In cases of intellectually disabled patients, there is sometimes difficult to obtain sufficient information due to the intellectual disorder, even though the patient has significant medical problems. Herein, we report a case of decreased oxygen saturation and inadequate air exchange during general anesthesia in an intellectually disabled patient. We also describe the subsequent management, including the diagnosis of tracheomalacia (TM) using bronchoscopy, and the management of airway compromise with manual and/or controlled respiration, which led to the prevention of complications.
Airway Management ; Anesthesia, General ; Bronchoscopes ; Bronchoscopy ; Diagnosis ; Humans ; Oxygen ; Respiration ; Tracheomalacia

Tracheomalacia is characterized by weakness of the tracheal walls and supporting cartilage. It results in dynamic compression of the airway, where the cross-sectional area of the trachea is reduced by expiratory compression. Acquired tracheomalacia results from complications associated with the use of endotracheal or tracheostomy tubes. In this report, we present three cases of patients with amyotrophic lateral sclerosis (ALS) successfully treated for tracheomalacia, including one case where the patient underwent surgery for combined tracheoesophageal fistula. We discuss the appropriate management strategies for tracheomalacia in patients with ALS. Through these case reports, we note the results of ALS patients who will have tracheostomy, and who are therefore at risk of sustaining a long term high cuff pressure, this study provides an evaluation for tracheomalacia and therapeutic management which should be considered for improving patient care outcomes.
Amyotrophic Lateral Sclerosis* ; Cartilage ; Humans ; Patient Care ; Trachea ; Tracheoesophageal Fistula ; Tracheomalacia* ; Tracheostomy

PURPOSE: This study was performed to investigate the indications, yield, and complications of flexible bronchoscopy for respiratory disease in children compared to earlier domestic studies and to examine if any differences existed in comparison to international studies. METHODS: The medical records of 100 cases of flexible bronchoscopy that were performed in 76 patients at the Department of Pediatrics of The Catholic University of Korea, Seoul St. Mary's Hospital from June 16, 2010 to August 6, 2013 were reviewed. RESULTS: A total of 76 patients (50 males and 26 females) were included in the study. The most common indication of flexible bronchoscopy was persistent pneumonia or pneumonia in immunocompromised patients (53 cases). The object of flexible bronchoscopy was accomplished in 65 of 100 cases, and, the treatment was changed in 24 of 65 cases. The most common abnormal finding was tracheomalacia that was found in 18 cases. In 67 cases where bronchoalveolar lavage was performed, bacteria were identified in 47 cases, fungi in 9 cases, and viruses in 22 cases. Complications occurred in 8 cases. CONCLUSION: Compared to earlier domestic studies, there was no significant change in diagnostic approaches and therapeutic improvement. However, this study showed that flexible bronchoscopy appears to be safe in patients with hemato-oncologic disease. Compared to international studies, the occurrence of complications due to flexible bronchoscopy was relatively low.
Bacteria ; Bronchoalveolar Lavage ; Bronchoscopy* ; Child* ; Fungi ; Humans ; Immunocompromised Host ; Korea ; Male ; Medical Records ; Pediatrics ; Pneumonia ; Seoul ; Tracheomalacia

No abstract available.
Adult ; Brain/diagnostic imaging ; Bronchoscopy ; *Chromosomes, Human, Pair 9 ; Death, Sudden, Cardiac/*etiology ; Gene Duplication ; Humans ; Karyotyping ; Male ; Mental Disorders/*complications/genetics/pathology ; Tomography, X-Ray Computed ; Tracheomalacia/diagnostic imaging ; Ventricular Fibrillation/complications

A case series was conducted at our institution on the the use of self-expanding metal stents (SEMS) in the cervical esophagus and their tolerability. Departmental records identified 20 consecutive stents placed in the cervical esophagus of 12 patients at our institution. There were 6 men and 6 women, mean age 67.2 years (range, 47.6-91.6 years). Ten patients had either primary or recurrent malignant disease and two had benign disease; a recalcitrant stricture at the oesophago-gastric anastomosis following oesophagectomy and a tracheo-oesophageal fistula secondary to tracheomalacia. Three patients received multiple stents on separate occasions requiring 2, 3, and 6 stents. Nineteen stents were placed radiologically with fluoroscopic guidance via a per-oral route under conscious sedation, and one was placed under direct endoscopic visualisation. Patients were followed up until death or to date. All stents were successfully deployed across the strictures. There was no foreign body sensation (FBS) reported after 16 of the procedures (80%). One patient reported transient FBS. Three stents were removed without complication because of symptoms; the endoscopically placed stent which was within 5 mm of cricopharyngeus and two which were inadvertently deployed across cricopharyngeus. There were no other significant complications related to the stent or procedure. All patients reported significant improvement in dysphagia with dysphagia scores improving from a mean of 3.1/4 to 0.9/4 (Wilcoxon matched-pairs signed-ranks test, P = 0.0158). One stent migrated in a patient with malignant disease; however, all 6 stents placed across the benign stricture migrated. Hence our case series concludes that SEMS can be safely and effectively deployed in the cervical esophagus.
Conscious Sedation ; Constriction, Pathologic ; Deglutition Disorders ; Esophagus* ; Female ; Fistula ; Foreign Bodies ; Humans ; Male ; Pharyngeal Muscles ; Sensation ; Stents* ; Tracheomalacia

Primary tracheal amyloidosis (PTA) can lead to airway obstructions, and patients with severe PTA should undergo bronchoscopic interventions in order to maintain airway patency. Focal airway involvements with amyloidosis can only be treated with mechanical dilatation. However, the PTA with diffused airway involvements and concomitant cartilage destructions requires stent placement. Limited information regarding the usefulness of silicone stents in patients with PTA has been released. Therefore, we report a case of diffused PTA with tracheomalacia causing severe cartilage destruction, which is being successfully managed with bronchoscopic interventions and silicone stent placements.
Airway Obstruction ; Amyloidosis* ; Bronchoscopy ; Cartilage* ; Dilatation ; Humans ; Silicones* ; Stents* ; Tracheomalacia

PURPOSE: This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection. METHODS: The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary's Hospital from April 2007 to January 2013. RESULTS: A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases. CONCLUSION: Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered.
Anoxia ; Asthma ; Bronchiolitis ; Bronchomalacia ; Bronchoscopy ; Child ; Edema ; Hemorrhage ; Humans ; Hypotension ; Korea ; Male ; Medical Records ; Mucus ; Pediatrics ; Pneumonia ; Pulmonary Atelectasis ; Retrospective Studies ; Seizures, Febrile ; Tracheomalacia

CT is increasingly being used for evaluating the cardiovascular structures and airways in the patients with congenital heart disease. Multi-slice CT has traditionally been used for the evaluation of the extracardiac vascular and airway abnormalities because of its inherent high spatial resolution and excellent air-tissue contrast. Recent developments in CT technology primarily by reducing the cardiac motion and the radiation dose usage in congenital heart disease evaluation have helped expand the indications for CT usage. Tracheobronchomalacia associated with congenital heart disease can be evaluated with cine CT. Intravenous contrast injection should be tailored to unequivocally demonstrate cardiovascular abnormalities. Knowledge of the state-of-the-art CT imaging techniques that are used for evaluating congenital heart disease is helpful not only for planning and performing CT examinations, but also for interpreting and presenting the CT image findings that consequently guide the proper medical and surgical management.
Contrast Media ; Electrocardiography ; Heart Defects, Congenital/complications/*radiography ; Humans ; Imaging, Three-Dimensional ; Radiation Dosage ; Tomography, Spiral Computed ; *Tomography, X-Ray Computed/methods ; Tracheomalacia/complications/congenital/radiography

Tracheomalacia is a malformation of the tracheal membranosa. It is maintained during spontaneous breathing but can be altered by bronchoscopy or positive airway pressure. Tracheomalacia is associated with a high mortality and may cause prolonged intubation and ventilation. Here, the case of a 13-day-old infant with jejunoileal stenosis that had surgery is reported. During induction of general anesthesia, endotracheal intubation was attempted several times with different sized endotracheal tubes. Airway obstruction occurred after the endotracheal intubation. After the airway was maintained, the operation was completed. Tracheomalacia was diagnosed after otolaryngology evaluation postoperatively.
Airway Obstruction ; Anesthesia, General ; Bronchoscopy ; Constriction, Pathologic ; Humans ; Infant ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Otolaryngology ; Respiration ; Tracheomalacia ; Ventilation

BACKGROUND: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. MATERIAL AND METHOD: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. RESULT: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. CONCLUSION: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Logistic Models ; Medical Records ; Retrospective Studies ; Silicones ; Stents ; Tracheal Stenosis ; Tracheomalacia ; Tracheostomy