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At least 1,009 records · Page 56Linked to original sources
PubMed1978

Ultrastructure of human foetal and neonatal hyaline cartilage.

Ultrastructural studies showed that human foetal and neonatal hyaline cartilage contained at least two types of chondrocytes. The predominant chondrocytes of chief cells were characterised by scanty, flat endoplasmic reticulum, few mitochondria, a rudimentary Golgi zone, and by the presence of clear cytoplasmic vacuoles which contained electron-dense granules and beaded filaments. The second type of cells had dark or electron-dense cytoplasm which contained numerous dilated endoplasmic reticulum and prominent Golgi zones; these cells gave rise to slender cytoplasmic processes from which the matrix vesicles were probably derived. The lacunar matrices surrounding both cell types were morphologically different reflecting some functional differences between these cells. Both types of cells participated in the formation of costochondral growth zones. Condrocytes with morphology of the chief cells proliferated, columnised, underwent hypertrophy, and differentiated either into a compact hypertrophic cell or a swollen pale cell. The cells also became hypertrophic and gave rise to increasing numbers of dense vesicles. Calcification was first noted in the longitudinal septa inside or adjacent to matrix vesicles. The recognition of the heterogeneity of chondrocytes in human hyaline cartilage may be helpful in understanding the pathology of the chondrodysplasias.

Cartilage↗
PubMed1989

Vessel dilator cricothyrotomy for transtracheal jet ventilation.

Needle cricothyrotomy is a safe, relatively easy procedure and has been described to enable pulmonary ventilation for patients in both elective and emergency situations. Conventional IV cannulae are short, thin-walled, and easily kinked and, therefore, do not provide a secure system to jet oxygen into the trachea. The vessel dilators of most 7-9 French introducer kits are firm, pliable, resist kinking, and can be passed easily into the tracheal lumen. We describe our experience with the use of vessel dilator cricothyrotomy to oxygenate and ventilate the lungs of patients in emergency and elective situations.

Catheterization↗
PubMedDate not supplied

Cricothyrotomy in the emergency department revisited.

Thirty-nine emergency cricothyrotomies were reviewed from the emergency department of Hennepin County Medical Center during the 4-year period ending December 1985. Due to technical changes in airway management and a desire to assess their impact, this experience was compared with a previously reported series of 38 emergency cricothyrotomies from the same department. Technical changes include the use of paralyzing agents, transtracheal needle ventilation, and the use of only vertical skin incisions and #4 Shiley tubes when cricothyrotomy is performed. The presenting problem, indications for cricothyrotomy and complications of the procedure were compared between the two series. Fewer cricothyrotomies were done as a fraction of total surgical and nonsurgical tracheal intubations in the present series (1.7%) compared to the previous series (2.7%). The complication rate decreased from 40% in the previous series to 23% in the present series. Incorrect site of tube placement (10%) and hemorrhage (8%) remain the two leading complications. However, the tube was in the trachea in all cases, and acceptable ventilation was achieved. No patient developed a clinically significant hematoma or hemorrhage from cricothyrotomy. It is concluded that our technical changes in airway management have helped to decrease both the relative frequency of cricothyrotomy and the complication rate.

Airway Obstruction↗
PubMed1985

Cricothyroidotomy for prolonged ventilatory support after cardiac operations.

Forty-nine patients required prolonged ventilatory support after cardiac operations. Cricothyroidotomy was used routinely in these patients after approximately 7 days of endotracheal intubation. There were no infections of the median sternotomy wounds despite frequent colonization of the stoma. The only immediate complication was mild stomal bleeding in a patient taking anticoagulants. Nineteen patients (39%) died of underlying disease. The average duration of cricothyroidotomy was 59 days (range, 3 to 270 days). Cannulas were successfully removed in all survivors after an average of 38 days (range, 6 to 187 days). All of the patients were followed by personal interview, telephone contact, or contact with the referring physician. The average length of follow-up was 17 months (range, 2 to 50 months). All symptomatic patients were evaluated by laryngoscopy and bronchoscopy. One patient required endoscopic removal of granulation tissue from the stomal site; 2 others required tracheal resection for stenosis at the balloon site. There were no instances of subglottic stenosis. There were 4 late deaths, none of which was related to the cricothyroidotomy. Based on these findings, we suggest that cricothyroidotomy, with its low complication rate, is the procedure of choice for patients requiring prolonged mechanical ventilation after cardiac operations.

Cardiac Surgical Procedures↗
PubMed1986

India ink pinprick experiments on surface organization of cricoarytenoid joints.

Collagen fiber organization in the articular surfaces of the cricoarytenoid joint (CAJ) was studied using a pinpricking technique used in biomechanical research in orthopedics. Four male human formalin preserved specimens (3 months to 20 years) and 6 male freshly autopsied specimens (19 to 30 yrs) were studied. Specimens were dissected using the stereomicroscope. Distinctive patterns of articular cartilage slits reflect the orientation of collagen fibers in the cricoid and arytenoid articular surfaces. The orientation of the collagen fibers reinforces the articular surfaces along the principle path of CAJ motion. No age related differences were found. This suggests that the orientation of collagen fibers in the CAJ articular surfaces is prenatally determined rather than significantly influenced by postnatal mechanical factors.

Adolescent↗
PubMed1990

Effects of lateral manual compression upon glottic incompetence: objective evaluations.

Forceful manual compression of the thyroid and cricoid cartilages modifies the position, shape, and tension of the vocal folds. This is the basis of the four laryngeal manual compression tests, adjunctive examinations used as a means of preoperative assessment of patients for medialization laryngoplasty, ie, Isshiki thyroplasty types I and IV and arytenoid adduction. The laryngeal manual compression tests are simple to perform and noninvasive. Each of the four examinations yields valuable information on the effects on the voice of changes in vocal cord characteristics produced by manual compression. In this report, one of the four tests, lateral manual compression, is evaluated objectively with well-attested methods of videostroboscopic, aerodynamic, and acoustic analysis. The technique of performing lateral manual compression is described, and advantages and disadvantages are noted and compared in 10 patients. Preliminary findings in 4 patients in this group indicate that medialization laryngoplasty should be considered when test results are conclusive of effective glottic closure. Data derived in this preliminary study will be augmented as patients are added to the series.

Adult↗
PubMed1988

The prevention of gastric inflation--a neglected benefit of cricoid pressure.

The ability of cricoid pressure to prevent inflation of the stomach during mask ventilation of a patient was studied. Fifty patients were randomly allocated to either have or not have cricoid pressure applied during a three-minute period of standardised mask ventilation. Patients who had had cricoid pressure applied had less gas in the stomach after mask ventilation (P less than 0.001). However, in a subgroup of patients considered difficult to ventilate, cricoid pressure seemed less successful in preventing gastric inflation. Cricoid pressure is a useful technique for reducing gastric inflation during mask ventilation, particularly in patients who are relatively easy to ventilate.

Cricoid Cartilage↗
PubMedDate not supplied

Elective coniotomy. A prospective study.

The view current over the last 60 years or so that coniotomy often leads to subglottic stenosis has recently been called into question. In the present study 103 electively performed coniotomies have been analysed. The operation was found to be much easier than tracheotomy. There was no case of severe peroperative or postoperative complications. Six months after decannulation 28 patients were alive and accessible to follow-up examination. No evidence of subglottic stenosis was found. The main disadvantage of this operation would seem to be a tendency for the development of voice changes.

Adult↗
PubMed1992

[Laryngotracheal fissure in infants. Indications, technique, results].

Since laryngotracheofissiure, or anterior cricotomy, has been introduced in 1980, the number of tracheotomies performed in infants has decreased as this procedure is an alternative to tracheotomy for difficult extubation. Since then, the indications of this procedure have become wider, but a number of preoperative criteria, such as the pulmonary capacity, must be strictly assessed. We report on our experience with 14 children who underwent laryngotracheofissiure during the past 4 years. The indications, the surgical technique and the results are evaluated.

Cricoid Cartilage↗
PubMed1986

[Age dependence of functional systems, exemplified by the vocal cord and cricothyroid articulation].

The age dependency of functional systems is treated at the vocal cord and the cricothyroid articulation. At the time of birth there is a different developmental stage of the vocal cord. The anterior parts are essentially further differentiated than the posterior ones. The cause is to be found in the insertion of the vocal muscle at the anterior part. By intrauterine muscle contraction the polypeptide chains of the collagenous fibres are directed. The oblique cricothyroid ligament which limits the tension of the vocal cord in the cricothyroid articulation is already well developed and protects the vocal ligament from overstretching. The differences in the development balance in the first decennium. At the same time a sex-different structure of the vocal cord develops, whereby the vocal cord of the woman above all consists of elastic, the vocal cord of the man of collagenous fibres. At old age the two kinds of fibres degenerate. The cricothyroid ligament, however, does not show any involutional processes and as in early childhood fulfils its protective function.

Adolescent↗
PubMed1985

Calcification and ossification in the arytenoid cartilage: incidence and patterns.

Calcification or ossification occurs early and commonly in the arytenoid cartilage. It may be difficult to detect, but there are only eight patterns that specifically identify ossification and calcification. Each arytenoid independently ossifies or calcifies. The cervical spine examination can specifically identify the patterns found at autopsy.

Adolescent↗
PubMed1993

[Anesthesia and laryngeal muscle, especially intrinsic laryngeal muscles].

The intrinsic laryngeal muscles are highly specialized for phonation, respiration and sphincter activity. The muscles are disposed between three unpaired cartilages (the thyroid, cricothyroid and epiglottic) and the paired arytenoid cartilages. These laryngeal muscles, which are striated in character, are bilaterally disposed and can be grouped as adductors and abductors of the glottis and tensors of the vocal cords. The motor neurons for the intrinsic laryngeal muscles are located in the caudal half of the nucleus ambiguous. The intrinsic laryngeal muscles receive motor nerve supply from the external branches of the superior laryngeal and recurrent nerves on each side. The external branch of the superior laryngeal nerve serves in motor innervation of the cricothyroid muscle, while the other laryngeal muscles receive a motor innervation from the recurrent nerve. Compared with limb skeletal muscles, the intrinsic laryngeal muscle have unique morphologic and histochemical characteristics. In general, the intrinsic laryngeal muscle fibers contain greater percentages of histochemically type 1 fibers than limb skeletal muscles. In addition, morphometrical studies of the subneural apparatus at the neuromuscular junctions of the intrinsic laryngeal muscles demonstrate the difference between the morphological features of the nerve endings and the distribution pattern of the motor end-plates of the laryngeal muscles and those of the limb skeletal muscles. Finally, the influence of anesthetic drugs including neuromuscular blocking agents on the intrinsic laryngeal muscles is discussed. The gross anatomical features such as the motor innervation, localization of the neurons for the motor nerve fibers, and arrangement and characteristics of the motor end-plates of the intrinsic laryngeal muscles are described based on a review of literature and our current investigations.

Anesthesia↗