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Biomedical subjects

L J Hoeve

Publications and source records attributed to L J Hoeve.

At least 19 recordsLinked to original sources
PubMed1997

Management of infantile subglottic hemangioma: laser vaporization, submucous resection, intubation, or intralesional steroids?

The infantile subglottic hemangioma can be treated in various ways. The results of the treatment used in the Sophia Children's Hospital, intralesional steroids and intubation (IS + I), are discussed and compared with the results of other current treatment methods: CO2 laser vaporization, submucous resection and intubation alone. A total of 18 infants were treated for subglottic hemangioma in our hospital: ten with IS + I alone, five were first treated with systemic therapy and later with IS + I alone and three with various therapies. IS + I was effective in 14 of the 15 patients, one patient was lost from follow up. The remaining three infants were treated with (combinations of) various therapies, because IS + I failed or was not tried. Two patients were finally cured, one still has a tracheotomy. Of other current therapies, CO2 laser vaporization is reported to be effective. In all 30% of the infants treated in Boston Children's Hospital with CO2 laser needed a tracheotomy. Moreover subglottic stenosis is a serious complication. Submucous resection is often successful. It may be complicated by subglottic stenosis and in some cases, depending on the localization of the hemangioma, it may be contraindicated. Intubation alone is less effective than intubation combined with intralesional steroids. Management of subglottic hemangioma in Sophia Children's Hospital is primarily intralesional steroids and intubation and secondarily submucous resection or tracheotomy. CO2 laser vaporization is seldom applied because of the risk of subglottic stenosis.

Female↗
PubMed1996

Acquired laryngeal stenosis in infants and children treated by laryngofissure and stenting.

Thirty young patients with acquired laryngeal stenosis were treated by means of a laryngofissure and stenting. The age distribution suggested two subgroups: infants aged 0-2 years (n = 24), and children aged 6-16 years (n = 6). The causes of the stenosis and the treatment results were different in these subgroups. Treatment resulted in successful decannulation in 22 of 24 infants, and in 5 of 6 children. Treatment included a re-operation in two patients. In 1 patient the therapy failed, and 2 patients died after fatal complications. Decannulation rate, duration of the tracheotomy, and the number of re-operations compare favorably to the results of other centers. The longer duration of stenting, and the high mortality rate may be considered disadvantages.

Adolescent↗
PubMed1995

Therapeutic reintubation for post-intubation laryngotracheal injury in preterm infants.

The failure to extubate a preterm infant after prolonged intubation is often caused by laryngotracheal injury. This condition is treated by tracheotomy, anterior cricoid split, or often, by reintubation and subsequent extubation attempts in a later stage. To assess the value of reintubation as treatment of post-intubation injury, we retrospectively studied a group of preterm infants from the neonatal intensive care unit in the Sophia Children's Hospital. Three categories of injury were distinguished according to the findings at laryngobronchoscopy: (a) edema or superficial lesions, (b) ulcerations and edema and (c) granulations. Twenty-three infants were therapeutically reintubated after post-intubation injury was diagnosed, for a mean period of 17 days. The therapy was successful in 22 patients, and a failure in one. The follow-up period was a mean 34 months. The result and the duration of the treatment vary with the category of the injury and the condition of the patient. Therapeutic reintubation is compared with alternatives such as anterior cricoid split and tracheotomy. We conclude that reintubation is a valuable therapy that should precede the decision for surgery.

Cricoid Cartilage↗
PubMed1995

Management of infant laryngeal disorders in relation to wound healing processes of the rabbit larynx.

Laryngotracheal injury caused by prolonged intubation is mostly treated by reintubation or surgical intervention. To understand the histopathological processes involved in wound healing of laryngeal trauma and to assess the value of reintubation as treatment for post-intubation injury, the findings of a study in preterm infants were placed next to the results of experimental studies on laryngeal disorders in young, growing rabbits. Observations at laryngobronchoscopy in the child are compared to histopathological investigations in the animal. In both series various, evidently similar categories of injury could be distinguished viz. edema, ulcerations and granulations. The results of treatment like reintubation would vary with the diagnosed category of the injury; the more granulation tissue, the less successful conservative treatment will be. It is concluded that histopathologic classification is essential for good management of intubation injuries and that therapeutic re-intubation in case of superficial lesions should precede the decision for surgery.

Animals↗
PubMed1993

The use of hypoglycaemic and cardiovascular drugs in 582 patients with diabetes mellitus. Description and quality assessment.

The medication of 582 patients taking insulin or oral hypoglycaemic agents has been analysed. A characterization is given of the patients and their antidiabetic medication. Subsequently, a description of the use of cardiovascular drugs, in comparison with an age-matched control group, is presented. The diabetic population investigated has an average age of 67 years. Most cardiovascular agents, with the exception of thiazide diuretics, are used to a larger extent in the diabetic group in comparison with the control group. Non-selective beta-blockers, possibly hazardous in patients with diabetes mellitus, appear to be prescribed without restriction in the diabetic patients investigated. The results of this study suggest that the choice of drugs for the treatment of cardiovascular co-morbidity in patients with diabetes mellitus can be improved.

Adult↗
PubMed1993

Complications of rigid laryngo-bronchoscopy in children.

Twenty-five complications (of which 2 were lethal) occurred in 1332 rigid laryngo-bronchoscopies performed under general anesthesia in the Sophia Children's Hospital during an 8 year period (1982-1990). The nature and circumstances of these complications were studied retrospectively. Important intraoperative complications were hemorrhage and cardiac arrhythmia; postoperative complications were intoxication and respiratory complications. Three risk factors: tetralogy of Fallot, biopsy/drainage, and extraction of an aspirated foreign body appeared to be significantly associated with complications. The results of this study were compared with those reported in studies of rigid and flexible laryngo-bronchoscopies in children.

Arrhythmias, Cardiac↗
PubMed1993

Foreign body aspiration in children. The diagnostic value of signs, symptoms and pre-operative examination.

One hundred and fifteen patients, between 6 months and 12 years of age, had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of signs, symptoms and examinations, and to determine the time that passed between aspiration and removal of the foreign body. The sensitivity of the symptoms choking and coughing was fairly high (81 and 78%), but the specificity was poor. The sensitivity of a chest radiograph was 82%, the specificity 44%. The sensitivity of radiographs on inspiration and expiration was 80%, the specificity 55%. The patients had been referred with the initial diagnosis foreign body aspiration (80), pneumonia (34), or subglottic laryngitis (1). In 85 patients a foreign body was identified and extracted. The other 30 patients had respiratory tract infections. The initial diagnosis of foreign body aspiration was correct in 61 out of 85 patients. In these cases, the period between aspiration and extraction of the foreign body was a mean 6 days, compared with 55 days, if the initial diagnosis was pneumonia or sub-glottic laryngitis. We conclude that the diagnosis of foreign body aspiration is too often missed, and that, apart from bronchoscopy, diagnostic tools are of little value.

Bronchoscopy↗
PubMed1992

A drug use review study in patients with obstructive lung disease. Assessment of the quality of drug therapy.

This study presents the results of an analysis of the pharmacy records of 778 patients with asthma or chronic obstructive lung diseases. The high percentage of patients taking oral corticosteroids was striking. Inhaled beta-agonists for use as needed have been prescribed to only a minority of patients using these agents. Only half of the patients on beta-agonists used inhaled corticosteroids prophylactically. Drug interactions capable of causing changes in plasma theophylline concentrations appeared in only a small number of patients. The results from studies like the one presented here can provide valuable data to be used for further discussion between physicians and pharmacists about rational drug therapy.

Adrenal Cortex Hormones↗
PubMed1992

Pediatric laryngobronchoscopy. 1332 procedures stored in a data base.

Laryngobronchoscopy (LBS), using both rigid and flexible bronchoscopes, has become a frequently performed operation in children. A data base was established to enable retrospective evaluation of a large number of LBSs carried out in a pediatric center. Experience with 1332 cases of LBS involving 808 patients over an 8-year period is presented. The main indications for LBS were inspiratory stridor, atelectasis, and suspected foreign body aspiration. Most frequent diagnoses at LBS were bronchopneumonia, intubation trauma, tracheomalacia, laryngomalacia, and foreign body aspiration. Only 25 complications occurred (1.9%) including two cases of xylometazoline intoxication.

Adolescent↗
PubMed1992

Ectopic cartilage in subglottic stenosis: hamartoma or reaction to trauma?

In an experimental study in growing rabbits an endolaryngeal injury to the subglottis resulted in the development of a stenosis due to the formation of scar tissue containing ectopic cartilage. For comparison, biopsies taken from the subglottic stenosis in 8 children were studied histologically. In 6 cases ectopic cartilage was observed; all patients had a history of endotracheal intubation. In 3 children the diagnosis hamartoma was made. In the remaining 3 cases the formation of ectopic cartilage might have been a direct reaction to the endolaryngeal intubation. The observations suggest that the formation of ectopic cartilage in acquired subglottic stenosis is not always due to a developmental aberration such as a hamartoma.

Animals↗
PubMed1990

Hearing loss related to zinc deficiency in rats.

Based on the observation that the zinc concentration in the cochlea of guinea pigs is very high, Shambaugh in North America has suggested that zinc plays an important role in hearing. Zinc deficiency is not infrequently present in growing children and elderly people, and thus might result in a hearing loss, which should be treated with zinc supplementation. The present experiment examined the effects of a zinc-deficient diet on hearing in 7-week-old rats. The auditory brainstem response threshold was measured in four rats before, during and after a zinc-deficient diet. Concentrations of zinc in the brain and in several other organs were measured, and the cochleas were examined microscopically. No hearing loss or morphological change in the cochlea of these animals was detected, although a clear zinc-deficient status was reached.

Animals↗
PubMed1990

Fiberoptic laryngoscopy under general anesthesia in neonates.

In the Sophia Children's Hospital we perform fiberoptic laryngoscopy in neonates under general anesthesia without the use of muscle relaxants in the diagnostics of functional laryngeal disorders. The necessary diagnostic and anesthetic equipment is described. Special attention is paid to the way in which the fiberscope is introduced into the breathing circuit and into the child's airway. Several advantages over other methods are discussed. The procedure has proved to be easy, safe and informative.

Anesthesia, General↗