Recurrent chest infections in two young non-smoker men

Pulmonary mucinous cystic carcinomas are rare salivary gland type carcinomas of the lung. They form part of a wide spectrum of mucin secreting glandular mixed type tumours. They comprise 0.1 – 0.2% of all lung tumours. They occur more frequently in young patients and present with cough or recurrent chest infections and therefore may be easily misdiagnosed. Since treatment depends fully on complete surgical resection early diagnosis is essential. Even with treatment the 10-year survival is quoted at 53%. We describe two cases of such rare tumours both of who underwent curative surgical resection. Both patients were younger than 35 years old and presented with recurrent chest infections. The patients were followed for up to eight years and the outcome recorded. A literature search confirms the occurrence in younger patients, who often present with pneumonias and that surgery is the only hope for cure.peer-reviewe

Blood vessels and their construction in the cavities of pulmonary tuberculosis

First of all, we investigated the origin, the construction and distribution of the bronchial arteries and veins in adult rabbits, and then observed various changes of the blood vessels in experimental cavities and caseous foci and also studied the effects of streptomycin and isoniazide on the blood vessels of the cavity wall. The summary findings of the present experiments are described in the following. 1) In ten out of the fifteen rabbits emloyed, the bronchial artery originates from the right supreme intercostal artery; in three cases, in addition to this origin, it originates also from the left supreme intercostal artery; and in another case from the intercostal thoracic artery; while in the remaining one from the arc of the aorta. 2) The bronchial veins are divided into the extra-pulmonary and the intra-pulmonary veins. The former arises from the submucous blood vessels located in the proximal part of the third bronchus, and running along with the bronchial artery, finally empties into the superior Vena cava; while the latter, originating from the submucous capillaries in the distal part of the third bronchus, and after anastomosing with one another in the capsule of the bronchus, is communicated with the pulmonary veins. 3) In the caseous foci, although blood vessels are obliterated, capillaries are newly formed around the main trunks of the pulmonary artery and vein as well as around their residual branches. 4) These caseous foci are supplied with arterial blood from the bronchial arteries, the blood vessels in the bronchial wall, and the newlyformed vessels of pulmonary arterial origin. 5) The capillaries in the cavity wall are classified into three types according to their origins; namely, Type I, those regenerating from fine branches of the pulmonary vessels; Type &#8545;, those regenerating from the main trunk of the pulmonary vessels; and Type &#8546;, those regenerating from the bronchial artery situated in the orifice of the drainage bronchus. 6) The tuberculous cavities only in the orifice of the drainage bronchus receive an abundant supply of arterial blood directly from the bronchial artery, but those in other regions receive a scanty blood supply indirectly from the anastomoses between the bronchial artery, its sister vessels and the pulmonary artery. 7) The regeneration of blood vessels in tuberculous foci has been confirmed to occur not only in the bronchial artery and its sister blood vessels but also in the pulmonary artery and vein as well. 8) The constructions of blood vessels in the cavities treated with streptomycin or isoniazide present no significant difference from those of the control. 9) The regeneration of blood vessels and hyperemia in the cavity wall of the cases treated with streptomycin present no significant difference from those observed in the control, but the cases treated with isoniazide show marked hyperemia, newly-formed vessels, and occasional bleedings.</p

Agreement Among Radiographs, Fluoroscopy and Bronchoscopy in Documentation of Airway Collapse in Dogs.

BackgroundAirway collapse is a common finding in dogs with chronic cough, yet the diagnosis can be difficult to confirm without specialty equipment.HypothesisBronchoscopic documentation of tracheobronchial collapse will show better agreement with fluoroscopic imaging than with standard radiography.AnimalsForty-two dogs prospectively evaluated for chronic cough.MethodsIn this prospective study, three-view thoracic radiographs were obtained followed by fluoroscopy during tidal respiration and fluoroscopy during induction of cough. Digital images were assessed for the presence or absence of collapse at the trachea and each lobar bronchus. Bronchoscopy was performed under general anesthesia for identification of tracheobronchial collapse at each lung segment. Agreement of imaging tests with bronchoscopy was evaluated along with sensitivity and specificity of imaging modalities as compared to bronchoscopy.ResultsAirway collapse was identified in 41/42 dogs via 1 or more testing modalities. Percent agreement between pairs of tests varied between 49 and 87% with poor-moderate agreement at most bronchial sites. Sensitivity for the detection of bronchoscopically identified collapse was highest for radiography at the trachea, left lobar bronchi, and the right middle bronchus, although specificity was relatively low. Detection of airway collapse was increased when fluoroscopy was performed after induction of cough compared to during tidal respiration.ConclusionsRadiography and fluoroscopy are complementary imaging techniques useful in the documentation of bronchial collapse in dogs. Confirming the presence or absence of tracheal or bronchial collapse can require multiple imaging modalities as well as bronchoscopy

Neglected foreign body aspiration mimicking bronchial carcinoma

Foreign body aspiration can occur in any age group, but it is more commonly seen in children. In adults, there is usually a predisposing condition that poses a risk of aspiration. If aspiration occurs, prompt diagnosis and extraction of the foreign body is needed to prevent early and late complications. We report a rare case of neglected foreign body aspiration in a 45-year-old schizophrenic opium addicted patient, which resulted in an occlusive lesion in the bronchus, mimicking bronchial carcinoma. © The Author(s) 2015

Bronchial and arterial sleeve resection for centrally-located lung cancers

The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections

Left main bronchus compression due to main pulmonary artery dilatation in pulmonary hypertension: two case reports

Abstract. Pulmonary arterial dilatation associated with pulmonary hypertension may result in significant compression of local structures. Left main coronary artery and left recurrent laryngeal nerve compression have been described. Tracheobronchial compression from pulmonary arterial dilatation is rare in adults, and there are no reports in the literature of its occurrence in idiopathic pulmonary arterial hypertension. Compression in infants with congenital heart disease has been well described. We report 2 cases of tracheobronchial compression: first, an adult patient with idiopathic pulmonary arterial hypertension who presents with symptomatic left main bronchus compression, and second, an adult patient with Eisenmenger ventricular septal defect and right-sided aortic arch, with progressive intermedius and right middle lobe bronchi compression in association with enlarged pulmonary arteries

Cancer mortality in Portugal

Following Population News, Trends and Attitudes #6 it was possible to identify that, despite circulatory system diseases represent the leading causes of death (COD) in Portugal, the share of deaths caused by neoplasms is increasing with time. Analysing data from 10th International Classification of Diseases available at Statistics Portugal (INE), one can observe that since 2010 mortality associated to neoplasms is the major COD for males. In 2015, males presented almost twice the number of deaths caused by neoplasms when compared to females: 356.0 against 169.9 per 100.000 individuals

Increased risk for other cancers in individuals with Ewing sarcoma and their relatives.

BackgroundThere are few reports of the association of other cancers with Ewing sarcoma in patients and their relatives. We use a resource combining statewide genealogy and cancer reporting to provide unbiased risks.MethodsUsing a combined genealogy of 2.3 million Utah individuals and the Utah Cancer Registry (UCR), relative risks (RRs) for cancers of other sites were estimated in 143 Ewing sarcoma patients using a Cox proportional hazards model with matched controls; however, risks in relatives were estimated using internal cohort-specific cancer rates in first-, second-, and third-degree relatives.ResultsCancers of three sites (breast, brain, complex genotype/karyotype sarcoma) were observed in excess in Ewing sarcoma patients. No Ewing sarcoma patients were identified among first-, second-, or third-degree relatives of Ewing sarcoma patients. Significantly increased risk for brain, lung/bronchus, female genital, and prostate cancer was observed in first-degree relatives. Significantly increased risks were observed in second-degree relatives for breast cancer, nonmelanoma eye cancer, malignant peripheral nerve sheath cancer, non-Hodgkin lymphoma, and translocation sarcomas. Significantly increased risks for stomach cancer, prostate cancer, and acute lymphocytic leukemia were observed in third-degree relatives.ConclusionsThis analysis of risk for cancer among Ewing sarcoma patients and their relatives indicates evidence for some increased cancer predisposition in this population which can be used to individualize consideration of potential treatment of patients and screening of patients and relatives

Effect of variations in atelectasis on tumor displacement during radiation therapy for locally advanced lung cancer

Purpose Atelectasis (AT), or collapsed lung, is frequently associated with central lung tumors. We investigated the variation of atelectasis volumes during radiation therapy and analyzed the effect of AT volume changes on the reproducibility of the primary tumor (PT) position. Methods and materials Twelve patients with lung cancer who had AT and 10 patients without AT underwent repeated 4-dimensional fan beam computed tomography (CT) scans during radiation therapy per protocols that were approved by the institutional review board. Interfraction volume changes of AT and PT were correlated with PT displacements relative to bony anatomy using both a bounding box (BB) method and change in center of mass (COM). Linear regression modeling was used to determine whether PT and AT volume changes were independently associated with PT displacement. PT displacement was compared between patients with and without AT. Results The mean initial AT volume on the planning CT was 189 cm3 (37-513 cm3), and the mean PT volume was 93 cm3 (12-176 cm3). During radiation therapy, AT and PT volumes decreased on average 136.7 cm3 (20-369 cm3) for AT and 40 cm3 (−7 to 131 cm3) for PT. Eighty-three percent of patients with AT had at least one unidirectional PT shift that was greater than 0.5 cm outside of the initial BB during treatment. In patients with AT, the maximum PT COM shift was ≥0.5 cm in all patients and \u3e1 cm in 58% of patients (0.5-2.4 cm). Changes in PT and AT volumes were independently associated with PT displacement (P \u3c .01), and the correlation was smaller with COM (R2 = 0.58) compared with the BB method (R2 = 0.80). The median root mean squared PT displacement with the BB method was significantly less for patients without AT (0.45 cm) compared with those with AT (0.8cm, P = .002). Conclusions Changes in AT and PT volumes during radiation treatment were significantly associated with PT displacements that often exceeded standard setup margins. Repeated 3-dimensional imaging is recommended in patients with AT to evaluate for PT displacements during treatment. Summary This study analyzed 12 patients with atelectasis and 10 patients without atelectasis who underwent repeat 4-dimensional fan beam computed tomography during radiation therapy. Patients with atelectasis had significantly greater tumor displacements than patients without atelectasis, and these tumor displacements often exceeded standard setup margins. Patients with atelectasis may benefit from repeated 3-dimensional imaging during radiation therapy and possible replanning for large tumor displacements