Bronchial and arterial sleeve resection for centrally-located lung cancers

The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections

Riverine Carbon Cycling as a Function of Seasonality

Montana has one of the most dynamic climate regimes in all of the United States, with seasonal changes spanning a large range of temperatures.  In Montana, we depend on water originating from snow and glacial melt. These freshwater ecosystems are considered to be some of the most vulnerable to climate change on Earth.  Glacially fed ecosystems are unique habitats for a vast array of life and geochemical processes, including carbon cycling. In order to study carbon cycling in environments vulnerable to change, an interdisciplinary approach including biogeochemical analyses of river DOM production and external allochthonous inputs is necessary to evaluate the impacts of climate change.  The overarching hypothesis for this work is: Seasonal changes in Montana rivers will cause shifts in carbon cycling as ecosystems respond to changes in temperature.  Unlike our initial hypothesis that the amount of sunlight and temperature would play a bigger role in what was happening, the time of the year was much more significant. In Big Sky OC levels in June for the sunny and canopy covered reaches were similar, 1.24 and 1.23 mg C/L, respectively; whereas at the end of July OC in the sunny reach was 0.42 mg C/Land the canopy cover reach was 0.955 mg C/L. The same trend is seen for the urban location in Bozeman. Cell abundance in the reaches followed similar trends, which were not solely based on temperature

Stenting treatment is a minimally traumatic and effective alternative to surgical repair for iatrogenic tracheobronchial lesion

Iatrogenic tracheobronchial injuries are rare but lifethreatening events, most frequently due to complication of endotracheal intubation or percutaneous tracheostomy. Their incidence is low (0.005–0.2% after double lumen or emergency single lumen intubation and up to 0.7% after percutaneous tracheostomy), but related mortality can be high and has been generally reported between 11% and 42% (1-5). Surgical repair has been considered the treatment of choice for a long time. More recently, along with the progressive evolution of interventional bronchoscopy, minimally invasive endoscopic treatment has gained diffusion as an effective alternative

Long term compensatory sweating results after sympathectomy for palmar and axillary hyperhidrosis

Endoscopic thoracic sympathectomy is currently the best treatment for primary upper extremity hyperhidrosis, but the potential for adverse effects, particularly the development of compensatory sweating, is a concern and often precludes surgery as a definitive therapy. This study aims to evaluate long-term results of two-stage unilateral versus one-stage bilateral thoracoscopic sympathectomy

A Novel Technique for Laryngotracheal Reconstruction for Idiopathic Subglottic Stenosis

Idiopathic subglottic stenosis is the most challenging condition in the field of upper airway reconstruction. We describe a successful novel technique for enlarging the airway space at the site of the laryngotracheal anastomosis in very high-level reconstructions

Tracheal surgery

Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases

Successful treatment of cerebral arterial gas embolism following uneventful TBNA

Fibrobronchoscopy is commonly considered a safe procedure with a low major complication rate not including cerebral arterial gas embolism (CAGE) a severe life threatening iatrogenic complication. Several cases of transbronchial needle aspiration (TBNA) has been related with CAGE when patient happens to have the high airway pressure that exceeds the pressure of the pulmonary veins allowing the air to enter the systemic circulation through the left heart. HBOT is the only effective treatment available for CAGE that provides 100% oxygen at high pressure, which accelerates nitrogen reabsorption and improves oxygenation of ischemic tissue. We reported a case of successful treatment with full recovery after early Hyperbaric Oxygen therapy of CAGE induced by an uneventful transbronchial biopsy during fibrobronchoscopy

Tracheal surgery

Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases

Long-term results of laryngotracheal resection for benign stenosis from a series of 109 consecutive patients

OBJECTIVES: Long-term results of patients undergoing laryngotracheal resection for benign stenosis are reported. This is the largest series ever published. METHODS: Between 1991 and March 2015, 109 consecutive patients (64 males, 45 females; mean age 39 ± 10.9 years) underwent laryngotracheal resection for subglottic postintubation (93) or idiopathic (16) stenosis. Preoperative procedures included tracheostomy in 35 patients, laser in 17 and laser plus stenting in 18. The upper limit of the stenosis ranged between actual involvement of the vocal cords and 1.5 cm from the glottis. Airway resection length ranged between 1.5 and 6 cm (mean 3.4 ± 0.8 cm) and it was over 4.5 cm in 14 patients. Laryngotracheal release was performed in 9 patients (suprahyoid in 7, pericardial in 1 and suprahyoid + pericardial in 1). RESULTS: There was no perioperative mortality. Ninety-nine patients (90.8%) had excellent or good early results. Ten patients (9.2%) experienced complications including restenosis in 8, dehiscence in 1 and glottic oedema requiring tracheostomy in 1. Restenosis was treated in all 8 patients with endoscopic procedures (5 laser, 2 laser + stent, 1 mechanical dilatation). The patient with anastomotic dehiscence required temporary tracheostomy closed after 1 year with no sequelae. One patient presenting postoperative glottic oedema underwent permanent tracheostomy. Minor complications occurred in 4 patients (3 wound infections, 1 atrial fibrillation). Definitive excellent or good results were achieved in 94.5% of patients. Twenty-eight post-coma patients with neuropsychiatric disorders showed no increased complication and failure rate. CONCLUSIONS: Laryngotracheal resection is the definitive curative treatment for subglottic stenosis allowing very high success rate at long term. Early complications can be managed by endoscopic procedures achieving excellent and stable results over time

A modified technique to simplify external fixation of the subglottic silicone stent

Several techniques have been previously proposed to fix silicone stents for subglottic tracheal stenosis. However, they require special tools or cumbersome manoeuvres. The proposed modified procedure offers a potential alternative fixing technique using absorbable suture buried subcutaneously and not requiring special devices. This procedure was successfully performed in 27 patients with inoperable complex subglottic stenosis. The mean distance from vocal folds, the mean length and mean diameter of stenosis were 17 ± 2 mm, 20 ± 2.9 mm and 6.9 ± 0.9 mm, respectively. The mean procedural time for fixing the stent was 5 ± 0.3 min. No intraoperative or postoperative complications such as stent damage, dislocation, plugging or vocal folds dysfunction were reported (mean follow-up 20 ± 7.7 months)