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Biomedical subjects

M Broniatowski

Publications and source records attributed to M Broniatowski.

At least 55 records · Page 3Linked to original sources
PubMed1985

Tube esophagostomy. A new technique in the management of long-term swallowing disorders.

Surgeons whose patients require long-term management of nutritional intake must usually choose from among nasogastric tube feedings, hyperalimentation by intravenous route, and/or gastrostomy. Cervical esophagostomy has been a useful but not widely employed alternative. The advantages of cervical esophagostomy over other modalities include the avoidance of laparotomy, absence of a nasogastric tube, and lack of the complications of a long-term indwelling intravenous catheter. The disadvantages of standard esophagostomy include the need to wear a tube to keep the fistula open, leakage, and skin irritation. Dobie et al presented a skin flap esophagostomy technique in 1978. We report a variation of this concept that has resulted in no salivary leakage and that allows the patient to dispense a tube between feedings. It provides a directional stoma in which the internal orifice is considerably inferior to the external one, resulting in continence and thus preventing substantial leakage.

Deglutition Disorders↗
PubMed1985

Near-total pharyngeal reconstruction by 'rotary-door' sternohyoid myocutaneous flap in the dog. A preliminary report.

Closure of the pharyngoesophagus after total laryngectomy or partial pharyngectomy is not a difficult problem in most cases. Primary suture repair of the defect is usually adequate, providing sufficient healthy mucosa is available. When this is not feasible, it may be necessary to mobilize tissue from distant sites. The deltopectoral and various myocutaneous flaps are often chosen for this purpose because of their reliability and versatility. Unfortunately, they necessitate either two-stage surgery or involve excessive bulk, and both methods result in unsightly defects, especially in women. The "rotary-door" sternohyoid myocutaneous flap avoids these drawbacks, while utilizing tissues within the surgical field in a single-stage procedure. Seven mongrel dogs underwent total laryngectomy and partial pharyngectomy. The pharyngeal defect was closed with a rotary-door sternohyoid myocutaneous flap. Three dogs had an uneventful recovery and two developed fistulae that closed spontaneously within three weeks of surgery. The pharyngocutaneous repair was found to be intact on postmortem examination.

Animals↗
PubMed1985

Laryngeal pacemaker. II. Electronic pacing of reinnervated posterior cricoarytenoid muscles in the canine.

A fully reliable means of rehabilitating patients with bilateral vocal cord paralysis has not yet been developed. In order to improve upon existing solutions to this problem, the authors have recently described a laryngeal pacemaker, initially tested through stimulation of a cross-over nerve-muscle pedicle from one sternohyoid muscle to the other in the canine. Afferent stimuli, initiated through elongation of the airway during inspiration, were detected by a linear strain gauge sutured to the tracheal rings and appropriately amplified. The current report deals with the application of this concept to pace a nerve-muscle pedicle reinnervating the posterior cricoarytenoid muscle. Videoscopic and cinematographic documentation of electrically paced abduction of the reinnervated vocal fold, synchronous with inspiration, was clearly demonstrated. Only miniaturization of an implantable electronic amplifier remains to permit an attempt at pacing of the paralyzed larynx in humans.

Animals↗
PubMed1985

Epiglottitis.

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Child↗
PubMed1985

Croup.

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Child↗
PubMedDate not supplied

The future of electronic pacing in laryngeal rehabilitation.

Fascinating advances are ongoing in the rehabilitation of the incompetent larynx. The advent of microprocessor technology makes possible the construction of potentially implantable devices designed to allow the pacing of various functions of the reinnervated canine larynx. The history of electrical neurostimulation as a technique in laryngeal rehabilitation is reviewed and future human applications discussed in terms of technical feasibility and clinical needs.

Animals↗
PubMedDate not supplied

Fine control of reinnervated muscle. Dynamic rehabilitation of facial paralysis.

Satisfactory rehabilitation of the paralyzed face has yet to be achieved. Ideally, both mobility and symmetry should be restored. In five rabbits, motion signals were picked up from the intact side by miniature strain gauges and channeled by means of an electronic circuit to electrodes placed around nerve pedicles previously implanted into the paralyzed side. An analog current produced in response to muscular contraction (afferent limb) resulted in graded and sustained contraction of the reinnervated side (efferent limb). In six animals, the tension of reinnervated strap muscles could be adjusted by varying the pulse width (0.1-10 msec) of a constant (0.5 mA) current applied to the nerve pedicles. Contraction (strain-gauge compression) of the intact face was followed by reciprocal graded relaxation of the reinnervated straps. Conversely, facial relaxation (elongation) induced graded strap contraction. An agonist-antagonist relationship was, thus, created between the two effectors. This approach may allow the paralyzed face to be electrically reanimated from the intact side in a symmetrical fashion closer to the physiologic state.

Afferent Pathways↗
PubMedDate not supplied

A canine model for global control of the reimplanted larynx. A potential avenue for human laryngeal transplantation.

Previous attempts at laryngeal transplantation have failed because the grafted organ could not be dynamically rehabilitated. Nerve-muscle pedicles were used to reinnervate each of the principal intrinsic laryngeal muscles in 20 dogs after autotransplantation with conservation of the essential nutrient vessels. Afferent information obtained by sensors fixed to the chest (a strain gauge and transthoracic impedance electrode) was channeled to an electronic package for coordinated stimulation of pedicles reinnervating the posterior cricoartenoideus (opening), the cricothyroideus (elongation) and the thyroarytenoideus (closure of the vocal cords) by perineural electrodes. Corresponding vocal cord motion was videotaped on the same screen as sensor displacements and stimulating currents (approximately 2 V, 60 Hz, and 4 msec pulse width). Clear responses were recorded in all evaluable animals (n = 8), but contraction was stronger with longer reinnervation time (3-7 weeks). Based on this feasibility study, chronic experiments are planned that will set the ground work for possible future human laryngeal transplantation.

Animals↗
PubMedDate not supplied

Selective feedback control of spastic musculature in a canine model.

Muscular spasm, the etiology of which remains elusive, has been difficult to control. The authors, therefore, proposed selective restraint of forced contractions by a closed-loop circuit. In four dogs, the strap (n = 6) and thyroarytenoid (n = 4) muscles were submitted to tetanic contractions via bipolar supramaximal stimulation (30 Hz, 6 mA, 0.5 msec) of ansa hypoglossi and recurrent laryngeal nerves, respectively. Subsequent reduction of distance between two sonomicrometer crystals embedded into muscle was used in lieu of "spastic information" for a stimulator to deliver blocking signals through tripolar electrodes passed downstream. By modifying frequency (30-110 Hz) and current (60-95%) distribution between the central cathode and the peripheral anodes, significant relaxation (up to 100%) was recorded within "blocking windows," varying with each nerve (3-18 mA sweeps). The selective restraint of unwanted contractions, leaving "normal" subthreshold tone undisturbed, may offer a more mature approach to spastic disorders than destructive procedures, such as nerve section and its chemical counterpart, botulinum toxin injection.

Action Potentials↗