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Biomedical subjects

H H Ramadan

Publications and source records attributed to H H Ramadan.

At least 37 records · Page 2Linked to original sources
PubMed1997

Endoscopic treatment of allergic fungal sinusitis.

Fungal sinusitis has been seen increasingly in immunocompetent individuals. The literature has stressed the importance of diagnosing these cases. Surgical debridement is the treatment of choice. Six immunocompetent individuals with allergic fungal sinusitis were seen at West Virginia University between January 1992 and December 1993. After adequate evaluation, endoscopic surgical debridement was performed. After surgery they were treated with systemic or topical steroids and oral antibiotics for several weeks. Two patients required a second procedure within a year. Four of our six patients had positive fungal cultures for Aspergillus or Curvularia. None of our patients had evidence of invasive disease on histopathology, and systemic antifungal therapy was not required. Patient course and response will be discussed in detail along with a brief review of allergic fungal sinusitis.

Adult↗
PubMed1997

Contemporary management of cerebrospinal fluid rhinorrhea.

Management of patients with cerebrospinal fluid rhinorrhea (CSF) remains controversial. Most studies recommend either an endoscopic or an external extracranial approach, depending on the surgeon's preference. Eighteen patients with CSF rhinorrhea have been managed at our institution since 1990. The causes of the CSF rhinorrhea consisted of functional endoscopic sinus surgery (7), lateral rhinotomy with excision of a benign nasal tumor (3), spontaneous rhinorrhea (7), and secondary repair after intranasal ethmoidectomy (1). In 11 patients the CSF leak was recognized at the time of surgery; in 10 of these patients it was repaired during the primary surgery, whereas one patient underwent secondary repair after failure of conservative management of his CSF fistula. Seven patients underwent exploration for spontaneous CSF rhinorrhea. Four patients had computer tomography scans that showed the leak, and two patients had cisternography to localize the leak. One patient underwent magnetic resonance cisternography. Both of these leaks were identified with cisternography and were then confirmed intraoperatively. Repair methods included a pedicled septal mucosal flap (4), a free mucosal graft from the septum (7), and a middle turbinate (5). Two patients had obliteration of the sinus with muscle/fascia and fibrin glue. Eight patients were repaired endoscopically. The remainder underwent repair through external approaches. Seventeen patients (at a minimum 1 year follow-up) remain free from leakage. One patient required a second repair 8 months after surgery. Iatrogenic trauma remains the most common cause of CSF rhinorrhea. Management at the initial setting is the least morbid approach and is successful in 95% of cases. Whether an endoscopic or external approach is used depends on surgical expertise and experience.

Adult↗
PubMed1997

Adenovirus and respiratory syncytial virus in chronic sinusitis using polymerase chain reaction.

The aim of this study is to investigate the role of adenovirus and respiratory syncytial virus (RSV) in chronic sinusitis using the polymerase chain reaction (PCR) to assay for the viruses. PCR has proved to be more sensitive and specific than viral cultures and immunoassays in the detection of viruses. Adenovirus and RSV are among the most common viruses to cause upper respiratory tract infections. Sinus mucosa biopsies from 20 patients undergoing endoscopic sinus surgery were sterilely collected. Four specimens (20%) tested positive for RSV by PCR and none tested positive for adenovirus. Only one specimen tested positive for RSV and one for adenovirus by viral culture and immunofluorescence. Bacterial cultures tested positive in 40% of the 20 specimens. PCR can be used to detect RSV in patients with chronic sinusitis and PCR is more sensitive than viral culture and immunofluorescence techniques on sinus polyps and mucosa.

Adenoviridae↗
PubMed1996

Endoscopic sinus surgery in the developmentally delayed child.

Functional endoscopic sinus surgery (FESS) has gained widespread support as the treatment of choice for chronic sinusitis in children. Seven developmentally delayed children were evaluated for chronic sinusitis with symptoms of cough, chronic rhinorrhea, and head banging because of pain. All seven were nonresponsive to repeated courses of oral and sometimes intravenous antibiotics; computed tomography scans on all revealed sinus disease. FESS was performed on all of them. Three children had marked respiratory difficulty at the end of the procedure, with two requiring reintubation. Two children were not able to take oral feedings postoperatively. Because of the complicated postoperative course, a second-look procedure was performed in only two children. We believe that FESS for developmentally delayed children should be tailored accordingly and that a second-look procedure should not be a routine.

Adolescent↗
PubMed1995

Laryngeal tuberculosis. A cause of stridor in children.

The number of tuberculosis (TB) cases reported in the United States has been on the decline for the last three decades. This trend has been dramatically reversed in the past few years, largely owing to the human immunodeficiency virus epidemic. Laryngeal TB, while well recognized in the adult population, is a rare disease in children. Only six cases have been described in the world literature since 1960. We describe three children with laryngeal TB who presented with stridor. One child required an emergency tracheotomy for control of the airway. The pathogenesis of laryngeal TB in children is postulated to differ from that in adults. In children primary infection of the larynx occurs, while in adults, laryngeal infection is secondary to pulmonary disease. All patients had triple anti-TB chemotherapy for 1 year. Laryngeal TB, although rare, may be seen more frequently in the near future and the diagnosis should always be considered.

Child↗
PubMed1995

Tracheostomal stenosis after laryngectomy: incidence and predisposing factors.

Laryngectomy for carcinoma of the larynx has been performed since it was first described in 1880. Since that time the complication of tracheostomal stenosis has plagued both surgeons and patients. The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Virginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. The charts of patients treated before 1991 were reviewed retrospectively; a prospective analysis was initiated in 1991. Only patients with a minimum of 6 months of follow-up were included in this study. The male-to-female ratio was 3:1, with an age range of 28 to 86 years (mean, 58 years). The overall rate of stenosis was 28.4%. The incidence of tracheostomal stenosis was higher in women (46.4%) than in men (21.6%) (p < 0.05). Since 1991 a plastic type of closure was used in 25 patients. The stenosis rate was 0% in these patients. Before 1991 a bevel or circle technique was used, with stenosis rates of 33% and 75%, respectively (p < 0.05). Infection at the site of the stoma, fistula, steroid use, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with an increased incidence of stenosis. The most important factor in prevention of stomal stenosis after laryngectomy is attention to detail while forming the stoma. With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encountered.

Adult↗
PubMed1995

Complications of endoscopic sinus surgery in a residency training program.

Endoscopic sinus surgery has emerged in the last decade as the treatment of choice for chronic sinusitis. Reports of complications of the procedure from different centers vary depending on the technique used and the experience of the surgeon. Between August 1990 and August 1993, 337 patients underwent endoscopic sinus surgery at West Virginia University. Most of the cases were performed by senior residents under faculty supervision. Minor complications were encountered in 15.1% of the cases and major complications in 1.5% of the patients. The most common major complication was cerebrospinal fluid leak. All patients with cerebrospinal fluid leaks were diagnosed and treated successfully at the time of surgery. Middle turbinate adhesions and orbital penetration were the most common minor complications. Routine partial middle turbinectomy did not decrease the adhesion rate. Endoscopic sinus surgery is a relatively safe procedure, even when performed by residents under adequate supervision.

Adolescent↗
PubMed1995

Cylindrical cell papilloma of the nasal septum.

Papillomas of the sinonasal tract are uncommon tumors. They can be subdivided into different histopathological entities including inverting papilloma, fungiform papilloma and cylindrical cell papilloma. Cylindrical cell papilloma is one of the rarest with only twenty-three cases reported. This rare histologically distinct variant of papillomas of the sinonasal tract behaves clinically like inverting papillomas. We present what we believe to be the first reported case of a cylindrical cell papilloma isolated to the nasal septum. The patient's pathology and a literature review of cylindrical cell papillomas of the sinonasal tract are presented.

Adult↗
PubMed1994

Prevalence of IgE-mediated hypersensitivity in children with adenotonsillar disease.

OBJECTIVE: To determine the prevalence of allergy in children with severe adenotonsillar disease and to determine if the persistence of symptoms following tonsillectomy may be related to the allergic state. DESIGN: A prospective study of a cohort of 108 patients. SETTING: Academic tertiary referral medical center. PARTICIPANTS: Consecutive children scheduled to undergo tonsillectomy for obstructive hypertrophy or recurrent infection were eligible to enroll in this study. Over a 17-month period, 108 patients enrolled. One-year follow-up data were obtained on 78% of patients. A group of 59 age-matched controls was used for comparison. INTERVENTION: Radioallergosorbent test analysis was performed on all study patients and controls. The study patients had the following surgical procedures: adenotonsillectomy in 61 cases (55%); adenotonsillectomy-myringotomy tubes in 31 cases (28%); tonsillectomy in 14 cases (13%); tonsillectomy-tubes in one case (< 1%); and adenotonsillectomy-unilateral tube in one case (< 1%). OUTCOME MEASURE: Detection of allergy and postsurgical outcome. RESULTS: Allergy was detected by radioallergosorbent test analysis in 23 (21%) of the study group and 12 (20%) of the control group. Fourteen patients (17%) reported obstructive symptoms unchanged or worse 1 year following surgery. Three of these children were allergic. Sixteen patients (21%) reported allergic symptoms unchanged or worse following surgery. Three of these children were allergic. In six patients (7%), asthma developed following tonsillectomy. None of these children were allergic. CONCLUSIONS: The prevalence of allergy in children with severe adenotonsillar disease is the same as that of age-matched controls. No relationship was detected between resolution of symptoms following tonsillectomy and the presence of allergy. We found no increased prevalence in the development of asthma following tonsillectomy in the allergic child.

Adenoidectomy↗
PubMed1994

Surgical treatment of sinusitis.

Chronic sinusitis has become more widely recognized recently because of the improved diagnostic tools that are now available. The advent of the nasal endoscopes and computed tomography scans have revolutionized our understanding of chronic sinus disease and have led to new surgical techniques. Functional endoscopic sinus surgery (FESS), a new surgical approach to chronic sinus disease, seems to have promising results in the treatment of chronic sinusitis as compared to prior traditional techniques.

Chronic Disease↗
PubMed1994

Osteoma of the malleus.

Osteomas of the temporal bone are benign neoplasms that may be encountered by otolaryngologists. Clinically they should be distinguished from exostoses, which involve the external auditory meatus and are a well recognized entity. Osteomas involving the middle ear and ossicles are extremely rare. There is only one case report in the literature of an osteoma involving an ossicle and in that patient, who presented with conductive loss, the incus was involved. The present report presents a 48-year-old white male, who on routine examination was found to have a mass in his left tympanic membrane. Under local anesthesia the mass was totally excised, after it had been separated from the umbo. Histopathologic sections of the mass revealed a benign osteoma. A brief review of osteomas and exostoses of the temporal bone is presented.

Audiometry↗
PubMed1993

Bilateral vocal cord paralysis with Shy-Drager syndrome.

Shy-Drager syndrome consists of progressive autonomic nervous system failure with Parkinson's disease-like symptoms and orthostatic hypotension. It can also result in airway compromise from bilateral vocal cord paralysis. Fewer than 30 cases of severe bilateral vocal cord paresis or paralysis associated with the Shy-Drager syndrome have been reported in the English literature. We present a case of a 72-year-old man who had a 2-year history of orthostatic hypotension, neurogenic bladder, impotence, anhydrosis, and extremity weakness and paresthesias. Hoarseness and dyspnea with stridor developed as a result of bilateral vocal cord paralysis in the median position and required an emergency tracheotomy. This combination of symptoms resulted in the diagnosis of Shy-Drager syndrome. We present the case along with literature review of bilateral vocal cord paralysis with the Shy-Drager syndrome.

Aged↗