Database : MEDLINE
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[PMID]: 29524827
[Au] Autor:Paul M; Kannaujia A; Chatterjee A; Mayilvaganan S
[Ad] Address:Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Department of Anesthesia, A Block, PIN-226014, India.
[Ti] Title:Serial fiber optic bronchoscopy (FOB) to predict the need of tracheostomy in tracheomalacia after thyroidectomy in long standing goiter.
[So] Source:J Clin Anesth;47:9-10, 2018 Mar 07.
[Is] ISSN:1873-4529
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 1011 MEDLINE  
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[PMID]: 29524603
[Au] Autor:Shieh HF; Smithers CJ; Hamilton TE; Zurakowski D; Visner GA; Manfredi MA; Jennings RW; Baird CW
[Ad] Address:Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115.
[Ti] Title:Descending Aortopexy and Posterior Tracheopexy for Severe Tracheomalacia and Left Mainstem Bronchomalacia.
[So] Source:Semin Thorac Cardiovasc Surg;, 2018 Mar 07.
[Is] ISSN:1532-9488
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Posterior descending aortopexy can relieve posterior intrusion of the left mainstem bronchus that may limit the effectiveness of posterior tracheobronchopexy. We review outcomes of patients undergoing both descending aortopexy and posterior tracheopexy for severe tracheobronchomalacia with posterior intrusion and left mainstem compression to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. METHODS: All patients who underwent both descending aortopexy and posterior tracheopexy from October 2012 to October 2016 were retrospectively reviewed. Clinical symptoms, tracheomalacia scores based on standardized dynamic airway evaluation by anatomical region, and persistent airway intrusion requiring reoperation were collected. Data were analyzed by Wald and Wilcoxon signed-ranks tests. RESULTS: 32 patients underwent descending aortopexy and posterior tracheopexy at median age 18 months (IQR 6-40 months). Median follow up was 3 months (IQR 1-7 months). There were statistically significant improvements in clinical symptoms postoperatively, including cough, noisy breathing, prolonged and recurrent respiratory infections, ventilator dependence, blue spells, and brief resolved unexplained events (BRUEs) (all P<.001), as well as exercise intolerance (P=.033), transient respiratory distress requiring positive pressure (P=.003), and oxygen dependence (P=.007). Total tracheomalacia scores improved significantly (P<.001), with significant segmental improvements in the middle (P=.003) and lower (P<.001) trachea, and right (P=.011) and left (P<.001) mainstem bronchi. 2 patients (6%) had persistent airway intrusion requiring reoperation with anterior aortopexy and/or tracheopexy. CONCLUSIONS: Descending aortopexy and posterior tracheopexy are effective in treating severe tracheobronchomalacia and left mainstem intrusion with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  3 / 1011 MEDLINE  
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[PMID]: 29514258
[Au] Autor:Rijnberg FM; Butler CR; Bieli C; Kumar S; Nouraei R; Asto J; McKavanagh E; de Coppi P; Muthialu N; Elliott MJ; Hewitt RJ
[Ad] Address:Tracheal Team, Great Ormond Street Hospital, London, UK.
[Ti] Title:Aortopexy for the treatment of tracheobronchomalacia in 100 children: a 10-year single-centre experience.
[So] Source:Eur J Cardiothorac Surg;, 2018 Mar 05.
[Is] ISSN:1873-734X
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Our study describes and analyses the results from aortopexy for the treatment of airway malacia in children. METHODS: Demographic data, characteristics and preoperative, operative and outcome details, including the need for reintervention, were collected for children undergoing aortopexy between 2006 and 2016. RESULTS: One hundred patients [median age 8.2 months, interquartile range (IQR) 3.3-26.0 months] underwent aortopexy. Sixty-four (64%) patients had tracheomalacia (TM) only, 24 (24%) patients had TM extending into their bronchus (tracheobronchomalacia) and 11 (11%) patients had bronchomalacia. Forty-one (41%) children had gastro-oesophageal reflux disease, of which 17 (41%) children underwent a Nissen fundoplication. Twenty-eight (28%) children underwent a tracheo-oesophageal fistula repair prior to aortopexy (median 5.7 months, IQR 2.9-17.6 months). The median duration of follow-up was 5.3 years (IQR 2.9-7.5 years). Thirty-five (35%) patients were on mechanical ventilatory support before aortopexy. Twenty-seven (77%) patients could be safely weaned from ventilator support during the same admission after aortopexy (median 2 days, IQR 0-3 days). Fourteen patients required reintervention. Overall mortality was 16%. Multivariable analysis revealed preoperative ventilation (P = 0.004) and bronchial involvement (P = 0.004) to be adverse predictors of survival. Only bronchial involvement was a predictor for reintervention (P = 0.012). CONCLUSIONS: Aortopexy appears to be an effective procedure in the treatment of children with severe airway malacia. Bronchial involvement is associated with adverse outcome, and other procedures could be more suitable. For the treatment of severe airway malacia with isolated airway compression, we currently recommend aortopexy to be considered.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher
[do] DOI:10.1093/ejcts/ezy076

  4 / 1011 MEDLINE  
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[PMID]: 29489104
[Au] Autor:Parshin VD; Vyzhigina MA; Rusakov MA; Parshin VV; Titov VA; Starostin AV
[Ti] Title:[POSTRESUSCITATION CICATRICIAL TRACHEAL STENOSIS. CURRENT STATE OF THE PROBLEM - THE SUCCESSES, THE HOPES AND DISAPPOINTMENTS.]
[So] Source:Anesteziol Reanimatol;61(5):360-366, 2016 Sep.
[Is] ISSN:0201-7563
[Cp] Country of publication:Russia (Federation)
[La] Language:rus
[Ab] Abstract:BACKGROUND: Currently, the trend continues to increase the number ofpatients with cicatricial tracheal stenosis (CTS). Therefore, prevention and treatment ofthis disease remains topical. The main cause ofcicatricial tracheal stenosis is damaging the trachea during mechanical ventilation. The scheme ofprevention of this disease in Russia hasn't brought the desired results. THE AIM: to clarify the modern etiology of cicatricial tracheal stenosis, to identify the trend in incidence rates, to determine whether there is an optimal safe alternative to tracheostomy including the use of minimally invasive techniques, to improve diagnostic and therapeutic algorithm at various stages of assistance, and also to study the results of innovative operations and new ways of maintaining gas exchange. MATERIALS AND METHODS: 1128 patients with cicatricial tracheal stenosis was treated from 1963 to 2015 in Petrovsky National Research Centre of Surgery and IMSechenov First Moscow State Medical University. Over time methods of di- agnosis, methods of anesthesia and operations have been varied. In this regard all patients were divided into two groups depending on the period of time from 1963 to 2000 (297 patients) andfrom 2001 to 2015 (831 patients). In recent decades there is a steady increase in the number of treated patients. So, if in the first group during the year operational treatment about the CTS 8,0 patients were underwent, in the second - to 55.4. Cicatricial tracheal stenosis appeared after lung mechanical ventilation at 1025 (for 90.9%) patients. They have undergone both radical one-stage treatment and multi-stage and sequential intraluminal procedures. In general there is a clear trend towards more aggressive surgical tactics. So, if in thefirst group, the tracheal resection with anastomosis was performedin 59 patients only, the second-330. Thefrequency ofpostoperative complications and mortality in the second group ofpatients was 12.9 and 0.7 %, respectively. RESULTS: Only a reasonable combination of all treatment methods, the principle of "every patient his own version of operation" allows to minimize the risk oftreatment and to get a good lasting result. Proof of such provision may be the fact that the frequency of complications and postoperative mortality at our patients have had a tendency to decrease and currently stands at 12.9 and 0.7 %, respectively for many years. It is 2.3 and 9.6 times less, respectively, than in the periodfrom 1963 to 2000. It appears that further reduction of these indicators will be at a slower pace, afurther solution of the CTS problem will be based on the prevention of disease. CONCLUSION: Prevention of cicatricial tracheal stenosis in the departments of reanimation and intensive care is currently inadequate. It requires fundamentally new approaches, but reform still has not brought the desired results. Diagnosis of the CTS at an early stage allows early treatment and to avoid complex and risky operations. Increasingly important, apart tracheoscopy for diagnosis of tracheomalacia purchase dynamic computed tomography and magnetic resonance - tomography. Treatment ofpatients with CTS requires a multidisciplinary approach, individual selection operations for a particular patient. The general trend of the further development of tracheal surgery is associated with an increase in the number of simultaneous resections, including at the long, two-level stenosis, as well as at relapse. The patients who had refused treatment or have elected him palliative options made possible surgery. The frequency of postoperative comnlications and mortality decreased significantiv, including after extensive and traumatic operations on the trachea.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:In-Process

  5 / 1011 MEDLINE  
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[PMID]: 29485824
[Au] Autor:Akdag A; Turgut A; Ceylan S; Kaya M
[Ti] Title:Annular Pancreas, Severe Tracheomalacia and Bronchomalacia in a Preterm Boy with Vacterl Association.
[So] Source:Genet Couns;27(2):207-10, 2016.
[Is] ISSN:1015-8146
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:VACTERL association includes vertebral anomalies, anal atresia, cardiac defects, tracheao-esophageal fistula, renal anomalies, and limb abnormalities. It is defined by the presence of at least three of these congenital malformations. The incidence has been estimated to be 1/10.000-1/40.000 live births. We report on a preterm infant with VACTERL presentin with respiratory complicatons due to the presence of severe tracheomalacia and bronchomalacia. He also had an annular pancreas.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:In-Process

  6 / 1011 MEDLINE  
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[PMID]: 29483471
[Au] Autor:Ikeda T; Nakano J; Yokomise H
[Ad] Address:Department of General Thoracic Surgery, Sakaide City Hospital, Sakaide, Japan.
[Ti] Title:[Tracheal Injury Successfully Treated without Surgery;Report of a Case].
[So] Source:Kyobu Geka;71(2):149-151, 2018 Feb.
[Is] ISSN:0021-5252
[Cp] Country of publication:Japan
[La] Language:jpn
[Ab] Abstract:A 73-year-old man was injured after crashing his automobile into a concrete wall, and was admitted to our hospital with breathing difficulties. Chest computed tomography showed extensive mediastinal emphysema, right traumatic pneumothorax, and a suspected tracheal injury at the membranous region. Because of the associated tracheomalacia, the site of the tracheal injury was difficult to find by bronchoscopy. In addition, as the patient's respiratory condition was stable, surgical treatment was not chosen. Due to the continuous air leakage from the right lung, the patient underwent surgery after mediastinal and subcutaneous emphysema improved. The postoperative course was uneventful.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:In-Data-Review

  7 / 1011 MEDLINE  
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[PMID]: 29482923
[Au] Autor:Cheng LTW; Sim TB; Kuan WS
[Ad] Address:Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
[Ti] Title:Noninvasive Ventilation as a Temporizing Measure in Critical Fixed Central Airway Obstruction: A Case Report.
[So] Source:J Emerg Med;, 2018 Feb 23.
[Is] ISSN:0736-4679
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Critical central airway obstruction (CAO) requires emergent airway intervention, but current guidelines lack specific recommendations for airway management in the emergency department (ED) while awaiting rigid bronchoscopy. There are few reports of the use of noninvasive ventilation (NIV) in tracheomalacia, but its use as a temporizing treatment option in fixed, malignant CAO has not, to the best of our knowledge, been reported. CASE REPORT: An 84-year-old woman presented to the ED in respiratory distress, too breathless to speak and using her accessory muscles of respiration, with bilateral rhonchi throughout the lung fields. Point-of-care arterial blood gas revealed severe hypercapnia, and NIV was initiated to treat a presumed bronchitis with hypercapnic respiratory failure. Chest radiography revealed a paratracheal mass with tracheal deviation and compression. A diagnosis of critical CAO was made. While arranging for rigid bronchoscopic stenting, the patient was kept on NIV to good effect. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recommendations for emergent treatment of life-threatening, critical CAO before bronchoscopic intervention are not well established. Furthermore, reports of NIV use in CAO are rare. We suggest that emergency physicians consider NIV as a temporizing measure for critical CAO while awaiting availability of bronchoscopy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:Publisher

  8 / 1011 MEDLINE  
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[PMID]: 29229483
[Au] Autor:Koivusalo AI; Rintala RJ; Pakarinen MP
[Ad] Address:Children's Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland. Electronic address: antti.koivusalo@hus.fi.
[Ti] Title:Outcomes of fundoplication in oesophageal atresia associated gastrooesophageal reflux disease.
[So] Source:J Pediatr Surg;53(2):230-233, 2018 Feb.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:AIM OF THE STUDY: Conservative management of gastrooesophageal reflux (GORD) in oesophageal atresia (OA) is sometimes inefficient, and fundoplication is required. We assessed the outcomes of fundoplication among OA patients from 1980 to 2016. METHODS: After ethical consent, hospital records of 290 patients, including 22 referred patients, were reviewed. Included were 262 patients with end-to-end repair. Excluded were patients who underwent oesophageal reconstruction (n=23) or no repair (n=5). Primary outcome measures included survival, retaining the native oesophagus, resolution of GGORD symptoms, failure of fundoplication, and long-term endoscopic results. MAIN RESULTS: Gross types of OA in 262 patients were A (n=12), B (n=2), C (n=217), D (n=10), E (n=19), and F (n=2). Eighty-six (33%) patients, type A (n=12, 100%), B (n=2, 100%), C (n=69, 31%), D (n=3, 30%), and F (n=1, 50%), underwent fundoplication at the median age of 5.4 (IQR 3.1-16) months. Main indications included recalcitrant anastomotic stenosis (RAS) in 41 (48%), respiratory symptoms in 16 (19%), and acute life threatening events (ALTE) in 15 (17%) of patients. Associated tracheomalacia in 25 (29%) patients were treated with aortopexy. Median follow-up was 7.5 (IQR 1.8-15) years. RAS resolved in 30 (73%) patients, whereas 11 (27%) with unresolved RAS underwent oesophageal resection (n=8) or replacement (n=3). Six (7%) patients died of heart failure (n=4), bolus impaction (n=1), and ALTE (n=1). Fundoplication failed in 27 (31%) patients, and 13 (15%) underwent redo fundoplication. Fundoplication failure was predicted by long-gap OA RR=3.8 (95%CI=1.1-13), P=0.04. In total GORD associated symptoms persisted in 7 (8%) patients, including one with permanent feeding jejunostomy. Latest endoscopy showed moderate or severe oesophagitis in 7% of fundoplicated and in 3% nonfundoplicated patients and intestinal metaplasia in 3% and 1% (p=0.20-0.29). CONCLUSION: Fundoplication provided a safe and relatively effective control of OA associated symptomatic GORD and oesophagitis. The failure rate of fundoplication was high in those with long-gap OA. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180225
[Lr] Last revision date:180225
[St] Status:In-Process

  9 / 1011 MEDLINE  
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[PMID]: 29217321
[Au] Autor:Thakkar H; Upadhyaya M; Yardley IE
[Ad] Address:Evelina Children's Hospital, Guy's & St. Thomas's NHS Foundation Trust, London, UK.
[Ti] Title:Bronchoscopy as a screening tool for symptomatic tracheomalacia in oesophageal atresia.
[So] Source:J Pediatr Surg;53(2):227-229, 2018 Feb.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:AIM: Oesophagealatresia/tracheo-oesophageal fistula (OA-TOF) is associated with tracheomalacia (TM). In our institution it is routine for OA-TOF patients to undergo dynamic flexible bronchoscopy (DFB) assessing both the site of the fistula and the presence or absence of TM. We aimed to determine the value of this investigation as a screening tool to predict subsequent symptomatic tracheomalacia in these patients. METHODS: All patients with OA-TOF who underwent DFB at the time of initial repair between June 2014 and November 2016 were included prospectively. The findings at DFB were recorded. Patients were grouped according to the presence or absence of TM and followed to determine which of them developed symptomatic airway problems. The sensitivity and specificity of TM at initial bronchoscopy as a screening tool for subsequent symptomatic TM were calculated. The study was given ethical approval by our institution. MAIN RESULTS: Twenty-three patients were included in the study. Median follow-up was for 7 (1-27) months. Fifteen (65%) were found to have TM at their first DFB; 13 (57%) subsequently developed airway symptoms, and of these 11 had TM at initial DFB. One patient with severe TM (>90% tracheal collapse) at initial DFB was completely asymptomatic following OA-TOF repair. The sensitivity was 85%, and specificity was 60%. The positive and negative predictive values were 73% and 75%, respectively. CONCLUSIONS: DFB is a useful tool in many aspects of the management of OA/TOF. However, it is not a good screening tool to predict symptomatic tracheomalacia with moderate sensitivity and a low specificity. LEVEL OF EVIDENCE: Level IIb, Retrospective cohort study.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180225
[Lr] Last revision date:180225
[St] Status:In-Process

  10 / 1011 MEDLINE  
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[PMID]: 29429770
[Au] Autor:Baxter KJ; Baxter LM; Landry AM; Wulkan ML; Bhatia AM
[Ad] Address:Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States. Electronic address: kmccurd@emory.edu.
[Ti] Title:Structural airway abnormalities contribute to dysphagia in children with esophageal atresia and tracheoesophageal fistula.
[So] Source:J Pediatr Surg;, 2018 Jan 31.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Long-term dysphagia occurs in up to 50% of repaired esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. The underlying factors are unclear and may include stricture, esophageal dysmotility, or associated anomalies. Our purpose was to determine whether structural airway abnormalities (SAA) are associated with dysphagia in EA/TEF. METHODS: We conducted a retrospective chart review of children who underwent EA/TEF repair in our hospital system from 2007 to 2016. Children with identified SAA (oropharyngeal abnormalities, laryngeal clefts, laryngomalacia, vocal cord paralysis, and tracheomalacia) were compared to those without airway abnormalities. Dysphagia outcomes were determined by the need for tube feeding and the modified pediatric Functional Oral Intake Scale (FOIS) at 1 year. RESULTS: SAA was diagnosed in 55/145 (37.9%) patients with EA/TEF. Oropharyngeal aspiration was more common in children with SAA (58.3% vs. 36.4%, p=0.028). Children with SAA were more likely to require tube feeding both at discharge (79.6% vs. 48.3%, p<0.001) and at 1 year (52.7% vs. 13.6%, p<0.001) and had lower mean FOIS (4.18 vs. 6.21, p<0.001). In the logistic regression model adjusting for gestational age, long gap EA, and esophageal stricture, the presence of SAA remained a significant risk factor for dysphagia (OR 4.17 (95% CI 1.58-11.03)). CONCLUSION: SAA are common in children with EA/TEF and are associated with dysphagia, even after accounting for gestational age, esophageal gap and stricture. This study highlights the need for a multidisciplinary approach, including early laryngoscopy and bronchoscopy, in the evaluation of the EA/TEF child with dysphagia. LEVEL OF EVIDENCE: Level II retrospective prognostic study.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180212
[Lr] Last revision date:180212
[St] Status:Publisher


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