COMPARISON OF CT VIRTUAL BRONCHOSCOPY WITH FIBRE OPTIC BRONCHOSCOPY IN THE EVALUATION OF ENDO-BRONCHIAL LESIONS

Background: Virtual bronchoscopy is a noninvasive tool for assessing the airway. It can be used along with multiplanar CT scan for better assessment of endobronchial tree. A lot of researches has been conducted in various parts of the world weather CT bronchoscopy can replace actual flexible fiberoptic bronchoscopy. We aimed to explore the utility of virtual bronchoscopy (VB) for evaluation of tracheobronchial lesions and weather this can be helpful for pulmonologist for better assessment of airway while using real time flexible bronchoscopy. Our age group comprised of patients from 21 years to a maximum a Results : ge of 80 years with a mean age of 52.6 years. VB was better in detecting external compression with a Kappa value of 0.68. VB had a moderate agreement with FOB to detect endoluminal lesions with kappa value of 0.70. None of the mucosal changes detected by FOB was detected by VB. In detecting obstructive lesions VB substantially agreed with FOB with a kappa value of 0.8. Moderate agreement was seen by VB in detecting both malignant and non-malignant lesions vompared to FOB. Virtual bronchoscopy when used in conjunction with axial CT Conclusion: images can enhance diagnostic accuracy of bronchial pathologies. VB cannot replace conventional bronchoscopy due to associated disadvantages such as the inability to perform a biopsy, the inability to detect mucosal infiltration, the relatively low specificity rate when compared to high sensitivity rates, and the inability to offer real-time evaluation

Carcinoma pulmonar de celulas pequeñas en paciente neumonectomizada no fumadora - primera criobiopsia por fibrobroncoscopia en bolivia, presentación de caso clínico / Small cell lung carcinoma in a non-smoking pneumonectomized patient - first cryobiopsy by fibrobronchoscopy in Bolivia, case report

El cáncer broncogénico tiene una base genética, que se expresa por factores externos relacionados a la exposición medioambiental y laboral, en los últimos años ha cambiado el perfil epidemiológico con incidencia creciente en mujeres sin hábito tabáquico en rangos de 50-70 años. Paciente femenino de 50 años con el antecedente de exposición a humo de leña y uso de pesticidas, con síndrome de atelectasia pulmonar masiva izquierda. Se realizó estudios fibrobroncoscopicos con toma de biopsia de masa tumoral endobronquial izquierda y se realizó la primera criobiopsia por fibrobroncoscopía en Bolivia, posteriormente paciente fue sometida a neumonectomia izquierda con estudio histopatológico concluyente de carcinoma indiferenciado de células pequeñas con primario pulmonar. Existe una fuerte asociación entre la exposición medio-ambiental y laboral y el cáncer broncogénico en pacientes no fumadores, incluso en variantes histopatológicas infrecuentes en este subgrupo como el cáncer de células pequeñas o microcítico.

Bronchogenic cancer has a genetic basis, which is expressed by external factors related to environmental and occupational exposure. In recent years, the epidemiological profile has changed with increasing incidence in women without tobacco habit in ranges of 50-70 years. A 50-year-old female patient with a history of exposure to wood smoke and pesticide use, with massive left lung atelectasis syndrome. Fibrobronchoscopy studies were performed with a biopsy of the left endobronchial tumor mass and the first cryobiopsy was performed by fibrobronchoscopy in Bolivia, later the patient underwent left pneumonectomy with a conclusive histopathological study of undifferentiated small cell carcinoma with a pulmonary primary. There is a strong association between environmental and occupational exposure and bronchogenic cancer in non-smokers, even in infrequent histopathological variants in this subgroup such as small cell or microcytic cancer.

Endobronchial Ultrasound Bronchoscopy in Patients with Acute Respiratory Failure on Noninvasive Ventilation: Report of Two Cases

Fiberoptic bronchoscopy (FOB) has simplified the direct examination of the lungs and is widely used for diagnosis and therapy. Fiberoptic bronchoscopes occupy a significant proportion of cross-section area of central airways, which can affect lung mechanics and gas exchanges that may lead to desaturation and cardiac arrhythmia. This makes bronchoscopy in critically ill patients with respiratory failure even more challenging. Use of noninvasive mechanical ventilation (NIV) may help to avoid use of invasive mechanical ventilation in selected patients with acute respiratory failure. It has been shown to be useful in hypoxemic patients to facilitate bronchoscopic examination for bronchoalveolar lavage, bronchial brushing, endobronchial biopsy (EBB), and transbronchial lung biopsy (TBLB). Noninvasive mechanical ventilation has also been used to facilitate other endoscopic procedures including transesophageal echocardiography (TEE) and upper gastrointestinal endoscopy for diagnostic and therapeutic interventions in hypoxemic patients. Endobronchial ultrasound (EBUS) bronchoscope, having a wider diameter than a conventional bronchoscope, may have a more pronounced effect on lung mechanics and gas exchanges, and its use in patients on NIV has not been reported. Contraindications of EBUS are mostly relative and similar to FOB. There are several studies suggesting the safety of NIV-supported FOB in hypoxemic patients. We describe our experience of the first two EBUS bronchoscopies and transbronchial needle aspiration (TBNA) was done in hypoxemic patients with NIV support.

Intubation with Vivasight Double?Lumen Tube Versus Conventional Double?Lumen Tube in Adult Patients Undergoing Lung Resection: A Retrospective Analysis

Objectives: The present study was designed to compare outcomes in patients undergoing thoracic surgery using the VivaSight double?lumen tube (VDLT) or the conventional double?lumen tube (cDLT). Design: A retrospective analysis of 100 patients scheduled for lung resection recruited over 21 consecutivemonths (January 2018–September 2019). Setting: Single?center university teaching hospital investigation. Participants: A randomized sample of 100 patients who underwent lung resection during this period were selected for the purpose to compare 50 patients in the VDLT group and 50 in the cDLT group. Interventions: After institutional review board approval, patients were chosen according to inclusion and exclusion criteria and we created a general database.The 100 patients have been chosen through a random process with the Microsoft Excel program (Microsoft 2018, Version 16.16.16). Measurements and Main Results: The primary endpoint of the study was to analyze the need to use fiberoptic bronchoscopy to confirm the correct positioning of VDLT or the cDLT used for lung isolation. Secondary endpoints were respiratory parameters, admission to the intensive care unit, length of hospitalization, postoperative complications, readmission, and 30?day mortality rate. The use of fiberoptic bronchoscopy was lower in the VDLT group, and the size of the tube was smaller.The intraoperative respiratory and hemodynamics parameters were optimal. There were no other preoperative, intraoperative, or postoperative differences between both groups. Conclusions: TheVDLT reduces the need for fiberoptic bronchoscopy, and it seems that a smaller size is needed.Finally,VDLT is cost?effective using disposable fiberscopes.

Disnea secundaria a oclusión subaguda de un bronquio fuente / Dyspnea secondary to subacute occlusion of a main bronchus

La presencia de un cuerpo extraño en la vía aérea es todo un desafío diagnóstico, especialmente cuando el paciente no manifiesta una etapa asfíctica y el cuadro clínico se presenta silente o lentamente progresivo. Pero también es un desafío terapéutico, dado que no es frecuente disponer de broncoscopía rígida y flexible en la misma institución médica ni tampoco suele haber una variedad de instrumental para poder asirlo, en especial cuando el objeto es romo y voluminoso, con lo cual la extracción del mismo requiere no sólo de pericia, sino de paciencia e inventiva para poder resolver el problema con los escasos medios que habitualmente se cuentan.

The presence of a foreign body in the airways is a diagnostic challenge, especially when the patient doesn't show an asphyctic stage and is in a silent or slowly progressive clinical condition. But it is also a therapeutic challenge, given the fact that it is not common to have both rigid and flexible bronchoscopies in the same medical institution, or a variety of tools to grab the foreign body, mostly when the object is blunt and voluminous, so that in order to be extracted the physician must have skill, patience and imagination to solve the problem with the few resources usually available.

Efficacy of remimazolam-alfentanil-mivacurium for fiberoptic bronchoscopy / 中华麻醉学杂志

Objective:To evaluate the efficacy of remimazolam-alfentanil-mivacurium for fiberoptic bronchoscopy.Methods:A total of 100 patients of both sexes, aged 18-64 yr, with body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective fiberoptic bronchoscopy, were divided into 2 groups ( n=50 each) using a random number table method: remimazolam-alfentanil-mivacurium group (group R) and propofol-alfentanil-mivacurium group (group P). Oxygen was inhaled by mask, and alfentanil 10 μg/kg was slowly injected intravenously in advance.One minute later, remimazolam 0.2 mg/kg was injected intravenously in group R, propofol 1.5-2.0 mg/kg was injected in group P until loss of consciousness, and mivacurium 0.14 mg/kg was then injected intravenously in 2 groups.When the bispectral index value was 40-60, mechanical ventilation was performed after laryngeal mask was placed by the same anesthesiologist.During the maintenance of anesthesia, remimazolam 1 mg·kg -1·h -1 was infused intravenously in group R, propofol 4-6 mg ·kg -1·h -1 was infused intravenously in group P, and mivacurium was intermittently injected in both groups to maintain muscle relaxation.Before induction (T 0), when the laryngeal mask was placed (T 1), immediately when fiber bronchoscope reached juga (T 2), at 10 min after the surgery (T 3), at the end of the surgery (T 4) and when patients regained consciousness (T 5), blood pressure (BP), (HR), pulse oxygen saturation (SpO 2), breathing at the end of the CO 2 partial pressure (P ETCO 2), BIS values and Modified Observer's Assessment/Alertness and Sedation (MOAA/S) score were recorded.The time from beginning of anesthesia to beginning of examination, total examination time, the time from the end of administration to laryngal mask airway removal, the time to recovery of spontaneous breathing and the time from emergence to discharge from postanesthesia care unit (PACU) were recorded.The occurrence of intraoperative and postoperative adverse reactions was recorded. Results:There was no significant difference in SpO 2, P ETCO 2, BIS values and MOAA/S score at each time pint and the time from beginning of anesthesia to beginning of examination, the time to recovery of spontaneous breathing and the time from emergence time to discharge from PACU between the 2 groups ( P>0.05). Compared with group P, systolic blood pressure and diastolic blood pressure were significantly increased at T 1, T 3 and T 4, the time from the end of administration to laryngal mask airway removal was prolonged, the incidence of intraoperative hypotension, postoperative cough and total adverse reactions were decreased in group R ( P<0.05). Conclusion:Remimazolam-alfentanil-mivacurium produces better efficacy than propofol-alfentanil-mivacurium for fiberoptic bronchoscopy.

Clinical characteristics and risk factors for plastic bronchitis caused by severe mycoplasma pneumonia in children / 中国小儿急救医学

Objective:To summarize the clinical characteristics of plastic bronchitis caused by severe mycoplasma pneumoniae pneumonia in children, to find the risk factors for plastic bronchitis, and to provide references for judging the prognosis and comprehensively formulating treatment plans.Methods:We retrospectively analyzed the clinical data(146 cases)of children with severe mycoplasma pneumoniae pneumonia who underwent bronchoscopy in the Department of Pediatric Respiratory Medicine of Shengjing Hospital of China Medical University from January 2017 to December 2019.According to whether it was plastic bronchitis, all patients were divided into plastic bronchitis group(68 cases) and non-plastic bronchitis group(78 cases), and the gender, age, laboratory examination indicators, imaging characteristics and treatment of children were collected under the circumstances.The single factor with clinical significance and statistical significance would be subjected to multivariate Logistic regression analysis.Results:There were no significant differences in gender, age, heat duration, white blood cell count, C-reactive protein value, and interleukin-6 value between the two groups(all P>0.05). The percentage of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, D-dimer, number of cases of pleural effusion, length of hospital stay, and number of endoscopy in the plastic bronchitis group were higher than those in non-plastic bronchitis group, the number of right upper lobe consolidation cases was less than that in the non-plastic bronchitis group, and the differences were statistically significant( P<0.05). Multiple Logistic regression analysis showed that pleural effusion( OR=4.898, 95% CI 2.195-10.926) and lactate dehydrogenase ( OR=1.051, 95% CI 1.003-1.101) were independent predictors of plastic bronchitis in children with severe mycoplasma pneumoniae pneumonia. Conclusion:For children with severe mycoplasma pneumoniae pneumonia, if lung CT shows that the upper lobe of the non-right lung is uniformly compacted and complicated with pleural effusion, lactate dehydrogenase is significantly increased, and attention should be paid to the possibility of plastic bronchitis.Timely improvement of fiberoptic bronchoscopy may shorten the course of the disease and reduce the occurrence of complications.

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.@*METHODS@#A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (@*RESULTS@#Compared with the control group, the observation group had significantly decreased MAP at T@*CONCLUSIONS@#Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.

Role of flexible fiberoptic bronchoscopy in diagnosis of indefinate pulmonary infiltrates

Background: Respiratory diseases commonly present and are mostly diagnosed by routine clinical assessment and noninvasive investigations. Bronchoscopy a novel diagnostic tool used in diagnosis of various infectious, inflammatory and neoplastic pulmonary diseases by retrieving samples from bronchial, alveolar and interstitial compartments of patients with lung infiltrates. We prospectively assessed diagnostic utility of bronchoscopy in patients who had respiratory symptoms, radiographic infiltrates and sputum smear is negative for acid-fast bacilli (AFB). Despite, recent technical innovations in bronchoscopy, routine FOB is practiced with high yield and cost effectiveness.Methods: A prospective study was performed in which bronchoscopy was performed in 40 patients between August 2018 and January 2019, who had respiratory symptoms, radiographic findings not consistent with any specific diagnostic entity and had sputum smear negative for AFB.Results: Out of total 40 patients, most 30 (75%) patients were from rural areas, more than half 24 (60%) of the patients were males. Out of total 21 (52%) of patients were current smokers. Most common presenting symptoms were cough 22 (55%) and hemoptysis 8 (20%) followed by fever 6 (15%) and weight loss 4 (10%). Tuberculosis was confirmed in 18 (45%) patients. Non tubercular diseases were diagnosed in 22 (55%). Interstitial lung disease (ILD) was diagnosed in 5 (12.5%), lung cancer in 5%, bronhiectasis in 7.5%, pneumonia in 12.5%, lung abscess in 2.5% and non-specific infection in 15%.Conclusions: Diagnostic utility of flexible bronchoscopy is ever growing and has certainly taken a turn from being a luxury to near necessity today. Its association with trivial complications makes it a safe procedure. Hence bronchoscopy should be considered in the evaluation of patients with respiratory symptoms, indefinate radiographic infiltrates and negative sputum AFB test.

Clinical study of brush liquid-based cytology combined with automatic immunohistochemistry in the classification and diagnosis of lung cancer / 中华肿瘤杂志

Objective@#To explore the feasibility of bronchoscopic brushing liquid-based slide cytology combined with automatic immunocytochemistry (ICC) for pathological typing of lung cancer.@*Methods@#A liquid-based thin-prep was prepared from 171 bronchoscopic brushing specimens of patients with pulmonary lesions. ICC was detected by automatic immunohistochemistry instrument while cytomorphological diagnosis was made. The results were compared with those of histopathological diagnosis.@*Results@#Among 171 patients, 130 (76.0%) could be classified by cell morphology alone, including 31 squamous cell carcinomas, 44 adenocarcinomas and 55 small cell carcinomas; 162 (94.7%) could be classified by cell morphology combined with ICC, including 38 squamous cell carcinomas, 61 adenocarcinomas and 63 small cell carcinomas (P<0.001). According to the gold standard of histopathological diagnosis, the coincidence rate of cytomorphology combined with ICC was higher than that of cell morphology alone. The coincidence rate of squamous cell carcinoma was increased from 85.2% to 97.1% (P=0.093), adenocarcinoma from 92.5% to 98.0% (P<0.001), and small cell carcinoma from 96.1% to 98.3% (P=0.465).@*Conclusion@#The combination of liquid-based thin-prep cytology and automatic immunohistochemistry can effectively improve the accuracy of pathological typing of brushing specimens under fiberoptic bronchoscopy, and provide more objective diagnostic results for clinical treatment.

Value of fiberoptic bronchoscopy in the diagnosis and treatment of refractory mycoplasma pneumoniae pneumonia in children / 中国实用儿科杂志

Mycoplasma pneumoniae is one of the main pathogens of common community-acquired pneumonia in children.The incidence of refractory mycoplasma pneumoniae pneumonia has been increasing in recent years,and the drugs are limited in children. Fiberoptic bronchoscopy plays an important role in the diagnosis and treatment of refractory mycoplasma pneumoniae pneumonia in children. In this paper,the diagnostic and therapeutic value of fiberoptic bronchoscopy in the treatment of refractory mycoplasma pneumoniae pneumonia in children was expounded from the aspects of endobronchial lesions,pathogen and cytokine analysis in bronchoalveolar lavage fluid,bronchoalveolar lavage,airway cleaning and local drug injection under bronchoscopy.

Retrospective analysis of 29 cases of neonatal atelectasis treated by ultrasound-assisted fiberoptic bronchoscopy and bronchoalveolar lavage / 中国小儿急救医学

Objective To evaluate the efficacy and safety of bronchoalveolar lavage( BAL) in the treatment of neonatal atelectasis with fiberoptic bronchoscopy under ultrasound monitoring. Methods From June 2018 to December 2018,29 children were diagnosed as atelectasis by lung ultrasound. After conventional mechanical vibration and sputum ineffective,BAL was treated with fiberoptic bronchoscopy. All patients be-fore operation were monitored by ultrasound to find the lung segment where the atelectasis was located. 0. 9%NaCl solution was injected by fibrobronchoscope(1～2 ml/kg),and then sucked to ensure the recovery rate of the lavage fluid was more than 50%. After each lavage,ultrasound was immediately used to monitor the recovery of atelectasis to determine whether or not to continue the lavage. One course of treatment could be continuously performed BAL 1 to 3 times a day,1 course per day,and up to 3 courses of lavage. We analyzed the efficacy,adverse reactions and complications of BAL in the treatment of neonatal atelectasis under ultra-sound monitoring. Results Twenty-nine patients underwent BAL treatment with fiberoptic bronchoscopy,25 cases (86. 2%) were cured,3 cases (10. 3%) were effective,and 1 case (3. 4%) was ineffective. All chil-dren had stable vital signs during treatment. Among them,11 cases (37. 9%) had transient hypoxemia, 3 ca-ses (10. 3%) had tracheal mucosal injury, and 2 cases (6. 9%) had hoarseness. There were no serious com-plications such as pulmonary hemorrhage,pneumothorax,and cardiac arrest. Conclusion BAL treatment of atelectasis under lung ultrasound monitoring has obvious effect,easy to operate,no radiation,no obvious ad-verse reactions and complications,which is worthy of clinical application.

Effect of bronchialveolar lavage on mechanical ventilation in children with severe pneumonia / 中国小儿急救医学

Objective To investigate the efficacy and application of bronchoalveolar lavage in chil-dren with severe pneumonia undergoing mechanical ventilation. Methods Using a prospective randomized controlled clinical study, 202 children with severe pneumonia received mechanical ventilation in Hunan Children′s Hospital from January 2016 to January 2018 were selected as the subjects. According to the digital method,all cases were divided into treatment group (101 cases) and control group (101 cases) randomly. The patients in the control group were given conventional treatment ( anti-infection and symptomatic thera-py) . The treatment group was treated with bronchoalveolar lavage on the basis of conventional treatment. The basic situation,the respiratory function before and after the treatment,the inflammation index,the curative effect and the prognosis of two groups were analyzed. Results There were no significant differences between the two groups in gender,age,course pre-admission,pediatric critical illness score,respiratory function and in-flammation index ( P>0. 05 ) . The respiratory function indexes of the treatment group were obviously im-proved 2 hours after the treatment and the PaO2 ,PaO2/FiO2 and SaO2 were significantly higher than those of the control group[PaO2:(82. 4 ± 6. 4) mmHg(1 mmHg=0. 133 kPa) vs. (74. 0 ± 5. 5) mmHg, PaO2/FiO2:(360. 2 ± 21. 3) mmHg vs. (332. 6 ± 23. 5) mmHg,SaO2:(94. 9 ± 8. 2)％ vs. (88. 6 ± 10. 3)％], while the PaCO2 were significantly lower than the control group [ ( 37. 3 ± 10. 3 ) mmHg vs. ( 45. 8 ± 5. 5 ) mmHg],and the differences were statistically significant (P<0. 05). Five days after treatment,the WBC, PCT and CRP of treatment group were significantly lower than those in the control group[WBC:(8. 5 ± 2. 4) × 109/L vs. (11. 7 ± 3. 5) × 109/L,PCT:(1. 2 ± 0. 7) μg/L vs. (2. 3 ± 0. 9) μg/L,CRP:(9. 1 ± 3. 2) mg/L vs. (16. 5 ± 4. 7) mg/L,P<0. 05,respectively]. The total effective rate in the treatment group was significantly higher than that in the control group[93. 1％(94/101)vs. 81. 2％(82/101)]. Mechanical venti-lation duration and PICU stay in treatment group were significantly shorter than those in the control group [(148. 5 ±30. 6)h vs. (159. 6 ±47. 3)h,(220. 8 ±49. 7)h vs. (330. 7 ±94. 6)h]. The positive rate of patho-genic bacteria was significantly higher than that in the control group [79. 2％(80/101)vs. 62. 4％(63/101), P<0. 05],but there was no significant difference in the 28 days mortality of the two groups[5. 0％(5/101) vs. 5. 9％(6/101),P>0. 05]. Conclusion The bronchoalveolar lavage can improve the respiratory func-tion,reduce the inflammatory reaction,shorten mechanical ventilation duration and PICU stay in children with severe pneumonia undergoing mechanical ventilation obviously. It is worth popularizing in the PICU because of the improvement of curative effect in these children.

A perplexing primary novel hilar lesion: Remember the pneumonic PPNHL!

A 60-year-old female presented with dyspnea, cough, and chest pain with a left hilar mass lesion. In our case, clinicoradiological correlation, bronchoscopy, and computed tomography-guided biopsy revealed the diagnosis of primary pulmonary non-Hodgkin's lymphoma (PPNHL) on histopathology and immunohistochemistry. We discuss the approach to hilar masses. PPNHL is a rare malignant lymphoma most common being mucosa-associated lymphoid tissue lymphoma. Various therapeutic options are available. The chemotherapy regimen consisting of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) is preferred.

Effects of oxycodone hydrochloride combined with propofol on hemodynamics and related indexes in painless fiberoptic bronchoscopy / 重庆医学

Objective To investigate the effects of oxycodone hydrochloride combined with propofol on hemodynamics and related indicators in painless fiberoptic bronchoscopy.Methods Ninety patients receiving fiberoptic bronchoscopic examination from January 2016 to May 2017 were selected and divided into the sufentanil+propofol group(group A) and oxycodone hydrochloride+propofol group(group B) according to the random number table method 45 cases in each group.The hemodynamic indicators,intraoperative propofol dosage and incidence rate of adverse reactions in both groups were observed.Results The respiratory rate(RR) in the bronchoscope reaching the glottis(T2) in the group A was significantly higher than that in the group B (P＜ 0.05);mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO2) and RR at the bronchoscope passing trachea carina(T3) and examination completing(T4) in the group A were significantly higher than those in the group B(P＜0.05).RR at 10 min after the examination completing(T5) in the group A was significantly higher than that in the group B,the difference was statistically significant(P＜0.05).The propofol dosage in the group A was significantlyhigher than that in the group B(P＜0.05);the incidence rate of adverse reactions in the group A was 31.11％,which was significantly higher than 6.67％ in the group B,the difference was statistically significant(P＜0.05).Conclusion Oxycodone hydrochloride combined with propofol can more stabilizes the change of hemodynamic parameters during the bronchofibroscopic examination process compared with sufentanil combined with propofol and can reduce the propofol dosage and incidence rate of adverse reactions.

Analysis on value of fiber bronchoscope brush liquid based cytology in diagnosing lung cancer / 重庆医学

Objective To evaluate the value of fiber bronchoscope brush liquid based cytology in diagnosis and classification diagnosis of lung cancer.Methods Eigh hundreds and seventeen cases of lung cancer were retrospectively analyzed.All cases con-ducted the fiber bronchoscopy brush liquid based cytology exmination and histopathological examination.Then their results were compared.Results Three hundreds and sixty-eight casesof lung cancer were diagnosed by fiber bronchoscopy brush liquid based cy-tology,invluding 177 cases of squamous cell carcinoma,84 cases of adenocarcinoma and 68 cases of small cell carcinoma,and 15 ca-ses were separately diagnosed as lung cancer.The sensitivity of was 44.01%,specifity rate was 94.40%,positive predictive value was 95.92%,negative predictive value was 36.04%,and the Kappa value was 0.250,there was statistically significant difference compared with the histopathological examination(P<0.01).Conclusion Fiber bronchoscopy brush liquid based cytology examina-tion is a high specificity method to diagnose lung cancer.

Application of fiberoptic bronchoscopy in the diagnosis and treatment of chronic cough in children / 中国小儿急救医学

Objective To explore the application value of fiberoptic bronchoscopy in the diagnosis and treatment of chronic cough in children. Methods A total of 113 children with chronic cough were enrolled in our hospital from January 2014 to December 2016. All the cases underwent fiberoptic bronchoscopy,the endoscopic manifestations and clinical symptoms were analyzed,and the pathogens in bronchoalveolar lavage fluid were detected. Results In the 113 children with chronic cough,64 cases (56. 6％) were boys and 49 cases (43. 4％) were girls,with 85 cases (75. 2％) under 5 years old. After fiberoptic bronchoscopy,30 cases (26. 5％) were diagnosed with bronchial foreign body,20 cases (17. 7％) were post-infection cough, 19 cases (16. 8％) with cough variant asthma,14 cases (12. 4％) with upper airway cough syndrome,14 cases ( 12. 4％) had airway abnormality, 9 cases ( 7. 9％) had protracted bacterial bronchitis, 4 cases (3. 6％) had bronchiolitis obliterans,and 3 cases (2. 7％) had bronchial tuberculosis. The most common pathogen was Streptococcus pneumonia in bronchoalveolar lavage fluid. The main adverse reactions in the operations was hypoxemia caused by airway obstruction. Conclusion Fiberoptic bronchoscopy is a very safe and reliable operation in the diagnosis and treatment of respiratory diseases in pediatrics, and plays an important role in the diagnosis of congenital developmental airway diseases,the detection of pathogens and the treatment of bronchial foreign bodies. For the chronic cough children who had repeated visits and poor treatment should accept fiberoptic bronchoscopy examination.

Application of Tracheal Intubation Guided by Fiberoptic Bronchoscopy in Children Snoring Disease Operation / 中国微创外科杂志

Objective To explore the value of tracheal intubation guided by fiberoptic bronchoscopy in children snoring disease operation.Methods A total of 50 patients underwent tracheal intubation guided by fiberoptic bronchoscope or laryngoscope from August 2015 to June 2016.There were 25 cases of fiberoptic bronchoscopy assigned into group A, 25 cases of laryngoscopy into group B.The intubation time, success rate and adverse reactions of the two groups were compared and analyzed.Results All the intubation in group A succeed at the first time.The intubation time was (20.1±4.3) s and the position was right.There was no need for replacement during the operation.Three cases in group B succeed at the second time because the tonsil was too big to expose the pharynx.The intubation got out of the pharynx in 3 cases in group B and were adjusted to the right position.The intubation time was (50.7±6.9) s and the success rate at the first time was 76% (19/25).Groups A behaved better than group B in aspects of the success rate of signal intubation and intubation time (Fisher''s Exact Test, P=0.022;t=-18.725, P=0.000).There were no adverse reactions in group A, such as pharyngorrhagia, odontoseisis or loss of tooth, laryngospasm and so on.There were 3 cases of hemorrhage from throat after intubation, 3 cases of loss of tooth in different degrees and 1 case of laryngospasm at second intubation time in group B.There was no significant difference in adverse reactions between the two groups (P>0.05).ConclusionFiberoptic bronchoscopy can be used for children snoring disease with good safety as well as rare adverse reactions.

The effect of fiberoptic bronchoscopy and bronchoalveolar lavage in the treatment of refractory Mycoplasma pneumoniae pneumonia in children / 临床儿科杂志

Objective To evaluate the clinical effects of fiberoptic bronchoscopy and bronchoalveolar lavage in the treatment of refractory Mycoplasma pneumoniae pneumonia.Method The clinical data of 55 children with refractory Mycoplasma pneumoniae pneumonia were retrospectively analyzed during February 2015 to February 2016.Results Among those 55 children,30 cases who received the treatment of bronchoscopy and bronchoalveolar lavage were assigned to treatment group,and the other 25 cases were assigned to control group.17 children in treatment group and 13 children in control group had lung lamellar shadow.After treatment,the improvement rates were 100％ and 69.2％ in treatment group and control group,respectively.There was significant difference between two groups (P=0.026).The total effective rate in treatment group was 96.7％,which was significantly higher than that of control group (64.0％) (P=0.006).The length of hospital stay were significantly shorter and average treatment fee were significantly lower in treatment group than those in control group (P＜0.01).There were no severe adverse reactions in treatment group.Conclusion The effects of fiberoptic bronchoscopy and bronchoalveolar lavage with local application of drug were remarkable in the treatment of refractory mycoplasma pneumonia,and there were no severe adverse reactions.

Effect of bronchoalveolar lavage with fiberoptic bronchoscopy combined with vibration sputum drainage on mechanically ventilated patients with severe pneumonia: a prospective randomized controlled trial in 286 patients / 中华危重病急救医学

Objective To investigate the curative effect of bronchoalveolar lavage with fiberoptic bronchoscopy combined with vibration sputum drainage in the treatment of severe pneumonia patients undergoing mechanical ventilation (MV).Methods A prospective randomized controlled trial was conducted. 286 severe pneumonia patients undergoing MV admitted to intensive care unit (ICU) of Hunan People's Hospital from January 2014 to July 2016 were enrolled, and they were divided into control group and observation group according to random number table, with 143 patients in each group. Patients in both groups received sensitive antibiotics for anti-infection, etiological treatment, and calefacient and humidifying treatment. The patients in the control group received bronchoalveolar lavage with fiberoptic bronchoscopy, and those in the observation group received bronchoalveolar lavage combined with vibration sputum drainage. The parameters of respiratory function and inflammation before and after treatment, curative effect, and prognosis were compared between the two groups.Results ① There were no significant differences in respiratory function parameters between the two groups before treatment, 2 hours after treatment, the parameters were improved in both groups. Moreover, oxygenation index (PaO2/FiO2) in observation group was significantly higher than that of control group [mmHg (1 mmHg = 0.133 kPa): 379.1±20.2 vs. 351.8±24.7], and arterial partial pressure of carbon dioxide (PaCO2) and airway resistance (Raw) were significantly lower than those of the control group[PaCO2 (mmHg): 36.5±5.8 vs. 45.3±6.9, Raw (cmH2O, 1 cmH2O = 0.098 kPa): 12.9±0.6 vs. 13.1±0.8, allP 0.05].Conclusion Compared with bronchoalveolar lavage with fiberoptic bronchoscopy alone, the treatment of bronchoalveolar lavage combined with vibration sputum drainage is more effective in sputum excretion for severe pneumonia patients undergoing MV, which could improve the respiratory function, reduce infection, shorten the duration of MV and the length of ICU stay, and improve the recovery.