摘要:

AbstractThe use of endotracheal tube to provide a prolonged airway and as an adjunct to artificial ventilation continues to be a controversial subject. With this controversy in mind, a six‐year survey was undertaken in utilizing three private hospitals to evaluate the number of patients requiring prolonged endotracheal intubation, their incidence of complication, and particularly to record the diagnosis for which this form of artificial airway was required. At the same time, primary and secondary tracheostomies were evaluated as to mortality, morbidity, and complications.There were 205 premature and newborns evaluated, with 108 of these neonates requiring endotracheal intubation for 48 hours or longer. The average duration was five and one‐half days. There were 26 survivors of 108 infants with one serious complication, or an incidence of 4 percent. The incidence of mortality and morbidity for tracheostomy in the neonate is much higher than that of endotracheal intubation and intubation should be the method of choice.Over 500 children requiring intensive care were evaluated. Of these, 64 cases required endotracheal intubation of 24 hours or longer with 43 survivors. There was one death with a mortality of 1.4 percent. In evaluating the diagnoses requiring endotracheal intubation, it is statistically significant that those patients other than post‐surgical or medically clean had an incidence of complication of 23 percent.There were over 1,200 adult patients who required some form of artificial ventilation with 454 requiring endotracheal intubation of 24 hours duration or longer. The average duration was 61 hours. Immediate and minor complications, such as cord granulomas, lacerations, laryngeal edema, etc., were not included. There were 11 adult complications which could be classified as serious with stenotic changes of the larynx or trachea. This gives an overall incidence of complication of 2.4 percent with no mortality. These statistics are better than those for tracheostomy; however, the severely anoxic, toxic, or infected patient was the one which had a significant incidence of complications. The suicide patient had an incidence of 17.5 percent, patients with pulmonary infection 12.3 percent, and the stroke patient, 5.6 percent.A comparative study of tracheostomies continues to indicate that there is a higher incidence of mortality and early complications in tracheostomy than endotracheal intubation; however, both endotracheal intubation and secondary tracheostomies following prolonged intubation show a much higher incidence of delayed complications. Treatment should be one of prevention with the proper choice of tube and cuff, more than just adequate nursing care with definite proper follow‐up of those patients who have had prolonged intubation. Frequent use of endoscopy and indirect laryngoscopy in these patients is mandatory for early treatment of delayed complications. Once these complications have manifested themselves, then treatment should follow the course as prescribed by the various authors finding success in the treatment of these

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00001

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractIn the evaluation of suspected occupational hearing losses, an expanding part of current otologic practice, the otologist is expected to differentiate noise sequelae from other types of ear pathology and to estimate the extent to which each abnormality contributes to the total hearing disability. The audiometric identification of acoustic trauma is possible only in early cases. When the noise effects are more advanced and when they are combined with aging, the pure tone curves are nonspecific. The standard battery of audiologic tests does not help in the quantitative separation of acoustic trauma from presbycusis. Most authorities consider that when acoustic trauma and presbycusis are concomitant, the effects of each are independent and that the influences of each upon auditory acuity are simply additive.There are significant individual differences in susceptibility to acoustic trauma and in the degree of hearing deterioration which occurs with aging. While it is not yet possible to make retrospective determinations of these variances, it is feasible to make age corrections of noise‐induced hypoacusis if one averages acoustic vulnerability and aging effects. Such averaging results in some inequalities in individual cases, but the validity of this approach in large numbers of cases is justifiable because of the absence of alternatives.The authors have modified the prebycusic data of Spoor (which combine several important hearing surveys conducted in the United States and in western Europe) by changing the calibration from ASA‐1954 to ANSI‐1969 and have prepared curves which demonstrate mean aggregate hearing levels at specified frequencies according to age and sex.Two formulae for age correction are presented along with examples of each formula and the authors' evalu

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00002

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractVertigo and dizziness may be considered spatial disorientation. This disorientation follows malfunction (following disease or injury) of the computer‐like action of the eyes, ears, proprioceptive sense, cervical spine, cerebrum, cerebellum, autonomic system or the master control in the reticular substance.It is felt that changes in nystagmus would follow injury or disease to any of these components. Studies have been reported of the establishment of parameters of cristo ocular and cristo spinal reflexes in persons with good spatial orientation. The differential diagnosis of 1,000 cases of patients with vertigo will be compared with “normals,” establishing, where possible, a differential diag

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00003

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe background of the treatment of sinusitis with aerosols is outlined. The experience of more than 10 years with aerosol Bacitracin is presented. The advantages over other methods of treatment will be discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00004

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractSince the introduction of tympanoplasty, there have been enthusiastic reports describing the use of skin, vein, fascia and perichondrium in repairing the tympanic membrane. Both endaural and postauricular techniques have been used. In the last few years most surgeons have concluded that fascia or perichondrium are the most suitable materials available for grafting. These materials have been placed either medial or lateral to the tympanic membrane.

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00005

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractCryosurgery is one conservative approach for Ménière's disease designed to control vertigo without adversely affecting the hearing in most cases. Report is made of 47 consecutive cases of cryosurgery. All patients were unresponsive to medical therapy. During the surgical procedure, the hearing is monitored at 2,000 cycles per second, and the vestibular function is monitored by evoked response to a loud click stimuli. Initial testing for threshold at 2,000 cycles and to a click stimulus is done by the evoked response. An initial freeze at —160°C. for two minutes is done, and the vestibular and auditory function is retested. A repeat freeze is completed unless there is a definite hearing change or the vestibular recording changes as evinced by the evoked response. If necessary, a third freeze is done, depending upon vestibular and auditory threshold changes. By this method a significant improvement of vertiginous symptoms resulted in 76 to 80 percent of the patients. The results of postoperative electronystagmography suggest an increase in unilateral weakness, but all cases showed a caloric response. In general, the hearing postoperatively continued to fluctuate as before surgery, accompanied by tinnitus, fullness, and recruitment. Morbidity in the way of hearing loss and temporary facial paralysis occurs in approximately 10 percent of the patients treated in this manner. Until a more knowledgeable approach to Ménière's disease is forthcoming, cryosurgery to the lateral semicircular canal still holds a position in the armamentarium for the treatment of patients who have incapacitating v

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00006

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00007

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractTwo hundred twenty cases of carcinoma of the tongue were reviewed. The three‐year determinant survival of 178 cases was 32.5 percent. The five‐year determinant survival of 169 cases was 29 percent. Only five patients of 41 who developed late node metastasis survived five years. Sixtynine of 79 patients treated forcureby X‐ray therapy developed recurrence. Thirteen were salvaged by secondary treatment. Twenty‐eight of 44 patients treated surgically developed recurrences. Eight were saved by secondary treatment. Because of a high percentage of recurrences at the primary site and a poor salvage of these recurrences, combined therapy is felt to offer the best hope for improved su

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00008

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractOrbital hypertelorism is one of the most severe congenital deformities, frequently achieving monstrous proportions because of the wide divergence between the ocular globes. It is complicated by ocular anomalies; prominent among which are strabismus and amblyopia. The etiology is for the most part congenital although traumatic hypertelorism is seen and careful differentiation must be made between the true and false varieties of the deformity. The basis of intercanthal distance is a poor criterion of hypertelorism and we prefer the use of the distance between the anterior lacrimal crests as a more reliable means of measurement and have checked all our cases by the use of anterior‐posterior skull laminagrams.The surgical technique used is based on that developed by Tessier and his associates in 1967; the original two‐stage procedure has been replaced by a one‐stage modification of this operation introduced by us (Converse,et al., 1970) with preservation of olfaction. The operation consists of raising a large scalp flap through a coronal incision with removal of a major portion of the frontal bone which is subsequently replaced. The frontal lobes are raised from the anterior cranial fossa exposing the roof of each orbit and the subperiosteal elevation is extended over the lower portion of the frontal bone and contiguous orbital rims. Combined with an incision through the lower eyelid, exposure of the entire orbit on its inner aspect just anterior to the optic foramen is obtained and lines of osteotomy are made through the orbital walls and combined with resection of an appropriate central portion of bone to enable medial motion of the orbits. The bony defects are grafted with autogenous bone grafts and the soft tissues are replaced in position.Twenty‐five cases of orbital hypertelorism involving bilateral and unilateral hypertelorism are presented without unusual complications being observer. The orbits have been mobilized medially for a distance up to 40 millimeters without complications, and the operative procedures are all performed in collaboration with the neurosurgeon.Most patients have required subsequent extraocular muscle balancing surgery and correction of medial canthal defo

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00009

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractOne hundred consecutive osteoplastic frontal sinus operations were reviewed. The obliteration of the frontal sinus was achieved by natural bony obliteration instead of by operative fat obliteration. The operation was performed for 6 cases of trauma, 13 cases for an osteoma, 56 cases for frontal sinusitis without previous frontal sinus surgery and 25 cases for frontal sinusitis with previous frontal sinus surgery. Headaches were the presenting chief complaint of all cases, and 93 of them had some degree of frontal sinusitis. Localized osteomyelitis of the frontal sinus was present in 42 cases. Although 85 patients were completely satisfied with the results of the operation, 15 continued to have frontal headaches. Complete bony obliteration of the frontal sinus occurred in 93 cases. The seven patients who had incomplete bony obliteration of the frontal sinus are being followed closely for signs and symptoms of recurrent frontal sinus disease.

ISSN:0023-852X    

DOI:10.1288/00005537-197208000-00010

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY