BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful...BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.展开更多
Introduction: Post-intubation tracheal stenosis (STPI) is a complication of ventilatory assistance by intubation and/or tracheotomy. Her frequency is estimated between 10% to 20%. The treatment of choice remains surge...Introduction: Post-intubation tracheal stenosis (STPI) is a complication of ventilatory assistance by intubation and/or tracheotomy. Her frequency is estimated between 10% to 20%. The treatment of choice remains surgery. It is based on tracheal resection-anastomosis which guarantees satisfactory and reliable long-term results. Objectives: To determine the frequency of post-intubation tracheal stenosis, to specify the diagnostic and therapeutic methods, to determine the complications and the evolution. Material and methods: This was a study carried out in the ENT and head and neck surgery department of the University Hospital Center Gabriel TOURE. Our study focused on two (02) cases of post-intubation tracheal stenosis (STPI) collected during a period of 1 year (January 2021 to December 2021). Results: They are all acquired, secondary to an intubation. The two (02) cases benefited from a tracheal anastomosis resection, the indications of which were specified and the results and complications evaluated. Conclusion: Our results show that resection anastomosis remains the reference treatment for STPI.展开更多
BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual dis...BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual disease in the postoperative setting.Definitive radiotherapy is an alternative approach to cure unresectable TACC.As the status of radiosensitivity in TACC is uncertain,the evidence for radiotherapy in unresectable TACC is not well established,especially in terms of the optimal dosage and its response evaluation.Herein,we report a case of locally advanced TACC.CASE SUMMARY A 49-year-old woman was diagnosed with TACC,which included a range of lesions arising in the upper trachea extending caudally 2 cm to 7 cm of the glottis.She was treated with definitive radiotherapy,given the low likelihood of complete resection of the disease.Due to the indolent growth and the propensity for infiltration along the airways,the scheduled radiation dose of 76 Gy in 38 fractions with 6-MV X-ray delivered by intensity-modulated radiotherapy was conducted to the primary tumor volume.After irradiation of 40 Gy,the patient’s dyspnea on exertion was dramatically relieved and bronchoscopy revealed that the previous large polypoid intra-luminal mass was significantly eliminated,with near-complete response.The patient completed two phases of scheduled radiotherapy,and acute reactions to treatment included subjective chest tightness and grade 2 esophagitis,managed medically.After 5 years of treatment,the patient is alive without recurrent disease,and there were no serious late radiation esophagus and lung damage,with only slight dysphagia without perforation and fistula.CONCLUSION Taken together,TACC is uncommon and the treatment of unresectable TACC is challenging.This case indicated that patients with unresectable TACC who rapidly respond to radiation may benefit from primary radical radiotherapy.Radiotherapy may be considered an effective alternative treatment modality.展开更多
BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of...BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.展开更多
BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tid...BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.展开更多
Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation ...Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.展开更多
The use of PRP involves a complex network of molecular events which accelerate tissue regenera-tion due to its richness in growth factors plus a variety of biologic mediators. Several communica-tions tell us about its...The use of PRP involves a complex network of molecular events which accelerate tissue regenera-tion due to its richness in growth factors plus a variety of biologic mediators. Several communica-tions tell us about its usefulness on the dental implantology field, plastic surgery, orthopedics and peripheral nerve regeneration after trauma. We have presented our successful experience of its use in pneumology when treating severe hemoptysis, respiratory fistulae, spontaneous pneumothorax and one tracheal rupture. In this article we present two cases of post intubation tracheal rupture successfully treated with the local instillation of PRP on one of them and with the injection of PRP along the lips of the tracheal wound on the other. Tracheal rupture is a rare but life threatening complication of emergency intubation requiring an effective response in order to avoid the risk of patient death due to secondary mediastinitis and sepsis. Up to now there is no general consensus in the treatment of this condition and alternatives in use are not universally accepted. The use of local autologous PRP in our experience has demonstrated a favorable performance in such cases, turning it in a highly promising tool for the treatment of conditions such as this, in which a rapidly effective and minimally invasive handling is required.展开更多
Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases ar...Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.展开更多
Polymeric immunoglobulin receptors(pIgR) are key participants in the formation and secretion of secretory Ig A(S-Ig A), which is critical for the prevention of microbial infection and colonization in the respiratory s...Polymeric immunoglobulin receptors(pIgR) are key participants in the formation and secretion of secretory Ig A(S-Ig A), which is critical for the prevention of microbial infection and colonization in the respiratory system. Although increased respiratory colonization and infections are common in HIV/AIDS, little is known about the expression of pIgR in the airway mucosa of these patients. To address this, the expression levels of pIgR in the tracheal mucosa and lungs of SHIV/SIV-infected rhesus macaques were examined by real-time RTPCR and confocal microscopy. We found that the levels of both PIGR m RNA and pIgR immunoreactivity were lower in the tracheal mucosa of SHIV/SIVinfected rhesus macaques than that in non-infected rhesus macaques, and the difference in pIgR immunoreactivity was statistically significant. IL-17 A, which enhances pIgR expression, was also changed in the same direction as that of pIgR. In contrast to changes in the tracheal mucosa, pIgR and IL-17 A levels were higher in the lungs of infected rhesus macaques. These results indicated abnormal pIgR expression in SHIV/SIV, and by extension HIV infections, which might partially result from IL-17 A alterations and might contribute to the increased microbial colonization and infection related to pulmonary complications in HIV/AIDS.展开更多
In this paper, the development of existing artificial tracheal stents was briefly introduced. Their structures, strengths and weaknesses were analyzed. A new woven artificial tracheal stent that used leno-based constr...In this paper, the development of existing artificial tracheal stents was briefly introduced. Their structures, strengths and weaknesses were analyzed. A new woven artificial tracheal stent that used leno-based construction was designed and fabricated at last. Additionally, a preliminary mechanical study was carried out on the new artificial tracheal stent, such as the radial supporting force and the elastic restoring force, making foundation for application of the new artificial tracheal stent.展开更多
Esophageo-tracheal fistula is a rare condition,and in most cases such fistulas are caused by malignant disease or emergency endotracheal intubation.A case where a wrapped tablet produced a fistula between the esophagu...Esophageo-tracheal fistula is a rare condition,and in most cases such fistulas are caused by malignant disease or emergency endotracheal intubation.A case where a wrapped tablet produced a fistula between the esophagus and trachea is described.The patient is a male born in 1938 who swallowed a tablet without unwrapping it.The patient was treated with selfexpanding metal stents(SEMS),but closure of the fistula was not achieved.Different examinations and treatment options are discussed.Surgical treatment for this condition has demonstrated considerable mortality and morbidity.In some cases closure of the fistula can be achieved by use of SEMS.Although we advise treatment of such cases with SEMS,in some cases treatment with stents will prove troublesome and the risk/benefit analysis will have to be reevaluated.展开更多
BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and...BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and hemoptysis.The most effective treatment for benign tumors is complete resection of the primary lesion at an early stage.Our experience has demonstrated that primary tracheal schwannoma can be safely excised with a high-frequency electric knife in a minimally invasive manner.CASE SUMMARY We report a 61-year-old asymptomatic woman who underwent chest computed tomography(CT),which accidentally found an intraluminal tracheal mass without enlarged lymph nodes.Then,the patient underwent bronchoscopy,which found that the tracheal mass originated from the left wall of the upper trachea,was less than 1.5 cm in size,immovable,smooth and 4 cm away from the vocal cord,resulting in partial upper respiratory tract obstruction.Treatment was performed using an endoscopic resection for en bloc removal of the tracheal mass.The diagnosis was primary tracheal schwannoma.A follow-up was performed after endoscopic surgery,and bronchoscopy and thoracic CT were used to monitor whether there was a recurrence.At present,there is no evidence of recurrence,and the patient had a good quality of life.Endoscopic resection may be effective and safe in the treatment of primary tracheal schwannoma.CONCLUSION Primary tracheal schwannoma is a very rare benign tumor.In this case,we cured it by complete endoscopic resection.展开更多
.Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with t....Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventy- five patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg);the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg);and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.展开更多
The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered...The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered incidentally either on radiological examination or at autopsy. We hereby report two cases of tracheal diverticulum with hoarseness in one case and dysphagia in the second case, where intubation was difficult in both cases. However, laryngeal mask airway was inserted successfully in case one and endotracheal intubation using a smaller size intubation tube in case two.展开更多
Primary porcine tracheal epithelial cells(PTECs) are an appropriate model for studying the molecular mechanism of various porcine respiratory diseases, including swine-origin mycoplasmas, which are isolated from respi...Primary porcine tracheal epithelial cells(PTECs) are an appropriate model for studying the molecular mechanism of various porcine respiratory diseases, including swine-origin mycoplasmas, which are isolated from respiratory tract of pigs and mainly found on the mucosal surface surrounding swine trachea. However, the short proliferation ability of primary PTECs greatly limits their lifespan. In this study, primary PTECs were carefully isolated and cultured, and immortal PTECs were constructed by transfecting primary PTECs with the recombinant constructed plasmid pEGFPhTERT containing human telomerase reverse transcriptase(hTERT). Immortal PTECs(hTERT-PTECs) maintained both the morphological and functional characteristics of primary PTECs, as indicated by the expression of cytokeratin 18, cellcycle analysis, proliferation assay, Western blotting, telomerase activity assay, karyotype analysis and quantitative RTPCR. Compared to primary PTECs, hTERT-PTECs had an extended replicative lifespan, higher telomerase activity, and enhanced proliferative activity. In addition, this cell line resulted in a lack of transformed and grown tumors in nude mice, suggesting that it could be safely applied in further studies. Moreover, hTERT-PTECs were vulnerable to all swineorigin mycoplasmas through quantitative analysis as indicated by 50% color changing unit(CCU_(50)) calculation, and no significant differences of adhesion ability between primary and immortal PTECs were observed. For the representative swine mycoplasma Mycoplasma hyopneumoniae(Mhp), except for DNA copies quantitative real-time PCR assay, indirect immunofluorescence assay and Western blotting analysis also depicted that hTERT-PTECs was able to adhere to different Mhp strains of different virulence. In summary, like primary PTECs, hTERT-PTECs could be widely used as an adhesion cell model for swine-origin mycoplasmas and in infection studies of various porcine respiratory pathogens.展开更多
An in vivo-in vitro transformation system was establi-shed in primary rat tracheal epithelial cells(RTE) whichwere cultured in serum-free F12 medium with the additionof growth factors.Carcinogens were given in vivo by...An in vivo-in vitro transformation system was establi-shed in primary rat tracheal epithelial cells(RTE) whichwere cultured in serum-free F12 medium with the additionof growth factors.Carcinogens were given in vivo by subcu-taneous injection or intratracheal instillation.About 7days after carcinogen exposure,RTE cells were cultured inserum-free medium and then selected in serum-containingmedium.Transformed colonies were counted 5-6 weeks afterthe plating of RTE cells.展开更多
BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,c...BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.展开更多
BACKGROUND Trauma is one of the leading causes of death in the pediatric population.Bronchial rupture is rare,but there are potentially severe complications.Establishing and maintaining a patent airway is the key issu...BACKGROUND Trauma is one of the leading causes of death in the pediatric population.Bronchial rupture is rare,but there are potentially severe complications.Establishing and maintaining a patent airway is the key issue in patients with bronchial rupture.Here we describe an innovative method for maintaining a patent airway.CASE SUMMARY A 3-year-old boy fell from the seventh floor.Oxygenation worsened rapidly with pulse oxygen saturation decreasing below 60%,as his heart rate dropped.Persistent pneumothorax was observed with insertion of the chest tube.Fiberoptic bronchoscopy was performed,which confirmed the diagnosis of bronchial rupture.A modified tracheal tube was inserted under the guidance of a fiberoptic bronchoscope.Pulse oxygen saturation improved from 60%to 90%.Twelve days after admission,right upper lobectomy was performed using bronchial stump suture by video-assisted thoracic surgery without complications.A follow-up chest radiograph showed good recovery.The child was discharged from hospital three months after admission.CONCLUSION A modified tracheal tube could be selected to ensure a patent airway and adequate ventilation in patients with bronchial rupture.展开更多
To apply a new airway treatment to humans, preclinical studies in an appropriate animalmodel is needed. Canine, porcine and leporine tracheas have been employed as animal airwaystenosis models using various methods su...To apply a new airway treatment to humans, preclinical studies in an appropriate animalmodel is needed. Canine, porcine and leporine tracheas have been employed as animal airwaystenosis models using various methods such as chemical caustic agents, laser, and electrocautery.However, existing models take a long time to develop (3- 8 weeks) and the mechanism of stenosisis different from that in humans. The aim of the present study was to establish a new and fasttracheal stenosis model in pigs using a combination of cuff overpressure intubation (COI) andelectrocautery. Fourteen pigs were divided into three groups: tracheal cautery (TC) group (n=3),COI group (n=3), and COI-TC combination group (n=8). Cuff overpressure (200/400/500 mmHg)was applied using a 9-mm endotracheal tube. Tracheal cautery (40/60 watts) was performed usinga rigid bronchoscopic electrocoagulator. After intervention, the pigs were observed for 3 weeks andbronchoscopy was performed every 7 days. When the cross-sectional area decreased by > 50%, itwas confirmed that tracheal stenosis was established. The time for tracheal stenosis was 14 days inthe TC group and 7 days in the COI-TC combination group. In the COI group, no stenosis occurred.In the COI-TC group, electrocautery (40 watts) immediately after intubation for>1 h with a cufpressure of 200 mmHg or more resulted in suficient tracheal stenosis within 7 days. Moreover, thedegree of tracheal stenosis increased in proportion to the cuff pressure and tracheal intubation time.The combined use of cuf overpressure and electrocautery helped to establish tracheal stenosis inpigs rapidly.展开更多
BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case w...BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case with 10 mo follow-up.CASE SUMMARY Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma.The patient then received four doses of toripalimab.Subsequently,rapid,progressive deterioration of the original fistula was found.Although the fistula enlarged rapidly after immunotherapy,it remained covered completely,and likely because of this,his condition remained stable.Therefore,immunotherapy could be continued to treat the primary tumor.Despite these efforts,the patient died of the advancement of his esophageal cancer.CONCLUSION Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.展开更多
文摘BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.
文摘Introduction: Post-intubation tracheal stenosis (STPI) is a complication of ventilatory assistance by intubation and/or tracheotomy. Her frequency is estimated between 10% to 20%. The treatment of choice remains surgery. It is based on tracheal resection-anastomosis which guarantees satisfactory and reliable long-term results. Objectives: To determine the frequency of post-intubation tracheal stenosis, to specify the diagnostic and therapeutic methods, to determine the complications and the evolution. Material and methods: This was a study carried out in the ENT and head and neck surgery department of the University Hospital Center Gabriel TOURE. Our study focused on two (02) cases of post-intubation tracheal stenosis (STPI) collected during a period of 1 year (January 2021 to December 2021). Results: They are all acquired, secondary to an intubation. The two (02) cases benefited from a tracheal anastomosis resection, the indications of which were specified and the results and complications evaluated. Conclusion: Our results show that resection anastomosis remains the reference treatment for STPI.
基金Supported by National Natural Science Foundation of China,No.81573024。
文摘BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual disease in the postoperative setting.Definitive radiotherapy is an alternative approach to cure unresectable TACC.As the status of radiosensitivity in TACC is uncertain,the evidence for radiotherapy in unresectable TACC is not well established,especially in terms of the optimal dosage and its response evaluation.Herein,we report a case of locally advanced TACC.CASE SUMMARY A 49-year-old woman was diagnosed with TACC,which included a range of lesions arising in the upper trachea extending caudally 2 cm to 7 cm of the glottis.She was treated with definitive radiotherapy,given the low likelihood of complete resection of the disease.Due to the indolent growth and the propensity for infiltration along the airways,the scheduled radiation dose of 76 Gy in 38 fractions with 6-MV X-ray delivered by intensity-modulated radiotherapy was conducted to the primary tumor volume.After irradiation of 40 Gy,the patient’s dyspnea on exertion was dramatically relieved and bronchoscopy revealed that the previous large polypoid intra-luminal mass was significantly eliminated,with near-complete response.The patient completed two phases of scheduled radiotherapy,and acute reactions to treatment included subjective chest tightness and grade 2 esophagitis,managed medically.After 5 years of treatment,the patient is alive without recurrent disease,and there were no serious late radiation esophagus and lung damage,with only slight dysphagia without perforation and fistula.CONCLUSION Taken together,TACC is uncommon and the treatment of unresectable TACC is challenging.This case indicated that patients with unresectable TACC who rapidly respond to radiation may benefit from primary radical radiotherapy.Radiotherapy may be considered an effective alternative treatment modality.
文摘BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.
文摘BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.
文摘Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.
文摘The use of PRP involves a complex network of molecular events which accelerate tissue regenera-tion due to its richness in growth factors plus a variety of biologic mediators. Several communica-tions tell us about its usefulness on the dental implantology field, plastic surgery, orthopedics and peripheral nerve regeneration after trauma. We have presented our successful experience of its use in pneumology when treating severe hemoptysis, respiratory fistulae, spontaneous pneumothorax and one tracheal rupture. In this article we present two cases of post intubation tracheal rupture successfully treated with the local instillation of PRP on one of them and with the injection of PRP along the lips of the tracheal wound on the other. Tracheal rupture is a rare but life threatening complication of emergency intubation requiring an effective response in order to avoid the risk of patient death due to secondary mediastinitis and sepsis. Up to now there is no general consensus in the treatment of this condition and alternatives in use are not universally accepted. The use of local autologous PRP in our experience has demonstrated a favorable performance in such cases, turning it in a highly promising tool for the treatment of conditions such as this, in which a rapidly effective and minimally invasive handling is required.
文摘Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.
基金supported by the Beijing Natural Science Foundation(7162136)
文摘Polymeric immunoglobulin receptors(pIgR) are key participants in the formation and secretion of secretory Ig A(S-Ig A), which is critical for the prevention of microbial infection and colonization in the respiratory system. Although increased respiratory colonization and infections are common in HIV/AIDS, little is known about the expression of pIgR in the airway mucosa of these patients. To address this, the expression levels of pIgR in the tracheal mucosa and lungs of SHIV/SIV-infected rhesus macaques were examined by real-time RTPCR and confocal microscopy. We found that the levels of both PIGR m RNA and pIgR immunoreactivity were lower in the tracheal mucosa of SHIV/SIVinfected rhesus macaques than that in non-infected rhesus macaques, and the difference in pIgR immunoreactivity was statistically significant. IL-17 A, which enhances pIgR expression, was also changed in the same direction as that of pIgR. In contrast to changes in the tracheal mucosa, pIgR and IL-17 A levels were higher in the lungs of infected rhesus macaques. These results indicated abnormal pIgR expression in SHIV/SIV, and by extension HIV infections, which might partially result from IL-17 A alterations and might contribute to the increased microbial colonization and infection related to pulmonary complications in HIV/AIDS.
基金Shanghai Municipal Commission of Health and Family Planning,China
文摘In this paper, the development of existing artificial tracheal stents was briefly introduced. Their structures, strengths and weaknesses were analyzed. A new woven artificial tracheal stent that used leno-based construction was designed and fabricated at last. Additionally, a preliminary mechanical study was carried out on the new artificial tracheal stent, such as the radial supporting force and the elastic restoring force, making foundation for application of the new artificial tracheal stent.
文摘Esophageo-tracheal fistula is a rare condition,and in most cases such fistulas are caused by malignant disease or emergency endotracheal intubation.A case where a wrapped tablet produced a fistula between the esophagus and trachea is described.The patient is a male born in 1938 who swallowed a tablet without unwrapping it.The patient was treated with selfexpanding metal stents(SEMS),but closure of the fistula was not achieved.Different examinations and treatment options are discussed.Surgical treatment for this condition has demonstrated considerable mortality and morbidity.In some cases closure of the fistula can be achieved by use of SEMS.Although we advise treatment of such cases with SEMS,in some cases treatment with stents will prove troublesome and the risk/benefit analysis will have to be reevaluated.
文摘BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and hemoptysis.The most effective treatment for benign tumors is complete resection of the primary lesion at an early stage.Our experience has demonstrated that primary tracheal schwannoma can be safely excised with a high-frequency electric knife in a minimally invasive manner.CASE SUMMARY We report a 61-year-old asymptomatic woman who underwent chest computed tomography(CT),which accidentally found an intraluminal tracheal mass without enlarged lymph nodes.Then,the patient underwent bronchoscopy,which found that the tracheal mass originated from the left wall of the upper trachea,was less than 1.5 cm in size,immovable,smooth and 4 cm away from the vocal cord,resulting in partial upper respiratory tract obstruction.Treatment was performed using an endoscopic resection for en bloc removal of the tracheal mass.The diagnosis was primary tracheal schwannoma.A follow-up was performed after endoscopic surgery,and bronchoscopy and thoracic CT were used to monitor whether there was a recurrence.At present,there is no evidence of recurrence,and the patient had a good quality of life.Endoscopic resection may be effective and safe in the treatment of primary tracheal schwannoma.CONCLUSION Primary tracheal schwannoma is a very rare benign tumor.In this case,we cured it by complete endoscopic resection.
文摘.Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventy- five patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg);the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg);and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.
文摘The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered incidentally either on radiological examination or at autopsy. We hereby report two cases of tracheal diverticulum with hoarseness in one case and dysphagia in the second case, where intubation was difficult in both cases. However, laryngeal mask airway was inserted successfully in case one and endotracheal intubation using a smaller size intubation tube in case two.
基金supported by the National Natural Science Foundation of China(31800161,31700157,31800160,31900159,and 31770193)the Natural Science Foundation of Jiangsu Province,China(BK20180297 and BK20170600)the Independent Research Project Program of Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base,Ministry of Science and Technology,China(2019sy004)。
文摘Primary porcine tracheal epithelial cells(PTECs) are an appropriate model for studying the molecular mechanism of various porcine respiratory diseases, including swine-origin mycoplasmas, which are isolated from respiratory tract of pigs and mainly found on the mucosal surface surrounding swine trachea. However, the short proliferation ability of primary PTECs greatly limits their lifespan. In this study, primary PTECs were carefully isolated and cultured, and immortal PTECs were constructed by transfecting primary PTECs with the recombinant constructed plasmid pEGFPhTERT containing human telomerase reverse transcriptase(hTERT). Immortal PTECs(hTERT-PTECs) maintained both the morphological and functional characteristics of primary PTECs, as indicated by the expression of cytokeratin 18, cellcycle analysis, proliferation assay, Western blotting, telomerase activity assay, karyotype analysis and quantitative RTPCR. Compared to primary PTECs, hTERT-PTECs had an extended replicative lifespan, higher telomerase activity, and enhanced proliferative activity. In addition, this cell line resulted in a lack of transformed and grown tumors in nude mice, suggesting that it could be safely applied in further studies. Moreover, hTERT-PTECs were vulnerable to all swineorigin mycoplasmas through quantitative analysis as indicated by 50% color changing unit(CCU_(50)) calculation, and no significant differences of adhesion ability between primary and immortal PTECs were observed. For the representative swine mycoplasma Mycoplasma hyopneumoniae(Mhp), except for DNA copies quantitative real-time PCR assay, indirect immunofluorescence assay and Western blotting analysis also depicted that hTERT-PTECs was able to adhere to different Mhp strains of different virulence. In summary, like primary PTECs, hTERT-PTECs could be widely used as an adhesion cell model for swine-origin mycoplasmas and in infection studies of various porcine respiratory pathogens.
文摘An in vivo-in vitro transformation system was establi-shed in primary rat tracheal epithelial cells(RTE) whichwere cultured in serum-free F12 medium with the additionof growth factors.Carcinogens were given in vivo by subcu-taneous injection or intratracheal instillation.About 7days after carcinogen exposure,RTE cells were cultured inserum-free medium and then selected in serum-containingmedium.Transformed colonies were counted 5-6 weeks afterthe plating of RTE cells.
文摘BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability.Currently,physical examinations of thyromental distance,mouth opening,Mafampaii classification,etc.combined with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult airways.However,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed preoperatively.Such patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction.Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/L.Due to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult airway.CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such patients.It is recommended to complete preoperative imaging examinations of the airway.For life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.
文摘BACKGROUND Trauma is one of the leading causes of death in the pediatric population.Bronchial rupture is rare,but there are potentially severe complications.Establishing and maintaining a patent airway is the key issue in patients with bronchial rupture.Here we describe an innovative method for maintaining a patent airway.CASE SUMMARY A 3-year-old boy fell from the seventh floor.Oxygenation worsened rapidly with pulse oxygen saturation decreasing below 60%,as his heart rate dropped.Persistent pneumothorax was observed with insertion of the chest tube.Fiberoptic bronchoscopy was performed,which confirmed the diagnosis of bronchial rupture.A modified tracheal tube was inserted under the guidance of a fiberoptic bronchoscope.Pulse oxygen saturation improved from 60%to 90%.Twelve days after admission,right upper lobectomy was performed using bronchial stump suture by video-assisted thoracic surgery without complications.A follow-up chest radiograph showed good recovery.The child was discharged from hospital three months after admission.CONCLUSION A modified tracheal tube could be selected to ensure a patent airway and adequate ventilation in patients with bronchial rupture.
基金funded by the National Research Foundationof Korea (No. NRF-2017R1C1B5076493).
文摘To apply a new airway treatment to humans, preclinical studies in an appropriate animalmodel is needed. Canine, porcine and leporine tracheas have been employed as animal airwaystenosis models using various methods such as chemical caustic agents, laser, and electrocautery.However, existing models take a long time to develop (3- 8 weeks) and the mechanism of stenosisis different from that in humans. The aim of the present study was to establish a new and fasttracheal stenosis model in pigs using a combination of cuff overpressure intubation (COI) andelectrocautery. Fourteen pigs were divided into three groups: tracheal cautery (TC) group (n=3),COI group (n=3), and COI-TC combination group (n=8). Cuff overpressure (200/400/500 mmHg)was applied using a 9-mm endotracheal tube. Tracheal cautery (40/60 watts) was performed usinga rigid bronchoscopic electrocoagulator. After intervention, the pigs were observed for 3 weeks andbronchoscopy was performed every 7 days. When the cross-sectional area decreased by > 50%, itwas confirmed that tracheal stenosis was established. The time for tracheal stenosis was 14 days inthe TC group and 7 days in the COI-TC combination group. In the COI group, no stenosis occurred.In the COI-TC group, electrocautery (40 watts) immediately after intubation for>1 h with a cufpressure of 200 mmHg or more resulted in suficient tracheal stenosis within 7 days. Moreover, thedegree of tracheal stenosis increased in proportion to the cuff pressure and tracheal intubation time.The combined use of cuf overpressure and electrocautery helped to establish tracheal stenosis inpigs rapidly.
基金Supported by National Natural Science Foundation of China,No. 81973784
文摘BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case with 10 mo follow-up.CASE SUMMARY Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma.The patient then received four doses of toripalimab.Subsequently,rapid,progressive deterioration of the original fistula was found.Although the fistula enlarged rapidly after immunotherapy,it remained covered completely,and likely because of this,his condition remained stable.Therefore,immunotherapy could be continued to treat the primary tumor.Despite these efforts,the patient died of the advancement of his esophageal cancer.CONCLUSION Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.
