Primera caracterización del árbol bronquial derecho en Cuba con el uso de la broncoscopia / First characterization of the right bronchial tree in Cuba by bronchoscopy

Introducción: El alcance de la maestría en el estudio endoscópico de las vías aéreas debe basarse en un conocimiento de la anatomía bronquial, sus divisiones, nomenclatura y los hallazgos endobronquiales normales. Objetivo: Caracterizar la anatomía del árbol bronquial derecho mediante broncoscopia flexible diagnóstica. Métodos: Se realizó un estudio descriptivo, de corte transversal prospectivo, en 2000 pacientes, en un periodo de 12 años, a los que se les realizó una revisión completa de las variantes del árbol bronquial derecho. Resultados: En el bronquio lobar superior la división más frecuente fue la bifurcación con 58,4 por ciento, el bronquio lobar medio siempre se bifurcó. En el segmento B6 predominó la bifurcación 87,7 por ciento y la más frecuente fue el tipo B6 y B6 b+c. El resto de los basales se comportaron de la manera siguiente: el segmento paracardiaco no apareció en un 8,15 por ciento, predominó la bifurcación con 89,15 por ciento y de estas, la división B8 y B9 + B10. En cuanto a las malformaciones congénitas estuvieron presentes 0,65 por ciento de bronquio traqueal, 0,15 por ciento de bronquio cardiaco accesorio y 5,15 por ciento de bronquio subsuperior. Conclusiones: El árbol bronquial derecho en la población cubana tiene características propias(AU)

Introduction: The skill scope in the airways endoscopic study should be based on the bronchial anatomy knowledge, its divisions, nomenclature and the normal endobronchial findings. Objective: To characterize the anatomy of the right bronchial tree using diagnostic flexible bronchoscopy. Methods: A descriptive, prospective cross-sectional study was carried out in 2000 patients, over a period of 12 years. A complete review of the right bronchial tree these variants was performed on these patients. Results: The most frequent division was the bifurcation with 58.4%, in the upper lobar bronchus. The middle lobar bronchus always bifurcated. In segment B6, bifurcation predominated (87.7percent), and the most frequent was type B6 and B6 b + c. The rest of the basals behaved as follows: the paracardiac segment did not appear in 8.15 percent, bifurcation predominated (89.15 percent) and out of these, B8 and B9 + B10 division. Regarding congenital malformations, we found 0.65 percent tracheal bronchus, 0.15 percent accessory cardiac bronchus and 5.15 percent subsurface bronchus. Conclusions: The right bronchial tree in the Cuban population has its own characteristics(AU)

Wheezy adult with chicken bone in the chest

A large foreign body aspiration in a healthy adult is rare in the literature. It is a frequent problem in children and adolescents. Adults are affected in altered sensorium, either due to sedation or neurological problems. Acute upper airway obstruction though rare in adults requires establishment of an airway using Laryngoscope or rigid bronchoscope. At times we have to recourse to tracheostomy to save the life. Foreign body often travels down the right sided airways, here we present a case of 30mm Chicken bone being lodged in the left main bronchus. The patient presented with unremitting cough and normal chest skiagram. Monophonic wheeze on auscultation and focused attention on the patient narration made us clinch the diagnosis. New onset wheezy chest or unremitting chronic airway disease on adequate therapy, with history of choking needs special attention. The CT scan is a better modality of the investigation. Three dimensional CT with multi-slice virtual bronchoscopy is advantageous. We discussed foreign body aspirations in adults, the various causes and presentations. Fiber optic bronchoscopy is the ideal method for visualization and extraction of non-life-threatening foreign bodies in adults. Once a foreign body is identified, it has to be removed as early as possible. Retained foreign bodies can precipitate many complications related to infection and inflammation. At rare incidence we may have to resort to thoracotomy to remove a complicated foreign body.

Lobation and bronchopulmonary segmentation of Callithrix jacchus (Linnaeus, 1758) / Lobação e segmentação broncopulmonar de Callithrix jacchus (Linnaeus, 1758)

Abstract The common marmoset (Callithrix jacchus) are small primates belonging to the family Cebidae, subfamily Callitrichinae and are the most well-known and common in adaptation to captivity. The scarcity of data in the literature on the anatomy of these marmosets and wild animals hinders the application of appropriate anesthetic and surgical procedures and therapeutics. In order to understand the anatomic variations in the lobation and bronchopulmonary segmentation the lungs were dissected from nine adult common marmoset (Callithrix jacchus) corpses, five males and four females. In the marmosets, the right lung presented cranial lobe, middle lobe, caudal lobe and accessory lobe while the left lung presented cranial and caudal lobes. The fissures were very pro-eminent in both the lungs. The main right bronchus emitted independent branches, one for each lobe, and it followed in a straight line in the caudal lobe as a continuation of this bronchus and the same was observed in the main left bronchus. The bronchopulmonary segmentation in the right lung ranged from one to five branches in the cranial lobe; the middle lobe had a single branch; the caudal lobe had three to five branches and the accessory lobe had three branches. In the left lung the cranial lobe bronchopulmonary segmentation ranged from one to five branches while in the caudal lobe it was three to four branches.

Resumo: Os saguis-de-tufos-brancos (Callithrix jacchus) são pequenos primatas que pertencem à família Cebidae, subfamília Callitrichinae e são os mais conhecidos e comuns na adaptação ao cativeiro. A escassez de dados disponíveis na literatura sobre a anatomia desses saguis e de animais silvestres dificulta a aplicação de procedimentos anestésicos, cirúrgicos e terapêuticos apropriados. Visando conhecer as variações anatômicas da lobação e segmentação broncopulmonar foram dissecados os pulmões de nove cadáveres de saguis-de-tufos-brancos (Callithrix jacchus) adultos, sendo cinco machos e quatro fêmeas. Nos saguis, o pulmão direito apresentou lobo cranial; lobo médio; lobo caudal e lobo acessório; e o pulmão esquerdo os lobos cranial e caudal. As fissuras são bem proeminentes em ambos os pulmões. O brônquio principal direito emitiu ramos independentes, um para cada lobo, sendo que no lobo caudal seguiu em linha reta como a continuação deste brônquio e o mesmo foi observado no brônquio principal esquerdo. Em relação à segmentação broncopulmonar, o pulmão direito apresentou no lobo cranial variando de um a cinco ramos; lobo médio com um único ramo; o lobo caudal com três a cinco ramos e o acessório com três ramos. No pulmão esquerdo o lobo cranial teve uma variação de um a cinco e no caudal foi de três a quatro ramos.

Morfologia da traqueia e lobação pulmonar de Leopardus pardalis (jaguatirica) / Morphology of the trachea and lung lobation of Leopardus pardalis (ocelot)

A espécie Leopardus pardalis, conhecida popularmente como jaguatirica, é um felino de médio porte com ampla distribuição em território nacional e está incluída na lista de espécies da fauna brasileira ameaçadas de extinção. Este estudo teve como objetivo caracterizar os aspectos macroscópicos e microscópico da traqueia e lobos pulmonares em L. pardalis. As análises foram feitas utilizando cinco exemplares de jaguatirica, sendo dois machos e três fêmeas, adultos, três desses exemplares foram a óbito por atropelamento em rodovias próximas ao município de Alta Floresta, e dois doados após a morte pelo IBAMA ao o Laboratório de Zoologia e Morfologia Animal. Nos espécimes a traqueia era um tubo flexível formado por pares de arcos cartilaginosos, apresentando epitélio pseudo-estratificado não ciliado no seu revestimento interno, e outros estruturas básicas deste órgão. O pulmão se mostrou como um órgão constituído por lobos separados por fissuras com um parênquima usual aos demais mamíferos descritos. No que diz respeito às caraterísticas anatômicas da traqueia e pulmão se mostraram semelhantes à de outros mamíferos, já nos aspectos microscópicos da traqueia apresentou certas peculiaridades diferindo dos demais trabalhos encontrados. No que tange o aspecto do parênquima pulmonar as características histológicas não variaram com as que estão descritas.(AU)

The species Leopardus pardalis, popularly known as ocelot, is a medium sized cat with wide distribution in the national territory and is included in the list of species of Brazilian fauna threatened with extinction. This study aimed to characterize the macroscopic and microscopic aspects of the trachea and lung lobes in L. pardalis. Analyses were performed using five copies of ocelot, two males and three females, adults, three of these specimens died from being run over on highways nearby the municipality of Alta Floresta, and two donated after death by IBAMA to the Laboratory of Zoology and Animal Morphology. In the trachea specimens was a flexible tube formed by pairs of cartilaginous arches, with pseudo-stratified epithelium ciliated not in its inner lining, and other basic structures of this body. Lung proved as a body made up of lobes separated by cracks with a usual parenchyma to the other described mammals. With respect to the anatomic features of the trachea and lung were similar to other mammals, as in the microscopic aspects of the trachea showed certain peculiarities found differing from the other jobs. Regarding the appearance of the lung parenchyma histological characteristics did not differ with those described.(AU)

Histological description of Cerdocyon thous (Linnaeus, 1766) respiratory system / Descrição histológica do sistema respiratório de Cerdocyon thous (Linnaeus, 1766)

The massive agricultural expansion converted the Cerdocyon thous, a South American native predator, in vulnerable specie. Basic data, such as histological description, are important to raise awareness on animal species, helping on preservation strategies. Considering the difficult in obtain samples, as the euthanasia of wild animals for this purpose is not allowed, data on histology are very scarce or inexistent. The objective of this paper was to provide a detailed histological description of the trachea and bronchial tree of the crab-eating fox Cerdocyon thous (Linnaeus, 1766). The specimens (one adult male and one adult female) used were provided by the Federal University of Pelotas (Pelotas, RS, Brazil) Rehabilitation Center of Wild Fauna (NURFS). Tissue samples were fixed in 10% formalin and included in paraffin. After slicing, samples were stained with HE (hematoxylin and eosin), PAS (periodic acid-Schiff) and resorcin fuchsin. Trachea had an average diameter of 7.87mm, and approximately 57% of the mucosa ciliated pseudo-stratified columnar epithelium was composed of goblet cells, mostly in the dorsal region. Bronchia and bronchioles had a mucosal fold with higher number of goblet cells. Using all these techniques there is no great remarkable differences from C. thous trachea and lung, when compared with the previous described structures for carnivores and most mammals, except for the goblet cells "regionalization". Described results are important to understand the animal physiological and behavioral habits, allowing the development of preservation and protection strategies.(AU)

A expansão agrícola maciça tornou o Cerdocyon thous, um predador nativo sul-americano, vulnerável. Dados básicos, tais como descrição histológica, são importantes para aumentar o conhecimento sobre as espécies, ajudando nas estratégias de preservação. A eutanásia de animais selvagens para a coleta de amostras não é permitida, por isso os dados sobre a histologia são muito escassos ou inexistentes. O objetivo deste trabalho foi de fornecer uma descrição histológica detalhada da traqueia e árvore brônquica do cachorro do mato Cerdocyon thous (Linnaeus 1766). Os espécimes (um macho e uma fêmea adultos) utilizados foram fornecidos pela Universidade Federal de Pelotas (Pelotas, RS, Brasil), Centro de Reabilitação da Fauna (NURFS). As amostras de tecido foram fixadas em formalina a 10% e incluídas em parafina. Após o corte, as amostras foram coradas com HE (hematoxilina e eosina), PAS (ácido periódico de Schiff) e resorcina fucsina. A traqueia tinha um diâmetro médio de 7,87 milímetros e aproximadamente 57% do diâmetro do epitélio colunar pseudo-estratificado ciliado da mucosa composto por células caliciformes, principalmente na região dorsal do órgão. Os brônquios e bronquíolos apresentaram cararísticas similares aos outros animais, contudo aparenta ter maior número de células caliciformes. Usando distintas técnicas de coloração, observou-se que não há diferenças notáveis da traqueia e do pulmão de C. thous quando comparados com os dados para carnívoros e para a maioria dos mamíferos, exceto a regionalização de células caliciformes. Os resultados descritos são importantes para compreender a fisiologia dos animais e hábitos comportamentais, permitindo o desenvolvimento de estratégias de preservação e proteção.(AU)

Construction and significance of three-dimensional visual model in bronchial tree of pig lung / 局解手术学杂志

Objective To explore the method and significance for constructing three-dimensional visual model in bronchial tree of pig lung. Methods A set of pig lung specimen was infused with epoxy resin-lead oxide through the trachea,and then casted. The Mimics 15. 0 was used to construct three-dimensional visual model in bronchial tree of pig lung by utilizing CT data of the cast specimen. Results In the reconstructed three-dimensional visual model of bronchial tree,the three-dimensional effect was realistic. This model not only clearly showed each lobar direction and distribution of bronchial tree,but also allowed three-dimensional arbitrary scaling,shifting or rotating at any angle, and the diameter and distance of each lobar bronchus could be measured with the sofeware. Conclusion The three-dimensional visual model in bronchial tree of pig lung can be successfully reconstructed from the CT dataset by using related sofeware like Mimics,which can bring morphological reference to anatomical teaching and will be helpful to the development of virtual operation.

Distribuição dos brônquios lobares dos pulmões do veado-catingueiro Mazama gouazoubira / Distribution of lobar bronchi of the lungs of brown brocket deer Mazama gouazoubira

Este estudo teve como objetivo descrever a lobação do pulmão do veado-catingueiro Mazama gouazoubira. Dois animais da espécie, obtidos post mortem por atropelamento em rodovia, foram utilizados para o estudo, obedecendo aos critérios da Lei Vigente (Lei 1.153/95). Através da dissecação, a pele foi completamente removida e os animais foram fixados em solução de formaldeído a 10 porcento. Através de um acesso ventral, o bloco de vísceras foi removido e posteriormente os pulmões foram dissecados do bloco por uma secção na região torácica da traqueia e de outras estruturas do hilo pulmonar. Os pulmões e a árvore brônquica foram dissecados, fotografados, as imagens foram registradas com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Os pulmõesapresentaram-se unidos pelas estruturas que penetravam a região do hilo pulmonar, o pulmão direito do veado-catingueiro mostrou ser composto pelos lobos cranial (segmento cranial e segmento caudal), médio, caudal e acessório. O pulmão esquerdo apresentou apenas lobo cranial (segmentado em parte cranial e parte caudal) e lobo caudal. A árvore brônquica se inicia emergindo para o pulmão direito um brônquio traqueal acima da bifurcação da traqueia que sequencialmente serão denominados de brônquios principais direito e esquerdo, os quais no nível do hilo pulmonar penetram nos pulmões direito e esquerdo respectivamente. Os pulmões e árvore brônquica de M. gouazoubira apresentaram a mesma descrição anatômica de outros ruminantes, como bubalinos, ovinos e bovinos.

The study aimed to describe the lung lobation of the brown brocket deer, Mazama gouazoubira. Two animal of the species, obtained postmortem by trampling on the highway, were used for the study, according to criteria of the Governing Law (1.153/95). The skin was completely removed and the animals were fixed in 10 percent formaldehyde. The viscera were removed and the lungs were dissected by a section of the block in the thoracic trachea and other structures of the pulmonary hilum. The lungs and bronchial tree were dissected, photographed and the images were recorded with a digital camera (Sony a200 Camera, 10.2mpx). The lungs showed themselves united by structures that penetrate the region of the pulmonary hilum, the right lung was found to be composed of the cranial lobes (segment cranial and caudal segment), middle, caudal and accessory. The left lung showed only cranial lobe (segmented into the cranial and caudal part) and caudal lobe. The bronchial tree begins emerges to the right lung one tracheal bronchus above the bifurcation of the trachea that are sequentially named right and left main bronchi, which at the level of the pulmonary hilum penetrate the left and right lungs respectively. The lungs and bronchial tree of M. gouazoubira showed the same anatomical description of other ruminants, like buffaloes, sheep and cattle.

hair an unusual foreign body in airways presenting with haemoptysis in an adult patient.

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Developmental anomalies of bronchial tree: a multidetector computerized tomography study / Anomalías del desarrollo del árbol bronquial: un estudio mediante tomografía computarizada multidetector

Anomalies of the bronchial tree may cause recurrent acute pulmonary infection and persistent obstruction symptoms. The developmental anomalies of the bronchial tree were presented mostly as case reports with an accompanying anomaly. However in this study, these anomalies were detected in multidetector computerized tomography (MDCT) images which have no reported pathology. Thoracic MDCT images of 400 patients (0-74 years old, 224 male and 176 female) were evaluated. Four tracheal bronchus (1percent) were detected. Three of them were displaced type, one of them was pig bronchus. And two accessory cardiac bronchus (0,5 percent) originated from medial wall of the intermediate bronchus were detected. According to our findings, incidence of tracheal bronchus and accessory cardiac bronchus seems to be higher in Turkish population.

Las anomalías del árbol bronquial pueden causar una infección pulmonar aguda recurrente y síntomas de obstrucción persistente. Las anomalías del desarrollo del árbol bronquial se presentan principalmente como informes de casos con una anomalía de acompañante. Sin embargo, en este estudio se detectaron estas anomalías en las imágenes de tomografía computarizada multidetector (TCMD), donde no se habían informado esta patología. Se evaluaron las imágenes de TCMD torácica de 400 pacientes (0-74 años, 224 hombres y 176 mujeres). Se detectaron cuatro bronquios traqueales (1 por ciento). Tres de ellos fueron de tipo desplazado, uno fue tipo bronquio de cerdo, y dos bronquio cardiaco accesorio (0,5 por ciento), originados de la pared medial del bronquio intermedio. De acuerdo con nuestros resultados, la incidencia de bronquio traqueal y bronquios cardiacos accesorios parecen ser mayor en la población turca.