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At least 541 records · Page 30Linked to original sources
PubMed1992

Tracheobronchial obstruction from esophageal carcinoma: bronchoscopic treatment with neodymium: yttrium-aluminum-garnet laser.

Tracheobronchial obstruction resulting from esophageal carcinoma is uncommon. Patients with advanced esophageal carcinoma with tracheobronchial obstruction usually present with severe dyspnea or hemoptysis or both and may die of suffocation. The Lahey Clinic experience using laser bronchoscopy for the palliation of symptoms of airway obstruction in patients with esophageal carcinoma is presented. From 1982 to 1990, nine patients were treated in 13 procedures using the neodymium: yttrium-aluminum-garnet laser. Of the patients, seven had undergone previous treatment of the primary tumor. Tumors were located in the trachea in seven patients and in the main stem bronchi in three patients. Improvement of the airway caliber was achieved in all patients with relief of the dyspnea. The mean hospital stay was 2 days. One patient lived 4 years after laser treatment with no recurrence of tumor, and one patient died 1 week after treatment as a result of his poor general condition. The rest of the patients lived 3 to 41 weeks, with a median survival of 35 weeks. No complications were related to the procedures, and in particular, no tracheoesophageal fistulas developed. Our experience indicates that bronchoscopic application of this laser in conjunction with other treatment modalities can improve the quality and duration of life in selected patients with esophageal carcinoma that invades and obstructs the trachea.

Aged↗
PubMed1986

Anesthesia for bronchoscopic laser surgery.

Choice of anesthesia for bronchoscopic laser surgery depends on the surgical technique. Fiberoptic bronchoscopy can be managed with either topical or general anesthesia, while rigid bronchoscopy usually requires general anesthesia. In either case precautions for laser surgery must be taken. Preoperative evaluations should include cardiovascular status and the anatomy of the lesion. Preoperative medication should include an anticholinergic agent. The influence of total intravenous vs. inhaled anesthetics on prolonged respiratory depression is discussed, and the techniques for providing controlled vs. spontaneous respiration are described. Finally, postoperative care, including the management of airway obstruction and hemorrhage, is outlined.

Anesthesia↗
PubMed2002

Non-bronchoscopic bronchoalveolar lavage in the microbiological diagnosis of pneumonia in mechanically ventilated patients.

A prospective study comparing standardized non-bronchoscopic bronchoalveolar lavage (sNB-BAL) and non-specific endotracheal aspirate (NsETA) in the microbiological diagnosis of pneumonia in mechanically ventilated patients is described. One hundred episodes in 82 mechanically ventilated patients with or without radiological and clinical diagnostic criteria of pneumonia were studied. NsETA and sNB-BAL was performed on the day of study. Fifty-one patients had pneumonia (21 ventilator-associated, 12 hospital-acquired, 18 community-acquired) and 49 had no pneumonia as defined by widely accepted clinico-radiological criteria. The sNB-BAL was found to be significantly more specific (0. 73) compared to NsETA (0.35) for the microbiological diagnosis of pneumonia. Colonization rates with NsETA were significantly higher compared to sNB-BAL (P value <0.0001). No patient had complications attributable to the sNB-BAL procedure. We conlude that sNB-BAL is a safe, effective, sensitive, specific and inexpensive procedure for the serial evaluation of pneumonia in mechanically ventilated patients.

Adolescent↗
PubMed2003

Is bronchoscopic photodynamic therapy a therapeutic option in lung cancer?

This study addresses whether photodynamic therapy (PDT) is a valid therapeutic option in lung cancer treatment. A total of 24 articles were reviewed in two categories: advanced (G1) and early (G2) disease. Details considered included the following: 1) number of patients in each series; 2) staging; 3) methodology; 4) mortality; 5) morbidity; 6) survival; 7) relief of symptoms; and 8) concomitant treatments. G1 (636 patients) had severe endobronchial obstructive cancer and PDT was primarily for symptom relief. G2 (517 patients) had early stage cancer and were treated with PDT for curative intent. There was no procedure-related mortality in either group. G1 had a 5-28% incidence of skin sensitivity. Haemoptysis occurred in two series; one fatal, an incidence of 2.2%. Almost all patients had symptomatic relief. Patients with lower disease stage and better performance status had improved survival rates. G2 had a 8-28% incidence of sunburn. Three patients in one series (38 patients) had haemoptysis. Survival after 5 yrs in complete remission/response patients was 70%. This review suggests that bronchoscopic photodynamic therapy has indications in selected lung cancer patients with early or advanced stage disease. However, in the absence of a formal comparative study, no claim can be made of its superiority over other endobronchial therapies.

Bronchoscopy↗
PubMed1997

Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study.

In contrast to the healthy population, distal airway bacterial colonization may occur in patients with chronic lung diseases, who often have altered pulmonary defences. However, the information dealing with this issue is insufficient and is based mainly on nonspecific samples, such as sputum cultures. Using quantitative cultures of bronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) samples, we studied the bacterial colonization of distal airways in 16 healthy subjects, 33 patients with bronchogenic carcinoma, 18 with chronic obstructive pulmonary disease (COPD), 17 with bronchiectasis, and 32 with a long-term tracheostomy due to laryngeal carcinoma. All patients were without exacerbation, and free from antibiotic treatment at least 1 month before the study protocol. Thresholds for quantitative cultures to define colonization were > or = 10(2) colony-forming units (cfu) x mL(-1) for PSB and > or = 10(3) cfu x mL(-1) for BAL. Only one healthy subject was colonized by a potential pathogenic microorganism (PPM) (Staphylococcus aureus 4x10(2) cfu x mL(-1) in a PSB culture). Colonization was observed in 14 (42%) bronchogenic carcinoma patients (19 non-PPMs, and 10 PPMs); in 15 (83%) COPD patients (22 non-PPMs and 7 PPMs); in 15 (88%) bronchiectasis patients (20 non-PPMs and 13 PPMs); and in 15 (47%) long-term tracheostomy patients (5 non-PPMs and 13 PPMs). The two most frequent non-PPMs isolated in all groups studied were Streptococcus viridans and Neisseria spp. Haemophilus spp., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were the most frequent PPMs isolated in bronchogenic carcinoma, COPD, bronchiectasis and long-term tracheostomized patients, respectively. Pseudomonas aeruginosa colonization was infrequent in all the groups. Our results show that distal airway bacterial colonization is a frequent feature in stable patients with chronic lung diseases and also in patients with long-term tracheostomy. However, the pattern of colonization differs among groups studied. The knowledge of different colonization patterns may be important for future antibiotic prophylactic strategies and for the empirical antibiotic regimens when exacerbations occur in these patients.

Adult↗
PubMed1981

Laryngoscopy in neonates and infants: experience with the flexible fiberoptic bronchoscope.

A small flexible fiberoptic bronchoscope was used for laryngeal examination in a series of neonates and infants; 104 laryngoscopies were performed in 59 patients. A high yield of diagnostic information was obtained in both postextubation patients and patients presenting with upper airway obstruction. No major complications were observed. This technique is useful in the evaluation of neonates and infants with potential upper airway problems.

Airway Obstruction↗
PubMed2000

Bronchoscopic needle aspiration biopsy.

Bronchoscopic needle aspiration biopsy, which encompasses transbronchial needle aspiration, transtracheal needle aspiration, and endobronchial needle aspiration, is a minimally invasive technique used to diagnose mediastinal and pulmonary masses and to stage lung cancer patients with mediastinal lymphadenopathy. Since it is safe, accurate, and potentially cost-efficient, its use may increase in the coming years. It is important that pathologists who examine cytology specimens understand this procedure, its limitations, and ways that it may be optimized.

Biopsy, Needle↗
PubMed1991

Closure of a tracheoesophageal fistula by bronchoscopic application of fibrin glue and decontamination of the oral cavity.

A tracheoesophageal fistula was successfully closed with a fibrin adhesive applied by means of a fiberoptic bronchoscope, instead of by esophagoscopy. To facilitate closure of the fistula, the technique was combined with decontamination of the oral cavity, to avoid bacterial contamination. The procedure is proposed as an alternative to surgery for critically ill patients.

Administration, Topical↗
PubMed1992

Pseudoepidemic of nontuberculous mycobacteria due to a contaminated bronchoscope cleaning machine. Report of an outbreak and review of the literature.

We describe a pseudoepidemic due to nontuberculous mycobacteria contaminating the water tank of a machine used to clean and disinfect fiberoptic endoscopes. Forty-six bronchoscopies performed on 41 patients during a six-month period yielded 16 specimens positive for acid-fast bacilli (AFB). One specimen showed Mycobacterium avium complex from an AIDS patient and one, M tuberculosis from a patient with active cavitary tuberculosis. In four patients, only the smears showed AFB; subsequent cultures remained negative. Of the rest, seven contained M chelonae and three M gordonae, all in patients with no clinical signs of mycobacterial disease. Two of the three M gordonae isolates represented laboratory contamination from an antimicrobial solution in a culture medium. Four patients in the beginning of the pseudoepidemic were treated for presumed tuberculosis until negative culture results were available. Control of the "outbreak" was achieved by regular disinfection of the implicated water tank in the cleaning machine. Contamination of bronchoscopes with nontuberculous mycobacteria can lead to unnecessary diagnostic and therapeutic interventions.

Bronchoscopy↗
PubMed1993

Serial fiberoptic bronchoscopic observations of endobronchial tuberculosis before and early after antituberculosis chemotherapy.

STUDY OBJECTIVE: To evaluate the antituberculous treatment responsiveness of endobronchial tuberculosis in the different stages of evolution. DESIGN: A prospective study before and after trial with 9 months of antituberculosis chemotherapy without steroid. PATIENTS AND INTERVENTION: One hundred thirty-six endobronchial lesions in 62 patients were subdivided into four types according to initial fiberoptic bronchoscopic (FOB) findings. Follow-up FOB was performed in 29 patients with 56 endobronchial lesions to detect the changes in the initial endobronchial lesion and bronchostenosis within 3 months after completion of 9 months of chemotherapy. RESULTS: The endobronchial lesions could be classified into four types: exudative (59 lesions, 43.3 percent), ulcerative (13 lesions, 9.7 percent), cicatricial (36 lesions, 26.5 percent), and bronchoglandular (28 lesions, 20.5 percent). In the reassessment of 56 lesions, all 19 exudative and all 9 ulcerative lesions showed complete improvement. Of the cicatricial lesions, most (10 of 12 lesions) showed no change in bronchostenosis, whereas 2 lesions showed improvement. In the bronchoglandular lesions, 6 of 18 lesions showed progressed bronchostenosis. Overall, we observed improved responses in 53.6 percent, progressed bronchostenosis in 10.7 percent, and stationary responses in the remaining 35.7 percent. The progressed lesions were found only in the bronchoglandular lesions. CONCLUSION: In the exudative, ulcerative, and cicatricial lesions, the administration of antituberculous chemotherapy alone resulted in favorable responses in the early posttreatment period.

Adolescent↗
PubMed1996

Virtual bronchoscopy. Relationships of virtual reality endobronchial simulations to actual bronchoscopic findings.

Advances in computer technology have permitted development of virtual reality images of the tracheobronchial tree using data sets derived from helical CT of the chest. To determine the relevance of these images to actual bronchoscopic findings, we compared "virtual bronchoscopy" images with videotaped bronchoscopy results in 20 patients who had undergone both helical chest CT and fiberoptic bronchoscopy during clinical evaluation of their thoracic problems. Suboptimal endobronchial simulations in ten patients identified important, readily-addressed technical requirements for this imaging procedure. In the ten patients with technically suitable renderings of the airway, virtual bronchoscopy simulations accurately demonstrated endobronchial obstructions by tumor in five, airway distortion and/or ectasia in four, and accessory bronchi in another. These preliminary observations suggest that virtual bronchoscopy simulations accurately represent major endobronchial anatomic findings. This technique may have a role in prebronchoscopy planning, endoscopy training, and/or endobronchial therapy, and merits further study.

Bronchial Diseases↗
PubMed1996

Bronchoscopic diagnosis of solitary pulmonary nodules and lung masses in the absence of endobronchial abnormality.

To evaluate the individual and additive diagnostic yield(s) of several bronchoscopic sampling techniques for the diagnosis of lung lesions with no corresponding airway abnormalities, consecutive patients with lung nodules or masses were prospectively evaluated between December 1989 and November 1994. A CT of the chest was done in all patients before flexible bronchoscopy (FB). Size, location, and character of the border of the lesion were determined. During FB, using biplane fluoroscopic guidance, the lesion was localized and following sampling techniques were done: brushing, transbronchial lung biopsy (TBLB), and Sofcor transbronchial needle aspiration (STBNA). Bronchial washings (BWs) were collected throughout the procedure. Problems associated with each sampling technique were noted. Forty-nine patients underwent 51 FB. A diagnosis was established by FB in 36 (73%). After a nondiagnostic FB, histologic diagnosis was established in 9 of 13 patients by other methods. A benign or malignant nature of lesion was established in other four patients by clinical follow-up. FB was diagnostic in 32 of 40 (80%) patients with primary lung cancer, in 3 of 6 (50%) patients with benign disease, and in 1 of 3 (33%) patients with metastatic disease to lung. All sampling procedures could be done in 33 of 51 (65%) FBs. Overall diagnostic yields were as follows: BW, 18 of 51 (35%); brush, 25 of 48 (52%); TBLB, 23 of 40 (57%); and STBNA, 19 of 37 (51%). In 12 of 51 (24%) FBs, only one sample was diagnostic. Lesions with sharp borders had a lower combined diagnostic yield, 13 of 24 (54%) compared to lesions with fuzzy borders, 20 of 24 (83%) (p=0.03). Yield of TBLB in lesions with fuzzy borders, 14 of 18 (78%), was higher than the yield for lesions with sharp borders, 6 of 19 (32%) (p=0.005). Size of the lesion in centimeters in patients with a positive FB (4.55+/- 2.35; mean +/-SD) was significantly larger than in patients with a nondiagnostic FB (3.14+/-1.31; mean+/-SD) (p=0.009, t test). Diagnostic yield was directly related to the size of the lesion. For lesions less than 2 cm, yield was 6 of 11 (54%) (p=0.19); for lesions less than 3 cm, yield was 12 of 21 (57%) (p=0.07); and for lesions greater than 3 cm, yield was 24 of 30 (80%). Yield from lesions located in the lower lobe basal segments or the apical segment of upper lobes was lower (11/19, 58%) than that from lesions in other parts of the lung (25/30, 83%) (p=0.05). FB was terminated prior to collecting all samples because of severe bleeding after brushing (n=3) or instability of the patient (n=4). None of the patients required intubation. There were no pneumothoraces. Diagnostic yield of FB depends on the location, size, character of the border of the lesion, and the ability to perform all sampling methods. Brushing, TBLB, and STBNA should be performed in all patients to give the best diagnostic yield. Routine cytologic examination of BW is unnecessary. Methods other than FB should be considered for lesions 2 cm or less in size, especially when they have a sharp border and/or are located in the basal segment of a lower lobe/apical segment of an upper lobe.

Adenocarcinoma↗
PubMed1996

Comparison of quantitative cultures to semiquantitative loop cultures of bronchoscopic protected specimen brush samples.

STUDY OBJECTIVE: To compare quantitative growth from a calibrated loop to growth from the standard serial dilution technique of culturing bronchoscopic protected specimen brush (PSB) samples and to determine the effect of refrigeration of the PSB sample on subsequent quantitative growth. DESIGN: Laboratory stock cultures were sampled with a PSB and cultured by both standard 100-fold serial dilution as well as 1:100 mL and 1:1,000 mL calibrated loops. Stock cultures were also sampled with a PSB and growth before and after refrigeration for 24 h at 4 degrees C (both serial dilution and calibrated loops) was compared. Clinical PSB samples from seven patients suspected of having lower respiratory tract infections were cultured by both techniques as well. SETTING: Clinical research laboratory and teaching hospital. PATIENTS AND INTERVENTIONS: PSB samples from inpatients and outpatients who had clinically indicated bronchoscopy. No interventions. MEASUREMENTS AND RESULTS: Quantitative growth from the 1:1,000 mL calibrated loop was within 1 log10 of growth from the serial dilution technique for 20 of 21 organisms, including 2 yeasts. Except for Haemophilus influenzae (known to be cold intolerant), there were no important differences in growth of bacteria before and after 24 h at 4 degrees C. For quantitative bacterial growth, there was a significant correlation between serial dilution and the 1:1,000 mL loop cultures (r=0.86, p < 0.0001). CONCLUSION: In this study, quantitative growth from a single 1:1,000 mL loop culture of PSB samples was comparable to growth from the standard serial dilution technique. Our results also suggest that overnight refrigeration of PSB samples may be possible in certain clinical situations.

Bacteria↗
PubMed1996

Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction.

Cryotherapy is used for endoscopic management of tracheobronchial obstruction (TBO). This study describes the use of a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen through a fiberoptic bronchoscope. The study group consisted of 22 patients, ages ranging from 28 to 82 years. Twenty patients had malignant TBO and two had bronchial obstruction (BO) following lung transplantation. Benign BO was first dilated with a balloon and followed with cryotherapy. Eighteen of the 20 malignant endobronchial lesions were completely removed. In three of these patients, the airway remained occluded due to extrinsic compression. Cryotherapy offers an alternative to Nd:YAG laser in the management of TBO. Cryotherapy offers other advantages such as being inexpensive, safe for the operator, and safe for other members of the team. Similarly for the patient, there is no danger of bronchial wall perforation or endobronchial fires, cryotherapy can be done under local anesthesia with conscious sedation, and it can be performed in an endoscopy suite.

Adult↗
PubMed1997

Bronchoscopic balloon dilatation in the combined management of postintubation stenosis of the trachea in adults.

Bronchoscopic balloon dilatation (BBD) using angioplasty balloon catheters has been employed successfully in the treatment of tracheobronchial stenoses in children and has worked with variable success in adults with bronchial stenosis. In adults with tracheal stenosis, BBD only has been reported anecdotally. In this study, experience with BBD using a valvuloplasty balloon catheter in the combined treatment (with Nd-YAG laser photoresection and stenting) of severe benign postintubation tracheal stenoses in three adults is delineated. BBD was particularly successful in establishing tracheal patency when laser photoresection was contraindicated or was too dangerous; BBD allowed easy insertion of tracheal stents and the "opening" of folded silicone stents. BBD is a simple, inexpensive, safe, and efficient adjunct in the combined treatment of severe postintubation rigid tracheal stenosis in selected adults.

Adult↗
PubMed2001

Extensive sampling improves preoperative bronchoscopic assessment of airway invasion by supracarinal esophageal cancer: a prospective study in 166 patients.

BACKGROUND: The utility of fiberoptic bronchoscopy in the preoperative assessment of patients with esophageal cancer has not been thoroughly investigated. More accurate staging could improve the design of clinical trials and avoid inappropriate surgical decisions in individual patients. STUDY OBJECTIVE: To evaluate the utility of bronchoscopy in the preoperative assessment of airway invasion by supracarinal esophageal cancer. DESIGN: We prospectively analyzed 220 bronchoscopies in 166 consecutive patients with supracarinal esophageal cancer and correlated the findings with operative results and survival. RESULTS: In 126 bronchoscopies (57.3%), no abnormal findings could be seen in the airways. Compared with histologic and cytologic results, the normal macroscopic appearance of the airways had a negative predictive value of 94.4%, but the positive predictive value of all macroscopic abnormalities for the diagnosis of airway invasion was low, particularly after radiation therapy. Endoluminal tumor mass, protrusion of the posterior tracheal wall, and signs of mucosal invasion were visible in 5.9%, 28.6%, and 4.1% of the bronchoscopies, respectively. However, in only 8.6% of the 220 bronchoscopies, cancer invasion was proved by biopsy or cytology. Bronchoscopy with biopsies and brush and washing cytology examinations was the sole decisive staging procedure, enabling the exclusion from surgery because of airway invasion in 18.1% of otherwise potentially operable patients, with an overall accuracy of 93.3% (95% confidence interval, 86.7 to 97.3%). The results of bronchoscopy were falsely negative in six patients, who all underwent surgery after neoadjuvant therapy. CONCLUSIONS: Fiberoptic bronchoscopy with systematic multiple biopsies and brush and washing cytology examinations is an accurate procedure in evaluating the possible invasion of supracarinal esophageal cancer into the airways. Macroscopic findings alone are not reliable; errors in sole bronchoscopic inspection would have resulted in operations that would be unlikely to help the patients or would have inappropriately excluded patients from surgery.

Adult↗
PubMed2001

Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease: indications and results.

STUDY OBJECTIVES: Bronchoscopic balloon dilatation (BBD) has become a valuable tool in the treatment of benign tracheobronchial stenoses. The objective of this study was to assess indications for and results of fiberoptic BBD in treating malignant lesions. DESIGN: One hundred twenty-six balloon dilatation procedures were performed in 78 patients with predominantly bronchial carcinoma. BBD was only performed when alternative modes of local treatment (eg, laser therapy or stent implantation) were not indicated or were inappropriate. Indications were symptomatic stenoses of the tracheobronchial tree: dyspnea or stridor (52%), retention pneumonia (15%), atelectasis (10%), retention of secretions (21%), or lung abscess (2%). RESULTS: Fifty-five percent of all procedures consisted of dilatations of tracheal or bronchial lesions (group 1). In 22% of procedures, a stent was dilated (group 2). In 13%, BBD was used to facilitate stent placement (group 3), and in 10% to enable the correct positioning of irradiation probes for brachytherapy (group 4). In group 1 and group 2, 2 of 2 lung abscesses resolved, 5 of 8 atelectases resolved, and 11 of 12 retention pneumonias resolved. Dyspnea improved in only 12 of 32 patients. No abscess recurred. Two pneumonias and two atelectases reappeared due to restenosis. Stent implantation and brachytherapy procedures were facilitated in 90% of cases. In 52% of cases, BBD was supported by high-frequency jet ventilation. Complications consisted of one fatal hemoptysis caused by a lacerated pulmonary artery, and minor bleeding not necessitating specific therapy. CONCLUSIONS: Fiberoptic BBD is useful in the management of airway stents prior to and postimplantation, as well as in the placement of brachytherapy catheters. BBD is also successful in the resolution of poststenotic lung abscesses, retention pneumonias, and atelectases.

Adult↗