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Flexible Bronchoscopy (flexible + bronchoscopy)
Selected AbstractsBronchoscopy 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] 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] 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] 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] Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough,PEDIATRIC PULMONOLOGY, Issue 8 2006John Saito MD Abstract Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n,=,19) were ,1.34 for forced expiratory volume at 0.5 sec (FEV0.5), ,2.28 for forced expiratory flows at 75% of forced vital capacity (FVC) (FEF75), ,2.25 for forced expiratory flows between 25,75% of FVC (FEF25,75), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF75 and FEF25,75 Z-scores (P,=,0.002 and P,=,<0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P,=,0.03). FVC was higher in subjects with neutrophilic inflammation (P,=,0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection. Pediatr Pulmonol. 2006; 41: 709,719. © 2006 Wiley-Liss, Inc. [source] Endobronchial foreign bodies in Vietnamese adults are related to eating habitsRESPIROLOGY, Issue 3 2010Lan Huu NGUYEN ABSTRACT Background and objective: A high percentage of bronchoscopically extracted foreign bodies in Ho Chi Minh City were pits of the sapote fruit, a finding previously unreported. This paper presents a review of foreign body extractions, which identifies the substances found, documents the diagnostic pathway and draws attention to the specific aspiration risk of the sapote pit. Methods: The records of 100 consecutive adults who were found to have a bronchial foreign body during flexible bronchoscopy were reviewed. Results: In 83% of patients, the foreign body extraction was performed more than 2 weeks after the aspiration had occurred. In only 34% of patients was the diagnosis of an aspirated foreign body considered early in the patient's clinical course. The most frequent foreign bodies found were sapote pits (41%), followed by small bones (38%). Foreign bodies were lodged more frequently in the right bronchial tree (64%). In 98% of patients, the foreign bodies were successfully removed with the flexible scope. There was one postoperative death, which was not ascribed to the procedure. Conclusions: Physicians need to consider foreign body aspirations when evaluating patients with recurrent pneumonia, unexplained cough or atelectasis. Awareness of this problem might lead to public health measures that could reduce the incidence of these aspirations. [source] Changing patterns in interventional bronchoscopyRESPIROLOGY, Issue 4 2009Nikolaos ZIAS ABSTRACT Background and objective: Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach. Methods: A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted. Patients were categorized into two groups according to the procedure used, that is, RB (251 patients), and FB (161 patients) groups. Patients with malignancies were included as a separate subgroup, comprising 178 RB and 117 FB patients. For every procedure, the location of the lesion, patient survival from the first interventional procedure performed, and in patients with malignancy, additional treatments received such as chemotherapy and radiation were recorded. Results: Ninety per cent of RB procedures were performed in patients with tracheal or main stem lesions, while over half the patients undergoing FB had more distal lesions. A trend towards increasing use of FB for interventional procedures in recent years was noted. Conclusions: FB is a valuable alternative to RB for treating less advanced malignant disease or distal airway lesions. [source] Endobronchial argon plasma coagulation for the management of post-intubation tracheal stenosisRESPIROLOGY, Issue 5 2006Masanori YASUO Abstract: Post-intubation tracheal stenosis is usually caused by pressure necrosis at the cuff. Despite the fact that this phenomenon is well known and both large volume and low pressure cuffs have been developed, this lesion nevertheless continues to occur. Although the best results for tracheal reconstruction are obtained by an experienced surgeon, not all patients are able to undergo this operation for either medical or personal reasons. Argon plasma coagulation (APC) using flexible bronchoscopy has been successfully employed in the treatment of post-intubation tracheal stenosis in two of the surgery-refused and inoperable patients. The patients immediately experienced a relief of symptoms after APC. APC was thus performed 3,4 times every 1,2 weeks for each patient. In addition, there were no complications related to this procedure. The number of published clinical reports describing APC in benign airway stenosis are increasing. APC has also been reported to have several advantages over other interventional endobronchial techniques in the management of tracheo-bronchial stenosis. We report two patients, and to our knowledge this is the first description of APC being used in the treatment of endobronchial dilatation for post-intubation tracheal stenosis. [source] | ||||||||||