Intrathoracic use of fibreoptic bronchoscope.
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Bronchoscopes↗
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Accuracy of the bronchoscopic DNA content analysis of non-small-cell lung carcinoma.
To assess the accuracy of the bronchoscopic DNA content analysis, samples of non-small-cell lung carcinomas (NSCLC) were investigated by means of flow cytometry. Samples were dissociated using the detergent Triton X-100. In 58 NSCLC cases, 39 (67%) had DNA aneuploid tumors. We compared the DNA indices of bronchoscopic brushing samples with 21 corresponding surgical samples. In 16 (76%) cases, DNA ploidy of both bronchoscopic and surgical samples were in concordance. In 3 (14%) cases, both bronchoscopic and surgical sample showed DNA aneuploidy, but the number of the DNA aneuploid stem cell lines was different. The cause of these differences was ascribed to the intratumor DNA heterogeneity. In 2 (10%) cases, the bronchoscopic sample showed DNA diploidy, but the surgical sample showed DNA aneuploidy. In these cases, tumor cells obtained by bronchoscopic brushing were so few that the small DNA aneuploid peak was undetectable in the DNA histogram. But the tumor DNA ploidy was evaluated correctly in 90% of 21 cases using bronchoscopic samples. Consequently, despite some drawbacks, the DNA ploidy diagnosis using bronchoscopic samples in this relatively small study, was almost as reliable as surgical samples.
Adenocarcinoma↗
Respiratory acidosis with the small Storz-Hopkins bronchoscopes: occurrence and management.
Carbon dioxide retention in the Storz rigid ventilating bronchoscope with the Hopkins lens system was investigated in the laboratory. The 3.5, 4.0, and 5.0 30-cm Storz bronchoscopes with a 3.95-mm (outside diameter) telescope lens were used in 10 mongrel dogs weighing between 8 and 15 kg. Significant (p less than 0.01) accumulation of arterial carbon dioxide tension (PaCO2) (respiratory acidosis) was observed after 5 and 10 minutes of ventilation through the 3.5 and 4.0 bronchoscopes, but no significant increase in PaCO2 was noted with the 5.0 bronchoscope. There was no significant change in arterial oxygen tension under the same conditions. Manual compression of the upper anterior abdominal wall during expiration was applied during bronchoscopy in 6 children. Arterial blood samples were taken before insertion of the bronchoscope and 5 minutes later with and without abdominal compression during expiration. A significant increase (p less than 0.05) in PaCO2 and a decrease in pH were observed after 5 minutes of the bronchoscopic procedure without manual compression of the abdominal wall, while no significant changes in PaCO2 were observed with abdominal compression.
Abdominal Muscles↗
Sputum cytology-positive, bronchoscopically negative adenocarcinoma of the lung.
Among a total of 114 cases of resected lung adenocarcinoma that were examined by sputum cytologic study before bronchoscopy, 17 were sputum cytology-positive, but had no abnormal bronchoscopic findings. In most of these cases, the reason for detection was sputum and bloody sputum (58.8 percent). Pathologically, many cases were classified as stage III A or more (82.4 percent) due to mediastinal lymph node metastases. More than 70 percent of the cases showed vascular invasion. The proportion of well-differentiated cases was also high (52.9 percent). The prognosis of these cases was worse than sputum cytology-negative adenocarcinoma without abnormal bronchoscopic findings and better than sputum cytology-positive adenocarcinoma with abnormal bronchoscopic findings. There was no significant difference between these cases and sputum cytology-negative adenocarcinoma with abnormal bronchoscopic findings. Combined with the bronchoscopic findings, sputum cytologic study is useful for preoperative evaluation of lymph node metastasis and prognosis. This combined approach can provide information necessary to perform sufficient dissection of mediastinal lymph nodes and proper adjuvant therapy in sputum cytology-positive adenocarcinoma cases, even though there are no abnormal bronchoscopic findings.
Adenocarcinoma↗
Contamination of a fiberoptic bronchoscope with Proteus species.
We have traced an episode of contamination of a fiberoptic bronchoscope with a Proteus species to an index patient. Bacterial cultures obtained by aspiration through the fiberoptic bronchoscope from 11 of 12 subsequent bronchoscopies in 8 additional patients grew a Proteus species with sensitivities similar to those of the initial isolate. Culture of the fiberoptic bronchoscopic specimen yielded an identical organism. There were no definitive ill effects in the patients. These findings necessitated a change in our fiberoptic bronchoscope disinfection protocol as well as development of culture surveillance mechanism to detect breaks in the cleaning procedure. The importance of this and avoiding potential outbreaks of fiberoptic bronchoscope-related infeciton is emphasized.
Bronchoscopes↗
The flexible fiberoptic bronchoscopic shuttle.
The purpose of this paper is to describe a novel and practical technique for endobronchial catheter placement utilizing the flexible fiberoptic bronchoscope. Placement of endobronchial catheters via the flexible bronchoscope is limited by the small dimension of the bronchoscope's internal channel and frequently requires repeated manipulation to verify position endobronchially. We describe preliminary experience with a technique that we call the "bronchoscopic shuttle," which circumvents this limitation. The spectrum of possible clinical uses for this technique is discussed.
Brachytherapy↗
[Advantages of blood gas analyses of an improved ventilation bronchoscope (author's transl)].
During bronchoscopy in elder patients the development of respiratory acidosis is a hazard. A new and improved ventilation bronchoscope decreases the risk, which was demonstrated by blood gas analyses. This bronchoscope differs from those normally used in the following ways: 1. An inflatable cuff on the outer tube seals the bronchoscope like a breathing tube against the trachea. 2. This bronchoscope, although in the endobronchial position, improves the ventilation of the contraleateral lung aided by wider side holes lying above the bifurcation. 3. Jet-ventilation can be employed.
Acidosis, Respiratory↗
[An improved bronchoscope (author's transl)].
This bronchoscope differs from those normally used in the following ways: 1. In the endobronchial position the bronchoscope makes possible improvement in ventilation of the contralateral lung by increasing the area of the side-openings above the bifurcation. - 2. An inflatable cuff on the outer tube seals the bronchoscope against the trachea like a breathing tube. - 3. Jet-ventilation van be employed when the bronchoscope is open.
Bronchoscopes↗
A study of glutaraldehyde disinfection of fibreoptic bronchoscopes experimentally contaminated with Mycobacterium tuberculosis.
Mycobacteria are difficult to inactivate, and concern about the spread of tuberculosis at bronchoscopy has a major influence on infection control practices. Recommendations from the UK Department of Health are based largely on in-vitro mycobactericidal assays which do not take into account the particular conditions encountered in endoscopy units. In this applied study cleaning and disinfection methods were examined using five bronchoscopes that were heavily contaminated with a recent isolate of Mycobacterium tuberculosis in sputum. Cleaning reduced contamination by a mean 3.5 log(10) colony forming units (cfu) per ml; all bronchoscopes were free of detectable mycobacteria after 10 min in 2% alkaline glutaraldehyde (AG). It is recommended that all bronchoscopes be thoroughly pre-cleaned and disinfected in 2% AG for 20 min as part of a uniform policy of infection control.
Bronchoscopes↗
Foreign body removal with the flexible fiberoptic bronchoscope.
Intrabronchial foreign bodies are occasionally encountered in adults but most available information in humans consists only of reports evaluating one or two cases. We surveyed our experience and found seven patients with intrabronchial foreign bodies who had been examined with the flexible fiberoptic bronchoscope, six of whom were managed successfully. Nine cases have been identified in the literature. Although there were no major complications in either our cases or those in the literature, several problems were identified which under other circumstances could have caused significant complications. We assessed all of these cases for situations which presented potential risk to the patient. These risks were grouped into the following problem categories: 1. selection of appropriate bronchoscope, 2. availability of appropriate instruments, 3. control of the foreign body, and 4. unexpected foreign bodies. Endoscopists planning to use the FFB in foreign body removal should be aware of the problems and hazards which may ensue if improperly managed, and should attempt to gain experience either in the animal laboratory or in models prior to approaching patients with foreign bodies with the flexible fiberoptic bronchoscope.
Adolescent↗
Flexible-bronchoscope biopsy of lung and bronchial wall in intrathoracic sarcoidosis.
1) Twenty of 25 patients (80%) with sarcoidosis had positive lung biopsies obtained by flexible-bronchoscope biopsy. 2) Three of the 5 negative biopsies were in patients with chronic sarcoidosis whose chest radiograph was unchanged for 1 yr or more. 3) Two insignificant pneumothoraces occurred as a complication of the bronchoscopic biopsy procedures. 4) Noncaseating epithelioid-cell granulomas found on fiberoptic bronchoscopic biopsy are no more specific for the diagnosis of sarcoidosis than similar findings in any other organ biopsy.
Biopsy↗
Endobronchial tuberculosis. Clinical and bronchoscopic features in 121 cases.
The clinical and bronchoscopic features of endobronchial tuberculosis in 121 patients were retrospectively investigated. The peak incidence occurred in the second decades, with 3.8 times higher incidence noted in female than in male subjects. A barking cough with sputum was the most common chief complaint in 61.1 percent. Parenchymal infiltration and/or consolidation was the most common roentgenographic finding of the chest in 58.6 percent. Hypertrophy with luminal narrowing was the most common bronchoscopic finding in 43 percent. Bronchoscopically, right upper and right main bronchus were the most frequently involved in 30.5 percent. It was concluded from these data that using fiberoptic bronchoscopy allows not only substantial meaningful assessment of endobronchial tuberculosis but also relieves atelectasis eventually resulting in successful treatment with antituberculosis drugs.
Bronchi↗
Tracheal stenosis. A method of dilation with use of the fiberoptic bronchoscope.
Tracheal stenosis is not an uncommon sequel of prolonged endotracheal intubation. In some cases, immediate reconstruction is not feasible. We use the flexible fiberoptic bronchoscope and a lucent, tapered endotracheal tube for tracheal dilation. The fiberoptic bronchoscope is passed through a special T connector into the endotracheal tube and used to guide the tube under direct vision through the stricture.
Adult↗
Pleuroscopy and cautery control of intrathoracic hemorrhage with a flexible fiberoptic bronchoscope.
Intrathoracic hemorrhage from adhesions torn by a spontaneous pneumothorax is relatively uncommon. Continued hemorrhage from such adhesions after the evacuation of 1,500 ml of blood would usually require thoracotomy for control. Through a flexible fiberoptic bronchoscope, we confirmed the source of hemorrhage and cauterized the bleeding point. This case illustrates another application for pleuroscopic examination, further broadening the use of the flexible fiberoptic bronchoscope.
Adult↗
Control of high density bacterial contamination of the fiberoptic bronchoscope.
In a double-blind study the fiberoptic bronchoscope was contaminated with five pathogenic organisms, each at a concentration of 10(9) organisms per milliliter. The shaft and inner channel of the bronchoscope were cleansed with five antiseptic regimens. Each regimen included equal 120-ml aliquots of one, two, or three solutions, respectively. The five different regimens were as follows: (1) physiologic saline solution; (2) 70 percent solution of isopropyl alcohol, followed by physiologic saline solution; (3) alkaline glutaraldehyde, followed by 70 percent solution of isoproply alcohol, followed by physiologic saline solution; (4) benzalkonium chloride, followed by 70 percent isopropyl alcohol, followed by physiologic saline solution; and (5) povidone-iodine solution, followed by 70 percent solution of isopropyl alcohol, followed by physiologic saline solution. The four regimens involving solutions other than saline solution alone were effective in reducing the count of residual bacterial colonies to 10(4) colonies per milliliter or less.
Alcohols↗
Bronchoscopic laser photodestruction of benign tumours in the trachea and large bronchi.
Potentialities and results of laser bronchoscopic surgery of exophytic benign tumours of the trachea and bronchi are described. The material includes 37 patients (33 men and 4 women) aged 28-69 (mean age 51 years). Tumours were removed by the Nd-YAG laser. In six patients laser photodestruction was combined with electrosurgery. In 31 patients manipulations were done via bronchofiberscope under local anaesthesia and in six patients via a rigid bronchoscope under general anaesthesia. Complete removal of pathologic tissues was achieved in all patients. During 1-5 years of follow-up none of the patients developed recurrent tumours.
Adult↗
Clinical performance of the Abbott RealTime Mycobacterium tuberculosis (MTB) PCR on bronchoscopic specimens for diagnosing pulmonary tuberculosis.
PURPOSE: We evaluated the performance of the Abbott RealTime Mycobacterium tuberculosis (MTB) PCR (RT MTB) on bronchoscopic specimens using conventional culture as the reference standard in a low-Tuberculosis (TB) prevalence setting. METHODS: A total of 6,988 specimens (4,682 bronchial aspirates [BAS] and 2,306 bronchoalveolar lavages [BAL]) from 4,118 patients with suspected pulmonary TB were included. When BAS and BAL specimens from the same bronchoscopy procedure were available, these were mixed 1:1 prior to culture inoculation and PCR testing. Following processing, specimens were inoculated into a Löwenstein-Jensen and a Bactec MGIT 960 tube and incubated at 37 °C for 3 months and at 35 °C for 8 weeks, respectively. RT MTB was performed as indicated by the manufacturer. RT MTB targets the insertion sequence IS6110 and the protein antigen B (PAB) gene, both highly conserved within the Mycobacterium tuberculosis complex. Whole genome Next generation sequencing of clinical MTBC isolates was performed when indicated. RESULTS: Among the 104 culture-positive specimens, 84 (1.2%) were detected by PCR. Additionally, 16 specimens (0.3% of all samples), from 16 patients, were PCR-positive despite negative culture results. Conversely, 20 specimens (0.4% of all samples), from 19 patients, were culture-positive but not detected by PCR. No significant differences were found between PCR-positive and PCR-negative specimens with respect to the number of IS6110 copies per isolate or PAB gene sequences (P = 0.69). Finally, there were 4,683 specimens (97.4%) from the remaining 4,014 patients tested PCR-negative/Culture-negative. Following the resolution of discrepancies based on clinical grounds the sensitivity and specificity of RT MTB were 83.9% (CI 95%, 76.0-90.0) and 99.9% (CI 95%, 99.9-99.9), respectively. These results exceed the minimum performance requirements defined in the WHO Target Product Profiles for molecular TB diagnostics. Although RT MTB is not a point-of-care test but rather a moderate-complexity automated NAAT, it is recommended by WHO as part of the Abbott RealTime MTB/MTB RIF-INH testing algorithm, in which MTBC detection by RT MTB is followed by reflex testing with the MTB RIF/INH assay for detection of rifampicin and isoniazid resistance. CONCLUSION: RT MTB shows a good performance on bronchoscopic specimens.
Mycobacterium tuberculosis↗
Fluoroscopically controlled transbronchial biopsy of solitary peripheral pulmonary lesions using the fibreoptic bronchoscope.
Experience of fluoroscopically controlled transbronchial biopsy using the fibreoptic bronchoscope in 30 patients with solitary lesions in the peripheral lung fields beyond bronchoscopic vision is described. At the time of submitting this paper for publication (30 January 1978) no account of the technique has been reported in the British literature. In 21 patients with a final diagnosis of bronchial carcinoma a positive biopsy diagnosis was obtained in 14 (67%). Five of seven patients (71%) with a final diagnosis of an inflammatory condition showed evidence of acute or chronic inflammation on biopsy. There were no complications. The procedure is indicated when a definitive diagnosis is required for management planning in clinically inoperable patients, or when a tissue diagnosis is particularly desired in an attempt to obviate the need for thoracotomy. The relative safety makes this the biopsy technique of choice for the evaluation of isolated peripheral pulmonary opacities.
Biopsy↗