scholarly journals Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy

2016 ◽  
Vol 65 (4) ◽  
Author(s):  
G. Stratakos ◽  
C. Zisis ◽  
I. Bellenis ◽  
V. Filaditaki ◽  
A. Liapikou ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Stent Placement ◽  
Poor Prognosis ◽  
Tracheoesophageal Fistula ◽  
Therapeutic Option ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Septic Complication ◽  
Tracheal Stent ◽  
Esophageal Stenting

Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement.

Fetoscopic balloon dilation and stent placement of congenital high airway obstruction syndrome leading to successful Caesarian delivery

2022 ◽  
Author(s):  
Alice King ◽  
Joshua R. Bedwell ◽  
Deepak K. Mehta ◽  
Gary E. Stapleton ◽  
Henri Justino ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Stent Placement ◽  
Maternal Morbidity ◽  
Tracheoesophageal Fistula ◽  
Balloon Dilation ◽  
Laryngeal Stenosis ◽  
Tracheal Stent ◽  
Neonatal Hypoxia ◽  
Exit Procedure

Introduction: Without fetal or perinatal intervention, congenital high airway obstruction syndrome (CHAOS) is a fatal anomaly. The ex utero intrapartum treatment (EXIT) procedure has been used to secure the fetal airway and minimize neonatal hypoxia, but is associated with increased maternal morbidity. Case Presentation: A 16-year-old woman (gravida 1, para 0) was referred to our hospital at 31 weeks gestation with fetal anomalies, including echogenic lungs, tracheobronchial dilation and flattened diaphragms. At 32 weeks, fetoscopic evaluation identified laryngeal stenosis, which was subsequently treated with balloon dilation and stent placement. The patient developed symptomatic and regular preterm contractions at post-operative day 7 with persistent sonographic signs of CHAOS, which prompted a repeat fetoscopy with confirmation of a patent fetal airway followed by Cesarean delivery under neuraxial anesthesia. Attempts to intubate through the tracheal stent were limited and resulted in removal of the stent. A neonatal airway was successfully established with rigid bronchoscopy. Direct laryngoscopy and bronchoscopy confirmed laryngeal stenosis with a small tracheoesophageal fistula immediately inferior to the laryngeal stenosis and significant tracheomalacia. A tracheostomy was then immediately performed for anticipated long term airway and pulmonary management. The procedures were well tolerated by both mom and baby. The baby demonstrated spontaneous healing of the tracheoesophageal fistula by day of life 7 with discharge home with ventilator support at three months of life. Conclusion: Use of repeated fetoscopy in order to relieve fetal upper airway obstruction offers the potential to minimize neonatal hypoxia, while concurrently decreasing maternal morbidity by avoiding an EXIT procedure. Use of the tracheal stent in CHAOS requires further investigation. The long-term reconstruction and respiratory support of children with CHAOS remain challenging

scholarly journals Tracheal Penetration and Tracheoesophageal Fistula Caused by an Esophageal Self-Expanding Metallic Stent

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Karan Madan ◽  
Arun Venuthurimilli ◽  
Vineet Ahuja ◽  
Vijay Hadda ◽  
Anant Mohan ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Stent Placement ◽  
Tracheoesophageal Fistula ◽  
Esophageal Stent ◽  
Metallic Stent ◽  
Rare Occurrence ◽  
Sems Placement ◽  
Esophageal Stenting

Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesophageal fistula (TEF) formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.

scholarly journals Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6

2021 ◽  
Vol 10 (8) ◽  
pp. 1583
Author(s):  
Robert Flisiak ◽  
Jerzy Jaroszewicz ◽  
Magdalena Rogalska ◽  
Tadeusz Łapiński ◽  
Aleksandra Berkan-Kawińska ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Mechanical Ventilation ◽  
Confidence Interval ◽  
Clinical Improvement ◽  
Interleukin 6 ◽  
Death Rate ◽  
Treatment Effectiveness ◽  
Therapeutic Option ◽  
Oxygen Supplementation ◽  
End Points

Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08–0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%.

Endoscopic Stent Placement as a Therapeutic Option for Post Bariatric Surgery Leaks: The Kuwait Experience

2011 ◽  
Vol 140 (5) ◽  
pp. S-619
Author(s):  
Jaber Al-Ali ◽  
Adel Ahmed ◽  
Fahad Al-asfar ◽  
Basel Alsumait ◽  
Fuad Hasan
Keyword(s):  
Bariatric Surgery ◽  
Stent Placement ◽  
Therapeutic Option ◽  
Endoscopic Stent ◽  
Post Bariatric Surgery

Tracheobronchial foreign body aspiration in children: a 5-year retrospective study from Shanghai, China

2019 ◽  
Author(s):  
Guodong Ding ◽  
Beirong Wu ◽  
Angela Vinturache ◽  
Chen Cai ◽  
Min Lu ◽  
...  
Keyword(s):  
Foreign Body ◽  
Descriptive Analysis ◽  
Sudden Onset ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Older Children ◽  
Female Ratio ◽  
X Ray ◽  
Presenting Symptoms ◽  
First Choice

Abstract Background Foreign body (FB) aspiration is a common and serious problem in childhood, but little information is available about this condition in Chinese context. We aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population. Methods A retrospective review of medical records of children aged 0-14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between 2013 and 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs. Results Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years. The male to female ratio was 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. Eleven percent were laryngotracheal FBs and 89% were bronchial FBs. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal x-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. In children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was successfully performed in 80.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during bronchoscopy due to acute respiratory failure. Conclusions Tracheobronchial FBs should be suspected in children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent. Flexible bronchoscopy has become the first choice in China used for FB removal from airways in children.

Intravenous Immunoglobulin as a Therapeutic Option for Mycoplasma pneumoniae Encephalitis

2019 ◽  
Vol 34 (11) ◽  
pp. 687-691
Author(s):  
Mebratu Daba ◽  
Peter B. Kang ◽  
John Sladky ◽  
Sharatchandra S. Bidari ◽  
Robert M. Lawrence ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Clinical Improvement ◽  
Treatment Regimen ◽  
Mycoplasma Pneumoniae ◽  
Therapeutic Option ◽  
Brain Magnetic Resonance Imaging ◽  
Therapeutic Interventions ◽  
Mri Findings ◽  
Prodromal Symptoms ◽  
Neurologic Symptoms

Objective: To analyze the outcomes of a cohort of children diagnosed with Mycoplasma pneumoniae encephalitis whose treatment regimens included intravenous immunoglobulin (IVIG). Methods: A retrospective study was performed at a single center between 2011 and 2016 of children diagnosed with Mycoplasma pneumoniae encephalitis whose acute treatment regimen included IVIG. Details of therapeutic interventions and the clinical course were retrieved from medical records via an institutionally approved protocol. The modified Rankin score was used to quantify outcomes. Results: Four children met inclusion criteria, 3 of whom had prodromal symptoms of infection lasting 5 to 7 days before onset of their neurologic symptoms. One patient presented with neurologic symptoms with no clinical prodrome. The initial treatment regimen included systemic corticosteroids, antibiotics, or both. IVIG was administered for a total dose of 2 g/kg divided over 2 to 4 days to all 4 children. All children showed clinical improvement after IVIG. The 3 children with prodromal symptoms showed immediate and dramatic clinical improvement after IVIG therapy. Discussion: The immediate response to immunomodulatory therapy in the patients with prodrome suggests that the neurologic syndrome may be caused at least in part by an autoimmune process. The child who did not respond to IVIG had no prodrome, and also had normal electroencephalographic (EEG) and brain magnetic resonance imaging (MRI) findings. These cases suggest that early administration of IVIG should be considered in patients suspected of having Mycoplasma encephalitis, particularly in those who have had prodromal symptoms.

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