We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.

• Klíčová slova
• Laryngeal cleft, Laryngo-tracheo-oesophageal cleft, Laryngotracheal abnormalities, Neonates,
• MeSH
• dítě MeSH
• ezofágus diagnostické zobrazování   chirurgie   abnormality   MeSH
• laryngoskopie MeSH
• larynx * diagnostické zobrazování   chirurgie   abnormality   MeSH
• lidé MeSH
• novorozenec MeSH
• trachea diagnostické zobrazování   chirurgie   abnormality   MeSH
• vrozené vady * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

OBJECTIVE: Blunt thoracic aortic injury is life-threatening injury. High suspicion on this clinical condition can be made by initial chest X-ray on emergency department. The aim of study was to detect which other signs, except widened mediastinum, are specific for rupture of the thoracic aorta. METHODS: To the study were included all Triage positive patients primary headed from the scene of injury to the Trauma center Level I from January to December 2014 and which have performed chest X-ray on emergency department followed by CT of chest, abdomen and pelvis. On chest X-ray were evaluated diameter of superior mediastinum, deviation of trachea, deviation of left and right main bronchus, aortic arch, fracture of first or second rib on the left side and obliteration of aortopulmonary space. RESULTS: Totally n=208 patients were enrolled to the study. Seven patients had blunt thoracic aortic injury on CT angiography. All these patients had widened superior mediastinum more than 80 mm (p=0.021). Six patients with blunt thoracic aortic injury had obliteration of aortic arch (p=0.0001) and obliteration of aortopulmonary space (p=0.0001). CONCLUSION: All patients after high energy trauma with widened mediastinum together with obliteration of aortic arch and obliteration of aortopulmonary space on initial chest X-ray without initial CT, must be indicated to the CT after initial stop the bleeding procedures for the exclusion of traumatic rupture of thoracic aorta.

• MeSH
• aorta thoracica diagnostické zobrazování   MeSH
• bronchy diagnostické zobrazování   MeSH
• CT angiografie MeSH
• dospělí MeSH
• fraktury žeber diagnostické zobrazování   MeSH
• kohortové studie MeSH
• lidé MeSH
• mediastinum diagnostické zobrazování   MeSH
• polytrauma diagnostické zobrazování   MeSH
• poranění hrudníku diagnostické zobrazování   MeSH
• rentgendiagnostika hrudníku MeSH
• retrospektivní studie MeSH
• ruptura aorty diagnostické zobrazování   MeSH
• skóre závažnosti úrazu MeSH
• trachea diagnostické zobrazování   MeSH
• tupá poranění diagnostické zobrazování   MeSH
• zkrácená stupnice závažnosti úrazů MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Recent years have witnessed an increased use of ultrasound in evaluation of the airway and the lower parts of the respiratory system. Ultrasound examination is fast and reliable and can be performed at the bedside and does not carry the risk of exposure to ionizing radiation. Apart from use in diagnostics it may also provide safe guidance for invasive and semi-invasive procedures. Ultrasound examination of the oral cavity structures, epiglottis, vocal cords, and subglottic space may help in the prediction of difficult intubation. Preoperative ultrasound may diagnose vocal cord palsy or deviation or stenosis of the trachea. Ultrasonography can also be used for confirmation of endotracheal tube, double-lumen tube, or laryngeal mask placement. This can be achieved by direct examination of the tube inside the trachea or by indirect methods evaluating lung movements. Postoperative airway ultrasound may reveal laryngeal pathology or subglottic oedema. Conventional ultrasound is a reliable real-time navigational tool for emergency cricothyrotomy or percutaneous dilational tracheostomy. Endobronchial ultrasound is a combination of bronchoscopy and ultrasonography and is used for preoperative examination of lung cancer and solitary pulmonary nodules. The method is also useful for real-time navigated biopsies of such pathological structures.

• MeSH
• epiglotis diagnostické zobrazování   MeSH
• hlasové řasy diagnostické zobrazování   patologie   MeSH
• intratracheální intubace MeSH
• laryngální masky MeSH
• lidé MeSH
• nemoci průdušnice diagnostické zobrazování   patologie   chirurgie   MeSH
• perioperační péče * MeSH
• rázové vlny s vysokou energií MeSH
• trachea diagnostické zobrazování   patologie   chirurgie   MeSH
• tracheostomie MeSH
• ultrasonografie MeSH
• ústa diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Researchers have been studying aerosol transport in human lungs for some decades. The overall lung deposition can be predicted with sufficient precision nowadays. However, the prediction of local deposition remains an unsolved problem. Numerical modeling of aerosol transport can provide detailed data with such precision and spatial resolution which were unavailable in the past. Yet, the necessary validation of numerical results represents a difficult task, as the experimental data in a sufficient spatial resolution are hardly available. This article introduces a method based on positron emission tomography, which allows acquisition of detailed experimental data on local aerosol deposition in a realistic model of human lungs. The method utilizes the Condensation Monodisperse Aerosol Generator modified for a safe production of radioactive aerosol particles and a special measuring rig. The scanning of the model is performed on a positron emission tomography-computed tomography scanner. The evaluation of aerosol deposition is based on a volume radioactivity analysis in a specialized, yet publicly available software. The reliability of the method was tested and its first results are discussed in the article. The measurements performed using the presented method can serve for validation of numerical simulations, since the presented lung model digital geometry is available.

• Klíčová slova
• Aerosol, aerosol deposition, positron emission tomography, targeted drug delivery,
• MeSH
• aerosoly aplikace a dávkování   farmakokinetika   MeSH
• biologické modely * MeSH
• bronchy diagnostické zobrazování   metabolismus   MeSH
• lékové transportní systémy MeSH
• lidé MeSH
• pozitronová emisní tomografie metody   MeSH
• trachea diagnostické zobrazování   metabolismus   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• aerosoly MeSH

The authors present a case of a 40-year-old man who intentionally stabbed himself several times in the trachea and larynx during a suicide attempt, and also inflicted other penetrating injuries of the stomach and liver upon himself. The preoperative examination using fiber-optic tracheoscopy and CT revealed only transection of the ligamentum cricothyroideum; the remaining two defects were discovered later, during the surgical revision. All three injuries were successfully treated with sutures, in one case using the transtracheal approach.

• MeSH
• dospělí MeSH
• laryngektomie metody   MeSH
• larynx diagnostické zobrazování   zranění   chirurgie   MeSH
• lidé MeSH
• penetrující rány diagnostické zobrazování   chirurgie   MeSH
• pokus o sebevraždu * MeSH
• radiografie MeSH
• trachea diagnostické zobrazování   zranění   chirurgie   MeSH
• tracheotomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: This study was undertaken to evaluate safety and biocompatibility of a novel biodegradable polydioxanone stent in a rabbit tracheal model. Metallic and silicone stents represent standard therapeutic approaches for hollow organ stenosis, although complications have been reported repeatedly. Biodegradable stents could reduce the risks associated with this procedure while still achieving the purpose of maintaining lumen patency. METHODS: A commercially available polydioxanone suture strand with a long safety record was used to manufacture the self-expanding stents. The polydioxanone stents were then implanted bronchoscopically and under fluoroscopic guidance into the tracheas of white rabbits (N = 25). Periodic clinical examination was performed. Histopathologic examination concluded the study for the 5 experimental groups at 3, 4, 5, 10, and 15 weeks after implantation. RESULTS: There were no unexpected deaths and no stent displacements during the study. The animals remained in good condition, without stent debris expectoration. Macroscopic examination revealed that the tracheal lumen stayed open. Histologic examination showed that tracheal damage score was highest 5 weeks after stenting, including in-stent necrosis of the epithelium. Stent degradation was complete with no remnants after 10 weeks, leaving the trachea completely healed at 15 weeks after implantation. CONCLUSIONS: This animal airway model has demonstrated acceptable safety and biocompatibility of this novel biodegradable polydioxanone stent. We suggest that polydioxanone stenting be used for further clinical studies for cases in which complete stent degradation after temporary airway treatment is desirable.

• MeSH
• bronchoskopie škodlivé účinky   přístrojové vybavení   MeSH
• časové faktory MeSH
• fluoroskopie MeSH
• intervenční radiografie metody   MeSH
• králíci MeSH
• modely u zvířat MeSH
• polydioxanon * MeSH
• protézy - design MeSH
• stenty * MeSH
• testování materiálů MeSH
• trachea diagnostické zobrazování   patologie   chirurgie   MeSH
• vstřebatelné implantáty * MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• polydioxanon * MeSH

The authors demonstrate a rare case of serious rupture in the area of the tracheal bifurcation with incomplete rupture of both bronchi which occurred after a severe multiple injury. The authors describe the difficult surgical solution, using temporary selective intubation of both main bronchi across the surgical field. The imperfect success of jet ventilation is ascribed to severe pulmonary contusion and major haemorrhage from the trachea which increased the risk of barotrauma. The authors emphasize the importance of peroperative and postoperative bronchoscopy.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• radiografie MeSH
• ruptura MeSH
• trachea diagnostické zobrazování   zranění   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: When deciding on the therapeutic procedure in sleep apnoea syndrome (SAS) it is important to know the anatomical conditions of the upper airways. METHODS AND RESULTS: We examined on account of SAS, verified by all night monitoring, using the MESAM4 method a total of 60 patients by means of computed tomography (CT). SAS without associated disease was diagnosed in 48 patients. To facilitate comparison of results of (CT) and MESAM4 we defined the MESAM4 score (M4) as the number of desaturations per hour multiplied by their depth (difference between mean minimal and basic saturation). Axial sections, 5mm thick at 5mm intervals were made from the level of the hard palate to the upper trachea in a vertical position to the longitudinal axis of the pharynx in the patient awake at the peak of the inspirium. The air-filled area, sagittal and coronary sections were measured at five levels (nasopharyngeal, velopharyngeal, retrobasilingual, at the level of the hyoid bone and trachea). The results differed significantly from the normal population examined by the same protocol (foreign standards). Macroglossia as a factor promoting SAS was also examined. CONCLUSIONS: The frontal and sagittal reformation reflected, on account of numerous inaccuracies, the actual state only partly. When the borderline between mild and more severe apnoea was set at M4 = 300, the correlation with the retrobasilingual section and coronary and velopharyngeal section was best. The authors suggest a simpler CT examination protocol which improves further the prediction of severity of SAS. The correlation with the body mass index (BMI) and the neck circumference (p < 0.001) confirmed the asset of CT parameters.

• MeSH
• dospělí MeSH
• farynx diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačová rentgenová tomografie * MeSH
• polysomnografie MeSH
• senioři MeSH
• syndromy spánkové apnoe diagnostické zobrazování   MeSH
• trachea diagnostické zobrazování   MeSH
• ústa diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

A case of a catheterobronchial fistula as a rare late complication of a ventriculoatrial shunt is reported. The ventriculoatrial shunt was implanted in a 4-month-old boy suffering from extreme postinfectious hydrocephalus. During the following years, twelfth nerve palsy on the right, vertebralgias, and salty taste sensations in the mouth associated with intermittent coughing and swelling of the neck and supraclavicular region on the right side developed. Valvography established a diagnosis of fistula 12 years after the implantation of a shunt. Ultrasonography of the neck and mediastinum and contrast-enhanced dynamic computed tomographic scanning demonstrated a catheterobronchial fistula to the subsegmental bronchus of the anterior segment of the right upper lung lobe, a thrombosis of the right internal jugular and both right and left brachiocephalic veins and the superior vena cava, and an extensive collateral venous system mainly draining into the azygos vein. Normalization of cerebrospinal fluid and blood flow and pressure allowed extraction of the "atrial" catheter without complications. One year after surgery the boys is in good health and without signs of shunt dependence.

• MeSH
• bronchografie MeSH
• hydrocefalus diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• kojenec MeSH
• lidé MeSH
• mozek diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• píštěle etiologie   patofyziologie   MeSH
• počítačová rentgenová tomografie MeSH
• trachea diagnostické zobrazování   MeSH
• trombóza etiologie   patofyziologie   MeSH
• vena cava superior patofyziologie   MeSH
• ventrikuloperitoneální zkrat škodlivé účinky   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The ultrastructure of the airway epithelium was studied after experimental Hexabrix tracheobronchography. Serious damage to the tracheal epithelium due to Hexabrix was recorded. 81 +/- 5% of goblet cells were stimulated to discharge mucus. 43 +/- 3% were completely exhausted and degenerated. The ciliated cells displayed vacuolar degeneration or severe pathological alteration. The average number of cilia/micron 2 fell to 3.3 +/- 0.5. As morphological signs of impaired self-cleaning ability the inspissated mucus and numerous bacteria appeared in the area of the disorganized ciliary border.

• MeSH
• bronchografie * MeSH
• cilie účinky léků   ultrastruktura   MeSH
• kontrastní látky farmakologie   MeSH
• králíci MeSH
• kyselina joxaglová * farmakologie   MeSH
• trachea diagnostické zobrazování   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kontrastní látky MeSH
• kyselina joxaglová * MeSH