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PubMed2001

Malignant lymphoma of bronchus-associated lymphoid tissue (BALT) coexistent with pulmonary tuberculosis.

A case in which malignant lymphoma occurred in association with a tuberculosis focus in a 70-year-old man is reported. Surrounding the epithelioid cell granulomas with caseous necrosis was a dense and diffuse monotonous infiltration of atypical lymphoid cells. Acid-fast bacilli were found in the granulomas and pulmonary tuberculosis was diagnosed. The infiltrating atypical lymphoid cells occasionally invaded the respiratory epithelium producing lymphoepithelial lesions. Immunohistochemically, the lymphoid cells were positive for CD20, and clonal rearrangement of the immunoglobulin heavy chain gene was demonstrated by polymerase chain reaction (PCR). We diagnosed the lesion as a pulmonary malignant lymphoma of bronchus-associated lymphoid tissue (BALT) occurring in the background of tuberculosis. This is the first reported case of pulmonary BALT lymphoma coexistent with pulmonary tuberculosis.

Aged↗
PubMed2000

Antigen uptake and subsequent cell kinetics in bronchus-associated lymphoid tissue.

OBJECTIVE: Bronchus-associated lymphoid tissue (BALT) plays an important role in the immunological defence of airways. However, the mechanisms of BALT development, antigen sampling, and subsequent cell kinetics remain unclear. To clarify these chronological processes, we used a Pseudomonas aeruginosa-exposed mouse model. METHODOLOGY: In BALB/c and C57BL/6 mice, BALT development was induced by inhalation of heat-killed P. aeruginosa after sensitization with subcutaneous injection of P. aeruginosa in the presence of Freund's complete adjuvant. Subsequently, we chronologically killed these mice who had inhaled PKH26-labelled P. aeruginosa and examined bacterial transport using fluorescence microscopy. The distribution of interleukin-4-positive cells and interferon-gamma-positive cells was studied immunohistochemically. RESULTS: The degree of BALT hyperplasia was greater in sensitized mice than in non-sensitized mice and in BALB/c mice than in C57BL/6 mice. PKH26-labelled bacteria were found in BALT earlier in sensitized mice than in non-sensitized mice. Immunohistochemical studies revealed that interleukin-4-positive cells predominated over interferon-gamma-positive cells in the peripheral areas of lymphoid follicles. CONCLUSION: These results indicate that administered antigens are actively transported into BALT and that sensitized Th2 lymphocytes play an important role in forming and maintaining BALT.

Animals↗
PubMed2001

Biotransformation in vitro of the 22R and 22S epimers of budesonide by human liver, bronchus, colonic mucosa and skin.

The pharmacological effects of glucocorticoids are greatly influenced by their pharmacokinetic properties. In the present report, the in vitro biotransformation of the 22R and 22S epimers of the topical steroid budesonide was studied in the S-9 fraction of human liver, bronchus, skin and colonic mucosa. The disappearance of unchanged epimers of budesonide was measured during 90 min of incubation by high performance liquid chromatography. The rate of disappearance was high in human liver while little biotransformation occurred in bronchial tissue and colonic mucosa, and none was detected in the skin. A marked decay of the initial concentration of unchanged budesonide epimers was noticed after 2 h incubation in cultured human hepatocytes, while only a small decrease was observed after 24 h incubation in cultured human airway smooth muscle cells and BEAS-2B cells. The 22R epimer of budesonide suffered greater in vitro biotransformation than the 22S epimer in human hepatic, bronchial and colonic tissues. These findings extend those of other studies, and confirm that the high therapeutic ratio of budesonide is due to negligible local biotransformation combined with high level of liver metabolism for locally absorbed budesonide.

Administration, Topical↗
PubMed2002

Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review.

OBJECTIVE: To conduct a systematic review to determine the relative effectiveness of treatments currently employed in the management of superior vena caval obstruction (SVCO). SEARCH STRATEGY: Electronic searching of the Cochrane Clinical Trials Register, Medline and Embase with identification of further studies from references cited in trials identified by electronic searching. SELECTION CRITERIA: Both randomized and non-randomized controlled trials in which patients with carcinoma of the bronchus and SVCO had been treated with any combination of steroids, chemotherapy, radiotherapy or insertion of an expandable metal stent. DATA COLLECTION AND ANALYSIS: There were three randomized and 98 non-randomized studies of which two and 44 respectively met the inclusion criteria. MAIN RESULTS: Superior vena caval obstruction was present at diagnosis in 10.0% of patients with small cell lung cancer (SCLC) and 1.7% of patients with non-small cell lung cancer (NSCLC). In one small randomized trial in SCLC, the rate of SVCO relapse was not significantly reduced by giving radiotherapy on completion of chemotherapy. In another, in NSCLC, the addition of induction chemotherapy to a course of synchronous chemo-radiotherapy did not provide greater relief of SVCO. In SCLC chemotherapy and/or radiotherapy relieved SVCO in 77%; 17% of those treated had a recurrence of SVCO. In NSCLC, 60% had relief of SVCO following chemotherapy and/or radiotherapy; 19% of those treated had a recurrence of SVCO. Insertion of an SVC stent relieved SVCO in 95%; 11% of those treated had further SVCO but recanalization was possible in the majority resulting in a long-term patency rate of 92%. Morbidity following stent insertion was greater if thrombolytics were administered. REVIEWERS' CONCLUSIONS: Chemotherapy and radiotherapy are effective in relieving SVCO in a proportion of patients whilst stent insertion may provide relief in a higher proportion and more rapidly. The effectiveness of steroids and the optimal timing of stent insertion (whether at diagnosis or following failure of other modalities) remain uncertain.

Adrenal Cortex Hormones↗
PubMed1979

Lobectomy with sleeve resection of the bronchus for malignant disease of the lung and the influence of the suture material used for the bronchial repair.

A series of 100 consecutive cases of lobectomy combined with sleeve resection of the bronchus for malignant disease of the lung is presented. In 13 of these cases a sleeve resection of the appropriate pulmonary artery was also carried out. An operative mortality of 8% was encountered and a crude 5-year survival of 40% was achieved. A comparison of absorbable and non-absorbable suture materials for the bronchial anastomosis indicated that the absorbable suture, Polyglycolic Acid (Dexon), minimized the morbidity from complications at the bronchial anastomosis.

Bronchi↗
PubMed1975

[The transsternal and transpericardial approach for surgical treatment of fistulas of the main bronchus after pneumonectomy (author's transl)].

The management of bronchopleural fistula after lung resection is discussed. The transsternal and transpericardial approach for surgical treatment of fistulas of the main bronchus after pneumonectomy is described. In 4 cases of 2000 lung resections occurred a bronchopleural fistula after right pneumonectomy. In all cases the fistula was closed definitive. In one case developed a fistula between the pleural space and the oesophagus after operation.

Adult↗
PubMed1989

A contribution on the prognostic significance of the tumor formula (pTNM) in squamous cell carcinoma of the bronchus.

Analysable data on survival time could be obtained in the context of a follow-up investigation for 435 of 518 patients who had been operated on for squamous-cell carcinoma of the bronchus in the period 1976 to 1986. For better comparison, all tumors were staged retrospectively according to the fourth edition (1987) TNM schedule of the UICC. The mean survival time after potentially curative operation was 7.15 years in stage I, the five-year actuarial survival was 60.8%. The corresponding values were 2.68 years and 31.6% respectively in stage II, compared to 1.14 years and 13.4% respectively in stage IIIa. The differences between tumor stages are statistically significant. The nature of the resection treatment within the tumor stages did not have any effect on the survival times. Tendency to keratinize, lymphangiosis carcinomatosa, and infiltration of tumor cells into vessels also had no prognostic significance. It was also analysed to what degree tumor size and extent as well as lymph-node involvement influence the prognosis after potentially curative operation. In the absence of lymph-node involvement, the prognosis of patients with T1 and T2 tumors was significantly better than that of patients with T3 tumors. However, when metastatic spreading into bronchopulmonary lymph nodes was present (N1), the prognoses of patients with T1, T2 and T3 tumors no longer differed significantly from each other. In mediastinal lymph-node involvement (N2) and T1 tumor, the survival times were significantly better than in mediastinal lymph-node involvement and T2 or T3 tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1984

Reconstructive surgery for tracheobronchial injuries including complete disruption of the right main bronchus.

Important features of diagnostic and operative management and the postoperative course of tracheobronchial injuries as well as pathological findings at the anastomosis are discussed in a review of our 11 cases from the last 12 years. Diagnosis was established clinically, localization of the rupture was carried out by rigid or fiberoptic bronchoscopy. Tracheobronchial continuity was reestablished by end-to-end anastomosis of the ruptured bronchi, by direct suture of any tracheobronchial tears, or by patching inveterated lesions. Two cases of rupture of the right main bronchus are presented separately, considering clinical, diagnostic, operative and histopathologic criteria.

Adolescent↗
PubMed1998

Tubular esophageal duplication associated with esophageal stenosis, pericardial aplasia, diaphragmatic hernia, ramification anomaly of lower lobe bronchus and partial pancreas anulare.

Alimentary tract duplications are rare anomalies, which are often associated with other congenital malformations. We report on a newborn with the combination of tubular esophageal duplication, congenital esophageal stenosis, ramification anomaly of lower left lobe bronchus, complete pericardial aplasia and malrotation of the bowel with a partial pancreas anulare. The diagnoses are based on esophagogram, bronchogram, bronchoscopy, gastroscopy, explorative thoracotomy and laparotomy. The treatment was a resection of the duplication per thoracotomy, esophageal myotomy with fundoplicatio.

Abnormalities, Multiple↗
PubMed2003

Inhalation of diesel exhaust for three months affects major cytokine expression and induces bronchus-associated lymphoid tissue formation in murine lungs.

The authors investigated the effects of exposure to diesel exhaust (DE) on murine lung tissues in vivo. BALB/c and C57BL/6 mice were exposed to DE with low (100 microg/m(3)) and high (3 mg/m(3)) DE particle levels for 3 months. The authors then examined morphological changes and the expression of mRNAs for various cytokines (tumor necrosis factor [TNF]-alpha, interleukin [IL]-1beta, IL-4, IL-6, IL-10, IL-12p40, and interferon [IFN]-gamma) and inducible nitric oxide synthase (iNOS) in the lungs, as well as TNF-alpha, IL-1beta, IL-10, IL-12p40, and Mac-1 mRNA expression in alveolar macrophages (AMs). TNF-alpha, IL-12p40, IL-4, and IL-10 mRNA expression were mildly increased, whereas IL-1beta mRNA and iNOS expression were slightly decreased, in the low- and high-level exposure groups. Flow cytometry of bronchoalveolar lavage fluid revealed a significant increase in Mac-1-positive cells in the high-level exposure group. On histological examination, bronchus-associated lymphoid tissue (BALT), containing B and T lymphocytes, had developed only in the high-level exposure group. Chronic inhalation of DE influences cytokine expression in the murine lung, and induces phagocytosis and BALT development. These findings suggest that DE may provoke immunological responses by acting as a foreign body in the lung, and that even low-level exposure may induce allergic reactions.

Administration, Inhalation↗
PubMed2004

Human immunodeficiency virus (HIV)-negative, API2-MALT1 fusion-negative bronchus-associated lymphoid tissue (BALT) lymphoma in a young male.

A 22-year-old male presented with multiple bilateral nodular shadows in the lungs by chest radiograph. He had been asymptomatic and showed no significant abnormal findings in laboratory examinations. He underwent a diagnostic partial lobectomy, and was diagnosed as having primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma; i.e. bronchus-associated lymphoid tissue (BALT) lymphoma/BALToma. Neither t(11;18)(q21;q21) chromosomal translocation nor API2-MALT1 chimeric transcript was found at diagnosis. Epstein-Barr virus (EBV) was also not detected in lymphoma cells. He had been a nonsmoker, and had also never shown any associated autoimmune disorders, chronic inflammatory lung diseases or human immunodeficiency virus (HIV) infection. However, he had suffered from moderate atopic dermatitis on his arms from childhood. It appears necessary to clarify whether atopy might play a role in the pathogenesis of API2-MALT1(-) BALT lymphoma for HIV(-) young patients who do not exhibit any other antecedent chronic antigenic stimulations.

Adult↗
PubMed2003

Lymphocyte homing to bronchus-associated lymphoid tissue (BALT) is mediated by L-selectin/PNAd, alpha4beta1 integrin/VCAM-1, and LFA-1 adhesion pathways.

Bronchus-associated lymphoid tissue (BALT) participates in airway immune responses. However, little is known about the lymphocyte-endothelial adhesion cascades that recruit lymphocytes from blood into BALT. We show that high endothelial venules (HEVs) in BALT express substantial levels of VCAM-1, in marked contrast to HEVs in other secondary lymphoid tissues. BALT HEVs also express the L-selectin ligand PNAd. Anti-L-selectin, anti-PNAd, and anti-LFA-1 mAbs almost completely block the homing of B and T lymphocytes into BALT, whereas anti-alpha4 integrin and anti-VCAM-1 mAbs inhibit homing by nearly 40%. alpha4beta7 integrin and MAdCAM-1 are not involved. Importantly, we found that mAbs against alpha4 integrin and VCAM-1 significantly block the migration of total T cells (80% memory phenotype) but not naive T and B cells to BALT. These results suggest that an adhesion cascade, which includes L-selectin/PNAd, alpha4beta1 integrin/VCAM-1, and LFA-1, targets specific lymphocyte subsets to BALT. This high level of involvement of alpha4beta1 integrin/VCAM-1 is unique among secondary lymphoid tissues, and may help unify lymphocyte migration pathways and immune responses in BALT and other bronchopulmonary tissues.

Animals↗
PubMed2000

Implications of a tracheal bronchus for adult anaesthetic practice.

The problems posed by tracheal intubation in the presence of a tracheal bronchus in adults are exemplified with three case histories. The anomaly has been categorized into three types on the basis of its potential to cause problems when attempting intubation. Suggestions are given for ways of securing the airway that are safe and less likely to result in obstruction and hypoxia.

Adult↗
PubMed1983

Small cell carcinoma of bronchus: 1970-1980. A retrospective analysis.

Seventy patients who had been referred to an oncology service during the past decade for management of small cell carcinoma of the bronchus were studied to determine survival in relation to different types of therapy as well as patterns of disease. Median survival for the entire group was 221 days. Treatments included radiotherapy, single agent chemotherapy, and combined modality treatment. Sites of metastatic disease did not influence outcome except as a sole extrathoracic site of disease. The biologic implications of these results are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Relationship between length of longitudinal extension and maximal depth of transmural invasion in roentgenographically occult squamous cell carcinoma of the bronchus (nonpolypoid type).

This study was designed to verify our hypothesis that there are two different growth types in roentgenographically occult squamous cell carcinoma of the bronchus. Serial blocks prepared from the entire bronchial tree of 83 resected specimens of occult carcinoma were used for the evaluation of the relationship between the length of longitudinal extension and the maximal depth of transmural invasion. We prepared a length-depth diagram of 92 lesions, including multifocal carcinomas, which confirmed that there are at least two types: Most of these lesions are of the creeping type, which shows a marked superficial growth; the minority are of the penetrating type, which shows a marked downward growth. The diagram suggests that occult carcinoma has a propensity either for longitudinal growth along the bronchial lumen or for transmural growth into the bronchial wall at the time of occurrence. It is likely that the penetrating type grows rapidly and becomes advanced in a short time. Identification of longer lesions of the creeping type is occasionally problematical both at bronchoscopy and at surgical treatment. The stump is usually positive for carcinoma unless frozen sections or imprint specimens of the margin of resection are examined, because it is frequently difficult to identify the proximal end of extension by bronchoscopy.

Bronchi↗
PubMed2002

Separate-lung ventilation strategy for reimplantation of esophageal bronchus.

IMPLICATIONS: We describe an original ventilation method designed to optimize lung recruitment and gas exchanges during surgery in a newborn with congenital esophageal atresia and ectopic esophageal implantation of the left mainstem bronchus. This strategy ensured constant adaptation of the mechanical ventilatory regimen to the surgical procedure-linked constraints.

Blood Gas Analysis↗