PubMed Health⌕ Search

Biomedical subjects

A S Hengerer

Publications and source records attributed to A S Hengerer.

At least 19 recordsLinked to original sources
PubMed2001

Safety of pediatric bedside tracheostomy in the intensive care unit.

BACKGROUND: Elective bedside pediatric tracheostomies in the intensive care unit have not been widely reported. Unlike in the adult population, this is not yet considered a safe or routine procedure in the pediatric population. We performed a preliminary study suggesting that bedside pediatric tracheostomies can be done safely and at reduced cost. DESIGN: Retrospective medical chart review. SETTING: Tertiary care referral center at a single university hospital. PATIENTS: Fifty-seven patients, ranging in age from 15 days to 8 years. Thirty operating room tracheostomies and 27 bedside tracheostomies were performed during a 6-year period. The mean age of the patients was 20.5 months, with no significant age difference between the 2 groups. The top 3 diagnoses necessitating tracheostomy were laryngotracheal disorders (18 patients [32%]), bronchopulmonary dysplasia (9 [16%]), and neurologic disorders (6 [11%]). INTERVENTIONS: Tracheostomy. MAIN OUTCOME MEASURES: The initial 48-hour postoperative period was examined to compare complication rates between groups. RESULTS: Overall, the 2 groups had similar complication rates (chi(2) = 0.12; P =.73). The operating room group had 3 complications (10%) related to bleeding, infection, and pneumothorax. The bedside group had 2 complications (7%), both involving pneumothorax. Each operating room tracheostomy incurred charges totaling $1693 vs $235 for each bedside tracheostomy. CONCLUSIONS: Historically, pediatric tracheostomy has been viewed as a technically demanding procedure with a high complication rate, thus encouraging routine operating room use. We found that pediatric tracheostomy performed in the intensive care unit, with attention to prudent patient selection and adherence to consistent, sound techniques, was as safe as operating room tracheostomy.

Child↗
PubMed2001

Lipoinjection augmentation of the soft palate for velopharyngeal stress incompetence.

OBJECTIVES/HYPOTHESIS: Velopharyngeal stress incompetence in professional musicians is an uncommon but potentially career-ending problem. Pharyngeal flaps, V-Y palatal pushback procedures, Teflon or collagen injection of the posterior pharyngeal wall, and speech therapy have all been used to address this problem. The ideal procedure for this subset of patients with velopharyngeal incompetence (VPI) with high-pressure, mild VPI would be one that combines low morbidity and an expedient recovery for the busy musician. We describe an approach of endoscopically assisted autologous lipoinjection of the soft palate. STUDY DESIGN: A retrospective review of our experience treating high-pressure stress VPI in two professional musicians. METHODS: Literature review and retrospective chart review. RESULTS: Two musicians underwent autologous lipoinjection of the soft palate for stress VPI. Patients resumed full play within 2 weeks of the operation with no serious complications. There has been no recurrence of the VPI after 18 and 12 months of follow-up, respectively. CONCLUSIONS: Velopharyngeal stress incompetence in musicians is an uncommon disorder. Velopharyngeal incompetence in these patients may not present as in a typical manner with hypernasality but may go undiagnosed for years mistakenly rationalized as a declining performance ability rather than a curable structural problem. The performance demands of professional musicians necessitate a timely solution to their VPI. More precise and limited contouring of palatal bulk can be achieved through the lipoinjection technique than compared with traditional palatal V-Y pushback or a standard pharyngeal flap. Lipoinjection of the palate can be performed as an outpatient procedure with only minor discomfort and an expedient recovery for the career musician.

Adipose Tissue↗
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↗
PubMed1989

Anatomic and audiologic sequelae after tympanostomy tube insertion or prolonged antibiotic therapy for otitis media.

In this study the anatomic and hearing sequelae are characterized for 43 children (86 ears) with recurrent acute otitis media and/or persistent otitis media with effusion who had received three or more tympanostomy tube placements and 46 children (92 ears) managed medically with repeated courses of therapeutic and/or or prophylactic antibiotics. In the surgical group 311 tympanostomy tube surgeries had been performed and in the medical group 1334 episodes of acute otitis media and/or 186 episodes of otitis media with effusion occurred. Tympanosclerosis was found in 6.5% of the medical group ears and 52.3% of the surgical group ears. Tympanic atrophy occurred in 4.3% of the medical group ears and 40.7% of the surgical group ears. The duration of the presence of the tympanostomy tube significantly influenced the tympanic membrane. The presence of middle ear fluid at the time of tube insertion, particularly high viscosity ("glue") fluid, correlated with persisting sclerosis (P less than 0.00001) and reduced tympanic membrane mobility (P less than 0.00001) but not tympanic membrane atrophy (P = 0.94) later. Abnormal hearing, defined as a hearing threshold greater than 20 dB occurred in 9.3 to 18.7% of the surgical ears and in 3.7 to 9.0% of the medical ears depending on the hearing frequency tested. Medical management consisting of recurrent use of therapeutic and/or prophylactic antibiotics was associated with infrequent anatomic and audiologic sequelae. Repeated placement of tympanostomy tubes may be associated with the frequent occurrence of both anatomic and audiologic sequelae.

Acoustic Impedance Tests↗
PubMed1988

The role of C.T. scans in managing the orbital complications of ethmoiditis.

Thirty-three cases of ethmoidities with orbital complications were reviewed to determine the accuracy of clinical diagnosis and the benefit of CT scans in planning treatment. Patients were classified according to the Schramm et al. 1982 criteria of orbital involvement with ethmoiditis: periorbital cellulitis with chemosis (PCC)-9, and orbital cellulitis (OC)-11, subperiosteal abscess (SPA)-9, and orbital abscess (OA)-4. These patients received CT scans acutely for diagnostic purposes and demonstrated an 84% accuracy with the final clinical groupings. Of 33 patients, 9 had a shift in clinical classification based on the CT scan result interpreted by the Radiology Department or surgical findings. There were no false positives in the periorbital or orbital cellulitis patients, and no false negatives in the subperiosteal and orbital abscess patients. Thus classification changes caused no change from medical to surgical treatment in any of the cases. The conclusion is that a knowledgeable clinical exam established the correct grouping in 70% of the patients versus 82% with the CT scan. An urgent CT scan is advised for patients in clinical groups SPA, OA, or cavernous sinus thrombosis (CST) to determine the imminent need for surgery, as the cases may be underestimated. Patients with PC or PCC can be managed medically with elective CT scans not routinely indicated.

Abscess↗
PubMed1988

New imaging techniques in diagnosis of cerebrospinal fluid fistula.

The localization of a cerebrospinal fluid fistula producing cerebrospinal fluid otorrhea can be very difficult. However, the exact anatomic localization of the bony defect is important when selecting the surgical approach to repair. Case reports of two patients in whom spontaneous cerebrospinal fluid otorrhea occurred following pressure equalization tube placement for middle-ear effusion are presented. Nuclear magnetic imaging supplemented CT scan findings, providing noninvasive localization of the defect. Preoperative impressions were confirmed at surgery. In addition to discussing the use of magnetic resonance imaging in evaluating cerebrospinal fluid otorrhea, the literature will also be reviewed.

Brain Diseases↗
PubMed1986

Three-dimensional computed tomography in maxillofacial trauma.

Roentgenographic evaluation of maxillofacial trauma is an integral component in the management of the acutely injured patient. Recent developments in computerized software permit three-dimensional computed tomographic (CT) reconstructions of complex anatomic parts. Five examples of complex maxillofacial trauma were demonstrated by conventional plain films, followed by two-dimensional and three-dimensional CT. Three-dimensional CT vividly demonstrates spatial relationships not easily conceptualized by present modalities.

Adult↗
PubMed1985

Histiocytosis X: otologic presentations.

Histiocytosis X is a relatively rare disease presenting as 3 clinical syndromes: eosinophilic granuloma, Hand-Schuller-Christian disease, and Abt-Letterer-Siwe disease. Although the clinical expressions of the disease differ, the underlying histopathology appears to be the same. Since the disease frequently involves and not infrequently presents in the head and neck region, it is particularly relevant to the otolaryngologist. We have recently treated two young children presenting with bilateral otorrhea. Although histiocytosis X was entertained early in the evaluation of these patients, the diagnosis was difficult and prolonged in both cases. One case ultimately required electron microscopic study to confirm the diagnosis. Important aspects of the diagnosis are reviewed. Treatment of histiocytosis X includes surgery, radiation therapy and chemotherapy. These treatment strategies are discussed, with particular emphasis on the management of the ear involvement.

Child, Preschool↗
PubMed1984

Acute epiglottitis: evolution of management in the community hospital.

One hundred and forty-eight cases of acute epiglottitis in children treated at the University of Rochester's Strong Memorial Hospital and two affiliated community hospitals between 1965 and 1983 are reviewed retrospectively. Patients seen prior to 1975 were usually managed with tracheotomy and intravenous antibiotics, while those after 1975 with nasotracheal intubation, antibiotics and steroids. Tracheotomy and nasotracheal intubation were equally safe in controlling the upper airway. We compared our results with other series, primarily from children's hospitals, using nasotracheal intubation and found comparable results. Steroids provided no significant effect on the duration of intubation or infectious complications, but was associated with gastrointestinal bleeding. Long- and short-term complications of intubation, including self-extubation are discussed. We conclude that nasotracheal intubation is a safe method of management for acute epiglottitis in the community hospital.

Acute Disease↗
PubMed1984

Choanal atresia. Clinical considerations for management.

Taking cognizance of the embryology and newer diagnostic techniques, the transpalatal route is strongly recommended as the optimal surgical procedure for the management of choanal atresia. It should be performed as soon as general anesthesia can be safely administered. In selected instances, but particularly when a patient is at increased surgical risk, necessitating surgical brevity, the endonasal puncture technique should be considered as the initial procedure. Parents must be appraised of the potential for subsequent growth deficiencies, mental retardation, and crossbite.

Abnormalities, Multiple↗
PubMed1984

Internal carotid artery thrombosis following soft palate injuries: a case report and review of 16 cases.

Sixteen cases with soft palate lacerations and neurologic sequelae secondary to internal carotid artery injury are presented and reviewed. In all 16 cases, it is probable that blunt trauma to the internal carotid artery produced an intimal tear causing an intraluminal thrombus to form. Within 48 hours of injury all patients demonstrated varying degrees of neurologic deficit with 5 deaths. This article recommends the following treatment protocol for these cases: 1. admission for 48 hours observation; 2. early ultrasound or angiography at first sign of neurologic changes; 3. immediate anticoagulation if internal carotid artery occlusion is discovered; 4. surgery is usually inappropriate as the thrombus presents in the inaccessible skull base or may embolize during attempted removal. The present case represents the result of this formulated treatment protocol.

Accidents↗