Results of Montgomery T-Tube in Primary Treatment of Laryngotracheal Stenosis

Introduction: For tracheal stenosis, tracheal resection and anastomosis is widely considered the treatment of choice. However, this surgical approach is not feasible when the glottis and subglottis are involved or in patients with a poor general condition and tracheal stents are a plausible means of providing a permanent or temporary airway opening. Objectives: Evaluate the features and the results of patients with Montgomery T-tube in tracheal stenosis. Methods: Fifteen patients with Myer-Cotton grades 2-3 circular cicatricial tracheal stenosis who received a Montgomery T-tube between 2002-2011 were analyzed in terms of age, gender, etiology, duration of intubation, location and size of the stenotic segment on computed tomography(CT), follow-up time with the T-tube, the complications that occurred after T-tube removed and additional tracheal surgery. Conclusion: A T-tube can be applied in tracheal stenosis at the first treatment before attempting surgery. The patients should be closely followed-up due to the possibility of re-stenosis and other complications.

Rosmarinic acid improves tracheal smooth muscle responsiveness and lung pathological changes in ovalbumin-sensitized rats

Objective:To evaluate the effect of rosmarinic acid on tracheal smooth muscle responsiveness and lung pathological changes in ovalbumin-sensitized rats.Methods:Rats were randomly divided into six groups:the control group,the asthmatic group,and the asthmatic groups treated with dexamethasone(1 mg/kg;oral gavage)or three doses of rosmarinic acid(0.5,1,and 2 mg/kg;oral gavage).For induction of asthma,rats received intraperitoneal injections and inhalation of ovalbumin.After 21 days,bronchoalveolar lavage fluid and lung samples were collected for histopathological analyses.Moreover,total and differential white blood cell counts were determined.Results:The rosmarinic acid-treated group had significantly lower tracheal smooth muscle responses to methacholine than the asthmatic group.In addition,rosmarinic acid reduced white blood cell count and the percentages of eosinophils,monocytes,and neutrophils while increasing the percentage of lymphocytes.Ovalbumin-induced lung pathological changes were significantly improved by treatment with rosmarinic acid.Conclusions:Rosmarinic acid improves tracheal smooth muscle responsiveness and lung pathological changes in ovalbumin-sensitized rats.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma:A case report

BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective:To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula.Methods:Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected,and all patients underwent tracheal silicone stenting,comparing dyspnea classification and Karnofsky score before and after stenting,and conducting post-treatment follow-up.Results:In 32 patients with tracheoesophageal fistula,dyspnea grading improved from grades III and IV to grades 0 to II.Before treatment,10 patients(31.06%)were in grade IV,17 patients(53.12%)were in grade III,and five patients(15.62)were in grade II;after treatment,13 patients(40.63%)were in grade I,12 patients(37.50%)were in grade I,and seven patients(21.87%)were in grade 0(P<0.05);Karnofsky score(37.52±4.86 before treatment)improved significantly to 71.39±8.24 one week after treatment(P<0.05).Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent,11 with silicone 18-14-14 stent,three with silicone Y15-12-12,and seven with silicone stent 16-13-13.Conclusion:Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible,simple,and safe,with reliable near-term efficacy,and is worthy of popularization and application.

基于“T-tube”模型的中心动脉脉搏波双通道盲辨识

提出了由两路人体外周动脉脉搏波(peripheral artery pulse wave,PAP)来估计中心动脉脉搏波(central aortic pulse wave,CAP)的多通道盲辨识(multi-channel blind system identification,MBSI)方法,旨在实现心血管系统中心动脉脉搏波的实时无创连续监测.首先简单介绍了多通路盲辨识算法,并证明了心血管系统IIR模型特性可由FIR模型逼近,从而简化了MBSI算法.然后介绍了心血管"T-tube"模型,并结合两路外周动脉实测(肱动脉、股动脉)脉搏波来重建中心动脉脉搏波和辨识模型.结果表明,MBSI算法稳定性较好,估计出的CAP波形畸变率百分比小于6%、形态整体能量误差百分比小于3%.

Aortic ostia of the bronchial arteries and tracheal bifurcation:MDCT analysis

AIM:To explore the anatomical relationships between bronchial artery and tracheal bifurcation using computed tomography angiography (CTA).METHODS:One hundred consecutive patients (84 men,16 women;aged 46-85 years) who underwent CTA using multi-detector row CT (MDCT) were investigated retrospectively.The distance between sites of bronchial artery ostia and tracheal bifurcation,and dividing directions were explored.The directions of division from the descending aorta were described as on a clock face.RESULTS:We identified ostia of 198 bronchial arteries:95 right bronchial arteries,67 left bronchial arteries,36 common trunk arteries.Of these,172 (87%) divided from the descending aorta,25 (13%) from the aortic arch,and 1 (0.5%) from the left subclavian artery.The right,left,and common trunk bronchial arteries divided at-1 to 2 cm from tracheal bifurcation with frequencies of 77% (73/95),82% (54/66),and 70% (25/36),respectively.The dividing direction of right bronchial arteries from the descending aorta was 9 to 10 o’clock with a frequency of 81% (64/79);that of left and common tract bronchial arteries was 11 to 1 o’clock with frequencies of 70% (43/62) and 77% (24/31),respectively.CONCLUSION:CTA using MDCT provides details of the relation between bronchial artery ostia and tracheal bifurcation.

Urgent Tracheal Resection and Reconstruction Assisted by Temporary Cardiopulmonary Bypass:a Case Report

SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anesthesiologist. Life-threa- tening airway obstruction can make the patient＇s gas ex- change extremely difficult. Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis.1 Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists.

Expression of pIgR in the tracheal mucosa of SHIV/SIV-infected rhesus macaques

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.

Case Reports:Anesthetic management of emergent critical tracheal stenosis

Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circu-lation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.

Development and Mechanical Properties of a Novel Woven Artificial Tracheal Stent

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.

T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation:An updated systematic review and metaanalysis

BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.

Reconstruction of the thoracic tracheal defects with portions of deepithelialized myocutaneous flaps after resection of a large tumor

Objective： To study the possibility of using portions of deepithelialized myocutaneous flaps to the reconstruction of thoracic tracheal defects after resection of a large tumor. Methods： From June 2007 to June 2012, five cases of defects of the thoracic trachea were reconstructed by applying portions of deepithelialized myocutaneous flaps. The patients were 27-61 years old with 4 male cases and 1 female. The cervical trachea ranged in diameter from 4-8.5 cm with circumferences of approximately 1/3-2/5 of the bronchial circumference. Results： M1 five patients with thoracic tracheal defects after resection of a large tumor were cured of portions of deepithelialized myocutaneous flaps, with no tracheal stricture remaining and vomica successfully eliminated. During the first 1 to 3 months after the operation, bronchoscopy showed that the tracheal lumens were smooth, and the visible skin of the musculocutaneous flaps became gray and exhibited a small amount of white discharge. Conclusions： Despite this being a small series and short follow-up, this thoracic tracheal reconstruction with portions of deepithelialized myocutaneous flaps shows encouraging preliminary results and could be an alternative to other methods for the treatment of carefully selected patients with thoracic tracheal defects.

Rapid response to radiotherapy in unresectable tracheal adenoid cystic carcinoma:A case report

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.

Continuous tracheal gas insufflation during protective mechanical ventilation in juvenile piglets with acute lung injury induced by endotoxin

Low tidal volume mechanical ventilation is difficult to correct hypoxemia, and prolonged inhalation of pure oxygen can lead to oxygen poisoning. We suggest that continuous tracheal gas insufflation （TGI） during protective mechanical ventilation could improve cardiopulmonary function in acute lung injury. Totally 12 healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH2O with a peak inspiratory pressure of 10 cmH2O. The piglets were challenged with lipopolysaccharide and randomly assigned into two groups （n=6 each group）： mechanical ventilation （MV） alone and TGI with continuous airway flow 2 I/min. FIO2 was set at 0.4 to avoid oxygen toxicity and continuously monitored with an oxygen analyzer. Tidal volume, ventilation efficacy index and mean airway resistant pressure were significantly improved in the TGI group （P〈0.01 or P〈0.05）. At 4 hours post ALl, pH decreased to below 7.20 in the MV group, and improved in the TGI group （P〈0.01）. Similarly, PaCO2 was stable and was significantly lower in the TGI group than in the MV group （P〈0.01）. PaO2 and PaO2/FIO2 increased also in the TGI group （P〈0.05）. There was no significant difference in heart rate, respiratory rate, mean artery pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between the two groups. Lung histological examination showed reduced inflammation, reduced intra- alveolar and interstitial patchy hemorrhage, and homogenously expanded lungs in the TGI group. Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy and may provide a better treatment for acute lung injury.

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

.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.

Anesthetic challenges in ventilating patients with tracheal diverticulum: Case reports and review of literature

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.

Treatment of primary tracheal schwannoma with endoscopic resection:A case report

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.

Iatrogenic esophago-tracheal fistula:Challenges in diagnosis and management

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.

Use of Platelet Rich Plasma (PRP) in the Treatment of Acute Post Intubation Tracheal Rupture: Report of Two Cases

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.