Journal of bronchology & interventional pulmonology
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J Bronchology Interv Pulmonol · Jul 2013
ReviewMethemoglobinemia in bronchoscopy: a case series and a review of the literature.
Methemoglobinemia results from oxidation of ferrous iron to ferric iron within the hemoglobin molecule. This molecule cannot bind oxygen and increases the affinity of normal hemoglobin for oxygen, which results in decreased oxygen offloading in peripheral tissues. At elevated levels, methemoglobinemia can cause dyspnea, cyanosis, and even death. Common local anesthesia agents have been correlated with methemoglobinemia. Bronchoscopy is a commonly performed clinical procedure which uses topical application of these anesthetics to provide patient comfort. Methylene blue is an agent thought to help reverse the effects of methemoglobinemia by facilitating the methemoglobin reductase system. ⋯ Using topical anesthetic during bronchoscopy appears relatively safe. No fatalities from methemoglobinemia after bronchoscopy have been reported. A high suspicion for methemoglobinemia is required in patients who develop hypoxia or cyanosis postprocedurally. Access to CO-oximetry can confirm the diagnosis but the clinical picture is often sufficient to proceed with methylene blue treatment or observation, based on how severely the patient is affected. Patients who return to baseline can be considered for discharge home.
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J Bronchology Interv Pulmonol · Jul 2013
Case Reports"The black bronchoscopy": a case of airway soot deposition.
The term "black bronchoscopy" is used to describe the black pigmentation of the airways. It is a rare condition with multiple etiologies. ⋯ Early flexible bronchoscopy allowed for a precise diagnosis of severe inhalation injury, and bronchial lavage was carried out to remove soot casts to reduce complications. Any patient suspected of having smoke inhalation injury should undergo early bronchoscopy to allow for a precise diagnosis, staging, and more aggressive treatment measures as the mortality among patients exposed to smoke with inhalation airway injury is high.
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J Bronchology Interv Pulmonol · Jul 2013
Case ReportsNeedle assembly malfunction: an unusual complication related to endobronchial ultrasound-guided transbronchial needle aspiration.
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration has become an invaluable tool for thoracic physicians. Along with medical complications, it is also important to understand the equipment-related malfunctions. ⋯ We report 2 rare cases of Olympus EBUS needle assembly malfunction (model NA-201SX-4021/4022). The first case describes needle breakage and the second case reports the separation of shaft of sheath-sliding mechanism.
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J Bronchology Interv Pulmonol · Jul 2013
Pleural pressure swing and lung expansion after malignant pleural effusion drainage: the benefits of high-temporal resolution pleural manometry.
Malignant pleural effusion is a common complication in end-stage cancer patients and can cause severe dyspnea. Therapeutic thoracentesis is often limited to 1 to 1.5 L. Pleural manometry can be used to recognize a not-expanded lung. ⋯ We demonstrated that a high pleural pressure swing after removal of only 200 mL was related to incomplete lung expansion. We confirmed the association between pleural elastance and lung expansion.
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J Bronchology Interv Pulmonol · Jul 2013
The safety of medical thoracoscopy in a group at high risk for complications.
The use of medical thoracoscopy (MT) for the diagnosis and/or palliative treatment of pleural effusions is expected to become more widespread in the coming years. The aims of the present study were to establish the safety of MT in a group of patients at high risk for complications and to determine the factors that affect the development of complications. ⋯ MT is a safe method for the diagnosis of patients with pleural effusion, even in patients at high risk for complications. However, complications, found in approximately half of the patients, should also be examined in terms of cost.