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External compression of bronchus by aneurysm from divided major aortopulmonary collateral artery after unifocalization.

The right ventricle to pulmonary artery connection with an extracardiac conduit, left pulmonary artery reconstruction, ligation of patent ductus arteriosus, and take-down of right Blalock--Taussig shunt were performed on a 1-year-8-month-old boy who had pulmonary atresia, ventricular septal defect, patent ductus arteriosus, and major aortopulmonary collateral arteries. He previously underwent the unifocalization and right modified Blalock--Taussig shunt at 9 months of age. He repeatedly had a difficulty in weaning from the mechanical ventilator. After removing the aneurysm from the divided major aortopulmonary collateral artery that compressed the left main bronchus externally, it was possible to wean him from the mechanical ventilator.

Aortic Aneurysm↗

Foreign body in tracheal bronchus simulating bronchogenic cancer.

A foreign body in the bronchial tree may mimic many pathological conditions. We present a case of a 62-year-old patient with a foreign body in the tracheal bronchus simulating bronchogenic cancer. After the removal of the foreign body, there has been a gradual regression of the foreign body induced inflammatory changes. To the best of our knowledge, a similar case has not been reported in the English medical literature.

Bronchi↗

Magnetic resonance imaging for aspirated peanut in the bronchus.

Peanut inhalation in the right main bronchus of a 15-month-old boy was diagnosed using a T1-weighted image produced by magnetic resonance imaging (MRI) because of the high fat content of the peanut. The T1-weighted MRI image may also be useful in diagnosing other kinds of aspirated nuts with high lipid content as well as peanuts. This method does not involve any X-ray exposure.

Arachis↗

Stimulation of the bronchus-associated lymphoid tissue of goats and its effect on in vitro colonization by Pasteurella haemolytica.

Twenty goats of about 7 months of age were divided into five groups. The goats in groups 1 and 2 were exposed once, using an intranasal spray to 2 ml of an inoculum containing 10(6) colony-forming units/ml of living or dead Pasteurella haemolytica A2, respectively. The goats in groups 3 and 4 were similarly exposed twice at a 2-week interval. Group 5 was the untreated control. The number and size of the bronchus-associated lymphoid tissue (BALT) in goats exposed twice to either living or dead organisms were significantly (p < 0.05) increased compared with those exposed once and with the unexposed control. In vitro colonization by living P. haemolytica A2 onto the lung tissue in which the BALT had been stimulated by two exposures of either living or dead organisms was significantly (p < 0.05) reduced. The study indicates that stimulation of the respiratory mucosal immunity may prevent P. haemolytica A2 infection.

Administration, Intranasal↗

The effects of dexamethasone on the response of bronchus-associated lymphoid tissue to intranasal administration of formalin-killed Pasteurella haemolytica A2 in goats.

A trial was conducted to observe the immediate and chronic effects in goats of dexamethasone administration on the bronchus-associated lymphoid tissue (BALT) response to intranasal administration of formalin-killed Pasteurella haemolytica A2. Twenty-four goats were divided into four groups. Those in group 1 were injected intramuscularly with 1 mg/kg dexamethasone on three consecutive days, followed by intranasal exposure to formalin-killed P. haemolytica A2 one day after the last dexamethasone treatment. The goats in group 2 were similarly injected with dexamethasone followed by intranasal exposure to formalin-killed P. haemolytica A2 21 days after the last dexamethasone treatment. The animals in group 3 were exposed intranasally to formalin-killed P. haemolytica A2 without prior dexamethasone treatment. The animals in group 4 were untreated controls. The intranasal exposures to formalin-killed P. haemolytica A2 were repeated 2 weeks later. Intranasal exposure to formalin-killed P. haemolytica 1 day after dexamethasone treatment further reduced the number and size of BALT compared to the untreated control. Significantly (p < 0.01) more reduction of BALT occurred in goats exposed to formalin-killed P. haemolytica A2 21 days after dexamethasone treatment. On the other hand, intranasal exposure of goats without prior dexamethasone treatment stimulated the BALT compared to the untreated controls.

Administration, Intranasal↗

5-year follow-up of cytotoxic chemotherapy as an adjuvant to surgery in carcinoma of the bronchus.

This report gives the 5-year findings of a double-blind study of long-term cytotoxic chemotherapy as an adjuvant to surgery in patients receiving busulphan or cyclophosphamide for carcinoma of the bronchus compared with a group receiving a placebo. Of 243 patients initially allocated busulphan, 234 cyclophosphamide and 249 placebo, 28%, 27% and 34% respectively were alive at 5 years. There were significant associations between mortality from bronchial carcinoma and histological involvement of the resected intrathoracic nodes and the histology of the tumour. Haematological toxicity, especially thrombocytopenia, was frequent and severe in the busulphan series, and low platelet counts continued long after chemotherapy was stopped.

Bronchial Neoplasms↗

Harmful effects of i.v. Corynebacterium Parvum given at the same time as cyclophosphamide in patients with squamous-cell carcinoma of the bronchus.

The effects are reported of a combination therapy of i.v. C. parvum and cyclophosphamide on the survival time and immune responses of patients with inoperable squamous-cell carcinoma of the bronchus. The immune status of the patients was evaluated by determining the antibody response to C. parvum, the E and EAC rosettes, the PHA response of blood lymphocytes, the skin-test reactivity to Candida and PPD, the response to DNCB and the chemotaxis and NBT-dye reduction capacity of neutrophil leucocytes. The survival time of patients treated with the combination therapy was found to be significantly shorter than that of untreated patients and of those receiving cyclophosphamide only. Severe side effects were observed after C. parvum infusions, with no decrease on repeated administration. The effect of C. parvum on the different immune parameters of cyclophosphamide-treated patients was negligible, though there was a normal antibody response to C. parvum.

Aged↗

Cytotoxic chemotherapy before and after radiotherapy compared with radiotherapy followed by chemotherapy in the treatment of small-cell carcinoma of the bronchus: the results up to 36 months.

This report compares the results up to 36 months of two sequences of radiotherapy and chemotherapy for small-cell anaplastic carcinoma of the bronchus, of limited extent (defined below). A total of 91 patients were allocated at random to treatment with radiotherapy to the primary site followed by 10 pulses of chemotherapy using cyclophosphamide, methotrexate and CCNU (RC), and 95 to two pulses of the same chemotherapy, followed by radiotherapy, followed by 8 pulses of chemotherapy (CRC). The median survival times were 36 weeks for the RC series and 45 weeks for the CRC series but there was no statistically significant difference in survival (P = 0.9, log-rank test). At 12 months, 32 (35%) of the RC and 38 (40%) of the CRC patients were alive, at 24 months, 8 (9%) and 4 (4%), and at 36 months, 7 (8%) and 1 (1%) respectively. The patients' general condition, grade of activity and respiratory assessment correlated significantly with survival. Of 38 patients reported to be in "excellent" condition at the start of treatment, 6 (16%) were alive at 3 years. Although there was evidence that the onset of metastases was slightly delayed in the CRC series, this difference had disappeared by 12 months.

Adult↗

Heterogeneity in microvascular density in lung tumours: comparison with normal bronchus.

The aim of this study was to test the hypotheses that (a) microvascular density (MVD) measured in histological sections of resected non-small cell lung carcinomas is an index of angiogenesis and (b) the measurement of MVD in a single block is representative of the overall MVD of the tumour. MVD was quantitated in one block per specimen of 60 lung tumours and nine normal lung tissues, and in 47 blocks taken from different regions of four tumours. Blood vessels were stained with antibody to von Willebrand Factor and MVD was quantitated using two methods: average density throughout the section (a-MVD) and density in the most vascularized area or 'hot spot' (h-MVD). Similar h-MVD values were found in tumours and in normal bronchus, whereas a-MVD was greater in the latter (P < 0.01). When 47 blocks from four tumours were analysed, inter-tumour variation was significant (P < 0.001) in spite of significant intra-tumour variation. The highest MVD value was not necessarily found in the periphery of the tumour. The four tumours were ranked into either two or four tiers according to their overall MVD. In 50 random selections of one block per tumour, the correct ranking was achieved in 68-74% of cases with the two-tier ranking and in 6-16% of cases with the four-tier ranking (h-MVD and a-MVD values respectively). These results suggest that elevated MVD values do not necessarily represent angiogenesis in non-small cell lung carcinomas. When only one block per tumour is examined, the chance of obtaining an accurate estimate of the vascularity of that tumour may be lower than 68%.

Adenocarcinoma↗

Submucosal glands are the predominant site of CFTR expression in the human bronchus.

We have used in situ hybridization and immunocytochemistry to characterize the cellular distribution of cystic fibrosis (CF) gene expression in human bronchus. The cystic fibrosis transmembrane conductance regular (CFTR) was primarily localized to cells of submucosal glands in bronchial tissues from non-CF individuals notably in the serous component of the secretory tubules as well as a subpopulation of cells in ducts. Normal distribution of CFTR mRNA was found in CF tissues while expression of CFTR protein was genotype specific, with delta F508 homozygotes demonstrating no detectable protein and compound heterozygotes expressing decreased levels of normally distributed protein. Our data suggest mechanisms whereby defects in CFTR expression could lead to abnormal production of mucus in human lung.

Bronchi↗

Role of inducible bronchus associated lymphoid tissue (iBALT) in respiratory immunity.

Bronchus-associated lymphoid tissue (BALT) is occasionally found in the lungs of mice and humans; however, its role in respiratory immunity is unknown. Here we show that mice lacking spleen, lymph nodes and Peyer's patches generate unexpectedly robust primary B- and T-cell responses to influenza, which seem to be initiated at sites of induced BALT (iBALT). Areas of iBALT have distinct B-cell follicles and T-cell areas, and support T and B-cell proliferation. The homeostatic chemokines CXCL13 and CCL21 are expressed independently of TNFalpha and lymphotoxin at sites of iBALT formation. In addition, mice with iBALT, but lacking peripheral lymphoid organs, clear influenza infection and survive higher doses of virus than do normal mice, indicating that immune responses generated in iBALT are not only protective, but potentially less pathologic, than systemic immune responses. Thus, iBALT functions as an inducible secondary lymphoid tissue for respiratory immune responses.

Animals↗

Inherent tone of human bronchus: role of eicosanoids and the epithelium.

1. Airway preparations of different species possess varying degrees of inherent tone which is the result of different metabolites of arachidonic acid in different species. In human bronchial smooth muscle in vitro we have investigated the effects of 5-lipoxygenase inhibition (zileuton, 10 microM), cyclo-oxygenase inhibition (indomethacin, 1 microM) and mechanical epithelium removal on inherent tone. The shunting of arachidonic acid by inhibition of one or other of these enzymes, as a possible explanation for the effects observed, has also been investigated. 2. Zileuton caused a significant fall in tone either alone (-107 +/- 33 mg) or after cyclo-oxygenase inhibition (-203 +/- 48 mg) and this effect was not significantly altered by epithelial removal (-191 +/- 43 mg alone; -333 +/- 88 mg after indomethacin). Indomethacin increased tone when applied alone (160 +/- 94 mg), but this effect only reached statistical significance after 5-lipoxygenase inhibition, (210+/-81 mg; P<0.05). Epithelial removal did not alter the effect of indomethacin when applied alone (213+/-97 mg), but significantly reduced the effect of indomethacin after 5-lipoxygenase inhibition (34 +/- 23 mg; P<0.05). 3. These data suggest that inherent tone in human bronchus is largely the result of contractile 5-lipoxygenase products. However, the involvement of cyclo-oxygenase products cannot entirely be discounted, since in the presence of 5-lipoxygenase inhibition contractile and relaxant eicosanoids originating from the bronchial epithelium appear to influence significantly inherent tone.

Adult↗

Naloxone blocks endomorphin-1 but not endomorphin-2 induced inhibition of tachykinergic contractions of guinea-pig isolated bronchus.

The recently identified endogenous agonists on the mu-opioid-receptor (mu OR), endomorphin-1 (EM-1) and endomorphin-2 (EM-2), induce a concentration dependent inhibition of electrical field stimulation (EFS)-induced tachykinin-mediated contractions of the guinea-pig bronchus (ED50s < 10 nM for both compounds). Surprisingly, only endomorphin-1 effects could be blocked by naloxone (10 microM), whereas endomorphin-2 effects were not affected by specific antagonists for the mu-, kappa-, and delta-opioid-receptor.

Analgesics, Opioid↗

Reproducibility of the WHO/IASLC grading system for pre-invasive squamous lesions of the bronchus: a study of inter-observer and intra-observer variation.

AIMS: Although many workers have graded pre-invasive squamous lesions arising in the bronchus, there has been no consensus classification system until the latest edition of the WHO/IASLC histological classification of pulmonary and pleural tumours. Because the value of any such system is dependent on its reproducibility, we have circulated a series of such lesions to a panel of histopathologists to assess interobserver and intra-observer variation when the WHO/IASLC classification was applied. METHODS AND RESULTS: Colour transparencies of 28 pre-invasive squamous lesions were assessed by six histopathologists (two with a special interest in pulmonary pathology, two generalists and two trainees) on three separate occasions over a period of 3 months, using the criteria of the WHO/IASLC (mild, moderate and severe dysplasia, and in-situ carcinoma). An additional category of metaplasia was added for those cases that showed no dysplasia. Weighted kappa coefficents of agreement (K(w)) were used to evaluate paired observations with a standard quadratic weighting being employed, such that kappa coefficients corresponded to intra-class correlation coefficients. Wilcoxon's sign-ranked test was used to measure the statistical significance of group trends, when comparing kappa values for the three grading systems. Various 3-point systems were also assessed, through combination of the above groups. Intra-observer agreement was substantially better than interobserver variation (mean: 0.71 vs. 0.55). Between the various pathologist groups, inter-observer variation was relatively minor, although intra-observer variation was higher within the trainee pathologist group. Using weighted kappa values, there was no significant difference in either inter-observer or intra-observer agreement between the five point grading system and a 3-point system of metaplasia/mild, moderate and severe/in-situ grades. However, there was a significant increase in variation when a 3-point system of metaplasia/mild, moderate/severe and in-situ carcinoma was used. CONCLUSION: This study shows levels of interobserver and intra-observer variation similar to those found in other grading systems in histopathology, with no significant decrease in variability found by abridging the system. The WHO/IASLC system is therefore recommended for future use in both clinical and research fields.

Bronchial Neoplasms↗

Bronchus-associated lymphoid tissue (BALT) and larynx-associated lymphoid tissue (LALT) are found at different frequencies in children, adolescents and adults.

The lung in 98 and the larynx in 51 consecutive autopsies (age: 17th gestational week to 99 years) were studied for the presence of organized lymphoid tissue in the epiglottis and in the wall of larger bronchi. Bronchus-associated lymphoid tissue (BALT) was seen in about 40% of patients younger than 20 years of age but in older patients only in exceptional cases. In the wall of the epiglottis, however, larynx-associated lymphoid tissue (LALT) was found at a frequency of approximately 80% in patients younger than 20 years and in 56% of the patients older than 20 years. The clinical relevance of LALT as a physiological entry site for antigens or for vaccination protocols using aerosols needs to be studied in further experiments.

Adolescent↗

Changes in lymphocyte subsets in the bronchus-associated lymphoid tissue of goats naturally infected with different Mycoplasma species.

The distribution of cells containing lysozyme, S-100 protein, CD3, CD4, CD8, major histocompatibility complex class II antigen and immunoglobulin G (IgG) was analysed in the bronchus-associated lymphoid tissue (BALT) of goats naturally infected with three Mycoplasma species. This study included the immunohistochemical characterization of the pneumonic lesions of 18 goats (3-5 months old) infected with one of the following Mycoplasma species: M. mycoides ssp. mycoides, Large Colony type (goats no. 1-6), M. mycoides ssp. capri (goats no. 7-12) and M. capricolum ssp. capricolum (goats no. 13-18). Microscopically, infected animals showed a moderate broncho-interstitial pneumonia, characterized by lymphoid hyperplasia of the BALT and infiltration of mononuclear cells in the alveolar walls and airways. The main cellular type in the BALT was represented by CD3+ T lymphocytes, and the ratio of CD4+:CD8+ cells was > 2. The BALT showed large germinal centres mainly composed of IgG+ B lymphocytes, with numerous S-100+ follicular dendritic cells. The presence of follicular dendritic cells confirmed the high degree of organization of this lymphoid tissue. The immunohistochemical results showed that activated T lymphocytes, particularly in the CD4 subset, and IgG+ B cells, play a major role in the immune response of the caprine lung infected with these species of mycoplasmas.

Animals↗