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Biomedical subjects

A Alvi

Publications and source records attributed to A Alvi.

At least 37 records · Page 2Linked to original sources
PubMed1996

Post-tonsillectomy hemorrhage: an assessment of risk factors.

Hemorrhage is the most frequent complication of tonsillectomy and is responsible for the majority of post-tonsillectomy fatalities. The incidence of this hemorrhage has been reported to be as high as 20% [6]. Despite continued efforts to reduce this problem, it remains a persistent risk. The charts of 1138 patients who underwent tonsillectomy with or without adenoidectomy from 7-1-89 to 6-30-93 were reviewed. Post-tonsillectomy hemorrhage occurred in 36 patients (3%). Preoperative, intraoperative and postoperative risk factors were assessed. Postoperative bleeding occurred more often in older patients (69% over age 11 years). Seventy-five per cent of these patients were operated on for chronic tonsillitis as compared to 11% operated on for upper airway obstruction. The majority of these patients presented after postoperative day 1 (83%). Four patients required blood transfusions. Postoperative hemorrhage occurred in 14% of patients with elevated postoperative mean arterial pressures. Intraoperative blood loss that exceeded 50 cm3 was also a significant risk factor for post-tonsillectomy hemorrhage. It is concluded that older age, a history of chronic tonsillitis, excessive intraoperative blood loss and elevated postoperative mean arterial pressure are significant risk factors for post-tonsillectomy hemorrhage. An awareness of these risk factors can help identify patients with potential to bleed postoperatively.

Adenoidectomy↗
PubMed1996

Extracapsular spread in the clinically negative neck (N0): implications and outcome.

Cervical metastasis is the most important prognostic factor in head and neck cancer patients. The prognostic significance of extracapsular spread of tumor in metastatic lymph nodes has also been documented. The presence of extracapsular spread further reduces the survival by 50% in those patients with cervical metastatic disease. Most patients with clinically negative necks (stage N0) have a good prognosis. However, some of these patients will have neck disease and distant metastasis and will eventually die. Because the presence of extracapsular spread is a predictor of poor outcome, we hypothesized that extracapsular spread may be a factor in the subset of patients with clinically negative necks who have poor outcomes. One hundred nine patients with clinically negative necks who had undergone neck dissection were identified. Occult metastasis was observed in 34% of patients. In this group, extracapsular spread was present in 18 (49%) patients. Overall, 103 patients were evaluable, of whom 70 (68%) remain free of disease 2 or more years after treatment. A subgroup of 68 patients had histologically negative nodes, of whom 56 (82%) are free of disease. Of patients with extracapsular spread, only 5 (31%) of 16 are free of disease. This is in contrast to patients with metastasis confined to the lymph node, of whom 9 (47%) of 19 are free of disease. Statistical analysis of these data shows that for this sample size this difference is significant. The addition of radiation therapy did not improve outcome in these patients. Extracapsular spread predicts a worse outcome in patients with subclinical cervical metastasis. Alternative modes of adjuvant therapy are suggested because of the poor results of postoperative radiation therapy in patients with extracapsular spread.

Carcinoma, Squamous Cell↗
PubMed1996

Electrodissection tracheotomy.

The acquired immune deficiency syndrome (AIDS) epidemic and other potentially fatal blood-borne infectious diseases have produced a heightened awareness for preventing accidental inoculation of surgeons and operating theatre staff. It is incumbent upon the head and neck surgeon to use safe and effective surgical technique in these patients to prevent such an event. We are seeing an increasing number of patients with AIDS and hepatitis undergoing tracheotomy. We present a sharps-free technique for tracheotomy which is safe for the hospital staff and the patient.

Blood Loss, Surgical↗
PubMed1996

Optic nerve elongation: does it exist?

The length of the optic nerves is a reflection of normal postnatal cranio-orbital development. Unilateral elongation of an optic nerve has been observed in two patients with orbital and skull base neoplasms. In the first case as compared to the patient's opposite, normal optic nerve, an elongated length of the involved optic nerve of 45 mm was present. The involved optic nerve in the second patient was 10 mm longer than the normal opposite optic nerve. The visual and extraocular function was preserved in the second patient. The first patient had only light perception in the affected eye. In this paper, the embryology, anatomy, and physiology of the optic nerve and its mechanisms of stretch and repair are discussed.

Journal Article↗
PubMed1996

Management of carcinoma of the supraglottic larynx: evolution, current concepts, and future trends.

The treatment of cancer of the supraglottic larynx has undergone an evolution. Better understanding of the anatomy and biology of cancer in this anatomic site has enabled surgeons to devise effective oncologic strategies while making every effort to preserve the function of the larynx. Certain recent concepts and changing trends have emerged in the treatment of cancer of the supraglottic larynx, including the treatment of the neck, significance of extracapsular spread of tumor in cervical lymph nodes, and conservation laser surgery. In 1985, Snyderman et al. reported the prognostic significance of extracapsular spread in patients with cancer of the supraglottic larynx. In 1990, Lutz et al. reported the results of our experience with the treatment of 202 patients. The review verified the significant risk of bilateral neck disease in these patients, even with adjuvant radiation therapy. Accordingly, since 1990 all patients having cancer of the supraglottic larynx have been treated in the Department of Otolaryngology at the University of Pittsburgh with bilateral neck dissections. The use of adjuvant radiation therapy has been based on the presence of extracapsular spread. This study documents the oncologic effectiveness of this treatment and confirms the efficacy of bilateral neck dissections in an attempt to control neck disease and the prognostic significance of extracapsular spread. We review the evolution of the treatment of cancer of the supraglottic larynx, present our results, and consider innovative surgical approaches.

Adult↗
PubMed1996

Trauma to the temporal bone: diagnosis and management of complications.

The temporal bone contains important sensory and neural structures that may be damaged in patients who experience craniofacial trauma. The most serious complications of temporal bone trauma include facial nerve paralysis, cerebrospinal fluid leak, and hearing loss. Injury to the temporal bone often presents with subtle signs and symptoms, such as otorrhea, facial palsy, and hemotympanum. A high index of suspicion and a thorough knowledge of how to diagnose injury to the temporal bone are paramount in treating patients who present to the emergency room with craniofacial trauma. This article provides an overview of temporal bone trauma, outlines a methodical approach to the patient with temporal bone trauma, details four cases, and describes the treatment of complications.

Adult↗
PubMed1996

The bicoronal flap approach in craniofacial trauma.

The utilization of the bicoronal scalp flap in craniofacial trauma has proved indispensable in the management of severe craniofacial injuries. It provides vast exposure of such critical structures as the cranium, frontal sinus, orbit and upper midface, compared with that for previous techniques of facial fracture reduction. Although the flap has great utility, severe complications, such as facial nerve injury, diplopia, telecanthus, and scalp necrosis, can occur. This article reviews the surgical anatomy, technique, and indications for the safe utilization of the bicoronal scalp flap approach in the management of craniofacial trauma.

Adult↗
PubMed1996

Oral cancer: how to recognize the danger signs.

Oral cancer remains a challenge to clinicians. Early treatment results in excellent cure rates and minimal functional disability. However, patients with advanced-stage disease often require extensive surgical procedures and adjuvant therapy. Despite radical treatment, survival rates are low and morbidity is high. Detection of oral cancer at an early stage, when it is most amenable to treatment, is an important goal. Only with continued education of the public and of healthcare providers, including primary care physicians and dentists, can this goal be achieved.

Health Education↗
PubMed1996

Acute epistaxis. How to spot the source and stop the flow.

The goals of epistaxis treatment are control of hemorrhage, prevention of cardiovascular and airway compromise, and determination of the cause and the source of bleeding. Distinguishing anterior from posterior epistaxis is important because therapeutic approaches differ. Epistaxis can usually be managed nonsurgically, but a surgical procedure is sometimes necessary. Cauterization, nasal packing, and use of an intranasal tampon or balloon catheter are effective nonsurgical interventions, but they may cause sinusitis, middle ear effusion, patient discomfort, and hypoxia. Surgical interventions include arterial ligation, endoscopic cauterization, and angiographic embolization. These highly effective methods incur the risks of general anesthesia and require technical expertise. A thorough and methodical approach to epistaxis is necessary, with otolaryngologic consultation when appropriate.

Acute Disease↗
PubMed1995

The neck mass. A challenging differential diagnosis.

In patients with neck masses, accurate history taking and physical examination often narrow the differential diagnosis tremendously. Diagnostic tests may be helpful but should be done only if management is affected as a result. Fine-needle aspiration, when necessary, is often valuable to obtain a tissue diagnosis, but its accuracy may depend on the experience of the cytopathologist. Antibiotic therapy is sufficient for some inflammatory masses; excision is generally needed for congenital lesions and malignant neoplasms.

Adult↗
PubMed1993

Clinical exacerbation of systemic lupus erythematosus after photodynamic therapy of laryngotracheal papillomatosis.

Photodynamic therapy was used to treat a patient with recurrent laryngotracheal papillomatosis who had a history of systemic lupus erythematosus (SLE). At the time of photoactivation, the patient's SLE was in remission for 2 years. Postoperatively, the patient was not compliant in avoiding sunlight exposure and developed photosensitive skin reactions of his face and hands. In addition, he had clinical activation of his SLE following that exposure.

Adult↗