摘要:

AbstractDuring the past 13 years, a number of prostheses of differing design and tissue seals have been used in laser stapedotomy for otosclerosis. This study compares the results of three different configurations of prostheses and tissue seals in a series of 53 patients. In 19, a platinum wire Teflon piston was placed in the laser stapedotomy fenestra and crimped on the long process of the incus; autologous venous blood was infiltrated into the oval window niche as a sealing mechanism. In 8 patients, a stainless steel bucket‐handle‐type prosthesis was used with a blood tissue seal. In 26 patients, a segment of autogenous vein was clad onto the bucket‐handle‐type prosthesis and placed into the laser fenestra. Two tissue seals (blood and vein) were also compared.The results were compared with regard to several audiometric parameters. It would appear that the bucket handle/vein configuration improves air‐bone gap closure in the low‐ and mid‐frequency speech range and also shows an advantage for air‐bone gap closure to 10 dB or less compared to the other configurations in this study. Mean postoperative gaps were significantly less for vein compared to the blood tissue seal. Physiologic and surgical implications are discussed, and the vein‐clad techniq

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00001

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe utility of on‐site microscopic evaluation of fine needle aspirates (FNAs) of the head and neck was assessed by comparing the diagnostic yield in 336 specimens obtained with immediate on‐site cytopathological procurement and evaluation to that achieved in 548 cases performed without immediate on‐site evaluation. Three hundred six (91%) of 336 immediate evaluation specimens were adequate for cytopathologic diagnosis, compared to 391 (71%) of 548 specimens not evaluated immediately (P<.001, chi‐squared test). The higher satisfactory rate in immediate evaluation cases was related primarily to1.immediate reaspiration of the masses until sufficient cytopathologic material was obtained for diagnosis; and2.optimal specimen preparation.It is concluded that immediate on‐site cytopathological procurement and evaluation of fine needle aspirates of head and neck masses is a valuable practice which assures a higher yield of adequate specimens compared to biopsies taken without immediate evaluation. The technique of immediate on‐site evaluation of FNAs is discussed and a cost‐benefit analysis of immediate on‐site evaluation of FN

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00002

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to determine if selective head and neck surgical procedures on a same‐day basis are justifiable. Two hundred consecutive head and neck same‐day procedures were reviewed, including 84 parotidectomies and 116 other procedures previously managed as inpatients. Of the 200 patients, 36 (18%) were admitted, 33 for overnight observation, and 164 (82%) were discharged the same day. There were no complications reported in the discharged patients and a later questionnaire showed that 97% of the patients were satisfied. The advantages of selective same‐day procedures outweigh the disadvantages for otolaryngologist and patient.The study shows that same‐day‐stay head and neck surgery for selective procedures is safe, reasonable, and cost‐effective, but the combined efforts of the otolaryngologists, nurses, and administrators are required. Because of rising healthcare costs, experts are predicting a significant increase in the next few years of outpatient surgery, including surgery of the he

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00003

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractSeventy‐two cases of laryngotracheal stenosis treated from 1981 through 1991 were reviewed to develop a system of classification which wouldbe useful in predicting the outcome of treatment. Decannulation and absence of dyspnea after exertion were the criteria of successful management. The probability of decannulation over time was computed using the Kaplan‐Meier technique. Cox multiple regression analysis was used to determine the effects of independent variables (age, sex, etiology, site of stenosis, length of stenosis, diameter of stenosis, and surgical technique) on treatment success. The only factors with a significant effect on the outcome were site of stenosis and diameter of stenosis. A classification into four clinical stages of stenosis based on site of lesion was shown to effectively predict the likelihood of successful decannulat

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00004

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractWegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life‐threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon‐dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent steno

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00005

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe authors previously reported that rat tibial nerves transected with CO2or KTP/532 laser transmit less horseradish peroxidase (HRP) than those transected with a scalpel. This may be due to laser‐specific effects or to thermal phenomena that are laser‐independent. This study investigated potential thermal effects on the transmission of HRP through the tibial branch of the sciatic nerve in rats. Bilateral nerve transections were performed on 18 animals using a scalpel (control) or an electrocautery device, which simulated the thermal effects produced by lasers. HRP retrograde transport and deposition in the rat spinal cord were analyzed. Thirteen of 15 animals showed a higher number of HRP‐labelled neurons on the scalpel side compared to the electrocautery side; a paired student's t test showed a significant difference (P= .028) in the numbers of HRP‐stained cell bodies between the control group (x = 687.13 ± 119.3) and the electrocautery group (x = 388.1 ± 111.2). In conclusion, reduced HRP uptake in tibial nerves transected with lasers may be in part due to thermal effects produced by t

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00006

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractA review of surgical therapy for pediatric cholesteatoma at the Arkansas Children's Hospital was performed. Fifty‐three children treated surgically for cholesteatoma were studied over a 10‐year period. Primary acquired, or attic retraction cholesteatomas, were generally treated with a canal up tympanomastoidectomy; there were very few complications or secondary procedures in this group. Middle ear or secondary acquired cholesteatomas were initially treated by both canal up and canal down procedures; however, a large percentage of these patients eventually required an open cavity procedure. The presence of cholesteatoma in the sinus tympani strongly predicted failure to control disease with a canal up procedure (P<.05); conversely, the absence of matrix in the sinus tympani was predictive for success when a canal up procedure was used for attic cholesteatoma (P<.05). Finally, it was determined that follow‐up was not adequate in our patient population. With this in mind, guidelines for the management of pediatric cholesteatoma will be pres

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00007

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractTo determine whether the routine use of fine‐needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA.Twenty‐nine (85.3%) of the 34 patients who had a positive FNA were confirmed by histology to have a thyroid neoplasm; in 24 patients, the neoplasm was malignant. Two of the 17 patients who had a negative FNA but underwent thyroidectomy based on other factors were found to have thyroid cancer. Only 8 (33.3%) of the 24 surgical specimens of patients who did not have an FNA were found to be malignant. FNA had a sensitivity of 93.5% and a specificity of 75.0%.The results indicate that the routine use of FNA for patients with thyroid nodules reduces the incidence of unnecessary surgery. Furthermore, FNA alone is sufficient to identify most patients at risk and is, therefore, cost‐effective. However, the presence of other findings suspicious of malignancy should preclude clinical decision making based on FNA

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00008

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractIt is a common clinical impression that preservation of hearing is more often achieved when removing a meningioma than a similarly sized acoustic tumor. However, relatively few reports have focused on postoperative hearing results after meningioma removal, and detailed audiometric data are not commonly provided, particularly in the neurosurgical literature.During the past 16 years, 56 meningiomas affecting the temporal bone have been surgically removed at the House Ear Clinic. Hearing preservation was attempted in 16 (29%) of the 56 cases, and these were the focus of this study. The primary presenting symptom was otologic in 67% of these cases, including hearing loss as the primary symptom in 27%.Measurable postoperative hearing was present in 11 (92%) of 12 patients with postoperative audiograms available, and 8 (67%) of 12 patients had good hearing postoperatively. Hearing was preserved near the preoperative level (within 10 dB speech reception threshold and 15% speech discrimination) in 75% of cases.

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00009

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe diagnosis and treatment of petrous apex cholesteatoma is a difficult surgical challenge. This study is a review of 14 cases of cholesteatoma involving the petrous apex. These cholesteatomas originated as a congenital primary lesion or secondary to an acquired lesion. The cases were evaluated according to the clinical features, the intraoperative findings, the radiological findings, and the surgical approaches. In this series, 83% of the patients presented with hearing loss and 50% presented with facial nerve weakness or paralysis ←House grade II to VI→. Intraoperative and radiological features revealed frequent direct labyrinthine and supralabyrinthine cell spread. The transpetrous surgical approach was used in all cases. The main factors affecting the surgical approach to be adopted are the inaccessible nature of the petrous apex, the extent of disease, the degree of facial nerve function, and the need for the prevention of cerebrospinal fluid leaks and the recurrence of the les

ISSN:0023-852X    

DOI:10.1288/00005537-199212000-00010

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY