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Background Performing an emergency cricothyroidotomy (EC) is extremely challenging, the devices used should be easy to handle and the selected technique reliable. However, there is still an ongoing debate concerning the most superior technique. Methods Three different techniques were compared using a standardized, simulated scenario regarding handling, performing, training and decision making: The scalpel-bougie technique (SBT), the surgical anatomical preparation technique (SAPT) and the Seldinger technique (ST). First, anaesthesia residents and trainees, paramedics and medical students (each group n = 50) performed a cricothyroidotomy randomly assigned with each of the three devices on a simulator manikin. The time needed for successful cricothyroidotomy was the primary endpoint. Secondary endpoints included first-attempt success rate, number of attempts and user-satisfaction. The second part of the study investigated the impact of prior hands-on training on both material selection for EC and on time to decision-making in a simulated “cannot intubate cannot ventilate” situation. Results The simulated scenario revealed that SBT and SAPT were significantly faster than percutaneous EC with ST (p < 0.0001). Success rate was 100% for the first attempt with SBT and SAPT. Significant differences were found with regard to user-satisfaction between individual techniques (p < 0.0001). In terms of user-friendliness, SBT was predominantly assessed as easy (87%). Prior training had a large impact regarding choice of devises (p < 0.05), and time to decision making (p = 0.05; 180 s vs. 233 s). Conclusion This study supports the use of a surgical technique for EC and also a regular training to create familiarity with the materials and the process itself.The trial was registered before study start on 11.11.2018 at ClinicalTrials.gov (NCT: 2018-13819) with Nicole Didion as the principal investigator.

Background Endobronchial ultrasound (EBUS) is widely used to diagnose lung cancer. Monitored anesthesia care (MAC) can enhance patient comfort and procedural conditions during EBUS. EBUS under MAC is usually safe but can lead to various complications. Case A 34-year-old male who had increased sputum for two months showed an enlarged paratracheal lymph node and planned for lymph node biopsy by EBUS. During EBUS under MAC, an unexpected oxygen saturation decline required intervention. After intubation, copious frothy fluid was suctioned from the bronchi, and oxygenation was recovered. A narrowed trachea and the EBUS bronchoscope might have resulted in upper airway obstruction, and suction performed under these conditions might have caused pulmonary edema. The patient received non-invasive ventilation and high-flow nasal cannula and recovered without complications. Conclusions When there is an expected risk of upper airway obstruction during EBUS, careful preoperative evaluation and preparation are essential to prevent negative pressure pulmonary edema.

ABSTRACT Schwannomas commonly develop in the cervical region, 25% – 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.

Introduction With the advances in critical care, the incidence of post intubation tracheal stenosis is increasing. Tracheal resection and anastomosis have been the gold standard for the management of grades III and IV stenosis. Scientific evidence from the literature on the determining factors and outcomes of surgery is not well described.

Membrane expansion integrates multiple forces to mediate precise tube growth and network formation. Defects lead to deformations, as found in diseases such as polycystic kidney diseases, aortic aneurysms, stenosis, and tortuosity. We identified a mechanism of sensing and responding to the membrane-driven expansion of tracheal tubes. The apical membrane is anchored to the apical extracellular matrix (aECM) and causes expansion forces that elongate the tracheal tubes. The aECM provides a mechanical tension that balances the resulting expansion forces, with Dumpy being an elastic molecule that modulates the mechanical stress on the matrix during tracheal tube expansion. We show in Drosophila that the zona pellucida (ZP) domain protein Piopio interacts and cooperates with the ZP protein Dumpy at tracheal cells. To resist shear stresses which arise during tube expansion, Piopio undergoes ectodomain shedding by the Matriptase homolog Notopleural, which releases Piopio-Dumpy-mediated linkages between membranes and extracellular matrix. Failure of this process leads to deformations of the apical membrane, tears the apical matrix, and impairs tubular network function. We also show conserved ectodomain shedding of the human TGFβ type III receptor by Notopleural and the human Matriptase, providing novel findings for in-depth analysis of diseases caused by cell and tube shape changes.

Dear Editor, An article published in 2020 in this journal reported a rare case of a young medical student presenting with low grade mucoepidermoid carcinoma (MEC) of central airway. Curative sleeve resection was done, with negative margins and no evidence of lymph nodal involvement. The current letter presents a 3-year follow up of the same individual and a short review of the evidence available for post-resection monitoring in such patients.

Hodgkin's disease with an initial tracheobronchial involvement is not common. The symptoms might be misleading, resulting in a diagnosis delay. We report the case of a 38-year-old woman with a one-month history of wheezing associated with a dry cough. The physical examination revealed a good general state of health, bilateral wheezing and supra-clavicular lymphadenopathy. The adenopathy biopsy's histopathology revealed Hodgkin lymphoma. The whole body FDG-PET scan was an important tool to assess the diagnosis as well as for the staging. The patient was treated with chemotherapy. Another unusual aspect is the tracheobronchial metastasis confirmed by a bronchial biopsy. Thus, our patient was put on a second-line chemotherapy. She died one year after the initial diagnosis. To conclude, it is an atypical clinical presentation of an Hodgkin lymphoma with a tracheobronchial relapse. It should be considered in the differential diagnosis of asthma or a tracheal tumor.

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Tracheal measurements in the intensive care unit (ICU) are important for the choice of endotracheal tube and may correlate with patient demographic characteristics and infections. The study included 42 surgical patients, age 60 [48-71] years, who underwent diagnostic chest computed tomography (CT) scans during treatment in the ICU, Osijek University Hospital, in 2019 and 2020. CT scans were analyzed using AW Server 3.2. Measurement analysis showed that the diameters of the tracheobronchial tree, the length of the trachea and left main bronchus were significantly larger in men compared to women (p

Selection and insertion of an endotracheal tube (ETT) of appropriate size for airway management during general anesthesia in pediatric patients is very important. A very small ETT increases the risk of inadequate ventilation, air leakage, and aspiration, whereas a very large ETT may cause serious complications including airway damage, post-intubation croup, and, in severe cases, subglottic stenosis. Although the pediatric larynx is conical, the narrowest part, the rima glottidis, is cylindrical in the anteroposterior dimension, regardless of development, and the cricoid ring is slightly elliptical. A cuffed ETT reduces the number of endotracheal intubation attempts, and if cuff pressure can be maintained within a safe range, the risk of airway damage may not be greater than that of an ETT without cuff. The age-based formula suggested by Cole (age/4 + 4) has long been used to select the appropriate ETT size in children. Because age-based formulas in children are not always accurate, various alternative methods for estimating the ETT size have been examined and suggested. Chest radiography, ultrasound, and a three-dimensional airway model can be used to determine the appropriate ETT size; however, there are several limitations.

Foreign body aspiration (FBA) is one of the common causes of significant morbidity and mortality in a toddler child. Airway foreign bodies might be presented as a spectrum, ranging from the acute onset of choking, cyanosis, and respiratory distress to delayed onset of mild respiratory distress, wheezing, persistent cough, and fever. Here, we report a case of peanut aspiration in a toddler child, who was initially being treated as acute bronchial asthma, and the diagnosis was subsequently confirmed on computed tomography (CT) chest as a case of tracheal FBA. A foreign body was successfully retrieved by rigid bronchoscopy under general anesthesia and was a peanut by morphology. The possibility of FBA should be considered in any toddler child, who presents for the first time with acute bronchial asthma-like symptoms; wheezing, coughing, or respiratory distress. In a resource-limited setting, low-dose CT chest can be an early noninvasive diagnostic tool to detect all airway foreign bodies.

In the process of tracheal extubation following general anesthesia, mechanical stimulation of sputum suction and extubation will not only cause airway reactions, such as cough and bronchospasm, but also provoke hemodynamic fluctuations, such as hypertension, tachycardia and arrhythmia, which will lead to cardiovascular and cerebrovascular accidents and even life-threatening events. At present, multiple methods have been employed to reduce the incidence of tracheal extubation response, including medication, such as use of opioids, local anesthetics and vasodilators, as well as laryngeal mask replacement and acupuncture with percutaneous electrical nerve stimulation, etc. In this article, the research progresses on different measures to prevent tracheal extubation response during the recovery of general anesthesia were reviewed.

Introduction: An essential part of anaesthesia is endotracheal intubation. The Endotracheal Tube (ETT) cuff pressure must not be higher than the predicted 22-30 mmHg tracheal perfusion pressure. If the ETT’s cuff is inflated with air while under nitrous oxide+oxygen anaesthesia, the cuff pressure may increase dangerously and result in ischaemia of the tracheal mucosa. Hence, distilled water as an alternative agent to air for inflation of cuffs of ETTs was used in the present study. Aim: To determine whether inflating the ETT cuff with distilled water, instead of air changes the pressure over time. To evaluate changes in cuff pressure over time, and to assess the knowledge about endotracheal cuff pressure monitoring with cuffill. Materials and Methods: The randomised clinical study was conducted from February 2022 to April 2022. The study included 50 patients undergoing elective surgery under general anaesthesia who were randomly divided into two groups. In Group-A, distilled water was used and in Group-B, air was used to inflate the cuffs of ETTs. General anaesthesia was given with nitrous oxide, oxygen and relaxant technique. The intra-cuff pressures of ETT cuffs were recorded by AG cuffill. Increase of pressures with time were recorded and analysed. Results: Mean ET cuff pressure by cuffill with air (Group-B) was 26±2.43 mmH2O after 0 minutes of intubation. After 15 minutes of intubation mean ET cuff pressure was 31.80±3.39 mmH2O. Mean ET cuff pressure by cuffill with distilled water (Group-A) was 25.56±2.02 mmHg after 0 minutes of intubation. After 15 minutes of intubation, mean ET cuff pressure was 28.5±2.26 cmH2O. There was a pressure difference observed between the groups with a mean difference of 3.217, t-value of 4.743 and a p-value of 0.001. Conclusion: For the purpose of inflating the cuffs of ETTs when the patient is under general anaesthesia with the use of nitrous oxide, oxygen, and relaxant method, distilled water may be considered a more desirable agent than air.

. To date, the blood vessels in allergic diseases of the respiratory system are an acting problem. It is known that the full functioning of tissues and organs depends on the state of vessels of a hemomicrocirculatory bed. The purpose of the work is to study morphological changes in the vessels of the hemomicrocirculatory channel of the guinea pig trachea with experimental ovalbumin-induced allergic inflammation. Material and methods. With the help of histological, morphometric and statistical methods studied the trachea of 48 male guinea pigs in conditions of experimental ovalbumin-induced allergic inflammation, which was modeled by subcutaneous sensitization and the subsequent inhalation of ovalbumin. To determine the structural and functional adjustment of arterioles, venules and blood capillaries, the outer diameter, diameter of the lumen, the thickness of the middle membrane and the cereal index of arterioles, the diameter of the lumen of venules and capillaries were determined. The results. It has been found that in all study groups, the size of the outer diameter of arterioles is increased (P */**

Background Gastric calibration tubes (GCTs) are a unique component of bariatric surgery. This study aimed to assess changes in the endotracheal tube (ETT) cuff pressure during laparoscopic bariatric surgery. Methods This was a prospective observational study consisting of 124 American Society of Anesthesiologists class I–III morbidly obese patients (body mass index > 40 kg/m2) undergoing elective laparoscopic bariatric surgery under general anesthesia. The baseline ETT cuff pressure was 28 cmH2O. Cuff pressure, peak airway pressure, and hemodynamic changes were observed during various steps of bariatric surgery. Immediate postoperative complications during the first 24 h were recorded. Results ETT cuff pressure increased significantly from the baseline (28 cmH2O) after insertion of GCT (36.3 ± 7.3 cmH2O) and creation of carboperitoneum (33.3 ± 3.8 cmH2O). Cuff pressure decreased significantly on GCT removal (24.0 ± 3.0 cmH2O) and release of carboperitoneum (24.7 ± 3.0 cmH2O). Peak airway pressure increased from the initial baseline value of 25.1 ± 3.7 to 26.5 ± 4.5 after GCT insertion, creation of carboperitoneum (32.6 ± 4.4), attainment of reverse Trendelenburg position (32.3 ± 4.0), and subsequent return to supine position 32.5 ± 4.8. Conclusions The endotracheal cuff pressure significantly varies during the intraoperative period. Routine monitoring and readjustment of cuff pressure are advisable in all laparoscopic bariatric surgeries to minimize the possibility of postoperative complications.

Tracheobronchial leiomyoma is a rare tumor of the airway. They arise from the lower respiratory tract tissue of the bronchi, trachea, and lung. Symptomatology is based on the degree of endoluminal bronchial obstruction, and surgical resection is generally the mainstay of treatment. We present the case of a 33-year-old male who suffered from chronic cough and breathlessness for two years caused by large endobronchial leiomyoma diagnosed by preoperative biopsy. The tumor was surgically resected through bronchotomy and complete preservation of the lung parenchyma. We stress the importance of a definitive preoperative diagnosis of this rare tumor to employ lung preserving surgical techniques.

Abstract The stay‐suture technique (SST) helps ensure safe replacement of the tracheostomy tube after accidental decannulation. We describe a patient found to have a retained stay suture in the glottis 2 weeks post‐decannulation. It is important to appreciate the possible complications associated with SST, including airway compromise, infection, and laryngospasm.

Objectives A polydioxanone (PDO) stent was developed to treat tracheomalacia in pediatric patients. However, its safety and efficacy need to be verified in animal studies before clinical trials in patients can be conducted. This study evaluated the safety and efficacy of a PDO stent in normal and tracheomalacia-model rabbits. Methods In total, 29 New Zealand white rabbits were used: 13 for evaluating the biocompatibility of the PDO stent in normal rabbits and 16 for the creation of a tracheomalacia model. The tracheomalacia model was successfully established in 12 rabbits, and PDO stents were placed in eight of those rabbits. Results The PDO stent was successfully positioned in the trachea of the normal rabbits using an endoscopic approach, and its degradation was observed 10 weeks later. The stent fragments did not induce distal airway obstruction or damage, and the mucosal changes that occurred after stent placement were reversed after degradation. The same procedure was performed on the tracheomalacia-model rabbits. The survival duration of the tracheomalacia rabbits with and without stents was 49.0±6.8 and 1.0±0.8 days, respectively. Thus, the PDO stent yielded a significant survival gain (P=0.001). In the tracheomalacia rabbits, stent degradation and granulation tissue were observed 7 weeks after placement, leading to airway collapse and death. Conclusion We successfully developed a PDO stent and an endoscopic guide placement system. The degradation time of the stent was around 10 weeks in normal rabbits, and its degradation was accelerated in the tracheomalacia model. The mucosal changes associated with PDO stent placement were reversible. Placement of the PDO stent prolonged survival in tracheomalacia-model rabbits.

Abstract Awake veno‐venous ECMO without anticoagulation is a safe and successful way to remove a significantly obstructive malignancy in the trachea.

The treatment of patients with chronic stenosis of the larynx and trachea is a laborious long process that requires special attention to the choice of surgical tactics and conservative therapy. The effectiveness of the performed surgical treatment largely depends on the course of the postoperative wound process, which explains the need for an individual approach to patient management in order to prevent the development of bacterial complications. One of the factors contributing to the occurrence of these complications are transient microorganisms that colonize the mucous membrane of the respiratory tract, represented mainly by Streptococci, Staphylococci and Neisseria, as well as Acinetobacter, Moraxella, Corinebacterium, Escherichia, Klebsiella. In order to prevent postoperative complications, it is necessary to carry out antibacterial prophylaxis with I–II generation cephalosporins (cefazolin, cefuroxime) or inhibitor-protected aminopenicillins (amoxicillin/clavulanate, ampicillin/sulbactam) during clean surgical interventions. In cases where a bacteriological examination reveals hospital strains of microorganisms, it is necessary to carry out antibacterial therapy aimed at eradication of the bacterial pathogen. In case of “dirty” surgical interventions in patients in cases where a bacteriological examination does not reveal pathogenic strains of microorganisms, it is recommended to carry out antibacterial therapy with broad-spectrum antibiotics, within 7–10 days after the surgery. Irrigation and inhalation therapy occupies a special place in the treatment of patients with chronic stenosis of the larynx and trachea. At the final stages of the operation, irrigation of the surgical area with solutions of glucocorticosteroids and anesthetics is used, and inhalation therapy is used starting from the early postoperative period, continuing throughout the entire period of inpatient treatment, as well as at the outpatient stage. Among the inhalation drugs used topic antibiotics, glucocorticosteroids, mineral water, mucolytics, and bacteriophages are most often used.

Introduction/Objective. Fiberoptic bronchoscopy often is too aggressive, which requires the use of other noninvasive diagnostic methods. The study presents research results on the diagnostic capabilities of virtual bronchoscopy with multidetector computed tomography and fiberoptic bronchoscopy in traumatic abnormalities of trachea and main bronchi. Methods. A total of 21 patients (six males and 15 females) at the ages of 11–82 years (50.65 ± 19.8) were studied by the methods of virtual bronchoscopy with multidetector computed tomography and fiberoptic bronchoscopy. The diagnostic capabilities of virtual bronchoscopy as compared to fiberoptic bronchoscopy were assessed by established criteria. Results. Ruptures of the trachea and/or bronchi were proven by fiberoptic bronchoscopy in 21 patients and by virtual bronchoscopy in 19 patients. The greatest frequency was reported for the post-intubation ruptures (15 patients, 71.42% with virtual bronchoscopy; 16 patients, 76.19% with fiberoptic bronchoscopy), followed by post-traumatic ruptures (three patients, 14.29%); ruptures of trachea and the left lower lobar bronchus as a result of an advanced neoplasm of the esophagus (one patient, 4.76%), diagnosed by both methods; mucosal erosion after instrumental manipulations (4.76%, after fiberoptic bronchoscopy). Conclusion. Achieved diagnostic accuracy in ruptures of trachea and bronchi by virtual bronchoscopy is 90.47% and by fiberoptic bronchoscopy it is 100%. In terms of localization, shape and size, almost complete correspondence of changes with those of fiberoptic bronchoscopy was found. The presence of abundant secretion in virtual bronchoscopy may be interpreted incorrectly and efficiency of virtual bronchoscopy decreases.

Tracheal injuries are relatively rare; however, their mortality rate is relatively high. Complete disruption of the trachea is extremely rare, and a systematic approach is required for early diagnosis and favorable outcomes. This is a case report of a 17-year-old male admitted to the emergency room after a motor vehicle accident. He was agitated and in respiratory distress with labored breathing and urgently intubated orotracheally. In the first flexible bronchoscopy, the diagnosis of the tracheal transaction was missed. Due to saturation drop and high peak ventilator pressures on the seventh day, the flexible bronchoscopy examination was performed in the operating room. This measure revealed complete tracheal transection in midportion. Neck exploration demonstrated complete tracheal transection. The area was debrided, and primary end-to-end anastomosis was performed. The patient was extubated at the end of the surgery.

Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

The COVID-19 pandemic has resulted in a significant increase in the number of tracheostomised patients in hospitals requiring ventilatory support. These patients require highly specialist care, but overwhelmed hospital systems with stretched human resources potentially leave these patients cared for by undertrained healthcare professionals. We describe a rare complication where a routine COVID-19 swab done incorrectly via a tracheostomy tube, resulted in a snapped-off swab in the trachea. We outline the events and our method of removal using rigid bronchoscopy through the tracheostomy stoma as endo-tracheal bronchoscopy was impossible due to significant sub-glottic stenosis. This case highlights the paramount importance of the unique care needed to safely manage tracheostomies during this ongoing pandemic.

Thymoma and T-Lymphoblastic Lymphomas (T-LBL) are primary mediastinal neoplasms that can have similar clinical presentations and overlapping histological features. Because of immature lymphocytes associated with thymoma, it may resemble T-LBL. In this present case report, a 20-year-old male patient with recurrent unresectable thymoma has received definitive chemoradiation therapy. Significant reduction of gross tumour volume was observed while patient underwent weekly image verification before radiotherapy at the end of fourth week, causing the suspicious about the possibility of a highly radiosensitive tumour in mediastinum like lymphoma or extragonadal germ cell tumour. External review of immumohistochemistry features were suggestive of T-LBL.

Spontaneous expectoration of the tissue fragments in primary lung carcinoma is an extremely unusual event. Expectoration of tumor fragments is a significant event that should not be ignored as it serves itself as a noninvasive tool to diagnose underlying malignancy if such samples are immediately preserved and subjected to histopathological examination. More so, expectoration of a large-sized fragment may provide substantial relief from the breathlessness. Reported here is the case of a middle-aged male patient with adenocarcinoma in the right lung, and mass extended up to trachea, who spontaneously coughed out pieces of tumor tissue.

COVID-19 pneumonia can cause respiratory failure which requires specialist management. However the inflammatory nature of the condition and the interventions necessary to manage these patients such as endotracheal intubation and tracheostomy can lead to large airway pathology which may go unrecognised. We describe five of the 44 (11%) consecutive patients referred to our specialist ARDS team between April and June 2020 with confirmed COVID-19 pneumonia who developed diverse large airway pathology which comprised of: supraglottic oedema, tracheal tear, tracheal granulation tissue formation, bronchomalacia, and tracheal diverticulum. Large airway pathology may be underappreciated in severely ill patients with COVID-19 pneumonia and should be considered in patients with unexplained air leak, prolonged need for mechanical ventilatory support, and repeated failed extubation or decannulation. If suspected, such patients should be managed by a team with expertise in large airway intervention and early specialist advice should be sought.

Although tracheal injury during esophagectomy is a rare complication, it is a dreaded one when encountered in the intraoperative period. It can be managed conservatively or by primary repair. We report an incident and successful management of tracheal injury during transhiatal esophagectomy performed in a case of carcinoma esophagus (upper one-third). The tracheal rent of the posterior wall of the trachea was repaired with bovine pericardial patch through a right thoracotomy we added one endotracheal tube (ETT), cut at 19 cm mark from its patient end, reversed to another ETT with a refashioned ETT connector. This innovation gave us enough length to place the tube comfortably inside the left main bronchus without making the ETT cuff herniate inside the tracheal tear. The tracheal rent was repaired with bovine pericardial patch hitched with pledgeted sutures through a right thoracotomy. Postrepair, the patient was electively ventilated; gastric pull-up was postponed pending the healing of the trachea. At the time of second surgery, we had to take all the precautions not to disrupt the repaired wall. The tracheal wall was found intact with some permanent deformity but functionally competent.

Objective(s): Baicalein, a compound extracted from a variety of herbs, showed various pharmacological effects. This study evaluated the relaxant effects of baicalein and its underlying molecular mechanisms of action on rat’s isolated tracheal smooth muscle.Materials and Methods: Tracheal smooth muscle were contracted by 10 μM methacholine or 60 mM KCl and the effects of cumulative concentrations of baicalein (5, 10, 20 and 40 mg/ml) and theophylline (0.2, 0.4, 0.6 and 0.8 mM) were evaluated. To examine the possible mechanism(s) of the relaxant effect of baicalein, its effect was also evaluated on incubated tissues with atropine, indomethacin, diltiazem, N(G)-Nitro-L-arginine methyl ester (L-NAME), glibenclamide, propranolol and chlorpheniramine.Results: A concentration-dependent and significant relaxant effect was seen for baicalein in non-incubated tissues contracted by KCl or methacholine (PConclusion: A potent relaxant effect comparable to the effect of theophylline was shown for baicalein, which was probably mediated via inhibition of histamine (H1) receptors, stimulation of beta2-adrenergic receptors and potassium channels activation.

Introduction. Rapid development of perinatal medicine has led to an increase in the number of fetal surgical interventions performed intrauterine, on the trachea and principal bronchi. Therefore, topographic and anatomical peculiarities of the trachea and its morphometric parameters in the human fetuses of different ages cause interest of morphologists and surgeons. The objective of the study was to determine the skeleto-topic nature and the morphometric indices of the thoracic part of the trachea in the human fetuses aged 4-6 months. Materials and methods. Anatomical study of typical and variant anatomy of the thoracic part of the trachea involved 37 specimens of human fetuses, of 81.0-230.0 mm of crown-rump length, by means of macro-microscopic preparation and morphometry. Results. In the examined 4-6-month-old human fetuses, trachea within the superior mediastinum is predominantly placed in the median sagittal plane (25 cases, 67.6%), or is slightly replaced to the right (9 observations, 24.3%) or to the left (3 cases, 8.1%) from the median sagittal plane. In the fetuses aged 4-6 months the bifurcation of the trachea into the principal bronchi, is usually skeleton-topically determined at the level of the body of the II thoracic vertebra, and the pulmonary trunk bifurcates into the pulmonary arteries at the level of the body of the III thoracic vertebra. An intensive increase in the length and external diameter of the trachea within the superior mediastinum is noted in the fetuses aged 4 and 6 months. During the 4th-6th month of intrauterine development, these morphometric indices of the thoracic part of the trachea are 1.6 times higher.

Abstract Background Adenoid cystic carcinoma of the trachea is a rare tumor, characterized by slow growth and low rate of local and distant metastasis. When achievable, complete surgical resection represents the optimal treatment approach, with the highest results in terms of overall survival. Radiation therapy is a reasonable alternative in cases of inoperable disease. Case presentation We report a case of an 82-year-old white man affected by primary adenoid cystic carcinoma of the trachea, treated with debulking surgery and radiotherapy on the residual disease. A three-dimensional conformal radiation therapy was conducted. The total dose amounted to 70 Gy, administered in 35 fractions of 2 Gy. The medium doses given to the esophagus and lungs were 23 Gy and 4.2 Gy respectively. The maximum dose delivered to the spinal cord was 31 Gy with satisfactory results in terms of local control of the disease. Conclusion A combined approach of surgical resection followed by radiotherapy on the residual disease provided an excellent result in terms of disease control, quality of life, and overall survival in a patient with locally advanced tracheal adenoid cystic carcinoma.

Objectives The purpose of this study is to shorten the decellularization time of trachea by using combination of physical, chemical, and enzymatic techniques. Methods Approximately 3.5-cm-long tracheal segments from 42 New Zealand rabbits (3.5±0.5 kg) were separated into seven groups according to decellularization protocols. After decellularization, cellular regions, matrix and strength and endurance of the scaffold were followed up. Results DNA content in all groups was measured under 50 ng/mg and there was no significant difference for the glycosaminoglycan content between group 3 (lyophilization+deoxycholic acid+de-oxyribonuclease method) and control group (P=0.46). None of the decellularized groups was different than the normal trachea in tensile stress values (P>0.05). Glucose consumption and lactic acid levels measured from supernatants of all decellularized groups were close to group with cells only (76 mg/dL and 53 mg/L). Conclusion Using combination methods may reduce exposure to chemicals, prevent the excessive influence of the matrix, and shorten the decellularization time.

Congenital tracheomalacia, resulting from incomplete tracheal cartilage development, is a relatively common birth defect that severely impairs breathing in neonates. Mutations in the Hedgehog (HH) pathway and downstream Gli transcription factors are associated with tracheomalacia in patients and mouse models; however, the underlying molecular mechanisms are unclear. Using multiple HH/Gli mouse mutants, including one that mimics Pallister–Hall Syndrome, we show that excessive Gli repressor activity prevents specification of tracheal chondrocytes. Lineage-tracing experiments show that Sox9+ chondrocytes arise from HH-responsive splanchnic mesoderm in the fetal foregut that expresses the transcription factor Foxf1. Disrupted HH/Gli signaling results in (1) loss of Foxf1, which in turn is required to support Sox9+ chondrocyte progenitors, and (2) a dramatic reduction in Rspo2, a secreted ligand that potentiates Wnt signaling known to be required for chondrogenesis. These results reveal an HH-Foxf1-Rspo2 signaling axis that governs tracheal cartilage development and informs the etiology of tracheomalacia. This article has an associated First Person interview with the first author of the paper.

This study was conducted to evaluate the possible mechanisms of the relaxant effects of hydroalcoholic extract of Plantago major (P. major) on tracheal smooth muscle (TSM) in rats. The effects of cumulative concentrations of P. major (5, 10, 20 and 40 mg/mL) and theophylline (0.2, 0.4, 0.6 and 0.8 mM) were evaluated on pre-contracted TSM with 10 μΜ methacholine or 60 mM KCl. To determine the possible mechanisms, the relaxant effect of the plant was also examined on incubated TSM with atropine, indomethacin, chlorpheniramine, glibenclamide, diltiazem, papaverine, and propranolol. The results indicated concentration-dependent relaxant effects for P. major in non-incubated TSM contracted by methacholine or KCl. There was no statistically significant difference in the relaxant effects of P. major between non-incubated and incubated tissues with indomethacin, papaverine, and propranolol. However, the relaxant effects of P. major in incubated tissues with atropine (p

The genome-scale transcriptional programs that specify the mammalian trachea and esophagus are unknown. Though NKX2-1 and SOX2 are hypothesized to be co-repressive master regulators of tracheoesophageal fates, this is untested at a whole transcriptomic scale and their downstream networks remain unidentified. By combining single-cell RNA-sequencing with bulk RNA-sequencing of Nkx2-1 mutants and NKX2-1 ChIP-sequencing in mouse embryos, we delineate the NKX2-1 transcriptional program in tracheoesophageal specification, and discover that the majority of the tracheal and esophageal transcriptome is NKX2-1 independent. To decouple the NKX2-1 transcriptional program from regulation by SOX2, we interrogate the expression of newly-identified tracheal and esophageal markers in Sox2/Nkx2-1 compound mutants. Finally, we discover that NKX2-1 binds directly to Shh and Wnt7b and regulates their expression to control mesenchymal specification to cartilage and smooth muscle, coupling epithelial identity with mesenchymal specification. These findings create a new framework for understanding early tracheoesophageal fate specification at the genome-wide level.

Salivary gland tumours of the tracheobronchial tree are rare and early diagnosis in T1 stage is further rare. We report a case of a young 21-year-old male medical student diagnosed and treated for the same prompted by a detailed respiratory examination.

Primary chondrosarcoma of the trachea is an extremely rare tumor. We report two cases of tracheal chondrosarcoma describing the role of surgical and conservative treatment. Endoscopic treatment with rigid bronchoscopy was performed in both patients to restore airway patency and obtain histological specimens for diagnosis. One of the patients subsequently underwent successful tracheal resection and reconstruction. The other patient, who had a contraindication to surgical treatment due to associated diseases underwent iterative endoscopic LASER treatment and is alive three years after the first diagnosis. Surgical treatment remains the treatment of choice of tracheal chondrosarcoma. When surgery is contraindicated endoscopic treatment may allow relatively longterm survival due to the slow growth of these tumors.

Abstract Background Although median sternotomy is standard during cardiac surgery, the procedure is associated with a risk of injury to mediastinal organs. Here, we discuss two cases of tracheal injury following median sternotomy during cardiac surgery. Case presentation Ventilation failure occurred in a 78-year-old Japanese man and a 71-year-old Japanese man after median sternotomy, and tracheal injury was identified. The sites of injury were directly repaired and covered with mediastinal fat tissue, following which ventilation was successful. The burn-like deposits observed at the site of tracheal injury and on the removed endotracheal tube support the notion that the injuries in our patients were caused by electrocautery prior to median sternotomy. In one case, short sternotracheal distance may have contributed to tracheal injury during post-sternal manipulation. In both cases, the relative inexperience of both surgeons also supports the suspected cause of injury. Conclusions Tracheal injury represents a potential complication following median sternotomy, especially when performed by inexperienced surgeons or in cases of short sternotracheal distance. Anesthesiologists should consider this rare yet potentially lethal complication.

Objectives The purpose of this study is to investigate if any change exists in the values of tracheal bifurcation angles (subcarinal angle [SCA] and interbronchial angle [IBA]), right and left bronchial angles (RBA and LBA) in different pediatric age groups. Methods Chest computed tomography (CT) images of children aged 18 years and younger were reviewed retrospectively by two radiologists who were blinded to each other’s measurements. One hundred and eighteen children were involved. RBA, LBA, SCA, and IBA were measured on coronal reformatted images. Subjects were classified into three groups according to their age. Measurement of IBA was done by measuring the angle between the lines drawn along the central axis of right and left main bronchi over their length. RBA and LBA were measured at the intersection points of the lines drawn along the inferior borders of the right and left main bronchi and the line passing through the longitudinal axis of trachea. Sums of RBA and LBA gave SCA. Interobserver agreement was also analyzed. Results SCA, IBA, and RBA values were statistically significant between children of ages less than 10 years and over 10 years P

Objectives Despite the modern advances in thyroid surgery, recurrent laryngeal nerve (rln) paralysis is still a critical problem. In order to decrease the rate of this complication, rln anatomy has been studied intensively. In our study, we aimed to recognize the relationship of rln and landmarks of the first tracheal ring. Methods Eighty-six female and 18 male patients who were undergone total thyroidectomy were included in this study. Trachea vertical height (tvh), right recurrent laryngeal nerve height (rrh), left recurrent laryngeal nerve height (lrh), right recurrent laryngeal nerve to trachea anterior face median raphe distance (rrd), left recurrent laryngeal nerve to trachea anterior face median raphe distance (lrd), right recurrent laryngeal nerve respect to trachea ratio (rrtr), and left recurrent laryngeal nerve respect to trachea ratio (lrtr) parameters of all patients were measured and compared in males and females using independent t-test and measurements on both right and left sides were compared statistically without sex discrimination. Results There were no significant differences between groups in tvh, rrh, rrd, lrd, rrtr, and lrtr parameters. Lrh parameter was significantly higher in males than in females (P