Safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy in patients with febrile neutropenia and pulmonary infiltrates.

Abstract:

OBJECTIVE:To evaluate the safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy in patients with febrile neutropenia and pulmonary infiltrates. PATIENTS AND METHODS:We retrospectively reviewed the medical records of all patients with neutropenic fever and pulmonary infiltrates evaluated by flexible bronchoscopy and BAL between January and December 2002 at the Mayo Clinic in Rochester, Minn. Appropriate demographic, clinical, microbiological, and histological data and procedure-related complications were summarized. Therapeutic decisions implemented based on Information obtained by bronchoscopy, and 28-day mortality were determined. RESULTS:Thirty-five patients with febrile neutropenia and associated pulmonary infiltrates were identified. Flexible bronchoscopy, including 35 BALs and 9 transbronchial biopsies, was performed safely (3 complications). The diagnostic yield of BAL was 49%. Sputum analysis was underused (only 34%) but complementary to BAL. The combined diagnostic yield of BAL and sputum analysis was 63%. Transbronchial biopsy provided additional information to BAL and sputum analysis In only 1 patient and did not substantially increase the combined diagnostic yield. The most common diagnoses identified were fungal pneumonias (15/35 [43%]) and diffuse alveolar hemorrhage (5/35 [14%]). Bronchoscopic findings resulted in management changes in 51% of patients. The 28-day mortality rate was 26% and was highest in patients who required mechanical ventilatory assistance before bronchoscopy. CONCLUSION:The favorable safety record, good diagnostic yield, and frequent therapeutic implications support the routine use of BAL for the evaluation of pulmonary inflitrates in neutropenic patients. Bronchoalveolar lavage should be combined with the analysis of several sputum specimens. Transbronchial biopsy did only change the management of 1 patient.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Peikert T,Rana S,Edell ES

doi

10.4065/80.11.1414

keywords:

subject

Has Abstract

pub_date

2005-11-01 00:00:00

pages

1414-20

issue

11

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(11)61434-1

journal_volume

80

pub_type

杂志文章
  • Medical management of a large aortic thrombus in a young woman with essential thrombocythemia.

    abstract::Aortic thrombus formation is rare in the patients with essential thrombocytosis (ET); therefore, no guidelines for its management have been established. Embolism from ET-associated large vessel thrombi is potentially lethal and has been managed surgically in a few reported cases. We describe herein a 45-year-old black...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.4065/76.4.427

    authors: Fang M,Agha S,Lockridge L,Lee R,Cleary JP,Mazur EM

    更新日期:2001-04-01 00:00:00

  • Percutaneous transcatheter embolization of coronary arteriovenous fistulas.

    abstract::Coronary artery fistulas are infrequently encountered vascular communications that are either congenital or due to cardiac trauma. Most patients with these anomalies are asymptomatic, but late complications can occur and include congestive heart failure, myocardial ischemia, arrhythmias, and endocarditis. Therefore, m...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.4065/71.1.37

    authors: Harris WO,Andrews JC,Nichols DA,Holmes DR Jr

    更新日期:1996-01-01 00:00:00

  • Vagotomy and pyloroplasty in the treatment of duodenal ulceration. Long-term results.

    abstract::In the years 1960 through 1966, vagotomy and pyloroplasty was performed for duodenal ulceration in 182 patients. Elective operation was performed in 84% of cases, and intractability of symptoms was the major indication. For emergency operations, bleeding was the main indication. Eight of 182 patients died in the posto...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:

    authors: Pemberton JH,van Heerden JA

    更新日期:1980-01-01 00:00:00

  • Acute lymphocytic leukemia in adults: a retrospective study and analysis of current management options.

    abstract:OBJECTIVE:To examine current therapeutic modalities for acute lymphocytic leukemia (ALL) in adults, analyze prognostic variables, and offer treatment recommendations. DESIGN:We reviewed our experience with 90 adult patients with ALL examined at the Mayo Clinic between 1982 and 1992 and used it as a background for disc...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)61817-5

    authors: Ho TC,Tefferi A,Su JQ,Litzow MR,Hoagland HC,Noël P

    更新日期:1994-10-01 00:00:00

  • Evaluation of quaternary aminoethyl-Sephadex A50 column chromatography for detection of anti-cytomegalovirus immunoglobulin M.

    abstract::The sensitivity of an indirect fluorescent antibody (IFA) test (screening test) for the detection of antibodies to cytomegalovirus (CMV) was examined by using 128 serum specimens and quaternary aminoethyl (QAE)-Sephadex A50 column chromatography to separate IgM from IgG class antibodies. Of these 128 rheumatoid factor...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)65437-8

    authors: Elder BL,Shelley CD,Smith TF

    更新日期:1987-05-01 00:00:00

  • Frequency and Appropriateness of Fasting Orders in the Hospital.

    abstract:OBJECTIVE:To evaluate the frequency and appropriateness of nil per os (nothing by mouth) (NPO) orders and determine the number of meals missed because of these orders among hospitalized patients. PATIENTS AND METHODS:We retrospectively analyzed inpatient NPO orders at an academic institution in the United States. The ...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/j.mayocp.2015.07.013

    authors: Sorita A,Thongprayoon C,Ahmed A,Bates RE,Ratelle JT,Rieck KM,Devalapalli AP,Issa M,Shah RM,Lalama MA,Wang Z,Murad MH,Kashiwagi DT

    更新日期:2015-09-01 00:00:00

  • Association Between Public Trust and Provider Specialty Among Physicians With Financial Conflicts of Interest.

    abstract:OBJECTIVES:To characterize public perception of physicians' conflicts of interest (COIs) across medical and surgical specialties. PATIENTS AND METHODS:A cross-sectional 6-arm randomized survey of a nonprobability sample from Amazon's Mechanical Turk occurred on December 11 to 16, 2018. Survey respondents were randomly...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/j.mayocp.2019.07.009

    authors: Niforatos JD,Chaitoff A,Mercer MB,Yu PC,Rose SL

    更新日期:2019-12-01 00:00:00

  • Congenital absence of the portal vein.

    abstract::A 4 1/2-year-old girl is described in whom the portal vein is absent and the venous return from the gastrointestinal tract, spleen, and pancreas is through the left renal vein into the inferior vena cava. She had a hepatoblastoma, which was treated surgically by right hepatic lobectomy. Regeneration occurred in the re...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:

    authors: Marois D,van Heerden JA,Carpenter HA,Sheedy PF 2nd

    更新日期:1979-01-01 00:00:00

  • Effect of aspirin and antiplatelet drugs on the outcome of the fecal immunochemical test.

    abstract:OBJECTIVE:To evaluate the effect of aspirin and nonaspirin antiplatelet agents (NAAAs) on the performance of the fecal immunochemical test (FIT). PARTICIPANTS AND METHODS:We performed a post hoc analysis of results from a clinical trial that involved 28,696 asymptomatic average-risk men and women aged 50 to 69 years i...

    journal_title:Mayo Clinic proceedings

    pub_type: 临床试验,杂志文章

    doi:10.1016/j.mayocp.2013.04.016

    authors: Bujanda L,Lanas Á,Quintero E,Castells A,Sarasqueta C,Cubiella J,Hernandez V,Morillas JD,Perez-Fernández T,Salas D,Andreu M,Carballo F,Bessa X,Cosme A,Jover R,COLONPREV Study Investigators.

    更新日期:2013-07-01 00:00:00

  • Prognostic Significance of Holter Monitor Findings in Patients With Light Chain Amyloidosis.

    abstract:OBJECTIVE:To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. PATIENTS AND METHODS:We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. RESULTS:Holter testing was don...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/j.mayocp.2018.08.039

    authors: Sidana S,Tandon N,Brady PA,Grogan M,Gertz MA,Dispenzieri A,Lin G,Dingli D,Buadi FK,Lacy MQ,Kapoor P,Gonsalves WI,Muchtar E,Warsame R,Kumar SK,Kourelis TV

    更新日期:2019-03-01 00:00:00

  • Comparison of analgesic requirements after liver transplantation and cholecystectomy.

    abstract::In a prospective study of 10 patients who underwent liver transplantation and 10 patients who underwent cholecystectomy, we analyzed the postoperative analgesic requirements and the resultant plasma morphine concentrations. Analgesia was more intense, with less medication, and the plasma morphine concentration was sig...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)65257-4

    authors: Eisenach JC,Plevak DJ,Van Dyke RA,Southorn PA,Danielson DR,Krom RA,Nagorney DM,Rettke SR

    更新日期:1989-03-01 00:00:00

  • Chest pain in a young woman.

    abstract::Chest pain in a young person is often caused by chest wall tenderness, associated with mitral valve prolapse, or attributed to psychologic factors. Ischemic cardiac pain may be overlooked because of its rare occurrence in this age group. A 35-year-old woman complained of substernal chest pressure precipitated by exert...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)64859-9

    authors: Click RL,Spittell JA Jr,Puga FJ

    更新日期:1988-04-01 00:00:00

  • The clinical significance of Bence Jones proteinuria.

    abstract::The detection of monoclonal light chains in the urine by the Bence Jones heat test is a useful adjuvant to the diagnosis of myeloma and other related diseases. The test is particularly helpful when no serum spike is noted. Overall, it is positive in approximately half of all patients with myeloma. In order to assess t...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:

    authors: Perry MC,Kyle RA

    更新日期:1975-05-01 00:00:00

  • Assessment of patients who have experienced anaphylaxis: a 3-year survey.

    abstract:DESIGN:A quality-control retrospective review of medical records was conducted for cases of anaphylaxis encountered at Mayo Clinic Rochester during a 3 1/2-year period. PATIENTS:For inclusion in the study, all patients had to manifest general symptoms of mediator release such as generalized pruritus, urticaria, angioe...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)61606-1

    authors: Yocum MW,Khan DA

    更新日期:1994-01-01 00:00:00

  • A computerized simulator for critical-care training: new technology for medical education.

    abstract::A patient simulator has been developed for training, certification, modeling, and demonstrating problems in the management of critical-care patients. The Critical Care & Hemodynamic Monitoring Training System consists of a personal computer, software, and a replica of a human torso designed to enable students to pract...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)65158-1

    authors: Saliterman SS

    更新日期:1990-07-01 00:00:00

  • Antiproliferative effect of the somatostatin analogue octreotide on growth hormone-producing pituitary tumors: results of a multicenter randomized trial.

    abstract:OBJECTIVE:To determine and quantify the in vivo effects of octreotide on the cell cycle kinetics of growth hormone-producing pituitary adenomas. DESIGN:A multicenter randomized trial had been conducted to assess the clinical efficacy of octreotide, and we studied tissue specimens from pituitary macroadenomas in 32 pat...

    journal_title:Mayo Clinic proceedings

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1016/S0025-6196(11)63358-2

    authors: Thapar K,Kovacs KT,Stefaneanu L,Scheithauer BW,Horvath E,Lloyd RV,Li J,Laws ER Jr

    更新日期:1997-10-01 00:00:00

  • Surgical technique and pitfalls of breast reconstruction immediately after mastectomy for carcinoma: initial experience.

    abstract::Breast reconstruction immediately after mastectomy is being used with increasing frequency. In a study of the first 100 consecutive patients at our institution who underwent this procedure, with (21 patients) or without (79 patients) later nipple reconstruction, 85% responded affirmatively on a follow-up questionnaire...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)62440-9

    authors: van Heerden JA,Jackson IT,Martin JK Jr,Fisher J

    更新日期:1987-03-01 00:00:00

  • Quality of life in 650 lung cancer survivors 6 months to 4 years after diagnosis.

    abstract:OBJECTIVE:To present the results of a quality-of-life (QOL) assessment performed with the current version of the Lung Cancer Symptom Scale (LCSS) questionnaire in a large single-institutional data set of 650 patients with lung cancer. PATIENTS AND METHODS:The study group included 650 patients with pathologically confi...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.4065/79.8.1024

    authors: Svobodník A,Yang P,Novotny PJ,Bass E,Garces YI,Jett JR,Bonner JA,Sloan JA

    更新日期:2004-08-01 00:00:00

  • Diagnosis and management of Waldenström macroglobulinemia: Mayo stratification of macroglobulinemia and risk-adapted therapy (mSMART) guidelines.

    abstract::Waldenström macroglobulinemia is a B-cell malignancy with lymphoplasmacytic infiltration in the bone marrow or lymphatic tissue and a monoclonal immunoglobulin M protein (IgM) in the serum. It is incurable with current therapy, and the decision to treat patients as well as the choice of treatment can be complex. Using...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章,评审

    doi:10.4065/mcp.2010.0304

    authors: Ansell SM,Kyle RA,Reeder CB,Fonseca R,Mikhael JR,Morice WG,Bergsagel PL,Buadi FK,Colgan JP,Dingli D,Dispenzieri A,Greipp PR,Habermann TM,Hayman SR,Inwards DJ,Johnston PB,Kumar SK,Lacy MQ,Lust JA,Markovic SN,Micall

    更新日期:2010-09-01 00:00:00

  • The epidemiology of skin and skin-related diseases: a review of population-based studies performed by using the Rochester Epidemiology Project.

    abstract::In Olmsted County, Minnesota, population-based epidemiologic research studies are possible because of a unique medical records linkage system, the Rochester Epidemiology Project (REP), which has been in place for almost half a century. We present a summary of epidemiologic data describing the incidence of skin disease...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章,评审

    doi:10.1016/j.mayocp.2013.08.018

    authors: Andersen LK,Davis MD

    更新日期:2013-12-01 00:00:00

  • Efficacy of brief couples support groups developed to manage the stress of in vitro fertilization treatment.

    abstract:OBJECTIVE:To assess the efficacy of brief couples support groups offered concurrently with in vitro fertilization (IVF) treatment. PATIENTS AND METHODS:Couples in IVF treatment were given the option of participating in a biweekly support group at the IVF clinic at Wilford Hall Medical Center, San Antonio, Tex. At leas...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.4065/77.10.1060

    authors: McNaughton-Cassill ME,Bostwick JM,Arthur NJ,Robinson RD,Neal GS

    更新日期:2002-10-01 00:00:00

  • Allergic granulomatosis and angiitis (Churg-Strauss syndrome). Report and analysis of 30 cases.

    abstract::The clinical and morphologic findings of allergic granulomatosis and angiitis of Churg and Strauss in 21 men and 9 women were reviewed. The classic features are those of systemic vasculitis in a setting of bronchial asthma and eosinophilia. Pathologically there is necrotizing vasculitis of small arteries and veins wit...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:

    authors: Chumbley LC,Harrison EG Jr,DeRemee RA

    更新日期:1977-08-01 00:00:00

  • Influence of recent advances in medical management on clinical outcomes of cirrhosis.

    abstract::Cirrhosis and its disease-related complications are the 12th leading cause of mortality among U.S. adults and are the 5th leading cause of death for individuals aged 45 to 54 years. Hospitalization costs for disease-related complications are estimated at 18,000 dollars per episode of care, and 10% of admitted patients...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章,评审

    doi:10.4065/80.11.1501

    authors: Talwalkar JA,Kamath PS

    更新日期:2005-11-01 00:00:00

  • Prevalence of use of herbal products by adults in the Minneapolis/St Paul, Minn, metropolitan area.

    abstract:OBJECTIVES:To document the prevalence of use of herbal products among adults in a large metropolitan area and to examine issues surrounding such use. SUBJECTS AND METHODS:Of people aged 18 years and older residing in the Minneapolis/St Paul, Minn, metropolitan area, 752 were randomly selected from Minnesota Department...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.4065/76.7.688

    authors: Harnack LJ,Rydell SA,Stang J

    更新日期:2001-07-01 00:00:00

  • High Exercise Capacity Attenuates the Risk of Early Mortality After a First Myocardial Infarction: The Henry Ford Exercise Testing (FIT) Project.

    abstract:OBJECTIVE:To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI). PATIENTS AND METHODS:This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwe...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/j.mayocp.2015.11.012

    authors: Shaya GE,Al-Mallah MH,Hung RK,Nasir K,Blumenthal RS,Ehrman JK,Keteyian SJ,Brawner CA,Qureshi WT,Blaha MJ

    更新日期:2016-02-01 00:00:00

  • The incidence and prevalence of myoclonus in Olmsted County, Minnesota.

    abstract:OBJECTIVE:To study the incidence and prevalence of diagnosed myoclonus in Olmsted County, Minnesota. Little is known about the frequency and distribution of myoclonus in the general population. DESIGN:Descriptive study with case ascertainment through a records-linkage system. PATIENTS AND METHODS:We used a medical re...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.4065/74.6.565

    authors: Caviness JN,Alving LI,Maraganore DM,Black RA,McDonnell SK,Rocca WA

    更新日期:1999-06-01 00:00:00

  • Diagnosis and treatment of viral myocarditis.

    abstract::Myocarditis, an inflammatory disease of heart muscle, is an important cause of dilated cardiomyopathy worldwide. Viral infection is also an important cause of myocarditis, and the spectrum of viruses known to cause myocarditis has changed in the past 2 decades. Several new diagnostic methods, such as cardiac magnetic ...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章,评审

    doi:10.1016/S0025-6196(11)60670-8

    authors: Schultz JC,Hilliard AA,Cooper LT Jr,Rihal CS

    更新日期:2009-11-01 00:00:00

  • Assessment of functional gastrointestinal disease: the bowel disease questionnaire.

    abstract::A need exists for a self-report questionnaire that reliably and accurately measures symptoms and that distinguishes patients with functional gastrointestinal disease from those with other conditions. We have developed such an instrument, the bowel disease questionnaire, and herein describe details of its discriminator...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)62169-7

    authors: Talley NJ,Phillips SF,Wiltgen CM,Zinsmeister AR,Melton LJ 3rd

    更新日期:1990-11-01 00:00:00

  • Apparent skepticism: capital punishment and medical evidence.

    abstract::In recent cases on the constitutionality of sentencing to death criminals who were younger than 18 years of age at the time of their crimes or who are mentally retarded, the US Supreme Court has rejected medical evidence that such persons categorically possess diminished culpability. Rather, the Court has accepted the...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/s0025-6196(12)60023-8

    authors: Helminski F

    更新日期:1993-01-01 00:00:00

  • Maternal inactivity: 45-year trends in mothers' use of time.

    abstract:OBJECTIVE:To examine 45-year trends in time use and physical activity energy expenditure (PAEE) in a nationally representative sample of US mothers. PARTICIPANTS AND METHODS:We quantified time allocation to physical activity (PA), sedentary behaviors (SED), and PAEE from 1965 to 2010 in mothers with older children (MO...

    journal_title:Mayo Clinic proceedings

    pub_type: 杂志文章

    doi:10.1016/j.mayocp.2013.09.009

    authors: Archer E,Lavie CJ,McDonald SM,Thomas DM,Hébert JR,Taverno Ross SE,McIver KL,Malina RM,Blair SN

    更新日期:2013-12-01 00:00:00