Idiopathic tracheal stenosis and hormone receptors.
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ABSTRACT:
SUBMITTER: Aziz J
PROVIDER: S-EPMC10482623 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
Publications
Idiopathic tracheal stenosis and hormone receptors.
Journal of thoracic disease 20230728 8
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Project description:BackgroundTracheal stenosis in adults is usually the result of mechanical injuries either from direct trauma, tracheotomy or intubation. Idiopathic stenosis in the cricotracheal section is a rare condition and occurs almost exclusively in females. Therefore, an influence of the female sexual hormones estrogen and progesterone has been assumed previously.MethodsTracheal specimens of 27 patients who received tracheal resection for either idiopathic tracheal stenosis (ITS) (n=11) or posttraumatic tracheal stenosis (PTTS) (n=16) between 2008 and 2019 in our surgical department were included and retrospectively analyzed. Immunohistochemical staining of tracheal specimens concerning the hormone receptor status of progesterone and estrogen was performed.ResultsWhile post-tracheotomy stenosis occurred in males (n=6) as well as in females (n=10), none of the patients with idiopathic stenosis were males. All of the idiopathic stenosis (n=11; 100%) showed a strong expression of the estrogen receptors (ERs) in the fibroblasts and expression of progesterone receptors (PRs) in fibroblasts in 8 of 11 (72.7%). In the post-tracheotomy patients, only 3/16 (18.8%) showed slight staining of PRs and 6/16 (37.5%) of ERs. Of those, only one male patient presented with expression of ERs and PRs and another male patient presented with isolated PRs. Oral intake of hormone compounds was seen in 11/27 (40.7%) patients: 7/11 (63.6%) in the ITS group and 4/16 (25%) in the PTTS (noteworthy that the PTTS group included 6 male patients).ConclusionsAlthough the number of patients is small, our results show that the expression of female sexual hormone receptors in the fibroblasts of the trachea is a persistent finding in ITS. Surgery provided good results with a favorable long-term outcome without recurrence of stenosis for ITS and PTTS. Further investigation with a special focus on hormones is needed to assist in the prevention of this rare disease.
| S-EPMC10323589 | biostudies-literature
Project description:Transcriptional analysis of idiopathic subglottic tracheal stenosis
2024-08-16 | GSE248105 | GEO
Project description:ObjectivesIdiopathic subglottic stenosis (iSGS) is an unexplained progressive fibrosis of the upper airway. iSGS almost exclusively affects women; as a result, female hormones (estrogen and progesterone) have been proposed to participate in the pathogenesis of iSGS. Our aim was to localize cell-specific gene expression of estrogen receptors (ESR1 and ESR2) and progesterone receptor (PGR) using an established iSGS single-cell RNA sequencing (scRNAseq) cell atlas.Study designEx vivo molecular study of airway scar and healthy mucosa from iSGS patients.MethodsAn established scRNAseq atlas consisting of 25,974 individually sequenced cells from subglottic scar (n = 7) or matched unaffected mucosa (n = 3) in iSGS patients was interrogated for RNA expression of ESR1, ESR2, and PGR. Results were quantified and compared across cell subsets, then visualized using Uniform Manifold Approximation and Projection (UMAP). Confirmatory protein assessment of endocrine receptors in fibroblasts from iSGS patients (n = 5) was performed via flow cytometry.ResultsThe proximal airway mucosa in iSGS patients demonstrates differential expression of endocrine receptors (ESR1, ESR2, PGR). Within airway scar, endocrine receptors are primarily expressed by fibroblasts, immune cells, and endothelial cells. Fibroblasts show strong ESR1 and PGR expression, while immune cells possess RNA for both ESR1 and ESR2. Endothelial cells predominantly express ESR2. Epithelial cells in unaffected mucosa express all three receptors, which are all reduced in airway scar.ConclusionsscRNAseq data localized endocrine receptor expression to specific cell subsets. These results provide the foundation for future work interrogating how hormone-dependent mechanisms promote, sustain, or participate in iSGS disease pathogenesis.Level of evidenceNA; Basic science Laryngoscope, 133:3506-3511, 2023.
| S-EPMC10755061 | biostudies-literature
Project description:Post-intubation tracheal stenosis is a condition that can occur as a consequence of tracheostomy or prolonged intubation. The development of two levels of airway narrowing is rare. We present the case of a 43-year-old male with a history of prolonged mechanical ventilation, who presented to our center with progressive respiratory impairment. Computed tomography with three-dimensional reconstruction demonstrated complex tracheal anatomy with double-level stenosis. The patient underwent successful endoscopic procedure.Supplementary informationThe online version contains supplementary material available at 10.1007/s12055-022-01426-y.
| S-EPMC9918691 | biostudies-literature
Project description:BackgroundEndoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.MethodsWe conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.ResultsThe technical success rate of stent removal was 98.9 and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1 ± 25.9 days in the TF group, and at 89.9 ± 15.0 day in the TS group. The total incidence of complications was 21.1 and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3, 59.6, and 36.1% for TF group, and 80.4, 75.7, 75.7% for TS group.ConclusionsFluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Clinicians should pay attention to the risk of hemoptysis for patients with malignant tumors and a combination with endoscopic hemostasis may help improve its safety.
| S-EPMC7789527 | biostudies-literature
Project description:The main prerequisite for the unimpaired wound healing after resection of tracheal stenosis is its tension-free end-to-end anastomosis. This is only achievable when the tracheal ends can be adequately mobilized. Several mobilization techniques have been described in the literature. Here, the authors describe a case of tracheal mobilization under video mediastinoscopic assistance that displayed a considerable advantage over blunt mobilization and a length gain of over 3 cm.
| S-EPMC4176060 | biostudies-other
Project description:iSGS exhibits distinct genomic methylation signatures. These signatures expand current understanding of the iSGS phenotype and may inform the direction of future experimental studies.
2021-03-12 | GSE168614 | GEO
Project description:BackgroundBenign airway stenoses are complex disorders that present with progressive dyspnoea, stridor, and significant respiratory distress. These conditions have a high recurrence rate and despite the plethora of endoscopic and open techniques available for treatment, the outcomes are variable. Our primary was to determine the pre-operative factors associated with an increased hazard of cricotracheal resection (CTR)/tracheal resection (TR) and reconstruction in cases of benign subglottic and tracheal strictures.MethodsWe performed a retrospective analysis of a prospectively maintained database of all patients ages 16 years and over with benign subglottic and tracheal stenoses that underwent endoscopic or surgical treatment at our institution between 2008 and 2022.ResultsNinety-seven patients were included in our series, with a strong female preponderance (n=79; 81%). Forty-one patients underwent formal resection and reconstruction, and 56 patients were managed conservatively. Subglottic stenosis (SGS) was the most common site of disease in the trachea (79%), and the common aetiology of all stenoses was idiopathic (52%). The median interval between first dilatation and formal resection was 5 [interquartile range (IQR), 0-173] months. Pre-operative tracheostomy rate was significantly higher in those who underwent TR (51% vs. 18%, P<0.001) yet the number of dilatations was equivocal between the surgical and non-surgical groups (P=0.30). The most significant independent predictors of TR were pre-operative tracheostomy, advanced Myer-Cotton grading and an increased number of involved airway subsites. Risk modelling using these parameters identified a low and a high-risk group for TR and the latter had a significantly reduced time to resection (P<0.001).ConclusionsBenign airway stenoses are a heterogeneous group of conditions which respond to both endoscopic and open surgical airway intervention. The underlying aetiology will influence the treatment paradigm. We found that more complex lesions, patients with pre-operative tracheostomy and previous smoking history conferred a higher hazard for resection.
| S-EPMC11635267 | biostudies-literature
Project description:ObjectivesThe authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19.Design, setting, and participantsThe data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed.InterventionsFlexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness, and rigid bronchoscopy was applied for the dilatation of tracheal stenosis.Measurements and main resultsIn the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men; 3.3%). The patients were divided into 2 groups as patients with tracheal stenosis (n = 7) and patients without tracheal stenosis (n = 201). There were no statistically significant differences between the 2 groups in terms of age, sex, body mass index, and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 v 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and 4 (57%) of them were complex-type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were treated successfully with bronchoscopic dilatation, and 4 of them were treated with tracheal resection.ConclusionsTracheal stenosis developed in 7 of 208 (3.3%) patients with COVID-19 who were treated with IMV. The most important characteristic of patients with tracheal stenosis was prolonged IMV support.
| S-EPMC8832874 | biostudies-literature
Project description:Tracheal stenosis is a rare but life-threatening disease in preterm infants. Misdiagnosis as congenital tracheal stenosis is common, making surgical management challenging. This report presents a case of a preterm infant with tracheal stenosis and congenital heart malformation treated with ECMO-assisted tracheal resection and end-to-end anastomosis. A male infant was born at 30 weeks of gestation with severe asphyxia, cardiac insufficiency, and pneumonia. Following failed medical treatment, fiberoptic bronchoscopy confirmed mid-tracheal to carinal stenosis. After a 2-week treatment course, ECMO-assisted tracheal resection and end-to-end anastomosis were performed successfully. This case confirms the feasibility of tracheal resection and end-to-end anastomosis in low-weight, preterm infants with tracheal stenosis born at 30 weeks gestation. The utilization of ECMO for oxygenation during surgery provides a clear surgical field and shorter operating time. Surgical intervention may be necessary for neonatal tracheal stenosis depending on the clinical presentation.
| S-EPMC10944969 | biostudies-literature