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Biomedical subjects

L D Holinger

Publications and source records attributed to L D Holinger.

At least 91 records · Page 5Linked to original sources
PubMed1981

Vocal cord paralysis and psychopathology. Data and clinical issues.

The nature and cause of psychiatric symptoms associated with the posthyroidectomy bilateral abductor vocal cord paralysis (BAVCP) syndrome are analyzed. The postthyroidectomy BAVCP syndrome is characterized by normal voice, airway obstruction, hypothyroidism, hypoparathyroidism, and psychiatric manifestations. Forty-five (35.2%) of 128 patients with postthyroidectomy BAVCP syndrome had psychiatric manifestations of some kind. The following four categories of psychiatric problems were found: (1) preexisting psychiatric symptoms exacerbated by the postthyroidectomy BAVCP syndrome, (2) psychiatric symptoms initiated by the syndrome, (3) psychiatric symptoms that were etiologically distinct from the syndrome, and (4) misdiagnosis. The variety of psychiatric symptoms, as well as the difficulty in determining the cause of the symptoms, makes it essential that surgeons, internists, and psychiatrists cooperate in the treatment of patients with the postthyroidectomy.

Humans↗
PubMed1980

Peroral endoscopy in neonates.

A study was made of 100 neonates examined by 171 procedures in a 5 year period. Thirty-six patients had vocal cord palsies: unilateral, bilateral, complete or incomplete. Twenty-four infants had laryngomalacia of which 5 had concomitant problems of multiple congenital anomalies or palsies of varying severity. Laryngeal stenosis was encountered in 13 patients. Four of these were congenital, and two required tracheotomy; 8 of the 9 patients with acquired stenosis required tracheotomy. Nine infants had cardiovascular anomalies. Three were seen following TEF repair. Esophageal foreign bodies (endotracheal tube) were removed from two infants. Of the 28 neonates who had tracheotomies, 13 had vocal cord palsies, 10 had laryngeal stenosis and 8 had congenital cardiovascular disease. In the 171 procedures, anesthesia was used 18 times for tracheotomy and 7 times for repeated procedures. There were 3 deaths in this series, all related to the underlying disease. This study indicates that endoscopic examinations of the neonate can be accomplished safely. It further indicates the diverse diseases for which endoscopy is indicated. General anesthesia is not mandatory for such examinations.

Age Factors↗
PubMed1980

The otolaryngologic manifestations of malignant lymphoma with a high content of epithelioid histiocytes (Lennert's lymphoma).

Malignant lymphoma with a high content of epithelioid histiocytes is a rare non-Hodgkin lymphoma first described by Lennert and Mestdagh (Lennert's lymphoma) in 1968. Distinguishing characteristics include frequent involvement of the nasopharynx, Waldeyer's ring, and cervical lymph nodes. Of the four patients included in this report, three had Waldeyer's ring involvement and four had cervical lymphadenopathy. Our experience and that of others demonstrate the unpredictable and variable course of the disease, as well as the inconsistent response to various therapeutic modalities; especially interesting is the remission obtained in one patient treated with corticosteroids alone, in contrast to the others who followed a rapid downhill course to death in spite of (or as a complication of) chemotherapy and radiation. The role of the otolaryngologist in the diagnosis and management of the disease is emphasized.

Adult↗
PubMed1980

Psychiatric manifestations of the post-thyroidectomy bilateral abductor vocal cord paralysis syndrome. Cases and theoretical issues.

Post-thyroidectomy bilateral abductor vocal cord paralysis (BAVCP) is a life-threatening syndrome characterized by serious psychiatric manifestations as well as by voice, airway, hypothyroid, and hypoparathyroid symptoms. Of the 128 patients with post-thyroidectomy BAVCP syndrome, 45 (35.2 per cent) had psychiatric complications: 21 of the 128 patients (16.4 per cent) had pre-existing psychiatric symptoms exacerbated by the post-thyroidectomy BAVCP syndrome, 16 (12.5 per cent) had psychiatric symptoms initiated by the syndrome, six (4.7 per cent) had psychiatric symptoms etiologically distinct from the syndrome, and two (1.6 per cent) were misdiagnosed. The role of psychiatric treatment is described. Theoretical aspects of laryngeal dysfunctions associated with psychiatric disorders and psychotropic medications are discussed.

Adult↗
PubMed1979

Histopathology of congenital subglottic stenosis.

Three patients with congenital subglottic stenosis are presented and whole organ serial-section studies of their larynges are discussed. A superiorly displaced first tracheal ring is observed to form a cartilaginous subglottic stenosis in one. This "trapped first ring" is demonstrated in horizontal, sagittal and coronal planes. Subglottic stenosis is a clinical diagnosis which describes multifarious histopathological forms of narrowing within the subglottic larynx.

Cricoid Cartilage↗
PubMed1978

Respiratory obstruction and apnea in infants with bilateral abductor vocal cord paralysis, meningomyelocele, hydrocephalus, and Arnold-Chiari malformation.

This report describes 21 infants and children with bilateral abductor vocal cord paralysis and associated meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Two life-threatening forms of respiratory distress are distinguished: (1) upper airway obstruction due to bilateral abductor cord paralysis and (2) apnea. Clinically significant episodes of apnea were documented in 13 infants. Ten infants had evidence of aspiration and dysphagia. Vocal cord paralysis, apnea, aspiration, and dysphagia were frequently temporally related to increased intracranial pressure.

Airway Obstruction↗
PubMed1977

Immediate tonsillectomy for the treatment of peritonsillar abscess.

Our experience with 119 cases of peritonsillar abscess supports the experience of others, that immediate tonsillectomy is a safe treatment which provides prompt, complete drainage of the abscess. There was one episode of immediate postoperative hemorrhage and one of delayed bleeding, but there were no anesthetic complications. If one believes that the abscess is an indication for tonsillectomy and plans to perform the procedure at some time, we recommend that it be performed as the drainage procedure. The total hospitalization time will as a rule be shortened and a second convalescent period avoided. Its major drawback is the inconvenience of inserting a relative emergency into the schedule.

Adolescent↗
PubMed1975

Simultaneous glottic and supraglottic laryngeal webs: report of a case.

In a rare case of simultaneous glottic and supraglottic webbing a tantalum keel, as described by McNaught, and a silcone elastomer keel, as described by Montgomery, were placed simultaneously via laryngofissure. Use of different materials appeared to have no bearing on the final, successful outcome.

Adult↗
PubMedDate not supplied

Foreign bodies of the upper aerodigestive tract.

Foreign bodies of the upper aerodigestive tract in the pediatric population are a common occurrence. However, despite significant advances in prevention, first aid and endoscopic technology, they remain a diagnostic and therapeutic challenge. Early diagnosis is the key to successful and uncomplicated management of these accidents. An orderly and systematic approach to these patients including a careful history, physical exam and radiographic studies is detailed in this review.

Bronchoscopy↗
PubMedDate not supplied

Complete repair of Tetralogy of Fallot with absent pulmonary valve including the role of airway stenting.

Tetralogy of Fallot (TOF) with absent pulmonary valve (APV) represents an extreme form of tetralogy where pulmonary insufficiency and mild annular stenosis often results in massive pulmonary arterial (PA) dilatation. The aneurysmal left and right PAs often compress the adjacent trachea and bronchi, leading to airway obstruction and respiratory failure in infancy. Between 1991 and 1997, 11 patients underwent a single stage repair of TOF and APV using a valved (10 patients) or nonvalved (1 patient) homograft conduit and PA reduction arterioplasty. There was one (1/11 [9.1%) perioperative and one (9.1%) late death. Both deaths were related to airway complications. Morbidity associated with postoperative respiratory complications and ventilator-dependency due to underlying tracheobronchomalacia is an important problem. Intermediate follow-up shows a high incidence of reintervention for conduit stenosis and/or insufficiency and tracheobronchial compression. These infants also required multiple hospitalizations for recurrent respiratory infections secondary to their tracheobronchomalacia. Stenting of the right and left main bronchi with balloon expandable metallic stents is a new experimental therapy that has been useful in two recent patients with respiratory failure despite satisfactory intracardiac repair. It may provide an attractive alternative therapy to prolonged mechanical ventilation with positive end expiratory pressure in patients with severe tracheobronchomalacia. Complete repair with a valved homograft conduit and reduction pulmonary arterioplasty in infancy at the time of diagnosis is the procedure of choice for infants with TOF with APV. With this approach the patient outcome is essentially determined by their airway status and airway management.

Bronchi↗
PubMedDate not supplied

Unilateral endolymphatic hydrops and associated abnormalities.

A case of unilateral endolymphatic hydrops is presented in which several significant histopathological findings are observed in the affected inner ear and are absent in the opposite ear. Moderate endolymphatic hydrops is present in all cochlear turns on the involved side. Atrophic changes in the cochlear and vestibular end-organs, partial collapse and infolding of Reissner's and the saccular membranes, and collapse of the posterior canal membrane are also seen. There is also marked narrowing of the proximal rugose portion of the endolymphatic sac, associated with a flattened, epithelial lining, dense fibrotic connective tissue, brown pigment deposition, and poor vascularity in a relatively narrowed and straightened vestibular aqueduct. Fibrosis, loss of vascularity, and brown pigment deposition are also observed in the bony channels surrounding the vestibular aqueduct.

Cochlea↗
PubMedDate not supplied

Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases.

The etiology of 389 cases of partial or complete bilateral abductor vocal cord paralysis has been determined and classified. One hundred and forty-nine were infants and children 12 years of age and under; 240 were adults, age 13 and older. In the infants and children the paralyses were congenital in 82 cases, of which 43 were associated with other congenital anomalies, and 39 were without associated anomalies. Fifty-nine cases were considered acquired, most being secondary to underlying congenital anomalies, particularly the associated findings of meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Eight cases of paralysis in this age group were of undetermined etiology. Of the 240 adult cases of bilateral vocal cord paralysis. 138 followed thyroidectomy. Fifty-two cases were associated with various neurologic disorders, including poliomyelitis, Parkinson's disease, cerebrovascular accident, Guillain-Barré syndrome, multiple sclerosis, neoplasms and other miscellaneous neurologic conditions. Sixteen cases were due to malignant neoplasms of the neck and mediastinum. The remaining 34 cases constitute a miscellaneous group which includes foreign bodies, bilateral neck dissection, infection, congenital lesions, trauma, and idiopathic paralyses. The characteristic symptoms of bilateral abductor vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. These symptoms are due to the stationary but flaccid midline position of the vocal cords which places them in a phonating position, where they both obstruct the airway and produce a faily clear voice or cry. This paradoxical combination of symptoms was frequently found to be responsible for a failure or delay in diagnosis.

Adolescent↗
PubMedDate not supplied

Subglottic stenosis in infants and children.

Of 158 cases of subglottic stenosis 115 were congenital and 43 acquired. Current follow-up has been obtained in 146 (92%) which constitutes the determinate group. Although stridor was the most common presenting symptom of the congenital group, 34% presented with recurrent or prolonged episodes of croup. Tracheotomy was required in 47 of the 107 determinate cases (44%). Further management of the congenital cases was based on the experience that children outgrow this disorder; periodic dilatation may augment the natural process. Of those infants and children tracheotomized, all but five have been decannulated, and there was one death - a mortality rate of 2.1%. Acquired subglottic stenosis proved to be a more difficult management problem. Tracheotomy was necessary in 38 of the 39 determinate cases (97%). Repeated active dilatations for prolonged periods were usually required as well as endoscopic removal of granulation tissue. Of those infants and children tracheotomized, all but eight have been decannulated. There were nine deaths; five were due to unrelated underlying disease; four were attributable to complications of long-term tracheostomy. Thus, in the entire series, 85 infants and children required tracheotomy and five deaths may be attributable to long-term tracheostomy complications - a mortality rate of 5.9%.

Child↗