Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “STRIDOR”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,135 records · Page 63Linked to original sources
PubMed2000

Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children.

Recently, gastroesophageal reflux (GER) has been found to contribute to many types of otolaryngologic pathology in infants and children. The complaints may be intermittent and unresponsive to usual therapies, such as antimicrobial treatments. A high index of suspicion for GER and for the concept of "silent" GER (GER without overt symptoms) is necessary for accurate diagnosis and treatment of otolaryngologic manifestations of GER in these patients. In this prospective historical cohort study, the records were reviewed from 101 children who underwent esophagoscopy and biopsy as a diagnostic test for GER at the time of other otolaryngologic procedures. Significant associations were found between the presence of histologic esophagitis and asthma, recurrent croup, cough, apnea, sinusitis, stridor, laryngomalacia, subglottic stenosis, posterior glottic erythema, and posterior glottic edema. There were no complications. Esophageal biopsy is a rapid, safe and effective diagnostic test for GER that should be considered at the time of other procedures in children with selected GER-associated problems.

Biopsy↗
PubMed1985

Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital.

Eighty patients at the Massachusetts General Hospital underwent resection of substernal goiter in the years 1976 to 1982. Mean age of the 50 women and 30 men was 56 years, and 10 (19 percent) had undergone prior thyroid surgery. The most common symptoms were cervical mass (69 percent), dysphagia (33 percent), and dyspnea (28 percent); 13 percent were asymptomatic. On examination, cervical mass was present in most (90 percent) but not all patients, 51 percent were obese, and more than one third had tracheal deviation. Fifty-one of 52 patients tested were euthyroid and one was mildly hypothyroid. Chest radiographs showed tracheal deviation in 79 percent and soft tissue mass in 56 percent. Seventy-eight patients underwent resection through a cervical collar incision only; one had cervical incision plus upper partial sternotomy; and one required cervical incision plus full median sternotomy. Pathologic examination revealed multinodular goiter in 41 (51 percent), follicular adenoma in 35 (44 percent), and Hashimoto's thyroiditis in 4 (5 percent). Mean goiter weight was 104 g, and the mean greatest dimension was 9 cm. Occult papillary carcinoma was found in two patients. There were no deaths or major complications. Analysis of our data indicate the following: (1) Substernal goiter may exist in the absence of symptoms or signs. (2) Extensive radiologic evaluation and thyroid function testing are rarely required. (3) With rare exceptions, substernal goiter represents an extension of a cervical growth through the thoracic inlet and can be approached through a cervical collar incision. (4) Histologically, these are multinodular goiters or follicular adenomas, although Hashimoto's thyroiditis may occur. (5) Given the small but present risks of acute stridor or occult malignancy and the negligible surgical risk, operation should be recommended. (6) Patients should be followed since, with or without levothyroxine, goiters may recur.

Adult↗
PubMed2000

Malignant laryngotracheal obstruction: a way to treat serial stenoses of the upper airways.

BACKGROUND: Six patients known to have inoperable esophageal carcinoma presented with stridor due to both malignant tracheal stenosis (n = 6) and bilateral vocal cord paralysis. Two patients also had respiratory-digestive fistula. METHODS: Patency was restored by endotracheal stenting plus unilateral cordectomy. Four patients had immediate relief. Two patients required enlargement of the cord incision. One of them declined reoperation and underwent tracheotomy. RESULTS: Stent function was uneventful. There was no dislodgement or mucous impaction. Fistula seal was complete. There was no aspiration through the new-shaped glottic orifice. Peak expiratory flow increased from 24.4% +/- 9.7% predicted normal before to 40.5% +/- 13.7% after the procedure, whereas the dyspnea score decreased from 74.2 +/- 12.7 to 24.2 +/- 14.0. CONCLUSIONS: Restoration of airway continuity in serial laryngotracheal stenoses using a combined approach is a feasible technique in end-stage cancer patients. It effectively relieves respiratory distress and ensures voice preservation. In addition, it may avoid the risks of tracheotomy.

Aged↗
PubMed2003

Tracheobronchial obstruction in children: experience with endoscopic airway stenting.

BACKGROUND: We reviewed our experience to determine the role of endoscopic airway stents in children with tracheobronchial obstruction. METHODS: Seventeen children (10 boys and 7 girls) aged 2 months to 16 years underwent tracheobronchial stenting. Etiology of the tracheobronchial obstruction included external vascular compression (n = 9); tracheobronchial anastomotic strictures after heart-lung/lung transplantation (n = 4); airway compression by malignant mediastinal mass (n = 2), and subglottic/high tracheal stenosis after prolonged intubation with a tracheostomy in situ (n = 2). Indications for airway stenting were failure to wean from ventilator after a mean of 82.5 days (range, 2 to 210) in 8 children; and dyspnea or stridor in the remaining 9 children. RESULTS: Ten children had a total of 24 uncovered self-expanding metal stents (either Magic Wallstent or Ultraflex Microvasive) and 7 children had silicone stents (2 straight, 3 Y and 2 T tube stents). At follow-up at 1 week to 72 months (median 21), only 8 of 17 (47%) children were alive but all the deaths were secondary to the underlying pathology and not related to tracheobronchial stenting. Six of 8 ventilator-dependent children were extubated after a mean of 5.3 days (range, 2 to 11) after airway stenting. For the 9 children stented for dyspnea, mean Medical Research Council dyspnea score decreased from 3.0 to 1.6 after stenting. CONCLUSIONS: Tracheobronchial stenting in children is only rarely needed and often undertaken in dire circumstances. The procedure has led to significant symptomatic benefit in dyspneic children and has enabled ventilator-dependent children to be extubated. Medium-term outlook after stenting with self-expanding metal stents for vascular compression of the airway is encouraging. The long-term outcome remains uncertain, however, and is ultimately influenced by the underlying disease.

Bronchial Diseases↗
PubMed1983

Primary tracheomalacia.

Tracheomalacia is a rare congenital malformation of the tracheobronchial cartilages in which the supporting cartilaginous rings permit expiratory collapse of the airway. The condition is usually mild and self-limited. There is a severe variant, however, that is life-threatening and warrants separate categorization. Four children with severe primary tracheomalacia were treated recently. The clinical symptoms, diagnostic findings, and eventual treatment of these patients were highly distinctive and almost identical in all 4, permitting us to make the following observations: (1) primary severe tracheomalacia must be suspected in infants with unexplained respiratory distress manifested by stridor and cyanosis; (2) symptoms are not present at birth but appear insidiously after the first weeks of life, are markedly aggravated by respiratory tract infections, and are made worse by agitation; (3) bronchoscopy is essential for definitive diagnosis and should be employed early in the diagnostic process; (4) tracheostomy is probably essential in most instances; and (5) resolution, although spontaneous, does not occur until after 2 years of age.

Cartilage Diseases↗
PubMed1981

Aggressive treatment of acquired phrenic nerve paralysis in infants and small children.

Transthoracic diaphragmatic plication is a simple and effective means of treatment for phrenic nerve injury and resultant diaphragmatic paralysis, and should be undertaken as soon as the diagnosis of diaphragmatic paralysis is established in a child with substantial respiratory difficulty. Seven of more than 1,500 patients sustained phrenic nerve injury during operation for congenital heart disease at our institution over the past five years. All but 1 patient were less than 5 months old, and the average weight was 3.8 kg. Five of the 7 could not be weaned from the ventilator, and the other 2 had persistent postoperative tachypnea and stridor. Before 1980, 3 patients were intubated for an average of 16 days prior to diagnosis by fluoroscopy. Since then, 4 patients have been intubated for an average of 7.8 days before diagnosis. All 7 underwent transthoracic diaphragmatic plication and were extubated by 6 days after operation (mean, 3.7 days). Six patients survived and are doing well. The 1 death occurred in 1976 in a premature infant with multiple congenital cardiac lesions; diagnosis was delayed until the twenty-eighth day after intubation and transthoracic diaphragmatic plication, until the sixty-second day. This infant died of pneumonia one month after extubation. These data support our policy of establishing an early diagnosis of phrenic nerve injury and early treatment utilizing transthoracic diaphragmatic plication in symptomatic children.

Cardiac Surgical Procedures↗
PubMed1987

Long-term fate of the diaphragm surgically plicated during infancy and early childhood.

Favorable early results have been reported utilizing transthoracic diaphragmatic plication in symptomatic children with phrenic nerve injury. However, little has been published about the late functional results of this technique. Since 1976, 10 of 3,000 patients operated on for congenital heart disease have sustained phrenic nerve injury with subsequent respiratory embarrassment. An additional patient sustained phrenic nerve injury as a result of birth trauma. The diagnosis was confirmed by paradoxical diaphragmatic motion on fluoroscopy. All but 2 patients were less than 5 months old at the time of diaphragmatic plication, and the average weight was 5.4 kg. The indication for diaphragmatic plication was inability to wean from the ventilator in 8 of the 11 patients and persistent postoperative tachypnea, stridor, and CO2 retention in the remaining 3 patients. A more aggressive approach to diagnosis and operative treatment since 1980 has resulted in a substantially shorter duration of endotracheal intubation and a shorter stay in the intensive care unit. Diaphragmatic fluoroscopy 1 to 7 years postoperatively has demonstrated return of normal function in 6 of 6 patients studied.

Age Factors↗
PubMed1979

Total lung ectoplasia with systemic arterial supply.

A 6-month-old girl was not to have fever and stridor. Investigations revealed an abnormal lung that communicated with the esophagus and had a systemic arterial supply from the abdominal aorta. Resection of the abnormal lung was performed successfully. We have termed this disorder total lung ectoplasia. Ten patients from the literature were reviewed.

Bronchopulmonary Sequestration↗
PubMed1979

Early and late results of surgical correction of pulmonary artery sling.

Since 1976, we have operated on 4 children with pulmonary vascular sling. They were 5, 12, 19, and 54 months old. All patients were seen initially with severe stridor. Diagnosis was made by barium swallow in all 4. Each child was operated on through a left thoracotomy; the left pulmonary artery was dissected deep between the trachea and esophagus. Systemic heparinization and microsurgical techniques were used. All patients improved after operation. Radioisotope pulmonary ventilation/perfusion scans were performed 9, 9, 14, and 21 months after operation. Decreased ventilation was noted in the right upper lobe of one scan; the other three ventilation scans were normal. Perfusion scans showed good patency of both pulmonary arteries in all 4 patients. It is concluded that pulmonary vascular slings should be treated surgically as soon as diagnosed. Delayed operation can lead to severe tracheomalacia, as demonstrated in our 54-month-old patient.

Child, Preschool↗
PubMed1988

Cricoid split for subglottic stenosis in infancy.

Historically, tracheostomy has been used for infants with airway obstruction caused by congenital or acquired subglottic stenosis. Postoperative morbidity and mortality with this provisional operation led Cotton, in 1980, to substitute anterior cricoid split as the primary definitive procedure. Within the past three years, anterior cricoid split has been performed in 4 infants, aged 3 to 9 months, with acquired (3 patients) or congenital (1 patient) subglottic stenosis requiring ventilation through an endotracheal tube. Following cricoid split, the trachea is stented for 12 to 14 days by a nasotracheal tube, with extubation and rigid bronchoscopy in the operating room with the patient under anesthesia to confirm healing and patency. During an 18- to 24-month follow-up in these 4 patients, morbidity has been minimal, patency has persisted, and stridor has not recurred. Accordingly, a conclusive operation, cricoid split, rather than a temporizing tracheostomy may be employed for certain obstructive tracheal lesions early in life.

Cricoid Cartilage↗
PubMed1997

Mediastinal parathyroid cysts.

BACKGROUND: Mediastinal parathyroid cysts are a relatively rare clinical entity. The clinical presentation can be quite varied, although most are found incidentally during investigations for esophageal or respiratory symptoms. METHODS: We present a review of the literature and describe two instructive cases showing specific clinical findings. The clinical presentation, radiologic and pathologic findings, and treatment of mediastinal parathyroid cysts are discussed. RESULTS: In the first patient, the presenting symptom was increasing hoarseness resulting from paresis of the right recurrent laryngeal nerve. This case illustrates the rare association of a benign mediastinal parathyroid cyst with unilateral vocal cord palsy. The second patient presented with the more classic findings of progressive dyspnea and stridor related to tracheal compression. CONCLUSIONS: Although mediastinal parathyroid cysts are rare and can have varied presentations, thorough investigation can reveal the underlying cyst. Surgical excision is the treatment of choice and can be expected to produce excellent results.

Aged↗
PubMed1997

External stabilization of long-segment tracheobronchomalacia guided by intraoperative bronchoscopy.

BACKGROUND: Symptomatic obstruction of long-segment tracheal or bronchial portions either related to congenital instability or secondary to vascular compression are rare malformations, which remain difficult to manage. A method of external tracheal or bronchial stabilization is described. METHODS: From July 1992 to April 1995, 7 children (age range, 4 months to 4 years; mean age, 19 months) and 1 adult (age, 46 years) were operated on for severe respiratory insufficiency. In 4 cases of congenital tracheal instability, 2 children had associated type IIIb esophageal atresia. Both children with esophageal atresia had previous operations (two and three times, respectively): 1 child had aortopexy and division of a patent ductus arteriosus and another child had distal tracheal resection elsewhere, both without relief of malacia. All children were intubated and ventilated since birth for 11 to 15 months. Secondary tracheobronchomalacia due to vascular compression was seen in 4 patients caused by double aortic arch (n = 2) and persisting ligamentum arteriosum after previous ligation of a patent ductus arteriosus (n = 2), with 1 child ventilated thereafter for 5 months. Operation was performed with the aid of extracorporeal circulation in all patients but 1, and consisted of transection of vascular rings and persistent ligamentum Botalli (n = 5), closure of multiple ventricular septal defects (n = 1) and extensive mobilization of the tracheobronchial tree as well as the great arteries. External stabilization of the severely dysplastic distal trachea (n = 6) or left main bronchus (n = 2) was achieved by suspending the malacic segment within an oversized and longitudinally opened ring-reinforced polytetrafluoroethylene prosthesis. Multiple plegeted sutures were placed extramucosally to the dysplastic tracheal wall and the dyskinetic pars membranacea, as well as to the polytetrafluoroethylene prosthesis in a radial orientation. Guided by simultaneous video-assisted bronchoscopy, reexpansion of the collapsed segments was achieved by gentle traction on the sutures while tying. RESULTS: Stenosis-free tracheobronchial reexpansion was achieved in all patients, as seen on repeated bronchoscopies during hospitalization and thereafter. All patients were extubated within 1 to 12 days after the operation. There was one late death, unrelated to the procedure, in a 31-month-old child 20 months after the operation. All other patients are free of stridor and in excellent clinical condition 21 to 54 months (mean, 38 months) thereafter. CONCLUSIONS: The presented method of bronchoscopically guided external tracheobronchial suspension within a ring-reinforced polytetrafluoroethylene prosthesis immediately relieves severe malacia of the trachea or main bronchi in infants as well as adults without necessitating resection. Midterm preliminary data suggest that growth potential of the affected segment exists within the oversized polytetrafluoroethylene prosthesis.

Abnormalities, Multiple↗
PubMed1999

Temporary tracheobronchial stenting in malignant lymphoma.

BACKGROUND: Temporary stenting is a new strategy in the treatment of malignant airway stenoses. Patients receive stents as primary palliation followed by tumor-specific therapy in order to reduce the stenosis and subsequently remove the stent. METHODS: We investigated this strategy of temporary airway stenting in 5 consecutive patients with malignant lymphoma (Non-Hodgkin's lymphoma, n = 3; Hodgkin's lymphoma, n = 2) who presented with severe dyspnoea. Nine stents (six Strecker, three Dumon stents) were implanted into the trachea or main bronchi. After stenting, patients underwent tumor-specific therapy (chemotherapy, n = 4; percutaneous radiotherapy, n = 1). RESULTS: Clinical improvement of dyspnoea and stridor was observed in each patient after stent implantation. In 4 patients (80%), stents could easily be removed after successful tumor-specific therapy, which led to reduction of stenosis after a mean interval of 26 days (14 to 52 days). One patient died during chemotherapy 6 days after stenting. CONCLUSIONS: The results show that temporary stenting is a valuable strategy in chemo- and radiosensitive malignancies, as it ameliorates the patients' respiratory condition until tumor-specific therapy is effective, and prevents poststenotic complications. It integrates stent implantation in a multi-therapy concept.

Adolescent↗
PubMed1999

Pulmonary artery sling: reimplantation versus antetracheal translocation.

BACKGROUND: We compared two repair techniques for pulmonary artery sling. The first comprised detachment of the aberrant left pulmonary artery from the right pulmonary artery and its implantation into the main pulmonary artery, and the second, translocation of the left pulmonary artery anterior to the trachea (without implanting it into the main pulmonary artery), resection of tracheal stenosis, and end-to-end reconstruction of the trachea. METHODS: Five symptomatic infants (3 boys and 2 girls; median age 5 months; range, 3 weeks to 11 months) with pulmonary artery sling were operated on through a median sternotomy with aid of cardiopulmonary bypass. In 3 patients, the left pulmonary artery was transected from the right pulmonary artery and implanted into the main pulmonary artery. In addition, the anterior trachea was augmented with a pericardial patch (n = 2). In the remaining 2 patients, associated tracheal stenosis was resected, the left pulmonary artery was translocated anterior to the trachea, and the trachea was reconstructed. RESULTS: All 5 infants survived the operation. The 3 patients in whom the left pulmonary artery was implanted into the main pulmonary artery had an uncomplicated postoperative course. All 3 patients, at a follow-up of 10 months to 7.9 years, were free of symptoms; the left pulmonary artery was documented to be widely patent. The remaining 2 patients in whom the left pulmonary artery was translocated anterior to the trachea could not be extubated. In both patients the distal trachea was compressed anteriorly by the left pulmonary artery. One of these patients died at 1 week postoperatively secondary to tracheal dehiscence. In the other patient, the left pulmonary artery was implanted into the main pulmonary artery with good result; at a follow-up of 3.9 years, mild residual stridor has persisted. CONCLUSIONS: In pulmonary artery sling, implantation of the aberrant left pulmonary artery into the main pulmonary artery, if necessary combined with anterior tracheoplasty, reliably eliminates tracheal and esophageal compression and maintains antegrade flow into the left pulmonary artery. Translocation of the left pulmonary artery anterior to the trachea without implanting it into the main pulmonary artery is not favored because that might result in anterior compression of the trachea. In addition, we are concerned about growth of the circumferential tracheal anastomosis in neonates and infants.

Female↗
PubMedDate not supplied

A review of laryngeal paralysis in dogs.

Laryngeal paralysis is now a frequently recognized disorder, particularly in older dogs of certain breeds such as the Labrador retriever, Afghan Hound and Irish Setter. The presenting signs may consist of exercise intolerance, inspiratory stridor, inspiratory dyspnoea, gagging, coughing and dysphonia. Two forms of laryngeal paralysis exist, hereditary and acquired. The hereditary form is found in young dogs and transmitted by an autosomal dominant gene. At present little is known about the aetiology of acquired laryngeal paralysis and therefore treatment is directed at relieving the laryngeal obstruction. Recent reports indicate that arytenoid lateralization achieves the best results as a method of surgical correction.

Animals↗
PubMed1998

Tracheal and oesophageal stenting for carcinoma of the upper oesophagus invading the tracheo-bronchial tree.

Two cases of combined tracheal and oesophageal stenting for carcinoma of the upper oesophagus invading the tracheo-bronchial tree are described. Case 1 describes the complication of respiratory distress following insertion of a high oesophageal stent. This caused severe stridor which required tracheal stenting. In case 2 prophylactic stenting of the airway prior to oesophageal stenting was performed as a staging CT demonstrated severe compromise of the distal trachea/bronchus in a patient who was experiencing both dysphagia and dyspnoea. In both cases the respiratory and dyspnoeic symptoms were relieved. These cases illustrate the effective use of tracheal/bronchial and oesophageal metal stents in palliating patients with combined respiratory and dysphagic symptoms secondary to oesophageal malignancy. When treating high oesophageal tumours tracheal compromise should be considered and prophylactic stenting of the airway prior to oesophageal stenting performed to avoid further airway compromise when the oesophageal stent expands.

Aged↗
PubMed2004

Neural classification of lung sounds using wavelet coefficients.

Electronic auscultation is an efficient technique to evaluate the condition of respiratory system using lung sounds. As lung sound signals are non-stationary, the conventional method of frequency analysis is not highly successful in diagnostic classification. This paper deals with a novel method of analysis of lung sound signals using wavelet transform, and classification using artificial neural network (ANN). Lung sound signals were decomposed into the frequency subbands using wavelet transform and a set of statistical features was extracted from the subbands to represent the distribution of wavelet coefficients. An ANN based system, trained using the resilient back propagation algorithm, was implemented to classify the lung sounds to one of the six categories: normal, wheeze, crackle, squawk, stridor, or rhonchus.

Algorithms↗
PubMed2004

Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy.

BACKGROUND: The ideal sedation for children undergoing GI endoscopy remains elusive. After ketamine was introduced as a sedative agent in our GI procedure suite, improved sedation and reduced complications were observed. The aim of this study was to assess the safety and effectiveness of ketamine as a sedative agent for GI endoscopy in pediatric patients. METHODS: A retrospective cohort study of 402 procedures (EGD, colonoscopy) was performed. Sedation-related complications were defined as hypoxia (oxygen saturation <95% by pulse oximetry), agitation, emergence reactions, stridor, laryngospasm, nausea, vomiting, aspiration, and muscle twitching, or any combination thereof. Sedation groups were defined as the following: Group I, midazolam and meperidine (n=192); Group II, midazolam, meperidine, and ketamine (n=82); and Group III, midazolam and ketamine (n=128). RESULTS: Group 1 (midazolam and meperidine) had the highest frequency of complications, most commonly hypoxia. Group 3 (midazolam and ketamine) had the lowest rate of complications (p=0.001) and the highest rate of adequate sedation, although the difference was not significant (p=0.07). CONCLUSIONS: The combination of midazolam and ketamine appears to provide safe and effective sedation for pediatric patients undergoing endoscopy.

Child↗