Resección de tumor traqueal / Tracheal tumor resection

Introducción: Los tumores primitivos de la tráquea son infrecuentes. Objetivo: Presentar la evolución de un paciente para resección de un tumor traqueal que ocluía el 95 por ciento de su luz. Caso Clínico: Disnea con tiraje supraesternal. No tolera el decúbito supino, presencia de tos y expectoración. Se le administró anestesia general endotraqueal convencional. Intubación con tubo No. 8. Se colocó en decúbito lateral izquierdo. Se procedió a realizar toracotomía. Con la tráquea abierta, el cirujano intubó el bronquio izquierdo con tubo No. 7. Se aspiraron secreciones, descendió la saturación de oxígeno. Se colocó sonda de levine en el pulmón derecho para oxigenación apneica con lo cual mejoró la saturación. En el pulmón ventilado se aplicó presión positiva al final de la espiración de 3 cm de agua con una fracción inspirada de oxígeno de 1. Luego de cerrada la pared posterior de la tráquea, se pasó una sonda nasogástrica a través del tubo colocado por vía orotraqueal. El cirujano fijó el extremo distal con una pinza. Se retiró el tubo orotraqueal inicial y se colocó un tubo 5.5 para intubar selectivamente el bronquio izquierdo por la boca y terminar la sutura de la tráquea y ambos bronquios. Terminado el procedimiento, se retiró el tubo y se ventilaron ambos pulmones. Conclusiones: La cirugía de tráquea impone un gran reto al anestesiólogo y al cirujano actuante, por lo que resultan imprescindibles las buenas relaciones del equipo de trabajo(AU)

Introduction: Primitive tumors of the trachea are rare. Objective: To present the evolution of a patient for removal of a tracheal tumor that occluded 95 percent of its light. Clinical case: Dyspnea with suprasternal retractions. No tolerance of supine decubitus, presence of cough and expectoration. The patient was administered conventional endotracheal general anesthesia. Intubation with tube number 8. The patient was placed in the left lateral decubitus position. A thoracotomy was performed. With the trachea open, the surgeon intubated the left bronchus with tube number 7. Secretions were aspirated, oxygen saturation decreased. A Levine tube was placed in the right lung for apneic oxygenation, which improved the saturation. In the ventilated lung, positive pressure was applied at the end of the expiration of 3 cm of water with an inspired fraction of oxygen of 1. After closing the posterior wall of the trachea, a nasogastric tube was passed through the tube placed via the orotracheal approach. The surgeon fixed the distal end with a clamp. The initial orotracheal tube was removed and a 5.5 tube was placed to intubate the left bronchus selectively through the mouth and complete the suture of the trachea and both bronchi. After the procedure, the tube was removed and both lungs were ventilated. Conclusions: The trachea surgery represents a great challenge for the anesthesiologist and the surgeon, a reason why good team working relations are essential(AU)

Tracheal polyp treated with endobronchial electrocautery.

Fibroepithelial polyps of trachea are extremely rare. Here, we report a case of tracheal polyp in a 40-year-old woman that was managed successfully with endobronchial electrocautery with a review of the relevant literature.

Initial experience of endobronchial silicon stents from a tertiary care centre in north India.

Background. Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. Methods. Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. Results. Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign postintubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. Conclusions. Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

Braquiterapia endobronquial de alta tasa de dosis en pacientes con obstrucción de la vía aérea central: experiencia en el Instituto Nacional del Cáncer y revisión de la literatura / High dose rate endobronchial brachytherapy in patients with central airway obstruction

Introduction: The main indication of modern high dose rate end bronchial brachyherapy (HDR EBBT) is the palliation of symptoms related to the growth of the endobronchial lung cancer. Methods: EBBT was performed to 27 patients who suffered symptomatic tumoral endobronchial or tracheal pathology, due to primary bronchial disease or secondary metastasis cancer, evaluating the rate of clinical benefit. The tumors were located at tracheal, carinal or proximal bronchial level. Fibrobronchoscopy was performed to all the patients to measure the degree of airway obstruction and to install brachytherapy endobronchial catheters. Between 1 to 4 fractions of 7 to 7.5 Gy were administered. Dyspnea, cough and hemoptysis were subjectively registered before and after treatment, according to an international validated scale. Results: After treatment, all symptoms considerably decreased, disappearing all of the severe categories. Hemoptysis and dyspnea resolved in a 100 percent and 40 percent of patients, respectively; and cough disappeared or was reduced to a minimum grade in 90 percent of cases.

Introducción: La indicación principal de la braquiterapia endobronquial moderna (BTEB) de alta tasa de dosis (HDR), es la paliación de síntomas por crecimiento endobronquial de cánceres pulmonares. Métodos: Se realizó BTEB HDR a 27 pacientes sintomáticos de patología tumoral endobronquial o traqueal, debido a patologías primarias bronquiales o secundarias metastásicas. Los tumores se ubicaban en tráquea, carina o a nivel bronquialproximal. Para observar mejorías en la sintomatología clínica, a todos se les realizó una fibrobroncoscopía (FBC) para medir el grado de obstrucción bronquial e instalar catéteres endobronquiales de braquiterapia. Se administraron entre 1 y 4 fracciones de 7 a 7,5 Gy. Se registró subjetivamente la disnea, tos y hemoptisis antes y después del tratamiento, de acuerdo a una escala internacionalmente validada. Resultados: Tras el tratamiento todos los síntomas disminuyeron considerablemente, desapareciendo toda sintomatología severa. La hemoptisis y disnea desaparecieron en el 100 por ciento y 40 por ciento de los pacientes respectivamente, y la tos desapareció o disminuyó a grado leve en el 90 por ciento de los pacientes.

Tracheal schwannoma: a rare tracheal tumour

Primary tracheal tumours are histologically similar but 100 times less common than main stem tumours. We report a case of primary tracheal schwannoma in a middle aged man. He had chronic cough for 2 years, and developed hemoptysis and stridor in the days preceding to presentation. He was treated by resection of the tumour and primary anatomosis of the trachea. The patient recovered well after surgery and had a near normal PEFR after one and a half year of follow-up and bronchoscopic examination excluded any recurrence

Pólipo traqueal / Tracheal polyp

Tumores benignos primários da traquéia são raros, sendo o mais freqüente a papilomatose benigna recorrente. Muitas vezes simulam doenças pulmonares obstrutivas, como asma e doença pulmonar obstrutiva crônica, sendo os pacientes tratados como portadores de tais doenças por longo período sem apresentar melhora. Deve-se, portanto, incluí-los no diagnóstico diferencial dos quadros de obstrução da árvore traqueobrônquica. Relata-se um caso de paciente com pólipo traqueal com evolução de três anos e espirometria evidenciando padrão de obstrução intratorácica variável, que evoluiu com melhora clínica e funcional completa após ressecção por via broncoscópica.

Benign tracheal tumors are rare, recurrent papillomatosis being the most common. They often simulate obstructive pulmonary diseases, such as asthma and chronic obstructive pulmonary disease, and patients with benign tracheal tumors often undergo long-term treatment for such diseases, without any improvement, Therefore, these tumors should be included in the differential diagnosis in patients presenting tracheobronchial tree obstruction. This report describes the case of a patient with a tracheal polyp. The patient presented symptoms for three years, and the spirometry findings suggested intrathoracic obstruction. The patient presented complete clinical and spirometric recovery after bronchoscopic resection of the tumor.

Tumores de tráquea: un caso de carcinoma adenoideo quístico / Tracheal tumors: a case of adenoidal cystic carcinoma

Los tumores de la tráquea son poco frecuentes y entre ellos el carcinoma adenoideo quístico es una neoplasia muy rara. La incidencia no difiere según el sexo y es más frecuente entre la tercera y quinta décadas de la vida. El tratamiento de elección es el quirúrgico, siempre que se trate de tumores resecables. Con este trabajo presentamos un caso intervenido por un tumor traqueal infrecuente, en una mujer con un carcinoma adenoideo quístico del tercio superior de la tráquea, con bordes de sección libres de tumor, que no recibió tratamiento oncológico(AU)

The tumors of the windpipe are not very frequent and among them the cystic adenoid carcinoma is a very strange neoplasia. The incidence doesn't differ according to the sex and it is more frequent between the third and fifth decades of the life. The election treatment is the surgical one, whenever it is tumors resecables. With this work we present a case intervened by an uncommon tracheal tumor, in a woman with a cystic adenoid carcinoma of the superior third of the windpipe, with section borders free of tumor that didn't receive treatment oncológico(AU)

Primary malignant tumors of the trachea: the Tata Memorial Hospital expeience

Primary tumors of the trachea are extremely rare. Treatment methods vary considerably and few studies have sought to provide adequate guidelines. This study reviews the records of patients treated for tracheal cancer at the Tata Memorial Hospital [TMH], Mumbai, India. Subjects and Fifteen patients with primary tracheal malignancies were identified in the TMH database during the period from 1983 to 2000. They were predominantly males [87%] belonging to an older age-group [67% above 40 years]. Common presenting symptoms were cough, hoarseness, hemoptysis and indications of airway obstruction. Squamous cell carcinoma was the commonest histologic subtype [40%] followed by adenoid cystic carcinoma [27%]. Ten patients received radical treatment. One patient underwent surgery [resection and anastomosis] and received postoperative radiotherapy. Another was explored but was found to be unresectable and was 1 of 2 patients treated with chemotherapy and radiotherapy. Laser resections and radiotherapy were used in 2 patients while 4 patients were managed with radiotherapy alone. One patient was treated elsewhere. The majority of patients [8/9] were treated with locoregional fields and doses ranging from 40 to 60 Gy [median 50 Gy]. Two patients also received intraluminal brachytherapy, 1 as part of initial treatment and another for recurrence. Only 5 patients treated at TMH [5/9] achieved local control of their disease. Follow-up times ranged from 1 month to 134 months, median of 38 months. Distant metastases were identified in 4 patients [bone n = 1 and lung n = 3]. Median survival was 38 months. Overall survival at 5 years was 37% by Kaplan-Meier method, but this figure should be treated with caution since only 6 patients had a follow-up of more than 2 years. Tracheal cancer is a rare malignancy. Radiation therapy is a reasonably effective modality for unresectable disease

Tumores primarios malignos de tráquea y bronquios principales / Malignant primary tumors of the trachea and primary bronchi

Los tumores de la tráquea y los bronquios principales son raros, por lo que no existe experiencia importante en el tratamiento de éstos. Los tipos histológicos más frecuentes son el carcinoma adenoideo quístico y el carcinoma de células escamosas. En nuestro caso estos tipos histológicos se presentaron en 2 pacientes respectivamente. El carcinoma mucoepidermoide fue el diagnóstico en otros 2 enfermos y el leiomiosarcoma de tráquea en un caso. La resección quirúrgica fue el tratamiento de elección con resección de carina en 3 enfermos, neumonectomía en 1 y resección de tráquea cervical en 3. La radioterapia adyuvante se utilizó en los cilindromas, los carcinomas de células escamosas y los tumores mucoepidermoides. Solo 1 de 7 pacientes mostró complicaciones y no hubo mortalidad posoperatoria. La mayor supervivencia ha sido de 172 meses en el caso del leiomiosarcoma. Una enferma con un cilindroma falleció a los 74 meses de operada y los 2 enfermos con tumores epidermoides de bronquio principal fallecieron 13 y 15 meses después de su operación, todos por enfermedad metastásica(AU)

As the trachea and primary bronchus tumors are rare, there is no an important experience in their treatment. The most frequent histological types are the adenoid cystic carcinoma and the squamous cell carcinoma. In our case, these histological cases were observed in 2 patients, respectively. The mucoepidermoid carcinoma was diagnosed in 2 other patients and the tracheal leiomyosarcoma in one case. Surgical resection was the election treatment with carina resection, in 3 patients; pneumonectomy, in 1; and cervical trachea resection, in 3. Adjuvant radiotherapy was used in cylindromas, squamous cell carcinomas and mucoepidermoid tumors. Only 1 of 7 patients had complications. There was no postoperative mortality. The highest survival has been of 172 months in the leiomyosarcoma. A female patient with a cylindroma died 74 months after the operation, whereas the 2 patients with epidermoid tumors of primary bronchus died on the13th and 15th months. All of them died due to metastatic disease(AU)

Schwannoma benigno do mediastino posterior com desenvolvimento em ampulheta para a traquéia / Benign schwannoma of the posterior mediastinum with a dumbbell-shaped lesion traversing the trachea

O schwannoma benigno é um dos tumores mais comuns do mediastino posterior, sendo que durante o seu crescimento pode haver envolvimento do canal medular em forma de ampulheta e, mais raramente, isso pode ocorrer na árvore traqueobrônquica. É relatado um caso de uma mulher de 45 anos, portadora de schwannoma benigno de mediastino posterior, com padrão de desenvolvimento em ampulheta para a parede póstero-lateral direita da traquéia. O tratamento foi realizado por meio da ressecção endoscópica da porção intratraqueal e a tumoração mediastinal foi ressecada por toracotomia. Oito meses após o procedimento não foi evidenciada recidiva da lesão

Abordaje del carcinoma de tiroides invasivo a traqueolaringe y grandes vasos / Surgical approach to carcinoma of the thyroid invasive to upper airways and major vessels

El cancer de tiroides que invade localmente el componente aerodigestivo o vascular tiene una incidencia relativamente baja, usualmente sin sintomas preoperatorios que sugieran el grado de su extension. Se requiere una alta sospecha clinica para establecer el diagnostico preoperatorio, asi como el conocimiento de las modalidades terapeuticas ante su hallazgo intra-operatorio, con el ánimo de realizar el esquema terapeutico optimo para cada circunstancia, con bajas tazas de morbilidad, mortalidad y recurrencia. Se informa un estudio retrospectivo realizado en el Hospital de Caldas en los pacientes con cancer tiroideo invasivo a laringotráquea y grandes vasos manejados por el grupo de Cirugia de Cabeza y Cuello entre agosto de 1994 y junio de 2000. Se analizo sintomatologia previa asociada, el abordaje diagnostico, el esquema terapeutico aplicado segun el grado de invasion, la recidiva local regional y a distancia, la morbilidad y la mortalidad. Se proponen algunas recomendaciones para cada caso.

Neurofibromatosis: reporte de un caso no habitual / Neurofibromatosis: report a case non usual

Presentamos un caso de Neurofibromatosis tipo 1 caracterizadas por lesiones dérmicas diseminadas como manchas parduzcas (cafe-au-lait), y neurofibroma a nivel cervical, que comprometio las raíces de los nervios espinales y ejercició presión sobre las estructuras contiguas y extensión hacia los agujeros intervertebrales. El diagnóstico, además de la clínica, se obtuvo a través de la Resonancia Magnética Nuclear. Se describe este caso por la poca frecuencia de comprensión radicular por neurofibroma

Tracheal tumour presenting as asthma

A case is reported in which a tracheal tumour presented with symptoms suggestive of bronchial asthma instead of stridor. In the assessment and management of airways obstructions and wheeze, it is important to bear in mind that disease other than asthma and chronic bronchitis may present in this way

Resección de lesiones traqueobronquiales con broncoscopia láser Nd: YAG / Resection of tracheobronchial lesions with bronchoscopic laser Nd: YAG a preliminary study

Existen numerosas causas mecánicas de obstrucción de la vía aérea; pueden ser benignas o malignas y, dependiendo del grado de obstrucción consecutivo a su crecimiento, pueden comprometer de manera grave la función ventilatoria, motivo por el que el diagnóstico y el tratamiento oportuno pueden prevenir, mejorar e incluso curar esta alteración al eliminar el proceso obstructivo de las vías aéreas superiores o inferiores. Este trabajo se refiere a procesos obstructivos laringotraqueobronquiales. Las lesiones benignas son postraumáticas, infecciosas y algunas neogormaciones de origen indeterminado. Las lesiones malignas pueden ser primarias o secundarias (metastásicas). El láser permite la conversión de energía lumínica en calor, que vaporiza o coagula los tejidos dependiendo de la potencia aplicada y la duración del tratamiento. El láser Nd:YAG es el que más frecuentemente se usa para endoscopia, ya que puede penetrar tejidos anormales, causando su coagulación al aplicarse por medio de un sistema de transmisión de cuarzo a través del endoscopio rígido o de fibra óptica. La resección con broncoscopia láser Nd:YAG ofrece una alternativa útil en el tratamiento paliativo, curativo o adyuvante de algunas lesiones que producen obstrucción de la vía aérea. Se evaluaron en forma consecutiva los resultados de los primeros 61 procedimientos de resección con broncoscopia láser Nd:YAG del departamento de endoscopia torácica de la Unidad de Neumología del Hospital General de México desde abril de 1995 hasta marzo de 1997. Se incluyó a 56 pacientes a quienes se practicó resección con broncoscopia láser ND:YAG, 34 resecciones de lesiones benignas y 27 de lesiones malignas. Los resultados inmediatos se consideraron como satisfactorios en 95 por ciento y no satisfactorios en 5 por ciento de los casos, Se evaluaron todos los pacientes con broncoscopia el mes, a los tres meses y a los seis meses, condiserándolos como satisfactorios en 90 por ciento e insatisfactorios en 10 por ciento de los casos

Tumor carcinoide da traqueia / Tracheal carcinoid tumor

Relatam um caso raro de carcinoide traquel, abordando o seu diagnostico e o tratamento. O Carcinoide da Traqueia e o terceiro tumor mais comum no orgao, representando 85//dos casos de Adenoma. Embora seja classificadocomo tumor benigno, apresenta, sem sombra de duvida, um baixo grau de malignidade com evidencias histologicas da invasao direta de estruturas contiguas, alem da possibilidade de metastases ganglionares no carcinoide atipico. Nos tumores malignos quase sempre associa-se a dioterapia pos-operatoria a resseccao cirurgica

Nd: YAG laser bronchoscopy; the first two successful cases in Puerto Rico

Two patients underwent bronchoscopic laser photoresection of tumors in the tracheobronchial tree with no mortality or significant morbidity. One patient had an adenoid cystic carcinoma of the trachea and the other a pleomorphic adenoma of left main stem bronchus. These were the first two cases performerd in Puerto Rico at San Pablo Medical Center. Both patients are symptomless at this time. We can conclude that laser is a safe and cost effective altenative in experienced hands to other procedures in properly selected patients with tumors of tracheobronchial tree in Puerto Rico

Lasers in pulmonology.

Lasers have multiple applications in pulmonary medicine. The Nd: Yag laser is at present widely accepted for the management of respiratory problems. The major indications are central tracheobronchial obstruction due to neoplasms, uncontrolled haemorrhage from malignant lesions and tracheal stenosis. Its role is entirely palliative and only occasionally curative. Two main complications are perforation and bleeding. The basic concepts, techniques and use in various respiratory problems are discussed.

Tratamiento quirúrgico endoscópico con laser en broncología: fotocoagulación / Endoscopic surgical treatment with laser in bronchology: photocoagulation

Se presenta la experiencia inicial en la aplicación de resección endoscópica con YAG láser. Los tratamientos fueron efectuados con broncoscopio rígido y flexible, con anestésia local o general con ventilación espontánea. Se trataron 5 enfermos con cancer, 1 con tumor benigno y 1 con granuloma inflamatorio. No hubo complicaciones ni siquiera en aquellos cuya condición clínica era crítica. La fotocoagulación endoscópica con láser es un procedimiento paliativo de trascedental importancia en portadores de cáncer de pulmón no quirúrgico, a los que se les da una sobrevida confortable, es curativo en los tumores benignos y granulomas traqueobronquiales.