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Lung Cancer (a) Diagnosis and Causes, Smoking Habits, etc.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Endo-bronchial splinting - silicone rubber stents have been used to relieve extrinsic pressure from nodes, etc. This has been particularly valuable during radiotherapy for lesions compressing the carina, when post-irradiation oedema may make the obstruction worse. Splints have also been useful with endotracheal and endo-bronchial masses in the main bronchi, and in avoiding postoperative tracheal obstruction after the removal of large intra-thoracic goitres or nodal masses in lymphoma. Such splints may be double-ended or Y shaped for carinal lesions. Examples of such splinting are shown in Illus. TRACH/BRON STENT.
Mediastinal masses
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Brent R. Weil, Robert C. Shamberger
Mass lesions of the mediastinum have multiple origins and may appear at any age throughout infancy, childhood, and adolescence. The mass may be cystic or solid, and of either congenital or neoplastic origin. The symptoms produced by a mediastinal mass are almost as diverse as the underlying pathology of these lesions, but most symptoms are due to the “mass effect” of the lesion which may compress the airway, vasculature, esophagus, or lung. Occasionally, they present with pain resulting from inflammation produced by infection or perforation of a cyst. Invasion of the chest wall by a malignant tumor will also produce pain. Many mediastinal lesions, in fact, are found as a radiographic abnormality on a study obtained for symptoms unrelated to the mass. Respiratory symptoms of expiratory stridor, cough, dyspnea, or tachypnea require urgent investigation. Cystic or solid lesions located at the carina may produce major airway obstruction. Lesions at this site are often “hidden” in the normal mediastinal shadow and may not be apparent on the anterior–posterior or lateral chest radiographs. Orthopnea and venous engorgement from superior vena caval syndrome occur with extensive involvement of the anterior mediastinum and are harbingers for respiratory obstruction upon induction of a general anesthetic. Less frequently, dysphagia from pressure on the esophagus is the presenting symptom. Neurologic symptoms from spinal cord compression or Horner's syndrome may occur with neurogenic tumors arising in the posterior mediastinum.
The patient with acute respiratory problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The respiratory tract is described as a tree with different generations of branches (see Figure 5.3). The trachea is the trunk, referred to as generation zero. At the carina, the trachea divides into the right and left major bronchi, referred to as first generation branches. These, in turn, branch again, with each successive branch becoming smaller. The walls of the respiratory tree are made of cartilage to prevent collapse, smooth involuntary muscle and an inner lining of mucous membrane. At generation 16, the bronchi become terminal bronchioles and the cartilage disappears. From generation 16 onwards, the diameter of airways is approximately 1 millimetre. The walls of these bronchioles are made of simple ciliated epithelial cells, secretory Clara cells and smooth muscle. Because there are many of these bronchioles, the total resistance to flow is low, but because they are so small in diameter, the lumen can become further narrowed and obstructed by secretions and inflammation. Generations 20 and onwards of the respiratory tree are the even smaller respiratory bronchioles, which finally merge with the alveolar ducts and alveolar sacs. The respiratory bronchioles, together with the alveolar ducts and sacs, are the site for gaseous exchange.
Successful treatment of a level IIIA tracheal rupture following endoscopic balloon dilation
Published in Acta Oto-Laryngologica Case Reports, 2023
Fredrik J. Landström, Eleftherios Ntouniadakis
Fifteen years later, she presented with increased dyspnea on exertion. Spirometry showed mild to moderate upper airway obstruction. Laryngoscopy revealed a relatively good vocal fold movement and the patient was opted for an endoscopic balloon dilation of the tracheal stenosis. Under suspension laryngoscopy in general anesthesia, using Superimposed High-Frequency Jet Ventilation (Twinstream™) (Carl Reiner GmbH, Vienna, Austria) a 10-cm long Rigiflex II esophageal dilation balloon (Boston Scientific, Marlborough, MA, USA) with a 3 cm diameter, in absence of continuous radial expansion balloons, was advanced into the stenotic part of the trachea and inflated to 1 atm pressure. Inspection revealed a total rupture of the posterior tracheal wall from the cricoid to the carina (Figure 1). Esophagoscopy showed no penetrating injury and a CT scan showed no signs of pneumo-mediastinum (Figure 2). The laceration was classified as level IIIA (Table 1). A cardiothoracic surgeon was consulted and after examining different treatment options including surgical repair and endotracheal stenting, a conservative treatment strategy was decided on.
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis
Published in Expert Review of Respiratory Medicine, 2023
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
We also explored the operation method, stenosis location, anesthesia type, and etiology on the incidence of hemorrhage. As shown in Table S1, the hemorrhage rate of every type of operation method varied in both the first treatment group (p = 0.048) and the retreatment group (p < 0.01), and electric snare ligating had the highest incidence of hemorrhage in the first treatment group, whereas balloon dilatation had the highest incidence of hemorrhage in the retreatment group. As shown in Table S2, the hemorrhage incidences of different stenosis locations were not similar. In the first treatment group, the carina had the highest incidence of hemorrhage. In the retreatment group, the bronchus intermedius had the highest incidence of hemorrhage. As shown in Table S3, anesthesia type also influenced the incidence of hemorrhage. The results showed that general anesthesia was related to a lower rate of bleeding than local anesthesia, although the severe bleeding rates were similar. As shown in Table S4, bronchial tuberculosis and tumors comprised most of the causes of CAO, and their incidence of hemorrhage was also significantly higher than that of other causes.
Bone versus soft-tissue setup in proton therapy for patients with oesophageal cancer
Published in Acta Oncologica, 2022
Muhammad Shamshad, Ditte Sloth Møller, Hanna Rahbek Mortensen, Mai Lykkegaard Ehmsen, Maria Fuglsang Jensen, Lone Hoffmann
Fiducial markers have been investigated as a surrogate for the tumour position to be used for the setup verification [17,32–34]. However, tissue deformation makes the marker-based registration unfeasible in some patients [17,27]. Other setup strategies have formerly been analysed for oesophageal cancer. Carina-based registration resulted in inadequate target coverage compared with a bony anatomy-based registration for targets not confined to the mid-thoracic region nearby the carina [35]. For lung and liver, tumour movement relative to the spinal cord has been observed and soft tissue matching improved the setup accuracy [36,37]. Similarly, for prostate cancer patients, higher target coverage and lower dose to the rectum was found for soft-tissue matching compared to bone match [38,39].