Flexible bronchoscopy in the 21st century:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1999
|
| Schriftenreihe: | Clinics in chest medicine
20,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII, 222 S. zahlr. Ill. |
Internformat
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| 245 | 1 | 0 | |a Flexible bronchoscopy in the 21st century |c Atul C. Mehta guest ed. |
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Datensatz im Suchindex
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| adam_text | FLEXIBLE BRONCHGSCOPY IN THE 21ST CENTURY
CONTENTS
Preface xiii
Atul C. Mehta
Future of Flexible Brortchoscopy 1
Muzaffar Ahmad and Raed A. Dweik
Predicting the future of such a versatile instrument that is used for clinical
and research applications is a difficult task. Despite some potential
threats, the future of bronchoscopy is likely to be filled with ever
expanding applications in clinical medicine and research. Many develop¬
ments are still in progress and newer applications continue to evolve. This
article reviews some of the recent advances in bronchoscopy and their
potential for future application in clinical practice and research. The au¬
thors also touch on developments in other disciplines that may impact
bronchoscopy by either enhancing its potential or limiting its use.
Infection Control in the Bronchoscopy Suite: A Review 19
Atul C. Mehta and Omar A. Minai
Bronchoscopy can occasionally transmit disease. Infection control in the
bronchoscopy suite is especially important because of the risk of transmit¬
ting HIV or tuberculosis. Many case reports, patient series, and small
studies have been published, but little comprehensive guidance is available
for clinicians who wish to learn more about the problem and prevent it.
We review the literature and describe three ways in which bronchoscopy
can cause disease: by transmitting infections between patients, by transfer¬
ring microorganisms within a patient, and by triggering coughing that can
cause airborne infection of patients or health care workers. Recommenda¬
tions for infection control are listed; they include installing powerful air
filters, using disposable bronschoscope suction valves, manually cleaning
all equipment before disinfection, controlling patient coughing, and in
some cases, giving patients prophylactic antibiotics.
Radiation Safety For Health Care Workers in the Bronchoscopy
Suite 33
Prasoon Jain, Peter Fleming, and Atul C. Mehta
Increased use of fluoroscopy during flexible bronchoscopy has raised con¬
cerns about radiation safety of health care workers in the bronchoscopy
CLINICS IN CHEST MEDICINE
VOLUME 20 • NUMBER 1 • MARCH 1999 ix
suite. We review the potential health risks associated with occupational
radiation exposure, the monitoring devices available, and discuss the mea¬
sures to reduce radiation exposure during flexible bronchoscopy.
Transbronchial Needle Aspiration: An Underused Diagnostic
Technique 39
Asok Dasgupta and Atul C. Mehta
Transbronchial needle aspiration is a diagnostic procedure with diverse
applications, yet it has failed to gain widespread popularity. This article
describes the methodology, evaluates published results, and addresses
technical issues regarding adequate sampling.
Early Diagnosis of Lung Cancer 53
Stephen Lam and Hiroshi Shibuya
Recent advances in computer assisted image analysis, tumor biology, PCR
based assays, fluorescence bronchoscopy, spiral CT, endobronchial treat¬
ment modalities, and chemoprevention make it possible to re examine the
strategy of early detection in the comprehensive management of lung
cancer.
Role of Bronchoscopy in AIDS 63
Suhail Raoof, Mark J. Rosen, and Faroque A. Khan
Pulmonary involvement in the HIV infected individual is the most im¬
portant cause of morbidity and mortality in the world. Flexible bronchos¬
copy has played an important role in the diagnosis of respiratory disorders
in AIDS. This article outlines the usefulness of bronchoscopy in diagnosis
of common respiratory disorders and compares it with other nonbroncho
scopic techniques. The importance of proper infection control measures
while performing bronchoscopy is emphasized.
Flexible Bronchoscopy in Lung Transplantation 77
E. P. Trulock
Bronchoscopy is an indispensable procedure in lung transplantation. Bron
choscopic inspection is an integral step in the evaluation of potential lung
donors. After transplantation, bronchoscopy is useful in the management
of airway complications, and it is the most reliable approach to the diagno¬
sis of infection and rejection in lung transplant recipients.
Role of Bronchoscopy in Massive Hemoptysis 89
Raed A. Dweik and James K. Stoller
Bronchoscopy plays an important role in the diagnosis and treatment of
massive hemoptysis. In this article, we review the definition, causes, natu¬
ral history, and treatment of massive hemoptysis with special emphasis on
the role of flexible bronchoscopy in the management of this challenging
medical problem. We discuss the various therapies for massive hemoptysis
that are administered through the flexible bronchoscope. Nonbroncho
scopic therapies are also briefly overviewed.
Endobronchial Laser Therapy 107
J. F. Turner, Jr and Ko Pen Wang
The endoscopic application of laser light in the treatment of diseases of
the airway has now been used for more than 25 years. Our discussion
reviews the current use of laser technology as applied in interventional
bronchology outlining the equipment, training and personnel require¬
ments, contraindications, and potential complications of endobronchial
laser therapy with a final discussion regarding this modality s current
indications and potential benefits in pulmonary medicine. The intent of
this article is to provide for the physician a reference outlining the current
scope of laser therapy in the treatment of benign and malignant chest
diseases rather than a manual of operative technique. We hope this over¬
view serves to better delineate those patients for whom endobronchial
laser therapy may be of benefit.
Cryotherapy, Electrocautery, and Brachytherapy 123
Francis D. Sheski and Praveen N. Mathur
This article concentrates on cryotherapy, electrocautery, and brachytherapy
as local treatment options for tracheobronchial lesions, using rigid or
flexible bronchoscopy (FB) as the means to deliver the therapy. For each
therapy a review of its history, theoretical and scientific basis, indications
and patient selection, equipment and technique, results, and complications
are undertaken, followed by a brief summary.
Airway Stents 139
Atul C. Mehta and Asok Dasgupta
Tracheobronchial stents are available for the palliative management of
endoluminal obstruction. This article discusses the history and types of
stents and provides detailed discussion of the insertion and outcomes
with the Wallstent, a type of stent that can be inserted using the flexible
bronchoscope.
Role of Bronchoscopy in Asthma Research 153
Mani S. Kavuru, Raed A. Dweik, and Mary Jane Thomassen
Fiberoptic bronchoscopy and associated techniques of airway sampling
have contributed immensely to our understanding of asthma pathogenesis.
The major advance of investigative bronchoscopy has been the ability to
obtain information that is not readily available by other monitoring meth¬
ods in asthmatics. The current paradigm of asthma, a chronic inflamma¬
tory airway disorder, has been strongly supported and advanced by the
study of mild asthmatics by investigative bronchoscopy. Bronchoalveolar
lavage, airway mucosal brushing, endobronchial biopsy, and measurement
of airway gases have been performed in mild asthmatics to further charac¬
terize the nature of inflammation with experimental challenge procedures
as well as with various anti inflammatory therapies. This article reviews
the following issues: general guidelines from several workshops and the
relative safety of bronchoscopy in asthma research; technical issues related
to specimen retrieval and processing; and data obtained from studies that
have used bronchoscopy for investigation of stable asthma, asthma with
allergen provocation, or asthma treated with anti inflammatory therapy
Role of Bronchoscopy in Lung Cancer Research 191
Robert P. Baughman and Elsira M. Pina
Bronchoscopy has allowed for sampling of lower respiratory samples by
researchers in lung cancer. We discuss the way bronchoscopic samples can
be used to enhance the ability to detect lung cancer using molecular
biologic and immunohistochemical techniques. Soluble tumor markers
measured in lung fluid are also being evaluated. Understanding the nor¬
mal immunologic response to lung cancer, as assessed by bronchoalveolar
lavage, allows the researcher to determine the efficacy of biologic response
modifiers and other treatment modalities. Prognostic indicators deter¬
mined from bronchoscopic derived samples are also being investigated.
Virtual Bronchoscopy 201
Edward F. Haponik, Suzanne Aquino, and David J. Vining
Progress in imaging and computer technology has led to the development
of three dimensional airway simulations that may mimic perspectives
obtained during flexible bronchoscopy. Preliminary experience with such
virtual bronchoscopy suggests intriguing educational research, diagnos¬
tic, and interventional roles. Whether this technologic advance contributes
to better patient outcomes requires further clinical investigation.
Index 219
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