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Biomedical subjects

H C Grillo

Publications and source records attributed to H C Grillo.

14 recordsLinked to original sources
PubMed1979

Surgical treatment of postintubation tracheal injuries.

Two hundred-eight patients underwent tracheal resection and reconstruction for postintubation injuries from 1965 to early 1979. All but seven had received ventilatory assistance. Thirty-three had undergone prior attempts at surgical reconstruction. Twenty-three had had endotracheal tubes only. the patients had 112 cuff lesions, 78 stomal, 13 at both levels, and four lesions of uncertain origin. One hundred ninety-four had stenosis with or without accompanying malacic change, four showed "pure" malacia, nine had tracheoesophageal fistulas, and one had a tracheoinnominate fistula. There were many laryngeal injuries: 25 of these were major injuries to the low subglottic larynx, necessitating partial or complete removal of the anterior cricoid cartilage. Two hundred sixteen reconstructions were dond, eight for restenosis after initial resection. Cervical approach was used in 126, cervicomediastinal in 83, transthoracic in sic, and cutaneous reconstruction in one. The length of resection extended to 7 cm. Techniques for obtaining tension-free anastomosis included cervical flexion in all, laryngeal release in 20, hilar release in two, and use of partial external splinting in four. Fifty-seven required laryngotracheal anastomosis and nine partial laryngoplasty. Concurrent tracheostomy was rare except in the last group. One hundred-two open stomas were variously managed. There were five deaths (2%)-only one in a truly elective patient. Nine failures (5%) occurred. Ninety-three percent (189 patients) showed good (168) or satisfactory (21) results. Granulations at the suture line, necessitating bronchoscopy, were the most common complication, now seemingly avoided by use of absorbable sutures. Only one patient had postoperative innominate arterial hemorrhage.

Adolescent↗
PubMed1978

Tracheal carcinoids.

Three cases of carcinoid tumor arising in the trachea are reported and contrasted with carcinoids arising in bronchi and carcinoids in general. Only eleven other documented examples of tracheal carcinoids are found in the English literature. The true prevalence of carcinoids primary in the trachea cannot be accurately determined from the literature because of imprecise nomenclature or because of the failure to distinguish this tumor from carcinoids primary in the bronchus. Presenting symptoms are hemoptysis, dyspnea and wheezing, often persisting for many years before the correct diagnosis is made. The treatment of choice is surgical resection of the involved segment of trachea and primary reconstruction. The prognosis is generally good. The tumor metastasized in one of our three cases and in none of the eleven cases in the English literature.

Adolescent↗
PubMed1978

Tracheal tumors: surgical management.

In a 15-year period, 63 patients with primary tracheal tumors were seen. Twenty-eight patients with primary tumors and 8 with secondary tumors of the trachea were treated by resection with single-stage reconstruction. There were 24 cylindrical resections of trachea, 2 lateral resections of trachea, and 10 carinal reconstructions. Thirty-five additional patients with primary tracheal tumors were managed by staged reconstruction, irradiation, or no treatment. The most common primary lesion was squamous cell carcinoma and the second, adenoid cystic carcinoma. Benign primary tumors and low-grade malignant tumors obtained excellent palliation and usually cure. Surgical removal of squamous cell carcinoma and adenoid cystic carcinoma, usually with adjunctive irradiation, provided good palliation or the probability of cure. Resection of selected secondary tumors provided long-term palliation.

Airway Obstruction↗
PubMed1976

Repair of inflammatory tracheoesophageal fistula.

Benign acquired tracheoesophageal fistula is uncommon. Erosin of the membranous wall of the trachea and the anterior esophageal wall by the high-pressure cuff on a tracheostomy tube, often against the anvil of a nasogastric tube, may produce such fistulas. Techniques for closure have included patching the tracheal defect with muscle and, often, multiple staged procedures, planned or unplanned. Since any cuff lesion severe enough to cause a fistula necessarily damages the trachea circumferentially at the same level, definitive correction must include circumferential tracheal resection as well as closure of the fitstula. Five patients with tracheoesophageal fistula due to cuff perforation had repair by such a single-stage procedure. Through an anterior approach the involved trachea was resected, primary anastomosis was done, and the esophagus was closed in layers. In 3 of these 5 patients muscle was interposed for added security. One patient had undergone a prior attempt at repair elsewhere. One required a second resection of trachea for subsequent stomal stenosis. Repair in 2 additional patients with fistulas of complex origin related to direct trauma, sepsis, and foreign body involved adaptation of the basic technique to the special problem; 1 of these procedures was necessarily staged. Results in all 7 patients have been good.

Adult↗
PubMedDate not supplied

Surgical treatment of post-intubation lesions of the trachea.

One hundred and fifty-six patients with post-intubation lesions of the trachea were treated surgically. Of these patients 14 had cuff lesions as a result of ventilatory assistance with endotracheal tubes only. Cuff lesions predominated in those who had tracheostomy tubes. There were six tracheo-esophageal and one tracheoarterial fistulas. The majority of the patients were repaired by end to end anastomosis through the cervical route, most of the others through the cervico-mediastinal route with only five patients by the transthoracic approach. Ninety-one percent have achieved either a good or satisfactory result to date.

Humans↗