Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance parameters with a dramatic improvement in lifestyle, whereas the three with tracheostomy were successfully decannulated. The routine use of these rings has alleviated the need for rib/cartilage grafts, primary resections with anastomosis, prolonged periods of cannulation, and multiple surgeries. Our experience in the use of ceramic rings for tracheomalacia repair will be presented, highlighting selection criteria for their use, intraoperative placement, perioperative complications, and post-operative followup for a minimum of 6 months.
The objective of this study was to find additional sonomorphological criteria for determining the status of enlarged lymph nodes. By using colour-coded duplex sonography the perfusion of 63 lymph nodes in the neck was analysed. The status was confirmed either histologically or clinically (29 metastases from squamous cell carcinomas and 34 acute or chronic inflammatory nodal diseases). A quantitative evaluation of the pulsatility measured in 51 lymph nodes by computing the Pourcelot-Ratio and the Mean Pulsatility Index yielded significant differences between the two groups. By definition of a limiting value of the Pourcelot-Ratio (0.75) for the prediction of benignity, the specificity and the accuracy in screening for metastases were improved as compared to clinical examination and B-mode sonography. Additional criteria of dignity were found by qualitative evaluation of nodal perfusion patterns (presence and distribution of perfusion, partial loss of perfusion). The use of colour-coded duplex sonography in nodal disease of the neck provides an improvement of early and noninvasive diagnosis of regional metastatic involvement.
For the first time liability of of ultrasonography in diagnosing paranasal sinus disease was controlled in 256 patients with acute maxillary sinusitis as compared to irrigation findings and in 150 patients with persistent maxillary sinus disease using x-rays, sinoscopy and sinumanometry as controls. Confidence in diagnosing the presence of discharge ranges up 90%. In cases of total opacity of the sinus, ultrasonography helps differentiating mucosal swelling, tumor and discharge.
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