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At least 271 records · Page 15Linked to original sources

PubMed2003

Follow-up after stent insertion in the tracheobronchial tree: role of helical computed tomography in comparison with fiberoptic bronchoscopy.

The aim of this study was to compare helical CT with fiberoptic bronchoscopy findings to appraise the medium-term results of proximal-airways stenting. Twenty-five patients with 28 endobronchial metallic stents inserted for local advanced malignancy ( n=13) or benign diseases ( n=12) underwent follow-up CT from 3 days to 50 months (mean 8 months). All studies were obtained using helical CT with subsequent multiplanar reformation and three-dimensional reconstruction including virtual bronchoscopy. The location, shape, and patency of stents and adjacent airway were assessed. The results of CT were compared with the results of fiberoptic bronchoscopy obtained with a mean delay of 2.5 days (SD 9 days) after CT scan. Twelve stents (43%) remained in their original position, patent and without deformity. Sixteen stents were associated with local complications: migration ( n=6); external compression with persistent stenosis ( n=4); local recurrence of malignancy ( n=4); fracture ( n=1); and non-congruence between the airway and the stent ( n=1). The CT demonstrated all the significant abnormalities demonstrated at fiberoptic bronchoscopy except two moderate stenoses (20%) related to granulomata at the origin of the stent. Ten of 14 stents inserted for benign conditions were without complications as compared with 2 of 14 in malignant conditions ( p=0.008). Computed tomography is an accurate noninvasive method for evaluating endobronchial stents. The CT is a useful technique for follow-up of patients who have undergone endobronchial stenting.

Adult↗

PubMed1987

Pediatric bronchoscopy during a 17-year period.

From 1969 through 1985, 1032 pediatric bronchoscopies were performed on a total of 748 children under 16 years of age. Of the children 27.4% were under 6 months of age and the smallest patient weighed 600 g. Rigid bronchoscopes with a diameter ranging from 2.5 to 6 mm were used. A flexible fiberoptic bronchoscope with a diameter of 3.5 mm was used only occasionally, mostly for the diagnosis of laryngeal dynamics. All the endoscopies were performed under general anesthesia, except for some laryngoscopies performed with a flexible bronchoscope. The most common indications for bronchoscopy were suspected foreign body (16.7%), stridor (14.5%), recurrent respiratory infections (12.3%) and dyspnoe (9.6%). Laryngomalacia was observed in 13.8% of the children investigated and in patients with inspiratory stridor laryngomalacia was diagnosed in 39.8% of the cases. Subglottic stenosis was confirmed in 7.0% of the children. Tracheal compression was found in 10.8% and tracheal stenosis in 2.5% of the cases. Bronchiectasis was observed in 2.5% and tuberculosis in only 0.5% of the cases. Bronchoscopy was completely normal in only 10.6% of the patients investigated. The complications of pediatric bronchoscopy in this series were infrequent.

Adolescent↗

PubMed1989

Diagnostic flexible bronchoscopy in human immunodeficiency virus (HIV)-positive children.

Twelve children with laboratory evidence of human immunodeficiency virus (HIV) infection underwent diagnostic flexible bronchoscopy with washings or bronchoalveolar lavage at Bellevue Hospital Center from October 1987 to April 1989. The patients included 7 boys and 5 girls ranging from age 3.5 months to 10 years 5 months. Indications for bronchoscopy included respiratory distress with or without focal changes on chest radiograph in 11 patients, and persistent but asymptomatic right middle lobe collapse in one child. The etiology of pneumonia was diagnosed in 7 children and included Pneumocystis carinii, (PCP) (17%), Streptococcus viridans (17%), mechanical obstruction (17%) and cytomegalovirus (CMV) (8%). Bronchoscopy was non-diagnostic in 5 cases. Techniques for maximal yield of information using flexible bronchoscopy in HIV-positive children are discussed.

Bronchoalveolar Lavage Fluid↗

PubMed2005

EUS-guided FNA of centrally located lung tumours following a non-diagnostic bronchoscopy.

OBJECTIVE: To assess the feasibility and yield of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in diagnosing centrally located lung tumours after a previously non-diagnostic bronchoscopy. BACKGROUND AND HYPOTHESIS: Bronchoscopy fails to establish a diagnosis in up to 30% of patients with suspected lung cancer. Intrapulmonary tumours located near or adjacent to the esophagus might be visualized and biopsied under real-time ultrasound guidance by EUS-FNA. DESIGN: Patients with suspected lung cancer and an intrapulmonary tumour located near or adjacent to the esophagus who had undergone a non-diagnostic bronchoscopy, underwent EUS-FNA for diagnostic purposes. Surgical-pathological verification occurred when EUS-FNA was non-diagnostic and in those patients diagnosed with non-small-cell lung cancer by EUS-FNA who were surgical candidates. RESULTS: EUS-FNA diagnosed lung cancer in 31 of 32 patients (97%). No complications occurred. The diagnosis obtained by EUS-FNA was confirmed in all 11 patients who were operated. In one case, in which EUS-FNA was non-diagnostic, a lymphoma was diagnosed after pneumonectomy. CONCLUSIONS AND SIGNIFICANCE: EUS-FNA qualifies as the next diagnostic step in patients with suspected lung cancer and a non-diagnostic bronchoscopy if the intrapulmonary mass is located adjacent or near the esophagus. In these cases, EUS-FNA may replace computed tomography of the chest (CT)-guided biopsies and reduce the number of exploratory thoracotomies.

Adult↗

PubMed2006

Bronchoscopy in children in South America.

Bronchoscopy is an important tool in the study of the airway. Diagnostic and therapeutic uses are well described in the literature and standardisation of the technique is well defined. Most relevant publications on bronchoscopy come from Europe and the United States, and in some countries they are used as guidelines for local hospitals. In spite of the limited experience published from South America, and the scarcity of financial resources, important information and research pathways have been developed in paediatric bronchoscopy. The information in this review was compiled from local publications, case reports, review articles, brief reports and congress presentations to provide an overview and share the experience about bronchoscopy in South American children.

Bronchoscopy↗

PubMed2004

The development of the first nurse-led bronchoscopy post in the United Kingdom.

Nurses routinely practice Gastrointestinal endoscopy in the United Kingdom (UK) but, to our knowledge, bronchoscopy has never been introduced as a nursing discipline. The need for a nurse bronchoscopist was identified within our respiratory unit and the post was developed. This process involved: (1) seeking a precedent for the role of nurse bronchoscopist, (2) designing an appropriate teaching programme, (3) obtaining hospital accreditation for the programme, (4) supervising and completing the training, and (5) implementing a nurse-led bronchoscopy service. The development phase took approximately 1 year. No precedent was found for nurse-led bronchoscopy in the UK or elsewhere. The training programme defined minimum entry requirements and was modelled on UK nurse GI endoscopy training and the British Thoracic Society bronchoscopy guidelines. The role of nurse bronchoscopist was deemed to comply with professional codes of nursing practice by the chief nurse and the hospital management board authorised a service framework for the post. The first trainee completed the programme in January 2003 and has now examined 125 patients independently [endobronchial tumour biopsy hit-rate = 95% (95% CI 76-99%)]. The post of nurse bronchoscopist has been successfully developed and accredited within our hospital.

Bronchoscopy↗

PubMed1978

The effects of fiberoptic bronchoscopy with and without atropine premedication on pulmonary function in humans.

Pulmonary function studies, including arterial blood gas analysis, were performed in 21 patients undergoing fiberoptic bronchoscopy. Eight received premedication with atropine and 13 did not. In the atropine-treated group there was no significant deterioration in pulmonary function immediately after bronchoscopy compared with baseline. Compared with the values obtained after topical lidocaine anesthesia, however, there was a decrease in peak expiratory flow rate (PEFR) (20 +/- 20%), forced expiratory volume in one second (FEV1.0) (11 +/- 12%), forced expiratory flow between 25 and 75% of vital capacity (FEF25-75) (22 +/- 16%), and forced expiratory flow at 75% of exhaled vital capacity (FEF75) (28 +/- 38%) and an increase in residual volume (RV) (16 +/- 19%). In the no-atropine group, postbronchoscopy values showed a decrease in PEFR (13 +/- 19%), forced vital capacity (FVC) (13 +/- )9%), FEV1.0 (14 +/- 16%), and oxygen partial pressure (Pa02) (11 +/- 9%) and an increase in RV (19 +/- 31%) and alveolar-arterial oxygen pressure gradient (deltaAaPO2) (91 +/- 129%) compared with baseline values. In this group also, topical lidocaine anesthesia resulted in a decrease in FVC compared with baseline. We conclude that the deleterious effect of bronchoscopy on pulmonary function is counterbalanced by the beneficial effect of atropine and that atropine is therefore a useful premedication for fiberoptic bronchoscopy.

Adolescent↗

PubMed2000

Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases.

OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration. METHODS: In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination. RESULTS: In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete. CONCLUSION: More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.

Adolescent↗

PubMed2001

Role of bronchoscopy in modern medical intensive care unit.

This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being used to improve respiratory failure and facilitate weaning from mechanical ventilation. Practical applications of recent advancements in technology (endobronchial stenting, laser therapy, and so forth), the increasing use of rigid bronchoscopy, and the new generation of flexible bronchoscopes like battery bronchoscopes, and ultra-thin bronchoscopes, are also discussed. The risks, potential benefits, complications, and suggested technique of performing bronchoscopy in mechanically ventilated patients are reviewed.

Bronchial Diseases↗

PubMed1999

Future of flexible bronchoscopy.

Despite some potential "threats" (Table 3), the future of bronchoscopy is likely full with ever expanding applications in clinical medicine and research (Tables 1 and 2). The role of bronchoscopy in lung cancer continues to expand and the usefulness of newer techniques needs to be established. The role of FB is also ever expanding in the immuno compromised host and critically ill patients. Future studies, however, should concentrate on patient outcome, especially survival and performance status. Therapeutic bronchoscopy has been extended to many areas and the emphasis of future research will likely continue to be at the molecular level rather than on studies of better instruments for retrieval purposes. The most exciting developments are likely to be in the field of gene therapy, which has made remarkable progress in the past decade. Gene therapy can be a powerful technology, but several hurdles must be overcome to make gene therapy a reality for treating human disease in the future. As the cost of technology continues to challenge health care delivery systems, a major challenge for the future of bronchoscopy is to evaluate new technologies and applications based on their impact on patient outcome, survival, and management of cost.

Bronchoscopes↗

PubMed1999

Virtual bronchoscopy.

Three-dimensional endoluminal tracheobronchial simulations can be derived successfully from thoracic helical CT scans, and can reproduce the appearances of major endobronchial abnormalities confirmed during FB. The prospects of ever-faster CT scanners (capable of submillimeter resolution) merged with greater computer power make it likely that current versions of virtual bronchoscopy images will seem primitive in the future. Initial descriptive reports suggest great potential, but the startling visual appeal of these 3-D portrayals of a patient's airway and mediastinal anatomy and the prospects of exploring this information in real time do not establish its clinical role. Such virtual bronchoscopy findings are generally predictable on the basis of currently available axial CT images alone. The extent to which these 3-D endobronchial renderings improve the already high predictive values of CT requires critical study. In their patients with lung cancer Cicero et al observed that neither the staging nor diagnosis was modified substantially, but virtual bronchoscopy contributed to enhanced understanding of the pathology of the neoplastic process. Whether this added perspective translates to tangible benefits for patients is an intriguing possibility that has yet to be proved. The unique 3-D endobronchial view may offer particular advantages in some individuals and contribute to the patient's noninvasive evaluation. Because of the already high yield of conventional CT, diagnostic yield alone is not likely to be the sole best measure of this evolving technology. Accordingly, future multidisciplinary research investigations will also need to prospectively address nuances of decision-making and measure appropriate patient outcomes. In these efforts the active dialogue between chest clinician and radiologist will remain essential to defining and realizing the true potential of virtual bronchoscopy.

Bronchoscopy↗

PubMed2002

[Role of flexible bronchoscopy in the re-expansion of persistent atelectasis in children].

OBJECTIVE: To evaluate the efficacy of flexible bronchoscopy plus bronchoalveolar lavage for the reexpansion of persistent atelectasis (course longer than 3 weeks) in children. PATIENTS AND METHODS: Retrospective review of the records of 83 children who underwent flexible fiberoptic bronchoscopy plus bronchoalveolar lavage for persistent atelectasis. Three categories of evolution were established for radiologic assessment: a) full re-expansion (full improvement over the initial image); b) partial re-expansion (decreased atelectasis of between 50% and 100%); and c) no change (if the decrease was less than 50% of the initial image). RESULTS: Endoscopy revealed mucus plugs in 54 patients (65%); bronchial malformations in 16 (19%); bronchial stenosis in 5 (6%); normal airways in 5 (6%) and other findings in 3 (4%). Radiologic changes after bronchoscopy showed full expansion for 34 patients (41%), partial re-expansion for 28 (34%) and no changes for 21 (25%). CONCLUSION: Flexible bronchoscopy plus bronchoalveolar lavage for the re-expansion of persistent atelectasis is useful in a high percentage of children.

Adolescent↗

PubMed2003

[Factors associated with complications caused by bronchoscopy in pediatric patients].

BACKGROUND: Although the role of flexible bronchoscopy as an important diagnostic and therapeutic tool in pediatric medicine has been demonstrated, the procedure can cause complications which should be foreseen by the bronchoscopist. However, no precise information is available about the factors associated with the presence of such complications. OBJECTIVE: To determine the incidence of complications caused by bronchoscopy in pediatric patients and the factors associated with their presence. MATERIAL AND METHOD: This was a retrospective cohort study which reviewed the records of patients aged between 1 month and 18 years who had undergone bronchoscopy between January 1 and December 31, 2002. The presence or absence of several variables considered predictive of postbronchoscopy complications was recorded in each patient. RESULTS: After adjustment for the method used to access the airway, age less than or equal to 3 months was the only independent factor associated with the presence of complications (odds ratio = 8.19; 95% confidence interval, 1.61-41.55; P=.01). CONCLUSIONS: We conclude that patients 3 months old or younger are at greater risk of presenting complications after bronchoscopies performed under general anesthesia. Consequently a risk-benefit analysis should be carried out for patients in this age group, and the possibility of performing the procedure under sedation should be considered.

Adolescent↗

PubMed1998

[Fiber optic bronchoscopy in extraction of tracheo-bronchial foreign bodies in adults].

The aim of this study was to determine the clinical, radiologic and endoscopic characteristics of adults with tracheobronchial foreign bodies (FB), and to review the role of fiberoptic bronchoscopy in extracting them. We reviewed the case histories and bronchoscopic reports for all patients over 14 years of age with FB treated between 1976 and 1995. Fifty-nine FB were removed from 56 patients; 68% were male and 48% were over 60 years of age. The most common clinical presentations were symptoms of respiratory infection and acute choking. In only in 28% could a risk factor for aspiration be identified. The X-ray was non specific and in 37% of cases the chest film was normal. In 66% FB aspiration was an unexpected endoscopic finding. The FB was removed from the right lung in 81.3%. FB were food items in 71% of cases. Fiberoptic bronchoscopy was useful for removal in 95% of cases, with few and unimportant complications. Two cases were resolved with rigid bronchoscopy and only one patient required surgery. FB aspiration is common and diagnosis is difficult in the adult. Fiberoptic bronchoscopy resolved most aspirations in adults with no important complications. The rigid bronchoscope should be reserved for very specific cases.

Adolescent↗

PubMed2003

Bronchoscopy and surgical staging procedures and their correlation with imaging.

Bronchoscopy, computed tomography (CT) and surgical staging procedures are complimentary methods of investigating patients with lung cancer. CT has been shown to be of value prior to bronchoscopy in the investigation of haemoptysis and malignancy, with excellent correlation between the detection of disease within the large airways on CT and direct visualisation at bronchoscopy. The utility of CT has been further increased by the development of multislice scanners with the generation of volumetric data enabling multiplanar image acquisition. Additionally the advent of CT co-registered with positron emission tomography will play an important role in guiding the choice of surgical staging procedures The increasing use of multidisciplinary medical care requires radiologists to have a greater understanding of the abilities and limitations of both bronchoscopy and surgical staging procedures in evaluating disease demonstrated on imaging.

Bronchoscopy↗

PubMed2004

[Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology].

INTRODUCTION: Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS: In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS: Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS: This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.

Bronchoscopes↗

PubMed1990

Experience with fibreoptic bronchoscopy in the diagnosis of pulmonary shadows in renal transplant recipients over a 12-year period.

Despite improvements in immunosuppressive therapy, pulmonary infections remain an important cause of morbidity and mortality in renal transplant recipients. Over a 12-year period (1 January 1977 to 31 December 1988) we prospectively assessed the value of fibreoptic bronchoscopy in diagnosing radiographic pulmonary shadows in this group of patients. Forty-eight bronchoscopies were performed on 46 patients. A definitive diagnosis was established in 28/48 (58%) procedures (and was partially definitive for one of two organisms ultimately identified in another). The procedure failed in 19/48 (40%), although in 15 of these, the radiographic shadows resolved on antibiotics (9) or spontaneously (3) or autopsy revealed acute pneumonia (3). In four instances a specific diagnosis was made by alternative means. Clinically useful information which led to changes in management was obtained in 17/48 (35%) procedures and bronchoscopy was thought to have favourably influenced survival in 16/48 (33%). Fibreoptic bronchoscopy is in our experience a safe (only one pneumothorax and no significant haemorrhage) and useful technique in evaluating pulmonary shadows in renal transplant recipients.

Adolescent↗

PubMed1989

A prospective randomized comparison of fine needle aspiration biopsy and fibreoptic bronchoscopy in the investigation of peripheral pulmonary opacities.

Twenty-nine patients, aged 66(+/- 7) years with a peripheral pulmonary opacity (mean diameter 3.6 +/- 1.8 cm) believed to be a tumor, were randomly allocated to initial investigation by either fibreoptic bronchoscopy or percutaneous fine needle aspiration biopsy, the latter performed under fluoroscopic control. The patients proceeded to the alternative investigation in the event of the first failing to achieve a diagnosis. Malignancy was confirmed by the initial procedure in 14/15 patients randomized to fine needle aspiration biopsy but only in 1/14 patients randomized to fibreoptic bronchoscopy (P less than 0.01). Overall, these figures were 25/28 fine needle aspiration biopsy and 2/15 fibreoptic bronchoscopy (P less than 0.01). These results confirm the clinical suspicion that fine needle aspiration biopsy is far more likely than fibreoptic bronchoscopy to establish the presence of malignancy in peripheral pulmonary opacities.

Aged↗