The surgeon's use of the rigid and flexible bronchoscopes in the diagnosis of bronchial carcinoma

The results of a prospective study comparing the rigid and flexible fibreoptic bronchoscopic techniques in the diagnosis and assessment of bronchial carcinoma are reported. One hundred and nine patients underwent fibreoptic bronchoscopy and these were compared with a similar group of 111 patients in whom the rigid bronchoscope was used. Bronchoscopic diagnosis of malignancy was achieved in 73.4% of patients in the fibreoptic group and in 73% using the rigid bronchoscope.     

螺旋CT仿真内窥镜对儿童气道非金属异物的诊断价值

目的：评价螺旋CT仿真内窥镜对儿童气道异物的诊断价值及急诊处理的意义。方法：40例气管支气管非金属异物患者均进行了螺旋CT及仿真内窥镜检查,并经纤维支气管镜取出。其方法：将螺旋CT容积扫描的图像数据传输到独立工作站,利用仿真内窥镜的软件功能重建为三维支气管图像。通过鼠标和键盘的操作使光标进入气管腔进而进入支气管腔内。结果：40例患者中,气管异物8例,右主支气管异物23例,左主支气管异物9例。仿真内窥镜表现为气道内结节者24例,支气管阻塞12例,假阴性4例。结论：CT仿真支气管内窥镜是一种完全无创的诊断方法;可以直观地显示异物的部位、大小、形态、数量及与支气管黏膜的关系,为纤支镜取出异物提供依据和更多的信息;可用于患者的复查,避免反复纤支镜检查给患者带来更多的痛苦。     

电子纤维支气管镜下局部注入激素对支气管结核的疗效观察

目的 观察经电子纤维支气管镜下局部注入激素治疗支气管结核的临床疗效.方法 选择确诊为支气管结核患者66例,在常规抗结核治疗的基础上按治疗方案的不同分为观察组(左氧氟沙星+阿米卡星+地塞米松)与对照组(左氧氟沙星+阿米卡星),对两组患者行纤维支气管镜下注射给药,观察两组在治疗后纤维支气管镜冲洗液涂片抗酸杆菌转阴率及镜下改变情况.结果 治疗2个月后,观察组在纤维支气管镜下的改善情况与对照组相比较,观察组总有效率为76.5%,而对照组为46.9%,组间差异有统计学意义(P<0.01);痰检结果观察组转阴率为79.4%,对照组转阴率为62.5%,两者间差异无统计学意义(P>0.05).结论 化疗加纤维支气管镜直视下注入左氧氟沙星、阿米卡星、地塞米松能提高临床疗效,但是加用激素对痰菌转阴率无影响.     

刷检、肺穿细胞学及肿瘤标志物对肺癌的诊断价值

目的探讨纤维支气管镜刷检与CT下肺穿刺细胞学对肺癌及其分型的诊断价值。方法对331例患者纤维支气管镜、肺穿涂片,进行瑞-吉氏染色、检验,对结果进行统计、分析,并记录其病理学结果 ,同时对肿瘤标志物CEA、CYFRA21-1、NSE进行检测。结果 331例中肺癌患者140例,细胞学诊断结果敏感性为85.7%,特异性为88.2%,符合率85.7%,其中肺腺癌78.9%,肺鳞癌64.3%,小细胞癌87.1%。肺腺癌肿瘤标志物CEA与对照组、鳞癌组及小细胞癌组比较（P〈0.05）有显著性差别。肺小细胞癌肿瘤标志物NSE与腺癌组、鳞癌组及对照组比较（P〈0.05）有显著性差别。结论纤维支气管镜与肺穿刺细胞学检查对肺癌的诊断及分型具有较高的临床价值。肿瘤标志物CEA、NSE对肺腺癌及小细胞癌的诊断、治疗及预后观察有一定临床价值。     

A technique for foreign body removal from the airway

We report a case in whom a foreign body was retrieved from the peripheral airway using a fibreoptic bronchoscope and a modified suction tube.     

依托咪酯与异丙酚在OSA气管插管应用中的比较

【目的】比较使用托咪酯或异丙酚麻醉诱导在阻塞性睡眠呼吸暂停（OSA）患者纤维支气管镜引导经鼻气管插管可行性和安全性。【方法】择期行悬雍垂腭咽成形术（UPPP）的OSA患者30例,随机分成依托咪酯o．2mg／kg（E组）和异丙酚2mg／kg（P组）麻醉诱导两组。利多卡因行鼻至气管上段表面麻醉,静脉推注2μg／kg芬太尼和依托咪酯或异丙酚,意识消失后经纤维支气管镜引导下经鼻气管插管,插管成功后查动脉血气及测呼吸末二氧化碳（PETCO2）。监测脑双频指数（BIS）、血压、心率、血氧饱和度。同时记录患者意识消失、自主呼吸恢复时间、达到最低BIS值的时间及动脉血气乳酸（LAC）值。【结果】两组皆完成纤维支气管镜引导经鼻气管插管,血压、心率、意识消失时间、最低BIS值、LAC值及PETCO2值差异无显著性,E组自主呼吸恢复时间及达到最低BIS值时间[（47．1±11．4）s,（33．8±9．6）s]显著短于P组[（89．8±17．5）S,（61．7±16．3）s（P〈0．01）]。【结论】两组皆完成OSA纤维支气管镜引导经鼻气管插管,但使用依托咪酯全麻诱导时呼吸恢复时间显著快于畀丙酚,故在OSA患者麻醉诱导时使用依托咪酯比异丙酚更安全。     

Upper Gastrointestinal Endoscopy in Saudi Arabia: Analysis of 6386 Procedures

SUMMARY Fibreoptic endoscopy is now established in the investigationof upper gastrointestinal disease. We report our findings ina large series of endoscopic procedures (6386) mostly in MiddleEastern Arabs, and compare the results obtained in Western patients.We find fibreoptic endoscopy to be feasible, safe, acceptableand effective     

Upper gastrointestinal endoscopy in Saudi Arabia: analysis of 6386 procedures

Fibreoptic endoscopy is now established in the investigation of upper gastrointestinal disease. We report our findings in a large series of endoscopic procedures (6386) mostly in Middle Eastern Arabs, and compare the results obtained in Western patients. We find fibreoptic endoscopy to be feasible, safe, acceptable and effective.     

Acute miliary tuberculosis presenting as acute respiratory failure

A 42 year old pregnant woman was admitted in acute respiratory failute. Viral pneumonia was suspected and oxygen therapy, CPAP, water restriction and diuretics were started with good response. She remained febrile and had an abnormal chest X-ray, a diagnosis of miliary tuberculosis was confirmed by transbronchial fibreoptic lung biopsy.     

Usefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis

We investigated the diagnostic value of induced sputum (IS) and bronchial lavage (BL) specimens in patients with suspected pulmonary tuberculosis who had negative spontaneous sputum specimens or who were unable to produce sputum spontaneously. IS specimens and BL specimens obtained using flexible fibreoptic bronchoscopy from 55 patients were evaluated for the presence of acid-fast bacilli (AFB) and cultured for Mycobacterium tuberculosis. Positive results were found with IS smear in 23 patients, BL smear in 26 patients, and IS or BL culture in 42 patients. Culture of BL specimens had a higher sensitivity than IS or BL smears or culture of IS specimens. The highest sensitivity rate was obtained with a positive BL or IS culture (86%). For early diagnosis (a positive IS or BL smear), the sensitivity was 57%. IS has a higher sensitivity rate than spontaneous sputum for the detection of tuberculosis, and fibreoptic bronchoscopy is useful for the early diagnosis of tuberculosis when AFB are not detected in spontaneous or induced sputum specimens.     

The influence of normobaric hyperoxia on hepatic oxygenation--experience with an animal model

We investigated the effect of a ventilation with an FiO2 of 1.0 on arterial and hepatic venous oxygenation in 23 G?ttingen minipigs. Under balanced anaesthesia (isoflurane/fentanyl), a fibreoptic catheter was placed into a hepatic vein. The correct position of the tip of the catheter was controlled manually after laparotomy. After measurement of baseline values (arterial and hepatic blood gases, ShvO2), in 13 minipigs normoventilation with an FiO2 of 1.0 was performed for 15 minutes. Thereafter, ventilation was continued with an FiO2 of 0.4. In the control group (n = 10), the animals were oxygenated with an FiO2 of 0.4 permanently. The changes due to hyperoxia were measured in hepatic venous oxygen saturation (ShvbgaO2: from 81.2 +/- 1.43% to 87.5 +/- 1.77%, ShvoximO2: from 82.6 +/- 1.14% to 90.5 +/- 0.90%), arterial (from 217.5 +/- 5.0 mmHg to 467.2 +/- 22.0 mmHg) and hepatic venous (from 51.8 +/- 2.0 mmHg) oxygen partial pressure. We found a correlation between hepatic venous oxygen partial pressure und ShvbgaO2 in the blood (r = 0.84, p < 0.001) and between ShvO2 (ShvbgaO2/ShvoximO2), which was either measured directly in the blood or by a fibreoptic catheter (r = 0.6, p < 0.001). Whereas the increase in ShvO2 during hyperoxia may be a result of increased arterial supply, the decrease in ShvO2 after the end of hyperoxia below baseline values needs further investigations. The continuous fibreoptic measurement of ShvoximO2, also under hyperoxic conditions is a valuable parameter for the monitoring of hepatic venous oxygenation.     

福马林对纤维胆道镜熏蒸消毒效果的测试

纤维胆道镜经水洗后继以含０．２５％戊二醛的醛立净溶液洗涤２分钟，再用８０ｍｌ／ｍ３福马林熏蒸消毒３０分钟，可使胆道镜各部位均无菌生长。仅水洗后以福马林熏蒸者不能达到无菌     

In which clinical scenario would awake fibreoptic nasal intubation be employed?

The routine way to access the uncomplicated airway is via direct laryngoscopy. When this is not possible, there are a number of other techniques to help visualization such as the video laryngoscopy. These require a degree of mouth opening. With almost complete trismus, the clinician should resort to awake fibreoptic nasal intubation to secure the airway.     

气道支气管曲霉病1例报告及文献复习

目的了解气道侵袭性曲霉病的临床特征、诊断和治疗。方法对1例气道侵袭性曲霉病患者的临床表现、纤维支气管镜检查和病理诊断进行分析并作文献复习。结果1例患者临床表现为咳嗽，胸闷，气急。纤维支气管镜下表现为新生物突出于管腔，病理示大量曲霉菌丝浸润至气道黏膜基层，伊曲康唑治疗24周后痊愈。结论气道侵袭性曲霉病以曲霉浸润到气道黏膜的基底层为特征，纤维支气管镜检查是有效的诊断手段，伊曲康唑是治疗气道侵袭性曲霉病的有效药物之一。     

Preparing and supporting patients undergoing a bronchoscopy

A bronchoscopy is an endoscopic examination of the upper respiratory tract, trachea and bronchial tree. The technique was developed in the 1960s and introduced into clinical practice a decade later (Stradling, 1991). The use of a flexible, fibreoptic instrument that incorporates a light source, biopsy and suction channel is inserted via the mouth or nose. This enables the bronchoscopist to inspect the airways visually, identify any abnormalities and obtain samples of secretions, cells or tissue biopsies (Lesser, 2003).     

乳管镜定位下切除乳管内病变的临床应用

目的探讨乳管镜(FDS)定位下切除乳管内病变的应用可行性和临床价值。方法 2010年6月~2010年12月门诊FDS检查发现有乳管内病变的乳头溢液患者80例,随机分为常规组和定位组各40例,分别进行常规腺体区段切除术和术中FDS定位下的区段切除术。结果 FDS定位组诊断符合率95.0%(38/40)高于常规组87.5%(35/40)。定位组与常规组相比,具有手术切口小、腺体破坏少、病理检出率高等优点。结论术中FDS定位下的手术具有良好的临床应用价值,能部分替代常规手术。     

Reproducibility of the measurement of ciprofloxacin concentration in bronchial mucosa

The reproducibility of ciprofloxacin estimations was investigated in duplicate samples of bronchial mucosa from patients undergoing fibreoptic bronchoscopy. At the time of biopsy, venous blood was collected from each patient. Between 3.5 and 5.0 h after dosing, penetration (%) into the mucosa was 162.13 (S.D. 19.77). The correlation coefficient (Pearson's) between duplicate samples was 0.93. The confidence limits (95%) for a single measurement were +/- 1.47 mg/kg.     

多层螺旋CT在气道异物中的临床应用

目的 评价多层螺旋CT对气道异物的诊断价值。方法 14例气管支气管异物患者均进行多层螺旋CT扫描检查及多种重建三维图像。并经纤维支气管镜取出异物。结果 14例患者中，多层螺旋CT均直接显示气道异物。其中：气管异物8例，左主支气管异物4例，右主支气管2例。结论 多层螺旋CT是一种安全无创伤的检查方法，可直观显示对气道异物的部位、大小、形态以及与支气管粘膜的关系，为纤维支气管镜取出异物提供依据及更多信息；并可用于患者的复查，避免反复纤维支气管镜检查给患者带来更多的痛苦。     

A case report of difficult ventilation with the Combitube - valve-like upper airway obstruction confirmed by fibreoptic visualisation

This case report describes difficulty with ventilation because of valve-like upper airway obstruction by aryepiglottic folds after uncomplicated insertion of a Combitube in a 30-year-old female patient. After correct (oesophageal) placement increased ventilation pressures occurred and a fibreoptic device was used to investigate the cause. Valve-like obstruction was discovered and subsequently observed during controlled ventilation. After removal of the Combitube and mask ventilation no valve mechanism was seen. This effect appeared to be due to an increased air stream caused by the obstruction of seven out of eight Combitube perforations.     

Another step for noninvasive ventilation in chronic obstructive pulmonary disease patients!

The use of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients who are not eligible for the technique because of their incapability to spontaneously eliminate accumulated secretions associated with hypercapnic encephalopathy is not recommended and is often considered a contraindication. In a case-control study, an experienced team reported the feasibility and safety of the use of NPPV with early fibreoptic bronchoscopy in selected acutely decompensated COPD patients with hypercapnic encephalopathy, and reported the patients' inability to spontaneously clear copious secretions. The reported data suggest that this innovative therapeutic may be considered as a potential alternative to endotracheal intubation.