First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis.

Introduction Tracheal stenosis following intubation is the most common indication for tracheal resection and reconstruction. Endoscopic dilation is almost always associated with recurrence. This study investigated first-line surgical resection and anastomosis performed in fit patients presenting with postintubation tracheal stenosis. Methods Between February 2011 and November 2014, a prospective study was performed involving patients who underwent first-line tracheal resection and primary anastomosis after presenting with postintubation tracheal stenosis. Results A total of 30 patients (20 male) were operated on. The median age was 23.5 years (range: 13-77 years). Seventeen patients (56.7%) had had previous endoscopic tracheal dilation, four (13.3%) had had tracheal stents inserted prior to surgery and one (3.3%) had undergone previous tracheal resection. Nineteen patients (63.3%) had had a tracheostomy. Eight patients (26.7%) had had no previous tracheal interventions. The median time of intubation in those developing tracheal stenosis was 20.5 days (range: 0-45 days). The median length of hospital stay was 10.5 days (range: 7-21 days). The success rate for anastomoses was 96.7% (29/30). One patient needed a permanent tracheostomy. The in-hospital mortality rate was 3.3%: 1 patient died from a chest infection 21 days after surgery. There was no mortality or morbidity in the group undergoing first-line surgery for de novo tracheal lesions. Conclusions First-line tracheal resection with primary anastomosis is a safe option for the treatment of tracheal stenosis following intubation and obviates the need for repeated dilations. Endoscopic dilation should be reserved for those patients with significant co-morbidities or as a temporary measure in non-equipped centres.

An enzyme-linked immunoelectrotransfer blot assay for diagnosis of human cystic echinococcosis.

An enzyme-linked immunoelectrotransfer blot (EITB) test was assessed for diagnosis of 47 pulmonary cystic echinococcosis (CE) cases admitted to Ain Shams University Hospitals for Surgery. Diagnosis of these cases was established on clinical examination, X-ray, sonography and indirect hemagglutination (IHA) test, which was negative in four cases (sensitivity 91.5%). Sera from patients with other parasitic infections, carcinomas or normal sera were used as controls. Human and Camel hydatid cyst fluids were used as antigens after separation and characterization of their antigenic components using 12.5% SDS-PAGE under reducing conditions. Six molecular weight antigens with molecular masses approximately 7, 20, 28, 35 and 127 kDa were of diagnostic importance. They were strongly recognized by sera of all CE patients specially with camel hydatid cyst fluid (HCF) giving a 100% sensitivity to the EITB test. Sera of patients with other parasitic infections as well as carcinomas and normal control sera couldn't recognize any of the above antigens and therefore were negative for the test. This results in 100% specificity of the EITB test. These data support the concept that EITB using camel hydatid fluid is a good diagnostic test for cystic echinococcosis.