Post-intubation tracheal lacerations: Risk-stratification and treatment protocol according to morphological classification

BackgroundPost-intubation tracheal laceration (PITL) is a rare condition (0.005% of intubations). The treatment of choice has traditionally been surgical repair. Following our first report in 2010 of treatment protocol tailored to a risk-stratified morphological classification there is now clear evidence that conservative therapy represents the gold standard in the majority of patients. In this paper we aim to validate our risk-stratified treatment protocol through the largest ever reported series of patients. MethodsThis retrospective analysis is based on a prospectively collected series (2003-2020) of 62 patients with PITL, staged and treated according to our revised morphological classification. ResultsFifty-five patients with Level I (#8), II (#36) and IIIA (#11) PITL were successfully treated conservatively. Six patients with Level IIIB injury and 1 patient with Level IV underwent a surgical repair of the trachea. No mortality was reported. Bronchoscopy confirmed complete healing in all patients by day 30. Statistical analysis showed age only to be a risk factor for PITL severity. ConclusionsOur previously proposed risk-stratified morphological classification has been validated as the major tool for defining the type of treatment in PITL

Rettopessi per via addominale secondo Wells con patch mycromesh PTFE (Goretex)

rolasso rettale completo (PR) è quella condizione patologica caratterizzata dalla fuoriuscita dal canale anale di tutti gli strati della parete rettale. La terapia chirurgica offre molteplici scelte, diver - se tra loro. A partire dagli anni ’70 si è assistito all’affermazione della rettopessi per via addominale, che meglio di ogni altra tecnica previe - ne il rischio di recidiva tanto da divenire l’intervento di scelta, anche nel paziente anziano quando le condizioni generali lo consentano. L’alta percentuale di successo della rettopessi anteriore risiede: 1) nella mobilizzazione del retto che può essere completa o limitata al solo piano posteriore; in ogni caso l’asse vascolare mesenterico-emorroida - rio va rispettato, mentre non vi è accordo sull’opportunità o meno di sezionare le ali del retto, che consente sì un migliore ancoraggio del retto ma può causare una denervazione del canale ano-rettale con conseguente alterazione dell’evacuazione; 2) nei processi di fibrosi cicatriziale potenziati dall’impiego di materiale protesico, che fissano il retto al sacro mantenendolo così nella posizione desiderata. L’esperienza degli Autori riguarda il trattamento chirurgico di 4 pazienti (2 di sesso maschile e 2 di sesso femminile), di età superiore ai 65 anni, affetti da prolasso completo del retto, sintomatico e tratta - to con accesso per via addominale. Dopo la mobilizzazione completa del retto, esso è stato ancorato al sacro tramite un patch di goretex fis - sato dapprima alla fascia presacrale e quindi sulla parete del retto secondo la tecnica di Wells, lasciando 1/3 di parete anteriore libero da sutura. I 4 pazienti hanno avuto un decorso postoperatorio regola - re; solo in 1 caso si è avuto un ritardo della canalizzazione. A circa 1 anno dall’intervento i risultati sono soddisfacenti, con assenza di reci - diva e di importanti turbe dell’evacuazione

The Endoscopic Treatment of Tracheo-bronchial Amyloidosis: A Challenging Issue

Tracheo-bronchial amyloidosis is a rare airway disorder that can be a challenge for the limitations of&nbsp; treatment,&nbsp; recurrence&nbsp; and&nbsp; complications.&nbsp; We&nbsp; report&nbsp; the&nbsp; complex&nbsp; clinical&nbsp; course&nbsp; of&nbsp; a&nbsp; patient&nbsp; with symptomatic&nbsp; localized&nbsp; tracheo-bronchial&nbsp; amyloidosis.&nbsp; Different&nbsp; procedures&nbsp; were&nbsp; performed&nbsp; due&nbsp; to recurrent amyloid over a period of three and half years from the first endoscopic resection</p

A new technique for treatment of tracheal stenosis

We show the use of a new endoscopic drill for the management of web-like tracheal stenosis. Our device creates radial holes within stenosis that facilitate the use of scissors for cutting the scar tissue and the subsequent mechanical dilatation

The technique of endoscopic airway tumor treatment

More than half of primary lung cancers are not resectable at diagnosis and 40% of deaths may be secondary to loco-regional disease. Many of these patients suffer from symptoms related to airways obstruction. Indications for therapeutic endoscopic treatment are palliation of dyspnea and other obstructive symptoms in advanced cancerous lesions and cure of early lung cancer. Bronchoscopic management is also indicated for all those patients suffering from benign or minimally invasive neoplasm who are not suitable for surgery due to their clinical conditions. Clinicians should select cases, evaluating tumor features (size, location) and patient characteristics (age, lung function impairment) to choose the most appropriate endoscopic technique. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement and local treatment of endobronchial lesions. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound (EBUS), autofluorescence bronchoscopy (AFB), and narrow band imaging (NBI). Other techniques, such as endobronchial intra-tumoral chemotherapy (EITC), EBUS-guided-transbronchial needle injection or bronchoscopy-guided radiofrequency ablation (RFA), are in development for the use within the airways. These endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer, benign or otherwise not approachable central airway lesions. We aimed at revising several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy (PDT)