Search PubMed⌕ Search

Biomedical subjects

A G Kerr

Publications and source records attributed to A G Kerr.

At least 55 records · Page 3Linked to original sources
PubMed1986

Long-term viability of transplanted ossicles.

Doubt has been raised about the long-term suitability of ossicular implants in tympanoplasty. Twenty-three ossicular implants that had been in the middle ear for a mean duration of 9.6 years were examined histologically by light microscopy. Although there were only two specimens showing subtotal replacement of the dead ossicular implant by new bone, the structural integrity of all implants was maintained and there was no evidence of overt osteoclastic bone resorption. Therefore our findings support the concept of prolonged survival of ossicular implants in the middle ear and we do not see any good reason for abandoning their use in reconstructive tympanoplasty.

Ear Ossicles↗
PubMed1986

Vestibular nerve section and saccus decompression: an evaluation of long-term results.

The 1972 AAOO committee (Alford, 1972) guidelines brought some uniformity into the evaluation of therapy for Menière's Disease. We have adhered to its recommendations in this long-term follow-up report of 21 saccus decompressions and 29 vestibular nerve sections performed on 46 patients between 1968 and 1977. Comparisons between these and other groups have been possible with regard to: control of vertigo; hearing; tinnitus; and development of hydrops in the contralateral ear. All the vestibular nerve section group have enjoyed sustained relief from vertigo. Class D results (recurrent vertigo) account for 14 per cent of the saccus decompression group at one year and 29 per cent at eight to 10-year follow-up. Hearing levels in both groups deteriorated in parallel as time progressed but tinnitus became less noticeable. Nineteen per cent of the long-term review patients showed evidence of developing cochlear hydrops in the contralateral ear. Conservative surgical procedures should be employed whilst any useful hearing exists, though the emphasis remains on controlling vertigo. Saccus decompression, despite its controversial therapeutic basis, will remain the first-line surgical procedure for many otologists. However, in the fit young Menière's cripple or saccus decompression failure with serviceable hearing, vestibular nerve section remains the treatment of choice.

Adult↗
PubMed1986

The anterior marginal perforation.

The anterior tympanomeatal angle remains the main problem area in anterior marginal perforations with both conventional onlay and underlay techniques. Here we describe a variation of Gerlach's quilting technique to overcome the problem and this modification has proven to be both simple and effective. When the graft is prepared a small tag is fashioned anteriorly and later pulled through a small tunnel under the anterior-superior annulus. This prevents the graft falling away anteriorly without producing the blunting associated with more extensive undermining of the anterior annulus.

Humans↗
PubMed1986

Operations on the saccus endolymphaticus and vestibular nerve: have they fulfilled their promise?

The rationale for operations on the saccus and vestibular nerve in patients incapacitated by Meniere's disease as a replacement for total labyrinthectomy, has been the expectancy that less radical procedures will protect these patients from total auditory incapacity. Aware of postoperative hearing losses in some patients after 3 years, we have studied the results in 21 Shambaugh saccus decompression (SD) and 29 middle fossa vestibular nerve section (VNS) operations, in order to assess the claims made for these procedures. We found that while control of vertigo was similar to that reported elsewhere, worse hearing (AAOO criteria) developed in many cases. With SD this increased from 14% at 1 year to 58% at 10 years, and with VNS it increased from 17% at 1 year to 48% at 10 years, when the worse preoperative audiogram was used. Only 17% of SD and 11% VNS ears with serviceable best preoperative hearing had retained this at 10 years. Nineteen percent developed audiometric evidence of contralateral disease during the first 10 postoperative years. It is concluded that although, regrettably, neither of these surgical therapies appears to have the capability of preventing the progress of hearing loss, the reality of bilateral disease justifies the continued use of SD or VNS by adequately trained surgeons.

Ear, Inner↗
PubMed1986

Cerebrospinal fluid rhinorrhea following surgery for acoustic neurinoma. Report of two cases.

In a series of 48 patients with acoustic neurinoma removed by the suboccipital route, one patient developed cerebrospinal fluid rhinorrhea and another patient had delayed-onset meningitis. Each complication was attributed to opening the posteromedial air-cell tract in the posterior wall of the internal auditory meatus. In operations requiring removal of the posterior meatal wall, it is important to look for the air-cell tract which may not be apparent on computerized tomography. If the tract is opened the cells should be occluded by bone wax.

Adult↗
PubMed1984

Porous prostheses: an electron microscopic study.

Proplast and Plastipore prostheses, removed at revision surgery, have been examined under the electron microscope. Foreign material in the multinucleated foreign body giant cells, previously reported under the light microscope, has been confirmed. The appearances were consistent with the conclusion that the giant cells were breaking down the prostheses by two different modes of action. X-ray elemental analysis is of limited value in this investigation because of the low atomic number of the elements involved. However, such analysis of this foreign material was consistent with the conclusion that it arose from the prosthesis.

Biocompatible Materials↗
PubMed1983

Congenital syphilitic deafness--a further review.

Initial optimism about the successful outcome of treatment of congenital syphilitic deafness with ampicillin and steroids has always been tempered with an awareness of the uncertain long-term results. This paper is a review of 16 patients treated with various combinations of ampicillin and steroid; these have been followed up for periods of five to 14 years. Ampicillin alone does not prevent progressive hearing loss in the majority of patients. Ampicillin combined with prednisone, or with prednisone and ACTH, has preserved the hearing in all but two ears which had useful hearing before treatment. The fact that the hearing in many of these ears, although maintained, continues to fluctuate still gives cause for concern.

Adrenocorticotropic Hormone↗
PubMed1982

Tissue culture of surgically prepared temporalis fascia.

Temporalis fascia which is used to graft the tympanic membrane has been shown to be viable in tissue culture by a previous pilot study. This present study reports the effect on the viability of the fascia by scraping loose connective tissue from it and allowing it to dry. Pieces of fascia from 30 patients were each divided in 4 and prepared to give explants, fresh, fresh and scraped, dried, and dried and scraped. The fascia grew from 17 patients when cultured fresh, 5 when fresh and scraped, 1 when dried, and none when dried and scraped. These results are significantly different and show that the fascia is devitilized when prepared by the normal method for use in tympanoplasty.

Culture Techniques↗
PubMed1981

Proplast and Plastipore.

Sixteen Proplast and 52 Plastipore prostheses, removed at revision surgery, have been examined histologically and the findings illustrated. The macroscopic appearance of the prostheses was preserved. Fibrous tissue capsule formation was common. It has been expected that the prostheses will be invaded by fibrous tissue and thereby stabilized. Fibrous tissue ingrowth was consistently seen in Proplast but not Plastipore prostheses. Multinucleated foreign body giant cells were present in large numbers in both types. There was histological evidence of breakdown of the prostheses.

Connective Tissue↗
PubMed1981

The surgical treatment of vertigo. The essentials of patient selection and long-term results.

The essential features of the posturing and positional mechanisms in man are defined and the causes of their dysfunction categorized to provide a scheme of surgical management appropriate for each. The authors' long-term results (two to twelve years) with (1) twenty-seven operations designed to decompress the endolymphatic system, (2) twenty-eight selective eighth nerve sections are documented and compared, by means of statistical analysis, with those reported by others during the past fifteen years. Although the latter procedure provided better control of vertigo, there was no difference between the two groups in regard to preservation of hearing. Nor was there any evidence from this study that either operation did anything to alter the progressive hearing loss that characterizes Meniere's disease. Nevertheless, because of failure of noninvasive therapy to control vertiginous symptoms in some patients, it would appear that there is still a definite place for surgical treatment. Saccus decompression is recommended as the initial procedure because it is technically less difficult. In patients whose vertigo persists in conjunction with useful auditory function vestibular nerve section should be considered before resorting to total labyrinthectomy.

Ear, Inner↗