Search PubMed⌕ Search

Biomedical subjects

S J Wetmore

Publications and source records attributed to S J Wetmore.

At least 19 recordsLinked to original sources
PubMed2001

Clostridium difficile colitis following antibiotic prophylaxis for dental procedures.

Clostridium difficile-induced diarrhea and colitis are common complications of therapeutic courses of antibiotics in the hospital setting. We report a case of Clostridium difficile colitis following antibiotic prophylaxis for endocarditis prior to dental procedures in the community setting. The infection necessitated hospital admission and a prolonged hospital stay. Dental practitioners must be aware of the significance of the disease and the risk associated with antibiotics, whether they are used for prophylaxis or treatment.

Aged↗
PubMed1999

Interactive effects of the middle ear pathology and the associated hearing loss on transient-evoked otoacoustic emission measures.

Sixty-three children aged 4 to 17 years were examined by tympanometry, pure-tone audiometry, transient-evoked otoacoustic emissions (TEOAEs), and otoscopy to evaluate the effects of middle ear pathologies and the associated hearing loss on TEOAEs. TEOAE measures were highly specific (93.8%) in identifying normal ears that passed both audiometric and tympanometric criteria. The sensitivity for identifying abnormal ears was also reasonable (83. 3%). The effects of the middle ear abnormality were most significant, regardless of the degree of hearing loss, when the tympanogram was type B with normal volume measures, which is associated with reduced eardrum mobility and middle ear fluid. The middle ear conditions producing the greater negative pressure, which in turn led to more conductive hearing loss, also produced more TEOAE failures. The mere presence of an open ventilation tube was not a determining factor for absent TEOAEs because 60% of the open ventilation tubes had normal TEOAEs. Provided that the clinician understands the effects of middle ear pathologies on otoacoustic emissions, TEOAEs can be a great asset for diagnosis of both otologic and audiologic disorders.

Acoustic Impedance Tests↗
PubMed1999

Immunologic and histologic observations in reovirus-induced otitis media in the mouse.

The goals of this study were to develop a mouse model for virally induced otitis media, and to study the immune response to infection. Intranasal inoculation of mice by reovirus was used to induce otitis media. Immunohistochemical evidence for the presence of reovirus in the nasopharynx, eustachian tubes, and middle ears and the amount of infiltrating B-cells and T-cells in those sites were serially evaluated by painlessly sacrificing animals over a 21 -day period. Reovirus antigen was detected in the middle ear mucosa by day 4 in 75% of infected animals, and histologic evidence for otitis media was found in 54% of all infected animals. A significant increase in B-cells in the nasopharynx and eustachian tubes was noted 7 to 10 days following infection. The number of infiltrating T-cells did not vary significantly from that in the control animals at any of the sites. These results provide a basis for further investigations of the immune response in otitis media.

Animals↗
PubMed1999

Cryosurgery for common skin lesions. Treatment in family physicians' offices.

OBJECTIVE: To review the principles of use, common techniques, and effectiveness of cryosurgery for common skin lesions that can be treated by family physicians in their offices. QUALITY OF EVIDENCE: MEDLINE and the Cochrane Database controlled trials register (1998 version) were searched. Much of the evidence for the effectiveness of cryosurgery or cryotherapy is based on of cryosurgery for treating common warts, external genital warts, lentigines, and basal cell carcinomas. Many of the trials reviewed were conducted in specialty clinics and, therefore, the results might not apply accurately to family practice. MAIN MESSAGE: Evidence from case report and series suggests that cryosurgery is effective for actinic keratoses, seborrheic keratoses, dermatofibroma, keloids, molluscum contagiosum, and benign nevi. Randomized comparative trials show that, for external genital warts, cryosurgery is more effective than podophyllin treatment, better than or equal to trichloroacetic acid, but less effective than electrodesiccation or surgical removal. Prospective randomized trials of cryosurgery for common warts showed that weekly cryotherapy produced more rapid cures, but the overall cure rate depended on number of treatments. Two freeze-thaw cycles and paring before freezing improved the cure rate for plantar warts.

Cryosurgery↗
PubMed1998

Procedures in ambulatory care. Which family physicians do what in southwestern Ontario?

OBJECTIVE: To determine how often family physicians perform 12 ambulatory care procedures and factors associated with procedure performance. DESIGN: Mailed, self-administered survey. The survey was conducted according to the Dillman Total Design method. SETTING: Family physicians' offices in London, Ont, and in surrounding communities. PARTICIPANTS: A total of 395 family physicians practising within the London area were mailed surveys, 237 in London and 158 outside London. Response rates were 80.6% and 75.9%, respectively. Nonresponders did not differ significantly from responders in sex but included more solo practitioners. MAIN OUTCOME MEASURES: Performance of ambulatory care procedures, sex, and practice characteristics of participant family physicians. RESULTS: For all responders, activities significantly associated with procedure performance were delivering babies, managing psychological problems, working emergency, and teaching. Mean total procedure scores ranged from 6.55 for managing psychological problems to 7.68 for working emergency. Sex-specific analysis showed that practice location and years in practice were significant factors for female but not for male family physicians. Mean total procedure scores for female physicians were 7.06 (outside London) and 4.74 (in London). CONCLUSIONS: Factors associated with procedure performance for family physicians in and around London included delivering babies, working in emergency, managing psychological problems, and teaching. Practice location was a significant factor for only female family physicians; those practising outside London performed procedures more than their urban counterparts and at similar rates to male physicians.

Ambulatory Care↗
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↗
PubMed1995

Incidence of adenovirus and respiratory syncytial virus in chronic otitis media with effusion using the polymerase chain reaction.

The aim of this study is to investigate the role of adenovirus and respiratory syncytial virus in the cause of chronic otitis media with effusion by use of the polymerase chain reaction for detection. The polymerase chain reaction has proved to be more sensitive and specific than viral cultures and immunoassays in the detection of viruses in other specimens. Adenovirus and respiratory syncytial virus were chosen because these viruses have been the most commonly isolated viruses in middle ear effusions in studies using other techniques. The effusions (132 total) were sterilely collected from 88 children undergoing myringotomy and ventilation tube placement for chronic otitis media with effusion. Nine (6.8%) specimens were positive for adenovirus by the polymerase chain reaction, and 13 (9.9%) were positive for respiratory syncytial virus by the polymerase chain reaction. Only one specimen was positive for adenovirus and respiratory syncytial virus by viral culture and immunofluorescence, respectively. Our results show that the polymerase chain reaction can be used to detect adenovirus and respiratory syncytial virus in chronic middle ear effusions and that PCR is more sensitive than viral culture and immunofluorescence techniques.

Adenoviridae Infections↗
PubMed1994

Correlation between the American Academy of Otolaryngology-Head and Neck Surgery five-minute hearing test and standard audiologic data.

The American Academy of Otolaryngology-Head and Neck Surgery recently developed a questionnaire called the "Five-Minute Hearing Test" and distributed it to many primary care physicians. Our literature review suggests that the test characteristics (i.e., sensitivity and specificity) of this screening instrument have not been published. The purpose of this study was to examine the validity of the test by correlating the "Five-Minute Hearing Test" results to various audiologic results obtained for the same patients and to analyze the test characteristics with pure-tone measures as a standard criterion. An original version of the "Five-Minute Hearing Test" was administered to 70 patients older than 55 years, and a revised version of the test was administered to additional 74 elderly patients. The "Five-Minute Hearing Test" scores in both original and revised versions significantly correlated with all audiologic measures, especially with the pure-tone measures. However, the American Academy of Otolaryngology-Head and Neck Surgery's recommended cutoff score for a referral yielded a high false-positive rate. If the cutoff score were changed, the "Five-Minute Hearing Test" would be a reliable hearing screening tool for identification of hearing loss among the elderly population. Specific recommendations include adjustment of the cutoff score to at least 15 and revision of a few selected test items.

Aged↗
PubMed1993

Epistaxis: a comparison of treatment.

Epistaxis is a common condition as well as a frequent otolaryngologic emergency, with up to 60% of people experiencing one episode in their lifetime and 6% seeking medical attention. Treatment is controversial, with many options being available. We retrospectively reviewed the hospital course and management of 65 patients who experienced epistaxis from January 1, 1986, to October 31, 1991, to compare medical and surgical treatment methods. Fifty-one patients were managed medically. Of these, 36 patients required one treatment (group 1), 10 required multiple treatments (group 2), and seven required multiple admissions (group 3). The mean lengths of hospitalization were 3.27, 4.90, and 5.57 days respectively. Fourteen patients were managed surgically. The preoperative stay of nine patients who underwent unsuccessful medical management at our institution (group 4) was 3.9 days, with an average postoperative stay of 7.3 days. The difference in length of stay was statistically significant between surgical and medical groups and the postoperative stay of group 4 was different from the length of stay of group 1 patients. The remaining five patients were initially treated elsewhere (group 5). Seventeen (33.3%) medical and only 1 (7%) surgical patients underwent unsuccessful initial therapy. Complication rates were not statistically different for each group. Transfusion requirements were evaluated as a possible predictive factor. Eighteen patients (35.3%) in the medically managed group required transfusions, compared with 11 patients (78.6%) treated surgically (p < 0.01). The medical group received an average of 0.91 units, compared to the surgical group that received 2.93 units preoperatively (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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↗
PubMed1992

Effect of wound infections on head and neck cancer.

There seems to be a consensus in the surgical literature that wound infections after surgery for cancer have a favorable effect on the course of certain malignant diseases. In a review of laryngeal cancer during a 10-year period, the recurrence rate was statistically lower in the group that suffered wound infections than in the group that did not have a wound infection.

Adult↗
PubMed1991

Surgical landmarks for the facial nerve.

A number of different approaches can be used to expose the facial nerve. The route taken will depend on the pathology and the portion of the nerve that requires exposure. When performing a parotidectomy approach to the extratemporal portion of the facial nerve, the tragal pointer is a key landmark, but other landmarks also should be used to identify the facial nerve safely. The lateral semicircular canal, the chorda tympani nerve, the digastric ridge, and the cochleariform process are some of the useful landmarks in the mastoid and middle ear. When performing a middle fossa approach, the superior semicircular canal, the greater petrosal nerve, and a window through the tegmen tympani into the attic are useful guideposts. The surgeon should use as many of the available landmarks as feasible to perform safe facial nerve surgery.

Ear, Inner↗
PubMed1990

Curvularia/Drechslera sinusitis.

Sinusitis due to unusual fungal pathogens is thought to occur primarily in immunocompromised individuals. However, the fungi Curvularia, Drechslera, and others produce sinusitis in healthy young adults. The signs and symptoms produced by these organisms are usually considered to be complications of sinusitis. Of the three cases that we report, two manifested decreased visual acuity, and the third presented with acute onset of seizures. Computed tomography scans were helpful in delineating the extent of disease and in following the results of therapy. Aggressive surgical treatment is necessary; indeed, two of our cases required a second operation to eradicate all disease. If histopathology shows tissue invasion by the fungus, intravenous amphotericin B is recommended. Fungal cultures and smears should be obtained when healthy patients present with complications of sinusitis.

Adolescent↗