Lung aplasia: anatomy, history, diagnosis and surgical management.

PURPOSE: The aim of the study was to define the details of the history and clarify the cause for respiratory distress, justify the need for surgical correction and suggest a rational operative technique for patients with lung aplasia. METHODS: Our experience with the management of 9 patients with lung aplasia and 1 patient with lung agenesis in the period from 1985 to 2004 is presented. All 10 patients were referred for respiratory distress. A detailed study of clinical symptoms and the data from X-ray, computed tomography (CT), tracheobronchoscopy and digital subtraction angiography (DSA) suggested that all patients had different degrees of mediastinal shift and heart rotation, tracheal kinking and compression of the aortic arch and innominate artery or emphysema of a single lung. Two of the patients required operation. RESULTS: We performed ipsilateral cephalad translocation of the diaphragm which resulted in complete recovery from respiratory distress and a significant improvement in tolerance of physical exercise in both patients. The good results in these patients were followed up for 8 and 2 years, respectively. CONCLUSIONS: We suggest that ipsilateral translocation of the diaphragm could be a useful alternative to unsuccessful symptomatic treatment in patients with lung aplasia.

[Changes in the bronchial tree under the influence of pelotherapy in patients with pulmonary tuberculosis]. / Izmeneniia bronkhial'nogo dereva pod vliianiem peloidoterapii u bol'nykh tuberkulezom legkikh.

It was shown with using the clinical materials relating to 400 patients with pulmonary tuberculosis that peloids such as humisole, torfot and peloidin used in combination with antituberculous drugs had a favourable effect on involution of specific and nonspecific processes in the bronchi and restoration of bronchial patency. This also permitted a decrease in the terms for elimination of inflammatory lesions in the tracheobronchial tree. Phonophoresis with peloidin proved to be the most efficient procedure of pelotherapy since its use provided summation of the therapeutic effects of the mud preparation and ultrasound vibrations as well as local action on the affected organ.

[20 years' experience using anesthesia in pediatric bronchology]. / Zwanzigjährige Narkoseerfahrungen in der Kinderbronchologie.

The authors inform about their experience with anesthesia gained in the last 20 years with 50,000 bronchological examinations in children. Different anesthesia methods are discussed. They conclude that local anesthesia in adults and in adolescents is a possible procedure using fiberscope. In infants and children the most preferred anesthesia is halothane-nitrous oxide-oxygen-anesthesia with relaxation by succinylcholine.

[An economical procedure for one-stage bronchofibroscopy and bronchography]. / Un procédé économique de bronchofibroscopie et bronchographie en un temps.

A fibreoptic bronchoscope is now commonplace as equipment for the respiratory physician. It can be used to facilitate and improve bronchography by certain technical modifications. First a fibreoptic bronchoscopy is performed by the nasal route. In this way bronchial lesions and anatomical variants can be seen. A careful aspiration of the bronchi to be examined as well as local anaesthesia bronchus by bronchus is performed. The fibreoptic scope is then withdrawn to the oropharynx, enabling a superior view of the larynx. A Métras catheter, whose angle is modified by the biopsy forceps is introduced into the free nostril and the catheter is easily passed between the vocal cords under the direct view of the fibreoptic scope. Thus, except for the Métras catheter which remains indispensable, one can pass all the long standing material that has been used in this examination. In addition the achievement of fiberoscopy and bronchography at the same time seems to us both a better technique and an appreciable saving of time. Since 1980, 40 bronchographies have been performed with this technique, with no failures.

[Spirometric modifications induced by bronchography. Effects of Salbutamol]. / Modifications spirométriques induites par la bronchographie. Effets du Salbutamol.

Bronchography enables an appreciation of the morphology and dynamics of the bronchi inaccessible to the fibroscope. However, this examination may aggravate pulmonary function in patients with chronic airflow obstruction. We have studied the effects of bronchography on forced expiration in order to identify and quantify possible spirometric changes. Thus spirometric tests were done at different times during the examination (V.C., F.E.V., flow-volume curves): before and after anaesthetizing the upper airways with xylocaine, after the introduction of contrast to the bronchi and finally after a Salbutamol aerosol. Spirometric values were unaffected by anaesthesia of the upper airways. On the other hand, the introduction of contrast led to a clear and constant fall in maximum expiratory flow, associated with a fall in forced vital capacity. These changes could not be reversed either after inhalation of Salbutamol or sub-cutaneous Terbutaline. The mechanisms producing the spirometric changes which we report does not seem to involve either the adrenergic system or the irritant receptors. Bronchial obstruction produced by the contrast does not alone appear to explain the changes induced by bronchography. Other mechanisms, not yet identified, probably contribute to the decrease in maximum expiratory flow.

Unusual pulmonary reactions to oily propyliodone (Dionosil) in bronchography.

Severe reactions to oily propyliodone are rare. Side-effects are usually mild and self-limiting. Three cases are reported of early pulmonary reactions, the cause of which may be a chemical pneumonitis or possibly an allergic response to one of the components of the contrast medium. There was a good response to corticosteroid therapy in all three patients.

Lidocaine concentration in blood after topical anaesthesia of the upper respiratory tract.

The venous blood concentration of lidocaine was determined after stepwise application of lidocaine spray (270 mg) to the upper respiratory tract in 10 patients scheduled for bronchography, and after oropharyngeal application (150 mg) to five intubated patients under general anaesthesia. The peak level of lidocaine (about 1 microgram)ml/occurred 20--30 min after spraying in the bronchography group, while there was a level plateau at about 0.5 microgram/ml after oropharyngeal application of the local anaesthetic. There was great variation in the lidocaine concentration in both groups, but the highest observed concentration, 2.7 micrograms/ml, was safely below the toxic level. The mean rise in systolic and diastolic blood pressures at the various stages of spraying and on passing the bronchography tube in the local anaesthesia patients was 14.5--17.5/6.5--11 mmHg (1.9--2.3/0.9--1.5 kPa) compared to preanaesthetic values. In a similar group of patients, also scheduled for diagnostic bronchography, thiopentone anaesthesia, succinylcholine relaxation and laryngotracheal lidocaine spray resulted in a peak blood pressure increase of 36.5/27 mmHg (4.9/3.6 kPa) on passing the tube. The mean increases in pulse rate (21--26/min) were similar in both bronchography patient groups. No serious cardiac arrhythmias were observed in any of the patients.

Inhalation of foreign bodies by children: a continuing challege in management.

In a review of 19 years' experience with inhalation of foreign bodies by children the 33 patients (mean age 28 months) were found to have presented most frequently with wheezing or coughing, or both, of recent onset, and to have decreased air entry, rhonchi or respiratory stridor, or a combination of these signs. Eighteen children had inhaled a nut, a pea or a bean. The other 15 had inhaled various organic and inorganic objects. All the children underwent bronchoscopy, and the foreign body was completely removed in 19 during the first procedure; the remainder required repeated bronchoscopy or direct surgical removal of the foreign body, or both. Permanent disability or death was not encountered. The findingsof the study indicate that early bronchoscopic removal is the preferred treatment when a child inhales a foreign body.

[Place of bronchography in the study and evaluation of the late results of the treatment of the pulmonary and pleural complications of acute pneumonia in children]. / Mesto bronkhografii v izuchenii i otsenke otdalennykh rezul'tatov lecheniia legochno-plevral'nyk oslozhnenii ostroi pnevmonii u detei.

Late bronchography was performed in 93 patients, in 46 patients it was made immediately after cupping the critical period of inflammation. The changes found were dependent on the character and size of the process. It has been established that in non-operated children contrasting the bronchi is indicated in late terms of chronic pneumonia in order to specify the residual changes and to choose further treatment.

Anesthesia for diagnostic procedures.

Invasive procedures such as angiography, pneumoencephalography and bronchography are often facilitated by the skillful administration of carefully selected anesthesia. The advantages of general anesthesia versus an awake patient during cerebral angiography are not yet resolved. Although computerized tomography and myelography can usually be accomplished with no anesthesia and local anesthesia, respectively, in children and in confused, uncooperative patients, sedation or general anesthesia may be necessary.

[General anesthesia for bronchoscopy and lipidol bronchography in children and infants]. / Anesthésie générale pour bronchoscopie et bronchographie lipiodolée chez l'enfant et le nourrisson

In 160 cases of children and infants, a technique of general anesthesia is described (penthiobarbital-suxamethonium, then halothane-oxygen with a mask in spontaneous ventilation if the bronchoscopy is followed by lipiodol bronchography). This technique is simple and efficacious and makes the child comfortable, especially in cases of repeated operation, and for the operator whose gestures are more rapid and less traumatising and this permits rapid awakening. No incidents or severe complications were noted.