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Biomedical subjects

J A Kirchner

Publications and source records attributed to J A Kirchner.

At least 19 recordsLinked to original sources
PubMed1992

Pattern of gross displacement of the vocal fold in adduction and abduction movements.

The pattern of gross displacement of the vocal fold during adduction and abduction was studied in 4 adult fresh human larynges (2 males and 2 females). Markers were placed on specific sites along the edge of the vocal fold. Preliminary observations showed upward and lateral movement of the free edge during abduction. The vocal fold as a whole glides into and fills the cavity of the laryngeal ventricle. To quantify this observation 14 larynges (8 males and 6 females) were studied, using a technique designed to measure vertical and horizontal displacement of the vocal fold. An average of a 1.34 mm elevation and 4.43 mm lateral excursion were observed at midvocal fold level. A model for studying the pattern of vocal fold abduction is suggested and discussed.

Adult↗
PubMed1991

Histo-anatomical structure of the human laryngeal ventricle.

A study of the microstructure of the human laryngeal ventricle and ventricular band was carried out on 20 human larynges in an attempt to up-date and elucidate the function of these structures. Celloidin and paraffin whole organ coronal serial sections were studied to clarify the epithelial, glandular as well as muscular structures of the ventricle and ventricular band. The present study showed that the superior thyro-arytenoid muscle was bilaterally present in 80% of cases. On the other hand, the ventricularis muscle was bilaterally present in 95% of cases. These ventricular muscular elements have been reported differently in the literature. The functional significance of these variations are discussed. The opening of the saccule into the ventricle is guarded anteriorly by the ventriculo-saccular fold. This fold was present in 19 out of 20 larynges. Neither the percentage of its presence, nor its orientation to the saccular opening has been reported in the literature. The function of this structure is discussed in the light of the present data.

Adolescent↗
PubMed1990

Histology of Isshiki thyroplasty type I.

Isshiki thyroplasty type I, an open surgical procedure to medialize the true vocal cord, has been proposed as an alternative to Teflon injection in selected cases of recurrent nerve paralysis or vocalis muscle atrophy. This operation was performed in a man with a mediastinal tumor and a paralyzed vocal cord in an intermediate position. He died 1 month later, and his larynx and recurrent nerve were studied histologically. The gross and microscopic changes in the larynx caused by this operation are discussed, and the pathologic changes in the recurrent nerve leading to the paralysis are examined.

Aged↗
PubMed1990

Laryngeal chondrosarcoma: incidence, pathology, biological behavior, and treatment.

Chondrosarcoma is the most common mesenchymal tumor of the larynx and approximately 200 cases have been collected in the world medical literature. It is less aggressive in the larynx than elsewhere: cervical or distant metastases are rare (8.5%), and although local recurrences are not uncommon, they are not catastrophic. A retrospective study was made on eight cases of laryngeal chondrosarcoma. Three cases had originally been diagnosed as idiopathic vocal cord paralysis, possibly because of early involvement of the cricoarytenoid joint or the distal portion of the recurrent nerve. This fact emphasizes the need for accurate laryngeal computed tomography in cases of vocal cord paralysis of unknown origin. Surgical excision is the treatment of choice for laryngeal chondrosarcoma, and conservative techniques may sometimes be appropriate. Supraglottic laryngectomy may be the technique of choice in the rare cases of epiglottic involvement.

Adult↗
PubMed1990

The nasogastric tube syndrome.

The nasogastric tube can produce sudden, life-threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo-documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pharyngodynia, hoarseness, or evolving stridor present in the postoperative period.

Adult↗
PubMed1989

Anatomic foramina in the thyroid cartilage: incidence and implications for the spread of laryngeal cancer.

Anatomic openings in the posterosuperior portion of the thyroid lamina of the larynx were first described in the 19th century. In the present study of 121 coronally sectioned larynges, such openings were found in 47 (39%), appearing bilaterally in 15 and unilaterally in 32. In a separate study of 69 cadaver larynges, the openings were found in 39 (57%), appearing bilaterally in 16 and unilaterally in 23. In 51 laryngectomy specimens removed for squamous cell cancer and showing foramina, tumor was not observed to invade or traverse the foramen in a single case, even in those specimens with tumor overlying the foramen and displaying framework invasion at other sites. Invasion by cancer through the foramen appears to be prevented by a layer of fibroelastic tissue overlying the medial surface of the foramen, parallel to the inner surface of the thyroid lamina. This layer of fibroelastic tissue may represent perichondrium.

Adenocarcinoma↗
PubMed1989

Fifteenth Daniel C. Baker, Jr, memorial lecture. What have whole organ sections contributed to the treatment of laryngeal cancer?

The study of whole organ sections of laryngectomy specimens has demonstrated the patterns by which cancer spreads from one part of the larynx and hypopharynx to another. These studies have also demonstrated the fibroelastic membranes and ligaments that form the boundaries of intralaryngeal compartments within which cancer is confined in its early stages. They thus have added support to the concept of partial laryngectomy for selected lesions and have illustrated the features of those types of laryngeal cancer that have not responded well to radiotherapy. Whole organ sections of laryngectomy specimens have allowed a more accurate interpretation of preoperative computed tomography and magnetic resonance imaging and have provided a reliable basis for clinical staging.

Biopsy↗
PubMed1987

A morphometric comparison of the changes in the laryngeal skeleton associated with invasion by tumor and by external-beam radiation.

Patterns of cartilage invasion by squamous carcinoma were examined in 40 laryngectomy specimens with particular reference to selective involvement of ossified cartilage. The study determines whether external radiation administered at therapeutic levels to the human larynx has selective effects on the osteoclast cell population and subsequent bone resorption. Radiated and nonirradiated tissues were compared as were cases with and without laryngeal framework involvement by cancer. Morphologic changes in ossified laryngeal cartilage showed that invasion is a largely indirect process dominated by local bone destruction with osteoclasts operating in front of the advancing tumor. Morphometric studies indicate that framework invasion correlates significantly with both increased numbers of osteoclasts and increased bone resorption. An original finding here was that radiation therapy resulted in similarly increased osteoclast activity among cases without framework involvement by cancer. In these cases radiation appeared to act independently of tumor in producing osteoclast activation.

Carcinoma, Squamous Cell↗
PubMed1987

Hunter's syndrome: a study in airway obstruction.

Hunter's disease is a genetically transmitted defect known to produce mucopolysaccharide infiltration of multiple organ systems. Upper airway obstruction is caused by an enlarged tongue, deformed pharynx, and short, thick neck. Its eventual lethal outcome by the second decade of life is known to result from an infiltrative cardiomyopathy leading to irreversible heart failure. Instead, our recent experience in the care of five patients with this disorder suggests the lethal event is related to progressive obstruction sequentially involving the upper, mid, and lower airway characterized by gradual deformation and collapse of the trachea. Autopsy and histopathologic whole organ sections demonstrate anteroposterior flattening of the trachea and bronchi with submucosal thickening producing structural alterations known only to this disease.

Airway Obstruction↗
PubMed1986

Avoiding problems in tracheotomy.

The surgeon can minimize postoperative problems that may develop after tracheotomy by 1. ligating the veins that cross the midline (over-dependence on cautery often results in postoperative bleeding); 2. dividing and suture-ligating the thyroid isthmus; 3. avoiding sharp dissection or blind clamping at the sternal notch; 4. leaving the deep layers of the wound open, to avoid subcutaneous or mediastinal emphysema; 5. avoiding a low horizontal skin incision; and 6. using guide sutures at tracheal opening in the infant.

Child, Preschool↗
PubMed1985

Laryngeal perichondritis and abscess.

Primary infection of the laryngeal cartilages has become rare in the antibiotic era. However, trauma, irradiation, a foreign body, or cancer may initiate the infection, particularly in the immunocompromised patient. We encountered three cases of perichondritis and abscess associated with airway intubation, nasogastric intubation, and external beam radiotherapy. Laryngeal perichondritis and abscess remain serious potential causes of laryngeal deformity and dysfunction.

Abscess↗
PubMed1979

Clinical vs histopathologic staging in laryngeal cancer.

One hundred fourteen serially sectioned, nonirradiated, laryngeal specimens that were removed for cancer have been examined to determine the accuracy of preoperative staging. Characteristics of the primary lesion, which indicate invasion of the laryngeal framework, have been demonstrated for each region in the larynx. Pathologic findings, such as submucosal extension, growth into the preepiglottic space, infraglottic extension, and involvement of the laryngeal ventricle, have been correlated with clinical staging. The relationship between tumor size and accuracy of clinical staging has been evaluated. For multiregional lesions, the location that yielded the highest probability of metastasis was designated as the primary site. Our findings indicate inaccurate staging for 37% of glottic tumors, 38% of supraglottic tumors, 50% of transglottic tumors, and 13% of subglottic lesions. In 89% of the cases that were staged inaccurately, the error was one of underestimation. Depth of tumor invasion was the most difficult measurement to determine.

Humans↗
PubMed1978

The long tracheostomy tube. Alternative management of distal tracheal stenosis.

The incidence of tracheal strictures has greatly increased, and even in the most controlled clinical setting, the treatment of this problem requires sophisticated surgical management. We present an alternative method of management that was initially used to secure a temporary airway in young and debilitated patients. This technique has provided both immediate relief of the airway obstruction and definitive long-term correction of the stenosis, with a low complication rate.

Adult↗
PubMed1978

Pediatric tracheostomy and associated complications.

A retrospective analysis of 123 pediatric tracheostomies reveals an overall complication rate of 33%. Immediate complications were present in 12% or 15 patients. The most frequent immediate complications were pneumomediastinum and pneumothorax. Delayed complications occurred in 24% or 30 patients. The most frequent delayed complications were subglottic stenosis, fused vocal cords, and tracheal granuloma. Four patients died because of tracheostomy-related complications. Age, underlying disease, and prior endotracheal intubation had a high degree of correlation with complications. The use of a mechanical respirator following tracheostomy did not appear to be significantly related to complications. Fifty percent of the delayed complications in this series were regarded as being unrelated to the tracheostomy or the trachesotomy tube itself.

Age Factors↗