Methods/Applications : Dafe - Diagnostic Auto Fluorescence Endoscopy

Bronchial carcinoma has become one of the most common cancers.
It is responsible for more cancer-related deaths than cancer of the breast, cancer of the intestine, liver cancer, lymphoma and cancer of the pancreas together. In industrial countries, it is the cause of approximately one third of all cancer deaths in men. While numbers in Germany remain fairly constant among men, the numbers of women with the disease continue to rise.

DAFE -AUTOFOURESENCE SYSTEM TO DETECT EARLY STAGE CANCER AND PRECANCEROUS TISSUE IN THE LUNGS.
OPERATING PROCEDURE AND OR PREPARATION

With the DAFE system from R. WOLF, the basic procedure is identical to that for conventional white-light endoscopy in the bronchial region. No additional preparation is necessary. In contrast to PDD (photodynamic diagnosis), no photosensitisers are necessary to generate the fluorescence.The fluorescence is produced in the body's own molecules, such as riboflavin and is therefore known as autofluorescence.

The extent of a tumour is much easier to recognise than under white light allowing more accurate staging. This is also true when a high-resolution video bronchoscope is used instead of a conventional fibre bronchoscope in white light bronchoscopy [Fuj00]. Especially with intraepithelial lesions, this can be decisive in the choice of therapy (see above) [Ren01].

It is a great advantage of autofluorescence endoscopy – in contrast to PDD (photodynamic diagnosis) – that no medication is required to produce the fluorescence. This avoids a number of potential problems such as the approvals for the medication (known as photosensitisers), the method of administering the medication and the dose, toxicity, fading of the tumour marker, etc.

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Methods / Applications : Bronchoscopy For Children

The most frequent indication requiring the interventions with rigid bronchoscopes in pediatrics is the aspiration of foreign bodies. The aspiration of foreign tracheobronchial bodies is a problem which is found primarily in childhood.
In 90 per cent of the cases children below the age of 15 are concerned, and 80 per cent of the children are below 4 years of age. Boys are affected twice as frequently as girls. There are several reasons for this accumulation within the first years of life. Children do not have a sufficient number of teeth to be able to chew food properly. A lack of co-ordination of the swallowing mechanism leads to frequent choking, thus causing the danger of aspiration. Moreover, there is a desire and continuous curiosity to explore everything that is in the vicinity. A lot of these items are put in the mouth whereby the child is not yet able to differentiate between potentially hazardous things and food. Another danger is the proximity to the ground where a lot of small things can be found.
The primary symptoms may differ considerably. On the one hand, a prolonged bout of coughing may be suspicious, and on the other hand cyanosis (bluish discoloration of the skin due to a lack of oxygen), apnoea (respiratory standstill) and even cardiac arrest may occur. In the US, about 2,000 deaths
occur per year as a consequence of aspiration.
The lethality caused by the aspiration of a foreign body is stated at about 1 per cent in general. Primarily children are concerned, in which a critical displacement of the respiratory tract occurs immediately after the aspiration which renders an adequate treatment impossible or the first-aider is not sufficiently trained for the event. Most frequently sausages, hard sweets, nuts and grapes are the causes of fatal aspiration.
Rigid bronchoscopes are used to remove foreign bodies as well as to examine the deeper passages of the respiratory tract.

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Methods/Applications : Indicators

Despite great efforts in recent decades, it has not been possible to significantly improve the 5-year survival rate of patients with bronchial carcinoma which remains poor at between 10% and 15%.

One reason for this is that with conventional forms of diagnosis (including white light endoscopy), preinvasive (in other words, intraepithelial) lesions cannot be adequately detected and localised [Ken01]. However, it can be assumed that a more or less high proportion of these precancerous lesions will develop into invasive carcinomas. This proportion is considerable with carcinoma in situ [Ven00] but cannot be ignored in cases of medium to severe dysplasia [Ris88].

Especially with the preinvasive lesions (stage 0 according to ISS) the chances of healing with a 5-year survival rate of over 90% must be considered good but diminish dramatically as the disease develops [Tho02].

The reason for the low sensitivity of conventional forms of diagnosis for intraepithelial lesions, on the one hand, is the small size of these lesions which are usually only a few millimetres in diameter (at times even less) and often extend over only a few cell layers [Lam00]. As a result, they cannot always be distinguished from surrounding healthy tissue by their form; in other words by their size and elevation.

On the other hand, differentiation between preinvasive lesions and healthy tissue based on colour is very restricted or even impossible.
As a result, for example, only approximately 30% of existing carcinomas in situ could previously be made visible 30% [Woo83]. With dysplasia, an even smaller proportion must be assumed due to the small dimensions and less conspicuous appearance.

Autofluorescence endoscopy is a great help in dealing with this problem. It leads to a significant improvement in the detection and localisation of intraepithelial lesions [Gou], [Ren01], [Hor99].

By exciting bronchial tissue by exposing it to violet and blue light at a defined wavelength, autofluorescence light is induced in the endogenous fluorophors of the bronchial walls. This radiation is in a waveband lower than that of the applied excitation light. The fluorescent response depends greatly on the state of the tissue (healthy tissue fluoresces strongly, whereas the fluorescence of pathological tissue is weaker) so that it is possible to distinguish early stage cancer and precancerous tissue clearly from healthy tissue, in contrast to conventional white light endoscopy [Zel].

Even tissue with only slight pathological changes stands out clearly from healthy tissue in the fluorescence image.

All patients with suspected preinvasive lesions or microinvasive carcinoma should therefore be examined by fluorescence bronchoscopy.

These include:

  • Patients with known or previously diagnosed lung cancer
  • Patients with lung cancer suspected on the basis of direct symptoms such as haemoptysis, dry cough, chronic or recurrent pneumonia, progressive dyspnoea, etc.
  • Patients with lung cancer suspected on the basis of diagnostic symptoms such as positive sputum cytology, increased tumour marker concentration, X-ray findings, etc.
  • Patients with suspected lung cancer due to their anamnesis 

When collecting the anamnesis, the following aspects should be taken into account:

  • Inhalation smoking, possibly also in conjunction with alcohol abuse
  • occupational influences (exposure to certain hard metals, aromatic hydrocarbons and ionising radiation)
  • predisposing disease (for example tuberculosis)
  • recurrence of a treated pulmonary tumour
  • pulmonary metastasis of an extrapulmonary tumour (possibly already treated)
  • formation of secondary tumours as a sequel to radiation or cytostatic therapy of another tumour 

For autofluorescence endoscopy, the endoscopically accessible bronchial regions and therefore central carcinomas and early forms are of significance.

CONTRAINDICATIONS

Patients who should be excluded from fluorescence bronchoscopic examination are primarily those barred from conventional white light endoscopy.

Also patients

  • who have received photosensitising substances in the preceding three months
  • who have been treated with cytostatic drugs or radiologically in the preceding three months
  • who have been treated chemoprophylactically in the preceding three months.
ADVANTAGES OF THE INDICATIONS

The decisive advantage of autofluorescence endoscopy is that it allows bronchial carcinoma to be visualised and treated at a stage at which the chances of healing are still very good.

Change from white light to autofluorescence with Cursor

It is also possible to detect lesions about which there is still controversy as to whether they should be resected or not (for example slight dysplasia) and to monitor their development during follow up (carcinogenesis). These lesions can, when necessary, be treated early with medication or surgically if malignant growth continues.

In some situations, the detection and localisation of preinvasive lesions (stage 0 according to ISS) also allows the option of employing endobronchial therapeutic methods such as PDT (photodynamic therapy) [Mon90], [McC97], [Fre96], [Fre99] laser therapy [Cav94], cryotherapy [Oze90], therapy with electrocautery [Box98], APC (argon plasma coagulation), brachytherapy [Per97] etc.

In contrast to surgical tumour resection (for example, lobectomy, bilobectomy or even pneumonectomy), which is recommended from ISS stage I onwards [Dom00], firstly most of these procedures can generally be repeated, for example, with recurrences or new occurrences and secondly due to their less invasive character they involve no or comparatively little reduction in quality of life of the patient at least in the medium to long term in many cases. In addition to this, classical surgical resection

  • is firstly not always possible: Some patients, for example, already have severely restricted lung function due to a history of smoking that would further deteriorate to an unacceptable level if the required resection was performed
  • is secondly not always possible to the extent considered ideal based on the diagnosis: For example, a fifth of all patients with a radiologically occult carcinoma already have multicentric lesions [Fuj00].

If the therapy is intended to be curative, postoperative lung function must also be guaranteed.

In surgical resection, a not insignificant risk of mortality must be accepted in the order of several percent for a lobectomy [Lod98] and increasing with the extent of the resection.

A further advantage of autofluorescence endoscopy is that the margins of the tumour can be visualised clearly.

Change from white light to autofluorescence with Cursor

The extent of a tumour is much easier to recognise than under white light allowing more accurate staging. This is also true when a high-resolution video bronchoscope is used instead of a conventional fibre bronchoscope in white light bronchoscopy [Fuj00]. Especially with intraepithelial lesions, this can be decisive in the choice of therapy (see above) [Ren01].

It is a great advantage of autofluorescence endoscopy – in contrast to PDD (photodynamic diagnosis) – that no medication is required to produce the fluorescence. This avoids a number of potential problems such as the approvals for the medication (known as photosensitisers), the method of administering the medication and the dose, toxicity, fading of the tumour marker, etc.

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Methods/Applications : Dafe - Advantages

The DAFE diagnostic autofluorescence endoscopy system from R. WOLF has a number of advantages:

  • Use of a small, light and therefore easy-to-handle camera unit (camera head and zoom lens); the freedom of movement that this permits also makes it possible to use rigid telescopes in the normal fashion.
  • The DAFE system allows the use of competitors' bronchoscopes. Special DAFE adapters are available for these instruments. Nevertheless, to achieve the best picture quality in the DAFE mode (-> picture brightness) the special DAFE bronchoscope from R. WOLF should be the instrument of choice.
  • The DAFE system can, of course, also be used for conventional white light endoscopy – without any restrictions either in handling or in the picture quality. It can also be considered as a completely normal endoscopic system.
  • The changeover between conventional white light endoscopy and DAFE is simple and fast by pressing a footswitch or at the touch of a button on the light source. Changing modes does not involve changing any system components or other measures.
  • To further improve the distinction between healthy tissue and pathological changes, the R. WOLF system goes one step further: A reflection image is superimposed on the pure autofluorescence image in the DAFE mode and both images are then processed in the camera controller.

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Product: Texas Optical Integrated Rigid Bronchoscope Set

Rigid bronchoscopes are used for diagnostic and therapeutic procedures for various indications in the bronchial system. Particularly in the case of foreign bodies or for interventional procedures such as tumor ablation or stent implant, the rigid bronchoscope has gained a reputation as the gold standard. The key factor with these techniques is to ensure that the working channel of the bronchoscope is as large as possible. This enables various forceps and instruments to be easily introduced synchronously or alone. Intubation is also frequently problematic with the rigid bronchoscope tube. An integrated optical view makes introducing the bronchoscope significantly easier.

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Products : Flexible Bronchoscopes

Richard Wolf offers a complete range of flexible fiber and video bronchoscopes. Featuring a high-resolution chip-on-the-tip design, Eye Max video endoscopes are uncompromising in their image quality. They permit examination of tissue in unparalleled detail and color fidelity. Thanks to the ergonomic handle, which has received an IF award, fatigue-free work is possible even during lengthy interventions.
And of course, like all Richard Wolf endoscopes, our flexible bronchoscopes are rugged and reliable.
Why not convince yourself of the advantages of the ingenious ergonomic handle and the optical quality of our bronchoscopes.

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Products : Fdafe – Diagnostic Auto-Fluorescence Endoscopy

Today bronchial carcinoma is one of the most common forms of cancer and is responsible for more cancer deaths than breast cancer, intestinal cancer, liver cancer, lymphomas, and pancreatic cancer combined. In industrialized countries it accounts for around one third of all cancer deaths in men. Whereas the death toll in Germany due to bronchial carcinoma has stopped rising for men, it continues to rise for women.

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Test Product

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Overview

Bronchoscopy can now look back on more than a century of development. In 1897 Professor Kilian, working at a university hospital, succeeded in removing an aspired bone splinter from the right main bronchus of a patient. Today modern bronchoscopy is an essential technique for assessing airway disease.

Richard Wolf offers a complete product range of flexible and rigid bronchoscopes for children and adults. Whether for the removal of foreign bodies or the early detection of lung cancer, our instruments and equipment are designed specifically to meet users’ needs.

Why not convince yourself of the outstanding quality of our bronchoscopy instruments?


ACCESSORIES FOR TRACHEOSCOPY AND BRONCHOSCOPY

Richard Wolf supplies comprehensive instrumentation for tracheoscopy and bronchoscopy.

  • Rigid and flexible endoscopes
  • Tracheoscope- Bronchoscope tubes
  • Trocars
  • Dissectors / Probes
  • Forceps / Scissors
  • Pleura Abrader -Needles
  • Powder Spray
  • Suction-Irrigation-Systems
  • Cannulas
  • Electrodes
  • Endo-Suture

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