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Biomedical subjects

D Shure

Publications and source records attributed to D Shure.

29 records · Page 2Linked to original sources
PubMed1985

Carinal forceps biopsy via the fiberoptic bronchoscope in the routine staging of lung cancer.

Main carinal biopsy was carried out in 58 consecutive patients with endobronchial (endoscopically visible) bronchogenic carcinoma. Overall, the results of the biopsy were positive in 8 of 58 patients (13.8%). The biopsy results were positive in 6 of 15 (40%) patients whose carina appeared abnormal as compared with 2 of 43 (4.7%) whose carina appeared normal (P = .0025). In those patients with subtle carinal abnormalities (carinal widening or erythema) but without gross tumor involvement, the biopsy findings were positive in 5 of 14 (36%). Unlike in previous studies, a significant percentage of positive carinal biopsy findings was associated with left upper lobe lesions. There were no complications associated with the procedure. Although the yield on blind carinal biopsies (visually normal carina) with the flexible fiberoptic bronchoscope is lower than that previously reported with the rigid bronchoscope, it remains a low-risk procedure that can spare a number of patients the morbidity and expense of more invasive surgical staging when applied as a routine part of diagnostic bronchoscopy in patients with endoscopically visible bronchogenic carcinoma.

Bronchoscopy↗
PubMed1984

Hemodynamics and gas exchange during angioscopy in the dog.

We have previously developed a technique for the in vivo visualization of the pulmonary arteries in the experimental animal with a fiberoptic instrument (angioscope). To assess the potential hemodynamic and gas exchange effects of angioscopy, we studied five dogs before and after pulmonary embolization. Sequential observations were made of arterial blood gases, mean arterial pressure, pulmonary artery pressure, heart rate, cardiac output, and the electrocardiogram. The most common arrhythmias were ventricular premature contractions which were comparable to those seen with right heart catheterization. Statistically significant, but clinically minor, effects were found on cardiac output, mean arterial pressure, and heart rate in dogs when angioscopy was performed after pulmonary embolization. We conclude that fiberoptic angioscopy does not induce deleterious effects on hemodynamics or gas exchange in the experimental animal, prior to or after embolization.

Animals↗
PubMed1984

The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma.

Transcarinal needle aspiration for staging subcarinal nodes was performed in 134 consecutive patients with suspected bronchogenic carcinoma at the time of diagnostic fiberoptic bronchoscopy using a prototype 20-gauge by 1-cm needle. The aspiration was performed before examination of the lower airways to avoid cellular contamination. Twenty-four patients had benign primary disease and negative needle aspirates. The transcarinal needle aspirate was positive in 15 percent of the 110 patients with bronchogenic carcinoma. There were no false-positives, and the transcarinal needle aspirate was the only evidence of unresectability in 69 percent (11/16) of those in whom it was positive. In addition, two subgroups of patients were identified in whom the aspirate is most likely to be positive--patients with endobronchial tumors (24 percent; 15/63) and those with an abnormal carina at bronchoscopy (38 percent; 8/21). No complication occurred. We conclude that transcarinal needle aspiration is a low-risk procedure that can save a significant number of patients the morbidity and cost of surgical staging and that it should be performed at the time of diagnostic bronchoscopy in all patients with an endobronchial lesion or a visually abnormal carina.

Adult↗
PubMed1983

Transbronchial needle aspiration of peripheral masses.

Transbronchial needle aspiration through a flexible fiberoptic bronchoscope was performed on peripheral lung masses in 42 consecutive patients with bronchogenic carcinoma using a 20-gauge by 1-cm prototype needle. The aspiration was preceded by routine washings and brushings and followed by transbronchial forceps biopsy. Adding transbronchial needle aspiration to the standard combination of transbronchial biopsy, brush, and wash significantly improved the diagnostic yield (48 to 69%, p = 0.046). Considering only lesions 2 cm or greater in diameter, the combination of transbronchial needle aspiration, brush, and wash was superior to transbronchial biopsy, brush, and wash (76 versus 52%, p = 0.041). No complications occurred with either transbronchial needle aspiration or transbronchial biopsy, but transbronchial needle aspiration produced less bleeding than did transbronchial biopsy. We conclude that transbronchial needle aspiration of peripheral mass lesions is a safe procedure that can increase the diagnostic yield of flexible fiberoptic bronchoscopy.

Aged↗
PubMed1983

Bronchogenic carcinoma presenting as an endobronchial mass.

The purpose of this study was to determine the optimal number of biopsy specimens which should be taken of an endobronchial mass lesion to assure the diagnosis of bronchogenic carcinoma. Five biopsies were performed on each of 18 consecutive mass lesions. Before biopsy, the tumor was well visualized, cleared of blood if possible, and the forceps carefully placed on the mass. Each biopsy specimen was placed in a separate coded container so that the pathologic interpretation was blind to the order in which the samples were taken. Ten out of a total of 90 biopsy specimens were negative for tumor and all of the tumors were diagnosed within the first three biopsy samples. The totals of negative diagnoses for each of the five biopsy specimens were not significantly different by the approximate Cochran Q test (p = 0.441) or by the exact test (p = 0.360), and no evidence was found for dependence of successive biopsies (p = 0.106) or for a patient effect (p = 0.325). The estimated probability of obtaining a diagnosis of malignancy after one biopsy was .889; after two biopsies, .9877; and after three, .9986. The yield is not meaningfully increased with more biopsies being done. We suggest performing three biopsies of endobronchial mass lesions to achieve an optimal diagnostic yield with minimal risk of bleeding.

Adenocarcinoma↗
PubMed1982

Sensitivity, specificity, and risk of diagnostic procedures in a canine model of Streptococcus pneumoniae pneumonia.

A canine model in which unilateral Streptococcus pneumoniae pneumonia was induced was used to evaluate the sensitivity, specificity, and risk of various technics proposed for the diagnosis of pulmonary infection. Control and infected animals were studied during spontaneous and mechanical ventilation. We found that three procedures provided a reasonable degree of combined specificity and sensitivity: transthoracic needle aspiration (TTN), catheter-brush biopsy (CBB), and transbronchial biopsy (TBB). Transtracheal aspiration, although sensitive, was consistently low in specificity, whereas TTN provided the highest sensitivity/specificity. Both CBB and TBB provided almost the same results in intubated animals, but specificity was lower in nonintubated animals. Gram-stained smears obtained by TTN, CBB, and TBB were highly specific, but often negative. The only risk encountered was pneumothorax. The TTN was associated with a 20 to 30% risk of pneumothorax; CBB and TBB did not appear to induce pneumothorax. These studies provide the first animal data regarding the comparative yield/risk of these diagnostic approaches. As such, they may prove useful in the design of future human investigations.

Animals↗
PubMed1981

Identification of pulmonary emboli in the dog: comparison of angioscopy and perfusion scanning.

Fifteen dogs were studied by perfusion scan, angioscopy and autopsy. In 10, emboli were formed in leg veins and released before study; five dogs were not embolized and served as controls. In controls, angioscopy disclosed no emboli, perfusion scans were normal after angioscopy and autopsy disclosed no emboli. Among the embolized dogs, 23 emboli were identified at autopsy. Perfusion scans disclosed 23 defects, but in three dogs there was a disparity between scan and autopsy localization. Angioscopy identified 21 of the 23 autopsy-defined emboli and localized them correctly; two emboli in vessels less than 1 mm in diameter were not visualized. Angioscopy may provide a useful new approach in animal investigations of pulmonary embolism and perhaps, after additional study, in selected patients.

Animals↗
PubMed1980

Angioscopic visualization of pulmonary emboli.

A flexible, fiberoptic device, fitted with an inflatable distal balloon, has been used to directly visualize the great veins, right cardiac chambers, pulmonary arteries, and experimental emboli in vivo in the dog. Insertion and manipulation of the device have been well-tolerated. The angioscope has significant potential for investigative and clinical application.

Animals↗