Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies.

AIM: To evaluate the frequency of complications in bronchoscopy from data compiled between 1/2/2002 to 1/2/2003. MATERIALS AND METHODS: Nineteen Italian centres of thoracic endoscopy participated in the study, for a total of 20,986 bronchoscopies (FBS), including 10,658 explorative bronchoscopies (EB) (50.79%), 5,520 bronchial biopsies (BB) (26.30%), 1,660 transbronchial biopsies (TBB) (7.91%), 1,127 broncho-alveolar lavages (BAL) (5.37%), 930 transbronchial needle-aspirates (TBNA) (4.43%), 1.091 therapeutic bronchoscopies (TB), comprising ND-YAG Laser, argon-plasma, electrocautery knife, stent insertion (5.20%). 82.4% of the procedures involved the use of a flexible bronchoscope, 16.3% were carried out using a rigid bronchoscope and 1.3% using the mixed technique. RESULTS: The total number of complications recorded was 227 (1.08% of the cases examined), including 20 (0.09%) during local anesthesia and pre-medication, 195 (0.92%) during the endoscopic procedures and 12 (0.05%) in the two hours following FBS. The total number of deaths was 4 (0.02%), due to cardiac arrest, pulmonary edema, delayed respiratory failure and shock in pre-medication, respectively. 68.28% of the complications were treated medically, 25.99% by means of endoscopy and 5.72% with surgery. The healing percentage was 98.2%. CONCLUSIONS: This study has shown that bronchoscopy is a safe method with low incidence of mortality and complications. The preparation, experience and continuous training of the operators of the medical and nursing team seem to play a fundamental role in reducing the incidence of complications at least in certain procedures such as BB and TBB.

Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography.

PURPOSE: The purpose of this study was to determine the role of plain chest radiography in the evaluation of patients with suspected foreign-body aspiration. MATERIALS AND METHODS: During a 5-year period, 31 patients (18 men and 13 women; age range 6 months to 85 years) were referred to our observation for clinical suspicion of foreign-body aspiration. Clinically, the patients presented with cough in 27/31 cases (87.1%), decreased breath sounds in 22/31 (71%), choking in 18/31 (58.1%), fever in 7/31 (22.6%) and cyanosis in 5/31 (16.1%). Suspected foreign-body aspiration had occurred 2-72 h before hospitalisation. Within 2 h of hospitalisation, all patients underwent plain chest radiography performed in the upright position (two projections) in 10/31 (32.3%) patients and in the supine decubitus position in the remaining 21 (67.7%) patients. Plain chest radiography was subsequently integrated with multislice computed tomography (MSCT) of the chest in 3/31 (9.7%) patients and with bronchoscopy in 27/31 (87.1%) patients. RESULTS: Plain chest radiography showed the presence of a foreign body in the tracheobronchial tree in 7/31 (22.6%) patients, who subsequently underwent successful bronchoscopy in all cases. Foreign bodies included tooth fragment (three cases), nail (two cases), metallic spiral of a ball-point pen (one case) and an earring (one case). In the remaining 24/31 patients, plain chest radiography was positive in 14 cases, showing atelectasis (seven cases), pneumonia (six cases), pulmonary hyperinflation (one case) and pneumomediastinum (one case). Such findings had been caused by an aspirated foreign body, which was subsequently removed by means of bronchoscopy in all 14 patients. Moreover, three of the remaining ten patients with negative plain chest radiograph were submitted to MSCT of the chest, which required in 1 case tracheobronchial aspiration of a foreign body that was subsequently removed by means of bronchoscopy. Overall, plain chest radiography showed the presence of foreign-body aspiration and/or pleuroparenchymal lesions in 21/31 patients (67.7%); bronchoscopy was positive in 23/27 patients (85.2%), localising the foreign body in the right main bronchus in 16/27 patients (59.3%), left main bronchus in 7/27 patients (25.9%), intermediate bronchus in 2/27 patients (7.4%) and right lower lobe bronchus in 2/27 patients (7.4%). No late complications were observed within 6 months of hospital discharge. CONCLUSIONS: Plain chest radiography remains the initial imaging modality for patients with clinically suspected tracheobronchial aspiration of a foreign body. Nevertheless, in the case of negative chest radiography and a clinical suspicion of foreign-body aspiration, MSCT-possibly integrated with virtual bronchoscopy-should be considered in order to avoid unnecessary bronchoscopy.

Prevalence, age distribution and aetiology of bronchiectasis: a retrospective study on 144 symptomatic patients.

The incidence of bronchiectasis (BCT) has probably decreased in developed countries in recent years, but reliable statistical data on its occurrence are still lacking. The aim of the present study was to retrospectively evaluate the prevalence, age distribution and aetiology of BCT, diagnosed in a selected series of symptomatic patients of a Western country by using bronchography. The authors analysed the main known predisposing and associated conditions (PACs), and the occurrence and age distribution of BCT in 144 consecutive patients who underwent bronchological examination (fibreoptic bronchoscopy and bronchography) in the years 1987-1994 because of recurrent purulent bronchitis and/or haemoptysis. The overall prevalence of BCT was 34% (49/144); its age distribution was: 17.2% (0-10 yrs), 43.7% (11-20 yrs), 38% (21-30 yrs), 37.5% (31-40 yrs), 33.3% (41-50 yrs), 40% (51-60 yrs), and 20% (61-70 yrs). Thirty-one PACs were found in 29/144 patients of the whole study group. The prevalence of BCT was significantly higher in the subgroup of 29 patients with PACs than in the subgroup of 115 patients without PACs (75.9% versus 23.5%; p < 0000001). The aetiology of BCT was mainly unexplained, as it was only possible to detect 24 PACs in 22/49 patients with BCT (44.9%): congenital, genetic and immune disorders (eight), localized airways obstructive diseases (five), pulmonary infections (three), bronchial asthma (two), pulmonary lobar fibrosis (two), ulcerative colitis (two), dermatomiositis (one), and toxin inhalation (one). The authors conclude that bronchiectasis still occurs in a large percentage of symptomatic patients of a developed country in the post-antimicrobial era, especially in the second to sixth decades, as well as in the presence of predisposing and associated conditions; its aetiology remains unknown in more than half of cases.

Endobronchial metastasis from stomach carcinoma.

We describe the case of a 57-yr-old female with endobronchial metastasis from stomach carcinoma. Respiratory symptoms began 3 months before the diagnosis of the gastric cancer. Chest computed tomography revealed a reticular lymphangitic carcinomatosis pattern with hilar and mediastinal lymphadenopathy. Fibreoptic bronchoscopy showed a spread submucosal infiltration which narrowed the apical segment of the left lower lobar bronchus. The biopsy specimen at that level was histologically identical to the gastric primitive cancer. To the authors' knowledge, stomach carcinoma has rarely been reported to give rise to airway metastases.

Community-acquired pneumonia in adults: a multicentric observational AIPO study.

The aim of this study was to obtain reliable data about the current aetiology (i.e. the frequency of the individual pathogens) of community-acquired pneumonia (CAP) while surveying the diagnostic and therapeutic behaviour of Italian chest physicians, compared with existing guidelines, and to test the usefulness of the current severity "criteria" or score as a predictor of disease outcome and guide for appropriate hospitalization. A prospective multicentre observational trial was carried out between October 1994 and February 1996 by the Italian Association of Hospital Pneumologists (AIPO) study group on respiratory infections. A total of 613 consecutive patients suffering from CAP were enrolled in 25 centres throughout Italy. Clinical, radiological and microbiological data were collected and patients were followed-up until complete resolution or death. Aetiological tests were not carried out in 204 patients. In the remaining 409 cases, the aetiology was defined by serological and quantitative microbiological tests in 184 (44.9%) patients. A total of 194 strains of pathogen were detected. The most frequently detected micro-organism was Streptococcus pneumoniae (18.5% of pathogen strains) but, unlike in other series of patients, high percentages of intracellular pathogens (32.5%, all with serological confirmation, mostly due to Chlamydia pneumoniae (13.4%) and of Gram-negative enterobacteria and Pseudomonas aeruginosa (12.5%) were also found. Antibiotic treatment differed from that recommended in American Thoracic Society guidelines, with a greater use of third-generation cephalosporins. Overall, a higher rate of hospitalization and a lower death rate than in other comparable studies was observed.