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Biomedical subjects

J A Schild

Publications and source records attributed to J A Schild.

14 recordsLinked to original sources
PubMed1991

Laryngeal changes during exercise and exercise-induced asthma.

Exercise-induced asthma is defined as bronchospasm within the distal airways initiated by exercise. Whether the larynx responds to produce an exacerbation or alleviation of symptoms during an attack has never been evaluated. Thirty subjects were tested, including 15 normals and 15 with exercise-induced asthma. Laryngeal response to exercise was determined by measuring the area of the glottic aperture before, during, and after exercise. The glottis was visualized with a flexible laryngoscope and video images were recorded during monitoring of respirations. Asthma was induced in subjects by having them exercise on an ergometer for 10 minutes while breathing dry air at 10 degrees C. Measurements were subsequently made from recorded images and relative glottic areas were compared between groups. Our data quantify the normal physiologic response of the larynx to exercise and demonstrate a substantial laryngeal contribution to asthma induced by exercise.

Adolescent↗
PubMed1990

Chondrosarcoma of the larynx. Diagnosis with magnetic resonance imaging and computed tomography.

Chondrosarcomas are the most common sarcomas of the larynx. They are generally slow-growing lesions with insidious onset of symptoms. We are presenting a case of chondrosarcoma that recurred 10 years after excision of a presumed chondroma. Computed tomographic and magnetic resonance imaging (MRI) scans were performed. Both studies delineated the lesion nicely. To the best of our knowledge, this is the first report on MRI characteristics of chondrosarcoma of the larynx. A review of the literature regarding the use of computed tomography in the management of chondrosarcoma is presented. The MRI characteristics are discussed and the two scanning modalities are compared. Computed tomography is an excellent study in its ability to demonstrate the extent of the lesion within the laryngeal skeleton. Furthermore, it is more highly sensitive than plain roentgenograms in the detection of calcifications that are highly suggestive of chondrosarcoma. Alternatively, MRI can also demonstrate the lesion within the larynx but it has the added advantage of superior contrast resolution of the tumor and paralaryngeal tissues. When the three-dimensional imaging capacity of MRI is considered as well, MRI seems to be the superior study.

Aged↗
PubMed1990

Epiglottic laryngoplasty for repair of blunt laryngopharyngeal trauma.

Two unique cases of blunt laryngopharyngeal trauma are presented in which identical injuries were sustained to the supraglottic larynx and hypopharynx. Examination of the patients included the use of magnetic resonance imaging to help define the extent of injury. A successful outcome was achieved in each instance by employing the reconstructive technique of epiglottic laryngoplasty to repair the mucosal defects.

Accidents, Traffic↗
PubMed1990

Platysma myocutaneous flap for repair of hypopharyngeal strictures.

Hypopharyngeal strictures, either isolated or in conjunction with laryngeal and esophageal strictures, can occur following lye ingestion. Extensive stricture formation requires reconstruction to create a functional funnel system that empties below the cricoid. Esophageal replacement is not a substitute for adequate hypopharyngeal reconstruction. The pectoralis major muscle is often inadequate, because it yields too much bulk and often leads to continued aspiration. The platysma myocutaneous flap for hypopharyngeal reconstruction has not been previously reported. The inferiorly based platysma myocutaneous flap was used in two of our patients with lye burns, and bilateral superiorly based flaps were used in one. All are able to eat normally and have no significant stenosis. The platysma myocutaneous flap is a relatively simple and reliable alternative that is within the capability of every head and neck surgeon.

Adult↗
PubMed1990

Successful use of nasal-CPAP for obstructive sleep apnea in Hunter syndrome with diffuse airway involvement.

A patient with Hunter syndrome and diffuse airway obstruction had daytime hypersomnolence, snoring, and alveolar hypoventilation. Polysomnography showed severe obstructive sleep apnea. In the past, all reported cases of sleep apnea in patients with mucopolysaccharidoses had been treated with tonsillectomy/adenoidectomy or tracheostomy. This patient, in whom tracheostomy would have been very difficult due to the diffuse nature of his airway involvement, was successfully treated with high pressure nasal CPAP and supplemental oxygen.

Adult↗
PubMed1989

Ventral cleft of the larynx in an adult. Case report.

Congenital clefts of the larynx are rare and usually found dorsally. This case report describes a patient with a partial anterior nonfunsion, or ventral cleft, of the thyroid cartilage. This was first noted on computed tomography of the larynx used for delineation of carcinoma and was confirmed by horizontal whole mount histologic sections of the resected larynx. The thyroid cartilage suggested arrested fusion of the laminae in the middle to late embryonic period. This patient had an adult form of this rarely reported anomaly and the first, to our knowledge, detected with CT scan.

Carcinoma, Squamous Cell↗
PubMed1987

Lathyrogenic agents as therapy for subglottic stenosis--a pilot study.

The surgical repair of subglottic stenosis (SGS) is often unsuccessful because of recurrence of the scar contracture. Over the past few years, two lathyrogenic agents (compounds that inhibit collagen cross-linking) have been shown effective in prevention of stenosis in animal models that have deep caustic esophageal burns. Since the principles of induced lathyrism have not been applied to the treatment of laryngotracheal stenosis, a pilot study using a canine model was conducted to test the efficacy of penicillamine and N-acetyl-L-cysteine in reduction of the rate of reformation of SGS. In all six animals used, a complete, 10 to 15 mm thick, mature SGS was induced experimentally, then opened with a CO2 laser. The dogs that were treated with lathyrogenic agents exhibited a lower rate of re-stenosis (one maintained patency throughout the 5 weeks of treatment) when compared to the two control dogs. Histologic sections of the subglottis in each dog revealed severe cricoid collapse, necrosis, and scarring, and thus demonstrated similarities to SGS in human beings. The two lathyrogenic agents used in this study are already approved for human use and may represent a valuable form of adjunctive therapy in the surgical management of SGS.

Acetylcysteine↗
PubMed1975

Delayed C.N.S. complications.

Patients with esophageal stricture being treated with dilatation, who developed esophageal perforation or local peritonitis and subsequent central nervous system infection, are reviewed. It is suggested that the vertebral venous system may be the route by which the metastatic infection is carried. Physicians caring for patients with esophageal stricture, who are receiving dilatation, should be aware of the possible intracranial complications and should be alert to the first sign of central nervous system abnormality.

Brain Abscess↗
PubMedDate not supplied

Evaluation and treatment of acute laryngeal fractures.

Treatment of laryngeal fractures continues to evolve, and the airway now can be restored without stenosis or aspiration in most cases. However, the best treatment of vocal cord dysfunction from trauma remains uncertain, and the value of computerized tomographic scan (CT) is controversial. In this report, we describe the symptoms, radiologic findings, and treatment of 15 consecutive cases of laryngeal trauma. The value of CT for assessing the cricoarytenoid area is discussed. We also found CT to be reliable for defining the extent of soft tissue trauma and for diagnosing the presence and displacement of any fractures. Endoscopic photographs are compared with CT scan photographs to illustrate the correlation of CT with the degree of trauma. Finally, we present a method of laryngeal fracture repair using autologous thyroid cartilage.

Acute Disease↗
PubMedDate not supplied

Subglottic stenosis in infants and children.

Of 158 cases of subglottic stenosis 115 were congenital and 43 acquired. Current follow-up has been obtained in 146 (92%) which constitutes the determinate group. Although stridor was the most common presenting symptom of the congenital group, 34% presented with recurrent or prolonged episodes of croup. Tracheotomy was required in 47 of the 107 determinate cases (44%). Further management of the congenital cases was based on the experience that children outgrow this disorder; periodic dilatation may augment the natural process. Of those infants and children tracheotomized, all but five have been decannulated, and there was one death - a mortality rate of 2.1%. Acquired subglottic stenosis proved to be a more difficult management problem. Tracheotomy was necessary in 38 of the 39 determinate cases (97%). Repeated active dilatations for prolonged periods were usually required as well as endoscopic removal of granulation tissue. Of those infants and children tracheotomized, all but eight have been decannulated. There were nine deaths; five were due to unrelated underlying disease; four were attributable to complications of long-term tracheostomy. Thus, in the entire series, 85 infants and children required tracheotomy and five deaths may be attributable to long-term tracheostomy complications - a mortality rate of 5.9%.

Child↗
PubMedDate not supplied

Evaluation of laryngeal calcium deposition: a new methodology.

Despite study for over 100 years, sites and patterns of laryngeal calcification and ossification are understood incompletely. Methodologies used in the past have included radiographic imaging and histologic staining with hematoxylin and eosin. Investigation of this subject offers potential application in the correlation of laryngeal disease with loss of normal calcification patterns. A technique for the detection of calcium deposition in human larynges, formerly used only in staining bony and cartilaginous tissue of small vertebrates, is described. This technique offers the advantage of whole organ staining and provides a sensitive means of determining degree and pattern of laryngeal calcification. The results of our pilot investigation with photographic examples are presented.

Adult↗
PubMedDate not supplied

Tracheostomy in the first year of life.

Three series totaling 301 infants under 1 year of age who had tracheotomies during three successive decades are reviewed. The first series (62 infants) was seen prior to 1953, the second (86 infants) was seen between 1954 and 1963, while the latest series (153 infants) was seen between 1964 and 1973. A comparison of the three series with reference to etiology, incidence, indications, management, and mortality leads to significant conclusions. (1) The incidence of tracheotomy is increasing. More aggressive approach to many problems, previously considered inoperable, resulted in an increased number of infants undergoing tracheotomy for postintubation problems and ventilatory support. (2) The incidence of congenital malformations of the airway necessitating tracheostomy has remained constant, while the downward trend in the incidence of inflammatory conditions was reversed. (3) Infants in the latest series underwent tracheotomy, on the average, at a later age than the 1954 to 1963 series, largely as a result of the increased number of patients with cardiac anomalies undergoing corrective cardiovascular surgery and subsequent tracheotomy at a later age. (4) A review of the 77 deaths in the latest series again shows the death rate to be dependent on the underlying systemic condition which necessitated tracheotomy, rather than the tracheostomy itself. (5) The importance of temporary intubation to relieve respiratory obstruction in infants is stressed, while the significant laryngeal damage following prolonged intubation and delayed tracheotomy is apparent.

Airway Obstruction↗