1/15. Therapy of iatrogenic subglottic stenosis: a steroid/antibiotic regimen.The authors have evaluated the efficacy of a medical regimen, consisting of systemic antibiotics and steroids, in the management of acute iatrogenic subglottic stenosis. The study consisted of the infliction of a standardized subglottic injury to three groups of five dogs: Group I animals were placed on prednisone 1 mg/kg/24 hours and potassium phenoxymethyl penicillin 50 mg/kg/24 hours from the day of the trauma. Group II were placed on a similar regimen from the eighth day after subglottic trauma. Group III received no medical therapy at all. Therapy was continued in treated Groups I and II for five weeks. At the end of the study the dogs were sacrificed and the final degree of subglottic stenosis evaluated, at which time the laryngotracheal complexes were submitted for pathological evaluation. A significant difference was found between the degree of stenosis attained in the three groups. The study suggests that the introduction of a steroid/antibiotic regimen has a beneficial effect in developing subglottic stenosis and that the timing of such therapy is of importance.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
2/15. Tracheobronchial rupture: a considerable risk for young teenagers.Tracheobronchial (TB) ruptures are ten times lower in children than in adults. Despite its rarity in the literature, we found that it is as common as in adults in our series. We investigated TB ruptures in childhood regarding age, trauma presentation, injury localization and treatment options. From 1994 through 2001, eight children (six male, two female) were admitted to our department with TB injury. All patients were healthy prior to trauma. The average and median ages were 9.8 and 11, respectively. All patients except one (iatrogenic) were suffering from blunt thoracic trauma. There were seven main bronchial (five right, two left) and one tracheal wounds. Six of the ruptures were circumferential. Urgent (n=6) and delayed (n=2) thoracotomies were performed; 'end-to-end' anastomosis (n=4), pneumonectomy (n=2) and 'primary suturing' (n=2) were applied. We had no mortality. Main bronchus rupture was overlooked in two patients as one of them had almost totally normal clinical appearance, and the other one had negative endoscopic findings. Both of these patients were successfully operated within 3 months. Our limited experience showed us that these kinds of injuries threaten school age population as well. False negative bronchoscopic results increase when additional injuries accompany. TB ruptures should be always taken into consideration after blunt chest trauma. Early or late repair of the lesion should be decided depending on the patient's clinical course.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
3/15. Treatment of iatrogenic injury of membranous trachea with intercostal muscle flap.Iatrogenic injuries of the membranous trachea are rare but potentially lethal, and most commonly require surgical treatment. Such injuries occur intraoperatively during specific thoracic surgery procedures or are associated with endotracheal anesthesia. Special technical difficulties in managing them surgically are encountered when lacerations are in proximity to the rigid rings of the trachea because of the lack of membranous tissue distal to the tear. We describe our technique used in a patient with such an iatrogenic tracheal injury during resection of invasive lung carcinoma.- - - - - - - - - - ranking = 8keywords = trachea (Clic here for more details about this article) |
4/15. Iatrogenic subcutaneous cervicofacial and mediastinal emphysema.subcutaneous emphysema of the head, neck and mediastinum occurs with a variety of disease processes. Most cases involve the passive escape of air from the aerodigestive tract into subcutaneous tissues. The many causes include head and neck surgical procedures, tracheal and esophageal trauma, intraoral trauma, foreign bodies and neoplasms of the aerodigestive tract, and pulmonary barotrauma from mechanical ventilation or in patients with pulmonary disorders. subcutaneous emphysema secondary to active injection of air has recently been reported following certain dental procedures. An interesting case of diffuse cervicofacial and mediastinal emphysema following a difficult extraction of an infected lower molar tooth with a high-pressure air drill is presented. The patient required airway observation and high-dose antibiotic therapy. Early recognition of this unique problem is essential in preventing such life-threatening complications as airway obstruction, mediastinitis, deep neck infection, and cardiac failure. Diagnostic and therapeutic recommendations are included.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
5/15. Iatrogenic perforation of the bronchus intermedius in a 1,100-g neonate.A 1,100-g infant was found to have a right tension pneumothorax following multiple attempts at endotracheal intubation. Despite the use of high-frequency ventilation, adequate oxygenation was not possible. bronchoscopy was hazardous, and bronchography of the right lung using propyliodone oil suspension confirmed perforation of the bronchus intermedius. At thoracotomy, while on high-frequency ventilation, the size of the perforation precluded suture repair, and right middle and lower lobectomies were performed. Follow-up at 1 year showed a small, though healthy infant. review of the surgical literature has not documented successful operative management of bronchial perforation in a neonate. Selective bronchography was precise in identifying the site of perforation and was well tolerated.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
6/15. Iatrogenic intubation injuries of the upper gastrointestinal tract in adults.Perforation of the hypopharynx, esophagus, and stomach complicated the insertion of flexible tubes in 11 adults. Nasogastric suction tubes were responsible for 5 instances of gastric perforation. Palliative intubation of obstructive carcinomas of the distal esophagus resulted in delayed perforation of the esophagus and stomach in 2 cases. The use of a Linton tube for decompression of bleeding varices caused esophageal rupture in 1 patient whereas 2 others developed pharyngoesophageal perforation due to misplaced endotracheal tubes. The remaining 1 case demonstrated penetration of a chest tube into the esophageal lumen. The radiographic features and mechanisms of these iatrogenic injuries are described and the pertinent literature is reviewed.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
7/15. Main stem bronchial occlusion in a neonate.In recent years it has become evident that partial obstruction of bronchi can be acquired postnatally secondary to mechanical trauma caused during prolonged endotracheal intubation. In the presented case, a complete obstruction of the right main stem bronchus developed during the neonatal period despite a relatively short time of intubation. The etiological background is discussed.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
8/15. Fatal paratracheal abscess in multiple sclerosis.Upper airway obstruction resulting from a paratracheal abscess developed insidiously and led to the death of a 43-year-old woman with multiple sclerosis. Repeated nasogastric intubation, required by an exacerbation of bulbar symptoms, may have initiated this unusual infection. Corticotropin and corticosteroid therapy may have impaired immunologic competence and masked fever and other symptoms of inflammation. hoarseness and inspiratory stridor should not be attributed to laryngeal paresis in patients with multiple sclerosis unless other causes of airway obstruction have been excluded by appropriate diagnostic studies.- - - - - - - - - - ranking = 5keywords = trachea (Clic here for more details about this article) |
9/15. Iatrogenic transmural perforation of the oesophagus in the preterm infant.Traumatic oesophageal perforation may occur during the intensive care of premature infants due to trauma of the laryngoscope blade, to traumatic intubation with an endotracheal tube or to forced passing of a nasogastric tube. Over a four-year period, three infants of 787 admitted to a neonatal intensive care unit were diagnosed as having this complication. The careful analysis of the position of the nasogastric tube in relation to surrounding structures can be an early clue to the diagnosis of this condition.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
10/15. Acquired lobar emphysema in premature infants with bronchopulmonary dysplasia: an iatrogenic disease?Five premature infants in whom bronchopulmonary dysplasia developed following prolonged neonatal respiratory support are presented. In all five patients, right middle and/or lower lobe emphysema related to focal obstructing endobronchial masses of granulation tissue subsequently developed. It is speculated that the granulation tissue formed in response to the repeated mechanical trauma of endotracheal tube suctioning.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
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