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Biomedical subjects

C W Vaughan

Publications and source records attributed to C W Vaughan.

117 records · Page 7Linked to original sources
PubMedDate not supplied

Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis.

Stenosis of the larynx and/or trachea presents perplexing problems. No one technique has proved totally satisfactory in the management of all varieties of stenosis. Recent reports have described the successful use of the CO2 laser in the endoscopic management of stenosis of the larynx and trachea. Failures of this technique need emphasis to assure appropriate selection of therapeutic method. Retrospectively, 49 cases of laryngeal stenosis, 6 cases of tracheal stenosis and 5 cases of combined laryngeal and tracheal stenosis were studied (total 60 patients) following treatment at the Boston University Affiliated Hospitals. Follow-up ranged from 1 to 8 years. Multiple procedures were required in 35 laryngeal patients. Of the laryngeal patients 39 were successfully managed (average number of procedures in successful cases 2.18). Of 11 tracheal patients with combined laryngeal and tracheal procedures, 3 were successfully managed (average number of procedures in successful cases 6). Failures in laryngeal stenosis included four patients in whom an adequate airway was not established though voice was present while maintaining tracheostomies. Thirteen patients failing endoscopic management required open surgery with good result. Factors associated with poor result or failure include circumferential scarring with cicatricial contracture, scarring wider than 1 cm in vertical dimension, tracheomalacia and loss of cartilage, previous history of severe bacterial infection associated with tracheostomy, and posterior laryngeal inlet scarring with arytenoid fixation. In these circumstances, multiple procedures, more extensive alternative open surgical techniques, or maintenance of tracheostomy were necessary. In successful cases only three or fewer procedures on average were required. The factors associated with failure or success of endoscopic methods in the management of laryngotracheal stenosis, including use of the CO2 laser and soft Silastic stents, are analyzed.

Adolescent↗
PubMedDate not supplied

Synergistic effects of sequential carbon dioxide and neodymium:yttrium aluminum garnet laser injuries. Experimental observations and measurements.

The carbon dioxide and neodymium:yttrium aluminum garnet lasers have well documented but characteristically different biological effects, yet little is known about their cumulative, synergistic, or paradoxical effects when used sequentially on living tissue. Using a Merrimack ML 880 laser, a series of superimposed CO2 and Nd:YAG lesions in various combinations were produced on the undersurface of dog tongues. Therapeutic time and power settings were chosen and the number of applications varied, with suitable controls. Observations and measurements were made on acute, healing, and healed lesions. All lesions were excised and submitted for routine hematoxylin and eosin histology. Acute lesions were also assessed for cell viability using rhodamine 123 as a supravital marker. The results show that, even though all the lesions eventually heal, the actual cell damage produced by the Nd:YAG laser is much more than is suggested by the size of the acute lesion. This cell damage can be reduced by the surface carbonization produced by initial application of the CO2 laser. Higher surface temperatures are reached in this combination with less fibrosis and scarring than equal energy counterparts where the Nd:YAG laser was applied first. The knowledge of these synergistic effects can be used to advantage in the clinical setting. The rhodamine 123 technique also appears to be a valid measure of acute thermal tissue injury.

Animals↗
PubMedDate not supplied

Otolaryngologic manifestations of orbital pseudotumors.

Orbital pseudotumor is believed to be a nonspecific, acute or chronic inflammatory process involving the intraorbital soft tissue. Orbital pseudotumor may masquerade as sinusitis with orbital complications or as a severe upper respiratory tract infection. Five cases are presented to illustrate the difficulties in diagnosis when initial symptoms relate to the upper respiratory system rather than to an isolated orbital mass. In these cases, orbital ultrasound and computed tomograms were helpful in making the diagnosis. Treatment consisted of systemic corticosteroids in four of the five patients. Recognition of early symptoms and findings, along with earlier involvement with the ophthalmologist, will make a more effective treatment regimen possible.

Adult↗
PubMedDate not supplied

Simultaneous carcinomas of the esophagus and upper aerodigestive tract.

A review of 150 consecutive head and neck cancer patients over a 22-month period revealed a multiple primary cancer rate of 19%, 9% in the head and neck region. Nine patients (6%) had simultaneous esophageal and head and neck cancers. Complete systematic esophagoscopic examinations, in addition to barium swallow radiographic studies, are recommended for all patients with head and neck cancers.

Adult↗
PubMedDate not supplied

Pretreatment airway management in obstructing carcinoma of the larynx.

Partial endoscopic excision of obstructing laryngeal carcinoma with the CO2 laser is an alternative to emergency tracheotomy or emergency laryngectomy whenever the airway control can be initially ensured by endotracheal intubation. The practical advantages of this approach are elimination of the septic complications of tracheotomy, the opportunity for planned preoperative chemotherapy or radiation therapy, and better nutritional and psychologic preparation of the patient for surgery.

Adult↗
PubMedDate not supplied

The use of CO2 laser in otolaryngology: a progress report.

Since 1971 the CO2 laser has been used in otolaryngology at Boston University School of Medicine, University of Illinois, and the Eye, Ear, Nose, and Throat Hospital, New Orleans; over 560 patients have been cared for and over 1,000 operations performed. The instruments have proved to be reliable and the use of CO2 laser relatively free of complications when appropriate precautions are taken. The nature of the laser wound is such that laser surgery has facilitated the management of numerous benign and malignant lesions of the larynx as well as the oral cavity, pharynx, and tracheobronchial tree. Laser surgery is associated with a minimal morbidity, excellent healing, minimal scar formation, and excellent residual function. The instrument has been most useful in the management of lesions situated in relatively inaccessible areas such as the nasopharynx, subglottic area of the larynx, and tracheobronchial tree. The advantages of laser surgery in otolaryngology are so significant that it can be recommended for continued usage. Many applications of this unique surgical instrument have been identified but others need to be explored in the future.

Carbon Dioxide↗