Tracheobronchopathia osteochondroplastica presenting as an isolated nodule in the right upper lobe bronchus with upper lobe collapse.
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Nociceptin/orphanin FQ (N/OFQ) has been reported to inhibit neurogenic contractions in various tissues, including guinea pig airways. In the present study, we investigated the ability of N/OFQ to affect cholinergic contractions of human bronchi elicited by electrical field stimulation (EFS). Tissues were obtained from 23 patients undergoing surgery for lung cancer. EFS (20 Hz, 320 mA, 1.5 ms, 10 s) was applied five times every 20 min. Contractions induced by EFS were abolished by either TTX (1 microM) or atropine (1 microM) and concentration-dependently (10 nM-1 microM) inhibited by N/OFQ (Emax, 11.5+/-1.8% inhibition). The inhibitory effects of N/OFQ were mimicked by the N/OFQ receptor (NOP) ligand [Arg14, Lys15]N/OFQ which displayed however, higher significant maximal effects (17.7+/-2.9% inhibition, P<0.05). The actions of N/OFQ and [Arg14, Lys15]N/OFQ were not affected by naloxone (1 microM) while prevented by the selective NOP receptor antagonist UFP-101 (10 microM). Moreover, the inhibitory effects of NOP agonists were no longer evident in tissues treated with tertiapin (10 microM), an inhibitor of inward-rectifier potassium channels. In conclusion, the present data demonstrate that N/OFQ inhibited acetylcholine (ACh) release in the human bronchi via NOP receptor activation. This effect may involve stimulation of potassium currents.
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Closure of the bronchial stump after pneumonectomy can be challenging. Some special situations such as tumor extension, technical pitfalls, or poor tissue quality of the bronchial stump may preclude safe closure of the airway with standard techniques. We describe here a technique of wedge carinal resection that provides the surgeon an alternative whenever the standard closure of the stump is inapplicable. This technique has been successfully used in a series of 4 patients.
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We report our experience with 5 patients with mucoepidermoid carcinoma treated by conservative resection, and review the literature on the 62 patients previously reported. A visual bronchoscopic diagnosis of adenoma was made in all 5 current patients. Bronchoscopic biopsy was performed in 4 and provided an accurate histological diagnosis in each. Conservative resection was accomplished with bronchoplastic techniques in 4 patients: sleeve lobectomy, 2; lobectomy with plastic bronchial closure, 1; and segmental tracheal resection, 1. The other patient underwent conventional lobectomy. All 5 patients are alive and free from disease 4 to 15 years following operation. The recently demonstrated correlation between histological grading and clinical behavior allows relatively benign variants of mucoepidermoid tumors to be accurately identified by bronchoscopic biopsy prior to thoracotomy. Because these tumors have a propensity to originate centrally in the tracheobronchial tree, bronchoplastic procedures frequently are required in order to accomplish tumor extirpation with limited pulmonary resection.
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