Biomedical subjects
Publications and source records attributed to J Friedberg.
Airway lesions preventing tracheotomy decannulation may not always be readily apparent or may be underestimated by the inexperienced observer. Examples of tracheal keloid, tracheomalacia due to vascular compression, vocal cord dislocation and fixation and subglottic webbing with emphasis on the need for meticulous endoscopy are demonstrated.
The mid-line cervical cleft is part of a broad spectrum of congenital mid-line branchiogenic syndromes. Two recent cases of this rare anomaly are presented, along with the clinical presentation, gross pathology and histopathology. The preferred operative technique of complete excision of the cervical cleft with Z-plasty is demonstrated. Embryologic origins and spectrum of severity of the mid-line branchiogenic syndromes is discussed.
Melanotic neuroectodermal tumor of childhood is a rare lesion, but its presentation appears to be quite characteristic and a clinical diagnosis may be made with some confidence. Although this is an extremely rapidly growing, aggressive tumor, local excision appears to be adequate for cure.
Few pediatricians can expect to acquire great personal experience in dealing with many of the aforementioned lesions. Nevertheless, an appreciation of the usual presentation and natural history of most of the entities will usually permit an accurate diagnosis and guide to management in all but the most obscure conditions.
Otolaryngologists are well aware of the potentially devastating consequences of inhaling a sharp foreign body. We report here a case of a laryngectomized patient who accidentally inhaled a safety pin through his tracheal stoma under highly unusual circumstances. This proved to be a life-threatening situation which resolved only after a complicated hospital admission culminating in a thoracotomy. We use this case to suggest guidelines that otolaryngologists may wish to discuss with their laryngectomized patients with regard to stomal care.
The clinical presentation of a neck mass in a child is obviously not always pathognomonic but a careful clinical appraisal can certainly limit the diagnostic options and reduce the need for complex and sometimes invasive investigations.
The clinical picture of hyperparathyroidism has changed since the implementation of routine serum calcium testing, resulting in more asymptomatic patients undergoing early surgical exploration. Although operative complications (e.g., recurrent laryngeal nerve paralysis, hypocalcemia, etc.) are not prevalent, the risk can be minimized by minimizing tissue dissection. For this reason, we feel that preoperative tumor localization is of great importance. We report our imaging results of parathyroid adenomas, utilizing ultrasonography, technetium-thallium subtraction scanning, digital subtraction angiography and magnetic resonance imaging. We also present an imaging protocol which, we have found, maximizes preoperative identification of these tumors.
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The formation of tracheal 'granuloma' in the tracheostomized infant, as a cause of aphonia and an obstacle to decannulation has long been recognized. Endobronchial or transtomal removal has been recommended; however, a number of these lesions were resected in conjunction with complete tracheostomy revision and found to be very much larger than suspected endoscopically and consisting of dense mature scar tissue. It is, therefore, suggested that resection of these lesions endoscopically or transtomally may be quite inadequate and an open procedure preferred.
The increasing success of modern neonatology has been associated with the use of prolonged intubation, ventilation and respiratory support. Inappropriate management of the endotrachial tubes or excessive and improper use of suction catheters may result in significant tracheobronchial injury. These injuries range from readily reversible abrasions through to obstructing granulomas, polyps and even bronchial stenosis and acquired bronchial atresia. These lesions are for the most part preventable with appropriate patient care. Examples of these lesions are presented.
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Stridor is a clinical sign, common to many disease entities which may compromise the airway. Although stridor may herald a life-threatening condition, most patients have a minor self-limiting condition. Diagnosis based on the character of the stridor alone is tenuous, and consideration of presentation other than the stridor is discussed in the management of these infants.
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From January 1983 to September 1984 our neonatal ICU (NICU) treated eight endotracheally intubated infants who had suspected airway obstruction characterized by hypercarbia dissonant with severity of lung disease and difficulty in ventilation with lack of chest movement, both on conventional intermittent mandatory ventilation and high-frequency oscillation. Bronchoscopic removal of necrotic tissue was possible in six infants, two of whom survived. Bronchoscopy showed desquamation of epithelial surfaces, leaving encrusted exudations considered to be characteristic of necrotizing tracheobronchitis (NTB). The four nonsurvivors of bronchoscopy and one of the infants not submitted to bronchoscopy had NTB confirmed at autopsy. NTB was not associated with any specific lung disease, humidifier, or ventilator. The autopsy frequency of NTB during this period was 5 per 160 NICU admissions. A separate chart review of unselected autopsied cases in 1981 and 1982 showed that 12 of 284 neonates admitted to the NICU had NTB. NTB appears to be a rediscovered condition related to endotracheal intubation and mechanical ventilation using high mean airway pressures.
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