Evaluation of angles of the tracheobronchial tree with the 3-dimensional reconstruction method: a morphometric and radiologic study / Evaluación de los ángulos del árbol traqueobronquial con el método de reconstrucción tridimensional: un estudio morfométrico y radiológico

SUMMARY: The objective of the current research is to assess the branching angles of the tracheobronchial tree and the correlation between these angles and the lung volume using the 3-dimensional reconstruction method. Thorax CT (computed tomography) images of 150 individuals, who were over 18 years of age and did not have any pathology on CT, were obtained retrospectively. A 3-dimensional reconstruction of the trachea, bronchi, and lungs was carried out. External and internal angles between the trachea and main bronchi, between the main bronchi and lobar bronchi, and between the lobar bronchi were measured. The volume measurement of the right and left lungs was performed. The individuals included in the study were grouped by sex and age (20-40 years, 41-61 years, and 62-87 years). The left subcarinal angle (LSA), total subcarinal angle (TSA), and left interbronchial angle (LIA) were found to be greater in the 62-87 age group. Both the external angle (LULB-LMBE) and the internal angle (LULB- LMBI) between the left upper lobar bronchus and the left main bronchus were observed to be greater in males. In males, a statistically significant negative moderate correlation was identified between the right lung volume and the right subcarinal angle (RSA). In females, a statistically significant positive moderate correlation was revealed between the external (RULB-IBE) and internal angles (RULB-IBI) between the right upper lobar bronchus and the intermediate bronchus, and the right lung volume. In the literature review we performed, we did not find any studies investigating the correlation between the branching angles of the tracheobronchial tree and the lung volume using the 3-dimensional reconstruction method. Therefore, we are of the opinion that our study will contribute to the literature.

El objetivo de la investigación fue evaluar los ángulos de ramificación del árbol traqueobronquial y la correlación entre estos ángulos y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Se obtuvieron retrospectivamente imágenes de tomografía computarizada de tórax de 150 individuos mayores de 18 años sin patología. Se realizó una reconstrucción tridimensional de la tráquea, los bronquios y los pulmones. Se midieron los ángulos externo e interno entre la tráquea y los bronquios principales, entre los bronquios principales y los bronquios lobares, y entre los bronquios lobares. Se realizó la medición del volumen de los pulmones derecho e izquierdo. Los individuos incluidos en el estudio fueron agrupados por sexo y edad (20-40 años, 41-61 años y 62-87 años). Se encontró que el ángulo subcarinal izquierdo, el ángulo subcarinal total y el ángulo interbronquial izquierdo eran mayores en el grupo de edad de 62 a 87 años. Tanto el ángulo externo (LULB-LMBE) como el ángulo interno (LULB-LMBI) entre el bronquio lobular superior izquierdo y el bronquio principal izquierdo era mayor en los hombres. En los hombres, se identificó una correlación moderada negativa estadísticamente significativa entre el volumen pulmonar derecho y el ángulo subcarinal derecho. En mujeres, se reveló una correlación positiva moderada estadísticamente significativa entre los ángulos externos (RULB-IBE) e internos (RULB-IBI) entre el bronquio lobar superior derecho y el bronquio intermedio, y el volumen pulmonar derecho. En la revisión bibliográfica que realizamos, no encontramos ningún estudio que analizara la correlación entre los ángulos de ramificación del árbol traqueobronquial y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Por lo tanto, consideramos que nuestro estudio contribuirá a la literatura especializada del tema.

Clinical and bronchoscopy features of tracheobronchial tuberculosis in children / 中国当代儿科杂志

OBJECTIVES@#To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis.@*METHODS@#The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB.@*RESULTS@#A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%.@*CONCLUSIONS@#The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.

Factors affecting the complication of pulmonary atelectasis in children with tracheobronchial tuberculosis / 预防医学

Objective@#To analyze the factors affecting the complication of pulmonary atelectasis among children with tracheobronchial tuberculosis (TBTB), so as to provide the reference for the prevention and treatment of pulmonary atelectasis complicated by TBTB.@*Methods@#Children with TBTB admitted to Department of Paediatrics, Linping Division of the Second Affiliated Hospital of Zhejiang University School of Medicine were selected as the study subjects from October 2018 to March 2023. Subjects's basic information, etiological examination results and laboratory testing results were collected using a self-designed questionnaire, and factors affecting the complication of pulmonary atelectasis among children with TBTB were identified using a multivariable logistic regression model. @*Results@#A total of 120 children with TBTB were included, with the age of 6 months to 12 years. There were 33 children at ages of less than one year (27.50%), 71 girls (59.17%) and 25 children with TBTB and pulmonary atelectasis (20.83%). Multivariable logistic regression analysis identified less than one year of age (OR=1.720, 95%CI: 1.126-3.358), type Ⅵ of TBTB (OR=1.669, 95%CI: 1.101-2.236), high level of C-reactive protein (OR=1.887, 95%CI: 1.088-2.686) and high level of procalcitonin (OR=1.844, 95%CI: 1.034-2.654) as risk factors for the complication of pulmonary atelectasis in children with TBTB.@*Conclusion@#Less than one year of age, type Ⅵ of TBTB, high level of C-reactive protein and high level of procalcitonin may increase the risk of pulmonary atelectasis in children with TBTB.

Effect of early interventional therapy with fiberoptic bronchoscope on inflammatory infiltrating tracheobronchial tuberculosis / 中国医师进修杂志

Objective:To investigate the effect of early interventional therapy with fiberoptic bronchoscope in patients with inflammatory infiltrating type (Ⅰ type) tracheobronchial tuberculosis (TBTB).Methods:Using prospective research methods, 306 patients with Ⅰ type TBTB diagnosed by fiberoptic bronchoscopy in the Third People′s Hospital of Kunming City from January 2019 to April 2022 were selected. The patients were divided into observation group and control group according to the random number table method with 153 cases each. The patients in control group were given routine anti-tuberculosis chemotherapy, and the patients in observation group were given routine anti-tuberculosis chemotherapy combined with early interventional therapy with fiberoptic bronchoscope. Sputum smear examination and tuberculosis culture were performed at the end of 1, 3 and 6 months of treatment, and the negative conversion of sputum culture was recorded. Chest X-ray, pulmonary function and fiberoptic bronchoscope were performed at the end of 1, 3 and 6 months of treatment to evaluate the improvement rate of clinical symptoms, effective absorption rate of lesions and effective absorption rate of obstructive pneumonia. The CD 4+, CD 8+, CD 4+/CD 8+, interferon γ (IFN-γ), interleukin-6 (IL-6) and C reactive protein (CRP) before and after treatment were detected. The random walking model of immune inflammation was evaluated. Results:The sputum negative conversion rates at the end of 1, 3 and 6 months of treatment in observation group were significantly higher than those in control group: 64.71%(99/153) vs. 52.29%(80/153), 80.39%(123/153) vs. 62.09%(95/153) and 91.50%(140/153) vs. 73.86%(113/153), and there were statistical differences ( P<0.05 or <0.01). The improvement rate of clinical symptoms at the end of 1 month of treatment in observation group was significantly higher than that in control group: 94.77%(145/153) vs. 66.67%(102/153), and there was statistical difference ( P<0.01); the clinical symptoms disappeared in both groups at the end of 3 and 6 months of treatment. The effective absorption rates of lesions at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 73.20%(112/153) vs. 51.63%(79/153) and 96.73%(148/153) vs. 85.62%(131/153), and there were statistical differences ( P<0.01); all the lesions were absorbed at the end of 6 months of treatment in both groups. The effective absorption rates of obstructive pneumonia at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 78.43% (120/153) vs. 39.87%(61/153) and 89.54%(137/153) vs. 79.08%(121/153), and there were statistical differences ( P<0.01 or <0.05); all obstructive pneumonia were absorbed at the end of 6 months of treatment in both groups. There were no statistical differences in CD 4+, CD 8+, CD 4+/CD 8+, IL-6, IFN-γ and CRP before treatment between the two groups ( P>0.05); the CD 4+, CD 4+/CD 8+ and IFN-γ after treatment in observation group were significantly higher than those in control group: 0.343 ± 0.032 vs. 0.311 ± 0.023, 1.37 ± 0.18 vs. 1.12 ± 0.16 and (38.47 ± 3.50) ng/L vs. (20.52 ± 2.96) ng/L, the CD 8+, IL-6 and CRP were significantly lower than those in control group: 0.251 ± 0.020 vs. 0.268 ± 0.021, (19.40 ± 3.31) ng/L vs. (34.58 ± 5.82) ng/L and (10.41 ± 2.87) mg/L vs. (17.47 ± 3.14) mg/L, and there were statistical differences ( P<0.01). The evaluation results of random walking model showed that CD 4+, CD 8+, CD 4+/CD 8+, IFN-γ, IL-6 and CRP in the observation group were better than those in the control group in the maximum random fluctuation, number of walking steps, positive walking growth rate, random fluctuation power law value, comprehensive improvement rate, recording times of comprehensive evaluation index and expected improvement value. Conclusions:Early interventional therapy with fiberoptic bronchoscope can effectively assist systemic drug therapy in patients with Ⅰ type TBTB, which can accelerate focus absorption, promote sputum negative conversion, enhance cellular immunity and effectively inhibit inflammatory reaction.

A rare case report of tracheobronchial aspergillosis with endobronchial aspergilloma in a patient clinically recovered from COVID-19

The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to an increased incidence of fungal infections. However, pulmonary infections are rare. COVID-associated pulmonary aspergillosis has been reported; however, there is no prior report of tracheobronchial aspergillosis with endobronchial aspergilloma as per the authors' literature search. We report such a case of a 65-year-old male with radiology and biopsy-proven endobronchial aspergilloma upon a background of tracheobronchial and pulmonary aspergillosis after having recovered clinically from severe COVID-19 disease.

Surgical treatment and outcome of primary tracheobronchial tumors in 15 children / 中华胸心血管外科杂志

Objective:To investigate the clinical manifestation, pathological types, treatment and prognosis of primary tracheobronchial tumors in children.Methods:We retrospectively studied the primary tracheobronchial tumors patients who diagnosed from May 2009 to Jan 2021 in Guangzhou Women and Children Medical Center. The clinical manifestations, pathological types, therapeutic methods and prognosis were analyzed.Results:There were 15 patients identified as the primary tracheobronchial tumors, including synovial sarcoma (1 case), pulmonary inflammatory myofibroblastic tumor(IMT 4 cases), mucoepidermoid carcinoma(7 cases), infantile hemangioma (1 case), Ewing's sarcoma (1 case). Respiratory symptoms are the most complaint at the time of diagnosis including 15 patients with cough, 2 with hemoptysis, and 1 with dyspnea. Endoscopic treatment of tracheobronchial tumors was performed under extracorporeal membrane oxygenation (ECMO) support in 1 patient. Sleeve lobectomy was performed in 3 patients, lobectomies in 6, and local tumor resections in 4 patients including 2 patients suffered second surgery due to tumor recurrence.Conclusion:The clinical manifestations of the primary tracheobronchial tumors in children are nonspecific. Complete resection led to excellent outcome.

Clinical analysis of 176 children with congenital tracheobronchial malformation / 中华实用儿科临床杂志

Objective:To investigate the clinical characteristics of congenital tracheobronchial malformation in children.Methods:Retrospective analysis was performed on the data of 176 children with congenital tracheobronchial malformation who were diagnosed by bronchoscopy at Children′s Hospital of Chongqing Medical University from January 2016 to October 2016, and were followed up by telephone for the presence of dyspnea, operation and death within 3 years after discharge.Results:(1) Among the 176 cases, there were 156 cases less than 3 years old, accounting for 88.64%.(2) Among the 176 cases, there were 54 cases with congenital tracheobronchial stenosis, 42 cases with congenital tracheomalacia, 26 cases with abnormal bronchial openings, 3 cases with airway diverticulum, 1 case with tracheoesophageal fistula, 1 case with bridging bronchus, and 49 cases with mixed type (2 or more malformations). (3) The most common clinical manifestations included recurrent or persistent dyspnea (86 cases), chronic cough (61 cases), and recurrent respiratory infection (34 cases) with the most frequent occurrence.Other manifestations included laryngeal stridor (14 cases), pulmonary atelectasis (29 cases), localized emphysema (6 cases), and difficulty extubation after endotracheal intubation (6 cases). (4) Among the 139 patients who underwent chest CT examination and airway reconstruction, only 44 cases were diagnosed correctly.(5) All 176 patients received routine medical treatment and bronchoscopy during hospitalization, among which 17 cases received surgical treatment.One hundred and seventy cases were improved in their condition and discharged, and 6 cases did not respond well.A total of 47 patients were followed up by telephone for 3 years.The proportion of children with dyspnea after 1 year, 2 years and 3 years were 59.57%, 51.06% and 38.30%, respectively.Among the follow-up patients, 4 patients received surgical treatment and 2 patients died.Conclusions:Congenital tracheobronchial malformation in children often occurs in infants, and their clinical manifestations are not typical.Therefore, suspected patients should receive chest CT and airway reconstruction as early as possible, and bronchoscopy can be employed in time if the diagnosis is unclear.The majority of children can obtain a favorable prognosis, with few death cases.Partial patients would present with a risk of recurrent or persistent dyspnea, and some critically ill children shall receive the airway stent implantation or surgical intervention.

Foreign body aspiration in children

Background: Foreign Body (FB) aspiration is a life-threatening problem in children. Here the demographic pattern, clinical presentation, type of Foreign Body (FB) and outcome of FB aspiration was examined.Methods: An observational case series study done in Institute of child health and research centre, Government Rajaji hospital, Madurai during November 2015 to June 2018. After a detailed history and clinical examination, children with definite evidence of FB in tracheobronchial tree were subjected to rigid bronchoscopy and with doubtful evidence were subject to FFBS. They were followed up for complications.Results: Of the 136 children, 86.03% (n=117) were under 3 years of age. A positive history of FB aspiration was present only in 51.4% (n=70). Unilateral hyperinflation was seen in 48.53% (n=66) but was normal in 13.97% (n=19). Flexible Fiber Optic Bronchoscopy (FFBS) diagnosed FBs in 61.02% (n=83) which included children with acute onset breathlessness and persistent radiological features. Peanut was the most common FB 64.71% (n=44). FBs were found in the right side in 50% (n=34) and in the left in 38.2% (n=26).' 36% (n=49) developed complications due to the FBs and 2.9% (n=4) due to procedure.Conclusions: FB aspiration is most common in children less than 3 years of age. Positive history of aspiration was seen in only 51.4% and chest X-ray was normal in 13.97%. FFBS diagnosed FB in 61.02%. Peanut was the most common FB. Persistent pneumonitis is the most common complication.

Diagnosis and emergency treatment of bronchial foreign body by fiberoptic bronchoscopy / 中国小儿急救医学

Tracheobronchial foreign body aspirations may cause cardiopulmonary arrest and sudden death.The incidence in children is higher than in adults.Rapid diagnosis and treatment are live saving.In this paper, we aimed to present our experience in tracheal foreign body aspirations by fiberoptic bronchoscopy.

Bronchial Fistula: Rare Complication of Treatment with Anlotinib / 中国肺癌杂志

BACKGROUND@#Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes.@*METHODS@#We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula."@*RESULTS@#Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months.@*CONCLUSIONS@#Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.

Study to Assess Prevalence of Tracheo- Bronchial Foreign Bodies Cases Reported to Tertiary Care Centre

Background: Tracheo-bronchial foreign bodies continue topresent challenges to otolaryngologists. The major issuesinvolve the accurate diagnosis and speedy, safe retrieval of theforeign body. Accidental foreign-body aspiration in therespiratory tract can lead to considerable morbidity andmortality in both adults and children. Hence; under the light ofabove mentioned data, the present study was undertaken forassessing the prevalence of Tracheo- bronchial foreign bodycases.Materials & Methods: Data of a total of 250 patients wasanalysed during the study period. The overall prevalence oftracheobronchial foreign body cases was assessed. Completedemographic details of all the cases were obtained from thedata record files. Patient data, clinical history, radiographic andbronchoscopic findings were also obtained from their recordfiles for defining the epidemiology of the patients. Record ofPreoperative Chest X-ray was also obtained. All the resultswere recorded in Microsoft excel sheet and were analysed bySPSS software.Results: The prevalence of tracheobronchial foreign bodycases was 11.2 percent (28 cases). Needles were found in39.29 percent of the cases, while peanuts were found in28.57 percent of the cases. Plastic objects were found in 21.43percent of the cases. Right bronchial tree was involved in 39.3percent of the cases, while foreign body was found in leftbronchial tree in 28.57 percent of the cases. Tranche wasfound in 21.43 percent of the cases.Conclusion: Because of associated high mortality with foreignbody aspiration, it is required to rapidly recognize from thepatient's history and start the prompt by bronchoscopy andextraction of the aspirated foreign body.

Congenital Esophageal Atresia Associated with a Tracheobronchial Remnant / 대한흉부외과학회지

A rare case of esophageal atresia/tracheo-esophageal fistula (EA-TEF) with an associated tracheobronchial remnant (TBR) is reported and discussed herein. A 13-month-old patient was seen with a complaint of vomiting of solid food 1 year after EA-TEF repair. An esophagogram showed a tapered narrowing in the lower segment of the esophagus. A re-operation was carried out and a pathologic examination of the resected stenotic segment revealed the presence of a TBR.

Clinical characteristics of tracheobronchial foreign body in children:A report of 228 cases / 中国实用儿科杂志

OBJECTIVE: To explore the clinical characteristics,diagnosis and treatment of tracheobronchial foreign body in children and analyze the risk factors for granuloma formation. METHODS: A retrospective analysis of 228 children diagnosed withtracheobronchial foreignbody was carried out,who were treated between January 2011 and December 2017,and the binary Logistic regression on risk factors of secondary airway intimal granulation after tracheobronchial foreign body was done.RESULTS: The high incidence age of tracheobronchial foreign body in children was 1～3 years old(76.3%),and the ratio of male to female was 2.3∶1. The plant foreign bodies were the main proportion(82.9%),and the foreign bodies in left lung(52.6%)was slightly higher than in the right lung(39.5%). Endotracheal granulation(74.4%),pneumonia(76.3%)and emphysema(51.3%)were the most common complications of tracheobronchial foreign body. The type and the remaining time of foreign body were the independent risk factor for the formation of endotracheal granulation(P<0.01). The longer the disease duration,the greater the risk of granulation formation(P<0.01). The ROC curve showed that the remaining time of foreign bodies could be used as a reliable indicator of endotracheal granulation,critical values of the independent correlation factor was the course of disease more than 7.5 d. All the foreign bodies in 228 cases(100%)were successfully removed by fiberoptic bronchoscopy under local anesthesia,226 cases of 1-time take-out(success rate 99.1%),and no obvious complications occurred during and after surgery. CONCLUSION: Children aged from 1 to 3 years old are the high incidence of respiratory foreign body,and plants are more common. Plant foreign body residue is prone to endotracheal granulation,and the longer thecourse,the higher risk the granulation. Avoiding feeding infants nuts,early identification and correct diagnosis,and choosing the suitable operation method is the key to preventing and treating foreign body inhalation.

Application of airway stenting in modern pediatric interventional respiratory diseases / 中国实用儿科杂志

With the popularization and development of lung CT scanning and technology of bronchoscopy in pediatrics,central airway obstruction has been diagnosed more and more.Central airway obstruction can affect airway ventilation and secretion discharge,such children are often hospitalized for repeated pneumonia,and sometimes need mechanical ventilation but may be difficult weaning from it. Malnutrition,hypoxic brain injury and backward growth and development are often associated. In the past,central airway obstruction has been mainly treated by surgery. However,with the development of minimally invasive technology of bronchoscopy in children,airway stent implantation has become an effective and alternative treatment recently. This article reviews the types of pediatric central airway obstruction,indications and contraindication of airway stent implantation,types and selection of stent,and the procedures of stent implantation.

Stents bronquiales bioabsorbibles y factores que afectan su velocidad de degradación / Bioresorbable bronchial stents and factors that affect the rate of degradation

Resumen Las causas que pueden conducir a la obstrucción de la vía aérea central pueden ser de origen funcional, por obstrucción de la luz, por lesión orgánica parietal o compresión extrínseca; a su vez, también pueden agruparse en obstrucciones malignas y no malignas. Cuando una obstrucción reduce el 50 % de la luz de la vía aérea causa síntomas debilitantes y es una de las indicaciones para implantar un stent bronquial. Los stents bronquiales actualmente disponibles son una solución incompleta para las obstrucciones de las vías aéreas. Por otra parte, un stent bronquial ideal debe cumplir con muchas características, tales como ser biocompatible, en muchos casos bioabsorbible, radio opaco, que no genere reacción inflamatoria, tener características similares a las de la vía aérea para disminuir la acumulación de secreciones, entre otras. Por esta razón los stents bronquiales bioabsorbibles se presentan como una alternativa atractiva que ofrece ciertas ventajas, aunque aún se encuentran en desarrollo. El presente artículo busca describir los avances alrededor de los stents bronquiales bioabsorbibles y los factores que afectan la degradación de los polímeros con los cuales se han fabricado.

Abstract The causes that can lead to obstruction of the central airway can be of functional origin, due to obstruction of the light, organic parietal lesion or extrinsic compression; in turn, they can also be grouped into malignant and non-malignant obstructions. When an obstruction reduces more than 50% of the lumen of the airway causes debilitating symptoms and is an indication to implant a bronchial stent. The bronchial stents currently available are an incomplete solution for obstructions of the airways. On the other hand, an ideal bronchial stent must comply with many characteristics, such as being biocompatible, in many cases bioabsorbable, radio opaque, that does not generate an inflammatory reaction, having characteristics similar to those of the airway to decrease the accumulation of secretions, between others. For this reason, bioabsorbable bronchial stents are presented as an attractive alternative that offers certain advantages, although they are still in development. This article seeks to describe the advances around the bioabsorbable bronchial stents and the factors that affect the degradation of the polymers with which they have been manufactured.

Carcinoma adenoideo quístico pulmonar primario con metástasis precoces exclusivas hepáticas, un caso inusual / Primary adenoid cystic carcinoma of bronchus with early liver metastases, an unusual case

RESUMEN El carcinoma adenoideo quístico (CAQ) es una patología propia de las glándulas salivales, casos excepcionales se han descrito como primarios en otras partes de la economía. Este es un caso de CAQ primario pulmonar (CAQPP), con respuesta parcial a radioterapia, además, presenta metástasis hepáticas, sin evidenciarse lesiones de metástasis en otras partes del organismo. Tales características hacen que debamos prestar atención a las formas atípicas de CAQ sobre todo al CAQPP y a su comportamiento poco predecible.

ABSTRACT Adenoid cystic carcinoma (ACC) is a pathology of the salivary glands, exceptional cases have been described as primary of the bronchus. This is a case of primary adenoid cystic carcinoma of the tracheobronchial tree (PACCTBT), with partial response to radiation therapy, in addition, presents liver metastases, without evidence of metastasis injuries in other parts of the body. Such characteristics mean that we should pay attention to the atypical forms of ACC, especially PACCTBT and its unpredictable behavior.

Avulsión de bronquio fuente derecho debido a traumatismo torácico cerrado / Right main bronchus avulsion due to thoracic blunt trauma

La incidencia de roturas traqueobronquiales secundarias a un traumatismo torácico cerrado es baja, y la mayoría de estos pacientes no llegan con vida a los centros de atención hospitalaria. La presentación clínica es variable dependiendo de la localización de las lesiones, los daños asociados y si las estructuras peribronquiales permanecen íntegras. Para su diagnóstico temprano se debe tener un alto índice de sospecha clínica y una correcta interpretación de los hallazgos semiológicos y radiológicos, lo que permite su rápida y correcta resolución. La demora en el tratamiento aumenta tanto la mortalidad como las complicaciones tempranas y tardías.

The incidence of tracheobronchial ruptures secondary to blunt thoracic trauma is low and most affected patients do not arrive alive to hospitals. Clinical presentation varies with the location of lesions, associated injuries and whether the peribronchial structures remain intact. Early diagnosis requires a high index of clinical suspicion and a correct interpretation of semiologic and radiologic findings, which allows for a rapid and correct resolution. Delay in treatment increases the mortality as well as early and late complications.

Congenital Esophageal Stenosis in Children: From Etiology to Prognosis

Congenital esophageal stenosis (CES) is a rare disease that has been reported to occur once in every 25,000 to 50,000 births. According to its etiology, CES is divided into 3 subtypes, tracheobronchial remnants (TBR), fibromuscular hypertrophy (FMH) and membranous diaphragm (MD). Symptoms begin at the weaning period and the introduction of solid food around 6 months with dysphagia and vomiting. Esophagography is first screening test and endoscopic ultrasonography plays important roles to diagnose subtypes deciding therapeutic plan. TBRs were generally treated with surgical resection and end-to-end anasotomosis, whereas FMH and MD had good response rate to endoscopic or radiologic guided dilatation. This article reviews the literature on the etiology, clinical course, diagnosis and management of CES including recent opinion.

Efficacy of interventional bronchoscopy in treatment of 76 patients with tracheobronchial tuberculosis / 实用医学杂志

Objective This study investigated the use of interventional bronchoscopic techniques in management of patients with tracheobronchial tuberculosis.Methods In this retrospective study,we analyzed the clinical data of 76 patients with endobronchial tuberculosis.All patients underwent bronchoscopy examination and diagnosed by pathology.According to different treatments,the patients were divided into two groups,the observation group (56 cases) adopted by bronchoscopy and chemotherapy and the control group (20 cases) adopted by chemotherapy only.The general features,treatment effectiveness in the two groups were compared and analyzed.Results Compared with the control group,the sputum negative rate,the recovery rate of symptom,and the total effective rate were higher (P ＜ 0.05).No severe side effects were found in the two groups.There was a positive relationship among frequency of bronchoscopy,the area of lesion (r =0.296,P =0.025 ＜ 0.05) and the type of histology (r =0.323,P =0.014 ＜ 0.05).Conclusions It is concluded that interventional bronchoseopic techniques are useful in management of patients with endobronchial tuberculosis.

Rol de la endoscopía en la lesión traumática de la vía aérea / Role of endoscopy in traumatic airway injury

Las lesiones del árbol traqueobronquial (aTB) es un evento no frecuente, pero con un alto riesgo de vida. La causa puede ser iatrogénica, secundaria a procedimientos médico y traumática por trauma cerrado o penetrante. Su incidencia no se conoce exactamente. La dificultad para establecer la incidencia de la lesión traumática se debe a que un 30 a 80% de las víctimas de trauma fallecen en el lugar del accidente por las lesiones asociadas. El pronóstico de los pacientes que logran llegar al hospital va a depender esencialmente de las características de la lesión en la vía aérea (VA) y las lesiones asociadas.

Injuries to the tracheobronchial tree (aTB) is an uncommon event, but with a high risk of life. The cause can be iatrogenic, secondary to medical and traumatic procedures by closed or penetrating trauma. Its incidence is not exactly known. The difficulty in establishing the incidence of the traumatic injury is due to the fact that 30 to 80% of trauma victims die at the scene of the accident due to the associated injuries. The prognosis of patients who reach the hospital will depend essentially on the characteristics of the airway (VA) lesion and associated lesions.