Kenneth A. Geller’s research while affiliated with University of California, Los Angeles and other places

Strictures of the esophagus are difficult and challenging problems. Whether a result of caustic ingestion, trauma, or surgery, or a congenital abnormality, the patient suffers a disruption of the fundamental act of swallowing. The seven cases of stricture of the cervical esophagus presented here were not alleviated by the usual methods of antegrade and retrograde dilation. Each patient underwent a two-stage reconstruction of the esophagus. The strictures in four patients were secondary to a caustic agent, two were congenital, and one was of unknown etiology. All patients no longer require dilation and are essentially cured. This procedure will add to the armamentarium of the surgeon who deals with “hopeless” strictures of the cervical esophagus and, in properly selected cases, should be successful.

This paper reviews the causes of voice change in the infant and child. Symptoms of dysphonia can be very early evidence of a serious problem, either within the larynx or resulting from a systemic disease. The need to investigate the cause of voice disturbances is stressed. The large number of diseases in which voice change occurs makes a complete examination of the child, both local and systemic, absolutely necessary in order to arrive at a specific diagnosis. The mechanism of voice change is described in each category of the numerous causes of dysphonia.

The charts of 15 patients with foregut cysts were reviewed. The lesions were intrathoracic in 14 patients and in the cervical area in one child. The importance of early diagnosis and surgical management is stressed. In untreated infants with foregut cysts, severe progressive and life-threatening airway obstruction may develop. Since the symptoms of this congenital lesion may simulate other more common diseases of the tracheobronchial tree and esophagus, the physician should become familiar with this disease entity so that proper diagnosis and surgical treatment will not be delayed. The study includes symptomatology, methods of diagnosis, pathologic findings and classification of the cysts.

The charts of 100 children with laryngeal paralysis were reviewed. The patients in this study had either unilateral or bilateral abductor vocal cord paralysis. The literature and pathophysiology are reviewed. A statistical analysis of each group of patients according to etiology is reported. The follow-up, progress and recovery are detailed. The need for observation and conservative therapy is reinforced by the tendency for spontaneous recovery. Suggestions regarding treatment are given.

An attempt has been made to outline an approach to some of the anesthetic and endoscopic problems that the pediatric patient presents. The methodology described may or may not be appropriate for every institution. Successful endoscopy in very large numbers has been performed with minimal morbidity and very few complications. Teamwork between endoscopist and anesthesiologist is essential in successful atraumatic endoscopy. Skill and mutual understanding as well as cooperation between specialists are necessary for the safe examination of the child who requires endoscopic procedures.

One hundred and forty cases of papilloma of the larynx and tracheobronchial tree are documented in the records of the Childrens Hospital of Los Angeles. The records of 90 patients were available and were reviewed intensively. The method of direct laryngoscopy with general anesthesia using apneic technique in most patients and intubation in some was an adequate method of treating patients with laryngeal papillomata. A general anesthetic was never used where obstruction was severe and the airway could not be controlled. The low incidence of papilloma of the tracheobronchial tree and an absence of parenchymal lung seeding in this series is attributed to the avoidance of a tracheotomy and fewer intubation anesthetics thus avoiding trauma to the trachea and bronchi. The immediate removal of the tracheotomy tube seems an alternative if the surgical procedure had been performed. In the patients in this series decannulation was accomplished in a very short period of time. The establishment of an airway seems to be a priority in the treatment of this disease and this can be accomplished by repeated endoscopic procedures rather than tracheotomy. Statistics are given, and prognosis based on the type of lesion and histopathology is documented.

The charts of 143 patients with foreign bodies in the larynx and tracheobronchial tree who were admitted to the Childrens Hospital of Los Angeles during the period 1973 to 1978 were reviewed. Of these children 84 were male and 59 were female. One hundred were private patients and forty-three were clinic patients. Of these foreign bodies 60 were nut meat which is by far the most common foreign body of the tracheobronchial tree. All foreign bodies were successfully removed. One hundred twenty-six were discharged within the first 24 hours after admission and treatment. Fifty-one or 36% of these patients were discharged on the same day after the foreign body was removed. Sixty-two of the foreign bodies were in the left bronchial tree, while 55 were in the right bronchial tree. One hundred thirty-eight were endoscoped under general anesthesia using the apneic technique and five patients were treated with oxygen standby only because of severe respiratory obstruction. A detailed description of the use of apneic technique with profound muscle relaxation, the avoidance of preoperative medication and the team approach to ventilating the patients are all described. The advantage of general anesthesia, and the potential intraoperative and postoperative problems are reviewed. Of the total number of cases 13 % were between 4 and 11 months of age, 44% were between 12 and 23 months of age and 57% were over 23 months of age.