Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. In 90% of cases, the source of massive hemoptysis is the bronchial circulation. Diagnostic studies for massive hemoptysis include radiography, bronchoscopy, and computed tomography (CT) of the chest. Bronchoscopy and chest radiography have been considered the primary methods for the diagnosis and localization of hemoptysis. Many researchers currently suggest that CT should be performed prior to bronchoscopy in all cases of massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. Knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patie...

https://pubs.rsna.org/doi/pdf/10.1148/rg.226015180

Bronchial and Nonbronchial Systemic Artery Embolization for Life-threatening Hemoptysis: A Comprehensive Review

Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.

/pdf/extracorporeal-blood-purification-and-organ-support-in-the-249l01znbw.pdf

Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation.

https://www.jvascsurg.org/article/S0741-5214(03)00707-9/pdf

Giant mediastinal bronchial artery aneurysm mimicking benign esophageal tumor: a case report and review of 26 cases from literature.

Background
Oesophagectomy followed by oesophagogastrostomy is the preferred treatment for early-stage oesophageal cancer. It carries the risk of anastomotic leakage after oesophagogastric anastomosis, which causes considerable morbidity and mortality and is one of the most dangerous complications. Omentoplasty has been recommended by some researchers to prevent anastomotic leaks associated with oesophagogastrostomy. However, the value of omentoplasty for oesophagogastrostomy after oesophagectomy has not been systematically reviewed.

Objectives
To assess the effects of omentoplasty for oesophagogastrostomy after oesophagectomy in patients with oesophageal cancer.

Search methods
A comprehensive search to identify eligible studies for inclusion was conducted using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PubMed and other reliable resources.

Selection criteria
Randomised controlled trials comparing omentoplasty versus no omentoplasty for oesophagogastrostomy after oesophagectomy in patients with oesophageal cancer were eligible for inclusion.

Data collection and analysis
Two review authors (Yong Yuan and Xiaoxi Zeng) independently assessed the quality of included studies and extracted data; disagreements were resolved through arbitration by another review author. Results of dichotomous outcomes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs), and continuous outcomes were expressed as mean differences (MDs) with 95% CIs. Meta-analysis was performed when available data were sufficiently similar. Subgroup analysis was carried out on the basis of different approaches to surgery.

Main results
Three randomised controlled trials (633 participants) were included in this updated review. No significant differences in hospital mortality were noted between the study group (with omentoplasty) and the control group (without omentoplasty) (RR 1.28, 95% CI 0.49 to 3.39). None of the included studies reported differences in long-term survival between the two groups. The incidence of postoperative anastomotic leakage was significantly less among study participants treated with omentoplasty than among those treated without (RR 0.25, 95% CI 0.11 to 0.55), but the additional benefit was seen in the subgroup analysis only for participants undergoing a transhiatal oesophagogastrectomy (THE) procedure (RR 0.23, 95% CI 0.07 to 0.79); transthoracic oesophagogastrectomy (TTE) (RR 0.19, 95% CI 0.03 to 1.03); or three-field oesophagectomy (RR 0.33, 95% CI 0.09 to 1.19 ). Omentoplasty did not significantly improve other surgery-related complications, such as anastomotic stricture (RR 0.91, 95% CI 0.33 to 2.57). However, participants treated with omentoplasty could reduce the duration of hospitalisation compared with that seen in the control group (MD -2.13, 95% CI -3.57 to -0.69).

Authors' conclusions
Omentoplasty may provide additional benefit in decreasing the incidence of anastomotic leakage after oesophagectomy and oesophagogastrostomy for patients with oesophageal cancer without increasing or decreasing other complications, especially among those treated with THE. It also has the potential to reduce the duration of hospital stay after operation. Further randomised controlled trials are needed to investigate the influences of omentoplasty on the incidence of anastomotic leakage and anastomotic stricture, long-term survival, duration of hospital stay and quality of life after oesophagectomy and oesophagogastrostomy when different surgical approaches are used.

Omentoplasty for oesophagogastrostomy after oesophagectomy

A patient is presented in whom rupture of a bronchial artery aneurysm produced a clinical picture indistinguishable from an aortic dissection. This case emphasises the importance of considering alternative diagnoses when a patient presents with symptoms typical of a particular condition.

https://heart.bmj.com/content/heartjnl/39/8/909.full.pdf

Ruptured bronchial artery aneurysm mimicking aortic dissection.

Bronchial artery aneurysm.

Rupture of a chronic expanding hematoma of the thorax into lung parenchyma.

Excision of an invasive thymoma: a cure for ulcerative colitis?

Upper sleeve lobectomy for lung cancer with tracheal bronchus

1998年10月～2004年5月に, 集学的治療を行った悪性胸膜中皮腫は7例で, 男性7例, 年齢50～72歳 (平均60.6±7.0歳), 病側は左4例, 右3例であった. 治療内容は, 胸膜肺全摘術, 術後化学療法 (ADM 60mg/m2, CPA 600mg/m2, CDDP 70mg/m2) および放射線療法 (術側全胸壁に54～60Gy) とした. 組織亜型は, epithelial type 5例, sarcomatous type 2例で, International Mesothelioma Interest Group (IMIG) による臨床病期はIII期5例, IV期2例であった. 病巣は全例肉眼的には完全切除された. 術後合併症は, 心不全3例で軽快した. 化学療法によるGrade 4の毒性は5例にみられ, 好中球減少が5例, 貧血が1例, 血小板減少が1例, 食欲不振が1例であった. 5例は治療を完遂したが, 1例はPSの低下のため化学療法・放射線療法を途中で中止し, 1例は化学療法により全身状態不良となり中止した. 全症例の2年生存率, 5年生存率はそれぞれ68.6%, 45.7%であり, 中間生存期間は29.0ヵ月であった. 悪性胸膜中皮腫に対する集学的治療は, 長期生存を期待できる.

Multimodality therapy for malignant pleural mesothelioma

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