1/14. Laryngeal diversion and tracheotracheal speech fistula for chronic aspiration.Intractable aspiration is a life-threatening problem and often requires a procedure for blocking or separating the larynx from the bronchial tree. The disadvantage of these techniques is a compromise of phonation. We report the use of a speech fistula after laryngotracheal diversion to restore voice. It allows for the definitive treatment of aspiration, while maintaining the use of the vocal folds for phonation.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/14. Recurrent cholangiocarcinoma: negative autopsy results after aggressive management.cholangiocarcinoma is one of the most common malignancies of the biliary tree. Most cases are perihilar. cholangiocarcinoma usually has an indolent, slowly progressive course and is associated with a high mortality rate. In this article, we discuss the management of perihilar cholangiocarcinoma by radiation therapy and chemotherapy in a case in which no recurrence was found on autopsy.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/14. Anaphylactic reactions after therapeutic injection of mistletoe (viscum album L.).mistletoe (viscum album) is a plant that is semiparasitic of several trees: apple, oak, pine trees, etc. Because of the probable cytolytic action of one of the leaf's most abundant composites, in some countries mistletoe is used as a complementary medicine. Although only a few adverse reactions have been noted (cephalea, fever), cases of anaphylactic shock have been described. We present three cases of severe reaction after injection of mistletoe extract. Two of the patients had cancer. The third, whose brother had cancer, used the plant for preventive purposes. We discuss the danger of possible severe reactions due to the use of products employed in so-called alternative therapies.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
4/14. Molecular changes track recurrence and progression of bronchial precancerous lesions.diagnosis of lung cancer is reached when the disease had grown to advanced stages in its natural history. Thus, novel molecular markers for early detection and risk assessment are needed. Here we performed a longitudinal study of 20 morphological lesions occurred in the bronchial tree of high-risk patients. The lesions were subjected to life (laser-induced fluorescence endoscopy) bronchoscopy and molecular follow-up over a 4 year period. The presence and the persistence of specific genetic alterations were correlated with recurrence or progression of the disease on follow-up. Molecular lesions considered as highly predictive of invasion could be prospectively used as diagnostic markers of high risk for lung cancer in exposed patients.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/14. Advanced cholangiocarcinoma in a patient with stage I primary sclerosing cholangitis.A 29-year-old woman presented with jaundice and fever in May 2001. cholangiography showed multiple strictures and beading of the biliary tree, with a large stricture in the common bile duct and marked dilatation of the hilar bile ducts. Typical cholangiography findings and elevated hepatobiliary enzymes suggested primary sclerosing cholangitis (PSC). At the same time, computed tomography detected a 2-cm tumor in the common bile duct, and angiography showed an encasement in the portal vein. Tumor markers, cytology, and biopsy were all negative for cancer. Although laparotomy showed a healthy liver and no lymph node metastasis was found, suggesting early-stage PSC and a low likelihood of accompanying cholangiocarcinoma (CCA) reported so far, the tumor in the resected common bile duct was subsequently diagnosed as CCA. Therefore, pancreatoduodenectomy was performed combined with partial resection of the portal trunk. histology also revealed invasion of the wall of the portal vein by cancer cells. The patient had a recurrence 5 months later and died 12 months after her operation. This is a rare case in which stage I PSC was complicated by advanced CCA.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/14. Two cases of endobronchial neurilemmoma and review of the literature in japan.Neurilemmomas are benign tumors which originate from schwann cells. They rarely occur in the trachea or bronchus. We encountered two cases of endobronchial neurilemmoma and in this context, reviewed 48 cases previously reported in japan. Neurilemmomas can occur in all regions of the bronchial tree and they often progress into both intraluminal and extraluminal spaces. Incomplete resection results in a local recurrence, despite being rare. As for appropriate therapies, surgery, bronchofiberoptic removal and yttrium aluminum garnet (YAG) laser resection can be chosen depending on the patient's status.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/14. Case report: serial percutaneous cholangioscopy with laser ablation for the management of locally recurrent biliary intraductal papillary mucinous tumor.We present a case of serial cholangioscopic laser fulguration of a biliary recurrence of pancreatic intraductal papillary mucinous tumor in a 76-year-old man. Through established percutaneous biliary drain tracts, the aseptic use of a standard 6.9 F ureteroscope and holmium laser fiber facilitated visual ablation within the biliary tree. Quarterly cholangioscopic laser ablation provided safe and effective local control without biliary infectious complications. This case appears to be the first treatment of recurrent intrabiliary intraductal papillary mucinous tumor by serial antegrade choledocoscopy and laser photocoagulation. Effective local control appears possible with minimal morbidity. Standard ureteroscopic equipment facilitates safe and efficient percutaneous antegrade choledocoscopy.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/14. Pneumomediastinum as a complication to treatment of mediastinal (thymic) large B-cell lymphoma.Mediastinal (thymic) large B-cell lymphoma (Med-DLBCL) is a subtype of diffuse large B-cell lymphomas (DLBCL) with a typical radiological appearance of bulky anterior mediastinal mass, often with areas of necrosis. We report a case of Med-DLBCL with unusual radiological findings and clinical development. Computed tomography (CT) obtained at presentation revealed a huge anterior mediastinal tumor with an axial diameter of 180 mm. Nineteen days after the first cycle of chemotherapy, chest radiography and CT revealed large areas of tumor necrosis and pneumomediastinum with air-fluid levels. To our knowledge, air-fluid levels inside Med-DLBCL have not been previously described. This finding, in combination with necrotic sputum, may indicate communication between the tracheobronchial tree and the tumor.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/14. A complication of transtracheal jet ventilation and use of the Aintree intubation catheter during airway resuscitation.We report the management of a patient requiring surgical laryngoscopy with a view to laser resection of an epiglottic recurrence of laryngeal cancer. Previous attempts at tracheal intubation and awake nasal fibreoptic intubation had failed. During a previous anaesthetic the patient had been both 'impossible to intubate and to ventilate'. neck scarring potentially complicated access for transtracheal jet ventilation. Nevertheless, a cricothyroid catheter was placed and surgery performed during low frequency 'volume' jet ventilation. Upper airway obstruction developed during the procedure, preventing exhalation, which led to raised intrathoracic pressure, cardiovascular collapse and barotrauma. The airway was re-established by insertion of an LMA Proseal. Fibreoptic placement of an Aintree intubation catheter through this allowed re-oxygenation and exchange for a cuffed tracheal tube. Some hours after the procedure, re-intubation was necessary. This was achieved using the Aintree intubation catheter as an aid to nasal fibreoptic intubation and as a tube exchanger. Novel roles of the Aintree intubation catheter and LMA Proseal in this case are discussed. Complications of transtracheal jet ventilation as well as possible methods for avoiding them are also reviewed.- - - - - - - - - - ranking = 7keywords = tree (Clic here for more details about this article) |
10/14. Virtual bronchoscopy for diagnosis of recurrent respiratory papillomatosis.Virtual bronchoscopy is a new method for viewing helical/spiral computed tomography (CT) images of the tracheobronchial trees. Using commercially available software to process the CT data, the tracheobronchial trees can be inspected through a series of three-dimensional images. Recently, this technique has been increasingly used to detect benign and malignant airway stenosis. We report the findings of virtual bronchoscopy in a 41-year-old man with recurrent respiratory papillomatosis (RRP). Several tiny nodules were evident in the lower trachea. Fiberoptic bronchoscopy was performed 1 month later during a planned surgery for laryngeal papillomas, and the findings were in agreement with virtual bronchoscopy. Detection of intrabronchial spreading in RRP is important since peripheral seeding of RRP can cause complications, including recurrent pneumonia, obstructive atelectasis, hemoptysis, and, rarely, may degenerate to squamous cell carcinoma. Virtual bronchoscopy is an alternative method for inspecting the tracheobronchial trees in patients with RRP when laryngeal papillomas impede fiberoptic bronchoscopy.- - - - - - - - - - ranking = 3keywords = tree (Clic here for more details about this article) |
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