plementemia. In all patients the clinical syndrome abated aDd the levels of complement returned to normal after discontinuation of therapy with the drug. It is suggested that the absence of antibodies to native DNA is the only consistent feature of the pJ'0C'3i oamide-a."SOciamd syndrome.!
Brion H. Hoff, M.D., AaaistantPro/eRor Department of Anesthuiology Center for HeoIthSciences UttloenitJI ofWi8c0n8in, Madison
1b:FERENCES 1 Kaplan AI, Zakher F, Sabin S: Drug-induced lupus erythematosus with iB vivo lupus erythematosus cells in pleurallluid. Chest 73:875-876, 1978
2 Utsinger PO, Zvaifler NI, Bluestein HG: Hypocomplementemia in procainamide-associated systemic lupus erythematosus (Jetter to editor). Ann Intern Med 84:293, 1976
Another Advantage of the Flexible Fiberoptic Bronchoscope An Easy Tracheal Cannulation in Preparation for Bronchography
FiGURE 1. Tip of bronchoscope ( B) is in anterior basal segment of right lower lobar bronchus. A O.035-inch guide wire (w) has been passed through aspirating channel and advanced into periphery of this segment.
graphic studies. In this report, a simplified method for performing bronchographic examination in conjunction with the llexible fiberoptic bronchoscopic procedure is described. TECHNIQUE
To the Editor: To the growing list of serendipitous advantages of the llexible fiberoptic bronchoscope, we add another. In the cases where bronchographic examination is desired in addition to bronchoscopic examination, the procedures are performed in sequence. By using the llexible fiberoptic bronchoscope as a laryngoscope, the trachea is easily cannulated under endoscopic direction. This technique not only saves time but also renders the introduction of the tracheal catheter more tolerable to the patient. TECHNIQUE
Following the completion of transnasal bronchoscopic examination, the tip of the bronchoscope is withdrawn to a level just above the epiglottis. A jelly-coated soft cathether is gently passed through the opposite nares to the supraglottic area, where the catheter is then slowly advanced under endoscopic control. By visualizing the catheter over the glottis, it is very easy to manipulate the catheter through the vocal cords into the trachea. The trachea, having previously been anesthetized for the bronchoscopic procedure, requires only little additional anesthesia.
Robert B. Wagne1', M.D., and Babu B. Poidipaty, M.D. Prince George's General Hospital and Medical Center Chtroerlv, Md
Bronchography Combined with Bronchoscopy A New Method To the Editor: The flexible fiberoptic bronchoscope has become an indispensable tool for the assessment of a wide variety of pulmonary disorders. Over the past two years in approximately 25 patients, we have employed a flexible fiberoptic bronchoscope for another purpose, the performance of broncho-
108 COIIUNICAnONS TO THE EDITOR
Approximately one hour prior to examination, the patient is premedicated with meperidine (Demerol) hydrochloride (50 mg intramuscularly) and atropine (0.4 mg intramuscularly ). The patient is then talcen to the lluoroscopic suite, where a Conventional llexible fiberoptic bronchoscopic procedure is performed. A 2 percent solution of lidocaine is used for topical anesthesia. After the flexible fiberoptic bronchoscopic procedure has been completed, a O.035-inch guide wire is passed through the aspirating channel of the bronchoscope (Fig 1). Under fluoroscopic observation the guide wire is directed into the area of the lung to be evaluated. The bronchoscope is slowly withdrawn over the positioned and firmly held guide wire. Next, a red Robinson catheter with the closed tip amputated is passed over the guide wire and advanced to the desired bronchial level The guide wire is withdrawn, and the catheter is now in proper position for instilling contrast material. More selective bronchographic studies can be accomplished with the use of an angiographic catheter. The bronchogram is completed in the conventional manner. Local anesthetic agent is instilled through the catheter if necessary. The additional time required to prepare the patient and position the cathether is rarely more than five minutes. DISCUSSION
We have found the combined bronchoscopic-bronchographic procedure to be extremely helpful in selected cases because it permits evaluation of airways and parenchyma not directly visualized by bronchoscopic examination alone. Our technique, which in principle is similar to Seldlnger's method for arterial catheterization, facilitates the bronchographic procedure. John S. Lutch, M.D., F.C.C.P. and Kecln G. Rt/tm, M.D. Departments of Medicine and Radiology
Umvemty of California School of Medicine, Davis and Woodland ClWc, WoodUmd, Calif
Reprint requests: Dr. Lutch, 1207 Fairchild Ct, Woodland. Cali/95695
CHEST, 75: 1, JANUARY, 1979
Brion H. Hoff, M.D., AaaistantPro/eRor Department of Anesthuiology Center for HeoIthSciences UttloenitJI ofWi8c0n8in, Madison
1b:FERENCES 1 Kaplan AI, Zakher F, Sabin S: Drug-induced lupus erythematosus with iB vivo lupus erythematosus cells in pleurallluid. Chest 73:875-876, 1978
2 Utsinger PO, Zvaifler NI, Bluestein HG: Hypocomplementemia in procainamide-associated systemic lupus erythematosus (Jetter to editor). Ann Intern Med 84:293, 1976
Another Advantage of the Flexible Fiberoptic Bronchoscope An Easy Tracheal Cannulation in Preparation for Bronchography
FiGURE 1. Tip of bronchoscope ( B) is in anterior basal segment of right lower lobar bronchus. A O.035-inch guide wire (w) has been passed through aspirating channel and advanced into periphery of this segment.
graphic studies. In this report, a simplified method for performing bronchographic examination in conjunction with the llexible fiberoptic bronchoscopic procedure is described. TECHNIQUE
To the Editor: To the growing list of serendipitous advantages of the llexible fiberoptic bronchoscope, we add another. In the cases where bronchographic examination is desired in addition to bronchoscopic examination, the procedures are performed in sequence. By using the llexible fiberoptic bronchoscope as a laryngoscope, the trachea is easily cannulated under endoscopic direction. This technique not only saves time but also renders the introduction of the tracheal catheter more tolerable to the patient. TECHNIQUE
Following the completion of transnasal bronchoscopic examination, the tip of the bronchoscope is withdrawn to a level just above the epiglottis. A jelly-coated soft cathether is gently passed through the opposite nares to the supraglottic area, where the catheter is then slowly advanced under endoscopic control. By visualizing the catheter over the glottis, it is very easy to manipulate the catheter through the vocal cords into the trachea. The trachea, having previously been anesthetized for the bronchoscopic procedure, requires only little additional anesthesia.
Robert B. Wagne1', M.D., and Babu B. Poidipaty, M.D. Prince George's General Hospital and Medical Center Chtroerlv, Md
Bronchography Combined with Bronchoscopy A New Method To the Editor: The flexible fiberoptic bronchoscope has become an indispensable tool for the assessment of a wide variety of pulmonary disorders. Over the past two years in approximately 25 patients, we have employed a flexible fiberoptic bronchoscope for another purpose, the performance of broncho-
108 COIIUNICAnONS TO THE EDITOR
Approximately one hour prior to examination, the patient is premedicated with meperidine (Demerol) hydrochloride (50 mg intramuscularly) and atropine (0.4 mg intramuscularly ). The patient is then talcen to the lluoroscopic suite, where a Conventional llexible fiberoptic bronchoscopic procedure is performed. A 2 percent solution of lidocaine is used for topical anesthesia. After the flexible fiberoptic bronchoscopic procedure has been completed, a O.035-inch guide wire is passed through the aspirating channel of the bronchoscope (Fig 1). Under fluoroscopic observation the guide wire is directed into the area of the lung to be evaluated. The bronchoscope is slowly withdrawn over the positioned and firmly held guide wire. Next, a red Robinson catheter with the closed tip amputated is passed over the guide wire and advanced to the desired bronchial level The guide wire is withdrawn, and the catheter is now in proper position for instilling contrast material. More selective bronchographic studies can be accomplished with the use of an angiographic catheter. The bronchogram is completed in the conventional manner. Local anesthetic agent is instilled through the catheter if necessary. The additional time required to prepare the patient and position the cathether is rarely more than five minutes. DISCUSSION
We have found the combined bronchoscopic-bronchographic procedure to be extremely helpful in selected cases because it permits evaluation of airways and parenchyma not directly visualized by bronchoscopic examination alone. Our technique, which in principle is similar to Seldlnger's method for arterial catheterization, facilitates the bronchographic procedure. John S. Lutch, M.D., F.C.C.P. and Kecln G. Rt/tm, M.D. Departments of Medicine and Radiology
Umvemty of California School of Medicine, Davis and Woodland ClWc, WoodUmd, Calif
Reprint requests: Dr. Lutch, 1207 Fairchild Ct, Woodland. Cali/95695
CHEST, 75: 1, JANUARY, 1979
