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At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Bronchoscopic management of airway obstruction in pediatric endobronchial tuberculosis.

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

Bronchial Diseases↗
PubMedDate not supplied

Serum concentration of D-dimers as a marker of the activation of the fibrinolytic system in patients undergoing bronchoscopic and thoracoscopic investigations.

BACKGROUND: Hypercoagulability is common even after minimally invasive surgical techniques and is pathogenetically linked to postoperative thrombotic and cardiac complications. The activation of the coagulation and fibrinolytic systems after bronchoscopic and thoracoscopic investigations has not yet been elucidated. OBJECTIVE: The aim of our study was to evaluate whether bronchoscopic and thoracoscopic investigations activate the fibrinolytic system. METHODS: This study assessed cross-linked fibrinogen degradation products (D-dimer) in 120 patients after bronchoscopy with and without biopsies and/or bronchoalveolar lavage and after thoracoscopy with biopsies of the parietal pleura. RESULTS: Both bronchoscopy and thoracoscopy induced a minor but significant increase in D-dimers in most patients, reversible mostly within 24 h. In rare cases, distinct increases lasting at least 24 h occurred. CONCLUSIONS: The slight and temporary increase in serum D-dimers induced by bronchoscopy and thoracoscopy is nonsignificant in most patients; however, in some cases, the coagulation/fibrinolytic systems may become markedly activated.

Antifibrinolytic Agents↗
PubMed2005

Bronchoscopic surfactant administration in pediatric patients with persistent lobar atelectasis.

Persistent lobar atelectasis in pediatric patients on mechanical ventilation results in impaired gas exchange and lung mechanics and contributes to a further need for mechanical ventilation. The most common types of atelectasis in children are resorption atelectasis following airway obstruction, and atelectasis due to surfactant deficiency or dysfunction. We aimed to determine whether bronchoscopic suctioning and surfactant application to atelectatic lung segments would result in improved oxygenation, ventilation, chest X-ray scoring, and early extubation. Five children with heterogeneous lung diseases (aged between 7 months and 15 years) were treated with a diluted surfactant preparation (Curosurf) in a concentration of 5-10 mg/ml (total dose 120-240 mg) which was instilled into the affected segments. Outcome parameters were gas exchange, radiographic resolution of atelectasis and extubation. All mechanically ventilated patients could be extubated within 24 h following the intervention. Bronchoscopic surfactant application could be carried out without adverse effects and brought improvements in oxygenation, respiratory rate, and partial or complete resolution of atelectases without recurrence.

Adolescent↗
PubMed1997

50 endobronchial tuberculosis cases based on bronchoscopic diagnosis.

Endobronchial tuberculosis (ETB) is most often a complication of primary pulmonary tuberculosis in children, although it may also occur in adults. Bronchoscopically, mass lesion (polypoid and ulcerous granuloma), submucosal infiltration and fibrostenosis may usually be seen. 50 ETB cases were diagnosed by bronchial biopsy, bronchial fine needle aspiration and washing. Bronchoscopically, mass lesions were found in 31 cases (62%), 21 (42%) of which were ulcerous granulomas and 10 (20%) polypoid mass, while 11 (22%) cases were of submucosal infiltrative appearance, 16 (32%) fibrostenosis and 5 (10%) hyperaemia and oedema. The diagnosis could be made in 42 cases with bronchial biopsy, whereas only in 8 cases with bronchial fine needle aspiration. Statistically, therefore, the bronchial biopsy was found to be significantly more advantageous as compared to the other diagnostic methods for the diagnosis of ETB (p < 0.0001).

Adolescent↗
PubMed1996

Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis.

The present study was performed on 10 patients with severe adult respiratory distress syndrome (ARDS), all suffering from sepsis (mean lung injury score [LIS] (1): 3.25 +/- 0.1; duration of mechanical ventilation upon study entry: 3.1 +/- 0.6 d). Ex vivo analysis of the alveolar surfactant system, obtained by bronchoalveolar lavage (BAL), showed severe impairment of surfactant function. Three hundred milligrams of natural surfactant/kg body weight (Alveofact) was delivered bronchoscopically in separate doses to each segment of both lungs. This caused an immediate increase in PaO2/FlO2 from 85 +/- 7 mm Hg to 200 +/- 20 mm Hg (p < 0.001), mainly due to a decrease in shunt flow (42 +/- 4 to 20 +/- 2% [p < 0.001]). Reanalysis of the alveolar surfactant showed that its function was significantly improved. In five patients the increase in arterial oxygenation was partially lost within the next few hours, and a second dose of 200 mg/kg surfactant was applied 18 to 24 h later, again increasing PaO2/FlO2 values. Eight patients survived the subsequent 14-d observation period with progressive improvement of gas exchange, and five patients were definitely weaned from the respirator. All fatalities were due to non-respiratory causes. We conclude that the bronchoscopic application of a high dose of surfactant aimed at overcoming inhibitory factors in the alveolar space of these patients, may offer a feasible and safe approach to improving gas exchange in severe ARDS.

Adolescent↗
PubMed2001

Bronchoscopic volume reduction: a safe and effective alternative to surgical therapy for emphysema.

Lung volume reduction surgery (LVRS), the removal of damaged, hyperexpanded lung, has been shown to improve respiratory function in many patients with end-stage emphysema. We report the results of an animal study using a new transbronchoscopic alternative to LVRS in which a washout solution and fibrin-based glue are used to collapse, seal, and scar target regions of abnormal lung. Twelve sheep had static and dynamic lung functions measured at baseline. Emphysema was produced by inhaled papain (7,000 U/wk x 4 wk), resulting in a significant increase of lung volumes, compliance, and airway resistance. The animals were then divided into three treatment groups of four animals, and underwent surgical volume reduction (SVR), bronchoscopic volume reduction (BVR), or bronchoscopy alone (Sham-BVR). Response to each intervention was assessed 8 to 12 wk after treatment by measuring lung function and examining lung tissue. BVR and SVR groups responded with significant and similar decreases in TLC and residual volume (RV). Tissue examination demonstrated that BVR caused collapse of the lung with focal scarring in 11 of 20 target territories (55% success rate). Three of the 11 target zones developed sterile abscesses. Postprocedure complications were less frequent with BVR than with SVR. This pilot study suggests that lung volume reduction can be achieved in animals without surgery using a bronchoscopic approach and a novel fibrin-based glue system. BVR has the potential for simplifying volume reduction, extending indications, and reducing morbidity, mortality, and costs in humans.

Animals↗
PubMed2003

Recruitment of antigen-specific Th1-like responses to the human lung following bronchoscopic segmental challenge with purified protein derivative of Mycobacterium tuberculosis.

Although the mechanisms of specific immunity to Mycobacterium tuberculosis in humans are poorly understood, responses of Th1-like CD4+ T cells appear to be essential for protection. We hypothesized that healthy individuals displaying positive skin-test responses to purified protein derivative of M. tuberculosis (PPD) would have the capacity to mobilize M. tuberculosis-specific Th1 cells to the lung in response to bronchoscopic challenge with PPD. Local instillation of 0.5 tuberculin units of PPD was followed 48 h subsequently by bronchoalveolar lavage (BAL) of PPD-challenged and control segments. In PPD-positive subjects, PPD challenge resulted in a 2.7-fold increase in total BAL cells and in an increase in the percentage of lymphocytes in BAL from 10 to 19%. The BAL lymphocytosis observed in PPD-challenged segments was characterized by an increased percentage of CD4+ T cells and by increased numbers of cells capable of antigen-specific interferon-gamma production. In contrast, PPD-negative subjects did not develop local inflammation following PPD challenge. These findings indicate that bronchoscopic challenge with PPD results in recruitment of antigen-specific recall responses to the lung. This novel approach may be useful in clarifying the basis of local immunity against M. tuberculosis, and could serve more generally as a model of the development of Th1-like responses in the human lung.

Adult↗
PubMedDate not supplied

Bronchoscopic cryotherapy.

Bronchoscopic cryotherapy of localized endobronchial tumors can be applied in selected patients who are not candidate for other traditional therapy. Twenty-eight patients were treated on 60 occasions with a closed liquid nitrogen system and a long insulated probe that was specifically designed to be used through an open ventilating bronchoscope. The conditions of 15 patients (54%) was improved, as judged by local tumor control, decreased bleeding, or improved airway patency. Fatal complications that could be ascribed to cryotherapy occurred in 2 of the 60 treatments (3%). Two patients have experienced complete control of squamous cell cancers four years and five years nine months after cryotherapy.

Aged↗
PubMedDate not supplied

Bronchoscopic limited lavage for cystic fibrosis patients. An adjunct to therapy.

Bronchoscopic aspiration of the tracheobronchial tree in patients with cystic fibrosis is a controversial procedure. Results of therapy are difficult to evaluate. Many different techniques have been described, adding to the confusion. Our experience using limited lavage with 4% acetylcysteine and saline have been most gratifying in 114 procedures at the Children's Hospital Medical Center of Akron, Ohio. Each was performed under general anesthesia using the rigid bronchoscope. There were no deaths. Timing of the procedure and patient selection are partially subjective. The most impressive results have been improved pulmonary compliance and improved quality of life in the patient. Details of the procedure, techniques of anesthesia, and results of therapy are presented.

Adolescent↗
PubMed1989

Low frequency oscillatory ventilation through the suction channel of a pediatric bronchoscope.

To determine whether low frequency oscillatory ventilation (LFOV) may be safely applied through the suction channel of a pediatric fiberoptic bronchoscope, we devised a system using a combination of jet ventilation and constant air suction, both delivered with a single interface valve. The system was tested on an in vitro lung model and on rabbits. With tidal volumes of 12 mL, inadvertent increase in functional residual capacity (FRC) measured in the lung model was minimal. All rabbits experienced marked hypoventilation (PaCO2 62 +/- 2 torr) on introduction of the bronchoscope, which promptly improved with administration of LFOV (PaCO2 41 +/- 4 torr). That baseline FRC remained stable indicated that air trapping did not occur. We conclude that LFOV improves ventilation in rabbits during bronchoscopy without causing air trapping. A similar system might be applied during bronchoscopy in full-term and premature infants, thus facilitating safer and more complete visualization of their airways and preserving the possibility of obtaining samples by suction.

Animals↗
PubMedDate not supplied

Cytofluorimetric evaluation of DNA ploidy in lung cancer: a bronchoscopic study.

The study of the biological characteristics of lung cancer is gaining more and more interest both because of their potential role as prognostic indicators and for therapeutic reasons. The DNA content estimated by flow cytometry in surgical samples of non-small cell lung cancer (NSCLC) has already been demonstrated to be correlated with survival in these patients. From July 1990 to February 1992 we analyzed the DNA distribution of bronchoscopic biopsies from 88 patients with lung cancer (18 small cell lung cancer, SCLC, and 68 NSCLC, two unspecified histology). Twenty-eight tumors (34.6%) had a diploid DNA distribution, while 53 were aneuploid (65.4%). A correlation was found between DNA ploidy and survival. Evaluation of the DNA content in bronchoscopic samples in a large series of patients could determine the role of this analysis prior to surgery in NSCLC and its value as a marker with respect to prognosis and response to therapy in SCLC.

Aged↗
PubMedDate not supplied

Bronchoscopic cryotherapy: preliminary experience.

Our preliminary experience with the bronchoscopic application of cryotherapy using rapid decompression of liquid nitrous oxide as cooling agent is reported. Seventeen applications through rigid bronchoscopy in twelve patients were performed. A single cryotherapy session was successful in the debulking of obstructive malignant lesions of the central airways in five patients (four non-small cell carcinoma, one renal cell cancer metastasis), and in the treatment of a capillary haemangioma (one patient). Two sessions were successful in the treatment of a metastatic melanoma (one patient) and benign granulation tissue (one patient). Cryotherapy was also successful in the treatment of early bronchial cancer (carcinoma in situ) in four patients, requiring repetitive sessions in two. There were no complications or side-effects. These preliminary findings confirm the safety and efficacy of bronchoscopic cryotherapy in a variety of airway lesions.

Adult↗
PubMed1996

"Blind" protected specimen brushing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia.

The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL). We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n = 24) and without antibiotic pretreatment (n = 64), and into those with (n = 78) and without (n = 10) right lower lobe infiltrates on chest radiography. No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively. We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

Biopsy↗
PubMed1997

Bronchoscopic diagnosis of sarcoidosis.

Transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA) of mediastinal lymph nodes and bronchoalveolar lavage (BAL) are routinely performed at fibreoptic bronchoscopy. Up to the present time, no data have been available on the efficacy of performing all three of these procedures simultaneously in the bronchoscopic work-up of sarcoidosis. A prospective study was undertaken to compare the diagnostic yield from TBLB, TBNA and BAL in patients presenting with clinical and radiological features typical of sarcoidosis. Thirteen consecutive patients with clinical and radiological features consistent with stage I and II sarcoidosis underwent bronchoscopy with TBLB, TBNA and BAL. Noncaseating granulomata (stain and culture negative for tuberculosis bacilli and fungi) were found in seven of the 13 patients by TBLB, and in six of the 13 patients by TBNA (of which four patients had negative TBLB). Eight of the 13 patients had classical "sarcoid" BAL findings, i.e. >12% lymphocytes, and high CD4+:CD8+ lymphocyte ratio. Combining TBLB, TBNA and BAL gave a diagnostic sensitivity of 100% (12 out of 12 patients) for sarcoidosis. The remaining patient had nondiagnostic bronchoscopic studies and mediastinoscopy biopsy showed a non-Hodgkin's lymphoma. Our data suggest that performing simultaneous transbronchial lung biopsy, transbronchial needle aspiration and bronchoalveolar lavage produces optimal results in the diagnosis of sarcoidosis.

Biopsy, Needle↗
PubMed1977

Alternative uses for the flexible fiberoptic bronchoscope in otolaryngology.

Currently there are many fiberoptic instruments available to the otolaryngologist. These include, in addition to the rigid endoscopes, the fiberoptic headlight, cable, indirect laryngoscope, nasopharyngoscope, flexible laryngoscope, flexible esophagoscope and flexible bronchoscope. Each possesses a certain unique characteristic to aid the otolaryngologist. For several of these, there are certain alternative uses. The purpose of this report is to discuss additional uses for the flexible fiberoptic bronchoscope in relation to the head and neck as it is the most versatile instrument.

Aged↗
PubMed1985

Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea.

There have been conflicting reports in our literature concerning the efficacy of bronchoscopic carbon dioxide laser surgery for the treatment of benign strictures of the trachea. We have examined our experience in the management of this disease over a 2 1/2-year period; in all cases, our initial management was performed utilizing the rigid, ventilating bronchoscope with the universal endoscopic coupler and carbon dioxide laser. Eight of 14 patients were successfully managed in this study; retrospective analysis of our results revealed that the presence of one or more of the following four factors was extremely important in predicting an unfavorable prognosis of patients with tracheal stenosis managed endoscopically with the carbon dioxide laser: 1. loss of cartilaginous support; 2. stenosis length greater than 1 cm; 3. circumferential scarring; and 4. carinal involvement.

Adolescent↗
PubMed1989

Bronchoscopic brachytherapy.

Increasing lung cancer mortality has created renewed interest in the bronchoscopic use of isotopes for palliation of recurrent airway carcinomas. In the first part of this paper we report our clinical experience with iodine-125 implantation for treatment of endobronchial carcinomas in 18 patients followed until death. Symptoms of cough, hemoptysis, and dyspnea were most effectively relieved with tumors limited to the bronchial lumen. Contraindications to this procedure include extensive extrabronchial tumors causing airway compression and severe debility. In the second part of this paper the development of a new isotope delivery system designed to overcome technical difficulties experienced in the treatment of some patients with interstitial iodine 125 is described. An isotope capsule was constructed to permit insertion and removal by means of a fiberoptic bronchoscope. This device was successfully tested in animals and is now approved for clinical trials. It represents a unique, new modality for treatment of superficial, multifocal, and less-advanced recurrent bronchogenic carcinomas.

Aged↗
PubMed1991

Bronchoscopic and roentgenographic correlates of a positive transbronchial needle aspiration in the staging of lung cancer.

A study was conducted to determine the bronchoscopic and chest roentgenographic findings associated with a positive TBNA. One hundred fifty-seven of 465 patients who were diagnosed for the first time as having carcinoma of the lung had a positive aspirate. Bronchoscopic findings associated with a positive TBNA of N2 nodes were carinal widening and endobronchial disease, especially of the right upper lobe. Mediastinal adenopathy noted on chest roentgenograms and subcarinal nodes on CAT scans were associated with a positive aspirate as well. In 34 of 465 patients, TBNA was the only means of establishing the diagnosis of pulmonary malignancy. A useful, simple and safe procedure, TBNA can be used to stage the mediastinum in patients with lung cancer and is most likely to be positive with endobronchial and nodal disease. It can also facilitate therapeutic decision-making in patients whose surgical candidacy is marginal.

Biopsy, Needle↗