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Gastrobronchial Fistula and Central Diaphragmatic Hernia after Sleeve Gastrectomy
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
In the operating room, the patient underwent a bronchoscopy, which showed abundant bilious secretions in the left main stem bronchus. After clearing the secretions, the fistula was visualized in medial basal segmental bronchus along with suture material. A standard posterolateral thoracotomy was then performed through the seventh intercostal space. After extensive adhesiolysis, a diaphragmatic hernia through the tendinous portion of the left hemidiaphram was identified and was adherent to the LLL. A fistula tract from the herniated stomach to the LLL could be palpated and was transected to allow mobilization of the lung. On closer examination, the superior segment of the LLL was noted to be normal while the basilar segments were consolidated. We decided to perform a basilar segmentectomy instead of a lobectomy. The anterior aspect of the interlobar fissure was dissected until the basal segmental pulmonary vessels were identified, which were then ligated and divided. This allowed the LLL bronchus to be exposed, and the fistula tract could be seen communicating with a large medial basilar bronchus through the lung parenchyma. This segmental bronchus was divided with a stapler, and the other segmental bronchi were divided en-bloc with the lung parenchyma using medium thickness stapler. The posterior aspect of the fissure was left intact to prevent torsion of the superior segment. There was no air leak from the staple line, and the superior segment inflated well.
Anatomy of the Larynx and Tracheobronchial Tree
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The right upper lobe bronchus is approximately 1 cm long and divides into an apical, posterior and anterior segmental bronchi, which supply the right upper lobe. A variation of this anatomy exists where the apical segmental bronchus originates from the trachea at the level of the carina.
Respiratory system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Bronchopulmonary segments = pyramidal structures within lung lobes separated by connective tissue septum/partition (SS by own a. + drained by own veins + same segmental bronchus → can be resected surgically if disease occurs in a segment)
Comparison between montelukast and tiotropium as add-on therapy to inhaled corticosteroids plus a long-acting β2-agonist in for patients with asthma
Published in Journal of Asthma, 2019
Makoto Hoshino, Kenta Akitsu, Junichi Ohtawa
There were some limitations in the present study. First, this study did not include a placebo arm. A study with a placebo arm is desirable in any clinical trial. Instead of a placebo, ICS/LABA maintenance therapy was used as a positive control to compare the two other regimens. Other long-term studies of asthma therapy have included a placebo group that enrolled patients with mild asthma [49]. It is also important to determine the therapeutic effectiveness of treatment options in real-life populations, settings, and durations in order to complement the clinical data. Second, we evaluated only a small number of patients, which could potentially affect the accuracy of the outcomes. To confirm the present findings, further studies with larger sample sizes should be performed. Third, only one segmental bronchus was assessed. The airway geometry of patients with asthma has been found to be narrowed heterogeneously [50]. Nevertheless, recent studies suggest that the dimensions of RB1 are closely related to dimensions of other bronchi [15,51,52]. Therefore, RB1 dimensions serve as a good surrogate for airway wall remodeling in asthma.
The elevated CXCL5 levels in circulation are associated with lung function decline in COPD patients and cigarette smoking-induced mouse model of COPD
Published in Annals of Medicine, 2019
Jun Chen, Luqi Dai, Tao Wang, Junyun He, Yashu Wang, Fuqiang Wen
All subjects received a standard lung function test according to the European Respiratory Society guidelines [31]. Patients showed a ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) below 70% after brochodilation and an increase in FEV1 below 12% after inhalation of 200 μg salbutamol were diagnosed as COPD. Plasma samples were obtained from 24 healthy volunteers and 63 COPD patients the morning after enrollment following standard protocol. Briefly, venous blood was collected from the median cubital vein and plasma was separated and stored immediately at –80 °C for further measurements. BALF samples were obtained from 24 healthy volunteers (with 17 overlaps receiving plasma test) and 28 COPD patients following standard protocol. Briefly, a bronchofiberoscope was wedged in the segmental bronchus of the right middle lobe, and four portions of sterile 0.9% saline solution were instilled. Aliquots of BALF samples were collected and stored at –80 °C for further measurements.
Impulse oscillometry and nitrogen washout test in the assessment of small airway dysfunction in asthma: Correlation with quantitative computed tomography
Published in Journal of Asthma, 2019
Leonello Fuso, Giuseppe Macis, Carola Condoluci, Martina Sbarra, Chiara Contu, Emanuele G. Conte, Giulia Angeletti, Paolo Montuschi
A semi-automated software, GE Advantage Window Thoracic VCAR, was used to analyze all CT scans for quantitative airway morphometry and lung densitometry to detect the remodeling and air trapping. A range from -756 HU to -950 HU was used to study lung densitometry. This range allowed to exclude the influence of the emphysematous portion which can overestimate the extent of air trapping. Air trapping was defined as a percentage of lung voxels less than -756 HU on expiratory CT (19). The parameters considered expression of airway remodeling were: bronchial lumen area (LA), bronchial wall area (WA) and bronchial wall area as percentage of the total bronchial area (WA%). They were calculated on inspiratory scans, in six different segmental bronchi in both right and left lung. The values obtained in the posterior-basal left lower lobe segmental bronchus (LB10) were chosen as representative.