Rotura de la cánula de traqueostomía: una causa rara de dificultad respiratoria en el nino traqueotomizado. Caso clínico / Fractured tracheostomy tube: a rare cause of respiratory distress in the tracheotomized child. Case report

La fractura y migración de la cánula de traqueostomía en el árbol traqueobronquial es una complicación poco frecuente de la traqueostomía. El diagnóstico precoz y el tratamiento adecuado son esenciales debido al riesgo potencial de obstrucción respiratoria fatal. El diagnóstico se debe sospechar en todo niño traqueotomizado que presenta dificultad respiratoria. Se confirma mediante radiografía de tórax y examen endoscópico. El tratamiento de elección es la remoción endoscópica de la cánula aspirada a través del estoma traqueal. Describimos la presentación clínica y el manejo de la rotura de cánula de traqueostomía que se presentó como cuerpo extrano en la vía aérea de un niño de 18 meses. También incluimos recomendaciones para el cuidado de la traqueostomía.

Fracture and migration of the tracheotomy tube in the tracheobronchial tree is an uncommon complication of tracheotomy. Early diagnosis and proper treatment are essential because of the potential risk of fatal respiratory obstruction. Diagnosis should be suspected in all tracheotomized children undergoing breathing difficulties. It is confirmed by chest x-ray and endoscopic examination. The recommended treatment includes the endoscopic removal of the aspirated cannula through the tracheal stoma. We describe the clinical presentation and the management of a broken tracheotomy tube which was presented as a foreign body in the airway of a 18-month-old child. Recommendations for tracheostomy care are listed.

Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees

PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age.

Sildenafil decreases rat tracheal hyperresponsiveness to carbachol and changes canonical transient receptor potential gene expression after antigen challenge

Inhibition of type-5 phosphodiesterase by sildenafil decreases capacitative Ca2+ entry mediated by transient receptor potential proteins (TRPs) in the pulmonary artery. These families of channels, especially the canonical TRP (TRPC) subfamily, may be involved in the development of bronchial hyperresponsiveness, a hallmark of asthma. In the present study, we evaluated i) the effects of sildenafil on tracheal rings of rats subjected to antigen challenge, ii) whether the extent of TRPC gene expression may be modified by antigen challenge, and iii) whether inhibition of type-5 phosphodiesterase (PDE5) may alter TRPC gene expression after antigen challenge. Sildenafil (0.1 µM to 0.6 mM) fully relaxed carbachol-induced contractions in isolated tracheal rings prepared from naive male Wistar rats (250-300 g) by activating the NO-cGMP-K+ channel pathway. Rats sensitized to antigen by intraperitoneal injections of ovalbumin were subjected to antigen challenge by ovalbumin inhalation, and their tracheal rings were used to study the effects of sildenafil, which more effectively inhibited contractions induced by either carbachol (10 µM) or extracellular Ca2+ restoration after thapsigargin (1 µM) treatment. Antigen challenge increased the expression of the TRPC1 and TRPC4 genes but not the expression of the TRPC5 and TRPC6 genes. Applied before the antigen challenge, sildenafil increased the gene expression, which was evaluated by RT-PCR, of TRPC1 and TRPC6, decreased TRPC5 expression, and was inert against TRPC4. Thus, we conclude that PDE5 inhibition is involved in the development of an airway hyperresponsive phenotype in rats after antigen challenge by altering TRPC gene expression.

Pulmonary melioidosis presenting with right paratracheal mass.

A rare case of pulmonary melioidosis is reported. The patient was a 62-year-old man presenting with subacute fever, dry cough, and significant weight loss. A chest x-ray revealed a right paratracheal mass. The findings from fiberoptic bronchoscopy were a blunt carina and normal tracheobronchial tree. The patient had an underlying disease of poorly controlled diabetes mellitus, heavy smoking, and heavy alcoholic drinking. One of the two cultured blood specimens grew B. pseudomallei. The pathological finding of transbronchial biopsy at the apical segment of the right upper lung showed lymphocytic infiltrates. He was treated with two weeks of intravenous ceftazidime plus cotrimoxazole followed by 5 months of oral doxycycline plus cotrimoxazole. Clinical symptoms significantly improved and the right paratracheal mass disappeared.

Traqueobronquite necrotisante: relato de um caso em lactente / Necrotizing tracheobronchitis in an infant

Objetivo: Alertar os pediatras emergencistas para uma causa pouco comum de obstruçäo de vias aéreas em crianças submetidas a ventilaçäo mecânica. Métodos: Os autores relatam um caso de traqueobronquite necrotisante em lactente de 8 meses e discutem a fisiopatologia, diagnóstico e abordagem terapêutica. Resultados: A crianca apresentou evoluçäo favorável associado ao diagnóstico precoce e pronta intervençäo broncoscópica. Conclusöes: Os pediatras emergencistas devem suspeitar de traqueobronquite necrotisante em todas as crianças sob ventilaçäo mecânica que apresentarem o quadro clínico típico caracterizado por obstruçäo aguda das vias aéreas, hiperinsuflaçäo pulmonar, mesmo fora do período neonatal. Essa situaçäo, uma vez reconhecida, constitui indicaçäo precisa de traqueobroncoscopia de urgência...

Tracheobronchial foreign bodies in children

Bronchoscopy was performed in 45 patients with suspicion of foreign body aspiration during 1996 at B-unit of National Institute of Child Health [NICH], Karachi. The common symptoms were sudden onset of dyspnoea of variable intensity and cough. In 35 patients the foreign body was found and removed. Betel nut [supari, chalia, Areca catechu] was the cause in majority [45%] of cases. Two patients died following removal while one died before bronchoscopy. Ten patients were referred from other cities. Foreign body aspiration should be suspected in patients who present with sudden onset of respiratory symptoms even in the absence of history of aspiration. Emergency bronchoscopy facility should be made available in all the centres dealing with paediatric emergencies and should be made part of surgical residency programme even at R1 level. Mass awareness should be created through electronic media and family physicians to decrease the incidence of such accidents

Effect of removal of tracheal epithelium on histamine responsiveness and oxygen tension

The present study was done to investigate the relation between the hyperresponsiyeness of the isolated guinea pig trachea devoid of epithelium of agonists example: histamine and the oxygen tension in the surrounding bathing fluid [Krebs' solution]. Histamine dose response curves were constructed using isolated guinea pig tracheas with intact epithelium and with those devoid of epithelium. The curves of the denuded tracheaI strips showed a parallel shift to the left. Meanwhile the oxygen tension was measured in the bathing surrounding the trachea with intact epithelium and surrounding the trachea with denuded epithelium and compared to the oxygen tension in Krebs solution containing no trachea under constant conditions. It was found that oxygen tension of Krebs' solution surrounding the intact tracheas was highly significantly decreased compared to the solution surrounding the denuded ones which was also decreased but to a lesser extent than the controls. The results of this could suggest that metabolism of oxygen by airway epithelium may contribute towards the modulation of smooth muscle response. Thus, in the absence of the airway epithelium similar to cases of bronchial asthma, there is a decrease in the oxygen metabolism which may be attributed to the hyperactivity of the bronchial muscles leading to bronchoconstriction

Effect of cooling on contraction of sensitized guinea-pig trachea

The effect of cooling on contractility of ovalbumin sensitized guinea pig trachea was elucidated and the possible mechanisms underlying the effects of cooling on contractility induced by histamine, 5-HT and ovalbumin were investigated. Cooling of temperature from 37C to 25C is associated with significant increase in tracheal contractions to exogenously administered 5-1T, histamine and ovalbumin. Verapamil incubation [10 muM] produced significant depression of the contractile responses at 25C but not at 37C. These results demonstrated that the cooling induced contractile augmentation of the sensitized guinea-pig trachea to ovalbumin is due to 5-HT and histamine. The mechanisms of this augmentation may involve the increased opening of calcium channels in the membranes to allow calcium influx or the mobilization of calcium from intracellular calcium stores

interesting and difficult foreign body trachea in an adult female

Foreign body in tracheobronchial tree though commonly seen in paedriatic age group is not so frequent in adults. With different age groups nature of the foreign bodies and their clinical presentation differ and hence the management too. We report a case of an adult female with an interesting and problematic foreign body trachea to emphasize the fact that foreign bodies, though inhaled by chance, may be troublesome to deal with