bronchoscopy - Dr Alok Nath Department of Pulmonary...

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Dr Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh
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An evolving field within pulmonary medicine that focuses on providing consultative and procedural services to patients with malignant and nonmalignant airway disorders Encompasses the following two main areas malignant and nonmalignant airway disorders artificial airways Extending to other lung diseases with therapies such as endoscopic lung volume reduction for emphysema and bronchial thermoplasty for asthma
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Flexible Bronchoscopy Rigid Bronchoscopy Artificial Airways Diagnostic Endobronchial biopsy Transbronchial lung biopsy TBNA CT scan-guided FOB Endobronchial US AFB Therapeutic Balloon dilatation Endobronchial heat R x Laser Argon plasma coagulation Electrocautery Photodynamic therapy Endobronchial cryotherapy Endobronchial brachyR x Placement of metallic stents Balloon and rigid dilatation Mechanical debulking Endobronchial heat R x Laser Argon plasma coagulation Electrocautery Photodynamic therapy Endobronchial cryotherapy Endobronchial brachyR x Placement of metallic and silicone stents Placement of dynamic and Y stents Placement of Montgomery T-tubes Percutaneous tracheostomy Minitracheostomy Placement of transtracheal oxygen catheter
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The main indication -presence of airway disorders resulting in central airway obstruction(CAO) The etiologies of CAO include malignant airway disorders and nonmalignant airway disorders sarcoidosis amyloidosis relapsing polychondritis infectious complications of tuberculosis, histoplasmosis complications of lung transplantation sequelae from the introduction of artificial airways
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With the advent of accurate staging procedures diligent observation of the target tissues, i.e. in the pre- neoplastic and carcinoma in situ stage is possible Medically unfit patients with early stage cancer have been treated successfully with intraluminal bronchoscopic treatment (IBT) Superior cost-effectiveness ; minimally invasive; interventions and provides a solution for h early stage lung cancer and medically inoperable patient
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RB is ideal for massive hemoptysis, tight airway stenosis, and a moderate-to-large tumor tissue burden in the airway Dilatation of airway stenoses can be achieved with controlled insertion of the barrel of the rigid bronchoscope, the sequential introduction of serially enlarging semi-rigid (Jackson) dilators, or balloon dilatation Mechanical debridement is accomplished by “coring” out the tissue with the barrel of the rigid bronchoscope or by grasping large pieces with rigid forceps
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“Therapeutic flexible bronchoscope”, - large working channel (3.2 mm) and can accommodate large flexible forceps, making it feasible to remove medium sized endobronchial tissue growths during flexible bronchoscopy procedures in selected patents Tumor destruction can also be accomplished with a variety of endobronchial tools including heat therapy (eg, laser therapy, electrocautery, argon plasma coagulation), photodynamic therapy, cryotherapy, or radiotherapy (brachytherapy)
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bronchoscopy - Dr Alok Nath Department of Pulmonary...

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