Rigid Bronchoscopy.

Rigid bronchoscopy is one of the oldest medical techniques used in the respiratory and thoracic fields. Even though its use declined after the development of flexible bronchoscopy, it has again gained importance with the growth of interventional pulmonology, becoming a critical technique taught as part of the training in this subspecialty. The therapeutic advantages compared to other approaches of thoracic pathologies makes rigid bronchoscopy a primary component in the present and future of interventional pulmonary medicine.

Historical perspectives of bronchoscopy. Connecting the dots.

The era of bronchoscopy began with Gustav Killian in 1876 when he removed a pork bone from a farmer's airway, using an esophagoscope. Prompted by this accomplishment, Chevalier Jackson, an American otolaryngologist, laid the platform for the modern-day rigid bronchoscope in the early twentieth century. In 1967 Shigeto Ikeda revolutionized the field of bronchoscopy by his innovation of the fiberoptic bronchoscope. Today, bronchoscopy and interventional pulmonology have become an integral part of pulmonary medicine and an established subspecialty. Numerous innovators have furthered the horizons of this technology. In the early 1980s Ko-Pen Wang introduced transbronchial needle aspiration to sample mediastinal lesions while Jean-François Dumon developed methods for laser photoresection and for placing stents thorough the bronchoscope. More recently, application of endobronchial ultrasound and electromagnetic navigation tools has further galvanized the role of bronchoscopy. The success of lung transplantation also belongs in part to flexible bronchoscopy. Today, researchers are looking into treating emphysema as well as asthma, using bronchoscopic techniques. We believe 2015 is a good time to look back on the history of bronchoscopy and to recognize its major milestones. This article attempts to connect the historical dots in this field of research, with the hope that our effort helps future generations improve the welfare of patients with lung ailments.

A historical appreciation of bronchopulmonary neuroendocrine neoplasia: resolution of a carcinoid conundrum.

In the three-quarters of a century that have elapsed since the first description of a bronchial carcinoid, the field has progressed from serendipitous radiological or bronchoscopic diagnosis to computed tomography, magnetic resonance imaging, and somatostatin receptor imaging identification. Similarly, pathologic techniques have advanced from a naïve assessment of neoplasia to a delineation of several tumor subtypes and an understanding of the neuroendocrine basis of the disease process. A key unresolved question is the identification of the genetic and environmental activators that are responsible for the initiation of pulmonary neuroendocrine cell proliferation and neoplastic transformation.

[When the scientific career favors the scholarly diffusion of innovation: doctor Max Fourestier]. / Quand la carrière scientifique d'un médecin favorise la diffusion d'innovations scolaires: l'exemple du docteur Max Fourestier.

In 1992, the hospital of Nanterre assumed Max Fourestier's surname, as this great doctor was in office there between 1948 and 1973. Max Fourestier's biography and career emphasize that he embarked on three specific professional fields : specialty medicine, social medicine and school medicine. At the time, Max Fourestier was developing his universal endoscope in his department in Nanterre, achieving an extensive experience of massive BCG vaccination in a tuberculosis clinic in Montreuil, called "social hygiene" and, finally, carrying out a lot of school innovations to achieve an equal division of time between school work and sport practices. He also implemented snow classes in public schools in 1953 or napping classes,forest classes and snow classes in infant schools in 1959. In short, this presentation reveals that the inherent process of Max Fourestier's school innovation reputation lies in the scientific will of its creator, which allows him to convey his teaching ideas at the international level. Finally, in addition to the inventory of the physician's various innovations, the major challenge of this presentation is to reveal the intertwining and strong connections of Max Fourestier's medical and school commitments. In 1992, the hospital of Nanterre assumed Max Fourestier's surname, as this great doctor was in office there between 1948 and 1973. Max Fourestier's biography and career emphasize that he embarked on three specific professional fields: specialty medicine, social medicine and school medicine. At the time, Max Fourestier was developing his universal endoscope in his department in Nanterre, achieving an extensive experience of massive BCG vaccination in a tuberculosis clinic in Montreuil, called "social hygiene" and,finally, carrying out a lot of school innovations to achieve an equal division of time between school work and sport practices. He also implemented snow classes in public schools in 1953 or napping classes, forest classes and snow classes in infant schools in 1959. In short, this presentation reveals that the inherent process of Max Fourestier's school innovation reputation lies in the scientific will of its creator, which allows him to convey his teaching ideas at the international level. Finally, in addition to the inventory of the physician's various innovations, the major challenge of this presentation is to reveal the intertwining and strong connections of Max Fourestier's medical and school commitments.

Flexible bronchoscopy.

Although bronchoscopy technology continues to evolve at a fairly rapid pace, basic procedures, such as bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration, continue to play a paramount role in the diagnosis of bronchopulmonary diseases. Pulmonologists should be trained in these basic bronchoscopic procedures.

Rigid bronchoscopy.

Complex airway diseases represent a therapeutic challenge and require multidisciplinary input. Surgery remains the definitive modality. Minimally invasive endobronchial techniques have resulted in symptom control and long-term improvements. The rigid bronchoscope remains the method of choice for the treatment of both benign and malignant central airway obstruction. However, it has limited use if lesions are located in the upper lobes or lung periphery, but significant technological advances allow for effective treatments using the flexible bronchoscope. Rigid and flexible bronchoscopes should be seen as complementary procedures and most cases require the use of both modalities.

Chevalier Jackson: pioneer and protector of children.

Chevalier Jackson was one of the greatest pioneers of otolaryngology. He was a pioneer of oesophagoscopy, bronchoscopy and the removal of foreign bodies. He changed the mortality rate for an airway foreign body from 98 per cent to a survival rate of 98 per cent. He became distressed by the number of preventable injuries in children from the ingestion of caustic substances, most commonly household lye. His experiences of children with oesophageal stricturing secondary to caustic ingestion moved him to start a campaign to force manufacturers to label all poisonous substances as such. This took him from the American Senate to the House of Representatives and back again; the Federal Caustic Poisons Act (1927) is still enforced today. In a career with over 400 publications, written during exacerbations of his pulmonary tuberculosis, his life story is a remarkable one, only part of which is widely known.

Gustav Killian: beyond his dehiscence.

For most doctors, Gustav Killian is best known for his eponymous pharyngeal dehiscence. Otorhinolaryngologists may also be familiar with his contributions to rhinology by way of his well-known incision and speculum. Few, however, will be aware of the true significance of his contributions to medicine. Killian was at the forefront of advances in ENT surgery at the turn of the twentieth century. From his early years to his revolutionary work on bronchoscopy and a narrowly missed Nobel Prize, this paper reviews the life and works of a most prolific and often overlooked surgical innovator.

Conferencia Dr. Hernán Alessandri R. 2011: historia del cáncer pulmonar: otro monstruo creado por el hombre / Hernán Alessandri lecture 2011: history of lung cancer: another monster created by mankind

In Profesor Alessandri's days lung cancer cases in Chile and all over the world were very few. In German medical papers in the third decade of XXth century some relationship between lung cancer and smoking habits was reported but only in the middle of the century medical literature reported evidences about this relationship. Smoking habit become universal in the XXth century. Medical community and public opinion were formally informed about the danger of smoking, for the first time in USA, in 1964 in the first Report of General Surgeon. Nowadays lung cancer is the cause of death of2,500 Chileans a year and over one million all over the world. Thoracic X rays and rigid bronchoscopy were for long time the only diagnostic methods in lung cancer. Today we have a lot of sophisticated tools that are mentioned in this paper. Surgery was and continues being the principal therapeutic weapon against the disease. The first surgical intervention performed was a pneumonectomy whose history is related in this review. Several other therapies are available in our days for the disease. A section of this paper is reserved to analyse patients and the disease. A very touching testimony of a poet written when he suffered from the disease is quoted in the text. The paper finishes with a light of hope based on the new immunological and molecular methods for treatment and the radiological approaches for early diagnosis that are available today.

En los tiempos del Prof. Alessandri los casos de cáncer pulmonar eran muy pocos en Chile y en el resto del mundo. La literatura médica alemana de la tercera década del siglo XX, observó cierta relación entre el hábito tabáquico y el cáncer pulmonar, pero sólo 20 años después la literatura médica evidenció esta relación. El hábito tabáquico se hizo universal en el siglo XX. La comunidad médica y el público general fueron advertidos por primera vez del peligro del tabaquismo en 1964 en el primer informe para el Cirujano General de EE.UU. Hoy día mueren al año 2.500 chilenos y 1 millón de personas en el mundo por la enfermedad. La radiografía de tórax y la broncoscopía rígida fueron por largo tiempo los únicos métodos diagnósticos en cáncer pulmonar. Hoy tenemos muchos métodos diagnósticos sofisticados que se revisan en este artículo. La cirugía era y continúa siendo la principal arma terapéutica contra la enfermedad. La primera intervención quirúrgica fue la neumonectomía cuya historia es relatada en esta publicación. Hoy día tenemos muchas otras armas terapéuticas disponibles. En el artículo se reserva una sección para analizar los pacientes y la enfermedad. Se cita un conmovedor testimonio de un poeta que lo escribió mientras sufría de la enfermedad. El artículo termina con una luz de esperanza en relación a nuevos métodos inmunológicos y moleculares de diagnóstico y radiológicos de diagnóstico precoz, disponibles hoy en día.

Bronchoscopy: the past, the present, and the future.

This article discusses bronchoscopy: its history, including development of instruments and techniques and important historical figures; current techniques and issues; and future possibilities and potential controversies.