M.S. a 63 years-old male patient, had a smoking history of 40 pack-years. The patient received antibiotic treatment on his admission to a hospital for pneumonia symptoms. He had a right hilar mass on his chest X-ray and was referred to our center for hemoptysis. Flexible bronchoscopy under local anesthesia disclosed ~80% obliteration of the right main bronchus with a vegetating mass. Massive bleeding ensued after the biopsy. We proceeded with rigid bronchoscopy under general anesthesia. Trachea and left main bronchus were evacuated and blood was aspirated. Right main bronchus was totally cleared by the application of YAP-laser coagulation, vaporization, and mechanical resection. Silicon stent of 12-30 mm was implanted to prevent from the obliteration of the bronchial lumen with recurrent growth of tumor. Biopsy revealed epidermoid cancer.
Y.Y. a 67 years-old nonsmoker female patient was admitted with severe shortness of breath. Her chest X-ray revealed atelectasis on the right lung. Bronchoscopy disclosed an endoluminal vegetative tumoral lesion infiltrating the carina and obliterating almost all of the right main bronchus, and more than half of left main bronchus. We learned from the patientís history that she was treated with bronchotomy for a carcinoid tumor located in right main bronchus, 13 years ago.
The patient underwent bronchoscopic laser resection of the tumor under general anesthesia after receiving the diagnosis of typical carcinoid tumor again. After the eradication of the tumor mass by coagulation and vaporization a Y-silicon Dumon stent was implanted. The residual tumor lesion on the right upper lobe, which could not be reached by laser was treated with radiotherapy.
K.K. a 62 years-old male patient had a smoking history of 40 pack-years. He was treated with left pneumonectomy for non-small lung cancer. We hospitalized the patient for severe shortness of breath advancing in the last 6 months due to compression and fibrosis as a result of radiotherapy. The patient had hypoxemia and hypercapnia, and flexible bronchoscopy could not proceed beyond 2 centimeters from the vocal cords. After then balloon dilatation was performed with rigid bronchoscopy under general anesthesia. Tracheal lumen was widened with rigid bronchoscopy to implant silicon Dumon stent of 16-80 mm size. Soon after the procedure, hypoxemia and dyspnea were amended. The patient admitted again with severe shortness of breath 10 days after the stent implantation. On repeated bronchoscopy we found that the stent was severely obliterated with secretions. The patient improved after the aspiration of the secretions. Later interview with the patient revealed that he did not perform isotonic saline nebulization that he should have done 3 times a week after the implantation.
I.K. a 47 years-old male patient had a smoking history of 8-10 cigarettes a day for 18 years. He was admitted to a physician with dyspnea and hemoptysis 2.5 years after the operation for thymoma. He was referred to our center for bronchoscopic laser resection and stent implantation to an endobronchial tumoral mass that was found in his bronchoscopy as almost completely obliterating the left main bronchus. Rigid bronchoscopy was performed under general anesthesia to obtain biopsy and eradicate the endobronchial lesion by coagulation and vaporization. A Dumon silicon stent of 12-40 mm size was implanted to 2 centimeters beyond left main bronchus for the findings of external compression. The patient was admitted again with sudden onset of dyspnea 8 months after the procedure. His control bronchoscopy revealed proximal migration of the stent in the left main bronchus that occluded the trachea. The stent, which migrated due to tumoral enlargement, was removed. Repeat laser treatment was planned to the patient, whose dyspnea was resolved.
O.S. a 68 years-old male patient had a smoking history of 100 pack-years. On his first admission, bronchoscopy was performed for a mass in the anterior mediastinum, which disclosed findings of external compression on the left main bronchus. The patient received the diagnosis of non-small lung cancer with aspiration cytology and was treated with chemotherapy and radiotherapy for his inoperable tumor. Follow-up examination of the patient revealed that the tumoral mass was not responsive to the therapy and he had progressive dyspnea. He was admitted again 5 months after with severe dyspnea in a state of severe hypoxemia and hypercapnia. Bronchoscopy disclosed compression of the lower trachea at the carina level by external compression and almost total obliteration of the orifices of both main bronchi. Y-silicon Dumon stent was implanted after dilatation with rigid bronchoscopy. The patientís breathing improved dramatically and hypoxemia and hypercapnia returned to normal after the stent implantation.
K.A. a 63 years-old male patient had a smoking history of 40 pack-years. An intracranial mass was discovered in his previous admission to physician with the complaints of personality changes and headache. His operation by the neurosurgery department revealed adenocancer, originating from the lung. He was referred to our center for bronchoscopic laser resection as he developed severe dyspnea after four courses of chemotherapy and cranial radiotherapy. Bronchoscopic examination disclosed an endobronchial vegetative lesion, which completely occluded the right main bronchus. The tumor was eradicated by YAP-laser coagulation, vaporization, and mechanical resection. The patient was admitted again with dyspnea 3 months after the procedure. On repeated bronchoscopy we found that both main bronchi were obliterated with tumor lesion. YAP-laser was applied again and Y-silicon dumon stent was implanted to provide the anatomical integrity of the carina and two main bronchi. Both the patientís dyspnea and quality of life returned to normal after the laser resection.
B.S. a 57 years-old female patient had right pneumonectomy for bronchoalveolar carcinoma, 2 years before her admission. Progressive dsyspnea developed 6 months after the operation. On her computerized tomography scan aorta was squeezing the left main bronchus. Chest surgery department referred the patient to our center for the implantation of stent to the almost completely obliterated left main bronchus by external compression discovered in the bronchoscopy. On her repeated bronchoscopic examination collapse and almost total obliteration of left main bronchus was noticed during expiration. A silicon Dumon stent of 12-40 mm size was implanted via rigid bronchoscopy under general anesthesia. Bronchoscopic examination repeated after the stent implantation revealed that left main bronchus was not obliterated. The paitentís inspiration and expiration completelty returned to normal.
İ.«. a 66 years-old male patient had a smoking history of 90 pack-years. Chest X-ray examination on his admission with the symptoms of malaise and weight loss revealed a hilar mass on the right side. Bronchoscopic examination that was performed for the tumoral lesion detected in the computerized tomographic scan found no abnormality except for mild obliteration of the right main bronchus due to external compression. Aspiration biopsy revealed non-small cell lung cancer, but the patient denied surgical treatment. The patient was admitted again with progressive dyspnea on exertion after one year of treatment with chemotherapy and radiotherapy. Control bronchoscopy disclosed almost complete obliteration of the right main bronchus due to external compression. A silicon type dumon stent of 12-25 mm size was implanted by through rigid bronchoscopy under general anesthesia. Auscultation of the right lung showed that lung sounds returned to normal, while his dyspnea was completely improved.
F.S. a 23 years-old female patient has remained intubated for a long time due to HELP syndrome that developed after delivery. Bronchoscopy performed upon her admission to the department of chest diseases with severe dyspnea after about 2 months, revealed the diagnosis of post-intubation tracheal stenosis. Her dyspnea recurred 1 month after she was treated with sleeve resection. She was referred to our center by department of thoracic surgery and bronchoscopy was performed, which disclosed a narrow tracheal lumen of 3 mm. Membraneous stricture was removed by YAP-laser vaporization. The patient was admitted again 3 months after the dilatation of trachea to its normal diameter with restenosis. YAP-laser procedure was repeated with implantation of a silicon stenotic stent. The patient remained symptomless (i.e. cured) after laser resection and stenotic stent implantation.
R.B. a 44 years-old female patient was investigated with computerized tomography and bronchoscopy in the department of chest diseases upon her referral with dyspnea after being treated for thyroid cancer in the department of oncology. Metastatic solid lesions were detected in the computerized tomography of thorax. Bronchoscopic examination revealed that tracheal segment ~2 cm proximal to the carina was obliterated almost completely due to external compression. A silicon stent of 80-15 mm size was implanted after balloon dilatation of the trachea. The patientís breathing improved after the procedure. A few weeks later, her dyspnea and ventilation perfusion mismatch got worse as the parenchymal lesions extended to the entire lung. The patient was intubated and connected to mechanical ventilator as her metabolic condition was deteriorated. Control bronchoscopy disclosed an almost completely open trachea without any problem due to stent.
S.C. a 62 years-old female patient was admitted to the department of chest diseases with dyspnea and stridor. She was receiving bronchodilator treatment. Her medical history revealed that she was hemiplegic due to a cerebrovascular accident and remained in the intensive care unit for more than two weeks. Bronchoscopy was performed, as the patient did not respond to bronchodilator therapy, which disclosed a membraneous fibrotic stricture in the middle trachea with an orifice of 3-4 mm presumably due to intubation. Flexible bronchoscope could not pass beyond the stricture. Membraneous part was eradicated by YAP-laser vaporization. Tracheal lumen was dilated to its normal diameter by dilatation balloon and rigid bronchoscope. The patient, whose breathing returned completely to normal after the laser resection is followed by our center without any finding of restenosis.
A.A. a 77 years-old male patient, is smoking cigarettes. Pneumonia and right upper lob atelectasis was diagnosed in the patient, who had symptoms of fever, and productive cough. Bronchoscopy was performed later as the patient had hemoptysis, which disclosed a broad based polypoid tumoral mass obliterating the tracheal lumen almost completely at the middle part. Flexible bronchoscope, which proceeded beyond the lesion showed complete obliteration of the right upper lobe due to external compression. Biopsy specimens from the right upper lobe orifice revealed epidermoid cancer. Biopsies repeated from the tracheal tumor revealed lipoma. Tracheal lesion was coagulated with YAP-laser. Endobronchial therapy was completed with mechanical resection and vaporization without any residual tumor on the tracheal wall. The patient was operated with pneumonectomy for the right upper lobe epidermoid cancer. Treatment of the tracheal lesion with laser resection has provided the opportunity of surgical cure to the patient.
Y.÷. a 64 years-old male patient has smoked for a long time. The patient had progressive dyspnea, after he received chemotherapy and radiotherapy for epidermoid cancer. Bronchoscopic examination showed that distal segment of trachea was almost completely occluded by a tumoral lesion. YAP-laser coagulation and vaporization without the chance of visualization beyond the tumor eradicated the endoluminal tumor in two procedures. Both main bronchial orifices and the tracheal carina were infiltrated with tumor. Residual tumor tissues on the tracheal and bronchial wall were completely vaporized by laser to provide the anatomical integrity of tracheobronchial tree. The patient, who was severely dyspneic and cyanotic, returned to normal after the bronchoscopic laser resection. Y-silicon stent, which was reserved for the tumor involvement of carina, was implanted to prevent from the obliteration of tracheal lumen by recurrent tumor tissue.
H.÷. a 34 years-old female patient was follwed by the department of neurology with the diagnosis of epilepsy. The patient was treated in the intensive care unit before, and referred to department of chest disease for dyspnea and stridor. Her bronchoscopic examination revealed a membraneous stricture with 3 mm opening in the middle part of trachea. YAP-laser was performed to eradicate the fibrotic membraneous tissue by vaporization. Tracheal lumen was dilated by rigid bronchoscope and balloon dilatation. Emergency laser resection was performed, as stenosis recurred after two months. Membraneous stricture was completely vaporized and tracheal lumen was dilated to its normal diameter. Curative treatment of the post-intubation tracheal stenosis was completed by implantation of a stenotic silicon stent to the stricture site.
H.E. a 63 years-old male patient had a smoking history of long time duration. The patient was referred to our center for endobronchial treatment for dyspnea and recurrent pneumonia, after he received chemotherapy and radiotherapy in oncology department with the diagnosis of epidermoid cancer. The patient had gastrostomy, as he could not eat due to esophageal compression. Bronchoscopy showed almost complete obliteration of distal tracheal lumen and left main bronchus. Tumoral tissue invading the trachea, carina, and left main bronchus was completely eradicated by YAP-laser coagulation, vaporization, and mechanical resection. Bronchoesophageal fistula was noted in the left main bronchus. Anatomical integrity of the tracheobronchial lumen and hence treatment of the fistula were provided by Y-silicon stent implantation.
A.K. a 31 years-old female patient was operated in the ENT (Ear Nose and Throat) surgery department for sinusitis under local anesthesia. On the next day of the operation, the patient had cough and dyspnea. Computerized tomography of the thorax, which was obtained, as the patient did not improve on asthma treatment of 6 months, revealed a stone obliterating the left bronchus. The patient was told that the stone removed by the ENT operation fell to the lung. Bronchoscopy showed the stone located in the left lower lobe bronchus. Rigid bronchoscopic interventions to remove the stone were not successful due to bleeding. Her chest X-ray in our center showed hyperinflation in the expiration. On rigid bronchoscopy we observed that the left main bronchus was completely obliterated by the stone and the surface was covered with hemorrhagic granulation tissue. YAP-laser was performed to coagulate the granulation tissue and the stone. After bleeding control, the stone extending from the left main bronchus to the lower lobe was fragmented into small pieces and removed. The patientís breathing returned completely to normal.
K.S. a 67 years-old male patient was being followed for broncholithiasis for a long time. Bronchoscopic examination was suggested to investigate his symptom of severe dyspnea. His chest X-ray and computerized tomographic scan of the thorax revealed stone in the lumen of both main bronchi. Bronchoscopy showed that both main bronchi were almost completely obliterated by stones. Removal of the stones by forceps was not possible due to the bleeding of granulation tissue, which covered the bronchial wall. YAP-laser was performed under general anesthesia to control bleeding by coagulating the granulation tissue. After the stones were fragmented into small pieces by coagulation and vaporization, both main bronchi were cleared from the stones. Bleeding was controlled by YAP-laser coagulation of the hemorrhagic granulation tissue. The patientís breathing returned completely to normal.
B.S. a 57 years-old female patient had respiratory failure due to total obliteration of left main bronchus by external compression of the aorta. The patient was previously treated by right pneumonectomy for bronchoalveolar carcinoma. The patient was admitted again with mild dyspnea five months after the implantation of silicon stent. Bronchoscopic examination showed that the stent was in its place and functional, but obliterated almost 50% by granulation tissue. Rigid bronchoscopy was performed under general anesthesia through the silicon stent to eradicate the granulation tissue by vaporization. The patientís breathing returned completely to normal after the left main bronchus was completely opened.
Z.Y. a 68 years-old patient had a smoking history of long duration. The paitent was referred to the department of chest diseases with progressive dyspnea by the oncology department, where he was treated fro lung cancer. The patient had severe dyspnea and auscultation of the lung was silent. Hypoxemia and hypercapnia were detected in the patient, who had shortness of breath. Bronchoscopic examination revealed a tumoral mass, which almost completely obliterated the lumen of lower trachea. It was not possible to visualize beyond the endotracheal mass. Tracheal mass was eradicated by YAP-laser coagulation and mechanical resection via rigid bronchoscopy under general anesthesia. It was noted that tracheal carina and left main bronchus were almost completely invaded by tumoral tissue and the lumen was completely obliterated. In the next two sessions, tumoral tissue was completely vaporized. Y-silicon stent was implanted to provide the anatomic integrity of tracheobronchial tree. The paitentís breathing status and arterial blood gases returned completely to normal.
Y.Y. a 67 years-old female patient was treated for typical carcinoid tumor by right bronchocotomy, 13 years before. He was treated by YAP-laser resection and Y-silicon stent implantation for the recurrence of carcinoid tumor, which obliterated the tracheal carina, right main bronchus, and left main bronchus. Control bronchoscopic examination showed that the stent was in its proper place and functional, but both main bronchi covered with a 5 mm granulation tissue. Six months after then, the stent was removed, while the anatomical structure was noted as returned to normal. Nodular granulation tissue in both main bronchi was completely eradicated by YAP-laser coagulation and vaporization. Granulation tissue is observed in 10% of the cases after the silicon stent implantation. Its treatment is reliably achieved by laser application. The patient is under follow-up without any problem.
O.E. a 60 years-old male patient had a smoking history of a long duration. He received chemotherapy and radiotherapy for the treatment of epidermoid lung cancer. Physical examination of the patient on his admission to the department of chest diseases with severe dyspnea revealed that the right lung was not aerated. Bronchoscopic examination showed obliteration of the right main bronchus by more than 50%, and the lobar bronchi almost completely by external compression. Right main bronchus and intermediate bronchus were dilated by rigid bronchoscopy under general anesthesia. Middle lobe orifice was obliterated with two white solid lesions. The lesions were removed by forceps to keep the middle lobe open. Dumon silicon stent of 12-40 mm size was implanted after the balloon dilatation of the right main bronchus. The patientís dyspnea was resolved, while breathing sounds in the right middle and lower lobes returned to normal.
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Son gŁncelleme 31 Ağustos 2002 Cumartesi