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Study objectives: To improve the current understanding of the etiology and natural history of primary lung cancer, we need to study the dynamic changes of clinical presentation and prognosis among [...]

Photodynamic therapy (PDT), brachytherapy, electrocautery, cryotherapy, and Nd-YAG laser therapy are therapeutic options available for management of endobronchial malignancies. All of these treatment modalities have been used for both palliation [...]

Objectives: To evaluate experience with the flexible bronchoscopic management of tracheobronchial foreign bodies (TFBs) in children (age ≤ 16 years). Design: All pediatric bronchoscopies performed by the bronchoscopy section at [...]

Background: A clinical prediction model to identify malignant nodules based on clinical data and radiological characteristics of lung nodules was derived using logistic regression from a random sample of patients (n=419) and tested on data from a separate group of patients (n=210). Objective: To use multivariate logistic regression to estimate the probability of malignancy in radiologically indeterminate solitary pulmonary nodules (SPNs) in a clinically relevant subset of patients with SPNs that measured between 4 and 30 mm in diameter. Patients and Methods: A retrospective cohort study at a multispecialty group practice included 629 patients (320 men, 309 women) with newly discovered (between January 1, 1984, and May 1, 1986) 4- to 30-mm radiologically indeterminate SPNs on chest radiography. Patients with a diagnosis of cancer within 5 years prior to the discovery of the nodule were excluded. Clinical data included age, sex, cigarette-smoking status, and history of extrathoracic malignant neoplasm, asbestos exposure, and chronic interstitial or obstructive lung disease, chest radiological data included the diameter, location, edge characteristics (eg, lobulation, spiculation, and shagginess), and other characteristics (eg, cavitation) of the SPNs. Predictors were identified in a random sample of two thirds of the patients and tested in the remaining one third. Results: Sixty-five percent of the nodules were benign, 23% were malignant, and 12% were indeterminate. Three clinical characteristics (age, cigarette-smoking status, and history of cancer [diagnosis, [equal to or greater than ] 5 years ago]) and 3 radiological characteristics (diameter, spiculation, and upper lobe location of the SPNs) wire independent predictors of malignancy. The area ([plus or minus] SE) under the evaluated receiver operating characteristic curve was 0.8328 [plus or minus] 0.0226. Conclusion: Three clinical and 3 radiographic characteristics predicted the malignancy in radiologically indeterminate SPNs.

Metastatic spread to subcarinal lymph nodes in patients with bronchogenic carcinoma generally indicates unresectability. Transcarinal needle aspiration of the main carina (TCNA) has been used to obviate the need for more invasive procedures, particularly thoracic surgery. Of 510 transbronchial needle aspirations performed at our institution from 1983 to 1991, 88 (17 percent) were from the main carina in patients with bronchogenic carcinoma. We reviewed these 88 TCNA procedures to assess our experience with TCNA in the staging of lung cancer. The TCNA results were positive in 32 of 88 (36 percent) patients (20 non-small-cell cancers, 12 small-cell lung cancers). Following bronchoscopy, TCNA was the only evidence of unresectability in all 20 patients with non-small-cell lung cancer and was the only mode of diagnosis in 5 of 12 (42 percent) patients with small-cell lung cancer. Thirteen patients with non-small-cell lung cancer and positive TCNA also had positive bronchial secretion cytologic studies. Five of these patients had further subcarinal sampling and in all cases metastatic involvement was confirmed. TCNA was positive in 29 of 67 (43 percent) patients with radiographic evidence of mediastinal adenopathy. Of the remaining 38 patients with radiographic evidence of mediastinal adenopathy and negative TCNA results, 23 patients had further mediastinal sampling with mediastinoscopy or thoracotomy and in all cases mediastinal spread of cancer was established. Nineteen of 58 (33 percent) patients with an endoscopically normal-appearing main carina had a positive TCNA, while 13 of 30 (43 percent) patients with broadening or widening of the main carina had positive TCNA results. There were no complications. We conclude that TCNA is often a safe and useful staging modality in patients with bronchogenic carcinoma., It is well understood that not all patients with bronchogenic carcinoma benefit from surgery. Small-cell carcinoma is generally believed to be a nonsurgical disease.[1] Subcarinal metastases (representing N2 disease) from [...]

Photodynamic therapy has been used since 1980 at our institution for the management of cancer of the tracheobronchial tree. We identified 13 patients (14 cancers) who were thought to be [...]

Tracheobronchopathia osteochondroplastica (TPO) is a condition in which bone or cartilage is produced by the supporting cartilage of the tracheobronchial tree, leading to an unusual rigidity of the respiratory system. Until recently, the diagnosis of this condition has been almost completely based on autopsy findings, but the increasing use of new methods of imaging the body may result in more frequent diagnoses. The factor, or factors, leading to TPO are unknown; many with the condition have no symptoms; and no definitive treatment has been described, although various treatments have been used. Prodded by a recent patient with TPO with severe narrowing of the larynx, the authors examined the patient records of a large institution for other cases. From 1954 to present, a group of 15 TPO patients were collected. The case population consisted of approximately equal numbers of men and women, with an average age of 63.5 years. Symptoms were cough, hemoptysis (bleeding from the respiratory system), difficult breathing upon physical exertion, and wheezing. However, 13 percent of the patients were totally free of symptoms. Although hemoptysis is frequently a symptom leading to diagnosis of TPO, the source of the bleeding cannot be found in the majority of patients and the cause of bleeding usually remains unknown. Reports in the literature indicate that TPO is commonly involved in the lower two-thirds of the trachea and bronchi (lower airway), but in 80 percent of these patients, the disease was more extensive in the trachea than in the bronchi. The increasing use of endoscopy (instruments for examining the walls of cavities) may make the clinical diagnosis of this condition more common. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 60-pack-year smoker presented with cough, dyspnea and orthopnea of three months' duration. Spirometry revealed severe reduction in maximal expiratory flow; CT of the chest and bronchoscopy demonstrated expiratory collapse [...]

Background: Postpneumonectomy syndrome (PPS) is a late complication of pneumonectomy characterized by mediastinal shift and bronchial compression. It is most common following right pneumonectomy but is also seen left pneumonectomy. It can be treated with mediastinal repositioning and tissue expander placement in the postpneumonectomy space, but there is some interest in less invasive modalities. Endobronchial stent placement may be an option. We looked at our experience treating PPS with these two modalities. Methods: All patients with PPS treated with mediastinal repositioning/tissue expander placement or bronchial stenting at our institution from 1991 to 2005 were reviewed. Results: Mean age at the time of pneumonectomy was 45 years. Mean follow-up was 33 months. Six patients underwent tissue expander placement. They had relief of symptoms with the following complications: wound infection, atrial fibrillation, expander leak and esophageal dysmotility. Two patients underwent silastic stent placement with immediate resolution of symptoms, however they suffered from frequent mucous plugging, stent migration, and granulation tissue formation requiring repeat bronchoscopic treatment and stent replacement. Conclusions: Mediastinal repositioning with tissue expander placement provides durable relief of symptoms. Endobronchial stenting is a less invasive treatment option for PPS, however patients require close follow-up due to a high complication rate. Need for frequent bronchoscopy often emergently present serious limitations in this small group. Keywords: Bronchoscopy | Pneumonectomy | Postoperative Complications/su [Surgery] | Radiography | Thoracic | Endobronchial Stents | Tissue expanders, Introduction Postpneumonectomy syndrome (PPS) is a rare complication occurring months to years after pneumonectomy (1). Lung and mediastinal contents herniate into the empty postpneumonectomy space causing displacement and rotation of [...]

To the Editor: We applaud Carden and colleagues for their excellent review of tracheomalacia (March 2005). (1) We would, however, like to clarify the definition. Tracheomalacia, according to Taber's Cyclopedic [...]

INTRODUCTION: Tracheopathia osteoplastica (TO) is a rare disease of the upper airway consisting of luminal narrowing caused by projections of cartilaginous, and bony spurs within the lumen. The posterior membrane [...]

The flexible fiberoptic bronchoscope is currently the standard tool for localization of radiographically occult cardnomas of the tracheobronchial tree. It allows direct inspection of proximal airways and can establish the [...]

PURPOSE: Dynamic airway collapse (DAC) is due to excessive laxity of the posterior membranous portion of the trachea and/or mainstem bronchi resulting in collapse of the airway during expiration, while [...]