Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes

Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Increased histopathological yield for granulomatosis with polyangiitis based on nasal endoscopy of suspected active lesions.

PURPOSE: To present the results of an endoscopic and histopathologic evaluation of suspected nasal active granulomatosis with polyangiits (GPA) lesions, describe them as seen by the ENT specialist, and propose a guide for tissue sampling of the nasal cavity to improve the yield of confirmatory histology. METHODS: Randomly selected patients seen from December 1997-October 2007 had a thorough endoscopic nasal evaluation, preceded by careful cleansing of the nasal cavity. Endoscopic lesions were described; sensitivities, specificities, and predictive values of the composites of endoscopic and histological activity were determined. RESULTS: Six lesions, some not previously described in detail, were observed: white submucosal nodules, mucosal swelling, polypoid nodules, vascular submucosal dilatations, bloody submucosal patches, and ulcers. Of these, polypoid nodules (PPV 100%), persistent white submucosal nodules (PPV 81%), and bloody submucosal patches (PPV 93%) had the better diagnostic performance with confirmed histological diagnosis. CONCLUSIONS: Careful nasal cavity preparation, observation, and description of the nasal mucosa can guide tissue sampling documenting active GPA. This can lead to a better histological yield when definitive proof of the disease is needed.

[Role of the ears, nose and throat specialist in the diagnosis and follow up of patients with primary vasculitidies]. / Papel del otorrinolaringólogo en el diagnóstico y seguimiento de pacientes con vasculitis primarias.

First manifestations of vasculitis can appear on the head and neck, still few physicians are aware of these diseases, as they are unspecific and because other conditions like infections and allergies are more frequent. Among them, signs and symptoms like epistaxis, nasal obstruction, discharge, burning pain of sinonasal region, headache, sinus polyps and crusts, the latter found in people who live in highly polluted cities with low humidity, in patients with respiratory scleroma, atrophy, those receiving local radiotherapy, and due to other conditions. Under the crusts, many infectious agents, like Staphylococcus aureus may grow and, in addition, other signs related to active vasculitis may be found. The ENT specialist is one of the first physicians visited by patients with these signs and symptoms. Their recognition is important to readily diagnose these diseases. We have selected three vasculitidies for discussion in this paper: granulomatosis with polyangiitis (Wegener), Churg-Strauss syndrome and relapsing polychondritis, since these three diseases present initial ENT problems with high frequency.

Vértigo en el niño. Valoración clínica, ruta diagnóstica y diagnóstico diferencial / Vertigo in children. Clinic evaluation, diagnosis and differential diagnosis

Vértigo, significa"sensación subjetiva de movimiento del entorno o de sí mismo"; debe distinguirse del mareo que implica aturdimiento distorsión visual u orientación alterada. La conservación del equilibrio depende de una adecuada información sobre la posición del cuerpo en el espacio, proporcionada por los sistemas vestibular, visual y propioceptivo. En el niño existen muchas causas o vértigo y el diagnóstico y tratamiento certeros dependen de su adeucado estudio. Debe realizarse una historia clínica completa orientada a las múltiples causas del vértigo, exploración física general, neurológica, otorrinolaringológica y estudios de laboratorio y gabinete. Se ha clasificado al vértigo en seis grupos: 1) paroxístico con hipoacusia, 2) paroxístico sin hipoacusia, 3) vértigo con pérdida del control postural o de la conciencia sin hipoacusia, 4) vértigo incoercible con signos neurológicos 5) vértigo incoercible con deterioro intelectual progresivo y signos neurológicos, 6) vértigo incoercible sin anomalías neurológicas. Los estudios de gabinete más útiles en el estudio del paciente con vértigo son: electronistagmografía, electroencefalografía tomografía computada y resonancia magnética nuclear; sin embargo, no en todos los pacientes están indicados. Su solicitud depende del grupo al que pertenezca el paciente

Cirugía del oído crónicamente infectado en niños del Instituto Nacional de Pediatría / Surgery for the chronically infected ear in children from the I.N.P

Se hace el estudio retrospectivo de 83 pacientes operados de oído en el Servicio de Otorrinolaringología del INP de enero de 1992 a diciembre de 1994. Se presentan los resultados del análisis de sexo, edad, lado infectado, diagnóstico definitivo, técnica quirúrgica utilizada, cirugías previas ipsi y contralaterales y complicaciones. Se discute el tema y se revisa la literatura respectiva

Epiglotitis. Una urgencia otorrinolaringológica. Presentación de cuatro casos / Epiglottitis. An otorhinolaryngologic emergency. Report of four cases

Se describen cuatro casos de epiglotitis; tres pacientes evolucionaron satisfactoriamente y hubo una defunción por causas múltiples. Los síntomas principales fueron; fiebre, tos, mal estado general, dificultad respiratoria, quejido inspiratorio, polipnea y estridor laríngeo. El diagnóstico clínico se corroboró con estudios de laboratorio y gabinete; el tratamiento consistió en ventilación asistida, nebulizaciones, esteroides y antibióticos

Cuerpos extraños en nariz. Criterios para evitar complicaciones: presentación de 58 casos / Foreign bodies in nose: rules to avoid complications: experience in 58 cases

En el presente trabajo se hace una revisión de la literatura con respecto al tema, así como la presentación de la experiencia del servicio de otorrinolaringología en el INP al atender a 58 pacientes en quienes se extrajeron 58 cuerpos extraños de la nariz, en el periodo de enero a junio de 1995. Asimismo se enumeran algunos preceptos importantes que el médico pediatra, el médico general y el propio otorrinolaringólogo deben tener siempre en mente al momento de atender a un paciente que aqueje las molestias propias de la introducción de un cuerpo extraño en la nariz