ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00001

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractLife‐threatening airway compromise is rarely reported as a major complication of coagulation disorders. However, before adequate factor‐replacement therapy became available, this complication was often fatal. A retrospective review of all patients with classic hemophilia admitted to our institution from 1964 through 1992 was performed. The records of 147 patients who had a total of 1804 admissions were examined. Fifteen episodes of airway obstruction occurred. Additionally, 6 cases of potential airway compromise and 5 cases of airway‐endangering oropharyngeal bleeding were identified. Tracheotomy was performed in 5 patients; 1 fatality occurred before modern replacement products were available. Patients with this disorder have a 13% chance of some form of airway‐endangering event with an 8% chance that it will be immediately life‐threatening. Tracheotomy and subsequent decannulation are safe procedures in these

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00002

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractNine cases of cervical necrotizing faciitis are presented. Five were odontogenic, three were pharyngeal in origin, and one developed from a soft‐tissue spider bite. The bacteriology represented a polyculture of gram‐positive, gram‐negative, as well as anaerobic bacteria, and initial medical treatment by third‐generation cephalosporin and metronidazole or clindamycin was successful and is recommended. Airway control is necessary early, as is a wide exploration of the fascial spaces of the neck, with frequent reexploration in either the operating room or at the bedside to evaluate the effects of treatment and to prevent further progression of the disease. Intensive medical support is crucial, and hyperbaric oxygen is advised for patients who are deteriorating under standard

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00003

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractWarthin's tumor previously has been thought to occur much more commonly in men than in women and rarely in African Americans. One hundred thirty‐two cases of Warthin's tumor treated at The Johns Hopkins Hospital from 1952 to 1992 were retrospectively reviewed. There were 90 (68%) men and 42 (32%) women, with an overall man‐to‐woman ratio of 2.2:1. The number and percentage of women with Warthin's tumor increased over each consecutive decade: 1952 to 1962, 5 (21%); 1963 to 1972, 6 (29%); 1973 to 1982, 11 (31%); and 1983 to 1992, 20 (39%). A positive smoking history was found in 88% of the men and in 89% of the women with a Warthin's tumor. Eleven (8%) African Americans and 1 (0.75%) Asian American were diagnosed to have a Warthin's tumor. Also, the incidence of African Americans with a Warthin's tumor increased over each decade: 0 (0%), 1 (4.8%), 2 (5.5%), and 8 (16%). This study's results indicate a progressive increase in the occurrence of this tumor in women and in African Americans and a higher overall incidence in African Americans than previously rep

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00004

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractGadolinium‐enhanced magnetic resonance imaging (MRI) is currently the gold standard for diagnosis of an acoustic neuroma. Its status in diagnosis of a recurrent or residual neuroma is not nearly as clear. A pilot study of 36 postoperative cases showed enhancement in 100% of the patients at the operative site. To examine the role of surgical trauma and biodegradable packing on enhanced MRI, an animal study was designed. Cats and monkeys that underwent posterior fossa surgical procedures had preoperative and postoperative MRI and histologic correlation of any enhanced area. Areas of postoperative enhancement should not be considered as diagnostic of tumor. Further studies are necessary to develop a criteria for recurrent tumor diagnosis with enhanced MR

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00005

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractMeningiomas arising from the petroclival dura have presented a challenge to both otolaryngologists and neurosurgeons. Access by means of subtemporal, suboccipital, translabyrinthine, or transcochlear routes have inherent limitations both surgically as well as from resultant morbidity.Since 1988, the authors have used a transpetrosal transtentorial (combined subtemporal suboccipital presigmoid) approach to these lesions in selected cases. The goals of this technique have been to preserve function of the cranial nerves, to avoid excessive retraction of the temporal lobe and cerebellum, and to eliminate damage to the venous sinus and Labbé's vein. Exposure of the base of the tumor for ablation of the blood supply and access for tumor removal is an important advantage of this approach

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00006

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe location of upper‐airway obstruction during sleep has been predicted by using waking measures that include physical examination and endoscopic Müller's maneuver. However, this prediction remains speculative. To objectively evaluate these clinical measures, 22 patients with severe obstructive sleep apnea had upper‐airway studies during nonsedated sleep with solid‐state manometry and videoendoscopy. Objective tongue‐base obstruction was measured with four methods, each identifying a different aspect of airway collapse during sleep. Manometry identified tongue obstruction during (1) early and (2) late inspiration, and videoendoscopy identified severe collapse without complete obstruction during (3) late inspiration, and (4) expiration. Twenty‐eight waking upper‐airway characteristics measured at waking clinical and endoscopic examination were then compared between patients with and without tongue‐base segment obstruction to identify characteristics that would discriminate tongue‐base obstruction. The results demonstrated that tongue‐base/hypopharyngeal pathology during wakefulness was present on clinical examination in 19 of 22 (86%) patients. Objectively, during sleep tongue‐base obstruction occurred on manometric early inspiration in 5 of 21 (24%) patients, on manometric late inspiration in 11 of 21 (52%), on endoscopic late inspiration in 14 of 19 (74%), and on endoscopic expiration in 8 of 19 (42%).Patients with tongue‐base obstruction during sleep were primarily discriminated on waking examination by nonobstructive upper oropharyngeal features (p<0.10). Near‐total collapse of the tongue base on supine endoscopy was the only characteristic associated with tongue‐base obstruction during sleep. Müller's maneuver did not discriminate patient groups. Results indicate that the incidence of tongue‐base abnormalities measured during sleep varies significantly depending on the measure used. This variability may contribute to variability in surgical success rates. Identification of airway pathology relevant to sleep‐related breathing disorders may require new methods of evaluation and a better understandi

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00007

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe protection afforded against CO2laser‐induced combustion by five different types of tracheal tubes or protective foil wraps was evaluated. They were compared before and after the application of human blood to their external surfaces. The tracheal tubes tested were polyvinylchloride (PVC) tubes wrapped with VentureTMcopper (Cu) foil tape, 3MTMaluminum (A1) foil tape, and the Laser‐GuardTMprotective coating. The Xomed Laser Shield IFTMand Mallinckrodt Laser‐FlexTMtracheal tubes were also tested. A CO2laser set to 38 W in the continuous mode was directed at the shaft of the tracheal tube under study, which had 5 L/min of oxygen flowing through it. The laser was actuated for 90 seconds or until combustion or melting occurred.The copper foil‐wrapped and aluminum foil‐wrapped PVC tracheal tubes were unaffected by 90 seconds of laser fire in five trials with each type of tape. However, the application of blood to the foil wrapped PVC tracheal tube shafts resulted in combustion in 3 of 5 copper foil‐wrapped tubes and melting of the underlying tracheal tube shaft in 3 of 5 aluminum foil‐wrapped PVC tracheal tubes. Blood did not affect the protection afforded by the Laser‐GuardTMcoating when it was applied to the shafts of PVC tracheal tubes. Similarly, the Xomed Laser Shield IFTMtracheal tube's shaft offered good protection from the laser both before and after application of blood. Combustion occurred in 1 of 4 Mallinckrodt Laser FlexTMtracheal tubes studied prior to the application of blood. The application of blood resulted in almost immediate combustion in all 4 Mallinckrodt Laser FlexTMtracheal tubes tested.The presence of blood on the surface of metallic foil‐wrapped or special tracheal tubes may make laser‐induced combustion more likely during airway surgery. However, the Laser‐GuardTMprotective coating and the Xomed Laser‐Shield IFTMtracheal tube provide good protection even

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00008

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractTympanometry was performed before (preoperative) and after (intraoperative) the administration of inhalation anesthesia including nitrous oxide and halothane on 109 children undergoing myringotomy with pressure equalization tube insertion. A total of 213 preoperative tympanograms were compared with their intraoperative counterparts and the presence or absence of middle ear effusion at myringotomy. When preoperative tympanograms were consistent with pneumatized middle ears, intraoperative findings demonstrated a mean middle ear pressure increase of +147 daPa. When preoperative tympanometry suggested middle ear effusion, less than 1% demonstrated intraoperative tympanometric changes and/or findings at surgery that would support anesthesia clearing middle ear effusion. Preoperative tympanometric data were poor predictors of the presence or absence of effusion at myringotomy. The relationship between inhalation anesthetics (i.e., nitrous oxide and halothane) and middle ear fluids, and the reliability of tympanometry to predict middle ear effusion are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00009

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractNormal human olfactory function is subject to a wide variety of factors. Although biopsy of human olfactory neuroepithelium has been reported by several researchers, there are no studies which have evaluated the effect of this procedure on olfactory function. In this retrospective study, we sought to determine if tissue removal from the olfactory cleft has an adverse influence on the sense of smell. Nineteen subjects underwent bilateral olfactory testing and subsequent endoscopic olfactory mucosal biopsy. All subjects were retested 6 weeks to 1 year after olfactory neuroepithelial biopsy. No statistical difference was found between olfactory tests performed before or after biopsy. These data suggest that biopsy of human olfactory neuroepithelium has no discernible adverse effect on the ability to smell.

ISSN:0023-852X    

DOI:10.1288/00005537-199407000-00010

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY