planned to seal this fistula under general anesthesia. We took advantage of laryngeal mask airway to insert the fiberoptic bronchoscope to guide the stent placement. Our method of sealing a large tracheoesophageal fistula w...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-03-15

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series

    International Nuclear Information System (INIS)

    Significant bleeding may occur following endobronchial forceps biopsy or brushing of necrotic or hypervascular tumors in the airways. In some cases, methods such as endobronchial instillation of iced saline lavage and epinephrine may fail to control bleeding. The present study evaluated the efficacy and safety of a new bronchoscopic technique using intratumoral injection of tranexamic acid (IIT) for control of bleeding during forceps biopsy in patients with endobronchial tumors with a high risk of bleeding. The study was a prospective case series carried out in a single center. Bronchoscopic IIT was performed in those patients who had endoscopically visible tumoral lesions with persistent active bleeding following the first attempt at bronchoscopic sampling. Tranexamic acid (TEA) was injected through a 22-gauge Wang cytology needle into the lesion in nominal doses of 250–500 mg. After 2–3 minutes, multiple forceps biopsy specimens were obtained from the lesion. Of the 57 consecutive patients included in the study, 20 patients (35.1%) underwent bronchoscopic IIT. The first attempt in 18 patients was endobronchial forceps biopsy (EBB), and because of a high risk of bleeding, the first attempt for the remaining two patients, who were on continuous dual antiplatelet therapy (aspirin and clopidogrel), employed endobronchial needle aspiration (EBNA) as a precautionary measure. Following IIT, subsequent specimens were obtained using EBB in all patients. Multiple forceps biopsy specimens (3–10) were obtained from the lesions (8 necrotic and 12 hypervascular) without incurring active bleeding. The following histopathologic diagnoses were made: squamous cell carcinoma (n = 14), adenocarcinoma (n = 2), small-cell lung cancer (n = 3), and malignant mesenchymal tumor (n = 1). No side effects of TEA were observed. Bronchoscopic IIT is a useful and safe technique for controlling significant bleeding from a forceps biopsy procedure and can be considered as a pre

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

    International Nuclear Information System (INIS)

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

  7. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi trial): study design and rationale.

    Science.gov (United States)

    Davey, C; Zoumot, Z; Jordan, S; Carr, D H; Polkey, M I; Shah, P L; Hopkinson, N S

    2015-03-01

    Although lung volume reduction surgery improves survival in selected patients with emphysema, there has been ongoing interest in developing and evaluating bronchoscopic approaches to try to reduce lung volumes with less morbidity and mortality. The placement of endobronchial valves is one such technique, and although some patients have had a significant improvement, responses have been inconsistent because collateral ventilation prevents lobar atelectasis. We describe the protocol of a trial (ISRCTN04761234) aimed to show that a responder phenotype, patients with heterogeneous emphysema and intact interlobar fissures on CT scanning, can be identified prospectively, leading to a consistent benefit in clinical practice. PMID:24664535

  8. 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.

  9. 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

  10. Non-fermentative gram-negative bacteria in hospital tap water and water used for haemodialysis and bronchoscope flushing: prevalence and distribution of antibiotic resistant strains.

    Science.gov (United States)

    Vincenti, Sara; Quaranta, Gianluigi; De Meo, Concetta; Bruno, Stefania; Ficarra, Maria Giovanna; Carovillano, Serena; Ricciardi, Walter; Laurenti, Patrizia

    2014-11-15

    This study provides a detailed description of the distribution of non-fermentative gram-negative bacteria (NFGNB) collected in water sources (tap water and water used for haemodialysis and bronchoscope flushing) from different wards of a tertiary care hospital. The aim is to identify risk practices for patients or to alert clinicians to the possible contamination of environment and medical devices. The resistance profile of NFGNB environmental isolates has shown that more than half (55.56%) of the strains isolated were resistant to one or more antibiotics tested in different antimicrobial categories. In particular, 38.89% of these strains were multidrug resistant (MDR) and 16.67% were extensively drug resistant (XDR). The most prevalent bacterial species recovered in water samples were Pseudomonas aeruginosa, Pseudomonas fluorescens, Ralstonia pickettii and Stenotrophomonas maltophilia. Analysis of antibiotic resistance rates has shown remarkable differences between Pseudomonadaceae (P. aeruginosa and P. fluorescens) and emerging pathogens, such as S. maltophilia and R. pickettii. Multidrug resistance can be relatively common among nosocomial isolates of P. aeruginosa, which represent the large majority of clinical isolates; moreover, our findings highlight that the emergent antibiotic resistant opportunistic pathogens, such as R. pickettii and S. maltophilia, isolated from hospital environments could be potentially more dangerous than other more known waterborne pathogens, if not subjected to surveillance to direct the decontamination procedures. PMID:25173861

  11. 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

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

    Institute of Scientific and Technical Information of China (English)

    孙瑞琳; 金发光; 姜华; 谢永宏; 刘伟; 安琦

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    NANCY SPEKLA GRANDE

    2002-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李文涛; 肖阳宝; 柳广南; 黄斯明; 凌芸; 张建全; 钟小宁

    2011-01-01

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

  15. Pulmonary carcinoma. Diagnostic and bronchoscopic treatment

    International Nuclear Information System (INIS)

    A historical recount of the bronchoscopy is made, from its beginnings 100 years ago, in a same way some techniques of diagnostic and treatment are mentioned, as the laser, fluorescence, cryotherapy, etc

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-04-15

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

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

    Institute of Scientific and Technical Information of China (English)

    胡兆秋; 杨国儒

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    孙剑; 蔡捍东; 赵志丹

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    陈云辉; 郑利先; 罗巍; 曾博文; 陈自瑜

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    梁昆峰; 蒲晓雯; 袁钻云; 董雪宁

    2016-01-01

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

  2. Bronchoscopic assessment of airway retention time of aerosolized xylitol

    Directory of Open Access Journals (Sweden)

    Kearney William R

    2006-02-01

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

  3. Pulmonary Parenchymal Lymphoma Diagnosed by Bronchoscopic Cryoprobe Lung Biopsy.

    Science.gov (United States)

    Schiavo, Dante; Batzlaff, Cassandra; Maldonado, Fabien

    2016-04-01

    A 51-year-old man presented with progressively worsening lung infiltrates and respiratory failure. Extensive investigations including bronchoscopy with bronchoalveolar lavage and conventional transbronchial forceps biopsies failed to establish the diagnosis. After transfer to our institution, he underwent repeat bronchoscopy with transbronchial cryobiopsy, which provided large, high-quality biopsy specimens establishing the diagnosis of parenchymal diffuse large B-cell lymphoma. PMID:26496093

  4. Successful Bronchoscopic Cryorecanalization in a Case of Endobronchial Lipoma

    Directory of Open Access Journals (Sweden)

    B. Lamprecht

    2011-01-01

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

  5. Airway management in a bronchoscopic simulator based setting

    DEFF Research Database (Denmark)

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

    2014-01-01

    practice on patients. OBJECTIVES: To evaluate the validity of airway simulation as an assessment tool for the acquisition of the preclinical basic skills in flexible optical intubation and to investigate anaesthetists' opinion on airway simulation. DESIGN: Observational study. SETTING: International airway...... anaesthetists in our study agreed completely that simulation-based training was useful regardless of the fidelity of the simulator. Local, practical issues such as cost and portability should decide available simulation modalities in each teaching hospital....

  6. Bronchoscopic Diagnosis of Langerhans Cell Histiocytosis and Lymphangioleiomyomatosis

    OpenAIRE

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

    2012-01-01

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

  7. Bronchoscopic assessment of airway retention time of aerosolized xylitol

    OpenAIRE

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

    2006-01-01

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

  8. 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...

  9. A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy

    OpenAIRE

    Porpodis K; Karanikas M; Zarogoulidis P; Kontakiotis T; Mitrakas A; Esebidis A; Konoglou M; Domvri K; Iordanidis A; Katsikogiannis N; Courcoutsakis N; Zarogoulidis K

    2012-01-01

    Konstantinos Porpodis1, Michael Karanikas2, Paul Zarogoulidis1, Theodoros Kontakiotis1, Alexandros Mitrakas2, Agisilaos Esebidis2, Maria Konoglou3, Kalliopi Domvri1, Alkis Iordanidis4, Nikolaos Katsikogiannis5, Nikolaos Courcoutsakis4, Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece; 21st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thra...

  10. 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

  11. Clinical risk factors and bronchoscopic features of invasive aspergillosis in Intensive Care Unit patients

    OpenAIRE

    ALIYALI, M.; HEDAYATI, M.T.; HABIBI, M.R.; KHODAVAISY, S.

    2013-01-01

    Summary Introduction. Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunocompromised patients. During recent years, a rising incidence of IA in Intensive Care Unit (ICU) patients has been reported. The patterns of IA related infection may differ according to the type of underlying disease. Unfortunately little is known about the characteristics of IA in ICU patients. In the present study we assessed IA related clinical and bronchoscopy findings in ICU patien...

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. Remoção de corpo estranho da via aérea de criança por broncoscopia através de traqueotomia ou traqueostomia Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy

    Directory of Open Access Journals (Sweden)

    José C. Fraga

    2003-08-01

    Full Text Available OBJETIVO: a maioria dos corpos estranhos aspirados para a via aérea é removida através de endoscopia respiratória. Em situações raras, a retirada deste material tem que ser realizada sob controle endoscópico, através de traqueotomia ou traqueostomia. A seguir, relatamos casos de crianças cuja remoção de corpos estranhos aspirados para a via aérea foi realizada por abertura traqueal. DESCRIÇÃO: revisão retrospectiva de prontuários, com relato de três crianças que aspiraram corpos estranhos para a via aérea. A primeira apresentou ruptura da cânula de traqueostomia, com aspiração da porção distal da mesma. Foi realizada remoção endoscópica através do traqueostoma. A segunda aspirou tampa de caneta, que não conseguia ser removida endoscopicamente, pois a mesma trancava e não passava na região subglótica. Foi realizado, então, traqueotomia cervical e remoção do corpo estranho sob controle endoscópico. A terceira apresentou corpo estranho aspirado para o brônquio principal esquerdo (palito de madeira, que foi removido através de broncoscopia, realizada pelo orifício da traqueostomia. Todas as crianças toleraram o procedimento endoscópico, com remoção do corpo estranho. No paciente em que foi realizada traqueotomia, a traquéia foi suturada após retirada do corpo estranho, não havendo necessidade de realização de traqueostomia. Nas crianças com traqueostomia prévia, a mesma foi recolocada após a retirada do corpo estranho. COMENTÁRIOS: uma minoria dos corpos estranhos aspirados para a via aérea de criança não pode ser removido somente por endoscopia. Quando o corpo estranho é demasiadamente largo que não passa na região subglótica, ou pontiagudo que possa traumatizar a via aérea, a remoção pode ser realizada por endoscopia, através de traqueotomia ou traqueostomia.OBJECTIVE: most foreign bodies in the airway are removed by respiratory endoscopy. Rarely, the removal of the foreign body has to be performed through endoscopic control by tracheotomy or tracheostomy. This article reports three cases of foreign body removal in children performed by tracheal opening. DESCRIPTION: retrospective review of records with report of three cases of children who aspirated foreign bodies into the airway. In the first case, there was rupture of the tracheostomy tube, with aspiration of its distal portion. Endoscopic removal was performed by tracheostomy. The second child aspirated a pen cap. It could not be removed by endoscopy because it would not pass through the subglottic region. Cervical tracheotomy was performed and the foreign body was removed with endoscopic control. In the last case, the foreign body was in the left main bronchus. It was removed by bronchoscopy through tracheostomy opening. All children presented good outcome after the endoscopic procedure. The trachea of the patient submitted to tracheotomy was sutured after the foreign body removal. Tracheostomy was not necessary. In the children with previous tracheostomy, the tube was put back after the foreign body removal. COMMENTS: most foreign bodies in the airway of children can be removed by endoscopy. When the foreign body is too large to pass through the subglottic region, or so sharp that it can injure the airway, the use of tracheotomy or tracheostomy is indicated.

  17. 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.

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

    Science.gov (United States)

    Chan, Ian A; Gamble, Jonathan J

    2016-04-01

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

  19. Tracheal collapse in two cats

    International Nuclear Information System (INIS)

    Two cats examined bronchoscopically to discover the cause of tracheal collapse were found to have tracheal obstruction cranial to the collapse. Cats with this unusual sign should be examined bronchoscopically to ascertain whether there is an obstruction, as the cause in these 2 cats was distinct from the diffuse airway abnormality that causes tracheal collapse in dogs

  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. Anesthesia for bronchoscopy.

    Science.gov (United States)

    Abdelmalak, Basem B; Gildea, Thomas R; Doyle, D John

    2012-01-01

    Bronchoscopic procedures are at times intricate and the patients often very ill. These factors and an airway shared with the pulmonologist present a clear challenge to anesthesiologists. The key to success lies in the understanding of both the underlying pathology and procedure being performed combined with frequent two-way communication between the anesthesiologist and the pulmonologist. Above all, vigilance and preparedness are paramount. Topics discussed in this review include anesthesia for advanced diagnostic procedures as well as for interventional/ therapeutic procedures. The latter includes bronchoscopic tracheal balloon dilation, tracheobronchial stenting, endobronchial electrocautery, bronchoscopic cryotherapy and other techniques. Special situations, such as tracheoesophageal fistula and mediastinal masses, are also considered. PMID:22762465

  2. Bronchoscopy: Diagnostic and Therapeutic for Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Bauer, Thomas L; Berkheim, David B

    2016-07-01

    The bronchoscope has gone through much advancement from its origin as a thin metal tube. It has become a highly sophisticated tool for clinicians. Both rigid and the flexible bronchoscopes are invaluable in the diagnosis and treatment of non-small cell lung cancer. Treatment of this disease process hinges on accurate diagnosis and lymph node staging. Technologies, such as endobronchial ultrasound, navigational bronchoscopy, and autofluorescence, have improved efficacy of endobronchial diagnosis and sample collection. If a patient is not a candidate for surgery and has a complication from a centrally located mass, the bronchoscope has been used to deliver palliative therapies. PMID:27261910

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

    Science.gov (United States)

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

    2016-02-01

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

  4. 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.

  5. Upper airway test (image)

    Science.gov (United States)

    An upper airway biopsy is obtained by using a flexible scope called a bronchoscope. The scope is passed down through ... may be performed when an abnormality of the upper airway is suspected. It may also be performed as ...

  6. Oxygen supplementation is required in healthy volunteers during bronchoscopy with lavage

    Science.gov (United States)

    Hypoxemia can complicate bronchoscopy. Common causes of hypoxemia during bronchoscopy include preexisting lung disease, upper airway obstruction, pneumothorax and bleeding secondary to either transbronchial lung biopsy or another interventional bronchoscopic procedure, hypoventil...

  7. Minimally Invasive Treatment for Lung Cancer

    Medline Plus

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

  8. 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.

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

    OpenAIRE

    Sayyed Gholamreza Mortazavi-Moghaddam; Sayyed Alireza Saadatjoo

    2014-01-01

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

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

    Science.gov (United States)

    Asano, Fumihiro

    2016-07-01

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

  11. Disinfecting endoscopes: how not to transmit Mycobacterium tuberculosis by bronchoscopy.

    OpenAIRE

    Leers, W. D.

    1980-01-01

    Mycobacterium tuberculosis was cultured from the bronchial washings of two patients who underwent bronchoscopy consecutively with the same bronchoscope. Active pulmonary tuberculosis was later confirmed in the first patient, whereas the second patient had clinical and serologic evidence of infection with respiratory syncytial virus. The bronchoscope had been cleaned with an iodophor disinfectant, which had not destroyed the tubercle bacilli. The agent recommended for chemical disinfection of ...

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

    Science.gov (United States)

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

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

    OpenAIRE

    Appavoo Arulvelan; Madhusudhan Soumya; Kannath Santhosh

    2015-01-01

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

  14. BRONCHOPULMONARY COMPLICATIONS OF INDOOR POLLUTION IN IRANIAN RUSTIC POPULATION

    OpenAIRE

    Kazem Amoli

    1994-01-01

    Chronic bronchopulmonary disorders occurred in a large number of rustic females who used to bake bread at their dwellings under unhgyienic conditions. Bronchoscopy revealed advanced pathological changes with characterised black areas infiltrating the bronchial walls. Findings in ten patients who referred with acute chronic respiratory symptoms and a positive history of indoor pollution are described with an emphasis on their bronchoscopic changes.

  15. 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.

  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. 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

  18. Bronchoalveolar lavage with trypsin in pulmonary alveolar proteinosis.

    OpenAIRE

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

    1996-01-01

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

  19. Mineral Oil Aspiration Related Juvenile Idiopathic Arthritis.

    Science.gov (United States)

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

    2015-01-01

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

  20. 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.

  1. Mineral Oil Aspiration Related Juvenile Idiopathic Arthritis

    Directory of Open Access Journals (Sweden)

    Andrew D. Nelson

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vrinda Oza

    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.

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

    Directory of Open Access Journals (Sweden)

    RC Balkissoon

    1996-01-01

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

  4. Endobronchial Valves for Emphysema without Interlobar Collateral Ventilation

    NARCIS (Netherlands)

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

    2015-01-01

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

  5. 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.

  6. 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

  7. Asthma control during the year after bronchial thermoplasty

    DEFF Research Database (Denmark)

    Cox, Gerard; Thomson, Neil C.; Rubin, Adalberto S.; Niven, Robert M.; Corris, Paul A.; Siersted, Hans Christian; Olivenstein, Ronald; Pavord, Ian D.; McCormack, David; Chaudhuri, Rekha; Miller, John D.; Laviolette, Michel

    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...

  8. Glue therapy in hemoptysis: A new technique

    Directory of Open Access Journals (Sweden)

    Rakesh K Chawla

    2012-01-01

    Full Text Available Hemoptysis is defined as the spitting of blood derived from the lungs or bronchial tubes as a result of pulmonary or bronchial hemorrhage. There is a large chunk of patients with hemoptysis who do not respond to conservative treatment including use of cough suppressants, antibiotics, vitamin C, hemostatics, and anxiolytics. The advanced management of such a situation is bronchial artery embolization (BAE or open thoracic surgery, which is often not possible. We have attempted a cheap, effective, and safe alternative in the form of intrabronchial instillation of glue (n-butyl cyanoacrylate under vision with the help of a therapeutic video bronchoscope (OLYMPUS T-180. The glue is instilled through a polyethylene catheter placed through the working channel of the video bronchoscope.

  9. 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.

  10. Tracheobronchopathia Osteochondroplastica

    Directory of Open Access Journals (Sweden)

    F Noorani

    2008-04-01

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

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

    Science.gov (United States)

    Valipour, Arschang; Burghuber, Otto Chris

    2015-12-01

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

  12. One lung ventilation in a patient with an upper and lower airway abnormality

    Directory of Open Access Journals (Sweden)

    Sangita R Kaza

    2012-01-01

    Full Text Available One-lung ventilation for a thoracotomy procedure was achieved with the help of a endobronchial blocker in a young girl with limited mouth opening, minimal neck extension, and a distorted tracheo-bronchial anatomy. As the patient would not cooperate for an awake nasotracheal intubation despite adequate preperation, an inhalational anesthetic was used to make the patient unconscious, taking care that spontaneous breathing was maintained. Nasotracheal intubation was done with the help of a fiberoptic bronchoscope. A wire-guided Arndt endobronchial blocker was placed coaxially through the endotracheal tube using a fiberoptic bronchoscope. This case report highlights that in a scenario of both upper and lower airway distortion, a bronchial blocker positioned through a nasotracheal tube under fiberoptic guidance might be the best option when one-lung ventilation is required.

  13. 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.

  14. Multidisciplinary approach to thoracic tissue sampling

    OpenAIRE

    Quint, L.E.

    2010-01-01

    Abstract When choosing the best method to undertake a biopsy of a lesion in the lung or mediastinum, it is important to consider the entire range of possible options, such as surgical, bronchoscopic/endoscopic, and radiologic techniques. Features to be considered include the anatomic location of the lesion, the amount of tissue needed, cost, availability of specific techniques, safety and risks, and expected diagnostic yield/accuracy.

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

    Science.gov (United States)

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

    2016-01-01

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

  16. Untersuchungen zur Mikrosatellitenalteration an zellfreien Desoxyribonukleinsäuren aus der Bronchiallavage bei Patienten mit Lungenkarzinom und Patienten mit benignen Lungenerkrankungen

    OpenAIRE

    Carstensen, Tim

    2011-01-01

    The early confirmation of the diagnosis of a lung carcinoma is the most significant prognostic factor. New findings concerning diagnostic methods are therefore of paramount importance. The key element of lung carcinoma diagnostics is the bronchoscopy. The recovery of bronchial lavage fluid (BLF) during bronchoscopy is an additional procedure, which is of relevance in tumours that are bronchoscopically not visible (extrabronchially or peripherally located tumours). So far B...

  17. Bronchoalveolar Immunologic Profile of Acute Human Lung Transplant Allograft Rejection

    OpenAIRE

    Gregson, Aric L.; Hoji, Aki; Saggar, Rajan; Ross, David J; Kubak, Bernard M; Jamieson, Beth D.; Weigt, S. Samuel; Lynch, Joseph P.; Ardehali, Abbas; Belperio, John A.; Yang, Otto O

    2008-01-01

    Bronchoalveolar lavage fluid (BALF) offers a potential means to diagnose acute rejection and could provide insight into the immune mechanisms responsible for lung allograft rejection. Transbronchial biopsies from 29 bronchoscopic procedures were assessed for rejection. Concurrent BALF lymphocyte subsets were examined by flow cytometry, including CD4+ and CD8+ T cells and their activation status via CD38 expression, NK, NK-like T (NT), B, T regulatory (Treg) and invariant receptor NK-T cells (...

  18. Landiolol reduces hemodynamic responses to bronchoscopy-assisted suctioning in intubated ICU patients

    OpenAIRE

    Tochikubo, Junpei; Adachi, Yushi U.; Ejima, Tadashi; Numaguchi, Atsushi; Matsuda, Naoyuki; Sato, Shigehito; Shiiya, Norihiko

    2014-01-01

    Landiolol is an ultra-short-acting β1-selective antagonist developed in Japan that was recently approved for the treatment of tachycardia in intensive care units (ICUs). This study investigated the protective effects of landiolol against the cardiovascular responses during bronchoscopic endotracheal suctioning. This study enrolled 15 patients requiring orotracheal intubation in an ICU. All of the patients required endotracheal suctioning using fiber bronchoscopy while sedated at a Ramsay Scal...

  19. Safety and effective use of landiolol in the ICU

    OpenAIRE

    Hifumi, Toru; Kato, Hiroshi; Koido, Yuichi; KAWAKITA, Kenya; Kuroda, Yasuhiro

    2014-01-01

    Supplemental landiolol administration (20 or 40 μg kg-1 min-1) effectively diminished harmful hemodynamic changes during bronchoscopic endotracheal suctioning compared to normal saline. However, inappropriate use of landiolol (i.e., failure of evaluating factors that influence hemodynamic changes) may iatrogenically further complicate pathophysiology, and relatively higher doses of landiolol may be dangerous. We recommend that landiolol should not be routinely used to control cardiovascular r...

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

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

    1982-01-01

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

  2. A rare complication of tracheal intubation

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

  4. Experimental Mycobacterium tuberculosis Infection of Cynomolgus Macaques Closely Resembles the Various Manifestations of Human M. tuberculosis Infection

    OpenAIRE

    Capuano, Saverio V.; Croix, Denise A.; Pawar, Santosh; Zinovik, Angelica; Myers, Amy; Lin, Philana L.; Bissel, Stephanie; Fuhrman, Carl; Klein, Edwin; Flynn, JoAnne L.

    2003-01-01

    Nonhuman primates were used to develop an animal model that closely mimics human Mycobacterium tuberculosis infection. Cynomolgus macaques were infected with low doses of virulent M. tuberculosis via bronchoscopic instillation into the lung. All monkeys were successfully infected, based on tuberculin skin test conversion and peripheral immune responses to M. tuberculosis antigens. Progression of infection in the 17 monkeys studied was variable. Active-chronic infection, observed in 50 to 60% ...

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

    Science.gov (United States)

    Rai, Lav; Higgins, William E.

    2006-03-01

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

  6. Conventional method and ultrasound guided transbronchial needle aspiration techniques in the diagnosis of intrathoracic lymphadenopathies

    OpenAIRE

    Kaya, Halide; Çetinkaya, Erdoğan

    2011-01-01

    Conventional transbronchial needle aspiration (TBNA) is one of the minimally invasive methods used for the diag­nosis of intrathoracic lymphadenopathies, which is an ef­fective, safe and cheap bronchoscopic technique. Endo­bronchial ultrasound (EBUS) guided TBNA is one of the most important advances in pneumology in recent years and has extended the diagnostic spectrum of broncho­scopic techniques. Today there are two different types of ultrasound probes for us...

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

    OpenAIRE

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

    2008-01-01

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

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

    OpenAIRE

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

    1997-01-01

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

  9. Induction for classic laryngeal mask airway insertion: Does low-dose fentanyl work?

    OpenAIRE

    Akanksha Dutt; Anjum Khan Joad; Mamta Sharma

    2012-01-01

    Background : Laryngeal mask airway (LMA) insertion requires an optimal balance of anesthesia. Propofol with different opioids is a preferred combination. Two doses of fentanyl were compared for the efficacy and side effects. Materials and Methods: 96 patients were randomly distributed into F 1 (fentanyl 1 mcg/kg) and F 2 (fentanyl 2 mcg/kg) groups. The conditions for LMA insertion, hemodynamic profile, bronchoscopic view, and incidence of sore throat were compared. Result: There was no ...

  10. BRONCHOPULMONARY COMPLICATIONS OF INDOOR POLLUTION IN IRANIAN RUSTIC POPULATION

    Directory of Open Access Journals (Sweden)

    Kazem Amoli

    1994-06-01

    Full Text Available Chronic bronchopulmonary disorders occurred in a large number of rustic females who used to bake bread at their dwellings under unhgyienic conditions. Bronchoscopy revealed advanced pathological changes with characterised black areas infiltrating the bronchial walls. Findings in ten patients who referred with acute chronic respiratory symptoms and a positive history of indoor pollution are described with an emphasis on their bronchoscopic changes.

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

    OpenAIRE

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

    2013-01-01

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

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

    OpenAIRE

    Trotter, Michael A.; Hopkins, Peter M.

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Cryotherapy for advanced carcinoma of the trachea and bronchi.

    OpenAIRE

    Maiwand, M O

    1986-01-01

    Cryotherapy was used to relieve symptoms in 75 patients suffering from advanced carcinoma of the trachea or bronchi. In all patients surgical resection, radiotherapy, or chemotherapy had been tried and been unsuccessful or had been thought to be unsuitable because of the patients' poor general condition. In cryotherapy the intraluminal tumour was frozen through a Stortz bronchoscope. Localised necrosis increased the patency of the lumen of the trachea or bronchi, resulting in relief of sympto...

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

    Science.gov (United States)

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

    2015-12-01

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

  16. Minimally Invasive Thoracic Surgery

    OpenAIRE

    McFadden, P. Michael

    2000-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

  18. 3D image fusion and guidance for computer-assisted bronchoscopy

    Science.gov (United States)

    Higgins, W. E.; Rai, L.; Merritt, S. A.; Lu, K.; Linger, N. T.; Yu, K. C.

    2005-11-01

    The standard procedure for diagnosing lung cancer involves two stages. First, the physician evaluates a high-resolution three-dimensional (3D) computed-tomography (CT) chest image to produce a procedure plan. Next, the physician performs bronchoscopy on the patient, which involves navigating the the bronchoscope through the airways to planned biopsy sites. Unfortunately, the physician has no link between the 3D CT image data and the live video stream provided during bronchoscopy. In addition, these data sources differ greatly in what they physically give, and no true 3D planning tools exist for planning and guiding procedures. This makes it difficult for the physician to translate a CT-based procedure plan to the video domain of the bronchoscope. Thus, the physician must essentially perform biopsy blindly, and the skill levels between different physicians differ greatly. We describe a system that enables direct 3D CT-based procedure planning and provides direct 3D guidance during bronchoscopy. 3D CT-based information on biopsy sites is provided interactively as the physician moves the bronchoscope. Moreover, graphical information through a live fusion of the 3D CT data and bronchoscopic video is provided during the procedure. This information is coupled with a series of computer-graphics tools to give the physician a greatly augmented reality of the patient's interior anatomy during a procedure. Through a series of controlled tests and studies with human lung-cancer patients, we have found that the system not only reduces the variation in skill level between different physicians, but also increases biopsy success rate.

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

    OpenAIRE

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

    2009-01-01

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

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

    OpenAIRE

    Mohammad Saquib Mallick

    2014-01-01

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

  1. Difficult Airway Management in A Case of Thalassaemia Major

    Directory of Open Access Journals (Sweden)

    Neerja Bharti

    2008-01-01

    Full Text Available Difficult to ventilate, difficult to intubate cases are the most challenging to anaesthesiologists. We present a case of thalassaemia with difficult airway who underwent splenectomy surgery. The severe maxillary prominence with protruded upper incisors, limited mouth opening, depressed nasal bridge and narrow anterior nares posed a problem in mask ventilation and subsequent tracheal intubation. The patient was intubated successfully using fibreoptic bronchoscope aided with intubating laryngeal mask airway (Fastrach.

  2. 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.

  3. Advances in bronchoscopy for lung cancer

    Directory of Open Access Journals (Sweden)

    Samjot Singh Dhillon

    2012-01-01

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

  4. Advances in bronchoscopy for lung cancer

    Science.gov (United States)

    Dhillon, Samjot Singh; Dexter, Elisabeth U.

    2012-01-01

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

  5. An Electrospray Solution to the Pulmonary Delivery Problem

    OpenAIRE

    Maguire, Michael John

    2010-01-01

    This thesis addresses the critically poor efficacy of existing strategies to treat lung disease. A new device is developed using electrospray technology to deliver molecules into respiratory tissues via a bronchoscope. Novel diagnostic and therapeutic interventions are now possible by delivering appropriate molecules to target sites. The impact of this thesis is to facilitate earlier diagnosis of lung disease and enable local delivery of therapeutics to the lungs. Delivering molecules into th...

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

    OpenAIRE

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

    2012-01-01

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

  7. 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.

  8. A rare complication of tracheal intubation

    Science.gov (United States)

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

    2016-01-01

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

  9. 診断時に胃転移を認めた小細胞肺癌の2 例

    OpenAIRE

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

    2012-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

  12. Endobronchial metastasis in breast cancer.

    OpenAIRE

    Albertini, R E; Ekberg, N L

    1980-01-01

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

  13. Awake Glidescope® intubation in a patient with a huge and fixed supraglottic mass -A case report-

    OpenAIRE

    Choi, Guen Seok; Park, Sang Il; Lee, Eun Ha; Yoon, Seok Hwa

    2010-01-01

    Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope® Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, w...

  14. An unusual case of lead poisoning in a honey buzzard (Pernis apivorus).

    Science.gov (United States)

    Lumeij, J T; Wolvekamp, W T; Bron-Dietz, G M; Schotman, A J

    1985-04-01

    The diagnosis and treatment of a case of lead poisoning in a honey buzzard (Pernis apivorus) are described. Presenting signs were diarrhoea and weakness. Lead poisoning was suspected after radiography and confirmed by measuring the lead concentration in a venous blood sample. Comparison values of venous lead concentrations in healthy racing pigeons (Columba livia) were established. A method for the removal of lead shor from the gizzard of birds with a bronchoscope and grasping forceps under fluoroscopic control is described. PMID:4013056

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

    OpenAIRE

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

    2011-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

  17. Endobronchial electrocautery wire snare prior to wedge bronchoplastic lobectomy for central-type lung cancer: A case report

    OpenAIRE

    Hidenori Kawasaki; Atsushi Nakamoto; Naohiro Taira; Takaharu Ichi; Tomofumi Yohena; Tsutomu Kawabata

    2015-01-01

    Introduction: Occasionally, it is difficult to design an appropriate treatment plan for central-type lung cancer. We present the usefulness of combined treatment with a bronchoscopic electrocautery wire snare prior to wedge bronchoplastic lobectomy for patients with central-type lung cancer. Presentation of case: A 64-year-old man, who was a long-term corticosteroid user, complicated with left obstructive pneumonia. Chest CT scan showed total atelectasis of the left lung due to obstruction...

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

    Science.gov (United States)

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

    2012-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Fachzi Fitri

    2014-09-01

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

  20. 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)

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

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

    Science.gov (United States)

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

    2014-11-01

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

  7. Interventionist Bronchoscopy

    International Nuclear Information System (INIS)

    Interventional bronchoscopy includes endoscopic diagnostic procedures through rigid bronchoscope, such as transcarinal puncture and principally, therapeutic bronchoscopy using lasers tends and endoscopic radiation. This is a review of our experience in this field, analyzing 36 transcarinal punctures with goods results in 10 cases (27%), 100 patients for whom it used laser in tracheobronchial disorders with satisfactory results in 81,5% and the placement of 8 Dumon's tends with different results, according to the tracheal pathology. The management of tracheal benign stenosis is controversial. It has had good results in 56,5% over 23 patients for whom we used endoscopic management

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

    International Nuclear Information System (INIS)

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

  9. Fluoroscopy-Guided Treatment of a Bronchopleural Fistula with a Platinum Vascular Occlusion Coil and N-butly-2-cyanoacrylate (NBCA) : A Case Report

    International Nuclear Information System (INIS)

    A bronchopleural fistula (BPF) following a pulmonary resection is relatively rare; however, it has high morbidity and mortality rates, despite advancements in treatment. Treatment options for a BPF include surgical procedures, conservative therapy, medical therapy, and in particular, the use of a bronchoscopy and different glues, coils, and sealants. This paper discusses a case of the treatment of a postoperative BPF, which is not identified on the bronchoscope, using a platinum vascular occlusion coil (microcoil) and N-butly-2-cyanoacrylate (NBCA) under fluoroscopic guidance. We hereby assert that such an approach as a combination might be an improvement to the minimally-invasive treatment methods currently in use

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-06-15

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

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

    Directory of Open Access Journals (Sweden)

    U. Caterino

    2015-01-01

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

  12. EVOTECH® endoscope cleaner and reprocessor (ECR simulated-use and clinical-use evaluation of cleaning efficacy

    Directory of Open Access Journals (Sweden)

    DeGagne Pat

    2010-07-01

    Full Text Available Abstract Background The objective of this study was to perform simulated-use testing as well as a clinical study to assess the efficacy of the EVOTECH® Endoscope Cleaner and Reprocessor (ECR cleaning for flexible colonoscopes, duodenoscopes, gastroscopes and bronchoscopes. The main aim was to determine if the cleaning achieved using the ECR was at least equivalent to that achieved using optimal manual cleaning. Methods Simulated-use testing consisted of inoculating all scope channels and two surface sites with Artificial Test Soil (ATS containing 108 cfu/mL of Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans. Duodenoscopes, colonoscopes, and bronchoscopes (all Olympus endoscopes were included in the simulated use testing. Each endoscope type was tested in triplicate and all channels and two surface sites were sampled for each scope. The clinical study evaluated patient-used duodenoscopes, bronchoscopes, colonoscopes, and gastroscopes (scopes used for emergency procedures were excluded that had only a bedside flush prior to being processed in the ECR (i.e. no manual cleaning. There were 10 to 15 endoscopes evaluated post-cleaning and to ensure the entire ECR cycle was effective, 5 endoscopes were evaluated post-cleaning and post-high level disinfection. All channels and two external surface locations were sampled to evaluate the residual organic and microbial load. Effective cleaning of endoscope surfaces and channels was deemed to have been achieved if there was 2 of residual protein, 2 of residual hemoglobin and 10 viable bacteria/cm2. Published data indicate that routine manual cleaning can achieve these endpoints so the ECR cleaning efficacy must meet or exceed these to establish that the ECR cleaning cycle could replace manual cleaning Results In the clinical study 75 patient-used scopes were evaluated post cleaning and 98.8% of surfaces and 99.7% of lumens met or surpassed the cleaning endpoints set for protein

  13. 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.

  14. Protein losing enteropathy secondary to a pulmonary artery stent

    International Nuclear Information System (INIS)

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

  15. 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.

  16. Diagnostic imaging in COPD

    International Nuclear Information System (INIS)

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

  17. Congenital lobar emphysema in an adult

    Directory of Open Access Journals (Sweden)

    Mir Sadaqat

    2011-01-01

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

  18. Does hyperbaric oxygen therapy prevent airway anastomosis from breakdown?

    Science.gov (United States)

    Dickhoff, Chris; Daniels, Johannes M A; van den Brink, Ad; Paul, Marinus A; Verhagen, Ad F T M

    2015-02-01

    Ischemia with subsequent necrosis of anastomoses, after central airway resection and reconstruction, remains a feared complication for thoracic surgeons and their patients. To date, there is no evidence to support the use of hyperbaric oxygen in the prevention of necrosis of airway reconstructions in humans. We present a patient who underwent central airway surgery with postoperative ischemia of an end-to-side anastomosis. Repeat visit to a hyperbaric oxygen chamber seemed to prevent the anastomosis from subsequent necrosis and dehiscence with complete healing as a result. In conclusion, hyperbaric oxygen treatment can be considered when ischemia or necrosis is observed in central airway anastomoses during postoperative bronchoscopic surveillance. PMID:25639406

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

    Science.gov (United States)

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

    2015-12-01

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

  20. 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...

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

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Arghya Mukherjee

    2014-10-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-10-15

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

  4. Tracheal collapse. Diagnosis and medical and surgical treatment.

    Science.gov (United States)

    Johnson, L

    2000-11-01

    Tracheal collapse remains a common clinical problem in middle-aged, small-breed dogs. Clinical signs are characteristic, and the diagnostic work-up serves to identify predisposing triggers of disease and to allow optimization of therapy for individual animals. Bronchoscopic confirmation of airway collapse aids in characterizing the extent of airway damage and allows collection of airway samples to rule out infectious or inflammatory airway disease. Once coincident diseases have been managed, cough suppressants are used to control signs and reduce chronic airway injury. PMID:11221980

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

    OpenAIRE

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

    2013-01-01

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

  6. 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...

  7. Paraneoplastic Choreoathetosis in a Patient with Small Cell Lung Carcinoma and Anti-CRMP5/CV2: A Case Report

    DEFF Research Database (Denmark)

    Lassen, Lisbeth Landschoff; Somnier, Finn; Aydin, Dogu

    2016-01-01

    signs of primary or metastatic tumors were revealed on chest X-ray, MRI or whole-body PET scan. EEG and bronchoscopy were also unremarkable. However, 6 months after the onset, a repeated PET scan and subsequent bronchoscopic biopsy revealed SCLC. In spite of chemotherapy, the SCLC progressed, and the...... patient died 14 months after the onset of the symptoms. Conclusion: We report paraneoplastic choreoathetosis associatedwith anti-CRMP5/CV2 antibodies. Such published case histories are rare. Although expected, we did not find any reduced signal intensity at the basal ganglia on the T1-weighted or...

  8. Protein losing enteropathy secondary to a pulmonary artery stent

    Directory of Open Access Journals (Sweden)

    Narayanswami Sreeram

    2012-01-01

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

  9. Renal cell carcinoma manifests primarily as endobronchial mass: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Rina Mukherjee

    2015-01-01

    Full Text Available Endobronchial metastasis (EBM from renal cell carcinoma (RCC is a very rare entity, though pulmonary metastasis of RCC is common. Here, we present a case of RCC with EBM, in which the primary tumor was detected after the detection of secondary. A 60-year-old man presented with cough for last 2 months. Contrast enhanced computed tomography (CECT chest followed by bronchoscopy revealed an endobronchial mass at left bronhi. CECT whole abdomen revealed a left-sided renal space occupying lesion (SOL. CT guided fine needle aspiration cytology of the SOL proved it as a RCC. Palliative bronchoscopic removal of endobronchial mass by snaring diathermy was done.

  10. Post-traumatic bronchial mucus plug leading to pneumonectomy

    Directory of Open Access Journals (Sweden)

    Khan M.S

    2012-01-01

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

  11. Assessment of smoke inhalation injury using volumetric optical frequency domain imaging in sheep models

    Science.gov (United States)

    Applegate, Matthew B.; Hariri, Lida P.; Beagle, John; Tan, Khay Ming; Chee, Chunmin; Hales, Charles A.; Suter, Melissa J.

    2012-02-01

    Smoke inhalation injury is a serious threat to victims of fires and explosions, however accurate diagnosis of patients remains problematic. Current evaluation techniques are highly subjective, often involving the integration of clinical findings with bronchoscopic assessment. It is apparent that new quantitative methods for evaluating the airways of patients at risk of inhalation injury are needed. Optical frequency domain imaging (OFDI) is a high resolution optical imaging modality that enables volumetric microscopy of the trachea and upper airways in vivo. We anticipate that OFDI may be a useful tool in accurately assessing the airways of patients at risk of smoke inhalation injury by detecting injury prior to the onset of symptoms, and therefore guiding patient management. To demonstrate the potential of OFDI for evaluating smoke inhalation injury, we conducted a preclinical study in which we imaged the trachea/upper airways of 4 sheep prior to, and up to 60 minutes post exposure to cooled cotton smoke. OFDI enabled the visualization of increased mucus accumulation, mucosal thickening, epithelial disruption and sloughing, and increased submucosal signal intensity attributed to polymorphonuclear infiltrates. These results were consistent with histopathology findings. Bronchoscopic inspection of the upper airways appeared relatively normal with only mild accumulation of mucus visible within the airway lumen. The ability of OFDI to not only accurately detect smoke inhalation injury, but to quantitatively assess and monitor the progression or healing of the injury over time may provide new insights into the management of patients such as guiding clinical decisions regarding the need for intubation and ventilator support.

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

    Science.gov (United States)

    Wang, Hui; Huang, Linian

    2016-08-20

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

  13. Three-dimensional true color topographical analysis of the pulmonary airways

    Science.gov (United States)

    Suter, Melissa J.; Reinhardt, Joseph M.; Sonka, Milan; Higgins, William E.; Hoffman, Eric A.; McLennan, Geoffrey

    2004-04-01

    The development of pulmonary airway disease is characterized by mucosal color and topographical changes. Traditionally subjective visual interpretation of a bronchoscope procedure defines the identification of pulmonary airway disease however we have developed an optical imaging system used in conjunction with CT images to potentially quantify and classify these subtle variations. This paper presents a method for the construction of true color 3D images of the pulmonary airways from both optical and CT image data. Shape from Shading methods in the past decade have continually strived to achieve this goal by extracting 3D information from captured 2D images however these attempts have been severely limited in their application to bronchoscope images. Conversely the utilization of CT scans provides a sound tool for determining the gross structural anatomy of the airways however the accuracy of the rendered topographical surface maps is limited due to the resolution of the CT image data. Through integration of both the optical and CT imaging modalities we hope to create high resolution true color 3D images providing the necessary color and texture information to aid in future detection and classification of possible pulmonary airway disease. Preliminary combined color and texture results associated with various pulmonary airway diseases are presented highlighting the usefulness of this analysis technique.

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

    Science.gov (United States)

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

    2015-08-01

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

  15. Cervical lung lobe herniation in dogs identified by fluoroscopy.

    Science.gov (United States)

    Nafe, Laura A; Robertson, Ian D; Hawkins, Eleanor C

    2013-10-01

    This study aimed to determine the frequency of cervical lung lobe herniation (CLLH) in dogs evaluated fluoroscopically and to identify associated characteristics. Reports of diagnostic procedures and patient summaries from 2008 to 2010 were reviewed retrospectively. Signalment, body weight, duration of cough, presence of heart murmur and airway collapse, and radiographic findings were compared between dogs with and without CLLH. Of the 121 dogs that were examined, CLLH occurred in 85 (70%). The extra-thoracic trachea kinked during herniation in 33 (39%) dogs with CLLH. Collapse of the intra-thoracic trachea (assessed fluoroscopically or bronchoscopically) and collapse of major bronchi (assessed fluoroscopically) were strongly associated with CLLH. Although redundant dorsal tracheal membrane on radiographs was associated with CLLH, extra-thoracic tracheal collapse, assessed fluoroscopically or bronchoscopically, was not. No other associations were found. Cervical lung lobe herniation was present in most dogs evaluated during cough and was associated with intra-thoracic large airway collapse, but not duration of cough. PMID:24155415

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

    Science.gov (United States)

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

    1990-01-01

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

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

    International Nuclear Information System (INIS)

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

  18. Transbronchial needle aspirates: how many passes per target site?

    Science.gov (United States)

    Diacon, A H; Schuurmans, M M; Theron, J; Brundyn, K; Louw, M; Wright, C A; Bolliger, C T

    2007-01-01

    Transbronchial needle aspiration is a bronchoscopic sampling method for a variety of bronchial and pulmonary lesions. The present study investigated whether and how serial needle passes contribute to the yield of transbronchial needle aspiration at specific target sites. A total of 1,562 needle passes, performed at 374 target sites in 245 patients with neoplastic disease (82%), non-neoplastic disease (15%) or undiagnosed lesions (3%), were prospectively recorded and rated for anatomical location, size, bronchoscopic appearance and underlying disease. Positive aspirates were obtained in 75% of patients and at 68% of target sites. A diagnosis was established with the first, second, third and fourth needle pass at 64, 87, 95 and 98% of targets, respectively. The absolute yield varied strongly with target site features, but the stepwise increment to the maximum yield provided by serial passes was similar across target sites. In conclusion, three transbronchial needle passes per site are appropriate when only a tissue diagnosis is sought and when alternative sites or sampling modalities are available. At least four or five passes should be carried out at lymph node stations critical for the staging of lung cancer. PMID:17005579

  19. Decreased ERCC1 Expression After Platinum-Based Neoadjuvant Chemotherapy in non-Small Cell Lung Cancer.

    Science.gov (United States)

    Podmaniczky, Eszter; Fábián, Katalin; Pápay, Judit; Puskás, Rita; Gyulai, Márton; Furák, József; Tiszlavicz, László; Losonczy, György; Tímár, József; Moldvay, Judit

    2015-04-01

    We have already demonstrated in a small cohort of 17 non-small cell lung cancer patients that ERCC1 (excision repair cross-complementation group 1) protein expression decreased after platinum-based treatment, however, certain clinicopathological parameters, such as histologic subtypes, ERCC1 expression scores, chemotherapeutic combinations, response rate, gender and smoking history were not analyzed. The aim of our present study was to extend the studied cohort and analyze those parameters. ERCC1 protein expression was examined in 46 patients treated with neoadjuvant chemotherapy. 46 bronchoscopic biopsy samples (27 squamous cell carcinomas /SCC/ and 19 adenocarcinomas /ADC/) together with their corresponding surgical biopsies were studied. ERCC1 immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissues. Staining scores were calculated by multiplying the percentage of positive tumor cells (0-100) by the staining intensity (0-3). 24/27 bronchoscopic SCC tissues expressed ERCC1. Thirteen of these cases became negative after neoadjuvant therapy and the expression differences between pre- and postchemotherapy samples were highly significant (p affects the ERCC1 expression probably referring to an induction of tumor cell selection. PMID:25194563

  20. Bronchography in patients with persistent cough

    International Nuclear Information System (INIS)

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

  1. Primary pulmonary Hodgkin's lymphoma

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

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

  3. Achieving competency in bronchoscopy: challenges and opportunities.

    Science.gov (United States)

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

    2014-05-01

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

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

    Directory of Open Access Journals (Sweden)

    José Cárdenas-García, MD

    2014-01-01

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

  5. The Hopkins rod-lens system.

    Science.gov (United States)

    Ellis, Harold

    2007-06-01

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

  6. Airway surface irregularities promote particle diffusion in the human lung

    International Nuclear Information System (INIS)

    Current NCRP and ICRP particle deposition models employed in risk assessment analyses treat the airways of the human lung as smooth-walled tubes. However, the upper airways of the tracheobronchial (TB) tree are line with cartilaginous rings. Recent supercomputer simulations of in vivo conditions (cited herein), where cartilaginous ring morphologies were based upon fibre-optic bronchoscope examinations, have clearly demonstrated their profound effects upon fluid dynamics. A physiologically based analytical model of fluid dynamics is presented, focusing upon applications to particle diffusion within the TB tree. The new model is the first to describe particle motion while simultaneously simulating effects of wall irregularities, entrance conditions and tube curvatures. This study may explain the enhanced deposition by particle diffusion detected in replica case experiments and have salient implications for the clinically observed preferential distributions of bronchogenic carcinomas associated with inhaled radionuclides. (author)

  7. ROLE OF FIBREOPTIC BRONCHOSCOPY IN EVALUATION OF PL EURAL EFFUSION CASES

    Directory of Open Access Journals (Sweden)

    Somnath

    2013-04-01

    Full Text Available ABSTRACT: Fibreoptic bronchoscopy which is usually used as a d iagnostic modality in many tacheobronchial pathologies is not routinely recomm ended for evaluating patients with pleural effusion. Present study was conducted in a tertiary care hospital in Rajahmundry where bronchoscopy is in regular use. Among 59 cases of ple ural effusion in which fibreoptic bronchoscopy was performed, the bronchial aspirate re ports were compared with the reports of the pleural fluid analysis. It was observed that out of the 59 patients only in 19 patients the diagnosis could be established. In comparison to the pleural fluid analysis report the yield was better. As per as tubercular pleural effusion is conc erned the bronchoscopic yield was good. We conclude in the study that fiberoptic bronchoscopy ca n be used as a diagnostic tool in the cases of pleural effusion where cause is unknown.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-08-01

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

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

    Science.gov (United States)

    Lampl, L

    2015-05-01

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

  10. A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Özgül

    2014-01-01

    Full Text Available Inflammatory myofibroblastic tumors (IMTs are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2013-04-01

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

  13. 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.

  14. 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.

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

    International Nuclear Information System (INIS)

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

  16. Airway management in Escobar syndrome: A formidable challenge

    Directory of Open Access Journals (Sweden)

    Shaji Mathew

    2013-01-01

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

  17. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Invasive tracheobronchial aspergillosis progressing from bronchial to diffuse lung parenchymal lesions.

    Science.gov (United States)

    Ohta, Hiromitsu; Yamazaki, Susumu; Miura, You; Kanazawa, Minoru; Sakai, Fumikazu; Nagata, Makoto

    2016-03-01

    Invasive tracheobronchial aspergillosis that is entirely limited or predominantly confined to tracheobronchial lesions is a relatively rare form of invasive pulmonary aspergillosis. Extended parenchymal opacities that are radiological manifestations of invasive aspergillosis sometimes occur following invasive tracheobronchial aspergillosis. However, it remains unclear whether or not invasive tracheobronchial aspergillosis is the initial stage of invasive pulmonary aspergillosis. A 61-year-old woman was admitted because of severe diarrhea and dehydration. Three days after admission, she complained of dyspnea. A computed tomography (CT) scan of the chest showed bronchial wall thickening. She developed respiratory failure despite antibiotic therapy. A CT scan showed obstructions of bronchial lumens and bronchiectasis in the right upper lobe. A spergillus fumigatus was identified from samples obtained in bronchoscopic examination. Bronchial lesions rapidly progressed to be extended. A spergillus infection with multiple parenchymal opacities was observed on CT scan. She responded to treatment with antifungal drugs. PMID:26839700

  20. Diffuse Cystic Lung Diseases: Diagnostic Considerations.

    Science.gov (United States)

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

    2016-06-01

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

  1. RETROGRADE INTUBATION IN A ZERO FINGER MOUTH OPENING PATIENT

    Directory of Open Access Journals (Sweden)

    Ismail J.

    2015-10-01

    Full Text Available The major responsibility of the anesthesiologist is to secure the airway and provide adequate ventilation to the anesthetised patient. Inability to manage difficult airway has been responsible for many of the total deaths attributable to anesthesia. A good clinical judgment is important for selecting the method for airway intervention. The retrograde intubation technique is a valuable option in places where fiber optic bronchoscope is not readily available or affordable for gaining airway access for surgery in cases with anticipated difficult airway. We report a case of right sided carcinoma of cheek with inability to open mouth posted for right sided modified radical neck dissection with myocutaneous flap insertion with anticipated difficult intubation. An awake retrograde nasal intubation with light sedation and local block was performed

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

    Science.gov (United States)

    Iyoda, A; Fujisawa, T; Moriya, Y

    2004-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    Amitabha Sengupta

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ravi Kishore

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    John Schweiger

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-05-15

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

  8. Anesthetic management for thoracic surgery in Rubinstein-Taybi syndrome.

    Science.gov (United States)

    Blazquez, E; Narváez, D; Fernandez-Lopez, A; Garcia-Aparicio, L

    2016-01-01

    Rubinstein-Taybi syndrome (RTS) is a chromosomopathy associated to molecular mutations or microdeletions of chromosome 16. It has an incidence of 1:125,000-700,000 live births. RTS patients present craniofacial and thoracic anomalies that lead to a probable difficult-to-manage airway and ventilation. They also present mental retardation and comorbidity, such as congenital cardiac defects, pulmonary structural anomalies and recurrent respiratory infections, which increase the risk of aspiration pneumonia. Cardiac arrhythmias have been reported after the use of certain drugs such as succinylcholine and atropine, in a higher incidence than in general population. There is an increased risk of postoperative apnea-hypopnea in these patients. We report the anesthetic management in a RTS patient undergoing emergent thoracic surgery due to oesophageal perforation and mediastinitis. Lung isolation was achieved with a bronchial blocker guided with a fiberoptic bronchoscope and one-lung ventilation was performed successfully. PMID:27062171

  9. 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™.

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

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Agrawal

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-06-01

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

  12. An innovative way to reinsert dislodged Arndt blocker using urological glide wire

    Science.gov (United States)

    Pillai, Rahul; Ancheri, Sneha Ann; Dharmalingam, Sathish Kumar; Sahajanandan, Raj

    2016-01-01

    The Arndt blocker is positioned in the desired bronchus using a wire loop which couples the blocker with a fiberoptic bronchoscope (FOB). The wire loop once removed cannot be reinserted in 5F and 7F blockers making repositioning of the blocker difficult. A 34-year-old female was to undergo left thoracotomy followed by laparoscopic cholecystectomy. The left lung was isolated with a 7F Arndt bronchial blocker. During one-lung ventilation, the wire loop was removed for oxygen insufflation. There was loss of lung isolation during the procedure and dislodgement of the blocker was confirmed by FOB. The initial attempts to reintroduce the blocker into the left main bronchus failed. An alternative technique using a glide wire was attempted which resulted in successful reintroduction of the Arndt blocker. The 0.032 inch zebra glide wire may be effectively used to reposition a dislodged Arndt blocker if the wire loop has been removed. PMID:27052085

  13. Open thoracotomy for pneumothorax.

    Science.gov (United States)

    Lazopoulos, Achilleas; Barbetakis, Nikolaos; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Lampaki, Sofia; Karavergou, Anastasia; Kipourou, Maria; Lada, Martha; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-02-01

    A thoracotomy is an incision into the pleural space of the chest. It is performed by surgeons (or emergency physicians under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. This surgical procedure is a major surgical maneuver it is the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer and as such requires general anesthesia with endotracheal tube insertion and mechanical ventilation, rigid bronchoscope can be also used if necessary. Thoracotomies are thought to be one of the most difficult surgical incisions to deal with post-operatively, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading to atelectasis or pneumonia. In the current review we will present the steps of this procedure. PMID:25774309

  14. Preserving lung after traumatic transection of left lower lobe bronchus from bullet injury.

    Science.gov (United States)

    Hanif, Muhammad Shoaib; Mishwani, A H; Oparka, J; Buchan, K

    2015-06-01

    A 22-year-old soldier was shot in the left chest by a bullet from close range. He was found to have a left haemothorax and remained shocked despite aggressive resuscitation. Due to difficult terrain and night time movement restrictions, there were limitations to the transfer of patient. So he was attended at a peripheral hospital. At emergency thoracotomy, three segmental arteries to left upper lobe were ligated and haemostasis was secured. The level of transection of left lower lobe bronchus was identified to be below the origin of the apical segmental bronchus. The lower lobe bronchus was successfully re-attached and followed up with a daily bronchoscopic clearance of distal airway. The patient made a full recovery. Anastomosis of left lower lobe bronchus after traumatic transection is a viable option for preserving an amputated lobe, in trauma settings, provided haemostatic control has been adequately achieved. PMID:24515083

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2016-09-01

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

  17. A rare case of lung carcinoma with mucoepidermoid histopathology: a case report and review of the literature.

    Science.gov (United States)

    Thomas, David; Modi, Yashpal; Dorai, Bhuvaneswari; Guron, Gunwant

    2015-01-01

    Mucoepidermoid carcinoma of the lung is exceedingly rare. Our case involves a 58-year-old male who presented with shortness of breath, dysphagia, and weight loss. He denied ever smoking. Chest x-ray revealed trapped lung, and CT demonstrated a right bronchial mass. Diagnosis of lung carcinoma was made by bronchoscopic FNA biopsy. EGFR mutation was negative. Staging workup demonstrated evidence of advanced disease. Performance status was good, and it was decided to start chemotherapy and radiation for palliation. Lung carcinomas often present as an obstructing hilar mass. There are different histological grades that affect progression and survival. Though uncommon, metastatic spread has been previously reported. Studies have investigated the possible role of tyrosine kinase inhibitors in both EGFR-mutated and non-mutated cases. Unfortunately, there has been little consensus as to which therapies are most beneficial. PMID:25887880

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

    International Nuclear Information System (INIS)

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

  19. 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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

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

    1994-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Hongwu WANG

    2010-09-01

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

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

    Directory of Open Access Journals (Sweden)

    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

  3. Avaliação da utilidade diagnóstica da fibrobroncoscopia óptica na tuberculose pulmonar BAAR negativa na prática clínica de rotina Evaluation of the diagnostic utility of fiberoptic bronchoscopy for smear-negative pulmonary tuberculosis in routine clinical practice

    Directory of Open Access Journals (Sweden)

    Alonso Soto

    2012-12-01

    Full Text Available Avaliamos o rendimento diagnóstico da fibrobroncoscopia óptica no diagnóstico de tuberculose pulmonar com baciloscopia negativa em pacientes atendidos em um hospital de referência em Lima, Peru. Dos 611 pacientes submetidos ao procedimento, 140 (23% foram diagnosticados com tuberculose com base nas amostras de LBA. Ser mais jovem e do sexo masculino foi associado a culturas positivas. Além disso, 287 pacientes realizaram baciloscopia de escarro após a broncoscopia, e os resultados aumentaram o rendimento diagnóstico em 22% em relação às amostras de LBA. Concluímos que amostras de LBA e de escarro pós-broncoscopia tiveram um bom rendimento diagnóstico nos pacientes com suspeita de tuberculose pulmonar com baciloscopia negativa.We evaluated the diagnostic yield of fiberoptic bronchoscopy for the diagnosis of smear-negative pulmonary tuberculosis in patients treated at a referral hospital in Lima, Peru. Of the 611 patients who underwent the procedure, 140 (23% were diagnosed with tuberculosis based on the analysis of BAL samples. Being young and being male were significantly associated with positive cultures. In addition, 287 patients underwent post-bronchoscopic sputum smear testing for AFB, the results of which increased the diagnostic yield by 22% over that obtained through the analysis of BAL samples alone. We conclude that the analysis of BAL samples and post-bronchoscopic sputum samples provides a high diagnostic yield in smear-negative patients suspected of having pulmonary tuberculosis.

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

    Directory of Open Access Journals (Sweden)

    Hira H

    2009-01-01

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

  5. Endobronchial Ultrasound Changed the World of Lung Cancer Patients: A 11-Year Institutional Experience.

    Directory of Open Access Journals (Sweden)

    Chia-Hung Chen

    Full Text Available The role of advanced bronchoscopic diagnostic techniques in the detection and staging of lung cancer has increased sharply in recent years. The development of endobronchial ultrasound (EBUS improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions (PLLs. We investigated the impact of using EBUS as a diagnostic method for tissue acquisition in lung cancer patients.In a single center observational retrospective study, 3712 subjects were diagnosed with lung cancer from 2003 to 2013 (EBUS was introduced in 2008. Thus, we divided the data into two periods: the conventional bronchoscopy period (2003 to 2007 and the EBUS period (2008 to 2013.A total of 3712 patients were included in the analysis. Comparing the conventional bronchoscopy period with the EBUS period data, there has been a significant reduction in the use of diagnostic modalities: CT-guided biopsy (P < 0.0001 and pleural effusion cytology (P < 0.0001. The proportion of subjects diagnosed using bronchoscopy significantly increased from 39.4% in the conventional period to 47.4% in the EBUS period (P < 0.0001. In the EBUS period, there has also been a significant increase in the proportion of patients proceeding directly to diagnostic surgery (P < 0.0001. Compared to bronchoscopy, the incidence of complications was higher in those who underwent CT guide biopsy. The incidence of iatrogenic pneumothorax significantly decreased in the EBUS period.Advanced bronchoscopic techniques are widely used in the diagnosis of lung cancer. At our institution, the increasing use of EBUS for providing lung cancer diagnosis has led to a significant reduction in other diagnostic modalities, namely CT-guided biopsy and pleural effusion cytology. These changes in practice also led to a reduction in the incidence of complications.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

  8. Microbiological pattern of ventilator associated pneumonia

    International Nuclear Information System (INIS)

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

  9. 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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  12. High resolution computed tomography(HRCT) findings of a solitary pulmonary nodule : differential diagnosis of cancer and tuberculosis

    International Nuclear Information System (INIS)

    To evaluate the role of HRCT in the differentiation of Pulmonary tuberculosis and lung cancer, where the manifestation of disease is a solitary pulmonary nodule(SPN). Forty eight SPNs including 29 cancers proven by surgery(n=10), by bronchoscopic biopsy(n=7) and by fine needle aspiration biopsy(n=12), and 19 tuberculous nodules proven by surgery(n=4), by bronchoscopic biopsy(n=4), by fine needle aspiration biopsy(n=5), by a positive result in AFB culture without evidence of malignant cells(n=3), and by a decrease in size on serial plain chests despite negative AFB culture(n=3) were included. Scanning parameters for HRCT were 140 KVp, 170 mA, 1.5 mm collimation, 3 sec scanning time, and a high spatial frequency algorithm was used. With regard to the marginal features of nodules, the findings more commonly observed in malignant nodules were greater average length of the longest spicule(5.35 ± 3.19 mm versus 2.75 ± 1.56 mm), and more commonspiculated nodules greater than 3 cm in diameter, 16(55%) versus 2(10.5%)(p<0.05). Regarding the internal characteristics of nodules and perinodular parenchymal changes, the findings more commonly observed in cases of cancer were air-bronchograms within nodules(14 ; 48.3%) and interlobar fissure puckering (6 ; 20.7%), whereas in tuberculosis cases the most common findings were low density of nodule(16 ; 84.2%), cavitation(12 ; 63.1%), and perinodular focal lung hypodensity(5 ; 26.3%), (p<0.05). no statstically significant difference was observed between the incidence of satellite lesion of tuberculous(73.7%) and of malignant nodules(34.5%). However, perilobular nodules or bronchovascular bundle thickening s were more commonly observed in the satellite lesions of malignant nodules(9 ; 90%), whereas centrilobular nodules or lobular consolidation were more commonly observed in those of tuberculous nodules(12 ; 85.7%), (p<0.05). HRCT provides detailed information concerning perinodular parenchymal changes and characteristics of

  13. 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

  14. 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.

  15. 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

  16. A follow up study on interstitial alveolitis

    Directory of Open Access Journals (Sweden)

    Kamat S

    2004-01-01

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

  17. COMPLETE LEFT MAIN BRONCHUS DISRUPTION DUE TO BLUNT CHEST TRAUMA

    Directory of Open Access Journals (Sweden)

    Mohammed Nasser Aldahmashi

    2014-12-01

    Full Text Available Isolated tracheobronchial disruption is an uncommon injury usually associated with severe blunt thoracic trauma. We report a 14 year-old female case with avulsion of the left main bronchus occurring after blunt chest trauma due to a down fallen wall. A successful surgical repair of the totally avulsed left main bronchus was carried out. The postoperative course was uneventful with improvement in the respiratory status. The patient regained wellness within days in the intensive care unit, and the diagnosis of traumatic rupture of the left main bronchus was approved by bonchoscopy and the computerized tomography (CT scan of the chest. Surgical repair of the disrupted left main bronchus was accomplished 10 days from the admission and the bronchoscopic evaluation of the anastomosis and patency was achieved. The patient was discharged with her lung fully expanded on chest X-ray. The diagnosis and preoperative management of this uncommon post traumatic condition is discussed. We conclude that, in a patient with sustained severe blunt thoracic trauma, a high index of suspicion for trachea-bronchial disruptions must be maintained to detect these rare lesions. Skilful and early surgical treatment is required for proper management of such cases.

  18. 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.

  19. Pulmonary infiltration with eosinophils in 14 dogs

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    1991-04-01

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

  1. 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.

  2. Clinical spectrum of pulmonary hamartoma diagnosed by surgical resection

    International Nuclear Information System (INIS)

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

  3. Collapse phenomenon during Chartis collateral ventilation assessment.

    Science.gov (United States)

    Gesierich, Wolfgang; Samitas, Konstantinos; Reichenberger, Frank; Behr, Juergen

    2016-06-01

    Chartis is increasingly used for bronchoscopic assessment of collateral ventilation before endobronchial valve (EBV) treatment for severe emphysema. Its prognostic value is, however, limited by the airway collapse phenomenon. The frequency and clinical significance of the collapse phenomenon remain largely unknown.We performed a retrospective analysis of 92 patients undergoing Chartis evaluation under spontaneous breathing (n=55) or jet ventilation (n=37) from May 2010 to November 2013. Collateral ventilation status (positive/negative/collapse phenomenon/unclear) was reassessed and correlated with high-resolution computed tomography (HRCT) fissure analysis and clinical response.In the absence of the collapse phenomenon, the predictive value of Chartis measurements and HRCT fissural analysis was comparable. The collapse phenomenon was observed in 31.5% of all assessments, and was more frequent in lower lobes (44.9% versus 16.9% in upper lobes) and under jet ventilation (41.4% versus 22.1% under spontaneous breathing). 69.8% of lobes with the collapse phenomenon had complete fissures. Most patients with the collapse phenomenon in the target lobe and complete fissures treated with EBVs were responders (n=11/15). All valve-treated collapse phenomenon patients with fissure defects were nonresponders (n=3).In the absence of the collapse phenomenon Chartis measurement is reliable to predict response to valve treatment. In patients with the collapse phenomenon, treatment decisions should be based on HRCT detection of fissure integrity. Chartis assessment should be performed under spontaneous breathing. PMID:27076587

  4. An approach to interstitial lung disease in India

    Directory of Open Access Journals (Sweden)

    J N Pande

    2014-07-01

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

  5. 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.

  6. Medical devices for the anesthetist: current perspectives

    Directory of Open Access Journals (Sweden)

    Ingrande J

    2014-03-01

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

  7. Interventional bronchoscopy in the management of thoracic malignancy.

    Science.gov (United States)

    Hardavella, Georgia; George, Jeremy

    2015-09-01

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

  8. Interventional bronchoscopy in the management of thoracic malignancy

    Directory of Open Access Journals (Sweden)

    Georgia Hardavella

    2015-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-08-15

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

  10. 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.)

  11. Haemophilia, AIDS and lung epithelial permeability

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Sergio Nicola Forti Parri

    2014-01-01

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

  13. 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.

  14. CT of the pulmonary parenchyma: Current clinical applications

    International Nuclear Information System (INIS)

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

  15. 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.

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

    Science.gov (United States)

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

    1992-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-15

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

  18. 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.

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

    Institute of Scientific and Technical Information of China (English)

    傅毅立; 李辉

    2009-01-01

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

  20. The clinical analysis of 125I particles implantation by fibrobronchoscope and percutaneous in the treatment of tracheal stenosis of advanced lung cancer

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy of 125I particles implantation in the treatment of tracheal stenosis due to advanced lung cancer. Methods: Eighteen cases with end stage lung cancer were collected.125I particles were implanted by inserting the bronchoscope into the pathological bronchial tubes of distal puncture. The number of 125I particles implanted ranged from 4-15. The tumor sizes were compared before and 30 d, 60 d, 180 d after the 125I particles implantation according to the examination of CT, and the clinical symptoms were studied. Results: The symptoms of shortness of breath were relieved after 125I particles implantation. Thirty days follow-up after the therapy showed 15 cases of enlarged bronchial lumen, 13 cases of disappeared obstructive pneumonia symptoms, and no obvious complication occurred during the follow-up. Conclusion: The implantation of 125I radioactive particles has a good effect for the tracheal stenosis in the treatment of advanced lung cancer; the therapy is safe and worth to be spread. (authors)

  1. Endobronchial Solitary Papilloma

    Directory of Open Access Journals (Sweden)

    Fidan Yıldız

    2011-12-01

    Full Text Available A sixty-four year old male patient came to the emergency service with a haemoptysis complaint for which his postero-anterior chest X-Ray and computerized thorax tomography had no pathological findings. To find the origin of the haemoptysis, indirect laryngoscopy and endoscopy inspections were made. However, there was no pathology found on these inspections. At fiberoptic bronchoscopy a lobulated, white lesion approximately 0.5 cm in diameter was found at the entrance of left lower lobe anterior segment. The lesion was removed by forceps biopsy resection. The pathological inspection of this lesion resulted in a diagnosis of endobronchial papilloma. Examination of this biopsy with HPV DNA gave negative result. To plan his treatment, we examined the patient 2 weeks and 6 months later. He had no complaint and his bronchoscopic inspection had no pathological findings. We decided to examine him periodically. The endobronchial solitary papilloma is a rare benign tumor of the bronchus but we must be careful about smokers since this benign lesion may become malignanat.

  2. Serial CT findings of bronchial lesions in patients with endobronchial tuberculosis during or after medical treatment

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the bronchial change of the endobronchial tuberculosis on CT scan during and after medical treatment to guide. We prospectively analyzed the bronchial changes on CT scans of 14 endobronchial tuberculous lesions in 11 patients. The diagnosis of the endobronchial tuberculosis was obtained by bronchoscopic biopsy, washing cytology. The mean period of treatment before follow-up CT scan is 5.2 months (2-12 months). Improving process of the endobronchial lesions were observed in 1 smooth tapered obstruction and 1 irregular narrowing. Normalization of the CT findings after or during the medical treatment were seen in 4 smooth narrowing, 1 irregular narrowing, 1 tapered obstruction, 1 V-shaped obstruction, 1 abrupt amputation, and 3 focal nodular narrowing. Little interval changes was observed in only 1 case of the V-shaped obstruction. The patency of most of the narrowed or obstructed bronchus were improved during or after medical treatment, except in one case of V-shaped obstruction

  3. Laryngeal structure and function in dogs with cough.

    Science.gov (United States)

    Johnson, Lynelle R

    2016-07-15

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

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Devrim Cabuk

    2013-01-01

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

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

    Science.gov (United States)

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

    2000-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-04-01

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

  9. Dynamics of human respiratory system mycoflora

    Directory of Open Access Journals (Sweden)

    Anna Biedunkiewicz

    2014-08-01

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

  10. 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.

  11. 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).

  12. Laryngeal mask airway: an alternative for the difficult airway.

    Science.gov (United States)

    Jones, J R

    1995-10-01

    The laryngeal mask airway (LMA) was invented by Dr. Archie Brain at the London Hospital, Whitechapel, in 1981. Dr. Brain's main objective for the LMA was that it would provide a better method of maintaining a patient's airway than by face mask. Also, the LMA would be less hemodynamically stressful than with insertion of an endotracheal tube. The LMA consists of a silicone rubber tube connected to a miniature silicone mask. The perimeter of the mask consists of an inflatable elliptical cuff, which forms a tip at the distal aspect of the LMA. The aperture bars in the dome of the mask lift the epiglottis away, so the lumen remains unobstructive. The LMA forms a low pressure seal around the larynx. The LMA is contraindicated in any situation where the patient is at risk for pulmonary aspiration. The LMA is not a substitute for a properly placed endotracheal tube in this situation. The American Society of Anesthesiologists' difficult airway algorithm recommends the insertion of an LMA when ventilation and/or intubation are difficult. The distal aperture of the LMA is in close approximation to the vocal cords, so a 6.0-mm internal diameter endotracheal tube can be passed over an intubating stylet or a pediatric fiberoptic bronchoscope to secure a patient's airway. PMID:7502644

  13. Management of malignant airway obstruction: clinical and dosimetric considerations using an iridium-192 afterloading technique in conjunction with the neodymium-YAG laser

    International Nuclear Information System (INIS)

    Fourteen patients with malignant airway obstruction have had 21 placements of a flexible nylon catheter for afterloading iridium-192 using the flexible fiberoptic bronchoscope. Prescribed therapy was completed in 13 patients (18 courses). All patients had prior full-dose external irradiation, and no effective surgical or chemotherapeutic options remained. While many have had a trial of neodymium-YAG (yttrium-aluminum-garnet) laser therapy alone, eight patients received laser treatment one to three weeks prior to planned brachytherapy to provide immediate relief of symptoms and/or facilitate access and safe catheter placement. Most patients (64%) had recurrent squamous cell lung cancer. A dose of 3000 cGy is currently specified to 5 mm and 10 mm in the bronchus and trachea, respectively. Nine of the 13 treated patients have had follow-up bronchoscopy at approximately three months post-treatment with improvement documented in seven and progression in two patients. A single patient treated with laser and 6000 rad at 5 mm developed a bronchoesophageal fistula. No other complication has been observed. The technique is simple and safe with the use of laser therapy when needed and appears to offer effective palliation in most patients even when standard therapy is exhausted

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

    Science.gov (United States)

    Trotter, Michael A; Hopkins, Peter M

    2014-11-01

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

  15. 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.

  16. 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

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

    Science.gov (United States)

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

    2015-01-01

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

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    Belgin Samurkaşoğlu

    2012-09-01

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

  20. Pulmonary alveolar proteinosis

    Directory of Open Access Journals (Sweden)

    Hadice Selimoğlu Şen

    2011-06-01

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

  1. Lung vasculature imaging using speckle variance optical coherence tomography

    Science.gov (United States)

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

    2012-02-01

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

  2. Radiologic findings of pulmonary endometriosis

    International Nuclear Information System (INIS)

    To describe the radiologic findings of pulmonary endometriosis. This study involved five patients with catamenial hemoptysis diagnosed as pulmonary endometriosis. All cases were diagnosed on the basis of bronchoscopic abnormalities. In one patient, endometrial glandular cells were seen on transthoracic fine needle aspiration biopsy. In three, hemoptysis ceased after Danazol treatment. The pattern, location and number of parenchymal abnormalities and the presence or absence of pleural lesion were analyzed retrospectively on plain chest radiographs (n=3D5) and CT scans(n=3D5). Follow-up study for each menstrual period was performed in two cases and changes from the initial lesion were assessed. Plain chest radiographic findings showed focal ground-glass opacity in three cases;two were in the right lung and one in the left. CT findings included ground-glass attenuation (n=3D3) and a mixed pattern of ground-glass attenuations and consolidations(n=3D2). Sites were single in four cases, and in one case, there were two; thus there were in all six lesions. Five of these were located in the right lung and subpleural region, continving to the pleura. Pleural lesion was not detected on either chest radiographs or CT scans. Follow-up CT scans (n=3D2) showed a similar lesion at the same site. In patient with repeated catamenial hemoptysis, CT may be helpful for the diagnosis of pulmonary endometriosis by exclusion of other diseases.=20

  3. Radiologic findings of pulmonary endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seon Bok; Lee, Eil Seong; Jung, Hae Kyoung; Kim, Uk Jung; Yi, Jeong Geun; Kang, Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of); Kook, Shin Ho [Kangbuk Samsung Hospital, Seoul (Korea, Republic of); Park, Jae Sung [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of); Ryu, Dae Sik [Kangnung Hospital, Kangnung (Korea, Republic of)

    1998-12-01

    To describe the radiologic findings of pulmonary endometriosis. This study involved five patients with catamenial hemoptysis diagnosed as pulmonary endometriosis. All cases were diagnosed on the basis of bronchoscopic abnormalities. In one patient, endometrial glandular cells were seen on transthoracic fine needle aspiration biopsy. In three, hemoptysis ceased after Danazol treatment. The pattern, location and number of parenchymal abnormalities and the presence or absence of pleural lesion were analyzed retrospectively on plain chest radiographs (n=3D5) and CT scans(n=3D5). Follow-up study for each menstrual period was performed in two cases and changes from the initial lesion were assessed. Plain chest radiographic findings showed focal ground-glass opacity in three cases;two were in the right lung and one in the left. CT findings included ground-glass attenuation (n=3D3) and a mixed pattern of ground-glass attenuations and consolidations(n=3D2). Sites were single in four cases, and in one case, there were two; thus there were in all six lesions. Five of these were located in the right lung and subpleural region, continving to the pleura. Pleural lesion was not detected on either chest radiographs or CT scans. Follow-up CT scans (n=3D2) showed a similar lesion at the same site. In patient with repeated catamenial hemoptysis, CT may be helpful for the diagnosis of pulmonary endometriosis by exclusion of other diseases.=20.

  4. [Lipoid pneumonia - an underestimated syndrome].

    Science.gov (United States)

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

    2010-01-01

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

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

    International Nuclear Information System (INIS)

    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.

  6. Tracheal reconstructions.

    Science.gov (United States)

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

    1998-12-01

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

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. The evaluation of various bioabsorbable materials on the titanium fiber metal tracheal prosthesis.

    Science.gov (United States)

    Mendak, S H; Jensik, R J; Haklin, M F; Roseman, D L

    1984-11-01

    A new type of tracheal prosthesis was studied. It consists of a rigid, porous cylinder of titanium fiber metal coated with a polymer that provides an initial air seal and then is absorbed to permit subsequent fibrous tissue ingrowth and reepithelialization. Fifteen such cylinders measuring 50 mm by 26 mm were coated with one of the following polymers: polycaprolactone 700 (3 coated internally and 3 externally); a copolymer of 75% poly-L-lactic acid and 25% polyglycolic acid (3 coated internally and 3 externally); and polyglactin 910 (3 coated externally). Fifteen kennel-conditioned mongrel dogs, each randomly assigned to one of these five groups, underwent implantation of the prosthesis through a right thoracotomy into a 5-cm defect in the distal intrathoracic trachea. There were no immediate postoperative deaths, and no instances of major air leak from the prosthesis. One animal died after two weeks secondary to a lower respiratory tract infection. Bronchoscopic evaluation revealed varying degrees of tissue ingrowth into the prostheses, with no evidence of infection or distal accumulation of secretions. Histological evaluation showed superior tissue ingrowth and reepithelialization with internally coated prostheses; two out of three polymers gave good results. PMID:6497477

  10. Timing of silicone stent removal in patients with post-tuberculosis bronchial stenosis

    Directory of Open Access Journals (Sweden)

    Jung Seop Eom

    2013-01-01

    Full Text Available Context: In patients with post-tuberculosis bronchial stenosis (PTBS, the severity of bronchial stenosis affects the restenosis rate after the silicone stent is removed. In PTBS patients with incomplete bronchial obstruction, who had a favorable prognosis, the timing of stent removal to ensure airway patency is not clear. Aims: We evaluated the time for silicone stent removal in patients with incomplete PTBS. Settings and Design: A retrospective study examined PTBS patients who underwent stenting and removal of a silicone stent. Methods: Incomplete bronchial stenosis was defined as PTBS other than total bronchial obstruction, which had a luminal opening at the stenotic segment on bronchoscopic intervention. The duration of stenting was defined as the interval from stent insertion to removal. The study included 44 PTBS patients and the patients were grouped at intervals of 6 months according to the duration of stenting. Results: Patients stented for more than 12 months had a significantly lower restenosis rate than those stented for less than 12 months (4% vs. 35%, P = 0.009. Multiple logistic regression revealed an association between stenting for more than 12 months and a low restenosis rate (odds ratio 12.095; 95% confidence interval 1.097-133.377. Moreover, no restenosis was observed in PTBS patients when the stent was placed more than 14 months previously. Conclusions: In patients with incomplete PTBS, stent placement for longer than 12 months reduced restenosis after stent removal.

  11. Decision making in patients with pulmonary nodules.

    Science.gov (United States)

    Ost, David E; Gould, Michael K

    2012-02-15

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

  12. Experimental study of bone morphogenetic proteins-2 slow release from an artificial trachea made of biodegradable materials: evaluation of stenting time.

    Science.gov (United States)

    Yamamoto, Yasumichi; Okamoto, Taku; Goto, Masashi; Yokomise, Hiroyasu; Yamamoto, Masaya; Tabata, Yasuhiko

    2003-01-01

    We manufactured an artificial trachea that slowly releases bone morphogenetic protein 2 (BMP-2) and used it to replace a section of the canine trachea. We made a three-layered prosthesis composed of an outer layer of gelatin sponge, a middle layer of collagen sponge, and an inner silicone tube. BMP-2 solution was soaked into the gelatin sponge layer. An approximately 3 cm length of the canine trachea was resected, and the artificial trachea was inserted into the resulting gap and anastomosed. The implanted portion was covered by periosteum. At 2, 4, and 8 weeks after surgery, the inner silicone tube was removed. Soon after removal of the silicone tube at 2 and 4 weeks, the dogs died of choking because of collapse of the trachea. One dog whose silicone tube was removed at 8 weeks was able to survive without choking. At 6 months after removal of the silicone tube, the bronchoscopic findings revealed that the gap in the trachea had been closed by regenerated tissue and covered by mucosa. We have demonstrated that our artificial trachea slowly releasing BMP-2 requires at least 8 weeks to achieve regeneration of solid tissue to support the tracheal gap. PMID:14524559

  13. 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.

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

    Science.gov (United States)

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

    2016-07-01

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

  15. 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.

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

    Science.gov (United States)

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

    2016-07-01

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

  17. Non-pharmacological treatments for COPD.

    Science.gov (United States)

    Mulhall, Patrick; Criner, Gerard

    2016-07-01

    Chronic obstructive pulmonary disease (COPD) affects roughly 10% of the global population and is growing in prevalence annually. COPD is characterized by progressive non-reversible narrowing of airways mainly due to cigarette smoking. Therapeutic interventions aimed at altering this progressive disease course can largely be grouped into pharmacological or non-pharmacological therapies. The focus of this paper is on the non-pharmacological aspects of COPD management, reviewing the current literature to provide an evidence-based management approach. Non-pharmacological therapies reviewed in this article include the implementation of comprehensive care models utilizing a coordinated multidisciplinary team, tele-monitoring and patient-centred approach to optimize COPD care and improve compliance. Preventing progression of COPD via smoking cessation remains of paramount importance, and newer therapeutic options including electronic cigarettes show promise in small studies as cessation aids. COPD has systemic manifestations that can be ameliorated with the enrollment in pulmonary rehabilitation programmes, which focus on exercise endurance to improve dyspnoea and quality of life. Advanced therapeutics for COPD includes lung volume reduction surgery for a pre-specified cohort and minimally invasive bronchoscopic valves that in recent reviews show promise. Lastly, patients on maximal COPD therapy with progressive disease can be referred for lung transplantation; however, this often requires a highly selected and motivated patient and care team. Survival rates for lung transplantation are improving; thus, this procedure remains a viable option as more expertise and experience are gained. PMID:27099216

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

    Science.gov (United States)

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

    1993-06-01

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

  19. 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.

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

    Science.gov (United States)

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

    2015-12-01

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

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

    International Nuclear Information System (INIS)

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

  2. Transbornchial Lung Biopsy without Fluoroscopic Guide in Tehran Imam Khomeini’s Hospital (1999

    Directory of Open Access Journals (Sweden)

    M Zahed Poor Anaraki

    2002-09-01

    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 six month period (March-September 1999. Results: Lung tissue wasnt 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 were detected. Only one of them required chest tube (1.51 percent. Conclusion: We concluded that blind TBLB was successful in our department with rates of complications comparable to other approved centers.

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

    Science.gov (United States)

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

    2013-01-01

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

  4. Stent placement for tracheobronchial disease

    Energy Technology Data Exchange (ETDEWEB)

    Walser, Eric M. [Department of Radiology, Rt 0709, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709 (United States)]. E-mail: emwalser@utmb.edu

    2005-09-01

    Early treatment for airway stenoses or occlusions involved open repair with the attendant risks of thoracotomy or sternotomy. With the advent of rigid and, more recently, flexible bronchoscopy, the placement of airway stents has come to the forefront in the treatment of benign and malignant tracheobronchial disease. This paper describes the history of surgical and endoluminal treatment of airway disease and discusses the indications and contraindications for airway stent placement. The advantages and limitations of such therapy are reviewed as well as the procedural details and the imaging evaluation and follow-up of patients undergoing endoluminal treatment. Although the placement of tracheobronchial stents is now primarily performed by interventional pulmonologists, imaging anatomically complex airway disease also requires the skills of an accomplished cross-sectional radiologist. Additionally, interventional radiologists using fluoroscopic guidance and alternative access routes to the airways can salvage failed bronchoscopic procedures and primarily treat selected cases. Due to the importance of pre- and post-procedural imaging in these patients, radiologists should be aware of airway anatomy suitable for stent placement and the appearance of various complications of this procedure.

  5. Rate of tumor sterilisation of lung cancer by external beam irradiation

    International Nuclear Information System (INIS)

    The prospective, together with the pneumologists, defined treatment concept included the repetition of bronchoscopic evaluations after the application of 60 Gy and 80 Gy. These radiation doses from 60 Gy up to 80 Gy have been given with a shrinking-field technique to the mediastinum and the primary. In order to record statistically the optical tumor changements we were urged to create a so-called bT-score. The structure of this score was orientated towards the periphery of the tracheobronchial tree. Hundred and forty-four patients with endoscopically and histologically verified bronchogenic carcinomas were treated. On the subjects 215 re-bronchoscopies accomplished with biopsies were performed and allowed to analyze the macro- and microscopical behavior under treatment. A histological/cytological elimination of tumor was achieved after 60 Gy in 35.1%, after 80 Gy in 62.3%. Macroscopically no tumor was visible after 60 Gy in 43.6%, after 80 Gy in 82%. A correlation between identical micro- and macroscopical observations was only seen in 61%, respectively in 71%. The escalation of the radiation dose from 60 Gy up to 80 Gy with shrinked fields could increase the local tumor sterilization rate by 1.8 times from 35.1% to 62.3%. (orig./MG)

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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.

  9. Radiologic findings of anthracofibrosis

    International Nuclear Information System (INIS)

    To evaluate the CT findings of bronchial anthracofibrosis. Fourteen patients with bronchoscopically confirmed anthracofibrosis were involved in this study. CT findings (n=3D12) were retrospectively analysed; the pattern, distri-bution and extent of bronchial and parenchymal abnormalities and additional findings such as mediastinal lymphadenopathy and pleural effusion were assessed. Age, sex, and occupational and disease history were history were also reviewed. Patients were aged between 63 and 95 (mean, 71.3) years, and ten were female. Only one patient had an occupational history, but four had a history of pulmonary tuberculosis. Frequent radiologic findings were bronchial wall thickening(n=3D6), atelectasis(n=3D8), mediastinal lymphad-enopathy(n=3D7) and mass(n=3D4). Other accompanying findings were bronchial wall calcification(n=3D3), consolidation(n=3D2) and pleural effusion(n=3D2). Right upper (n=3D7) and right middle lobe(n=3D7) were the most commonly involved sites, and multifocal involvement (n=3D7) was frequent. Bronchial wall thickening, atelectasis and mediastinal lymphadenopathy were characteristic CT findings of anthracofibrosis. When such findings are noted in older or aged female patients, anthracofibrosis should be included in the differential diagnosis

  10. Marker detection evaluation by phantom and cadaver experiments for C-arm pose estimation pattern

    Science.gov (United States)

    Steger, Teena; Hoßbach, Martin; Wesarg, Stefan

    2013-03-01

    C-arm fluoroscopy is used for guidance during several clinical exams, e.g. in bronchoscopy to locate the bronchoscope inside the airways. Unfortunately, these images provide only 2D information. However, if the C-arm pose is known, it can be used to overlay the intrainterventional fluoroscopy images with 3D visualizations of airways, acquired from preinterventional CT images. Thus, the physician's view is enhanced and localization of the instrument at the correct position inside the bronchial tree is facilitated. We present a novel method for C-arm pose estimation introducing a marker-based pattern, which is placed on the patient table. The steel markers form a pattern, allowing to deduce the C-arm pose by use of the projective invariant cross-ratio. Simulations show that the C-arm pose estimation is reliable and accurate for translations inside an imaging area of 30 cm x 50 cm and rotations up to 30°. Mean error values are 0.33 mm in 3D space and 0.48 px in the 2D imaging plane. First tests on C-arm images resulted in similarly compelling accuracy values and high reliability in an imaging area of 30 cm x 42.5 cm. Even in the presence of interfering structures, tested both with anatomy phantoms and a turkey cadaver, high success rates over 90% and fully satisfying execution times below 4 sec for 1024 px × 1024 px images could be achieved.

  11. 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.

  12. Diagnostic approach to localised organising pneumonia: A case report

    Directory of Open Access Journals (Sweden)

    Đurić Mirna

    2015-01-01

    Full Text Available Introduction. Localised organising pneumonia, radiologically presented with oval or round shadows mimicing lung cancer or metastases, is a major issue in differential diagnosis. Case report. A female patient was hospitalized to clarified the etiology of multiple nodular lung lesions. The chest X-ray and the chest computed tomography (CT revealed bilateral patchy and nodular shadows, and round lung lesions, respectively. Neither sputum analyses, nor histology of bronchoscopy samples clarified the etiology of these lung lesions. As secondary deposits in the lungs were suspected, video-assisted thoracoscopy and anterolateral right minithoracotomy with atypical upper and lower lobe resection were performed. The frozen-section analysis suggested the benign nature of the lesion, and the definite histopathological finding of localised organising pneumonia was established. Due to bilateral lung lesions, corticosteroids were applied. Seven weeks later, the chest CT finding revealed a total regression of the lesions. Conclusion. A surgical resection was necessary to diagnose the localised organising pneumonia which mimiced secondary malignant lesions, thus establishing the definite etiology of lung lesions. Bronchoscopic cryobiopsy, recently introduced in order to obtain peripheral lung biopsy samples, has provided new possibilities in the diagnosis and treatment of neoplastic and non-neoplastic lung diseases.

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

    International Nuclear Information System (INIS)

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

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

    Institute of Scientific and Technical Information of China (English)

    梁军; 王晋; 徐幼; 臧丽格; 余晓燕

    2012-01-01

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

  15. Transbronchial needle aspiration. An underused diagnostic technique.

    Science.gov (United States)

    Dasgupta, A; Mehta, A C

    1999-03-01

    Despite its proven usefulness, TBNA is not widely used. An American College of Chest Physicians (ACCP) survey showed that only 11.8% of pulmonologists use TBNA. Most pulmonologists in the 1980s were not formally trained in TBNA. This lack of training has unfortunately translated to minimal emphasis on TBNA in current training programs in a large number of institutions. Technical problems with the procedure (faulty site selection, incomplete needle penetration, catheter kinking that prevents adequate suction, etc.), the confusing array of needles, low diagnostic yields, unproven concerns regarding the safety of the procedure, inadequate cytopathology support, and bronchoscopic damage have all perpetuated the image of limited usefulness for this procedure. Limitations to the practice of TBNA are: Lack of training during fellowship Technical inadequacies Lack of cytopathologists trained in TBNA interpretation Fear of bronchoscope damage Safety issues Failure to reproduce published successes Reservations regarding usefulness of TBNA results Hands-on experience with TBNA, developing familiarity and expertise with only a few needles, and paying careful attention to anatomy, procedure techniques, and specimen acquisition may all help to increase yield. The following lists how better results can be obtained with TBNA: Preprocedure Review TBNA instruction tapes Attend hands-on courses Practice with lung models Review patient's CAT scans Familiarize with one-two cytology and histology needle Obtain a trained assistant Procedural Identify target site Needle to airway angle at least greater than 45 degrees Insert entire length of the needle Use scope channel to support the catheter Release suction before withdrawing needle (for staging) Specimen acquisition Avoid delay in preparing slides Adequate sampling (at least two) Use smear method for cytology specimen Analyze all samples flush solutions cell block Postprocedure Find an experienced cytopathologist Review your procedure

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2016-07-15

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

  18. Evaluation of bioaerosol exposures during hospital bronchoscopy examinations.

    Science.gov (United States)

    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. PMID:25275615

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Clinical characteristics of sarcoidosis patients diagnosed in a university hospital

    Directory of Open Access Journals (Sweden)

    Özlem Abakay

    2012-09-01

    Full Text Available Objectives: The clinical characteristics and treatment resultsof patients diagnosed with sarcoidosis was investigatedin Dicle University Medical Faculty Hospital.Materials and methods: A total of 39 patients were includeddiagnosed with sarcoidosis between 01 January2008 and31 December 2011.Demographic data, laboratoryfindings, spirometric test data, diagnostic methodsand treatment regimens for the study were recorded form.According to pulmonary function test results of patients,61.5% were normal pattern, 30.8% were restrictive patternand 7.7% were obstructive pattern.Results: Of the 39 patients 15.4% male, 84.6% werefemale. The mean age was 39.5±13.1 years for males,females 44.8±14.0 years. All patients of was 17.9%stage 1, 66.7% stage 2, 10.3% stage 3 and 5.1% stage4. 61.5% were symptomatic, 38.5% were asymptomatic.Methods of diagnosis of the patients examined, 25.6% ofpatients bronchoscopic biopsy procedures, 74.4% of patientssurgical biopsy procedures. Of the 56.4% patientshad received corticosteroid treatment, 5.1% patients hadreceived corticosteroid + methotrexate treatment, 38.5%were followed up without the pharmacological treatment.Pharmacological treatment in the group complete at thetime of the study 20.5% concluded the treatment of theperson. Patients who treatment ending 8.4 months hadused pharmacological treatment.Conclusions: Interstitial lung diseases which are prevalentamong patients with sarcoidosis diagnosed by examiningthe clinical features, differential diagnosis and treatmentmay be possible detection of potential problems. JClin Exp Invest 2012; 3 (3: 363-367Key words: Sarcoidosis diagnosis, treatment

  1. 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.

  2. Swept-source anatomic optical coherence elastography of porcine trachea

    Science.gov (United States)

    Bu, Ruofei; Price, Hillel; Mitran, Sorin; Zdanski, Carlton; Oldenburg, Amy L.

    2016-02-01

    Quantitative endoscopic imaging is at the vanguard of novel techniques in the assessment upper airway obstruction. Anatomic optical coherence tomography (aOCT) has the potential to provide the geometry of the airway lumen with high-resolution and in 4 dimensions. By coupling aOCT with measurements of pressure, optical coherence elastography (OCE) can be performed to characterize airway wall stiffness. This can aid in identifying regions of dynamic collapse as well as informing computational fluid dynamics modeling to aid in surgical decision-making. Toward this end, here we report on an anatomic optical coherence tomography (aOCT) system powered by a wavelength-swept laser source. The system employs a fiber-optic catheter with outer diameter of 0.82 mm deployed via the bore of a commercial, flexible bronchoscope. Helical scans are performed to measure the airway geometry and to quantify the cross-sectional-area (CSA) of the airway. We report on a preliminary validation of aOCT for elastography, in which aOCT-derived CSA was obtained as a function of pressure to estimate airway wall compliance. Experiments performed on a Latex rubber tube resulted in a compliance measurement of 0.68+/-0.02 mm2/cmH2O, with R2=0.98 over the pressure range from 10 to 40 cmH2O. Next, ex vivo porcine trachea was studied, resulting in a measured compliance from 1.06+/-0.12 to 3.34+/-0.44 mm2/cmH2O, (R2>0.81). The linearity of the data confirms the elastic nature of the airway. The compliance values are within the same order-of-magnitude as previous measurements of human upper airways, suggesting that this system is capable of assessing airway wall compliance in future human studies.

  3. High Genetic Diversity among Stenotrophomonas maltophilia Strains Despite Their Originating at a Single Hospital

    Science.gov (United States)

    Valdezate, Sylvia; Vindel, Ana; Martín-Dávila, Pilar; Del Saz, Begoña Sánchez; Baquero, Fernando; Cantón, Rafael

    2004-01-01

    The levels of genetic relatedness of 139 Stenotrophomonas maltophilia strains recovered from 105 hospitalized non-cystic fibrosis patients (51% from medical wards, 35% from intensive care units, and 14% from surgical wards) and 7 environmental sources in the same hospital setting during a 4-year period were typed by the pulsed-field gel electrophoresis (PFGE) technique. A total of 99 well-defined distinct XbaI PFGE patterns were identified (Simpson's discrimination index, 0.996). The dendrogram showed a Dice similarity coefficient ranging from 28 to 80%. Two major clusters (I and II), three minor clusters (III, IV, and V), and two independent branches were observed when using a 36% Dice coefficient, indicating a high diversity of genetic relatedness. It is of note that 84% of strains were grouped within two major clonal lineages. No special cluster gathering was found among strains belonging to the same sample type specimen, patients' infection or colonization status, and ward of precedence. Despite this fact, three different clones (A, B, and C) recovered from respiratory samples from six, three, and two patients, respectively, and two clones, D and E, in two bacteremic patients each, were identified. Isolation of an S. maltophilia strain belonging to the clone A profile in a bronchoscope demonstrated a common source from this clone. This study revealed a high genetic diversity of S. maltophilia isolates despite their origin from a single hospital, which may be related to the wide environmental distribution of this pathogen. However, few clones could be transmitted among different patients, yielding outbreak situations. PMID:14766838

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-05-15

    The management of solitary lung nodules poses a common clinical problem and biopsy is often required. Several guidelines provide slightly different recommendations and there are no uniform recommendations regarding the ideal technique of puncture guidance (e.g. percutaneous versus bronchoscopic or thoracoscopic). Fine needle aspiration biopsy (FNA) and core biopsy are well established techniques. Both can be performed under CT and to some extent ultrasound guidance. Diagnostic accuracies of FNA and core biopsy for malignant lesions are around 95 %. Core biopsy is superior to FNA for establishing a specific diagnosis with a diagnostic yield of 81-88 % versus 17-21 %. In clinical routine practice core biopsy is the superior tool when compared to FNA. Central lesions in close proximity to bronchi may be biopsied with endobronchial ultrasound (EBUS)-guided bronchoscopy. In all other lesions percutaneous, ideally CT-guided biopsy should be the method of first choice. (orig.) [German] Solitaere Lungenrundherde stellen ein haeufiges differenzialdiagnostisches Problem dar, das oftmals mit der Bildgebung alleine nicht endgueltig zu loesen ist und eine Biopsie erfordert. Die Indikation zur Biopsie variiert zwischen den Leitlinien, und die beste Technik der Biopsie (perkutan vs. bronchoskopisch vs. thorakoskopisch) ist oftmals nicht eindeutig. Feinnadelaspirations- (FNA) und Stanzbiopsie stehen als lange etablierte Standardtechniken zur Verfuegung. Beide koennen CT- und bedingt ultraschallgesteuert durchgefuehrt werden. Die diagnostische Aussagekraft fuer die Diagnose maligner Tumoren liegt fuer beide Techniken bei 95 %. Die Stanzbiopsie ist jedoch der FNA fuer die spezifische Diagnose benigner Prozesse mit einer Genauigkeit von 82-88 vs. 17-21 % ueberlegen. Die Stanzbiopsie ist gegenueber der FNA das in der klinischen Routine ueberlegene Werkzeug. Bei sehr zentralen Herden in Nachbarschaft zu einem Bronchus kann primaer eine bronchoskopische EBUS-gesteuerte (endobronchialer

  5. Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients

    Directory of Open Access Journals (Sweden)

    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."

  6. An Analysis of Inhalation Injury Diagnostic Methods and Patient Outcomes.

    Science.gov (United States)

    Ching, Jessica A; Ching, Yiu-Hei; Shivers, Steven C; Karlnoski, Rachel A; Payne, Wyatt G; Smith, David J

    2016-01-01

    The purpose of this study was to compare patient outcomes according to the method of diagnosing burn inhalation injury. After approval from the American Burn Association, the National Burn Repository Dataset Version 8.0 was queried for patients with a diagnosis of burn inhalation injury. Subgroups were analyzed by diagnostic method as defined by the National Burn Repository. All diagnostic methods listed for each patient were included, comparing mortality, hospital days, intensive care unit (ICU) days, and ventilator days (VDs). Z-tests, t-tests, and linear regression were used with a statistical significance of P value of less than .05. The database query yielded 9775 patients diagnosed with inhalation injury. The greatest increase in mortality was associated with diagnosis by bronchoscopy or carbon monoxide poisoning. A relative increase in hospital days was noted with diagnosis by bronchoscopy (9 days) or history (2 days). A relative increase in ICU days was associated with diagnosis according to bronchoscopy (8 days), clinical findings (2 days), or history (2 days). A relative increase in VDs was associated with diagnosis by bronchoscopy (6 days) or carbon monoxide poisoning (3 days). The combination of diagnosis by bronchoscopy and clinical findings increased the relative difference across all comparison measures. The combination of diagnosis by bronchoscopy and carbon monoxide poisoning exhibited decreased relative differences when compared with bronchoscopy alone. Diagnosis by laryngoscopy showed no mortality or association with poor outcomes. Bronchoscopic evidence of inhalation injury proved most useful, predicting increased mortality, hospital, ICU, and VDs. A combined diagnosis determined by clinical findings and bronchoscopy should be considered for clinical practice. PMID:26594867

  7. Intrapulmonary recombinant factor VIIa for diffuse alveolar hemorrhage in children.

    Science.gov (United States)

    Park, Jeong A; Kim, Byoung-Ju

    2015-01-01

    Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders, and it has a high mortality rate. The current treatment options of corticosteroids, transfusions, and immunosuppressants have been limited and largely unsuccessful, and they can be accompanied by multiple complications. Intrapulmonary administration of recombinant activated factor VII (rFVIIa) has been reported in adults, but there are scarce data on its use in children. The present article reviews our institutional experience with intrapulmonary rFVIIa for the treatment of DAH in children. The study included 6 pediatric patients with acute, bronchoscopically confirmed DAH treated between 2011 and 2013. The median age was 11 years, and patient diagnoses were as follows: acute myeloid leukemia (2 patients), myelodysplastic syndrome (1 patient), hemophagocytic lymphohistiocytosis (1 patient), T-cell lymphoblastic lymphoma (1 patient), and idiopathic pulmonary hemosiderosis (1 patient). These patients were treated with intrapulmonary rFVIIa concurrent with methylprednisolone, fresh-frozen plasma, and maintenance of the platelet count >50 000/mm(3). Complete and sustained hemostasis after rFVIIa treatment and an absence of adverse events were observed in all patients. The PaO2/fraction of inspired oxygen ratio increased significantly, and rapid clinical improvements were observed. Two patients who received hematopoietic stem cell transplantation died of subsequent respiratory syncytial virus and Acinetobacter baumannii infections, but the other 4 patients exhibited rapid improvement, were successfully weaned from ventilators, and experienced long-term survival. Our findings indicate that intrapulmonary administration of rFVIIa is an effective and safe treatment option for children with DAH; however, further clinical studies are needed. PMID:25548333

  8. 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

  9. Lung adenocarcinoma with Lambert–Eaton myasthenic syndrome indicated by voltage-gated calcium channel: a case report

    Directory of Open Access Journals (Sweden)

    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.

  10. Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosing disease activity and monitoring therapeutic response in patients with pulmonary mycobacteriosis

    International Nuclear Information System (INIS)

    To evaluate the usefulness of 18F-FDG PET in the imaging of pulmonary lesions related to disease activity and in monitoring responses to treatment in patients with pulmonary mycobacteriosis (PM). We used high-resolution computed tomography (HRCT) and 18F-FDG PET to evaluate 47 consecutive untreated patients with PM, 25 with tuberculosis (TB) and 22 with Mycobacterium avium-intracellulare complex (MAC), who presented with small peripheral pulmonary nodules ≤3 cm, and compared the findings. The diagnosis of mycobacteriosis was confirmed by bacteriological examinations of bronchoscopic or surgically resected specimens. PET scans were visually and quantitatively analysed using SUVmax. In addition, 14 patients with PM underwent repeat PET scanning during antimycobacterial therapy, and changes in 18F-FDG uptake were clinically evaluated (6 during treatment and 12 after treatment). Of all the lesions, 87.2% had SUVmax levels ranging from 3 to 7 (5.05±1.56, range 2.5-7.6, n=47). Further, SUV levels in patients with PM reflected disease activity as estimated by HRCT, but did not differ significantly between those with TB (4.96±1.61, n=25) and MAC (5.15±1.53, n=22). 18F-FDG uptake was significantly decreased in all 14 patients who received chemotherapy, indicating a positive response to treatment. 18F-FDG PET is considered to be useful for the diagnosis and evaluation of disease activity along with HRCT findings, and in monitoring response to chemotherapy in patients with PM. (orig.)

  11. [Experimental study on novel hybrid artificial trachea transplantation].

    Science.gov (United States)

    Liu, Wenliang; Xiao, Peng; Liang, Hengxing; An, Ran; Cheng, Gang; Yu, Fenglei

    2014-04-01

    We developed and designed a new type of artificial trachea. The basic structure of the artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings on both sides. Dualmesh was sutured on titanium rings. This experimentation follows the replacement of trachea in dogs with a combined artificial trachea to investigate the feasibility of this type of prosthesis. Sixteen dogs were implanted with the combined artificial trachea after resection of 5 cm of cervical trachea. The 5 cm-long trachea of dogs on the necks were resected and the reconstruction of the defect of the trachea was performed with trachea prosthesis. According to the method of trachea reconstruction, the models were divided into 2 groups, artificial trachea implantation group (the control group, n = 8) and group of artificial trachea implantation with growth factor (the experimental group, n = 8). Then computer tomography scan (CT), bronchoscope and pathologic examination were conducted periodically to observe the healing state of the hybrid artificial trachea. None of the dogs died during operation of cervical segmental trachea construction. But four dogs in the control group died of apnea in succession because artificial trachea was displaced and the lumen was obstructed, while 2 dogs died in the experimental group. In the first month there was granulation around anastomosis with slight stenosis. The rest of dogs were well alive until they were sacrificed 14 months later. The mean survival time of the experimental group was longer than that of the control group. The rate of infection, anastomotic dehiscence, severe stenosis and accidental death in the experimental group were lower than the control group (P anastomosis effectively but infections and split or displacement of the artificial trachea are still major problems affecting long-term survival of the animals. Application of growth factors to a certain extent promotes tissue healing by changing the local environment

  12. Hemorrhagic small intestine cancer with solitary pulmonary metastasis initially presented as suspected primary lung cancer: an autopsy report.

    Science.gov (United States)

    Iwata, Takashi; Inoue, Kiyotoshi; Kiriike, Sachiko; Izumi, Nobuhiro; Mizuguchi, Shinjiro; Tsukioka, Takuma; Morita, Ryuhei; Nishiyama, Noritoshi; Takemura, Masashi; Osugi, Harusi; Wakasa, Kenichi; Suehiro, Shigefumi

    2007-12-01

    Cancer of the small intestine presenting with a solitary pulmonary metastasis is rare. Diagnosis and treatment of hemorrhagic small intestinal disease is clinically problematic due to its anatomic aspect, especially after multiple laparotomies. The case that we present here was a 79-year-old man who was initially diagnosed with suspected T2N2M0 lung cancer. After non-diagnostic results on two bronchoscopic biopsies and computed tomography-guided needle biopsy, he was admitted for thoracoscopic biopsy and possible curative operation. The patient had a history of multiple laparotomies for gastric ulcer and had no abdominal symptoms. A fecal occult blood test was positive; this was thought to be because of persistent bloody sputum. During the preoperative evaluation period, massive intestinal hemorrhage occurred. Intestinal tumor was identified by double-balloon enteroscopy and emergency laparotomy was performed to control the bleeding. The histopathological diagnosis was metastatic adenocarcinoma. However, intestinal bleeding started again. His systemic status deteriorated progressively, resulting in death. Autopsy revealed a large polypoid tumor with hemorrhagic necrosis in the jejunum that was histologically and immunohistochemically diagnosed as primary poorly differentiated adenocarcinoma in the small intestine. Multiple small submucosal tumors with central ulceration were confirmed as intramural metastases. A lung mass in the right lower lobe was diagnosed as a metastatic lesion. In the diagnosis and treatment of the disease, we faced several clinically difficult problems. We here describe in detail the clinical course and the diagnostic and therapeutic difficulties of this rare case, with some references to the literature. PMID:18432067

  13. A study of usefulness of washes and brush cytology with respect to histopathology in diagnosis of lung malignancy by using fiberoptic bronchoscopy

    Directory of Open Access Journals (Sweden)

    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.

  14. Fusion of intraoperative cone-beam CT and endoscopic video for image-guided procedures

    Science.gov (United States)

    Daly, M. J.; Chan, H.; Prisman, E.; Vescan, A.; Nithiananthan, S.; Qiu, J.; Weersink, R.; Irish, J. C.; Siewerdsen, J. H.

    2010-02-01

    Methods for accurate registration and fusion of intraoperative cone-beam CT (CBCT) with endoscopic video have been developed and integrated into a system for surgical guidance that accounts for intraoperative anatomical deformation and tissue excision. The system is based on a prototype mobile C-Arm for intraoperative CBCT that provides low-dose 3D image updates on demand with sub-mm spatial resolution and soft-tissue visibility, and also incorporates subsystems for real-time tracking and navigation, video endoscopy, deformable image registration of preoperative images and surgical plans, and 3D visualization software. The position and pose of the endoscope are geometrically registered to 3D CBCT images by way of real-time optical tracking (NDI Polaris) for rigid endoscopes (e.g., head and neck surgery), and electromagnetic tracking (NDI Aurora) for flexible endoscopes (e.g., bronchoscopes, colonoscopes). The intrinsic (focal length, principal point, non-linear distortion) and extrinsic (translation, rotation) parameters of the endoscopic camera are calibrated from images of a planar calibration checkerboard (2.5×2.5 mm2 squares) obtained at different perspectives. Video-CBCT registration enables a variety of 3D visualization options (e.g., oblique CBCT slices at the endoscope tip, augmentation of video with CBCT images and planning data, virtual reality representations of CBCT [surface renderings]), which can reveal anatomical structures not directly visible in the endoscopic view - e.g., critical structures obscured by blood or behind the visible anatomical surface. Video-CBCT fusion is evaluated in pre-clinical sinus and skull base surgical experiments, and is currently being incorporated into an ongoing prospective clinical trial in CBCT-guided head and neck surgery.

  15. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

    Science.gov (United States)

    Johnson, Kathleen N; Botros, Daniel B; Groban, Leanne; Bryan, Yvon F

    2015-01-01

    There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the 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 broncho-scope. Overall, geriatric-focused airway

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    Mohammad Saquib Mallick

    2014-01-01

    Full Text Available Background: Foreign body aspiration (FBA is a common cause of respiratory compromise in early childhood. The objective of this study was to describe the features and outcomes of children with FBA in early and late presentations and to examine the reasons for the delay in diagnosis. Patients and Methods: This is a retrospective review of all children who were admitted with suspected FBA between July 2001 and June 2010. Patient′s characteristics, history, clinical, radiographic, bronchoscopic findings, reason for delay presentation, and complications were noted. Results: A total of 158 children admitted to the hospital with suspected FBA were included in this study. The average age was 3.28 years. Forty-eight (30.3% children were presented late (more than 14 days after FBA and 110 (69.7% children were presented early (0-14 days. The common clinical manifestations of FBA were persistent cough (100% and choking (72%. The most frequent radiological finding observed was air trapping (40% followed by atelectasis (14%. Chest radiographs were normal in 32.2% patients. Ten children in early diagnosis group and 29 children in late diagnosis group presented with complications. The diagnosis delay was mainly attributed to physician misdiagnosis (41.6%. Rigid bronchoscopy was performed in all patients. Foreign body was found in all of the cases except six. Watermelon seeds and peanuts accounted for 80% of the aspiration. Conclusion: FBA is difficult to diagnose in children. Delay in diagnosis appears to result from a failure to give serious consideration to the diagnosis. Early diagnosis and removal of foreign bodies must be achieved to avoid complications.

  18. Pulmonary tuberculosis with airspace consolidation vs mycoplasma pneumonia in adults: high-resolution CT findings

    International Nuclear Information System (INIS)

    To analyse and compare high-resolution CT findings of pulmonary tuberculosis with consolidation and mycoplasma pneumonia. Twenty patients with pulmonary tuberculosis [confirmed by sputum culture (n=9) and bronchoscopic biopsy (n=11)] and airspace consolidation on high-resolution CT and 17 patients with mycoplasma pneumonia, confirmed by serologic test, were included in this study. High-resolution CT findings were analyzed in terms of ground-glass opacities, distribution of consolidation, type of nodules, cavities, interlobular septal thickening, bronchial dilatations, bronchial wall thickening and pleural effusion. In patients with tuberculosis, average age was 33.5 years (range, 20-67); in those with mycoplasma pneumonia it was 32.5 years (range, 17-74). Segmental and subsegmental distributions were most common in both diseases; the preferred site of consolidation was different, however; for tuberculosis it was the upper lobes (13 cases, 65%; bilateral involvement, 7 cases); for mycoplasma pneumonia it was the lower lobes (11 cases, 64.7%). Non-segmental (diffuse and random) distribution of ground-glass opacities were seen in two patients(11.8%) with mycoplasma pneumonia. Centrilobular nodules, branching linear opacities and alveolar nodules were not different in both diseases, but there were nodules above 10mm in 14 cases of tuberculosis and in only one case of mycoplasma pneumonia. Tree-in-bud appearances were seen in five cases of tuberculosis. Cavities without air-fluid level were noted in ten cases of tuberculosis. Other interlobular septal thickening, bronchial wall thickening, bronchial dilatation and pleural effusion were not different in both diseases. There was considerable overlap between high resolution CT findings of tuberculosis with airspace consolidation and those of mycoplasma pneumonia. The location of consolidation, type of nodules, and the presence of tree-in-bud appearance and cavities help in the differentiation of the two diseases, however

  19. [A case of obstructive ventilatory disturbance caused by bronchial wall granulation due to a fish bone].

    Science.gov (United States)

    Kimura, M; Hara, H; Matsushima, T; Kobori, M

    1992-11-01

    A 62-year-old man was admitted to Kawasaki Medical School Kawasaki Hospital after suffering from wheezing for one year. His chest X-ray film showed no significant findings in the lung fields and mediastinum. A chest CT film showed a small protrusion at the posterior wall of the right main bronchus. Bronchofiberscopy disclosed a polypoid tumor with a smooth surface in the right main bronchus, confirming the finding of the chest CT, and a restiform eminence at the truncus intermedius. The restiform eminence was revealed to be a fish bone after removal from the bronchus using the forceps of a bronchofiberscope. Histological examination of a bronchoscopic biopsy specimen from the tumor of the right main bronchus showed inflammatory granulation tissue. We confirm subsequently questioned the patient who revealed that he had aspirated another fish bone two months earlier, and we presumed that the tumor of the right main bronchus might be granulation tissue secondary to the impaction of a fish bone. The patient was not aware that he had aspirated a foreign body, but it was presumed that he had aspirated the fish bone one year earlier, coinciding with the onset of wheezing. Immediately after removal, his wheezing disappeared. Comparison of the results of pulmonary function tests after removal with those before showed improvement of V25/predicted V25 ratio from 24% to 72%, and improvement of V50/V25 ratio from 3.7 to 2.4. This is considered to be a rare case of bronchial granulation due to a foreign body, which was recognized as a small polypoid tumor by chest CT. PMID:1484442

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

    Directory of Open Access Journals (Sweden)

    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

  1. Mitomycin, cisplatin, and vindesine followed by radiotherapy combined with cisplatin in stage III nonsmall cell lung cancer: long-term results

    International Nuclear Information System (INIS)

    Purpose: To assess the tolerance, response rate, pattern of failure, and long-term survival of patients with unresectable nonsmall cell lung cancer treated with one cycle of induction chemotherapy followed by concurrent cisplatin and radiotherapy. Methods and Materials: From 1986 to 1988, 45 patients with histologically proven nonsmall cell lung cancer clinical Stage III (29 IIIA and 16 IIIB) were included in this study. Patients received one cycle of Mitomycin C 10 mg/m2 day 1, Cisplatin 120 mg/m2 day 1, and Vindesine 3 mg/m2 days 1, 8, 15, and 22, by i.v. bolus injection. Radiotherapy was started within 4-6 weeks after completion of chemotherapy, with a total tumor dose of 60 Gy, at 2 Gy/day. Cisplatin, 20 mg/m2/day by i.v. continuous infusion was administered for days 1-5 of radiation treatment. Results: The main toxic acute effects were nausea-vomiting grade 1-3 in 38 patients (85%). Ten patients (22%) developed esophagitis grade 3. Leukopenia grade 1-2 was observed in 18 patients (40%), grade 3 in 12 (27%), and grade 4 in 4 (9%). Three patients (6.6%) died by granulocytopenia and sepsis. A bronchoscopic proven complete response was achieved in 9 patients (21.5%) and partial response in 28 patients (67%). With a minimum follow-up of 65 months, overall median survival was 13 months, 2-year survival was 21%, and 5-year survival was 7%, with no statistical difference between Stage IIIA and IIIB. Median survival of patients with complete response was 23.2 months, and 5-year survival was 33%. Conclusion: This treatment scheme produced a severe toxicity and in spite of a high response rate, long-term survival is poor, similar to previous studies with radiotherapy alone

  2. Pulmonary tuberculosis mimicking lung cancer on radiological findings: Evaluation of chest CT findings in pathologically proven 76 patients

    International Nuclear Information System (INIS)

    To evaluate chest CT features of pulmonary tuberculosis mimicking lung malignancy. We retrospectively reviewed chest CT findings for 76 consecutive patients (21-84 years, average: 63 years; M : F = 30 : 46) who underwent an invasive diagnostic procedure under the suspicion of lung cancer and were pathologically diagnosed as pulmonary tuberculosis by bronchoscopic biopsy (n = 49), transthoracic needle biopsy (n = 17), and surgical resection (n = 10). We categorized the chest CT patterns of those lesions as follows: bronchial narrowing or obstruction without a central mass like lesion (pattern 1), central mass-like lesion with distal atelectasis or obstructive pneumonia (pattern 2), peripheral nodule or mass including mass-like consolidation (pattern 3), and cavitary lesion (pattern 4). CT findings were reviewed with respect to the patterns and the locations of the lesions, parenchymal abnormalities adjacent to the lesions, the size, the border and pattern of enhancement for the peripheral nodule or mass and the thickness of the cavitary wall in the cavitary lesion. We also evaluated the abnormalities regarding the lymph node and pleura. Pattern 1 was the most common finding (n = 34), followed by pattern 3 (n = 23), pattern 2 (n = 11) and finally, pattern 4 (n = 8). The most frequently involving site in pattern 1 and 2 was the right middle lobe (n = 14/45). However, in pattern 3 and 4, the superior segment of right lower lobe (n = 5/31) was most frequently involved. Ill-defined small nodules and/or larger confluent nodules were found in the adjacent lung and at the other segment of the lung in 31 patients (40.8%). Enlarged lymph nodes were most commonly detected in the right paratracheal area (n = 9/18). Pleural effusion was demonstrated in 10 patients. On the CT, pulmonary tuberculosis mimicking lung cancer most commonly presented with bronchial narrowing or obstruction without a central mass-like lesion, which resulted in distal atelectasis and obstructive

  3. Transbronchial needle aspiration "by the books"

    Directory of Open Access Journals (Sweden)

    Kupeli Elif

    2011-01-01

    Full Text Available Background : Training for advanced bronchoscopic procedures is acquired during the interventional pulmonology (IP Fellowship. Unfortunately a number of such programs are small, limiting dissemination of formal training. Objective : We studied success of conventional transbronchial needle aspiration (C-TBNA in the hands of physicians without formal IP training. Methods : A technique of C-TBNA was learned solely from the literature, videos and practicing on inanimate models at "Hands-On" courses. Conventional TBNA with 21 and/or 19 gauge Smooth Shot Needles (Olympus® , Japan was performed on consecutive patients with undiagnosed mediastinal lymphadenopathy. Results : Thirty-four patients (male 23, mean age 54.9 ± 11.8 years underwent C-TBNA. Twenty-two patients had nodes larger than 20 mms. Suspected diagnoses were malignancy in 20 and nonmalignant conditions in 14. Final diagnoses were malignancy 17, sarcoidosis 4, reactive lymph nodes 12, and tuberculosis 1. Final diagnosis was established by C-TBNA in 14 (11 malignancy, 3 sarcoidosis; yield 41.1%, mediastinoscopy in 14, transthoracic needle aspiration in 3, peripheral lymph node biopsies in 2 and by endobronchial biopsy in 1. Nodal size had an impact on outcome (P = 0.000 while location did not (P = 0.33. C-TBNA was positive in 11/20 when malignancy was suspected (yield 55%, while 3/14 when benign diagnosis was suspected (yield 21.4% (P = 0.05. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 66.6%, 100%, 100%, 65%, and 79.4%, respectively. There were no complications or scope damage. Conclusion : Conventional-TBNA can be learned by the books and by practicing on inanimate models without formal training and results similar to those published in the literature could be achieved.

  4. Impact of Cardiopulmonary Bypass on Respiratory Mucociliary Function in an Experimental Porcine Model.

    Directory of Open Access Journals (Sweden)

    Rodrigo Sánchez-Véliz

    Full Text Available The impact of cardiac surgery using cardiopulmonary bypass (CPB on the respiratory mucociliary function is unknown. This study evaluated the effects of CPB and interruption of mechanical ventilation on the respiratory mucociliary system.Twenty-two pigs were randomly assigned to the control (n = 10 or CPB group (n = 12. After the induction of anesthesia, a tracheostomy was performed, and tracheal tissue samples were excised (T0 from both groups. All animals underwent thoracotomy. In the CPB group, an aorto-bicaval CPB was installed and maintained for 90 minutes. During the CPB, mechanical ventilation was interrupted, and the tracheal tube was disconnected. A second tracheal tissue sample was obtained 180 minutes after the tracheostomy (T180. Mucus samples were collected from the trachea using a bronchoscope at T0, T90 and T180. Ciliary beat frequency (CBF and in situ mucociliary transport (MCT were studied in ex vivo tracheal epithelium. Mucus viscosity (MV was assessed using a cone-plate viscometer. Qualitative tracheal histological analysis was performed at T180 tissue samples.CBF decreased in the CPB group (13.1 ± 1.9 Hz vs. 11.1 ± 2.1 Hz, p < 0.05 but not in the control group (13.1 ± 1 Hz vs. 13 ± 2.9 Hz. At T90, viscosity was increased in the CPB group compared to the control (p < 0.05. No significant differences were observed in in situ MCT. Tracheal histology in the CPB group showed areas of ciliated epithelium loss, submucosal edema and infiltration of inflammatory cells.CPB acutely contributed to alterations in tracheal mucocilliary function.

  5. Aerodigestive Foreign Bodies in Adult Ethiopian Patients: A Prospective Study at Tikur Anbessa Hospital, Ethiopia

    Directory of Open Access Journals (Sweden)

    Abebe Bekele

    2014-01-01

    Full Text Available Introduction. Foreign bodies (FBs in the aerodigestive tract are important causes of morbidity and mortality and pose diagnostic and therapeutic challenges. The best method of removal of an esophageal and tracheobronchial FB is endoscopic guided extraction. Objective. To present our experience of the removal of aerodigestive FBs in adult Ethiopian patients using rigid endoscopes. Methods. A hospital-based prospective study, at Tikur Anbessa Referral and Teaching Hospital, from January 2011 to December 2012 (over two years. Results. A total of 32 patients (18 males and 14 females with a mean age of 28.0±12.74 years were treated for FB ingestion and aspiration at Tikur Anbessa Hospital. The FBs were impacted at the esophagus in 18 (56.2% patients, at the pharynx in 7 (21.8%, and at the air way in 7 (21.8% patients. Pieces of bones were the commonest objects found in the esophagus (17/18 of the cases and the pharynx (4/7, while fractured tracheostomy tubes and needles were frequently seen in the air way (3/7 cases each. The foreign bodies were visible in plain radiographs of 26 (81.2% patients. Successful extraction of FBs was achieved by using Mc gill forceps in 11 cases, rigid esophagoscopes in 9 patients, and bronchoscopes in 4 cases. Four cases required open surgery to remove the foreign bodies. Two complications (one pneumothorax and one esophageal perforation occurred. All patients were discharged cured. Discussion and Recommendations. Aerodigestive FBs are not so rare in the hospital and timely diagnosis and removal of accidentally ingested and aspirated foreign body should be performed so as to avoid the potentially lethal complications associated. Rigid esophagoscopy requires general anesthesia and is associated with its own complications, but our experience and outcome of its use are encouraging.

  6. 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.

  7. Inhaled nedocromil sodium reduces histamine release from isolated large airway segments of asthmatic subjects in vivo.

    Science.gov (United States)

    Maxwell, D L; Hawksworth, R J; Lee, T H

    1993-09-01

    Placement of an intrabronchial single balloon catheter provides the possibility of measuring histamine release in isolated large airway segments in vivo. We wanted to assess the protective effect of nedocromil sodium on intrabronchial histamine release after hyperosmolar challenge. Six mild asthmatics were bronchoscoped 30 min after inhalation of 4 mg nedocromil sodium or placebo, given via a metered dose inhaler in a randomized, double-blind, cross-over study. Lavage of the left main bronchus was carried out proximal to a balloon catheter inflated at its bifurcation, and specimens were assayed for histamine and prostaglandin D2 (PGD2) by radioimmunoassay. The rise in histamine concentration in bronchial epithelial fluid following hyperosmolar saline challenge was significantly greater following placebo than following nedocromil sodium (mean +/- SEM prechallenge histamine concentration on placebo day 6.9 +/- 2.9 nM; post-challenge: 25.3 +/- 8.0 nM; mean +/- SEM prechallenge histamine concentration on the day nedocromil sodium was given: 3.7 +/- 0.7 nM; post-challenge 5.8 +/- 1.7 nM). Changes in PGD2 levels reflected the changes in histamine, but the variability of response was large, and there were no significant differences between the effects of placebo and nedocromil sodium. The procedure caused significantly greater falls in peak expiratory flow rates following placebo (mean +/- SEM percentage fall 20.2 +/- 4.4%) than following nedocromil sodium (0.9 +/- 5.8%, p airways, and that nedocromil sodium inhibits histamine release from mediator cells in vivo. PMID:7693506

  8. Diagnostic Value of Transbronchial Lung Biopsy in Peripheral Lung Cancer

    Directory of Open Access Journals (Sweden)

    Wenhui TANG

    2009-03-01

    Full Text Available Background and objective Lung cancer is the leading cause of cancer-related death worldwide. Because the locations of peripheral lung cancer are special, diagnosis of peripheral lung cancer is difficult. The aim of this study was to evaluate diagnostic value of transbronchial lung biopsy (TBLB in peripheral lung cancer. MethodsTransbronchial lung biopsy (TBLB were performed in 78 cases of peripheral lung cancer which could not be observed by bronchoscope, 42 cases among whom were diagnosed by pathology and cytologic examination. Thirty-six cases of peripheral lung cancer were not able to be diagnosed by TBLB, 22 cases among them were diagnosed by percutaneous lung biopsy (PNLB, and 14 cases being left were diagnosed by surgical operation, lymphadenopathy biopsy, pleura biopsy and sputum cytologic examination successively. Results The positive rate produced by transbronchial lung biopsy, brush biopsy were 53.8% and 8.9% respectively. The total positive rate was 57.7%. The positive rate produced by TBLB was higher than that of brush biopsy (P <0.01. Along with tumor's diameter enlarge, the positive rate of diagnosis was higher. The positive rate of right lung was higher than that of left lung. The positive rate of inferior lung was higher than that of upper lung. The lesions near the inner belt and hilus pulmonis, had the higher positive rate. Complicatin frequency in PNLB was much higher than that in TBLB. Conclusion Transbronchial lung biopsy is an important method in diagnosingof peripheral lung cancer. Combination of TBLB can increase the diagnostic positive rate of peripheral lung cancer.

  9. Improving patient safety after rigid bronchoscopy in adults: laryngeal mask airway versus face mask – a pilot study

    Directory of Open Access Journals (Sweden)

    Nisi F

    2015-04-01

    Full Text Available Fulvio Nisi,1 Antonio Galzerano,1 Gaetano Cicchitto,2 Francesco Puma,3 Vito Aldo Peduto1 1Department of Anesthesiology, Intensive Care and Pain Therapy Centre, 2Department of Pneumology and Respiratory Medicine, 3Department of Thoracic Surgery, AO Santa Maria della Misericordia, Perugia, Italy Background: There are still no clear guidelines in the literature on per procedural bronchoscopic management for anesthesiologists, and few relevant datasets are available. To obtain rapid recovery from anesthesia, it is often necessary to keep patients in the recovery room for several hours until they become clinically stable. In this study, we tested the hypothesis that the laryngeal mask airway (LMA enables better respiratory and hemodynamic recovery than the oxygen face mask (FM in patients undergoing rigid bronchoscopy. Methods: Twenty-one patients undergoing elective bronchoscopy of the upper airway were randomized to ventilation assistance with FM or LMA after a rigid bronchoscopy procedure under general anesthesia. The primary endpoint was duration of post-surgical recovery and the secondary endpoints were postoperative hemodynamic and respiratory parameters. Assessment of the study endpoints was performed by an intensive care specialist blinded to the method of ventilation used. The statistical analysis was performed using the Fisher’s Exact test for nominal data and the Student's t-test for continuous data. Results: There was no statistically significant difference in post-procedural time between the two groups (P=0.972. The recovery parameters were significantly better in the LMA group than in the FM group, with significantly fewer desaturation, hypotensive, and bradycardic events (P<0.05. Conclusion: We conclude that the LMA may be safer and more comfortable than the FM in patients undergoing rigid bronchoscopy. Keywords: face mask, laryngeal mask airway, anesthesiology, rigid bronchoscopy, safety 

  10. Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study

    International Nuclear Information System (INIS)

    Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions. In some cases, however, it is difficult to obtain adequate biopsy samples for pathological diagnosis. Adequate prediction of the diagnostic accuracy of TBB with EBUS-GS is important before deciding whether bronchoscopy should be performed. We retrospectively reviewed 149 consecutive patients who underwent TBB with EBUS-GS for small-sized peripheral lung lesions (≤30 mm in diameter) from April 2012 to March 2013. We conducted an exploratory analysis to identify clinical factors that can predict an accurate diagnosis by TBB with EBUS-GS. All patients underwent thin-section chest computed tomography (CT) scans (0.5-mm slices), and the CT bronchus sign was evaluated before bronchoscopy in a group discussion. The final diagnoses were pathologically or clinically confirmed in all studied patients (malignant lesions, 110 patients; benign lesions, 39 patients). The total diagnostic yield in this study was 72.5 % (95 % confidence interval: 64.8–79.0 %). Lesion size, lesion visibility on chest X-ray, and classification of the CT bronchus sign were factors significantly associated with the definitive biopsy result in the univariate analysis. In the multivariate analysis, only the CT bronchus sign remained as a significant predictive factor for successful bronchoscopic diagnosis. The CT bronchus sign was also significantly associated with the EBUS findings of the lesions. Our results suggest that the CT bronchus sign is a powerful predictive factor for successful TBB with EBUS-GS

  11. Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

    International Nuclear Information System (INIS)

    The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs

  12. 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.

  13. 13[C]-urea breath test as a novel point-of-care biomarker for tuberculosis treatment and diagnosis.

    Directory of Open Access Journals (Sweden)

    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.

  14. Lung donor selection criteria.

    Science.gov (United States)

    Chaney, John; Suzuki, Yoshikazu; Cantu, Edward; van Berkel, Victor

    2014-08-01

    The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant. PMID:25132970

  15. 儿童支气管异物246例临床分析%Clinical analysis of bronchial foreign bodies in 246 children

    Institute of Scientific and Technical Information of China (English)

    马渝燕; 焦安夏; 江沁波; 饶小春; 潘跃娜; 刘玺诚

    2010-01-01

    目的 回顾性研究儿童支气管异物的临床特点以及电子支气管镜在诊断治疗儿童支气管异物中的作用.方法 2000年1月至2009年8月北京儿童医院经支气管镜诊断治疗的支气管异物患儿246例,应用Olympus电子支气管镜,在局部黏膜麻醉下经鼻插入支气管镜逐级观察支气管结构,使用篮状异物钳或齿状异物钳钳取异物.结果 246例患儿中,支气管异物以果仁或果壳类(230例,占93.5%)最为常见,异物嵌顿位置以右下叶支气管开口(98例,占39.8%)为最多.钳取异物手术次数平均为(1.9±1.3)次,一次取出率为58.5%(144例).阻塞于左右主支气管、右中叶和右下叶支气管的异物一次取出率较高,分别为91.1%、60.0%和55.1%.篮状异物钳钳取所需次数(1.4±0.9)明显低于齿状异物钳所需次数(2.1±1.4),差异有统计学意义(P=0.000).结论 儿童支气管异物种类以果仁或果壳类植物性异物为主,阻塞部位以右下支气管为多见.位于左右主支气管异物一次取出率明显高于其他部位.用篮状异物钳钳取异物所需手术次数明显少于使用齿状异物钳.%Objective To analyze the characters of bronchial foreign bodies in children and the utilization of bronchoscope in the treatment of bronchial foreign bodies. Methods A total of 246 children were diagnosed with bronchial foreign bodies at our hospital during January 2000 until August 2009. Under local mucosal anesthesia, a bronchoscope was inserted through nasal cavity into bronchi. After identifying the site of foreign body, grasping forceps was guided through bronchoscope to remove the foreign body from airway. Results Among 246 cases, hard nut and skin of melon seed were found ( n = 230, 93.5% ). The most common site of foreign body was in right lower lobe bronchi ( n =98, 38.9% ). The average operative frequency was 1.9 ± 1.3 and one-time extraction ratio 58.5% ( n = 144). The one-time extraction ratio of patients with foreign

  16. Interventional bronchoscopy with the use of mechanical ventilation by larynx mask or tracheal intubation under general anesthesia%经喉罩或气管插管连接行常规机械通气在全身麻醉介入治疗手术中的安全性

    Institute of Scientific and Technical Information of China (English)

    王婷; 张杰; 王娟; 党斌温; 徐敏; 裴迎华; 张晨阳

    2011-01-01

    Objective To explore and evaluate the technique of performing interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia.Methods From July 2009 to January 2010,29 patients received interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia.Airway pressure and tidal volume before and after bronchoscope insertion,arterial blood gas analysis during interventional bronchoscopy,complications and operation time were recorded.The factors influencing ventilation effects were evaluated.Results All the patients' condition were kept stable during interventional bronchoscopy and no severe complications occurred.Tidal volume was reduced by 27.1%,while peak airway pressure,plateau pressure and mean airway pressure were increased by 63.1%,43.7% and 32.4% following insertion of the bronchoscope respectively.Patients using tracheal intubation had their peak pressure increased by 79.3%,which was higher than that of patients using larynx mask (55.3%).Conclusions Interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia was safe and reliable.Although peak airway pressure increased following insertion of bronchoscope,the mean airway pressure was maintained in a low level.When performing interventional bronchoscopy during mechanical ventilation,the inside diameter of larynx mask and tracheal intubation should be as large as possible to minimize airway pressure and auto-PEEP.%目的 探索并评价使用喉罩或气管插管联合常规机械通气在介入治疗手术中的应用价值.方法 纳入2009年7月至2010年1月收入首都医科大学附属北京天坛医院呼吸科在全身麻醉下经喉罩或气管插管联合常规机械通气条件下接受气管镜介入治疗的患者29例,其中男19例,女10例,年龄19 ~74岁,平均(47±18)岁.观察手术前后的气

  17. Left mainstem bronchial narrowing: a vascular compression syndrome? Evaluation by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Background and objective. Vascular compression of the left mainstem bronchus (LMSB) between the descending aorta (DA) and pulmonary artery (PA) has been suggested as a cause for LMSB narrowing in children. These anatomic relationships have not been compared with those in children with a normal LMSB. Materials and methods. We undertook a retrospective review of the medical and radiologic records of 10 symptomatic young children (1-19 months, 5 boys, 5 girls) with MR demonstration of LMSB narrowing and compared them to 40 young children without great vessel or bronchial abnormality on MR (1 week-19 months, 28 boys, 12 girls). Chest MR evaluation included assessment of airway and great vessel anatomy with specific attention to the course of the LMSB and its relationship to the adjacent DA and PA. The position of the DA in relation to the spine was carefully evaluated. Results. Five children had focal and five had diffuse LMSB narrowing. DA position at the level of the crossing LMSB: in 40 % of symptomatic children the DA was located in front of the adjacent vertebral body; in 40 %, 1/2-3/4 and in 20 % 1/4-1/2 of the circumference of the DA was located anterior to the spine. In the control group, the DA was prespinal in 10 %, with a trend toward a more paraspinal location of the DA. The trend toward a difference in position of the DA between symptomatic and control patients was statistically significant (P < 0.05). DA position was not related to age (up to 19 months). At the level where the LMSB crossed the DA, a segment of the PA was located anterior to the LMSB, more often the right PA (RPA) or pulmonary bifurcation in symptomatic children and the left PA (LPA) in controls. No correlation was apparent between length of LMSB narrowing and DA or PA position. Chest radiographic abnormalities, when present, were subtle. Excellent MR/bronchoscopic correlation of LMSB narrowing was found in nine of the ten symptomatic children. One child underwent posterior aortopexy and

  18. 视频喉镜下鼻插管在非急症气道中的应用

    Institute of Scientific and Technical Information of China (English)

    温顺; 叶宏伟; 冯玉峰

    2015-01-01

    目的观察对比在成人非急症气道患者中视频喉镜(glidescope videolaryngoscope)下鼻插管和纤支镜(fiberoptic bronchoscope)下鼻插管的临床效果。方法选取2010年6年~2014年5年随机收住在我院重症医学科的符合非急症气道的患者44例,按随机数字法分成两组,视频喉镜(贝格--康奈尔(上海)能源技术有限公司生产的型号为CEL-100的电子视频喉镜)组22例,纤支镜组22例,以下简称G组(n=22)和F组(n=22),插管前均留置血流动力学监测唯捷流技术(Vigileo Edawards Lifesciences, CA, USA),充分镇痛镇静,预充氧3min,分别记录镇痛镇静前(基础值),镇痛镇静达到目标评分后,插管即刻,插管后第1、3min的收缩压(SBP)、心率(HR)、每搏量(SV)、心输出量(CO)以及一次性气管插管成功例数,插管时间,鼻出血情况等。结果与镇静后比较,插管时两组的HR、SAP、CO均升高,其中G组0.05);插管时间G组

  19. Left mainstem bronchial narrowing: a vascular compression syndrome? Evaluation by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hungate, R.G.; Newman, B.; Meza, M.P. [Department of Radiology, Children`s Hospital of Pittsburgh and University of Pittsburgh Medical Center, 3705 Fifth Avenue, Pittsburgh, PA 15213 (United States)

    1998-07-01

    Background and objective. Vascular compression of the left mainstem bronchus (LMSB) between the descending aorta (DA) and pulmonary artery (PA) has been suggested as a cause for LMSB narrowing in children. These anatomic relationships have not been compared with those in children with a normal LMSB. Materials and methods. We undertook a retrospective review of the medical and radiologic records of 10 symptomatic young children (1-19 months, 5 boys, 5 girls) with MR demonstration of LMSB narrowing and compared them to 40 young children without great vessel or bronchial abnormality on MR (1 week-19 months, 28 boys, 12 girls). Chest MR evaluation included assessment of airway and great vessel anatomy with specific attention to the course of the LMSB and its relationship to the adjacent DA and PA. The position of the DA in relation to the spine was carefully evaluated. Results. Five children had focal and five had diffuse LMSB narrowing. DA position at the level of the crossing LMSB: in 40 % of symptomatic children the DA was located in front of the adjacent vertebral body; in 40 %, {sup 1}/{sub 2}-{sup 3}/{sub 4} and in 20 % {sup 1}/{sub 4}-{sup 1}/{sub 2} of the circumference of the DA was located anterior to the spine. In the control group, the DA was prespinal in 10 %, with a trend toward a more paraspinal location of the DA. The trend toward a difference in position of the DA between symptomatic and control patients was statistically significant (P < 0.05). DA position was not related to age (up to 19 months). At the level where the LMSB crossed the DA, a segment of the PA was located anterior to the LMSB, more often the right PA (RPA) or pulmonary bifurcation in symptomatic children and the left PA (LPA) in controls. No correlation was apparent between length of LMSB narrowing and DA or PA position. Chest radiographic abnormalities, when present, were subtle. Excellent MR/bronchoscopic correlation of LMSB narrowing was found in nine of the ten symptomatic

  20. Clinical application of multicolor fluorescence in situ hybridization on early diagnosis of lung cancer%多色荧光原位杂交(M-FISH)在肺癌早期诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    姚汉清; 朱慕云; 姜正华; 朱湘平; 刘娟; 秦艳; 王正东

    2012-01-01

    目的 探讨多色荧光原位杂交(M-FISH)在肺癌早期诊断中的临床意义.方法 通过苏北人民医院2007年1月至2011年1月89例肺癌患者支气管镜活检组织及刷检细胞标本作为观察组.结果 89份标本中61份标本中有X染色体数目的增多,其中男性45份,女性16份.具有异常X染色体数目的细胞比例为15.1%~93.2%.26例Y染色体异常,占29.21%,其中8例Y染色体增多的标本均为男性患者,占8.99%,另18例男性患者发生Y染色体数目减少,占20.22%.结论 原位荧光杂交技术对肺癌组织细胞进行检测,有助于肺癌的早期诊断,同时对于判断治疗效果、预后及有无复发等均有辅助作用.%Objective To explore the clinical significance of multicolor fluorescence in situ hybridization ( M - FISH) in the early diagnosis of lung cancer. Methods The hospital from January 2007 to 2011 in January, 89 cases of lung cancer patients with bronchoscopic biopsy and brush biopsy cell samples as the observation group. Results Totally 89 specimens, 61 specimens, the increase in the number of X chromosomes, including 45 men and 16 women were. The proportion of cells with abnormal X - chromosome number was 15. 1% to 93. 2% . 26 cases of Y chromosome abnormalities, accounting for 29.21% , 8 cases of Y chromosome number of specimens of patients were male, accounting for 8. 99% , another 18 cases of male patients with Y chromosome reduction in the number, accounting for 20. 22%. Conclusions Fluorescence in situ hybridization for detection of lung carcinoma cells, contribute to the early diagnosis of lung cancer, determine treatment, prognosis, and with or without recurrence have a supporting role.

  1. Animal study of improved percutaneous airway dilator%一种改良经皮气管扩张器的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    冯清亮; 姜万富; 黄润全; 吴建; 江勇豪

    2014-01-01

    Objective To demonstrate the feasibility and safety of the new percutaneous tracheal dilator for percutaneous dilatational tracheostomy (PDT).Methods PDT was performed by using new and old percutaneous tracheal dilator in 35 mongrel dogs under monitoring by fiberoptic bronchoscope (10 old,25 new).Disposable tracheal tube was intubated and the whole procession of expansion,ostomy and catheter were observed.Results Disposable tracheal tubes were successfully intubated in all the 25 dogs.The average operation time was (3.0±0.7) min [old (3.7±0.8) min,P<0.05].The blood loss volume was (2.0±0.6) ml [old (3.2±0.5)ml,P<0.05].No severe complications such as pneumothorax,high blood occurred after operation.Conclusions The new percutaneous tracheal dilator can be used in PDT,and the operation is safe and peomormed quickly.%目的 论证新型经皮气管扩张器的可行性及安全性.方法 使用传统和新型经皮气管扩张器对35例杂交犬在纤支镜监视下行经皮气管扩张造口(传统扩张器10例,新型扩张器25例),置入一次性气管套管,观察扩张、造口、置管等全过程.结果 25例新型经皮气管扩张器均成功置入一次性气管套管,手术时间(3.0±0.7)min[传统(3.7±0.8) min,P<0.05],出血(2.0±0.6)ml[传统(3.2±0.5)ml,P<0.05],未出现气胸、大出血等严重并发症.结论 新型经皮扩张器能顺利实施经皮气管切开,手术快速安全.

  2. SU-C-BRA-07: Virtual Bronchoscopy-Guided IMRT Planning for Mapping and Avoiding Radiation Injury to the Airway Tree in Lung SAbR

    Energy Technology Data Exchange (ETDEWEB)

    Sawant, A; Modiri, A; Bland, R; Yan, Y; Ahn, C; Timmerman, R [University of Texas SouthWestern Medical Center, Dallas, TX (United States)

    2015-06-15

    Purpose: Post-treatment radiation injury to central and peripheral airways is a potentially important, yet under-investigated determinant of toxicity in lung stereotactic ablative radiotherapy (SAbR). We integrate virtual bronchoscopy technology into the radiotherapy planning process to spatially map and quantify the radiosensitivity of bronchial segments, and propose novel IMRT planning that limits airway dose through non-isotropic intermediate- and low-dose spillage. Methods: Pre- and ∼8.5 months post-SAbR diagnostic-quality CT scans were retrospectively collected from six NSCLC patients (50–60Gy in 3–5 fractions). From each scan, ∼5 branching levels of the bronchial tree were segmented using LungPoint, a virtual bronchoscopic navigation system. The pre-SAbR CT and the segmented bronchial tree were imported into the Eclipse treatment planning system and deformably registered to the planning CT. The five-fraction equivalent dose from the clinically-delivered plan was calculated for each segment using the Universal Survival Curve model. The pre- and post-SAbR CTs were used to evaluate radiation-induced segmental collapse. Two of six patients exhibited significant segmental collapse with associated atelectasis and fibrosis, and were re-planned using IMRT. Results: Multivariate stepwise logistic regression over six patients (81 segments) showed that D0.01cc (minimum point dose within the 0.01cc receiving highest dose) was a significant independent factor associated with collapse (odds-ratio=1.17, p=0.010). The D0.01cc threshold for collapse was 57Gy, above which, collapse rate was 45%. In the two patients exhibiting segmental collapse, 22 out of 32 segments showed D0.01cc >57Gy. IMRT re-planning reduced D0.01cc below 57Gy in 15 of the 22 segments (68%) while simultaneously achieving the original clinical plan objectives for PTV coverage and OAR-sparing. Conclusion: Our results indicate that the administration of lung SAbR can Result in significant injury to

  3. 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

  4. SU-C-BRA-07: Virtual Bronchoscopy-Guided IMRT Planning for Mapping and Avoiding Radiation Injury to the Airway Tree in Lung SAbR

    International Nuclear Information System (INIS)

    Purpose: Post-treatment radiation injury to central and peripheral airways is a potentially important, yet under-investigated determinant of toxicity in lung stereotactic ablative radiotherapy (SAbR). We integrate virtual bronchoscopy technology into the radiotherapy planning process to spatially map and quantify the radiosensitivity of bronchial segments, and propose novel IMRT planning that limits airway dose through non-isotropic intermediate- and low-dose spillage. Methods: Pre- and ∼8.5 months post-SAbR diagnostic-quality CT scans were retrospectively collected from six NSCLC patients (50–60Gy in 3–5 fractions). From each scan, ∼5 branching levels of the bronchial tree were segmented using LungPoint, a virtual bronchoscopic navigation system. The pre-SAbR CT and the segmented bronchial tree were imported into the Eclipse treatment planning system and deformably registered to the planning CT. The five-fraction equivalent dose from the clinically-delivered plan was calculated for each segment using the Universal Survival Curve model. The pre- and post-SAbR CTs were used to evaluate radiation-induced segmental collapse. Two of six patients exhibited significant segmental collapse with associated atelectasis and fibrosis, and were re-planned using IMRT. Results: Multivariate stepwise logistic regression over six patients (81 segments) showed that D0.01cc (minimum point dose within the 0.01cc receiving highest dose) was a significant independent factor associated with collapse (odds-ratio=1.17, p=0.010). The D0.01cc threshold for collapse was 57Gy, above which, collapse rate was 45%. In the two patients exhibiting segmental collapse, 22 out of 32 segments showed D0.01cc >57Gy. IMRT re-planning reduced D0.01cc below 57Gy in 15 of the 22 segments (68%) while simultaneously achieving the original clinical plan objectives for PTV coverage and OAR-sparing. Conclusion: Our results indicate that the administration of lung SAbR can Result in significant injury to

  5. Application of different methods of tracheal intubation in patients undergoing cervical vertebra surgery%不同气管插管方法在颈椎手术中的应用

    Institute of Scientific and Technical Information of China (English)

    谢言虎; 柴小青; 音樱; 章蔚; 耿擎天

    2012-01-01

    Objective To compare the outcomes of tracheal intubation with different tecniques of maintain axis stability ( MILS), fiberoptic bronchoscope ( FOB) and blind tracheal intubation instrument (BT1I) in the patients undergoing cervical spine surgery. Methods Ninety patients undergoing selective cervical spine surgery were equally randomized into 3 groups of A (intubation with MILS) ,B (intubation with FOB) and CCintubation with BTII). The events related to intubation were compared among three groups. Results The time spent for intubation in group A was the least among three groups. The success rates of intubation in groups of B and C were 100% and 96. 7%, respectively, which were higher than 80% in group A(P<0. 05). There were no severe complications related to intubation in three groups. Conclusion To reduce the risk for cervical spine injury and increase the success rate of intubation, tracheal intubation in the patients undergoing cervical spine surgery is better to be guided by FOR BTII can provide a new intubation technique for the patients with cervical vertebrae injury.%目的 比较不同气管插管方法在颈椎手术中的应用效果.方法 90例颈椎择期手术患者按插管方法随机均分为三组:A组采用手法保持轴线稳定性(MILS);B组采用纤维支气管镜(FOB);C组采用盲探气管插管装置(BTⅡ).比较三组患者的气管插管相关资料.结果 A组插管费时最少.B、C组插管成功率分别为100%和96.7%,均明显高于A组的80%(P<0.05).三组患者均无严重并发症发生.结论 颈椎手术麻醉宜在FOB引导等技术下实施气管插管,以减少颈椎损伤机率,提高插管成功率.BTⅡ技术可为颈椎损伤患者插管提供了一种新的方法.

  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. 005. History of the recently established bronchoscopy unit of the pulmonology clinic of lamia’s general hospital

    Science.gov (United States)

    Manos, Emmanouil; Gkika, Dimitrs; Kolovos, Dimitrios; Giannakou, Georgia; Pathiaki, Eirini; Mavromati, Evagelia; Divani, Smaroula; Vardouli, Anna; Tsiligrou, Vaina; Karkanis, Konstantinos; Angel, Jacob

    2015-01-01

    Objective The Bronchoscopy Unit of General Hospital of Lamia provides the necessity of six counties in Thessalia and Central Greece. The first bronchoscopy was performed during Christmas of 2012 while from the opening (February 14th, 2014), the unit is presenting an increasing activity (in number and variety of medical practice). Methods From December 21st in 2012 to September 15th in 2014, were performed 158 bronchoscopic examinations in 152 patients (hospitalized and outpatients), 130 men and 28 women, with an average age 72.4 (29 to 89) years old. There were accomplished 80 biopsies (bronchial, transbronchial), 83 brushing, collected 57 cultures for common bacteria and 86 for och-bacilli (acid-fast microscopy in 12), 20 conventional transbronchial needle aspiration (TBNA), two transbronchial biopsies, seven BAL, 25 bronchial toilets in elderly patients and were removed two foreign bodies (one bone segment surrounding by granulomatous tissue and one segment of animal bowel-“kokoretsi”). Results We observed gradual increase of the incoming patients [Quarterly: 5(1st-3rd/2013), 14(4th-6th/2013), 17(7th-9th/2013), 21(10th-12th/2013), 32(1st-3rd/2014), 38(4th-6th/2014), 31(6th-Middle 9th/2014)]. There were diagnosed 70 cases of lung cancer in 93 patients (75.3%) {12 small cell lung carcinoma (SCLC), 57 non-small cell lung carcinoma (NSCLC) [28 squamous, 25 adenocarcinomas, one combo (adeno- and squamous carcinoma), one BAC και two suspicious samples for cancer]}. 49/49 were diagnosed in evident endobronchial lesion (100%) and 21/44 in non-revealing bronchoscopy (47.8%). Biopsy confirmed diagnosis in 52/93, brushing in 31/93, ΤΒΝΑ alone in 4/8 while washing alone in 3/93 patients. Five cases of active tuberculosis were diagnosed (4 M. Τuberculosis, 1 M. Smegmatis), two cases of sarcoidosis, one metastatic (uroepithelial) carcinoma, four cases of granulomatic tissue, one lipoid pneumonia, one sarcomatoid carcinoma of the lung, while the cultures isolated

  8. A bovine model of respiratory Chlamydia psittaci infection: challenge dose titration.

    Directory of Open Access Journals (Sweden)

    Petra Reinhold

    Full Text Available This study aimed to establish and evaluate a bovine respiratory model of experimentally induced acute C. psittaci infection. Calves are natural hosts and pathogenesis may resemble the situation in humans. Intrabronchial inoculation of C. psittaci strain DC15 was performed in calves aged 2-3 months via bronchoscope at four different challenge doses from 10(6 to 10(9 inclusion-forming units (ifu per animal. Control groups received either UV-inactivated C. psittaci or cell culture medium. While 10(6 ifu/calf resulted in a mild respiratory infection only, the doses of 10(7 and 10(8 induced fever, tachypnea, dry cough, and tachycardia that became apparent 2-3 days post inoculation (dpi and lasted for about one week. In calves exposed to 10(9 ifu C. psittaci, the respiratory disease was accompanied by severe systemic illness (apathy, tremor, markedly reduced appetite. At the time point of most pronounced clinical signs (3 dpi the extent of lung lesions was below 10% of pulmonary tissue in calves inoculated with 10(6 and 10(7 ifu, about 15% in calves inoculated with 10(8 and more than 30% in calves inoculated with 10(9 ifu C. psittaci. Beside clinical signs and pathologic lesions, the bacterial load of lung tissue and markers of pulmonary inflammation (i.e., cell counts, concentration of proteins and eicosanoids in broncho-alveolar lavage fluid were positively associated with ifu of viable C. psittaci. While any effect of endotoxin has been ruled out, all effects could be attributed to infection by the replicating bacteria. In conclusion, the calf represents a suitable model of respiratory chlamydial infection. Dose titration revealed that both clinically latent and clinically manifest infection can be reproduced experimentally by either 10(6 or 10(8 ifu/calf of C. psittaci DC15 while doses above 10(8 ifu C. psittaci cannot be recommended for further studies for ethical reasons. This defined model of different clinical expressions of chlamydial

  9. Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study

    International Nuclear Information System (INIS)

    Lung cancer diagnosis is usually achieved through a set of bronchoscopic techniques or computed tomography guided-transthoracic needle aspiration (CT-TTNA). However these procedures have a variable diagnostic yield and some patients remain without a definite diagnosis despite being submitted to an extensive workup. The aim of this study was to evaluate the efficacy and cost of linear endobronchial (EBUS) and endoscopic ultrasound (EUS) guided fine needle aspiration (FNA), performed with one echoendoscope, for the diagnosis of suspicious lung cancer lesions after failure of conventional procedures. One hundred and twenty three patients with an undiagnosed but suspected malignant lung lesion (paratracheal, parabronchial, paraesophageal) or with a peripheral lesion and positron emission tomography positive mediastinal lymph nodes who had undergone at least one diagnostic flexible bronchoscopy or CT-TTNA attempt were submitted to EBUS and EUS-FNA. Patients with endobronchial lesions were excluded. Of the 123 patients, 88 had a pulmonary nodule/mass and 35 were selected based on mediastinal PET positive lymph nodes. Two patients were excluded because an endobronchial mass was detected at the time of the procedure. The target lesion could be visualized in 121 cases and FNA was performed in 118 cases. A definitive diagnosis was obtained in 106 cases (87.6%). Eighty-eight patients (72.7%) had non-small cell lung cancer, 15 (12.4%) had small cell lung cancer and metastatic disease was found in 3 patients (2.5%). The remaining 15 negative cases were subsequently diagnosed by surgical procedures. Twelve patients (9.9%) had a malignant tumor and in 3 (2.5%) a benign lesion was found. The overall sensitivity, specificity, positive and negative predictive values of EBUS and EUS-FNA to diagnose malignancy were 89.8%, 100%, 100% and 20.0% respectively. The diagnostic accuracy was 90.1% in a population with 97.5% prevalence of cancer. The ultrasonographic approach avoided expensive

  10. Exposure to 1 ppm ozone attenuates the immediate antigenic response of canine peripheral airways

    Energy Technology Data Exchange (ETDEWEB)

    Kleeberger, S.R.; Kolbe, J.; Turner, C.; Spannhake, E.W. (Johns Hopkins Medical Institutions, Baltimore, MD (USA))

    1989-01-01

    The effect of oxidant exposure on the immediate airway response to immunologic challenge is controversial. We investigated the response of canine peripheral airways to antigen aerosol, 1-3 h and 24 h after a 5-min exposure to 1 ppm ozone. In dogs that were natively sensitive to Ascaris suum antigen, resistance to flow through the collateral system (Rcs) was measured using the wedged bronchoscope technique. In eight dogs, four sublobar segments of each lung were wedged: two were exposed to ozone for 5 min and two (control) received air with 5% CO2. Ozone caused a mean ( +/- SE) increase in Rcs of 75 +/- 15%, which returned to baseline after 1-3 h. The increase in Rcs elicited by subsequent administration of antigen aerosol (25 microliters, 0.27 mg protein/ml) to the ozone-exposed segments (312.0 +/- 70.6%) was attenuated by 22% compared to controls (398.9 +/- 83.0%; p less than .05). In another series of experiments (n = 5), segments were exposed to ozone or air and challenged with antigen 24 h later and a significant attenuation (38%) of the antigen-induced increase in Rcs was detected compared to controls (178.5 +/- 57.9 vs 289.0 +/- 62.2; p less than .05). Cellular influx of polymorphonuclear leukocytes (PMNs) was not detected by bronchoalveolar lavage (BAL) 1-3 h after ozone, but was found after 24 h (19.8 vs. 4.7%; p less than .01). A significant increase in PMNs was detected in exposed subepithelial tissues 1-3 h after ozone compared to unexposed tissues. Tissue PMNs were not significantly different from unexposed tissues after 24 h, but a shift toward degranulation of mast cells was detected in ozone-exposed tissues at this time. These data suggest that the Rcs response to antigen is attenuated 1-3 h and 24 h after acute (5 min) exposure to 1 ppm ozone, and this effect occurs independently of PMNs in the airways.

  11. Lung cancer screening with low-dose computed tomography: Canadian experience

    International Nuclear Information System (INIS)

    In 2003, the department of medical imaging at the University Health Network in Toronto, Ontario, became the first Canadian site of the International Early Lung Cancer Action Program (I-ELCAP). We report the results from the first 1000 baseline studies. Between June 2003 and December 2005, we enrolled 1000 high-risk smokers (that is, smokers with a history of a least 10 pack years, or the equivalent of one pack daily for 10 years), aged 55 years or older. A low-dose helical computed tomography (CT) (40 to 60 mA, 120 kV) was performed with 1.0mm to 1.25 collimation. Nodules found at baseline were followed according to the I-ELCAP protocol: 1) no noncalcified nodules (NCNs) or NCNs ≤ 4 mm or nonsolid nodules < 8 mm, annual repeat: 2) NCNs ≥ 5mm or nonsolid nodules ≥ 8 mm, 3-month follow up: or 3) nonsolid nodules ≥ 15 mm, antibiotics and 1-month follow-up. The first 100 study participants were aged 63 years, standard deviation (SD) 6 years, with a smoking history of 38 pack years, SD 22 pack years; 662 (66%) were former smokers, and 338 (34%) were current smokers; 453 (45%) were men, and 547 (55%) were women. Of the participants, 256 (26%) had a positive baseline low-dose computed tomography (LCDT) scan; 227 (23%) were followed after 3 months and 15 (1.6%) after 1 month; 7 (0.7%) received a contrast-enhanced CT and 6 (0.6%) an immediate CT-guided biopsy. Twenty-six invasive procedures were performed: 22 CT-guided biopsies, 1 ultrasound-guided lymph node metastasis biopsy, 1 bronchoscopic biopsy and 2 surgeries. The malignancy rate of the invasive procedures was 85%. Overall, the malignancy prevalence is 2.2%. Of the malignancies, 20 are lung carcinomas: 19 non-small-cell lung carcinomas (NSCLCs) (14 adenocarcinoma or bronchioalveolar carcinoma [BAC], 4 squamous carcinoma, and 1 large-cell carcinoma) and 1 small-cell carcinoma; 15 (78%) of the NSCLCs are Stage 1. Fourteen patients underwent surgery (1 pneumonectomy, 9 lobectomies, and 4 segmentectomies). Our

  12. 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

  13. Differentiation of tuberculous pneumonia and community-acquired pneumonia; usefulness of chest radiography and serum CA-125

    International Nuclear Information System (INIS)

    To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. Forty-five patients with a high fever (>38 .deg. C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung volume (p < 0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3-1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3-114.8) U/ml (p < 0.005). Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125

  14. Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的对比应用%Comparison of the Airtraq laryngoscopes and Macintosh laryngoscopes in patients with difficult tracheal intubation

    Institute of Scientific and Technical Information of China (English)

    杨改生; 薛晓东; 夏舒萌; 黄俊梅; 张晋东

    2012-01-01

    laryngoscope ( A group). ECG, non - invasive blood pressure ( NIBP) , SpO2 and end - tidalcarbon dioxide ( ETCO2 ) were monitored. Before induction of anesthesia, all patients were given sufentanil (0. 3 μg/kg) , propofol TCI (4 μg /ml, blood plasma target level) , vecuronium bromide 0. 03 mg/kg to produce loss of verbal response. All patients were administered with suxa-methonium (2 mg/kg). If tracheal intubation failed for two times with the Macintosh or Airtraq laryngoscopes, it should be combined Macintosh laryngoscopes with fiberoptic bronchoscope to complish tracheal intubation. The time of intubation, the number of unsuccessful intubation attempts, changes of haemodynamics, complications during and after laryngoscopy and intubation were documented and compared between the groups. Results In the Macintosh laryngoscope group, 16 patients' tracheal intubation were successfully carried out in one time, 12 patients were successfully carried out in two times, 6 patients failed and required combining Macintosh laryngoscopes with fiberoptic bronchoscope to complish tracheal intubation. Intubation with the Airtraq laryngoscope was quicker ( 35 ± 16 ) s than with the Macintosh laryngoscope ( 82 ± 38) s ( P < 0. 01 ). The changes of blood pressure and heart rate were less in Airtraq group than in Macintosh group (P < 0. 01 ) . Conclusions The Airtraq laryngoscope can raise a-chievement ratio, shorten the duration of trachealintubation, reduce stress reactionand and prevent some complica-tions in difficult airway patients.

  15. DIAGNOSTIC VALUE OF BRONCHOALVEOLAR LAVAGE IN LEUKEMIC AND BONE MARROW TRANSPLANT PATIENTS: THE IMPACT OF ANTIMICROBIAL THERAPY

    Directory of Open Access Journals (Sweden)

    John Norman Greene

    2014-12-01

    colonizers The bronchoscopy technique and procedure was similar for each patient, utilizing a Fujinon 470S bronchoscope for every procedure The BAL specimens were collected without suction connected to the bronchoscope prior to a systematic airway survey.  The BAL was performed by instilling two 60cc aliquots of room temperature sterile 0.9% saline followed by slow manual aspiration. Correlates of a positive BAL yield and time on antibiotics were initially analyzed via a chi-square test, or a Fisher’s exact test if the expected count was less than 5.Statistical analyses were performed with Statistical Analysis Software Version 9.3.ResultsA total of 302 patient records were evaluated.  The age range was 18-85 with an average age of 53.5.  Thirty eight percent of the patients were female and 41.8% of the patients had undergone HSCT.  A minority of the patients required mechanical ventilation either at the time of BAL or within 48 hours. One hundred seven of the 297 patients had a positive BAL culture for an overall BAL yield of 36%.  Of the 37 patients on antibiotics for less than 24 hours, including all 4 patients who were not on any antibiotics, twenty-one (56.8% had a positive BAL culture compared with eighty-five of the 259 (32.8% patients who had been on antibiotics longer than 24 hours at the time the BAL specimen was obtained and had a positive cultur.  Forty-eight patients were not receiving chemotherapy or immunosupressants, 15 (31.3% of whom had a positive BAL yield.  One hundred twenty-six patients were on chemotherapy and 32 (25.4% had a positive BAL culture.  Forty-one patients were not on chemotherapy but were on immunosupressants and 14 (34.1% had a positive BAL yield.  Eighty patients were on both chemotherapy and immunosupressants and 46 (57.5% had a positive BAL cultur. There were 64 patients with a normal WBC count and 30 (46.9% had a positive BAL culture.  Patients with an abnormal WBC or frank neutropenia were less likely to have a positive BAL

  16. 喉罩下经支气管镜钬激光联合氩气刀和二氧化碳冷冻治疗儿童获得性重度声门下狭窄%Study on tracheal intubation related severe subglottic stenosis under laryngeal mask by using holmium laser combined with argon plasma coagulation and cryotherapy through bronchoscopy

    Institute of Scientific and Technical Information of China (English)

    许煊; 祝彬; 石苗茜; 任海丽; 封志纯

    2015-01-01

    目的:探讨2例气管插管相关性重度声门下狭窄喉罩下支气管镜诊断及介入治疗的操作方法、有效性及安全性。方法2例男性患儿,年龄分别为4和11个月,因气管插管后出现脱机困难及呼吸困难,经CT及支气管镜检查,诊断为气管插管相关的重度声门下狭窄,在对家长进行详细告知支气管镜下介入手术不可预知情况并由家长签字同意后,遂对2例患儿进行经喉罩支气管镜下钬激光联合氩气刀和二氧化碳( CO2)冷冻治疗,分析患儿的临床资料、并发症及术后转归、随访情况。结果2例手术过程顺利,例1术后紧贴声门下的肉芽组织被完全清除,2例患儿声门下环形狭窄完全解除,治疗前呼吸道狭窄处周长约2.5 mm,治疗后,周长达5.2 mm,4.0 mm支气管镜进出无障碍,术后气管导管均成功拔除,呼吸困难均明显改善。2例患儿治疗后即刻、7 d、30 d和90 d镜下检查结果示狭窄处开放良好。术中有血氧饱和度下降及心率增快或减慢,暂停操作及恢复给氧后立即恢复,术中及术后未见异常血流动力学改变,2例目前仍在随访中。结论经喉罩钬激光、氩气刀及CO2冷冻治疗可用于后天性肉芽组织增生引起的声门下狭窄,方法安全、有效,近期效果显著,远期仍在进一步随访评估。%Objective To explore the operating methods,the effectiveness and safety for 2 cases of tracheal in-tubation related severe subglottic stenosis under laryngeal mask by using bronchoscopy in the diagnosis and interven-tional treatment. Methods Two male patients ( age at 4 and 11 months) both had difficulty breathing and weaning failure after endotracheal intubation,who were diagnosed with severe subglottic stenosis through CT and bronchoscopy examination. All parents signed their consent after being fully informed of treatment risks. Two cases were treated under bronchoscopic holmium laser combined with argon plasma coagulation and

  17. Propofol Combined with Remifentanil on Tracheal and Bronchial Foreign Body Removal in Children%异丙酚联合瑞芬太尼在小儿气管异物取出术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    温晓娟

    2015-01-01

    Objective:To investigate the effect of propofol combined with remifentanil on tracheal and bronchial foreign body removal in children .Methods:In 86 cases of tracheal and bronchial foreign body removal in children .Using the method of random number table ,the cases were randomly divided into the observation group and control group .Obser-vation group:1 .0μg/kg remifentanil ,1 .5mg/kg propofol intravenous pumping anesthesia ,control group:1 .0mg/kg of ketamine ,1 .0mg/kg propofol intravenous pumping anesthesia .The two groups were spontaneously breathing ,to start operation after sleeping .Anesthesia maintain , the observation group:remifentanil to 0 .2 ~ 0 .5mg/kg per minute , propofol 2 .0~3 .0mg/kg per minute doses of continuous intravenous pumping ;the control group according to individu-al children with additional ketamine .1% tetracaine throat and trachea surface anesthesia .High frequency jet ventilation was applied in two groups .Record the operation time ,wake up of time ,and during the operation ,adverse reactions oc-curred in the operation situation;observe conditions and frequency of bronchoscope .Results:There was statistic signifi-cance in the operation time ,recovery time ,conditions and frequency of bronchoscope ,the adverse reaction of the patients with the incidence (P<0 .05) ,the observation group were better than the control group .Conclusion:Propofol combined with remifentanil on tracheal and bronchial foreign body removal in children ,satisfactory anesthesia effect ,less adverse reaction .%目的:探讨异丙酚联合瑞芬太尼在小儿气管异物取出术中的临床应用效果.方法:纳入86例气管异物患儿 ,按照随机数字表法分为观察组和对照组 ,每组43例.观察组:1 .0μg/kg瑞芬太尼、1 .5mg/kg异丙酚静脉泵入麻醉 ,对照组:1 .0mg/kg氯胺酮、1 .0mg/kg异丙酚静脉泵入麻醉.两组均保留自主呼吸 ,待患儿熟睡后手术开始.术中麻醉维持 ,观察组:瑞芬太尼以每分钟0

  18. Does high dose rate irradiation of obstructive intrabronchial malignancy justify the high cost? A study of 83 patients

    International Nuclear Information System (INIS)

    Purpose: Over a 6 year period, 1989 through 1994, 83 patients (pts) (76 pts with primary lung carcinoma (ca) and 7 pts with a solitary metastic lesion to the lung) and with bronchoscopically identified obstructive tumor, causing symptoms (sx's) of cough, hemoptysis and/or shortness of breath (SOB) were treated with high dose rate (HDR) Ir-192 intrabronchial irradiation (XRT), and are the basis of this study. The purpose of this retrospective study is to determine the survival and relief of sx's, compare our results to those in the classic radiation oncology lung ca literature, and determine if the improvement is sufficient to justify the high cost of adding HDR XRT to standard external beam XRT. Methods and Materials: 44 pts presented with de novo disease and initially received a course of external beam XRT (5000 - 6000 cGy, standard fractionation) followed by 3 HDR tx's of 800 cGy per treatment (tx) calculated at one cm depth, separated by one week intervals, for a total HDR dose of 2400 cGy. 39 pts presented with locally recurrent disease following prior tx with external beam XRT, and they received 3 HDR tx's, 1000 cGy per tx, one cm from the center of the catheter, separated by one week intervals, for a total dose to the tumor of 3000 cGy. All patients presented with one or more obstructive sx's. Relief of these sx's were determined at last follow-up (FU) or until death. All patients have been followed for a minimum of 6 months (mos). Results: Our results show overall median survivals of 13 mos since initial diagnosis and 6 mos since treatment. In light of these results, we attempted to determine a subgroup of patients who might have a statistically significant increase in survival. The subgroups we analyzed were 1) pts with recurrent disease, 2) those treated in later years of the study, surmising we were more selective as our experience increased, 3) squamous histology with its natural history to remain localized, and 4) younger patients, age below 50. Our

  19. Clinical value of virtual bronchoscopy in early diagnosis of central malignant lung neoplasm in high risk patients

    International Nuclear Information System (INIS)

    Virtual bronchoscopy (CT-VB) is a recently developed 3D visualization technique that employs thin-section spiral computed tomographic data of the thorax for non-invasive evaluation of the tracheo-bronchial tree. The purpose of this study was to compare the efficacy of multislice-CT virtual bronchoscopy in detecting early endobronchial manifestation of central lung cancer with that of flexible fiberoptic bronchoscopy. For this purpose, a group of 50 high risk patients (cigarette pack-years, long standing history of COLD) underwent both FOB and CT-VB investigation. Multislice CT was performed using the following parameters: collimation, 1 mm; pitch factor, 0.937-1.375; reconstruction interval, 0.8 mm and postprocessing was based on volume rendering technique. Images of eight standard tracheo-bronchial sections were obtained from each patient both during FOB and CT-VB and were independently interpreted respectively by a pneumologist and a bronchiseptica. Airway evaluation was based on the analysis of changes in the mucosal architecture, the shape of the ostia and of the carinae and on the presence of secretion deposits as early signs of tumor onset. The sensitivity of virtual bronchoscopy in discriminating diseased from healthy patients was 94 % and its specificity 65 %. Its positive predictive value 56 % and its negative predictive value 96 %. According to the ROC analysis, except for the assessment of the secretion deposits, the other three criteria evaluated separately during virtual bronchoscopic assessment of the airways contributed equally in discriminating diseased from disease-free patients (areas under curve ranging between 0,797 and 0,845). The best AUC was associated with the evaluation of the sum of all three parameters together (0,858). Nevertheless, FOB and CT-VB results in the evaluation of the shape of the ostia resulted to agree moderately while just a fair agreement was observed with respect to the evaluation of the mucosal architecture and of the

  20. 原发性支气管肺淀粉样变9例临床分析%Primary bronchial and pulmonary amyloidosis:A clinical analysis of 9 cases

    Institute of Scientific and Technical Information of China (English)

    张丽娜; 孙军平; 张明月; 刘玉霞; 杨冰; 薛新颖; 汪建新

    2014-01-01

    shadows in diffuse pulmonary interstitial parenchymal amyloidosis patients. The prognosis of pulmonary nodular parenchymal amyloidosis patients was usually good. Tracheobronchial amyloidosis usually exacerbated due to repeated infections and required bronchoscopic interventional therapy, anti-inflammation therapy, and cough-suppressing or phlegm-resolving therapy. The prognosis of diffuse pulmonary interstitial amyloidosis patients was usually poor. Conclusion Primary bronchial and pulmonary amyloidosis has no specific clinical and imaging manifestations, and is diagnosed according to its pathology. Expectant treatments such as anti-inflammation therapy can alleviate its symptoms.

  1. 经支气管镜确诊的2168例肺癌的临床特点分析%Analysis of Clinical Features of 2 168 Confirmed Cases of Lung Cancer Diagnosed by Bronchoscopy

    Institute of Scientific and Technical Information of China (English)

    张宇; 于力克; 谢海燕; 胡韦华; 郝可可; 夏宁

    2011-01-01

    Objective To investigate the clinical characteristics of confirmed cases of lung cancer diagnosed by bronchoscopy. Methods A retrospective analysis was conducted to study the clinical features such as gender,age,pathologic type,lesion location,bronchoscopic image and sampling method of 2,168 confirmed cases of lung cancer diagnosed by bronchoscopy. Results The sex ratio (M/F) was 4.8 : 1 and the peak incidence was between 60 to 69 years of age. The most common pathologic type was squamous cell carcinoma (44.56%),followed by adenocarcinoma (25.92%) and small cell lung cancer (18.27%). Squamous cell carcinoma had the highest incidence rate (50.61%) a-mong men,while adenocarcinoma had the highest rate among women (56.18%). The positive rates diagnosed by forceps biopsy,brush biopsy,bronchial alveolar lavage and transbronchial needle aspiration were 81.60%,49.37%, 18.24% and 62.65% respectively. The positive rate by forceps biopsy combined with brush was 89.06%. Conclusion Bronchoscopy is an important approach in the diagnosis of lung cancer. The incidence and pathologic type of lung cancer vary depending on age and gender. Bronchoscopy and improving biopsy technique can markedly increase the diagnostic rate and help in early diagnosis of lung cancer.%分析经支气管镜确诊肺癌的临床特点.方法 回顾性分析经支气管镜确诊为肺癌的2 168例患者的性别、年龄、病理类型、病变部位、镜下表现、取材方法等特点.结果 该组患者男女比例为4.8:1,60~69岁为发病年龄高峰.鳞癌是最主要的病理类型(占44.56%),其次为腺癌(占25.92%)和小细胞癌(占18.27%).男性鳞癌发病率最高(占50.61%),女性腺癌发病率最高(占56.18%).钳检、刷检、支气管肺泡灌洗、经支气管镜针吸的诊断阳性率分别为81.60%、49.37%、18.24%和62.65%,钳检联合刷检阳性率为89.06%.结论 支气管镜检查是诊断肺癌的重要手段.不同年龄、不同性别的肺癌患者发病不同,病

  2. 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

  3. 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

  4. 氧瞬得可视喉镜用于意外困难气管插管20例临床分析%The use of airtraq oPtical laryngoscoPe in unanticiPated difficult tracheal intubation of 20 Patients

    Institute of Scientific and Technical Information of China (English)

    李光元; 李明强

    2014-01-01

    Objective To summarize the experiences usinG the Airtraq optical larynGoscope( AL)in the manaGement of unanticipated difficult endotracheal intubation. Methods Twenty surGical patients with General anesthesia usinG tracheal intubation were induced with propofol-remifentanyl and injected with atracuriun (0. 5 mG/kG). And then,larynGoscope with Macintosh directly throuGh oral tracheal intubation,and located the tracheal intubation by end tidal carbon dioxide detection method. AttemptinG oral tracheal intubation with Macintosh larynGoscope were failed for twice time,the AL was used to accomplish tracheal intubation. Results In all the patients,tracheal intubations with AL as a rescue intubation device Got clear GradeⅠCormack-Lehane Glottis exposure,with once-time successful intubation attemptinG in l8 patients. But in other 2 patients,tracheal intubations were accomplished by combined use of a fibreoptic bronchoscope which GuidinG tracheal tube into the Glottis throuGh AL after tracheal tube slidinG backward into the esophaGus repeatedly. DurinG the intubation attempts,interval mask ventilation were Given maintaininG SaO2≥90% in all patients. Conclusion AL offers an new effective technique as a rescue airway device in deal with unanticipated difficult tracheal intubation.%目的:总结应用氧瞬得可视喉镜处理意外困难气管插管的临床经验。方法20例拟在气管插管全身麻醉下手术的患者,以丙泊酚-瑞芬太尼静脉诱导,阿曲库铵0.5 mG/kG 静脉注射后以Macintosh 直接喉镜行经口明视下气管插管术,以呼气末二氧化碳检测法确定气管导管位置。直接喉镜试插2次未能成功,改用氧瞬得可视喉镜引导插管。结果20例患者改用氧瞬得喉镜气管插管后,声门显露完整清楚,C-L分级均为l级,l8例气管插管l 次成功,2例通过喉镜观察到导管向后反复滑入食道,经联合使用纤维支气管镜引导,气管导管插入成功;插管过程

  5. Comparison of autofluorescence imaging bronchoscopy and white light bronchoscopy for detection of lung cancers and precancerous lesions

    Directory of Open Access Journals (Sweden)

    Wang Y

    2013-07-01

    WLB was not higher than 10, and the pooled negative likelihood ratio for AFI and WLB was not lower than 0.1.Conclusion: The sensitivity of AFI is higher than that of WLB, while the specificity of AFI is lower than that of WLB. The overall diagnostic performance of AFI is slightly better than that of WLB in detecting lung cancers and precancerous lesions. AFI should find its place in routine bronchoscopic examination and may improve the diagnostic outcome on endoscopy.Keywords: autofluorescence imaging bronchoscopy, autofluorescence bronchoscopy, light bronchoscopy, lung cancers, precancerous lesions

  6. 平扫液体衰减反转恢复及增强T1WI序列对脑转移瘤的综合诊断价值%Synthetic diagnostic value of plain FLAIR combined with contrast-enhanced T1WI sequence in intracranial metastatic tumor

    Institute of Scientific and Technical Information of China (English)

    刘金来; 常慧贤; 金艳; 徐焱

    2010-01-01

    Objective To investigate the synthetic diagnostic value of plain FLAIR combined with contrast-enhanced T1WI sequence in intracranial metastatic tumor. Methods Retrospective analysis of 48 patients with intracranial metastatic tumor, the primary tumor have been confirmed by fiber bronchoscope biopsy or surgical biopsy. All the patients were performed MRI scans with plain FLAIR and contrast-enhanced T1WI sequence. Contrast-enhanced FLAIR scans for suspicious lesions in plain FLAIR but negative in contrast-enhanced T1WI. Comparative analysis the appearances of 192 lesions in plain FLAIR and contrast-enhanced T1WI sequence, and analyze the synthetic diagnostic value of both sequence. Results One hundred and two lesions were detected in plain FLAIR sequence, and 56 lesions with the clear border.One hundred and eighty-three lesions were detected in contrast-enhanced T1WI sequence, and 181 lesions with the clear border. And 192 lesions were detected with plain FLAIR combined with contrast-enhanced T1WI sequence. Conclusions Plain FLAIR scans are useful to detect edema of the metastatic tumor, and have higher sensitivity of the cortex region lesions. Contrast-enhanced T1WI scans are useful to detect the negative lesions in plain MRI scans, and have a higher diagnostic specificity. A combination scans of both sequence can improve the diagnostic accuracy.%目的 探讨平扫液体衰减反转恢复(FLAIR)与增强T1WI序列结合后对脑转移瘤的综合诊断价值.方法 48例脑转移瘤患者原发灶均经过纤维支气管镜活检或手术活检病理证实,所有患者均进行了FLAIR平扫及增强T1WI扫描,对于FLAIR平扫发现可疑病变而增强T1WI扫描表现阴性的患者,加扫增强FLAIR序列.对比分析192处脑转移瘤病灶在平扫FLAIR及增强T1WI序列的显示情况,进一步分析其综合诊断价值. 结果 192处脑转移瘤病灶中,平扫FLAIR序列检出可疑病灶102个,能够明确瘤灶边界的有56个;增强T1WI

  7. 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.

  8. 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.

  9. Desenvolvimento de uma órtese de Dumon modificada para aplicações traqueais: um estudo experimental em cães Development of a modified Dumon stent for tracheal applications: an experimental study in dogs

    Directory of Open Access Journals (Sweden)

    Rogério Gastal Xavier

    2008-01-01

    : Four different densities were tested in order to obtain the silicone prototypes. The pressure required for compression considering a contact area of 1 cm2, and a 30% reduction in diameter was calculated for each density. The best density was 70-75 Shore A hardness. Powdered barium sulfate was added to the silicone to make the stent radiopaque and easily identifiable in radiological imaging. This novel stent presents a corrugated external surface with discontinuous and protruding arcs resembling the tracheobronchial rings (for intercalation and fixation in the lumen of the lower airways, a highly polished inner surface and smooth extremities (to prevent friction-related damage. The prototype considered most appropriate in terms of rigidity and flexibility was bronchoscopically implanted in normal canine tracheas. After eight weeks, the animals were euthanized, and the tracheas were removed for anatomopathological analysis. RESULTS: There were no postimplantation complications, and none had to be removed. After eight weeks, the devices were found to be well-positioned. Histopathology revealed a well-preserved epithelial basal membrane, foci of denuded epithelium, mild submucosal inflammatory infiltrate with scattered granulation tissue, vascular neoformation, and no microorganisms. CONCLUSIONS: The stent developed proved resistant to mechanical stress, biocompatible in the canine trachea and well-preserved at the study endpoint.

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

    Directory of Open Access Journals (Sweden)

    Salma

    2015-10-01

    Full Text Available INTRODUCTI ON: Foreign body aspiration in pediatrics is a potentially fatal accident which will continue until children explore their surroundings with their hand and mouth. Pediatric aspirations will persist until mankind exists. Not all foreign body aspirations are witnessed hence chances of delay in diagnosing an aspiration are high. Delay in diagnosis depends on site and character of foreign body aspirated. The chest x - ray findings and type of foreign body extracted vary depending on the duration the foreign body remains in airway . OBJECTIVE: To study the X - ray finding in pediatric airway aspiration and its relation to time lapse, the type and site of lodgment of foreign body extracted via bronchoscopy. The type of foreign body in relation to time lapse in aspiration. MATERIAL AND METHODS: This was a prospective study done in Bapuji child health institute and research center, JJM Medical College, Davangere . History and pre bronchoscopy x - Ray finding were noted for 65 children who were posted for suspicious bronchoscopy from August 2011 to September 2013. 11 children were excluded from study as they showed no foreign body on bronchoscopy. Time lapse in aspir ation and seeking medical care was noted. The bronchoscopic findings regarding site of foreign body lodgment and type of foreign body were recorded. The type of foreign body and variation of x - ray picture in relation to time lapse in aspiration were noted. Data collected was analyzed using descriptive statistics. RESULT: It was observed that mean age was 28 months. About 80% of the cases were between 1 to 3 years age. 82% (n=53/54 were radio lucent foreign body, only 1.5% (n=1/54 were radio o paque. Site of lodgment of foreign body was right main bronchus in 48% (n=26/54, left main bronchus 46% (n=25/54 , tracheal 1.85% (n=1/54, subglottic 1.85% (n=1/54, carinal 1.85% (n=1/54, multiple site i.e. left bronchus +right bronchus+ carinal 1.85% (n=1/54. Groundnut was most common

  11. Traqueostomía percutánea por dilatación: Reporte de 70 casos

    Directory of Open Access Journals (Sweden)

    Jorge A Ramírez- Arce

    2006-06-01

    percutaneous tracheostomy was perform in 70 patients between august 2002 and october 2004 at the Critical Care Unit of the Hospital Dr. Rafael Angel Calderón Guardia. The procedure was performed following a modification of the Ciaglia technique. Epidemiological data and complications were collected. Results: Eighty percent were men and 20 % women. The main complications were transient low oxygen saturation (7.14 %, tracheal ring fracture (4.2 %, bronchoscope puncture (4.2 %, unplanned extubation (2.85% and mild bleeding (2.85%. Average surgical time was 8.14 minutes. There was no mortality associated with the procedure. Conclusion: This technique is safe and can be performed by medical intensivists. There should be a multidisciplinary team to support the performance of this procedure. Percutaneous tracheostomy should be the first choice technique for tracheostomy in the critical care unit.

  12. 三维CT在气管狭窄诊断中的应用%The Application of Three-Dimensional CT on the Diagnosis of Tracheal Stenoses

    Institute of Scientific and Technical Information of China (English)

    辛衍忠; 闫宇博; 张翔宇; 李吉尧; 崔键

    2011-01-01

    Objective: We evaluated the ability of three-dimensional CT to estimate tracheal stenoses in comparison to conventional fiberoptic bronchoscopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures. Methods: Spiral CT was performed in 64 patients with suspected tracheal stenoses and in 20 normal subjects. Tracheal stenoses due to an endolu-minal neoplasm were detected in 52 patients, whilst traumatic tracheal stricture was observed in the other 12 patients. Multiplanar reformatting (MPR), volume rendering techniques (VRT) and virtual endoscopy (VE) for trachea evaluation were applied and findings were compared to fiberoptic bronchoscopy. The accuracy of the procedure in describing the localization and degree of stenosis was tested by two radiologists in a blinded controlled trial. Results: The imaging modalities tested showed the same stenoses as the ones detected by flexible bronchoscopy and achieved accurate and non-invasive morphological characterization of the strictures, as well as additional information about the extraluminal extent of the disease. No statistically significant differences were observed between bronchoscopic findings and the MPR, VRT and VE image evaluations (P = 0.715, 0.413 and 0.417 respectively). Conclusion: Three-dimensional CT may provide a high fidelity, noninvasive and reproducible evaluation of the trachea compared to bronchoscopy. They may play a role in assessment of airway patency distal to high-grade stenoses, and represent a reliable alternative method for patients not amenable to conventional bronchoscopy.%目的:我们检测三维CT在气管狭窄的诊断中的作用和纤维支气管镜相比较,用以帮助临床胸外科医生判断气管结构的解剖学特征.方法:对怀疑气管狭窄的患者64例及20例正常病例检查螺旋CT,其中52例发现腔内新生物造成狭窄,另外12例为外伤后狭窄,应用多平面重建(MPR)、容积重建技术(VRT)、仿

  13. Surgical Therapeutic Strategy for Non-small Cell Lung Cancer with Mediastinal Lymph Node Metastasis (N2

    Directory of Open Access Journals (Sweden)

    Yanchu TIAN

    2010-04-01

    Full Text Available Background and objective Approximately 30% of patients who are diagnosed with non-small cell lung cancer (NSCLC are classified as N2 on the basis of metastasis to the mediastinal lymph nodes. The effectiveness of surgery for these patients remains controversial. Although surgeries in recent years are proved to be effective to some extent, yet due to many reasons, 5-year survival rate after surgery varies greatly from patient to patient. Thus it is necessary to select patients who have a high probability of being be cured through an operation, who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis. Methods 165 out of 173 patients with N2 NSCLC were treated with surgery in our department from January 1999 to May 2003, among whom 130 were male, 43 female and the sex ratio was 3:1, average age 53, ranging from 29 to 79. The database covers the patients’ complete medical history including the information of their age, sex, location and size of tumor, date of operation, surgical methods, histologic diagnosis, clinical stage, post-operative TNM stage, neoadjuvant treatment and chemoradiotherapy. The methods of clinical stage verification include chest X-ray, chest CT, PET, mediastinoscopy, bronchoscope (+?, brain CT or MRI, abdominal B ultrasound (or CT, and bone ECT. The pathological classification was based on the international standard for lung cancer (UICC 1997. Survival time was analyzed from the operation date to May 2008 with the aid of SPSS (Statistical Package for the Social Sciences program. Kaplan-Meier survival analysis, Log-rank test and Cox multiplicity were adopted respectively to obtain patients’ survival curve, survival rate and the impact possible factors may have on their survival rate. Results The median survival time was 22 months, with 3-year survival rate reaching 28.1% and 5-year survival

  14. Volume software measuring pulmonary volume of lung volume reduction in animal experiment%应用Volume软件测定肺减容动物实验中肺容积变化的研究

    Institute of Scientific and Technical Information of China (English)

    李文涛; 郑厚文; 黎雨; 傅钰雁; 柳广南

    2013-01-01

    [Objective] To evaluate the value of volume software of multi-slice spiral CT in measuring pulmonary volume of lung volume reduction in animal experiment.[Methods] Eight young pigs (16~22 kg) were randomly divided into experimental group and control group.Each pig was treated with biological lung volume reduction under fiberoptic bronchoscope guide before operation and one week after,one month and three month after the operation,its lung volume was measured respectively by volume software,then relation with its morphology and histopathology was analyzed and the effectiveness of lung volume reduction was evaluated.[Result] The control group with 4 young pigs whose right lung volume / total lung declined from (48.9±4.7)% to (48.2±5.7)% after three months were no significant differences (P >0.05).But there were straightly reduced from (57.9±1.6)% to (49.6± 2.65)% in experimental group with other 4 young pigs (P <0.05).Meanwhile three months later its volume of target lung dramatically decreased,following pulmonary fibrosis in varying degrees,which extremely consisted with the imaging changes.Yet the control group with 4 pigs had no significant changes in morphology and histopathology,even preoperative and postoperative CT scans.[Conclusion] It is a simple,rapid,accurate and no trauma method estimated by volume software supplied by multi-slice spiral CT for measuring pulmonary volume of lung volume reduction in animal experiments.%目的 探讨多层螺旋CT定量分析Volume软件在肺减容术动物实验中肺容积测定的应用价值.方法 8头健康约克幼猪,随机分为实验组、对照组各4头,经纤维支气管镜行生物性肺减容术,采用多层螺旋CT扫描,Volume软件动态监测术前、术后1周,术后1,3个月肺容积变化,分析其与术后3个月取出的动物肺脏其形态学,组织病理学的关联性 结果 对照组4头幼猪,右肺容积/总肺容积平均比值由术前(48.9±4.7)%到术后3个月减至(48

  15. Basic pulmonary function tests in pig farmers

    Directory of Open Access Journals (Sweden)

    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

  16. 内镜清洗消毒过程中污染因素及预防措施研究%Risk factors for contamination during cleaning and disinfection of endoscopes and prevention measures

    Institute of Scientific and Technical Information of China (English)

    强明珠; 陶爱女; 周明娟

    2015-01-01

    OBJECTIVE To explore the risk factors for iatrogenic infections during the cleaning and disinfection of endoscopes and put forward corresponding prevention countermeasures so as to reduce the incidence of infections due to the use of endoscopes .METHODS The risk factors for the iatrogenic infections were observed through onsite examination during the cleaning and disinfection of endoscopes ,totally 184 endoscopes in use were randomly ex‐tracted .The quality of cleaning and disinfection of the endoscopes was determined through the sampling of lumens and surfaces of the endoscopes .RESULTS Of 184 samples ,169 were qualified with the qualified rate of 91 .85% ;the qualified rates of the gastroscopes ,bronchoscopes ,colonoscopes ,and laryngoscopes were 86 .00% ,95 .56% , 89 .36% ,and 97 .62% ,respectively .The bacterial colony counts of 15 samples exceeded the standard .A total of 26 strains of pathogens have been isolated ,including 14 strains of Helicobacter pylori ,8 strains of Escherichia coli ,2 strains of Pseudomonas aeruginosa ,1 strain of Staphylococcus aureus ,and 1 strain of Mycobacterium tu‐berculosis .Among the causes of unqualified cleaning and disinfection of the 15 samples ,the incomplete cleaning ac‐counted for 40 .00% ,the inappropriate use of disinfectants 40 .00% ,the inappropriate self‐protection 13 .33% , not taking special treatment for patients with special infections 6 .67% .CONCLUSION The risk factors for the iat‐rogenic infections during the cleaning and disinfection of endoscopes are complicated .It is necessary for the hospital to strengthen the cleaning of endoscopes ,education of disinfection staff ,and culture ,standardize the cleaning and disinfection procedure ,and establish scientific surveillance mode so as to prevent the iatrogenic infections .%目的:研究内镜清洗消毒过程中发生医源性感染的危险因素,并提出相对的预防策略,降低内镜使用引发的感染率。方法通过现场检查总

  17. Application of information technology in registration and management of endoscope ’ s cleaning and sterilization%信息技术在内镜清洗消毒登记管理中的应用

    Institute of Scientific and Technical Information of China (English)

    贾彩莲

    2014-01-01

    Objective To explore the clinical application effect of information technology in registration and management of endoscope ’s cleaning and sterilization.Methods Between January 2011 and January 2013, using endoscope cleaning program in computer information system to conduct scientific management for registration of endoscope cleaning and sterilization , then comparing the effect of endoscope cleaning and sterilization with manual registration .Results After adopting computer records , various endoscope ’ s cleaning and sterilization time were significantly less than those adopting manual records ,gastroscope [(8.73 ±0.35) vs (23.79 ±1.92)], colonoscopy [(8.26 ±0.47) vs (23.57 ±1.89)], laryngoscope [(8.56 ±0.51) vs (23.85 ±1.32)], bronchoscope [(8.13 ±0.68) vs (23.61 ±1.56)], duodenoscope [(8.35 ±0.84) vs (23.89 ±1.68)],with statistically significant differences (t=15.38,14.77,15.02,15.28,15.13, respectively;P<0.01), and the data integrity reached 100.00%, which was significantly higher than 77.33% with manual record, with a statistically significant difference (χ2 =38.34,P<0.05).Conclusions Information technology applied in the endoscope ’ s cleaning and sterilization work for registration and management is not only scientific , standardized and convenient , but also save time and human resources .%目的:探讨信息技术在内镜清洗消毒登记管理中的临床应用效果。方法2011年1月-2013年1月期间使用内镜洗消程序计算机信息系统对内镜清洗消毒登记进行科学的管理,并与采用手工登记内镜清洗消毒的情况进行对比分析。结果计算机记录胃镜、肠镜、喉镜、支气管镜及十二指肠镜所用时间分别为(8.73±0.35),(8.26±0.47),(8.56±0.51),(8.13±0.68),(8.35±0.84)min,少于手工记录的(23.79±1.92),(23.57±1.89),(23.85±1.32),(23.61±1.56),(23.89±1.68)min,两种记

  18. Two-level management of application of endoscope%医院内镜使用的两级管理

    Institute of Scientific and Technical Information of China (English)

    王靖; 李莉; 周辉

    2012-01-01

    OBJECTIVE To strengthen the standardized management of endoscope to avoid the iatrogenic infections due to the poor cleaning and disinfection of endoscope so as to ensure the safety of the patients and medical staff. METHODS Through the nosocomial infection administration office and the nosocomial infection monitoring team, by means of the on site inspection in combination with sampling testing, the management system, equiping facilities, disinfection procedure, the use of disinfectants,and the disinfection effect were examined; the inspection records of using endoscopes from Jan 2010 to Jun 2011 were respectively reviewed. RESULTS There was difference in the qualified rate of the sterilization of endoscopes by the two-level of hospital and department, the qualified rate of the sterilization of bronchoscope by the hospital-level inspection was 14. 3% lower than that by the department-level inspection, 15. 9% lower of the laryngoscope, 10. 4% lower of the gastroscope, 11. 2% lower of the colonoscope, 2. 1 % lower of the arthroscope, 1. 6% lower of the laparoscope, 3. 1% lower of the cystoscope, 5. 2% lower of the disinfectant, 4. 6% lower of the air, 14. 9% lower of the object surface and 11. 8% lower of the staffs hands. CONCLUSION Only as the nosocomial infections control office establishes the sound regulations and systems, standardizes the operation procedure and regularly supervise the disinfection effect can eliminate the iatrogenic infections due to lax sterilization of endoscope.%目的 加强内镜医院感染规范化管理,避免因内镜清洗消毒缺陷引起医源性感染,保证患者及医务人员安全.方法 通过医院感染管理办公室和科室医院感染监控小组两级管理组织,采用现场查看及抽样检测相结合的方法,分别对全院使用中的各种内镜检查其管理制度、消毒设施的配备、消毒程序的规范、消毒剂的使用方法及消毒效果;回顾性分析2010年1月-2011年6月使用

  19. 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

  20. 支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较%Contrast in respiratory mechanics and blood gas between bronchial blocker and double lumen tube in one lung ventilation

    Institute of Scientific and Technical Information of China (English)

    傅志玲; 陈卫民

    2011-01-01

    Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P<0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P < 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P> 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.%目的 比较支气管堵塞器(BB)与双腔气管导管(DLT)在单肺通气中对呼吸力学和血气的影响.方法 将36例择期行肺叶切除术和食管癌根治术患者按投硬币法随机分为BB组(17例)和DLT组(19例).BB组完成单腔管插管后在纤维支气管镜引导下置入BB,DLT组完成插管后用纤维支气管

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

    Directory of Open Access Journals (Sweden)

    Alexandre P. Machado

    2006-12-01

    Full Text Available BACKGROUD: Endoscopes are routinely used in hospitals and clinics of the world and they can be potential sources of cross-infection when the decontamination process is unsuitable AIM: The routines of flexible endoscope (bronchoscopes, esophagogastroduodenoscopes and colonoscopes disinfection procedures used in two Brazilian university hospitals were evaluated during a 3-year period METHODS: Aleatory samples from internal channels of endoscopes were collected after patient examination and after cleaning/disinfection procedures RESULTS: A contamination >3 log10 was achieved in samples recovered from endoscopes after patient examination. These samples yielded gram-negative bacilli (n = 142: 56%, gram-positive cocci (n = 43: 17%, yeast cells (n = 43: 17%, and gram-positive bacilli (n = 26: 10%. Approximately, 72 out of 149 samples (48.32% collected after undergoing the cleaning and disinfection procedures disclosed gram-negative bacilli (n = 55: 61%, gram-positive cocci (n = 21: 23%, gram-positive bacilli (n = 8: 9% and yeast cells (n = 6: 7%. Esophagogastroduodenoscopes and colonoscopes were the most frequently contaminated devices. Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter spp, Serratia marcescens, Proteus mirabilis, Citrobacter freundii, Staphylococcus aureus, Staphylococcus coagulase negative, Micrococcus luteus, Candida albicans, C. tropicalis, C. glabrata, C. guilliermondii, Bacillus spp and Corynebacterium spp were predominantly identified CONCLUSION: Inappropriate cleaning and low times of disinfection were respectively the major factors associated with the presence of microorganisms in colonoscopes and esophagogastroduodenoscopes. By analyzing the identified germs, hospital disinfection was considered of either intermediate or poor level. After this investigation, both university centers improved their previous protocols for disinfection and conditions for reprocessing endoscopes.RACIONAL: Endoscópios s

  2. IMP3 can predict aggressive behaviour of lung adenocarcinoma

    Science.gov (United States)

    2012-01-01

    Background Lung cancer most often presents as an inoperable tumour and the diagnosis is usually performed on a small biopsy/cytology specimen. In the group of non small cell lung cancer - not otherwise specified, adenocarcinoma phenotype can be determined immunohistochemically using TTF-1 and Napsin A. Expression of oncofetal protein IMP3 in human cancer is associated with poor differentiation and aggressive behaviour. In the present study expression of IMP3 was correlated with expression of TTF-1 and Napsin A, histological subtype and clinical stage of lung adenocarcinoma. We were interested whether distant metastases are associated with IMP3 overexpression, regardless of the histologic subtype of adenocarcinoma. Methods In retrospective study, consecutive series of 105 patients with advanced lung adenocarcinoma diagnosed from 2006 to 2009 in Clinical Hospital Center Split, Croatia, were analysed. Clinical data were collected from the Pulmology Department and time of death from the Mortality Registry. Paraffin blocks of bronchoscopic biopsies were collected from the Institute of Pathology and 15 cases excluded from the analysis due to insufficient material. Expression of IMP3, Napsin A and TTF-1 were analysed by indirect enzyme immunohistochemistry. Statistical analysis was performed and P values less than 0.05 considered significant. Results Of 90 patients, 71 (78%) were males and 19 (22%) females. Median age for males was 61.5 years (min-max 43–83) and for females 61 years (min-max 44–86). Pleural effusion was found in 15 (16.6%) and distant metastases in 45 (50%) cases. According to histological subtypes, there were 34 acinar, 2 lepidic, 2 papillary and 52 solid subtypes. IMP3 overexpression was found in 63 cases (70%) and was correlated with solid subtype (P = 0.002) and negative/weak Napsin A expression (P = 0.004). Strong Napsin A expression correlated with TTF-1 expression (P = 0.003) and lower histological grades (P = 0.031). Patients

  3. IMP3 can predict aggressive behaviour of lung adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Beljan Perak Renata

    2012-11-01

    Full Text Available Abstract Background Lung cancer most often presents as an inoperable tumour and the diagnosis is usually performed on a small biopsy/cytology specimen. In the group of non small cell lung cancer - not otherwise specified, adenocarcinoma phenotype can be determined immunohistochemically using TTF-1 and Napsin A. Expression of oncofetal protein IMP3 in human cancer is associated with poor differentiation and aggressive behaviour. In the present study expression of IMP3 was correlated with expression of TTF-1 and Napsin A, histological subtype and clinical stage of lung adenocarcinoma. We were interested whether distant metastases are associated with IMP3 overexpression, regardless of the histologic subtype of adenocarcinoma. Methods In retrospective study, consecutive series of 105 patients with advanced lung adenocarcinoma diagnosed from 2006 to 2009 in Clinical Hospital Center Split, Croatia, were analysed. Clinical data were collected from the Pulmology Department and time of death from the Mortality Registry. Paraffin blocks of bronchoscopic biopsies were collected from the Institute of Pathology and 15 cases excluded from the analysis due to insufficient material. Expression of IMP3, Napsin A and TTF-1 were analysed by indirect enzyme immunohistochemistry. Statistical analysis was performed and P values less than 0.05 considered significant. Results Of 90 patients, 71 (78% were males and 19 (22% females. Median age for males was 61.5 years (min-max 43–83 and for females 61 years (min-max 44–86. Pleural effusion was found in 15 (16.6% and distant metastases in 45 (50% cases. According to histological subtypes, there were 34 acinar, 2 lepidic, 2 papillary and 52 solid subtypes. IMP3 overexpression was found in 63 cases (70% and was correlated with solid subtype (P = 0.002 and negative/weak Napsin A expression (P = 0.004. Strong Napsin A expression correlated with TTF-1 expression (P = 0.003 and lower histological grades (P

  4. Analysis of allergic bronchopulmonary aspergillosis in 8 children%儿童变应性支气管肺曲霉病8例

    Institute of Scientific and Technical Information of China (English)

    陈兰勤; 殷菊; 徐保平; 胡英惠; 申昆玲

    2015-01-01

    Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University from March 2010 to December 2013.The clinical features,laboratory results,image characteristics and the prognosis information were reviewed.Results Eight ABPA cases met the diagnostic criterion.All patients were school-age children (7 years and 2 months to 13 years and 8 months old).Cough (8 cases),productive sputum (8 cases),wheezing (5 cases),fever (4 cases) and hemoptysis (3 cases) were the main clinical features.Six of the 8 patients showed eosinophilia.IgE level was elevated in 7 patients (1.000-5.000 IU/L).All 8 patients were allergic to aspergillus fumigatus,while only 2 cases were positive in sputum culture for aspergillus fumigatus.CT scans showed pulmonary opacities in all 8 cases,while 7 patients had typical central bronchiectasis.Seven patients were treated with the regimen,which included glucocorticosteroid,antifungal agents (voriconazole or itraconazole) and regular bronchoscope.The symptoms of all treated patients relieved,the total serum IgE level and eosinophil cell count decreased spontaneously after the therapy.Conclusions ABPA is rare in children and the clinical features are non-specific.If the patient has elevated total IgE level in serum and eosinophilia,especially in patients with underling diseases,ABPA should be suspected.The positive result of specific antibodies to aspergillus fumigatus and central bronchiectasis on the radiology may give the suggestive diagnosis.ABPA patients generally have good response to the therapy of glucocorticosteroid and antifungal agents.

  5. 免疫过滤法、平板双向扩散法、酶联免疫吸附试验法血清学检验技术对农民肺诊断价值的Meta分析%Electrosyneresis、ouchterlony double diffusion、ELISA in diagnosing of farmer's lung with Meta analysis

    Institute of Scientific and Technical Information of China (English)

    王群; 许蕾; 刘军; 赵明静; 王笑歌

    2011-01-01

    Objective To investigate the value of electrosyneresis ,ouchterlony double diffusion ,ELISA in diagnosing of farm er' s lung with Meta analysis.Methods Articles of electrosyneresis、 ouchterlony double diffision、 ELISA on farm er' s lung published in English or Chinese from 1960 to Decem ber 2010 were collected . took clinical manfestation , physical exam ination , iconography and lung function ,fiberoptic bronchoscope as golden standards .The software of Revm an 5 .0 and Meta-disc 1 .4 were used for calculated the sensitivity ,specificity ,sum mary receiver operating characteristic curves ,area under the curve and the heterogenerty .Results 5 articles accord with the internalize standard .The sensitivity [0 .78 (0 .59 -0 .90 ) ] and D0R [23 .56 (4 .62 -120 .01 ) ] of ouchterlony double diffusion is higher than the electrosyneresis and elisa the electrosyneresis had the highestAUC (0 .9044 ) and Q * (0 .8360) .Conclusion The electrosyneresis and ouchterlony double diffusion are two useful serum diagnostic toll for detecting barm er' s lung .[英文关键词]electrosyneresis ; ouchterlony double diffusion ; ELISA ; farm er's lung ;Meta analysis%目的 通过Meta分析评价免疫过滤法、平板双向扩散法、酶联免疫吸附试验法对农民肺的诊断价值.方法 收集1960年1月至2010年12月国内外以临床表现、体格检查、影像学及肺功能改变、纤维支气管镜检查为金标准确诊农民肺,并以血清学检验技术免疫过滤法、平板双向扩散法、酶联免疫吸附试验法诊断农民肺的相关文献.采用Review Manager 5.0、Meta-Disc 1.4软件,检验异质性,根据异质性结果选择相应效应模型,计算合并灵敏度和合并特异度,合并阳性似然比、合并阴性似然比、DOR值及其95%CI.绘制综合受试者工作特征曲线、计算曲线下面积综合评价各血清学方法的诊断效能.结果 5篇文献符合纳入标准.合并敏感性和特异性后,免疫过滤

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

    Directory of Open Access Journals (Sweden)

    Fernando A. Díaz Couselo

    2008-10-01

    remain as a diagnostic and therapeutic challenge in cancer patients. In order to evaluate the etiology, diagnostic methods used, Intensive Care Unit admission and in-hospital mortality, we conduced an observational, prospective study which included all patients with cancer and recent pulmonary infiltrates admitted to the Instituto Alexander Fleming between August 2003 and March 2006. Diagnostic methods were categorized in sequential steps of complexity: 1st step: radiological pattern of the pulmonary infiltrates, blood and sputum cultures, serological tests and empirical treatment response; 2nd step: bronchoalveolar lavage (BAL, non bronchoscopic tracheal aspirate and mini-BAL; 3rd step: pulmonary or extrapulmonary biopsies. Pulmonary infiltrate etiology was classified as: infection, treatment complication, disease progression, cardiovascular or mixed. Diagnosis was classified as proved or probable. A total of 106 samples from 103 patients were included. The etiologies were infection in 61 cases, disease progression in 4, treatment complication in 6, cardiovascular in 6 and mixed in 7. Proved diagnosis was obtained in 33 cases and probable diagnosis in 51 while 22 cases could not be diagnosed. Nine of the 10 diagnoses of mycoses were in oncohematologic cases. Seventy cases did not go further than procedures included in the 1st step. Thirty two cases stopped after diagnostic procedures of the 2nd step and 4 required biopsies. Forty four cases required Intensive Care Unit admission. In-hospital mortality was 30.2%. In our study, infection was the most frequent etiology. Mycoses were more frequent in oncohematologic cases. A proved or probable diagnosis was obtained in 84 (79.2% cases. In 53.7% of the cases only non-invasive diagnostic methods were required.

  7. 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

  8. Application of Dexmedetomidine in the Surgery of Obstructive Sleep Apnea Hypopnea Syndrome%右美托咪啶用于阻塞性睡眠呼吸低通气暂停综合征患者手术的麻醉效果

    Institute of Scientific and Technical Information of China (English)

    龚华渠; 叶占勇; 侯景利; 代雪梅

    2012-01-01

    continuously during operation. Results: All the patients were intuba-ted successfully. Among them, 15 patients were inserted blindly through nose, 3 patients were inserted through mouth by laryngoscope , and 3 patients were inserted by bronchoscope. The levels of SpO2 of them were above 92%. There were 18 patients who could be extubated smoothly and they entered wards with nasopharyngeal airway consciously, 3 patients entered intensive care unit (ICU )with tubes because of inaccurate hemostasis and then they were obverved for 12 - 24h and extubated consciously. Conclusions: For OSAS patients, dexmedetomidine can not only provide favourable insertion in anesthesia induction, it can also keep the vital signs of the patients more stable during operation and make patients more peaceful after operation.

  9. Comparisons of airway establishment among four surgical methods%四种外科气道技术的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈犹白; 张海钟; 陈聪慧; 韩岩

    2016-01-01

    Objective To compare efficacy, time consumed and complications among cricothyroid membrane puncture guided tracheostomy ( CMPGT ) , surgical tracheostomy ( ST ) , surgical cricothyroidotomy ( SC) , and percutaneous tracheostomy using Griggs'guide wire dilating forceps ( GWDF) for the establishment of airway in urgent need of medical attention.Methods Twenty miniature swine were randomly ( random number) divided into four groups.The procedures of CMPGT, ST, SC and GWDF were carried out when patients'SpO2 ( oxygen saturation of blood ) declined to 80% by suspension of oxygen supply after general anesthesia. Procedure performed time, ventilation resumed time, SpO2 and electrocardiograph ( ECG) and arterial blood gases ( ABG) analysis including SaO2 , PaO2 , PaCO2 , blood pH, and heart rate, blood pressure were recorded.Fiberoptic bronchoscope was used to assess any damage to the tracheal wall.Complications were noted and scored in a two-month follow-up period.Results Airways were successfully established in all swine.The times consumed for SC, GWDF, CMPGT, and ST were (86 ±12) s, (165 ±63) s, (174 ±34) s, and (519 ±128) s, respectively, however a shorter time for ventilation resumed was found in CMPGT procedure (23 ±4) s, P<0.01.ECG showed that SpO2 and T-wave decreased and Q-T shortened after oxygen suspension and recovered to normal level rapidly after ventilation.There were significant differences in ECG and ABG between pre-and post-operative periods ( P<0.05) in all groups.Minimal intra-operative bleeding was found in two swine of each group.In ST group, moderate intra-operative bleeding was encountered in three swine.Three pigs were suffered from hypotension owing to prolonged hypoxemia.There was minimal postoperative bleeding occurred in one swine, thus leading to stoma infection.In SC group, moderate intra-operative bleeding was noticed in one swine. One miniature swine had slight injury at laryngeal cartilage resulting in difficult decannulation happened

  10. 颈脊髓损伤气管切开术后拔管指征及延迟、失败原因探讨%Indications,Causes of Delay and Failure of Decannulation after Tracheostomy in Treatment of Cervical Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    赵唯; 李想; 张军卫; 洪毅

    2014-01-01

    Objective To investigate the indications,delay and failure causes of decannulation after tracheostomy in treatment of cervical spinal cord injury. Methods Clinical data of 63 patients with cervical spinal cord injury after tracheosto-my was reviewed,and self-designed indications guidance for decannulation was used to choose the time of removing tubes. The delay and failure causes of decannulation were analyzed. Results The patients′oxygenation,expectoration and swallowing a-bilities were recoveried,the pulmonary infection was controlled,and there were no laryngeal edema by laryngoscope and bron-choscopes examinations and no obvious airway constriction in distal cannula. All above conditions were used as decannulation indications. Fifty four patients(85. 7%)underwent removal surgery of the tracheostomy tubes successfully within 3 months af-ter injury. The mean interval between incision of tracheal and decannulation was 43. 2 d. Seven patients(11%)had delayed decannulation,and the causes including repeated pulmonary infection in 3 patients,granulation tissue hyperplasia in distal tra-cheostomy tube in 2 patients,drinking bucking induced by recurrent laryngeal nerve injury after anterior cervical fusion in 1 patient and psychologic factor in 1 patient. Decannulation failure occurred in 2 patients and one received tracheostomy again and was discharged with the tracheostomy tubes,the other one died of acute respiratory failure. Conclusion Self-designed indication for decannulation may guide the time of removing the tracheostomy tubes safely for patients with cervical spinal cord injury after tracheostomy. Repeated pulmonary infection is the main cause of delayed and failed decannulation. Incidence rates of tracheal stenosis and tracheomalacia are low,but the complications may be life threatening,which should be given much more attention.%目的:探讨颈脊髓损伤患者气管切开术后拔管指征及延迟、失败的原因。方法对我科收治的63例气管

  11. 气管腺样囊性癌表皮生长因子受体基因突变的检测%Detection of epidermal growth factor receptor in tracheal adenoid cystic carcinoma

    Institute of Scientific and Technical Information of China (English)

    李冬妹; 王洪武

    2014-01-01

    目的 了解气管腺样囊性癌肿瘤组织表皮生长因子受体(EGFR) 18、19、20、21位点基因突变情况,为气管腺样囊性癌的分子靶向治疗奠定基础.方法 将自2004年至2013年在煤炭总医院经气管镜下取出的气管腺样囊性癌共36例蜡块标本,提取肿瘤细胞DNA,采用ARMS法进行EGFR18、19、20、21位点基因突变检测.采用Fisher精确概率法比较两组之间阳性率的差别.P<0.05为差异有统计学意义.结果 36例气管腺样囊性癌蜡块包埋标本中,EGFR基因突变阳性率为31% (11/36).14%(5/36)存在双突变(19外显子缺失突变及21外显子突变),0%(0/36)出现EGFR基因20外显子突变.临床分期为Ⅳ期的标本EGFR基因突变率为63%(5/8),临床分期为Ⅱ~Ⅲ期的标本中EGFR基因突变率为21%(6/28),两组间有明显差异(P<0.05).结论 气管腺样囊性癌EGFR基因突变率介于肺腺癌与鳞癌之间.气管腺样囊性癌EGFR基因突变在已有血行转移的患者中阳性率明显高于无血行转移者,晚期气管腺样囊性癌患者可能从EGFR-酪氨酸激酶抑制剂治疗中获益.%Objective To investigate the status of epidermal growth factor receptor (EGFR) gene mutations in exon 18,19,20,and 21 in tracheal adenoid cystic carcinoma,to experimentally explore the potentiality of molecularly targeted therapy in this disease.Methods The tumor cell DNA was harvested for EGFR gene mutation detection in exon 18,19,20,and 21 by ARMS method,which was extracted from paraffin embedded bronchoscopic biopsy specimens in 36 patients with adenoid cystic carcinoma at Meitan General Hospital from 2004 to 2013.The difference of mutation rate between groups was compared using Fisher's exact probability test.P <0.05 was considered as statistical significance.Results The gene mutation rate of EGFR was 31% (11/36) in the 36 paraffin embedded specimens of tracheal adenoid cystic carcinoma.Among them,14% (5/36) expressed double mutation

  12. Lesão brônquica e pneumotórax após reintubação usando um cateter para troca da via aérea Lesión brónquica y neumotórax posterior a la reintubación usando un catéter para el cambio de la vía aérea Bronchial injury and pneumothorax after reintubation using an airway exchange catheter

    Directory of Open Access Journals (Sweden)

    Juliano P. de Almeida

    2013-02-01

    pneumothorax caused by a bronchial perforation during a reintubation using an airway exchange catheter (AEC in a patient with a head and neck cancer. CASE REPORT: A 53 year old man with oropharynx carcinoma was admitted to ICU for severe pneumonia and severe acute respiratory distress syndrome (ARDS. The patient was recognized as a difficult-to-intubate patient and an endotracheal tube (ETT was inserted through a bronchoscope. After one week of treatment, it was observed an endotracheal cuff perforation. Exchanging the endotracheal tube was necessary to achieve satisfactory pulmonary ventilation. An AEC Cook 14 was used to perform the reintubation. After reintubation, the patient presented a worsening in oxygen saturation and a chest radiography (CXR revealed a large pneumothorax. A chest tube was inserted and we observed immediate improvement in oxygen saturation. A repeat CXR confirmed correct positioning of the chest tube and reexpansion of the right lung. A bronchoscopy performed showed a posterior laceration in the right main bronchus. The patient was extubated the following day. After four days, the chest tube was removed. A CXR performed a day after chest tube removal revealed a small right upper pneumothorax, but the patient remained asymptomatic. CONCLUSIONS: Airway exchange catheter is a valuable tool to handle with difficult-to-intubate patients. Although the physicians generally focus their attention in avoid barotrauma - caused by oxygen supplement or jet ventilation through AEC - concern for insertion technique can minimize life threatening complications and increase the safety of AEC.