الفهرس 
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Abstract
Interventional bronchoscopy has rapidly evolved in recent years. The field includes the use of more complex diagnostic procedures such as endobronchial ultrasound, the use of bronchoscopic interventions for the relief of central airway obstruction (CAO) due to malignancy and, more recently, the development of therapeutic interventions for non-malignant disease (Toma et al., 2005).
Flexible bronchoscopy is a well established procedure in pulmonary medicine. It is considered an important tool in the diagnosis, staging, and the therapy of lung cancer and many other varieties of pulmonary diseases (Qullette, 2006).
In current practice, the fibreoptic bronchoscopy is employed in the majority of bronchoscopic procedures. Various diagnostic techniques like endobronchial biopsy, bronchial washing and bronchial brushing are employed during fiber optic bronchoscopy. Studies have confirmed that employing various techniques in combinations increases the diagnostic yield of fiber optic bronchoscopy (Choudhry et al., 1999).
A lot of diagnostic and therapeutic procedures can be performed via rigid bronchoscope. It has a great advantage in case of flooding of the airway by blood and secretions. There are numerous accessory instruments designed for use in rigid bronchoscopy, such as biopsy forceps, foreign body forceps, scissors, rigid-probe for cryotherapy, laser fiber. Flexible bronchoscope can pass through the rigid tube to remove secretion in the distal airway or for other purpose when needed. The rigid bronchoscope is the instrument of choice for most resection procedures of the airway and complicated airway diseases. It offers a secure airway with the ability to ventilate. The rigid tube itself is actually a good instrument of mechanical debridement and airway dilatation. The choice of the tools for de-obstruction depends on the characteristic and the cause of the obstruction (benign versus malignant, endo-luminal versus extrinsic), the availability and the experience of the operator (Dutau and Breen, 2010).
Although most foreign bodies can be removed with flexible bronchoscopy, rigid bronchoscopy is occasionally needed (Sakr and Dutau, 2010).
Rigid and flexible bronchoscopy remain complementary techniques, and most often used concurrently during these procedures (Delage and Marquette, 2010).
The present study was conducted in the period between May 2013 to October 2013 to study the indication and outcome of bronchoscopic work up in bronchoscopy unit, Chest Department, Ain Shams University. All patients underwent either Fiber optic or Rigid bronchoscope were included in this study, they were 100 patients either admitted to chest department or from chest out patient. All the patients were subjected to the following (according to the policy of the bronchoscopy unit, Chest Depatment, AinShams university Hospital): 1. Full history taking. 2. Thorough clinical examination including general and local examination. 3. Radiological work up (conventional CXR or CT Scan). 4. Premedical bronchoscopic assessment including: Arterial blood gases Electrocardiography Routine laboratory investigations: Fiber optic bronchoscope under local anesthesia include: (PT, PTT, INR). Fiber optic and Rigid bronchoscope under general anesthesia include :( CBC, PT, PTT, INR).
Other selected investigations according to the patient co-morbidity.
All patients undergoing fiber optic bronchoscopy (F.O.B) or rigid bronchoscope were subjected to preparations, premedications, procedure itself and sampling either ,biopsy, bronchial lavage, trans bronchial needle aspiration (TBNA), broncho alveolar lavage (BAL) and brushing. They were sixty five male patients representing 65% and thirty five female patients representing 35%. The mean age of patients was 50.92years old (±20.099SD) with a range of a 1 to 88 years old. Most of the patients presented in the 6th decade of life which reflects the morbidity in the higher age group. Fifty six patients 56% were smokers while forty four patients representing (44%) were non smokers. Adenocarcinoma was found in seven patients representing (35%). Four of these patients (representing 20%) were smokers, while the other three patients (representing 15%) were non smokers. Squamous cell carcinoma was diagnosed in six patients (representing 30%), and all of them were smokers. Small cell lung cancer was present in four patients (representing 20%), and all of them were smokers. Large cell lung cancer was diagnosed in three patients (representing 15%) and all of them were smokers.
Fifteen cases (40,54%.) their histopathological results were inflammatory ,non conclusive to malignancy.
The radiological work up of all patients with lung cancer showing abnormalities as eight cases represented with effusion (21,62%), six cases represented with mediastinal LN (16,22%), nine cases represented with mass (24,32%),four cases represented with heterogeneous opacity (10,81%).
In the present study, we found that there was a great correlation between radiological work up such as CT chest and the diagnostic results of the specimens such as lung cancer. Four cases, three males (75%) and one female (25%) were represented by foreign body aspiration, the most common site of FB inhalation was in the RMB (50%), one case in trachea (25%), one case in LMB (25%).
So we can conclude that the RMB is the common site of FB aspiration and bronchoscope is very effective procedure for inhaled foreign body removal with fewer complications and proper use of diagnostic techniques provides a high degree of success.
Two cases were diagnosed as TB in spite of their work up of TB as tuberculin test and sputum Z& N were negative . They diagnosed by broncho alveolar lavage. They underwent bronchoscope because they were highly suspicious for TB by their clinical symptoms and radiological work up.
So we can conclude that the diagnostic role of fiber optic bronchoscope in pulmonary tuberculosis has been established especially in countries where the prevalence of tuberculosis is high.
The complications of bronchoscope in the present study showing that eighty five cases (85%) showing no complications and those who had complications were fifteen cases (15%), four cases (4%) represented with bleeding, eight cases (8%) represented with desaturation, two cases (2%) were mechanical ventilated, and finally one case (1%) represented with surgical emphysema, no mortality was detected. So we can conclude the safety of the bronchoscope and the mortality obviously depends on the accuracy of selection of patients for the procedure and the experience of the bronchoscopist and the facilities available.