Influence of bronchial circulation and corticosteroid therapy on bronchial anastomotic healing

In order to assess the effect of revascularization on the healing of bronchial anastomoses in a canine model, we developed a microsurgical technique that permits the immediate reperfusion of the distal bronchial segment by a direct anastomosis of the bronchial artery to an intercostal artery. This technique was applied to dogs that underwent hilar stripping and bronchial transection and reanastomosis, and it prevented the development of ischemic bronchial damage. In addition, several groups of dogs that had undergone bronchial transection and reanastomosis and, in some cases, reestablishment of bronchial arterial circulation, were treated with 40 mg of prednisone daily for periods of 7 and 21 days. The animals treated with corticosteroids demonstrated a lesser degree of inflammatory damage to the bronchial anastomotic site than similar groups of untreated animals. These findings support the hypothesis that restoration of bronchial arterial blood flow at the time of lung transplantation can reduce anastomotic damage to the distal or donor bronchial component. Our results further suggest that corticosteroid therapy alone does not increase bronchial anastomotic damage, and, in fact, may reduce inflammation at the bronchial anastomotic site.     

Selective lobar bronchial blockade using a double-lumen endotracheal tube and bronchial blocker

We report our experience of a selective lobar bronchial blockade (SLBB) technique with a bronchial blocker (BB) which was employed successfully with a routine double-lumen endotracheal tube (DLT) in three patients. For the first case, we selectively blocked the infected left lower lobe in a surgical patient with a lung abscess in a DLT setting. For the second case, we applied this method to block the right middle and lower lobes in order to assess air leakage from the upper lobe during video-assisted thoracic surgery (VATS). For the third case, selective continuous positive airway pressure (CPAP) to the blocked lobes on the operative side resulted in oxygenation improvement with one-lung ventilation (OLV) in a DLT. This novel technique provides benefits during general thoracic surgery by preventing contamination, providing a better operative field, and improving oxygenation with lobar CPAP.     

Traumatic bronchial rupture and platypnea-orthodeoxia

A patient with blunt trauma and traumatic bronchial rupture and lung collapse had prominent symptoms of platypnea-orthodeoxia syndrome. These symptoms were relieved by bronchial repair. The syndrome is rarely seen and is usually associated with a patent foramen ovale or atrial septal defect. The syndrome has not been described previously in association with traumatic bronchial rupture.     

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.