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PubMed1979

Surgical treatment of adenoid cystic carcinoma of the left main bronchus and trachea by left pneumonectomy, resection of 7.5 cm of trachea, and direct reanastomosis of right lung.

A 23-year-old woman, who had suffered recurrent acute bronchitis, dyspnoea, and stridor, was found to have a tracheal stenosis and complete left main bronchus obstruction. Biopsy of the tumour showed an adenoid cystic carcinoma. After pneumonectomy the trachea was closed through tumour tissue. Two weeks later a right thoracotomy showed that a tumour had invaded the trachea from the carina up to 6 cm and the right stem bronchus for 1 cm. Under extracorporeal circulation 7.5 cm of the trachea and right bronchus were resected. A direct tracheal anastomosis was easy to perform. Spontaneous respiration with efficient coughing returned after five days. Unfortunately, one month later, high fever caused by a lung abscess developed, which provoked a massive haemoptysis with fatal outcome.

Adult↗
PubMed1980

Immunological state of patients with carcinoma of the bronchus before and after radiotherapy.

The immunological state of 30 patients with carcinoma of the bronchus was assessed before and after radiotherapy by lymphocyte response to PHA and E and EAC rosette formation. The results were compared with those from age-matched patients with benign chest disease and a group of healthy control subjects. Differences were found between the three groups and decreased immunological responses were found to correlate with shorter survival times for patients with cancer of the bronchus. These differences were not associated with the extent of the disease, or with the smoking habits of the patients. Significant differences in percentage EAC cell rosetting were demonstrated between lymphocytes from patients with malignant disease (31.3 +/- 2.0) and those for control groups (21.5 +/- 1.9 and 24.0 +/- 2.2). Cancer patients and benign chest disease patients both had significantly decreased mean E rosetting values (59.3% and 55.6%) compared with healthy control subjects (69.7%). The group of cancer patients with a normal percentage of T lymphocytes and total number of lymphocytes after radiotherapy, or those with low percentage EAC cell rosettes, had a greater than 80% survival after seven months compared with less than 50% for the rest of the patients with carcinoma of the bronchus.

Adult↗
PubMed1982

Radiology of the superior segment of the lower lobe: a regional perspective introducing the B6 bronchus sign.

The radiological findings of atelectasis, consolidation, or mass lesions in the superior segment of the lower lobe of the lung (B6 in Boyden's classification) are analyzed. Cases were collected over several years and supplementary series were assembled to study the configurations of the segmental bronchi, the right oblique fissure, and the left pulmonary artery in lateral projection. The upper part of the right oblique fissure could be distinguished from the horizontal fissure on the frontal radiographs by position and angulation; its visualization indicated atelectasis or displacement of the superior segment. Visualization was much less common on the left. Consolidation produced a visible superior segment air bronchogram (the B6 sign) much more often on the left, where the bronchus is usually larger. Orientation and position of the bronchus permit its identification. Other key anatomic landmarks were the descending aorta on frontal radiographs and the posterior margins of the left pulmonary artery and bronchus intermedius on lateral views.

Adult↗
PubMed1993

Accessory cardiac bronchus: CT features and clinical significance.

PURPOSE: The accessory cardiac bronchus is a rare congenital anomaly of the tracheobronchial tree that arises from the medial wall of the bronchus intermedius. This report documents the computed tomographic (CT) appearance of this anomaly. MATERIALS AND METHODS: Six patients with this anomaly were identified. All six underwent CT; three underwent correlative bronchoscopy, and one had both bronchoscopic and surgical confirmation. RESULTS: In all six cases, a distinct airway could be identified originating from the medial wall of the bronchus intermedius. Associated lung parenchymal tissue was identified in four cases, while in three cases a discrete soft-tissue mass was seen, presumably representing vascularized bronchial or vestigial parenchymal tissue. In two cases, the lumen of the airway was filled with debris. CONCLUSION: Recognition of this anomaly is important, as associated clinical complications, including recurrent episodes of both infection and hemoptysis, may be anticipated in a small percentage of patients.

Adult↗
PubMed2002

Muscarinic M2 receptors in acetylcholine-isoproterenol functional antagonism in human isolated bronchus.

The muscarinic functional antagonism of isoproterenol relaxation and the contribution of muscarinic M2 receptors were examined in human isolated bronchus. In intact tissues, acetylcholine (ACh) precontraction decreased isoproterenol potency and maximal relaxation (-log EC50 shift = -1.49 +/- 0.16 and E(max) inhibition for 100 microM ACh = 30%) more than the same levels of histamine contraction. The M2 receptor-selective antagonist methoctramine (1 microM) reduced this antagonism in ACh- but not histamine-contracted tissues. Similar results were obtained for forskolin-induced relaxation. After selective inactivation of M3 receptors with 4-diphenylacetoxy-N-(2-chloroethyl)piperadine hydrochloric acid (30 nM), demonstrated by abolition of contractile and inositol phosphate responses to ACh, muscarinic recontractile responses were obtained in U-46619-precontracted tissues fully relaxed with isoproterenol. Methoctramine antagonized recontraction, with pK(B) (6.9) higher than in intact tissues (5.4), suggesting participation of M2 receptors. In M3-inactivated tissues, methoctramine augmented the isoproterenol relaxant potency in U-46619-contracted bronchus and reversed the ACh-induced inhibition of isoproterenol cAMP accumulation. These results indicate that M2 receptors cause indirect contraction of human bronchus by reversing sympathetically mediated relaxation and contribute to cholinergic functional antagonism.

Acetylcholine↗
PubMed1997

Diagnosis and management of left main stem bronchus compression.

There are four major variants of congenital vascular tracheal compression: innominate artery, aberrant subclavian, aorta or aortic arch anomaly, and pulmonary artery sling. These forms of vascular compression typically involve the trachea and/or the right main stem bronchus. We present eight cases of congenital vascular compression involving the left main stem bronchus. These cases represent a poorly understood variant of vascular tracheal compression. This variant represents approximately 10% of our pediatric tracheobronchial compression or stenosis patients. The finding, both noted endoscopically and now illustrated by magnetic resonance imaging, is caused by compression of the left main stem bronchus between the descending aorta and a portion of the pulmonary artery. Frequently, the descending aorta is in an abnormal anterior position with relation to the thoracic spine. Recognition of this entity is important in our experience and has influenced clinical management. In four of eight children, it required a surgical procedure directed toward the relief of the left main stem compression.

Abnormalities, Multiple↗
PubMed2000

Estimating the diameter of the left main bronchus.

Two hundred and six standard PA chest X-rays were measured. The mean diameter of the left main bronchus (LMB) was 12.6 +/- 1.9 mm. The mean diameter of the 92 male LMB was 13.0 +/- 2.6, and for females 11.8 +/- 1.6. These data correspond closely to that reported by others. The correlation between the diameter of the LMB and that of the trachea was 0.74 but was not precise enough to be useful as an estimate for clinical use. Similarly there was good correlation between the diameter of the right main bronchus and that of the left (r = 0.75) but not precise enough to be clinically useful. In contrast to previous claims, only direct measurement of the left main bronchus has sufficient precision to define the appropriate size of left double-lumen tube to be selected for lung separation.

Adult↗
PubMed2004

Rupture of left main bronchus associated with radiotherapy-induced bronchial injury and use of a double-lumen tube in oesophageal cancer surgery.

We report a case of rupture of the left main bronchus in a female patient with oesophageal carcinoma, who had received thoracic radiotherapy preoperatively. Endotracheal intubation was achieved with a left-sided double-lumen tube. After almost three hours of intubation and one and half hours of one-lung ventilation, bronchial injury was detected. Immediate surgical repair of the membranous part of the bronchus was undertaken, as well as completion of the oesophagectomy. Radiotherapy-induced damage to the bronchus was thought to have contributed to the rupture. The presentation, diagnosis and management of intraoperative bronchial rupture are discussed.

Bronchi↗
PubMed2002

Ex vivo development of functional human lymph node and bronchus-associated lymphoid tissue.

We introduce a novel in vivo model of human mucosal immunity, based on the implantation of human fetal bronchial mucosa and autologous peribronchial lymph node (PLN) in the severe combined immunodeficiency (SCID) mouse. In the SCID host, human fetal bronchi implanted alone retain macrophages and mast cells but lose T cells. In contrast, fetal bronchi co-implanted with PLN contain, in addition to macrophages and mast cells, numerous T cells and B cells, often clustered in intramucosal bronchus-associated lymphoid tissue (BALT). Functionally, bronchus-PLN cografts are able to mount robust alphabeta and gammadelta T-cell-mediated immune responses to Pseudomonas aeruginosa and 3,4-epoxy-3-methyl-1-butyl-diphosphate challenges. No other autologous lymphoid organ (bone marrow, thymus, liver) allows for BALT development in co-implanted bronchi, which suggests special ontogenetic and functional relations between extramucosal PLN and intramucosal BALT. Overall, the bronchus-PLN cograft appears as a promising model for human bronchial immune development and function. Our study is the first to document long-term ex vivo maintenance of functional human lymph nodes as native appendices to mucosal tissue. Our results, therefore, suggest a simple strategy for developing similar experimental models of human immune function in other mucosae.

Abortion, Spontaneous↗
PubMed2006

A preliminary study on the monitoring of mixed venous oxygen saturation through the left main bronchus.

INTRODUCTION: The study sought to assess the feasibility and accuracy of measuring mixed venous oxygen saturation (SvO2) through the left main bronchus (SpO2(trachea)) METHODS: Twenty hybrid pigs of each sex were studied. After anesthesia, a Robertshaw double-lumen tracheal tube with a single-use pediatric pulse oximeter attached to the left lateral surface was introduced toward the left main bronchus of the pig by means of a fibrobronchoscope. Measurements of SpO2(trachea) and oxygen saturation from pulmonary artery samples (SvO2(blood)) were performed with an intracuff pressure of 0 to 60 cmH2O. After equilibration, hemorrhagic shock was induced in these pigs by bleeding to a mean arterial blood pressure of 40 mmHg. With the intracuff pressure maintained at 60 cmH2O, SpO2(trachea) and SvO2(blood) were obtained respectively during the pre-shock period, immediately after the onset of shock, 15 and 30 minutes after shock, and 15, 30, and 60 minutes after resuscitation. RESULTS: SpO2(trachea) was the same as SvO2(blood) at an intracuff pressure of 10, 20, 40, and 60 cmH2O, but was reduced when the intracuff pressure was zero (p < 0.001 compared with SvO2(blood)) in hemodynamically stable states. Changes of SpO2(trachea) and SvO2(blood) corresponded with varieties of cardiac output during the hemorrhagic shock period. There was a significant correlation between the two methods at different time points. CONCLUSION: Measurement of the left main bronchus SpO2 is feasible and provides similar readings to SvO2(blood) in hemodynamically stable or in low saturation states. Tracheal oximetry readings are not primarily derived from the tracheal mucosa. The technique merits further evaluation.

Animals↗
PubMed2004

Does the presence of a tracheal bronchus affect the margin of safety of double-lumen tube placement?

During double-lumen tube (DLT) placement, the anesthesiologist must be mindful of the margin of safety. We determined how this margin is affected by the presence of a tracheal bronchus by elucidating the mathematical relationship between some relevant physical dimensions of the trachea, bronchi, and DLT. Our results suggest that a tracheal bronchus only rarely affects the intrinsic margin of safety of DLT placement. When the tracheal bronchus is located much higher than its most frequently seen location (within 2 cm from the carina), however, there is increased risk that it could be blocked by the tracheal cuff of a left-sided DLT.

Bronchi↗
PubMed1984

Thickening of the posterior wall of the bronchus intermedius in right lung pneumonia.

A recent paper in the literature described thickening of the posterior wall of the bronchus intermedius (PWBI) in patients with congestive heart failure, and/or enlarged lymph nodes and neoplastic infiltrations. At this institution we have seen two recent cases of right upper lobe viral pneumonia demonstrating abnormal thickening of the posterior wall of the bronchus intermedius on lateral chest radiographs. A retrospective survey of our museum cases supported the hypothesis that pneumonia of the right lung, involving the right upper, middle, lower or any combination of these lobes may show thickening of the posterior wall of the bronchus intermedius.

Adult↗
PubMed1999

Extraction of a rubber bullet from a bronchus after 1 year: complete resolution of chronic pulmonary damage.

Inhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose. The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe. Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia. The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchoscopy can be avoided.

Bronchi↗
PubMed1999

Tracheal bronchus associated with lung cancer: a case report.

Tracheal bronchus is a rarely found congenital bronchial anomaly. It usually originates from the right lateral wall of the trachea at the level < 2 cm above the tracheal bifurcation. The patients usually are asymptomatic, but some may experience recurrent pneumonia, chronic bronchitis, or bronchiectasis. It is very rare for a malignant tumor to grow from this aberrant bronchus. There are only four cases of lung cancer developing from the tracheal bronchus reported in the world literature, and we present a fifth case.

Aged↗
PubMed1986

Roentgenographically occult bronchogenic squamous cell carcinoma: location in the bronchi, depth of invasion and length of axial involvement of the bronchus.

Forty patients with roentgenographically occult lung cancer underwent surgical resection. In thirty-five, cancer was detected by mass screening and in five at outpatient clinic. Bronchoscopic localization was accomplished in all cases. Serial block-sections of bronchi of all surgical specimens were prepared and examined microscopically. Forty-two lesions of bronchogenic squamous cell carcinoma were found including two of concurrent occult carcinoma. The site of tumor in the bronchi, the depth of mural invasion and the axial length of involved portion were investigated microscopically. The depth was measured with a micrometer. Fifteen lesions occurred in a subsegmental or a sub-subsegmental bronchus and 27 in a segmental or a central bronchus. Based on the depth of invasion (DI), occult bronchogenic carcinomas were classified microscopically into six categories (DI0 to DI5). Of the 42 lesions, 6 were judged as carcinoma in situ (DI0), 4 as suspicious invasion (DI1), 7 as intramucosal invasion (DI2), 17 as extramuscular invasion (DI3), 5 as extracartilaginous invasion (DI4) and 3 as extrabronchial invasion (DI5). Microscopic analysis revealed the presence of at least two types of infiltration in the bronchial wall. One was the creeping type in which carcinoma extended flatly along the superficial layers of bronchus and was presumed to stay as an occult lung cancer for a long time. The other, the penetrating type in which carcinoma extended deeply into the wall, was presumed to advance within a short period.

Aged↗
PubMed2006

Effects of [Nphe1]nociceptin(1-13)NH2, [Phe1(CH2-NH)Gly2]nociceptin(1- 13)NH2, and nocistatin on nociceptin inhibited constrictions of guinea pig isolated bronchus.

Electric field stimulation (EFS) causes excitatory non adrenergic-non cholinergic (eNANC) and cholinergic constrictions in the guinea pig isolated bronchus, the activation of eNANC and cholinergic nerves respectively. We investigated the effects of [Nphe1]nociceptin(1-13)NH2 ([Nphe1]NC(1-13)NH2), [Phe1(CH2-NH)Gly2]nociceptin(1- 13)NH2 ([F/G] NC(1-13)NH2), and nocistatin (NST) on nociceptin (NC) inhibited constrictions in isolated bronchus of guinea pig. The results show that NC (1 micromol/L) inhibited EFS-induced eNANC and cholinergic constrictions compared with the control, in which nociceptin was not applied. After pretreatment with [Nphe1]NC(1-13)NH2, [F/G]NC(1-13)NH2, or NST, the inhibitions of NC were antagonized by [Nphe1]NC(1-13)NH2 and [F/G]NC(1-13)NH2 but not NST. However, [Nphe1]NC(1-13)NH2, [F/G]NC(1-13)NH2, and NST did not affect the inhibitions induced by morphine. Furthermore, [Nphe1]NC(1-13)NH2, [F/G]NC(1-13)NH2 and NST did not cause any appreciable effects on EFS-induced eNANC and cholinergic constrictions in guinea pig bronchi. The results demonstrate that [Nphe1]NC(1-13)NH2 and [F/G]NC(1- 13)NH2 but not NST act as selective antagonists of the NC receptor and the effects of NC on EFS-induced constrictions of guinea pig isolated bronchus.

Animals↗
PubMed1996

Relationships between divisions of the lingular bronchus and vascularization patterns in the lingula.

In 100 left human lungs the main bronchus, the pulmonary artery and the pulmonary veins were injected with 65% methyl methacrylate (Duracryl) and then digested in sulphuric acid. The resulting specimens were studied concerning the divisions of the lingular bronchus and the types of arterial and venous vascularization of the lingula. As a rule the lingular bronchus divided into two segmental bronchi. A single lingular artery was found in 80% of the cases and a single lingular vein in 58%. Atypical bronchial divisions were almost always associated with unusual types of vascularization. Patterns of bronchial division showed complete concordance with those of arterial vascularization of the lingula in 64% of the lungs and consistency with venous drainage patterns in 54%.

Adolescent↗
PubMed2003

[Comparison of RR-formoterol with rac-formoterol in bronchodilating effect on human bronchus].

OBJECTIVE: To compare the bronchodilating effect of RR-formoterol (RR-FMT) with that of racemic formoterol (rac-FMT) on human bronchus. METHODS: Human bronchial spiral strips (2 - 4 mm internal diameter,15 mm length) were suspended in tissue baths under resting tension of 1.0 g. The changes of tension induced by RR-FMT and rac-FMT(10 pmol x L(-1) - 3.2 micromol x L(-1)) in a cumulative concentration manner were studied under resting tension conditions or precontraction with carbamylcholine (10 micromol x L(-1)) or histamine(100 micromol x L(-1)) in human bronchus. RESULT: The bronchodilating effect of RR-FMT was more potent than that of rac-FMT under resting condition(P<0.05). RR-FMT and rac-FMT reversed histamine or carbamylcholine-induced contraction, and the bronchodilating effect of RR-FMT was more potent than that of rac-FMT (P<0.05). CONCLUSION: The bronchodilating effect of RR-FMT is more potent than that of rac-FMT in both the resting condition and carbamylcholine or histamine-induced contraction in human bronchus in vitro.

Aged↗