Susanti Ie

Pulmonary toxicity of polymeric hexamethylene diisocyanate aerosols in mice

The acute pulmonary response of male C57BL/6 mice exposed to respirable polymeric hexamethylene diisocyanate biuret trimer aerosol (HDI-BT), a component of polyurethane spray paints, was examined. Mice were exposed to concentrations of 1 and 10 mg/m(3) HDI-BT for 5 h and were evaluated 6, 18, 42, 90, 186, and 378 h after the end of exposure. Mice exposed to 1 or 10 mg/m(3) HDI-BT exhibited dose-dependent lung function impairment, edema, neutrophilic inflammation, cellular proliferation, and histologic lesions in terminal bronchioles and alveolar ducts. Impairment of pulmonary function, indicated by decreased frequency and increased enhanced pause (Penh), was maximal immediately after exposure and progressively recovered at later time points. Lung weight and lavage fluid protein content peaked at 6 and 18 h after exposure, respectively. Total cells and macrophages recovered in lavage fluid peaked 90 h after exposure. Neutrophils recovered in lavage fluid peaked between 18 and 42 h after exposure. Proliferative lesions, as identified histologically and by bromodeoxyuridine incorporation, were maximal 90 h after exposure. In contrast, no inflammatory cell influx, protein leakage, or lung pathology were observed in mice exposed to 360 ppb HDI monomer vapor. This model will be useful for investigating molecular mechanisms by which HDI-BT causes lung injury, which is known to occur in humans exposed occupationally to this pulmonary toxicant.

Right vocal cord paralysis and mediastinal lymphadenopathy

A non-smoking 45-year-old white man presented with a globus sensation worsened by lying down, with no complaints of hoarseness or dysphonia. He denied fever, fatigue, cough, chest pain, sweats, weight loss, reflux, arthralgias, myalgias and rash. He also denied exposure to asbestosis, beryllium, silica, HIV or tuberculosis, but he reported a recent cat bite. Physical examination revealed normal vital signs, no cervical or supraclavicular lympadenopathy and a normal cardiorespiratory system. He was referred to the otolaryngology department. Laryngoscopy revealed right vocal cord paralysis. A CT scan of the neck/chest identified diffuse mediastinal lymphadenopathy without parenchymal changes (figures 1 and 2). Figure 1 CT scan of high right paratracheal lymph node. Figure 2 CT …

Mucosal Airway Laceration Secondary To Endobronchial Ultrasonography

Endobronchial ultrasound-guided transbronchial needle aspiration is becoming the standard of care for mediastinal sampling to diagnose and stage lung cancer. It is considered to be safe and rivals the gold standard, mediastinoscopy, in safety and accuracy. The present article describes a mucosal airway laceration and pneumothorax associated with the procedure.

Vertebral body tumor biopsy: An expanded role of endobronchial ultrasound-guided transbronchial needle aspiration.

Endobronchial ultrasound has become routinely utilized to improve sampling of mediastinal and hilar lymph nodes in the evaluation of suspected lung cancer. In addition, unconventional uses of this technology have also been occasionally reported, such as to drain a bronchogenic cyst. We present a case where endobronchial ultrasonography allowed for a safe approach to the biopsy of a vertebral body tumor. The case further illustrates how this technology may allow the bronchoscopist to diagnose metastatic disease, which may not reside within the lung or be directly attached to the main airways.

Not all right-sided hearts are the same-the importance of identifying the correct diagnosis.

Scimitar syndrome is characterized by an anomalous venous return with the characteristic chest roentgenogram (CxR) appearance of the anomalous vein draining into the inferior vena cava (IVC). This appears as a curvilinear opacity paralleling the right border of the heart resembling a curved sword or Scimitar. A 27-year-old white woman with a reported history of dextrocardia was admitted after a drug overdose. Examination demonstrated an obtunded woman with tachycardia and right sided heart sounds. Her CxR revealed a right sided heart image with two curvilinear opacities in the retrocardiac area. Chest computed tomography (CT) demonstrated that these opacities join to represent an anomalous vein draining into IVC. Furthermore, an anomalous systemic artery arising from the abdominal aorta was seen to supply the right lower lobe. The patient was eventually diagnosed with Scimitar syndrome. This syndrome affects 1-3 in 100,000 live births while nearly half of the patients remain asymptomatic with some initially being misdiagnosed as dextrocardia, such as in our case. Correctly diagnosing these patients is of paramount importance as some can develop severe pulmonary hypertension and right ventricular failure. In turn, close ongoing echocardiographic monitoring can help identify those that may benefit from surgical interventions to prevent them from developing these complications.

New cancer or carcinoid progression to small cell lung cancer

Carcinoids and small cell lung cancer share neuroendocrine cellular origins. Surgery is the definitive treatment in typical carcinoid with few recurrences. For patients considered to be poor surgical candidates, ablative and cryotherapies have been utilized with good results. The long-term consequences of these alternatives approaches are unclear. We report a case of typical carcinoid treated with various alternative approaches over a period of 6 years with either transformation to small cell lung cancer or the development of a new primary in the same location.

Nonsurgical Modalities for Treatment of Early-stage Lung Cancer

For patients with early-stage non–small cell lung cancer, the gold standard of treatment remains surgery. The natural history of patients with early-stage lung cancer who do not undergo any treatment has been retrospectively reviewed and despite identification of lung cancer at it earliest stages, survival is poor in patients who do not undergo treatment. For patients who decline or are deemed too high risk for surgery conventional radiation therapy has been the preferred nonsurgical approach, but local control rates remain low when compared with surgical resection. There have been ongoing advances in nonsurgical treatment approaches for early-stage non–small cell lung cancer. Knowledge of the various nonsurgical modalities, their effectiveness, and risks is needed to provide each patient with the most appropriate, effective, and advanced care.

The safety of cryobiopsy in diagnosing carcinoid tumors.

Background:Cryotherapy probes have recently found an expanding role as a routine diagnostic instrument to sample endobronchial pathology. However, its overall safety and efficacy in biopsying carcinoid tumors has not been clearly established. Carcinoid tumors are more vascular and may be prone to more bleeding when biopsied by a cryoprobe. Methods:Review of 5 cases that underwent cryoprobe biopsies for carcinoid tumors was carried out. Results:Cryobiopsy was successful to diagnose all suspected cases of endobronchial carcinoid tumors. The samples obtained were of good quality and devoid of crush artifact. There was no associated significant bleeding or other complications. Conclusions:Cryotherapy probe biopsy should be considered a safe and effective approach to diagnose carcinoid tumors.