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Wound epithelialization deficits in the transforming growth factor-alpha knockout mouse.

In vitro, transforming growth factor-alpha is an important factor controlling epithelial cell proliferation and migration. However, the transforming growth factor-alpha knockout mouse has shown no wound epithelialization defect in tail amputation and full-thickness back wounds. To resolve this disparity, we combined a full-thickness head wound and a partial-thickness ear wound on the transforming growth factor-alpha knockout mouse for analysis of wound epithelialization with or without granulation tissue formation. Three-millimeter ear wounds were made on the transforming growth factor-alpha knockout and heterozygous control mice. Full-thickness head wounds were made using a 6-mm trephine on the crown of the skull. In the ear model, transforming growth factor-alpha knockout mice had significantly larger epithelial gaps versus control at post-operative day 3 and 5. Epithelial thickness at the wound edge of transforming growth factor-alpha deficient mice was also depressed at post-operative day 3 and post-operative day 5 compared to control mice. On post-operative day 8, most wounds of both groups were epithelialized. In contrast, no difference in epithelial gap or new granulation tissue was found in the head model. The data support the concept that transforming growth factor-alpha plays a significant early role in wound epithelialization in vivo but its deficit is compensated if accompanied by granulation tissue formation. The data further show the importance of appropriate wound models to address the role of vulnerary factors.

Animals↗

Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction?

OBJECTIVES: To elucidate the cause of late operative site pain in six cases of scoliosis managed with Isola posterior instrumentation that required removal of the implants. METHOD: Microbiologic examination of wound swabs and enriched culture of operative tissue specimens was undertaken in all cases. Histologic study of the peri-implant membranes also was conducted. RESULTS: The presentation in all cases was similar: back pain appearing between 12-20 months after surgery, followed by a local wound swelling leading to a wound sinus. In only one of these cases was the discharge positive for bacterial growth. Implant removal was curative. Histologic examination of tissue specimens revealed a neutrophil-rich granulation tissue reaction suggestive of an infective etiology despite the failure to isolate organisms. Within the granulation tissue was metallic debris that varied from very sparse to abundant from fretting at the distal cross-connector junctions. A review of recent literature describing similar problems suggests that late onset spinal pain is a real entity and a major cause of implant removal. CONCLUSIONS: On reviewing the evidence for an infective etiology versus a metallurgic reaction etiology for these cases of late onset spinal pain, it was concluded that a subacute low-grade implant infection was the main cause. Histologic findings would seem to confirm low-grade infection. There may be more than one causative factor for late operative site pain, as it is possible that fretting at cross connection junctions may provide the environment for the incubation of dormant or inactive microbes.

Adolescent↗

Gene transfer of human hepatocyte growth factor into rat skin wounds mediated by liposomes coated with the sendai virus (hemagglutinating virus of Japan).

Hepatocyte growth factor (HGF) regulates cell growth, cell motility, and morphogenesis in various types of cells, including epithelial and endothelial cells, indicating that it probably promotes epithelial repair and neovascularization during wound healing. To better understand the effects of HGF on wound healing, we performed human HGF-gene transfer into skin wounds in rats. The rat HGF mRNA levels, and human and rat HGF protein concentrations in the wounds in HGF gene-transfer rats were significantly elevated at 3 days, 3 to 14 days, and 3 and 14 days after gene transfer, respectively. An expression of human HGF mRNA and protein was revealed in squamous cells in the epidermis, in endothelial cells and smooth muscle cells in blood vessels, and in fibroblasts in granulation tissues at 3, 7, and 14 days after gene transfer in HGF gene-transfer rats. The wound lesion area in HGF gene-transfer rats was significantly less than that in control rats from 3 to 7 days after gene transfer. The re-epithelialization rate, microvessel counts in granulation tissues, proliferating cell nuclear antigen index of fibroblasts in granulation tissues, and the proliferating cell nuclear antigen index in the epidermis of HGF gene-transfer rats were significantly increased at 3 and 7 days after gene transfer. Semiquantitative reverse transcriptase-polymerase chain reaction revealed that the expression levels of transforming growth factor-beta1 and Colalpha2(I) mRNAs in the wounds of HGF gene-transfer rats were significantly decreased at 7 and 14 days, respectively. The hydroxyproline concentration in the wound was significantly less in HGF gene-transfer rats than in control rats at 3 days after gene transfer. These results suggest that HGF gene transfer into a skin wound may aid re-epithelialization and neovascularization in the early phase of wound healing, and that HGF may play a role in modulating cutaneous wound healing.

Animals↗

Microbiology of stents in laryngotracheal reconstruction.

OBJECTIVES: Granulation tissue often forms around a laryngotracheal stent, tracheostomy tube, or other airway prosthesis, especially if infection occurs. We studied the types and frequency of organisms colonizing stents used in pediatric laryngotracheal reconstruction. STUDY DESIGN: This prospective study included 21 patients undergoing 23 consecutive laryngotracheal reconstructions with stents between 1991 and 1999. METHODS: After endoscopic removal, each laryngotracheal stent was placed immediately in a sterile container and transported to the laboratory. Specimens for culture were obtained from biofilms on the stents and plated on agars for growth of aerobic, anaerobic, and fungal organisms. Culture results were analyzed with regard to patient age, duration of stenting, and graft type. RESULTS: All stents were colonized with more than one pathogen (range 2-7). The most frequent aerobic isolates were Streptococcus viridians, Pseudomonas aeruginosa, Staphylococcus aureus,Haemophilus influenza, and Neisseria species. Anaerobic organisms were isolated in 26% of cases. Candida species were isolated in 57% of the cases; patients whose stents were colonized with Candida were significantly (P =.007) older (mean 77.5 months) than those not colonized with this organism (mean 26.1 months) CONCLUSIONS: The antibiotic agents currently used for children undergoing laryngotracheal reconstruction target mainly aerobic organisms. Despite prophylactic measures, the incidence of granulation tissue formation is clinically significant, and the prevalence of anaerobic, including fungal, pathogens is high. Antibiotic therapy directed toward controlling anaerobic and fungal organisms could help in controlling local inflammation and thus granulation tissue formation.

Adolescent↗

Experimental trial of balloon-expandable, metallic Palmaz stent in the trachea.

OBJECTIVE: To determine the effect of the Palmaz stent, which has been successfully used to relieve airway obstruction in a small group of children, on the normal and operated on animal trachea. DESIGN: In this experimental trial, stents were placed bronchoscopically in the thoracic tracheae of 4 groups of 50 anesthetized cats. The cats in group 1 (adults, n = 10) and group 2 (kittens, n = 10) had normal tracheae; the cats in group 3 (adults, n = 15) underwent horizontal tracheal incision and closure; and the cats in group 4 (adults, n = 15) underwent pericardial patch tracheoplasty. In group 3 and 4, the stents were inserted in 10 cats and 5 cats served as controls. Stents were inflated to a 15-mm diameter in group 1 and an 8-mm diameter in the other groups. Half of the animals with stents were killed 5 weeks after the procedure, and the others, 10 weeks after the procedure. SETTING: The Hospital for Sick Children, Toronto, Ontario. RESULTS: In group 1, 1 animal died of tracheal perforation. A mild cough was noted in 15 of the 39 cats with stents. In group 4, 3 cats had difficulty eating and lost weight. The results of esophagoscopy excluded esophageal inflammation or obstruction in these 3 animals. The results of bronchoscopy indicated a nonobstructing rim of granulation tissue at the end of the stent in 15 of 20 cats in groups 1 and 2 and 17 of 20 cats in groups 3 and 4 and at the repair site in all animals with stents from groups 3 and 4. The results of autopsy indicated the cross-sectional area at the site of the stent was greater than normal in group 1 (P < .003) and smaller than the normal trachea at the site of the tracheoplasty in group 4 controls without stents (P < .02); however, the cross-sectional area at the tracheoplasty site with the stent was not smaller (P < .13). The results of histologic examination indicated a mild inflammatory reaction, with granulation tissue in all animals with stents, but in group 1, with overexpanded stents, the reaction was more severe, with epithelial ulceration, fibrosis, and sealed-off perforations in most animals. In group 3, the tracheae with stents had significantly more inflammatory reaction, granulation tissue, and epithelial damage than the controls without stents. CONCLUSIONS: The Palmaz stent provokes an inflammatory reaction in the normal trachea and the trachea recently operated on. With the exception of the group 1 animals with overexpanded stents, this reaction is clinically insignificant. The Palmaz stent is able to maintain a normal lumen size after pericardial tracheoplasty in cats.

Angioplasty, Balloon↗

Endothelial cell proliferation in prostatic carcinoma and prostatic hyperplasia: correlation with Gleason's score, microvessel density, and epithelial cell proliferation.

BACKGROUND: Tumor angiogenesis is necessary for tumor growth and metastasis, and increasing intratumoral microvessel density (MVD) in prostate carcinoma has been shown in several studies to be associated with increasing tumor stage. But, the relationships of endothelial cell proliferation to intratumoral MVD, tumor cell proliferation, and Gleason's score remain unknown in prostate carcinoma. EXPERIMENTAL DESIGN: Using a double-immunolabeling technique (paraffin-reactive MIB1 Ab to determine Ki67 labeling index (Ki67LI) and anti-CD34 to quantify microvessels), we immunostained 20 prostatic carcinomas and adjacent benign prostate hyperplasia (BH) and four cases of trauma-induced granulation tissue. We correlated intratumoral endothelial cell proliferation with intratumoral MVD, tumor cell proliferation, and Gleason's score, and we compared these measurements with endothelial cell proliferation, MVD, and epithelial cell proliferation in adjacent BH. RESULTS: The intratumoral endothelial cell proliferation index (mean 0.15%) and intratumoral MVD measured 30-fold (p = 0.00007) and 1.9-fold (p = 0.000003) greater than that of adjacent BH, respectively. However, the intratumoral endothelial cell proliferation index did not correlate with intratumoral MVD, tumor cell proliferation, or Gleason's score. Nor did intratumoral MVD correlate with tumor cell proliferation. In comparison, the mean MVD and endothelial cell proliferation rates in granulation tissue were 199 and 6.50%, respectively, the latter 43-fold greater than the mean intratumoral endothelial cell proliferation index (p = 0.00023). CONCLUSIONS: Endothelial cells are actively proliferating in prostatic carcinoma, and their proliferation appears independent of intratumoral MVD and tumor cell proliferation. Yet, the relatively low intratumoral hyperplasia, suggests that endothelial cell migration and capillary remodeling play an important role in neovascularization of prostatic carcinoma, especially when compared with granulation tissue, which showed a 43-fold greater endothelial cell proliferation index. Moreover, the lack of correlation of intratumoral endothelial cell proliferation and intratumoral MVD with tumor cell proliferation suggests that tumor angiogenesis and tumor-cell proliferation are regulated by different mechanisms.

Cell Division↗

Identification and partial characterization of angiogenesis bioactivity in the lower respiratory tract after acute lung injury.

Survival after acute lung injury (ALI) depends on prompt alveolar repair, a process frequently subverted by the development of granulation tissue within the alveolar airspace. Immunohistochemical examination of the intraalveolar granulation tissue confirmed that capillaries as well as myofibroblasts were the principal cellular constituents. We therefore hypothesized that angiogenesis factors would be present on the air-lung interface after ALI. To evaluate this hypothesis, bronchoalveolar lavage fluid from patients with ALI (n = 25) and patient controls (n = 8) was examined for angiogenesis bioactivity by its ability of induce endothelial cell migration. While lavage fluid from controls had no bioactivity, lavage fluid from 72% of patients with ALI promoted endothelial cell migration. Heparin affinity, ion exchange, and gel filtration chromatography resolved the bioactivity into at least two moieties. One appeared identical to the well characterized endothelial cell growth factor, basic fibroblast growth factor. The other was a 150-kD non-heparin binding protein that mediated endothelial cell migration and attachment in vitro, and the growth of new vessels in vivo. These data are consistent with the hypothesis that the growth of capillaries into the alveolar airspace results from angiogenesis factors present on the alveolar surface of the lung after ALI.

Acute Disease↗

Proliferation of pannus tissue cells in rheumatoid arthritis.

Proliferation of pannus tissue cells has been investigated under in vitro conditions after labeling of joint tissues with 3H-thymidine. It was demonstrated that there is only a minimal proliferation of chondrocytes as well as of pannus tissue cells. Slight increased proliferation was observed in granulation tissue poor in lymphocytes and plasma cells, and perhaps in those areas of destroying pannus tissue that exhibited polymorphonuclear granulocytes (PMNs) at the pannus-cartilage junction. These results are in contrast to the idea that pannus tissue is a tumor-like lesion, for the present observations, even within the limits of autoradiographic investigations on a heterogeneous tissue, and indicate that pannus tissue has to be regarded as an inflammatory granulation tissue.

Arthritis, Rheumatoid↗

The role of cathepsin B1 in the collagen breakdown of carrageenin granuloma in rats.

The crude cathepsin B1 isolated from granulation tissue was separated into two major peaks (P-2 and P-3 fractions) by chromatography on CM-cellulose. The changes in cathepsin B1 activity were studied at various phases of the development of granulation tissue. The cathepsin B1 activity of P-2 fraction, in contrast with that of P-3 fraction, increased with the passage of time after carrageenin injection and the cathepsin B1 activity of P-2 fraction was higher in the resorbing tissues than in non-resorbing tissues, suggesting that cathepsin B1 in P-2 fraction plays an important role in the resorption of granulation tissue, including collagen breakdown.

Animals↗

Reversal of the wound healing deficit in diabetic rats by combined basic fibroblast growth factor and transforming growth factor-beta1 therapy.

Wound healing is impaired in the diabetic state because of, at least in part, low expression of growth factors. Individual growth factors can partially activate healing, yet the actual wound environment presents a dynamic continuum of multiple cellular signals. Complex interactions among growth factors and target cells can have synergistic effects, and several examples of combinatorial, in vivo activity are evident in the literature. In this study, the implantation of a combination of basic fibroblast growth factor and transforming growth factor-beta in rats induced fivefold to sevenfold increases in granulation tissue formation in comparison with implantation of each growth factor alone. Diabetes was induced in adult, male Sprague-Dawley rats with streptozotocin. Incisional wounds and sponge granulation tissue were produced in separate groups and then treated with an injection of 2 microg transforming growth factor-beta1 combined with 10 microg basic fibroblast growth factor on day 3. DNA, collagen, and protein were analyzed in granulation tissue on days 7 and 9, and biomechanical properties of incisions were tested on days 7, 14, and 21. The combination of transforming growth factor-beta1 and basic fibroblast growth factor had marked, positive effects on biochemical parameters of wound healing and reversed the tensile strength deficit of diabetic wounds. Nonradioactive in situ hybridization showed increased expression of messenger RNA for type I and III procollagen and transforming growth factor-beta1 in normal and diabetic wounds, whereas ultrastructural examination showed a marked reorganization of collagen fibrils. These findings reinforce the concept that appropriate mixtures of cytokines rather than individual cytokines may more adequately stimulate tissues in cases of impaired wound healing.

Journal Article↗

Effect of hyperbaric oxygen and growth factors on rabbit ear ischemic ulcers.

OBJECTIVE: To test the influence of hyperbaric oxygen (HBO), platelet-derived growth factor-BB (PDGF-BB), and transforming growth factor-beta 1 (TGF-beta 1) on the deficit in wound healing produced by ischemia in a noncontractive dermal ulcer standardized model in the rabbit ear. DESIGN AND INTERVENTIONS: Dermal ulcers were created in the ischemic ears of 42 anesthetized young female New Zealand white rabbits. The controls were ulcers created in nonischemic ears of eight anesthetized young female New Zealand white rabbits. Either PDGF-BB (5 micrograms), TGF-beta 1 (1 microgram), or buffer alone was applied to each wound, which was then covered. Some groups were treated with HBO on days 0 through 4. Wounds were harvested on day 7 and were evaluated histologically. MAIN OUTCOME MEASURES: The amount of epithelial regrowth and granulation tissue production were measured. The wounds were evaluated for glycosaminoglycan and collagen content. Angiogenesis was measured. RESULTS: Hyperbaric oxygen alone, in the ischemic model, increased the production of new granulation tissue by approximately 100% at 7 days without significantly affecting new epithelial growth (P = .03). In contrast, PDGF-BB and TGF-beta 1 each increased the new granulation tissue volume by greater than 200% in 7 days (P = .0001) and also had a statistically significant effect on new epithelial growth. However, the addition of growth factors to HBO treatment produced a synergistic total reversal of the wound-healing deficit produced by ischemia (P = .0001). CONCLUSIONS: Both PDGF-BB and TGF-beta 1 alone are more effective than HBO treatment by itself in accelerating the impaired wound healing produced by ischemia. However, the combination of HBO with either of the growth factors has a synergistic effect that totally reverses the deficit produced by ischemia.

Animals↗

Effects of keratinocyte growth factor-2 (KGF-2) on wound healing in an ischaemia-impaired rabbit ear model and on scar formation.

Keratinocyte growth factor-2 (KGF-2), also described as fibroblast growth factor-10 (FGF-10), is a member of the fibroblast growth factor family. KGF-2 shares 57 per cent sequence homology to previously reported KGF-1 (FGF-7). In skin, both growth factors are expressed in the dermal compartment. KGF-1 and KGF-2 bind to the same receptor with high affinity, the KGFR isoform of FGFR2, which is exclusively expressed by epithelial cells. This study examines the in vivo function of topically applied KGF-2 on wound healing using an ischaemia-impaired rabbit dermal ulcer model, in young and aged animals. Histological analysis of the wounds showed that KGF-2 significantly promoted re-epithelialization in both young and old animals. Similar results have been observed with KGF-1 in this model. In addition, KGF-2 enhanced granulation tissue formation in both young and old rabbits, a biological effect not found with KGF-1, suggesting a possible indirect mechanism which enhances neo-granulation tissue formation. Immunohistological staining of day 7 wounds with proliferating cell nuclear antigen (PCNA) antibody demonstrated a significant increase of dermal cell proliferation in KGF-2-treated wounds compared with placebo wounds. These results suggest a mesenchymal-epithelial interaction that is mediated by a paracrine feedback loop of KGF-2. Because of the wound healing impairment observed with ageing, the wound healing response to KGF-2 was also studied in ischaemic wounds of aged animals. Administration of KGF-2 led to significant stimulation of epithelial growth and granulation tissue formation. The effects seen in the old animals were delayed compared with the young animals. Lastly, the effect of KGF-2 was examined in a rabbit model of scar formation. Quantification of scar elevation index showed no significant differences in scar formation when KGF-2 was compared with buffer placebo. Compared with other growth factors, including KGF-1 and TGF-beta which have previously been examined in these models, KGF-2 is the most effective and causes no obvious scarring.

Age Factors↗

A homologue of Drosophila tissue polarity gene frizzled is expressed in migrating myofibroblasts in the infarcted rat heart.

Myocardial infarction results in the formation of granulation tissue in the injured ventricular wall. This tissue contains myofibroblasts in highly organized arrays; their contractile properties may help to prevent the infarct area from dilatation. The mechanisms that control myofibroblast alignment are unknown. We found that myofibroblasts express a homologue of Drosophila tissue polarity gene frizzled (fz2) when migrating into the granulation tissue. The expression is decreased after the cells have aligned. This suggests that fz2 is involved in the spatial control of cardiac wound repair after infarction, possibly through intra- and intercellular transmission of polarity signals as in developing Drosophila. Mutations in the fz2 gene may impair myofibroblast alignment in the infarct area, thereby resulting in ventricular dilatation and aneurism following infarction.

Animals↗

[Healing of operative cardiac wounds].

Healing process of operative cardiac wounds was studied histopathologically in 14 patients who died 28 hours to 5 years after the operation of cardiac valve replacement. Repair of wounds in aorta and free wall of atrium was characterized by production of neointima and proliferation of collagen fiber at adventitia of aorta or epicardium of heart. Adhesion with granulation tissue at left ventricular venting wounds was observed in the case of 18th post-operative day. Reticulofibrosis of surrounding intracardiac muscle played an important role in development of granulation tissue. Cicatrix with collagen fiber was appeared from one month after the operation. In spite of attenuation of ventricular scar, aneurysmal bulging could not be observed. The basic healing pattern of wound in atrial septum was production and thickening of neointima. Granulation tissue rarely developed at the septum. Adhesion between sutured edges of atrial septal endocardium could not be observed and the dead space there remained over a period of 7 months after the operation. These findings indicated the continuous presence of unexpected weakness of the sutured septum until sufficient thickening of neointima had developed.

Adult↗

Aminoguanidine prevents impaired healing and deficient angiogenesis in diabetic rats.

The diabetic organism is unable to produce normal amount of granulation tissue which results in delayed wound healing, a significant clinical problem. In the present study, the effect of oral administration of aminoguanidine (AG), in the diabetes-induced inhibition of angiogenesis and granulation tissue formation was tested. Subcutaneous implantation of sponge discs in nondiabetic rats induced a wound repair response as determined by the amount of hemoglobin (vascular index) and granulation tissue formation (morphometric analysis) of the implants. In the streptozotocin-induced diabetic rats the predominant response indicative of healing was inhibitory. Aminoguanidine was effective in preventing in 50% the diabetes-induced inhibition of fibrovascular tissue growth in the implants, as indicated by the values of hemoglobin content and vascular growth areas of the implants. These results indicate that AG holds potential therapeutic value in the management of healing impairment of the diabetic condition.

Administration, Oral↗

The angiogenic peptide vascular endothelial growth factor (VEGF) is expressed in chronic sacral pressure ulcers.

Chronic decubital lesions have a limited potential to heal. Evidence suggests that a lack of local revascularization is involved in this aetiology. The present study investigated the expression of one of the most important angiogenic factors, the vascular endothelial growth factor (VEGF), in different regions of sacral chronic decubital lesions and in normal skin by immunohistochemical, biochemical, molecular, and cell biology methods. To elucidate some of the factors responsible for the induction of VEGF in chronic skin ulcers, cultured fibroblasts were exposed to hypoxia and/or growth factors. In the central part (zone I) of chronic ulcers and in normal skin, immunostaining for VEGF remained largely negative. However, VEGF could be immunostained in cells in the granulation tissue adjacent to central necrosis (zone II). VEGF receptor 2 (VEGFR-2; KDR) could also be identified in microvessels. High VEGF levels were present in homogenates from granulation tissue by enzyme-linked immunosorbent assay (ELISA) and western blot experiments: low concentrations were found in areas of central necrosis and negligible amounts were present in normal skin. Reverse transcriptase-polymerase chain reaction (RT-PCR) showed that only the splice variants VEGF(121) and VEGF(165) were expressed. In cultured fibroblasts, hypoxia or platelet-derived growth factor (PDGF) raised VEGF production. The angiogenic peptide VEGF is present in all zones of chronic decubital ulcers. Its strong expression within the adjacent granulation tissue supports the view that there is no deficiency of VEGF. VEGF may be involved in the healing process of chronic skin lesions, but it seems that loss of another factor may be responsible for the poor healing response.

Aged↗

[The changes in endogenous growth factors and their relation with wound healing].

OBJECTIVE: To explore the effects of endogenous growth factors on the formation of scars and ulcers after trauma or burn. METHODS: The amounts of endogenous epidermal growth factor (EGF), tumor necrosis factor(TNF) and nitric oxide (NO) in scar and the developing granulation tissues after trauma or burn were determined and their relation with the wound healing were studied. RESULTS: The results showed that EGF, TNF and NO could be found in all scars and the granulation tissues, but their concentration varied with different tissues, sex and age of patients. In male patients or youngsters, the amounts of EGF, TNF and NO in scars were much greater than those in granulation tissues. CONCLUSIONS: The results indicated that the growth factors are necessary for wound healing, but insufficiency or overproduction of the endogenous growth factors may lead to the development of chronic ulcers or scar formation after trauma or burn.

Adult↗

Role of multidetector CT virtual bronchoscopy in the evaluation of post-tracheostomy tracheal stenosis--a preliminary study.

AIM: To study the technique and utility of virtual bronchoscopy (virtual reality endobronchial simulation, VRES) as a tool to evaluate post-tracheostomy tracheal stenoses and to correlate the findings of virtual and invasive bronchoscopy and to follow-up treated lesions or those currently under treatment that were initially diagnosed with VRES. METHODOLOGY: This prospective study comprised nine patients in the age group 13 to 65 years presenting with breathlessness and stridor following one or multiple tracheostomies. They underwent plain CT using a multidetector CT (MDCT) scanner (Siemens Volume Zoom) using narrow (1 mm) collimation. These thin slice images were post-processed using an Irix-based workstation with a 'Fly-Through' endoscopy application. These patients also underwent a rigid (three patients) or fiberoptic (six patients) bronchoscopy. RESULTS: Of the nine patients that underwent VRES, five were found to have stenoses, three had obstructing granulation tissue, one had an obstructing membrane and one had synechiae. The invasive bronchoscopic findings supported the VRES diagnosis in all but one case of stenosis, one of granulation tissue and the case with synechiae. Membranes and synechiae were relatively difficult to diagnose without the corresponding axial and multiplanar images. VRES achieved a higher sensitivity, while invasive bronchoscopy a higher specificity. CONCLUSIONS: VRES proved to be comparable to invasive bronchoscopy in the depiction of post-tracheostomy tracheal stenoses, with a notable advantage in critical stenoses in that the airway distal to the stenosis could be assessed with VRES but not with invasive bronchoscopy. A preliminary VRES was found to be of assistance in the selection of patients for the more invasive therapeutic procedures such as laser ablation of granulation tissue and its follow-up.

Adolescent↗