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Biomedical subjects

K M Grundfast

Publications and source records attributed to K M Grundfast.

80 records · Page 5Linked to original sources
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Congenital hereditary bilateral abductor vocal cord paralysis.

Congenital hereditary bilateral abductor vocal cord paralysis has been found in a father, his son and daughter. Though the disorder was previously believed to be inherited in a sex-linked manner, it now appears that there is an autosomal dominant variant. The vocal cord paralysis was associated with swallowing difficulty during infancy in all three of the family members. Although both the son and daughter required tracheostomies during the neonatal period, both manifested improvement of vocal cord movement during infancy so that decannulation was possible before 14 months of age. Localized delay in neurologic maturation is suspected as the etiology.

Age Factors↗
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Anterior cricoid split: a "simple" surgical procedure and a potentially complicated care problem.

The anterior cricoid split (ACS) has been described as an alternative to tracheotomy in management of the premature infant who develops upper airway compromise after extubation. Sixteen patients at the Children's Hospital National Medical Center (CHNMC) and ten patients at four other hospitals had the ACS operation. For the patients at the CHNMC, average gestational age was 29 weeks, birth weight was 1,264 g, and length of time intubated was 6.2 weeks. Overall success in achieving extubation after the ACS was 69% at the CHNMC and 40% for the group of other hospitals. However, a success rate in achieving extubation after ACS was 75% for both the CHNMC and the group of other hospitals in patients who had become stable enough to have been previously discharged from a neonatal intensive care unit. Problems encountered following the ACS include malposition of tip of the endotracheal tube, increased need for assisted ventilation, myocardial infarction, subcutaneous emphysema, and unexplained inability to ventilate. Analysis of results suggests that the ACS is a valuable operative procedure that can avoid need for tracheotomy in infants with adequate pulmonary function who have narrowing within the airway at the subglottic level. Postoperative care may be problematic and the infant having had the ACS is best managed by an experienced team of experts who are familiar with care of the infant with respiratory insufficiency.

Cricoid Cartilage↗
PubMedDate not supplied

Differentiating upper from lower airway compromise in neonates.

Technologic advancements and improvements in supportive care have resulted in increased survival of very low birth weight and premature infants. With salvage of these high risk newborns, many difficult management problems arise. Respiratory distress of the newborn is the most common airway problem that affects these patients and subglottic edema or stenosis may frequently complicate management of the airway. Decision-making in airway maintenance and respiratory care can be problematic due to multiple factors that must be considered. The otolaryngologist is often consulted when upper airway obstruction is suspected. Relevant respiratory physiology is reviewed in order to help direct therapeutic decision-making. Parameters of assessment are enumerated and methods for choosing among therapeutic alternatives are presented. A paradigm to aid in differential diagnosis is described.

Apnea↗
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Laryngeal dysgenesis.

A case of a previously undescribed anomaly of the larynx is presented and offers insight and support of current concepts of fetal laryngeal development. The patient possessed unilateral absence of true and false vocal cords, laryngeal ventricle, and saccule. Current concepts of embryological development would place the development of this anomaly and most of the patient's other multiple anomalies in the period of the 6th to 9th weeks of fetal life. This report lends substantiation to the stages of laryngeal development by demonstrating an aberration in the normal sequential development. Additionally, the time period of this maldevelopment is suggested by the concurrence of multiple other anomalies. Aspects of laryngeal embryology relevant to laryngeal maldevelopment are reviewed.

Abnormalities, Multiple↗
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External auditory canal stenosis and partial atresia without associated anomalies.

Unilateral or bilateral ear canal stenosis or atresia occurring without microtia or associated anomalies may go undetected during early childhood. Summaries of ten cases illustrate difficulties in making early diagnoses. An unusual case of inherited isolated bilateral external canal atresia occurring in a mother and daughter is included. Potential pitfalls in diagnosis and management are discussed.

Child↗
PubMedDate not supplied

Subglottic stenosis: retrospective analysis and proposal for standard reporting system.

A retrospective analysis was undertaken reviewing management of 67 patients treated for subglottic stenosis (SGS) at the Children's Hospital National Medical Center (CHNMC) between 1980 and 1985. Forty-seven (90%) of the patients were followed for at least 18 months from the time diagnosis was made. Twenty-three (66%) of the patients followed for at least 18 months were successfully decannulated or had an adequate airway without tracheotomy. To compare efficacy of management of SGS at the CHNMC with management outcomes previously reported, a review of medical literature was undertaken and data from the most significant reports on management of SGS were collated and tabulated. Since analysis of published reports did not yield a consensus regarding optimal methods for management, and statistics in many published reports were absent or unclear, authors of the previously published reports were contacted personally by means of a letter and survey questionnaire. Results of the survey show that many authors have not performed a statistical review of their case data to determine relative efficacy of different surgical procedures. Thus, retrospective review of cases managed at the CHNMC as well as information obtained from leading experts in management of SGS indicate that there is no single optimal procedure or technique for management of all cases of SGS. Further, the way in which surgical procedures for management of SGS are being reported makes difficult the process of meaningfully comparing results reported by different surgeons. A reporting system is proposed that uses specific terms and objective parameters.

Adolescent↗