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Wang F, Liu Y, Xu H, Qian Y, Zou J, Yi H, Guan J, Yin S. Association between Upper-airway Surgery and Ameliorative Risk Markers of Endothelial Function in Obstructive Sleep Apnea. Sci Rep 2019; 9:20157. [PMID: 31882827 PMCID: PMC6934655 DOI: 10.1038/s41598-019-56601-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/13/2019] [Indexed: 12/01/2022] Open
Abstract
The objective of our study was to evaluate the effects of upper-airway surgery on improvement of endothelial function-related markers in patients with obstructive sleep apnea (OSA). Subjects with moderate to severe OSA who underwent upper-airway surgery, with a follow-up duration of at least 6 months, were included. Pre- and postoperative polysomnographic variables and endothelial function-related markers were compared. Subgroup and correlation analyses were conducted to find possible indicators for better endothelial function-related markers after upper-airway surgery. In total, 44 patients with OSA were included. The mean follow-up duration was 1.72 ± 0.92 years. Serum VEGFA [-20.29 (CI: -35.27, -5.31), p < 0.05], Ang2 [-0.06 (CI: -0.16, 0.03), p < 0.05], E-selectin [-7.21 (CI: -11.01, -3.41), p < 0.001], VWF [-58.83 (CI: -103.93, -13.73), p < 0.05], VWFCP [-33.52 (CI: -66.34, -0.70), p < 0.05], and TM [-0.06 (CI: -0.09, -0.03), p < 0.05] were significantly lower after upper-airway surgery. However, other risk markers of endothelial function, such as Ang1, ICAM1, VEGFR1, and VCAM, did not change significantly. Correlations between improved endothelial function-related markers and ameliorated oxyhemoglobin saturation and glucolipid metabolism were established. Upper-airway surgery might be associated with an improvement in endothelial function in patients with OSA. These changes may be associated with improved oxygen saturation after upper-airway surgery.
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Affiliation(s)
- Fan Wang
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Yuenan Liu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, 200020, Shanghai, China.
| | - Yingjun Qian
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, 200020, Shanghai, China
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, 200020, Shanghai, China.
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, 200020, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, 200020, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, 200020, Shanghai, China
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Liu J, Liao X, Li Y, Luo H, Huang W, Peng L, Fang Q, Hu Z. Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation. Anaesthesist 2017; 66:667-671. [PMID: 28656353 DOI: 10.1007/s00101-017-0330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/13/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increasing number of studies have shown that low tidal volume (TV) with positive end-expiratory pressure (PEEP) offers lung protection during one-lung ventilation (OLV). Considering the unique physiological characteristics of infants, we aimed to determine the feasibility and effect of low TV with PEEP in infants undergoing OLV during thoracoscopy. PATIENTS AND METHODS We randomized 60 infants to a conventional group (group I: TV, 8-10 ml/kg; RR, 23-45 bpm; PEEP, 0 cmH2O) or a low TV with PEEP group (group II: TV, 5-7 ml/kg; RR, 23-45 bpm; PEEP, 4-6 cmH2O). Arterial blood gas analyses were performed at four time points: 5 min of two-lung ventilation (TLV, T0), and 20 min, 40 min, and 60 min of OLV (T1, T2, T3); hemodynamic parameters (heart rate, mean blood pressure), temperature, as well as gas exchange (SpO2 and PETCO2) and ventilation parameters (FiO2, PEEP, Pmax) were recorded simultaneously. Lung compliance and shunt were also calculated. RESULT No significant difference was found between both groups at T0. Compared with T0, PETCO2, Pmax, PaCO2, lactic acid, and intrapulmonary shunt volume (Qs/Qt) were increased while PaO2 and respiratory system compliance (Cdyx) were decreased noticeably in both groups at T1, T2, and T3. At T1, T2, and T3, Pmax and Qs/Qt were much lower while PETCO2, PaCO2, and Cdyx were higher in group II than in group I. There was no significant difference in lactic acid and PaO2 measurements between the two groups at T1, T2, and T3. CONCLUSION Low TV with PEEP could be an effective intraoperative ventilation strategy for infants undergoing OLV during video-assisted thoracoscopic surgery and may reduce the risk of lung injury. However, this strategy, as well as the influence of intraoperative hypercapnia on infants, needs further investigation.
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Affiliation(s)
- Jing Liu
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Xinfang Liao
- FoShan City Nanhai District People's Hospital, 528200, Foshan, China
| | - Yongle Li
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Hui Luo
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Weijian Huang
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Lingli Peng
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Qin Fang
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Zurong Hu
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China.
- , No. 521, Xingnandadao, Panyu District, Guangzhou, Guangdong, China.
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Franzen D, Schneiter D, Freitag L. [Not Available]. Praxis (Bern 1994) 2016; 105:1433-1440. [PMID: 27911659 DOI: 10.1024/1661-8157/a002532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Die interventionelle Bronchologie ist eine verhältnismässig junge Subspezialisierung der Pneumologie und Thoraxchirurgie. Die Bronchoskopie hat sich in der Vergangenheit vor allem auf die Diagnostik von pulmonalen Infektionen und Malignomen beschränkt. Durch ein ständig wachsendes Armamentarium an therapeutischen Möglichkeiten wachsen jedoch die Indikationen für endobronchiale Eingriffe zusehends. Das heutige Arsenal an therapeutischen Möglichkeiten der interventionellen Bronchologie wird in diesem Artikel vorgestellt.
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Affiliation(s)
- Daniel Franzen
- 1 Klinik für Pneumologie, Universitätsspital Zürich
- 3 Interventionelles Lungenzentrum (ILZ), Universitätsspital Zürich
| | - Didier Schneiter
- 2 Klinik für Thoraxchirurgie, Universitätsspital Zürich
- 3 Interventionelles Lungenzentrum (ILZ), Universitätsspital Zürich
| | - Lutz Freitag
- 1 Klinik für Pneumologie, Universitätsspital Zürich
- 2 Klinik für Thoraxchirurgie, Universitätsspital Zürich
- 3 Interventionelles Lungenzentrum (ILZ), Universitätsspital Zürich
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Zhang C, Wu J, Hu Z, Yan C, Gao X, Liang W, Liu D, Li F, Wang Z. Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring. PLoS One 2016; 11:e0160139. [PMID: 27532103 PMCID: PMC4988652 DOI: 10.1371/journal.pone.0160139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/14/2016] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Respiratory symptoms are often associated with gastroesophageal reflux disease (GERD). Although the role of multichannel intraluminal impedance–pH (MII-pH) monitoring in GERD is clear, little is known regarding the characteristics of patients with respiratory symptoms based on MII-pH monitoring and anti-reflux therapy. We evaluated a cohort of GERD patients to identify the MII-pH parameters of GERD-related respiratory symptoms and to assess the anti-reflux therapy outcomes. Methods We undertook a prospective study of patients who were referred for GERD evaluation from January 2011 to January 2012. One hundred ninety-five patients underwent MII-pH monitoring and esophageal manometry, and one hundred sixty-five patients underwent invasive anti-reflux therapy that included laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. The patient characteristics and MII-pH parameters were analyzed, and the symptom scores were assessed at baseline and at 1- and 3-year follow-up evaluations. Results Of the 195 patients, 96 (49.2%) exhibited respiratory symptoms and significantly more reflux episodes (70.7±29.3) than patients without respiratory symptoms (64.7±24.4, p = 0.044) based on the MII-pH monitoring results. Moreover, the group of patients with respiratory symptoms exhibited more proximal reflux episodes (35.2±21.3) than the non-respiratory symptomatic group (28.3±17.9, p = 0.013). One hundred twenty-five patients following the Stretta procedure (n = 60, 31 with respiratory symptoms) or LTF (n = 65, 35 with respiratory symptoms) completed the designated 3-year follow-up period and were included in the final analysis. The symptom scores after anti-reflux therapy all decreased relative to the corresponding baseline values (p<0.05), and there were no significant differences in the control of respiration between the Stretta procedure and LTF (p>0.05). However, LTF significantly reduced the recurrence (re-operation) rate compared with the Stretta procedure (0 vs. 19.4%, p = 0.006). Conclusions MII-pH monitoring effectively detected respiratory-related predictive parameters, including total/proximal reflux episodes and symptom correlations. We found that GERD patients with respiratory symptoms exhibited more proximal and total reflux episodes but not more acid-related episodes, as determined by MII-pH monitoring. Thus, such monitoring could be useful for diagnosing atypical GERD patients with respiratory symptoms. Furthermore, LTF exhibited a more significant effect on controlling typical symptoms in all GERD patients and reducing the recurrence rate than the Stretta procedure in patients with respiratory symptoms.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
| | - Jimin Wu
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
| | - Zhiwei Hu
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
| | - Chao Yan
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiang Gao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Weitao Liang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Diangang Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- * E-mail: (ZW); (FL)
| | - Zhonggao Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
- * E-mail: (ZW); (FL)
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Janda P, Leunig A, Sroka R, Betz CS, Rasp G. Preliminary Report Of Endolaryngeal And Endotracheal Laser Surgery Of Juvenile-Onset Recurrent Respiratory Papillomatosis By Nd:Yag Laser and a New Fiber Guidance Instrument. Otolaryngol Head Neck Surg 2016; 131:44-9. [PMID: 15243556 DOI: 10.1016/j.otohns.2003.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES: Recurrent respiratory papillomatosis (RRP) caused by human papilloma virus (type 6 and 11) is the most common benign neoplasm of the larynx in children. Despite being a benign disease, treatment is very difficult and is characterized by frequent recurrence, spread throughout the respiratory tract, and malignant degeneration. Besides surgical resection and the established CO2 laser treatment, laser surgery by fiber-guided Nd:YAG laser light promises to be a bloodless and effective treatment procedure. To improve this new method, a novel fiber guidance instrument has been developed to aid in endolaryneal laser surgery of RRP. STUDY DESIGN AND SETTING: The method described uses a specially designed instrument for fiber guidance that is equipped with a bendable distal tip to move the fiber end precisely. Moreover, the instrument includes an additional channel for the suction of smoke and pyrolysis products. Up to now, 5 patients (aged 4 to 8 years) with RRP were treated by Nd:YAG laser light (λ = 1064 nm; power, 10W; irradiance, 3.5 kW/cm 2 , continuous wave) with a prototype version of the new instrument and were followed up for 12 months each. RESULTS: Because of the adequate length and the bendable distal tip with a range of −5° up to 45° to the optical axis of the fiber and less than 10% light loss at maximal deflection, RRP can be treated by Nd:YAG laser light easily and precisely. The continuous suctioning ensured an optimum view of the operating field and a minimal load of potential infectious laser plume and toxic pyrolysis products for the patient as well as for the physician. The laser treatment of RRP with the new fiber guidance instrument was only minimally traumatic. During 1-year follow-up visits, all Nd:YAG laser light-treated patients, showed a regression of the disease. CONCLUSIONS: The new fiber guidance instrument enables a precise and easy treatment of the RRP with fiber-guided laser systems (eg, Nd:YAG-, diode-, and KTP-lasers) and an effective removal of infectious laser plume as well as toxic pyrolysis products. A follow-up period of 1 year revealed that Nd:YAG laser surgery seems to prevent a rapid recurrence of juvenile respiratory papillomatosis in the treated patients.
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Affiliation(s)
- Philip Janda
- Department of Otorhinolaryngology, Ludwig-Maximilians University, Munich, Germany.
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Rees CJ, Tridico TI, Kirse DJ. Expanding Applications for the Microdebrider in Pediatric Endoscopic Airway Surgery. Otolaryngol Head Neck Surg 2016; 133:509-13. [PMID: 16213920 DOI: 10.1016/j.otohns.2005.06.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: The microdebrider has been described for treating laryngeal papillomas, but there are no reports of other uses for this instrument in the pediatric airway. The objective of this article is to describe expanding applications for the microdebrider in pediatric airway surgery. STUDY DESIGN AND SETTING: Retrospective review, tertiary care academic institution. RESULTS: The microdebrider was used in 75 pediatric airway procedures. Twenty-two of these cases involved novel, previously unreported applications of the microdebrider. CONCLUSIONS: The microdebrider can be used safely and effectively for a variety of pediatric airway pathologies, including papillomas, granulations, and stenoses from the larynx to the distal trachea. SIGNIFICANCE: Correct usage of the various tip configurations on the microdebrider has made management of many airway lesions commonly encountered by pediatric otolaryngologists safer, more expedient, and simpler than management by other methods. In our practice, this instrument largely has supplanted the use of the CO2 laser and some open approaches for pediatric airway lesions.
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Affiliation(s)
- Catherine J Rees
- Department of Otolaryngology, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
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QUAMMEN CW, TAYLOR RM, KRAJCEVSKI P, MITRAN S, ENQUOBAHRIE A, SUPERFINE R, DAVIS B, DAVIS S, ZDANSKI C. The Virtual Pediatric Airways Workbench. Stud Health Technol Inform 2016; 220:295-300. [PMID: 27046595 PMCID: PMC5588666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Virtual Pediatric Airways Workbench (VPAW) is a patient-centered surgical planning software system targeted to pediatric patients with airway obstruction. VPAW provides an intuitive surgical planning interface for clinicians and supports quantitative analysis regarding prospective surgeries to aid clinicians deciding on potential surgical intervention. VPAW enables a full surgical planning pipeline, including importing DICOM images, segmenting the airway, interactive 3D editing of airway geometries to express potential surgical treatment planning options, and creating input files for offline geometric analysis and computational fluid dynamics simulations for evaluation of surgical outcomes. In this paper, we describe the VPAW system and its use in one case study with a clinician to successfully describe an intended surgery outcome.
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Affiliation(s)
| | - Russell M. TAYLOR
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pavel KRAJCEVSKI
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sorin MITRAN
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Richard SUPERFINE
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Stephanie DAVIS
- Department of Pediatrics, Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Carlton ZDANSKI
- Department of Otolaryngology/Head and Neck Surgery and Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Nishijima E. [Advances in pediatric thoracic surgery during the past 50 years]. Nihon Geka Gakkai Zasshi 2014; 115:323-328. [PMID: 25702512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Surgical strategies and treatment for pediatric airway and lung diseases have advanced significantly, especially in the fields of subglottic stenosis, congenital tracheal stenosis, congenital cystic lung lesions, and endoscopic surgery, during the past 50 years. Pediatricians, pathologists, and pediatric surgeons have engaged in continuous discussions at scientific meetings to establish standard terminology and operative indications and to refine surgical techniques such as laryngoplasty, sliding tracheoplasty, lobectomy under thoracotomy and thoracoscopy. The modified Myer-Cotton grading system for subglottic stenosis was proposed and proved to be useful in selecting reconstructive operative techniques. The addition of aortopexy to sliding tracheoplasty was also confirmed to be effective in maintaining a wide postoperative tracheal lumen. The disease entities of each type of cystic lung lesion were clarified, and the clinical and etiological importance of bronchial/bronchiolar atresia was emphasized. A classification of congenital cystic lung disease was proposed based on anatomic and embryologic considerations. In this classification, congenital pulmonary airway anomaly was introduced to replace congenital cystic adenomatoid malformation of the lung. Intralobar sequestration of the lung must be located in the lower lobe in this definition and classification.
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Abstract
Neurosurgery can alter cardiorespiratory performance via central networks and includes deep brain stimulation (DBS), a routinely employed therapy for movement disorders and chronic pain syndromes. We review the established cardiovascular effects of DBS and the presumed mechanism by which they are produced via the central autonomic network. We then review the respiratory effects of DBS, including modulation of respiratory rate and lung function indices, and the mechanisms via which these may occur. We conclude by highlighting the potential future therapeutic applications of DBS for intractable airway diseases.
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Affiliation(s)
- Jonathan A Hyam
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Gompelmann D, Eberhardt R, Herth FJF. Interventional pulmonology procedures: an update. Panminerva Med 2013; 55:121-129. [PMID: 23676954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Bronchoscopy is the most important tool in diagnosis of respiratory diseases, but also provides therapeutic options in various disorders. Besides hemoptysis, airway stenoses are a frequent indication for therapeutic bronchoscopy interventions. Thereby, a broad spectrum of endoscopic techniques including electrocautery, argon plasma coagulation, laser treatment, cryosurgery and stent implantation is available. In the last decade, development of new endoscopic modalities provides also treatment of patients with chronic obstructive pulmonary disease and uncontrolled asthma.
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Affiliation(s)
- D Gompelmann
- Department of Pneumology and Respiratory Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
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Vyzhigina MA, Mizikov VM, Sandrikov VA, Luk'ianov MV, Titov VA, Zhukova SG, Parshin VD, Riabova OS, Kurilova OA, Alekseev AV, Buniatian AA. [Respiratory support in anaesthetic management for thoracic surgery and their comparative characteristics: over 2000 anaesthesia experience]. Anesteziol Reanimatol 2013:34-41. [PMID: 24000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung finction in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, OLV differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated AL V in thoracic surgery were developed.
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Orlando G, Wood KJ, De Coppi P, Baptista PM, Binder KW, Bitar KN, Breuer C, Burnett L, Christ G, Farney A, Figliuzzi M, Holmes JH, Koch K, Macchiarini P, Mirmalek Sani SH, Opara E, Remuzzi A, Rogers J, Saul JM, Seliktar D, Shapira-Schweitzer K, Smith T, Solomon D, Van Dyke M, Yoo JJ, Zhang Y, Atala A, Stratta RJ, Soker S. Regenerative medicine as applied to general surgery. Ann Surg 2012; 255:867-80. [PMID: 22330032 PMCID: PMC3327776 DOI: 10.1097/sla.0b013e318243a4db] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues, or organs to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues, and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate.
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Affiliation(s)
- Giuseppe Orlando
- Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA.
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Brodlie M, Barwick SC, Wood KM, McKean MC, Welch A. Inflammatory myofibroblastic tumours of the respiratory tract: paediatric case series with varying clinical presentations. J Laryngol Otol 2011; 125:865-8. [PMID: 21481297 DOI: 10.1017/s0022215111000648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To highlight the clinical importance of inflammatory myofibroblastic tumours of the respiratory tract in children, and to present a case series of three children which illustrates this tumour's variable clinical presentation. CASE HISTORY The series includes: a nine-year-old girl with a diagnosis of juvenile idiopathic arthritis, who presented with finger clubbing and was found to have an inflammatory myofibroblastic tumour in her right upper lobe; a 15-year-old adolescent with a left main stem bronchial inflammatory myofibroblastic tumour, who presented with breathlessness and chest pain; and a 12-year-old girl with a tracheal inflammatory myofibroblastic tumour who presented with stridor. In each case, the tumour was resected surgically. CONCLUSION Inflammatory myofibroblastic tumour are a rare but clinically important and pathologically distinct lesion of the respiratory tract in children. The cases in this series highlight some of the varied clinical presentations of inflammatory myofibroblastic tumours, and illustrate some of this tumour's different anatomical locations within the paediatric respiratory tract.
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MESH Headings
- Adolescent
- Anaplastic Lymphoma Kinase
- Antirheumatic Agents/therapeutic use
- Arthralgia/etiology
- Arthritis, Juvenile/diagnosis
- Bronchoscopy
- Child
- Dyspnea/etiology
- Female
- Granuloma, Plasma Cell/diagnosis
- Granuloma, Plasma Cell/metabolism
- Granuloma, Plasma Cell/surgery
- Histiocytoma, Benign Fibrous/diagnosis
- Histiocytoma, Benign Fibrous/surgery
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/metabolism
- Lung Neoplasms/surgery
- Methotrexate/therapeutic use
- Neoplasms, Muscle Tissue/diagnosis
- Neoplasms, Muscle Tissue/metabolism
- Neoplasms, Muscle Tissue/surgery
- Osteoarthropathy, Secondary Hypertrophic/etiology
- Receptor Protein-Tyrosine Kinases/metabolism
- Recurrence
- Respiratory Sounds/etiology
- Respiratory Tract Diseases/diagnostic imaging
- Respiratory Tract Diseases/metabolism
- Respiratory Tract Diseases/surgery
- Skin Neoplasms/surgery
- Staining and Labeling
- Thigh/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- M Brodlie
- Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.
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14
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Kawata H. [Optimal timing of pediatric surgery to prevent deleterious effects on associated cardiac defects]. Nihon Geka Gakkai Zasshi 2011; 112:225-230. [PMID: 21819010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although cardiac defects are thought to have deleterious effects on the outcome of general pediatric surgery due to low cardiac output syndrome and hypoxemia, both pediatric surgery and cardiac surgery can be performed at the optimal timing with good results. However, some conditions requiring pediatric surgery may have deleterious effects on the outcome of cardiac surgery. Airway obstructive diseases sometimes require concomitant repair of the associated cardiac defects. In particular, tracheal stenosis may be repaired in cooperation with not only general pediatric and cardiac surgeons but also with pediatric thoracic surgeons who work in other healthcare institutions. Low birth-weight infants with symptomatic patent ductal artery are at risk of poor outcome. For patients with right isomerism, midgut malrotation or sliding hernia should be diagnosed early and repaired at the optimal timing to prevent urgent surgical intervention. Pediatric surgery should be performed at the optimal timing to prevent any deleterious effects on cardiac defects. Moreover, respiratory infection and neurologic disease should be treated to reduce late deaths.
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Affiliation(s)
- Hiroaki Kawata
- Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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15
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Van Niekerk ML. Paediatric thoracoscopy: state of the art. S AFR J SURG 2011; 49:33-35. [PMID: 21933481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 12/22/2010] [Indexed: 05/31/2023]
Abstract
Brad Rogers reported the first significant use of thoracoscopy in children in the late 1970s. Over the past two decades there has been an exponential growth and expansion of this technique. Many advanced procedures, including lobectomy, repair of tracheo-esophageal fistula, excision of mediastinal tumours and diaphragmatic hernia repairs, are being done routinely in pediatric surgery centres around the world. This article reviews the state of the art of thoracoscopic surgery in children. The author selected five procedures which in his opinion are most relevant for this discussion. The thoracoscopic technique seems to offer a favourable alternative to open surgery, but more clinical research is necessary to confirm the benefits of minimal access surgery.
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Affiliation(s)
- M L Van Niekerk
- Division of Paediatrics Surgery, Department of Surgery, University of Pretoria.
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17
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18
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Abstract
Pediatric airway surgery presents many significant challenges to the anesthesia provider. The clinical experience of the Massachusetts Eye and Ear Infirmary serves as a guide in this review to describe the clinical reasoning and perioperative management of the pediatric patient needing airway surgery, with specific emphasis on diagnostic procedures, trauma, laryngotracheal reconstruction, juvenile recurrent respiratory papillomatosis, and adenotonsillectomy.
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Affiliation(s)
- Corey E Collins
- Department of Anesthesiology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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19
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Vergnon L, Jullian MS. [7/12. Strange bodies low aerial pathways in childhood]. Soins Pediatr Pueric 2009:43-44. [PMID: 19994720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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20
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Copăescu C, Tomulescu V. [The Fifth Romanian Congress of the Society of Endoscopic Surgery and other Interventional Techniques. The Second Romanian Conference of Surgical Nurses. Symposium of the Romanian society of Pediatric Surgery, Minimally Invasive Techniques. Bucharest, November 11-14, 2009]. Chirurgia (Bucur) 2009; 104:785-788. [PMID: 20352674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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21
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Schwarzbach MHM, Ronellenfitsch U, Wang Q, Rössner ED, Denz C, Post S, Hohenberger P. Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care. Langenbecks Arch Surg 2009; 395:333-40. [PMID: 19513745 DOI: 10.1007/s00423-009-0507-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 05/20/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate effects of a clinical pathway (CP) for video-assisted thoracoscopic surgery (VATS) on process quality, outcome quality, and hospital costs. MATERIALS AND METHODS We implemented a CP for VATS and compared 34 patients treated with CP to 77 patients treated without CP. Indicators for process quality were duration of catheter placement, pain intensity, respiratory exercising, and mobilization. Outcome quality was measured through morbidity, mortality, reoperations, and readmissions. Cost of hospital stay was calculated using an imputed daily rate. RESULTS Foley catheters were removed significantly earlier after CP implementation. All patients on CP were mobilized and received pulmonary exercising on the operation day. Pain levels were low after CP implementation. Median hospital stay significantly reduced by 5 days. Perioperative outcome quality remained unchanged. Costs significantly diminished by 1,510 Euro per stay. CONCLUSIONS CP implementation had positive effects on process quality. Specifically, catheter management was improved and a good pain control achieved. Patients benefited from shortened stay and were treated at lower cost. A clear effect on outcome quality was not found. CPs are a promising tool for quality improvement and cost containment in thoracic surgery.
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Affiliation(s)
- Matthias H M Schwarzbach
- Department of Surgery, Division of Surgical Oncology and Thoracic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
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22
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Tomulescu V, Stănciulea O, Bălescu I, Vasile S, Tudor S, Gheorghe C, Vasilescu C, Popescu I. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur) 2009; 104:141-150. [PMID: 19499656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Since 1997 when the first robotic procedure was performed various papers pointed the advantages of robotic-assisted laparoscopic surgery, this technique is now a reality and it will probably become the surgery of the future. The aim of this paper is to present our preliminary experience with the three-arms "da Vinci S surgical system", to assess the feasibility of this technique in various abdominal and thoracic procedures and to point out the advantages of the robotic approach for each type of procedure. MATERIALS AND METHODS Between 18 January 2008 and 18 January 2009 153 patients (66 men and 87 women; mean age 48,02 years, range 6 to 84 years) underwent robotic-assisted surgical procedures in our institution; we performed 129 abdominal and 24 thoracic procedures, as follows: one cholecystectomy, 14 myotomies with Dor fundoplication, one gastroenteroanastomosis for unresectable antral gastric cancer, one transthoracic esophagectomy, 14 gastrectomies, one polypectomy through gastrotomy, 22 splenectomies,7 partial spleen resections, 22 thymectomy, 6 Nissen fundoplications, one Toupet fundoplication, one choledocho-duodeno-anastomosis, one drainage for pancreatic abscess, one distal pancreatectomy, one hepatic cyst fenestration, 7 hepatic resections, 29 colonic and rectal resections, 5 adrenalectomies, 12 total radical hysterectomies and pelvic lymphadenectomy, 3 hysterectomies with bilateral adnexectomy for uterine fibroma, one unilateral adnexectomy, and 2 cases of cervico-mediastinal goitre resection. RESULTS 147 procedures were robotics completed , whereas 6 procedures were converted to open surgery due to the extent of the lesion. Average operating room time was 171 minutes (range 60 to 600 minutes, Median length of stay was 8,6 days (range 2 to 48 days). One system malfunctions was registered. Post-operatory complications occurred in 14 cases. There were no deaths. CONCLUSIONS Our preliminary experience suggests that robotic surgery is feasible and worth of clinical application. The best indications for robotic surgery are the procedures that require a small operating field, a fine a precise dissection (suitable for pelvic and gastric lymphadenectomy, nerve sparing in total mesorectal excision) and safe intracorporeal sutures.
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Affiliation(s)
- V Tomulescu
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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Svistushkin VM, Ovchinnikov IM, Nikiforova GN, Bankhaeva ZB, Rudenko MV, Detochka IV. [Experience with the use of surgical lasers for the treatment of patients with upper respiratory tract and ear diseases]. Vestn Otorinolaringol 2009:36-39. [PMID: 19738589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The objective of this study was to analyse the efficiency and safety of the use of a holmium- YAG laser (wave length 2.09 mcm) and an erbium-activated glass-based fiber laser scalpel (wave length 1.56 mcm) in ENT-surgery. Priority methods for the surgical intervention in the nasal cavity, paranasal sinuses, and middle ear were developed to treat patients with distorted nasal septa, vasomotor rhinitis, polypous rhinosinusitis, Eustachian tube dysfunction, and various forms of chronic suppurative otitis media. Long-term observations demonstrated fairly good stability of beneficial outcomes of the treatment with the above methods in the majority of the patients. It is concluded that surgical technologies with the use of modern medical lasers provide extensive possibilities for a great variety of interventions in patients with upper respiratory tract and ear diseases.
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Robinson NE, Zhuang M. Custom-designed airway surgery for the horse: a dream that may become reality. Equine Vet J 2008; 40:195-7. [PMID: 18442960 DOI: 10.2746/042516408x298263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- N E Robinson
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824, USA
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Fanjul M, García-Casillas MA, Parente A, Cañizo A, Laín A, Matute JA, Vázquez J. [Diode laser application for the treatment of pediatric airway pathologies]. Cir Pediatr 2008; 21:79-83. [PMID: 18624274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED Laser application for the treatment of pediatric airway pathologies represents a very attractive option because of the limited inflammatory reaction after photocoagulation. One novel laser used for such pathologies is the diode laser. AIM The purpose of this report is to present our preliminary experience in the use of diode laser in the treatment of pediatric airway lesions. METHODS A retrospective review of 22 patients (11 males and 11 females) who underwent laser procedures from 1999 to 2006 was performed. Nineteen patients were treated at our center while 3 were referred after a laser application from other institution. In all procedures flexible bronchoscopy was used. The mean age was 1.25 years (range 1 month-4.8 years). Lasers were applied for various lesions: laryngomalacia and arytenoid lesions (n = 5), angiomas (n = 3), lymphangiomas (n = 3), sacular cyst and other mucous lesions (n = 3), granulomas, scarring lesions (n = 4) and paralysis of vocal cord in adduction (n = 1). RESULTS None of the patient developed complications related to the endoscopic laser application. The mean number of laser therapy attempts were 1.4 per patient (range 1-3). The patients remained intubated for a mean of 2.8 days (range 4 hours-13 days) after the procedure. The duration of PICU stay after laser therapy was a mean of 4.6 days (range 1-8 days). The best outcomes were seen in sacular cysts (excelent in 3 patients). Also, all 3 patients with granulomas showed a good response to treatment. Multiple laser sessions (1-3; mean 1.4) were required to sucessfully manage the artynenoid lesions. However, the children with vascular lesions demonstrated differents outcomes. Of the 3 patients with subglottic angioma, 2 underwent a subsequent surgical procedure due to the development of subglottic stenosis; and one requiered further systemic steroid therapy. Of the children with lymphangioma, one needed 3 laser sessions and two required surgi- cal resections. Despite laser treatment, 3 of the 4 patients with scarring lesions required surgery. CONCLUSIONS The endoscopic application of diode laser for the management of pediatric airways lesions provides good outcomes in selected patients. Sacular lesions, granulomas and arytenoid lesions are, in our experience, excellents indications. In other anomalies laser is a good adjuvant. The application of laser should be tailored according to the pathology.
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Affiliation(s)
- M Fanjul
- Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid.
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26
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Tong CH, Xu LL, Wang Z. [The study and clinical application of bronchoscopic lung volume reduction]. Zhonghua Jie He He Hu Xi Za Zhi 2008; 31:9-11. [PMID: 18366898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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27
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Newton PO, Perry A, Bastrom TP, Lenke LG, Betz RR, Clements D, D'Andrea L. Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine (Phila Pa 1976) 2007; 32:1875-82. [PMID: 17762296 DOI: 10.1097/brs.0b013e31811eab09] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter study of prospectively collected pulmonary function testing and radiographic measures in patients surgically treated for adolescent idiopathic scoliosis (AIS). OBJECTIVE The objectives of this study were 1) to identify the factors that determine pulmonary function more than 2 years after surgery for AIS; and 2) to determine what factors, if any, can predict an increase or decrease in the percent predicted 2-year pulmonary function. SUMMARY OF BACKGROUND DATA Thoracic spinal deformity can lead to significant pulmonary impairment. Studies have shown that patients with AIS experienced a significantly greater improvement in pulmonary function at 2 years after surgery when treated with a posterior approach compared to an anterior approach. METHODS Pulmonary function testing (PFT) and radiographic examination of 254 patients with AIS were completed prospectively. Demographic data, associations between radiographic measurements of spinal deformity, and the results of spirometry underwent correlation analysis and subsequent step-wise multiple regression analysis. RESULTS The variables found to be significant predictors of 2-year pulmonary function (FVC, FEV1, TLC) include: preop PFT (R = 0.20-0.39), having an open thoracotomy (as opposed to thoracoscopic or posterior) (R = 0.07-0.09), surgical time (R = 0.03-0.07), and thoracoplasty (R = 0.02-0.04). These models explain 40 to 51% of the variance in 2-year PFT. For patients undergoing open thoracotomy with a thoracoplasty, approximately 54% had a 15% decrease, or more, in percent predicted PFT. This compared with 11% and 15%, respectively of patients who either had posterior or thoracoscopic procedures with no thoracoplasty that had a 15% decrease or more in percent predicted PFT. CONCLUSION Aside from preoperative PFT values, open anterior approaches predict the largest percent of variance in 2-year PFT. Additionally, a clinically significant reduction in the predicted 2-year pulmonary function is more likely when performing a thoracoplasty. The magnitude of the effects for both these variables, however, is modest. This may facilitate the decision-making process as regards to operative intervention.
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Affiliation(s)
- Peter O Newton
- Department of Orthopedics, Rady Children's Hospital-San Diego, San Diego, CA, USA.
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Abstract
In the past, rudimentary devices were used to look closely into the chest; currently, advanced video technology, computers, and high-tech electronics are being used to perform many surgical procedures that formerly required a large, open incision. The goal of video-assisted thoracoscopic surgery (VATS) is the same as for comparable open procedures, but it is accomplished with less pain, less patient morbidity, and a shorter hospital stay. In addition to evaluating and treating thoracic injuries, VATS has demonstrated effectiveness in detecting and managing many other conditions, such as pleural disease, interstitial lung disease, and thoracic malignancies.
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Affiliation(s)
- Fadi M Khraim
- University of New York at Buffalo, School of Nursing, USA
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Yu CW, Hsieh MJ, Hwang KP, Huang CC, Ng SH, Ko SF. Mediastinal mature teratoma with complex rupture into the pleura, lung, and bronchus complicated with mycoplasma pneumonia. J Thorac Cardiovasc Surg 2007; 133:1114-5. [PMID: 17382673 DOI: 10.1016/j.jtcvs.2007.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Revised: 12/13/2006] [Accepted: 01/05/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Ching-Wen Yu
- Department of Pediatrics, Yuan's General Hospital, Kaohsiung, Taiwan
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Davidson EJ, Martin BB, Parente EJ. Use of successive dynamic videoendoscopic evaluations to identify progression of recurrent laryngeal neuropathy in three horses. J Am Vet Med Assoc 2007; 230:555-8. [PMID: 17302556 DOI: 10.2460/javma.230.4.555] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 3 racehorses were evaluated because of poor performance or abnormal noise originating from the upper portion of the respiratory tract. CLINICAL FINDINGS During maximal exercise, initial dynamic videoendoscopy of the upper respiratory tract revealed complete arytenoid cartilage abduction in 2 horses and incomplete but adequate abduction of the left arytenoid cartilage in 1 horse. Subsequent exercising endoscopic evaluation revealed severe dynamic collapse of the left arytenoid cartilage and vocal fold in all 3 horses. TREATMENT AND OUTCOME 2 horses were treated with prosthetic left laryngoplasty and raced successfully. One horse was retired from racing. CLINICAL RELEVANCE Idiopathic laryngeal hemiplegia can be a progressive disease. Successive dynamic videoendoscopic upper airway evaluations were used to confirm progression of left laryngeal hemiplegia in these 3 horses. Videoendoscopy of the upper respiratory tract during exercise should be considered as part of the clinical evaluation of horses with signs of upper respiratory tract dysfunction.
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Affiliation(s)
- Elizabeth J Davidson
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348-1692, USA
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Abstract
Bronchoscopy is an important tool in the study of the airway. Diagnostic and therapeutic uses are well described in the literature and standardisation of the technique is well defined. Most relevant publications on bronchoscopy come from Europe and the United States, and in some countries they are used as guidelines for local hospitals. In spite of the limited experience published from South America, and the scarcity of financial resources, important information and research pathways have been developed in paediatric bronchoscopy. The information in this review was compiled from local publications, case reports, review articles, brief reports and congress presentations to provide an overview and share the experience about bronchoscopy in South American children.
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Kubyshkin SI, Gorbunov VA, Pyshnyĭ DV. [The operation of tracheostomy: mistakes and complications]. Voen Med Zh 2006; 327:30-6. [PMID: 17300058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
OBJECTIVE To determine the effect of morphine administration on commonly monitored cardio-respiratory variables and recovery quality in horses undergoing anaesthesia and surgery. STUDY DESIGN Prospective, randomized clinical study. ANIMALS Thirty-eight thoroughbred horses, 32 geldings and six mares, 3-13 years old, weighing 411-600 kg. MATERIALS AND METHODS A standard anaesthetic technique was used. Twenty minutes after induction of anaesthesia horses received 0.1 mg kg(-1) (0.1 m) or 0.2 mg kg(-1) (0.2 m) morphine by intravenous injection. A control group did not receive morphine. Heart rate, respiratory rate (fr), mean arterial pressure (MAP) and blood gases were measured before morphine administration and every 10 minutes thereafter. Horses were positioned for 35 minutes in right lateral recumbency for tension palatoplasty by cautery and were then moved into dorsal recumbency for additional intraluminal surgery comprising one or more of aryepiglottic fold resection, sub-epiglottal mucosal resection, ventriculectomy and cordectomy. A subjective recovery score from 0 (worst) to 5 (best) was assigned by a single observer who was unaware of treatment group. Two-way repeated measures anova, one-way anova, Kruskal-Wallis test, Mann-Whitney test, Pearson and Spearman correlation coefficients, and chi-squared tests were used to analyse the data where appropriate. RESULTS Arterial partial pressure of oxygen (PaO(2)) decreased significantly over time and was significantly lower in horses that received morphine. One horse in the control group and two horses in each of the morphine groups had a PaO(2) <13 kPa. No other significant cardiopulmonary effects were detected. Recovery scores [median (range)] were higher in morphine recipients: 4 (2-5) in 0.1 m, 4 (3-5) in 0.2 m compared with 3 (2-4) in the control group. CONCLUSIONS AND CLINICAL RELEVANCE The lower PaO(2) in morphine recipients did not appear to be of clinical significance in healthy horses because the number of horses with a low PaO(2) was similar between groups. The quality of recovery was significantly better in morphine recipients. These results indicate that morphine may be considered for use in clinical cases although further work is required to assess the analgesic properties of the drug in this species.
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Affiliation(s)
- Emma J Love
- Department of Clinical Veterinary Science, University of Bristol, Langford House, Langford, Bristol, UK.
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Dunning J, Nandi J, Ariffin S, Jerstice J, Danitsch D, Levine A. The Cardiac Surgery Advanced Life Support Course (CALS): Delivering Significant Improvements in Emergency Cardiothoracic Care. Ann Thorac Surg 2006; 81:1767-72. [PMID: 16631670 DOI: 10.1016/j.athoracsur.2005.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 12/01/2005] [Accepted: 12/02/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND A 3-day cardiac surgery advanced life support course was designed with a series of protocols to manage critically ill cardiac surgical patients and patients who suffer a cardiac arrest. We sought to determine the effect of this course on the management of simulated critically ill and cardiac arrest patients. METHODS Twenty-four candidates participated in the course. Critically ill patients were simulated using intubated mannikins, with lines and drains in situ, and a laptop with an intensive care unit monitor simulation program. Candidates were tested before and after the course with rigidly predesigned clinical situations. Candidates were split into groups of 6, and cardiac arrests were simulated in the same fashion, with all required surgical equipment immediately available. All scenarios were videotaped, and after blinding, an independent surgeon assessed the times to achieve predetermined clinical endpoints. RESULTS The time to successful definitive treatment was significantly faster postcourse for the critically ill patient scenarios: (565 secs [SD 27 secs] precourse, compared with 303 secs [SD 24 secs] postcourse; p < 0.0005). In addition, the times taken to achieve a wide range of predetermined objectives, including airway check, assessing breathing, circulation assessment, treating with oxygen, appropriate treatment of the circulation, and requesting blood gases, chest radiographs, and electrocardiograms, were also significantly faster in the postcourse scenarios. Times to successful chest reopening and internal cardiac massage were also significantly improved in cardiac arrest patients: (451 secs [SD 39 secs] precourse and 228 secs [SD 17 secs] postcourse; p = 0.011). CONCLUSIONS Structured training and practice in the management of critically ill cardiac surgical patients and patients suffering a cardiac arrest leads to significant improvements in the speed and quality of care for these patients.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom.
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Takao M, Tarukawa T, Shimamoto A, Shimpo H. Principle for video-assisted thoracic surgery. Eur J Cardiothorac Surg 2005; 28:657; author reply 657-8. [PMID: 16125953 DOI: 10.1016/j.ejcts.2005.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 05/13/2005] [Accepted: 06/27/2005] [Indexed: 10/25/2022] Open
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Affiliation(s)
- Damon Kamming
- Department of Anaesthesia, Royal National Throat Nose and Ear Hospital, London.
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Pillai JB, Smith J, Hasan A, Spencer D. Review of pediatric airway malacia and its management, with emphasis on stenting. Eur J Cardiothorac Surg 2005; 27:35-44. [PMID: 15621469 DOI: 10.1016/j.ejcts.2004.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 09/05/2004] [Accepted: 10/04/2004] [Indexed: 11/21/2022] Open
Abstract
Malacia of the pediatric airway presents itself in a variety of clinical circumstances. Pediatric airway stenting is a more recent treatment modality. Complications may necessitate stent removal. This is usually performed bronchoscopically. We were forced to surgically remove a complicated airway stent. The Palmaz stent had been inserted for bronchomalacia presenting after interrupted aortic arch surgery in a 4-month old child with DiGeorge syndrome. This prompted us to review pediatric airway malacia, its management options and long-term outcomes, in an attempt to crystallize the current status of this relatively uncommon and difficult issue. The role of stents is analysed.
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Affiliation(s)
- Jain Bhaskara Pillai
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.
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Sasaki M, Hirai S, Kawabe M, Uesaka T, Morioka K, Ihaya A, Tanaka K. Triangle target principle for the placement of trocars during video-assisted thoracic surgery. Eur J Cardiothorac Surg 2005; 27:307-12. [PMID: 15691687 DOI: 10.1016/j.ejcts.2004.10.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2004] [Revised: 10/11/2004] [Accepted: 10/19/2004] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The baseball-diamond principle is generally used for trocar placement during video-assisted thoracic surgery; however, we are unable to treat all peripheral lung lesions using this principle. Therefore, we have developed another method for determining trocar placement based on a modification of the conventional principle. We have termed this method the triangle target principle. This report describes the instrument positioning that we now use for many video-assisted thoracic surgical procedures. METHODS We position 3 trocars in an equilateral triangle, with the target lesion at the apex. One vertex of the base becomes the site of the first trocar placement for introduction of the thoracoscopic camera. Another vertex of the base becomes the site for the second trocar for forceps or the endoscopic stapler. The third trocar is for forceps and is inserted to create the vicinity of target lesion. Four types of the triangle target principle were developed according to sites of the target lesion. RESULTS Between January 2000 and December 2002, we used this principle for 161 patients who underwent video-assisted thoracic surgery and all intrathoracic lesions were accessible except in 3 patients requiring intraoperative modifications. CONCLUSIONS We conclude that video-assisted thoracic surgery by this principle is more effective and easier than the conventional principle to treat intrathoracic disease.
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Affiliation(s)
- Masato Sasaki
- Department of Surgery (II), University of Fukui, Faculty of Medical Sciences, 23-3 Shimoaizuki, Matsuoka Fukui 911-1104, Japan.
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Shanmugam G, MacArthur K, Pollock JC. Congenital lung malformations?antenatal and postnatal evaluation and management. Eur J Cardiothorac Surg 2005; 27:45-52. [PMID: 15621470 DOI: 10.1016/j.ejcts.2004.10.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Revised: 10/01/2004] [Accepted: 10/06/2004] [Indexed: 11/22/2022] Open
Abstract
We reviewed our institutional experience with pulmonary resection for congenital bronchopulmonary malformations and analysed the management and outcome of pregnancies with a prenatal diagnosis of congenital lung malformations. Between January 1993 and December 2003, 31 patients underwent evaluation and pulmonary resection for bronchopulmonary malformations. Common clinical presentations were respiratory distress (9), respiratory infections/pneumonias (22), and dyspnoea (9). Diagnostic modalities included chest radiography, CT scan (22), MRI scan (7), arteriography (1), and bronchoscopy (5). There were 13 congenital cystic adenomatoid malformations (CCAM), six pulmonary sequestrations, three bronchogenic cysts, and nine congenital lobar emphysemas (CLE). Fifteen patients who underwent resection were diagnosed by antenatal ultrasound. No foetus had hydrops or associated malformations. No pregnancy was terminated. There was no foetal demise. Regression of the sonographic appearance was observed in six cases. Amniotic puncture was required for hydramnios in three cases. Eight emergency resections were performed (CCAM 4; CLE 3; Bronchogenic cyst 1). Surgical procedures included 24 lobectomies, one right middle lobectomy with a wedge resection of the right lower lobe, one completion right lower lobectomy, four sequestrectomies, one mediastinal mass excision and one wedge resection for a bronchogenic cyst. There were no deaths. Postoperative complications included: persistent air leak (n=2; one requiring completion lobectomy) and pneumothorax (1). Persistent mild symptoms were present in five patients, at long-term follow-up. Congenital cystic adenomatoid malformation and congenital lobar emphysema were the commonest congenital anomalies. Congenital lung malformations are increasingly diagnosed antenatally, sometimes necessitating emergent surgical resection. The natural history is variable. All infants with a prenatal diagnosis require postnatal evaluation. Patients should be evaluated for associated disorders. The presence of mass effects is an indication for therapeutic decompression. The risk of pulmonary compression, infection and malignant degeneration makes resection imperative, even in asymptomatic patients. Lobectomy is the procedure of choice, is well tolerated, and leads to excellent outcomes.
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Affiliation(s)
- Ganesh Shanmugam
- Department of Paediatric Cardio Thoracic Surgery, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, Scotland, UK
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Hamano K, Kumada S, Hayashi M, Naito R, Hayashida T, Uchiyama A, Kurata K. Laryngeal dystonia in a case of severe motor and intellectual disabilities due to Japanese encephalitis sequelae. Brain Dev 2004; 26:335-8. [PMID: 15165675 DOI: 10.1016/s0387-7604(03)00194-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Revised: 10/06/2003] [Accepted: 10/06/2003] [Indexed: 11/29/2022]
Abstract
Laryngeal dystonia is characterized by stridor due to vocal cord dystonia and is observed in extrapyramidal disorders. Recently, botulinum toxin injection has been used as a primary therapy. Generally, severe motor and intellectual disabilities (SMID) are frequently complicated by various types of respiratory disorders. We report a SMID case with Japanese encephalitis sequelae showing repeated vocal cord abductor disturbance due to laryngeal dystonia, in addition to generalized dystonia, in whom MRI revealed basal ganglia lesions. Tracheostomy was effective for the case, and we believe that botulinum toxin injection may be inappropriate in SMID, both ethically and technically. Also, laryngeal dystonia should be considered as a cause of respiratory disorders in SMID.
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Affiliation(s)
- Kimiko Hamano
- Department of Pediatrics, Metropolitan Fuchu Medical Center for Severe Motor and Intellectual Disabilities, 2-9-2 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan.
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Bondarenko MV. [The volume of surgery on the abdominal cavity organs in patients with associated cardiovascular and respiratory system diseases]. Klin Khir 2004:29-32. [PMID: 15560576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The cardiovascular and respiratory disturbances are the main risk factor in acute and chronic surgical deseases of the abdominal cavity organs, including oncological. It is limits the possibility and volume of the diagnostics and surgical tactics choice. The complicated current of main disease is a risk factor of operation perform and the reason of the undertaking inadequate and palliative intervention, which significant reduce of the quality of life. Real by risk level reductions in surgery is a determination of tissues viability, estimation of compensatory reserve sick evidences for determination for operation performance including simultaneous and staged.
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Postma GN, Goins MR, Koufman JA. Office-based laser procedures for the upper aerodigestive tract: emerging technology. Ear Nose Throat J 2004; 83:22-4. [PMID: 15366418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
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Kubba H, Cooke J, Hartley B. Can we develop a protocol for the safe decannulation of tracheostomies in children less than 18 months old? Int J Pediatr Otorhinolaryngol 2004; 68:935-7. [PMID: 15183585 DOI: 10.1016/j.ijporl.2004.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Revised: 02/18/2004] [Accepted: 02/24/2004] [Indexed: 11/25/2022]
Abstract
Expanding indications for airway and head and neck surgery have led to a number of children under 18 months of age being deemed suitable for decannulation of their tracheostomies. We present four cases to illustrate the particular problems encountered in this age group and suggest modifications to our previously-published decannulation protocol.
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Affiliation(s)
- Haytham Kubba
- Department of Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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Bondarenko MV. [Mortality rate in reconstructive plastic surgery in patients with cardiorespiratory diseases]. Lik Sprava 2004:61-4. [PMID: 15318828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The results of the reconstruct-plastic operations of 25 patients are presented in the article. The treatment of patients has some specific pecularities. They are the following: difficulties in diagnosing stomach and large intestine cancer recurrence after surgical treatment as well as surgical reoperation restriction resulted from cardio-vascular system, especially heart coronary arteries being affected through the disease development. To improve surgical treatment results of such patients it is recommended to examine vital organs in order to prevent fatal complications and mortality of the surgical operations.
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Abstract
Preventing and managing complications of airway surgery in children requires proactive attention to both surgical and anaesthetic aspects of the planned procedure. Preoperative evaluation should include a thorough physical examination and, especially in children with multiple congenital anomalies, flexible fibreoptic nasopharyngolaryngoscopy, direct laryngoscopy and rigid or flexible bronchoscopy. The goal is to identify dynamic abnormalities such as laryngomalacia or vocal cord paralysis, tracheal or bronchial lesions, gastro-oesophageal reflux disease (GORD), aspiration, laryngotracheal stenosis, totally obstructing tracheostomy-associated granulation tissue and Noonan syndrome preoperatively, and then to plan surgical management to achieve the best possible outcome for each patient.
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Affiliation(s)
- Robert F Yellon
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Radev R, Nenkov R, Kornovski S, Dokov V, Kuzmanov I, Kuzmanov S, Nenkova S, Nanev B. [The application of argon plasma coagulation in thoracic surgery: principles, surgical technique and clinical results]. Khirurgiia (Mosk) 2004; 60:20-3. [PMID: 16044870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND In recent years, together with the well-known high-frequency electro-coagulation, the application of plasma coagulation has been also introduced in the clinical practice. The argon plasma coagulator (APC) is one of the representatives of this surgical technique. By its nature, the APC represents a non-contact electrothermal tissue coagulation, combining the principle of the augmented surface and enhanced autogenous haemostatic mechanisms. AIM The main objective of this study was to evaluate whether APC is an effective and safe modality in the open pulmonary surgery. MATERIALS AND METHODS For the period from 01.01.2003 to 30.01.2004 year, in the Clinic of Thoracic Surgery, we have applied the technique of APC to 15 patients. The distribution by sex was: 10 males and 5 females. According to the nosological units, the distribution was as follows: pulmonary carcinoma in 3, pulmonary echinococcosis in 4, pleural empyema in 6, pulmonary abscessus in 1 and esophageal ahalasia in 1 patient. In our practice, we have used an argon plasma coagulator of BERCHTOLD GmbH. A power setting of 20W with exposition time 15 s and an argon gas flow setting of 1,5-2 1/h have been used in our series. Energy dose applied in our patients didn't exceed 300 J/cm2. RESULTS The results we have obtained demonstrate the following fundamental advantages of APC: a possibility to work with long electrode--tissue distance; a possibility for large surface coagulation as well as coagulation under variable angle, limited and well controlled depth of penetration, substantial reduction of carbonization; regular distribution of the energy over the whole coagulating surface, a possibility to treat effectively larger bleeding surfaces. CONCLUSIONS Although initial, our experience gives us the confidence to recommend the use of APC as an effective and safe procedure in the pulmonary surgery.
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Abstract
Although the association between gastroesophageal reflux (GER) and typical esophageal symptoms, such as heartburn and regurgitation, is straightforward, this is not the case for the relation between GER and respiratory symptoms. The strongest link is the finding of abnormal reflux in the proximal esophagus or pharynx. This finding, in conjunction with evidence of airway injury such as seen on laryngoscopy, strongly supports the relation between GER and airway disease. Medical therapy provides relief to some patients, but with less consistency than for those with typical symptoms of GER disease. This is likely due to persistent aspiration or injury from supraesophageal reflux. Laparoscopic antireflux surgery is extremely safe and effective for reducing reflux as well as aspiration, and appears to be more effective than medical treatment for treating GER-related respiratory symptoms.
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Norzila MZ, Norrashidah AW, Rusanida A, Sushila S, Azizi BH. Local experience in paediatric flexible bronchoscopy. Med J Malaysia 2003; 58:350-5. [PMID: 14750374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
All children who underwent flexible bronchoscopy in the respiratory unit at Paediatric Institute, Hospital Kuala Lumpur from June 1997 to June 2002 were reviewed. A hundred and ten children underwent the procedure under sedation or general anaesthesia. The median age of these children was eight months. (Q1 3, Q3 30) The commonest indication for performing flexible bronchoscopy was for chronic stridor (50 cases) followed by persistent or recurrent changes such as lung infiltrates, atelectasis and consolidation on the chest radiographs (22). Laryngomalacia was found to be the commonest cause of stridor in 29 children. Two patients were diagnosed with pulmonary tuberculosis. With regard to safety, three procedures were abandoned due to recurrent desaturation below 85%. One of these patients had severe laryngospasm that required ventilation for 48 hours but recovered fully. Two neonates developed pneumonia requiring antibiotics following bronchoscopy. No patients developed pneumothorax or bleeding following the procedure. Bronchoscopy is a safe procedure when performed by well-trained personnel. Since it is an invasive procedure the benefits must outweigh the risks before it is performed.
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Affiliation(s)
- M Z Norzila
- Department of Paediatrics, Institut Pediatrik, Hospital Kuala Lumpur
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Abstract
Lasers have become important tools for the equine surgeon in the treatment of upper respiratory tract disease in the horse. Multiple wavelengths and delivery systems are available. Indications for the use of lasers in the upper respiratory tract primarily include minimally invasive procedures not possible with conventional surgical instrumentation. New applications for the use of lasers to treat upper respiratory disease are likely to evolve with the development and introduction of new wavelengths and delivery systems.
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Affiliation(s)
- Scott E Palmer
- New Jersey Equine Clinic, 279 Millstone Road, Clarksburg, NJ 08510, USA.
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