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Biomedical subjects

Henri G Colt

Publications and source records attributed to Henri G Colt.

11 recordsLinked to original sources
PubMed2007

A spray catheter technique for pleural anesthesia: a novel method for pain control before talc poudrage.

BACKGROUND: Chemical pleurodesis causes severe pain, prompting physicians to perform thoracoscopic talc poudrage under general or neuroleptanalgesia. We describe a novel method for pain control in five patients with pneumothoraces and severe chronic obstructive pulmonary disease. METHODS: Patients were premedicated with IM pethidine and IV midazolam. The pleural space was examined with the flex-rigid pleuroscope. Before talc poudrage, 250 mg lidocaine was administered via spray catheter, and pain scores measured immediately after the procedure and on postoperative days 1 and 2 were 3, 2, and 2, respectively. RESULTS: No complications were noted, and 30-day mortality was 0%. CONCLUSION: Lidocaine via spray catheter is effective for pain control before pleurodesis.

Aged↗
PubMed2006

Thoracoscopy: origins revisited.

The ways in which thoracoscopy has evolved wonderfully illustrate how a diagnostic and therapeutic technique can transcend a particular medical or surgical subspecialty. In this review, an in-depth history is provided to enable readers to better understand the nature of minimally invasive endoscopic pleural imaging techniques.

Equipment Design↗
PubMed2006

Tracheobronchomalacia and excessive dynamic airway collapse.

Tracheobronchomalacia and excessive dynamic airway collapse are two separate forms of dynamic central airway obstruction that may or may not coexist. These entities are increasingly recognized as asthma and COPD imitators. The understanding of these disease processes, however, has been compromised over the years because of uncertainties regarding their definitions, pathogenesis and aetiology. To date, there is no standardized classification, diagnosis or management algorithm. In this article we comprehensively review the aetiology, morphopathology, physiology, diagnosis and treatment of these entities.

Airway Obstruction↗
PubMed2006

In vitro study of the safety limits of bronchoscopic argon plasma coagulation in the presence of airway stents.

OBJECTIVE AND BACKGROUND: The purpose of this study was to identify the safety limits of bronchoscopic argon plasma coagulation (APC) around indwelling airway stents. METHODOLOGY: This is an experimental in vitro study simulating a patient-care environment. Uncovered and covered Nitinol (Ultraflex), uncovered and covered Wallstent and studded silicone stents were deployed in the tracheobronchial tree of a ventilated and oxygenated heart-lung block from an expired pig. APC was performed at power settings of 40 and 80 W using F(I)O(2) of 0.21, 0.40 and 1.00 and an argon gas-flow rate of 0.8 L/min through a flexible fiberoptic bronchoscope. The primary outcome was the time taken for the APC to cause stent damage. Stent damage was defined as discoloration, ignition or rupture. RESULTS: Airway fires involving all five stents consistently occurred in the presence of 100% oxygen at powers of 40 W and 80 W. At lower F(I)O(2) (0.21 and 0.40) silicone stents were not damaged at 40 W and 80 W. Uncovered Ultraflex stents were undamaged using 40 W at either F(I)O(2) (0.21 and 0.40), but could be damaged using both F(I)O(2) levels when the power was increased to 80 W. Covered Ultraflex and both uncovered and covered Wallstents were damaged at both power settings (40 W and 80 W) and F(I)O(2) (0.21 and 0.40) levels, with a trend towards earlier damage using higher F(I)O(2) and power. CONCLUSION: Working within the parameters identified in this study (power 40 W, F(I)O(2) 0.21, APC flow-rate 0.8 L/min), APC is a safe method for tissue devitalization and destruction and avoids the risk of airway stent ignition, especially if short bursts of APC are employed. The safety limits identified using an F(i)O(2) of 0.4, however, are also important because some patients undergoing resection may require oxygen therapy.

Animals↗
PubMed2006

Writing an application for a human subjects institutional review board.

After reading this article, readers will be able to do the following: understand the role and responsibilities of an institutional review board (IRB); recognize the major areas that must be addressed in an IRB submission; and avoid common mistakes in writing a research application submission to an IRB.

Documentation↗
PubMed2006

Treatment of adult tracheobronchomalacia and excessive dynamic airway collapse : an update.

Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are both dynamic forms of central airway obstruction characterized by a decrease of >/=50% in the cross-sectional area of the tracheobronchial lumen. The differences between these two entities, however, are not uniformly accepted in the medical community. While TBM is characterized by a weakness of the tracheobronchial cartilaginous structures, EDAC is marked by excessive bulging of the posterior membrane into the airway lumen during exhalation. These disease entities are probably underdiagnosed because they present with a variety of nonspecific symptoms similar to patients with other obstructive ventilatory disorders such as asthma and COPD. Diagnosis is confirmed by dynamic radiologic imaging studies or bronchoscopy. Current therapeutic management depends on the extent, type, and severity of airway abnormalities noted and the clinical presentation. Proposed management alternatives include conservative medical therapy, and minimally invasive and open surgical interventions. Inhaled bronchodilators should be used only if symptoms and ventilatory function improve after use. Continuous positive airway pressure acts as a pneumatic stent and should be considered as an alternative or additional therapeutic modality. Endoluminal stent insertion can improve symptoms and pulmonary function in patients with central airway obstruction and should be considered for patients with symptoms refractory to conservative therapy. Several open surgical procedures have also been performed over the years, including tracheostomy, airway splinting, tracheal resection and, more recently, external tracheal stents. Endobronchial laser therapy, resorbable stents, application of grafting materials used to support the collapsed airway as well as the use of cartilage regeneration techniques are experimental, and their efficacy in humans remains to be determined. Future studies should compare therapeutic interventions and outcomes such as functional status, ventilatory function, and bronchoscopic and radiologic appearances in order to define the costs and benefits of individual and combined treatment modalities.

Adult↗
PubMed2005

Rigid and semirigid pleuroscopy: the future is bright.

Pleuroscopy provides the pulmonologist with a unique opportunity to visualize the contents of the pleural space, perform biopsy of the parietal pleura under direct visual guidance, allow optimal chest tube placement and perform pleurodesis to prevent recurrent pleural effusion or pneumothorax in selected patients. We discuss the techniques, indications, contraindications and complications of pleuroscopy using rigid and semirigid instruments. In addition, the potential value and expanding role of pleuroscopy with semirigid instrumentation is debated.

Contraindications↗
PubMedDate not supplied

Virtual reality and written assessments are of potential value to determine knowledge and skill in flexible bronchoscopy.

BACKGROUND: Technically challenging professions such as those of the defense and transportation industries increasingly use computer-based simulation and written self-learning instruments for education and to determine competency. A structured learning curriculum does not exist, however, for flexible bronchoscopy, a minimally invasive diagnostic procedure performed on thousands of patients by respiratory specialists, otolaryngologists, anesthesiologists, and surgeons worldwide. OBJECTIVE: To explore an analogous strategy of measuring theoretical knowledge in flexible bronchoscopy and specific technical skills using written knowledge assessments and a virtual reality bronchoscopy simulator. METHODS: Twelve trainees from a university pulmonary medicine training program were asked to identify and enter five specific bronchial segments on command using a virtual reality bronchoscopy skill station, and to complete a 50-question examination pertaining to bronchoscopy theory. Their performance scores and opinions pertaining to the use of these methods of assessment were then recorded. RESULTS: Trainees correctly identified and entered 71% of the bronchial segments required on command (median 60%, range 40-100%). Fifty percent (3/6) of the trainees who had performed more than 200 flexible bronchoscopies successfully entered all segments required. None (0/6) of those who had performed less than 200 flexible bronchoscopies correctly located, identified and entered all required segments. Despite disparate performance, all trainees believed that technical skills could be improved through practice and instruction using computer-based simulation. On the written assessment, only 51% of questions were answered correctly (median 52%, range 32-60%). No relationship between technical skill and theoretical knowledge was noted. In addition, neither bronchoscopy skill nor theoretical knowledge were associated with years of training or number of bronchoscopies previously performed. CONCLUSIONS: Trainees concluded that (1) bronchoscopy simulation was realistic, (2) simulator-based practice would help improve technical skills, and (3) a written questionnaire would benefit theoretical knowledge acquisition if designed as a learning instrument. The wide variability noted in this study as well as the lack of a relationship between technical skill, knowledge of bronchoscopy theory, extent of training, and bronchoscopy experience suggest that competency should not be assumed based on years of bronchoscopy training or on an arbitrary number of procedures performed.

Bronchoscopy↗