SEARCH · Search PubMed
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.
The effects of surgical trauma on the cricoarytenoid joint were analyzed using canine models. The cricoarytenoid joints of seven dogs were surgically disrupted. In four of the dogs an arthroplasty with silastic implantation was simultaneously performed. The histologic findings and the unsuccessful functional results are presented and discussed.
Explore the source record for details and available documents.
Using histopathological and immunofluorescent techniques, we investigated the development of the glandular system of the larynx from 12 human fetuses. Glandular buds were first observed at the fourth month of gestation and glandular distribution became evident from the fifth month in the larynx. Ciliated or nonciliated epithelium covered the cavity of the larynx, with the exception of the true vocal cord. Immunofluorescent examination revealed the presence of IgG in the fetal larynx, but there was little fluorescence for IgA, IgM and IgE. Secretory component (SC) synthesis, on the other hand, was found in each serous-type glandular epithelium or acinus from the fourth month on. Our observations suggest that the local immune system by SC, which binds to IgA as SIgA in human laryngeal mucosa, is inherently acquired in the fetal larynx.
Severe, incessant aspiration can be a most troublesome sequel to the already tragic problem of a vegetative mental state in a previously normal child. Three patients, aged 2 to 4 years, underwent surgery to treat their aspiration. A different type of procedure was used for each patient: cord closure combined with an epiglottic flap, cord closure alone, and a laryngeal stent. Laryngeal histopathology of a case is presented for the first time; findings suggest that the theoretical reversibility of that particular type of procedure could prove formidable. Clinically, the immediate cessation of aspiration has provided all parents and health care personnel with a surprising sense of gratification and has enabled each child to be transferred to a less-costly care facility or to home.
Short Rib Polydactyly Syndrome (SRPS) is a group of rare congenital disorders characterized by polydactyly, short limbs, and short ribs. Infants with type I SRPS (Majewski syndrome) may exhibit dysgenesis of the larynx, which is manifested by epiglottic hypoplasia. Photographic documentation of laryngeal findings obtained at autopsy in an affected infant is provided. To our knowledge, such photographic documentation has not been previously published. Normal laryngeal development is reviewed, based on the Carnegie system of staging. The developmental errors leading to SRPS are thought to occur at 33 to 48 days of fetal life (Carnegie stages 15 through 19).
Isshiki type III thyroplasty is a laryngeal framework surgical procedure that lowers a patient's pitch. To objectively assess the procedure, preoperative and postoperative voice recordings, as well as electroglottography and photoglottography were performed. Jitter, shimmer, and glottographic quotients were measured to assess changes in vibratory pattern. The mean and range of frequencies in contextual speech was also determined. Analysis of the preoperative and postoperative data from two patients with over 1 year follow-up showed a decrease in frequency of vibration. Postoperatively, the vocal folds still vibrated in a regular pattern as described by the myoelastic-aerodynamic theory. There was no increase in jitter or shimmer quotient. The Isshiki type III thyroplasty appears capable of lowering fundamental frequency of speech without adversely affecting the vibratory mode of the vocal folds.
Longitudinal voice quality changes following Isshiki thyroplasty type I were investigated in a group of 13 patients exhibiting unilateral vocal fold paralysis. Thyroplasty type I medializes the paralyzed fold by using a Silastic implant for external lateral compression of the abducted fold. No perioperative complications were experienced. We observed significantly higher voice fundamental frequency, significantly louder voice intensity, and significantly longer maximum phonation time, both immediately following phonosurgery and up to 3 months postoperatively. Surgical refinements of thyroplasty type I are described.
A method for closure of large tracheocutaneous fistulas occurring in the cricothyroid membrane is described. Though an infrequent complication, large defects in this area can be successfully repaired with this technique.
Fifteen infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary tracheal anastomosis. The etiology of the stenosis was congenital in 3 cases and was acquired after prolonged intubation in 12. Fourteen patients were tracheotomy dependent at the time of surgery, and 13 (87%) of the 15 were classified grade III (7 cases) and IV (6 cases) according to Cotton. The resection included the cricoid only in 5 cases and the cricoid and a segment of trachea (1 to 4 rings) in 10 cases. Decannulation was achieved after a single open procedure in 14 (93%) of the cases. The authors encountered no lesion of the recurrent laryngeal nerves and no fatalities. There was, however, 1 restenosis. Twelve cases were decannulated within 6 months, most of them at 2 months. The postoperative voice is normal in 10 cases, and a slight dysphonia is present in 4 cases. Twelve patients show no exertional dyspnea, and 2 exhibit a slight stridor while practicing sports. Ten of 14 cases have been followed for more than 5 years, with the longest follow-up now being 14 years. In all cases, the laryngotracheal development is normal. The results of this small series compare favorably with those of laryngotracheoplasty procedures usually performed for subglottic stenosis in infants and children. In the future, partial cricoid resection with primary tracheal anastomosis should be considered as an important treatment option for severe subglottic stenoses in infants and children.
Explore the source record for details and available documents.
STUDY OBJECTIVES: Because efforts to secure adequate arterial oxygenation during cardiac resuscitation are more important than efforts to promote CO(2) elimination, we investigated whether continuous transtracheal oxygenation (TTO) could represent a potentially simpler alternative to conventional positive-pressure ventilation with 100% O(2) through an endotracheal tube. DESIGN: Controlled and randomized. SETTING: Animal laboratory. PARTICIPANTS: Thirty male Sprague-Dawley rats. INTERVENTIONS: The technique for TTO was initially developed and tested in five rats. A model of ventricular fibrillation (VF) was then used to compare the effects of TTO (n = 5) with the effects of O(2) delivery through an endotracheal tube as part of positive-pressure ventilation (n = 5) or through a mask without additional airway intervention (n = 5). VF was induced and left untreated for 4 min, after which chest compression and one of the three oxygenation interventions was started. Defibrillation was attempted after 6 min of chest compression. In a subsequent series, defibrillation was attempted after 10 min of chest compression in rats treated with either TTO (n = 5) or endotracheal intubation (ET; n = 5). MEASUREMENT AND RESULTS: TTO and ET secured adequate arterial PO(2) during chest compression (213 +/- 77 mm Hg and 154 +/- 36 mm Hg; not significant), whereas the mask yielded an arterial PO(2) of only 49 +/- 38 mm Hg (p < 0.05). Each rat treated with TTO or ET was successfully resuscitated and survived the postresuscitation interval, but none of the rats treated with the mask survived. TTO maintained its efficacy after increased duration of chest compression. CONCLUSION: TTO was as effective as conventional positive-pressure ventilation with 100% O(2) for securing oxygenation, resuscitation, and short-term survival and more effective than O(2) delivered through a mask.
A four-year experience with transtracheal aspiration was reviewed in order to determine those patients at risk for developing life-threatening complications. One hundred procedures were performed by at least 20 different physicians trained according to an established protocol. Complications were limited to minimal subcutaneous emphysema in 19 percent (10/52), pneumomediastinum in 3 percent (3/93), and gross but self-limited hemoptysis in 1 percent (one patient); occasional unifocal premature ventricular contractions were noted in one patient. We conclude that patients not at risk of developing life-threatening complications from transtracheal aspiration can be identified. They (1) are able to cooperate and have a clearly identifiable and normal cricothyroid membrane, (2) have the procedure performed only by well-trained or supervised physicians, (3) have an arterial oxygen pressure of at least 70 mm Hg with administration of supplemental oxygen, and (4) have a prothrombin activity of at least 65 percent of the control value or a normal bleeding time or a platelet count of at least 100,000/cu mm. To minimize subcutaneous emphysema or pneumomediastinum, no patient should have therapy with intermittent positive-pressure breathing or any other procedure that might induce coughing for the subsequent 24 hours.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Computed tomography (CT) provides a unique method of evaluating abnormalities of the larynx by virtue of its cross-sectional images. Several reports have demonstrated its utility in staging laryngeal carcinoma and defining the extent of injury in cases of laryngeal trauma [1-8]. In order to appreciate subtle abnormalities of the larynx, a thorough understanding of the normal structures in this small anatomic area is crucial. Although previous studies have defined the normal CT anatomy of the larynx, many of the CT-anatomic correlations of the normal larynx used earlier-generation CT scanners with relatively poor resolution or were limited to transaxial images [9-13]. We have correlated high-resolution transaxial, coronal, and sagittal CT in vivo images with line drawings displaying normal laryngeal anatomy. The exquisite anatomic detail apparent in these images provides a sound basis for understanding subtle abnormalities in pathologic cases.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.