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Bronchial tree of the human embryo: Categorization of the branching mode as monopodial and dipodial.PloS One 2021Some human organs are composed of bifurcated structures. Two simple branching modes-monopodial and dipodial-have been proposed. With monopodial branching, child branches...
Some human organs are composed of bifurcated structures. Two simple branching modes-monopodial and dipodial-have been proposed. With monopodial branching, child branches extend from the sidewall of the parent branch. With dipodial branching, the tip of the bronchus bifurcates. However, the branching modes of the human bronchial tree have not been elucidated precisely. A total of 48 samples between Carnegie stage (CS) 15 and CS23 belonging to the Kyoto Collection were used to acquire imaging data with phase-contrast X-ray computed tomography. Bronchial trees of all samples were three-dimensionally reconstructed from the image data. We analyzed the lobar bronchus, segmental bronchus, and subsegmental bronchus. After calculating each bronchus length, we categorized the branching mode of the analyzed bronchi based on whether the parent bronchus was divided after generation of the analyzed bronchi. All lobar bronchi were formed with monopodial branching. Twenty-five bifurcations were analyzed to categorize the branching mode of the segmental and subsegmental bronchi; 22 bifurcations were categorized as monopodial branching, two bifurcations were not categorized as any branching pattern, and the only lingular bronchus that bifurcated from the left superior lobar bronchus was categorized as dipodial branching. The left superior lobar bronchus did not shorten during the period from CS17 or CS18, when the child branch was generated, to CS23. All analyzed bronchi that could be categorized, except for one, were categorized as monopodial branching. The branching modes of the lobar bronchus and segmental bronchus were similar in the mouse lung and human lung; however, the modes of the subsegmental bronchi were different. Furthermore, remodeling, such as shrinkage of the bronchus, was not observed during the analysis period. Our three-dimensional reconstructions allowed precise calculation of the bronchus length, thereby improving the knowledge of branching morphogenesis in the human embryonic lung.
Topics: Bronchi; Embryo, Mammalian; Humans; Imaging, Three-Dimensional; Tomography, X-Ray Computed
PubMed: 33449967
DOI: 10.1371/journal.pone.0245558 -
Chinese Journal of Cancer Jun 2017Right upper lobectomy (RUL) for lung cancer with different dissecting orders involves the most variable anatomical structures, but no studies have analyzed its effects...
Different dissecting orders of the pulmonary bronchus and vessels during right upper lobectomy are associated with surgical feasibility and postoperative recovery for lung cancer patients.
BACKGROUND
Right upper lobectomy (RUL) for lung cancer with different dissecting orders involves the most variable anatomical structures, but no studies have analyzed its effects on postoperative recovery. This study compared the conventional surgical approach, VAB (dissecting pulmonary vessels first, followed by the bronchus), and the alternative surgical approach, aBVA (dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients.
METHODS
According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into aBVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare perioperative outcomes.
RESULTS
Three hundred one patients were selected (109 in the aBVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the aBVA cohort than in the VAB cohort (164 vs. 221 min, P < 0.001), and less blood loss occurred in the aBVA cohort (92 vs. 141 mL, P < 0.001). The rate of conversion to thoracotomy was lower in the aBVA cohort than in the VAB cohort (0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the aBVA cohort than in the VAB cohort (3.6 vs. 4.5 days, P = 0.001). The rates of postoperative complications were comparable (P = 0.629). The median overall survival was not arrived in both cohorts (P > 0.05). The median disease-free survival was comparable for all patients in the two cohorts (not arrived vs. 41.97 months) and for patients with disease recurrences (13.25 vs. 9.44 months) (both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences (6.4% vs. 7.8%), distant metastases (10.1% vs. 8.3%), and both (1.8% vs. 1.6%) (all P > 0.05).
CONCLUSIONS
Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the aBVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.
Topics: Adult; Aged; Aged, 80 and over; Aortic Dissection; Blood Vessels; Bronchi; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Postoperative Care; Vascular Surgical Procedures
PubMed: 28655346
DOI: 10.1186/s40880-017-0220-9 -
International Journal of Molecular... Feb 2022Exposure of the airways epithelium to environmental insults, including cigarette smoke, results in increased oxidative stress due to unbalance between oxidants and... (Review)
Review
Exposure of the airways epithelium to environmental insults, including cigarette smoke, results in increased oxidative stress due to unbalance between oxidants and antioxidants in favor of oxidants. Oxidative stress is a feature of inflammation and promotes the progression of chronic lung diseases, including Chronic Obstructive Pulmonary Disease (COPD). Increased oxidative stress leads to exhaustion of antioxidant defenses, alterations in autophagy/mitophagy and cell survival regulatory mechanisms, thus promoting cell senescence. All these events are amplified by the increase of inflammation driven by oxidative stress. Several models of bronchial epithelial cells are used to study the molecular mechanisms and the cellular functions altered by cigarette smoke extract (CSE) exposure, and to test the efficacy of molecules with antioxidant properties. This review offers a comprehensive synthesis of human in-vitro and ex-vivo studies published from 2011 to 2021 describing the molecular and cellular mechanisms evoked by CSE exposure in bronchial epithelial cells, the most used experimental models and the mechanisms of action of cellular antioxidants systems as well as natural and synthetic antioxidant compounds.
Topics: Animals; Bronchi; Cigarette Smoking; Epithelial Cells; Humans; Inflammation; Oxidative Stress
PubMed: 35163691
DOI: 10.3390/ijms23031770 -
Annals of Anatomy = Anatomischer... May 2021The development in interventional respiratory medicine entails the need of bronchial anatomical knowledge, whose variations assume their greatest importance nowadays.... (Observational Study)
Observational Study
The development in interventional respiratory medicine entails the need of bronchial anatomical knowledge, whose variations assume their greatest importance nowadays. The aim of this study was to describe the frequency of these variations and to analyze the bronchial lengths, barely registered before in literature. This observational descriptive study (from June 2018 until April 2019) was conducted in a sample of 17 pairs of lungs, which were dissected and measured at the Cadaver Donation Centre (Universidad Complutense, Madrid), and a second sample of 50 bronchoscopies, performed at the San Carlos Clinic Hospital, which were analyzed during the procedure. Our results show that there are no significant differences in the incidence of variations by sex in any of both samples, and neither in the average length of any bronchus by sex nor lobar pattern. Left main bronchus presents the longest length and left upper lobe bronchus the shortest. The highest percentage of variations is contained in the right lower lobe (25.4%), and the most frequent variation in the subsuperior bronchus (B*) (19.4%). The middle lobe and the left lower lobe present the lowest percentage of variations (11.9%). Only 37.3% of the pairs of lungs/patients did not have any anatomical variation in the general sample. Despite of the small size of the sample, results show a high percentage of variations and a minority of completely normal pairs of lungs, which invites us to reflect about the probable high prevalence of variations in the general population. Further studies with greater samples are needed to confirm our hypothesis.
Topics: Anatomic Variation; Bronchi; Bronchoscopy; Cadaver; Humans; Trachea
PubMed: 33515691
DOI: 10.1016/j.aanat.2021.151677 -
Respiratory Medicine 2021Electromagnetic navigational bronchoscopy (ENB) is an important, minimally invasive diagnostic tool for malignant and benign peripheral lung lesions, offering lower...
RATIONALE
Electromagnetic navigational bronchoscopy (ENB) is an important, minimally invasive diagnostic tool for malignant and benign peripheral lung lesions, offering lower complication risks than transthoracic needle aspirations. As a relatively new technology, the best sampling modality and lesion characteristics for ENB has yet to be determined. We evaluated the sensitivity and diagnostic yield of different sampling modalities (needle aspiration, brush biopsy, transbronchial forceps biopsies) and radiographical lesion characteristics by Tsuboi classification. We also evaluated the difference in yield and sensitivity with the addition of radial probe EBUS to augment ENB.
METHODS
We completed a retrospective chart review of all patients that had ENB performed at our institution since its implementation in 2011. We reviewed the lesion size, location, Tsuboi classification, cytology, pathology results and analyzed biopsy specimen tool types.
RESULTS
We included a total of 248 patients who had ENB performed between 2011 and 2018. Average age was 67 years and 50% female. A total of 270 lesions were targeted with a mean size of 24 ± 12 mm. Sensitivity for malignancy was 59.2% with a diagnostic yield of 72.3%. Sensitivity and diagnostic accuracy trended higher with combined sampling modalities (brush and transbronchial needle aspiration and forcep biopsy). Lesions with type I and type II Tsuboi classification of bronchus sign had higher sensitivity compared to type III classification (67.9% [n = 101 type I], 64.6% [n = 65 type II], 37.9% [n = 36 type III]), p = 0.01 and p = 0.04.
CONCLUSION
For navigation bronchoscopy, sensitivity is higher in bronchus sign lesions that end directly into lesion (Tsuboi type I) and travel through malignant lesions (Tsuboi type II) compared to tangentially circumventing the lesion (Tsuboi type III).
Topics: Aged; Biopsy; Bronchi; Bronchoscopy; Electromagnetic Phenomena; Female; Humans; Lung; Lung Neoplasms; Male; Retrospective Studies; Sensitivity and Specificity; Surgery, Computer-Assisted
PubMed: 33721698
DOI: 10.1016/j.rmed.2021.106357 -
Journal of Cardiothoracic Surgery Jul 2023Dieulafoy's disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This... (Review)
Review
BACKGROUND
Dieulafoy's disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This paper reports a case of bronchial Dieulafoy's disease and summarizes the data of similar cases reported in literature.
METHODS
We report a case of bronchial Dieulafoy's disease (BDD) in Tunisia. We also present a review of literature related to BDD from 1995 to 2022 using the PubMed, Google Scholar, web of science and Chinese National Knowledge Infrastructure Databases. Clinical characteristics, chest imaging, bronchoscopic and angiographic findings were summarized. Treatment courses were identified as well as patients' outcome.
RESULTS
We report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy's disease of the bronchus. Ninety cases of BDD were reported from 1995 to 2022. The main symptom was hemoptysis. Chest imaging findings were not specific. The diagnosis of BDD was mainly based on the bronchoscopy, branchial angiography and pathological findings or surgical specimens. Bronchoscopy findings were mostly nodular or prominent lesions (52.4%). Twenty-eight patients underwent bronchoscopic biopsies, 20 had massive bleeding and 10 died. Bronchial angiography mainly showed tortuous and dilation of bronchial artery, and the lesions were mainly located in the right bronchus. Selective bronchial artery embolization (SBAE) was performed in 32 patients and 39 patients underwent surgery.
CONCLUSION
To our knowledge, this is the first case of bronchial Dieulafoy's disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopic biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required.
Topics: Male; Humans; Adult; Hemoptysis; Bronchi; Bronchoscopy; Hemorrhage; Embolization, Therapeutic; Gastrointestinal Hemorrhage
PubMed: 37403165
DOI: 10.1186/s13019-023-02242-0 -
Chinese Journal of Traumatology =... Nov 2022Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with... (Review)
Review
Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented.
Topics: Humans; Female; Adult; Pneumothorax; Bronchi; Wounds, Nonpenetrating; Bronchoscopy; Trachea
PubMed: 35031204
DOI: 10.1016/j.cjtee.2021.12.007 -
Anatomical Record (Hoboken, N.J. : 2007) Dec 2019Although pulmonary ganglia were considered to be an analogue of the myenteric ganglia of intestines in embryos, there seemed to be no morphological evaluation in the...
Although pulmonary ganglia were considered to be an analogue of the myenteric ganglia of intestines in embryos, there seemed to be no morphological evaluation in the later stage of development. We conducted immunostainings of intrapulmonary nerves using 17 human fetuses at 14-18 and 28-34 weeks. The ganglion cells were small (15-20 μm in diameter) in the earlier group, but they increased in size (20-30 μm) in the late group. One ganglion, containing 5-30 cell bodies, was usually located "outside" of the bronchial smooth muscle or cartilage. In addition, a few ganglion was found beneath the mucosa of the trachea and principal bronchi. The highest density of ganglia (5-15 ganglia per section with 50 μm interval) was found at the origin of the subsegmental bronchi, but ganglia were absent along more peripheral bronchi those are responsible for contraction and obstruction of the airway. Therefore, in topographical relation between smooth muscle and nerve, intrapulmonary intrinsic neurons were different from intestinal myenteric neurons. Consequently, a previous hypothesis of "embryonic intramuscular bronchial ganglia" seemed not to be based on observations of the peripheral bronchus but on the central bronchus than the sub-subsegmental level. An extrinsic migration and redistribution of ganglia might occur at midterm to provide the final location outside of airway smooth muscles. Finally, no ganglion cell bodies were positive either for neuronal nitric oxide synthase or tyrosine hydroxylase. Instead of the classical entity of autonomic nerves, nonadrenergic noncholinergic (NANC) innervation might be dominant even in fetuses. Anat Rec, 302:2233-2244, 2019. © 2019 American Association for Anatomy.
Topics: Bronchi; Fetus; Ganglia; Humans; Intestines; Muscle, Smooth; Neurons
PubMed: 31241243
DOI: 10.1002/ar.24208 -
Brazilian Journal of Anesthesiology... 2023
Topics: Humans; Lung; Bronchi; Trachea
PubMed: 37075899
DOI: 10.1016/j.bjane.2023.04.002 -
Multimedia Manual of Cardiothoracic... Sep 2021We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material...
We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material while fully preserving the parenchyma. We used a biportal VATS approach. The centrally located bronchial tumor at the juncture between the right main bronchus, the right upper lobe bronchus, and the bronchus intermedius was first resected. The right upper lobe bronchus was rotated caudally, toward the bronchus intermedius, together with a slight clockwise rotation posteriorly to facilitate the approximation and tension-free closure of the bronchial defect. This video tutorial demonstrates the operative steps and explains how the rotational aspect is achieved.
Topics: Bronchi; Bronchial Neoplasms; Carcinoid Tumor; Humans; Plastic Surgery Procedures; Thoracic Surgery, Video-Assisted
PubMed: 34662004
DOI: 10.1510/mmcts.2021.046