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1.
Am J Rhinol Allergy ; 29(5): 394-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26358354

RESUMO

OBJECTIVE: To quantify maxillary sinus volume and mucosal surface area (SA) that is accessible endoscopically via a middle meatal antrostomy and to explore the financial implications of using multiple disposable instruments for this procedure. METHODS: Eight cadaver maxillary sinuses configured with image guidance software were evaluated. In each sinus, a standard middle meatal antrostomy was created, through which curved microdebriders of 15, 40, 70, and 120° were placed. The SA and volume of the region accessible by each microdebrider tip was calculated. RESULTS: Mean maxillary sinus volume was 16.5 ± 2.5 cm(3) and mean SA was 31.0 ± 2.3 cm(2). The 15, 40, 70 and 120° microdebriders accessed an average of 10, 25, 41, and 66%, respectively, of the SA, and of 2, 9, 17, and 36%, respectively, of the volume. There was a trend toward improved accessibility of the superior half versus the inferior half of the maxillary sinus. When instruments of different degrees were combined to maximize accessibility, 81% of the SA of the sinus could be accessed. CONCLUSIONS: Microdebriders with increasing curvatures allowed for greater access of the maxillary sinus mucosa through an middle meatal antrostomy. No single microdebrider curvature or combination of curvatures reached the entirety of the maxillary sinus wall. Knowledge about the area of reach for these blades can lead to lower per procedure costs.


Assuntos
Endoscopia/métodos , Seio Maxilar/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças dos Seios Paranasais/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Cadáver , Humanos
2.
Laryngoscope ; 124(11): 2645-50, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24591190

RESUMO

OBJECTIVES/HYPOTHESIS: To examine the relationship between cerebrospinal fluid (CSF) rhinorrhea and obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective chart review of patients who underwent surgical repair of encephaloceles and/or CSF rhinorrhea at a tertiary medical center over a 12-year period. METHODS: Pertinent demographic, clinical, and surgical data including age, sex, and medical and surgical history were obtained. Patients were classified by etiology of CSF leak into a spontaneous leak group and a nonspontaneous leak group, which included patients with documented trauma, malignancy, or known iatrogenic injury. RESULTS: We retrospectively identified 126 patients who underwent repair of encephalocele or CSF rhinorrhea. Of these, 70 (55.5%) were found to have a spontaneous etiology, whereas 56 (44.4%) had a nonspontaneous cause. Patients with spontaneous CSF rhinorrhea were more likely than their nonspontaneous counterparts to have a diagnosis of OSA (30.0% vs. 14.3%, P = .0294) and radiographic evidence of an empty sella on magnetic resonance imaging MRI (55.4% vs. 24.3%, P = .0027). Overall, patients in the spontaneous CSF rhinorrhea group were more likely to be female compared to the nonspontaneous group (84.3% vs. 41.1% female, P = .0001). CONCLUSIONS: Our study shows that patients with spontaneous CSF rhinorrhea are significantly more likely to have a diagnosis of OSA compared to those with nonspontaneous causes of CSF leaks, or to the general population (incidence of 1%-5% in various population studies). Given the known association between OSA and intracranial hypertension (ICH), it may be prudent to screen all patients with spontaneous CSF rhinorrhea for symptoms of OSA as well as for ICH, and vice versa. LEVEL OF EVIDENCE: 4


Assuntos
Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Rinorreia de Líquido Cefalorraquidiano/complicações , Estudos de Coortes , Encefalocele/complicações , Encefalocele/diagnóstico , Encefalocele/cirurgia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/cirurgia , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Int Forum Allergy Rhinol ; 4(4): 272-9, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24449482

RESUMO

BACKGROUND: Allergic fungal rhinosinusitis (AFRS) is a refractory subtype of chronic rhinosinusitis. There is a paucity of data investigating the association of epidemiologic markers of disease severity. The primary objective of this study is to evaluate components of disease severity with socioeconomic status and health care access. METHODS: A retrospective analysis was performed on patients diagnosed with AFRS by Bent and Kuhn criteria from 2000 to 2013. Severity of disease was measured by orbitocranial involvement, bone erosion, Lund-Mackay score, serum immunoglobulin E (IgE), and mold hypersensitivity. The North Carolina State Data Center provided county-specific socioeconomic and demographic data. Fisher's exact test, Wilcoxon rank sum test, Pearson correlations, and multivariable linear regression models were used to explore associations between variables. RESULTS: Of 93 patients, 58% were African American and 39% Caucasian with a male:female ratio of 1.4:1 and average age at presentation of 29 years. Race, age, insurance status, and gender were not associated with severity of disease. Bone erosion was correlated with residence in counties with lower income per capita (p = 0.01). Patients with orbitocranial involvement resided in more rural counties (p = 0.01) with less primary care providers per capita (p = 0.02). Residence in counties with older or poorer quality housing was associated with a higher prevalence of bone erosion (p = 0.02). CONCLUSION: Within our cohort of patients residing in North Carolina, markers of disease severity (bone erosion and orbitocranial involvement) in AFRS were associated with lower income, rural counties, poor housing quality, and less health care access.


Assuntos
Micoses/epidemiologia , Rinite Alérgica Perene/epidemiologia , Sinusite/epidemiologia , Adolescente , Adulto , Idoso , Osso e Ossos/patologia , Criança , Feminino , Acesso aos Serviços de Saúde , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Micoses/sangue , Micoses/diagnóstico , North Carolina/epidemiologia , Rinite Alérgica , Rinite Alérgica Perene/sangue , Rinite Alérgica Perene/diagnóstico , População Rural , Índice de Gravidade de Doença , Sinusite/sangue , Sinusite/diagnóstico , Fatores Socioeconômicos , Adulto Jovem
4.
Radiother Oncol ; 97(3): 395-8, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20950881

RESUMO

BACKGROUND: Glomus jugulare tumors are rare, typically benign, tumors that arise from the neural crest cells that are associated with the autonomic ganglia in and around the jugular bulb. Treatment options for glomus jugulare tumors include embolization followed by resection, fractionated external beam radiation therapy (EBRT), stereotactic radiosurgery (SRS), and/or stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: 18 patients were treated with linear-accelerator based stereotactic body radiation therapy (SBRT) between May 2002 and November 2008. Fifteen patients (83%) had single glomus jugulare tumors and 3 patients had bilateral glomus jugulare tumors (although each of these patients had a single tumor targeted). The median tumor volume was 5.83 cm(3) (range, 0.32-35.47 cm(3)). Ten tumors (56%) were previously untreated, and 8 (44%) tumors were persistent after previous surgical resection. One patient had undergone previous EBRT and 2 patients were previously treated with Gamma Knife radiosurgery to the intracranial portion of their tumor, with planned SBRT to the extracranial portion 2-4 months later at our institution. The median prescribed dose was 20 Gy in 3 fractions (range: 16-25 Gy in 1-5 fx) to the 80% isodose line. The median prescription coverage of the tumor was 93.6% (range: 83-98.72%). RESULTS: Median follow-up for the entire cohort was 22 months. All the patients were alive at the time of the last follow-up with imaging available for review. The tumor was stable in 17 patients and decreased in size in one patient--yielding a local control rate of 100%. No patients experienced any new or worsening treatment-related neurologic deficits. CONCLUSIONS: SBRT is a safe and efficacious treatment modality for glomus jugulare tumors.


Assuntos
Tumor do Glomo Jugular/cirurgia , Aceleradores de Partículas , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Tumor do Glomo Jugular/diagnóstico , Tumor do Glomo Jugular/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Planejamento da Radioterapia Assistida por Computador , Tomografia Computadorizada por Raios X
5.
Otolaryngol Head Neck Surg ; 142(5): 715-21, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20416462

RESUMO

OBJECTIVES: 1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD. STUDY DESIGN: Historical cohort study. SETTING: Tertiary care, university-based pediatric hospital. SUBJECTS AND METHODS: Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery. RESULTS: Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid. CONCLUSION: Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups.


Assuntos
Hemorragia/etiologia , Tonsilectomia , Doenças de von Willebrand/complicações , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Desamino Arginina Vasopressina/uso terapêutico , Feminino , Hemorragia/terapia , Humanos , Masculino , Complicações Pós-Operatórias , Doenças de von Willebrand/tratamento farmacológico
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