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Biomedical subjects

Joseph L Smith

Publications and source records attributed to Joseph L Smith.

8 recordsLinked to original sources
PubMed2006

Transnasal endoscopic surgery of the pituitary: modifications and results over 10 years.

OBJECTIVE: A 10-year retrospective review of three endoscopic approaches used by the authors for pituitary gland surgery is presented. We review our results and complications and outline the advantages and disadvantages of each. The variations in nasal anatomy that factor in the endoscopic approach are tabulated and discussed. METHODS: A chart review and examination of computed tomography and magnetic resonance imaging scans of patients who have had endoscopic pituitary surgery by the authors was performed. We gathered specific details of the operative approach, nasal-sinus anatomy, tumor location, required ancillary nasal procedures, and postoperative complications. RESULTS: Ninety patients had endoscopic pituitary surgery. Operative reports and review of radiographic studies were possible for 75 patients. The surgical approach progressed over 10 years from endoscopic transseptal (42) to bilateral transostial (13) to unilateral transostial (20). Adequate exposure for the degree of resection was achieved in all patients. Complications included hemorrhage requiring return to the operating room (1), transient visual field loss (2), and transient diabetes insipidus (7). Four patients subsequently had craniotomy to resect suprasellar tumor extension. The average follow-up was 6 years. One patient required revision endoscopic resection 3 years later for tumor recurrence. Anatomic findings included nasal septal deflections in 36 (48%) of the patients, abnormalities of the turbinates in 42 (56%), and variances of the sphenoid sinus septum in 59 (79%) of the patients. In the unilateral transostial approach, the operative side was often determined by anatomic factors. CONCLUSION: The authors have exclusively used endoscopic surgery of pituitary gland tumors for over 10 years. Modifications to the approach have occurred as a result of increased surgeon experience and improved technology. The unilateral transostial approach is safe, effective, and recommended.

Adult↗
PubMed2005

Dentigerous cysts presenting as head and neck infections.

OBJECTIVE: To describe dentigerous cysts presenting as head and neck infections. STUDY DESIGN AND SETTING: Retrospective analysis of 327 charts with an admitting diagnosis of head and neck infection, deep neck space infection, and dentigerous cysts treated at a tertiary care hospital between 1975 and 2004. RESULTS: Seven patients were identified who had dentigerous cysts that presented as head and neck infections. Six of these patients had recurrent infections at the same site and one was diagnosed with a submasseteric space abscess. The incidence of head and neck infections with dentigerous cysts as the underlying causative pathology was 2.1%. CONCLUSION: Head and neck infections with dentigerous cysts as underlying pathology are more common than perceived. SIGNIFICANCE: Typically not considered as sources of infection, dentigerous cysts must be considered in cases of head and neck infection. EBM RATING: C.

Adult↗
PubMed2005

Hunting-related shooting incidents in Pennsylvania, 1987-1999.

BACKGROUND: Characteristics and rates of shooting injuries associated with hunting various game species are unreported. METHODS: For the 1,345 hunting-related shooting incidents in Pennsylvania from 1987 to 1999, age-adjusted hunter injury rates and case-fatality ratios were calculated for each of seven species hunted. Differences in the incidents and injuries were tested (p < 0.05). RESULTS: Fall turkey hunters had the highest (7.5 per 100,000 hunters) and grouse hunters the lowest (1.9 per 100,000) injury rate. The case-fatality ratio was highest for deer hunters (10.3%) and lowest for pheasant hunters (1.3%). Poor skill was the leading cause of deer hunting injuries, and poor judgment the leading cause for injuries during the hunting of other species. Coinciding with changes in regulations requiring orange clothing for hunters, the injury rates for fall turkey hunters initially decreased (rate ratio, 4.1), then increased (rate ratio, 0.5). Hunters younger than 20 years had the highest injury rates. CONCLUSIONS: The rates and characteristics of hunting-related shooting injuries varied by hunted species. Hunter orange clothing regulations appeared to reduce fall turkey hunting injury rates.

Accidents↗
PubMed2005

State-dependent laryngomalacia in sleeping children.

Laryngomalacia is a common congenital laryngeal abnormality. Despite its being widely discussed in the literature, the pathophysiology is not clearly understood. Both anatomic and neuromuscular theories have been suggested to explain laryngomalacia. We report 4 cases of laryngomalacia in which the presenting signs occurred during sleep. Awake flexible nasopharyngolaryngoscopy failed to demonstrate supraglottic structure collapse. Only while the patients were breathing spontaneously under general anesthesia was laryngomalacia noted. A proposed algorithm for diagnosis and treatment is included. These 4 cases of state-dependent laryngomalacia support a neuromuscular cause for laryngomalacia.

Child, Preschool↗
PubMedDate not supplied

Spontaneous pneumomediastinum presenting with retropharyngeal emphysema.

Spontaneous pneumomediastinum is a rare condition that may follow increases in intrathoracic pressure. Patients may present with symptoms isolated to the head and neck. Although this condition is usually benign, there are other potentially fatal conditions, which often present similarly and clinically are difficult to differentiate from this entity. Despite this condition being described in the thoracic and medical literature, very little is found in the otolaryngological literature. This article reports 4 cases in which presenting symptoms were limited to the head and neck and otolaryngologists were the initial consultants. This highlights the need for otolaryngologists to be aware of this clinical entity.

Adolescent↗
PubMedDate not supplied

Predicting deep neck space abscess using computed tomography.

PURPOSE: To investigate objective measures that could increase the positive predictive value of computed tomography (CT) in diagnosing deep neck space infections (DNSIs). METHODS: A retrospective analysis of patients surgically treated at a tertiary care hospital for DNSIs for more than 2 years were reviewed. Patients who had had CT with contrast scanning suggestive of deep neck space abscess within 24 hours before surgery were included. The average Hounsfield units for each abscess were calculated. Based on the intraoperative finding of pus, the patients were divided into groups. Student t tests compared the average Hounsfield units, white blood cell count, and maximum temperature between the groups. Outcomes were measured by comparing overall length of hospital stay, length of postoperative stay, and complications. RESULTS: Of the 32 patients surgically drained, 24 (75%) had discreet collections of pus, whereas 12 (25%) did not. Hounsfield unit measurement was not reliable in distinguishing abscess from phlegmon. None of the other clinical variables studied to distinguish abscess from phlegmon were statistically different either. A statistical difference between the 2 groups was not identified. CONCLUSION: Although CT with contrast plays an important role in the diagnosis and management of DNSIs, the decision for surgical drainage of an abscess should be made clinically. A negative exploration rate of nearly 25% despite careful selection criteria should be expected.

Abscess↗