The management of long tracheal lesions requires development of tracheal implants, which would enable resection combined with anastomosis. The authors' scientific study is based on tracheal allotransplantation on an animal model (sheep), using tracheal epithelial cells of the recipient. The project covers preparation of the graft, so that all components of the major histocompatibility complex (MHC), which participate in graft rejection, are removed. Histological examination of the allograft with cultivated epithelial cells showed its good healing with revasculatization and with no signs of graft rejection.

Acute hypercapnic respiratory failure is a rare but life-threatening complication in grossly obese patients with severe obstructive sleep apnoea (OSA). Facial trauma or upper airway surgery, respiratory tract infections, bronchospasm, use of pain medication and concomitant obstructive or restrictive pulmonary impairment predispose to the development of respiratory failure in such patients. We present a case of a morbidly obese male patient in whom moderately severe OSA (the apnoea-hypoponea index, AHI of 37/hour) was treated with uvulapalatopharyngoplasty (UPPP) because he declined treatment with non-invasive ventilation. The early postoperative period was complicated by severe hypercapnic respiratory failure in association with worsening of OSA: arterial PO2 was 4.14 kPa, PCO2 9.7 kPa, AHI increased to 93.8/hour, minimal nocturnal arterial oxygen saturation was 46%. Therapy with non-invasive ventilation using bi-level positive airway pressure (BiPAP) was initiated immediately, and resulted in marked improvements in the patient's clinical condition, in association with the improvements in arterial blood gases. Before the discharge, nocturnal continuous positive airway pressure (CPAP) therapy to treat OSA on the long-term basis was initiated. Two months after the release, the patient's blood gases were within the normal range, and he reported marked improvements in his clinical condition including alleviation of daytime sleepiness and increased physical endurance. Our case demonstrates that in the presence of severe OSA, life-threatening hypoxaemia and hypercapnia were successfully alleviated using BiPAP in the postoperative period after UPPP.

Actinomycosis is an infrequent chronic progressive granulomatous and suppurative disease caused by Actinomyces israelii, a natural inhabitant of the gastrointestinal tract. We report a rare case of a 68-year-old man with primary endobronchial actinomycosis who presented in the emergency respiratory ward with massive hemoptysis and dyspnea. An urgent fiberoptic bronchoscopy revealed hypertrophic mucosa and a narrowed lingular bronchus with a pale extruding exophyt. Diffuse bleeding from the mucosa adjacent to the exophyt was present. Histopathologic evaluation revealed chronic inflammation with abscess formation and clusters of Actinomyces colonies. Therapy with clindamycin maintained for 7 weeks prevented recurrence of the disease. In the light of our case and the review of literature we conclude that early recognition of primary endobronchial actinomycosis associated with hemoptysis and proper antibiotic treatment are essential to prevent undesirable complications including unwarranted surgery (Fig. 2, Ref. 30). Full Text (Free, PDF) www.bmj.sk.