Routine Preoperative Examination Research Articles

Facial nerve course in congenital aural atresia – identified by preoperative CT scanning and surgical findings

Conclusions. The facial nerve courses shown by preoperative CT imaging coincide with the surgical findings in most congenital aural atresia cases. CT scanning is critical in evaluation of a patient's candidacy for atresia surgery. Objectives. To evaluate the diagnostic value of preoperative CT scanning of the facial nerve course in congenital aural atresia. Subjects and methods. All inpatients (135 cases) with congenital aural atresia had routine preoperative CT examination. The facial nerve courses were observed in the operation and compared with the preoperative CT imaging. Results. CT imaging showed that the mastoid portions of the facial nerves in 57% of cases (77/135) were located at the level of the round window, and 17% (23/135) were located at the levels of the oval window and the cochlea. Differential overlapping of the oval window by the facial nerve could also be shown in most of the cases. In the majority of cases (75%, 61/81) the tympanic portions of the facial nerve on CT imaging could be confirmed by surgical findings. In severe overlapping of the oval window or cases with anterior displacement, stapedectomy or tympanoplasty, respectively, could not be performed as usual.

Prolonged cardiac arrest unveiled silent sick sinus syndrome during general and epidural anesthesia

Patients who have silent sick sinus syndrome (SSS) can show various unexpected arrhythmias during surgery. The severity of these bradyarrythmias is affected by anesthetic methods. We report a unique case of a patient with silent SSS who developed 40 s of asystole under combined general and epidural anesthesia. A 40-year-old woman with no apparent cardiac disease underwent abdominal hysterectomy. General anesthesia was induced and maintained with propofol, fentanyl, and vecuronium combined with thoracic epidural anesthesia. During surgery, severe bradycardia, triggered by peritoneal manipulation, occurred, leading to 40 s of asystole. She was diagnosed as having SSS by a postoperative 24-h Holter electrocardiogram. We propose that the possible existence of SSS should be kept in mind even in a patient who shows no abnormalities on routine preoperative examination, especially in those in whom vagomimetic anesthetic methods are used.

Warfarin-induced skin necrosis after open heart surgery due to protein S and C deficiency

Warfarin-induced skin necrosis is the rare but potentially devastating complication of anticoagulant therapy and commonly occurs in previously undetected C- and S-protein deficient patients. Because routine preoperative examination does not include protein C and S level measurement, detection of these patients preoperatively is generally not possible, which increases the risk of occurrence of this important complication. In this report we present and discuss such a patient, who died from warfarin-induced skin necrosis after coronary artery bypass surgery.

Detection of micrometastases in bone marrow and sentinel lymph nodes of breast cancer patients

Objective To study the sensitivity and clinical significance of HE-staining, IHC and RT-PCR in detecting breast cancer micrometastases in bone marrow and sentinel lymph nodes (SLNs). Methods After general anesthesia, all patients underwent bone marrow puncture and sentinel lymph node biopsy (SLNB) by 1% isosulfan blue, and then HE-staining, IHC and RT-PCR were used to detect micrometastases. Results Of 62 patients with breast cancer whose axillary lymph nodes showed negative HE-staining results, 15 cases presented with positive RT-PCR and 9 cases showed positive IHC results positive in bone marrow micrometastases detection. PT-PCR and IHC showed good uniformity (kappa=0.6945) and there was significant difference in detective rate between these two methods ( X 2=4.1667, P = 0.0412). In SLN samples, 13 showed positive RT-PCR results, while 7 showed positive IHC results. PT-PCR and IHC showed good uniformity (κ=0.6483) and significant difference was also found in detective rate between these two methods ( X 2=4.1667, P = 0.0412). Both bone marrow and SLN samples were RT-PCR positive in 3 cases, which indicated that bone marrow micrometastases did not always accompany SLN micrometastases( X 2=0.067, P = 0.796). Conclusion Even if no axillary lymph node involvement or distant metastases are present in routine preoperative examination, micrometastases can still be detected in bone marrow or SLNs. Because the bone marrow micrometastases and axillary node micrometastses are not present simultaneously, combination test of multiple indicators will detect micrometastases more accurately.

Comparative study between MRI features and pathology in FIGO stage I and II endometrial carcinoma

Abstract To analyze MRI features of FIGO stage I and II endometrial carcinoma and to study the value of MRI in assessing myometrial and cervical invasion of endometrial carcinoma. Thirty patients with surgicopathologically proven endometrial carcinoma were included in this retrospective study. All patients underwent T1-weighted spin-echo, T2-weighted fast spin-echo and dynamic contrast-enhanced fast multiplanar spoiled gradient echo sequences before surgery. The type, signal intensity and enhancement features of the tumors and the appearance of junctional zone or subendometrial enhancement were analyzed. The MRI diagnosis of myometrial and cervical invasion was correlated with pathologic findings. Endometrial carcinoma demonstrated diffuse widening of endometrial stripe (n=14) or polypoid or large mass in the endometrial cavity (n=16). The tumors were usually isointense relative to the myometrium on T1WI and hyperintensity on T2WI. In the first phase of dynamic contrast-enhanced sequences, diffuse endometrial carcinoma usually showed mild (n=8) or moderate (n=5) enhancement, while focal endometrial carcinoma tended to enhance markedly (n=6) or moderately (n=9). On T2WI junctional zone was seen in 18 cases. On dynamic contrast-enhanced images subendometrial enhancement was seen in 17 cases. The sensitivity, specificity and diagnostic accuracy of dynamic contrast-enhanced images in combination with T2WI were 87.5%, 95.5% and 93.3% for assessing deep myometrial invasion, and 75%, 95.5% and 90% for assessing cervical invasion. MRI is accurate and reliable in the evaluation of myometrial and cervical invasion of endometrial carcinoma, and should be performed as preoperative routine examination.

Usefulness of Routine Preoperative Examinations in Children Undergoing Elective Minor Surgery

Usefulness of Routine Preoperative Examinations in Children Undergoing Elective Minor Surgery

The Foreign Body Granuloma Of A Plant Thorn Preoperatively Detected By Ultrasonography

We report herein a case of a small foreign body granuloma that was detected preoperatively by ultrasonography in spite of the patient's unawareness of injury by a plant thorn. We propose that high-performance ultrasonography is valuable for routine preoperative examination of soft tissue tumors even if they are tiny in size.

Randomized clinical trial of routine preoperative duplex imaging before varicose vein surgery

Duplex imaging is used increasingly for preoperative evaluation of varicose veins, but its value in terms of the long-term results of surgery is not clear. Patients with primary varicose veins were randomized to operation with or without preoperative duplex imaging. Reoperation rates, clinical and duplex findings were compared at 2 months and 2 years after surgery. Two hundred and ninety-three patients (343 legs) had varicose vein surgery after duplex imaging (group 1; 166 legs) or no imaging (group 2; 177 legs). In 44 legs (26.5 per cent), duplex examination suggested a different surgical procedure than had been considered on clinical grounds; the procedure was changed accordingly for 29 legs. At 2 months, incompetence was detected at the saphenofemoral or saphenopopliteal junction (or both) in 14 legs (8.8 per cent) in group 1 and in 44 legs (26.5 per cent) in group 2 (P < 0.001). At 2 years, two legs (1.4 per cent) had undergone or were awaiting reoperation in group 1, and 14 legs (9.5 per cent) in group 2 (P = 0.002). In the remainder, major incompetence was found in 19 legs (15.0 per cent) in group 1 and in 53 (41.1 per cent) in group 2 (P < 0.001). Routine preoperative duplex examination led to an improvement in results 2 years after surgery for patients with primary varicose veins.

Difficult Tracheal Intubation Due to Lingual Tonsillar Hypertrophy: A case report

Lingual tonsillar hypertrophy (LTH) is a rare and dangerous condition in the management of the upper airway. It is not detectable from the history or on routine preoperative physical examination. Enlarged lingual tonsils can cause posterior displacement. A 56 year old man was scheduled for emergency laryngeal microscopic surgery for the removal of a throat foreign body. After the induction of general anesthesia, intubation with a rigid laryngoscope was impossible due to LTH. After recovery of self respiration, the endotracheal tube intubation was possible by the combined use of a laryngoscope, Magil forceps and fiberoptic bronchoscope.

脊椎手術後に発症した冠動脈狭窄の２例

Ishemic heart disease including myocardial infarction is one of the most serious perioperative complications. We experienced two cases of ischemic heart disease due to abrupt arrhythmia after spinal surgery. One case showed ventricular fibrillation soon after surgery and the other showed atrial premature contraction two days after surgery on electrocardiogram. Although they did not present any abnormal findings on routine preoperative examinations (chest x-ray radiograph, electrocardiogram, and echocardiogram), constriction of the coronary artery was indicated by postoperative angiography. They were treated by coronary artery bypass graft and completely recovered without after-effects.Patients with spinal disorders seldom display symptoms of myocardial ischemia because of reduced daily activities in terms of motor dysfunction. On the other hand, positional changes under unstable cardiovascular dynamics during surgery may have possibility to induce the ischemic responses of heart muscles. In other words, it is extremely difficult to make the accurate diagnosis of myocardial ischemia preoperatively and is critical once it occurrs.We should bear in mind that asymptomatic myocardial ischemic patients who do not show any abnormal findings in usual preoperative screening do exist when attempting spinal surgery.

Multidetector CT arteriography with volumetric three-dimensional rendering to evaluate patients with metastatic colorectal disease for placement of a floxuridine infusion pump.

We sought to evaluate the usefulness of multidetector CT (MDCT) arteriography with volumetric three-dimensional (3D) rendering to depict the hepatic vascular anatomy. Our study population was patients who had undergone arterial mapping in preparation for placement of a hepatic arterial floxuridine infusion pump for treatment of metastatic hepatic colorectal carcinoma. We retrospectively reviewed the medical records of 26 patients with hepatic colorectal metastases who had been scheduled for implantation of a hepatic artery pump. Before surgery, all patients underwent MDCT arteriography with volumetric 3D rendering of the hepatic vessels. The axial and 3D arteriograms were evaluated for their usefulness in depicting hepatic arterial anatomy. Subsequently, three patients also underwent catheter angiography. Twenty-two of the 26 patients imaged had a hepatic artery floxuridine infusion pump implanted. Results of the CT arteriography were correlated with findings at surgery or on catheter angiography if surgery was not performed. MDCT arteriography correctly revealed hepatic arterial anatomy in all 25 patients with angiographic or surgical confirmation. One patient with aberrant hepatic arterial anatomy did not have angiographic or surgical confirmation. Classic hepatic arterial anatomy was identified in 16 (64%) of 25 patients. The following hepatic arterial variants were found in one patient each: the common hepatic artery arising directly from the aorta; a replaced left hepatic artery; an accessory right hepatic artery; a replaced left hepatic artery and accessory right hepatic artery; a replaced right hepatic artery; a right hepatic arterial branch arising early (before the origin of the gastroduodenal artery); and replaced right and left hepatic arteries. Three patients were not suitable candidates for placement of a hepatic artery floxuridine pump. The patient who had no angiographic or surgical confirmation was also not considered a good surgical candidate because of replaced right and left hepatic arteries. Two patients (8%) had an accessory left hepatic artery. MDCT arteriography with volumetric 3D rendering is an accurate, noninvasive method of depicting hepatic arterial anatomy and, therefore, of selecting patients with colorectal metastatic disease who could benefit from hepatic artery pump implantation. Catheter angiography provides no additional information, and we have eliminated it as a routine preoperative imaging examination.

Familial Neurofibromatosis-1 and Gilbert Syndrome

BACKGROUND Neurofibromatosis (NF) is a genetic disorder of the neural sheet, affecting almost all organ systems. METHOD A family that consisted of the father and his three children, two males and one female, having NF-1 is evaluated in detail for cosmetic purposes. The routine preoperative laboratory examinations, including complete blood counts, serum biochemistries, urinary analysis, extremity and chest roentgenograms, ultrasounds of the abdomen and the affected regions, and pelvic computed tomographies, revealed characteristics of NF-1 and unexpected hyperbilirubinemia. The patients are evaluated further for the cause of hyperbilirubinemia by the fasting test. Variously localized plexiform neurofibromas of the three children are totally excised. RESULTS The father was affected as a result of a mutation, and his three children had inherited the disease. The father, having subcutaneous neurofibromas, differs from the children, as they have elephantiasis neurofibromatosa. The children had various rare clinical presentations besides disfiguring deformities. Two male patients had retroperitoneal neurofibromas, and one had splenomegaly and osseous changes. Gilbert's disease was diagnosed, interestingly, and coincidentally in the three patients with elephantiasis due to NF-1. DISCUSSION An interesting diagnosis of NF occurring coincidentally with Gilbert's disease in a family is reported. This clinical study is the first report of Gilbert's disease accompanying familial NF.

Cost of routine screening for carotid and lower extremity occlusive disease in patients with abdominal aortic aneurysms

Objective: The burden of clinically relevant noncoronary atherosclerotic occlusive disease in patients with abdominal aortic aneurysms (AAAs) is poorly defined. Furthermore, the cost-effectiveness of routine versus selective preoperative noninvasive examination of the carotid and lower extremity arterial beds has not been established in patients who undergo elective AAA repair. Methods: Diagnostic vascular laboratory study results were reviewed in 206 patients who underwent evaluation before AAA repair from 1994 to 1998. The patients underwent routine preoperative carotid duplex scan examinations and lower extremity Doppler scan arterial studies with ankle-brachial index (ABI) determinations. The medical records were reviewed for the identification of clinical evidence consistent with cerebrovascular or lower extremity arterial occlusive disease. The costs of routine screening and selective screening were determined with Medicare reimbursement schedules. Results: The prevalence rate of advanced (80% to 100%) carotid artery stenosis (CAS) was 3.4%, and 18% of the patients had CAS between 60% and 100%. Advanced peripheral vascular occlusive disease (PVOD; ABI, <0.3) was found in 3% of the patients, and 12% of the patients had an ABI of less than 0.6. Most patients with advanced CAS (71%) or advanced PVOD (83%) had clinical indications of their disease. The absence of clinical evidence of disease had a negative predictive value of 99% for both advanced CAS and PVOD. The cost of routine screening for all patients for advanced CAS was $5445 per case. Routine screening for severe PVOD costs were $3732 per case discovered. In contrast, the costs for selective screening for advanced CAS or PVOD in patients with appropriate history or symptoms were $1258 and $785 per case found, respectively. Conclusion: Routine noninvasive diagnostic testing for the identification of asymptomatic CAS and PVOD in patients with AAA may not be justified. Preoperative screening is more clearly indicated for patients with AAAs who have clinical evidence suggestive of CAS or PVOD. (J Vasc Surg 2002;35:754-8.)

COMPARATIVE STUDY OF HELICAL CT SCAN ANGIOGRAPHY AND CONVENTIONAL ARTERIOGRAPHY FOR EVALUATION OF LIVING RENAL TRANSPLANT DONORS

291 OBJECTIVES: Conventional arteriography is the most invasive examination for the evaluation of potential renal transplant donors, but this technique is still used as the routine preoperative examination before renal transplantation. This prospective study was designed to assess if the helical CT scan could be a potential substitute for conventional renal arteriography in the evaluation of kidney transplant donors. PATIENTS AND METHODS: Renal transplant donors and patients with renovascular disease were included in this study. All these patients underwent helical CT angiography (HCTA) and conventional renal angiography (CA). The findings obtained by HCTA were compared with those of CA. We defined the criteria to judge visualizability of renal vessels, as well visualized (WV), poorly visualized (PV), and non-visualized (NV). The renal vessels defined as WV could be clearly identified and those as PV could also be identified, but not clearly. We checked the main renal arteries, main branches, and aberrant vessels, and pathological conditions, such as stenosis and aneurysms. Fifty-four renal units in 27 patients were evaluated in this study. RESULTS: With HCTA main renal arteries were WV in 51 of 54 (94.45%) renal units and 3 (5.5%) were PV. The main artery was detectable in all renal units. Using CA, 47 of 54 (87.03%) main arteries were WV, and 7 of 54 (13%) were PV. Also, CA detected all the main arteries. The main branches of the renal artery were WV by HCTA in 38 of 54 (70.37%) renal units, PV in 14 (25.92%) renal units and NV in two renal units (3.7%). CA showed WV images in 47 of 54 renal units (87.03%), PW in 6 (11.11%) renal units and in one case the main branches could not be visualized (1.85%). Stenosis was shown by HCTA as follows: WV in 4 of 6 (66%) renal units, PV in one (16.6%) and the remaining unit was not proven (16.6%). CA visualized well 4 of 6 (66%) stenoses, one was PV (16.6%) and one was not proved (16.6%). For renal artery aneurysms, HCTA showed WV in 5 of 7 (71.4%) renal units and NV in the other 2 units. In one renal unit the lesion was in the renal parenchyma, and in an other renal unit the renal artery aneurysm was occupied by a thrombus. CA showed WV in 3 of 7 (42.8%) renal units, PV in 2 renal units (28.5%), and in 2 renal units the lesion could not be visualized (28.5%). Aberrant vessels and early branches as shown by HCTA were WV in 100% of the 10 renal units. Among these 10 renal units, CA showed WV in 5 (50%) renal units, PV in 4 (40%) and in one unit it did not prove the existence of a polar artery (10%). A comparison of the two methods with surgery showed that HCTA was 96.94% sensitive and CA was 96.18% sensitive. As a final result of both methods, CA showed WV details in 80.91% renal units, PV in 15.26% and NV in 3.81%. HCTA showed WV in 82.44% of the renal units, PV in 13.74% and NV in 3.05%. CONCLUSIONS: The percentage of WV, PV and NV showed by CA was quite similar with HCTA, being slightly advantageous in terms of visualizability of the renal artery and abnormal vessels. HCTA is less invasive than CA, it has at least the same performances and our study suggests that it could be a suitable replacement for conventional renal arteriography for the evaluation of potential kidney donors.

Angiographically assisted helical CT of the liver.

T he sensitivity of CT in the detection of liver tumors is high when contrast material is directly delivered to either the liver parenchyma or the tumors using an angiographic technique I I , 2]. CT hepatic arteriography alone has not been established as a routine preoperative examination because of the high prevalence of perfusion abnormalities resulting from replaced or anomalous hepatic arteries or from hemodynamic changes caused by hepatic neoplasms or cirrhosis I 11. Researchers have described the usefulness OfCT during arterial portography (CTAP) in the preoperative workup of patients with suspected liver malignancy 121.Although the recent development of helical biphasic contrast-enhanced CT with IV bolus injection of contrast material has obviated the need for more invasive angiographically assisted CT in many patients with unresectable malignant tumors or benign lesions, we still believe that angiographic CT is indispensable in patients before potential liver resection. The superiority of CTAP to helical biphasic contrast-enhanced CT in the diagnosis of hepatocellular carcinoma (HCC) has been described [31. Angiographically assisted CT has the ability to show subtly altered vascularity in tumors, which is not satisfactorily shown with helical biphasic contrast-enhanced CT. However, CTAP has limitations, especially regarding detection of HCC in patients with cirrhosis. The accuracy of angiographically assisted CT for liver tumors is improved by the use of Cf arteriography and CTAP combined [4, 51This pictorial essay points out potential diagnostic pitfalls and shows findings of CT arteriography and CTAP combined for imaging various neoplastic processes ofthe liver.

甲状腺腫ようの術前検査

Fifty patients were treated surgically and postoperative pathological diagnoses were obtained for thyroid tumors resected in our clinic between January 1, 1987 and April 31, 1989. These patients underwent a variety of preoperative examinations (CT, MRI, thallium scintigraphy (T1), and fine needle aspiration (FNA)) by retrospective study. The diagnostic accuracy of these preoperative examination methods showed echo (specificity 80.0%, sensitivity 70.6%), CT (75.0%, 69.2%), MRI (75.0%, 70.0%), T1 (82.4%, 80.4%), and FNA (80.0%, 70.6%). Thirty one patients treated surgically, underwent both echo examination and FNA as routine preoperative examinations, in addition to postoperative pathological diagnosis. In these patients, validity showed positive rate 87.5%, and negative rate 73.3%. These results indicated that echo and FNA as preoperative routine examination methods for the diagnosis of thyroid tumors, showed high diagnostic accuracy, and the potential to reduce both the physical and economic shares of patients.

Screening of F.VIII:C Antibodies by an Enzyme‐Linked Immunosorbent Assay

An enzyme-linked immunosorbent assay (Elisa) method was developed in order to examine prevalence and titer of antibodies directed against the factor VIII coagulant protein (F.VIII:C) in hemophilia A and nonhemophilia A patients. Highly purified F.VIII:C was used as immunosorbent on microtiter plates with a peroxidase-conjugated goat anti human IgG antibody for F.VIII:C antibody detection. Results determined by Elisa were compared with measurements according to the Bethesda method. Initially 24 plasma samples containing an F.VIII:C inhibitory activity ranging from 0 to 7,700 Bethesda units (BU) were analysed. At plasma dilutions of 1:128 the optical density determined by our Elisa measurement and the corresponding BU showed a logarithmic correlation. The coefficient of correlation was r = 0.92 with a standard deviation of 0.002 from the regression curve. Plasma samples were analysed from 53 hemophilia A patients, from 21 nonhemophilia patients with acquired F.VIII:C antibodies and from 460 randomly selected nonhemophilia patients presenting for routine preoperative coagulation examination. F.VIII:C antibody-positive Elisa results and positive BU were found in 7 hemophilia A patients and the 2 patients with a history of acquired F.VIII:C antibodies. Positive Elisa results and negative BU were found in 1 hemophilia A patient and 25 out of 460 nonhemophilia A patients (5.43%) suggesting F.VIII:C antibodies without inhibitory potency on F.VIII:C in these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Screening of F.VIII:C Antibodies by an Enzyme-Linked Immunosorbent Assay

An enzyme-linked immunosorbent assay (Elisa) method was developed in order to examine prevalence and titer of antibodies directed against the factor VIII coagulant protein (F.VIII:C) in hemophilia A and nonhemophilia A patients. Highly purified F.VIII:C was used as immunosorbent on microtiter plates with a peroxidase-conjugated goat anti human IgG antibody for F.VIII:C antibody detection. Results determined by Elisa were compared with measurements according to the Bethesda method. Initially 24 plasma samples containing an F.VIII:C inhibitory activity ranging from 0 to 7,700 Bethesda units (BEJ) were analysed. At plasma dilutions of 1:128 the optical density determined by our Elisa measurement and the corresponding BU showed a logarithmic correlation. The coefficient of correlation was r=0.92 with a standard deviation of 0.002 from the regression curve. Plasma samples were analysed from 53 hemophilia A patients, from 21 nonhemophilia patients with acquired F.VIII:C antibodies and from 460 randomly selected nonhemophilia patients presenting for routine preoperative coagulation examination. F.VIII:C antibody-positive Elisa results and positive BU were found in 7 hemophilia A patients and the 2 patients with a history of acquired F.VIII:C antibodies. Positive Elisa results and negative BU were found in 1 hemophilia A patient and 25 out of 460 nonhemophilia A patients (5.43%) suggesting F.VIII:C antibodies without inhibitory potency on F.VIII:C in these cases. The Elisa method proved to be suitable for F.VIII:C antibody screening in hemophilia and nonhemophilia patients. The Elisa protocol is easy to reproduce.

Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis

This retrospective study was aimed at establishing the importance of the leukocyte differentiated count and not only routine white blood cell count in patients treated with antithyroid drug. From 1975 to September 1992, 77 patients with antithyroid drug-induced agranulocytosis were examined. In 12 patients (15.6%), the total white blood cell (WBC) count was greater than 3000/mm3. Eight of them showed a downward trend in their leukocyte counts (3000-4000/mm3). Consequently, granulocyte counts were measured. Two of the 12 patients had "symptomatic" agranulocytosis detected after the occurrence of infection. Because antithyroid drug-induced agranulocytosis was strongly suspected, granulocyte counts were checked. In the remaining two patients, the total WBC count was 5700/mm3 and 5900/mm3, respectively. One was hospitalized to receive thyroid surgery. Although she was asymptomatic, agranulocytosis was unexpectedly detected on a routine preoperative examination. The other was diagnosed as agranulocytosis by routine WBC and granulocyte count monitoring since June 1989. Correct diagnosis was based on the leukocyte differentiated counts. We concluded that the leukocyte differentiated count and not only routine white blood count was critically important for the correct diagnosis of antithyroid drug-induced agranulocytosis in patients with Graves' disease.

Bronchoscopy during the first month of life

During the 6-year period from 1984 to 1989, 196 bronchoscopies were performed on 132 neonates. The indications were grouped into four categories: (1) difficulties in artificial ventilation or failure to wean the baby from the ventilator (52); (2) other respiratory difficulties (52); (3) audible stridor (16); and (4) routine preoperative or postoperative examination of esophageal atresia patients (12). The most common finding was laryngomalacia or tracheomalacia (31). Other findings were: obstructing tracheal or bronchial granulation or stricture (23), obstructing mucous plug (22), grave tracheobronchitis (11), tracheoesophageal H-fistula (5), laryngeal perforation (3), congenital laryngeal stenosis (2), and complete laryngotracheoesophageal cleft (1). Four patients had miscellaneous pathology. The findings were normal in 30 patients. A therapeutic procedure was included in 99 of the 196 bronchoscopies. Seven serious complications occurred during the operative bronchoscopies, two of them requiring immediate pulmonary surgery. All complications were successfully managed. In contrast, no complications occurred in the 97 purely diagnostic bronchoscopies. In experienced hands, bronchoscopy of the newborn is a safe and useful examination. Complications occur when therapeutic procedures are included. Therefore, operative bronchoscopy should only be performed in conditions in which immediate thoracotomy and pulmonary surgery can be performed.