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At least 19 recordsLinked to original sources
PubMedDate not supplied

Fiberoptic bronchoscopy in the diagnosis of lung cancer comparison of pre-and post-bronchoscopy sputa, washings, bruchings and biopsies.

Fiberoptic bronchoscopy (brushings, washings and biopsies) was performed and pre- and post-bronchoscopy sputum cytologies obtained on 70 patients with histopathologically proven lung cancer. Bronchoscopy, with its associated procedures performed in 52 patients with primary bronchogenic carcinoma, was diagnostic in 41 (79%). Of all the various methods of obtaining specimens, bronchial brushing and bronchial biopsy gave the highest percentage yield (67%). However, since brush specimens could be obtained from peripheral lesions under fluoroscopic guidance, a greater number of positive specimens were obtained by this procedure (34) than by forceps biopsy (25), making brushing more useful. Pre- and post-bronchoscopy sputa were positive and thus of value in two cases when brushing and biopsy were both negative. Bronchial washing did not add significantly to the yield of positives and could therefore be eliminated as an unnecessary cost-and time-consuming procedure. Fiberoptic bronchoscopy was not helpful in diagnosing mediastinal tumors (5), lung metastases (7) and bronchial adenomas (6).

Adenoma↗
PubMed1978

Bronchoscopy in the community hospital.

A new Pulmonary Medicine-Thoracic Surgery service was established in a community hospital in July 1974. This report details the experience of 409 bronchoscopies performed from July 1, 1974 through Dec 31, 1976. There were no deaths and four complications--one aspiration and three pneumothoraces resulting from transbronchial lung biopsy. Final diagnoses for which bronchoscopy was done were as follows: cancer--141; infectious disease--97; interstitial disease--33; obstructive lung disease--58; hemoptysis--35; miscellaneous--45. In the cancer group, a cytohistologic diagnosis was made in 82 patients by bronchoscopy alone, 31 additional diagnoses were made by scalene node biopsy or mediastinoscopy, and the remainder by surgical exploration and/or resection. In 268 patients with benign disease, bronchoscopy established the diagnosis in 87% of the cases. Pulmonary Medicine tended not to repeat nondiagnostic bronchoscopy but rather to refer immediately for a definitive surgical procedure. Thoracic Surgery tended not to reduplicate bronchoscopy for the purpose of "confirmation." A conjoint medical-surgical approach to bronchial disease, at the community level and based on a mutual understanding of capability and limitation, is feasible, productive, and economical.

Bronchoscopy↗
PubMed1977

Fiberoptic bronchoscopy and culture bacteria from the lower respiratory.

Forty-five specimens were obtained by sequential translaryngeal aspiration and fiberoptic bronchoscopy from 31 clinically unifected patients with lung cancer in order to evaluate the reliability of routine fiberoptic bronchoscopy for culture of the lower respiratory tract. Bacteria were recovered brom 98 percent (44) of the specimens obtained via fiberoptic bronchoscopy and from 58 percent (26) of the specimens obtained by the preceding translaryngeal aspiration. The microorganisms grown from cultures of specimens obtained by fiberoptic bronchoscopy consisted of mixtures of both nonpathogenic and potenitally pathogenic bacteria. Potentially pathogenic bacteria were present in 87 percent (39) of the specimens from fiberoptic bronchoscopy and 31 percent (14) of specimens from translayngeal aspiration. The results of cultures from the two procedures agreed completely in only a single instance. Culture of washings or secretions obtained by routine fiberoptic bronchoscopy is not recommended because it provides inaccurate and clinically confusing information about the presence or types of bacteria in the lower respiratory tract prior to instrumentation.

Aged↗
PubMed1978

Comparison of diazepam and flunitrazepam for sedation during local anaesthesia for bronchoscopy.

Diazepam and flunitrazepam were compared as amnesic and sedative adjuncts to local anaesthesia for diagnostic bronchoscopy in 92 patients. After local anaesthesia of the pharynx, larynx and trachea with lignocaine, atropine plus diazepam of flunitrazepam was injected i.v. The co-operation of the patients and the technical circumstances under which the bronchoscopy was performed were good in each group. None of the treatments significantly modified arterial pressure or heart rate. Two hours after the injection, flunitrazepam 0.01 mg kg-1 more frequently caused amnesia for pictures shown to the patients during the first 15 min after injection (failure to recall 42--75%, and for bronchoscopy 67%), than did diazepam 0.125 mg kg-1 (failure to recall 21--67%; bronchoscopy 38%). Double doses of the drugs caused amnesic actions similar to those of flunitrazepam 0.01 mg kg-1. When failure to recall was assessed on the following day, 29% and 5% of the patients remembered bronchoscopy after flunitrazepam 0.01 and 0.02 mg kg-1 respectively; after diazepam 0.125 and 0.25 mg kg-1 the corresponding percentages was 59% and 30% (P less than 0.05% v. fluintrazepam). The ability to stand and walk on a stright line was similar after the smaller doses of both drugs, but after the larger doses recovery was slower after flunitrazepam. Psychomotor performance was still distinctly impaired 2 h after the injection of the larger doses.

Adult↗
PubMed1976

Bacteriology of the lower respiratory tract as determined by fiber-optic bronchoscopy and transtracheal aspiration.

For assessment of the validity of cultures of tracheobronchial secretions and exudates (TBSE) obtained by fiber-optic bronchoscopy, the aerobic and anaerobic flora of expectorated saliva and TBSE obtained by fiber-optic bronchoscopy from nine healthy volunteers and eight patients were compared with those obtained by fiber-optic bronchoscopy as well). Normal volunteers yielded both aerobic and anaerobic bacteria in amounts usually less than 104.5 colony-forming units (cfu)/ml in TBSE obtained by fiberoptic bronchoscopy. In patients with chronic bronchitis, 42 isolates of aerobic bacteria (104-105.5 cfu/ml) and only 10 isolates of anaerobes (usually less than 104 cfu/ml) were reovered from 15 samples obtained by trantracheal aspiration. The data lead to the conclusion that low-level contamination (less than or equal to 104 cfu/ml) with oral flora is common in TBSE obtained by fiber-optic bronchoscopy. A single potential pathogen in numbers of greater than or equal to 105 cfu/ml may be of etiologic significance, particularly if recovered from purulent drainage material from a localized portion of the lung. Under circumstances in which quantitative bacteriology cannot be done, TBSE obtained by transtracheal aspiration will most reliably reflect the bacterial flora present in the lung.

Adult↗
PubMed1979

Acute lobar atelectasis: a prospective comparison of fiberoptic bronchoscopy and respiratory therapy.

To evaluate the usefulness of fiberoptic bronchoscopy for treatment of acute lobar atelectasis, 31 subjects were randomly allocated to fiberoptic bronchoscopy followed by respiratory therapy for 48 hours, or to respiratory therapy alone for the same period. No significant differences between groups with regard to restoration of volume loss were detected after the first treatment intervention, at 24 or at 48 hours (P greater than 0.20). Specifically, the mean percentage resolution of volume loss immediately after bronchoscopy (38 per cent) closely approximated that after the first respiratory therapy treatment in subjects who had not undergone bronchoscopy (37 per cent). An air bronchogram proved to be a predictor of delayed resolution for both groups. At 24 hours, 26 per cent of the air bronchograms demonstrated 83 per cent resolution (P less than 0.001). These results suggest that fiberoptic bronchoscopy does not add to respiratory therapy in the treatment of acute lobar atelectasis and that an air bronchogram predicts delayed resolution of collapse.

Adolescent↗
PubMed1976

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

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

Airway Obstruction↗
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↗
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↗
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↗
PubMed1979

The usefulness of fiberoptic bronchoscopy in evaluating new pulmonary lesions in the compromised host.

Thirty-four fiberoptic bronchoscopies employing various bronchoscopic technics were carried out in 33 immune-compromised patients for the evaluation of new pulmonary lesions. Transbronchial biopsy was performed only with fluoroscopic guidance and was omitted in patients with a bleeding tendency. Bronchial brushing and bronchial washing were successfully carried out despite the presence of contraindications to biopsy. Brushing and washing were diagnostically useful in 66 and 74 per cent of the cases, respectively, compared to 71 per cent for forceps biopsy. The combined over-all yield was 88 per cent, with no serious complications encountered. The most common etiology of new infiltrates was opportunistic infection. Among bacterial infections, gram-negative organisms were the most common, and among fungal etiologies, Coccidioides immitis was the predominant pathogen in this series from Tucson, Arizona. Although the roentgenographic pattern was not helpful in predicting the etiology of the new infiltrates, diffuse lesions were more frequently evaluated correctly by fiberoptic bronchoscopy than localized lesions. The low incidence of complications and the high over-all yield indicate that fiberoptic bronchoscopy, employing bronchial brushing and washing as supplements to transbronchial biopsy (and as a replacement to biopsy in patients with a bleeding diathesis), can be very useful in evaluating new pulmonary lesions in the immune-compromised patient. When used together, these technics significantly increase the diagnostic yield and eliminate the risks associated with performing more invasive diagnostic procedures in the compromised host.

Adult↗
PubMed1978

Effect of age on amnesia and sedation induced by flunitrazepam during local anaesthesia for bronchoscopy.

Bronchoscopy was undertaken in 79 outpatients using local anaesthesia plus an i.v. injection of flunitrazepam 0.01 mg kg-1. The co-operation of the patients and the ease of bronchoscopy were good regardless of the age of the patient. There was an increase in amnesia for the bronchoscopy with increasing age, but the most distinct difference between different age groups was that the amnesic action of flunitrazepam was evident earlier and persisted longer in patients of more than 60 yr. Eye co-ordination and ability to stand steadily and walk on a line returned to normal more slowly in patients more than 60 than in those less than 60 yr, but no differences in recovery were noted between patients less than 40 and those of 40--59 yr, or between those 60--69 and those more than 70 yr.

Adult↗
PubMed1976

Jet ventilation for fiberoptic bronchoscopy under general anesthesia.

An oxygen jet method ventilating patients during laryngoscopy has been applied to fiberoptic bronchoscopy. A 3.5 mm plastic tube 24.5 cm long was inserted into the trachea through the mouth. An intermittent jet of oxygen at 3.5 atm (50 psi) was applied to this tube using a 1.5 mm ID plastic catheter to ventilate the patient. Anesthesia was accomplished with intravenous thiamylal and Innovar. The patients were paralyzed with continuous succinylcholine. The technique has subsequently been used without complications in more than 1,000 patients. A fluidic ventilator was developed for delivering and controlling the oxygen jet. The airway pressure can be monitored continuously and, by the use of fluidic devices, the jet can be set to cut off automatically if the airway pressure is too high. The above techique for laryngoscopy with the fluidic ventilator was used in 28 patients undergoing fiberoptic bronchoscopy (Olympus 5.7 mm diameter). The airway pressure was continuously monitored with a line attached to the suction port of the bronchoscope. Arterial PCO2 ranged from 23 to 42 mmHg and PO2 from 105 to 325 mmHg. The high PO2 levels were maintained even during suctioning. General anesthesia for fiberoptic bronchoscopy can be performed using an endotracheal tube not smaller than 8 mm internal diameter (ID). The advantages of the oxygen jet technique are that it can be used in smaller patients and that the upper airway can be examined.

Anesthesia, General↗
PubMed1976

Therapeutic fibreoptic bronchoscopy in intensive care.

Experience with therapeutic bronchoscopy using the fibreoptic bronchoscope in intensive care has shown it to be a useful procedure. The Nosworthy connection has also been modified to allow intermittent positive-pressure ventilation to be maintained during bronchoscopy. This procedure is valuable in those cases where sputum or blood are retained in the airways despite adequate physiotherapy and endotracheal suction. Fibreoptic bronchoscopy should be available as a routine service in intensive therapy units.

Adolescent↗
PubMedDate not supplied

Ultraviolet-fluorescence bronchoscopy in early detection of bronchogenic carcinoma.

The still unsatisfactory prognosis of bronchogenic carcinoma prompted the search for possibilities of better early and detailed diagnosis. This led us to the idea of UV-fluorescence bronchoscopy. The patient inhales 5 ml of an aqueous 5% solution of fluorescein, together with a beta2 stimulator, 10-15 minutes before the bronchoscopy, by means of a pressure inhaler. While the normal mucous membrane cleanses itself by virtue of ciliary action (secretions containing fluorescein are expectorated or drawn off during the bronchoscopy), carcinoma, carcinomatous lymphangiosis, superficial tumor infiltrations and nonciliated metaplasias are stained. These places fluoresce in UV light, even when they cannot be observed with the naked eye or with an optical system. In this way, they are made visible for directed biospy. Malignant changes not discernible by means of the methods hitherto employed can thus be diagnosed and sites determined with greater accuracy for proposed resection.

Bronchi↗
PubMed1977

Absence of clinical pneumonia following bronchoscopy with contaminated and clean bronchofiberscopes.

Two hundred forty-nine fiberoptic bronchoscopy procedures were surveyed for the presence of bronchoscopy-related pneumonia. The first 103 procedures were performed during a period when the fiberscope was presemably contaminated with Pseudomonas aeruginosa. Chart review of these 103 procedures and prospective epidemiologic surveillance of the remaining 146 procedures revealed no cases of bronchoscopy-related pneumonia.

Bronchi↗
PubMed1978

Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients.

The flexible fiberoptic bronchoscope is used increasingly often as a multipurpose instrument in critical care medicine. In poor risk patients who need continuous mechanical ventilation, rigid open tube bronchoscopy is a problem. With the flexible fiberoptic bronchoscope, however, diagnostic and therapeutic procedures can be carried out without interruption of ongoing mechanical ventilation. This procedure offers the possibility of bronchoscopy with reduced risk in debilitated patients. However, in these critically ill patients, the cardiopulmonary system is functioning at the borderline of its ability. Therefore, even the small changes in ventilation pattern caused by flexible fiberoptic bronchoscopy (FFB) may in some cases cause dangerous cardiopulmonary distress. For example, changes of intrabronchial pressure, tidal volume, PaO2, PaCO2 and cardiac output may be caused by the procedure. Further, it is of great importance to restrict suction through the instrument to short periods to avoid dangerous alterations in the ventilation perfusion relationship. Since serious complications may occur, it is mandatory that the bronchoscopist be aware of the potential pathophysiologic effects of FFB during mechanical ventilation of critically ill patients.

Animals↗