• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.117-121
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• 1998

Relapsing polychondritis is a rare disesase involving any cartilaginous structure of entire body and is characterized by recurrent episode of inflammation and degeneration of cartilage and most commonly involve ear, nose, larynx, trachea, ribs, Eustachian tube, etc. Its signs and symptoms are recurrent swelling of auricle, saddle nose deformity, polyarthralgia, hoarseness and dyspnea, audiovestibular disturbance and cardiovascular abnormality, etc. Characteristic histologic findings are loss of normal basophilic staining of cartilage, perichondrial inflammatory infiltration with plamsa cells, lymphocytes and neutrophils, and finality, destruction of cartilage and replacement with scar tissue. Our case had saddle nose deformity, arthralgia, tracheal collapse, hearig loss and positive histologic finding but no auricular perichnodritis. Her major problem was airway. obstruction due to tracheal collapse. This case was diagnosed with relapsing polychondritis according to the Damiani's criteria. This case indicates that any patients complaining of airway obstruction have to be examined systemically.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.283-291
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• 2009

Background: Tracheal reconstruction after extended tracheal resection still remains as a major surgical challenge because good clinical outcomes are usually correlated with limited tracheal resection. Recent investigations with a using cryopreserved trachea for the reconstruction of a trachea have been carried out to overcome this problem. In this study, we analyzed viability of tracheas, which is an important determining factor for the success of transplanting a cryopreserved trachea and the development of post-transplantation tracheal stenosis, according to three different experimental factors: 1) the warm-ischemic time, 2) the cryopreservation solution and 3) the preserving temperature, to determine a better cryopreservation protocol and a better composition of the cryopreservation solution. Material and Method: Rats tracheas were harvested for different warm-ischemic times (0 hr, 12 hrs, 24 hrs). The tracheas were treated with recombinant insulin growth factor-1 (IGF) and they were stored at three different temperatures $(4^{\circ}C,\;-80^{\circ}C,\;-196^{\circ}C)$ for two weeks. After two weeks, we thawed the stored trachea and isolated the cells of the tracheas with using type II collagenase. We cultured the cells for seven days and then we compared the cellular viability by the MTT reduction assay. Result: Though cryopreservation is required to preserve a trachea for a longer time period, the viability of the tracheas stored at $-80^{\circ}C$ and $-196^{\circ}C$ was significantly reduced compared to that of the tracheas stored at $4^{\circ}C$. The viability of the tracheas with warm-ischemic times of 12 hrs and 24 hrs was also reduced in comparison to the tracheas with a warm-ischemic time of 0 hrs. Our data showed that the warm ischemic time and the parameters of crypreservation negatively affect on trachea viability. However, a cryopresrvation solution containing IGF-1 improved the cellular viability better than the existing cryopreservation solution. For the warm ischemic time group of a 0 hr, the addition of IGF-1 improved the viability of trachea at all the preserving temperatures. Conclusion: These experiments demonstrate that the viability of cryopreserved trachea can improved by modifying the components of the crypreservation solution with the addition of IGF-1 and reducing the warm-ischemic time.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.534-538
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• 2001

Background: Knowledge of size and morphology of the normal trachea is important for airway management and tracheal reconstruction. Conventional radiography is a simple method used to measure the tracheal diameter, but it is not accurate because of the artifacts related to image magnification and overlapping by the shoulder. The purpose of this study was to provide the normal values of the tracheal size and anatomy in Korean adults using Computerized Topography. Material and Method: There were 43 men and 34 women included in this study. They were divided into three age groups(group 1, 20-39 years ; group 2, 40-59 yeas , groups 3, $\geq$60 years). The anteroposterior and transverse diameters and cross - sectional areas of the trachea were measured at the level of the thoracic inlet(Level 1) and the aortic arch(Level 2). These values obtained at each level were compared between age groups and sexes. Result: In 43 men, the anteroposterior / transverse diameters(mean SD in millimeters) of the trachea at levels 1 and 2 were 19.95$\pm$2.99 / 17.72$\pm$2.13 and 19.77$\pm$2.57 / 18.02$\pm$2.19, respectively. In 34 women, those values at levels 1 and 2 were 15.56$\pm$2.12 / 14.18$\pm$2.07 and 15.35$\pm$1.82 / 15.00$\pm$1.60, respectively. At both levels, the anteroposterior and transverse diameters were significantly greater in men than in women (p<0.05). The cross-sectional area of the trachea at levels 1 and 2 were 279.14$\pm$61.37 / 281.93$\pm$63.97 $\textrm{mm}^2$ in men and 173.29$\pm$35.81 / 181.88$\pm$34.74 in women, respectively. They also showed significantly greater values in men than in women(P<0.05). There was no significant difference in diameters and cross-sectional areas of the trachea between age groups. Conclusion: There are significant differences in the internal diameter and cross- sectional area of the trachea between men and women in normal Korean adults, while the age difference was insignificant. We believed CT is a relatively accurate and safe way to measure the internal diameter and cross-sectional areas of the trachea.

• Tuberculosis and Respiratory Diseases
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• v.43 no.3
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• pp.420-433
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• 1996

Background : There have been many debates about the effects of nitric oxide on the neurogenic inflammation. The role of nitric oxide in the neurogenic inflammation of airways will be required a better understanding of the localization and types of nitirc oxide synthase(NOS) activity in the neurogenic inflammation of airways. Method : To investigate the role of nitric oxide in airway neurogenic inflammation, 1) the effects of neurokinin receptor antagonist (FK224) and nitric oxide synthase inhibitor, $N^{\omega}$-nitro-L-arginine (L-NNA) on plasma extravastion were evaluated in four groups of Sprague-Dawley rats ; sham operation group(sham NANC group), electrical vagal stimulation group(NANC2 group), intravenous pretreatment groups with FK224 (1mg/kg ; FK224 group), and L-NNA(1mg/kg ; L-NNA group) 15 minutes before vagal NANC stimulation. 2) NOS activity in trachea with neurogenic inflammation was localized by immunohistochemical stain. Immunohistochemical stain was performed by antibodies specific for inflammatory cells(iNOS), brain(bNOS), and endothelium (eNOS) on trachea obtained from sham NANC, NANC2, and FK224 groups. Results : The results are that plasma extravsation in neurogenic inflammation of rat airways was inhibited by FK224, but enhanced by L-NNA pretreatment(P<0.05). There was significantly increased infiltration of inflammatory cells in subepithelium of neurogenic inflammatory trachea, but the reduction of subepithelial infiltration of inflammatory cells was observed after pretreatment with FK224(P<0.05). Immunostaining with anti-iNOS antibody showed strong reactivity only in infiltrated inflammatory cells in neurogenic rat trachea, and these iNOS reactivity was reduced by pretreatment with FK224. bNOS immunoreactivity was significantly increased only in the nerves both of neurogenic inflammatory and FK224 pretreated trachea compared with sham NANC trachea(p<0.05). eNOS immunoreactivity was not significant change in endothelium in neurogenic inflammation of rat trachea. Conclusion : These results suggest that nitric oxide released from iNOS in infiltrated inflammatory cells has main role in neurogenic inflammation of rat trachea. The presence of bNOS immunoreactivity in the nerves indicates that nitric oxide may be released from the nerves in rat trachea with neurogenic inflammation.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.149-152
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• 1975

In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.183-187
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• 2007

A glomus tumor is composed of modified smooth muscle cells that are similar to those of the glomus body. Its occurrence in the trachea is quite rare. To our knowledge, only 20 cases of glomus tumor of the trachea have been reported worldwide and there has been only 1 case in Korea. We report one case of a 58-year-old man with dyspnea who had a glomus tumor in the upper trachea with a review of literatures. The chest CT scan and bronchoscopy demonstrated a 2.5 cm sized lobulated tumor at the posterior wall of the upper trachea. It had an elongated shape with a broad base and with a highly vascularity. A simple resection of 3 levels of the trachearing was with a tumor and end-to-end anastomosis performed. Microscopic and immunohistochemical staining of the tumor revealed the characteristics of a glomus tumor.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1182-1190
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• 1996

The best treatment of congenital or acquired tracheal stenosis is resection and end to end anastomosis. Various prosthetic material and tissue graft replacement can be considered when the stenotic segment is too long, but their uses are still limited due to many serious complications. The present study examined the effect of immunosuppression and cryopreserved allograft trachea after intraperitoneal omental implantation for evaluation of the possibility of tracheal transplantation. Thirty tracheal segments were harvested from fifteen donor Wistar rats. Among them eighteen segments were implanted immediately(group I, II, III) and twelve segments were used for cryopreservation(group IV, V). Heterotopical intraperitoneal implantation was performed in five groups of rats(n=6); Group I was Wistar syngeneic controls and received no immunosuppression. Group II and III were those of Sprague-Dawley recipients, the former receiving no immunosuppression and the latter receiving immunosuppression(Cyclosporin A 15mg/kg/day, Methylprednisolone 2mg/kg/day). Group IV and V were groups of Sprague-Dawley recipients, the former receiving immunosuppression and the latter receiving no Immunosuppression. After 28 days, rats were sacrificed and the tracheal segments were histologically evaluated. Epithelial thickness was significantly decreased in group II, IV. Epithelial regeneration score was also significantly decreased in II. All rats maintained well their round tracheal contour. In conclusion; I) trachea could be preserved for a long time with cryo method, 2) epithelium could regenerate fully with omentopexy in cryopreserved trachea, 3) immunosuppresion was not necessary with cryopreserved trachea.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.757-760
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• 1999

A rare small cell carcinoma of the trachea was managed in a 59 year old female patient. The diagnosis was confirmed by histopathological and immunohistochemical studies. Surgical resection and adjuvant chemotherapy were done. The patient died 6 months later due to multiple metastasis.

• Herbal Formula Science
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• v.8 no.1
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• pp.191-211
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• 2000

Objectives: In order to evaluate the effect of jungcheonwhadamgangki-tang on Balb/c mouse of allergy-sensitive to bronchial asthma induced by ovalbumin. Methods: The changes of diameter lumen of trachea which was upper respiratory organ, weight and gross appearance of lung, histology of lung and trachea, numbers of inflammatory cells in the bronchoalveolar lavage fluld(BALF) were observed. Results : The results are obtained as follows. 1. The diameters of trachea lumen were significantly increased in Jungcheonwhadam gangki-tang treated group as compared with control group. 2. Inflammatory cells including neutrophil and eosinophil in BALF were significantly. in Jungcheonwhadamgangki-tang treated group as compared with control group. 3. Weight of lung and black spots, which resulted from infiltration of inflammatory were significantly decreased in Jungcheonwhadamgangki-tang treated group as compared with control group.4. Hypertrophy of mucous membrane of trachea and bronchus and bronchioles in the lung, peritracheal, peribronchus and peribronchiolar inflammatory cell infiltration, and mucoid exudate deposit in the lumen were significantly decreased in Jungcheonwhadamgangki-tang treated group as compared with control group. Conclusions : It is considered that Jungcheonwhadamgangki-tang has somewhat favorable effect on the bronchial asthma because the bronchial asthma specific series of abnormalities in respiratory system were decreased after oral administration of Jungcheonwhadamgangki-tang in this study. In future, it is needed that the toxicological and dosage specific study of Jungcheonwhadamgangki-tang to use against bronchial asthma with safe.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.540-542
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• 2009

Glomus tumor is a distinctive type of perivascular tumor whose cell type is a modified smooth cell that closely resembles the glomus body, and this is where the tumor's name is derived. This kind of neoplasm is a benign and rather uncommon neoplasm that can be found in any part of the body, yet it is most commonly seen in the subungual area. Glomus tumor of the trachea is extremely rare. We present the clinicopathologic findings of a resected glomus tumor of the trachea along with a review of the related literature.