A comparison of changes in the mucous glands and goblet cells of nasal, sinus, and bronchial mucosa

A comparison of mucous gland size in the bronchial and nasal mucosa was performed on material from 24 random necropsies. The Reid index and counts of mucous gland acini were used as measures of hypertrophy. In 14 of these cases the relationship between goblet cell hyperplasia in the sinus mucosa and the presence of chronic bronchitis was investigated by comparing the proportion of goblet cells with the corresponding Reid index. No significant correlation was found between nasal and bronchial mucous gland size, and no association was demonstrated between the proportion of goblet cells in the sinus mucosa and the presence of chronic bronchitis as assessed by the Reid index. These findings suggest that a direct association between chronic bronchitis and chronic sinusitis probably does not exist, and that the inclusion of chronic bronchitis in the `sino-bronchial syndrome' is not valid. We feel that this term should be restricted to the association of chronic sinusitis with bronchiectasis or adult pulmonary mucoviscidosis. If either infection or air pollution were the predominant cause of mucous gland hypertrophy, changes similar to those found in the bronchi would be expected in the nose and sinuses. Since our results show they are not found there, then some other factor, such as cigarette smoking, must be responsible.     

Dependence of the incidence of emphysema on smoking history, age, and sex

The relationship between the incidence of emphysema and smoking history, age, sex, and percentage bronchial mucous gland volume is investigated using the series of necropsy cases reported by Ryder, Dunnill, and Anderson (1971). Using those cases originating from hospital, it is shown that the incidence of emphysema is dependent on smoking history, age, and sex. Percentage bronchial mucous gland volume is not related to emphysema when the three other variables have been allowed for. Thus sex has an effect on the incidence of emphysema over and above the difference between the sexes in the occurrence of smoking. It is also shown that it is reasonable to extrapolate these conclusions from hospital necropsy cases to the general population.     

Relation of perceived nasal and bronchial hyperresponsiveness to FEV1, basophil counts, and methacholine response.

Perceived nasal and bronchial hyperresponsiveness to tobacco smoke and cold air were assessed in 912 working men in the Paris area. Baseline lung function measurements and peripheral leucocyte counts with standard differential counts were performed. At least one perceived nasal or bronchial hyperresponsiveness symptom was reported by 15.7%. Current smoking was significantly less frequent among those with cough induced by tobacco smoke. Rhinitis induced by cold air was associated with lower FEV1 (p less than 0.01) and the association remained after adjustment for smoking, asthma, and wheezing (p = 0.06). Symptoms induced by cold air were related to circulating basophils. Neither perceived nasal nor perceived bronchial hyperresponsiveness was significantly related to the airway response to methacholine in a sample of the group (n = 324) surveyed again five years later. The result suggest that the symptom of rhinitis provoked by cold air is a possible "new" risk factor or marker for chronic airflow limitation.     

Bronchial fistula postpneumonectomy: predictive factors

OBJECTIVE: To determine predictive factors of bronchial fistula following pneumonectomy. PATIENTS AND METHODS: In 14 years (1989-2003), we collect 58 cases of bronchial fistula following 725 consecutive pneumonectomy in the service of thoracic surgery of the Sainte Marguerite Hospital in Marseilles. There were 53 cases (91.4%) of cancers and 5 cases (8.6%) of various pathology. The average age of the patients was of 61 +/- 10 years (range 24 to 80 years). The sex ratio M/F was 8.7. The software of regression SPSS (version11.5) was used to identify the factors risk of a bronchial fistula after a univariate and multivariate analysis. RESULTS: The prevalence of the bronchial fistula after a pneumonectomy was 8%.The preoperative factors which increased to a significant degree the incidence of the bronchial dent to the univariate analysis were the chronic smoking (P < 0.001), the existence of COPD (P = 0.001) and of a previous thoracic surgery (P = 0.01). Operational data like a right- side pulmonary resection (P < 0.001), the type of bronchial stup carried out (P = 0.03) as and an extended pneumonectomy to the auricule (P = 0.03) were significant risk factors. With the logistic regression the significant risk factors were the chronic smoking (P = 0.002), the existence of COPD (P = 0.003), a previous pulmonary surgery (P = 0.03) and the right - side of the pneumonectomy (P < 0.001). The indication of the pneumonectomy was retained neither by the univariate analysis, nor by the logistic regression significant risk factors. CONCLUSION: The predictive factors of a bronchial fistula after a pneumonectomy are dominated by respiratory co-morbidities. To prevent this complication, we insist on the stop of the tobacco, a better respiratory preparation and the acquisition of a protocol adapted of the bronchial stub after a pneumonectomy particularly on the right side.     

A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysema

The quantitative anatomy of the bronchi has been studied in sudden deaths in normal subjects, in deaths from status asthmaticus and chronic bronchitis, and in patients with emphysema. In the normal bronchi the observed range of values for the percentage volume of mucous glands was between 7·6 and 16·7. In the status asthmaticus group the mucous gland volume was greatly increased and in no case was there an overlap with the normal subjects. In the 19 cases of chronic bronchitis, two cases had values of 15·2 and 15·4% respectively, but all the others had values higher than the normal range and, in two instances, values of over 40% were obtained. The values obtained for mucous gland volume in the bronchi in emphysema were variable, approximately half being within the normal range. The bronchial smooth muscle accounted for 4·6±2·2% of the volume of the normal bronchial wall. The values obtained in chronic bronchitis and emphysema did not differ significantly from this but in those dying of status asthmaticus there was a very significant increase with a mean value of 11·9±3·36.     

Mucous gland adenoma of the trachea: case report and literature review

Adenoma arising from bronchial mucous glands is extremely rare. Such tumors are truly benign, in contradistinction to other tumors previously grouped under the term "bronchial adenoma." We present the first case reported of mucous gland adenoma arising in the trachea. This case was initially misdiagnosed as asthma, a common error with obstructing tracheo-bronchial lesions.     

Quantitative study of bronchial mucous gland enlargement.

Histological sections from 30 lower lobe bronchi, taken from coalminers' lungs collected for the British National Coal Board's Pneumoconiosis Field Research, were selected according to the proportion of mucous gland area occupying the non-cartilaginous part of the bronchial wall. The total gland area expressed as a percentage of the non-cartilaginous wall was called the gland index. Estimations were made of the total number of gland cells and acini on a section and of their numbers per unit area of gland. These estimations were compared with the gland index. The total numbers of gland cells and acini were found to be directly related to the gland index (r=0.84 and 0.86), whereas no relationship was found between the number of gland cells or acini per unit area of gland and the gland index (r=0.08 and 0.02). This indicates that bronchial mucous gland enlargement is primarily a hyperplastic change. A direct relationship between the numbers of gland cells per unit area of gland and acini per unit area gland was found (r=0.69), and this suggests that acinar enlargement is likely to be caused by accumulation of mucus in the acinar lumen.     

Bronchial gland dimensions in coalminers: influence of smoking and dust exposure.

Bronchi from 94 coalminers were examined for enlargement of the mucous glands. The measurements used were the mean and maximum ratios of gland thickness to wall thickness, the mean acinar diameter, and the ratio of the gland area to the area of the non-cartilaginous portion of the bronchial wall. The relationships between these measurements and the subjects' smoking habits and their past exposure to dust in the coal mines were analysed. Smoking was found to be significantly related to mean and maximum gland-to-wall ratios. In addition, coalmine dust exposure was found to be significantly related to maximum gland:wall ratio. No significant relationships were found between gland dimensions and pneumoconiosis or dust retained in the lung. These results lend support to the view that irritants encountered in an occupational environment may play an important part in the development of hypersecretion of mucus.     

A PATHOLOGICAL study of the lungs and heart in fatal and non-fatal chronic airways obstruction.

The lungs and hearts from 50 patients were examined using morphometric techniques to determine the size of the right ventricle, the amount, type, and distribution of emphysema, the size of the bronchial mucous glands, and the proportion of the lung occupied by small airways of less than 2 mm diameter. The patients were divided into three groups according to the clinical history: 18 died as a result of chronic airways obstruction, 17 had symptoms of chronic chest disease but died from some unrelated cause, and 15 had no symptoms related to the respiratory system. The total amount of emphysema was found to be greater in the fatal than the symptomatic group who in turn had more emphysema than the asymptomatic group. A positive correlation was found between the amount of emphysema and the right ventricular weight. The amount of panlobular emphysema in the lung was found to be greater in the fatal group than in the others but this did not apply to the amount of centrilobular emphysema. The amount of panlobular, but not centrilobular, emphysema showed a positive correlation with right ventricular weight. As the total amount of emphysema increased it was found that there was an increase in each of three zones in the lung-apical, middle, and lower. There was no relationship between the bronchial mucous gland size and either the clinical state of the patients with symptoms or the right ventricular weight. The proportion of lung occupied by the lumen of small airways was significantly reduced in the fatal group as compared to the other two groups and also showed a negative (inverse) correlation with right ventricular weight. The total amount of emphysema, the amount of panlobular emphysema, and reduction in small airways lumen in the lung are the three factors in chronic airways obstruction which are quantitatively related to death in chronic airways obstruction and to right ventricular weight.     

Parenchymal, bronchiolar, and bronchial measurements in centrilobular emphysema: Relation to weight of right ventricle

Measurements of lung parenchyma, membranous bronchioles, and bronchial mucous gland hyperplasia were made on lungs from eight cases of pure centrilobular emphysema (CLE) and on five normal lungs. The lungs were fixed in formalin and inflated under partial vacuum at a standard transpulmonary pressure of +30 cm. H₂O. The results obtained from the upper halves and the lower halves of the lungs were compared. The circulatory effects of the disease were measured by weighing the heart ventricles, by studying the small pulmonary arteries in microscopical sections, and by post-mortem arteriography. Whereas the parenchymal and internal surface areas destroyed by the emphysematous spaces were relatively moderate and localized, right ventricular hypertrophy was noted in most of the cases. In these cases bronchiolar stenoses were found scattered throughout the whole lung and there was a reduction in the number of these bronchioles, mainly in the upper halves of the lungs. In CLE ventilatory disturbances were caused not only by the centriacinar dilated spaces delaying gas diffusion, but also by scattered bronchiolar stenoses situated at the termination of the conducting air passages. The stenoses seemed the more important cause. It was shown statistically that chronic arterial pulmonary hypertension and right ventricular hypertrophy were mainly the result of functional disturbances, especially hypoxia and abnormalities of VA/Q produced by the two structural changes situated at the end of the small airways.     

Treatment of Non-Cystic Fibrosis Bronchiectasis

Bronchiectasis is currently growing in importance due to both the increase in the number of diagnoses made as well as the negative impact that its presence has on the baseline disease that generates it. The fundamental aspects in these patients are the colonization and infection of the bronchial mucous by potentially pathogenic microorganisms (PPM), which are the causes in most cases of the start of the chronic inflammatory process resulting in the destruction and dilatation of the bronchial tree that is characteristic in these patients. The treatment of the colonization and chronic bronchial infection in these patients should be based on prolonged antibiotic therapy in its different presentations. Lately, the inhaled form is becoming especially prominent due to its high efficacy and limited production of important adverse effects. However, one must not overlook the fact that the management of patients with bronchiectasis should be multidisciplinary and multidimensional. In addition to antibiotic treatment, the collaboration of different medical and surgical specialties is essential for the management of the exacerbations, nutritional aspects, respiratory physiotherapy, muscle rehabilitation, complications, inflammation and bronchial hyperreactivity and the hypersecretion that characterizes these patients.     

Bronchial cartilage in chronic bronchitis

An examination has been made of the amount of bronchial cartilage in the subsegmental bronchi of nine chronic bronchitics and seven controls. The axial pathway in four or five representative bronchopulmonary segments were carefully dissected in each lung. In each segment the mean extent of cartilage arranged circumferentially in the walls of the bronchi was significantly less in the chronic bronchitic patient than in the controls. Of the 42 specimens from the various bronchopulmonary segments of the controls, the cartilage was arranged circumferentially to the fifth generation or further in 33, but extended this far in only 14 of the 50 specimens from the chronic bronchitics. Using certain defined criteria, deficiency of cartilage was found in 25 of 50 specimens from 11 lungs of the chronic bronchitics and in only one of 42 specimens from nine control lungs. There was a negative correlation between the degree of bronchial gland enlargement, as measured by the gland/wall ratio, and the average extent of circumferentially arranged cartilage along the bronchi (r=−0·8, p<0·01). Similarly, the number of bronchopulmonary segments affected increased and the average extent of circumferentially arranged cartilage decreased with increase in severity of the bronchitis. We think that the deficiency of bronchial cartilage in chronic bronchitics would favour collapse of the affected bronchi during forceful expiration or cough.     

Sources of pathogens causing pleuropulmonary infections after lung cancer resection.

OBJECTIVE: The source of pathogens responsible for pleuropulmonary complications after lung resection is not yet completely understood, yet knowing this source is very important for proper perioperative use of antibiotics in lung surgery. We studied prospectively the value of sputum samples -- collected 3 days before and 3 days after surgery -- and of intraoperative bronchial swabs in the diagnosis of infective pulmonary complications following lung cancer resection. METHODS: In a prospective trial, we studied 194 patients (18 women and 176 men, age range 34-79 years, mean 57 years) who were operated on for lung cancer. The infection screen consisted of intraoperative bronchial swabs, and sputum samples obtained prior to and 3 days after surgery. Before the operation, all patients were free of clinical signs of respiratory infection. In patients with postoperative infection, causative pathogens were identified from sputum, tracheal aspirate, thoracic puncture and thoracic drainage fluids. RESULTS: Thirty-four patients suffered from 32 pleuropulmonary infections, and two from wound infection. Pathogenic organisms were isolated from preoperative and postoperative sputum samples and from intraoperative bronchial swabs in 50, 64 and 27% of patients, respectively. Postoperative infective complications were caused by gram-negative bacteria and Candida albicans in 75% of patients. These potential pathogens were recovered from preoperative sputum samples and from intraoperative bronchial swabs in only 18 and 13% of cases, but from postoperative sputum samples in 63% of cases. A strong correlation in identified pathogens was found between the postoperative sputum samples and the samples collected for microbiological diagnosis of subsequent postoperative infective complications (P<0.01). CONCLUSIONS: Our results indicate that pathogens that cause pleuropulmonary infective complications are probably acquired postoperatively from the patient's oral cavity, pharynx and hypopharynx. Appropriate antibiotic prophylaxis is discussed.     

Pulmonary atelectasis during anesthesia in a boy with upper respiratory tract infection

A 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy. The main features of his case history were chronic otitis media, bronchial asthma and signs and symptoms of upper respiratory tract infection (persistent runny nose and cough, occasionally with fever). Immediately after tracheal intubation we observed that the right side of the chest failed to rise with inspiration; breathing sounds were absent on the right and hypoxemia developed. A chest film taken in the operating room revealed upper right lobe atelectasis. Surgery was postponed and tracheobronchial lavage was performed with fiberoptic bronchoscopy and aspiration of mucous plugs.Upper airway infections are a common problem in children and increase the risk of respiratory complications during anesthesia. Patients with upper respiratory tract symptoms present a dilemma, and consensus about how to deal with such situations is lacking.We review the literature, discuss the anesthetic implications of upper airway infections, and suggest a two-phase approach for cases such as we report: first myringotomy using general anesthesia and a face mask, and second, once the upper airway infection has resolved, adenoidectomy with general anesthesia and tracheal intubation.     

A clinicopathological study of fatal chronic airways obstruction.

A clinicopathological study of 21 patients who died as a result of chronic airways obstruction was carried out. Thirteen patients had been in right ventricular failure for at least one year before death and the other eight patients did not have right ventricular failure. The patients with long-standing right ventricular failure died at a younger age, on average, than those without failure. There were no significant quantitative differences between the two groups in the length of history of chest disease, blood gas estimations, respiratory function tests or degree of polycythaemia. The group with right ventricular failure had significantly larger mean right and left ventricular weights than the group without failure, but there were no significant differences in amounts of emphysema, size of bronchial mucous glands, proportion of small airways lumen in the lung or number of thick-walled peripheral lung vessels between the two groups. The findings did not support the division of this series of patients, with fatal chronic airways obstruction, into two distinct groups broadly defined as 'emphysematous' and 'bronchitic', either clinically or pathologically. A history of right ventricular failure correlated well with the finding of right ventricular hypertrophy at necropsy. Electrocardiographic evidence of right ventricular hypertrophy was found to correspond with the size of the right ventricle at necropsy in 66% of cases. The radiographic diagnosis of emphysema proved an accurate assessment when compared to the necropsy findings, and radiographic estimations of right ventricular enlargement were accurate in 65% of cases. Histological evidence of acute bronchitis was present in 20 of the 21 patients (95%), and five patients showed histological evidence of minor pulmonary thromboembolism. Ten patients in the series showed an increase in the weight of the left ventricular as well as the right ventricle.     

Effects of airway infection by Pseudomonas aeruginosa: a computed tomographic study

BACKGROUND: Pseudomonas aeruginosa commonly infects the airways of patients with bronchiectasis. A study was undertaken to examine the relationship between infection of the airways with this pathogen, the morphological pattern of bronchiectasis on thin section computed tomographic (CT) scanning, symptom duration, smoking habits of the patients, and the presence of airflow obstruction. METHODS: Thin section CT scans of 22 adult patients with bronchiectasis and concurrent sputum infected by P aeruginosa (Pa +ve) and those of 45 randomly selected patients not infected by P aeruginosa (Pa -ve) were analysed independently by two thoracic radiologists. Patients with cystic fibrosis were excluded. Each scan was scored at a lobar level for extent of bronchiectasis, severity of bronchial wall thickening and dilatation, predominant pattern of bronchiectasis, presence of mucus plugging, and degree of decreased attenuation of the lung parenchyma. RESULTS: The Pa +ve group had more extensive bronchiectasis and a greater degree of bronchial wall thickening and dilatation on the CT scan than the Pa -ve group; more extensive decreased attenuation was seen in the Pa +ve group. These findings were robust on multivariate analysis; decreased attenuation was also independently related to the duration of sputum production. CONCLUSION: Patients with bronchiectasis infected by P aeruginosa have more extensive and severe bronchiectasis on thin section CT scanning than those without P aeruginosa infection. The bronchi and small airways are both involved, reflecting the end result of complex interactions between host airways and the numerous virulence factors produced by P aeruginosa.


     

Prevention of bronchopleural complications in children by the use of Scalpel-1 laser

One of the causes of early postoperative complications in children after surgery for bronchiectases is the development of an abscess of the stump of the resected bronchus due to infection of the bronchial mucous membrane which remains on the stump after manipulations with YK and YO suturing apparatuses. Treatment of the end of the bronchial stump by a focused beam of the "Scalpel-1" laser (power of 100 Wt) leads to coagulation of the mucosa and considerable improvement of the immediate and late-term results of operative treatment of chronic pathological conditions of the lungs in children.     

Convergence of the epidemiology and pathology of COPD

The epidemiology of chronic obstructive pulmonary disease (COPD) has been dominated by one hypothesis stating that cigarette smoking and chronic bronchitis were the key to pathogenesis and another that asthma, chronic bronchitis, and even emphysema are related to different expressions of a primary airway abnormality. The first hypothesis was rejected in the late 1960s based on a longitudinal study of working men where only a fraction of smokers developed COPD and where development of COPD was independent of the absence or presence of chronic bronchitis. Chronic bronchitis in more advanced COPD was subsequently associated with a more rapid decline in lung function and more frequent exacerbations. The second hypothesis is more difficult to test but longitudinal studies have shown that the presence of bronchial hyperresponsiveness may predict the subjects who go on to develop COPD. This brief review attempts to reconcile these findings with the pathology found in the lung.     

Mucous cell adenoma originating from bronchial gland

The clinical and pathological features of a mucous adenoma arising from bronchial gland and manifesting with productive cough and dyspnoea over a period of four years in a 44-year-old male is presented. Origin of the tumour from the proximal part of the bronchial tree necessitated a pneumonectomy with resultant cure.     

A study of the impact of long-term tobacco smoking on postoperative intensive care admission

Smoking is a risk factor for intra-operative pulmonary complications and a wide range of postoperative pulmonary, cardiovascular, infection and wound-related complications. These may all lead to unplanned postoperative intensive care admission. We tested the hypothesis that smokers have an increased incidence of postoperative intensive care admission and more postoperative complications than nonsmokers in a general and orthopaedic surgical population. The following information was assessed in 6026 surgical patients: age, sex and smoking status (pack-years), history of heart and lung disease, American Society of Anesthesiologists (ASA) physical classification, intensive care admission and postoperative complications. Two thousand five hundred and twenty-six (46%) were smokers but for 620 patients (10.3%) smoking status was not confirmed. Postoperative intensive care admission was required by 319 patients (5.3%). Patients with > 50 pack-years were admitted to the intensive care more frequently than were smokers with < or = 50 pack-years history and nonsmokers (p < 0.001). Ex-smokers with > 50 pack-years history had the same risk of postoperative admission to intensive care as smokers with > 50 pack-years history. Smokers admitted to intensive care with > 50 pack-years history had a higher incidence of chronic lung disease (p < 0.005) and heavy alcohol consumption (p < 0.001). These smokers also had a higher incidence of postoperative pulmonary complications (odds ratio = 3.91, p < 0.01). The mortality rate was 37% in smokers with > 50 pack-years history and 24% in nonsmokers (odds ratio = 2.02, p = 0.08). We conclude long-term tobacco smoking (> 50 pack-years) carries a higher risk of postoperative admission to intensive care, and there seems to be a dose relationship between the amount of tobacco consumed and the risk of postoperative intensive care admission.