Role of bronchoscopy in modern medical intensive care unit.

This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being used to improve respiratory failure and facilitate weaning from mechanical ventilation. Practical applications of recent advancements in technology (endobronchial stenting, laser therapy, and so forth), the increasing use of rigid bronchoscopy, and the new generation of flexible bronchoscopes like battery bronchoscopes, and ultra-thin bronchoscopes, are also discussed. The risks, potential benefits, complications, and suggested technique of performing bronchoscopy in mechanically ventilated patients are reviewed.

Therapeutic flexible bronchoscopy.

Since the development of the flexible bronchoscope in late 1960s, its use in the management of various pulmonary disorders, especially lung Ca, has expanded tremendously. It is not only of great diagnostic value, with the recent development of various therapeutic modalities such as Nd:YAG laser, tracheobronchial stents, and cryotherapy, but also its value in management of terminal lung Ca has improved dramatically. Its potential in curing early-stage lung Ca presently is being explored. At present, it is at least partially successful in achieving this goal. More importantly, because of lack of the training in RB and widespread usage of FB, it is more likely that its role in the various interventional procedures, such as Nd:YAG laser therapy, tracheobronchial stent deployment, brachytherapy, and cryotherapy, will grow exponentially. Because of availability of a variety of therapeutic modalities, such as APC, PDT, and balloons, interventional pulmonologists are well equipped to improve the quality of life of terminally ill patients with cancer and maybe to cure early stage lung Ca.

Waist-hip ratio and blood pressure correlation in an urban Indian population.

Truncal obesity judged by increased waist-hip ratio (WHR) is an important risk factor for atherosclerosis. One of the mechanisms postulated by which truncal obesity increases coronary risk is high blood pressure (BP). Studies of correlation of WHR with systolic and diastolic BP have shown conflicting results. A study on 443 persons (250 males, 193 females) for WHR measurement during a comprehensive cardiovascular survey in an urban population of Rajasthan was undertaken. The mean WHR in males was 0.90 +/- 0.07 and in females 0.87 +/- 0.08. The median value was 0.91 in males and 0.88 in females. Correlational analysis of WHR with anthropometric and clinical parameters showed that in males there was a positive relationship of WHR with weight (r = 0.11), body mass index (r = 0.13) and systolic (r = 0.11) and diastolic BP (r = 0.11) but not with age and height. In females no significant relationship was seen with these variables. When classified according to the US Fifth Joint National Committee (JNC-V) recommendations for diagnosis of truncal obesity (WHR males > 0.95, females > 0.85) it was seen in 42 (17%) males and 131 (68%) females. Sub-analysis of these two groups showed that mean values of systolic and diastolic BP were not significantly different in truncally obese subjects. However, stratified analysis after classifying WHR in four groups (WHR < 0.85, 0.85-0.89, 0.90-0.95 and > 0.95) showed that in males there was a significantly rising trend of weight, body mass index, systolic and diastolic BP with increasing WHR. WHR of > or = 0.85 was associated with higher systolic and diastolic BP.