Contributions of bronchoscopic microsampling in the supplemental diagnosis of small peripheral lung carcinoma

BACKGROUND: Making a preoperative pathologic diagnosis in patients with small lung nodules remains challenging. We have developed a new, noninvasive bronchoscopic microsampling probe to examine biochemical substances in epithelial lining fluid. We used this probe to measure tumor markers in fluid from tissues surrounding lung nodules less than 30 mm in diameter to test its adjunctive diagnostic utility in lung cancer. METHODS: In 12 patients, epithelial lining fluid was collected in triplicate or duplicate from tissue within 2 cm of small peripheral lung nodules and from the contralateral lung. The diagnosis of adenocarcinoma was surgically confirmed in all patients. Fifteen patients without lung cancer served as controls. Concentrations of carcinoembryonic antigen, cytokeratin fragment 19, and sialyl SSEA-1 were measured in the fluid. RESULTS: Carcinoembryonic antigen and cytokeratin fragment 19 concentrations were significantly higher in fluid near the nodules (median, 8.7 and 87.2 ng/mg, respectively) than on the contralateral sides (median, 1.5 and 3.7 ng/mg, respectively) or in fluid collected from the controls (median, 2.0 and 2.8 ng/mg, respectively). CONCLUSIONS: Measurements of carcinoembryonic antigen and cytokeratin fragment 19 collected by our microsampling probe may be a useful diagnostic adjunct in patients with small peripheral lung nodules.     

Transesophageal bronchoscopic ultrasound-guided fine-needle aspiration for diagnosis of peripheral lung cancer

Peripheral lung cancer is still a diagnostic challenge. The transbronchial approach with bronchoscopy or the transthoracic approach with radiologic imaging has been used extensively for the pathologic diagnosis of peripheral lung cancer. However, the explorability or feasibility with these modalities depends on the lesion location or patient's respiratory function. Herein, we report a case with severe pulmonary emphysema and lung cancer located at a parenchymal region difficult to access through an airway with a bronchoscope. Successful diagnosis was obtained by a transesophageal ultrasound-guided needle aspiration using an endobronchial ultrasound bronchoscope. This technique is accurate and less invasive in the primary diagnosis of lung cancer adjoining the esophagus.     

Assessment of fiberoptic bronchoscopic examination in inhalation injury--analysis of 32 cases

68 times of fiberoptic bronchoscopic serial examinations in 32 patients with inhalation injury were performed at early stage after injury. Bronchoscopic abnormalities including congestion, erythema, edema and necrosis were observed. Patients were divided into three groups according to the degree of damage: mild, moderate and severe. 8 patients with mild inhalation injury, their bronchoscopic abnormalities included slight congestion and edema, these changes extended to the carina with disappearance of the trachea rings, airway lumen was slight narrowed, carina was blunted, these lesions were resolved within one week after injury. The fiberoptic bronchoscopy of patients with moderate injury showed moderate congestion and edema of mucosa of the trachea, disappearance of the trachea rings, the lumen was more narrowed as compared with mild injury. The blunted carina widen to 0.5 cm due to swelling, the mucosa of primary bronchus showed slight congestion and edema. These lesions were resolved 2 weeks after injury. The fiberoptic bronchoscopic abnormalities of 13 patients with severe inhalation injury were extreme congestion and edema of the trachea mucosa with necrosis; hemorrhage and ulceration of the mucosa were seen. The trachea lumen was significantly narrowed, the carina widened to 1 cm, and even the primary bronchus mucosa manifested moderate congestion and edema with necrosis. However, secondary bronchus mucosa was only slightly damaged. All lesions resolved about three weeks after injury. The results of the fiberoptic bronchoscopy correlated with the clinical course, blood gas analysis, as well as the prognosis.     

Routine double contrast barium enema and fiberoptic colonoscopy in the diagnosis of colorectal carcinoma

The diagnostic efficacy of routine double-contrast barium enema and fiberoptic coloscopy for detection of cancer was retrospectively studied in 303 patients consecutively operated for colorectal adenocarcinoma in a 52-month period from January 1980. Double-contrast barium enema was performed in 180 patients with 184 carcinomas, 157 (85%) of which were revealed by this examination. The detection rate of carcinoma according to site was 89% between cecum and descending colon, 92% in sigmoid colon and 71% in rectum. Fiberoptic colonoscopy was done in 176 patients with 181 carcinomas, 163 (90%) of which were detected by the endoscopical examination. The detection rate of carcinoma according to site was 86% between cecum and descending colon, 90% in sigmoid colon and 95% in rectum. The two methods were equally effective in detecting carcinoma of the colon. Colonoscopy was superior to barium enema in detection of rectal carcinoma.     

右美托咪啶抑制患者清醒纤维支气管镜插管反应的临床剂量探讨

【摘要】 目的 测定右美托咪啶抑制患者清醒纤维支气管镜插管反应的半数有效剂量(ED50)。方法 选择全身麻醉、预计存在困难气道的20例患者,ASA分级Ⅰ或Ⅱ级,年龄38~65岁,体重45~70 kg;右美托咪啶持续静脉输注10 min后,用1%丁卡因对舌根部、咽喉部及声门上进行表面麻醉,2%利多卡因2 mL经环甲膜穿刺行气管表面麻醉,然后行经鼻纤维支气管镜插管。右美托咪啶的给药剂量按序贯法确定,相邻剂量之间的比率为1.2。采用改良Dixon序贯法计算右美托咪啶抑制清醒纤维支气管镜插管反应的ED50及其95%可信区间,并采用logistic回归模型进行概率单位转换分析ED50及其95%可信区间。结果 右美托咪啶抑制患者清醒纤维支气管镜插管反应的ED50为0.74 μg/kg,其95%可信区间为0.68 μg/kg~0.82 μg/kg。结论 静脉输注右美托咪啶0.74 μg/kg,可以为50%的已行气道表面麻醉的患者在清醒纤维支气管镜插管过程中提供满意的气管插管条件,且无气管插管反应发生。     

支原体肺炎并肺不张患儿行高压球囊扩张气道成形术的护理

总结经支气管镜介导球囊扩张气道成形术治疗30例肺炎支原体肺炎并发肺不张患儿的护理经验。提出术前做好用物准备,特别是抢救用品的准备;操作过程中做好患儿咳嗽的护理及心理护理,掌握球囊扩张的时机及加压力度;术后密切观察并发症是操作成功的保证。     

Current role of surgery in small cell lung carcinoma

Small cell lung carcinoma represents 15–20% of lung cancer. Is is characterized by rapid growth and early disseminated disease with poor outcome. For many years surgery was considered a contraindication in Small Cell Lung Cancer (SCLC) since radiotherapy and chemoradiotherapy were found to be more efficient in the management of these patients. Never the less some surgeons continue to be in favor of surgery as part of a combined modality treatment in patients with SCLC. The revaluation of the role of surgery in this group of patients is based on clinical data indicating a much better prognosis in selected patients with limited disease (T1-2, N0, M0), the high rate of local recurrence after chemoradiotherapy with surgery considered eventually more efficient in the local control of the disease and the fact that surgery is the most accurate tool to access the response to chemotherapy, identify carcinoids misdiagnosed as SCLC and treat the Non Small Cell Lung Cancer component of mixed tumors. Performing surgery for local disease SCLC requires a complete preoperative assessment to exclude the presence of nodal involvement. In stage I surgery must always be followed by adjuvant chemotherapy, while in stage II and III surgery must be planned only in the context of clinical trials and after a pathologic response to induction chemoradiotherapy has been confirmed. Prophylactic cranial irradiation should be used to reduce the incidence of brain metastasis     

乳腺黏液癌的超声诊断现状

超声已成为诊断乳腺癌的最重要的影像学检查方法之一。乳腺黏液癌为特殊类型的乳腺癌,临床较少见,目前对其超声声像图表现的认识相对不足。本文围绕常规超声、CEUS和超声弹性成像诊断乳腺黏液癌的现状进行综述。     

原发性胆囊癌的诊断治疗现状

原发性胆囊癌的发病率在消化道恶性肿瘤中占第 5位 ,死亡率占第 9位。其恶性程度高 ,临床症状出现迟 ,早期诊断困难 ,患者就诊时多属晚期 ,根治机会少 ,预后极差。虽然医学研究和检查手段在不断发展 ,但胆囊癌的术后生存率仍无显著提高。胆囊癌在肿瘤发病率中占 0 .6%～ 3 % ,女性发病较高。胆囊癌在胆囊切除标本中的检出率为 1 %～ 3 %。胆囊癌极少发生在年轻患者 ,在我国 ,胆囊癌最小年龄为 2 8岁 ,最大年龄为 87岁 ,平均5 9 .6岁 ,高峰年龄为 60～ 70岁。一般认为 ,胆囊癌的发病机制主要与胆囊结石所致慢性炎症、胆囊息肉、胆总管囊肿、…     

Current trends in the diagnosis and treatment of carcinoma of the pancreas

Causes of diagnostic delay and survival figures were compared in three groups of patients (total 191 patients) with ductal adenocarcinoma of the pancreas between the years 1951 and 1960 and 1971 and 1980. The main causes of delay between onset of symptoms and definitive treatment were patient delay in seeking medical advice and delay by the initial doctor in referring the patient. Recent direct imaging techniques of ultrasound, computerized axial tomographic scanning, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography did not significantly decrease this diagnostic delay. Operative mortality in the groups treated by pancreatoduodenectomy between 1951 and 1960 and 1971 and 1980 were 13.9 and 3.4 percent, respectively. The mean survival rates for these groups were 14 and 20.4 months, respectively. Patients with unresectable carcinoma of the pancreas between 1971 and 1980 had an operative mortality rate of 10 percent and a mean survival of 6.7 months. Various aspects of symptomatology and operative findings in patients with carcinoma of the pancreas are emphasized to aid early diagnosis.     

Bronchial carcinoma and the lymphatic sump: the importance of bronchoscopic findings

The lymphatic sump of Borrie is an important area of regional node metastasis in each lung. The sump area is of increased importance on the right side, since bilobectomy has been recommended to ensure complete removal of lymphatic disease in patients with lower or middle lobe carcinoma. The role of bronchoscopy in assessing lymphatic metastasis of bronchial carcinoma was investigated in 42 patients at the North Carolina Memorial Hospital. Because of the high incidence of associated lymphatic metastases, bilobectomy is indicated for right lower or middle lobe lesions observed at bronchoscopy. Simple lobectomy may be utilized when bronchoscopic findings are negative and when there is no involvement of the lymph nodes of the sump of Borrie at the time of operation. If there is gross nodal involvement of the lymphatic sump, pneumonectomy will be required.     

Preclinical feasibility of bronchoscopic fluorescence-guided lung sentinel lymph node mapping

ObjectiveLung sentinel lymph node mapping, where peritumorally injected material is tracked through the lymphatics, aims to find the first potential sites of nodal metastasis. We sought to evaluate the preclinical feasibility of bronchoscopic fluorescence-guided sentinel lymph node mapping.MethodsHealthy Yorkshire pigs were used; sentinel lymph node mapping was performed with indocyanine green. The primary fluorescence imaging method was an ultrathin composite fiberscope placed in the bronchoscope working channel. Secondary methods used a fluorescence thoracoscope placed in the trachea (rigid bronchoscopy) and pretracheal fascial plane (mediastinoscopy) to validate ultrathin composite fiberscope settings for sentinel lymph node detection. A tracheostomy was created, and the pig was placed in a lateral decubitus position. Transbronchial intraparenchymal indocyanine green injection was performed primarily in the right lower lobe. Ultrathin composite fiberscope and rigid bronchoscopy were performed with (n = 6) or without (n = 2) mediastinoscopy, with the former group guiding dose and ultrathin composite fiberscope optimization. Fluorescent targets were interrogated by endobronchial ultrasound before ultrathin composite fiberscope–guided transbronchial needle aspiration. Specimen fluorescence was documented before creating cytological smears. Pigs were killed postprocedure for nodal dissection.ResultsA total of 100 μL of 10 mg/mL indocyanine green generated strong transbronchial fluorescence with low risk of indocyanine green contamination. Fluorescence was detectable by 10 minutes postinjection. There was concordance among ultrathin composite fiberscope, rigid bronchoscopy, and mediastinoscopy. Except for 1 pig with airway contamination, ultrathin composite fiberscope–guided endobronchial ultrasound transbronchial needle aspiration obtained fluorescent material in all pigs. Specimen fluorescence was associated with specimen adequacy.ConclusionsBronchoscopic fluorescence-guided sentinel lymph node mapping was feasible, with specimen fluorescence providing real-time feedback on sentinel lymph node biopsy success. If translated to clinical practice, attention must be paid to minimizing indocyanine green leakage.     

Significance of early bronchoscopic airway abnormalities after lung transplantation.

Abnormal bronchoscopic allograft airway appearance with erythema, friability and sloughing-presumed to be ischemic-has been described early after lung transplantation, but its association with post-operative spirometry or other outcomes is largely unknown. We conducted a prospective cohort study to assess the impact of such airway changes in all lung transplant recipients from January 1997 to July 2000. Twenty-four (59%) of 41 patients were classified as having ischemic-appearing airways. Timing and value of peak pulmonary function tests, mortality, incidence of infection, rejection, anastomotic stricture and bronchiolitis obliterans syndrome were not significantly different when compared to patients with normal-appearing airways over a mean follow-up period of 761.2 +/- 412.4 days.     

纤维光导乳管镜用于乳头溢液的诊断

目的　评价纤维光导乳管镜检查对乳头溢液的诊断价值。方法　应用三菱公司FV 2 0 0 0E型半硬性纤维光导乳管镜检查系统 ,对 2 6 9例乳头溢液进行诊断 ,并与术后病理诊断作对比分析。结果　 2 6 9例患者中发现乳管内占位性病变 12 9(48% )例 ,其中单发病变 92 (71 3% )例 ,多发病变2 7(2 0 9% )例 ,弥漫性病变 10 (7 8% )例 ,镜下诊断导管内乳头状瘤 12 5 (96 9% )例 ,恶性病变 4 (3 1% )例。镜下诊断乳头状瘤与病理诊断符合率为 91 9% ,与乳腺癌的诊断符合率为 75 %。另外 14 0(5 2 % )例诊断为非肿瘤性良性疾病 ,主要为乳腺导管扩张症、乳管炎。结论　纤维光导乳管镜检查乳头溢液准确、可靠。     

Problems concerning the diagnosis and treatment of multiple primary carcinoma of the lung

Data on 44 patients with multiple primary carcinoma of the lung are presented. Twenty had metachronous tumors, and 24 had synchronous tumors. Twenty-one patients had undergone complete resection for both tumors, and 14 had undergone resection for only one of two tumors. The remaining 9 patients underwent no operation and were treated with photodynamic, radiation and/or chemotherapy. Long-term survival of more than 3 years was achieved for 11 patients, nine of whom had synchronous lesions. Furthermore, they included 3 patients who underwent nonsurgical therapy for both lesions. On the other hand, the prognosis after resection of the second tumor in patients with metachronous lesions was poor. This was thought to be the result of failure to diagnose the second lesion due to incomplete long-term follow-up. We conclude that careful attention to the operative indications is necessary for patients with multiple lesions, particularly lesions such as early squamous cell carcinomas.