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At least 199 records · Page 11Linked to original sources

PubMed2000

[Anesthesia for a cervical myelopathy patient with tracheal stenosis].

A 71-year-old male with cervical myelopathy was scheduled for C 3-7 laminectomy. Once he had been rejected of general anesthesia in other hospital because of his tracheal stenosis. The diameter of the narrowest part of his trachea was 5 mm probably resulting from tracheostomy at 2 years of age. His cervical myelopathy seemed to be no problem for anesthesia induction because he had no problems in his neck movement and opening mouth. We evaluated his tracheal stenosis carefully using bronchofiberscopy, chest X-ray, computed tomography and pulmonary function tests. After intravenous fentanyl 100 micrograms and midazolam 2.5 mg, it was impossible to ventilate the patient. Therefore, tracheal intubation was performed immediately after lidocaine administration into the trachea. During surgery, tracheal tube dilated the narrowed portion. After surgery, the tracheal tube was removed under bronchofiberscopic observation without any problems. Tracheal stenosis was observed by chest X-ray after surgery, but he had no complaints.

Aged↗

PubMed1986

A new model of tracheal stenosis and its repair with free periosteal grafts.

Stenosis of 50% to 80% of the cervical or thoracic tracheal lumen was created in 17 piglets by encircling the trachea with silicone rubber sheet for 3 to 19 days (median 14 days). In 13 animals thoracic tracheal stenosis was repaired by longitudinal incision and insertion of a free tibial periosteal graft into the defect. An omental pedicle graft was applied to the surface of the free periosteal graft to augment its blood supply in three of these animals. An endotracheal silicone rubber splint was left in place for 2 to 3 weeks after the operations. Four animals served as untreated controls. In 12 of 13 piglets respiratory obstruction was relieved. One repair failed because of graft necrosis. In two animals put to death 1 month and 2 months later, stenosis was absent and the grafts showed variable ossification. The luminal surface had epithelialized. In nine of 10 animals put to death 3 months after the operation, tracheal cross-sectional areas had doubled, stenosis and granulation tissue were absent, and all the grafts had ossified and epithelialized. A mild stenosis (24%) developed over a 2 mm length in one animal and the graft had not ossified. The omental pedicle graft did not improve vascularization of the free periosteal graft. These studies describe a model of tracheal stenosis that can be used to assess various methods of repair. The results indicate that tracheal stenosis can be successfully treated by incision and insertion of a free periosteal graft into the defect.

Animals↗

PubMed1980

Resection of distal tracheal stenosis in a baby with agenesis of the lung.

A newborn infant with agenesis of the left lung and critical distal tracheal stenosis required tracheal resection and reanastomosis. This case illustrates the combined use of flow-volume curves, radiology and endoscopy in the diagnosis and management of airway obstruction in infants. It also establishes the feasibility of complete tracheal reconstruction in small babies.

Female↗

PubMed2000

[Successful weaning from mechanical ventilation in an infant with congenital tracheal stenosis and bronchial malacia using endobronchial stent, nasal CPAP and continuous sedation].

A 1.9 kg male infant who showed respiratory distress at his birth, was diagnosed by bronchoscopy as having congenital segmental stenosis of trachea with complete ring. Tracheoplasty was performed and the infant was admitted to ICU. After admission to ICU, we suspected the residual tracheal stenosis and the left main bronchial malacia by bronchoscopy. Although we tried to wean him from mechanical ventilation, but failed and re-intubated him four times because of marked respiratory acidosis after extubation. Bronchoscopy was performed repeatedly, and the residual tracheal stenosis and the left main bronchial malacia were apparent. After patch tracheoplasty of the costal cartilage to the residual tracheal stenosis and implantation of angioplastic expandable metallic stent to the left main bronchus, he was successfully extubated under continuous sedation. In addition, nasal CPAP was effective to reduce retraction and wheezing after extubation. He was discharged from ICU on the 183rd ICU day.

Bronchi↗

PubMed2003

End-to-end anastomosis in chronic tracheal stenosis.

OBJECTIVE: This study assessed the efficacy and safety of end-to-end anastomosis of the trachea following segmental resection in chronic tracheal stenosis. METHODS: End-to-end anastomoses of the trachea were performed in 35 patients with chronic tracheal stenosis; 18 patients with tracheal invasion of thyroid cancer and 17 patients with long-term intubation and blunt injuries of the trachea. RESULTS: All operations were successful, except one whose unilateral recurrent nerve had not been identified in the recurrent thyroid cancer invasion with trachea. CONCLUSION: This operation provides a one-step cure for the stenosed trachea and can be applied to the resection of less than six tracheal segments.

Adenocarcinoma↗

PubMedDate not supplied

CO2 laser repair of subglottic and upper tracheal stenosis.

This study uses seven large adult canines. Microendoscopic forceps and electrocautery excisions of subglottic and upper tracheal mucosa, perichondrium, and cartilage results in stenoses in all animals. Four partial lesions are created in the upper trachea, and three complete stenoses occur in the subglottic region. Five of the animals require permanent tracheostomy. Three months later six animals have excisions with the CO2 laser, and one animal with upper tracheal stenosis is a control. After three months follow-up, two of the canines with upper tracheal stenosis show a slightly improved airway and one remains the same as preexcision. All three animals with subglottic lesions redevelop complete stenosis.

Animals↗

PubMed2005

Surgical treatment of pulmonary artery sling and tracheal stenosis.

BACKGROUND: Pulmonary artery sling is a rare vascular ring and is commonly associated with tracheal stenosis. Symptomatic newborns and infants with these complex lesions have a high mortality rate without surgical intervention. The ideal operation remains controversial, with debate focusing on the need for left pulmonary artery for reimplantation and the technique of tracheal reconstruction. METHODS: From 1983 to 2003, 14 patients with pulmonary artery sling (mean age, 7 months; range, 6 days to 27 months) underwent repair of pulmonary artery sling alone (6 patients), tracheoplasty alone (1 patient), and pulmonary artery sling repair with tracheoplasty (7 patients). Preoperatively, 7 patients were intubated, 2 had VATER (vertebral, anal, tracheal, esophageal, and radial anomalies) syndrome, and 2 patients had agenesis of the right lung. The left pulmonary artery was reimplanted at the ductal insertion site in 13 patients. One patient had left pulmonary artery translocation. Tracheoplasty employing extracorporeal circulation consisted of autologous pericardial patch (6 patients) or slide tracheoplasty (2 patients). Six patients with pulmonary artery sling and mild tracheal stenosis required only left pulmonary artery reimplantation. Concomitant procedures included closure of atrial septal defect (4 patients), ventricular septal defect (4 patients), and shunt for Fallot's tetralogy (2 patients). RESULTS: There were 2 hospital deaths (2 of 14;14%) from abdominal sepsis (1) and renal failure (1). Reoperations included diaphragm plication (2), tracheostomy (1), and bronchoscopy with laser resection of granulation tissue (5 patients: 2 slide, 3 pericardium). Follow-up was complete in all patients (mean, 42 months) with 1 late death from fungal sepsis. At follow-up, all left pulmonary artery anastomoses were patent by echocardiography, and no patient has required reoperation for trachea reconstruction. CONCLUSIONS: These data demonstrate that tracheal repair is not always necessary in the presence of pulmonary artery sling; that agenesis of the right lung is not a contraindication to successful complete repair; and that simultaneous correction of intracardiac defects can be safely performed in selected patients. This study suggests that in newborns and infants, pericardial patch and slide tracheoplasty are effective methods for trachea reconstruction.

Abnormalities, Multiple↗

PubMed1999

Screw-thread vs Dumon endoprosthesis in the management of tracheal stenosis.

STUDY OBJECTIVES: A frequent complication of the widely used Dumon silicone stent is its tendency to migrate when used in tracheal stenosis. We compared the clinical efficacy and complications (including migration) of the Dumon stent with a screw-thread stent, a device with an increased stent-to-wall contact surface and, theoretically, less tendency to migrate. DESIGN: Retrospective case analysis. SETTING: Academic hospital. MATERIALS AND METHODS: Forty-six patients with tracheal stenoses (23 benign and 23 malignant) requiring the placement of 50 stents (29 Dumon and 21 screw-thread) were studied. In 26 patients Dumon stents were used, and in 20 patients screw-thread stents were used. Both patient groups had comparable clinical and stenosis-related characteristics. RESULTS: Stent insertion and follow-up were uneventful in both the Dumon and the screw-thread insertions, respectively: 62% vs 67% (not significant). There were seven migrations in the Dumon group, compared to only one migration in the screw-thread group, respectively: 24% vs 5%. This difference did not reach statistical significance (p = 0.1). All of the migrations occurred in the benign stenosis group, and none occurred in the malignant-stenosis group, respectively: 8 of 23 vs 0 of 23, p = 0.004. Within the benign-stenosis group, the Dumon stent had a significantly increased risk for migration when compared to the screw-thread stent, respectively: 7 of 13 vs 1 of 11, p = 0.033. CONCLUSIONS: The screw-thread stent and the Dumon stent are equally effective in the management of tracheal stenosis. There is a general trend toward a decreased migration rate, and a significantly lower risk for migration in patients with benign tracheal stenosis. The (less expensive) screw-thread stent may represent an attractive alternative in the management of tracheal stenosis in general, and may be preferable to the Dumon stent in treating benign tracheal stenosis.

Aged↗

PubMed2004

[A case of giant thyroid tumor with tracheal stenosis].

A 61-year-old female underwent resection of a giant thyroid tumor, and tracheal stenosis ensued. She had cough, dyspnea, and palpitation in the supine position. The giant thyroid tumor was of the size of 11 x 12 cm and the diameter of trachea was 8 x 6 mm at 3.5 cm below the vocal cord, at which point the trachea was the narrowest on cervical computed tomography. The peak expiratory flow rate from the flow-volume curve was 2.94 l x sec(-1) (% predicted value 55.2%) in the upright position. We were concerned about difficult airway management. Oro-tracheal intubation with an armored tube (ID 7.5 mm) was performed after intravenous midazolam 2 mg and fentanyl 50 microg, 4% lidocaine spray 2 ml with oxygen 6 l x min(-1) inhalation keeping spontaneous breathing and consciousness. Anesthesia was induced and maintained with intravenous propofol, fentany, vecuronium and nitrous oxide in oxygen to keep the bispectral index between 40 and 60. The extracted thyroid tumor was 620 g in weight. A careful preoperative evaluation of the airway using ultrasonography, CT, MRI, laryngoscopy, bronchoscopy and respiratory function test, especially peak expiratory flow rate of the flow-volume curve is important in such a case of a giant thyroid tumor. Intubation under conscious sedation with midazolam and fentanyl is useful for a patient with a giant thyroid tumor and tracheal stenosis.

Anesthesia, General↗

PubMed2000

[A case of idiopathic tracheal stenosis].

A 44-year-old woman who had been treated for bronchial asthma for 5 years was admitted for further evaluation of progressive dyspnea. Physical examination revealed wheezing originating in the neck. A flow-volume curve suggested upper-airway stenosis. The patient had no history of trauma, endotracheal intubation, granulomatous diseases, or any other severe respiratory tract infections. Chest radiography and laboratory examination showed no abnormalities. Tracheal X-P, computed tomography and magnetic resonance imaging of the neck, and bronchoscopy demonstrated circumferential subglottic tracheal stenosis extending for 40 mm. The diameter of the lumen was 5 mm at its narrowest. The trachea distal to the lesion was normal. Bronchoscopic biopsy revealed thickened tracheal mucosa and submucosa with increased fibrous tissue and chronic inflammatory cell infiltration, suggesting a nonspecific inflammatory process. These findings are compatible with idiopathic tracheal stenosis, which was reported by Bhalla et al. The patient was treated with Nd-YAG laser surgery via a fiberoptic bronchoscope, which resulted in a great improvement in respiration. Regression of the lesion has not occurred in the 40 months since the laser surgery. The majority of patients with this condition have been treated by surgical resection of the stenotic lesion and reconstruction. However, the success of Nd-YAG laser surgery in the present case suggests that this approach would be a satisfactory alternative procedure for treatment of idiopathic tracheal stenosis.

Bronchoscopy↗

PubMed2006

[Dose-reduced 16-slice multidetector-row spiral computed tomography in children with bronchoscopically suspected vascular tracheal stenosis -- initial results].

PURPOSE: To evaluate the diagnostic accuracy of contrast-enhanced dose-reduced 16-slice multidetector-row CT (MDCT) in newborns and infants with fiberoptic bronchoscopically suspected vascular-induced tracheal stenosis. MATERIALS AND METHODS: 12 children (4 days to 3 years, 1.2 - 13.5 kg body weight) were examined using i. v. contrast-enhanced 16-slice MDCT (SOMATOM Sensation 16, Forchheim, Germany) without breath-hold and under sedation (11/12). All MDCTs were performed with a dose reduction. The beam collimation was 16 x 0.75 mm, except in the case of one child. MPRs along the tracheal axis in the x-, y- and z-directions and volume-rendering-reconstructions (VRTs) were calculated based on a secondary raw data set in addition to conventional axial slices. 2 radiologists used a three-point grade scale to evaluate the image quality, motion, and contrast media artifacts as well as the usefulness of the 2D- and 3D-reconstructions for determining the diagnosis. Statistical analysis was performed on the basis of a Kappa test. RESULTS: In all cases the cause of the fiberoptic bronchoscopically suspected tracheal stenosis was revealed: compression due to the brachiocephalic trunk (n = 7), double aortic arch (n = 2), lusorian artery (n = 1), vascular compression of the left main bronchus (n = 2). In 3 patients further thoracic anomalies, such as tracheobronchial (n = 2), and vascular (n = 2) and vertebral (n = 1) anomalies were found. The attenuation in the anomalous vessels was 307 +/- 140 HU. The image noise was 9.8 +/- 1.9 HU. The mean dose reduction was 82.7 +/- 3.2 % compared to a standard adult thoracic CT. All examinations were rated as diagnostically good (median 1, range 1, k = 1). 3D images did not show any stair artifacts (median 2, range 1 - 2, k = 1). The image noise was minor to moderate and hardly any motion artifacts were seen (median 1, range 1 - 2, k = 0.8). Contrast media artifacts were rated zero to minor (median 1.5, range 1 - 2, k = 0.676). MPRs (median 1, range 1, k = 1) and VRTs (median 1, range 1, k = 1) were found to be useful for diagnosis. Subsequent vascular surgery was performed on 8 patients. CONCLUSION: Contrast-enhanced dose-reduced 16-slice MDCT is effective for demonstrating the cause of fiberoptic bronchoscopically suspected vascular-induced tracheal stenosis even in very small and severely ill children despite the small contrast media amount and free breathing.

Airway Obstruction↗

PubMed1994

Management of severe congenital tracheal stenosis.

We have managed 23 infants and children with severe tracheal stenosis due to congenital complete tracheal rings producing a long-segment stenosis of the trachea. Nineteen (83%) have survived this life-threatening cause of airway obstruction, 7 of whom also had pulmonary artery slings. Pericardial patch tracheoplasty facilitated by partial cardiopulmonary bypass is currently our preferred technique for surgical repair. Eighteen patients (78%) underwent operative intervention, 3 of whom (17%) have died since surgery. The mean follow-up is 4.5 years. Bronchoscopy is essential for preoperative diagnosis and accurate intraoperative incision of the trachea, and is critical for long-term postoperative airway management. The more distal lesions are associated with increased complications and a higher mortality rate.

Airway Obstruction↗

PubMed1996

[A case of tracheal stenosis caused by invasion of recurrent lung cancer palliated with dumon stent after Nd-YAG laser and bouginage using of tracheal tube].

The patient was 67 year-old male with tracheal stenosis caused by invasion of recurrent lung cancer after right upper sleeve lobectomy. He visited to our hospital for the purpose of palliation with tracheal stent. But rigid bronchoscope cannot be passed through its lesion because of severe stenosis. So the bouginage was performed. This method was that tracheal tube was inserted into his trachea through the hole of tracheotomy during six days following Nd-YAG laser therapy. After this treatment, rigid bronchoscope was inserted into the trachea and Dumon stent was placed safely and easily. It seems to be an useful palliation for patients with severs invasive tracheal stenosis.

Aged↗

PubMed2003

Esophageal carcinoma with tracheal stenosis due to tumor invasion and long survival after chemoradiotherapy.

For patients who have esophageal carcinoma with tracheal invasion surgery is usually not indicated because operative complications are considerable and the prognosis is poor. We experienced complete regression of a large esophageal carcinoma with tracheal stenosis due to tumor invasion without tracheo-esophageal fistula. Irradiation of 68 Gy was delivered to a long T field from the neck to the lower thoracic esophagus, and was combined with chemotherapy using cisplatin and 5-fluorouracil. The tumor decreased markedly in size and the tracheal stenosis resolved. The patient has survived for 4 years, although second primary early esophageal carcinoma and hypopharyngeal carcinoma were detected 2 years after his initial chemoradiotherapy. Although the prognosis of advanced esophageal carcinoma with invasion of other organs is usually poor, the effect of chemoradiotherapy can sometimes be dramatic and a good result can be achieved in such patients.

Combined Modality Therapy↗

PubMed1994

[Endoscopic treatment of iatrogenic tracheal stenosis by laser Nd:YAG].

The authors present the technique and results of endoscopic Nd:YAG laser treatment of inflammatory tracheal stenoses. This kind of therapy was employed in 10 patients with tracheal stenosis, resulting from long-term nastotracheal intubation (6 cases), tracheostomy tube after radical laryngectomy (3 cases) and tracheal trauma. The laser fiber was introduced into trachea by the operative channel of a flexible bronchoscope and vaporization of obstructing tissues carried out using contact method in continuous mode of light emission (power 7-20 Watts). The achievement of normal tracheal patency usually required several laser therapy sessions (3-5), repeated in 3-5 days intervals. The short-term results are encouraging: in all cases the normal tracheal was lumen was restored, resulting in alleviation of patients' symptoms. In 3 cases a recurrent tracheal stenosis, requiring additional laser treatment was observed.

Endoscopy↗

PubMed1995

Endotracheal intubation under image guidance for a child with tracheal stenosis.

A case of successful endotracheal intubation using an image intensifier in a 9-year-old boy with tracheal stenosis was reported. After the induction of anesthesia, the trachea was observed by use of mobile surgical X-ray apparatus under artificial ventilation using a face mask. Because the tracheal wall of the stenotic part was smooth and seemed soft, we selected a plain 5.5 mm diameter endotracheal tube and intubated under observation using an image intensifier. We observed the tube pass through the stenotic part of the trachea without difficulty. We consider that endotracheal intubation under image guidance is useful in a patient with tracheal stenosis.

Adenocarcinoma, Papillary↗

PubMed1985

Intubation-related tracheal stenosis in very-low-birth-weight infants. Diagnosis and treatment.

Five infants who developed intubation-related tracheal stenosis were treated surgically with an anterior cricoid split instead of a tracheostomy. This surgery allowed early extubation and discharge of these patients who, on follow-up, have had adequate phonation and no further respiratory compromise. We suggest that this surgery be considered for all infants who develop intubation-related tracheal stenosis.

Cricoid Cartilage↗

PubMed2000

[Inner surface imaging of laryngeal and tracheal stenosis by spiral-CT: role of a new diagnostic procedure].

BACKGROUND: Inner-surface-reconstruction calculated from helical-CT data sets offers a new diagnostic option for upper airway assessment. Using a special software, it is possible to create a continuous overview on the inner surface of hollow viscera on a monitor, similar to an endoscopic view. However, reports on the clinical value of this examination procedure with regard to laryngeal or tracheal stenosis are rare. METHOD: We compared the results of this "virtual endoscopy" with real endoscopic or intraoperative findings in 11 patients suffering from laryngeal or tracheal stenosis of various etiologies. RESULTS: Data on extension and localization of airway stenosis obtained by virtual endoscopy corresponded well with our endoscopic or intraoperative findings in all patients. The grade of airway stenosis as assessed by inner-surface-reconstruction could be confirmed by endoscopy in 8 of 11 cases investigated. Detection of 2 additional airway stenoses distal to an endoscopically non-passable tracheal stenosis was possible by virtual endoscopy in one case. CONCLUSION: As a supportive diagnostic procedure, virtual endoscopy offers a valuable overview on extension and localization of laryngeal or tracheal stenoses with regard to a possible therapeutic management.

Adult↗