Chest surgery clinics of North America
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Aspiration of tracheobronchial foreign bodies occurs more commonly in children, but under certain circumstances, it also can occur in adults. The most common symptoms are choking followed by a protracted cough. Physical examination findings include fever, stridor, retractions, and decreased breath sounds. ⋯ The procedure is generally safe and well tolerated. Many patients are managed under general anesthesia, but foreign bodies often can be removed with a flexible bronchoscope with the patient under local anesthesia. Surgery should be performed only as a last resort and rarely is necessary.
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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. ⋯ 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.
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Because the lung cancer epidemic shows no signs of abating, little doubt exists that the need for interventional bronchoscopists will persist for many years to come. The Nd:YAG laser and the rigid bronchoscope remain crucial weapons in the fight against lung cancer. With more than 4000 published interventions pertaining to it, this combination is ideal for treating central airways obstruction. ⋯ Although it is unclear what role these technologies will have, prospective controlled studies must be done to help clarify this question. The future may lay in combining these various technologies along with Nd:YAG laser bronchoscopy to maximize the therapeutic, palliative, and possibly even curative effect. As the experience of the medical community with Nd:YAG laser bronchoscopy continues to grow and as more health-care professionals are made aware of its therapeutic capability, fewer patients with cancer will need to suffer and die from the complications of airway obstruction.
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The rigid bronchoscope is a unique and invaluable instrument that allows evaluation, control, and therapeutic manipulation of the proximal tracheobronchial tree. Massive hemoptysis, foreign body removal, airway stenosis, laser resection, and pediatric bronchoscopy are the most common indications for the rigid bronchoscope. Improved anesthetic agents have improved the safety and comfort of the procedure for patients having either diagnostic or therapeutic procedures. The ability to use the rigid bronchoscope in therapeutic situations depends, however, on a level of skill and experience with the instrument that can be obtained only by its frequent use for diagnostic indications in the proximal airway.
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Chest Surg. Clin. N. Am. · Nov 2001
ReviewEndoscopic management of airway complications after lung transplantation.
Airway complications remain a source of significant morbidity after lung transplantation. The current incidence of such complications is 12% to 15%. The associated mortality is 2% to 3%. ⋯ Similarly, the routine use of vascularized soft tissue reinforcement no longer seems justified. Most complications can be managed readily with a combination of endoscopic techniques, including débridement (with or without laser or cryotherapy), dilation, and stent placement. Resective procedures rarely are indicated, and retransplantation should be reserved for exceptional cases.