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Jiwangga D, Mahyudin F, Mastutik G, Meitavany EN, Juliana, Wiratama PA. Synergistic Effects of SDS and H 2O 2 Combinations on Tracheal Scaffold Development: An In Vitro Study Using Goat Trachea. Int J Biomater 2024; 2024:6635565. [PMID: 38205070 PMCID: PMC10776195 DOI: 10.1155/2024/6635565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Currently, a tissue-engineered trachea has been popularly used as a biological graft for tracheal replacement in severe respiratory diseases. In the development of tissue-engineered tracheal scaffolds, in vitro studies play a crucial role in allowing researchers to evaluate the efficacy and safety of scaffold designs and fabrication techniques before progressing to in vivo or clinical trials. This research involved the decellularization of goat trachea using SDS, H2O2, and their combinations. Various quantitative and qualitative assessments were performed, including histological analysis, immunohistochemistry, and biomechanical testing. Hematoxylin and eosin staining evaluated the cellular content, while safranin O-fast green and Masson's trichrome staining assessed glycosaminoglycan content and collagen distribution, respectively. The immunohistochemical analysis focused on detecting MHC-1 antigen presence. Tensile strength measurements were conducted to evaluate the biomechanical properties of the decellularized scaffolds. The results demonstrated that the combination of SDS and H2O2 for goat tracheal decellularization yielded scaffolds with minimal cellular remnants, low toxicity, preserved ECM, and high tensile strength and elasticity. This method holds promise for developing functional tracheal scaffolds to address severe respiratory diseases effectively.
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Affiliation(s)
- Dhihintia Jiwangga
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Gondo Mastutik
- Department of Anatomic Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Estya Nadya Meitavany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Juliana
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Priangga Adi Wiratama
- Department of Anatomic Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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2
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Feng YG, Tao SL, Mei LY, Dai FQ, Tan QY, Wang RW, Zhou JH, Deng B. Surgical treatment of severe benign tracheal stenosis. J Cardiothorac Surg 2023; 18:293. [PMID: 37833733 PMCID: PMC10576339 DOI: 10.1186/s13019-023-02369-0] [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: 03/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To present clinical experiences regarding surgical treatment of patients with severe cicatricial tracheal stenosis. PATIENTS AND METHODS From January 2008 to March 2020, 14 patients underwent tracheal resection and reconstruction under general anesthesia. Nine cases had cervical tracheal stenosis and five cases had thoracic tracheal stenosis. The mean diameter and length of strictured trachea was 0 - 8 mm with a mean of 4.5 ± 2.4 mm and 1 - 3 cm with a mean of 1.67 ± 0.63 cm, respectively. General anesthesia and mechanical ventilation were performed in ten cases and four patients underwent femoral arteriovenous bypass surgery due to severe stenosis. End-to-end anastomosis of trachea was performed in 13 cases and the anastomosis between trachea and cricothyroid membrane was performed in one case. Absorbable and unabsorbable sutures were used for the anterior and posterior anastomoses, respectively. Postoperative neck anteflexion was maintained by a suture between the chin and superior chest wall. The relevant data of the 14 patients were retrospectively reviewed, and the operation time, blood loss, postoperative hospital stay, postoperative complications and follow-up were retrieved. RESULTS There was no intraoperative death. The length of resected trachea ranged from 1.5 to 4.5 cm with a mean of 1.67 ± 0.63 cm. Operation time ranged from 50 - 450 min with a mean of 142.8 ± 96.6 min and intraoperative hemorrhage ranged from 10 - 300 ml with a mean of 87.8 ± 83.6 ml. Follow-up period ranged from 5 to 43 months with a mean of 17.9 ± 10.6 months. None of the patients had recurrent laryngeal nerve paralysis during postoperative follow-up. Ten cases were discharged uneventfully. Anastomosis stenosis occurred in three cases who received interventional therapies. Bronchopleurocutaneous fistula occurred in one patient after 6 days postoperatively and further treatment was declined. CONCLUSION The strategies of anesthesia, mechanical ventilation, identification of stenosis lesion, the "hybrid" sutures and postoperative anteflexion are critical to be optimized for successful postoperative recovery.
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Affiliation(s)
- Yong-Geng Feng
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Shao-Lin Tao
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Long-Yong Mei
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Fu-Qiang Dai
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Qun-You Tan
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Ru-Wen Wang
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Jing-Hai Zhou
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China.
| | - Bo Deng
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China.
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Shrestha S, Shin Y, Sostin OV, Pinkhasova P, Chronakos J. Upper Airway Complications in COVID-19: A Case Series. Cureus 2023; 15:e37163. [PMID: 37153305 PMCID: PMC10162402 DOI: 10.7759/cureus.37163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
Prolonged intubation is associated with several complications leading to upper airway obstruction, including tracheal stenosis and tracheomalacia. Tracheostomy may potentially decrease the risk of tracheal injury in patients with upper airway obstruction. The ideal timing to perform tracheostomy remains controversial. Prolonged intubations were particularly common during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to present a series of five cases of upper airway complications in patients who underwent mechanical ventilation in the setting of COVID-19 and discuss their clinical aspects, risk factors, and therapeutic strategies.
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Chang DG, Park JB, Kim HJ, Park SB. Delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture: a case report. Eur J Med Res 2021; 26:77. [PMID: 34284813 PMCID: PMC8290576 DOI: 10.1186/s40001-021-00550-6] [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: 03/10/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Among the several complications associated with anterior cervical discectomy and fusion (ACDF), airway compromise is considered one of the serious life-threatening conditions and usually requires emergent treatment, including airway establishment and hematoma evacuation surgery. Postoperative retropharyngeal hematoma commonly occurred during the on immediate phase with airway compromise, but have a rarity on late onset of this complication. Enlightened by this existing fact, we report the first case of delayed onset postoperative retropharyngeal hematoma after anterior cervical surgery with a sequela of tracheal stricture. Case presentation A 55-year-old male underwent ACDF for disc herniation at C5–6 that had not responded to conservative treatment over 3 months. The symptoms significantly improved after surgery, and he was discharged on postoperative day 3. On the 7 days after ACDF, the patient complained of sudden-onset left-deviated neck swelling. The follow-up plain radiographs and neck-enhanced computed tomography (CT) scans showed anterior and right lateral displacement of the airway including the trachea by a large retropharyngeal hematoma. We performed an emergent forceful endotracheal intubation that was maintained for 2 days until the patient underwent hematoma evacuation surgery. On the second day after hematoma evacuation surgery, the patient complained of hoarseness with a foul breath odor. Laryngoscopy showed tracheal ischemic mucosal damage that had been induced by forceful endotracheal intubation. Antibiotics and systemic corticosteroids were administered, and the symptoms improved. One month after hematoma evacuation surgery, he complained of dyspnea on exertion, and laryngoscopy showed tracheal stricture. The patient underwent bronchoscopic dilatation and is doing well without recurrence of symptoms. Conclusions Early surgery to remove the delayed onset retropharyngeal hematoma, rather than forceful endotracheal intubation followed by delayed surgery, might yield better results and avoid unexpected complications of tracheal stricture.
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Affiliation(s)
- Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. .,Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, 11765, Gyeonggi-do, Korea.
| | - Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Soo-Bin Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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5
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Khan A, Hashim Z, Gupta M, Lal H, Agarwal A, Nath A. Rigid bronchoscopic interventions for central airway obstruction - An observational study. Lung India 2020; 37:114-119. [PMID: 32108594 PMCID: PMC7065553 DOI: 10.4103/lungindia.lungindia_454_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Central airway obstruction (CAO) is a significant cause of morbidity and mortality in patients with thoracic malignancies. In this prospective study, we describe the role of rigid bronchoscopy (RB) in the multimodality management of CAO. Methods Prospective description of different rigid bronchoscopic techniques used for CAO between July 2016 and July 2019. Results A total of 152 procedures (124 therapeutic/palliative and 28 diagnostics) in 111 adults and 10 pediatric patients were performed. The mean age in 111 adults (66 males) and 10 pediatric (5 males) patients were 45.4 ± 15.8 (range 16-80) and 5.4 ± 3.6 (range 1-10) years, respectively. Palliation of the airway obstruction (48.8%) and establishment of diagnosis (23.2%) were the main indications of RB in our study. Mechanical debulking in 53 (57%) and airway dilatation in 40 (43%) patients were the most utilized interventions during the palliative or therapeutic RB. There was a significant decrease in mean (modified Medical Research Council) dyspnea scale from 3.9 ± 1.0 to 1.42 ± 0.63 and increase in mean Visual Analogue Scale from 2.06 ± 0.74 to 8.7 ± 0.54 after the procedure (P < 0.0001). Additional therapy was undertaken in 38 (31.4%) of 121 patients, and surgical excision was the primary form of definitive treatment in 17 patients Moderate bleeding was encountered in 13.3% of the procedures mainly in the diagnostic RB. The mean procedure duration was 28.4 (range, 11-49) min and 13.2 (7-22) min in the adults and pediatric patients, respectively. A total of 31 patients succumbed to the illness due to the progressive nature of their disease. Conclusions An individualized approach to interventional procedures is safe and effective way to achieve and maintain palliation of CAO. RB with multimodality treatment achieves the goal in majority of the patients.
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Affiliation(s)
- Ajmal Khan
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Zia Hashim
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aarti Agarwal
- Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Alok Nath
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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6
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Maweni RM, Manikavasagar V, Sunderland N, Chaudhry S. Thoracic oesophageal cancer as a cause of stridor: a literature review. BMJ Case Rep 2018; 2018:bcr-2018-224872. [PMID: 29844036 DOI: 10.1136/bcr-2018-224872] [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: 11/04/2022] Open
Abstract
An 83-year-old woman, with a background of treated squamous cell oesophageal cancer, presented with a 3-week history of stridor. Of note, the patient had no risk factors for oesophageal cancer other than age. Clinical examination was unremarkable apart from stridor. Laboratory investigations, including arterial blood gas on room air, were unremarkable. Radiological examination revealed a 4.5×3.5×3.6 cm mass involving the posterior trachea and invading the tracheal orifice. Oesophagogastroduodenoscopy and rigid bronchoscopy confirmed an extensive tumour arising from the lower oesophagus and invading the trachea, causing 90% airway obstruction for a 6 mm length ending 1.5 cm above the carina. Biopsy revealed a poorly differentiated carcinoma with foci of squamous cell carcinoma. Unfortunately, the patient passed away 2 months after palliative tracheal stent placement.
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Affiliation(s)
| | | | | | - Sajid Chaudhry
- Acute Medical Unit, Croydon University Hospital, London, UK
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7
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Multimodality Surgical Approach in Management of Laryngotracheal Stenosis. Case Rep Otolaryngol 2018; 2018:4583726. [PMID: 29808149 PMCID: PMC5902080 DOI: 10.1155/2018/4583726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
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8
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Khan A, Nath A, Mangla L, Paul M, Neyaz Z. Use of dedicated optical tracheal dilator for postintubation tracheal stenosis: First report from India. Lung India 2018; 35:417-420. [PMID: 30168462 PMCID: PMC6120308 DOI: 10.4103/lungindia.lungindia_372_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Postintubation tracheal stenosis is preventable yet commonly occurring clinical condition. Early in the disease, nonspecific symptoms may predominate but once the stenosis reaches a critical stage life-threatening respiratory compromise may ensue. Bronchoscopic interventions are an invaluable tool in the management both as a primary treatment and as an interim procedure before the surgery. Optical dilatational tracheoscopy is a safe and minimally invasive procedure in the treatment of benign tracheal stenosis. Involvement of multidisciplinary team early in the treatment planning gives the best possible results.
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Affiliation(s)
- Ajmal Khan
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Alok Nath
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Loveleen Mangla
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Mekhala Paul
- Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
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9
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Ahn HJ, Khalmuratova R, Park SA, Chung EJ, Shin HW, Kwon SK. Serial Analysis of Tracheal Restenosis After 3D-Printed Scaffold Implantation: Recruited Inflammatory Cells and Associated Tissue Changes. Tissue Eng Regen Med 2017; 14:631-639. [PMID: 30603516 DOI: 10.1007/s13770-017-0057-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/04/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023] Open
Abstract
Tracheal restenosis is a major obstacle to successful tracheal replacement, and remains the greatest challenge in tracheal regeneration. However, there have been no detailed investigations of restenosis. The present study was performed to analyze the serial changes in recruited inflammatory cells and associated histological changes after tracheal scaffold implantation. Asymmetrically porous scaffolds, which successfully prevented tracheal stenosis in a partial trachea defect model, designed with a tubular shape by electrospinning and reinforced by 3D-printing to reconstruct 2-cm circumferential tracheal defect. Serial rigid bronchoscopy, micro-computed tomography, and histology [H&E, Masson's Trichrome, IHC against α-smooth muscle actin (α-SMA)] were performed 1, 4, and 8 weeks after transplantation. Progressive stenosis developed especially at the site of anastomosis. Neutrophils were the main inflammatory cells recruited in the early stage, while macrophage infiltration increased with time. Recruitment of fibroblasts peaked at 4 weeks and deposition of α-SMA increased from 4 weeks and was maintained through 8 weeks. During the first 8 weeks post-transplantation, neutrophils and macrophages played significant roles in restenosis of the trachea. Antagonists to these would be ideal targets to reduce restenosis and thus play a pivotal role in successful tracheal regeneration.
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Affiliation(s)
- Hee-Jin Ahn
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Roza Khalmuratova
- 2Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080 Korea
| | - Su A Park
- 3Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Gajeongbuk-ro 156, Daejeon, 34103 Korea
| | - Eun-Jae Chung
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Hyun-Woo Shin
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea.,2Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080 Korea.,4Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Korea.,5Cancer Research Institute and Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Seong Keun Kwon
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
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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: 17] [Impact Index Per Article: 2.4] [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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11
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Raman T, Chatterjee K, Alzghoul BN, Innabi AA, Tulunay O, Bartter T, Meena NK. A bronchoscopic approach to benign subglottic stenosis. SAGE Open Med Case Rep 2017; 5:2050313X17713151. [PMID: 28620493 PMCID: PMC5464515 DOI: 10.1177/2050313x17713151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives: Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. Methods: We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing. Results: We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications. Conclusion: Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.
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Affiliation(s)
- Tuhina Raman
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kshitij Chatterjee
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bashar N Alzghoul
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ayoub A Innabi
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ozlem Tulunay
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nikhil K Meena
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Abstract
Tracheal and Bronchial injuries are potentially life threatening complications which require urgent diagnosis and therapeutic intervention. They typically occur in association with blunt and penetrating chest trauma although they are increasingly being encountered in patients following endobronchial intervention and percutaneous tracheostomy insertion. Their precise incidence is unknown. Presenting features include dyspnoea, stridor, respiratory and haemodynamic compromise, haemoptysis, surgical emphysema, pneumothorax and persistent significant airleak. There may be other additional injuries to consider in trauma patients with large airway injury. Familiarity with the diagnosis and management of large airway injuries is important for medical teams engaged in emergency medicine, thoracic surgery and medicine, anaesthesia and intensive care. Although early surgical intervention is the mainstay of treatment, endobronchial manoeuvres to seal defects are receiving increasing attention particularly for patients with medical co-morbidities which may contraindicate formal surgery or transfer or where local surgical expertise is not available.
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13
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Karapantzos I, Zarogoulidis P, Karanikas M, Thomaidis V, Charalampidis C, Karapantzou C. Obstruction of the right stem bronchus due to ovarian local metastasis: a 5-year follow-up. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:445. [PMID: 27999779 DOI: 10.21037/atm.2016.10.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Currently interventional bronchoscopy is used for debulking, desobstruction and airway patency stabilization. The interventional techniques are being used for both benign and malignant cases. There are two types of stents that are currently being used, silicon and self-expandable metallic. The method of application and stent remains for the treating physician to choose. In the current case we will present a case of metastatic disease from ovarian cancer in the airway lumen and a long term follow-up.
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Affiliation(s)
- Ilias Karapantzos
- Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department, Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Karanikas
- General Surgery Department, "Genisis" Private Clinic, Thessaloniki, Greece
| | - Vasilis Thomaidis
- Department of Maxillofacial Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Chrysa Karapantzou
- Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
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14
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Elsayed H, Mostafa AM, Soliman S, Shoukry T, El-Nori AA, El-Bawab HY. First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis. Ann R Coll Surg Engl 2016; 98:425-30. [PMID: 27138847 PMCID: PMC5209981 DOI: 10.1308/rcsann.2016.0162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction Tracheal stenosis following intubation is the most common indication for tracheal resection and reconstruction. Endoscopic dilation is almost always associated with recurrence. This study investigated first-line surgical resection and anastomosis performed in fit patients presenting with postintubation tracheal stenosis. Methods Between February 2011 and November 2014, a prospective study was performed involving patients who underwent first-line tracheal resection and primary anastomosis after presenting with postintubation tracheal stenosis. Results A total of 30 patients (20 male) were operated on. The median age was 23.5 years (range: 13-77 years). Seventeen patients (56.7%) had had previous endoscopic tracheal dilation, four (13.3%) had had tracheal stents inserted prior to surgery and one (3.3%) had undergone previous tracheal resection. Nineteen patients (63.3%) had had a tracheostomy. Eight patients (26.7%) had had no previous tracheal interventions. The median time of intubation in those developing tracheal stenosis was 20.5 days (range: 0-45 days). The median length of hospital stay was 10.5 days (range: 7-21 days). The success rate for anastomoses was 96.7% (29/30). One patient needed a permanent tracheostomy. The in-hospital mortality rate was 3.3%: 1 patient died from a chest infection 21 days after surgery. There was no mortality or morbidity in the group undergoing first-line surgery for de novo tracheal lesions. Conclusions First-line tracheal resection with primary anastomosis is a safe option for the treatment of tracheal stenosis following intubation and obviates the need for repeated dilations. Endoscopic dilation should be reserved for those patients with significant co-morbidities or as a temporary measure in non-equipped centres.
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Affiliation(s)
- H Elsayed
- Ain Shams University Hospital , Cairo , Egypt
| | - A M Mostafa
- Ain Shams University Hospital , Cairo , Egypt
| | - S Soliman
- Ain Shams University Hospital , Cairo , Egypt
| | - T Shoukry
- Ain Shams University Hospital , Cairo , Egypt
| | - A A El-Nori
- Ain Shams University Hospital , Cairo , Egypt
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15
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Akter F, Coghlan G, de Mel A. Nitric oxide in paediatric respiratory disorders: novel interventions to address associated vascular phenomena? Ther Adv Cardiovasc Dis 2016; 10:256-70. [PMID: 27215618 DOI: 10.1177/1753944716649893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nitric oxide (NO) has a significant role in modulating the respiratory system and is being exploited therapeutically. Neonatal respiratory failure can affect around 2% of all live births and is responsible for over one third of all neonatal mortality. Current treatment method with inhaled NO (iNO) has demonstrated great benefits to patients with persistent pulmonary hypertension, bronchopulmonary dysplasia and neonatal respiratory distress syndrome. However, it is not without its drawbacks, which include the need for patients to be attached to mechanical ventilators. Notably, there is also a lack of identification of subgroups amongst abovementioned patients, and homogeneity in powered studies associated with iNO, which is one of the limitations. There are significant developments in drug delivery methods and there is a need to look at alternative or supplementary methods of NO delivery that could reduce current concerns. The addition of NO-independent activators and stimulators, or drugs such as prostaglandins to work in synergy with NO donors might be beneficial. It is of interest to consider such delivery methods within the respiratory system, where controlled release of NO can be introduced whilst minimizing the production of harmful byproducts. This article reviews current therapeutic application of iNO and the state-of-the-art technology methods for sustained delivery of NO that may be adapted and developed to address respiratory disorders. We envisage this perspective would prompt active investigation of such systems for their potential clinical benefit.
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Affiliation(s)
- Farhana Akter
- UCL Centre for Nanotechnology and Regenerative Medicine; Division of Surgery and Interventional Science, UCL, UK
| | - Gerry Coghlan
- Pulmonary Hypertension Unit, Royal Free London NHS Foundation Trust, UK
| | - Achala de Mel
- Lecturer in Regenerative Medicine, UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, Royal Free NHS Trust Hospital, 9th Floor, Room 355, Pond Street, London NW3 2QG, UK
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16
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Özdemir C, Sökücü SN, Karasulu L, Önür ST, Dalar L. Placement of self-expandable bifurcated metallic stents without use of fluoroscopic and guidewire guidance to palliate central airway lesions. Multidiscip Respir Med 2016; 11:15. [PMID: 27134746 PMCID: PMC4851784 DOI: 10.1186/s40248-016-0052-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/19/2016] [Indexed: 11/21/2022] Open
Abstract
Background Self-expandable metallic stents (SEMS) can be used to treat malignant obstructions and fistulas of the central airways. SEMS can be placed using different methods. Recently, a rigid bronchoscope has been used for stent placement without the need for fluoroscopy. We retrospectively evaluated patients for whom SEMS were placed using a rigid bronchoscope, without employing guidewires or fluoroscopy. We describe the intra- and post-procedural complications of the method. Methods Data collected between January 2014 and July 2015 were retrospectively evaluated by reference to hospital records. Results The mean patient age was 58.14 ± 8.48 years (44–72 years) and 13 out of the 14 patients were male. Twelve had lung cancer, one a thyroid papillary carcinoma with a bronchomediastinal fistula, and one an esophageal carcinoma with a tracheoesophageal fistula. Covered metallic Y-shaped stents were placed in all patients. Before placement, argon plasma coagulation was performed on two patients, diode laser treatment on four, and de-obstruction on nine. No procedure-related mortality was noted. Only two patients required follow-up in the intensive care unit; they were moved to a regular ward after two days. No patient required stent replacement or repositioning. The most common early complication was mucus plugs. Conclusion Endobronchial placement of covered self-expandable metallic stents was safe and readily performed in patients with airway obstructions. Neither fluoroscopic nor guidewire guidance was required. Neither patients nor staff were exposed to radiation, and costly guidewire guidance was not necessary. The procedure is cost-effective.
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Affiliation(s)
- Cengiz Özdemir
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey
| | - Sinem Nedime Sökücü
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey
| | - Levent Karasulu
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey
| | - Seda Tural Önür
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey
| | - Levent Dalar
- School of Medicine, Department of Pulmonary Medicine, Istanbul Bilim University, Istanbul, Turkey
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17
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Hohenforst-Schmidt W, Linsmeier B, Zarogoulidis P, Freitag L, Darwiche K, Browning R, Turner JF, Huang H, Li Q, Vogl T, Zarogoulidis K, Brachmann J, Rittger H. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle - a perspective on a new tool to avoid stent migration of Dumon stents. Ther Clin Risk Manag 2015; 11:837-50. [PMID: 26045666 PMCID: PMC4448926 DOI: 10.2147/tcrm.s83230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.
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Affiliation(s)
- Wolfgang Hohenforst-Schmidt
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany ; II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
| | - Bernd Linsmeier
- Department of Thoracic Surgery, Medinos Clinic Sonneberg, Sonnerberg, Germany
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg, Essen, Germany
| | - Robert Browning
- Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA
| | - J Francis Turner
- Division of Interventional Pulmonology and Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ, USA
| | - Haidong Huang
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Johannes Brachmann
- II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
| | - Harald Rittger
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
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