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Interventional bronchoscopy is widely used in histopathological diagnosis of airway disorders.Hemorrhage is the most frequently encountered and difficult-to-manage complication during bronchoscopy,and massive hemorrhage could be life-threatening.There were differences in the incidence of hemorrhage caused by different interventional procedures.At present,the prevention of bleeding induced by intervention is relatively lacking,and the choice of treatment may be not the same in different endoscopy centers.We review the prevention and treatment of hemorrhage complicated by interventional bronchoscopy in this article,which may help to improve the understanding and management ability of hemorrhage during bronchoscopy.
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Objective To investigate the time of spontaneous recovery of atelectasis after removing the acute airway foreign bodies in miniature pigs.Methods Twenty-two miniature pigs were inserted into the occlusion stent in the right lower lobe bronchus by using bronchoscopy.After confirming the formation of atelectasis,the occlusion stent was removed and the imaging changes were observed for 3 weeks continuously.Results Atelectasis was formed within 1 week after the airway occlusion stent implantation in miniature pigs.Pulmonary reexpansion was observed obviously on week 3 after removal of airway occlusion stent (P ＜0.05).Conclusions The spontaneous recovery time of atelectasis,which caused by an acute foreign body airway obstruction within 1 week,may take 3 weeks at least.
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Objective To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. Methods A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. Results 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation Ⅱ score [APACHE Ⅱscore: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P 100 μg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE Ⅱ score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.
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Objective To evaluate the combined detection of serum galactomannan (GM test) and 1,3-β-D-glucan (G test) in diagnosis of invasive pulmonary aspergillosis (IPA).Methods A total of 136 patients suspected for IPA were enrolled in the study from Jinhua Central Hospital in Zhejiang Province from January 2007 to December 2011.GM and G tests were performed.x2 test was used to conpare the sensitivity,specificity,positive predictive value and negative predictive value of individual test and combined test,and the area under the ROC curve (AUC) was used to determine the effectiveness of the tests.Results The sensitivity and specificity of G test were 84.0％ and 80.9％,and those for GM test were 78.0％ and 88.2％,respectively.The combination of two tests (parallel) increased sensitivity to 92.0％ and the serial test increased the specificity to 92.6％.The AUC of the combined test was 0.923(95％ CI:0.867-0.980).Conclusion The combination of GM test and G test can improve the diagnostic effectiveness for IPA.
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Objective To compare the efficacy and the side-effect of three different ways in treating the patients with malignant pleural effusion. Methods 98 patients histologically proved malignant pleural effusion were randomly divided into three groups, bleomycin group(BLM), bleomycin with mycobacterium group( BLM + UTL) and blemycin with intertleukino2 ( BLM +IL). 31 patients were treated with bleomycin intrapleural injection in BLM group,32 patients were treated with bleomycin and Utilin's(mycobacterium) intrapleural injection in BLM + ULL group and 35 patients were treated with bleomycin and intertleukin-2 intrapleural injection in BLM + IL group. The therapeutic efficacy, change of performance and side effects were compared among the three groups after one period of treatment. The changes of CEA and TNF in the pleural effusion were examined before and after treatment. Results The therapeutic efficacy and performance improvement were higher in BLM+UTL and BLM+IL group than that of BLM group(P＜0. 05) ,the pleural CEA of post-treatment in three groups were lower than that of pre-treatment(P＜0.01) ,the CEA after treatment in BLM+UTL group and BLM+IL group was lower than that of BLM group(P＜0. 01,respectively). The pleural TNF of post-treatment in BLM+UTL and BLM+IL groups was higher than that of pre-treatment(P＜0. 01 ) in BLM group. The pleural TNF of post-treatment in BLM+UTL and BLM+IL group was higher than that of BLM group ( P＜0. 01 ). Conclusion Intrapleural injection of mycobacterium with bleomycin or interlekin-2 with bleomycin has better efficacy than using bleomycin only in treating malignant pleural effusion.
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AIM: To investigate the effect of propofol on expression of protein kinase C (PKC) mRNA during pulmonary ischemia and reperfusion injury (PIRI) in rabbits. METHODS: Single lung ischemia and reperfusion animal model was used in vivo. The rabbits were randomly divided into three groups ( n =9 in each): sham operated group (sham), PIR group (I-R) and PIR+ propofol group (PPF). Changes of several parameters including malondialdehyde (MDA), superoxide dismutase (SOD), wet to dry ratio of lung tissue weight (W/D) and index of quantitative assessment of histologic lung injury (IQA) were measured at 60 minutes after reperfusion in lung tissue. Meanwhile the location and expression of PKC mRNA were observed. Lung tissue was also prepared for light microscopic and electron microscopic observation at 60 minutes after reperfusion. RESULTS: As compared with group I-R, PKC mRNA strongly expressed in intima and extima of small pulmonary artery as well as thin-wall vessels (mostly small pulmonary veins) in PPF group. The average optical density values of PKC-?、? and ? mRNA in small pulmonary veins PPF in group showed significantly higher than that in I-R group (all P