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Biomedical subjects

L J Bartels

Publications and source records attributed to L J Bartels.

At least 19 recordsLinked to original sources
PubMed1999

Auricular carcinoma with temporal bone invasion: outcome analysis.

Invasion of the temporal bone by cutaneous carcinoma of the auricle and periauricular skin is an ominous prognostic sign. Management includes aggressive resection of cutaneous disease as well as resection of temporal bone to obtain a medial margin. Analysis of data from 21 patients with temporal bone invasion caused by cutaneous malignancy is presented. Overall survival is approximately 63%. Cumulative survival is significantly decreased in patients with squamous cell carcinoma when compared with other invasive malignancies. Univariate and covariate analyses demonstrate that nodal status, positive microscopic soft tissue margins, and persistent perineural disease at the skull base did not significantly affect survival in this series. There is a trend toward increased survival in patients receiving postoperative radiation in this series.

Adult↗
PubMed1998

Reconstruction after temporal bone resection.

Reconstruction of soft tissue defects after temporal bone resection can vary from simple closure of the external auditory canal to complex flap coverage of extensive defects. Between 1987 and 1996, 34 patients underwent lateral skull base resections and reconstruction for invasive carcinoma of the temporal bone. Seven underwent sleeve resection and/or radical mastoidectomy. Sleeve resection was managed with tympanoplasty, canalplasty, or obliteration of the external auditory canal (10). There were 24 lateral temporal bone resections and four subtotal temporal bone resections. Larger defects created by lateral and subtotal temporal bone resections required closure with a combination of temporalis flaps and local rotational cutaneous flaps (13). Lower island trapezius flaps (five), free flaps (four), and pectoralis major flaps (two) were also used. Indications and efficacy of each method are discussed, and treatment outcomes are presented.

Adult↗
PubMed1991

Facial nerve and medially invasive petrous bone cholesteatomas.

Eight patients with extensive petrous bone cholesteatomas that invaded the labyrinth and fallopian canal are presented. The eight cases are added to a tabulation of prior literature reports to elucidate concepts of routes of extension of medially invasive temporal bone cholesteatoma. Medially invasive petrous bone cholesteatoma develops insidiously, often without symptoms other than facial palsy and/or unilateral deafness. Typically, a history of chronic ear disease can be obtained. While hearing is unlikely to be preserved in this group of patients, facial nerve function can usually be preserved, and a facial nerve graft was not necessary in our series. Acute facial nerve palsy or facial nerve paresis progressing to palsy in patients with a history of chronic ear disease should be studied radiographically for petrous bone cholesteatoma, even if there is no physical evidence of cholesteatoma.

Adult↗
PubMed1990

Primary fallopian canal glomus tumors.

Primary fallopian canal glomus tumor has been reported only once previously, although the occurrence of glomus body tissue in the fallopian canal was documented many years ago. Facial paresis as a presenting symptom of glomus tumors is well known, as is facial nerve invasion by glomus tumors. However, a primary fallopian canal glomus tumor that extends extratemporally to the pes anserinus is unusual. Although facial nerve grafting may be necessary for removal of some glomus jugulare tumors, the need for facial nerve grafting appears to be uniform in the patients with primary fallopian canal glomus tumors. The primary fallopian canal glomus tumors that we report did not involve the jugular fossa or the Jacobson's branch of the glossopharyngeal nerve. Both tumors did extend to the middle ear and mastoid and followed the facial nerve extratemporally. The latter features appear to typify primary fallopian canal glomus tumors.

Adult↗
PubMed1990

KTP laser stapedotomy: is it safe?

Recent published concerns about the potential for visible light lasers to injure the inner ear have led to differing conclusions. While one has advised cautious application of a visible light laser, another eschewed visible light lasers in favor of the CO2 laser. Others have anguished over the efficacy of stapes surgeons as numbers of suitable candidates for otosclerosis surgery decline. In three years' experience with the KTP-532 laser, 80 primary and revision stapedotomies have been completed by this author. The author's experience with low morbidity and high air-bone gap closure rates are presented. The absence of apparent cochlear injury suggests that properly used KTP laser systems are safe. Competitive results were obtained with less than prolific numbers of stapes surgeries.

Adult↗
PubMed1989

The early signs and symptoms of neurotologic complications of chronic suppurative otitis media.

The delay in the diagnosis of neurotologic complications of chronic suppurative otitis media has been explained in a number of ways, including antibiotic suppression, surgical drainage, and a lowered index of clinical suspicion because the problem is relatively rare today. Twelve cases of neurotologic complications of chronic suppurative otitis media were reviewed to determine the early and late findings that should raise the physician's index of suspicion. Purulent, malodorous drainage, headache, and fever were the significant early findings. Altered mental status was a late finding, and usually indicated established intracranial infection. By drawing attention to the early findings, we hope to lower the morbidity and mortality associated with these complications.

Brain Abscess↗
PubMed1988

Pediatric glomus tumors.

Glomus tumors of the middle ear are unusual in adults, but exceedingly rare in children. While a dull, red bulging tympanic membrane in the adult may suggest a glomus tumor, it generally signifies infection in the child. This report details our management of a 10-year-old girl afflicted with bilateral chronic middle ear cleft infection that obscured bilateral glomus tumors. Review of the current English language literature reveals seven additional case reports of otologic glomus tumors in children less than fourteen years of age. Two additional cases are presented that were given to the senior author by personal communication, producing a total of 10 cases for review. Glomus tumors in children may be hidden by otitis media and appear more likely to be endocrine active. Failure to cure the lesion is apparent in five of six case reports of children with glomus jugulare tumors; three of these children are reported to have expired. Complete surgical extirpation is advocated for childhood glomus tumors.

Adolescent↗
PubMed1986

Esophageal perforations: the role of computerized tomography in diagnosis and management decisions.

External drainage is indicated when a neck abscess results from esophageal or hypopharyngeal perforation. Diagnosis, extent of disease, and timing of abscess drainage have traditionally challenged the surgeon in management of the perforated esophagus or hypopharynx. Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study. Five specific case presentations feature diagnosis and management.

Abscess↗
PubMed1986

Malignant external otitis with optic neuritis.

Malignant external otitis (MEO) is a progressive necrotizing infection which spreads to the skull base. The causative organism is usually Pseudomonas aeruginosa and 90% of the patients are diabetic. The infection gains access to the skull base at the temporal bone. Cranial nerve involvement is common. We present a case of malignant external otitis causing blindness due to optic neuritis. Progressive vascular involvement along the skull base is the pathogenic mechanism that best explains spread from the temporal bone to the orbital apex.

Aged↗
PubMed1983

Management of aneurysms of the petrous portion of the internal carotid artery by resection and primary anastomosis.

Intrapetrosal internal carotid artery aneurysms are distinctly uncommon lesions which are difficult to diagnose and treat. With the evolution of the infratemporal fossa approach, direct surgical management of these aneurysms is possible. Application of this technique is detailed in a case report. A discussion of alternate therapeutic modalities and a review of aneurysmal pathophysiology and diagnosis are included.

Aneurysm↗
PubMed1981

Total obliteration of the mastoid, middle ear, and external auditory canal. A review of 27 cases.

In the past 22 years, 27 patients had undergone total obliteration of the mastoid, middle ear, and external auditory canal. Most of the patients had severely diseased ears, many with multiple previous operations. When performed for chronic otorrhea, the operation resulted in a dry ear in all but two cases, though healing was prolonged in some. Secondary revisions for hearing were unsuccessful. We review the indications for this procedure and the experience of others who had used similar techniques. Though seldom indicated, the mastoid obliteration operation results in a dry ear in almost all patients.

Adolescent↗
PubMed1980

Small cell anaplastic carcinoma of the larynx: review of the literature and report of a case.

The case study of a patient with small cell anaplastic carcinoma (oat cell) of the larynx is detailed and the literature is reviewed. Small cell anaplastic carcinoma of the larynx has been demonstrated to be histologically identical to small cell anaplastic carcinoma of bronchogenic origin. The aggressive biologic behavior of this tumor justifies managing small cell anaplastic carcinoma as a systemic disease. Because of early widespread dissemination of tumor, surgery or radiotherapy alone or in combination have not been successful in controlling the disease. The combination of radiotherapy with chemotherapy has been shown to be the most effective approach to the treatment of small cell anaplastic carcinoma of the lung. We believe that a similar regimen should be considered the treatment of choice for small cell anaplastic carcinoma of the larynx.

Aged↗
PubMed1979

Long-term effect of otosclerosis on bone conduction.

There have not been many studies of long-term sensorineural function in otosclerosis. The reports of long-term follow-up of lateral canal fenestration cases show a surprising stability of bone conduction. Because the experience of the senior author in stapes surgery suggests that some patients with clinically proven otosclerosis have a tendency for progression of sensorineural hearing loss, a review of over 500 ears in patients with proven otosclerosis was undertaken. Data from the study indicate that patients with otosclerosis have more sensorineural hearing loss than the general population. Also some otosclerotic ears have a tendency for progression of sensorineural hearing loss.

Audiometry↗