الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 184 |  |  |
| | | from | 184 | | |
Abstract
Central airway obstruction (CAO) involving the trachea and main bronchi is a significant cause of morbidity and mortality among the patients of thoracic diseases. Primary and metastatic carcinomas of the lung are the most common causes of central airway obstruction (CAO). Spray cryotherapy (SCT) is the application of liquid nitrogen in a non-contact form. It leads to cellular death with the preservation of the tissue scaffolding, which can be distributed over a wide area. The aim of the work was to assess safety, efficacy and immunological effects of bronchoscopic spray cryotherapy for treatment of endobronchial malignant tumors. This prospective randomized controlled study was conducted at Chest Medicine Department (Bronchoscopy Unit) Mansoura University Hospitals during the period from April 2018 to July 2020 after approval of Mansoura Faculty of Medicine Institutional Research Board (MFM-IRB) code: MD.18.03.18.R1. Results: This study included 14 male patients and 2 females with a median age 56 (46 – 64) years; 50% were smokers while 12.5% were ex-smokers and 37.5% were non- smokers. As regards cell type of endobronchial tumors among studied patients: 6 cases (37.5%) were adenocarcinoma, 6 cases were squamous cell carcinoma (37.5%), 2 cases were large cell carcinoma (12.5%) and 2 cases were undifferentiated carcinoma (12.5%). As regard clinical response in studied patients: there was a significant reduction of dyspnea score after cryospray when compared to that before treatment (P: 0.003). Also there was a significant reduction of cough score after treatment when compared to that before treatment (P: 0.002). Hemoptysis had been improved significantly after cryospray when compared to that before treatment (P: 0.001). Pneumothorax occured in two patients (12.5%) and needed ICT insertion. Transient hypotension and bradycadia occurred in one patient (6.3%), treated with IV fluids and ephedrine. Transient hypoxemia was observed in one patient (6.3%). One patient (6.3%) had type 2 respiratory failure and required MV for 24 hour after therapy, weaned and discharged .There were no deaths in our study. As regard immunological assessment there was statistically significant increase in serum interleukin 12 levels after cryospray versus that before. The median values before cryospray was 2.85 (2.24- 4.25), increased to 6.18 (3.9- 9.4) after therapy (p 0.002). Also there was statistically significant increase in BAL interleukin 12 levels after cryospray. The median values before therapy was 3.59 (2.22 –10.11), increased to 4.81 (2.27 – 42.18) after cryospray (p 0.003). Conclusion: Spray Cryotherapy for endobronchial malignant tumors is a safe, effective modality in alleviating symptoms, improving performance, quality of life and ventilatory functions in patients with malignant central airway obstruction. Spray cryotherapy has immune-mediated tumoricidal mechanisms.