Endobronchial Biopsy: A Guide for Asthma Therapy Selection in the Era of Bronchial Thermoplasty

Objective. Bronchial thermoplasty (BT) reduces airway smooth muscle in patients with severe asthma. We developed a novel standardized histologic grading system assessing inflammation and structural remodeling on endobronchial biopsy (EBBx) in severe persistent asthma and evaluated airway structure before and after BT. In addition, we correlated invasive and non-invasive inflammatory markers in severe persistent asthma. Methods. Thirty-three patients with severe persistent asthma underwent bronchoscopy, including bronchoalveolar lavage (BAL) and diagnostic EBBx. The control group (N = 41) underwent EBBx for other clinical indications. Biopsies were graded for airway inflammation and epithelial and submucosal structural features. We also evaluated airway histology in three patients before and after BT. Results. Compared to the control group, patients with severe persistent asthma more often had intraepithelial eosinophils and lymphocytes (67% vs. 17% and 61% vs. 27%; p < .001 and p = .005, respectively) and prominent smooth muscle and goblet cell hyperplasia (88% vs. 29% and 47% vs. 22%, p < .001 and p = .004, respectively). Other features including epithelial denudation and basement membrane thickening were not significantly different. Following BT, airway smooth muscle was no longer prominent due to partial replacement by fibrosis. Increased submucosal eosinophilic inflammation and BAL eosinophilia correlated with exhaled nitric oxide (eNO, p = .05 for both). Conclusions. We developed a clinically applicable standardized histologic grading system which identified structural but not inflammatory changes before and after BT in severe persistent asthmatics. Additionally, we demonstrated that eNO is representative of submucosal eosinophilia in this population. This semi-quantitative assessment will be useful for practicing pathologists assessing EBBx from severe persistent asthma patients for diagnostic and clinical research purposes.     

老年人经喉罩全凭七氟醚吸入用于 支气管镜检查的可行性

目的观察老年人经喉罩全凭七氟醚吸入在支气管镜检查术中的麻醉效果及安全性。方法 30例择期行支气管镜检查老年人患者,年龄65~81岁,性别不限,ASA I~III级。经面罩全凭吸入七氟醚进行诱导,全凭七氟醚吸入维持,围手术期将麻醉深度指数(NI)维持在(40±10)范围内调整七氟醚呼气末浓度。记录麻醉诱导前(T1)、置入喉罩后即刻(T2)、支气管镜至声门(T3)、支气管镜至支气管(T4)、灌洗或活检(T5)、术毕去除喉罩时(T6)和去除喉罩后5min(T7)时的MAP、SPO2、PETCO2、HR、NI、T2~T6时呼气末七氟醚浓度(CTsevo)、记录手术持续时间、麻醉时间、术毕至患者苏醒时间和术后读取七氟醚总用量。结果 MAP、SPO2、PETCO2及HR7个时间点均值差异无显著性,NI在T2~T5与T1比较差异有显著性(P<0.05),CTsevo在T2~T5手术时间点均值差异无显著性,手术时间为(18.7±9.2)min,麻醉时间为(21.9±9.3)min,苏醒时间为(5.1±1.2)min,七氟醚平均用量为30.4mL,30例老年患者均顺利完成手术操作。结论老年人经喉罩全凭七氟醚吸入麻醉可安全有效地应用于支气管镜检查术。     

纤维支气管镜在新生儿重症监护室的应用分析

 目的  探讨纤维支气管镜在新生儿重症监护室(neonatal intensive care unit,NICU)中的应用指征和安全性。方法  回顾性分析2012年1月至2014年5月在上海市儿童医院NICU住院的35例患儿的纤维支气管镜检查结果及相关临床资料。结果  35例患儿中,31例存在不同程度的气道畸形。20例进行支气管肺泡灌洗液培养,其中14例与痰培养或气管插管尖端培养结果一致。23例患儿在纤维支气管镜检查前后进行影像学检查,16例提示肺部炎症改善。28例好转出院,2例死亡,5例放弃治疗出院。21例在纤维支气管镜检查前后查血气分析提示差异无统计学意义,31例检查后查血常规提示C-反应蛋白下降。结论  纤维支气管镜检对新生儿某些疾病具有诊断和治疗的双重价值,在NICU中应用相对安全。       

纤维支气管灌洗治疗重型颅脑损伤合并肺部感染的临床分析及护理效果评估

重型颅脑损伤患者常出现的严重并发症之一即是肺部感染,其发病率较高,达57%,严重影响到患者的预后及转归,此外,患者晚期死亡的主要原因多为由肺部感染而引起的多脏器功能衰竭,因此,在对重型颅脑损伤患者进行治疗时,必须加强对肺部感染防治,从而有效提高重型颅脑损伤的治愈率。     

Gas flow during bronchoscopic ablation therapy causes gas emboli to the heart: a comparative animal study

BACKGROUND: Thermal ablation is one of the most commonly used modalities to treat central airway obstruction. Both laser and argon plasma coagulation (APC) have been reported to cause gas emboli and cardiac arrest. We sought to determine whether bronchoscopic ablation therapy can result in systemic gas emboli, correlate their presence with the rate of gas flow, and establish whether a zero-flow (ZF) modality would result in the significant reduction or elimination of emboli. METHODS: CO(2) laser delivered through a photonic bandgap fiber (PBF) and APC were applied in the trachea and mainstem bronchi of six anesthetized sheep at varying dosages and gas flow rates. Direct epicardial echocardiography was used to obtain a four-chamber view and detect gas emboli. RESULTS: The presence of gas flow accompanying APC and the CO(2) laser with forward flow correlated significantly with the appearance of gas bubbles in the atria. A definite dose response was observed between the gas flow rate and the number of bubbles seen. When the CO(2) laser was delivered through a PBF with ZF to the trachea or bronchi, no bubbles were observed. CONCLUSION: Bronchoscopic thermal ablation therapy using gas flow is associated with gas emboli in a dose-dependent fashion. The use of the flexible PBF with ZF is not associated with the development of gas emboli. Further study is required to determine whether a clinically safe threshold of gas emboli exists, and the relationships among the pathologic depth of tissue destruction, gas flow, pulse duration, and the development of gas emboli.     

支气管镜在儿童反复咳喘性疾病中的诊断价值

目的探讨电子支气管镜检查术在儿童反复咳喘性疾病中的应用价值。方法对该院2015年3月-2017年11月收治的297例反复咳嗽、喘息的患儿行支气管镜检查及治疗的临床资料进行综合分析。结果 297例反复咳喘的患儿支气管镜检查镜下表现最常见的是支气管内膜炎,共193例,占65.0%,是反复咳喘患儿最常见的表现;气管、支气管软化的患儿23例,占7.7%;喉软化者18例,占6.1%;气管、支气管狭窄者13例,占4.4%;异物者7例,占2.4%;结构异常者17例,占5.8%;肺含铁血黄素沉着症2例,占0.7%;肿瘤2例,占0.7%;左主支气管未发育1例,占0.3%;支气管憩室1例,占0.3%;支气管镜下未见明显异常者20例,占6.7%。结论对于儿童反复咳喘性疾病,支气管镜检查能够明确病因并且指导治疗,在临床上应用价值较高。     

Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement: A cadaver study

Objectives

Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera.

Tracheobronchopathia osteochondroplastica

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder with unknown aetiology. We report one case of TO in a patient with non-Hodgkin pulmonary lymphoma and benign epidermal and trichylemmal cysts on the periorbital region and scalp. To the authors' knowledge, the coincidence of these processes has never been described before. The case was evaluated with conventional X-ray, computed tomography, magnetic resonance imaging, fibre-optic bronchoscopy with 2 months interval, histopathological evaluation, Tc-99 m MDP bone scintigraphy and microbiological studies including PCR testing of bronchial biopsy and lavage specimens for Mycobacterium tuberculosis. Additionally, case reports of TO in the Turkish literature are summarized.