ObjectiveTo explore the clinical value of Goddard CT grade for comprehensive evaluation of emphysema-type COPD. MethodsA total of 150 patients with emphysema-type COPD were recruited in the study. Chest CT scan was performed with German Siemens Difinition 64-slice spiral CT machine. The Goddard scoring of lung CT manifestations was used to grade lung emphysema. Lung function indexes were measured including FEV1, FVC, FEV1/FVC, RV, TLC, RV/TLC, DLCO, FEV1% pred, FVC% pred and DLCO% pred, etc. The correlation between Goddard scores and pulmonary function indexes were analyzed. The incidence of hospitalizations, length of hospital stay, severity of illness and complications in the previous year were compared between the patients with different Goddard CT grade. ResultsThere were 57 cases of mild emphysema, 53 cases of moderate emphysema, and 40 cases of severe emphysema judged by Goddard scoring. The pulmonary Goddard scores were positive correlated with RV, TLC, and RV/TLC which reflecting pulmonary function (r value was 0.385, 0.349, 0.455, respectively, all P < 0.05), and negatively correlated with DLCO and DLCO% pred which reflecting pulmonary diffusing capacity (r value was-0.771, -0.787, respectively, P < 0.05). Compared with the mild and moderate emphysema-type patients, the incidence of hospitalization more than one time due to acute exacerbation was significantly higher (χ2 value was 44.69, 25.66, respectively, P < 0.05), the average length of hospital stay was significantly longer [(13.5±4.2) d vs. (6.4±3.1) d and (9.0±3.8) d, P < 0.05] in the severe emphysema-type COPD patients. The severe emphysema-type COPD patients suffered from more severe acute exacerbation, and higher incidence of heart failure, ischemic heart disease and respiratory failure than the mild and moderate emphysema-type patients (P < 0.05). ConclusionsGoddard CT grade in complement with pulmonary function evaluation can provide more comprehensive evaluation of emphysema-type COPD. The higher Goddard score is, the more frequently and severe the acute exacerbation occurs, more easily the COPD patients complicated with respiratory failure, heart failure and other complications.
ObjectiveTo analyze the clinic characteristics and the flexible bronchoscopic findings of 1 221 cases of endobronchial tuberculosis,and try to find out some useful clues for the diagnosis of endobronchial tuberculosis. MethodsThe clinic characteristics and the bronchoscopic findings of 1 221 cases of endobronchial tuberculosis were summarized and analyzed. ResultsIn the 1 221 cases of bronchial tuberculosis,there were 491 males and 730 females with mean age of 45.5±16.8 years(ranged between 6 and 84 years). The peak incidence of endobronchial tuberculosis in females was between 20 and 50 years old,and in males was between 45 and 70 years old. The lesions were more common in the right lung (757 cases,62.00%). The most susceptible segment involved was the right upper lobe(316 cases,25.88%). The cases of left main bronchus tuberculosis (270 cases,22.11%) were more than right main bronchus tuberculosis(247 cases,20.23%). The most common bronchoscopic appearances were oedematous-hyperaemic and necrosis. The typical changes include caseous necrosis(117 cases,14.50%),fibrostenotic(130 cases,10.65%),and granuloma(92 cases,7.53%),which often occurred in the left main bronchus. The most common endoscopic classification of endobronchial tuberculosis was type Ⅱ(531 cases,43.49%)and type Ⅲ(505 cases,41.36%). ConclusionsBronchial tuberculosis occures in females more of ten than males. Female patients were mainly under the age of 50 years,while male patients was mainly above the age of 45 years. The most susceptible segments are the right upper lobe and the left main bronchus. The most common endoscopic classification is necrotizing ulcerative and granulation proliferative.
ObjectiveTracheobronchial foreign bodies (TFBs) aspiration is rare in adults,although it can occur at any age. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in adult patients of central south China. MethodsA total of 244 patients with TFBs over the age of 14 years were reviewed retrospectively from January 1997 to February 2012. The incidence,risk factors,clinical manifestations,radiological findings,types and locations of TFBs were analyzed. ResultsAmong the 27719 patients,TFBs were found only in 0.88%(244) cases. The prevalence of TFB aspiration increased steadily with age beginning in the fifth decade. The incidence of TFBs was 0.62% among people aged 70 to 80 years. Risk factors such as cerebrovascular diseases and neural degenerative disease were found among 32 (6.6%) patients. Among 153 patients with clear history of foreign body aspiration,135 patients (88.2%) were addicted to the hot pepper. Paroxysmal cough (81.1%) was the most common clinical manifestations of TFBs. Only 12 cases (4.9%) were found with non-opaque foreign bodies by chest X-ray but 106 cases (43.4%) were found with opaque foreign bodies by chest CT. The most common indirect chest imaging findings were recurrent infections and consolidation of the same area.Bone fragments of animals was the most common type in foreign bodies (47.2%). The most common position of foreign bodies was the right bronchial (65.6%). Total foreign bodies of 234 patients (95.9%) had been successfully removed by flexible bronchoscopy. ConclusionAlthough TFBs is rare in adults in south China,but yield by flexible bronchoscopy (0.88%) is much higher than that is reported in western countries (0.32%-0.33%). Addiction to the hot pepper and speaking loudly when having dinner may be the major risk factor for high incidence in central south China.