scholarly journals Optimization of anesthetic tactics in the surgical treatment of multiple primary non-small cell lung cancer

2021 ◽  
Vol 2 (2) ◽  
pp. 42-49
Author(s):  
S. N. Tikhonova ◽  
D. A. Rozenko ◽  
N. D. Ushakova ◽  
N. N. Popova ◽  
A. M. Skopintsev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Gas Exchange ◽  
Main Bronchus ◽  
Pulmonary Ventilation ◽  
Left Lung ◽  
Functional Correction ◽  
Multiple Primary ◽  
Lobar Bronchus ◽  
Life Threatening ◽  
The Right

The article describes a clinical case of surgical treatment of a patient with multiple primary malignant lesions of the lungs (cancer of the left lung, central peribronchial nodular tumor with involvement of the upper lobe and distal parts of the main bronchus; cancer of the right lung, central tumor with involvement of the upper lobar bronchus). Radical treatment became possible due to using the potential of artifi cial gas exchange of both lungs with two devices with fundamentally different ventilation mechanics. The choice of an optimal tactics for the functional correction of the supposed hypoxemia by volumetric and high-frequency pulmonary ventilation allowed avoiding an imbalance in the ventilation/perfusion ratio and preventing the development of life-threatening complications, as well as ensured an adequate gas exchange for the patient during surgical treatment.

scholarly journals Broken metallic tracheostomy tube migrating into the tracheobronchial tree

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Nilam U. Sathe ◽  
Ratna Priya ◽  
Sheetal Shelke ◽  
Kartik Krishnan
Keyword(s):  
Foreign Body ◽  
Tracheostomy Tube ◽  
Main Bronchus ◽  
Tracheobronchial Tree ◽  
Life Saving ◽  
Wear And Tear ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Periodic Replacement

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening.

scholarly journals THE CASE OF COMBINATION OF MULTIPLE ENDOCRINE NEOPLASIA SYNDROME (MEN SYNDROME) AND ASPERGILOMA (CLINICAL OBSERVATION)

2021 ◽  
Vol 29 (2) ◽  
pp. 63-68
Author(s):  
N. S. Opanasenko ◽  
◽  
M. I. Kalenichenko ◽  
�. V. Tereshkovich ◽  
B. M. Konik ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Multiple Endocrine Neoplasia ◽  
Elective Surgery ◽  
Left Lung ◽  
Anterior Mediastinum ◽  
Electrolyte Balance ◽  
Endocrine Neoplasia ◽  
Secondary Hypothyroidism ◽  
Multiple Endocrine Neoplasia Syndrome ◽  
The Right

The clinical case of staged surgical treatment of multiple endocrine neoplasia and aspergilloma syndrome in a 21-year-old patient is presented. The patient was admitted to NIFP with the diagnosis: adrenocorticotropic hormone-producing tumor of the anterior mediastinum; diabetes mellitus, insulin dependent; secondary hypothyroidism; shingles; cavitary lesion of the upper lobe of the left lung, the lesion of the upper lobe of the right lung; hirsutism, edema syndrome. At the first stage, the patient underwent a sternotomy with removal of the tumor of the anterior mediastinum with adipose tissue and mediastinal lymph dissection, removal of the tumor of S3 of the right lung. At discharge, the patient was recommended to returm to NIFP in 2 months for elective surgery for aspergilloma of the upper left lung. But one month after discharge, the patient developed hemoptysis. She underwent a video-assisted typical resection of S1-S2 of the left lung. Removal of hormone-producing tumors allowed to normalize glycemia, discontinue insulin, normalize thyroid function and lead to regression of hirsutism and osteoporosis, restored muscle strength and normalized water-electrolyte balance. Key words: multiple endocrine neoplasia syndrome, aspergilloma, surgical treatment.

scholarly journals Fatal congenital lobar emphysema in a puerpera: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanyi Gan ◽  
Liang Xia ◽  
Yushang Yang ◽  
Qiang Pu ◽  
Lunxu Liu
Keyword(s):  
Left Lung ◽  
Middle Lobe ◽  
Left Hemithorax ◽  
Recurrent Pneumonia ◽  
Mediastinal Shift ◽  
Life Threatening ◽  
Right Middle Lobe ◽  
Lobar Emphysema ◽  
The Right

Abstract Background Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are usually asymptomatic and only a small fraction may present with coughing, recurrent pneumonia and respiratory distress. In imaging studies, the most frequently affected lobe of CLE is the left upper lobe, followed by the right middle lobe. However, multilobar involvement with severe mediastinal shift is extremely rare. Case presentation We report a case of fatal CLE in a 28-year-old puerpera with postpartum respiratory failure. Chest computed tomography (CT) revealed emphysema of the right upper, middle and lower lobes resulting in adjacent atelectasis. Hyperinflation of the right upper lobe crossed the midline, leading to a deviation of the mediastinal structure to the left hemithorax and severe compression of the left lung. Conclusions Early and timely diagnosis of CLE with routine follow-up is necessary for patients. CLE, especially with multilobar involvement or mediastinal shift, could be life-threatening and should be promptly and aggressively treated to prevent severe complications.

scholarly journals Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

2019 ◽  
Vol 47 (6) ◽  
pp. 2740-2745
Author(s):  
Seung Youp Baek ◽  
Jin Hwan Kim ◽  
Goo Kim ◽  
Jin Ho Choi ◽  
Chang Young Jeong ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Left Lung ◽  
Lung Ventilation ◽  
Surgical Excision ◽  
One Lung Ventilation ◽  
Lower Lung ◽  
Endobronchial Blocker ◽  
Surgical Field ◽  
The Right

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

scholarly journals Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Qingtao Gu ◽  
Shouliang Qi ◽  
Yong Yue ◽  
Jing Shen ◽  
Baihua Zhang ◽  
...  
Keyword(s):  
Flow Rate ◽  
Main Bronchus ◽  
Tracheobronchial Tree ◽  
Sectional Area ◽  
Pulmonary Lobectomy ◽  
Airflow Velocity ◽  
Cross Sectional ◽  
Lobar Bronchus ◽  
Cfd Method ◽  
The Right

Abstract Background Pulmonary lobectomy has been a well-established curative treatment method for localized lung cancer. After left upper pulmonary lobectomy, the upward displacement of remaining lower lobe causes the distortion or kink of bronchus, which is associated with intractable cough and breathless. However, the quantitative study on structural and functional alterations of the tracheobronchial tree after lobectomy has not been reported. We sought to investigate these alterations using CT imaging analysis and computational fluid dynamics (CFD) method. Methods Both preoperative and postoperative CT images of 18 patients who underwent left upper pulmonary lobectomy are collected. After the tracheobronchial tree models are extracted, the angles between trachea and bronchi, the surface area and volume of the tree, and the cross-sectional area of left lower lobar bronchus are investigated. CFD method is further used to describe the airflow characteristics by the wall pressure, airflow velocity, lobar flow rate, etc. Results It is found that the angle between the trachea and the right main bronchus increases after operation, but the angle with the left main bronchus decreases. No significant alteration is observed for the surface area or volume of the tree between pre-operation and post-operation. After left upper pulmonary lobectomy, the cross-sectional area of left lower lobar bronchus is reduced for most of the patients (15/18) by 15–75%, especially for 4 patients by more than 50%. The wall pressure, airflow velocity and pressure drop significantly increase after the operation. The flow rate to the right lung increases significantly by 2–30% (but there is no significant difference between each lobe), and the flow rate to the left lung drops accordingly. Many vortices are found in various places with severe distortions. Conclusions The favorable and unfavorable adaptive alterations of tracheobronchial tree will occur after left upper pulmonary lobectomy, and these alterations can be clarified through CT imaging and CFD analysis. The severe distortions at left lower lobar bronchus might exacerbate postoperative shortness of breath.

Aerosol deposition in the lung with asymmetric airways obstruction: in vivo observation

1989 ◽  
Vol 67 (6) ◽  
pp. 2579-2585 ◽  
Author(s):  
C. S. Kim ◽  
M. A. Eldridge ◽  
L. Garcia ◽  
A. Wanner
Keyword(s):  
Main Bronchus ◽  
Left Lung ◽  
Aerosol Deposition ◽  
Base Line ◽  
Deposition Pattern ◽  
Before And After ◽  
Airway Obstructions ◽  
L 51 ◽  
The Right

Both the total and regional aerosol deposition were measured in six adult sheep before and after an induction of asymmetric airway obstructions, either by local instillation of carbachol solution (CS, 0.1%) distal to the right main bronchus or inhalation challenge of the right lung with carbachol aerosol (CA, 10 breaths). Total lung deposition was determined by monitoring inert monodisperse aerosols [1.0 micron mass median aerodynamic diam (MMAD)] breath-by-breath, at the mouth, by means of a laser aerosol photometer. Cumulative aerosol deposition over the first five breaths as a percent of the initial aerosol concentration (AD5) was used as a deposition index. Regional deposition pattern was determined by scintigraphic images of sulfur-colloid aerosol (1.5 microns MMAD) tagged with 99mTc. Radioactivity counts in the right (R) and left lung (L) were expressed as a percent of the whole lung count. Half-lung AD5 was then determined by multiplying AD5 by fractional radioaerosol depositions in R or L. Pulmonary airflow resistance (RL mean +/- SE), as determined by an esophageal balloon technique, increased by 111 +/- 28 and 250 +/- 96% after CA and CS, respectively (P less than 0.05). AD5 also increased in all the sheep tested by 29 +/- 3 and 52 +/- 8%, respectively, after CA and CS (P less than 0.05). Radioaerosol deposition pattern was even at base line (R/L = 51:49) but shifted toward the unchallenged L after CS (R/L = 40:60). Deposition pattern after CA was variable: a shift toward L in three, no change in one, and a shift toward the R lung in two sheep.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe stenosis of a long tracheal segment, with agenesis of the right lung and left pulmonary arterial sling

2006 ◽  
Vol 16 (1) ◽  
pp. 89-91 ◽  
Author(s):  
Hamish M. Munro ◽  
Andrea M. C. Sorbello ◽  
David G. Nykanen
Keyword(s):  
Pulmonary Artery ◽  
Surgical Repair ◽  
Main Bronchus ◽  
Left Lung ◽  
Proximal Part ◽  
Pulmonary Vasculature ◽  
Severe Stenosis ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
The Right

A baby presented at term with respiratory distress was managed with extracorporeal membrane oxygenation. Bronchoscopy revealed tracheal hypoplasia, complete tracheal rings, and agenesis of the right main bronchus. Echocardiography showed a left pulmonary arterial sling arising from the proximal part of the right pulmonary artery. Cardiac catheterization demonstrated abnormal pulmonary vasculature in the left lung which would have prevented survival, even after surgical repair. Diagnostic catheterization was important in delineating the anatomy, and aided in the decision not to proceed with surgical repair.

scholarly journals Life-threatening hemoptysis accompanied by internal thoracic artery aneurysms in a 28-year-old perinatal woman: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yujun Li ◽  
Yuyao Wang ◽  
Zhike Liang ◽  
Chuzhi Pan ◽  
Xiaomei Huang ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Bronchial Artery ◽  
Main Bronchus ◽  
Treatment Options ◽  
Perinatal Period ◽  
Bronchial Arteries ◽  
Superior Mediastinum ◽  
Active Hemorrhage ◽  
Life Threatening ◽  
The Right

Abstract Background Life-threatening hemoptysis presents an immediate diagnostic and therapeutic challenge, especially during the perinatal period. Case presentation A 28-year-old perinatal woman with no significant past medical or surgical history presented with repeating hemoptysis and respiratory failure. Computed tomography revealed a 2.1 × 3.2  cm2 inhomogeneous tumorous lesion in the right superior mediastinum and a right main bronchus obstruction along with atelectasis of the right lung. Bronchoscopy showed a tumorous protrusion blocking the right main bronchus with active hemorrhage, and malignancy was suspected. Bronchial artery embolization (BAE) was performed to control the bleeding. The arteriogram revealed tortuosity, dilation and hypertrophy of the right bronchial arteries and aneurysms of the internal thoracic artery (ITA). The bleeding completely stopped after BAE. Bronchoscopy was performed again to remove residual blood clots. The patient recovered soon after the procedure and was discharged. Conclusions Life-threatening hemoptysis concomitant with ITA aneurysms, which may have a misleading clinical diagnosis and treatment options, has not been reported previously in perinatal women. BAE could be used as a first-line treatment irrespective of the underlying causes.

scholarly journals Morphological study of larynx, trachea, and lungs of Didelphis marsupialis (LINNAEUS, 1758)

2020 ◽  
Vol 13 (10) ◽  
pp. 2142-2149
Author(s):  
Bruna Tassia Santos Pantoja ◽  
Armando Reinaldo Marques Silva ◽  
Renata Mondego-Oliveira ◽  
Thamires Santos Silva ◽  
Babara Carvalho Marques ◽  
...  
Keyword(s):  
Hyaline Cartilage ◽  
Main Bronchus ◽  
Thyroid Cartilage ◽  
Left Lung ◽  
Phylogenetic Study ◽  
Thoracic Cavity ◽  
Formaldehyde Solution ◽  
Running Water ◽  
Morphological Studies ◽  
The Right

Background and Aim: From a biomedical point of view, the value of marsupials as a model of primitive mammals is indisputable. Among its species, the possum is a model that allows the study of the ontogeny of different organic systems, as well as their physiological aspects. The relevance of anatomical, functional, evolutionary, and phylogenetic study of marsupials for the development of comparative morphology is extensively documented in the literature. However, there are still many aspects to be further evaluated, as the anatomy and histology of the respiratory tract of this species. The aim of this study was to describe the morphology of the larynx, trachea, and lungs of Didelphis marsupialis. Materials and Methods: Five adult male animals were donated to the Comparative Animal Anatomy Laboratory – LAAC/ CCAA-UFMA, for morphological studies. Specimens were washed in running water to perform biometrics. Then, they were fixed with 10% formaldehyde solution. After the fixation period, the specimens were positioned in dorsal decubitus position, for dissection of the respiratory system organs, by opening the ventral region of the neck and thoracic cavity, with subsequent removal of the pectoral muscles, ribs, and sternum. For histological analysis, fragments of 1 cm2 of the larynx (epiglottis and thyroid cartilages), trachea, and lungs were collected and fixed in 10% formaldehyde solution. Right after fixation, the fragments were dehydrated in increasing concentrations of ethyl alcohol (70, 80, 95, and 100%), diaphanized in xylene, embedded in paraffin, and sectioned into thin slices of 5 μm using a microtome. Sections were stained using the hematoxylin and eosin technique. Results: Anatomically, the larynx starts right after the pharynx. It consisted of four cartilages: Epiglottis, cricoid, thyroid, and arytenoid. The trachea was made of dorsally incomplete cartilaginous rings. At the entrance of the thoracic cavity, it bifurcated into the left and right main bronchus. The left lung was smaller than the right lung, with two lobes (cranial and caudal). The right lung presents the cranial, middle, caudal, and accessory lobes. Histologically, the epiglottis consisted of elastic cartilage and is covered by a non-keratinized stratified squamous epithelium. Thyroid cartilage is made of hyaline cartilage covered by smooth muscle. The trachea presents hyaline cartilage, with ciliated pseudo-stratified epithelium, serous glands, isogenic groups of chondrocytes, and perichondrium. The lung consisted of bronchi, bronchioles, and alveoli, also presenting blood vessels and arteries. Conclusion: Morphologically, the larynx, trachea, and lungs of D. marsupialis were similar to those of the other Didelphids described in the literature.

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