-
Journal of Cardiothoracic Surgery Jun 2023Bronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize... (Review)
Review
OBJECTIVE
Bronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize the data of BDD patients reported in domestic and foreign literature to improve the understanding, diagnosis and treatment of this disease.
METHODS
A case of BDD with hemoptysis during bronchoscopy was reported. In addition, we searched for "bronchial Dieulafoy disease" through Pubmed, Web of Science, CNKI and Wanfang databases, covering the literature related to BDD that was definitely diagnosed or highly suspected from January 1995 to December 2021, and summarized the clinical characteristics, chest imaging, bronchoscopic manifestations, angiographic characteristics, pathological characteristics, treatment and outcome of patients.
RESULTS
The patient was a 68 year old male. Tracheoscopy revealed nodular and mass like changes in the basal segment of the left lower lobe, which appeared massive hemorrhage when touching the surface. The computed tomography angiophy of the bronchial artery confirmed that the branches of the left bronchial artery were tortuous and dilated, and then the left lower lobe of the lung was resected. During the operation, 3 thick tortuous nutrient artery vessels were sent out from the descending aorta, and 1 thick tortuous nutrient artery was sent out from the autonomic arch. All of them were ligated and cut. The pathology after the operation was in accordance with BDD; The patient did not have hemoptysis after discharge and is still under follow-up. The database identified 65 articles from January 1995 to December 2021. After removing repeated reports, meetings, incomplete information and nursing literature, 60 articles were included to report 88 cases of BDD. BDD can occur at all ages, with a male to female ratio of about 1.6:1. It mainly starts with hemoptysis, and can also be seen due to cough, infection, and respiratory failure; Inflammatory changes such as pulmonary patch shadow, exudation shadow and ground glass shadow of pulmonary hemorrhage were more common in chest imaging; The diagnosis of BDD is mainly based on the bronchoscopy, bronchial angiography and pathological findings of surgical or autopsy specimens. Bronchoscopic findings were mostly non pulsating, smooth nodular or mucosal processes. Bronchial angiography mainly showed tortuous dilatation of bronchial artery, and the lesions were mainly located in the right bronchus, more from the bronchial artery; Diagnosis depends on pathology, showing submucosal expansion of bronchus or abnormal artery rupture and bleeding; 54 cases underwent selective bronchial artery embolization, 39 cases underwent pulmonary lobectomy, 66 cases improved, and 10 cases died (all of them were caused by massive hemorrhage during bronchoscopic biopsy).
CONCLUSION
BDD is rare, but may cause fatal massive hemoptysis. Bronchial angiography is considered to be an effective method to diagnose BDD. Since pathological biopsy may lead to fatal bleeding, the necessity of pathological diagnosis remains controversial. Interventional and surgical treatment plays an important role in patients with cough accompanied by massive hemoptysis.
Topics: Humans; Male; Female; Aged; Hemoptysis; Bronchial Diseases; Cough; Bronchoscopy; Lung; Bronchial Arteries; Embolization, Therapeutic
PubMed: 37370170
DOI: 10.1186/s13019-023-02279-1 -
Scientific Reports Apr 2022Because of its extremely rare incidence, the safety and efficacy of bronchial artery embolization (BAE) for the treatment of hemoptysis caused by pulmonary metastasis...
Because of its extremely rare incidence, the safety and efficacy of bronchial artery embolization (BAE) for the treatment of hemoptysis caused by pulmonary metastasis from HCC are not well known. We therefore evaluated the safety and efficacy of BAE in these patients. Data from 18 patients with hepatocellular carcinoma (HCC) and pulmonary metastasis who received BAE for the treatment of hemoptysis between 2003 and 2021 were retrospectively reviewed. Technical and clinical success were achieved in 100% and 94% of patients, respectively. Of the 18 embolization procedures, six were performed using polyvinyl alcohol (PVA) particles only, five were performed using gelfoam only, three were performed using gelfoam plus microcoils, one was performed using PVA plus microcoils, one was performed using embospheres, one was performed using lipiodol plus PVA and gelfoam, and one was performed using hystoacryl with microballoon protection. In eight patients for whom CT just before BAE and at follow-up were available, the mean size of the largest metastatic tumor decreased from 5.1 to 3.7 cm (P = 0.035). Hemoptysis recurred in three patients (17%) during follow-up. The median overall and hemoptysis-free survival periods were 149 days and 132 days, respectively. BAE is an effective and safe option for the treatment of hemoptysis in patients with pulmonary metastasis from HCC, with a favorable clinical success rate and a low rate of hemoptysis recurrence. In addition, we also observed BAE to have a positive antitumor effect on pulmonary metastases from HCC, but this requires confirmation in a future study.
Topics: Bronchial Arteries; Carcinoma, Hepatocellular; Hemoptysis; Humans; Liver Neoplasms; Lung Neoplasms; Neoplasm Recurrence, Local; Polyvinyl Alcohol; Retrospective Studies
PubMed: 35484185
DOI: 10.1038/s41598-022-10972-9 -
La Tunisie Medicale Feb 2021Hemoptysis is an alarming symptom that requires immediate investigation and management. Bronchial artery embolization (BAE) is a minimally invasive procedure that has...
INTRODUCTION
Hemoptysis is an alarming symptom that requires immediate investigation and management. Bronchial artery embolization (BAE) is a minimally invasive procedure that has become the treatment of choice of recurrent and massive hemoptysis.
AIM
To assess the efficacy and safety of BAE for management of recurrent and/or massive hemoptysis.
METHODS
A retrospective analysis was carried out of the medical records of 46 patients who were hospitalized in our department of pneumology in Mohamed Taher Maamouri hospital for hemoptysis and who underwent bronchial arteriography (BA) for the purpose of transarterial embolization.
RESULTS
The most frequent causes of hemoptysis included idiopathic bronchiectasis (32.6%), pulmonary tumors (26%) and tuberculosis (8.6%) Embolization was successfully performed in 97.5% of cases. Immediate cessation of haemoptysis was achieved in 95%. Recurrence of haemoptysis was noted in 12% of cases. No major complication involving the vital or the functional prognosis, related to BAE was noted. Conclusions: Our study confirms the safety and the efficacy of the BAE for management of massive and/or recurrent hemoptysis.
Topics: Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Neoplasm Recurrence, Local; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 33899197
DOI: No ID Found -
Environmental Health Perspectives Sep 1995Results of studies of the epidemiology, physiology, histopathology, and cell biology of asthma have revised our conception of the disease. Epidemiologic studies have... (Review)
Review
Results of studies of the epidemiology, physiology, histopathology, and cell biology of asthma have revised our conception of the disease. Epidemiologic studies have shown asthma to be an important cause of death, suffering, and economic hardship. Physiologic studies have shown that asthma is a chronic illness characterized by persistent bronchial hyperreactivity. Histopathologic studies have shown characteristic changes: epithelial damage, deposition of collagen beneath the basement membrane, eosinophilic and lymphocytic infiltration, and hypertrophy and hyperplasia of goblet cells, submucosal glands, and airway smooth muscle. Studies of the functions of cells in the airway mucosa suggest that asthma may be fundamentally mediated by a difference in the type of lymphocyte predominating in the airway mucosa but may also involve complex interactions among resident and migratory cells. Asthma may thus result from sensitization of a subpopulation of CD4+ lymphocytes, the Th2 subtype, in the airways. These lymphocytes produce a family of cytokines that favor IgE production and the growth and activation of mast cells and eosinophils, arming the airways with the mechanisms of response to subsequent reexposure to the allergen. This conceptual model has stimulated research along lines that will almost certainly lead to powerful new treatments, and it has already put current therapies in a new light, clarifying the role of antinflammatory agents, especially of inhaled corticosteroids. This conceptual model has some limitations: it ignores new evidence on the role of the mast cell in producing cytokines and depends on results of studies of the effects of inhalation of allergen, although most asthma exacerbations are provoked by viral respiratory infection. Preliminary studies suggest that viral infection and allergen inhalation may involve the activation of different pathways, with viral infection activating production of cytokines by airway epithelial cells. Similar study of the mechanisms activated by inhalation of air toxics may provide important clues as to how they might induce or exacerbate asthma.
Topics: Air Pollutants; Asthma; Bronchial Hyperreactivity; Eosinophils; Humans; Lymphocytes; Models, Biological
PubMed: 8549478
DOI: 10.1289/ehp.95103s6229 -
Anales Del Sistema Sanitario de Navarra 2004Respiratory emergencies in a patient with cancer can have their origin in pathologies of the airway, of the pulmonary parenchyma or the large vessels. The cause can be... (Review)
Review
Respiratory emergencies in a patient with cancer can have their origin in pathologies of the airway, of the pulmonary parenchyma or the large vessels. The cause can be the tumour itself or concomitant complications. Obstruction of the airway should be initially evaluated with endoscopic procedures. Surgery is rarely possible in serious situations. The endobronchial placement of stents or radioactive isotopes (brachytherapy), tumoural ablation by laser or photodynamic therapy can quickly alleviate the symptoms and re-establish the air flow. Treatment of haemoptysis depends on the cause that is provoking it and on its quantity. Bronchoscopy continues to be the front line procedure in the majority of cases; it provides diagnostic information and can interrupt bleeding through washes with ice-cold serum, endobronchial plugging or topical injections of adrenaline or thrombin. External radiotherapy continues to be an extraordinarily useful procedure in treating haemoptysis caused by tumours and in carefully selected situations of endobronchial therapy with laser or brachytherapy, and bronchial arterial embolisation can provide a great palliative effect. Respiratory emergencies due to pulmonary parenchyma disease in the oncology patient can have a tumoural, iatrogenic or infectious cause. Early recognition of each of these will determine the administration of a specific treatment and the possibilities of success.
Topics: Airway Obstruction; Emergency Treatment; Hemoptysis; Humans; Lung Neoplasms; Respiration Disorders
PubMed: 15723108
DOI: No ID Found -
Medicine Oct 2022To evaluate the safety and clinical application of a computer-aided surgery system (CAS) combined with high-frequency bronchial ventilation in 2-port thoracoscopic...
To evaluate the safety and clinical application of a computer-aided surgery system (CAS) combined with high-frequency bronchial ventilation in 2-port thoracoscopic anatomical segmentectomy. A total of 301 patients who underwent 2-port thoracoscopic segmentectomy between January 1, 2019 and March 1, 2022 in the 960th Hospital of the People's Liberation Army and the Department of Thoracic Surgery of Zibo Municipal Hospital were retrospectively analyzed. The experimental and control groups were created according to the different methods of appearing the intersegmental plane of the lung. The experimental group comprised 152 patients who underwent CAS reconstruction combined with high-frequency ventilation, and the control group comprised 149 patients who underwent CAS reconstruction combined with expansion collapse. The characteristics of the patients, including age, sex, smoking history, forced expiratory volume in 1 second/forced vital capacity, Maximal ventilation, diameter of pulmonary nodules, intraoperative blood loss, postoperative drainage volume, drainage tube removal time, length of hospital stay after extubation, postoperative complication rate, operation time and appearance time of the intersegmental plane, were compared between the 2 groups. All patients completed the operation between high-frequency bronchial ventilation and expansion collapse group. There was no significant difference in Forced expiratory volume in 1 second/Forced vital capacity [(101.05 ± 11.86) vs (101.86 ± 11.61)], maximum expiratory volume [(86.36 ± 17.59 L) vs (85.28 ± 17.68 L)], the diameter of lung nodules [(13.61 ± 3.51 cm) vs (13.21 ± 3.41 cm)], intraoperative blood loss [(47.50 ± 45.90 mL) vs (48.49 ± 34.65 mL)], postoperative drainage volume [(425.16 ± 221.61 mL) vs (444.70 ± 243.72 mL)], drainage tube removal time [(3.88 ± 1.85 days) vs (3.43 ± 1.81 days)], or postoperative hospital stay [(6.07 ± 2.14 days) vs (5.82 ± 1.88 days) between the experimental group and the control group (P > .05)]. There were significant differences in operation time [(95.05 ± 26.85 min) vs (117.85 ± 31.70 min), P = .017] and intersegmental plane appearance time [(2.37 ± 1.03 min) vs (14.20 ± 3.23 min), P < .001]. High-frequency bronchial ventilation is safe and feasible when used in quickly and accurately identifying the intersegmental plane and is worthy of clinical application in 2-port thoracoscopic segmentectomy.
Topics: Humans; Pneumonectomy; Thoracic Surgery, Video-Assisted; Lung Neoplasms; Retrospective Studies; Blood Loss, Surgical; High-Frequency Ventilation
PubMed: 36316920
DOI: 10.1097/MD.0000000000031611 -
BMC Pulmonary Medicine Aug 2009The lung consists of at least seven compartments with relevance to immune reactions. Compartment 1 the bronchoalveolar lavage (BAL), which represents the cells of the...
The lung consists of at least seven compartments with relevance to immune reactions. Compartment 1 the bronchoalveolar lavage (BAL), which represents the cells of the bronchoalveolar space: From a diagnostic point of view the bronchoalveolar space is the most important because it is easily accessible in laboratory animals, as well as in patients, using BAL. Although this technique has been used for several decades it is still unclear to what extent the BAL represents changes in other lung compartments. Compartment 2 bronchus-associated lymphoid tissue (BALT): In the healthy, BALT can be found only in childhood. The role of BALT in the development of the mucosal immunity of the pulmonary surfaces has not yet been resolved. However, it might be an important tool for inhalative vaccination strategies. Compartment 3 conducting airway mucosa: A third compartment is the bronchial epithelium and the submucosa, which both contain a distinct pool of leukocytes (e.g. intraepithelial lymphocytes, IEL). This again is also accessible via bronchoscopy. Compartment 4 draining lymph nodes/Compartment 5 lung parenchyma: Transbronchial biopsies are more difficult to perform but provide access to two additional compartments lymph nodes with the draining lymphatics and lung parenchyma, which roughly means "interstitial" lung tissue. Compartment 6 the intravascular leukocyte pool: The intravascular compartment lies between the systemic circulation and inflamed lung compartments. Compartment 7 periarterial space: Finally, there is a unique, lung-specific space around the pulmonary arteries which contains blood and lymph capillaries. There are indications that this "periarterial space" may be involved in the pulmonary host defense.All these compartments are connected but the functional network is not yet fully understood. A better knowledge of the complex interactions could improve diagnosis and therapy, or enable preventive approaches of local immunization.
Topics: Adaptive Immunity; Bronchoalveolar Lavage Fluid; Humans; Immunity, Innate; Leukocytes; Lung; Lung Diseases; Lymphocytes; Respiratory Mucosa
PubMed: 19671154
DOI: 10.1186/1471-2466-9-39 -
The British Journal of Radiology Sep 2012To retrospectively evaluate the depiction of bronchial and non-bronchial systemic arteries with 64-detector row CT in patients undergoing endovascular treatment for...
OBJECTIVE
To retrospectively evaluate the depiction of bronchial and non-bronchial systemic arteries with 64-detector row CT in patients undergoing endovascular treatment for life-threatening haemoptysis.
METHODS
64-detector row helical CT and conventional angiography of the thorax were performed in 28 patients (25 males, 3 females; age range, 18-65 years; mean age, 40 years) with life-threatening haemoptysis. CT images were analysed to identify abnormal bronchial and non-bronchial systemic arteries and also to localise them in two planes.
RESULTS
Using multidetector CT (MDCT), 43 bronchial arteries were identified on the right side and 46 on the left side. 89% of the right bronchial arteries originated from the right intercostobronchial arteries. A common trunk of origin of the right and left bronchial artery was noted in 46% of cases. 23 non-bronchial systemic arteries were noted on the right side and 41 on the left side. Pleural thickening >3 mm was confirmed to be a good predictor of non-bronchial systemic supply. An internal mammary artery diameter of >3 mm and an inferior phrenic artery diameter of >2 mm were sensitive indicators for non-bronchial systemic supply.
CONCLUSION
MDCT is a good investigation tool for evaluating life-threatening haemoptysis as it confirms the disease process, identifies the origin and ostial position of bronchial arteries, detects non-bronchial systemic arteries and acts as a roadmap for percutaneous transcatheter embolisation.
Topics: Adolescent; Adult; Aged; Angiography; Bronchial Arteries; Female; Hemoptysis; Humans; Male; Middle Aged; Radiography, Thoracic; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult
PubMed: 22595498
DOI: 10.1259/bjr/24730002 -
Clinical and Experimental Allergy :... Jan 2023Allergic asthmatics with both an early (EAR) and a late allergic reaction (LAR) following allergen exposure are termed 'dual responders' (DR), while 'single responders'...
INTRODUCTION
Allergic asthmatics with both an early (EAR) and a late allergic reaction (LAR) following allergen exposure are termed 'dual responders' (DR), while 'single responders' (SR) only have an EAR. Mechanisms that differentiate DR from SR are largely unknown, particularly regarding the role and phenotypes of neutrophils. Therefore, we aimed to study neutrophils in DR and SR asthmatics.
METHODS
Thirty-four allergic asthmatics underwent an inhaled allergen challenge, samples were collected before and up to 24 h post-challenge. Cell differentials were counted from bronchial lavage, alveolar lavage and blood; and tissue neutrophils were quantified in immune-stained bronchial biopsies. Lavage neutrophil nuclei lobe segmentation was used to classify active (1-4 lobes) from suppressive neutrophils (≥5 lobes). Levels of transmigration markers: soluble (s)CD62L and interleukin-1Ra, and activity markers: neutrophil elastase (NE), DNA-histone complex and dsDNA were measured in lavage fluid and plasma.
RESULTS
Compared with SR at baseline, DR had more neutrophils in their bronchial airways at baseline, both in the lavage (p = .0031) and biopsies (p = .026) and elevated bronchial neutrophils correlated with less antitransmigratory IL-1Ra levels (r = -0.64). DR airways had less suppressive neutrophils and more 3-lobed (active) neutrophils (p = .029) that correlated with more bronchial lavage histone (p = .020) and more plasma NE (p = .0016). Post-challenge, DR released neutrophil extracellular trap factors in the blood earlier and had less pro-transmigratory sCD62L during the late phase (p = .0076) than in SR.
CONCLUSION
DR have a more active airway neutrophil phenotype at baseline and a distinct neutrophil response to allergen challenge that may contribute to the development of an LAR. Therefore, neutrophil activity should be considered during targeted diagnosis and bio-therapeutic development for DR.
Topics: Humans; Neutrophils; Histones; Asthma; Hypersensitivity; Allergens; Phenotype; Bronchial Provocation Tests
PubMed: 35437872
DOI: 10.1111/cea.14149 -
International Archives of Allergy and... 2021Epicutaneous (e.c.) allergen exposure is an important route of sensitization toward allergic diseases in the atopic march. Allergen sources such as house dust mites...
Inhibition of Both Cyclooxygenase-1 and -2 Promotes Epicutaneous Th2 and Th17 Sensitization and Allergic Airway Inflammation on Subsequent Airway Exposure to Protease Allergen in Mice.
INTRODUCTION
Epicutaneous (e.c.) allergen exposure is an important route of sensitization toward allergic diseases in the atopic march. Allergen sources such as house dust mites contain proteases that involve in the pathogenesis of allergy. Prostanoids produced via pathways downstream of cyclooxygenases (COXs) regulate immune responses. Here, we demonstrate effects of COX inhibition with nonsteroidal anti-inflammatory drugs (NSAIDs) on e.c. sensitization to protease allergen and subsequent airway inflammation in mice.
METHODS
Mice were treated with NSAIDs during e.c. sensitization to a model protease allergen, papain, and/or subsequent intranasal challenge with low-dose papain. Serum antibodies, cytokine production in antigen-restimulated skin or bronchial draining lymph node (DLN) cells, and airway inflammation were analyzed.
RESULTS
In e.c. sensitization, treatment with a nonspecific COX inhibitor, indomethacin, promoted serum total and papain-specific IgE response and Th2 and Th17 cytokine production in skin DLN cells. After intranasal challenge, treatment with indomethacin promoted allergic airway inflammation and Th2 and Th17 cytokine production in bronchial DLN cells, which depended modestly or largely on COX inhibition during e.c. sensitization or intranasal challenge, respectively. Co-treatment with COX-1-selective and COX-2-selective inhibitors promoted the skin and bronchial DLN cell Th cytokine responses and airway inflammation more efficiently than treatment with either selective inhibitor.
CONCLUSION
The results suggest that the overall effects of COX downstream prostanoids are suppressive for development and expansion of not only Th2 but also, unexpectedly, Th17 upon exposure to protease allergens via skin or airways and allergic airway inflammation.
Topics: Allergens; Animals; Anti-Inflammatory Agents, Non-Steroidal; Cell Differentiation; Cyclooxygenase 1; Cyclooxygenase 2; Cyclooxygenase Inhibitors; Female; Immunization; Mice; Papain; Peptide Hydrolases; Respiratory Hypersensitivity; Skin; T-Lymphocyte Subsets; Th17 Cells; Th2 Cells
PubMed: 33873179
DOI: 10.1159/000514975