Hiroya Iwatake

End-to-end anastomosis in chronic tracheal stenosis.

OBJECTIVE This study assessed the efficacy and safety of end-to-end anastomosis of the trachea following segmental resection in chronic tracheal stenosis. METHODS End-to-end anastomoses of the trachea were performed in 35 patients with chronic tracheal stenosis; 18 patients with tracheal invasion of thyroid cancer and 17 patients with long-term intubation and blunt injuries of the trachea. RESULTS All operations were successful, except one whose unilateral recurrent nerve had not been identified in the recurrent thyroid cancer invasion with trachea. CONCLUSION This operation provides a one-step cure for the stenosed trachea and can be applied to the resection of less than six tracheal segments.

A case of relapsing polychondritis involving placement of an expandable metallic stent

Relapsing polychondritis is a relatively uncommon disease characterized by recurrence of progressive inflammation of cartilaginous structures. Laryngotracheal involvement occurs in 50-70% of cases, and occasionally results in acute airway obstruction. We reported a case of relapsing polychondritis with severe tracheal stenosis that was treated by the placement of two expandable metallic stents. A 58-year-old man was hospitalized with fever and breathing difficulties. A tracheostomy was performed and a silicone T-tube was placed. A diagnosis of relapsing polychondritis was made based on the biopsy from auricular and tracheal cartilages. Two expandable metallic stents were placed in the trachea to bilateral main bronchus. This dilated the airway lumen and resulted in the dyspnea disappearing completely. However, 18 months later a sudden massive hemorrhage occurred through the tracheostoma, and he died of respiratory failure. Autopsy showed a tracheoinnominate artery fistula. We discuss the management of relapsing polychondritis with severe tracheal stenosis.

Two Cases with Metastatic Cervical Lymph Nodes from Nasopharyngeal Carcinoma Simultaneously Showing Tuberculous Caseosa.

We had encountered two men, 51-year and 35-year-old, with nasopharngeal carcinoma. These patients showed nasopharyngeal tumor and metastatic lymph nodes in the neck. After chemotherapy followed by radiation, bilateral neck dissection was performed under general anesthesia.Poorly differentiated carcinoma was diagnosed histologically in both patients, however, resected of neck lymph nodes showed caseating granuloma suggesting tuberculous. Thus, it was suggested that tuberculous lymph nodes might be caused by decreased immunological competence due to nasopharyngeal carcinoma.There have been few cases with lymphadenitis which have demonstrated both cancer cells and tuberculous caseosa.We discuss the mechanism based on previous reports.