Tracheobronchopathia osteochondroplastica: a cause of chronic cough and haemoptysis

Tracheobronchopathia osteochondroplastica (TPO) is a rare disorder of the tracheopulmonary tree characterised by osseous and cartilaginous submucosal nodules projecting into the tracheal lumen, sparing the posterior tracheal membranous wall. Symptoms are non-specific and may include dry cough, hoarseness, dyspnoea, recurrent pneumonia and occasionally haemoptysis. A fibreoptic bronchoscopy showing multiple tracheal nodules followed by pathological biopsy is required to reach the final diagnosis. Here, we report two cases of TPO, both with history of biomass fuel exposure and almost similar clinical presentions with chronic cough, shortness of breath and intermittent haemoptysis. They both underwent fibreoptic bronchoscopy showing multiple tracheal nodules whose histopathological analysis showed the diagnosis of TPO. Both patients were treated conservatively and remained in good health afterwards. Physicians should be aware about the need of advanced surgical procedures including endotracheal stent placement in more severe cases.

Tracheobronchoplasty after a trial with a silicone Y-stent in a patient with Mounier-Kuhn syndrome

Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare disorder characterized by the widening of the trachea and the main bronchi. It is a form of tracheomalacia called ‘cartilaginous malacic’ and is characterized by deformation of the tracheal cartilages and intrusion of the redundant membranous wall into the lumen of the airway. We present a patient with Mounier-Kuhn syndrome managed like patients with tracheomalacia of other aetiologies—a tracheobronchoplasty with a reconstructed D-shaped trachea and stabilization of the posterior membranous wall by attaching a polypropylene mesh to the posterior membranous wall of the trachea and the main bronchi after a trial period with a tracheobronchial Y-shaped silicone stent.

Surgical treatment of a female patient with tracheomalacia and expiratory tracheal stenosis

Abnormal mobility of the posterior membranous wall of the trachea and large bronchi is seen in many bronchopulmonary chronic inflammatory diseases. Currently, clear explanation of a mechanism of the expiratory tracheal stenosis (ETS) is absent. The advanced ETS is associated with severe ventilation abnormalities including asphyxia and syncope. The latter conditions are considered as indications for surgical treatment. Results of the surgical treatment are controversial and are not fully acceptable. For this reason, the surgical treatment for ETS is not routinely used and any successive case of such treatment is of great interest. Strict indications, such as life-threatening conditions or failure of optimal medical treatment, are required for surgical treatment of patients with tracheomalacia and ETS. Surgical treatment for tracheomalacia and ETS is contraindicated in the case of lobar bronchial lesion impeding stabilization the membranous part of the tracheobronchial tree.

PS02.230: CLOSURE OF POSTESOPHAGECTOMY GASTROTRACHEAL FISTULA FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY THROUGH THE STOMACH CONDUIT OPENING

Background The prevalence gastro-tracheal fistula following esophagectomy is rare, however, very difficult to cure, and often results in fatal outcomes. We experienced surgical repair of gastro-tracheal fistula after minimally invasive esophagectomy, thereby reported here. Methods A 66 year-old male patient had undergone VATS esophagectomy combined with cervical esophagogastrostomy through posteromediastinal route for his esophageal cancer (pT2N2M0). After concurrent chemo-radiation therapy for local recurrence in subcarinal area, gastro-tracheal fistula was developed between the posterior membranous wall of trachea just above carina and gastric conduit. Surgical correction was performed through right posterolateral thoracotomy. After longitudinal incision on the gastric conduit near the location of gastro-esophageal fistula, the fistula tract was exposed, and closed using three layer sutures with vicryl 3–0. Results The patient stayed at intensive care unit for only one day. During the periods of nil per os, the nutrition had supported by intravenous administration and jejunostomy. After 2 weeks of nil per os, postoperative bronchoscopy and endoscopy was performed. No remnant fistula was noted on both examinations suggesting successful fistula closure. And, the patient was discharged without any complications on postoperative day 28. Conclusion Conduit-airway fistula could be caused by diverse risk factors such as thermal injury during the dissection, external beam irradiation, and severe malnutrition. Less invasive procedures including endoscopic interventions could be amenable, however, direct surgical repairs might be required for prompt closure of fistula and minimizing further complications. Disclosure All authors have declared no conflicts of interest.

Tracheobronchopathia Osteochondroplastica. An underrecognized entity?

diopathic disease of the trachea and major bronchi characterized by multiple submucosal osteocartilaginous nodules. The nodules may be either focal or diffuse, and typically spare the membranous wall of the airways. Symptoms are non-specific, and include dry cough, dyspnea, recurrent respiratory infections and occasionally hemoptysis. TPO is rarely considered as a diagnosis in part due to lack of awareness among clinicians. The diagnosis can be based on a typical bronchoscopic appearance and generally does not require biopsy of the lesions. When available, histology reveals bone formation within the submucosa with normal overlying respiratory epithelium. TPO is a benign disorder, marked by a generally favorable clinical evolution. There is currently no established treatment for the removal of airway nodules, or the prevention of further tissue growths. Interventional bronchoscopy techniques have a role in the relief of symptomatic airway obstruction, when indicated.

Natural Plants Treatment for Ovarian Cysts in Women Without Surgery

Women normally have two ovaries as part of their reproductive organs. The ovaries function by secreting the important reproductive hormone—estrogen which regulate the monthly menstrual cycle at puberty. Each ovary also produce the eggs that carry the female gametes required to fuse with the male sperm cells in the formation of foetus. One of the abnormalities of the ovaries that had been long recognized is the development of sacs with membranous wall enclosing fluid, semi-solid matter or altered blood described as ovarian cyst which alter the size of the ovaries and make them larger. This abnormality usually disorganize the regular monthly cycles along with other complications including pains and infertility in women. The causes for the development of ovarian cysts are not clearly understood while surgical operation had been the most popular method of treatment. There is ethno-medicinal evidence for the treatment of ovarian cysts in Nigeria which dates back to more than one hundred years This paper describes how 274 of clinically confirmed cases of ovarian cysts in women between the ages of 22-52 years were treated successfully without surgery at the NARL specialist clinic, Ibadan, Nigeria in the last 16 years (1988-2004) using natural plant medicines made with the fiber of Cocos nucifera and a few other tropical plants. The implications of this finding are discussed.