Tracheal Mucosa Research Articles

Discomfort following transurethral cystoscopy and catheterization: effects of gender and topical steroids

Discomfort following transurethral cystoscopy and catheterization: effects of gender and topical steroids

Influence of head flexion after endotracheal intubation on intraocular pressure and cardio-respiratory response in patients undergoing cataract surgery

During preparation and draping of periorbital area, neck flexion causes displacement of the endotracheal tube tip toward the carina. Stimulation of the tracheal mucosa may cause bucking, increased intraocular pressure (IOP), laryngospasm, bronchospasm, change in end-tidal carbon dioxide pressure (PETCO2) or peripheral arterial haemoglobin oxygen saturation (SpaO2) during light anaesthesia. To investigate the influence of head and neck flexion after endotracheal intubation on heart rate (HR), systolic and diastolic blood pressure (SAP and DAP), SpaO2, PETCO2 and IOP in patients undergoing cataract surgery during general anesthesia. In this prospective observational study, 106 ASA physical status I and II patients scheduled for elective cataract surgery under general anaesthesia were studied. Anaesthesia was induced with thiopental sodium, lidocaine and fentanyl. Atracurium 0.5 mg/kg was given to facilitate tracheal intubation. HR, SAP, DAP, SpaO2, PETCO2, and IOP were measured at 1, 2, and 5 minutes after head flexion. Mean SAP, DAP, IOP, and HR were significantly increased after head flexion compared with baseline values (P < 0.05). PETCO2 and SpaO2 were significantly decreased at 1 and 2 minutes after head flexion compared with baseline values (P < 0.001). It is concluded that endotracheal tube movement by changes in head and neck position has significant effects on heart rate, systolic and diastolic blood pressures, laryngeal reflexes, SpaO2, PETCO2, and intraocular pressure in patients undergoing cataract surgery under general anaesthesia.

Pathogenesis and Subsequent Cross-Protection of Influenza Virus Infection in Pigs Sustained by an H1N2 Strain

The H1N1, H3N2 and, more recently, H1N2 subtypes of influenza A virus are presently co-circulating in swine herds in several countries. The objectives of this study were to investigate the pathogenesis of Sw/Italy/1521/98 (H1N2) influenza virus, isolated from respiratory tissues of pigs from herds in Northern Italy, and to evaluate its potential cross-protection against the Sw/Fin/2899/82 (H1N1) strain. In the pathogenesis test, eight pigs were intranasally infected with H1N2 virus; at pre-determined intervals, these animals were killed and necropsied, along with eight uninfected animals. In the cross-protection test, sixteen pigs were infected by intranasal (i.n.) and intratracheal (i.t.) routes with either H1N2 or H1N1 virus. Twenty days later, all pigs were challenged (by the same route), with either the homologous H1N2 or heterologous H1N1 virus strains. Control group was inoculated with culture medium alone. On post-challenge days (PCD) 1 and 3, two pigs from each infected group, along with one control pig, were killed. Clinical, virological, serological and histopathological investigations were performed in both the pathogenicity and cross-protection tests. In the pathogenicity test, mild clinical signs were observed in two pigs during 3 and 4 days, respectively. Virus was isolated from two pigs over 6 days and from lung samples of pigs killed on post-infection days 2 and 4. Seroconversion was detected in the two infected animals killed 15 days after infection. In the cross-protection study, mild clinical respiratory signs were detected in all pigs infected with either the H1N2 or H1N1 virus. The virus was isolated from nasal swabs of almost all pigs till 6 days. After the challenge infection, the pigs remained clinically healthy and virus isolation from the nasal secretions or lung samples was sporadic. Antibody titres in H1N1 or H1N2 infected groups were similar, whereas the H1N2 sub-type induced less protection against re-infection by homologous and heterologous virus than H1N1 sub-type. The controls had no signs of the disease. In the H1N2 infected pigs, a reduced number of goblet cells in nasal and tracheal mucosa and small foci of lymphomononuclear cell infiltrates in the submucosa were detected. Furthermore, the goblet cell reduction was related to the time of infection. Diffuse mild interstitial pneumonia was also recorded in pigs infected with the H1N2 virus and challenged with either H1N1or H1N2 pigs. These studies showed the moderate virulence of the H1N2 virus and a partial cross-protection against heterologous infection.

Tracheal Ring Fracture as a Consequence of External Laryngeal Manipulation During Endotracheal Intubation

We report a case of tracheal ring fracture after external laryngeal manipulation for assisting intubation because of difficult laryngoscopy during induction of anesthesia. The patient was a 64-year-old female suffering from a large multinodular goiter scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy. Laryngoscopy was performed, which did not visualize the glottis. With application of forceful external laryngeal manipulation, intubation was successfully achieved on the third attempt. But on skin incision and tissue exposure, a single fractured site on the second tracheal ring was noted. Fiberoptic bronchoscopy was performed and showed the tracheal mucosa remaining unmolested without endotracheal lesion or cartilage dislodgement into the trachea. The operation was carried out uneventfully and the fracture was treated conservatively. After extubation, the patient recovered smoothly and had no symptoms suggestive of tracheal narrowing or hoarseness of voice. Neck computed tomography and fiberoptic bronchoscopy were performed postoperatively, both of which showed normal tracheal ring alignment without evidence of edema or hematoma. The patient was discharged 3 days after operation. At the 3-month follow-up, she displayed good airway function and phonation. After review of her clinical history, we speculated that the tracheal ring fracture was caused by forced external compression of the tracheal cartilage during endotracheal intubation.

α5β1 Integrin Blockade Inhibits Lymphangiogenesis in Airway Inflammation

The integrin alpha5beta1 has been previously implicated in tumor angiogenesis, but its role in the remodeling of both blood vessels and lymphatics during inflammation is at an early stage of understanding. We examined this issue using a selective, small-molecule inhibitor of alpha5beta1 integrin, 2-aroylamino-3-{4-[(pyridin-2-ylaminomethyl)heterocyclyl]phenyl}propionic acid (JSM8757), in a model of sustained airway inflammation in mice with Mycoplasma pulmonis infection, which is known to be accompanied by robust blood vessel remodeling and lymphangiogenesis. The inhibitor significantly decreased the proliferation of lymphatic endothelial cells in culture and the number of lymphatic sprouts and new lymphatics in airways of mice infected for 2 weeks but did not reduce remodeling of blood vessels in the same airways. In inflamed airways, alpha5 integrin immunoreactivity was present on lymphatic sprouts, but not on collecting lymphatics or blood vessels, and was not found on any lymphatics of normal airways. Macrophages, potential targets of the inhibitor, did not have alpha5 integrin immunoreactivity in inflamed airways. In addition, macrophage recruitment, assessed in infected airways by quantitative reverse transcription-polymerase chain reaction measurements of expression of the marker protein ionized calcium-binding adapter molecule 1 (Iba1), was not reduced by JSM8757. We conclude that inhibition of the alpha5beta1 integrin reduces lymphangiogenesis in inflamed airways after M. pulmonis infection because expression of the integrin is selectively increased on lymphatic sprouts and plays an essential role in lymphatic growth.

In situ tissue engineering for tracheal reconstruction using a luminar remodeling type of artificial trachea

After successful trials of tracheal reconstruction using mesh-type prostheses in canine models, the technique has been applied clinically to human patients since 2002. To enhance tissue regeneration, we have applied a new tissue engineering approach to this mesh-type prosthesis. The prosthesis consists of a polypropylene mesh tube reinforced with a polypropylene spiral and atelocollagen layer. The cervical tracheas of 18 beagle dogs were replaced with the prosthesis. The collagen layer was soaked with peripheral blood in 6 of the dogs, with bone marrow aspirate in another 6, and with autologous multipotential bone marrow-derived cells (mesenchymal stem cells) in another 6. The dogs were humanely killed at 1 to 12 months after the operation. All 18 dogs survived the postoperative period. Bronchoscopically, 3 of 4 dogs in the peripheral blood group showed stenosis, whereas no stenosis was evident in all 8 of the dogs in the bone marrow and mesenchymal stem cell groups 6 months after the operation. Faster epithelialization and fewer complications, such as mesh exposure and luminal stenosis, were observed in these two groups than in the peripheral blood group. Histologically, the cells from autologous bone marrow were found to proliferate into the tracheal tissue during the first month. Cilial movement in these two groups was faster than that in the peripheral blood group and recovered to 80% to 90% of the normal level. Bone marrow aspirate and mesenchymal stem cells enhance the regeneration of the tracheal mucosa on this prosthesis. This in situ tissue engineering approach may facilitate tracheal reconstruction in the clinical setting.

Amelioration of Airway Stenosis in Rabbit Models by Photodynamic Therapy with Talaporfin Sodium (NPe6)

It is difficult to treat patients with acquired airway stenosis, and the quality of life of such patients is therefore lowered. We have suggested the application of photodynamic therapy (PDT) as a new treatment for airway stenosis and have determined the efficacy of PDT in animal disease models using a second-generation photosensitizer with reduced photosensitivity. An airway stenosis rabbit model induced by scraping of the tracheal mucosa was administered NPe6 (5 mg kg(-1)), and the stenotic lesion was irradiated with 670 nm light emitted from a cylindrical diffuser tip at 60 J cm(-2) under bronchoscopic monitoring. PDT using NPe6 improved airway stenosis (P = 0.043) and respiratory stridor. A significant prolongation of survival time was seen in the PDT-treated animals compared to that in the untreated animals (P = 0.025) and 44% of the treated animals achieved long-term survival (>60 days). In conclusion, PDT using NPe6 is effective for improvement in airway stenosis.

Central vs. peripheral sites of action of antitussive agents in anesthetized guinea pigs

Dextromethorphan (DEX), SKF10047, codeine, DAMGO, mexiletine and baclofen have all been reported to prevent cough, in part, through direct peripheral effects on airway sensory nerves. We evaluated the ability of these drugs to modify coughing evoked by citric acid (CA) applied topically to the tracheal mucosa of anesthetized GPs. Drugs were applied topically to the tracheal mucusa (10‐100 μM) or were microinjected (0.1‐500nmol) bilaterally into nTS. CA (0.001‐2M) applied topically in ascending doses and in 100 μL aliquots evoked 13±2 coughs cumulatively (n=36). Mexiletine applied topically to the tracheal mucosa nearly abolished CA evoked coughing (3±1 coughs; n=6). None of the other drugs had any effect on cough when applied topically to the tracheal mucosa (n≤4). By contrast, all 6 drugs studied dose dependently inhibited (90‐100%) cough when microinjected bilaterally into the nTS sites of cough receptor termination (n=3‐6). Microinjection of the drugs into adjacent nTS locations was without effect on cough (n≤3). The data indicate that baclofen, DEX, SKF10047, DAMGO and codeine prevent cough receptor dependent cough by actions in the CNS and not in the periphery.

Tracheal resection with end-to-end anastomosis preserving paries membranaceus trachea for patients with papillary thyroid carcinoma

Conclusion. Sleeve resection of the trachea while preserving the paries membranaceus trachea appears useful for patients in whom papillary thyroid carcinoma has invaded as far as the tracheal mucosa. Objectives. While tracheal sleeve resection with end-to-end anastomosis is advantageous, risks of suture failure or other serious complications exist. Since feeding arteries enter the trachea from the posterior and lateral walls, we conduct tracheal anastomosis preserving the paries membranaceus trachea. Patients and methods. This study retrospectively examined therapeutic outcomes and postoperative complications for sleeve resection followed by end-to-end anastomosis in 12 patients between 1994 and 2005. Results. Tracheal suture failure occurred in one patient and sutures were redone. One patient developed esophageal fistula, but recovered with conservative treatment. One patient required re-intubation. In three patients, recurrent laryngeal nerves were paralyzed bilaterally. No patients displayed recurrence in the tracheal resection margin or preserved paries membranaceus trachea. The 10-year survival rate was 72.9%.

Surgical management of tracheal shaving for papillary thyroid carcinoma with tracheal invasion

Conclusion: Patients showed improved quality of life following tracheal shaving and the carcinoma was well controlled locally, as long as invasion had not progressed to the mucosal surface of the trachea. However, compared with papillary thyroid carcinoma (PTC) with no tracheal invasion, metastasis was common and invasion of organs other than the trachea was frequent, putting many patients into the high-risk group. The clinical course for such patients thus requires careful monitoring, with particular attention to metastasis to other locations. Tracheal shaving can be recommended for patients with PTC with tracheal invasion. Objectives: Macroscopically, in cases where invasion into the trachea has not reached the tracheal mucosa surface, we perform tracheal surface resection (tracheal shaving). We retrospectively investigated rates of local control, metastasis and survival in patients who had undergone tracheal shaving. Patients and methods: Subjects comprised 22 patients with PTC who underwent tracheal shaving between January 1994 and December 2005. Results: Local control was achieved in 21 patients (95%), and metastasis was seen in 6 patients (27%). With two patients dying from causes other than cancer, 5- and 10-year survival rates were 93% and 41%, respectively. The two surviving patients are still cancer-bearing.

In vivoreal time histology examination of the upper airway mucosa using confocal endomicroscopy

Objectives. We aim to establish whether in vivo confocal endomicroscopy (1) delivers a clear image of subcellular structures within the upper airway mucosa and (2) allows leucocytes to be identified using topical antibodies against CD45, the common leucocyte antigen. Methods. Endoscopic confocal images were captured from the supraglottic and tracheal mucosa in anaesthetised Landrace–Large white hybrid pigs using a rigid endoscope (Optiscan, Melbourne, Auctralia). 10% fluroscein was administered intravenously as contrast; 30 min later 0.05% acriflavine was applied as a topical contrast to the mucosa immediately prior to imaging of two pigs. In a further two pigs, 10% fluorescently labelled anti-CD45 antibody was applied topically immediately prior to imaging. Images were captured and reviewed on a computer screen at the time of examination. Results. High-resolution (x1000 magnification) images of the nuclei and cytoplasm of individual cells within the stratified squamous and respiratory epithelium of the supraglottis and trachea were captured using concurrent fluroscein and acriflavine staining. Intravenous fluroscein highlighted subsurface capillaries within which individual erythrocytes appeared as unstained shadows. Discrete leucocytes were clearly visible within the mucosa following topical application of anti-CD45 antibody. Conclusion. In vivo confocal endomicroscopy allows examination of the upper airway mucosa at cellular resolution in real time. We have, for the first time, combined in vivo confocal imaging with antibody targeting of specific cell markers in the upper airway in large animals. Combining confocal endomicroscopy with topical antibodies against tumour markers (e.g. EGFR and p53) may allow tumours to be diagnosed and characterised during endoscopic examination without taking a biopsy.

The effect of negative air ions on the respiratory organs and blood

The effect of ionized air containing negatively charged ions at a concentration of 320000–350000 ions/cm3 inhaled by rats was studied. It was demonstrated that the inhalation of negative air ions for 60 min activated the secretion of goblet cells without impairing the tracheal mucosa and changing the protein profile of bronchoalveolar lavage. It was also found that the level of spontaneous production of reactive oxygen species by unfractionated blood cells increased after the action of negative air ions in both males and females. However, the intensity of their generation induced by opsonized zymosan increased only in females. Different sensitivities of the female and male blood antioxidant enzymes—superoxide dismutase and glutathione reductase—to negative air ions were observed. These results allow the effect of negative air ions on the respiratory organs and blood to be interpreted as priming and weak activation via a direct action on the mucosa of primary target respiratory organs and then on the blood.

Cyclic adenosine monophosphate regulation of ion transport in porcine vocal fold mucosae.

Cyclic adenosine monophosphate (cAMP) is an important biological molecule that regulates ion transport and inflammatory responses in epithelial tissue. The present study examined whether the adenylyl cyclase activator, forskolin, would increase cAMP concentration in porcine vocal fold mucosa and whether the effects of increased cAMP would be manifested as a functional increase in transepithelial ion transport. Additionally, changes in cAMP concentrations following exposure to an inflammatory mediator, tumor necrosis factor-alpha (TNFalpha) were investigated. In vitro experimental design with matched treatment and control groups. Porcine vocal fold mucosae (N = 30) and tracheal mucosae (N = 20) were exposed to forskolin, TNFalpha, or vehicle (dimethyl sulfoxide) treatment. cAMP concentrations were determined with enzyme-linked immunosorbent assay. Ion transport was measured using electrophysiological techniques. Thirty minute exposure to forskolin significantly increased cAMP concentration and ion transport in porcine vocal fold and tracheal mucosae. However, 30-minute and 2-hour exposure to TNFalpha did not significantly alter cAMP concentration. We demonstrate that forskolin-sensitive adenylyl cyclase is present in vocal fold mucosa, and further, that the product, cAMP increases vocal fold ion transport. The results presented here contribute to our understanding of the intracellular mechanisms underlying vocal fold ion transport. As ion transport is important for maintaining superficial vocal fold hydration, data demonstrating forskolin-stimulated ion transport in vocal fold mucosa suggest opportunities for developing pharmacological treatments that increase surface hydration.

Radiologic and histologic characterization of silk fibroin as scaffold coating for rabbit tracheal defect repair

To explore the feasibility of silk fibroin as a biomaterial coating used in tracheal defect reconstruction. Silk fibroin was subcutaneously embedded in three rabbits and as an artificial implant material coating to reconstruct 12 rabbits' tracheal defects. The postoperative radiologic and histologic characterization was summarized. The thickness of the fibroblasts layer covering the porus and nonporus silk fibroin film was 240.4 +/- 9.9 and 302.3 +/- 10.5 microm, respectively, and there was no statistical difference (P > 0.05) within each group. There was no foreign-body granuloma or macrophagocyte infiltration around the silk film. The tracheal reconstruction study showed a normal mucous membrane with normal cilial growth on the artificial implant and no visible granulation tissue in the reconstructed tracheal cavity. Silk fibroin is a potential new biomaterial coating for tracheal defect reconstruction. The mechanism of silk fibroin appears to promote tracheal mucous membrane, which may be related to its molecular structure and biology.

Bilateral idiopathic orbital inflammation 3 years before systemic Wegener&amp;acute;s granulomatosis in a 7-year-old girl

Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis characterized by the involvement of the upper or lower airways, lungs, and kidneys, but it can affect almost any organ including the orbit. WG is rare in childhood. This case report describes a 7-year-old girl who presented bilateral idiophatic orbital inflammation and antineutrophil cytoplasmic antibodies-negative titres. Computed tomography scan and magnetic resonance imaging showed enlargement of both lacrimal glands with infiltration. Treatment with corticosteroids achieved remission of the disease. Three years later, she developed a systemic affectation with tracheal stenosis, pulmonary affectation, renal failure, and respiratory tract mucosa inflammation. Lacrimal gland biopsy showed perivascular nonspecific granulomas and ANCA titres remain negative. Treatment with corticosteroids and cyclophosphamide was done. A relapse occurred 2 years later, with complete remission with antitumor necrosis factor-alpha. No other symptoms have appeared after 9 years of follow-up. Early diagnosis and treatment is crucial to increase the survival rate in these patients.

End-stage renal disease secondary to IgA nephropathy in recessive dystrophic epidermolysis bullosa: a case report

Epidermolysis bullosa (EB) consists of a group of dominant or recessive autosomal diseases characterised by skin and mucosa fragility. The lesions leave erosions and scars that, in turn, can cause stenosis of tracheal, oesophageal, and genitourinary tract mucosae. The significantly increased survival of EB patients has determined the onset of complications never observed before, including genitourinary disorders such as hydroureteronephrosis, recurrent urinary tract infections, renal amyloidosis, IgA nephropathy and post-infectious glomerulonephritis. A 6-year-old boy diagnosed with recessive dystrophic EB Hallopeau-Siemens type (RDEB-HS) was referred to our clinic because of microhaematuria that evolved into intra-infectious macrohaematuria. Renal biopsy revealed an increase in both extracellular matrix and mesangial cells, with a focal segmental glomerulosclerosis with severe chronic tubulointerstitial damage. Immunofluorescence showed IgA mesangium deposits. Five years later, he was started on haemodialysis, because of worsening renal function. This is a rare case of a child with EB who was successfully treated with haemodialysis. The pertinent literature has been reviewed.

Short reflex expirations (expiration reflexes) induced by mechanical stimulation of the trachea in anesthetized cats

Fifty spontaneously breathing pentobarbital-anesthetized cats were used to determine the incidence rate and parameters of short reflex expirations induced by mechanical stimulation of the tracheal mucosa (ERt). The mechanical stimuli evoked coughs; in addition, 67.6% of the stimulation trials began with ERt. The expiration reflex mechanically induced from the glottis (ERg) was also analyzed (99.5% incidence, p < 0.001 compared to the incidence of ERt). We found that the amplitudes of abdominal, laryngeal abductor posterior cricoarytenoid, and laryngeal adductor thyroarytenoid electromyograms (EMG) were significantly enhanced in ERg relative to ERt. Peak intrathoracic pressure (esophageal or intra-pleural pressure) was higher during ERg than ERt. The interval between the peak in EMG activity of the posterior cricoarytenoid muscle and that of the EMG of abdominal muscles was lower in ERt compared to ERg. The duration of thyroarytenoid EMG activity associated with ERt was shorter than that in ERg. All other temporal features of the pattern of abdominal, posterior cricoarytenoid, and thyroarytenoid muscles EMGs were equivalent in ERt and ERg.In an additional 8 cats, the effect of codeine administered via the vertebral artery was tested. Codeine, in a dose (0.03 mg/kg) that markedly suppressed cough did not significantly alter either the incidence rate or magnitudes of ERt.In the anesthetized cat the ERt induced by mechanical stimulation of the trachea was similar to the ERg from the glottis. These two reflex responses differ substantially only in the frequency of occurrence in response to mechanical stimulus and in the intensity of motor output.

Cytochrome P450 3A, NADPH cytochrome P450 reductase and cytochrome b5 in the upper airways in horse

Gene and protein expression as well as catalytic activity of cytochrome P450 (CYP) 3A were studied in the nasal olfactory and respiratory mucosa and the tracheal mucosa of the horse. We also examined the activity of NADPH cytochrome P450 reductase (NADPH P450 reductase), the amount of cytochrome b 5 and the total CYP content in these tissues. Comparative values for the above were obtained using liver as a control. The CYP3A related catalytic activity in the tissues of the upper airways was considerably higher than in the liver. The CYP3A gene and protein expression, on the other hand, was higher in the liver than in the upper airway tissues. Thus, the pattern of CYP3A metabolic activity does not correlate with the CYP3A gene and protein expression. Our results showed that the activity of NADPH P450 reductase and the level of cytochrome b 5 in the relation to the gene and protein expression of CYP3A were higher in the tissues of the upper airways than in the liver. It is concluded that CYP3A related metabolism in horse is not solely dependent on the expression of the enzyme but also on adequate levels of NADPH P450 reductase and cytochrome b 5.

Threading a bead in trachea—A case report

Summary A rare case of a rounded bead, as a foreign body, in the trachea is mentioned. Unusual presentation is described. Fogarty balloon catheter is used to thread the bead and to extract without damaging tracheal mucosa.

Investigating the Failure to Aspirate Subglottic Secretions with the Evac Endotracheal Tube

Aspiration of subglottic secretions is a widely used intervention for prevention of ventilator-associated pneumonia. However, using the Hi-Lo Evac endotracheal tube (Hi-Lo Evac; Mallinckrodt; Athlone, Ireland) (Evac ETT), dysfunction of the suction lumen and subsequent failure to aspirate the subglottic secretions are common. Our objective in this study was to determine the causes of suction lumen dysfunction experienced with the Evac ETT. We studied 40 adult patients intubated with the Evac ETT. In all cases for which dysfunction of the suction lumen was observed, the subglottic suction port was examined visually using a flexible bronchoscope. Dysfunction of the suction lumen occurred in 19 of 40 patients (48%). In 17 of these (43%), it was attributed to blockage of the subglottic suction port by suctioned tracheal mucosa. Evacuation of subglottic secretions using the Evac ETT is often ineffective due to prolapse of tracheal mucosa into the subglottic suction port.