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Biomedical subjects

S M Pransky

Publications and source records attributed to S M Pransky.

46 records · Page 3Linked to original sources
PubMed1990

Fourth branchial pouch sinus: principles of diagnosis and management.

The fourth branchial pouch sinus is a congenital anomaly which most frequently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is more common than has previously been suspected. It has been found on the left side in 93% of the 28 cases reported in the English literature. Barium swallow during periods of quiescence and nasopharyngoscopy have frequently been successful in identifying the presence of these embryological remnants. Definitive therapy consists of total excision of the sinus tract, which can be facilitated by direct endoscopic placement of a Fogarty catheter into the sinus lumen before surgical exploration. The embryological basis for the occurrence of these sinuses is discussed.

Branchioma↗
PubMed1990

Surgical therapy of obstructive sleep apnea in children with severe mental insufficiency.

Obstructive sleep apnea is the underlying cause of a variety of pediatric maladies, including pulmonary hypertension and failure to thrive. In children, unlike adults, obstruction secondary to lymphoid hyperplasia is often encountered; adenotonsillectomy restores airway patency. Patients who fail this procedure, such as children with cerebral palsy and associated muscular hypotonia, may face tracheotomies. We report on 10 pediatric patients with severe mental insufficiency and obstructive sleep apnea in whom palatal hypotonicity and lack of adenotonsillar hypertrophy was identified. Uvulopalatopharyngoplasty was performed in conjunction with adenotonsillectomy to enlarge the diameter of the nasopharyngeal inlet with successful resolution of the obstructive symptoms in eight patients. The remaining two children required more surgery. This procedure is presented as a possible alternative to tracheotomy in selected patients.

Child↗
PubMed1990

Cervicofacial mycobacterial adenitis in children: endemic to San Diego?

Nontuberculous mycobacteria (NTM) are an important cause of cervicofacial lymphadenitis in children. A dramatic increase has been seen in confirmed cases of NTM lymphadenitis in San Diego in the past few years. This report encompasses a span of 2 years 9 months, during which 22 children had confirmed NTM infection and another 14 had necrotizing granulomatous lymphadenitis in whom the specific diagnosis of NTM could not be made. This apparent increase in the prevalence of NTM as compared to previous reports in the literature suggests a possible endemic risk for NTM in the San Diego area. These cases are reviewed and our diagnostic and surgical approach to possible NTM infection is described. We also discuss possible explanations for the increasing occurrence of NTM in the San Diego area.

California↗
PubMed1989

Laryngeal diversion in the treatment of chronic aspiration in children.

Chronic aspiration in children can be life-threatening, especially in patients with underlying pulmonary disorders. Numerous surgical procedures have been described to treat chronic aspiration. In patients with severe chronic aspiration, laryngeal diversion is the most effective procedure for reducing soilage of the pulmonary tract. Over a 10-year period at the Children's Hospital of Philadelphia, 14 patients with life-threatening aspiration were managed with a laryngeal diversion. Surgical correction of aspiration resulted in stabilization or improvement of pulmonary function in these patients. The surgical management of chronic aspiration in the pediatric patient is discussed.

Adolescent↗
PubMed1989

Actinomycosis of the middle ear.

Actinomycosis is an uncommon infection of the middle ear. Only 21 cases of actinomycosis of the middle ear have been reported in the English literature prior to this paper. The offending organism is Actinomyces israelii, which is an anaerobic, filamentous organism that is difficult to grow in culture. The infection is chronic and is seldom diagnosed prior to tympanomastoidectomy. The identification of small, yellow, glue-like masses, which are called sulfur granules, is often the key to making the diagnosis of actinomycosis of the middle ear. Following tympanomastoidectomy, penicillin is given orally for 3-6 months.

Actinomycosis↗
PubMed1989

Evaluation of the compromised neonatal airway.

Differentiating upper- from lower-airway compromise in the neonate may be difficult. Knowledge of the multiple problems that affect the airway and an organized approach to assessment aid in determining the site(s) of respiratory compromise. Although endoscopy provides information about the status of the upper airway, the length of time elapsed from extubation may affect the predictive value of observations made at endoscopy. The otolaryngologist should avoid recommending surgical intervention for relief of upper-airway compromise when the major cause of respiratory insufficiency is in the lower airway. Conversely, appropriate surgical intervention at the appropriate time may obviate the need for a tracheotomy. Lastly, if the prognosis is such that continued intubation is necessary and may lead to laryngeal or subglottic damage, a tracheotomy should be performed.

Apnea↗
PubMed1987

An approach to the failed cricoid split operation.

The cricoid split operation is a well established treatment for subglottic stenosis; the success rate for this procedure is approximately 77%. The management of patients who fail this operation has traditionally involved tracheostomy followed by delayed laryngotracheoplasty. We have treated 22 patients using the cricoid split--6 required subsequent tracheostomy. Two-thirds of the patients with a tracheostomy have been unable to be decannulated, even after laryngotracheoplasty. In contrast, 3 patients had repeat cricoid split operations instead of tracheostomy. All 3 of these children have had no further problems with their airway. The authors propose that in patients who fail the cricoid split operation one consider repeating the procedure instead of performing a tracheostomy.

Child↗
PubMedDate not supplied

Differentiating upper from lower airway compromise in neonates.

Technologic advancements and improvements in supportive care have resulted in increased survival of very low birth weight and premature infants. With salvage of these high risk newborns, many difficult management problems arise. Respiratory distress of the newborn is the most common airway problem that affects these patients and subglottic edema or stenosis may frequently complicate management of the airway. Decision-making in airway maintenance and respiratory care can be problematic due to multiple factors that must be considered. The otolaryngologist is often consulted when upper airway obstruction is suspected. Relevant respiratory physiology is reviewed in order to help direct therapeutic decision-making. Parameters of assessment are enumerated and methods for choosing among therapeutic alternatives are presented. A paradigm to aid in differential diagnosis is described.

Apnea↗
PubMedDate not supplied

Clinical assessment of flap perfusion by fiberoptic fluorometry.

Perfusion fluorometry, a method which quantifies tissue fluorescence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.

Aged↗