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Biomedical subjects

P H Holinger

Publications and source records attributed to P H Holinger.

18 recordsLinked to original sources
PubMed1978

Respiratory obstruction and apnea in infants with bilateral abductor vocal cord paralysis, meningomyelocele, hydrocephalus, and Arnold-Chiari malformation.

This report describes 21 infants and children with bilateral abductor vocal cord paralysis and associated meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Two life-threatening forms of respiratory distress are distinguished: (1) upper airway obstruction due to bilateral abductor cord paralysis and (2) apnea. Clinically significant episodes of apnea were documented in 13 infants. Ten infants had evidence of aspiration and dysphagia. Vocal cord paralysis, apnea, aspiration, and dysphagia were frequently temporally related to increased intracranial pressure.

Airway Obstruction↗
PubMed1977

Rhinoscleroma of the lower respiratory tract.

Rhinoscleroma is a chronic granulomatous disease of the respiratory tract endemic to Eastern Europe and Central America which is being recognized with increasing frequency in other countries, including the United States. It was initially described as a lesion of the nose and upper respiratory tract, but is now known to involve the larynx, trachea and bronchi as well to cause slowly progressive asphyxia. Eleven cases of rhinoscleroma with varying degrees of involvement of the lower respiratory tract (larynx, trachea and bronchi) are presented. Present day treatment is both medical, consisting primarily of streptomycin and tetracycline, and endoscopic dilatation. Prolonged medication with careful dose control is necessary. Lower respiratory tract involvement should be considered in patients with chronic destructive granulomatous nasal pathology. This should be especially emphasized if they have an Eastern European or Central American background, or have travelled in these areas in which rhinoscleroma is endemic.

Adult↗
PubMed1976

Anesthetic management for carbon dioxide laser surgery of the larynx.

Fifty-one patients underwent 71 carbon dioxide laser procedures under general anesthesia for various intralaryngeal pathology. Anesthesia was induced with thiopental sodium, followed by succinylcholine to facilitate endotracheal intubation. For maintenance of anesthesia, 70% nitrous oxide was supplemented with halothane, enflurane or small doses of fentanyl. Succinylcholine, d-tubocurare or pancuronium were used to maintain muscular relaxation of jaw, pharyngeal and laryngeal muscles for a smooth lasing procedure. Small diameter (16-22 Fr.), red rubber, cuffed endotracheal tubes provided maximum working space, facilitated the controlled ventilation and reduced the explosion hazard of the anesthetic gases. Safely eyeglasses were used by all the personnel in the operating room against accidental injury to the cornea by the laser beam. Anesthetic management provided excellent operative conditions with maximum safety to the patient and the personnel in the operating room.

Adolescent↗
PubMed1975

Open tube, proximal illumination mirror and direct laryngeal photography.

Equipment is described for mirror and open tube direct laryngoscopic photography. It consists of specially constructed reflex camera systems that provide adequate exposure and depth of the desired field, sharpness of focus, correct color and effective composition for meaningful illustrations. The separate cameras for still and motion pictures consist of units that contain the light source, lenses, optic reflex systems and film chambers. The mirrors for indirect laryngoscopy and the open tube direct laryngoscopes are attached by rigid, easily released clamps for quick interchange. It is stressed that the laryngologist himself must be the photographer. The pictures are adjuncts to case recording, are supportive evidence of investigative work and may be used as chronologic sequences in study of physiology and pathology and in pre- and postoperative evaluation.

Humans↗
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

Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases.

The etiology of 389 cases of partial or complete bilateral abductor vocal cord paralysis has been determined and classified. One hundred and forty-nine were infants and children 12 years of age and under; 240 were adults, age 13 and older. In the infants and children the paralyses were congenital in 82 cases, of which 43 were associated with other congenital anomalies, and 39 were without associated anomalies. Fifty-nine cases were considered acquired, most being secondary to underlying congenital anomalies, particularly the associated findings of meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Eight cases of paralysis in this age group were of undetermined etiology. Of the 240 adult cases of bilateral vocal cord paralysis. 138 followed thyroidectomy. Fifty-two cases were associated with various neurologic disorders, including poliomyelitis, Parkinson's disease, cerebrovascular accident, Guillain-Barré syndrome, multiple sclerosis, neoplasms and other miscellaneous neurologic conditions. Sixteen cases were due to malignant neoplasms of the neck and mediastinum. The remaining 34 cases constitute a miscellaneous group which includes foreign bodies, bilateral neck dissection, infection, congenital lesions, trauma, and idiopathic paralyses. The characteristic symptoms of bilateral abductor vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. These symptoms are due to the stationary but flaccid midline position of the vocal cords which places them in a phonating position, where they both obstruct the airway and produce a faily clear voice or cry. This paradoxical combination of symptoms was frequently found to be responsible for a failure or delay in diagnosis.

Adolescent↗
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

Bilateral abductor vocal cord paralysis in Charcot-Marie-Tooth disease.

This report descirbes the unusual association of bilateral abductor vocal cord paralysis (BAbVCP) and Charcot-Marie-Tooth disease in a boy and his natural mother who have been followed for eight years. The boy initially presented with life-threatening respiratory distress at age ten years; BAbVCP was documented by direct laryngoscopy. Mirror laryngoscopy confirmed BAbVCP in the mother. Neurological diagnosis was made by history, physical examination, electromyography, and nerve conduction velocity studies. The BAbVCP may represent an additional genetic marker within the spectrum of heredodegenerative disorders. Of clinical importance is examination of voice and respiratory symptomatology of patients with heredodegenerative diseases and neurological work-up of patients with familial vocal cord paralysis. Further genetic and clinical studies of X cranial nerve involvement in heredodegenerative disorders are warranted.

Adolescent↗
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↗