100% of maximal perfusion, 4 = 0-25% of maximal perfusion). Ratings for 
comparable lung regions will be compared. 
Pulmonary Function Tests: Oxygen saturations will be measured in room air using a Nellcor 
pulse oximeter. Spirometry, flow volume loops, and lung volumes by whole body plethysmog- 
raphy will be measured on the Medical Graphics 1070/1085 system. This system is located in 
the divisional pediatric pulmonary function laboratory (ASB-4). The mouthpiece, tubing, and 
protective filter will be discarded after use. The protective filter (PALL Protec filter model PF- 
30S) has a pore size of 0.1/x and protects the spirometer from contamination. 
The PFT technicians will wear eye shields, fine particle respirators, gowns, and gloves 
while performing the test. 
Bronchoscopy: Bronchoscopy will be performed using a 4.7 mm Olympus fiberoptic 
bronchoscope. Patients will receive intravenous sedation with midazolam and Demerol 
according to standard hospital procedures. The nose will be anesthetized with 2% lidocaine, the 
larynx and vocal cords will be anesthetized with 2% lidocaine, and the lower airways will be 
anesthetized with topical 1% lidocaine. This is a routine clinical procedure in the division; 60- 
70 fiberoptic bronchoscopies are performed by the division each year without significant 
complications. The safety of this procedure is well established. Airway surface fluid and cells 
will be obtained by bronchoalveolar lavage. Briefly, the tip of the bronchoscope will be 
positioned in the same segment of the lobe each time and 20cc of sterile preservative- free saline 
will be injected and then rapidly aspirated and collected in a suction trap. This will be 
performed a total of 5 times. The usual volume of fluid recovered is 40-50% of that 
administered. At the end of the procedure, the other airways will be checked and suctioned free 
of any retained fluid. 
Airway brushings will be obtained using sterile, disposable biopsy brushes and the cells 
from these brushes will be removed into sterile culture medium by shaking. 
Bronchial biopsies will be obtained via the channel of the bronchoscope using fine (2mm) 
biopsy forceps. 
The instruments used for this study will be specially purchased and will not be in general 
use. 
Prevention of cross contamination of infection between patients will be accomplished by 
rigorous cleaning and sterilization of the bronchoscope using procedures as outlined below. 
1. Immediately after use, the suction channel is extensively rinsed with the remaining 
saline or tap water. 
2. As soon as possible, the bronchoscope is cleaned thoroughly with an enzymatic soap 
solution. 
a. Attach suction to suction outlet. Suction enzymatic solution through channel. 
b. Brush the channel several times with a cleaning brush (the enzymatic soap should 
be suctioned through the channel while the brush is in the channel to ensure 
adequate cleaning action). 
c. The main shaft of the bronchoscope is gently washed with a 4x4 and the 
enzymatic soap solution. 
d. Rinse the main shaft and the suction channel with water. 
e. Completely disassemble suction adapter. Using a brush and the enzymatic 
solution, clean the suction adapter and the top end of the suction channel. 
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Recombinant DNA Research, Volume 17 
