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Li Z, Lu X, Wu K, Wang J, Li Y, Li Y, Ren K, Han X. Graphene oxide-loaded rapamycin coating on airway stents inhibits stent-related granulation tissue hyperplasia. Eur J Cardiothorac Surg 2024; 66:ezae270. [PMID: 38980196 DOI: 10.1093/ejcts/ezae270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/24/2024] [Accepted: 07/09/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES Our objective was to explore the safety and efficacy of a graphene oxide-loaded rapamycin-coated self-expandable metallic airway stent (GO@RAPA-SEMS) in a rabbit model. METHODS The dip coating method was used to develop a GO@RAPA-SEMS and a poly(lactic-co-glycolic)-acid loaded rapamycin-coated self-expandable metallic airway stent (PLGA@RAPA-SEMS). The surface structure was evaluated using a scanning electronic microscope. The in vitro drug-release profiles of the 2 stents were explored and compared. In the animal study, a total of 45 rabbits were randomly divided into 3 groups and underwent 3 kinds of stent placements. Computed tomography was performed to evaluate the degree of stenosis at 1, 2 and 3 months after the stent operation. Five rabbits in each group were sacrificed after the computed tomography scan. The stented trachea and blood were collected for further pathological analysis and laboratory testing. RESULTS The in vitro drug-release study revealed that GO@RAPA-SEMS exhibited a sudden release on the first day and maintained a certain release rate on the 14th day. The PLGA@RAPA-SEMS exhibited a longer sustained release time. All 45 rabbits underwent successful stent placement. Pathological results indicated that the granulation tissue thickness in the GO@RAPA-SEMS group was less than that in the PLGA@RAPA-SEMS group. The TUNEL and hypoxia-inducible factor-1α staining results support the fact that the granulation inhibition effect in the GO@RAPA-SEMS group was greater than that in the PLGA@RAPA-SEMS group. CONCLUSIONS GO@RAPA-SEMS effectively inhibited stent-related granulation tissue hyperplasia.
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Affiliation(s)
- Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Xin Lu
- School of Chemical Engineering, Zhengzhou University, Zhengzhou, China
| | - Kunpeng Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Jing Wang
- School of Chemical Engineering, Zhengzhou University, Zhengzhou, China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Yifan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
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Messina G, Di Filippo V, Capasso F, Puca MA, Leonardi B, Grande M, Rainone A, Leone F, Vicario G, De Gregorio S, Cerullo G, Ponticiello A, Pirozzi M, Farese S, Zotta A, Natale G, Messina G, Vicidomini G, Fiorelli A, Ciardiello F, Fasano M. Modified blade: an interventional option in rigid bronchoscopy for non-resectable benign tracheal stenosis. J Cardiothorac Surg 2024; 19:73. [PMID: 38331792 PMCID: PMC10851474 DOI: 10.1186/s13019-024-02576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Benign tracheobronchial stenosis is a abnormal tracheal lumen narrowing that may incur progressive dyspnea and life-threatening hypoxemia. There is no consensus on which patients should be treated with endoscopic or surgical method. This study investigates the outcomes of bronchoscopic dilatation in the treatment of benign tracheal stenosis using a device equipped with a blade to cut the stenotic lesions with dense fibrosis. MATERIALS AND METHODS The procedure was carried out in an operating room under general anesthesia. All patients were intubated with a Rigid Bronchoscope (RB) placed just above the stenosis. Through Rigid Bronchoscopy combined modalities were used as needed: radial incisions of the mucosal stenosis with blade at the levels of 4, 8 and 12 o'clock, with back and forth movements, then the stenotic area was dilated more easily with a rigid bronchoscope. Dilatation was performed by passing the RB of increasing diameter through stenotic areas and then Balloon dilatation of increasing diameter. There were no complications during the procedure. RESULT We conducted an observational, retrospective, single-centre study in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2011 to September 2021. We included all consecutive patients with benign tracheal stenosis inoperable. During the study period, 113 patients were referred to our department with benign tracheal stenosis inoperable. 61 patients were treated with the blade. During the follow-up, a recurrence of the stenosis was observed in 8 patients in the first month and in 4 patients in the third month. Instead in the patients treated with the use of laser (52 patients), during the follow-up a recurrence was observed in 16 patients in the first month and in 6 patients in the third month; no patient relapsed after 6 months and after 1 year. Long term successful bronchoscopic management with blade was attained by 99% in simple and 93% in mixed stenosis and in complex type stenosis. CONCLUSION Our study underlines the importance of the use of the blade in bronchoscopic treatment as a valid conservative approach in the management of patients with inoperable benign tracheal stenosis as an alternative to the use of the laser, reducing the abnormal inflammatory reaction in order to limit recurrences.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy.
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Francesca Capasso
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Maria Antonietta Puca
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
- Nutrition Science, University of Foggia, Foggia, Italy
- Pneumology Unit, Hospital of Caserta, Caserta, Italy
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Mario Grande
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Anna Rainone
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Francesco Leone
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Giuseppe Vicario
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Simona De Gregorio
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giuseppe Cerullo
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | | | - Mario Pirozzi
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Stefano Farese
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Alessia Zotta
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | | | - Giovanni Vicidomini
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Morena Fasano
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
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Zhang Y, Dai Z, Xia Q, Wu Y, TingxiaoZhao, Chen Q, Xia C, Zhang J, Xu J. Bibliometric and visualized analysis of scientific publications on subglottic stenosis based on web of science core collection. J Cardiothorac Surg 2024; 19:55. [PMID: 38311728 PMCID: PMC10840188 DOI: 10.1186/s13019-024-02515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Subglottic Stenosis (SGS), with increasing numbers of studies, is the most specific and common clinical type of Laryngotracheal Stenosis (LTS). There is rapid publication turnover with newer management introduced and expanding research field. To our knowledge, there is no bibliometric analysis of SGS yet. METHODS In August 2022, we performed a thorough search in the Web of Science Core Collection database using the word "subglottic stenosis," and "SGS." The 580 articles were arranged based on correlation. The collected articles were then analyzed with an assessment of relevant factors. Meanwhile, we analyzed the top 100 most-cited articles on SGS. RESULTS The frequency of publication on SGS has increased substantially over time. The USA has contributed the most articles (n = 301). Vanderbilt University published most of the articles among other institutions (n = 18). Laryngoscope topped the list of journals and has published 89 SGS-related articles. Research hotspots shift from surgical treatment to conservative management. CONCLUSIONS The SGS-related literature has grown rapidly in recent years. This study represents the first bibliometric analysis of scientific articles on SGS. Areas to improve in SGS research can be identified after this analysis of the most impactful articles on this topic.
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Affiliation(s)
- Yaping Zhang
- Center for General Practice Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Zhanqiu Dai
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qixin Xia
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yufeng Wu
- Hangzhou Medical College, Hangzhou, People's Republic of China
| | - TingxiaoZhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Qi Chen
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Chen Xia
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, China.
| | - Jiongnan Xu
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
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Zhang C, Li W, Li Y, Fang N, Xu M, Ke L, Li L, Liu G. Treatment of mixed and refractory post-tuberculosis tracheobronchial stenosis with L-shaped silicone stents: case series and a literature review. Ther Adv Respir Dis 2024; 18:17534666241254901. [PMID: 38785036 PMCID: PMC11119346 DOI: 10.1177/17534666241254901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
The two patients included in the study had mixed and refractory post-tuberculosis tracheobronchial stenosis (PTTS), having experienced unsuccessful interventional therapies such as balloon dilation and V-shaped stent placement before the operation. Following the secure placement of L-shaped silicone stents, examinations with a fiberbronchoscope during the first and third months post-operation revealed a significant reduction in bronchial mucosa inflammation for both patients. Additionally, the opening diameter of the upper and lower branch segments increased, and chest CT scans indicated a noticeable absorption of left pulmonary lesions. Three months post-operation, fiberbronchoscopy confirmed the stable fixation of the stent without any movement. The patients exhibited substantial improvements in pulmonary function, dyspnea index, and blood gas analysis, with no reported adverse complications. After 7 months, a follow-up fiberbronchoscope for one case revealed excellent stent fixation. Simultaneously, the chest CT scan indicated favorable re-expansion. The placement of L-shaped silicone stents proves effective in preventing displacement, alleviating airway stenosis or obstruction, and ensuring the safety and efficacy of PTTS treatment - particularly in cases where V-shaped silicone stent placement has failed. To our knowledge, this is the first study describing the L-shaped silicone stent in two patients with PTTS.
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Affiliation(s)
- Changwen Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wentao Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ni Fang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mingpeng Xu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lan Ke
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lifang Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guangnan Liu
- The Second Affiliated Hospital of Guangxi Medical University, No. 166, Daxue Road, Nanning, Guangxi Province, Xixiangtang District, Nanning 530000, China
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Wadiwala IJ, Yu Lee‐Mateus A, Alhayek B, Abia‐Trujillo D, Chadha R, Hazelett BN, Fernandez‐Bussy S. Atypical distal tracheal fibrous bridge and bronchial stenosis in an adult patient with bronchopulmonary dysplasia. Respirol Case Rep 2023; 11:e01203. [PMID: 37593371 PMCID: PMC10427834 DOI: 10.1002/rcr2.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
Tracheobronchial stenosis (TBS) in adults derives from congenital and acquired conditions, including prolonged mechanical intubation, expiratory central airway collapse, infectious or inflammatory disease, and malignancy. The most common clinical presentation is shortness of breath, recurrent infections, and chronic cough. TBS is usually diagnosed via computed tomography or bronchoscopy, with the latter doubling as a therapeutic tool. We present a case of an atypical fibrotic bridge connecting the walls of the distal trachea and fibrotic bronchial stenosis treated with electrocautery knife and balloon dilation, in an adult patient with bronchopulmonary dysplasia.
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Affiliation(s)
- Ishaq J. Wadiwala
- Department of Cardiovascular and Thoracic SurgeryMayo ClinicJacksonvilleFloridaUSA
| | | | - Bakr Alhayek
- Division of Hematology and Oncology, Department of Internal MedicineMayo ClinicJacksonvilleFloridaUSA
| | - David Abia‐Trujillo
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Ryan Chadha
- Department of AnesthesiologyMayo ClinicJacksonvilleFloridaUSA
| | - Britney N. Hazelett
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
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Maranini B, Guzzinati I, Casoni GL, Ballotta M, Lo Monaco A, Govoni M. Case Report: Middle lobe syndrome: a rare presentation in eosinophilic granulomatosis with polyangiitis. Front Immunol 2023; 14:1222431. [PMID: 37638004 PMCID: PMC10448582 DOI: 10.3389/fimmu.2023.1222431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by necrotizing inflammation of small- and medium-sized blood vessels and the presence of circulating ANCA. Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic ANCA-associated vasculitis, characterized by peripheral eosinophilia, neuropathy, palpable purpuras or petechiae, renal and cardiac involvement, sinusitis, asthma, and transient pulmonary infiltrates. Middle lobe syndrome (MLS) is defined as recurrent or chronic atelectasis of the right middle lobe of the lung, and it is a potential complication of asthma. Case presentation Herein, we describe a case of MLS in a 51-year-old woman, never-smoker, affected by EGPA, presenting exclusively with leukocytosis and elevated concentrations of acute-phase proteins, without any respiratory symptom, cough, or hemoptysis. Chest computed tomography (CT) imaging documented complete atelectasis of the middle lobe, together with complete obstruction of lobar bronchial branch origin. Fiberoptic bronchoscopy (FOB) revealed complete stenosis of the middle lobar bronchus origin, thus confirming the diagnosis of MLS, along with distal left main bronchus stenosis. Bronchoalveolar lavage (BAL) did not detect any infection. Bronchial biopsies included plasma cells, neutrophil infiltrates, only isolated eosinophils, and no granulomas, providing the hypothesis of vasculitic acute involvement less likely. First-line agents directed towards optimizing pulmonary function (mucolytics, bronchodilators, and antibiotic course) were therefore employed. However, the patient did not respond to conservative treatment; hence, endoscopic management of airway obstruction was performed, with chest CT documenting resolution of middle lobe atelectasis. Conclusion To the best of our knowledge, this is the first detailed description of MLS in EGPA completely resolved through FOB. Identification of MLS in EGPA appears essential as prognosis, longitudinal management, and treatment options may differ from other pulmonary involvement in AAV patients.
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Affiliation(s)
- Beatrice Maranini
- Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Maria Ballotta
- Section of Anatomic Pathology, Azienda Ospedaliera Rovigo, Rovigo, Italy
| | - Andrea Lo Monaco
- Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Moroni L, Giudice L, Lanzillotta M, Cariddi A, Ramirez GA, Bozzolo EP, Germinario B, Gallina G, Viscardi S, Carretta A, Dagna L. Role of systemic immunosuppression on subglottic stenosis in granulomatosis with polyangiitis: Analysis of a single-centre cohort. Eur J Intern Med 2023; 114:108-112. [PMID: 37156712 DOI: 10.1016/j.ejim.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Subglottic stenosis (SGS) is a potentially life-threatening manifestation of granulomatosis with polyangiitis (GPA). Endoscopic dilation is effective, but relapses are frequent and the benefit of systemic immunosuppression in this setting is still controversial. We aimed to investigate the role of immunosuppressive treatment on SGS relapse risk. METHODS This is a retrospective observational study based on review of medical charts among our cohort of patients with GPA. RESULTS Twenty-one patients with SGS-GPA were identified, with a prevalence of 20% among our entire GPA cohort (n = 105). Compared to patients without SGS, patients with SGS-GPA had an earlier disease onset (mean age 30.2 vs. 47.3 years, p<0.001), and lower BVAS (mean 10.5 vs 13.5; p = 0.018). Five patients didn't receive systemic immunosuppression for SGS and they all (100%) relapsed after the first procedure, while among medical treatment group relapse rate was 44% (p = 0.045). When single treatment regimens are considered, rituximab (RTX) and cyclophosphamide (CYC) yielded a protective role towards the need of subsequent dilation procedure after the first if compared with absence of medical treatment. Patients with SGS and generalized disease, who initially received either a RTX- or a CYC-based induction treatment, and higher cumulative doses of glucocorticoids, showed a delayed median time to SGS relapse (36 vs. 12 months, p = 0.024). CONCLUSIONS Subglottic stenosis is highly prevalent in patients with GPA and may define a milder systemic disease subset occurring more frequently in younger patients. Systemic immunosuppression provides benefit in preventing recurrence of SGS in GPA patients and regimens based on cyclophosphamide or rituximab might have a non-redundant role in this setting.
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Affiliation(s)
- Luca Moroni
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy.
| | - Laura Giudice
- Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy
| | - Marco Lanzillotta
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy
| | - Enrica P Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Bruno Germinario
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy
| | - Gabriele Gallina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy
| | - Stefano Viscardi
- Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy; Unit of Thoracic Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Angelo Carretta
- Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy; Unit of Thoracic Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Faculty of Medicine, Via Olgettina 58, 20132 Milan, Italy
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Tyagi R, Arunachalam M, Mittal S, Hadda V, Mohan A, Guleria R, Madan K. COVID-19-Associated Tracheal Stenosis (COATS): A New Entity? J Bronchology Interv Pulmonol 2023; 30:176-179. [PMID: 35916435 DOI: 10.1097/lbr.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rahul Tyagi
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
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9
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Xiao R, Gu L, Li AM, Gan YL, He CY, Liao JX, Li YS, Xu L, Guo SL. IL-11 drives the phenotypic transformation of tracheal epithelial cells and fibroblasts to enhance abnormal repair after tracheal injury. BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR CELL RESEARCH 2023; 1870:119438. [PMID: 36758859 DOI: 10.1016/j.bbamcr.2023.119438] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
Tracheal stenosis (TS) is a multifactorial and heterogeneous disease that can easily lead to respiratory failure and even death. Interleukin-11 (IL-11) has recently received increased attention as a fibrogenic factor, but its function in TS is uncertain. This study aimed to investigate the role of IL-11 in TS regulation based on clinical samples from patients with TS and a rat model of TS produced by nylon brush scraping. Using lentiviral vectors expressing shRNA (lentivirus-shRNA) targeting the IL-11 receptor (IL-11Rα), we lowered IL-11Rα levels in the rat trachea. Histological and immunostaining methods were used to evaluate the effects of IL-11Rα knockdown on tracheal injury, molecular phenotype, and fibrosis in TS rats. We show that IL-11 was significantly elevated in circulating serum and granulation tissue in patients with TS. In vitro, TGFβ1 dose-dependently stimulated IL-11 secretion from human tracheal epithelial cells (Beas-2b) and primary rat tracheal fibroblasts (PRTF). IL-11 transformed the epithelial cell phenotype to the mesenchymal cell phenotype by activating the β-catenin pathway. Furthermore, IL-11 activated the atypical ERK signaling pathway, stimulated fibroblasts proliferation, and transformed fibroblasts into alpha-smooth muscle actin (α-SMA) positive myofibroblasts. IL-11-neutralizing antibodies (IL-11NAb) or ERK inhibitors (U0126) inhibited IL-11 activity and downregulated fibrotic responses involving TGFβ/SMAD signaling. In vivo, IL-11Rα knockdown rats showed unobstructed tracheal lumen, relatively intact epithelial structure, and significantly reduced granulation tissue proliferation and collagen fiber deposition. Our findings confirm that IL-11 may be a target for future drug prevention and treatment of tracheal stenosis.
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Affiliation(s)
- Rui Xiao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Lei Gu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - An-Mao Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yi-Ling Gan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Chun-Yan He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Jia-Xin Liao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yi-Shi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Li Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Shu-Liang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
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10
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Progressive stridor: extraintestinal airway manifestations in a pediatric patient with inflammatory bowel disease. Clin J Gastroenterol 2022; 15:929-933. [DOI: 10.1007/s12328-022-01674-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/29/2022] [Indexed: 02/07/2023]
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11
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Marchant F, Mäkitie A, Salo J, Räsänen J. Tracheal and laryngotracheal resections and reconstructions-a single-centre experience. J Thorac Dis 2022; 14:2053-2060. [PMID: 35813757 PMCID: PMC9264091 DOI: 10.21037/jtd-21-1963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
Background Surgical resection has proven to be the most effective long-term treatment in managing airway stenoses and has shown to decrease the risk of tumor recurrence and mortality in patients with tumor infiltration to the airways. However, there are only a few Nordic reports on the results of a tracheal resection (TR) and cricotracheal resection (CTR). This study aimed to evaluate the volume and short-term outcome of TR and CTR at our institution. Methods Retrospective review of patients who underwent TR or CTR between 2004 and 2019 at the Helsinki University Hospital (Helsinki, Finland). Results Forty-four patients were included, of which 21 (47.7%) underwent surgery for a tumor, whereas 23 (52.3%) were operated for a benign stenosis. The most common tumor type was thyroid carcinoma with tracheal invasion (15.9%). The distance between the upper margin of the stenosis or tumor infiltration and the vocal cords was in median 3 [interquartile range (IQR), 2–5] cm and the median length of resection 2.5 (IQR, 2–3.5) cm. Overall success rate was 75% (no need for reoperation or postoperative intervention). Complications occurred in 20 (45.5%) patients, of which 10 patients were operated for a tumor, and 10 for a benign stenosis. Conclusions Tracheal and CTRs were effective in treating tracheal and subglottic stenoses with variable etiology. However, complications were common especially following cricotracheal tumor resections. These procedures show a clear need for further centralization due to their complex nature and should therefore be performed primarily at institutes with highly experienced multi-professional teams.
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Affiliation(s)
- Felipe Marchant
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jarmo Salo
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Jain B, Chandrakantham U. A case of severe subglottic stenosis masking as bronchial asthma. IMC JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.55010/imcjms.16.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tracheal stenosis is an uncommon and dangerous complication after intubation and tracheostomy and its clinical presentation may be misinterpreted as bronchial asthma. A careful vigilant clinical history and examination is required for the diagnosis of such tracheal stenosis. Here, we describe a case of post intubation subglottic tracheal stenosis in a young male who presented with features mimicking bronchial asthma.
IMC J Med Sci 2022; 16(2): 005. DOI: https://doi.org/10.55010/imcjms.16.015
*Correspondence: Bhupendra Kumar Jain, Department of Pulmonary Medicine, Chhindwara Institute of Medical Sciences, Chhindwara, Jabalpur Medical University, Madhya Pradesh, India; ORCID : 0000-0002-6619- 8596;Email: drbhupendrakjain@gmail.com
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Affiliation(s)
- Bhupendra Jain
- Department of Pulmonary Medicine, Chhindwara Institute of Medical Sciences, Chhindwara, Jabalpur Medical University, Madhya Pradesh, India
| | - Umamaheswar Chandrakantham
- Department of Pulmonary Medicine, Chhindwara Institute of Medical Sciences, Chhindwara, Jabalpur Medical University, Madhya Pradesh, India
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13
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An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management. CURRENT PULMONOLOGY REPORTS 2022; 11:29-38. [PMID: 35261874 PMCID: PMC8892813 DOI: 10.1007/s13665-022-00286-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/27/2022]
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14
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Guedes F, Branquinho MV, Sousa AC, Alvites RD, Bugalho A, Maurício AC. Central airway obstruction: is it time to move forward? BMC Pulm Med 2022; 22:68. [PMID: 35183132 PMCID: PMC8858525 DOI: 10.1186/s12890-022-01862-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/14/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Central airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stem bronchi, bronchus intermedius or lobar bronchus. MAIN BODY It is a common clinical situation consensually considered under-diagnosed. Management of patients with CAO can be difficult and deciding on the best treatment approach represents a medical challenge. This work intends to review CAO classifications, causes, treatments and its therapeutic limitations, approaching benign and malign presentations. Three illustrative cases are further presented, supporting the clinical problem under review. CONCLUSION Management of CAO still remains a challenge. The available options are not always effective nor free from complications. A new generation of costume-tailored airway stents, associated with stem cell-based therapy, could be an option in specific clinical situations.
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Affiliation(s)
- Fernando Guedes
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
- Pulmonology Department, Bronchology Unit, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| | - Mariana V Branquinho
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
| | - Ana C Sousa
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
| | - Rui D Alvites
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
| | - António Bugalho
- CUF Tejo Hospital e CUF Descobertas Hospital, Lisbon, Portugal
- Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Lisbon, Portugal
| | - Ana Colette Maurício
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal.
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.
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15
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Puri HV, Asaf BB, Mundale VV, Pulle MV, Bishnoi S, Munjal M, Kumar A, Kumar A. Predictors of Anastomotic Complications After Resection and Anastomosis for Tracheal Stenosis. Indian J Otolaryngol Head Neck Surg 2021; 73:447-454. [PMID: 34692457 DOI: 10.1007/s12070-020-02238-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022] Open
Abstract
Resection and anastomosis is an effective option for the management of complex tracheal stenosis, however, it's not without the complications. This study aims at evaluating various factors predicting anastomotic complications after trachea resection and anastomosis. This is a retrospective analysis of database from a dedicated thoracic surgical unit in New Delhi, India over 7 years. An analysis of demographic details, perioperative variables including complications were carried out. Analysis of various factors predicting anastomotic complications was performed. Out of 65 patients in the study, 49 (75.3%) were males and 16 (24.7%) were females. Median age of the patients was 31 years. Stenosis was cervical in 80%, cervico-thoracic in 15.4% and thoracic in 4.6% of patients. Median length of stenosis was 2.9 cm (1-4.2). 53 (81.6%) patients had some kind of preoperative intervention, where as rest 12 (18.4%) patients had no intervention at all. Out of 65 patients, 26 (40%) had crico-tracheal anastomosis while 39 (60%) had tracheo-tracheal anastomosis. Median length of resected tracheal segment was 3.3 cm (1-5). Overall complication rate (anastomotic + non-anastomotic) was 18.4% in which anastomosis related were in 4 (6.1%) patients. Resection of tracheal segment ≥ 3.5 cm, presence of diabetes mellitus and pre-operative use of corticosteroids were statistically significant factors for the onset of complications. Perioperative mortality rate was 1.5% (n = 1). Length of resection > 3.5 cm, presence of diabetes mellitus and pre-operative prolonged use of corticosteroids were significant predictors for the anastomotic complications.
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Affiliation(s)
- Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Vivek Vishwas Mundale
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Mohan Venkatesh Pulle
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Manish Munjal
- Department of Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Akhil Kumar
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
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16
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Wang S, Zhou R, Zhu S, Yan D. Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy. BMC Pulm Med 2021; 21:323. [PMID: 34663273 PMCID: PMC8521980 DOI: 10.1186/s12890-021-01690-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/30/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Therapeutic bronchoscopy is one of the effective methods in the treatment and management of malignant central airway stenosis (MCAS). However, restenosis after therapeutic bronchoscopy frequently occurs and severe restenosis (SR) can be life-threatening. Therefore, this study aimed at investigating the risk factors for SR after therapeutic bronchoscopy. METHODS The data of 233 consecutive cases with MCAS who were subjected to therapeutic bronchoscopy between 2015 and 2020 at a tertiary hospital were collected. Patients were divided into SR group and non-SR during 6 months after therapeutic bronchoscopy. Multiple logistic regression analysis was performed to determine the risk factors for SR. RESULTS SR during 6 months after therapeutic bronchoscopy occurred in 39.5% (92/233) of patients. The location and the initial degree of MCAS were associated with SR, as assessed by multiple logistic regression analysis (P < 0.05). The risk of SR after therapeutic bronchoscopy in the left main bronchus, right main bronchus, and right intermediate bronchus increased, compared to the risk when of MCAS was located in the trachea (OR (95% CI) of 8.821 (1.850-25.148), 6.583 (1.791-24.189), and 3.350 (0.831-13.511), respectively). In addition, the initial degree of MCAS was positively associated with an increased risk of SR (OR 1.020; 95% CI 1.006-1.035). CONCLUSIONS MCAS located in the left main bronchus, right main bronchus and right intermediate bronchus, as well as the higher initial degree of MCAS were independent risk factors for SR during 6 months after therapeutic bronchoscopy.
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Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Renzhi Zhou
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
| | - Siyao Zhu
- Shaoxing University School of Medicine, Shaoxing, 312000, Zhejiang Province, China
| | - Dan Yan
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
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17
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CT findings of non-neoplastic central airways diseases. Jpn J Radiol 2021; 40:107-119. [PMID: 34398372 DOI: 10.1007/s11604-021-01190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Non-neoplastic lesions of central airways are uncommon entities with different etiologies, with either focal or diffuse involvement of the tracheobronchial tree. Clinical symptoms of non-neoplastic tracheobronchial diseases are non-specific, and diagnosis is difficult, especially in the early stages. Three-dimensional computed tomography (3D-CT) is an evaluable tool as it allows to assess and characterize tracheobronchial wall lesions and meanwhile it enables the evaluation of airways surrounding structures. Multiplanar reconstructions (MPR), minimum intensity projections (MinIP), and 3D Volume Rendering (VR) (in particular, virtual bronchoscopy) also provide information on the site and of the length of airway alterations. This review will be discussed about (1) primary airway disorders, such as relapsing polychondritis, tracheobronchophathia osteochondroplastica, and tracheobronchomegaly, (2) airway diseases, related to granulomatosis with polyangiitis, Chron's disease, Behcet's disease, sarcoidosis, amyloidosis, infections, intubation and transplantation, (3) tracheobronchial malacia, and (4) acute tracheobronchial injury. 3D-CT findings, especially with MPR and 3D VR reconstructions, allows us to evaluate tracheobronchial disease morphologically in detail.
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18
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Haywood M, Lovell L, Roe J, Clunie G, Sandhu G, Al Yaghchi C. Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study. Clin Otolaryngol 2021; 46:1229-1236. [PMID: 34087029 DOI: 10.1111/coa.13820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/13/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well-recognised sequela of LTS and airway surgery, however studies have employed mostly non-validated assessments post-operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post-operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold-standard management framework for its management. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASURES We performed a retrospective cohort study of adult airway reconstruction procedures from 2016-2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post-operative day one and post-stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores. RESULTS Forty-four patients underwent forty-six reconstructions. Baseline incidence of penetration-aspiration was considerably higher than the general population and worsened in the immediate post-operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post-operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent. CONCLUSIONS We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.
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Affiliation(s)
- Matthew Haywood
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Lindsay Lovell
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Justin Roe
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Gemma Clunie
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
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19
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Lin X, Ye M, Li Y, Zhou H, Chen C. A novel designed V-shaped silicone stent for the treatment of unilateral main bronchial stenosis V-shaped stent for bronchial stenosis. Ann Thorac Surg 2021; 113:e215-e218. [PMID: 34048757 DOI: 10.1016/j.athoracsur.2021.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 11/01/2022]
Abstract
Benign main bronchial stenosis may cause a potentially life-threatening condition. Airway silicone stenting is an important option of bronchoscopic treatments for patients with main bronchial stenosis. However, stent migration is one of the most frequent complications, which require repeated bronchoscopic interventions. To resolve this issue, we therefore in the report described a novel designed V-shaped silicone stent for the treatment of unilateral main bronchial stenosis. This method may be widely applied to clinical practice to prevent stent migration.
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Affiliation(s)
- Xiaoxiao Lin
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Min Ye
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Haixiao Zhou
- Department of Endoscopy, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Chengshui Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China.
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20
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Pomerantz B, Pomerantz M, Finn A. Idiopathic subglottic stenosis in a young female patient. BMJ Case Rep 2021; 14:14/5/e241525. [PMID: 34031079 DOI: 10.1136/bcr-2020-241525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A previously healthy 30-year-old woman presented with 3 years of progressive shortness of breath and audible wheezing. One year prior to presentation, she developed a chronic non-productive cough. Pulmonary function testing revealed flattened inspiratory and expiratory peaks, characteristic of an extrathoracic fixed tracheal obstruction. Bronchoscopy confirmed subglottic stenosis (SGS). She had no history of intubation, tracheostomy or evidence of a systemic inflammatory illness. She was diagnosed with idiopathic SGS and referred for rigid bronchoscopy with balloon dilatation resulting in improvement in her symptoms.
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Affiliation(s)
| | - Michael Pomerantz
- Division of Pulmonary Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Arkadiy Finn
- Division of Hospital Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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21
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Liu J, Yao X, Wang Z, Ye J, Luan C, He Y, Lin H, Fu J. A flexible porous chiral auxetic tracheal stent with ciliated epithelium. Acta Biomater 2021; 124:153-165. [PMID: 33529770 DOI: 10.1016/j.actbio.2021.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
Tracheal stent placement is a principal treatment for tracheobronchial stenosis, but complications such as mucus plugging, secondary stenosis, migration, and strong foreign body sensation remain unavoidable challenges. In this study, we designed a flexible porous chiral tracheal stent intended to reduce or overcome these complications. The stent was innovatively designed with a flexible tetrachiral and anti-tetrachiral hybrid structure as the frame and hollows filled with porous silicone sponge. Detailed finite element analysis (FEA) showed that the designed frame can maintain a Poisson's ratio that is negative or close to zero at up to 50% tensile strain. This contributes to improved airway ventilation and better resistance to migration during physiological activities such as respiration and neck movement. The preparation process combined indirect 3D printing with gas foaming and particulate leaching methods to efficiently fabricate the stent. The stent was then subjected to uniaxial tension and local radial compression tests, which indicated that it not only has the same desirable auxetic performance but also has flexibility similar to the native trachea. The porous sponge facilitated the adhesion of cells, allowed nutrient diffusion, and would prevent the ingrowth of granulation tissue. Furthermore, a ciliated tracheal epithelium similar to that of the native trachea was differentiated from normal human bronchial primary epithelial cells on the internal wall of the stent under air-liquid interface conditions. These results suggest that the designed stent has the potential for application in the treatment of tracheobronchial stenosis.
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Affiliation(s)
- Jiapeng Liu
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Xinhua Yao
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China.
| | - Zhenwei Wang
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Jian Ye
- Department of Pneumology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, People's Republic of China
| | - Congcong Luan
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Yong He
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Hui Lin
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, People's Republic of China
| | - Jianzhong Fu
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
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22
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Park JW, Ko Y, Kim C. Use of an Insulation-Tipped Knife during Rigid Bronchoscopic Treatment of Benign Tracheobronchial Stenosis. ACTA ACUST UNITED AC 2021; 57:medicina57030251. [PMID: 33800300 PMCID: PMC7998586 DOI: 10.3390/medicina57030251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Tracheal or bronchial tears are potential complications of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an insulation-tipped (IT) knife in combination with rigid bronchoscopic dilatation for treating benign tracheobronchial stenosis. Materials and Methods: We conducted a chart review of patients with benign tracheobronchial stenosis who were treated with rigid bronchoscopy and an IT knife at two referral centers. Treatment success was defined as a clinically stable state without worsening symptoms after 3 months of treatment. Results: Of the 23 patients with benign tracheobronchial stenosis, 15 had tracheal stenosis and 6 had main bronchial stenosis. Among them, three cases were of simple stenosis (13%), while the others were of complex stenosis (87%). The overall treatment success rate was 87.0%. Pneumomediastinum and subcutaneous emphysema occurred due to bronchial laceration in two cases of distal left main bronchial stenosis (8.7%), and no other significant acute complications developed. Silicone stents were inserted in 20 patients, and successful stent removal was possible in 11 patients (55.0%). Six of the seven stents inserted in patients with post-intubation tracheal stenosis were removed successfully (85.7%). However, most of the patients with post-tracheostomy tracheal stenosis required persistent stenting (80%). Pulmonary function was significantly increased after treatment, and the mean increase in the forced expiratory volume in 1 s was 391 ± 171 mL (160–700 mL). Conclusion: The use of an IT knife can be suggested as an effective and safe modality for rigid bronchoscopic treatment of benign tracheobronchial stenosis.
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Affiliation(s)
- Ji-Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea;
| | - Yousang Ko
- Department of Pulmonary and Critical Care Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, Korea;
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63241, Korea
- Correspondence: ; Tel.: +82-64-717-1613; Fax: +82-64-717-1097
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Huan N, Ng KL, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA. Topical mitomycin-C as an adjuvant to multimodal endoscopic treatment for tracheobronchial stenosis secondary to endobronchial tuberculosis. Respirol Case Rep 2021; 9:e00711. [PMID: 33532074 PMCID: PMC7829630 DOI: 10.1002/rcr2.711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/02/2022] Open
Abstract
Tracheobronchial stenosis secondary to endobronchial tuberculosis (TSTB) is a rare but debilitating complication of endobronchial tuberculosis (EBTB). Topical mitomycin-C (TMC) has been successfully utilized to restore airway patency and to prevent recurrence of TSTB, although little is known about its exact efficacy. Here, we report the biggest case series to date involving seven patients who received TMC as part of multimodality endoscopic treatment for TSTB with varying levels of success. All patients presented with dyspnoea during or after treatment completion for pulmonary tuberculosis (PTB). Four patients had short-segment concentric membranous TSTB while two patients had concurrent bronchomalacia. Another one patient had a thick fibrotic band adjacent to luminal opening. We hypothesize that TMC is more efficacious in short membranous stenosis without concurrent bronchomalacia and/or thick fibrotic bands. More studies are needed to bridge the current gaps in knowledge regarding the optimal role and benefits of TMC for TSTB patients.
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Affiliation(s)
| | - Khai Lip Ng
- Department of PulmonologySerdang HospitalKajangMalaysia
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Jenson M, Forshee WA, Padilla RM, Wynn G. Endobronchial Tuberculosis and Bronchostenosis: A Rare Case of Bronchial Occlusion in a Patient With History of Tuberculosis. Cureus 2021; 13:e12717. [PMID: 33614322 PMCID: PMC7883571 DOI: 10.7759/cureus.12717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary tuberculosis is common worldwide, and many of these patients develop endobronchial tuberculosis (EBTB). Bronchostenosis is a known complication of EBTB though most patients with endobronchial stenosis do not develop severe bronchostenosis or occlusion. We present a rare case of a patient with a right upper lobe bronchus occlusion and a history of tuberculosis.
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Affiliation(s)
- Matthew Jenson
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - William A Forshee
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Rebekah M Padilla
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Gregory Wynn
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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25
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Masui T, Uemura H, Syugyo M, Kitahara T. Resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage for subglottic stenosis. BMJ Case Rep 2020; 13:13/12/e239203. [PMID: 33318283 PMCID: PMC7737046 DOI: 10.1136/bcr-2020-239203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Subglottic stenosis is a disease that causes dyspnoea by congenital or acquired stenosis of the cricoid cartilage and trachea. The cause of acquired subglottic stenosis varies. In this case, we present a case of idiopathic subglottic stenosis. Tracheotomies are performed in many cases, but they require long-term insertion of a tracheal cannula and make treatment difficult. In this case study, we performed a tracheoplasty by resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage and implemented a cannula-free observation protocol.
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Affiliation(s)
- Takashi Masui
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Hirokazu Uemura
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Masayuki Syugyo
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Tadashi Kitahara
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
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26
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Aydogmus U, Kis A, Ugurlu E, Ozturk G. Superior Strategy in Benign Tracheal Stenosis Treatment: Surgery or Endoscopy? Thorac Cardiovasc Surg 2020; 69:756-763. [PMID: 32886930 DOI: 10.1055/s-0040-1715435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Due to the variations in (laryngeal) tracheal stenosis (TS) patient groups, there is still no consensus on which patient should be treated with endoscopy or surgery. The aim of the present study was to generate an algorithm in the light of the related literature and the data obtained from a clinic where both endoscopic and surgical treatments are conducted. METHOD A retrospective analysis was performed on the data of a total of 56 patients during 2013 to 2019. A total of 38 patients were subject to surgery with 31 as a first treatment option and 7 due to the unsatisfactory results of endoscopic treatments. Endoscopic approaches were tried on a total of 29 patients with 25 as initial treatment and 4 due to postsurgical recurrence. RESULTS Symptomatic full control ratio was determined as 69% with endoscopic treatments, 89.5% in subglottic stenosis (SGS) surgery (n = 19), and 89.5% in trachea surgery (n = 19). However, success rates with no recurrence were determined, respectively, as 40.0, 36.4, and 36.4% for patients subject to dilatation, stent, or T tube treatment. Dilatation was observed to be successful in patients with stenotic segment lengths of less than 1.5 cm (p = 0.02). Failure rates increased in SGS (p = 0.03) and TS (p = 0.12) in the surgical group with increasing stenotic segment length. The presence of comorbidities was not effective on treatment success. CONCLUSION Endoscopic methods are preferred in cases of web-like stenosis. Surgical methods should first be considered for other patients and endoscopic methods should be used on patients who are not suited for surgery or in cases of postsurgical recurrence.
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Affiliation(s)
- Umit Aydogmus
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
| | - Argun Kis
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
| | - Erhan Ugurlu
- Department of Chest Disease, Pamukkale University, Denizli, Turkey
| | - Gokhan Ozturk
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
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Akram MJ, Khalid U, Abu Bakar M, Ashraf MB, Butt FM, Khan F. Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases. Expert Rev Respir Med 2020; 14:1173-1181. [PMID: 32664764 DOI: 10.1080/17476348.2020.1796642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome. OBJECTIVE To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD. METHODS A cross-sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t-test was used to compare mean difference of clinical characteristics between pre- and post-airway stenting. Kaplan-Meier curves were used to assess overall survival. RESULTS A total of 51 patients had stent insertion with mean age 46.63±17.10years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients, respectively. There was statistically significant mean difference in pre- and post-procedure oxygen saturation (mean (M)=89.8, standard deviation (SD)=6.70 vs M =95.5,SD=2.54.p =0.001) and performance status (M =3.65,SD =0.6 vs M =2.59, SD=0.83.p =0.001). Overall median survival was 16±3.44 weeks, highest amongst patients with intrinsic obstruction (27±6.51 weeks). CONCLUSION Airway stenting is an effective endoscopic procedure to re-establish airway patency in MAD with minimal complications..
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Affiliation(s)
- Muhammad Junaid Akram
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Usman Khalid
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Mohammad Bilal Ashraf
- Consultant Pulmonology & Critical Care Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Faheem Mehmood Butt
- Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center , Lahore, Pakistan
| | - Faheem Khan
- Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center , Lahore, Pakistan
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Aravena C, Almeida FA, Mukhopadhyay S, Ghosh S, Lorenz RR, Murthy SC, Mehta AC. Idiopathic subglottic stenosis: a review. J Thorac Dis 2020; 12:1100-1111. [PMID: 32274178 PMCID: PMC7139051 DOI: 10.21037/jtd.2019.11.43] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive workup that includes a complete history, physical examination, pulmonary function testing, auto-antibodies, imaging studies, and endoscopic procedures. This approach, however, helps to exclude other conditions such as granulomatosis with polyangiitis (GPA). It is also helpful to characterize the lesion and outline management strategies. Therapeutic endoscopic procedures and surgery are the most common management modalities, but medical therapy can also play a significant role in preventing or delaying recurrence. In this review, we describe the morphology, pathophysiology, clinical presentation, evaluation, management, and prognosis of iSGS.
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Affiliation(s)
- Carlos Aravena
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco A Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sanjay Mukhopadhyay
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Subha Ghosh
- Department of Diagnostic Radiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert R Lorenz
- Head and Neck Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Moser JB, Stefanidis K, Vlahos I. Imaging Evaluation of Tracheobronchial Injuries. Radiographics 2020; 40:515-528. [DOI: 10.1148/rg.2020190171] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Joanna B. Moser
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Stefanidis
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ioannis Vlahos
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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30
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Abstract
PURPOSE OF REVIEW Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases. RECENT FINDINGS Newly published articles highlight both the surgical and anesthetic challenges encountered during tracheobronchial resections and emphasize the importance of creating specialized, high-volume centers for good patient outcomes. Of great importance is the development of a preoperative joint anesthetic-surgical plan which includes a patient-specific airway management strategy. This review presents newer and less commonly employed anesthetic management strategies which have been recently described in the literature to allow expansion of care to patients who were previously deemed too high risk for surgery. SUMMARY With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.
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Challenging tracheal resection anastomosis: Case series. Auris Nasus Larynx 2020; 47:616-623. [PMID: 32035696 DOI: 10.1016/j.anl.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was conducted to review our experience in Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, in the last 2 years in the management of high-risk patients who underwent cricotracheal resection due to different pathologies. METHODS This case series included nine patients with severe, grade III or IV subglottic / cervical tracheal stenosis. These patients were considered high risk patients due to unusual pathology / etiology of stenosis or associated surgical field morbidity. Four patients had recurrent stenosis after previous unsuccessful cricotracheal resection, three patients had subglottic stenosis due to external neck trauma which compromised the surgical field. One patient had upper tracheal neoplasm, and in 1 patient there was upper tracheal stenosis associated with tracheo-esophageal fistula. RESULTS Successful decannulation was achieved in all patients (n = 9) without any reported major intraoperative or postoperative compilations. CONCLUSION Cases of subglottic / upper tracheal stenosis due to uncommon pathologies like neoplastic lesions, external neck trauma compromising the surgical field and revision cricotracheal resection, can be successfully managed by cricotracheal resection. However, a highly skilled team, well familiar with these surgeries, is mandatory to achieve an optimum outcome.
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32
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Biswas A, Mehta HJ, Jantz MA. A 62-Year-Old Woman With Refractory Wheezing. Chest 2019. [PMID: 29519312 DOI: 10.1016/j.chest.2017.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CASE PRESENTATION A 62-year-old Hispanic woman, a resident of Puerto Rico, presented with symptoms of chronic cough and shortness of breath for the past 2 years that were slowly and progressively getting worse. She received a diagnosis of asthma on the basis of her history of symptomatic "wheezing" and had been on treatment with inhaled bronchodilators and corticosteroids with minimal symptomatic improvement. The peculiarity of her symptoms was that her dyspnea was worse when she was reclining in bed and she would often hear a "whistling" noise in her throat during those times. Additionally, she reported difficulty swallowing and would often drink water to aid in swallowing food. There was no prior history of endotracheal intubations or surgeries. She denied any history of joint pain, skin rashes, eye pain, hair loss, mouth ulcers, photosensitivity, diarrhea, blood-mixed stool, or blood in the urine.
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Affiliation(s)
- Abhishek Biswas
- Department of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL.
| | - Hiren J Mehta
- Department of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
| | - Michael A Jantz
- Department of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
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Jin F, Li Q, Li S, Wang H, Bai C, Zeng Y, Zhou R, Cai Z, Chen L, Feng J, Feng Q, Guo S, Hou G, Huang H, Lai G, Li W, Wang C, Zhang N, Zhou Y. Interventional Bronchoscopy for the Treatment of Malignant Central Airway Stenosis: An Expert Recommendation for China. Respiration 2019; 97:484-494. [PMID: 30970361 DOI: 10.1159/000497213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/19/2022] Open
Abstract
Malignant central airway stenosis refers to airway stenosis caused by primary or metastatic malignant tumors which may lead to different levels of dyspnea or asphyxia in patients. With the rapid development of interventional pulmonology, therapeutic bronchoscopy has become one of the main methods for the diagnosis and treatment of malignant central airway stenosis. However, the level of diagnosis and treatment of respiratory intervention techniques in China is uneven at present, the treatment methods are not uniform, the treatment effects vary greatly, and some treatments even lead to serious complications. The interventional treatment technology for malignant central airway stenosis in China needs to be standardized. Therefore, the relevant experts of the Beijing Health Promotion Association Respiratory and Oncology Intervention and Treatment Alliance have formulated this consensus after several rounds of full discussion.
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Affiliation(s)
- Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China,
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Dongfang Hospital, Tongji University, Shanghai, China
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongwu Wang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yiming Zeng
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Hospital of Fujian Medical University, Quanzhou, China
| | - Rui Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhigang Cai
- Department of Respiratory and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liangan Chen
- Department of Respiratory and Critical Care Medicine, PLA General Hospital, Beijing, China
| | - Jing Feng
- Department of Respiratory and Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin, China
| | - Qixiao Feng
- Department of Respiratory and Critical Care Medicine, Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Hou
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haidong Huang
- Department of Respiratory Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Guoxiang Lai
- Department of Respiratory Pulmonary and Critical Care Medicine, The General Hospital of Fuzhou Military Region, Fuzhou, China
| | - Wangping Li
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Changhui Wang
- Department of Respiratory Pulmonary and Critical Care Medicine, Tenth People's Hospital of Shanghai, Shanghai, China
| | - Nan Zhang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Yunzhi Zhou
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
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Niu JM, Zhang J, Qiu XJ, Wang J, Pei YH, Wang YL, Wang T. Application of Micro-Tech stents in malignant carinal stenosis. Oncol Lett 2019; 17:3990-3996. [PMID: 30930995 DOI: 10.3892/ol.2019.10051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/01/2019] [Indexed: 11/06/2022] Open
Abstract
Malignant carinal stenosis is a disease process that is not always suitable for treatment with a Y-shaped stent. When one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is infeasible. In this complex condition, a cone-shaped stent is selected to maintain the patency of the trachea and the other main bronchus. The efficacy of the bare cone-shaped Micro-Tech stent to treat malignant carinal stenosis was evaluated in the current study. The medical records of 47 patients with malignant carinal stenosis who underwent Micro-Tech stent placement between January 2004 and October 2017 in Beijing Tian Tan Hospital (Beijing, China) were analyzed retrospectively. A total of 47 bare Micro-Tech stents (28 Y-shaped and 19 cone-shaped) were successfully inserted in the patients. Following stent placement, immediate satisfactory results were achieved in all patients, especially an improvement of dyspnea (100%), cough (81.1%) and stridor (100%). The Karnofsky scores were significantly increased (P<0.001), and the American Thoracic Society Dyspnea Index values were significantly decreased (P<0.001). Following a median of 88 days, initial bronchoscopic interventions were performed for tumor overgrowth (84.6%), stent fracture (7.7%) and granulation tissue (7.7%). Restenting was performed in two patients due to tumor progression (n=1) and stent fracture (n=1). Removal of a Y-shaped stent was attempted in one patient, but failed, as the stent had become partly embedded in the airway mucosa. In conclusion, cone-shaped Micro-Tech stent placement maintained tracheal-unilateral main bronchus patency and benefitted patients with malignant carinal stenosis in whom Y-shaped stents were not suitable for insertion.
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Affiliation(s)
- Jin-Mu Niu
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jie Zhang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiao-Jian Qiu
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Juan Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ying-Hua Pei
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yu-Ling Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ting Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Frequency, treatment, evolution, and factors associated with the presence of tracheobronchial stenoses in granulomatosis with polyangiitis. Retrospective analysis of a case series from a single respiratory referral center. Semin Arthritis Rheum 2019; 48:714-719. [DOI: 10.1016/j.semarthrit.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
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Abstract
Airway stent implantation is a highly effective treatment for airway stenosis. However, it is presently unclear whether patients with airway stents can safely undergo magnetic resonance imaging (MRI). Such stents may be metallic or non-metallic, and MRI may induce stent dislodgment or heating and may be associated with stent-induced artifacts. We thoroughly reviewed the literature, experimental data, and manufacturer information on non-metallic, stainless steel (SS) and nickel-titanium alloy stents. Non-metallic stents are made of non-ferromagnetic materials associated with no MRI concerns. SS stents may shift in a magnetic field, generating significant artifacts. Nickel-titanium alloy stents are not at risk of dislodgement or heating, but may create some artifacts affecting image quality. Both non-metallic and nickel-titanium alloy stents are safe for patients who must undergo MRI. However, the safety of SS stents depends on the type of steel used.
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Affiliation(s)
- Yang Xia
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Rui Jin
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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Hentze M, Schytte S, Pilegaard H, Klug TE. Single-stage tracheal and cricotracheal segmental resection with end-to-end anastomosis: Outcome, complications, and risk factors. Auris Nasus Larynx 2018; 46:122-128. [PMID: 29934237 DOI: 10.1016/j.anl.2018.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/11/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Management of tracheal stenosis remains controversial. Endoscopic interventions commonly provide immediate relief of symptoms, but are associated with high recurrence rates. In contrast, high success rates have been reported in patients undergoing tracheal resection. However, well-defined indications and contraindications for tracheal resection are lacking and previous studies commonly ignore patient-related outcomes (e.g. dyspnoea). We aimed to evaluate the outcome of tracheal resection at our institution and identify risk factors for complications. METHODS All adult patients undergoing tracheal resection at Aarhus University Hospital between January 2009 and September 2016 were included RESULTS: Twenty-seven patients were included. The most frequent aetiologies for tracheal stenosis were previous tracheostomy (n=8), prolonged intubation (n=3), a combination of the two (n=5), and intraluminal tumour (n=7). Sixteen patients underwent high tracheal resection, seven patients low tracheal resection, and four patients partial cricotracheal resection. Surgical success (no dyspnoea and no need for additional intervention) was achieved in 74% of patients. Four of six patients undergoing resection because of malignant disease were recurrence-free during the follow-up period. Fifteen (56%) patients suffered complications (transient or permanent). Four (15%) patients had recurrent stenosis and underwent reintervention. Other permanent complications included idiopathic hoarseness (15%), unilateral recurrent nerve palsy (11%), and dysphagia (7%). Previous treatment (endoscopic and open surgery) (OR=5.5, p=0.06) and chronic diseases (OR=8.3, p=0.02) were associated with increased risk for complications. CONCLUSIONS Tracheal resection was efficient treatment for the alleviation of dyspnoea in adults with tracheal stenosis. However, complications were frequent and careful preoperative patient selection and information are crucial.
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Affiliation(s)
- Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Denmark.
| | - Sten Schytte
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Denmark
| | - Hans Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Denmark
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Bhandari A, Wang YH, Lv SX, Xia EJ, Wang OC. Novel strategy of stents in thyroid mass: a case series report of managing severely dyspneic patients. Onco Targets Ther 2017; 10:4997-5004. [PMID: 29081662 PMCID: PMC5652908 DOI: 10.2147/ott.s145418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Tracheal and bronchial stenosis is a life-threatening condition causing difficulty in breathing and even severe respiratory distress. The silicone tracheobronchial stents were placed using the rigid bronchoscopy into the trachea of severe dyspneic patients and they exhibited symptomatic improvement as well as a rise in the saturation of oxygen. The bronchial stents were applicable to many extensive malignant airway stenosis patients, such as those with esophageal cancer, lung cancer, and laryngeal cancer. But the effectiveness of bronchial stents for thyroid cancer is not certain. Case presentation Here, we report 3 emergency patients with a thyroid mass referred to our hospital because of grade 4 dyspnea according to the American Thoracic Society shortness of breath guidelines. The main clinical symptoms were severe dyspnea and stridor. The radiographic examination and tomographic examination showed the narrowing and displacement of the trachea. To the best of our knowledge, ideal airway management for the massive thyroid mass was considered to be temporary tracheobronchial stent placement pre-operation. Conclusion In our study, we applied the tracheobronchial stent to massive thyroid mass patients with dyspnea and aimed to not only improve preoperative airway obstruction but also to protect the potential airway collapse from post-operative tracheomalacia following extubation. We found that application of tracheobronchial stents may provide a new strategy to dyspneic patients with huge thyroid mass.
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Affiliation(s)
- Adheesh Bhandari
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ying-Hao Wang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Shi-Xu Lv
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Er-Jie Xia
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ou-Chen Wang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Nagano H, Kishaba T, Nei Y, Yamashiro S, Takara H. Indications of airway stenting for severe central airway obstruction due to advanced cancer. PLoS One 2017; 12:e0179795. [PMID: 28651011 PMCID: PMC5484493 DOI: 10.1371/journal.pone.0179795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/05/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Management of severe central airway obstruction due to advanced cancer is a medical and technical challenge. The impact of airway stenting on the clinical outcome of such patients is unclear. METHOD This single-center, retrospective study evaluated 21 patients who underwent airway stenting for advanced cancer. We examined predictors of the post-stenting mortality, including age, serum albumin, tracheal diameter, smoking, opioid use, respiratory failure, and performance status (PS). We also compared survival according to the PS. RESULTS The mean survival period after stenting was 85.2 days. On univariate analysis, age, albumin, PS before airway stenting, respiratory failure, admission route, and PS grade were the candidates as possible predictors of prognosis after the procedure. On multivariate analysis, PS before airway stenting was identified as possible predictor of prognosis after stenting (HR 1.6180, 95% CI 0.969 to 2.7015, p = 0.066). The mean survival period after stenting was significantly longer in the good PS group, compared to the poor PS group (147.8 days vs. 38.2 days,p = 0.0346). CONCLUSION Airway stenting for advanced cancer may be more effective for patients in good general condition than in those with poor performance status.
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Affiliation(s)
- Hiroaki Nagano
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yuichirou Nei
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Shin Yamashiro
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Hiroaki Takara
- Department of Radiology, Okinawa Chubu Hospital, Okinawa, Japan
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Karush JM, Seder CW, Raman A, Chmielewski GW, Liptay MJ, Warren WH, Arndt AT. Durability of Silicone Airway Stents in the Management of Benign Central Airway Obstruction. Lung 2017. [PMID: 28623537 DOI: 10.1007/s00408-017-0023-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The literature is devoid of a comprehensive analysis of silicone airway stenting for benign central airway obstruction (BCAO). With the largest series in the literature to date, we aim to demonstrate the safety profile, pattern of re-intervention, and duration of silicone airway stents. METHODS An institutional database was used to identify patients with BCAO who underwent rigid bronchoscopy with dilation and silicone stent placement between 2002 and 2015 at Rush University Medical Center. RESULTS During the study period, 243 stents were utilized in 63 patients with BCAO. Pure tracheal stenosis was encountered in 71% (45/63), pure tracheomalacia in 11% (7/63), and a hybrid of both in 17% (11/63). Median freedom from re-intervention was 104 (IQR 167) days. Most common indications for re-intervention include mucus accumulation (60%; 131/220), migration (28%; 62/220), and intubation (8%; 18/220). The most common diameters of stent placed were 12 mm (94/220) and 14 mm (96/220). The most common lengths utilized were 30 mm (60/220) and 40 mm (77/220). Duration was not effected by stent size when placed for discrete stenosis. However, 14 mm stents outperformed 12 mm when tracheomalacia was present (157 vs. 37 days; p = 0.005). Patients with a hybrid stenosis fared better when longer stents were used (60 mm stents outlasted 40 mm stents 173 vs. 56 days; p = 0.05). CONCLUSION Rigid bronchoscopy with silicone airway stenting is a safe and effective option for the management of benign central airway obstruction. Our results highlight several strategies to improve stent duration.
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Affiliation(s)
- Justin M Karush
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725W. Harrison St, Suite 774, Chicago, IL, 60612, USA
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725W. Harrison St, Suite 774, Chicago, IL, 60612, USA
| | - Anish Raman
- Rush Medical College, Chicago, IL, 60612, USA
| | - Gary W Chmielewski
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725W. Harrison St, Suite 774, Chicago, IL, 60612, USA
| | - Michael J Liptay
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725W. Harrison St, Suite 774, Chicago, IL, 60612, USA
| | - William H Warren
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725W. Harrison St, Suite 774, Chicago, IL, 60612, USA
| | - Andrew T Arndt
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725W. Harrison St, Suite 774, Chicago, IL, 60612, USA.
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Su Z, Li S, Zhou Z, Chen X, Gu Y, Chen Y, Zhong C, Zhong M, Zhong N. A canine model of tracheal stenosis induced by cuffed endotracheal intubation. Sci Rep 2017; 7:45357. [PMID: 28349955 PMCID: PMC5368979 DOI: 10.1038/srep45357] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/23/2017] [Indexed: 01/14/2023] Open
Abstract
Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis.
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Affiliation(s)
- Zhuquan Su
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ziqing Zhou
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaobo Chen
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingying Gu
- Pathology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Chen
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changhao Zhong
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minglu Zhong
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- Sate Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Pepper VK, Onwuka EA, Best CA, King N, Heuer E, Johnson J, Breuer CK, Grischkan JM, Chiang T. Endoscopic management of tissue-engineered tracheal graft stenosis in an ovine model. Laryngoscope 2017; 127:2219-2224. [PMID: 28349659 DOI: 10.1002/lary.26504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of bronchoscopic interventions in the management of tissue-engineered tracheal graft (TETG) stenosis. STUDY DESIGN Animal research study. METHODS TETGs were constructed with seeded autologous bone marrow-derived mononuclear cells on a bioartificial graft. Eight sheep underwent tracheal resection and orthotopic implantation of this construct. Animals were monitored by bronchoscopy and fluoroscopy at 3 weeks, 6 weeks, 3 months, and 4 months. Bronchoscopic interventions, including dilation and stenting, were performed to manage graft stenosis. Postdilation measurements were obtained endoscopically and fluoroscopically. RESULTS Seven dilations were performed in six animals. At the point of maximal stenosis, the lumen measured 44.6 ± 8.4 mm2 predilation and 50.7 ± 14.1 postdilation by bronchoscopy (P = 0.3517). By fluoroscopic imaging, the airway was 55.9 ± 12.9 mm2 predilation and 65.9 ± 22.4 mm2 postdilation (P = 0.1303). Stents were placed 17 times in six animals. Pre- and poststenting lumen sizes were 62.8 ± 38.8 mm2 and 80.1 ± 54.5 mm2 by bronchoscopy (P = 0.6169) and 77.1 ± 38.9 mm2 and 104 ± 60.7 mm2 by fluoroscopy (P = 0.0825). Mortality after intervention was 67% with dilation and 0% with stenting (P = 0.0004). The average days between bronchoscopy were 8 ± 2 for the dilation group and 26 ± 17 in the stenting group (P = 0.05). One hundred percent of dilations and 29% of stent placements required urgent follow-up bronchoscopy (P = 0.05). CONCLUSION Dilation has limited efficacy for managing TETG stenosis, whereas stenting has a more lasting clinical effect. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2219-2224, 2017.
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Affiliation(s)
- Victoria K Pepper
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Ekene A Onwuka
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of General Surgery, the Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Cameron A Best
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Nakesha King
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of General Surgery, the Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Eric Heuer
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Jed Johnson
- Nanofibers Solutions, Inc, Columbus, Ohio, U.S.A
| | - Christopher K Breuer
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of General Surgery, the Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Jonathan M Grischkan
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Tendy Chiang
- Tissue Engineering Program, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
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Abstract
The lungs are a common site of metastatic disease. Pulmonary metastases develop due to local blood flow and cellular or biochemical properties of tumor cells. Metastases develop from any type of malignancy and may occur via hematogenous, lymphatic, aerogenous, and/or direct spread. Metastatic disease may present with symptoms indistinguishable from primary lung cancer, including dyspnea, hemoptysis, and chest pain. Radiographically, these may present as parenchymal lung disease, mediastinal lymphadenopathy, airway obstruction, or pleural and vascular disease. No part of the thorax is spared from metastatic potential. This review highlights complications of non-pulmonary solid malignancies based on sites of anatomic metastases.
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Affiliation(s)
- Jonathan Puchalski
- Yale University School of Medicine, 15 York Street, LCI 100, New Haven, CT 06510, USA.
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Abstract
Endobronchial tuberculosis (EBTB) is a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. Patients may present with symptoms secondary to disease itself or from the complication of disease like endobronchial obstruction. Diagnosis requires a high index of suspicion. Computed tomography (CT) and bronchoscopy along with microbiological investigations are the most useful diagnostic tools for the confirmation as well as for the evaluation of the tracheobronchial stenosis. The goals of treatment are eradication of tubercle bacilli with anti-tubercular medications and the prevention of airway stenosis. Interventional Bronchoscopic techniques and surgery is required for those patients who develop severe tracheobronchial stenosis that causing significant symptoms including dyspnea, repeated post obstructive pneumonia or bronchiectasis.
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Affiliation(s)
- Talha Shahzad
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Ozkul Y, Songu M, Ozturkcan S, Imre A, Erdogan N, Ates D, Ozkul Z. Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes. Acta Otolaryngol 2016; 136:933-6. [PMID: 27092981 DOI: 10.3109/00016489.2016.1170877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1 hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58 ± 12.02 (range =15-70) mm. Mean follow-up for the study group was 60.16 ± 34.10 (range =18-137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%). CONCLUSION T-tube is not an effective treatment of tracheal stenosis.
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Sedat Ozturkcan
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Nezahat Erdogan
- b Department of Radiology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Zelal Ozkul
- c Department of Anaesthesia and Reanimation , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
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Sigvard A, Bødtger U. Case reports - When bronchial obstruction in the young adult is not asthma and inhalers do not help. J Asthma 2016; 53:660-4. [PMID: 26666550 DOI: 10.3109/02770903.2015.1130150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Localised bronchial obstruction is a rare differential diagnosis to asthma. CASE STUDY We describe two younger patients treated unsuccessfully for asthma and eventually diagnosed with localised bronchoconstriction. RESULTS Bronchoscopy revealed bronchoconstriction: Tracheobronchomalacia in case 1 and fixed obstruction in case 2. CONCLUSION A systematic approach to the asthma patient with absent response to therapy facilitates rational use of therapeutic and diagnostic resources.
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Affiliation(s)
- Anne Sigvard
- a Department of Internal Medicine , Unit of Pulmonary Medicine , Naestved Sygehus, Naestved , Denmark.,b Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup , Glostrup , Denmark
| | - Uffe Bødtger
- a Department of Internal Medicine , Unit of Pulmonary Medicine , Naestved Sygehus, Naestved , Denmark.,c Institute for Regional Health Research, University of Southern Denmark , Odense , Denmark
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Faisal M, Harun H, Hassan TM, Ban AYL, Chotirmall SH, Abdul Rahaman JA. Treatment of multiple-level tracheobronchial stenosis secondary to endobronchial tuberculosis using bronchoscopic balloon dilatation with topical mitomycin-C. BMC Pulm Med 2016; 16:53. [PMID: 27080697 PMCID: PMC4832514 DOI: 10.1186/s12890-016-0209-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tracheobronchial stenosis is a known complication of endobronchial tuberculosis. Despite antituberculous and steroid therapy, the development of bronchial stenosis is usually irreversible and requires airway patency to be restored by either bronchoscopic or surgical interventions. We report the use of balloon dilatation and topical mitomycin-C to successful restore airway patency. CASE PRESENTATION We present a 24-year old lady with previous pulmonary tuberculosis and laryngeal tuberculosis in 2007 and 2013 respectively who presented with worsening dyspnoea and stridor. She had total left lung collapse with stenosis of both the upper trachea and left main bronchus. She underwent successful bronchoscopic balloon and manual rigid tube dilatation with topical mitomycin-C application over the stenotic tracheal segment. A second bronchoscopic intervention was performed after 20 weeks for the left main bronchus stenosis with serial balloon dilatation and topical mitomycin-C application. These interventions led to significant clinical and radiographic improvements. CONCLUSION This case highlights that balloon dilatation and topical mitomycin-C application should be considered in selected patients with tracheobronchial stenosis following endobronchial tuberculosis, avoiding airway stenting and invasive surgical intervention.
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Affiliation(s)
- Mohamed Faisal
- Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Hafaruzi Harun
- Respiratory Unit, Serdang Hospital, Jalan Puchong, 43000, Kajang, Selangor Darul Ehsan, Malaysia
| | - Tidi M Hassan
- Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Y L Ban
- Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Dalar L, Karasulu L, Abul Y, Özdemir C, Sökücü SN, Tarhan M, Altin S. Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis. Ann Thorac Surg 2016; 101:1310-7. [DOI: 10.1016/j.athoracsur.2015.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/26/2015] [Accepted: 10/01/2015] [Indexed: 12/20/2022]
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50
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Ozkul Y, Songu M, Imre A, Ates D, Arslanoglu S, Pinar E, Onal K. CO₂ laser treatment of tracheal stenosis. Acta Otolaryngol 2015; 135:1160-2. [PMID: 26137899 DOI: 10.3109/00016489.2015.1063687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Delivery of a carbon dioxide laser is an effective method and can be used in selected cases of tracheal stenosis. OBJECTIVES To present retrospective experience in tracheal stenosis of 16 patients treated by bronchoscopic delivery of carbon dioxide laser, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in 14 cases, and idiopathic in two cases. The duration of intubation ranged between 1 hour to 26 days. According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.3 ± 0.5. Mean length of the stenosis was 23.75 ± 6.95 (range = 15-40) mm. Mean follow-up for the study group was 23.81 ± 7.11 (range = 12-38) months. Postoperative decannulation was achieved in 13 patients (81.3%), and decannulation was not achieved in three patients (18.7%).
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Secil Arslanoglu
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Ercan Pinar
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Kazim Onal
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
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