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Biomedical subjects

A Willner

Publications and source records attributed to A Willner.

15 recordsLinked to original sources
PubMed2000

Tracheal stenosis and congenital heart disease in patients with Down syndrome: diagnostic approach and surgical options.

Upper airway obstruction is a prevalent feature in patients with Down syndrome. However, these patients may be completely asymptomatic in the early months of life. The recognition of a problem within the airway quite often occurs when these children present for cardiac surgery, diagnostic radiography with sedation, or during the induction and intubation for anesthesia. Tracheal stenosis is rare in the general population, but is seen somewhat more frequently in patients with Down syndrome. The incidence of tracheal stenosis in children with congenital heart disease, which is seen in 40% of patients with Down syndrome, has been reported to be 1.2%. Patients with Down syndrome also tend to have other upper airway obstructive pathology such as nasopharyngeal, oropharyngeal, and subglottic compromise. These entities, combined with the high incidence of cardiac disease, put these children at risk for acute and chronic cardiopulmonary compromise. We present two patients with Down syndrome and congenital heart disease who were found to have significant tracheal stenosis at the time of their cardiac surgery. The perioperative management of their airway defects including diagnostic evaluation and treatment modalities are discussed.

Cardiac Surgical Procedures↗
PubMed1998

Treatment of Postcraniotomy Tension Pneumocephalus via Endoscopic Closure of the Nasofrontal Recess.

Tension pneumocephalus can be a life-threatening complication following cranial surgery. We report a 14-year-old female who developed tension pneumocephalus following her most recent external approach to a recurrent pilocytic astrocytoma of the skull base and clivus. Because the risk of devascularization of the recently placed bone grafts was a concern, an endoscopic approach was chosen instead of a cramotomy. Endoseopic decompression was accomplished by opening the anterior ethmoid and frontal recess air cells after performing an uncinectomy. The nasofrontal recess areas were then packed from below with grafts of muscle and fascia lata. Follow-up magnetic resonance imaging (MRI) at three and eight months showed complete resolution of the intracranial air. At two-year follow-up, the patient is still asymptomatic. This case report presents treatment of tension pneumocephalus through endoscopic decompression and closure of the nasofrontal recess as a viable option if significant risks are associated with craniotomy and the status of the mucosa of the nasal frontal recess is known.

Case Reports↗
PubMed1995

Extraluminal laryngotracheal fixation with absorbable miniplates.

OBJECTIVE: To determine if miniplates made of polydioxanone can be used successfully for extraluminal laryngotracheal fixation. DESIGN: Twelve rabbits underwent anterior and posterior laryngotracheofissure with extraluminal fixation of the divided segments with polydioxanone miniplates. Three control animals did not undergo plating. Animals were killed after 2, 4, and 12 weeks. Larynges were removed and examined to determine the intraluminal area and histologic status of the repair site. RESULTS: The intraluminal area of the animals in the experimental group was 1.6 times that of those in the control group. The trachea was relined with respiratory mucosa by 2 weeks. Little inflammatory reaction was evident. Plate resorption was almost complete at 12 weeks. CONCLUSION: Polydioxanone plating is a feasible and well-tolerated method of extraluminal laryngotracheal fixation. It may be useful in the treatment of grade 2 or 3 subglottic stenosis.

Absorption↗
PubMed1994

Reconstruction of the pediatric airway with an open stented tracheotomy tube.

Reconstructive techniques for the stenotic pediatric airway have greatly enhanced the otolaryngologists ability to decannulate the tracheotomy-dependent child. Stents have played an important role in this process by both maintaining the reconstructed lumen and acting as a scaffold. However, decannulation is often not achieved after the first surgical intervention with some patients requiring two, three or more procedures. In an effort to improve upon the design of today's stents, an open stented tracheotomy tube was evaluated at our institution. This stent is designed to provide advantages of immediate postoperative voice and nutrition, and ease of evaluation, as well as to provide for safe and adequate healing. Four patients underwent laryngotracheal reconstruction with this stent over a 10-month period. All patients could vocalize and eat immediately postoperatively but recalcitrant granulation tissue and restenosis has prevented decannulation in three of the cases. The experience with this stent exemplifies the persistent difficulties of stent use in pediatric airway reconstruction. It also points out that progress is still needed in current reconstructive techniques as well as in the development of new techniques.

Adolescent↗
PubMed1994

Rib-muscle pedicle flap for the repair of congenital tracheal stenosis.

Congenital tracheal stenosis (CTS) is an uncommon congenital anomaly that presents early in life with symptoms of biphasic stridor. Most cases require surgical correction. Techniques have included dilation, resection of the involved segment, and tracheoplasty. Today pericardium and costal cartilage are the most frequently used materials for tracheoplasty, but patients still often encounter problems with the graft, with the procedure, or with late complications. This preliminary study was undertaken to determine the feasibility of a rib-intercostal muscle pedicle flap for the treatment of CTS. Tracheoplasties were performed on seven 3.5- to 5.5-kg piglets with a pedicled segment of the right fourth rib via a lateral thoracotomy incision. The method was found to be technically feasible, and pedicles of greater than 2.5 cm were easily developed. The repair provided good structural support and an airtight seal at high ventilator pressures. Histologic examination after 2 weeks showed the flap to be incorporating into the native trachea and to be without degenerative changes. This "vital" composite flap has several real and theoretic advantages over current methods of repair and may prove to be valuable in the treatment of CTS. The clinical application of this myo-osseous pedicle graft in the treatment of patients with stenoses not amenable to surgical resection and primary anastomosis should be explored.

Animals↗
PubMed1992

Auricular injury as a presentation of child abuse.

Child abuse causes serious physical and emotional injury. Those abused, however, are usually unable or unwilling to gain access to agencies that might help them. The otolaryngologist, while usually not the patient's primary physician, may be in the position to detect child abuse. We describe a 3-year-old boy who sustained auricular trauma as the result of child abuse. The importance of physician recognition of an abuse case and the institution of appropriate measures are discussed.

Child Abuse↗
PubMed1991

An enteric duplication cyst occurring in the anterior two-thirds of the tongue.

Enteric duplication cysts are cysts that are attached to the alimentary tract and that are lined by some type of gastrointestinal mucosa. Such cysts are especially rare when found in the oral cavity. We report the case of an 8-month-old female with an unusual duplication cyst in the anterior two-thirds of the tongue. Eighteen cases of intraoral cysts have been previously reported in the literature, this one being the 7th case of a true duplication cyst of the anterior two-thirds of the tongue which contains gastric mucosa. The case presents many aspects of the diagnosis and management of this unusual lesion. The literature and present etiological theories are discussed.

Cysts↗
PubMed1983

Reluctance to readmit psychiatric patients.

Psychiatric patients whom staff on an inpatient service were reluctant to readmit were compared to all other patients about whom no such reservations had been expressed. The former group revealed a much greater number of readmissions and a greater proportion of males. Although no statistically significant differences in diagnoses were found, there tended to be a greater proportion of patients with personality and affective disorders and a lesser proportion of those with neurotic and other disorders in this group. There was agreement among clinicians that patients with antisocial and aggressive personalities were difficult to treat, resulting in staff reluctance to readmit them. Marked disagreement about readmitting other patients who did not respond well to treatment efforts indicated differing tolerance among clinicians and also different attitudes toward, and philosophies of, treatment of difficult chronic patients. These data raise further questions concerning factors contributing to chronicity and poor prognosis in psychiatric patients. Recent work indicates that consideration should be given not only to individual characteristics of patients but also to the contribution of the characteristics and attitudes of their families, mental health professionals, and programs in the maintenance of chronicity.

Antisocial Personality Disorder↗
PubMedDate not supplied

An electronic device for rehabilitation of senile dementia patients.

Senile dementia patients are usually considered hopeless--incapable of learning or improving. There is hope for improvement in such patients, however, and certain techniques effective in enhancing alertness in other brain-damaged patients can be helpful to these patients. A simple, widely available electronic television game is used, and a special training technique was designed to teach the patients how to successfully play the game. The fascinating attraction of this game engages the patient's attention, and success in playing the game promotes alertness. The training method encourages the patient to succeed at the game and thereby enhances his interest in his surroundings and his competence and self-esteem.

Aged↗