• Tuberculosis and Respiratory Diseases
• /
• v.40 no.1
• /
• pp.29-34
• /
• 1993

Background: The development of the flexible fiberoptic broncoscope by Ikeda was an important technologic advance in the diagnosis and management of patients with pulmonary disease. But, cross contamination related to fiberoptic bronchoscope was reported in cases involving tubercle bacilli, MOTT and other agents. Therefore, cleaning and disinfecting of fiberoptic bronchoscope requires careful attention. Methods: From September 1991 to May 1992, medical records of all patients with positive culture for MOTT in bronchial washing specimens were reviewed. Also to evaluate bactericidal effect of 2% glutaraldehyde, culture was performed after inoculum of MOTT, Serratia marsescens and Pseudomonas aeruginosa to the disinfectant solution. Results: In 2% alkaline glutaraldehyde, MOTT was not survived only after 30 minute exposure, but P. aeruginosa and S. marsescens were rapidly inactivated with no survivors after exposure to 2% glutaraldehyde. Since vigorous mechanical cleansing and more than 30 minute of contact time within washing machine, no more outbreak was observed. Conclusions: It is also very important that bronchoscopes must be meticulously cleaned after each procedure and more than 30 minute exposure would be required for eradication of MOTT with 2% glutaraldehyde. However even the most strictly applied infection control measures cannot exclude contamination completly and clinicians have to stay alert to this possibility. Prompt detection of pseudoepidemics is possible if abrupt increase in isolation rates, especially if they involve unusual or generally nonpathogenic organisms, are readily recognized.

• Tuberculosis and Respiratory Diseases
• /
• v.42 no.5
• /
• pp.677-684
• /
• 1995

Background: Broncholithiasis is uncommon but clinically important because it may cause a variety of nonspecific symptoms and signs prior to the onset of lithoptysis, and rarely massive hemoptysis. Method: A retrospective clinical study was done on 11 case of broncholithiasis diagnosed at Kyungpook National University Hospital from Jan. 1985 to Dec. 1993. The study investigated the clinical features, radiologic findings, bronchoscopic findings and management. Results: 1) The common symptoms included cough, dyspnea, hemoptysis, fever and purulent sputum. Lithoptysis occurred in 3 patients. 2) The radiologic findings were variable and nonspecific. Hilar calcification and parenchymal calcification were the most common findings. 3) The bronchoscopy was performed in 10 patients and revealed broncholiths in 9 patients. 4) Chemical composition of broncholiths was analyzed in 2 patients. Calcium carbonate was main component. 5) In 6 out of 9 patients in whom broncholiths was revealed by bronchoscopy, broncholiths were successfully extracted through the flexible bronchoscope. 6) In 9 patients, broncholithiasis was related to tuberculosis and in 1 case, related to silicosis. Conclusion: Broncholithiasis shows a variable clinical spectrum. Tuberculosis is the most common cause of broncholithiasis. In the case of no accompanied complication, nonsurgical management such as bronchoscopic removal and conservative therapy is an effective measure.

• Tuberculosis and Respiratory Diseases
• /
• v.68 no.5
• /
• pp.267-272
• /
• 2010

Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

• Tuberculosis and Respiratory Diseases
• /
• v.54 no.1
• /
• pp.71-79
• /
• 2003

Background : A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. Methods : Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia ($PaO_2/FIO_2$ ratio ${\leq}200$ on oxygen 10 L/min via mask with reservoir bag) were enrolled. The CPAP 5-6 $cmH_2O(F_IO_2\;1.0)$ was delivered through an inflatable face mask using a conventional mechanical ventilator. The CPAP began 10 min before starting the BAL and continued for 30 min after the procedure was completed. A bronchoscope was passed through a T-adapter and advanced through the mouth. BAL was performed using the conventional method. The vital signs, pulse oxymetry values, and arterial blood gases were monitored during the study. Results : (1) Median age was 56 years(male:female=4:3). (2) The baseline $PaO_2$ was $78{\pm}16mmHg$, which increased significantly to $269{\pm}116mmHg$(p=0.018) with CPAP. After the BAL, the $PaO_2$ did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The $SpO_2$ showed a similar trend with the $PaO_2$ and did not decrease to below 90 % during the duration of the study. (3) The $PaCO_2$ increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases. Conclusion : In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.