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Biomedical subjects

R H Ossoff

Publications and source records attributed to R H Ossoff.

At least 91 records · Page 5Linked to original sources
PubMed1986

Implementing the ANSI Z 136.3 laser safety standard in the medical environment.

The American National Standards Institute (ANSI) is an organization comprising several committees of expert volunteers who have traditionally determined the industry consensus standards in various fields. The existing federal legislation and the suggested state laser-safety regulation are based on the 1980 ANSI Standard, "For the Safe Use of Lasers." It was quickly recognized that the safety needs of the industrial and medical environments differed sufficiently to prompt the American National Standards Institute to form a committee to write a new set of standards for "Laser Safety in the Health Care Environment" (ANSI Z 136.3). This standard will apply not only to hospitals but also to offices, clinics, and anywhere else that the laser is used for medical purposes. This paper will outline this important laser-safety standard and describe in detail how best to implement it in the environment in which the otolaryngologist--head and neck surgeon practices.

Equipment Safety↗
PubMed1986

Safety precautions for bronchoscopic CO2 laser surgery.

Certain safety precautions are necessary in the performance of CO2 laser bronchoscopy. These include special instrumentation and careful selection of patients. Assessment of tumor vascularity is mandatory because of the limited hemostasis provided by the CO2 laser. The x-ray film evaluation of the integrity of the tracheobronchial tree--for treatment that involves the palliation of obstructing malignant lesions--is outlined.

Bronchial Neoplasms↗
PubMed1986

Paragangliomas of the head and neck.

Nonchromaffin paragangliomas of the head and neck are usually benign, slow-growing lesions arising from neural crest tissue. Although uncommon, these neoplasms should always be considered in the differential diagnosis of a neck mass. The diagnostic and therapeutic challenges posed by these lesions require continued clinical attention.

Adult↗
PubMed1985

Analysis of complete responders after initial treatment with chemotherapy in head and neck cancer.

We treated 60 patients with cisplatin-based combination chemotherapy before definitive surgery and/or radiation. All had squamous cell tumors of the head and neck, stages II to IV, M0. Twelve patients (20%) achieved a complete remission after chemotherapy. Eight of these patients showed no histologic evidence of residual disease after biopsy or surgery. Definitive local therapy with surgery and/or radiation was carried out on almost all patients regardless of the extent of the response to preceding chemotherapy. Chemotherapy-induced complete responders have had an improved survival rate in comparison with patients achieving a partial response or less. The extent of primary tumor correlates inversely with a complete response to chemotherapy.

Adult↗
PubMed1985

Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea.

There have been conflicting reports in our literature concerning the efficacy of bronchoscopic carbon dioxide laser surgery for the treatment of benign strictures of the trachea. We have examined our experience in the management of this disease over a 2 1/2-year period; in all cases, our initial management was performed utilizing the rigid, ventilating bronchoscope with the universal endoscopic coupler and carbon dioxide laser. Eight of 14 patients were successfully managed in this study; retrospective analysis of our results revealed that the presence of one or more of the following four factors was extremely important in predicting an unfavorable prognosis of patients with tracheal stenosis managed endoscopically with the carbon dioxide laser: 1. loss of cartilaginous support; 2. stenosis length greater than 1 cm; 3. circumferential scarring; and 4. carinal involvement.

Adolescent↗
PubMed1985

The use of modern technology in head and neck cancer.

The use of lasers in the management of patients with squamous cell cancer of the head and neck has grown from investigational work to therapeutic practice. Management of early midcordal glottic cancer and superficial T1 oral cavity carcinomas routinely involves the use of the carbon dioxide laser. Investigational work with the Nd:YAG laser and argon pumped dye laser in management of advanced disease and in the diagnosis and treatment of early disease will most likely stimulate long-term multi-institutional studies.

Carbon Dioxide↗
PubMed1985

Reconstructive techniques after ablative head and neck surgery.

This article describes the reconstructive alternatives available to the head and neck surgeon today. Myocutaneous flaps, osteomyocutaneous flaps, and free flaps for reconstruction in the head and neck are detailed. Complications attendant to the use of these flaps are reported and cataloged.

Female↗
PubMed1984

Potential applications of photoradiation therapy in head and neck surgery.

Current theories of carcinogenesis suggest that premalignant changes should be expected in any area of the mucous membrane exposed to a carcinogen. The place of triple endoscopy in the workup and management of head and neck malignant neoplasms has been well established. Hematoporphyrin derivative has been shown to lend reproducible results in the study of tumor fluorescence. This compound has been used in in vitro and in vivo diagnosis and in the treatment of various tumors. It has not been used extensively in the head and neck, but its properties are ideal for diagnosis and treatment of selected head and neck tumors. Potential applications of photoradiation therapy in otolaryngology-head and neck surgery include detection of small primary tumors, delineation of resection margins, detection of early recurrences, and palliative and curative therapy of lesions.

Antineoplastic Agents↗
PubMed1984

Preoperative combination chemotherapy for advanced stage head and neck cancer. Promising early results.

We treated 19 consecutive patients with cisplatin, bleomycin, and methotrexate before definitive surgery or radiation therapy. Fourteen patients (74 percent) had partial or complete tumor regression after chemotherapy. With a minimum follow-up time of 27 months, none of the 4 patients who had a major histologic response relapsed, and only 2 of the remaining 15 patients continued disease-free. The achievement of a complete histologic response after preoperative chemotherapy may correlate with long-term disease-free survival after surgery and radiation therapy for head and neck cancer.

Aged↗
PubMed1984

Instrumentation for CO2 laser surgery of the larynx and tracheobronchial tree.

This article discusses the safety principles necessary in laser surgery of the aerodigestive tract, and reviews the instrumentation currently used in microlaryngeal and bronchoscopic laser surgery that satisfies these criteria. Such use will contribute to reduction of morbidity rates associated with laser surgery in these procedures.

Bronchial Diseases↗
PubMed1984

Laser surgery for benign laryngeal disease. Conservation and ergonomics.

In surgery, the era of tissue conservation and advanced engineering ergonomics has arrived. As a surgical tool, lasers will undergo extensive development. The most precise of surgical tools, its ability to focus to spots equal to its wavelength will permit intracellular surgery. A new technology must be mastered by the operator, who must have a solid foundation in laser physics. The small spot size possible with the new laser laryngoscopy coupler introduces one more refinement in the growing trend toward "conservational" surgery of the larynx for both benign and malignant laryngeal disease.

Biopsy↗
PubMed1984

Tracheoesophageal puncture for voice restoration: modification of the Blom-Singer technique.

We have used a modification of the Blom-Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty-eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom-Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used.

Esophagus↗
PubMed1984

Injuries to the bronchi and lungs caused by laser-ignited endotracheal tube fires.

A CO2 laser attached to an operating room microscope was used to produce extraluminal and intraluminal ignition of various endotracheal tubes in dogs. Extraluminal ignition was produced in Silastic and red rubber endotracheal tubes. The red rubber tube ignited before the tube lumen was penetrated. The Silastic tube failed to ignite while the cuff was inflated. When the cuff was deflated, ignition occurred before the lumen was penetrated. No lung or bronchial injuries were detected in the red rubber or Silastic endotracheal tube extraluminal fires. Intraluminal fires were produced in Silastic, red rubber, and polyvinylchloride (PVC) endotracheal tubes. Microscopic examination of the bronchi and lungs revealed severe injuries in dogs intubated with the PVC and red rubber endotracheal tubes. No injuries to the bronchi and lungs were detected in the Silastic tube group, although the potentially toxic effects of silica ash require further investigation.

Animals↗
PubMed1984

Safe instrumentation in laser surgery.

Safe instrumentation in laser surgery involves three basic principles. First, the armamentarium used in conjunction with the operative procedure should be nonflammable. Second, the surfaces of instruments should be nonreflective. Finally, there must be a provision for adequately evacuating smoke and steam from the operative field. This article discusses these principles and reviews instrumentation currently used in microlaryngeal and bronchoscopic laser surgery that satisfies these standards.

Bronchoscopes↗