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In locoregional esophageal carcinoma (EC), airway involvement is the most common route of extraesophageal metastasis. The prognosis remains poor even with a multimodality approach. Although airway stenting is well known for restoration of the airway, the survival benefit is still lacking.A total of 37 of patients with airway involvement from EC who underwent airway stenting at a single institution from 2015 to 2020 were retrospectively reviewed. Survival curves after stent placement among different groups were analyzed using Kaplan-Meier method.Of 37 patients, 34 were male, and the mean age was 58.9 years (42 to 80). EC was commonly located at midesophagus (51.4%). The site of airway involvement was left main bronchus (48.6%), trachea (32.4%), multiple sites (16.2%), and right main bronchus (2.7%). The nature of airway involvement was tumor invasion (91.9%), compression (62.2%), and fistula (37.8%). Twenty-three patients (62.2%) had airway involvement at the time of esophageal cancer diagnosis. Only 4 patients underwent esophageal stenting. The median survival time after stent placement was 97 days (5 to 539). Chemotherapy and/or radiotherapy were given before stent placement in 18 patients (48.6%). Treatment-naive before airway stenting and diagnosis of airway involvement at the same time of EC diagnosis were independent predictors for the increased survival after stent placement (P0.05). Poststent treatment was associated with improved survival (P=0.002).In patients with malignant airway involvement from EC who underwent airway stenting, the prognostic predictors for improved survival were treatment-naive status, receiving treatment after airway stenting, and early-onset of airway involvement.

Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID‐19). Multiple anti‐inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life‐threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID‐19‐related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID‐19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome., We report two cases of immunocompromised patients with severe coronavirus disease 2019 (COVID‐19)‐related cytokine release syndrome requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, intravenous immunoglobulin (IVIG), and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies.

Background: Silicosis is an occupational lung disease from chronic exposure of crystalline silica dust. It is usually chronic and progressive with signs and symptoms may not appear until years after exposure. Chest radiography with enlargement of the hilum is common but only 5–10% of cases had eggshell calcification which increases our suspicion of silicosis. In an early stage, patients with silicosis may not have a symptom. Early detection of the disease is useful and preventing progression of the disease Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) was a useful diagnostic procedure for mediastinal lesions. Objective: To demonstrate role of EBUS-TBNA in a case of silicosis Result: We reported three cases of patients with silicosis presented with abnormal chest radiography with mediastinal adenopathy without circumference calcification, eggshell calcification. Some of them also had no lung parenchymal lesion from computed tomography of the thorax. We perform EBUS revealed mediastinal lymph nodes in various sizes in each patient. EBUS-TBNA was performed under conscious sedation. Mediastinal lymph node tissue was obtained for pathology and cytology. Pathology revealed fibrotic stroma with anthracotic pigment and silica particles. Conclusion: EBUS-TBNA is useful for confirming the diagnosis of silicosis in an early stage of the disease.

Background: Bronchial thermoplasty is one of the treatments for severe asthma. Previous studies, both AIR2 and PAS2 study, demonstrated a significant improvement in asthma control after bronchial thermoplasty. Our hospital is only one center performing bronchial thermoplasty in Thailand. We report our treatment results in our experiences. Objective: To demonstrate our result of bronchial thermoplasty in severe asthma in Thailand Method: We conducted a descriptive study then analyzed the result of therapy Result: During the past three years, bronchial thermoplasty was performed in twenty patients with severe asthma. 70-percent of them were female with average age of 52.95 years old, 80 percent had allergic rhinitis as comorbidity. All of them were treated with ICS and LABA, 90 percent were also treated with LAMA, 50 percent were received oral corticosteroid and 25 percent were treated with omalizumab. But their symptoms were not controlled. Most of them had to use SABA as reliever about 17.16 puffs per week. They visited the emergency department frequently, 7.55 times/year and had to admitted 4.85 times/year. After performing bronchial thermoplasty, patients9 symptoms were significantly improved. The treatment could reduce rate of ED visits and hospitalization significantly. Oral corticosteroid could be tapered off and Omalizumab was discharged within 3 months after treatment without any adverse event. Quality of life was also accessed with AQLQ and showed significant improvement in all aspects. Conclusion: In Thailand, bronchial thermoplasty is safe and effective for treating severe asthma. Severe exacerbation and hospitalization and quality of life were significantly improved after the procedures.

We report a case series of 3 patients presented with critical central airway obstruction from different etiologies. They were undergone ECMO prior to bronchoscopic intervention. Case1 17-year-old female with tracheal stenosis from tuberculosis presented with stridor. Computed tomography revealed severe stenosis of trachea and left main bronchus. Since sudden obstruction might be occurred during bronchoscope and caused fatal outcomes. Therefore, prophylactic ECMO was performed prior to rigid bronchoscopy with Nd-YAG laser, balloon dilation and Y-stent insertion. ECMO could be weaned off immediately. Case2 72-year-old man, post right pneumonectomy two years ago, presented with shortness of breath. He was found recurrent squamous cell carcinoma that obstructed nearly entire left main bronchus. ECMO was initiated, followed by rigid bronchoscope with Nd-YAG laser and metallic stent insertion. He could be extubated and ECMO could be decannulated intraoperatively. Case3 55-year-old man with endotracheal tumor, presented with progressive dyspnea. The remaining tracheal lumen was 5 mm. ECMO was initiated prior to rigid bronchoscope with Nd-YAG laser. The intervention succeeded, ECMO was decannulated intraoperatively without any related complication. Conclusion: Using ECMO as prophylactic respiratory support is helpful and safe during the bronchoscopic intervention in a patient with critical central airway obstruction.

Background: NIV during post extubation is recommended to prevent reintubation in high risk patients. However the current evidence did not demonstrate its benefit when applied routinely after extubation. The use of targeted-volume NIV may be more appropriate in this clinical setting, with changing in required respiratory support. Objective: To demonstrate the effect of targeted-volume NIV for prevention of reintubation. Methods: A prospective randomized controlled study was conducted in patients who had been on mechanical ventilation for more than 48 hours. Patients were randomized into targeted-volume NIV group (intervention group) or oxygen mask group (controlled group).Reintubation rate within 48 hours was recorded as a primary endpoint. Secondary endpoints included respiratory failure rate within 48 hours, incidence of VAP/HAP, hospital length of stay and mortality rate. Result: Fifty-two patients were enrolled. No difference in baseline clinical characteristics was observed. Common causes of respiratory failure were pneumonia (57.69%) and sepsis (30.77%). The targeted-volume NIV group was observed to have a trend towards lower reintubation rate within 48 hours compared to oxygen mask group (0% vs 5%;p=0.051).Respiratory failure rate within 48 hours was significantly lower in intervention group compared to controlled group (0% vs 42.31%; p Conclusion: Our study is the first study to demonstrate the benefit of targeted-volume NIV in reducing respiratory failure rate after extubation in medical ICU patients.

A 37-year-old male patient, presented with breathlessness for one day. He complained bilateral knees and ankles pain with swelling and low grade fever with dyspnea on exertion about 1 month. He denied significant medical history, except chronic alcohol drinking. Physical examination revealed low grade fever, decrease breath sound with dullness on percussion of right hemithorax, swelling of both knees and generalized discrete hyperpigmented subcutaneous nodules over trunk and lower extremities. Chest radiography revealed right pleural effusion with pneumothorax, so ICD tube was inserted. Effusion showed exudative profile with PMN predominate. Pleural effusion amylase was 131,000 U/L, but serum amylase was 648U/L. Endoscopic retrograde pancreatography could identify fistula tract to right pleura. Unfortunately patient developed iatrogenic hemothorax, so thoracotomy was done. Intraoperation revealed diffuse nodules of pleura. Pleural pathology revealed adipose tissue with diffuse fat necrosis (Figure A and B). Skin biopsy was done from lesion of right tight, revealed feature of pancreatic panniculitis (Figure C and D). PPP syndrome with pancreaticopleural fistula was diagnosed. He was treated with total parenteral nutrition, octreotide injection and kept him nil per os. His pleural effusion, skin lesions and polyarthritis were gradually improved.

A 70-year-old man presented with progressive dyspnoea and weight loss. Physical examination revealed only mild pale conjunctiva. The workup showed mild anaemia, mild impaired renal function, and high globulin level. Multiple myeloma was excluded by normal serum protein electrophoresis. The chest radiography and computed tomography (CT) revealed bilateral multifocal patchy infiltration with mediastinal adenopathy. Bronchoscopy was performed. Bronchoalveolar lavage (BAL) fluid examination was negative for infection and malignancy. Tissue pathology revealed diffuse lymphoplasmacytic cell infiltration. Immunohistochemistry revealed positive highlight for CD38, immunoglobulin G (IgG), and IgG4. Serum IgG subclass was requested and showed an IgG4 level of 7230 mg/dL. Examination of bone marrow and submental lymph node pathology were also positive for IgG4. IgG4-related disease with pulmonary involvement was diagnosed. Treatment with prednisolone (30 mg/day) resulted in improvement in his dyspnoea and almost complete resolution of the pulmonary infiltration on repeated CT at 6 month. This case highlighted a rare occurrence of IgG4-related disease which was successfully treated with steroid.