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Bronchoscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marcus D. Jarboe, James D. Geiger
When evaluating for a tracheoesophageal fistula, careful and thorough examination is necessary. Standard type-C fistulas are usually clear but second or higher H-type fistulas can be quite subtle. Gentle probing with a Kumpe catheter +/− an 0.035 angled glidewire can be revealing.
Autologous Stem Cell Transplantation in Relapsing Polychondritis
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Falk Hiepe, Andreas Thiel, Oliver Rosen, Gero Massenkeil, Gerd-Rüdiger Burmester, Andreas Radbruch, Renate Arnold
A 41-year-old female was admitted to our hospital with relapsing polychondritis, which was first diagnosed in 1985. Manifestations of the disease included severe arthritis, costosternal pain, vasculitis, scleritis, saddle nose and tracheal involvement; the patient had also suffered a life-threatening episode of pyoderma gangrenosum. Despite continuous and intensive conventional therapy for several years, no remission was achieved. The patient was at risk of developing a tracheo-esophageal fistula upon further disease progression. The previous treatment regimens had included intravenous immunoglobulins, high-dose methylprednisolone, methotrexate, monoclonal anti-CD4 antibody and intravenous cyclophosphamide (cumulative dose 6.0 g) with concomitant steroid therapy. At the time of admission, the patient was receiving a daily dose of 30 mg methylprednisolone, and her Karnofsky score was 60%.
Respiratory Medicine
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Colin Wallis, Helen Spencer, Sam Sonnappa
This should include an upper gastrointestinal contrast study to evaluate oesophageal motility and to rule out underlying anatomical defects such as hiatus hernia, pyloric narrowing resulting in hold up to gastric emptying or malrotation of the upper small bowel. A video fluoroscopy study examines the swallowing reflex in specific detail especially with different consistencies of food including liquids, semi-solids and solids. This will demonstrate spill-over or recurrent aspiration into the trachea and also the efficiency of the cough reflex in the face of such stimulation. A particularly severe example is illustrated in Fig. 4.27. A tracheo-oesophageal fistula requires specific investigation with a tube oesophagram carried out by an experienced radiologist. Gastro-oesophageal reflux also requires investigation with a pH study, sometimes in combination with impedance measurements or a radio isotope milk scan. There is no gold standard test to prove that aspiration has occurred. There is interest in the value of alveolar lavage sampling for chemicals such as pepsin or cytological evaluation of lipid laden macrophages.
Comparison of Prenatal Ultrasound and Autopsy Findings of Fetuses Terminated in Second Trimester: A Five-Year Experience of a Tertiary Center
Published in Fetal and Pediatric Pathology, 2023
Ezgi Yılmazer Yonder, Murat Cagan, Ozgur Deren, Kadri Safak Gucer
In the present study, anal atresia (36.4%) was the most frequent anomaly among the pathological findings of the gastrointestinal system as in the study by Phelps et al. [19]. None of these cases were diagnosed by US. Stoll et al. evaluated 86 cases and showed an accompanying pathology in 74.4% of cases [20]. Since ultrasonic diagnostic signs are mostly indirect findings such as bowel dilatation and intraluminal calcifications in late pregnancy, the prenatal detection frequency of this condition is low and in most cases, anorectal atresia is detected only after birth. We detected omphalocele in 2 fetuses, and genetic study showed 4p deletion in one and trisomy 18 in the other. In one fetus with omphalocele in prenatal US, the autopsy excluded the diagnosis and found different findings. Tracheoesophageal fistula was detected in 2 fetuses at autopsy. In a study conducted at Oxford Children’s Hospital in 2016, the sensitivity in diagnosing prenatal TEF was 26% and this frequency increased to 57% in tertiary care centers. Only 67% of fetuses that have been diagnosed with prenatal TEF had a history of polyhydramnios [21]. In our cases, polyhydramnios was not observed because it accompanied renal anomalies in both, and this situation made prenatal diagnosis difficult.
Endoscopic visualization for tracheoesophageal puncture tract sizing
Published in Acta Oto-Laryngologica, 2021
Lisa M. Evangelista, Tess Andrews, Ahmed Bayoumi, Maggie A. Kuhn, Nogah Nativ-Zeltzer, Peter C. Belafsky
Methods aimed at reducing TEP complications and their negative sequelae, and techniques for optimizing TEP speech quality have been well-documented in the current literature. However, the use of visual feedback with instrumentation for TEP management has not been well highlighted. With complex free flap reconstructions becoming more common, unpredictable anatomy can prove challenging during creation of the tracheoesophageal fistula during primary and secondary punctures. Endoscopic visualization has been used to confirm the vibratory segment within the esophageal lumen upon palpation prior to puncture [13]. As clinical caseloads are increasingly comprised of patients with complex reconstruction, clinicians can provide a more contemporary practice through the use of visual feedback for tracheoesophageal puncture tract sizing.
Clinical and endoscopic features of esophageal tuberculosis: a 20-year retrospective study
Published in Scandinavian Journal of Gastroenterology, 2020
Jing Xiong, Wen Guo, Yandong Guo, Lanbo Gong, Side Liu
Clinical features of esophageal TB are often lack of specific and highly variable. Dysphagia is the commonest complaints of esophageal TB, while other patients present with odynophagia, retrosternal pain as well as the systemic symptoms of TB, such as evening low-grade fever, drenching night sweats, decrease in appetite and weight loss [4]. Dysphagia may be induced by intrinsic esophageal involvement with TB and extrinsic compression by the surrounding mediastinal lymph nodes [5]. Complaints of paroxysmal postprandial cough or aspiration pneumonia is suggestive of tracheoesophageal fistula [6]. Severe bleeding may be suspected as an aorto-esophageal fistula [7]. In our report, most patients presented with dysphagia or retrosternal pain. Thus, esophageal TB needs to be kept in mind as an important differential diagnosis of dysphagia or retrosternal pain in TB endemic regions.