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At least 163 records · Page 9Linked to original sources
PubMed1998

Real-time bronchoscope tip localization enables three-dimensional CT image guidance for transbronchial needle aspiration in swine.

STUDY OBJECTIVE: To determine the feasibility of using real-time bronchoscope position technology coupled with previously acquired three-dimensional CT data to enhance transbronchial needle aspiration (TBNA). DESIGN: Eight swine were given percutaneously created target lesions for TBNA. A miniature position sensor was placed at the tip of a bronchoscope, and real-time position information during bronchoscopy was presented on a monitor simultaneously displaying previously acquired three-dimensional CT data. INTERVENTIONS: TBNA of target lesions and submucosal ink-spot injection of computer-generated targets. MEASUREMENTS AND RESULTS: TBNA specimens revealed successful aspiration of target material. Distances between ink marks made at computer-generated tracheal targets varied, on average (+/- SD), 4.2 mm +/- 2.6 mm from predetermined computer-distance coordinates. CONCLUSION: Real-time bronchoscope position technology coupled with previously acquired CT images may aid with TBNA of nonvisible extrabronchial lesions.

Animals↗
PubMed1989

Transbronchial catheter drainage via fiberoptic bronchoscope in intractable lung abscess.

The use of the fiberoptic bronchoscope as a drainage procedure for lung abscess has become more and more widespread. We have recently adopted the technique of inserting a simple polyethylene catheter through the flexible fiberoptic bronchoscope into the abscess cavity of 11 patients with lung abscess. All cases had not responded to aggressive postural drainage and adequate antibiotic therapy for at least a week. The results were as follows: 1) Among 11 patients, the therapeutic response was dramatic in 6 patients. 2) In the successful group, the abscess sizes were greater than 8cm in diameter and the airfluid levels were higher than two-thirds of the cavity. 3) Additional diagnoses, other than bacterial lung abscess, could be made in 2 cases when otherwise the diagnosis would have remained in doubt. The authors suggest that catheter drainage via fiberoptic bronchoscope is an effective treatment modality in the large lung abscess with a high air-fluid level which is intractable to other medical approaches, and it is also a safe procedure.

Adult↗
PubMed2001

[Virtual bronchoscope system].

In this article, we describe the features of Virtual Bronchoscope System(VBS) and its practical use. VBS is constructed based on 3-D chest CT images. The bronchus region is automatically extracted from 3-D chest CT images by a three-dimensional region growing method. The surface rendering is employed for construction of virtualized tracheo-bronchial tree. It gives us an environment where we can observe inside the bronchi from an arbitrary viewpoint and a view direction. By mouse operation, the user can control the viewpoint and the view direction to fly through inside the airway in real time. VBS is applicable for a variety of purposes such as diagnosis, surgical planning, informed consent, education and training. One of extension of this system is a teaching tool for medical students. In the module for educational use, we have developed four functions for using the system as a teaching tool as follows: (a) automated display of bronchial anatomical names, (b) presenting questions about the currently observed branch in the endoscopic view, (c) display of the path which the user should follow, and (d) display of a question about the location of the artificially created tumor in the bronchus. These functions use the processed results of automated anatomical labeling. The method proposed here combines the knowledge based processing technique 'automated labeling of bronchial branch' and the novel visualization technique 'virtual bronchoscope'. This is one of new teaching tools of medical images. We conclude that this virtual bronchoscope system might have an important role in the medial students' education.

Bronchi↗
PubMedDate not supplied

A new thin-type bronchoscope improves diagnostic accuracy of peripheral pulmonary carcinoma.

We investigated the XBF-4B40 (4B40) thin bronchoscope, which has a 4.0-mm outer diameter and a 2.0-mm biopsy channel, and studied its impact on the diagnosis of lung carcinoma. We analyzed 30 peripheral lung carcinoma cases by performing bronchoscopic examination using the 4B40 and the type 200 videoscope and recorded the most distal bronchus level reached. In addition, transbronchial aspiration biopsy, forceps biopsy, or brushing was performed, and the diagnosis accuracy between the two instruments was determined. The mean of the most distal bronchus reached by the 4B40 and the type 200 videoscope was the 4.5th and the 3rd, respectively. The 4B40 reached significantly further into the distal bronchus than the type 200 videoscope (p<0.0001). Accuracy for lesions detected in the right segment 1 or left segment 1+2 using the 4B40 and the type 200 videoscope was significantly different (p<0.0001) at 90.0 and 0%, respectively. The new type of bronchoscope, XBF-4B40, is useful for peripheral pulmonary lesion diagnosis with diagnosis accuracy improvements in the right segment 1 or the left segment 1+2.

Adenocarcinoma↗
PubMed2004

[Lung cancer with ground glass opacity diagnosed by transbronchial lung biopsy using an ultrathin bronchoscope and virtual bronchoscopy].

Although thoracic computed tomography (CT) screening indicated that there are many patients who have pulmonary shadow with ground glass opacity, it is sometimes difficult to obtain the appropriate specimens for histological diagnosis of such patients. We herein report a lung cancer patient with ground glass opacity who was diagnosed preoperatively by an ultrathin bronchoscope and virtual bronchoscopy. A 78-year-old female was admitted to our hospital due to bacterial pneumonia. At the admission, CT showed another abnormal small shadow in her right middle lobe. Since the shadow was not visible by fluoroscopy, we reconstructed the images of virtual bronchoscopy using the data obtained by multidetector CT. The location of the shadow was determined in the peripheral area of a dorsal branch of right B4aialpha. Then the transbronchial lung biopsy using an ultrathin bronchoscope with simultaneous CT guidance was performed. The histological findings of the biopsy specimens revealed that the shadow was highly suspicious for malignancy. Therefore, the right middle lobectomy was conducted, and the tumor was diagnosed as an adenocarcinoma. An ultrathin bronchoscope with virtual bronchoscopy is useful to diagnose a pulmonary shadow with ground glass opacity.

Aged↗
PubMed2005

Oral insertion of a flexible bronchoscope is associated with less discomfort than nasal insertion for Korean patients.

OBJECTIVE: The route of bronchoscope insertion varies between centres, without a firm rationale based on well-designed studies. We therefore compared nasal and oral insertion of a flexible bronchoscope and evaluated efficacy and patient satisfaction. DESIGN: Prospective randomised study of patients who underwent flexible bronchoscopy from May to September 2003 and who were randomly assigned to nasal and oral insertion approaches. RESULTS: Clinical characteristics, factors related to the procedure and patient satisfaction were analysed. In total, 307 patients were randomly assigned to the nasal (n = 158) or oral insertion groups (n = 149). No difference in baseline characteristics was identified between the groups. Insertion by the oral route was associated with a smaller amount of lidocaine use during the procedure (P = 0.04) and less frequent insertion site bleeding (P = 0.005). Patients assigned to oral insertion reported less discomfort during anaesthesia (P = 0.01) and scope insertion (P < 0.001), as well as less dyspnoea (P = 0.04) and coughing (P = 0.03). CONCLUSION: Oral insertion of a flexible bronchoscope was associated with less discomfort for patients than nasal insertion, although the route of insertion had no significant effect on outcome.

Adult↗
PubMed2006

Evaluation of bronchoscopic-assisted percutaneous tracheostomy.

The convenience of bedside percutaneous tracheostomy (PT) is growing in popularity. Some centers are placing PTs without the assistance of bronchoscopy. The study objective was to identify operative and perioperative problems with PT placement and to identify potential problems with bronchoscopy-free placement. All operative and perioperative events were prospectively recorded as a performance improvement project at our institution while performing bronchoscopic-assisted bedside PTs. One hundred eighty-three patients underwent PT placement, all with the assistance of a bronchoscope. Although most PT was performed without incident, some of the complications can be severe. The majority of difficulties can be prevented with bronchoscopic assistance. An unexpected procedural difficulty that has not been previously reported is the dilatational difficulty in the younger patient population. Some of these patients required an additional tracheal incision with a scalpel. This may be from a healthy pretracheal fascia and/or musculature.

Adolescent↗
PubMedDate not supplied

[The role of bronchoscopy with a flexible bronchoscope in the diagnosis of pulmonary tuberculosis].

Bronchoscopy with flexible bronchoscope has been proved as a useful method that has been applied also in the diagnostics of pulmonary tuberculosis during the recent years. In order to evaluate its role and use at the Institute for Diseases of the Chest and Tuberculosis Golnik documentation of 51 patients treated during 1985 and 1986 was surveyed. Prior to the examination from all patients the sputum on Mycobacterium tuberculosis was obtained at least three times and it was negative. Aspirations were obtained from 40 patients and the diagnosis was confirmed in 21 patients by recovery from tubercle bacilli specimens (52.5%). Transbronchial biopsy was performed in 34 patients and it was positive in 27 (79.4%), out of them in 7 patients the biopsy sample of the lungs was bacteriologically (38.9%) and in 23 patients histologically positive (67.6%). By bronchoscopy with flexible bronchoscope the final diagnosis was confirmed in 40 patients (78.4%). Bronchoscopy with flexible bronchoscope as well as transbronchial biopsy have proved to be a successful method in the diagnostics of active pulmonary tuberculosis. It should be used in patients in whom the sputum smear for acid fast bacilli were frequently negative yet there is a suspicion of pulmonary tuberculosis.

Adolescent↗
PubMed1990

[Problems of intubation using the flexible LF-1 fiberoptic bronchoscope. Development of an intubation aid].

Fiberoptic endotracheal intubation with an endoscope (external diameter 4 mm) especially designed for anesthesiologists proved to be safe providing small-diameter tubes were used. The use of large-diameter tubes (I.D. 7.5-8.5 (mm)) involves a risk of the tip of the tube clinging to the arytenoid cartilages preventing any further advancement. To avoid this complication another special tube has been constructed, which fills the space between the endotracheal tube and the bronchoscope and centers the bronchoscope within the endotracheal tube. When this new tube was used there were no problems either in passing the bronchoscope through this "inner" tube or in withdrawing the inner tube after successful intubation. With the new device it was even possible to pass tubes with wider lumen into the trachea over the fiberscope with minimal difficulty and trauma.

Bronchoscopes↗
PubMed1989

[Pneumonia in artificially ventilated patients: the significance of Gram preparation und bronchoscopic specimen collection methods in diagnosis and therapy].

The value of the Gram preparation of tracheal secretion compared to bacterial culture was checked in 48 patients with lower respiratory tract infections under mechanical ventilation with regard to antibiotic therapy. In 20 patients attention was also paid to the information value of a bronchial secretion obtained bronchoscopically using a brush. In 34 patients (71%) there was an exact agreement between the result of the Gram preparation and that of the culture. The antibiotic therapy initially administered on the basis of the Gram preparation from the tracheal secretion had to be corrected in 6 patients (12.5%) according to the culture and resistance results and in 6 patients (12.5%) because clinical improvement had not occurred after three days. Only 67% of the bacteria found in the tracheal secretion were isolated also with the bronchoscopic brush technique. The antibiotic therapy was not altered on the basis of the result obtained by bronchoscopy in any case. We conclude that for calculated antibiotic therapy Gram preparation has great significance. Bronchoscopic methods of obtaining material did not influence antibiotic therapy in bacterial pneumonia.

Bacterial Infections↗
PubMed1982

[Bronchoscopic diagnosis of central lung cancer].

A comparative evaluation of diagnostic value of bronchioscopy was carried out by means of different models of rigid bronchoscopes and a bronchofibroscope in 356 patients with central cancer of the lung. Rigid bronchoscopes offer considerable advantages in diagnosing cancer of primary and lobular bronchi. Application of optical telescopes with rod-type lenses and flexible optical forceps increased the diagnostic efficiency of rigid bronchoscopes. Bronchofibroscopy improved the results of diagnosis of cancer of segmental bronchus.

Adult↗
PubMed1993

Bronchoscopic ultrasonography in the diagnosis of lung cancer.

An ultrasonic bronchoscope has been newly developed for diagnosis and lymph node staging in the hilum and mediastium. The instrument comprises an Echo-camera, SSD-630 (Aloka), and a transbronchial ultrasonic probe similar to the currently used videobronchoscope. The scope is equipped with an ultrasonic transducer in its tip. The maximum diameter of the probe head is 6.3 mm and that of the transducer, 5.0 mm. The frequency employed is 7.5 Megahertz (MHz) and the direction of scanning is parallel to the bronchoscopic axis. The device can easily be introduced into the lobar bronchus under topical anesthesia in a similar procedure to that used for routine videobronchoscopy. The location of the transducer in the airway is confirmed by monitoring endoscopic images on a TV monitor screen. With the device, 25 patients, who had given their consent for the ultrasonographic study beforehand, were examined during the two-month period, January and February, 1992. Vessels such as the thoracic aorta, pulmonary artery and truncus brachiocephalicus were good landmarks for diagnosis. Lung cancer was detected in five patients by biopsy, three malignant lesions in the hilum were diagnosed by videobronchoscopy while two malignant lesions in the periphery were confirmed by bronchoscopic ultrasonography as anterior mediastinal lymph node swellings.

Adult↗
PubMed1997

Transmission of a highly drug-resistant strain (strain W1) of Mycobacterium tuberculosis. Community outbreak and nosocomial transmission via a contaminated bronchoscope.

CONTEXT: Nosocomial transmission of multidrug-resistant tuberculosis (MDR TB) has been reported primarily in New York State and has generally been presumed to occur via respiratory aerosols. OBJECTIVE: To assess nosocomial transmission of MDR TB. In 1995, 8 patients with MDR TB were identified in South Carolina; all were resistant to 7 drugs and had matching DNA fingerprints (strain W1). Community linkswere identified for 5 patients (Patients 1-5). However, no links were identified forthe other 3 patients (Patients 6-8) except being hospitalized at the same hospital as 1 community patient. DESIGN: Outbreak investigation. SETTING: Community and hospital. PATIENTS: Eight patients whose MDR TB isolates had DNA fingerprint patterns matching strain W1. MAIN OUTCOME MEASURES: Clinical characteristics of patients with strain W1 Mycobacterium tuberculosis isolates. RESULTS: Patient 5 (community patient) and Patient 8, diagnosed April 1995 and November 1995, respectively, had clinical courses consistent with MDR TB, with smear-positive and culture-positive specimens and cavitary lesions on chest radiograph; both died of MDR TB less than 1 month after diagnosis. Patients 6 and 7 (diagnosed May 1995) each had 1 positive culture for MDR TB; specimens were collected during bronchoscopy. Patient 6 had a skin test conversion after bronchoscopy. Neither Patient 6 nor Patient 7 had a clinical course consistent with MDR TB, neither was treated for MDR TB, and both are alive and well. No evidence of laboratory contamination of specimens, transmission on inpatient wards, or contact among patients was found. All 4 received bronchoscopies in May 1995; Patients 6, 7, and 8 had bronchoscopies 1, 12, and 17 days, respectively, after Patient 5. Observations revealed that bronchoscope cleaning was inadequate, and the bronchoscope was never immersed in disinfectant. CONCLUSIONS: Inadequate cleaning and disinfection of the bronchoscope after the procedure performed on Patient 5 led to subsequent false-positive cultures in Patients 6 and 7 and transmission of infection to Patient 6 and active MDR TB to Patient 8.

Aged↗
PubMed1996

Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.

BACKGROUND: Bedside percutaneous dilational tracheostomy, a relatively new method of tracheal cannulation, provides safe and ready access to the trachea to relieve airway obstruction and tracheopulmonary secretions. The dilational technique has undergone various modifications during the past decade. Complications of this procedure are primarily related to the lack of direct visualization during tracheostomy tube placement and to poor patient selection. OBJECTIVE: To report the utility of percutaneous dilational tracheostomy with bronchoscopic guidance in 162 critically ill patients. MAIN OUTCOME MEASURES: Mortality rates and complications associated with this technique. RESULTS: Twenty-five patients (15.4%) died while hospitalized. No deaths were related to tracheostomy. There were four (2.5%) major complications: one pneumothorax and three posterior tracheal tears, which healed spontaneously. There were five (3.1%) minor complications: one posterior mucosal disruption, one minor bleeding episode, and three minor episodes of cellulitis. One hundred thirty-seven patients (84.6%) were discharged. Twenty-nine patients (21.2%) were available for follow-up and were experiencing no significant problems or complications following the procedure. Compared with standard open tracheostomy, charges were reduced by $1628.20 per patient ($263,768.40 total savings). CONCLUSIONS: Bedside percutaneous tracheostomy with bronchoscopic guidance is safe and cost-effective. Complications compare favorably with that of open tracheostomy. Major complications should be avoided with continuous bronchoscopic observation during the procedure.

Adult↗
PubMed2001

Bronchoscopic instillation of surfactant in acute respiratory distress syndrome.

Abnormalities of surfactant action in acute respiratory distress syndrome (ARDS) result in decreased lung compliance and significant hypoxemia. Several case reports and small studies suggest that there is an improvement in patients with ARDS following the administration of surfactant. However, there is no clear-cut ideal method for surfactant administration. The bronchoscopic administration of surfactant may represent an effective method of surfactant delivery in ARDS. Bronchoscopic instillation offers the theoretical advantages that the surfactant may be distributed directly to the desired regions of the lung, a more economical use of surfactant, and the opportunity to lavage leaked serum proteins prior to instillation. Surfactant has been administered in adults with success. We present a case of initial improvement in oxygenation index, ventilation index, and mechanical ventilatory support in a pediatric patient with ARDS following the bronchoscopic administration of surfactant.

Bronchoscopy↗
PubMed1996

Bronchoscopic evaluation of bronchial healing after carinal reconstruction.

Bronchoscopic evaluation of the anastomoses created by carinal reconstruction was carried out over a period of 7 weeks in 6 patients who had undergone carinal and lobar resections for lung cancer, and 4 who had undergone carinal resection without pulmonary resection for carinal tumors. The techniques of reconstruction included end-to-end and end-to-side tracheobronchial anastomoses with omental, fat, or pleural wrapping. Bronchial healing at the anastomosis was evaluated using a bronchial healing score (BHS) based on the bronchoscopic findings. The degree of healing was scored on a 0 to 4 scale, with 0 indicating normal mucosa; 1, edema or reddening; 2, mucosal color changes; 3, ulceration; and 4, diffuse ulceration. One postoperative death occurred as a result of anastomotic leakage. The remaining nine patients were divided into three groups according to the bronchoscopic findings on postoperative day (POD) 7: group A (n = 3) had mild ischemia at the anastomosis, group B (n = 3) had moderate ischemia at the anastomosis, and group C (n = 3) had severe ischemia at the anastomosis. Bronchial healing of the anastomosis improved over a 7-week period in groups A and B, but was delayed in group C. These findings led to the conclusion that wound healing of the anastomosis following carinal reconstruction requires more than 7 weeks due to the consequent devascularization resulting from the extended bronchial resection and lymph node dissection.

Aged↗
PubMed1990

Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis.

The ability to make a definitive diagnosis in sputum smear-negative pulmonary tuberculosis by bronchoscopic aspiration, bronchoalveolar lavage (BAL), and examination of postbronchoscopy sputum were compared. Thirty-four patients with lesions on chest x-rays suspected of being pulmonary tuberculosis were entered into the study. The diagnosis of pulmonary tuberculosis was subsequently confirmed in 28 patients and the method of arriving at the final diagnosis was analyzed. A positive acid-fast bacilli (AFB) smear result was obtained in 4/28 (14%) of cases by a combination of bronchoscopic techniques and postbronchoscopy sputum examination. Prebronchoscopy sputum culture was positive in 12/28 (43%). Combined with bronchoscopy specimens, a positive AFB culture result was obtained in 26/28 (93%). Sputum examination, bronchoscopic aspiration, and BAL are complementary techniques and together they give a high yield of definitive diagnosis of pulmonary tuberculosis.

Adolescent↗
PubMed1999

Bronchoscopic removal of bronchial foreign bodies through the laryngeal mask airway in pediatric patients.

The laryngeal mask airway was used to perform fiberoptic removal of bronchial foreign bodies (peanuts) in two pediatric patients. Laryngeal mask airway offers easy access to the airway, safe respiratory management and direct visualization of the airway during bronchoscopic procedures. Laryngeal mask airway allows the use of larger bronchoscopes than can usually be used for children when bronchoscopy is performed through an endotracheal tube. In each case, the peanuts were removed safely and easily using a Fogarty catheter through the fiberoptic bronchoscope. These cases suggest that laryngeal mask airway is useful in maintaining a secure airway during the removal of bronchial foreign bodies in children.

Bronchi↗