An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.
Adolescent ; Airway Obstruction ; Bronchi ; Bronchoscopes ; Bronchoscopy ; Cough ; Drug Therapy ; Dyspnea ; Female ; Granulation Tissue ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Pulmonary Atelectasis ; Rupture ; Silicones ; Stents* ; Ventilation

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.
Aged ; Airway Obstruction ; Bronchi ; Bronchoalveolar Lavage ; Bronchoscopy ; Cryotherapy* ; Drug Therapy ; Endometrial Neoplasms ; Female ; Fever ; Hemoptysis ; Hemorrhage ; Humans ; Intensive Care Units* ; Radiography ; Respiration, Artificial ; Surgical Instruments ; Thorax ; Ventilation

BACKGROUND: Anaplastic thyroid cancer (ATC) is a rare type of thyroid malignancy and one of the most aggressive solid tumors, responsible for between 14% and 50% of the total annual mortality associated with thyroid cancer. METHODS: A retrospective study was made of all ATC cases diagnosed by biopsy in the Philippine General Hospital between 2008 and 2013. RESULTS: A total of 15 patients were identified, with a median age at diagnosis of 63 years. All tumors were at least 6 cm in size upon diagnosis. All patients had a previous history of thyroid pathology, presenting with an average duration of 11 years. Eleven patients presented with cervical lymphadenopathies, whereas seven exhibited signs of distant metastases, for which the lungs appeared to be the most common site. More than 70% of the patients presented with a rapidly growing neck mass, leading to airway obstruction. Only three patients were treated using curative surgery; the majority received palliative and supportive forms of treatment. In addition, only three patients were offered radiotherapy. Chemotherapy was not offered to any patient. Only two patients were confirmed to still be alive during the study period. The median survival time for the other patients was 3 months; in the majority of cases the patient died within the first year following diagnosis. CONCLUSION: Our experience with ATC demonstrated concordance with other institutions with respect to current clinical profile, presentation, and prognosis. An absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival. Curative surgery offers the most effective means of prolonging survival. Radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy.
Airway Obstruction ; Biopsy ; Diagnosis ; Drug Therapy ; Hospitals, General* ; Humans ; Lung ; Lymph Nodes ; Mortality ; Neck ; Neoplasm Metastasis ; Pathology ; Philippines ; Prognosis ; Radiotherapy ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms*

PURPOSE: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedation may lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration (Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. MATERIALS AND METHODS: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedation and airway obstruction levels were assessed using the Observer's Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. RESULTS: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect> or =m) for sedation scores (m> or =2, 3, 4, and 5) and airway-obstruction scores (m> or =2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 microg/mL and 1.53, 1.64, and 2.09 microg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). CONCLUSION: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.
Adult ; Aged ; Airway Obstruction/*drug therapy ; Anesthesia ; Anesthetics, Intravenous/blood/pharmacokinetics/*pharmacology ; Female ; Humans ; Hypnotics and Sedatives/*pharmacology/therapeutic use ; Male ; Middle Aged ; Probability ; Propofol/*pharmacology/therapeutic use ; Sleep Apnea, Obstructive/physiopathology

Smoking is associated with poor symptom control and impaired therapeutic responses in asthma. A total of 843 patients with asthma were recruited. The patients received treatment for 1 yr according to the severity of their asthma. We compared the forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 to forced vital capaity (FVC), atopy, total IgE, emphysema on high-resolution computed tomography (HRCT), the number of near-fatal asthma attacks, and physiological fixed airway obstruction between the smoking and nonsmoking groups. The study population consisted of 159 (18.8%) current smokers, 157 (18.7%) ex-smokers, and 525 (62.5%) nonsmokers. Although the prevalence of atopy was not different between the smoking and nonsmoking groups, the total IgE was higher among the smokers than the nonsmokers. Compared with the nonsmoking group, the smokers had a lower FEV1 % predicted and forced expiratory flow between 25 and 75% of FVC. A greater prevalence of emphysema and a significantly higher number of asthmatic patients with fixed airway obstruction were detected in the smoking versus nonsmoking group. The 37.5% of asthmatic patients who were former or current smokers showed decreased pulmonary function and increased IgE, emphysema on HRCT, and fixed airway obstruction, indicating that smoking can modulate the clinical and therapeutic responses in asthma.
Airway Obstruction/etiology ; Asthma/complications/*diagnosis/*drug therapy ; Female ; Forced Expiratory Volume/physiology ; Humans ; Immunoglobulin E/analysis ; Male ; Middle Aged ; Pulmonary Emphysema/etiology/radiography ; Respiratory Function Tests ; Respiratory Insufficiency/etiology ; Smoking/*adverse effects ; Tomography, X-Ray Computed

BACKGROUND: A tracheobronchial obstruction in lung cancer is associated with significant morbidity and mortality due to dyspnea, cough, hemoptysis, and recurrent respiratory infection. It is well known that one of standard treatments is photodynamic therapy (PDT) in tracheobronchial obstruction after radiotherapy, chemotherapy, and/or surgery. We reported here the role of PDT in airway obstruction in patients advanced lung cancer. METHOD: Pre-treatment protocol consisted of clinical, radiologic, and bronchoscopic examination, pulmonary function test, and assessment of Karnofsky performance status. A 2 mg/kg of porfimer sodium was injected intravenously, and then followed by cylindrical and/or interstitial irradiation with 630 nm of laser after 48 hours. The repeated bronchoscopy for debridement of necrotic tissue and re-illumination was performed after 48 hours. RESULT: Improved airway obstruction and selective tumor necrosis were achieved by photodynamic therapy in all cases. Dyspnea and performance status were improved in three cases. A purulent sputum, fever and hemoptysis were improved in one of five cases. After PDT, all patients showed temporarily aggravation of dyspnea, two of five showed febrile reaction for a few days and nobody presented photosensitivity reaction, hemoptysis and respiratory failure. CONCLUSION: Our experiences of PDT are effective in palliation of inoperable advanced lung cancer in terms of tracheobronchial obstruction.
Airway Obstruction ; Bronchoscopy ; Cough ; Debridement ; Dihematoporphyrin Ether ; Drug Therapy ; Dyspnea ; Fever ; Hemoptysis ; Humans ; Karnofsky Performance Status ; Lung Neoplasms* ; Lung* ; Mortality ; Necrosis ; Photochemotherapy* ; Radiotherapy ; Respiratory Function Tests ; Respiratory Insufficiency ; Sputum

Primary thyroid lymphoma (PTL) is a relatively rare disease, accounting for less than 0.5~5% of all thyroid malignancies. We encountered two cases of a primary thyroid lymphoma with Hashimoto's thyroiditis; one in a 63-year-old man and the other in a 79-year-old woman. The first case was a mucosa-associated lymphoid tissue lymphoma, and the other was a diffuse large B-cell lymphoma. Both patients underwent surgery and radiotherapy after being diagnosed using fine-needle aspiration cytology (FNAC). Both patients recovered well with no recurrence throughout the study period. The role of the surgeon in the treatment and diagnosis of thyroid lymphoma has been reduced due to the development of FNAC and combination therapy with chemotherapy and radiotherapy. On the other hand, surgery can be an effective treatment option for PTL confined to the thyroid, for achieving a definitive diagnosis, and in the treatment of patients with an airway obstruction.
Aged ; Airway Obstruction ; Biopsy, Fine-Needle ; Diagnosis ; Drug Therapy* ; Female ; Hand ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Middle Aged ; Radiotherapy ; Rare Diseases ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Thyroiditis

Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease (RDD), is a rare histiocytic disorder of unknown etiology. Most patients with RDD have spontaneous remission, but in some patients, the disease recurs after complete remission and may not respond to general treatment. Some patients with RDD involving the extranodal system can have serious symptoms such as vital organ dysfunction due to mass effects, neurological symptoms caused by intracranial involvement, and respiratory distress with airway involvement. We report the case of a 7-year-old girl with severe dyspnea due to refractory extranodal RDD that caused progressive upper airway obstruction. She was admitted because of nasal congestion and persistent cervical lymphadenopathy, and diagnosed as having RDD by cervical lymph node incisional biopsy. The initial prednisone treatment did not improve her symptoms. The following contrast-enhanced neck computed tomography revealed a newly developed airway mass protruding in the upper trachea. After 8 weeks of chemotherapy with vinblastine, methotrexate, and prednisone, complete remission was attained. Seven months after chemotherapy cessation, the disease recurred, and chemotherapy with vincristine, cytarabine, and prednisone was resumed. Despite the chemotherapy and emergency radiotherapy, no improvement was observed in the cervical lymph node enlargement and airway obstructive symptom due to the upper tracheal mass. 2-Chlorodeoxyadenosine (cladribine) therapy was initiated, and the patient got complete remission after 6 cycles of the cladribine treatment and maintained no evidence of disease for 2 years. We suggest that cladribine is an effective treatment option for recurrent/refractory RDD.
Airway Obstruction ; Biopsy ; Child ; Cladribine ; Cytarabine ; Drug Therapy ; Dyspnea ; Emergencies ; Estrogens, Conjugated (USP) ; Female ; Histiocytosis, Sinus ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Methotrexate ; Neck ; Prednisone ; Radiotherapy ; Remission, Spontaneous ; Trachea ; Vinblastine ; Vincristine

OBJECTIVETo objectively evaluate the clinical effect of traditional Chinese medicine in treating children's respiratory syncytial viral pneumonia (RSVP) of phlegm-heat blocking Fei syndrome (PHBFS).

METHODSA single-blinded multi-center, blocked, randomized and parallel-controlled method was adopted. The clinical study was carried out on 206 children with RSVP-PHBFS who were assigned to two groups, 108 in the test group treated through intravenous dripping of Qingkailing Injection () in combination of oral intake of Er'tong Qingfei Oral Liquid () and 98 in the control group with intravenous dripping of ribavirin injection in combination with oral intake of potassium guaiacol sulfonate oral liquid, all for 10 days. The clinical efficacy was evaluated and compared at the end of the trial from various aspects by three methods including comprehensive efficacy, post-treatment main symptoms score difference and survival analysis of the main symptoms.

RESULTSAfter treatment, in the test group, 60 patients were cured, 36 markedly alleviated, and 12 improved. In the control group, 41 were cured, 38 markedly alleviated, 18 improved and 1 unchanged. Comparison on the comprehensive efficacy between the two groups shows a better efficacy in the test group (chi(2)=4.4527, P=0.0348). Scores of the main symptoms were lowered after treatment in both groups, the difference was 22.41+/-4.99 scores in the test group and 17.61+/-6.34 scores in the control group, being more significant in the former (t=-5.99, P<0.01). Survival analysis shows that there was significant difference between the two groups in the effect initiating time on such symptoms as fever, cough, copious sputum, shortness of breath, and rales, which was earlier in the test group (P<0.01 or P<0.05).

CONCLUSIONEvaluation of the efficacy of traditional Chinese medicine in treating children with RSVP-PHBFS by using the three methods jointly could better show the objectivity of the evaluation.

Airway Obstruction ; complications ; mortality ; therapy ; Child, Preschool ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Fever ; complications ; mortality ; therapy ; Hot Temperature ; Humans ; Infant ; Male ; Medicine, Chinese Traditional ; methods ; Pneumonia, Viral ; drug therapy ; mortality ; pathology ; Respiratory Syncytial Virus Infections ; drug therapy ; mortality ; pathology ; Respiratory System ; pathology ; Ribavirin ; administration & dosage ; Single-Blind Method ; Survival Analysis ; Syndrome ; Treatment Outcome

Airway structural changes that occur in patients with asthma in response to persistent inflammation are termed airway remodeling. The cysteinyl leukotrienes (LTC4, D4 and E4) are known to play important roles in the pathobiology of asthma. To evaluate the effect of low dose montelukast (MK) on the development of airway remodeling using a chronic murine model of allergic airway inflammation with subepithelial fibrosis, BALB/c mice, after intraperitoneal ovalbumin (OVA) sensitization on days 0 and 14, received intranasal OVA periodically on days 14-75. MK treated mice received montelukast sodium intraperitoneally on days 26-75. The OVA sensitized/challenged mice developed an extensive eosinophil cell inflammatory response, goblet cell hyperplasia, mucus occlusion, and smooth muscle hypertrophy of the airways. In addition, in OVA sensitized/challenged mice, dense collagen deposition/fibrosis was seen throughout the lung interstitium surrounding the airways, blood vessels, and alveolar septae. The cysteinyl leukotriene 1 (CysLT1) receptor antagonist, MK significantly reduced the airway eosinophil infiltration, goblet cell hyperplasia, mucus occlusion, and lung fibrosis except airway smooth muscle hypertrophy in the OVA sensitized/challenged mice. The OVA sensitized/challenged mice had significantly increased epithelial desquamation compared with control mice. MK markedly reduced epithelial desquamation of airways in OVA/MK treated animals compared with OVA sensitized/challenged mice. MK treatment did not affect the levels of CysLT in lung tissue. Our results show that the important role of cysteinyl leukotrienes in the pathogenesis of asthma. Lower dose of CysLT1 receptor antagonism has a significant anti-inflammatory effect on allergen-induced lung inflammation and fibrosis but not airway smooth muscle hypertrophy in an animal model of asthma.
Respiratory Mucosa/pathology ; Receptors, Leukotriene/metabolism ; Quinolines/*therapeutic use ; Pulmonary Fibrosis/pathology ; Muscle, Smooth/pathology ; Mucus/secretion ; Mice, Inbred BALB C ; Mice ; Lung/pathology ; Leukotrienes/*biosynthesis ; Leukotriene Antagonists/*therapeutic use ; Hypertrophy ; Hyperplasia ; Goblet Cells/pathology ; Drug Evaluation, Preclinical ; Dose-Response Relationship, Drug ; Disease Models, Animal ; Cysteine/*biosynthesis ; Collagen/metabolism ; Asthma/*drug therapy/metabolism/pathology ; Anti-Asthmatic Agents/*therapeutic use ; Animals ; Airway Obstruction/drug therapy/pathology ; Acetates/*therapeutic use