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Evaluating the records of the Thoracic Endoscopy Unit of the Department of Surgery, University of Chieti, Italy--from November 1987 to November 1991, data related to the use of fiber bronchoscopy in preventing and treating complications after thoracotomy are referred. The usefulness of fiber bronchoscopy as a therapeutic procedure is underlined.
Indications for bronchoscopy, the equipment and technique performance in dogs and cats are presented. The method is invasive, therefore exact indications such as chronic cough of noncardial origin, foreign bodies, parasitic invasion, paralysis of the larynx or tumours are required. Bronchoscopy enables the surgeon to take samples of bronchial discharge.
The techniques of interventional bronchoscopy have acquired an important place in the management of lung cancer. Techniques to relieve obstruction requiring the use of rigid bronchoscopy under general anaesthetic were the first to be introduced. Laser therapy, which was initially used for coagulation can be replaced by electrocautery. The development of endobronchial stents provides a natural complement to techniques aimed at clearing bronchial obstruction by helping to maintain patency in the long term. Other therapeutic techniques can be deployed in association with those already mentioned, including photodynamic therapy and brachytherapy using low doses of radiation applied locally. These have particular potential for the treatment of early disease. Questions remain as to the precise indications for the different techniques and of how to identify which approach is most appropriate for individual patients.
OBJECTIVE: To investigate the application of flexible bronchoscopy in the postoperative management of lung transplantation. METHODS: Four male patients with end-stage chronic obstructive pulmonary disease received examination with bronchoscope following the unilateral lung transplant for management of airway complications. One patient developed stenosis at tracheal anastomosis 2 months after transplantation and underwent balloon dilatation and endobronchial metallic stent placement. RESULTS: The 4 patients showed good recovery after transplantation with obviously improved pulmonary function and quality of life. CONCLUSION: Flexible bronchoscopy provides a valuable means for postoperative management of lung transplantation.
AIM: Autofluorescence bronchoscopy (AFB) has been proposed to widen traditional white light bronchoscopy (WLB) possibilities of early diagnosis of neoplastic and preneoplastic lesions of the tracheo-bronchial mucosa in high risk groups. The authors report their study on AFB with the aim of establishing its role in the early diagnosis of bronchogenic carcinoma and its positive predictive value (PPV) compared and associated to WLB. METHODS: From May 2002 to May 2004 we performed WLB and AFB in 213 patients (177 males, 36 females), mean age 63.7 years (range 18-84 years), who were divided into 2 main groups (group A: patients at risk for bronchogenic carcinoma, n=82; group B: patients to be operated on for bronchogenic carcinoma, n=131). In total, 237 WLB-AFB were performed (101 in group A, 136 in group B) and 77 biopsies for pathological examination. RESULTS: The 2 tools (WLB and AFB) were concordant in 156 (66%) and discordant in 81 (34%) cases. Considering the biopsies performed, we obtained a PPV of 26% for lesions visible with WLB, of 40% for those visible with AFB, of 38% for those visible with the association of both. In group A, in 56 patients of the follow-up subgroup, we found 2 dysplastic areas and 1 carcinoma in situ. In group B there was a discordant extension of the pathologic area visible with WLB and with AFB in 30 cases which was positive in 18 of them at histological examination. CONCLUSIONS: In our experience, AFB has revealed to be a valid tool for both early diagnosis of neoplastic recurrences or a second primary lung neoplasia in patients in follow-up after resection and preoperative evaluation of resection margins in patients candidate to surgery. More studies are needed to widen its indications in the early diagnosis in high risk groups, to improve its potentialities and optimize its learning curve in order to establish the procedural guide lines.
BACKGROUND: This is a prospective study of peri-procedure and post-procedure complications and successful weaning of long-term mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy (PDT). METHODS: Video bronchoscopy guided PDT was performed for long-term mechanically-ventilated patients in a medical intensive care unit (ICU). Peri-procedure and post-procedure complications were prospectively observed and evaluated. The success of weaning and the factors affecting the outcomes of these patients after PDT were also investigated. RESULTS: A total of 107 patients with mechanical ventilation were enrolled. The average duration of trans-laryngeal intubation was 27.8 +/- 18.4 days which was longer than reported in previous studies. There were 70 men and 37 women, all of whom underwent bedside PDT at a medical ICU. The complication rates during and post-procedure were 8.4% and 14%, respectively. The most common complications were desaturation during the procedure and bleeding during the follow-up period. Only one death was procedure related (0.9%). After PDT, 50 patients (46.7%) were successfully weaned from mechanical ventilation. The rate of successful weaning (p = 0.02) increased while the days to achievement (p < 0.001) decreased with decreasing duration of trans-laryngeal intubation. Gender, age, body weight, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of procedure, endotracheal tube diameter and position, and history of self-extubation were not related to successful weaning. CONCLUSIONS: PDT is a bedside procedure with relatively low complication and mortality rates when performed for patients on long-term mechanical ventilation in a medical ICU. The previous duration of trans-laryngeal intubation was an important determinant for successful weaning after PDT.
UNLABELLED: The objective of this pilot project was to devise a new image acquisition and processing technique to produce PET/CT images rendered in 3-dimensional (3D) volume that can then be reviewed in several 3D formats such as virtual bronchoscopy and colonoscopy "fly-throughs" and external "fly-arounds." METHODS: We tested the new imaging and processing protocol on 24 patients with various malignancies to determine whether it could dependably acquire and reformat standard tomographic 2-dimensional PET/CT images into 3D renderings. RESULTS: This new technique added helpful information to the diagnostic interpretation for 2 of the 24 patients. Further, in the 6 patients undergoing mediastinoscopy, bronchoscopy, or endoscopy, 3D imaging helped in preprocedural planning. CONCLUSION: In this initial study, we demonstrated both the feasibility of rendering PET/CT images into 3D volumes and the potential clinical utility of this technique for diagnostic lesion characterization and preprocedural planning.
Over the last 10 years, 53 patients with hemoptysis, but with a normal chest radiograph underwent diagnostic fiberoptic bronchoscopy. Forty-three patients did not show any abnormal findings, the site of bleeding could be localised in five and non-specific mucosal changes were seen in the remaining five patients. Thirty-two patients were followed up clinically for a 3-18 months period. One patient on follow-up developed tubercular pleural effusion. Bronchogenic carcinoma was not detected in any of these patients during the procedure or at follow up. A review of literature revealed a 3 per cent incidence of bronchogenic carcinoma and the risk factors associated with higher incidence were age above 40 years, cigarette smoking and a longer duration of hemoptysis. We conclude that fiberoptic bronchoscopy has little role in this relatively benign condition (hemoptysis) especially when the risk factors are absent.
The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli. Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them. The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them. Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination. Two of the cases had concomitant bronchogenic carcinoma. We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.
Laser bronchoscopy was performed 87 times in 58 patients over a three-year period at Wilkes-Barre General Hospital. Fifty-six patients (97 percent) had malignant disease, including bronchogenic carcinoma (46), metastatic neoplasm to bronchus or lung (eight), or direct extension of esophageal carcinoma (two); benign pathology included tracheal papillomatosis (one) and granulation tissue (one). Eighty-six percent of tumors were proximally located (trachea, carina, mainstem bronchi). A standardized procedure utilizing both rigid and flexible bronchoscopy and the Nd:YAG laser was employed, with two deaths (2.3 percent) and eight complications (9.2 percent). Results were good or excellent in all five patients treated for bleeding and in 68 of 82 patients (83 percent) treated for obstruction. The patient with an obstructing or bleeding endobronchial lesion can achieve palliation through Nd:YAG laser bronchoscopic resection.
Forty-eight patients with primary bronchial carcinomas have been examined, and 41 of these carcinomas (85%) were confirmed by histopathological or cytological tests on samples taken during flexible fiberoptic bronchoscopy. Thirty-seven patients (77%) were diagnosed histopathologically, based on forceps biopsy, and four cases cytologically, based on investigations of bronchial secretions and brush biopsies. In nine of 14 patients with peripheral tumours the diagnosis was verified by flexible fiberoptic bronchoscopy. We find this a very safe and useful method in the early diagnosis of bronchial carcinoma.
A series of 65 broncho-pulmonary TB simulating lung cancer with negative AFB in sputum were diagnosed by fiber-bronchoscopy. 60% of the cases were at the age of forty and over. According to the radiographic features, they could be divided into 3 varieties: (1) 31 cases showed mass or nodal shadow. 7 of the 11 cases with cavities mimicked cancer origin in appearance. (2) 30 cases showed atelectasis and segmental shadows with 16 cases in nonpredisposing location of TB. (3) 4 cases with diffuse interstitial and micronodular shadows were different from miliary TB. Of a total of 65 cases, 7 accompanied with hilar/mediastinum adenopathy. Using fiber-bronchoscopy, bronchial lesions were found in 24 cases (36.9%). TB diagnosed by pathological and bacteriological examination were 89.2% and 32.2% respectively. TB combined with squamous cell cancer of the lung was found in one patient. These data indicated that TBB and TBLB provided an effective method in the differential diagnosis of TB and cancer of lung.
Flexible fiberoptic bronchoscopy with bronchoalveolar lavage was performed in 16 pediatric patients with the acquired immunodeficiency syndrome (AIDS) and deterioration in pulmonary function suggestive of opportunistic infection. In 62% of the patients Pneumocystis carinii was identified. Culture results showed a pure growth of Pseudomonas aeruginosa for one patient in addition to the Pneumocystis carinii. Bronchoscopy with lavage was well tolerated, with few complications even among patients with significant tachypnea and hypoxia. Because of its relative safety and effectiveness, this procedure should be considered the first invasive measurement used for evaluation of parenchymal lung disease in this population of patients.
5-year experience gained in three Moscow hospitals with bronchoscopic examinations of tracheobronchial lesions is analyzed. Out of 10809 procedures performed 337 were indicative of deforming bronchitis. Diagnostic evidence was furnished by x-ray, bronchography, fiber bronchoscopy with biopsy, radiologic evaluation of the lungs. Local bronchoscopic treatment was delivered to 209 patients. As a rule, the course involved 5-6 therapeutic bronchoscopies and was repeated on demand. The response was achieved in 97.6% of the patients.
A study of 970 patients treated for bronchogenic carcinoma (operation, cytostatic therapy, irradiation) reveal that only 122 (12.5%) were evaluated by the bronchoscopy. Among 47 (38.5%) out of 122 patients recidivation was confirmed (cytology or histology). The efficacy of radiology and sputum cytology is poor. Only 22/47 (47%) had radiologic evidence of recidivation and 18/47 (38%) had positive sputum cytology. Radiology and sputum cytology reveal recidivation in 27/47 (57%) patients. It means that bronchoscopy is the method of choice in the posttherapeutic monitoring of patients with bronchogenic carcinoma.
Complex examination using fiber bronchoscopy under local anesthesia with urgent cytologic examination of samples was performed in 206 outpatients with clinically suspected lung cancer. Malignancy was diagnosed in 138 cases. Tumor was cytologically confirmed in 95.7% of cases; its pattern was established in 88.7%. It is inferred that cytologic method improves the diagnostic potential of fiber bronchoscopy and assures shorter duration of outpatient examination.
Sixty patients were studied with respect to ECG modifications during bronchoscopy under local or general anesthesia, using dynamic electrocardiography. The increase in heart rate and incidence of extra-systoles were greater under local than general anesthesia. When pindolol, a beta-blocker with practically no bronchospastic effect was administered before the procedure, there was a significant decrease in the incidence of tachycardia and extra-systoles. This drug appears to be useful before bronchoscopy.
We have experienced 83 patients with pulmonary tuberculosis in last 22 months. A rapid diagnosis of pulmonary tuberculosis was established in 14 (16.9%) out of 83 patients by bronchoscopic examinations. Out of 30 bronchoscopic examinations, exacerbation of the chest X-ray findings was seen in 4 patients, however there was no significant unfavourable effects on the results of treatment. A survey on the use of bronchoscopy for diagnosing pulmonary tuberculosis was undertaken through a questionnaire distributed to about 90 hospitals in Japan. Only a few exacerbation was experienced by TBLB, BAL, etc., in some hospitals. Above results suggests that bronchoscopy is a useful procedure for the rapid diagnosis of pulmonary tuberculosis.