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Biomedical subjects

H C Grillo

Publications and source records attributed to H C Grillo.

At least 109 records · Page 6Linked to original sources
PubMed1984

Management of obstructive tracheal disease in children.

Fifty-two patients from seven weeks to 15 years of age were treated for congenital (six patients) or acquired (46 patients) tracheal lesions. Twenty underwent tracheal resection and reconstruction: congenital stenosis 3 (5 to 9 yr), postintubation stenosis 9 (11 to 15 yr), TEF 1 (15 yr), posttraumatic 2 (9 to 15 yr) idiopathic 1 (14 yr) and primary tumors 4 (8 to 15 yr). There were two carinal resections. There were two deaths and two postoperative stenoses, one of which was corrected later, giving 17 final good results. Thirty-two patients were treated nonoperatively.

Adolescent↗
PubMed1983

Combined approach to "dumbbell" intrathoracic and intraspinal neurogenic tumors.

The unexpected finding of an extension of a neurogenic tumor from the thorax through the spinal foramen into the neural canal complicates its removal. Serious neurological complications may result from a two-stage approach, whether done first through the thorax or neural canal. Vertebral tomography or computed tomographic scanning reveals enlargement of a spinal foramen in advance of operation. Myelography confirms the probable presence of an intraspinal component. Four patients have been operated on using an approach designed to allow wide posterolateral thoracotomy and concomitant laminectomy for single-stage removal of the entire tumor. In 3 patients the diagnosis was schwannoma and in 1, neurofibroma. All had good results.

Adult↗
PubMed1983

Tracheal surgery.

In the last 20 years the techniques for resection of the trachea with primary reconstruction have evolved to a point where most lesions involving up to 50% of the trachea can be successfully and dependably managed. A notable exception is the lengthy infiltrating adenoidcystic carcinoma. Postintubation stenosis is largely correctible in an initial operative approach. The operation has such a high degree of success that it appears to be the treatment of choice. Primary tracheal tumors and selected secondary tracheal tumors are often amenable to surgical resection, with the addition of radiotherapy for certain histologic types. Results strongly support this aggressive approach. Three problems of current interest seem to be yielding to surgical correction although decisions about the time of surgery, the delicacy of surgical execution from the postoperative management all present difficult problems. These are the repair of the rare congenital tracheal stenosis in children, resection and reconstruction of the carina and correction of subglottic and upper tracheal stenosis.

Burns↗
PubMed1983

Acquired nonmalignant tracheoesophageal fistula.

Acquired tracheoesophageal fistula (TEF) caused by cuffed tracheal tubes, surgical trauma, and blunt injuries is an unusual and serious problem. Several differing approaches to management have been proposed. We have repaired such fistulas in 20 patients; 14 of them were related to tracheal intubation, three to blunt trauma, two followed anterior cervical spine fusions, and one resulted from a foreign body. Fistula closure on ventilator-dependent patients was usually delayed until they were weaned from respiratory support. Four patients had esophageal diversion before repair of their fistulas. There was sufficient tracheal damage to require resection and end-to-end anastomosis in 13 patients. The esophageal defect was closed directly in 16 patients, and end-to-end reconstruction of the esophagus was accomplished in four. There were two deaths, and one fistula recurrence required reoperation. These results support our recommendations to delay fistula closure in most ventilator patients, to use esophageal diversion selectively, to employ tracheal resection when there is evidence of extensive damage, and to directly repair the esophagus.

Adolescent↗
PubMed1982

Carcinoma of the lung: what can be done if the carina is involved?

When carcinoma of the lung invades the carina, it is by definition a stage III lesion and frequently incurable. However, when lymph node invasion does not preclude resection for cure and when there are no other contraindications to such resection, techniques are now available for resection of the carina and primary reconstruction. While tracheal sleeve pneumonectomy is the operation most frequently employed for invasion of the carina by bronchogenic carcinoma that is otherwise operable, occasionally the lower lobe may also be saved. When the carina is involved by a primary neoplasm of the airways, primary resection with carinal reconstruction with or without various amounts of pulmonary resection is clearly indicated when possible.

Carcinoma↗
PubMed1982

Management of tracheal tumors.

Since 1962, 110 primary tracheal tumors have been seen including 43 squamous cell carcinomas, 38 adenoid cystic, and 29 varied. Sixty-nine patients underwent resection of their primary tumors; an additional 33 patients with secondary tumors involving the trachea also underwent resection. Seventy-three of these 102 patients underwent primary reanastomosis. In 17, laryngotracheal resection was required; staged resections were done for the rest. Survival data indicate that benign tumors are cured by resection with reconstruction and that patients with squamous cell carcinoma, adenoid cystic carcinoma, and other types of malignant lesions obtained either long-term palliation or cure if surgical resection was possible. In patients with selected types of secondary tumors, resection and reconstruction provide prolonged palliation.

Airway Obstruction↗
PubMed1982

Carinal reconstruction.

Thirty-six carinal resections were performed: 23 for primary neoplasms of the airways, 5 for bronchogenic neoplasms, and 8 for inflammatory lesions. In 31 cases, primary reconstruction was done. Eleven reconstructions were performed without pulmonary resection; in 5, right upper lobectomy was also done, in 9 pneumonectomy, and 6 patients had had a prior left pneumonectomy. Five staged reconstructions were attempted. The mode of reconstruction depended on the precise location and extent of the lesion. Bronchial anastomoses to the side and end of the trachea or to the end of the trachea and to the side of a bronchus predominated. Four deaths occurred among the 31 patients who had primary reconstruction (13%). Two patients with anastomotic stenoses had successful reexcision. Attempts at staged reconstruction failed.

Adult↗
PubMed1982

Esophageal perforation.

Esophageal perforation can be caused by any instrument, device, or foreign body reaching the hypopharynx. Diagnosis remains difficult. If esophageal perforation is suspected, Gastrografin (meglucamine diatrizoate) swallow study, eventually followed by barium swallow study, is the most useful diagnostic test. Absolute rules cannot be made about the selection of nonoperative or surgical treatment. If diagnosed early, cervical or thoracic esophageal perforations can sometimes be treated conservatively if there are no signs of systemic sepsis. Recurrent leakage after surgical closure is not unusual. Local tissue flaps can reinforce the closure, particularly after delayed operation, thereby often avoiding the necessity for a reoperation or an esophageal exclusion.

Esophageal Diseases↗
PubMed1982

Primary reconstruction of airway after resection of subglottic laryngeal and upper tracheal stenosis.

Eighteen patients with low subglottic laryngeal stenosis and upper tracheal stenosis underwent resection of the anterior and lateral cricoid cartilage and upper trachea with reconstruction by primary laryngotracheal anastomosis. The posterior cricoid plate and recurrent laryngeal nerves were preserved. The distal trachea was tailored obliquely with an anterior prow and was anastomosed to the thyroid cartilage anteriorly and to the residual cricoid posteriorly. Where the stenosis was circumferential, scarred mucosa was resected from the anterior surface of the posterior cricoid lamina and the defect covered with a tailored flap of membranous tracheal wall. In 14 patients the lesions followed intubation injury. In 2 the stenosis was idiopathic. One stenosis resulted from inhalation burn and one from localized amyloidosis. Many patients had undergone previous surgical repairs. Sixteen patients had good to excellent results from six months to five and one-half years later. Reconstruction of the burned airway failed. One additional patient is still under treatment with a T tube.

Adolescent↗
PubMed1981

Operative and nonoperative management of esophageal perforations.

During a 21-year period, 72 patients were treated for esophageal perforations; the diagnosis was made only at postmortem examination in 13 other patients. Fifty-eight of 85 patients (68%) sustained iatrogenic perforations, 11 patients (13%) had "spontaneous" perforation, nine patients (11%) had foreign body related perforation, and seven patients (8%) had perforation caused by external trauma. Eleven cervical perforations, contained between the cervical paravertebral structures, plus eight thoracic perforations, contained in the mediastinum, were treated with antibiotics, intravenous hydration, and nasogastric drainage. The mortality rate after this nonoperative approach was 16% (3/19 patients). Indications for operative treatment in 53 patients were hydropneumothorax with mediastinal emphysema, sepsis, shock and respiratory failure. The operative mortality rate in these instances was 17% (9/53 patients). Six of the nine patients who died had been operated on more than 24 hours after the onset of symptoms. For cervical perforations the best results were obtained by drainage plus repair of the perforation (mortality rate: 0%; 0/10 patients) and for thoracic perforations by suturing supported by a pedicled pleural flap (mortality rate: 11%; 1/9 patients). Simple drainage of thoracic perforation was followed by a mortality rate of 43% (3/7 patients).

Esophageal Perforation↗
PubMed1979

Surgical treatment of postintubation tracheal injuries.

Two hundred-eight patients underwent tracheal resection and reconstruction for postintubation injuries from 1965 to early 1979. All but seven had received ventilatory assistance. Thirty-three had undergone prior attempts at surgical reconstruction. Twenty-three had had endotracheal tubes only. the patients had 112 cuff lesions, 78 stomal, 13 at both levels, and four lesions of uncertain origin. One hundred ninety-four had stenosis with or without accompanying malacic change, four showed "pure" malacia, nine had tracheoesophageal fistulas, and one had a tracheoinnominate fistula. There were many laryngeal injuries: 25 of these were major injuries to the low subglottic larynx, necessitating partial or complete removal of the anterior cricoid cartilage. Two hundred sixteen reconstructions were dond, eight for restenosis after initial resection. Cervical approach was used in 126, cervicomediastinal in 83, transthoracic in sic, and cutaneous reconstruction in one. The length of resection extended to 7 cm. Techniques for obtaining tension-free anastomosis included cervical flexion in all, laryngeal release in 20, hilar release in two, and use of partial external splinting in four. Fifty-seven required laryngotracheal anastomosis and nine partial laryngoplasty. Concurrent tracheostomy was rare except in the last group. One hundred-two open stomas were variously managed. There were five deaths (2%)-only one in a truly elective patient. Nine failures (5%) occurred. Ninety-three percent (189 patients) showed good (168) or satisfactory (21) results. Granulations at the suture line, necessitating bronchoscopy, were the most common complication, now seemingly avoided by use of absorbable sutures. Only one patient had postoperative innominate arterial hemorrhage.

Adolescent↗
PubMed1978

Tracheal carcinoids.

Three cases of carcinoid tumor arising in the trachea are reported and contrasted with carcinoids arising in bronchi and carcinoids in general. Only eleven other documented examples of tracheal carcinoids are found in the English literature. The true prevalence of carcinoids primary in the trachea cannot be accurately determined from the literature because of imprecise nomenclature or because of the failure to distinguish this tumor from carcinoids primary in the bronchus. Presenting symptoms are hemoptysis, dyspnea and wheezing, often persisting for many years before the correct diagnosis is made. The treatment of choice is surgical resection of the involved segment of trachea and primary reconstruction. The prognosis is generally good. The tumor metastasized in one of our three cases and in none of the eleven cases in the English literature.

Adolescent↗
PubMed1978

Tracheal tumors: surgical management.

In a 15-year period, 63 patients with primary tracheal tumors were seen. Twenty-eight patients with primary tumors and 8 with secondary tumors of the trachea were treated by resection with single-stage reconstruction. There were 24 cylindrical resections of trachea, 2 lateral resections of trachea, and 10 carinal reconstructions. Thirty-five additional patients with primary tracheal tumors were managed by staged reconstruction, irradiation, or no treatment. The most common primary lesion was squamous cell carcinoma and the second, adenoid cystic carcinoma. Benign primary tumors and low-grade malignant tumors obtained excellent palliation and usually cure. Surgical removal of squamous cell carcinoma and adenoid cystic carcinoma, usually with adjunctive irradiation, provided good palliation or the probability of cure. Resection of selected secondary tumors provided long-term palliation.

Airway Obstruction↗