Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974± 1998. A. Debeljak, J. S AE orli, E. MusAEicAE, P. Kecelj. #ERS Journals Ltd 1999. ABSTRACT: The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult.Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974±1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies.Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket.Foreign bodies in the tracheobronchial system are rare in adults. Aspiration of foreign bodies can occur in children [1], as well as in adults or elderly people [2]. Therapeutic bronchoscopy for foreign bodies removal was introduced into clinical practice 100 yrs ago by the German otolaryngologist G. Killian [3]. Currently both, rigid and flexible bronchoscopies are utilized for this indication [4].In the present study, the authors reviewed their experience with therapeutic bronchoscopy for the removal of foreign bodies from 1974±1998. More specifically, diagnosis, techniques of removal and types of foreign bodies present in the tracheobronchial tree were investigated. Patients and methodsThe authors' Clinical Department for Respiratory Diseases and Allergy covers a population of one million inhabitants in Slovenia. Bronchoscopic records and the collection of foreign bodies in the endoscopic department were retrospectively examined. If possible, hospital documen-tation of the patients with foreign bodies aspiration was reviewed. Between 1974±1998, 37,466 bronchoscopies were performed, 33,716 (90%) with the flexible and 3,750 (10%) with the rigid bronchoscope. Sixty-two bronchoscopies (i.e. 0.2%) were performed in an attempt to remove foreign bodies.There were 42 male and 20 female patients ranging in age 18±86 yrs (meanSD 5514 yrs). Prior to bronchoscopy, a complete medical history, physical examination and chest radiograph at full inspiration were obtained. Premedication included 1 mg of atropine. Topical anaesthesia (nose, pharynx and larynx) was performed wi...

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After a favorable experience with gemcitabine at a low dose in a prolonged infusion in combination with cisplatin for advanced non-small-cell lung cancer, here, we present the results from a phase II trial for patients with malignant pleural mesothelioma. Eligible patients had biopsy-proven malignant pleural mesothelioma, were chemo-naive, Eastern Cooperative Oncology Group performance status 0-2, had normal hematopoietic liver and renal function, and gave informed consent. Treatment consisted of gemcitabine 250 mg/m in a 6-h infusion on days 1 and 8 and cisplatin at 75 mg/m on day 2 of a 3-week cycle for four cycles, followed by two additional cycles without cisplatin. Seventy-eight patients (58 men, 20 women; age 33-82 years, median 58) were recruited into the trial. The histologic types were as follows: epitheloid 56 (71.8%); four sarcomatoid (5.1%); mixed 15 (19.2%); and mesothelioma, three not otherwise specified (3.8%). Grades 3-4 toxicity included two (2.6%) patients with anemia, 18 (23.1%) with neutropenia, and one with nausea/vomiting. Reversible thrombocytosis with platelets over 1000-10/l was recorded in 10 (12.8%) patients and grade 2 alopecia in 60 (76.9%). Four (5.1%) patients showed a complete response and 35 (44.9%) showed a partial response with a response rate of 39/78 (50%). Minimal response or stable disease was seen in 35 (44.9%), whereas only four (5.1%) patients progressed during treatment. Most patients reported symptomatic improvement with a higher or a stable quality of life score in 70 (89.7%) cases. The median progression-free survival was 8.0 months (confidence interval 6.9-9.0). The median overall survival was 17.0 months (confidence interval 14.7-19.2). One-year, two-year, and three-year survival rates were 67.3, 32.7, and 19.8%, respectively. Epitheloid histological type was the only statistically significant favorable prognostic factor for progression-free survival and overall survival. Because of the acceptable toxicity, remarkable activity, and reasonable cost, this treatment should be further explored.

pericardial effusion, effusive-constrictive pericarditis or cardiac tamponade. 2 For the majority of patients, a clinical manifestation of neoplastic pericarditis is absent or remains unrecognised during their life. Cardiac tamponade as the initial manifestation of a malignancy is rare and such patients have a very limited life expectancy. 3 Here we reported a 69-year-old woman with clinical signs of cardiac tamponade as the initial presentation of lung cancer. The literature has been reviewed at length.

The success rate of cytological examination of the bronchoalveolar lavage fluid (BALF) in patients with primary or metastatic lung tumors varies considerably according to different authors. In a prospective study, we have tried to establish the sensitivity of BAL in comparison with both transbronchial lung biopsy (TBB) and brushing. BAL was performed in 61 patients with lung malignancies and in 56 patients with nonmalignant lung disease: 39 patients had primary lung cancer, 22 had metastatic spread into the lungs. First the part of the lung involved was washed out with 100 ml physiological saline solution during bronchoscopy. Following BAL, 5 TBB and brushing were performed. The smears were stained by the May-Grünwald-Giemsa method. Malignant cells were found in BALF from 17 patients, in TBB specimens from 43 and in brushing smears from 26. TBB was significantly the most successful method applied. Malignant cells were never found in BALF only, nor were they ever found in patients with non-malignant lung disease. The sensitivity of the three methods was equal for primary as compared to metastatic tumors and for interstitial infiltrates as compared to coin lesions. Malignant cells were most frequently found in centrifuged specimens. BAL may be used in suspected malignant interstitial or rounded pulmonary infiltrates when it cannot be reached by forceps or brush, or when TBB and brushing are contra-indicated.