[Efficacy of high-frequency electrotome combined with balloon dilatation and cryotherapy through electronic bronchoscope in the management of lumen occlusion type of tracheobronchial tuberculosis].

The lumen-occlusion type of tracheobronchial tuberculosis is the most severe type of tracheobronchial stenosis of tuberculosis, often leading to atelectasis or even lung damage in patients. Some patients require surgical resection of the diseased airways and lungs, which can seriously affect their quality of life and even be life-threatening. In order to improve the treatment ability of bronchoscopy physicians for lumen occlusion type of tracheobronchial tuberculosis, this article retrospectively analyzed 30 cases of tracheobronchial tuberculosis with lumen occlusion in Hunan Chest Hospital, and summarized the experience of achieving better results by high-frequency electrotome combined with balloon dilatation and cryotherapy.

[Clinical and bronchoscopy features of tracheobronchial tuberculosis in children]. / å„¿ç«¥æ°”ç®¡æ”¯æ°”ç®¡ç»“æ ¸çš„ä¸´åºŠåŠæ”¯æ°”ç®¡é•œä¸‹ç‰¹å¾åˆ†æž.

OBJECTIVES: To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis. METHODS: The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB. RESULTS: A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%. CONCLUSIONS: The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.

Feasibility and long-term safety of Ho:YAG laser lithotripsy in broncholithiasis patients.

BACKGROUND: Treatment of broncholithiasis is complex, especially in the case of a large or transbronchial broncholith. Holmium-yttrium aluminum garnet (Ho:YAG) laser lithotripsy may be a useful treatment in broncholithiasis; however, as it is not yet common practice, the optimal parameters are unknown. METHODS: We performed a single-center retrospective analysis of the clinical data of 13 broncholithiasis patients who underwent Ho:YAG laser lithotripsy from May 2012 to October 2018. RESULTS: For the 13 patients (2 males and 11 females), Ho:YAG laser lithotripsy was performed 17 times, in total. All procedures were performed under general anesthesia with rigid bronchoscopy. We initially set the Ho:YAG laser to a pulse frequency of 5 Hz and a pulse energy of 0.8 J, gradually increasing these as required. The pulse frequency range we employed was 5-15 Hz, and the pulse energy range was 0.8-1.6 J. All broncholiths were successfully extracted after lithotripsy, and all symptoms improved. Hemoptysis, bronchial esophageal fistula, and pneumonia were the most common complications; however, there were no long-term complications. CONCLUSIONS: Ho:YAG laser lithotripsy is an effective and safe treatment for broncholithiasis, over a long-term follow up.

Bronchus compression relieved by patent ductus arteriosus stenting.

BACKGROUND: Patent ductus arteriosus (PDA) stenting is evolving as an alternative to surgical aorto-pulmonary shunts for infants with ductal-dependent pulmonary blood flow. Given anatomical proximity, the PDA can compress the ipsilateral bronchus. We report a case series of four patients with bronchial compression by a tortuous PDA who underwent PDA stenting. METHODS: Our four patients received PDA stents for ductal-dependent pulmonary blood flow despite preprocedure imaging evidence of bronchial compression. We reviewed the cross-sectional chest imaging to assess the degree of bronchial compression and the variables that affect it, namely PDA size, PDA tortuosity, and the anatomical relationship between the compressed bronchus and the PDA. RESULTS: Three out of the four patients had postprocedure imaging, and all showed relief of the previously seen bronchial compression. Post-PDA stenting patients had a smaller and straight PDA with significant lateralization away from the compressed bronchus. None of the four patients developed symptoms of bronchial compression poststenting. CONCLUSIONS: Our study suggests that pre-existing bronchial compression does not preclude PDA stenting. Stent placement in an engorged and tortuous PDA led to significant improvement in pre-existing bronchial compression. Improvement may be attributed to PDA shrinkage, straightening, and lateralization. Further studies are needed to confirm our findings.

Bronchiolitis and Bronchiolar Disorders.

Bronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue diseases, inflammatory bowel diseases, lung transplant allograft rejection, graft versus host disease in allogeneic stem cell recipients, neuroendocrine cell hyperplasia, infections, drug toxicity (e.g., penicillamine, busulfan), inhalation injury (e.g., cigarette smoke, nylon flock, mineral dusts, hard metals, Sauropus androgynous); idiopathic, common variable immunodeficiency disorder, and a host of other disorders or insults. The spectrum of bronchiolar disorders is wide, ranging from asymptomatic to fatal obliterative bronchiolitis. In this review, we discuss the salient clinical, radiographic, and histological features of these diverse bronchiolar disorders, and discuss a management approach.

Case report of endoprosthesis -Y implantation in severe respiratory failure in the MPSII patient; comparison with literature data.

BACKGROUND: The tracheobronchomalacia is a life-threatening complication of mucopolysaccharidosis (MPS) without known effective, optimal treatment. The severe expiratory collapse of the trachea and bronchi is one of causes of the high rate of deaths in the course of airway impairment in MPSII patients. CASE PRESENTATION: Due to the adynamic tracheobronchomalacia despite of enzymatic treatment (ERT) in our MPSII patient, a life-saving tracheal bifurcated type-Y endoprosthesis (a self-expanding, metal stent for the prosthesis of tracheal and bronchial stenosis) was implanted. In the followed months, the breathing efficiency improved, but then gradual worsening, progression of bronchi occlusion at the stent border resulted in patient's death. CONCLUSION: The Y-stent implantation appears to be a short-term, life-saving solution without satisfactory long-term effects due to the progress of peripheral bronchomalacia and increased tissue proliferation and granulation, that arises during the illness' course.

Refractory traumatic bronchopleural fistula: Is extracorporeal membrane oxygenation the new gold standard?

INTRODUCTION: A refractory bronchopleural fistula leading to respiratory failure in a trauma patient is one of the most challenging pathologies to manage in one of the most challenging patient populations. Modern equipment and techniques have decreased and perhaps even eliminated the need for anticoagulation with ECMO, and it is finding an important niche in saving this patient population from refractory hypoxia. We review here our experience with three refractory traumatic bronchopleural fistulae utilizing venovenous ECMO as the primary treatment modality. MATERIAL AND METHODS: Retrospective chart review of three cases of refractory traumatic bronchopleural fistula treated primarily with ECMO and an ultra-lung protective strategy. RESULTS: The use of an ultra-lung protective strategy with ECMO allowed sealing of all three bronchopleural fistula. CONCLUSIONS: Traumatic bronchopleural fistulae require careful thought and early utilization of lung protective strategies to facilitate healing of the injured lung.

Pulmonary and Bronchiolar Involvement in Sjogren's Syndrome.

Sjogren's syndrome (SS) is a chronic autoimmune disease characterized by mononuclear cells (principally lymphocytes) infiltrating exocrine glands (e.g., salivary and lacrimal glands), leading to destruction of exocrine epithelial cells and dryness of mucosal surfaces. Cardinal symptoms are dry eyes (xerophthalmia) and dry mouth (xerostomia). Extraglandular sites are affected in 30 to 40% of cases of SS (particularly neurological, kidneys, skin, and lungs). B cell hyperactivity, autoantibody production, and hypergammaglobulinemia are cardinal features of SS. Primary SS is not associated with other autoimmune diseases. However, SS can complicate diverse autoimmune disorders (particularly systemic lupus erythematosus, rheumatoid arthritis, and scleroderma); this form is termed "secondary SS." Pulmonary involvement is usually not a dominant feature of SS, but may be severe in some cases. In this review, we discuss specific tracheal, bronchiolar, and pulmonary complications of SS including xerotrachea, bronchiolitis, bronchiectasis, interstitial lung disease, nonspecific interstitial pneumonia, usual interstitial pneumonia, lymphoid interstitial pneumonia, organizing pneumonia, acute fibrinous and organizing pneumonia, pulmonary cysts, pleural effusions, pulmonary amyloidosis, and bronchus- or lung-associated lymphomas.

Stress and uncertainty in parents of children with tracheobronchial malacia and stenosis.

BACKGROUND: An increasing number of children are undergoing flexible bronchoscopy because of tracheobronchial malacia and stenosis, but there is little research related to their parents' stress and uncertainty. AIM: To explore and identify risk factors associated with stress and uncertainty among Taiwanese parents of children with tracheobronchial malacia and tracheabronchostenosis in a paediatric intensive care unit. METHODS: A cross-sectional study design was implemented using two psychometric scales: Parenting Stress Index and Parents' Perception of Uncertainty Scale. Parents of Taiwanese children (0-18 years/o) with a diagnosis of tracheobronchial malacia or/and tracheabronchostenosis who underwent bronchoscopy in a paediatric intensive care unit were recruited. The analysis used descriptive statistics and multivariable linear regression. RESULTS: Ninety parents who were caring for a total of 51 children were recruited. Stress and uncertainty both scored high and were positively correlated with each other. Four risk factors arising from parental stress were unemployment, parental uncertainty, the child's tracheobronchial malacia and tracheabronchostenosis and use of oxygen. CONCLUSIONS: Identifying likely causes of stress and uncertainty is essential for this parental group, particularly for parents facing unemployment, feelings of uncertainty and caring for children with both tracheobronchial malacia and tracheabronchostenosis and requiring oxygen. RELEVANCE TO CLINICAL PRACTICE: Nursing practice can focus on better parental support for those parents who are unemployed, show feeling of uncertainty and care for children with combined tracheobronchial malacia and tracheabronchostenosis and other medical care, such as breathing symptom management, nasogastric feeding and oxygen therapy.

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.

Metallic small y stent placement at primary right carina for bronchial disease.

BACKGROUND: Metallic large Y stent placement has been used mainly for airway disease around the main carina. However, few studies have reported this treatment for bronchial disease around the primary right carina. METHODS: Twenty-eight patients were treated by small y stent. All stents were custom-designed and placed under fluoroscopic guidance. Clinical and imaging data were analyzed retrospectively. RESULTS: Thirty-one stents were successfully inserted in 28 patients. Twenty-five patients succeed at the first attempt (89.3%), and 3 patients needed a second attempt. Twelve complications occurred in 10 patients (35.7%). Stent restenosis and sputum retention were the most common complications. Five patients underwent successful stent removal due to complications or cure efficacy. During follow up, 17 patients died of tumors and one died of myocardial infarction. The 1-, 3-, and 5-year survival rates were 49.3, 19.6 and 19.6%, respectively. CONCLUSIONS: Metallic small y stent placement is technically feasible, effective and safe for bronchial disease around the primary right carina.

A Rare Case of Posterior Circulation Stroke Caused by Bronchial Artery Embolization.

Bronchial artery embolization (BAE) is an effective treatment for massive hemoptysis. Stroke is a rare complication of BAE, with only a few cases reported in the literature. We report one such case. Posterior circulation strokes after BAE can be caused by connections between the vertebral arteries and the bronchial arteries (shunting between pulmonary and systemic circulations), backflow of embolization material from the bronchial or intercostal arteries to the subclavian artery or through backflow of emblospheres into the aortic lumen leading to subsequent embolization of the cerebral circulation. New-onset focal neurologic signs, change in mental status, or delay in recovery from anesthesia after BAE warrants brain imaging to rule out a stroke. Our case had a poor outcome, unlike the majority of previously reported cases.

[Efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis].

Objective: To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis (TBTB). Methods: From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT (computer tomography), bronchial reconstructions and bronchoscopy. All patients underwent routine anti-tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council (mMRC) dyspnea scale and complications. Results: Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for (10±4) times, and then these patients received balloon dilatation through bronchoscope for (7±3) times subsequently. The total effective rates were 76.53% and 72.45% after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses (t=-15.012, P<0.01). The average of mMRC score changed from (3.8±0.5) before the procedure, to (1.1±0.7), (1.2±0.7) and (1.2±0.7) immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy (t=30.398-31.058, P<0.01), but not among the 3 scores after treatments. No serious complications were observed in all cases. Conclusions: Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronchial tuberculosis. A shorter course of disease indicated more benefits for patients.

Homemade Hypertonic Saline: Essential Treatment Can Be Available and Affordable.

BACKGROUND: Nebulized hypertonic saline (HS) treatment is unavailable to large populations worldwide. OBJECTIVES: To determine the bacterial contamination and electrolyte concentrations in homemade (HM-HS) vs. pharmacy made (PM-HS). METHODS: We conducted three double-blind consecutive trials: 50 boiled-water homemade 3%-HS (B-HM-HS) bottles and 50 PM-HS. The bottles were cultured after 48 hours. Electrolyte concentrations were measured in 10 bottles (5 per group). Forty bottles (20 per group) were distributed to volunteers for simulation of realistic treatment by drawing 4 ml HS three times daily. From each bottle, 4 ml samples were cultured after 1, 5, and 7 days. Volunteers prepared 108 bottles containing 3%-HS, sterilizing them using a microwave oven (1100-1850W). These bottles were cultured 24 hours, 48 hours, and 1 month after preparation. RESULTS: Contamination rates of B-HM-HS and PM-HS after 48 hours were 56% and 14%, respectively (P = 0.008). Electrolyte concentrations were similar: 3.7% ± 0.4 and 3.5% ± 0.3, respectively (P = NS). Following a single day of simulation B-HM-HS bottles were significantly more contaminated than PM-HS bottles: 75% vs. 20%, respectively (P < 0.01). By day 7, 85% of PM-HS bottles and 100% of B-HM-HS bottles were contaminated (P = 0.23). All 108 microwave-oven prepared bottles (MICRO-HS) were sterile, which was significantly better than the contamination rate of B-HM-HS and PM-HS (P < 0.001). Calculated risk for a consecutive MICRO-HS to be infected was negligible. CONCLUSIONS: Microwave preparation provides sterile HS with adequate electrolyte concentrations, and is a cheap, fast, and widely available method to prepare HS.

[Holmium: yttrium-aluminum-garnet (Ho: YAG) laser lithotripsy in the treatment of broncholithiasis].

Objective: To assess the effectiveness of Ho: YAG Laser in the treatment of broncholithiasis. Methods: We retrospectively reviewed the clinical data of 6 patients who underwent Ho: YAG Laser lithotripsy in Peking University First Hospital during May 2012 to October 2015. 4 females and 2 males, with a median age of 60 years, were enrolled. Among 6 patients, persistent cough(n=2), hemoptysis(n=2), recurrent pneumonia(n=2) were the main clinical symptoms. Broncholiths were found in the left side in 1 patient and right side in 5 patients. 2 broncholiths were located in main bronchus and 4 in segmental bronchus. There were 2 patients with intraluminal broncholiths and 4 with transbranchial broncholiths. All 6 patients received Ho: YAG Laser(0.8-1.2 J pulse energies, 5-10 Hz frequencies, 365 µm laser fibers) under rigid bronchoscopy in general anesthesia and experienced relief of symptoms. Results: Complete removal of broncholith was accomplished in intraluminal broncholith group and 1 patient in transbracnhial broncholith group, the other 3 transbracnhial broncholiths were partly removed. Complications included perioperative massive hemolysis(n=1), bronchoesophageal fistula(n=1) and postoperative pneumonia (n=2), no long term complications were encounted. Conclusion: The Ho: YAG were associated with acute complications including fistula, perioperative massive hemolysis, infections and no long-term side effects. It represents a safe and effective therapy option for broncholithiasis.

Pulmonary Complications of Childhood Cancer Treatment.

Pulmonary complications of childhood cancer treatment are frequently seen. These can lead to adverse sequelae many years after treatment, with important impact on morbidity, quality of life and mortality in childhood cancer survivors. This review addresses the effects of chemotherapy, radiotherapy, surgery and alloimmunity (in haematopoietic cell transplantation) on the lung in children. It highlights the complexity of lung damage and lung disease in relation to growth and development, infections and other external factors. Screening high risk childhood cancer survivors for treatment related late effects, with therapy based screening protocols, using full medical assessment and pulmonary function tests is important. This will lead to recognition of pulmonary sequelae of cancer treatment, early detection of lung damage in survivors and better treatment and prevention.

Balloon-expandable Metallic Stents for Airway Diseases.

Stent placement is an essential treatment for airway diseases. Although self-expandable metallic stents and silicone stents are commonly applied for the treatment of airway diseases, these stents are unsuitable for the treatment of small airway diseases encountered in pediatric patients and lung transplant recipients with airway complications. Currently, only vascular balloon-expandable metallic stents are available for the treatment of small airway diseases; however, little research has been conducted on the use of these stents in this field. We have launched a prospective feasibility study to clarify the safety and efficacy of balloon-expandable metallic stents for the treatment of airway diseases.

[Bronchopulmonary infections caused by atypical pathogens in children : Myth or reality?] / Les infections broncho-pulmonaires à germes atypiques chez l'enfant : Mythe ou réalité ?

Mycoplasma pneumoniae and Chlamydia pneumoniae are the most common atypical pathogens seen in respiratory infections in children. Currently, the management of atypical pneumonia due to these pathogens is blurry. The clinical features are hardly specific ; it appears that M. pneumoniae respiratory infect ions are associated with chest pain and the absence of wheezing, however, further confirmations are needed. Hoarseness is frequently seen with C. pneumoniae infection. Co-infections with viruses, bacteria or even between M. pneumoniae and C. pneumoniae can be frequent. Infection with either of these bacteria seems to increase the incidence of asthma. PCR appears to be the most sensitive and specific for rapid diagnosis of M. pneumoniae and C. pneumoniae infections, however, it cannot dif ferentiate asymptomatic carriage from infection. Serodiagnosis can be helpful. This requires two serum samples taken with several weeks interval. Macrolides are the classical antibiotics used for treatment of these pathogens. In vivo efficacy of antibiotic treatment of M. pneumoniae remains unclear. Resistance to macrolides in M. pneumoniae treatment has been described. In conclusion, there is still a lack in scientific literature of high level evidences and clear consensus in the management of suspicious infection due to M. pneumoniae and C. pneumoniae.

Les germes atypiques les plus fréquemment rencontrés dans les infections respiratoires chez l'enfant sont Mycoplasma pneumoniae ou Chlamydia pneumoniae. La prise en charge des bronchopneumopathies atypiques à ces deux germes reste actuellement floue. La symptomatologie est pauvre, aucun signe clinique spécifique n'a pu être à ce jour identifié. Il semblerait que les infections respiratoires à M. pneumoniae sont associées à des douleurs thoraciques ou à une absence de wheezing même si cela reste à confirmer. Les infections à C. pneumoniae seraient plus souvent associées à des laryngites. Les co-infections virales, bactériennes ou entre les deux germes atypiques, M. pneumoniae et le C. pneumoniae, ne sont pas rares. Une infection par une de ces deux bactéries augmenterait l'incidence de l'asthme. Le diagnostic par PCR semble être la méthode diagnostique la plus spécifique et la plus sensible, autant pour le M. pneumoniae que pour le C. pneumoniae. Cependant, elle ne permet pas de différencier les infections des portages asymptomatiques. Le diagnostic par sérologie peut être utile mais nécessite deux échantillons à quelques semaines d'intervalle. Les macrolides sont la classe d'antibiotique classiquement utilisées dans le traitement des infections à ces deux germes. L'ef ficacité du traitement antibiotique pour le M. pneumoniae est actuellement remis en doute par certaines études. Des résistances au traitement du M. pneumoniae par macrolide sont décrites. En conclusion, il manque encore de littérature scientifique à hauts niveaux de preuve et de concensus clairs dans la prise en charge des suspicions d'infection à M. pneumoniae et C. pneumoniae.

[Causes of death among prostate cancer patients of different ages].

To date, there is no unified approach to evaluating and treating patients with suspected prostate cancer taking into account their age and comorbidities. That was the rationale for conducting this study. AIM: To assess the clinical course of prostate cancer in men of all ages with comorbidities. MATERIALS AND METHODS: The study included 408 patients aged 50 to 92 years (mean age 74.3 years) with histologically verified prostate cancer. 30 (7.4%) patients had stage T1 disease, 273 (66.9%) - T2, 91 (22.3%) - T3 and 14 (3.4%) - T4. The maximum follow-up was 22 years, the minimum one - 6 months (on average 15.4 years). RESULTS: During the follow-up 159 patients died (39%), 51 of them (32%) of prostate cancer, 108 (68%) - from other diseases. Among the latter the causes of death were cancer (20.4%), cardiovascular and bronchopulmonary diseases (79.6%). Cancer-specific survival rate was 41.4 +/-12,4%, the survival rate for other diseases 23.4 +/-10,6% (p<0.05). CONCLUSION: We need a differentiated approach to selecting treatment for patients with prostate cancer, especially of old age, including the option for active surveillance of patients with clinically insignificant prostate cancer.