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Biomedical subjects

G N Postma

Publications and source records attributed to G N Postma.

36 records · Page 2Linked to original sources
PubMed2000

Vocal fold paresis.

Vocal fold paresis (VFP) is a relatively common and often overlooked condition that can be difficult to diagnose based on the laryngeal examination alone. A retrospective review of the records of 50 consecutive adult patients with VFP was performed. In each case, the diagnosis of VFP was confirmed by laryngeal electromyography. The presenting symptoms were dysphonia (100%), vocal fatigue (76%), diplophonia (40%), and odynophonia (12%), and the findings were unilateral vocal fold hypomobility (50%), unilateral bowing (36%), and bilateral bowing (22%). Laryngoplasty and/or lipoinjection was performed in 54% of the subjects, and significant vocal improvement was achieved in 85%. VFP appears to be underdiagnosed because many VFP patients have compensatory hyperkinetic disorders at presentation. Although the diagnosis of VFP may be suspected based on the patient's symptoms and findings, the diagnostic sine qua non is laryngeal electromyography. In addition, surgical treatment for VFP appears to be safe and effective.

Adult↗
PubMed2000

Ambulatory pH monitoring methodology.

Twenty-four-hour ambulatory double-probe pH monitoring is the current "gold standard" for the evaluation of gastroesophageal and extraesophageal reflux. The following article seeks to characterize some of the areas of controversy and describes the methodology of ambulatory pH monitoring used at the Center for Voice Disorders of Wake Forest University.

Acid-Base Equilibrium↗
PubMed2000

Uvulopalatopharyngoplasty versus sequential uvulopalatoplasty for surgical treatment of snoring.

Military personnel serving on active duty suffering from loud, bothersome snoring often require surgical treatment. This elective treatment should not disrupt the command and should have minimal impact on military readiness. Major drawbacks of the standard procedure, uvulopalatopharyngoplasty, include postoperative pain requiring convalescent leave, postoperative bleeding, and velopharyngeal incompetence. In addition, the surgery consumes limited operating room time for what many consider elective surgery. Sequential uvulopalatoplasty was developed as an alternative. This is performed with a carbon dioxide laser under local anesthesia in a clinic setting, but it requires cumbersome laser precautions and expensive laser equipment. Standard electrocautery can be used instead of a laser for this procedure. This avoids additional expense, special precautions, and equipment but is equally safe and effective. We compare time lost from work, duration and level of pain experienced, number of days until regular diet resumed, and effectiveness between uvulopalatopharyngoplasty and sequential uvulopalatoplasty. We found sequential uvulopalatoplasty to have less impact on military readiness while being as effective as uvulopalatopharyngoplasty for snoring. This makes it an ideal treatment modality for patients desiring surgical correction of snoring.

Adult↗
PubMed1998

Bilateral medialization laryngoplasty.

OBJECTIVES: To present indications, techniques, and results of bilateral medialization laryngoplasty (BML). STUDY DESIGN: Retrospective review of 39 consecutive patients who had BML for correction of glottal insufficiency attributable to presbylaryngis (n = 16), bilateral vocal fold paresis (n = 13), unilateral paralysis with contralateral bowing (n = 4), and other miscellaneous neurologic diseases (n = 6). METHODS: Complete preoperative and postoperative clinical and acoustical data were analyzed for 74% (29/39) of the subjects. All 39 subjects completed a patient survey to assess their long-term outcomes. RESULTS: Overall, 90% (35/39) of the patients who had BML experienced significant improvement in voice and swallowing function. Subsequently, 36% (14/39) of the patients underwent adjunctive lipoinjection for closure of small residual glottal gaps (vocal "fine-tuning"). Of the BML patients (with or without lipoinjection) who had complete preoperative and postoperative voice data, 83% (24/29) had complete glottal closure after surgery, resulting in normal or near-normal voices. Eighty-five percent (33/39) of the patients responded that they "would have surgery again." Of the six patients who said that they would not have surgery again, three had good results and one had progressive neurologic disease. The mean duration of follow-up was 17 months. CONCLUSIONS: BML is an effective rehabilitative surgical treatment for symptomatic vocal fold bowing. In addition, lipoinjection is useful as an adjunct to BML to enhance the voice outcome in selected cases.

Female↗
PubMed1998

Transient vocal fold immobility.

Temporary vocal fold immobility resolving in 4 weeks or less is considered a transient immobility. Many different disorders may lead to this type of laryngeal motion impairment. It is important for otolaryngologists to be familiar with the differential diagnosis for transient vocal fold immobility in order to optimize the management of these unusual cases.

Adult↗
PubMed1998

Microvascular lesions of the true vocal fold.

Microvascular lesions, also called varices or capillary ectasias, in contrast to vocal fold polyps with telangiectatic vessels, are relatively small lesions arising from the microcirculation of the vocal fold. Varices are most commonly seen in female professional vocalists and may be secondary to repetitive trauma, hormonal variations, or repeated inflammation. Microvascular lesions may either be asymptomatic or cause frank dysphonia by interrupting the normal vibratory pattern, mass, or closure of the vocal folds. They may also lead to vocal fold hemorrhage, scarring, or polyp formation. Laryngovideostroboscopy is the key in determining the functional significance of vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization. Indications for surgery are recurrent hemorrhage, enlargement of the varix, development of a mass in conjunction with the varix or hemorrhage, and unacceptable dysphonia after maximal medical and speech therapy due to a functionally significant varix.

Adult↗
PubMed1998

Thoracic duct injury during anterior cervical discectomy: a rare complication. Case report.

Chylous fistula resulting from intraoperative injury to the cervical thoracic duct is well described as a complication of neck dissection. However, injury to the thoracic duct during spinal surgery is rarely reported. The authors present the first case of thoracic duct injury occurring during cervical discectomy and fusion via an anterior approach. The anomalous location of the terminal arch of the thoracic duct in this patient contributed to the complication. The morbidity of chyle leakage is minimized by its early recognition, a thorough understanding of lymphatic system anatomy, and aggressive management of the thoracic duct injury.

Adult↗
PubMed1997

Management of persistent chylothorax.

The aggressive management of persistent chylothorax is necessary for avoidance of significant morbidity and possible mortality. The failure of TPN and chest tubes to rapidly control a chylothorax should lead to consideration of thoracic duct ligation.

Carcinoma, Squamous Cell↗
PubMed1997

Electrocautery versus carbon dioxide laser for uvulopalatoplasty in the treatment of snoring.

Laser-assisted uvulopalatoplasty is a popular method for reducing snoring. Drawbacks are the large initial expense of the laser unit and related equipment and required safety precautions. The equipment required for electrocautery for cautery-assisted uvulopalatoplasty is significantly less expensive to obtain and operate compared with the carbon dioxide laser. Ninety-eight patients were randomly assigned to one of two treatment groups to undergo uvulopalatoplasty: one performed with the carbon dioxide laser and the other with electrocautery. We compared postoperative pain, time off work, efficacy, and the number of treatments required to achieve a satisfactory result. We found no statistically significant difference in any of these parameters between the two treatment groups (P > 0.05). Our data show that the use of the carbon dioxide laser offers no advantage over electrocautery in performing uvulopalatoplasty to treat snoring.

Absenteeism↗
PubMed1997

Speech outcomes after laryngeal cancer management.

As our ability to treat laryngeal cancer and prolong the lives of our patients improves, we must place increasing importance on maintaining the best voice possible in every case. Treatment options for laryngeal cancer continue to expand, and it is important that otolaryngologists stay well informed; not only concerning the local control and disease-free survival associated with each new treatment, but also the expected voice result. This article describes the voice and speech outcomes that are associated with various treatments for laryngeal cancer. In addition, comparisons of the expected voice results for different therapeutic modalities are examined.

Carcinoma, Squamous Cell↗
PubMed1996

Optimal concentration of epinephrine for vasoconstriction in neck surgery.

The addition of epinephrine to local anesthetics decreases bleeding, reduces systemic toxicity, and increases duration of action. However, epinephrine has significant side effects. Four concentrations of epinephrine were compared to determine the minimum concentration required for maximal vasoconstriction. Eighty-one subjects undergoing surgical procedures with general anesthesia were injected with 1% lidocaine containing varying concentrations of epinephrine. Blood flow measurements were then made at 1-minute intervals for 10 minutes using a laser Doppler flowmeter. There were no differences in blood flow reduction between epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000. However, epinephrine 1:800,000 provided significantly less vasoconstriction. We recommend using an epinephrine concentration of 1:200,000 or 1:400,000 to provide optimal initial hemostasis while minimizing potential side effects.

Anesthesia, General↗
PubMed1996

Isolated subglottic scleroma.

Scleroma, more commonly known as rhinoscleroma, is a progressive, chronic, granulomatous disease of the respiratory tract and adjacent tissues. Early diagnosis and prolonged therapy are critical in avoiding its late sequelae. We describe an unusual case of scleroma presenting as worsening chronic lung disease. The variety of clinical presentations and treatment modalities is reviewed.

Aged↗
PubMed1995

Reversible blindness secondary to acute sphenoid sinusitis.

Sphenoid sinusitis is an elusive diagnosis with significant morbidity if not diagnosed and treated promptly. We have reported an unusual case of acute sphenoiditis mimicking Gradenigo's syndrome. This resulted in virtual bilateral blindness that entirely resolved with aggressive surgical and medical treatment. It is recommended that sphenoid sinusitis be strongly considered in patients with acute headache and fever. A detailed cranial nerve examination should be performed, and CT scans of the skull base and paranasal sinuses should be obtained. Immediate surgery is strongly recommended for acute sphenoid sinusitis at the first suggestion of a complication and in those patients not promptly responding to medical therapy. It is apparent that irreversible damage to the optic nerve can occur before the development of gross intraorbital pathology. Therefore we believe that delaying surgery until the visual acuity is worse than 20/60, as advocated by some authors, may not be in the patient's best interest. Surgery should be directed at removing the purulent material, obtaining cultures, removing irreversibly diseased mucosa, and maintaining drainage of the sphenoid sinus.

Acute Disease↗
PubMed1995

Effect of local epinephrine on cutaneous bloodflow in the human neck.

The effectiveness of local anesthetics is improved by the addition of a vasoconstrictor which increases duration of action and decreases both systemic toxic reactions and local bleeding. Epinephrine, the standard drug for vasoconstriction, has some limitations due to potential dose-related cardiac and local toxic effects. The authors examined the minimal effective epinephrine concentration required for maximal cutaneous vasoconstriction in the human subject so as to limit potential dose-related side effects. In a randomized, double-blinded prospective study, 23 patients undergoing head and neck surgical procedures under general anesthesia were enrolled to quantify the effect of subdermal infiltration of 1% lidocaine with epinephrine at varying concentrations on local cutaneous bloodflow utilizing laser Doppler flowmetry. A comparison of the onset of vasoconstriction and magnitude of diminished bloodflow was made for several commonly used concentrations of epinephrine, with 1% lidocaine and normal saline serving as controls. There were no significant differences (P > .05) between epinephrine concentrations of 1:400,000, 1:200,000, 1:100,000, and 1:50,000 when examining onset and magnitude of vasoconstriction.

Anesthesia, General↗
PubMedDate not supplied

Brown tumor of the mandible.

Brown tumor is a focal lesion differentiated from other giant-cell tumors by the presence of hyperparathyroidism. Treatment of brown tumors must be initially directed towards correcting the hyperparathyroidism. Tumor regression may occur with resolution of the hyperparathyroidism. Persistent or large destructive tumors are treated with resection or curettage.

Adult↗