Biomedical subjects
D E Henrich
Publications and source records attributed to D E Henrich.
Tracheotomy and the intensive care unit patient.
Transportation of the intensive care unit (ICU) patient to the operating room for tracheotomy has been implicated as an unnecessary source of complications and has been cited as a relative indication for percutaneous tracheotomy. However, there is very little evidence in the literature to support this claim. We evaluated 100 consecutive patients who were transported from the ICU to the operating room for tracheotomy. There were no complications related to patient transportation. A total of five complications occurred, all unrelated to patient transportation. Two patients receiving pressure control ventilation developed a pneumothorax on postoperative days 7 and 8, respectively. There were three minor complications directly related to the tracheotomy: peristomal cellulitis, tracheitis, and hemorrhage of less than 25 cc on postoperative day 1. The minor complications were treated appropriately and resolved without any adverse sequelae. We provide a detailed review of 100 consecutive ICU patient tracheotomy cases and compare this with 109 tracheotomies in non-ICU patients. Transportation of the ICU patient does not appear to increase the risk of complications during tracheotomy and should not be cited as a cause of complications in the percutaneous tracheotomy literature. The results with standard surgical tracheotomy in the controlled setting of the operating room should serve as the standard by which other procedures are judged.
Pediatric craniocervical necrotizing fasciitis.
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Effect of stenting on graft vascularization after laryngotracheoplasty.
The management of pediatric airway stenosis has been an important topic of debate over the last few decades as prolonged intubation has become more common in the neonate. Although many surgical options are available, most would agree that use of expansion techniques (laryngotracheoplasty) with cartilaginous grafting is the procedure of choice for the severely stenotic airway. Controversy persists, however, regarding the role of stents. Advocates feel that stents serve to counteract scar contracture and support the newly constructed airway. In contrast, recent studies suggest that stenting results in impaired wound healing and an increased complication rate. The present study addresses the effect of stenting on the vascularization of cartilaginous grafts in an animal model. Thirty-six New Zealand white rabbits were evaluated after laryngotracheoplasty with autogenous cartilage grafting. Half of the animals were stented with a 2-cm section of an endotracheal tube that was secured just below the glottis. Three rabbits from each group were then painlessly sacrificed on days 4, 6, 8, 10, 14, and 21. Gross and histologic comparisons of the stented and nonstented specimens revealed similar wound healing. Measurements of graft vascularization were obtained with a computerized image measurement program, and a comparison was made regarding the rate of vascularization. There was a statistically significant increase in the rate of vascularization in the stented group (mean 73% versus 55% at day 10; p < .05). This analysis suggests that stenting does not inhibit early wound healing and specifically graft vascularization after laryngotracheoplasty.
Composite graft survival. An auricular amputation model.
OBJECTIVE: To study the effects of corticosteroids and fibroblast growth factor on composite graft survival using a rabbit model of auricular amputation and reimplantation. DESIGN: Randomized, "blinded," placebo-controlled, prospective animal study. SETTING: Animal laboratory in tertiary care center. INTERVENTION: Amputation of the distal 2 cm of the rabbit ear as a composite graft and reimplantation with simple 6-0 prolene sutures. All animals underwent the same surgical procedure and were randomized into the following four groups: (1) surgical reimplantation alone; (2) 30 mg/kg intramuscular methylprednisolone sodium succinate for 5 days, starting immediately postoperatively; (3) topical basic fibroblast growth factor for 5 days postoperatively; and (4) delayed reimplantation with corticosteroids. In group 4, the ears of the animal were amputated, placed in iced saline containers for 90 minutes, and given 30 mg/kg intramuscular methylprednisolone for 5 days, with the first dose starting immediately prior to reimplantation. MAIN OUTCOME MEASURES: Percentage graft survival and histologic characteristics of viable and nonviable composite graft tissue. RESULTS: The groups that received corticosteroids and delayed reimplantation with corticosteroids had a statistically significant increase in percentage of graft survival compared with the control group (P < .003 and P < .006, respectively). The growth factor group showed no significant difference from the control group. CONCLUSION: Neovascularization occurred in the viable grafts, thus suggesting its role in graft survival. This study establishes the efficacy of corticosteroids in enhancing composite graft survival.
Outpatient uvuloplasty: an inexpensive, single-staged procedure for the relief of symptomatic snoring.
Outpatient uvulopalatoplasty is an inexpensive alternative to laser-assisted uvulopalatoplasty for relief of symptomatic snoring. This single-stage procedure successfully reduced snoring in properly selected patients. Patients reported improvement in most cases, with 55% indicating great improvement or complete resolution. Spouses reported 83% of the patients were significantly improved or resolved. To date we have had no complications, including bleeding, infection, or velopharyngeal insufficiency or stenosis.
The influence of arterial insufficiency and venous congestion on composite graft survival.
A rabbit auricular amputation model was used to study the relative effects of arterial insufficiency (AI) and venous congestion (VC) on composite graft survival. The percentage of graft survival was significantly greater for the AI group (45.8%) than for the VC group (15.9%) 2 weeks postoperatively. The percentage of graft survival at 3 weeks for the VC, AI, and noligation groups were not statistically different. All three groups were statistically different from the control group, which had both the central artery and vein ligated. The VC group also exhibited significantly more graft edema, as measured by maximal graft thickness, than the other three groups. The impact of AI and VC on composite graft survival is investigated and discussed. These results suggest that venous congestion is more detrimental to early graft survival than arterial insufficiency.
Monitoring nasal and oral airway patency.
The hypothesis that upper airway breathing behaviors generally follow the rules of a physiologic regulating system implies the existence of sensors that monitor the airway environment. The purpose of this study was to assess the sensitivity of the monitoring system to sudden changes in airway patency in healthy, adult subjects. An instrument capable of changing airway dimensions in about 10 ms was used to assess psychophysical recognition and physiologic responses to sudden changes in airway size. Our results indicate that psychophysical recognition of change in patency occurred at a mean constriction area of 0.31 cm2. These findings suggest that recognition of change in airway size occurs well before the airway becomes flow-limiting or severely obstructed.
Tinnitus and acoustic neuromas: analysis of the effect of surgical excision on postoperative tinnitus.
In this retrospective review of the 160 acoustic neuroma cases treated at The University of Iowa between 1980 and 1991, follow-up information was obtained for 82% by telephone interview. Postoperative tinnitus was a symptom reported by 75% of the acoustic neuroma patients. Overall, among patients with tinnitus preoperatively, the condition postoperatively was absent in 45%, lessened in 17%, unchanged in 30%, and greater in 8%. Detailed results are compared to other series and significant differences in the depth of comparison described.
The Carolina Children's Communicative Disorders Program. An opportunity for North Carolina's children.
The CCCDP provides devices and services to underprivileged children with communication disorders. Since its organization, the program has helped 197 children, including 21 given cochlear implants, and has disbursed 258 hearing aids or devices. It is cost-efficient program that has potential to help many of our state's needful children. We solicit referrals from all NC physicians, audiologists, speech pathologists, educators, and other professionals. Applications and financial forms will be furnished on request.
Inorganic bone and demineralized bone matrix impregnated bone cement: a preliminary in vivo study.
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Undifferentiated small-cell neoplasm of the petrous apex. A case report.
We present a rare case of undifferentiated small-cell neoplasm involving the temporal bone petrous apex. The symptoms, physical examination, importance of roentgenographic findings, and pathologic findings are reviewed. While not absolutely conclusive, the collective evidence in this case supports a diagnosis of small-cell carcinoma of the lung with metastasis to the petrous apex. A discussion of temporal bone malignancies, their frequencies, and characteristics is included. To our knowledge, a review of the literature over the past 25 years reveals no other published cases of an undifferentiated small-cell carcinoma in the temporal bone.
Fatal craniocervical necrotizing fasciitis in an immunocompetent patient: a case report and literature review.
BACKGROUND: Craniocervical necrotizing fasciitis (CCNF) is a rapidly progressive, severe bacterial infection of the superficial fascial planes of the head and neck. Group A beta-hemolytic Streptococcus, staphylococcus aureus, and obligate anaerobic bacteria are common pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CCNF. Recently the lay press has referred to necrotizing fasciitis in several articles about "flesh eating" bacteria, which have resulted in several deaths. METHODS: We report the first case of a fatality in an otherwise immunocompetent patient. The patient was a 66-year-old black man with no identifiable source of infection and no history or evidence of immunocompromising disorders. RESULTS: Despite aggressive surgical debridement and broad-spectrum antibiotic coverage, he died 30 hours after admission from multisystem organ failure secondary to overwhelming sepsis. CONCLUSION: Treatment consists of early recognition of CCNF combined with aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broad-spectrum intravenous antibiotic coverage. Although 11 other fatal cases of CCNF have been previously reported, all had an underlying medical problem which created an immunocompromised state, usually diabetes mellitus or chronic alcoholism. We present a case report and literature review along with a discussion of the related anatomy.