[Palliative therapy of central bronchial carcinoma].
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Airway Obstruction↗
Biomedical subjects
L Freitag
Publications and source records attributed to L Freitag.
[Endobronchial prosthesis: experience report].
Between January 1988 and December 1990 a total of 84 endobronchial prosthesis were implanted in 55 patients at the Ruhrlandklinik, Essen. Bronchial carcinoma (33/55) was the leading indication for placing an endoluminal stent. Since the technique of implantation seldom leads to serious complications, non-malignant tracheobronchial stenosis and malacia play an increasing role in airway stenting. Implantation was usually performed under general anaesthesia and through rigid tube bronchoscopes with enlarged diameters. Most frequently a flexible silicone stent (Dumon) was used, Montgomery (5/84), Gianturco (5/84), Orlowski (4/84) and Strecker stents were also implanted. The respiratory gain was greatest in central stenosis, 79/84 stents were positioned into trachea or main stem bronchus. Permanent and temporary stenting were performed with success. Dislocation and hemoptysis seldom occur, mucus plugging and incrustation were more frequent complications.
Bronchi↗
The role of bronchoscopy in pulmonary complications due to mustard gas inhalation.
Over the last five years we have repetitively treated a group of 21 Iranian soldiers who developed pulmonary complications as a result of severe inhalation injury due to mustard gas during the Iran-Iraq war. Early respiratory manifestations included hemorrhagic inflammation of the tracheobronchial tree accompanied by severe erosions. Secondary complications consisted of chronic infections, suppurative bronchitis, and extensive stenotic process of the entire tracheobronchial tree with life-threatening sequelae. After a delay of up to 15 months, scars, ulcers, and strictures developed in the central airways. Progressive deterioration of gas exchange was common. At this point, bronchoscopy, both diagnostic and therapeutic, was invaluable in evaluating the conditions in these patients since many required multiple therapeutic bronchoscopies. Repeated bougienage of the stenotic tracheobronchial lesions and laser photoresection of scarring tissue was life-saving. The recurrence rate of stenosis was very high, with intervals of less than six months on the average. One pneumonectomy was necessary, with the excised lung showing bronchiectasis and chronic pneumonia. To this date we have performed 146 therapeutic bronchoscopies. In four patients, silicone stents had to be implanted. One patient received brachytherapy and external beam radiation therapy in an effort to prevent continued scarring and life-threatening stenoses of the tracheobronchial tree. Our experience demonstrates the extreme usefulness of bronchoscopy in the diagnosis and treatment of pulmonary complications due to inhalation of poisonous gases.
Bronchoscopy↗
Limited and radical resection for tracheal and bronchopulmonary carcinoid tumour. Report on 227 cases.
Bronchopulmonary carcinoid tumours occur at all levels from the trachea to the lung periphery. Over a 20-year period. 227 patients with carcinoid tumour underwent thoracotomy. The age at operation ranged from 14 to 79 years. Haemoptysis, chronic cough, recurrent infection and wheeze were the most common symptoms; 24% of patients were asymptomatic. The primary tumour was within the trachea or the main, lobar or segmental bronchi in 190 patients (83.7%). A variety of surgical procedures were employed: pneumonectomy in 32 patients; lobectomy and bilobectomy including bronchial sleeve resection in 144; segmentectomy in 18; wedge excision in 19; bronchial sleeve only in 5; carinal resection in 2; tracheal resection in 4 and bronchotomy in 3 cases. There was only 1 hospital death in the 227 patients (mortality: 0.44%). Survival at 5 and 10 years in patients with benign carcinoid was 97.5% and 95%, respectively. In patients with the atypical form it was 41.2%. The peripheral carcinoid was usually totally removed by an ample wedge excision or segmental resection and the central bronchial carcinoid by sleeve resection with lobectomy rather than pneumonectomy. The atypical variant, because of the frequency of lymphatic involvement, should be treated as a bronchial carcinoma by radical resection.
Adolescent↗
[Indications for surgery and results of 207 thoracotomies in children with diseases of the lung, pleura and mediastinum].
Between 1968 and 1988, 207 children with congenital, inflammatory, and neoplastic diseases of the lung, pleura, and mediastinum underwent thoracotomy. In 34 patients indication for operation was a therapy-resistent recurrent spontaneous pneumothorax, in 25 benign and malignant mediastinal tumors, in 26 pulmonary metastases of extrathoracic primary tumors, in 42 bronchiectasis and post-pneumonic empyema with callosity, in 21 bronchogenic and enterogenous cysts. 22 children had benign tumors of the trachea, bronchi, and lung, 5 malignant tumors of the lung and chest wall. In a smaller number of children congenital defects, parasitic cysts, and aspergillomas as well as foreign bodies, were present. The surgical procedure included anatomical and atypical resections, bronchoplastic interventions, exstirpation of tumors and cysts, decortications and partial resections of the parietal pleura. There was no perioperative mortality.
Child↗
[Procollagen-III-peptide in bronchoalveolar lavage fluid as an index of fibrosis in sarcoidosis and idiopathic lung fibrosis?].
In order to answer the question whether in sarcoidosis and idiopathic pulmonary fibrosis there is a relationship between the activity of alveolitis (T4/T8 ratio in sarcoidosis, number of granulocytes in idiopathic pulmonary fibrosis) and the activity of connective tissue formation (type III procollagen peptide in the BAL fluid) BAL was performed in 12 healthy subjects, 33 patients with type II sarcoidosis, and 26 patients with idiopathic pulmonary fibrosis. In the unconcentrated BAL fluid of the healthy subjects, P3P was not measurable. On the basis of the T4/T8 ratio and P3P in type II sarcoidosis, three groups of patients with possibly different risks of progression were found: 1) T4/T8 normal and P3P not or only mildly elevated, 2) T4/T8 elevated and P3P normal or only mildly elevated, 3) T4/T8 elevated and P3P greatly increased. In patients with idiopathic pulmonary fibrosis, the concentration of P3P correlated significantly with the number of granulocytes and the clinical activity parameters. On the basis of these results, we conclude that P3P levels in the BAL fluid, as a direct measure of connective tissue neogenesis, may be a valuable addition to cellular and immunocytological BAL findings.
Bronchoalveolar Lavage Fluid↗
High frequency oscillators with adjustable waveforms: practical aspects.
We have shown that several types of high frequency oscillator can be modified to produce non-sinusoidal flow patterns. We are convinced that the ability to adjust the wave form is a useful feature of a high frequency ventilator. As the required energy is related to (frequency) all the machines we have examined are large, heavy and noisy. Some problems could probably be overcome by engineering skill. For this reason we have not presented detailed power charts of our machines (built mostly by us). However, one has to admit that none of the devices is sophisticated enough to satisfy a physician who is not enthusiastic for high frequency ventilation. On the other hand, we have treated several patients suffering from bronchiectasis using a linear motor piston heavier than the patient. Asymmetric oscillations helped to clear the airways of purulent sputum. Despite all the noise and unsophisticated appearance of the machine, it was accepted well by the patients because they felt relief. This suggests that, regardless of all obstacles, research in HFV technology should be continued.
Equipment Design↗
High frequency oscillation for respiratory physiotherapy.
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Animals↗
Mobilization of mucus by airway oscillations.
The effects of high frequency asymmetric airway oscillations on mucus clearance were evaluated in excised tracheas of sheep, in an animal model of excessive mucus production, and in patients with bronchiectasis. Asymmetric high frequency ventilation (15 Hz) with expiratory biased flow profiles (expiratory peak-flow greater than inspiratory peak-flow) could move mucus droplets towards the pharynx in rigid and flexible tracheas by gas-liquid interaction. In rigid tracheas the mucus was transported towards the periphery of the model lung if the oscillations were inspiratory biased. In very collapsible tracheas, however, even inspiratory biased oscillations moved the mucus cephalad. Parameters influencing direction and speed of mucus are airflow profile, peak-flow, airway compliance and lung resistance. Gamma-camera studies showed that in anesthetized dogs radiolabeled artificial mucus followed the direction of the bias during high frequency ventilation. In five human volunteers with bronchiectasis and excessive secretions the asymmetric airway oscillations were superimposed during spontaneous breathing using a mouthpiece. Airway wall vibrations following the pressure swings of the oscillator could be observed. During forced expiration inward bulging of the posterior membranes of trachea and bronchi occurred at the negative pressure phase of the oscillations. This event was associated with increased appearance of sputum in the central airways. We conclude that high frequency ventilation with asymmetric flow profiles applied via tube or mouthpiece might be an effective future treatment of mucostasis.
Airway Resistance↗
Removal of excessive bronchial secretions by asymmetric high-frequency oscillations.
The present study evaluated whether high-frequency oscillations (HFO) with biased flow profiles applied at the airway opening are capable of altering mucus clearance. In eight anesthetized sheep, artificial mucus (100 P) was infused continuously (1 ml/min) into the left main bronchus via a cannula inserted through the dorsal wall of the left main bronchus after thoracotomy. Outcoming mucus was collected every 10 min from the end of a cuffed orotracheal tube. Animals were ventilated with a Harvard respirator at a low frequency with superimposed HFO at 14 Hz with asymmetrical waveforms generated by a digitally controlled electromagnetic piston pump (expiratory bias: peak expiratory flow 3.8 l/s, peak inspiratory flow 1.3 l/s; inspiratory bias: reverse of expiratory bias). The influence of posture and of HFO airflow bias on mucus clearance was determined. In the horizontal position, mucus clearance with expiratory biased HFO was 3.5 +/- 2 (SD) ml/10 min. Head-down tilt produced a clearance of 3.1 +/- 3 ml/10 min; addition of HFO with expiratory bias increased clearance to 11.0 +/- 2.0 ml/10 min (P less than 0.05). No clearance occurred with inspiratory biased HFO during head-down tilt. These results indicate that expiratory biased HFO at the airway opening can clear excessive airway secretions and augment clearance by postural drainage.
Animals↗
[Use of microcomputers in polysomnography].
Constantly falling prices and increasing power combine to make the personal computer an attractive alternative to established recording devices for use in polysomnography. Apart from its price advantage, digital recording of psychophysiological signals offers the possibility of selective display (compression and zooming to parts of special interest), and also semi-automatic evaluation. In order to be able to feed the data acquired in the sleep laboratory into the computer, an interface for signal matching, an analog/digital converter, and suitable software, are required. In order to reduce the wealth of data to the clinically relevant (and, in the last resort, also manageable) amount, preprocessing hardware, such as EEG filters, snore detectors, etc., are required. The system we recommend comprises individual hardware, modules for the pickup of physiological signals, and flexibly combinable software routines that permit adaptation to any future expansions of changing medical problems.
Humans↗
Laser smoke effect on the bronchial system.
The photoresection of endobronchial tumors produces smoke which is partly inhaled by the patient as well as the surgical staff. In an animal study we investigated whether a single exposure or repetitive exposures to smoke might have harmful side effects on the airways. Eleven sheep were exposed to smoke produced by laser-vaporizing (6,500 J) sections of bronchial tissue (1 cm3) in a Plexiglas chamber. The smoke analysis revealed 0.92 mg/liter particles with a mean particle size of 0.54 micron. Carbon monoxide content was estimated as 0.04%. We measured the effects of one or three separate ten-minute exposures on airway resistance, gas exchange, and mucociliary clearance rate in the trachea. We found that the smoke inhalation resulted in a decrease of arterial PO2 with relatively little change in airway mechanics. Tracheal mucus velocity, a marker of lung mucociliary clearance, was significantly depressed in a dose-dependent manner with increasing smoke exposures. Results of bronchoalveolar lavages performed before and one day after the exposure showed that the smoke inhalation induced a severe inflammation with dramatic increases of inflammatory cells. The total number of cells per milliliter lavage return increased from 3.2 million to 25 million; percent neutrophils increased from 2.3 to 45.6% and percent macrophages decreased from 86 to 41%. These findings indicate that the side effects of smoke inhalation during intrabronchial laser surgery should not be neglected. The impairment of the defense mechanism of the lung combined with the inflammation as well as hypoxia might be fatal in compromised patients. Effective smoke removal devices should be developed to protect the patient as well as the surgeon.
Animals↗
[Lung-esophagus abnormality and esophageal pseudodiverticulosis. Esophagopulmonary fistulas of various origins].
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Adult↗