Joseph Long

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.

There is a tendency among contemporary epistemologists to call every social or existential theory of knowledge pragmatism or neopragmatism. In this paper, I hope to show that this tendency is an error. In the first section, I will explore and attempt to define epistemic pragmatism. In the second section, I will explicate an existential alternative to pragmatism, epistemic contextualism, and differentiate it from pragmatism. In conclusion, I will apply my definition of pragmatism and the pragmatism-contextualism distinction in an attempt to codify the theories of knowledge of some of the popular so-called neopragmatists. Epistemic Pragmatism The term "pragmatism" (and indeed, the term "contextualism") refers to much more than simply a theory of knowledge. Pragmatism can rightly be described as a complete philosophical Weltanschauung, a plenary and exhaustive view of the world and the human animal's relationship to it. Furthermore, pragmatism is a holistic, organic system in which every part and parcel coheres with and relies upon every other. Thus, it may be in some way inappropriate or illegitimate to partition off pragmatism's epistemology or metaphysics or...