Abstract
The production of bronchial stenosis by the simple method of the endobronchial application of a caustic has given rise to considerable experimental work. Adams and Livingstone painted the orifice of a bronchus with a 35% silver nitrate solution, which resulted in complete stenosis of that bronchus in a high percentage of attempts. This demanded repetition in view of the many possibilities for the application of such a method in clinical conditions.
Following the technique of Adams and Livingstone 1 we have failed to produce complete stenosis in either dogs or monkeys in experiments during the last 1 1/2 years. Either we produced so great a destruction that rupture of the bronchus or a serious pneumonitis distal to the bronchus occurred, or stenosis failed to result. Stenosis with complete collapse of the lobe distal to this occurred in but a small percentage of our animals.
The desirability of the method led to a search for other solutions which might be more efficacious. To produce a permanent bronchial occlusion by a safe method, the substance should act slowly and over a long period of time. It must penetrate deeply and produce a peribronchial fibrosis with little damage to the mucosa of the bronchus or to the lung distal to the application. If it be used on the bronchus to a lobe, the seat of an inflammatory process, there should be ideally no denudation of the epithelium of the bronchus.
Concentrated solutions of the acridine dyes were tested for this purpose, since it is well known that when these dyes are used for urethral irrigation they produce considerable periurethral fibrosis. Our experiments with 37 dogs show that a 25% aqueous solution of acid acriflavine applied to a bronchus by the bronchoscopic route produces with great regularity in from 3 to 4 weeks an occlusion of that bronchus.
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