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PubMed1992

Comparison of nebulized and sprayed topical anaesthesia for fibreoptic bronchoscopy.

We compared the efficacy of nebulized (N) and sprayed (S) topical anaesthesia prior to fibreoptic bronchoscopy in a blinded study involving 54 patients aged 57 +/- 26 yrs (mean +/- SD). Cough frequency, recorded on cassette tape, was the index of efficacy. All patients received 100 mg lignocaine sprayed into the pharynx, or nebulized in random order prior to bronchoscopy, and all received intravenous diazepam sedation. Each patient received a further 100 mg of lignocaine solution through the bronchoscope onto the vocal cords and major airways during the procedure. No significant difference was found in overall cough frequency between N and S groups (8.7 +/- 6.9 coughs.min-1 N vs 10.5 +/- 6.0 S), and cough frequency was also similar between N and S during the periods above and below the vocal cords. Furthermore, no differences were found in cough frequency between N and S among smokers, patients with asthma and COPD, and patients who had a biopsy procedure, although a trend was seen in all comparisons towards a lower cough frequency with the nebulized route. Most patients in the S group found the spray unpleasant, whereas only one in the N group complained. We conclude that nebulized and sprayed lignocaine have similar efficacy as topical anaesthetics in fibreoptic bronchoscopy, but patient preference favours the nebulized route.

Administration, Intranasal↗
PubMed2003

[Survey of bronchoscopy in the Pulmonology Centers of the Upper Silesian region in 2002. Part I. Doctor and patient].

The aim of the study is to present the up-to-date data concerning bronchoscopy in the Silesian region in the year 2002. The study was performed as a survey. The survey was mailed to all the 18 pulmonological centres in the silesian region. Questions included in the survey, were divided into three groups: Doctor, Patient, Performance. This article, which is the first part of the analysis, presents data concerning doctors and patients. We conclude, on the ground of the collected data, that there are differences in performing bronchoscopy in the analysed centres. It may result from the fact, that the practice is often guided by personal experience and some drugs and diagnostic procedures are not equally available. It seems to be necessary to perform prospective clinical studies in order to indicate the optimal procedures in bronchoscopy.

Attitude of Health Personnel↗
PubMed2003

[Survey of bronchoscopy in the Pulmonology Centers of the Upper Silesian region in 2002. Part II. Performance].

The aim of the study is to present the up-to-date data concerning bronchoscopy in the Silesian region in the year 2002. The study was performed as a survey. The survey was mailed to all the 18 pulmonological centres in the silesian region. The questions included in the survey, were divided into three groups: Doctor, Patient, Performance. This article, which is the second part of the analysis, presents data concerning the Performance. We conclude, on the ground of the collected data, that there are differences in performing bronchoscopy in the analysed centres. It may result from the fact, that the practice is often guided by personal experience and some drugs and diagnostic procedures are not equally available. It seems to be necessary to perform prospective clinical studies in order to indicate the optimal procedures in bronchoscopy. One should also recommend to work up up-to-date instructions for the postgraduate training in the fields of bronchology.

Bronchoscopy↗
PubMed2003

[The value of fiberoptic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis].

Although mycobacterial culture positivity is the gold standard for the diagnosis, the initial approach to the diagnosis of pulmonary tuberculosis (PTbc) is the detection of acid-fast bacilli (AFB) in respiratory specimens as recommended by the World Health Organization. But the physicians have to make a decision for the patients whose sputum smears are negative or who can not produce sputum. Waiting for culture results with radiological follow up or empirical antituberculous therapy are the standard options. In our study we aimed to assess the diagnostic yield of fiberoptic bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. Fifty six patients who suspected to have PTbc with sputum smear negative were enrolled in the study (fiberoptic bronchoscopy and selective bronchial washings were done to all patients. Bronchial washings were obtained from the affected parts). Mucosal biopsies were done in patients in where endobronchial abnormalities were noted. Transbronchial biopsies were done in selected patients from the radiological localizations. Ziehl-Nielsen staining and culture in Löwenstein-Jensen medium were the microbiological studies. Typical granulomas were expected to detect on histopathologic examination. Bronchoscopic lavage smears were positive for Mycobacterium tuberculosis in 13 (23%) patients. Twenty eight (50%) patients had positive culture. Histopathological results confirmed tuberculosis in eight of 20 patients who had undergone mucosal biopsies, four of seven of transbronchial biopsies, two of three of needle aspiration biopsies. By bronchoscopic procedures early diagnosis was performed in 27 (48.21%) patients. We concluded that fiberoptic bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. It is useful and necessary in selected cases.

Adolescent↗
PubMed2004

[Virtual bronchoscopy for follow-up investigation of main airway stenoses].

The aim of the study was to compare the utility and effectivity of conventional and virtual bronchoscopy in the follow up of patients with main airway stenosis. 23 patients with trachea or main bronchi stenosis were enrolled in the study. The causes of the stenosis were malignant or benign tumor, struma and stent. The stenoses were evaluated before and after the different interventions (i.e. mechanical dilatation, laser photocoagulation, stent implantation, radiotherapy, chemotherapy or surgical resection.) The mean time between the first and second endoscopic and virtual bronchoscopic examinations was 140 days. The authors found good correlation between bronchofiberoscopy and virtual bronchoscopy findings. The data of virtual bronchoscopy were more exact. Based on this study the virtual bronchocopy can replace the traditional invasive method to follow-up patients with main airway stenosis.

Adult↗
PubMed2004

[Bronchoscopy: new diagnostic and therapeutic technology, new indications].

Over the last few years developments have been concentrated on the diagnostic and therapeutic properties of bronchoscopy. Autofluorescence and fluorescence bronchoscopy significantly enhance the detection rate of premalignant and early neoplastic endobronchial lesions. Unfortunately, this technique is hampered by a low specificity. Endobronchial ultrasound examination is the first tool that has enabled the bronchoscopist to get an impression of the tracheal wall beyond its epithelial surface including the mediastinal and the hilar structures. Currently, the complexity of the procedure prevents its widespread application. Intervention bronchoscopy involves mechanical and laser removal of processes that may impede the central airways. Electrocauterization and laser dissection are regularly used to remove intrabronchial tumour depositions. Airway stenting is indicated if there are stenoses caused by compression from abnormalities located externally to the airways.

Bronchial Diseases↗
PubMed2004

[Our experience using autofluorescence bronchoscopy].

INTRODUCTION: Lung cancer is responsible for most cancer deaths in the world. The main reason for the poor prognosis is late diagnosis. Many patients could be successfully treated in early stage. AIMS: The authors performed 369 bronchological examination on 336 patients using autofluorescence bronchoscopy between 1998 and 2003 to detect preinvasive lesions and early forms of lung cancer. METHODS: Storz D-Light autofluorescence system has been used to perform the examinations. RESULTS: In one third of these patients invasive lung cancer developed during follow-up. Combining traditional white light and autofluorescence technique 50% more intraepithelial lesions have been observed and sensitivity has been increased by 69% compared to the lone use of white light bronchoscopy. CONCLUSIONS: Supported by most international studies these results emphasise that autofluorescence bronchoscopy has a major role in the early diagnosis of preinvasive bronchial lesions and may help in the prevention and early therapy of lung cancer.

Bronchial Neoplasms↗
PubMed2004

[Usefulness of flexible bronchoscopy for aspiration of foods into the tracheobronchial trees in 2 patients with severe motor and intellectual disabilities].

Two patients with severe motor and intellectual disabilities who suffered from acute asphyxia and respiratory failure due to aspiration of foods into the tracheobronchial trees were reported. Numerous food particles were found in the tracheobronchial trees of both the patients. One patient showed recurrent atelectasis at various sites. After oral intubation, flexible bronchoscopy could successfully remove food particles from the tracheobronchial trees in both the patients without any complications. A rigid bronchoscope is usually recommended for removal of foreign bodies from the airways in children. However, it is difficult to use in patients with severe motor and intellectual disabilities, because their airway may show deformation or the aspirated foods may enter the peripheral bronchi. Our cases suggest that flexible bronchoscopy can be useful for removing foreign bodies from the tracheobronchial trees in neurologically handicapped patients for whom rigid bronchoscopy can not be applied.

Acute Disease↗
PubMed2004

[Lung cancer with ground glass opacity diagnosed by transbronchial lung biopsy using an ultrathin bronchoscope and virtual bronchoscopy].

Although thoracic computed tomography (CT) screening indicated that there are many patients who have pulmonary shadow with ground glass opacity, it is sometimes difficult to obtain the appropriate specimens for histological diagnosis of such patients. We herein report a lung cancer patient with ground glass opacity who was diagnosed preoperatively by an ultrathin bronchoscope and virtual bronchoscopy. A 78-year-old female was admitted to our hospital due to bacterial pneumonia. At the admission, CT showed another abnormal small shadow in her right middle lobe. Since the shadow was not visible by fluoroscopy, we reconstructed the images of virtual bronchoscopy using the data obtained by multidetector CT. The location of the shadow was determined in the peripheral area of a dorsal branch of right B4aialpha. Then the transbronchial lung biopsy using an ultrathin bronchoscope with simultaneous CT guidance was performed. The histological findings of the biopsy specimens revealed that the shadow was highly suspicious for malignancy. Therefore, the right middle lobectomy was conducted, and the tumor was diagnosed as an adenocarcinoma. An ultrathin bronchoscope with virtual bronchoscopy is useful to diagnose a pulmonary shadow with ground glass opacity.

Aged↗
PubMed2004

[The role of bronchoscopy in examination and treatment of esophageal tumours].

The role of bronchoscopy in examination and treatment of esophageal tumours. The esophageal tumours are diagnosed in many cases in inoperable stage, and if a surgical resolution is possible, it's a heroic, great operation with high mortality rates and poor results. The involvement of great airways should be explored preoperatively by imaging methods, but bronchoscopy is also mandatory. The authors report their one year's experience of 121 bronchoscopic examinations in esophageal cancer patients. The finding was negative in 40.5% of all examinations, and 29.7% was concerned the cancer propagation to bronchial system. 29.8% of all examinations resulted a suspicion of propagation. The opinion of bronchologist can be decisive postoperatively if a fistula is suspected, or after an esophageal stent implantation airway symptoms occur. Bronchoscopy is a standard method for removal of airway excretion. The author's overview is comparing their fifteen years experience with international literature.

Adult↗
PubMed2005

Low mutational rate of K-ras codon 12 in singular bronchoscopy specimens in suspected lung cancer.

Mutations of the K-ras gene are found in a subset of non-small- cell lung carcinomas (NSCLC). The aim of our study was to determine the K-ras codon 12 mutation in the first, singular bronchoscopy specimen in parallel with the cytological examination for the diagnosis of lung cancer. Samples were obtained by diagnostic bronchoscopy in 140 patients with suspected lung tumors. The analysis of K-ras mutations was carried out by a sensitive two-step mutation- enriched polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. This method has been confirmed earlier to be positive for mutated tumor cells and negative for normal lung parenchyma and bronchus. Of the 140 patients with suspected cancer, 93 were diagnosed as NSCLC by cytology or histology in either the same specimen used for the detection of K-ras mutation or in later biopsies. However, only four K-ras codon 12 mutations were detected in the first bronchoscopic material: one in adenocarcinoma, two in squamous cell tumors, and one mutation was found in a patient with dysplasia which was diagnosed later as a squamous cell carcinoma. Our findings indicate that although the K-ras (codon 12) mutation is a gene lesion infrequently detectable in a singular specimen taken at the first bronchoscopy examination in cases of clinically suspected lung cancer, the detection of this mutation can help to confirm the cytological diagnosis of NSCLC or may be even diagnostic in cytologically negative cases.

Adult↗
PubMed2005

Detection of cancerous endobronchial lesions by autofluorescence bronchoscopy combined with mutation analysis of p53.

Early lung cancer screening failed to reduce lung cancer mortality. New techniques such as autofluorescence bronchoscopy (AF) and the identification of specific genetic alteration might change future outcomes of lung cancer screening. It was the aim of our study to combine p53 analysis with white-light bronchoscopy (WL) or WL and AF to improve the diagnostic yield in a series of 36 patients with histologically proven lung cancer, pulmonary metastasis or suspected lung cancer. - Endobronchial sites were analysed by WL (n = 71), AF (Storz) (n = 34), histopathology (n = 71) and p53 mutations were examined by SSCP analysis on additional biopsies (n = 69). The overall frequency of cancerous lesions was 19, of which 14 were macroscopically visible lesions. The addition of p53 and autofluorescence improved the yield to 17 of 19 cases. In 7 preinvasive lesions (dysplasia/metaplasia) 4 were identified macroscopically and 5 of 7 lesions by all 3 methods. In the WL/p53 group the diagnostic yield was 7 of 9 cancerous lesions compared to 10 of 10 cancerous lesions in the AF group. It should be noted that all methods were associated with false positive results. However, the combination of conventional with autofluorescence bronchoscopy and mutation analysis is a promising approach which is applicable to clinical routine and may be further enhanced by the inclusion of a panel of markers of tumour progression.

Bronchoscopy↗
PubMed2006

Evaluation of the efficacy of nebulised lignocaine as adjunctive local anaesthesia for fibreoptic bronchoscopy: a randomised, placebo-controlled study.

Optimisation of topical anaesthesia for flexible fibreoptic bronchoscopy (FOB) is becoming increasingly important as a wider range of more complex, and thereby more prolonged, interventional endoscopic procedures are becoming available. Lignocaine is the most commonly used topical anaesthetic agent for bronchoscopy, but there is variability in current practice as to its optimum mode of administration. In this prospective, randomised, placebo-controlled, blinded study, we examine whether there was enhanced effectiveness of additional nebulised lignocaine as compared to our current regime utilising two visual analogue scales as markers of efficacy. Treatment groups were matched in terms of age (p = 0.39), gender, concomitant sedation (p = 0.51 midazolam; p = 0.12 fentanyl) and dose of background administered lignocaine (290 mg). We found no significant additional differences between any of the treatment groups in terms of general ease of procedure (p = 0.09) or in cough severity (p = 0.12). We conclude that this study does not support the hypothesis that additional nebulised lignocaine confers any additional benefit to the ease of procedure or cough severity in patients undergoing fibreoptic bronchoscopy. We suggest that preparation regimes for bronchoscopic examinations need optimization.

Administration, Inhalation↗
PubMed2006

[Bronchoscopy in the diagnosis of lung cancer: an evaluation of current practice].

INTRODUCTION: Bronchoscopy is frequently practised by respiratory physicians, particularly when there is a suspicion of lung cancer. However, few guidelines are available and practice varies widely. BACKGROUND: Studies of current practice are few and unstandardised. Few data are available regarding equipment or procedure (information, prior investigations, environment, standardised reporting etc.). The evaluation of new techniques such as endobronchial ultrasound, autofluorescence bronchoscopy, transbronchial needle aspiration (TBNA) has been covered in recent publications. These evaluations are often undertaken without rigourous methodology (retrospective studies) but underline the feasibility of these techniques. Some, especially TBNA are nevertheless underused in practice. In the published studies evaluating practice the results of these investigations are often similar to those obtained in clinical trials even if a learning period is necessary. Complications are rare. Few studies of cost effectiveness are available but they support the use of these new techniques. VIEWPOINT: A national study under the aegis of the SLPF (French Respiratory Society) is necessary to obtain comprehensive and reliable data on the practice of bronchoscopy in the investigation of lung cancer. CONCLUSIONS: Studies evaluating current practices are few and unstandardised, and probably give only a partial survey of the success achieved and the difficulties encountered by respiratory physicians in their clinical routine.

Bronchoscopy↗
PubMedDate not supplied

Role of bronchoscopy in early diagnosis of lung cancer.

Lung cancer is a leading cause of cancer deaths and the incidence is rising. Most patients with lung cancer present to the clinician in a fairly advanced stage and at best only 25-30% of patients can be offered curative resection. Screening tests using sputum cytology and chest radiograph have been used with limited success. Value of low dose spiral CT scan as screening tool for lung cancer is being evaluated and its limitations include high costs, need for repeated scanning and necessity to obtain histological confirmation with additional procedures. There have been significant advances in the early diagnosis of lung cancer in high risk patient groups using bronchoscopic methods such as white light bronchoscopy, autofluorescence bronchoscopy, high magnification bronchoscopy, narrow band imaging and endobronchial ultrasound. These techniques appear to be promising tools as they might allow to visualise changes of early lung cancer and also permit sampling for histological confirmation.

Bronchoscopy↗
PubMed1991

Comparative study of midazolam and diazepam in premedication of bronchoscopy.

Two types of benzodiazepines were used in premedication of flexible bronchoscopy. The agents were introduced in randomized, double-blind trial. Midazolam (Dormicum Hoffmann-La Roche AG) was given to 21 patients (0.07 mg/kg i.v.), diazepam (Seduxen Richter) to 22 patients (0.14 mg/kg i.v.) and placebo (saline) to 20 patients (0.07 ml/kg i.v.). Vigility, motor functions and anxiety were estimated from the application to 3 hours after endoscopy. Breathing, pulse rate, blood pressure and local reactions were followed as well. The course of bronchoscopy, anterograde amnesia and acceptability of further intervention were evaluated. Midazolam offered short term action, stronger sedative and anxiolytic effect than diazepam (48% to 27%). The anterograde amnesia was more frequent (90.5% to 55% in diazepam), acceptability of further bronchoscopy after midazolam was present in 95% of patients, after diazepam in 86% of patients. These favourable properties can be utilized especially in cases with enhanced anxiety and necessity of further endoscopies.

Adult↗
PubMedDate not supplied

Cryptogenic hemoptysis: role of fiberoptic bronchoscopy.

Fiberoptic bronchoscopy (FOB) was performed for recurrent hemoptysis in 79 patients with normal chest roentgenograms. Seventy per cent were females with a mean age of 31.93 years. Normal findings were obtained in 60 patients. In 19 patients with abnormal findings on bronchoscopy underlying malignant disease was discovered in 3 patients following bronchoscopy. All these patients were elderly male smokers. In three patients unexplained left recurrent laryngeal nerve palsy was discovered. Thus, FOB as a diagnostic aid for cryptogenic hemoptysis is useful only in elderly male smokers.

Adult↗
PubMedDate not supplied

[The role of bronchoscopy with a flexible bronchoscope in the diagnosis of pulmonary tuberculosis].

Bronchoscopy with flexible bronchoscope has been proved as a useful method that has been applied also in the diagnostics of pulmonary tuberculosis during the recent years. In order to evaluate its role and use at the Institute for Diseases of the Chest and Tuberculosis Golnik documentation of 51 patients treated during 1985 and 1986 was surveyed. Prior to the examination from all patients the sputum on Mycobacterium tuberculosis was obtained at least three times and it was negative. Aspirations were obtained from 40 patients and the diagnosis was confirmed in 21 patients by recovery from tubercle bacilli specimens (52.5%). Transbronchial biopsy was performed in 34 patients and it was positive in 27 (79.4%), out of them in 7 patients the biopsy sample of the lungs was bacteriologically (38.9%) and in 23 patients histologically positive (67.6%). By bronchoscopy with flexible bronchoscope the final diagnosis was confirmed in 40 patients (78.4%). Bronchoscopy with flexible bronchoscope as well as transbronchial biopsy have proved to be a successful method in the diagnostics of active pulmonary tuberculosis. It should be used in patients in whom the sputum smear for acid fast bacilli were frequently negative yet there is a suspicion of pulmonary tuberculosis.

Adolescent↗