Ho Ching

Copyright 2015 American Medical Association. All rights reserved. IMPORTANCE: This study reviews a single center's experience of performing staged laryngotracheoplasty for the treatment of laryngotracheal stenosis with the ultimate goal of attaining long-term airway patency without restenosis. OBJECTIVE: to identify staged LTP as an efficacious surgical treatment option for laryngotracheal stenosis. DESIGN, SETTING, AND PARTICIPANTS: from January 2000 to January 2012, patients at a tertiary care academic institution presenting with diagnoses of laryngeal or laryngotracheal stenosis were retrospectively identified. Medical records from adult patients were inspected, and patient demographics, clinical data, and clinical outcomes were recorded. All patients undergoing staged LTP were initially included. Patients with history of head and neck malignant neoplasm were excluded. INTERVENTIONS: Staged LTP. MAIN OUTCOMES AND MEASURES: The primary outcomewas long-term decannulation, defined as decannulation for duration of at least 6 months. RESULTS: Sixty-one patients were included in this study. The mean patient age was 47.1 at the time of first-stage LTP and had a mean follow-up of.32 years from the first-stage reconstruction. Etiology of stenosis included prolonged intubation in 27 patients, autoimmune disease in 9, idiopathic causes in 11, blunt laryngeal trauma in 10, and other causes in 4. Forty-nine patients were successfully decannulated, while to date 12 remain tracheostomy or tympanostomy tube dependent. Univariate analyses showed no significant association between decannulation and age, sex, history of intubation, surgeon, etiology of stenosis, or length of stenosis. Multivariate logistic regression analysis showed a significant inverse relationship between grade of stenosis and probability of decannulation. CONCLUSIONS AND RELEVANCE: Staged LTP is an option for the reconstruction laryngotracheal stenosis. Our experience shows excellent decannulation rates in the selected patients with stenosis, many of whom have failed treatment with other surgical modalities.

How do our minds grasp the world? The nlajor task in explaining the relation between mind and the world is to indicate how facts, experiences, and judgments stand in justificatory relation. This paper examines three ways of explaining the cognitive relation between mind and world: inferentialism, conceptualism, and social pragmatism. These three theories differ from the traditional foundationalism, coherentism, and reliabilism in that they no longer attempt any analysis of the epistemic notions such as knowledge and evidence abstractly; rather, they explore, in a Wittgensteinean way, these notions in relation to linguistic practices. In this paper, I will first examine the debate between inferentialism and conceptualism, a debate involving Sellars, Davidson, McDowell, and Brandom. I will show that both inferentialism and conceptualism have difficulties in giving a complete account of empirical justification and that their difficulties can be remedied only by resorting to some social pragmatisnl notions such as the social development of conceptual capacities and the social recognition of cognitive performance.