État des connaissances. -Les traitements médicaux de l'emphysème ont une efficacité limitée. La r... more État des connaissances. -Les traitements médicaux de l'emphysème ont une efficacité limitée. La réduction de volume chirurgicale est actuellement peu utilisée compte tenu d'une morbi-mortalité élevée. La réduction volumique endobronchique au moyen de spirales (Lung * Auteur correspondant. Adresse Modele + RMR-597; No. of Pages 8 2 G. Deslee et al. Réduction volumique ; Bronchoscopie ; Spirales
After more than 50 years of research, airway transplantation remains a major challenge in the fie... more After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
An 11-year-old girl was referred to our institution with complete obstruction of the left main st... more An 11-year-old girl was referred to our institution with complete obstruction of the left main stem bronchus by an endoluminal mass and was successfully treated by a combination of laser and mechanical debulking. Coring of the mass both allowed histological diagnosis (inflammatory myofibroblastic tumour) and definitive treatment with no recurrence after 3 years of follow-up. This case report emphasizes the major role of interventional bronchoscopy in the management of tumoural obstruction in children in whom benign conditions are frequent. Interventional bronchoscopy, which is minimally invasive when compared to surgery, in the vast majority of cases allows a precise diagnosis as it provides large samples of tissue removed during coring; in some cases it can be curative by itself and preserves lung parenchyma and function.
A 39-year-old-woman was treated successfully by a combination of endobronchial and bronchial arte... more A 39-year-old-woman was treated successfully by a combination of endobronchial and bronchial artery embolization for massive hemorrhage originating from the posterior segment of the right upper lobe. Endobronchial embolization was performed using a silicone spigot placed via fl exible bronchoscopy in order to prevent alveolar inundation preceding and during the time of bronchial artery embolization. Massive hemorrhage is a rare and severe condition associated with a high mortality that requires rapid intervention and management. We describe a case that emphasizes the effi cacy of a multidisciplinary approach including the use of a new bronchoscopic technique.
stents may have resulted in suboptimal management of complex airway pathologies. A prospective st... more stents may have resulted in suboptimal management of complex airway pathologies. A prospective study is warranted to further investigate the safety profile and complications associated with stent customization.
and a 55-year-old woman with known history of tracheobronchial papillomatosis were admitted with ... more and a 55-year-old woman with known history of tracheobronchial papillomatosis were admitted with hemoptysis and dyspnea, respectively. They presented increasing frequencies of respiratory infections in the preceding year despite therapy with interferon ␣ -2A, acyclovir, methotrexate and endobronchial treatment. Moreover, the 2nd patient presented 6 months previously to another institution with central airway obstruction which was treated with a covered metallic stent. Both patients underwent rigid bronchoscopy which revealed airway obstruction by papillomatous lesions. In the 2nd case, the metallic stent was broken due to fatigue and was infiltrated by a giant papilloma. Both patients re-
reduction in the vibration response on the affected side which correlated with the CXR. Sensitivi... more reduction in the vibration response on the affected side which correlated with the CXR. Sensitivity was 100%, specificity was 87% and positive predictive value and negative predictive value were 86 and 100%, respectively. Conclusions: This study demonstrates that VRI can be safely used to assess patients with pneumothoraces. Moreover, the analysis of breath sound distribution images obtained noninvasively can distinguish between patients with a normal chest examination from those with pneumothoraces.
patient was weaned off ventilation. The stent stayed in place for 2 years without major complicat... more patient was weaned off ventilation. The stent stayed in place for 2 years without major complications. This case represents the first stent ever inserted in a very rare condition combining tracheomegaly and extrinsic compression in Marfan's syndrome. It is also the first report of successful placement of the largest tracheal stent which was manufactured exclusively for the airway.
We report the first case in the literature of thoracoscopic bronchial reimplantation in 5 month-o... more We report the first case in the literature of thoracoscopic bronchial reimplantation in 5 month-old boy. The child was born with congenital cystic adenomatoid malformation of the right lower lobe associated with lower intralobar pulmonary sequestration diagnosed prenatally. An iatrogenic middle lobar bronchus injury was detected per-operatively during thoracoscopic lobectomy. Management and follow-up were exposed.
The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrins... more The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.
A 34-yr-old male presented with a 1-week history of a productive cough associated with small volu... more A 34-yr-old male presented with a 1-week history of a productive cough associated with small volume haemoptysis. This was preceded by a 3-month history of a chronic nonproductive cough and 6 kg weight loss. He denied chest pain, fever or night sweats. He admitted to increasing fatigue, but denied arthalgia, myalgia or skin rash. His past medical history was noncontributory.
In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma pre... more In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma prevalence are low. In most other areas, HDM allergen exposure is higher than the threshold for sensitization. In this setting, is HDM allergen exposure a factor which is causally related to the development of asthma in HDMsensitive individuals?
Mounier-Kuhn syndrome is a rare condition that combines tracheobronchomegaly (TBM) and severe tra... more Mounier-Kuhn syndrome is a rare condition that combines tracheobronchomegaly (TBM) and severe tracheobronchomalacia. Symptoms can be severe with recurrent bronchopulmonary infections and cough-induced syncope. Therapeutic management is non-specific and limited to chest physiotherapy and antibiotics during infectious exacerbations. We report a case of Mounier-Kuhn syndrome that was successfully managed by treating the posterior collapse of the central airway with yttrium aluminum pevroskyte laser. Endoscopic aspects, respiratory symptoms, and lung function tests all improved and remained stable with a follow-up of 8 years. Laser, at low power settings, could be a new therapeutic option in selected cases of tracheobronchomalacia. #
OBJECTIVES: After lung transplant, between 9 and 13% of bronchial anastomoses develop complicatio... more OBJECTIVES: After lung transplant, between 9 and 13% of bronchial anastomoses develop complications severe enough to warrant therapeutic intervention. These complications include stenosis, dehiscence, granulation tissue, bronchomalacia and fistula. Most of these have already been included in a classification or another, but none of these have been universally accepted. Moreover, no grading system has integrated all of these complications. The Groupe Transplantation (GT) (Transplant Group), from the Société de Pneumologie de Langue Française (SPLF) [French Language Pulmonology Society], maintains a prospective national registry of lung transplants performed in France. The GT has mandated the Groupe d'Endoscopie de Langue Française (GELF), also from the SPLF, to develop an endoscopic classification, in order to describe the macroscopic aspect of the bronchial anastomoses, and downhill airways, using a standardized and exhaustive grading system.
État des connaissances. -Les traitements médicaux de l'emphysème ont une efficacité limitée. La r... more État des connaissances. -Les traitements médicaux de l'emphysème ont une efficacité limitée. La réduction de volume chirurgicale est actuellement peu utilisée compte tenu d'une morbi-mortalité élevée. La réduction volumique endobronchique au moyen de spirales (Lung * Auteur correspondant. Adresse Modele + RMR-597; No. of Pages 8 2 G. Deslee et al. Réduction volumique ; Bronchoscopie ; Spirales
After more than 50 years of research, airway transplantation remains a major challenge in the fie... more After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
An 11-year-old girl was referred to our institution with complete obstruction of the left main st... more An 11-year-old girl was referred to our institution with complete obstruction of the left main stem bronchus by an endoluminal mass and was successfully treated by a combination of laser and mechanical debulking. Coring of the mass both allowed histological diagnosis (inflammatory myofibroblastic tumour) and definitive treatment with no recurrence after 3 years of follow-up. This case report emphasizes the major role of interventional bronchoscopy in the management of tumoural obstruction in children in whom benign conditions are frequent. Interventional bronchoscopy, which is minimally invasive when compared to surgery, in the vast majority of cases allows a precise diagnosis as it provides large samples of tissue removed during coring; in some cases it can be curative by itself and preserves lung parenchyma and function.
A 39-year-old-woman was treated successfully by a combination of endobronchial and bronchial arte... more A 39-year-old-woman was treated successfully by a combination of endobronchial and bronchial artery embolization for massive hemorrhage originating from the posterior segment of the right upper lobe. Endobronchial embolization was performed using a silicone spigot placed via fl exible bronchoscopy in order to prevent alveolar inundation preceding and during the time of bronchial artery embolization. Massive hemorrhage is a rare and severe condition associated with a high mortality that requires rapid intervention and management. We describe a case that emphasizes the effi cacy of a multidisciplinary approach including the use of a new bronchoscopic technique.
stents may have resulted in suboptimal management of complex airway pathologies. A prospective st... more stents may have resulted in suboptimal management of complex airway pathologies. A prospective study is warranted to further investigate the safety profile and complications associated with stent customization.
and a 55-year-old woman with known history of tracheobronchial papillomatosis were admitted with ... more and a 55-year-old woman with known history of tracheobronchial papillomatosis were admitted with hemoptysis and dyspnea, respectively. They presented increasing frequencies of respiratory infections in the preceding year despite therapy with interferon ␣ -2A, acyclovir, methotrexate and endobronchial treatment. Moreover, the 2nd patient presented 6 months previously to another institution with central airway obstruction which was treated with a covered metallic stent. Both patients underwent rigid bronchoscopy which revealed airway obstruction by papillomatous lesions. In the 2nd case, the metallic stent was broken due to fatigue and was infiltrated by a giant papilloma. Both patients re-
reduction in the vibration response on the affected side which correlated with the CXR. Sensitivi... more reduction in the vibration response on the affected side which correlated with the CXR. Sensitivity was 100%, specificity was 87% and positive predictive value and negative predictive value were 86 and 100%, respectively. Conclusions: This study demonstrates that VRI can be safely used to assess patients with pneumothoraces. Moreover, the analysis of breath sound distribution images obtained noninvasively can distinguish between patients with a normal chest examination from those with pneumothoraces.
patient was weaned off ventilation. The stent stayed in place for 2 years without major complicat... more patient was weaned off ventilation. The stent stayed in place for 2 years without major complications. This case represents the first stent ever inserted in a very rare condition combining tracheomegaly and extrinsic compression in Marfan's syndrome. It is also the first report of successful placement of the largest tracheal stent which was manufactured exclusively for the airway.
We report the first case in the literature of thoracoscopic bronchial reimplantation in 5 month-o... more We report the first case in the literature of thoracoscopic bronchial reimplantation in 5 month-old boy. The child was born with congenital cystic adenomatoid malformation of the right lower lobe associated with lower intralobar pulmonary sequestration diagnosed prenatally. An iatrogenic middle lobar bronchus injury was detected per-operatively during thoracoscopic lobectomy. Management and follow-up were exposed.
The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrins... more The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.
A 34-yr-old male presented with a 1-week history of a productive cough associated with small volu... more A 34-yr-old male presented with a 1-week history of a productive cough associated with small volume haemoptysis. This was preceded by a 3-month history of a chronic nonproductive cough and 6 kg weight loss. He denied chest pain, fever or night sweats. He admitted to increasing fatigue, but denied arthalgia, myalgia or skin rash. His past medical history was noncontributory.
In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma pre... more In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma prevalence are low. In most other areas, HDM allergen exposure is higher than the threshold for sensitization. In this setting, is HDM allergen exposure a factor which is causally related to the development of asthma in HDMsensitive individuals?
Mounier-Kuhn syndrome is a rare condition that combines tracheobronchomegaly (TBM) and severe tra... more Mounier-Kuhn syndrome is a rare condition that combines tracheobronchomegaly (TBM) and severe tracheobronchomalacia. Symptoms can be severe with recurrent bronchopulmonary infections and cough-induced syncope. Therapeutic management is non-specific and limited to chest physiotherapy and antibiotics during infectious exacerbations. We report a case of Mounier-Kuhn syndrome that was successfully managed by treating the posterior collapse of the central airway with yttrium aluminum pevroskyte laser. Endoscopic aspects, respiratory symptoms, and lung function tests all improved and remained stable with a follow-up of 8 years. Laser, at low power settings, could be a new therapeutic option in selected cases of tracheobronchomalacia. #
OBJECTIVES: After lung transplant, between 9 and 13% of bronchial anastomoses develop complicatio... more OBJECTIVES: After lung transplant, between 9 and 13% of bronchial anastomoses develop complications severe enough to warrant therapeutic intervention. These complications include stenosis, dehiscence, granulation tissue, bronchomalacia and fistula. Most of these have already been included in a classification or another, but none of these have been universally accepted. Moreover, no grading system has integrated all of these complications. The Groupe Transplantation (GT) (Transplant Group), from the Société de Pneumologie de Langue Française (SPLF) [French Language Pulmonology Society], maintains a prospective national registry of lung transplants performed in France. The GT has mandated the Groupe d'Endoscopie de Langue Française (GELF), also from the SPLF, to develop an endoscopic classification, in order to describe the macroscopic aspect of the bronchial anastomoses, and downhill airways, using a standardized and exhaustive grading system.
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