O colapso traqueal é caracterizado por alterações tanto anatômicas como histológicas da cartilagem hialina dos anéis traqueais e do músculo traqueal dorsal, ocasionando colapso dinâmico da traqueia durante o ciclo respiratório. A etiologia do colapso de traqueia é desconhecida e provavelmente multifatorial. O esforço repetido das vias respiratórias causa inflamação crônica da mucosa traqueal, manifestando assim a tosse, que exacerba o processo inflamatório. O colapso de traqueia manifesta um sinal clínico importante chamado síndrome de angústia respiratória. Geralmente acomete cães de raça miniatura ou toy, sendo mais observado em cães de idade média, ou idosos. O procedimento traqueoscópico é considerado padrão ouro no diagnóstico para àqueles animais com alterações respiratórias, em especial nos casos de colapso traqueal. A intervenção cirúrgica objetiva estabilizar a cartilagem da traqueia e o músculo traqueal. O avanço da tecnologia possibilitou o desenvolvimento de próteses (stents) de materiais diversos. A finalidade do uso do stent é manter o suporte cartilaginoso, eventualmente perdido pela via aérea. Em função disso, o objetivo deste trabalho foi de descrever e avaliar a colocação de stents intraluminais autoexpansivos de nitinol (liga de titânioníquel), no interior do lúmen traqueal de cães com colapso de traqueia pela técnica de traqueoscopia, e também avaliar as complicações trans e pós-operatórias, com acompanhamento periódico dos pacientes. Foram incluídos neste trabalho sete cães, com peso corporal inferior a 5kg, com diagnóstico clínico, radiográfico e endoscópico de colapso traqueal cervicotorácico e intratorácico, atendidos no HCV-FAVET/UFRGS. Os critérios de inclusão avaliados foram: manifestação de dispneia e tosse, tratamento clínico sem remissão dos sinais e colapso de traqueia grau III ou IV. O procedimento foi realizado utilizando o método diagnóstico de traqueoscopia rígida, sem o auxílio de fluroscopia, para a colocação dos stents, na tentativa de corrigir o defeito traqueal destes animais. Foi realizada radiografia cervicotorácica em todos os cães, em duas posições em ângulo de 90º, para avaliação do posicionamento do stent e da correção do defeito traqueal logo após o procedimento. Este exame foi igualmente realizado, aos 15 dias e mensalmente, até término do período de avaliação, de sete meses. Os animais foram submetidos à traqueoscopia aos 50 dias e aos sete meses após a colocação do stent, para avaliar a presença de colapso em outra região traqueal e/ou de brônquios ocorrência de fraturas do stent em quatro cães e presença de tecido de granulação. Pelas avaliações radiográficas e traqueoscópicas não foi evidenciada ocorrência de migração do stent em nenhum cão, mas fratura em quatro deles. Foi observada presença de tecido de granulação excessivo em todos eles. Neste estudo, a técnica de colocação de stent intraluminal autoexpansivo de nitinol por meio de traqueoscopia sem o uso de fluroscopia é considerada efetiva, pois houve melhora na qualidade, mas não no aumento de expectativa de vida desses cães. / The tracheal collapse is a disease characterized by both anatomical and histological changes in the hialine cartilage of the tracheal rings and the dorsal muscle, causing dynamic collapse of the trachea during the respiratory cycle. The etiology of tracheal collapse is unknown and probably multifactorial. Repeated airway stress causes chronic inflammation of the tracheal mucosa, thus manifesting cough, which exacerbates the inflammatory process. The collapse of the trachea demonstrates a significant clinical sign called respiratory distress syndrome. Usually affects breeds miniature or toy, more observed in middle-age or elderly. The tracheoscopic procedure is considered the gold standard in diagnosis for those animals with respiratory changes, especially in cases of tracheal collapse. The surgery aims to stabilize the cartilage of the trachea and tracheal muscle. The advancement of technology has enabled the development of prostheses (stents) of various materials. The purpose of a stent to keep the cartilaginous support is eventually lost by air. As a result, the objective of this study was to describe and evaluate the placement of intraluminal autoexpansives nitinol stents (nickel-titanium alloy), inside the tracheal lumen of dogs with tracheal collapse by tracheoscopy technique and also evaluate complications trans and postoperative, with periodic patient monitoring. This work seven dogs whith body weight less than 5kg, with clinical, radiographic and endoscopic diagnosis of cervicalthoracic and intrathoracic tracheal collapse seen at HCV-FAVET/UFRGS were included. Inclusion criteria were: manifestation of dyspnea and cough, clinical treatment without remission of sings and collapsing trachea grade III or IV. The procedure was performed using the diagnostic method of rigid tracheoscopy, without the aid of fluoroscopy for the placement of stents in an attempt to correct the tracheal defect of these animals. Cervicalthoracic radiography was performed in all dogs, in two positions at 90 °, to evaluate the positioning of the stent and the fix tracheal defect after the procedure. This examination was also performed at 15 days and monthly until the end of the evaluation period of seven months. The animals underwent tracheoscopy at 50 days and at seven months after stent placement, to assess the presence of tracheal collapse in another and / or bronchi occurrence of stent fractures in four dogs and the presence of granulation tissue region. By radiographic and reviews tracheoscopycs was not evidence of stent migration occurred in any dog, but fracture in four of them. Presence of excessive granulation tissue was observed in all of them. In this study, the technique of placing intraluminal autoexpansive nitinol stenting through tracheoscopy without the use of fluoroscopy is considered effective because there was an improvement in quality, but not the increase in life expectancy of these dogs.

O colapso traqueal é caracterizado por alterações tanto anatômicas como histológicas da cartilagem hialina dos anéis traqueais e do músculo traqueal dorsal, ocasionando colapso dinâmico da traqueia durante o ciclo respiratório. A etiologia do colapso de traqueia é desconhecida e provavelmente multifatorial. O esforço repetido das vias respiratórias causa inflamação crônica da mucosa traqueal, manifestando assim a tosse, que exacerba o processo inflamatório. O colapso de traqueia manifesta um sinal clínico importante chamado síndrome de angústia respiratória. Geralmente acomete cães de raça miniatura ou toy, sendo mais observado em cães de idade média, ou idosos. O procedimento traqueoscópico é considerado padrão ouro no diagnóstico para àqueles animais com alterações respiratórias, em especial nos casos de colapso traqueal. A intervenção cirúrgica objetiva estabilizar a cartilagem da traqueia e o músculo traqueal. O avanço da tecnologia possibilitou o desenvolvimento de próteses (stents) de materiais diversos. A finalidade do uso do stent é manter o suporte cartilaginoso, eventualmente perdido pela via aérea. Em função disso, o objetivo deste trabalho foi de descrever e avaliar a colocação de stents intraluminais autoexpansivos de nitinol (liga de titânioníquel), no interior do lúmen traqueal de cães com colapso de traqueia pela técnica de traqueoscopia, e também avaliar as complicações trans e pós-operatórias, com acompanhamento periódico dos pacientes. Foram incluídos neste trabalho sete cães, com peso corporal inferior a 5kg, com diagnóstico clínico, radiográfico e endoscópico de colapso traqueal cervicotorácico e intratorácico, atendidos no HCV-FAVET/UFRGS. Os critérios de inclusão avaliados foram: manifestação de dispneia e tosse, tratamento clínico sem remissão dos sinais e colapso de traqueia grau III ou IV. O procedimento foi realizado utilizando o método diagnóstico de traqueoscopia rígida, sem o auxílio de fluroscopia, para a colocação dos stents, na tentativa de corrigir o defeito traqueal destes animais. Foi realizada radiografia cervicotorácica em todos os cães, em duas posições em ângulo de 90º, para avaliação do posicionamento do stent e da correção do defeito traqueal logo após o procedimento. Este exame foi igualmente realizado, aos 15 dias e mensalmente, até término do período de avaliação, de sete meses. Os animais foram submetidos à traqueoscopia aos 50 dias e aos sete meses após a colocação do stent, para avaliar a presença de colapso em outra região traqueal e/ou de brônquios ocorrência de fraturas do stent em quatro cães e presença de tecido de granulação. Pelas avaliações radiográficas e traqueoscópicas não foi evidenciada ocorrência de migração do stent em nenhum cão, mas fratura em quatro deles. Foi observada presença de tecido de granulação excessivo em todos eles. Neste estudo, a técnica de colocação de stent intraluminal autoexpansivo de nitinol por meio de traqueoscopia sem o uso de fluroscopia é considerada efetiva, pois houve melhora na qualidade, mas não no aumento de expectativa de vida desses cães. / The tracheal collapse is a disease characterized by both anatomical and histological changes in the hialine cartilage of the tracheal rings and the dorsal muscle, causing dynamic collapse of the trachea during the respiratory cycle. The etiology of tracheal collapse is unknown and probably multifactorial. Repeated airway stress causes chronic inflammation of the tracheal mucosa, thus manifesting cough, which exacerbates the inflammatory process. The collapse of the trachea demonstrates a significant clinical sign called respiratory distress syndrome. Usually affects breeds miniature or toy, more observed in middle-age or elderly. The tracheoscopic procedure is considered the gold standard in diagnosis for those animals with respiratory changes, especially in cases of tracheal collapse. The surgery aims to stabilize the cartilage of the trachea and tracheal muscle. The advancement of technology has enabled the development of prostheses (stents) of various materials. The purpose of a stent to keep the cartilaginous support is eventually lost by air. As a result, the objective of this study was to describe and evaluate the placement of intraluminal autoexpansives nitinol stents (nickel-titanium alloy), inside the tracheal lumen of dogs with tracheal collapse by tracheoscopy technique and also evaluate complications trans and postoperative, with periodic patient monitoring. This work seven dogs whith body weight less than 5kg, with clinical, radiographic and endoscopic diagnosis of cervicalthoracic and intrathoracic tracheal collapse seen at HCV-FAVET/UFRGS were included. Inclusion criteria were: manifestation of dyspnea and cough, clinical treatment without remission of sings and collapsing trachea grade III or IV. The procedure was performed using the diagnostic method of rigid tracheoscopy, without the aid of fluoroscopy for the placement of stents in an attempt to correct the tracheal defect of these animals. Cervicalthoracic radiography was performed in all dogs, in two positions at 90 °, to evaluate the positioning of the stent and the fix tracheal defect after the procedure. This examination was also performed at 15 days and monthly until the end of the evaluation period of seven months. The animals underwent tracheoscopy at 50 days and at seven months after stent placement, to assess the presence of tracheal collapse in another and / or bronchi occurrence of stent fractures in four dogs and the presence of granulation tissue region. By radiographic and reviews tracheoscopycs was not evidence of stent migration occurred in any dog, but fracture in four of them. Presence of excessive granulation tissue was observed in all of them. In this study, the technique of placing intraluminal autoexpansive nitinol stenting through tracheoscopy without the use of fluoroscopy is considered effective because there was an improvement in quality, but not the increase in life expectancy of these dogs.

O colapso traqueal é caracterizado por alterações tanto anatômicas como histológicas da cartilagem hialina dos anéis traqueais e do músculo traqueal dorsal, ocasionando colapso dinâmico da traqueia durante o ciclo respiratório. A etiologia do colapso de traqueia é desconhecida e provavelmente multifatorial. O esforço repetido das vias respiratórias causa inflamação crônica da mucosa traqueal, manifestando assim a tosse, que exacerba o processo inflamatório. O colapso de traqueia manifesta um sinal clínico importante chamado síndrome de angústia respiratória. Geralmente acomete cães de raça miniatura ou toy, sendo mais observado em cães de idade média, ou idosos. O procedimento traqueoscópico é considerado padrão ouro no diagnóstico para àqueles animais com alterações respiratórias, em especial nos casos de colapso traqueal. A intervenção cirúrgica objetiva estabilizar a cartilagem da traqueia e o músculo traqueal. O avanço da tecnologia possibilitou o desenvolvimento de próteses (stents) de materiais diversos. A finalidade do uso do stent é manter o suporte cartilaginoso, eventualmente perdido pela via aérea. Em função disso, o objetivo deste trabalho foi de descrever e avaliar a colocação de stents intraluminais autoexpansivos de nitinol (liga de titânioníquel), no interior do lúmen traqueal de cães com colapso de traqueia pela técnica de traqueoscopia, e também avaliar as complicações trans e pós-operatórias, com acompanhamento periódico dos pacientes. Foram incluídos neste trabalho sete cães, com peso corporal inferior a 5kg, com diagnóstico clínico, radiográfico e endoscópico de colapso traqueal cervicotorácico e intratorácico, atendidos no HCV-FAVET/UFRGS. Os critérios de inclusão avaliados foram: manifestação de dispneia e tosse, tratamento clínico sem remissão dos sinais e colapso de traqueia grau III ou IV. O procedimento foi realizado utilizando o método diagnóstico de traqueoscopia rígida, sem o auxílio de fluroscopia, para a colocação dos stents, na tentativa de corrigir o defeito traqueal destes animais. Foi realizada radiografia cervicotorácica em todos os cães, em duas posições em ângulo de 90º, para avaliação do posicionamento do stent e da correção do defeito traqueal logo após o procedimento. Este exame foi igualmente realizado, aos 15 dias e mensalmente, até término do período de avaliação, de sete meses. Os animais foram submetidos à traqueoscopia aos 50 dias e aos sete meses após a colocação do stent, para avaliar a presença de colapso em outra região traqueal e/ou de brônquios ocorrência de fraturas do stent em quatro cães e presença de tecido de granulação. Pelas avaliações radiográficas e traqueoscópicas não foi evidenciada ocorrência de migração do stent em nenhum cão, mas fratura em quatro deles. Foi observada presença de tecido de granulação excessivo em todos eles. Neste estudo, a técnica de colocação de stent intraluminal autoexpansivo de nitinol por meio de traqueoscopia sem o uso de fluroscopia é considerada efetiva, pois houve melhora na qualidade, mas não no aumento de expectativa de vida desses cães. / The tracheal collapse is a disease characterized by both anatomical and histological changes in the hialine cartilage of the tracheal rings and the dorsal muscle, causing dynamic collapse of the trachea during the respiratory cycle. The etiology of tracheal collapse is unknown and probably multifactorial. Repeated airway stress causes chronic inflammation of the tracheal mucosa, thus manifesting cough, which exacerbates the inflammatory process. The collapse of the trachea demonstrates a significant clinical sign called respiratory distress syndrome. Usually affects breeds miniature or toy, more observed in middle-age or elderly. The tracheoscopic procedure is considered the gold standard in diagnosis for those animals with respiratory changes, especially in cases of tracheal collapse. The surgery aims to stabilize the cartilage of the trachea and tracheal muscle. The advancement of technology has enabled the development of prostheses (stents) of various materials. The purpose of a stent to keep the cartilaginous support is eventually lost by air. As a result, the objective of this study was to describe and evaluate the placement of intraluminal autoexpansives nitinol stents (nickel-titanium alloy), inside the tracheal lumen of dogs with tracheal collapse by tracheoscopy technique and also evaluate complications trans and postoperative, with periodic patient monitoring. This work seven dogs whith body weight less than 5kg, with clinical, radiographic and endoscopic diagnosis of cervicalthoracic and intrathoracic tracheal collapse seen at HCV-FAVET/UFRGS were included. Inclusion criteria were: manifestation of dyspnea and cough, clinical treatment without remission of sings and collapsing trachea grade III or IV. The procedure was performed using the diagnostic method of rigid tracheoscopy, without the aid of fluoroscopy for the placement of stents in an attempt to correct the tracheal defect of these animals. Cervicalthoracic radiography was performed in all dogs, in two positions at 90 °, to evaluate the positioning of the stent and the fix tracheal defect after the procedure. This examination was also performed at 15 days and monthly until the end of the evaluation period of seven months. The animals underwent tracheoscopy at 50 days and at seven months after stent placement, to assess the presence of tracheal collapse in another and / or bronchi occurrence of stent fractures in four dogs and the presence of granulation tissue region. By radiographic and reviews tracheoscopycs was not evidence of stent migration occurred in any dog, but fracture in four of them. Presence of excessive granulation tissue was observed in all of them. In this study, the technique of placing intraluminal autoexpansive nitinol stenting through tracheoscopy without the use of fluoroscopy is considered effective because there was an improvement in quality, but not the increase in life expectancy of these dogs.

Much of the impetus for this research can be attributed to Kenneth W. Hinchcliff, who has studied exercise-induced pulmonary haemorrhage (EIPH) extensively. This thesis focused on EIPH in Thoroughbred racehorses competing in South Africa. Using tracheobronchoscopy, the prevalence and severity of EIPH and the association with racing performance was determined. Thereafter, the prevalence of other respiratory tract disorders and their association with racing performance is reported. This is followed by a study assessing interobserver variability using grading systems in the detection of respiratory tract disorders. Finally, there is a report on the immunopathogenesis of EIPH. Using tracheobronchoscopy after racing, the prevalence and severity of EIPH was assessed in 1,005 racehorses competing at high altitude (> 1,400 meters above sea level) and at sea level in a racing jurisdiction that does not allow the use of furosemide and nasal dilator strips. The prevalence and severity of EIPH was affected by altitude as racing at sea level was associated with a higher prevalence and greater severity of EIPH. Results also suggested that EIPH was associated with superior performance in South African Thoroughbred racehorses. Upper and lower respiratory tract disorders identified following tracheobronchoscopic examination included left arytenoid asymmetry, left laryngeal hemiplegia, epiglottic deformity, epiglottic entrapment, subepiglottic cysts, dorsal displacement of the soft palate, pharyngeal lymphoid hyperplasia (PLH), laryngeal and tracheal dirt, tracheal mucous (TM), tracheal stenosis and tracheal cartilage ring spikes in Thoroughbred racehorses after racing. Overall, there was a low prevalence of grade 2 and 3 arytenoid cartilage asymmetry, left laryngeal hemiplegia, epiglottic entrapment, subepiglottic cysts and epiglottic deformity, while more severe grades of PLH, laryngeal debris, tracheal debris, TM and tracheal cartilage ring spikes had a higher prevalence. An association with sex was identified as tracheal cartilage ring spikes occurred more often in male racehorses. Superior racing performance was identified in racehorses with grade 3 tracheal mucous and tracheal cartilage ring spikes. Endoscopic grading of EIPH, PLH, arytenoid cartilage movement (ACM), and TM was performed by 3 observers that were blinded to each racehorse’s identity and race day performance using previously established grading criteria. Excellent interobserver reliability was seen using the EIPH grading system, while the weighted kappa for PLH, ACM and TM was lower. The study demonstrated sufficient reliability for the use of the EIPH, PLH, ACM and TM grading systems in racehorses competing in South Africa. The study concluded that tracheobronchoscopy seemed to be a practical screening technique that may have prognosticative validity and clinical dependability and that would allow safe and quick assessment of the respiratory tract of a large number of racehorses in field conditions. Venous blood was collected from 10 horses in each EIPH grade classification (grade 0 to 4) following tracheobronchoscopic examinations for the determination of the presence and severity of EIPH. Following RNA isolation and cDNA synthesis, real-time PCR was used to detect equine cytokine-specific mRNA for interleukin (IL) -1, -6, -10, interferon (INF) -ã, and tumor necrosis factor (TNF) -á. Results of this study indicated that increased IL-6, and -10 mRNA production was associated with more severe forms of EIPH. Also, there was greater expression of IL-6 mRNA at sea level and TNF-á mRNA at high altitude. This study concluded that although it was unclear whether the inflammatory response observed in the study was due to pre-existing pulmonary inflammation or as a direct consequence of pulmonary bleeding, the study demonstrated a systemic correlation to pulmonary inflammation. The research reported in this thesis has contributed substantially to the determination of the prevalence, severity and affect on racing performance of respiratory tract disorders in Thoroughbred racehorses competing in South Africa. Also, determination of an association between EIPH and inflammation at a molecular level may assist future researchers in anti-cytokine therapies which may help reduce the prevalence and severity of EIPH. / Thesis (PHD)--University of Pretoria, 2007. / Companion Animal Clinical Studies / unrestricted