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The American Journal of Case Reports Dec 2023BACKGROUND An aortopulmonary window (APW) is an uncommon congenital defect of the septation between the ascending aorta and pulmonary trunk. The combination of APW and...
BACKGROUND An aortopulmonary window (APW) is an uncommon congenital defect of the septation between the ascending aorta and pulmonary trunk. The combination of APW and interrupted aortic arch (IAA) is even rarer, with the hallmark characteristics of high peri-operative mortality and postoperative obstruction of the aortic arch, pulmonary artery, and left main bronchus. These complications often need re-interventions. CASE REPORT We present 2 cases with diagnoses of APW and IAA that were treated with single-stage repair. Case 1: A male 32-week premature newborn (weight 1789 g) had APW type I and IAA type A. He had severe postoperative aortic arch obstruction on postoperative day 1, and we re-intervened promptly. He was still asymptomatic after 6 years. Case 2: A male term neonate had APW type III and IAA type A. He had left vocal cord paralysis and left bronchial compression postoperatively. We applied prolonged noninvasive respiratory supports. The complications resolved without re-intervention on postoperative day 66. Progressive arch stenosis at anastomosis after operation required close follow-up with echocardiography. CONCLUSIONS These 2 reports highlight the feasibility of single-stage surgical repair while addressing 2 challenges: (1) Recurrent arch stenosis: Lower body weight and direct end-to-side anastomosis without patch augmentation could be risk factors for re-intervention. (2) Bronchial compression: Presentation of the second reported case implied that bronchial compression may not warrant immediate re-intervention unless there is complete obstruction, persistent atelectasis, or recurrent infection. Further studies on long-term outcomes of different surgical procedure would help us to clarify the proper way to avoid re-intervention.
Topics: Humans; Infant, Newborn; Male; Aorta; Aorta, Thoracic; Aortopulmonary Septal Defect; Constriction, Pathologic; Treatment Outcome
PubMed: 38124359
DOI: 10.12659/AJCR.942193 -
Interactive Cardiovascular and Thoracic... May 2012We present a 53-year old man with destroyed lung syndrome (right upper and middle lobes and S6 of lower lobe with bronchial stricture between the right main and...
We present a 53-year old man with destroyed lung syndrome (right upper and middle lobes and S6 of lower lobe with bronchial stricture between the right main and intermediate bronchus) due to tuberculosis 25 years earlier. Aspergillus infection in the destroyed lung was suspected on the basis of antigen positivity. The patient underwent right upper and middle lobectomy, S6 segmentectomy and bronchial resection from the distal end of the right main bronchus to the proximal end of the right basal bronchus. The membranous part of the right main bronchus was cerclaged in order to circularize the flattened bronchus and to match its diameter with that of the basal bronchus. End-to-end anastomosis was then carried out. The postoperative course was uneventful. Pathological examination revealed Aspergillus infection in the cavity of the destroyed lung. Bronchoscopic findings 6 weeks after surgery revealed good healing of the anastomosed portion without stenosis.
Topics: Anastomosis, Surgical; Antifungal Agents; Bronchi; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Humans; Male; Middle Aged; Pneumonectomy; Pulmonary Aspergillosis; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pulmonary
PubMed: 22361125
DOI: 10.1093/icvts/ivs054 -
International Journal of Particle... 2020Due to the excellent outcomes with image-guided stereotactic body radiotherapy for patients with early-stage non-small cell lung cancer (NSCLC) and the low...
PURPOSE
Due to the excellent outcomes with image-guided stereotactic body radiotherapy for patients with early-stage non-small cell lung cancer (NSCLC) and the low treatment-related toxicities using proton therapy (PT), we investigated treatment outcomes and toxicities when delivering hypofractionated PT.
MATERIALS AND METHODS
Between 2009 and 2018, 22 patients with T1 to T2 N0M0 NSCLC (45% T1, 55% T2) received image-guided hypofractionated PT. The median age at diagnosis was 72 years (range, 58-90). Patients underwent 4-dimensional computed tomography simulation following fiducial marker placement, and daily image guidance was performed. Nine patients (41%) were treated with 48 GyRBE in 4 fractions for peripheral lesions, and 13 patients (59%) were treated with 60 GyRBE in 10 fractions for central lesions. Patients were assessed for CTCAEv4 toxicities with computed tomography imaging for tumor assessment. The primary endpoint was grade 3 to 5 toxicity at 1 year.
RESULTS
The median follow-up for all patients was 3.5 years (range, 0.2-8.8 years). The overall survival rates at 3 and 5 years were 81% and 49%, respectively. Cause-specific survival rates at 3 and 5 years were 100% and 75%, respectively. The 3-year local, regional, and distant control rates were 86%, 85%, and 95%, respectively. Four patients experienced in-field recurrences between 18 and 45 months after treatment. One patient (5%) developed a late grade 3 bronchial stricture requiring hospitalization and stent.
CONCLUSION
Image-guided hypofractionated PT for early-stage NSCLC provides promising local control and long-term survival with a low likelihood of toxicity. Regional nodal and distant relapses remain a problem.
PubMed: 33274252
DOI: 10.14338/IJPT-20-00013.1 -
British Journal of Anaesthesia Mar 2003In the last decade, stents suitable for the management of tracheobronchial stenoses and obstruction have evolved from bulky prostheses requiring tracheal resection to... (Review)
Review
In the last decade, stents suitable for the management of tracheobronchial stenoses and obstruction have evolved from bulky prostheses requiring tracheal resection to small devices that are self-expanding and can be inserted using fibreoptic techniques. The experience base for this review is more than 100 patients between 1989 and 2001 who have been anaesthetized for stent insertion. Early cases required rigid bronchoscopy for the routine of insertion. Anaesthetic techniques have evolved from those that were designed and developed for laser surgery in the central airways. The advent of modern devices now extends the variety of anaesthetic management techniques that can be used. But the original one, based on the requirement for use of a rigid bronchoscope, is best for dealing with complications and extracting problem stents. The most frequent complication of the processes of stent insertion has been respiratory failure because of carbon dioxide retention, consequent on obstruction with secretions in the area of the carina. The nature of central airway problems suggests that anaesthesia induction, management and teaching should not be founded on the conventional model-base of upper airway obstruction.
Topics: Adult; Airway Obstruction; Anesthesia; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Equipment Design; Humans; Intubation, Intratracheal; Laryngeal Masks; Postoperative Complications; Preoperative Care; Radiography; Stents; Tracheal Stenosis
PubMed: 12594151
DOI: 10.1093/bja/aeg053 -
Journal of the American Veterinary... Oct 2009To detect abnormalities of the lower respiratory tract (trachea, principal bronchi, and lobar bronchi) in brachycephalic dogs by use of endoscopy, evaluate the...
OBJECTIVE
To detect abnormalities of the lower respiratory tract (trachea, principal bronchi, and lobar bronchi) in brachycephalic dogs by use of endoscopy, evaluate the correlation between laryngeal collapse and bronchial abnormalities, and determine whether dogs with bronchial abnormalities have a less favorable postsurgical long-term outcome following correction of brachycephalic syndrome.
DESIGN
Prospective case series study.
ANIMALS
40 client-owned brachycephalic dogs with stertorous breathing and clinical signs of respiratory distress.
PROCEDURES
Brachycephalic dogs anesthetized for pharyngoscopy and laryngoscopy between January 2007 and June 2008 underwent flexible bronchoscopy for systematic evaluation of the principal and lobar bronchi. For dogs that underwent surgical correction of any component of brachycephalic syndrome, owners rated surgical outcome during a follow-up telephone survey. Correlation between laryngeal collapse and bronchial abnormalities and association between bronchial abnormalities and long-term outcome were assessed.
RESULTS
Pugs (n = 20), English Bulldogs (13), and French Bulldogs (7) were affected. A fixed bronchial collapse was recognized in 35 of 40 dogs with a total of 94 bronchial stenoses. Abnormalities were irregularly distributed between hemithoraces; 15 of 94 bronchial abnormalities were detected in the right bronchial system, and 79 of 94 were detected in the left. The left cranial bronchus was the most commonly affected structure, and Pugs were the most severely affected breed. Laryngeal collapse was significantly correlated with severe bronchial collapse; no significant correlation was found between severity of bronchial abnormalities and postsurgical outcome.
CONCLUSIONS AND CLINICAL RELEVANCE
Bronchial collapse was a common finding in brachycephalic dogs, and long-term postsurgical outcome was not affected by bronchial stenosis.
Topics: Airway Obstruction; Animals; Bronchi; Bronchoscopy; Constriction, Pathologic; Dog Diseases; Dogs; Female; Laryngeal Diseases; Male; Skull; Trachea
PubMed: 19793013
DOI: 10.2460/javma.235.7.835 -
Medicina (Kaunas, Lithuania) 2002During the flowering of cardiothoracic surgery over the past 50 years, surgery of the major airway failed to develop correspondingly. The relative rarity of such cases... (Comparative Study)
Comparative Study
UNLABELLED
During the flowering of cardiothoracic surgery over the past 50 years, surgery of the major airway failed to develop correspondingly. The relative rarity of such cases accounts in past for this laggardness. Surgical diseases of the trachea, whether inflammatory or neoplastic, largely are presented as an obstructive problems of the airway. Surgical management of these lesions is based on simple concept of resection of the involved area of the trachea, when the larynx has not been lost because of affection by the primary disease. Primary end-to-end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, based on Belsey's experience it was widely believed, that only 2 cm at most could be removed and the trachea reconstruction by end-to-end suture in any dependable fashion. During the period of 30 years tracheobronchial surgical reconstructions have been accomplished in 187 patients.
CONCLUSION
Management of the patients with stenosis of the trachea and main bronchi must be started promptly. Emergency treatment for the patients with severe tracheal stenosis is rigid bronchoscopy under general anesthesia. Circular tracheal resection is the best method of radical treatment for patients with benign and malignant tracheal narrowing. Sleeve resection is the ideal form of excisional therapy for benign endobronchial tumors, neoplasms of low-grade malignant potential, and bronchostenosis. For patients with tracheobronchial stenosis who are no candidates for surgical reconstruction, tracheobronchial stenting is the management of choice.
Topics: Bronchi; Bronchial Diseases; Bronchial Neoplasms; Bronchoscopy; Constriction, Pathologic; Emergencies; Humans; Intubation, Intratracheal; Plastic Surgery Procedures; Stents; Suture Techniques; Trachea; Tracheal Neoplasms; Tracheal Stenosis
PubMed: 12560612
DOI: No ID Found -
International Journal of Molecular... Oct 2015Intractable advanced lung cancer can be treated palliatively with photodynamic therapy (PDT) combined with chemotherapy to remove central and peripheral (lobar or... (Clinical Trial)
Clinical Trial
Intractable advanced lung cancer can be treated palliatively with photodynamic therapy (PDT) combined with chemotherapy to remove central and peripheral (lobar or segmental bronchi) bronchial stenosis and obstruction. We present data for 12 (eight men, four women) consecutive patients with 13 advanced non-small cell lung carcinomas in whom curative operations were contraindicated, who underwent PDT combined with chemotherapy for local control of the intraluminal lesions. The mean age was 73.3 years (range, 58-80 years), and the stages of cancer were IIA-IV. The median stenosis rates before treatment, one week post-treatment, and one month post-treatment were 60% (range, 30%-100%), 15% (range, 15%-99%), and 15% (range 15%-60%), respectively. The mean and median survival times were 9.3 and 5.9 months, respectively. The overall 1-year survival rate was 30.0%. No PDT-related morbidity or mortality occurred. In this single-institution study, all patients experienced improved symptoms and quality of life at one week after treatment; furthermore, an objective response was evidenced by the substantial increase in the openings of the bronchial lumen and prevention of obstructive pneumonia. Therefore, PDT with chemotherapy was useful and safe for the treatment of bronchial obstruction.
Topics: Aged; Aged, 80 and over; Airway Obstruction; Carcinoma, Non-Small-Cell Lung; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Photochemotherapy
PubMed: 26512656
DOI: 10.3390/ijms161025466 -
Anaesthesia Jul 1999
Topics: Airway Obstruction; Anesthesia; Bronchial Diseases; Constriction, Pathologic; Humans; Intubation, Intratracheal; Laryngeal Neoplasms; Mediastinal Neoplasms; Tracheal Stenosis
PubMed: 10417451
DOI: 10.1046/j.1365-2044.1999.01036.x -
BMJ Case Reports Sep 2018Biliary anatomic pathologies are rare disease occurrences that can result from a number of causes, most commonly iatrogenic, infectious and malignant aetiologies....
Biliary anatomic pathologies are rare disease occurrences that can result from a number of causes, most commonly iatrogenic, infectious and malignant aetiologies. Communications between the biliary and bronchial systems are even rarer and few cases have been documented in the literature. The present study describes a case of a 70-year-old man who underwent a pancreaticoduodenectomy (Whipple Procedure) as a curative procedure for an early stage neuroendocrine tumour. He presented nearly a decade after surgery with a communication between the biliary and bronchial tree initially manifesting as bilioptysis. His underlying medical conditions and poor clinical picture made treatment options limited. Therefore, he was treated conservatively with percutaneous biliary balloon dilation of the anastomotic stricture followed by temporary percutaneous internal/external drain and made a full recovery.
Topics: Aged; Ampulla of Vater; Biliary Fistula; Bronchial Fistula; Carcinoma, Neuroendocrine; Common Bile Duct Neoplasms; Dilatation; Drainage; Humans; Male; Pancreaticoduodenectomy; Postoperative Complications; Time Factors
PubMed: 30181397
DOI: 10.1136/bcr-2017-221895 -
Anaesthesia Jul 1999A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed... (Review)
Review
A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass.
Topics: Adult; Airway Obstruction; Anesthesia, Endotracheal; Bronchial Diseases; Constriction, Pathologic; Female; Humans; Mediastinal Neoplasms; Mediastinoscopy; Tomography, X-Ray Computed; Tracheal Stenosis
PubMed: 10417460
DOI: 10.1046/j.1365-2044.1999.00961.x