Pediatric flexible fiberoptic bronchoscopy--a preliminary report.

The introduction of flexible fiberoptic bronchoscopy into clinical use in 1968 had led a veritable explosion in the application of pulmonary endoscopy. In 1978, Wood and his colleagues, using a 3.5 mm Olympus 3C4 pediatric bronchoscope, expanded this technique to pediatric field. Up-to-now, they have more than 2000 bronchoscopies in pediatric patients, however, there has been no report in this field in Taiwan. I, using a new Olympus pediatric flexible fiberoptic bronchoscope 3C20, sedation and topic anesthesia, performed 24 airway examinations in 22 patients in the past 7-month period. The youngest patient was a 1672 gm, 4 day-old baby. The most frequent indication was stridor and most common diagnosis was laryngomalacia. The complications were not common and could have been avoidable if performed by an expert. My conclusion is that pediatric fiberoptic bronchoscopy is possible even in small babies less than 3 kg of weight.

Multifocal atrial tachycardia as a prognostic indicator in patients with severe chronic obstructive pulmonary disease requiring mechanical ventilation.

The records of 121 patients admitted to the Medical Intensive Care Unit (MICU) of Chang Gung Memorial Hospital with severe chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation were reviewed retrospectively. Eighty-seven percent (20/23) of the patients with multifocal atrial tachycardia (MAT) expired during their ICU admission in contrast to 23.5% (23/98) of those without MAT. The only differences between these two groups were incidence of cor pulmonale, and right axis deviation, right bundle branch block, pulmonale P in electrocardiogram. MAT might be considered as a grave prognostic sign in patients with COPD severe enough to require mechanical ventilation.