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Biomedical subjects

J Werkhaven

Publications and source records attributed to J Werkhaven.

14 recordsLinked to original sources
PubMed2000

Sarcoidosis of the pediatric larynx.

Sarcoidosis is a chronic granulomatous disease of unknown pathogenesis. Reports of sarcoidosis are much less common in the pediatric literature than in the adult literature. The disease is usually systemic; rarely, however, single organs are affected. Isolated laryngeal involvement is an unusual presentation. We report a well-documented case of isolated laryngeal sarcoidosis in a 14-year-old white boy who presented to our institution with a 6-month history of dysphonia, dyspnea on exertion, and extremely sonorous snoring at night owing to his supraglottic airway disease. To our knowledge, this is only the second case of isolated laryngeal sarcoidosis reported in the pediatric literature. We review the literature and discuss the differential diagnosis, diagnostic evaluation, and treatment with carbon dioxide laser epiglottectomy and intralesional glucocorticoid deposition, which resulted in marked resolution of our patient's symptoms.

Adolescent↗
PubMed1997

Airway management in a patient with Hecht's syndrome.

Hecht's syndrome, described in 1969, is a rare autosomal dominant phenotype that includes trismus, pseudocamptodactyly, and somewhat short stature. A 5-year-old white boy with Hecht's syndrome and frequent otitis media, nasal obstruction, and sleep apnea is described to illustrate the otolaryngologic manifestations of this syndrome. Airway management in these patients is complicated by trismus, which does not improve after the induction of anesthesia. Mask anesthesia with spontaneous ventilation has been used successfully in these patients but may be difficult in the majority of otolaryngologic procedures. Blind nasotracheal intubation is an alternative, but in this case it was impossible because of adenoid hypertrophy. In this patient, laryngoscopy and orotracheal intubation were done using a Bullard laryngoscope, and transnasal KTP laser adenoidectomy was done to relieve the obstruction and apnea. The details of Hecht's syndrome and its management are presented in this case review.

Adenoidectomy↗
PubMed1996

Laser applications in pediatric laryngeal surgery.

The use of lasers in the pediatric patient has seen great advances. The development of new instruments and delivery equipment has made the laser available for use in smaller anatomic locations. Experience with adults has shown the appropriate laser parameters to minimize thermal effects and scarring. The carbon dioxide laser remains the laser used in most pediatric applications for endoscopic work, but other lasers have shown unique advantages in pediatric patients as well.

Adult↗
PubMed1995

Analgesia after bilateral myringotomy and placement of pressure equalization tubes in children: acetaminophen versus acetaminophen with codeine.

Despite the brief nature of the procedure with limited tissue trauma, some form of analgesia is required in most children after bilateral myringotomy and placement of pressure equalization (PE) tubes. Previous studies have demonstrated the relative inefficacy of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs), with 30%-55% of patients requiring supplemental postoperative analgesia. We undertook a prospective study evaluating the efficacy of the preoperative administration of oral acetaminophen (15 mg/kg) versus acetaminophen (10 mg/kg) and codeine (1 mg/kg). Fifty ASA grade I or II patients were randomized to receive oral midazolam premedication (0.7 mg/kg) mixed in either acetaminophen or acetaminophen with codeine elixir. Anesthesia was induced and maintained with halothane in nitrous oxide and oxygen. Postoperative pain was assessed at four times during the postoperative course using an objective pain scale. The two groups were similar with respect to age, weight, gender, duration of anesthesia, and duration of the surgical procedure. The patients who received acetaminophen with codeine had lower pain scores at all four points when compared with patients who received acetaminophen. None of the 25 patients who received acetaminophen with codeine required supplemental analgesics compared with 12 of 25 who received acetaminophen. No adverse effects were noted in either group. We conclude that the preoperative administration of acetaminophen with codeine provides superior analgesia after bilateral myringotomy and placement of PE tubes.

Acetaminophen↗
PubMed1995

Auditory dysfunction in selected syndromes and patterns of malformations: review and case findings.

Hundreds of syndromes may be associated with hearing impairment. Within recent years, there has been heightened research and clinical interest in hearing and syndromes, probably due to both advances in molecular genetics and improved techniques for auditory assessment of infants and young children. An example of the current appreciation for the possible relation between auditory dysfunction and syndromes or patterns of malformations is the inclusion of syndromes as a risk factor for hearing impairment by the 1990 Joint Committee on Infant Hearing. In this paper, we review syndromes and patterns of malformation that are frequently or occasionally associated with hearing impairment. In addition, we illustrate, in case studies, auditory findings that may be associated with three of these syndromes and patterns of malformation: Carpenter syndrome, ichthyosiform dermatosis, and Townes syndrome. We conclude with a discussion of strategies for audiologic assessment and management of infants and children with syndromes and patterns of malformations.

Adolescent↗
PubMed1992

Effect of steroids or tissue precooling on edema and tissue thermal coagulation after CO2 laser impact.

The carbon dioxide laser is frequently used in laryngeal microsurgery. Some surgeons have empirically used preoperative steroids or precooling with ice prior to laser impact to limit the resultant tissue thermal coagulation and/or edema. An animal model was designed to quantitatively test these effects. Depillated areas of rat skin were exposed to a CO2 beam of 1 mm diameter at 15 W for 0.1 sec after either administration of Decadron (0.25 mg/kg) immediately prior to impact or precooling more than 10 degrees C below basal body temperature. Measurement of edema was quantitated as extravasation of Evans's blue dye that had been injected intravenously. Tissue thermal coagulation was measured on hematoxylin and eosin stained histologic sections. In comparison to controls, statistically significant reduction in edema was seen only at the 24 hour time period after laser exposure for the steroid group (P less than .002) but not for the precooling group. Tissue thermal coagulation was significantly smaller for both the steroid and the ice group (P less than .006 and P less than .001, respectively) when compared to controls.

Animals↗
PubMed1991

Surgery for benign lesions of the glottis.

This article examines benign lesions of the glottis and adjacent structures commonly encountered in clinical practice. The goals of management are to understand the cause and the characteristics of these lesions and to provide the most conservative management possible. Nonsurgical management is selected, if possible, with surgical intervention reserved for refractory conditions. Traditional cold steel operative techniques as well as carbon dioxide laser techniques are discussed in this article.

Cysts↗
PubMed1989

Posttracheotomy granulation tissue managed by carbon dioxide laser excision.

The problem of accumulation of granulation tissue and scar at the superior edge of the tracheostoma is a frequent problem in the management of chronic tracheotomy patients. This traditionally has been managed by cup forceps excision or by eversion through the tracheostoma with a skin hook and blind resection. These methods often lead to hemorrhage, and incomplete removal in a bloody field. We have used the carbon dioxide laser via a bronchoscope for ablation of the granulation tissue and/or scar at the stomal edge and at the tracheotomy tube proximal tip without morbidity in 13 pediatric cases. With experience, removal with the laser often proceeds more quickly than conventional methods. The scar and granulation tissue are excised under direct vision with minimal hemorrhage. We believe this to be a reasonable alternative in the management of this recurring problem.

Adolescent↗
PubMed1988

Lingual thyroid in a young infant presenting as airway obstruction: report of a case.

A case of lingual thyroid causing airway obstruction in a 3-month-old infant is reported. Endoscopic examination for stridor disclosed an obstructing 4 X 3 cm base of tongue lesion. Nuclear isotope scanning confirmed this to be the only thyroid tissue present in this patient. A transoral excision using the CO2 laser was performed without complication. Only one other case of airway obstruction in the young infant secondary to lingual thyroid has been reported, that being the original case description in 1869. A review of the embryology and discussion of the suggested therapies is presented. The rationale for use of the CO2 laser for this lesion is discussed.

Airway Obstruction↗
PubMed1987

Endogenous porphyrin fluorescence in tumors.

The fluorescence of endogenous porphyrins in tumors has been attributed to the presence of several different species of bacteria inhabiting ulcerated and necrotic tissues. We have examined this "autofluorescence" in carcinogen-induced tumors in the hamster oral mucosa and in patients with cancer of the oral cavity. In several instances, bright autofluorescence of normal tissues has been observed. This represents a potential false-positive identification of cancer when systemic hematoporphyrin derivative fluorescence is used as a diagnostic technique.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1986

Light dosimetry in animal models: application to photodynamic therapy in otolaryngology.

Photodynamic therapy (PDT) for treatment of head and neck cancer uses a photoactive compound that is illuminated with 630 nm (red) light. The effectiveness of PDT depends on the penetration of light into tissue that is both tissue and wavelength dependent. The characterization of the optical properties of an animal oral mucosa and skin has been done to determine the amount of light below these tissues available to be used for photodynamic therapy. The tissue absorbance of visible light from 400 nm to 700 nm has been determined in vitro for hamster check pouch mucosa and for athymic mouse skin. The pattern of absorbance is similar for both tissues and demonstrates greater transmission at the longer wavelengths. The diffuse transmittance of light in vivo for these animal models was measured with an interstitial fiberoptic probe. At 630 nm the diffuse transmittance for nude mouse skin averages 10% of the incident light energy, and that for the hamster mucosa almost 50% of the incident light energy.

Animals↗
PubMedDate not supplied

Bronchial casts in children.

Bronchial casts were found in four children during a 2-year period at the Children's Memorial Hospital. These four children represent 0.2% of the 1,943 endoscopic cases during that time. Thirty other cases of bronchial casts have been reported previously in children 9 years of age or younger, only 12 of which were not associated with cystic fibrosis. Casts may be a complication of many diseases; cystic fibrosis, asthma, bronchitis, allergic bronchopulmonary aspergillosis, and bronchocentric granulomatosis are the most common. With the exception of cystic fibrosis, these diseases may all have an allergic pulmonary reaction as the underlying cause. In all four cases reported here, the diagnosis was made at endoscopy because the clinical picture is not dissimilar from that of bronchial foreign bodies. Management includes endoscopic removal of the cast, chest physical therapy with nebulized acetylcysteine, and an evaluation to determine the underlying condition.

Bronchi↗
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↗