scholarly journals Use of an Insulation-Tipped Knife during Rigid Bronchoscopic Treatment of Benign Tracheobronchial Stenosis

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 251
Author(s):  
Ji-Won Park ◽  
Yousang Ko ◽  
Changhwan Kim
Keyword(s):  
Tracheal Stenosis ◽  
Treatment Success ◽  
Stable State ◽  
Forced Expiratory Volume ◽  
Rigid Bronchoscopy ◽  
Bronchial Stenosis ◽  
Tracheobronchial Stenosis ◽  
Acute Complications ◽  
The Mean ◽  
Post Intubation

Background and Objectives: Tracheal or bronchial tears are potential complications of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an insulation-tipped (IT) knife in combination with rigid bronchoscopic dilatation for treating benign tracheobronchial stenosis. Materials and Methods: We conducted a chart review of patients with benign tracheobronchial stenosis who were treated with rigid bronchoscopy and an IT knife at two referral centers. Treatment success was defined as a clinically stable state without worsening symptoms after 3 months of treatment. Results: Of the 23 patients with benign tracheobronchial stenosis, 15 had tracheal stenosis and 6 had main bronchial stenosis. Among them, three cases were of simple stenosis (13%), while the others were of complex stenosis (87%). The overall treatment success rate was 87.0%. Pneumomediastinum and subcutaneous emphysema occurred due to bronchial laceration in two cases of distal left main bronchial stenosis (8.7%), and no other significant acute complications developed. Silicone stents were inserted in 20 patients, and successful stent removal was possible in 11 patients (55.0%). Six of the seven stents inserted in patients with post-intubation tracheal stenosis were removed successfully (85.7%). However, most of the patients with post-tracheostomy tracheal stenosis required persistent stenting (80%). Pulmonary function was significantly increased after treatment, and the mean increase in the forced expiratory volume in 1 s was 391 ± 171 mL (160–700 mL). Conclusion: The use of an IT knife can be suggested as an effective and safe modality for rigid bronchoscopic treatment of benign tracheobronchial stenosis.

Surgical repair for post-tuberculosis tracheobronchial stenosis

2020 ◽  
pp. 021849232096397
Author(s):  
Vu Huu Vinh ◽  
Nguyen Van Khoi ◽  
Nguyen Viet Dang Quang ◽  
Huynh Quang Khanh
Keyword(s):  
Tracheal Stenosis ◽  
Treatment Plan ◽  
Argon Plasma Coagulation ◽  
Case Series ◽  
The Other ◽  
Segmental Resection ◽  
Stent Insertion ◽  
Bronchial Stenosis ◽  
Tracheobronchial Stenosis ◽  
End To End

Aim Post-tuberculosis tracheobronchial stenosis is rare but one of the most dangerous complications of tracheobronchial tuberculosis. Balloon dilatation, stent insertion, laser photoresection, argon plasma coagulation, and cryotherapy are some of the initial treatments recommended for mild to moderate cases. Here, we report a case series of patients who underwent segmental resection and end-to-end anastomosis for bronchial stenosis and a sliding technique for severe and long-segment tracheal stenosis. Methods We retrospectively reviewed the medical records of patients with post-tuberculosis tracheobronchial stenosis operated on in our thoracic surgery department. Of the 7 cases that were treated, two had severe tracheal stenosis stretching over 50% of the tracheal length, one was operated on using resection and end-to-end anastomosis, and the other had sliding tracheoplasty. The other 5 cases of bronchial stem stenosis were treated with segmental resection and end-to-end anastomosis. Results All five patients with bronchial stenosis had a good outcome; the ipsilateral lung was well ventilated and respiratory function was good. One patient with tracheal stenosis, treated with segmental resection and end-to-end anastomosis, died after the surgery, and the other patient, treated with slide tracheoplasty, had a good recovery. Conclusion The treatment plan for patients with post-tuberculosis tracheobronchial stenosis should be on a patient-by-patient basis. Sliding tracheoplasty can be a treatment option in patients with long-segment tracheal stenosis.

scholarly journals Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

2015 ◽  
Vol 3 (9) ◽  
pp. 14
Author(s):  
Audra Fuller ◽  
Mark Sigler ◽  
Shrinivas Kambali ◽  
Raed Alalawi
Keyword(s):  
Mitomycin C ◽  
Topical Application ◽  
Tracheal Stenosis ◽  
Argon Plasma Coagulation ◽  
Balloon Dilation ◽  
Argon Plasma ◽  
Rigid Bronchoscopy ◽  
Definitive Treatment ◽  
Plasma Coagulation ◽  
Post Intubation

Tracheal stenosis is an uncommon but known complication of endotracheal intubation and tracheostomy. Surgery is currently the definitive treatment for tracheal stenosis but carries a significantly higher risk for adverse events as it often involves complex procedures.  Here we present our experience using topical application of mitomycin C, along with various bronchoscopic interventions, as a treatment for tracheal stenosis. The patients in our series developed tracheal stenosis post-intubation or post-tracheostomy. Each patient in our series underwent the same basic procedures involving rigid bronchoscopy and balloon dilation, ablation of granulation tissue with cryotherapy and argon plasma coagulation, and finally application of topical mitomycin C. Our experience with these four cases shows a good initial success rate with topical mitomycin C application for the treatment of tracheal stenosis. Most patients required a repeat intervention a few weeks later. Our results suggest that success with topical mitomycin C is more likely in post-intubation rather than post-tracheostomy tracheal stenosis. Bronchoscopic therapy and topical application of mitomycin C may work better as a bridge to definitive surgery rather than as a stand-alone therapy.

An unusual early onset post-intubation tracheal stenosis

2018 ◽  
Vol 57 (3) ◽  
Author(s):  
Simone Scarlata ◽  
Chiara Rivera ◽  
Massimiliano Carassiti ◽  
Felice E. Agrò ◽  
Vincenzo Denaro ◽  
...  
Keyword(s):  
Tracheal Stenosis ◽  
Early Onset ◽  
Post Intubation

Can the Expiratory Disproportion Index Distinguish PVFMD from Subglottic Stenosis in Obese Patients?

2021 ◽  
pp. 000348942199015
Author(s):  
Kevin Calamari ◽  
Stephen Politano ◽  
Laura Matrka
Keyword(s):  
Vocal Fold ◽  
Forced Expiratory Volume ◽  
Subglottic Stenosis ◽  
Obese Patients ◽  
Level Of Evidence ◽  
Prior Literature ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Paradoxical Vocal Fold Movement ◽  
Rule Out

Objectives: Expiratory disproportion index (EDI) is the ratio of forced expiratory volume in 1 second (FEV1) divided by peak expiratory flow rate (PEFR) multiplied by 100. Prominent EDI (>50) values can differentiate subglottic stenosis (SGS) from paradoxical vocal fold movement disorder (PVFMD), but this has not been verified when considering body habitus. We hypothesize that the predictive value of elevated EDI in differentiating SGS from PVFMD will be lower in obese patients than non-obese patients. Methods: Patients ≥ 18 years old with recorded PFT values, BMI, and airway imaging were reviewed retrospectively from 01/2011 to 10/2018. EDI was recorded for 4 cohorts: non-obese/SGS, non-obese/ PVFMD, obese/SGS, and obese/ PVFMD, to determine the mean EDI and the sensitivity/specificity of an elevated EDI. Results: Mean EDI values were 69.32 and 48.38 in the non-obese SGS and PVFMD groups, respectively ( P < .01). They were 58.89 and 47.67 in the obese SGS and PVFMD groups, respectively ( P < .05). At a threshold of >50, EDI had a sensitivity of 90.0% and specificity of 51.6% in differentiating between SGS and PVFMD cases in non-obese patients and 51.6% and 63.6% in obese patients. Conclusion: Prior literature has established that EDI can distinguish SGS from PVFMD in the general population. Our results show that the mean EDI values were significantly different in both cohorts, but an elevated EDI was not as sensitive at identifying SGS cases in obese patients. This suggests that the EDI should be used with caution in obese patients and should not be relied upon to rule out SGS. Level of Evidence: 3.

scholarly journals Elimination of nasal obstruction improves pulmonary functions and oxygenation

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eman Sobh ◽  
Fatma Elhussieny ◽  
Taghreed Ismail
Keyword(s):  
Nasal Obstruction ◽  
Blood Gases ◽  
Medical Problem ◽  
Forced Expiratory Volume ◽  
Nasal Packing ◽  
Nasal Pack ◽  
Arterial Blood ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

scholarly journals GERMLINE HYPERMUTABILITY IN DROSOPHILA AND ITS RELATION TO HYBRID DYSGENESIS AND CYTOTYPE

Genetics ◽  
1981 ◽  
Vol 98 (3) ◽  
pp. 565-587
Author(s):  
William R Engels
Keyword(s):  
Cell Survival ◽  
Chromosomal Rearrangements ◽  
Stable State ◽  
Hybrid Dysgenesis ◽  
Mutation Rates ◽  
Female Sterility ◽  
Genetic Element ◽  
Two Generations ◽  
The Mean ◽  
P Factor

ABSTRACT In its hypermutable state, an unstable singed allele, snw, mutates in the germline to two other alleleic forms at a total frequency usually between 40 and 60%. In its stable state, the mutation rate of snw is essentially zero. Its state depends on an extrachromosomal condition indistinguishable from a property called cytotype previously studied as a component of hybrid dysgenesis. Of the two known systems of hybrid dysgenesis, denoted P-M and I-R, snw hypermutability is determined by the P-M system and appears to be independent of the I-R system. Cytotype, as defined by the control of snw mutability, is self-reproducing in the cytoplasm or nucleoplasm of the germline through at least two generations. However, it is not entirely autonomous, being ultimately determined by the chromosomes after sufficiently many generations of backcrossing. This combination of chromosomal and extrachromosomal transmission agrees well with previous studies on cytotype. Temperature differences have little effect on the mean mutation rates, but they have a pronounced effect on the intrinsic variance among individuals. The latter effect suggests that high temperatures reduce germ-cell survival during the development of dysgenic flies. Chromosomal rearrangements produce no apparent effects on the behavior of snw. Hypermutability is thought to be caused by the excision or other alteration of an inserted genetic element in the snw gene. This element might be a copy of the "P factor," which is though to be a mobile sequence capable of causing female sterility and other dysgenic traits in the P-M system.

scholarly journals The mutation load under tetrasomic inheritance and its consequences for the evolution of the selfing rate in autotetraploid species

1999 ◽  
Vol 74 (1) ◽  
pp. 31-42 ◽  
Author(s):  
J. RONFORT
Keyword(s):  
Inbreeding Depression ◽  
Deleterious Mutation ◽  
Stable State ◽  
Approximate Solutions ◽  
Balance Model ◽  
Deleterious Mutations ◽  
Selfing Rate ◽  
Mutation Load ◽  
Mean Fitness ◽  
The Mean

Single-locus equilibrium frequencies of a partially recessive deleterious mutation under the mutation–selection balance model are derived for partially selfing autotetraploid populations. Assuming multiplicative fitness interactions among loci, approximate solutions for the mean fitness and inbreeding depression values are also derived for the multiple locus case and compared with expectations for the diploid model. As in diploids, purging of deleterious mutations through consanguineous matings occurs in autotetraploid populations, i.e. the equilibrium mutation load is a decreasing function of the selfing rate. However, the variation of inbreeding depression with the selfing rate depends strongly on the dominance coefficients associated with the three heterozygous genotypes. Inbreeding depression can either increase or decrease with the selfing rate, and does not always vary monotonically. Expected issues for the evolution of the selfing rate consequently differ depending on the dominance coefficients. In some cases, expectations for the evolution of the selfing rate resemble expectations in diploids; but particular sets of dominance coefficients can be found that lead to either complete selfing or intermediate selfing rates as unique evolutionary stable state.

scholarly journals Adrenergic airway vascular smooth muscle responsiveness in healthy and asthmatic subjects

2001 ◽  
Vol 90 (2) ◽  
pp. 665-669 ◽  
Author(s):  
Jorge Brieva ◽  
Adam Wanner
Keyword(s):  
Blood Flow ◽  
Smooth Muscle ◽  
Vascular Smooth Muscle ◽  
Dead Space ◽  
Healthy Subjects ◽  
Contractile Response ◽  
Mucosal Blood Flow ◽  
Forced Expiratory Volume ◽  
Baseline Values ◽  
The Mean

The purpose of the present study was to determine the responsiveness of airway vascular smooth muscle (AVSM) as assessed by airway mucosal blood flow (Q˙aw) to inhaled methoxamine (α1-agonist; 0.6–2.3 mg) and albuterol (β2-agonist; 0.2–1.2 mg) in healthy [ n = 11; forced expiratory volume in 1 s, 92 ± 4 (SE) % of predicted] and asthmatic ( n = 11, mean forced expiratory volume in 1 s, 81 ± 5%) adults. Mean baseline values for Q˙aw were 43.8 ± 0.7 and 54.3 ± 0.8 μl · min−1· ml−1of anatomic dead space in healthy and asthmatic subjects, respectively ( P < 0.05). After methoxamine inhalation, the maximal mean change in Q˙aw was −13.5 ± 1.0 μl · min−1· ml−1in asthmatic and −7.1 ± 2.1 μl · min−1· ml−1in healthy subjects ( P < 0.05). After albuterol, the mean maximal change in Q˙aw was 3.0 ± 0.8 μl · min−1· ml−1in asthmatic and 14.0 ± 1.1 μl · min−1· ml−1in healthy subjects ( P < 0.05). These results demonstrate that the contractile response of AVSM to α1-adrenoceptor activation is enhanced and the dilator response of AVSM to β2-adrenoceptor activation is blunted in asthmatic subjects.

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