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Category: BRONCHOSCOPY IN DISEASES OF THE TRACHEA AND BRONCHI
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
In most cases of bronchiectasis there are strong
indications for a bronchoscopic diagnosis, to eliminate such
conditions as foreign body, cicatricial bronchial stenosis, or
endobronchial neoplasm as etiologic factors. In the idiopathic types
considerable benefit has resulted from the endobronchial lavage and
endobronchial oily injections mentioned under lung abscess. It is
probable that if bronchoscopic study were carried out in every case,
definite causes for many so-called idiopathic cases would be
discovered. Lung-mapping as elsewhere herein explained is invaluable
in the study of bronchiectasis.
Bronchial asthma affords a large field for bronchoscopic study. As
yet, sufficient data to afford any definite conclusions even as to the
endoscopic picture of this disease have not been accumulated. Of the
cases seen in the Bronchoscopic Clinic some showed no abnormality of
the bronchi in the intervals between attacks, others a chronic
bronchitis. In cases studied bronchoscopically during an attack, the
bronchi were found filled with bubbling secretions and the mucosa was
somewhat cyanotic in color. The bronchial lumen was narrowed only as
much as it would be, with the same degree of cough, in any patient not
subject to asthma. The secretions were removed and the attack quickly
subsided; but no influence on the recurrence of attacks was observed.
It is essential that the bronchoscopic studies be made, as were these,
without anesthesia, local or general, for it is known that the
application of cocain or adrenalin to the larynx, or even in the nose,
will, with some patients, stop the attack. When done without local
anesthesia, allowance must be made for the reaction to the presence of
the tube. In those cases in which other means have failed to give
relief, the endobronchial application of novocain and adrenalin,
orthoform, propaesin or anesthesin emulsion may be tried. Cures have
been reported by this treatment. Argentic nitrate applied at weekly
intervals has proven very efficient in some cases. Associated
infective disease of the bronchial mucosa brings with it the questions
of immunity, allergy, anaphylaxis, and vaccine therapy; and the often
present defective metabolism has to be considered.
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