Bronchial Stenosis Research Articles

Y Reverse: Modified technique in challenging airway management.

Self-expanding Y-metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y-stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy. This retrospective study included 15 consecutive patients, suffering from tracheal-carina-lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y-stent insertion using the modified technique Y reverse. The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant. Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi.

Clinical characteristics of HIV-associated tracheobronchial Talaromyces marneffei infection in seven patients in Guangxi, China.

Tracheobronchial Talaromyces marneffei (T. marneffei) infections among HIV-infected patients are rare. To improve understanding, we analyzed the clinical features, immune mechanisms, treatment, and prognosis of these patients. We collected clinical information from HIV-positive patients with talaromycosis admitted to the Fourth People's Hospital of Nanning from January 2015 to June 2022. Patients who presented with culture and/or histopathological proof of tracheobronchial T. marneffei infection were included. A total of 108 patients with respiratory infections who underwent bronchoscopy were enrolled. Seven patients with tracheobronchial T. marneffei infection, all of whom were men with a median age of 48 years (range 39-50 years), were analyzed. Cough, sputum, fever, and weight loss were the most common symptoms. The total white blood cell count was normal or decreased, and all lymphocyte counts were decreased. All patients had reduced CD4+ T-cell counts, with values less than 50 cells/µL. The chest CT imaging signs included patchy signals or large areas of exudation, bronchial stenosis and occlusion. This was different from the lack of bronchial involvement. Endoscopically, the trachea and bronchial mucosa showed congestion, edema, surface attachment, nodules, lumen stenosis, obstruction, etc. T. marneffei spores were found via bronchial mucosal pathology in all 7 patients. Five patients were initially treated with intravenous infusion of amphotericin B for 2 weeks, followed by oral itraconazole capsules (200mg) twice daily, and two patients were initially treated with itraconazole. Six patients were remission, and 1 died. The clinical features of trachea invasion and nontracheal invasion are not unique, but chest CT reveals manifestations such as masses, solid shadows, and bronchial stenosis/obstruction. Bronchoscopy should be performed if possible, and the presence or absence of trachea T. marneffei infection should be confirmed. Antiviral therapy combined with antifungal therapy can improve patient prognosis.

The Significance of Blunt Thoracic Trauma-Related Bronchial Stenosis Development in Terms of Loss of Earning Capacity in the Profession: Case Report

The Significance of Blunt Thoracic Trauma-Related Bronchial Stenosis Development in Terms of Loss of Earning Capacity in the Profession: Case Report

Modern problems of bronchial tuberculosis in the world and the Russian Federation: A review

In the Russian Federation there is a positive trend in reducing the incidence of tuberculosis. However, there is a tendency to increase the prevalence of tuberculosis in the bronchi. According to foreign authors, the prevalence of bronchial tuberculosis ranges from 10% to 40%. There are no official statistics on the incidence of bronchial tuberculosis in the Russian Federation. The main contingent of bronchial tuberculosis lesions are young non-smoking women. At the same time, the most common target is the left main bronchus. Currently, no additional methods have been developed in the scheme of specific treatment of patients with pulmonary tuberculosis complicated by bronchial tuberculosis. It is important to understand that the eradication of MBT after an effective course of chemotherapy does not prevent the formation of cicatricial bronchial stenosis. It is also important to note that bacterial excretion in patients with bronchial tuberculosis is much more common than in patients with a comparable process in the lungs, but without bronchial damage. Consequently, tuberculosis of the trachea and bronchi has not only clinical, but also great epidemiological significance.

Clinical characteristics of 29 cases of pulmonary mucormycosis treated with and without surgery

Objective: To analyze the clinical characteristics of patients with pulmonary mucormycosis treated with and without surgery. Methods: This was a single-center, retrospective study. We retrieved "pulmonary mucormycosis" from the electronic medical records of China-Japan Friendship Hospital between 2016 and 2022. A total of 29 patients with pulmonary mucormycosis were collected. There were 19 males and 10 females with a median age of 49 (47, 67) years. Mann-Whitney U test, χ² test, Kaplan-Meier curve and log-rank test were used to compare the differences between groups. Results: The most common underlying disease was diabetes (19, 65.5%). The most frequent imaging findings were consolidation (25, 86.2%) and nodule or mass (21, 72.4%). Bronchial stenosis (16, 55.2%), obstruction by fungal plugs (18, 62.1%), pseudomembranous necrotizing bronchitis (19, 65.5%) were common. Treatment strategies were developed by the multi-disciplinary team (MDT). Among 16 patients who did not undergo surgery, 10 had bilateral multifocal lesions and 6 had unifocal lesions. All patients received antifungal therapies, and surgeries were performed in 13 (44.8%) patients. Patients who underwent surgery had numerically lower in-hospital mortality (15.4% vs. 31.3%, P=0.410). Involvement of unilateral multiple lesions was more common in patients who underwent surgeries (6/13 vs. 1/16, P=0.019). Patients who underwent surgery were more likely to have lobar and segmental bronchial involvement (13/13 vs. 9/16, P=0.007). A total of 15 patients underwent mNGS, 14 (93.3%) had positive results. Performing metagenomic next generation sequencing for diagnosis shortened the time from disease onset to diagnosis (log-rank P=0.014). Conclusion: Metagenomic next-generation sequencing aided early diagnosis. The patients who underwent surgery included unilateral multiple lesions and visualisation of endobronchial abnormalities on lobar or segmental bronchus in unilateral lung.

EP.08E.06 The Peripheral Bronchial Occlusion or Stenosis after Dumon Y-stenting is Prognostic Factor in Patients with Advanced Lung Cancer

EP.08E.06 The Peripheral Bronchial Occlusion or Stenosis after Dumon Y-stenting is Prognostic Factor in Patients with Advanced Lung Cancer

Pulmonary Artery Endograft Implantation Using a Parallel Stent Grafting Technique to Enable the Treatment of a Bronchial Anastomosis Complication After Lung Transplantation.

Bronchial stenosis associated with bronchial anastomosis dehiscence after lung transplantation is a catastrophic complication following lung transplantation with a paucity of therapeutic solutions. To describe an adaptation of the parallel stent grafting technique in the pulmonary arterial territory to treat this challenging situation. This is a case report of a 52-year-old patient who presented bronchus stenosis and bronchial anastomosis dehiscence after lung transplantion. Bronchial stenting and lung retransplantation were contraindicated. Therefore, an endovascular approach using pulmonary artery endograft placement to prevent bleeding during repeated right bronchial balloon dilation was propposed. The technique consists of the deployment of an aortic extender endoprosthesis in the right main pulmonary artery and a balloon expandable stent in the upper lobe pulmonary artery (using a parallel graft configuration) through the common femoral and right internal jugular veins, respectively. Intraoperative transesophageal echocardiogram and one-lung ventilatory ventilation are needed. The patient underwent a new bronchoscopy 16 days after the procedure, that showed epithelization at the previous eroded zone, enabling bronchocopic balloon dialtion to be safely performed. A post-operative contrast-enhanced CT scan revealed an adequate positioning of the stent grafts. Despite all eforts, the patient succumbed to ventilator associated pneumonia on postoperative day 108. The technique's advantages include its feasibility even in situations in which other techniques may be contraindicated and its potential use in emergencies. Its limitations include the need for experienced interventionists to perform it, and the potential risk of acute tricuspid regurgitation. This study illustrates the early feasibility of the parallel stent grafting technique applied to the pulmonary artery territory. However, it's safety profile regarding infectious risk was not demontrated.

Management of airway complications following lung transplantation: first interventional bronchoscopy report from Türkiye.

Lung transplantation is the treatment of last resort for many chronic lung diseases. Airway complications (AC) following lung transplantation, such as bronchial stenosis, dehiscence, malacia, and fistula, account for frequent hospital admissions, additional treatment costs, decreased quality of life, and reduced survival rates. Beyond surgical and medical preventive efforts, interventional bronchoscopy (IB) can be used in the management of these complications. The aim of the study is to evaluate the efficacy of IB on the management of AC following lung transplantation. A retrospective analysis was done using the data of lung transplant patients with AC referred to the interventional pulmonology unit between December 2012 and December 2019. From a total of 116 lung transplants, the data of 14/116 (12%) patients and 14/220 (6.3%) anastomoses in the same lung transplant group with AC requiring IB were analyzed. In these 14 patients, the diseases leading to lung transplantation were interstitial lung diseases (ILD) (50.0%), bronchiectasis (28.6%), pulmonary arterial hypertension (PAH) (7.1%), chronic obstructive pulmonary disease (COPD) (7.1%), and COPD + bronchiectasis (7.1%). Airway stenosis was the most common airway complication, and it developed mostly in the right bronchial system.The 14 patients underwent 27 total sessions of IB with an average of 2-3 per patient. Airway patency was successfully achieved in 74.1% of the procedures. Mechanical dilatation with a balloon and/or a rigid tube was the most preferred procedure (81.5%). Permanent airway patency was achieved in eight (57.4%) patients. No early complications were encountered (0%). The late complication rate was 48.1%. The most frequent late complication was restenosis, which cannot be directly attributed to IB. IB is safe to perform on lung transplant patients with AC. It has low procedural complication rates and can be performed repeatedly. Because of the high rate of restenosis, interventional pulmonologists should find out treatment modalities with lower rates of restenosis.

CRRT experience in a patient diagnosed with anthracofibrosis in intensive care : a case report

Bronchial anthracofibrosis is a condition characterized by dark pigmentation (anthracosis) in the bronchial mucosa, often accompanied by bronchial stenosis or obstruction due to fibrosis in the same area. Diagnosis is frequently established by bronchoscopy in patients who do not fully respond to treatment, show radiological abnormalities, and have obstructive lung disease. When looking at the literature on anthracofibrosis, it is mostly seen in conjunction with tuberculosis, but it can also frequently accompany pneumonia, therefore necessitating close monitoring. In intensive care unit (ICU), continuous renal replacement therapy (CRRT) is one of the frequently used treatment methods in critically ill patients with acute kidney injury (AKI) due to sepsis. It is particularly preferred in patients with acute renal failure (ARF) who have hemodynamic instability and are using inotropic agents. Our case is a 78-year-old male patient who was admitted to ICU due to pneumonia secondary to sepsis, septic shock, and AKI. During his follow-ups in ICU, due to frequent airway obstructions, a bronchoscopy was performed, and a diagnosis of anthracofibrosis was made. CRRT was planned as he was hypotensive and anuric under the support of inotropic agents. However, both the Disseminated Intravascular Coagulation picture due to sepsis that occurred in the patient and intrabronchial hemorrhages-clot plugs, as well as obstruction in the airway and increase in airway pressure due to anthracofibrosis were observed. The increase in airway pressure could not be performed for a long time as it increased the hemodynamic instability for CRRT. With this case report, it is intended to emphasize the effects of an increase in airway pressure on CRRT. In cases of obstructive lung diseases that do not respond to bronchodilators, such as anthracofibrosis, it should be kept in mind that the increase in airway pressure can cause more hemodynamic instability, especially in critically ill patients, and measures should be taken to reduce airway pressure

Chest computed tomography manifestations in neonates with chronic granulomatous disease

To study chest computed tomography (CT) manifestations in neonates with chronic granulomatous disease (CGD) to provide clues for early diagnosis of this disease. A retrospective analysis was conducted on the clinical data and chest CT scan results of neonates diagnosed with CGD from January 2015 to December 2022 at Anhui Provincial Children's Hospital. Nine neonates with CGD were included, with eight presenting respiratory symptoms as the initial sign. Chest CT findings included: consolidation in all 9 cases; nodules in all 9 cases, characterized by multiple, variably sized scattered nodules in both lungs; masses in 4 cases; cavities in 3 cases; abscesses in 6 cases; bronchial stenosis in 2 cases; pleural effusion, interstitial changes, and mediastinal lymphadenopathy each in 1 case. CT enhancement scans showed nodules and masses with uneven or ring-shaped enhancement; no signs of pulmonary emphysema, lung calcification, halo signs, crescent signs, bronchiectasis, or scar lesions were observed. There was no evidence of rib or vertebral bone destruction. Fungal infections were present in 8 of the 9 cases, including 6 with Aspergillus infections; three of these involved mixed infections with Aspergillus, with masses most commonly associated with mixed Aspergillus infections (3/4). The primary manifestations of neonatal CGD on chest CT are consolidation, nodules, and/or masses, with Aspergillus as a common pathogen. These features can serve as early diagnostic clues for neonatal CGD.

Venous retrograde approach for endovascular angioplasty in chronic total pulmonary vein occlusion -a case report

IntroductionFibrosing mediastinitis (FM) is a rare disease characterized by excessive proliferation of fibrous tissue in the mediastinum and can cause bronchial stenosis, superior vena cava obstruction, pulmonary artery and vein stenosis, etc.Case presentationAn aging patient with intermittent chest tightness and shortness of breath was diagnosed with FM associated pulmonary hypertension (FM-PH) by echocardiography and enhanced CT of the chest, and CT pulmonary artery (PA)/ pulmonary vein (PV) imaging revealed PA and PV stenosis. Selective angiography revealed complete occlusion of the right upper PV, and we performed endovascular intervention of the total occluded PV. After failure of the antegrade approach, the angiogram revealed well-developed collaterals of the occluded RSPV-V2b, so we chose to proceed via the retrograde approach. We successfully opened the occluded right upper PV and implanted a stent.ConclusionsThis report may provide new management ideas for the interventional treatment of PV occlusion.

Impact of preoperative respiratory distress on outcomes of slide tracheoplasty.

Children with congenital tracheal stenosis born in the developing world face a high risk of mortality due to limited access to proper treatment. Patients who required preoperative respiratory support were suspected to have poor survival after slide tracheoplasty; however, this was not clearly demonstrated in the previous studies. This study aims to investigate the impact of preoperative respiratory conditions on outcomes of slide tracheoplasty. From 2016 to 2022, children who underwent slide tracheoplasty were retrospectively reviewed. Patients with respiratory distress requiring emergency operations (group A) were compared with patients in stable condition who were scheduled for surgery (group B). Perioperative results revealed that group A (n = 43) had a longer bypass time (P < 0.001), operation time (P = 0.01), postoperative ventilation time (P < 0.001) and length of intensive care unit stay (P = 0.00125) than group B (n = 60). The early mortality rate was 7.8%, and the actuarial 5-year survival rate was 85.3%. The cumulative incidence test revealed that group A was highly significant for overall mortality [sudistribution (SHR) 4.5; 95% confidence interval (CI) 1.23-16.4; P = 0.023]. Risk factors for overall mortality were prolonged postoperative ventilation time (hazard ratio 3.86; 95% CI 1.20-12.48; P = 0.024), bronchial stenosis (hazard ratio 5.77; 95% CI 1.72-19.31; P = 0.004), and preoperative tracheal mucositis (hazard ratio 5.67; 95% CI 1.51-21.31; P = 0.01). Four patients needed reintervention during a follow-up of 28.4 months (interquartile range 15.3-47.3). Preoperative respiratory distress negatively affected the outcomes of patients who required slide tracheoplasty. Therefore, early detection of congenital tracheal stenosis and aggressive slide tracheoplasty are crucial and obligatory to enhance long-term survival in this lethal congenital airway disease.

Dose-Escalated Radiotherapy for Primary Tracheobronchial Adenoid Cystic Carcinoma.

Primary tracheobronchial adenoid cystic carcinoma (ACC) is a rare malignancy, so the optimal radiotherapy (RT) dose remains unestablished. We aimed to evaluate the effectiveness of dose-escalated RT for primary tracheobronchial ACC. We retrospectively reviewed 48 patients who had undergone definitive or postoperative RT. Patients classified into the low- and high-dose groups received RT doses <70.0 and ≥70.0 Gy in EQD2, respectively. The primary endpoint was freedom from local progression (FFLP) and overall survival (OS). Throughout the follow-up period, seven patients (14.6%) experienced local progression, while 31 (64.6%) exhibited distant metastasis, most commonly in the lungs. In total, the 5-year FFLP and OS rates were 85.7 and 84.7%, respectively. Multivariate analysis revealed that regional lymph node metastasis at diagnosis and receipt of definitive RT were associated with poorer OS. In the subgroup analysis, the definitive RT group had a 5-year FFLP rate of 33.3 and 78.2% in the low- and high-dose groups (p = 0.065), whereas 5-year OS rates were 66.7 and 79.0%, respectively (p = 0.022). Four patients (8.3%) experienced Grade 3 toxicity with tracheal or main bronchus stenosis. Dose-escalated RT with conventional fractionation may be effective in patients with tracheobronchial ACC, especially for a definitive aim.

Single Lung Transplantation After Open Window Thoracotomy for Empyema: A Case Report

A 41-year-old woman with lymphangioleiomyomatosis developed a bronchial anastomotic stenosis after left single lung transplantation (LTx). A part of the hyperinflated right native lung was excised in an attempt to remedy the left lung compression, which appeared to affect the bronchial anastomotic stenosis and ventilation/perfusion mismatch. However, a persistent air leak after the surgery caused empyema and an open window thoracotomy (OWT) was performed. She remained oxygen-dependent and was relisted for lung transplantation. A right single LTx on the side of OWT was performed, achieving long-term survival with no activity limitations for the patient. We report here the first successful LTx after OWT for empyema.

Characteristics of atypical Pulmonary Tuberculosis without typical clinical features diagnosed by pathology

PurposeSome patients with pulmonary tuberculosis (PTB) do not display typical clinical features, leading to delays in diagnosis and treatment. MethodsWe retrospectively analyzed PTB patients admitted to the Second Affiliated Hospital of Chongqing Medical University between 2017 and 2020. They are divided into pathological group (diagnosed through pathological biopsy) and control group (diagnosed via sputum or lavage fluid). Clinical data of both groups were compared. Based on radiographic features, the pathological group was further divided into the inflammation group, peripheral nodule group, and central occupancy group. We then statistically analyzed the computed tomography (CT) signs, bronchoscopic manifestations and results of pathological biopsy for each subgroup. ResultsThe pathological group consisted of 75 patients, while the control group had 338 patients. Multivariate logistic regression analysis showed that the pathological group had more diabetes (OR = 3.266, 95% CI = 1.609–6.630, P = 0.001), lower ESR (OR = 0.984, 95% CI = 0.971–0.998, P = 0.022), and lower CRP (OR = 0.990, 95% CI = 0.980–0.999, P = 0.036). In the three subgroups, the exudative lesions in the inflammation group were mostly located in atypical areas of PTB. The lobulation sign and spiculation sign were frequently observed in the peripheral nodule group. All presented with significant hilar mediastinal lymphadenopathy in the central occupancy group. In the pathological group, bronchoscopic manifestations typically included mucosal edema and bronchial stenosis. ConclusionDiabetes is an independent risk factor for atypical PTB. Expression of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in atypical PTB is low. Radiologically, it is most easily misdiagnosed when presented as peripheral solid nodules or masses, so a biopsy is recommended.

Understanding the Mechanisms of Main Bronchial Compression in Patients with Intracardiac Anomalies

BackgroundThe study focuses on vascular compression of the main bronchus in the aortopulmonary space, examining potential contributors within the same axial plane. Its goal is to uncover mechanisms of bronchial compression in patients with intracardiac anomalies and review surgical outcomes, aiming to enhance future results. MethodsThe morphology and topology of structures within the axial plane of the aortopulmonary space were objectively analyzed, including the sternum, ascending aorta, heart, pulmonary artery, descending aorta, and other relevant elements. Identified deviations from the normal configuration were systematically identified. Operative procedures included mobilizing and removing the compressing vessel, followed by suspending the airway wall to a rigid prosthesis (external stenting), vertebra, or ascending aorta. ResultsComputed tomography revealed potential factors contributing to bronchial stenosis, including anteriorly deviated descending aorta (20 patients), dilated pulmonary artery (6), cardiomegaly (12), flat chest (7), funnel chest (3), posteriorly deviated ascending aorta after arterial switch operation (3), low aortic arch (3), and aberrant subclavian artery (2). Kaplan-Meier analysis demonstrated operative survival rates of 96% at 1 year, 87% at 5 years, and 80% at 8-15 years. Ten-year follow-up computed tomography after external stenting procedure revealed the narrowest diameter of the stented bronchus as 94.4% of the reference. ConclusionsConsistent long-term airway patency was observed post-surgery. While the pulmonary artery and descending aorta exert direct compressive effects in most cases, various other potential mechanisms may contribute to bronchial compression. Identifying and addressing these factors through a multidisciplinary approach is crucial for sustaining bronchial patency and preventing complications.

Numerical investigation of the effects of the bronchial stenosis on airflow in human respiratory tract

Obstructive lung diseases are slowly progressing diseases that are characterized by a narrowing of airway diameter and make it harder to breathe. Although obstructive lung diseases have a high mortality rate, there are many clinical methods for early diagnosis such as impulse oscil-lometry, thorax computed tomography scans, and pulmonary function tests. The objective of this study is to investigate the effects of obstructions in main bronchitis on the airflow pattern and provide a better understanding to flow characteristics in healthy and obstructed (bronchi-al obstructions) human airways throughout a tidal breathing pattern. Seven-generation lung airway model of a healthy person was reconstructed from computed tomography (CT) images and additional models were created artificially for investigation of how obstructed airways affect flow characteristics, flow rate, tidal volumes, and air distributions. A person-specific non-uniform pressure inlet boundary condition for 12 breaths per minute was created as a time-dependent pressure profile and implemented in FLUENT software as a macro for dis-tal airways and atmospheric pressure outlet boundary condition defined at the trachea exit. Numerical simulations were carried out in SST k-w turbulence model and validated with an experimental study. Various flow properties such as lobar distribution rates, maximum flow rate changes, and airflow characteristics at different flow rates (quiet breathing-15 L/min and intense activity level-60 L/min) in the carina region, mid-trachea and sagittal section of the trachea were obtained in the human respiratory tract by computationally. The results show that regardless of flow rate, the airflow characteristics are similar for healthy models and mod-els with various stenosis grades during inhalation. In terms of maximum flow rate drop, for both inspiration and expiration phases 16%, 45%, and %80 decreases were observed in OM-I, OM-II, and OM-III, respectively. In line with the decrease in maximum flow rate similar drop, percentages were obtained for tidal volumes. Besides, with the increase of stenosis grade, the inhaled air volume distribution to the right and left upper lobes decreased between 15%-95%.

Fabrication of a 3D printed everolimus-eluting stent made of thermoplastic polyurethane and polylactide

Bronchial stenoses are one of the most common airways complications after lung transplantation. One of the main methods to restore airway patency is bronchial stenting. However, bronchial stenting is associated with a number of complications, such as stent migration, granulation tissue formation along the proximal and distal edges, and mucus obstruction of the lumen. This article demonstrates the possibility of manufacturing an everolimus-eluting stent from thermoplastic polyurethane and polylactide using 3D printing.

Resistin Pathway as Novel Mechanism of Post-lung Transplantation Bronchial Stenosis.

Bronchial stenosis remains a significant source of morbidity among lung transplant recipients. Though infection and anastomotic ischemia have been proposed etiologies of the development of bronchial stenosis, the pathophysiologic mechanism has not been well elucidated. In this single-centered prospective study, from January 2013 through September 2015, we prospectively collected bronchoalveolar lavage (BAL) and endobronchial epithelial brushings from the direct anastomotic site of bronchial stenosis of bilateral lung transplant recipients who developed unilateral post-transplant bronchial stenosis. Endobronchial epithelial brushings from the contralateral anastomotic site without bronchial stenosis and BAL from bilateral lung transplant recipients who did not develop post-transplant bronchial stenosis were used as controls. Total RNA was isolated from the endobronchial brushings and real-time polymerase chain reaction reactions were performed. Electrochemiluminescence biomarker assay was used to measure 10 cytokines from the BAL. Out of 60 bilateral lung transplant recipients, 9 were found to have developed bronchial stenosis with 17 samples adequate for analysis. We observed a 1.56 to 70.8 mean-fold increase in human resistin gene expression in the anastomotic bronchial stenosis epithelial cells compared with nonstenotic airways. Furthermore, IL-1β (21.76±10.96pg/mL; control 0.86±0.44pg/mL; P <0.01) and IL-8 levels (990.56±326.60pg/mL; control 20.33±1.17pg/mL; P <0.01) were significantly elevated in the BAL of the lung transplant patients who developed anastomotic bronchial stenosis. Our data suggest that the development of postlung transplantation bronchial stenosis may be in part mediated through the human resistin pathway by IL-1β induced transcription factor nuclear factor-κβ activation and downstream upregulation of IL-8 in alveolar macrophages. Further study is needed in the larger patient cohorts and to determine its potential therapeutic role in the management of post-transplant bronchial stenosis.

Bilateral stenting for malignant tracheal and bronchial stenosis

Malignant lesions of tracheal bifurcation usually lead to respiratory failure and risk of mortality. Airway stenting is the only minimally invasive method for these patients. The authors present a patient with T4N3M0 left-sided lung cancer (inoperable stage IIIc) complicated by respiratory failure due to tracheal bifurcation obstruction. Bilateral stenting by self-expanding stents with perforated coatings was effective for airway recanalization and provided subsequent chemotherapy.