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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
PubMed2005

Short use of muscle relaxants following single stage laryngotracheoplasty in children.

OBJECTIVE: The postoperative management of children undergoing single stage laryngotracheoplasty (SSLTP) includes intubation and muscle paralysis to secure the airway and protect the wound. We reduced the period of postoperative muscle paralysis in an attempt to decrease the incidence of pulmonary complications. The objective of this study was to evaluate the influence of the duration of muscle paralysis on pulmonary complications and outcome. METHODS: Medical records of all children admitted, between 1994 and 2002, to the pediatric intensive care unit following SSLTP were analysed. Children were grouped according to the number of days muscle paralysis was used. RESULTS: Thirty-six children (15 male, 21 female, mean age 32 months (9-162 months)) underwent SSLTP for laryngeal stenosis. Prior to surgery 29 needed a tracheotomy (mean duration 11.1 months). Shorter muscle paralysis leads to shorter intubation and mechanical ventilation and therefore PICU and hospital length of stay were 12.4 and 9.9days shorter in the group with short use of muscle paralysis (p<0.001 and p=0.002, respectively). There was no significant difference in postoperative complications, but a trend towards fewer atelectases in children with short muscle paralysis could be recognised. Postoperatively we observed no auto-extubations in either group and success rate of SSLTP was comparable in both groups (94 and 95%). CONCLUSION: Children undergoing SSLTP can safely benefit from a postoperative strategy using a short duration of muscle relaxants. They have fewer days on mechanical ventilation with a concomitant decrease in duration of hospital stay.

Adolescent↗
PubMed2004

Slide tracheoplasty for congenital tracheal stenosis.

BACKGROUND/PURPOSE: The aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS. METHODS: A retrospective review of 3 infants with CTS treated with slide tracheoplasty was conducted at our institution. They all underwent bronchoscopy, tracheobronchography, and echocardiography. Therapy consisted of slide tracheoplasty and simultaneous correction of associated vascular malformations. RESULTS: A pulmonary artery sling was missed initially on esophagography in 2 patients. Stridor became worse in 2 patients after tracheobronchography. After surgical therapy, 2 patients survived and were discharged 12 days after surgery. Both are without symptoms at follow-up of 12 and 20 months. One patient had inoperable restenosis and died 27 days after the operation. CONCLUSIONS: Esophagography is not a reliable tool to depict associated vascular anomalies for patients with CTS. According to the literature, computer tomography has become more reliable to depict the tracheobronchial tree and is useful to elucidate associated vascular anomalies as well. Compared with other surgical techniques for infants with CTS reported in the literature, slide tracheoplasty has fewer postoperative complications and comparable survival rates.

Esophagoscopy↗
PubMed2003

Aspirated foreign bodies in children: why are they more commonly found on the left?

The objective was to present our experience in the brochoscopic removal of foreign bodies in children. This was carried out through a retrospective analysis of the medical records of 96 patients in whom endoscopic removal of an inhaled foreign body was required, at the department of paediatric otorhinolaryngology, Eramus Medical Centre, Rotterdam. The participants were all children who underwent bronchoscopy after suspected foreign body aspiration from 1990 to 2000. The main outcome measures were confirmed diagnosis of foreign body aspiration and localization of aspirated foreign body. It was seen that in children up to 3 years of age, there was no significant difference in foreign body distribution and in children aged 3 and older foreign bodies were more commonly found in the right main bronchus. It was concluded that aspirated foreign bodies are equally distributed between the left and right main bronchus in children younger than 3 years. This could be explained by the handling of choking infants by their parents.

Bronchi↗
PubMed2002

A pilot case control follow-up study on hearing in children treated with tobramycin in the newborn period.

OBJECTIVE: To assess the occurrence of hearing loss in children due to neonatal exposure to long courses of tobramycin and/or high tobramycin serum concentrations. METHODS: This was a pilot case-control study in 3-4-year old children. Data on tobramycin administration were abstracted from the patient files of an earlier study. Patients exposed in the neonatal period to either long courses (>7 days) or high serum concentrations of tobramycin constituted the study group. The control group consisted of patients without tobramycin exposure. Patients were matched for other risk factor according to criteria of the joint committee on infant hearing. All patients underwent the following investigations: otoscopy and pneumatic otoscopy, followed by impedance audiometry, to exclude middle ear effusion. Click-evoked oto-acoustic emissions (ce-OAE) as well as distortion product oto-acoustic emissions (dp-OAE), tested at f2 frequencies ranging from 1 to 10 kHz, were measured to assess hearing. All patients with abnormal ce-OAE results underwent brainstem electric response audiometry (BERA) as well. Since aminoglycoside ototoxicity is usually bilateral, results were compared per patient and not per ear. RESULTS: A total of 29 patients were tested. Eleven patients were excluded due to middle ear effusion. Data for 18 patients were analyzed. In the tobramycin treated group (n=9) both ce-OAE and dp-OAE (at all tested frequencies) were not detectable in six ears of three patients. All other patients had normal ce-OAE's as well as normal dp-OAE's in this frequency range. Difference between the tobramycin treated and control group for OAE as well as dp-OAE showed a trend (P=0.08). In all three patients with undetectable emissions BERA confirmed a cochlear loss of 60-70 dB at 3 kHz in both ears. These three patients had the longest total exposure to tobramycin: 20-24 days and 84-92 mg/kg, respectively. No relation to either peak or trough serum concentrations could be detected. CONCLUSION: There was no statistical relation between hearing loss and tobramycin exposure, probably due to sample size. Our results do indicate a need for a case-control follow-up study of hearing in neonates exposed to long courses of aminoglycosides.

Acoustic Impedance Tests↗
PubMed1999

Differences in nasal cellular infiltrates between allergic children and age-matched controls.

Little is known about the cellular infiltrates in the nasal mucosa of children. This study was set up to compare the nasal cellular infiltrates in biopsy specimens from allergic children and controls. Atopic children were distinguished from controls on the basis of symptoms of allergic rhinitis and/or asthma, total serum immunoglobulin (Ig)E, family history and specific serum IgE to food and aeroallergens. Fifteen allergic patients (median age 4.3 yrs) and 15 age-matched nonallergic control subjects were evaluated. The number of cells positive for CD1a, CD4, CD8, CD19, CD68, chymase, tryptase, IgE and major basic protein was determined in the mucosa of the inferior turbinate. A significantly higher number of IgE-positive cells and mast cells was found in the epithelia of the allergic group. In the lamina propria, higher numbers of IgE-positive cells and eosinophils were found. Langerhans' cells positive for IgE were only seen in allergic children with specific serum IgE against aeroallergens. These children also had a higher number of IgE-positive mast cells compared to controls and atopic children without specific serum IgE. These results show that the nasal cellular infiltrates of allergic children differ from nonallergic control subjects. Prior to the detection of specific serum immunoglobulin E, cellular changes can be found in the nasal mucosa of atopic children.

Biopsy↗
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↗