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Background: The position of the catheter tip of totally implantable venous access devices (TIVAD) is a risk factor for postoperative complications. The study aim was to assess the early and late complications (EC and LC) associated with the position of the catheter tip in cancer patients. Methods: We reviewed cancer patients who had a TIVAD placed in 2020. EC (≤ 90 days), LC (> 90 days) and risk factors for TIVAD-associated complications were assessed. The vertical mismatch of the catheter tip was compared to an “ideal position” (> 10 mm below the carina and ≥ 20 mm below the right main bronchus (RMB)) using chest x-ray, post-implantation. Results: 301 patients were included. Median follow-up after TIVAD implantation was 9.4 months. All TIVAD catheters were inserted via the internal jugular vein (IJV). The mean distance between the catheter tip and the carina and the RMB was 21.3 mm and 6.63 mm respectively. In total, 11.3% patients developed EC and 5.6% had LC. An association was found between the position of the catheter tip from the carina (≤ 10 mm vs. > 10 mm) and the occurrence of EC (18.3% vs. 8.6%, p = 0.01) and for the catheter insertion side (left IJV vs. right IJV) (19.1% vs. 9.0% p = 0.02). Multivariate analysis showed that left IJV catheter insertion (OR 2.76), and a catheter tip located ≤ 10 mm below the carina (OR 2.71) are significant independent risk factors of EC. Conclusions: TIVAD catheter tip located at ≤ 10 mm below the carina, and a left-side inserted catheter, are higher risk of EC. [ABSTRACT FROM AUTHOR]

Background: Lung cancer, often diagnosed late, is a leading cause of death worldwide. Bronchoscopic biopsies are crucial for early detection, especially in smokers. In Pakistan, where smoking is prevalent, understanding lung cancer patterns is essential. This study examines the types and locations of lung cancers diagnosed via bronchoscopic biopsies in a tertiary care hospital, providing insights for better diagnosis and treatment. Objectives: To determine the prevalence of different types of lung malignancies by using bronchoscopic guided endobronchial biopsies. Methodology: It was a retrospective cross-sectional study conducted in in-patient of Department of Pulmonology, department Nishtar Medical University Multan study of 43 patients enrolled between June 2022 to Oct 2023 by using consecutive non probability sampling method. All were smokers more than 20 pack year. Data analysis was done by using SPSS 23 version. Results: Out of 43 patients 34 (79%) were male and 9 (21%) were female. Bronchoscopic biopsy result showed small cell carcinoma being the most common tumour in our study 15 (34.88%) cases followed by Squamous cell carcinoma 14 (32.55%), Adenocarcinoma 6(13.95%), invasive carcinoma with hepatoid features 1 (2.32%), carcinoid tumour 1(2.32%), organizing Pneumonia 1(2.32%) and in biopsy was inconclusive in 5 (11.62%) cases. Tumour involvement by the location was also assessed in the present study. Most common site of origin was found to be Left main bronchus 11 (25.58%) followed by Right Main bronchus 9 (20.93%), Left upper lobe 9 (20.93%), Right upper lobe 5(11.62%), Left lower lobe 4 (9.30%), Lingular lobe 3 (6.97%), Right lower lobe 2(0.86%). Conclusion: This study revealed that small cell carcinoma is the most prevalent type of lung cancer diagnosed via bronchoscopic biopsies among smokers with over 20 pack-years of smoking history. These findings highlight the critical role of bronchoscopic biopsies in the early detection of lung cancer in high-risk populations, underlining the need for targeted screening and tailored treatment approaches to improve patient outcomes in regions with high smoking prevalence. [ABSTRACT FROM AUTHOR]

Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could not be retrieved. Subsequent chest radiographs showed marked improvement.

Tracheobronchial injuries (TBIs) have a high mortality rate unless aggressive treatment is used. The clinical presentation is variable depending on the presence of associated injuries and on whether the peribronchial tissues remain intact. High index of clinical suspicion and accurate interpretation of radiological findings are necessary to diagnose the injury at presentation and allow prompt surgical intervention with primary repair of the airway. Herein, we describe a case of complete right main bronchus rupture in a 10-year-old boy diagnosed by chest computed tomography. [ABSTRACT FROM AUTHOR]

Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could not be retrieved. Subsequent chest radiographs showed marked improvement. [ABSTRACT FROM AUTHOR]

Background: Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after pneumonectomy. The incidence of BPF reported in the literature varies from 0.3% to 20%., Purpose: To determine the feasibility and efficacy of using Y-shaped, single-plugged, covered, metallic stents to treat right bronchopleural fistulas., Material and Methods: We have designed a Y-shaped, single-plugged, covered, self-expandable, metallic airway stent to fit the specific anatomy of the right main bronchus. The stent has a main tube and two branches, resembling an inverted "Y". One of the branches is closed (plugged) and bullet-shaped; the other one tubular and open. The entire stent is encased in a nitinol wire mesh. Stent size can be individualized using multislice spiral computed tomography (MSCT) measurements of the airways. Under fluoroscopic guidance, we have implanted 15 Y-shaped stents in 15 patients with right bronchopleural fistulas., Results: Stent insertion was successful in all patients. All fistulas were successfully closed immediately after stent placement. Follow-up was performed for 1-34 months. Positive clinical outcomes were seen in 13 of 15 patients. Two patients died of intractable pulmonary infection and multiorgan failure. The fistula completely healed and the stent could be removed in five patients; however, two of them were left with a small, aseptic, residual right lung cavity. The remaining eight patients are still alive with the stent in situ., Conclusion: The placement of Y-shaped, single-plugged, covered, self-expandable metallic airway stents seems to be a feasible and safe method for the treatment of bronchopleural fistulas involving the right main bronchus. This stent is a promising therapeutic alternative for bronchopleural fistulas involving the right main bronchus.