摘要:

AbstractIntracranial extension (ICE) is the spread of tumor into the subarachnoid space through dura or along cranial nerve roots. The single‐stage removal of the skull base tumor with its ICE has been confounded by cerebrospinal fluid management and defect reconstruction.The purpose of this report is to review a current protocol for managing the cranial base tumor and its ICE as a unit. The ventricular shunting paper of 19871is retracted.All tumors were managed at a single stage. Defect reconstruction was size dependent. Ninety‐eight neurotologic skull base tumors with ICE were managed from 1971 to 1991. The new protocol was initiated in 1987. Results specific to this group are highlighted. For glomus tumors, cerebrospinal fluid leak rates have been dramatically reduced overall from 14.5% to 4%. The leak rates for nonglomus tumors, overall, have improved slightly. Complications are discussed.The development of this surgical approach protocol improves the functional outcome in patients of surgeons who aspire to disease “cure” rather than

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00001

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractFull development of the frontal sinus is not achieved until approximately 19 years of age. An evaluation of frontal sinus injuries isolated to the subset of patients less than 20 years old has yet to be reported. In order to determine whether age was a factor in the clinical course of patients with frontal sinus fractures, 209 patients who sustained frontal sinus fractures from January 1985 to April 1990 were identified using the trauma registry from all six major trauma centers, one of which is a pediatric trauma center, in a county of 2.5 million people. Forty patients (19%) were between the ages of 6 and 19 years at the time of their injury. Computed tomography imaging of these pediatric patients identified associated head and neck fractures in 37 (93%) as well as significant central nervous system injury in 22 (55%). Seventeen pediatric patients were treated nonoperatively and 1 died prior to the planned surgery. A detailed analysis of extent of injury and treatment together with a comparison of the 169 adult and the 40 pediatric patients is presented.

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00002

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractAnacusis following hearing preservation surgery for acoustic neuroma removal in which the cochlear nerve was preserved has been explained on the basis of neural or vascular compromise. In the absence of pathologic evidence for either theory, a physiologic model was chosen. Electrical promontory stimulation with monitoring of subjective and electrically evoked auditory brainstem responses was undertaken. A positive response to stimulation suggests a vascular impairment of the cochlea sparing the cochlear nerve and spiral ganglion. The absence of response suggests loss of neural integrity at the level of the spiral ganglion or cochlear nerve. Six patients who suffered anacusis following hearing preservation surgery for acoustic neuroma were studied. Data regarding electrical promontory stimulation, auditory brainstem responses, and implications of the possible role of cochlear implantation are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00003

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractInflammatory sinonasal disease is a common problem in patients infected with the human immunodeficiency virus (HIV). Although some patients present with acute or chronic sinusitis, many describe persistent nasal congestion and thick, tenacious postnasal drainage, even in the absence of infection. The efficacy of guaifenesin as a mucolytic is poorly documented and support for its use in this setting is primarily anecdotal. This double‐blind, placebo‐controlled study assessed changes in nasal symptoms among 23 HIV‐infected patients receiving either 3 weeks of guaifenesin (2400 mg daily) or placebo. The guaifenesin group reported less nasal congestion and thinner postnasal drainage compared to the placebo group and these differences were statistically significant (P<.05). Guaifenesin appears to be effective in managing HIV‐infected patients with symptomatic rhinosinusitis and may be a useful adjunct for treating acute and chronic sinusitis in this pop

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00004

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractChronic suppurative otitis media has been clinically defined as a chronic discharge from the middle ear in the presence of a perforation of the tympanic membrane. However, irreversible tissue pathology in the middle ear or mastoid can occur behind an intact tympanic membrane. One hundred forty‐four human temporal bones with chronic otitis media were divided into two groups: those with perforated (28) and those with nonperforated (116) tympanic membranes. The histopathological findings of their middle ears were compared.Granulation tissue in various degrees was the most prominent pathological feature. It was observed in 96% of temporal bones with perforation of the tympanic membrane, and in 97% of those without perforation. Also found were ossicular bony changes (96% with perforation; 90.5% without), middle ear effusion (93% with perforation; 89% without), cholesterol granuloma (21% with perforation; 12% without), cholesteatoma (36% with perforation; 4% without), and tympanosclerosis (43% with perforation; 20% without).This study shows that the histopathological changes of the middle ear are similar in temporal bones with and without perforation of the tympanic membrane. The clinician should, therefore, be aware that an intact tympanic membrane does not necessarily preclude the presence of gross pathological changes of the middle ear clef

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00005

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractLaryngospasm, if prolonged, can result in serious sequelae due to the lack of a uniformly effective treatment. Prevention, therefore, through pharmacologic intervention, is an attractive concept. In order to study the effects of various drugs in preventing laryngospasm, a reliable animal model capable of producing sequential, repetitive episodes of laryngospasm is necessary. In this study, the canine model of laryngospasm previously described by Aviv,et al.was modified to overcome technical factors which limited its use in this regard. Details of the technique and the results from eight animals will be presented. Results in two animals with the use of prophylactic topical lidocaine will also be discussed. The reliability and reproducibility of this model make it ideal for the study of laryngospasm and open the way for investigation into its prevention.

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00006

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractTonsillectomy results in severe throat pain, ear pain, and trismus until the exposed and inflamed muscle becomes covered with regenerated mucosa. Sucralfate binds with the fibrinous exudate of duodenal ulcers, forming a protective barrier that promotes healing. If a similar buffer could be created in the tonsillar bed, morbidity may be diminished.A double‐blind, randomized study was completed in 34 adult patients to determine whether sucralfate, given four times daily for 10 days as a swish and swallow, would significantly reduce postoperative pain and promote healing and recovery. Sucralfate significantly lowered postoperative throat pain, otalgia, and trismus.Sucralfate is a safe and well‐tolerated topical agent that offers significant pain reduction and may promote healing in tonsillectomy patie

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00007

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractA retrospective analysis of 268 trauma patients with facial fractures who received computed tomography of the head was undertaken to assess an association with skull base fractures.The incidence of skull base fracture was compared to facial fractures of various anatomic locations. Skull base fractures were significantly increased in orbital wall/rim fractures (36.0%,P= .0823). In contrast, skull base fractures related to orbital floor (27.3%,P= .6191) and maxillary/zygomatic (29.4%,P= .1148) fractures were not significantly greater and were infrequently seen with mandible (4.0%,P= .0454) and nasal (7.7%,P= .0345) fractures. The incidence of skull base fracture was directly associated with the number of facial fractures per patient; one facial fracture (21.0%), two facial fractures (30.4%), and three or more facial fractures (33.3%) (P<.05).The incidence of skull base fractures was related to the location of facial fractures and the number of facial fractures per patient. The results provide additional clinical information to facilitate the prompt detection and diagnoses of skull base fracture.

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00008

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractInfant botulism is a national problem with over 1000 confirmed cases in the United States since it was first recognized as a distinct clinical entity in 1976. The disease is characterized by a progressive, symmetrical descending paralysis of cranial nerves with eventual involvement of axial and trunk muscle innervation. Most infants progress to complete respiratory failure.An initial report in 1979 recommended early tracheotomy for avoidance of long‐term intubation complications. However, over the past 10 years at St. Christopher's Hospital for Children, analysis of airway management in 11 patients with infant botulism revealed a median intubation time of 16 days. Following extubation, all patients progressed to complete respiratory recovery without adverse laryngotracheal sequelae. Otolaryngologists consulted for the airway management of infants with botulism should adopt a conservative approach with meticulous monitoring of endotracheal tube sizes and leak pressures. Tracheotomy is rarely require

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00009

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractTraditional treatment of otosyphilis with penicillin and corticosteroids has achieved hearing improvement; however, selecting which patients with a positive fluorescent treponemal antibody absorption (FTA‐ABS) test will benefit from treatment remains a problem. In order to study this problem, 18 patients with cochleovestibular dysfunction of unknown etiology and positive syphilis serology were treated with intravenous penicillin and corticosteroids. In addition, lumbar puncture and human immunodeficiency virus (HIV) testing were performed on all patients.Hearing improved in 5 (31%) of 16 patients, tinnitus decreased in 11 (85%) of 13, and vertigo improved in 6 (86%) of 7. Factors associated with hearing improvement were hearing loss present less than 5 years, fluctuating hearing, and age less than 60. Improvement was unrelated to the severity of the loss or previous therapy. All patients with cerebrospinal fluid abnormalities, including two patients with HIV disease, had subjective improvements. A diagnostic and treatment protocol is presente

ISSN:0023-852X    

DOI:10.1288/00005537-199211000-00010

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY