scholarly journals Flexible CO2Laser Fiber in the Pediatric Airway

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Kimberly K. Caperton ◽  
G. Paul Digoy
Keyword(s):  
Granulation Tissue ◽  
Carbon Dioxide Laser ◽  
Tissue Injury ◽  
Case Series ◽  
Laser Technique ◽  
Pediatric Airway ◽  
Laser Fiber ◽  
Tissue Removal ◽  
Laryngotracheal Reconstruction ◽  
Left Main Stem Bronchus

Objective. Our institution has been using a novel flexible laser fiber in pediatric surgical airway procedures, which has been quite successful. The purpose of this paper is to present our preliminary experience in the treatment of pediatric airway lesions using this laser technique.Methods.A case series reviewing 40 patients undergoing 95 laser procedures is reported. Indications included removal of suprastomal granulation tissue, removal of granulation after laryngotracheal reconstruction, subglottic and supraglottic stenoses, recurrent respiratory papillomas, subglottic hemangioma, laryngeal cleft, and left main stem bronchus stenosis. Procedures were performed via microdirect laryngoscopy and bronchoscopy.Results. No complications including postoperative glottic webs, concentric scar formation, or airway fires occurred in any of the patients (after the series was completed, we did experience an airway fire. It was a flash flame that was self-limited and caused no long-term tissue injury).Conclusions. The endoscopic application of a new flexible carbon dioxide laser fiber for management of pediatric airways lesions provides good outcomes in selected patients. Distal respiratory papillomas, subglottic stenosis, and granulation tissue are, in our experience, appropriate indications.

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

scholarly journals The effect of hyperbaric oxygen treatment on late radiation tissue injury after breast cancer: A case-series of 67 patients

2020 ◽  
Vol 50 (3) ◽  
pp. 206-213
Author(s):  
Nicole E Spruijt ◽  
◽  
Roy van den Berg ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Hyperbaric Oxygen ◽  
Tissue Injury ◽  
Case Series ◽  
Shoulder Abduction ◽  
Hyperbaric Oxygen Treatment ◽  
Normal Tissues ◽  
Oxygen Treatment ◽  
Shoulder Motion

Introduction: Late radiation tissue injury (LRTI) after breast cancer may benefit from hyperbaric oxygen treatment (HBOT). This study aimed to report the LRTI symptom scores up to 12 months after HBOT and identify risk factors for poor scores. Methods: A case-series of 67 patients who underwent a mean of 44 sessions of HBOT was analysed. LRTI symptoms were scored at four time points using the LENT-SOMA scale (Late Effects in Normal Tissues – Subjective, Objective, Management, and Analytic), a visual analog scale for pain, and the range of shoulder motion. Results: Between starting HBOT and 12 months after HBOT 57 patients (85%) reported at least one point improvement in their LENT-SOMA score. Median pain and fibrosis scores improved significantly between the start and end of HBOT (P < 0.001), and remained stable three and 12 months after HBOT. The median breast oedema score improved significantly 12 months after HBOT (P = 0.003). Median shoulder abduction increased significantly from 90 to 165 degrees (P = 0.001) and median shoulder anteflexion increased significantly from 115 to 150 degrees (P = 0.004). Various risk factors were identified for poor scores despite HBOT; the most common risk factor was a poor score at start of HBOT. Conclusions: In this case-series, patients who underwent HBOT for LRTI after breast cancer reported significant improvement in pain, fibrosis, oedema, and shoulder movement. The improvement persisted up to 12 months after HBOT. A poor score at the start of HBOT was predictive for a poor score 12 months after HBOT.

scholarly journals Development of Epoxy Resin-Based Elastomeric Microfluidic Devices Using CO2 Laser Ablation for DNA-Amplification Point-Of-Care (POC) Applications: Assessment of Microchannels' Dimensions and Quality

2021 ◽  
Author(s):  
Heba Mansour ◽  
Ahmed M.R. Fath El-Bab ◽  
Emad A. Soliman ◽  
Ahmed L. Abdel-Mawgood
Keyword(s):  
Laser Ablation ◽  
Epoxy Resin ◽  
Epoxy Resins ◽  
Carbon Dioxide Laser ◽  
Microfluidic Devices ◽  
Microfluidic Chips ◽  
Laser Technique ◽  
Lab On Chip ◽  
Expensive Equipment ◽  
The Impact

Abstract Microfluidic devices are a rising technology to automatize chemical and biological operations. In this context, laser ablation has significant potential for polymer-based microfluidic platforms' fast and economical manufacturing. Nevertheless, the manufacturing of epoxy-based microfluidic chips is considered highly cost full due to demand for cleanroom facilities that utilize expensive equipment and lengthy processes. Therefore, this study targeted investigating the feasibility of epoxy resins to be fabricated as a lab-on-chip using carbon dioxide laser ablation. The chemical structural properties and thermal stability of the plain epoxy resins were characterized by Fourier transform infrared spectral analysis (FT-IR) and thermogravimetric analysis (TGA). Moreover, a specific migration test was performed to quantify potential migrants by gas chromatography coupled to mass spectrometry (GC-MS) to prove that the cured epoxy resin would not release unreacted monomers to the biological solution test, which caused inhibition of the sensitive biological reactions. By investigating the impact of this process on microchannels' dimensions and quality, a laser technique using CO2 laser was used in vector mode to engrave into a transparent epoxy resin chip. The resulting microchannels were characterized using 3D Laser microscopy. The outcomes of this study showed considerable potential for laser ablation in machining the epoxy-based chips, whereas the microchannels were produced with minor bulges' height (0.027 µm) with no clogging. Moreover, a reasonable depth of 99.31 µm with roughness (Ra) of 14.52 µm was obtained at a laser speed of 5 mm/s and laser power of 1.8 W. This process can produce epoxy resin-based microfluidic chips without the need for cleanroom facilities that require expensive equipment and lengthy process.

Tracheal Perforation Developed during Endotracheal Granulation Tissue Removal with CO2 Laser: A case report

1997 ◽  
Vol 32 (3) ◽  
pp. 473
Author(s):  
Jae Yong Shim ◽  
Keon Hee Ryu ◽  
Yoon Ki Lee ◽  
Jae Yub Jung
Keyword(s):  
Case Report ◽  
Co2 Laser ◽  
Granulation Tissue ◽  
Tissue Removal

scholarly journals Airway Stenosis Related to Foreign Body Aspiration: An Under-recognized Long term Complication

2019 ◽  
Vol 12 ◽  
pp. 117954761986381 ◽  
Author(s):  
Ravindra M Mehta ◽  
Nadakuditi Rashmi ◽  
Pooja Bajaj ◽  
Shyam Krishnan ◽  
Lakshmipriya Srinivasan
Keyword(s):  
Foreign Body ◽  
Granulation Tissue ◽  
Case Series ◽  
Foreign Body Aspiration ◽  
Areca Nut ◽  
Tissue Formation ◽  
Airway Patency ◽  
Granulation Tissue Formation ◽  
Airway Stenosis

Introduction: Sequelae of chronic foreign body aspiration include occlusive granulation tissue formation, which can cause delayed fixed airway stenosis. The aim of this study is to highlight this complication, which should be diagnosed early and treated proactively. Methods: We present a case series of areca nut aspiration, an organic foreign body commonly chewed in Southeast Asia, complicated by delayed airway stenosis and examine the peculiar nature of areca nut that predisposes to this complication. Results: Long-term sequelae of areca nut aspiration are granulation tissue formation, potentially complicated by airway stenosis due to the mechanical and chemical irritant nature of areca nut. Discussion: Organic impacted foreign bodies such as areca nut can cause delayed complications of airway stenosis. Both the sharp edges of the areca nut and chemical irritation caused by alkaloids released by the nut in constant contact with the airway mucosa can predispose to this long-term complication. Early diagnosis and appropriate therapeutic interventions such as balloon bronchoplasty can help restore airway patency and prevent lung damage.

Laser Therapy for Refractory Myringitis in Children

2002 ◽  
Vol 127 (3) ◽  
pp. 163-168 ◽  
Author(s):  
Frank P. Fechner ◽  
Michael J. Cunningham ◽  
Roland D. Eavey
Keyword(s):  
Laser Treatment ◽  
Tertiary Care ◽  
Case Series ◽  
Laser Technique ◽  
Retrospective Case ◽  
Tympanic Membrane Perforations ◽  
Specialty Hospital ◽  
Associated Symptoms ◽  
Initial Results

OBJECTIVE: We present the application and initial results of a CO2 laser technique for the treatment of medically refractory chronic granular myringitis (CGM). STUDY DESIGN AND SETTING: Retrospective case series of 15 treated ears in 13 consecutive patients between the ages of 6 and 14 years (median age, 9.0 years) cared for in a tertiary care specialty hospital. RESULTS: Eleven of 15 treated ears had total resolution of CGM and associated symptoms; median follow-up time was 10 months. Three ears were improved, and 1 ear remained unchanged. Three of 5 preoperative tympanic membrane perforations healed after laser treatment; 1 patient developed a postoperative, dry perforation. Hearing was not impaired in any patient tested. CONCLUSION: Preliminary results suggest that CGM, when refractory to medical treatment, can often be treated effectively by a single laser treatment.

Wound healing complications with lenvatinib identified in a pharmacovigilance database

2018 ◽  
Vol 25 (8) ◽  
pp. 1817-1822 ◽  
Author(s):  
Connie Cheng ◽  
Afrouz Nayernama ◽  
S Christopher Jones ◽  
Denise Casey ◽  
Peter E Waldron
Keyword(s):  
Wound Healing ◽  
Kinase Inhibitors ◽  
Tissue Injury ◽  
Risk Mitigation ◽  
Adverse Event Reporting System ◽  
Case Series ◽  
Wound Dehiscence ◽  
Safety Risk ◽  
Impaired Healing ◽  
Wide Range

The U.S. Food and Drug Administration (FDA) has approved several vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors, including lenvatinib, for thyroid and renal malignancies. Inhibition of the VEGFR signaling pathway impairs angiogenesis and can disrupt wound healing. The objective of this work was to evaluate wound healing complications as a potential safety risk for patients treated with lenvatinib. We searched the FDA Adverse Event Reporting System (FAERS) database for postmarketing reports of wound healing complications with lenvatinib between 13 February 2015 (FDA approval date) and 15 February 2017. The search identified nine FAERS cases of lenvatinib-associated wound healing complications that were not previously reported in the medical literature. Seven cases involved postoperative wound healing complications, such as impaired healing or wound dehiscence. In our case series, the reported time to identification of delayed wound healing from tissue injury or surgery varied over a wide range (4–58 days). The time of initial lenvatinib exposure relative to the tissue injury was also highly varied in our series, which may have influenced the development and detection of impaired healing. FAERS case-level evidence suggests that lenvatinib may have contributed to wound healing complications based on temporality and biologic plausibility. Healthcare professionals should be aware of this safety risk to facilitate prompt recognition and risk mitigation.

Laryngotracheal Reconstruction in Adults Aged 60 Years and Older

2019 ◽  
Vol 160 (6) ◽  
pp. 1065-1070 ◽  
Author(s):  
Saad C. Rehman ◽  
Deborah X. Xie ◽  
James R. Bekeny ◽  
Alexander Gelbard ◽  
Christopher T. Wootten
Keyword(s):  
Complete Blood Count ◽  
Tertiary Care ◽  
Case Series ◽  
Tracheal Resection ◽  
Distribution Width ◽  
Free Survival ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction

Objective The primary aim of this study is to evaluate the safety, efficacy, and execution of major open laryngotracheal operations for patients in the advanced decades. Study Design Case series with chart review. Setting Multidisciplinary clinic at a tertiary care academic hospital. Subjects and Methods Patient characteristics, operative course, and postoperative outcomes were retrospectively recorded for all airway reconstruction operations performed between 1999 and 2016 on patients aged ≥60 years Long-term success was defined as prosthesis-free survival at last follow-up. Descriptive statistics were performed. Results Twenty-nine patients met inclusion criteria, and the median age was 71 years (interquartile range, 63-74). Tracheal resection was the most common procedure (13 patients), followed by laryngotracheal reconstruction (7 patients). Fifteen patients began their operation with a tracheostomy, 6 of whom underwent decannulation prior to leaving the operating room. Three additional patients underwent decannulation at follow-up appointments and were prosthesis-free at most recent follow-up. The mean time to decannulation among these patients was 3 months. Of the 14 patients beginning their procedure without a tracheostomy, only 2 required permanent airway prosthesis. The overall long-term rate of prosthesis-free survival was 72.4% (21 of 29 patients). Factors suggestive of long-term success include lower McCaffrey grade and lack of pulmonary disease, hypertension, or diabetes, as well as decreased red blood cell distribution width on preoperative complete blood count. Conclusion Through careful patient selection, preoperative workup, and meticulous postoperative care, airway reconstruction procedures in patients aged ≥60 years are reasonably successful. Of 29 patients, 21 (72.4%) were successfully breathing long-term without airway prosthesis.

Analysis of Outcomes of Vascularized Flap Reconstruction in Patients with Advanced Mandibular Osteoradionecrosis

2009 ◽  
Vol 141 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Daniel S. Alam ◽  
Michael Nuara ◽  
James Christian
Keyword(s):  
Data Collection ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Fistula Formation ◽  
Wound Complications ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
End Stage

OBJECTIVE: To examine outcomes of vascularized bone flap reconstruction of end-stage osteoradionecrosis of the mandible. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary care academic hospital. SUBJECTS: Patients with end-stage radiation-induced osteoradionecrosis (ORN) refractory to conservative therapy with wound complications including chronic infections, fistula formation, and pathologic fracture were included. RESULTS: Outcomes of 33 patients were prospectively collected and analyzed, making this the largest series on this subject in the literature and the only one with planned data collection. Data on preoperative variables including radiation dose, sub-site location, treatment date, and prior therapy, along with intraoperative issues and postoperative outcomes, were tracked and are presented. ORN was seen to develop in a bimodal distribution based on the timing of interval surgical intervention. The extent of local soft tissue injury often required the use of contralateral recipient vessels. Local wound complication rates were higher than that seen in primary reconstructions. CONCLUSIONS: Successful reconstruction was achieved in all of the patients in this series. Long-term resolution of infectious complication and disease resolution was seen in 91 percent of the patients in this series.

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