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At least 253 records · Page 14Linked to original sources
PubMed1982

[Pharyngolaryngectomy without nasogastric feeding tube nor tracheal cannula (author's transl)].

Thirty three patients have been operated with total laryngectomy (LT) or pharyngolaryngectomy (PLT) with or without Zadical neck dissection, without nasogastric feeding to be and in five cases without tracheal cannula (but connection of a large tracheostomy). The authors demonstrated that there is no increasement of pharyngeal fistua. The beginning of oral alimentation has been made between the 4th and the 6th postoperative day. Such a procedure is more comfortable for the patients and decrease the hospitalisation duration.

Adult↗
PubMed1982

Management of esophageal and pharyngeal perforation in the newborn infant.

Perforation of the esophagus or pharynx may occur during placement of endotracheal or nasogastric tubes in the newborn infant. Controversy exists, however, whether medical or surgical therapy is better in the management of these perforations. Nine patients who had esophageal or pharyngeal perforation in the neonatal period and were treated medically with antibiotics, nutritional support, and closed chest-tube drainage of pneumothoraces are described. All perforations healed without surgical repair. No mortality or morbidity occurred secondary to these perforations. This study, together with a review of the 73 patients described in the literature, indicate that perforations of the pharynx and esophagus can be satisfactorily managed medically. There is no apparent advantage to routine early surgical exploration. Only complications such as mediastinitis and mediastinal mass formation seem to require surgical treatment. Medical therapy with close observation for signs of sepsis and/or mediastinal changes will enable most newborn infants to avoid an operation and will identify those infants for whom surgery is definitely indicated.

Ampicillin↗
PubMed1981

Aspiration pneumonitis: etiology, therapy, and prevention.

Aspiration pneumonitis is a serious potential complication of many procedures that oral and maxillofacial surgeons perform. It is therefore necessary for all practitioners to be familiar with current concepts concerning the pathophysiology and treatment of this disorder. More importantly, techniques that decrease the likelihood of aspiration should be practiced whenever possible. This paper presents the etiology, therapy (in both office and hospital settings), and means of preventing pulmonary aspiration. Special emphasis will be given to the current controversies surrounding the use of corticosteroids and antibiotics.

Anesthesia, Dental↗
PubMed1982

Nosocomial sinusitis.

During a 24-month period, 34 cases of nosocomial sinusitis associated with nasopharyngeal instrumentation were identified in 32 severely traumatized patients, accounting for 5% of all nosocomial infections. Diagnosis was based on roentgenographic findings consistent with acute sinusitis and either purulent material aspirated from the involved sinus or purulent nasal discharge. All patients had fever and most had leukocytosis. Forty-one pathogens, mostly Gram-negative bacilli, were recovered from 25 patients by aspiration of their sinuses; 14 infections were polymicrobic. Possible predisposing factors were nasotracheal tubes, nasogastric tubes, nasal packing, high-dose corticosteroids, prior antibiotic therapy, and facial and cranial fractures. With treatment and removal of the nasal tube, 20 patients had clinical resolution of their disease. Seven, although asymptomatic, had persistent radiological abnormalities consistent with chronic sinusitis. Five patients died of intercurrent disease before resolution of their sinusitis. Sinusitis should be ruled out as a cause of infection in febrile intensive care patients with an indwelling nasal tube.

Adrenal Cortex Hormones↗
PubMed1995

The role of the fiberscope in the critically ill patient.

The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The main cause of failure is lack of expertise in maneuvering the fiberscope. Other technical causes of failure include fogging or clouding of the fiberscope's lens, drifting off the midline, and inability to advance the endotracheal tube or withdraw the fiberscope after completing intubation. Proper selection of the size of the fiberscope in relation to the size of the endotracheal tube, adequate lubrication, and careful passage of the fiberscope through the distal opening of the tracheal tube (not the Murphy eye) prevent difficulties encountered during advancement of the tube or upon withdrawal of the bronchoscope. Patient-related causes include inadequate topical anesthesia, which leads to abrupt movement of the larynx, laryngeal spasm, coughing, and copious secretions; a large floppy epiglottis; and tumor and edema of the upper airway, which also interfere with exposure of the larynx. Various approaches for learning and applying fiberoptic endoscopy have been instituted. The key to increased success involves initial training and practice with an intubation model and tracheobronchial tree. These models enable the learner to develop the eye-hand coordination skills needed to use the fiberscope properly. The fiberscope is best used in patients after learning to perform three simultaneous movements--advancing the fiberscope, coordinated rotation of the insertion cord, and bending the tip of the fiberscope while traversing the airway. After the technical skills of the fiberscope become second nature, the endoscopist can give more attention to patient-related factors to improve the success rate of tracheal intubation. Expert use of the fiberscope can be a life-saving measure through alleviating major airway complications and unnecessary tracheostomies.

Airway Obstruction↗
PubMed1994

Pulmonary complications of feeding tubes: a new technique of insertion and monitoring malposition.

OBJECTIVE: To confirm the value of a new technique that will ensure safe introduction of feeding tubes. DESIGN: Two case reports; an anatomical and physiologic description of deglutition; and a case study. SETTING: A level 2 regional referral centre. PATIENTS: Thirteen anesthetized adult patients and 7 awake subjects, comprising patients scheduled to undergo elective surgery, medical staff and health care volunteers. INTERVENTIONS: Airway sampling for carbon dioxide with capnography in 13 anesthetized adults with the tip of the feeding tube in the pharynx, in the esophagus and in the trachea, and airway sampling for carbon dioxide from the pharynx and esophagus in 7 awake subjects during introduction of the feeding tube. Fluoroscopic monitoring of the position of the tip of the feeding tube during introduction in two patients and two volunteers. MAIN OUTCOME MEASURES: Carbon dioxide levels at the tip of the feeding tube during introduction. RESULTS: In all patients, with the tube either in the trachea or pharynx, a normal capnogram was displayed. When the tube was introduced into the esophagus no capnogram curve was seen, indicating the absence of carbon dioxide. With the subject lying down during introduction, the weighted tube followed the posterior pharyngeal wall to the upper esophageal sphincter. CONCLUSION: Positioning of the patient lying down with the head flexed and capnographic measurement of carbon dioxide levels from the tip of the feeding tube during insertion is a safe, accurate and cost-effective method for the introduction of feeding tubes.

Aged↗
PubMedDate not supplied

The effect of immunization route on rat serum and tear antibody responses to Chlamydia trachomatis.

The effect of immunization route on the kinetics of serum and tear antibody responses to Chlamydia trachomatis was studied in a rat model. Rats received Chlamydia trachomatis serovar C/TW elementary bodies for two immunization cycles by ocular topical (OT) application or subconjunctival (SC) injection and in a second experiment for three immunization cycles by either OT application, gastrointestinal intubation (GI), or intraperitoneal injection (IP). Serum IgG and tear IgA antibodies to whole elementary bodies were measured sequentially following the secondary (2 degrees) and tertiary (3 degrees) immunization cycles. Serum IgG levels were minimal in the OT immunized group following 2 degrees and 3 degrees immunization. Serum IgG levels for the SC, GI, and IP immunized groups rose steadily following 2 degrees immunization reaching maximal levels between day (d)24 and d31. Levels of serum IgG antibodies were highest in the GI group following 3 degrees immunization. Tear IgA antibody responses were greatest in rats immunized by the OT route, the 2 degrees IgA response peaked by d9 and declined by d24. The 3 degrees OT tear IgA response peaked by d13 and was greater than the 2 degrees response. Tear IgA antibody levels in SC and GI immunized rats appeared by d3 following 2 degrees immunization but remained at low levels and were not noted until d20 in the GI group following 3 degrees immunization. Tear IgA antibody responses were not detectable in IP animals following 2 degrees or 3 degrees immunization. This study documents the immunogenicity of Chlamydia trachomatis serovar C/TW in the rat and shows that the OT route is most effective in eliciting IgA antibody responses in tears.

Animals↗
PubMed1993

Deglutition after supra-glottic laryngectomy.

This study of swallowing after a horizontal supra-glottic laryngectomy proposes to analyze the frequency of long-term post-operative complications, their mechanisms of onset, as well as their compensatory mechanisms. It rests on the study of three groups of patients: a retrospective series of 74 charts, a group of 14 patients studied at a distance from the intervention, and a group of 15 patients who have been entered in a prospective study concerning the post-operative care of partial laryngectomies. For these two groups, the swallowing work-up consisted of, besides a clinical evaluation, a video-laryngoscopy and a video-radioscopy. Knowledge of the compensatory possibilities as a function of the specifics of the surgical technique, and their evaluation for each patient with video-radioscopy allows for an adapted care protocol.

Deglutition↗
PubMedDate not supplied

Effectiveness of pH measurements in predicting feeding tube placement: an update.

This paper reports further findings from an ongoing clinical study designed to evaluate the extent to which pH values of aspirates from feeding tubes can be used to differentiate between gastric and intestinal tube placement and gastric and respiratory tube placement. The sample consisted of 405 aspirates from small-bore nasogastric tubes and 389 aspirates from nasointestinal tubes, which were obtained from 605 subjects ranging in age from 18 to 94 years. Data were collected at the time of initial placement and again, when possible, after feedings were initiated. A total of 794 pH-meter readings were made concurrently with X-rays to determine feeding tube position. Gastric placement was successfully distinguished from intestinal placement of the feeding tubes on the basis of pH-meter readings (p < .0001). Approximately 85% of the 405 pH-meter readings from gastric fluid were between 0 and 6.0, while over 87% of the 389 pH-meter measurements performed on intestinal aspirates were greater than 6.0. Four aspirates from feeding tubes inadvertently placed in the respiratory tract (two in the pleural space and two in the tracheobronchial tree) were tested with a pH-meter, all had pH values greater than 6.5.

Adolescent↗
PubMed1993

[The use of laparostomy in treating diffuse suppurative peritonitis].

The results of surgical intervention with the use of laparostomy in 29 patients with diffuse purulent peritonitis at the terminal stage are presented. In 11 cases, laparostomy was performed during the first operation, in 18--for postoperative peritonitis. At the time of operations, laser radiation, gastrointestinal intubation were widely used.

Aged↗
PubMed1993

Esophageal-aortic erosion associated with double aortic arch and tracheomalacia. Experience with 2 infants.

Patients with double aortic arch may require lengthy intubation for ventilatory support. The need for endotracheal and nasogastric intubation may be prolonged in such patients because of associated tracheomalacia. Iatrogenic tracheal or esophageal erosion with subsequent aortic fistulization is an unusual but catastrophic complication that may result from such intubation. We report the cases of 2 infants with double aortic arch and tracheomalacia who developed iatrogenic esophageal-aortic erosion. This complication was successfully managed in 1 of the infants. We conclude from our experience that the important steps in preventing this complication include 1) expediting the exclusion of upper-airway compromise in intubated infants who have a presentation characteristic of bronchospastic airway disease (hyperinflation and hypercapnia) that seems unresponsive to usual therapeutic measures; and 2) expediting the diagnosis of vascular ring in order to minimize the duration of dual tracheal and esophageal intubation. Effective management of this problem, once established, requires primary closure of the esophageal perforation, removal of the nasogastric tube, interposition of thick viable tissue between the esophagus and the aorta, and decompressive gastrostomy and feeding jejunostomy. Concomitant aortopexy may be appropriate.

Aorta, Thoracic↗