Apparatus and methods are provided for use with a subject who is undergoing respiration. A motion sensor senses motion of a subject. A breathing pattern analysis unit analyzes components of the sensed motion that result from the subject's respiration. The breathing pattern analysis unit includes double-movement-respiration-cycle-pattern-identification functionality that designates respiration cycles as being double-movement-respiration-cycles (DMRC's) by determining that the cycles define two subcycles. Double-movement-respiration-cycle-event-identification functionality of the breathing pattern analysis unit identifies a DMRC event by detecting that the subject has undergone a plurality of DMRC's. An output is generated that is indicative of the subject having used accessory muscles in breathing, in response to identification of the double-movement-respiration-cycle event. Other embodiments are also described.

Monitoring, predicting and treating clinical episodes

Methods and systems (10) for monitoring vital signs for the prediction and treatment of physiological ailments are provided. The methods and systems (10) may be applied to the monitoring of a broad range of physiological ailments or 'episodes,' including, but not limited to, asthma, hypoglycemia, coughing, edema, sleep apnea, labor, and REM sleep stages, among others. The methods and systems (10) employ sensors (30, 110, 380), for example, non-contact sensors, adapted to detect vital signs, such as heart rate or respiration rate, to produce signals (50) that can be analyzed for trends, for deviations, or for comparison to prior conditions or criteria. The sensors (30, 110, 380) may be positioned whereby the subject (12) need not be viewed by the health care provider. Some methods and systems employ the use of 'scores' based upon the combination of sensed vital signs or based upon a comparison of the vital signs to criteria.

Methods and systems for monitoring patients for clinical episodes

A method is provided for predicting an onset of an asthma attack. The method includes sensing at least one parameter of a subject without contacting or viewing the subject or clothes the subject is wearing, and predicting the onset of the asthma attack at least in part responsively to the sensed parameter. Also provided is a method for predicting an onset of an episode associated with congestive heart failure (CHF), including sensing at least one parameter of a subject without contacting or viewing the subject or clothes the subject is wearing, and predicting the onset of the episode at least in part responsively to the sensed parameter. Other embodiments are also described.

Techniques for prediction and monitoring of clinical episodes

Currently there is no agreement on the treatment of patients who develop a peritonsillar abscess (PTA). This lack of consensus results in highly variable and possibly expensive therapeutic regimens that may not provide optimum quality patient care at reasonable cost. The present study evaluates surgical, medical, diagnostic, and cost factors that affect the management of PTA based on the following: 1. a cohort study of 123 patients with PTA treated using needle aspiration as the initial surgical drainage; 2. a national survey of the PTA management practices of otolaryngologists; and 3. meta-analyses of various components of the treatment regimen for PTA. In the cohort study, patients diagnosed with PTA were treated by both otolaryngologists and emergency medicine specialists with needle aspiration as the primary surgical modality resulting in a 96% acute resolution rate for PTA. In the national survey, questionnaires were sent to 2000 randomly selected members of the American Academy of Otolaryngology-Head and Neck Surgery regarding their management of PTA. The return rate was 73%. Ninety-six percent of the physicians who returned survey forms treated an average of seven PTAs per year using either needle aspiration, incision and drainage, or abscess tonsillectomy to drain the abscess initially. The incidence of PTA in the United States and Puerto Rico among patients 5 to 59 years of age treated by survey practitioners is 30.1 per 100,000 person years, accounting for approximately 45,000 cases per year. Four meta-analyses were completed to quantify the success rate of needle aspiration in the treatment of PTA (94%), the recurrence rate of PTA (10% to 15%), the rate at which penicillin-resistant microorganisms are found in patients with PTA (0% to 56%), and the rate of prior oropharyngeal infections associated with PTA (11% to 56%). The recurrence rate for PTA in the United States is 10%, which is significantly different from the recurrence rate of 15% reported from the rest of the world (P < .002). A clinical intervention for PTA is proposed based on the clinical series, the national survey data, and the meta-analyses. These clinical guidelines recommend that needle aspiration be used as the initial surgical drainage procedure for all patients with a PTA other than those who have indications for abscess tonsillectomy. Patients should be treated in an outpatient setting, should receive penicillin if they are not allergic to it, and should receive adequate pain medication. The evidence does not suggest that there is any benefit in examining the abscess contents for microorganisms. Approximately 30% of patients with PTA can be expected to exhibit relative indications for a tonsillectomy.(ABSTRACT TRUNCATED AT 400 WORDS)

Peritonsillar abscess : incidence, current management practices, and a proposal for treatment guidelines

The partial horizontal supracricoid laryngectomy with cricohyoidoepiglottopexy consists of resection of the whole thyroid cartilage and paraglottic space. The cricoid cartilage, the hyoid bone, most of the epiglottis, and at least one arytenoid cartilage are conserved. Thirty-six patients with squamous cell carcinoma of the glottis who underwent this procedure from 1974 through 1986 are presented. All 36 recovered physiologic deglutition and phonation. None required a permanent tracheotomy. The 3-year actuarial survival rate was 86.5%. The local recurrence rate was 5.5%. The indications for the procedure are carcinomas of the glottis that 1) spread beyond the confines of the membranous portion of the true vocal cord or 2) present with limitation of true vocal cord mobility. The procedure is presented as a useful alternative to radiotherapy, partial vertical laryngectomy, and total laryngectomy in select cases of glottic carcinoma.

Supracricoid laryngectomy with cricohyoidoepiglottopexy: a partial laryngeal procedure for glottic carcinoma.

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches. The patients ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow-up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis. The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.

Changing face of treatment of peritonsillar abscess.

• This work represents a 12-year experience from the Eastern Virginia Medical School, Norfolk, with 115 patients who had pharyngoesophageal resections for cancer treatment. Each patient received reconstruction by one of four major techniques: deltopectoral flaps (n = 43), pectoralis myocutaneous flaps (n = 36), gastric pull-ups (n = 19), and free jejunal autografts (n = 17). An analysis of the procedures with emphasis on the functional results indicates that each technique has advantages in specific circumstances. Guidelines for the application of these techniques are presented. ( Arch Otolaryngol Head Neck Surg 1987;113:40-44)

https://jamanetwork.com/journals/OTOL/articlepdf/613792/archotol_113_1_012.pdf

Functional Evaluation of Pharyngoesophageal Reconstructive Techniques

A respiratory sound analyzer system for use in the noisy ambient environments, such as in medical transport vehicles including helicopters, boats, aircraft, ambulances, and other vehicles, as well as at fire scenes, disasters, sporting events, rock concerts, and the like, includes an array of miniature accelerometers which are connected to the chest of a patient. Rather than relying on traditional auscultation, the on-board personnel will analyze a conditioned signal on a display screen or other device to monitor a patient's breathing patterns. Successive signals may be stored and compared with each other to determine a deterioration in a patient's breathing pattern, and signals may also be compared with stored normal and abnormal breathing signals. Ambient noise effects can be reduced or eliminated from the sensed breathing signal by a number of means. For example, the accelerometers can be heavily padded to deaden impinging sound waves, signals from accelerometers placed on the patient at locations where respiratory sounds will not be detected can be subtracted from the signals from accelerometers on the patient's chest, and filters can be used to isolate breath sounds from ambient noises.

Respiratory sound analyzer for use in high noise environments

Encouraged by their experience since 1978 with blunt esophagectomy and gastric reconstruction in the management of pharyngolaryngeal malignancy, the authors have extended their use of this technique to the management of thoracic esophageal cancer. A study of 43 blunt esophageal resections is presented; 23 were performed in the management of pharyngolaryngeal cancer, and 20 were performed (22 attempted) for the resection of intrathoracic esophageal cancer. In the first group, two deaths occurred secondary to liver failure in cirrhotic patients with moist ascites. One death occurred due to anastomotic leak in the neck of a patient with laryngeal cancer treated with extended mediastinal dissection and tracheal resection for surgical and radiation failure. Two tracheal injuries occurred; one could be managed through the neck, and one required thoractomy for repair. In the 20 resections performed for intrathoracic cancer, there were no deaths, no tracheal injuries, and one chest was explored for bleeding in the splenic bed, which decompressed itself into the right chest. The overall mortality was 7.5%. The evaluation emphasizes: The applicability of this technique for the management of esophageal problems at all levels. The safety of the technique, particularly in the typical population with advanced aged and severe underlying medical illness. Good functional results with palliation and/or cure. The benefit of intact mediastinal pleura in avoiding certain thoracic complications. The authors conclude that blunt esophagectomy is a safe resection procedure with limited morbidity and mortality, and that gastric reconstruction is reliable and affords excellent functional results. They are encouraged to continue management of panesophageal cancer with this technique.

Management of panesophageal cancer by blunt resection without thoracotomy and reconstruction with stomach.

Vertical hemilaryngectomy has been expanded aggressively in recent years so that, in some cases, the term subtotal laryngectomy would be more appropriate. Reconstruction after these extended resections is a problem. Intraluminal stenting has not been successful in cases where resection has been aggressive. The resulting lumen is inadequate. As a means of overcoming this problem, the epiglottic reconstruction procedure has been promoted.



This paper presents experiences with 12 patients who underwent epiglottic reconstruction after subtotal laryngectomy. Indications, anatomic details, and overall results using this reconstructive technique are outlined. It is the conclusion of the author that epiglottic reconstruction is an effective procedure for preservation of function after subtotal laryngectomy.

Epiglottic reconstruction and subtotal laryngectomy.

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