Endoscopic occlusion of the bronchial stump in bronchial insufficiency

The results of endoscopic occlusion of the stump of the main bronchus in its insufficiency were studied in follow-up periods of up to 3 years in 27 patients. The indications for the method were developed and the techniques of the occlusion described. Endoscopic occlusion is most expedient and sparing in early insufficiency of the bronchial stump under conditions of acute pyothorax and the presence of complications in a solitary lung. Its application is not opposed to the other commonly used methods of treating bronchial fistulas after pulmonectomy.     

Primary bronchial leiomyosarcoma

Leiomyosarcoma is a malignant neoplasm of smooth muscle and occurs very rarely as a primary tumour in the lung. A case with a rapidly progressive clinical course is berein reported and the diagnostic and therapeutic possibilities discussed.     

Adenocystic bronchial cancer

Among 4005 patients with lung cancer 26 (0.65%) of them had adenocystic bronchial cancer, including 13 male and 13 female patients aged 13 to 60 years. Overall 33 operations have been performed at 26 patients, 5 of them were operated twice, and 1 patient underwent 3 surgical procedures. The plastic operations on bronchi (10) were the main surgical procedures. Four patients underwent pneumonectomy with resection of tracheal bifurcation, and 2 patients - circular resection of primary bronchus with resection of carine and tracheobronchial angle. One patient died after surgery, postoperative complications were seen at 4 patients including hemothorax (1), bleeding (1) and empyema (2). Twenty-five patients have been discharged, 21 of them were followed-up. Three patients survived more 3 years, 6 patients - more 5 years, 8 - more 10 years, 2 - more 15 years, and 2 - more 20 years. Long-term results of radical surgical treatment argue the efficacy of these surgeries at adenocystic bronchial cancer.     

Multifocal bronchial cancer

Since the entire surface of the bronchial mucosa is exposed to carcinogenic stimuli, the possibility of developing multiple primary lung carcinomas must be discussed. Multiple primary lung carcinomas do not necessarily occur simultaneously (synchronous), they can also develop successively (metachronous). They can be localized ipsilateral as well as contralateral, and histologically they have an identical or different character. In our study of 612 patients with bronchogenic carcinoma we found 18 patients (2.9%) to have a synchronous multiple primary carcinoma. The growing clinical relevance of the diagnosis of the multiple primary bronchogenic carcinoma--which is certainly diagnosed to rarely--and the distinction from metastases will be discussed.     

Instrumental bronchial tears

Two case reports of bronchial tears following airway instrumentation are presented, one of which resulted in death. Both patients developed pneumothoraces and other complications after attempts had been made under general anaesthesia to insert bronchial stents. It appeared that bronchial tears were made during instrumentation with the stent introducer and these cases demonstrate that great care should be taken when rigid materials, such as plastic guides and bougies, are used blindly in the airway.     

Traumatic bronchial injury

IntroductionTracheobronchial injury is a recognized, yet uncommon, result of blunt trauma to the thorax. Often the diagnosis and treatment are delayed, resulting in attempted surgical repair months or even years after the injury.Presentation of the caseWe present a case report of a 31-year old female who suffered a left main bronchus transection after a motor vehicle accident. The diagnostic, management issues, and clinical findings surrounding this injury are reviewed.DiscussionTracheobronchial disruption is a rare, life-threatening injury. Suspicion should be high when pneumomediastinum and pneumothorax are refractory to adequate pleural drainage. Flexible bronchoscopy with intubation distal to the injury may be necessary to prevent loss of the airway. Advance preparation should include setups for bronchoscopy, thoracotomy, and cardiopulmonary bypass. Patient survival depends on preparation and prompt surgical intervention.ConclusionA high level of suspicion and the liberal use of bronchoscopy are important in the diagnosis of tracheobronchial injury. A tailored surgical approach is often necessary for definitive repair.     

Normal bronchial healing without bronchial wrapping in canine lung transplantation.

The deleterious effect of steroids on bronchial healing in lung transplantation has led to the development of techniques to protect the anastomosis and to the exclusion of steroid-dependent patients from transplantation. The effect of steroids on bronchial healing was tested in a canine single-lung allotransplantation model. Twenty size-matched mongrel dogs (20 to 30 kg) underwent left lung transplantation without anastomotic wrap or direct revascularization. Postoperatively, all received daily doses of cyclosporine (15 mg/kg) and azathioprine (1 mg/kg) and were subdivided into three steroid dosage groups. Group A (n = 10) animals received 1.5 mg/kg of prednisone per day whereas groups B (n = 5) and C (n = 5) received 5.0 mg/kg of prednisone per day for 28 postoperative days. In addition, group C received prednisone (5.0 mg.kg-1.day-1) for 1 month preoperatively. In group A, 8 of 10 dogs survived 28 days without evidence of respiratory compromise, with anastomotic bursting pressure greater than 510 mm Hg. In group B, all 5 dogs survived to 28 days without evidence of respiratory compromise and with intact bronchial anastomoses (bursting pressures greater than 510 mm Hg). In group C, 3 of 5 animals survived to 28 days with intact anastomoses. Histological examination demonstrated normal bronchial healing in all anastomoses. These data suggest that preoperative steroid dependence should not be a contraindication to lung transplantation and that bronchial anastomotic wrapping with vascular tissue may not be essential.     

Partial bronchial stenosis following inadvertent right bronchial intubation in a neonate

This case reports difficulties encountered in weaning a premature infant with bronchopulmonary dysplasia from prolonged mechanical ventilation. On chest X-ray alternating atelectasis and hyperinflation of the right lung were observed. This resulted from a short episode of misplaced endotracheal tube that produced a traumatic bronchial stenosis. Treatment by prednisolone allowed the detubation.