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Biomedical subjects

D M Fliss

Publications and source records attributed to D M Fliss.

At least 73 records · Page 4Linked to original sources
PubMed1992

Aerobic bacteriology of chronic suppurative otitis media without cholesteatoma in children.

Medical management of chronic suppurative otitis media without cholesteatoma in children was shown recently to be efficacious. We undertook a prospective study in order to determine 1) the organisms associated with the disease and their sensitivity to various antibiotics and 2) their association with clinical variables. Pseudomonas was isolated from 84% of the patients, enteric gram-negative bacilli from 32%, Staphylococcus aureus from 20%, streptococci from 14%, and Hemophilus influenzae from 15%. Pseudomonas aeruginosa was the sole isolate in 48 of the 128 patients (38%). The sensitivity of P aeruginosa (78 isolates) was 100% (of isolates) to mezlocillin and ciprofloxacin, 99% to tobramycin and ceftazidime, 97% to piperacillin, 94% to gentamicin, and 78% to ceftriaxone. The isolated organisms and their sensitivity to antibiotics were not associated with age, sex, duration of otorrhea, or the presence of granulation tissue or polyps. We believe that our data may contribute to the appropriate choice of antibiotics when nonsurgical management of chronic suppurative otitis media without cholesteatoma is considered.

Adolescent↗
PubMed1992

Ethmoidectomy decompression for the treatment of Graves' optic neuropathy.

When orbital decompression becomes necessary in Graves' optic neuropathy, medial wall decompression is a necessary component of the decompression procedure. The ethmoidectomy approach allows more direct visualization of the posterior ethmoids and sphenoids to effect maximum decompression. This is particularly important in cases in which computed tomography shows the medial rectus muscle to be enlarged posteriorly in the orbit. The procedure provides excellent visualization of the medial rectus. As with any medial wall decompression procedure, postoperative restriction of horizontal motility is a frequent complication, often necessitating more than one subsequent operation. The authors describe their experience with the procedure in 25 patients with Graves' optic neuropathy.

Adult↗
PubMed1992

Pleomorphic adenoma: a preliminary histopathologic comparison between tumors occurring in the deep and superficial lobes of the parotid gland.

Twenty-four cases of pleomorphic adenoma of the parotid gland were retrospectively reviewed. The histopathological features of capsular thickness, penetration and completeness, tumoral cell population and mitotic activity were analyzed in twelve superficial lobe and twelve deep lobe tumors. The capsules were found to be significantly thicker and less likely to be penetrated by tumor in the deep lobe group. No significant differences in completeness of encapsulation, cell population or mitotic activity were found between the two groups. This may explain the clinical suggestion that the less aggressive surgical approach which is often performed does not compromise the prognosis for recurrence in the deep lobe lesions.

Adenoma↗
PubMed1992

AIDS-related Kaposi's sarcoma of the sphenoid sinus.

The head and neck region is frequently involved by AIDS-related Kaposi's sarcoma, the oral cavity being the most common site of occurrence. We report on the first case of AIDS-related Kaposi's sarcoma involving the sphenoid sinus where radionuclide bone scanning and MRI were effective in suggesting the diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Air cyst of the maxillary sinus (pneumosinus dilatans, pneumocoele).

A cystic dilatation of a paranasal sinus by an entrapped air mass has been termed pneumosinus dilatans or a pneumocoele. The occurrence of this condition in the maxillary sinus is quite rare. In the present case, a mid-face mass mimicking an osteoma was the presenting sign of the disease. The pathogenesis, clinical features and radiological aspects of this entity are reviewed. In order to avoid confusion with other conditions of different aetiopathogenesis, we propose to label the lesion as 'air cyst' of the paranasal sinus, a term that best describes the nature of the lesion.

Adult↗
PubMed1991

Chronic suppurative otitis media without cholesteatoma in children in southern Israel: incidence and risk factors.

The incidence and risk factors for chronic suppurative otitis media without cholesteatoma in children in Southern Israel were determined by comparing 88 children with the disease to 76 controls with similar age distribution who visited 3 clinics serving representative populations of the region. Data were collected during the child's visit to the clinic by means of a structured interview with the parents and by extracting information from medical records. The calculated yearly incidence was 39/100,000 children 0 to 15 years of age. Significantly increased risk for chronic suppurative otitis media was associated with a history of acute and recurrent otitis media, a parental history of chronic otitis media, larger families and more siblings, a higher crowding index and care in large daycare centers. The sex, parental age and education, allergy, sinusitis and recurrent upper respiratory tract infections were not associated with chronic suppurative otitis media.

Adolescent↗
PubMed1991

Necrotizing soft-tissue infections in the head and neck: a clinicopathological study.

The clinicopathological aspects of 15 patients with necrotizing soft-tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature. Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy-appearing tissues at the periphery of the lesions. The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen-section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the patients.

Adult↗
PubMed1990

Medical management of chronic suppurative otitis media without cholesteatoma in children.

To determine whether systemic administration of antibiotics may eliminate or reduce the need for tympanomastoid surgery in chronic suppurative otitis media without cholesteatoma, we undertook a randomized, prospective study comparing three regimens: (1) daily suction and débridement, with intravenous administration of mezlocillin until 3 days after the discharge stopped, (2) daily suction and débridement, with intravenous use of ceftazidime until 3 days after the discharge stopped, and (3) daily suction and débridement without antibiotics. No topical antimicrobial agents were used during the study. Fifty-one patients were included, and 48 children completed the study. The duration of discharge from the ear before treatment was 2 to 123 months (median 20 months). In 26 patients (51%), the disease was bilateral. Aerobic cultures, obtained with the Alden-Senturia middle ear aspirator, yielded Pseudomonas aeruginosa in 98%, enteric gram-negative bacilli in 33%, staphylococci in 25%, and Haemophilus influenzae in 12%. The first 33 patients were randomly assigned to one of the three regimens. In the 21 patients treated with suction and antibiotics (either mezlocillin or ceftazidime), the discharge stopped completely, versus in only 1 (8%) of 12 patients in the suction-only regimen (p less than 0.01). Therefore the following 18 patients were randomly assigned to one of only two groups, which included the two suction-and-antibiotic regimens. In all patients treated initially with antibiotics, discharge stopped after 4 to 18 days (mean 12.0 days), but 25% needed treatment for greater than 14 days. Amoxicillin prophylaxis was administered to 27 (56%) of the patients after completion of therapy. All patients were followed for 6 months. Drainage recurred in 12 (25%) patients during the first 3 months after the study. The recurrence rate was not affected by the antibiotic regimen, the patient's age, the duration of drainage before initiation of antibiotic therapy, or prophylaxis. We conclude that intravenous wide-spectrum antibiotic therapy in conjunction with daily suction and débridement is efficacious for the treatment of chronic suppurative otitis media without cholesteatoma.

Adolescent↗
PubMed1990

Burkitt's lymphoma of the tonsil.

A case of Burkitt's lymphoma involving the tonsil in a 10-year-old Bedouin boy, is presented. The biological behaviour and the clinical presentation of this unusual neoplasm are discussed and the English language literature is reviewed. The diagnosis was made by histological examination, electron microscopy and confirmed by immunohistochemistry. The patient showed an excellent symptomatic response to surgery and chemotherapy.

Antigens, Differentiation, B-Lymphocyte↗
PubMed1990

Adenoid cystic carcinoma of the external auditory canal.

Adenoid cystic carcinoma of the external auditory canal is much less common than squamous cell carcinoma and basal cell carcinoma. Signs and symptoms of the case presented here consisted of a longstanding discharging ear, a progressive hearing loss, and the presence of a circumferential subcutaneous induration in the distal third of the external auditory canal. No dizziness, tinnitus, or facial weakness was present. Computed tomography showed a soft tissue mass in the external auditory canal and middle ear with no lytic areas of the mastoid or the temporal region. A biopsy specimen was interpreted as an adenoid cystic carcinoma. Treatment consisted of radical excision of the external auditory canal via a modified temporal bone resection. This radical approach resulted in the local eradication of the lesion.

Carcinoma, Adenoid Cystic↗
PubMed1989

[Cefaclor and trimethoprim-sulfamethoxazole for recurrent otitis media].

The efficacy of cefaclor and of trimethoprim-sulfamethoxazole (TMP-SMX) in the management of recurrent otitis media was evaluated in a randomized single-blind controlled trial. The median age of the patients was 12 months (range 5-37); there were 37 boys and 19 girls. All had received 1 or more courses of antibacterials for acute otitis media in the previous 2-3 weeks. 27 were treated with oral cefaclor suspension, 40 mg/kg/day in 3 divided doses, and 29 with 1 mg/kg/day of TMP-SMX (trimethoprim 8 mg, sulfamethoxazole 40 mg) in 2 divided doses, each group for 10 days. 70% of the cefaclor group and 90% of the TMP-SMX group were cured after the 10 days of therapy (0.1 greater than p greater than 0.05). Results were not better on the 21st day as compared with the 10th. Our data indicate a mild preference for TMP-SMX (although p was not less than 0.05), since it needs to be given only twice a day and costs less than cefaclor.

Acute Disease↗
PubMed1989

Granular cell lesions in head and neck: a clinicopathological study.

Twenty-five cases of granular cell lesions in the region of the head and neck are presented. The adult form (18 cases) was more frequent in women, and the most frequent sites were the tongue, the skin, and subcutaneous tissues, followed by the lip and buccal mucosa. One lesion occurred in the larynx. The congenital forms (7 cases) all occurred in female infants and involved the mucosa overlying either the anterior ridge of the maxilla or the mandible. Immunohistochemical studies revealed positive staining for S100 protein in all the granular cell tumors of the adult but in none of the congenital granular cell epulides. Embryonic antigen was present in the cells of all the congenital cases and in three-quarters of the adult cases. The significance of the histological and immunohistochemical findings is discussed. We conclude that the congenital and adult lesions are similar morphologically but are not necessarily of similar histogenesis. The findings with respect to S100 protein favor a neural (Schwann cell) origin of the adult granular cell tumor, but not the congenital form.

Adult↗
PubMed1989

Solitary basal cell carcinoma in a child.

Basal cell carcinoma in children is rare. Its occurrence has been described in association with nevoid basal cell carcinoma syndrome, preexisting organoid nevus, and xeroderma pigmentosum. We present a case of solitary basal cell carcinoma in a 13-year-old boy with nonactive damaged skin or a genetically transmitted syndrome. The contribution of this case is to alert the physician to the possibility of basal cell carcinoma in children so that appropriate treatment may be initiated immediately and any delay avoided.

Adolescent↗