Vascular Neonatal Thymus Transplantation in Rabbits.

BACKGROUND: Successful vascular adult thymus transplant has been reported in different animal models but not in rabbits. These animal models are slightly larger than the murine and substantially smaller than the porcine. We describe in rabbits a supermicrosurgical technique for vascular neonatal thymus transplant and provide histologic evidence of tissue viability. METHODS: Newborn (New Zealand, n = 12, 6 female) and adult (New Zealand, n = 12, 6 female) rabbits were used as donors and recipients, respectively. Whole thymuses were extracted from donors and grafted into recipients. Immediate direct vascularization was accomplished by anastomosis to the right common carotid artery and the right external vena cava. At day 14, graft sites were surgically explored, and grafted thymuses were explanted for histologic evaluation. All recipients were followed over 2 weeks for clinical signs of graft-vs-host reaction. RESULTS: The vascular pedicles of the thymus grafts ranged 0.5 to 0.8 mm in vessel diameter. From the 12 transplants, 3 recipients (3/12; 25%) died during the surgical procedure because of blood loss after clamp release. On histology, from the 9 (9/12; 75%) successful at revascularization, none (0/9; 0%) had signs of acute rejection or necrosis, and all (9/9; 100%) evidenced normal cytoarchitecture. No clinical signs of graft-vs-host reaction were evidenced during follow-up. CONCLUSIONS: Vascular neonatal thymus transplant in rabbits is surgically feasible. This technique will enable a novel approach for studying the biology of the thymus.

Transnasal Humidified Rapid Insufflation Ventilatory Exchange in Laryngotracheal Resection and Reconstruction: A Report of Two Pregnant Cases.

Introduction: The incidence of tracheal stenosis is progressively increasing. A risk factor for developing this clinical condition is a history of prolonged endotracheal intubation. A transnasal humidified rapid insufflation ventilatory exchange, known as THRIVE, has gained importance in tracheal resection surgeries. Case Presentation: Herein, we describe the anesthetic management of two obstetric patients, a 19-year-old and 29-year-old, with a history of prolonged endotracheal intubation and a diagnosis of tracheal stenosis. The patients required the resection of the tracheal segment and end-to-end anastomosis. The anesthetic management focused on THRIVE using a high-flow nasal cannula. Conclusions: This system proved to be a safe anesthetic technique for pregnant women and the fetus. Furthermore, it allowed surgeons to better visualize the surgical field without the risk of accidental injury to the endotracheal tube.

Pseudotumor inflamatorio de laringe y traquea / Inflammatory Pseudotumor of Larynx and Trachea

El pseudotumor inflamatorio de laringe y tráquea es una entidad benigna, muy poco frecuente; de etiología desconocida, que en algunos casos puede llevar a insuficiencia respiratoria aguda. Se presenta principalmente en la población joven. Presentamos el caso de un joven de 16 años, con diagnóstico de tumor miofibroblástico de laringe y tráquea, con compromiso extenso y comportamiento agresivo, no respuesta al tratamiento, por lo que requirió trasplante laringotraqueal, ante inminente obstrucción de la vía aérea. En esta patología, la resección quirúrgica completa es la mejor opción de tratamiento; sin embargo se acompaña de alta morbilidad. Los corticosteroides no han mostrado buena respuesta en la vía aérea superior y la radioterapia tiene un efecto lento.

Pseudotumor inflammatory of larynx and trachea is an uncommon benign entity. The etiology is unknown and sometimes can cause severe respiratory distress. It is primarily seen in younger generation A case of intratracheal inflammatory pseudotumor of larynx and trachea in a 16 year- old boy is presented with extensive aggressive behavior, and non answer to the treatment, reason why he requiredlaryngotracheal transplantation before imminent obstruction of the airway. Complete surgical resection is the best treatment option, however, it represent a high level morbidity. Corticosteroids has been used, but in the central upper airways the effect was not favorable, and radiotherapy has a slow effect.