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Biomedical subjects

C M Myer

Publications and source records attributed to C M Myer.

At least 91 records · Page 5Linked to original sources
PubMed1991

Functional endoscopic sinus surgery in the immunocompromised child.

Fungal sinusitis in the immunocompromised child is an aggressive, invasive process that may result in a fatal outcome if not diagnosed early. As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapeutic agents resulting in severe agranulocytopenia, more patients have become susceptible to fungal sinus disease. Functional endoscopic sinus surgery has emerged recently as an important surgical modality in the treatment of sinus disease in adults and children. Use of this technique in immunosuppressed children has allowed early diagnosis of fungal sinonasal disease, resulting in earlier surgical intervention. The high-quality fiberoptic capability of nasal endoscopes allows very detailed visualization of the internal anatomy of the nose and detects early mucosal changes as a result of intranasal fungal disease. Our experience using functional endoscopic sinus surgery in immunocompromised children over an 18-month period is reviewed. Our philosophy for diagnosis and management of immunocompromised children with suspected fungal sinonasal disease is discussed.

Adolescent↗
PubMed1991

The diagnosis and management of mastoiditis in children.

Even though mastoiditis as a complication of AOM is uncommon, its recognition is imperative to institute timely therapy. Acute coalescent mastoiditis generally follows a severe bout of AOM. Intravenous antimicrobial therapy and myringotomy drainage are usually satisfactory measures. However, refractory cases may require a simple mastoidectomy. Chronic mastoiditis in children is treated initially with intravenous antimicrobial therapy and vigorous aural toilet, which is successful in most patients. Mastoidectomy may be required in selected patients. The clinician must be aware of the differential diagnosis of chronic otorrhea so that biopsies can be obtained whenever a neoplasm is suspected.

Child↗
PubMed1990

Magnetic resonance imaging in the diagnosis of innominate artery compression of the trachea.

In the past, the diagnosis of tracheal compression by intrathoracic arterial structures has been made by using bronchoscopy alone or in combination with one of a variety of imaging techniques, including barium contrast esophagography and cineangiography. However, all of these imaging techniques involve exposure of patients to ionizing radiation and, in the case of angiography, an invasive procedure. The use of magnetic resonance imaging in the diagnosis of thoracic arterial disease is well documented and, more specifically, has been found to be useful in the diagnosis of innominate artery compression of the trachea and congenital vascular rings. This report documents the use of magnetic resonance imaging at the Children's Hospital Medical Center, Cincinnati, Ohio, in the diagnosis of innominate artery compression of the trachea. In addition, the radiographic appearance of this entity is contrasted with other compressive lesions of the trachea.

Brachiocephalic Trunk↗
PubMed1990

Abnormalities of the bony thorax causing tracheobronchial compression.

A number of intrathoracic and extrathoracic causes of airway obstruction have been well documented in the literature. At times, tracheal compression may be caused by abnormalities of the bony thorax whose previously unrecognized significance can result in unexpected difficulties when extubation is attempted following a routine intubation. Alternatively, patients may develop progressive distress secondary to their skeletal abnormalities. We report on cases illustrating anomalies of the manubrium, sternum and spine which have caused significant, occasionally life-threatening, tracheal and bronchial narrowing including pectus excavatum and scoliosis. A protocol is presented detailing the appropriate methods of diagnosis and treatment of these types of deformities.

Adolescent↗
PubMed1990

Laryngeal and laryngotracheoesophageal clefts: role of early surgical repair.

An uncommon congenital anomaly of the developing aerodigestive tract is the congenital laryngeal cleft and its extension, the congenital laryngotracheoesophageal (LTE) cleft. Because of the subtle findings sometimes seen with clefts confined to the larynx, the diagnosis may be difficult. The potential problems of airway obstruction and repeated aspiration frequently associated with laryngeal and LTE clefts mandate early surgical repair. Over the past 3 years, 14 patients with congenital laryngeal or LTE clefts have been managed at Children's Hospital Medical Center, Cincinnati, Ohio. This report details our experience and philosophy regarding the diagnosis and management of the condition, and presents the histopathologic findings of a case of complete LTE cleft in which surgical repair was delayed and death resulted.

Abnormalities, Multiple↗
PubMed1989

Congenital absence of the nose: a case report.

Congenital absence of the nose (arhinia, congenital nasal atresia) is a rare anomaly which is infrequently described in the literature. Herein we present a case of congenital absence of the nose recently evaluated and treated at Children's Hospital Medical Center (CHMC), Cincinnati, OH. CT and MRI studies were obtained. To our knowledge, no such radiographic evaluations have been described in patients with congenital absence of the nose. In addition to complete absence of the anterior soft tissues of the nose, thin anterior and thick posterior atretic plates were present. MRI was useful in defining the nature of the soft tissue mass which filled the single hypoplastic nasal cavity. The lip, alveolus, and palate were remarkably well developed. A thorough investigation revealed no other congenital defects. At 15 days of life, because of the airway support required and the associated feeding difficulties, a nasal airway was created using a combination of sublabial, transpalatal and percutaneous approaches. Frequent home dilation of the surgically created opening has been successful in maintaining nasal patency thus allowing the patient to go without continuous stenting.

Dilatation↗
PubMed1989

Sialorrhea.

Sialorrhea is a frequent problem in children with mental retardation and cerebral palsy. In addition to cosmetic considerations, serious medical and psychosocial consequences may result from the situation. The most effective treatment at the present time is bilateral submandibular gland excision and parotid duct ligation. Various means of physical therapy may play a valuable adjunctive role. Control of sialorrhea improves appearance, hygiene, and self-esteem as well as reduces the demands of those who care for the child with sialorrhea.

Child↗
PubMed1989

Perilymphatic fistulas in children: rationale for therapy.

We report 26 consecutive patients (32 ears) who were identified in a 2 year period (July 1, 1985-June 30, 1987) with unexplained sudden, fluctuating, or progressive sensorineural hearing loss (SNHL). All patients underwent an exploratory tympanotomy and a perilymphatic fistula was identified in 13 patients (14 ears). The mean change of 14 +/- 27 dB in speech reception threshold before and after surgery was significant at p = 0.08 among children with fistula and ranged from -30 to 80 dB. In children with sudden, progressive or fluctuating SNHL and multiple sensory deficits, including blindness or contralateral SNHL, or prior head trauma, prompt surgical exploration is mandatory. Additionally, the aggressive management of otitis media with effusion is essential in such patients to minimize fluctuations in hearing caused by superimposed conductive hearing loss. Caution must be exercised to separate fluctuating hearing loss from fluctuations in audiologic testing.

Adolescent↗
PubMed1989

Surgical management of sialorrhea.

Sialorrhea is a distressing problem in children with cerebral palsy, in children with other neurologic disorders, and in normal children. The constant need for clothing or bib changes in handicapped patients frequently results in further social isolation and causes normal children to be viewed as "impaired." The surgical treatment of sialorrhea at Children's Hospital Medical Center, Cincinnati, Ohio, has evolved over the past 5 years. Since 1981, 70 surgical procedures have been performed for drooling at this institution; follow-up information is available on 52 patients. The surgical procedures performed included submandibular rerouting alone, submandibular duct rerouting with bilateral tympanic neurectomy with bilateral submandibular gland excision, and bilateral submandibular gland excision with bilateral parotid duct ligation. Our review indicates that bilateral submandibular gland excision with parotid duct ligation is the only procedure in which consistent control of sialorrhea can be expected. Postoperative complications after this procedure were minimal and only one parent complained that the child had a dry mouth after the procedure. Postoperative hospitalization after bilateral submandibular gland excision and bilateral parotid duct ligation was not significantly different from that required after any of the other procedures. In conclusion, this surgical procedure appears to be the most effective surgical treatment for sialorrhea and precludes the need for multiple operative procedures for this problem.

Humans↗