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Dilatation tracheoscopy for laryngeal and tracheal stenosis in patients with Wegener's granulomatosis.

Schokkenbroek AA, Franssen CF, Dikkers FG - Eur Arch Otorhinolaryngol (2007)

Bottom Line: Two patients did not experience a recurrence of SGS or TS.DT can offer a simple and repeatable solution to SGS and TS due to WG.One patient has a definitive tracheostoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, University Medical Center Groningen, University of Groningen, PO box 30001, 9700 RB Groningen, The Netherlands.

ABSTRACT
Wegener's granulomatosis (WG) frequently involves the subglottis and trachea and may compromise the upper airway. The objective of this study is to evaluate retrospectively the effect of treatment of subglottic stenosis (SGS) and tracheal stenosis (TS) by dilatation tracheoscopy (DT) in patients with WG. We performed a cohort study on all patients who underwent DT between February 2001 and September 2005 in our institution. From this cohort we identified a total of nine WG patients. In all patients, clinical, serological and histopathological data had been prospectively collected by a standardized protocol from the time point of diagnosis. In the nine patients that were identified with SGS or TS due to WG (eight women and one man), a total of 22 DT's were performed. Two patients needed a tracheostoma (one temporarily). The mean follow-up after the first DT was 25.4 +/- 14.1 months. Two patients did not experience a recurrence of SGS or TS. Six patients required a second DT without recurrence of local disease. The remaining patient underwent 8 DT's in a 4-year period. DT can offer a simple and repeatable solution to SGS and TS due to WG. Seven of the nine patients required more than one dilatation and some patients experience a functional restriction. One patient has a definitive tracheostoma.

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Patient nr 6 after pulse therapy and intubation. The picture was taken one week after Fig. 4
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Fig5: Patient nr 6 after pulse therapy and intubation. The picture was taken one week after Fig. 4

Mentions: In the nine patients identified with SGS or TS due to WG, a total of 22 DT’s were performed (Table 3). The mean follow-up after treatment was 25.4 ± 14.1 months (Table 3). Two patients (numbers 7 and 8) did not experience a recurrence of significant stenosis. Six patients (numbers 1, 2, 3, 4, 6, 9) required a second DT without recurrence of local disease activity after the second DT. One of these patients (patient number 6) had acute WG in the trachea, proven by biopsy (Fig. 4). She was treated with high dose prednisolone (intravenous methylprednisolone 1000 mg on three consecutive days) and intubation for a week. She could be detubated a week later (Fig. 5). Two patients needed a tracheostoma (patient numbers 2 and 5). One patient (number 5) developed a cricoid stenosis 5 years after the diagnosis of WG. Initially the stenosis was treated with two DT’s. During a pregnancy the patient required an emergency tracheotomy because of a threatened airway. After pregnancy she was treated with a CO2 laser and three DT’s. Unfortunately, however, she required a definitive tracheostomy. Currently the process of decannulation is taking place. One patient (number 2) became respiratory insufficient at diagnosis of WG and had a tracheotomy for 3 months. She subsequently developed a cicatricial SGS, but she has enough lumen to live without a tracheostomy (Table 3).Table 3


Dilatation tracheoscopy for laryngeal and tracheal stenosis in patients with Wegener's granulomatosis.

Schokkenbroek AA, Franssen CF, Dikkers FG - Eur Arch Otorhinolaryngol (2007)

Patient nr 6 after pulse therapy and intubation. The picture was taken one week after Fig. 4
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2279159&req=5

Fig5: Patient nr 6 after pulse therapy and intubation. The picture was taken one week after Fig. 4
Mentions: In the nine patients identified with SGS or TS due to WG, a total of 22 DT’s were performed (Table 3). The mean follow-up after treatment was 25.4 ± 14.1 months (Table 3). Two patients (numbers 7 and 8) did not experience a recurrence of significant stenosis. Six patients (numbers 1, 2, 3, 4, 6, 9) required a second DT without recurrence of local disease activity after the second DT. One of these patients (patient number 6) had acute WG in the trachea, proven by biopsy (Fig. 4). She was treated with high dose prednisolone (intravenous methylprednisolone 1000 mg on three consecutive days) and intubation for a week. She could be detubated a week later (Fig. 5). Two patients needed a tracheostoma (patient numbers 2 and 5). One patient (number 5) developed a cricoid stenosis 5 years after the diagnosis of WG. Initially the stenosis was treated with two DT’s. During a pregnancy the patient required an emergency tracheotomy because of a threatened airway. After pregnancy she was treated with a CO2 laser and three DT’s. Unfortunately, however, she required a definitive tracheostomy. Currently the process of decannulation is taking place. One patient (number 2) became respiratory insufficient at diagnosis of WG and had a tracheotomy for 3 months. She subsequently developed a cicatricial SGS, but she has enough lumen to live without a tracheostomy (Table 3).Table 3

Bottom Line: Two patients did not experience a recurrence of SGS or TS.DT can offer a simple and repeatable solution to SGS and TS due to WG.One patient has a definitive tracheostoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, University Medical Center Groningen, University of Groningen, PO box 30001, 9700 RB Groningen, The Netherlands.

ABSTRACT
Wegener's granulomatosis (WG) frequently involves the subglottis and trachea and may compromise the upper airway. The objective of this study is to evaluate retrospectively the effect of treatment of subglottic stenosis (SGS) and tracheal stenosis (TS) by dilatation tracheoscopy (DT) in patients with WG. We performed a cohort study on all patients who underwent DT between February 2001 and September 2005 in our institution. From this cohort we identified a total of nine WG patients. In all patients, clinical, serological and histopathological data had been prospectively collected by a standardized protocol from the time point of diagnosis. In the nine patients that were identified with SGS or TS due to WG (eight women and one man), a total of 22 DT's were performed. Two patients needed a tracheostoma (one temporarily). The mean follow-up after the first DT was 25.4 +/- 14.1 months. Two patients did not experience a recurrence of SGS or TS. Six patients required a second DT without recurrence of local disease. The remaining patient underwent 8 DT's in a 4-year period. DT can offer a simple and repeatable solution to SGS and TS due to WG. Seven of the nine patients required more than one dilatation and some patients experience a functional restriction. One patient has a definitive tracheostoma.

Show MeSH
Related in: MedlinePlus