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PubMed2001

Use of rigid and flexible bronchoscopy among pediatric otolaryngologists.

OBJECTIVE: To explore how rigid and flexible bronchoscopy are used in pediatric otolaryngologic practice. DESIGN: Survey. PARTICIPANTS: Members of the American Society of Pediatric Otolaryngology who practice in the United States and Canada and were listed in the membership directory were eligible. Of the 206 members, 24 practicing outside the United States or Canada and 11 without an e-mail address or a fax machine were excluded. Hence, a questionnaire was e-mailed or faxed to 171 pediatric otolaryngologists. MAIN OUTCOME MEASURES: Questions concerned the practice setting, type and number of bronchoscopies, indications, complications, and medicolegal cases. RESULTS: Responses were received from 120 subjects (70.2%), with 3 retired and 2 practicing only otology, leaving 115 respondents who completed at least some of the questionnaire. Rigid and flexible bronchoscopy were performed by 72.7% (56/77) of those in academic settings and by 71.1% (27/38) of those in group or solo practices. In the last 12 months, approximately 10 454 total bronchoscopies were performed, with 2052 flexible and 9117 rigid bronchoscopies. Stridor, suspected foreign body inhalation, and laryngomalacia were the most common indications for bronchoscopy. Of the 83 respondents practicing rigid and flexible bronchoscopy, 25 (30.1%) used both instruments to manage complex or repeated foreign bodies, 25 (30.1%) used both to manage patients with cystic fibrosis, and 15 (18.1%) used both to manage simple foreign bodies. Complications were reported by 15.7% of the respondents, the most common being arrhythmia. Familiarity with a case resulting in medicolegal action was reported by 32.2% of the respondents. CONCLUSIONS: Rigid and flexible bronchoscopy have multiple uses in pediatric otolaryngologic practice. Also, flexible bronchoscopy appears to be emerging as a more frequently used diagnostic and therapeutic tool.

Bronchoscopes↗

PubMed1998

Foreign body aspiration in children: value of radiography and complications of bronchoscopy.

PURPOSE: The authors undertook a 10-year review of bronchoscopies for airway foreign bodies in children to test assertions in previous reports that (1) characteristic abnormalities in chest radiographs are important indicators of the need for bronchoscopy and (2) experienced operators incur negligible complications. METHODS: The medical records of 293 children who underwent bronchoscopies by experienced pediatric surgeons for suspected airway foreign bodies were reviewed for patient age, symptoms, duration of symptoms before bronchoscopy, prebronchoscopy radiographs, type of foreign body, anatomic location of foreign body, success of bronchoscopic removal, length of hospital stay, and complications. RESULTS: Of the 293 bronchoscopies, 265 showed airway foreign bodies. A choking episode was recorded in 228 of the 265 patients with foreign bodies and 5 of the 28 with negative bronchoscopy. The surgeon thought that radiographs were normal at the time of bronchoscopy in 110 patients who had foreign bodies. Nine patients with foreign bodies had atypical radiographs; three had bilateral emphysema and six had upper lobe or bilateral atelectasis or pneumonia. There were three complications: one vocal cord injury requiring temporary tracheostomy, one tracheal laceration from removal of an aspirated tooth, and one severe postoperative subglottic edema requiring a 4-day hospital stay. The age of the patients, symptoms, types of foreign bodies, locations of foreign bodies, management, and outcomes were similar to those of previous reports. CONCLUSIONS: In children with airway foreign bodies, chest radiograph findings are frequently normal and can display abnormalities uncharacteristic for foreign body aspiration. Children witnessed to choke while having small particles in their mouths and noted subsequently to have raspy respiration, wheezing, or coughing should undergo prompt bronchoscopy regardless of radiographic findings. Complications of bronchoscopy for foreign body aspiration are uncommon but occur even in experienced hands.

Adolescent↗

PubMed2003

CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration.

OBJECTIVE: Computed tomography (CT) virtual bronchoscopy is a noninvasive technique that provides an internal view of trachea and major bronchi by three-dimensional reconstruction. The aim of this study was to investigate the usefulness of virtual bronchoscopy in the evaluation of suspected foreign body aspiration in children. MATERIALS AND METHODS: Twenty-three children (12 girls, 11 boys) with a mean age of 2.4 years (8 months-14 years) who were admitted to emergency room with a suspicion of foreign body aspiration were included in this study. Chest radiograms, spiral computed tomography scans and virtual bronchoscopy images were obtained. Then, rigid bronchoscopy was performed within 24 h. RESULTS: CT virtual bronchoscopy and conventional bronchoscopy revealed the location of the foreign body in seven patients. It was in the right main bronchus in four patients, in the right lower lobe bronchus in one patient, and in the left main bronchus in two patients. There was no discordance between two modalities. CT examination revealed hyperaeration of the ipsilateral lung in four patients, hyperaeration of the ipsilateral lung and mediastinal shift in one patient and bronchiectatic changes in one patient. CT detected no additional finding in one patient with a foreign body in the right main bronchus. In 10 of 16 patients without foreign body, CT examination demonstrated atelectasis, infiltration, peribronchial thickening, and paratracheal lymphadenpoathy. CONCLUSION: Helical CT scanning with virtual bronchoscopy should be performed in only selected cases with suspected foreign body aspiration. When the chest radiograph is normal and the clinical diagnosis suggests aspirated foreign body, helical CT and virtual bronchoscopy can be considered in order to avoid needless rigid bronchoscopy.

Adolescent↗

PubMed1998

Autofluorescence bronchoscopy in the detection of squamous metaplasia and dysplasia in current and former smokers.

BACKGROUND: New methods are needed to detect precancerous lesions in lung tissue. We conducted a study to determine the utility of LIFE (laser-induced fluorescence emission) autofluorescence bronchoscopy for the detection of squamous metaplasia and dysplasia in current and former smokers. METHODS: In this prospective, single-center study, 53 participants underwent standard white-light bronchoscopy and 39 underwent both white-light and LIFE bronchoscopy. Bronchial biopsy specimens were obtained from all participants at six pre-determined sites using white-light bronchoscopy and from all other sites that appeared to be abnormal in participants who underwent LIFE bronchoscopy. Relationships between LIFE imaging and histologic findings were examined for 245 biopsy specimens obtained from those participants who had undergone LIFE bronchoscopy. RESULTS: LIFE imaging revealed abnormalities designated as either class II or class III in 89 (36.3%) and 16 (6.5%) of the 245 sites examined, respectively, and histopathologic examination showed dysplasia and metaplasia in eight (3.3%) and in 52 (21.2%) of the 245 specimens, respectively. Among the 105 biopsy specimens obtained from sites with abnormal LIFE imaging, only 26 (24.8%) exhibited squamous metaplasia and/or dysplasia, similar to the findings for sites with normal LIFE imaging (34 [24.3%] of 140). Comparison of individuals examined by LIFE imaging with those who underwent white-light bronchoscopy alone revealed no increase in the detection of dysplasia or metaplasia with LIFE bronchoscopy. CONCLUSION: In this population of current and former smokers, abnormalities detected by LIFE bronchoscopy did not improve the detection of squamous metaplasia or dysplasia.

Adult↗

PubMedDate not supplied

Gut decontamination prevents bronchoscopy-induced bacterial translocation. An experimental study in rats.

BACKGROUND: Selective gut decontamination is suggested to suppress the gram-negative bacterial overgrowth in the intestine and consequently to reduce bacterial translocation. OBJECTIVE: The purpose of the present study is to examine the effects of gut decontamination on bronchoscopy-induced bacterial translocation, and intestinal mucosal injury. METHODS: Forty-five rats were assigned into three groups. Group 1 served as control (n=15). Group 2 (n=15) and group 3 (n=15) underwent bronchoscopy. In addition, group 3 underwent gut decontamination. Gut decontamination was performed two days prior to bronchoscopy with erythromycin and neomycin. Twenty-four hours after bronchoscopy, blood, mesenteric lymph nodes, spleen, liver, ileum and cecum were harvested for bacterial determination. The ileum was also assessed and graded histologically according to Chiu's injury scale. RESULTS: In the bronchoscopy group, bacterial translocation to the mesenteric lymph nodes was found in 7/15 rats (46.7%), compared to none of the controls (p=0.01). These rats also showed significant evidence of intestinal injury, compared to the controls (mean ranks, 32.7 or 8.5, p<0.0001). On the other hand, gut decontamination prevented bacterial translocation, compared to the bronchoscopy group (p=0.011). However, gut decontamination provided no beneficial effect on the intestinal mucosal injury, compared to the bronchoscopy group. These animals also revealed significant intestinal injury, compared to the controls (mean ranks, 27.8 or 8.5, p<0.0001). CONCLUSIONS: Our data shows that despite no amelioration in bronchoscopy-induced intestinal mucosal injury, gut decontamination has a preventive role for bronchoscopy-induced bacterial translocation.

Animals↗

PubMed1983

Diagnostic utility of fiberoptic bronchoscopy in patients with Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome.

The records of 35 adult male patients with suspected Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome were reviewed to determine the diagnostic utility of fiberoptic bronchoscopy. Twenty-two of the 24 patients (92%) shown to have Pneumocystis pneumonia were diagnosed by bronchoscopy; 20 patients were diagnosed after 1 bronchoscopy and 2 patients after 2 bronchoscopies. The sensitivity of bronchoscopy specimens for diagnosing Pneumocystis pneumonia was 79% for transbronchial biopsies (19 of 24), 78% for transbronchial biopsy touch preparations (7 of 9), 55% for bronchial washings (11 of 20), and 39% for bronchial brushings (7 of 18). The overall sensitivity of fiberoptic bronchoscopy was 85% (22 positive of 26 total bronchoscopies). Complications, occurring during 6 of the 37 bronchoscopies, were slight hemoptysis (1 patient), fever (2 patients), septic shock (1 patient), and pneumothorax (2 patients). Fiberoptic bronchoscopy is a safe and effective procedure for making the early diagnosis of Pneumocystis carinii pneumonia in adult male patients with the acquired immune deficiency syndrome.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Chest roentgenographic guidelines in the selection of patients for fiberoptic bronchoscopy.

We conducted this study to define the value of fiberoptic bronchoscopy (FOB) in the evaluation of chest radiographic abnormalities and to provide guidelines for fiberoptic bronchoscopy on the basis of chest radiographic appearances. Fiberoptic bronchoscopy without fluoroscopy was carried out in 530 patients, 455 male and 75 female, aged 19 to 85 years, during a 1-year period at Chest Department, Veterans General Hospital, Taipei. Of 530 patients, 19 (3.6 percent) had normal chest radiographs, and the remaining 511 (96.4 percent) patients had abnormal chest radiographs. Overall diagnostic yield of FOB was 55.4 percent in patients with abnormal chest radiographs and 52.6 percent in patients with normal chest radiographs. On the basis of radiographic findings, patients with lobar collapse (87.0 percent), hilar abnormalities (81.8 percent), pericardial effusions (66.7 percent), mass lesions (> 4 cm) (65.7 percent), and pleural effusions (64.9 percent) were most frequent to obtain a positive diagnosis via bronchoscopy (p < 0.001). Of 530 patients; mass lesion was the most frequent abnormality on bronchoscopy and had the highest incidence of providing a positive diagnosis (36.2 percent) (p < 0.001). A predilection of mass lesion on bronchoscopy was seen for chest radiographic features of lobar collapse (64.8 percent) and mass (> 4 cm) (47.0 percent) (p < 0.001). Of 19 patients with normal chest radiographs, a correct diagnosis was made in 4 (21.1 percent) with bronchoscopic findings of mass lesions, 3 (15.8 percent) with endobronchial abnormalities, and 3 (15.8 percent) patients with abnormal bronchial mucosa. Indeed, the decision to perform bronchoscopy should be guided by many factors other than chest radiograph. In this study, however, emphasis has been placed on the incidence of positive diagnosis via bronchoscopy on the basis of chest radiographic patterns. In this respect, we believe that in patient with lobar collapse, hilar abnormality, pericardial effusion, mass lesion (> 4 cm), and pleural effusion on the chest radiograph bronchoscopy should be considered.

Adult↗

PubMed1996

A randomized, double-blind, placebo-controlled study of lorazepam as premedication for bronchoscopy.

To our knowledge, no study has clearly demonstrated the advantage of sedative premedication for bronchoscopy. In a double-blind study, we evaluated the efficacy of oral lorazepam as premedication for bronchoscopy. One hundred patients were randomly assigned to receive placebo (group A) or lorazepam (2 mg) (group B) approximately 1.5 h before bronchoscopy. Immediately after the procedure and the following day, a questionnaire addressing the patient's perception of the procedure was administered. Specifically, subjects were asked to grade the bronchoscopy as very easy, easy, difficult, or very difficult to tolerate and if they would agree to a second bronchoscopy if believed necessary. In addition, their recollection of the procedure was graded as clear, indistinct, or not at all. No difference was found between the two groups for age, duration of the bronchoscopy, and the answers to the questionnaire administered immediately after the procedure. Most patients from both groups found their level of sedation adequate. On the following day, however, group B reported with lower frequency that the technique was difficult or very difficult (38.0% vs 65.3% for group A; p < 0.005) and that they would be less reluctant to a repeated bronchoscopy (30.0% vs 57.1% for group A; p < 0.015). Moreover, their recollection of the procedure was now less precise than for those who had received the placebo (p < 0.005). This suggests that the difference observed between the two groups at 24 h was related to the amnesic effect of lorazepam. We conclude that lorazepam, by improving patient's perception of the bronchoscopy, is a useful premedication and may facilitate patient's investigation when a second bronchoscopy becomes necessary.

Bronchoscopy↗

PubMed2000

Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules.

STUDY OBJECTIVES: To evaluate factors affecting the diagnostic yield of flexible fiberoptic bronchoscopy in evaluating solitary pulmonary nodules (SPNs). DESIGN: Retrospective analysis of bronchoscopies performed over a 4-year period. SETTING: A tertiary teaching hospital. PATIENTS: One hundred seventy-seven patients with pulmonary nodules without endobronchial lesions who underwent bronchoscopy with brushing, washing, and transbronchial biopsy. RESULTS: There were 151 malignant and 26 benign lesions. The diagnostic accuracy of bronchoscopy in malignant and benign lesions were 64% (97 of 151) and 35% (9 of 26), respectively. The yield of bronchoscopy was directly related to lesion size (p < 0.001, chi(2)). When lesions were grouped according to distance from the hilum, yields of bronchoscopy in central, intermediate, and peripherally located lesions were 82, 61, and 53%, respectively (p = 0.05, chi(2)). When we stratified distance from the hilum by lesion size, the difference in yield was not significant. However, lesions </= 2 cm had a diagnostic yield of 14% (2 of 14) when located in the peripheral third vs 31% (5 of 16) when located in the inner two thirds of the lung. There was a trend toward higher combined diagnostic yield in right middle and lingular lobes when compared to all other segments (p = 0.09, chi(2)). Transbronchial biopsy, washing, and brushing were complementary in improving the yield of bronchoscopy. CONCLUSIONS: Size is the strongest determinant of diagnostic yield in bronchoscopy when evaluating SPNs. The yield of bronchoscopy is particularly low in lesions </= 2 cm that are located in the outer third of the lung. Thus, alternative diagnostic approaches may be preferable in this situation.

Adult↗

PubMed2002

The changing pattern of bronchoscopy in an HIV-infected population.

STUDY OBJECTIVE: s: Little information exists on the impact of antiretroviral therapies (ARTs) on HIV-related bronchoscopic activity. This study was performed to identify any changes to our pattern of use of bronchoscopy over the last decade, and how this might relate to the introduction of more effective ARTs to our center in 1996. DESIGN: Retrospective data analysis. SETTING: Academic medical center. PATIENTS: HIV-positive patients attending the clinic. METHODS: Basic demographic details and bronchoscopy status were collected and compared for all patients with HIV attending our center between 1989 and 1998. Poisson regression analysis was performed to more formally identify the risk factors for bronchoscopy. Individual case notes and bronchoscopic findings were also examined for all patients undergoing bronchoscopy in 1990, 1995, and 1998. RESULTS: From 1996 to 1998, bronchoscopic rates fell dramatically by 60% (p < 0.0001) despite a linear increase in patients receiving follow-up. Prior use of protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor (NNRTI) combinations was significantly associated with a decreased risk of bronchoscopy even after adjusting for CD4 counts. Indications for bronchoscopy and diagnostic yield remained relatively stable in 1990, 1995, and 1998, although rates of pulmonary infection (Pneumocystis carinii pneumonia, bacteria, and virus) requiring bronchoscopy among our HIV population fell significantly from 1990 to 1998. CONCLUSION: Improvements in HIV health care are having a dramatic impact on the rates of certain pulmonary infections requiring bronchoscopy. Of these, the introduction of more effective ARTs to our service in 1996 seems most closely related to the temporal decline in bronchoscopy. PI/NNRTI combinations may have additional protective effects to their recognized action on CD4 counts.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

[Phonation bronchoscopy].

BACKGROUND: Fluorescence bronchoscopy is one of the methods of the early detection of lung cancer that involves the large airways. The method is based on the detection of the altered autofluorescence of malignantly transformed tissue, and confirmed by biopsy and histopathologic examination. METHOD: Fluorescence bronchoscopy was performed in 18 patients, mean age of 51.2 years (male n = 12, female n = 6) due to the suspected lung cancer. Fluorescence bronchoscopy was performed using the Xillix LIFE-Lung System, Vancouver, Canada. After conventional white-light bronchoscopy, the tracheobronchial tree was illuminated by blue light (442 nm) using helium-cadmium laser, and the results of autofluorescence were classified into three classes. Normal mucosa was of green fluorescence (Class I), abnormal mucosa was red or dark brown fluorescence (Class II and II), which was the indication for performing biopsy. RESULTS: Normal endoscopy findings were established in 15 patients by conventional bronchoscopy. In the same group, by fluorescence bronchoscopy, Class I of fluorescence (normal finding) was found in 9 patients, while Class II changes occurred in 6 patients. Histopathologic analysis of bronchial mucosa with Class II changes was performed detecting planocellular carcinoma in situ in one patient. Tumor-like changes were detected in 3 patients by conventional bronchoscopy, and were determined as Class III changes by fluorescence bronchoscopy. By the biopsy of these chages carcinoma was documented in 2 patients while in one patient metaplasia of epithelium and granulation tissue around aspirated foreign body was detected. CONCLUSION: Fluorescence bronchoscopy is one of the methods for detecting metaplasia, carcinoma in situ and cancerous changes of bronchial epithelium in the large airways. However, the high rate of falsely positive findings represents a limitation of this method.

Adult↗

PubMed1992

[Bronchoscopy for initial care following severe thoracic trauma--basically indicated?].

UNLABELLED: The study objective was to determine the usefulness of routine early (within 24 h after admission) and late (on the 3rd posttraumatic day) flexible fiberoptic bronchoscopy in patients with severe chest trauma. METHODS: By history, physical examination, and radiologic findings, we identified 15 consecutive patients, all of whom were anaesthetized, orally intubated, and mechanically ventilated. There was no change in ventilation, including FIO2, for bronchoscopy. The patients had continuous cardiovascular monitoring and peripheral pulse oximetry. The bronchoscope was inserted through a tight-fitting side port at the endotracheal tube connector. Pulse rate, mean arterial pressure, and arterial blood gases were recorded before, 1 min after, and 10 min after bronchoscopy, as were intracranial pressure (ICP) in 7 patients with an ICP probe (early bronchoscopy only) and the duration of the examination. Statistical significance was tested by means of the Wilcoxon test for correlating samples. Significance was assumed at P less than 0.05 in a two-sided test. RESULTS: Early bronchoscopy revealed two bronchial avulsions, two aspirations, and ruled out one suspected aspiration. Late bronchoscopy showed plugging of at least 3 segmental bronchi by clots in 4 patients, none of whom was able to expectorate effectively. In general, changes in the observed vital parameters were minimal. There was a significant but clinically irrelevant increase in mean pulse rate before and 1 min after early bronchoscopy. DISCUSSION: We conclude that bronchoscopy should always be considered in patients with severe chest trauma, the decision being based on typical radiological findings as well as clinical signs and symptoms. Given the proper indication, bronchoscopy supplies valuable information at minimal risk to the patient.

Adult↗

PubMed2006

The effect of fiberoptic bronchoscopy on exhaled nitric oxide.

Nitric oxide has been extensively studied as a noninvasive marker of airway inflammation. Assuming that bronchoscopy can produce not only systemic but also local inflammatory response, we hypothesized that bronchofiberoscopy can be responsible for an increase in nitric oxide synthesis with resulting increase in fractional concentration of exhaled nitric oxide (FE(NO)). Fifty five subjects (F/M-23/32; mean age 53.9 +/-17.3 yr) undergoing diagnostic bronchoscopy participated in the study. The indications for bronchoscopy were as follows: interstitial lung diseases (n=13; 23.6%), lung cancer (n=11; 20.0%), hemoptysis (n=10; 18.2%), differential diagnosis of asthma/dyspnea (n=9; 16.4%), pulmonary infections (n=7; 12.7%), and others (n=5; 9.1%). During bronchoscopy bronchial washing (n=18), bronchoalveolar lavage (BAL) (n=26), and bronchial biopsies (n=24) were performed. FE(NO) was analyzed on-line with chemiluminescence analyzer (NIOX, Aerocrine, Sweden) according to the ATS guidelines, before and at 1, 2, 3 and 24 h after bronchoscopy. The mean FE(NO) before bronchoscopy was 21.0 +/-3.31(SE) ppb, it decreased to 14.8 +/-2.10 ppb 1 h after bronchoscopy, reached a nadir at 2 h (14.4 +/-2.28 ppb; P<0.05), and was not different from baseline 24 h after bronchoscopy (22.8 +/-2.90 ppb). There were no differences in the FE(NO) profile in BAL patients compared with those in whom only the bronchial washing was performed. We conclude that bronchoscopy leads to a decrease in FE(NO). The underlying mechanisms are at present unclear.

Biopsy↗

PubMed2006

[Influence of bronchoscopy on nitric oxide in exhaled air].

UNLABELLED: Nitric oxide has been extensively studied as a noninvasive marker of airway inflammation, especially in asthma. Assuming, bronchoscopy can produced not only systemic but also local inflammatory response we hypothesized that bronchofiberoscopy can be responsible for an increase in nitric oxide synthesis with resulting increase in fractional concentration of exhaled nitric oxide (FE(NO)). Seventeen subjects (10 M, 7 F), at mean age of 53.8+/-14.1 yrs undergoing diagnostic bronchoscopy participated in the study. The indications for bronchoscopy were as follows: lung cancer (n=5; 29%), interstitial lung diseases (n=3; 18%), slowly resolving pneumonia (n=3; 18%), hemoptysis (n=3; 18%), differential diagnosis of asthma/ dyspnea (n=3; 18%). During bronchoscopy bronchial washing (n=7) and bronchoalveolar lavage (BAL) (n=10) has been performed. FE(NO) has been analyzed on-line with chemiluminescence analyzer (NIOX, Aerocrine, Sweden) according to American Thoracic Society guidelines, before and at 1, 2, 3 and 24 hours after bronchoscopy. Mean FE(NO) before bronchoscopy was 19.7+/-4.5 ppb (mean +/- SEM), post - bronchoscopy a decrease with a nadir at second hour (12.1+/-1.5 ppb, p<0.05) was observed, FE(NO) 24 hours after bronchoscopy was not different than baseline (18.4+/-2.5 ppb). There were no differences in the FE(NO) profile in BAL patients when compared to those in whom only the bronchial washing has been performed. CONCLUSIONS: Bronchoscopy leads to a significant decrease in exhaled nitric oxide. The underlying mechanisms are unclear. Future studies including analysis of other inflammatory markers are needed to explain these changes.

Asthma↗

PubMed1989

The role of fiberoptic bronchoscopy in evaluating the causes of pleural effusions.

To evaluate the diagnostic merit of fiberoptic bronchoscopy in pleural effusions, we performed fiberoptic bronchoscopy in addition to thoracocentesis and closed pleural biopsy in 140 patients who were admitted for diagnostic investigation of the causes of pleural effusions. The patients were divided into subgroups based on clinical features and roentgenographic findings of chest x-ray films. In 39 patients, the pleural effusions were due to various nonneoplastic disorders and in 95 patients it was caused by malignancy. In six patients, the causes of the pleural effusions remained undetermined. A final diagnosis was made by pleural examination in 68 patients, by fiberoptic bronchoscopy in 58 patients, and by either one or both in 100 patients. In 82 patients who had no hemoptysis, a final diagnosis was made by pleural examination in 57 cases and by fiberoptic bronchoscopy in 11 cases only. The diagnostic yield of fiberoptic bronchoscopy (47/58) was superior to that of pleural examination (11/58) in 58 patients presenting with hemoptysis. In 74 patients who had pleural effusions as the sole roentgenographic abnormality, the final entity was established by pleural examination in 45 and by fiberoptic bronchoscopy in 12. The diagnostic merit of fiberoptic bronchoscopy was significantly higher in 59 patients who had concurrent pulmonary abnormalities on their chest roentgenograms. A final diagnosis was made in 43 cases by fiberoptic bronchoscopy in comparison with 21 cases by pleural examination. For patients with unknown pleural effusions, fiberoptic bronchoscopy was more likely to yield a diagnosis than thoracocentesis with closed pleural biopsy in those who had hemoptysis or pulmonary abnormality on chest x-ray films, whereas the reverse applied when these features were absent.

Adult↗

PubMed1997

Bronchoscopy in the diagnosis and therapy of chest injuries.

Owing to its technical possibilities, bronchoscopy has also come into frequent use in the treatment of trauma patients, not only for diagnostic but also for therapeutic purposes. It has become a mandatory procedure in the treatment of chest injuries. Following discussion of its history, possibilities and scope, the authors present the results of treatment over the last two years at the University Hospital of Traumatology Zagreb, Croatia. There were 407 bronchoscopies performed in 157 trauma patients (on the average, 2.59 bronchoscopies per patient). According to indications for bronchoscopy, patients were classified into four groups: (a) patients with atelectasis (N = 51), with a total of 68 bronchoscopic procedures (1.33 per patient; (b) patients who developed infiltrates (N = 48) with 162 bronchoscopies (3.37 per patient); (c) patients with excessive secretions (N = 42) with 153 bronchoscopies (3.64 per patient); and (d) patients who developed respiratory insufficiency in the course of treatment (N = 16) with 24 bronchoscopic procedures (1.5 per patient). The best results were achieved in the atelectasis patients--in 74.47% of them there was no need of additional bronchoscopies, whereas in the group with excessive secretions or infiltrates bronchoscopy had to be repeated several times. It may be concluded that today, bronchoscopy is a routine diagnostic and therapeutic method in the treatment of chest injuries.

Bronchoscopy↗

PubMed2000

Detection and localization of early lung cancer by fluorescence bronchoscopy.

BACKGROUND: Curative therapy is available for patients with Stage 0 lung carcinoma, with a >90% 5-year survival rate. Promising chemopreventive agents also are under investigation currently to reduce the risk of lung carcinoma in high risk populations. However, preinvasive bronchial lesions (moderate to severe dysplasia and carcinoma in situ) are very small and thin. They are difficult to localize by conventional white-light bronchoscopy. Fluorescence bronchoscopy is a new diagnostic tool for the detection of these preinvasive lesions. METHODS: The data on the use of fluorescence bronchoscopy to detect and localize preinvasive lesions in current heavy smokers and in former smokers at the British Columbia Cancer Agency as well as the worldwide experience cited in MEDLINE, Index Medicus, and Deutsches Institut fur Medizinische Dokumentation und Information (Cologne, Germany) comparing white-light and fluorescence bronchoscopy using the lung imaging fluorescence endoscope (LIFE)-Lung device (Xillix Technologies Corp., Richmond, British Columbia, Canada) were reviewed. RESULTS: Among current heavy smokers and former smokers with sputum atypia, the prevalence of carcinoma in situ was 1.6%. Moderate or severe dysplasia was found in another 19%. The preinvasive lesions were found to be small: 55% measured < or = 1.5 mm in greatest dimension. Over 1000 cases have been reported in the literature between 1994 and 1999. Overall, 40% of the preinvasive lesions were detected by white-light bronchoscopy alone. The addition of fluorescence bronchoscopy increased the detection rate to an average of 80%. CONCLUSIONS: Preinvasive lesions, especially dysplastic lesions, are small. They are difficult to detect and localize by white-light bronchoscopy. Fluorescence bronchoscopy improves the detection rate. It is an important part of the armamentarium in the overall management of early lung cancer.

Bronchoscopy↗

PubMed2005

Foreign body removal by flexible fiberoptic bronchoscopy in infants and children.

Rigid bronchoscopy is the preferred method for removal of foreign bodies lodged in the airways, but some studies found that flexible bronchoscopy can also achieve a high success rate. The aim of the present work was to report our experience in using flexible bronchoscopy for foreign body retrieval in infants and children. Reports of all bronchoscopies performed from 1994-2003 at a tertiary-level pediatric hospital in Mexico City were reviewed. Those with a final diagnosis of foreign body aspiration were analyzed. Of 2,376 bronchoscopies performed during the study period, 59 (2.5%) yielded a final diagnosis of foreign body aspiration: 28 lodged in the right bronchi, 15 in the left bronchi, and those remaining, in the larynx or trachea. Foreign bodies were organic in nature in 38 (64.4%), mainly peanuts, pumpkin seeds, and beans, while 21 (35.6%) were inorganic, mainly pen caps and pins. In 23 cases, flexible bronchoscopy was attempted as the initial therapeutic procedure. Among these latter patients, the procedure was successful in 21 (91.3%). Ages of these 21 patients ranged from 9 months to 16 years (median, 5 years). The only two patients in whom foreign bodies could not be removed through flexible bronchoscopy were males, 2 years of age, both with a peanut lodged in right main bronchus. In conclusion, flexible bronchoscopy must be taken into account as initial therapeutic method for foreign body removal in infants and children.

Adolescent↗