Biomedical subjects
Publications and source records attributed to F P Stitik.
This report demonstrates the normal cross-sectional appearance of the bronchial tree as seen on computed tomography. Key sections are emphasized in order to provide general orientation. Where significant, anatomic variations are identified. Detailed knowledge of the normal appearance of the bronchi is a prerequisite to identifying abnormalities that affect both the bronchi and the hilum.
Computed tomography (CT) can be used to diagnose both inflammatory and neoplastic diseases that arise from or affect the bronchi. The clarity of anatomic detail that can be obtained with CT is demonstrated. This clarity of anatomic detail should be of use in those cases for which bronchoscopy, mediastinoscopy, or other staging procedures are planned. The overall usefulness of CT in patients with bronchial lesions has yet to be established.
Computed tomography (CT) with thin sections (2-5 mm) was used to assess tissue density in 91 apparently noncalcified pulmonary nodules in 88 patients. The study included 45 primary lung malignancies and 13 metastases proven by subsequent lung biopsy or thoracotomy. There were 33 benign lesions of which 13 were biopsy proven. The other 20 nodules were presumed benign on the basis of serial radiography showing no growth. A representative CT number based on the 32 most dense voxels was calculated for each lesion. For the primary malignancies, the mean representative CT number was 92 H, with a standard deviation of 18 H. The highest representative CT number for any malignant lesion was 147 H. Of the 33 benign lesions, 20 had a representative CT number of 164 H or greater. It is presumed that nodules with representative CT numbers of 164 H are benign, and that diffuse calcification likely accounts for the higher CT number of some benign lesions. CT has proven to be more objective and more sensitive than standard tomography in assessing the density of pulmonary nodules.
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A total of 100 tantalum cine laryngotracheograms were performed in adults with documented or suspected upper airway obstruction. With appropriate precautions, tantalum powder proved to be a safe material for delineating tracheal and laryngeal abnormalities. A cine recording to document tracheomalacia as well as a careful evaluation of the larynx are useful extensions of examination of patients with suspected upper airway obstruction. Tracheomalacia was found in 35% of our series; 29% showed laryngeal abnormalities. With modifications to correct for magnification, the tantalum tracheogram gives the surgeon the exact length of trachea to be resected. When tantalum becomes approved by the Food and Drug Administration, we expect that tantalum cine laryngotracheography will be the preferred means for study of upper airway obstruction.
A prospective study designed to detect early lung cancer in a high risk outpatient volunteer population is in progress. At present all 10,362 volunteers have been recruited into the project. A review of the radiographs of patients with lung cancer identified on the initial screen, or in retrospect, has led to the following conclusions: (1) Independent double reading is important in a screening project. (2) There are no reliable radiographic criteria to distinguish early lung cancer from benign disease. (3) The lateral chest radiograph is useful in the high risk patient. From these conclusions the authors have three recommendations for the practicing radiologist. (1) Since double reading improves sensitivity, attempt to doubly read a chest radiograph by removing your eyes from the film and look at it a second time before finalizing your report. (2) Consider any newly appearing, noncalcified lesion in the chest radiograph of a high risk individual as primary lung cancer until proven otherwise. (3) Consider the "routine chest radiograph" in a high risk patient as a challenge to detect early lung cancer rather than the drudgery of day to day clinical practice.
A novel technique for the generation of tantalum aerosols (aerodynamic mass median diameter, 5.8 mum; sigma g, +/-2.14) for inhalation bronchography via the mouth was applied in 26 anesthetized dogs. Ventilatory patterns during periods of aerosol inhalation were controlled by either bilateral electrophrenic stimulation of the diaphragm (EPS), or by intermittent, negative pressure at the body surface (INPV). We studied patterns of tracheobronchial deposition with regard to both the sites of particle deposition longitudinally along airways within lobes, and the topographic distribution of aerosol among the lung lobes. Bronchographic patterns were accordingly studied after inhalations by either (1) EPS and INPV in the supine posture with constant tidal volumes, but varied inspiratory flow (30 to 90 liter per min); or (2) EPS with constant tidal volume and peak inspiratory flow in the prine, right, and left lateral decubitus body positions. Under all airflow conditions, the aerosol was deposited on the surfaces of ciliated airways. Deposition was nearly entirely confined to subsegmental bronchi and above with vigorous inspirations, but extended distally to subsegmental bronchi in greater proportion with decreases in the inspiratory flow. Airways among the basal lung lobes were particularly subject to distal subsegmental and bronchiolar deposition with low rates of inspiratory airflow. Regionally, the aerosol was deposited preferentially in dependent lung lobes after inhalations with EPS in the right and left lateral decubitus positions, and in the basal lung lobes with EPS in the supine posture. A greater caudocranial uniformity in lobar aerosol distribution occurred with inhalations by INPV in the supine posture, and by EPS in the prone posture. The canine model strongly suggests that for clinical inhalation bronchography, nonhomogeneities in lobar deposition may be averted by inhalations in multiple body positions, and that deposition of the aerosol may be confined to ciliated airway surfaces by inertial impaction accompanying high rates of inspiratory airflow.
This paper describes the clinical management of patients with malignant cells in their sputum and a normal chest roentgenogram and those with asymptomatic peripheral pulmonary masses. The source of malignant cells in the sputum of patients with no roentgenographic abnormalities can be localized by tantalum bronchography and fiberoptic bronchoscopy. Peripheral pulmonary masses can be diagnosed preoperatively by needle biopsy or transbronchial fiberoptic bronchoscopy with little morbidity and no mortality. These procedures are not necessary, however, if there is firm clinical and roentgenographic evidence of malignancy. Bronchogenic carcinomas presenting as asymptomatic circumscribed peripheral pulmonary masses have a 25% incidence of occult mediastinal lymph node metastases. In view of this relatively high incidence of metastasis, we think mediastinoscopy should routinely be performed prior to thoracotomy is asymptomatic patients with a peripheral pulmonary mass and no roentgenographic evidence of mediastinal widening.
In a series of experiments in dogs, the bronchial mucosa was either excised or destroyed prior to closure of a bronchial stump following a lobectomy or the reanastomosis of a divided bronchus. The experiments were designed to simulate the clinical situation in which focal areas of squamous-cell carcinoma in situ in the bronchial margin would be managed by local ablation of the mucosa rather than by excision of additional bronchus. The experiments demonstrated that the bronchial mucosa is not necessary for bronchial healing. They also demonstrated that functionally and morphologically normal bronchial epithelium regenerates across the denuded bronchus. The source of this regenerated epithelium appears to be the submucosal glands which remain in the bronchial wall after a variety of local ablative procedures. Since our clinical experience has demonstrated that these submucosal glands frequently contain small foci of squamous-cell carcinoma in situ, we have concluded that either excision or thermal destruction of the bronchial mucosa has very limited clinical application and should be considered only in patients who cannot tolerate excision of more than one lobe of the lung.
We have successfully treated severe pulmonary edema of various etiologies and the concomitant hypoxia in 17 infants and children with continuous positive pressure spontaneous breathing. The pressure used was 8 to 14 cm of water above atmospheric pressure. No significant changes occurred in arterial or central venous blood pressure, and no patient developed clinical evidence of peripheral venous engorgement. Pulmonary edema cleared within 24 hours in all cases. We believe this rapid clearing may differentiate pulmonary edema from pneumonia and pulmonary hemorrhage. The pathophysiology and the roentgenologic findings are presented.
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