Therapeutic bronchoscopy

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					Electronic Poster Discussion                                                                                                 Room B7 - 10:45-12:45

                                                   Tuesday, September 18th 2007

                                                                                 331. Therapeutic bronchoscopy

                                                                     Evaluation of the effect of endrobronchial route administration of
                                                                     tranexamic acid in airway bleeding
                                                                     E. Marquez-Martin1 , J. Martin-Juan1 , D. Gonzalez-Vergara1 , F. Rodriguez-
                                                                     Panadero1 . 1 Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio
                                                                     University Hospital, Seville, Spain

                                                                     Background: Tranexamic acid (TxA) is an antifibrinolitic drug of intravenous
                                                                     administration used to control the airway bleeding, but its use in the endobronchial
                                                                     route has not been described.
                                                                     Objective: To describe our experience in the use of TxA by the endobronchial
                                                                     route to control the airway bleeding
                                                                     Methods: We analyse the patients with bleeding in the bronchoscopy room during
                                                                     two years. We divide the patients in two groups: Group 1: haemoptysis in the last
                                                                     24 hours; Group 2: iatrogenic bleeding.
                                                                     Results: 70 patients were analysed (57 male, 13 female) with a mean age of 63
                                                                     years (22−88). Group 1 (n = 36) most usual illness was the neoplasic disease (10)
                                                                     and the bronchiectasis (8). In 21 cases we controlled the bleeding only TxA, but
                                                                     in 5 of those we had to use a Fogarty balloon (Fg). In 6 cases we controlled
                                                                     the bleeding only with cold serum (CS). In another 9 occasion we had to add
                                                                     adrenalin (AD) but it wasn’t effective. In 3 of them the bleeding was controlled
                                                                     with TxA and in the other 6 we had to use Fg. Group 2 (n= 34): most common
                                                                     procedure was the biopsy. We used TxA alone successfully in 17 patients (50%).
                                                                     In 9 patients we controlled the bleeding with CS but in another 8 we had to add
                                                                     AD and in 4 of those we need TxA to stop haemorrhage.
                                                                     Conclusions: In our serie of cases TxA has shown to be useful by the endo-
                                                                     bronchial route in the treatment of the acute airway bleeding so it should be
                                                                     studied to be included in futures guidelines.

                                                                     Cisplatin injected into and around endobronchial tumors through a flexible
                                                                     bronchoscope for preoperative loco-regional chemotherapy
                                                                     F. Celikoglu1 , S.I. Celikoglu1 . 1 Institute of Respiratory Diseases and Tuberculosis,
                                                                     Istanbul University, Istanbul, Turkey

                                                                     The objective of this study is to evaluate the potential favorable effect on survival
                                                                     rate of the preoperative direct injection of anticancer drugs into and around tumor
                                                                     through bronchoscope (endobronchial intratumoral chemotherapy) in patients with
                                                                     early lung cancer.
                                                                     Several recent clinical studies on the detection and mapping of sentinel lymph
                                                                     nodes in the patients with lung cancer established firmly that the delivery of a
                                                                     tracer substance intra-operatively or endoscopicaly by direct injection around the
                                                                     tumor area are transported to the sentinel and regional lymph nodes through the
                                                                     lymphatic drainage. So, we can anticipate the transport of a cytotoxic drug to
                                                                     lymph nodes through lymphatic channels would occur as the same manner when
                                                                     it is injected directly into and around the tumor.
                                                                     Methods and Results: The intra-tumoral delivery is realized by injection of
                                                                     cisplatin into the malignant growth in the airways, as well as in the peribronchial
                                                                     area around the tumor via a needle-catheter through a flexible bronchoscope.
                                                                     Selected ten NSCLC patients with stage I and II disease with endobronchial
                                                                     tumor involvement were treated by 3 “endobronchial intratumoral chemotherapy
                                                                     (EITC)” one week apart, then resection was performed. No metastatic lymph node
                                                                     has been found in the resected specimen. 3 years survival was 85%. Follow up
                                                                     patiens continues. To assess the significance of the results of this clinical trial,
                                                                     further randomized comparative studies were required.

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Electronic Poster Discussion                                                                                                                   Room B7 - 10:45-12:45

                                                                  Tuesday, September 18th 2007

E3226                                                                                 on blood pressure (BP), heart rate and oxygen saturation were seen between terli-
Endovascular treatment of massive hemoptysis by bronchial artery                      pressin and CNSS. No serious complications were experienced both in terlipressin
embolization. Long-term follow-up over a 5-year period                                and in CNSS group. Time to haemostasis did not differ between terlipressin
E. Serasli1 , V Kalpakidis2 , V. Tsara1 , K. Iatrou2 , D. Siopi1 , A. Fotiadou2 ,
               .                                                                      and CNSS (1.3±1.29 min vs.1.3±1.65 min). However, local vasoconstriction and
D. Antoniou1 , P. Christaki1 . 1 2nd Chest Clinic, G. Papanikolaou General            mucosal pallor occurred significantly more rapidly in terlipressin group (1.1±0.88
Hospital, Thessaloniki, Greece; 2 Interventional Radiology Dept, G. Papanikolaou      min vs.2.1±1.83, p < 0.05 min).
General Hospital, Thessaloniki, Greece                                                Conclusion: Terlipressin is safe and effective for therapy of endobronchial
                                                                                      bleeding. No systemic effects were observed after intrabronchial administration.
Background: Bronchial artery embolization (BAE) is a well-established, non-
surgical procedure in the emergency treatment of massive hemoptysis.
Aim: This study aims to evaluate the long-term prognosis of BAE for the                                          before/after Terlipressin     Cold normal saline solution
management of massive hemoptysis in our center.                                                                  application
Patients and Methods: Twenty concecutive patients (mean age:59±14 yrs) with
massive hemoptysis, underwent BAE with microspheres (Embospheres), polyvinyl          Systolic BP (mmHg)         before        158±26          153±18
alcohol particles (PVA) or/and steel coils (GD Coils) after thoracic aortography
and diagnostic selective and superselective catheterization of bronchial arteries                                after         145±18          144±26
and systemic collateral vessels in the bleeding lung area. Hemoptysis was due         Diastolic BP (mmHg)        before        99±12           97±14
to bronchiectasis (55%), non-operable aspergillomas (15%), active tuberculosis                                   after         90±12           88±11
(15%), malignancy (10%) and cystic fibrosis (5%). Mean duration of follow-up           Heart rate (min-1)         before        109±20          105±18
was 29±18 months. The recurrent-free time was calculated with Kaplan-Meier                                       after         102±20          98±17
Results: Immediate control of bleeding was achieved in all patients. Recurrent
cases of hemoptysis were observed in 6/20 patients (30%) within 3 years and
4 of them (66.6%) occurred early in the first 3 months. Reccurent-free time
was 9 months (SE:4)(95% CI: 0−17). Repeated interventions were required in            E3229
all early recurrences, due to either recannalization of the occluded arteries or      A retrospective review of tracheobronchial foreign bodies for 10 years in
non-bronchial systemic artery supply. Combined use of microspheres and coils          South Korea
was proved effective in these cases. No serious compications were observed.           K.-S. Kim1 , C.-Y. Son1 , J.-H. Lim1 , G.-J. Cho1 , I.-J. Oh1 , Y.-i. Kim1 , S.-C. Lim1 ,
Conclusions: BAE is an effective and safe intervention in cases of massive hemop-     Y.-C. Kim1 , S.-H. Yang2 , E.-T. Jeong2 , H.-S. Park3 , S.-Y. Kim3 , K.-O. Park4 .
tysis. However, recurrences are common and long-term follow-up is considered            Internal Medicine, Chonnam National University Hopital, Gwangju, Korea,
important with a view to perform repeated interventions with combination of           Republic of; 2 Internal Medicine, Wonkwang University Medical School, Iksan,
embolic materials.                                                                    Korea, Republic of; 3 Internal Medicine, Chungnam National University Medical
                                                                                      School, Daejeon, Korea, Republic of; 4 Internal Medicine, Ilgok Hospital,
E3227                                                                                 Gwangjju, Korea, Republic of
Intrabronchial airway pressures in intubated patients during bronchoscopy
under pressure- and volume-controlled ventilation                                     Background: The aim of this study is to assess the clinical characteristics of
E.R. Nakstad1 , H. Opdahl2 , F. Borchsenius1 , O.H. Skjoensberg1 . 1 Department       tracheobronchial foreign body aspiration and to evaluate the efficacy of treatment
of Pulmonary Medicine, Ullevaal University Hospital, Oslo, Norway; 2 Intensive        modality in children and adults.
Care Unit, Ullevaal University Hospital, Oslo, Norway                                 Methods: This is a retrospective review of 64 patients who underwent broncho-
                                                                                      scopic procedures for the treatment of aspirated foreign bodies from December
Background: During bronchoscopy of intubated patients the tube is partially           1994 through March 2004 at Chonnam National University Hospital.
obstructed by the endoscope, causing increased air-flow resistance. This may result    Results: There were 47 male patients and 17 female patients, aged from 1
in increased intrabronchial pressures not reflected by ventilator recordings as well   month to 78 years. Most patients had no underlying illness except one patient
as reduced tidal volumes (Tv).                                                        with cerebrovascular accident contributing to foreign body aspiration. The most
Methods: 16 patients underwent bronchoscopy during sequences of volume (VC)           common symptom was cough, as seen in 54 patients (84.3%). Other presenting
–and pressure controlled (PC) ventilation through 8mm (n = 15) and 8.5mm (n = 1)      symptoms were dyspnea (48.8%), fever (20.3%), sputum (14%), vomiting (7.8%),
endothracheal tubes, using a 5.1mm endoscope. The ventilator was set to random        and chest pain (4.6%). Foreign bodies were visualized in plain chest radiographs
2 minute PC-VC-PC or VC-PC-VC sequences. In PC mode, the ventilator peak              in 12 cases (18.8%), while others showed air trapping(21, 32.8%), pneumonia(15,
pressures and PEEP used before bronchoscopy were maintained. In VC mode               23.4%), atelectasis(7, 10.9%), and normal findings(9, 14.1%). Foreign bodies
the previous tidal volumes were the constant factor. An intrabronchial transducer     were more frequently found in the right bronchial tree(36) compared to the left
recorded airway pressures.                                                            bronchial tree(22, p = 0.04). To remove the foreign bodies, twenty(31.2%) cases
Results (median values and ranges): Under bronchoscopy in PC mode Tv was              were removed with flexible bronchoscopy, while 42(65.6%) and 2(3.2%) needed
reduced from 673ml (585–800) to 447ml (260–600), the inspiratory intrabronchial       rigid bronchoscopy and surgery, respectively.
pressure was 27.5cm H2 O (16−45) and the end-expiratory intrabronchial pressure       Conclusions: Tracheobronchial Foreign body aspiration occurred in bimodal age
increased from 10cm (7−10) to 13cm H2 O (8−26). The rise in arterial pCO2             distribution in the infancy and old age around 60 years. They are found more
was +0.97kPa. Under VC mode the Tv was 657.5ml (500–880), inspiratory                 frequently in the right bronchial tree and patients whose foreign bodies were
intrabronchial pressure increased from 30cm (23−43) to 37.5cm H2 O (24−50),           diagnosed later than 2 days after aspiration were more likely to complicate
the end-expiratory pressure from 13cm (6−15) to 16.5cm H2 O (10−28), while            infection.
median rise in arterial pCO2 was +0.155 kPa.
Conclusions: During bronchoscopy with PC ventilation a considerable decrease          E3230
in Tv was observed, whereas end-expiratory intrabronchial pressures and PaCO2         Therapeutic bronchoscopy experience in Turkey
were only moderately elevated. In VC mode the Tv was unaltered, but inspiratory       Y. Karakoca1 , G. Karaagac1 , C. Aydemir2 . 1 Pulmonology, Medicana Hospitals
and end-expiratory intrabronchial pressures reached considerably higher values,       Camlica, Umraniye, Istanbul, Turkey; 2 General Thoracic Surgery, Medicana
increasing the risk of barotraumas.                                                   Hospitals Camlica, Umraniye, Istanbul, Turkey

E3228                                                                                 Our study consists of the results of a 7-year long research of interventional
Effects of intrabronchial terlipressin versus cold normal saline solution             bronchoscopy in treatment of tracheobronchial stenosis. In total 629 sessions
application in endobronchial bleeding                                                 between February 2000 and 2007, 579 patients (194 females, 385 males, mean
J. Zatloukal1 , V Kolek1 , A. Vaclavik1 . 1 Department of Respiratory Medicine,
                 .                                                                    age 51.4 years; range 3−89 years) tracheobronchial obstruction were treated at our
University Hospital, Olomouc, Czech Republic                                          centers by using Nd-YAP laser (n= 515), Cryotherapy (n= 414), bronchoscopic
                                                                                      balloon dilatation (n= 373), by inserting silicone stents (n= 398), Freitag Dynamic
Background: Endobronchial bleeding is one of the most serious complications in        Stent (n = 5), Ultraflex Covered Nitinol Metal Stent (n= 3), Polyflex Stent (n = 2)
bronchology. Intrabronchial instillation of vasopressin derivatives can be used in    and by resection via resection balloon (n= 57). Dumon Harrel Universal rigid
the treatment of this event.                                                          bronchoscope was used under general anesthesia. All patients had taken total in-
Objectives: To study local and systemic effects, safety and side effects of           travenous propofol as anesthetic agent. The diagnoses were benign (n = 19, 3.2%),
intrabronchially applied terlipressin in comparison with the cold normal saline       non-small cell lung cancer (n = 517, 96%), small cell lung cancer (n = 11, 1.8%),
solution (CNSS).                                                                      metastatic lung cancer (n = 29, 5%) and other neoplasms (n = 3; 0.5%). Dyspnea
Methods: A double blind randomised prospective study was realised with 40             score and mean oxygen saturation level of patients after the therapeutic broncho-
patients (20−70 yrs). Patients had no history of hypertension and coagulopathy,       scopic procedures showed immediate improvement. Intraoperative complications
no anticoagulative therapy. They underwent endobronchial biopsy with continuing       occurred in 119 patients (hemorrhage n = 51, arrhythmia n = 23, perforation n=
bleeding. Terlipressin 0.5 mg (20 patients) or CNSS 5 ml (20 patients) was applied    1, cardiac arrest n = 3). Postoperative complications occurred in patients (cardiac
intrabronchially.                                                                     complications n = 6, sepsis n = 33, Acute Lung Injury – Acute Respiratory Distress
Results: No significant increase of systemic blood pressure or heart rate after        Syndrome n = 4, respiratory failure n = 4, pulmonary embolism n = 7, hemoptysis
administration of terlipressin was observed. No significant differences of influence    n = 1, granuloma formation n= 16, stent migration n= 6, mucoid impaction n=

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Electronic Poster Discussion                                                                                                                     Room B7 - 10:45-12:45

                                                                      Tuesday, September 18th 2007

42, vocal cord edema n = 1 and vocal cord ssnechia n = 1). As a result we can             55 patients, preceded obligatory sanitation of affected bronchopulmonary parts, in
state that laser resection and silicon stent insertion as endoscopic management           11 patients was progressing destructive process in parenchyma, distal entered in a
procedures are effective, safe and repeatable for palliation of malignant stenosis.       bronchus of obturator. In the last years in 16 patients with pyopneumothorax and
                                                                                          in 9 with giant pulmonary abscesses for temporal occlusion of bronchus was used
E3231                                                                                     obturator, designs of authors, with built in him sanitative character (Russian patent
The endoscope sanitation of tracheobronchial tree in patients with                        #2092108). It has provided in conditions executed occlusion, an opportunity of
abscessing pneumonias                                                                     sanitation of damaged bronchopulmonary zones in a combination with gradual
T. Pertseva1 , I. Ivakh1 . 1 Internal Medicine, DSMA, Dniepropetrovs’k, Ukraine           lung spread. 4 patients has died. Positive results of treatment (recovery) are
                                                                                          received in 75 from 79 treated by this method of patients.
Aim: to define influence of sanitation on the terms of treatment in patients (pts)
with the abscessing pneumonias (AP).                                                      E3233
Study population and Methods: we investigated 47 pts (28 male, mean age                   Diagnostics and treatment of tracheobronchial foreign bodies
33.2±2.4 yrs) with AP. We evaluated clinical and laboratory data: the medical             Y. Sukhomlin1 , D. Stupachenko1 , A. Visotskiy2 , N. Monogarova3 . 1 Thoracic
history, chest X-ray (in 2 positions). Sputum for microbiological investigation and       Surgery, Donetsk Regional Clinical Hospital, Donetsk, Ukraine; 2 Chair of
antimicrobial drugs susceptibility were tested. All pts were obtained the mucolytic       Faculty Surgery, Donetsk State Medical University, Donetsk, Ukraine; 3 Chair of
and antibacterial therapy with taking into account of sensitivity of microflora.           Internal Diseases, Donetsk State Medical University, Donetsk, Ukraine
All pts were divided on three groups similar to age, sex and severity of disease.
The pts in 1 gr. obtained only the basic therapy. In pts of 2d gr. – in addition to       Background: tracheobronchial foreign bodies (FB) is a widespread phenomenon
the basic therapy we used sanitations of the bronchial tree with injections of a 4%       not having a tendency to the decline and is the real threat for the life of patient.
sodium hydrogen carbonate. In pts of 3d gr. – in addition to the basic therapy we         Objective: To improve the results of diagnostics and treatment of patients with
used sanitations of the bronchial tree with injections of a daily doze of antibiotic      this pathology.
in the draining bronchial tube by means of the device of the “Olympus” company            Material and methods: From 1997 to 2006 year 103 cases of respiratory
BF type TE.                                                                               tract FB were diagnosed. There were 59 men (57.3%) and 44 women (42.7%)
Sanitations were carried out every other day under local anesthesia of 2%                 in age from 17 to 78 years. The terms of being of FB varied from 1 day to
lidocaine. X-ray control was performed on 21 day after the beginning of therapy.          17 years. In 23 patients FB were removed by outpatient fiberoptic bronchoscopy
Results: Estimation efficiency of therapy is summarized in table 1.                        (FBS), 46 patients required hospitalization. In 34 patients FB were found after
Conclusion: The use endobronchial sanitations with the injection of the antibiotics       hospitalization with presumptive diagnosis of pneumonia, empyema of pleura,
in the draining bronchial tube in addition to the basic therapy and endobronchial         lung cancer, hemoptysis.
sanitations 4% sodium hydrogen carbonate, reduces the terms of the hospital stay          Results: During admission 69 patients informed about the aspiration of FB.
and duration the antibiotic therapy in pts with AP.                                       Main complaints were: cough (N = 63), shortness of breath (N = 24), hemoptysis
                                                                                          (N = 16). 22 patients did not have any complaints. Chest X-ray was made in all
                                                                                          cases. Radiopaque FB were found in 12 cases. In 41 patients indirect signs of FB
Table 1
                                                                                          presence were detected. In 50 cases X-ray showed no pathology. FBS is the basic
Group     Terms of the hospital stay    Duration of the systemic antibiotic therapy       method of diagnostics, which allowed to diagnose FB in 100 (97.1%) cases and to
          (day)                         (day)                                             suspect its presence in 3 (2.9%). Bronchosocpy is the main method of treatment
                                                                                          of FB, it allowed to extract FB at all patients. In 46 cases it was made by FBS.
                                                                                          Large, wedged and fixed by granulations FB were diagnosed in 57 patients and
1         50±2.1                        28.2±2.8
                                                                                          removed by rigid bronchoscopy.
2         38±3.2                        20.1±3.1                                          Conclusions: Clinical manifestations and chest X-ray findings are not basis in
3         21±1.2                        14.2±2.4                                          diagnostics of tracheobronchial FB. FBS have a high diagnostic value. In all
                                                                                          cases extraction of FB was possible without surgical intervention.

E3232                                                                                     Nd:YAG laser resection in the palliative treatment of centrally located lung
Medical obturation fistulus of the bronch by acute purulent destruction of                 cancer
lungs                                                                                     V Canak1 , B. Zaric1 , A. Milovancev2 , S. Jovanovic1 , E. Budisin1 , V Nisevic1 .
                                                                                            .                                                                    .
Y. Kolkin1 , V Vecherko1 , E. Pershin1 , V. Kolkina1 . 1 Department of Surgery
              .                                                                             Clinic for Pulmonary Oncology, Institute for Pulmonary Diseases of Vojvodina,
Faculty, Donetsk State Medical University, Donetsj, Ukraine                               Medical Faculty, University of Novi Sad, Sremska Kamenica, Serbia; 2 Clinic
                                                                                          for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Medical
                                                                                          Faculty, University of Novi Sad, Sremska Kamenica, Serbia
The present research is based on experience of supervision 509 patients with
various forms of acute purulent destruction of lungs, taking place of treatment
in clinic for the period 1991 – 2006 years. In connection with formation of               Introduction: The aim of the study was to determine the effect of Nd:YAG
pulmopleural fistulas, 79 patients, in the age of from 15 to 68 years, were exposed        laser resection of centrally located tumors on various symptoms, signs, time to
temporal occlusion of lobar or segmentary bronchus. In 49 patients process was            progression and survival in lung cancer patients. The question is how effective can
located in right lung, in 27 in left. In 3 cases disease had bilateral character. In 24   laser resection be in symptom control, time to progression and can it influence
patients was damaged the upper lobus. In 43 – lower and in 12 cases is marked             survival of lung cancer patients?
polysegmentary destruction of lungs. Occlusion “Solid” obturator, executed to the         Patients and Methods: We evaluated effects of Nd:YAG laser resection on
                                                                                          cough,dyspnoea,thoracic pain,haemoptisys,body weight loss, atelectasis, postob-
                                                                                          structive pneumonia, pulmonary function tests, bronchoscopic findings, perfor-
                                                                                          mance status, time to progression and survival rate in lung cancer patients. 178
                                                                                          patients were divided into two groups. Patients in group I (81) were treated with
                                                                                          combination of brachytherapy and EBRT, patients in group II (97) were treated
                                                                                          with Nd:YAG laser in combination with brachytherapy and EBRT. Symptoms
                                                                                          and signs of lung cancer have been evaluated before and after the treatment, and
                                                                                          on regular control every three moths until the end of life. All patients received
                                                                                          standard institutional chemoradiotherapy regiment during the course of disease.
                                                                                          Results: After the treatment in both groups we observed significant improvement
                                                                                          in all investigated parameters. Improvement in dyspnoea, thoracic pain, body
                                                                                          weight loss and ECOG status is significantly better in group II. Time to progression
                                                                                          and survival, using Kaplan-Meier cumulative proportion, Cox-Mantel and Peto and
                                                                                          Peto Wilcoxon test are significantly better in group II.
                                                                                          Conclusion: Laser resection improves symptom control in lung cancer patients
                                                                                          with central airway obstruction. Longer time to progression and survival of lung
                                                                                          cancer patients is the result of imminent airway desobstruction.

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Electronic Poster Discussion                                                                                                                  Room B7 - 10:45-12:45

                                                                   Tuesday, September 18th 2007

E3235                                                                                  estrogen and progesterone therapy. Recurrent hemoptysis stopped following the
Pulmonary textiloma extracted by fiberoptic bronchoscopy 30 years after                 medical treatment. To our knowledge this is one of the few cases of endobronchial
thoracotomy                                                                            endometriosis, in which the diagnosis was confirmed by histopathological exam-
P. Grigore, M. Alexe, E. Crisan, R. Ulmeanu, E. Tabacu, R. Posea, B. Coman.            ination of bronchial brushing specimens and GnRH analogues provided a good
Bronchology Department, “Marius Nasta” Institute of Pneumology, Bucharest,             control of the disease.
Romania; Bronchology Department, “Marius Nasta” Institute of Pneumology,
Bucharest, Romania; Bronchology Department, “Marius Nasta” Institute of                E3238
Pneumology, Bucharest, Romania; Bronchology Department, “Marius Nasta”                 Needle in the division of left main bronchus induces granuloma in 48h.
Institute of Pneumology, Bucharest, Romania; Pneumology Department, “Marius            Bronchoscopic removal of dangerous foreign body from airway (needle)
Nasta” Institute of Pneumology, Bucharest, Romania; Thoracic Surgery, “Marius          through tracheostomy
Nasta” Institute of Pneumology, Bucharest, Romania; Thoracic Surgery, “Marius          M. del R. Rodr´guez Moreno1 , A. Romero Ortiz2 , L. Cabrera Torres2 ,
Nasta” Institute of Pneumology, Bucharest, Romania                                     I. Rodr´guez Moreno, N. Quilez Ruiz-rico2 , M.V Roz´ a Garc´a2 . 1 Department
                                                                                               ı                                       .     u       ı
                                                                                       of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain;
Introduction: Pulmonary textiloma is very rare and its diagnosis is difficult, even       Service of Pulmonology, Virgen de las Nieves University Hospital, Granada,
when using computerized tomography (CT) scan. The diagnosis is usually made            Spain
by hystological examination after surgical resection.
                                                                                       Introduction: Tracheobronchial foreign body aspirations are infrequently seen in
Objectives: To highlight the potential diagnosis pitfalls and consequences of a
pulmonary textiloma.
                                                                                       Design: History: A 61-year-old-man with Tracheostomy, Laryngectomy in 1991,
Case report: We report the case of a 58 years-old man with a history of left lower
                                                                                       Epidermoid Carcinoma of the Tonsil. Ex-Smoker of 78 pack-years. 48h before,
lobe resection for bronchiectasis 30 years before, who was admitted to hospital
                                                                                       after manipulation and cleaning of tracheostomy using a syringe with needle, an
for hemoptisis.
                                                                                       accident it’s occurs and the needle is lodged in bronchial system. Initial attempt
We present the clinical, radiological and endoscopic findings in this case. CT scan
                                                                                       of extraction in local hospital is failed and the patient is derived to reference
showed, beside bronchiectasis of the upper left lobe, a pulmonary lesion suggesting
                                                                                       hospital. Examination no revealed changes of respiratory murmur, no fever.
a tumour. By repeated fiberopic bronchoscopies, we discovered and extracted an
                                                                                       Methods: Chest X-Rays, Laboratory data, Bronchoscopy and Biopsy were ob-
unusual foreign body – textiloma, which was obstructing a subsegmental bronchus
of the apical dorsal branch of the upper left lobe.
After the extraction, we recorded a rapid clinical and radiological improvement.
                                                                                       – Chest X-Rays: Presence of needle in left upper mediastinum (see picture).
Conclusions: Even rare, textiloma should be considered when an atypical pul-
                                                                                       – Laboratory data: Leukocytes: Normal, Haemoglobin: 13. Coagulation: Normal.
monary mass is found in a patient with past history of thoracotomy. To the best of
                                                                                       – Flexible bronchoscopy: which revealed the presence of a needle in the carina of
our knowledge, this is the first case of a pulmonary textiloma treated conservative
                                                                                          the left main bronchus. After to catch the needle with biopsy claw and back out
by fiberoptic bronchoscopy extraction.
                                                                                          airways, we observe a granuloma in the site of leant of the needle (see video
E3236                                                                                     pictures). A biopsy specimen of the mass was obtained. Biopsy: Granuloma of
Romanian experience in tracheo-bronchial stenting                                         foreign body.
E. Crisan, R. Ulmeanu, G. Cadar, R. Stoica, N. Galie, I. Cordos, C. Saon,              Conclusions:
D. Gologanu. Bronchology, “Marius Nasta” National Institute of Pneumology,             1. We describe by first time the presence of Granuloma of foreign body only 48
Bucharest, Romania                                                                         hours after aspiration of a needle in a patient with previous Laryngectomy,
                                                                                           Tracheostomy and Epidermoid Carcinoma of the Tonsil.
                                                                                       2. It is necessary emphasising the importance of early diagnosis and Broncho-
With a delay compared to other countries, the technique of tracheo-bronchial
                                                                                           scopic removal of foreign bodies in this potential extremely dangerous situation,
stenting was introduced in Romania in May 2003. Up to now, 73 patients
                                                                                           but completely reversible condition.
performed endotracheal prosthesis placement in our Bronchology Departement,
                                                                                       3. When the foreign body is so sharp that it can injure the airway, the use of
the only center offering this procedure in Romania. Among the stents we used,
                                                                                           tracheostomy is indicated.
55 were polymeric (13 Dumon, 34 Poliflex, 8 Mongomery), 12 metallic and 6
bifurcated stents (Freitag). These patients had a great range of age (18 – 78), 60%    E3239
were males and 25 % had former tracheostomy. We used the rigid bronchoscope            The effect of interventional bronchoscopy on cardiopulmonary functions in
and general anesthesia with jet-ventilation. In the majority of cases (46) the         complete endobronchial obstruction
indication was palliative, for malignant tracheal stenosis; among these 7 had          E. Ibrahim1 , A. Fouad1 , A. Shaaban2 , T. Morsi1 , A. Ali1 . 1 Chest Department,
former pneumectomy and 4 had eso-tracheal fistula. The other indication was             Alexandria Faculty of Medicine, Alexandria, Egypt; 2 Pathology Department,
iatrogenic tracheal stenosis after prolonged intubation (27). The localization of      Alexandria Faculty of Medicine, Alexandria, Egypt
the stenosis was correlated with its etiology: in the upper third malign in 18%, in
the medium third in 60% and in the lower third in 83% of the cases.                    Objective: To evaluate the cardio-pulmonary effects of interventional bron-
The benefits of tracheal stenting were immediate, with rapid improvement of             choscopy applied to patients with bronchial obstruction.
quality of life. We had no major incident in performing the technique. The             Patients and Method: Twenty-Four patients with different endobronchial
complications occurred during the follow up were: accumulation of bronchial            lesions were included. The following were estimated before, one day after and
secretions and formation of granulomatous tissue ; these complications imposed         one week after the interventional bronchoscopy (electrocautery and cryocauterty):
bronchoscopic treatment of aspirations and excision.                                   Pulmonary function tests, arterial blood gasometry, and echocardiography with
The conclusions of the study are that: (1) our performances improved, as we            Doppler study and six-minutes walking distance test.
managed situations with Freitag stents and patients with former pneumectomy;(2)        Results: Mean age of the twenty-Four patients was 55.96±13.59 years. The
the majority of cases had malignant stenosis; (3) the localisation of the stenosis     pulmonary functions improved both one day and one week after the interventional
correlated with its etiology; (4) no major incidents occurred; (5) for proper choice   bronchoscopy, but this improvement was only statistically significant one week
of the stent type we will need a prostheses bank.                                      after the intervention in FEV1, FEV1/FVC and PEFR. The FEV1 improved in
                                                                                       7 cases (29%) one day after the intervention and in 11cases (46%) one week
E3237                                                                                  after. Arterial oxygen tension improved significantly only one week after the
Catamenial hemoptysis; a rare cause of hemoptysis                                      intervention. Before the intervention, the mean left ventricular ejection fraction
S. Borekci1 , O. Elbek1 , E. Dikensoy2 , Y. Kibar3 , K. Bakir3 , O. Dikensoy1 .        (EF%) was 61.17% ± 10.54 that was considered normal and it did not significantly
  Pulmonary Diseases, University of Gaziantep, School of Medicine, Gaziantep,          change neither one day after the intervention nor one week after. The six-minutes
Turkey; 2 Gynecology&Obstetrics, University of Gaziantep, School of Medicine,          walking distance was 215±52.52 m before and it reached 250.21±55.02 m one
Gaziantep, Turkey; 3 Pathology, University of Gaziantep, School of Medicine,           day after the intervention and 282.92±66.31 m one week after. It improved in
Gaziantep, Turkey                                                                      8 cases (33%) one day after the intervention and in 17 cases (70.8%) one week
Catamenial hemoptysis is a rare condition that is associated with the presence of      Conclusion: Pulmonary functions improvement was more marked one week
intrapulmonary or endobronchial endometrial tissue. Diagnosis and therapy for          than one day after the intervention. The echocardiographic parameters did not
this condition are still matters of debate. We describe a case of endobronchial        significantly change. It is estimated that more time is needed for significant
endometriosis with catamenial hemoptysis. The patient was a 22 yrs-old girl pre-       improvement in cardiac functions.
sented with recurrent hemoptysis episodes for the last two years. High resolution
computed tomography scan revealed rare micronoduler infiltrations of pulmonary          E3240
parenchyma bilaterally. Bronchoscopic examination was performed within first            Diode laser therapy combined with inhaled corticosteroids (ICS) in therapy
days of menses, and indicated multiple purplish-red submucosal patches in distal       of obstructing processes of large airways
one third of trachea and bilateral bronchial trees that bled easily when touched.      Z. Tudjman1 , V Ostojic1 , M. Artukovic1 , M. Radulovic-Pevec1 , B. Pevec1 ,
The cytological evaluation of the bronchial brushing specimens demonstrated            A. Stipic Markovic1 . 1 Dpt for Internal Diseases, General Hospital “Sveti Duh”,
clusters of small cuboidal cells consistent with an endometrial origin. Follow-        Zagreb, Croatia
up bronchoscopic examination at the end of the menstrual cycle revealed that
the previous tracheobronchial lesions disappeared. The patient was treated with        Laser therapy is non-surgical method for reconstruction of large airways lumen
Gonadotropin-Releasing Hormone (GnRH) analogues and hormones including                 in patients with benign and malignant obstructing processes of large airways in

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Electronic Poster Discussion                                                                                                                  Room B7 - 10:45-12:45

                                                                    Tuesday, September 18th 2007

order to restore ventilation and relieve additional symptoms, improving quality         a regidbronchoscopies in the patients with different pathology of the lungs.
of life (QOL) and prolonged survival (PS). Laser therapy produces strong local          Tuberculosis of the bronchos was found in 1540 patients (6.7 %). The tactic was
thermal effect which leads to several side-effects.                                     worked out on bronchial treatment with use of the different outlines. It was taking
Our aim was to estimate effect of ICS on reduction of side-effects in patients          into account: – the form of the TB; – the trend of the process; – the presence of
treated with laser.                                                                     the microbacteria of the tuberculosis (MBT); – level of the resistance. Outcome of
Diode laser was performed in 206 patients, predominantly with inoperable                the illness was evaluated on the following criterias: – full resolution; – formation
malignant processes but also in patients with benign tumors, granulations and           by walls or concentric shape type of scars with different level of stenosis. The
scars. Group of 92 patients received diode laser recanalization only, while 114         use of bronchial methods allow significantly expand and improve treatment of
patients received laser therapy and ICS premedication before, during and after          tuberculosis of the bronchos and lungs.
laser treatment.
Laser beam was delivered via quartz fiber inserted through the fiberbronchoscope,
mostly in local anesthesia (15−25W power, 1−2s pulses). Therapeutic effect
was compared clinically, by immediate and follow up bronchoscopy, respiratory
function tests, chest x-ray and CT.
Our results showed almost equal efficacy of laser recanalization in both groups.
Successful recanalization was achieved in about 85% patients (after 3−4 laser
sessions per patient). Complications occured in 5% of laser seanses, predominantly
due to bronchoopstruction, and rarely due to bleeding and appearing of necrotic
masses. Patients receiving combined laser and ICS therapy had 50% lower
incidence of dyspnoea, cough, benign recidives and less post-laser necrosis.
In this prospective study QOL and PS were also improved. We can conclude that
addition of ICS may be useful in reduction of laser therapy complications.

Easy endobronchial resection
Y. Karakoca1 , G. Karaagac1 , C. Aydemir2 . 1 Pulmonology, Medicana Hospitals
Camlica, Umraniye, Istanbul, Turkey; 2 General Thoracic Surgery, Medicana
Hospitals Camlica, Umraniye, Istanbul, Turkey

Various endobronchial resection methods (Nd-YAG/Nd-YAP laser, Argon plasma
coagulation, cryotherapy, etc.) could be performed for endoluminal tumors and le-
sions. Balloon dilatation and tamponade are widely used with other endobronchial
methods for control of bleeding or dilatation. We developed a new resection
technique and designed a special balloon for resecting endoluminal tumoral
lesions. This device is a balloon catheter covered with a special web-shaped
material available in various sizes. We used resector balloon in 38 interventions
for resecting endobronchial tumors and also control of bleeding and dilatations
were successfully achieved during the procedures. Endobronchial tumor resection
becomes a simpler and safer method with the use of this special balloon.

Is endobronchial treatment in general anesthesia with jet ventilation safe
J. Skrickova1 , P. Stourac2 , A. Hrazdirova1 , P. Turcani1 . 1 Department of
Respiratory Diseases and TB, Masaryk University Hospital, Brno, Czech
Republic; 2 Department of Anesthesiology and Intensive Care Medicine, Masaryk
University Hospital, Brno, Czech Republic

Aim: We evaluate the complications developing during or after the endobronchial
electrosurgary and laser brocnhsocopy in general anesthesia with jet ventilation
and we investigate the safety of this procedures.
Patients a Methods: In the years 2002–2006 158 patients underwent 217
endobronchial therapeutic procedures in general anesthesia with jet ventilantion
through rigid bronchoscope (141 patinets with endobronchial lung cancers, 6 with
endobronchial metastases of melanoma, 3 with endobronchial metastasis of renal
carcinoma and 7 patients were before the morphological diagnosis). According the
American Society of Anesthesiologists’ (ASA) physical classification were 55%
patients ASA III and 45% ASA IV. We started with the endobronchiasl treatment
because of dyspnea in 100% patients, in 57 % patients was cough and in 12%
hemoptysis and in 2% patients were pneumonias.
Results: During and after procedures we observed in 28% patients hypoxemia,
in 23 % hemorrhage >250 cm3 , in 10% arytmias, in 5% patients we observed
hypertension and in 2% developed after procedure respiratory failure and this
patients were 24 hours on invasive ventilation. Any complications we observed
in 40% of all endobronchial procedures. The endobronchial treatment leads
to improvement of symptoms in 80% patients. The difference in number of
complications in patients with ASA III and with ASA IV was not statistically
significant (p = 0.009).
Conclusinos: Endobronchial treatment (electrosurgary and laser brochoscopy) in
general anesthesia with jet ventilation is therapeutic procedure with acceptable
rate of complications in patients with endobronchial growth of malignancies and
in patients with ASA classification III and IV.

Experience of the bronchial treatment of tuberculosis of the bronchos in the
conditions of the tuberculosis epidemic in Ukraine
O. Shpak, O. Vengerova. Endoscopy, Institute of Phthisiology and Pulmonology
Academy of Medical Science, Kiev, Ukraine

Since 1995 the epidemia of tuberculosis was announced in Ukraine. Tuberculosis
of the bronchos (TB) is secondary illness and starts if it has an active tuberculosis
process in the lungs or in the internal chest lymph. TB could be only diagnosed
by bronchoscopy. In the preiod of the last 10 years (1996–2006), the endoscopic
department conducted 22925 bronchial researches, like fibrobronchoscopies as

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