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Characteristics of tantalum dust and dust generator for bronchography.

The two tantalum powders, "5mu" and "1.4mu", available from Fansteel Metals, are characterized with respect to particle size. Results show that these powders cannot be used directly for tantalum bronchography, but require fractionation to achieve a range of sizes for effective use in tantalum bronchography. This task can be accomplished with the BAHCO Micro Particle Classifier. The powder designated "1.4mu" is superior to the "5mu" powder because about 60% by weight can be salvaged by separation for use in bronchography, compared to only 7% by weight of the "5mu" powder. Theoretical considerations of particle deposition in the human respiratory tract indicate that the material obtained with throttle 16 of the BAHCO is best suited for tantalum bronchography. The dust generator is a good tool to deliver a dust cloud into the lung. The generator can operate for approximately 2 1/2 hours before the brush of the brush feed must be replaced; a procedure taking about 10 min. Additional maintenance is unnecessary. The breathing resistance of 1.1 inch of water imposed by the generator system, and which has to be overcome by the patient, is judged acceptable. The bronchograms obtained by introducing tantalum dust for 10 min into an artificially ventilated dog lung were clear, with deposition heaviest at bifurcations. These results suggest that the generator should now be used for human bronchography.

Animals

Localization of occult bronchogenic carcinoma by bronchography.

Bronchography is seldom recommended today to localize radiographically and bronchoscopically occult bronchogenic carcinoma. We report a case in which bronchography promptly localized such a tumor that had been occult to multiple bronchoscopies and chest computed tomograms (CTs). The patient is free of recurrence 32 months after lobectomy. Bronchography should be considered when bronchoscopies and CT fail to reveal a radiographically occult carcinoma.

Bronchography

[Prophylactic use of antibiotics for fever following fiberoptic bronchoscopy and bronchography].

To evaluate the effect of bacampicillin hydrochloride on fever following fiberoptic bronchoscopy and bronchography, we conducted multi-institutional randomized study. In bronchographic examinations, the rise of body temperatures in the bacampicillin group (0.82 +/- 0.13 degrees C: mean +/- SE) was significantly smaller than that in the control group (1.39 +/- 0.25 degrees C) on the second day of examination. Bacterial infection may contribute to the rise of temperature on the day following bronchography, but no pneumonia or sepsis was observed. There was no differences in the rise of body temperature on the first, third or fourth day. In fiberoptic bronchoscopic examinations, there was no difference between the two groups. We conclude that there is no clinical indication of the value of prophylactic use of antibiotics in either fiberoptic bronchoscopy or bronchography.

Adult

High resolution CT and bronchography in the assessment of bronchiectasis.

To elucidate the reliability of CT in the assessment of bronchiectasis, a retrospective study of high resolution CT and bronchography was carried out. A segment by segment comparison of 259 segmental bronchi from 70 lobes of 27 lungs in 19 patients was performed using bronchography as standard. CT was positive in 87 of 89 segmental bronchi with bronchiectasis giving a false-negative rate of 2%. CT was negative in 169 of 170 segmental bronchi without bronchiectasis at bronchography, giving a false-positive rate of 1%. There was agreement between the two modalities in identifying the different types of bronchiectasis.

Adult

The effect of bronchography on pulmonary ventilation.

Using a gamma camera and the Xenon-133 washout method the reduction in lung function during unilateral bronchography was assessed in eleven patients. A considerable reduction in the washout rate was observed in the lung examined with bronchography both absolutely and compared with the opposite lung. Some improvement occurred after coughing out the contrast medium. It is concluded that the ventilatory function of the lungs is considerably impaired during bronchography and this should be borne in mind when referring patients with reduced lung function for this examination.

Adolescent

Bronchography in children aged 3 years and under. Anaesthetic techniques and results.

Bilateral bronchography was performed on 89 children aged between 3 months and 3 years. The bronchographic technique involves instillation of oily propyliodone into the tracheobronchial tree by positive pressure ventilation, and the procedure is carried out under general anaesthesia. Technically adequate bronchograms were obtained in 84 of the children, and with a solitary exception the complications of bronchography were few and trivial. In bronchiectatic children bronchography is a valuable and accurate investigation, which should in general be restricted to those patients who on clinical grounds are thought to have surgically manageable bronchiectasis.

Anesthesia, Inhalation

Postmortem assessment of chronic airways obstruction by tantalum bronchography.

Tantalum bronchography was performed on 22 left lungs obtained at necropsy. Seven were from patients dying in cor pulmonale as a result of chronic airways obstruction and 15 were from unselected necropsies. Of the latter group, nine had no evidence of respiratory disease and six had pathological changes of emphysema and bronchial mucous gland enlargement when the lungs were examined following formalin fixation. A range of changes in the bronchographic appearances from the normal to the groosly abnormal is illustrated. The main changes in severely diseases lungs were: irregularity of the bronchial walls, failure of the walls to taper towards the periphery, areas of narrowing and dilatation, and 'pooling' of tantalum at the ends of airways. A count was made of the numbers of small airway branches in the most distal 4 cm of the lung and also of the number of airways of less than 1 mm in diameter. Patients dying in cor pulmonale had a significantly reduced total number of patent small airways in the area measured and also fewer patent airways of less than 1 mm diameter compared to both the other groups. Histological study of four of the lungs in greater detail revealed that the reduction in small airways filling was the result of a combination of obliteration and obstruction of the lumen by pus. Tantalum bronchography provides a good indication of the state of the bronchial tree at the time of death, and the changes seen are the result of both acute and chronic disease processes.

Adult

Airway visualization by tantalum inhalation bronchography.

A novel technique for the generation of tantalum aerosols (aerodynamic mass median diameter, 5.8 mum; sigma g, +/-2.14) for inhalation bronchography via the mouth was applied in 26 anesthetized dogs. Ventilatory patterns during periods of aerosol inhalation were controlled by either bilateral electrophrenic stimulation of the diaphragm (EPS), or by intermittent, negative pressure at the body surface (INPV). We studied patterns of tracheobronchial deposition with regard to both the sites of particle deposition longitudinally along airways within lobes, and the topographic distribution of aerosol among the lung lobes. Bronchographic patterns were accordingly studied after inhalations by either (1) EPS and INPV in the supine posture with constant tidal volumes, but varied inspiratory flow (30 to 90 liter per min); or (2) EPS with constant tidal volume and peak inspiratory flow in the prine, right, and left lateral decubitus body positions. Under all airflow conditions, the aerosol was deposited on the surfaces of ciliated airways. Deposition was nearly entirely confined to subsegmental bronchi and above with vigorous inspirations, but extended distally to subsegmental bronchi in greater proportion with decreases in the inspiratory flow. Airways among the basal lung lobes were particularly subject to distal subsegmental and bronchiolar deposition with low rates of inspiratory airflow. Regionally, the aerosol was deposited preferentially in dependent lung lobes after inhalations with EPS in the right and left lateral decubitus positions, and in the basal lung lobes with EPS in the supine posture. A greater caudocranial uniformity in lobar aerosol distribution occurred with inhalations by INPV in the supine posture, and by EPS in the prone posture. The canine model strongly suggests that for clinical inhalation bronchography, nonhomogeneities in lobar deposition may be averted by inhalations in multiple body positions, and that deposition of the aerosol may be confined to ciliated airway surfaces by inertial impaction accompanying high rates of inspiratory airflow.

Aerosols

Bronchography in patients with hemoptysis.

Retrospective analysis of 196 cases suggests that bronchography has limited value in the evaluation of hemoptysis. Most patients with a single episode of hemoptysis and normal plain chest roentgenographic and bronchoscopic findings do not require bronchographic examination. Advances in cytologic and biopsy procedures (fiberoptic bronchoscopy, bronchial brushing, needle aspiration) have largely replaced the usefulness of bronchography even when the plain chest roentgenogram is abnormal.

Bronchial Diseases

[Indications and limitations of bronchography in surgery of carcinoma of the lung].

Starting from a consecutive series of 53 bronchographies performed under local anesthesia, in subjects with carcinoma of the lung ascertained by operation, the Authors analyse both the bronchographical aspects which most frequently come under the surgeon's observation, and the usefulness of this investigation in formulating the operating plan. As regards carcinomas of the large and medium bronchi, the bronchographic aspects they found most frequently are occlusion (82%) both in the form of sudden arrest and in the form of a cone image and stenosis (18%). In peripheral carcinomas, on the other hand, most characteristic bronchographic signs are identified as occlusion (58%) (amputation and stenosis) and dislocation (38%) with rigidity of one or more small calibre bronchi (rigid impairment). On the basis of their experience the Authors conclude that bronchography constitutes an almost indispensable examination for diagnostic purposes in malignant neoplasias, especially in the initial stage, when located outside the field of action of bronchoscopy, and can supply elements indispensable in the preoperative operatability judgement. In fact it not only gives very reliable information on the anatomical situation of the bronchus, as well as on the site and presumed starting-point of the neoplasia, but also supplies more approximate elements with regard to the extent of the neoplasia and any presence of lymphoglandular metastases.

Bronchial Neoplasms

[Unilateral bronchography at a young age and ventilatory function].

In 21 males, aged about 20, 18 out of them with chronic bronchopulmonary diseases (bronchiectases, focal fibrosis, deforming bronchitis) and three healthy--VC, FEFR1, FVC, MMV50, MEFR200-1200, MAEFR, MAEFR25-75 and MEFR50 and MEFR90 were spirographically investigated prior to, two hours afert and 24 hours after unilateral bronchography; the three of the investigations were combined with a subsequent inhalation bronchodilatation test with orziprenalin--aersol (alupent). A mixed (restrictive-obstructive) ventilation syndrome with bronchospasm was established to develop after the bronchography. The restrictive syndrome is prevailing and that is conditioned by the absence of a definite manifestation of the obstruction at the level of the flow rates with small pulmonary volmes. The restrictive syndrome is admitted to be conditioned by "fear of coughing and the obstructuve-by the opaque medium and bronchospasm after the injection of the opaque substance.

Adult

Biological disposition of perfluoroctylbromide: tracheal administration in alveolography and bronchography.

Perfluoroctylbromide, given tracheally either as neat liquid in alveolography or as 10:1 emulsion in bronchography, was cleared roentgenologically from the lungs within 24 hours. Quantitative analysis was performed on a gas chromatograph. The rats were given either 2 ml/kg of neat liquid or 0.4 ml/kg emulsion. One per cent of the neat liquid and 8% of the emulsion were recovered from the tissues respectively 24 hours later. The lungs had the largest amount followed by the intestine, adipose tissue and lymph nodes. Dogs were sacrificed at various intervals following 4 ml/kg of neat liquid or 2 ml/kg of emulsion. Less than 1% of the dose was found in the tissues at 24 hours. A similar pattern of perfluoroctylbromide distribution was observed as in the rats. The tissue contents of perfluoroctylbromide at three months were below the limit of detection. The perfluoroctylbromide levels in the blood and urine of dogs and human volunteers were either non-detectable or barely detectable over a 48-hour period.

Animals

Bronchial web diagnosed by bronchography.

Bronchial webs are rare lesions which often go unrecognized. The authors describe a patient who presented with right-lower-lobe bronchiectasis and at-electasis secondary to a web in the right-lower-lobe bronchus. This is the first known instance where such a lesion has been demonstrated by bronchography. The etiology of this and similar lesions reported in the literature remains obscure.

Bronchi

Barium sulfate bronchography. Report of a complication.

Alveolarization of the barium sulfate and subsequent retention of barium sulfate for years was demonstrated in three patients in whom dilute suspension of barium sulfate in water was used for bronchography. Pathologic examination in one patient showed barium sulfate within macrophages in the alveolar spaces and walls and in the perivascular and peribronchial interstitium. Since the residual barium sulfate interferes with imaging procedures of the lungs, it represents an unwanted event in patients with pulmonary disease. High-resolution computed tomography is the preferred method of evaluating for bronchiectasis. If bronchogram is performed, it should be performed after bronchoscopy using oily propyliodone (Dionosil).

Adult

Bronchography in the recognition of congenital cystic bronchiectasis.

Congenital cystic bronchiectasis is an uncommon disease. Most of the reported cases have been in infants and young children. This paper presents four cases of older children and younger adults who had congenital cystic bronchiectasis. Distribution of the disease is lobar or may even involve an entire lung. Bronchography plays an important role in the diagnosis of congenital cystic bronchiectasis. The three important bronchographic signs of congenital cystic bronchiectasis are: (1) absence of contrast filling of the bronchial glands duct; (2) contrast filling of numerous cysts which communicate directly with the bronchial tree; and (3) nonvisualization of normal lung parenchyma within the area of involvement.

Adolescent

[Bronchography in children].

In spite of improvement in the exploratory techniques of the respiratory tract, tracheo-bronchography preserves numerous indications in the study of children's congenital or acquired bronchopneumopathies. The main indications of this investigation consist in the detection of bronchectasies or in the exploratory study of chronic and relapsing bronchial diseases. The investigation makes possible to precise the severity of the disease, to value the results of the medical management and, at last, to select the patients amenable to surgery. Another indications are to be found in the appraisal of some malformative broncho-pneumopathies, with special reference to lung hypoplasias and sequestrations. The technical conditions of the investigation have largely benefited of short duration general anesthesy and of various material improvements (televised fluoroscopy, orientable catheters of small calibre).

Adolescent

[General anesthesia for bronchoscopy and lipidol bronchography in children and infants].

In 160 cases of children and infants, a technique of general anesthesia is described (penthiobarbital-suxamethonium, then halothane-oxygen with a mask in spontaneous ventilation if the bronchoscopy is followed by lipiodol bronchography). This technique is simple and efficacious and makes the child comfortable, especially in cases of repeated operation, and for the operator whose gestures are more rapid and less traumatising and this permits rapid awakening. No incidents or severe complications were noted.

Anesthesia, General

[Acquired tracheobronchial stenosis of the premature infant under artificial respiration. Value of bronchography and endoscopic balloon dilatation. Apropos of 7 cases].

The authors report about a series of 7 cases of acquired tracheobronchial stenosis in premature infants who were intubated as soon as they were born and ventilated. Two important points can be pointed out: the merits of bedside bronchography, which allows diagnosing the lesions, the merits of balloon dilatation during tracheobronchoscopy on the ENT operating theatre to treat the stenosis. This technique allowed improving ventilation and removing the tube in 6 of 7 cases.

Bronchography