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Bronchoscopy
Kinds of Bronchoscopy Selected AbstractsSpecific bronchoalveolar lavage fluid T cells associate with disease in a pair of monozygotic twins discordant for sarcoidosisJOURNAL OF INTERNAL MEDICINE, Issue 6 2001J. Grunewald Abstract.,Grunewald J, Eklund A (Karolinska Hospital, Stockholm, Sweden). Specific bronchoalveolar lavage fluid T cells associate with disease in a pair of monozygotic twins discordant for sarcoidosis (Case report). J Intern Med 2001; 250: 535,539. A 49-year-old Caucasian woman had an acute onset of sarcoidosis. Bronchoscopy with bronchoalveolar lavage (BAL) showed a pronounced accumulation of BAL fluid CD4+ T cells expressing the T-cell receptor (TCR) AV2S3 gene. In line with this observation, the patient was HLA-DR17 positive, previously shown to strongly correlate with lung compartmentalized AV2S3+ T cells. At follow-up after recovery, reduced numbers of BAL fluid AV2S3+ T cells were found. Interestingly, BAL fluid of a healthy monozygotic twin sister contained normal numbers of AV2S3+ lung T cells. This report shows the T-cell repertoire of BAL fluid T cells to correlate with the disease (sarcoidosis), indicating a local and specific immune response triggered by an unknown antigen in sarcoidosis. [source] Bronchoscopy in Japan: A survey by the Japan Society for Respiratory Endoscopy in 2006RESPIROLOGY, Issue 2 2009Hiroshi NIWA ABSTRACT Background and objective: In order to obtain information on the clinical application of bronchoscopy in Japan, the Japan Society for Respiratory Endoscopy (JSRE) conducted a postal survey. Methods: A questionnaire was sent to 526 authorized institutes of the JSRE. The subject was bronchoscopy procedures performed during 2006. Results: The response rate was 71.3%. The total number of bronchoscopies performed was 74 770. Of these, 74 412 were flexible bronchoscopies and 358 were rigid bronchoscopies. At least one JSRE-authorized specialist had worked with 97% of respondents. Eighty-five per cent of respondents performed bronchoscopy under topical anaesthesia for almost all patients. Seventy-five per cent of respondents routinely used the oral route. The reported numbers of diagnostic bronchoscopies was 12 509 for simple bronchoscopy, 25 971 for forceps biopsy, 26 289 for brush biopsy, 25 659 for bronchial washing, 1387 for transbronchial needle aspiration and 6716 for BAL. Three deaths were caused by forceps biopsy (0.012%). The morbidity rates for these diagnostic procedures ranged from 0.14% to 2.5%. The reported numbers of therapeutic bronchoscopies was 476 for tracheobronchial stent, 164 for neodymium (Nd): yttrium-aluminium garnet (YAG) laser photoresection (LPR), 40 for photodynamic therapy, 81 for balloon dilatation, 145 for endobronchial electrocautery, 120 for argon plasma coagulation, 109 for microwave coagulation (MWC), 116 for ethanol injection, 110 for foreign body removal and 89 for bronchial occlusion. Deaths occurred only as a consequence of Nd : YAG LPR (0.61%). The morbidity rates for these therapeutic procedures ranged from 0% to 5%. Conclusions: The preparation for, and practice of, bronchoscopy varied greatly between respondents. Diagnostic bronchoscopy was well tolerated and safe. Therapeutic procedures did not appear to be practised widely or frequently. [source] Early Laryngeal Inhalation Injury and its Correlation with Late SequelaeTHE LARYNGOSCOPE, Issue 2 2006Tulio A. Valdez MD Abstract Objective: Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries. Study Design: This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution. Methods: Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted. Results: All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction. Conclusion: The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness. [source] Aspergillus Colonization of the Lung Allograft Is a Risk Factor for Bronchiolitis Obliterans SyndromeAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009S. S. Weigt Multiple infections have been linked with the development of bronchiolitis obliterans syndrome (BOS) post-lung transplantation. Lung allograft airway colonization by Aspergillus species is common among lung transplant recipients. We hypothesized that Aspergillus colonization may promote the development of BOS and may decrease survival post-lung transplantation. We reviewed all lung transplant recipients transplanted in our center between January 2000 and June 2006. Bronchoscopy was performed according to a surveillance protocol and when clinically indicated. Aspergillus colonization was defined as a positive culture from bronchoalveolar lavage or two sputum cultures positive for the same Aspergillus species, in the absence of invasive pulmonary Aspergillosis. We found that Aspergillus colonization was strongly associated with BOS and BOS related mortality in Cox regression analyses. Aspergillus colonization typically preceded the development of BOS by a median of 261 days (95% CI 87,520). Furthermore, in a multivariate Cox regression model, Aspergillus colonization was a distinct risk factor for BOS, independent of acute rejection. These data suggest a potential causative role for Aspergillus colonization in the development of BOS post-lung transplantation and raise the possibility that strategies aimed to prevent Aspergillus colonization may help delay or reduce the incidence of BOS. [source] Comparison of breathing tube connectors during invasive bronchial procedures,ANAESTHESIA, Issue 6 2009N. Rahe-Meyer Summary Bronchoscopy and bronchial suctioning during intra-operative artificial ventilation often causes leakage from the ventilation circuit with a decrease in ventilatory parameters and possible workplace contamination with anaesthetic gases. Different connectors have been developed to reduce gas leakage. We evaluated the following connectors : VBM 2 mm, 3 mm and 5 mm, Bodai Suction-Safe, Bodai Bronch-Safe and Bodai Trach-Safe, as well as the BE 105-7, BE 105-8 and SH 7-45. Invasive bronchial instruments (catheters, bronchoscopes and bronchial blockers) with 1.67,7.33 mm diameter were used. Pressure-controlled ventilation was performed on a test lung using a ventilator. Sevoflurane concentration in the room was measured 0.2 and 1.5 m from the connector using a photo-acoustic infrared-spectroscope. The VBM connectors caused the least gas leak and ensured stability of ventilation parameters even at peak pressures when combined with smaller instruments. With instruments > 6 mm, BE 105-7, BE 105-8 and SH 7-45 connectors performed best. The Bodai connectors showed a reduced ability to prevent leakage and to keep ventilatory parameters stable. All connectors, excluding the Bodai Trach-Safe, prevented exposure to anaesthetic gases beyond the current safety recommendations when combined with the fitting instruments. The connectors showed different ranges of tightness, equivalent to different ranges of compatibility with the instruments used. [source] Bronchoscopy during percutaneous tracheostomyANAESTHESIA, Issue 7 2000A. Guha No abstract is available for this article. [source] Fluorescence Bronchoscopy for Selection of Surgical Procedure in Patients With Early Staged Endobronchial CarcinomaARTIFICIAL ORGANS, Issue 4 2005Yoshio Tsunezuka Abstract:, Background: It is sometimes difficult to determine the extent of resection in patients with endobronchial carcinoma because preoperative white-light bronchoscopic (WLB), examination, is, not, sensitive, enough, to, examine, the extent fully. Light-Induced Fluorescence Endoscopy (LIFE) is recognized as a useful modality for the diagnosis of early staged bronchial carcinoma, but there have been no reports of its significance in surgical treatment. We have studied the influence of LIFE upon the selection of surgical procedures or other treatments in patients with endobronchial carcinoma preoperatively. Methods: Conventional WLB and LIFE were performed within 7 days of operation. Biopsy specimens were taken from the marginal regions of the areas that were suspicious for malignancy on LIFE examination and WLB. We decided the resection line before operation and kept the resected central margin 1 cm apart from the area revealed as suspicious by LIFE. Results: From January 1999 to March 2003, 75 patients underwent LIFE. LIFE was performed to decide the surgical procedures for 12 patients (16.0%). Surgical therapy was performed in 8 (66.7%). LIFE findings dramatically changed the surgical procedures for 3 patients, lobectomy changed to sleeve lobectomy in 2 and laser therapy to segmentectomy in 1. LIFE revealed larger abnormal areas of bronchial cancer compared to WLB in 7 (58.3%). Conversely, WLB overestimated the extent of abnormal area in 1 (8.3%). WLB revealed the same cancer area as LIFE in 4. In all patients, the resected bronchial margins were cancer free intraoperatively and postoperatively. Conclusion: LIFE can be more sensitive than WLB and be more beneficial for judging the extent of neoplastic bronchial changes for some patients. LIFE may be a useful modality for the preoperative selection of surgical procedures, especially whether sleeve resection is needed or not, for some centrally located superficial endobronchial carcinoma. [source] Bronchoscopy in Japan: A survey by the Japan Society for Respiratory Endoscopy in 2006RESPIROLOGY, Issue 2 2009Hiroshi NIWA ABSTRACT Background and objective: In order to obtain information on the clinical application of bronchoscopy in Japan, the Japan Society for Respiratory Endoscopy (JSRE) conducted a postal survey. Methods: A questionnaire was sent to 526 authorized institutes of the JSRE. The subject was bronchoscopy procedures performed during 2006. Results: The response rate was 71.3%. The total number of bronchoscopies performed was 74 770. Of these, 74 412 were flexible bronchoscopies and 358 were rigid bronchoscopies. At least one JSRE-authorized specialist had worked with 97% of respondents. Eighty-five per cent of respondents performed bronchoscopy under topical anaesthesia for almost all patients. Seventy-five per cent of respondents routinely used the oral route. The reported numbers of diagnostic bronchoscopies was 12 509 for simple bronchoscopy, 25 971 for forceps biopsy, 26 289 for brush biopsy, 25 659 for bronchial washing, 1387 for transbronchial needle aspiration and 6716 for BAL. Three deaths were caused by forceps biopsy (0.012%). The morbidity rates for these diagnostic procedures ranged from 0.14% to 2.5%. The reported numbers of therapeutic bronchoscopies was 476 for tracheobronchial stent, 164 for neodymium (Nd): yttrium-aluminium garnet (YAG) laser photoresection (LPR), 40 for photodynamic therapy, 81 for balloon dilatation, 145 for endobronchial electrocautery, 120 for argon plasma coagulation, 109 for microwave coagulation (MWC), 116 for ethanol injection, 110 for foreign body removal and 89 for bronchial occlusion. Deaths occurred only as a consequence of Nd : YAG LPR (0.61%). The morbidity rates for these therapeutic procedures ranged from 0% to 5%. Conclusions: The preparation for, and practice of, bronchoscopy varied greatly between respondents. Diagnostic bronchoscopy was well tolerated and safe. Therapeutic procedures did not appear to be practised widely or frequently. [source] Posttransplant Bronchiolitis Obliterans Syndrome Is Associated with Bronchial Epithelial to Mesenchymal TransitionAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009S. Hodge Bronchiolitis obliterans syndrome (BOS) compromises lung transplant outcomes and is characterised by airway epithelial damage and fibrosis. The process whereby the normal epithelial configuration is replaced by fibroblastic scar tissue is poorly understood, but recent studies have implicated epithelial mesenchymal transition (EMT). The primary aim of this study was to assess the utility of flow cytometry in detecting and quantifying EMT in bronchial epithelial cells. Large airway brushings were obtained at 33 bronchoscopies in 16 BOS-free and 6 BOS grade 1,3 patients at 2,120 months posttransplant. Flow cytometry was used to assess expression of the mesenchymal markers ,SMA, S100A4 and ED-A FN and HLA-DR. TGF ,1 and HGF were measured in Bronchoalveolar lavage (BAL). Expression of all three mesenchymal markers was increased in BOS, as was HLA-DR. BAL HGF, but not TGF ,1 was increased in BOS. Longitudinal investigation of one patient revealed a 100% increase in EMT markers concurrent with a 6-fold increase in BAL TGF ,1 and the diagnosis of BOS at 17 months posttransplant. Flow cytometric evaluation of bronchial epithelium may provide a novel and rapid means to assess lung allografts at risk of BOS. [source] Exfoliative sputum cytology of cancers metastatic to the lung,DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2005Tehmina Z. Ali M.D. Abstract Although largely replaced by fine-needle aspiration (FNA) and bronchoscopy, cytological examination of sputum for exfoliated malignant cells still is considered a valuable initial diagnostic test in patients presenting with a lung mass. Thirty-five cases of secondary/metastatic tumors involving the lung and diagnosed on sputum were retrospectively reviewed from our cytopathology files for a period of 22 yr (1980,2001). Clinical history and the relevant histopathological material were examined and correlated with the cytological findings. In all cases, a history of malignancy was known. Cytological diagnoses included colonic adenocarcinoma (7 cases); non-Hodgkin's lymphoma (NHL; 5 cases); malignant melanoma (MM; 5 cases); breast carcinoma (5 cases); Hodgkin's lymphoma (HL; 3 cases); pancreatic adenocarcinoma (2 cases); prostatic adenocarcinoma (2 cases); and 1 case each of urothelial carcinoma, endometrial carcinoma, renal cell carcinoma, hepatic small-cell carcinoma, squamous-cell carcinoma (cervix), and leiomyosarcoma (LMS). Cellular preservation was optimal in all cases. The smear background was relatively clean in 25 (71%) cases and predominantly inflamed and/or necrotic in 10 (29%) cases. In non-lymphoid tumors (27 cases), isolated single malignant cells were seen in 7 (26%) cases (all cases of MM and prostatic adenocarcinoma), whereas 20 (74%) cases displayed fragments with intact tumor architecture. Overall, only 10/35 (29%) cases showed noticeable tumor-cell necrosis. In one case (LMS), cell block sections were used for immunoperoxidase (IPOX) studies with positive staining for desmin and actin. Exfoliation of cancer cells in sputum from secondary tumors in the lung is a rare phenomenon in current-day practice, with metastatic colonic adenocarcinoma seen most commonly. Intact tumor architecture was observed in exfoliated cells in 75% of the cases. Diagn. Cytopathol. 2005;33:147,151. © 2005 Wiley-Liss, Inc. [source] Biopsy site selection for endobronchial ultrasound guide-sheath transbronchial biopsy of peripheral lung lesionsINTERNAL MEDICINE JOURNAL, Issue 2 2008D. I. K. Fielding Abstract Background: Choice of biopsy method for peripheral lung lesions is usually between CT-guided fine-needle aspiration biopsy (CT FNA) and bronchoscopy. Endobronchial ultrasound guide-sheath biopsy (EBUS GS) is a new method to improve the yield of bronchoscopy. Guidance on which lesions would be appropriate for either method is needed. The aim of the study was to compare the diagnostic yields and pneumothorax rate of EBUS GS and CT FNA in terms of the location of the lesion needing biopsy, in particular, whether the lesion is touching the pleura. Methods: Prospective series of EBUS GS were compared to retrospective review of CT FNA carried out simultaneously in a large teaching hospital. Results: For EBUS GS 140 cases were carried out with mean lesion size 29 mm. Overall diagnostic sensitivity was 66%. For lesions not touching visceral pleura it was 74% compared with 35% where it was on the pleura (P < 0.01). For CT FNA 121 cases were carried out with mean lesion size 37 mm. The overall diagnostic sensitivity was 64%. Rate of pneumothorax and ICC placement in EBUS GS was 1 and 0% and in CTFNA was 28 and 6%, with P < 0.001 for both. Conclusion: Lesion location, in particular, connection to the visceral pleura, can improve decision-making in referral for either CT FNA or EBUS GS to maximize diagnostic yield and minimize pneumothorax rate. [source] Awake nasal intubation using a combination of the EndoFlex® tube and fibreoptic bronchoscopy in patients with difficult airwaysACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010J. H. Liu No abstract is available for this article. [source] Combining the EndoFlex® tube with fiberoptic bronchoscopy in difficult intubationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009K. SUGIYAMA We applied a combination technique using the EndoFlex® tube with fiberoptic bronchoscopy for a 69-year-old man presenting with limited mouth opening and neck movement. Awake nasotracheal intubation was performed under conscious sedation with propofol and fentanyl. After positioning the tip of the EndoFlex® tube in the oropharynx, the fiberoptic bronchoscope was inserted into the tube until the tip reached the bevel of the tube. Anterior flexion of the distal tip of the EndoFlex® tube facilitated uncomplicated insertion of the tube into the trachea without impingement on the arytenoids. Fiberoptic visualization confirmed that the distal-tip flexing mechanism of the EndoFlex® tube corrected the direction of the tube tip anteriorly, allowing entry into the trachea. We present a case where this technique proved valuable for tracheal intubation in a patient with limitations of mouth opening and neck movement. [source] Different resistance mutations can be detected simultaneously in the blood and the lung of HIV-1 infected individuals on antiretroviral therapyJOURNAL OF MEDICAL VIROLOGY, Issue 3 2004Natalie C. White Abstract In this retrospective study, matched peripheral blood and lung samples from patients on antiretroviral therapy were studied in order to investigate whether differences in mutations associated with resistance to nucleoside analogues could be detected between the lung and blood. Discordant mutation patterns in the reverse transcriptase (RT) between plasma and cell free bronchoalveolar lavage fluid (BAL-fluid) HIV-1 genomic RNA was observed in five out of seven patients on nucleoside reverse transcriptase inhibitor (NRTI) monotherapy and six out of seven on combination therapy. In the cellular compartments, DNA recovered from peripheral blood mononuclear cells (PBMCs) and cells from BAL-cells discordant HIV-1 resistance genotypes were detected in 15 out of 44 matched samples. Differences in resistant genotypes between PBMCs and BAL-cells were most pronounced in patients receiving combination antiretroviral therapy. The pattern and number of mutations in RT associated with resistance differed in the BAL-cells compared to PBMCs in four out of 12 subjects not receiving antiretroviral therapy at the time of bronchoscopy, three from 14 patients on NRTI monotherapy, five out of nine on dual combination therapy and three out of nine on HAART. The differences in the detection of resistance mutations between blood and the lung suggest that the lung is a site of replication for HIV-1. J. Med. Virol. 72:352,357, 2004. © 2004 Wiley-Liss, Inc. [source] Pulmonary aspiration of a two-unit bridge during a deep sleepJOURNAL OF ORAL REHABILITATION, Issue 6 2005Ö. K. BA summary, Aspiration of teeth and dental restorations is a recognized, yet an infrequent happening in the literature. Main reasons of aspiration are maxillofacial trauma, dental treatment procedures or ethanol intoxication and dementia. The present case of a 2-unit bridge aspiration is however, not related with any trauma, dental procedure or systemic disease. A 37-year-old male patient had aspirated his bridge while sleeping and the bridge remained unidentified for 1 year despite the radiographic controls. He was then referred to the Chest Diseases Department of School of Medicine, Ege University and the radio-opaque object in the right intermediate bronchus was diagnosed to be an aspirated dental prosthesis. Subsequent to the failure of the rigid bronchoscopy, the patient was referred to the Thoracic Surgery Department and had to be operated for retrieval of the foreign body. [source] Tracheobronchography and angiocardiography of paediatric cardiac patients with airway disordersJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2002YF Cheung Objective: We report our experience in combining tracheobronchography and angiocardiography in the assessment of a selected cohort of paediatric cardiac patients with problematic airway disorders. Methodology: The clinical records of 11 patients who underwent 17 studies at a median age of 5.5 months (range 3 months to 10.8 years) were reviewed. Tracheobronchography and angiocardiography were performed under general anaesthesia using a non-ionic contrast agent. The findings were compared with those of flexible bronchoscopy and magnetic resonance imaging (MRI). Results: Seven patients had cardiac lesions associated with vascular anomalies potentially compressing the airway, while four had no identifiable aberrant or enlarged vessels. All examinations but one were performed without complications. Tracheobronchography demonstrated extrinsic vascular compression with secondary airway malacia in three (27%), intrinsic tracheobronchial stenosis in five (45%), and airway malacia in three patients (27%). Precise measurement of the airway calibre and real-time fluoroscopic monitoring facilitated transcatheter tracheobronchial interventions (six balloon dilations, three stent implantations) in four patients. In conjunction with angiocardiography, cine-tracheobronchography provided detailed information on the spatial relationship between vascular and airway structures in all patients; allowed dynamic assessment of airway malacia; and facilitated preoperative planning in six patients. In contrast, bronchoscopy failed to differentiate malacia from extrinsic compression in four patients (36%), while MRI, performed in six patients, was unsatisfactory in one due to a motion artefact and failed to diagnose airway malacia and extrinsic compression in three patients. Conclusions: Tracheobronchography is relatively safe in paediatric cardiac patients. Combined tracheobronchography and angiocardiography, a less operator-dependent imaging modality compared to bronchoscopy and MRI, delineated the airway and vascular anatomy in detail; facilitated preoperative planning; and permitted transcatheter tracheo-bronchial interventions. The dynamic capability of tracheobronchography supplements that of flexible bronchoscopy and MRI in the diagnosis of airway malacia. [source] Medical and surgical management of severe barium aspiration in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008Stacy D. Meola DVM Abstract Objective, To describe the medical and surgical management of a unique case of barium sulfate aspiration pneumonia in a dog. Case Summary, A 5-year-old spayed female black Labrador Retriever weighing 33 kg was presented for evaluation of barium aspiration pneumonia. Approximately 200 mL of barium had been instilled into the caudal lung lobes via an improperly placed orogastric tube. Right caudal, right middle, and accessory lung lobectomies were performed, and the dog was managed intensively for 19 days in the hospital. New or Unique Information Provided, This is the first report of a complete diagnostic work-up including bronchoscopy, bronchoalveolar lavage, culture, thoracotomy, and pulmonary histopathology for severe barium sulfate aspiration in a dog with an excellent outcome. [source] Markers of eosinophilic and neutrophilic inflammation in bronchoalveolar lavage of asthmatic and atopic childrenALLERGY, Issue 8 2010D. Snijders To cite this article: Snijders D, Agostini S, Bertuola F, Panizzolo C, Baraldo S, Turato G, Faggian D, Plebani M, Saetta M, Barbato A. Markers of eosinophilic and neutrophilic inflammation in bronchoalveolar lavage of asthmatic and atopic children. Allergy 2010; 65: 978,985. Abstract Background:, Recent studies performing fiberoptic bronchoscopy in children have improved our understanding of asthma pathophysiology. Eosinophilic, but also neutrophilic, inflammation has been described in asthma, but the relationship with atopy was incompletely investigated. The aim of this study is to examine inflammatory cells and mediators in children with asthma compared to the appropriate controls, i.e. atopic children without asthma and children with no atopy or asthma. Moreover, asthmatic children were analysed separately based on the presence of atopy and stratified by age. Methods:, We recruited 191 children undergoing fiberoptic bronchoscopy for appropriate indications: 91 asthmatics (aged 1.4,17 years), 44 atopics without asthma (1.6,17.8 years) and 56 nonasthmatic nonatopic controls (1.4,14 years). In bronchoalveolar lavage, total and differential cell counts and inflammatory mediators, including ECP, eotaxin, IL-8 and TNF,, were analysed. Results:, Eosinophils and ECP levels were increased in asthmatic children when compared to controls (P = 0.002 and P = 0.01, respectively), but also atopic children without asthma had increased ECP levels compared to controls (P = 0.0001). Among asthmatic children, eosinophils and ECP levels were not different between atopic and nonatopic individuals. Neither neutrophils nor the related mediators (IL-8 and TNF,) differed significantly in the three groups. This pattern of inflammation was observed in both preschool and school-aged asthmatic children. Conclusions:, This study suggests that markers of eosinophilic, but not neutrophilic inflammation, are increased in asthmatic children and also in atopic children without asthma. Of interest, in asthmatic children, the activation of the eosinophilic response is not solely because of the presence of atopy. [source] Matrix metalloproteinases-7, -8, -9 and TIMP-1 in the follow-up of diisocyanate-induced asthmaALLERGY, Issue 1 2010P. Piirilä Abstract Background:, Diisocyanate-induced asthma (DIA) is known to be associated with poor prognosis. We wished to clarify if matrix metalloproteinases (MMP)-7, -8 or -9 or tissue inhibitor of matrix metalloproteinases (TIMP-1) are associated with the functional or inflammatory outcome in DIA patients. Methods:, This is a longitudinal study where 17 patients with DIA diagnosed by a specific challenge test to diisocyanates were monitored. Exposure to diisocyanates was terminated seven (mean) months before the challenge test. The studies included spirometry, histamine challenge test and bronchoscopy. MMP-7, MMP-8, TIMP-1 [Enzyme-linked immunosorbent assay (ELISA)- and immunofluorometric assay-methods], MMP-9 (ELISA and zymography), interferon-gamma, tumour necrosis factor-alpha, interleukin-6, -8, -15, -17, CXCL-5/ENA-78, monocyte chemoattractant protein-1 and macrophage inhibitory factor (MIF) (ELISA) were assayed from bronchoalveolar lavage (BAL) fluid. Inhaled steroid therapy was initiated after the examinations, which were repeated at 6 months and at 3 years during the treatment. The results were compared with those of 15 healthy controls. Results:, Inhaled steroid medication increased BAL levels of MMP-9 and MMP-9/TIMP-1 and decreased MMP-7 and MMP-7/TIMP-1. The increase in MMP-9 levels was associated with a decline in the TH-2 type inflammation. Conclusions:, Our data suggest that reduced TH-2 type inflammation in DIA after inhaled steroid medication is reflected as elevated MMP-9 and MMP-9/TIMP-1 levels in BAL. MIF may be the inducer of MMP-9. This might point to some protective role for MMP-9 in DIA. [source] Eosinophils in bronchial mucosa of asthmatics after allergen challenge: effect of anti-IgE treatmentALLERGY, Issue 1 2009E. L. J. Van Rensen Background:, Anti-IgE, omalizumab, inhibits the allergen response in patients with asthma. This has not been directly related to changes in inflammatory conditions. We hypothesized that anti-IgE exerts its effects by reducing airway inflammation. To that end, the effect of anti-IgE on allergen-induced inflammation in bronchial biopsies in 25 patients with asthma was investigated in a randomized, double-blind, placebo-controlled study. Methods:, Allergen challenge followed by a bronchoscopy at 24 h was performed at baseline and after 12 weeks of treatment with anti-IgE or placebo. Provocative concentration that causes a 20% fall in forced expiratory volume in 1 s (PC20) methacholine and induced sputum was performed at baseline, 8 and 12 weeks of treatment. Changes in the early and late responses to allergen, PC20, inflammatory cells in biopsies and sputum were assessed. Results:, Both the early and late asthmatic responses were suppressed to 15.3% and 4.7% following anti-IgE treatment as compared with placebo (P < 0.002). This was paralleled by a decrease in eosinophil counts in sputum (4,0.5%) and postallergen biopsies (15,2 cells/0.1 mm2) (P < 0.03). Furthermore, biopsy IgE+ cells were significantly reduced between both the groups, whereas high-affinity IgE receptor and CD4+ cells were decreased within the anti-IgE group. There were no significant differences for PC20 methacholine. Conclusion:, The response to inhaled allergen in asthma is diminished by anti-IgE, which in bronchial mucosa is paralleled by a reduction in eosinophils and a decline in IgE-bearing cells postallergen without changing PC20 methacholine. This suggests that the benefits of anti-IgE in asthma may be explained by a decrease in eosinophilic inflammation and IgE-bearing cells. [source] Basement membrane thickening and clinical features of children with asthmaALLERGY, Issue 6 2007E. S. Kim Background:, Asthma is a chronic inflammatory disease, characterized by airway inflammation, bronchial hyper-responsiveness, and airway obstruction. Although asthma induces partially reversible airway obstruction, obstruction can sometimes become irreversible. This may be a consequence of airway remodeling, which includes a number of structural changes, such as epithelial detachment, basement membrane (BM) thickening, smooth muscle hypertrophy, and new vessel formation. This study evaluated children with asthma for the presence of BM thickening. Methods:, Eighteen children with asthma and 24 control subjects underwent flexible bronchoscopy with endobronchial biopsy. Light microscopy was used to measure BM thickness in paraffin-embedded biopsy sections. The association between BM thickening and age, sex, duration of asthma, asthma severity, FEV1, FEV1/FVC, FEF25,75%, methacholine PC20, eosinophil count, and presence of atopy was examined. Results:, Basement membrane thickness was greater in subjects with asthma (8.3 ± 1.4 ,M) than in control subjects (6.8 ± 1.3 ,M, P = 0.0008). Multiple regression analysis revealed that sex, FEV1/FVC, total IgE, and atopy (IgE for Dermatophagoides pteronyssinus >0.34 kUA/l) were significant predictive factors for BM thickness. There was no significant association between BM thickness and age, duration of asthma, FEV1, FEF25,75%, methacholine PC20, eosinophil count, or asthma severity. Conclusions:, Basement membrane thickening has been known to be present in children with asthma. In addition, we report an association between BM thickness and sex, FEV1/FVC, total IgE, and the presence of IgE specific to D. pteronyssinus. [source] Use of sheath of ureteric stent as a tube exchanger during bronchoscopyPEDIATRIC ANESTHESIA, Issue 6 2009Renu Sinha No abstract is available for this article. [source] Total contralateral atelectasis following rigid bronchoscopy in a child with scarf pin aspirationPEDIATRIC ANESTHESIA, Issue 10 2006Madan M. Maddali No abstract is available for this article. [source] Anesthesia for removal of inhaled foreign bodies in childrenPEDIATRIC ANESTHESIA, Issue 11 2004Amit Soodan MD Summary Background:, Foreign body aspiration may be a life-threatening emergency in children requiring immediate bronchoscopy under general anesthesia. Both controlled and spontaneous ventilation techniques have been used during anesthesia for bronchoscopic foreign body removal. There is no prospective study in the literature comparing these two techniques. This prospective randomized clinical trial was undertaken to compare spontaneous and controlled ventilation during anesthesia for removal of inhaled foreign bodies in children. Methods:, Thirty-six children posted for rigid bronchoscopy for removal of airway foreign bodies over a period of 2 years and 2 months in our institution were studied. After induction with sleep dose of thiopentone or halothane, they were randomly allocated to one of the two groups. In group I, 17 children were ventilated after obtaining paralysis with suxamethonium. In group II, 19 children were breathing halothane spontaneously in 100% oxygen. Results:, All the patients in the spontaneous ventilation group had to be converted to assisted ventilation because of either desaturation or inadequate depth of anesthesia. There was a significantly higher incidence of coughing and bucking in the spontaneous ventilation group compared with the controlled ventilation group (P = 0.0012). Conclusion:, Use of controlled ventilation with muscle relaxants and inhalation anesthesia provides an even and adequate depth of anesthesia for rigid bronchoscopy. [source] Topical airway anaesthesia for paediatric bronchoscopyPEDIATRIC ANESTHESIA, Issue 9 2003Cormac Fahy No abstract is available for this article. [source] Life threatening unilateral pulmonary overinflation might be more successfully treated by contralateral selective intubation than by emergency pneumonectomyPEDIATRIC ANESTHESIA, Issue 5 2003Josef Holzki MD Summary During a period of 3 years, three infants were admitted to our hospital for unilateral emergency pneumonectomy due to life threatening overinflation of one lung, preventing adequate ventilation of the unaffected contralateral side. All three patients were able to be stabilized by unilateral selective bronchial intubation of the unaffected lung after bronchoscopy, ruling out a flap valve mechanism. No emergency pneumonectomies were required. In one patient, lung function of the overinflated side (three lobes) recovered fully and, in the two remaining patients, one lobe of the overinflated side recovered. The overinflated lobes were removed later by elective surgery, thus not exposing the children to a potentially dangerous emergency operation. These results are in contrast with reports in the literature. Emergency pneumonectomy in neonates and infants due to overinflation of one lung may be avoided by selective unilateral intubation of the main stem bronchus of the compressed lung. [source] Difficult paediatric intubation when fibreoptic laryngoscopy failsPEDIATRIC ANESTHESIA, Issue 9 2002Agnes Ng Summary We report an unusual problem with fibreoptic bronchoscopy in an 8-year-old girl with Negar syndrome. She had a history of difficult airway since birth, and had undergone mandibular distraction for severe obstructive sleep apnoea when she was aged 2 years. Nagar syndrome is a Treacher,Collins like syndrome with normal intelligence, conductive bone deafness and problems with articulation. The patients have malar hypoplasia with down slanting palpebral fissures, high nasal bridge, micrognathia, absence of lower eyelashes, low set posteriorly rotated ears, preauricular tags, atresia of external ear canal, cleft palate, hypoplasia of thumb, with or without radius, and limited elbow extension. Protracted attempts with a fibreoptic bronchoscope failed to visualize the glottis, and this was only possible when the tube was guided to the larynx by blind nasal intubation. Apparently, the healing of the wounds for the mandibular distraction in the mandibular space on the inside of the rami of the mandible had caused differential fibrosis on either side of the hyoid, leading to a triplane distortion of the larynx with a left shift, clockwise rotation to a 2,8 o'clock direction and a slight tilt towards the left pharyngeal wall. The large epiglottis overlying this had precluded a view of the larynx. Finally, the older technique of breathguided intubation facilitated fibreoptic bronchoscopy to achieve tracheal intubation. [source] Transforming growth factor-,1 in bronchoalveolar lavage fluid from children with cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 11 2009William T. Harris MD Abstract Rationale Transforming factor ,1 (TGF-,1) genetic polymorphisms have been identified as a modifier of cystic fibrosis (CF) lung disease severity. However, few data link TGF-,1 protein levels and clinical markers of CF lung disease severity. Objectives To determine the association between protein levels of TGF-,1 in pediatric CF bronchoalveolar lavage fluid (BALF) and clinical parameters of CF lung disease severity. Methods Total TGF-,1 was measured in BALF from 30 pediatric CF patients and 12 non-CF disease controls undergoing clinically indicated flexible bronchoscopy, and compared to four indicators of clinical disease: infection, inflammation, pulmonary function, and recent/recurrent hospitalization. Results TGF-,1 was elevated in CF BALF compared to non-CF controls (135,±,15,pg/ml vs. 57,±,10,pg/ml, P,<,0.01). In CF BALF, increased TGF-,1 was associated with elevated BALF PMN % (r,=,0.67, P,<,0.01). BALF TGF-,1 was increased in CF subjects whose FEV1 after the completion of antibiotic therapy remained below CF age-normative median values (205.9,±,20.5,pg/ml vs. 106.4,±,24.0, P,=,0.01). BALF TGF-,1 was increased in CF children hospitalized in the previous year compared to those not recently hospitalized (169.9,±,21.6,pg/ml vs. 107.5,±,17.5,pg/ml, P,=,0.04). Neither the presence of a bacterial pathogen nor bacterial quantity was associated with BALF TGF-,1. Conclusions In CF, BALF TGF-,1 is elevated compared to non-CF controls. Increased BALF TGF-,1 is associated with neutrophilic inflammation, diminished lung function and recent hospitalization. Further investigation is needed to address mechanisms behind these associations. Pediatr Pulmonol. 2009; 44:1057,1064. ©2009 Wiley-Liss, Inc. [source] Therapeutic bronchoscopy in a child with sand aspiration and respiratory failure from near drowning,case report and literature reviewPEDIATRIC PULMONOLOGY, Issue 10 2009N. Kapur MBBS Abstract Foreign matter aspiration occurs relatively commonly in drowning and near-drowning events. In most cases, stomach contents are aspirated. Sand aspiration rarely occurs and there are no reported cases in children with near drowning. Limited data are available on clinical presentation and management of sand aspiration with accidental burial. We report a 3-year-old boy who nearly drowned while swimming in brackish waters and was found face down in sand. Sand aspiration was suspected when the child continued to have persistent wheezing and high ventilatory requirement despite intensive bronchodilator and corticosteroids therapy with an inability to wean after 4 days post-near-drowning event. Radiology was non-specific in the absence of sand bronchogram. Presence of sand in the airways was confirmed when a bronchoscopy was undertaken and sand seen in the bronchoalveolar lavage fluid. Sequential lung washing followed by exogenous surfactant administration (3,ml/kg) was undertaken and lead to significant improvement such that within 12,hr post-therapeutic lavage, his ventilatory requirements reduced substantially. The child was extubated 4 days post-lavage and on review 2 months post-event, was clinically well with airway resistance within normal predicted values measured on forced oscillatory spirometry (IOS). Pediatr Pulmonol. 2009; 44:1043,1047. ©2009 Wiley-Liss, Inc. [source] Association of lower airway inflammation with physiologic findings in young children with cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 5 2009Stacey L. Peterson-Carmichael MD Abstract Background The relationship between lower airway markers of inflammation and infection with physiologic findings is poorly understood in young children with cystic fibrosis (CF). The goal of this study was to evaluate the association of bronchoalveolar lavage fluid (BALF) markers of infection and inflammation, including mediators linked to airway remodeling, to infant lung function values in young children with CF undergoing clinically indicated bronchoscopy. Methods Plethysmography and the raised volume rapid thoracoabdominal compression (RVRTC) technique were performed in 16 sedated infants and young children with CF prior to bronchoscopy. BALF was collected and analyzed for pathogen density, cell count, % neutrophils, transforming growth factor beta 1 (TGF-,1), matrix metalloproteinases (MMP), and interleukin-8 (IL-8). Results There was a significant direct correlation between functional residual capacity (FRC), the ratio of residual volume to total lung capacity (RV/TLC) and FRC/TLC with % neutrophils (P,<,0.05). Forced expiratory flows were inversely correlated to % neutrophils (P,<,0.01). Lung function parameters did not differentiate those with and without lower airway infection; however, pathogen density directly correlated with FRC and inversely correlated with flows (P,<,0.05). In a subset of the population, MMP-2 directly correlated with RV/TLC and inversely correlated with flows (P,<,0.05) and TGF-,1 directly correlated with FRC (P,<,0.05). Conclusions Results from this study suggest that lower airway inflammation as well as mediators linked to airway remodeling play an active role in pulmonary deterioration in CF infants and young children undergoing clinically indicated bronchoscopy. Pediatr Pulmonol. 2009; 44:503,511. © 2009 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||