The management of difficult extubation in pre-term infants.
Explore the source record for details and available documents.
Female↗
Biomedical subjects
C D Verwoerd
Publications and source records attributed to C D Verwoerd.
Wound healing of laryngeal trauma and the development of subglottic stenosis.
Explore the source record for details and available documents.
Animals↗
Injury- and age-linked differences in wound healing and stenosis formation in the subglottis.
We studied the effects of superficial and deep endolaryngeal trauma of the subglottic airway in young and adult rabbits. In both age groups a soft stenosis was formed as long as the cartilaginous cricoid ring is not involved. This stenosis comprised a thickened subepithelial zone of scar tissue, separated from the cricoid cartilage by a layer of fatty tissue. Injury of the internal side of the cricoid cartilage induced a compact mass of scar tissue with local differentiation into fibrocartilage. In young animals only, injury of the cartilage led to remodelling of the cricoid ring (indentation or collapse of the traumatized sectors). On the basis of the differentiating effects of age and depth of the lesion, three histopathological types of subglottic stenosis were distinguished. The experimental results provide an explanation for the variability in the histopathological features of the wall of the stenotic subglottic airway, as observed in biopsies and postmortem specimens.
Aging↗
Management of infant laryngeal disorders in relation to wound healing processes of the rabbit larynx.
Laryngotracheal injury caused by prolonged intubation is mostly treated by reintubation or surgical intervention. To understand the histopathological processes involved in wound healing of laryngeal trauma and to assess the value of reintubation as treatment for post-intubation injury, the findings of a study in preterm infants were placed next to the results of experimental studies on laryngeal disorders in young, growing rabbits. Observations at laryngobronchoscopy in the child are compared to histopathological investigations in the animal. In both series various, evidently similar categories of injury could be distinguished viz. edema, ulcerations and granulations. The results of treatment like reintubation would vary with the diagnosed category of the injury; the more granulation tissue, the less successful conservative treatment will be. It is concluded that histopathologic classification is essential for good management of intubation injuries and that therapeutic re-intubation in case of superficial lesions should precede the decision for surgery.
Animals↗
Intrinsic and extrinsic factors relevant to the morphology of the growing cricoid ring after a combined anterior and posterior cricoid split: an experimental study in rabbits.
The effects of a Rethi procedure upon the cricoid is investigated in young rabbits. An anterior and posterior cricoid split carried out upon the larynx of a young rabbit was demonstrated to result in an enlarged cricoid lumen in the adult stage due to an enhancement of both the anterior and posterior transversal diameter of the ring. These changes are ascribed to a release of interlocked stresses in the cricoid cartilage and the action of the cricopharyngeal and cricothyroid muscle.
Animals↗
Reduction of the number of neck treatments in patients with head and neck cancer.
With modern diagnostic imaging techniques, the head and neck oncologist is faced with increasing information on the status of neck nodes of patients with head and neck cancer. It is often difficult to include this new diagnostic information in clinical management because strategies of neck treatment date from times when only clinical examination was available. Computed tomography, magnetic resonance imaging, and ultrasonography (US) may provide information on the status of neck nodes. In the University Hospital Leiden and the University Hospital Rotterdam, US of the neck, when combined with ultrasonographic fine-needle aspiration biopsy (US-UGF-NAB), has proved to be an accurate diagnostic test for nodal disease. The combined procedure is characterized by high sensitivity and specificity. Therefore, this technique is suited for detecting, demonstrating, and excluding nodal metastases. This article will discuss how to interpret the new diagnostic information supplied by US-UGFNAB. A different approach in the clinical management of the neck, based on techniques from the field of clinical decision analysis, will be presented. It is concluded that US-UGFNAB is a promising concept of methodic use of both cytologic examination and an imaging technique in the examination of patients with squamous cell carcinoma of the upper aerodigestive tract. Application of the test may produce an accurate classification of patients with a head and neck tumor and change indications for elective and therapeutic neck treatment.
Biopsy, Needle↗
Reconstruction of the growing cricoid with a composite graft of demineralized bovine bone and autogenous perichondrium; a comparative study in rabbits.
In growing rabbits, the feasibility of a new type of composite graft for the reconstruction of defects in the cricoid ring is studied. This graft consists of Demineralized Bovine Bone matrix (DBBM) enfolded in a perichondrial flap. The cartilage formed in the DBBM by cells, derived from the perichondrium, is demonstrated to provide a valuable substitute for resected parts of the cricoid. A specific feature of this reconstruction is that it allows further growth and does not result in a secondary stenosis during later development.
Animals↗
Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum.
Using the nose of growing rabbits as an experimental model, the effects on nasal growth of various Killian-type partial resections of the cartilaginous septum were studied. Larger resections in young animals caused decreased height and length of the nose in the adult stage. Partial resection of the basal rim of the cartilaginous nasal septum demonstrated no effects on the postnatal growth of the nasal dorsum. This is in agreement with the hypothesis that the growth of the nasal dorsum is mainly the result of expansion of an area of thick cartilage within the nasal septum extending from the sphenoid to the nasal dorsum.
Animals↗
Ectopic cartilage in subglottic stenosis: hamartoma or reaction to trauma?
In an experimental study in growing rabbits an endolaryngeal injury to the subglottis resulted in the development of a stenosis due to the formation of scar tissue containing ectopic cartilage. For comparison, biopsies taken from the subglottic stenosis in 8 children were studied histologically. In 6 cases ectopic cartilage was observed; all patients had a history of endotracheal intubation. In 3 children the diagnosis hamartoma was made. In the remaining 3 cases the formation of ectopic cartilage might have been a direct reaction to the endolaryngeal intubation. The observations suggest that the formation of ectopic cartilage in acquired subglottic stenosis is not always due to a developmental aberration such as a hamartoma.
Animals↗
Present day treatment of nasal fractures: closed versus open reduction.
Explore the source record for details and available documents.
Fracture Fixation↗
The influence of ageing on wound healing of the cricoid.
In young and adult rabbits the effects of one anterior or two bilateral splits of the cricoid were studied. Interruption of the cricoid ring elicits wound healing of the cut edges and induces changes in form and size of the separated parts of the cricoid (indirect effect). It was demonstrated that with increasing age i) the wound healing capacities of the hyaline cartilage is highly diminished or lost and ii) the induced remodelling, involving the total ring in young animals, is in the adult stage confined to the posterior part. Moreover, the observations suggest that dividing the cricoid ring in an anterior and posterior part at a young age can result in a stimulation of growth of the anterior part, in comparison with unoperated control animals.
Aging↗
Ultrasound-guided fine-needle aspiration biopsy of neck nodes.
The assessment of nodal involvement in patients with squamous cell carcinoma of the head and neck is still a major diagnostic problem. Although the sensitivity of imaging techniques for detection of neck nodes is gradually improving, the specificity for metastases remains low. Cytologic examination could, theoretically, supply additive information. Computed tomographic-and magnetic resonance-guided aspiration techniques have been described, but these were not efficacious and laborious. In 1984, we developed a technique for ultrasound-guided (UG) fine-needle aspiration biopsy (FNAB). This technique is described herein, and the value of UGFNAB is compared with conventional FNAB. All statistical characteristics of UGFNAB appeared to be superior to conventional FNAB (sensitivity, 98% vs 88%; specificity, 95% vs 82%; positive predictive value, 98% vs 93%; negative predictive value, 95% vs 74%; and accuracy, 97% vs 87%). Furthermore, UGFNAB was characterized by less nondiagnostic aspirations. It is concluded that UGFNAB is a reliable technique for differentiation between benign nodes and cervical lymph node metastases and it may, therefore, contribute to a more accurate assessment of the neck in squamous cell carcinoma of the head and neck.
Biopsy, Needle↗
Histologic evaluation of crushed cartilage grafts in the growing nasal septum of young rabbits.
The evolution of crushed cartilage grafts in a growing nasal septum of young rabbits was histologically investigated. Crushing leads to necrosis of the greater part of the graft. The characteristic distribution of surviving cells in isolated areas at the surface of the graft reflects different mechanical properties of the centrally and peripherally located cartilage. The necrotic parts are eliminated and replaced by new cartilage formed by surviving chondrocytes or perichondrium. The result is a complex structure composed of two types of cartilage and of fibrous tissue without any distinct organization, but nevertheless capable of growth. However, it lacks strength to transform growth into adequate lengthening of the septum. Subsequently, this will lead to the development of multiple deviations. It is concluded that crushed cartilage is no suitable implant for the reconstruction of parts of the septum which are essential in supporting the outgrowth of the nose.
Animals↗
Wound healing of autologous implants in the nasal septal cartilage.
The cartilaginous nasal septum of the child is often involved in trauma or congenital deformation. In perspective of its role in postnatal growth of the midface, the wound healing of septal cartilage in reaction to various surgical procedures was studied in young rabbits. It was concluded that (1) elevation of mucoperichondrium does not induce significant histologic reactions in the septal cartilage and (2) the wound reaction of cut edges includes only a +/- 0.8-mm-deep zone and lasts no longer than 2 weeks, resulting in a stump, encapsulated by fibrous tissue. Reconnection of separated parts occurs 2 weeks after surgery, mostly by merging of the perichondrial layers. Reimplantation of resected cartilage does not lead to normalisation of septal growth. This is not caused by extensive necrosis, loss of morphological organisation or decreased growth potential of the reimplanted cartilage. The essential factor seems to be dislocation (duplication, angulation) of the implant versus the non-mobilised parts of the septum preventing the growth of the implant to contribute fully to the lengthening of the total septum.
Animals↗
Trauma of the cricoid and interlocked stress.
In young rabbits the effects were studied of an anterior midline and a bilateral split with and without traumatisation of the perichondrium and subperichondrial cartilage on the inner side of the ring. Various interventions produced specific patterns of distortions. It is concluded that release of interlocked stress in the cartilage is of paramount importance for the development of deformities. A specific feature of the circular cartilaginous structure seems to be that the tensile forces on the outer side of the ring exceed those on the inner side.
Animals↗
Ultrasound-guided percutaneous drainage of deep neck abscesses.
Deep neck abscesses may still result in significant morbidity and mortality. Surgical therapy carries the risk of damage to cranial nerves and arteries. Excellent results of ultrasound-guided percutaneous catheter drainage of abdominal abscesses led us to apply this technique to the management of deep neck abscesses. Five patients were treated with ultrasound-guided catheter drainage and antibiotics. All patients were cured without complications or recurrences. We consider this cheap and highly effective treatment as a valuable alternative to conventional therapy.
Abscess↗
Wound healing of the nasal septal perichondrium in young rabbits.
The effects of elevation of the perichondrium of the nasal septum, whether or not followed by resection of the cartilage, was histologically studied in young rabbits. The perichondrium has proved to be a highly reactive tissue. The degree of reaction varied from a transient oedema to the production of large quantities of cells, differentiating into new cartilage. The type of reaction appeared to depend on the conditions at the inner surface of the elevated perichondrium. The new cartilage differs from the original septal cartilage in morphology and growth potential. The data described above can contribute to the interpretation of previous observations in children.
Animals↗
Anatomy of the upper lateral cartilages in the human newborn.
The morphology of the upper lateral cartilages in the newborn child was studied by dissection of the nose in two stillborns. It was found that the cartilaginous nasal dorsum extends from the tip of the nose for the full length under the nasal bones and in lateral direction on the inner surface of the frontal process of the maxilla. Septum and upper lateral cartilages form a double vaulted structure as in the fetal stages. The marked differences between the neonate and adult anatomy must be respected in rhino- and facial surgery in young children.
Cartilage↗