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Biomedical subjects

H C Grillo

Publications and source records attributed to H C Grillo.

159 records · Page 9Linked to original sources
PubMedDate not supplied

Reconstruction of the trachea after resection for neoplasm.

Sixty-three patients with primary tracheal tumours were seen in a 15-year period. The most common lesion was squamous-cell carcinoma, the next most common lesion was adenoid cystic carcinoma, and the remaining lesions were a variety of malignant and benign lesions. There were 3 carcinoid tumors in the group. Twenty-four cylindrical resections of the trachea, 2 lateral resections of the trachea, and 10 carinal reconstructions were performed. The balance of the patients seen in this period of time were not amenable to single-stage reconstruction and were managed by staged procedures, by irradiation, or by no treatment at all. Twenty-eight of the patients in the group with resections had primary tumors and 8 had secondary tumors. Secondary tumors included carcinoma of the thyroid, carcinoma of the esophagus, and recurrent carcinoid tumor in the left main bronchus. Although the numbers in any group are small and the period of follow-up not very long, indications are that surgical removal of squamous-cell carcinoma and adenoid cystic carcinoma of the trachea, usually with adjunctive irradiation, provides good palliation or the possibility of cure. Resection of benign primary tumors and low-grade malignant tumors resulted in excellent palliation and usually cure. Resection of selected secondary tumors did not offer much prospect for cure but did provide long-term palliation.

Anesthesia↗
PubMedDate not supplied

Endoscopic palliation of obstructive esophagogastric malignancy.

To investigate the efficacy of alternative endoscopic palliative therapies for obstructive esophagogastric malignancy, the experience of 53 patients treated between 1979 and 1986 was analyzed. Forty-seven patients had placement of intraesophageal prostheses. Ten patients had prostheses placed after neodymium:YAG laser therapy. In four of these patients, prosthesis placement was planned as part of the initial therapy. Twelve patients initially received laser therapy. In six, recurrent tumor was treated with intraesophageal prostheses 3 to 24 weeks after laser treatment. Comparing neodymium:YAG laser therapy to placement of the prosthesis, both techniques provided similar improvement in dysphagia. Patients receiving prostheses required less additional treatment for dysphagia. Life table analysis comparing survival rates from diagnosis to death showed no difference. The palliation provided by prostheses and neodymium:YAG laser appears to be quite similar; however, the prosthesis seems to be more lasting and require fewer resources.

Adenocarcinoma↗
PubMedDate not supplied

Acquired tracheomalacia: detection by expiratory CT scan.

PURPOSE: The purpose of this work was to determine whether cross-sectional area and coronal and sagittal diameter measurements of the trachea between inspiration and end-expiration on CT are significantly different between patients with acquired tracheomalacia and those without this condition. METHOD: Inspiratory and end-expiratory CT scans of the trachea of 23 normal patients and 10 patients with acquired tracheomalacia were analyzed. Percent changes in cross-sectional area, coronal, and sagittal diameters were calculated. RESULTS: For patients with tracheomalacia, mean percent changes in the upper and middle trachea between inspiration and expiration were 49 and 44%; mean changes in the coronal and sagittal diameters in the upper and middle tracheal were 4 and 10% and 39 and 54%, respectively. Control group mean percent changes in the upper and middle tracheal area were 12 and 14%, respectively, and mean changes in the coronal and sagittal diameters in the upper and middle trachea were 4 and 4% and 11 and 13%, respectively. Significant differences were calculated for changes in cross-sectional area and sagittal diameter between groups (p < 10-5). Based on receiver operator curve analysis, a > 18% change in the upper trachea and 28% change in the midtrachea between inspiration and expiration were observed; the probability of tracheomalacia was 89-100%. The probability of tracheomalacia was > 89%, especially if the change in sagittal diameter was > 28%. CONCLUSION: By measuring changes in tracheal cross-sectional area and sagittal diameters between inspiratory and end-expiratory CT, a significant difference can be identified between normal patients and those with acquired tracheomalacia.

Adult↗
PubMedDate not supplied

Reconstructive techniques for extensive post-intubation tracheal stenosis.

Extensive destruction of the trachea by post-intubation stenosis is usually the result of ill-advised treatment, either conservative or excisional, of an already existing stenosis. Under these circumstances, reconstruction may be done by use of adjunctive techniques, the chief of which is laryngeal release. The rarity of the need for adjunctive procedures is indicated by the fact that only 28 patients out of 208 required such procedures in an extensive series of reconstructions for these lesions. This series included 33 patients who had undergone prior attempts at surgical reconstruction and many extensive lesions which were referred to us because of their difficulty. It is emphasized that these stenoses can generally be managed safely by intubation if they are non-resectable and non-reparable, with long-term life expectancy.

Humans↗
PubMedDate not supplied

Surgical treatment of post-intubation lesions of the trachea.

One hundred and fifty-six patients with post-intubation lesions of the trachea were treated surgically. Of these patients 14 had cuff lesions as a result of ventilatory assistance with endotracheal tubes only. Cuff lesions predominated in those who had tracheostomy tubes. There were six tracheo-esophageal and one tracheoarterial fistulas. The majority of the patients were repaired by end to end anastomosis through the cervical route, most of the others through the cervico-mediastinal route with only five patients by the transthoracic approach. Ninety-one percent have achieved either a good or satisfactory result to date.

Humans↗