• Korean Journal of Veterinary Research
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• v.37 no.1
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• pp.87-101
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• 1997

The development of trachea in fetuses on 60, 90 and 120 days of gestation and neonates of Korean native goats was investigated by microscopy and scanning and transmission electron microscopy. The results were summarized as follows; Light microscopic studies: 1. In the 60-day-old fetuses, the tracheal walls were differentiated and divided into four layers of the mucosa, submucosa, muscle and cartilage, and adventitia. The tracheal epithelium is composed of stratified ciliated columnar epithelium at 60- and 90-day-old fetuses while the epithelium observed at 120-day-old fetuses was pseudostraified ciliated colummar epithelium. 2. In the 90-day-old fetuses, tracheal glands extended into the submucosa and peripheral area of the tracheal cartilage. The blood vessels were observed in the submucosa and adventitia. The elastic and collagenous fibers were observed in the tracheal walls. 3. In the neonates, the tracheal walls consisted of mucosa with well-developed folds, submucosa, tracheal glands, muscle and cartilage, collagenous and elastic fibers, and adventitia, which were more developed than those of 120-day-old fetuses. The tracheal epithelium was developed as that in adults. Scanning electron microscopic studies: 4. In the 60-day-old fetuses, most of tracheal epithelial cells were nonciliated but short microvilli were sporadically observed on the luminal surface. On rare occasions, a few cells have solitary cilium. 5. In the 90-day-old fetuses, the ciliated cells appeared increasingly and cilia elongated longer than those of 60-day-old fetuses. 6. In the 120-day-old fetuses, the nonciliated cells covered with microvilli in dome-shape were barriered by thick carpet of cilia. The nonciliated cells also have many papillary projectons on the apical surface. 7. In the neonates, the nonciliated cells in tracheal epithelium were covered compactly with numerous cilia, and many secretory droplets were found on the cilia. Transmission electron microscopic studies: 8. In the 60-day-old fetuses, nonciliated cells of the tracheal epithelium contain large amounts of glycogen granules in the supernuclear and subnuclear areas meanwhile a few cell organelles were formed. Cilia were well formed along the apical cell membranes of the ciliated cells. Also found in the ciliated cells were basal corpuscles, mitochondria and short chains in granular endoplasmic reticulum(GER). Between the epithelial cells presented were well-defined junctional complex with zonula occludens and desmosomes. The nuclei were variable in size and shape. The more developed nucleoli were observed conspicuosly. 9. In the 90-day-old fetuses, nonciliated cells contained large glycogen granules. Accumulated glycogen granules were observed in the subnuclear and supranuclear portion of the cytoplasm. A few short microvilli were covered with glycocalyx. Ciliated cells contained numerous mitochondria and short chains of GER. 10. In the 120-day-old fetuses, the ciliated cells contained numerous mitochondria, abundant short chains of GER and nucleoli. Nonciliated cells contained some Golgi complex and mitochondria. The cell borders were well-defined and distinct junctional complex with zonula occludens, desmosomes, and interdigitorum. 11. In the neonates, well-developed goblet cells were observed in the tracheal epithelium. Ultrastructures of ciliated and nonciliated cells on the tracheal epithelia were similar in pattern as those in adults.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.61-69
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• 1997

A total of 55 patients underwent surgical managements for postintubation tracheal stenosis from July 1975 through March 1997. All but 8 had received ventilatory assistance. The patients had S cuff lesions, 17 stoma lesions, 7 at both levels, 5 at subglottic lesions. Thirty two patients underwent the sleeve tracheal resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Twenty two patients received the Montgomery T-tube for relief of airway obstruction. Simple excision of granulation tissue was done in 7 patients. Rethi procedures(anterior division of cricoid cartilage, partial wedge resection of lower thyroid cartilage and T-tube molding) were performed in 2 subglottic stenosis patients. And the other subglottic patient was received permanent tracheal fenestration at 1975. The tracheoesophageal fistula patient was done sleeve tracheal resection and end-to-end anastomosis with interrupted double layer closure of esophageal fistula site. Cervical approach was used in 49 cases, cervicomediastinal in 13 cases and median stemotomy In 6 cases. Techniques for obtaining tension-free anastomosis included a cervical neck flexion(15-30$^{\circ}$) in all sleeve resection patients and laryngeal release in one. The length of resection was 1.5 to 5.0 on A total of 41 patients(74.5%) had good(24 patients) or satisfactory(17 patients) results. But in ten cases, the restenosis of anastomosis site which is the most common complication was developed Two of them underwent a second reconstruction and 8 patients required T-tube insertion for airway maintenance. Three patients(5.4%) died. The causes of death were tracheo-innominate artery fistula(2) and sudden obstruction of airway(1).

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.117-121
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• 1998

Relapsing polychondritis is a rare disesase involving any cartilaginous structure of entire body and is characterized by recurrent episode of inflammation and degeneration of cartilage and most commonly involve ear, nose, larynx, trachea, ribs, Eustachian tube, etc. Its signs and symptoms are recurrent swelling of auricle, saddle nose deformity, polyarthralgia, hoarseness and dyspnea, audiovestibular disturbance and cardiovascular abnormality, etc. Characteristic histologic findings are loss of normal basophilic staining of cartilage, perichondrial inflammatory infiltration with plamsa cells, lymphocytes and neutrophils, and finality, destruction of cartilage and replacement with scar tissue. Our case had saddle nose deformity, arthralgia, tracheal collapse, hearig loss and positive histologic finding but no auricular perichnodritis. Her major problem was airway. obstruction due to tracheal collapse. This case was diagnosed with relapsing polychondritis according to the Damiani's criteria. This case indicates that any patients complaining of airway obstruction have to be examined systemically.

• Journal of Chest Surgery
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• v.28 no.8
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• pp.766-771
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• 1995

The trachea is defined as the airway from the inferior border of the cricoid cartilage to the top of the carinal spur. This paper would confirm the normal tracheal length of Korean adults through the actual measurement using the fiberoptic bronchoscopy. The subjects of this study were 25 patients, 13 males and 12 females between the age of 20 to 69 without abnormality on the neck, trachea, mediastinum and lung pharenchyme on the preoperative chest X-ray, who received the operations from the period of July to September, 1994. For those patients who had heart diseases, the cardiothoracic ratio was below 50%. The measurement was performed on the patients with endotracheal intubation under the general anesthesia in supine and neutral position. The tracheal length was calculated by the difference between the length from the tip of the endotracheal tube [E-tube to carina and to the needle which was inserted into the E-tube at the lower border of the palpated cricoid cartilage, by inserting the broncoscopy through the E-tube. The result was as follow : 1 The measured tracheal length for men was 11.8 0.2 cm[mean standard deviation and women was 10.5 0.3 cm, and that was longer than this [p<0.01 . The average was 11.2 1.0 cm and the standard error was 0.20 cm. 2 According to the correlation between the tracheal length to weight, height[Ht , age, and body surface area[BSA respectively, the Ht [p=0.003 , age [p=0.055 , and the BSA[p=0.017 were significant, while weight was not [p=0.314 . 3 From the regression analysis of the tracheal length[T.L. to the Ht, Age, and the BSA which were significant, the following equation was derived.i Ht : T.L.= -1.29 + 0.076 x Ht [P=0.003 ii Age: T.L.= 10.04 + 0.028 x Age [P=0.055 iii BSA : T.L.= 5.60 + 3.48 x BSA [P=0.017 iv In multi-regression : T.L. = -4.15 + 0.034 x Age + 0.085 x Ht [P=0.0002]

• Korean Journal of Bronchoesophagology
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• v.7 no.2
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• pp.128-139
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• 2001

The purpose of this study was to review the literatures of experimental tracheal reconstruction. Although there have been significant advancements in the surgical treatment of the long circumferential tracheal injuries, there still has been a difficult problem with high morbidity and mortality. The method for tracheal reconstruction after circumferential resection is preferred end-to-end anastomosis for defects up to 6 cm in length, but larger tracheal defects require the use of tracheal allograft, various artificial prosthesis or autogenous organs. The tracheal allotransplantation has been widely used as there was significantly improved the method of surgical technique, preservation and immunosuppression. But it has been limited by a number of factors such as few donor, limited use of immunosuppressant, delayed revascularization and re-epitheliazation. Experimental studies on the tracheal prosthesis have a long history and they tried to use silicone, polytetrafluoroethylene, polypropylene mesh, Dacron, Marlex mesh, external or internal stents. Other experimental studies were reported the use of autogenous tissues that were cartilage. jejunum, aorta, skin, muscle, periostium or esophagus. But a great variety of these protheses have been resulted unsatisfactory in a significant Proportion of cases. Alternatively, the tissue-engineering technique has showed a new approach to reconstruct trachea and much progress in tissue-engineering bas been made recently. In conclusion, although the tracheal allotransplantation and the use of prosthesis and allograft have been reported a lot of limitation to overcome, we could sooner expect good result of ideal tracheal prosthesis.

• Korean Journal of Bronchoesophagology
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• v.2 no.1
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• pp.46-56
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• 1996

Perichondrium is generally used for reconstruction of airway and successful regeneration of cartilage framework using perichondrium are reported by several authors. It has many advantages for airway reconstruction. It can maintain the stable framework and it has higher flexibility so it's easy to design according to the shape of defects. It resist strongly against infection process. Its airtightness and rapid mucosalization enables to predict good postoperative recovery and results. To investigate the differences in cartilage regeneration between avascular and vascularized perichondrial flap, this study was designed with vascularized flaps composed of vascularized perichondrium and central auricular artery and vein. Morphologic study was performed to determine the fate of the grafted perichondrium at regular intervals using light microscopy with H & E stain. Chondrogenic potential and formation of cartilaginous plate of experimental group was superior than in the control group. Grafted perichondrium was fed by consistent feeding vessel. At 6 weeks, the regenerated cartilage could hardly be distinguished form the normal cartilage framework but in control group, regenerated cartilaginous tissue was generally immature in same period. In conclusion, this study indicated that consistent vasculature to grafed tissue is the essential factor for successful reconstruction of cartilaginous framework.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.27-34
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• 1998

Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1127-1133
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• 1998

Background: There are no ideal substitutes for tracheal replacement. Therefore we investigated the possibility of clinical use of cryopreserved tracheal homograft with special interest in the viability and rejection of the epithelial cell and cartilage. Material and Method: Rabbit's trachea was sected and stored in liquid nitrogen tank for 1 month. Tracheal replacement was done in 45 rabbits with autograft(n=15, Group 1), fresh allograft(n=15, Group 2) and cryopreserved homograft(n=15, Group 3). After 7, 14, and 30 days, 5 rabbits in each group were sacrificed and the regeneration of epithelium and cartilage and the degree of rejection were assessed by counting the monocellular infiltration. Result: Investigation at day 7, showed no difference in epithelial regeneration, however, at days 14 and 30, Group 1 showed better regeneration of epithelium than groups 2 and 3. There was no difference of epithelial regeneration between group 2 and 3. There was little rejection at day 7, but at days 14 and 30, there was significant rejection in group 2 and group 3.(P<0.05). Group 3 showed lesser rejection than group 2 at days 14 and 30, but it was not statistically significant. Cartilage showed no rejection and maintained its viability in groups 2 and 3. Conclusion: Cryopreserved tracheal homograft can maintain its viability, therefore it may represent a possibility of clinical application for tracheal replacement. However, cryopreservation can not eliminate the antigenicity of the trachea completely. Furthere studies for lowering the antigenicity and rejection should be performed for an ideal substitute for tracheal replacement.

• Tuberculosis and Respiratory Diseases
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• v.52 no.1
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• pp.54-61
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• 2002

Background: Tracheal stenosis is an urgent but uncommon disease. Therefore, primary care clinicians have limited clinical experience. Animal models of a tracheal stenosis can be used conveniently for the learning, teaching, and developing new diagnostic and therapeutic modalities for tracheal stenosis. Recently, a canine model of a tracheal stenosis was developed using a Nd-YAG laser. To describe the methods and results of developed animal model, we performed this study. Methods : Six Mongrel dogs were generally anesthetized and the anterior 180 degree of tracheal cartilage of the animal was photo-coagulated using a Nd-YAG laser. The animals were bronchoscopically evaluated every week for 4 weeks and a pathologic evaluation was also made. Results : Two weeks after the laser coagulation, the trachea began to stenose and the stenosis progressed through 4 weeks. All animals suffered from shortness of breath, wheezing, and weight loss in the 3 weeks after the laser treatment, and two died of respiratory failure just before the fourth week. The gross pathologic findings showed the loss of cartilage and a dense fibrosis, which resulted in a fibrous stricture of the trachea. Microscopy also showed that the fibrous granulation tissue replaced destroyed cartilage. Conclusion : The canine model can assist in the understanding and development of new diagnostic and therapeutic modalities for tracheal stenosis.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.231-234
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• 1996

In the bronchial stenosis due to benign causes, bronchoplastic procedure has been considered as one of the best surgical treatment, because of preserving normal lung tissue below the affected bronchi. We have treated 2 patients (tracheal leiomyoma, bronchial stenosis due to chronic inflammatory cicatrization) that suffered from benign tracheal and bronchial stenosis by bronchoplastic procedure using autologous costal cartilage covered with pericardium. Patients showed good patency of bronchoplastic bronchi in bronchoscopic examination that was performed at 6 months afte the operation.