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PubMedDate not supplied

Bronchoscopic imaging of pulmonary mucosal vasculature responses to inflammatory mediators.

In current clinical practice, the initial stage in the detection of pulmonary airway disease is the clinician's interpretation of a bronchoscopy procedure. Due to the nature of this form of detection, diseases are often well advanced upon discovery. This paper proposes a new method for examining the pulmonary airway microcirculatory system via fluorescein imaging techniques similar to those used extensively in ophthalmology. Through the use of a specialized bronchoscopy imaging system we are able to successfully show that fluorescein emission detected in the rabbit trachea exhibits a clear response to inflammatory mediators and thus to changing local vascularity. The clinical implications of this technique are extensive including most importantly the potential use as an evaluation tool for pulmonary disease evaluation and likely other endoscopically accessible organs.

Animals↗
PubMed1991

Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncontaminated distal airway secretions.

We tested the effectiveness of protected bronchoalveolar lavage (PBAL), performed through a protected transbronchoscopic balloon-tipped (PBT) catheter, in collecting distal airway secretions with a minimal degree of contamination. The PBAL had less than or equal to 1% squamous epithelial cells in 91% of specimens and an absence of bacterial growth in 59% of patients without pneumonia. Using a threshold of 10(4) cfu/ml we had one false positive result in 33 patient without pneumonia and one false negative in 13 patients with pneumonia. Quantitative bacterial cultures of the PBAL specimens had a diagnostic sensitivity of 97% and a specificity of 92%, with a positive predictive value of 97% and a negative predictive value of 92%. The diagnostic efficiency was 96%. The presence of intracellular organisms in much greater than or equal to 2% of the recovered alveolar cells (Giemsa stain) was seen in all but two patients with pneumonia (on corticosteroids) and in none of the patients without pneumonia. Gram stains of the PBAL specimens were positive in all but one patient with pneumonia and negative in all but one patient without infection (patient with endobronchial narrowing secondary to neoplasm with false positive cultures). Either the Giemsa or the Gram stain was positive in all patients with pneumonia, allowing early and accurate diagnosis of lower respiratory tract infection before the results of cultures were available. The time off antibiotic therapy before bronchoscopy did not affect the result of PBAL cultures, contrary to what we observed for the protected brush specimen.

Anti-Bacterial Agents↗
PubMedDate not supplied

Acute upper airway obstruction in infants and children. Evaluation by the fiberoptic bronchoscope.

All infants and children seen by the pediatric pulmonary service who display symptoms of upper airway obstruction undergo transnasal fiberoptic evaluation with the 3.2 mm flexible instrument. The procedure enables the observer to immediately visualize the nasopharynx, supraglottic, glottic and subglottic structures. Instrumentation is done in the sitting upright position and takes the skilled observer about 20 seconds to perform. The differentiation of epiglottitis from subglottic croup, foreign body aspiration and other less common causes of airway obstruction is easily performed and well tolerated. The fiberoptic instrument is often utilized both as a diagnostic and therapeutic tool. It can be utilized to intubate cases of epiglottitis and to evaluate the epiglottis to determine the appropriate time for extubation. This procedure is superior to oral airway examination because it does not distort airway anatomy, can be performed in the upright position, and does not further exacerbate airway obstruction.

Adolescent↗