PubMed Health⌕ Search

Biomedical subjects

K M Grundfast

Publications and source records attributed to K M Grundfast.

At least 55 records · Page 3Linked to original sources
PubMed1990

An improved stent method for choanal atresia repair.

Short intranasal stents secured sublabially have a number of advantages. They provide secure fixation without an external ligature across the columella. The short length of the stents allows them to sit only in the operative area where the atretic plate had been removed. This lessens the chance of intranasal syechiae formation and eliminates the possibility of erosion in the anterior septal and nasal alar region from pressure exerted by a stent. Since the stents do not protrude from the nose, they cannot be grasped by infants or young children and are not visible externally. School-aged children who have undergone repair of a unilateral choanal atresia can attend school without having to suffer the embarrassment of being teased about a tube protruding from the nose. When compared with other stenting methods, the posterior stent is more secure and less likely to become dislodged.

Child↗
PubMed1990

The inferiorly based superior tympanomeatal flap for removal of congenital cholesteatoma.

We believe that the IB-STMF is preferable to the P-TMF for removal of a congenital cholesteatoma from the anterior superior portion of the mesotympanum. Though developing an IB-STMF may require extra time and special care to avoid tearing the flap, the exposure that is achieved affords the best chance for complete removal of the mass, thus decreasing the chance for persistence or recurrence of the lesion.

Child↗
PubMed1990

Sudden onset of velopharyngeal insufficiency in Klippel-Feil syndrome.

A 17-year-old girl with Klippel-Feil vertebral anomalies presented with sudden onset of VPI and hoarseness after a minor neck torsion injury. Her symptoms were felt to be due to compression of the brain stem by the odontoid process (through basilar invagination). The VPI and hoarseness responded to conservative management with oral steroids.

Adolescent↗
PubMed1989

Vocal cord paralysis.

The information presented in this article demonstrates that unilateral or bilateral vocal cord paresis or paralysis in infants and children is difficult to diagnose and difficult to manage. In an attempt to provide the otolaryngologist with a concise set of relevant guidelines, the following rules for management are presented here. 1. Suspect bilateral abductor vocal cord paralysis (BAVP) when a neonate or infant presents with high-pitched inspiratory stridor and evidence of airway compromise. Factors that should increase the suspicion of BAVP include associated Arnold-Chiari malformation; congenital anatomic abnormality involving the mediastinum (for example, tracheoesophageal fistula, vascular ring, other vascular anomalies); dysmorphic syndromes, especially those involving brainstem dysfunction; and manifest findings indicative of neuromuscular disorder. The neonate or infant with Arnold-Chiari malformation and inspiratory stridor has bilateral abductor vocal cord paralysis until proven otherwise. 2. Suspect unilateral vocal cord paresis or paralysis in an infant or child with hoarse voice, low-pitched cry, or breathy cry or voice. The infant who develops mild stridor and hoarse cry following surgical repair of a patent ductus arteriosus or tracheoesophageal fistula has a unilateral vocal cord paralysis until proven otherwise. 3. Direct laryngoscopy with the flexible fiberoptic nasopharyngolaryngoscope and photodocumentation using a videocassette recorder offers the best method for diagnosis of vocal cord paresis or paralysis. Additional diagnostic studies that may be helpful include radiographic studies, CT scan, MRI scan, electromyography of the larynx, and, in older children, stroboscopy. 4. In using a flexible direct laryngoscope be careful not to interpret all motions of the vocal cords or arytenoids as evidence to preclude the diagnosis of vocal cord paralysis or paresis and be careful not to mistake the anterior intraluminal portion of a normal cricoid for an "anterior glottic web." 5. Tracheotomy is often required in order to assure adequate airway during infancy for children with BAVP. However, with the advent of sophisticated cardiorespiratory monitoring equipment and methods for monitoring blood oxygen and carbon dioxide levels, tracheotomy can be delayed until attempts have been made to improve the adequacy of the airway with neurosurgical intervention or other procedures.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1988

Treatment of recurrent respiratory papillomatosis with human leukocyte interferon. Results of a multicenter randomized clinical trial.

Recurrent respiratory papillomatosis is a relentless disease of viral origin in which squamous papillomas frequently obstruct the respiratory tract of children and young adults. No therapy has been proved to be curative for this process. Recent reports have suggested that interferon may cure or dramatically control airway papillomatosis. We evaluated the efficacy of human leukocyte interferon in the treatment of respiratory papillomatosis. One hundred twenty-three patients were randomly assigned to receive treatment with either surgery plus interferon or surgery alone. Interferon (2 X 10(6) IU per square meter of body-surface area) was given daily for one week, then three times per week for one year; treatment was followed by a year of observation, without the drug. Both study groups underwent serial endoscopy to remove papillomas and to document the efficacy of treatment during the two years of study. During the first six months, the growth rate of papillomas in the interferon group was significantly lower than in the control group (P = 0.0007). This difference diminished during the second six months and was no longer statistically significant (P = 0.68). Our data do not show that interferon is either curative or of substantial value as an adjunctive agent in the long-term management of recurrent respiratory papillomatosis. The initial benefit of interferon is not sustained.

Child, Preschool↗
PubMed1988

Gaining access to school for the child with a tracheostomy.

Admission to school for a child with a tracheostomy can present numerous problems. Reasons cited by school authorities for denying access to school for these children include liability issues, financial constraints, inadequately trained health personnel in the schools, logistic problems, and the fears of school staff. Attempting to exclude children with tracheostomies from school is discriminatory and illegal. At the Children's Hospital National Medical Center a model program was developed to resolve conflicts and facilitate the assimilation of the child with a tracheostomy into the school system.

Child↗
PubMed1988

Broken Aboulker stents in the tracheal lumen.

Aboulker stents (AS) used in laryngotracheoplasty have yielded good results and few complications. Although the complications are few, a potentially serious complication is fracture of the stent. The Aboulker stent produced in France has been used with increasing frequency. Dr. Robin Cotton reported on a method of modifying the stent so that a metal tracheotomy tube could be inserted and wired to the stent. This method avoids the problem of suprastomal tracheal collapse often encountered with other stenting methods. However, though the method is generally effective, transverse break of the AS has occurred in 5 cases in 3 different institutions. When transverse break of the AS occurs, the airway can be compromised rapidly and removal of the stent can be treacherous. During attempts to remove the stent, any tilt of the distal broken segment can cause immediate complete occlusion of the tracheal airway. In this paper, 3 cases of transverse break of the AS are analyzed, and suggestions for avoiding stent breakage are outlined.

Child, Preschool↗
PubMed1987

Congenital aberrantly located cutaneous Stensen's duct orifice--a newly described anomaly.

A case of a child born with an aberrant, cutaneous Stensen's (parotid) duct orifice and ipsilateral preauricular skin tags is reported. This congenital anomaly has been reported in the medical literature only once previously. Possible explanations for pathogenesis of this unusual anomaly are discussed and a simple method of surgical correction is described.

Choristoma↗
PubMed1987

Periorbital cellulitis.

Periorbital cellulitis is a common complication of sinusitis in children. At some hospitals lumbar puncture is routinely done as part of the complete evaluation of children admitted with periorbital cellulitis. Presumably, the lumbar puncture is done to rule out meningitis which could be the result of extension of infection from the orbit to the central nervous system (CNS). However, the degree to which periorbital cellulitis is associated with CNS complication is not known and the necessity for routine lumbar puncture is questioned. Therefore, records of 102 children admitted to the Children's Hospital National Medical Center from 1975 to 1982 with the diagnosis of periorbital cellulitis were reviewed. There were two cases of meningitis and one case of bilateral subdural effusions. Review of the literature and the findings in this study suggests that routine lumbar puncture in seemingly uncomplicated cases of periorbital cellulitis probably is not indicated in children 6 months of age or older.

Adolescent↗
PubMed1987

The reevaluation visit for acute otitis media.

Seventy children with acute otitis media diagnosed at a suburban, private primary care practice were examined after a ten-day course of antibiotic therapy and were then monitored closely for an additional 20 days. Parents were advised to seek prompt attention if symptoms of earache, fussiness, or fever recurred at any time during the 30-day study period. Of 14 symptomatic recurrences of acute otitis media, eight (57 percent) occurred within one week of discontinuing antibiotic therapy. Four (10 percent) of 41 children with persistent otitis media with effusion on days 10 to 14 developed symptomatic acute otitis media over the next 18 days, as did four (17 percent) of 23 children who had a normal middle ear examination on days 10 to 14. Early follow-up visits immediately following antibiotic therapy commonly detect persistent otitis media with effusion but appear to have limited value in detecting asymptomatic, posttreatment acute otitis media. the optimal timing of reevaluation visits for children with acute otitis media deserves further study.

Acute Disease↗
PubMed1984

Cholesteatoma medial to an intact tympanic membrane in 34 young children.

Thirty-five cholesteatomas medial to intact eardrums were treated in 34 children between 1976 and 1982. Six (18%) children had never had a documented episode of otitis media. Seventeen (50%) children, in whom the lesion was diagnosed at an early stage, underwent simple excision of the cholesteatoma without the need for extensive middle ear surgery. Findings from postoperative audiograms were normal for all such children. Cholesteatoma has recurred in eight (23%) children to date. Most recurrences were diagnosed 15 months or less after surgery. Routine careful otoscopic examination is essential in order to discover cholesteatoma at an early stage and to avoid hearing loss and the need for extensive otomastoid surgery. In order to perform an accurate examination of the eardrum, a halogen-illuminated otoscope and pneumo-otoscopy should be used by the pediatrician routinely. Particular attention should be paid to the posterior-superior quadrant of the tympanic membrane where a cholesteatoma is usually located.

Audiometry↗