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PubMed1996

Presentation of AIDS-related pulmonary Kaposi's sarcoma diagnosed by bronchoscopy.

Kaposi's sarcoma (KS) is the most common neoplasm in persons infected with the human immunodeficiency virus (HIV). However, information about the presenting features of pulmonary KS is limited. To describe the clinical, laboratory, and radiographic features of pulmonary KS, medical records and chest radiographs of 168 patients with pulmonary KS diagnosed by bronchoscopy during a 7-yr period were reviewed. All of the patients were HIV-seropositive males, of whom 95% identified homosexual or bisexual sex as a risk factor for HIV infection. The median CD4 lymphocyte count was 19 cells/microliter. The most common symptoms were cough, dyspnea, and fever. Patients with a concurrent opportunistic pneumonia had a higher median serum lactate dehydrogenase (LDH) concentration than did those with pulmonary KS alone (p<0.001). The most common chest radiograph findings were bronchial-wall thickening, nodules, Kerley B lines, and pleural effusions. The presence of granular opacities or cystic spaces usually indicated concomitant Pneumocystitis carinii pneumonia (p < 0.001). Twenty-six patients (15.5%, 95% CI = 10.2% to 20.8%) had pulmonary KS in the absence of mucocutaneous involvement. The presentation of pulmonary KS is characterized by symptoms that cannot be distinguished from those of a superimposed infection. An elevated serum LDH concentration or a chest radiograph with granular opacities or cystic spaces should raise the suspicion of concurrent opportunistic pneumonia. The diagnosis of pulmonary KS should be considered in an HIV-infected homosexual or bisexual male with respiratory symptoms even in the absence of mucocutaneous lesions.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Cytokines derived from alveolar macrophages induce fever after bronchoscopy and bronchoalveolar lavage.

As much as one-third of patients develop fever and flu-like symptoms after fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) for yet unknown reasons. The aim of the present study was to investigate factors mediating these side effects. Fifty consecutive patients with various pulmonary diseases who underwent FOB without further interventions (n = 30) or combined with BAL (n = 20) were enrolled. Serum levels of the proinflammatory cytokines IL-1beta, IL-6, and TNF-alpha were determined directly prior to (t0), directly after (t1), and 6 h after (t2) the procedures by ELISA. In parallel, blood cultures were drawn at t2. At to and t1, generally only low cytokine concentrations could be detected. At t2, however, significant increases of cytokine levels were found. IL-6 and TNF-alpha were significantly higher in patients after BAL than in patients after FOB. Comparing patients who developed fever (n = 12) with those who did not (n = 38), irrespective of the endoscopic procedures performed, dramatic increases of all three cytokines were detected in febrile patients that were significantly higher than in patients without fever. In the FOB group only patients who received local anesthesia by prilocaine bolus injection into the airways via the working channel of the bronchoscope developed fever and increases of IL-6 and IL-beta, whereas patients anaesthetized by inhalation of a prilocaine aerosol remained afebrile and had slight IL-6 increases only. There was a highly significant correlation between IL-6 values at t2 and the number of BAL alveolar macrophages (r = 0.98). All blood cultures remained sterile. These results indicate that fever after FOB and BAL is induced by proinflammatory cytokines derived from alveolar macrophages activated by instillation of fluid into the airways.

Adult↗

PubMed1998

Investigative use of bronchoscopy in asthma.

The incorporation of bronchoscopy and bronchoscopic procedures into the investigation of asthma mechanisms, treatment, and in particular, the role of airway inflammation has contributed significantly to the enhanced understanding of this disease. Carefully drafted guidelines have allowed the gradual inclusion of subjects with more severe disease in studies utilizing bronchoscopic investigative tools. Many more questions remained unanswered, including the importance of persistence of airway inflammation in asymptomatic asthma, the specific antiinflammatory effects of new (and old) asthma therapies, the contribution of airway structural changes (subepithelial fibrosis) to nonreversible obstruction, the role of antiinflammatory versus proinflammatory cytokines in the pathogenesis of airway inflammation and the heterogeneity of disease expression in various groups of subjects. We are confident that current and future meticulously designed and executed research studies utilizing bronchoscopic techniques will significantly add to our knowledge of disease mechanisms and lead us to new and improved treatments for asthma.

Airway Obstruction↗

PubMed1990

Tracheal mucus rheology in patients undergoing diagnostic bronchoscopy. Interrelations with smoking and cancer.

We examined the differences in tracheal mucus rheology between nonsmokers and smokers, and between smokers with and without lung cancer. Mucus was collected from patients undergoing diagnostic bronchoscopy without atropine by holding a cytology brush in contact with the tracheal mucosa for 10 to 15 s. Samples were obtained from 43 patients 24 to 79 yr of age: nine nonsmokers, 18 current smokers, and 16 exsmokers (greater than 6 months); 12 patients (nine smokers, three exsmokers) had lung cancer. Pulmonary function testing showed that the nonsmoker patients had significant restrictive lung disease, and the patients with cancer had significant irreversible airway obstruction. The viscoelastic properties of the mucus samples were determined by magnetic microrheometry. Two parameters are reported: G* (modulus of rigidity) and tan delta (loss tangent), each measured at 1 and 100 rad/s. G* is an index of overall deformability (elastic and viscous), and tan delta is the ratio of viscous to elastic deformability. For nonsmoker patients, the viscoelastic parameters were virtually identical to those found previously for normal volunteers. For smokers without cancer, the mucus had a lower value of tan delta 1 rad/s and therefore was predicted to be more easily transportable by ciliary action; for exsmokers without cancer, ciliary transportability as calculated from viscoelasticity was even higher because of both low tan delta and low G*. Mucus from patients with cancer was not significantly different from that of nonsmokers; however, the mucus was predicted to be less easily clearable by ciliary action than was that from smokers and exsmokers without cancer, mainly because of a higher tan delta at 1 rad/s.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1975

Absence of bacteremia after fiberoptic bronchoscopy.

Fiberoptic bronchoscopy was performed in 43 consecutive afebrile patients with lung cancer. Blood cultures were drawn before the procedure, immediately afterward, and 30 min later. Although bacteria were isolated from all bronchoscopic washings and the majority of translaryngeal aspirates cultured, all blood cultures were bacteriologically sterile. No fever or evidence of infection developed in any patient within 24 hours after the procedure.

Bronchoscopy↗

PubMed1975

Lidocaine blood concentrations during fiberoptic bronchoscopy.

Blood lidocaine concentrations were measured in 21 patients during routine fiberoptic bronchoscopy. In one patient, concentrations were in the toxic range. Measureable, but generally safe, concentrations were observed in the remaining patients. Cardiac and central nervous system toxicity may result from lidocaine adsorption, particularly in the seriously ill patient, although none was observed during the course of these studies.

Absorption↗

PubMed1975

Fever and pneumonia after flexible fiberoptic bronchoscopy.

The frequencies of fever, parenchymal infiltration, and bacteremia were studied prospectively after 100 flexible fiberoptic bronchoscopies performed transnasally under topical anesthesia. Fever occurred after 16 per cent, and parenchymal infiltration, after 6 per cent of the procedures. Most complications were mild and transient; however, one patient developed rapidly progressive pneumonia and died. No organisms were isolated from cultures of blood drawn at the time of the procedure or during complications. The organisms most commonly isolated from the sputum of the patients who developed pneumonia were the aerobic and anaerobic bacteria normally found in the mouth. Isolation of a significant pathogen before the procedure did not predispose to development of a complication. Advanced age (greater than 60 years) and the endoscopic findings of abnormalities were significant predisposing factors. Bronchial brushing, but not bronchial biopsy or bronchial washing, was associated with significantly higher complication rates in patients with bronchial carcinomas than in those without a neoplasm. The mechanism of the fever and parenchymal infiltration is thought to be related to obstructive atelectasis and infection produced by organisms present in the airways at the time of the procedures.

Adult↗

PubMed1976

Disseminated pulmonary blastomycosis in an immunosuppressed patient. Diagnosis by fiberoptic bronchoscopy.

A 73-year-old man with malignant lymphoma who was undergoing treatment with systemic chemotherapy presented with an acute, febrile illness associated with cough and sputum production. The patient developed bilateral, diffuse, pulmonary interstitial infiltrates with rapidly progressive respiratory insufficiency. The diagnosis was made by demonstrating Blastomyces dermatitidis in bronchial brush and transbronchial lung biopsy specimens obtained through fiberoptic bronchoscopy.

Aged↗

PubMed1979

A cluster of Mycobacterium gordonae isolates from bronchoscopy specimens.

During a 2.5-year period, 52 patients at Yale-New Haven Hospital had Mycobacterium gordonae recovered from specimens obtained by suction at bronchoscopy; 2 of them also had smears positive for acid-fast bacilli. Almost all of the isolates came from patients bronchoscoped by the same physician, one of 4 who performed the procedure during that period. Only this physician added one drop of green dye, stored in a 100-ml bottle, to the cocaine used for topical anesthesia during the procedure; cultures of the dye yielded Mycobacterium gordonae. Contamination with this organism, a cause of positive acid-fast smears, may result in an initial inappropriate diagnosis of Mycobacterium tuberculosis.

Administration, Topical↗

PubMed1980

Fiberoptic bronchoscopy in the immunocompromised host: the significance of a "nonspecific" transbronchial biopsy.

Fifty-eight flexible fiberoptic bronchoscopies were performed in 49 immunocompromised patients in the diagnostic evaluation of pulmonary infiltrates. Transbronchial lung biopsy (TBB) provided a specific diagnosis in only 12 of 47 procedures (26%). The addition of bronchial brushings to the procedures slightly increased the diagnostic yield. The yield of bronchial brushings was enhanced in patients with diffuse infiltrates on chest roentgenogram (P less than 0.05). Nonspecific inflammatory or fibrotic changes were the most common histologic finding on TBB when pulmonary parenchyma was obtained (found in 16 of 47 procedures, or 34%). Alternative specific etiologic diagnoses were established in 7 of these 16 cases by other diagnostic modalities. Contrary to previous reports, further evaluation of nonspecific changes on TBB may lead to changes in therapy and improved prognosis in selected patients. Complications related to the bronchoscopic procedures were infrequent and resulted in no prolonged morbidity.

Adult↗

PubMed1981

Clinical efficacy of early and delayed fiberoptic bronchoscopy in patients with hemoptysis.

We analyzed the records of 129 consecutive patients with hemoptysis to evaluate whether or not early (during hemoptysis or during the 48 h after hemoptysis stopped) fiberoptic bronchoscopy (FB) more frequently localized and/or diagnosed the source of bleeding and influenced clinical outcome than delayed FB (48 h or more after hemoptysis stopped). Patients were divided into 3 groups on the basis of their final diagnoses: neoplasm (31 patients), bronchitis/bronchiectasis (52 patients), and miscellaneous (46 patients). Although the likelihood of visualizing active bleeding (41 versus 8%) or its site (34 versus 11%) was significantly higher with early versus delayed FB, respectively, neither active bleeding nor a bleeding site were visualized in at least 60% of the 92 patients who underwent early FB. Definitive (endoscopic) diagnoses by early or delayed FB occurred primarily in patients with neoplasm. Clinical outcome based on the results of FB was not significantly different between the early and delayed groups. Thus, early, single FB was generally neither diagnostic nor therapeutically decisive in these patients with hemoptysis.

Adult↗

PubMed1982

Mycobacterial cross-contamination of bronchoscopy specimens.

Bronchoscopy specimens from 3 patients investigated during 1 wk at a large teaching hospital were culture positive for the same serovar of Mycobacterium intracellulare. Review of laboratory records and patient data suggested that only the first patient examined was a genuine excretor of mycobacteria; the isolates from the other 2 patients were false positives caused by inadequate disinfection of part of the collection apparatus between use. The investigations confirm the suitability of glutaraldehyde as a rapid, highly effective antimycobacterial disinfectant and illustrate the value of serotyping when dealing with mycobacterial isolates of questionable significance.

Aged↗

PubMed1983

The use of quantitative cultures and antibody coating of bacteria to diagnose bacterial pneumonia by fiberoptic bronchoscopy.

This study uses quantitative cultures and immunofluorescent demonstration of antibody-coated bacteria to differentiate colonizing from infecting bacteria in lower respiratory secretions obtained by fiberoptic bronchoscopy. The fiberoptic bronchoscope was passed transnasally without the use of a nasotracheal tube, and a single-sheath cytology brush dipped in lower respiratory secretions served as inoculum for quantitative cultures. Secretions were also collected by aspiration through the bronchoscope side channel for fluorescent examination. None of 60 control patients had greater than 4,000 colony-forming units (CFU) per brush of a single bacterium on quantitative culture. In contrast, more than 4,000 CFU per brush were isolated from 29 of 33 episodes of clinically defined lower respiratory infection (p less than 0.001). Only 1 of 60 control patients had antibody-coated bacteria in their lower respiratory secretions, but antibody coating was demonstrated in association with 24 of 33 episodes of infection (p less than 0.001).

Adult↗

PubMed1984

Correlation between gallium lung scans and fiberoptic bronchoscopy in patients with suspected Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome.

We retrospectively examined the sensitivity and specificity of gallium lung scans for detecting Pneumocystis carinii pneumonia in 22 patients with known or suspected acquired immune deficiency syndrome. Correlations were made between bronchoscopic results and gallium scan findings interpreted using a simple system (normal or abnormal) and a graded score (1 to 4). All 12 patients with Pneumocystis had abnormal scans by both interpretations (sensitivity, 100%). Five of these 12 patients had normal arterial PO2 values, chest roentgenograms, or both. In the 10 patients without Pneumocystis, scans were read as abnormal in 8 using the simple system (specificity, 20%) but were abnormal in only 1 using the grading system (specificity, 90%). Five patients with Pneumocystis pneumonia had scans and bronchoscopy after treatment; neither method of interpretation correlated with the presence of organisms. We conclude: (1) gallium scanning is a sensitive initial diagnostic test in patients with suspected Pneumocystis pneumonia; (2) a graded scoring system improves specificity; (3) an abnormal gallium scan (3 or greater) in patients with suspected Pneumocystis pneumonia is an indication for biopsy, even when the PO2 and/or chest roentgenogram are normal.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Bronchoscopy in ventilator-associated pneumonia: agreement of calibrated loop and serial dilution.

RATIONALE: Although the serial dilution technique for quantitative culture of bronchoalveolar fluid is considered to be the gold standard for the diagnosis of ventilator-associated pneumonia, it is more labor intensive than the calibrated loop technique. OBJECTIVE: We sought to determine the agreement between the calibrated loop and serial dilution techniques in the diagnosis of ventilator-associated pneumonia. METHODS: We prospectively measured bacterial colony counts by the serial dilution and calibrated loop techniques in 121 bronchoalveolar lavage samples of 104 patients with suspected ventilator-associated pneumonia. MEASUREMENTS AND MAIN RESULTS: At the time of bronchoscopy, patients had received mechanical ventilation for a median of 8 d. Patients were receiving antibiotics when 90 of the 121 (74.4%) bronchoalveolar samples were obtained. The colony counts of 13 bacterial isolates were too numerous to count by the calibrated loop technique; by serial dilution technique, their counts ranged from 4.70 to 6.74 log10 cfu/ml. Fifty other bacteria had paired colony counts measured by each of the two techniques: the bias (95% confidence interval) between the two techniques was -0.380 (-0.665 to -0.095) log10 cfu/ml, with precision of 1.002 log10 cfu/ml and 95% limits of agreement of -2.344 to 1.584 log10 cfu/ml. Using the threshold of 4 log10 cfu/ml as a criterion for the diagnosis of ventilator-associated pneumonia, there was discordance only for one bacterial organism between the two techniques. CONCLUSIONS: The calibrated loop technique can be used for the diagnosis of ventilator-associated pneumonia using bronchoalveolar lavage fluid.

Anti-Bacterial Agents↗

PubMedDate not supplied

Special new low resistance to flow tube and endotracheal tube adapter for use during fiberoptic bronchoscopy.

This paper describes endotracheal tubes and adapters which are designed specially for fiberoptic bronchoscopy; the tubes are designed in such a way that they are wide at the upper part but are narrow and thin walled in the part of the tube which goes through and below the cords. By designing tubes in this manner, the resistance to flow of gas through the tube when the fiberoptic bronchoscope is in place is very much reduced and the safety of the whole precedure is enhanced. A special adapter for use under these circumstances is also described which utilizes a commercially available swivel tracheostomy adapter with a special silicone diaphragm fitted onto the top to enable the fiberoptic bronchoscope to be placed through the diaphragm and keep a sealed system. A plug is available for the hole in the diaphragm when the fiberoptic bronchoscope is not being used. Clinical and laboratory data show that these pieces of equipment perform the function for which they were designed.

Adult↗

PubMedDate not supplied

Newer techniques in fiberoptic bronchoscopy.

Flexible fiberoptic bronchoscopy has assumed a major role in the diagnosis and management of upper respiratory tract and pulmonary diseases. A new technique, utilizing a C-arm fluoroscopic control with an image intensification system, for the localization of peripheral lung lesions and subsegmental parenchymal infiltrates, is described. This method has proved useful in the early histologic and cytologic diagnosis of nonendoscopically visible bronchogenic carcinoma and in the drainage of lung abscesses. By employing a transendotracheal tube route with a ventilating, side-arm adaptor, continuous airway control and a selected inspired oxygen or anesthetic content is maintained. In addition, the problems of arterial hypoxemia, airway resistance, and ventilation-perfusion abnormalities are minimized. Several representative cases are discussed.

Aged↗

PubMedDate not supplied

Therapeutic rigid bronchoscopy in the neonatal intensive care unit.

Often the acutely ill neonate requires endoscopic intervention for deteriorating respiratory status in spite of vigorous pulmonary toilet. Although fiberoptic bronchoscopy has been suggested at times, its mechanical airway obstruction would preclude its use in the very sick child. Rigid endoscopy using a ventilating bronchoscope may be safely and effectively used in the neonatal unit for bedside therapy, avoiding the risk to transfer to and from an operating room. Five case studies are presented outlining the indications and utility of this procedure.

Adolescent↗