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Inuit of Nunavik are coping with living conditions that can influence respiratory health. Our objective was to investigate associations between respiratory health in Inuit communities and their airway microbiome. Oropharyngeal samples were collected during the Qanuilirpitaa? 2017 Inuit Health Survey and subjected to metagenomic analyses. Participants were assigned to a bronchial obstruction group or a control group based on their clinical history and their pulmonary function, as monitored by spirometry. The Inuit microbiota composition was found to be distinct from other studied populations. Within the Inuit microbiota, differences in diversity measures tend to distinguish the two groups. Bacterial taxa found to be more abundant in the control group included candidate probiotic strains, while those enriched in the bronchial obstruction group included opportunistic pathogens. Crossing taxa affiliation method and machine learning consolidated our finding of distinct core microbiomes between the two groups. More microbial metabolic pathways were enriched in the control participants and these were often involved in vitamin and anti-inflammatory metabolism, while a link could be established between the enriched pathways in the disease group and inflammation. Overall, our results suggest a link between microbial abundance, interactions and metabolic activities and respiratory health in the Inuit population., (© 2023. Springer Nature Limited.)

BACKGROUND Post-tuberculosis bronchomalacia (PTBM) is one of the main conditions occurring in patients after tracheobronchial tuberculosis (TBTB), and is also associated with the recurrence of symptoms. The present study aimed to investigate the predictors of PTBM in patients who had been undergoing appropriate TB treatment. MATERIAL AND METHODS Clinical data of 104 patients with symptomatic airway stenosis after TBTB between January 01, 2019 and June 31, 2020 were recorded and analyzed. The association between baseline clinical characteristics, laboratory results, and PTBM was calculated with logistical regression. The time from onset of bronchoscopic intervention was examined by Kaplan-Meier estimates; differences between the 2 groups were tested by the log-rank test. RESULTS Fifty-seven patients (54.81%) had PTBM. In the multivariate logistical analysis, the left main bronchus stenosis lesion (odds ratio [OR]=3.763), neutrophil (NEUT) count (OR=1.527), and platelet (PLT) (OR=1.010) count were predictors of PTBM. During follow-up, patients with BM had a significantly longer duration from onset of bronchoscopic intervention than patients without BM (hazard ratio=2.412, P<0.0001). Further, all patients needing long-term bronchoscopic intervention therapy were subsequently identified as having PTBM. Additionally, blood PLT counts were significantly decreased to normal levels in the non-BM group (P<0.05), but not in the BM group (P>0.05). CONCLUSIONS PTBM is most likely to occur in the left main bronchus. The inflammatory and immune responses associated with NEUT and PLT may represent therapeutic targets of PTBM. Our study is the first to report that decreased blood PLT count has the potential to monitor the treatment response.

Background: Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China., Methods: From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV 1 and FEV 1 /forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV 1 and FEV 1 /FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data., Findings: Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 μm (PM 2·5 ) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m 2 . The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM 2·5 , and increase of BMI by 5 kg/m 2 were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China., Interpretation: In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM 2·5 exposure and increase of BMI by 5 kg/m 2 . Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population., Funding: Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: Although tracheobronchial diverticulum (DV) rarely cause problems, attention should be paid during esophagectomy, which requires careful dissection around the trachea and bronchi. Here, we retrospectively review cases of tracheobronchial DVs among esophageal cancer patients and report two cases of bronchial DV injury during thoracoscopic esophagectomy that were successfully repaired., Methods: The thin-section CT images of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2013 to December 2015 were retrospectively reviewed. The localization, number, and size (largest axial diameter) of all detected DVs were recorded., Results: A total of 180 patients were enrolled in this study. The incidence of tracheal DV was 5.0%, and that of bronchial DV was 40.0%. The median diameter of the tracheal diverticula was 2.45 [interquartile range (IQR) 2.00-8.17] mm and that of the bronchial diverticula was 1.90 (IQR 1.51-2.46) mm. All tracheal diverticula presented at the right tracheal wall 4.5-6.0 cm below the vocal cords; bronchial diverticula presented at the subcarinal lesions. We experienced two cases with bronchial diverticulum injuries during thoracoscopic esophagectomy, which were repaired by primary closure and confirmed that there was no air leak. No postoperative complications associated with bronchial injury occurred in either patient., Conclusion: Since tracheobronchial DVs are not as rare as previously thought, careful evaluation of thin-slice CT scans is necessary before thoracoscopic esophagectomy. If a tracheobronchial DV is injured during surgery, it is important to carefully repair it and confirm that there is no air leak to avoid complications.

Background: Klebsiella pneumoniae is commonly isolated after lung transplantation. This study observed an increase in bronchial complications after an outbreak of Klebsiella pneumoniae carbapenemase-producing Klebsiella (KPC-KP)., Methods: The study enrolled 173 patients who had undergone bilateral lung transplantation between 2012 and 2018 to examine the association between bronchial complications after lung transplantation and KPC-KP. The KPC-KP group was defined as patients whose isolates from sputum or bronchoalveolar lavage fluid were positive for KPC-KP. The presence of bronchial complications was defined as a positive finding on bronchoscopy in accordance with the criteria of the International Society for Heart and Lung Transplantation. Risk factors for bronchial complications were analyzed., Results: KPC-KP was identified in 29 patients (16.8%), and bronchial dehiscence was observed in 13 patients (7.5%). Smoking (odds ratio [OR], 5.690; 95% confidence interval [CI], 1.106- to 9.260; P = .037), the presence of KPC-KP (OR, 5.360; 95% CI, 1.380 to 20.810; P = .015), and bronchial necrosis (OR, 7.009; 95% CI, 1.811 to 27.124; P = .005) were associated with bronchial dehiscence in a multivariate logistic regression model., Conclusions: The presence of KPC-KP in lung-transplant recipients significantly increased the risk of bronchial dehiscence, independent of bronchial necrosis. Thus, patients with KPC-KP require greater surveillance and follow-up bronchoscopy, irrespective of the presence or absence of bronchial necrosis or the overall patient condition., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Patients with pulmonary tuberculosis (PTB) have a high risk of concomitant tracheobronchial tuberculosis (TBTB), which commonly causes severe complications such as tracheobronchial stenosis. The prevalence and predictors of TBTB in China remain unclear due to the lack of prospective and large-scale studies., Objectives: To investigate the incidence of TBTB in PTB patients in southern China, and elucidate the predictors of TBTB and related tracheobronchial stenosis., Methods: We prospectively performed bronchoscopy in PTB patients to diagnose TBTB at four medical centres in southern China from September 2015 to August 2016. Clinical and epidemiological data were recorded and analysed to determine predictors of TBTB and related tracheobronchial stenosis., Results: A total of 345 (23.9%) of the 1,442 PTB patients undergoing bronchoscopy were diagnosed with TBTB. Female sex (OR 2.53), age < 50 years (OR 1.88), living in urban (OR 2.19), diabetes (OR 1.84), coughing (OR 2.61), and symptoms ≥4 weeks (OR 1.66) were predictors of PTB concomitant with TBTB. About 59.7% TBTB patients developed tracheobronchial stenosis, of which 23.3% cases presented severe airway narrowing. Female sex (OR 2.27), age < 50 years (OR 2.11), shortness of breath (OR 1.97), and symptoms ≥4 weeks (OR 1.71) were predictors of TBTB-related tracheobronchial stenosis., Conclusions: About 23.9% of PTB patients undergoing bronchoscopy present with TBTB in Guangdong province, southern China. Young and middle-aged females with symptoms persisting for ≥4 weeks (the main predictors of TBTB and related tracheobronchial stenosis) should receive bronchoscopy immediately when diagnosed with PTB., (© 2018 S. Karger AG, Basel.)

Exercise-induced bronchoconstriction (EIB) can occur in individuals with and without asthma, and is prevalent among athletes of all levels. In patients with asthma, symptoms of EIB significantly increase the proportion reporting feelings of fearfulness, frustration, isolation, depression and embarrassment compared with those without symptoms. EIB can also prevent patients with asthma from participating in exercise and negatively impact their quality of life. Diagnosis of EIB is based on symptoms and spirometry or bronchial provocation tests; owing to low awareness of EIB and lack of simple, standardised diagnostic methods, under-diagnosis and mis-diagnosis of EIB are common. To improve the rates of diagnosis of EIB in primary care, validated and widely accepted symptom-based questionnaires are needed that can accurately replicate the current diagnostic standards (forced expiratory volume in 1 s reductions observed following exercise or bronchoprovocation challenge) in patients with and without asthma. In patients without asthma, EIB can be managed by various non-pharmacological methods and the use of pre-exercise short-acting β 2 -agonists (SABAs). In patients with asthma, EIB is often associated with poor asthma control but can also occur in individuals who have good control when not exercising. Inhaled corticosteroids are recommended when asthma control is suboptimal; however, pre-exercise SABAs are also widely used and are recommended as the first-line therapy. This review describes the burden, key features, diagnosis and current treatment approaches for EIB in patients with and without asthma and serves as a call to action for family physicians to be aware of EIB and consider it as a potential diagnosis.

Background: Airways can be affected by non-neoplastic lesions leading to critical stenosis of the lumen. Incidence, etiology, and clinical significance of endobronchial benign lesions are not systematically characterized.This study aimed to assess the epidemiology of nonmalignant processes involving the bronchial tree on clinical, pathologic, endoscopic, and radiologic grounds., Methods: We retrospectively analyzed bronchoscopy procedures over 10 years at the Bronchoscopy Unit of Modena University Hospital. All the endoscopically growing benign lesions with histologic confirmation were considered. For each lesion, we evaluated demographics, clinical features and outcome, the endoscopic aspect and radiologic characteristics by means of computed tomography as assessed by 2 experienced radiologists blinded with regard to the diagnosis., Results: Over the study period, we analyzed 10,431 bronchoscopies and identified 2075 cases of tracheobronchial alterations. Among these, 11.2% had a benign etiology with an average annual incidence of 23 new cases/year and a general incidence of 2.2%. Anthrachosis was the most prevalent bronchial lesion. In total, 22% of benign lesions presented airway stenosis >50% and required bronchoscopic treatment. Bronchial stenosis was most frequently observed in tuberculosis (P=0.031) and aspergillosis (P=0.020) when compared with sarcoidosis. Immunosuppressive status was significantly associated with endobronchial aspergillosis (P=0.0001) and the 1-year survival from diagnosis resulted significantly lower irrespectively to the immune system condition., Conclusions: A consistent proportion of endobronchial benign lesions are reported. One fifth of these are associated with critical stenosis of the airway lumen, requiring rigid bronchoscopy. Among these, aspergillosis is characterized by the poorest prognosis, regardless of host immunity status.

Objectives: The aim of this study was to determine the incidence of endobronchial lesions in patients presenting with hemoptysis. We also aimed to characterize features that would predict whether bronchoscopy would be useful., Methods: A retrospective chart review was conducted on 185 consecutive patients who presented with hemoptysis from January 1, 2006 to December 31, 2015 at Methodist Le Bonheur Healthcare-affiliated hospitals in Memphis, Tennessee. Data collection included demographic information, description of hemoptysis, imaging results, bronchoscopy results, and the final diagnosis., Results: A total of 185 patients presented with hemoptysis during our study period. Of these, 14 patients were excluded because of age (younger than 18 years) and incomplete data (inadequate information about the procedure performed, lack of imaging studies, incorrect International Classification of Diseases, Ninth Revision coding). The final analysis was performed in 171 patients; 87 underwent bronchoscopy either to determine etiology or to aid in management. Most patients (73%) had mild hemoptysis, with approximately half of the patients having hemoptysis for ≤1 day. Of 87 people who underwent bronchoscopy, 12 (13.8%) were found to have endobronchial lesions, and 35 (51.7%) patients were found to have either active bleeding or had fresh blood in their airway during bronchoscopy. Final diagnoses included pneumonia/bronchitis in 30 (18.9%) patients, malignancy in 24 (15.1 %), and anticoagulation toxicity in 23 (14.5%) patients., Conclusions: Bronchoscopy should be strongly considered in patients presenting with hemoptysis, especially if it is frank blood, of >1 week's duration, or both, because the information obtained can be vital for management. This appears to hold true even for patients who have no abnormalities seen on computed tomography chest imaging upon initial workup.

Interleukin-13(IL-13) might play an important role in driving aggregate bronchitic symptoms pathogenesis. However, none of the studies assessed the interaction between air pollutants exposure and IL-13 gene on the risk of aggregate bronchitic symptoms in non-asthma children. To assess the independent and joint effects of the exposure to air pollution and IL-13 haplotypes on the risk of aggregate bronchitic symptoms, we conducted a cross-sectional study and focused on non-asthma children. The study population consisted of 2944 children. The effect of each air pollutant on the risk of aggregate bronchitic symptoms was estimated as odds ratios per interquartile range (IQR) change. In the multiple logistic regressions, adjusted for confounding factors, the risk of chronic phlegm was associated with PM 2.5 exposure (aOR, 1.59; 95% CI, 1.07-2.37 per 12.51μg/m3 change), O 3 exposure (aOR, 1.54 95% CI, 1.05-2.27 per 8.28ppb change) and SO 2 exposure (aOR, 1.19; 95% CI, 1.02-1.39 per 0.98ppb change). Our study further provides the evidence that gene-environment interactions between IL-13 haplotype and O 3 exposure on chronic phlegm (95% CI for interaction, 1.01-1.38). Identifying children who are more sensitive to air pollution helps us to provide them an efficient prevention to avoid aggregate bronchitic symptoms., (Copyright © 2018. Published by Elsevier B.V.)

Introduction: Both fibrosing mediastinitis (FM) and bronchial anthracofibrosis (BAF) are unique diseases. The combined appearance of FM and BAF is extremely rare., Objectives: The aim of this study was to investigate the clinical features of patients with coexisting FM and BAF., Method: Between January 2003 and December 2015, a total of eight patients were diagnosed at the Peking Union Medical College Hospital as having combined FM and BAF. The clinical presentations, radiographic features and bronchoscopic findings of the eight patients were reviewed., Results: The patients were five women and three men with a median age of 64 years (range 56-86 years). Symptoms included dyspnea (eight patients), cough (seven patients), chest pain (two patients), hemoptysis (two patients) and so on. Chest CT of all eight patients showed mediastinal soft-tissue lesions, with multiple narrowed or obliterated lobar or segmental bronchi and arteries. Bronchoscopy showed that all of the patients had multiple stenoses of lobar or segmental bronchi with anthracotic pigmentation on the mucosa. Echocardiography showed that all of the patients had elevated pulmonary arterial systolic pressure (median 81 mm Hg, range 51-107 mm Hg). Each of the eight patients had a history of exposure to, or infection with, tuberculosis, although there was no evidence of active disease. All of the eight patients had long-term exposure to indoor coal or biomass fuel smoke., Conclusions: FM can coexist with BAF, characterized by prominent pulmonary hypertension. The possible etiological factors are tuberculosis and coal or biomass fuel exposure., (© 2017 The Authors. The Clinical Respiratory Journal Published by John Wiley & Sons Ltd.)

Exercise-Induced Bronchoconstriction (EIB) is an acute, transient airway narrowing occurring after exercise which may impact athletic performance. Studies report 10% of the general population and up to 90% of asthmatics experience EIB. Ninety-two players from three elite hurling squads underwent a spirometric field-based provocation test with real-time heart rate monitoring and lactate measurements to ensure adequate exertion. Players with a new diagnosis of EIB and those with a negative field-test but with a previous label of EIB or asthma underwent further reversibility testing and if negative, methacholine challenge. Eight (8.7%) of players had EIB, with one further athlete having asthma with a negative field test. Interestingly, only three out of 12 players who had previously been physician-labelled with EIB or asthma had their diagnosis objectively confirmed. Our study highlights the role of objective testing in EIB.

Background: Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children. The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB., Methods: A retrospective, descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014., Results: The median age of the enrolled patients was 3.4 years, with 73.2% of patients under five years old. The most common subtype was tumorous type (145/157, 92.4%). If only involved bronchus were considered, the common affected sites were right middle lobe bronchus (49/228, 21.5%), left upper lobe bronchus (41/228, 18.0%), right upper lobe bronchus (41/228, 18.0%), right main bronchus (35/228, 15.4%), respectively. Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044), with an odds ratio of 2.313 (95% confidence interval: 1.009-5.299). Before the bronchoscopy, only 16 (10.2%) patients were highly suspected of EBTB, while the others were diagnosed as PTB without EBTB (69.4%), or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission., Conclusions: The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions. The most frequent subtype of EBTB in children is tumorous type. The lesions are seen in the right bronchial system more frequently. FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.

Background: The objective of this study was to identify the characteristics and incidence of Tracheobronchial branching abnormalities in patients with microtia and to evaluate the risk of anesthesia., Methods: A total of 204 consecutive microtia patients and 465 nose cosmetic patients without microtia received a preoperative chest computed tomography. A retrospective study was performed with the clinical and imaging data from July 2016 to April 2017., Results: With the chest computed tomography images, a total of 7 cases were documented with Tracheobronchial branching abnormalities, including 6 cases among the microtia patients and 1 case among the cosmetic patients without microtia. The incidence of Tracheobronchial branching abnormalities was higher in microtia patients than the cosmetic patients without microtia (2.94% versus 0.22%, P < 0.01)., Conclusions: The incidence of Tracheobronchial branching abnormalities was high in patients with microtia. Preoperative diagnosis of tracheal bronchus can help anesthesiologists avoid complications. Microtia with Tracheobronchial branching abnormalities may involve a new syndrome previously undiscovered or just another extension with the very wide spectrum of microtia., (Copyright © 2017. Published by Elsevier B.V.)

Background/aim: The endobronchial tuberculosis (EBTB) is an uncommon type of tuberculosis. The respiratory symptoms in EBTB are usually nonspecific and misleading. The aim of the study is to determine the clinical features and diagnostic aspects of EBTB., Patients and Methods: Twenty-eight cases of endobronchial tuberculosis collected from January 2009 to October 2015., Results: EBTB was found in 16 females and 12 males. The mean age was 48 years. The history of tuberculosis and tuberculosis contagion were not found in any case. The respiratory symptoms were dominated by cough and dyspnea. Hemoptysis was found in 7 cases. The chest X-ray showed associated pulmonary lesions in 26 cases. Bronchoscopy finded an endobronchial granular lesion in 15 cases, a tumorous pattern in 7 cases; a thickening spurs in 4 cases and ganglio-bronchial fistula in two cases. Bronchial biopsies had found a caseo-follicular tuberculosis in 27 cases. Pleural biopsy confirmed associated pleural tuberculosis in one case. The research of Koch bacillus in the sputum was positive in 13 cases and culture in 6 cases. The antituberculosis treatment was started in all patients and an oral corticosteroids treatment was associated in 5 cases. The evolution was good in 26 cases., Conclusion: This study showed clinical, radiological and endoscopic bronchial tuberculosis polymorphism making its diagnosis difficult and the importance of a bacteriological and/or histological confirmation., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Environmental pollution is a risk factor for cardiorespiratory diseases. Energy generated by thermoelectric power plants (TEPP) represents a relevant source of pollution. The aim of this study was to evaluate the relationship between living near a coal-fired TEPP and the consultation rates for bronchial obstructive crises (BOC) in the province of Concepción, Chile., Methods: Population-based study. The epidemiological weeks from 2012 to 2014 were analyzed. The dependent variable was the emergency consultation rate for BOC in two health centers within 5 km of a TEPP (Coronel) and two that were more than 40 Km away from a TEPP (Talcahuano). The independent variables were the commune, climatological variables (air temperature and relative atmospheric humidity), environmental pollutants (PM 10 , PM 2.5 and nitrogen oxide), weeks with the highest consultation rate and the years. Rates, Pearson's correlation and gross risk measures were calculated and adjusted for environmental and climatological variables., Results: BOC rates were significantly higher in Coronel (RR = 4.9 95% CI 4.0-5.8; p < 0.05). The PM 2.5 it showed the strongest correlation with BOC rates (r = 0.3; p < 0.01) in Coronel, but not Talcahuano. Linear regression modelling indicated that proximity to a TEPP (health center location) and temperature explained 26 and 18% of the variance in BOC rates, respectively., Conclusions: Rates of emergency consultation for BOC were significantly higher among a population living within 5 km of a coal-fired TEPP than those living 40 km away.

Purpose: Accessory cardiac bronchus (ACB) is a very rare congenital anomaly and may cause some clinical complications, such as recurrent episodes of both infection and hemoptysis. The purpose of this study was to assess the multidetector computed tomography (MDCT) characteristics of ACB and to classify this anomaly according to the MDCT aspects., Materials and Methods: The routine thoracic CT scans from 5790 patients were evaluated retrospectively. The prevalence, location, length, diameter, division angle, distance from the carina, and the type of ACB were evaluated., Results: A total of 12 ACBs were identified, with a prevalence of 0.2%. All ACBs originated from the intermediate bronchus. The median largest diameter of the ACBs was 7.75 mm (range: 5.8 to 10.30 mm), the median length was 12.1 mm (range: 8.6 to 35 mm), the median division angle was 61 degrees (range: 42 to 93 degrees), and the median distance from the carina was 16.95 mm (range: 5.7 to 22.20 mm). Six cases (50%) had a blind extremity (type 1: diverticulum or stump type), 3 cases (25%) had a mutiloculated cystic change at the end (type 2: cystic type), and 3 cases (25%) had a ventilated lobulus demarcated by an anomalous fissure (type 3: ventilated type)., Conclusions: ACBs can be classified into 3 types according to their MDCT features. Recognition of ACB is important, as it is associated with clinical complications and is also salient in trauma cases.

Introduction: Innate or acquired immune deficiency may show respiratory manifestations, often characterized by small airway involvement. The purpose of this article is to provide an overview of small airway disease across the major causes of immune deficiency., Background: In patients with common variable immune deficiency, recurrent lower airway infections may lead to bronchiolitis and bronchiectasis. Follicular and/or granulomatous bronchiolitis of unknown origin may also occur. Bronchiolitis obliterans is the leading cause of death after the first year in patients with lung transplantation. Bronchiolitis obliterans also occurs in patients with allogeneic haematopoietic stem cell transplantation, especially in the context of systemic graft-versus-host disease., Viewpoint and Conclusion: Small airway diseases have different clinical expression and pathophysiology across various causes of immune deficiency. A better understanding of small airways disease pathogenesis in these settings may lead to the development of novel targeted therapies., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: Anastomotic airway complications are a major cause of morbidity and mortality after lung transplantation (LTx). In this study, the authors identified types and clinical outcomes of airway complications after LTx., Materials and Methods: All bronchial anastomotic complications were analyzed in a total of 94 LTx cases involving 90 recipients who underwent surgery between July 2006 and May 2014. Fifteen LTx cases (14 recipients) with incomplete medical records for fiberoptic bronchoscopy (FBS) and three cases underwent heart-lung transplantation (HLT) were excluded. Postoperative FBS at 24-48 hours, 1, 3, 6, and 12 months, and then yearly after the transplantation were performed., Results: A total of 76 LTx cases (75 recipients) were analyzed. The mean age of the recipients was 49.55 years (range, 18-71 years), and 38 (49.4%) were male. Twenty-one out of 76 cases (27.6%) experienced early anastomotic complications, and 12 (15.8%) presented late anastomotic complications. The early anastomotic airway complications presented in various forms: stenosis, 1 case; narrowing, 1; necrosis & dehiscence, 3; fistula, 4; granulation, 10; and infection, 2. Late complications almost entirely presented in the form of bronchial stenosis; five recipients showed stenosis at the anastomosis site, and one of them showed improvement after ballooning. Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site. Three of these patients showed improvement after ballooning or bronchoplasty., Conclusion: By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.

Objectives: To describe the presentation and clinical course of subglottic stenosis (SGS), in particular the development of concurrent airway lesions, in patients with Granulomatosis with Polyangiitis (Wegener's) (GPA)., Materials and Methods: Retrospective review of clinical data from all patients presenting to our institution from 2000 to 2012 with SGS and GPA., Results: Thirty-five patients were identified. The average age at diagnosis was 33 years old. Eleven patients (31%) presented with SGS as part their initial manifestation of GPA. The remaining patients developed SGS later, at a median of 2.5 years from diagnosis (range 6 months to 14 years). Twelve patients (34%) were noted to have multilevel airway involvement. Seven patients (20%) had documentation of cricoarytenoid joint fixation and vocal cord immobility. This was typically progressive in nature and occurred at an average of two years following the diagnosis of SGS. Six patients (17%) had mid/distal tracheal stenosis and four (11%) had bronchial stenosis. The majority of patients (86%) had evidence of concurrent sinonasal involvement, ten patients (29%) had evidence of otologic involvement and eight (23%) had ocular involvement., Conclusions: Cricoarytenoid joint fixation and distal stenosis occur not infrequently in patients with GPA and SGS, resulting in progressive multilevel airway stenosis in about one third of patients. It is critical to identify multilevel stenosis when managing the airways of these patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

In order to find relationship between exposure to traffic and traffic-related air pollutants, pulmonary function tests and a detailed questionnaire were conducted among 3997 selected inhabitants of Warsaw (Poland) and 988 residents of rural areas. Advanced statistical analyses (including GRM models, correspondence analysis and parametrical tests) have been completed. Statistically significant differences between average percentages of predicted values of pulmonary function parameters were found. Among urban area inhabitants the values of FEV1, MEF50 and FEV1/FVC were statistically significant (p<0.05) lower compared with the residents of rural areas (in the non-smoking group this differences were strong (p<0.001)). General linear regression models indicated that residence in the vicinity of urban busy roads fosters a decrease of spirometric parameters. Physical activity however has a positive effect on pulmonary function (exemplified by FEV1) and allows to reduce part of the negative health effects of traffic-related emissions. The results of the presented study demonstrate that long-term residence under the influence of heavy traffic and high concentrations of traffic-related air pollutants reduces respiratory function parameters, which may result in increased bronchial hyperresponsiveness., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background and Objective: Incidence and predictors of endobronchial tuberculosis (EBTB) remain unknown because of the lack of prospective studies. Our objective was to assess the incidence and predictors of concomitant EBTB in patients with active pulmonary tuberculosis (PTB)., Methods: We prospectively performed routine bronchoscopic examination in all patients with PTB to detect EBTB. Clinical and bronchoscopic findings were analyzed to elucidate predictors of EBTB., Results: Bronchoscopies of 429 PTB patients were performed at a tertiary referral hospital in Korea. Among those, 233 patients (54.3%) had EBTB. Female gender (odds ratio (OR) 4.35, 95% confidence interval (CI) 1.78-10.63), longer symptom duration (>4 weeks; OR 1.86, 95% CI 1.05-5.46), and no previous history of tuberculosis (OR 4.16, 95% CI 1.22-14.18) were found to be the independent predictors of concomitant EBTB in patients with active PTB. Most of the EBTB/PTB patients had mild stenosis, and more than 20% of them had severe stenosis at the time of diagnosis. Patients with EBTB had follow-up bronchoscopy to evaluate persistent airway stenosis. Persistent bronchostenosis with the lumen narrowed by more than one third occurred in 20.7% (30/145) of patients. The involvement length and decreased forced expiratory volume in 1 s were the risk factors for persistent bronchostenosis., Conclusions: In patients with active PTB, 50% or more have EBTB. Female gender and longer duration of symptoms are the main predictors of concomitant EBTB. Immediate diagnostic bronchoscopy in patients with active PTB should be considered in selected patients for detection of brocnhostenosis., (© 2015 The Authors Respirology published by Wiley Publishing Asia Pty Ltd on behalf of Asian Pacific Society of Respirology.)

Purpose: Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree. EBTB may require aggressive treatment, including lung resection, because of severe bronchostenosis and its complications, despite formal anti-TB chemotherapy. We present our experience of treating 25 patients with EBTB., Methods: We reviewed retrospectively the medical records of 25 patients with EBTB treated between 2002 and 2012 at the Department of Thoracic Surgery in Beijing Chest Hospital., Results: All 25 patients (5 male, 20 female) underwent surgery for fibrostenotic type EBTB. Bronchoscopy showed fibrostenotic change in all patients and a cough was the most common symptom. Postoperatively, all patients were given anti-TB therapy to take for 6-9 months., Conclusions: EBTB tends to occur at a higher incidence in young women. Surgery may be required for severe bronchostenosis and its complications and should be performed for symptomatic fibrostenotic type EBTB. During the operation, attention should be paid to prevent severe complications and postoperative anti-TB therapy is mandatory.

Introduction: Disease prevalence can be spatially analysed to provide support for service implementation and health care planning, these analyses often display geographic variation. A key challenge is to communicate these results to decision makers, with variable levels of Geographic Information Systems (GIS) knowledge, in a way that represents the data and allows for comprehension. The present research describes the combination of established GIS methods and software tools to produce a novel technique of visualising disease admissions and to help prevent misinterpretation of data and less optimal decision making. The aim of this paper is to provide a tool that supports the ability of decision makers and service teams within health care settings to develop services more efficiently and better cater to the population; this tool has the advantage of information on the position of populations, the size of populations and the severity of disease., Methods: A standard choropleth of the study region, London, is used to visualise total emergency admission values for Chronic Obstructive Pulmonary Disease and bronchiectasis using ESRI's ArcGIS software. Population estimates of the Lower Super Output Areas (LSOAs) are then used with the ScapeToad cartogram software tool, with the aim of visualising geography at uniform population density. An interpolation surface, in this case ArcGIS' spline tool, allows the creation of a smooth surface over the LSOA centroids for admission values on both standard and cartogram geographies. The final product of this research is the novel Cartogram Interpolation Surface (CartIS)., Results: The method provides a series of outputs culminating in the CartIS, applying an interpolation surface to a uniform population density. The cartogram effectively equalises the population density to remove visual bias from areas with a smaller population, while maintaining contiguous borders. CartIS decreases the number of extreme positive values not present in the underlying data as can be found in interpolation surfaces., Discussion: This methodology provides a technique for combining simple GIS tools to create a novel output, CartIS, in a health service context with the key aim of improving visualisation communication techniques which highlight variation in small scale geographies across large regions. CartIS more faithfully represents the data than interpolation, and visually highlights areas of extreme value more than cartograms, when either is used in isolation., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

It has long been known that air pollution is harmful to human health, as many epidemiological studies have been conducted into its effects. Collectively, these studies have investigated both the acute and chronic effects of pollution, with the latter typically based on individual level cohort designs that can be expensive to implement. As a result of the increasing availability of small-area statistics, ecological spatio-temporal study designs are also being used, with which a key statistical problem is allowing for residual spatio-temporal autocorrelation that remains after the covariate effects have been removed. We present a new model for estimating the effects of air pollution on human health, which allows for residual spatio-temporal autocorrelation, and a study into the long-term effects of air pollution on human health in Greater London, England. The individual and joint effects of different pollutants are explored, via the use of single pollutant models and multiple pollutant indices., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: This study investigated the incidence, diagnosis, treatment, and risk factors for nonmalignant airway erosion after subtotal esophagectomy for thoracic esophageal carcinoma., Methods: Clinical data from all patients with thoracic esophageal carcinoma who underwent right transthoracic subtotal esophagectomy from 2000 to 2012 at our institution were retrospectively reviewed, and the clinical course and outcome of those who developed airway erosion were investigated in detail. Risk factors for airway erosion were calculated by multivariate analysis., Results: Of 1,091 patients enrolled, 15 patients (1.4%) developed nonmalignant airway erosion, which occurred at postoperative day (POD) 7 to 92 (median, 24). Anastomotic leakage or gastric-tube necrosis was detected prior to airway erosion in 14 cases (93.3%). Endoscopic and surgical therapy was administrated to 3 patients. Airway erosion was cured in 9 patients (60.0%). Five patients died from airway erosion directly (mortality, 33.3%). Alimentary leakage or necrosis (p<0.001), preoperative radiotherapy (p=0.004), and reconstruction through the posterior mediastinal route (p=0.051) were independent risk factors for airway erosion development., Conclusions: Airway erosion is a fatal complication after subtotal esophagectomy. Preoperative radiotherapy dramatically increases the risk of developing airway erosion and reduces the probability of spontaneous healing. Aggressive treatment of alimentary leakage or necrosis and reconstruction through the anterior route help to decrease the risk of airway erosion, especially in high-risk patients., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: The objective was to apply quality indicators in respiratory disease triage during a set time period., Methods: This was a retrospective, descriptive, and comparative study of all patients attending the emergency department of Acosta Ñu Children's Hospital with breathing difficulty, between January 1 and July 31, 2011., Results: Two thousand five hundred eighty-two patients were included in the study. The delay in medical care according to severity of breathing difficulty was as follows: for critical patients, 1 minute (100% compliance); for emergencies, 6.4 minutes (93.4% compared with 95% standard); for urgencies, 15.8 minutes (90% compared with the standard 90%); and for semiurgencies, 35 minutes (92.4% vs. 85% standard). Regarding to the admission-triage time indicator: mean time was 6.1 minutes; 2220 patients (86%) were classified in less than 10 minutes from the time of hospital admission, and 2453 (95%) were evaluated before 15 minutes. Respiratory rate was recorded in 2368 patients (91.7%), and pulse oximetry in 2443 (94.6%). Both parameters were recorded in 2271 children (88%). Errors in classification were detected, mainly tendency to underestimate the risk or exacerbate the clinical situation; 441 patients underwent subtriage (20.5%), and 44 overtriage (1.7%). There were drawbacks to classify emergencies error rate 45.8% (P < 0.00001). Relationship between pathophysiologic diagnosis and triage level was significant (P < 0.00001)., Conclusions: Indicators of triage quality were acceptably met in respiratory disease. Breathing difficulty was identified and classified as urgent, although problems arouse at differentiation between moderate and severe dyspnea.

A survey of 1097 workers of metallurgical enterprises showed that a chronic bronchitis is the most common bronchopulmonary disease (8,8-13,3%) in copper production workers There are much less detected chronic obstructive pulmonary disease (0.8-1.7%), asthma (0.3-0.4%), and only in copper-smelting plant workers - a toxic chemical pneumosclerosis (0.6%). Working conditions determine a higher prevalence of respiratory diseases and their development in less industrial work record in the manufacturing workers employed in electrolytic processing of copper and auxiliary shops. The conclusion about the need to improve working conditions and the use of more effective personal respiratory protection devices for copper production workers has been made.

Background/aims: Various pulmonary diseases may be associated with bronchial anthracofibrosis (BAF). Our aim was to identify a relationship between BAF and endobronchial tuberculosis (EBTB)., Methods: In total, 156 patients, diagnosed with EBTB using bronchoscopy, between June 1999 and May 2008, were included. Clinical and bronchoscopic findings between patients with BAF (n = 72, BAF group) and without BAF (n = 84, non-BAF) were analyzed retrospectively., Results: The crude odds ratio (OR) of BAF for EBTB was 8.88 (95% confidence interval, 6.37 to 12.37). On multivariate analysis, adjusting for age, history of biomass smoke exposure, and comorbidities, the most significant independent factor for EBTB was a history of biomass smoke exposure (adjusted OR, 17.471; adjusted p < 0.001). EBTB was more frequent in the right lung, particularly the right middle lobar bronchus, in the BAF group. Actively caseating, edematous-hyperemic, and ulcerative were the major types, with 77 (49%), 33 (21%), and 31 cases (20%), respectively. The BAF group had more ulcerative type, while the non-BAF group had more actively caseating type. The duration of EBTB treatment was similar between the groups. No significant difference was observed in the development of complications during treatment and posttreatment bronchostenosis between the groups., Conclusions: These findings suggest that BAF may be a risk factor for EBTB and affect the location and morphological type at the time of EBTB development.

The effect of harmful behavioral factors on the development of chronic bronchopulmonary diseases (CBPD) was investigated in 1811 copper-nickel industry workers. The study showed that the most pronounced negative impact on respiratory system was caused by smoking. It manifested itself both by a decrease in the number of healthy individuals and by an increased risk for developing chronic bronchitis and chronic obstructive pulmonary disease. Excessive alcohol consumption and obesity did not significantly affect the development of CBPD. However, when combined with smoking, they potentiate its negative pneumotropic action. It is concluded that early detection and management of modifiable non-productive risk factors for CBPD is an effective way to improve the respiratory health of this category of workers.

Background: Endobronchial obstructions are rarely seen in children and are often misdiagnosed resulting in delay of definitive treatment. A variety of diseases can cause endobronchial obstructions in childhood, but data is limited as to the frequency, distribution and clinical characteristics of endobronchial obstructions diagnosed with flexible bronchoscopy (FB)., Objective: To document endobronchial obstructions detected by FB., Methods: FB results from three pediatric pulmonology centers in Istanbul were evaluated., Results: A total of 2,555 children underwent an FB procedure during the study period. Endobronchial obstructions were detected in 10% (n = 256) of the patients. Among FB in patients who had endobronchial obstructions, the four most common indications for bronchoscopy were persistent infiltrations (30%, n = 72), persistent wheezing (28%, n = 70), chronic cough (26%, n = 66) and atelectasis (23%, n = 59). The most common endobronchial obstructions detected in the patients were aspirated foreign bodies (35.9%, n = 92), endobronchial tuberculosis (31.6%, n = 81), mucous plugs occluding airway (16.7%, n = 43) and granulation scars (6%, n = 16). Other pathologies included hydatid cysts (n = 5), hemangiomas (n = 5), tumors (n = 5), submucosal nodules (n = 5) and polyps (n = 4). Endobronchial obstructions were most commonly located in the right bronchus (51%, n = 130) followed by the left bronchus (33%, n = 85), bilaterally (8%, n = 21) and trachea (8%, n = 20)., Conclusions: Endobronchial obstructions can be caused by a number of different diseases which require various medical or surgical treatments. In the presence of clinical or radiological findings suggesting an endobronchial obstruction, FB should be performed promptly., (Copyright © 2012 S. Karger AG, Basel.)

A screening study was performed to identify factors of the raised risk of cardiovascular and bronchopulmonary diseases among workers involved in weapons and military technology recycling and disposal. A high prevalence of risk factors such as smoking, excess body mass, adiposis, disorders of the carbohydrate, lipid and purine metabolism was found for workers aged 35 years and older. Circulatory, musculoskeletal, and eye diseases prevailed in the structure of first diagnosed diseases. Taking into account an unfavorable profile of risk factors, groups with the raised risk of cardiovascular and bronchopulmonary diseases were identified. An expansion of the standard scope of examination in the framework of regular medical monitoring in compliance with the applicable regulatory documents by inclusion of screening studies would provide additional opportunities for the early diagnosing and prevention of the above diseases.

Endobronchial tuberculosis (EBTB), of which the incidence has been increasing in recent years, is a special type of pulmonary tuberculosis. The endobronchial tuberculose focuses often injure the tracheobronchial wall and lead to tracheobronchial stenosis. The tracheobronchial stenosis may cause intractable tuberculosis and make patients become chronic infection sources of tuberculosis, or may even cause pulmonary complications and result in death. The etiological confirmation of Mycobacterium tuberculosis is most substantial for diagnosis. However, because the positive rate of acid-fast bacillus staining for sputum smears is low and the clinical and radiological findings are usually nondistinctive, the diagnosis of EBTB is often mistaken and delayed. For early diagnosis, a high index of awareness of this disease is required and the bronchoscopy should be performed as soon as possible in suspected patients. The eradication of Mycobacterium tuberculosis and the prevention of tracheobronchial stenosis are two most substantial treatment goals. To get treatment goals, the diagnosis must be established early and aggressive treatments must be performed before the disease progresses too far.

The article devoted to respiratory pathology (RP) in patients with UC and CD with clinical-radiological and functional (a function of external respiration--ERF) methods. The study included 220 patients with IBD (164--with UC and 56--with CD), aged 18-76 years (average age 40.6 years). ERF was studied by spirograph and recording flow-volume curve of forced expiration using pnevmotaograph "Eton-1" (Russia), 11 patients underwent HDCT at on multislice computer tomograph Toshiba Aquilion-16 (Japan). The study found that RP was most often detected by pulmonary function tests (44.1%), with a targeted detection of respiratory symptoms (32.9%), especially during HDCT. Much less marked physical (8.6%) and radiological (12.3%), signs of pulmonary disease, which indicates the low sensitivity of standard X-ray study of the CO. Airflow obstruction in the majority (78.3%) patients were represented mainly by obstruction of small bronchus, while in 51.6% of patients with impaired respiratory functions had no respiratory complaints, and 79.4% of patients had no radiographic signs of RP.

The aim of research is to study of the spirometry figures of bronchoobstructive syndrome in concomitant intestinal parasitosis. There are 81 patients aged from 5 to 61 years (male 43, female 38) were examined. The patients were divided into 2 groups: 1 group - patients treated only with bronchodilator therapy (14 patients with protozoa, 14 - with helminth, 12 - with combination of parasitosis); 2 group - patients treated with bronchodilator therapy in common with anti-parasitic therapy (14 patients with protozoa, 17 - with helminth, 10 - with combination of parasitosis). There are 22 patients with bronchoobstructive syndrome without parasites were included in control group. Functional disorders at the initial examination are not significantly distinguished between patients with protozoa, helminth, with combined parasitosis and patients without parasites. Considerable differences manifested in dynamics after treatment: only bronchodilator therapy of patients infected with parasites is not lead to sufficient increase of the indices of external respiration function, even the decreasing of the most parameters were observed in patients with helminth. The least growth of spirometric indices were observed in patients from group 1 - 2,17/ 5,09% predicted volumes (-6,81min; 10,54max), the highest growth were observed in patients from group 2 - 20,26/ 12,45% p.v. (2,77min; 43,85max). The spirographic indicators increase after treatment in the control group was more moderate in comparison with 1 and 2 groups - 5,96/ 2,97% p.v. (0,39min; 9,59max). Thus, using antiparasitic therapy in common with bronchodilator therapy in treatment of patients with intestinal parasitosis (group 2) is lead to the reliably significant positive dynamic of spirometry parameters in comparison not only to 1 group (<0,05 for many parameters) but also to control group (<0,01 for many parameters).

The objective was to determine the prevalence of bronchial diverticula in smokers on thin-section CT and the relationship to clinical and other morphological features on CT. Thin-section CT images of 503 cigarette smokers were assessed for the profusion and location of diverticula in the major airways. The extent of the bronchial diverticula was recorded as follows: grade 0, none; grade 1, one to three diverticula; grade 2, more than three diverticula. The extent of emphysema, bronchial wall thickness, clinical features, and pulmonary function were compared in the sub-groups stratified according to the extent of bronchial diverticula. A total of 229/503 (45.5%) smokers had bronchial diverticula, with 168/503 (33.3%) and 61/503 (12.2%) having grade 1 and 2 bronchial diverticula respectively. Subjects with grade 2 bronchial diverticula were heavier smokers, reported a history of coughing more frequently, and showed more severe functional impairment, greater extent of emphysema and more severe bronchial wall thickening compared with subjects with grade 1 and those individuals without bronchial diverticula (P < 0.05). Multivariate regression analysis revealed that only bronchial wall thickness predicted the extent of the bronchial diverticula (P < 0.0001). Bronchial diverticula are a frequent finding in the major airways of smokers, and they are associated with other markers of smoking-related damage.

There is an increasing concern about the possible adverse effects of diesel exhaust particulates on human health. In a diesel exposed occupational group composed of 120 toll collectors, a cross-sectional study was performed to evaluate the chest radiographs and 40 toll collectors were selected for computed tomography examination according to hyperinflation and linear markings. The wall thicknesses and luminal diameters of trachea, main bronchi, and segmental bronchi of right apical and posterior basal segments were measured with manual tracing method. The walls of right upper bronchus in exsmoker toll collectors were significantly thicker than those of nonsmokers (p=0.011). A positive correlation was observed between age and the right upper bronchus wall thickness (r=0.577, p=0.000). An inverse correlation was found between the working duration and the diameter of right main bronchus (r=-0.366, p=0.020). A positive correlation was seen between smoking and the right upper bronchus wall thickness (r=0.457, p=0.005). Diesel exposure might have a role in increase of thickness of large airways wall and a decrease in the diameters of large airways. Studies in this area are needed to protect the population under the diesel exposure risk.

The use of spirometry is not yet widespread enough in chronic respiratory or at -risk patients whose diagnosis is incomplete. There is scarce knowledge and inadequate management of the burden of these diseases, particularly chronic obstructive pulmonary disease (COPD). Pneumobil, an initiative aimed at raising awareness among smokers and ex -smokers, was reactivated 10 years after its launch in Portugal. It found a large prevalence of bronchial obstruction as measured by spirometry (30% and 25% in men and women respectively) in a sample of 5324 smoke -exposed individuals, 50% current smokers, screened at state or business (private company group) health institutions. This risk is neither mainly attributable to occupational exposure nor mainly related to respiratory symptoms, which were very common in our population. Only dyspnoea (OR=1.28; p=0.02) and frequent episodes of sputum production (OR=1.21; p=0.008) or acute bronchitis (OR=1.31; p=0.05) were somewhat related to bronchial obstruction. Prior knowledge of COPD is rare and bronchial obstruction is not correlated (p=0.204) to a possible diagnosis of COPD.

The data of a retrospective analysis of the studies conducted over a decade in 171 patients with benign and malignant esophageal diseases operated on at the Acad. V. Vakhidov Republican Specialized Center of Surgery were examined. The incidence and nature of early postoperative complications were studied in patients with surgical benign malignant esophageal diseases. The pattern of early postoperative complications mainly involved bronchopulmonary complications. The incidence of postoperative respiratory disorders was greater in patients with benign esophageal diseases than that in those with malignant ones. Overall mortality after reconstructive operations on the esophagus depended on neither respiratory nor specific causes and it was virtually equal in both benign and malignant esophageal lesions.

Introduction: Bronchial complications owing to the airway anastomosis in lung transplantation are important causes of morbidity and mortality. They occur in up to 27% of cases as defined by stenosis, necrosis, and dehiscence. Treatment depends on the type of complication., Objective: To report our experience to treat this complication., Methods: Between 2000 and 2007, we performed 71 lung transplants of which 36 were bilateral. The total number of anastomoses was 107:52 to the right and 55 to the left. The telescoping technique was initially used (14 initial unilateral transplants), and after October, 2003 it was changed to an end-to-end anastomosis (57 transplants and 93 anastomoses)., Results: Eight patients developed bronchial complications including two that were bilateral. There were 4 stenosis, 3 dehiscences, and 3 necrosis complications (9.4%). The complication rate for telescoping anastomosis was 21.4%, and for the end-to-end technique, 7.5%. The treatment of the stenosis used metallic or plastic self-expandable stents. Two bronchial dehiscences resulted in case of bronchopleural fistulae, empyema, and death; the other patient experienced spontaneous resolution. Concerning bronchial necrosis, 1 patient developed fistulization to the pulmonary artery and massive hemoptysis, and the other with bilateral necrosis, a spontaneous resolution., Conclusion: Our bronchial anastomosis complication rate was comparable with that in other reports. The rate for the telescoping technique was greater compared with the end-to-end technique. The treatment of bronchial stenosis with a self-expandable prosthesis showed good results.

Objective: To determine prevalence of various radiographic signs in cats with feline bronchial disease (FBD) and evaluate intra- and interobserver variability in radiographic interpretation for examiners with variable degrees of experience in radiographic interpretation., Design: Retrospective case series., Animals: 40 cats with FBD and 40 control cats without thoracic disease., Procedures: Radiographic abnormalities in cats with FBD were scored by consensus of 2 radiologists. Radiographs of control cats and cats with FBD were examined twice by 5 other individuals, and diagnostic accuracy and observer agreement were assessed., Results: In cats with FBD, the most common radiographic signs were bronchial (n=37) and unstructured interstitial (30) lung patterns, lung hyperinflation (31) and hyperlucency (21), aerophagia (19), and lung soft tissue opacities (11). Ratios of lung inflation on ventrodorsal views were significantly higher in cats with FBD. For the 5 examiners, sensitivity ranged from 71% to 89% and specificity ranged from 43% to 74%. Intraobserver agreement was good (N=0.47 to 0.60), but the agreement between examiners was only poor to good (N=0.22 to 0.70). For most examiners, significant associations were found between examiner diagnosis (correct vs incorrect), level of examiner certainty, and bronchial pattern severity., Conclusions and Clinical Relevance: Findings suggested that several radiographic abnormalities can commonly be seen in cats with FBD but highlighted the limitations of thoracic radiography. Examiner diagnosis and level of confidence were significantly associated with severity of a bronchial pattern.

Miners engaged into open-cast and underground extraction of copper-nickel ores in Kolsky Transpolar area have chronic bronchitis as a main nosologic entity among chronic bronchopulmonary diseases (19.1% of the workers). Considerably lower (4.0% of the workers) occurrence concerns chronic obstructive lung disease and bronchial asthma, both developed before the occupational involvement (1.3% of the workers). Complex of occupational and nonoccupational risk factors is connected mostly with smoking that increases COLD/CB risk 10.7-15.8-fold.

Objective: The diagnosis of tuberculosis in patients with negative acid-fast bacillus smears poses a challenge to both clinicians and public health authorities. In an attempt to aid diagnosis in such cases, an expert committee was established in Ciudad de La Habana, Cuba in 1995. The aim of this study was to describe the progress of the committee's work and the corresponding results for the period 1996 through 2003., Patients and Methods: For each patient studied by the commission, we analyzed the following data: patient's residence and referring center, tentative diagnosis proposed by the attending physician, history of antibiotic treatment, and final diagnosis made by the commission., Results: Of the 1703 patients studied, 84.8% were from La Habana, 48.4% were 55 years or older, and 63.8% were men. Between 2001 and 2003, 11.3% of patients were already on antituberculosis treatment when their case was studied by the commission. The corresponding percentage for 1996 through 2000 was 16.9% (P=.001). Active tuberculosis was confirmed in 43.1% of a total of 918 patients with full test results during the period 1996 through 2000 and in 52.2% of a total of 619 patients (52.2%) during the period 2001 through 2003 (P< .001). Of 344 patients with suspected pulmonary tuberculosis and negative acid-fast bacillus smears between 2001 and 2003, 128 (37.2%) were diagnosed with active tuberculosis., Conclusions: These findings indicate that the work of the commission is viable, sustainable, and useful for preventing overdiagnosis and inappropriate treatment, and that it also serves an educational purpose.

Examinations were made in 220 male workers exposed to dust-gas (low-silicon dioxide, nitric oxides, and carbon oxide) mixture, physical exercises, and cooling microclimate on deep-mined output of copper-nickel ore. Twenty-eight per cent of the workers were found to have evolving chronic bronchitis that did not substantially affect the patients' working capacity; 3.2% had chronic obstructive pulmonary disease and 1.4% had asthma that had developed before the onset of professional activity. 32.3% of the examinees were ascertained to have individual clinicofunctional disorders that permit their identification as a bronchopulmonary disease risk group to carry out early preventive and rehabilitative measures.

Background: Tracheobronchomalacia (TBM) disorders in children have never been studied using quantified measurements and validated clinical outcome measures. The objectives of the study were to prospectively examine the relationship between malacia lesions and their respiratory illness profiles., Methods: The site of malacia lesions (eg, tracheomalacia, TBM, and bronchomalacia) were determined, measured, and related to the respective cricoid (ie, airway/cricoid ratio) using the color histogram mode technique. These children and normal control subjects were followed up for 12 months with their respiratory illness profiles determined using the Canadian Acute Respiratory Illness Scale (CARIFS) and cough diary scores., Measurements: Outcome measures were respiratory illness frequency (> 12 months), severity score (day-1 CARIFS score), and significant cough interfering with daily activity (score of >or= 3) and illness resolution (time to return to a quarter of CARIFS day 1 score)., Results: The group of 116 children were composed of patients with malacia (n = 81) and control subjects (n = 35). The median age of the group was 2.1 years (age range, 0.2 to 17.3 years). The adjusted relative risk of illness frequency was 2.1 (95% confidence interval [CI], 1.3 to 3.4), and of significant cough was 7.2 (95% CI, 1.01 to 27.22) for the malacia group while CARIFS day 1 score was 1.66 (95% CI, 1.1 to 2.56) compared to control subjects. Illness resolution rates at day 14 in the malacia group trended 25% slower than those for control subjects. Malacia type and severity of lesions were not associated with increased rates of illness or worse clinical profiles., Conclusion: Children with malacia have an increased likelihood of respiratory illness frequency, severity, significant cough, and tendency for delayed recovery. However, neither the site nor the severity of malacia exhibited any significant dose effect on respiratory illness profiles.

Early changes under exposure to chrysotile-asbestos dust include light arterial hypoxemia, lower bronchial permeability of small bronchi. Early asbestosis and dust bronchitis manifest with impaired pulmonary ventilation of mixed type, that is associated with moderate arterial hypoxemia in dust bronchitis.

Findings are that chronic bronchitis (14.1-18.5% of workers) is leading among bronchopulmonary diseases in workers engaged into electrolysis and auxiliary workshops of aluminium production. Chronic obstructive lung disease (COLD) and bronchial asthma (BA) occur in 1.6-2.4% of the workers requiring employment. Among other variants of BA, potroom asthma--occupational form of the disease--should be emphasized. Risk of chronic bronchitis and COLD depends on length of exposure to the occupational hazards, and intensity of smoking habit.