Zeitschriftenartikel zum Thema „Trachea“
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1
Inozemtsev, E. O., I. S. Kurganskiy, S. A. Lepekhova, O. A. Goldberg und E. G. Grigoriev. „Method of Formation of Tracheo-Tracheal Anastomosis with a Continuous Single-Row Suture in the Experiment“. Acta Biomedica Scientifica 3, Nr. 6 (05.01.2019): 144–49. http://dx.doi.org/10.29413/abs.2018-3.6.21.
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The work is devoted toanew suture in the formation of tracheo-tracheal anastomosis. Despite the improvement of surgical technique in tracheal interventions, the number of postoperative complications (insufficiency and stenosis of anastomosis) remains high, with postoperative lethality reaching 18.2 %. The main problem is the lack of a unified point of view on the choice of the method of anastomosis, in particular, inclusion in the mucosal suture. Several variants of tracheo-tracheal anastomosis are suggested, but a large number of complications testify to the shortcomings of the methods used.The aim of this work is to optimize the imposition of a continuous single-row suture for the formation of tracheo-tracheal anastomosis with a shortening of the trachea.Materials and methods. The study was carried out on the basis of the scientific department of experimental surgery with the vivarium of Irkutsk Scientific Centre of Surgery and Traumatology using Wistar rats, and approved by the ethical committee.Results. A technique for the formation of tracheo-tracheal anastomosis with the use of an original continuous singlerow suture with a shortening of the trachea was developed. Step by step a sequence of operations from access to the cervical trachea to the formation of an anastomosis.Conclusion. The discussed version of the seam in the formation of tracheo-tracheal anastomosis makes it possible to accurately compare and reliably stabilize the sewn ends of the trachea.
2
Darr, A., S. Mohamed, D. Eaton und MS Kalkat. „Tracheo-oesophageal fistula in a patient with chronic sarcoidosis“. Annals of The Royal College of Surgeons of England 97, Nr. 7 (01.10.2015): e100-e102. http://dx.doi.org/10.1308/003588415x14181254790446.
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Sarcoidosis is a common multisystem granulomatous condition of unknown aetiology, predominantly involving the respiratory system. Tracheal stenosis has been described but we believe that we present the first case of a tracheo-oesophageal fistula secondary to chronic sarcoidosis. A 57-year-old woman with sarcoidosis, a known tracheal stricture and a Polyflex® stent in situ presented with stridor. Bronchoscopy confirmed in-stent stenosis, by exuberant granulation tissue. The stent was removed and the granulation tissue was resected accordingly. Postoperatively, the patient was noticed to have an incessant cough and video fluoroscopy raised the suspicion of a tracheo-oesophageal fistula. A repeat bronchoscopy demonstrated marked granulation tissue, accompanied by a fistulous connection with the oesophagus at the mid-lower [middle of the lower] third of the trachea. Three Polyflex® stents were sited across the entire length of the trachea. Sarcoidosis presents with varying clinical manifestations and disease progression. Tracheal involvement appears to be a rare phenomenon and usually results in stenosis. To date, there has been little or no documented literature describing the formation of a tracheo-oesophageal fistula resulting from sarcoidosis. Early reports documented the presence of sarcoidosis induced weakening in the tracheal wall, a process termed tracheal dystonia. Weaknesses are more apparent in the membranous aspect of the trachea. Despite the rare nature of such pathology, this case report highlights the need to consider the presence of a tracheo-oesophageal fistula in sarcoidosis patients presenting with repeat aspiration in the absence of an alternate pathology.
3
Lim, S., J. Jeong, HG Heng, S. Sung, Y. Choi, H. Oh, K. Kim, Y. Cho, Y. Jung und K. Lee. „Computed tomographic features of tracheal shapes and dimensions in awake dogs“. Veterinární Medicína 63, No. 3 (28.03.2018): 131–36. http://dx.doi.org/10.17221/124/2017-vetmed.
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There are several reports in the veterinary literature on tracheal assessment; however, there is a lack of studies on the trachea in voluntarily breathing dogs. The aim of this study was to describe the natural shape of the trachea in awake dogs and to assess tracheal dimensions and the width-to-height ratio. Thoracic computed tomographic images of awake small breed dogs without any signs of respiratory malfunction (n = 19) were evaluated. Each trachea was categorised into one of four different shapes: circular, horseshoe, crescent or focal dorsal invagination. The circular shape was prominent, particularly in the thoracic inlet and intrathoracic area, while the horseshoe shape was also normally present. In this group of normal dogs, there were no crescent-shaped tracheas, but focally invaginated tracheas were observed. The mean tracheal heights at five locations, namely the caudal endplate of the fourth cervical vertebra, cranial endplate of the seventh cervical vertebra, mid-body of the first thoracic vertebra, mid-body of the third thoracic vertebra, and 1 cm cranial to the carina were 9.12, 8.96, 9.34, 9.88 and 10.16 mm, respectively. The widths at these same sites were 12.26, 10.42, 10.07, 9.82 and 10.23 mm, respectively. The width-to-height ratios of each tracheal location were 1.38, 1.20, 1.10, 1.01 and 1.03, the last two of which are consistent with the circular shape of the intrathoracic trachea. Multi-detector computed tomography under non-general anaesthesia is a non-invasive and unparalleled imaging tool for describing tracheal appearance in healthy awake dogs.
4
Byanet, O., J. A. Bosha und B. O. Onoja. „A Quantitative Study on the Trachea of the Red Sokoto (Maradi) Goat (Capra hircus)“. Veterinary Medicine International 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/142715.
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The trachea forms the part of the conducting system which transports air from the external environment to the lungs. The aim of this study was to provide quantitative dimensions of the trachea of Red Sokoto goat (Capra hircus). Quantitative analysis was conducted on nine tracheas from goats (ages were ranged between eight months and three years) without sex variation in this study. The results showed that tracheas were extended from the cricoid cartilage of larynx to the hilus of the lungs, where they were divided into the right and left bronchi. They were structurally composed of the cartilaginous rings that were incomplete dorsally but bridged by tracheal muscles at the ends of the tracheal cartilages. The mean length of the trachea from the first to the last ring was 257 ± 7.11 mm and the number of tracheal rings varied from 35 to 57, with a mean value of 49.33 ± 2.78. The left bronchial mean length (19.78 ± 2.66 mm) was significantly longer than the right (10.44 ± 1.79 mm). The cross-sectional area (CSA) was wider at the intrathoracic area (221.5 ± 0.2 mm2) than cervical area (176 ± 0.1 mm2).
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Bottasso-Arias, Natalia, Lauren Leesman, Kaulini Burra, John Snowball, Ronak Shah, Megha Mohanakrishnan, Yan Xu und Debora Sinner. „BMP4 and Wnt signaling interact to promote mouse tracheal mesenchyme morphogenesis“. American Journal of Physiology-Lung Cellular and Molecular Physiology 322, Nr. 2 (01.02.2022): L224—L242. http://dx.doi.org/10.1152/ajplung.00255.2021.
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Tracheobronchomalacia and complete tracheal rings are congenital malformations of the trachea associated with morbidity and mortality for which the etiology remains poorly understood. Epithelial expression of Wls (a cargo receptor mediating Wnt ligand secretion) by tracheal cells is essential for patterning the embryonic mouse trachea’s cartilage and muscle. RNA sequencing indicated that Wls differentially modulated the expression of BMP signaling molecules. We tested whether BMP signaling, induced by epithelial Wnt ligands, mediates cartilage formation. Deletion of Bmp4 from respiratory tract mesenchyme impaired tracheal cartilage formation that was replaced by ectopic smooth muscle, recapitulating the phenotype observed after epithelial deletion of Wls in the embryonic trachea. Ectopic muscle was caused in part by anomalous differentiation and proliferation of smooth muscle progenitors rather than tracheal cartilage progenitors. Mesenchymal deletion of Bmp4 impaired expression of Wnt/β-catenin target genes, including targets of WNT signaling: Notum and Axin2. In vitro, recombinant (r)BMP4 rescued the expression of Notum in Bmp4-deficient tracheal mesenchymal cells and induced Notum promoter activity via SMAD1/5. RNA sequencing of Bmp4-deficient tracheas identified genes essential for chondrogenesis and muscle development coregulated by BMP and WNT signaling. During tracheal morphogenesis, WNT signaling induces Bmp4 in mesenchymal progenitors to promote cartilage differentiation and restrict trachealis muscle. In turn, Bmp4 differentially regulates the expression of Wnt/β-catenin targets to attenuate mesenchymal WNT signaling and to further support chondrogenesis.
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Kao, James, Christopher N. Fortner, Lynne H. Liu, Gary E. Shull und Richard J. Paul. „Ablation of the SERCA3 gene alters epithelium-dependent relaxation in mouse tracheal smooth muscle“. American Journal of Physiology-Lung Cellular and Molecular Physiology 277, Nr. 2 (01.08.1999): L264—L270. http://dx.doi.org/10.1152/ajplung.1999.277.2.l264.
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Sarcoplasmic/endoplasmic reticulum Ca2+-ATPase 3 (SERCA3), an isoform of the intracellular Ca2+ pump that has been shown to mediate endothelium-dependent relaxation of vascular smooth muscle, is also expressed in tracheal epithelium. To determine its possible role in regulation of airway mechanical function, we compared tracheal contractility in gene-targeted mice deficient in SERCA3 (SERCA3−) with that in wild-type tracheae. Cumulative addition of ACh elicited concentration-dependent increases in isometric force (ED50 = 2 μM, maximum force = 8 mN/mm2) that were identical in SERCA3− and wild-type tracheae. After ACh stimulation, substance P (SP) elicited a transient relaxation (42.6 ± 3.2%, n = 28) in both tracheae. However, the rate of relaxation was significantly ( P < 0.04, n = 9) more rapid in the wild-type [half-time ( t ½) = 34.3 s] than in the SERCA3−( t ½ = 61.6 s) trachea. The SP relaxation was reduced by rubbing the trachea, indicative of epithelial cell involvement. This was verified using a perfused trachea preparation. SP in the outside medium had no effect, whereas SP in the perfusate bathing the epithelial side elicited a relaxation. Nitric oxide synthase inhibition (0.2 mM N ω-nitro-l-arginine) reduced the SP relaxation by 36.5 ± 12.5%, whereas the SP effect was abolished by eicosanoid inhibition (10 μM indomethacin). ATP also elicited an epithelium-dependent relaxation similar to SP but with a more rapid relaxation in the SERCA3−trachea than in the wild-type trachea. Our results indicate that SERCA3 gene ablation does not directly affect smooth muscle, which is consistent with the distribution of the isoform, but suggest that SERCA3 plays a role in epithelial cell modulation of airway smooth muscle function.
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Linkov, Gary, Arash Hanifi, Farzad Yousefi, Derrick Tint, Sudheer Bolla, Nathanial Marchetti, Ahmed M. S. Soliman und Nancy Pleshko. „Compositional Assessment of Human Tracheal Cartilage by Infrared Spectroscopy“. Otolaryngology–Head and Neck Surgery 158, Nr. 4 (16.01.2018): 688–94. http://dx.doi.org/10.1177/0194599817752310.
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Objectives To assess the potential of infrared fiber-optic spectroscopy to evaluate the compositional properties of human tracheal cartilage. Study Design Laboratory-based study. Methods Twenty human cadaveric distal tracheas were harvested (age range 20-78 years; 6 females, 14 males) for compositional analysis. Histologic staining, Fourier transform infrared imaging spectroscopy data on collagen and proteoglycan (PG) content, and near-infrared (NIR) fiber-optic probe spectroscopic data that reflect protein and water content were evaluated. NIR fiber-optic probe data were also obtained from the proximal trachea in 4 human cadavers (age range 51-65 years; 2 females, 2 males) in situ for comparison to distal trachea spectral data. Results In the distal trachea cohort, the spectroscopic-determined ratio of PG/amide I, indicative of the relative amount of PG, was significantly higher in the tissues from the younger group compared to the older group (0.37 ± 0.08 vs 0.32 ± 0.05, P = .05). A principal component analysis of the NIR spectral data enabled separation of spectra based on tracheal location, likely due to differences in both protein and water content. The NIR-determined water content based on the 5200-cm−1 peak was significantly higher in the distal trachea compared to the proximal trachea ( P < .001). Conclusions Establishment of normative compositional values and further elucidating differences between the segments of trachea will enable more directed research toward appropriate compositional end points in regenerative medicine for tracheal repair.
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Sotres-Vega, Avelina, Jaime Villalba-Caloca, Farid Ramirez-Zamora, Diana Pérez-Covarrubias und J. Alfredo Santibáñez-Salgado. „Cryopreserved tracheal segments: a new tool for bench surgical training in thoracic surgery“. Acta Cirurgica Brasileira 27, Nr. 8 (August 2012): 585–88. http://dx.doi.org/10.1590/s0102-86502012000800012.
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PURPOSE: To present a new low-cost high fidelity bench model of cryopreserved trachea that can be used to learn surgical skills from medical students to cardiothoracic surgery fellows. METHODS: Ten tracheas were harvested from ten non-trachea related research dogs at the moment of euthanasia. Each trachea was trimmed in six or seven rings segments. They were cryopreserved and stored during 60 days. The day programmed for surgical skills practice, they were thawed to room temperature. RESULTS: Forty segments have been used. After defrosting, all the segments kept their normal anatomic shape and structural integrity. Two incisions were made on every tracheal segment and sutured with running or separate stitches with 5-0 polypropilene. There were no complications such as cartilage ruptures, neither tears on the mucosae, the cartilages nor the membranous posterior membrane. CONCLUSIONS: The cryopreserved trachea is a high fidelity, practical, reproducible, portable, low-cost bench model. It allows cardiothoracic fellows to learn how to handle a trachea, as well as to perfect their surgical and suture abilities before applying them on a real patient's trachea.
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Mikheev, Mikheev V., und Sergey N. Trushin. „A clinical case of successful treatment of complete abruption of the trachea from the larynx“. I.P. Pavlov Russian Medical Biological Herald 29, Nr. 1 (15.03.2021): 117–24. http://dx.doi.org/10.23888/pavlovj2021291117-124.
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Tracheobronchial injuries as a consequence of chest blunt trauma are rare. Blunt traumas of the cervical part of the trachea are a rarer pathology presenting a serious diagnostic problem for a clinician. Traumas of the larynx and the trachea account for 40 to 80% of lethality. The tracheas cervical part is vulnerable despite that it is covered with the neck muscles, spine, clavicles, and mandible. In cut/stab wounds, the tracheas cervical part is often damaged together with the adjacent structures. In blunt trauma, under a direct action of a traumatizing agent, the mobile trachea displaces toward the spine, accompanied by damage to the tracheal cartilages, its membranous part, and the soft surrounding tissues with preservation of the integrity of the skin.
Tracheal ruptures along the distance up to 1 cm from the cricoid cartilage account for not more than 4% of all tracheal ruptures. A complete tracheal rupture and its abruption from the larynx are extremely rare pathology. Because of severe respiratory disorders, most victims die at the site where their injury occurred.
This article presents a clinical case of the successful treatment of patient Z., 41 years of age, with complete tracheal abruption from the larynx. The cause of tracheal damage was blunt neck trauma in a traffic accident. A peculiarity of this clinical case was that the victim arrived at a specialized thoracic surgery unit with a functioning tracheostomy two days after the trauma.
Conclusion. Tracheal trauma is a potentially fatal condition. Therefore, early diagnosis of tracheobronchial damage is essential since it permits timely surgical intervention and diminished risk of lethal outcome. When dealing with patients with trauma of the head, neck, and chest with non-corresponding clinical data and the absence of effective recommended standard therapeutic measures, a clinician should become alert and exclude the tracheal and bronchial damage.
X-ray computed tomography and fibrotracheobronchoscopy are strongly recommended as reliable methods to diagnose tracheobronchial damages. In a surgical intervention, it is necessary to perform the primary suture on the trachea, avoid preventive tracheostomy, and delay interventions associated with poorer prognosis and a high complication rate.
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Wangensteen, O. D., L. A. Schneider, S. C. Fahrenkrug, G. M. Brottman und R. C. Maynard. „Tracheal epithelial permeability to nonelectrolytes: species differences“. Journal of Applied Physiology 75, Nr. 2 (01.08.1993): 1009–18. http://dx.doi.org/10.1152/jappl.1993.75.2.1009.
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We developed a new excised tracheal preparation to measure the epithelial permeability of large lipid-insoluble nonelectrolytes and macromolecules. Tracheae were suspended vertically in a Ringer solution bath, and a solution containing labeled test solutes was positioned in the center of the tracheal segment, away from damaged ends. Permeability coefficients, calculated from solute fluxes into the bath, were constant for > or = 2 h at 37 degrees C, and no histological changes were observed. Measurements after epithelial removal with detergent indicate that in the intact trachea the epithelium represents > 90% of the resistance to transport. For the rat trachea, permeability coefficients for sucrose, inulin, and Dextran 20 were 9.22, 2.20, and 0.214 x 10(-7) cm/s, respectively. Values for cat tracheae were similar, those for rabbit tracheae were lower, and those for guinea pig tracheae were markedly greater. With the assumption of transport by diffusion through thin rectangular slits between epithelial cells, the rat and guinea pig data fit a slit width of 7–8 nm, whereas the rabbit and cat data cannot be explained by a model with slits of a single size.
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Махутов, Valeriy Makhutov, Скворцов, Moisey Skvortsov, Иноземцев, Evgeniy Inozemtsev, Лепехова, Svetlana Lepekhova, Григорьев und Evgeniy Grigoryev. „CIRCULAR RESECTION OF THE TRACHEA FOR CICATRICIAL STENOSIS“. Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук 1, Nr. 4 (28.11.2016): 150–55. http://dx.doi.org/10.12737/23004.
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The primary interventions for trachea in the thoracic surgery units are performed for the treatment of cicatricial ste-nosis of the trachea. Circular resection of the trachea is one of the treatment procedures in this pathology. The benefit of this method as compared to the others is that the resection with tracheo-tracheal anastomosis allows a one-stage recovery of patient with this pathology.The first successful resection of the trachea was performed in the late 19th century, and since then this surgery tech-nique is constantly being improved. Several methods of suture placing in anastomosis surgery are proposed, different suture materials are used, special devices are developed to facilitate the anastomosis performing. There are several tactics depending on the presence or absence of tracheostome in the patient. Different methods are worked out to approximate the trachea ends with different diameters. Prevention of anastomosis leakage is achieved by strengthen-ing the anastomosis area to reduce the suture tension. In addition, there are studies dealing with the improvement of trachea regeneration by physiotherapy impact on the anastomosis area. Laser therapy and hyperbaric oxygenation are also put forward for use.Nevertheless, a number of items remain to be solved: indications for circular resection of the trachea are not clearly formulated, the size of trachea fragment to be resect is the subject of active discussion.
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Begis, D., C. Delpuech, P. Le Tallec, L. Loth, M. Thiriet und M. Vidrascu. „A finite-element model of tracheal collapse“. Journal of Applied Physiology 64, Nr. 4 (01.04.1988): 1359–68. http://dx.doi.org/10.1152/jappl.1988.64.4.1359.
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The trachea has been approximated by an appropriate finite-element model. The three-dimensional equilibrium problems set by the tracheal deformation under various stresses have been solved using a convenient augmented Lagrangian functional. The dimensions were obtained from human tracheae. Mechanical constants for the anatomic components were calculated from the stress-strain relationships. The compressive narrowing is essentially due to the invagination of the posterior membrane in the tracheal lumen for transmural pressures down to -7 kPa. A surface of contact between the membranous wall and the lateral walls appears when the transmural pressure equals -6 kPa. The transmural pressure-area relationship is sigmoidal with a compliance equal to 0.08 kPa-1 for a transmural pressure of -2 kPa. The tracheal collapse is greater when the material constants of the membranous wall decrease or when the tracheal segment is subjected to a longitudinal tension. A slight flexion of the trachea induces an asymmetric deformation.
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Nimeri, Nuha, Haytham Ali und Nazla Mahmoud. „Lethal severe congenital tracheal stenosis with tracheal ring complicating respiratory distress syndrome in an extremely premature infant: first reported case in Qatar with a literature review“. BMJ Case Reports 13, Nr. 12 (Dezember 2020): e236107. http://dx.doi.org/10.1136/bcr-2020-236107.
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In the context of prematurity, lethal congenital airways malforamtion can be masked by the symptoms of respiratory distress syndrome. A high index of suspicion is required. We present the case of a 28-week preterm infant, with atypical protracted respiratory insufficiency despite the escalation of mechanical ventilation. The possibility of airway obstruction was considered in view of severe chest retraction while on the mechanical ventilator. It was also difficult to pass suction catheters beyond a certain depth in the trachea; however, intubation of the upper trachea was accomplished twice without difficulty. Flexible bronchoscopy revealed complete tracheal ring with severe tracheal stenosis; there was no evidence of tracheo-oesophageal fistula. Due to advanced multi-organ dysfunction at diagnosis, a decision was made with the family to re-orientate from intensive care to compassionate care. Ethical considerations in similar cases should incorporate the improved outcomes of prematurity and recent advances in tracheal reconstruction.
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Akopov, A. L., G. V. Papayan, S. D. Gorbunkov, S. V. Orlov, D. D. Karal-Ogly, P. A. Kaplanyan, E. A. Gubareva, E. V. Kuevda und D. M. Kuznetsova. „Fluorescence imaging in evaluating the revascularization of heterotopically transplanted primate trachea segment“. Russian Journal of Transplantology and Artificial Organs 22, Nr. 2 (12.07.2020): 80–85. http://dx.doi.org/10.15825/1995-1191-2020-2-80-85.
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Objective: to assess the potentials of using indocyanine green fluorescence angiography in evaluating revascularization of tissue-engineered construct that was obtained from the decellularized biological matrix of primate trachea, including using mesenchymal stem cells, after heterotopic tracheal allotransplantation. Material and methods. Tracheas were obtained from two male hamadryas baboons. After decellularization, 4 cm segments of tracheas were implanted under the lateral part of the latissimus dorsi in two healthy primates, one after recellularization with mesenchymal stem cells (animal 1), and the second without recellularization (animal 2). Immunosuppressive therapy was not performed. Blood flow in the transplanted segment of the trachea was evaluated 60 days after transplantation by surgical isolation of the flap of the latissimus dorsi with the transplanted segment of the trachea, while maintaining blood flow through the thoracodorsal artery. Indocyanine green near-infrared fluorescence angiography was visualized using a FLUM-808 multispectral fluorescence organoscope. Results. Sixty days after implantation, the tracheal cartilaginous framework macroscopically appeared to be intact in both animals, tightly integrated into the muscle tissue. The framework retained its natural color. After intravenous injection of indocyanine green, the tracheal vessels were visualized in both animals. Intercartilaginous vessels and portions of the cartilaginous semi-rings devoid of vessels were clearly distinguished. The entire implanted segment was almost uniformly vascularized. No local disruptions in blood supply were observed. The fluorescence brightness of the tracheal vessels was 193 ± 17 cu and 198 ± 10 cu in animals 1 and 2, respectively. The average muscle brightness in the implantation zone was 159 ± 9 cu and 116 ± 8 cu in animals 1 and 2, respectively. Conclusion. Indocyanine green fluorescence angiography is characterized by high-contrast images and high sensitivity. This facilitates vascular patency visualization and allows to assess the degree of neoangiogenesis after experimental transplantation of the tracheal segment, at different stages of experiment, without euthanizing the animal.
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Grubb, B. R., A. M. Paradiso und R. C. Boucher. „Anomalies in ion transport in CF mouse tracheal epithelium“. American Journal of Physiology-Cell Physiology 267, Nr. 1 (01.07.1994): C293—C300. http://dx.doi.org/10.1152/ajpcell.1994.267.1.c293.
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The cystic fibrosis (CF) mouse trachea has become a model for gene transfer. To characterize ion transport properties of tracheal epithelium from normal and CF mice, tracheas were excised, mounted in Ussing chambers, and basal properties and responses to pharmacological agents and/or ion substitution protocols measured. No difference in basal short-circuit (Isc) was observed between normal (29.1 +/- 3.8 muA/cm2, n = 21) and CF (34.7 +/- 4.5 muA/cm2, n = 16) tracheas. The relative contribution of Na+ transport to basal Isc was small (30-40%). Ionomycin stimulated large increases in Isc in both normal and CF murine tracheas [change in Isc (delta Isc) with ionomycin: 30.5 +/- 8.8 muA/cm2, n = 11, normal; 27.3 +/- 6.7 muA/cm2, n = 6, CF]. Unexpectedly, forskolin increased Isc in both CF and normal amiloride-pretreated tracheas (delta Isc: 10.5 +/- 2.1 muA/cm2, n = 21, normal; 13 +/- 2.3 muA/cm2, n = 16, CF). Forskolin was observed to increase intracellular Ca2+ in both normal and CF tracheal cells, suggesting this as a mechanism to induce Cl- secretion. These similarities in ion transport, in part reflecting the dominance of Ca(2+)-regulated Cl- conductance, suggest that the murine trachea is not an ideal target for assessment of CF correction by gene transfer.
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Perpina, M., J. Cortijo, E. Fornas, M. Palau, JL Ortiz und E. Morcillo. „Hyperreactivity and 45Ca movements in sensitized guinea-pig tracheal muscle“. European Respiratory Journal 4, Nr. 4 (01.04.1991): 450–57. http://dx.doi.org/10.1183/09031936.93.04040450.
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Responses to KCl and histamine and 45Ca movements were studied in trachea from normal and actively sensitized guinea-pigs. Sensitized tracheas were hyperresponsive and hypersensitive to KCl and histamine. 45Ca uptake experiments show that sensitized tracheal muscle behaves as normal except that the uptake of 45Ca in low concentration (0.03 mM) Ca2+ solution was higher and the number of binding sites for the high affinity component of 45Ca uptake (as estimated by Scatchard-coordinate plot) was augmented. Additionally, in sensitized tracheal muscle, incubation in low (0.03 mM) Ca2+ solution followed by La3+ wash-out resulted in a greater amount of residual 45Ca than in normal tissues. KCl, but not histamine, increased the La3+ resistant 45Ca content. This increase was greater in sensitized than in normal trachea. This demonstrates the existence of hyperreactivity and altered 45Ca movements in sensitized trachealis muscle.
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Lawrence, David A., Brittany Branson, Isabel Oliva und Ami Rubinowitz. „The Wonderful World of the Windpipe: A Review of Central Airway Anatomy and Pathology“. Canadian Association of Radiologists Journal 66, Nr. 1 (Februar 2015): 30–43. http://dx.doi.org/10.1016/j.carj.2014.08.003.
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A variety of pathologic processes can involve the central airways. Abnormalities may either diffusely or focally involve the tracheal or mainstem bronchial walls. Diseases that diffusely involve the tracheal wall can be subclassified as sparing the membranous trachea or circumferentially involving the tracheal wall. Focal diseases of the trachea and mainstem bronchi include benign and malignant causes. Additionally, congenital and acquired morphologic abnormalities of the trachea will be reviewed.
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Mazzone, Stuart B., und Alice E. McGovern. „Innervation of tracheal parasympathetic ganglia by esophageal cholinergic neurons: evidence from anatomic and functional studies in guinea pigs“. American Journal of Physiology-Lung Cellular and Molecular Physiology 298, Nr. 3 (März 2010): L404—L416. http://dx.doi.org/10.1152/ajplung.00166.2009.
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In the present study, we describe a subset of nerve fibers, characterized by their immunoreactivity for the calcium-binding protein calretinin, that are densely and selectively associated with cholinergic postganglionic neurons in the guinea pig tracheal ganglia. Retrograde neuronal tracing with cholera toxin B, combined with immunohistochemical analyses, showed that these nerve fibers do not originate from sensory neurons in the nodose, jugular, or dorsal root ganglia or from motor neurons in the nucleus ambiguus, dorsal motor nucleus of the vagus nerve, spinal cord, stellate ganglia, or superior cervical ganglia. Calretinin-immunoreactive nerve fibers disappeared from tracheal segments after 48 h in organotypic culture, indicating that the fibers were of extrinsic origin. However, calretinin-positive nerve fibers persisted in tracheal ganglia when tracheae were cocultured with the adjacent esophagus intact. Immunohistochemical analysis of the esophagus revealed a population of cholinergic neurons in the esophageal myenteric plexus that coexpressed calretinin. In functional studies, electrical stimulation of the esophagus in vitro evoked measurable contractions of the trachea. These contractions were not altered by prior organotypic culture of the trachea and esophagus to remove the extrinsic innervation to the airways but were significantly ( P < 0.05) inhibited by the ganglionic blocker hexamethonium or by physical disruption of the tissue connecting the trachea and esophagus. These data suggest that a subset of esophageal neurons, characterized by the expression of calretinin and acetylcholine, provide a previously unrecognized excitatory input to tracheal cholinergic ganglia in guinea pigs.
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Rosen, Frederick S., Anna M. Pou und William L. Buford. „Tracheal Resection with Primary Anastomosis in Cadavers: The Effects of Releasing Maneuvers and Length of Tracheal Resection on Tension“. Annals of Otology, Rhinology & Laryngology 112, Nr. 10 (Oktober 2003): 869–76. http://dx.doi.org/10.1177/000348940311201008.
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To determine the relationships among length of trachea resected, total tracheal length, and anastomotic tension when using various release maneuvers, we studied 10 adult human cadavers: 5 male and 5 female. The trachea was transected between rings 2 and 3. Precision, handheld spring tensiometers (Geneva Gage, LLC) were used to measure the tension required to approximate, and then overlap, the proximal segment relative to the distal segment, and the distal segment relative to the proximal segment after these maneuvers: no release, blunt dissection, neck flexion, suprahyoid release (SHR) without neck flexion, SHR with neck flexion, and right hilar release. After the tension measurements were recorded, the trachea was harvested and the total tracheal length was measured. Length-tension curves were plotted for both the superior and inferior tracheal segments after each release maneuver. The stiffness coefficient for the trachea and the resting load on the trachea following each release maneuver were calculated. An exponential length-tension relationship existed for the distal tracheal segment regardless of whether release maneuvers were performed. The proximal tracheal segment exhibited a linear length-tension relationship initially, but displayed an exponential relationship after SHR. We could resect 6.68 cm (range, 4.2 to 9.9 cm), 13.3 rings (range, 10 to 20 rings), or 65.5% (range, 42% to 100%) of the trachea without undue tension (< 1,000 g) on the anastomosis. We conclude that various tracheal release maneuvers are effective in increasing the length of trachea that can be relatively safely resected. However, these maneuvers are not uniformly effective across subjects.
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Goddard, Catharine A., Martin J. Evans und William H. Colledge. „Genistein activates CFTR-mediated Cl−secretion in the murine trachea and colon“. American Journal of Physiology-Cell Physiology 279, Nr. 2 (01.08.2000): C383—C392. http://dx.doi.org/10.1152/ajpcell.2000.279.2.c383.
Annotation:
The action of the isoflavone genistein on the cystic fibrosis transmembrane conductance regulator (CFTR) has been studied in many cell systems but not in intact murine tissues. We have investigated the action of genistein on murine tissues from normal and cystic fibrosis (CF) mice. Genistein increased the short-circuit current ( I sc) in tracheal (16.4 ± 2.8 μA/cm2) and colonic (40.0 ± 4.4 μA/cm2) epithelia of wild-type mice. This increase was inhibited by furosemide, diphenylamine-2-carboxylate, and glibenclamide, but not by DIDS. In contrast, genistein produced no significant change in the I sc of the tracheal epithelium (0.9 ± 1.1 μA/cm2) and decreased the I sc of colons from CF null (−13.1 ± 2.3 μA/cm2) and ΔF508 mice (−10.3 ± 1.3 μA/cm2). Delivery of a human CFTRcDNA-liposome complex to the airways of CF null mice restored the genistein response in the tracheas to wild-type levels. Tracheas from ΔF508 mice were also studied: 46% of trachea showed no response to genistein, whereas 54% gave an increase in I scsimilar to that in wild type. We conclude that genistein activates CFTR-mediated Cl− secretion in the murine trachea and distal colon.
21
Wycherly, Benjamin, Sonya Malekzadeh, Matthew Kirk Steehler, Burke Kevin und Bhaskar Kallakury. „R453 – Cryoballoon Dilation of Tracheal Stenosis“. Otolaryngology–Head and Neck Surgery 139, Nr. 2_suppl (August 2008): P196—P197. http://dx.doi.org/10.1016/j.otohns.2008.05.610.
Annotation:
Problem The endoscopic management of tracheal stenosis remains ineffective, despite advances in dilation and resection techniques. The vascular literature reveals improved patency rates of stenosis with cryodilation compared to balloon angioplasty. The proposed mechanism is a decrease in collagen deposition with cryotherapy. Similarly, tracheal cryotherapy maintains the cartilaginous framework of the airway while minimizing collagen deposition. The objective of this study is to compare collagen deposition in tracheal injuries dilated with room temperature versus subfreezing temperature balloons. Methods Six New Zealand White rabbits underwent endoscopic tracheal injury with a nylon brush. At 3 weeks post injury, dilation was performed by a balloon inflated with either room temperature saline (n=3), or nitrous oxide to −10 °C, (n=3). Rabbits were sacrificed at 2 and 4 weeks post dilation. Segments of injured trachea were histologically examined for collagen and graded as none, mild, moderate, or severe. Results Collagen deposition at 2 weeks post dilation was graded as moderate to severe in all specimens. In the 4 week post dilation tracheas, marked differences in collagen deposition were noted. While the trachea dilated at room temperature was graded as moderate to severe, the cryoballoon dilated trachea showed minimal to no collagen deposition. Despite the observed differences in collagen deposition, sub-mucosal thickness differed between specimens by an average of 0.2 mm. Conclusion This preliminary study suggests that dilation with balloon cryotherapy decreases collagen deposition in the injured airway. Significance Long-term patency of immature tracheal stenosis may be improved with the addition of subfreezing temperatures to endoscopic dilation techniques. Support A grant was provided by Boston Scientific, Inc. in the form of money and supplies.
22
Grace, R. F. „Spontaneous Respiration via an Open Trachea for Resection of a High Tracheal Stenosis in a Child“. Anaesthesia and Intensive Care 30, Nr. 4 (August 2002): 502–4. http://dx.doi.org/10.1177/0310057x0203000420.
Annotation:
The successful management of tracheal stenosis requires compromise between the competing interests of the surgical and anaesthetic teams and the resources available. A seven-year-old girl with marked tracheal stenosis was successfully managed spontaneously breathing via an open trachea and a laryngeal mask. Anaesthesia was maintained by propofol infusion. When the trachea was opened, supplemental oxygen was administered via a modified cholangiocatheter placed into the distal segment. At no point was the trachea intubated.
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Yoshimura, Takaaki, Noriyo Colley, Shunsuke Komizunai, Shinji Ninomiya, Satoshi Kanai, Atsushi Konno, Koichi Yasuda, Hiroshi Taguchi, Takayuki Hashimoto und Shinichi Shimizu. „Construction of a detachable artificial trachea model for three age groups for use in an endotracheal suctioning training environment simulator“. PLOS ONE 16, Nr. 3 (29.03.2021): e0249010. http://dx.doi.org/10.1371/journal.pone.0249010.
Annotation:
Tracheal suctioning is an important procedure to maintain airway patency by removing secretions. Today, suctioning operators include not only medical staff, but also family caregivers. The use of a simulation system has been noted to be the most effective way to learn the tracheal suctioning technique for operators. While the size of the trachea varies across different age groups, the artificial trachea model in the simulation system has only one fixed model. Thus, this study aimed to construct multiple removable trachea models according to different age groups. We enrolled 20 patients who had previously received proton beam therapy in our institution and acquired the treatment planning computed tomography (CT) image data. To construct the artificial trachea model for three age groups (children, adolescents and young adults, and adults), we analyzed the three-dimensional coordinates of the entire trachea, tracheal carina, and the end of the main bronchus. We also analyzed the diameter of the trachea and main bronchus. Finally, we evaluated the accuracy of the model by analyzing the difference between the constructed model and actual measurements. The trachea model was 8 cm long for children and 12 cm for adolescents and young adults, and for adults. The angle between the trachea and bed was about 20 degrees, regardless of age. The mean model accuracy was less than 0.4 cm. We constructed detachable artificial trachea models for three age groups for implementation in the endotracheal suctioning training environment simulator (ESTE-SIM) based on the treatment planning CT image. Our constructed artificial trachea models will be able to provide a simulation environment for various age groups in the ESTE-SIM.
24
Manolakis, Al, P. Bordei, C. Dina und D. M. Iliescu. „Peculiar case of branching of the trachea together with both, main and lobar, bronchi into a fetal lung“. ARS Medica Tomitana 21, Nr. 2 (01.05.2015): 112–15. http://dx.doi.org/10.1515/arsm-2015-0030.
Annotation:
Abstract Using as study method the injection of plastic followed by corrosion, we described, on an 8 months fetal lung, a particular branching pattern of the right bronchial tree were the superior lobar bronchus arise on the right side of the trachea, at 4.1 cm cranial to tracheal bifurcation. Other features of tracheo-bronchial branching encountered in this case: the level and tracheal bifurcation site and origin and the trajectory of the main bronchi, the middle lobar bronchi of the right lung and apical bronchus of the inferior lobar bronchi. To these peculiarities of the tracheo-bronchial tree are described also the peculiarities of the pulmonary arteries branches, which accompanies bronchial ramifications.
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Callan, Edward, Eugene J. Karandy und Raymond L. Hilsinger. „“Saber-Sheath” Trachea“. Annals of Otology, Rhinology & Laryngology 97, Nr. 5 (September 1988): 512–15. http://dx.doi.org/10.1177/000348948809700514.
Annotation:
Narrowing of the intrathoracic trachea in the coronal plane with anteroposterior lengthening is characteristic of the saber-sheath trachea deformity. This structural disorder is strongly associated with chronic obstructive pulmonary disease and may be related to chronic bronchitis. Although lateral compression suggests weakening and collapse, the supporting tracheal cartilage is usually thickened and densely calcified. We present a patient who was discharged after uneventful total laryngectomy but later complained of increasing airway obstruction from crusted secretions, resulting in visits to the emergency room and admission to the hospital. After the diagnosis was made by computed tomography, tracheal dilation was performed with some improvement. The diagnostic findings of the saber-sheath trachea, differential diagnosis, possible causes, and clinical implications are discussed.
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Kimura, Akari, Koji Araki, Yasushi Satoh, Sachiyo Mogi, Kazuko Fujitani, Takaomi Kurioka, Shogo Endo, Akihiro Shiotani und Taku Yamashita. „Inhibition of extracellular signal-regulated kinase pathway suppresses tracheal stenosis in a novel mouse model“. PLOS ONE 16, Nr. 9 (29.09.2021): e0256127. http://dx.doi.org/10.1371/journal.pone.0256127.
Annotation:
Tracheal stenosis is a refractory and recurrent disease induced by excessive cell proliferation within the restricted tracheal space. We investigated the role of extracellular signal-regulated kinase (ERK), which mediates a broad range of intracellular signal transduction processes in tracheal stenosis and the therapeutic effect of the MEK inhibitor which is the upstream kinase of ERK. We histologically analyzed cauterized tracheas to evaluate stenosis using a tracheal stenosis mouse model. Using Western blot, we analyzed the phosphorylation rate of ERK1/2 after cauterization with or without MEK inhibitor. MEK inhibitor was intraperitoneally injected 30 min prior to cauterization (single treatment) or 30 min prior to and 24, 48, 72, and 96 hours after cauterization (daily treatment). We compared the stenosis of non-inhibitor treatment, single treatment, and daily treatment group. We successfully established a novel mouse model of tracheal stenosis. The cauterized trachea increased the rate of stenosis compared with the normal control trachea. The phosphorylation rate of ERK1 and ERK2 was significantly increased at 5 min after the cauterization compared with the normal controls. After 5 min, the rates decreased over time. The daily treatment group had suppressed stenosis compared with the non-inhibitor treatment group. p-ERK1/2 activation after cauterization could play an important role in the tracheal wound healing process. Consecutive inhibition of ERK phosphorylation is a potentially useful therapeutic strategy for tracheal stenosis.
27
Hirano, T., C. Konaka, S. Okada, H. Shibanuma, E. Shimizu, T. Okunaka, H. Sakai, Y. Ebihara und H. Kato. „Endoscopic Diagnosis and Treatment of a Case of Respiratory Papillomatosis“. Diagnostic and Therapeutic Endoscopy 3, Nr. 3 (01.01.1997): 183–87. http://dx.doi.org/10.1155/dte.3.183.
Annotation:
Respiratory papilloma is a rare lesion that arises in the larynx, trachea and bronchus. We describe a patient with laryngeal papilloma that spread to the trachea and which was effectively treated by Nd-YAG laser. Two years after the initial treatments of the laryngeal and tracheal papillomas, a recurrent lesion (solitary papilloma) was observed on the membranous portion of the trachea. We examined the recurrent lesion by bronchoscopy including bronchoscopic ultrasound (US), helical computed tomography (CT) and tracheal biopsies. Respiratory papillomatosis sometimes shows either malignant transformation or invasion to tracheal wall without displaying cytohistological atypia. Therefore, we concluded that bronchoscopic US and helical CT were useful for deciding on therapeutic strategy in cases of recurrence of tracheal papilloma.
28
Carr, E. R. M., und E. Benjamin. „In vitro study investigating post neck surgery haematoma airway obstruction“. Journal of Laryngology & Otology 123, Nr. 6 (02.09.2008): 662–65. http://dx.doi.org/10.1017/s0022215108003423.
Annotation:
AbstractObjectives:To investigate whether the possible pressure produced by a haematoma in the neck would be sufficient to directly compress the trachea to the point of airway obstruction.Study design:In vitro study.Methods:Varying pressures were applied over the second and third cartilaginous rings of 10 pig tracheas in vitro and the anterior–posterior compression was measured.Results:At pressures of 257 mmHg, equivalent to the maximum possible pressure in the neck (i.e. systolic blood pressure), there was an average compression of 20.8 per cent of the original anterior–posterior tracheal diameter.Conclusions:This study suggests that the pressures in haematomas observed after neck surgery would not be sufficient to cause airway obstruction due to direct pressure on the trachea. Therefore, the most likely cause of airway obstruction would be supraglottic oedema secondary to venous obstruction.
29
Paramita, Swandari, Emil Bachtiar Moerad, Sjarif Ismail und Eva Marliana. „Antiasthmatic effect of Curcuma aeruginosa extract on isolated organ of the trachea“. F1000Research 7 (15.11.2018): 1799. http://dx.doi.org/10.12688/f1000research.16416.1.
Annotation:
Background:Asthma is a major health problem worldwide. Antiasthma drugs have side effects and can be expensive. It is important to develop antiasthma drugs from medicinal plants that have fewer side effects and are cheaper. One of the medicinal plants used for antiasthma treatment comes fromCurcuma aeruginosa(Zingiberaceaefamily). The aim of the research is to examine spasmolytic activity of ethanol extract ofC. aeruginosaon isolated guinea pig tracheas to determine the antiasthma effects.Methods:The spasmolytic activity ofC. aeruginosaextracts was tested in separated organs of guinea pig trachea. Guinea pig was sacrificed and its trachea rings were suspended in L-shaped wire loops in organ baths containing the Krebs solution aerated with carbogen. Isometric contractions of tracheal rings were measured by the transducer coupled to the amplifier. The trachea rings were exposed to DMSO as negative control, aminophylline as positive control andC. aeruginosaextracts. The single concentration-relaxation curve was obtained in every preparation.Results:The result showed that the decrease of the spasmolytic activity in the guinea pig tracheal tone due toC. aeruginosaextract was significantly better (p=0.022) when compared to the negative control. Meanwhile, the EC50value of aminophylline (0.019 ± 0.05) was not significantly different (p=0.454) withC. aeruginosa(0.024 ± 0.05).Conclusion:It could be concluded thatC. aeruginosaextracts have the potency to be further developed as a new natural source of the antiasthma agents.
30
Pavlovic, D., M. Fournier, M. Aubier und R. Pariente. „Epithelial vs. serosal stimulation of tracheal muscle: role of epithelium“. Journal of Applied Physiology 67, Nr. 6 (01.12.1989): 2522–26. http://dx.doi.org/10.1152/jappl.1989.67.6.2522.
Annotation:
There is evidence implying an active role of airway epithelium in the modulation of bronchomotor tone. To study this phenomenon, we designed an in vitro system allowing pharmacological stimulation of either the inside or outside of the airway lumen. Rat tracheas were excised, cannulated, and their inside and outside perfused independently with Krebs solution. Two hooks were inserted through opposite sides of the tracheal wall, the lower one was attached to a fixed point, while the upper one was connected to a force transducer. Isometric contractions of the tracheal muscle were elicited by carbachol solution perfused in single and cumulative concentrations. In one-half of the preparations the epithelium was mechanically removed. Stimulation of the inside or outside of the trachea produced equal maximal tracheal muscle tension [1.55 +/- 0.14 and 1.2 +/- 0.09 (SE) g in and out, respectively]. The time course of tension development was longer when carbachol was administered inside the trachea: an effect that was abolished when the epithelium was removed. In addition, removal of the epithelium was found 1) to increase the maximal tension irrespective of the route of carbachol perfusion and 2) to increase the sensitivity of the preparation to carbachol stimulation.
31
Bedolla, Carlos N., Catherine Rauschendorfer, Drew B. Havard, Blaine A. Guenther, Julie A. Rizzo, August N. Blackburn, Kathy L. Ryan und Megan B. Blackburn. „Spectral Reflectance as a Unique Tissue Identifier in Healthy Humans and Inhalation Injury Subjects“. Sensors 22, Nr. 9 (28.04.2022): 3377. http://dx.doi.org/10.3390/s22093377.
Annotation:
Tracheal intubation is the preferred method of airway management, a common emergency trauma medicine problem. Currently, methods for confirming tracheal tube placement are lacking, and we propose a novel technology, spectral reflectance, which may be incorporated into the tracheal tube for verification of placement. Previous work demonstrated a unique spectral profile in the trachea, which allowed differentiation from esophageal tissue in ex vivo swine, in vivo swine, and human cadavers. The goal of this study is to determine if spectral reflectance can differentiate between trachea and other airway tissues in living humans and whether the unique tracheal spectral profile persists in the presence of an inhalation injury. Reflectance spectra were captured using a custom fiber-optic probe from the buccal mucosa, posterior oropharynx, and trachea of healthy humans intubated for third molar extraction and from the trachea of patients admitted to a burn intensive care unit with and without inhalation injury. Using ratio comparisons, we found that the tracheal spectral profile was significantly different from buccal mucosa or posterior oropharynx, but the area under the curve values are not high enough to be used clinically. In addition, inhalation injury did not significantly alter the spectral reflectance of the trachea. Further studies are needed to determine the utility of this technology in a clinical setting and to develop an algorithm for tissue differentiation.
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Kloek, Joris, Ingrid van Ark, Nanne Bloksma, Fred De Clerck, Frans P. Nijkamp und Gert Folkerts. „Glutathione and other low-molecular-weight thiols relax guinea pig trachea ex vivo: interactions with nitric oxide?“ American Journal of Physiology-Lung Cellular and Molecular Physiology 283, Nr. 2 (01.08.2002): L403—L408. http://dx.doi.org/10.1152/ajplung.00376.2001.
Annotation:
The aim of this study was to determine the effects of glutathione (GSH) on trachea smooth muscle tension in view of previously reported interactions between GSH and nitric oxide (NO) (Gaston B. Biochim Biophys Acta 1411: 323–333, 1999; Kelm M. Biochim Biophys Acta 1411: 273–289, 1999; and Kharitonov VG, Sundquist AR, and Sharma VS. J Biol Chem 270: 28158–28164, 1995) and the high (millimolar) concentrations of GSH in trachea epithelium (Rahman I, Li XY, Donaldson K, Harrison DJ, and MacNee W. Am J Physiol Lung Cell Mol Physiol 269: L285–L292, 1995). GSH and other thiols (1.0–10 mM) dose dependently decreased the tension in isolated guinea pig tracheas. Relaxations by GSH were paralleled with sevenfold increased nitrite levels ( P < 0.05) in the tracheal effluent, suggesting an interaction between GSH and NO. However, preincubation with a NO scavenger did not reduce the relaxations by GSH or its NO adduct, S-nitrosoglutathione (GSNO). Inhibition of guanylyl cyclase inhibited the relaxations induced by GSNO, but not by GSH. Blocking potassium channels, however, completely abolished the relaxing effects of GSH ( P < 0.05). Preincubation of tracheas with GSH significantly ( P< 0.05) suppressed hyperreactivity to histamine as caused by removal of tracheal epithelium. These data indicate that GSH plays a role in maintaining tracheal tone. The mechanism is probably an antioxidative action of GSH itself rather than an action of NO or GSNO.
33
Coon, Robert L., Patrick J. Mueller und Philip S. Clifford. „Functional anatomy of the vagal innervation of the cervical trachea of the dog“. Journal of Applied Physiology 89, Nr. 1 (01.07.2000): 139–42. http://dx.doi.org/10.1152/jappl.2000.89.1.139.
Annotation:
The canine cervical trachea has been used for numerous studies regarding the neural control of tracheal smooth muscle. The purpose of the present study was to determine whether there is lateral dominance by either the left or right vagal innervation of the canine cervical trachea. In anesthetized dogs, pressure in the cuff of the endotracheal tube was used as an index of smooth muscle tone in the trachea. After establishment of tracheal tone, as indicated by increased cuff pressure, either the right or left vagus nerve was sectioned followed by section of the contralateral vagus. Sectioning the right vagus first resulted in total loss of tone in the cervical trachea, whereas sectioning the left vagus first produced either a partial or no decrease in tracheal tone. After bilateral section of the vagi, cuff pressure was recorded during electrical stimulation of the rostral end of the right or left vagus. At the maximum current strength used, stimulation of the left vagus produced tracheal constriction that averaged 28.5% of the response to stimulation of the right vagus (9.0 ± 1.8 and 31.6 ± 2.5 mmHg, respectively). In conclusion, the musculature of cervical trachea in the dog appears to be predominantly controlled by vagal efferents in the right vagus nerve.
34
Ikeda, Masakazu, Mitsuyoshi Imaizumi, Susumu Yoshie, Ryosuke Nakamura, Koshi Otsuki, Shigeyuki Murono und Koichi Omori. „Implantation of Induced Pluripotent Stem Cell–Derived Tracheal Epithelial Cells“. Annals of Otology, Rhinology & Laryngology 126, Nr. 7 (12.06.2017): 517–24. http://dx.doi.org/10.1177/0003489417713504.
Annotation:
Objectives: Compared with using autologous tissue, the use of artificial materials in the regeneration of tracheal defects is minimally invasive. However, this technique requires early epithelialization on the inner side of the artificial trachea. After differentiation from induced pluripotent stem cells (iPSCs), tracheal epithelial tissues may be used to produce artificial tracheas. Herein, we aimed to demonstrate that after differentiation from fluorescent protein-labeled iPSCs, tracheal epithelial tissues survived in nude rats with tracheal defects. Methods: Red fluorescent tdTomato protein was electroporated into mouse iPSCs to produce tdTomato-labeled iPSCs. Embryoid bodies derived from these iPSCs were then cultured in differentiation medium supplemented with growth factors, followed by culture on air-liquid interfaces for further differentiation into tracheal epithelium. The cells were implanted with artificial tracheas into nude rats with tracheal defects on day 26 of cultivation. On day 7 after implantation, the tracheas were exposed and examined histologically. Results: Tracheal epithelial tissue derived from tdTomato-labeled iPSCs survived in the tracheal defects. Moreover, immunochemical analyses showed that differentiated tissues had epithelial structures similar to those of proximal tracheal tissues. Conclusions: After differentiation from iPSCs, tracheal epithelial tissues survived in rat bodies, warranting the use of iPSCs for epithelial regeneration in tracheal defects.
35
Drobyazgin, E. A., Yu V. Chikinev, I. E. Sudovykh und I. V. Peshkova. „Endoscopic interventions in tumor of trachea“. Grekov's Bulletin of Surgery 176, Nr. 4 (28.08.2017): 18–21. http://dx.doi.org/10.24884/0042-4625-2017-176-4-18-21.
Annotation:
OBJECTIVE. The authors assessed possibilities of endoscopic methods for restoration and maintenance of trachea patency. MATERIAL AND METHODS. The article presents results of endoscopic treatment of 26 patients with trachea tumors. Tumor lesions of trachea was the main cause of contraction (primary tracheal cancer had 9 patients; esophageal cancer with invasion inside trachea - 5 patients; relapse of trachea cancer - 1case; relapse of larynx cancer - 1 case; lung cancer with invasion inside trachea - 3 cases; thyroid cancer - 2 patients). RESULTS. Endoscopic interventions were applied in order to restore the trachea patency such as tumor bougienage, electro-excision, tumor cutting, trachea stenting. There was observed bleeding in 3 patients, though it didn’t influence on operation approach. The patency of trachea was restored in all cases. Trachea stenting was performed in 19 patients as a preventive measure (silicone stents in 4 cases; self-expandable metal stent in 15 cases). Medical care remained actual in both restoration and trachea patency supporting. CONCLUSIONS. Endoscopic methods showed the high efficacy in treatment of patients with trachea tumors.
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Trigaux, J. P., G. Hermes, P. Dubois, B. Van Beers, L. Delaunois und J. Jamart. „CT of Saber-Sheath Trachea“. Acta Radiologica 35, Nr. 3 (Mai 1994): 247–50. http://dx.doi.org/10.1177/028418519403500310.
Annotation:
The diagnosis of saber-sheath trachea is easy at CT due to its cross-sectional imaging, but the significance of this CT sign has not been evaluated in the diagnosis of chronic obstructive pulmonary disease (COPD). Various signs of COPD were compared between a series of 20 patients with a saber-sheath trachea at CT (tracheal index <66%) and a group of 20 pneumologic control patients without saber-sheath trachea (tracheal index ≥70%). These signs included clinical and standard radiographic indices of COPD, sternum-spine distance and 3 functional tests of COPD: forced expiratory volume in one second, carbon monoxide diffusing lung capacity, and functional residual capacity (FRC). A significant difference was found between the 2 groups, concerning the values of FRC (p < 10−4) and of sternum-spine distance (p < 10−2). The tracheal index was significantly correlated with the FRC values (r = −0.611; p < 10−5) and with the sternum-spine distance (r = −0.322; p < 0.05). No other significant difference was observed. It is concluded that saber-sheath trachea is basically a sign of hyperinflation.
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Ševčíková, Marieta K., Karol Ševčík, Mária Figurová, Alexandra Agyagosová-Valenčáková, Marián Hluchý, L’ubica Horňáková, Mária Lapšanská, Zoltán Kerekes und Zdeněk Žert. „Retrospective analysis of tracheal hypoplasia in brachycephalic and non-brachycephalic dogs: Inter- and intra-observer agreement of measurements“. Acta Veterinaria Hungarica 70, Nr. 3 (06.10.2022): 192–200. http://dx.doi.org/10.1556/004.2022.00018.
Annotation:
Abstract This retrospective study was undertaken on the records of intraluminal diameter of the trachea in 185 dogs, in which hypoplasia of the trachea had been suspected. The relative size of the trachea was measured using the tracheal diameter (TD), thoracic inlet distance (TI), thoracic tracheal diameter (TT) and the width of the third rib (3R), expressed as ratios TD:TI and TT:3R. Thirty-five dogs were diagnosed as having tracheal hypoplasia. Bulldogs and non-bulldog brachycephalic dogs had significantly smaller measured trachea diameters compared to the predicted values calculated on the basis of their body weight. Radiographs of each dog were investigated by four observers. Inter- and intra-observer reliability (ICCinter, ICCintra) was based on the measurements taken by four observers to evaluate the reproducibility of the protocol. There was a good ICCinter (0.8) and ICCintra (0.89) agreement. Craniocaudal tangential radiographs, centred on the cranial thoracic aperture, did not show a significant difference in tracheal diameter measurements compared to the right lateral radiographs. In conclusion, our findings indicate that bulldogs and non-bulldog brachycephalic dogs have smaller tracheal diameters than non-brachycephalic dogs.
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Pandey, G., B. Thakur und M. Devkota. „Adenoid cystic carcinoma in trachea: A rare presentation“. Journal of Pathology of Nepal 6, Nr. 11 (17.03.2016): 965–67. http://dx.doi.org/10.3126/jpn.v6i11.15684.
Annotation:
Primary tracheal tumors are rare. Adenoid cystic carcinoma of trachea is even rarer. It occurs as a polypoidal mass in trachea presenting with dyspnea and respiratory distress due to tracheobronchial obstruction. We report a case of young male presenting with dyspnea for some time. CT scan revealed mass in trachea obliterating its lumen. Histopathological examination conirmed the diagnosis.
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Kato, I., K. Uesugi, M. Kikuchihara, H. Iwasawa, J. Iida, K. Tsutsumi, H. Iwatake und I. Takeyama. „Tracheostomy—The horizontal tracheal incision“. Journal of Laryngology & Otology 104, Nr. 4 (April 1990): 322–25. http://dx.doi.org/10.1017/s0022215100112599.
Annotation:
AbstractThe complication rate after emergency tracheostomy is two to five times greater than after elective procedures. One of the main causes of the high risk of complications in emergency tracheostomy appears to be the amount of time required to open the trachea. Therefore, simple and fast procedures are mandatory. We have developed a new procedure as follows: A horizontal skin incision is performed. Strap muscles are dissected and retracted laterally. A transverse cut between tracheal rings below the thyroid isthmus is performed up to membranous portion of the trachea. The cut ends of the trachea remain open naturally because of the elasticity of the trachea. Skin and tracheal cut-ends are then joined by interrupted sutures.We have used this procedure during the past three years and have not experienced any major complications. This demonstrates the clear advantage and the more physiological nature of the procedure over various other incisions of the tracheal wall.
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Philippe, Grégory, Nicolas Pichon, Justine Lerat, Jean Bernard Amiel, Marc Clavel und Muriel Mathonnet. „Successful Treatment of Anterior Tracheal Necrosis after Total Thyroidectomy Using Vacuum-Assisted Closure Therapy“. Critical Care Research and Practice 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/252719.
Annotation:
Total thyroidectomy involving the adjacent structures of the trachea can cause tracheal damage such as early tracheal necrosis. The authors describe the first case of anterior tracheal necrosis following total thyroidectomy treated using vacuum-assisted closure device. After two weeks of VAC therapy, there was no evidence of ongoing infection and the trachea was partially closed around a tracheotomy cannula, removed after 3 months. The use of a VAC therapy to reduce and close the tracheal rent and to create a rapid granulation tissue over tracheal structure appeared as a good opportunity after anterior tracheal necrosis.
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Wei, Yi, Xiao-Lin Zhou, Tai-Hang Liu, Peng Chen, Xia Jiang, Zhan-Qi Dong, Min-Hui Pan und Cheng Lu. „A Matrix Metalloproteinase Mediates Tracheal Development in Bombyx mori“. International Journal of Molecular Sciences 22, Nr. 11 (25.05.2021): 5618. http://dx.doi.org/10.3390/ijms22115618.
Annotation:
The trachea of insects is a tubular epithelia tissue that transports oxygen and other gases. It serves as a useful model for the studying of the cellular and molecular events involved in epithelial tube formation. Almost all of the extracellular matrix can be degraded by Matrix metalloproteinases (MMPs), which is closely related to the processes of development and regeneration. The regulation of trachea by MMPs is roughly known in previous studies, but the detailed regulation mechanism and involved gene function are not fully explored. In this article, we found MMP1 expressed highly during tracheal remodeling, and knocked out it makes the tracheal branch number reduced in Bombyx mori. In trachea of transgenic BmMMP1-KO silkworm, the space expanding of taenidium and epidermal cells and the structure of apical membrane were abnormal. To explore the underlying mechanism, we detected that DE-cadherin and Integrin β1 were accumulated in trachea of transgenic BmMMP1-KO silkworm by immunohistochemistry. Moreover, 5-Bromo-2′-Deoxyuridine (BrdU) labeling showed that knockout of BmMMP1 in silkworm inhibited tracheal cell proliferation, and BmMMP1 also regulated the proliferation and migration of BmNS cells. All of the results demonstrated that BmMMP1 regulates the development of the tracheal tissue by expanding the space of tracheal cuticles and increases the number of tracheal branches by degrading DE-cadherin and Integrin β1.
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Brown, I. G., P. M. Webster, N. Zamel und V. Hoffstein. „Changes in tracheal cross-sectional area during Mueller and Valsalva maneuvers in humans“. Journal of Applied Physiology 60, Nr. 6 (01.06.1986): 1865–70. http://dx.doi.org/10.1152/jappl.1986.60.6.1865.
Annotation:
Pressure-area behavior of the excised trachea is well documented, but little is known of tracheal compliance in vivo. Extratracheal tissue pressures are not directly measurable, but transmural pressure for the intrathoracic trachea is inferred from intra-airway and pleural pressure differences. Extramural pressure of the cervical trachea is assumed to be atmospheric. The difference in transmural pressure between the intra- and extrathoracic tracheal segments should be exaggerated during Mueller and Valsalva maneuvers. We used the acoustic reflection technique to measure tracheal areas above and below the thoracic inlet during these isovolume-pressure maneuvers. We found that 10 cmH2O positive pressure increased tracheal area in the extrathoracic segment by 34 +/- 16% (mean +/- SD) and in the intrathoracic segment by 35 +/- 15%. There was a reduction in area of 27 +/- 16 and 24 +/- 14%, respectively, for the extra- and intrathoracic segments with 10 cmH2O negative pressure. We conclude that the effective transmural pressure gradients do not vary significantly between intra- and extrathoracic tracheal segments.
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Horita, Keiichi, Cao Zhi Li und Tsuyoshi Itoh. „Experimental Study of Autogenous Vein Patches for Repair of Defective Tracheal Membranous Walls“. Asian Cardiovascular and Thoracic Annals 5, Nr. 4 (Dezember 1997): 227–30. http://dx.doi.org/10.1177/021849239700500409.
Annotation:
The feasibility of using vein patch grafts to repair defective tracheal membranous walls was determined. The right jugular veins of 5 adult mongrel dogs were harvested through midline cervical incisions and used as patch grafts. Each cervical trachea was exposed and a full-thickness lesion (2 × 1 cm) was created in the cervical tracheal membranous wall by resecting part of the trachea at the fourth ring below the cricoid cartilage. The defect was repaired by grafting a vein patch to the posterior surface of the injured trachea. All the dogs survived without complications until euthanasia 6 months later. Bronchoscopic examination demonstrated adequate tracheal patency with no inspiratory or expiratory collapse. The constrictive ratio of the cross-sectional area of the most stenotic site to that of the third tracheal ring below the membranous patch was 1.06 ± 0.28. Histologic examination revealed neoepithelium on the surfaces of all the patch grafts. The results indicate that jugular vein patch grafts can be used to repair tracheal membranous wall lesions.
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Corfield, D. R., S. E. Webber und J. G. Widdicombe. „Distribution of blood flow in the perfused tracheae of sheep: a search for arteriovenous anastomoses“. Journal of Applied Physiology 74, Nr. 4 (01.04.1993): 1856–61. http://dx.doi.org/10.1152/jappl.1993.74.4.1856.
Annotation:
The possible existence of arteriovenous anastomoses (AVAs) in the tracheobronchial circulation has been largely ignored; however, their presence would have many implications. Here we have searched for AVAs in the tracheal circulation of seven anesthetized sheep that were ventilated through a low cervical tracheostomy. Arteries to the midcervical trachea were isolated and perfused in situ at systemic blood pressure; blood flow was measured with an electromagnetic flow probe. A vein draining the perfused segment was cannulated. Radiolabeled microspheres (16 microns diam) injected into the arterial inflow of the perfusion indicated the distribution of blood flow (cervical trachea, 69.9 +/- 4.55% (SE); esophagus, 15.1 +/- 3.9%; connective tissue and blood vessels near trachea, 9.5 +/- 1.8%; lymph nodes, 4.0 +/- 2.2%; skeletal muscle, 0.17 +/- 0.07%; trachea below intubation, 0.00%; larynx, 0.00%; other tissues 0.81 +/- 0.32%). Less than 0.6% of the activity was detected in the tracheal venous blood and lungs, indicating little shunting via AVAs. Within the trachea, blood flow (per wet weight of tissue) to the mucosa overlying smooth muscle was approximately 25% of that to the mucosa overlying cartilage. Intra-arterial infusion of methacholine doubled perfusion blood flow without altering the proportion of shunted blood. Within the trachea, blood flow increased most to the mucosa overlying smooth muscle and to smooth muscle. In conclusion the contribution of AVAs to total blood flow in the cervical trachea is < 1%.
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Aktaş, Fatma, und Turan Aktaş. „Volume Measurement in the Diagnosis of Mounier Kuhn Syndrome and an Unknown Accompanying Pathology: Pulmonary Artery Enlargement“. Current Medical Imaging Formerly Current Medical Imaging Reviews 15, Nr. 8 (27.09.2019): 796–801. http://dx.doi.org/10.2174/1573405615666190220110628.
Annotation:
Background: Mounier Kuhn Syndrome (MKS) is a rare congenital anomaly characterized by abnormal dilatation of the trachea and main bronchi. The aim of this study is to discuss tracheal volume measurement in MKS, and the pathologies accompanying MKS, especially pulmonary artery enlargement. Materials and Methods: 38 patients, 18 of whom were diagnosed with MKS and 20 as control group, were included in the study. Trachea volume and pulmonary artery diameter were measured through thorax-computed tomography (CT) images of the patients. Accompanying pathologies were recorded. Results: In the measurements done through the CT scans, the trachea volume was found to be 25.45 cm3 in the control group and 44.17 cm3 in the patient group. The most frequent accompanying pathologies were tracheal diverticulum, bronchiectasis and pulmonary artery enlargement. Conclusion: In patients with MKS, there is a significant difference in volume calculation as in trachea diameter. Though bronchiectasis and tracheal diverticulum are known as pathologies most frequently accompanying MKS, to the knowledge of the researchers, pulmonary artery enlargement due to the increase in pulmonary truncus diameter was first emphasized in this article.
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Iyer, Subramania, Narayana Subramaniam, Sivakumar Vidhyadharan, Krishnakumar Thankappan, Deepak Balasubramanian, Balasubramanian K. R., Arun Nair, Kishore Purushottaman, Janarthanan Ramu und Zachariah Paul. „Tracheal Allotransplantation–Lessons Learned“. Indian Journal of Plastic Surgery 53, Nr. 02 (August 2020): 306–8. http://dx.doi.org/10.1055/s-0040-1716420.
Annotation:
AbstractReconstruction of long tracheal defects still proves to be a challenge. Free fasciocutaneous flaps with cartilaginous struts or an allotransplant trachea have been reported but not been widely performed. This article reports with the experience of using a tracheal allotransplant in such a defect.A 43-year-old lady presented with adenoid cystic carcinoma involving the entire trachea from subglottic area up to the carina, leading to a life-threatening airway occlusion. After preliminary stenting, allotransplant trachea obtained from a brain-dead individual was revascularized in the forearm of the patient after mechanical decellularization to reduce the immune load and fulfil the need for immunosuppression in the background of active cancer. Subsequently, the trachea and larynx were resected. The vascularized neotrachea was transferred successfully into the neck. The patient did well initially but succumbed to a fatal hemorrhage due to innominate vein aneurysmal rupture on the 22nd day after the transplant.The technical details of resection, fabrication of the neotrachea, its transfer, and the lessons learnt in this tracheal allotransplant are described.
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Mousa Khaleel, Iman, Khalid Ibrahim Abd Alkhazraji und Mahdi Abdul kreem Atiea. „Detection of morphometrical, histological and histochemical characteristics of lung and trachea in adult local squirrel (Sciurus anomalus)“. Bionatura 7, Nr. 3 (15.09.2022): 1–9. http://dx.doi.org/10.21931/rb/2022.07.03.39.
Annotation:
The present study aimed to identify the topography, morphology, histochemistry and histology of lung structures, bronchial divisions and trachea in adult local Squirrel (Sciurus anomalus) as a species inhabited in Iraqi environments. This work was conducted on thirty local Squirrel of both sexes (15) males and (15) females were divided into three equal groups, first for http://wsx5customurl.comanatomical perceptions, second to resin cast technique and the third for histological study. Anatomically, in both sexes, the trachea appeared as a cartilaginous structure consisting of flexible cartilaginous rings, C-like, connected by annular ligaments. It begins at the end of the cricoid cartilage from the level of the second cervical vertebra to the fourth thoracic vertebral plane; eventually, it splits into the right and left main bronchi. Count tracheal rings, the entire weight of the lung, full length, the diameter of the trachea and right and left bronchi. The trachea in females was slightly less than in males but not significantly. The bronchial tree was detected in resin cast, which was constructed of the trachea divided into left and right primary bronchi (Main bronchi), the right one was split into four secondary bronchi to enter the right lobes and two secondary bronchi to the left one. The left lung contains one lobe, whereas four lobes were observed in the right. Histologically, the wall of the trachea consists of four layers. Epithelial cells of ciliated pseudostratified columnar and goblet cells that reacted positively with PAS were covered in the mucosa. Submucosa was devoid of the tracheal glands. The Trachealis muscle is connected from the outer aspect of rings. Similarly to the trachea, the primary bronchi are structured but smaller in diameter; they break up within the lung into primary, secondary and tertiary bronchi, then it terminates in respiratory bronchioles that contain Clara cells and open at the end in the sacs of alveoli. Two types of pneumocystis were observed lining the alveoli. The current study concluded anatomically and histologically that there were no significant differences between males and females of local squirrels. The lobulation of the lung in squirrels is different from other animals. The trachea and lung histologically resembled numerous animals, however, the wall had micro morphometric changes. But, the surface lining cells of the tracheal and bronchi mucosa secrete neutral mucin, with no submucosal glands in the tracheal wall. Keywords: Trachea, Local Squirrel, Bronchial Tree, Histochemical, Lung.
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Tijana, Durmić, Čurović Ivana, Bogdanović Milenko und Savić Slobodan. „Iatrogenic tracheoarterial fistula: Case report and literature review“. Medicine, Science and the Law 57, Nr. 3 (Juli 2017): 143–45. http://dx.doi.org/10.1177/0025802417720567.
Annotation:
Tracheo-innominate fistula is a rare but recognised life-threatening complication most commonly associated with prolonged endotracheal intubation. We report the case of a 16-year-old boy who developed a tracheo-innominate fistula secondary to the prolonged intubation after a pool accident. After 16 days of hospitalisation, the patient died as a consequence of a massive haemorrhage into the tracheobronchial tree and asphyxia. This is a rare complication, and to our knowledge, no case of tracheo-innominate fistula or any other case series concerning this rare complication has been reported in Serbia recently. This case report addresses the epidemiology of a trachea-innominate fistulisation as a complication of prolonged tracheal intubation, with a special overview of its forensic importance as an iatrogenic injury.
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Idiatullin, R. M., S. N. Styazhkina, R. R. Arslanov, P. V. Isaeva und G. F. Nizamova. „RARE COMPLICATION OF SURGICAL TREATMENT OF THYROID CANCER“. Tavricheskiy Mediko-Biologicheskiy Vestnik 23, Nr. 2 (2020): 223–26. http://dx.doi.org/10.37279/2070-8092-2020-23-2-223-226.
Annotation:
Thyroid cancer is the leading cancer in the endocrine system. Over the past few decades, the incidence of this pathology worldwide has increased at a higher rate than other cancers. The main method of treatment for thyroid cancer is surgical. Some of the complications that can result from surgical treatment are tracheomalacia and trachea damage. Tracheomalacia is a pathological softening of tracheal rings resulting from prolonged compression of the trachea resulting in degenerative changes in cartilages. As a result of the removal of the thyroid tumor, a defect of its wall may form. Damage of the trachea can occur when the thyroid isthmus is separated from it. In addition, when separating the thyroid gland from the trachea, performing central lymphodissection, the blood supply of the trachea may be disturbed, which is carried out according to the segmental type, characterized by a lack of the number of collaterals. There is presented a clinical case of successful treatment of a rare complication after thyroid surgery for papillary cancer in the form of trachea in a patient of 49 years. By analyzing the clinical example, taking into account the macroscopic picture of trachea defects, their location and dimensions, it is possible to assume segmental disorder of blood supply of the upper third of the trachea in the postoperative period with the development of ischemic changes and regions of necrosis of ring ligaments. In order to prevent such complications in thyroid operations, it is necessary to preserve the paratracheal vascular anastomotic network by carefully preparing the tracheal branches of the lower thyroid artery.
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Idiatullin, R. M., S. N. Styazhkina, R. R. Arslanov, P. V. Isaeva und G. F. Nizamova. „RARE COMPLICATION OF SURGICAL TREATMENT OF THYROID CANCER“. Tavricheskiy Mediko-Biologicheskiy Vestnik 23, Nr. 2 (2020): 223–26. http://dx.doi.org/10.37279/2070-8092-2020-23-2-223-226.
Annotation:
Thyroid cancer is the leading cancer in the endocrine system. Over the past few decades, the incidence of this pathology worldwide has increased at a higher rate than other cancers. The main method of treatment for thyroid cancer is surgical. Some of the complications that can result from surgical treatment are tracheomalacia and trachea damage. Tracheomalacia is a pathological softening of tracheal rings resulting from prolonged compression of the trachea resulting in degenerative changes in cartilages. As a result of the removal of the thyroid tumor, a defect of its wall may form. Damage of the trachea can occur when the thyroid isthmus is separated from it. In addition, when separating the thyroid gland from the trachea, performing central lymphodissection, the blood supply of the trachea may be disturbed, which is carried out according to the segmental type, characterized by a lack of the number of collaterals. There is presented a clinical case of successful treatment of a rare complication after thyroid surgery for papillary cancer in the form of trachea in a patient of 49 years. By analyzing the clinical example, taking into account the macroscopic picture of trachea defects, their location and dimensions, it is possible to assume segmental disorder of blood supply of the upper third of the trachea in the postoperative period with the development of ischemic changes and regions of necrosis of ring ligaments. In order to prevent such complications in thyroid operations, it is necessary to preserve the paratracheal vascular anastomotic network by carefully preparing the tracheal branches of the lower thyroid artery.