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The object of this study was to see if the addition of anticoagulants to a regimen of cytotoxic drugs would improve the prognosis in patients with small cell carcinoma of the bronchus. Twenty-four patients were randomly allocated to receive chemotherapy or chemotherapy plus anticoagulants. The median survival in the group receiving the anticoagulants was not improved.
The clinical features of 208 patients with large cell anaplastic carcinoma of the bronchus are reviewed. Of the sample 47.6% had disseminated disease at presentation, and 95% were cigarette smokers. The median survival was 6.0 months and five-year survival was 5.9%. Twenty-seven per cent of the patients had surgical resection of tumour. The median survival of resected patients was 13.0 months and five-year-survival was 21%. Radiotherapy was ineffective in controlling the disease in this series.
Seventeen patients in whom a squamous carcinoma in situ of the bronchus had been resected have been followed for up to 16 years. The crude mortality rate for these patients is remarkably high, with seven (41%) dead after five years and 14 (82%) after 10 years. Half the patients had died as a direct result of malignant disease by 10 years--because of recurrence, metastatic disease, or the development of a second tumour. A guarded long-term prognosis must be given in these patients owing to the many deaths (mainly from other respiratory diseases) besides those from recurrent cancer.
In a randomised prospective trial of chemotherapy with and without radiotherapy in small-cell carcinoma of the bronchus, 37 of 366 patients presented with obstruction of the superior vena cava at the time of diagnosis. In the study all patients received four cycles of combination chemotherapy over a period of 12 weeks and, provided there was not progressive disease, then received either radiotherapy to the mediastinum and primary tumour followed by eight further courses of chemotherapy or eight cycles of chemotherapy alone. Of the 37 patients presenting with superior vena caval obstruction, nine had relapsed and treatment was stopped during or after the initial four cycles of chemotherapy. Of the remainder, 15 patients received radiotherapy plus chemotherapy and 13 chemotherapy alone. After four cycles of chemotherapy (12 weeks) 21 of the 37 patients had initial complete relief of symptoms secondary to superior vena caval obstruction, 10 had substantial but partial relief, and six had no relief. Twelve patients developed recurrence of superior vena caval obstruction, of whom six had received radiotherapy and four chemotherapy alone; two relapsed in the initial 12 weeks of the study. The median survival of the patients with superior vena caval obstruction allocated at diagnosis to either treatment arm was identical. The survival of patients with obstruction was similar to that of other patients in the main study. Chemotherapy is an effective treatment for superior vena caval obstruction and there appears to be no additional advantage in giving radiotherapy after 12 weeks of cyclical chemotherapy.
In a prospective study of 13 patients requiring pneumonectomy for unilateral post-tuberculous lung destruction the left side was found to be affected in 12. Review of a further 172 cases showed the left lung to have been destroyed in 109 (63%). It is suggested that this predominance of the left side is due to the anatomical characteristics of the left main bronchus and that disordered haemodynamics also appear to play a part.
Two patients with narrowing of a mainstem bronchus each showed two unusual functional features that are likely to be characteristic of this condition. The maximum inspiratory flow-volume curve showed an end inspiratory "tail" and the forced expiratory spirogram had a biphasic shape with normal initial curvature but a "straight line" appearance in later expiration. In one patient relief of the bronchial stenosis by the insertion of a stent restored normal contours to the spirogram and flow-volume curves.
BACKGROUND: Bronchus associated lymphoid tissue (BALT) is a normal component of the lung's immune system in many animals and may be analogous to gut associated lymphoid tissue (GALT). This study aimed at assessing the nature and extent of BALT in human lung and determining whether its expression is induced within the human airway in response to smoking. METHODS: Paraffin embedded, formalin fixed full thickness bronchial wall sections were examined from 31 whole lung specimens derived from both smokers and non-smokers. Samples were taken from throughout the bronchial tree to include main stem bronchi, lobar bronchi and segmental bronchi, as well as first to third generation carinae. Standard 4 microns step sections were stained by haematoxylin and eosin and immunocytochemical methods to show foci of BALT. RESULTS: Examination of 256 airway sites detected 46 foci of BALT. These differed from those described in other mammals in being distributed throughout the bronchial tree, in being found in relation to bronchial glandular epithelium as well as luminal bronchial epithelium, and in lacking any accompanying M cells. Analysis by smoking status showed that the expression of BALT was significantly more common in smokers than non-smokers (82% (14/17) v 14% (2/14) respectively). CONCLUSIONS: The findings support the view that BALT in humans is an integral feature in a comparatively small proportion of lungs from non-smokers while being significantly more prominent in lungs from smokers. The tissue shows several important differences from that described in other mammals.
BACKGROUND: Bronchus-associated lymphoid tissue (BALT) is well characterised in rabbits and rats. In humans, however, it does not seem to be present in the healthy adult lung, although it can develop after certain microbial stimulation. METHODS: In the present study a consecutive series of lungs from 88 children who had died of sudden infant death syndrome (SIDS) and 34 control cases of comparable age were examined for the presence of BALT. RESULTS: BALT was present in 36.4% of the patients who had died of SIDS and in 44.1% of the control cases. The probability of finding BALT increased with age, with similar kinetics in both groups. CONCLUSIONS: Future studies need to define when and at what rate BALT disappears as children get older. In young children BALT may act as an entry site for antigens to initiate an immune response, as is well documented for the gut-associated lymphoid system.
A rare case of primary malignant melanoma of the bronchus is described. Before considering this diagnosis, metastasis from an occult primary must be convincingly excluded and the tumour should conform to certain guidelines. This patient presented with a solitary lung tumour for which she underwent left lower lobectomy and continues to be tumour free 54 months after surgery. Two possible mechanisms of aetiology are suggested.
A 15 year old girl who was labelled as having MacLeod's syndrome on the basis of a chest radiograph was subsequently, at the age of 23 years, found to have an adenoid cystic carcinoma obstructing the left main bronchus. This case emphasises the need to exclude a central lesion in cases of unilateral hyperlucent lung.
The posterior wall of the bronchus intermedius (PWBI) is outlined on most lateral chest radiographs by air in the lumen and in adjacent lung. In a prospective review over a 19-month interval, the authors found 36 patients whose PWBI was thick, defined as thickness greater than the normal upper limit of 3.0 mm (33 patients) or as increase of 1.5 mm in thickness compared with control radiographs (three patients). Uniform thickening was found in 23 patients as a sign of congestive heart failure. Nine subjects with neoplastic thickening of the PWBI demonstrated either uniform (six patients) or lobulated (three patients) enlargement. Two patients with sarcoidosis showed lobulated thickening of the PWBI. Inspection of lateral chest radiographs for thickening of the PWBI may be helpful in establishing bronchial involvement by edema, neoplasm, or enlarged lymph nodes.
Dieulafoy's disease is a vascular anomaly characterized by the presence of a dysplastic artery that is related to an epithelial ulcer. The French surgeon Georges Dieulafoy first described it in 1898. Most frequently, it is a gastrointestinal condition, but occurrence in the bronchus has been reported in a few cases. The case of a 52-year-old man with massive hemoptysis, for which he underwent successful embolotherapy 10 years previously, is described. Over the next 10 years, he had several hospital admissions due to hemoptysis, and he underwent successful embolotherapy on each occasion. This case report underlines the importance of bronchial arteriography as the investigation of choice for massive hemoptysis.
Bronchus-associated lymphoid tissue (BALT) was first described in the lungs of rabbits and differs greatly between species. It is part of the integrated mucosal immune system. This review clarifies its morphological definition and focuses on the situation in humans. The frequency of BALT at different ages, after chronic stimulation and in different diseases is described. In healthy humans, BALT can only be found in the lungs of children and adolescents. The role of BALT in lung transplantation and in the development of low-grade malignant lymphomas in the airways is also discussed. Furthermore, questions concerning the inducibility of BALT as an entry site for vaccines, and the regulation of its activity for future therapeutic interventions in pulmonary immune reactions are addressed.
OBJECTIVE: Bronchus-associated lymphoid tissue (BALT) is a part of the integrated mucosal immune system. It may play an important functional role for antigen uptake and induction of specific immune reactions. The aim of this study was to investigate whether it is possible to induce or modulate BALT by the repetitive inhalation of the synthetic lipopeptide MALP-2. METHODS: Female Lewis rats (245 +/- 19 g) inhaled 25 microg of MALP-2 six times at intervals of 1 week. One week after the last inhalation, they were sacrificed. Cells of the bronchoalveolar lavage and the left lung were investigated by flow cytometry. The middle lobe of the right lung was embedded in paraffin. BALT was semiquantitatively measured in 15 serial cross sections per animal. RESULTS: After repetitive inhalation of the diluent as well as MALP-2, BALT was found. The total area was increased after repetitive treatment with MALP-2. In addition, the preferential incidence of BALT was higher after MALP-2 application, in association with a bronchial diameter of 0.6-1 mm. The cellular analysis revealed no differences in the number of leukocyte subsets between the control and MALP-2 group. CONCLUSION: MALP-2 is a potent local stimulator and can be used to modulate BALT by repetitive inhalant treatment. The functional significance of enlarged or activated BALT has to be elucidated in future studies.
BACKGROUND: The functions of the bronchus-associated lymphoid tissue (BALT) are under the control of the autonomic nervous system (sympathetic and parasympathetic nerve fibers). OBJECTIVES: The relationships between the adrenergic nerve fibers and beta-adrenergic receptors were studied in the human BALT with the aim to demonstrate a probable neuromodulation. METHODS: Morphological observations (staining with hematoxylin-eosin and scanning electron microscopy images) were carried out on samples of human BALT harvested during autopsies. Moreover, histochemical staining for norepinephrine (adrenaline = adrenergic nerve fibers) as well as for other catecholamines was performed. Finally, beta-adrenergic receptors were stained by means of a beta-blocking, radiolabeled drug (pindolol 125I). All our data were submitted to morphometric analysis (quantitative analysis of images and statistical analysis of data). RESULTS: Our results provide direct evidence of the presence and distribution of catecholaminergic nerve fibers and related beta-adrenergic receptors in BALT. beta-Adrenergic receptors are present above all in the most richly innervated part of the BALT, and are, therefore, in close relationship with their related adrenergic nerve fibers. CONCLUSIONS: Studies on the distribution of adrenergic neurotransmitters and related beta-adrenergic receptors in the human BALT are the first step for the demonstration of a probable neuromodulation of BALT.
The cholinergic staining of human bronchus-associated lymphoid tissue (BALT) was studied in humans. Morsels of the human lung (containing BALT) were harvested, after having obtained the appropriate approvals, during autopsies in 24 human subjects. The samples were stained by means of the enzymatic technique of acetylcholinesterase (AChE) and/or the monoclonal immunohistochemical method of choline acetyltransferase (ChAT). A morphometrical analysis was performed by means of quantitative analysis of images and statistical analyses of the data. AChE and proteins were also measured by biochemical assay. Our results demonstrate that both AChE and ChAT are localized in the BALT of young and old humans. These enzymes undergo age-related changes. The biochemical values of AChE are as follows: 22.3 +/- 2.5 international units in young subjects and 78.5 +/- 1.9 international units in old ones. The morphometrical values of AChE confirm the biochemical ones. The morphometrical data for ChAT are 31.6 +/- 1.4 conventional units in young subjects and 71.2 +/- 1.5 conventional units in old ones. Further results are needed to draw definite conclusions concerning the location and the distribution of these two enzymatic activities in BALT. In our opinion, the presence of AChE and ChAT in BALT can be both 'non-neuronal', with a role in general metabolism, and/or 'neuronal' with a role in neuroimmunomodulation.
50 patients with carcinoma of the bronchus were studied during their pre-operative assessment for lung surgery. Lung function test indications of generalised airway obstruction agreed closely with clinical evidence of chronic bronchitis. These findings support the suggestion that the shape of the FVC tracing and the maximal expiratory flow-volume curve can be used to distinguish between the presence of generalised airway obstruction due to chronic bronchitis and of localised obstruction due to the tumour alone. The effectiveness of a method of predicting the risk of cardiopulmonary complications after lung surgery based upon pre-operative lung function test results is demonstrated.
Histological changes in bronchus-associated lymphoid tissue (BALT) following single intratracheal administration of five different antigens were studied in the rat. After administration of T-dependent antigens (i.e., horseradish peroxidase, bovine serum albumin, and Bacillus Calmette Guérin) only minor changes in BALT in the rat occurred. Intratracheal administration of a T-independent antigen (lipopolysaccharide) and a partly T-independent antigen (paratyphoid vaccine) resulted after 1 week in an increase in cytoplasmic IgM-containing (cIgM) blast cells and plasma cells; these appeared to enter via the high endothelial venules (HEV). After 6 weeks, germinal centers were seen.