Airway self-expandable metallic stents (SEMS) were initially studied in malignant airway obstruction; however, their use in benign airway diseases has become progressively more frequent. This may be explained by their ease of insertion compared with silicone stents, which require rigid bronchoscopy for insertion. While initial experience with SEMS in benign disease suggested efficacy and promising short-term safety profile, long-term follow-up revealed significant complication rates. In addition to a high complication rate, the management of these complications is made more difficult by the semipermanent nature of these devices. Reported complications include infection, granulation tissue formation, stent migration, stent fracture, airway perforation and fistula formation, as well as extension of the initial injury, potentially eliminating other therapeutic options such as surgical resection. Therefore, SEMS should only be used in nonmalignant large airway disease as a last resort for patients in whom other endoscopic methods, including silicone stents and dilations, as well as surgical options have failed or are technically not feasible.

The purpose of this study was to determine whether mean power output in 30 seconds was greater in a paced effort test or an all-out effort under optimal loading conditions. Nine male athletes volunteered to participate. All testing was done on a Monark cycle ergometer with continuous measurement of velocity and resistance. Power output was calculated (Resistance x Velocity) and corrected for acceleration of the flywheel. For each subject, optimal resistance for peak power output was determined with 5 brief (7-second) tests. Subsequently, 3 all-out 30-second tests using 80, 90 and 100% of this estimated optimal resistance, then 3 paced effort 30-second tests were completed on separate days. Pacing was accomplished with velocity feedback at 80, 100 or 120% of optimal velocity calculated from the all-out tests. Subjects were encouraged to try to exceed the target velocity if possible during the final 10 seconds of the paced effort test. The best all-out test (772 +/- 35 W) was not different (paired t test, p = 0.31) from the best paced effort test (787 +/- 27 W). Furthermore, there was no significant difference between mean power output in the all-out tests at 90% (736 +/- 28 W) and 100% (766 +/- 36 W) of estimated optimal resistance for peak power output (1.16 +/- 0.05 N x kg[-1]), but mean power at 80% of the estimated optimal resistance was lower (722 +/- 31 W; ANOVA for repeated measures, p < 0.05). In conclusion, a paced effort test does not permit greater mean power output over 30 seconds than an all-out test, and there is considerable latitude in apparent optimal resistance for mean power output in a 30-second test.

Schwannomas are benign nerve-sheath tumors that arise from Schwann cells. They can present as endobronchial lesions with symptoms of obstruction and hemoptysis. We describe the first case of multiple endobronchial schwannomas at 3 different sites in a single patient. The autofluorescence ratio was <0.5 for 2 of 3 lesions. The optimal follow-up and treatment plan for these lesions remain unknown, especially in asymptomatic patients.

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