[The endoscopic picture of bronchus closure following pulmonary resection using the bronchus wedge excision and cross suture technic].
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Bronchi↗
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[Obstruction of the left main bronchus by a piece of tumor during right-sided pulmonectomy in a patient with adenoma of the upper lobe right bronchus].
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Adenoma↗
[Unusual bronchial anomaly: association of tracheal bronchus and accessory cardiac bronchus].
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Aged↗
[A successful end-to-side anastomosis between the left upperlobe bronchus and the trachea for stenosis of left main bronchus due to tuberculosis].
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Adult↗
Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy.
The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.
Adult↗
[The value of multislice spiral computed tomography in demonstrating the relationship between bronchus and peripheral lung cancer].
OBJECTIVE: To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchus and peripheral lung cancer. METHODS: We prospectively performed volumetric targeted scans of 0.5 mm collimation with MSCT and reconstructed images of multiplanar reconstruction (MPR), curved multiplanar reformations (CMPR) and surface shaded display (SSD) in 53 peripheral lung cancers. The results were compared with macroscopic and microscopic specimens. RESULTS: (1) The third- to seventh-order branches of the bronchi were clearly shown in all patients by the designed protocol. CT demonstrated the tumor-bronchus relationship in 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistic analysis showed that there was no significant difference between the two groups (chi(2) = 2.8, P > 0.05). (2) The tumor-bronchus relationship was identified as four types with MSCT. Type I: bronchus was obstructed abruptly by the tumor, type II: bronchus penetrated into the tumor with tapered narrowing and interruption, type III: bronchus lumen shown within tumor was patent and intact, type IV: bronchus ran at the periphery of the tumor with intact or narrowed lumen. (3) Type I was shown in 31 of 53 (58.5%) tumors with squamous-cell carcinoma slightly more common than adenocarcinoma. Type II and type III were seen equally in 8 of 53 (15.1%) tumors which occurred only in adenocarcinomas. Type IV was seen in 15 of 53 (28.3%) tumors with adenocarcinoma being slightly more frequent than squamous cell carcinoma. (4) The tumor at the fourth-order bronchus was more common in squamous cell carcinoma, whereas that at the fixth-order bronchus was more likely in adenocarcinoma. CONCLUSION: Volumetric targeted scan of ultra-thin section with MSCT and followed by MPR, CMPR and SSD reconstruction can greatly improve the manifestation of the bronchioles and accurately demonstrate the patterns of tumor-bronchus relationship, thereby reflecting pathologic changes to some extent.
Aged↗
Guinea pig bronchus as a model for icosanoid studies.
Strips of guinea pig bronchus dissected from the upper, middle, and lower lobe and divided in two segments referred to as external and internal bronchi, were analyzed for their reactivity to several icosanoids. The external bronchi produced much more contractile force than the internal bronchi, and the reactivity to the agonists was different. The order of potency of prostanoids and histamine on the external bronchus was U44069 congruent to histamine greater than PGF2 alpha and on the internal bronchus U44069 greater than histamine greater than PGF2 alpha. The internal bronchus did not react to PGE2, whereas this agonist produced a dose-dependent relaxation on the external bronchus. The order of potency of leukotrienes and histamine on the external bronchus was LTD4 greater than LTC4 greater than LTE4 greater than LTA4 greater than histamine and on the internal bronchus LTC4 greater than LTD4 greater than LTA4 = LTE4 greater than histamine. LTB4 has a significant myotropic activity on guinea pig bronchus. Because of its sensitivity and characteristic responses to icosanoids, it is suggested that the guinea pig bronchus may be as suitable (and possibly more) a pharmacological preparation as the trachea or the parenchyma to study the bronchoreactivity.
Animals↗
Chronic unilateral occlusion of an extrapulmonary primary bronchus induces pulmonary hypertension syndrome (ascites) in male and female broilers.
Previously, it was demonstrated that acute (4 min) and chronic (12 d) occlusion of an extrapulmonary primary bronchus triggers pulmonary hypertension but not pulmonary hypertension syndrome (PHS, ascites) in broilers. The present study was conducted to determine whether a more prolonged period of bronchus occlusion causes PHS similar to that induced by clamping one pulmonary artery. Male and female broiler chicks, 14 to 18 d old, were anesthetized, the thoracic inlet was opened, and a silver clip was positioned to fully obstruct the left extrapulmonary primary bronchus (BRONCHUS CLAMP group) or the left pulmonary artery (PA-CLAMP group). Sham-operated chicks were anesthetized and the thoracic inlet was opened; however, neither the pulmonary artery nor the bronchus was clamped (SHAM group). An electrocardiogram (ECG) was obtained whenever clinical ascites became apparent in individual broilers, or prior to the final necropsy for broilers surviving to the end (Day 36) of the experiment. The right:total ventricular weight ratio (RV:TV) was evaluated as an index of pulmonary arterial pressure. Early post-surgical mortality (up to 21 d of age) was higher in the PA-CLAMP group (27% for males and females combined) than in the BRONCHUS CLAMP (10%) and SHAM (2%) groups. Cumulative ascites mortality (Days 22 to 36) also was higher in the PA-CLAMP group (86% for males, 77% for females) than in the BRONCHUS CLAMP (69% for males, 41% for females) and SHAM (23% for males, 0% for females) groups. Ascitic birds in all treatment groups had higher RV:TV ratios and more negative ECG Lead II S-wave amplitudes than nonascitic birds, reflecting the right ventricular hypertrophy and generalized ventricular dilation typically associated with PHS. These results demonstrate that unilateral bronchus occlusion is an effective experimental model for triggering ascites at a lower incidence than that obtained by occluding one pulmonary artery. Following the onset of pulmonary hypertension, the pathophysiological progression leading to ascites appears to be similar for broilers with either unilateral bronchus or pulmonary artery occlusion.
Animals↗
Case report: Endotracheal tube malposition in a patient with a tracheal bronchus.
PURPOSE: A tracheal bronchus is a congenital abnormality of the tracheobronchial tree, in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We report a patient with a tracheal bronchus that was found incidentally during surgery in the prone position, and the potential airway management problems which may have ensued. CLINICAL FEATURES: A 70-yr-old female underwent posterior spinal decompression and fusion in the prone position. Intraoperatively, end-tidal CO2 and airway pressure increased. Fibreoptic bronchoscopy revealed that the endotracheal tube (ETT) was kinked at the 16 cm mark, which was corrected by rotating the patient's head and ETT. When the bronchoscope was advanced beyond the tip of the ETT, a tracheal-bronchial tree trifurcation was identified. Endobronchial intubation was suspected. As the ETT was withdrawn, the endoluminal view remained unchanged. During bronchoscopy, the patient's trachea was nearly extubated in the prone position. Subsequent bronchoscopy of the major bronchial divisions showed that the trifurcation represented left main stem bronchus, bronchus intermedius and right upper lobe bronchus. Once the tracheal bronchus was recognized, the tip of the ETT was repositioned 3 cm above the tracheal trifurcation, and the rest of the case was uneventful. CONCLUSION: This case highlights the diagnostic challenge and airway management implications of one variant of a tracheal bronchus when airway problems are encountered intraoperatively. This knowledge should be applied in the differential diagnosis and management of intraoperative hypoxemia; and in the proper positioning of the ETT.
Aged↗
CT bronchus sign in malignant solitary pulmonary lesions: value in the prediction of cell type.
The aim of this study was to evaluate differences in the prevalence of patterns of CT bronchus sign in malignant solitary pulmonary lesions (SPLs), according to their histologic cell types and with respect to size, location, and degree of cell differentiation. Computed tomography scans of 78 patients, in whom pathologically confirmed malignant SPLs with CT bronchus sign were present, were randomly selected and reviewed by two radiologists under consensus. All 78 were CT scans done using spiral technique with 10-mm collimation and 10-mm reconstruction intervals with enhancement, and 75 included additional high-resolution CT scans. Lesions were classified into four cell types as squamous cell carcinoma (n = 24), small cell carcinoma (n = 12), adenocarcinoma (n = 23), bronchioloalveolar carcinoma (BAC; n = 9), and others (n = 12), into three degrees of differentiation, into three size groups, and according to location (central or peripheral). Patterns of CT bronchus sign were classified into abruptly obstructing (I), patent (II), displacing (III), or tapered narrowing (IV) types. The relationships between the patterns of CT bronchus sign and cell type and degree of cell differentiation were evaluated. Eighty patterns of CT bronchus sign were observed in 78 patients. According to cell type, squamous cell carcinoma showed most often type-I pattern (45.8%) but no type-II pattern, which was the most common pattern observed in BAC (77.8%) and adenocarcinoma (34.8%; p<0.01). Small cell carcinoma showed a varied distribution among the four patterns of CT bronchus sign. According to location, in central squamous cell carcinomas, type-I pattern was more common(55%; p<0.01). Bronchioloalveolar carcinoma showed more peripheral lesions and in both central and peripheral lesions, type-II pattern was significantly more common (100 and 66.7%; p<0.01). In SPLs with CT bronchus sign of obstructing pattern, especially if central location, squamous cell carcinoma should be suspected, whereas in SPLs with patent CT bronchus sign, regardless of the location, the strong possibility of BAC should be considered.
Adult↗
Radiographic relationship of the origin of the bronchial arteries to the left main bronchus.
The purpose of this study was to demonstrate that the relationship of the left main bronchus to the bronchial arteries is a reliable radiographic landmark for accurate catheterization of the right and left bronchial arteries. Sixty-six bronchial angiograms and chest radiographs in 43 patients were reviewed. The relationship of the tip of the catheter during initial bronchial angiography (used as the point of bronchial arterial origin) and the radiolucent shadow of the left main bronchus in patients with and without radiographic evidence of anatomic distortion caused by pulmonary disease was categorized into three groups: within the shadow of the left main bronchus, near the left main bronchus, and far from the left main bronchus. The origin of the right and left bronchial arteries was within or near the shadow of the left main bronchus in 94% of bronchial angiograms performed in patients with and without distorted thoracic anatomy. The most frequent location was within the shadow of the left main bronchus. The left main bronchus can be used as a reliable reference point for catheterization of the right or left bronchial arteries in patients with and without thoracic anatomic distortion.
Adult↗
Tachykinin receptors mediating non-cholinergic contraction of the guinea-pig isolated main bronchus in response to field stimulation.
1. The primary aim of the present study was to classify the receptors activated by tachykinins released by field stimulation of intramural nerve terminals of the guinea-pig isolated main bronchus by using the novel non-peptide NK1 and NK2 receptor-selective antagonists SR 140333 and SR 48968, respectively. 2. Log concentration-response curves to substance P (SP), the NK1 receptor-selective agonist [Sar9, Met(O2)11]-SP and the NK2 receptor-selective agonist [Nle10]-neurokinin (NK) A(4-10) were constructed in the presence of indomethacin (2 mumol/L) and phosphoramidon (5 mumol/L). Substance P was the least potent of these agonists. 3. In left and right main bronchi, SR 140333 (100 nmol/L) antagonized concentration-related contractions evoked by SP yielding pKB values of 8.02 and 7.68, respectively. SR 140333 (10 nmol/L) antagonized the effects of [Sar9, Met(O2)11]-SP on the left bronchus with a pKB value of 8.04. 4. SR 48968 (100 nmol/L) antagonized the effects of SP yielding pKB estimates of 7.88 (left bronchus) and 7.31 (right bronchus). 5. [Nle10]-NKA(4-10) was more potent in the left than in the right main bronchus. SR 48968 (0.1-10 nmol/L) antagonized the effects of [Nle10]-NKA(4-10) on the left bronchus with pKB estimates of 8.26-10.25. 6. In the presence of indomethacin (2 mumol/L), phosphoramidon (5 mumol/L) and atropine (1 mumol/L), electrical field stimulation (EFS; 30 V, 1 ms, 15 s at 1, 3, 10 and 30 Hz) produced prolonged contractions. SR 48968 (0.1 mumol/L) markedly reduced responses to stimulation, whereas SR 140333 (0.3 mumol/L) caused a small but significant rightward displacement of the log frequency-response curve. In combination, these concentrations of SR 48968 and SR 140333 produced complete inhibition to field stimulation at 10 Hz. 7. These results indicate that: (i) both NK1 and NK2 receptor subtypes are present in the guinea-pig main bronchi with the left bronchus being more sensitive to an NK2 receptor agonist; and (ii) EFS of the main bronchus leads to frequency dependent contractions due to the release of tachykinin(s) that predominantly activate an NK2 receptor.
Animals↗
Studies of plasma zinc, copper, caeruloplasmin, and growth hormone: with special reference to carcinoma of the bronchus.
The levels of plasma zinc, copper, caeruloplasmin, and growth hormone were determined in a group of normal people and in four groups of patients who were suffering from carcinoma of the bronchus, other forms of malignancy, chest illnesses, and diseases other than chest illness or malignancy. The plasma zinc was higher, and the plasma copper lower, in people without malignancy below the age of 30 years than they were in other age groups.It was confirmed that about 66% of patients with carcinoma of the bronchus had plasma zinc levels less than 11.5 mumol/l but low levels were also found in 23% of other cases of malignancy and in 9% of the other patients. In carcinoma of the bronchus the low plasma zinc was found to be associated with epidermoid and anaplastic tumours and was to some extent related to the duration of the disease. In carcinoma of the bronchus the plasma copper was found to be higher than in all other groups, and values higher than 26.5 mumol/l were considered to support a diagnosis of carcinoma of the bronchus. There was, however, no relationship between the increase in the plasma copper and the decrease in the plasma zinc.Raised caeruloplasmin levels above 420 mg/l were found in 65% of cases of carcinoma of the bronchus, and these high levels were usually associated with raised plasma copper. Growth hormone was normal in all groups except six patients with carcinoma of the bronchus with secondary carcinoma of the liver, in whom it was raised. Surgical operations lowered plasma zinc and raised growth hormone but did not affect plasma copper.A plasma zinc below 11.5 mumol/l is helpful in the diagnosis of carcinoma of the bronchus, but by itself it is not sufficiently specific to be considered diagnostic or to form a reliable screening test. A raised plasma copper and a raised plasma caeruloplasmin were useful supportive findings.
Adolescent↗
Squamous cell carcinoma of the right upper lung congenital tracheal bronchus.
Tracheal bronchus, directly arising from the abnormal tracheal wall, is a rare congenital anomaly of the airway. Lung cancer developing in a tracheal bronchus is even more rare. A 68-year-old man had a mass shadow over the right upper lung on chest radiography. Bronchoscopy revealed an abnormally displaced bronchus stemming from the right side of the tracheal wall, 2 cm above the carina. Arising from this tracheal bronchus was a tumor, a biopsy of which showed squamous cell carcinoma. During surgery, a bronchus arising from the right lateral wall of the trachea and supplying the apical segment of the right upper lobe was found. There was a tumor occluding the lumen of the tracheal bronchus, causing distal obstructive pneumonitis. The patient underwent right upper lobectomy with closure of the tracheal bronchus and radical lymph node dissection. The subsequent pathologic examination of the specimen revealed squamous cell carcinoma with surrounding pneumonitis. Bronchogenic cancers developing in a tracheal bronchus are rarely reported in the English language literature. Surgical resection appears to be the treatment of choice.
Bronchi↗
Tracheal reconstruction after lower tracheal resection using the inverted right bronchus--an experimental study.
An experimental study of tracheal reconstruction after lower tracheal resection using the inverted bronchus was performed in 8 dogs. After right upper lobectomy, the five cartilage rings of the lower trachea, ending three cartilage rings above the carina, was circumferentially resected; the right bronchus was transected just above the right second carina, the portion of the transected trachea above the carina was closed, and the right bronchus was inverted. The peripheral end of the upper trachea was anastomosed to the inverted right bronchus, and the intermediate bronchus was anastomosed to the lateral wall of the left bronchus. After completion of the airway reconstruction, the anastomotic site was wrapped with an omental flap. Although anastomotic complication were observed in two dogs, all the dogs survived the operation. Bronchoscopically and histopathologically, the findings for the inverted bronchus were almost normal three to four weeks after the operation. The clinical relevance of such a tracheal reconstruction is discussed.
Anastomosis, Surgical↗
An experimental study of tracheal reconstruction using a freed piece of the right bronchus.
An experimental study of tracheal reconstruction using a separate piece of bronchus was performed in 6 dogs. After right upper lobectomy, a five-cartilage-ring length of the trachea extending from five cartilage rings above the carina was circumferentially resected; the right bronchus was transected just below the carina and above the second carina to provide the piece of bronchus, which was then interposed between the distal end of the upper trachea and the proximal end of the lower trachea by end-to-end anastomoses. One-stoma type carinal reconstruction (an anastomosis between the carina and the right intermediate bronchus) was performed. After completion of the airway reconstruction, the anastomotic site was wrapped with an omental flap. One dog died 14 days after operation due to anorexia and weakness, the necropsy in this dog revealed severe ischemic change of the interposed bronchus and ulcer formation at the stump of the upper bronchus. The other 5 dogs survived the operation. Bronchoscopically, the findings for the interposed free bronchus revealed severe ischemic change immediately after the operation, but almost normal findings were observed four to five weeks after the operation. The clinical relevance of this method of tracheal reconstruction is discussed.
Anastomosis, Surgical↗
The IL-5 receptor on human bronchus selectively primes for hyperresponsiveness.
BACKGROUND: The role of IL-5-induced eosinophilia in airway hyperresponsiveness has been questioned. In addition, eosinophil-independent IL-5-induced airway hyperresponsiveness has been demonstrated in animals. OBJECTIVE: In this study, IL-5 was investigated for direct effects on human bronchial responsiveness. METHODS: Human muscle preparations were isolated from organ donor and surgical tissue. Bronchus, jejunum, and saphenous vein were incubated for 24 hours in vitro with recombinant human (rh) IL-5. Contractility to acetylcholine (bronchus, jejunum) and phenylephrine (saphenous vein) was then investigated. RT-PCR was used to evaluate IL-5 receptor alpha (IL-5R(alpha)) expression in various tissues and to assess bronchus and saphenous vein eosinophils through use of CCR3 expression. RESULTS: rhIL-5 primed bronchus for an exaggerated contraction to acetylcholine. The acetylcholine concentration that produced 50% of the control maximum response was reduced 17- to 20-fold in bronchus treated with 1 and 10 nmol/L rhIL-5. The lower concentration of 0.1 nmol/L rhIL-5 had no effect. The rhIL-5 effect on bronchial contractility was attenuated by antibodies to IL-5 (TRFK-5; 100 nmol/L) and human IL-5R(alpha) (100 nmol/L). rhIL-5 (10 nmol/L) did not enhance contractility of saphenous vein or jejunum. When RT-PCR was used, IL-5R(alpha) expression was strong in bronchus muscle, weak in trachealis, saphenous vein, and atrial muscle, and undetectable in jejunum, urinary bladder, and pulmonary and renal artery muscle. Comparable weak expression of CCR3 was identified in bronchus and saphenous vein. CONCLUSION: The findings are consistent with an airway tissue-selective expression of the IL-5 receptor that mediates IL-5-induced airway hyperresponsiveness independent of eosinophils. In asthma, in which IL-5 expression is elevated, IL-5 might directly induce bronchial hyperresponsiveness.
Acetylcholine↗
Tracheal bronchus: classification, endoscopic analysis, and airway management.
OBJECTIVE: Tracheal bronchus (bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum. STUDY DESIGN/METHODS: Retrospective case series. RESULTS: The tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12-year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right-sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy. CONCLUSIONS: Otolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options.
Bronchi↗