All issues
Volume 30 (1979)
- Issue 6 Pages 355-
- Issue 5 Pages 301-
- Issue 4 Pages 245-
- Issue 3 Pages 183-
- Issue 2 Pages 63-
- Issue 1 Pages 1-
Volume 30, Issue 2
Displaying 1-15 of 15 articles from this issue
- |<
- <
- 1
- >
- >|
-
Shigeto Ikeda1979 Volume 30 Issue 2 Pages 63-77
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSA review was made on recent progress in flexible bronchofiberscopy based on the author's 26 year experience since he first developed the bronchofiberscope in 1966. Presently available bronchofiberscopes manufactured by four different companies in Japan; Machida Endoscope Co., Olympus Optical Co., Asahi Optical Co. and Fuji Optical Co., were classified into two categories of “standard type” and “biopsy type with large channels” and their specifications and functions were compared. Progress in recording apparatuses such as still-cameras, cine-cameras and video TV systems were then discussed. The recent technique of diagnostic bronchofiberscopy for lung cancer was described with special reference to early cancer in the hilum as well as in the periphery. By using that technique, the rate of definitive diagnosis is 97.8% at present. Therapeutic bronchofiberscopy for bronchial washing and removal of foreign bodies was also discussed.View full abstractDownload PDF (9077K) -
[in Japanese]1979 Volume 30 Issue 2 Pages 78
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSDownload PDF (187K) -
Kurata Yuge1979 Volume 30 Issue 2 Pages 79-88
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSClinical cases of tracheal stenosis were investigated to study the cause of it. One hundred and eighty-two cases of tracheal stenosis were experienced (according to the data from the division of otorhinolaryngology of 37 universities) between January 1974 and July 1978. Of these cases, about 50% was caused by tracheotomy and about 20% was caused by wounds, of which 60% was caused by traffic accidents.
In order to examine the vessels in the tracheas of rabbits, latex was injected into the aortasof 11 rabbits, and the following results were obtained. The tracheoesophageal arteries of rabbits are branched from right and left longitudinal tracheoesophageal arteries (tentatively named). The right one is branched from the right subclavian artery and the left one from the left common carotid artery. There were some variations at the bifurcation of the left longitudinal tracheoesophageal artery. The branches of the longitudinal tracheoesophageal arteries were ligated at 2 to 4 sites on each side of the right and left, but there was no change in the trachea. There were many vessels in the tracheal mucosa, and the anastomoses were very complicated. It was considered that there was no problem in hemodynamics in the cases of end-to-end anastomosis.
Curettage of tracheal mucosa, tracheotomy, intubation and crushing of trachea were conducted in rabbits and rats. Curettage of the whole circumference of tracheal mucosa did not result in stenosis. Regarding a cannula used for tracheotomy, its shape and size rather than its material are important factors for tracheal stenosis under the consideration of its fitness to the tracheal lumen. Using a tube with cuffs, inflammation of the trachea reaching to the perichondrium was already observed 10 hours after the intubation. When the cannula used was too large, necrosis and desquamation of the whole layers of mucosa, formation of pseudomembrane and respiratory obstruction were observed, even though the application time was short. When tracheal cartilages of more than 3 annuli were crushed, severe stenosis occurred. However, deformation and stenosis will be protected against to some degree if a T-tube, for example, is inserted in time into the crushed site.View full abstractDownload PDF (8428K) -
Kiyoshi Togawa1979 Volume 30 Issue 2 Pages 89-92
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSStenosis of the upper airway caused by any pathology decreases normal ventilation, leading to serious disturbance in gas exchange.
1) Partitioning of the upper airway resistance.
The normal value of the upper airway resistance under quiet breathing is around 1.5cmH2O/L/sec., in which two-thirds are made by the nose and one-third by the pharyngo-larynx. When the mobility of the hemilarynx is disturbed, the value of laryngeal resistance may exceed that of nasal resistance; however, there are no signs of dyspnea. In case of bilateral laryngeal paralysis, dyspnea always appears, the resistance of which reaches more than 6cmH2O/L/sec.
2) Respiratory function in laryngeal stenosis.
Various respiratory function tests were performed on laryngeal diseases. On the relationgraph between VC% and FEV1.0% these data of laryngeal stenosis dropped in the territory showing pathologic changes, either obstructive or restrictive. In case of bilateral laryngeal paralysis, the MEFV curve showed diminished peak flow with a plateau-formation, a characteristic pattern of upper airway stenosis. In other cases such changes of the curve were not evident.
3) Respiratory gas analysis.
Continuous FO2 and FCO2 measurements were performed by sampling the respiratory gas through the tracheostoma. In bilateral laryngeal paralysis, SaO2 and PO2 values measured percutaneously showed slightly lower value than normal. When a pneumotachograph-mask is applied to record the respiratory pattern, these values decrease further, probably due to additional airway resistance and dead space.
In conclusion, upper airway stenosis not only of severe degree, but of a moderate degree as to feel slight difficulty in breathing, may affect the pulmonary function results. A tracheostomy or successful laryngeal or tracheal reconstruction will recover the normal ventilation.View full abstractDownload PDF (370K) -
Shigenori Nakajima1979 Volume 30 Issue 2 Pages 93-96
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThe treatment for bronchoconstriction should be aimed at the treatment of bronchoedema, bronchospasm, hypersecretion of mucous and ventilation-perfusion imbalance. Stimulation of β-adrenergic receptors and blockade of α-adrenergic receptors and cholinergic receptors can be considered as the therapeutic approach to bronchoconstriction, and the effectiveness of β-stimulants, α-blockers and anticholinergic compound on bronchospasm has been reported. It has been recognized that new β-stimulants have some different actions, and the effects of β-stimulants on bronchospasm are increased when α-blockers and β-stimulants are used together. Corticosteroids have been employed for the treatment of bronchoedema and hypersecretion of mucous. It has also been observed that β-stimulants and cromeglycate protect against exercise induced bronchospasm and allergen induced bronchoconstriction.View full abstractDownload PDF (452K) -
Yoshio Kurosu, Kozo Inami1979 Volume 30 Issue 2 Pages 97-101
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSIatrogenic injury, such as traumatic intubation and tracheostomy, is the prime cause of airway stenosis in children, as in the case of adults. However, due to the anatomical and functional incompetence of these children, any degree of airway stenosis can be fatal unless treated promptly and correctly.
The signs, the site, and the cause of airway problems should be assessed correctly and appropriate measures instituted in a stepwise fashion. Mainly, these measures consist of proper posioning of the head and adequate ventilation and oxygenation, according to the circumstances.
Under any circumstances, utmost care and effort should be taken in selecting the appropriate size endotracheal tube and in intubating atraumatically in these children. Our experience has been that the optimal tube sizes for Japanese children are 0.5mm, smaller than those calculated by the Corfield formula. Especially in smaller children, the fact that the so called “asphyxial interval” should be avoided at all costs is stressed.View full abstractDownload PDF (629K) -
Tsuneo Ishihara1979 Volume 30 Issue 2 Pages 102-106
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThere are three types of tracheal stenosis following intratracheal intubation and tracheostomy. They are; stomal stenosis which occurs at the site of tracheostomy, cuff level stenosis which occurs at the site of an inflated cuff of an intratracheal tube and tip stenosis at the site of a canula tip by irritation of a tracheal tube.
Up to date we have treated 3 cases of stomal stenosis, 3 cases of cuff level stenosis and one case of tip stenosis by means of tracheal reconstruction. In one case of stomal stenosis, tracheal stenosis recurred after reconstruction. This was due to an inadequate resection of the lesion of tracheal malacia. Operative results were satisfactory in the other cases.
Oblique tomography and flow-volume curve to diagnose tracheal stenosis and high speed ci ne tracheography to evaluate the state of postoperative airway passage were useful.
This paper deals with the methods of diagnosis and surgical technique for tracheal stenosis and also deals with methods to evaluate the airway passage following reconstruction of tracheal stenosis.View full abstractDownload PDF (5195K) -
Masazumi Maeda1979 Volume 30 Issue 2 Pages 107-110
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSTechnically this operation can be classified into two different methods: the anastomosis of the upper trachea to cricoid cartilage, and to the remaining larynx after partial resection of cricoid cartilage. While the former is almost the same as the the end-to-end anastomosis of the trachea, the latter is different in the following ways:
First, the resection of cricoid cartilage must be made at the lower border of the thyroid cartilage anteriorly and through the posterior cricoid lamina below the crico-thyroid joints posteriorly. This oblique resection line intends to prevent the injury of recurrent laryngeal nerve at the posterior crico-thyroid joint. Second, the cut surface at the level of anterior crico-thyroid joint is smaller than the tracheal lumen by 44% from luminal reconstruction by using silicon. This result indicates that the lumen of the trachea must be reduced for approximation to the remaining larynx after removal of cricoid cartilage.
Eight cases of laryngotracheal stricture were successfully operated upon by end-to-end direct anastomosis between the larynx and the trachea. Four cases were operated upon, anastomosing the trachea to the remaining larynx resected cricoid cartilage partially. Among these, 3 had suffered from difficult decanulation after tracheotomy and 1 from endotracheal infiltration of thyroid cancer. Thus, this operation is suitable for subglottic stenosis originating from the lesion of the upper trachea. It is still an unsolved problem as to how far into the subglottic region is resectable.
One case died from heart failure 3 months after operation and one from bleeding due to infiltration of thyroid cancer a month postoperatively. The remaining 6 were uneventful postoperatively and are now living normal life.View full abstractDownload PDF (1729K) -
Yasuo Harada1979 Volume 30 Issue 2 Pages 111-113
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSFive cases of tracheal stenosis due to tracheostomy are presented, and aspects of etiology and pathophysiology of the disease are discussed. A new soft, flexible T-tube was used for all five cases.
One patient, 1 year and 7 months old, had decannulaticn after tracheostomy. Eight months of nasotracheal intubaticn had been unsuccessful. But a silicon T-tube was effective for the decannulation. In three other cases the T-tubes were inserted for about 7 months to 12 months. All patients were allowed to stay at home after one week of postoperative observation. In the last case, since the cartilage of the trachea disappeared at the anterior wall, the costal cartilage was transplanted under the skin near the stoma. Six months later the costal cartilage was applied on the anterior wall plastics. Even for these cases the T-tube was useful for tracheal reconstruction. No side effects were seen during this process. For decannulation in children, it is better to wait, with the T-tube inserted.View full abstractDownload PDF (2403K) -
Kinya Takemoto1979 Volume 30 Issue 2 Pages 114-119
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThe author presented 28 patients with chronic stenosis of the larynx and cervical trachea, which were treated over a period of 13 years.
Successful decannulation was achieved in 26 of the 28 patients. In 24 cases, laryngeal and tracheal reconstruction were performed and in 2 cases, silicon T-tubes were used for stenting following repair of stenosis in the thoracical trachea region. Two cases have not as yet been decannulated.
The techniques which have successfully repaired chronic laryngeal and cervical tracheal stenosis are presented:
1. Surgical treatment is necessary only when cicatrical stricture in the larynx and trachea becomes apparent due to invasion of the cartilageneous framework. Appropriate resection of its scar tissue and necrotic cartilage was done in order to keep the sufficient lumen and this was followed by muco-cutaneous suture to keep the wound open. One month after the operation, the scar around the fistula had become firm enough to become the framework to maintain the lumen. If the tracheal mucosa degenerates to fibrous tissue, the trachea is opened and after removal of scar tissue the raw area is covered with nasal septal grafts.
2. In stenosis with median fixation of the vocal cord, the author applied a new technique for widening of the anterior glottal space instead of the lateralization method. The median portion of the thyroid cartilage is resected 10 to 15mm wide bilaterally. The mucosa of the anterior commissure of the cord is separated at the midline. The edge of each side of the mucosa is sutured to the perichondrium and to the skin of the same side. The anterior part of the glottic space is widened to become 4mm apart to ensure an adequate airway.
3. The wound is left open to prevent the reproduction of the cicatricial stricture and the skin flap is closed secondarily 1 or 2 months after surgery.View full abstractDownload PDF (6273K) -
Takeo Sato1979 Volume 30 Issue 2 Pages 120-122
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSSixty consecutive patients with laryngeal and tracheal stenosis caused by various traumas were treated. Among them, thirty cases were the result of prolonged intubation.
The larynx with stenosis was anteriorly opened according to our standardized surgical method. The airway was reconstructed in a gutter-like form by using the core mold after removal of fibrous scar tissue and transplantation of pedicle skin flap. The anterior laryngeal opening was closed secondarily by the door flap enclosed with cartilage. A silicon tube core mold was inserted in order to make a better laryngeal and tracheal framework.View full abstractDownload PDF (338K) -
Takeshi Hirose, Tokio Tomono, Katsura Yamamoto, Kunimasu Shimada1979 Volume 30 Issue 2 Pages 123-126
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThe treatment for late cases that showed stenosis of the larynx and trachea is troublesome and usually requires a long time and the perseverance of bath patients and doctors to be cured.
We devised an operation designed to produce a one stage cure:
1. The scar tissue of the stenosis area is resected.
2. To reconstruct the inner lining of the lumen, the island pedicle neck flap is inserted.
3. To insure the stable structural framework, the cartilage of the rib is usually used.
4. The stent is inserted into the lumen by using a finger cot, filled with silicon sponge, to maintain an adequate airway for about four weeks.
5. The external covering is done by direct closure or a rotated neck flap.
6. Tracheostoma should remain open for four to six months.
In five cases, all obtained satisfactory results for airway by this method.
We were concerned at first about the occurrence of necrosis of the flap and the cartilage. However, our experience with hemilaryngectomy (Conley) indicates that the cervical flap is the appropriate choice in these cases. We also believed in the stability of transplanted cartilage and therefore were confident in doing these operations. When this operation is done very carefully, with special attention given to treatment of the flaps, it is possible to complete the reconstruction in a short period.View full abstractDownload PDF (5944K) -
1979 Volume 30 Issue 2 Pages 127-137
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSDownload PDF (2345K) -
1979 Volume 30 Issue 2 Pages 138-165
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSDownload PDF (6133K) -
1979 Volume 30 Issue 2 Pages 166-177
Published: April 10, 1979
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSDownload PDF (2538K)
- |<
- <
- 1
- >
- >|