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At least 541 records · Page 30Linked to original sources
PubMed1997

Infectious pseudomonas subglottic stenosis occurring in a patient with acquired immunodeficiency syndrome.

Pseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.

AIDS-Related Opportunistic Infections↗
PubMed2006

The Larynxane ST intralaryngeal endoprosthesis for laryngotracheal pathologies.

OBJECTIVES: The authors present their experience of a new intralaryngeal silicone prosthesis used to manage laryngotracheal pathologies associated with severe deglutition and respiratory disorders. STUDY DESIGN: This retrospective study, conducted in the head and neck surgery department of the Strasbourg University Hospital, France, included 10 patients (12 prostheses inserted) and was conducted from November 2000 to November 2003. METHODS: A pre-operative clinical examination and a computed tomography and/or magnetic resonance scan assessed patients' laryngeal function. Two different semirigid laryngotracheal prostheses were used, inserted under general anaesthetic into the region from the supraglottic area to the first tracheal cartilages including the vocal folds and the ventricles. In group one (n = 5), patients presented with laryngeal stenosis with preserved deglutition function, and patent prostheses were used to restore laryngeal patency. In group two (n = 5), patients suffered from severe deglutition disorders and were in poor general condition and so required a cuffed tracheostomy tube, therefore obstructed prostheses were inserted to stop aspirations and to suppress the cuff of the tracheostomy tube. The study was performed under the authorization of the Biomedical Research Patients' Protection Committee of Alsace I, France. RESULTS: The mean implantation duration was six months. The prosthesis used in the first group restored laryngeal patency without further complications such as aspiration or prosthesis (mucous) obstruction. The prosthesis used in group two prevented aspiration and allowed to change a cuff by an uncuffed tracheostomy tube. CONCLUSIONS: The intralaryngeal prosthesis used in group one constituted a reversible and effective method of treating laryngotracheal stenoses. The intralaryngeal prosthesis used in group two constituted an alternative to classical larynx exclusion techniques. The insertion is performed in few minutes under general anaesthetic through an endoscopic procedure. This reversible technique aimed to treat patients rapidly to reduce complications and post-operative morbidity.

Adult↗
PubMed2004

[When there is pharyngeal obstruction].

Any narrowing of the throat not only impairs the patient's voice, but also his swallowing abilities and even more dramatically his airways. Changes of the patient's voice due to tumors, trauma or functional disturbances do not immediately endanger the patient's live but render his vocal communication abilities more difficult or even impossible. Swallowing disturbances--often not diagnosed at an early stage--may lead to a life threatening pneumonia due to repeated aspirations. Laryngeal airway obstruction can be caused by functional disorders of the laryngopharyngeal musculature, by benign or malignant tumors, or may present as a consequence of surgery and/or irradiation. A variety of treatment options are available to restore the patient's voice, rehabilitate his swallowing and maintain the airway patency. Often times minor surgical interventions (e.g. phonosurgery) help to improve the patient's quality of life, even in a palliative situation.

Airway Obstruction↗
PubMed1987

Glottic and tracheal stenosis in spinal cord injured patients.

Between 1965 and 1985, 47 cases of glottic and/or tracheal stenosis were diagnosed at the Rocky Mountain Regional Spinal Cord Injury System. A retrospective review of medical records identified associated injuries, pulmonary and other medical complications in this patient population. Radiographic and endoscopic reviews utilised a grading system to classify the severity of stenosis. The clinical symptoms of stenosis were multiple, including dysphonia, aspiration, dysphagia, odynophagia, dyspnea and excessive secretions. The wide spectrum of treatment modalities included endoscopy with excision and/or dilation, general medical management, steroids, radiation therapy, intubation, stent insertion and surgical repair of the stenotic area. Outcome status was reviewed and suggestions provided for the early diagnosis and treatment of this potentially life-threatening condition.

Adult↗
PubMed2005

Fetal laryngeal stenosis/atresia and congenital high airway obstructive syndrome (CHAOS): a case report.

Congenital high airway obstructive syndrome (CHAOS) is a rare but fatal disease with predictably characteristic features including stenotic or atretic upper airway, hyperplastic lungs, elevated diaphragm, massive fetal ascites and fetal hydrops. Diagnosis of CHAOS by ultrasound scan is possible and clinically important since advanced intrauterine surgery to correct the defect is possible. We report a case of fetus of CHAOS with massive ascites, pulmonary hyperplasia and laryngeal stenosis/atresia. We feel that it is important to recognize the entity both by ultrasound scan and by the pathologist so that some cases can be corrected by intrauterine fetal surgery.

Adolescent↗
PubMed1999

Paediatric subglottic stenosis.

Most reports on paediatric subglottic stenosis have arisen from tertiary referral centres. At the Sheffield Children's Hospital, referrals come from the surrounding region such that almost all paediatric airway problems from this area are seen. This allows an opportunity to look at the overall picture of this condition. A retrospective study was performed to identify all children with subglottic stenosis requiring a tracheostomy since 1979 and to examine the management and eventual outcome in relation to the severity of their stenosis. Forty-two children were identified. There have been four mortalities, two of which have been tube related. Twenty-two laryngotracheoplasty procedures have been performed in 17 patients. Successful decannulation has been achieved in 82%. In the majority of children with more minor stenoses conservative management has lead to successful decannulation. However, with increasingly severe stenosis the necessity of undergoing a laryngotracheoplasty procedure to provide an adequate airway becomes more likely.

Child↗
PubMed2000

Paediatric airway stenosis: laryngotracheal reconstruction or cricotracheal resection?

Modern surgical management of paediatric laryngotracheal stenosis includes a wide variety of surgical procedures. These can broadly be divided into two groups. First, laryngotracheal reconstruction (LTR) procedures in which the cricoid cartilage is split and the framework is expanded with various combinations of cartilage grafts and stents; and second, cricotracheal resection (CTR) where a segmental excision of the stenotic segment is done and an end-to-end anastomosis is performed. In this article we review the literature and our experience and discuss the relative indications for CTR and LTR in children. High decannulation rates have been reported for CTR; however, it remains a more extensive procedure than LTR involving extensive tracheal mobilization. If the tracheostomy site is included in the resection then a significant length of trachea is excised. Alternatively, LTR with cartilage grafting can precisely correct a specific stenosis with minimum morbidity and high decannulation rates for grade 2 and selected grade 3 stenosis. For the more severe stenosis treatment with LTR has been less successful. Retrospective data from this institution suggests that the children with grade 4 stenosis treated with LTR are more likely to require a subsequent open procedure to achieve decannulation than those treated with CTR. LTR is a less extensive procedure and is preferred for grade 2, selected grade 3 stenosis. CTR is the preferred option for grade 4 and severe grade 3 stenosis with a clear margin between the stenosis and the vocal cords.

Child↗
PubMed2001

Failed paediatric laryngotracheoplasty.

INTRODUCTION: Clinical experience with the surgical treatment of paediatric laryngeal stenosis is decreasing, and therefore it is important to highlight the factors that may contribute to failure. METHOD: Retrospective study of 28 children undergoing laryngotracheoplasty (LTP) for laryngeal stenosis was carried out over an 11-year period. RESULTS: Twenty-one patients were decannulated after their initial surgery. One child died prior to stent removal, and the initial surgery was unsuccessful in six patients. Four of these underwent a second LTP. Three additional patients were decannulated, including one patient following endoscopic surgery only. One child is waiting decannulation, one child has not undergone further surgery, and another has undergone multiple failed LTP and remains dependent on the tracheostomy. CONCLUSIONS: Factors identified as contributing to surgical failure in this series included severity of stenosis, cause of stenosis, presence of gastro-oesophageal reflux, other airway abnormalities, timing of surgery, type of surgery employed, and factors related to post-operative management.

Adolescent↗
PubMed2003

Relapsing polychondritis.

Relapsing polychondritis (RP) is a rare, inflammatory disease with multisystem involvement and it should be considered in the aetiology of sudden respiratory distress. A 49-year-old woman was admitted to the emergency service of Osmangazi Hospital in acute respiratory distress. She had a tracheostomy following a diagnosis of laryngeal stenosis 10 years earlier. She was managed thereafter at another hospital with a diagnosis of asthma. At admission she was in respiratory distress, had arthralgias, bilateral subconjunctival hyperaemia, periorbital oedema and skin lesions. A thoracic CT showed tracheal wall thickening. Calcification of the auricular regions were noted bilaterally. Bronchi, conjunctiva and skin lesions were biopsied with a provisional diagnosis of RP. The diagnosis of RP in this patient was based on clinical, pathological and radiological findings. Steroid therapy was begun and she was referred to a surgical centre for stenting. This case report emphasizes the need to consider the possibility of RP as a cause of sudden respiratory distress.

Female↗
PubMed2000

Role of infection in the development of acquired subglottic stenosis in neonates with prolonged intubation.

OBJECTIVE: To examine whether clinically diagnosed infection correlates with subsequent development of subglottic stenosis in intubated neonates. METHODS: Sixty-two neonatal infants intubated for more than 14 days were examined. Several risk factors for subglottic stenosis, including infection, duration of intubation, frequency of intubation, the size of the endotracheal tube etc., were evaluated by multiple logistic regression analysis. RESULTS: Infection that occurred within 14 days of intubation showed a positive correlation with subsequent subglottic stenosis. The duration of intubation, frequency of intubation and the size of the endotracheal tube did not affect the development of subglottic stenosis. The majority of infections were considered to be respiratory tract infections, including pneumonia. CONCLUSIONS: Infection occurring within 14 days of intubation is considered to be a risk factor for acquired subglottic stenosis in neonates intubated for more than 14 days. Prevention of infection within 14 days of intubation may reduce the incidence of subglottic stenosis in neonates.

Gestational Age↗
PubMed1997

Laryngotracheal stenosis in children after intubation. Report of five cases.

Acquired laryngotracheal stenosis is a serious long term complication of tracheal intubation with an incidence of 0.7 to 8% in intubated children. We report five cases of subglottic stenosis over a 4.5-year period and review the pathology and pathogenesis of the condition. A diagnosis of subglottic stenosis was suspected when extubation failed due to the onset of dyspnoea or laryngeal stridor. An incidence of 0.9% of all intubated children was observed. We conclude that the main components contributing to stenosis are pathologies with decreased mucosal capillary perfusion pressure and intubation conditions.

Child, Preschool↗
PubMed1997

Unsuspected subglottic stenosis in a two-year-old.

Unsuspected subglottic stenosis was encountered in the operating room in a 23-month-old girl who had been diagnosed having Vater syndrome without the component of tracheooesophageal fistula. Her scheduled elective thumb reconstruction was postponed until tracheal reconstruction was performed. A rational approach to handle this situation is described.

Anesthesia↗