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La purpurina es un pigmento en polvo de cobre, que se utiliza con frecuencia en actividades artesanales y manualidades escolares. La ingestión o inhalación de esta sustancia provoca un cuadro de intoxicación por cobre potencialmente fatal en niños. Se describe el caso de un niño de 15 meses con intoxicación por cobre, que se presenta con dificultad respiratoria aguda, alteración del sensorio y anemia hemolítica. El inicio temprano del tratamiento mediante broncoscopia y lavado bronquial con posterior intubación endotraqueal y ventilación mecánica, lograron la remisión completa del cuadro respiratorio sin secuelas. Ante una ingestión y/o inhalación de purpurina, debe indicarse de inmediato la broncoscopia con lavado bronquial, aún en ausencia de síntomas respiratorios.
Glitter is a powdered copper pigment frequently used in craft and decorative activities especially in schools and kindergartens.Ingestion or inhalation of this substance can cause acute, potentially fatal copper poisoning in children. We describe a case of a 15-month-old child with copper poisoning, presenting with acute respiratory distress, neurological impairment, and hemolytic anemia. Early onset of treatment by bronchoscopy and bronchial lavage with subsequent endotracheal intubation and mechanical ventilation, achieved complete remission of the respiratory symptoms without sequelae. In presence of glitter ingestion or inhalation, bronchoscopy with bronchial lavage should be indicated early even in the absence of respiratory symptoms.
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Humanos , Masculino , Lactante , Síndrome de Dificultad Respiratoria del Recién Nacido , Intoxicación , Polvos , Respiración Artificial , Broncoscopía , Cobre , Ingestión de AlimentosRESUMEN
OBJECTIVE: To evaluate the diagnostic value of bronchial lavage P16INK4A promoter methylation and lung cancer. MATERIALS AND METHODS: The databases of PubMed, Medline, China National Knowledge Infrastructure, and Wanfang were electronically searched by two reviewers to find the suitable studies related to the association between P16INK4A promoter methylation and lung cancer. The P16INK4A promoter methylation rate was extracted from each included individual study. The diagnostic sensitivity, specificity, and area under the receiver operating characteristic ROC curve of bronchial lavage P16INK4A as a biomarker for diagnosis of lung cancer were pooled by stata11.0 software (Stata Corporation, College Station, TX, USA). RESULTS: At last, 10 publications were included in this meta‑analysis. Of the included 10 studies, five are published in English with relatively high quality and other five papers published in Chinese have relatively low quality. The pooled sensitivity and specificity of bronchial lavage P16INK4A promoter methylation for lung cancer diagnosis were 0.61 (95% confidence interval [CI]: 0.57–0.65) and 0.81 (95% CI: 0.78–0.85), respectively, with random effect model. The ROC curve were calculated and drawn according to Bayes’ theorem by stata11.0 software. The systematic area under the ROC was 0.72 (95% CI: 0.68–0.76), which indicated that the diagnostic value of bronchial lavage P16INK4A promoter methylation for lung cancer was relatively high. Moreover, no significant publication bias was existed in this meta‑analysis (t = 0.69, P > 0.05). CONCLUSION: Bronchial lavage P16INK4A promoter methylation can be a potential biomarker for diagnosis of lung cancer.
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Objective To explore the effects of bed side painless fiberoptic bronchoscopy for bronchoalveolar lavage (BAL) under chest computed tomography (CT) guidance and mechanical ventilation in the patients with severe pulmonary infection (SPI).Methods A total of 131 cases of SPI undermechanical ventilation support were randomly (random number) divided into CT group (C group),chest Xray examination group (X group) and without radiological examination group (N group).The bronchoalveolar lavage (BAL) by using painless fiberoptic bronchoscopy with invasive mechanical ventilation was carried out in patients of these three groups.Vital signs and variables of respiratory mechanics ofpatients were monitored before and 1 h,2 h,and 4 h after BAL and the time consumed for BAL was simultaneous recorded.Meanwhile,infection related biomarkers on the 3rd d and 5thd after BAL,positive detection rate of pathogenic bacteria,the time of invasive mechanical ventilation used during BAL and total duration of mechanical ventilation support were measured.Results During BAL and at 10 min after BAL,heart rate and respiratory rate of C group and X group were lower than those of N group (P ＜ 0.05),however,there was no significant difference in SBP and DBP among groups (P ＞ 0.05).One and two hours after BAL,peak inspiratory pressure (PIP),work of breathing ventilation (WOBvent) and airway resistance (RAW) in C group and X group were lower than those in N group,therefore,dynamic compliance (Cdyn) in C and X groups was better than that in N group (P ＜0.05).Four hours after BAL.Cdyn in C group and X group was better than that in N group (P ＜ 0.05),But there were no significant differences in PIP,WOBvent and RAW among groups (P ＞ 0.05).BAL time (BAL-t) in C group (16.81 ±2.62) min was shorter than that in X group (20.12 ± 3.81) min and N group (23.69 ± 2.76) min,(P ＜ 0.05).Three and five days after BAL,core body temperature,WBC and procalcitonin (PCT) in C and X group were lower than those in N group (P ＜0.05),and those in C group was lower than those in X group (P ＜0.05).Pathogenic micro-organism detection rate in C group (80.55％,29/36) was higher than that in X group (72.09％,31/43) and N group (59.65％,34/57) (P ＜ 0.05).Total mechanical ventilation time (MV-t) in C group (114.36 ± 38.39) h was shorter than that in X group (132.07 ± 42.51) h and N group (165.28 ± 67.28) h (P ＜ 0.05).Conclusions BAL by using painless fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation,decrease airway hyper-reactivity,shorten the BAL time,ICU stay and duration of mechanical ventilation,facilitate drainage of lung infection exudates and pathogen detection rate and improve efficacy of comprehensive treatment.
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Objective To investigate the influence of application of local anesthesia with lidocaine on bronchial lavage fluid (BLF) pseudomonas aeruginosa culture and drug sensitivity in cases with lung infection .Methods Two hundred and seventy speci-men of BLF were collected from 135 patients with infection of lung .And BLF were collected directly from right-broncho in control group ,and from left-broncho in lidocaine group .The outcome of pseudomonas aeruginosa culture and drug sensitivity were com-pared in the two groups .Results Fourty-two cases were postitive in BLF pseudomonas aeruginosa culture in the control group ,and 40 cases were postitive in lidocaine group .The positive rates were 31 .11% and 29 .63% ,respectively .There were no significance between the two groups (P<0 .001) .Compared with the control group ,the sensitive strains of pseudomonas aeruginosa were obvi-ously less and the drug tolerance strains were much more in lidocaine group for Ciprofloxacin and Levofloxacin (P<0 .05) .Howev-er ,there were no influence for drugs such as Piperacillin/Tazobactam and Ceftazidime ,etc .Conclusion 2% lidocaine has no influ-ence on the outcome of BLF pseudomonas aeruginosa culture .But it may reduce the drug sensitivity of Ciprofloxacin and Levofloxa-cin in cases with infection of lung .
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El diagnóstico citológico e histopatológico en casos de tumores pulmonares se realiza con alta confiabilidad a través de muestras obtenidas por fibrobroncoscopía (FBC). Puede haber diferencias que dependen de la localización del tumor. Objetivo: Determinar la sensibilidad del lavado, cepillado bronquial y biopsia por (FBC) en una muestra de tumores pulmonares centrales, donde hay alteraciones endoscópicas evidentes y en otra de tumores pulmonares periféricos con sospecha de malignidad donde las alteraciones son menos frecuentes. Casos: Se estudiaron 86 enfermos con tumores pulmonares, 44 centrales (Grupo A) y 42 periféricos (Grupo B). Todos fueron objeto de estudio por FBC con lavado y cepillado; en 15 casos se practicó biopsia. Resultados: Hubo una diferencia significativa (p < 0.005) con respecto a la apariencia normal y anormal entre tumores centrales (A) y periféricos (B). El diagnóstico de malignidad basado en la presencia de células malignas por cepillado y lavado bronquiales fue positivo en 21 del Grupo A y en 14 del Grupo B con sensibilidad de 60 y 40%, respectivamente. En 15 casos de tumor endobronquial se practicó biopsia. En los casos negativos, 23 del A y 28 del B, se emplearon otros métodos diagnósticos (p < 0.05). Se detectaron 76 casos de neoplasias, predominando el carcinoma bronquiogénico (43%). Diez casos fueron procesos infecciosos. Conclusión: El estudio por FBC permanece como un importante método diagnóstico en casos de tumores pulmonares. El lavado y el cepillado tuvieron resultados positivos en 35/86, cifra relativamente baja que sugiere la necesidad de mejorar la calidad de las muestras obtenidas. La negatividad por FBC obliga el empleo de otros métodos diagnósticos. El costo estimado de los procedimientos, erogado por el paciente en dólares americanos, es notablemente menor que en países como Holanda, que se tomó como comparativo.
Cytologic and histologic diagnosis of lung tumors can usually be done by means of fiberoptic bronchoscopy (FOB), but there are some differences in cases of central or peripheral tumors. Objective: To determine the sensititivity of bronchial brushing, lavage and biopsy performed by FBO in a sample of central tumors, with evident bronchial alterations, and another sample of peripheral lesions in which these alterations are less frequent. A preliminary comparison of the costs of FOB in Mexico and Holland was also done. Cases: There were 86 patients with tumoral lesions suspicious of malignancy, 44 central (Group A) and 42 peripheral (Group B); all were subjected to FOB, lavage and bronchial brush ings; biopsy was done in 15 cases of endobronchial lesions. Results: There was a significat difference (p < 0.005) as to the normal or abnormal appearance of the bronchial mucosa between central tumors (A) and peripheral (B) lesions. Diagnosis of malignancy by lavage and brushing based in the finding of malignant cells was positive in 21 of the Group A and in 14 of Group B, sensitivity of 60% and 40% respectively. Biopsy was performed in 15 cases with endobronchial tumor. In the negative cases, 23 in Group A and 28 in Group B, other diagnostic methods were employed (p < 0.05). A total of 76 cases of malignancy were detected; bronchogenic carcinoma was predominant (43%). Ten cases of infectious diseases were identified. Conclusion: FOB remains as an important diagnostic tool in cases of lung tumors. Bronchial lavage and brushing had positive results for malignant cells in 35/86; this relative low figure suggests the need to improve the quality of the samples obtained by FOB. Other diagnostic methods must be used in cases with negative FOB results. Estimated costs, in US dollars, of diagnostic methods are much lower in Mexico than in an European country, The Netherlands.
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We assessed whether acid fast bacilli (AFB) determination in gastric lavage (GL) and bronchial lavage (BL) contributes to diagnosis in cases radiologically suggestive of pulmonary tuberculosis but with either negative AFB in sputum or the inability to expectorate sputum. Of 129 cases recruited for the study, 22 were excluded due to evaluation as inactive disease or non-tuberculosis disease. The remaining 107 cases were evaluated in 2 groups. Group A consisted of 49 patients that could not expectorate sputum and from whom GL was obtained. In group B, BL was performed in 58 patients that had negative sputum smear. Smear positivity was 61.2% (30/49) and culture positivity was 30.6% (15/49) in group A, 51.7% (30/58) and 81% (47/58), respectively, in group B. Thirteen cases, in whom AFB could not be detected microbiologically but who were radiologically strongly suggestive of tuberculosis, were regarded as tuberculosis according to 'from treatment to diagnosis' criteria. In conclusion, detection of AFB positivity in the diagnosis of tuberculosis is important in terms of early initiation of treatment and detection of resistant bacilli. Therefore, we suggest that it would be helpful to obtain GL in cases where the patient is unable to expectorate sputum, and perform BL in cases with negative sputum smear.