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Biomedical subjects

B Benjamin

Publications and source records attributed to B Benjamin.

120 records · Page 7Linked to original sources
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Ten-year review of pediatric tracheotomy.

One hundred sixty-four consecutive tracheotomies are reviewed over the 10-year period 1972-1981. Early in the series acute inflammatory airway obstruction was the major indication for tracheotomy, being 60% of cases in the first 3 years. In the last 3 years this fell to approximately 15%. After 1975 nasotracheal intubation replaced tracheotomy for acute epiglottis. More recently it has become the treatment of choice for acute laryngotracheobronchitis. Tracheotomy prior to reconstructive surgery for major craniofacial abnormalities is becoming more frequent. Acquired subglottic stenosis is not a problem in our hospital despite the use of long-term nasotracheal intubation in premature infants, and no tracheotomies were performed for this indication. There were few major complications. Decannulation difficulties were due to obstruction by stomal granulation tissue or displaced flap of anterior tracheal wall. There was no case of hemorrhage, no posttracheotomy stenosis, and no death was attributable to tracheotomy. These results demonstrate that in a major pediatric hospital tracheotomy is a relatively safe and effective procedure with minimal morbidity.

Acute Disease↗
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Congenital laryngeal hemangioma.

Congenital subglottic hemangioma consistently occurs in a site below the vocal cord. It is a distinct clinical entity with typical clinical features. However, congenital hemangioma in other sites can cause airway obstruction. An anatomical classification is proposed on the basis of review of 23 consecutive cases. It is important to accurately identify the site and distribution of the lesion before commencing treatment. Radiation has been an acknowledged form of treatment, and in our hospital we have confirmed that radiation therapy, either by external beam, or by insertion of a radioactive gold grain, gives good results. The theoretical possibility of radiation-induced malignancy in the thyroid gland is reduced to an absolute minimum by use of a radioactive grain for localized tumor-dose with minimum radiation of surrounding tissue.

Female↗
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Anesthesia for laryngoscopy.

The requirements of anesthesia for laryngoscopy and microlaryngeal surgery must be compatible with maximum safety and minimum patient discomfort. Some techniques require the use of an endotracheal tube while some do not. Others use a modified tube or a jetting system. In general, for pediatric endoscopy we prefer spontaneous respiration with inhalational anesthesia supplemented by topical lignocaine (lidocaine), and in adults, a relaxant technique with controlled jet ventilation supplemented by topical lignocaine. A new pediatric microlaryngoscope and a new tube for jet ventilation in older children and adults are described.

Age Factors↗
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Tracheomalacia in infants and children.

The clinical features of tracheomalacia depend on the location, length, and severity of the weakness of the tracheal wall. There is firm evidence that tracheomalacia in association with tracheoesophageal fistula is due to malformation and deficiency in the tracheal wall, but in other types of tracheomalacia the evidence is less conclusive. A classification is proposed, based on the known histopathologic and endoscopic changes. Endoscopy is considered the most reliable diagnostic examination.

Arteriovenous Malformations↗
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Technique of laryngeal photography.

Many techniques for photography during direct laryngoscopic examination have been described over the years. At present the best quality laryngeal photographs are obtained using a modern 35-mm single-lens reflex camera with the Hopkins telescopes and a synchronized electronic flash generator. This versatile system gives consistently reliable results.

Anesthesia↗
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Evaluation of choanal atresia.

A series of 65 cases of choanal atresia seen in 19 years is reviewed. We use a wisp of cotton fiber held under the nose and a plastic catheter passed into each nasal cavity to test nasal patency. Horizontal computerized tomography is confirmed as the radiological study of choice, and a standard endoscopic technique used during surgical correction is described.

Airway Obstruction↗
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Vocal cord granulomas.

A series of 16 vocal cord granulomas in adults and children were studied; of these, seven occurred postintubation. All granulomas were removed at least once and the recurrence rate was high. On average, there were three removals, and some patients are still under observation. The recurrence rate did not seem to be related to removal by surgical excision or by laser. We postulate, contrary to conventional teaching, that vocal ulcer and vocal cord granuloma should be regarded as separate entities which occur at the same anatomical site.

Adolescent↗
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A new adult microlaryngoscope.

A new "slimline" binocular microlaryngoscope has been designed for use in adults in whom the larynx is difficult or impossible to visualize with standard microlaryngoscopes.

Equipment Design↗
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Vocal nodules in children.

We reviewed 27 pediatric patients who had vocal nodules removed surgically in a 5-year period. Age of operation, duration of symptoms, indications for operation, and the results of removal are analyzed. The techniques of laryngoscopic assessment with telescopes and of microsurgical removal are described in detail. The 27 children had 53 nodules removed. Almost all had normal or improved voices as judged by the parents' answers to a written questionnaire. From the results of this series, microsurgical removal of vocal nodules in children is justified in selected patients.

Adolescent↗
PubMedDate not supplied

New endoscope for (laser) endoscopic diverticulotomy.

In the United States, traditional treatment of the hypopharyngeal (Zenker's) diverticulum has been single stage transcutaneous diverticulectomy. Complications following this procedure include mediastinitis, vocal cord paralysis, esophageal stenosis, fistula, and recurrent or persistent diverticulum. Endoscopic diverticulotomy, widely used throughout Europe, is relatively straightforward and efficacious. Transoral management of these diverticulae has allowed symptomatic relief with a low incidence of complications. A new endoscope has been developed to facilitate use of the carbon dioxide laser for endoscopic diverticulotomy. The instrument combines the characteristics of the Dohlman endoscope (bilateral distal slots) with a wider proximal end for microscopic endoscopy, a smoke evacuator channel, a fiberoptic light carrier, and a handle adaptable for suspension microendoscopy.

Aged↗