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Sample records for pre-rhdnase therapy tracheal

  1. Successful Treatment of Anterior Tracheal Necrosis after Total Thyroidectomy Using Vacuum-Assisted Closure Therapy

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    Grégory Philippe

    2012-01-01

    Full Text Available Total thyroidectomy involving the adjacent structures of the trachea can cause tracheal damage such as early tracheal necrosis. The authors describe the first case of anterior tracheal necrosis following total thyroidectomy treated using vacuum-assisted closure device. After two weeks of VAC  therapy, there was no evidence of ongoing infection and the trachea was partially closed around a tracheotomy cannula, removed after 3 months. The use of a VAC  therapy to reduce and close the tracheal rent and to create a rapid granulation tissue over tracheal structure appeared as a good opportunity after anterior tracheal necrosis.

  2. Laser Therapy for an Obstructing Primary Tracheal Lymphoma in a Patient With AIDS

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    Brian E Louie

    2005-01-01

    Full Text Available A patient with AIDS presented with progressive dyspnea leading to respiratory failure with near complete airway obstruction due to primary tracheal lymphoma. Laser therapy was used locally to debulk the tumour, which facilitated extubation and led to definitive treatment with chemotherapy. Alternatives for local airway control are discussed.

  3. Efficacy of voice therapy in patient with arytenoid dislocation as a complication of tracheal intubation

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    Md Noorain Alam

    2015-01-01

    Full Text Available Introduction: Tracheal intubation is the placement of a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit through which certain drugs are administered. Arytenoid dislocation is one of the rare reported complications of tracheal intubation. Decreased volume and breathiness are the most common voice symptoms. Need for the Study: There is lack of prospective and systemic study of the incidence of arytenoid dislocation and efficacy of voice therapy in such cases. Aim of the Study: Present study was carried out to find out the efficacy of voice therapy as independent management option in persons with arytenoid dislocation as a consequence of tracheal intubation. Materials and Methods: The study was based on a case study of a 37 year old male patient who reported to C U Shah Medical College and Hospital, Surendranagar with complaint of breathy and soft voice quality post laparotomy as a consequence of intubation. ENT examination revealed both vocal cord bowing with ? subclinical sublaxtition of arytenoid. Pre and post voice therapy assessment was done using GRBAS scale (for perceptual analysis, Praat software (for acoustical analysis and VHI scale (for measuring the effect of voice disorder on the quality of life. Voice therapy was given for two months and pre and post findings were compared. Results: Significant improvement was observed on all the measures. Conclusion: Although arytenoid cartilage dislocation following the use of intubation is a rare event, it is important to be aware of its occurrence and to conduct diagnostic tests as early as possible in case of persistent hoarseness. Voice therapy may be used as an adjunct to phonosurgery or independently an effective intervention.

  4. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

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    Shin, Ji Hoon; Beak, Jung Hwan; Oh, Yeon Mok; Ha, Eun Ju; Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2013-10-15

    We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

  5. [Advanced lung cancer with recurrence of liver and tracheal metastases responsive to multimodality therapy - a case report].

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    Higaki, Naozumi; Nakane, Shigeru; Uemura, Hisashi; Okada, Kaoru; Miyake, Yasuhiro; Murakami, Masakazu; Hayashida, Hirohito; Oka, Yoshio; Kusakabe, Yoshito; Tsuruta, Naotoshi; Tetsumoto, Satoshi; Saito, Yoshiyuki; Niju, Takashi; Ikeda, Toshiyuki; Nezu, Riichiro

    2014-11-01

    We report a case of advanced lung cancer with recurrence of liver and tracheal metastases that were responsive to multimodality therapy. The patient was a 77-year-old man who suffered from advanced lung cancer with chronic obstructive pulmonary disease (COPD) and alcohol-induced liver cirrhosis. The primary lung cancer was surgically resected. Eight months after resection of the primary lung cancer, a solitary liver tumor appeared and hepatic resection was performed. Histological findings showed that both the primary lung tumor and the solitary liver tumor were squamous cell carcinoma (SCC). Subsequently, he developed a recurrence in his trachea 8 months after hepatic resection. Radiotherapy, endobronchial argon plasma coagulation (APC), and systemic chemotherapy were administered. The tracheal tumor remained stable without any liver metastasis for 25 months.

  6. Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration

    DEFF Research Database (Denmark)

    Bonnema, Steen Joop; Nielsen, Viveque E; Boel-Jørgensen, Henrik;

    2008-01-01

    INTRODUCTION: The impact on tracheal anatomy and respiratory function of recombinant human (rh)TSH-stimulated (131)I therapy in patients with goiter is not clarified. METHODS: In a double-blinded design, patients (age 37-87 yr) with a large multinodular goiter (range, 99-440 ml) were randomized...... previously. In the placebo group, no significant changes in the lung function or SCAT were found throughout the study. In the rhTSH group, a slight decrease was observed in the forced vital capacity 1 wk after therapy, whereas the mean individual change in SCAT was significantly increased by 10.5% (95...

  7. Effects of Phenytoin Therapy on Bispectral Index and Haemodynamic Changes Following Induction and Tracheal Intubation

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    Parmod P Bithal

    2009-01-01

    Full Text Available Laryngoscopy and tracheal intubation (LTI increase blood pressure and heart rate (HR. Intensity of these changes is influenced by the anaesthetic depth assessed by the bispectral index (BIS. We determined the effect of phenytoin on anaesthetic depth and its influence on haemodynamics following LTI. Fifty patients of ASA grades I and II on oral phenytoin 200 to 300mg per day for more than one week were compared with 48 control patients. Standard anaesthesia technique was followed. BIS, non invasive mean blood pressure (MBP and HR were recorded 30, 60, 90 and 120 sec after LTI. Phenytoin group needed lesser thiopentone for induction, 5 mg (1.1 vs. 4.3 mg (0.7 [p=0.036]. BIS was significantly lower in the phenytoin group vs. the control 30, 60, 90 and 120 sec after LTI [43.1 (16.0 vs. 48.9 (14.9, p=0.068, 56.3 (16.7 vs. 64.3 (14.4, p=0.013, 59.8 (15.8 vs. 67.5 (12.1, p=0.008, 62.6 (14 vs. 68.9 (11.2, p=0.017, and 64.2 (11.3 vs. 69 (11.7, p=0.033], respectively. MBP was also lower in the phenytoin group 30, 60, 90 and 120 sec after LTI [112.8 mmHg (13.8, vs. 117.9 mmHg (18 p=0.013, 108.6 (12.8 vs. 117.5 (16 p=0.003, 106.1 mmHg (14.1 vs. 113.2 mmHg (14.9, p=0.017, 101.8 mmHg (13.8 vs. 109.5 mmHg (14.1, p=0.007], respectively. HR was lower in phenytoin group at 30 sec. (p=0.027, 60 sec (p=0.219, and again at 120 sec (p=0.022. Oral phenytoin therapy for over a week results in greater anaesthetic depth as observed using BIS, which also attenuated haemodynamic response of LTI.

  8. Managing iatrogenic tracheal injuries

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    A. Goonasekera C

    2005-01-01

    Full Text Available We present three cases of iatrogenic tracheal injury. Two patients suffered acute tracheal injuries during anesthesia/surgery, one was managed surgically and the other conservatively. The third case is a delayed tracheal injury presenting as a fistula. The reasons for surgical vs conservative management of tracheal injuries and preventive measures are discussed.

  9. Endoscopic treatment of tracheal stenosis.

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    Freitag, Lutz; Darwiche, Kaid

    2014-02-01

    For all cases of tracheal obstructions surgery should be considered first. Interventional endoscopic procedures can provide immediate relief. Intraluminally growing tumors can be resected with laser, argon-plasma coagulation, an electrosurgical knife or cryo-probe. Photodynamic therapy of smaller tracheal tumors can be curative. Narrowing from intramural tumor growth or wall destruction requires internal splinting with an airway stent. Scar strictures can be dilated with balloons but the biotrauma may stimulate new scarring. In benign strictures and malacias, tracheal stents should only be placed if all other methods are exhausted. Complications including stent migration, mucostasis, halitosis and granulation tissue development must be considered. Most important for a good outcome is a multidisciplinary approach. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Post intubation tracheal stenosis in children

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    Marco Caruselli

    2014-12-01

    Full Text Available Many authors have reported that tracheal stenosis is a complication that can follow tracheal intubation in both adults and children. The symptoms, when they do appear, can be confused with asthma, with subsequent treatment providing only mild and inconsistent relief. We report here the case of an 8 year old girl admitted to our hospital for whooping cough that was not responding to therapy.

  11. CT of tracheal agenesis

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    Strouse, Peter J.; Hernandez, Ramiro J. [C.S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States); Newman, Beverley [Children' s Hospital of Pittsburgh, PA (United States). Department of Pediatric Radiology; Afshani, Ehsan [Children' s Hospital of Buffalo, NY (United States). Departments of Radiology and Pediatrics; Bommaraju, Mahesh [Women' s and Children' s Hospital of Buffalo, Division of Neonatology, University Pediatrics Associates, Buffalo, NY (United States)

    2006-09-15

    Tracheal agenesis is a rare and usually lethal anomaly. In the past, opaque contrast medium was injected via the esophagus to demonstrate the anatomy. To demonstrate the utility of helical and multidetector CT in delineating the aberrant anatomy in newborns with tracheal agenesis. Four newborns with tracheal agenesis were identified from three institutions. Imaging studies and medical records were reviewed. Each child was imaged with chest radiography. One child was imaged on a single-detector helical CT scanner and the other three on multidetector scanners. Helical and multidetector CT with 2D and 3D reconstructions clearly delineated the aberrant tracheobronchial and esophageal anatomy in each infant. Minimum intensity projection reformatted CT images were particularly helpful. One infant each had type I and type II tracheal agenesis. Two infants had type III tracheal agenesis. All four infants died. CT is a useful tool for delineating the aberrant anatomy of newborns with tracheal agenesis and thus helps in making rational clinical decisions. (orig.)

  12. Tracheal mucormycosis pneumonia: a rare clinical presentation.

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    Mohindra, Satyawati; Gupta, Bhumika; Gupta, Karan; Bal, Amanjit

    2014-11-01

    This article reports an unusual case of tracheal mucormycosis following H1N1 pneumonia and reviews previously reported cases. A 40-y-old female with a 5-y history of diabetes mellitus, adequately controlled by oral hypoglycemic agents, developed tracheal mucormycosis after successful treatment for H1N1 pneumonia. The condition was diagnosed during workup for decannulation due to subglottic and upper tracheal obstruction by necrotic chewing gum-like tissue and cartilage. The patient was managed successfully by treatment with amphotericin B and surgical intervention in the form of laryngofissure and Montgomery tube placement. A review of the literature revealed only 5 previously reported cases of tracheal mucormycosis. A high degree of suspicion, early endoscopy and biopsy, histopathological evidence of the infection, and early institution of therapy are the keys to successful outcome.

  13. Iatrogenic tracheal tear.

    LENUS (Irish Health Repository)

    Dias, A

    2010-10-01

    Large post intubation tracheal tears are usually detected intra-operatively due to unstable signs namely impaired ventilation and mediastinal emphysema and often require surgical management. Smaller tracheal tears are often missed during anaesthesia and recognized during the postoperative period. Conservative management should be considered in these latter cases.

  14. Recombinant Human Thyrotropin-Aided Radioiodine Therapy in Tracheal Obstruction by an Invading Well-Differentiated Thyroid Carcinoma

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    Nickolaos Pontikides

    2013-01-01

    Full Text Available Papillary thyroid carcinomas (PTCs usually extend to lymph nodes in the neck and mediastinum. Rarely, they invade the neighboring upper airway anatomical structures. We report a 56-year-old woman who presented with symptoms of upper airway obstruction. Imaging studies revealed a lesion derived from the thyroid which invaded and obstructed the trachea, which appeared to be a highly differentiated PTC. Total thyroidectomy was performed, with removal of the endotracheal part of the mass along with the corresponding anterior tracheal rings. Two months later, a whole body I131 scan after recombinant human thyroid-stimulating hormone (rh-TSH administration was performed and revealed a residual mass in upper left thyroid lobe. Subsequently, 150 mCi I131 were given following rh-TSH administration. Nine months later, there was no sign of residual tumor. This case is the first one reported in the literature regarding rh-TSH administration prior to RAI ablation in a PTC obstructing the trachea.

  15. Posterior tracheal diverticulosis.

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    Madan, Karan; Das, Chandan J; Guleria, Randeep

    2014-10-01

    Multiple tracheal diverticulosis is a rare clinical entity. Tracheal diverticula are usually recognized radiologically as solitary right paratracheal air collections on thoracic computed tomography examination. They are usually asymptomatic but can occasionally present with persistent symptoms. We herein report the case of a 50-year-old male patient who underwent extensive evaluation for persistent cough. Multiple posterior right paratracheal air collections were recognized on thoracic multidetector computed tomography examination, which was confirmed as multiple-acquired posterior upper tracheal diverticula on flexible bronchoscopy. The patient improved with conservative medical management.

  16. Monitoring and humidification during tracheal gas insufflation.

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    Delgado, E; Hoffman, L A; Tasota, F J; Pinsky, M R

    2001-02-01

    In order to use tracheal gas insufflation (TGI) in a safe and effective manner, it is important to understand potential interactions between TGI and the mechanical ventilator that may impact upon gas delivery and carbon dioxide (CO2) elimination. Furthermore, potentially serious complications secondary to insufflation of cool, dry gas directly into the airway and the possibility of tube occlusion must be considered during use of this adjunct modality to mechanical ventilation. Regardless of the delivery modality (continuous TGI, expiratory TGI, reverse TGI, or bidirectional TGI), conventional respiratory monitoring is required. However, TGI with mechanical ventilation can alter tidal volume and peak inspiratory pressure and can lead to the development of intrinsic positive end-expiratory pressure. Therefore, depending on the gas delivery technique used, it is important to carefully monitor these ventilatory parameters for TGI-induced changes and understand the potential need for adjustments to ventilator settings to facilitate therapy and avoid problems. Optimally, gas insufflated by the TGI catheter should be conditioned by addition of heat and humidity to prevent mucus plug formation and potential damage to the tracheal mucosa. Finally, patients must be closely monitored for increases in peak inspiratory pressure from obstruction of the tracheal tube and should have the TGI catheter removed and inspected every 8-12 hours to assess for plugs.

  17. Tracheal agenesis: A report of two cases

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    A V Desai

    2016-01-01

    Full Text Available Tracheal agenesis is an extremely rare congenital anomaly involving the respiratory system. It is generally associated with anomalies of other systems. Antenatal diagnosis of this condition is difficult; therefore, it presents as a medical emergency in the labor room. Intubation in these babies is difficult. As many of these babies are born prematurely, respiratory distress syndrome (RDS adds to the management difficulties. Here, we describe two babies with this lethal anomaly and RDS where esophageal intubation and surfactant therapy proved beneficial. Furthermore, described are other associated anomalies.

  18. Tracheal adenoid cystic carcinoma masquerading asthma: A case report

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    Kurul Cuneyt

    2004-10-01

    Full Text Available Abstract Background Tracheal tumors are often misdiagnosed as asthma and are treated with inhaled steroids and bronchodilators without resolution. Case Presentation Here, a patient with tracheal adenoid cystic carcinoma who had been previously diagnosed with difficult asthma was reported. The possibility of the presence of localized airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction, was obtained. Conclusion The presenting case report emphasizes the fact that not all wheezes are asthma. It is critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy, localized obstructions should be ruled out before establishing the diagnosis of asthma.

  19. 原发性气管肿瘤的呼吸介入治疗(附14例报告)%Interventional bronchoscopy therapy of primary tracheal tumors: report of 14 cases

    Institute of Scientific and Technical Information of China (English)

    张冬青; 陈成水; 叶民; 金旭如; 叶君如; 周颖

    2013-01-01

    tumors,especially appropriate indications and the role of interventional bronchoscopy.Methods:A retrospective analysis of the clinical data of 14 patients with primary tracheal tumors admitted to our department during the period of 2003 to 2009 was performed,all cases had detailed chest radiography,bronchoscopy and pathologic diagnosis.Results:Early clinical symptoms of all cases are unspecific,including cough and dyspnea.The majority malignant tumors included squamous cell carcinomas and adenoid cystic carcinomas; benign tumors consisted of pleiomorphic adenoma,leiomyoma,Chondroma,etc.Nine cases received surgery,and 5 of 9 received interventional bronchoscopic techniques at the same time; and the main therapy of another 5 cases were interventional bronchoscopic treatment.And the main interventional bronchoscopic techniques consisted of electrocoagulation and argon-beam coagulation.The main goal of interventional bronchoscopic treatment included benign tracheal tumors and keeping the airway open before sugery and as palliative therapy of advanced malignant tumors.Conclusion:Among primary tracheal tumors,we must pay more attention to the nonspecific symptoms.Surgery should be considered as the first choice of treatment,and interventional bronchoscopic techniques can be used in the diagnosis and provide treatment of endobronchial benign tumours,and as a way to keep the airway open until subsequent definitive resection can be done or as palliative therapy of unresectable malignant tumors.%目的:探讨原发性气管肿瘤的诊断和治疗方法,以及呼吸介入治疗的应用价值.方法:回顾性分析温州医科大学附属第一医院呼吸内科2003-2009年间原发性气管肿瘤14例的诊断和治疗经过.结果14例患者临床上均以不同程度的咳嗽、呼吸困难为主.病理组织学类型,恶性9例,以鳞癌、腺样囊性癌为主,良性肿瘤5例,包括:梭形细胞肿瘤、脂肪瘤和软骨瘤等.14例中9例患者接

  20. Research of music therapy on improving comfort degree of patients with awake tracheal intubation%音乐疗法对提高清醒气管内插管术中患者舒适度的研究

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    谢明亮; 车灵; 李海珍; 孙建明; 李学安; 胡丽华

    2014-01-01

    Objective To explore the effect of music therapy on improving comfort degree of patients with awake tracheal intubation. Methods 100 patients underwent awake tracheal intubation were randomly divided into study group and control group,50 cases in each.The study group was used music therapy research,control group was not used music therapy. Results The heart rate,systolic blood pressure of two groups before intubation had no significant difference;the heart rate and systolic blood pressure of study group after music therapy[(82.16±5.59)times/min, (118.44±6.05)mm Hg]were lower than those of control group[(96.64±5.67)times/min,(129.37±6.76)mmHg],the difference was statistically significant(P < 0.05).The anxiety score of the study group and control group during tracheal intubation was (27.04±5.16),(40.16±6.52) respectively,the difference was significant(t=5.368,P<0.05).In study group of 50 cases, grade 0 in 38 cases(76%),9 cases of grade Ⅰ(18%),3 cases of gradeⅡ(6%), 0 case of gradeⅢ;In control group of 50 cases,grade 0 in 13 cases(26%),22 cases of gradeⅠ(44%),6 cases of gradeⅡ(12%),9 cases of gradeⅢ(18%).the pain degree of study group significantly relieved pain. Conclusion Application of music therapy is helpful to improve the comfort of patients with tracheal intubation.%目的:观察音乐疗法对提高清醒气管内插管术中患者舒适度的作用。方法将100例接受清醒气管内插管患者随机分为研究组和对照组,各50例。研究组采用音乐疗法进行研究,对照组采用无音乐疗法。结果插管前两组患者的心率、收缩压比较,差异无统计学意义;研究组音乐疗法后插管中心率(82.16±5.59)次/min、收缩压(118.44±6.05)mm Hg均低于对照组(96.64±5.67)次/min、(129.37±6.76)mm Hg,差异有统计学意义(P<0.05)。两组患者气管插管中焦虑情况比较,患者焦虑评分分别为研究组(27.04±5.16),对照组(40.16±6.52),

  1. Tracheal Sounds Acquisition Using Smartphones

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    Bersain A. Reyes

    2014-07-01

    Full Text Available Tracheal sounds have received a lot of attention for estimating ventilation parameters in a non-invasive way. The aim of this work was to examine the feasibility of extracting accurate airflow, and automating the detection of breath-phase onset and respiratory rates all directly from tracheal sounds acquired from an acoustic microphone connected to a smartphone. We employed the Samsung Galaxy S4 and iPhone 4s smartphones to acquire tracheal sounds from N = 9 healthy volunteers at airflows ranging from 0.5 to 2.5 L/s. We found that the amplitude of the smartphone-acquired sounds was highly correlated with the airflow from a spirometer, and similar to previously-published studies, we found that the increasing tracheal sounds’ amplitude as flow increases follows a power law relationship. Acquired tracheal sounds were used for breath-phase onset detection and their onsets differed by only 52 ± 51 ms (mean ± SD for Galaxy S4, and 51 ± 48 ms for iPhone 4s, when compared to those detected from the reference signal via the spirometer. Moreover, it was found that accurate respiratory rates (RR can be obtained from tracheal sounds. The correlation index, bias and limits of agreement were r2 = 0.9693, 0.11 (−1.41 to 1.63 breaths-per-minute (bpm for Galaxy S4, and r2 = 0.9672, 0.097 (–1.38 to 1.57 bpm for iPhone 4s, when compared to RR estimated from spirometry. Both smartphone devices performed similarly, as no statistically-significant differences were found.

  2. Tracheal rupture post-emergency intubation

    OpenAIRE

    Andrea Billè; Luca Errico; Francesco Ardissone; Luciano Cardinale

    2009-01-01

    Tracheal rupture is an uncommon and potentially lifethreatening complication of endotracheal intubation. We present a case of intrathoracic tracheal rupture in a female patient who required emergent endotracheal intubation for acute respiratory distress related to chronic obstructive pulmonary disease exacerbation. Possible contributing factors to tracheal injury included overinflation of the tube cuff, chronic obstructive pulmonary disease, and chronic steroid use. The patient underwent surg...

  3. 21 CFR 878.3720 - Tracheal prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheal prosthesis. 878.3720 Section 878.3720...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3720 Tracheal prosthesis. (a) Identification. The tracheal prosthesis is a rigid, flexible, or expandable tubular device made of a...

  4. Changes in oxidative stress from tracheal aspirates sampled during chest physical therapy in hospitalized intubated infant patients with pneumonia and secretion retention

    OpenAIRE

    Leelarungrayub J; Borisuthibandit T; Yankai A; Boontha K

    2016-01-01

    Jirakrit Leelarungrayub,1 Thirasak Borisuthibandit,2 Araya Yankai,1 Kritsana Boontha1 1Department of Physical Therapy, Faculty of Associated Medical Sciences, 2Department of Pediatric, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: This study aimed to show the changes in oxidative stress and clinical condition from either chest physical therapy (CPT) or CPT with aerosol treatment in infant patients with pneumonia.Methods: From 52 intubated patients, three groups...

  5. Tracheal quadrifurcation associated with congenital heart disease

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    Bhat, Venkatraman; Gadabanahalli, Karthik; Ahmad, Ozaire [Narayana Multispeciality Hospital and Mazumdar Shaw Cancer Center, Department of Radiology, Bangalore (India)

    2015-08-15

    Tracheal anomalies are known in association with congenital cardiac defects. Some of the well-described anomalies include accessory (displaced) tracheal bronchus with variants, tracheal trifurcation and accessory cardiac bronchus. Here we describe a case of tracheal quadrifurcation associated with complex congenital heart disease. Illustration of complex airway anatomy was simplified by the use of multidetector CT using a variety of image display options. Awareness of this complex anomaly will expand our knowledge of tracheal anomalies and equip the anesthesia and surgical team for better airway management. (orig.)

  6. Morbid obesity and tracheal intubation.

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    Brodsky, Jay B; Lemmens, Harry J M; Brock-Utne, John G; Vierra, Mark; Saidman, Lawrence J

    2002-03-01

    The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. We studied 100 morbidly obese patients (body mass index >40 kg/m(2)) to identify which factors complicate direct laryngoscopy and tracheal intubation. Preoperative measurements (height, weight, neck circumference, width of mouth opening, sternomental distance, and thyromental distance) and Mallampati score were recorded. The view during direct laryngoscopy was graded, and the number of attempts at tracheal intubation was recorded. Neither absolute obesity nor body mass index was associated with intubation difficulties. Large neck circumference and high Mallampati score were the only predictors of potential intubation problems. Because in all but one patient the trachea was intubated successfully by direct laryngoscopy, the neck circumference that requires an intervention such as fiberoptic bronchoscopy to establish an airway remains unknown. We conclude that obesity alone is not predictive of tracheal intubation difficulties. In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (greater-than-or-equal to 3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation.

  7. The indirect measurement of laryngeal and tracheal resistance.

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    Schumann, K; Beck, C; Mann, W

    1979-06-01

    We used a body-plethysmograph to determine air-way resistances in 485 cases of laryngeal and tracheal stenoses. We decided in 143 cases to intervene after observing resistance exceeding 60 mm H2O/l and sec. A vocal chord was lateral fixated in 49 patients suffering bilateral recurrent paralysis. Optimal results were obtained at a postoperative resistance level of 30 mm H2O/l and sec (standard value: 14.77+/-6.53--n = 387). The patients could carry out work of medium intensity and had a steady voice. We performed tracheal interventions in 94 cases of tracheal stenoses. A mean, post-operative resistance of 29.9 mm H2O/l and sec, with a tracheal diameter of 7--8 mm was attained. In practice, only a few patients found the remaining obstruction a hindrance during work of maximal intensity. No recurrences were observed after treatment. Airway resistances exceeding 150 mm H2O/l and sec were found in 13 new admissions and 73 times in those undergoing therapy. In these cases asphyxiation threatens. These patients have to be tracheotomized or intubated immediately.

  8. Tracheal and bronchial tumors.

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    Varela, Patricio; Pio, Luca; Brandigi, Elisa; Paraboschi, Irene; Khen-Dunlop, Nazhia; Hervieux, Erik; Muller, Cecile; Mattioli, Girolamo; Sarnacki, Sabine; Torre, Michele

    2016-12-01

    Although primary tracheobronchial tumors are extremely rare in children, recurrent respiratory symptoms resistant to conventional therapy require further investigations to exclude possible malignant obstructive causes. As the matter of fact, early diagnosis may allow minimally invasive surgeries, improving the standard of living and the globally survival rate. The aim of this article is to provide an overview of diagnosis and management of tracheobronchial tumors in the early age, since only few reports are reported in the worldwide literature.

  9. Changes in oxidative stress from tracheal aspirates sampled during chest physical therapy in hospitalized intubated infant patients with pneumonia and secretion retention

    OpenAIRE

    Leelarungrayub, Jirakrit; Borisuthibandit, Thirasak; Yankai,Araya; Boontha, Kritsana

    2016-01-01

    Objective This study aimed to show the changes in oxidative stress and clinical condition from either chest physical therapy (CPT) or CPT with aerosol treatment in infant patients with pneumonia. Methods From 52 intubated patients, three groups were composed: groups A, B, and C comprising 21 patients aged 5.3±0.6 months (CPT program), 20 patients aged 5.6±0.7 months (aerosol treatment before CPT program), and eleven patients aged 5.0±0.35 months (control), respectively. CPT was composed of ma...

  10. Tracheal diaphragm: a very unusual form of congenital tracheal stenosis.

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    Le Bret, Emmanuel; Teissier, Natacha; Menif, Khaled; Bruniaux, Jacqueline; Gharbi, Nourredine; Ben Jaballah, Nejla; Serraf, Alain; Van den Abbeele, Thierry

    2007-01-01

    A 3.2-kg newborn was intubated for neonatal respiratory distress owing to a congenital tracheal stenosis. The preoperative assessment showed a sphincter-like stenosis located 1 cm above the carina. The child was cured by resection-anastomosis through sternotomy under cardiopulmonary bypass. The pathological examination showed hypoplastic cartilage islets embedded in a fibroelastic conjunctive tissue. The posterior membranous region was preserved with the existence of smooth muscle cells. This curious malformation resembled a diaphragm at the junction between trachea and carina.

  11. Tracheoesophageal fistula--a complication of prolonged tracheal intubation.

    Science.gov (United States)

    Paraschiv, M

    2014-01-01

    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results.

  12. Tracheal remodelling in response to hypoxia

    Science.gov (United States)

    Centanin, Lazaro; Gorr, Thomas A.; Wappner, Pablo

    2010-01-01

    The insect tracheal system is a continuous tubular network that ramifies into progressively thinner branches to provide air directly to every organ and tissue throughout the body. During embryogenesis the basic architecture of the tracheal system develops in a stereotypical and genetically controlled manner. Later, in larval stages, the tracheal system becomes plastic, and adapts to particular oxygen needs of the different tissues of the body. Oxygen sensing is mediated by specific prolyl-4-hydroxylases that regulate protein stability of the alpha subunit of oxygen-responsive transcription factors from the HIF family. Tracheal cells are exquisitely sensitive to oxygen levels, modulating the expression of hypoxia-inducible proteins that mediate sprouting of tracheal branches in direction to oxygen-deprived tissues. PMID:19482033

  13. Optical metabolic imaging for monitoring tracheal health

    Science.gov (United States)

    Sharick, Joe T.; Gil, Daniel A.; Choma, Michael A.; Skala, Melissa C.

    2016-04-01

    The health of the tracheal mucosa and submucosa is a vital yet poorly understood component of critical care medicine, and a minimally-invasive method is needed to monitor tracheal health in patients. Of particular interest are the ciliated cells of the tracheal epithelium that move mucus away from the lungs and prevent respiratory infection. Optical metabolic imaging (OMI) allows cellular-level measurement of metabolism, and is a compelling method for assessing tracheal health because ciliary motor proteins require ATP to function. In this pilot study, we apply multiphoton imaging of the fluorescence intensities and lifetimes of metabolic co-enzymes NAD(P)H and FAD to the mucosa and submucosa of ex vivo mouse trachea. We demonstrate the feasibility and potential diagnostic utility of these measurements for assessing tracheal health and pathophysiology at the single-cell level.

  14. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review.

    Science.gov (United States)

    Xu, Xiaohan; Xing, Na; Chang, Yanzi; Du, Yingying; Li, Zhisong; Wang, Zhongyu; Yan, Jie; Zhang, Wei

    2016-04-01

    Tracheobronchial rupture is an uncommon but potentially serious complication of endotracheal intubation. The most likely cause of tracheal injury is massive overinflation of the endotracheal tube cuff and pre-existing tracheal wall weakness. We review the relevant literature and predisposing factors contributing to this complication. Only articles that reported at least the demographic data (age and sex), the treatment performed and the outcome were included. Papers that did not detail these variables were excluded. We also focus on a case of tracheal laceration after tracheal intubation in a patient with severe thyroid carcinoma. This patient received surgical repair and recovered uneventfully. Two hundred and eight studies that reported cases or case series were selected for analysis. Most of the reported cases (57·2%) showed an uneventful recovery after surgical therapy. The overall mortality was 19·2% (40 patients). Our patient too recovered without any serious complication. Careful prevention, early detection and proper treatment of the problem are necessary when tracheal rupture occurs. The morbidity and mortality associated with tracheal injury mandate a high level of suspicion and expedient management.

  15. Use of a Nitinol Wire Stent for Management of Severe Tracheal Stenosis in an Eclectus Parrot (Eclectus roratus).

    Science.gov (United States)

    Mejia-Fava, Johanna; Holmes, Shannon P; Radlinsky, MaryAnn; Johnson, Dan; Ellis, Angela E; Mayer, Jörg; Schnellbacher, Rodney; Divers, Stephen J

    2015-09-01

    A 25-year-old, female eclectus parrot (Eclectus roratus) presented for dyspnea 3 weeks after anesthesia and surgery for egg yolk coelomitis. Radiography, computed tomography, and tracheoscopy revealed multiple tracheal strictures spanning a length of 2.6 cm in the mid to distal trachea. Histopathologic examination revealed mild fibrosis, inflammation, and hyperplasia consistent with acquired tracheal strictures. Tracheal resection was not considered possible because of the length of the affected trachea. The strictures were resected endoscopically, and repeated balloon dilation under fluoroscopic guidance over the course of 10 months resulted in immediate but unsustained improvement. Computed tomography was used to measure the stenotic area. A 4 × 36-mm, custom-made, nitinol wire stent was inserted into the trachea under fluoroscopic guidance. After stent placement, intermittent episodes of mild to moderate dyspnea continued, and these responded to nebulization with a combination of saline, acetylcysteine, and dexamethasone. Multiple attempts to wean the patient off nebulization therapy and to switch to a corticosteroid-free combination were unsuccessful. The parrot eventually developed complications, was euthanatized, and necropsy was performed. Histologically, the tracheal mucosa had widespread erosion to ulceration, with accumulation of intraluminal exudate and bacteria, severe degeneration of skeletal muscle and tracheal rings, prominent fibrosis, and mild to moderate, submucosal inflammation. Clinicopathologic findings in this case suggested tracheomalacia, which has not been previously described in birds. Custom-made tracheal stents can be used for severe tracheal stenosis in birds when tracheal resection and anastomosis is not possible. Complications of tracheal stent placement in birds may include tracheitis and tracheomalacia. To our knowledge, this is the first report of tracheal stent placement in an avian species.

  16. [A 2-month-old child with complex tracheal hypoplasia].

    Science.gov (United States)

    De Cloedt, L; Papadopoulos, J; Corouge, P; Khalil, T; Van Laer, P

    2013-12-01

    We describe the case of a 2-month-old child with complex tracheal hypoplasia with bilateral bronchial hypoplasia and left pulmonary hypoplasia. Tracheal hypoplasia is complex when it is associated with critical stenosis, cricoid stenosis, bronchial hypoplasia, tracheal bronchus, or esophageal atresia with severe tracheomalacia. Slide tracheoplasty is the gold standard treatment for the complex tracheal hypoplasia.

  17. Anaesthetic management in thoracoscopic distal tracheal resection.

    Science.gov (United States)

    Acosta Martínez, J; Beato López, J; Domínguez Blanco, A; López Romero, J L; López Villalobos, J L

    2017-03-01

    Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Laryngeal morbidity after tracheal intubation

    DEFF Research Database (Denmark)

    Sørensen, M K; Rasmussen, N; Kristensen, M S

    2013-01-01

    BACKGROUND: Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower...... with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. METHODS: This randomised trial included 130 elective surgical patients scheduled for general anaesthesia with endotracheal intubation. Pre- and post-operative assessment of hoarseness, vocal fold pathology......, and voice analysis using the Multidimensional Voice Program was performed. Induction of anaesthesia was standardised. After complete neuromuscular paralysis, intubation was done with an Endoflex tube or a conventional endotracheal tube with stylet. RESULTS: Post-operative hoarseness was found in 45...

  19. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy.

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

  20. A Case Report of Tracheal Extramedullary Plasmacytoma

    Institute of Scientific and Technical Information of China (English)

    Kun Wang; Yunchao Huang; Anning Chen

    2008-01-01

    @@ Introduction Extramedullary plasmacytoma (EMP) is an uncommon tumor that often develops outside the bone and arises from clonal proliferation of atypical plasma cells before EMP is diagnosed. Multiple myeloma(MM) must be excluded by performing laboratory tests such as serum protein electrophoresis, bone marrow biopsy and skeletal imaging ex-aminations. A bone marrow biopsy should show no evidence of mul-tiple myeloma, and less than 3% of plasma cells. Monoclonal bands of serum protein and Bence-Jones protein in the urine can sometimes be detected. EMP can involve any extraosseous organs, but it pre-dominantly affects the head and neck areas. Any extra-osseous organ may also be involved[1,2]. Tracheal involvement is a rare finding. Only a few cases of primary tracheal extramedullary plasmcytoma have been reported[2-4], Here we present a rare case of truly localized tra-cheal extram edullary plasmacytoma without evidence of myelomaelsewhere.

  1. Optical Coherence Tomography Evaluation of Tracheal Inflammation

    Science.gov (United States)

    2004-09-01

    0.50). A dose - response curve shows a weak correlation between the increase in mucosal thickness with dosage of S Pneumoniae inoculated (Figure 5...10000 100000 1000000 Figure 5: Dose response curve for septic tracheal mucosal thickness. DISCUSSION These studies confirm the feasibility of high

  2. Massive aspiration past the tracheal tube cuff caused by closed tracheal suction system.

    Science.gov (United States)

    Dave, Mital H; Frotzler, Angela; Madjdpour, Caveh; Koepfer, Nelly; Weiss, Markus

    2011-01-01

    Aspiration past the tracheal tube cuff has been recognized to be a risk factor for the development of ventilator-associated pneumonia (VAP). This study investigated the effect of closed tracheal suctioning on aspiration of fluid past the tracheal tube cuff in an in vitro benchtop model. High-volume low pressure tube cuffs of 7.5 mm internal diameter (ID) were placed in a 22 mm ID artificial trachea connected to a test lung. Positive pressure ventilation (PPV) with 15 cm H₂O peak inspiratory pressure and 5 cm H₂O positive end-expiratory pressure (PEEP) was used. A closed tracheal suction system (CTSS) catheter (size 14Fr) was attached to the tracheal tube and suction was performed for 5, 10, 15, or 20 seconds under 200 or 300 cm H₂O suction pressures. Amount of fluid (mL) aspirated along the tube cuff and the airway pressure changes were recorded for each suction procedure. Fluid aspiration during different suction conditions was compared using Kruskal-Wallis and Mann-Whitney test (Bonferroni correction [α = .01]). During 10, 15, and 20 seconds suction, airway pressure consistently dropped down to -8 to -13 cm H₂O (P suctioning. Aspiration along the tube cuff was higher with -300 cm H₂O than with -200 cm H₂O suction pressure (P suction time as compared to 5 seconds (P suction with the closed tracheal suction system. © SAGE Publications 2011.

  3. Cuffed tracheal tubes in children: past, present and future.

    Science.gov (United States)

    Weiss, Markus; Dullenkopf, Alexander

    2007-01-01

    This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance. The main points in proper handling of cuffed tracheal tubes in children are highlighted. Finally, an outlook on future developments in the design of pediatric cuffed tracheal tubes and an overview of tasks to be performed in evaluating them is given.

  4. Surgical intervention strategies for congenital tracheal stenosis associated with a tracheal bronchus based on the location of stenosis.

    Science.gov (United States)

    Morita, Keiichi; Yokoi, Akiko; Fukuzawa, Hiroaki; Hisamatsu, Chieko; Endo, Kosuke; Okata, Yuichi; Tamaki, Akihiko; Mishima, Yasuhiko; Oshima, Yoshihiro; Maeda, Kosaku

    2016-09-01

    The aim of this study was to determine the appropriate surgical intervention strategies for congenital tracheal stenosis (CTS) associated with a tracheal bronchus based on the location of stenosis. The medical records of 13 pediatric patients with CTS associated with a tracheal bronchus at a single institution between January 2006 and December 2015 were retrospectively reviewed. Type 1: tracheal stenosis above the right upper lobe bronchus (RULB) (n = 1). One patient underwent slide tracheoplasty and was successfully extubated. Type 2: tracheal stenosis below the RULB (n = 7). Tracheal end-to-end anastomosis was performed before 2014, and one patient failed to extubate. Posterior-anterior slide tracheoplasty was performed since 2014, and all three patients were successfully extubated. Type 3: tracheal stenosis above the RULB to the carina (n = 5). One patient underwent posterior-anterior slide tracheoplasty and was successfully extubated. Two patients with left-right slide tracheoplasty and another two patients with tracheal end-to-end anastomosis for the stenosis below the RULB could not be extubated. Tracheal end-to-end anastomosis or slide tracheoplasty can be selected for tracheal stenosis above the RULB according to the length of stenosis. Posterior-anterior slide tracheoplasty appears feasible for tracheal stenosis below the RULB or above the RULB to the carina.

  5. An Active Endoscopy Robotic System for Direct Tracheal Inspection

    Institute of Scientific and Technical Information of China (English)

    YU Lian-zhi; YAN Guo-zheng; MA Guan-ying; ZAN Peng

    2007-01-01

    The development of active endoscopy techniques is one important area of medical robot. This paper designed a new flexible and active endoscopy robotic system for direct tracheal inspection. The mobile mechanism of the robot is based on the inchworm movement actuated by pneumatic rubber actuator. There are five air chambers controlled independently, by adjusting pressures in air chambers, the robot can move in a straight mode or in a bending mode. The inspection sensors and some therapy surgery tools can be equipped in the front of the robot.The prototype was made and its mechanical characteristics were analyzed. The robot could move smoothly in a small plastic tube, and the robot is respectable to be used for inspection in human trachea directly.

  6. Successful treatment of subglottic tracheal stenosis with a mucosa-lined radial forearm fascia flap

    OpenAIRE

    Mandapathil, M; Hoffmann, T. K; Freitag, L; Reddy, Naveen Krishna; Lang, S.; Delaere, Pierre

    2012-01-01

    Short-segment tracheal stenosis is often treated by segmental resection and end-to-end anastomosis. Longer-segment stenosis can sometimes be treated using dilation, laser therapy, bronchoscopic stent insertion and segmental resection and reconstruction. Long-segment restenosis with a buildup of scar tissue due to successful resection surgery in the past represents a particular therapeutic challenge and a sufficiently vascularized transplant may be the only option. We describe the case of a 37...

  7. Medical image of the week: tracheal perforation

    Directory of Open Access Journals (Sweden)

    Parsa N

    2014-12-01

    Full Text Available A 45 year old Caucasian man with a history of HIV/AIDS was admitted for septic shock secondary to right lower lobe community acquired pneumonia. The patient’s respiratory status continued to decline requiring emergency intubation in a non-ICU setting. Four laryngoscope intubation attempts were made including an inadvertent esophageal intubation. Subsequent CT imaging revealed a tracheal defect (Figure 1, red arrow with communication to the mediastinum and air around the trachea consistent with pneumomediastinum (Figure 2, orange arrow and figure 3, yellow arrow. Pneumopericardium (figure 4, blue arrow was also evident post-intubation. The patient’s hemodynamic status remained stable. Two days following respiratory intubation subsequent chest imaging revealed resolution of the pneumomediastinum and pneumopericardium and patient continued to do well without hemodynamic compromise or presence of subcutaneous emphysema. Post-intubation tracheal perforation is a rare complication of traumatic intubation and may be managed with surgical intervention or conservative treatment (1.

  8. [Surgery of traumatic tracheal and tracheobronchial injuries].

    Science.gov (United States)

    Palade, E; Passlick, B

    2011-02-01

    Tracheal injuries are altogether rare events and can be divided into three broad categories: tracheobronchial injuries caused by external violence, iatrogenic ruptures of the trachea and inhalation trauma. Successful management of tracheobronchial injuries requires a fast and straightforward diagnostic evaluation. In all severely injured patients with cervicothoracic involvement an injury of the tracheobronchial system should be actively excluded. Although it is commonly agreed that posttraumatic injuries require surgical intervention the management of iatrogenic injuries is presently shifting towards a more conservative treatment.

  9. Etude Par Ponction Tracheale De La Flore Bacterienne Des Pneumopathies Infectieuses.

    Science.gov (United States)

    Schoutens, E; Koster, J P; Arouete, A; Tombroff, M; Yourassowsky, E

    1971-01-01

    The authors analyse the bacteriological data gathered by 100 successive tracheal Punctures and compare these results to those obtained by sputum cultures, which had either been collected by routine or when withdrawing the catheter for tracheal aspiration. This plain and not hazardous technique allows to draw the following conclusions : 1) The culture of routinely collected sputum at the patient's bed-side often misleads the physician (6 times on 10) whereas newly expectorated sputum brought immediately to the laboratory more truly shows the tracheo-bronchic flora (valuable results in 75 % of the cases). 2) The tracheal puncture, which reduces the causes of errors, due to the contamination of the sputum by the rhino-pharyngeal flora, to a minimum, particularly is indicated in the following cases : patients who do not expectorate (including suspects of pulmonary tuberculosis), instantly earnest pneumopathia, bad response to applied antibiotic therapy, tests of the true efficiency of an antibiotic therapy. 3) The bacteriological study of these punctures performed on patients, who caused therapeutical problems and who had been submitted to antibiotic therapies evidenced the following data : 40 % of the punctures were sterile, 39 % showed one single germ (18 Gram negative, 16 Gram positive, 2 BK, 3 aspergillus), 15 % showed 2 simultaneous germs and 6 % were not significant.

  10. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  11. Surgical Reconstruction for Severe Tracheal Obstruction in Morquio A Syndrome.

    Science.gov (United States)

    Pizarro, Christian; Davies, Ryan R; Theroux, Mary; Spurrier, Ellen A; Averill, Lauren W; Tomatsu, Shunji

    2016-10-01

    Progressive tracheal obstruction is commonly seen in Morquio A syndrome and can lead to life-threatening complications. Although tracheostomy can address severe upper airway obstruction, lower airway obstruction, commonly associated with a narrow thoracic inlet and vascular compression, requires an alternative approach. We describe the case of a 16-year-old patient with Morquio A syndrome whose near-fatal tracheal obstruction was relieved by timely surgical tracheal vascular reconstruction with dramatic resolution of his respiratory symptoms.

  12. [Design and study of carbon fiber tracheal prosthesis].

    Science.gov (United States)

    Qi, L; Liu, D; Han, Z; Wang, F

    1998-12-01

    32 healty adult dogs were selected for this experiment. 10 of them were subjected to the tracheal biomechanics test using indices including the relation between stretcher ratio (lambda) and stress (T), the squeeze stress (delta jy) of medical silk thread on trachea, the side stress (Ts) inducing the tracheal collapse, the functional maximum angle (psi max) of tracheal, and the sever area torsion angle (theta max) of tracheal functional maximum curved. According to the indices measured, two types of tracheal prosthesis were designed, and were made of carbon fiber and silicon. They were the straight tube type tracheal prosthesis and the bifurcate type tracheal prosthesis. The straight tube type tracheal prosthesis was studied with a design of two groups comprising a total of 11 dogs. In the experiment group (n = 6), the outer surface of the tube was not coated with silicon, the average survival period was 379.8 days. In the control group (n = 5), the outer surface of the tube was coated with silicon, the average survival period was 90.4 days. The bifurcate type tracheal prosthesis was studied in 11 dogs, the average survival period was 4.32 days. The main causes of death in the experiment were infection and anastomotic dehiscent.

  13. File list: ALL.Lng.20.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Lng.20.AllAg.Tracheal_epithelial_cells hg19 All antigens Lung Tracheal epitheli...barchive.biosciencedbc.jp/kyushu-u/hg19/assembled/ALL.Lng.20.AllAg.Tracheal_epithelial_cells.bed ...

  14. File list: ALL.Lng.50.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Lng.50.AllAg.Tracheal_epithelial_cells hg19 All antigens Lung Tracheal epitheli...barchive.biosciencedbc.jp/kyushu-u/hg19/assembled/ALL.Lng.50.AllAg.Tracheal_epithelial_cells.bed ...

  15. File list: ALL.Lng.05.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Lng.05.AllAg.Tracheal_epithelial_cells hg19 All antigens Lung Tracheal epitheli...barchive.biosciencedbc.jp/kyushu-u/hg19/assembled/ALL.Lng.05.AllAg.Tracheal_epithelial_cells.bed ...

  16. File list: ALL.Lng.10.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Lng.10.AllAg.Tracheal_epithelial_cells hg19 All antigens Lung Tracheal epitheli...barchive.biosciencedbc.jp/kyushu-u/hg19/assembled/ALL.Lng.10.AllAg.Tracheal_epithelial_cells.bed ...

  17. [Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyangiitis (Wegener)].

    Science.gov (United States)

    Stoica, Radu; Negru, Irina; Matache, Radu; MirunaTodor

    2014-01-01

    Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

  18. [Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyanaiitis (Wegener)].

    Science.gov (United States)

    Stoica, Radu; Negru, Irina; Matache, Radu; MirunaTodor

    2014-01-01

    Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

  19. Synchrotron imaging of the grasshopper tracheal system : morphological and physiological components of tracheal hypermetry.

    Energy Technology Data Exchange (ETDEWEB)

    Greenlee, K. J.; Henry, J. R.; Kirkton, S. D.; Westneat, M. W.; Fezzaa, K.; Lee, W.; Harrison, J. F.; North Dakota State Univ.; Arizona State Univ.; Union Coll.; Field Museum of Natural History

    2009-11-01

    As grasshoppers increase in size during ontogeny, they have mass specifically greater whole body tracheal and tidal volumes and ventilation than predicted by an isometric relationship with body mass and body volume. However, the morphological and physiological bases to this respiratory hypermetry are unknown. In this study, we use synchrotron imaging to demonstrate that tracheal hypermetry in developing grasshoppers (Schistocerca americana) is due to increases in air sacs and tracheae and occurs in all three body segments, providing evidence against the hypothesis that hypermetry is due to gaining flight ability. We also assessed the scaling of air sac structure and function by assessing volume changes of focal abdominal air sacs. Ventilatory frequencies increased in larger animals during hypoxia (5% O{sub 2}) but did not scale in normoxia. For grasshoppers in normoxia, inflated and deflated air sac volumes and ventilation scaled hypermetrically. During hypoxia (5% O{sub 2}), many grasshoppers compressed air sacs nearly completely regardless of body size, and air sac volumes scaled isometrically. Together, these results demonstrate that whole body tracheal hypermetry and enhanced ventilation in larger/older grasshoppers are primarily due to proportionally larger air sacs and higher ventilation frequencies in larger animals during hypoxia. Prior studies showed reduced whole body tracheal volumes and tidal volume in late-stage grasshoppers, suggesting that tissue growth compresses air sacs. In contrast, we found that inflated volumes, percent volume changes, and ventilation were identical in abdominal air sacs of late-stage fifth instar and early-stage animals, suggesting that decreasing volume of the tracheal system later in the instar occurs in other body regions that have harder exoskeleton.

  20. Access to the tracheal pulmonary pathway in small rodents

    Directory of Open Access Journals (Sweden)

    Roberto S. A. Ribeiro

    2015-06-01

    Full Text Available ABSTRACT The tracheal pulmonary route is used in diverse experimental models for the study of drugs, infectious agents, and diseases. In view of its importance and associated difficulties, the present article proposes to give research groups up-to-date information on techniques to access the tracheal pulmonary pathway of small rodents.

  1. Comparison of cuffed and uncuffed preformed oral pediatric tracheal tubes.

    Science.gov (United States)

    Weiss, Markus; Bernet, Vera; Stutz, Katharina; Dullenkopf, Alexander; Maino, Paolo

    2006-07-01

    In preformed cuffed tracheal tubes the position of the cuff within the airway is given by its distance to the tube bend placed at the lower teeth. The aim of this study was to compare the design of cuffed and uncuffed preformed pediatric oral tracheal tubes with regard to anatomical landmarks. Complete series of cuffed and uncuffed preformed oral pediatric tracheal tubes sized from internal diameter 3.0-7.0 mm if available were ordered from five different manufacturers. The distance from the bend to the distal tube tip and to the upper border of the cuff were measured and compared with anatomical airway landmarks in the developing child. Between cuffed and uncuffed tracheal preformed tubes up to 37 mm differences in the bend-to-tracheal tube tip distances were found for given age groups. Thus uncuffed preformed tracheal tubes were more at risk for inadvertent endobronchial intubation than cuffed preformed tracheal tubes. Comparison of bend-to-upper border of the cuff distances with teeth-to-vocal cord distances calculated from anatomical data revealed that several of the tracheal tube cuffs become positioned within the subglottic larynx or even within the vocal cords when inserted according to the bend. There is a need for improvement in cuffed preformed pediatric tracheal tubes, namely a standard bend-to-tracheal tube tip distance to allow a safe insertion depth, a short cuff placed on the tube shaft as distally as possible and an intubation depth mark to verify a proper position of the cuff in the trachea.

  2. Endoscopic laser reshaping of rabbit tracheal cartilage: preliminary investigations

    Science.gov (United States)

    Tsang, Walter; Lam, Anthony; Protsenko, Dmitry; Wong, Brian J.

    2005-04-01

    Background: Tracheal cartilage deformities due to trauma, prolonged endotracheal intubation or infection are difficult to correct. Current treatment options such as dilation, laser ablation, stent placement, and segmental resection are only temporary or carry significant risks. The objectives of this project were to design and test a laser activated endotracheal stent system that can actively modify the geometry of tracheal cartilage, leading to permanent retention of a new and desirable tracheal geometry. Methods: Ex vivo rabbit tracheal cartilage (simulating human neonate trachea) were irradiated with an Er: Glass laser, (λ= 1.54um, 0.5W-2.5W, 1 sec to 5 sec). Shape change and gross thermal injury were assessed visually to determine the best laser power parameters for reshaping. A rigid endoscopic telescope and hollow bronchoscope were used to record endoscopic images. The stent was constructed from nitinol wire, shaped into a zigzag configuration. An ex vivo testing apparatus was also constructed. Results: The best laser power parameter to produce shape change was 1 W for 6-7 seconds. At this setting, there was significant shape change with only minimal thermal injury to the tracheal mucosa, as assessed by visual inspection. The bronchoscopy system functioned adequately during testing in the ex vivo testing apparatus. Conclusion: We have successfully designed instrumentation and created the capability to endoscopically reshape tracheal cartilage in an ex vivo rabbit model. The results obtained in ex vivo tracheal cartilage indicated that reshaping using Er: Glass laser can be accomplished.

  3. Effects of acute respiratory virus infection upon tracheal mucous transport

    Energy Technology Data Exchange (ETDEWEB)

    Gerrard, C.S.; Levandowski, R.A.; Gerrity, T.R.; Yeates, D.B.; Klein, E.

    Tracheal mucous velocity was measured in 13 healthy non-smokers using an aerosol labelled with /sup 99m/Tc and a multidetector probe during respiratory virus infections. The movement of boluses of tracheal mucous were either absent or reduced in number in five subjects with myxovirus infection (four influenza and one respiratory syncytial virus) within 48 hr of the onset of symptoms and in four subjects 1 wk later. One subject with influenza still had reduced bolus formation 12-16 wk after infection. Frequent coughing was a feature of those subjects with absent tracheal boluses. In contrast, four subjects with rhinovirus infection had normal tracheal mucous velocity at 48 hr after the onset of symptoms (4.1 +/- 1.3 mm/min). Tracheal mucous velocity was also normal (4.6 +/- 1.1 mm/min) in four subjects in whom no specific viral agent could be defined but had typical symptomatology of respiratory viral infection. During health tracheal mucous velocity was normal (4.8 +/- 1.6 mm/min) in the eleven subjects who had measurements made. Disturbances in tracheal mucous transport during virus infection appear to depend upon the type of virus and are most severe in influenza A and respiratory syncytial virus infection.

  4. Anisotropic properties of tracheal smooth muscle tissue.

    Science.gov (United States)

    Sarma, P A; Pidaparti, R M; Meiss, R A

    2003-04-01

    The anisotropic (directional-dependent) properties of contracting tracheal smooth muscle tissue are estimated from a computational model based on the experimental data of length-dependent stiffness. The area changes are obtained at different muscle lengths from experiments in which stimulated muscle undergoes unrestricted shortening. Then, through an interative process, the anisotropic properties are estimated by matching the area changes obtained from the finite element analysis to those derived from the experiments. The results obtained indicate that the anisotropy ratio (longitudinal stiffness to transverse stiffness) is about 4 when the smooth muscle undergoes 70% strain shortening, indicating that the transverse stiffness reduces as the longitudinal stiffness increases. It was found through a sensitivity analysis from the simulation model that the longitudinal stiffness and the in-plane shear modulus are not very sensitive as compared to major Poisson's ratio to the area changes of the muscle tissue. Copyright 2003 Wiley Periodicals, Inc.

  5. Snake Envenomation Causing Distant Tracheal Myonecrosis

    Science.gov (United States)

    Khimani, Amina; Mcnierney, Afton; Surani, Sara; Surani, Salim

    2013-01-01

    Snakebites are often believed to be poisonous. However, this is not always the case. In fact, each bite differs from snake to snake, depending on if the snake is poisonous and if there is envenomation. Venom in pit viper snakebites is often associated with local necrosis. The abundant literature selections and research articles justify local myonecrosis due to envenomation, but there is not much in the literature regarding myonecrosis at a site distant from the snakebite. We hereby present a case of a 42-year-old man who was transferred to our emergency department after a rattlesnake bit him twice. The patient, besides developing local myonecrosis at the site of the snakebite, developed necrosis of the scrotum as well as tracheal pressure myonecrosis at the site of the endotracheal tube balloon. In this review, we will attempt to discuss the myonecrosis pathophysiology and management related to the rattle snakebite. PMID:24083047

  6. Snake Envenomation Causing Distant Tracheal Myonecrosis

    Directory of Open Access Journals (Sweden)

    Amina Khimani

    2013-01-01

    Full Text Available Snakebites are often believed to be poisonous. However, this is not always the case. In fact, each bite differs from snake to snake, depending on if the snake is poisonous and if there is envenomation. Venom in pit viper snakebites is often associated with local necrosis. The abundant literature selections and research articles justify local myonecrosis due to envenomation, but there is not much in the literature regarding myonecrosis at a site distant from the snakebite. We hereby present a case of a 42-year-old man who was transferred to our emergency department after a rattlesnake bit him twice. The patient, besides developing local myonecrosis at the site of the snakebite, developed necrosis of the scrotum as well as tracheal pressure myonecrosis at the site of the endotracheal tube balloon. In this review, we will attempt to discuss the myonecrosis pathophysiology and management related to the rattle snakebite.

  7. A rare cause of stridor: Isolated tracheal amyloidosis

    Directory of Open Access Journals (Sweden)

    Numbere K Numbere

    2014-01-01

    Full Text Available A 50-year-old man presented to clinic with a two-year history of progressive exertional dyspnea and voice hoarseness. This history suggested upper airways obstruction, which was confirmed on computed tomography imaging that revealed extensive thickening of the proximal tracheal wall causing severe luminal narrowing. Bronchoscopic debulking was then performed and the samples obtained confirmed tracheal amyloidoisis. Extensive investigation confirmed that disease was localized solely to the trachea. Ultimately, after multiple discussions, the chosen treatment modality was radiotherapy, which proceeded relatively uneventfully and achieved excellent radiological and clinical response. Although tracheal amyloidosis is rare, it is most commonly observed as part of a multisystem presentation. The present report describes the even more uncommon diagnosis of isolated tracheal amyloidosis and highlights the role of radiotherapy in its management.

  8. Tracheal diverticulum: case report; Diverticulo traqueal: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, Carlos Jader; Hoffmann, Luciano Lerch [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Inst. de Cardiologia. Servico de Radiologia

    2003-03-01

    A case of incidental finding of a tracheal diverticulum in a patient submitted to computed tomography of the chest is reported. The computed tomography features of this lesion area discussed and the literature is reviewed (author)

  9. Congenital Tracheal Stenosis in a Patient with Cleft Lip | Qureshi ...

    African Journals Online (AJOL)

    Congenital Tracheal Stenosis in a Patient with Cleft Lip. ... of the distal trachea, in addition to a right sided cleft lip without cleft palate. Management of CTS depends on several factors, with surgery being the definitive form of treatment.

  10. Tracheal intubation and sore throat: a mechanical explanation.

    Science.gov (United States)

    Chandler, M

    2002-02-01

    Although tracheal intubation remains a valuable tool, it may result in pressure trauma and sore throat. The evidence for an association between these sequelae is not conclusive and sore throat may be caused at the time of intubation. This hypothesis was tested in a mechanical model and the results from tracheal intubation compared with those from insertion of a laryngeal mask airway, which is associated with a lower incidence of sore throat. Use of the model suggests that the tracheal tube and laryngeal mask airway impinge on the pharyngeal wall in different manners and involve different mechanisms for their conformation to the upper airway, but that in a static situation, the forces exerted on the pharyngeal wall are low with both devices. It also suggests that the incidence of sore throat should be lower for softer and smaller tracheal tubes and that the standard 'Magill' curve (radius of curvature 140 +/- 20 mm) is about optimum for the average airway.

  11. CT findings of tracheal mucormycosis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Joo, Jong Kwan; Jung, Hyun Seouk; Kim, Ki Jun; Lee, Sung Yong; Kim, Kyung Mi [The Catholic Univ. of Korea, Inchon (Korea, Republic of)

    1999-09-01

    Pulmonary mucormycosis is a opportunistic mycosis, typically occurring in immunocompromised or diabetic patients. It is characterized as an infection of the pulmonary parenchyma and larger bronchi, and involves extensive vascular thrombosis and tissue necrosis. A variety of CT findings have been reported, but tracheal involvement is extremely rare. We report the case of a patient with tracheal mucormycosis placing particular emphasis on the CT findings.

  12. Unilateral pulmonary agenesis associated with tracheal stenosis : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Suk; Yoon, Chong Hyun; Kim, Kyung Sook; Kim, Ki Soo; Pi, Soo Young [Univ. of Ulsan, Ulsan (Korea, Republic of). Colle. of Medicine

    1998-02-01

    Unilateral pulmonary agenesis is a rare congenital anomaly and is frequently associated with other congenital anomalies. We report a case of left pulmonary agenesis associated with congenital tracheal stenosis in a newborn infant. Simple chest radiographs showed an overinflate right lung and mediastinal shifting to the left side. Chest ST and reconstructed three-dimensional images showed left pulmonary agenesis and tracheal stenosis. These anomalies of the tracheobronchial system were confirmed by bronchography. (author). 10 refs., 3 figs.

  13. COMPUTED TOMOGRAPHIC, RADIOGRAPHIC, AND ENDOSCOPIC TRACHEAL DIMENSIONS IN ENGLISH BULLDOGS WITH GRADE 1 CLINICAL SIGNS OF BRACHYCEPHALIC AIRWAY SYNDROME

    NARCIS (Netherlands)

    Kaye, Benjamin M; Boroffka, Susanne A E B; Haagsman, Annika N; Haar, Gert Ter

    2015-01-01

    Tracheal hypoplasia is commonly seen in English Bulldogs affected with brachycephalic airway syndrome. Previously published diagnostic criteria for tracheal hypoplasia in this breed have been a radiographic tracheal diameter:tracheal inlet ratio (TD:TI) < 0.12 or a tracheal diameter:third rib diamet

  14. Tracheal extubation in children: halothane versus isoflurane, anesthetized versus awake.

    Science.gov (United States)

    Pounder, D R; Blackstock, D; Steward, D J

    1991-04-01

    The authors compared the incidence of respiratory complications and arterial hemoglobin desaturation during emergence from anesthesia in children whose tracheas were extubated while they were anesthetized or after they were awake and to whom halothane or isoflurane had been administered. One hundred children 1-4 yr of age undergoing minor urologic surgery were studied. After a standard induction technique, patients were randomized to receive either isoflurane or halothane. In 50 patients tracheal extubation was performed while they were breathing 2 MAC of either halothane or isoflurane in 100% oxygen. The remaining 50 patients received 2 MAC (volatile agent plus nitrous oxide) during the operation, but tracheal extubation was delayed until they were awake. A blinded observer recorded the incidence of respiratory complications and continuously measured hemoglobin saturation for 15 min after extubation. When tracheal extubation occurred in deeply anesthetized patients, no differences were found between the two volatile agents. When tracheal extubation of awake patients was performed, the use of isoflurane was associated with more episodes of coughing and airway obstruction than was halothane (P less than 0.05). Awake tracheal extubation following either agent was associated with significantly more episodes of hemoglobin desaturation than was tracheal extubation while anesthetized.

  15. Biomechanical and biochemical characterization of porcine tracheal cartilage.

    Science.gov (United States)

    Hoffman, Benjamin; Martin, Matthew; Brown, Bryan N; Bonassar, Lawrence J; Cheetham, Jonathan

    2016-10-01

    The trachea is essential to respiratory function and is a mechanically and biochemically complex composite tissue. Tissue-engineering approaches to treat tracheal diseases require detailed knowledge of the native mechanical and biochemical properties of the trachea. Although the porcine trachea represents an excellent preclinical model, relevant mechanical and biochemical composition are incompletely characterized. Experimental. The mechanical and biochemical properties of 12 intact porcine tracheas were determined to characterize their compliance, as well as the aggregate modulus, bidirectional elastic modulus, hydraulic permeability, and biochemical characteristics of individual cartilage rings. Data demonstrate the glycosaminoglycan content of tracheal rings was (mean ± standard deviation) 190 ± 49 μg/mg. Hydroxyproline content was 8.2 ± 3.2 μg/mg, and DNA content was 1.3 ± 0.27 μg/mg, a four-fold difference between circumferential elastic modulus (5.6 ± 2.0 megapascal [MPa]) and longitudinal composite elastic modulus (1.1 ± 0.7 MPa, P biochemical and mechanical properties of porcine tracheal cartilage, which is considered an excellent candidate for xenogenic tracheal graft and a source for tissue-engineered tracheal reconstruction. The range of parameters characterized in this study agrees with those reported for hyaline cartilage of the airway in other species. These characteristics can be used as quantitative benchmarks for tissue-engineering approaches to treat tracheal disease. NA. Laryngoscope, 126:E325-E331, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Fetal MRI in experimental tracheal occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Wedegaertner, Ulrike [Department of Diagnostic and Interventional Radiology, Universitaetsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg (Germany)]. E-mail: wedegaer@uke.uni-hamburg.de; Schroeder, Hobe J. [Experimental Gynecology, Department of Obstetrics and Prenatal Medicine, Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany); Adam, Gerhard [Department of Diagnostic and Interventional Radiology, Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany)

    2006-02-15

    Congenital diaphragmatic hernia (CDH) is associated with a high mortality, which is mainly due to pulmonary hypoplasia and secondary pulmonary hypertension. In severely affected fetuses, tracheal occlusion (TO) is performed prenatally to reverse pulmonary hypoplasia, because TO leads to accelerated lung growth. Prenatal imaging is important to identify fetuses with pulmonary hypoplasia, to diagnose high-risk fetuses who would benefit from TO, and to monitor the effect of TO after surgery. In fetal imaging, ultrasound (US) is the method of choice, because it is widely available, less expensive, and less time-consuming to perform than magnetic resonance imaging (MRI). However, there are some limitations for US in the evaluation of CDH fetuses. In those cases, MRI is helpful because of a better tissue contrast between liver and lung, which enables evaluation of liver herniation for the diagnosis of a high-risk fetus. MRI provides the ability to determine absolute lung volumes to detect lung hypoplasia. In fetal sheep with normal and hyperplastic lungs after TO, lung growth was assessed on the basis of cross-sectional US measurements, after initial lung volume determination by MRI. To monitor fetal lung growth after prenatal TO, both MRI and US seem to be useful methods.

  17. Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

    LENUS (Irish Health Repository)

    Salah, Nazar

    2009-12-01

    Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.

  18. Detecting changes in respiratory patterns in high frequency chest compression therapy by single-channel blind source separation.

    Science.gov (United States)

    Zhu, Xiaoming; Parhi, Keshab K; Warwick, Warren J

    2009-01-01

    High Frequency Chest Compression (HFCC) is used as a method to remove the mucus in the airway for Cystic Fibrosis (CF) patients. As the characteristics of the tracheal sound reflect the conditions of airways, in this paper, we propose a novel method to evaluate the respiratory patterns in HFCC therapy by using single channel tracheal sounds only. The difficulty of analyzing tracheal sounds lies in that it has a wider frequency band than the air flow at the mouth, and is always corrupted by other biomedical signals and noises. During HFCC therapy, the tracheal sound is also affected by the HFCC machine noise. For this reason, it is difficult to extract respiratory patterns and other related features by traditional filtering techniques. In this paper, we demonstrate use of single-channel independent component analysis to extract respiratory patterns from the tracheal sounds before, during and after HFCC therapy, and use basis features in the tracheal sound to detect the change in respiratory patterns.

  19. [Successful treatment of subglottic tracheal stenosis with a mucosa-lined radial forearm fascia flap].

    Science.gov (United States)

    Mandapathil, M; Hoffmann, T K; Freitag, L; Reddy, N; Lang, S; Delaere, P

    2012-12-01

    Short-segment tracheal stenosis is often treated by segmental resection and end-to-end anastomosis. Longer-segment stenosis can sometimes be treated using dilation, laser therapy, bronchoscopic stent insertion and segmental resection and reconstruction. Long-segment restenosis with a buildup of scar tissue due to successful resection surgery in the past represents a particular therapeutic challenge and a sufficiently vascularized transplant may be the only option. We describe the case of a 37-year-old patient who underwent a tracheal reconstruction using a mucosa-lined radial forearm flap. Subsequent to a traumatic laryngotracheal fracture, long-term ventilation and multiple surgical interventions, the patient had developed a functionally relevant subglottic stenosis (5.5 cm). Following longitudinal anterior resection of the trachea 1 cm above and below the stenosis, a Dumon® stent was inserted. Simultaneously, a radial forearm fascia flap was harvested, as were two full-thickness buccal mucosa grafts, which were sutured onto the subcutaneous tissue and fascia of the forearm flap. Beginning caudally, the mucosa-lined flap was then sutured, air-tight, into the anterior tracheal defect with the mucosa facing the lumen. Finally, end-to-end anastomosis connected the blood vessels of the radial forearm flap to the recipient blood vessels in the neck. The patient was successfully extubated after 24 h and discharged after 5 days. A postoperative CT scan revealed optimal placement of the stent and the patient's speech and breathing were sufficiently re-established. The stent was removed bronchoscopically 6 weeks after surgery. Examinations during the 6-month follow-up period showed that the diameter of the reconstructed airway was retained and the patient remained symptom-free.

  20. [Surgical approaches in surgery for cicatrical tracheal stenosis].

    Science.gov (United States)

    Parshin, V D; Rusakov, M A; Parshin, V V; Mirzoian, O S; Khoruzhenko, A I

    2015-01-01

    At present time several surgical approaches are being used for cicatrical tracheal stenosis including cervicotomy, longitudinal- circumferential sternotomy and thoracotomy. Besides location of stenosis an approach is being determined by constitutional and anatomical features of patient, surgeon's and anesthesiologist's experience, well-coordinated work of operating team. If pathological process is placed in cervico-laryngeal, cervical and upper thoracic segment cervicotomy is preferable. Partial longitudinal-circumferential sternotomy is believed to be adequate in case of lesion of thoracic trachea and its bifurcation. This approach provides all types of tracheal reconstructions. Technical difficulties appear if process is localized in membranous wall of suprabifurcational part, bifurcation and primary bronchus. In these cases we recommend thoracotomy through the bed of resected the 3rd or the 4th ribs and patient's position on his front. Interventions including pulmonary tissue resection and tracheal edges convergence are possible through thoracotomy.

  1. Menthol inhibiting parasympathetic function of tracheal smooth muscle

    Science.gov (United States)

    Wang, Hsing-Won; Liu, Shao-Cheng; Chao, Pin-Zhir; Lee, Fei-Peng

    2016-01-01

    Menthol is used as a constituent of food and drink, tobacco and cosmetics nowadays. This cold receptor agonist has been used as a nasal inhalation solution in the daily life. The effect of menthol on nasal mucosa in vivo is well known; however, the effect of the drug on tracheal smooth muscle has been rarely explored. Therefore, during administration of the drug for nasal symptoms, it might also affect the trachea via oral intake or inhalation. We used our preparation to test the effectiveness of menthol on isolated rat tracheal smooth muscle. A 5 mm long portion of rat trachea was submersed in 30 ml Krebs solution in a muscle bath at 37ºC. Changes in tracheal contractility in response to the application of a parasympathetic mimetic agent were measured using a transducer connected to a Pentium III computer equipped with polygraph software. The following assessments of menthol were performed: (1) effect on tracheal smooth muscle resting tension; (2) effect on contraction caused by 10-6 M methacholine as a parasympathetic mimetic; (3) effect of the drug on electrically induced tracheal smooth muscle contractions. Results indicated that addition of a parasympathetic mimetic to the incubation medium caused the trachea to contract in a dose-dependent manner. Addition of menthol at doses of 10-5 M or above elicited a relaxation response to 10-6 M methacholine-induced contraction. Menthol could also inhibit electrical field stimulation (EFS) induced spike contraction. However, it alone had a minimal effect on the basal tension of trachea as the concentration increased. We concluded that the degree of drug-induced tracheal contraction or relaxation was dose-dependent. In addition, this study indicated that high concentrations of menthol might actually inhibit parasympathetic function of the trachea. PMID:27994497

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  6. Evaluation of histological changes after tracheal occlusion at different gestational ages in a fetal rat model

    Directory of Open Access Journals (Sweden)

    Rodrigo Melo Gallindo

    2013-01-01

    Full Text Available OBJECTIVES: To evaluate the histological changes of tracheal cartilage and epithelium caused by tracheal occlusion at different gestational ages in a fetal rat model. METHODS: Rat fetuses were divided into two groups: a External control, composed of non-operated rats, and b Interventional group, composed of rats operated upon on gestational day 18.5 (term = 22 days, divided into triads: 1 Tracheal occlusion, 2 Internal control and 3 Sham (manipulated but not operated. Morphological data for body weight, total lung weight and total lung weight/body weight ratio were collected and measured on gestational days 19.5, 20.5 and 21.5. Tracheal samples were histologically processed, and epithelial, chondral and total tracheal thicknesses were measured on each gestational day. RESULTS: The tracheal occlusion group exhibited an increase in total lung weight/body weight ratio (p<0.001. Histologically, this group had a thicker epithelial thickness (p<0.05 and thinner chondral (p<0.05 and total tracheal thicknesses (p<0.001. These differences were more prominent on gestational days 20.5 and 21.5. CONCLUSION: Tracheal occlusion changed tracheal morphology, increased epithelial thickness and considerably decreased total tracheal thickness. These changes in the tracheal wall could explain the development of tracheomegaly, recently reported in some human fetuses subjected to tracheal occlusion.

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  20. File list: DNS.Lng.10.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  1. File list: Pol.Lng.10.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  2. File list: His.Lng.10.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  3. Congenital tracheal defects: embryonic development and animal models

    Directory of Open Access Journals (Sweden)

    Zenab Arooj Sher

    2016-03-01

    Full Text Available Tracheal anomalies are potentially catastrophic congenital defects. As a newborn begins to breathe, the trachea needs to maintain an appropriate balance of elasticity and rigidity. If the tracheal cartilages are disorganized or structurally weak, the airways can collapse, obstructing breathing. Cartilage rings that are too small or too rigid can also obstruct breathing. These anomalies are frequently associated with craniofacial syndromes, and, despite the importance, are poorly understood. In this review, we summarize the spectrum of pathological phenotypes of the trachea and correlate them with the molecular events uncovered in mouse models.

  4. Repair of tracheal epithelium by basal cells after chlorine-induced injury

    Directory of Open Access Journals (Sweden)

    Musah Sadiatu

    2012-11-01

    The data are consistent with a model where surviving basal cells function as progenitor cells to repopulate the tracheal epithelium after chlorine injury. In areas with few remaining basal cells, repair is inefficient, leading to airway fibrosis. These studies establish a model for understanding regenerative processes in the respiratory epithelium useful for testing therapies for airway injury.

  5. Rac promotes epithelial cell rearrangement during tracheal tubulogenesis in Drosophila.

    Science.gov (United States)

    Chihara, Takahiro; Kato, Kagayaki; Taniguchi, Misako; Ng, Julian; Hayashi, Shigeo

    2003-04-01

    Cell rearrangement, accompanied by the rapid assembly and disassembly of cadherin-mediated cell adhesions, plays essential roles in epithelial morphogenesis. Various in vitro and cell culture studies on the small GTPase Rac have suggested it to be a key regulator of cell adhesion, but this notion needs to be verified in the context of embryonic development. We used the tracheal system of Drosophila to investigate the function of Rac in the epithelial cell rearrangement, with a special attention to its role in regulating epithelial cadherin activity. We found that a reduced Rac activity led to an expansion of cell junctions in the embryonic epidermis and tracheal epithelia, which was accompanied by an increase in the amount of Drosophila E-Cadherin-Catenin complexes by a post-transcriptional mechanism. Reduced Rac activity inhibited dynamic epithelial cell rearrangement. Hyperactivation of Rac, on the other hand, inhibited assembly of newly synthesized E-Cadherin into cell junctions and caused loss of tracheal cell adhesion, resulting in cell detachment from the epithelia. Thus, in the context of Drosophila tracheal development, Rac activity must be maintained at a level necessary to balance the assembly and disassembly of E-Cadherin at cell junctions. Together with its role in cell motility, Rac regulates plasticity of cell adhesion and thus ensures smooth remodeling of epithelial sheets into tubules.

  6. Difficult Tracheal Intubation in Obese Gastric Bypass patients

    DEFF Research Database (Denmark)

    Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.

    2016-01-01

    Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess...

  7. An ovine tracheal explant culture model for allergic airway inflammation

    Directory of Open Access Journals (Sweden)

    Abeynaike Latasha

    2010-08-01

    Full Text Available Abstract Background The airway epithelium is thought to play an important role in the pathogenesis of asthmatic disease. However, much of our understanding of airway epithelial cell function in asthma has been derived from in vitro studies that may not accurately reflect the interactive cellular and molecular pathways active between different tissue constituents in vivo. Methods Using a sheep model of allergic asthma, tracheal explants from normal sheep and allergic sheep exposed to house dust mite (HDM allergen were established to investigate airway mucosal responses ex vivo. Explants were cultured for up to 48 h and tissues were stained to identify apoptotic cells, goblet cells, mast cells and eosinophils. The release of cytokines (IL-1α, IL-6 and TNF-α by cultured tracheal explants, was assessed by ELISA. Results The general morphology and epithelial structure of the tracheal explants was well maintained in culture although evidence of advanced apoptosis within the mucosal layer was noted after culture for 48 h. The number of alcian blue/PAS positive mucus-secreting cells within the epithelial layer was reduced in all cultured explants compared with pre-cultured (0 h explants, but the loss of staining was most evident in allergic tissues. Mast cell and eosinophil numbers were elevated in the allergic tracheal tissues compared to naïve controls, and in the allergic tissues there was a significant decline in mast cells after 24 h culture in the presence or absence of HDM allergen. IL-6 was released by allergic tracheal explants in culture but was undetected in cultured control explants. Conclusions Sheep tracheal explants maintain characteristics of the airway mucosa that may not be replicated when studying isolated cell populations in vitro. There were key differences identified in explants from allergic compared to control airways and in their responses in culture for 24 h. Importantly, this study establishes the potential for the

  8. A canine model of tracheal stenosis induced by cuffed endotracheal intubation

    Science.gov (United States)

    Su, Zhuquan; Li, Shiyue; Zhou, Ziqing; Chen, Xiaobo; Gu, Yingying; Chen, Yu; Zhong, Changhao; Zhong, Minglu; Zhong, Nanshan

    2017-01-01

    Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis. PMID:28349955

  9. Submental tracheal intubation in oromaxillofacial surgery

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    Sharma Ramesh

    2008-01-01

    Full Text Available Background: Oromaxillofacial surgical procedures present a unique set of problems both for the surgeon and for the anesthesist. Achieving dental occlusion is one of the fundamental aims of most oromaxillofacial procedures. Oral intubation precludes this surgical prerequisite of checking dental occlusion. Having the tube in the field of surgery is often disturbing for the surgeon too, especially in the patient for whom skull base surgery is planned. Nasotracheal intubation is usually contraindicated in the presence of nasal bone fractures seen either in isolation or as a component of Le Fort fractures. We utilized submental endotracheal intubation in such situations and the experience has been very satisfying. Materials and Methods: The technique has been used in 20 patients with maxillofacial injuries and those requiring Le Fort I approach with or without maxillary swing for skull base tumors. Initial oral intubation is done with a flexo-metallic tube. A small 1.5 cm incision is given in the submental region and a blunt tunnel is created in the floor of the mouth staying close to the lingual surface of mandible and a small opening is made in the mucosa. The tracheal end of tube is stabilized with Magil′s forceps, and the proximal end is brought out through submental incision by using a blunt hemostat taking care not to injure the pilot balloon. At the end of procedure extubation is done through submental location only. Results: The technique of submental intubation was used in a series of twenty patients from January 2005 to date. There were fifteen male patients and five female patients with a mean age of twenty seven years (range 10 to 52. Seven patients had Le Fort I osteotomy as part of the approach for skull base surgery. Twelve patients had midfacial fractures at the Le Fort II level, of which 8 patients in addition had naso-ethomoidal fractures and 10 patients an associated fracture mandible. Twelve patients were extubated in the

  10. Review of 23 cases of postintubation tracheal obstructions in birds.

    Science.gov (United States)

    Sykes, John M; Neiffer, Donald; Terrell, Scott; Powell, David M; Newton, Alisa

    2013-09-01

    Although recognized as a potential complication after endotracheal intubation in birds, the complication rate of postintubation tracheal obstruction in this taxon is unknown. Twenty-three cases of postintubation obstruction in birds from two institutions are reported. Clinical signs were noted an average of 16.6 days postintubation and consisted primarily of indications of acute respiratory distress. Diagnosis was confirmed via tracheoscopy or radiology. Five birds died before treatment could be initiated. Medical treatment alone was successful in three birds that had mild changes consisting primarily of a luminal mucoid plug that could be manually removed without tracheal surgery but was unsuccessful in an additional six birds. Tracheal resection and anastamosis was successful in four birds and unsuccessful in five birds. Overall mortality was 70%. Postintubation tracheal obstruction in birds appears to be more common in zoo practice than is suggested by the literature, as a total of 1.8% (1.2-2.7%, 95% confidence interval) of intubations or 3.5% (2.3-5.3%, 95% confidence interval) of individual animals intubated in these institutions resulted in this complication. Multiple cases were found in Ciconiiformes (n = 4), Columbiformes (n = 4), Gruiformes (n = 4), Anseriformes (n = 3), Galliformes (n = 3), and Passeriformes (n = 2). No cases were found in Coraciiforms, Falconiforms, or Psittaciformes despite many (>40) recorded intubations. The specific cause of these lesions is unclear, but some type of tracheal mucosa trauma or irritation is suggested by histologic findings. Prevention may include selective intubation, use of a laryngeal mask airway in place of intubation, careful placement of an endotracheal tube, minimal movement of the head and neck after placement, humidification of anesthetic gases, and gentle positive-pressure ventilation.

  11. Comparison of innate immune agonists for induction of tracheal antimicrobial peptide gene expression in tracheal epithelial cells of cattle.

    Science.gov (United States)

    Berghuis, Lesley; Abdelaziz, Khaled Taha; Bierworth, Jodi; Wyer, Leanna; Jacob, Gabriella; Karrow, Niel A; Sharif, Shayan; Clark, Mary Ellen; Caswell, Jeff L

    2014-10-12

    Bovine respiratory disease is a complex of bacterial and viral infections of economic and welfare importance to the beef industry. Although tracheal antimicrobial peptide (TAP) has microbicidal activity against bacterial pathogens causing bovine respiratory disease, risk factors for bovine respiratory disease including BVDV and stress (glucocorticoids) have been shown to inhibit the induced expression of this gene. Lipopolysaccharide is known to stimulate TAP gene expression, but the maximum effect is only observed after 16 h of stimulation. The present study investigated other agonists of TAP gene expression in primary cultures of bovine tracheal epithelial cells. PCR analysis of unstimulated tracheal epithelial cells, tracheal tissue and lung tissue each showed mRNA expression for Toll-like receptors (TLRs) 1-10. Quantitative RT-PCR analysis showed that Pam3CSK4 (an agonist of TLR1/2) and interleukin (IL)-17A significantly induced TAP gene expression in tracheal epithelial cells after only 4-8 h of stimulation. Flagellin (a TLR5 agonist), lipopolysaccharide and interferon-α also had stimulatory effects, but little or no response was found with class B CpG ODN 2007 (TLR9 agonist) or lipoteichoic acid (TLR2 agonist). The use of combined agonists had little or no enhancing effect above that of single agonists. Thus, Pam3CSK4, IL-17A and lipopolysaccharide rapidly and significantly induce TAP gene expression, suggesting that these stimulatory pathways may be of value for enhancing innate immunity in feedlot cattle at times of susceptibility to disease.

  12. Transoral tracheal intubation of rodents using a fiberoptic laryngoscope.

    Science.gov (United States)

    Costa, D L; Lehmann, J R; Harold, W M; Drew, R T

    1986-06-01

    A fiberoptic laryngoscope which allows direct visualization of the deep pharynx and epiglottis has been developed for transoral tracheal intubation of small laboratory mammals. The device has been employed in the intubation and instillation of a variety of substances into the lungs of rats, and with minor modification, has had similar application in mice, hamsters, and guinea pigs. The simplicity and ease of handling of the laryngoscope permits one person to intubate large numbers of enflurane anesthetized animals either on an open counter top or in a glove-box, as may be required for administration of carcinogenic materials. Instillation of 7Be-labeled carbon particles into the lungs of mice, hamsters, rats, and guinea pigs resulted in reasonably consistent interlobal distribution of particles for each test animal species with minimal tracheal deposition. However, actual lung tissue doses of carbon exhibited some species dependence.

  13. Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology.

    Science.gov (United States)

    Zambudio, Antonio Ríos; Calvo, Maria Jose Roca; Lanzas, Juan Torres; Medina, J García; Paricio, Pascual Parrilla

    2003-04-01

    Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

  14. Functional optical imaging of tracheal health (Conference Presentation)

    Science.gov (United States)

    Gil, Daniel A.; Sharick, Joe T.; Gamm, Ute A.; Choma, Michael A.; Skala, Melissa C.

    2017-04-01

    The health of the tracheal mucosa is an important, but poorly understood, aspect of critical care medicine. Many critical care patients are mechanically ventilated through an endotracheal tube that can cause local inflammation and blunt damage to the ciliated epithelial cells lining the trachea. These cilia clear mucus and infectious agents from the respiratory tract, so impaired ciliary function may lead to increased susceptibility to respiratory infection. Therefore, a minimally-invasive method to monitor mucosal health and ciliary function in intubated patients would be valuable to critical care medicine. Optical metabolic imaging (OMI) can quantitatively assess the metabolic state of cells by measuring the fluorescence intensities of endogenous metabolic co-enzymes NAD(P)H and FAD. OMI is especially attractive for assessing tracheal health because OMI is label-free, and ciliary function is tightly linked to the levels of NAD(P)H and FAD. In this study, we apply widefield OMI to ex vivo mouse tracheae (n=6), and demonstrate that the optical redox ratio (fluorescence intensity of NAD(P)H divided by the intensity of FAD) is sensitive to changes in the cellular metabolism of the tracheal mucosa. We observed a 46% increase in the redox ratio 20 minutes after treatment with 10mM of sodium cyanide (pcellular respiration. In addition to being a proof-of-concept demonstration, Pseudomonas aeruginosa, an important cause of morbidity and mortality in CF patients and in the ICU, produces hydrogen cyanide. Our results support the development of minimally-invasive fiber-optic probes for in vivo monitoring of tracheal health.

  15. Low tracheal tumor and airway management: An anesthetic challenge

    Directory of Open Access Journals (Sweden)

    Richa Saroa

    2015-01-01

    Full Text Available We describe a case presenting with tracheal tumor wherein a Microlaryngeal tube was advanced into the trachea distal to the tumor for primary airway control followed by cannulation of both endobronchial lumen with 5.5 mm endotracheal tubes to provide independent lung ventilation post tracheal transection using Y- connector attached to anesthesia machine. The plan was formulated to provide maximal surgical access to the trachea while providing adequate ventilation at the same time. A 32 yrs non smoker male, complaining of cough, progressive dyspnea and hemoptysis was diagnosed to have a broad based mass in the trachea on computed tomography of chest. Bronchoscopy of the upper airway confirmed presence of the mass at a distance of 9 cms from the vocal cords, obstructing the tracheal lumen by three fourth of the diameter. The patient was scheduled to undergo the resection of the mass through anterolateral thoracotomy. We recommend the use of extralong, soft, small sized microlaryngeal surgery tube in tumors proximal to carina, for securing the airway before the transection of trachea and bilateral endobronchial intubation with small sized cuffed endotracheal tubes for maintenance of ventilation after the transection of trachea in patients with mass in the lower trachea.

  16. A new porous tracheal prosthesis sealed with collagen sponge.

    Science.gov (United States)

    Teramachi, M; Kiyotani, T; Takimoto, Y; Nakamura, T; Shimizu, Y

    1995-01-01

    We have designed a new tracheal prosthesis to overcome problems with an earlier device, which included stenosis and exposure of its constituent mesh. A polypropylene mesh cylinder, reinforced with a polypropylene spiral, is sealed with collagen sponge made from porcine dermal collagen. Using this prosthesis, we performed cervical tracheal reconstructions on 11 dogs. Three dogs died within 3 months of reconstruction. Their causes of death were anesthetic accident, diarrhea, and suffocation, respectively. Bronchoscopically, the inner surface of the prosthesis was almost covered with host tissue by 2 months. However, in one dog, a relatively large area of the mesh was exposed in the tracheal lumen at 6 months; a smaller area was exposed in two other dogs. The appearance of the inner surface rapidly became lustrous, and central stenosis was not significant, even after 12 months. Histologically, an incomplete epithelial lining at 6 months was seen on the reconstructed surface and included ciliated columnar, cuboidal, and squamous epithelium. These observations have revealed that this prosthesis has high biocompatibility and the potential to overcome problems of stenosis of the prosthesis lumen. However, because ulceration persists with this prosthesis, additional improvement is needed to reduce the incidence of mesh exposure.

  17. Submental tracheal intubation for resection of recurrent giant pituitary tumor:a case report

    Institute of Scientific and Technical Information of China (English)

    Zhong Hejiang; Wang Yunling; Yang Tiande

    2011-01-01

    Airway management in the patients who receive transmaxillary approach for resection of giant pituitary tumor presents a clinical challenge to the anesthesiologists. Oral or nasal route for tracheal intubation can interfere with surgical procedures. This report describes submental tracheal intubation for airway management in a patient who underwent resection of recurrent giant pituitary tumor via transmaxillary approach. Submental tracheal intubation is an adaptable and safe alternative technology for airway management during operation.

  18. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.

    Science.gov (United States)

    Pang, Lei; Feng, Yan-Hua; Ma, Hai-Chun; Dong, Su

    2015-04-01

    In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques.

  19. Tracheal perforation managed by temporary tracheostomy in a horse : clinical communication

    Directory of Open Access Journals (Sweden)

    M.N. Saulez

    2005-06-01

    Full Text Available Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by diverting air away from the site of tracheal perforation. After conservative management, the gelding recovered completely.

  20. Simultaneous tracheal and oesophageal pH monitoring during mechanical ventilation.

    Science.gov (United States)

    Hue, V; Leclerc, F; Gottrand, F; Martinot, A; Crunelle, V; Riou, Y; Deschildre, A; Fourier, C; Turck, D

    1996-01-01

    OBJECTIVE: To simultaneously record tracheal and oesophageal pH in mechanically ventilated children to determine: (1) the feasibility and safety of the method; (2) the incidence of gastro-oesophageal reflux (GOR) and pulmonary contamination; and (3) their associated risk factors. DESIGN: Prospective study. SETTING: Paediatric intensive care unit in a university hospital. PATIENTS: Twenty mechanically ventilated children (mean age 6.7 years) who met the following inclusion criteria: endotracheal tube with an internal diameter of 4 mm or more (cuffed or uncuffed), mechanical ventilation for an acute disease, no treatment with antiacids, prokinetics, or H2-receptor blockers, and no nasogastric or orogastric tube. METHODS: The tracheal antimony pH probe was positioned 1 cm below the distal end of the endotracheal tube. The oesophageal antimony pH probe was positioned at the lower third of the oesophagus. pH was recorded on a double channel recorder and analysed with EsopHogram 5.01 software and by examination of the trace. The following definitions were used: GOR index, percentage of time pH 4.8%; tracheal reflux, fall in tracheal pH Tracheal reflux (pH aspiration. Episodes of tracheal reflux were associated with a GOR index > 10% (p tracheal and oesophageal pH monitoring was feasible in the setting of this study. Tracheal reflux can occur without pathological GOR, and GOR may occur without tracheal reflux. Further prospective studies in larger groups of patients are now justified. PMID:8813870

  1. Acquired Tracheal Diverticulum as an Unexpected Cause of Endotracheal Tube Cuff Leak

    Directory of Open Access Journals (Sweden)

    Flores-Franco René Agustin

    2015-10-01

    Full Text Available Introduction: Tracheal diverticulum has been associated with problems during endotracheal intubation but there are no reports concerning air leakage around an endotracheal tube (ETT.

  2. Correction of congenital diaphragmatic hernia in utero VIII: Response of the hypoplastic lung to tracheal occlusion.

    Science.gov (United States)

    Harrison, M R; Adzick, N S; Flake, A W; VanderWall, K J; Bealer, J F; Howell, L J; Farrell, J A; Filly, R A; Rosen, M A; Sola, A; Goldberg, J D

    1996-10-01

    Most fetuses with congenital diaphragmatic hernia (CDH) diagnosed before 24 weeks' gestation die despite optimal postnatal care. In fetuses with liver herniation into the chest, prenatal repair has not been successful. In the course of exploring the pathophysiology of CDH and its repair in fetal lambs, the authors found that obstructing the normal egress of fetal lung fluid enlarges developing fetal lungs, reduces the herniated viscera, and accelerates lung growth, resulting in improved pulmonary function after birth. They developed and tested experimentally a variety of methods to temporarily occlude the fetal trachea, allow fetal lung growth, and reverse the obstruction at birth. The authors applied this strategy of temporary tracheal occlusion in eight human fetuses with CDH and liver herniation at 25 to 28 weeks' gestation. With ongoing experimental and clinical experience, the technique of tracheal occlusion evolved from an internal plug (two patients) to an external clip (six patients), and a technique was developed for unplugging the trachea at the time of birth (Ex Utero Intrapartum Tracheoplasty [EXIT]). Two fetuses had a foam plug placed inside the trachea. The first showed dramatic lung growth in utero and survived; the second (who had a smaller plug to avoid tracheomalacia) showed no demonstrable lung growth and died at birth. Two fetuses had external spring-loaded aneurysm clips placed on the trachea; one was aborted due to tocolytic failure, and the other showed no lung growth (presumed leak) and died 3 months after birth. Four fetuses had metal clips placed on the trachea. All showed dramatic lung growth in utero, with reversal of pulmonary hypoplasia documented after birth. However, all died of nonpulmonary causes. Temporary occlusion of the fetal trachea accelerates fetal lung growth and ameliorates the often fatal pulmonary hypoplasia associated with severe CDH. Although the strategy is physiologically sound and technically feasible, complications

  3. Intubação traqueal Tracheal intubation

    Directory of Open Access Journals (Sweden)

    Toshio Matsumoto

    2007-05-01

    Full Text Available OBJETIVO: Revisar os conceitos atuais relacionados ao procedimento de intubação traqueal na criança. FONTES DOS DADOS: Seleção dos principais artigos nas bases de dados MEDLINE, LILACS e SciELO, utilizando as palavras-chave intubation, tracheal intubation, child, rapid sequence intubation, pediatric airway, durante o período de 1968 a 2006. SÍNTESE DOS DADOS: O manuseio da via aérea na criança está relacionado à sua fisiologia e anatomia, além de fatores específicos (condições patológicas inerentes, como malformações e condições adquiridas que influenciam decisivamente no seu sucesso. As principais indicações são manter permeável a aérea e controlar a ventilação. A laringoscopia e intubação traqueal determinam alterações cardiovasculares e reatividade de vias aéreas. O uso de tubos com balonete não é proibitivo, desde que respeitado o tamanho adequado para a criança. A via aérea difícil pode ser reconhecida pela escala de Mallampati e na laringoscopia direta. A utilização da seqüência rápida de intubação tem sido recomendada cada vez mais em pediatria, por facilitar o procedimento e apresentar menores complicações. A intubação traqueal deve ser realizada de modo adequado em circunstâncias especiais (alimentação prévia, disfunção neurológica, instabilidade de coluna espinal, obstrução de vias aéreas superiores, lesões laringotraqueais, lesão de globo ocular. A extubação deve ser meticulosamente planejada, pois pode falhar e necessitar de reintubação. CONCLUSÕES: A intubação traqueal de crianças necessita conhecimento, aprendizado e experiência, pois o procedimento realizado por pediatras inexperientes pode resultar em complicações ameaçadoras da vida.OBJECTIVE: To review current concepts related to the procedure of tracheal intubation in children. SOURCES: Relevant articles published from 1968 to 2006 were selected from the MEDLINE, LILACS and SciELO databases, using the

  4. Difficult Tracheal Intubation in Obese Gastric Bypass patients.

    Science.gov (United States)

    Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, Jannie; Rønholm, Ebbe; Larsen, Jens Fromholt

    2016-11-01

    Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) 2, ASA scores >2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.

  5. Cuffed Endotracheal Tube Size and Leakage in Pediatric Tracheal Models

    Directory of Open Access Journals (Sweden)

    Jun Hyun Kim

    2014-04-01

    Full Text Available Object: Cuffed endotracheal tubes are increasingly used in pediatric patients in the hope that they can reduce air leakage and tube size mismatch by just inflating the cuff. Authors compared influence of various tube sizes and different levels of cuff pressures to air leakage around the cuff, in artificial tracheal models. Methods: Six PVC cylinders of different internal diameters (ID: 8.15, 8.50, 9.70, 12.05, 14.50, and 20.00 mm were prepared. An artificial lung connected with cylinder was ventilated with an anesthesia machine. Cuffed endotracheal tubes of different sizes (ID 3.0~8.0 were located in the cylinders and the cuff was inflated with various pressures (15, 20, 25, 30 and 35 cm H2O. Expiratory tidal volume was measured with more than 25% loss of baseline expiratory tidal volume was considered significant air leakage. Results: Tube sizes same as, or larger than ID 5.0 didn’t show significant air leakage for any trachea model, only if the inflated cuff size is larger than the cylinder ID, except ID 5.5 tube at cuff pressure 15 cm H2O and 20 cm H2O, in 12.05 mm cylinder. Tubes sizes same as or smaller than ID 4.5, which have short cuff lengths and sizes than tubes larger than, or same as ID 5.0, leaked significantly at any tracheal models, except ID 4.5 tube at cuff pressure 35 cm H2O, in 8.50 mm cylinder. Conclusion: In PVC pediatric tracheal models, tubes same as, or smaller than ID 4.5 are inferior to tubes same as, or larger than ID 5.0 in preventing air leakage, and may need a higher cuff pressure to reduce air leakage. Further clinical studies could be designed based on our results.

  6. Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study

    Directory of Open Access Journals (Sweden)

    Angélica de Fátima de Assunção Braga

    Full Text Available Abstract Background and objectives: The temporary fetal tracheal occlusion performed by fetoscopy accelerates lung development and reduces neonatal mortality. The aim of this paper is to present an anesthetic experience in pregnant women, whose fetuses have diaphragmatic hernia, undergoing fetoscopic tracheal occlusion (FETO. Method: Retrospective, descriptive study, approved by the Institutional Ethics Committee. Data were obtained from medical and anesthetic records. Results: FETO was performed in 28 pregnant women. Demographic characteristics: age 29.8 ± 6.5; weight 68.64 ± 12.26; ASA I and II. Obstetric: IG 26.1 ± 1.10 weeks (in FETO; 32.86 ± 1.58 (reversal of occlusion; 34.96 ± 2.78 (delivery. Delivery: cesarean section, vaginal delivery. Fetal data: Weight (g in the occlusion and delivery times, respectively (1045.82 ± 222.2 and 2294 ± 553; RPC in FETO and reversal of occlusion: 0.7 ± 0.15 and 1.32 ± 0.34, respectively. Preoperative maternal anesthesia included ranitidine and metoclopramide, nifedipine (VO and indomethacin (rectal. Preanesthetic medication with midazolam IV. Anesthetic techniques: combination of 0.5% hyperbaric bupivacaine (5-10 mg and sufentanil; continuous epidural predominantly with 0.5% bupivacaine associated with sufentanil, fentanyl, or morphine; general. In 8 cases, there was need to complement via catheter, with 5 submitted to PC and 3 to BC. Thirteen patients required intraoperative sedation; ephedrine was used in 15 patients. Fetal anesthesia: fentanyl 10-20 mg.kg-1 and pancuronium 0.1-0.2 mg.kg-1 (IM. Neonatal survival rate was 60.7%. Conclusion: FETO is a minimally invasive technique for severe congenital diaphragmatic hernia repair. Combined blockade associated with sedation and fetal anesthesia proved safe and effective for tracheal occlusion.

  7. The diagnostic difficulties in tracheal neoplasms; Trudnosci diagnostyczne w nowotworach tchawicy

    Energy Technology Data Exchange (ETDEWEB)

    Bartnik, W.; Szewczyk, M.; Lomikowska, E.; Meler, M.; Rosolowska, J. [Wojewodzki Szpital Zespolony, Kalisz (Poland)

    1994-12-31

    Since 1990-1992 in the Dept. of ENT Kalisz 5 patients with tracheal neoplasms were treated. On the base of this cases the diagnostic difficulties has been presented. A rare case of tracheal carcinoma adenoides treated by telecobaltotherapy was described. 6 years survival rate was observed. (author)

  8. Osteochondroma of the tracheal wall in a Fischer's lovebird (Agapornis fischeri, Reichenow 1887).

    Science.gov (United States)

    Weissengruber, G; Loupal, G

    1999-01-01

    A Fischer's lovebird with dyspnea and stridorous breathing was examined by endoscopy. Tracheal stenosis was observed slightly cranial of the middle of the cervical segment. Histologically, an osteochondroma was identified as the cause of this stenosis. This is the first description of a tracheal osteochondroma in a bird.

  9. Ventilatory responses to hypoxia nullify hypoxic tracheal constriction in awake dogs.

    Science.gov (United States)

    Sorkness, R L; Vidruk, E H

    1986-10-01

    Three awake dogs with chronic tracheostomies were used to study the effects of hypoxia (12% O2) on tracheal smooth muscle tone. Pressure changes within a water-filled cuff in an isolated portion of the cervical trachea reflected changes in tracheal tone. During spontaneous ventilation, hypoxia produced hyperventilation, but no significant change in tracheal tone. If hypocapnia was prevented with inspired CO2 during hypoxia, one of three dogs increased tracheal tone, and all dogs increased ventilation beyond that measured with hypoxia alone. When the awake dogs were ventilated mechanically to prevent changes in ventilation, hypoxia always increased tracheal tone. We made independent changes in ventilation and CO2 similar to the spontaneous responses to hypoxia to test these effects on tracheal tone. When the dogs were ventilated mechanically first with 2% CO2, and then with no CO2, the resulting drop in end-tidal CO2 always decreased tone. When the tidal volume on the ventilator was increased under hyperoxic, isocapnic conditions, tracheal tone always decreased. We conclude that the normal ventilatory response to hypoxia opposes the bronchoconstrictor effect of hypoxia, resulting in no net change in tracheal smooth muscle tone.

  10. The effects and safety of closed versus open tracheal suction system:a meta analysis

    Institute of Scientific and Technical Information of China (English)

    董亮

    2012-01-01

    Objective To evaluate the effects and safety of closed tracheal suction system (CTSS) versus open tracheal suction system(OTSS) for mechanically ventilated patients. Methods All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad

  11. File list: NoD.Lng.05.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  19. Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy

    Directory of Open Access Journals (Sweden)

    Lilibeth Fermin

    2017-01-01

    Full Text Available Extracorporeal Membrane Oxygenation (ECMO for repair of tracheal injury during transhiatal esophagectomy Tracheal injury is a rare but potentially fatal complication of esophagectomies requiring prompt recognition and treatment. We describe a case of tracheal injury recognized in the operative period of an open transhiatal esophagectomy for squamous cell carcinoma of the mid to distal esophagus. When injury was discovered, attempts to improve oxygenation and ventilation by conventional methods were unsuccessful. Therefore, peripheral ECMO was used to support oxygenation during the tracheal defect repair. The use of ECMO for the repair of a tracheal injury during esophagectomy is very uncommon but, in our case, provided adequate oxygenation and ventilation while the surgeon repaired the injury and the patient was able to be promptly weaned from ECMO support and extubated not long after.

  20. [The Use of a Tracheal Tube for Guiding Nasogastric Tube Insertion].

    Science.gov (United States)

    Saima, Shunsuke; Asai, Takashi; Okuda, Yasuhisa

    2016-04-01

    An obese patient was scheduled for shoulder joint surgery under general anesthesia. After induction of anesthesia and tracheal intubation, insertion of a gastric tube was difficult. A new tracheal tube was prepared, the connecter was removed, and the tube was cut longitudinally. The tube was inserted orally into the esophagus. A gastric tube was passed through the nose, and its tip was taken out of the mouth. The tip of the gastric tube was passed through the tracheal tube, and its correct position in the stomach was confirmed by auscultation of the epigastrium. The tracheal tube was carefully taken out from the esophagus leaving the gastric tube in the stomach. The cut tracheal tube was peeled off from the gastric tube. Correct positioning of the gastric tube was re-confirmed.

  1. CLINICAL APPLICATION OF ACUPUNCTURE ON ALLEVIATION OF STRESS REACTION INDUCED BY TRACHEAL INTUBATION IN GENERAL ANESTHESIA

    Institute of Scientific and Technical Information of China (English)

    SHI Jin-hua

    2006-01-01

    By summarizing the formation of stress reaction induced by tracheal intubation and method of medicinal control, the recognition of Chinese medicine in treatment of cardiac arrhythmia and hypertension with acupuncture and the clinical application of acupuncture on stress reaction induced by tracheal intubation,it is concluded that the side effects of tracheal intubation are inevitable, even though there are many methods presented for the prevention and treatment for it. In recent years, the functions of acupuncture in anesthesia,especially in regulation of circulatory properties have been developed gradually and have been applied by many physicians in controlling the stress reaction induced by tracheal intubation in general anesthesia. Being a kind of dual-directional and positive regulation and stimulation, acupuncture provides definite and safe effects on controlling the stress reaction induced by tracheal intubation.

  2. Development of a patient specific artificial tracheal prosthesis: design, mechanical behavior analysis and manufacturing.

    Science.gov (United States)

    Chua C H, Matthew; Chui, Chee Kong; Rai, Bina; Lau D P, David

    2013-01-01

    There is a need to create patient specific organ replacements as there are differences in the anatomical dimensions among individuals. High failure rates in tracheal prosthesis are attributed to the lack of mechanical strength and flexibility, slow rate of growth of ciliated epithelium and leakage of interstitial fluid into the lumen. This paper proposes a methodology of design, simulations and fabrication of a patient specific artificial tracheal prosthesis for implantation to closely mimic the biomechanical properties of the natural trachea, and describes the prototype device and its materials. Results show that the patient-specific trachea prosthesis has mechanical properties approximate that of normal tracheal rings. The user centric tracheal prosthesis is demonstrated to be a promising candidate for tracheal replacement.

  3. The Drosophila SRF homolog is expressed in a subset of tracheal cells and maps within a genomic region required for tracheal development.

    Science.gov (United States)

    Affolter, M; Montagne, J; Walldorf, U; Groppe, J; Kloter, U; LaRosa, M; Gehring, W J

    1994-04-01

    The Drosophila homolog of the vertebrate serum response factor (SRF) was isolated by low stringency hybridization. Nucleotide sequence analysis revealed that the Drosophila SRF homolog (DSRF) codes for a protein that displays 93% sequence identity with human SRF in the MADS domain, the region required for DNA binding, dimerization and interaction with accessory factors. The DSRF gene is expressed during several phases of embryonic development. In the egg, both the RNA and the protein are maternal in origin and slowly decrease in amount during gastrulation. After germ band retraction, high levels of zygotic expression are observed in a distinct subset of peripheral tracheal cells distributed throughout the embryo. Many of these cells are at the tip of tracheal branches and are in direct contact with the target tissues. The DSRF gene was mapped to position 60C on the second chromosome, and overlapping deficiencies which remove the gene were identified. Analysis of tracheal development in embryos carrying these deletions revealed a degeneration of most of the major branches of the tracheal system. Although the initial migration of tracheal cells was not affected in those deficient embryos, many tracheal cells appeared not to maintain their correct position and continued to migrate. Thus, the DSRF gene might play a role in the proper formation and maintenance of the trachea.

  4. Biomechanical and biocompatibility characteristics of electrospun polymeric tracheal scaffolds.

    Science.gov (United States)

    Ajalloueian, Fatemeh; Lim, Mei Ling; Lemon, Greg; Haag, Johannes C; Gustafsson, Ylva; Sjöqvist, Sebastian; Beltrán-Rodríguez, Antonio; Del Gaudio, Costantino; Baiguera, Silvia; Bianco, Alessandra; Jungebluth, Philipp; Macchiarini, Paolo

    2014-07-01

    The development of tracheal scaffolds fabricated based on electrospinning technique by applying different ratios of polyethylene terephthalate (PET) and polyurethane (PU) is introduced here. Prior to clinical implantation, evaluations of biomechanical and morphological properties, as well as biocompatibility and cell adhesion verifications are required and extensively performed on each scaffold type. However, the need for bioreactors and large cell numbers may delay the verification process during the early assessment phase. Hence, we investigated the feasibility of performing biocompatibility verification using static instead of dynamic culture. We performed bioreactor seeding on 3-dimensional (3-D) tracheal scaffolds (PET/PU and PET) and correlated the quantitative and qualitative results with 2-dimensional (2-D) sheets seeded under static conditions. We found that an 8-fold reduction for 2-D static seeding density can essentially provide validation on the qualitative and quantitative evaluations for 3-D scaffolds. In vitro studies revealed that there was notably better cell attachment on PET sheets/scaffolds than with the polyblend. However, the in vivo outcomes of cell seeded PET/PU and PET scaffolds in an orthotopic transplantation model in rodents were similar. They showed that both the scaffold types satisfied biocompatibility requirements and integrated well with the adjacent tissue without any observation of necrosis within 30 days of implantation.

  5. Vasoactive intestinal peptide stimulates tracheal submucosal gland secretion in ferret

    Energy Technology Data Exchange (ETDEWEB)

    Peatfield, A.C.; Barnes, P.J.; Bratcher, C.; Nadel, J.A.; Davis, B.

    1983-07-01

    We studied the effect of vasoactive intestinal peptide (VIP) on the output of 35S-labeled macromolecules from ferret tracheal explants either placed in beakers or suspended in modified Ussing chambers. In Ussing chamber experiments, the radiolabel precursor, sodium (35S)sulfate, and all drugs were placed on the submucosal side of the tissue. Washings were collected at 30-min intervals from the luminal side and were dialyzed to remove unbound 35S, leaving radiolabeled macromolecules. Vasoactive intestinal peptide at 3 X 10(-7) M stimulated bound 35S output by a mean of + 252.6% (n . 14). The VIP response was dose-dependent with a near maximal response and a half maximal response at approximately 10(-6) M and 10(-8), M, respectively. The VIP effect was not inhibited by a mixture of tetrodotoxin, atropine, I-propranolol, and phentolamine. Vasoactive intestinal peptide had no effect on the electrical properties of the of the tissues. We conclude that VIP stimulates output of sulfated-macromolecules from ferret tracheal submucosal glands without stimulating ion transport. Our studies also suggest that VIP acts on submucosal glands via specific VIP receptors. Vasoactive intestinal peptide has been shown to increase intracellular levels of cyclic AMP, and we suggest that this may be the mechanism for its effect on the output of macromolecules. This mechanism may be important in the neural regulation of submucosal gland secretion.

  6. Association of tracheal mucus or blood and airway neutrophilia with racing performance in Thoroughbred horses in an Australian racing yard.

    Science.gov (United States)

    Salz, R O; Ahern, B J; Boston, R; Begg, L M

    2016-04-01

    To determine the variation of tracheal mucus scores, tracheal blood scores and transendoscopic tracheal wash (TW) cytology in a population of Thoroughbred (TB) racehorses and assess their association with racing performance. A total of 220 endoscopic examinations were performed and TWs obtained from 155 TB racehorses. Samples were collected 60-120 min following gallop work. Tracheal mucus score, tracheal blood score and TW cytology were analysed and their association with racing performance assessed. Of the total examinations and samples, 194 from 135 horses fitted the criteria for inclusion. The overall prevalence of visible tracheal mucus was 2.5% (5/194) and of increased tracheal mucus was 0%. The prevalence of visible tracheal blood was 8.8% (17/194) and of increased tracheal blood was 4.6% (9/194). A total of 36% (70/194) of TWs contained elevated percentages of neutrophils and of these, 96% (67/70) occurred in the absence of any visible tracheal mucus. There was no significant association between tracheal mucus score or TW cytology and subsequent racing performance. There was a statistically significant association (P = 0.004) between increased tracheal blood scores and poor racing performance. Visible tracheal blood seen after strenuous exercise in clinically normal TB racehorses was a risk factor for poor racing performance, but the presence of airway neutrophilia was not. No horses in this study were found to have increased tracheal mucus, so the association of increased tracheal mucus with racing performance could not be assessed. © 2016 Australian Veterinary Association.

  7. Pneumomediastinum, pneumothorax and pneumoretroperitoneum following endoscopic retrieval of a tracheal foreign body from a cat : clinical communication

    Directory of Open Access Journals (Sweden)

    A.B. Zambelli

    2006-06-01

    Full Text Available 6-year-old entire male cat was presented with a 1-week history of severe dyspnoea without coughing. Upon auscultation, an inspiratory and particularly pronounced expiratory wheeze was noted, with severe dyspnoea. The minimum database was normal. Plain thoracic radiographs showed signs of a mural or intraluminal intrathoracic (1-T4 tracheal narrowing. A dynamic collapsing trachea was ruled out using fluoroscopy. Bronchoscopy was performed and a dark green and brown spiculated foreign object was found just cranial to the carina. Following removal, the cat rapidly developed extensive truncal subcutaneous emphysema and oxygen-responsive dyspnoea and cyanosis. Follow-up radiographs demonstrated unilateral pneumothorax and lung collapse, marked pneumomediastinum and dissection of air through the tracheal wall. A thoracic drain was placed and the pneumothorax resolved rapidly. Follow-up radiographs demonstrated resolution of pneumothorax and development of extensive retroperitoneal air. The cat made an uneventful recovery. The foreign object was the calyx and stem of a flower. This article emphasises the importance of diagnostic imaging in the dyspnoeic patient, both for confirming initial suspicions of respiratory tract disease, and in managing and charting post-therapy resolution or complications.

  8. Advances in diagnosis of tracheal and bronchial diverticulum%气管支气管憩室的诊断进展

    Institute of Scientific and Technical Information of China (English)

    谢冬; 姜格宁; 徐志飞

    2012-01-01

    Tracheal and bronchial diverticulum is a rare benign entity,characterized by round or spherical outpouchings of the tracheal and bronchial wall. Tracheal diverticulum is commonly seen on right side,containing air or fluids.The development of new techniques such as thin-layer CT and multidetector computed tomography have led increasingly reports of incidental findings of this entity. This paper reviews the classification,diagnosis and therapy of this entity.%气管支气管憩室是一种少见的良性气管疾病,气管憩室多数位于胸廓入口处气管右后侧,表现为圆形或卵圆形囊泡,内含气体或液体.近年来,随着薄层CT及多层螺旋CT的应用,气管支气管憩室的报道日趋增多,该文综述了气管支气管憩室分类及诊断治疗进展.

  9. Pest status and incidence of the honey bee tracheal mite in Finland

    Directory of Open Access Journals (Sweden)

    S. KORPELA

    2008-12-01

    Full Text Available Colonies of honey bees (Apis mellifera L. were surveyed for the presence of the honey bee tracheal mite (Acarapis woodi Rennie in Finland between 1991 and 1997. Colony background information and winter loss data were obtained from beekeepers who had taken tracheal mite infested samples. A total of 2116 samples from honey bee colonies of 402 beekeepers were investigated. Infestations were found in 8% of the beekeeping operations and in 10% of the samples inspected. In the last years of the survey more than 20% of apiaries were infested. This increase may be partly explained by tracheal mite infestations found in commercial queen-rearing apiaries. A field experiment with colonies infested at different levels showed that colonies in which 20% or more of bees are infested with tracheal mites have an increased risk of dying during the winter under Finnish conditions. This infestation level was found among colonies in 92% of the infested apiaries. Comparison of the tracheal mite prevalence in apiaries with their winter losses indicated that infestations were associated with colony mortality. The results of this survey point to the high pest potential of the tracheal mite in Finland, in contrast to findings on tracheal mites from elsewhere in Europe. Therefore, strategies to prevent further spread of the mite are highly recommended and methods for effective control should be sought.;

  10. Tracheal CT morphology: correlation with distribution and extent of thoracic adipose tissue

    Energy Technology Data Exchange (ETDEWEB)

    Ap Dafydd, Derfel [Imperial College Healthcare NHS Trust, Department of Radiology, Charing Cross Hospital, London (United Kingdom); Desai, Sujal R. [King' s College Hospital NHS Foundation Trust, King' s College London, King' s Health Partners, London (United Kingdom); Gordon, Fabiana; Copley, Susan J. [Imperial College, London (United Kingdom)

    2016-10-15

    To evaluate the relationship between adipose tissue measurements and anterior bowing of the posterior tracheal wall in a large nonselected group of patients undergoing CT pulmonary angiography (CTPA). Consecutive patients undergoing CTPA over a 4-month period were analyzed retrospectively. Using an adapted scoring system (posterior bowing, flattening, mild/moderate or severe anterior bowing of the posterior tracheal membrane), the axial morphology and cross-sectional area of the trachea at the narrowest point and 1 cm above the aortic arch were evaluated. Measurements of adipose tissue were taken (anterior mediastinal fat width, sagittal upper abdominal diameter and subcutaneous fat thickness at the level of the costophrenic angle). Relationships between tracheal morphology and measurements of adipose tissue were analyzed. 296 patients were included (120 males, 176 females, mean age 59 years, range 19-90). Severe anterior bowing of the posterior tracheal wall correlated with increasing sagittal upper abdominal diameter (p = 0.002). Mild/moderate and severe anterior bowing of the posterior tracheal wall correlated with increasing mediastinal fat width (p = 0.000 and p = 0.031, respectively). Tracheal cross-sectional area was inversely correlated with increasing subcutaneous fat thickness (p = 0.022). The findings demonstrate a statistically significant relationship between CT tracheal morphology and adipose tissue measurements in a large nonselected population. (orig.)

  11. Tracheal rupture caused by blunt chest trauma: radiological and clinical features

    Energy Technology Data Exchange (ETDEWEB)

    Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S. [Dept. of Diagnostic Radiology, Justus Liebig Univ., Giessen (Germany); Hoppe, M. [Dept. of Diagnostic Radiology, University Hospital, Philipps University, Marburg (Germany); Popella, C. [Dept. of ENT, Justus Liebig University, Giessen (Germany)

    2000-03-01

    The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

  12. Cell autonomy of HIF effects in Drosophila: tracheal cells sense hypoxia and induce terminal branch sprouting.

    Science.gov (United States)

    Centanin, Lázaro; Dekanty, Andrés; Romero, Nuria; Irisarri, Maximiliano; Gorr, Thomas A; Wappner, Pablo

    2008-04-01

    Drosophila tracheal terminal branches are plastic and have the capacity to sprout out projections toward oxygen-starved areas, in a process analogous to mammalian angiogenesis. This response involves the upregulation of FGF/Branchless in hypoxic tissues, which binds its receptor Breathless on tracheal cells. Here, we show that extra sprouting depends on the Hypoxia-Inducible Factor (HIF)-alpha homolog Sima and on the HIF-prolyl hydroxylase Fatiga that operates as an oxygen sensor. In mild hypoxia, Sima accumulates in tracheal cells, where it induces breathless, and this induction is sufficient to provoke tracheal extra sprouting. In nontracheal cells, Sima contributes to branchless induction, whereas overexpression of Sima fails to attract terminal branch outgrowth, suggesting that HIF-independent components are also required for full induction of the ligand. We propose that the autonomous response to hypoxia that occurs in tracheal cells enhances tracheal sensitivity to increasing Branchless levels, and that this mechanism is a cardinal step in hypoxia-dependent tracheal sprouting.

  13. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

    Directory of Open Access Journals (Sweden)

    Payal Kajekar

    2014-01-01

    Full Text Available Background and Aims: Pentax airway scope (AWS has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade, total dose of local anaesthetic used, anaesthetists rating and patient′s tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%. The mean (standard deviation intubation time and total time to complete the tracheal intubation was 5.4 (2.4 and 13.9 (3.7 min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS. Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.

  14. Effects of ozone on lamb tracheal mucosa. Quantitative glycoconjugate histochemistry

    Energy Technology Data Exchange (ETDEWEB)

    Mariassy, A.T.; Sielczak, M.W.; McCray, M.N.; Abraham, W.M.; Wanner, A. (Univ. of Miami, Miami Beach, FL (USA))

    1989-11-01

    Whether or not the previously reported O3-induced abnormality in the postnatal development of tracheal secretory function in lambs is accompanied by changes in epithelial cell populations and their glycoconjugate composition was determined. Six lambs were killed at birth and 12 lambs at age 2 weeks. Of the latter 12, six were exposed to O3 (1 ppm, 4 hours daily for 5 days during the 1st week of life) and five had air-sham exposures (controls). Tracheal glycoconjugates were localized in situ with lectins to detect N-acetyl-galactosamine (galNAc), alpha-D-galactose (alpha-gal), beta-D-gal(1----3)-galNAc (beta-gal), and fucose (fuc). Mean (+/- SD) epithelial cell density (cells/mm basal lamina) was 418 +/- 57 in the newborns, 385 +/- 63 in controls (P was not significant), and 342 +/- 47 in O3-exposed lambs (P less than 0.05). Mucous cell density was 87 +/- 12 in newborns, 63 +/- 10 in controls (P less than 0.05), and 76 +/- 10 in O3 exposed lambs (P was not significant). Ciliated cells remained unchanged from birth to 2 weeks (P was not significant), but decreased (P less than 0.05) in O3-exposed lambs. All counted mucous cells contained fuc and galNAc at birth and retained these residues after sham and O3 exposure. The alpha-gal-containing mucous cells declined from 97 +/- 13 to 7 +/- 1 (P less than 0.05) and beta-gal containing cells from 39 +/- 5 to 25 +/- 4 in controls. In contrast, cells containing alpha-gal 71 +/- 10 remained at newborn levels (97 +/- 13) and beta-gal-containing cells increased from 40 +/- 5 at birth to 58 +/- 8 in O3-exposed animals (P less than 0.05). It was concluded that early postnatal exposure of lambs to O3 causes a decrease in epithelial cell density, but retards the developmental decrease in the number of tracheal mucous cells and alters the lectin detectable carbohydrate composition of mucus in these cells.

  15. Anesthetic management of a large mediastinal mass for tracheal stent placement

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    Suman Rajagopalan

    2016-04-01

    Full Text Available ABSTRACT The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

  16. [Tracheal phospholipid composition and respiratory distress syndrome of the newborn].

    Science.gov (United States)

    Obladen, M

    1979-03-01

    Tracheal or pharyngeal aspirates were collected in 50 newborn infants with and without respiratory distress syndrome (RDS). After lipid extraction the phospholipids were analyzed with 2-dimensional thin layer chromatography. Surface-active are lecithin (PC), phosphatidylglycerol (PG), and phosphatidylinositol (PI). Newborn infants with RDS always have a complete lack of PG, which makes up to 11% of phospholipid-phosphors in mature newborns. In all infants with and without RDS, a sharp increase of PC occurs in the lung effluent after birth. The recovery from RDS is characterized by marked changes of PI: this phospholipid rises up to twice its initial value if the infants survive. The PI-increase parallels the clinical improvement and reaches its maximum usually on the 5th day of life. At the time of the PI-peak, the infants' surfactant function is sufficient to maintain alveolar stability with spontaneous breathing. In infants dying from RDS the PI-increase was not observed.

  17. Evolutional trends in the management of tracheal and bronchial injuries

    Science.gov (United States)

    2017-01-01

    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. PMID:28203439

  18. Endoscopic laser treatment of subglottic and tracheal stenosis

    Science.gov (United States)

    Correa, Alex J.; Garrett, C. Gaelyn; Reinisch, Lou

    1999-06-01

    The ideal laser produces discrete wounds in a reproducible manner. The CO2 laser with its 10.6 micron wavelength is highly absorbed by water, its energy concentrated at the point of impact and the longer wavelength creates less scatter in tissue. The development of binocular endoscopic delivery system for use with binocular microlaryngoscopes have aided in using CO2 laser to treat patients with subglottic and tracheal stenosis. Often, patients with these disease processes require multiple endoscopic or open reconstructive procedures and my ultimately become tracheotomy dependent. The canine model of subglottic stenosis that has been develop allows testing of new agents as adjuncts to laser treatment. Mitomycin-C is an antibiotic with antitumor activity used in chemotherapy and also in ophthalmologic surgery due to its known inhibition of fibroblast proliferation. Current studies indicate this drug to have significant potential for improving our current management of this disease process.

  19. Failure to predict difficult tracheal intubation for emergency caesarean section.

    Science.gov (United States)

    Basaranoglu, Gokcen; Columb, Malachy; Lyons, Gordon

    2010-11-01

    Difficult tracheal intubation following induction of general anaesthesia for caesarean section is a cause of morbidity and mortality. Our aim was to evaluate five bedside predictors that might identify women with potential intubation difficulty immediately prior to emergency caesarean section. Women requiring emergency caesarean section with general anaesthesia and tracheal intubation who had been assessed by the same experienced anaesthesiologist preoperatively were included in this study. Mallampati score, sternomental distance, thyromental distance, interincisor gap and atlantooccipital extension were all measured. The same anaesthesiologist performed laryngoscopy and graded the laryngeal view according to Cormack and Lehane. Exact logistic regression was used to identify significant independent predictors for difficult intubation (Cormack and Lehane grades ≥ 3) with two-sided P value less than 0.05 considered as significant. In 3 years, 239 women were recruited. Cormack and Lehane grades of 2 or less (easy) were found in 225 and grade of at least 3 (difficult) in 14 women. Patients' characteristics (age, height, weight, BMI or weight gain) were not significantly associated with difficulty of intubation. The incidence of difficult intubation was 1/17 women [95% confidence interval (CI) from 1/31 to 1/10]. A positive result from any of the five predictors combined had a sensitivity of 0.21 (95%CI 0.05-0.51), a specificity of 0.92 (95%CI 0.88-0.96), a positive predictive value of 0.15 (95%CI 0.032-0.38) and a negative predictive value of 0.95 (95%CI 0.91-0.97) for a Cormack and Lehane grade of at least 3 at laryngoscopy. Airway assessment using these tests cannot be relied upon to predict a difficult intubation at emergency caesarean section as the low sensitivity means that 79% (95%CI 49-95) of difficult intubations will be missed.

  20. A grossly abnormal trachea- severe tracheal diverticulosis and Mounier-Kuhn syndrome.

    Science.gov (United States)

    Lyons, O D; Gilmartin, J J

    2014-03-01

    A 53-year-old smoker presented with a history of recurrent lower respiratory tract infections. A diagnosis of Tracheal Diverticulosis due to Tracheobronchomegaly (Mounier-Kuhn Syndrome) was made. The clinical history, diagnosis and treatment options are discussed.

  1. A case of Toriello-Carey syndrome with severe congenital tracheal stenosis.

    Science.gov (United States)

    Yokoo, Noritaka; Marumo, Chieko; Nishida, Yoshinobu; Iio, Jun; Maeda, Shinji; Nonaka, Michiko; Maihara, Toshiro; Chujoh, Satoru; Katayama, Tetsuo; Sakazaki, Hisanori; Matsumoto, Naomichi; Okamoto, Nobuhiko

    2013-09-01

    Toriello-Carey syndrome is rare condition characterized by agenesis of the corpus callosum, the Pierre Robin sequence, and facial anomalies such as telecanthus, short palpebral fissures, and a small nose with anteverted nares [Toriello and Carey, 1988]. In addition, tracheal and laryngeal anomalies are common complications in patients with Toriello-Carey syndrome, and these anomalies can lead to death [Kataoka et al., 2003]. Congenital tracheal stenosis is a life-threatening condition with high mortality. Even if surgery is successful, several serious complications can result in a high risk of mortality. We describe a case of a Japanese boy with Toriello-Carey syndrome who had severe congenital tracheal stenosis, in whom surgical tracheal plasty was avoided because of adequate respiratory care, allowing the patient to be alive at 18 months of age. Copyright © 2013 Wiley Periodicals, Inc.

  2. Paclitaxel Drug-eluting Tracheal Stent Could Reduce Granulation Tissue Formation in a Canine Model

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    Ting Wang

    2016-01-01

    Conclusions: The paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo, suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.

  3. Effect of Montelukast on bradykinin-induced contraction of isolated tracheal smooth muscle of guinea pig

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    A Noor

    2011-01-01

    Conclusion: It is concluded that montelukast significantly inhibits, in a dose-dependent manner, the bradykinin-induced contraction of the guinea pig tracheal smooth muscle, and alludes to an interaction between the bradykinin and leukotriene mediators.

  4. Surgical treatment of postintubation tracheal stenosis: Iranian experience of effect of previous tracheostomy

    Directory of Open Access Journals (Sweden)

    Hashemzadeh S

    2012-01-01

    Full Text Available Shahryar Hashemzadeh1, Khosrow Hashemzadeh2, Farzad Kakaei3, Raheleh Aligholipour4, Kamyar Ghabili51Tuberculosis and Lung Disease Research Center, 2Department of Cardiovascular Surgery, Shahid Madani Hospital, 3Department of General Surgery, 4Students Research Committee, 5Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Postintubation tracheal stenosis remains the most common indication for tracheal surgery. In the event of a rapid and progressive course of the disease after extubation, surgical approaches such as primary resection and anastomosis or various methods of tracheoplasty should be selected. We report our experience with surgical management of moderate to severe postintubation tracheal stenosis. We also compared intraoperative variables in postintubation tracheal stenosis between those with and without previous tracheostomy.Methods: Over a 5-year period from June 2005 to July 2010, 50 patients aged 14–64 years with moderate (50%–70% of the lumen to severe (>70% postintubation tracheal stenosis underwent resection and primary anastomosis. Patients were followed up to assess the surgical outcome. To study the effect of previous tracheostomy on treatment, surgical variables were compared between patients with previous tracheostomy (group A, n = 27 and those without previous tracheostomy (group B, n = 23.Results: Resection and primary anastomosis was performed via either cervical incision (45 patients or right thoracotomy (five patients. In two patients with subglottic stenosis, complete resection of the tracheal lesion and anterior portion of cricoid cartilage was performed, and the remaining trachea was anastomosed to the thyroid cartilage using a Montgomery T-tube. There was only one perioperative death in a patient with a tracheo-innominate fistula. The length of the resected segment, number of resected rings, and subsequent duration of surgery were significantly

  5. Hangman fracture combined with tracheal injury:a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    GAO Meng-liang; LIU Xue-peng; ZHANG Yin-feng; SUN Hai-yan; WANG Qian-jun; SONG Yuan-jin; SUN Jia-shu; HAO Qi-quan; WANG Ying-sheng; CHU Chao; SUN Shu-fa

    2013-01-01

    Objective To investigate the morbidity, clinical characteristics and treatment experience of Hangman fracture combined with tracheal injury and to discuss the classiifcation, degrees, injury mechanism, clinical manifestations, accessory examination and treatment experience of tracheal injury, so as to improve clinicians’ understanding of the disease. Methods The clinical data of 1 case of Hangman fracture combined with tracheal injury were reported.“Hangman fracture, tracheal injury and cervical spine fracture”were taken as the keywords to search for documents in the databases such as china national knowledge internet ( CNKI ) Database, Wanfang Theses and Dissertations Database, VIP Full-Text Database, Pubmed Database and so on, and then these documents were reviewed. Results At present, similar reports about the cases of Hangman fracture combined with tracheal injury had not been found at home and abroad. However, there were a large number of literature reviews about tracheal injury, and 26 articles in all. The classiifcation, degrees, injury mechanism, clinical manifestations and treatment experience of tracheal injury were mainly reported. The patient was followed up for 6 months after he left our hospital. Bone union was achieved, and his trachea was healed perfectly, without wheeze or choking sensation in chest. He was still followed up. Conclusions Hangman fracture combined with tracheal injury is very rare, and no reports have been found until now. Great attention should be paid to the patient with Hangman fracture who has lacerations of skin in the underjaw and parietal region, with serious swelling in the anterior and posterior neck, skin satiety in the anterior neck, subcutaneous ecchymoma and sense of snow grip. It should be checked carefully if there is tracheal injury. Tracheal injury can be mainly divided into 3 categories and 5 degrees. There are 3 dominant theories about the injury mechanism. Clinical manifestations mainly include skin

  6. Pest status and incidence of the honey bee tracheal mite in Finland

    OpenAIRE

    Korpela, S.

    2008-01-01

    Colonies of honey bees (Apis mellifera L.) were surveyed for the presence of the honey bee tracheal mite (Acarapis woodi Rennie) in Finland between 1991 and 1997. Colony background information and winter loss data were obtained from beekeepers who had taken tracheal mite infested samples. A total of 2116 samples from honey bee colonies of 402 beekeepers were investigated. Infestations were found in 8% of the beekeeping operations and in 10% of the samples inspected. In the last years of the s...

  7. Thermal model for curing implantable silicone in the moulding process applied to tracheal stents

    OpenAIRE

    Freitas, Matheus S.; Serenó, Lídia; Silveira, Zilda C.; da Silva, Jorge Vicente Lopes; Ciurana, Quim de

    2015-01-01

    Tracheal stents are a kind of endoprosthesis used to prevent tracheal obstruction due to different illnesses or disorders. Stent design has to fulfil several requirements such as the prevention of migration, easy removal if needed and radiopacity allowance. Although some commercial solutions can be found on the market, there is a constant demand for new designs in order to obtain more anatomical geometries and customized solutions. This study shows a numerical model developed to predict appro...

  8. Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air and Saline Filled Cuffs

    Science.gov (United States)

    2017-01-31

    AFRL-SA-WP-SR-2017-0004 Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air - and Saline-Filled... Air Force Research Laboratory 711th Human Performance Wing U.S. Air Force School of Aerospace Medicine Aeromedical Research Department 2510 Fifth...Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air - and Saline-Filled Cuffs 5a. CONTRACT NUMBER FA8650-14

  9. Airtraq® versus Macintosh laryngoscope: A comparative study in tracheal intubation

    Science.gov (United States)

    Bhandari, Geeta; Shahi, K. S.; Asad, Mohammad; Bhakuni, Rajani

    2013-01-01

    Background: The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation. Materials and Methods: Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups. Results: We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001. Conclusion: Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant. PMID:25885839

  10. Securing the airway in a child with tracheal agenesis – an alternative perspective

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    Slavomir Nosal

    2011-03-01

    Full Text Available Tracheal agenesis is an extremely rare, typically fatal congenital anomaly characterised by typical clinical manifestation, failed endotracheal intubation and difficult emergency management. The prognosis and possibility of surgical correction rest on early diagnosis, anatomy, birth weight, and associated anomalies. Tracheal agenesis causes considerable resuscitation difficulties immediately after birth, as tracheal intubation is impossible. Although emergency management, by either bag and mask ventilation or oesophageal intubation, provides some pulmonary gas exchange through tracheo-oesophageal connection, they are associated with overdistension of the stomach and the risk of stomach perforation. We have performed selective intubation of the distal trachea in a child with tracheal agenesis through the tracheo-oesophageal connection with the help of a fibroendoscope. A standard guide wire was passed through the working port of the flexible endoscope and under direct vision was directed through the tracheo-oesophageal connection into the distal trachea. At this point, the endoscope was removed, leaving the guide wire in place. The endotracheal tube size 2 Fr was passed over the guide wire into the distal trachea. The infant showed dramatic improvement and maintained good saturations on mechanical ventilation. The infant was taken for a computed tomography (CT scan, which showed Floyd’s type II tracheal agenesis, the oesophagus connecting with the distal trachea before it bifurcates. The endotracheal tube was seen ending in the carina. Transoesophageal intubation of the short distal segment of the trachea through the tracheo-oesophageal connection might offer a new perspective for short-term securing of the airway in a child with tracheal agenesis and should be considered in any child with suspected tracheal agenesis to buy the time while evaluating the exact anatomy of the anomaly and the possibility of tracheal reconstruction in selected

  11. Prediction of the mid-tracheal level using surface anatomical landmarks in adults

    Science.gov (United States)

    Jang, Young-Eun; Kim, Eun-Hee; Song, In-Kyung; Lee, Ji-Hyun; Ryu, Ho-Geoul; Kim, Hee-Soo; Kim, Jin-Tae

    2017-01-01

    Abstract Endotracheal tube (ETT) should be placed at the optimal level to avoid single lung ventilation or accidental extubation. This study was performed to estimate the mid-tracheal level by using surface anatomical landmarks in adult patients. Neck computed tomography images of 329 adult patients between the ages of 16 and 79 years were reviewed. In the midline sagittal plane, the levels corresponding to the vocal cords, cricoid cartilage, suprasternal notch, manubriosternal junction, and carina were identified. The surface distances from the cricoid cartilage to the suprasternal notch (extCC-SSN) and that from the suprasternal notch to the manubriosternal junction (extSSN-MSJ) were measured. The relationship between mid-tracheal level and the surface distances was analyzed using Bland–Altman plot. The difference between the extCC-SSN and the mid-tracheal level was −6.6 (12.5) mm, and the difference between the extSSN-MSJ and the mid-tracheal level was −19.2 (6.1) mm. The difference between the extCC-SSN and the mid-tracheal level was smaller in females compared with males [−1.7 (11.7) mm vs −12.8 (10.7) mm; P < 0.001]. The mid-tracheal level, which is helpful in planning the insertion depth of an ETT, can be predicted by the surface distance between the cricoid cartilage and suprasternal notch in adults, especially in females. PMID:28328810

  12. Fascin links Btl/FGFR signalling to the actin cytoskeleton during Drosophila tracheal morphogenesis.

    Science.gov (United States)

    Okenve-Ramos, Pilar; Llimargas, Marta

    2014-02-01

    A key challenge in normal development and in disease is to elucidate the mechanisms of cell migration. Here we approach this question using the tracheal system of Drosophila as a model. Tracheal cell migration requires the Breathless/FGFR pathway; however, how the pathway induces migration remains poorly understood. We find that the Breathless pathway upregulates singed at the tip of tracheal branches, and that this regulation is functionally relevant. singed encodes Drosophila Fascin, which belongs to a conserved family of actin-bundling proteins involved in cancer progression and metastasis upon misregulation. We show that singed is required for filopodia stiffness and proper morphology of tracheal tip cells, defects that correlate with an abnormal actin organisation. We propose that singed-regulated filopodia and cell fronts are required for timely and guided branch migration and for terminal branching and branch fusion. We find that singed requirements rely on its actin-bundling activity controlled by phosphorylation, and that active Singed can promote tip cell features. Furthermore, we find that singed acts in concert with forked, another actin cross-linker. The absence of both cross-linkers further stresses the relevance of tip cell morphology and filopodia for tracheal development. In summary, our results on the one hand reveal a previously undescribed role for forked in the organisation of transient actin structures such as filopodia, and on the other hand identify singed as a new target of Breathless signal, establishing a link between guidance cues, the actin cytoskeleton and tracheal morphogenesis.

  13. The Recovery Process of Murine Tracheal Epithelium Injured by 5-FU and Its Microarray Analysis

    Directory of Open Access Journals (Sweden)

    Jingru ZHANG

    2009-02-01

    Full Text Available Background and objective Although there are increasing reports on localization of tracheal stem cells, the mechanism of proliferation and differentiation of tracheal stem cells remains unclear. Methods In this study, we developed an ex vivo model of murine tracheal epithelial injury and regeneration induced by 5-FU. The regenerationprocess of murine tracheal epithelium was observed and analyzed by morphological, immunofluorescence and microarray methods. Results After treatment with 5-FU, the differentiated mature cells were dead and desquamated. Only a few cells remained in G0 phase and located on the basement membrane. After being put back in normal culture media, the cells became flat, cubic and restored as pseudostratified epithelium at last. These G0 phase cells were ABCG2 positive. We detected the differences of stem cell genes between normal tracheal epithelial cells and regenerated epithelial cells at 24 h and 48 h after injured by 5-FU using stem cell differentiation gene microarray. At 24 h, 8 genes were up-regulated and 31 genes were down-regulated. At 48 h, 5 genes were up-regulated and 42 genes were down-regulated. Conclusion The differently expressed genes were mainly associated with cell cycle regulation, intercellular junction, FGF, BMP, Notch and Wnt signaling pathways, which suggested these alterations might be closely associated with the proliferation and differentiation of tracheal stem cells.

  14. Possible mechanism(s) for relaxant effects of Foeniculum vulgare on guinea pig tracheal chains.

    Science.gov (United States)

    Boskabady, M H; Khatami, A; Nazari, A

    2004-07-01

    In a previous study the relaxant (bronchodilatory) effect of Foeniculum vulgare on isolated guinea pig tracheal chains was demonstrated. To study mechanisms responsible for this effect the present study evaluated the inhibitory effect of this plant on contracted tracheal chains of guinea pig. The relaxant effects of aqueous and ethanol extracts and an essential oil from Foeniculum vulgare were compared to negative controls (saline for aqueous extract and essential oil and ethanol for ethanol extract) and a positive control (diltiazem) using isolated tracheal chains of the guinea pig precontracted by 10 microM methacholine (group 1) and 60 mM KCl (group 2, n = 7 for each group). In the group 1, experiments diltiazem, ethanol extract, and essential oil from Foeniculum vulgare showed a significant relaxant effect on methacholine induced contraction of tracheal chains compared to those of negative controls (p Foeniculum vulgare. However with regard to the effect of KCl on calcium channels, the results indicated that the inhibitory effect of ethanol extracts and essential oil from Foeniculum vulgare on calcium channels is not contributing to their relaxant (bronchodilatory) effects on guinea pig tracheal chains. However the results suggest a potassium channel opening effect for this plant, which may contribute on its relaxant effect on guinea pig tracheal chains.

  15. Idiopathic tracheal stenosis: a clinicopathologic study of 63 cases and comparison of the pathology with chondromalacia.

    Science.gov (United States)

    Mark, Eugene J; Meng, Fanqing; Kradin, Richard L; Mathisen, Douglas J; Matsubara, Osamu

    2008-08-01

    Tracheal stenosis in adults usually is the result of mechanical injuries either from direct trauma or intubation. Rarely do cases develop in patients without such a precedent history, and there are few reports of the pathology of idiopathic tracheal stenosis (ITS). We reviewed clinicopathologically, 63 tracheal resections for tracheal stenosis in patients who had no antecedent explanation for their stenosis. We contrasted these 63 cases with 34 cases of tracheal stenosis owing to chondromalacia (CM) after mechanical injury. All 63 cases occurred in females, with a mean age of 49 years. The most common symptom was dyspnea on exertion. The average duration of symptoms was greater than 2 years. One-third of the patients gave a history of gastroesophageal reflux. All but one of the cases occurred in the subglottic region and/or upper one-third of the trachea. Pathologically, most cases showed extensive keloidal fibrosis and dilation of mucus glands, a finding that was not obvious in most cases of CM. ITS has relatively normal cartilage with smooth inner and outer perichondrium, whereas CM has extensive degeneration of cartilage with irregular border of inner perichondrium observable at shirt sleeve magnification. Immunohistochemical staining for estrogen receptor and progesterone receptor was positive in fibroblasts cells in most cases. ITS is a rare disease and restricted to females. It may represent some form of fibromatosis. ITS can be distinguished histologically from CM in tracheal resection specimens in most cases.

  16. Mechanical properties of tracheal tubes in the American cockroach (Periplaneta americana)

    Science.gov (United States)

    Webster, Matthew R.; De Vita, Raffaella; Twigg, Jeffrey N.; Socha, John J.

    2011-09-01

    Insects breathe using an extensive network of flexible air-filled tubes. In some species, the rapid collapse and reinflation of these tubes is used to drive convective airflow, a system that may have bio-inspired engineering applications. The mechanical behavior of these tracheal tubes is critical to understanding how they function in this deformation process. Here, we performed quasi-static tensile tests on ring sections of the main thoracic tracheal trunks from the American cockroach (Periplaneta americana) to determine the tracheal mechanical properties in the radial direction. The experimental findings indicate that the stress-strain relationships of these tracheal tubes exhibit some nonlinearities. The elastic modulus of the linear region of the stress-strain curves tubes was found to be 1660 ± 512 MPa. The ultimate tensile strength, ultimate strain and toughness were found to be 23.7 ± 7.33 MPa, 2.0 ± 0.7% and 0.207 ± 0.153 MJ m-3, respectively. This study is the first experimental quantification of insect tracheal tissue, and represents a necessary step toward understanding the mechanical role of tracheal tubes in insect respiration.

  17. An Apical-Membrane Chloride Channel in Human Tracheal Epithelium

    Science.gov (United States)

    Welsh, Michael J.

    1986-06-01

    The mechanism of chloride transport by airway epithelia has been of substantial interest because airway and sweat gland-duct epithelia are chloride-impermeable in cystic fibrosis. The decreased chloride permeability prevents normal secretion by the airway epithelium, thereby interfering with mucociliary clearance and contributing to the morbidity and mortality of the disease. Because chloride secretion depends on and is regulated by chloride conductance in the apical cell membrane, the patch-clamp technique was used to directly examine single-channel currents in primary cultures of human tracheal epithelium. The cells contained an anion-selective channel that was not strongly voltage-gated or regulated by calcium in cell-free patches. The channel was also blocked by analogs of carboxylic acid that decrease apical chloride conductance in intact epithelia. When attached to the cell, the channel was activated by isoproterenol, although the channel was also observed to open spontaneously. However, in some cases, the channel was only observed after the patch was excised from the cell. These results suggest that this channel is responsible for the apical chloride conductance in airway epithelia.

  18. Characterization of a biologically derived rabbit tracheal scaffold.

    Science.gov (United States)

    Lange, P; Shah, H; Birchall, M; Sibbons, P; Ansari, T

    2016-07-15

    There is a clinical need to provide replacement tracheal tissue for the pediatric population affected by congenital defects, as current surgical solutions are not universally applicable. A potential solution is to use tissue engineered scaffold as the framework for regenerating autologous tissue. Rabbit trachea were used and different detergents (Triton x-100 and sodium deoxycholate) and enzymes (DNAse/RNAse) investigated to create a decellularization protocol. Each reagent was initially tested individually and the outcome used to design a combined protocol. At each stage the resultant scaffold was assessed histologically, molecularly for acellularity and matrix preservation. Immunogenicity of the final scaffold was assessed by implantation into a rat model for 4 weeks. Both enzymes and detergents were required to produce a completely acellular (DNA content 42.78 ng/mg) scaffold with preserved collagen and elastin however, GAG content were reduced (8.78 ± 1.35 vs. 5.5 ± 4.8). Following in vivo implantation the scaffold elicited minimal immune response and showed significant cellular infiltration and vasculogenesis. The luminal aspect of the implanted scaffold showed infiltration of host derived cells, which were positive for pan cytokeratin. It is possible to create biologically derived biocompatible scaffolds to address specific pediatric clinical problems. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2016.

  19. Tracheal ulcer due to Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly.

    Science.gov (United States)

    Ito, Takeo; Fujisaki, Hideaki; Nishio, Suehiro; Hiroshige, Shigeo; Miyazaki, Eishi; Kadota, Jun-ichi

    2014-03-01

    A 74-year-old man was referred to our hospital because of a tracheal stenosis circumscribed with soft tissue density and a left pulmonary nodule. Open biopsy of a right submandibular lymph node revealed diffuse large B-cell lymphoma, and the malignant cells were positive for Epstein-Barr virus gene products. Bronchofiberscopy revealed a tracheal necrotizing ulcer. After chemotherapy, the tracheal ulcer resolved. To our knowledge, this is the first report of a case of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly with a tracheal ulcer.

  20. Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet.

    Science.gov (United States)

    Warner, Matthew A; Fox, Jonathan F

    2016-02-15

    Tracheal wall disruption is a rare complication of endotracheal intubation, typically occurring in the posterior (membranous) trachea lacking cartilaginous support. We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation.

  1. Airway management using laryngeal mask airway in insertion of the Montgomery tracheal tube for subglottic stenosis -A case report-.

    Science.gov (United States)

    Park, Jung Sun; Kwon, Young-Suk; Lee, Sangseock; Yon, Jun Heum; Kim, Dong Won

    2010-12-01

    The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.

  2. Tracheal reconstruction by re-inforced Gore-Tex in esophageal submuscular tunneling: An experimental study

    Directory of Open Access Journals (Sweden)

    Hodjati Hossein

    2011-01-01

    Full Text Available Background: Tracheal reconstructions are aimed at rearranging or replacing parts of the tracheal tissue by different techniques. Here we introduce a new technique for tracheal reconstruction. Methods: In 10 adult dogs, after intubation with an endotracheal tube, a segment of trachea including seven tracheal rings was resected circumferentially. A submuscular tunnel was induced between mucosal and muscular layers of the adjacent esophagus lying right next to the trachea. The esophageal submuscular tunnel starts and ends exactly at the level of distal and proximal ends of tracheal resection, respectively. Inforced Gore-Tex passed through the esophageal submuscular tunnel the distal segment of trachea and end-to-end anastomosis were made between distal ends of Gore-Tex and trachea, then endotracheal tube removed and the same procedure was made for proximal ends of Gore-Tex and trachea. Afterward, the proximal and distal ends of the esophageal tunnel were approximated to proximal and distal tracheal parts over the anastomosis. Results: All dogs, except one due to anesthetic problem, survived and tolerated the operation; the first two dogs experienced postoperative fever, aspiration pneumonia, and died due to tracheoesophageal fistula. All survived animals were eating and barking well. We started to scarify dogs at least 6 and 12 weeks after operation for microscopy and pathologic examination. The Gore-Texes were patent and supported externally with fibrous connective tissue in esophageal tunneling, with in growth of respiratory epithelium on inner surfaces. Conclusion: Air tightness, good re-epithelialization, and relatively no limitation of esophageal length and no risk of luminal collapse are advantages of tracheal reconstruction by submuscular esophageal tunneling. This new method is worthy of further investigation, as it is technically feasible and easy to implement.

  3. Effect of three interventional bronchoscopic methods on tracheal stenosis and the formation of granulation tissues in dogs

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jie; WANG Ting; WANG Juan; PEI Ying-hua; XU Min; WANG Yu-ling; ZHANG Xia; WANG Chen

    2010-01-01

    Background Therapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation (APC), cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue. Methods Twelve specially bred research mongrel dogs were divided into three groups. In group 1 (four dogs) mild (procedure 1; two dogs) or moderate (procedure 2; two dogs) damage was induced mechanically. Group 2 (six dogs) received APC at different powers or durations (procedure 3:30 W, 1 amis; procedure 4:30 W, 2 cm/s; procedure 5:25 W, 3 cm/s). Group 3 (two dogs) received cryotherapy (procedure 6: two freeze-thaw cycles of 30 seconds). Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed. Results In group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4. Conclusions Lesions and stimuli from a foreign body (the stent) are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe

  4. Field isolates of Mycoplasma ovipneumoniae exhibit distinct cytopathic effects in ovine tracheal organ cultures.

    Science.gov (United States)

    Niang, M; Rosenbusch, R F; DeBey, M C; Niyo, Y; Andrews, J J; Kaeberle, M L

    1998-02-01

    Ovine tracheal ring explants were infected with four different Mycoplasma ovipneumoniae and one M. arginini field isolate and their ability to induce cytopathic effects was tested by measuring ciliary activity and intracellular calmodulin release. Infected tracheal rings showed significantly decreased ciliary activity as compared to the non-infected control rings. There were, however, marked differences between isolates in the onset and severity of the effects which correlated with their ability to produce hydrogen peroxide. Infected tracheal rings released more calmodulin than the non-infected controls. The amount of calmodulin released also varied between isolates, and somewhat reflected the degree of loss of ciliary activity in the corresponding rings induced by the different isolates. Light and electron microscopic examinations of infected tracheal rings revealed disorganisation and sloughing of the epithelium, and association of mycoplasmas only with the cilia. Following repeated in vitro passages, the organisms had reduced ability to inhibit ciliary activity which correlated with decreased hydrogen peroxide production. Addition of catalase to the organ cultures delayed loss of ciliary activity. These results suggest that M. ovipneumoniae induced ciliostasis in ovine tracheal ring explants which correlated with hydrogen peroxide production. Furthermore, these M. ovipneumoniae-induced injuries to respiratory epithelial cells could contribute to the role that this organism may play in sheep respiratory disease.

  5. Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2008-02-01

    The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.

  6. Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy.

    Science.gov (United States)

    Tsujikawa, Shogo; Okutani, Ryu; Oda, Yutaka

    2012-04-01

    Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.

  7. Effect of 1,1-dimethylphenyl 1,4-piperazinium on mouse tracheal smooth muscle responsiveness.

    Science.gov (United States)

    Dorion, G; Israël-Assayag, E; Beaulieu, M J; Cormier, Y

    2005-06-01

    Bronchial hyperresponsiveness is one of the main features of asthma. A nicotinic receptor agonist, 1,1-dimethylphenyl 1,4-piperazinium (DMPP), has been shown to have an inhibitory effect on airway response to methacholine in an in vivo model of asthma. The aims of this study were to 1) verify whether nicotinic acetylcholine receptors (nAChR) were present on mouse tracheal smooth muscle, 2) verify whether bronchoprotection observed in mice was due to a direct effect on airway smooth muscle, and 3) compare the effects of nicotinic agonists to that of salbutamol. Alpha3-, alpha4-, and alpha7-nAChR subunits were detected by immunofluorescence on tracheal tissues from normal BALB/c mice. The effect of DMPP on tracheal responsiveness was verified by an isometric method. Tracheas were isolated from normal mice, placed in organ baths, and contracted with a single dose of methacholine. Cumulative doses of DMPP or salbutamol were added to the baths. Results show that mouse tracheal smooth muscle is positive for alpha4- and alpha7-nAChR subunits and that the epithelium is positive for alpha3-, alpha4-, and alpha7-subunits. DMPP induced a greater dose-dependent relaxation of tracheal smooth muscles precontracted with methacholine than with salbutamol. These results suggest that the smooth muscle-relaxing effect of DMPP could have some interest in the treatment of obstructive pulmonary diseases.

  8. Tracheal Agenesis: A Challenging Prenatal Diagnosis—Contribution of Fetal MRI

    Directory of Open Access Journals (Sweden)

    Charline Bertholdt

    2015-01-01

    Full Text Available Tracheal agenesis is a rare congenital anomaly. The prevalence is less than 1 : 50 000 with a male to female ratio of 2 : 1. This anomaly may be isolated but, in 93% of cases, it is part of polymalformative syndrome. The most evocative diagnosis situation is the ultrasonographic congenital high airway obstruction syndrome. Dilated airways, enlarged lungs with flattened diaphragm, fetal ascites and severe nonimmune hydrops can be observed. In the absence of a congenital high airway obstruction syndrome, the antenatal diagnosis of tracheal agenesis is difficult. Tracheal agenesis should be suspected in the presence of an unexplained polyhydramnios associated with congenital malformations. The fetal airway exploration should then be systematically performed by fetal thoracic magnetic resonance imaging. A case of Floyd’s type II tracheal agenesis, detected during the postnatal period, is reported here. The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis would have been easy if a systematical examination of upper airways had been performed. Prenatal diagnosis of tracheal agenesis is possible with fetal MRI but the really challenge is to think about this pathology.

  9. Bronchoprotective effect of simulated deep inspirations in tracheal smooth muscle.

    Science.gov (United States)

    Pascoe, Christopher D; Donovan, Graham M; Bossé, Ynuk; Seow, Chun Y; Paré, Peter D

    2014-12-15

    Deep inspirations (DIs) taken before an inhaled challenge with a spasmogen limit airway responsiveness in nonasthmatic subjects. This phenomenon is called bronchoprotection and is severely impaired in asthmatic subjects. The ability of DIs to prevent a decrease in forced expiratory volume in 1 s (FEV1) was initially attributed to inhibition of airway narrowing. However, DIs taken before methacholine challenge limit airway responsiveness only when a test of lung function requiring a DI is used (FEV1). Therefore, it has been suggested that prior DIs enhance the compliance of the airways or airway smooth muscle (ASM). This would increase the strain the airway wall undergoes during the subsequent DI, which is part of the FEV1 maneuver. To investigate this phenomenon, we used ovine tracheal smooth muscle strips that were subjected to shortening elicited by acetylcholine with or without prior strain mimicking two DIs. The compliance of the shortened strip was then measured in response to a stress mimicking one DI. Our results show that the presence of "DIs" before acetylcholine-induced shortening resulted in 11% greater relengthening in response to the third DI, compared with the prior DIs. This effect, although small, is shown to be potentially important for the reopening of closed airways. The effect of prior DIs was abolished by the adaptation of ASM to either shorter or longer lengths or to a low baseline tone. These results suggest that DIs confer bronchoprotection because they increase the compliance of ASM, which, consequently, promotes greater strain from subsequent DI and fosters the reopening of closed airways.

  10. [Noninvasive positive pressure ventilation in postoperative period of tracheal surgery].

    Science.gov (United States)

    De La Torre, C A; Hernández, F; Sanabria, P; Vázquez, J; Miguel, M; Luis, A L; Barrena, S; Aguilar, R; Ramírez, M; Hernández, S; Borches, D; Lassaletta, L; Tovar, J A

    2011-04-01

    Reconstructive surgery of the airway often means prolonged periods of intubation during the post-operatory period, increasing the needs for drugs and favoring the appearance of infectious complications. We present an original system of ventilatory support with non-invasive positive pressure ventilation (NIPPV) using in patients subjected to reconstructive surgery of the airway. A retrospective study in patients undergoing reconstructive procedures of the airway in the year 2009 was carried out. We exclude those treated endoscopically and those who had vascular rings. The positive pressure mechanism used in the Surgery Critical Care Unit was a design made by the unit based on the circuit devised by Mapleson that provides optimum levels of ventilation without need for connection to a respiratory. We analyze the results, postoperatory intubation time, time dependent on NIPPV and medical treatment received. A total of 7 patients (1 Female and 6 Males) with median age of 1.6 (0.1-7.5) years were included. The diagnoses were: 4 subglottic stenosis, 2 had tracheal stenosis and 1 subcarinal stenosis with involvement of both principal bronchioles. The techniques used were: laryngotracheoplasty with costal cartilage graft (4), tracheoplasty with costal cartilage (1) and sliding tracheoplasty (2) with bilateral bronchoplasty in one of them. The mean time of nasotracheal intubation was 3 days, and mean time of NIPPV was 2.3. No patient required reintubation and none had infectious complications. Ventilatory support by VPPNI allows effective extubation in these patients, it being possible to maintain a safe airway. Infectious complications, frequent in prolonged intubations, were not observed in any of the cases.

  11. Tracheal injury during extraction of an esophageal foreign body: Repair utilizing venovenous ECMO

    Directory of Open Access Journals (Sweden)

    Shunpei Okochi, MD

    2017-05-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is a form of life support with an ever-expanding range of indications. Veno-venous (VV ECMO is often utilized to support children with respiratory compromise, and has been employed successfully in the acute setting of traumatic tracheobronchial injury as well as during elective tracheal surgery. We present a successful case of VV ECMO used in the perioperative management of a tracheal repair for a traumatic laceration caused by attempts to retrieve an esophageal foreign body. While this mechanism of injury appears to be rare, we believe that VV-ECMO allowed for the optimal management of this child and should be considered for other extensive tracheal injuries in children.

  12. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Aman Jyoti

    2014-01-01

    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  13. The use of scaning electron microscopy in postvaccinal evaluation of tracheal epithelium of Coturnix coturnix japonica

    Directory of Open Access Journals (Sweden)

    Santin Elizabeth

    2003-01-01

    Full Text Available This study aimed at evaluating the use of scanning electron microscopy in the study of the post-vaccinal respiratory reaction of the tracheal epithelium of quails (Coturnix coturnix japonica immunized against Newcastle disease. A number of 36 quails were distributed into four groups: T1 fraction three-quarters control birds (non-vaccinated; T2 fraction three-quarters birds vaccinated with Ulster 2C strain; t3 fraction three-quarters birds vaccinated with B1 strain; t4 fraction three-quarters birds vaccinated with LaSota strain. Regardless the experimental group, birds did not show detectable clinical signs of post-vaccinal respiratory reaction. However, the analysis of tracheal fragments by scanning electron microscopy showed that birds vaccinated with B1 and LaSota strains developed epithelial sloughing of the trachea, whereas those vaccinated Ulster 2C strain did not develop this change, demonstrating intact tracheal epithelium, similar to the control group.

  14. Tracheal epithelial-myoepithelial carcinoma associated with sarcoid-like reaction: A case report.

    Science.gov (United States)

    Dong, Huawei; Tatsuno, Brent K; Betancourt, Jaime; Oh, Scott S

    2015-01-01

    Epithelial-myoepithelial carcinomas are rare tumors that primarily originate in the salivary glands but have also been found in the tracheobronchial tree. We report the first case of epithelial-myoepithelial carcinoma associated with sarcoidosis. A 61 year old Hispanic man presented with altered mental status and hypercalcemia. Imaging revealed diffuse intra-thoracic and intra-abdominal lymphadenopathy. A diagnostic bronchoscopy was performed where an incidental tracheal nodule was discovered and biopsied. Pathology was consistent with epithelial-myoepithelial carcinoma. Lymph node biopsy demonstrated non-caseating granulomas consistent with sarcoidosis. Patient underwent tracheal resection of the primary tumor with primary tracheal reconstruction. Hypercalcemia subsequently normalized with clinical improvement. Repeat CT imaging demonstrated complete resolution of lymphadenopathy. Our findings are suggestive of a possible paraneoplastic sarcoid-like reaction to the epithelial-myoepithelial carcinoma with associated lymphadenopathy and symptomatic hypercalcemia.

  15. Two cases of takotsubo syndrome related to tracheal intubation/extubation.

    Science.gov (United States)

    Jakobson, Triin; Svitškar, Nikolai; Tamme, Kadri; Starkopf, Joel; Karjagin, Juri

    2012-01-01

    Takotsubo cardiomyopathy is an acute, reversible left ventricular dysfunction with characteristic contractility disorder and is usually preceded by emotional or physical stress. Two cases of Takotsubo cardiomyopathy related to tracheal manipulation are presented. Both the patients had all the typical symptoms and signs of Takotsubo cardiomyopathy, and both of them recovered completely within weeks. Tracheal manipulation is a well-known stress factor during the perioperative period, and experience from these two cases stresses the crucial role of measures aimed to stress reduction. Proper premedication and calm environment are recommended to produce anxiolysis before intubation. The administration of α- and β-blockers is also recommended to inhibit sympathetic stress caused by tracheal manipulation.

  16. Tracheal epithelial-myoepithelial carcinoma associated with sarcoid-like reaction: A case report

    Directory of Open Access Journals (Sweden)

    Huawei Dong

    2015-01-01

    Full Text Available Epithelial-myoepithelial carcinomas are rare tumors that primarily originate in the salivary glands but have also been found in the tracheobronchial tree. We report the first case of epithelial-myoepithelial carcinoma associated with sarcoidosis. A 61 year old Hispanic man presented with altered mental status and hypercalcemia. Imaging revealed diffuse intra-thoracic and intra-abdominal lymphadenopathy. A diagnostic bronchoscopy was performed where an incidental tracheal nodule was discovered and biopsied. Pathology was consistent with epithelial-myoepithelial carcinoma. Lymph node biopsy demonstrated non-caseating granulomas consistent with sarcoidosis. Patient underwent tracheal resection of the primary tumor with primary tracheal reconstruction. Hypercalcemia subsequently normalized with clinical improvement. Repeat CT imaging demonstrated complete resolution of lymphadenopathy. Our findings are suggestive of a possible paraneoplastic sarcoid-like reaction to the epithelial-myoepithelial carcinoma with associated lymphadenopathy and symptomatic hypercalcemia.

  17. Effects of fenoterol on beta-adrenoceptor and muscarinic M-2 receptor function in bovine tracheal smooth muscle

    NARCIS (Netherlands)

    De Vries, B; Roffel, AF; Kooistra, JM; Meurs, H; Zaagsma, J

    2001-01-01

    Prolonged (18 h) incubation of isolated bovine tracheal smooth muscle with the beta (2)-adrenoceptor agonist fenoterol (10 muM) induced desensitization of isoprenaline-induced adenylyl cyclase activity in bovine tracheal smooth muscle membranes, characterized by a 25% decrease in maximal effect (E-m

  18. 人工气管研究进展%RESEARCH PROGRESS OF ARTIFICIAL TRACHEAL PROSTHESIS

    Institute of Scientific and Technical Information of China (English)

    王嵩; 史宏灿

    2011-01-01

    目的 对人工气管的研究状况进行分析,为人工气管的发展提供理论参考.方法 广泛查阅近年有关人工气管研究的相关文献,并进行总结分析.结果 越来越多的新材料被用于人工气管的相关研究,较好地解决了人工气管移位、管道阻塞、感染等并发症,显示出了良好的生物相容性和稳定的结构特性,但大部分研究仍处于动物实验阶段,临床应用较少.结论 人工气管材料的选择是人工气管成功研制的关键,高分子可降解材料以其独特的生物学性能成为目前人工气管领域研究的新方向.%Objective To review the research of the artificial tracheal prosthesis in the past decade so as to provide theoretical references for the development of the artificial tracheal prosthesis. Methods The literature about the artificial tracheal prosthesis was extensively reviewed and analyzed. Results Many new materials are used for the research of artificial tracheal prosthesis which have excellent biocompatibility and stability of the structural characteristics. And many complications such as migration, obstruction, and infection have been resolved, but so far none of the new materials has been used for clinical treatment successfully. Conclusion The choice of the materials for artificial tracheal prosthesis is the key to succeed.Biodegradable polymer materials with its unique biological properties become the new direction of the tracheal prosthesis research.

  19. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD?

    Directory of Open Access Journals (Sweden)

    Camiciottoli G

    2015-04-01

    Full Text Available Gianna Camiciottoli,1 Stefano Diciotti,2 Francesca Bigazzi,1 Simone Lombardo,3 Maurizio Bartolucci,4 Matteo Paoletti,1 Mario Mascalchi,3 Massimo Pistolesi1 1Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; 2Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi,” University of Bologna, Cesena, Italy; 3Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy; 4Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy Abstract: A substantial proportion of patients with chronic obstructive pulmonary disease (COPD develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory–expiratory low dose computed tomography (CT and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28 and in females (n=27. Women with a predominant conductive airway phenotype (n=10 showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001. Intrathoracic tracheal collapsibility was directly correlated with inspiratory–expiratory volume variation at CT and with forced expiratory volume (1 second, and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD

  20. Laryngeal mask airway guided tracheal intubation in a neonate with the Pierre Robin syndrome

    DEFF Research Database (Denmark)

    Hansen, T G; Joensen, H; Henneberg, S W

    1995-01-01

    Endotracheal intubation in infants with the Pierre Robin syndrome may sometimes be impossible to accomplish by conventional means. To aid difficult tracheal intubation many different techniques have been described. We present a case, in which we successfully intubated a small-for-date newborn boy...... with the Pierre Robin syndrome by using a modified laryngeal mask airway (no. 1) as a guide for the endotracheal tube. The technique is easy to perform, less traumatic and less time-consuming than multiple attempts at laryngoscopy or blind tracheal intubation....

  1. A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Directory of Open Access Journals (Sweden)

    Birkholz Torsten

    2010-01-01

    Full Text Available A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

  2. A retropharyngeal–mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Science.gov (United States)

    Birkholz, Torsten; Kröber, Stefanie; Knorr, Christian; Schiele, Albert; Bumm, Klaus; Schmidt, Joachim

    2010-01-01

    A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal–mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal–mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation. PMID:21063569

  3. Intra-tracheal Administration of Haemophilus influenzae in Mouse Models to Study Airway Inflammation.

    Science.gov (United States)

    Venuprasad, K; Theivanthiran, Balamayooran; Cantarel, Brandi

    2016-03-02

    Here, we describe a detailed procedure to efficiently and directly deliver Haemophilus influenzae into the lower respiratory tracts of mice. We demonstrate the procedure for preparing H. influenzae inoculum, intra-tracheal instillation of H. influenzae into the lung, collection of broncho-alveolar lavage fluid (BALF), analysis of immune cells in the BALF, and RNA isolation for differential gene expression analysis. This procedure can be used to study the lung inflammatory response to any bacteria, virus or fungi. Direct tracheal instillation is mostly preferred over intranasal or aerosol inhalation procedures because it more efficiently delivers the bacterial inoculum into the lower respiratory tract with less ambiguity.

  4. Tracheal respiration in insects visualized with synchrotron x-ray imaging.

    Science.gov (United States)

    Westneat, Mark W; Betz, Oliver; Blob, Richard W; Fezzaa, Kamel; Cooper, W James; Lee, Wah-Keat

    2003-01-24

    Insects are known to exchange respiratory gases in their system of tracheal tubes by using either diffusion or changes in internal pressure that are produced through body motion or hemolymph circulation. However, the inability to see inside living insects has limited our understanding of their respiration mechanisms. We used a synchrotron beam to obtain x-ray videos of living, breathing insects. Beetles, crickets, and ants exhibited rapid cycles of tracheal compression and expansion in the head and thorax. Body movements and hemolymph circulation cannot account for these cycles; therefore, our observations demonstrate a previously unknown mechanism of respiration in insects analogous to the inflation and deflation of vertebrate lungs.

  5. Metabolic detoxication pathways for sterigmatocystin in primary tracheal epithelial cells.

    Science.gov (United States)

    Cabaret, Odile; Puel, Olivier; Botterel, Françoise; Pean, Michel; Khoufache, Khaled; Costa, Jean-Marc; Delaforge, Marcel; Bretagne, Stéphane

    2010-11-15

    Human health effects of inhaled mycotoxins remain poorly documented, despite the large amounts present in bioaerosols. Among these mycotoxins, sterigmatocystin is one of the most prevalent. Our aim was to study the metabolism and cellular consequences of sterigmatocystin once it is in contact with the airway epithelium. Metabolites were analyzed first in vitro, using recombinant P450 1A1, 1A2, 2A6, 2A13, and 3A4 enzymes, and subsequently in porcine tracheal epithelial cell (PTEC) primary cultures at an air-liquid interface. Expressed enzymes and PTECs were exposed to sterigmatocystin, uniformly enriched with (13)C to confirm the relationship between sterigmatocystin and metabolites. Induction of the expression of xenobiotic-metabolizing enzymes upon sterigmatocystin exposure was examined by real-time quantitative real-time polymerase chain reaction. Incubation of 50 μM sterigmatocystin with recombinant P450 1A1 led to the formation of three metabolites: monohydroxy-sterigmatocystin (M1), dihydroxy-sterigmatocystin (M2), and one glutathione adduct (M3), the latter after the formation of a transient epoxide. Recombinant P450 1A2 also led to M1 and M3. P450 3A4 led to only M3. In PTEC, 1 μM sterigmatocystin metabolism resulted in a glucuro conjugate (M4) mainly excreted at the basal side of cells. If PTEC were treated with β-naphthoflavone prior to sterigmatocystin incubation, two other products were detected, i.e., a sulfo conjugate (M5) and a glucoro conjugate (M6) of hydroxy-sterigmatocystin. Exposure of PTEC for 24 h to 1 μM sterigmatocystin induced an 18-fold increase in the mRNA levels of P450 1A1, without significantly induced 7-ethoxyresorufin O-deethylation activity. These data suggest that sterigmatocystin is mainly detoxified and is unable to produce significant amounts of reactive epoxide metabolites in respiratory cells. However, sterigmatocystin increases the P450 1A1 mRNA levels with unknown long-term consequences. These in vitro results obtained in

  6. Cytokinetics and histogenesis of cultured hamster tracheal epithelium. Effects of vitamin A and cigarette smoke condensate.

    NARCIS (Netherlands)

    Rutten, A.A.J.J.L.

    1988-01-01

    The studies reported in this thesis primarily deal with the influence of vitamin A (all-trans retinol) and cigarette smoke condensate on cellular proliferation, and differentiation and intercellular communication in tracheal epithelium. The experiments were carried out with Syrian Golden hamster tra

  7. Timing of tracheal intubation: monitoring the orbicularis oculi, the adductor pollicis or use a stopwatch?

    DEFF Research Database (Denmark)

    Koscielniak-Nielsen, Z J; Horn, A; Sztuk, F

    1996-01-01

    The most suitable time for tracheal intubation, following vecuronium 0.1 mg kg-1, was estimated in 120 patients. The trachea was intubated at cessation of the visually observed response of the orbicularis oculi muscle to facial nerve stimulation (group 1; n = 30), or of the manually detected resp...

  8. Vascular-pedicled costal cartilage graft for the treatment of subglottic and upper tracheal stenosis.

    Science.gov (United States)

    Hashizume, K; Kanamori, Y; Sugiyama, M; Tomonaga, T; Nakanishi, H

    2004-12-01

    Free costal cartilage graft for the treatment of subglottic and tracheal stenosis is widely used, but postoperative granulation formation is a problem. To reduce the risk of granulation formation after free costal graft, a new operation of costal cartilage graft with vascular pedicle was introduced. A vascular pedicled fifth costal cartilage graft is prepared using internal thoracic artery and vein and intercostal artery and vein as a vascular pedicle. The prepared graft is brought to the upper trachea. The anterior wall of cricoid is split, and the costal cartilage graft is implanted to the split part and tracheostomy. Extubation on the next day is possible if the general condition of the patient permits. In 3 cases of subglottic or upper tracheal stenosis, this operation was performed. All the patients had tracheostomy made during early infancy. The postoperative course was uneventful, and all the patients were extubated soon after the operation. No granulation tissue was observed by postoperative bronchoscopic examinations. Costal cartilage graft with vascular pedicle is a safe and useful new operation for the treatment of subglottic and upper tracheal stenosis. There also is a possibility of using this procedure for the treatment of long segment tracheal stenosis.

  9. Two cases of tracheal disease misdiagnosed as difficult-to-treat asthma.

    Science.gov (United States)

    Alici, Ibrahim Onur; Kar Kurt, Ozlem; Dursun, Adile Berna; Yilmaz, Aydin; Erkekol, Ferda Oner

    2013-11-01

    Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma.

  10. Thymoma in middle mediastinum that induced tracheal compression—Case report and literature review

    Directory of Open Access Journals (Sweden)

    Teiko Sakurai

    2017-01-01

    Conclusion: We encountered a thymoma in the middle mediastinum that showed enlargement over a 2-year period, inducing severe tracheal compression. Thymomas can occur widely in pharyngeal pouch-derived locations and should be considered in differential diagnosis of a middle mediastinum tumor.

  11. Should EMS-paramedics perform paediatric tracheal intubation in the field?

    NARCIS (Netherlands)

    Gerritse, B.M.; Draaisma, J.M.T.; Schalkwijk, A.; Grunsven, P.M. van; Scheffer, G.J.

    2008-01-01

    OBJECTIVE: To determine the incidence and success rate of out-of-hospital tracheal intubation (TI) and ventilation of children, taking account of the type of healthcare provider involved. METHODS: A prospective observational study to analyse a consecutive group of children for which a

  12. Equine tracheal epithelial membrane strips - An alternate method for examining epithelial cell arachidonic acid metabolism

    Energy Technology Data Exchange (ETDEWEB)

    Gray, P.R.; Derksen, F.J.; Robinson, N.E.; Peter-Golden, M.L. (Michigan State Univ., East Lansing (United States) Univ. of Michigan, Ann Arbor (United States))

    1990-02-26

    Arachidonic acid metabolism by tracheal epithelium can be studied using enzymatically dispersed cell suspensions or cell cultures. Both techniques require considerable tissue disruption and manipulation and may not accurately represent in vivo activity. The authors have developed an alternate method for obtaining strips of equine tracheal epithelium without enzymatic digestion. In the horse, a prominent elastic lamina supports the tracheal epithelium. By physical splitting this lamina, they obtained strips ({le}12 x 1.5 cm) of pseudostratified columnar epithelium attached to a layer of elastic tissue 30-100 {mu}m thick. Epithelial strips (1.2 x 0.5 cm) were attached to plexiglass rods and incubated with ({sup 3}H)arachidonic acid in M199 medium (0.5 {mu}Ci/ml) for 24 hours at 37C. The strips incorporated 36{+-}4% (mean {+-} SEM) of the total radioactivity and released 8.0{+-}1.2% of incorporated radioactivity when stimulated by 5.0 {mu}M calcium ionophore A23187. The extracted supernatant was processed using HPLC, resulting in peaks of radioactivity that co-eluted with authentic PGE{sub 2}, PGF{sub 2}{alpha}, and 12-HETE standards. The greatest activity corresponded to the PGE{sub 2} and PGF{sub 2}{alpha} standards, which is a similar pattern to that reported for cultured human tracheal epithelium.

  13. Intermediate Levels of Resistance to Tracheal Mites in Crosses Between Resistant and Susceptible Strains

    Science.gov (United States)

    Bioassays and sampling of field colonies were used to test the hypothesis that the resistance to tracheal mites in Russian honey bees is a dominant trait. Earlier studies with Buckfast bees as a resistant parent had suggested dominance or partial dominance in their crosses with either a Canadian su...

  14. Tracheal compliance and limit flow rate changes in a murine model of asthma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Trachea is the unique passage for air to flow in and out. Its tone is of importance for the respiration system. However, investigation on how tracheal tone changes due to asthma is limited. Aiming at studying how the mechanical property changes due to asthma as well as the compliance and flow limitation, the following methods are adopted. Static and passive pressure-volume tests of rats’ trachea of the asthmatic and control groups are carried out and a new type of tube law is formulated to fit the experimental data, based on which changes of compliance and limit flow rate are investigated. In order to give explanation to such changes, histological examinations with tracheal soft tissues are made. The results show that compliance, limit flow rate and material constants included in the tube law largely depend on the longitudinal stretching ratio. Compared with the control group, the tracheal compliance of asthmatic animals decreases significantly, which results in an increased limit flow rate. Histological studies indicate that asthma can lead to hyperplasia/hypertrophy of smooth muscle cells, and increase elastin and collagen fibres in the muscular membrane. Though decreasing compliance increases sta- bility, during the onset of asthma, limit flow rate is much smaller due to the lower transmural pressure. Asthma leads to a stiffer trachea and the obtained results reveal some aspects relevant to asthma-induced tracheal remodelling.

  15. Twenty years of experience with the rabbit model, a versatile model for tracheal transplantation research

    Institute of Scientific and Technical Information of China (English)

    Margot Den Hondt; Bart M Vanaudenaerde; Pierre Delaere; Jan J Vranckx

    2016-01-01

    Pathologies comprising more than half the length of the trachea are a challenge to the reconstructive surgeon. Innovative tracheal transplantation techniques aim to offer the patient a curative solution with a sustained improvement in quality of life. This review summarizes the authors’ experience with the rabbit as a versatile model for research regarding tracheal transplantation. Because of the segmental blood supply of the trachea, it is not feasible to transplant the organ together with a well-defined vascular pedicle. As such, the key element of successful tracheal transplantation is the creation of a new blood supply. This vascularized construct is created by prelaminating the rabbit trachea heterotopically, within the lateral thoracic fascia. After prelamination, the construct and its vascular pedicle are transferred to the orthotopic position in the neck. This model has become gold standard because of the advantages of working with rabbits, the anatomy of the rabbit trachea, and the reliability of the lateral thoracic artery flap. In this paper, the key elements of surgery in the rabbit are discussed, as well as the tracheal anastomosis and the harvest of the lateral thoracic artery flap. Practical tips and tricks are presented. The data described in this review represent the fundaments of ongoing translational research in the center over the past twenty years.

  16. Tracheal compliance and limit flow rate changes in a urine model of asthma

    Institute of Scientific and Technical Information of China (English)

    TENG ZhongZhao; WANG YiQin; LI FuFeng; YAN HaiXia; LIU ZhaoRong

    2008-01-01

    Trachea is the unique passage for air to flow in and out. Its tone is of importance for the respiration system. However, investigation on how tracheal tone changes due to asthma is limited. Aiming at studying how the mechanical property changes due to asthma as well as the compliance and flow limitation, the following methods are adopted. Static and passive pressure-volume tests of rats' trachea of the asthmatic and control groups are carried out and a new type of tube law is formulated to fit the experimental data, based on which changes of compliance and limit flow rate are investigated. In order to give explanation to such changes, histological examinations with tracheal soft tissues are made. The results show that compliance, limit flow rate and material constants included in the tube law largely depend on the longitudinal stretching ratio. Compared with the control group, the tracheal compliance of asthmatic animals decreases significantly, which results in an increased limit flow rate. Histological studies indicate that asthma can lead to hyperplasia/hypertrophy of smooth muscle cells, and increase elastin and collagen fibres in the muscular membrane. Though decreasing compliance increases sta-bility, during the onset of asthma, limit flow rate is much smaller due to the lower transmural pressure. Asthma leads to a stiffer trachea and the obtained results reveal some aspects relevant to asthma-induced tracheal remodelling.

  17. Intervention with flexible bronchoscopy in patiens with respiratory failure caused by tracheal stenosis

    Institute of Scientific and Technical Information of China (English)

    王继旺

    2013-01-01

    Objective To investigate the efficiency and safety of intervention with flexible bronchoscope under general anesthesia by using laryngeal mask in patients with severe tracheal stenosis induced respirtory failure.Methods A total of 16 in-patients with respiratory failure caused by

  18. Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, Charlotte Vallentin; Thøgersen, Bente; Afshari, Arash;

    2012-01-01

    Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patien...

  19. Dilatation tracheoscopy for laryngeal and tracheal stenosis in patients with Wegener's granulomatosis

    NARCIS (Netherlands)

    Schokkenbroek, Ada A.; Franssen, Casper F. M.; Dikkers, Frederik G.

    2008-01-01

    Wegener's granulomatosis (WG) frequently involves the subglottis and trachea and may compromise the upper airway. The objective of this study is to evaluate retrospectively the effect of treatment of subglottic stenosis (SGS) and tracheal stenosis (TS) by dilatation tracheoscopy (DT) in patients wit

  20. In vitro isolation and cultivation of rabbit tracheal epithelial cells using tissue explant technique.

    Science.gov (United States)

    Shi, Hong-Can; Lu, Dan; Li, Hai-Jia; Han, Shi; Zeng, Yan-Jun

    2013-04-01

    Epithelial cells from tracheal mucosa offer significant potential as a cell source in development of tissue-engineered trachea. The purpose of this study was to investigate and optimize a suitable culture system for tracheal epithelial cells, including the methods of primary culture, passage, identification, and cryopreservation. Epithelial cells were isolated from rabbit tracheal mucosa using tissue explant technique and were subjected to immunohistochemistry, immunofluorescence, and cryopreservation after purification. Epithelial cells reached confluency at 14-15 d. Immunohistochemical staining for cytokeratin showed brown yellow-positive cytoplasm and blue-counterstained nuclei, while immunofluorescence staining for cytokeratin showed green-positive cytoplasm and clear cell outline, indicating that the cultured cells had properties of epithelial cells. After recovery, epithelial cells exhibited high survival and viability. The results demonstrated that in vitro isolation and cultivation model was successfully established to provide high proliferative capacity, typical morphology and characteristics of tracheal epithelial cells from trachea mucosa by the use of the tissue explant technique.

  1. Effect of cisatracurium versus atracurium on intraocular pressure in patients undergoing tracheal intubation for general anesthesia

    Directory of Open Access Journals (Sweden)

    Mitra Jabalameli

    2011-01-01

    Conclusions: Compared with atracurium, administration of cisatracurium can better prevent the increase of IOP following tracheal intubation in general anesthesia. The observed difference might be related to different effects on hemodynamic variables. Application of these results in patients under ophthalmic surgery is warranted.

  2. Laryngeal mask airway guided tracheal intubation in a neonate with the Pierre Robin syndrome

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Joensen, Henning; Henneberg, Steen Winther;

    1995-01-01

    Endotracheal intubation in infants with the Pierre Robin syndrome may sometimes be impossible to accomplish by conventional means. To aid difficult tracheal intubation many different techniques have been described. We present a case, in which we successfully intubated a small-for-date newborn boy...

  3. Cytokinetics and histogenesis of cultured hamster tracheal epithelium : effects of vitamin A and cigarette smoke condensate

    NARCIS (Netherlands)

    Rutten, A.A.J.J.L.

    1988-01-01

    The studies reported in this thesis primarily deal with the influence of vitamin A (all-trans retinol) and cigarette smoke condensate on cellular proliferation, and differentiation and intercellular communication in tracheal epithelium. The experiments were carried out with Syrian Golden ha

  4. Relaxing action of adrenergic β2-agonists on guinea-pig skinned tracheal muscle

    Directory of Open Access Journals (Sweden)

    Kayo Nemoto

    1999-01-01

    Full Text Available Although adrenergic β2-agonist-induced smooth muscle relaxation has been attributed to increased intracellular cyclic AMP (cAMP, a relaxation response has been observed at low β2-agonist concentrations that do not cause increased cAMP To elucidate the mechanism of tracheal muscle relaxation induced by low concentrations of β2-agonists, we used a guinea-pig skinned tracheal smooth muscle preparation to examine the effects on the contractile protein system. The isotonic contraction of β-escin-treated skinned tracheal muscle from guinea-pig was measured. When the intracellular Ca2+ concentration was maintained at 1 μmol/L in the presence of guanosine 5′-triphosphate (GTP; 100 μmol/L, neither isoproterenol (10nmol/L nor salbutamol (60 nmol/L affected Ca2+ sensitivity, but a significant decrease in Ca2+ sensitivity was observed in the presence of okadaic acid (1 μmol/L. The decrease in Ca2+ sensitivity was a slow response and was blocked by pretreatment with propranolol (1 μmol/L. Forskolin (1 μmol/L did not affect Ca2+ sensitivity. These results suggest that adrenergic b 2-agonists may activate protein phosphatase through an unknown pathway involving the β2-receptor, which enhances dephosphorylation of the myosin light chain and/or thin filament proteins, resulting in relaxation of the tracheal smooth muscle.

  5. Mangiferin Prevents Guinea Pig Tracheal Contraction via Activation of the Nitric Oxide-Cyclic GMP Pathway

    Science.gov (United States)

    Vieira, Aline B.; Coelho, Luciana P.; Insuela, Daniella B. R.; Carvalho, Vinicius F.; dos Santos, Marcelo H.; Silva, Patricia MR.; Martins, Marco A.

    2013-01-01

    Previous studies have described the antispasmodic effect of mangiferin, a natural glucoside xanthone (2-C-β-Dgluco-pyranosyl-1,3,6,7-tetrahydroxyxanthone) that is present in mango trees and other plants, but its mechanism of action remains unknown. The aim of this study was to examine the potential contribution of the nitric oxide-cyclic GMP pathway to the antispasmodic effect of mangiferin on isolated tracheal rings preparations. The functional effect of mangiferin on allergic and non-allergic contraction of guinea pig tracheal rings was assessed in conventional organ baths. Cultured tracheal rings were exposed to mangiferin or vehicle, and nitric oxide synthase (NOS) 3 and cyclic GMP (cGMP) levels were quantified using western blotting and enzyme immunoassays, respectively. Mangiferin (0.1–10 µM) inhibited tracheal contractions induced by distinct stimuli, such as allergen, histamine, 5-hydroxytryptamine or carbachol, in a concentration-dependent manner. Mangiferin also caused marked relaxation of tracheal rings that were precontracted by carbachol, suggesting that it has both anti-contraction and relaxant properties that are prevented by removing the epithelium. The effect of mangiferin was inhibited by the nitric oxide synthase inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME) (100 µM), and the soluble guanylate cyclase inhibitor, 1H-[1], [2], [4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) (10 µM), but not the adenylate cyclase inhibitor, 9-(tetrahydro-2-furyl)adenine (SQ22536) (100 µM). The antispasmodic effect of mangiferin was also sensitive to K+ channel blockers, such as tetraethylammonium (TEA), glibenclamide and apamin. Furthermore, mangiferin inhibited Ca2+-induced contractions in K+ (60 mM)-depolarised tracheal rings preparations. In addition, mangiferin increased NOS3 protein levels and cGMP intracellular levels in cultured tracheal rings. Finally, mangiferin-induced increase in cGMP levels was abrogated by co-incubation with either ODQ or L

  6. Mangiferin prevents guinea pig tracheal contraction via activation of the nitric oxide-cyclic GMP pathway.

    Directory of Open Access Journals (Sweden)

    Aline B Vieira

    Full Text Available Previous studies have described the antispasmodic effect of mangiferin, a natural glucoside xanthone (2-C-β-Dgluco-pyranosyl-1,3,6,7-tetrahydroxyxanthone that is present in mango trees and other plants, but its mechanism of action remains unknown. The aim of this study was to examine the potential contribution of the nitric oxide-cyclic GMP pathway to the antispasmodic effect of mangiferin on isolated tracheal rings preparations. The functional effect of mangiferin on allergic and non-allergic contraction of guinea pig tracheal rings was assessed in conventional organ baths. Cultured tracheal rings were exposed to mangiferin or vehicle, and nitric oxide synthase (NOS 3 and cyclic GMP (cGMP levels were quantified using western blotting and enzyme immunoassays, respectively. Mangiferin (0.1-10 µM inhibited tracheal contractions induced by distinct stimuli, such as allergen, histamine, 5-hydroxytryptamine or carbachol, in a concentration-dependent manner. Mangiferin also caused marked relaxation of tracheal rings that were precontracted by carbachol, suggesting that it has both anti-contraction and relaxant properties that are prevented by removing the epithelium. The effect of mangiferin was inhibited by the nitric oxide synthase inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME (100 µM, and the soluble guanylate cyclase inhibitor, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ (10 µM, but not the adenylate cyclase inhibitor, 9-(tetrahydro-2-furyladenine (SQ22536 (100 µM. The antispasmodic effect of mangiferin was also sensitive to K⁺ channel blockers, such as tetraethylammonium (TEA, glibenclamide and apamin. Furthermore, mangiferin inhibited Ca²⁺-induced contractions in K⁺ (60 mM-depolarised tracheal rings preparations. In addition, mangiferin increased NOS3 protein levels and cGMP intracellular levels in cultured tracheal rings. Finally, mangiferin-induced increase in cGMP levels was abrogated by co-incubation with either ODQ

  7. An unusual salvage technique for posterior tracheal membranous laceration associated with transhiatal esophagectomy: A transcervical–transsternal approach

    Directory of Open Access Journals (Sweden)

    Seyed Ziaeddin Rasihashemi

    2017-09-01

    Full Text Available Various surgical approaches may be employed for esophageal resection. Major airway injuries due to transhiatal esophagectomy include vertical tears in the membranous trachea. Tracheal injury is an uncommon but potentially fatal complication. This article describes the technique to repair the posterior membranous tracheal tear, extended just over the carina through a transcervical–transsternal approach, thereby avoiding a second thoracotomy. Six patients with posterior membranous tracheal injury underwent this procedure. The laceration ranged from 3 cm to 5 cm in length. Four patients had received neoadjuvant chemoradiation. The management of tracheal laceration added approximately 60 minutes to the total operation time. There was no mortality related to tracheal injury. Patients were followed up for 6 months after surgery, and both posterior tracheal wall and transverse tracheotomy remained intact without stenosis. The transcervical–transsternal approach decreases the need of thoracotomy and its complications in patients with tracheal laceration in any stage, even in cases of an extended tear down to the carina.

  8. Interaction of the tracheal tubules of Scutigera coleoptrata (Chilopoda, Notostigmophora with glandular structures of the pericardial septum

    Directory of Open Access Journals (Sweden)

    Gero Hilken

    2015-06-01

    Full Text Available Notostigmophora (Scutigeromorpha exhibit a special tracheal system compared to other Chilopoda. The unpaired spiracles are localized medially on the long tergites and open into a wide atrium from which hundreds of tracheal tubules originate and extend into the pericardial sinus. Previous investigators reported that the tracheal tubules float freely in the hemolymph. However, here we show for the first time that the tracheal tubules are anchored to a part of the pericardial septum. Another novel finding is this part of the pericardial septum is structured as an aggregated gland on the basis of its specialized epithelium being formed by hundreds of oligocellular glands. It remains unclear whether the pericardial septum has a differently structure in areas that lack a connection with tracheal tubules. The tracheal tubules come into direct contact with the canal cells of the glands that presumably secrete mucous substances covering the entire luminal cuticle of the tracheal tubules. Connections between tracheae and glands have not been observed in any other arthropods.

  9. BMI as a Predictor for Potential Difficult Tracheal Intubation in Males.

    Science.gov (United States)

    Uribe, Alberto A; Zvara, David A; Puente, Erika G; Otey, Andrew J; Zhang, Jianying; Bergese, Sergio D

    2015-01-01

    Difficult tracheal intubation is a common source of mortality and morbidity in surgical and critical care settings. The incidence reported of difficult tracheal intubation is 0.1%-13% and reaches 14% in the obese population. The objective of our retrospective study was to investigate and compare the utility of body mass index (BMI) as indicator of difficult tracheal intubation in males and females. We performed a retrospective chart review of patients who underwent abdominal surgeries with American Society of Anesthesiologists I to V under general anesthesia requiring endotracheal intubation. The following information was obtained from medical records for analysis: gender, age, height, weight, BMI, length of patient stay in the Post Anesthesia Care Unit, past medical history of sleep apnea, Mallampati score, and the American Society of Anesthesiologists classification assigned by the anesthesia care provider performing the endotracheal intubation. Of 4303 adult patients, 1970 (45.8%) men and 2333 (54.2%) women were enrolled in the study. Within this group, a total of 1673 (38.9%) patients were morbidly obese. The average age of the study group was 51.4 ± 15.8 and the average BMI was 29.7 ± 8.2 kg/m(2). The overall incidence of the encountered difficult intubations was 5.23% or 225 subjects. Thus, our results indicate that BMI is a reliable predictor of difficult tracheal intubation predominantly in the male population; another strong predictor, with a positive linear correlation, being the Mallampati score. In conclusion, our data shows that BMI is a reliable indicator of potential difficult tracheal intubation only in male surgical patients.

  10. Evidence that CFTR is expressed in rat tracheal smooth muscle cells and contributes to bronchodilation

    Directory of Open Access Journals (Sweden)

    Mettey Yvette

    2006-08-01

    Full Text Available Abstract Background The airway functions are profoundly affected in many diseases including asthma, chronic obstructive pulmonary disease (COPD and cystic fibrosis (CF. CF the most common lethal autosomal recessive genetic disease is caused by mutations of the CFTR gene, which normally encodes a multifunctional and integral membrane protein, the CF transmembrane conductance regulator (CFTR expressed in airway epithelial cells. Methods To demonstrate that CFTR is also expressed in tracheal smooth muscle cells (TSMC, we used iodide efflux assay to analyse the chloride transports in organ culture of rat TSMC, immunofluorescence study to localize CFTR proteins and isometric contraction measurement on isolated tracheal rings to observe the implication of CFTR in the bronchodilation. Results We characterized three different pathways stimulated by the cAMP agonist forskolin and the isoflavone agent genistein, by the calcium ionophore A23187 and by hypo-osmotic challenge. The pharmacology of the cAMP-dependent iodide efflux was investigated in detail. We demonstrated in rat TSMC that it is remarkably similar to that of the epithelial CFTR, both for activation (using three benzo [c]quinolizinium derivatives and for inhibition (glibenclamide, DPC and CFTRinh-172. Using rat tracheal rings, we observed that the activation of CFTR by benzoquinolizinium derivatives in TSMC leads to CFTRinh-172-sensitive bronchodilation after constriction with carbachol. An immunolocalisation study confirmed expression of CFTR in tracheal myocytes. Conclusion Altogether, these observations revealed that CFTR in the airways of rat is expressed not only in the epithelial cells but also in tracheal smooth muscle cells leading to the hypothesis that this ionic channel could contribute to bronchodilation.

  11. Particle Deposition in Oral-tracheal Airway Models with Very Low Inhalation Profiles

    Institute of Scientific and Technical Information of China (English)

    Zheng Li

    2012-01-01

    Considerable progress has been made on modeling particle deposition in the oral-tracheal airway under some normal breathing conditions,i.e.,resting,light activity and moderate exercise.None of these standard breathing patterns correspond to very low inhalation profiles.It is known that particle deposition in the oral-tracheal airway is greatly influenced by flow and particle inlet conditions.In this work,very low inhalation flow rates are considered.Particle deposition is numerically investigated in different oral-tracheal airway models,i.e.,circular,elliptic and realistic oral-tracheal airway models.Both micro- and nano-particles that are normally present in cigarette smoke are considered.Results show that inhalation profiles greatly influence the particle deposition.Due to relatively low flow rate,for ultra-fine particles,the oral deposition is enhanced due to longer residence time in oral cavity and stronger Brownian motion.However,for larger particles,less particles deposit in the oral-tracheal airway due to the weaker impaction.The transition happens when particle size changes from 0.01 μm to 0.1 μm.The influence of the limited entrance area is shown and discussed.Under the low inhalation profiles,the highest deposition fraction could be in either circular or realistic models depending on the particle property and the geometric characteristic of oral cavity.The knowledge obtained in this study may be beneficial for the design of bionic inhaler and understanding of health effect from smoke particle on human being.

  12. Trypsin as enhancement in cyclical tracheal decellularization: Morphological and biophysical characterization

    Energy Technology Data Exchange (ETDEWEB)

    Giraldo-Gomez, D.M., E-mail: davidmauro2008@gmail.com [Posgrado en Ciencia e Ingeniería de Materiales, Universidad Nacional Autónoma de México (UNAM), Unidad de Posgrado Edificio “C” 1er Piso, Circuito de Posgrados, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D. F., México (Mexico); Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México (UNAM), Circuito Exterior, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D.F., México (Mexico); Leon-Mancilla, B. [Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Edificio “D” Planta Baja, Circuito Interior, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D.F., México (Mexico); Del Prado-Audelo, M.L. [Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México (UNAM), Circuito Exterior, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D.F., México (Mexico); and others

    2016-02-01

    There are different types of tracheal disorders (e.g. cancer, stenosis and fractures). These can cause respiratory failure and lead to death of patients. Several attempts have been made for trachea replacement in order to restore the airway, including anastomosis and implants made from synthetic or natural materials. Tracheal allotransplantation has shown high rejection rates, and decellularization has emerged as a possible solution. Decellularization involves the removal of antigens from cells in the organ or tissue, leaving a matrix that can be used as 3D cell-scaffold. Although this process has been used for tracheal replacement, it usually takes at least two months and time is critical for patients with tracheal disorders. Therefore, there is necessary to develop a tracheal replacement process, which is not only effective, but also quick to prepare. The aim of this research was to develop a faster trachea decellularization protocol using Trypsin enzyme and Ethylenediaminetetraacetic acid (EDTA) as decellularization agents. Three protocols of cyclic trachea decellularization (Protocols A, B, and C) were compared. Following Protocol A (previously described in the literature), 15 consecutive cycles were performed over 32 days. Protocol B (a variation of Protocol A) — EDTA being added — with 15 consecutive cycles performed over 60 days. Finally, Protocol C, with the addition of Trypsin as a decellularization agent, 5 consecutive cycles being performed over 10 days. For the three protocols, hematoxylin–eosin (H&E) staining and DNA residual content quantification were performed to establish the effectiveness of the decellularization process. Scanning Electron Microscopy (SEM) was used to observe the changes in porosity and microarrays. To evaluate the structural matrices integrity, Thermogravimetric Analysis (TGA) and biomechanical test were used. None of the protocols showed significant alteration or degradation in the components of the extracellular matrix

  13. Gaslini's tracheal team: preliminary experience after one year of paediatric airway reconstructive surgery

    Directory of Open Access Journals (Sweden)

    Torre Michele

    2011-10-01

    Full Text Available Abstract Background congenital and acquired airway anomalies represent a relatively common albeit challenging problem in a national tertiary care hospital. In the past, most of these patients were sent to foreign Centres because of the lack of local experience in reconstructive surgery of the paediatric airway. In 2009, a dedicated team was established at our Institute. Gaslini's Tracheal Team includes different professionals, namely anaesthetists, intensive care specialists, neonatologists, pulmonologists, radiologists, and ENT, paediatric, and cardiovascular surgeons. The aim of this project was to provide these multidisciplinary patients, at any time, with intensive care, radiological investigations, diagnostic and operative endoscopy, reconstructive surgery, ECMO or cardiopulmonary bypass. Aim of this study is to present the results of the first year of airway reconstructive surgery activity of the Tracheal Team. Methods between September 2009 and December 2010, 97 patients were evaluated or treated by our Gaslini Tracheal Team. Most of them were evaluated by both rigid and flexible endoscopy. In this study we included 8 patients who underwent reconstructive surgery of the airways. Four of them were referred to our centre or previously treated surgically or endoscopically without success in other Centres. Results Eight patients required 9 surgical procedures on the airway: 4 cricotracheal resections, 2 laryngotracheoplasties, 1 tracheal resection, 1 repair of laryngeal cleft and 1 foreign body removal with cardiopulmonary bypass through anterior tracheal opening. Moreover, in 1 case secondary aortopexy was performed. All patients achieved finally good results, but two of them required two surgeries and most required endoscopic manoeuvres after surgery. The most complex cases were the ones who had already been previously treated. Conclusions The treatment of paediatric airway anomalies requires a dedicated multidisciplinary approach and a

  14. Severe stenosis of a long tracheal segment, with agenesis of the right lung and left pulmonary arterial sling.

    Science.gov (United States)

    Munro, Hamish M; Sorbello, Andrea M C; Nykanen, David G

    2006-02-01

    A baby presented at term with respiratory distress was managed with extracorporeal membrane oxygenation. Bronchoscopy revealed tracheal hypoplasia, complete tracheal rings, and agenesis of the right main bronchus. Echocardiography showed a left pulmonary arterial sling arising from the proximal part of the right pulmonary artery. Cardiac catheterization demonstrated abnormal pulmonary vasculature in the left lung which would have prevented survival, even after surgical repair. Diagnostic catheterization was important in delineating the anatomy, and aided in the decision not to proceed with surgical repair.

  15. Drosophila convoluted/dALS is an essential gene required for tracheal tube morphogenesis and apical matrix organization.

    Science.gov (United States)

    Swanson, Lianna E; Yu, Marcus; Nelson, Kevin S; Laprise, Patrick; Tepass, Ulrich; Beitel, Greg J

    2009-04-01

    Insulin-like growth factors (IGFs) control cell and organism growth through evolutionarily conserved signaling pathways. The mammalian acid-labile subunit (ALS) is a secreted protein that complexes with IGFs to modulate their activity. Recent work has shown that a Drosophila homolog of ALS, dALS, can also complex with and modulate the activity of a Drosophila IGF. Here we report the first mutations in the gene encoding dALS. Unexpectedly, we find that these mutations are allelic to a previously described mutation in convoluted (conv), a gene required for epithelial morphogenesis. In conv mutants, the tubes of the Drosophila tracheal system become abnormally elongated without altering tracheal cell number. conv null mutations cause larval lethality, but do not disrupt several processes required for tracheal tube size control, including septate junction formation, deposition of a lumenal/apical extracellular matrix, and lumenal secretion of Vermiform and Serpentine, two putative matrix-modifying proteins. Clearance of lumenal matrix and subcellular localization of clathrin also appear normal in conv mutants. However, we show that Conv/dALS is required for the dynamic organization of the transient lumenal matrix and normal structure of the cuticle that lines the tracheal lumen. These and other data suggest that the Conv/dALS-dependent tube size control mechanism is distinct from other known processes involved in tracheal tube size regulation. Moreover, we present evidence indicating that Conv/dALS has a novel, IGF-signaling independent function in tracheal morphogenesis.

  16. A microprocessor-controlled tracheal insufflation-assisted total liquid ventilation system.

    Science.gov (United States)

    Parker, James Courtney; Sakla, Adel; Donovan, Francis M; Beam, David; Chekuri, Annu; Al-Khatib, Mohammad; Hamm, Charles R; Eyal, Fabien G

    2009-09-01

    A prototype time cycled, constant volume, closed circuit perfluorocarbon (PFC) total liquid ventilator system is described. The system utilizes microcontroller-driven display and master control boards, gear motor pumps, and three-way solenoid valves to direct flow. A constant tidal volume and functional residual capacity (FRC) are maintained with feedback control using end-expiratory and end-inspiratory stop-flow pressures. The system can also provide a unique continuous perfusion (bias flow, tracheal insufflation) through one lumen of a double-lumen endotracheal catheter to increase washout of dead space liquid. FRC and arterial blood gases were maintained during ventilation with Rimar 101 PFC over 2-3 h in normal piglets and piglets with simulated pulmonary edema induced by instillation of albumin solution. Addition of tracheal insufflation flow significantly improved the blood gases and enhanced clearance of instilled albumin solution during simulated edema.

  17. Study on loss mechanism of SMA tracheal stent subjected to cough excitation.

    Science.gov (United States)

    Zhu, Zhiwen; Li, Xinmiao; Xu, Jia

    2015-01-01

    A kind of Ti-Ni shape memory alloy (SMA) hysteretic nonlinear model is developed, and the loss mechanism of a SMA tracheal stent subjected to cough excitation is studied in this paper. Nonlinear differential items are introduced to express the hysteretic phenomena of Ti-Ni SMA, and the fitting effect of the SMA constitutive model on the experimental data is proved by the partial least-square regression method. The nonlinear dynamic model of a Ti-Ni SMA tracheal stent subjected to cough excitation is developed, and the system's dynamic response is obtained. The numerical results show that the system's vibration is little in weak excitation, becomes large with the increase of the stochastic excitation, and finally becomes little again with the further increase of the stochastic excitation; the stochastic resonance phenomenon occurs in the process, which may cause stent fracture or loss.

  18. Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

    Science.gov (United States)

    Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

    2009-03-01

    An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds.

  19. Sensitivity of bronchoprovocation and tracheal mucous velocity in detecting airway responses to O3. [Sheep

    Energy Technology Data Exchange (ETDEWEB)

    Abraham, W.M.; Januszkiewicz, A.J.; Mingle, M.; Welker, M.; Wanner, A.; Sackner, M.A.

    1980-05-01

    This study was undertaken to determine whether measurements of tracheal mucous velocity or airway reactivity to inhaled carbachol more sensitively detect airway effects of inhaled ozone (O3) in conscious sheep. Dose-response curves of mean pulmonary flow resistance (RL) to carbachol were obtained by measuring RL after five breaths of carbachol aerosol with stepwise increases in drug concentration. The animals then breathed 0.5 ppM O3 through an endotracheal tube for 2 h. The dose-response curves were repeated immediately after the 0.5 ppM O3 exposure and 24 h later. In conscious sheep, airway hyperreactivity appears to be a more sensitive indicator of airway effects produced by short-term exposure to 0.5 ppM O3 than depression of tracheal mucous velocity.

  20. Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

    Directory of Open Access Journals (Sweden)

    S. Gursoy

    2012-01-01

    Full Text Available Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism.

  1. The effect of mucolytic agents on the rheologic and transport properties of canine tracheal mucus.

    Science.gov (United States)

    Martin, R; Litt, M; Marriott, C

    1980-03-01

    The effect of several sulfhydryl and other agents on the rheologic and mucociliary transport properties of a model secretion, reconstituted canine tracheal mucus, was investigated. The mucus was obtained via the canine tracheal pouch. Rheologic properties were determined by mirorheometry, and the ciliary transport rate was determined using the frog palate technique. It was found that N-acetyl cysteine decreased the elastic modulus, leading to improved mucociliary transport at concentrations such that the mucin did not precipitate. S-carboxymethyl cysteine had no effect on either mucus properties or mucociliary transport rate, and its reported effectiveness in vivo must be due to some mechanism other than solubilization of mucin. Similar results were found with other blocked sulfhydryl compounds. Urea and potassium iodide to decrease mucus elasticity, but are harmful to cilia at the concentrations needed.

  2. Benign tracheal stenosis a case report and up to date management.

    Science.gov (United States)

    Karapantzos, Ilias; Karapantzou, Chrysa; Zarogoulidis, Paul; Tsakiridis, Kosmas; Charalampidis, Charalampos

    2016-11-01

    Benign tracheal stenosis is situation that occurs usually after stress is applied to a certain area in the trachea during the intubation of a patient or inflammation caused during an infection. In the current case report we will present a 65-year-old man with a benign tracheal stenosis due to a 15-day intubation with a high pressure and low volume intubation tube. Current methodology was applied in his case with an excellent result with a 1-year follow up. Cryotherapy, electrocautery-knife, balloon dilation and semi-rigid bronchoscopic technique were applied. Currently there are several techniques that can be used by pulmonary physicians or ear, nose and throat experts. It remains for the treating physician to choose its method based on his training, equipment and tissue damage.

  3. MUTATION OF p53 GENE IN TRANSFORMED RAT TRACHEAL EPITHELIAL CELLS INDUCED BY RADIATION

    Institute of Scientific and Technical Information of China (English)

    赵永良; 吴德昌; 刘国廉; 项晓琼

    1998-01-01

    The highly conserved domain (exon 5-8) of p53 gene in transformed rat tracheal epithelial (RTE) cells was analyzed by means of polymerase chain reaction and single strand conformation polymorphism (PCR-SSCP). The result showed that single strand of exon 8 gene had mobility shift in polyacrylamide nondenaturing gel. DNA sequencing proved the mutation was G→C transversion at condon 265.

  4. Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placement

    OpenAIRE

    Wojtczak, Jacek A.; Davide Cattano

    2014-01-01

    Waveform capnography was recommended as the most reliable method to confirm correct endotracheal tube or laryngeal mask airway placements. However, capnography may be unreliable during cardiopulmonary resuscitation and during low flow states. It may lead to an unnecessary removal of a well-placed endotracheal tube, re-intubation and interruption of chest compressions. Real-time upper airway (laryngo-tracheal) ultrasonography to confirm correct endotracheal tube placement was sh...

  5. BMI as a Predictor for Potential Difficult Tracheal Intubation in Males

    Directory of Open Access Journals (Sweden)

    Alberto A Uribe

    2015-06-01

    Full Text Available Introduction: Difficult tracheal intubation is a common source of mortality and morbidity insurgical and critical care settings. The incidence reported of difficult tracheal intubation is 0.1 to 13%and reaches 14% in the obese population. The objective of our retrospective study was to investigateand compare the utility of BMI as indicator of difficult tracheal intubation in males and females.Material and methods: We performed a retrospective chart review of patients who underwentabdominal surgeries with ASA I to V under general anesthesia requiring endotracheal intubation. Thefollowing information was obtained from medical records for analysis: gender, age, height, weight,BMI, length of patient stay in the Post Anesthesia Care Unit (PACU, past medical history of sleepapnea, Mallampati score, and the ASA classification assigned by the anesthesia care providerperforming the endotracheal intubation.Results: Of 4303 adult patients, 1970 (45.8% men and 2333 (54.2% women, were enrolled in thestudy. Within this group, a total of 1673 (38.9% patients were morbidly obese. The average age of thestudy group was 51.4 ± 15.8 and the average BMI was 29.7 ± 8.2 kg/m². The overall incidence of theencountered difficult intubations was 5.23%, or 225 subjects. Thus, our results indicate that BMI is areliable predictor of difficult tracheal intubation predominantly in the male population; another strongpredictor, with a positive linear correlation, being the Mallampati score.Conclusions: In conclusion, our data shows that BMI is a reliable indicator of potential difficult trachealintubation only in male surgical patients.

  6. The effect of lidocaine on neutrophil respiratory burst during induction of general anaesthesia and tracheal intubation.

    LENUS (Irish Health Repository)

    Swanton, B J

    2012-02-03

    BACKGROUND AND OBJECTIVE: Respiratory burst is an essential component of the neutrophil\\'s biocidal function. In vitro, sodium thiopental, isoflurane and lidocaine each inhibit neutrophil respiratory burst. The objectives of this study were (a) to determine the effect of a standard clinical induction\\/tracheal intubation sequence on neutrophil respiratory burst and (b) to determine the effect of intravenous lidocaine administration during induction of anaesthesia on neutrophil respiratory burst. METHODS: Twenty ASA I and II patients, aged 18-60 years, undergoing elective surgery were studied. After induction of anaesthesia [fentanyl (2 microg kg-1), thiopental (4-6 mg kg-1), isoflurane (end-tidal concentration 0.5-1.5%) in nitrous oxide (66%) and oxygen], patients randomly received either lidocaine 1.5 mg kg-1 (group L) or 0.9% saline (group S) prior to tracheal intubation. Neutrophil respiratory burst was measured immediately prior to induction of anaesthesia, immediately before and 1 and 5 min after lidocaine\\/saline. RESULTS: Neutrophil respiratory burst decreased significantly after induction of anaesthesia in both groups [87.4 +\\/- 8.2% (group L) and 88.5 +\\/- 13.4% (group S) of preinduction level (P < 0.01 both groups)]. After intravenous lidocaine (but not saline) administration, neutrophil respiratory burst returned towards preinduction levels, both before (97.1 +\\/- 23.6%) and after (94.4 +\\/- 16.6%) tracheal intubation. CONCLUSION: Induction of anaesthesia and tracheal intubation using thiopentone and isoflurane, inhibit neutrophil respiratory burst. This effect may be diminished by the administration of lidocaine.

  7. Dexmedetomidine for tracheal extubation in deeply anesthetized adult patients after otologic surgery: a comparison with remifentanil.

    Science.gov (United States)

    Fan, Qing; Hu, Chunbo; Ye, Min; Shen, Xia

    2015-07-23

    Remifentanil and dexmedetomidine are well known to suppress airway reflexes during airway procedures. Smooth tracheal extubation is important after otologic surgery. The purpose of this study is to compare the effectiveness of dexmedetomidine or remifentanil infusion for producing smooth tracheal extubation in deeply anesthetized patients after otologic surgery. Seventy-four ASA I-II adult patients (18-60 years old) scheduled for elective otologic surgery were randomly assigned to one of three groups: sevoflurane-remifentanil (Group SR, n = 25), sevoflurane-dexmedetomidine (0.5 μg/kg) (Group SD5, n = 24), or sevoflurane-dexmedetomidine (0.7 μg/kg) (Group SD7, n = 25). Remifentanil or dexmedetomidine were administered for 10 min at the end of surgery. The primary outcome was the rate of smooth extubation. Respiratory pattern, airway obstruction, hemodynamic and respiratory profiles, time to awake, rescue analgesics in the post-anesthesia care unit (PACU), and postoperative nausea and vomiting (PONV) were also recorded. The rate of smooth tracheal extubation as defined 1 min post-extubation was the same for Groups SR and SD7 (P > 0.05), but the rate of smooth extubation was lower for Group SD5 than for the other two groups (p  0.05), but the mean arterial pressure and heart rate were higher in Group SR at 10 and 15 min after extubation (p awake were comparable for all groups (p > 0.05). The need for rescue analgesic in the PACU was more common in Group SR than in both dexmedetomidine groups (P MAC sevoflurane, dexmedetomidine 0.7 ug/kg and remifentanil provided similar rates for smooth tracheal extubation in spontaneously breathing, anesthetized adults. Dexmedetomidine exhibited opioid-sparing effects postoperatively and was associated with less PONV than remifentanil.

  8. [Chronic cough and worsening dyspnea: a case of idiopathic tracheal stenosis].

    Science.gov (United States)

    Conti, Valentina; Calia, Nunzio; Pasquini, Claudio; Zardi, Silvia; Finetti, Cinzia; Stomeo, Francesco; Ravenna, Franco

    2013-04-01

    We report a case of idiopathic tracheal stenosis in a 75-year-old woman, who presented to our observation with a diagnosis of asthmatic bronchitis characterized by cough and exertional dyspnea, later complicated by the appearance of tirage. Biopsy of the lesion showed focal squamous metaplasia of the epithelium lining, multiple sclerosis and chronic inflammatory infiltration of the corium. The patient was treated with endoscopic destruction via rigid bronchoscopy, through the combined action of YAG laser and mechanical debulking.

  9. Effect of tobacco smoke exposure on rat tracheal submucosal glands: an ultrastructural study

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, D.J.; Jakins, P.R.

    1981-08-01

    The ultrastructural appearance of rat tracheal submucosal glands after exposure to tobacco smoke for up to two years is described. Within the mucous cells many of the rough endoplasmic reticulum cisternae were grossly dilated with an accumulation of amorphous, electron-lucent material. The Golgi zones were prominent, and the secretion granules often contained dense cores, and appeared to have coalesced. Histochemically, increased amounts of sulphated mucus were present in exposed rats. Serous, ciliated, and myoepithelial cells were unaffected by smoke exposure.

  10. Effects of ozone on the cholinergic secretory responsiveness of ferret tracheal glands

    Energy Technology Data Exchange (ETDEWEB)

    McBride, R.K.; Oberdoerster, G.; Marin, M.G. (Univ. of Rochester School of Medicine and Dentistry, NY (USA))

    1991-06-01

    Oxidant air pollutants exacerbate several pulmonary diseases. Inhalation of ozone has been shown to induce airway smooth muscle hyperresponsiveness. Oxidant injury could also affect airway secretory mechanisms. The authors postulated that oxidant exposure would alter the glycoconjugate secretory function of airway submucosal glands. To test this hypothesis they examined the effects of in vivo ozone exposure on the in vitro secretory responsiveness of ferret tracheal glands. Ferrets were exposed to 1 ppm ozone, 24 hr/day for 3 or 7 days. Following exposure, glandular explants, denuded of surface epithelial cells, were prepared and incubated in medium containing 3H-glucosamine for 18 hr. Basal secretion of labeled glycoconjugates was significantly increased 31% following 3 days of ozone exposure (P less than or equal to 0.05) and remained elevated 11% after 7 days of exposure compared to the air-exposed group. After 3 or 7 days of exposure to ozone, tracheal gland responsiveness to carbachol was increased as indicated by significantly lower EC50 values (log molar concentration) of -6.43 {plus minus} 0.04 (n = 6) and -6.50 {plus minus} 0.11 (n = 5), respectively; compared to -6.20 {plus minus} 0.08 (n = 6) for the air-exposed group. There was no difference in carbachol EC50 values for air and 7-day ozone-exposed animals treated with dexamethasone. Dexamethasone did not attenuate the ozone-induced increase in basal secretion. Tracheal gland responsiveness to {alpha}- or {beta}-adrenergic agonists was not changed by oxidant exposure. These experiments suggest that oxidant injury not only increases basal secretion of respiratory glycoconjugates but also increases tracheal gland sensitivity to a cholinergic agonist.

  11. Bordetella avium Causes Induction of Apoptosis and Nitric Oxide Synthase in Turkey Tracheal Explant Cultures

    OpenAIRE

    Miyamoto, David M.; Ruff, Kristin; Beach, Nathan M.; Dorsey-Oresto, Angella; Masters, Isaac; Temple, Louise M.

    2011-01-01

    Bordetellosis is an upper respiratory disease of turkeys caused by Bordetella avium in which the bacteria attach specifically to ciliated respiratory epithelial cells. Little is known about the mechanisms of pathogenesis of this disease, which has a negative impact in the commercial turkey industry. In this study, we produced a novel explant organ culture system that was able to successfully reproduce pathogenesis of B. avium in vitro, using tracheal tissue derived from 26 day-old turkey embr...

  12. Relaxant effects of Ocimum basilicum on guinea pig tracheal chains and its possible mechanism(s

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Boskabady

    2005-01-01

    Full Text Available Therapeutic effects of Ocimum basilicum on respiratory diseases especially dyspnea have been reported in Iranian ancient medical books. In the present study, the relaxant effects of macerated and soxhlet extracts of this plant on tracheal chains of guinea pigs were evaluated. The relaxant effects of 4 cumulative concentrations of macerated and soxhlet extracts (0.25, 0.5, 0.75 and 1.0 W/V in comparison with saline as negative control and 4 cumulative concentrations of theophylline (0.25, 0.5, 0.75, and 1.0 mM as positive control were examined on precontracted tracheal chains of two groups of 6 guinea pig by 60 mM KCl (group 1 and 10 µM methacholine (group 2. Decrease in contractile tone of tracheal chains was considered as relaxant effect. In group 1 experiments only the last two higher concentrations of theophylline showed significant relaxant effect compared to that of saline (p<0.001 for both concentrations, which were significantly greater than those of macerated and soxhlet extracts (p<0.001 for all cases and in group 2 experiments both macerated and soxhlet extracts showed concentrationdependent relaxant effects compared to that of saline (p<0.05 to p<0.001 for both extracts. There were significant differences between the relaxant effects of both extracts with those of theophylline in group 2 experiments (p<0.01 to p<0.001. The relaxant effects of macerated and soxhlet extracts in group 1 were significantly lower than those of groups 2. These results showed a potent relaxant effect of Ocimum basilicum on tracheal chains of guinea pigs which were lower than theophylline at concentrations used.

  13. Removal of the stylet from the tracheal tube: effect of lubrication.

    Science.gov (United States)

    Taylor, A M; Hung, O R; Kwofie, K; Hung, C R; Hung, D R; Guzzo, A

    2012-08-01

    We compared the work needed to retract a non-lubricated and a lubricated stylet from a tracheal tube over 24 h. Stylets were lubricated with sterile water, silicone fluid, lidocaine spray, lidocaine gel, MedPro(®) lubricating gel or Lacri-Lube(®). The mean (SD) work in joules needed to retract the stylet by 5 cm from the tracheal tube was recorded immediately (time 0), at 5 and 30 min and at 1, 3 and 24 h. At time 0 lubrication with sterile water (0.53 (0.09); p = 0.001), silicone fluid (0.43 (0.10); p lubrication (0.94 (0.28)). Where a tracheal tube is pre-loaded with a stylet for use at an indeterminate time, silicone fluid was the best choice of lubricant as it performed consistently well up to 24 h. At 24 h only silicone fluid (0.49 (0.01)) outperformed no lubrication (0.77 (0.24); p = 0.04).

  14. Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopes--a manikin study.

    LENUS (Irish Health Repository)

    Maharaj, Chrisen H

    2006-11-01

    The Airtraq laryngoscope is a novel intubation device that may possess advantages over conventional direct laryngoscopes for use by personnel that are infrequently required to perform tracheal intubation. We conducted a prospective study in 20 medical residents with little prior airway management experience. After brief didactic instruction, each participant took turns performing laryngoscopy and intubation using the Macintosh (Welch Allyn, Welch Allyn, NY) and Airtraq (Prodol Ltd. Vizcaya, Spain) devices, in 3 laryngoscopy scenarios in a Laerdal Intubation Trainer (Laerdal, Stavanger, Norway) and 1 scenario in a Laerdal SimMan manikin (Laerdal, Kent, UK). They then performed tracheal intubation of the normal airway a second time to characterize the learning curve. In all scenarios tested, the Airtraq decreased the duration of intubation attempts, reduced the number of optimization maneuvers required, and reduced the potential for dental trauma. The residents found the Airtraq easier to use in all scenarios compared with the Macintosh laryngoscope. The Airtraq may constitute a superior device for use by personnel infrequently required to perform tracheal intubation.

  15. Myosin Id is required for planar cell polarity in ciliated tracheal and ependymal epithelial cells.

    Science.gov (United States)

    Hegan, Peter S; Ostertag, Eric; Geurts, Aron M; Mooseker, Mark S

    2015-10-01

    In wild type (WT) tracheal epithelial cells, ciliary basal bodies are oriented such that all cilia on the cell surface beat in the same upward direction. This precise alignment of basal bodies and, as a result, the ciliary axoneme, is termed rotational planar cell polarity (PCP). Rotational PCP in the multi-ciliated epithelial cells of the trachea is perturbed in rats lacking myosin Id (Myo1d). Myo1d is localized in the F-actin and basal body rich subapical cortex of the ciliated tracheal epithelial cell. Scanning and transmission electron microscopy of Myo1d knock out (KO) trachea revealed that the unidirectional bending pattern is disrupted. Instead, cilia splay out in a disordered, often radial pattern. Measurement of the alignment axis of the central pair axonemal microtubules was much more variable in the KO, another indicator that rotational PCP is perturbed. The asymmetric localization of the PCP core protein Vangl1 is lost. Both the velocity and linearity of cilia-driven movement of beads above the tracheal mucosal surface was impaired in the Myo1d KO. Multi-ciliated brain ependymal epithelial cells exhibit a second form of PCP termed translational PCP in which basal bodies and attached cilia are clustered at the anterior side of the cell. The precise asymmetric clustering of cilia is disrupted in the ependymal cells of the Myo1d KO rat. While basal body clustering is maintained, left-right positioning of the clusters is lost.

  16. Video-assisted instruction improves the success rate for tracheal intubation by novices.

    Science.gov (United States)

    Howard-Quijano, K J; Huang, Y M; Matevosian, R; Kaplan, M B; Steadman, R H

    2008-10-01

    Tracheal intubation via laryngoscopy is a fundamental skill, particularly for anaesthesiologists. However, teaching this skill is difficult since direct laryngoscopy allows only one individual to view the larynx during the procedure. The purpose of this study was to determine if video-assisted laryngoscopy improves the effectiveness of tracheal intubation training. In this prospective, randomized, crossover study, 37 novices with less than six prior intubation attempts were randomized into two groups, video-assisted followed by traditional instruction (Group V/T) and traditional instruction followed by video-assisted instruction (Group T/V). Novices performed intubations on three patients, switched groups, and performed three more intubations. All trainees received feedback during the procedure from an attending anaesthesiologist based on standard cues. Additionally, during the video-assisted part of the study, the supervising anaesthesiologist incorporated feedback based on the video images obtained from the fibreoptic camera located in the laryngoscope. During video-assisted instruction, novices were successful at 69% of their intubation attempts whereas those trained during the non-video-assisted portion were successful in 55% of their attempts (P=0.04). Oesophageal intubations occurred in 3% of video-assisted intubation attempts and in 17% of traditional attempts (Pvideo laryngoscopy for tracheal intubation training.

  17. Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

    DEFF Research Database (Denmark)

    Rokamp, K.Z.; Secher, N.H.; Møller, Ann;

    2010-01-01

    ABSTRACT: BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without...... the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. RESULTS: In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54...... patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure...

  18. Clinical significance of differentiating post-intubation and post-tracheostomy tracheal stenosis.

    Science.gov (United States)

    Shin, Beomsu; Kim, Kang; Jeong, Byeong-Ho; Eom, Jung Seop; Song, Won Jun; Kang, Hyung Koo; Kim, Hojoong

    2017-04-01

    Post-intubation tracheal stenosis (PITS) and post-tracheostomy tracheal stenosis (PTTS) are serious complications in mechanically ventilated patients. Although the aetiologies and mechanisms of PITS and PTTS are quite different, little is known about the clinical impact of differentiating one from the other. We retrospectively conducted a chart review of 117 patients with PITS and 88 patients with PTTS who were treated with interventional bronchoscopy at Samsung Medical Center between January 2004 and December 2013. Compared to patients with PITS, patients with PTTS had a lower BMI, poorer performance status and more frequent neurological aetiologies, mid-to-lower tracheal lesions, total obstruction and mixed stenosis types. Although there were no differences in the number of patients who received silicone stents between the two groups, Montgomery T-tubes were more frequently used in the PTTS group than in the PITS group. The final success rate without surgery, mortality or tracheostomy in situ was higher in the PITS group than in the PTTS group (76.9% vs 63.6%, P = 0.043). Additionally, airway prosthesis removal was achieved in 46.2% of patients in the PITS group and in 33.0% of the PTTS group (P = 0.063). There were significant differences between PITS and PTTS in terms of patient and stenosis characteristics, treatment modalities and clinical outcomes. Therefore, PITS and PTTS should be considered two different entities. © 2016 Asian Pacific Society of Respirology.

  19. Mechanical evaluation of gradient electrospun scaffolds with 3D printed ring reinforcements for tracheal defect repair.

    Science.gov (United States)

    Ott, Lindsey M; Zabel, Taylor A; Walker, Natalie K; Farris, Ashley L; Chakroff, Jason T; Ohst, Devan G; Johnson, Jed K; Gehrke, Steven H; Weatherly, Robert A; Detamore, Michael S

    2016-04-21

    Tracheal stenosis can become a fatal condition, and current treatments include augmentation of the airway with autologous tissue. A tissue-engineered approach would not require a donor source, while providing an implant that meets both surgeons' and patients' needs. A fibrous, polymeric scaffold organized in gradient bilayers of polycaprolactone (PCL) and poly-lactic-co-glycolic acid (PLGA) with 3D printed structural ring supports, inspired by the native trachea rings, could meet this need. The purpose of the current study was to characterize the tracheal scaffolds with mechanical testing models to determine the design most suitable for maintaining a patent airway. Degradation over 12 weeks revealed that scaffolds with the 3D printed rings had superior properties in tensile and radial compression, with at least a three fold improvement and 8.5-fold improvement, respectively, relative to the other scaffold groups. The ringed scaffolds produced tensile moduli, radial compressive forces, and burst pressures similar to or exceeding physiological forces and native tissue data. Scaffolds with a thicker PCL component had better suture retention and tube flattening recovery properties, with the monolayer of PCL (PCL-only group) exhibiting a 2.3-fold increase in suture retention strength (SRS). Tracheal scaffolds with ring reinforcements have improved mechanical properties, while the fibrous component increased porosity and cell infiltration potential. These scaffolds may be used to treat various trachea defects (patch or circumferential) and have the potential to be employed in other tissue engineering applications.

  20. [Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)].

    Science.gov (United States)

    López-López, C; Murillo-Pérez, M A; Morales-Sánchez, C; Torrente-Vela, S; Orejana-Martín, M; García-Iglesias, M; Cuenca-Solanas, M; Alted-López, E

    2014-01-01

    To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5 minutes before, meanwhile and 15 minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P.05) were shown. Data for the painless procedure were significantly different on day 6 (P<.05) CONCLUSION: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  1. Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

    Directory of Open Access Journals (Sweden)

    Droissart Raphaël

    2009-11-01

    Full Text Available Abstract Background A gastro-tracheal fistula following esophagectomy for cancer is a rare but potentially lethal complication. We report the successful surgical closure after failed endoscopic treatment, of a gastro-tracheal fistula following esophago-gastrectomy for cancer after induction chemo-radiotherapy. Case presentation A 58 year-old male patient presented with a distal third uT3N1 carcinoma of the esophagus. After induction chemo-radiotherapy, he underwent an esophago-gastrectomy with radical lymphadenectomy and reconstruction by gastric pull-up. Immediate postoperative outcome was uneventful. On the 15th postoperative day however, our patient was readmitted in the Intensive Care Unit with severe bilateral basal pneumonia. Three days later a gastro-tracheal fistula was diagnosed upon gastroscopy and bronchoscopy. His good general condition allowed for an endoscopic primary approach which consisted in the insertion of a covered stent in the trachea along with clipping and glueing of the gastric fistular orifice. Two attempts proved unsuccessful. Conclusion After several weeks of conservative measures, surgical re-intervention through a right thoracotomy with transection of the fistula and closure by primary interrupted sutures of both fistular orifices along with intercostal muscle flap interposition led to excellent patient outcome. Oral feeding was started and our patient was discharged.

  2. Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

    Directory of Open Access Journals (Sweden)

    Møller Ann M

    2010-12-01

    Full Text Available Abstract Background To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. Method In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. Results In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100 cm H2O and the pressure exceeded 30 cm H2O (upper recommended level for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121 cm H2O and above 60 cm H2O (upper recommended level for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O. There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured. Conclusion For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery.

  3. Aspergillus Tracheobronchitis Causing Subtotal Tracheal Stenosis in a Liver Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Sonia Radunz

    2013-01-01

    Full Text Available Invasive aspergillosis is recognized as one of the most significant opportunistic infections after liver transplantation. Diagnosis of invasive aspergillosis in transplant recipients has been proven to be challenging, and optimal approach to the treatment of invasive aspergillosis is still controversial. We here present an unusual case of Aspergillus tracheobronchitis in the setting of liver transplantation. A 47-year-old female patient with persistent dry cough after liver transplantation developed respiratory insufficiency and was readmitted to the intensive care unit 55 days after liver transplantation. A CT scan revealed subtotal tracheal stenosis; bronchoscopy was performed, and extended white mucus coverings causative of the tracheal stenosis were removed. Microbiological assessment isolated Aspergillus fumigatus. The diagnosis was obstructive Aspergillus tracheobronchitis. The patient was started on a treatment of voriconazole 200 mg orally twice daily, adjusted to a trough level of 1–4 mg/L. For further airway management, a tracheal stent had to be implanted. The patient is alive and well 28 months after liver transplantation. Invasive aspergillosis should be considered a possible etiology in liver transplant patients presenting with unspecific symptoms such as persistent dry cough. Optimal strategies for improved and early diagnosis as well as prophylaxis need to be defined.

  4. 气管异种移植的现状%General situation of tracheal xenotransplantation

    Institute of Scientific and Technical Information of China (English)

    卢涛; 刘愉

    2016-01-01

    Tracheal xenotransplantation is still in the stage of animal experiments and has not been used in clinical practice largely because the problem of immunological rejection following xenotransplantation has not been settled and the ethical dispute is also a controversial issue.The preservation and revascularization of xenografts remain to be solved.The key to success of tracheal xenotransplantation depends on eliminating the immunological rejection.The general situation of tracheal xenotransplantation on its research progress and challenges is introduced in this paper.%气管异种移植目前还处于动物实验阶段,尚不能应用于临床,主要原因是异种气管移植后的免疫排斥问题未能解决,社会伦理学方面还存有争议。移植气管的保存与再血管化也是当前所面临的主要问题。其中,能否解决移植后宿主对气管的免疫排斥是移植成败的关键。该文通过介绍异种气管移植的概况,了解其研究进展及所面临的挑战。

  5. 气管浆细胞瘤的手术治疗及文献复习%Surgical treatment of tracheal extramedullary plasmocytoma and pertinent literature review

    Institute of Scientific and Technical Information of China (English)

    Shanqing Li; Naixin Liang; Hongsheng Liu; Cheng Huang; Yingzhi Qin

    2007-01-01

    Objective:To study the diagnostic method, surgical management and complications of the tracheal malignant tumor, as well as the characteristics of plasmocytoma. Methods:One patient with tracheal plasmocytoma and pertinent literature were analyzed retrospectively. Results:Resection of the tracheal tumor and reconstruction of the trachea were performed successfully in this case, and the pathological diagnosis is plasmocytoma. Conclusion:The nature, location and extent of tracheal tumor are precisely determined from radiologic studies before resection, as well as tracheal intubation and tracheal anastomosis without tension in operative procedures, are very important for triumphal operation. Even extramedullary plasmocytoma may occur in a lot of organs, but the incidence of it is rare. Both surgery and radiotherapy are cardinal methods for extramedullary plasmocytoma.

  6. Ascorbic acid inhibits the squamous metaplasia that results from treatment of tracheal explants with asbestos or benzo[a]pyrene-coated asbestos.

    Science.gov (United States)

    Holtz, G; Bresnick, E

    1988-01-01

    Hamster tracheal explants were maintained in culture in the presence or absence of benzo[a]pyrene (BP), crocidolite asbestos, or BP-coated crocidolite. Dose-dependent squamous metaplasia was observed in the treated samples. L-Ascorbic acid and DL-alpha-tocopherol were able to partially protect the tracheal explants from the metaplastic response induced by crocidolite. Furthermore, ascorbic acid reduced the extent of metaplasia observed in hamster tracheal explants that were exposed to BP-crocidolite.

  7. Effect of rocuronium on the bispectral index under anesthesia and tracheal intubation

    Science.gov (United States)

    Yue, Hui; Han, Jinyu; Liu, Ling; Wang, Kaiyuan; Li, Jincheng

    2016-01-01

    The aim of the present study was to investigate the effect of various doses of rocuronium on bispectral index (BIS) responses to propofol induction and tracheal intubation, as well as the role of the non-depolarization muscle relaxant rocuronium on the depth of sedation. A total of 72 patients (American Society of Anesthesiologists physical status I–II) were anaesthetized with propofol using a target-controlled infusion, and randomly divided into two sedation level groups (n=36). The patients were divided into 2 groups according to the BIS value: A normal sedation group (group 1), with a stable BIS value at 40–60, and a deep sedation group (group 2), with a BIS value <20 or with burst suppression. Each group was randomly divided into 4 subgroups A-D (n=9) according to the various doses of rocuronium (0.3, 0.6, 0.9 and 1.2 mg/kg). Tracheal intubation was performed after 2 min of rocuronium administration. BIS, electromyography (EMG), heart rate (HR) and mean arterial pressure (MAP) were recorded continuously and averaged over 1 min during baseline (T1), steady state (T2), 2 min after rocuronium infusion (T3), and 0, 2 and 5 min after tracheal intubation. The results demonstrated that HR and MAP decreased significantly at T2 and T3 compared with T1. Following tracheal intubation (L0), HR and MAP significantly increased compared with T2 and T3, and returned to levels similar to those prior to intubation after 5 min. In group 1C and 1D, BIS was significantly decreased at T3 compared with T2; BIS was significantly increased at L0 compared with T3 in group 1A and 1B. EMG at earlier stages of anesthesia was significantly higher compared with other points, and was significantly increased at L0 compared with T3 in group 1A and 1B. These results demonstrated that BIS response may be associated with the dosage of rocuronium in the normal sedation group, although no association was observed with the deep sedation group. Tracheal intubation resulted in marked hemodynamic

  8. [Therapeutic bronchoscopic treatment of postintubation tracheal stenosis: 5 cases].

    Science.gov (United States)

    Karakoca, Yalçin; Karaağaç, Güler; Karakoca, Sevinay; Yildiz, Tülay; Yazanel, Orhan; Sariman, Nesrin; Yildiz, M Erdem; Tekinsoy, Bülent

    2004-01-01

    Benign airway obstruction is known as curable by therapeutic bronchoscopic methods. Compared by surgical therapies it is comfortable and has no risks for the patients. For five patients who applied our clinic after tracheostomy and endotracheal intubation stenosis we used therapeutic bronchoscopic methods; "laser-stenotic silicon stent". In two patients after vaporization of membranous stricture by Neodimum Yttrium Aliminum Pevroskite Laser (Nd-YAP laser) who were seen posttracheostomy and postentubation; stenotic stent was implanted mechanically and/or by means of baloon dilatation. Membranous stricture area was coagulated by Nd-YAP-laser in other three cases and anatomic airway diameter was achieved mechanically and by baloon dilatation. In the follow up period we applied stenotic silicon stent implantation after second laser resection in whom restenosis observed. In conclusion; patients who had stenotic silicon stent implantation and having no problems in the follow up this therapeutic method is found to be curative.

  9. Biocompatibility of a new device of self-expandable covered and non-covered tracheal stent: comparative study in rats

    Directory of Open Access Journals (Sweden)

    Olavo Ribeiro Rodrigues

    2013-01-01

    Full Text Available PURPOSE: To investigate the compatibility of a new model of self-expandable tracheal stent in rats. METHODS: A new device of polyurethane covered and non - covered stent was placed in the trachea of Wistar rats. Animals were distributed in two groups: the polyurethane covered and non-covered group. Macroscopic parameters included position within the tracheal lumen, adherence to the mucosa, degree of dilatation, permeability and internal diameter. Microscopic findings evaluated were: incorporation, inflammatory activity, granulation tissue and epithelial revetment injuries. The observation follow-up was six weeks. All parameters were quantified based on determined score values. Incorporation of the stents was evaluated based on the observation if the stent was fixed into the trachea or if it could be removed. Degree of dilatation was performed by external diameter measurements. Granulation tissue was evaluated by measurements of height of the tissue growing into the tracheal lumen. RESULTS: 100% of non-covered stents had total attachment to mucosa and 100% of polyurethane covered type had adherence only. Regarding dilatation, granulation tissue, inflammatory activity and internal diameter measurements, there were no significant differences between the groups. Pathological tracheal wall injuries were present in both groups. CONCLUSION: Both models of stent demonstrated biocompatibility with the trachea. Rats are suitable for an experimental model of tracheal stent study.

  10. A prospective randomised controlled trial of the LMA Supreme vs cuffed tracheal tube as the airway device during percutaneous tracheostomy.

    Science.gov (United States)

    Price, G C; McLellan, S; Paterson, R L; Hay, A

    2014-07-01

    We studied the performance of the LMA Supreme against a cuffed tracheal tube, our standard method of airway control during percutaneous tracheostomy, in 50 consecutive patients from three general critical care units. The primary outcome measure was adequacy of ventilation calculated as the difference in arterial carbon dioxide tension before and after tracheostomy. On an intention-to-treat analysis, there was no difference in the increase in arterial carbon dioxide tension between groups, with a median (IQR [range]) for the LMA Supreme of 0.9 (0.3-1.6 [0-2.8]) kPa, and for the tracheal tube of 0.8 (0.4-1.2 [0-2.5]) kPa, p = 0.82. Eight patients out of 25 (32%) crossed over from the LMA Supreme group to the tracheal tube group before commencement of tracheostomy due to airway or ventilation problems, compared with none out of 25 in the tracheal tube group, p = 0.01, and tracheostomy was postponed in two patients in the LMA Supreme group due to poor oxygenation. There were more clinically important complications in the LMA Supreme group compared with the tracheal tube group.

  11. Inflammatory Mediators in Tracheal Aspirates of Preterm Infants Participating in a Randomized Trial of Inhaled Nitric Oxide

    Science.gov (United States)

    Amann, Elena; Uhlig, Ulrike; Yang, Yang; Fuchs, Hans W.; Zemlin, Michael; Mercier, Jean-Christophe; Maier, Rolf F.; Hummler, Helmut D.; Uhlig, Stefan; Thome, Ulrich H.

    2017-01-01

    Background Ventilated preterm infants frequently develop bronchopulmonary dysplasia (BPD) which is associated with elevated inflammatory mediators in their tracheal aspirates (TA). In animal models of BPD, inhaled nitric oxide (iNO) has been shown to reduce lung inflammation, but data for human preterm infants is missing. Methods Within a European multicenter trial of NO inhalation for preterm infants to prevent BPD (EUNO), TA was collected to determine the effects of iNO on pulmonary inflammation. TA was collected from 43 premature infants randomly assigned to receive either iNO or placebo gas (birth weight 530–1230 g, median 800 g, gestational age 24 to 28 2/7 weeks, median 26 weeks). Interleukin (IL)-1β, IL-6, IL-8, transforming growth factor (TGF)-β1, interferon γ-induced protein 10 (IP-10), macrophage inflammatory protein (MIP)-1α, acid sphingomyelinase (ASM), neuropeptide Y and leukotriene B4 were measured in serial TA samples from postnatal day 2 to 14. Furthermore, TA levels of nitrotyrosine and nitrite were determined under iNO therapy. Results The TA levels of IP-10, IL-6, IL-8, MIP-1α, IL-1β, ASM and albumin increased with advancing postnatal age in critically ill preterm infants, whereas nitrotyrosine TA levels declined in both, iNO-treated and placebo-treated infants. The iNO treatment generally increased nitrite TA levels, whereas nitrotyrosine TA levels were not affected by iNO treatment. Furthermore, iNO treatment transiently reduced early inflammatory and fibrotic markers associated with BPD development including TGF-β1, IP-10 and IL-8, but induced a delayed increase of ASM TA levels. Conclusion Treatment with iNO may have played a role in reducing several inflammatory and fibrotic mediators in TA of preterm infants compared to placebo-treated infants. However, survival without BPD was not affected in the main EUNO trial. Trial registration NCT00551642 PMID:28046032

  12. The relationships between tracheal index and lung volume parameters in mild-to-moderate COPD

    Energy Technology Data Exchange (ETDEWEB)

    Eom, Jung Seop, E-mail: ejs00@hanmail.net [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Lee, Geewon, E-mail: rabkingdom@naver.com [Department of Radiology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739 (Korea, Republic of); Lee, Ho Yun, E-mail: hoyunlee96@gmail.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Oh, Jin Young, E-mail: indr71@hanmail.net [Division of Pulmonology, Department of Internal Medicine, Dongguk University Ilsan Medical Center, 814 Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773 (Korea, Republic of); Woo, Sook-young, E-mail: sookyoung12.woo@samsung.com [Biostatistics Team, Samsung Biomedical Research Institute, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Jeon, Kyeongman, E-mail: kjeon@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Um, Sang-Won, E-mail: sangwonum@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Koh, Won-Jung, E-mail: wjkoh@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); Suh, Gee Young, E-mail: suhgy@skku.edu [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 (Korea, Republic of); and others

    2013-12-01

    Background: Although elongated morphological changes in the trachea are known to be related to lung function in chronic obstructive pulmonary disease (COPD), whether the tracheal morphological changes are associated with airflow limitations or overinflation of the lung in the early stages of COPD has not yet been determined. Thus, our aim was to investigate the association of tracheal index (TI) with lung function parameters, including lung volume parameters, in COPD patients with mild-to-moderate airflow limitations. Materials and methods: A retrospective study was conducted in 193 COPD patients with GOLD grades 1–2 (post-bronchodilator forced expiratory volume in 1 s [FEV{sub 1}] ≥ 50% predicted with FEV{sub 1}/forced vital capacity ratio ≤ 70%; age range, 40–81) and 193 age- and gender-matched subjects with normal lung function as a control group (age range, 40–82). Two independent observers measured TI at three anatomical levels on chest radiographs and CT scans. Results: Compared with the control group, TI was reduced significantly and “saber-sheath trachea” was observed more frequently in COPD patients. Patients with GOLD grade 2 disease had a lower TI than those with GOLD grade 1. TI had apparent inverse correlations with total lung capacity, functional residual capacity, and residual volume, regardless of the anatomical level of the trachea. Even after adjustments for covariates, this association persisted. Conclusions: TI is reduced even in mild-to-moderate COPD patients, and TI measured on chest CT shows significant inverse relationships with all lung volume parameters assessed, suggesting that tracheal morphology may change during the early stages of COPD.

  13. Tracheal size variability is associated with sex: implications for endotracheal tube selection.

    Science.gov (United States)

    Karmakar, Arunabha; Pate, Mariah B; Solowski, Nancy L; Postma, Gregory N; Weinberger, Paul M

    2015-02-01

    Whereas selection of endotracheal tube (ETT) size in pediatric patients benefits from predictive nomograms, adult ETT sizing is relatively arbitrary. We sought to determine associations between cervical tracheal cross-sectional area (CTCSA) and clinical variables. One hundred thirty-two consecutive patients undergoing noncontrasted chest computed tomography (CT) at a single tertiary care institution from January 2010 to June 2011 were reviewed. Patients with improper CT technique, endotracheal intubation, and pulmonary/tracheal pathology were excluded. Tracheal luminal diameters in anteroposterior (D1) and transverse (D2) were measured 2 cm inferior to the cricoid and used to determine CTCSA = π*D1*D2*¼. The demographic variables of age, height, weight, and body mass index (BMI) were tested for association with CTCSA by Spearman correlation. Wilcoxon rank-sum test was used to compare CTCSA by race and sex. Multivariate linear regression was performed including all clinical variables. There were 91 patients who met inclusion criteria. There was no correlation between age, weight, or BMI and CTCSA. There was a significant positive correlation between patient height and CTCSA (P = .001, R = 0.35); however, this was confounded by sex. Female patients had significantly smaller CTCSA (mean = 241 mm(2)) compared to male patients (mean = 349 mm(2), P < .001). Multivariate linear regression stratified by sex revealed that height is correlated with CTCSA only in males (P = .028). Males also had more variability in CTCSA (SD 118.6) compared to females (SD 65.5). Our data suggest that selection of ETT size in male patients should include height as a predictive factor. For female patients, it may be appropriate to select a uniformly smaller diameter ETT size. © The Author(s) 2014.

  14. Cocaine residue in plasma, cardiac and tracheal tissues of chronic cocaine-treated guinea-pigs

    Directory of Open Access Journals (Sweden)

    Malinee Wongnawa

    2010-03-01

    Full Text Available Supersensitivity of adrenoceptors to catecholamines is one of the mechanisms of cocaine-related cardiac complication. The precise mechanism of cocaine enhancing supersensitivity of adrenoceptors is unconcluded. The aim of this study was todetermine the levels of cocaine in plasma, cardiac and tracheal tissues in order to correlate with the supersensitivity ofadrenoceptors to catecholamines. In this study, two groups of ten guinea-pigs each were injected with 2.5 mg/kg cocaine or normal saline solution intraperitoneally twice daily for 14 days. After 24 hours of cocaine cessation, the cocaine levels in plasma, cardiac and tracheal tissues were determined using high performance liquid chromatography. The results showed that the cocaine levels in plasma and tracheal smooth muscle were 5.08±0.63 ng/ml and 2.8±0.41 ng/mg, respectively, while those in atria and ventricle were lower than 17.5 ng/g and 3.8 ng/g, respectively. These levels were less than the level that had been reported to block norepinephrine uptake (more than 30.34 ng/ml. Moreover, it had been demonstrated that cocainetreatment in the same condition as the present study produced supersensitivity to norepinephrine and epinephrine in isolatedguinea-pig atria as well as in trachea which is almost entirely not innervated by the adrenergic nerves. In addition, supersensitivityto oxymetazoline, isoproterenol and salbutamol which are not the substrates of neuronal reuptake were also demonstrated. All these data support the postsynaptic mechanism of cocaine enhancing supersensitivity which might be correlated with cardiac complication in chronic cocaine use.

  15. Tracheal sounds and airflow dynamics in surgically treated unilateral vocal fold paralysis.

    Science.gov (United States)

    Saarinen, A; Rihkanen, H; Malmberg, L P; Pekkanen, L; Sovijärvi, A R

    2001-03-01

    The aim of this study was to investigate the changes in tracheal sounds and airflow dynamics in patients who underwent surgical medialization of a unilaterally paralysed vocal fold. Ten adults with unilateral vocal fold paralysis but no history of pulmonary diseases were included. Vocal fold medialization was performed by an injection of autologous fascia into the paralysed vocal fold. Recording of tracheal sounds, flow-volume spirometry and body plethysmography were carried out before and 4-14 months after the operation. The mean number of inspiratory wheezes per respiratory cycle increased from 0.02 (range 0-0.10) to 0.42 (range 0-0.86) and the mean number of expiratory wheezes per respiratory cycle from 0.03 (range 0-0.20) to 0.36 (range 0-0.89). The increment was statistically significant (P=0.03 and P=0.04, respectively). The mean expiratory sound amplitude, in terms of root mean square (RMS), increased from 31.5 dB (range 24.0-38.0) to 34.9 dB (range 25-42) (P=0.03) and the average peak inspiratory flow (PIF) decreased from 4.63 l s-1 (range 2.84-7.51) to 4.03 l s-1 (range 2.27-6.68) (P=0.01). The results indicate that when the paralysed vocal fold is brought into midline by a surgical procedure, the prevalence of inspiratory and expiratory wheezes increases and sound intensity rises. According to this preliminary data tracheal sound analysis gives additional information for the assessment of the subtle changes in the larynx.

  16. Extracellular matrix-dependent differentiation of rabbit tracheal epithelial cells in primary culture.

    Science.gov (United States)

    Baeza-Squiban, A; Boisvieux-Ulrich, E; Guilianelli, C; Houcine, O; Geraud, G; Guennou, C; Marano, F

    1994-01-01

    The differentiation of tracheal epithelial cells in primary culture was investigated according to the nature of the extracellular matrix used. Cultures obtained by the explant technique were realized on a type I collagen substratum either as a thin, dried coating or as a thick, hydrated gel supplemented with culture medium and serum. These two types of substratum induced distinct cell morphology and cytokeratin expression in the explant derived cells. Where cells are less proliferating (from Day 7 to 10 of culture), differentiation was evaluated by morphologic ultrastructural observations, immunocytochemical detection of cytokeratins, and determination of cytokeratin pattern by biochemical analysis. The epithelium obtained on gel was multilayered, with small, round basal cells under large, flattened upper cells. The determination of the keratin pattern expressed by cells grown on gel revealed an expression of keratin 13, already considered as a specific marker of squamous metaplasia, that diminished with retinoic acid treatment. Present results demonstrated by confocal microscopy that K13-positive cells were large upper cells with a dense keratin network, whereas lower cells were positively stained with a specific monoclonal antibody to basal cells (KB37). Moreover, keratin neosynthesis analysis pointed out a higher expression of K6, a marker of hyperproliferation, on gel than on coating. All these data suggest a differentiation of rabbit tracheal epithelial cells grown on gel toward squamous metaplasia. By contrast, the epithelium observed on coating is nearly a monolayer of very large and spread out cells. No K13-positive cells were observed, but an increase in the synthesis of simple epithelium marker (K18) was detected. These two substrata, similar in composition and different in structure, induce separate differentiation and appear as good tools to explore the mechanisms of differentiation of epithelial tracheal cells.

  17. Agonal gasps of cardiac arrest victim can aid in confirming tracheal intubation using Umesh's intubation detector.

    Science.gov (United States)

    Umesh, Goneppanavar; Magazine, Rahul

    2013-09-01

    Several patients of cardiac arrest may be found in a state of agonal gasps that are of insufficient tidal volume and are not considered as a sign of life. However, this volume is sufficient enough to cause appreciable inflation and deflation of the reservoir bag of Umesh's intubation detector (UID) as evidenced in all 12 victims of cardiac arrest with gasping efforts in this study. Therefore, we conclude that the agonal gasps during cardiac arrest can reliably be used to confirm tracheal intubation using the UID device. Copyright © 2013. Published by Elsevier B.V.

  18. Paclitaxel Drug-eluting Tracheal Stent Could Reduce Granulation Tissue Formation in a Canine Model

    Institute of Scientific and Technical Information of China (English)

    Ting Wang; Jie Zhang; Juan Wang; Ying-Hua Pei; Xiao-Jian Qiu; Yu-Ling Wang

    2016-01-01

    Background:Currently available silicone and metallic stents for tracheal stenosis are associated with many problems.Granulation proliferation is one of the main complications.The present study aimed to evaluate the efficacy of paclitaxel drug-eluting tracheal stent in reducing granulation tissue formation in a canine model,as well as the pharmacokinetic features and safety profiles of the coated drug.Methods:Eight beagles were randomly divided into a control group (bare-metal stent group,n =4) and an experimental group (paclitaxel-eluting stent group,n =4).The observation period was 5 months.One beagle in both groups was sacrificed at the end of the 1st and 3rd months,respectively.The last two beagles in both groups were sacrificed at the end of 5th month.The proliferation of granulation tissue and changes in tracheal mucosa were compared between the two groups.Blood routine and liver and kidney function were monitored to evaluate the safety of the paclitaxel-eluting stent.The elution method and high-performance liquid chromatography were used to characterize the rate of in vivo release of paclitaxel from the stent.Results:Compared with the control group,the proliferation of granulation tissue in the experimental group was significantly reduced.The drug release of paclitaxel-eluting stent was the fastest in the 1st month after implantation (up to 70.9%).Then,the release slowed down gradually.By the 54 month,the release reached up to 98.5%.During the observation period,a high concentration of the drug in the trachea (in the stented and adjacent unstented areas) and lung tissue was not noted,and the blood test showed no side effect.Conclusions:The paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo,suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.

  19. Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need

    DEFF Research Database (Denmark)

    Rokamp, K.Z.; Secher, N.H.; Møller, Ann

    2010-01-01

    ABSTRACT: BACKGROUND: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. METHOD: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without...... and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured. CONCLUSION: For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked...

  20. An unusual long standing tracheal foreign body – A rare incidence

    Directory of Open Access Journals (Sweden)

    Santosh Kumar Swain

    2015-03-01

    Full Text Available Foreign body (FB inhalation is often encountered by emergent otolaryngology services. A long standing undiagnosed FB in trachea is very rare and lethal. Inhalation of betel nut and presenting at the proximal trachea is rarer. As often in the airway FB gravitate to bronchi, long standing tracheal FB is a rare presentation and also rare in the literature. Children who are not given proper individual attention at an early age are more liable to inhale FB. FB aspiration is associated with significant morbidity.

  1. EFFECTS OF ALFENTANIL AND ESMOLOL ON HEMODYNAMIC AND CATECHOLAMINE RESPONSE TO TRACHEAL INTUBATION

    Institute of Scientific and Technical Information of China (English)

    龚志毅; 罗爱伦

    1999-01-01

    Objective. To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine responsee to tracheal intubation.Mahods. Thirty-five adult patients were randomly allocated to one of three groups, Group A (control group), Group B (esmolol groap) and Group C (alfentanil group). The patients received either 2 mg/kg esmolol (in Group B) or 30μg/kg alfentanil (in Group C) before intulmtion. Tracheal intubation was performed with 4 mg/kg thiopental and 0. 1 mg/kg vecuronium and 3% isoflurane. Systolic blood pressure(SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), norepinephrine(NE),epinephrine(E) and dopamine (DA) were measured before and after intubtttion.Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0.05),Three min after tracheal intubation,the control group SBP increased to 160±30mmHg and Group B remained at the baseline level ,147±5mmHg,and Goup C significantly decreased to 91±22mmHg(P<0.01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0.05).NE in Groups A and B increased significatly to 5.75±3.51 and 6.75±3.30nmol/L 3 min after intubation(P<0.01).In Group C,3min after intubation NE was not significantly different from the baseline but E becreased significantly(P<0.01).Conclusion.2mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.

  2. EFFECTS OF ALFENTANIL AND ESMOLOL ON HEMODYNAMIC AND CATECHOLMINE RESPONSE TO TRACHEAL INTUBATION

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation.Methods.hiry-five adult patients were randomly allocated to one of three groups,Grup A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(inGroup B)or 30 μg/kg alfentanil(in GroupC)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0.1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(BP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation.Results.The control group had a baeline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0.05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,14±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0.01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of contrl group(P<0.05).NE in Groups A and B increased significantly to 5.75±3.51 and 6.75±3.30 nmol/L 3 min after intubation(P<0.01).In Group C,3 min after intubation NE was not significantly differnt from the basline but E decreased significantly(P<0.01).Conclusion.2 ?g/kg esmolol can moerate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.

  3. Pirenzepine block of ACh-induced mucus secretion in tracheal submucosal gland cells

    Energy Technology Data Exchange (ETDEWEB)

    Farley, J.M.; Dwyer, T.M. (Univ. of Mississippi Medical Center, Jackson (USA))

    1991-01-01

    Muscarinic stimulation of mucus secretion, as measured by the release of ({sup 3}H)glycoprotein, was studied in explants from the tracheal epithelium of weanling swine. The mucus glycoprotein secretion was transient, ceasing within the first 10 min of a continuous exposure to 100 {mu}M ACh. Increasing the solutions' osmotic pressure did not alter basal mucus glycoprotein secretion. Mucus glycoprotein secretion was inhibited by 2-10 {mu}M PZP, indicting that the M{sub 3} muscarinic receptors mediate cholinergic stimulation of mucus production.

  4. A 46-year-old man with tracheomegaly, tracheal diverticulosis, and bronchiectasis: Mounier-Kuhn syndrome

    Directory of Open Access Journals (Sweden)

    Ashish K Jaiswal

    2012-01-01

    Full Text Available Lower respiratory tract infection is one of the common causes of morbidity in India which is occasionally undiagnosed. In this regard tracheobronchomegaly is one of those conditions which masquerade as chronic bronchitis and bronchiectasis and are usually undiagnosed. It is a well-defined clinical and radiologic entity characterized by marked dilatation of the trachea and the central bronchi and is frequently associated with recurrent lower respiratory tract infection. Tracheobronchomegaly has been described by a variety of names, including Mounier-Kuhn syndrome, tracheal diverticulosis, tracheobronchiectasis, tracheocele, tracheomalacia, and tracheobronchopathia malacia.

  5. Comparative efficacy of Combination of Propofol or Thiopental with Remifentanil on Tracheal Intubation without Muscle Relaxants

    Directory of Open Access Journals (Sweden)

    k Naseri

    2007-10-01

    Full Text Available Introduction & Objective: In some medical situations administration of muscle relaxants after intravenous anesthetics for tracheal intubation may be unnecessary or sometimes could be hazardous. In such situations, replacing an alternative drug for the facilitation of tracheal intubation is obvious. Remifentanil is a short acting opioid drug which may be useful in solving this problem. The aim of this study was to compare the effects of propofol or thiopental in combination with remifentanil in the absence of muscle relaxants on larengoscopy and intubation conditions in general anesthesia. Materials & Methods: This is a randomized double-blind clinical trial which was performed in 1386 in Be’sat hospital of Sanandaj. Forty two ASA 1 and 2 patients recruited to receive propofol, 2 Mg/Kg, or thiopental, 5Mg/K. All patients received lidocaine, 1.5 Mg/Kg, and remifentanil, 2.5 µg/Kg, 30 seconds before anesthetics administration. larengoscopy and tracheal intubation were done 90 seconds after induction of anesthesia. On the basis of mask ventilation, jaw relaxation, vocal cords position and patient's response to intubations and endotracheal tube cuff inflation the intubation conditions were assessed and recorded as excellent, good ,acceptable or poor. The mean arterial pressure and heart rate were measured before and after anesthetics administration and also 45 seconds and two and five minutes after intubations. Data were analyzed by X2, fisher exact test ant student T-test using SPSS software. Results: Excellent or good larengoscopy and intubation conditions were observed in 9 (%42.9 of thiopental patients and 20 (%95.2 of propofol patients (p<0.05. Mean arterial pressure and heart rate decreased more significantly in propofol group in comparison with the thiopental group (p<0.05. Conclusion: Combination of remifentanil and propofol or thiopental could facilitate ventilation via face mask in all patients. Although combination of propofol and

  6. Thoracoscopic Surgery for Glomus Tumor: An Uncommon Mediastinal Neoplasm and Iatrogenic Tracheal Rupture

    Science.gov (United States)

    Fang, Zhongjie; Ma, Dehua; Luo, Huarong

    2017-01-01

    Mediastinal glomus tumors are rarely recognized, and only seven cases have been reported in the literature. Here, we describe a rare mediastinal glomus tumor and review the characteristics of this rare clinical case. The patient was a 50-year-old female who presented with coughing for 3 months. Her chest computed tomography scan demonstrated a localized tumor in the posterior superior mediastinum. Intraoperatively, we found a longitudinal rupture of the membranous trachea above the carina. We completely resected the tumor and repaired the tracheal rupture under a thoracoscopy using a pedicled muscle flap. The tissue was diagnosed as a mediastinal glomus tumor according to its histological and immunophenotypic characteristics.

  7. Resection And Reconstructive-plastic Surgery In Treatment Of Extended And Multifocal Cicatrical Tracheal Stenosis

    Directory of Open Access Journals (Sweden)

    Otabek Eshonkhodjaev

    2015-12-01

    Full Text Available Background. Main issues of treatment of patients with cicatricial stenosis of trachea (CST are to increase its efficacy and safety, as well as to determine indications and contraindications for circular resection and reconstructive interventions on the trachea in patients with extended lesions of trachea, with stenoses involving subvocal cords part of larynx and well as multifocal narrowing of the trachea which could improve treatment results and quality of life of patients, to gain recovery and reduce disability and mortality.Material and methods. One hundred two patients aged from 11 to 62 years with CST were surgically treated. Stenotic site length in patients varied from 0,3 to 7 cm. Most frequently (64,2%, CST length of more than 2 cm was observed. In critical and decompensated stenosis with diameter of CST up to 5 mm with the threat of asphyxiation by the first stage we used endoscopic laser-and electric destruction of constriction followed by restricted zone bouging. If long-term rehabilitation was necessary and in case of absence of the conditions to the implementation of circular tracheal resection, we used tracheal stents. Circular resection of the trachea was performed in 24 patients. In case of contraindications, 28 patients underwent reconstructive plastic surgery with dissection the stenosis, excision of scar tissue and formation of trachea lumen in T-tube. After removing T-tube plasty of anterior tracheal wall and of soft tissues of the neck defects was performed using local tissues and grafts with microsurgical techniques.Results. Long-term results of treatment evaluated and studied in a period of 6 months to 5 years in 89 (87.3% patients. 13 patients continues to one of the stages of complex treatment. Еhe patients are under dynamic endoscopic control. Good results were achieved in the treatment of 71 patients (79.8%, satisfactory - in 12 (13.4%, unsatisfactory results in 6 (6.7% patients.Conclusions. 1. Patients with CST

  8. [Quantification of the acute respiratory insufficiency of laryngo-tracheal origin].

    Science.gov (United States)

    Pintilie, Cătălina; Burlacu, Gabriela; Costinescu, V

    2009-01-01

    Acute respiratory insufficiency defines that status in which the respiratory system is not able to supply the metabolic requirements of the organism. The laryngo-tracheal segment plays an important role in the respiratory function, an obstruction at this level inducing an important limitation of oxygen intake. Due to the requirement of fast repermeabilisation of this segment, it is necessary to define all criteria (clinical and laboratory examination) required to diagnose and to evaluate the respiratory failure. The present paper depicts the clinical aspects, the acid-base equilibrium impairment induced by high level airway obstruction and the functional investigations available by ventilation tests.

  9. Tracheal granuloma because of infection with a novel mycobacterial species in an old FIV-positive cat.

    Science.gov (United States)

    De Lorenzi, D; Solano-Gallego, L

    2009-03-01

    A 15-year-old domestic shorthair feline immunodeficiency virus-positive cat was presented with a five day history of productive cough and acute respiratory distress. Physical examination revealed inspiratory dyspnoea and diffuse gingivostomatitis. Radiographs showed an intratracheal mass located at the level of the sixth and the seventh cervical vertebrae. Bronchoscopy revealed a unique intratracheal mass occluding about 85 per cent of the tracheal lumen. The tracheal mass was removed bronchoscopically. A diagnosis of pyogranulomatous inflammation referable to a mycobacterial infection was made based on cytological and histopathological findings. 16S rRNA polymerase chain reaction testing and sequence analysis identified a novel mycobacterial species, likely a slow grower, with 95 per cent identity with Mycobacterium xenopi. To our knowledge, this is the first description of a tracheal mycobacterial granuloma in a cat, and the first time, a mycobacterium with this sequence has been identified.

  10. Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents

    DEFF Research Database (Denmark)

    Lundstrøm, Lars H; Duez, Christophe Hv; Kehlet Nørskov, Anders

    2017-01-01

    and morbidity. Use of neuromuscular blocking agents (NMBA) to facilitate tracheal intubation is a widely accepted practice. However, because of adverse effects, NMBA may be undesirable. Cohort studies have indicated that avoiding NMBA is an independent risk factor for difficult and failed tracheal intubation......) for adults and adolescents allocated to tracheal intubation with direct laryngoscopy. To look at various outcomes, conduct subgroup and sensitivity analyses, examine the role of bias, and apply trial sequential analysis (TSA) to examine the level of available evidence for this intervention. SEARCH METHODS......) = 0%, D(2)= 0%, GRADE = low); however, TSA showed that only 6% of the information size required to detect or reject a 20% relative risk reduction (RRR) was accrued, and the trial sequential monitoring boundary was not crossed. AUTHORS' CONCLUSIONS: This review supports that use of an NMBA may create...

  11. [Reconstruction of tracheal defect using the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum].

    Science.gov (United States)

    Lin, Huang; Tang, Ping-zhang; Li, Sen-kai

    2005-05-01

    To reconstruct tracheal defect after tumor excision, we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum. The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy. The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully. All flaps survived with epithelization and osteogenesis. The endotracheal tubes were pulled out safely without trachea stenosis in all the patients. The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged. This method extends the application of the musculo-periosteum flap.

  12. Influence of growth factors and medium composition on benzo[a]pyrene- and vitamin A-induced cell proliferation and differentiation in hamster tracheal epithelium in organ culture

    NARCIS (Netherlands)

    Wolterbeek, A.P.M.; Ciotti, M.A.L.T.; Schoevers, E.J.; Roggeband, R.; Baan, R.A.; Feron, V.J.; Rutten, A.A.J.J.L.

    1996-01-01

    Tracheal organ cultures and isolated tracheal epithelial cells are frequently used to study effects of carcinogens and retinoids on both proliferation and differentiation of respiratory tract epithelial cells. For each of these in vitro models, optimal culture conditions have been established,

  13. Antispasmodic effect of Mentha piperita essential oil on tracheal smooth muscle of rats.

    Science.gov (United States)

    de Sousa, Albertina Antonielly Sydney; Soares, Pedro Marcos Gomes; de Almeida, Arisa Nara Saldanha; Maia, Alana Rufino; de Souza, Emmanuel Prata; Assreuy, Ana Maria Sampaio

    2010-07-20

    Mentha piperita is a plant popularly known in Brazil as "hortelã-pimenta" whose essential oil is used in folk medicine for its anti-inflammatory, antispasmodic, expectorant actions and anti-congestive. Here, it was investigated the effect of Mentha piperita essential oil (peppermint oil) in rat tracheal rings along with its mechanism of action. Tracheal tissue from male Wistar rats (250-300 g) were used. Peppermint oil was added in cumulative concentrations [1-300 microg/ml] to the tissue basal tonus or pre-contracted by carbachol [10 microM] at 10 min intervals, incubated or not with indomethacin [10 microM], L-N-metyl-nitro-arginine [100 microM], hexamethonium [500 microM], or tetraethylammonium [5 mM]. Peppermint oil [100 and 300 microg/ml] inhibited the contractions induced by carbachol, which was reversed by indomethacin, L-N-metyl-nitro-arginine and hexamethonium, but not by tetraethylammonium. These data suggest the participation of prostaglandin E(2), nitric oxide and autonomic ganglions in the peppermint oil relaxant effect and may be correlated with its popular use in respiratory diseases. Peppermint oil exhibited antispasmodic activity on rat trachea involving prostaglandins and nitric oxide synthase. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Variation in the mechanical properties of tracheal tubes in the American cockroach

    Science.gov (United States)

    Becker, Winston R.; Webster, Matthew R.; Socha, John J.; De Vita, Raffaella

    2014-05-01

    The insect cuticle serves the protective role of skin and the supportive role of the skeleton while being lightweight and flexible to facilitate flight. The smart design of the cuticle confers camouflage, thermo-regulation, communication, self-cleaning, and anti-wetting properties to insects. The mechanical behavior of the internal cuticle of the insect in tracheae remains largely unexplored due to their small size. In order to characterize the material properties of insect tracheae and understand their role during insect respiration, we conducted tensile tests on ring sections of tracheal tubes of American cockroaches (Periplaneta americana). A total of 33 ring specimens collected from 14 tracheae from the upper thorax of the insects were successfully tested. The ultimate tensile strength (22.6 ± 13.3 MPa), ultimate strain (1.57 ± 0.68%), elastic modulus (1740 ± 840 MPa), and toughness (0.175 ± 0.156 MJ m-3) were measured. We examined the high variance in mechanical properties statistically and demonstrated that ring sections excised from the same trachea exhibit comparable mechanical properties. Our results will form the basis for future studies aimed at determining the structure-function relationship of insect tracheal tubes, ultimately inspiring the design of multi-functional materials and structures.

  15. Retention of tracheal intubation skills by novice personnel: a comparison of the Airtraq and Macintosh laryngoscopes.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2007-03-01

    Direct laryngoscopic tracheal intubation is a potentially lifesaving manoeuvre, but it is a difficult skill to acquire and to maintain. These difficulties are exacerbated if the opportunities to utilise this skill are infrequent, and by the fact that the consequences of poorly performed intubation attempts may be severe. Novice users find the Airtraq laryngoscope easier to use than the conventional Macintosh laryngoscope. We therefore wished to determine whether novice users would have greater retention of intubation skills with the Airtraq rather than the Macintosh laryngoscope. Twenty medical students who had no prior airway management experience participated in this study. Following brief didactic instruction, each took turns performing laryngoscopy and intubation using the Macintosh and Airtraq devices in easy and simulated difficult laryngoscopy scenarios. The degree of success with each device, the time taken to perform intubation and the assistance required, and the potential for complications were then assessed. Six months later, the assessment process was repeated. No didactic instruction or practice attempts were provided on this latter occasion. Tracheal intubation skills declined markedly with both devices. However, the Airtraq continued to provide better intubating conditions, resulting in greater success of intubation, with fewer optimisation manoeuvres required, and reduced potential for dental trauma, particularly in the difficult laryngoscopy scenarios. The substantial decline in direct laryngoscopy skills over time emphasise the need for continued reinforcement of this complex skill.

  16. Lipoma de traqueia simulando doença pulmonar obstrutiva Tracheal lipoma mimicking obstructive lung disease

    Directory of Open Access Journals (Sweden)

    Vinícius Turano Mota

    2010-02-01

    Full Text Available Os tumores de traqueia são raros e podem ser de difícil diagnóstico, por mimetizarem outras afecções pulmonares de caráter obstrutivo, como asma e DPOC. Relatamos um caso de lipoma de traqueia em uma paciente que fora tratada para asma e DPOC, sem resposta adequada, até apresentar complicações infecciosas. A presença do tumor foi sugerida por TC de tórax e confirmada por fibrobroncoscopia. A paciente foi submetida à ressecção endoscópica do tumor; porém, evoluiu para o óbito por pneumonia e choque séptico.Tracheal tumors are rare and can be difficult to diagnose due to their capacity to mimic other obstructive lung diseases, such as asthma and COPD. We report the case of a female patient with a tracheal tumor. She had previously been treated for asthma and COPD, with little response to the treatment. The onset of infectious complications prompted further investigation. Chest CT images suggested the presence of a tumor, which was confirmed by fiberoptic bronchoscopy. The tumor was endoscopically resected. However, the patient evolved to death due to pneumonia and septic shock.

  17. Distinguishing tracheal and esophageal tissues with hyperspectral imaging and fiber-optic sensing

    Science.gov (United States)

    Nawn, Corinne D.; Souhan, Brian E.; Carter, Robert, III; Kneapler, Caitlin; Fell, Nicholas; Ye, Jing Yong

    2016-11-01

    During emergency medical situations, where the patient has an obstructed airway or necessitates respiratory support, endotracheal intubation (ETI) is the medical technique of placing a tube into the trachea in order to facilitate adequate ventilation of the lungs. Complications during ETI, such as repeated attempts, failed intubation, or accidental intubation of the esophagus, can lead to severe consequences or ultimately death. Consequently, a need exists for a feedback mechanism to aid providers in performing successful ETI. Our study examined the spectral reflectance properties of the tracheal and esophageal tissue to determine whether a unique spectral profile exists for either tissue for the purpose of detection. The study began by using a hyperspectral camera to image excised pig tissue samples exposed to white and UV light in order to capture the spectral reflectance properties with high fidelity. After identifying a unique spectral characteristic of the trachea that significantly differed from esophageal tissue, a follow-up investigation used a fiber optic probe to confirm the detectability and consistency of the different reflectance characteristics in a pig model. Our results characterize the unique and consistent spectral reflectance characteristic of tracheal tissue, thereby providing foundational support for exploiting spectral properties to detect the trachea during medical procedures.

  18. Mean tracheal sound energy during sleep is related to daytime blood pressure.

    Science.gov (United States)

    Nakano, Hiroshi; Hirayama, Kenji; Sadamitsu, Yumiko; Shin, Shizue; Iwanaga, Tomoaki

    2013-09-01

    The pathological role of snoring independent of obstructive sleep apnea remains under debate. The authors hypothesized that snoring sound intensity, as assessed by mean tracheal sound energy (Leq) during sleep, is related to daytime blood pressure. Retrospective analysis of clinical records and polysomnography data. Sleep laboratory at a national hospital in Japan. Consecutive patients who underwent diagnostic polysomnography with suspicion of sleep apnea between January 2005 and December 2009 (n = 1,118). Not applicable. Leq was calculated from tracheal sound spectra recorded every 0.2 sec during polysomnography. Daytime high blood pressure (HBP) was defined as taking antihypertensive drugs or having a systolic blood pressure ≥ 140 mm Hg or a diastolic blood pressure ≥ 90 mmHg at the patient's first clinical visit. Patient age, sex, body mass index, apnea-hypopnea index, alcohol consumption, and smoking were considered as confounders. Leq during sleep was associated with HBP after adjusting for all confounding factors (n = 1,074, P = 0.00019). This association was demonstrated even in nonapneic nonobese patients (n = 232, P = 0.012). The association between snoring intensity, as assessed by mean sound energy, and blood pressure suggests a pathological role for heavy snoring. Further study in a general population is warranted.

  19. Influenza A infection attenuates relaxation responses of mouse tracheal smooth muscle evoked by acrolein.

    Science.gov (United States)

    Cheah, Esther Y; Mann, Tracy S; Burcham, Philip C; Henry, Peter J

    2015-02-15

    The airway epithelium is an important source of relaxant mediators, and damage to the epithelium caused by respiratory tract viruses may contribute to airway hyperreactivity. The aim of this study was to determine whether influenza A-induced epithelial damage would modulate relaxation responses evoked by acrolein, a toxic and prevalent component of smoke. Male BALB/c mice were inoculated intranasally with influenza A/PR-8/34 (VIRUS-infected) or allantoic fluid (SHAM-infected). On day 4 post-inoculation, isometric tension recording studies were conducted on carbachol pre-contracted tracheal segments isolated from VIRUS and SHAM mice. Relaxant responses to acrolein (30 μM) were markedly smaller in VIRUS segments compared to SHAM segments (2 ± 1% relaxation vs. 28 ± 5%, n=14, pacrolein and SP were reduced in VIRUS segments (>35% reduction, n=6, pacrolein were profoundly diminished in tracheal segments isolated from influenza A-infected mice. The mechanism through which influenza A infection attenuates this response appears to involve reduced production of PGE2 in response to SP due to epithelial cell loss, and may provide insight into the airway hyperreactivity observed with influenza A infection.

  20. TRACHEAL INTUBATION USING McGRATH VIDEO LARYNGOSCOPE IN MYASTHENIA GRAVIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Venkata Sesha Sai Krishna

    2015-07-01

    Full Text Available BACKGROUND : Mc G rath video laryngoscope has been successfully used for managing difficult intubation in various clinical scenarios. In this case series, we aimed to evaluate the success rate and time taken to complete intubation without using muscle relaxants in myasthenia gravis patients coming for thymectomy. METHODS: We prospectively evaluate the use of Mcgrath video laryngoscope for intubation in ten myasthenia gravis patients coming for thymectomy. Intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack & Lehane grade, and patients tolerance of the procedure were recorded. RESULTS: The procedure was successful in all patients the mean (SD intubation time and total time to complete the tracheal intubation was 4.82 (0.53 and 10.21 (0.81 min, respectively. The laryngeal view was grade I in five and grade II in four patients. CONCLUSION: The Mcgrath Video Laryngoscope allowed a quicker intubation time, fewe r intubation attempts and greater ease of intubation in myasthenia gravis patients coming for thymectomy.

  1. Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    McHugh, Kieran; Afaq, Asim; Roebuck, Derek J. [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom); Broderick, Nigel [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Gabra, Hany O.; Elliott, Martin J. [Great Ormond Street Hospital for Children, Department of Cardiothoracic Surgery, London (United Kingdom)

    2010-05-15

    Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. To report a series of five infants who developed tracheomegaly following FETO. Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition. (orig.)

  2. Respiratory mechanics measured by forced oscillations during mechanical ventilation through a tracheal tube.

    Science.gov (United States)

    Scholz, Alexander-Wigbert; Weiler, Norbert; David, Matthias; Markstaller, Klaus

    2011-05-01

    The forced oscillation technique (FOT) allows the measurement of respiratory mechanics in the intensive care setting. The aim of this study was to compare the FOT with a reference method during mechanical ventilation through a tracheal tube. The respiratory impedance spectra were measured by FOT in nine anaesthetized pigs, and resistance and compliance were estimated on the basis of a linear resistance-compliance inertance model. In comparison, resistance and compliance were quantified by the multiple linear regression analysis (LSF) of conventional ventilator waveforms to the equation of motion. The resistance of the sample was found to range from 6 to 21 cmH(2)O s l(-1) and the compliance from 12 to 32 ml cmH(2)O(-1). A Bland-Altman analysis of the resistance resulted in a sufficient agreement (bias -0.4 cmH(2)O s l(-1); standard deviation of differences 1.4 cmH(2)O s l(-1); correlation coefficient 0.93) and test-retest reliability (coefficient of variation of repeated measurements: FOT 2.1%; LSF 1.9%). The compliance, however, was poor in agreement (bias -8 ml cmH(2)O(-1), standard deviation of differences 7 ml cmH(2)O(-1), correlation coefficient 0.74) and repeatability (coefficient of variation: FOT 23%; LSF 1.7%). In conclusion, FOT provides an alternative for monitoring resistance, but not compliance, in tracheally intubated and ventilated subjects.

  3. [McGRATH® MAC Is Useful to Learn Tracheal Intubation Using a Macintosh Laryngoscope].

    Science.gov (United States)

    Wakasugi, Keiko; Niyama, Yukitoshi; Kita, Asuka; Sonoda, Hajime; Yamakage, Michiaki

    2015-10-01

    Learning tracheal intubation using a Macintosh laryngoscope (McL) is important although video laryngoscope is becoming popular. The purpose of this study was to compare the usefulness as a training device for intubation technique using McL with three devices; McGRATH® MAC (MAC), Airwayscope® (AWS) and McL. In this prospective study, 60 nurses not experienced in tracheal intubation were randomly assigned to MAC, AWS, and McL groups (each group: n=20), and 10 times of practice using each device were carried out. We compared the intubation time using McL and the nurse's anatomical understanding of the larynx before and after the practice. The intubation time before the practice was comparable among the three groups, but the time after the practice was significantly shorter in the McL and MAC groups compared to the AWS group (P=0.001). The practice significantly improved anatomical understanding of the larynx in all groups (PMAC and AWS groups compared with the McL group (PMAC may possess advantages compared to Airwayscope® and Macintosh laryngoscope as a training device for learning intubation technique using Macintosh laryngoscope and understanding anatomy of the larynx.

  4. Possible Mechanisms for Functional Antagonistic Effect of Ferula assafoetida on Muscarinic Receptors in Tracheal Smooth Muscle

    Science.gov (United States)

    Kiyanmehr, Majid; Boskabady, Mohammad Hossein; Khazdair, Mohammad Reza; Hashemzehi, Milad

    2016-01-01

    Background The contribution of histamine (H1) receptors inhibitory and/or β-adrenoceptors stimulatory mechanisms in the relaxant property of Ferula assa-foetida. (F. asafoetida) was examined in the present study. Methods We evaluated the effect of three concentrations of F. asafoetida extract (2.5, 5, and 10 mg/mL), a muscarinic receptors antagonist, and saline on methacholine concentration-response curve in tracheal smooth muscles incubated with β-adrenergic and histamine (H1) (group 1), and only β-adrenergic (group 2) receptors antagonists. Results EC50 values in the presence of atropine, extract (5 and 10 mg/mL) and maximum responses to methacholine due to the 10 mg/mL extract in both groups and 5 mg/mL extract in group 1 were higher than saline (P < 0.0001, P = 0.0477, and P = 0.0008 in group 1 and P < 0.0001, P = 0.0438, and P = 0.0107 in group 2 for atropine, 5 and 10 mg/mL extract, respectively). Values of concentration ratio minus one (CR-1), in the presence of extracts were lower than atropine in both groups (P = 0.0339 for high extract concentration in group 1 and P < 0.0001 for other extract concentrations in both groups). Conclusion Histamine (H1) receptor blockade affects muscarinic receptors inhibitory property of F. asafoetida in tracheal smooth muscle PMID:27540324

  5. Measurement of human surfactant protein-B turnover in vivo from tracheal aspirates using targeted proteomics.

    Science.gov (United States)

    Tomazela, Daniela M; Patterson, Bruce W; Hanson, Elizabeth; Spence, Kimberly L; Kanion, Tiffany B; Salinger, David H; Vicini, Paolo; Barret, Hugh; Heins, Hillary B; Cole, F Sessions; Hamvas, Aaron; MacCoss, Michael J

    2010-03-15

    We describe a method to measure protein synthesis and catabolism in humans without prior purification and use the method to measure the turnover of surfactant protein-B (SP-B). SP-B, a lung-specific, hydrophobic protein essential for fetal-neonatal respiratory transition, is present in only picomolar quantities in tracheal aspirate samples and difficult to isolate for dynamic turnover studies using traditional in vivo tracer techniques. Using infusion of [5,5,5-(2)H(3)] leucine and a targeted proteomics method, we measured both the quantity and kinetics of SP-B tryptic peptides in tracheal aspirate samples of symptomatic newborn infants. The fractional synthetic rate (FSR) of SP-B measured using the most abundant proteolytic fragment, a 10 amino acid peptide from the carboxy-terminus of proSP-B (SPTGEWLPR), from the circulating leucine pool was 0.035 +/- 0.005 h(-1), and the fractional catabolic rate was 0.044 +/- 0.003 h(-1). This technique permits high-throughput and sensitive measurement of turnover of low abundance proteins with minimal sample preparation.

  6. Oxygen-induced plasticity in tracheal morphology and discontinuous gas exchange cycles in cockroaches Nauphoeta cinerea.

    Science.gov (United States)

    Bartrim, Hamish; Matthews, Philip G D; Lemon, Sussan; White, Craig R

    2014-12-01

    The function and mechanism underlying discontinuous gas exchange in terrestrial arthropods continues to be debated. Three adaptive hypotheses have been proposed to explain the evolutionary origin or maintenance of discontinuous gas exchange cycles (DGCs), which may have evolved to reduce respiratory water loss, facilitate gas exchange in high CO2 and low O2 micro-environments, or to ameliorate potential damage as a result of oversupply of O2. None of these hypotheses have unequivocal support, and several non-adaptive hypotheses have also been proposed. In the present study, we reared cockroaches Nauphoeta cinerea in selected levels of O2 throughout development, and examined how this affected growth rate, tracheal morphology and patterns of gas exchange. O2 level in the rearing environment caused significant changes in tracheal morphology and the exhibition of DGCs, but the direction of these effects was inconsistent with all three adaptive hypotheses: water loss was not associated with DGC length, cockroaches grew fastest in hyperoxia, and DGCs exhibited by cockroaches reared in normoxia were shorter than those exhibited by cockroaches reared in hypoxia or hyperoxia.

  7. Bordetella avium causes induction of apoptosis and nitric oxide synthase in turkey tracheal explant cultures.

    Science.gov (United States)

    Miyamoto, David M; Ruff, Kristin; Beach, Nathan M; Stockwell, Stephanie B; Dorsey-Oresto, Angella; Masters, Isaac; Temple, Louise M

    2011-09-01

    Bordetellosis is an upper respiratory disease of turkeys caused by Bordetella avium in which the bacteria attach specifically to ciliated respiratory epithelial cells. Little is known about the mechanisms of pathogenesis of this disease, which has a negative impact in the commercial turkey industry. In this study, we produced a novel explant organ culture system that was able to successfully reproduce pathogenesis of B. avium in vitro, using tracheal tissue derived from 26 day-old turkey embryos. Treatment of the explants with whole cells of B. avium virulent strain 197N and culture supernatant, but not lipopolysaccharide (LPS) or tracheal cytotoxin (TCT), specifically induced apoptosis in ciliated cells, as shown by annexin V and TUNEL staining. LPS and TCT are known virulence factors of Bordetella pertussis, the causative agent of whooping cough. Treatment with whole cells of B. avium and LPS specifically induced NO response in ciliated cells, shown by uNOS staining and diaphorase activity. The explant system is being used as a model to elucidate specific molecules responsible for the symptoms of bordetellosis.

  8. beta. -Adrenoceptors in human tracheal smooth muscle: characteristics of binding and relaxation

    Energy Technology Data Exchange (ETDEWEB)

    van Koppen, C.J.; Hermanussen, M.W.; Verrijp, K.N.; Rodrigues de Miranda, J.F.; Beld, A.J.; Lammers, J.W.J.; van Ginneken, C.A.M.

    1987-06-29

    Specific binding of (/sup 125/I)-(-)-cyanopindolol to human tracheal smooth muscle membranes was saturable, stereo-selective and of high affinity (K/sub d/ = 5.3 +/- 0.9 pmol/l and R/sub T/ = 78 +/- 7 fmol/g tissue). The ..beta../sub 1/-selective antagonists atenolol and LK 203-030 inhibited specific (/sup 125/I)-(-)-cyanopindolol binding according to a one binding site model with low affinity in nearly all subjects, pointing to a homogeneous BETA/sub 2/-adrenoceptor population. In one subject using LK 203-030 a small ..beta../sub 1/-adrenoceptor subpopulation could be demonstrated. The beta-mimetics isoprenaline, fenoterol, salbutamol and terbutaline recognized high and low affinity agonist binding sites. Isoprenaline's pK/sub H/- and pK/sub L/-values for the high and low affinity sites were 8.0 +/- 0.2 and 5.9 +/- 0.3 respectively. In functional experiments isoprenaline relaxed tracheal smooth muscle strips having intrinsic tone with a pD/sub 2/-value of 6.63 +/- 0.19. 32 references, 4 figures, 2 tables.

  9. Use of nitinol self-expandable stents in 26 dogs with tracheal collapse.

    Science.gov (United States)

    Beranek, J; Jaresova, H; Rytz, U

    2014-02-01

    A study was designed to describe a novel approach to the treatment of tracheal collapse (TC) in dogs using self-expandable nitinol stents. Medical records were reviewed retrospectively for 26 client owned dogs in which nitinol stents were deployed. The entire length of trachea was supported independently of the extent of TC. Two overlapping stents were used instead of one in cases where one stent was not spanning the entire trachea adequately. The diameter of the cranial radiolucent portion of trachea, just behind the cricoid cartilage, was measured as a specific landmark to select the appropriate size of the stent. Two self-expandable nitinol stents were inserted in 9 of 26 dogs; the trachea in the rest of the cases was supported with only one stent. A follow up tracheoscopy was performed in 10 of 26 cases with recurrent clinical signs. Secondary tracheal stenosis in these cases was caused by stent fracture, granuloma or excessive stent shortening. Additional stents were placed successfully to expand the stenotic lumen. A support of the entire trachea may decrease risk of nitinol fracture at the end of the implant. Long term clinical improvement (25 of 26 dogs, 96 %) is comparable with the results of other studies.

  10. Cyclic nucleotide phosphodiesterase isoenzymes in guinea-pig tracheal muscle and bronchorelaxation by alkylxanthines.

    Science.gov (United States)

    Miyamoto, K; Kurita, M; Sakai, R; Sanae, F; Wakusawa, S; Takagi, K

    1994-09-15

    In this study the phosphodiesterase (PDE) isoenzymes in guinea-pig trachealis smooth muscle were separated by DEAE-Sepharose anion exchange chromatography, identified, and characterized. Furthermore the effect of theophylline and 1-n-butyl-3-n-propylxanthine (BPX) on the isolated PDE isoenzymes and on their tracheal relaxant effect were investigated and compared with the nonxanthine PDE inhibitors amrinone and Ro 20-1724. We identified five distinct isoenzymes in guinea-pig tracheal muscle; calcium/calmodulin-stimulated cyclic AMP PDE (PDE I), cyclic GMP-stimulated cyclic AMP PDE (PDE II), cyclic GMP-inhibited and amrinone-sensitive cyclic AMP PDE (PDE III), cyclic AMP-specific and Ro 20-1724-sensitive PDE (PDE IV), and cyclic GMP-specific PDE (PDE V). BPX strongly inhibited the PDE IV isoenzyme with high selectivity, while the inhibitory effect of theophylline was weak. The PDE IV inhibitors BPX and Ro 20-1724 synergistically increased the relaxant effect of the beta 2-adrenoceptor agonist salbutamol in carbachol-contracted trachea much more strongly than theophylline. In contrast, amrinone, a PDE III inhibitor, hardly influenced the relaxant effect of salbutamol, suggesting that the PDE IV isoenzyme is functionally associated with beta 2-adrenoceptors in guinea-pig trachea and that inhibition of this enzyme potentiates the ability of salbutamol to increase the intracellular cyclic AMP content. These results indicate that the PDE IV isoenzyme plays a significant role in alkylxanthine-mediated relaxation of guinea-pig trachea.

  11. Selective tracheal relaxation and phosphodiesterase-IV inhibition by xanthine derivatives.

    Science.gov (United States)

    Miyamoto, K; Kurita, M; Ohmae, S; Sakai, R; Sanae, F; Takagi, K

    1994-05-17

    The effects of substitutions in the xanthine nucleus on tracheal relaxant activity, atrium chronotropic activity, adenosine A1 affinity, and inhibitory activities on cyclic AMP-phosphodiesterase isoenzymes in guinea pigs were studied. Substitution with a long alkyl chain at the N1-position of xanthine nucleus increased the tracheal relaxant activity without leading to positive chronotropic action, and long alkyl chains at the N3-position increased both activities. N7-substitutions with n-propyl and 2'-oxopropyl groups, such as in denbufylline, increased bronchoselectivity. N7-substitution decreased the adenosine A1 affinity, but substitution at either the N1- or N3-position increased it. The bronchorelaxant activity of xanthine derivatives was closely correlated with their inhibition of phosphodiesterase-IV, but not with their adenosine A1 affinity; the positive chronotropic effects were related to their inhibition of phosphodiesterase-III. This study confirms that the bronchorelaxation of xanthine derivatives is mediated by inhibition of the isoenzyme phosphodiesterase-IV. The results of structure-activity analysis suggest that substitutions at the N1- and N7-positions should be tried in the development of xanthine derivatives that are selective bronchodilators and phosphodiesterase-IV inhibitors.

  12. Intrinsic Transient Tracheal Occlusion Training and Myogenic Remodeling of Rodent Parasternal Intercostal Fibers

    Science.gov (United States)

    Smith, Barbara K.; Mathur, Sunita; Ye, Fan; Martin, A. Daniel; Truelson, Sara Attia; Vandenborne, Krista; Davenport, Paul W.

    2014-01-01

    It is recognized that diaphragm muscle plasticity occurs with mechanical overloads, yet less is known regarding synergistic parasternal intercostal muscle fiber remodeling. We conducted overload training with intrinsic transient tracheal occlusion (ITTO) exercises in conscious animals. We hypothesized ITTO would yield significant fiber hypertrophy and myogenic activation that would parallel diaphragm fiber remodeling. Sprague-Dawley rats underwent placement of a tracheal cuff and were randomly assigned to receive daily ten-minute sessions of conscious ITTO or observation (SHAM) over two weeks. After training, fiber morphology, myosin heavy chain isoform composition, cross-sectional area, proportion of Pax7-positive nuclei, and presence of embryonic myosin (eMHC) were quantified. Type IIx/b fibers were 20% larger after ITTO training than with SHAM training (ITTO: 4431±676 μm2, SHAM: 3689±400 μm2, p<0.05), and type I fibers were more prevalent after ITTO (p<0.01). Expression of Pax7 was increased in ITTO parasternals and diaphragm (p<0.05). In contrast, the proportion of eMHC-positive fibers was increased only in ITTO parasternals (1.2 (3.4-0.6)%, SHAM: 0 (0.6-0%, p<0.05). Although diaphragm and parasternal type II fibers hypertrophy to a similar degree, myogenic remodeling appears to differ between the two muscles. PMID:25509059

  13. INCIDENCE OF RESIDUAL NEUROMUSCULAR BLOCKADE AT TRACHEAL EXTUBATION: COMPARISON OF ATRACURIUM WITH VECURONIUM

    Directory of Open Access Journals (Sweden)

    Shwetha S

    2015-11-01

    Full Text Available BACKGROUND: Occurrence of undetected residual neuromuscular blockade is a common event in the post anaesthesia care unit. AIM: To compare the incidence and degree of residual neuromuscular blockade with the use of intermediate acting neuromuscular blocking agents Atracurium and Vecuronium. METHODS: 360 patients satisfying the inclusion and exclusion criteria were enrolled in the study and randomly allocated into one of the two study groups of 180 each to receive either Atracurium or Vecuronium intraoperatively. The anaesthesiologist blinded from the study extubated the patient based on the standard clinical criteria and the corresponding Train of Four(TOF ratios were noted by a blinded research assistant using a TOF watch (TOF- Watch® SX Organon, Ireland Ltd., Dublin, Ireland. Residual neuromuscular blockade was defined as a TOF ratio of 0.9 thirty minutes after tracheal extubation. CONCLUSION: We conclude from our study that significant post-operative residual curarization (TOF < 0.9 exists in majority of patients at the time of tracheal extubation (54.4% incidence despite the use of intermediate acting neuromuscular blocking drugs. The incidence and degree of post-operative residual curarization is significantly greater with Vecuronium compared to Atracurium. Thus we suggest that quantitative neuromuscular monitoring is required to assure complete neuromuscular recovery.

  14. An Investigation of Topics and Trends of Tracheal Replacement Studies Using Co-Occurrence Analysis.

    Science.gov (United States)

    Ghorbani, Fariba; Feizabadi, Mansoureh; Farzanegan, Roya; Vaziri, Esmaeil; Samani, Saeed; Lajevardi, Seyedamirmohammad; Moradi, Lida; Shadmehr, Mohammad Behgam

    2017-04-01

    This study evaluated tracheal regeneration studies using scientometric and co-occurrence analysis to identify the most important topics and assess their trends over time. To provide the adequate search options, PubMed, Scopus, and Web of Science (WOS) were used to cover various categories such as keywords, countries, organizations, and authors. Search results were obtained by employing Bibexcel. Co-occurrence analysis was applied to evaluate the publications. Finally, scientific maps, author's network, and country contributions were depicted using VOSviewer and NetDraw. Furthermore, the first 25 countries and 130 of the most productive authors were determined. Regarding the trend analysis, 10 co-occurrence terms out of highly frequent words were examined at 5-year intervals. Our findings indicated that the field of trachea regeneration has tested different approaches over the time. In total, 65 countries have contributed to scientific progress both in experimental and clinical fields. Special keywords such as tissue engineering and different types of stem cells have been increasingly used since 1995. Studies have addressed topics such as angiogenesis, decellularization methods, extracellular matrix, and mechanical properties since 2011. These findings will offer evidence-based information about the current status and trends of tracheal replacement research topics over time, as well as countries' contributions.

  15. Umesh's intubation detector (UID) for rapid and reliable identification of tracheal intubation by novices in anaesthetised, paralysed adult patients.

    Science.gov (United States)

    Umesh, Goneppanavar; Tim, Thomas Joseph; Prabhu, Manjunath; Prasad, Krishnamurthy N; Jasvinder, Kaur

    2013-10-01

    Oesophageal intubation can lead to life threatening complications if left undetected. Several devices and techniques are available to confirm tracheal intubation and for early detection of oesophageal intubation. This study was carried out to evaluate the utility of the Umesh's intubation detector device for rapid and reliable differentiation of tracheal from oesophageal intubation by novice users. In this prospective, double blind and randomised study, 100 healthy patients undergoing general anaesthesia with endotracheal intubation received two identical size endotracheal tubes; one inserted into trachea and the other into the oesophagus. The Umesh's intubation detector was connected to one of the tubes randomly and a novice was asked to observe for inflation of the reservoir bag of the device while two chest compressions of approximately one inch each were given to the patient. Out of the total 100 tracheal intubations, 96 were correctly identified while the observers could not clearly conclude whether the tube was in trachea or oesophagus in the other four patients. Out of the total 100 oesophageal intubations, 99 were correctly identified. There were no complications related to the study. Umesh's intubation detector device can be used by novices for rapid and reliable differentiation of tracheal from oesophageal intubation in healthy adult patients.

  16. Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.

    LENUS (Irish Health Repository)

    Malik, M A

    2009-05-01

    The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.

  17. Patients with cardiac arrest are ventilated two times faster than guidelines recommend : An observational prehospital study using tracheal pressure measurement

    NARCIS (Netherlands)

    Maertens, Vicky L.; De Smedt, Lieven E. G.; Lemoyne, Sabine; Huybrechts, Sofie A. M.; Wouters, Kristien; Kalmar, Alain F.; Monsieurs, Koenraad G.

    Aim: To measure ventilation rate using tracheal airway pressures in prehospitally intubated patients with and without cardiac arrest. Methods: Prospective observational study. In 98 patients (57 with and 41 without cardiac arrest) an air-filled catheter was inserted into the endotracheal tube and

  18. Patients with cardiac arrest are ventilated two times faster than guidelines recommend : An observational prehospital study using tracheal pressure measurement

    NARCIS (Netherlands)

    Maertens, Vicky L.; De Smedt, Lieven E. G.; Lemoyne, Sabine; Huybrechts, Sofie A. M.; Wouters, Kristien; Kalmar, Alain F.; Monsieurs, Koenraad G.

    2013-01-01

    Aim: To measure ventilation rate using tracheal airway pressures in prehospitally intubated patients with and without cardiac arrest. Methods: Prospective observational study. In 98 patients (57 with and 41 without cardiac arrest) an air-filled catheter was inserted into the endotracheal tube and co

  19. The feasibility of laryngoscope-guided tracheal intubation in microgravity during parabolic flight: A comparison of two techniques

    DEFF Research Database (Denmark)

    Groemer, Gernot E.; Brimacombe, Joseph; Haas, Thorsten

    2005-01-01

    We determined the feasibility of laryngoscope-guided tracheal intubation (LG-TI) in microgravity obtained during parabolic flight and tested the hypothesis that LG-TI is similarly successful in the free-floating condition, with the patient's head gripped between the anesthesiologist's knees, as i...

  20. Functional characterization of serum- and growth factor-induced phenotypic changes in intact bovine tracheal smooth muscle

    NARCIS (Netherlands)

    Gosens, R; Meurs, H; Bromhaar, MMG; McKay, S; Nelemans, SA; Zaagsma, J

    2002-01-01

    1 The present study aims to investigate whether phenotypic changes, reported to occur in cultured isolated airway smooth muscle (ASM) cells, are of relevance to intact ASM. Moreover, we aimed to gain insight into the signalling pathways involved. 2 Culturing of bovine tracheal smooth muscle (BTSM) s

  1. Potentiation by viral respiratory infection of ovalbumin-induced guinea-pig tracheal hyperresponsiveness: role for tachykinins.

    Science.gov (United States)

    Ladenius, A. R.; Folkerts, G.; van der Linde, H. J.; Nijkamp, F. P.

    1995-01-01

    1. We investigated whether virus-induced airway hyperresponsiveness in guinea-pigs could be modulated by pretreatment with capsaicin and whether viral respiratory infections could potentiate ovalbumin-aerosol-induced tracheal hyperresponsiveness. 2. Animals were inoculated intratracheally with bovine parainfluenza-3 virus or control medium 7 days after treatment with capsaicin (50 mg kg-1, s.c.). Four days after inoculation, tracheal contractions were measured to increasing concentrations of substance P, histamine and the cholinoceptor agonist, arecoline. 3. In tracheae from virus-infected guinea-pigs, contractions in response to substance P, histamine and arecoline were significantly enhanced (P arecoline completely. 4. In another series of experiments animals were first sensitized with ovalbumin (20 mg kg-1, i.p.). After 14 days animals were exposed to either saline or ovalbumin aerosols for 8 days. After 4 aerosol exposures (4 days) animals were inoculated with either parainfluenza-3 virus or control medium. One day after the last ovalbumin aerosol, tracheal contraction in response to increasing concentrations of substance P, histamine and arecoline was measured. 5. Tracheae from ovalbumin-aerosol-exposed control inoculated animals showed a similar degree of airway hyperresponsiveness to saline-aerosol-exposed virus-treated guinea-pigs. Virus inoculation of ovalbumin-treated animals significantly potentiated the tracheal contractions to substance P compared to either of the treatments alone. The contractions in response to histamine and arecoline were only slightly enhanced.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7582502

  2. Effect of Fluticasone and Salmeterol on Tracheal Responsiveness to Ovalbumin and Lung Inflammation, Administrated during and after Sensitization

    Directory of Open Access Journals (Sweden)

    Zahra Gholamnezhad

    2014-01-01

    Full Text Available The effect of duration of administration of fluticasone propionate and salmeterol on tracheal responsiveness to ovalbumin and total and differential white blood cell in sensitized guinea pig was examined. Six groups of guinea pigs (n=7 were sensitized to ovalbumin. Three groups of them were subjected to inhaled fluticasone propionate and salmeterol, one group during sensitization (A, one group after that (for 18 days, B, and the other one during sensitization but with 18 days delay before measurements (C. Three other groups were treated with placebo in the same manner. The tracheal responsiveness to ovalbumin and total and differential white blood cells of three placebo groups were significantly higher than those of control group (P<0.001 for all cases. Tracheal responsiveness to ovalbumin and total and differential white blood cell in treated groups with fluticasone propionate and salmeterol were significantly decreased compared to those of placebo groups (nonsignificant to P<0.001. The improvement in all variables in treatment groups A and C were more pronounced than group B. The results showed that fluticasone propionate and salmeterol had a prevention effect on tracheal hyperresponsiveness to ovalbumin and lung inflammation which was more pronounced when administered during than after sensitization.

  3. Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis

    Directory of Open Access Journals (Sweden)

    S. A. R. Nouraei

    2008-04-01

    Full Text Available Background: Upper airway compromise due to tracheobronchial stenosis commonly occurs in patients with Wegener's Granulomatosis (WG. There is at present no consensus on the optimal management of this life-threatening condition. Objective: To assess the results of laryngo-tracheo-bronchoscopy, intralesional steroid therapy, laser surgery, and dilatation in managing obstructive tracheobronchial WG. Methods: Records of eighteen previously-untreated stridulous patients with obstructive tracheobronchial WG, treated between 2004 and 2006 were prospectively recorded on an airway database and retrospectively reviewed. Information about patient and lesion characteristics and treatment details were recorded. Treatment progress was illustrated using a timeline plot, and intervention-free intervals were calculated with actuarial analysis. Results: There were nine males and the average age at presentation was 40 (16 years [range 13–74]. There were thirteen patients with tracheal, and five patients with tracheal and bronchial lesions. The average tracheal lesion height was 8 (3 mm, located 23 (9 mm below the glottis. There were 1, 10 and 7 Myer-Cotton grade I, II and III lesions respectively. Mean intervention-free interval following minimally-invasive treatment was 26 (2.8 months. Following endobronchial therapy the median intervention-free interval was 22 months (p>0.8 vs. tracheal lesions. No patient required a tracheostomy or endoluminal stenting. Conclusions: Intralesional steroid therapy and conservative endoluminal surgery is an effective strategy for treating airway compromise due to active tracheal and bronchial WG, obviating the need for airway bypass or stenting. We recommend the combination of endotracheal dilatation, conservative laser surgery and steroid therapy as the standard of care for treating airway compromise due to obstructive tracheobronchial WG.

  4. [Anesthesia management by residents does not alter the incidence of recall of tracheal extubation: a teaching hospital-based propensity score analysis].

    Science.gov (United States)

    Inoue, Satoki; Abe, Ryuichi; Tanaka, Yuu; Kawaguchi, Masahiko

    The memory of emergence from anesthesia is recognized as one type of anesthesia awareness. Apart from planed awake extubation, unintentional recall of tracheal extubation is thought to be the results of inadequate anesthesia management; therefore, the incidence can be related with the experience of anesthetists. To assess whether the incidence of recall of tracheal extubation is related to anesthetists' experience, we compared the incidence of recall of tracheal extubation between patients managed by anesthesia residents or by experienced anesthetists. This is a retrospective review of an institutional registry containing 21,606 general anesthesia cases and was conducted with the board of ethical review approval. All resident tracheal extubations were performed under anesthetists' supervision. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anesthetist managements), yielding 3,475 matched patient pairs. The incidence of recall of tracheal extubation was compared as primary outcomes. In the unmatched population, there was no difference in the incidences of recall of tracheal extubation between resident management and anesthetist management (6.5% vs. 7.1%, p=0.275). After propensity score matching, there was still no difference in incidences of recall of tracheal extubation (7.1% vs. 7.0%, p=0.853). In conclusion, when supervised by an anesthetist, resident extubations are no more likely to result in recall than anesthetist extubations. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. Anesthesia management by residents does not alter the incidence of recall of tracheal extubation: a teaching hospital-based propensity score analysis

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    Satoki Inoue

    Full Text Available Abstract Background and objectives: The memory of emergence from anesthesia is recognized as one type of anesthesia awareness. Apart from planed awake extubation, unintentional recall of tracheal extubation is thought to be the results of inadequate anesthesia management; therefore, the incidence can be related with the experience of anesthetists. To assess whether the incidence of recall of tracheal extubation is related to anesthetists' experience, we compared the incidence of recall of tracheal extubation between patients managed by anesthesia residents or by experienced anesthetists. Methods: This is a retrospective review of an institutional registry containing 21,606 general anesthesia cases and was conducted with the board of ethical review approval. All resident tracheal extubations were performed under anesthetists' supervision. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (resident managements and controls (anesthetist managements, yielding 3,475 matched patient pairs. The incidence of recall of tracheal extubation was compared as primary outcomes. Results: In the unmatched population, there was no difference in the incidences of recall of tracheal extubation between resident management and anesthetist management (6.5% vs. 7.1%, p = 0.275. After propensity score matching, there was still no difference in incidences of recall of tracheal extubation (7.1% vs. 7.0%, p = 0.853. Conclusion: In conclusion, when supervised by an anesthetist, resident extubations are no more likely to result in recall than anesthetist extubations.

  6. Endotracheal tubes for critically ill patients: an in vivo analysis of associated tracheal injury, mucociliary clearance, and sealing efficacy.

    Science.gov (United States)

    Li Bassi, Gianluigi; Luque, Nestor; Martí, Joan Daniel; Aguilera Xiol, Eli; Di Pasquale, Marta; Giunta, Valeria; Comaru, Talitha; Rigol, Montserrat; Terraneo, Silvia; De Rosa, Francesca; Rinaudo, Mariano; Crisafulli, Ernesto; Peralta Lepe, Rogelio Cesar; Agusti, Carles; Lucena, Carmen; Ferrer, Miguel; Fernández, Laia; Torres, Antoni

    2015-05-01

    Improvements in the design of the endotracheal tube (ETT) have been achieved in recent years. We evaluated tracheal injury associated with ETTs with novel high-volume low-pressure (HVLP) cuffs and subglottic secretions aspiration (SSA) and the effects on mucociliary clearance (MCC). Twenty-nine pigs were intubated with ETTs comprising cylindrical or tapered cuffs and made of polyvinylchloride (PVC) or polyurethane. In specific ETTs, SSA was performed every 2 h. Following 76 h of mechanical ventilation, pigs were weaned and extubated. Images of the tracheal wall were recorded before intubation, at extubation, and 24 and 96 h thereafter through a fluorescence bronchoscope. We calculated the red-to-green intensity ratio (R/G), an index of tracheal injury, and the green-plus-blue (G+B) intensity, an index of normalcy, of the most injured tracheal regions. MCC was assessed through fluoroscopic tracking of radiopaque markers. After 96 h from extubation, pigs were killed, and a pathologist scored injury. Cylindrical cuffs presented a smaller increase in R/G vs tapered cuffs (P = .011). Additionally, cuffs made of polyurethane produced a minor increase in R/G (P = .012) and less G+B intensity decline (P = .022) vs PVC cuffs. Particularly, a cuff made of polyurethane and with a smaller outer diameter outperformed all cuffs. SSA-related histologic injury ranged from cilia loss to subepithelial inflammation. MCC was 0.9 ± 1.8 and 0.4 ± 0.9 mm/min for polyurethane and PVC cuffs, respectively (P < .001). HVLP cuffs and SSA produce tracheal injury, and the recovery is incomplete up to 96 h following extubation. Small, cylindrical-shaped cuffs made of polyurethane cause less injury. MCC decline is reduced with polyurethane cuffs.

  7. Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine.

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    Cai-neng Wu

    Full Text Available The WEI Jet Endotracheal Tube (WEI JET is a new tracheal tube that facilitates both oxygenation and ventilation during the process of intubation and assists tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult tracheal intubation due to unstable cervical spine.Ninety patients with unstable cervical spine disorders (ASA I-III with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy.No statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015 and first attempt success rate (p = 0.000. The intubation time was significantly longer in the WEI group (110.8±18.3 s than in the LW group (63.3±27.5 s, p = 0.000 and DL group (66.7±29.4 s, p = 0.000, but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01. The WEI JET significantly reduced successful tracheal intubation attempts compared to the LW group (p = 0.043. The severity of sore throat was similar in three groups (p = 0.185.The combined use of WEI JET under direct laryngoscopy helps to assist tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders.Chinese Clinical Trial Registry ChiCTR-TRC-14005141.

  8. [Complex control of the source of infection in sepsis : Extracorporeal membrane oxygenation (ECMO) as a bridging concept for tracheal fistula repair in sepsis-associated ARDS].

    Science.gov (United States)

    Weiterer, S; Schmidt, K; Deininger, M; Ulrich, A; Tochtermann, U; Eberhardt, R; Hofer, S; Weigand, M A; Brenner, T

    2016-09-01

    Here, we present a case of a tracheal fistula due to an anastomotic insufficiency following abdominothoracic esophageal resection. Despite immediate discontinuity resection, the tracheal fistula could not be surgically closed, resulting in incomplete control of the source of infection and an alternative treatment concept in the form of interventional fistula closure using a Y-tracheal stent. However, owing to existing severe acute respiratory distress syndrome (ARDS), which is associated with a considerable risk of peri-interventional hypoxia, a temporary bridging concept using venovenous extracorporeal membrane oxygenation (ECMO) was implemented successfully.

  9. Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

    Science.gov (United States)

    Karippacheril, John George; Umesh, Goneppanavar; Nanda, Shetty

    2013-10-01

    A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. We report a case where, in the absence of a fiberscope, a novel inexpensive Universal Serial Bus camera was used to obtain an optimal laryngoscopic view. This provided direct visual confirmation of tracheal intubation with a Laser Flex tube, when capnography failed to show any trace. Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.

  10. [Tension pneumomediastinum and tension pneumothorax following tracheal perforation during cardiopulmonary resuscitation].

    Science.gov (United States)

    Buschmann, C T; Tsokos, M; Kurz, S D; Kleber, C

    2015-07-01

    Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR.

  11. Novel use of laryngeal mask airway classic excel™ for bronchoscopy and tracheal intubation

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    Anusha Kannan

    2013-01-01

    Full Text Available The usage frequency and scope of supraglottic airway devices in anesthesia has expanded since the original laryngeal mask airway (LMA prototype was invented by Dr Archie Brain in the early 1980s. Today, anesthesiologists are spoilt-for-choice with more than thirty options. The LMA Classic Excel™ was introduced to anesthesia practice in 2009; designed with an epiglottic elevating bar and a removable airway connector to facilitate tracheal intubation using the LMA as a conduit. We present a case report of a women diagnosed with papillary carcinoma of thyroid, who underwent bronchoscopic assessment of the trachea and subsequent intubation for an en-bloc dissection and removal of thyroid gland through the LMA Classic Excel™.

  12. The pathogenicity of Mycoplasma ovipneumoniae and Mycoplasma arginini in ovine and caprine tracheal organ cultures.

    Science.gov (United States)

    Jones, G E; Keir, W A; Gilmour, J S

    1985-10-01

    The effects of M. ovipneumoniae and M. arginini on tracheal organ cultures prepared from a neonatal kid and a foetal lamb were studied. Both organisms were isolated from the cultures throughout the 14 days of observation. M. ovipneumoniae produced ciliostasis and loss of cilia, confirmed by scanning electron microscope (SEM), after 4 days. These effects were sudden and profound in lamb explants, and gradual and less pronounced in kid explants. Clusters of organisms attached to epithelial surfaces and in association with cilia were visible by SEM. M. arginini also induced ciliostasis and cilia loss in both kid and lamb explants, but onset was more rapid, at 2 days, and there was evident recovery after day 6, with apparent regeneration of cilia. No clearly recognizable mycoplasmas were observed by SEM in M. arginini-infected explants.

  13. [Fiberoptic tracheal intubation through a laryngeal mask airway in a pediatric patient with treacher collins syndrome].

    Science.gov (United States)

    Ogata, Tokiko; Saito, Tomoyuki; Tachikawa, Mayumi; Arai, Takero; Okuda, Yasuhisa

    2013-12-01

    A 6-month-old girl with Treacher Collins syndrome was scheduled for tracheotomy because of severe airway obstruction. During slow induction of anesthesia with inhalation of sevoflurane, assisted mask ventilation was successfully performed using oropharyngeal airway. Either direct laryngoscope or GlideScope Video Laryngoscope could not reveal any part of the epiglottis (Cormack and Lehane grade 4). Even fiberoptic bronchoscopic examination assisted by GlideScope Video Laryngoscope gave a poor view of the pharynx on the video monitor. Laryngeal mask airway (LMA) was inserted easily and allowed adequate ventilation, through which fiberoptic intubation was successfully achieved. We cut the LMA short in order to pass the 3 mm tracheal tube until the glottis through it.

  14. Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer

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    John Schweiger

    2013-01-01

    Full Text Available Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the position and depth of the ulcer, a reinforced endotracheal tube (ETT was placed via the tracheostomy. Four days later, the reinforced ETT was replaced with a Shiley distal extended tracheostomy tube to bypass the ulceration. Careful inspection and evaluation of the tracheostomy site before PCT prevented a potentially life-threatening issue in our patient.

  15. Adherence of Pseudomonas aeruginosa to tracheal cells injured by influenza infection or by endotracheal intubation.

    Science.gov (United States)

    Ramphal, R; Small, P M; Shands, J W; Fischlschweiger, W; Small, P A

    1980-02-01

    Adherence of Pseudomonas aeruginosa to normal, injured, and regenerating tracheal mucosa was examined by scanning electron microscopy. Uninfected and influenza-infected murine tracheas were exposed to six strains of P. aeruginosa isolated from human sources and one strain of platn origin. All of the strains tested adhered to desquamating cells of the infected tracheas, but not to normal mucosa, the basal cell layer, or the regenerating epithelium. Adherence increased when the incubation time of the bacteria with the trachea was prolonged. Strains isolated from human tracheas appeared to adhere better than strains derived from the urinary tract. After endotracheal intubation of ferrets, P. aeruginosa adhered only to the injured cells and to areas of exposed basement membrane. We call this phenomenon "opportunistic adherence" and propose that alteration of the cell surfaces or cell injury facilitates the adherence of this bacterium and that adherence to injured cells may be a key to the pathogenesis of opportunistic Pseudomonas infections.

  16. Tracheal compression delays alveolar collapse during deep diving in marine mammals.

    Science.gov (United States)

    Bostrom, Brian L; Fahlman, Andreas; Jones, David R

    2008-05-31

    Marine mammals have very compliant alveoli and stiff upper airways; an adaptation that allows air to move from the alveoli into the upper airways, during breath-hold diving. Alveolar collapse is thought occur between 30 and 100 m and studies that have attempted to estimate gas exchange at depth have used the simplifying assumption that gas exchange ceases abruptly at the alveolar collapse depth. Here we develop a mathematical model that uses compliance values for the alveoli and upper airspaces, estimated from the literature, to predict volumes of the respiratory system at depth. Any compressibility of the upper airways decreases the volume to contain alveolar air yielding lung collapse pressures 2x that calculated assuming an incompressible upper airway. A simple relationship with alveolar volume was used to predict relative pulmonary shunt at depth. The results from our model agree with empirical data on gas absorption at depth as well as the degree of tracheal compression in forced and free diving mammals.

  17. Successful Flexible Bronchoscopic Management of Dynamic Central Airway Obstruction by a Large Tracheal Carcinoid Tumor

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    Vijay Hadda

    2014-01-01

    Full Text Available Typical carcinoid of the trachea presenting as an endoluminal polypoidal mass is a rare occurrence. Herein, we report a case of a 34-year-old female patient who presented with features of central airway obstruction. Flexible bronchoscopy demonstrated a large pedunculated growth arising from the lower end of the trachea near carina which was flopping in and out of the main tracheal lumen and the proximal right bronchus leading to dynamic airway obstruction. Successful electrosurgical excision (using a snare loop of the polypoidal growth was performed using the flexible bronchoscope itself. The patient had immediate relief of airway obstruction and histopathological examination of the polyp demonstrated features of typical carcinoid (WHO Grade I neuroendocrine tumor.

  18. A simple technique for the utilization of postmortem tracheal and bronchial tissues for ultrastructural studies.

    Science.gov (United States)

    Ferguson, C C; Richardson, J B

    1978-07-01

    Human tracheal and bronchial tissues were taken from autopsy cases within five hours of death. The tissue was placed in a modified Krebs-Henseleit solution at either 37 degrees C. or 7 degrees C. A combination of 95 per cent oxygen and 5 per cent carbon dioxide was bubbled through the Krebs-Henseleit solution. Two hours after equilibration of the tissue in the bath at 37 degrees C. and electrical field stimulation was applied to the tissue and, if the tissue was physiologically active, it was utilized for further studies. At the termination of these studies the tissue was processed for electron microscopy. Control tissue was taken directly from the same area as the test tissue and was processed for electron microscopy without immersion in the Krebs-Henseleit solution. The tissue, after immersion in the Krebs-Henseleit solution for at least three hours, showed evidence of substantial recovery from the period of anoxia.

  19. Differential Muc2 and Muc5ac secretion by stimulated guinea pig tracheal epithelial cells in vitro

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    Adler Kenneth B

    2006-02-01

    Full Text Available Abstract Background Mucus overproduction is a characteristic of inflammatory pulmonary diseases including asthma, chronic bronchitis, and cystic fibrosis. Expression of two mucin genes, MUC2 and MUC5AC, and their protein products (mucins, is modulated in certain disease states. Understanding the signaling mechanisms that regulate the production and secretion of these major mucus components may contribute significantly to development of effective therapies to modify their expression in inflamed airways. Methods To study the differential expression of Muc2 and Muc5ac, a novel monoclonal antibody recognizing guinea pig Muc2 and a commercially-available antibody against human MUC5AC were optimized for recognition of specific guinea pig mucins by enzyme-linked immunosorbent assay (ELISA, Western blot, and immunohistochemistry (IHC. These antibodies were then used to analyze expression of Muc2 and another mucin subtype (likely Muc5ac in guinea pig tracheal epithelial (GPTE cells stimulated with a mixture of pro-inflammatory cytokines [tumor necrosis factor-α (TNF-α, interleukin 1β (IL-1β, and interferon- γ (IFN-γ]. Results The anti-Muc2 (C4 and anti-MUC5AC (45M1 monoclonal antibodies specifically recognized proteins located in Muc2-dominant small intestinal and Muc5ac-dominant stomach mucosae, respectively, in both Western and ELISA experimental protocols. IHC protocols confirmed that C4 recognizes murine small intestine mucosal proteins while 45M1 does not react. C4 and 45M1 also stained specific epithelial cells in guinea pig lung sections. In the resting state, Muc2 was recognized as a highly expressed intracellular mucin in GPTE cells in vitro. Following cytokine exposure, secretion of Muc2, but not the mucin recognized by the 45M1 antibody (likely Muc5ac, was increased from the GPTE cells, with a concomitant increase in intracellular expression of both mucins. Conclusion Given the tissue specificity in IHC and the differential hybridization

  20. COMPARISON OF INTRAVENOUS LIGNOCAINE AND MAGNESIUM SULPHATE FOR ATTENUATION OF PRESSOR RESPONSE DURING TRACHEAL INTUBATION

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    Megha

    2015-03-01

    Full Text Available BACKGROUND : Laryngoscopy and Endotracheal intubation are the heart of airway management. But it induces stress response which is very detrimental for the patient. Various drugs are been tried to reduce this stress response. Magnesium Sulphate and lignocaine is been tried to reduce the pressor response during laryngoscopy and endotracheal intubation. AIM: To compare the effectiveness of Magnesium sulphate and lignocaine to reduce the pressor response during tracheal intubation. STUDY DESIGN: Contro lled clinical trial was undertaken which included three groups having fifty patients in each group . METHOD: ASA I patients were included in the study. In Control group [group 1] normal saline 10 ml was given 1 min before induction. In magnesium sulfate [gr oup 2] 50% in dose of 50mg/kg diluted in 10 ml magnesium sulfate was given 1min before induction over a period of 1min. In lignocaine group [group3] lignocaine 2% [xylocard] was given in the dose of 1 . 5mg /kg diluted in 10 ml, 90 seconds before induction. Haemodynamic changes were noted in all the three groups. STATISTICAL ANALYSIS: The students paired[t] test was used in statistical analysis. RESULT: Both the drugs produced tachycardia and hypotention. Increase in pulse rate in [ group 2] was 20.44% which was comparatively more and statistically significant to 7 . 55% increase in pulse rate produced by lignocaine. Reduction in systolic blood pressure in lignocaine group was 13 . 23% which was more and statis tically significant to 5 . 25% decrease produced by magnesium sulphate. Reduction in rate pressure product was due to attenuation of hypertensive response alone in magnesium sulfate group. Whereas attenuation of both hypertensive and tachy cardiac response c ontributed to decrease in rate pressure product in lignocaine group. CONCLUSION: It can be concluded that magnesium sulfate is effective in protecting against the hypertensive response alone, while lignocaine is effective in attenuating

  1. Acrolein relaxes mouse isolated tracheal smooth muscle via a TRPA1-dependent mechanism.

    Science.gov (United States)

    Cheah, Esther Y; Burcham, Philip C; Mann, Tracy S; Henry, Peter J

    2014-05-01

    Airway sensory C-fibres express TRPA1 channels which have recently been identified as a key chemosensory receptor for acrolein, a toxic and highly prevalent component of smoke. TRPA1 likely plays an intermediary role in eliciting a range of effects induced by acrolein including cough and neurogenic inflammation. Currently, it is not known whether acrolein-induced activation of TRPA1 produces other airway effects including relaxation of mouse airway smooth muscle. The aims of this study were to examine the effects of acrolein on airway smooth muscle tone in mouse isolated trachea, and to characterise the cellular and molecular mechanisms underpinning the effects of acrolein. Isometric tension recording studies were conducted on mouse isolated tracheal segments to characterise acrolein-induced relaxation responses. Release of the relaxant PGE₂ was measured by EIA to examine its role in the response. Use of selective antagonists/inhibitors permitted pharmacological characterisation of the molecular and cellular mechanisms underlying this relaxation response. Acrolein induced dose-dependent relaxation responses in mouse isolated tracheal segments. Importantly, these relaxation responses were significantly inhibited by the TRPA1 antagonists AP-18 and HC-030031, an NK₁ receptor antagonist RP-67580, and the EP₂ receptor antagonist PF-04418948, whilst completely abolished by the non-selective COX inhibitor indomethacin. Acrolein also caused rapid PGE₂ release which was suppressed by HC-030031. In summary, acrolein induced a novel bronchodilator response in mouse airways. Pharmacologic studies indicate that acrolein-induced relaxation likely involves interplay between TRPA1-expressing airway sensory C-fibres, NK₁ receptor-expressing epithelial cells, and EP₂-receptor expressing airway smooth muscle cells.

  2. Stimulatory effect of Crocus sativus (saffron) on beta2-adrenoceptors of guinea pig tracheal chains.

    Science.gov (United States)

    Nemati, H; Boskabady, M H; Ahmadzadef Vostakolaei, H

    2008-12-01

    To study the mechanism(s) of the relaxant effects of Crocus sativus (Iridaceae), the stimulatory effect of aqueous-ethanolic extracts of this plant and one of its constituent, safranal was examined on beta-adrenoceptors in tracheal chains of guinea pigs. The beta(2)-adrenergic stimulatory was tested by performing the cumulative concentration-response curves of isoprenaline-induced relaxation of pre-contracted isolated guinea pig tracheal chains. The studied solutions were included two concentrations of aqueous-ethanolic extract from Crocus sativus (0.1 and 0.2g%), safranal (1.25 and 2.5 microg), 10nM propranolol, and saline. The study was done in two different conditions including: non-incubated (group 1, n=9) and incubated tissues with 1 microM chlorpheniramine (group 2, n=6). The results showed clear leftward shifts in isoprenaline curves obtained in the presence of only higher concentration of the extract in group 1 and its both concentrations in group 2 compared with that of saline. The EC(50) (the effective concentration of isoprenaline, causing 50% of maximum response) obtained in the presence of both concentrations of the extract (0.17+/-0.06 and 0.12+/-0.02) and safranal (0.22+/-0.05 and 0.22+/-0.05) in group 1 and only in the presence of two concentrations of the extract (1.16+/-0.31 and 0.68+/-0.21) in group 2 was significantly lower compared to saline (1.00+/-0.22 and 4.06+/-1.04 for groups 1 and 2, respectively) (pCrocus sativus on beta(2)-adrenoceptors which is partially due to its constituent, safranal. A possible inhibitory effect of the plant on histamine (H(1)) receptors was also suggested.

  3. New parachute cuff and positive end-expiratory pressure to minimize tracheal injury and prevent aspiration.

    Science.gov (United States)

    Nordin, U; Lyttkens, L

    1979-01-01

    A new parachute cuff has been tested in combination with a positive end-expiratory pressure (PEEP) on mongrel dogs. During positive-pressure ventilation the intracuff and intratracheal pressures showed synchronous, identical pressure variations, and therefore theoretically with this type of cuff the pressure against the tracheal wall would be minimal. The cuff provided a seal against gas leakage from the lungs throughout the entire test period, i.e., for up to 7 h. To avoid aspiration of mouth contents during the passive exhalation phase, different amounts of PEEP were tested. A PEEP of 4.0--8.0 cm H2O always produced a seal against a column of fluid in the mouth exerting a hydrostatic pressure of 5.4--8.8 cm H2O against the cuff. This seal was maintained during the whole test period. No difference in sealing capacity was found when the cuff was used with a normal respiratory frequency (20/min) and with high-frequency positive-pressure ventilation (60/min). When the PEEP is eliminated, e.g., when the respirator is disconnected for suction of the endotracheal tube, the sealing effect will be abolished. As the cuff extends up into the larynx there will be no pooling of fluid above the cuff. The risk of aspiration can therefore be diminished by suction of oral cavity before disconnecting the respirator. With the use of the pneumatic valve principle together with high-frequency positive-pressure ventilation, an open respirator system can produce a continuous PEEP, thereby preventing aspiration even during suctioning of the tracheal tube.

  4. Tracheal relaxation of five medicinal plants used in Mexico for the treatment of several diseases

    Institute of Scientific and Technical Information of China (English)

    Amanda Snchez-Recillas; Paul Mantecn-Reyes; Patricia Castillo-Espaa; Rafael Villalobos-Molina; Maximiliano Ibarra-Barajas; Samuel Estrada-Soto

    2014-01-01

    Objective:To assess the relaxant effect of several organic extracts obtained fromAgastache mexicana(A. mexicana),Cochlospermum vitifolium(C. vitifolium),Cordia morelosana(C. morelosana),Lepechinia caulescens(L. caulescens)andTalauma mexicana(T. mexicana) used inMexican traditional medicine for the treatment of several diseases.Methods:Extracts were obtained by maceration at room temperature using hexane, dichloromethane and methanol for each plant material.The organic extracts were evaluatedex vivo to determine their relaxant activity on the contractions induced by carbachol(cholinergic receptor agonist,1 μmol/L) in isolated rat tracheal rings.Results:A total of15 extracts were evaluated(three for each species).All test samples showed significant relaxant effect, in a concentration-dependent manner, on the contractions induced by1 μmol/L carbachol, with exception of extracts fromC. morelosana.Active extracts were less potent than theophylline [phosphodiesterase inhibitor,EC50:(28.79±0.82) μg/mL] that was used as positive control.Concentration-response curves revealed that the extracts with more significant effects were dichloromethanic extracts ofT. mexicana [Emax:(103.03±3.32)% andEC50:(159.39±3.72) μg/mL) andC. vitifolium [Emax:(106.58±2.42)% andEC50:(219.54±7.61) μg/mL].Finally, hexanic and dichloromethanic extracts fromA. mexicana were fully effective but less potent than T. mexicana andC. vitifolium.Conclusions:Less polar extracts obtained fromA. mexicana,T. mexicana and C. vitifolium exhibited greater relaxant effect on tracheal rat rings, which allows us to suggest them as sources for the isolation of bioactive molecules with potential therapeutic value in the treatment of asthma.

  5. Posture-dependent change of tracheal sounds at standardized flows in patients with obstructive sleep apnea.

    Science.gov (United States)

    Pasterkamp, H; Schäfer, J; Wodicka, G R

    1996-12-01

    The ability of awake subjects with obstructive sleep apnea (OSA) to dilate their pharynx during inspiration may be defective. Airflow through a relatively more narrow pharyngeal passage should lead to increased flow turbulence and hence to louder respiratory sounds. We therefore studied the increase of tracheal sound intensity (TSI) in the supine position as an indicator of abnormal pharyngeal dynamics in patients with documented OSA. Sound was recorded with a contact sensor at the suprasternal notch in 7 patients with OSA (age, 52 +/- 8 years; body mass index, 29.0 +/- 3; apnea-hypopnea index, 58 +/- 17; means +/- SD), and in 8 control subjects, including obese subjects and snorers (age, 39 +/- 8 years; body mass index, 28.6 +/- 4). Subjects breathed through a pneumotachograph and aimed at target flows of 1.5 to 2 L/s, first sitting, then supine. Flow and sound signals were digitized at a 10-KHz rate. Fourier analysis was applied to sounds within the target flow range and average power spectra were obtained. Spectral power was calculated for frequency bands 0.2 to 1, 1 to 2, and 2 to 3 KHz. In the supine position, OSA patients had a significantly greater increase of inspiratory TSI than control subjects: 7.5 +/- 1.2 dB vs 1.7 +/- 3.4 dB (p TSI also increased in supine subjects, but the change was significantly greater in OSA subjects only at high frequencies. These findings confirm our earlier observations that did not include obese subjects or snorers among control subjects. Measuring posture effects on tracheal sounds is noninvasive and requires little time and effort. The greater increase of inspiratory TSI in supine OSA patients compared to subjects without OSA suggests a potential value for daytime acoustic screening.

  6. Anesthesia management by residents does not alter the incidence of recall of tracheal extubation: a teaching hospital-based propensity score analysis

    OpenAIRE

    Satoki Inoue; Ryuichi Abe; Yuu Tanaka; Masahiko Kawaguchi

    2017-01-01

    Abstract Background and objectives: The memory of emergence from anesthesia is recognized as one type of anesthesia awareness. Apart from planed awake extubation, unintentional recall of tracheal extubation is thought to be the results of inadequate anesthesia management; therefore, the incidence can be related with the experience of anesthetists. To assess whether the incidence of recall of tracheal extubation is related to anesthetists' experience, we compared the incidence of recall of tr...

  7. Monitoramento microbiológico seqüencial da secreção traqueal em pacientes intubados internados em unidade de terapia intensiva pediátrica Sequential microbiological monitoring of tracheal aspirates in intubated patients admitted to a pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Cid E. Carvalho

    2005-02-01

    Full Text Available OBJETIVO: Estudar seqüencialmente a flora traqueal em pacientes internados em unidade de terapia intensiva pediátrica e associar esta flora com o tempo de internação, a utilização prévia de antimicrobianos e o diagnóstico de pneumonia associada à ventilação mecânica. MÉTODOS: A população estudada foi constituída de pacientes pediátricos admitidos em uma unidade de terapia intensiva pediátrica entre novembro de 2002 e dezembro de 2003 e submetidos a ventilação mecânica. Foram coletadas três amostras seriadas de secreção traqueal de cada paciente. A primeira coleta foi realizada dentro das primeiras 6 horas após a admissão, e as amostras seguintes, depois de 48 e 96 horas. RESULTADOS: Foram estudados 100 pacientes com idade entre 1 dia e 14 anos. Nas três coletas realizadas, observou-se um aumento do percentual de culturas positivas para Pseudomonas aeruginosa, de 6 para 22% (p = 0,002, e também uma diminuição das culturas positivas para Staphylococcus aureus, de 23 para 8% (p = 0,009. No grupo com uso prévio de antimicrobianos, houve maior freqüência de isolamento de Candida spp (p OBJECTIVE: To evaluate, sequentially, tracheal aspirates from patients admitted to a pediatric intensive care unit and to associate these pathogens with length of hospital stay, previous use of antimicrobial therapy and diagnoses of ventilator-associated pneumonia. METHODS: The study population consisted of patients admitted to a pediatric intensive care unit, between November 2002 and December 2003, on ventilator support. Three tracheal aspirates were collected serially from each patient. The first tracheal aspirate sample was obtained 6 hours after admission to the intensive care unit and the remaining samples were collected after 48 and 96 hours. RESULTS: One hundred patients aged from one day to 14 years were assessed. Positive tracheal cultures were observed to have increased in the three tracheal aspirate samples collected from

  8. ANAESTHESIA FOR EVALUATION AND EXCISION OF TRACHEAL TUMOUR AT CARINA EXTENDING INTO RIGHT MAIN BRONCHUS: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Deepraj Singh

    2014-04-01

    Full Text Available A tracheal tumor at carinal angle is uncommon. Presented here is an interesting case of a 22 year old, HBsAg positive female with a tracheal tumor at carina extending into the right main bronchus. The patient reported shortness of breath along with fatigue and cough. Routine and other appropriate investigations were done during which X-ray chest and CT scan revealed right lung collapse with ipsilateral shift of mediastinum. Telescopic evaluation and biopsy performed under general anesthesia using supraglottic Jet Ventilation further revealed proliferative growth arising from the anterior wall of the carina extending into the right main bronchus. Subsequently, excision of the tumor through tracheotomy under general anesthesia was carried out. The patient recovered completely with no postoperative complications.

  9. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2014-05-15

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  10. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices.

    Science.gov (United States)

    Arslan, Z I; Yildiz, T; Baykara, Z N; Solak, M; Toker, K

    2009-12-01

    The aim of this study was to evaluate the effectiveness of the Airtraq and CTrach in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 microg kg(-1) fentanyl, 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p cervical spine immobilisation.

  11. Hemodynamic changes during tracheal intubation using propofol and rocuronium after pre-treatment with ephedrine in adult patients

    Directory of Open Access Journals (Sweden)

    Yeshraj Gangaiah

    2015-12-01

    Results: Pre-treatment with ephedrine hydrochloride prior to induction with propofol provided enhanced intubating conditions compared to propofol alone during rapid tracheal intubation 60 seconds after rocuronium bromide injection. However, it did not produce significant elevations of systolic and diastolic blood pressure as well as mean arterial pressure from the baseline. Pre-treatment in the EPR group resulted in an increase in the heart rate compared to the SPR group 1 min post intubation. Conclusion: The findings of the present study display that pre-treatment with ephedrine prior to propofol administration produces better intubating conditions compared to propofol alone during rapid tracheal intubation with rocuronium without significant hemodynamic changes. However, pre-treatment produced mild tachycardia, which was advantageous. It did not have any effect on the duration of laryngoscopy and the time taken for intubation. [J Exp Integr Med 2015; 5(4.000: 193-199

  12. Influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients' intra-operative serum indexes

    Institute of Scientific and Technical Information of China (English)

    Sheng-Yong Liang

    2015-01-01

    Objective:To analyze the influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients’ intra-operative serum indexes.Methods: 162 patients who received EMR from September 2013 to September 2014 in our hospital were enrolled and randomly divided into the observation group, including 81 cases, who received local mucosal anesthesia combined with non tracheal intubation general anesthesia, and the control group, including 81 cases, who received local mucosal anesthesia combined with routine tracheal intubation general anesthesia. Then inflammation index, stress index and immune index, etc were compared.Results:1) after general anesthesia, serum cytokine levels of IL-23, IL-32, PCT,β-EP and TNF-α, etc of the observation group were all significantly lower than those of the control group(P<0.05); 2) after general anesthesia, serum cytokine levels of COR, ET, TH and Ins, etc of the observation group were significantly lower than those of the control group(P<0.05); 3) after general anesthesia, serum levels of sICAM 1, CD11b, CD18 and CD20 of the observation group were lower than those of the control group; CD56 level was higher than that of the control group(P<0.05).Conclusion:Local mucosal anesthesia combined with non tracheal intubation general anesthesia provides sufficient anesthetic depth for EMR patients, and at the same time, can effectively reduce intra-operative systemic inflammatory response and stress response and contribute to the protection of body's immune function.

  13. Enhancement of Methacholine-Evoked Tracheal Contraction Induced by Bacterial Lipopolysaccharides Depends on Epithelium and Tumor Necrosis Factor

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    T. Secher

    2012-01-01

    Full Text Available Inhaled bacterial lipopolysaccharides (LPSs induce an acute tumour necrosis factor-alpha (TNF-α- dependent inflammatory response in the murine airways mediated by Toll-like receptor 4 (TLR4 via the myeloid differentiation MyD88 adaptor protein pathway. However, the contractile response of the bronchial smooth muscle and the role of endogenous TNFα in this process have been elusive. We determined the in vivo respiratory pattern of C57BL/6 mice after intranasal LPS administration with or without the presence of increasing doses of methacholine (MCh. We found that LPS administration altered the basal and MCh-evoked respiratory pattern that peaked at 90 min and decreased thereafter in the next 48 h, reaching basal levels 7 days later. We investigated in controlled ex vivo condition the isometric contraction of isolated tracheal rings in response to MCh cholinergic stimulation. We observed that preincubation of the tracheal rings with LPS for 90 min enhanced the subsequent MCh-induced contractile response (hyperreactivity, which was prevented by prior neutralization of TNFα with a specific antibody. Furthermore, hyperreactivity induced by LPS depended on an intact epithelium, whereas hyperreactivity induced by TNFα was well maintained in the absence of epithelium. Finally, the enhanced contractile response to MCh induced by LPS when compared with control mice was not observed in tracheal rings from TLR4- or TNF- or TNF-receptor-deficient mice. We conclude that bacterial endotoxin-mediated hyperreactivity of isolated tracheal rings to MCh depends upon TLR4 integrity that signals the activation of epithelium, which release endogenous TNFα.

  14. Interactions between Type III receptor tyrosine phosphatases and growth factor receptor tyrosine kinases regulate tracheal tube formation in Drosophila

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    Mili Jeon

    2012-04-01

    The respiratory (tracheal system of the Drosophila melanogaster larva is an intricate branched network of air-filled tubes. Its developmental logic is similar in some ways to that of the vertebrate vascular system. We previously described a unique embryonic tracheal tubulogenesis phenotype caused by loss of both of the Type III receptor tyrosine phosphatases (RPTPs, Ptp4E and Ptp10D. In Ptp4E Ptp10D double mutants, the linear tubes in unicellular and terminal tracheal branches are converted into bubble-like cysts that incorporate apical cell surface markers. This tube geometry phenotype is modulated by changes in the activity or expression of the epidermal growth factor receptor (Egfr tyrosine kinase (TK. Ptp10D physically interacts with Egfr. Here we demonstrate that the Ptp4E Ptp10D phenotype is the consequence of the loss of negative regulation by the RPTPs of three growth factor receptor TKs: Egfr, Breathless and Pvr. Reducing the activity of any of the three kinases by tracheal expression of dominant-negative mutants suppresses cyst formation. By competing dominant-negative and constitutively active kinase mutants against each other, we show that the three RTKs have partially interchangeable activities, so that increasing the activity of one kinase can compensate for the effects of reducing the activity of another. This implies that SH2-domain downstream effectors that are required for the phenotype are likely to be able to interact with phosphotyrosine sites on all three receptor TKs. We also show that the phenotype involves increases in signaling through the MAP kinase and Rho GTPase pathways.

  15. Tracheal dysplasia precedes bronchial dysplasia in mouse model of N-nitroso trischloroethylurea induced squamous cell lung cancer.

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    Moumita Ghosh

    Full Text Available Squamous cell lung cancer (SCC is the second leading cause of lung cancer death in the US and has a 5-year survival rate of only 16%. Histological changes in the bronchial epithelium termed dysplasia are precursors to invasive SCC. However, the cellular mechanisms that cause dysplasia are unknown. To fill this knowledge gap, we used topical application of N-nitroso-tris chloroethylurea (NTCU for 32 weeks to induce squamous dysplasia and SCC in mice. At 32 weeks the predominant cell type in the dysplastic airways was Keratin (K 5 and K14 expressing basal cells. Notably, basal cells are extremely rare in the normal mouse bronchial epithelium but are abundant in the trachea. We therefore evaluated time-dependent changes in tracheal and bronchial histopathology after NTCU exposure (4, 8, 12, 16, 25 and 32 weeks. We show that tracheal dysplasia occurs significantly earlier than that of the bronchial epithelium (12 weeks vs. 25 weeks. This was associated with increased numbers of K5+/K14+ tracheal basal cells and a complete loss of secretory (Club cell secretory protein expressing CCSP+ and ciliated cells. TUNEL staining of NTCU treated tissues confirmed that the loss of CCSP+ and ciliated cells was not due to apoptosis. However, mitotic index (measured by bromodeoxyuridine incorporation showed that NTCU treatment increased proliferation of K5+ basal cells in the trachea, and altered bronchial mitotic population from CCSP+ to K5+ basal cells. Thus, we demonstrate that NTCU-induced lung epithelial dysplasia starts in the tracheal epithelium, and is followed by basal cell metaplasia of the bronchial epithelium. This analysis extends our knowledge of the NTCU-SCC model by defining the early changes in epithelial cell phenotypes in distinct airway locations, and this may assist in identifying new targets for future chemoprevention studies.

  16. Expandable metallic stent in the treatment of subglottic tracheal stenosis: Report of long-term failure in 4 cases

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young Min; Hong, Ki Whan; Chung, Kyung Ho; Kim, Chong Soo; Sohn, Myung He; Choi, Ki Chul [Chonbuk National University Medical School, Chunju (Korea, Republic of); Song, Ho Young [Ulsan University, Medical School, Seoul (Korea, Republic of)

    1994-06-15

    Subglottic stenosis is more likely to develop secondary to endotracheal intubation if one or more traumarelated risk factors are involved. Subglottic stenosis have been dealt with many medicosurgical procedures such as dilatation, stent, laryngofissure with or without skin of mucosal graft, and segmental resection. We report long-term failure of expandable metallic stent in the treatment of subglottic tracheal stenosis in 4 cases which had been presented with respiration difficulty due to framework problem of subglottic trachea after surgical operation.

  17. ShikaniTM Seeing Optical Stylet-aided tracheal intubation in patients with a large epiglottic cyst

    Institute of Scientific and Technical Information of China (English)

    LIN Na; LI Mei; SHI Song; LI Tian-zuo; ZHANG Bing-xi

    2011-01-01

    Large epiglottic cysts can block the glottis,leading to serious consequences.This condition presents a challenge in terms of airway management for anesthesiologists during induction of anesthesia.We report the use of a ShikaniTM Seeing Optical Stylet combined with a Macintosh laryngoscope to aid tracheal intubation in seven patients with large epiglottic cysts.Use of this technique can avoid cyst rupture and allow smooth,safe intubation.

  18. trans-Caryophyllene, a Natural Sesquiterpene, Causes Tracheal Smooth Muscle Relaxation through Blockade of Voltage-Dependent Ca2+ Channels

    Directory of Open Access Journals (Sweden)

    Jader Santos Cruz

    2012-10-01

    Full Text Available trans-Caryophyllene is a major component in the essential oils of various species of medicinal plants used in popular medicine in Brazil. It belongs to the chemical class of the sesquiterpenes and has been the subject of a number of studies. Here, we evaluated the effects of this compound in airway smooth muscle. The biological activities of trans-caryophyllene were examined in isolated bath organs to investigate the effect in basal tonus. Electromechanical and pharmacomechanical couplings were evaluated through the responses to K+ depolarization and exposure to acetylcholine (ACh, respectively. Isolated cells of rat tracheal smooth muscle were used to investigate trans-caryophyllene effects on voltage-dependent Ca2+ channels by using the whole-cell voltage-clamp configuration of the patch-clamp technique. trans-Caryophyllene showed more efficiency in the blockade of electromechanical excitation-contraction coupling while it has only minor inhibitory effect on pharmacomechanical coupling. Epithelium removal does not modify tracheal smooth muscle response elicited by trans-caryophyllene in the pharmacomechanical coupling. Under Ca2+-free conditions, pre-exposure to trans-caryophyllene did not reduce the contraction induced by ACh in isolated rat tracheal smooth muscle, regardless of the presence of intact epithelium. In the whole-cell configuration, trans-caryophyllene (3 mM, inhibited the inward Ba2+ current (IBa to approximately 50% of control levels. Altogether, our results demonstrate that trans-caryophyllene has anti-spasmodic activity on rat tracheal smooth muscle which could be explained, at least in part, by the voltage-dependent Ca2+ channels blockade.

  19. Tratamento cirúrgico das estenoses traqueais congênitas Surgical treatment of congenital tracheal stenoses

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    Ricardo Mingarini Terra

    2009-06-01

    Full Text Available OBJETIVO: Analisar os desfechos dos pacientes submetidos ao reparo de estenose congênita de traqueia. MÉTODOS: Análise retrospectiva dos pacientes com estenose traqueal congênita tratados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2001 e 2007. RESULTADOS: Seis meninos e uma menina (idade ao diagnóstico entre 28 dias e 3 anos foram incluídos. Cinco pacientes apresentavam malformações intracardíacas e/ou de grandes vasos associadas. A extensão das estenoses foi curta em três pacientes, média em um e longa em três. As técnicas utilizadas foram traqueoplastia com enxerto de pericárdio em três pacientes, ressecção e anastomose em dois, traqueoplastia em bisel em um e correção de anel vascular em um. Um paciente morreu no intraoperatório por hipóxia e instabilidade hemodinâmica e outro no 11º dia pós-operatório por choque séptico. Outras complicações observadas foram pneumonia, arritmia, estenose na anastomose e estenose residual, malácia e formação de granulomas. O tempo médio de seguimento pós-operatório foi de 31 meses; quatro pacientes ficaram livres da doença e um necessitou de tubo T para manter a via aérea pérvia. CONCLUSÕES: A estenose congênita de traqueia é uma doença curável. Entretanto, seu reparo é complexo e está associado a taxas de morbidade e mortalidade significativas.OBJECTIVE: To analyze the outcomes of patients undergoing repair of congenital tracheal stenosis. METHODS: This was a retrospective review of congenital tracheal stenosis patients treated between 2001 and 2007 at the University of São Paulo School of Medicine Hospital das Clínicas in São Paulo, Brazil. RESULTS: Six boys and one girl (age at diagnosis ranging from 28 days to 3 years were included. Five of the patients also had cardiac or major vessel malformations. The stenosis length was short in three patients, medium in one and long in three. The techniques used were

  20. Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2006-07-01

    Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal Intubation Trainer and one scenario in a Laerdal SimMan Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.

  1. Relaxant effect of Thymus vulgaris on guinea-pig tracheal chains and its possible mechanism(s).

    Science.gov (United States)

    Boskabady, M H; Aslani, M R; Kiani, S

    2006-01-01

    Thymus vulgaris for the treatment of respiratory diseases is indicated widely, and relaxant effects on smooth muscle have been shown previously. In the present study, the relaxant effects of macerated and aqueous extracts of Thymus vulgaris on tracheal chains of guinea-pigs were examined using cumulative concentrations of macerated and aqueous extracts in comparison with saline (as the negative control) and theophylline (as the positive control). The relaxant effects of four cumulative concentrations of macerated and aqueous extracts (0.25, 0.5, 0.75 and 1.0 g %) in comparison with saline (as the negative control) and four cumulative concentrations of theophylline (0.25, 0.5, 0.75 and 1.0 mm; as the positive control) were examined for their relaxant effects on precontracted tracheal chains of guinea-pig by 60 mm KCl and 10 microm methacholine in two different conditions: non-incubated tissues and incubated tissues with 1 microm propranolol and 1 microm chlorphenamine. There were significant correlations between the relaxant effects and the concentrations for both extracts and theophylline in all experimental groups (p Thymus vulgaris on guinea-pig tracheal chains that was comparable to theophylline at the concentrations used.

  2. The Effects of Passive Smoking on Laryngeal and Tracheal Mucosa in Male Wistar Rats During Growth: An Experimental Study.

    Science.gov (United States)

    Zaquia Leão, Henrique; Galleano Zettler, Claudio; Cambruzzi, Eduardo; Lammers, Marcelo; Rigon da Luz Soster, Paula; Bastos de Mello, Fernanda; Reghelin Goulart, Guilherme; de Campos, Deivis; Pereira Jotz, Geraldo

    2017-01-01

    Cigarettes contain toxic and carcinogenic substances. In this context, cigarette smoking, and similar activities, are associated with numerous pathologies, being considered a risk factor in up to 10% of the total number of deaths in adults. Recent evidence suggests that the exposure of children to smoking in the early days of their development causes many diseases. Using light microscopy, this study aims to analyze the possible histopathological effects of an experimental model of chronic inhalation of cigarette smoke (passive smoking) on the laryngeal and tracheal mucosa of young Wistar rats. A total of 24 young Wistar rats were studied for a period of 120 days. The animals were divided into two groups: passive smoking (n = 16) and control (n = 8). The level of exposure to cigarette smoke was evaluated from the urinary cotinine level. Although no cancerous lesions were identified, histopathological analysis in the laryngeal and tracheal mucosa of all the animals in the experimental group showed that the proportion of moderate and focal inflammation was higher in animals exposed to chronic inhalation of cigarette smoke (P = 0.041). Histopathologic analysis revealed moderate and focal inflammatory lesions in the region of the infraglottic mucosa in exposed animals, although without dysplastic or neoplastic lesions in the laryngeal and tracheal mucosa. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  3. Insulin- and Warts-Dependent Regulation of Tracheal Plasticity Modulates Systemic Larval Growth during Hypoxia in Drosophila melanogaster

    Science.gov (United States)

    Wong, Daniel M.; Shen, Zhouyang; Owyang, Kristin E.; Martinez-Agosto, Julian A.

    2014-01-01

    Adaptation to dynamic environmental cues during organismal development requires coordination of tissue growth with available resources. More specifically, the effects of oxygen availability on body size have been well-documented, but the mechanisms through which hypoxia restricts systemic growth have not been fully elucidated. Here, we characterize the larval growth and metabolic defects in Drosophila that result from hypoxia. Hypoxic conditions reduced fat body opacity and increased lipid droplet accumulation in this tissue, without eliciting lipid aggregation in hepatocyte-like cells called oenocytes. Additionally, hypoxia increased the retention of Dilp2 in the insulin-producing cells of the larval brain, associated with a reduction of insulin signaling in peripheral tissues. Overexpression of the wildtype form of the insulin receptor ubiquitously and in the larval trachea rendered larvae resistant to hypoxia-induced growth restriction. Furthermore, Warts downregulation in the trachea was similar to increased insulin receptor signaling during oxygen deprivation, which both rescued hypoxia-induced growth restriction, inhibition of tracheal molting, and developmental delay. Insulin signaling and loss of Warts function increased tracheal growth and augmented tracheal plasticity under hypoxic conditions, enhancing oxygen delivery during periods of oxygen deprivation. Our findings demonstrate a mechanism that coordinates oxygen availability with systemic growth in which hypoxia-induced reduction of insulin receptor signaling decreases plasticity of the larval trachea that is required for the maintenance of systemic growth during times of limiting oxygen availability. PMID:25541690

  4. Insulin- and warts-dependent regulation of tracheal plasticity modulates systemic larval growth during hypoxia in Drosophila melanogaster.

    Directory of Open Access Journals (Sweden)

    Daniel M Wong

    Full Text Available Adaptation to dynamic environmental cues during organismal development requires coordination of tissue growth with available resources. More specifically, the effects of oxygen availability on body size have been well-documented, but the mechanisms through which hypoxia restricts systemic growth have not been fully elucidated. Here, we characterize the larval growth and metabolic defects in Drosophila that result from hypoxia. Hypoxic conditions reduced fat body opacity and increased lipid droplet accumulation in this tissue, without eliciting lipid aggregation in hepatocyte-like cells called oenocytes. Additionally, hypoxia increased the retention of Dilp2 in the insulin-producing cells of the larval brain, associated with a reduction of insulin signaling in peripheral tissues. Overexpression of the wildtype form of the insulin receptor ubiquitously and in the larval trachea rendered larvae resistant to hypoxia-induced growth restriction. Furthermore, Warts downregulation in the trachea was similar to increased insulin receptor signaling during oxygen deprivation, which both rescued hypoxia-induced growth restriction, inhibition of tracheal molting, and developmental delay. Insulin signaling and loss of Warts function increased tracheal growth and augmented tracheal plasticity under hypoxic conditions, enhancing oxygen delivery during periods of oxygen deprivation. Our findings demonstrate a mechanism that coordinates oxygen availability with systemic growth in which hypoxia-induced reduction of insulin receptor signaling decreases plasticity of the larval trachea that is required for the maintenance of systemic growth during times of limiting oxygen availability.

  5. Comparison of intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment

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    Madhusudan M

    2014-07-01

    Full Text Available Background: Suxamethonium is considered as the “gold standard” for tracheal intubation. Because of innumerable contraindications for the use of this drug, there is a continuous search for other alternatives. Methods: In a prospective, randomized and double-blind study, we compared the intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment. We recruited 50 patients and allocated them into 2 groups (n= 25 each; Group S: received suxamethonium 1.5 mg/kg and Group R: received rocuronium 0.6 mg/ kg with ephedrine 100 µg/kg pretreatment. All patients were induced with 2 mg/kg propofol and intubation was attempted at 60 seconds. Haemodynamic responses and quality of intubating conditions were assessed. Results: Both groups were comparable in respect to age, sex, weight, Mallampati grade, Cormack Lehane grade and duration of laryngoscopy. Although both groups had clinically acceptable intubating conditions (good and excellent, there were more number of patients with better intubation score in Group S compared to Group R (p = 0.014. Conclusion: Suxamethonium still continues to be the “gold standard” for providing ideal tracheal intubation conditions. However, in conditions where suxamethonium is contraindicated, rocuronium-ephedrine combination can be used as an alternative to intubate the trachea at 60 seconds.

  6. Syngeneic immune response to rat tracheal epithelial cells transformed in vitro by N-methyl-N-nitro-N-nitrosoguanidine

    Energy Technology Data Exchange (ETDEWEB)

    Braslawsky, G.R. (Oak Ridge National Lab., TN); Steele, V.; Kennel, S.J.; Nettesheim, P.

    1981-01-01

    Two cell lines (2-10-1 and 8-10-2) derived by exposure of primary tracheal explants to MNNG in vitro were not tumorigenic in syngeneic F-334 rats or athymic BALb/c (nu/nu) mice at early passage, but became tumorigenic at late passage. These cell lines are therefore suited to study the expression of neoantigens during neoplastic development. Transplantation resistance to late-passage, tumorigenic cells was induced in syngeneic rats using an immunization protocol of repeated cell inoculation and tumour ablation. Spleen cells from such animals were reactive in 20h microcytotoxicity assays against neoplastic cell lines, but unreactive to normal tracheal epithelial cells. Similarly, immune spleen cells co-cultivated in vitro for 6 days with irradiated neoplastic cell lines before assay for microcytotoxicity were strongly reactive, whereas co-cultivation with normal epithelial cells did not stimulate reactivity. Antibody to these neoplastic cell lines was demonstrated in sera of tumor-resistant rats by an indirect radiolabelled-antibody binding test and by indirect immunofluorescence. There was no significant binding to normal tracheal epithelial cell outgrowths.

  7. Tracheal reconstruction using chondrocytes seeded on a poly(L-lactic-co-glycolic acid)-fibrin/hyaluronan.

    Science.gov (United States)

    Hong, Hyun Jun; Chang, Jae Won; Park, Ju-Kyeong; Choi, Jae Won; Kim, Yoo Suk; Shin, Yoo Seob; Kim, Chul-Ho; Choi, Eun Chang

    2014-11-01

    Reconstruction of trachea is still a clinical dilemma. Tissue engineering is a recent and promising concept to resolve this problem. This study evaluated the feasibility of allogeneic chondrocytes cultured with fibrin/hyaluronic acid (HA) hydrogel and degradable porous poly(L-lactic-co-glycolic acid) (PLGA) scaffold for partial tracheal reconstruction. Chondrocytes from rabbit articular cartilage were expanded and cultured with fibrin/HA hydrogel and injected into a 5 × 10 mm-sized, curved patch-shape PLGA scaffold. After 4 weeks in vitro culture, the scaffold was implanted on a tracheal defect in eight rabbits. Six and 10 weeks postoperatively, the implanted sites were evaluated by bronchoscope and radiologic and histologic analyses. Ciliary beat frequency (CBF) of regenerated epithelium was also evaluated. None of the eight rabbits showed any sign of respiratory distress. Bronchoscopic examination did not reveal stenosis of the reconstructed trachea and the defects were completely recovered with respiratory epithelium. Computed tomography scan showed good luminal contour of trachea. Histologic data showed that the implanted chondrocytes successfully formed neocartilage with minimal granulation tissue. CBF of regenerated epithelium was similar to that of normal epithelium. Partial tracheal defect was successfully reconstructed anatomically and functionally using allogeneic chondrocytes cultured with PLGA-fibrin/HA composite scaffold.

  8. True tracheal bronchus: Classification and anatomical relationship on multi-detector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Jeong; Kim, Young Tong; Jou, Sung Shick; Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2017-04-15

    To propose the imaging classification of true tracheal bronchus (TTB) on multi-detector computed tomography (MDCT), and to evaluate its anatomical relationship with surrounding structures. This study included 44 patients who were diagnosed with TTB on MDCT for 6 years. We classified TTB into five types, based on the existence of the right upper lobe bronchus originating from the right main bronchus and the number of segmental bronchi of TTB. We analyzed the site of origin and the running direction of TTB based on its anatomical relationship with surrounding structures and some ancillary findings. The imaging classification of TTB included Type I (47.7%), Type II (13.6%), Type III (11.4%), Type IV (25.0%), and Type V (2.0%). According to the site of origin of TTB, below the aortic arch (52.3%) and at the level of the aortic arch (43.1%) were the two main sites of origin, whereas the frequency of the site of origin above the azygos arch, at the level of the azygos arch, and below the azygos arch was 27.3%, 38.6%, and 34.1%, respectively. Considering both aortic and azygos arches, below the aortic arch and below the azygos arch were the most common sites of origin (27.3%). With respect to the running direction of TTB, in all cases, TTB passed below the azygos arch to the right upper lobe. There was no statistically significant (p > 0.05) difference in age or sex between types of TTB. Ancillary findings included tracheal stenosis (n = 2), narrowing of the right main bronchus (n = 2), luminal narrowing of TTB and bronchiectasis at the distal portion (n = 1), and a highly located azygos arch above the aortic arch (n = 2). The proposed imaging classification of TTB and its anatomical relationship with surrounding structures will improve our understanding of various imaging features and embryological development of TTB. Radiologists should pay careful attention to evaluation of the airway including the trachea on thoracic imaging.

  9. THE LMA PROSEAL: AN EFFECTIVE ALTERNATIVE TO TRACHEAL INTUBATION FOR LAPAROSCOPIC CHOLECYSTECTOMY

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    Sanchita Sarma

    2015-12-01

    Full Text Available An Anaesthesiologist has the fundamental responsibility to maintain a patent airway during surgical procedures. Although the tracheal tube is considered ideal for laparoscopic procedures, there is consistent flow of reports highlighting the safety of LMA ProSeal in laparoscopic surgeries. The aim of this study was to compare the effects of insertion and removal of LMA ProSeal and Endotracheal tube on haemodynamic responses, to evaluate the efficacy and safety of use of LMA ProSeal as an airway device for Laparoscopic cholecystectomy and to note other observations, if any. Sixty patients undergoing elective Laparoscopic Cholecystectomy of 35-45 minutes duration were randomly divided into two groups comprising of 30 patients in each. Group E: Patients receiving EndoTracheal Tube (ETT. Group P: Patients receiving LMA ProSeal (LMA-PS. A standard General Anaesthesia protocol and routine monitoring was applied in all patients. Monitoring of Heart Rate (HR, Systolic Blood Pressure (SBP, Diastolic Blood Pressure (DBP, Mean Arterial Blood Pressure (MAP and SPO2 preoperatively (As baseline, after intubation or placement of LMA-PS, at 1min, 3mins, 5mins and every 5mins thereafter till the reading at removal and after 5mins of removal of ETT or LMA-PS. For both the groups, baseline value for ETCO2 was taken from connection of ETCO2 cable following placement of airway devices (ETT/LMA-PS.All data were analyzed by specific statistical methods applicable to the various sets of data. Tests employed were Student T test, Fisher’s exact test which were performed on SPSS software. Microsoft Word and Excel have been used to generate graphs, tables etc. SpO2 was well maintained in both the groups throughout the procedure. On statistical analysis, it was found that the increase in HR,SBP,DBP, MAP were highly significant after instrumentation, at 1 min and 3 mins with Group E showing a greater rise than Group P. It became insignificant at 5 mins and there after

  10. Chronic intrinsic transient tracheal occlusion elicits diaphragmatic muscle fiber remodeling in conscious rodents.

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    Barbara K Smith

    Full Text Available BACKGROUND: Although the prevalence of inspiratory muscle strength training has increased in clinical medicine, its effect on diaphragm fiber remodeling is not well-understood and no relevant animal respiratory muscle strength training-rehabilitation experimental models exist. We tested the postulate that intrinsic transient tracheal occlusion (ITTO conditioning in conscious animals would provide a novel experimental model of respiratory muscle strength training, and used significant increases in diaphragmatic fiber cross-sectional area (CSA as the primary outcome measure. We hypothesized that ITTO would increase costal diaphragm fiber CSA and further hypothesized a greater duration and magnitude of occlusions would amplify remodeling. METHODOLOGY/PRINCIPAL FINDINGS: Sprague-Dawley rats underwent surgical placement of a tracheal cuff and were randomly assigned to receive daily either 10-minute sessions of ITTO, extended-duration, 20-minute ITTO (ITTO-20, partial obstruction with 50% of cuff inflation pressure (ITTO-PAR or observation (SHAM over two weeks. After the interventions, fiber morphology, myosin heavy chain composition and CSA were examined in the crural and ventral, medial, and dorsal costal regions. In the medial costal diaphragm, with ITTO, type IIx/b fibers were 26% larger in the medial costal diaphragm (p<0.01 and 24% larger in the crural diaphragm (p<0.05. No significant changes in fiber composition or morphology were detected. ITTO-20 sessions also yielded significant increases in medial costal fiber cross-sectional area, but the effects were not greater than those elicited by 10-minute sessions. On the other hand, ITTO-PAR resulted in partial airway obstruction and did not generate fiber hypertrophy. CONCLUSIONS/SIGNIFICANCE: The results suggest that the magnitude of the load was more influential in altering fiber cross-sectional area than extended-duration conditioning sessions. The results also indicated that ITTO was

  11. Neoadjuvant Therapy in Differentiated Thyroid Cancer

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    Le, Valerie H.; Camille, Nadia; Miles, Brett A.; Teng, Marita S.; Genden, Eric M.; Misiukiewicz, Krzysztof J.

    2016-01-01

    Objectives. Invasion of differentiated thyroid cancer (DTC) into surrounding structures can lead to morbid procedures such as laryngectomy and tracheal resection. In these patients, there is a potential role for neoadjuvant therapy. Methods. We identified three studies involving the treatment of DTC with neoadjuvant chemotherapy: two from Slovenia and one from Japan. Results. These studies demonstrate that in selected situations, neoadjuvant chemotherapy can have a good response and allow for a more complete surgical resection, the treatment of DTC. Additionally, the SELECT trial shows that the targeted therapy lenvatinib is effective in the treatment of DTC and could be useful as neoadjuvant therapy for this disease due to its short time to response. Pazopanib has also demonstrated promise in phase II data. Conclusions. Thus, chemotherapy in the neoadjuvant setting could possibly be useful for managing advanced DTC. Additionally, some of the new tyrosine kinase inhibitors (TKIs) hold promise for use in the neoadjuvant setting in DTC.

  12. Neoadjuvant Therapy in Differentiated Thyroid Cancer

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    Rajan P. Dang

    2016-01-01

    Full Text Available Objectives. Invasion of differentiated thyroid cancer (DTC into surrounding structures can lead to morbid procedures such as laryngectomy and tracheal resection. In these patients, there is a potential role for neoadjuvant therapy. Methods. We identified three studies involving the treatment of DTC with neoadjuvant chemotherapy: two from Slovenia and one from Japan. Results. These studies demonstrate that in selected situations, neoadjuvant chemotherapy can have a good response and allow for a more complete surgical resection, the treatment of DTC. Additionally, the SELECT trial shows that the targeted therapy lenvatinib is effective in the treatment of DTC and could be useful as neoadjuvant therapy for this disease due to its short time to response. Pazopanib has also demonstrated promise in phase II data. Conclusions. Thus, chemotherapy in the neoadjuvant setting could possibly be useful for managing advanced DTC. Additionally, some of the new tyrosine kinase inhibitors (TKIs hold promise for use in the neoadjuvant setting in DTC.

  13. [Use of the Dynamic Stent in the palliation of carinal and distal tracheal stenosis].

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    Ricci, F; Puma, F; Santoprete, S; Urbani, M; Vinci, D; Sanguinetti, A; Ottavi, P; Porcaro, G; Daddi, G

    2002-01-01

    Satisfactory palliation of the lesions involving the carinal region is difficult to achieve because the stenting is conducted in an unsuitable anatomy, in highly symptomatic patients. During the period 1987-2000 we performed 785 operative rigid bronchoscopies in 524 patients, 184 of whom received a respiratory stent. The stenting of the carinal region was carried out in 27 patients with the use of the Frietag Dynamic stent. In this group of patients indication for stenting was as follows:--advanced lung cancer (22);--esophageal cancer invading the lower trachea (1);--severe tracheobronchomalacia (2);--postintubation stenosis of the lower trachea (2). No perioperative mortality was observed. All patients experienced symptomatic improvement. Follow-up ranged from 1 to 60 months: all neoplastic patients died for advanced disease without significant respiratory problems with a median survival of 5.6 months; three patients treated for benign diseases are still alive at 2, 31 and 65 months from stent deployment. No major complications were observed: in two patients the stent was removed after few days due to mucous retention; furthermore we observed symptomatic respiratory infections caused by a residual space between the tracheal wall and the prosthesis in other two patients with severe COPD. Dynamic stent is to be considered the stent of choice for palliation of the carinal region because it is effective and well tolerated with a low complications rate. The main limitations of such prosthesis are the shortness of the right bronchial branch and the size, sometimes inadequate.

  14. Hyperelastic modeling of swelling in fibrous soft tissue with application to tracheal angioedema.

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    Gou, Kun; Pence, Thomas J

    2016-01-01

    Angioedema, the rapid swelling of under-skin tissue, is typically triggered by complex biochemical processes that disrupt an original steady state filtration of liquid through the tissue. Swelling stabilizes once a new steady state is achieved in which the tissue has significantly increased liquid content. These processes are controlled by events at the molecular to the cellular length scale. For describing consequences at organ level length scales it is useful to invoke consolidated continuum mechanics treatments within a generalized hyperelastic framework. We describe the challenges associated with such modeling and demonstrate their use in the context of tracheal angioedema. The trachea is modeled as a two layered cylindrical tube. The inner layer and outer layer represent the soft mucosal tissue and the stiffer cartilaginous tissue respectively. Axially oriented fibers contribute anisotropy to the inner layer, and the swelling is largely confined to this layer. A boundary value problem is formulated; existence and uniqueness is verified. Numerical solutions track airway constriction as a function of mucosal swelling.

  15. Rib-muscle pedicle flap for the repair of congenital tracheal stenosis.

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    Willner, A; Velez, F J

    1994-08-01

    Congenital tracheal stenosis (CTS) is an uncommon congenital anomaly that presents early in life with symptoms of biphasic stridor. Most cases require surgical correction. Techniques have included dilation, resection of the involved segment, and tracheoplasty. Today pericardium and costal cartilage are the most frequently used materials for tracheoplasty, but patients still often encounter problems with the graft, with the procedure, or with late complications. This preliminary study was undertaken to determine the feasibility of a rib-intercostal muscle pedicle flap for the treatment of CTS. Tracheoplasties were performed on seven 3.5- to 5.5-kg piglets with a pedicled segment of the right fourth rib via a lateral thoracotomy incision. The method was found to be technically feasible, and pedicles of greater than 2.5 cm were easily developed. The repair provided good structural support and an airtight seal at high ventilator pressures. Histologic examination after 2 weeks showed the flap to be incorporating into the native trachea and to be without degenerative changes. This "vital" composite flap has several real and theoretic advantages over current methods of repair and may prove to be valuable in the treatment of CTS. The clinical application of this myo-osseous pedicle graft in the treatment of patients with stenoses not amenable to surgical resection and primary anastomosis should be explored.

  16. A comparison of fiberoptical guided tracheal intubation via laryngeal mask and laryngeal tube

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    Thomas Metterlein

    2015-01-01

    Full Text Available Background: Fiberoptical assisted intubation via a placed laryngeal mask airway (LMA has been described as save and easy procedure to manage a difficult airway. The laryngeal tube (LT is a promising alternative to the LMA as supraglottic airway device. Fiberoptical assisted intubation via LT is possible, however considered more difficult. The aim of this study was to compare the fiberoptical assisted intubation via LT and LMA. Materials and Methods: A total of 22 anesthesiologists with different levels of experience participated in the study performed on an adult airway model. Primarily the supraglottic device was placed and correct position was confirmed by successful ventilation. A 5 mm internal diameter tracheal tube was loaded onto a flexible 3.6 mm fiberscope and the so prepared device was inserted into the proximal lumen of the LMA or the LT. The glottis was passed under visual control and the tube advanced into the trachea. After removal of the fiberscope, ventilation was examined clinically by inspection. Success rates, procedure time and observed complications of LMA versus LT were compared (U-test; P < 0.05. Results: Placement of the endotracheal tube was successful in all attempts using both the LMA and LT. There was no difference in the time needed for the placement procedure (33 [26-38] s LMA; 35 [32-38] s LT. Only minor technical complications were observed in both groups. Conclusion: A fiberoptical assisted intubation via LT can be considered as a relevant alternative in advanced airway management.

  17. Mechanism of soman-induced contractions in canine tracheal smooth muscle. (Reannouncement with new availability information)

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    Adler, M.; Moore, D.H.; Filbert, M.G.

    1992-12-31

    The actions of the irreversible organophosphorus cholinesterase (ChE) inhibitor soman were investigated on canine trachea smooth muscle in vitro. Concentrations of soman > or - 1 nM increased the amplitude and decay of contractions elicited by electric field stimulation. The effect on decay showed a marked dependence on stimulation frequency, undergoing a 2.4-fold increase between 3 and 60 Hz. Soman also potentiated tensions due to bath applied acetylcholine (ACh). Little or no potentiation was observed for contractions elicited by carbamylcholine, an agonist that is not hydrolyzed by ChE. Concentration of soman > or - 3 nM led to the appearance of sustained contractures. These contractures developed with a delayed onset and were well correlated with ChE activity. Alkylation of muscarinic receptors by propylbenzilylcholine mustard antagonized the actions of soman on both spontaneous and electrically-evoked muscle contractions. The results are consistent with a mechanism in which the toxic actions of soman are mediated by accumulation of neurally-released ACh secondary to inhibition of ChE activity. An important factor in this accumulation is suggested to be the buffering effect of the muscarinic receptors on the efflux of ACh from the neuroeffector junction. Tracheal smooth muscle, Cholinesterase inhibitors, Muscarinic receptor, Soman, Organophosphate.

  18. Changes in DNA Methylation in Mouse Lungs after a Single Intra-Tracheal Administration of Nanomaterials

    Science.gov (United States)

    Tabish, Ali M.; Poels, Katrien; Byun, Hyang-Min; luyts, Katrien; Baccarelli, Andrea A.; Martens, Johan; Kerkhofs, Stef; Seys, Sven; Hoet, Peter; Godderis, Lode

    2017-01-01

    Aims This study aimed to investigate the effects of nanomaterial (NM) exposure on DNA methylation. Methods and Results Intra-tracheal administration of NM: gold nanoparticles (AuNPs) of 5-, 60- and 250-nm diameter; single-walled carbon nanotubes (SWCNTs) and multi-walled carbon nanotubes (MWCNTs) at high dose of 2.5 mg/kg and low dose of 0.25 mg/kg for 48 h to BALB/c mice. Study showed deregulations in immune pathways in NM-induced toxicity in vivo. NM administration had the following DNA methylation effects: AuNP 60 nm induced CpG hypermethylation in Atm, Cdk and Gsr genes and hypomethylation in Gpx; Gsr and Trp53 showed changes in methylation between low- and high-dose AuNP, 60 and 250 nm respectively, and AuNP had size effects on methylation for Trp53. Conclusion Epigenetics may be implicated in NM-induced disease pathways. PMID:28081255

  19. A comparison of sevoflurane versus propofol for tracheal intubation in children

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    Viren Darji

    2014-07-01

    Full Text Available The study was conducted in 60 ASA I Children, 4-12 years of age, of either sex undergoing elective surgery. All patients were premedicated with I.V. Midazolam 0.02 mg/kg, Inj. Fentanyl 2μg/kg and Glycopyrolate 0.05mg/kg. 10 minutes before surgery. Patients were randomly divided into two groups. Group S (SEVOFLURANE 8%+40% O 2 +60%N 2 O and Group P (I.V. Propofol 1%w/v .Centralization of pupils and miosis were used as end points for intubation. Anesthesia was maintained with O 2 , nitrous oxide and sevoflurane. Induction time, Quality of Intubation, Hemodynamic response and complications during endotracheal intubation in children with inhalational induction with Sevoflurane versus and complications during endotracheal intubation studied. Conclusion: In premedicated children both sevoflurane and propofol provides good quality of anesthesia for intubation. Induction time and Hemodynamic response was less in propofol than sevoflurane. Quality of intubating condition was better with propofol than sevoflurane .So Propofol is better than Sevoflurane for tracheal intubation in Children. However Sevoflurane is acceptable alternative in patients with difficult venous access

  20. Ambroxol inhibits rhinovirus infection in primary cultures of human tracheal epithelial cells.

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    Yamaya, Mutsuo; Nishimura, Hidekazu; Nadine, Lusamba Kalonji; Ota, Chiharu; Kubo, Hiroshi; Nagatomi, Ryoichi

    2014-04-01

    The mucolytic drug ambroxol hydrochloride reduces the production of pro-inflammatory cytokines and the frequency of exacerbation in patients with chronic obstructive pulmonary disease (COPD). However, the inhibitory effects of ambroxol on rhinovirus infection, the major cause of COPD exacerbations, have not been studied. We examined the effects of ambroxol on type 14 rhinovirus (RV14) infection, a major RV group, in primary cultures of human tracheal epithelial cells. RV14 infection increased virus titers and cytokine content in the supernatants and RV14 RNA in the cells. Ambroxol (100 nM) reduced RV14 titers and cytokine concentrations of interleukin (IL)-1β, IL-6 and IL-8 in the supernatants and RV14 RNA in the cells after RV14 infection, in addition to reducing susceptibility to RV14 infection. Ambroxol also reduced the expression of intercellular adhesion molecule-1 (ICAM-1), the receptor for RV14, and the number of acidic endosomes from which RV14 RNA enters the cytoplasm. In addition, ambroxol reduced the activation of the transcription factor nuclear factor kappa B (NF-κB) in the nucleus. These results suggest that ambroxol inhibits RV14 infection partly by reducing ICAM-1 and acidic endosomes via the inhibition of NF-κB activation. Ambroxol may modulate airway inflammation by reducing the production of cytokines in rhinovirus infection.

  1. A systematic review and meta-regression analysis of mivacurium for tracheal intubation.

    Science.gov (United States)

    Vanlinthout, L E H; Mesfin, S H; Hens, N; Vanacker, B F; Robertson, E N; Booij, L H D J

    2014-12-01

    We systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people.

  2. Effects of oral clonidine premedication on haemodynamic response to laryngoscopy and tracheal intubation: a clinical trial.

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    Talebi, H; Nourozi, A; Fateh, S; Mohammadzadeh, A; Eghtesadi-Araghi, P; Jabbari, S; Kalantarian, M

    2010-12-01

    The objective of this study was to evaluate the efficacy of pre-anesthetic orally administration of clonidine on pulse rate and blood stress response to laryngoscopy and tracheal intubation. In a double-blinded, randomized study, 274 ASA I and II subjects with age of 18 to 45 years scheduled for elective surgery under general anesthesia were enrolled. They were randomly allocated to receive oral clonidine (0.2 mg) or placebo as premedication 90-120 min before surgery. All the patients received Succinylcholine (1.5 mg kg(-1)) after induction of anesthesia with Fentanyl (50 microg) and Thiopentone (5 mg kg(-1)). The anesthesia was maintained with halothane (1.5 Mac) in 50% mixture of N2O/O2. Heart rate and systolic blood pressure were recorded before, immediately after and then every 5 min after intubation until 20 min. The Clonidine group showed a significant superiority over placebo in the prevention of increase in systolic blood pressure as well as heart rate over the intubation. A significant difference was observed in both heart rate and systolic blood pressures were significantly higher in Control group at three subsequent measurements following intubation. The results of this study suggest that orally administered clonidine in preanesthetic period, provides more haemodynamic stability and attenuates the stress response to laryngoscopy and intubation.

  3. Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

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    Sandeep Bansal

    2012-01-01

    Full Text Available Objective. To demonstrate the risk associated with blocked proximal tracheal stents when a patient presents with acute respiratory distress, with blockage of stent and what is the best management we can offer without damage to the stent and its associated complications. Case Report. A 22-yr-old, male patient, presented in severe respiratory distress. He had history of corrosive poisoning for which he was tracheotomised. A stainless steel wire mesh stent was placed in the trachea, from the subglottis, to just above the carina. One month later, he presented with a critically compromised airway with severe respiratory distress. Emergency tracheostomy was done and the metallic stent had to be cut open, in order to provide an airway. Conclusion. Management of blocked proximal stents with patient in respiratory distress remains a challenge. Formation of granulation tissue is common and fibreoptic bronchoscopic assisted intubation may not always be possible. A regular follow up of all patients with stents is essential. Placement of stents within a few centimetres of cricotracheal junction should not be encouraged for long term indications.

  4. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections†.

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    Gonzalez-Rivas, Diego; Yang, Yang; Stupnik, Tomaz; Sekhniaidze, Dmitrii; Fernandez, Ricardo; Velasco, Carlos; Zhu, Yuming; Jiang, Gening

    2016-01-01

    Locally advanced lung tumours often require complex surgical techniques to achieve an oncological and safe procedure. Sleeve resections when operating on endobronchial lesions or hilar tumours should be attempted whenever possible rather than performing a pneumonectomy. These procedures result in improved survival, better quality of life, a reduced loss of lung function and an improved operative mortality compared with pneumonectomy. Although the most common approach is an open thoracotomy, these complex surgical techniques can be performed in a thoracoscopic way with the skills and the experience gained from major video-assisted thoracoscopic procedures (VATS). However, despite the multiple advantages of VATS compared with thoracotomy, such as decreased postoperative pain and better recovery, this minimally invasive approach is still not widely adopted for advanced stages of lung cancer and complex resections. Concerns about performing an adequate oncological resection and safe reconstruction VATS are the main reasons for the low adoption of these minimally invasive approaches. Like other thoracoscopic techniques, VATS sleeve procedures also have a steep learning curve, and should therefore be performed either by or with skilled and experienced VATS surgeons to ensure safety and avoid complications. In this article, we describe the technique of thoracoscopic sleeve procedures through a single-incision (uniportal) approach for bronchial, bronchovascular, tracheal and carinal reconstruction, and review the literature reporting sleeve resections by VATS.

  5. Effects of inspiratory resistance, inhaled beta-agonists and histamine on canine tracheal blood flow

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    Kelly, W.T.; Baile, E.M.; Brancatisano, A.; Pare, P.D.; Engel, L.A. (Dept. of Respiratory Medicine, Westmead Hospital, Westmead, NSW (Australia))

    1992-01-01

    Tracheobronchial blood flow is potentially important in asthma as it could either influence the clearance of mediators form the airways, thus affecting the duration and severity of bronchoispasm, or enhance oedema formation with a resultant increase in airflow obstruction. In anaesthetized dogs, spontaneously breathing via a tracheostomy, we investigated the effects of three interventions which are relevant to acute asthma attacks and could potentially influence blood flow and its distribution to the mucosa and remaining tissues of the trachea: (1) increased negative intrathoracic pressure swings (-25[+-]1 cmH[sub 2]O) induced by an inspiratory resistance; (2) variable inhaled doses of a beta-adrenoceptor-agonist (terbutaline); and (3) aerosolized histamine sufficient to produce a threefold increase in pulmonary resistance. Microspheres labelled with different radioisotopes were used to measure blood flow. Resistive breathing did not influence tracheobronchial blood flow. Following a large dose of terbutaline, mucosal blood flow (Qmb) increased by 50%. After inhaled histamine, Qmb reached 265% of the baseline value. We conclude that, whereas increased negative pressure swings do not influence tracheobronchial blood flow or its distribution, inhalation of aerosolized terbutaline, corresponding to a conventionally nebulized dose, increases mucosal blood flow. Our results also confirm that inhaled histamine, in a dose sufficient to produce moderate bronchoconstriction, increases tracheal mucosal blood flow in the area of deposition. (au).

  6. Vilse, a conserved Rac/Cdc42 GAP mediating Robo repulsion in tracheal cells and axons.

    Science.gov (United States)

    Lundström, Annika; Gallio, Marco; Englund, Camilla; Steneberg, Pär; Hemphälä, Johanna; Aspenström, Pontus; Keleman, Krystyna; Falileeva, Ludmilla; Dickson, Barry J; Samakovlis, Christos

    2004-09-01

    Slit proteins steer the migration of many cell types through their binding to Robo receptors, but how Robo controls cell motility is not clear. We describe the functional analysis of vilse, a Drosophila gene required for Robo repulsion in epithelial cells and axons. Vilse defines a conserved family of RhoGAPs (Rho GTPase-activating proteins), with representatives in flies and vertebrates. The phenotypes of vilse mutants resemble the tracheal and axonal phenotypes of Slit and Robo mutants at the CNS midline. Dosage-sensitive genetic interactions between vilse, slit, and robo mutants suggest that vilse is a component of robo signaling. Moreover, overexpression of Vilse in the trachea of robo mutants ameliorates the phenotypes of robo, indicating that Vilse acts downstream of Robo to mediate midline repulsion. Vilse and its human homolog bind directly to the intracellular domains of the corresponding Robo receptors and promote the hydrolysis of RacGTP and, less efficiently, of Cdc42GTP. These results together with genetic interaction experiments with robo, vilse, and rac mutants suggest a mechanism whereby Robo repulsion is mediated by the localized inactivation of Rac through Vilse.

  7. Effects of Artesunate on Tracheal Smooth Muscle from the Guinea—pig

    Institute of Scientific and Technical Information of China (English)

    Mao-ShengYang; Jian-ChuXiao

    1997-01-01

    Artesunae is a derivative of qinghaosu,with a sesquiterpene structure.The specific action and the clinical uses of artesunate are on the preliminary stage,on the one hand ,artesunate has specific action of both antiinflammation and antivirus,and also has protective effect on the pulmonary alveolar macrophages,whuich may be advantageous to the treatment of the airway non-specific inflammation of asthma,.On the other hand,qinghaousu has the activities to relax vascular smooth muscle and to cause hypotension.The expectorant action,the antitussive action and the antuiasthmatic action of qinghaosu were preported.Artesunate may also have antiasthmatic activity,because the antimalarial potency of artesunate is stronger than that of qinghaosu,and Artesunate can block Ca2+ influx by inhibiting calcium-dependent chloride current.The main aims of this paper are to investigate the site,the mode,and the mechanism of artesunate action on isolated tracheal smooth muscle from the guinea-pig.

  8. Complicações da intubação traqueal em pediatria Complications of tracheal intubation in pediatrics

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    Nélio de Souza

    2009-01-01

    Full Text Available OBJETIVO: Descrever a frequência e os tipos de complicações da intubação traqueal e suas principais causas. MÉTODOS: Estudo transversal de pacientes internados na UTI Pediátrica da Santa Casa de Misericórdia de São Paulo, entre maio/98 e dezembro/99 e que foram submetidos a intubação traqueal por mais de 24 horas. Os critérios de exclusão incluíam intubações anteriores, cirurgias ou traumas em região cervical ou orofaringe. RESULTADOS: Foram estudados 147 casos com idade variando de um mês até 15 anos e três meses. Em 31,3% foram usados tubos traqueais de tamanho inadequado e 14,3% necessitaram cinco ou mais tentativas para serem intubados. Houve maior dificuldade de intubação por parte dos médicos residentes. O maior número de tentativas de intubação traqueal foi relacionado com aumento de traumas, hipóxia, bradicardia e piora no escore de Downes após a extubação. Foram observados 21,8% de extubação acidental, que se relacionou com piora no escore de Downes e necessidade de reintubação. Os médicos residentes também causaram maior número de traumas e de bradicardia. CONCLUSÃO: A maioria das complicações pode ser atribuída à falta de experiência e treinamento do médico que realizou a intubação traqueal, devendo-se para minimizá-las implementar programas de treinamento e aumentar a supervisão durante a intubação traqueal.OBJECTIVE: To describe the frequency and types of tracheal intubation complications and their main causes. METHODS: Cross sectional study of patients who were submitted to tracheal intubation for more than 24 hours at the Pediatric ICU of Santa Casa de Misericórdia de São Paulo, between May 1998 and December 1999. Exclusion criteria were previous intubations, surgeries or traumas in the cervical region or oropharynx. RESULTS: A study of 147 patients with ages varying from 1 month to 15 years and 3 months was carried out. An inadequate tracheal tube had been used in 31.3% of

  9. Coexistence of squamous cell tracheal papilloma and carcinoma treated with chemotherapy and radiotherapy: a case report

    Directory of Open Access Journals (Sweden)

    Paliouras D

    2015-12-01

    Full Text Available Dimitrios Paliouras,1 Apostolos Gogakos,1 Thomas Rallis,1 Fotios Chatzinikolaou,2 Christos Asteriou,1 Georgios Tagarakis,3 John Organtzis,4 Kosmas Tsakiridis,5 Drosos Tsavlis,4 Athanasios Zissimopoulos,6 Ioannis Kioumis,4 Wolfgang Hohenforst-Schmidt,7 Konstantinos Zarogoulidis,4 Paul Zarogoulidis,4 Nikolaos Barbetakis1 1Thoracic Surgery Department, Theagenio Cancer Hospital, 2Department of Forensic Medicine and Toxicology, Faculty of Medicine, 3Department of Cardiothoracic Surgery, AHEPA University Hospital, 4Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, 5Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Panorama, Thessaloniki, 6Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 7Medical Clinic I, “Fuerth” Hospital, University of Erlangen, Fuerth, Germany Background: Papillomatosis presents, most frequently, as multiple lesions of the respiratory tract, which are usually considered benign. Malignant degeneration into squamous cell carcinoma is quite common, although curative approaches vary a lot in modern literature.Case report: We report a case of a 66-year-old male patient with the coexistence of multiple squamous cell papilloma and carcinoma in the upper trachea with severe airway obstruction that was diagnosed through bronchoscopy and treated by performing an urgent tracheostomy, followed by concurrent chemotherapy and radiotherapy. There was no evidence of recurrence after a 12-month follow-up period.Conclusion: This study underlines the diagnostic and therapeutic value of bronchoscopy as well as multimodality palliative treatment in such cases. To the best of our knowledge, this is the first study to describe an immediate treatment protocol with tracheostomy and concurrent chemotherapy/radiotherapy in a patient with squamous cell tracheal papilloma and carcinoma

  10. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

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    Zarogoulidis P

    2012-06-01

    Full Text Available Paul Zarogoulidis,1 Theodoros Kontakiotis,1 Kosmas Tsakiridis,2 Michael Karanikas,3 Christos Simoglou,4 Konstantinos Porpodis,1 Alexandros Mitrakas,3 Agisilaos Esebidis, 3 Maria Konoglou,5 Nikolaos Katsikogiannis,6 Vasilis Zervas,1 Christina Aggelopoulou,7 Dimitrios Mikroulis,4 Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Cardiothoracic Department, Saint Luke Private Hospital, Thessaloniki, Greece; 31st University Surgery Department, 4Cardiothoracic Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 51st Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 6Surgery Department (NHS, 7Neurology Department (NHS, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GreeceAbstract: Management of a "difficult airway" remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a "difficult airway" and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and

  11. Metabolic detoxification pathways for 5-methoxy-sterigmatocystin in primary tracheal epithelial cells.

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    Cabaret, Odile; Puel, Olivier; Botterel, Françoise; Delaforge, Marcel; Bretagne, Stéphane

    2014-01-01

    1.  The health effects of inhaled mycotoxins remain poorly documented despite their presence in bioaerosols. 5-methoxy-sterigmatocystin is produced in association with sterigmatocystin by some Aspergillus spp., sometimes in larger amounts than sterigmatocystin. Whereas sterigmatocystin can be metabolized through cytochromes P450 (CYP), UDP-glucuronosyltransferases and sulfotransferases in airway epithelial cells, little is known about 5-methoxy-sterigmatocystin. 2.  The 5-methoxy-sterigmatocystin metabolites were analyzed using human recombinant CYP and porcine tracheal epithelial cell (PTEC) primary cultures at an air-liquid interface. The induction of xenobiotic-metabolizing enzymes was examined by real-time quantitative PCR for mRNA expression and 7-ethoxyresorufin O-deethylation activity. 3.  CYP1A1 metabolized 5-methoxy-sterigmatocystin into hydroxy-nor-methoxy-sterigmatocystin, nor-methoxy-sterigmatocystin and dihydroxy-methoxy-sterigmatocystin. CYP1A2 led to monohydroxy-methoxy-sterigmatocystin. In PTEC, 5-methoxy-sterigmatocystin metabolism resulted into a glucuroconjugate of 5-methoxy-sterigmatocystin, a sulfoconjugate and a glucuroconjugate of monohydroxy-methoxy-sterigmatocystin. The exposure of PTEC for 24 h to 1 µM 5-methoxy-sterigmatocystin induced a significant increase in the mRNA levels of CYP1A1, without significant induction of the 7-ethoxyresorufin O-deethylation activity. 4.  These data suggest that 5-methoxy-sterigmatocystin is mainly detoxified in airway cells through conjugation, as sterigmatocystin. However, while CYP produced a reactive metabolite of sterigmatocystin, no such metabolite was detected with 5-methoxy-sterigmatocystin. Nevertheless, 5-methoxy-sterigmatocystin increases the CYP1A1 mRNA levels. The long-term consequences remain unknown.

  12. Effect of rigid cervical collar on tracheal intubation using Airtraq®

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    Padmaja Durga

    2014-01-01

    Full Text Available Background and Aims: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq ® was evaluated. Methods: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C and without rigid cervical collar (group NC. The ease of insertion of Airtraq ® into the oral cavity, intubation time, intubation difficulty score (IDS were compared using Wilcoxon sign ranked test and McNemar test, using SPSS version 13. Results: Intubation using Airtraq ® was successful in the presence of the cervical collar in 96% which was comparable to group without collar (P = 0.24. The restriction of mouth opening resulted in mild difficulty in insertion of Airtraq ® . The median Likert scale for insertion was - 1 in the group C and + 1 in group NC (P < 0.001. The intubation time was longer in group C (30 ± 14.3 s vs. 26.9 ± 14.8 s compared to group NC. The need for adjusting manoeuvres was 18.5% in group C versus 6.2% in group NC (P = 0.003 and bougie was required in 12 (18.5% and 4 (6.2% patients in group C and NC, respectively, to facilitate intubation (P = 0.02. The modified IDS score was higher in group C but there was no difference in the number of patients with IDS < 2. Conclusion: Tracheal intubation using Airtraq ® in the presence of rigid cervical collar has equivalent success rate, acceptable difficulty in insertion and mild increase in IDS.

  13. The effect of nitroglycerin on response to tracheal intubation. Assessment by radionuclide angiography

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    Hart, A.P.; Camporesi, E.M.; Sell, T.L.; Croughwell, N.; Silva, R.; Jones, R.H.; McIntyre, R.W.; Stanley, T.E.; Reves, J.G. (Duke Univ. Medical Center, Durham, NC (USA))

    1989-06-01

    The effect of intravenous (IV) nitroglycerin (NTG) on perioperative myocardial ischemia as detected by single pass radionuclide angiocardiography was studied in 20 patients scheduled for elective coronary artery bypass grafting (CABG). Ten patients, selected at random, received IV NTG 1 microgram.kg-1.min-1 (NTG group) and 10 others, IV saline (control group). Anesthetic induction consisted of midazolam 0.2 mg.kg-1, vecuronium 0.1 mg.kg-1, and 50% N{sub 2}O in O{sub 2}. ECG leads I, II, and V5 were monitored for ST segment changes. Single pass radionuclide angiocardiography (RNA) was performed at 5 times: prior to induction, prior to tracheal intubation, and at 1, 3.5, and 6 min following intubation. The presence of new regional wall motion abnormalities (RWMA) was determined from each RNA study as compared with the preinduction measurement. Apart from one patient in the control group who developed a new v wave after intubation, there was no evidence of ischemia by pulmonary capillary wedge pressure. No ECG evidence of ischemia was detected in any patient. Despite this, new regional wall motion abnormalities were observed in 3 patients in the control group and 1 patient in the NTG group. Blood pressure and heart rate responses of patients with new RWMA were not significantly different from other patients. The low incidence of ischemia in this population precludes a definitive statement regarding the efficacy of IV NTG, but the lower incidence of RWMA in the NTG group suggests a protective effect.

  14. Intercostal muscle motor behavior during tracheal occlusion conditioning in conscious rats

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    Jaiswal, Poonam B.

    2016-01-01

    A respiratory load compensation response is characterized by increases in activation of primary respiratory muscles and/or recruitment of accessory respiratory muscles. The contribution of the external intercostal (EI) muscles, which are a primary respiratory muscle group, during normal and loaded breathing remains poorly understood in conscious animals. Consciousness has a significant role on modulation of respiratory activity, as it is required for the integration of behavioral respiratory responses and voluntary control of breathing. Studies of respiratory load compensation have been predominantly focused in anesthetized animals, which make their comparison to conscious load compensation responses challenging. Using our established model of intrinsic transient tracheal occlusions (ITTO), our aim was to evaluate the motor behavior of EI muscles during normal and loaded breathing in conscious rats. We hypothesized that 1) conscious rats exposed to ITTO will recruit the EI muscles with an increased electromyogram (EMG) activation and 2) repeated ITTO for 10 days would potentiate the baseline EMG activity of this muscle in conscious rats. Our results demonstrate that conscious rats exposed to ITTO respond by recruiting the EI muscle with a significantly increased EMG activation. This response to occlusion remained consistent over the 10-day experimental period with little or no effect of repeated ITTO exposure on the baseline ∫EI EMG amplitude activity. The pattern of activation of the EI muscle in response to an ITTO is discussed in detail. The results from the present study demonstrate the importance of EI muscles during unloaded breathing and respiratory load compensation in conscious rats. PMID:26823339

  15. Matrix metalloproteinase-9-deficient dendritic cells have impaired migration through tracheal epithelial tight junctions.

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    Ichiyasu, Hidenori; McCormack, Joanne M; McCarthy, Karin M; Dombkowski, David; Preffer, Frederic I; Schneeberger, Eveline E

    2004-06-01

    When sampling inhaled antigens, dendritic cells (DC) must penetrate the tight junction (TJ) barrier while maintaining the TJ seal. In matrix metalloproteinase (MMP)-9-deficient mice, in vivo experiments suggest that migration of DC into air spaces is impaired. To examine the underlying mechanisms, we established a well-defined in vitro model using mouse tracheal epithelial cells and mouse bone marrow DC (BMDC). Transmigration was elicited with either macrophage inflammatory protein (MIP)-1alpha or MIP-3beta in a time-dependent manner. Control MMP-9(+/+) BMDC cultured with granulocyte macrophage-colony-stimulating factor for 7 d showed a 30-fold greater transepithelial migration toward MIP-3beta than MIP-1alpha, indicating a more mature DC phenotype. MMP-9(-/-) BMDC as well as MMP-9(+/+) BMDC in the presence of the MMP inhibitor GM6001, although showing a similar preference for MIP-3beta, were markedly impaired in their ability to traverse the epithelium. Expression levels of CCR5 and CCR7, however, were similar in both MMP-9(-/-) and MMP-9(+/+) BMDC. Expression of the integral TJ proteins, occludin and claudin-1, were examined in BMDC before and after transepithelial migration. Interestingly, occludin but not claudin-1 was degraded following transepithelial migration in both MMP-9(-/-) and control BMDC. In addition, there was a > 2-fold increase in claudin-1 expression in MMP-9(-/-) as compared with control BMDC. These observations indicate that occludin and claudin-1 are differentially regulated and suggest that the lack of MMP-9 may affect claudin-1 turnover.

  16. Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq(tm video laryngoscope in obese patients

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    Dante Ranieri Jr.

    2014-06-01

    Full Text Available Purpose: this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq(tm laryngoscopes. Methods: from 132 bariatric surgery patients (body mass index = 35 kg m-1, cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n = 64 or an Airtraq(tm (n = 68 laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack-Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. Results: intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9 + 22.8 s and 13.7 + 3.1 s for the Macintosh and Airtraq(tm laryngoscope groups (p < 0.01, respectively. Cormack-Lehane scores were also lower for the Airtraq(tm group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq(tm. Cervical circumference (p < 0.01 and interincisor distance (p < 0.05 influenced the time required for intubation in the Macintosh group but not in the Airtraq(tm group. Conclusion: in obese patients despite increased neck circumference and limited mouth opening, the Airtraq(tm laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails.

  17. Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS).

    Science.gov (United States)

    Mudakanagoudar, Mahantesh S; Santhosh, M C B

    2016-01-01

    Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. Difference between ETLMI (2.49 ± 0.44) and ETTI (2.81 ± 0.65) as well as MACLMI (1.67 ± 0.13) and MACTI (1.77 ± 0.43) was statistically very significant, while BISLMI (49.05 ± 10.76) and BISTI (41.25 ± 3.25) was significant. Insertion conditions were comparable in both the groups. We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  18. [Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)].

    Science.gov (United States)

    Mudakanagoudar, Mahantesh S; Santhosh, M C B

    2016-01-01

    Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by Anova and Student's t test. Difference between ETLMI (2.49±0.44) and ETTI (2.81±0.65) as well as MACLMI (1.67±0.13) and MACTI (1.77±0.43) was statistically very significant, while BISLMI (49.05±10.76) and BISTI (41.25±3.25) was significant. Insertion conditions were comparable in both the groups. We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index. Copyright © 2014. Publicado por Elsevier Editora Ltda.

  19. Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS

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    Mahantesh S. Mudakanagoudar

    2016-02-01

    Full Text Available BACKGROUND: Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD. Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. AIMS: To compare concentration of sevoflurane (end tidal and MAC value required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. METHOD: The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion and Group TI (tracheal intubation. No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. RESULTS: Difference between ETLMI (2.49 ± 0.44 and ETTI (2.81 ± 0.65 as well as MACLMI (1.67 ± 0.13 and MACTI (1.77 ± 0.43 was statistically very significant, while BISLMI (49.05 ± 10.76 and BISTI (41.25 ± 3.25 was significant. Insertion conditions were comparable in both the groups. CONCLUSION: We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.

  20. Un nuevo caso de pseudotumor inflamatorio de la tráquea A new case of inflammatory tracheal tumor

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    Edelberto Fuentes Valdés

    2008-12-01

    Full Text Available El pseudotumor inflamatorio de tráquea es poco frecuente y puede simular un tumor cuando se localiza en la luz traqueal o bronquial. El objetivo del presente artículo fue presentar un nuevo caso y revisar la literatura especializada. Se trató de una paciente de 23 años de edad, con cuadro de disnea de varios años de evolución, tratada con el diagnóstico de asma bronquial. Fue intervenida de urgencia por empeoramiento de la disnea y diagnóstico de tumor intratraqueal, según estudio broncoscópico. Se practicó la resección de 5 anillos traqueales con anastomosis término-terminal. La evolución posoperatoria fue satisfactoria y la paciente se encuentra libre de recidiva 5 años después de la operación.The inflammatory tracheal pseudotumor is rare and it may mimic a tumor when it is located in the tracheal or bronchial light. The objective of this article was to present a new case and to review the specialized literature. The case of a 23-year-old patient with a picture of dyspnea of several years of evolution treated with diagnosis of bronchial asthma was reported. She underwent emergency surgery due the worsening of dypsnea and to the diagnosis of intratracheal tumor according to a bronchoscopic study. The resection of 5 tracheal rings was performed with termino-terminal anastomosis. The postoperative evolution was satisfactory and the patient has been free of relapse five years after the operation.

  1. Protective effects of anisodamine on cigarette smoke extract-induced airway smooth muscle cell proliferation and tracheal contractility

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    Xu, Guang-Ni; Yang, Kai; Xu, Zu-Peng; Zhu, Liang; Hou, Li-Na; Qi, Hong; Chen, Hong-Zhuan, E-mail: hongzhuan_chen@hotmail.com; Cui, Yong-Yao, E-mail: yongyaocui@yahoo.com.cn

    2012-07-01

    Anisodamine, an antagonist of muscarinic acetylcholine receptors (mAChRs), has been used therapeutically to improve smooth muscle function, including microvascular, intestinal and airway spasms. Our previous studies have revealed that airway hyper-reactivity could be prevented by anisodamine. However, whether anisodamine prevents smoking-induced airway smooth muscle (ASM) cell proliferation remained unclear. In this study, a primary culture of rat ASM cells was used to evaluate an ASM phenotype through the ability of the cells to proliferate and express contractile proteins in response to cigarette smoke extract (CSE) and intervention of anisodamine. Our results showed that CSE resulted in an increase in cyclin D1 expression concomitant with the G0/G1-to-S phase transition, and high expression of M2 and M3. Functional studies showed that tracheal hyper-contractility accompanied contractile marker α-SMA high-expression. These changes, which occur only after CSE stimulation, were prevented and reversed by anisodamine, and CSE-induced cyclin D1 expression was significantly inhibited by anisodamine and the specific inhibitor U0126, BAY11-7082 and LY294002. Thus, we concluded that the protective and reversal effects and mechanism of anisodamine on CSE-induced events might involve, at least partially, the ERK, Akt and NF-κB signaling pathways associated with cyclin D1 via mAChRs. Our study validated that anisodamine intervention on ASM cells may contribute to anti-remodeling properties other than bronchodilation. -- Highlights: ► CSE induces tracheal cell proliferation, hyper-contractility and α-SMA expression. ► Anisodamine reverses CSE-induced tracheal hyper-contractility and cell proliferation. ► ERK, PI3K, and NF-κB pathways and cyclin D1 contribute to the reversal effect.

  2. Receptor-Type Guanylyl Cyclase at 76C (Gyc76C) Regulates De Novo Lumen Formation during Drosophila Tracheal Development

    Science.gov (United States)

    Patel, Unisha

    2016-01-01

    Lumen formation and maintenance are important for the development and function of essential organs such as the lung, kidney and vasculature. In the Drosophila embryonic trachea, lumena form de novo to connect the different tracheal branches into an interconnected network of tubes. Here, we identify a novel role for the receptor type guanylyl cyclase at 76C (Gyc76C) in de novo lumen formation in the Drosophila trachea. We show that in embryos mutant for gyc76C or its downsteam effector protein kinase G (PKG) 1, tracheal lumena are disconnected. Dorsal trunk (DT) cells of gyc76C mutant embryos migrate to contact each other and complete the initial steps of lumen formation, such as the accumulation of E-cadherin (E-cad) and formation of an actin track at the site of lumen formation. However, the actin track and E-cad contact site of gyc76C mutant embryos did not mature to become a new lumen and DT lumena did not fuse. We also observed failure of the luminal protein Vermiform to be secreted into the site of new lumen formation in gyc76C mutant trachea. These DT lumen formation defects were accompanied by altered localization of the Arf-like 3 GTPase (Arl3), a known regulator of vesicle-vesicle and vesicle-membrane fusion. In addition to the DT lumen defect, lumena of gyc76C mutant terminal cells were shorter compared to wild-type cells. These studies show that Gyc76C and downstream PKG-dependent signaling regulate de novo lumen formation in the tracheal DT and terminal cells, most likely by affecting Arl3-mediated luminal secretion. PMID:27642749

  3. Relaxant effect of Pimpinella anisum on isolated guinea pig tracheal chains and its possible mechanism(s).

    Science.gov (United States)

    Boskabady, M H; Ramazani-Assari, M

    2001-01-01

    We have studied the relaxant effect of Pimpinella anisum on isolated guinea pig tracheal chains and its possible mechanism(s). The bronchodilatory effects of aqueous and ethanol extracts and essential oil were examined on precontracted isolated tracheal chains of the guinea pig by 10 microM methacholine in two different conditions including: non-incubated tissues (group 1) and incubated tissues with 1 microM propranolol and 1 microM chlorpheniramine (group 2). In addition, the anticholinergic effects of essential oil and 10 nM atropine were tested by comparing the cumulative log concentration-response curves of methacholine induced contraction of tracheal chains and the effective concentration of methacholine, causing 50% of maximum response (EC(50)) in the presence of essential oil or atropine. Aqueous and ethanol extracts, essential oil and theophylline (1 mM) showed significant relaxant effects compared to those of controls. Although relaxant effect of essential oil was lower than theophylline, there was no significant difference between the effect of aqueous and ethanol extracts and that of theophylline. There was also no significant difference between the relaxant effects obtained in group 1 and 2 experiments. The results also showed parallel rightward shifts of methacholine-response curves and significant increase in EC(50) with the presence of atropine or essential oil. These results indicated bronchodilatory effects of essential oil, aqueous, and ethanol extracts from P. anisum. The results also showed that the relaxant effect of this plant is not due to an inhibitory effect of histamine (H(1)) or stimulatory effect of beta(2)-adrenergic receptors, but due to inhibitory effects on muscarinic receptors.

  4. Preparation and characterization of paclitaxel-loaded poly lactic acid-co-glycolic acid coating tracheal stent

    Institute of Scientific and Technical Information of China (English)

    Kong Yingying; Zhang Jie; Wang Ting; Qiu Xiaojian; Wang Yuling

    2014-01-01

    Background In-stent restenosis caused by airway granulation poses a challenge due to the high incidence of recurrence after treatment.Weekly applications of anti-proliferative drugs have potential value in delaying the recurrence of airway obstruction.However,it is not practical to subject patients to repeated bronchoscopy and topical drug applications.We fabricated novel pacilitaxel-eluting tracheal stents with sustained and slow pacilitaxel release,which could inhibit the formation of granulation tissue.And we assessed the quality and drug release behaviors of drug-eluting stents (DESs) in vitro.Methods Stents were dipped vertically into a coating solution prepared by dissolving 0.5 g (2% w/v) of poly lactic acid-coglycolic acid (PLGA) and 0.025 g (0.1% w/v) of pacilitaxel in 25 ml of dichloromethane.DES morphology was examined by scanning electron microscopy (SEM).Pacilitaxel release kinetics from these DESs was investigated in vitro by shaking in PBS buffer followed by high performance liquid chromatography (HPLC).Results Using an orthogonal experimental design,we fabricated numerous pacilitaxel/PLGA eluting tracheal stents to assess optimum coating proportions.The optimum coating proportion was 0.1% (w/v) pacilitaxel and 2% (w/v) PLGA,which resulted in total pacilitaxel loading of (16.380 6±0.002 1) mg/stent.By SEM the coating was very smooth and uniform.Pacilitaxel released from DES was at (0.376 3±0.003 8) mg/d,which is a therapeutic level.There was a prolonged,sustained release of pacilitaxel of >40 days.Conclusions Paclitaxel-loaded PLGA coating tracheal stents were successfully developed and evaluated.Quality assessments demonstrated favorable surface morphology as well as sustained and effective drug release behavior,which provides an experimental reference for clinical practitioners.

  5. EVALUATION OF TRACHEAL INTUBATING CONDITIONS AND SERUM POTASSIUM LEVELS WITH DIFFERENT DOSES OF SUCCINYLCHOLINE : A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

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    Shravan Kumar

    2015-08-01

    Full Text Available BACKGROUND: Utility of succinylcholine for rapid sequence induction is a common practice for more than last 50 years. The ED 95 dose of succinylcholine is 0.3mg/kg. Regularly 2 - 3 times ED 95 doses of non - depolarizing muscle relaxants are being used for tracheal intubation, but succinylcholine is being used traditionally in a dose of 1mg/kg which is more than 3.5 times ED 95. However, according to the available literature evidence doses as smal l as 0.4 mg /kg may also provide clinically acceptable intubating conditions with the possibility of earlier return of neuromuscular function which avoids critical hemoglobin desaturation in unanticipated difficult airway& CVCI situations. We did a study to evaluate the ease of tracheal intubation with low doses of succinylcholine in Indian population. AIM: To evaluate tracheal intubating conditions and serum potassium levels with different doses of succinylcholine. DESIGN: A prospective randomized double bli nd comparative study. METHODS: 80 patients belonging to ASA PS I&II were randomly divided into 4 groups A,B,C&D who received 0.5mg/kg,0.6mg/kg,0.7mg/kg& 1mg/kg of succinylcholine respectively. All the patients were pre - medicated with Tab. Alprazolam 0.25 mg PO previous night and fentanyl 1mcg/kg 5 min before induction, induced with sleep dose of thiopentone followed by administration of test drug. After 1 min , 3yrs experienced anesthesiologist attempted tracheal intubation& assessment of intubating conditions w ere done using Cooper& colleagues criteria. N - M effects were monitored preoperatively and up to 3 min after dug administration. Haemodynamic parameters& serum potassium were measured preoperatively , continued up to 5 min & 1 hour after drug administration res pectively. RESULTS: Clinical intubation cumulative scores in GROUP A were significantly different from other GROUPS ( B, C, D with ( p<0.05 on ANOVA. N - M monitoring has revealed significant twitch height depression in Group D

  6. Syngeneic immune response to rat tracheal epithelial cells transformed in vitro by N-methyl-N-nitro-N-nitrosoguanidine.

    OpenAIRE

    Braslawsky, G. R.; Steele, V.; Kennel, S. J.; Nettesheim, P.

    1981-01-01

    Two cell lines (2-10-1 and 8-10-2) derived by exposure to primary tracheal explants to MNNG in vitro were not tumorigenic in syngeneic F-344 rats or athymic BALB/c (nu/nu) mice at early passage, but became tumorigenic at late passage. These cell lines are therefore suited to study the expression of neoantigens during neoplastic development. Transplantation resistance to late-passage, tumorigenic cells was indicated in syngeneic rats using an immunization protocol of repeated cell inoculation ...

  7. Severe hypoxaemia in field-anaesthetised white rhinoceros (Ceratotherium simum and effects of using tracheal insufflation of oxygen

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    M. Bush

    2004-06-01

    Full Text Available White rhinoceros anaesthetised with etorphine and azaperone combination develop adverse physiological changes including hypoxia, hypercapnia, acidosis, tachycardia and hypertension. These changes are more marked in field-anaesthetised rhinoceros. This study was designed to develop a technique to improve safety for field-anaesthetised white rhinoceros by tracheal intubation and oxygen insufflation. Twenty-five free-ranging white rhinoceros were anaesthetised with an etorphine and azaperone combination for translocation or placing microchips in their horns. Once anaesthetised the rhinoceros were monitored prior to crating for transportation or during microchip placement. Physiological measurements included heart and respiratory rate, blood pressure and arterial blood gas samples. Eighteen rhinoceros were intubated using an equine nasogastric tube passed nasally into the trachea and monitored before and after tracheal insufflation with oxygen. Seven rhinoceros were not intubated or insufflated with oxygen and served as controls. All anaesthetised rhinoceros were initially hypoxaemic (percentage arterial haemoglobin oxygen saturation (% O2Sa = 49 % + 16 (mean + SD and PaO2 = 4.666 + 1.200 kPa (35 + 9 mm Hg, hypercapnic (PaCO2 = 8.265 + 1.600 kPa (62 + 12 mm Hg and acidaemic (pHa = 7.171 + 0.073 . Base excess was -6.7 + 3.9 mmol/ℓ, indicating a mild to moderate metabolic acidosis. The rhinoceros were also hypertensive (systolic blood pressure = 21.861 + 5.465 kPa (164 + 41 mm Hg and tachycardic (HR = 107 + 31/min. Following nasal tracheal intubation and insufflation, the % O2Sa and PaO2 increased while blood pHa and PaCO2 remained unchanged.Tracheal intubation via the nose is not difficult, and when oxygen is insufflated, the PaO2 and the % O2Sa increases, markedly improving the safety of anaesthesia, but this technique does not correct the hypercapnoea or acidosis. After regaining their feet following reversal of the anaesthesia, the animals

  8. The effect of the jaw-thrust manoeuvre on the ability to advance a tracheal tube over a bronchoscope during oral fibreoptic intubation.

    Science.gov (United States)

    Han, S H; Oh, A Y; Jung, C W; Park, S J; Kim, J H; Nahm, F S

    2013-05-01

    During fibreoptic intubation, it is often difficult to advance a tracheal tube over the fibreoptic bronchoscope. We performed a prospective randomised study to investigate the effect of the jaw-thrust manoeuvre on the ability to advance a tracheal tube during oral fibreoptic intubation. After placing the bronchoscope in the trachea, an assistant randomly applied a jaw-thrust manoeuvre (jaw-thrust group) or sham manoeuvre (control group) in 82 patients during tube advancement. The jaw-thrust group had a higher success rate on the first attempt (70.7% vs 34.1%, p = 0.002), required fewer attempts (median (IQR [range]) 1 (1-2 [1-3]) vs 2 (1-3 [1-4]), p thrust manoeuvre facilitates the advancement of a tracheal tube over the bronchoscope during oral fibreoptic intubation. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  9. Evaluation of the GlideScope for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar.

    Science.gov (United States)

    Bathory, I; Frascarolo, P; Kern, C; Schoettker, P

    2009-12-01

    Application of cervical collars may reduce cervical spine movements but render tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesised that despite the presence of a Philadelphia Patriot cervical collar and with the patient's head taped to the trolley, tracheal intubation would be possible in 50 adult patients using the GlideScope and its dedicated stylet. Laryngoscopy was attempted using a Macintosh laryngoscope with a size 4 blade, and the modified Cormack-Lehane grade was scored. Subsequently, laryngoscopy with the GlideScope was graded and followed by tracheal intubation. All patients' tracheas were successfully intubated with the GlideScope. The median (IQR) intubation time was 50 s (43-61 s). The modified Cormack-Lehane grade was 3 or 4 at direct laryngoscopy. It was significantly reduced with the GlideScope (p collar and having their head taped to the trolley is possible with the help of the GlideScope.

  10. [Use of a metal guide in the working channel of a fiberoptic scope to insert a tracheal tube in an infant with Treacher Collins syndrome and choanal atresia].

    Science.gov (United States)

    Rodríguez Conesa, A M; Etxániz Alvarez, A; Rey Calvete, A M; Pérez Gil, J; Nieto Mouronte, C M

    2010-02-01

    Neonates with Treacher Collins syndrome can present difficult airways. Ventilation through a face mask and laryngoscopy for tracheal intubation may prove impossible due to the craniofacial malformations that are characteristic of this syndrome. Furthermore, patients with this syndrome are at high risk of airway obstruction, meaning that awake fiberoptic endoscopy provides the best option for tracheal intubation. This technique is especially difficult in children, however, and material required for performing it in neonates is not always available. We report the case of a 5-day-old infant boy with Treacher Collins syndrome and bilateral choanal atresia in whom we used a flexible metal guide inserted into the working channel of a fiberoptic scope. The tracheal tube could then be inserted.

  11. [Prophylactic use of icatibant before tracheal intubation of a patient with hereditary angioedema type III. (A literature review of perioperative management of patients with hereditary angioedema type III)].

    Science.gov (United States)

    Iturri Clavero, F; González Uriarte, A; Tamayo Medel, G; Gamboa Setién, P M

    2014-01-01

    Type III hereditary angioedema is a rare familial disorder that has recently been described as a separate condition. Triggers for episodes of angioedema include surgery, dental procedures, and tracheal intubation maneuvers. Since episodes affecting the upper airway are potentially life-threatening, prophylactic treatment is recommended in these situations. The use of icatibant (Firazyr(®)), for prevention of angioedema prior to tracheal intubation, is reported in a patient with type iii hereditary angioedema. A literature review on the anesthetic management of this condition was conducted.

  12. Comparison of dexmedetomidine and lignocaine on attenuation of airway and pressor responses during tracheal extubation

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    Vivek Bharti Sharma

    2014-01-01

    Full Text Available Background: Haemodynamic stability and rapid emergence after general anaesthesia used in spinal surgery is a common practice, the goal of which is to permit early neurological motor and sensory examination. Extubation is almost always associated with hypertension, increased airway response and arrhythmias. We have compared the effects of the α-2 agonist Dexmedetomidine and Lignocaine given at the end of the procedure on attenuation of airway and pressor responses following tracheal extubation. This study is a randomised, placebo-controlled, double-blinded study. Materials and Methods: Sixty ASA I-III patients, aged 18-70 years, scheduled to undergo spinal surgery at the level of thoracic, lumbar or sacral region were randomly divided into three groups. Balanced general anaesthesia comprising standard procedures and drugs were used for monitoring, induction and maintenance. At the last skin suture, inhalation anaesthetic was discontinued. After turning the patient supine and return of spontaneous efforts, in Group D Dexmedetomidine 0.5 μg/kg, in Group L Lignocaine 1.5 mg/kg and in Group P normal saline (10 ml were administered as bolus intravenously over 60 seconds. Systolic, diastolic and mean arterial pressures and heart rate were recorded before intravenous administration and also every minute for 3 minutes, at 5, 10 and 15 minutes post-extubation. Duration of emergence and extubation were noted and attenuation of airway response and quality of extubation was evaluated on cough grading. Results: Mean arterial pressures and heart rate were higher in Group L and Group P than in Group D but not statistically significant. The duration of emergence, extubation and recovery were comparable in all the groups (P > 0.05. Extubation Quality Scores was 1 in 80%, 2 in 20% in Group D; in Group L, the quality scores were 1 for 55%, 2 for 45% and I Group P 1 for 35%, 2 for 45% and 3 for 20% of the patients. The requirement of rescue analgesia was also less

  13. PARTIAL TRACHEAL OBSTRUCTION IN CANINES OBSTRUÇÃO PARCIAL DA TRAQUÉIA EM CANINO

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    Claudia Gorgulho Nogueira Fernandes

    2010-04-01

    Full Text Available Partial tracheal obstruction caused by foreign bodies is a rare afliction in canines which can lead to tracheitis, bronchitis or pneumonia. The main clinical indications are dyspnea, coughing and cyanosis, which may lead to the death of the animal. One female Rottweiler dog of one year and seven months of age was treated at the Veterinary Hospital of the University of Cuiabá (UNIC/MT for coughing and breathing difficulty. The radiology exam showed an opaque, circular object located in the cranial cervical trachea. The animal was therefore submitted to a surgical procedure for the removal of the foreign body which was subsequently identified as a child’s marble. The results were satisfactory, confirmed by the lack of respiratory difficulty signs after the surgical procedure.

    KEY WORDS: Canine, foreign body, trachea.

    A obstrução traqueal incompleta por corpos estranhos é uma afecção rara na espécie canina, que pode causar traqueíte, bronquite e pneumonia. Os principais sinais clínicos são dispneia, tosse e cianose, que podem levar o animal a óbito. Um canino da raça Rottweiler, fêmea, com um ano e sete meses de idade, foi atendido no Hospital Veterinário da Universidade de Cuiabá/UNIC/MT, apresentando tosse e angústia respiratória. O exame radiológico revelou uma estrutura radiopaca de formato circular localizado na traqueia cervical cranial. O animal foi, então, submetido à traqueotomia para retirada do corpo estranho, ocasião em que se pôde confirmar que se tratava de uma bola de gude. Os resultados foram satisfatórios, confirmados através de ausência de sinais de dificuldade respiratória após o procedimento cirúrgico.

    PALAVRAS-CHAVES: Canino, corpo estranho, traqueia.

  14. Effects of toxin of red tide, Ptychodiscus brevis, on canine tracheal smooth muscle: a possible new asthma-triggering mechanism.

    Science.gov (United States)

    Asai, S; Krzanowski, J J; Anderson, W H; Martin, D F; Polson, J B; Lockey, R F; Bukantz, S C; Szentivanyi, A

    1982-05-01

    The red tide toxin produced by Ptychodiscus brevis becomes airborne by the thrashing action of the surf and wind and induces cough, rhinorrhea, watery eyes, and sneezing in normal humans and wheezing in asthmatic patients. The mechanism of the contractile response induced by P. brevis toxin (PBTX) was investigated with isolated canine tracheal smooth muscle. Tetrodotoxin and atropine blocked the contractile effect of PBTX, and neostigmine potentiated the contraction. Mepyramine, phentolamine, methysergide, and chlorisondamine did not inhibit the effect of PBTX. This is the first description of a naturally occurring airborne substance that causes smooth muscle contraction by stimulating the axon sodium channels, resulting in the release of acetylcholine at postganglionic parasympathetic efferent nerve endings. The in vitro effect of PBTX on canine tracheal smooth muscle indicates that PBTX is capable of causing respiratory irritation and thus may precipitate an asthmatic attack. It is possible, however, that the mechanism is vivo may also include stimulation of a cough receptor reflex and/or stimulation of sodium channels of afferent vagus nerve fibers. In vitro evidence suggests that isoproterenol, atropine, and verapamil may be used to eliminate or prevent the respiratory symptoms that follow exposure to airborne red tide toxin. The use of high-pressure liquid chromatography separated fractions indicates that the neurotoxic component, not the hemolytic component, is responsible for contractions.

  15. A single dose of esmolol blunts the increase in bispectral index to tracheal intubation during sevoflurane but not desflurane anesthesia.

    Science.gov (United States)

    Choi, Seung Ho; Kim, Chang Seok; Kim, Jong Hoon; Kim, Bum Su; Kim, Eun Mi; Min, Kyeong Tae

    2009-07-01

    Activation of the peripheral nerve system by endotracheal intubation is accompanied by an increase in bispectral index (BIS). Esmolol produces a dose-dependent attenuation of the adrenergic response to endotracheal intubation. Desflurane increases sympathetic nerve activity and plasma norepinephrine relative to sevoflurane. The authors hypothesized that esmolol might blunt the BIS response to endotracheal intubation more during sevoflurane anesthesia than desflurane anesthesia. In this double blind, randomized study, after the induction of anesthesia, patients were mask-ventilated with either sevoflurane or desflurane (end-tidal 1 minimum alveolar concentration) and received normal saline or esmolol (0.5 mg/kg) 1 minute before intubation (sevoflurane-control, sevoflurane-esmolol, desflurane-control, and desflurane-esmolol groups, n=20/group). BIS, mean arterial pressure, and heart rate were measured before the induction of anesthesia (awake), before esmolol injection (time point -1), immediately before intubation (time point 0), and every minute for 5 minutes after tracheal intubation (time point 1 to 5). Compared with preintubation, esmolol attenuated the increase in BIS at 1 minute after intubation during sevoflurane anesthesia (5.1% for esmolol and 31.7% for control) but not during desflurane anesthesia (28.6% for esmolol and 30.8% for control). Mean arterial pressure and heart rate increased after intubation in all groups but the changes were greater in the control groups than the esmolol groups. In conclusion, a single dose of esmolol blunted the increase in BIS to tracheal intubation during sevoflurane but not desflurane anesthesia.

  16. Case report: respiratory inductance plethysmography as a monitor of ventilation during laser ablation and balloon dilatation of subglottic tracheal stenosis.

    Science.gov (United States)

    Atkins, Joshua H; Mirza, Natasha; Mandel, Jeff E

    2009-01-01

    We describe a 61-year-old female who underwent KTP laser ablation and CRE balloon dilatation of symptomatic idiopathic subglottic stenosis (50% obstruction). The procedure was conducted, using our standard approach for such cases, under total intravenous general anesthesia with subglottic high-frequency jet ventilation (HFJV) via Lindholm laryngoscope. The patient was enrolled in an ongoing investigational protocol in which respiratory inductance plethysmography (RIP; Ambulatory Monitoring Inc., Ardsley, N.Y., USA) bands were used to monitor ventilation in addition to pulse oximetry and visual inspection. HFJV instituted with an Acutronic Monsoon jet ventilator (Acutronic Medical, Hirzel, Switzerland) resulted in a rapid increase in RIP signal amplitude consistent with breath stacking and inadequate expiratory flow around the tight stenosis. High pressure alarms sounded and automatic cessation of jet ventilation ensued. After successful tracheal dilation under intermittent apnea, subsequent jet ventilation produced only modest RIP amplitude changes. RIP may be an important safety monitor during jet ventilation for patients with obstructive tracheal lesions to lessen the risk of both barotrauma and hypoventilation. RIP remains under active study by our group for this purpose.

  17. Sedation with a remifentanil infusion to facilitate rapid awakening and tracheal extubation in an infant with a potentially compromised airway

    Directory of Open Access Journals (Sweden)

    Naples J

    2016-10-01

    Full Text Available Jeffrey Naples,1,2 Mark W Hall,1,2 Joseph D Tobias,3,4 1Department of Pediatrics, The Ohio State University, 2Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, 3Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 4Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA Abstract: Sedation is generally required during endotracheal intubation and mechanical ventilation in infants and children. While there are many options for the provision of sedation, the most commonly used agents such as midazolam and fentanyl demonstrate a context-sensitive half-life, which may result in a prolonged effect when these agents are discontinued following a continuous infusion. We present a 20-month-old infant who required endotracheal intubation due to respiratory failure following seizures. At the referring hospital, multiple laryngoscopies were performed with the potential for airway trauma. To maximize rapid awakening and optimize respiratory function surrounding tracheal extubation, sedation was transitioned from fentanyl and midazolam to remifentanil for 18–24 hours prior to tracheal extubation. The unique pharmacokinetics of remifentanil are presented in this study, its use in this clinical scenario is discussed, and its potential applications in the pediatric intensive care unit setting are reviewed. Keywords: remifentanil, sedation, pediatric, airway, extubation

  18. Stomach position in prediction of survival in left-sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion.

    Science.gov (United States)

    Cordier, A-G; Jani, J C; Cannie, M M; Rodó, C; Fabietti, I; Persico, N; Saada, J; Carreras, E; Senat, M-V; Benachi, A

    2015-08-01

    To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1-4, stomach position on the four-chamber view of the heart with respect to thoracic structures. Logistic regression analysis was used to investigate the effect of management center (Paris, Brussels, Barcelona, Milan), stomach grading, observed-to-expected lung area-to-head circumference ratio (O/E-LHR), gestational age at delivery, birth weight in expectantly managed CDH, gestational ages at FETO and at removal and period of tracheal occlusion, on postnatal survival in CDH cases treated with FETO. We identified 67 expectantly managed CDH cases and 47 CDH cases that were treated with FETO. In expectantly managed CDH, stomach position and O/E-LHR predicted postnatal survival independently. In CDH treated with FETO, stomach position and gestational age at delivery predicted postnatal survival independently. In left-sided CDH with or without FETO, stomach position is predictive of postnatal survival. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  19. Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

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    Sinan Kahraman

    2013-01-01

    Full Text Available Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period.

  20. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

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    Chaoliang Tang

    2015-01-01

    patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT or I-gel facilitated endotracheal tube intubation (Group TI. Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05 versus Group TT. Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

  1. Video-assisted thoracoscopic surgery resection and reconstruction of thoracic trachea in the management of a tracheal neoplasm

    Science.gov (United States)

    Li, Shuben; Liu, Jun; He, Jiaxi; Dong, Qinglong; Liang, Lixia; Yin, Weiqiang; Pan, Hui

    2016-01-01

    Intratracheal tumor is a rare tumor, accounting for only 2% of upper respiratory tract neoplasms. Its symptoms are similar to those of head and neck cancers, including coughing up blood, sore throat, and airway obstruction. The diagnosis of this disease is often based on the findings of fibrobronchoscopy or computed tomography (CT). Surgery remains the treatment of choice for tracheal tumor. In patients with benign neoplasms or if the tumors have limited involvement, fibrobronchoscopic resection of the tumor can be performed. For malignant tumors, however, radical resection is required. In the past, open incision is used during the surgery for tumors located in thoracic trachea. Along with advances in video-assisted thoracoscopic surgery (VATS) minimally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve the radical resection of the tumor and meanwhile dramatically reduce the injury to the patients. In this article we describe the application of VATS resection and reconstruction of trachea in the management of a tracheal neoplasm. PMID:27076958

  2. Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

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    Carlos Ferrando

    2011-01-01

    Full Text Available Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score. Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared. Results. The Airtraq significantly decreased the Cormack-Lehane score (=0.04. On the other hand, there were no differences in times of laryngoscopy (=0.645; IC 95% 3.1, +4.8 and intubation (=0.62; C95%  −6.1, +10.0 between the two devices. No relevant complications were found during the maneuvers of intubation using both devices. Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation.

  3. Effects of S100A9 in a rat model of asthma and in isolated tracheal spirals.

    Science.gov (United States)

    Yin, Lei-Miao; Li, Hai-Yan; Zhang, Qing-Hua; Xu, Yu-Dong; Wang, Yu; Jiang, Yong-Liang; Wei, Ying; Liu, Yan-Yan; Yang, Yong-Qing

    2010-07-30

    S100A9 is a member of the S100 family of proteins that contain two EF-hand calcium-binding motifs. We previously reported that S100A9 was differentially expressed during the early airway response phase of asthma and can be regulated by acupuncture. To understand the possible role of S100A9 in asthma, the effects of the S100A9 were investigated in a rat model of asthma and in isolated tracheal spirals. The pulmonary function and isometric tension were measured after the administration of purified recombinant S100A9. The results of in vivo experiments showed that S100A9 (0.1microg/kg) significantly decreased the pulmonary resistance and increased the dynamic compliance. The in vitro experimental results showed that S100A9 (100, 200, 400, or 800ng/ml, final concentrations) significantly reduced the isometric tension of isolated tracheal spirals. These results suggest that S100A9 elicits dose-dependent anti-asthmatic effects and may provide further insight into the treatment of asthma.

  4. Ontogenetic changes in tracheal structure facilitate deep dives and cold water foraging in adult leatherback sea turtles.

    Science.gov (United States)

    Davenport, John; Fraher, John; Fitzgerald, Ed; McLaughlin, Patrick; Doyle, Tom; Harman, Luke; Cuffe, Tracy; Dockery, Peter

    2009-11-01

    Adult leatherbacks are large animals (300-500 kg), overlapping in size with marine pinniped and cetacean species. Unlike marine mammals, they start their aquatic life as 40-50 g hatchlings, so undergo a 10,000-fold increase in body mass during independent existence. Hatchlings are limited to the tropics and near-surface water. Adults, obligate predators on gelatinous plankton, encounter cold water at depth (<1280 m) or high latitude and are gigantotherms that maintain elevated core body temperatures in cold water. This study shows that there are great ontogenetic changes in tracheal structure related to diving and exposure to cold. Hatchling leatherbacks have a conventional reptilian tracheal structure with circular cartilaginous rings interspersed with extensive connective tissue. The adult trachea is an almost continuous ellipsoidal cartilaginous tube composed of interlocking plates, and will collapse easily in the upper part of the water column during dives, thus avoiding pressure-related structural and physiological problems. It is lined with an extensive, dense erectile vascular plexus that will warm and humidify cold inspired air and possibly retain heat on expiration. A sub-luminal lymphatic plexus is also present. Mammals and birds have independently evolved nasal turbinates to fulfil such a respiratory thermocontrol function; for them, turbinates are regarded as diagnostic of endothermy. This is the first demonstration of a turbinate equivalent in a living reptile.

  5. Polymeric implant materials for the reconstruction of tracheal and pharyngeal mucosal defects in head and neck surgery

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    Rickert, Dorothee

    2009-01-01

    Full Text Available The existing therapeutical options for the tracheal and pharyngeal reconstruction by use of implant materials are described. Inspite of a multitude of options and the availability of very different materials none of these methods applied for tracheal reconstruction were successfully introduced into the clinical routine. Essential problems are insufficiencies of anastomoses, stenoses, lack of mucociliary clearance and vascularisation. The advances in Tissue Engineering (TE offer new therapeutical options also in the field of the reconstructive surgery of the trachea. In pharyngeal reconstruction far reaching developments cannot be recognized at the moment which would allow to give a prognosis of their success in clinical application. A new polymeric implant material consisting of multiblock copolymers was applied in our own work which was regarded as a promising material for the reconstruction of the upper aerodigestive tract (ADT due to its physicochemical characteristics. In order to test this material for applications in the ADT under extreme chemical, enzymatical, bacterial and mechanical conditions we applied it for the reconstruction of a complete defect of the gastric wall in an animal model. In none of the animals tested either gastrointestinal complications or negative systemic events occurred, however, there was a multilayered regeneration of the gastric wall implying a regular structured mucosa.In future the advanced stem cell technology will allow further progress in the reconstruction of different kind of tissues also in the field of head and neck surgery following the principles of Tissue Engineering.

  6. Effect of one minimum alveolar concentration sevoflurane with and without fentanyl on hemodynamic response to laryngoscopy and tracheal intubation

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    Anwar Hoda

    2011-01-01

    Full Text Available Background : Drug combinations can be used for optimum obtundation of the hemodynamic response to tracheal intubation. The objective of this trial was to compare the hemodynamic response to laryngoscopy and tracheal intubation after administration of 2 μg/kg fentanyl bolus or a placebo with 2% end tidal sevoflurane at induction of anesthesia. Materials and Methods : A total of 70 surgical patients of either gender, age 18-45 years were selected for this double blind, randomized, placebo controlled trial, with 35 in each group. All patients received a standardized induction with thiopentone, atracurium, and an end tidal concentration of 1 minimum alveolar concentration (MAC sevoflurane. Heart rate and noninvasive blood pressure were compared to the baseline post induction and for seven minutes post intubation. Some adverse events were noted. Results : The maximum heart rate response was significantly less in the sevoflurane fentanyl group (15% vs. 22%. Significant difference between groups was observed in the systolic blood pressure at six minutes post intubation. Hemodynamic adverse events recorded were similar. Conclusion : Addition of 2 μg fentanyl bolus to 1 MAC sevoflurane anesthesia at induction attenuated the hemodynamic response to a maximum of 15% above baseline values.

  7. Acute lung injury after tracheal instillation of acidified soya-based or Enfalac formula or human breast milk in rabbits.

    Science.gov (United States)

    Chin, C; Lerman, J; Endo, J

    1999-03-01

    The aim of this study was to compare the severity of the acute lung injury after tracheal instillation of acidified soya-based or Enfalac infant formula, or human breast milk (HBM) in anesthetized rabbits. Alveolar-arterial oxygen tension gradient (A-aDO2) and dynamic compliance were measured before (baseline) and hourly for four hours after tracheal instillation of 0.8 ml x kg(-1) soya-based or Enfalac infant formula or HBM (all acidified to pH 1.8 with hydrochloric acid) or no fluid (control) in 24 anesthetized and tracheotomized adult rabbits. The A-aDO2, the difference between alveolar and arterial oxygen tensions, was corrected for barometric pressure and carbon dioxide tension. Dynamic compliance was the ratio of the expired tidal volume to the peak inspiratory airway pressure, normalized to body weight. Baseline A-aDO2 and dynamic compliance were similar among the four groups. In the control rabbits, A-aDO2 remained unchanged throughout the four hours, whereas mean A-aDO2 increased 180 mm Hg in the soya-based group (P soya > control (P soya > control.

  8. Alleviating stress response to tracheal extubation in neurosurgical patients: A comparative study of two infusion doses of dexmedetomidine

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    Ankur Luthra

    2017-01-01

    Full Text Available Background: Tracheal extubation is almost always associated with increase in sympathoadrenal activity may result in hypertension, tachycardia, and arrhythmias. Attempts have been made to oppose the pressor response by the use of various drugs. Dexmedetomidine decreases norepinephrine which reduces the blood pressure and the heart rate (HR. We hypothesize that the infusion of dexmedetomidine may produce more stable hemodynamics during extubation as compared to boluses. Materials and Methods: Ninety adult patients aged 18–65 years, the American Society of Anesthesiologists Grade I–II undergoing intracranial surgeries for various neurologic problem at All India Institute of Medical Sciences were enrolled in this randomized controlled trial. Primary Objectives: (1 To observe the hemodynamic changes (HR and mean arterial pressure [MAP] and airway responses during tracheal extubation following two infusion doses of dexmedetomidine. Secondary Objectives: (1 Time to emergence and time to tracheal extubation, (2 Early postoperative complications such as laryngospasm and bronchospasm, and (3 adverse effects of the study drug. Patients were assigned into three groups – (1 Group D0.2 – 0.2 μg/kg/h diluted to 50 ml, (2 Group D0.4 – 0.4 μg/kg/h diluted to 50 ml and Group P (Placebo – 0.9% NS 50 ml. The hemodynamics including the HR and MAP were recorded just before the loading dose of the study drug and then were recorded every 5 min till the infusion was stopped at tracheal extubation and every 1 min till 10 min postextubation. In addition, the airway, respiratory and cardiovascular complications along with postoperative nausea and vomiting, shivering, cough grading, Aldrete score, Ramsay sedation scale, and intraoperative awareness were recorded. Statistical Analysis: Continuous variables such as HR and MAP were analyzed using analysis of variance and categorical variables were analyzed using the Chi-square test. Results: Patient demographics

  9. Fetal imaging and therapy for CDH-Current status.

    Science.gov (United States)

    Oluyomi-Obi, Titilayo; Van Mieghem, Tim; Ryan, Greg

    2017-06-01

    In congenital diaphragmatic hernia (CDH), herniation of the abdominal organs into the fetal chest causes pulmonary hypoplasia and pulmonary hypertension, the main causes of neonatal mortality. As antenatal ultrasound screening improves, the risk of postnatal death can now be better predicted, allowing for the identification of fetuses that might most benefit from a prenatal intervention. Fetoscopic tracheal occlusion is being evaluated in a large international randomized controlled trial. We present the antenatal imaging approaches that can help identify fetuses that might benefit from antenatal therapy, and review the evolution of fetal surgery for CDH to date. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Early Diagnosis and Interventional Bronchoscopy of Primary Tracheal Tumors%原发性气管肿瘤的早期诊断和呼吸介入治疗

    Institute of Scientific and Technical Information of China (English)

    林晓萍

    2016-01-01

    -CT and metastatic lesions biopsy.The majority malignant tumors included squamous cell carcinomas and adenoid cystic carcinomas, and the rest were spindle cell sarcomatoid carcinoma,carcinoid,and myopericytoma.5 cases received surgery, and 3 of 5 cases received interventional bronchoscopic therapy at the same time.And the main therapy of another 7 cases were interventional bronchoscopy,which consisted of electrocautery,argon-beam coagulation and stenting.Conclusion:Primary tracheal tumors are rare and early clinical symptoms are unspecific,therefore,we must pay more attention to them.Early diagnosis can be made by neck-chest CT and bronchoscopy.Surgery should be considered as the first choice of treatment,and interventional bronchoscopic techniques have important roles in the diagnosis,treatment of benign tracheal tumors,as a way to keep the airway open before subsequent definitive resection and as palliative therapy of advanced malignant tumors.Interventional bronchoscopy to unresectable tumors can lead to symptom remission and thus improve patient’s life quality.

  11. A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2006-11-01

    The Airtraq laryngoscope is a novel single use tracheal intubation device. We compared the Airtraq with the Macintosh laryngoscope in patients deemed at low risk for difficult intubation in a randomised, controlled clinical trial. Sixty consenting patients presenting for surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Macintosh (n = 30) or Airtraq (n = 30) laryngoscope. All patients were intubated by one of four anaesthetists experienced in the use of both laryngoscopes. No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, was successfully intubated on the first attempt. There was no difference between groups in the duration of intubation attempts. In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest improvements in the intubation difficulty score, and in ease of use. Tracheal intubation with the Airtraq resulted in less alterations in heart rate. These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in low risk patients.

  12. Significant Amelioration of Tracheal Stenosis following Lenvatinib in a Patient Who Has Anaplastic Thyroid Carcinoma with Bronchomediastinal Infiltration: A Case Report

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    Takahiro Fukuhara

    2017-02-01

    Full Text Available Background: Anaplastic thyroid carcinoma has an extremely poor prognosis, and no known drugs have exhibited acceptable efficacy. In recent years, novel anticancer tyrosine kinase inhibitors have been developed. We encountered a case of tracheal stenosis due to mediastinal and tracheal infiltration of anaplastic carcinoma for which lenvatinib exhibited remarkable effects; owing to this, airway management could be performed, even though the patient’s condition was considered critical. Case Report: A 55-year-old man presented with locally advanced anaplastic thyroid carcinoma that was observed to have mediastinal infiltration. Tracheal stenosis due to infiltration of the trachea occurred, and the condition of the patient rapidly deteriorated. Radiation and chemotherapy consisting of cetuximab, cisplatin, and fluorouracil were ineffective, but his tracheal stenosis was relieved 2 weeks after initiation of lenvatinib, after which the patient could be discharged. However, the lenvatinib was ineffective for his liver, bone, and brain metastatic lesions, and the patient remained in a critical condition. Conclusion: We encountered a case in which lenvatinib was effective for locally advanced anaplastic thyroid carcinoma, leading to an improvement in quality of life and a prolonged life. The drug was effective for the primary lesion, but mixed efficacy was noted for distant metastatic lesions.

  13. Role of the M2 muscarinic receptor pathway in lidocaine-induced potentiation of the relaxant response to atrial natriuretic peptide in bovine tracheal smooth muscle.

    Science.gov (United States)

    Yunoki, Motonari; Nakahara, Tsutomu; Mitani, Akiko; Sakamoto, Kenji; Ishii, Kunio

    2003-01-01

    We earlier reported that lidocaine augments the relaxation and accumulation of guanosine 3',5'-cyclic monophosphate produced by atrial natriuretic peptide (ANP) in bovine tracheal smooth muscle contracted with methacholine. However, the mechanism of that augmentation remains to be elucidated. In this study, we examined the role of muscarinic receptor-mediated signalling in the potentiation of ANP-induced relaxation by lidocaine. Lidocaine (100 micro M) augmented the relaxant responses to ANP in methacholine (0.3 microM)-contracted bovine tracheal smooth muscle but had no effect on the relaxant effects of ANP in preparations contracted with 100 micro M histamine. Treatment of tracheal preparations with methoctramine (0.03 microM), an M2 muscarinic receptor antagonist, enhanced ANP-induced relaxation and this treatment abolished the synergistic action of lidocaine on ANP. In radioligand-binding experiments, lidocaine concentration dependently displaced the specific binding of [3H]- N-methyl scopolamine to cloned human M2 and M3 muscarinic receptors expressed in Chinese hamster ovary cells. These results suggest that lidocaine acts as an M2 muscarinic receptor antagonist, thereby potentiating the relaxant responses to ANP in the bovine tracheal smooth muscle contracted with muscarinic receptor agonists.

  14. The use of the Molt mouth gag to assist in oral fiberoptic tracheal intubation of a developmentally challenged patient presenting with severe trismus.

    Science.gov (United States)

    Kamel, Ihab; Mulligan, Joseph; Luke, Jessica; Barnette, Rodger

    2015-02-15

    Airway management in developmentally challenged, and often uncooperative, patients presents difficulty for the anesthesiologist and may be further complicated by severe trismus. We describe a case wherein the use of the Molt mouth gag significantly facilitated airway control using fiberoptic tracheal intubation.

  15. [Comparision of forced expiratory time, recorded by two spirometers with flow sensors of various types, and acoustic duration of tracheal forced expiratory noises].

    Science.gov (United States)

    Malaeva, V V; Pochekutova, I A; Korenbaum, V I

    2015-01-01

    In the sample of 44 volunteers forced expiratory time values obtained in spirometers, equipped with flow sensor of Lilly type and turbine flow sensor, and acoustic duration of tracheal forced expiratory noises are compared. It is shown that spirometric forced expiratory time is dependent on flow sensor type. Therefore it can't be used in diagnostic aims.

  16. Evaluation of a smartphone camera system to enable visualization and image transmission to aid tracheal intubation with the Airtraq(®) laryngoscope.

    Science.gov (United States)

    Lee, Delice Weishan; Thampi, Swapna; Yap, Eric Peng Huat; Liu, Eugene Hern Choon

    2016-06-01

    Using three-dimensional printing, we produced adaptors to attach a smartphone with camera to the eyepiece of the Airtraq(®) laryngoscope. This low-cost system enabled a team to simultaneously view the laryngoscopy process on the smartphone screen, and also enabled image transmission. We compared the Airtraq(®) with the smartphone Airtraq(®) system in a crossover study of trainee anesthesiologists performing tracheal intubation in a manikin. We also evaluated the smartphone Airtraq(®) system for laryngoscopy and tracheal intubation in 30 patients, including image transmission to and communication with a remote instructor. In the manikin study, the smartphone Airtraq(®) system enabled instruction where both trainee and instructor could view the larynx simultaneously, and did not substantially increase the time required for intubation. In the patient study, we were able to view the larynx in all 30 patients, and the remote instructor was able to receive the images and to respond on correctness of laryngoscopy and tracheal tube placement. Tracheal intubation was successful within 90s in 19 (63 %) patients. In conclusion, use of a smartphone with the Airtraq(®) may facilitate instruction and communication of laryngoscopy with the Airtraq(®), overcoming some of its limitations.

  17. Safety and reliability of the sealing cuff pressure of the Microcuff pediatric tracheal tube for prevention of post-extubation morbidity in children: A comparative study.

    Science.gov (United States)

    Al-Metwalli, Roshdi Roshdi; Sadek, Sayed

    2014-10-01

    The objective of this study is to evaluate the efficacy and safety of sealing pressure as an inflation technique of the Microcuff pediatric tracheal cuffed tube. A total of 60 children were enrolled in this study. After induction of anesthesia and intubation with Microcuff pediatric tracheal tube, patients were randomly assigned, to one of the three groups. Control group (n = 20) the cuff was inflated to a cuff pressure of 20 cm H2O; sealing group (n = 20) the cuff was inflated to prevent the air leak at peak airway pressure of 20 cm H2O and the finger group (n = 20) the cuff was inflated to a suitable pressure using the finger estimation. Tracheal leak, incidence and severity of post-extubation cough, stridor, sore throat and hoarseness were recorded. The cuff pressure as well as the volume of air to fill the cuff was significantly low in the sealing group when compared with the control group (P sore throat were significantly high in the finger group compared with both the control and the sealing group (P = 0.0009 and P = 0.0026). Three patients in the control group developed air leak around the endotracheal tube cuff. The incidence and severity of other complications were similar in the three groups. In pediatric N2O, free general anesthesia using Microcuff pediatric tracheal tub, sealing cuff pressure is safer than finger palpation technique regarding post-extubation morbidities and more reliable than recommended safe pressure in prevention of the air leak.

  18. The pressure exerted on the tracheal wall by two endotracheal tube cuffs: A prospective observational bench-top, clinical and radiological study

    Directory of Open Access Journals (Sweden)

    Blunt Mark

    2010-12-01

    Full Text Available Abstract Background The Lotrach endotracheal tube has a unique low-volume, low-pressure (LVLP cuff, which has been designed to prevent pressure injury to the tracheal wall. We aimed to estimate the pressure exerted on the tracheal wall by the LVLP cuff and a conventional cuff in a bench-top, clinical and radiological study. Method In the bench-top study, a model trachea was intubated with the LVLP cuff and the conventional cuff. The cuff pressure was controlled using a constant pressure device. We assessed the pressure exerted on the tracheal wall by measuring the ability of the cuffs to support a column of water using a standard protocol. In the clinical study, we tested the ability of both cuffs to prevent air leak during a staged recruitment manoeuvre. In the radiological study, we recorded the degree of anatomical distortion of the trachea from both cuffs in the antero-posterior (AP and transverse tracheal diameters. We performed statistical analysis using non-inferiority tests. Results In the bench-top study, the LVLP cuff achieved a plateau at a mean height of 25.2 cmH2O (SD 0.34. In contrast, the conventional cuff failed to maintain any water above the cuff and a plateau could not be measured. In the clinical study, the mean pressure at which air leak occurred was 30.0 +/- 0.8 cmH2O (SD 3.8 using the LVLP cuff and 32.4 +/- 0.7 cmH2O (SD 3.0 using the conventional cuff. In the radiological study, the mean degree of anatomical distortion of the trachea in AP and transverse tracheal diameter was 2.9 +/- 2.2 mm (SD 2.1 and 1.8 +/- 1.4 mm (SD 1.4 using the LVLP cuff and 4.4 +/- 1.3 mm (SD 1.4 and 2.6 +/- 1.5 mm (SD 1.6 using the conventional cuff. Conclusions The bench-top and clinical studies both demonstrated that the LVLP cuff exerted approximately 30 cmH2O of pressure on the tracheal wall. These results are supported by our radiological study. We conclude that the LVLP cuff exerts an acceptable amount of pressure on the tracheal wall when

  19. A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased anesthesiologist discomfort compared to a pillow of 4 cm height during tracheal intubation in adult patients

    Science.gov (United States)

    Hong, Hyo Ju; Kim, Sung Hoon; Hwang, Jung Won; Lee, Hyung Chul

    2016-01-01

    Background Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients. Methods This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient's head was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist's discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed. Results There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups. The discomfort score during tracheal intubation was higher in the 8 cm group when the patient's head was elevated 4 cm first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of head elevation. Conclusions A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients. PMID:27066204

  20. Propofol for pediatric tracheal intubation with deep anesthesia during sevoflurane induction: dosing according to elapsed time for two age groups.

    Science.gov (United States)

    Politis, George D; Stemland, Christopher J; Balireddy, Ravi K; Brockhaus, Julie; Hughes, Kevin R; Goins, Matthew D; McMurry, Timothy L

    2014-02-01

    To determine, for two different age groups, the effect of duration of sevoflurane administration on the amount of propofol needed when performing tracheal intubation. Classic Dixon's Up-and-Down sequential method. University based operating rooms. 106 ASA physical status 1 and 2 patients aged one to 11 years. Patients were allocated to the 1-6 year (≥ 12 and propofol was promptly administered. Propofol dose was determined according to age group and whether propofol was given 2-4, 4-6, or 6-8 minutes after the start of sevoflurane induction, with Dixon's Up and Down Method used separately for each specific age/time group. Tracheal intubation conditions one minute after propofol were evaluated. Isotonic regression determined propofol ED50 estimates for excellent tracheal intubation conditions, and linear regression determined the effect of propofol dose on change in systolic blood pressure (SBP). Estimated propofol ED50 doses for 1-6 year olds, with 95% confidence intervals (CIs), were 1.48 mg/kg (0.80, 2.03), 0.00 mg/kg (0.00, 0.38), and 0.07 mg/kg (0.00, 0.68) in the 2-4, 4-6, and 6-8 minute groups, respectively, with estimated differences between the 2-4 minute group versus the 4-6 and 6-8 minute groups being 1.47 mg/kg (95% CI = 1.04, 2.06) and 1.41 mg/kg (95% CI = 0.74, 2.04), respectively. Estimated propofol ED50 doses for 6-11 year olds, with 95% CIs, were 2.35 mg/kg (1.97, 2.45) and 2.33 mg/kg (1.59, 2.45) in the 2-4 and 4-6 minute groups, respectively. Diminutions in SBP at one minute and two minutes after propofol administration were dose dependent for children 1-6 years of age, decreasing 5.3% and 8.1% for each 1 mg/kg of propofol, respectively. The amount of propofol needed to supplement sevoflurane in children 1-6 years of age can be expected to decrease after 4 minutes of sevoflurane. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Continuous postoperative infusion of remifentanil inhibits the stress responses to tracheal extubation of patients under general anesthesia

    Directory of Open Access Journals (Sweden)

    Zhao G

    2017-04-01

    Full Text Available Guoliang Zhao, Xiaoyue Yin, Ya Li, Jianlin Shao Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China Purpose: The study aimed to assess the combined effects of parecoxib with three different doses of remifentanil and its effect on the stress and cough responses following tracheal extubation under general anesthesia.Methods: A total of 120 patients with American Society of Anesthesiologists (ASA scores of I or II, undergoing selective thyroidectomy with total intravenous anesthesia (propofol-remifentanil and tracheal intubation, were randomly allocated to be treated with an intravenous injection of parecoxib and a continuous infusion of remifentanil at 0.1 μg/kg/min (R1, 0.2 μg/kg/min (R2, 0.3 μg/kg/min (R3, or an isotonic saline injection (the control group. Hemodynamic vital signs, emergence time, extubation time, sedation-agitation scale (SAS score, pain visual analog scale (VAS score, occurrence of coughing, and side effects were recorded before surgery and during the peri-extubation period. The vital signs included blood pressure (BP, heart rate (HR, respiratory rate (R, and peripheral arterial oxygen saturation (SPO2.Results: BP, HR, the occurrence rate of coughing, and extubation awareness decreased with the dose of remifentanil, and the differences among the groups were significant (P < 0.05. Emergence and extubation time increased with the dose of remifentanil, and the differences among the groups were significant (P < 0.05. The occurrence rates of respiratory depression and bradycardia in group R3 were significantly higher than those in other groups (P < 0.05. SAS and VAS were lowest in group R3, and the differences among the groups were significant (P < 0.05. BP, HR, SAS, and VAS increased with time in the remifentanil groups.Conclusion: The combined use of parecoxib and a moderate dose of remifentanil can effectively suppress the stress and coughing

  2. The use of the Airtraq® optical laryngoscope for routine tracheal intubation in high-risk cardio-surgical patients

    Directory of Open Access Journals (Sweden)

    Fiedler Britta

    2011-10-01

    Full Text Available Abstract Background The Airtraq® optical laryngoscope (Prodol Ltd., Vizcaya, Spain is a novel disposable device facilitating tracheal intubation in routine and difficult airway patients. No data investigating routine tracheal intubation using the Airtaq® in patients at a high cardiac risk are available at present. Purpose of this study was to investigate the feasibility and hemodynamic implications of tracheal intubation with the Aitraq® optical laryngoscope, in high-risk cardio-surgical patients. Methods 123 consecutive ASA III patients undergoing elective coronary artery bypass grafting were routinely intubated with the Airtraq® laryngoscope. Induction of anesthesia was standardized according to our institutional protocol. All tracheal intubations were performed by six anesthetists trained in the use of the Airtraq® prior. Results Overall success rate was 100% (n = 123. All but five patients trachea could be intubated in the first attempt (95,9%. 5 patients were intubated in a 2nd (n = 4 or 3rd (n = 1 attempt. Mean intubation time was 24.3 s (range 16-128 s. Heart rate, arterial blood pressure and SpO2 were not significantly altered. Minor complications were observed in 6 patients (4,8%, i.e. two lesions of the lips and four minor superficial mucosal bleedings. Intubation duration (p = 0.62 and number of attempts (p = 0.26 were independent from BMI and Mallampati score. Conclusion Tracheal intubation with the Airtraq® optical laryngoscope was feasible, save and easy to perform in high-risk patients undergoing cardiac surgery. In all patients, a sufficient view on the vocal cords could be obtained, independent from BMI and preoperative Mallampati score. Trial Registration DRKS 00003230

  3. Effects of heat and moisture exchangers on tracheal mucociliary clearance in laryngectomized patients: a multi-center case-control study.

    Science.gov (United States)

    van den Boer, C; Muller, S H; van der Noort, V; Olmos, R A Valdés; Minni, A; Parrilla, C; Hilgers, F J M; van den Brekel, M W M; van der Baan, S

    2015-11-01

    After total laryngectomy, inspired air is no longer optimally conditioned by the upper airways. Impaired mucociliary clearance and histological changes of respiratory epithelium, such as loss of ciliated cells, have been described in laryngectomized patients. Heat and moisture exchangers (HMEs) are passive humidifiers that re-condition the inspired air. Aim of this study was to assess the effect of HMEs on tracheal epithelium and tracheal mucus transport velocity (TMV). Tracheal brush biopsies were collected in three groups of TLE patients: 21 long-term HME users, 10 non-HME users, and 16 non-HME users before and after 4-9 months HME use. Tracheal epithelium biopsies were assessed using a digital high-speed camera mounted onto a light microscope. TMV was determined by scintigraphy in the first two patient groups. Significantly more ciliated cells were found in HME users compared to non-HME users (p = 0.05). TMV was higher in HME users (median 2 mm/min; 0-7.9) compared to non-HME users (median 0.8 mm/min; 0-12.3), but this difference was not significant (p = 0.37). One-hour breathing without HME in long-term HME users did not measurably decrease TMV (p = 0.13). The long-term use of an HME restores/prevents the loss of tracheal ciliated cells. A significant improvement in TMV was not found. Short-term (one hour) detachment of an HME has no measurable effect on TMV.

  4. Tracheal rupture after intubation and placement of an endotracheal balloon catheter (A-view®) in cardiac surgery.

    Science.gov (United States)

    Timman, Simone T; Mourisse, Jo M; van der Heide, Stefan M; Verhagen, Ad F

    2016-09-01

    The endotracheal balloon catheter (A-view®) is a device developed to locate atherosclerotic plaques of the ascending aorta (AA) in cardiac surgery to prevent stroke. The saline-filled balloon is located in the trachea and combines the advantages of transoesophageal echocardiography (e.g. used before performing the sternotomy) and intraoperative epiaortic ultrasound scanning (e.g. complete view of the AA). We report the first severe complication after the use of A-view®. This is a case of a 66-year old woman who underwent elective myocardial revascularization complicated by an intraoperative iatrogenic tracheal rupture of 6 cm, after uncomplicated intubation and the use of an endotracheal balloon catheter (A-view®), which required direct surgical repair with a posterolateral thoracotomy after the myocardial revascularization was completed, weaning from bypass and closure of the median sternotomy.

  5. Unusual case of respiratory embarrassment secondary to tracheal compression by a dilated oesophagus in a patient with recurrent achalasia.

    Science.gov (United States)

    Brodie, Andrew; Okeahialam, Nicola; Farinella, Eriberto

    2016-05-04

    We present the case of a 79-year-old woman with recurrent achalasia following a laparoscopic Heller's cardiomyotomy. The patient presented to the emergency department, with epigastric pain, severe dyspnoea and profound respiratory acidosis. She required intubation and ventilation followed by gastric decompression with nasogastric tube and the administration of intravenous antibiotics for a lower respiratory tract infection. Once stable, she underwent a CT scan revealing a massively dilated oesophagus causing marked tracheal compression. She received a period of continuous positive airway pressure ventilation while on the intensive care unit, for persistent low saturations, however, this was promptly ceased due to exacerbation of gastric dilation and fears over perforation. The patient responded well to conservative measures and was discharged home 18 days later awaiting follow-up with operating consultant surgeon. 2016 BMJ Publishing Group Ltd.

  6. Genetic mutations in live infectious bronchitis vaccine viruses following single or dual in vitro infection of tracheal organ cultures.

    Science.gov (United States)

    Ball, Christopher; Bennett, Sarah; Forrester, Anne; Ganapathy, Kannan

    2016-12-01

    Despite regular co-vaccination of two different strains of live infectious bronchitis vaccine viruses, little is known about possible mutations in these viruses following vaccination. As an alternative to chicks, this study used an in vitro infection model to identify single-nucleotide polymorphisms (SNPs) within the part-S1 gene of two live infectious bronchitis virus vaccine strains (793B and Massachusetts) following single or dual inoculation onto tracheal organ cultures. Results indicate that viral titres reduced over the duration of the study; conversely, the amount of detected infectious bronchitis virus genome increased. Results demonstrate a greater number of non-synonymous SNPs in both vaccine strains when they are co-inoculated, compared with the single inoculations. The influence of the increased SNP and hydrophobic properties of the translated proteins on the vaccine viruses' virulence is unknown.

  7. Predictive performance of three multivariate difficult tracheal intubation models: a double-blind, case-controlled study.

    Science.gov (United States)

    Naguib, Mohamed; Scamman, Franklin L; O'Sullivan, Cormac; Aker, John; Ross, Alan F; Kosmach, Steven; Ensor, Joe E

    2006-03-01

    We performed a case-controlled, double-blind study to examine the performance of three multivariate clinical models (Wilson, Arné, and Naguib models) in the prediction of unanticipated difficult intubation. The study group consisted of 97 patients in whom an unanticipated difficult intubation had occurred. For each difficult intubation patient, a matched control patient was selected in whom tracheal intubation had been easily accomplished. Postoperatively, a blinded investigator evaluated both patients. The clinical assessment included the patient's weight, height, age, Mallampati score, interincisor gap, thyromental distance, thyrosternal distance, neck circumference, Wilson risk sum score, history of previous difficult intubation, and diseases associated with difficult laryngoscopy or intubation. The Naguib model was significantly more sensitive (81.4%; P thyromental distance, Mallampati score, interincisor gap, and height. This model is 82.5% sensitive and 85.6% specific with an area under the receiver operating characteristic curve of 0.90.

  8. Affinities of pirenzepine for muscarinic cholinergic receptors in membranes isolated from bovine tracheal mucosa and smooth muscle

    Energy Technology Data Exchange (ETDEWEB)

    Madison, J.M.; Jones, C.A.; Tom-Moy, M.; Brown, J.K.

    1987-03-01

    Muscarinic cholinergic receptors have been classified into subtypes based on their high (M-1 subtype) or low (M-2 subtype) affinities for the nonclassic antagonist pirenzepine, and this classification has important experimental and therapeutic implications. Because muscarinic receptors are abundant in the airways where they mediate several different cellular responses, the goal of this study was to characterize the affinities of pirenzepine for the muscarinic receptors in bovine tracheal mucosa and smooth muscle. After isolating membrane particulates from mucosa and smooth muscle, as well as from bovine cerebral cortex (a known source of M-1 receptors), we used /sup 3/H-quinuclidinyl benzilate to label muscarinic receptors in the particulates and performed competition radioligand binding assays in the presence of either atropine or pirenzepine. Receptors from all 3 tissues (mucosa, smooth muscle, and cerebral cortex) were of a relatively uniform affinity for atropine (range of KI values: 0.8 +/- 0.4 X 10(-9) to 2.4 +/- 1.7 X 10(-9) M), as would be predicted for this classic muscarinic antagonist. By contrast, affinities for pirenzepine differed depending on the tissue. In cerebral cortex, the majority of receptors were of high affinity for pirenzepine (KI = 1.8 +/- 1.4 X 10(-8) M). In both mucosa and smooth muscle, receptors were of low affinity for pirenzepine (Kl = 4.8 +/- 0.4 to 6.9 +/- 3.8 X 10(-7) M). We conclude that muscarinic cholinergic receptors in bovine tracheal mucosa and smooth muscle are predominantly of the M-2 subtype.

  9. Deviation of tracheal pressure from airway opening pressure during high-frequency oscillatory ventilation in a porcine lung model.

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    Johannes, Amélie; Zollhoefer, Bernd; Eujen, Ulrike; Kredel, Markus; Rauch, Stefan; Roewer, Norbert; Muellenbach, Ralf M

    2013-04-01

    Oxygenation during high-frequency oscillatory ventilation is secured by a high level of mean airway pressure. Our objective was to identify a pressure difference between the airway opening of the respiratory circuit and the trachea during application of different oscillatory frequencies. Six female Pietrain pigs (57.1 ± 3.6 kg) were first ventilated in a conventional mechanical ventilation mode. Subsequently, the animals were switched to high-frequency oscillatory ventilation by setting mean airway opening pressure 5 cmH(2)O above the one measured during controlled mechanical ventilation. Measurements at the airway opening and at tracheal levels were performed in healthy lungs and after induction of acute lung injury by surfactant depletion. During high-frequency oscillatory ventilation, the airway opening pressure was set at a constant level. The pressure amplitude was fixed at 90 cmH(2)O. Starting from an oscillatory frequency of 3 Hz, the frequency was increased in steps of 3 Hz to 15 Hz and then decreased accordingly. At each frequency, measurements were performed in the trachea through a side-lumen of the endotracheal tube and the airway opening pressure was recorded. The pressure difference was calculated. At every oscillatory frequency, a pressure loss towards the trachea could be shown. This pressure difference increased with higher oscillatory frequencies (3 Hz 2.2 ± 2.1 cmH(2)O vs. 15 Hz 7.5 ± 1.8 cmH(2)O). The results for healthy and injured lungs were similar. Tracheal pressures decreased with higher oscillatory frequencies. This may lead to pulmonary derecruitment. This has to be taken into consideration when increasing oscillatory frequencies and differentiated pressure settings are mandatory.

  10. "THE ROLE OF PROSTAGLANDINS AND MAST CELLS IN THE MODULATION OF ACUTE ACID-INDUCED TRACHEAL CONTRACTION IN RAT"

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    M. H. Pipelzadeh

    2004-05-01

    Full Text Available The exact role of the epithelial lining of the trachea in modulating the bronchial tone is controversial. The present study was an attempt to verify the role of both prostaglandins and mast cells in the acute phase of acid inspiration in rat. Four groups (n = 6 of N. Mari rats were employed. The first group was used as placebo control, and normal saline was injected. To the second group hydrochloric acid (25 µl with pH of 1.3 was injected into the trachea through the criothyroid membrane. The third and fourth groups were pretreated for three consecutive days either with indomethacin (10 mg/Kg or nebulized sodium cromoglycate (20 mg/Kg, 1 hour prior to installation of the acid. Three minutes after instillation of acid, the trachea was removed. The tracheal spirals were prepared and immediately suspended in an organ bath containing Tyrode’s solution. Dose response curves to acetylcholine (10-9 to 10-3M were constructed. The results showed that the responses to acetylcholine in the acid treated trachea were significantly (P<0.01 reduced compared with the control saline treated trachea due to acute acid-induced tracheal contraction. Incubation with atropine, induced reduction of baseline tension and reversed the responses to acetylcholine. Both indomethacin and sodium cromoglycate, reversed the responses to acetylcholine and were in similar range as the control trachea. In conclusion, it seems that both prostaglandins and mast cells are important mediators in the acute phase of airway smooth muscle contraction following instillation of acid.

  11. A styletted tracheal tube with a posterior-facing bevel reduces epistaxis during nasal intubation: a randomized trial.

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    Sugiyama, Kazuna; Manabe, Yozo; Kohjitani, Atsushi

    2014-05-01

    Epistaxis is a common complication of nasal intubation. Ease of insertion of the tracheal tube may be influenced by bevel orientation and tip bending. We examined ease of insertion and epistaxis with two tubes with different orientations and with or without a stylet to modify tip bending. Two hundred patients scheduled to undergo oral or maxillofacial surgery were randomized into four groups according to method of nasal intubation used after induction of anesthesia. In one group, a Portex(®) tracheal tube was inserted with bevel facing left (Portex Group). In the second group, a Parker Flex-Tip(®) tube (Parker Group) was inserted with the bevel facing posteriorly, and in the last two groups, a stylet bent at 60° anteriorly was used with the Portex tube (Stylet-Portex Group) or Parker tube (Stylet-Parker Group). When the tube advanced without resistance, insertion was defined as "smooth", and when resistance was encountered, insertion was defined as "impinged". Severity of epistaxis was evaluated as none, mild, moderate, or severe. Smooth insertion was observed in 60% of patients in the Portex Group; 80% in the Parker Group; 100% in the Stylet-Portex Group; and 100% in the Stylet-Parker Group. Epistaxis was found in 50%, 24%, 20%, and 4% of patients, respectively. The styletted tip (difference: 30%; 95% confidence interval [CI]: 20.3 to 38.5; P tube with a posterior-facing bevel improves ease of insertion through the nasopharynx and decreases the severity of epistaxis during nasal intubation. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000011327.

  12. Lung development in laminin γ2 deficiency: abnormal tracheal hemidesmosomes with normal branching morphogenesis and epithelial differentiation

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    Uitto Jouni

    2006-02-01

    Full Text Available Abstract Background Laminin γ2 (Lamc2, one of the polypeptides in laminin-332 (laminin-5, is prominent in the basement membrane of alveolar walls and airways of developing and adult lung. Laminins are important for lung morphogenesis and based on its localization, a function for laminin γ2 in lung development has been hypothesized. Targeted deletion of the laminin γ2 gene in mice results in skin blistering and neonatal death at 3–5 days after birth due to failure to thrive. Methods Examination of lung development in Lamc2-/- mice through 1–2 days postnatal was accomplished by morphometric analysis, lung bud culture, electron microscopy, immunohistochemical and immunofluorescence staining. Results Compared to littermate controls, Lamc2-/- lungs were similar in morphology during embryonic life. At post-natal day 1–2, distal saccules were mildly dilated by chord length measurements. Epithelial differentiation as evaluated by immunohistochemical staining for markers of ciliated cells, Clara cells, alveolar type I cells and alveolar type II cells did not reveal a difference between Lamc2-/- and littermate control lungs. Likewise, vascular development, smooth muscle cell differentiation, and elastic fiber formation looked similar, as did airway basement membrane ultrastructure. Branching morphogenesis by lung bud culture was similar in Lamc2-/- and littermate control lungs. Since laminin-332 is important for hemidesmosome formation, we examined the structure of tracheal hemidesmosomes by transmission electron microscopy. Compared to littermate controls, Lamc2-/- tracheal hemidesmosomes were less organized and lacked the increased electron density associated with the basement membrane abutting the hemidesmosome. Conclusion These findings indicate that laminin γ2 and laminin-332, despite their prominence in the lung, have a minimal role in lung development through the saccular stage.

  13. Laminin-332 alters connexin profile, dye coupling and intercellular Ca2+ waves in ciliated tracheal epithelial cells

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    Olsen Colin E

    2006-08-01

    Full Text Available Abstract Background Tracheal epithelial cells are anchored to a dynamic basement membrane that contains a variety of extracellular matrix proteins including collagens and laminins. During development, wound repair and disease of the airway epithelium, significant changes in extracellular matrix proteins may directly affect cell migration, differentiation and events mediated by intercellular communication. We hypothesized that alterations in cell matrix, specifically type I collagen and laminin α3β3γ2 (LM-332 proteins within the matrix, directly affect intercellular communication in ciliated rabbit tracheal epithelial cells (RTEC. Methods Functional coupling of RTEC was monitored by microinjection of the negatively charged fluorescent dyes, Lucifer Yellow and Alexa 350, into ciliated RTEC grown on either a LM-332/collagen or collagen matrix. Coupling of physiologically significant molecules was evaluated by the mechanism and extent of propagated intercellular Ca2+ waves. Expression of connexin (Cx mRNA and proteins were assayed by reverse transcriptase – polymerase chain reaction and immunocytochemistry, respectively. Results When compared to RTEC grown on collagen alone, RTEC grown on LM-332/collagen displayed a significant increase in dye transfer. Although mechanical stimulation of RTEC grown on either LM-332/collagen or collagen alone resulted in intercellular Ca2+ waves, the mechanism of transfer was dependent on matrix: RTEC grown on LM-332/collagen propagated Ca2+waves via extracellular purinergic signaling whereas RTEC grown on collagen used gap junctions. Comparison of RTEC grown on collagen or LM-332/collagen matrices revealed a reorganization of Cx26, Cx43 and Cx46 proteins. Conclusion Alterations in airway basement membrane proteins such as LM-332 can induce connexin reorganizations and result in altered cellular communication mechanisms that could contribute to airway tissue function.

  14. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates).

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    Abdelgadir, Ibtihal S; Phillips, Robert S; Singh, Davinder; Moncreiff, Michael P; Lumsden, Joanne L

    2017-05-24

    Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects. To assess the efficacy of indirect laryngoscopy, or videolaryngoscopy, versus direct laryngoscopy for intubation of children with regards to intubation time, number of attempts at intubation, and adverse haemodynamic responses to endotracheal intubation. We also assessed other adverse responses to intubation, such as trauma to oral, pharyngeal, and laryngeal structures, and we assessed vocal cord view scores. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and trial registers (www.clinicaltrials.gov and www.controlledtrials) in November 2015. We reran the search in January 2017. We added new studies of potential interest to a list of 'Studies awaiting classification' and will incorporate them into formal review findings during the review update. We performed reference checking and citation searching and contacted the authors of unpublished data to ask for more information. We applied no language restrictions. We included only randomized controlled trials. Participants were children aged 28 days to 18 years. Investigators performed intubations using any type of indirect laryngoscopes, or videolaryngoscopes, versus direct laryngoscopes. We used Cochrane standard methodological procedures. Two review authors independently reviewed titles, extracted data, and assessed risk of bias. We included 12 studies (803 children) in this review and meta-analysis. We identified three studies that

  15. Lightwand光棒在急救气管插管中的应用%Lightwand-guided tracheal intubation used in emergency cases

    Institute of Scientific and Technical Information of China (English)

    李荣钢; 郑晓春; 陈江湖; 涂文劭

    2014-01-01

    Objective To explore the feasibility and time required for lightwand-guided tracheal intubation used in the emergency cases.Methodan experienced anesthesiologist underwent training for an airway management technique that involved lightwand-guided tracheal intubation via laryngoscope. The use of muscle relaxant and sedatives drug depended on the condition of the 45 patients who was in need of tracheal intubation. direct lightwand-guided tracheal intubation was applied for patients with cardiac arrest and deep coma while those who were conscious or in light coma were intubated by muscle relaxant and sedatives drugs. The duration of the intubation process was recorded.Result success rate of lightwand-guided tracheal intubation is 97.78%(44/45).intubation under laryngoscope was applied in one case instead because the patient’s mouth was full of food scraps. Time for the lightwand-guided tracheal intubation is(16.13±3.86)seconds. conclusion lightwand-guided tracheal intubation used in emergency cases is simple and feasible and makes it easier to get access to the patients with small mouth opening and limited neck mobility. it can also help maintain a stable circulatory function in patients, while laryngeal mask airway(lma) and laryngoscope are still needed in case of contingency.Conclusion lightwand-guided tracheal intubation used in emergency cases is simple and feasible,making it easier to get access to the patients with small mouth opening and limited neck mobility. it can also help maintain a stable circulatory function in patients, while laryngeal mask airway(lma) and laryngoscope are still needed in case of contingency.laryngoscope are still needed in case of contingency.%目的:探索lightwand光棒气管插管用于急救插管的可行性及所需的时间。方法由熟练掌握光棒技术气管插管的麻醉医师进行插管,45例急救患者根据患者病情决定是否使用镇静剂和肌松剂诱导插管。呼吸心跳骤停和深度昏迷没

  16. Safety and reliability of the sealing cuff pressure of the Microcuff pediatric tracheal tube for prevention of post-extubation morbidity in children: A comparative study

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    Roshdi Roshdi Al-Metwalli

    2014-01-01

    Full Text Available Objectives: The objective of this study is to evaluate the efficacy and safety of sealing pressure as an inflation technique of the Microcuff pediatric tracheal cuffed tube. Materials and Methods: A total of 60 children were enrolled in this study. After induction of anesthesia and intubation with Microcuff pediatric tracheal tube, patients were randomly assigned, to one of the three groups. Control group (n = 20 the cuff was inflated to a cuff pressure of 20 cm H 2 O; sealing group (n = 20 the cuff was inflated to prevent the air leak at peak airway pressure of 20 cm H 2 O and the finger group (n = 20 the cuff was inflated to a suitable pressure using the finger estimation. Tracheal leak, incidence and severity of post-extubation cough, stridor, sore throat and hoarseness were recorded. Results: The cuff pressure as well as the volume of air to fill the cuff was significantly low in the sealing group when compared with the control group (P < 0.001; however, their values were significantly high in the finger group compared with both the control and the sealing group (P < 0.001. The incidence and severity of sore throat were significantly high in the finger group compared with both the control and the sealing group (P = 0.0009 and P = 0.0026. Three patients in the control group developed air leak around the endotracheal tube cuff. The incidence and severity of other complications were similar in the three groups. Conclusion: In pediatric N 2 O, free general anesthesia using Microcuff pediatric tracheal tub, sealing cuff pressure is safer than finger palpation technique regarding post-extubation morbidities and more reliable than recommended safe pressure in prevention of the air leak.

  17. The effects of dexmedetomidine on hemodynamic responses to tracheal ntubation in hypertensive patients: A comparison with esmolol and sufentanyl

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    Hale Yarkan Uysal

    2012-01-01

    Full Text Available Background: Hypertension and tachycardia caused by tracheal intubation can be detrimental in hypertensive patients. This study was conducted in order to compare the effects of dexmedetomidine on hemodynamic response to tracheal intubation in hypertensive patients with esmolol and sufentanyl. Methods: Sixty hypertensive patients scheduled for noncardiac surgery under general anesthesia were randomly as-signed to receive one of the three drugs before induction of anesthesia. Groups I, II, and III respectively received esmo-lol (100 mg dexmedetomidine (1 μg/kg and sufentanyl (0.25 μg/kg. Heart Rate (HR, systolic (SAP and diastolic (DAP arterial pressures were recorded before drug administration (baseline; T1, after drug administration (T2, after induction of anesthesia (T3, immediately after intubation (T4 and 3, 5 and 10 minutes after intubation (T5, T6, and T7, respectively. The mean percentage variations from T1 to T4 were calculated for all variables (HR, SAP and DAP. Thiopental dose, onset time of vecuronium and intubation time were also assessed. Results: No differences were observed between the three groups regarding demographic data (p > 0.05. Median thi-opental dose was significantly lower in Group II (325 mg; range: 250-500 compared to Group I (425 mg; range: 325-500; p < 0.01 and Group III (375 mg; range: 275-500; p = 0.02. The onset time of vecuronium was longest in Group I (245.2 ± 63 s vs. 193.9 ± 46.6 s and 205.5 ± 43.5 s; p < 0.01 and p < 0.05. In Group I, HR significantly decreased after drug administration compared to baseline (83.8 ± 20.4 vs. 71.7 ± 14.8; p = 0.002. Compared to the baseline (90.4 ± 8.4, DAP decreased after induction and remained below baseline values at T5, T6 and T7 (71.3 ± 12.8, 76.2 ± 10.7, 68.9 ± 10.8 and 62.1 ± 8.7, respectively; p < 0.05 in Group II. According to the mean percen-tage variation, a significant reduction in HR was assessed in Group II compared to Group III (-13.4 ± 17.6% vs. 11

  18. A polyethylene glycol grafted bi-layered polyurethane scaffold: preliminary study of a new candidate prosthesis for repair of a partial tracheal defect.

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    Choi, Hong-Shik; Suh, Hwal; Lee, Ja-Hyun; Park, Si-Nae; Shin, Sang-Hyun; Kim, Young-Ho; Chung, Sung Min; Kim, Hyun Kyung; Lim, Jae-Yol; Kim, Han Su

    2008-07-01

    The purpose of this study was to develop an artificial prosthesis for use in the reconstruction of a tracheal defect due to trauma, malignancy, stenosis, or other causes. Bi-layered porous-dense film polyurethane (PU) was manufactured for the main framework. Polyethylene glycol (PEG) was grafted onto the inner surface of the PU scaffold to act as a surfactant. The scaffold was transplanted into three beagles. An endoscopic examination was performed for the evaluation of the formation granulation tissue, to evaluate the status of the respiratory mucosa and the amount of crust at 1, 4, 8, and 12 weeks after surgery. A histological examination was also performed at 4, 8, and 12 weeks after surgery. All three beagles studied survived to the expected date. The endoscopic examination showed formation of granulation tissue; the crust was not very severe and the circular tracheal framework was well preserved. The histological examination showed that a large amount of fibrous tissue had grown through the pores of the porous scaffold. Pseudostratified columnar ciliated mucosa was also noted on the surface of scaffold, as visualized by scanning electron microscopy. The use of a bi-layered polyethylene grafted polyurethane scaffold is a good candidate prosthesis for tracheal reconstruction.

  19. Guided insertion of the ProSeal laryngeal mask airway is superior to conventional tracheal intubation by first-month anesthesia residents after brief manikin-only training.

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    Hohlrieder, Matthias; Brimacombe, Joseph; von Goedecke, Achim; Keller, Christian

    2006-08-01

    In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I-II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H2O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 +/- 24 s versus 89 +/- 62 s) in the guided ProSeal group (both P mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.

  20. [Tracheal intubation through the intubating laryngeal mask airway training on manikin: comparison of single use and reusable devices from the same manufacturer].

    Science.gov (United States)

    Haardt, V; Lenfant, F; Cailliod, R; Freysz, M

    2008-04-01

    Recently, the French Society for Anaesthesia and Intensive Care (SFAR) has updated algorithms for difficult airway management, in which, the place of the intubating laryngeal mask (ILMA) is well defined. Moreover, in the guidelines, the SFAR recommended that the training for the different techniques for difficult intubation should initially be achieved on manikins. However, few data are available for disposable ILMA learning process on manikins. To compare, on manikin, the learning curves of the disposable and reusable ILMA. Forty operators (anaesthesiologist, nurse, resident), experienced with conventional tracheal intubation but novice to commercially available ILMAs (Sebac, Pantin, France), underwent videotape learning and manikin training. After randomisation, each participant had to perform 10 timed consecutive tracheal intubations with either reusable or disposable ILMA. The learning curve was built according to the duration of successful procedure. Failure was considered if tracheal intubation could not be achieved or if the procedure lasted more than five minutes. No difference was noted between the two groups in terms of learning curves, number and repartition of the failed attempts during the learning process. This study shows that both disposable and reusable ILMA share similar learning process on manikins. Further studies are needed to evaluate the efficiency of the disposable ILMA in the clinical field of difficult intubation.

  1. Clinical outcome of tracheal extubatedcardiac surgery patients who did not meet protocol driven laboratory criteria for extubation

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    Khosro Barkhordari

    2016-12-01

    Full Text Available Background: We retrospectively compared the clinical outcome of post-cardiac surgery tracheal extubation between patients extubated with a lower than normal pH and patients extubated according to our routine institutional protocol. Our main goal was to clarify that strict adherence to the current criteria is dispensable. Methods: In this retrospective cohort study, we recruited 256 patients who met our study criteria and divided them into the exposed group (n= 95 and the control group (n= 161. The inclusion criteria consisted of coronary artery bypass grafting alone and age> 18 years. The exclusion criteria comprised the use of corticosteroids in the preceding 2 weeks, Serum creatinine (SCr> 2 mg/dL, uncontrolled diabetes, liver dysfunction, Glasgow coma scale <13, and acetazolamide and sodium bicarbonate use. The arterial blood gas (ABG characteristics before and 6 hours after extubation, extubation failure rate, length of stay in the in ICU, length of stay in the hospital and mortality were compared between the two groups. Results: In the control group, the males outnumbered the females and the ejection fraction was higher relative to that in the exposure group (P= 0.01 and P= 0.02, respectively. There were more patients with chronic obstructive pulmonary disease in the exposure group (P< 0.005 and also the euroSCORE was higher (P< 0.002. There were no significant differences between the groups regarding the ABG values at the time of ICU admission. Significantly higher levels of FiO2 and PaCO2 (P< 0.001 for both as well as lower HCO3 and pH (P< 0.001 for both were observed in the exposure group immediately before extubation. Following extubation, there was a significant increase in pH and a significant reduction in FiO2 need in the exposure group (P< 0.001 for both. The extubation failure rate, length of stay in the in ICU, length of stay in the hospital, and mortality rate were not different between the 2 groups. Conclusion: The patients with

  2. Nursing Experience of Prevention of Pressure Ulcer Associated With Tracheal Intubation%预防气管插管相关性压疮的护理体会

    Institute of Scientific and Technical Information of China (English)

    刘妹; 陈少清; 苏泉妹

    2016-01-01

    目的:气管插管相关性压疮在医疗器具性压疮中占有很大比例,通过对气管插管相关性压疮的干预进行原因分析,制订相应的护理措施,提高风险防范能力及护理质量。方法选取2014年2月~2016年2月我院ICU收治的80例患者临床资料进行回顾性分析,年龄20~60岁,插管时间7~12天,对引起气管插管相关性压疮的原因进行分析,并提出相应的处理措施。结果80例患者中,其中未进行干预的气管插管相关性压疮5例(6.25%),进行早期干预的相关性压疮1例(1.25%),气管插管是导致医疗器具性压疮排名前3位的医疗器械之一。结论专业技能培训,全面的评估、早期的干预对预防医疗器械相关性压疮有显著影响。%Objective Tracheal intubation related ulcer in a large proportion of bedsore medical devices,based on the causes analysis of tracheal intubation related pressure ulcer intervention,formulate corresponding nursing measures,improve the ability of risk prevention and nursing quality. Methods The clinical data of 80 cases were selected from February 2014 to February 2016 in ICU in our hospital were retrospectively analyzed, age 20 to 60,intubation time 7 to 12 days,causes of tracheal intubation related pressure ulcer were analyzed,and the corresponding measures are put forward.ResultsIn 80 patients,including 5 cases of bedsore tracheal intubation related of intervention (6.25%),1 cases of bedsore correlation of early intervention (1.25%),tracheal intubation is one of the medical devices cause bedsore medical appliances ranked in the top 3. Conclusion Professional skils training,comprehensive assessment,early intervention on the prevention of medical device related pressure ulcers have a significant impact.

  3. Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study.

    Science.gov (United States)

    Terré, R; Mearin, F

    2012-05-01

    The chin-down posture is generally recommended in patients with neurogenic dysphagia to prevent tracheal aspiration; however, its effectiveness has not been demonstrated. To videofluoroscopically (VDF) assess the effectiveness of chin-down posture to prevent aspiration in patients with neurogenic dysphagia secondary to acquired brain injury. Randomized, alternating, cross-over study (with and without the chin-down posture) in 47 patients with a VDF diagnosis of aspiration [31 stroke, 16 traumatic brain injury (TBI)] and 25 controls without aspiration (14 stroke, 11 TBI). During the chin-down posture, 55% of patients avoided aspiration (40% preswallow aspiration and 60% aspiration during swallow). The percentage was similar in both etiologies (58% stroke and 50% TBI). Fifty-one percent of patients had silent aspiration; of these, 48% persisted with aspiration while in the chin-down posture. A statistically significant relationship was found between the existence of pharyngeal residue, cricopharyngeal dysfunction, pharyngeal delay time and bolus volume with the persistence of aspiration. The chin-down posture did not change swallow biomechanics in patients without aspiration. Only half the patients with acquired brain injury avoided aspiration during cervical flexion; 48% of silent aspirators continued to aspire during the maneuver. Several videofluoroscopic parameters were related to inefficiency of the maneuver. Therefore, the indication for chin-down posture should be evaluated by videofluoroscopic examination. © 2012 Blackwell Publishing Ltd.

  4. Pulmonary transcriptome analysis in the surgically induced rabbit model of diaphragmatic hernia treated with fetal tracheal occlusion.

    Science.gov (United States)

    Engels, Alexander C; Brady, Paul D; Kammoun, Molka; Finalet Ferreiro, Julio; DeKoninck, Philip; Endo, Masayuki; Toelen, Jaan; Vermeesch, Joris R; Deprest, Jan

    2016-02-01

    Congenital diaphragmatic hernia (CDH) is a malformation leading to pulmonary hypoplasia, which can be treated in utero by fetal tracheal occlusion (TO). However, the changes of gene expression induced by TO remain largely unknown but could be used to further improve the clinically used prenatal treatment of this devastating malformation. Therefore, we aimed to investigate the pulmonary transcriptome changes caused by surgical induction of diaphragmatic hernia (DH) and additional TO in the fetal rabbit model. Induction of DH was associated with 378 upregulated genes compared to controls when allowing a false-discovery rate (FDR) of 0.1 and a fold change (FC) of 2. Those genes were again downregulated by consecutive TO. But DH+TO was associated with an upregulation of 157 genes compared to DH and controls. When being compared to control lungs, 106 genes were downregulated in the DH group and were not changed by TO. Therefore, the overall pattern of gene expression in DH+TO is more similar to the control group than to the DH group. In this study, we further provide a database of gene expression changes induced by surgical creation of DH and consecutive TO in the rabbit model. Future treatment strategies could be developed using this dataset. We also discuss the most relevant genes that are involved in CDH.

  5. Does the site of anterior tracheal puncture affect the success rate of retrograde intubation? A prospective, manikin-based study.

    Science.gov (United States)

    Harris, Eric A; Arheart, Kristopher L; Fischler, Kenneth E

    2013-01-01

    Background. Retrograde intubation is useful for obtaining endotracheal access when direct laryngoscopy proves difficult. The technique is a practical option in the "cannot intubate / can ventilate" scenario. However, it is equally useful as an elective technique in awake patients with anticipated difficult airways. Many practitioners report difficulty successfully advancing the endotracheal tube due to anatomical obstructions and the acute angle of the anterograde guide. The purpose of this study was to test whether a more caudal tracheal puncture would increase the success rate. Methods. Twenty-four anesthesiology residents were randomly assigned to either a cricothyroid or a cricotracheal puncture group. Each was instructed how to perform the technique and then attempted it on a manikin at their assigned site. Data collection included whether the trachea was intubated, the number of attempts required, and the total time. Results. Both groups displayed a high degree of success. While the group assigned to the cricotracheal site required significantly more time to perform the procedure, they accomplished it in fewer attempts than the cricothyroid group. Conclusion. Retrograde intubation performed via a cricotracheal puncture site, while more time consuming, resulted in fewer attempts to advance the endotracheal tube and may reduce in vivo laryngeal trauma.

  6. Replication and adaptive mutations of low pathogenic avian influenza viruses in tracheal organ cultures of different avian species.

    Directory of Open Access Journals (Sweden)

    Henning Petersen

    Full Text Available Transmission of avian influenza viruses (AIV between different avian species may require genome mutations that allow efficient virus replication in a new species and could increase virulence. To study the role of domestic poultry in the evolution of AIV we compared replication of low pathogenic (LP AIV of subtypes H9N2, H7N7 and H6N8 in tracheal organ cultures (TOC and primary embryo fibroblast cultures of chicken, turkey, Pekin duck and homing pigeon. Virus strain-dependent and avian species-related differences between LPAIV were observed in growth kinetics and induction of ciliostasis in TOC. In particular, our data demonstrate high susceptibility to LPAIV of turkey TOC contrasted with low susceptibility of homing pigeon TOC. Serial virus passages in the cells of heterologous host species resulted in adaptive mutations in the AIV genome, especially in the receptor-binding site and protease cleavage site of the hemagglutinin. Our data highlight differences in susceptibility of different birds to AIV viruses and emphasizes potential role of poultry in the emergence of new virus variants.

  7. Escargot controls the sequential specification of two tracheal tip cell types by suppressing FGF signaling in Drosophila.

    Science.gov (United States)

    Miao, Guangxia; Hayashi, Shigeo

    2016-11-15

    Extrinsic branching factors promote the elongation and migration of tubular organs. In the Drosophila tracheal system, Branchless (Drosophila FGF) stimulates the branching program by specifying tip cells that acquire motility and lead branch migration to a specific destination. Tip cells have two alternative cell fates: the terminal cell (TC), which produces long cytoplasmic extensions with intracellular lumen, and the fusion cell (FC), which mediates branch connections to form tubular networks. How Branchless controls this specification of cells with distinct shapes and behaviors is unknown. Here we report that this cell type diversification involves the modulation of FGF signaling by the zinc-finger protein Escargot (Esg), which is expressed in the FC and is essential for its specification. The dorsal branch begins elongation with a pair of tip cells with high FGF signaling. When the branch tip reaches its final destination, one of the tip cells becomes an FC and expresses Esg. FCs and TCs differ in their response to FGF: TCs are attracted by FGF, whereas FCs are repelled. Esg suppresses ERK signaling in FCs to control this differential migratory behavior.

  8. Detection of Bordetella avium by TaqMan real-time PCR in tracheal swabs from wildlife birds.

    Science.gov (United States)

    Stenzel, T; Pestka, D; Tykałowski, B; Śmiałek, M; Koncicki, A; Bancerz-Kisiel, A

    2017-03-28

    Bordetella avium, the causing agent of bordetellosis, a highly contagious infection of the respiratory tract in young poultry, causes significant losses in poultry farming throughout the world. Wildlife birds can be a reservoir of various pathogens that infect farm animals. For this reason the studies were conducted to estimate the prevalence of Bordetella avium in wildlife birds in Poland. Tracheal swab samples were collected from 650 birds representing 27 species. The bacterial DNA was isolated directly from the swabs and screened for Bordetella avium by TaqMan real-time PCR. The assay specificity was evaluated by testing DNA isolated from 8 other bacteria that can be present in avian respiratory tract, and there was no amplification from non-Bordetella avium agents. Test sensitivity was determined by preparing standard tenfold serial dilutions of DNA isolated from positive control. The assay revealed to be sensitive, with detection limit of approximately 4.07x10^2 copies of Bordetella avium DNA. The genetic material of Bordetella avium was found in 54.54% of common pheasants, in 9.09% of Eurasian coots, in 3.22% of black-headed gulls and in 2.77% of mallard ducks. The results of this study point to low prevalence of Bordetella avium infections in wildlife birds. The results also show that described molecular assay proved to be suitable for the rapid diagnosis of bordetellosis in the routine diagnostic laboratory.

  9. The effect of vitamin E on tracheal responsiveness and lung inflammation in sulfur mustard exposed guinea pigs.

    Science.gov (United States)

    Boskabady, Mohammad Hossein; Amery, Sediqa; Vahedi, Nassim; Khakzad, Mohammad Reza

    2011-02-01

    Pulmonary complications of sulfur mustard (SM) range from mild respiratory symptoms to even severe bronchial stenosis. In the present study, the protective effect of vitamin E on tracheal responsiveness (TR) and lung inflammation of SM-exposed guinea pigs were examined. Guinea pigs were exposed to ethanol (control group), 40 mg/m(3) inhaled SM and ethanol vehicle (sulfur mustard exposed (SME) group), SME treated with vitamin E (SME + E), SME with dexamethasone (SME + D) and both drugs (SME + E + D), (n = 8 for each group). TR to methacholine, total and differential white blood cell (WBC) count of lung lavage and serum cytokines were evaluated 14 days post-exposure. TR, WBC, interleukin 4 (IL-4), interferon gamma (INF-γ), eosinophil, and monocyte levels in SME guinea pigs were significantly higher, but lymphocyte was lower than those of controls (P SME + E, SME + D and SME + E + D, INF-γ in SME + E and SME + E + D and WBC in SME + E were significantly decreased compared to that of the SME group (P SME + D + E was significantly higher than that of SME + E (P SME + D (P SME guinea pigs.

  10. Prevalence of streptococcus group B in tracheal tube secretions of neonates with respiratory distress: a brief report

    Directory of Open Access Journals (Sweden)

    Khosravi N

    2013-02-01

    Full Text Available Background: Infection with group B streptococcus (GBS can present with respiratory distress, Pneumonia, meningitis and Osteomyelitis in neonates. The aim of this study was to determine the prevalence of GBS colonization in trachea of intubated neonates.Methods: This observational analytic study was performed upon 33 intubated neonates due to respiratory distress in neonatal intensive care unit (NICU Rasoul Hospital in Tehran, Iran during 2010-2012. Tracheal secretions cultured upon TODD-HEWITT BROTH and sheep blood agar 5%., chi-square test was used for compare the qualitative variables. P<0.05 was considered meaningful.Results: Three cases had positive streptococcal culture (9.1% and four cases had posi-tive culture for non-streptococcal organisms. no meaningful relation observed between positive GBS culture and neonatal gender, kind of delivery, PROM.Conclusion: Prevalence of GBS positive results (9% in present study is very close to GBS colonization in pregnant women; although the higher colonization rate of pregnant women are expected.

  11. Bone Marrow-Derived Multipotent Stromal Cells Attenuate Inflammation in Obliterative Airway Disease in Mouse Tracheal Allografts

    Directory of Open Access Journals (Sweden)

    Alicia Casey

    2014-01-01

    Full Text Available Obliterative bronchiolitis (OB remains the most significant cause of death in long-term survival of lung transplantation. Using an established murine heterotopic tracheal allograft model, the effects of different routes of administration of bone marrow-derived multipotent stromal cells (MSCs on the development of OB were evaluated. Tracheas from BALB/c mice were implanted into the subcutaneous tissue of major histocompatibility complex- (MHC- disparate C57BL/6 mice. At the time of transplant, bone marrow-derived MSCs were administered either systemically or locally or via a combination of the two routes. The allografts were explanted at various time points after transplantation and were evaluated for epithelial integrity, inflammatory cell infiltration, fibrosis, and luminal obliteration. We found that the most effective route of bone marrow-derived MSC administration is the combination of systemic and local delivery. Treatment of recipient mice with MSCs suppressed neutrophil, macrophage, and T-cell infiltration and reduced fibrosis. These beneficial effects were observed despite lack of significant MSC epithelial engraftment or new epithelial cell generation. Our study suggests that optimal combination of systemic and local delivery of MSCs may ameliorate the development of obliterative airway disease through modulation of immune response.

  12. The preventive effects of natural adjuvants, G2 and G2F on tracheal responsiveness and serum IL-4 and IFN-γ (th1/th2 balance in sensitized guinea pigs

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Boskabady

    2014-07-01

    Full Text Available OBJECTIVE:The effects of natural adjuvants on lung inflammation and tracheal responsiveness were examined in sensitized guinea pigs.METHODS:The responses of guinea pig tracheal chains and the serum levels of interleukin-4 and interferon-gamma were examined in control pigs and three other groups of guinea pigs: the sensitized group and two other sensitized groups treated with either adjuvant G2 or adjuvant G2F (n = 7 for each group. Sensitization of the animals was achieved by injection and inhalation of ovalbumin.RESULTS:The results showed that sensitized animals had increased tracheal responsiveness and increased serum levels of interleukin-4 and interferon-gamma compared to controls (p<0.05 to p<0.001. Treatments with either G2 or G2F prevented the increase in tracheal responsiveness and serum interleukin-4 (p<0.01 to p<0.001. However, the serum levels of interferon-gamma and the interleukin-4-to-interferon-gamma ratio was increased in the treated groups (p<0.001 for all cases.CONCLUSIONS:These results indicate important preventive effects of two natural adjuvants, particularly G2, on the changes in tracheal responsiveness, serum cytokines and the interleukin-4-to-interferon-gamma ratio (T helper 1/T helper 2 balance in sensitized guinea pigs.

  13. The Prehospital Predictors of Tracheal Intubation for in Patients who Experience Convulsive Seizures in the Emergency Department.

    Science.gov (United States)

    Sato, Kenichiro; Arai, Noritoshi; Omori-Mitsue, Aki; Hida, Ayumi; Kimura, Akio; Takeuchi, Sousuke

    2017-08-15

    Objective To identify the prehospital factors predicting the performance of tracheal intubation (TI) at the emergency department (ED) in patients with convulsive seizure or epilepsy. Methods We performed a retrospective analysis of seizure patients who underwent TI at the ED soon after arrival. The clinical variables obtained in the prehospital setting were reviewed. Patients The study population included consecutive adult patients who were transported to an urban tertiary care ED due to convulsive seizure between August 2010 and September 2015. Results Among the 822 eligible patients, 59 patients (7.2%) underwent TI at the ED. Four independent prehospital predictors were identified using multivariate analysis: age ≥50 years (+1 point), meeting the definition of convulsive status epilepticus (+4 points), and an on-scene heart rate of ≥120 bpm (+1 point) led to a higher likelihood of TI, while a higher on-scene (alert or confused) level of consciousness (-3 points) led to a lower likelihood of TI. The derived prediction rule (the sum of all points) had good predictive performance with an area under the curve of 0.88 (95% confidence interval: 0.79-0.97), a sensitivity of 0.62, a specificity of 0.91, and a positive likelihood ratio of 10.6, when the cut-off value was set to 5 points. Conclusion We constructed a simple prehospital prediction rule to help predict the need for TI in seizure patients, even in the prehospital phase. This may possibly lead to the more effective management of seizure patients in the ED.

  14. Haemodynamic changes and intubating conditions during tracheal intubation in children under anaesthesia: a comparative study of two induction regiments

    Directory of Open Access Journals (Sweden)

    Katarina Šakić

    2009-02-01

    Full Text Available Aim To compare the haemodynamic changes and intubation conditionsfollowing induction of anaesthesia with alfentanil-propofol-rocuronium with those following alfentanil-propofol combinationin children.Methods A prospective, non-randomized and non blinded trialwas performed in 208 children ( ASA I-II, both gender, aged 2-12years undergoing elective adenoidectomy with or without tonsillectomy.Children scheduled for tonsillectomy or adenotonsillectomyreceived alfentanil 0.02 mg kg-1, propofol 2 mg kg-1 androcuronium 0.45 mg kg-1 before tracheal intubation (R-group.Children scheduled for adenoidectomy received alfentanil 0.02mg kg-1and propofol 3 mg kg-1 before intubation (C-group. Haemodynamicvalues (heart rate, systolic arterial pressure, diastolicarterial pressure, mean arterial pressure were recorded at predeterminedtime intervals before surgical incision. The intubatingconditions were evaluated applying the Copenhagen Scoring System(excellent, good, poor.Results There was no statistical difference in haemodynamicbaseline values, neither prior nor after the intubation betweenthe two groups. There was a statistically significant increase inheart rate, systolic and diastolic arterial pressure after intubationin both groups (p<0.05. Mean arterial pressure after the intubationincreased statistically significantly only in R-group (p=0.001.There was no hypotension, bradycardia, hypoxemia or other complications.Overall intubation conditions were scored excellent in72.3%, good in 21.5% and poor in 6.2% patients. There were nosignificant differences in intubation conditions between the twogroups (p=0.244Conclusion Both induction regiments provided the clinically acceptablehaemodynamics and intubation conditions during trachealintubation in children.

  15. Comparison of the Effect of Fentanyl, Sufentanil, Alfentanil and Remifentanil on Cardiovascular Response to Tracheal Intubation in Children

    Directory of Open Access Journals (Sweden)

    Mohamad-Esmaeil Darabi

    2011-06-01

    Full Text Available Objective:Laryngoscopy and tracheal intubation may cause significant cerebral and systemic hemodynamic responses. Many drugs have been shown to be effective in modifying these hemodynamic responses, including fentanyl, sufentanil, alfentanil and remifentanil. The purpose of the current study was to compare the efficacy of fentanyl, sufentanil, alfentanil and remifentanil on blunting cardiovascular changes during laryngoscopy and intubation in children. Methods:Eighty children, 1-6 years old, classified as American Society of Anesthesiologists physical status I and II who were scheduled for elective surgery with general anesthesia and orotracheal intubation, were enrolled in this randomized and double-blinded study. Patients were randomly assigned into four groups of 20 patients. Group F received fentanyl 1µg/kg-1, group S received sufentanil 0.1 µg/kg-1, group A received alfentanil 10 µg/kg-1 and group R received remifentanil 1 µg/kg-1 intravenously. After establishment of neuromuscular blockade confirmed with a nerve stimulator, laryngoscopy and orotracheal intubation were performed 3 min after induction. Hemodynamic variables including systolic and diastolic blood pressure (SAP, DAP and heart rate (HR were recorded at base line (before opioid administration, before laryngoscopy and one minute after orotracheal intubation. Findings:The patients characteristics and laryngoscopy grade were similar in all groups. There was no significant difference in the mean values of SAP, DAP and HR at each measured time between the four groups. There was significant difference in the mean values of SAP, DAP and HR measured over time in each group. Conclusion:The intravenous fentanyl attenuated laryngoscopy-induced SAP, DAP and HR increases better than sufentanil, alfentanil or remifentanil and hemodynamic stability is better preserved with fentanyl.

  16. Comparing the Effect of Dexamethasone before and after Tracheal Intubation on Sore Throat after Tympanoplasty Surgery: A Randomized Controlled trial

    Directory of Open Access Journals (Sweden)

    Mahmoud Eidi

    2014-04-01

    Full Text Available Introduction: Presence of a sore throat after surgery is a common side effect of general anesthesia with intratracheal intubation and can cause discomfort for the patient and prolong the recovery process. In this study we compared the effect of dexamethasone before and after intubation on the incidence of sore throat after tympanoplasty surgery.   Materials and Methods: In a double-blind, randomized clinical trial, 70 patients aged 30–60 years with American Society of Anesthesiologists (ASA physical status I or II who were candidates for tympanoplasty under anesthetic conditions were studied in two separate groups. The first group received intravenous (IV dexamethasone (8 mg 30 mins prior to intubation while the second group received the same dose of dexamethasone 30 mins after intubation. The incidence and severity of the sore throat in both groups were then evaluated.   Results: There was no significant difference between two groups in intensity of sore throat (62.9% vs. 57.1%, cough (65.7% vs. 62.9%, or hoarseness (62.9% vs. 65.7% within 24 h after surgery. Detection of blood in oral secretions or on the tracheal tube was the same in both groups (5.7%. The incidence of coughs during the extubation was 0% in first group and 11.4% in second group.   Conclusion:  According to the results of this research there was no significant difference in incidence and intensity of sore throat in patients receiving dexamethasone before or after intubation. Further, no significant difference in intensity of coughs or hoarseness was observed.  

  17. Comparison of classic laryngeal mask airway with Ambu laryngeal mask for tracheal tube exchange: A prospective randomized controlled study

    Directory of Open Access Journals (Sweden)

    Shruti Jain

    2013-01-01

    Full Text Available Background and Aim: Exchanging endotracheal tube (ETT with classic laryngeal mask airway TM (CLMA TM prior to emergence from anaesthesia is a safe technique to prevent the coughing and haemodynamic changes during extubation. We had compared CLMA TM and AMBU laryngeal mask TM (ALM TM during ETT/laryngeal mask (LM for haemodynamic changes and other parameters. Methods: A total of 100 American Society of Anesthesiologist Grade I and II adult female patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were selected and randomly divided into two groups of 50 patients each. In Group I, CLMA TM and in Group II, ALM TM was placed prior to tracheal extubation. Haemodynamic parameters were recorded during ETT/LM exchange. Glottic view was seen through the LM using flexible fibrescope. Coughing/bucking during removal of LM, ease of placement and post-operative sore throat for both groups were graded and recorded. Statistical Analysis: Data within the groups was analysed using paired t-test while between the groups was analysed using unpaired t-test. Chi-square test was used to analyse grades of glottic view, coughing, and post-operative sore throat. Results: In Group I, there was a significant rise in systolic blood pressure and heart rate in contrast to insignificant rise in Group II. Glottis view was significantly better in Group II. Incidence of coughing, ease of placement and post-operative sore throat was identical between both groups. Conclusion: ALM TM is superior to CLMA TM for exchange of ETT before extubation due to greater haemodynamic stability during exchange phase and is better positioned.

  18. Effects of Fentanyl-lidocaine-propofol and Dexmedetomidine-lidocaine-propofol on Tracheal Intubation Without Use of Muscle Relaxants

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    Volkan Hancı

    2010-05-01

    Full Text Available The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30 or 2 mg/kg fentanyl (Group F, n = 30, both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05. The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01. Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05. Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05. After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05. We conclude that endotracheal intubation was better with the dexmedetomidine–lidocaine–propofol combination than with the fentanyl–lidocaine–propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.

  19. The probable significance of tracheal tufts in the 8th abdominal segment of Heliothis virescens (F.) on the development of its parasitoid, Toxoneuron nigriceps (Viereck).

    Science.gov (United States)

    Rao, Asha; Henderson, Ruth E; Bradleigh Vinson, S

    2009-09-01

    The 8th abdominal segment of Heliothis virescens (Fabricius) larvae contains aerating trachea and tracheole tufts that end in the hemocoel of the 8th segment, unlike the tracheae that invade tissues in other segments. These tracheal tufts from the 8th abdominal segment extend to the tokus region, which along with the telson cavity is known to act as a "lung" for hemocytes in Calpodes ethlius and a few other lepidopteran larvae. The goal of this research was to study the effects of these tracheal tufts in the 8th abdominal segment on parasitoid development inside the host larvae, H. virescens. The first objective was to determine if the eggs of the parasitoid, Toxoneuron nigriceps, are predominantly located among the tracheal tufts of the 8th abdominal segment compared to other body cavity regions irrespective of their oviposition site or the position of the host larvae. The results showed that several hours after oviposition most of the eggs are found in the 8th abdominal segment irrespective of the oviposition site or the position of the host larvae. The second objective was to study the effect of varying oxygen concentrations in vitro on various developmental stages of the egg. The results showed that decreasing oxygen concentrations adversely affects the parasitoid egg development in vitro. A third objective was to determine the oxygen concentration in 8th abdominal segment of the host larvae and compare it to other regions of the body using an oxygen sensor placed in vivo. The results suggested relatively high concentration of oxygen in the 8th abdominal segment compared to other regions of the host, thus supporting our hypothesis that the increased oxygen level in the 8th abdominal segment is important to the development of the parasitoid eggs.

  20. “双管法”镍钛记忆合金支架置入术治疗气管狭窄和气管瘘的临床应用%Clinical use of "double-barreled" nickel-titanium memory alloy stent placement for treatment of tracheal stenosis and fistula

    Institute of Scientific and Technical Information of China (English)

    魏宁; 顾玉明; 徐浩; 祖茂衡; 张庆桥; 许伟; 崔艳峰; 刘洪涛; 王文亮

    2012-01-01

    Objective To assess the efficacy of "double-barreled" nickel-titanium memory alloy stent placement for treatment of benign or malignant tracheal stenosis and tracheal fistula under local anesthesia and digital subtraction angiography(DSA) monitoring.Methods A retrospective analysis was performed on the profiles of 25 typical cases who received intubation via the nasal cavity or tracheal fistula (O2:2-4 L/min) followed by endotracheal placement of various n ickel-titanium memory alloy stents under DSA monitoring and laryngopharyngeal or tracheal local anesthesia between 2003 and 2011.Results Nickel-titanium stents,including 2 integrated inverted Y-shaped stents,a bullet-like membrane-coated stent,5 tubular membrane-coated stents and 20 tubular common stents,were successflly implanted in 25 patients.Stent placement was associated with marked improvement in dyspnea,and the grading reduced from Ⅲ-Ⅳ to 0- Ⅰ.Furthermore,pulse oxygen saturation (SPO2) was improved to (92.55±3.08)% during spontaneous breathing as compared with (73.24± 3.07)% previously during high-flow oxygen therapy (P< 0.05).Conclusion The "double-barreled" nickel-titanium memory alloy stent placement under local anesthesia and DSA monitoring is worthwhile for clinical application due to its safety,effectiveness and simplicity.%目的 探讨在局麻和数字减影血管造影机(DSA)监视下应用“双管法”置入镍钛记忆合金支架急诊治疗气管良恶性狭窄和气管瘘的疗效.方法 回顾性分析2003-2011年间,在DSA监视和咽喉、气管局麻下,先经鼻或气管瘘口留置通气导管,予以2~4 L/min流量供氧,再经气管置入不同类型镍钛记忆合金气管支架的25个典型病例.结果 25例患者行镍钛记忆合金支架均成功,共置入一体式倒Y型支架2枚,“子弹头”覆膜支架1枚,管状覆膜支架5枚,管状裸支架20枚.所有患者术后呼吸困难明显改善,气促评级由Ⅲ~Ⅳ级改善为0~Ⅰ级,氧饱

  1. “Manually Ventilating Test” in Anesthesia Management of Children with Massive Anterior Mediastinal Masses Requiring Tracheal Intubation.A case series

    Directory of Open Access Journals (Sweden)

    Mohammad Gharavi

    2014-08-01

    Full Text Available The risk of life-threatening complications during induction of anesthesia in patients with anterior mediastinal mass is well recognized. Maintenance of spontaneous ventilation during anesthesia is an accepted standard goal in all published reports. However, the decision to paralyze the patient, which is really needed in most surgical procedures, is still a challenging event. In this study, “manually ventilating test” as a predictive test was assessed to make the decision to paralyze children with massive anterior mediastinal masses who needed tracheal intubation. . It seems that manually ventilating test may at least be a simple and reliable test to identify cases that could be paralyzed successfully

  2. Hippocrates (ca 460-375 bc), Introducing Thoracotomy Combined With a Tracheal Intubation for the Parapneumonic Pleural Effusions and Empyema Thoracis.

    Science.gov (United States)

    Tsoucalas, Gregory; Sgantzos, Markos

    2016-12-01

    Hippocrates was the first physician to describe in accuracy pleural effusion and pneumonia. To treat empyema thoracis he had introduced a combined method of tracheal intubation with a simultaneously thoracotomy. The surgical incision was used for the pus to be progressively drainaged. If the patient was too weak to eat, he had suggested for nutritional mixtures to be administered through an oral-gastric tube. Thus Hippocrates composed in his operating theatre, an icon similar to modern surgical operations. © The Author(s) 2016.

  3. Detection and strain differentiation of infectious bronchitis virus in tracheal tissues from experimentally infected chickens by reverse transcription-polymerase chain reaction. Comparison with an immunohistochemical technique

    DEFF Research Database (Denmark)

    Handberg, Kurt; Nielsen, O.L.; Pedersen, M.W.;

    1999-01-01

    Oligonucleotide pairs were constructed for priming the amplification of fragments of nucleocapsid (N) protein and spike glycoprotein (S) genes of avian infectious bronchitis virus (IBV) by reverse transcription-polymerase chain reaction (RT-PCR). One oligonucleotide pair amplified a common segment......3896 and 793B strains of IBV, respectively, Groups of specific pathogen free chickens were experimentally inoculated with the Massachusetts (H120, M41), the D1466 and the 793B strains of IBV, and tracheal tissue preparations were made from each bird for RT-PCR and for immunohistochemistry (IHC) up to 3...

  4. The Hsp60C gene in the 25F cytogenetic region in Drosophila melanogaster is essential for tracheal development and fertility

    Indian Academy of Sciences (India)

    Surajit Sarkar; Subhash C. Lakhotia

    2005-12-01

    Earlier studies have shown that of the four genes (Hsp60A, Hsp60B, Hsp60C, Hsp60D genes) predicted to encode the conserved Hsp60 family chaperones in Drosophila melanogaster, the Hsp60A gene (at the 10A polytene region) is expressed in all cell types of the organism and is essential from early embryonic stages, while the Hsp60B gene (at 21D region) is expressed only in testis, being essential for sperm individualization. In the present study, we characterized the Hsp60C gene (at 25F region), which shows high sequence homology with the other three Hsp60 genes of D. melanogaster. In situ hybridization of Hsp60C-specific riboprobe shows that expression of this gene begins in late embryonic stages (stage 14 onwards), particularly in the developing tracheal system and salivary glands; during larval and adult stages, it is widely expressed in many cell types but much more strongly in tracheae and in developing and differentiating germ cells. A P-insertion mutant (Hsp60C1) allele with the P transposon inserted at $-251$ position of the Hsp60C gene promoter was generated. This early larval recessive lethal mutation significantly reduces levels of Hsp60C transcripts in developing tracheae and this is associated with a variety of defects in the tracheal system, including lack of liquid clearance. About 10% of the homozygotes survive as weak, shortlived and completely sterile adults. Testes of the surviving mutant males are significantly smaller, with fewer spermatocytes, most of which do not develop beyond the round spermatid stage. In situ and Northern hybridizations show significantly reduced levels of the Hsp60C transcripts in Hsp60C1 homozygous adult males. The absence of early meiotic stages in the Hsp60C1 homozygous testes contrasts with the effect of testis-specific Hsp60B (21D) gene, whose mutation affects individualization of sperm bundles later in spermiogenesis. In view of the specific effects in tracheal development and in early stages of spermatogenesis, it is

  5. Radioiodine therapy of benign non-toxic goitre. Potential role of recombinant human TSH

    DEFF Research Database (Denmark)

    Fast, S; Bonnema, S J; Hegedüs, L

    2011-01-01

    This review provides an update on recombinant human TSH (rh-TSH) augmented radioiodine (¹³¹I) therapy and outlines its potential role in the treatment of symptomatic benign multinodular non-toxic goitre. In some countries, ¹³¹I has been used for three decades to reduce the size of nodular goitres......-56% amplification of goitre reduction at one-year post radioiodine compared to conventional (without rh-TSH) ¹³¹I therapy. Although patient satisfaction is not improved at one-year, this approach facilitates tracheal decompression and is particularly promising in large goitres. The majority of multinodular non......-toxic goitre patients may not require amplified goitre reduction. But as an alternative strategy, rh-TSH allows up to 80% reduction of the therapeutic ¹³¹I activity while still achieving goitre reduction comparable to that of conventional ¹³¹I therapy and maintaining high patient satisfaction. The dose...

  6. Family Therapy

    Science.gov (United States)

    ... may be credentialed by the American Association for Marriage and Family Therapy (AAMFT). Family therapy is often short term. ... challenging situations in a more effective way. References Marriage and family therapists: The friendly mental health professionals. American Association ...

  7. Hormone Therapy

    Science.gov (United States)

    ... types of estrogen therapy relieve vaginal dryness. • Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures. • Combined estrogen and progestin therapy may reduce the risk of ...

  8. Radiation Therapy

    Science.gov (United States)

    ... the area is stitched shut. Another treatment, called proton-beam radiation therapy , focuses the radiation on the ... after radiation treatment ends. Sore mouth and tooth decay. If you received radiation therapy to the head ...

  9. Electroconvulsive therapy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007474.htm Electroconvulsive therapy To use the sharing features on this page, please enable JavaScript. Electroconvulsive therapy (ECT) uses an electric current to treat depression ...

  10. Proton Therapy

    Science.gov (United States)

    ... IMRT) Brain Tumor Treatment Brain Tumors Prostate Cancer Lung Cancer Treatment Lung Cancer Head and Neck Cancer Images related to Proton Therapy Videos related to Proton Therapy Sponsored by Please ...

  11. Feminist Therapy.

    Science.gov (United States)

    Laidlaw, Toni; Malmo, Cheryl

    1991-01-01

    Traces roots of feminist therapy and its independence from traditional and prevalent theories and therapy practices. Asserts that Freudian theory and humanistic assumptions are sexist and contribute to powerlessness of women. In contrast, feminist therapy is seen as dealing directly with client-counselor relationships, trust, advocacy, and…

  12. Differential Activity of NO Synthase Inhibitors as Chemopreventive Agents in a Primary Rat Tracheal Epithelial Cell Transformation System

    Directory of Open Access Journals (Sweden)

    Sheela Sharma

    2002-01-01

    Full Text Available A model to study the effectiveness of potential chemopreventive agents that inhibit neoplastic process by different mechanisms has been used to test the efficacy of seven nitric oxide synthase (NOS inhibitors. Five selective inducible NOS (iNOS inhibitors: S-methyl isothiourea (S-MITU, S-2-aminoethyl isothiourea (S-2-AEITU, S-ethyl isothiourea (S-EITU, aminoguanidine (AG, 2-amino-4-methyl pyridine (2AMP, and two non selective general NOS inhibitors: L-N6-(1-iminoethyl lysine (IEL and Nω-nitro-L-arginine (NNLA, were tested for efficacy against a carcinogen, benzo[a]pyrene (B[a]P-induced primary rat tracheal epithelial (RTE cell transformation assay. RTE cells were treated with B[a]P alone or with five nontoxic concentrations of an NOS inhibitor and the resulting foci at the end of 30 days were scored for inhibition of transformation. The results indicate that all three isothiourea compounds inhibited B[a]Pinduced RTE foci in a dose-dependent manner. SAEITU was the most effective inhibitor with an IC50 (the molar concentration that inhibits transformation by 50% of 9.1 μM and 100% inhibition at the highest dose tested (30 μM. However, both S-EITU and SMITU showed a maximum percent inhibition of 81% and 100% at 1 mM with an IC50 of 84 and 110 μM, respectively. 2-AMP did not show any dose-dependent response, but was highly effective (57% inhibition at an intermediate dose of 30 μM and an IC50 of 25 μM. Similar to thiourea compounds, AG exhibited good dose-dependent inhibition with a maximum inhibition of 86% at 1 mM. NNLA and IEL were negative in this assay. Based on the IC50 values, NOS inhibitors were rated for efficacy from high to low as follows: S-2AEITU<2-AMP

  13. Safety And Efficacy Of Proseal Laryngeal Mask Airway Versus Classic Laryngeal Mask Airway And Endo Tracheal Tube During Elective surgery

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    Soad A. Mansour , Wafaa G.Ahmed , Kawthar A. Azzam ,Tarek M. EL said

    2005-12-01

    Full Text Available The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway (PLMA, classic Laryngeal mask airway (LMA and cuffed Endo Tracheal Tube (ETT as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA(groupI,classic LMA (groupIIand ETT (group III . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation ­ Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2

  14. New microbicidal functions of tracheal glands: defective anti-infectious response to Pseudomonas aeruginosa in cystic fibrosis.

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    Sonia Bastonero

    Full Text Available Tracheal glands (TG may play a specific role in the pathogenesis of cystic fibrosis (CF, a disease due to mutations in the cftr gene and characterized by airway inflammation and Pseudomonas aeruginosa infection. We compared the gene expression of wild-type TG cells and TG cells with the cftr DeltaF508 mutation (CF-TG cells using microarrays covering the whole human genome. In the absence of infection, CF-TG cells constitutively exhibited an inflammatory signature, including genes that encode molecules such as IL-1alpha, IL-beta, IL-32, TNFSF14, LIF, CXCL1 and PLAU. In response to P. aeruginosa, genes associated with IFN-gamma response to infection (CXCL10, IL-24, IFNgammaR2 and other mediators of anti-infectious responses (CSF2, MMP1, MMP3, TLR2, S100 calcium-binding proteins A were markedly up-regulated in wild-type TG cells. This microbicidal signature was silent in CF-TG cells. The deficiency of genes associated with IFN-gamma response was accompanied by the defective membrane expression of IFNgammaR2 and altered response of CF-TG cells to exogenous IFN-gamma. In addition, CF-TG cells were unable to secrete CXCL10, IL-24 and S100A8/S100A9 in response to P. aeruginosa. The differences between wild-type TG and CF-TG cells were due to the cftr mutation since gene expression was similar in wild-type TG cells and CF-TG cells transfected with a plasmid containing a functional cftr gene. Finally, we reported an altered sphingolipid metabolism in CF-TG cells, which may account for their inflammatory signature. This first comprehensive analysis of gene expression in TG cells proposes a protective role of wild-type TG against airborne pathogens and reveals an original program in which anti-infectious response was deficient in TG cells with a cftr mutation. This defective response may explain why host response does not contribute to protection against P. aeruginosa in CF.

  15. Review on the Antimicrobial Resistance of Pathogens from Tracheal and Endotracheal Aspirates of Patients with Clinical Manifestations of Pneumonia in Bacolod City in 2013

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    Alain C. Juayang

    2015-01-01

    Full Text Available Microbiological content specifically bacterial and fungal etiologies from tracheal aspirates in a tertiary hospital in Bacolod City was reviewed for baseline information. A total of 130 tracheal aspirates were subjected for culture to isolate and identify the pathogen and determine their susceptibilities to various antibiotics. Productions of certain enzymes responsible for antibiotic resistance like ESBL (Extended Spectrum Beta-Lactamase, metallo-β-lactamase, and carbapenemase were also studied. Out of 130 specimens, 69.23% were found to be positive for the presence of microorganisms. Most infections were from male patients aging 60 years and above, confined at the Intensive Care Units (ICU. Pseudomonas aeruginosa and Klebsiella pneumoniae were found to be the most frequent bacterial isolates and non-Candida albicans for fungal isolates, respectively. Among the various antibiotics tested, most isolates were found to be resistant to third generation cephalosporins and penicillins, but susceptible to aminoglycoside Amikacin. On the other hand, production of ESBL and carbapenemase was found to be common among members of Enterobacteriaceae especially K. pneumoniae.

  16. Malignant tracheal-mediastinal-parenchymal-pleural fistula after chemoradiation plus bevacizumab: management with a Y-silicone stent inside a metallic covered stent.

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    Machuzak, Michael S; Santacruz, Jose F; Jaber, Wissam; Gildea, Thomas R

    2015-01-01

    Tracheal or bronchial-mediastinal fistulas are a rare entity associated to high mortality. We report a case of a 58-year-old man with an unresectable non-small cell carcinoma of the lung, treated with chemoradiation followed by bevacizumab. Approximately, 6 weeks after starting bevacizumab he developed a severe cough with copious secretions He could not lie supine due to the feeling of drowning. Investigations revealed a large tracheo-mediastinal-parenchymal-pleural fistula. Palliative management was offered with interventional bronchoscopic techniques. He was found to have a large central airway defect that obliterated almost 40% of the trachea. Under general anesthesia and positive pressure ventilation, a unique approach was used to rebuild an eroded tracheal and right main stem bronchial wall. A self-expanding metallic stent (SEMS) was placed to provide a scaffold of support, whereas a Dumon Y-stent was placed inside the SEMS. This combination allowed for a patent, stable airway; recreating the normal anatomy in a minimally invasive manner walling off the fistula. The patient was discharged 2 days after the bronchoscopic intervention, with significant palliation of his symptomatology. Eighteen months later, the upper lobe cavity persists with a stable airway and stents perfectly positioned with clinically insignificant evidence of stent related granulation in the upper trachea.

  17. An assessment of the ratio of height to thyromental distance compared to thyromental distance as a predictive test for prediction of difficult tracheal intubation in Thai patients.

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    Krobbuaban, B; Diregpoke, S; Kumkeaw, S

    2006-05-01

    Preoperative evaluation is important in the detection of patients at risk for difficult tracheal intubation. Thyromental distance (TMD) is often used for these purposes, but its value as an indicator for difficult intubation is questionable, as it varies with patient size and body proportions. The purpose of the present study was to evaluate and compare the accuracies of the ratio of patient's height to TMD (ratio of height to TMD = RHTMD) and TMD alone in the prediction of difficult tracheal intubation in Thai patients. The authors collected data on 382 consecutive patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. Thyromental distance and RHTMD were evaluated preoperatively. Difficult intubation was defined in the present study by Cormack and Lehane grade 3 or 4. The optimal predictive value was chosen using a receiver operating characteristic (ROC) curve. The areas under the ROC curves (AUC) of TMD and RHTMD were compared to determine the performance of the different predictive tests used. The sensitivity, specificity, and positive and negative predictive values of each of the predictive tests were calculated according to standard formulae. Difficult intubation occurred in 42 patients (10.9 %). The predictive advantage of RHTMD has a similar specificity with improved sensitivity in comparison with TMD. The AUC of RHTMD was significantly greater than the AUC of TMD (p = 0.00). The authors concluded that RHTMD had better accuracy in predicting difficult intubation than TMD.

  18. Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases.

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    Krajc, Tibor; Janik, Miroslav; Benej, Roman; Lucenic, Martin; Majer, Ivan; Demian, Juraj; Harustiak, Svetozar

    2009-12-01

    The report is a retrospective review of 238 benign tracheal stenoses of various etiologies treated between 1995 and 2008. To show that urgent segmental resection has complication rates similar to elective resection and, therefore, preoperative dilation is not necessary, we analysed records of patients who underwent either standard segmental resections with anterolateral mediastinal tracheal mobilization, single-suture anastomosis and neck flexion; or insertion of T-tube with oval-shaped horizontal arm. Primary segmental resection was performed in 164 patients (68.9%), including 14 cases with concomitant tracheo-esophageal fistula (TEF). T-tube as an initial treatment suited 74 (31.1%) patients. We encountered two partial and one complete anastomotic disruptions following subglottic resections treated by T-tube insertion and costal cartilage tracheoplasty or permanent tracheostomy. Restenosis rate in segmental resection was 3.1%. No difference in complication rate between urgent and elective segmental resections was experienced. We treated a small number of patients by endotracheal stent insertion but the results were discouraging. Urgent segmental resection without prior rigid bronchoscopy dilation is our strategy of choice whenever possible. As an alternative to dilation we prefer temporary insertion of modified T-tube. Stand-alone endoluminal dilation and stenting has yet to prove its safety and long-term efficacy.

  19. Urothelial Superior Vena Cava Syndrome with Limited Response to Radiation Therapy.

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    Bingham, Nishan; Wallace Iii, H James; Monterroso, Joanne; Verschraegen, Claire; Waters, Brenda L; Anker, Christopher J

    2015-01-01

    Radiation therapy (RT) is the standard of care for cases of superior vena cava (SVC) syndrome secondary to metastatic adenopathy. Histologies vary in radiosensitivity and response time, making alternative therapies such as chemotherapy and/or intravenous stenting preferable alternative options for certain diagnoses. Metastatic urothelial carcinoma is a particularly rare cause of SVC syndrome with only 3 cases reported in the literature. Consequently, optimal management remains challenging, particularly in cases of high tumor burden. Here we present a case of highly advanced metastatic urothelial cancer with SVC syndrome and tracheal compression. The patient started urgent RT but expired midway through her treatment course due to systemic progression of disease, requiring SVC and tracheal stenting. The authors review the literature including discussion of the few other known cases of SVC syndrome due to urothelial carcinoma and a review of this histology's response to RT. This experience suggests, that in cases of SVC syndrome with widespread advanced disease, stenting and chemotherapy with or without RT may be the most important initial treatment plan, depending on goals of care.

  20. Urothelial Superior Vena Cava Syndrome with Limited Response to Radiation Therapy

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    Nishan Bingham

    2015-01-01

    Full Text Available Radiation therapy (RT is the standard of care for cases of superior vena cava (SVC syndrome secondary to metastatic adenopathy. Histologies vary in radiosensitivity and response time, making alternative therapies such as chemotherapy and/or intravenous stenting preferable alternative options for certain diagnoses. Metastatic urothelial carcinoma is a particularly rare cause of SVC syndrome with only 3 cases reported in the literature. Consequently, optimal management remains challenging, particularly in cases of high tumor burden. Here we present a case of highly advanced metastatic urothelial cancer with SVC syndrome and tracheal compression. The patient started urgent RT but expired midway through her treatment course due to systemic progression of disease, requiring SVC and tracheal stenting. The authors review the literature including discussion of the few other known cases of SVC syndrome due to urothelial carcinoma and a review of this histology’s response to RT. This experience suggests, that in cases of SVC syndrome with widespread advanced disease, stenting and chemotherapy with or without RT may be the most important initial treatment plan, depending on goals of care.