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PubMed1990

[Significance of fiberoptic bronchoscopy after pulmonary resection of lung cancer for early detection in second lung cancer].

By the end of 1988, seventy five cases after pulmonary resection for lung cancer and one case after pulmonary resection for basal cell hyperplasia were examined with fiberoptic bronchoscopy as postoperative follow up. Endobronchial tumor was detected in 14 cases. In seven cases, endobronchial tumor was located at site far from the surgical bronchial anastomosis. These tumors were suspected as second lung cancer as long as examined by fiberoptic bronchoscopy. Histological type of all of these was squamous cell carcinoma. Re-operations were performed in five cases and two of them were early lung cancer. In 6 cases (13.6%) among 44 cases examined with fiberoptic bronchoscopy after pulmonary resection for central type squamous cell carcinoma, second lung cancer was detected. In the case of central type squamous cell carcinoma, usually the tumor appears to be of same histological type and at same location. Among those cases those who smoke heavily should be separated as high risk group. If this group is followed with fiberoptic bronchoscopy or sputum cytological examination, it is more possible to detect second lung cancer at an early stage.

Bronchoscopy↗

PubMed1990

The role of bacterial cultures from bronchoscopy washings in AIDS related patients.

The clinical significance of bronchoscopy washing cultures for bacteria had been questioned before the era of the acquired immune deficiency syndrome (AIDS), and the procedure was felt to be misleading more than helpful. Little has been mentioned of its utility in AIDS patients undergoing fiberoptic bronchoscopy. The correlation of these cultures was retrospectively reviewed for 30 bronchoscopies performed in 26 patients with advanced AIDS related illnesses. Normal respiratory flora was the most common finding in 14/28 (50%) of the cultures submitted, followed by Staphylococcus aureus in 7/28 (25%). Correlating chest radiographs with culture results revealed that in only five cases were cultures definitely or possibly relevant. All five had radiographic changes compatible with bacterial processes, and clinical findings suggestive of disease. The routine submission of bronchoscopy washings for bacterial culture in patients with HIV associated disease should be discouraged without clinical and radiologic correlation.

Acquired Immunodeficiency Syndrome↗

PubMed1990

[The risks of bronchoscopy in coronary patients].

In order to study the electrical changes that may occur during bronchoscopy in coronary patients we have carried out continuous electrocardiographic recordings during the course of endoscopy in 36 patients. We have been able to compare two groups: Group 1 consisting of 18 patients with coronary disease, and Group 2 with 18 non-coronary patients. There was no difference for sex, age or blood gases at the time of the examination in either group. Continuous electrocardiographic recording was started one hour before the examination and went on until two hours after, and was analysed as a function of the different durations of the endoscopy and any possible incidents. The blood potassium and the lidocaine blood levels at the end of the examination did not differ between the two groups. We observed no disorders of rhythm or of conduction. The only common change in the two groups was a frequent elevation of heart rate. There was no difference between the two groups. We have on the other hand been able to show in 3 coronary patients problems of repolarisation, which looked like current ischaemia occurring during the bronchoscopy and disappearing after the examination. We had no clinical upsets and do not have to regret having done any of the examinations, but these observations suggest we should be particularly careful in considering the indications for bronchoscopy, and the surveillance of patients during bronchoscopy where there is coronary disease.

Adult↗

PubMed1989

[Fiber bronchoscopy and bronchoalveolar lavage in patients with asthma. A description of the method].

Fiber bronchoscopy under local anaesthesia is an examination procedure frequently employed in the remainder of Scandinavia, Europe and USA. It requires only few resources and the costs are considerably less than fiber bronchoscopy under general anaesthesia. Bronchoalveolar lavage (BAL) in connection with fiber bronchoscopy is rapidly undertaken but analysis of the material obtained requires considerable time. A method of induction of local anaesthesia, performance of BAL and preparation of the washings obtained is described. Fiber bronchoscopy and BAL are considered to be safe examination procedures in patients with mild asthma in a stable phase. The examination is only associated with slight discomfort for the patients, who will frequently accept repeated investigations, and complications are rare. BAL is a valuable examination procedure in research and the results have increased the knowledge of mechanisms in a series of interstitial pulmonary diseases. Future investigations of the humoral and cellular components in BAL fluid in asthmatic patients will contribute to increase knowledge of the pathological mechanisms in asthmatic disease.

Adult↗

PubMed1989

Fiberoptic bronchoscopy in diagnosis of patients with suspected active pulmonary tuberculosis.

Patients suspected of having active pulmonary tuberculosis, in whom acid-fast bacilli (AFB) are not demonstrated on sputum direct smear, present a difficult diagnostic and therapeutic problem. Flexible fiberoptic bronchoscopy is a useful procedure in evaluating these patients. Within five years, during the period of January 1983 to December 1987, 112 patients who were suspected of having active pulmonary tuberculosis underwent fiberoptic bronchoscopy. The diagnosis of pulmonary tuberculosis was established by using this procedure in 76 per cent of cases. Immediate diagnosis were made from microscopic specimens obtained from bronchoscopy in 38 of 65 patients (58%). It is concluded that fiberoptic bronchoscopy should be performed in evaluating patients with negative smears for AFB who are clinically suspected of having tuberculosis before initiating a trial of antituberculous drugs. The technique is safe and markedly efficacious in making an immediate diagnosis and uncovering other diseases that present themselves like tuberculosis.

Adolescent↗

PubMed1987

The effectiveness of bronchoscopy in the diagnosis of Pneumocystis carinii and cytomegalovirus pulmonary infections in acquired immunodeficiency syndrome.

We evaluated the sensitivity of bronchoscopy for the diagnosis of Pneumocystis carinii and cytomegalovirus pulmonary infections in patients with acquired immunodeficiency syndrome. The antemortem and postmortem diagnoses were compared in 36 patients who underwent fiberoptic bronchoscopy within two weeks of death. In autopsy-proved cases of Pneumocystis carinii pneumonia (PCP), the organism was correctly identified antemortem in 22 (88%) of 25 cases, including 94% of adequate transbronchial bronchoscopic biopsy specimens, 95% and 88% of bronchoalveolar lavage (BAL) cell blocks and smears, respectively, and 79% of brushing. In 11 patients who underwent simultaneous adequate biopsy, BAL, and brushings, the diagnostic sensitivity for PCP was 100%. The negative predictive value of bronchoscopy for PCP was 85%. Bronchoscopy yielded the diagnosis of cytomegalovirus infection in only 55% of autopsy-proved cases. Diagnostic sensitivity was also reduced when an important diagnostic procedure, such as transbronchial biopsy or BAL, was inadequate or not performed.

Acquired Immunodeficiency Syndrome↗

PubMed1988

[Is there a risk of global respiratory insufficiency with the use of intramuscular midazolam as premedication for bronchoscopy?].

To determine whether midazolam i.m. as premedication for bronchoscopy involves a risk of overall respiratory failure, we compared hydrocodonum (15 mg i.m.) with midazolam (5-7.5 mg i.m., weight related) as premedication in flexible bronchoscopy in two groups of 30 patients. The two groups were comparable. Arterial blood gases were measured before premedication, before bronchoscopy, and 10 and 60 minutes after the procedure. Significant respiratory depression did not occur in either group. Side effects were rare and similar. Confusional states, as reported with midazolam given orally, were not noted. Midazolam administered as reported above is of value as premedication in flexible bronchoscopy.

Blood Gas Analysis↗

PubMed1988

[Serum levels of lidocaine as affected by high frequency jet ventilation during bronchoscopies under local anesthesia].

Fiberoptic bronchoscopy is a valuable procedure in the diagnosis and treatment of pulmonary disorders and is usually performed under local anesthesia. The local application and ultrasonic nebulization of lidocaine is widely accepted for inducing topical anesthesia in the respiratory tract. We produced local anesthesia of the trachea and bronchial tree by nebulizing lidocaine via high-frequency jet ventilation (HFJV). At the same time, we measured serial plasma concentrations of lidocaine to determine the potential for toxicity due to systemic absorption from the tracheobronchial tree. METHOD. Twelve adult patients without known heart or liver disease were studied during diagnostic bronchoscopy. As premedication 0.5 mg atropine and diazepam (10 mg) or midazolam (5 mg) were given. After topical anesthesia of the oropharynx, all patients were intubated with a Hi-Lo jet endotracheal tube using a flexible bronchoscope. Spontaneous breathing was supported with a high-frequency jet ventilator (Acutronic MK 800). The humidification ventilator pump was used as a device for local anesthetic administration (lidocaine 0.5%). The following continuous application scheme was used: 0-5 min: 100 ml/h; 5-10 min: 50 ml/h; over 10 min: 5-25 ml/h. Plasma samples for lidocaine levels were taken intravenously 5 min after intubation and then at 5-min intervals. The last sample was taken 30 min after bronchoscopy. The plasma lidocaine concentration was determined by liquid chromatography. RESULTS. In general, this mode of lidocaine administration produced adequate anesthesia and was safe. None of the patients studied required additional lidocaine doses during bronchoscopy. Heart rates and blood pressures were stable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1981

Cardiac arrhythmias. Frequency during fiberoptic bronchoscopy and correlation with hypoxemia.

To evaluate the occurrence of ECG abnormalities during fiberoptic bronchoscopy in relation to specific stages of the procedure and to hypoxemia, we prospectively studied 50 hospitalized patients aged 53 +/- 18 years (mean +/- SD) who were undergoing bronchoscopy by continuously monitoring cardiac rhythm with a continuous two-channel ECG recorder and oxygen saturation by using ear oximetry. Major disturbances of cardiac rhythm (ie, atrial, ventricular, or both) developed in 20 (40%) patients. Ventricular arrhythmias were recorded in ten patients (20%) and occurred with greatest frequency during passage of the bronchoscope through the vocal cords in five of these patients. Atrial arrhythmias were detected in 16 patients (32%), but their occurrence did not correlate closely with any one stage of the procedure. Arrhythmias were most frequent in association with periods of maximum oxygen desaturation in 12 of these 20 patients. Oxygen desaturation persisted for greater than one hour after bronchoscopy in 34 (68%) of 50 subjects. Notably, no correlation was observed between the frequency of arrhythmias during bronchoscopy and patients' age, sex, prior medications, or preexisting cardiac or pulmonary disorders. In no case was an ECG abnormality associated with adverse clinical sequelae.

Adolescent↗

PubMed1995

[High-resolution computed tomography (HRCT) versus bronchoscopy in predicting the need for bronchial embolization in hemoptysis].

September, 1992, through May, 1994, thirty patients with hemoptysis were examined with CT, HRCT and bronchoscopy. Our study was aimed at comparing CT and HRCT with fiberoptic bronchoscopy in the identification and assessment of hemoptysis causes and of lesion shape and extent. These data are of basic importance for the interventional radiologist when an intravascular treatment is scheduled. The causes of hemoptysis included cystic fibrosis in 14 patients, bronchiectasis and bronchiolectasis in 11, tuberculosis in 3 and aspergillosis in one. In only one patient the etiology of hemoptysis remained undetected. Among the most common patterns, the "ground-glass" one was the main finding (50%), while bronchiectasis and bronchiolectasis were demonstrated in 40% of the patients. In the extent 10% of cases the cause of hemoptysis was identified with small lesions as a result of previous tubercular infections. Among the causes of hemoptysis, our study included only inflammatory, and not neoplastic, diseases. In 97% of patients, CT and HRCT allowed the diagnosis of lesion type, extent and site, while bronchoscopy did the same in only 35% of patients, because of its lack of accuracy in identifying and characterizing peripheral lesions. Our results suggest that CT and HRCT should be performed after bronchoscopy and before bronchial embolization. Confirming literature data, our study proves CT and HRCT to play a basic role in the diagnosis of the inflammatory conditions causing hemoptysis.

Bronchi↗

PubMed1995

[A case of productive aspergilloma on the inner wall of a cavity, in which perbronchial fiberoptic bronchoscopy within the cavity was useful for the diagnosis and therapeutic evaluation].

A 45-year-old man complaining of bloody sputum was admitted. He had been treated for pulmonary tuberculosis since October 1988. He had bloody sputum in October 1989. His chest X-ray findings showed a cavitary lesion with a thickened and irregular wall in the right upper lobe. Fiberoptic bronchoscopy revealed white nodules on the cavity wall and the biopsy specimen from the nodule yielded a fungus granuloma. Aspergillus fumigatus was cultured from the sputum obtained after the bronchoscopy. Based on these findings, endobronchial aspergillosis and productive aspergilloma on the inner wall of a cavity was diagnosed. He was treated with oral anti-fungal drugs for 4 years. On chest X-ray films taken in June 1993, the cavity had enlarged, and the thickening and irregularity of the cavity wall had disappeared. Transbronchial fiberoptic bronchoscopy within the cavity showed whitish nodules and the cytology specimen obtained from the nodules by brushing yielded fungi, he was treated with oral itraconazol. Six months later, re-examination of the cavity revealed that the wall had become thinner and that the nodules on the inner wall had disappeared. This case illustrates the importance of bronchoscopy, in the diagnosis and evaluation of treatment of productive aspergilloma on the inner wall of a cavity.

Administration, Oral↗

PubMed1993

[A case of B cell lymphoma with negative findings in both chest X-ray and CT images, but lesions of the bronchial mucosa detected on bronchoscopy].

A 68-year-old woman presented to our hospital on January 7, 1992 with swelling of a right cervical lymph node as the chief complaint. After biopsy of the cervical lymph node, non-Hodgkin's lymphoma was diagnosed (diffuse medium cell type, B cell) and she was hospitalized on January 10. Except for the enlargement of the right cervical lymph node noted at the time of hospitalization, no abnormal findings on examination or in chest X-ray and CT scan were noted. However, at bronchoscopy rubor and swelling of the mucosa of the right second carina and the bifurcation between the left upper division and the lingular bronchus were noted, and biopsy was therefore performed. The histologic appearance of the biopsy tissue was similar to that of the lymph node, showing infiltration by malignant lymphoma. The tumor was diagnosed to be stage IIA of the Ann Arbor classification, and COP-BLAM therapy was commenced on January 15. On January 21, the cervical lymph node was no langer present. At bronchoscopy performed on January 25, the abnormal portion of the bronchi had disappeared, and no infiltration was observed in the biopsied specimen. There have been some reports describing lesions within the bronchi in cases of malignant lymphoma. However, there have been few cases in which no abnormalities were found in the chest X-ray and diagnosis was made by bronchoscopy. Thus, it seems to be useful and important to perform bronchoscopy in order to determine the stage of malignant lymphoma.

Aged↗

PubMed1993

The role of bronchoscopy in lung cancer.

Flexible fiberoptic bronchoscopy is the most useful invasive technique for diagnosing lung cancer. This article details the use and efficacy of bronchoscopy with such established techniques as forceps biopsy, brush biopsy, and bronchial washing in the diagnosis and staging of bronchoscopically visible central lung cancer and peripheral lung cancer. The efficacy of such newer techniques as transbronchial needle aspiration, transbronchial curettage, ultrathin fiberoptic bronchoscopy, and quantitation of tumor markers in bronchoalveolar lavage fluid is also discussed, along with the complications of bronchoscopy and new techniques for detecting early lung cancer.

Biomarkers, Tumor↗

PubMed1995

Rigid bronchoscopy. The forgotten art.

Rigid bronchoscopy is superior to flexible fiberoptic bronchoscopy in several clinical situations. General anesthesia is usually used with side port ventilation. In children, removal of foreign bodies is an important indication. Tracheal stricture dilatation and cryotherapy are indications in adults, but laser bronchoscopy has become the major indication for rigid bronchoscopy in adult medicine.

Adult↗

PubMed1977

[Fibre optic bronchoscopy in children (author's transl)].

Since 1974 the authors have used fibre optics of Olympus, Tokyo, particular the models BF Type 4B and BF Type 3A applicable for children. Even in children, tube bronchoscopy can not at all be replaced by fibre optic bronchoscopy. By fibre optic bronchoscopy diagnostics may by improved considerably. Laryngotracheoscopy proved to be of special advantage in newborns with the sign of stridor. Fibre optic bronchoscopy should be used as a supplementary procedure in bronchological centres for children.

Age Factors↗

PubMed1997

Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.

Airway Obstruction↗

PubMed1997

[Room air contamination with halothane during pediatric bronchoscopy].

Halothane anesthesia is frequently used for pediatric bronchoscopy. A disadvantage of the equipment used, a rigid bronchoscope together with inhalation anesthesia is the contamination of the working environment. The aim of this study was to determine the exposure of anesthetist and endoscopist during pediatric bronchoscopy under halothane anesthesia in a worst-case working environment and to compare these measurements with the currently valid international threshold values. Ten children (ASA I-III) scheduled for diagnostic bronchoscopy were included in the study. After induction with thiopentone and relaxation with atracurium all children were intubated with a rigid bronchoscope and manually ventilated through a bypass of the bronchoscope. Anesthesia was maintained by means halothane (0.5-2.0 vol%) in 100% oxygen with a flow of 10 l/min. The investigation was done in an operating room without air conditioning and scavenging system. Trace concentrations were measured every 2 minutes in the breathing zones of the anesthetist and the endoscopist by means of a highly sensitive direct reading instrument. Lower detection limit was 0.02 ppm. The mean age (+/- SD) of the children was 29.9 +/- 15.9 months (range: 4 weeks-48 months). Ventilation and oxygenation were stable throughout the bronchoscopic procedure. Mean exposure (+/- SEM) to halothane was 57.7 +/- 18.9 ppm for the anesthetist and 96.3 +/- 22.9 ppm for the endoscopist. The difference was statistically significant (ANOVA, P < 0.05). All international threshold values (2-50 ppm) were exceeded by far. Peak concentrations higher than 200 ppm halothane could be detected several times. The main result of the present study is that under the given situation in the operating room with insufficient room ventilation and no scavenging system halothane anesthesia for rigid bronchoscopy in children results in an occupational exposure that is higher than all known health regulation guidelines. Therefore, in case of insufficient working conditions total intravenous anesthesia might be a better alternative also in very small infants.

Air Pollutants, Occupational↗

PubMed1976

Management of tracheobronchial foreign bodies in children: a reevaluation of postural drainage and bronchoscopy.

The efficacy of the inhalation-postural drainage technique for removal of aspirated foreign bodies was compared with that of bronchoscopy in 76 children. Twelve of 49 children on postural drainage coughed out the foreign body (25%); the other 37 required bronchoscopy. The foreign body was successfully removed in 56 of 63 children who were bronchoscoped (89%). Our experience suggests that a trial of inhalation-postural drainage, administered in a hospital, may be valuable in the initial management of aspirated foreign bodies. If unsuccessful after several treatments, however, the technique should be abandoned, and bronchoscopy performed. Delay of foreign body removal beyond 24 hours may be associated with increased morbidity and prolonged hospital stay. With recent improvements in pediatric endoscopic instruments, the efficacy of bronchoscopy exceeds 90%.

Bronchi↗