Broncholithiasis: bronchoscopic vs. surgical management.
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The aim of the present study was to evaluate in HIV-positive patients with bacterial pneumonia, the diagnostic value of a new endoscopic technique that uses a single catheter to perform a telescopic plugged catheter (TPC) followed by a modified protected bronchoalveolar lavage (mpBAL). Fifty-eight HIV-positive patients with respiratory infection were included in the study. Samples from TPC and mpBAL were cultured quantitatively. Standard bronchoalveolar lavage was performed to rule out opportunistic infections. According to the clinical and microbiological results, patients were classified in the study group (27 with bacterial pneumonia) or the control group (31 without bacterial pneumonia). Sensitivity of TPC was 56% [95% confidence intervals (CI) 37-75%] and its specificity was 100%; these figures were 56% (CI, 37-75%) and 94% (CI, 86-100%) for mpBAL. When both techniques were assessed together, sensitivity increased to 70% (CI, 53-87%). The use of a single catheter reduced the cost of the originally described pBAL procedure by approximately 50%. The use of a single catheter to perform a TPC followed by a mpBAL can improve the diagnostic yield in HIV-positive patients with bacterial pneumonia, and reduces its cost.
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RATIONALE AND OBJECTIVES: The purpose of the study was to determine if airway instillation of iodinated nanoparticles results in contrast material enhancement of tracheobronchial lymph nodes in dogs. MATERIALS AND METHODS: Eight dogs underwent intrabronchial instillation of iodinated nanoparticles; six dogs received 900 mg each, and two dogs received 450 mg each. Spiral computed tomography (CT) was then performed 2-34 days later. RESULTS: CT scans obtained 2 days after instillation showed the presence of contrast material within the lung parenchyma but no nodal enhancement. Scans obtained 6-34 days after instillation showed enhancement of the right, left, and middle tracheobronchial lymph nodes (analogous to the mediastinal nodes in humans). Mean nodal attenuation on CT images was 117 HU +/- 43, and the mean nodal volume was 129 mm3 +/- 113. Histologic specimens of the nodes showed macrophage hyperplasia. CONCLUSION: Iodinated nanoparticles instilled into small airways are transported to the tracheobronchial lymph nodes, where they result in contrast enhancement.
Twenty cases suffering from rhinoscleroma were studied. Bronchoscopy was performed for detection of secondary involvement of the subglottic region, trachea and bronchus. The study revealed that the larynx was involved in 40 per cent, the trachea in 20 per cent and the bronchus in 10 per cent of cases. The intranasal lesion, endotracheal and endobroncheal lesions all occur in the form of an atrophic stage, granulomatous (proliferative) stage and finally a fibrotic or scarring stage. The role of bronchoscopy in early diagnosis, initial symptomatic treatment and in follow-up is discussed in the light of the available literature.
A case is reported in which an inhaled sewing needle, stuck fast in the trachea, became displaced through the tracheal wall during attempted removal via flexible bronchoscopy. The inherent risks and pitfalls of this procedure are highlighted.
Chronic aspiration is a cause of life-threatening respiratory complications and repeated hospital admissions, particularly in children with neurological disabilities. Determining the source of aspiration is important for optimizing treatment. This report describes a simple technique to demonstrate salivary aspiration during fibreoptic bronchoscopy. A child with a history of recurrent pneumonia was given methylene blue orally 2 h prior to fibreoptic bronchoscopy. Bronchoscopy was carried out through a laryngeal mask airway under inhalational anaesthesia. The stained saliva was seen to be pooling in the valleculae and then running down the trachea into the bronchi, confirming salivary aspiration.
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The endobronchial hamartochondroma is a very rare, slowly growing benign tumor. We report a case of hamartochondroma conglomerate located in the left main bronchus. The resection via rigid endoscopy with ND-YAG laser and forceps was successful, and no complications occured. The rigid endoscopy with laser-application in such case is a safe and effective procedure in endobronchial hamartochondroma.
UNLABELLED: The classification of pulmonary involvement in sarcoidosis is based upon the radiographic stage of disease. We investigated 170 patients with new detected sarcoidosis (stage I / II / III: 79 / 39 / 52) for differences between the stages in demographic data, lung function values and results of BAL. With a multinomial logistic regression model to estimate probabilities, we found an increased probability for stage I with lower age (p < 0.001), higher IVC and FEV1 (p < 0.001), a less intensive smoking history (p<0.035), in BAL with a lower count of eosinophils (p < 0.014), mast cells (p < 0.004), CD8 lymphocytes (p < 0.015) and a less content of alkaline phosphatase (p < 0.004). For stage III the opposite results apply. With higher cell counts in BAL the probability of stage II increased, of stage III decreased (p < 0.013). The most relevant diagnostic BAL parameter in sarcoidosis, i.e. the count of lymphocytes and CD4 cells, was not different between the radiographic stages. CONCLUSION: Between patients with different radiographic stages of sarcoidosis there are differences in demographic data, lung function values and the pattern of alveolitis.