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Biomedical subjects

D C Lanza

Publications and source records attributed to D C Lanza.

At least 19 recordsLinked to original sources
PubMed1997

In situ hybridization for Aspergillus and Penicillium in allergic fungal sinusitis: a rapid means of speciating fungal pathogens in tissues.

Allergic fungal sinusitis (AFS) is a serious form of sinonasal fungal disease that is commonly associated with Aspergillus or Dematiaceous fungi. This study was performed to determine the incidence of Aspergillus or Penicillium in AFS by using in situ hybridization (ISH) for Aspergillus and Penicillium ribosomal RNA (rRNA). The Fontana-Masson melanin stain (FMMS) was also used to detect pigmented fungi (A. niger and Dematiaceous fungi). ISH was performed on 26 patients: 17 AFS cases with histologic evidence of fungi, 5 AFS cases without histologic evidence of fungi, 3 cases of invasive fungal sinusitis (IFS), and 1 case of fungus ball. Nine AFS specimens with histologic evidence of fungi were ISH positive. Positivity was also noted in two of three IFS cases, while no staining was seen in the fungus ball and in six AFS specimens without fungi demonstrable by silver stains. Six ISH-positive cases were FMMS positive, suggesting A. niger. Five ISH-negative AFS specimens were FMMS positive, suggesting Dematiaceous fungi. In summary, many AFS patients in our institution demonstrate Aspergillus/Penicillium organisms. Ancillary techniques may help identify fungi responsible for AFS if cultures are negative or not performed. ISH for rRNA is a useful means for rapidly speciating fungi in human tissues.

Adult↗
PubMed1997

Heterotopic brain in the pterygopalatine fossa.

Heterotopic brain outside the cranial vault is uncommon. It occurs most frequently in the nasal region, although rests elsewhere in the aerodigestive tract have been reported. We describe a case of heterotopic brain in the pterygopalatine fossa.

Biopsy↗
PubMed1996

New technology.

Our Academy has proposed this primer, The Ethical Otolaryngologist, to serve as guide to help individual otolaryngologists determine the ethical nature of technologic advancements. Ultimately, each otolaryngologist will decide for himself or herself what he or she believes to be ethical. However, we otolaryngologists should make these decisions while recalling our sworn responsibility to our patients and our responsibility to our chosen profession in otolaryngology. Examples and questions that were presented are intended to assist each of us in making ethical determinations about the care we render to patients. There are many facets to the ethical implications of new technology touched on in this chapter, and they include the following: 1. Categories of new technology and technology assessment studies. 2. Otolaryngologists adopting or developing new technologies. 3. Otolaryngologists teaching and learning new technologies. 4. Supervision of clinical applications of new technologies. In conclusion, nearly all of us who are otolaryngologists have entered this aspect of health care because we enjoy patient contact, the challenges of surgery, the continuing education process, and above all, we are interested in helping our patients prevent and alleviate disease. Our training has encouraged us to put the patient's best interests above all else. This is our utmost ethical responsibility.

Education, Medical, Continuing↗
PubMed1996

Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles.

The authors review their experience with endoscopic repair of skull base defects associated with cerebrospinal fluid (CSF) rhinorrhea and/or encephaloceles involving the paranasal sinuses. Between January 1991 and December 1995, 51 patients were evaluated for anterior and middle cranial fossa defects at a tertiary care facility. Of these patients, 36 underwent endoscopic repair of skull base defects. Factors related to surgical success were analyzed. These factors included etiology, defect location, number of prior attempts at repair, type of graft(s) used, fluorescein use, complications, durations of lumbar drain placement, and duration of CSF leakage prior to repair. During the first attempt, successful endoscopic repair was accomplished in 34 (94.4%) of the 36 patients. The mean duration of follow-up was 24.6 months, with a range of 2 to 57 months. The authors conclude that an endoscopic approach provides a safe and effective means for repairing many skull base defects.

Adolescent↗
PubMed1996

Acoustic rhinometry in the study of the acute nasal allergic response.

Acoustic rhinometry is a recently developed method for the objective assessment of nasal patency. In this study, acoustic rhinometry was used to measure changes in nasal cavity dimensions in the immediate response to nasal allergen challenge in eight pollen-sensitive subjects. Acoustic rhinometric changes were compared with subjective symptoms, as well as histamine in nasal secretions, cytology of nasal mucosal scrapings, and changes in olfactory function. A significantly greater decrease in nasal airway caliber occurred following allergen challenge as compared to buffer diluent challenge in the same individuals (70% +/- 7% versus 22% +/- 5%). During an allergic response, a strong correlation was found between the minimum cross-sectional area and the volume of the nasal cavity measured by acoustic rhinometry (r = .9). However, no correlation was observed between nasal airway caliber and concomitant subjective congestion reported by the subjects. A modest decrease in olfactory function was seen following allergen challenge (3.1 +/- 1.4 fewer odors identified correctly out of 20; p = .08). However, the alterations of olfactory function did not correlate with changes in nasal patency. The results presented in this study demonstrate that acoustic rhinometry has great potential as a reproducible method for the objective assessment of nasal obstruction occurring in nasal allergen challenge studies.

Acoustics↗
PubMed1995

Head and neck manifestations of eosinophilia-myalgia syndrome.

Eosinophilia-myalgia syndrome (EMS) is a multisystemic disease that occurs in patients who have consumed products containing L-tryptophan. Prominent features include incapacitating myalgias, arthralgias, neuropathies, and eosinophilia. Despite the frequent association of dysphagia, dyspnea, and the potential for aspiration, the otolaryngology literature is devoid of information on EMS. In order to determine the frequency of otolaryngic symptoms, questionnaires were distributed to patients with EMS in 33 different US states. Among the 28 various head and neck manifestations studied, 70% of EMS patients complained of generalized muscle spasms, 66% xerostomia, 62% dyspnea, and 56% dysphagia. In addition, the epidemiology, clinical presentation, diagnostic criteria, and treatment options are discussed. This paper assesses the frequency of otolaryngic manifestations of EMS, as well as introduces this syndrome to the otolaryngologist-head and neck surgeon. It is important for the otolaryngologist to be aware of EMS and its manifestations and treatments so that patients with this potentially lethal disease can receive appropriate evaluation and expeditious treatment.

Adult↗
PubMed1995

Advantages and disadvantages of three-dimensional computed tomography intraoperative localization for functional endoscopic sinus surgery.

Intraoperative three-dimensional computed tomography (3-D-CT) localization has been available for use during functional endoscopic sinus surgery (FESS) for several years, although relatively few otolaryngologists operate in conjunction with this technology. Proponents of intraoperative localization believe that operating with stereotaxis enhances surgical precision and reduces complications. A 1-year review was conducted at the University of Pennsylvania from January 1994 through January 1995. During this period 5% of sinus operations were performed in conjunction with intraoperative localization. The advantages and disadvantages of using intraoperative localization were evaluated for each case. Also examined were type and indication for surgery, anesthesia used, added time, and cost. Overall, intraoperative localization was found to be helpful when anatomy was distorted or obscured. However, selecting patients who may have benefited from localization was often not possible using preoperative data. Ideally, localization should be available for all FESS. Criteria are outlined which will need to be met prior to localization becoming a significant aspect of FESS.

Adult↗
PubMed1995

MR evaluation of frontal sinus osteoplastic flaps with autogenous fat grafts.

PURPOSE: To investigate the MR findings in patients who have had osteoplastic frontal sinus flaps placed for inflammatory sinonasal disease. METHODS: The MR images of 13 patients who had improvement of symptoms after osteoplastic frontal sinus flap placement with fat autograft were prospectively evaluated for the presence of high intensity on T2-weighted scans, contrast enhancement, and replacement of frontal sinus fat by lower-signal soft tissue. All studies were performed on a 1.5-T unit using a 5-in round surface coil placed over the nasion. Sagittal T1-weighted, axial and coronal fast spin-echo T2-weighted, and precontrast and postcontrast axial and coronal T1-weighted images were obtained through the operative bed. The T2-weighted and postgadolinium sequences were done with a fat-suppression technique. RESULTS: Hyperintensity within the frontal sinuses on T2-weighted images and enhancement (peripherally and/or centrally where fat was replaced with soft tissue) were found to some degree in all patients. The degree of replacement of frontal sinus fat with soft tissue ranged from 4% to 85% (mean, 43%). Five patients with persistent symptoms had no distinguishing MR features when compared with asymptomatic patients. CONCLUSIONS: Although increased T2-weighted intensity, fat replacement, and enhancement are findings compatible with inflammation, these changes may be seen in patients who are asymptomatic after placement of osteoplastic frontal sinus flaps; they may represent the normal granulation process. MR findings after flap placement are nonspecific and have limited utility in distinguishing symptomatic patients with recurrent inflammatory disease from asymptomatic patients whose imaging findings are related to postoperative scar tissue.

Adipose Tissue↗
PubMed1994

Complications of ethmoidectomy: a survey of fellows of the American Academy of Otolaryngology-Head and Neck Surgery.

A survey regarding complications of sinus surgery was mailed to 6969 otolaryngologists; 3933 responses (56.44%) were obtained, and 3043 of these physicians (77.37%) reported that they performed ethmoidectomy. Completed questionnaires were available for review from 42.21% of all Academy fellows (2942 physicians). Responses were tabulated and summarized question by question. Physicians generally did not rate their residency training in ethmoidectomy highly. The survey confirmed that there has been a marked rise in the frequency of ethmoidectomy and in the amount of training in ethmoidectomy since 1985. Empirical complication rates were calculated for different procedures and time periods. Poisson regression models were then constructed to describe the rate of complications under varying conditions such as the type of surgery performed, time period, experience and training of the surgeon, and type of complication encountered. The models permitted determination of the statistical significance of variables in relation to incidence or complications. The study did not demonstrate a clear and consistent statistical relationship between the incidence of complications, the type of surgery performed, and the quality of training. Moreover, physicians who provided data from record review tended to report higher rates than those who estimated responses. The majority of physicians discussed specific potential complications with their patients before surgery and routinely performed preoperative computed tomography. The study demonstrated that physicians who experienced complications at higher rates were more likely to discuss these complications with patients before surgery.

Ethmoid Sinus↗
PubMed1994

The effect of human olfactory biopsy on olfaction: a preliminary report.

Normal human olfactory function is subject to a wide variety of factors. Although biopsy of human olfactory neuroepithelium has been reported by several researchers, there are no studies which have evaluated the effect of this procedure on olfactory function. In this retrospective study, we sought to determine if tissue removal from the olfactory cleft has an adverse influence on the sense of smell. Nineteen subjects underwent bilateral olfactory testing and subsequent endoscopic olfactory mucosal biopsy. All subjects were retested 6 weeks to 1 year after olfactory neuroepithelial biopsy. No statistical difference was found between olfactory tests performed before or after biopsy. These data suggest that biopsy of human olfactory neuroepithelium has no discernible adverse effect on the ability to smell.

Alzheimer Disease↗
PubMed1992

Current concepts in the surgical management of chronic and recurrent acute sinusitis.

It was previously believed that sinusitis lasting longer than 3 months might lead to irreversible disease. Experience with functional endoscopic sinus surgery indicates that this is rarely the case. Functional endoscopic sinus surgery describes an approach whereby target areas of obstruction are cleared of disease, which allows for ventilation of secondarily involved sinuses and return of mucociliary function. Although endoscopic sinus surgery is one of the techniques most frequently used to manage chronic sinus disease, it is not a suitable surgical approach for every otolaryngologist or all patient settings. Success with this endoscopic approach for chronic sinus disease is based primarily on rigorous perioperative medical care and postoperative surgical debridement. The greatest advancement that the nasal endoscope has brought to patient care is the ability to diagnose disease and follow objectively the effects of different treatment modalities. This advantage is recognized by allergists and used at several centers.

Acute Disease↗
PubMed1992

Current concepts in the surgical management of nasal polyposis.

One of the most common and occasionally frustrating health care problems is that of nasal polyposis. Patient symptoms are debilitating and have a tendency to recur despite the treatment modality used. Nasal endoscopy is a significant advancement for the early diagnosis and objective assessment of treatment modalities used for nasal polyposis. Surgery used in conjunction with medical therapies offers a safe, thorough means of relieving patient symptoms. It is possible to monitor these patients closely for recurrence with nasal endoscopy as well as debride early recurrences before they become symptomatic.

Endoscopy↗
PubMed1991

Histiocytic necrotizing lymphadenitis (Kikuchi's disease).

Histiocytic necrotizing lymphandenitis (HNL), or Kikuchi's disease, is a newly recognized disease of unknown origin that causes cervical lymphadenitis, usually in young women. Initially described in Japan, cases of HNL are being reported in the United States and other western countries with increasing frequency. Symptoms of HNL include tender cervical adenopathy, fever, weight loss, and night sweats. Laboratory studies reveal leukopenia with relative granulocytopenia and lymphocytosis. Lymph node biopsy reveals areas with frank cellular necrosis, karyorrhexis, and absence of plasma cells. The histologic features of HNL are distinctive but can be confused with those of lymphoma. We describe two cases of HNL and present recommendations for diagnosis and treatment.

Adult↗
PubMed1991

Applied nasal anatomy & embryology.

The embryology & anatomy of the nose as it is applied to rhinoplasty is surveyed so that the surgeon in training can develop a basis from which to review the literature. This review demonstrates the need for the consolidation and clarification of the nomenclature associated with the complex anatomy of the nasal pyramid.

Humans↗
PubMed1990

Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients.

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.

Adolescent↗