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Archives of Iranian Medicine Jun 2021Tracheobronchomalacia (TBM), presenting with the softening of the walls of trachea and bronchi, can cause respiration problems. Despite the importance of TBM, data on...
BACKGROUND
Tracheobronchomalacia (TBM), presenting with the softening of the walls of trachea and bronchi, can cause respiration problems. Despite the importance of TBM, data on its prevalence and related factors are limited. In the current study, the prevalence and predictive factors of this illness were investigated.
METHODS
This cross-sectional study was conducted on patients who were bronchoscopy candidates in the diagnostic department of pulmonary diseases in Afzalipour hospital in Kerman, Iran, from May 2017 to May 2018. First, all patients diagnosed with TBM were assessed based on their demographic variables, spirometry indices, anthracofibrosis and TBM severity. TBM was defined as a 50% or higher decrease in the diameter of the main tracheal and bronchial walls on expiration. These patients constituted the case group. Other patients for whom the bronchoscopy findings were not in concordance with TBM were selected through convenience sampling as control group to equal the number of patients in the case group. Data were analyzed using SPSS version 23.
RESULTS
In this study, 132 (9.38%, 95% CI: 8-11) of the total 1406 cases who underwent bronchoscopy had tracheomalacia. Also, 22 patients (16.66%) had bronchomalacia, at the same time. Based on the multivariable logistic test results, age ( = 0.03, 95% CI: 1.00-1.04, OR = 1.02) and having anthracofibrosis (<0.0001, 95% CI: 1.26-4.68, OR = 2.43) were identified as predictive factors for tracheomalacia.
CONCLUSION
The findings of the present study suggest that the presence of anthracotic plaques can be considered as a possible predictive factor for TBM.
Topics: Bronchi; Bronchoscopy; Cross-Sectional Studies; Humans; Retrospective Studies; Tracheobronchomalacia
PubMed: 34488309
DOI: 10.34172/aim.2021.67 -
Development (Cambridge, England) Feb 2022The tracheal epithelium is a primary target for pulmonary diseases as it provides a conduit for air flow between the environment and the lung lobes. The cellular and...
The tracheal epithelium is a primary target for pulmonary diseases as it provides a conduit for air flow between the environment and the lung lobes. The cellular and molecular mechanisms underlying airway epithelial cell proliferation and differentiation remain poorly understood. Hedgehog (HH) signaling orchestrates communication between epithelial and mesenchymal cells in the lung, where it modulates stromal cell proliferation, differentiation and signaling back to the epithelium. Here, we reveal a previously unreported autocrine function of HH signaling in airway epithelial cells. Epithelial cell depletion of the ligand sonic hedgehog (SHH) or its effector smoothened (SMO) causes defects in both epithelial cell proliferation and differentiation. In cultured primary human airway epithelial cells, HH signaling inhibition also hampers cell proliferation and differentiation. Epithelial HH function is mediated, at least in part, through transcriptional activation, as HH signaling inhibition leads to downregulation of cell type-specific transcription factor genes in both the mouse trachea and human airway epithelial cells. These results provide new insights into the role of HH signaling in epithelial cell proliferation and differentiation during airway development.
Topics: Animals; Autocrine Communication; Cell Differentiation; Cell Proliferation; Cells, Cultured; Down-Regulation; Embryo, Mammalian; Epithelial Cells; Hedgehog Proteins; Humans; Lung; Mice; Mice, Knockout; Signal Transduction; Smoothened Receptor; Trachea; Transcription Factors
PubMed: 35112129
DOI: 10.1242/dev.199804 -
Journal of Thoracic Disease Mar 2014Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present... (Review)
Review
Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management.
PubMed: 24624290
DOI: 10.3978/j.issn.2072-1439.2013.11.08 -
JTCVS Techniques Feb 2023Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed...
OBJECTIVES
Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed vigorously, no clear guidelines about the modality are available.
METHODS
Through a sternotomy approach, a combination of posterior pexy and anterior tracheopexy using a tailored ringed polytetrafluoroethylene prosthesis is performed. Patient demographic characteristics, as well as operative details and postoperative outcomes, are included in the analysis.
RESULTS
Between 2018 and 2022, 9 children underwent the operation under review. All patients showed severe clinical symptoms of tracheomalacia, which was confirmed on bronchoscopy. The median age was 9 months. There was no operative mortality. Eight patients could be weaned from the ventilator. One patient died because of interstitial lung disease with bronchomalacia and concomitant severe cardiac disease. The longest follow-up now is 4 years, and shows overall excellent clinical results, without any reintervention.
CONCLUSIONS
Surgical treatment of tracheomalacia through a combination of posterior and anterior pexy is feasible, with acceptable short- and midterm results.
PubMed: 36820339
DOI: 10.1016/j.xjtc.2022.11.011 -
Frontiers in Physiology 2014The cough reflex is modulated throughout growth and development. Cough-but not expiration reflex-appears to be absent at birth, but increases with maturation. Thus,... (Review)
Review
The cough reflex is modulated throughout growth and development. Cough-but not expiration reflex-appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children. Prolonged acute cough is usually related to the long-lasting effects of a previous viral airway infection or to the particular entity called protracted bacterial bronchitis. Cough pointers and type may orient toward specific etiologies, such as barking cough in croup or tracheomalacia, paroxystic whooping cough in Pertussis. Cough is productive in protracted bacterial bronchitis, sinusitis or bronchiectasis. Cough is usually associated with wheeze or dyspnea on exertion in asthma; however, it may be the sole symptom in cough variant asthma. Thus, pediatric cough has particularities differentiating it from adult cough, so the approach and management should be developmentally specific.
PubMed: 25221517
DOI: 10.3389/fphys.2014.00322 -
American Journal of Speech-language... Aug 2019Purpose The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic...
Purpose The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution. Method A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period. Results Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution. The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%). Conclusions Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.
Topics: Adult; Airway Obstruction; Chronic Disease; Equipment Design; Female; Humans; Male; Middle Aged; Respiratory Insufficiency; Retrospective Studies; Tracheostomy; Treatment Outcome
PubMed: 31318610
DOI: 10.1044/2019_AJSLP-18-0187 -
The Clinical Respiratory Journal Jan 2024Several studies mentioned parenchymal findings after SARS-CoV-2 pneumonia, but few studies have mentioned alterations in the airways. The aim of this study was to...
INTRODUCTION
Several studies mentioned parenchymal findings after SARS-CoV-2 pneumonia, but few studies have mentioned alterations in the airways. The aim of this study was to estimate the prevalence of tracheomalacia and to analyse the clinical characteristics in a cohort of patients with SARS-CoV-2.
METHODS
The study population consisted of all patients with SARS-CoV-2 admitted a hospital serving a population of 500 000 inhabitants. Patients were visited between 2 and 6 months after hospital discharge. In this visit, all patients were subjected to an exhaustive clinical questionnaire and underwent clinical examination, pulmonary function tests and chest CT.
RESULTS
From February 2020 to August 2021, 1920 patients were included in the cohort and tracheomalacia was observed in 15 (0.8%) on expiratory HRCT imaging. All patients with tracheomalacia also presented ground glass opacities in the CT scan and 12 patients had airway sequelae.
CONCLUSIONS
Tracheomalacia is an exceptional sequela of SARS-CoV-2 survivors.
Topics: Humans; COVID-19; Male; Female; Middle Aged; Tracheomalacia; Tomography, X-Ray Computed; Aged; SARS-CoV-2; Prevalence; Adult; Respiratory Function Tests
PubMed: 38666787
DOI: 10.1111/crj.13719 -
Frontiers in Pediatrics 2017Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with... (Review)
Review
Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with tracheoesophageal fistula (EA/TEF). EA/TEF patients are at high risk of having aspiration, and retrospective studies have associated CRM with both recurrent aspiration and atopy. However, studies evaluating the association between CRM in this population and either aspiration or atopy have reported conflicting results. Furthermore, CRM in this population may be due to other related conditions as well, such as tracheomalacia and/or recurrent infections. Aspiration is difficult to confirm, short of lung biopsy. Moreover, even within the largest evidence base assessing the association between CRM and aspiration, which has evaluated the potential relationship between gastroesophageal reflux and asthma, findings are contradictory. Studies attempting to relate CRM to prior aspiration events may inadequately estimate the frequency and severity of previous aspiration episodes. There is convincing evidence documenting that chronic, massive aspiration in patients with repaired EA/TEF is associated with the development of bronchiectasis. While chronic aspiration is likely associated with other CRM in patients with repaired EA/TEF, this does not appear to have been confirmed by the data currently available. Prospective studies that systematically evaluate aspiration risk and allergic disease in patients with repaired EA/TEF and document subsequent CRM will be needed to clarify the causes of CRM in this population. Given the prevalence of CRM, patients with repaired EA/TEF should ideally receive regular follow-up by multidisciplinary teams with expertise in this condition, throughout both childhood and adulthood.
PubMed: 28421172
DOI: 10.3389/fped.2017.00062 -
Frontiers in Pediatrics 2020Tracheal pathology in children are primarily congenital. They can be considered primary or , when this is seen as an inherent defect within the cartilages of the... (Review)
Review
Tracheal pathology in children are primarily congenital. They can be considered primary or , when this is seen as an inherent defect within the cartilages of the tracheal segment. While segmental cartilage defects are very rare, there are often occasions when one or more cartilages can be considered missing from the length of trachea, contributing to airway abnormality. Secondary tracheal pathologies can often be seen in relation to disorders affecting nearby vascular elements or thoracic cage in general. In general, the pathological entity of tracheal disorders can be classified into either tracheomalacia or tracheal stenosis.
PubMed: 32656164
DOI: 10.3389/fped.2020.00297 -
Gland Surgery Apr 2020Retrosternal goiter refers to when the thyroid gland extends from the neck to the substernal portion, descending below the thoracic inlet into the mediastinum. It is...
BACKGROUND
Retrosternal goiter refers to when the thyroid gland extends from the neck to the substernal portion, descending below the thoracic inlet into the mediastinum. It is typically accompanied by compressive symptoms, and most patients need to undergo surgery. This retrospective study set out to analyze the surgical approach to retrosternal goiter and to evaluate perioperative complications, with the aim of recommending best surgical technique.
METHODS
We carried out retrospective analysis of 115 patients with retrosternal goiter treated at our center between May 4, 2011 and March 19, 2019. We analyzed patient characteristics, surgical methods, and perioperative complications using SPSS.
RESULTS
Of the 115 patients in our study, 112 underwent thyroidectomy by cervical approach, with only 3 requiring an extracervical approach. The median age of the patients was 52.3 years, and the majority were female (81.74%). Most of the patients (73.91%) experienced no symptoms but were diagnosed with tracheal compression during surgery or preoperative imaging examination. Ninety-eight (85.22%) of our patients underwent preoperative evaluation of their condition by CT imaging. No obvious surgical contraindications were found before thyroid function tests. The mean operation time was 115.11 min, and the average amount of bleeding during surgery was 54.43 mL. The mean postoperative hospital stay was 5.38 days. In 109 cases (94.78%), the goiter was found to be benign, and malignancy was diagnosed in 6 patients (5.22%). Of the 112 patients who were treated with the cervical approach, 7 (6.25%) experienced recurrent laryngeal nerve palsy; 6 of these cases were transitory and 1 was permanent. The number of patients treated by cervical and extracervical approach who experienced transient hypocalcaemia was 23 (20.54%) and 2, respectively. Transient hypoparathyroidism affected 16 patients (14.29%) treated by cervical approach. Two patients had tracheomalacia phenomenon and one patient had pleural effusion after surgery. No cases experienced permanent hypocalcemia, permanent hypoparathyroidism, postoperative hematoma, tracheostomy, or death.
CONCLUSIONS
Retrosternal goiter surgery is challenging for surgeons. The best surgical approach for the patient should be based on CT scan evaluation. In our study, based on preoperative CT imaging and in-operation evaluation, 50% of the tumor volume was located below the thoracic inlet and 50% of the tumor volume was located above the thoracic inlet in almost all of the patients. Both sections could be successfully removed via a cervical incision, and no obvious complications were observed during the perioperative period. With careful planning and execution before surgery and meticulous operation during surgery, most retrosternal goiters can be safely treated by cervical approach.
PubMed: 32420264
DOI: 10.21037/gs.2020.03.43