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At least 253 records · Page 14Linked to original sources

PubMed1990

[Results of bronchoscopy studies in patients with pleural effusion].

The authors investigated in a group of 141 patients included in a study of pleural exudates at the Second Clinic for TB and Respiratory Diseases, Medical Faculty, Charles University Prague, endoscopic findings in correlation with the basic diagnosis and type of exudate. The group comprised 45 women and 96 men, mean age 52 and 54 years resp. 60.3% of the group suffered from neoplastic disease, most frequently bronchogenic carcinoma which was recorded in 56 of the patients. 114 patients were subjected to bronchoscopy, a tumour was detected by this examination in 33%, inflammatory changes in 19%, stenosis of the segments in 9% and merely dilated carinae in 3% of the subjects with pleural exudates who were subjected to bronchoscopy. The authors verified during bronchoscopy by cytological or histological examination 79% bronchogenic carcinomas, 35% other tumours. Bronchoscopy was the decisive examination; due to it the type of exudate was determined in 17 patients, i. c. 12%. In patients with other than neoplastic disease the endoscopic finding supported the basic diagnosis in 30% of the examined subjects, but did not assess the type of exudate in any of the patients. Bronchoscopy revealed pathological changes in 16 patients (11% of the group) where the skiagram of the chest indicated only changes suggesting a pleural exudate. Fifteen of them suffered from neoplastic disease, one from TB of the intrathoracic nodes. The authors conclude that the importance of bronchoscopic examination in patients with pleural exudates is increasing due to the changed spectrum of basic diagnoses and that it should be made in all patients with an obscure pleural exudate.

Bronchoscopy↗

PubMed1990

[Diagnostic value of bronchoscopy in diagnosis of pulmonary tuberculosis: bronchial aspirate, bronchial washing and transbronchial lung biopsy].

The diagnosis of pulmonary tuberculosis is confirmed by the detection of Mycobacterium tuberculosis in sputum. Bronchoscopy has been used for diagnosis of various pulmonary diseases. The value of bronchoscopy such as bronchial aspirate, bronchial washing and transbronchial lung biopsy in diagnosis of pulmonary tuberculosis was evaluated, and the results were as follows: 1) One hundred ninety cases were investigated bronchoscopically due to suspicion of pulmonary tuberculosis with sputum negative smear and 92 cases were confirmed to be pulmonary tuberculosis. 2) Out of 91 cases examined by bronchial aspirate and 46 cases by bronchial washing, smear positivity was 20.9% and 23.9% and culture positivity was 58.2% and 84.8%, respectively. Transbronchial lung biopsy showed positive findings of tuberculosis in 75.8% out of 33 specimens. 3) Out of 88 sputa taken before bronchoscopy and 50 sputa after bronchoscopy, smear positivity was 0% and 12%, and culture positivity was 54.5% and 40% respectively. Gastric lavage culture positivity was 29.4% in 17 cases examined. 4) Diagnosis of tuberculosis was made rapidly in 28 cases (30.4%) by smear positive results of bronchial aspirate, bronchial washing and sputa after bronchoscopy, and relatively rapidly in 20 cases (21.7%) by transbronchial lung biopsy.

Biopsy↗

PubMed1989

Flexible bronchoscopy for foreign body in airway.

The flexible bronchoscopy has not yet been popular in the foreign body in the airway, especially in children. We performed the flexible bronchoscopy for 27 patients with foreign bodies in the airway including 22 patients who had not been removed foreign bodies by the rigid bronchoscopy. Nineteen of 27 patients were children. The success rate of flexible bronchoscopy was 81% (22/27 cases) in all patients, 77% (17/22 cases) in patients failed by the figid bronchoscopy, and 82% (9/11 cases) in young children of 2 years old or less. For the removal of foreign bodies under the flexible bronchoscope, a biopsy forceps and a Fogarty balloon catheter were effective. The flexible bronchoscope is useful for foreign bodies in the airway, even in young children.

Adolescent↗

PubMed1995

[Fiber bronchoscopy in old age. Its diagnostic importance, tolerability and safety].

Fibreoptic bronchoscopic procedure has arisen as fundamental investigation in pneumology. This is of documented value regarding young subjects, however the utility of bronchoscopy in the elderly has not yet been fully evaluated. The aim of this study was to assess the efficacy and safety of fibreoptic bronchoscopy in the elderly. We analyzed both retrospectively and prospectively our experience evaluating the indications, endoscopy findings and tolerance of the procedure in this population. Obviously patients suffering from mental illness or psychotic disease have been not included in this second session of the study. We found that elderly subjects were better compliant than young patients for the bronchoscopic procedure. The analysis showed that no differences were found, between young and elderly patients, for the total number of complications recorded. Analysing the results concerning investigations for haemoptysis we have also observed a high diagnostic value for fibreoptic bronchoscopy even in the aged group, particularly for neoplastic diseases. Our data demonstrate that fibreoptic bronchoscopy is a well tolerated procedure even in elderly patients and is associated with few complications. Fibreoptic bronchoscopy procedure provides useful diagnostic guidelines which enhances the choices of a more appropriate treatment.

Aged↗

PubMed1993

Fibreoptic bronchoscopy in the diagnosis of pulmonary tuberculosis--a Malaysian experience.

We report our experience on the use of fibreoptic bronchoscopy in the diagnosis of pulmonary tuberculosis. The case records of 1,274 patients who underwent fibreoptic bronchoscopy at the National Tuberculosis Centre, Kuala Lumpur, Malaysia during a three-year period were reviewed. In 120 of them the final diagnosis was tuberculosis. Bronchoscopy confirmed the diagnosis in 37 patients (30.8%). This was achieved by bronchial aspiration for culture in 26 patients (70.3%) and bronchial biopsy for histopathology in 11 patients (29.7%). It was the exclusive method of confirmation in 16 patients (13.3%). Sputum culture was positive in 62 patients (51.7%) including 41 patients (34.2%) in whom bronchoscopy was unhelpful. Six patients had diagnosis confirmed by other means while in 36 others (30%) it was based on clinical features and supportive basic investigations. There were no complications noted. We conclude that while sputum examination remains the mainstay for diagnosing pulmonary tuberculosis, fibreoptic bronchoscopy serves as a safe and useful adjunct.

Adolescent↗

PubMed1995

Laser bronchoscopy.

The worldwide epidemic of cancer of the lung has stimulated the development of therapies to relieve endobronchial obstruction. Table 3 lists a number of endobronchial therapies that might be used to treat malignant central airway obstruction. With over 15 years of worldwide experience, the Nd:YAG laser has proven to be the most important of these tools. Laser bronchoscopy can be performed with rigid or flexible instruments and produces a rapid recanalization of the airway with associated relief of symptoms. The treatment is repeatable and has acceptable immediate complications and infrequent delayed complications. To be effective, laser bronchoscopy can only be used for the treatment of intraluminal obstructions. Obstruction by submucosal infiltration and external compression require other endobronchial therapies. The performance of laser bronchoscopy requires an extra commitment by the bronchoscopist. A thorough understanding of airway and mediastinal anatomy is mandatory along with an appreciation of laser physics and tissue interaction. Attendance at specialized training courses may be required to satisfy local credentialing bodies. In the past 15 years, thousands of patients have benefited from the development of laser bronchoscopy techniques. No longer a therapy of last resort, laser bronchoscopy has proven to be an excellent tool to relieve the symptoms of central airway obstruction.

Anesthesia↗

PubMed1996

[The effect of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on results of spirometric measurements].

The effect of fiberoptic bronchoscopy and bronchoalveolar lavage on the functioning of the respiratory system was studied in 72 patients (42 males and 30 females). The bronchoscopy was performed in the sitting position. Supplemental oxygen was not given to all the evaluated patients. The group included 24 patients with lung cancer, 9 with sarcoidosis, 12 with tuberculosis, 1 with farmer's lung and 10 with other lung diseases (pneumonia, COPD). A control group consisted of 16 patients who were undergoing routine diagnostic endoscopy but who were seen to be without lung disease. Group BF (39 individuals) received only a bronchoscopic examination, group BF+BAL (33 persons) received a bronchoscopy followed by BAL using 140 ml. of normal saline solution as a lavage fluid. After the bronchoscopic examination there were significant differences in all spirometric measurements, except MEF25. The bronchoscopy and bronchoalveolar lavage caused a transient fall in FEV1, VC, MEF50, MEF75 (7.7-9.4%) which was similar in both groups. These measurements returned to normal after 24 hours. The testing of pulmonary functioning before the bronchoscopy was seen to be clinically important for safety of the patient undergoing this procedure.

Adult↗

PubMed1976

Current developments in bronchoscopy. The role of the flexible fiberscope.

The development and increasing use of flexible fiberoptic bronchoscopy has added immeasurably to the potential of diagnostic and therapeutic bronchoscopy. However, neither the flexible nor rigid (open tube) bronchoscope should be regarded as the "primary instrument", but the use of one or the other in the individual case should depend on relative indications. Ideally, bronchologists should be proficient with both rigid and flexible instruments; it is preferable that those experienced only in flexible bronchoscopy work in collaboration with those who are familiar with open tube bronchoscopy as well. In any case, the need for facility in management of airway obstruction, indirect and direct laryngoscopy, and proper administration of topical anesthetics to the larynx and tracheobronchial tree should be recognized. Indications, instrumentarium and technique, special applications, contraindications and complications of flexible bronchoscopy are reviewed.

Airway Obstruction↗

PubMed2000

A pseudo-outbreak of Aureobasidium species lower respiratory tract infections caused by reuse of single-use stopcocks during bronchoscopy.

OBJECTIVE: To investigate and control an apparent outbreak of lower respiratory tract infections due to Aureobasidium species. DESIGN: Outbreak investigation. SETTING: University-affiliated medical center. PATIENTS: Nine patients who underwent bronchoscopy between June and August 1998. RESULTS: Ten bronchoalveolar lavage (BAL) fluid cultures from nine patients grew Aureobasidium species during the outbreak period; whereas, respiratory specimens from only two patients grew Aureobasidium species during the preceding 6 years. No patient was judged to have true infection due to Aureobasidium species either before or after bronchoscopy. Nine of the 10 bronchoscopies that yielded Aureobasidium species were performed in the outpatient bronchoscopy suite. The Aureobasidium isolates were not associated with any one bronchoscope. Observation of bronchoscopy procedure revealed that plastic stopcocks labeled for single use were reused on different patients during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfection machine designed for bronchoscopes. Culture of the stopcocks after they had been "disinfected" yielded a heavy growth of Aureobasidium species, while culture of fluid from the automated disinfection machine was negative. Reuse of the stopcocks was halted, and, during the following 6-month period, Aureobasidium species were not isolated from any BAL specimen. CONCLUSIONS: Reuse of medical equipment labeled for single use is potentially hazardous, especially if no quality control system is in place to monitor sterility and function after reprocessing.

Bronchoalveolar Lavage↗

PubMed2001

Nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa following bronchoscopy associated with improper connection to the Steris System 1 processor.

OBJECTIVE: To assess nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa (IRPA) following bronchoscopy during August through October 1998. DESIGN: Traditional and molecular epidemiological investigation of a case series. SETTING: University-affiliated community hospital. PATIENTS: 18 patients with IRPA bronchial-wash isolates. INTERVENTIONS: We reviewed clinical data, performed environmental cultures and molecular analysis of all IRPA isolates, and observed disinfection of bronchoscopes. RESULTS: Of 18 patients who had IRPA isolated from bronchoscopic or postbronchoscopic specimens, 13 underwent bronchoscopy for possible malignancy or undiagnosed pulmonary infiltrates. Following bronchoscopy, 3 patients continued to have IRPA isolated from sputum and demonstrated clinical evidence of infection requiring specific antimicrobial therapy. The remaining 15 patients had no further IRPA isolated and remained clinically well 3 months following bronchoscopy. Pulsed-field gel electrophoresis revealed that all strains except one were >95% related. STERIS SYSTEM 1 had been implemented in July 1998 as an automatic endoscope reprocessor (AER) for all endoscopes and bronchoscopes. Inspection of bronchoscope sterilization cycles revealed incorrect connectors joining the bronchoscope suction channel to the STERIS SYSTEM 1 processor, obstructing peracetic acid flow through the bronchoscope lumen. No malfunction warning was received, and spore strips remained negative. CONCLUSIONS: The similarity of diverse connectors and limited training by the manufacturer regarding AER for bronchoscopes were the two factors responsible for the outbreak. Appropriate connections were implemented, and there was no further bronchoscope contamination. We suggest active surveillance of all bronchoscopy specimen cultures, standardization of connectors of various scopes and automated processors, and systematic education of staff by manufacturers with periodic on-site observation.

Bronchoscopes↗

PubMed1998

Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study.

BACKGROUND: Fiberoptic bronchoscopy has been recommended to verify the position of double-lumen tubes (DLT), but this remains controversial. The authors studied the role of bronchoscopy for placing and monitoring right- and left-sided DLTs after blind intubation and after positioning the patient. METHODS: Two hundred patients having thoracic surgery requiring DLT insertion were prospectively studied. "Blind" tracheal intubations were done with 163 left-sided and 37 right-sided disposable polyvinyl chloride Robertshaw tubes. Bronchoscopy was performed by a different anesthesiologist after intubation and conventional clinical verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malpositioned when it had to be moved >0.5 cm to correct its position. Critical malpositions were those that might have affected patient safety or influenced the surgical procedure if left uncorrected. RESULTS: After "blind" DLT intubation, clinical evidence of malpositioning was found in 28 patients. This was confirmed by fiberoptic assessment. In 172 patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 79 cases, 25 of which were critical. After patient positioning, DLTs were found to be displaced in 93 patients, 48 of which were critical. Right-sided DLTs were significantly more likely to be malpositioned than were left-sided DLTs. Two complications were related to unsatisfactory lung separation in the 200 patients studied. CONCLUSIONS: After blind intubation and patient positioning, more than one third of DLTs required repositioning. Routine bronchoscopy is therefore recommended after intubation and after patient positioning.

Adolescent↗

PubMed1997

[Exposure of the pediatric surgeon to inhalation-anesthetic during pediatric bronchoscopy procedures].

BACKGROUND: General anaesthetic agents are frequently used for paediatric bronchoscopy. A disadvantage of this open system anaesthesia seems to be the contamination of the working environment. The aim of this study was to determine the exposure of the endoscopist during paediatric bronchoscopy under general anaesthesia in different working environments and to compare these measurements with the currently valid international threshold limit values. MATERIAL AND METHODS: 25 children (ASA I-III) scheduled for diagnostic bronchoscopy were included in the study. After inhalational induction all children were intubated with a nonflexible bronchoscope and manually ventilated through a side arm of the bronchoscope. Maintenance of anaesthesia was achieved with sevoflurane (2-3 vol%) in 80% oxygen. Trace concentrations were measured every 90 seconds in the breathing zones of the paediatrician by means of a highly sensitive direct-reading instrument (Brüel & Kjaer 1302). The lower detection limit was 0.02 ppm. The investigation was done in an OT with and without air conditioning and scavening system. RESULTS: The mean age of the children was 50.3 months (range: 3-109 months). Ventilation and oxygenation were stable throughout the bronchoscopic procedure. Mean exposure of the paediatrician without air-conditioning and scavening system to sevoflurane was over 50 ppm for the endoscopist. All international threshold limit values were exceeded. Peak concentrations higher than 100 ppm sevoflurane were detected repeatedly in 40% of anaesthesias. During bronchoscopy in the operating room equipped with laminar air flow (20.2 air exchanges per hour) and narcotic gas evacuation (30 l/min) the mean exposure of the paediatrician was 26.4 ppm sevoflurane. CONCLUSIONS: The main finding of the present study is that under inhalation anaesthesia with sevoflurane for paediatric bronchoscopy occupation exposure is higher than the limits stated in all known health regulation guidelines. Therefore, in case of such working conditions, the use of total intravenous anaesthesia is advocated also in very small infants.

Adult↗

PubMed1988

Bronchoscopy for aspirated foreign bodies in children. Experience in 131 cases.

One hundred thirty-one children underwent rigid bronchoscopy under general anesthesia for suspected aspirated foreign bodies. There were 79 boys and 52 girls, with a mean age of 2.1 years. Physical examination showed decreased breath sounds (n = 130) and wheezing (n = 119) over the affected site. Chest roentgenograms were diagnostic or suggestive of aspirated foreign bodies in 127 cases (97%). Radiopaque lesions were noted on roentgenograms in ten cases. Four infants had a preoperative hypoxic arrest. Two patients had negative results of bronchoscopy (1.5%). Extraction of the aspirated foreign body was carried out at laryngoscopy in two patients and by forceps under direct vision at bronchoscopy in 97 patients. A Fogarty catheter was used in 12 cases. Postendoscopic complications included fever (n = 27), pulmonary infiltrate (n = 11), ventilatory support (n = 4), and pneumothorax (n = 2). Rigid bronchoscopy for aspirated foreign body in children is a safe, effective, and sometimes life-saving procedure. Morbidity is low and mortality is zero.

Bronchi↗

PubMed1980

Evaluation of response to chemotherapy with fiberoptic bronchoscopy in non-small cell lung cancer.

Fiberoptic bronchoscopy was performed before and during administration of chemotherapy in 32 patients with unresectable non-small cell carconoma of the lung. Pretreatment findings varied with the histologic cell type. Direct visual and/or pathologic evidence of cancer was obtained in 11 of 11 patients with epidermoid, in 5 of 7 with large cell, and in 9 of 14 with adenocarcinoma. In 5 of the 32 patients, intrathoracic tumor was documented at bronchoscopy but not by chest x-ray. During chemotherapy, one of five episodes of response and eight of 21 episodes of chest tumor progression were detected solely by bronchoscopy, while in an additional two objective responses and six progressions, bronchoscopic and radiographic findings simultaneously improved or deteriorated. The likelihood of documenting disease progression by bronchoscopy also depended upon the histologic type of cancer. Enlarging chest tumor found solely by chest x-ray occurred exclusively in patients with large cell carcinoma and adenocarcinoma. During chemotherapeutic treatment of our pateints, addition of serial bronchoscopic examinations to standard means of assessing tumor response frequently allowed the earlier discontinuation of an ineffective drug regimen.

Adenocarcinoma↗

PubMed1981

Growth of lung cancer colonies from bronchoscopy washings.

Cells from bronchoscopy washings from 30 patients with lung cancer were plated in tissue culture using a human tumor stem cell assay technique. These culture results were subsequently compared to routine cytology readings carried out on the same specimens. The stem cell culture showed colony growth from 9 of 11 cytologically positive bronchoscopy washing specimens. More colonies grew from cytologically positive specimens (average of six colonies per plate) than from cytologically negative specimens (average of 0.8 colonies per plate). With additional refinements, the stem cell culture system could be used to improve the diagnostic yield of bronchoscopy washings. However, at present, the low number of tumor colonies grown from the washings precludes performing chemosensitivity studies on tumor cells from the bronchoscopy washing specimens.

Bronchoscopy↗

PubMed2005

Use of laryngeal mask airway in flexible bronchoscopy in infants and children.

In the past two decades, flexible bronchoscopy (FB) has gained increasing popularity among pediatric pulmonologists. The objective of this study was to review our experience with pediatric flexible bronchoscopy over the past 15 years, with special focus on route of bronchoscopy. This is a retrospective study. We reviewed our pediatric FB procedures performed at the University of Michigan, Mott Children's Hospital, from 1988-2003. The study included 1,947 procedures in 1,548 patients, with a mean of 1.3 procedures/patient. The male:female ratio was 1.66:1, and age was 4.9 +/- 5.6 years (mean +/- SD). Patients <2 years of age represented 46.6% of the study population. The laryngeal mask airway (LMA) was the most common route for flexible bronchoscopy in children 2 years of age and above. Complication rates were lower with the use of the LMA (1.9%) compared to the nasal route (3.5%). Stridor was the most common indication in the age group <2 years (20.8%), while persistent pulmonary infiltrates were more common in the older age groups (32.2-37%). Laryngomalacia was the most common finding in patients with stridor (31.5%), while inflammatory changes were more common with other indications. Procedure-related complications were reported in 2.3% of procedures. Bronchoalveolar lavage (BAL) samples were obtained and analyzed in 51.2% of FB procedures (n=1,000), of which 19.4% yielded positive microbiology cultures. In conclusion, FB is a safe procedure in pediatrics. Children less than 7 years of age represent the majority of FB subjects. The LMA offered a lower rate of procedure-related complications when compared to the nasal route or endotracheal tube. It also reduced procedure time and anesthesia time.

Adolescent↗

PubMed1989

Effects of diagnostic procedures during fiberoptic bronchoscopy on heart rate, blood pressure, and blood gases.

To investigate the effects of several endoscopic procedures like introduction of the bronchoscope, removal of the instrument, catheter suction, bronchoalveolar lavage and transbronchial biopsy on heart rate, systemic blood pressure, and transcutaneously measured blood gases 77 consecutive patients (age, 20-83 years) were studied. All patients received 101 O2/min via face mask during bronchoscopy. Sedation was performed with midazolam or diazepam. The different characteristics of each patient, e.g. age, sex, smoking habits, baseline values of heart rate and systemic blood pressure, underlying pulmonary disease and kind of premedication were examined separately to analyse their special effects on the course of bronchoscopy. During the fiberoptic bronchoscopy neither a slight decrease in transcutaneous pO2 nor a small increase in transcutaneous pCO2 led to a critical situation. Nevertheless it should be stressed that the time after removal of the instrument and finishing supplemental oxygen may be critical regarding hypoxia and hypercapnia especially in older patients with hypoxia being already present before starting the endoscopy. The hemodynamic indices did not change significantly. There was no difference between midazolam or diazepam concerning the parameters under study. If supplemental oxygen is given and adequate premedication is performed, monitoring of hemodynamics and blood gases during fiberoptic bronchoscopy is not necessary in patients without cardiovascular or respiratory risk.

Adult↗

PubMed2001

[Virtual bronchoscopy].

Flexible bronchoscopy represents a clinically well-established invasive diagnostic tool. Virtual bronchoscopies, calculated from thin-slice CT sections, allow astonishing immitations of reality although principal differences exist between both technologies: the fact that colour representation is artificial and concommitant interventions are impossible limits the clinical use of virtual bronchoscopy. However, its value increases when calculations can be attained within minutes due to technological advancements, and when virtually any chest CT is suitable for further postprocessing. Indications, findings and the clinical role of virtual bronchoscopy are discussed.

Bronchoscopy↗