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The mucociliary system of the respiratory tract is easily influenced by temperature - and humidity variations in the surrounding air. A series of functional in vitro experiments on heat-exposed rabbit trachea has been performed. The present investigation deals with the corresponding morphological changes of tracheal surface structures after exposure to temperatures between 40°C and 50°C and at a constant humidity of approximately 90 per cent. The following pathological findings were observed at a temperature of 42°C: 1. Fusion of cilia in their distal ends after 20-45 min., 2. appearance of submembranous vesicles without visible matrix after 45-165 min., 3. disappearance of vesicles and a definite deterioration of ciliary structures after 165 min. [ABSTRACT FROM AUTHOR]

The innervation of the epithelium of the avian trachea was investigated in the domestic fowl ( Gallus domesticus) with cholinesterase and fluorescence techniques and electron microscopy. In the subepithelial tissues there were many nerves associated with acetylcholinesterase but only a very few containing catecholamines. The nerves were arranged in two interconnected plexuses, one plexus of myelinated and unmyelinated axons lying external to the tracheal cartilages, and another plexus of unmyelinated axons and ganglion cells lying between the cartilages and the epithelium. The presence of intraepithelial axons was established with the electron microscope. The majority of the intraepithelial axons lay near to the basal cells and the ciliated cells and some approached close to the surface of the epithelium. Two types of vesicle, agranular and granular occurred in the axon profiles. Convincing evidence for synapses between intraepithelial axons and epithelial cells was not seen. A sensory function is suggested for these axons. [ABSTRACT FROM AUTHOR]

Twenty-four tracheas taken from autopsies of children ranging in age from premature to 14 years and in weight from 1 1/2 pounds to 155 pounds, were studied. Details of the growth patterns in length and cross section are discussed. Length and cross-section area are found to have different growth curves. "Flattening" of the trachea is also found to be age related. Application of the data to the selection of proper endotracheal tubes for anesthesia is made in this study, including special attention to length in the newborn infant. [ABSTRACT FROM AUTHOR]

Langerhans cells, normally found in epidermis, were observed in the epidermoid epithelium and lamina propria of the trachea and urinary bladder of vitamin A deficient Wistar rats. The cells possessed the typical rod (disc) shaped granules described by other investigators. A second type of granule (dense granule) was also present. Morphological evidence was obtained of a continuum between the dense granules and the typical Langerhans cell granules, suggesting that one is the product of the other. The fact that Langerhans cells were observed in the lamina propria of these tissues suggests that the origin of the cell is likely to be from the mesenchyme. Their presence, however, appears to be related to the stratified squamous nature of the epithelium with which they are associated, for they were not seen in normal trachea or bladder. [ABSTRACT FROM AUTHOR]

, , 667-679. Anatomic mobilization of the trachea permits resection of one-half or more with primary anastomosis. An anterior approach by a cervical or cervicomediastinal route utilizes cervical flexion to devolve the larynx and tracheal mobilization with preservation of the lateral blood supply. The transthoracic route is employed for lower tracheal lesions. Over 100 tracheal resections have been done using these methods of direct reconstruction. Eighty-four patients suffered from benign strictures, 79 resulting from intubation injuries. Eleven primary tracheal tumours and five secondary tumours are included. The majority of lesions following intubation occurred at the level of the cuff. It was possible to repair 78 of the 84 stenotic lesions through a cervical or cervicomediastinal approach. Seventy-three of the 84 patients with inflammatory lesions obtained an excellent or good functional and anatomic result. Nine of 11 patients with primary neoplasms who underwent reconstruction are alive and without known disease. There were five early postoperative deaths in these 100 consecutive patients who underwent tracheal reconstruction. [ABSTRACT FROM PUBLISHER]

This paper examines the relationship between the intrathoracic and bronchial pressures and the flow time course during forceful expiration in patients with severe chronic airways obstruction and tracheobronchial collapse. After an initial peak flow, the flow rate (V) of forceful expirations usually fitted the patient's maximum expiratory flow volume (MEFV) curve. The great reduction in flow after the peak corresponded to a large reduction of the thoracic gas volume (TGV) due to the high intrathoracic pressures compressing the lungs. An occasional slight rise in flow in the middle of the slow phase corresponded to an increase of the TGV due to reduction of the intrathoracic pressure. The early peak flow was found to exceed considerably the ˙V expected from the MEFV curve. Pressure measurements in the right lower lobe bronchus suggest that this could be due to at least two factors: first, a rapid reduction in bronchial volume and, secondly, a short time lag before flow limitation develops, allowing initial rapid transit of air. During a forced expiration, flow limitation was initiated when the equal pressure points were sufficiently upstream to allow compression of small as well as large airways. The evidence suggested that tracheobronchial collapse followed the initiation of flow limitation and was unlikely to have had more than a slight subsidiary effect on the maximum flow. Due to greater compression, the TGV and hence the flow rate were smaller during a forceful expiration than during a less forceful expiration. [ABSTRACT FROM PUBLISHER]

A study was undertaken to clarify the pathogenesis of tracheal stenosis complicating the use of cuffed tracheostomy tubes, a complication of increasing clinical significance. Tracheostomy with a cuffed inflated tube was established in dogs and was maintained for two weeks. The effects of tracheostomy were assessed by bronchoscopy, tracheography, and histology at the time of killing, eight weeks after extubation. Animals were divided into four groups, each mimicking a common clinical situation. A control group had uncuffed tubes. A method was designed to determine the pressure developed between the cuff and the tracheal wall. Cuff inflation was maintained at low pressure and at high pressure in a second and third group of animals. A fourth group of animals received prednisone during the two weeks of low pressure inflation. Tracheal stenosis, resembling the defect we have encountered in humans, occurred at the tracheostome in all animals. The greater the diameter of the tracheostomy tube relative to the tracheal diameter, the more severe was the resultant stenosis. Greater degrees of tracheal injury occurred with cuffed than with uncuffed tubes, and still greater injury was observed in animals in which high inflationary pressures or steroids were used. These findings suggest that tracheal stenosis complicating cuffed tracheostomy tubes is the result of ischaemic death of tracheal cartilage due to pressure and infection. Steroids used concomitantly accelerate these changes. [ABSTRACT FROM PUBLISHER]

The postnatal growth of the pre-acinar or conducting airways of the lung was examined by measuring the dimensions of selected axial pathways in lungs at different stages of development. The material included both formalin-fixed specimens and bronchograms. A method of comparing the relative sizes of each part of the pathways was developed which allowed for differences between the number of branches or generations measured in each specimen. The results indicate that the pre-acinar airways of the infant may be regarded as a miniature version of those in the adult and that this relationship persists during postnatal growth. Each individual branch grows in a symmetrical fashion both in length and in diameter and bears a constant relation to the whole. The physiological function of the conducting airways during growth was investigated using published data on the breathing pattern of infants. Particular attention was given to the conditions of airflow, to the warming and humidification of inhaled air, and to the filtration of airborne dust. [ABSTRACT FROM PUBLISHER]

Breathing is silent in health but audible at a distance in chronic bronchitis and asthma. This clinical observation was tested by measurements of the intensity of the inspiratory breath sounds at the mouth at flow rates up to 60 1./min. There was a higher rate of increase in the intensity of the sound for equal increments in flow rate in these two diseases than in healthy subjects. Bronchodilator drugs reduced the intensity of abnormally loud inspiratory sounds. The noise is generated by turbulent flow of air in the upper respiratory tract, the trachea, and the central bronchi. Reduction of bronchial calibre increases flow velocity and intensifies turbulence. The intensity of the inspiratory sound in chronic bronchitis and asthma reflects calibre changes in the trachea, the principal bronchi, and their lobar and segmental branches. An inverse correlation exists between the intensity of the inspiratory sound, the forced expiratory volume in one second, and the peak expiratory flow rate in chronic bronchitis and asthma, but not in primary emphysema. Discrepancies between sound, airway resistance, and forced expiratory measurements may indicate the site and mechanism of airway obstruction in individual patients. The sound of inspiration heard with the unaided ear close to the patient's mouth is an important clinical sign. Noisy inspiration is common in chronic bronchitis and asthma, and the degree of narrowing of the central bronchi can be inferred from the loudness of the noise. Silent inspiration in the presence of severe expiratory obstruction is a sign of primary emphysema. [ABSTRACT FROM PUBLISHER]

Transplantation of the heart and both lungs is being considered as a clinical possibility in several surgical centres today. This paper reviews the experimental development of surgical techniques in this field. In the 1940s Demikhov in the U.S.S.R. succeeded in developing a technique by which he could carry out cardiopulmonary transplantation without the use of any artificial means of recipient support during the procedure. He obtained survivors for up to six days; late deaths occurred mainly from pulmonary complications. The techniques and results of subsequent workers using hypothermia or pump-oxygenator support are reviewed. Recent work has focused on the problem of the return of spontaneous respiration following denervation of the lungs which, of necessity, occurs during this procedure. [ABSTRACT FROM PUBLISHER]

Two cases of the rare condition of tracheobronchomegaly are reported. They occurred in people of completely different racial origin and residence. They showed the characteristic features of this condition—loud, rasping, prolonged, remarkably ineffective cough, abnormally wide trachea and major bronchi, laxity of the cartilaginous rings and membranous part of these airways demonstrable on straight chest radiographs and bronchoscopy and confirmed at bronchography. Evidence is submitted of congenital aetiology. [ABSTRACT FROM PUBLISHER]

The article focuses on Ewing's Sarcoma of the rib, presenting as the superior mediastinal syndrome. The complex of signs and symptoms known as "the superior mediastinal syndrome" results from compression of the vital structures in the superior mediastinum, mainly the superior vena cava and the trachea. The characteristic clinical picture is a patient with edema, venous engorgement and cyanosis of the face and head, wheezing, and dyspnea. Other features which may occur are increased intracranial pressure, headache, tinnitus or somnolence. The signs and symptoms vary, depending on whether the mediastinal compression impinges to a greater degree upon the airway or upon the venous system. In adults the clinical problems result mainly from venous compression, whereas in children the airway obstruction is seen most frequently. The most common cause of this syndrome in adults is bronchogenic carcinoma; in children, a lymphoma. Other malignant causative lesions have included Hodgkin's sarcoma, neural tumors, thymic tumors, teratomas and metastatic visceral tumors.

Provides a historical background of the development and use of O'Dwyer tube in laryngeal diphtheria. Introduction of laryngeal intubation by Joseph P. O'Dwyer in the early 1880s; Modifications to standard tracheal cannula to increase the expulsive power of the cough; Problems of laryngeal obstruction; Evidence of the decreased incidence of diphptheria and in the frequency of the need for intubation.

Studies the microcirculation of the trachea by researchers from Los Angeles, California. Role of the subglottic airway may play in ensuring thermal and moisture constancy of inspired air at the pulmonary alveolus; Development of a method of microvascular casting by silicone rubbers which permits filling of selected regions of the vascular tree for subsequent detailed anatomic study; Safety and efficacy of the novel method in making a detailed view of the minute blood vessels of the rabbit's tracheal mucosa.

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Brief, gentle extrinsic pressure on the trachea at the level of the cricothyroid membrane during lateral roentgenography of the neck is suggested as a safe, simple, and reliable means of evaluating the retrotracheal pre-cervical soft tissues in infants and children. [ABSTRACT FROM AUTHOR]

. , , 526-528. . This is the case report of an infant born alive with absence of both lungs, atresia of the oesophagus, and the first arch syndrome. [ABSTRACT FROM PUBLISHER]