1/7. Tracheocoele in a Duchenne muscular dystrophy patient. Case report.Tracheocoele, a congenital or acquired lesion, is rarely detected radiologically and even more rarely diagnosed clinically. This tracheal lesion is characterised by the presence of a single cystic lesion filled with air or a mixture of liquid and air, of extremely variable size, occurring in almost all cases, in a locus minoris resistentiae situated in the right posterolateral portion of the trachea. The rare case is described of a voluminous tracheocoele located in the left paratracheal region, extending from the cricoid to sternal notch, manifesting clinically, 3 months prior to evaluation in our hospital in a 27-year-old male suffering from Duchenne muscular dystrophy since the age of 5 years. For 10 years, the patient had been treated with intermittent positive pressure ventilation via nasal mask, due to progressive deterioration of respiratory function. diagnosis of tracheocoele, initially made at computed axial tomography scan, was confirmed by flexible laryngotracheoscopy under local anaesthesia. Due to severe comorbidity associated with the clinical picture described, the absence of a significant set of symptoms, and the problems concerning anaesthesiological management of the patient, palliative treatment was the only choice. This consisted in cervical compression bandaging during assisted nasal ventilation. Close follow-up was performed in order to monitor any progression of the lesion or onset of related complications. This is the second case of tracheocoele originating in the left paratracheal region reported in the literature, and the first associated with Duchenne muscular dystrophy and prolonged use of a positive pressure respirator. The aetiopathogenic mechanisms that may have determined the formation of this rare lesion are then taken into consideration.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/7. Off pump coronary artery bypass grafting in a patient with tracheopathia osteoplastica.Tracheopathia osteoplastica is a rare disease of the tracheobronchial tree, which is often misdiagnosed and recognised only at post-mortem. We report the case of a 66-year-old man with this condition, mistakenly thought to be suffering from chronic bronchiectasis. He underwent successful coronary artery bypass grafting for unstable angina using an off-pump technique. A case report and brief literature review is presented.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
3/7. Management of radiation-induced tracheocutaneous tissue defects by transplantation of an ear cartilage graft and deltopectoral flap.patients suffering from head and neck cancer often require temporary tracheostomy during therapy. The tracheostomy can usually be closed when postoperative swelling decreases and swallowing ability recovers. However, some patients, especially after adjuvant radiotherapy, may develop severe chronic wounds resulting in persistent tracheocutaneous fistula. Local wound care and plastic reconstruction strategies are required in such cases. We present two patients with head and neck cancer treated with primary surgical regimen including temporary tracheostomy and adjuvant radiotherapy. Both patients developed a persistent, poorly healing wound with persistent tracheocutaneous tissue defect. After local debridement and wound care, the peristomal necrotic tissue was excised down to the level of the trachea. The defect of the anterior tracheal wall was closed with a autogenous ear cartilage graft. The graft was harvested from the cavum conchae and sutured to the tracheal defect. The soft tissue defect was covered by transposition of a well-vascularized, fasciocutaneous deltopectoral flap. In both cases, the flaps healed satisfactorily. The donor defect was closed primarily. Complications were not observed in these two cases. A flexible tracheo-bronchoscopy showed no stenosis of the trachea at the site of cartilage graft transplantation. In conclusion, treatment of persistent radiated tracheocutaneous defects by cartilage graft and deltopectoral flap turned out to be a safe and reliable procedure which can be performed as a one-stage method with low morbidity at the donor site.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
4/7. Tracheobronchopathia osteochondroplastica.The clinical, pathological and physiological features of two patients suffering from tracheobronchopathia osteochondroplastica (TO) are described. Unequivocal evidence of extrapulmonary airways obstruction was not able to be obtained by lung function testing, despite extensive central airway involvement in both patients. TO is a rare condition of which there is only one other clinical report from this country. As the bronchoscopic appearance may closely resemble that of endobronchial neoplasms, TO should be remembered in the differential diagnosis of patients with haemoptysis.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
5/7. Tracheobronchopathia osteochondroplastica.A 65 year old man presented with exacerbation of the chronic bronchitis from which he had been suffering for several years. A chest X-ray revealed disatelectatic pulmonary zones. bronchoscopy showed numerous nodules, beginning at the mid-trachea and extending into the major bronchi. Histological examination of the biopsy specimens demonstrated well-differentiated cartilaginous tissue, consistent with tracheobronchopathia osteochondroplastica.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
6/7. Spiral CT and endoscopic findings in a case of tracheobronchopathia osteochondroplastica.The following is a report of CT and bronchoscopic findings in a 58-year-old man, a miner for approximately 30 years and suffering from pulmonary silicosis, admitted for a restaging of his lung disease. CT scans showed thickening of the interstitial structures and revealed a distorted trachea, with changes of its caliber, because of nodules of calcific density in the internal mucosa, clearly separated from the cartilaginous rings. The patient underwent fiberoptic bronchoscopy, confirming the presence of numerous nodules on the anterior and lateral walls, sparing the pars membranacea. Brushing and biopsies revealed a squamous metaplasia. 99mTc bone scintigraphy showed no abnormal mediastinal uptake. The radiological and endoscopic picture was compatible with the diagnosis of tracheobronchopathia osteochondroplastica.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
7/7. Amyloid deposits in the trachea and esophagus ultrastructural confirmation.The clinical details of two patients suffering from amyloid infiltration of the trachea and esophagus respectively are presented. The "amyloid tumor" in the trachea presented with dysphonia and a swelling in the lower subglottic region. Attempts at complete surgical excision of it were unsuccessful. The patient with esophageal amyloid presented acutely with dysphagia and features of dehydration and malnutrition. Systematized amyloidosis was discovered at autopsy, but no primary initiating cause for it was found. In both cases it was possible to confirm the diagnosis by electron microscopy. The current views on the composition, structure, causation and treatment of amyloid disease are reviewed.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |