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Biomedical subjects

R J Toohill

Publications and source records attributed to R J Toohill.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

A method to evaluate upper airway mechanics following intervention in snorers.

PURPOSE: To describe a method that measures multisegment upper airway changes following intervention for snoring and obstructive apnea that controls for physiological fluctuations during sleep. PATIENTS AND METHODS: Retropalatal, retroglossal, and retrohyoid airway segments were evaluated before and after application of an oral appliance (OA) in four snoring subjects. Twelve airway segments were evaluated. Physiological fluctuations during sleep were controlled with variably applied nasal continuous positive pressure (CPAP), benzodiazepam-induced sleep, and obtaining measures at zero flow on the first test breath. Airway area was measured endoscopically. RESULTS: The methodology identified that following intervention with an OA, maximum retroglossal airway size increased 23.3% +/- 7.5% (P < .05) and retrohyoid size decreased -63.5% +/- 16.0% (P < .05). No changes in retropalatal area (-2.5% +/- 3.0%) or closing pressure were observed. The level of primary obstruction shifted inferiorly in one patient. Airway measures prior to intervention showed small alterations of applied pressure (1 cm H2O) changed retropalatal and retroglossal area an average of 10% +/- 0.9%/cm H2O. CONCLUSION: The mechanical effects of limited airway intervention can be measured with a hypotonic, pressure-controlled methodology. At small airway areas, the airway is highly collapsible and airway size fluctuates. Small changes in applied or physiological forces may alter the airway as significantly as the effects of the intervention being evaluated. The hypotonic upper airway method provides a method to control airway collapse and evaluate interventions, such as OA or surgery, for snoring and obstructive sleep apnea syndrome.

Biomechanical Phenomena↗
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Repair of laryngeal stenosis with nasal septal grafts.

Autogenous nasal septal grafts were utilized in 18 dogs. The availability, method of transfer, placement, take, stability and long-term survival of these grafts are presented. Transfer of septal cartilage or composite grafts of nasal mucosa and cartilage to surgically created defects of cricoid and thyroid cartilage was performed on eight animals. Ten animals had composite grafts three months after stenosing procedures. Results were excellent in all grafts to the cricoid and subglottic areas. Grafts to the thyroid and glottic regions were characterized by severe resorption of cartilage and fibrosis. Composite grafts to the glottic area were successful in improving the airway. Results are documented by microlaryngeal photographs and histologic sections. A literature review accompanies the presentation with emphasis on clinical utilization of composite nasal septal grafts. Twelve previously reported cases of repair by this method for laryngeal and upper tracheal stenosis are discussed. A patient with severe traumatic laryngeal stenosis successfully rehabilitated is added to this list and details the clinical value of these grafts.

Aged↗
PubMedDate not supplied

Fatal complication from an alkaline battery foreign body in the esophagus.

Foreign bodies and alkali burns in the trachea and esophagus are potentially fatal. Some camera batteries contain 45% potassium hydroxide electrolyte which can leak and cause liquification necrosis upon tissue contact. This report describes a case of an alkali battery foreign body in the esophagus with a subsequent fatal course which was masked by steroid therapy. A discussion of corrosive burns of the esophagus, their etiology, clinical course and pathology is presented.

Alkalies↗
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Role of esophagoscopy in the evaluation of patients with head and neck carcinoma.

A retrospective study was conducted of 696 patients with squamous cell carcinoma of the head and neck seen over a 10-year period. Special focus was placed on secondary esophageal primaries in this group in an effort to define the role of esophagoscopy in the management of these patients. Second primary esophageal lesions were infrequently encountered (17 of 696, or 2.4% of the patients). Diagnostic accuracy of the esophagogram in a series of patients with index head and neck tumors and in a separate series of patients with index esophageal lesions was found to be high (98 + %). Based upon this study, we do not feel that esophagoscopy is always indicated as part of the initial workup for all head and neck cancer patients. Rather, we consider the barium swallow esophagogram to be a relatively safe and acceptably accurate alternative in most cases, with esophagoscopy reserved for specific indications.

Barium Sulfate↗
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Complications associated with a narrow bore nasogastric tube.

The use of a new narrow bore nasogastric feeding tube with stylet has resulted in two cases of misplacement with traumatic laceration of the visceral pleura. Diagnoses were made by chest x-ray film, one case immediately and the other 24 hours later. In both cases, the narrow bore tube was inserted asymptomatically by a graduate physician. Detailed case reports of both patients are presented, those patients at risk for abnormal placement of this nasogastric tube are discussed, and new guidelines for safer use are proposed.

Aged↗
PubMedDate not supplied

Limitations of bronchoscopic carbon dioxide laser surgery.

Laser technology has provided new options in the endoscopic management of patients with selected diseases of the tracheobronchial tree. At present, bronchoscopic laser surgery is performed using either the carbon dioxide laser or the neodymium:yttrium aluminum garnet (Nd:YAG) laser. Strong and his colleagues first performed bronchoscopic laser surgery over 10 years ago when they successfully coupled the CO2 laser to a rigid ventilating bronchoscope. Since that time, the indications for bronchoscopic laser surgery have expanded and the instruments used have become both safer and more "user friendly." Despite these advances in CO2 laser technology, certain limitations are associated with its use for the endoscopic management of patients with tracheobronchial lesions. This paper discusses these limitations, places this technology in perspective, and reviews recent publications which have suggested that the Nd:YAG laser may be more efficacious than the CO2 laser for the treatment of the same group of patients.

Bronchial Diseases↗
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Delayed aerodigestive tract complications following combined therapy for thyroid cancer.

Radical surgery for papillary adenocarcinoma of the thyroid has been associated with a significant incidence of complications. In some instances, postoperative irradiation is given when there is some suspicion of persistent or occult disease, although thyroid suppression and ablative radioiodine therapy have proved to be very effective adjuvants to surgery. Three patients with papillary adenocarcinoma of the thyroid developed severe, delayed complications 25, 7, and 2 years, respectively, after treatment with primary radical surgery and postoperative irradiation. The degree of injury to the aerodigestive tract as a result of the surgery and irradiation therapy makes treatment difficult regardless of the modality. The possible mechanisms that cause these complications, along with proposed methods of treatment, are discussed.

Adenocarcinoma, Papillary↗
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Carbon dioxide laser management of laryngeal stenosis.

A retrospective review of 20 cases of laryngeal stenosis treated with the carbon dioxide laser was conducted at the Medical College of Wisconsin and Northwestern University. The stenoses were grouped into four categories: supraglottic, glottic, subglottic, and combined glottic-subglottic. Twenty patients had 21 lesions excised by 40 laser procedures. Eleven of 21 stenoses were successfully managed by carbon dioxide laser endoscopy: 3 of 3 supraglottic, 6 of 10 glottic, 2 of 4 subglottic, and 0 of 4 combined laryngeal/tracheal stenoses. Eleven of the 20 patients had significant airway improvement or decannulation. Soft tissue stenoses of the supraglottic area respond favorably to carbon dioxide laser excision. In other regions of the larynx, the use of supplemental stents, steroid injections, dilatations, and the micro-trapdoor surgical flap technique in scar stenosis may increase the rate of success. The lower success rate in the posterior commissure, subglottic, and combined laryngotracheal stenoses is due to the circumferential, thick stenosis with a vertical depth of more than 1 cm and the fibrotic fixation of the arytenoid cartilages. Small cicatrices appear to respond better to laser vaporization than the large ones which frequently recur.

Adolescent↗
PubMedDate not supplied

Association of laryngeal and pulmonary malignancies: a continuing challenge.

Over a 10-year period, 790 patients with squamous cell carcinoma of the head and neck were treated at The Medical College of Wisconsin Affiliated Hospitals and were followed for a minimum of 7 years. Of the 218 patients with index primary laryngeal tumors, 43 (19.7%) developed additional malignancies in the head and neck, esophagus, or lung. Secondary lung tumors were the most common, occurring in 23 patients (10.6%). Of the 218 patients with index primary laryngeal carcinoma, 113 were treated successfully and never developed a recurrence of the original tumor. Twenty-one second primary lung malignancies developed in this group of successfully treated laryngeal tumor patients. The occurrence of these pulmonary malignancies was distributed fairly evenly over time. Three patients developed second primary lung tumors more than 7 years after initial treatment. The appearance of a secondary malignancy in the lung had a devastating effect upon survival. None of our patients survived more than 2 years after detection of the lung lesion. The relatively high incidence and delayed onset of second primary lung tumors in this group call into question the concept of 5-year "cures." Our challenge for the future should be the prevention and early detection of these second primary lung tumors.

Carcinoma, Squamous Cell↗
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Composite nasal septal graft reconstruction of the partial laryngectomized canine.

Composite nasal septal grafts provide excellent autogenous replacement tissue for the partial laryngectomy defect. The added factor of a mucosa similar to that removed appears advantageous for preservation of the airway. Arytenoid preservation or replacement tends to improve glottic rehabilitation by pseudocord formation. It is believed that the composite nasal septal graft would be of special advantage in the patient who had received previous irradiation.

Animals↗
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CO2 laser repair of subglottic and upper tracheal stenosis.

This study uses seven large adult canines. Microendoscopic forceps and electrocautery excisions of subglottic and upper tracheal mucosa, perichondrium, and cartilage results in stenoses in all animals. Four partial lesions are created in the upper trachea, and three complete stenoses occur in the subglottic region. Five of the animals require permanent tracheostomy. Three months later six animals have excisions with the CO2 laser, and one animal with upper tracheal stenosis is a control. After three months follow-up, two of the canines with upper tracheal stenosis show a slightly improved airway and one remains the same as preexcision. All three animals with subglottic lesions redevelop complete stenosis.

Animals↗
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Accessory muscle activity and respiration.

The relationship between the accessory muscle activity (sternohyoid and sternothyroid) and respiration was studied in canines. These animals do not have an omohyoid muscle such as found in primates. Therefore, chair-trained monkeys that have all three accessory muscles were used in a portion of the study. Findings in canines supported those previously reported. The sternothyroid muscle fired spontaneously with the onset of inspiration, but there was no similar activity in the sternohyoid. The activity of both muscles was observed after sectioning the recurrent laryngeal nerves and inducing hypoxia and hypercarbia. The severely hypoxic animals produced some negligible activity in the sternohyoid muscle. The data obtained from the chair-trained monkeys showed no consistent accessory muscle activity during normal respiration with recordings taken immediately after electrode placement, at 24 hours, and one week later. Respiratory activity was consistent in the omohyoid and sternothyroid but not in the sternohyoid muscle when partial airway obstruction and hypoxia were induced.

Airway Obstruction↗
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Experimental induction of squamous metaplasia in the dog trachea with cuffed endotracheal tubes.

Clinical reports cite the development of squamous metaplasia in tracheas following tracheostomy, laryngectomy, and cuffed intubation. The purpose of this study was (1) to develop an experimental model using the dog trachea and study the effects of prolonged cuffed intubation and (2) to determine whether squamous metaplasia is produced by prolonged contact of the endotracheal cuff with the tracheal mucosa. Modifications of widely used high-volume, low-pressure 8-mm endotracheal tubes were made with the distal portion of the tube, its cuff, and the inflating catheter attached. This model formed an implantable cuffed tube approximately 8 cm in length. The dogs remained intubated for 14 days, at which time they were killed; seven animals were available for histologic study. Varying degrees of squamous metaplasia were produced in all animals.

Animals↗
PubMedDate not supplied

Osteoplastic flap versus modified endoscopic Lothrop procedure in patients with frontal sinus disease.

The aim of the present study was to review the clinical results of osteoplastic flap procedure with abdominal fat obliteration and modified endoscopic Lothrop procedure. Charts of patients with frontal sinus disease who underwent osteoplastic flap procedure with abdominal fat obliteration or modified endoscopic Lothrop procedure were retrospectively reviewed. Forty-three patients with frontal sinus disease underwent osteoplastic flap procedure with abdominal fat obliteration. Frontal sinus disease was chronic sinusitis in 21, mucocele in 18, and papilloma in four. None of the patients had recurrence within 3 to 12 years follow-up period. Six patients had decreased forehead sensation, one had a CSF leak, and one had loss of the fat graft. Fifteen patients with chronic frontal sinusitis underwent modified endoscopic Lothrop procedure. The follow-up period ranged from 0.5 to 2.5 years. Two patients had recurrence of disease 2 and 6 months after surgery and required osteoplastic flap. In patients with chronic frontal sinusitis, both procedures achieved good relief of symptoms; however, follow-up time of modified endoscopic Lothrop procedure was smaller than that of osteoplastic flap procedure. In conclusion, osteoplastic flap procedure with abdominal fat obliteration provides successful treatment in patients with frontal chronic sinusitis, mucocele, or papilloma. Modified endoscopic Lothrop procedure achieves the relief of symptoms in patients with chronic frontal sinusitis. With the future availability of long term follow-up results, modified endoscopic Lothrop procedure may reduce the number of osteoplastic flap procedures in patients with chronic frontal sinusitis.

Adult↗
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Sinonasal disease in patients with sarcoidosis.

Sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.

Adult↗
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Surgical treatment of aspirin triad sinusitis.

Aspirin sensitivity, asthma, and chronic sinusitis with polyposis comprises the syndrome of Aspirin Triad (AT). The sinusitis associated with this disease is often fulminate and difficult to treat. In order to evaluate the surgical treatment of chronic sinusitis of AT a 17-year retrospective study of 80 patients was performed. Friedman Class III or IV sinus CT scans were present in 73 patients (90%) preoperatively. Twenty-five patients (30.1%) had steroid-dependent asthma and an additional 40 (50%) required intermittent oral steroids for asthma control. All patients underwent bilateral sinus surgery by either a conservative or a radical approach. Patients were followed from 3 weeks to 16 years postoperatively, with an average followup of 3 years. Sixty-eight patients (85%) had significant improvement in their sinus symptoms and 67 (83%) had relief of their asthma. The eight patients (10%) who remained steroid dependent required smaller doses of steroids. Seven patients (8.8%) had nonoperative orbital complications. There was a significant incidence of revision surgery after both conservative and radical sinus procedures. We conclude that surgical treatment by either a conservative or a radical approach controlled the sinusitis in the majority of AT patients, but neither was effective in eliminating the need for subsequent sinus surgery in a significant number of patients with severe sinus disease (Classes III and IV). Control of the sinus disease has a definite beneficial effect on steroid dependency and the need for intermittent oral steroids in managing the asthma in AT. We recommend conservative surgery in the surgical treatment of these patients. AT patients also require close long-term followup with intense medical management of their chronic respiratory inflammation that appears to put them at increased risk for nonoperative complications of their severe sinusitis.

Administration, Oral↗
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Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitis.

UNLABELLED: Gastroesophagopharyngeal reflux (GEPR) has been suggested as a cause of pediatric sinusitis. However, its contribution to the pathogenesis of chronic sinusitis in adults has not been systematically investigated. We evaluated the prevalence of GEPR in 11 CT confirmed chronic sinusitis patients (51 +/- 4 years) who had not responded to conventional therapy, and 11 normal healthy controls (44 +/- 7 years). A 3-site ambulatory esophagopharyngeal pH monitoring technique (probe location: 2 cm proximal, 3-4 cm distal to UES and 5 cm proximal to LES high pressure zones) was used. A pharyngeal pH drop was accepted as a true reflux event only if it was coincident with or preceded by esophageal pH declines of a similar or larger magnitude. Studies were performed while subjects were on a uniform 2500 calorie diet (provided). RESULTS: Ambulatory pH monitoring documented GEPR in seven of 11 patients (1-12 episodes) and two of 11 normal volunteers (1,2 episodes) (p < 0.05). A total of 34 nonbelch related pharyngeal acid reflux events were identified in patients, but none was associated with coughing. In both groups, all pharyngeal acid events occurred in the upright position. Compared to normal controls prevalence of pharyngeal reflux of gastric acid is significantly higher in patients with chronic sinusitis unresponsive to conventional therapy and suggests a different esophagopharyngeal distribution pattern of gastric refluxate in this patient group; these findings suggest that GEPR may contribute to the pathogenesis of chronic sinusitis in some adult patients.

Adult↗