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At least 541 records · Page 30Linked to original sources
PubMed1990

Computed tomography and bronchoscopy in chest radiographically occult main-stem neoplasm diagnosis and Nd-YAG laser treatment in 8 patients.

We studied 8 adult patients with variable symptoms of cough, dyspnea, stridor, wheezing, or hemoptysis. Fiberoptic bronchoscopy in all showed complete or nearly complete endobronchial obstruction of a main-stem bronchus by neoplasm with a mean bronchial diameter of 1.9 mm +/- 1.6 mm (mean +/- standard deviation). In 4 patients, a lobar bronchus was also completely obstructed. No mass was visible on chest radiographs of any patient; however, computed tomography in each showed main-stem endobronchial obstruction, lobar obstruction (4 instances in 3 patients), and in 6 patients hypoperfusion of the involved lung. Computed tomographic scan showed additional abnormalities that were unsuspected on viewing chest radiographs or at bronchoscopy, including mediastinal adenopathy in 3 patients and an extraluminal tumor component in 4. After therapy with Nd-YAG laser, main-stem airway diameter increased to a mean of 9.6 mm +/- 1.0 mm (P less than .05) and pulmonary functions improved. Results suggest the complementary role of computed tomography and fiberoptic bronchoscopy in the detection and laser-treatment planning of chest radiographically occult severe neoplastic obstruction of the main-stem bronchus.

Bronchial Neoplasms↗
PubMed1990

[Is bronchoscopy a useful additional preoperative examination in esophageal carcinoma?].

Between 1980 and 1987 95 patients with esophageal carcinoma had a bronchoscopy. In 67 patients (70.5%) no pathological findings could be detected. In 24 patients (25.3%) signs of impingement were present and in 4 patients (4.2%) tumor infiltration into the tracheobronchial tree was visible. The correlation between tumor length and bronchoscopic findings revealed a marked increase of direct and indirect tumor evidence in esophageal carcinomas of more than 5 cm in length. Pathologic bronchoscopic findings were detected twice as often in patients with carcinoma of the upper third of the esophagus in comparison with those of the middle third. In 5 patients (5.3%) bronchoscopy revealed an unknown additional bronchial carcinoma. 67 of the 95 patients underwent operation. In 59 patients the esophagus was resected. Among the normal bronchoscopic findings the operability rate was 77.6%. In contrast, only half of the patients with pathological bronchoscopic findings were operable, the other patients received radiotherapy. We recommend, therefore, preoperative bronchoscopy as an important investigation for assessment of operability and for evaluation of synchronous neoplasms in patients with an esophageal carcinoma.

Adenocarcinoma↗
PubMed1990

[Methodology and effectiveness of bronchoscopy with polychromatic analysis in patients with pulmonary tuberculosis and sarcoidosis].

A procedure of polychromatic analysis (PA) was improved by using light filter occular attachments. In 154 patients, including those with pulmonary tuberculosis (101) and sarcoidosis (53), a diagnostic effectiveness of a traditional bronchoscopy is compared to that with PA, including morphoendoscopic comparison. As against traditional bronchoscopy, PA made it possible to find out in 34.8% an additional number of non-specific endobronchitis cases accompanying pulmonary tuberculosis, and at the same time to approach in 90.2% an endoscopic diagnosis to a pathomorphologic one. In several patients the authors managed to additionally distinguish by means of PA infiltrative bronchial tuberculosis of tuberous type. In pulmonary sarcoidosis the use of PA also allowed to increase a diagnostic effectiveness of the traditional bronchoscopy.

Adolescent↗
PubMed1990

[The value of fiberoptic bronchoscopy in diagnosis of HIV associated infections].

32 patients with HIV infection presenting with fever or abnormal chest radiograph or both were investigated at the University Hospital of Mainz (FRG). Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was undertaken in each patient, additionally other methods were used for isolating pathogens (i.e. urine sample, stool and blood culture etc.). In 26 patients one or more complicating diseases were documented, in six persons no reason for fever or pulmonary symptoms could be detected. 21 patients had a pulmonary complication, 13 were found to have pneumocystis carinii pneumonia. Bacterial lung diseases were diagnosed in seven individuals (three caused by M. tuberculosis, two by S. pneumoniae, one by E. cloacae and one by S. aureus). One nonspecific interstitial pneumonitis was diagnosed. By other diagnostic procedures 25 non-pulmonary complications were established. -Fiberoptic bronchoscopy is most accurate for the detection of pulmonary pathogens in HIV infected persons when transbronchial biopsy and bronchoalveolar lavage is combined, especially in pneumocystis carinii pneumonia. Bronchoscopy should be performed also if the chest radiograph is normal.

Adolescent↗
PubMed1990

[Pulse oximetry during fiberoptic bronchoscopy under local anesthesia].

Pulse oximetry during fiberoptic bronchoscopy in local anaesthesia was performed in 81 patients (52 male, 29 female), median age 60 years (range 25-80); 18 had impaired lung function with FEV1 less than 50%. Premedication consisted of atropine, diazepam and midazolam. The arterial haemoglobin oxygenation (SaO2) was registered continuously. Supplementary oxygen in doses of 2 1/min was administered to 41 patients (group 1), while 40 patients were examined without oxygen (group 2). The two groups were comparable as regards sex, age and lung function. Mean values of SaO2 during bronchoscopy were higher in group 1 (median 96%) than in group 2 (92%) (p less than 0.001). Minimum values of SaO2 were similarly higher in group 1 (median 93%) than in group 2 (87%) (p less than 0.001). The percentage numbers of patients experiencing hypoxaemic episodes with SaO2 less than or equal to 90% and SaO2 less than or equal to 85% were 34% and 5% in group 1 compared to 80% and 35% in group 2, respectively (p less than 0.01). The decrease in SaO2 and the frequency of hypoxaemic episodes were highest in patients with impaired lung function. Supplementary oxygen in doses of 2-3 1/min and pulse oximetry are recommended as routine procedures during fiberoptic bronchoscopy in local anaesthesia.

Adult↗
PubMed1989

[Benefits of bronchoscopy in hemoptysis and normal pulmonary X-rays in patients over 40 years of age].

Opinion has been divided as to the benefit of bronchoscopy in cases of haemoptysis but normal chest radiograms. In this study such patients were compared with a reference group of haemoptysis patients with X-ray changes. Of the former group 44 underwent bronchoscopy, but after a follow-up of 57 months malignancy has been found in only one case, as compared with a malignancy rate of 47 per cent in the reference group. Thus it is concluded that bronchoscopy is to be recommended in cases of haemoptysis and X-ray changes, whereas non-invasive investigation should suffice in patients under 40 years of age and without X-ray changes, though the risk of malignancy increases with age, particularly in smokers and ex-smokers.

Adult↗
PubMed1988

[Monitoring of bronchoscopy in artificially ventilated patients using peripheral pulse oximetry--a useful monitoring method?].

In the present study, flexible bronchoscopy was monitored by means of peripheral pulse oximetry in 62 artificially ventilated patients of a surgical intensive-care ward. The study was designed to establish whether falls of arterial oxygen saturation due to bronchoscopy can be detected at an early stage and whether they can possibly be influenced by an appropriate investigation technique. 270 comparative measurements of hemoglobin oxygen saturation were carried out; the oxygen saturation directly measured in the arterial blood served as reference value. The statistical analysis revealed a correlation of r = 0.85. In ten patients, there was an impairment of respiratory function and hypoxemia due to bronchoscopy. In all cases, this could be detected in good time from the fall of oxygen saturation. Pulmonary impairment was partially prevented or further impairment was avoided by an appropriate technique of investigation.

Adolescent↗
PubMed1986

[Premedication in fiber optic bronchoscopy from the patient's and the physician's viewpoint--a randomized study for the comparison of midazolam and hydrocodone].

To evaluate side effects and patients' assessment of fiberoptic bronchoscopy under local anesthesia, 122 consecutive patients answered questions from an outside interviewer (an experienced psychiatrist) and not from the endoscopists themselves. The effect of premedication with midazolam (5 mg i.m.) and hydrocodonum (15 mg i.m.) was compared in a randomized study. In a multiple choice questionnaire 68% of all patients indicated considerable fear in the days before bronchoscopy. They were more afraid of the possible diagnosis of cancer (23%) than of dyspnea or asphyxiation (14%). Coughing is considered the worst side effect of bronchoscopy by 25% of patients (36% of the endoscopists) followed by dyspnea during insertion of the scope (21%) and discomfort during local anesthesia. Although the patients premedicated with midazolam are more sedated (p = 0.025 by physicians' assessment vs. p = 0.11 in patients' view), they cough more (p = 0.001 vs. p = 0.22) and usually tolerate the examination less well (p = 0.009 vs. p = 0.08) than patients premedicated with hydrocodonum. 42% of patients premedicated with midazolam had anterograde amnesia. Although they did not remember all the unpleasant side effects, only 77% said they would repeat the procedure with the same premedication, compared with 90% of patients premedicated with hydrocodonum (p = 0.08). Before and two hours after premedication the reaction times had not changed (optical sign, Wiener reaction device) and were identical in the two patient groups. At that time 37% of the patients premedicated with midazolam and 27% of those premedicated with hydrocodonum were still sleepy and could not be regarded as fit for any form of travel.

Adult↗
PubMed1985

High-frequency jet ventilation during bronchoscopy in a dog.

A dog with severe pulmonary disease caused by Filaroides osleri (Oslerus osleri) infection was anesthetized with thiopental sodium IV for diagnostic bronchoscopy. The dog was ventilated continuously during bronchoscopy with a high-frequency jet ventilator (using a rate of 100 breaths/min, drive pressure of 20 psi, and inspiratory fraction of 0.30). High-frequency jet ventilation provided satisfactory ventilatory support during bronchoscopy despite the dog's pulmonary disease.

Animals↗
PubMed1983

A double-blind controlled study comparing temazepam with papaveretum as premedication for fibreoptic bronchoscopy.

One hundred patients undergoing routine fibreoptic bronchoscopy were randomly allocated to receive premedication with either intramuscular papaveretum or oral temazepam in a double-blind manner. They all received atropine before and oxygen during the procedure. Patients found the drugs equally acceptable in terms of discomfort, anxiety and the possibility of repeat bronchoscopy, but more had recall of the procedure with papaveretum. There was no difference in secretions, coughing, relaxation and consciousness, as assessed by the bronchoscopist, but patients who had received papaveretum were more cooperative. Arterial blood gases were performed before and 45 minutes after bronchoscopy. Those given papaveretum had a significant fall in mean arterial oxygen tension of 0.96 kPa, while there was no significant change in the temazepam group. There was also a small mean rise in arterial carbon dioxide tension in both groups, with the mean rise in the papaveretum group (0.625 kPa) being significantly higher than the temazepam group (0.2 kPa). Premedication with temazepam is a useful alternative to papaveretum and has the advantage of oral administration and causing less respiratory depression.

Anti-Anxiety Agents↗
PubMed1984

Local anesthetic techniques for bronchoscopies.

Local anesthetic techniques are often preferable to general anesthesia for bronchoscopies since these examinations are mostly undertaken as outpatient procedures. To be successful bronchoscopy under local anesthesia must satisfy three criteria: the technique used must produce adequate anesthesia: the procedure must be safe: and the technique should be easy for the patient as well as for the physician. Local anesthesia of the respiratory tract for these procedures can be achieved by laryngotracheal spraying or ultrasonic nebulizer administration of lidocaine. For fiberoscopic procedures lidocaine can also be administered through the fiberoscope. When the local anesthetic techniques are supplemented with light sedation, the procedure is easier and more acceptable to the patients. Using small doses of diazepam, flunitrazepam, or midazolam i.v. one can produce amnesia for the procedure and still discharge the patients 2 h after the procedure with a responsible adult. In many cases local anesthesia supplemented by intravenous sedation is a proper alternative and should be preferred to general anesthesia in ambulatory practice for diagnostic bronchoscopies.

Anesthesia, Local↗
PubMed1984

[How bothersome is fiber bronchoscopy under local anesthesia?].

All the 79 (7.4%) complications of 1066 fiberoptic bronchoscopies performed under standardized topical anaesthesia in in- and outpatients were analyzed retrospectively. With the 4.9 mm bronchoscope the transnasal route was possible in all cases, and with the 6.0 mm bronchoscope in 92%. There were no deaths and no major complications, with the exception of one tension-pneumothorax, one pneumonia, one pulmonary edema and one 500 ml hemorrhage. The most frequent complications were minor hemorrhages (4.1%) which occurred mainly after biopsies and were rarely recognized by the patients. laryngospasms (1.5%) and bronchospasms (1.4%). The rate of complications was higher in patients with a FEV1 of less than 60% predicted (p = 0.02) and in patients with a pO2 below 50 mm Hg (p = 0.06). We recommend the administration of oxygen during fiberoptic bronchoscopy. Fever within 36 hours after bronchoscopy was observed in 12% and subsided without antibiotic therapy. In the light of these risks, patients should be informed prior to the procedure of the possible occurrence of shortness of breath, hemorrhage and fever.

Adult↗
PubMed1984

[Bronchoscopy in the diagnosis of complicated pulmonary hydatid cyst in children].

The diagnosis of pulmonary hydatid cysts in children is generally easy and does not require endoscopic exploration, because the radiological aspects of an intact or a complicated cyst are most often suggestive. There are, nevertheless, some cases of pulmonary hydatids where the cyst is partially evacuated and then infected, whose radiological image is atypical showing parenchymatous opacities (systematised or not) which are readily associated with adenopathy. Usually immunology fails to aid the clinician in this later stage in the cyst's evolution. Two recent cases are reported of Tunisian children aged 5 and 10 years old with chronic pulmonary opacities posing a diagnostic problem. One child presented with a persistent cough, the other with recurrent haemoptysis and both had negative immunology. Bronchoscopy enabled a positive diagnosis to be made in both cases by showing the presence of an intra-bronchial membrane. A simultaneous bronchogram showed an arrest of the contrast in the affected bronchial segment. Although non specific, this image of arrested contrast should in our opinion be discussed in the differential diagnosis when the membrane could not be seen at bronchoscopy. At operation surgery confirmed the retention of infected membrane but in our two children infection had led to the destruction of a lower lobe which was removed. These situations where the diagnosis of pulmonary hydatids is difficult are far from being rare in countries of hgh endemiology such as Tunisia. Our observations show the advantage of bronchoscopy, which sometimes enable one to see or to remove a fragment of the membrane and thus entrust the child to a surgeon with a definitive diagnosis.

Bronchoscopy↗
PubMed1978

Fiberoptic bronchoscopy. Comparison of procedures used in the diagnosis of lung cancer.

We have compared the relative value of various techniques used in association with fiberoptic bronchoscopy for the diagnosis of lung cancer. We analyzed the results in 114 patients who underwent diagnostic fiberoptic bronchoscopy and in whom a definite histologic diagnosis of lung cancer was made. A comparison of the diagnostic yield from cytologic examination of prebronchoscopy and postbronchoscopy sputum and of fiberoptic bronchial biopsy, brushing, and washing was made. Over-all, bronchial washings gave the highest diagnostic yield (75.4%) and forceps biopsy the next higher (65.8%). The combination of bronchial washings and forceps biopsy gave the highest diagnostic yield (95.8%). In six patients, postbronchoscopy sputum was the only source of positive diagnostis; in 20 patients only one procedure was positive. Our results suggest that although fiberoptic bronchoscopy washings and forceps biopsy have the highest diagnostic yield, brushings and postbronchoscopic sputum examination are also important diagnostic maneuvers and should be routinely performed.

Biopsy↗
PubMed1982

Increases in diagnostic yield of fiberoptic bronchoscopy by fluoroscopy.

Fiberoptic bronchoscopy was performed in 46 patients in the evaluation of pulmonary lesions. Twenty-five of the patients had lung cancer; the remainder had benign lesions. Definitive diagnosis was established in all patients by a combination of forceps biopsy, brush biopsy, bronchial aspiration, and post-bronchoscopy sputum studies. All endoscopically visible lesions were diagnosed by forceps biopsy. Fluoroscopic localization of biopsy forceps and brush made the yield in peripheral, nonvisualized lesions almost equal to that of more central lesions. Fluoroscopic control markedly increases the diagnostic yield in fiberoptic bronchoscopy.

Adult↗
PubMed1980

Atenolol pretreatment in fiberoptic bronchoscopy. Effect on cardiac arrhythmias, heart rate and arterial blood pressure.

Fifty one patients undergoing fiberoptic bronchoscopy were premedicated with atropine and anesthetised with thiopental, nitrous oxide and succinylcholine as a muscle relaxant. Twenty-six patients consisted the control group while twenty-five were given alcohol orally for three consecutive days before the procedure. The treatment group had no cardiac arrhythmias during bronchoscopy while six of the control subjects developed arrhythmias. Heart rate and mean arterial pressure were maintained significantly lower in the treatment group, thus the hypertensive response to tracheal intubation and bronchoscopy was significantly attenuated by atenolol.

Aged↗
PubMed1981

[Diagnostic value of fiberoptic bronchoscopy in pneumopathies in immunodeficient adults: a report on 59 examinations (author's transl)].

Fifty-nine fiberoptic examinations with endobronchial sampling, brushings, distal bronchial biopsy, and alveolar lavage were conducted during the course of recent pneumopathies in immunodeficient adults with malignant hemopathies (41 cases), solid tumors (7 cases), and other affections (11 cases). Diagnosis was established by fiberoptic bronchoscopy in 4 cases with specific locations of hemopathy or cancer, after bronchial biopsy, in 5 cases of mycoses, after bronchial biopsy, aspiration and/or alveolar lavage, in 4 patients with bacterial pneumonia after bronchial aspiration, and in 1 case of pneumocystosis, after distal biopsy. Diagnosis was not confirmed in the other cases. Mortality (50 p. cent) was similar in the diagnosed group and the group without confirmation of diagnosis. No significant complications due to the examination were observed, except for worsening of the respiratory condition in 7 patients with hypoxemia. The role of fiberoptic bronchoscopy in causing these alterations cannot be excluded. Fiberoptic bronchoscopy appears to be a safe examination except in patients with hypoxemia (PaO2 less than or equal to 50 mmHg). Distal biopsy appeared to be of less value than bronchial biopsy in these patients, as there was a positive correlation between the results of the latter examination and the macroscopic lesions observed in all cases.

Adult↗