犬・猫の呼吸器臨床研究会

気管支鏡検査(LTBS)研究班の報告(2019.3.7更新 計18)

犬・猫の呼吸器臨床における気管支鏡検査の適応と症例、診断基準に検する文献レビュー

テーマは、「ラリンゲルマスクを介した喉頭および気管気管支鏡検査800例-Procedure(手順)、Safety(安全性)、Utility(有用性)」、「BALF細胞診300例からの診断基準の再考」、「Interventional bronchoscopyの症例報告(気管/気管支内ステント留置、異物回収、高周波治療など)、各手技の臨床的有用性と合併症」

動物でのラリンゲルマスクの適用


Sakai DM, Martin-Flores M, Jones AK, et al. Laryngeal mask airway and transient hypercapnic hyperpnea for video-endoscopic assessment of unilateral laryngeal paralysis in dogs. Vet Surg 2018;47:543-548.

ラリンゲルマスクおよび一時的な高炭酸ガスによる過呼吸下での片側喉頭麻痺の犬におけるビデオ内視鏡評価

OBJECTIVE: To evaluate the ability to assess laryngeal function and to diagnose unilateral laryngeal paralysis (uLP) via airway endoscopy and carbon dioxide (CO2 ) stimulation.

STUDY DESIGN: Experimental study.

ANIMALS: Six healthy, adult beagles.

METHODS: Dogs were anesthetized with sevoflurane and dexmedetomidine. Laryngeal activity was observed via endoscopy placed through a laryngeal mask airway (LMA). The absolute and normalized glottic gap areas (AGGA and NGGA, respectively) and the glottic length (GL) were measured at inspiration and before and after surgically induced uLP. Measurements were obtained at eupnea and during hypercapnic hyperpnea produced by the administration of CO2 . Values for each hemilarynx were also measured. Video recordings were observed by 2 surgeons who scored function as normal or uLP.

RESULTS: The AGGA and NGGA increased similarly during CO2 administration in intact dogs and in dogs with uLP; the GL increased in dogs with uLP but not in intact dogs. The AGGA and NGGA of the intact hemilarynx increased more than those of the affected hemilarynx in dogs with uLP. uLP was correctly identified more frequently by observers at hypercapnic hyperpnea than during eupnea.

CONCLUSION: The increase in AGGA and NGGA at peak inspiration during CO2 administration was not limited by uLP, but asymmetry in hemilarynx AGGA and NGGA was observed in dogs with uLP. CO2 administration facilitated the identification of uLP.

CLINICAL SIGNIFICANCE: Laryngeal endoscopy through an LMA coupled with administration of CO2 in anesthetized dogs facilitates the observation of arytenoid function and may improve the diagnosis of naturally occurring mild laryngeal paralysis.

コメント:ラリンゲルマスクにおける片側喉頭麻痺の判断には正常犬との比較には高炭酸ガス(ETCO2の上昇)による過呼吸での気管支鏡での観察が判断しやすいと考えられる(とも動物病院 櫻井智敬-2018.11.30)。


Yang TM, Wei QZ, Lu WZ, et al. Three-Way Laryngeal Mask Reduces Anesthesia-Related Stress Responses in Bronchoalveolar Lavage: An Experimental Canine Study. J Coll Physicians Surg Pak 2016;26:250-254.

気管支洗浄におけるThree-Way Laryngeal Maskが麻酔に関連するストレス反応を軽減する:実験犬での研究

OBJECTIVE: To compare the ventilatory effects of the three-way laryngeal mask airway (TLMA) and tracheal tube (TT) on hemodynamics, respiratory function, and stress responses in a canine model during bronchoalveolar lavage (BAL).

STUDY DESIGN: Experimental study.

PLACE AND DURATION OF STUDY: The 303rd Hospital of the Chinese People's Liberation Army in May 2013.

METHODOLOGY: Sixteen dogs were divided into two groups. MAP, SpO2 and HR were recorded before anesthesia (T0), immediately before intubation (T1), during intubation (T2), at 3 (T3) and 10 (T4) minutes after mechanical ventilation, at 10 (T5), 20 (T6), and 30 (T7) minutes during the course of BAL, during extubation (T8), and 3 minutes after extubation (T9). Tidal volume, peak inspiratory airway pressure, and expiratory CO2 pressure were recorded at time points T2, T5, T6, T7, and T8. Stress responses variables, including epinephrine and norepinephrine levels, were examined at time points T0, T2, T3, T5, T8, and T9.

RESULTS: BAL was successfully completed in all animals. In comparison to the TT, the TLMA was capable of maintaining hemodynamic stability and ventilation (p < 0.05), and producing less stress responses (p < 0.05).

CONCLUSION: In a canine model, ventilation with the TLMA was better than the TT during BAL in terms of maintaining effective ventilation and stable hemodynamics, and producing less stress responses.

コメント:TTよりもTLMAによる換気の方がBALの間は良好である。BALに関しては気管挿管ではなくラリンゲルマスクでの麻酔管理が覚醒後に関しても全身状態を良好に保つ可能性がある(とも動物病院 櫻井智敬-2018.11.30)。


Wiederstein I, Moens YP. Guidelines and criteria for the placement of laryngeal mask airways in dogs. Vet Anaesth Analg 2008;35:374-382.

イヌでのラリンゲルマスクの配置におけるガイドラインおよび基準

OBJECTIVE: To evaluate the criteria for the insertion and correct placement of the laryngeal mask airway (LMA) in dogs.

STUDY DESIGN:Prospective descriptive clinical study.

ANIMALS:  Thirty healthy dogs (ASA I or II) of different breeds, age 0.33-7.0 years (2.8 +/- 2.1; mean +/- SD), weight 2.2-59.0 kg (23.9 +/- 14.4), anaesthetized for elective surgery.

MATERIALS AND METHODS: The dogs were sedated with intravenous (IV) medetomidine (10 microg kg(-1)) and butorphanol (0.2 mg kg(-1)). If considered necessary, IV propofol (1 mg kg(-1) over 30 seconds) was administered until the LMA was inserted and positioned correctly. The position of the LMA was evaluated using predefined criteria for its insertion and inflation of the cuff, together with the ability to ventilate the dogs through the LMA.

RESULTS: The criteria for insertion, inflation and ventilation which indicated a clinically optimal position of the LMA and its seal around the larynx were met in 19 dogs (63.3%). The dogs could be manually ventilated with inspiratory peak pressures of 10 cm H(2)O without capnographic or audible evidence of leakage. In 11 dogs (36.7%), the LMA was positioned suboptimally with leakage during manual ventilation with inspiratory peak pressures not exceeding 10 cmH(2)O. There was no evidence of breed-related differences in LMA placement and position.

CONCLUSIONS AND CLINICAL RELEVANCE: The technique for the insertion of the LMA using predefined criteria to evaluate a correct positioning and a seal led to a successful placement in dogs of both brachycephalic and nonbrachycephalic breeds. The LMA, in most of the dogs, was easily placed, well tolerated and offered a useful less invasive means of securing the upper airway.

コメント:ラリンゲルマスクの正確な位置決めおよび密着度を評価するために所定の基準を用いた技術は、短頭種および非短頭種でラリンゲルマスクの配置に成功した(ほさか動物病院 菅沼鉄平-2018.12.20)。


Wiederstein I, Auer U, Moens Y. Laryngeal mask airway insertion requires less propofol than endotracheal intubation in dogs. Vet Anaesth Analg 2006;33:201-206.

犬においてラリンゲルマスクでの挿管は気管チューブ挿管に比較してプロポフォールの使用量を減らす

OBJECTIVE: To compare the doses of propofol required for insertion of the laryngeal mask airway (LMA) with those for endotracheal intubation in sedated dogs.

STUDY DESIGN: Randomized prospective clinical study. Animals Sixty healthy dogs aged 0.33-8.5 (3.0 +/- 2.3, mean +/- SD) years, weighing 2.2-59.0 (23.4 +/- 13.6, mean +/- SD) kg, presented for elective surgery requiring inhalation anaesthesia.

METHODS: Animals were randomly assigned to receive either a LMA or an endotracheal tube. Pre-anaesthetic medication was intravenous (IV) glycopyrrolate (0.01 mg kg(-1)) medetomidine (10 microg kg(-1)) and butorphanol (0.2 mg kg(-1)). Repeated IV propofol injections (1 mg kg(-1) in 30 seconds) were given until LMA insertion or endotracheal intubation was achieved, when the presence or absence of laryngospasm, the respiratory rate (fr) and the total dose of propofol used were recorded.

RESULTS: The total propofol dose (mean +/- SD) required for LMA insertion (0.53 +/- 0.51 mg kg(-1)) was significantly lower than for endotracheal intubation (1.43 +/- 0.57 mg kg(-1)). The LMA could be inserted without propofol in 47% of dogs; the remainder needed a single 1 mg kg(-1) bolus (n = 30). Endotracheal intubation was possible without propofol in 3.3% of the dogs, 47% needed one bolus and 50% required two injections (n = 30). The f(r) (mean +/- SD) was 18 +/- 6 and 15 +/- 7 minute(-1) after LMA insertion and intubation, respectively.

CONCLUSION AND CLINICAL RELEVANCE: Laryngeal mask airway insertion requires less propofol than endotracheal intubation in sedated dogs therefore propofol-induced cardiorespiratory depression is likely to be less severe. The LMA is well tolerated and offers a less invasive means of securing the upper airway.

コメント:ドミトール使用下ではあるが気管挿管に比較してラリンゲルマスクがプロポフォールの使用量がかなり減少することは麻酔管理からの点においても血圧低下や呼吸抑制を軽減できると考えられる(とも動物病院 櫻井智敬-2018.11.30)。


 

動物での気管支鏡の臨床適用


Liu Y, Yan B, Huang Z, et al. Feasibility and safety of fiber optic micro-imaging in canine peripheral airways. PLoS One 2014;9:e84829.

イヌ末梢気道における光ファイバーマイクロイメージングの適用範囲と安全性

PURPOSE: To assess the feasibility and safety of imaging canine peripheral airways (<1 mm) with an experimental micro-imaging fiber optic bronchoscope. METHODS: Twenty healthy dogs were scoped with a micro-imaging fiber optic bronchoscope (0.8 mm outer diameter). Images at various levels of the bronchioles, mucosal color, and tracheal secretions were recorded. The apparatus was stopped once it was difficult to insert. CT imaging was performed simultaneously to monitor progression. The safety of the device was evaluated by monitoring heart rate (HR), respiratory rate (RR), mean artery pressure (MAP), peripheral oxygen saturation (SpO2) and arterial blood gases (partial pressure of arterial carbon-dioxide, PaCO2, partial pressure of arterial oxygen, PaO2, and blood pH). RESULTS: (1) According to the CT scan, the micro-imaging fiber was able to access the peripheral airways (<1 mm) in canines. (2) There was no significant change in the values of HR, MAP, pH and PaCO2 during the procedure (P>0.05). Comparing pre-manipulation and post-manipulation values, SpO2 (F = 13.06, P<0.05) and PaO2 (F = 3.01, P = 0.01) were decreased, whereas RR (F = 3.85, P<0.05) was elevated during the manipulation. (3) Self-limited bleeding was observed in one dog; severe bleeding or other complications did not occur. CONCLUSION: Although the new apparatus had little effect on SpO2, PaO2 and RR, it can probe into small peripheral airways (<1 mm), which may provide a new platform for the early diagnosis of bronchiolar diseases.

コメント:光ファイバーを用いた気管支鏡で犬の1mm以下の末梢気道を描出できるかどうか、またその安全性を評価した。SpO2、PaO2、RRには多少の影響があったが、HR、 MAP、pHには影響がなかった。1mm以下の末梢気管支を調べる事で、気管支疾患の早期診断になりそうである(カンナ動物病院 山中一大-2018.12.21)


Andreasen CB. Bronchoalveolar lavage. Vet Clin North Am Small Anim Pract 2003;33:69-88.

気管支肺胞洗浄

Bronchoalveolar lavage is a valuable diagnostic technique when appropriate patient selection is made, which includes diseases that involve the pulmonary parenchyma and patients that can safely undergo general anesthesia. Bronchoalveolar lavage cytology has the potential to provide a definitive diagnosis or additional diagnostic information with a less invasive procedure than lung aspiration or thoracotomy. Limitations of accuracy in cell counts and negative findings are considerations when interpreting bronchoalveolar lavage fluid results.

コメント:小動物臨床領域での気管支肺胞洗浄についての文献(JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30)


Johnson L. Small animal bronchoscopy. Vet Clin North Am Small Anim Pract 2001;31:691-705, viii.

小動物における気管支鏡検査

Bronchoscopy is a useful diagnostic and therapeutic tool in veterinary medicine. The increased availability of fiberoptic technology and video-endoscopy has enhanced recognition of the benefits gained from visualization of the lower airways in animals with lower respiratory tract disease. Specimens retrieved from the lower airway during bronchoscopy have greater diagnostic capacity, and a better understanding of the pathophysiology of disease is provided through application of bronchoscopy to animals with respiratory tract disease.

コメント:気管支鏡検査について獣医学の観点から述べた文献(JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30)


Rha JY, Mahony O. Bronchoscopy in small animal medicine: indications, instrumentation, and techniques. Clin Tech Small Anim Pract 1999;14:207-212.

小動物臨床における気管支鏡検査:適応、装置、手技について

Bronchoscopy is a useful tool in the evaluation and management of canine and feline respiratory diseases. Diagnostic indications include the evaluation of structural diseases (tracheobronchial collapse, stricture, intraluminal mass); inflammatory conditions (chronic bronchitis, pneumonia); and traumatic injuries. Several airway-sampling techniques are available with bronchoscopy; bronchoalveolar lavage has proved to be the most satisfactory specimen-collection technique. Therapeutic indications of bronchoscopy at this time in veterinary medicine are mainly limited to foreign body removal. As advances are made in veterinary bronchopulmonary medicine, other therapeutic applications of the bronchoscope may be realized.

コメント:犬と猫を対象。診断の指標や適応症例について記載(JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30)。


Wood RE, Pick JR. Model systems for learning pediatric flexible bronchoscopy. Pediatr Pulmonol 1990;8:168-171.

小児気管支鏡検査学習のためのモデルの研究

Considerable practice is necessary to develop the skills essential to successful and safe performance of flexible bronchoscopy, especially in pediatric patients. We review a number of model systems, both mechanical and living, for learning and maturing bronchoscopic skills. For each of the animal models (canine, feline, leporine, and simian), the relevant anatomy and anesthetic techniques as well as the relative advantages and disadvantages of each model are discussed.

コメント:ヒトの小児患者を想定した基礎研究のため、イヌ、ネコ、ウサギ、サルを動物モデルとして解剖、麻酔、各モデルの長所や短所について述べた文献(JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30)


Venker-van Haagen AJ. Otoscopy, rhinoscopy, and bronchoscopy in small animal clinics. Vet Q 1985;7:222-224.

小動物臨床における耳鏡検査、鼻鏡検査、気管支鏡検査

Otoscopy, rhinoscopy, and bronchoscopy are indispensable techniwues in ear, nose, and throat clinics and in diseases of the trachea and the bronchial tree. The quality of the instruments used in these techniques is of primary importance. The endoscopic procedures, the instruments used, and the indications for the examinations are discussed.

コメント:耳鏡検査、鼻鏡検査、気管支鏡検査の概要について述べた文献。気管支鏡については喉頭、上気道疾患の診断に不可欠な技術であると述べている。使用機材についての記載が主である。図が4つあるが気管支鏡については正常犬の気管分岐部の白黒写真のみ(JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30)。


O’Brien JA. Bronchoscopy in the dog and cat. J Am Vet Med Assoc 1970;156:213-217.

犬と猫における気管支鏡検査

コメント:犬と猫における気管支鏡の最初の文献と思われるが情報得られず。アブストラクトもなし(JASMINEどうぶつ循環器病センター 侭田 和也-2018.11.30)。


 

気管支鏡検査適応疾患


Johnson LR, Johnson EG, Vernau W, et al. Bronchoscopy, Imaging, and Concurrent Diseases in Dogs with Bronchiectasis: (2003-2014). J Vet Intern Med 2016;30:247-254. doi: 10.1111/jvim.13809

気管支拡張症の犬における気管支鏡検査、画像検査および併発疾患(2003–2014)

BACKGROUND: Bronchiectasis is a permanent and debilitating sequel to chronic or severe airway injury, however, diseases associated with this condition are poorly defined. OBJECTIVE: To evaluate results of diagnostic tests used to document bronchiectasis and to characterize underlying or concurrent disease processes. ANIMALS: Eighty-six dogs that had bronchoscopy performed and a diagnosis of bronchiectasis. METHODS: Retrospective case series. Radiographs, computed tomography, and bronchoscopic findings were evaluated for features of bronchiectasis. Clinical diagnoses of pneumonia (aspiration, interstitial, foreign body, other), eosinophilic bronchopneumopathy (EBP), and inflammatory airway disease (IAD) were made based on results of history, physical examination, and diagnostic testing, including bronchoalveolar lavage fluid analysis and microbiology. RESULTS: Bronchiectasis was diagnosed in 14% of dogs (86/621) that had bronchoscopy performed. Dogs ranged in age from 0.5 to 14 years with duration of signs from 3 days to 10 years. Bronchiectasis was documented during bronchoscopy in 79/86 dogs (92%), thoracic radiology in 50/83 dogs (60%), and CT in 34/34 dogs (100%). Concurrent airway collapse was detected during bronchoscopy in 50/86 dogs (58%), and focal or multifocal mucus plugging of segmental or subsegmental bronchi was found in 41/86 dogs (48%). Final diagnoses included pneumonia (45/86 dogs, 52%), EBP (10/86 dogs, 12%) and IAD (31/86 dogs, 36%). Bacteria were isolated in 24/86 cases (28%), with Streptococcus spp, Pasteurella spp, enteric organisms, and Stenotrophomonas isolated most frequently. CONCLUSIONS AND CLINICAL IMPORTANCE: Bronchiectasis can be anticipated in dogs with infectious or inflammatory respiratory disease. Advanced imaging and bronchoscopy are useful in making the diagnosis and identifying concurrent respiratory disease.

コメント:気管支拡張症の診断には胸部X線写真検査よりもCT、気管支鏡検査の方が有用であった。

気管支拡張症と診断された86頭の犬の併発疾患として気管虚脱(48% 41/86)、肺炎(誤嚥、間質性、異物性、その他)(52% 45/86)、炎症性気道疾患(36% 31/86)、好酸球性気管支肺症(12% 10/86)が認められた。また培養検査にて細菌が24/86 28%で検出されStreptococcus spp、Pasteurella spp、腸内細菌、およびStenotrophomonasが分離された(ほさか動物病院 菅沼鉄平-20190.1.25)。


 

人におけるInterventional bronchoscopyのこれまでと現在


掲載準備中


 

人におけるラリンゲルマスクを介した気管支鏡検査


掲載準備中


 

犬・猫のBALF細胞診 診断基準


Foster SF, Martin P, Braddock JA, et al. A retrospective analysis of feline bronchoalveolar lavage cytology and microbiology (1995-2000). J Feline Med Surg 2004;6:189-198.

猫のBALF解析の細胞診と微生物学に関する調査

A retrospective study of 88 bronchoalveolar lavage specimens from 80 cats presenting to the University of Sydney Veterinary Centre between 1995 and 2000 was performed. Bronchoalveolar lavage cytology and microbiology in conjunction with other diagnostic aids and patient records were used to classify cases as lower respiratory tract infections (LTRIs), LRTI revisits, feline bronchial disease, cardiac disease, neoplastic disease and multisystemic disease. Cases for which a definitive diagnosis could not be made were classified as inconclusive. Infectious agents identified were Mycoplasma spp., Pasteurella spp., Bordetella bronchiseptica, Salmonella typhimurium, Pseudomonas sp., Cryptococcus neoformans, Aelurostrongylus abstrusus and Eucoleus aerophilus. The study highlights the importance of bronchoalveolar lavage cytology and microbiology in the evaluation of feline lower respiratory tract disease.

コメント:15年間で80頭の猫に88回行われたBAL検体の解析に対する調査。猫の下気道疾患の評価にBALの細胞診と細菌学検査の重要性について述べられている(犬・猫の呼吸器科 城下幸仁-2019.3.7)


Woods KS, Fefarges AMN, Abraham-Ogg ACG, et al. Comparison of bronchoalveolar lavage aspiration techniques in healthy dogs: manual aspiration and suction pump aspiration:2012 ACVIM Forum Abstructs. J Vet Intern Med 2012;26:820.

健常犬におけるBAL回収法の比較:用手法とサクションバルブ法

The purpose of the study was to compare the diagnostic qual¬ity of bronchoalveolar lavage fluid (BALF) cellular component acquired by manual aspiration via polyethylene tubing (MAPT) and suction pump aspiration (SPA) via suction trap connection techniques in healthy dogs.

Bronchoalveolar lavage was performed under general anesthesia using bronchoscopic guidance in twelve healthy beagles. Following passage of the endoscope, sterile polyethylene tubing was inserted through the biopsy channel and MAPT performed with a 35mL syringe attached to the tubing wedged in the bronchus. Similarly, SPA was performed using 5kPa negative pressure applied directly to the bronchoscope’s suction valve via disposable aspiration tube. MAPT and SPA techniques were performed in randomized order in opposite caudal lung lobes of each dog. Two lavages boluses were infused at each site using a weight- adjusted aliquot volume (1 mL/kg). The BALF samples were submitted and prepared for total nucleated cell count and differ¬ential cell count. A subjective scale for quality and percent of retrieved fluid were evaluated. Results were compared using a paired Wilcoxon sign rank test.

The proportion of BALF retrieved was significantly higher (mean difference 19.02%, p = 0.001) for SPA than MAPT. From the BAL cell differential analysis, a higher percentage of epithelial cells was present when compared to SPA (mean differ¬ence =0.81, p = 0.05).

The results suggest that SPA provided BALF samples of higher diagnostic quality than MAPT in healthy dogs. The SPA technique may improve the diagnostic accuracy and significance of BAL in dogs.

Statement on prior publication: Abstract presented at the Ontario Veterinary College Graduate Research Symposium, Uni¬versity of Guelph, Guelph, Ontario, Canada; November 16th, 2011.

コメント:サクションバルブ法は、用手法より質の高いBALFサンプルを得られた(犬・猫の呼吸器科 城下-2018.12.5)


Allerton FJ, Leemans J, Tual C, et al. Correlation of bronchoalveolar eosinophilic percentage with airway responsiveness in cats with chronic bronchial disease. J Small Anim Pract 2013;54:258-264.

慢性気管支疾患の猫のおけるBALF中好酸球と気道過敏性との関連性

OBJECTIVES: To retrospectively assess the relationship between bronchoalveolar lavage fluid analysis and lung function parameters as assessed by means of barometric whole body plethysmography and airway responsiveness testing in cats with chronic bronchial disease and to evaluate the potential application of barometric whole body plethysmography and airway responsiveness testing to distinguish between eosinophilic and non-eosinophilic bronchitis. METHODS: Twelve cats presented for chronic bronchial disease with complete bronchoalveolar lavage fluid and barometric whole body plethysmography data were identified. Cats were retrospectively assigned to eosinophilic bronchitis or non-eosinophilic bronchitis groups on the basis of bronchoalveolar lavage fluid eosinophil percentage (threshold 17%). Airway responsiveness was quantified by calculating the concentration of carbachol-inducing bronchoconstriction (C-Penh-300), defined as a 300% increase of basal enhanced pause (Penh). RESULTS: Log Penh was significantly higher and C-Penh-300 significantly lower in eosinophilic bronchitis cats compared to non-eosinophilic bronchitis cats (P=0.031 and P=0.032, respectively). Bronchoalveolar lavage fluid eosinophil percentage was moderately correlated with log Penh (P=0.012, r=0.70) and showed a weak inverse correlation with C-Penh-300 (P=0.047, r=-0.58). CLINICAL SIGNIFICANCE: This study provides supportive evidence of a correlation between airway eosinophilic inflammation and plethysmographic measures of bronchoconstriction and airway responsiveness. Further investigation of the use of barometric whole body plethysmography to differentiate between forms of chronic bronchial disease in cats is indicated.

コメント:

 


Woods KS, Defarges AM, Abrams-Ogg AC, et al. Comparison of manual and suction pump aspiration techniques for performing bronchoalveolar lavage in 18 dogs with respiratory tract disease. J Vet Intern Med 2014;28:1398-1404.

呼吸器疾患犬18頭における、BALFの手動吸引(MA)とサクション吸引(SPA)の比較

BACKGROUND: Different aspiration techniques to retrieve bronchoalveolar lavage fluid (BALF) affect sample quality in healthy dogs. Studies evaluating these techniques in dogs with respiratory disease are lacking.

OBJECTIVES: To compare sample quality of BALF acquired by manual aspiration (MA) and suction pump aspiration (SPA).

ANIMALS: Eighteen client-owned dogs with respiratory disease.

METHODS: Randomized, blinded prospective clinical trial. Manual aspiration was performed with a 35-mL syringe attached directly to the bronchoscope biopsy channel and SPA was performed with a maximum of 50 mmHg negative pressure applied to the bronchoscopesuction valve using the suction trap connection. Both aspiration techniques were performed in each dog on contralateral lung lobes, utilizing 2 mL/kg lavage volumes per site. Samples of BALF were analyzed by percentage of retrieved infusate, total nucleated cell count (TNCC), differential cell count, semiquantitative assessment of slide quality, and diagnosis score. Data were compared by paired Student’s t-test, Wilcoxon signed-rank test, chi-squared test, and ANOVA. Cohen’s kappa coefficient was used to assess agreement.

RESULTS: The percentage of retrieved BALF (P = .001) was significantly higher for SPA than MA. Substantial agreement was found between cytologic classification of BALF obtained with MA and SPA (kappa = 0.615). There was no significant difference in rate of definitive diagnosis achieved with cytologic assessment between techniques (P = .78).

CONCLUSIONS AND CLINICAL IMPORTANCE: Suction pump aspiration, compared to MA, improved BALF retrieval, but did not significantly affect the rate of diagnostic success of bronchoalveolar lavage (BAL) in dogs with pulmonary disease.

コメント: SPAの方がBALFの回収率は有意に高かったが、BALによる犬の呼吸器疾患診断率にMAとSPAの有意差はなかった(カンナ動物病院 山中一大-2018.12.11)。


 

犬・猫におけるInterventional bronchoscopy-症例報告


Musani AI, Veir JK, Huang Z, et al. Photodynamic therapy via navigational bronchoscopy for peripheral lung cancer in dogs. Lasers Surg Med 2018;50:483-490.

気管支鏡を用いた犬の末梢肺腫瘍のレーザー治療

OBJECTIVE:In the setting of lung cancer, photodynamic therapy (PDT) is typically used to treat centrally located endobronchial tumors. The development of navigational bronchoscopy has opened the potential for using PDT to treat peripheral lung tumors. However, there is limited information about the feasibility of this approach for treating peripheral lungcancers, and about its effects on surrounding healthy lung tissue. We studied the use of PDT delivered by electromagnetic navigational bronchoscopy to treat peripheral lung cancer in dogs.

MATERIALS AND METHODS: Three dogs with peripheral lung adenocarcinomas were given intravenous porfimer sodium (Photofrin® [Pinnacle Biologics, Inc., Chicago, IL]) to photosensitize the tumors, then navigational bronchoscopy was used to deliver photoradiation. One week after PDT, the tumors and involved lung lobe were surgically excised and evaluated histologically.

RESULTS: PDT was successful in all three dogs and was associated with tolerable and manageable adverse effects. Tissue sections from within PDT-treated tumors showed regions of coagulative central necrosis admixed with small numbers of inflammatory cells, and arterial thrombosis. Viable adenocarcinoma was seen in the surrounding areas.

CONCLUSION: These results suggest that PDT can be successfully deployed to treat peripheral lung cancers using navigational bronchoscopy. Furthermore, damage to surrounding noncancerous tissues can be minimized with accurate placement of the optical fiber. Studies of this modality to treat peripheral lung cancers in humans may be warranted.

コメント:末梢の肺腫瘍にレーザー治療(PDT)を試みた。PDTにより、腫瘍を分散させることが出来る可能性が示された。さらに、光ファイバーを正確に配置させることで、正常組織へのダメージも最小限にでき得る(カンナ動物病院 山中一大-2018.12.11)。


Martin-Flores M, Cortright CC, Koba SJ. Removal of an Airway Foreign Body via Flexible Endoscopy Through a Laryngeal Mask Airway. J Am Anim Hosp Assoc 2015;51:325-328.

ラリンゲルマスクを介した軟性鏡による気道異物除去の1例

A Silky terrier weighing 4.7 kg was presented with an airway foreign body after having aspirated a fragment of an orotracheal tube that was identified on radiological examination. Due to the small size of the patient, flexible endoscopy could not be performed through the lumen of a tracheal tube. Following IV induction of general anesthesia, the airway was instrumented with a laryngeal mask airway that was attached via a three-way connector to an anesthesia breathing circuit. A flexible endoscope was passed through the free port of the connector. That arrangement allowed for the passage of an endoscope through the lumen of the laryngeal mask airway and into the trachea without interrupting the continuous supply of O2 and sevoflurane.

コメント:4.7kgのシルキーテリアで、ラリンゲルマスクを通し、軟性気管支鏡を気道内に揷入することで気道異物を除去した。ラリンゲルマスクを用いることで、酸素や吸入麻酔薬の供給を妨げずに内視鏡を揷入する事が出来た(カンナ動物病院 山中一大-2018.12.11)。