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At least 739 records · Page 41Linked to original sources
PubMed2001

Acquired subglottic stenosis caused by methicillin resistant Staphylococcus aureus that produce epidermal cell differentiation inhibitor.

Local infection of the trachea in intubated neonates is one of the main risk factors for development of acquired subglottic stenosis, although its role in the pathogenesis is unclear. Methicillin resistant Staphylococcus aureus (MRSA) is often the cause of critical illness in neonatal patients. Two cases are reported of acquired subglottic stenosis following bacterial infection of the trachea, suggesting an association with the staphylococcal exotoxin, epidermal cell differentiation inhibitor (EDIN). EDIN-producing MRSA were isolated from purulent tracheal secretions from both infants. Acquired subglottic stenosis in both cases was probably caused by delayed wound healing as the result of EDIN inhibition of epithelial cell migration.

Epidermal Growth Factor↗
PubMed1989

Glottic and cervical tracheal narrowing in patients with obstructive sleep apnea.

There are several studies showing that patients with idiopathic obstructive sleep apnea (OSA) have a narrow and collapsible pharynx that may predispose them to repeated upper airway occlusions during sleep. We hypothesized that this structural abnormality may also extend to the glottic and tracheal region. Consequently, we measured pharyngeal (Aph), glottic (Agl), cervical tracheal (Atr1), midtracheal (Atr2), and distal (Atr3) tracheal areas during tidal breathing in 66 patients with OSA (16 nonobese and 50 obese) and 8 nonapneic controls. We found that Aph, Agl, and Atr1, but not Atr2 or Atr3, were significantly smaller in the OSA group than in the control group. Obese patients with OSA had the smallest upper airway area, although the nonapneic controls had the largest areas. Multiple linear regression analysis revealed that the pharyngeal area, cervical tracheal area, and body mass index were all independent determinants of the apnea-hypopnea index, accounting for 31% of the variability in apnea-hypopnea index. Aph, Agl, and Atr showed significant correlation with the body mass index. We conclude that sleep-disordered breathing is associated with diffuse upper airway narrowing and that obesity contributes to this narrowing. Furthermore, we speculate that a common pathophysiological mechanism may be responsible for this reduction in upper airway area extending from the pharynx to the proximal trachea.

Adult↗
PubMedDate not supplied

Contribution of virtual endoscopy to the investigation of laryngotracheal pathological conditions.

Three-dimensional CT scan imaging obtained by using helicoidal CT scan provides the basis for an endoscopic exam said to be virtual since no invasive procedure is actually performed. Compared to optical endoscopy this easily accessible exam offers additional information especially for the analysis of the infraglottic and tracheal areas, which are two anatomically rigid segments. This property facilitates their three-dimensional reconstruction. Our study encompassed 6 patients presenting with a stenosis of the laryngotracheal tract. In 5 of them it was possible to correlate optical and virtual endoscopic imaging. Coupling both exams significantly improved the diagnostic investigation and facilitated the management of the disease. However, the real contribution of virtual endoscopy to the exploration of tumoral conditions still remains to be determined given the low degree of tissue resolution. As a consequence parietal and extraparietal lesional spreading is more accurately assessed by axial scan imaging.

Adult↗
PubMed1975

Therapeutic problems in laryngo-tracheal stenoses.

History revealed iatrogenic injury (tracheostomy, intubation, artificial respiration) to be the reason for tracheal stenosis in each of our 32 cases (18 female, 14 male). So far 23 cases have been treated successfully and they live without a cannula; seven are still under treatment, while two patients died (severe heart-attack, spontaneous pneumothorax) and one refused further treatment. We were relatively successful in six cases of sleeve resection. All other 26 cases were treated by creating a tracheal groove, in which tracheal mucosa and skin of the neck were joined and the caudal end mostly kept open by using a pedicle skin flap. Intrathoracic stenoses require a sternotomy. An additional thyroidectomy and lateral traction to the tracheal walls by using loops out of the sternomastoid muscle became necessary in many cases and we obligatorily used tamponades of plastic inlay bolts, the average time of treatment being 8 months.

Adolescent↗
PubMed1979

Indirect measurement of laryngeal and tracheal resistance.

We used a body plethysmograph to determine airway resistances in 485 cases of laryngeal and tracheal stenoses. 143 cases who had resistances exceeding 60 mm H2O/l.a.sec underwent surgery. A vocal cord was laterally fixed in 49 patients suffering from bilateral recurrent paralysis. Optimal results were obtained at a postoperative resistance level of 30 mm H2O/l.a.sec (standard value: 14.77 +/- 6.53 - n - 387). The patients could carry out work of medium intensity and had a steady voice. We performed tracheal interventions in 94 cases of tracheal stenoses. A mean postoperative resistance of 29.9 mm HWO/l.a.sec, with a tracheal diameter of 7-8 mm was attained. In practice, only a few patients found the remaining obstruction a hindrance, during work of maximal intensity. No recurrences were observed after treatment. Airway resistance exceeding 150 mm H2O/l.a.sec were found in 13 new admissions and 73 times in those undergoing therapy. In these cases asphyxiation threatens. These patients must be tracheotomized or intubated immediatly.

Airway Resistance↗
PubMed1979

Cryosurgery and laser surgery in the treatment of malignant and benign laryngeal processes.

Cryosurgery of the larynx is still in the stage of development. In the treatment of laryngeal papillomas cryosurgery has been quite successful. The use of cryosurgery in laryngo-hypopharyngeal carcinoma and in laryngeal stenosis is still restricted to special indications (old age, risk patients). A combination of cryosurgery and telecobalt irradiation has proven valuable in the management of tumors. After the basic physics of laser radiation are explained, the principle mechanisms of interaction between the CO2 laser on human tissue are mentioned. This is followed by the description of the different indications for laser surgery in the larynx. A chordectomy and the opening of a subglottic stenosis with the laser beam are described and documented with photographs. Finally, there is an outlook to an eventually broader spectrum of indications for laser surgery in the field of ent.

Adult↗
PubMed1985

Surgical correction of subglottic stenosis in children. A follow-up study.

In general, subglottic stenosis in children is one of the most difficult problems to treat surgically. Six patients, aged 4-9, requiring a tracheostomy due to severe subglottic stenosis are reviewed. Decannulation was difficult to perform in these cases. All children in this series underwent surgical correction of subglottic stenosis. Patients had been successfully decannulated with no evidence of recurrent stenosis and were followed up for a period of 2-9 years. Our cases which were followed up for 2-9 years address the issue raised by opponents of surgical correction of subglottic stenosis in children, namely the consideration that the laryngeal growth potential may be adversely affected by surgery.

Child↗
PubMed1987

Dilatation of laryngeal and tracheal stenoses.

21 patients suffering from laryngeal or tracheal stenosis have been treated by dilatation. Of these, 9 regained health and needed no reconstructive surgery after dilatation. With regard to these results and those presented in the literature, the dilatation technique is a suitable method especially in infancy and if the stenosis is situated between the vocal cords or within the trachea. Yet, satisfactory results are only available if dilatation has been strictly indicated.

Adult↗
PubMed1988

Morphometric study of the growth of the subglottis after interruption of the circular structure of the cricoid.

In young rabbits the growth of the subglottis was studied over a period of 20 weeks after interruption of the circularity of the cricoid on the ventral side. In all cases the cricoid developed into a U-like structure which did not cause an airway narrowing. However, a cricoid lesion combined with an injury to the soft tissue lining led up to a subglottic stenosis. It was concluded that when the soft tissue layer is undamaged, an intact circular structure of the cricoid is not compulsory for the normal development of the subglottis.

Animals↗
PubMedDate not supplied

Reconstruction of the anterior laryngeal wall with a composite graft of demineralized bovine bone matrix and autogenous perichondrium. An experimental study in adult rabbits.

In this study the feasibility to reconstruct the anterior laryngeal wall in adult rabbits with a composite graft of demineralized bovine bone matrix and autogenous perichondrium was investigated. It is demonstrated that demineralized bovine bone, which is a porous biomaterial, is completely transformed into autologous cartilage, once it is implanted in a vascularized perichondrial pocket. It appeared to be possible to reconstruct the anterior laryngeal wall in adult rabbits with this newly formed cartilage. As the biomaterial has been transformed into autologous tissue it is entirely incorporated at the recipient site giving rise to solid connections (cartilaginous and/or fibrous) with the surrounding tissues.

Animals↗
PubMedDate not supplied

Airflow resistance monitoring in laryngotracheal stenosis. Laser surgery in bilateral vocal cord paralysis.

Thirty-seven patients with laryngotracheal stenosis were treated within the last 3 years at the ENT Department of the Semmelweis University of Medicine in Budapest. Unilateral laser arytenoidectomy was performed in the group with pure vocal cord paralysis. Airflow resistance of the upper respiratory tract was measured with a modified Rhinotest MP 500 active anterior rhinomanometer through the tracheostomal orifice before and after the operation. The mean preoperative resistance was 0.951 Pa/cm3/s, which was reduced to 0.487 Pa/cm3/s postoperatively. In the successfully decannulated cases the postoperative resistance value averaged 0.360 Pa/cm3/s. The resistance limit (including nasal and pharyngeal resistances) seems to be 0.50 Pa/cm3/s.

Adult↗