[Laser-based endoscopic measurement of airway dimensions]. / Lasergestützte endoskopische Vermessung der grossen Atemwege.

Bronchoscopy is the technique of choice for the evaluation of a stenosis in the large airways. However, no system has been successfully employed for the bronchoscopic measurement of airway stenosis. The purpose of these study was the development and validation of a method for measuring the cross-sectional areas in the large airways. Furthermore, this application should be used for the 3D-reconstruction and visualisation of airway stenosis. A laser probe inserted into the operating channel of the bronchoscope enabled assessment of the distance between the images and the tip of the bronchoscope by means of projecting a ring of light on to the endoluminal wall. Image distortion due to the wide-angle lens was corrected by a computer program developed by us. Plastic tubes with known diameters were used for validation. Additionally, distortion-corrected bronchoscopic images were compared with distortion-free videoscopic image analysis of tracheal slices taken from pigs. When plastic tubes were used, the correlation coefficient (r) was slightly higher (r = 0,99, p < 0,01) than the correlation of cross-sectional areas between bronchoscopic and videoscopic images of tracheal slices (r = 0,88, p < 0,01). Furthermore the system could be used in a few patients for 2D and 3D measurement and visualisation of airway stenosis. Application of the present method offer quantitative assessment of airway stenosis located in the large airways.

Value of bronchial artery embolisation with platinum coils in tumorous pulmonary bleeding.

We performed bronchial artery embolizations (BAE) using platinum coils with Dacron fibres in 30 consecutive patients with haemoptysis due to bronchial carcinoma. The aim of the study was to compare immediate results of bleeding cessation, recurrence and survival rates with a historical control group of 15 patients with tumorous pulmonary bleeding who were treated conservatively (non-BAE-group). Bronchial artery embolisation with platinum coils stopped active bleeding in all patients immediately. Comparing the BAE group and controls the cessation of first time haemoptysis (BAE 100% versus non-BAE 93%) and the rates of bleeding recurrence (BAE 50% versus non-BAE 47%) were similar in either group. In case of recurrent bleeding, repeated BAE led to a definite cessation of pulmonary haemorrhage in every case. In contrast, all patients with recurrent haemoptysis without a repeated BAE (8 patients, 27%) and all patients with bleeding recurrence in the non-BAE group died from pulmonary haemorrhage (8 patients, 53%). The mean survival time of the BAE group was significantly longer compared with the non-BAE group, 139 (range: 1-818) days versus 62 (range: 1-186) days (P<0.05). We conclude that consistent BAE proved beneficial in tumorous pulmonary bleeding, particularly with regard to the permanent arrest of haemorrhage in case of recurrence.

[Aspiration of petroleum by a "fire-eater"]. / Die Aspiration von Petroleum be einem "Feuerpsucker".

A 21-year-old man suffered from cough, dyspnoea and hemoptysis following accidental aspiration of petroleum. Chest x-ray and computerized tomography one day after the aspiration showed infiltrates in the lower fields. Fiberbronchoscopy revealed severe bronchitis without any signs of necrosis. Flunisolide inhalation (200 micrograms/d) and intravenous application of prednisolone (50 mg/d) and clindamycine (600 mg/d) improved pulmonary function within a few days. The infiltrates resolved over the following two weeks. This favourable result clearly shows that conservative treatment has a role in petroleum aspiration.