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Chest Mar 2019Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and... (Review)
Review
Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.
Topics: Bronchi; Conservative Treatment; Humans; Minimally Invasive Surgical Procedures; Patient Selection; Stents; Trachea; Wounds and Injuries
PubMed: 30059680
DOI: 10.1016/j.chest.2018.07.018 -
Folia Morphologica 2023Understanding the dimensions of the lower airway is critical for performing respiratory surgery, selecting and designing appropriate airway equipment, and removing... (Review)
Review
Understanding the dimensions of the lower airway is critical for performing respiratory surgery, selecting and designing appropriate airway equipment, and removing aspirated foreign bodies via bronchoscopy, anaesthesia, and radiography. The purpose of this study was to analyse the trachea and bronchus morphologically in children and adults, as well as to standardise the data for these structures' measurements. Various databases were reviewed for studies on lower airway dimensions. The criteria for inclusion and exclusion were established. Finally, it was agreed to look into 28 studies that took place between 1984 and 2021. The length of the trachea, its anterior-posterior (AP) and transverse dimensions, the lengths and transverse diameters of the right and left major bronchus, and the subcarinal angle were also investigated in the study. In studies where measurements were performed with different methods and procedures. It was revealed that age and gender were effective in the difference in lower respiratory tract dimensions. The mean values of all parameters were greater in adults than in children, the AP diameter of the trachea in adults was greater than the transverse diameter. In children, it was observed that the transverse diameter was larger than the AP diameter on average, the left main bronchus was longer than the right main bronchus, and the transverse diameter was smaller than the right main bronchus in most of the studies. The articles reviewed for this study revealed that measurements were done using a variety of different procedures and approaches, and the resulting data were inconsistent and could not be standardized. The data collected will be beneficial both conceptually and clinically; we believe that additional comparison research involving children and adults in bigger groups are necessary.
Topics: Adult; Child; Humans; Bronchi; Bronchoscopy; Databases, Factual; Tomography, X-Ray Computed; Trachea
PubMed: 36000591
DOI: 10.5603/FM.a2022.0073 -
Anaesthesia Jul 2016
Review
Topics: Bronchi; Humans; Tomography, X-Ray Computed; Trachea
PubMed: 27291599
DOI: 10.1111/anae.13531 -
Internal Medicine (Tokyo, Japan) Apr 2023
Topics: Humans; Bronchi; Bronchoscopy; Bronchial Diseases; Trachea
PubMed: 35945016
DOI: 10.2169/internalmedicine.0308-22 -
Current Topics in Microbiology and... 2020Pulmonary respiration inevitably exposes the mucosal surface of the lung to potentially noxious stimuli, including pathogens, allergens, and particulates, each of which... (Review)
Review
Pulmonary respiration inevitably exposes the mucosal surface of the lung to potentially noxious stimuli, including pathogens, allergens, and particulates, each of which can trigger pulmonary damage and inflammation. As inflammation resolves, B and T lymphocytes often aggregate around large bronchi to form inducible Bronchus-Associated Lymphoid Tissue (iBALT). iBALT formation can be initiated by a diverse array of molecular pathways that converge on the activation and differentiation of chemokine-expressing stromal cells that serve as the scaffolding for iBALT and facilitate the recruitment, retention, and organization of leukocytes. Like conventional lymphoid organs, iBALT recruits naïve lymphocytes from the blood, exposes them to local antigens, in this case from the airways, and supports their activation and differentiation into effector cells. The activity of iBALT is demonstrably beneficial for the clearance of respiratory pathogens; however, it is less clear whether it dampens or exacerbates inflammatory responses to non-infectious agents. Here, we review the evidence regarding the role of iBALT in pulmonary immunity and propose that the final outcome depends on the context of the disease.
Topics: Bronchi; Humans; Immunity, Mucosal; Lymphocytes; Respiration
PubMed: 31974759
DOI: 10.1007/82_2019_191 -
Scientific Reports Jan 2021The knowledge of airway length is the theoretical basis in the diagnosis and management of airway disease. The objective of this study is to measure the length of...
The knowledge of airway length is the theoretical basis in the diagnosis and management of airway disease. The objective of this study is to measure the length of trachea and left and right main bronchus in Chinese Shanghai population. A total of 153 consecutive adult patients with minor pulmonary disease in Xinhua hospital were enrolled for bronchoscopy examination. Measurements were conducted on head and neck neutral position and height, weight and age for each patient were recorded either. Student t test and multiple linear regression was used to compare means between males and females and to analyze correlation among height, weight, sexual dimorphism and the lengths of the trachea and bronchus. The lengths of the trachea and left main bronchus are significantly different between male and female patients (P < 0.01), but not for the lengths of right main bronchus between man and woman. Multiple linear regression analysis showed that height but not sexual dimorphism and weight correlated with the lengths of the trachea and right main bronchus. The lengths of the trachea and left main bronchus are significantly longer in males than in females. Moreover, height but not sexual dimorphism and weight influenced the length of airway.
Topics: Adult; Aged; Asian People; Bronchi; China; Female; Humans; Male; Middle Aged; Trachea; Young Adult
PubMed: 33500472
DOI: 10.1038/s41598-021-81744-0 -
BMC Pulmonary Medicine Mar 2021Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the... (Review)
Review
BACKGROUND
Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications.
CASE PRESENTATION
A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet.
CONCLUSIONS
There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.
Topics: Aged; Bronchi; Bronchoscopy; Esophagoscopes; Esophagus; Female; Foreign Bodies; Humans; Lasers, Solid-State; Tomography, X-Ray Computed
PubMed: 33731031
DOI: 10.1186/s12890-021-01458-x -
Advances in Immunology 2010Bronchus-associated lymphoid tissue (BALT) is a constitutive mucosal lymphoid tissue adjacent to major airways in some mammalian species, including rats and rabbits, but... (Review)
Review
Bronchus-associated lymphoid tissue (BALT) is a constitutive mucosal lymphoid tissue adjacent to major airways in some mammalian species, including rats and rabbits, but not humans or mice. A related tissue, inducible BALT (iBALT), is an ectopic lymphoid tissue that is formed upon inflammation or infection in both mice and humans and can be found throughout the lung. Both BALT and iBALT acquire antigens from the airways and initiate local immune responses and maintain memory cells in the lungs. Here, we discuss the development and function of BALT and iBALT in the context of pulmonary immunity to infectious agents, tumors, and allergens as well as autoimmunity and inflammatory diseases of the lung.
Topics: Animals; Bronchi; Humans; Immunity, Mucosal; Lymphocyte Activation; Lymphocytes; Lymphoid Tissue; Respiratory Mucosa
PubMed: 21034975
DOI: 10.1016/B978-0-12-381300-8.00007-1 -
Multimedia Manual of Cardiothoracic... Aug 2023A minimally invasive pulmonary segmentectomy allows adequate oncological treatment in selected cases while preserving lung parenchyma and minimizing perioperative...
A minimally invasive pulmonary segmentectomy allows adequate oncological treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay. Most lung segments may be resected as segmentectomies or as part of bisegmentectomies (as is the case for the lingula). In the author's experience, left upper division resection (S1, S2, S3 trisegmentectomy) may be challenging. Because the lingula and lingular structures need to be preserved, they may obstruct visualization and hamper the movement of the dissecting instruments. This has been the author's experience using an anterior approach. In contradistinction, a posterior approach allows direct access to the artery and arterial branches and greatly facilitates access to the segmental bronchus. Dissection of the bronchus proceeds from back to front, away from the artery. In addition, when we are isolating and encircling the bronchus, we have already freed the artery from the bronchus and it is safely out of the way. The advantages of a posterior approach are particularly apparent when pathological nodes between the bronchus and artery make the dissection tedious, as in the case presented. Regardless of the surgical approach, S1/S2/S3 trisegmentectomy remains a challenging procedure that requires great care in its execution.
Topics: Humans; Dissection; Bronchi; Arteries; Length of Stay
PubMed: 37605931
DOI: 10.1510/mmcts.2023.061 -
Chinese Medical Journal Sep 2021The effectiveness of bronchial thermoplasty (BT) has been reported in patients with severe asthma. This study compared the effects of BT and cryoballoon ablation (CBA)...
BACKGROUND
The effectiveness of bronchial thermoplasty (BT) has been reported in patients with severe asthma. This study compared the effects of BT and cryoballoon ablation (CBA) therapy on the airway smooth muscle (ASM).
METHODS
Eight healthy male beagle dogs were included in this experiment. In the preliminary experiment, one dog received BT treatment for both lower lobe bronchus, another dog received CBA treatment for 7 s on the upper and lower lobe of right bronchus, and 30 s on the left upper and lower lobe. The treatments were performed twice at an interval of 1 month. In subsequent experiments, the right lower lobe bronchus was treated with BT, and the left lower lobe bronchus was treated with CBA. The effects of treatment were observed after 1 (n = 3) month and 6 months (n = 3). Hematoxylin-eosin staining, Masson trichrome staining, and immunohistochemical staining were used to compare the effects of BT and CBA therapy on the ASM thickness, collagen fibers synthesis, and M3 receptor expression after treatment. One-way analysis of variance with Dunnett post hoc test was used to analyze the differences among groups.
RESULTS
In the preliminary experiment, the ASM ablation effect of 30-s CBA was equivalent to that of 7-s CBA (ASM thickness: 30.52 ± 7.75 μm vs. 17.57 ± 15.20 μm, P = 0.128), but the bronchial mucociliary epithelium did not recover, and large numbers of inflammatory cells had infiltrated the mucosal epithelium at 1-month post-CBA with 30-s freezing. Therefore, we chose 7 s as the CBA treatment time in our follow-up experiments. Compared with the control group (35.81 ± 11.02 μm), BT group and CBA group (13.41 ± 4.40 μm and 4.81 ± 4.44 μm, respectively) had significantly decreased ASM thickness after 1 month (P < 0.001). Furthermore, the ASM thickness was significantly lower in the 1-month post-CBA group than in the 1-month post-BT group (P = 0.015). There was no significant difference in ASM thickness between the BT and CBA groups after six months (9.92 ± 4.42 μm vs. 7.41 ± 7.20 μm, P = 0.540). Compared with the control group (0.161 ± 0.013), the average optical density of the ASM M3 receptor was significantly decreased in 6-month post-BT, 1-month post-CBA, and 6-month post-CBA groups (0.070 ± 0.022, 0.072 ± 0.012, 0.074 ± 0.008, respectively; all P < 0.001). There was no significant difference in the average optical density of ASM M3 receptor between the BT and CBA therapy groups after six months (P = 0.613).
CONCLUSIONS
CBA therapy effectively ablates the ASM, and its ablation effect is equivalent to that of BT with a shorter onset time. A neural mechanism is involved in both BT and CBA therapy.
Topics: Animals; Bronchi; Bronchial Thermoplasty; Bronchoscopy; Cryosurgery; Dogs; Humans; Male; Muscle, Smooth
PubMed: 34553699
DOI: 10.1097/CM9.0000000000001681