PURPOSE: To describe our experience using the Gianturco Z-stent (G-Z stent) for the management of malignant tracheobronchial stenosis, with special reference to complications. METHODS: Thirty-six stents were used in 22 patients with 28 lesions. Thirteen patients were grade 5 according to the Hugh-Jones classification. The technical success rates, follow-up results, and complications were reviewed on the basis of the patients' charts and radiographs. RESULTS: All stents were successfully placed in the ideal position without procedure-related complications. After the procedure, respiratory status improved in 95% (21/22) of patients, and performance status improved in 77% (17/22). Mean survival after stent placement was 15 weeks. Four patients suffered from increased thick secretions requiring multiple suctioning and aspiration by bronchoscopy. One of these patients died from asphyxiation 2 weeks after placement. Stent disruption and/or migration was observed in six patients. Of these six, four experienced life-threatening hemoptysis; all four had received aggressive anticancer treatment. CONCLUSION: G-Z stents are useful for palliation of malignant tracheobronchial obstruction. However, complications of stent strut fracture and migration give cause for concern.

Aged↗

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Effects of electrical stimulation of n. vagus on the respiratory unit discharge in the brain stem of cats.

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Animals↗

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Intensive sequential post-induction therapy for adults with acute myelogenous leukemia in first remission: long-term follow-up and results.

We designed a post-induction therapy including intensive sequential therapy with non-cross-resistant drugs in an effort to prolong disease-free survival (DFS) for adults with acute myelogenous leukemia. Forty-five patients entered this study and 33 of 35 patients entering complete remission received the post-induction therapy. With a median follow-up for survivors of 3.5 years from complete remission, the actuarial 5-year DFS was 46% +/- 19% (95% confidence interval). The five-year DFS for patients over 45 years of age was comparable to that for patients under 45 years of age (50% +/- 26% vs 47% +/- 28%). Furthermore, the actuarial 5-year DFS for patients who required two courses of induction therapy was comparable to that for patients who required only one course of induction therapy (45% +/- 29% vs 50% +/- 25%). The toxicity of post-induction therapy was tolerable and no patients died during complete remission.

Aclarubicin↗

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Thyroid gland flap for glottic reconstruction after vertical laryngectomy.

A thyroid gland flap was devised and applied in five cases of vertical partial laryngectomy to correct the laryngeal defect. The upper pole of the thyroid gland, dissected along with the superior thyroid artery and vein, was placed in the wound after removal of the tumor to compensate for the loss of bulk, and relined using a cervical skin flap. Good phonatory function was obtained without any disturbance of respiration or deglutition. The thyroid gland flap was adjustable to the size of the defect and easily placed in the larynx. Follow-up study for 6 to 18 months after the surgery revealed that the flap was less likely to shrink than the other flaps because of its abundant blood supply.

Aged↗

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Reconstruction of the anterior commissure with a free mucosal flap.

INTRODUCTION: To prevent stenosis and adhesion of the anterior commissure in the laryngeal reconstruction, we devised a technique of relining using a free labial mucosal graft and human fibrin glue. MATERIALS AND METHODS: A single large piece of mucosal flap was prepared, folded at the anterior commissure, and sutured onto the raw wound of the larynx from both sides of the posterior glottis. Alternate suturing from both right and left sides was performed anteriorly, and the wound on the laryngeal lumen was fully covered by the mucosal graft. We applied this technique on a patient with laryngeal stenosis and two patients with laryngeal cancer. RESULTS: Without the use of a stent, we successfully reconstructed the anterior commissure and obtained a good result in voice quality in each case. CONCLUSION: Large mucosal defects including the anterior commissure should be relined to acquire good voice quality. Relining using a free mucosal flap was a useful method since there were no limitations to size and placement. The adhesive property of human fibrin glue was indispensable in this procedure.

Adolescent↗