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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(12): 1064-1070, 2021 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-34915619

RESUMO

Objective: To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. Methods: A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.1%), including 21 cases (72.4%) of tracheal stenosis after tracheotomy, 6 cases (20.7%) of tracheal stenosis after tracheal intubation], cervical post-traumatic tracheal stenosis (1 case, 3.4%) and tuberculous tracheal stenosis (1 case, 3.4%), respectively. Three-dimensional reconstruction of tracheal computerized tomography (CT) and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention. The degree of stenosis was Cotton-Myer grade Ⅱ (7 cases, 24.1%), grade Ⅲ (11 cases, 37.9%) and grade Ⅳ (11 cases, 37.9%), respectively. All cases received placement of T-tubes and follow-up. Fisher's exact test was used for comparison between groups. Results: T-tube placement was performed 39 times in 29 patients. T-tubes were successfully placed for 24 cases (82.8%). The main complication during the operation was tracheal mucosal tear (6 cases, 20.7%), which resolved in all cases within 2 weeks. The main postoperative complication was secretion retention (27 cases, 93.1%), which was relieved after home nebulization treatment in 26 cases; and followed by granulation hyperplasia, especially located in T-tube upper margin (12 cases, 41.4%), of which 8 cases were cured after bronchoscopic intervention. None of the patients had T-tube migration. There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis. After 18 months to 24 months of follow-up, attempt was made to remove the T-tube in 9 patients but failed in 4 patients. The failure was due to collapse of the airway after the T-tube was removed. Conclusion: T-tube placement is a safe and reliable treatment for benign complex subglottic tracheal stenosis with high efficiency and manageable complications.


Assuntos
Estenose Traqueal , Humanos , Intubação Intratraqueal/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Traqueia , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia
2.
J Card Surg ; 36(12): 4597-4603, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34647349

RESUMO

BACKGROUND AND AIM OF THE STUDY: Long-term laryngotracheal complications have not been described in adult patients undergoing cardiac surgery. The purpose of this study was to determine the incidence of and risk factors for laryngotracheal complications following cardiac surgery. METHODS: A retrospective chart review of patients at high risk for laryngotracheal complications following cardiac surgery between 2006 and 2016 was performed. High-risk patients were reviewed to determine the presence of laryngotracheal complications including laryngotracheal stenosis, keyhole deformity, or vocal cord immobility. Logistic regression was used to identify predictors of long-term laryngotracheal complications. RESULTS: Of 11,417 patients who underwent cardiac surgery, 1099 were identified as at high risk. Of these, 24 (2.2%) developed laryngotracheal complications following their surgery and intensive care unit (ICU) stay. Laryngotracheal stenosis and keyhole deformity were present in 13 (1.2%) and 6 (0.5%) patients, respectively. Logistic regression demonstrated older age (age ≥ 70 odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.83) was protective, while readmission to ICU for ventilation (OR 3.11, 95% CI 1.17-8.25) and receiving a tracheostomy (OR 7.83, 95% CI 2.22-27.6) were associated with laryngotracheal complications. CONCLUSIONS: The incidence of long-term laryngotracheal complications following cardiac surgery was 2.2%. Readmission to ICU for ventilation and having a tracheostomy performed were associated with laryngotracheal complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Laringoestenose , Estenose Traqueal , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Laringoestenose/epidemiologia , Laringoestenose/etiologia , Laringoestenose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Estenose Traqueal/epidemiologia , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos
3.
Int J Pediatr Otorhinolaryngol ; 150: 110939, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34673420

RESUMO

OBJECTIVE: Aortopexy including innominate artery suspension is a well-established treatment of anterior vascular compression and associated tracheomalacia. We report the results of our case series of cervical approach to innominate artery suspension and hypothesize that increased distance from the innominate to the sternum is predictive of superior symptomatic outcome. STUDY DESIGN: Retrospective Case Series. METHODS: All cases of cervical innominate artery suspension at our institution over the last 10 years were reviewed. CT scans of the neck and chest were reviewed to obtain anatomical measurements including anterior-posterior thoracic outlet distance, thymic thickness, and sternum-innominate artery distance. Measurements were compared with surgical outcomes as verified by follow up bronchoscopy and clinical course to determine factors predictive of success. RESULTS: Ten cases of cervical innominate artery suspension were performed by the otolaryngology service at our institution over the last 10 years. Six patients had improvement in their symptoms. The average sternum-innominate artery distance (SID) was larger (14.4 mm (95% CI 9.1-19.7)) in patients who had improvement in clinical symptoms following innominate suspension compared to those that did not improve (6.3 mm (95% CI 2.5-10.1)) (p value = 0.02). Similarly, the anterior-posterior distance of the thoracic outlet was larger (34.9 mm (95% CI 27.4-42.4)) in patients who had improvement post-op compared to those that did not improve (22.6 mm (95% CI 18.2-27.2) (p value = 0.01). Two patients required spine surgery to achieve improvement in their symptoms. CONCLUSION: Cervical innominate artery suspension is successful in carefully selected patients. More space in the thoracic outlet and larger distance from the innominate artery to the sternum is associated with symptomatic improvement.


Assuntos
Estenose Traqueal , Traqueomalácia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Broncoscopia , Humanos , Estudos Retrospectivos
5.
In Vivo ; 35(6): 3175-3180, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697148

RESUMO

BACKGROUND/AIM: Tracheal stenosis can cause respiratory problems in mature, small-breed dogs. This study aimed to evaluate the placement of an intratracheal titanium alloy stent to prevent tracheal stenosis in canine tracheal anastomosis. MATERIALS AND METHODS: The self-expandable intratracheal stent was an alloy of nickel and titanium, at the same atomic ratio. Vital signs and respiratory patterns, C-reactive protein, radiography, computed tomography, and endoscopy results after intraluminal stenting were assessed for 3-5 months. RESULTS: No dogs showed evidence of intraluminal tracheal stenosis or tracheitis in the region of stent insertion on tracheoscopy and computed tomography after tracheal stent placement. After 1-2 weeks of tracheal stent placement, all dogs resolved coughing and dyspnea signs and resumed normal activities. CONCLUSION: The intratracheal stent showed no movement or deformation in the trachea, and had flexibility and an appropriate radial force. Therefore, titanium alloy tracheal stents are useful in stenotic operations for tracheal reconstruction.


Assuntos
Estenose Traqueal , Ligas , Anastomose Cirúrgica , Animais , Cães , Stents , Titânio , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Estenose Traqueal/etiologia , Estenose Traqueal/prevenção & controle , Estenose Traqueal/cirurgia
6.
Vestn Otorinolaringol ; 86(4): 36-40, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499445

RESUMO

The relevance of the study is due to the need to improve the methods of managing patients after reconstructive surgery on the larynx and trachea. OBJECTIVES: To optimize the management of wounds after tracheostomy and/or reconstuctive operations on larynx and trachea on the basis of use of modern dressings in the inpatient and outpatient settings. MATERIAL AND METHODS: The patients were divided into two: group I tracheostomy after reconstructive operations on the larynx and trachea. The postoperative area was ligated with drugs based on sodium alginate. Tracheostomy of group II patients was carried out according to the standard technique. RESULTS: In the first group of patients, postoperative wounds healed by primary intention on the 5-6th day after the operation in patients with bilateral paralysis of the larynx and on the 8-10th day in patients with chronic cicatricial stenosis of the larynx and trachea. In group II, postoperative wounds in the tracheostomy foramen area healed on day 7 in patients with bilateral paralysis of the larynx and on days 10-14 in patients with chronic cicatricial stenosis of the larynx and trachea. CONCLUSIONS: The Proposed algorithm for the management of patients after reconstructive operations on the larynx and trachea, of tracheostomy have improved clinical outcomes after surgery and to reduce the economic costs for this group of patients.


Assuntos
Laringe , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Humanos , Laringe/cirurgia , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos
7.
Gen Thorac Cardiovasc Surg ; 69(12): 1589-1592, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34581947

RESUMO

Blunt tracheal injury is a rare but life-threatening condition. Several indications for treatment have been reported. Conservative treatment (i.e., stenting) can be performed when the patient is clinically stable or has medical contraindications to surgical treatment. Although some studies have reported the use of tracheal stents as treatment for iatrogenic injury and blunt trauma, the efficacy of these stents is unknown. Herein, we report a case of emergency tracheoplasty for the management of tracheal stent prolapse in a patient with blunt tracheobronchial trauma. This report highlights the necessity of being cautious about the migration and prolapse of tracheal stents, which can more frequently occur in blunt trauma than in malignant stenosis or iatrogenic injury. Due to the limitations of non-surgical treatments, early surgical intervention may be lifesaving.


Assuntos
Estenose Traqueal , Ferimentos não Penetrantes , Humanos , Prolapso , Stents , Traqueia/diagnóstico por imagem , Traqueia/lesões , Traqueia/cirurgia , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
8.
PLoS One ; 16(9): e0256127, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34587174

RESUMO

Tracheal stenosis is a refractory and recurrent disease induced by excessive cell proliferation within the restricted tracheal space. We investigated the role of extracellular signal-regulated kinase (ERK), which mediates a broad range of intracellular signal transduction processes in tracheal stenosis and the therapeutic effect of the MEK inhibitor which is the upstream kinase of ERK. We histologically analyzed cauterized tracheas to evaluate stenosis using a tracheal stenosis mouse model. Using Western blot, we analyzed the phosphorylation rate of ERK1/2 after cauterization with or without MEK inhibitor. MEK inhibitor was intraperitoneally injected 30 min prior to cauterization (single treatment) or 30 min prior to and 24, 48, 72, and 96 hours after cauterization (daily treatment). We compared the stenosis of non-inhibitor treatment, single treatment, and daily treatment group. We successfully established a novel mouse model of tracheal stenosis. The cauterized trachea increased the rate of stenosis compared with the normal control trachea. The phosphorylation rate of ERK1 and ERK2 was significantly increased at 5 min after the cauterization compared with the normal controls. After 5 min, the rates decreased over time. The daily treatment group had suppressed stenosis compared with the non-inhibitor treatment group. p-ERK1/2 activation after cauterization could play an important role in the tracheal wound healing process. Consecutive inhibition of ERK phosphorylation is a potentially useful therapeutic strategy for tracheal stenosis.


Assuntos
Aminoacetonitrila/análogos & derivados , Modelos Animais de Doenças , MAP Quinases Reguladas por Sinal Extracelular/antagonistas & inibidores , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Inibidores de Proteases/farmacologia , Estenose Traqueal/tratamento farmacológico , Aminoacetonitrila/farmacologia , Animais , Proliferação de Células , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fosforilação , Transdução de Sinais , Estenose Traqueal/enzimologia , Estenose Traqueal/patologia
10.
J Laryngol Otol ; 135(10): 897-903, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34384506

RESUMO

OBJECTIVE: This study aimed to compare treatment outcomes in patients with laryngeal and tracheal stenosis treated during and prior to the coronavirus disease 2019 pandemic period. METHOD: Patients treated for laryngotracheal lesions with impending airway compromise during the active pandemic period were matched with those treated for similar lesions in the preceding years in a monocentric tertiary hospital setting. RESULTS: During the pandemic period of 55 days, 31 patients underwent 47 procedures. Seven patients (2 children, 5 adults) had open airway surgery, and one had an operation-specific complication. Twenty-four patients (10 children, 14 adults) underwent 40 endoscopic interventions without any complications. Operation specific results during and prior to the pandemic were comparable. CONCLUSION: The management strategy in patients with laryngotracheal lesions and impending airway compromise should not be altered during periods of risk from coronavirus disease 2019. Avoiding a tracheostomy by performing primary corrective surgery or proceeding with a definitive decannulation would be beneficial in these patients to reduce the risk of contagion.


Assuntos
COVID-19/transmissão , Endoscopia/estatística & dados numéricos , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Adulto , Idoso , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Cateterismo/efeitos adversos , Pré-Escolar , Tomada de Decisão Clínica/ética , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , SARS-CoV-2/genética , Centros de Atenção Terciária/estatística & dados numéricos , Traqueostomia/efeitos adversos , Resultado do Tratamento
11.
Pediatr Surg Int ; 37(12): 1737-1741, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34453197

RESUMO

PURPOSE: The factors related to infectious complications after tracheoplasty for congenital tracheal stenosis (CTS) remain unclear; we, therefore, assessed these factors in this study. METHODS: We divided 47 patients who underwent slide tracheostomy and tracheal resection for CTS between May 2016 and December 2020 into an infected group and a non-infected group. Their characteristics were compared between groups. Results are presented as the median (range) or incidence. RESULTS: Infectious complications were observed in 12 patients (25.5%). Empyema and mediastinitis were seen in 5 cases (10.6%). There was a significant difference in the following factors in the infected and non-infected groups, respectively: weight, 5457 (2868-20,750) g and 6554 (2275-20,800) g (p = 0.025); surgical time, 575.5 (313-646) min and 349 (270-651) min (p < 0.001); extracorporeal circulation time, 303.5 (186-610) min and 216 (117-478) min (p = 0.001); and postoperative intubation time, 13 (7-28) days, and 6 (5-22) days (p < 0.001). Age, malnutrition, cardiovascular comorbidities, and preoperative methicillin-resistant Staphylococcus aureus detection were not significantly different between the two groups. CONCLUSION: There were a few serious infectious complications and no perioperative deaths. Attention should be paid to low body weight, long surgical and extracorporeal circulation time, and intubation time in relation to infectious complications.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Complicações Pós-Operatórias/microbiologia , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Constrição Patológica , Humanos , Lactente , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Traqueia/anormalidades , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Resultado do Tratamento
12.
Mol Med Rep ; 23(5)2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34240225

RESUMO

Tracheal stenosis following injury cannot be effectively treated. The current study compared the protective effects of different anti­inflammatory drugs on tracheal stenosis and investigated their possible mechanisms. Rabbit tracheal stenosis models following injury were constructed and confirmed using hematoxylin and eosin (H&E) staining. A total of 30 rabbits were divided into the control (CON), penicillin (PEN), erythromycin (ERY), budesonide (BUD) and PEN + ERY + BUD groups (n=6). Stenotic tracheal tissue, serum and bronchoalveolar lavage fluid (BALF) were collected 10 days after continuous treatment. Pathological changes in the tracheas were observed by H&E staining. Histone deacetylase 2 (HDAC2) expression in tracheal tissues was detected by immunofluorescence. Immunohistochemistry was performed to detect collagen I (Col­I) and collagen III (Col­III) levels in tracheal tissues. Transforming growth factor ß1 (TGF­ß1), vascular endothelial growth factor (VEGF) and interleukin 8 (IL­8) levels in serum and BALF samples were determined using ELISA kits. Western blotting detected HDAC2, IL­8, TGF­ß1 and VEGF levels in tracheal tissues. H&E staining demonstrated that tracheal epithelial hyperplasia and fibroblast proliferation in the ERY and PEN + ERY + BUD groups markedly improved compared with the CON group. Furthermore, in tracheal tissues, HDAC2 expression was significantly increased and IL­8, TGF­ß1, VEGF, Col­I and Col­III levels were significantly decreased in the ERY and PEN + ERY + BUD groups compared with the CON group. Additionally, the results for the PEN + ERY + BUD were more significant compared with the ERY group. In serum and BALF samples, IL­8, TGF­ß1 and VEGF levels in the ERY and PEN + ERY + BUD groups were significantly lower compared with the CON group, with the results of the PEN + ERY + BUD group being more significant compared with the ERY group. There were no significant differences between the PEN, BUD and CON groups. ERY inhibited tracheal granulation tissue proliferation and improved tracheal stenosis following injury and synergistic effects with PEN and BUD further enhanced these protective effects. The mechanism may involve HDAC2 upregulation and inhibition of local airway and systemic inflammatory responses.


Assuntos
Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Eritromicina/uso terapêutico , Penicilinas/uso terapêutico , Substâncias Protetoras/uso terapêutico , Estenose Traqueal/metabolismo , Estenose Traqueal/prevenção & controle , Animais , Anti-Inflamatórios/farmacologia , Líquido da Lavagem Broncoalveolar/química , Budesonida/farmacologia , Colágeno/metabolismo , Modelos Animais de Doenças , Eritromicina/farmacologia , Tecido de Granulação/efeitos dos fármacos , Histona Desacetilase 2/genética , Histona Desacetilase 2/metabolismo , Hiperplasia/tratamento farmacológico , Hiperplasia/metabolismo , Interleucina-8/sangue , Interleucina-8/metabolismo , Penicilinas/farmacologia , Substâncias Protetoras/farmacologia , Coelhos , Traqueia/lesões , Traqueia/patologia , Estenose Traqueal/etiologia , Estenose Traqueal/patologia , Fator de Crescimento Transformador beta1/sangue , Fator de Crescimento Transformador beta1/metabolismo , Regulação para Cima/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/sangue , Fator A de Crescimento do Endotélio Vascular/metabolismo
14.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 35(6): 501-504;510, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34304507

RESUMO

Objective:To investigate the relevant influencing factors for perioperative airway events of infantile subglottic hemangioma, and to further discuss the strategies of perioperative airway management. Methods:A total of 36 infants with subglottic hemangioma that had no response to the drug therapy and underwent surgical treatment from July 2007 to April 2017 were enrolled. The relevant influencing factors, including gender, age, birth weight, age of onset, degree of tracheal stenosis and histories of underlying diseases(congenital heart disease and respiratory disease), were also recorded simultaneously. Intraoperative SpO2 decline, intraoperative emergency tracheal intubation, intraoperative emergency tracheotomy, whether preserving tracheal intubation after operation or not, and postoperative emergency tracheal intubation were included in the perioperative airway events of infantile subglottic hemangioma. The relevant influencing factors of perioperative airway events were analyzed so that meaningful statistical indicators were selected for grouped logistic regression analysis, and the correlation was evaluated based on OR value and 95% confidence interval(CI). Based on the correlation between influencing factors and airway events, perioperative airway management was discussed. Results:①The degree of tracheal stenosis was a risk factor for SpO2 decline(95%CI[2.121-33.818]); ②The degree of airway stenosis, history of comorbid cardiovascular disease and respiratory disease were the influencing factors for intraoperative emergency tracheal intubation(95%CI[0.863-21.692], [0-+∞] and [1.741-232.403], respectively); ③The degree of airway stenosis was the influencing factor for postoperative emergency tracheal intubation(95%CI[1.277-20.421]); ④The degree of airway stenosis was a risk factor for whether preserving postoperative tracheal intubation or not(95%CI[1.523-13.296]). Conclusion:①Infants with a history of preoperative underlying diseases are more likely to present with intraoperative airway instability and SpO2 decline, which deserves more preoperative and postoperative attention. Tracheal intubation should be performed timely in case of intraoperative SpO2 decline. ②Preoperative tracheotomy should be performed in infants with preoperative grade Ⅲ airway stenosis, especially those with comorbid heart diseases or respiratory diseases. ③The degree of airway stenosis is an extremely important influencing factor for perioperative airway management of infantile subglottic hemangioma. For infants whose airway stenosis were greater than 60% of airway diameter, the airway maintenance should be closely monitored. Once SpO2 decreases, tracheal intubation should be performed immediately. It's recommended to preserve tracheal intubation so as to ensure the airway stability. The tracheal intubation could be prolonged to 48-72 hours postoperatively. ④The surgical approach has no significant effect on perioperative airway management.


Assuntos
Hemangioma , Estenose Traqueal , Manuseio das Vias Aéreas , Hemangioma/cirurgia , Humanos , Lactente , Intubação Intratraqueal , Estudos Retrospectivos
15.
Forensic Sci Med Pathol ; 17(3): 481-485, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34263414

RESUMO

Delayed subglottic stenosis (SGS) is an unusual complication. Here, we report a particular case of delayed SGS. A 17-year-old female suffered extensive injuries including severe neck trauma in a car accident, and complained of dyspnea after 30 days. Tracheal stenosis was observed by fiber optic bronchoscopy, but no specific treatment was administered to the patient. While being transferred to a tertiary hospital 3 days later, the patient fell into deep coma due to hypoxia, and died of hypoxic-ischemic encephalopathy and severe pulmonary infection in the intensive care unit (ICU) 58 days later. Postmortem autopsy and pathological investigation revealed tracheal stenosis 3.0 cm below the vocal cords with a diameter of 0.5 cm, which was caused by a cricoid cartilage fracture, fibrous tissue proliferation and inflammatory cell infiltration. We believed that external forces caused the cricoid fracture and mucosal damage, and after a month of fibrous repair, scar tissue formed the stenosis and caused her death. This report describes a rare condition in which slowly progressive intralaryngeal stenosis formation after external neck trauma could cause asphyxial death in a previously asymptomatic adult.


Assuntos
Laringoestenose , Estenose Traqueal , Adolescente , Asfixia/etiologia , Constrição Patológica , Cartilagem Cricoide , Feminino , Humanos , Laringoestenose/etiologia , Estenose Traqueal/etiologia
16.
Colloids Surf B Biointerfaces ; 206: 111949, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34216848

RESUMO

Antibacterial and antihyperplasia airway stents are highly desirable for tracheal stenosis. Herein, a series of polylactic acid (PLA) and silver nanoparticles (AgNPs) nanofiber membranes (PLA, PLA-4 %AgNPs and PLA-6 % AgNPs) were prepared by electrospinning. The physicochemical and biological properties of the resultant nanofiber membranes were examined. The SEM and drug release results indicated that the AgNPs were successfully introduced into PLA, and could be sustained to be released from membranes. The membranes showed antibacterial activity against S. aureus and P. aeruginosa, and cytocompatibility towards CCC-HPF-1 and NHBE cells. Furthermore, the membranes were used to cover a self-expandable metallic stent for use in the treatment of rabbit tracheal stenosis. The in vivo results revealed that the membranes, especially the AgNPs-coated airway stent could suppress tracheal stenosis by reducing inflammation and collagen deposition. Additionally, the study further confirmed that the inhibition of bacterial content in the trachea could be positively correlated with the reduction in tracheal granulation tissue hyperplasia. Conclusively, the PLA/AgNPs nanofiber membrane-coated airway stent has practical value for patients with clinical tracheal stenosis.


Assuntos
Nanopartículas Metálicas , Nanofibras , Estenose Traqueal , Animais , Antibacterianos/farmacologia , Humanos , Poliésteres , Coelhos , Prata , Staphylococcus aureus , Stents
17.
J Cardiothorac Surg ; 16(1): 176, 2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34147095

RESUMO

BACKGROUND: Oesophageal atresia is a congenital malformation of the oesophagus and a serious malformation of the digestive system, postoperative complications include acute respiratory failure, pneumonia, anastomotic fistula, anastomotic stenosis, tracheal stenosis, gastroesophageal reflux and eosinophilic oesophagitis, anastomotic fistula is one of the important causes of postoperative death. The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia. METHODS: A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2013 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis. RESULTS: A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F = 4.199, P = 0.043), low birth weight (F = 7.668, P = 0.007) and long gap defects (F = 6.107, P = 0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2 = 4.499, P = 0.034, OR = 2.775) and long gap defects (Wald2 = 6.769, P = 0.009, OR = 4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F = 5.338, P = 0.023), anastomotic fistula (F = 11.381, P = 0.001), endoscopic surgery (F = 6.343, P = 0.013), preoperative neutrophil count (F = 8.602, P = 0.004), preoperative low albumin (F = 8.410, P = 0.005), and a preoperative prognostic nutritional index < 54 (F = 5.54, P = 0.02) were risk factors for refractory anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2 = 11.417, P = 0.001, OR = 8.798), endoscopic surgery (Wald2 = 9.633, P = 0.002, OR = 4.808), and a prognostic nutritional index < 54 (Wald2 = 4.540, P = 0.002, OR = 2.3798) were independent risk factors for refractory anastomotic stenosis. CONCLUSION: Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of refractory anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Atresia Esofágica/cirurgia , Estenose Esofágica/etiologia , Complicações Pós-Operatórias/etiologia , Fístula Traqueoesofágica/etiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco , Estenose Traqueal/etiologia , Fístula Traqueoesofágica/cirurgia
18.
Chest ; 159(6): e385-e388, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34099155

RESUMO

CASE PRESENTATION: A 57-year-old man with a history of polysubstance use presented with shortness of breath, wheezing, productive cough, subjective fever, and chills of 3-day duration. Additionally, he reported worsening shortness of breath for the last 3 months. Of note, the patient was reported to have had, in the previous 6 months, two episodes of pneumonia that was treated with antibiotics and steroids. He was also diagnosed several years prior with adult-onset asthma due to intermittent wheezing and was prescribed an albuterol inhaler. The albuterol did not help relieve his wheezing, and he stopped refilling it.


Assuntos
Coagulação com Plasma de Argônio/métodos , Biópsia/métodos , Broncoscopia/métodos , Papiloma , Doenças da Traqueia , Estenose Traqueal , Idoso , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Imuno-Histoquímica , Masculino , Papiloma/patologia , Papiloma/fisiopatologia , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Tomografia Computadorizada por Raios X/métodos , Doenças da Traqueia/patologia , Doenças da Traqueia/fisiopatologia , Estenose Traqueal/diagnóstico , Estenose Traqueal/fisiopatologia , Resultado do Tratamento
19.
Semin Pediatr Surg ; 30(3): 151059, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34172205

RESUMO

Tracheal resection is an uncommon procedure in children. It was described many years ago and many surgeons still rely on historical reports when performing the procedure, despite the technological and clinical advancements achieved during the last decades. We consider complex tracheal resections those resections of 30 to 50% of tracheal length, corresponding to at least 6-7 rings. With proper intra and post-operative management, this surgery is safe in children. In this review, we focused on the experience with this procedure of 3 reference centers, with 49 patients operated. We present a management algorithm for these patients, describing pre-operative evaluations, decision on surgical approach, need of tracheotomy, type of intra-operative oxygenation, surgical steps, and post-operative care.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Criança , Humanos , Lactente , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Traqueostomia , Traqueotomia , Resultado do Tratamento
20.
Semin Pediatr Surg ; 30(3): 151058, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34172213

RESUMO

Acquired tracheal stenosis can result from iatrogenic injury or, less commonly, tracheal tumors. Symptoms can arise insidiously and typically include respiratory distress, sleep disordered breathing, or exercise intolerance. Diagnostic evaluation includes cross-sectional imaging and endoscopy. Various endoscopic and open procedures exist to address acquired tracheal stenosis and treatment should be tailored to the patient. Cervical slide tracheoplasty without cardiopulmonary bypass is a versatile technique that can address different types of tracheal stenosis. It allows for immediate reconstruction with vascularized tissue and continued opportunity for growth as the child ages, with high success rates with minimal morbidity.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Criança , Humanos , Lactente , Estudos Retrospectivos , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Resultado do Tratamento
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