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Challenge to this incurable disease!Tracheal collapse is not an incurable disease!

Only one in Japan, only in the world.This remedy.


Tracheal collapsemoves air in and out of the lungsA disease in which the trachea collapses and makes it impossible to breatheis. It is said that the incidence is high in middle-aged and elderly small dogs, but it is seen in almost all dog breeds, including Japanese medium-sized dogs and large dogs such as Golden Retrievers and Labrador Retrievers.  

Symptoms are firstmild coughstarting witha cough that sticks in the throat,action to restore,breathing like a pig,goose breathAnd so on, and at the endcyanosisand have difficulty breathing. Currently, this disease is positioned as an intractable disease, and the current situation is that there is no active treatment. Our hospital has been actively treating this disease for a long time. Especially developed in 2000, absolutelyA new type of orthodontic appliance Parallel Loop Line Prostheses (PLLP)has been used with excellent therapeutic results.Instead of giving up on tracheal collapse as an incurable disease, we should not wait until it becomes irreparable, and we should take a “positive view” from the early stages, including medical treatment, such as light coughing. I suggest something.  

Only one in Japan and only in the world.

At our hospital, we aim for a radical cure through surgical treatment for tracheal collapse.  


* There are some difficult expressions and words, but I would like to explain them in sentences that even the general public can fully understand.


Tracheal collapse is a common respiratory disease in dogs, commonly seen in middle-aged (7-8 years old) small dogs (Pomeranian, Yorkshire Terrier, Maltese, Chihuahua, Poodle).

Surprisingly, however, it is also common in pure breeds of Japanese dogs (such as Shiba Inu) and mixed breeds. In large dogs such as Golden Retrievers and Labrador Retrievers, and small dogs such as Pomeranians and Yorkshire Terriers, the onset can occur as young as 1 to 2 years old.


This disease can be summarized simply as "a disease in which the trachea collapses". The trachea is a tubular structure that extends from the throat into the chest to the bronchus just above the heart. In most dogs, it starts before entering the chest, that is, in the last neck, and when it gets worse, it becomes impossible to breathe in and out.


The cause has not yet been elucidated. Studies have been conducted to some extent on the triggering factors, morphological changes after tracheal collapse, changes in the cartilage that make up the trachea, and their pathology, but the underlying cause is unknown. is the current situation. Also, in breeds where it occurs at a very young age, a genetic predisposition has been attributed. Pomeranians, Yorkshire Terriers, Golden Retrievers, Labrador Retrievers, Boxers, etc.

What does a tracheal collapse actually look like in a tracheoscopy? A tracheal endoscope will help you understand the situation.


First, the normal trachea maintains a clean round shape as shown in Figure 1.


In tracheal collapse, this gradually collapses (Figures 2-4).


In the end, it collapses to the point that it is a wonder to be alive.

And above all, there is still no cure for it. In medical therapy, even if you can cover up a mild cough,A fundamentally collapsed trachea cannot be widened.Even if you don't have specialized knowledge, you can't imagine that the collapsed windpipe will expand with medicine, right? Then, with a simpler idea, if it collapses, it might be better to open it surgically, but I can't find the means to do so.

how do i spread it?

In the old days, there was a method of sewing the trachea to shrink it, and a method of cutting a syringe jacket into a spiral or C shape and fixing it to the outside of the trachea and suturing it (prosthesis method). This kind of method is introduced in textbooks, but the results are not as good as expected, and there is no one who performs surgery with this method at present.

Also, you shouldn't. Do not.


I have also experienced failures. In addition, although he underwent surgery using this method at another hospital, he developed dyspnea half a year later, and a year later, he was in continuous pain every day, and had to undergo another surgery at his request. This was the very embodiment of the word misery, a sight that made you want to cover your eyes. Rejection caused severe granulation tissue growth around the trachea, and the inside of the trachea became so thick that the core of a ballpoint pen could barely fit inside. It will end up. It was really bad.


On the other hand, there is also a method called a stent method, which inserts a metal expansion device into the lumen of the trachea under endoscope or X-ray fluoroscopy. Currently, endotracheal stents for dogs are on the market in the United States and are also available in Japan. The technique is very simple. If you push out the stent that has been contracted into the trachea under anesthesia, it will automatically expand in the trachea, so it can be completed in a very short time. However, some problems have been pointed out.


First, since the trachea is originally very sensitive, it is necessary to insert a foreign object into it. For example, I think that everyone has the experience of accidentally swallowing a grain of rice into the trachea while eating. Just imagining the pain at that time, the state of the cough, it seems like I'm going to cough. Coughing can be exacerbated by placing long stents into the sensitive tracheal lumen. In addition, it is possible that granulation tissue enters the trachea after attachment and further narrows the trachea.


Next, it is pointed out that metal stents may cause metal failure due to three-dimensional movement of the neck. And once you put it in, it's impossible to take it out. Also, although it depends on the shape of the stent, there is a problem with the means to stop it at any place. In human doctors, the stent method is the mainstream treatment for trachea/bronchomalacia, a disease similar to tracheal collapse in dogs. Silicone stents, called dynamic stents, have already established themselves as the gold standard, and this seems very ideal because it can be made to patient-specific sizes using, for example, CT.

However, if you listen to the voices of doctors in the field, the opinion that they do not want to use it is still conspicuous.

It is not something that can be maintained permanently, and there are actually many problems such as phlegm removal and granulation tissue growth.

From the above, you will be caught in the "curse" that the collapse of the trachea cannot be cured.


For early cases, "let's see how it goes while treating it medically"

(I wonder if the trachea collapsed by the medicine will return to normal...)


"If you make me lose weight, it will heal."

(But I'm not fat...)


If this progresses to an intermediate level, "Let's try a little more internal medicine."

(I wonder how long I won't be able to sleep...)


And it's severe, "I've already given up. There's no cure."


This was the reality. Even today, it is considered one of the representative intractable diseases, in that it does not respond remarkably to internal medicine and that surgical treatment results are unsatisfactory.

So let's go back to the starting point. Why can't we simply expand the collapsed trachea? If a stent can't expand from the inside, why not from the outside?

The reason why the stent method failed was that the stent itself had not been sufficiently developed. Similarly, the reason why the prosthesis method has not become popular is that the development of the prosthesis itself, which satisfies various conditions, was insufficient.


Again, the primary lesion of tracheal collapse in dogs is, with very few exceptions, the posterior neck. I often see medium-sized dogs that pull hard when walking, and this is the part where the collar hits. As you can easily imagine, this part can freely move up, down, left and right, looking up at the owner, looking down, looking to the side, looking back, and even licking the buttocks. . The trachea is a flexible structure that can sufficiently follow this movement.

Therefore, the prosthesis placed in this part must also have sufficient flexibility. And while maintaining the power to expand the collapsed trachea firmly. Then, is there a prosthesis that satisfies all of these strict requirements: not too hard, not too soft, no tissue reaction after implantation, and size options for various dog breeds?


In Japan, there are Flexible Spiral Line Prostheses (FSLP) proposed in 1990 by Dr. Kogi, who has a practice in Osaka (named by me and approved by Dr. Kogi). I have also used it in nearly 20 cases, and the results are excellent. FSLP uses acrylic material for optical fibers and processes it into a spiral shape.

However, there was an objection that the material was not for medical use, and at present there was no official paper published by not only the inventor but also other researchers. In addition, from my experience, there was a drawback that it took time during the operation, and depending on the situation, it could become a little dangerous during the operation.


So I used this same material"Acrylic material for optical fiber"In 2000, we created an extremely ideal prosthesis that satisfies all of the above conditions and has excellent operability and safety. It exhibits a unique three-dimensional zigzag cylindrical shape.Parallel Loop Line Prostheses (PLLP)named.

The material is not developed for medical use like FSLP. However, the FSLP and PLLP that we have actually used have shown excellent performance over many years, so we investigated this material. As a result, we found that the material is mostly PMMA, and the surface is coated with a few microns of fluororesin. PMMA is a material used for intraocular lenses (lenses that are placed after the lens that has been removed during cataract surgery), and fluoropolymers are also unique in their low reactivity to living organisms. is used. Although it was not developed for medical use in this way, it turned out that the material was used for medical use. There are experimental implant cases and real cases that could be dissected after death. A pathological examination is also conducted at the same time, but even after a long time of nine years, there is almost no foreign body reaction, and it has been determined that implantation in the body is sufficiently possible.


Fig. 5 is an endoscopic photograph after surgery, and you can see that it has been clearly corrected into a cylindrical shape when compared with the collapsed one before surgery on the previous page. A nylon thread with a traction suture is visible in the tracheal lumen. This nylon thread is wrapped around the tracheal mucosa a few weeks after surgery.


As of 2017, 17 years have passed since the development of PLLP. 620 cases have been operated using PLLP. The conclusion I got as a result is that"Tracheal Collapse Can Be Cured" is. It's not a disease that can't be cured, it's not a disease that shouldn't be touched. There is a child who has entered the 15th year at the longest postoperative course. Some children have a cough immediately after surgery. This is due to the insertion of the prosthesis around the trachea and the suture inserted into the trachea. However, more than 80% of people have little or no coughing, and do not need any medicine at all.


However, sometimes it can't be cured. There are still cases where no matter how hard you try, there are cases where you can't get out of hand. Since it is an indispensable organ for breathing without replacement, some kind of trouble is not zero. There are many cases such as sudden death of unknown cause, dehiscence of the trachea, collapsing of the bronchus, inflammation of the trachea and complications of other respiratory diseases. If the cause is severe, the risk of death is sufficient. It boasts a success rate of about 95% in the whole, but still a few% may die after the operation.

And many of the reasons are "too late". The disease has an insidious and progressive character. It starts with a mild cough, but it's actually more advanced than you think. Coughing seems to have increased in intensity and frequency. But it wasn't that bad. However, a conspicuous cough finally started, and when I went to the hospital and had an X-ray taken, it turned out to be the terminal stage of tracheal collapse. In such a case, not only the trachea, but also the entire respiratory system, as well as various organs such as the heart and liver, will be affected, and surgery is not possible.


And it's also true that the line between "too late" is really uncertain. It can also get worse quickly from heat and humidity.

This disease can be cured by properly diagnosing it before it becomes terminal and unmanageable, and by considering the degree of progression and performing surgery early. Of course, there are risks involved, but even if the condition is severe, it may be possible to treat it sufficiently after understanding the age, number of years elapsed, and the condition of various organs, including heart function. The big criterion is not the severity of the collapse. This raises the question of where the collapsed part is.


Collapse of the trachea only. If it reaches the bronchi, surgery becomes impossible. In addition, the physical strength to withstand anesthesia remains. We also perform an approach to the thoracic trachea.  


If there is a child suffering from tracheal collapse, please think again before deciding that it will not be cured. I hope that you will be able to get a proper medical examination rather than just a simple cough. There is no reason to be pessimistic. Tracheal collapse is a curable disease.

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​Tracheal collapse

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