Etanercept and infliximab associated with cutaneous vasculitis.
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Aged↗
Biomedical subjects
W E Davis
Publications and source records attributed to W E Davis.
Differential diagnosis of PTSD, schizophrenia, and depression with the MMPI-2.
This study used 102 male, veteran, psychiatric inpatients to describe patterns of MMPI-2 clinical and content scales that most accurately discriminate among patients diagnosed with PTSD, schizophrenia, and depression. Single scale accuracy classification using scales PK and PS was unacceptably low. Optimally weighted scales, including PK, Sc, BIZ, and ANX, correctly classified 70% of the patients. Suggestions for facilitating the use of formal decision rules are offered.
Adult↗
Endoscopic partial inferior turbinoplasty.
Endoscopic partial inferior turbinoplasty with a microdebrider has been introduced as an alternative to other inferior turbinectomy techniques for the treatment of nasal airway obstruction. Between June 1994 and December 1997, 100 patients underwent endoscopic partial inferior turbinoplasty. Concurrent septoplasty was performed in 81 patients, and functional endoscopic sinus surgery was performed in 43 patients. Synechiae formation in 12 patients was the most common complication and resolved in nearly all cases. Postoperative improvement in nasal patency occurred in 93% of the patients. In the 48 patients for whom preoperative subjective scores were available, a significant difference was noted when comparing preoperative and postoperative subjective and outcome scores of nasal patency (P < 0.0001). Patients with underlying allergy and chronic sinusitis tended to have lower outcome scores. Postoperative rhinomanometry was obtained in 21 patients and revealed a normalized mean total nasal resistance of 0.23 Pa/mL/second. This improved to 0. 17 Pa/mL/second with topical decongestion (P = 0.0029), revealing the retention of the turbinate mucosa's vasoactive capability. We conclude that endoscopic partial inferior turbinoplasty provides a good alternative to other inferior turbinectomy techniques and is associated with excellent outcomes and minimal morbidity.
Adolescent↗
Body-scaled ratio as a control parameter for prehension in 5- to 9-year-old children.
The purpose of the experiment was threefold: (a) To find evidence that grasping is body-scaled and thus remains invariant during development; (b) to seek evidence that the body-scaled ratio of cube and hand size serves as a control parameter for the phase transition from one-handed to two-handed grasping by identifying the presence of sudden jump, enhanced variance, multistability, and hysteresis; and (c) to examine whether the stability properties of the observed grasping patterns increase with age. Thirty-three children aged 5, 7, and 9 years old were required to grasp and lift 14 cardboard cubes of different sizes (2.2, 3.2, 4.2, etc. to 16.2 cm diameter). Three conditions were used: (a) an increasing condition with sizes ordered from the smallest size to the largest; (b) a decreasing condition, with the sizes ordered from the largest to the smallest; and (c) twice in a different random order. Video recordings were analyzed and scored for the percentage of one-handed grasps. The results showed that the shift from one-handed to two-handed grasping occurred at the same body-scale ratio between cube size and finger span for all three age groups. Evidence was found for the presence of a sudden jump, enhanced variance, multistability, and hysteresis, indicating that the body-scaled ratio of cube and hand size serves as a control parameter. No change with age for the stability properties of the grasping patterns were observed.
Anthropometry↗
Long-term outcome analysis of functional endoscopic sinus surgery: correlation of symptoms with endoscopic examination findings and potential prognostic variables.
One hundred eighty-two patients were evaluated after functional endoscopic sinus surgery. The goal was to establish whether any anatomical finding correlated with symptoms and to find any historical predictors of symptomatic failure. Of all physical findings reviewed, only scarring of middle meatal antrostomy and scarring of the ethmoids approached significance in predicting poor outcome. Surprisingly, of the historical factors reviewed, only gastroesophageal reflux disease was statistically significant as a predictor of poor symptomatic outcome.
Adult↗
Six methods to assess potential radioactive air emissions from a stack.
In accordance with U.S. Title 40, Code of Federal Regulations, Part 61, "National Emission Standards for Hazardous Air Pollutants," Subpart H, U.S. Department of Energy stack emissions which have the potential to cause an exposure > or = 1 muSv y-1 to the offsite maximally exposed individual must meet the continuous monitoring requirements dictated therein. Since February 1993, all 125 stacks operated by the Westinghouse Hanford Company on the U.S. Department of Energy's Hanford Site have been assessed for their potential unabated radionuclide emissions using one of six methods approved for use by the U.S. Environmental Protection Agency, Region 10. These potential emissions combined with the CAP88 code were used to produce dose estimates to the maximally exposed individual. Results show there are 106 stacks in compliance and below the potential to emit greater than the EPA threshold. The 19 remaining stacks will be brought into full compliance under a Federal Facilities Compliance Agreement which was established in February, 1994. While each method maintains the safety and protection of the occupational worker, the public, and the environment, significant cost benefits may be derived by applying the best available technology. The CAP88 code and the methods for estimating potential emissions are presented, as well as the associated results.
Air Pollutants, Radioactive↗
Endoscopic partial inferior turbinectomy using a power microcutting instrument.
A technique for removing part of the inferior turbinate with a powered instrument is presented. This new technique is safe, quick, easy to teach, predictable and enables removal of the same amount of tissue and bone as is removed with other techniques of partial inferior turbinectomy.
Endoscopes↗
Anatomy of the paranasal sinuses.
This article portrays the anatomy of the ethmoid bone and lateral nasal wall in a detailed, but easily digested form. Understanding the anatomy of the lateral wall of the nose is the cornerstone of competent paranasal sinus surgery.
Cavernous Sinus↗
Suprahyoid and inferior constrictor release for laryngeal lowering.
OBJECTIVE: To quantify accurately the suprahyoid and inferior constrictor releases, which are used to decrease tension across a tracheal anastomosis performed after tracheal resection. DESIGN: Intraoperative tension measurements at 0.5-cm intervals of the released laryngotracheal unit were obtained using a spring balance after division of the trachea. SUBJECTS: A selected series of eight patients undergoing total laryngectomy for laryngeal carcinoma, excluding those with cervical soft-tissue involvement, tongue-base involvement, or a history of radiation therapy to the head and neck. RESULTS: The suprahyoid and inferior constrictor releases together permit a tension-free, inferior displacement of 2 cm. The suprahyoid release alone permits an inferior laryngotracheal displacement of 3.5 cm without exceeding the critical, anastomotic failure tension of 1700 g. Using the releasing techniques together permits inferior displacement of 4 cm without notably exceeding this critical tension. CONCLUSIONS: The closure of 2-cm defects without a releasing procedure is supported by this study. Larger defects of 3.5 cm, and occasionally 4 cm, can be closed safely without exceeding the critical tension level using a suprahyoid release. This study supports the use of the suprahyoid and inferior constrictor releases together for the uncomplicated closure of 4-cm defects.
Aged↗
Effect of partial middle turbinectomy on nasal airflow and resistance.
We report the first prospective study of the effect of partial middle turbinectomy on nasal airflow and resistance as measured objectively by active anterior rhinomanometry. Our study group consisted of 31 consecutive patients who underwent functional endoscopic sinus surgery with simultaneous partial middle turbinate resections. We found that all patients had significant improvement in nasal airflow (p < 0.001) and significant decrease in nasal resistance (p < 0.001). Thus we found no deleterious effect on nasal function. Additionally, we reviewed the literature on retrospective series in which patients had received partial middle turbinectomies and found no evidence that nasal function was impaired after surgery. We conclude that partial middle turbinectomy may be performed without adversely altering nasal function, as measured by active anterior rhinomanometry.
Adolescent↗
Symptom outcome after functional endoscopic sinus surgery in patients with cystic fibrosis: a prospective study.
Twenty-nine consecutive patients with cystic fibrosis were offered functional endoscopic sinus surgery. Twenty-six of these patients underwent surgery. A symptom questionnaire was obtained from the patient or parent before surgery. At the end of the study this symptom questionnaire was again administered to the same individual, and 21 completed it. There were 14 male and 7 female patients, with a mean age of 12.3 years and a median age of 8.7 years. Mean follow-up was 34.3 months. Results for the following symptoms were significant: nasal airway obstruction was improved (p < 0.0002), olfactory function was improved (p < 0.0037), purulent nasal discharge was decreased (p < 0.001), and activity level was increased (p < 0.001). Other parameters are also reported in the text. In summary, this study prospectively studies the effects of functional endoscopic sinus surgery on symptoms in patients with cystic fibrosis. The study points out several significant areas of symptom improvement and supports the selective use of functional endoscopic sinus surgery in patients with cystic fibrosis. Indications for surgery are provided.
Activities of Daily Living↗
Arthroscopic removal of osteochondral fragments from the proximal interphalangeal joint of the pelvic limbs in three horses.
Osteochondral fragments detected in the proximal interphalangeal joint in the pelvic limbs of 3 horses (2 Standardbreds and 1 Thoroughbred) caused joint enlargement and lameness. Fragments were removed by use of arthroscopy. Accurate placement of the arthroscope into the dorsal joint space was necessary to obtain an adequate view of the fragments. After surgery, 2 of the horses resumed racing without joint problems, and the third was in training to race. High-detail radiographs are necessary to detect osteochondral fragments in horses with joint enlargement or lameness localized to the proximal interphalangeal joint.
Animals↗
Immunotherapy in patients undergoing functional endoscopic sinus surgery.
A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients. Data supported the following conclusions: (1) Immunotherapy given either before or after surgery does not statistically influence middle meatotomy patency, synechiae formation, or recurrence of polyps after functional endoscopic sinus surgery. However, the data do suggest, for all three outcome parameters, that allergic patients who undergo immunotherapy do better than those who do not undergo immunotherapy and, with the exception of recurrent polyps, do as well as nonallergic patients. (2) The prevalence of preoperative polyps is the same for allergic and nonallergic patients in this study, but polyp recurrence is higher in allergic patients. (3) Approximately 40% of allergic patients who began preoperative immunotherapy stopped immunotherapy after surgery because their allergic symptoms resolved or were minimal. A comment regarding this observation is provided.
Adolescent↗
Systemic reactions to immunotherapy: the American Academy of Otolaryngic Allergy morbidity and mortality survey.
Anaphylaxis may be defined as a systemic, immunoglobulin E-mediated (Gell-Coombs type I) hypersensitivity reaction triggered by exposure to an antigen in a previously sensitized patient. Anaphylaxis may occur in a variety of circumstances; however, when it occurs as the result of immunotherapy, it is of great concern to the practicing allergist. When describing or reporting anaphylaxis relating to immunotherapy, most allergists speak in terms of the types of reactions, local vs. systemic. Germane to this discussion is the use of the term systemic reaction, which can mean anything from mild allergy symptoms resulting from an allergy injection to bradycardia and hypotension (shock). In this article we report serious or significant systemic reactions, which are characterized by any of the following symptoms: urticaria, sneezing or nasal obstruction, throat tightness or congestion, wheezing, and shock (bradycardia or hypotension). There were no fatalities reported from the survey group. The overall reaction rate was 0.3%.
Anaphylaxis↗
Functional endoscopic sinus surgery in patients with chronic sinusitis and asthma.
Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.74 to 0.99+), and 85% reported that functional endoscopic sinus surgery improved their asthma (0.60 to 0.97). Of the 13 patients who used both inhalers and systemic medication, 53.8% were able to eliminate some of their medication (0.21 to 0.79). Furthermore, 61.5% of these patients had a concomitant reduction in their inhaler use (0.28 to 0.85). All patients (six) who used only inhalers experienced a reduction in their inhaler use (0.54 to 1.00), and two patients were able to eliminate their inhalers completely. One of two patients who were steroid dependent was able to discontinue steroids after surgery. Of patients who used steroids intermittently (13), 53.8% were able to eliminate the use of steroids after surgery (0.21 to 0.79). Patients who required preoperative hospital admissions (4) and emergency room or urgent physician office visits (18) had a 75.0% and 81.3% (p < 0.001) reduction in visits, respectively, after surgery. Because 43% of the cost of asthma is the result of hospitalizations and emergency department/urgent physician office visits, a significant impact on health care costs can be realized with functional endoscopic sinus surgery in this patient population.
Adolescent↗
Functional endoscopic sinus surgery in patients with normal computed tomography scans.
Eighteen patients were operated on by functional endoscopic sinus surgery who had no ostiomeatal unit obstruction on computed tomography scan and had unremarkable paranasal sinuses. These patients also had no apparent ostiomeatal unit obstruction on diagnostic nasal endoscopy. Data were collected on these patients regarding the impact of very limited functional endoscopic sinus surgery on their principal complaint of recurrent sinusitis with facial pain/headache thought to be of sinogenic origin. Sixteen patients (88.9%) had a reduction in the number of sinus infections requiring antibiotic therapy. This reduction was significant at p < 0.0001. Twelve of 14 patients whose facial pain/headache was believed to be of sinogenic origin had a significant reduction in severity (95% confidence interval, 49.2% to 95.3%). We discuss the role of reversible nasal mucosal disease in the pathophysiology of recurrent rhinosinusitis in this patient population. This was a very small, select group of patients who had specific complaints and had had medical treatment failures. This therapy is not recommended for every patient, but only a select few with classic complaints of sinus headaches or recurrent sinusitis and negative computed tomography scans.
Endoscopy↗
Airway resistance and work of breathing in tracheostomy tubes.
Recommendations for sizing of tracheostomy tubes are generally based on anatomic considerations with the largest fitting tube most commonly placed. Once in the tracheostomy site, the tube assumes the new role of the upper airway. Consideration of the airway resistance of each tracheostomy tube and change in work of breathing are important in maintaining the respiratory system homeostasis. The airflow dynamics of neonatal, pediatric, and adult tracheostomy tubes were studied. Flow rates were plotted against change in pressure for inspiratory and expiratory flows and resistances for each tube were calculated. The expiratory resistances were larger for the neonatal tubes and pediatric tubes 0 and 00, while inspiratory resistances were the limiting factor in the adult tubes and the larger pediatric tubes. Comparison of calculated resistances of the tracheostomy tubes was made with known physiologic airway resistances. Adult tubes 8 and 10 most closely simulated the upper airway resistance of adults and neonatal tube 0 appeared most appropriate for the newborn. Work of breathing was determined for each tracheostomy tube. Increasing tube diameter as well as decreasing tidal volume and respiratory rate decreased the amount of work required to maintain a given flow.
Adult↗