Three cases of cranial nerve paresis following epidural and spinal anesthesia are presented. One patient had combined oculomotor and abducens nerve paresis, while the other two patients had solitary abducens nerve pareses. The authors postulate that mechanical traction is the cause of cranial nerve paresis following epidural and spinal anesthesia.
{"title":"Cranial nerve paresis following epidural and spinal anesthesia.","authors":"A S Whiting, L N Johnson, D E Martin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Three cases of cranial nerve paresis following epidural and spinal anesthesia are presented. One patient had combined oculomotor and abducens nerve paresis, while the other two patients had solitary abducens nerve pareses. The authors postulate that mechanical traction is the cause of cranial nerve paresis following epidural and spinal anesthesia.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"972-3"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13241171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A review of 306 eyes undergoing pars plana vitrectomy for the complications of proliferative diabetic retinopathy revealed that 26 (8.5%) required a second vitrectomy operation. Among the eyes that required repeat vitrectomy, the eventual visual acuity ranged from 20/20 to 20/400 in 35% and was no light perception in 31%. Reasons for subsequent surgery included recurrent vitreous hemorrhage in 54% of eyes, retinal detachment in 42% and neovascular glaucoma in 4%. Twelve eyes (46%) remained with a permanent retinal detachment despite attempts at surgical repair, and eleven of these twelve eyes subsequently developed rubeosis iridis.
{"title":"Re-operation following pars plana vitrectomy for the sequelae of proliferative diabetic retinopathy.","authors":"G C Brown, W E Benson, W S Tasman, J A McNamara","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A review of 306 eyes undergoing pars plana vitrectomy for the complications of proliferative diabetic retinopathy revealed that 26 (8.5%) required a second vitrectomy operation. Among the eyes that required repeat vitrectomy, the eventual visual acuity ranged from 20/20 to 20/400 in 35% and was no light perception in 31%. Reasons for subsequent surgery included recurrent vitreous hemorrhage in 54% of eyes, retinal detachment in 42% and neovascular glaucoma in 4%. Twelve eyes (46%) remained with a permanent retinal detachment despite attempts at surgical repair, and eleven of these twelve eyes subsequently developed rubeosis iridis.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"955-8"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13240618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1990-01-01DOI: 10.4324/9780203450413_perilymph_fistula
T. O. Wilcox, R. A. Hendrix
Perilymph fistula, an abnormal communication between the inner ear and the middle ear, is an enigmatic otologic disorder which may present with auditory or vestibular symptoms. It is typically located at the oval or round windows, but several other locations have been suggested. It may be congenital or spontaneous, or due to trauma or surgery. It often poses a diagnostic dilemma because of the lack of a definitive test. Among the differential diagnoses of the perilymph fistula are Ménière's disease, infection, tumor and central nervous system disorders. Clinically, the definitive diagnosis of a perilymph fistula can only be made by exploratory tympanotomy. A current review of the etiology, diagnosis and management of perilymph fistula is presented.
{"title":"Perilymph fistula.","authors":"T. O. Wilcox, R. A. Hendrix","doi":"10.4324/9780203450413_perilymph_fistula","DOIUrl":"https://doi.org/10.4324/9780203450413_perilymph_fistula","url":null,"abstract":"Perilymph fistula, an abnormal communication between the inner ear and the middle ear, is an enigmatic otologic disorder which may present with auditory or vestibular symptoms. It is typically located at the oval or round windows, but several other locations have been suggested. It may be congenital or spontaneous, or due to trauma or surgery. It often poses a diagnostic dilemma because of the lack of a definitive test. Among the differential diagnoses of the perilymph fistula are Ménière's disease, infection, tumor and central nervous system disorders. Clinically, the definitive diagnosis of a perilymph fistula can only be made by exploratory tympanotomy. A current review of the etiology, diagnosis and management of perilymph fistula is presented.","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 1","pages":"989-97"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70586880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The authors summarize their experience and review the pertinent literature on photocoagulation in the treatment of selected patients with retinoblastoma. Photocoagulation appears to be an appropriate method of management in cases where the tumor is no greater than 3.0 mm in diameter and 2.0 mm in thickness and is confined to the sensory retina, without seeding into the adjacent vitreous. Photocoagulation alone is generally unsuccessful for tumors greater than 4.5 mm in diameter and greater than 2.5 mm in thickness and supplemental treatment with other modalities was often necessary in such cases. Based on personal observations the authors point out certain misconceptions regarding photocoagulation of retinoblastoma and define their current indications and contraindications for this treatment modality.
{"title":"Treatment of retinoblastoma with photocoagulation.","authors":"J A Shields, C L Shields","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The authors summarize their experience and review the pertinent literature on photocoagulation in the treatment of selected patients with retinoblastoma. Photocoagulation appears to be an appropriate method of management in cases where the tumor is no greater than 3.0 mm in diameter and 2.0 mm in thickness and is confined to the sensory retina, without seeding into the adjacent vitreous. Photocoagulation alone is generally unsuccessful for tumors greater than 4.5 mm in diameter and greater than 2.5 mm in thickness and supplemental treatment with other modalities was often necessary in such cases. Based on personal observations the authors point out certain misconceptions regarding photocoagulation of retinoblastoma and define their current indications and contraindications for this treatment modality.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"951-4"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13240617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Branchial cleft cysts, sinuses and fistulas are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulties in differential diagnosis and surgical management. In order to study the clinical presentation and surgical management of branchial cleft anomalies, the operative records of the Children's Hospital of Philadelphia (CHOP) were reviewed for a five year period, January 1, 1982 through December 31, 1986. All patients with a pathologically-confirmed post-operative diagnosis of a branchial cleft anomaly were included in a retrospective chart review. Their case histories were studied to determine symptoms upon presentation, presence or absence of drainage, type of lesion, site of lesion, characteristics of the lesion, accuracy of pre-operative diagnosis, recurrence and complications. A total of 71 patients, 39 males and 32 females, underwent surgical excision of a branchial cleft cyst, sinus or fistula during the study period. There were 23 branchial cleft cysts, 50 sinuses and 3 fistulas. A correct pre-operative diagnosis was established in 60 (85%) of the patients, being highest for patients with branchial cleft fistulas. Incorrect pre-operative diagnoses included thyroglossal duct cyst, cervical lymphadenitis, dermoid, dermal inclusion cyst, lymphangioma and malignant neoplasm. The clinical presentation, pre-operative evaluation, pitfalls in diagnosis, surgical management and post-operative complications are discussed and strategies for the management of branchial cleft anomalies are presented.
{"title":"Branchial cleft anomalies: a five-year retrospective review.","authors":"J F Kenealy, A J Torsiglieri, L W Tom","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Branchial cleft cysts, sinuses and fistulas are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulties in differential diagnosis and surgical management. In order to study the clinical presentation and surgical management of branchial cleft anomalies, the operative records of the Children's Hospital of Philadelphia (CHOP) were reviewed for a five year period, January 1, 1982 through December 31, 1986. All patients with a pathologically-confirmed post-operative diagnosis of a branchial cleft anomaly were included in a retrospective chart review. Their case histories were studied to determine symptoms upon presentation, presence or absence of drainage, type of lesion, site of lesion, characteristics of the lesion, accuracy of pre-operative diagnosis, recurrence and complications. A total of 71 patients, 39 males and 32 females, underwent surgical excision of a branchial cleft cyst, sinus or fistula during the study period. There were 23 branchial cleft cysts, 50 sinuses and 3 fistulas. A correct pre-operative diagnosis was established in 60 (85%) of the patients, being highest for patients with branchial cleft fistulas. Incorrect pre-operative diagnoses included thyroglossal duct cyst, cervical lymphadenitis, dermoid, dermal inclusion cyst, lymphangioma and malignant neoplasm. The clinical presentation, pre-operative evaluation, pitfalls in diagnosis, surgical management and post-operative complications are discussed and strategies for the management of branchial cleft anomalies are presented.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"1022-5"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13240683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many patients with uveitis have such characteristic ocular signs and symptoms, associated systemic disorders, and laboratory abnormalities that a satisfactory clinical diagnosis can be established without the need for invasive intraocular studies. Most other patients with uveitis have mild, self-limited and/or readily controllable disease that does not warrant aggressive invasive testing. In contrast, some patients with uveitis have atypical ophthalmic and/or systemic features or do not respond to conventional antiinflammatory therapies. Such patients may be candidates for invasive diagnostic testing. In this paper, the author describes the techniques of aqueous aspiration, vitreous aspiration, diagnostic vitrectomy, fine-needle aspiration biopsy, controlled aspiration of subretinal fluid, incisional chorio-retinal biopsy and diagnostic enucleation employed in selected patients with uveitis or a simulating condition. The author stresses the potential risks as well as benefits of the different invasive diagnostic techniques and emphasizes the limited indications for these procedures.
{"title":"Invasive diagnostic techniques for uveitis and simulating conditions.","authors":"J J Augsburger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Many patients with uveitis have such characteristic ocular signs and symptoms, associated systemic disorders, and laboratory abnormalities that a satisfactory clinical diagnosis can be established without the need for invasive intraocular studies. Most other patients with uveitis have mild, self-limited and/or readily controllable disease that does not warrant aggressive invasive testing. In contrast, some patients with uveitis have atypical ophthalmic and/or systemic features or do not respond to conventional antiinflammatory therapies. Such patients may be candidates for invasive diagnostic testing. In this paper, the author describes the techniques of aqueous aspiration, vitreous aspiration, diagnostic vitrectomy, fine-needle aspiration biopsy, controlled aspiration of subretinal fluid, incisional chorio-retinal biopsy and diagnostic enucleation employed in selected patients with uveitis or a simulating condition. The author stresses the potential risks as well as benefits of the different invasive diagnostic techniques and emphasizes the limited indications for these procedures.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"964-71"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13241170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laryngomalacia, the most common congenital abnormality of the larynx, is a mild self-limiting disorder in the vast majority of cases. Severely obstructive cases do occur. In the past, these have required treatment with a tracheotomy. At St. Christopher's Hospital for Children, laryngomalacia was diagnosed in one-hundred and fifty-three infants during the three-year period from 1986 through 1988. Patients who had unusually severe symptoms, such as apneic spells, impaired ability to eat and severe choking episodes, were evaluated with four channel nasal thermister pneumocardiograms (sleep studies). Four infants with severe laryngomalacia had sleep studies which demonstrated obstructive apnea. In these infants, the carbon dioxide laser was used to vaporize excess floppy supraarytenoid tissue, a supraarytenoidectomy.
{"title":"Laser supraarytenoidectomy for laryngomalacia with apnea.","authors":"L I Katin, J A Tucker","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Laryngomalacia, the most common congenital abnormality of the larynx, is a mild self-limiting disorder in the vast majority of cases. Severely obstructive cases do occur. In the past, these have required treatment with a tracheotomy. At St. Christopher's Hospital for Children, laryngomalacia was diagnosed in one-hundred and fifty-three infants during the three-year period from 1986 through 1988. Patients who had unusually severe symptoms, such as apneic spells, impaired ability to eat and severe choking episodes, were evaluated with four channel nasal thermister pneumocardiograms (sleep studies). Four infants with severe laryngomalacia had sleep studies which demonstrated obstructive apnea. In these infants, the carbon dioxide laser was used to vaporize excess floppy supraarytenoid tissue, a supraarytenoidectomy.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"985-8"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13241174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A new orbital implant to increase prosthetic motility following enucleation.","authors":"J C Flanagan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"974-6"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13122287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adenoma and adenocarcinoma of the middle ear and mastoid cavity.","authors":"H V Girdhar-Gopal, D O Mikaelian","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"1058-60"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13240609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The inverted papilloma is a true neoplasm of the nose and paranasal sinuses with unusual biological and clinical characteristics. It is a benign process which exhibits certain malignant features such as recurrence, localized destruction of tissues and the possibility of malignant degeneration. Inverted papillomas occur most commonly on the lateral nasal wall, but a small percentage are discovered elsewhere including the ethmoid and sphenoid sinuses, the nasopharynx and the nasal septum. Controversy exists about whether septal papillomas are true inverted papillomas or whether they represent the more commonplace squamous papillomas found in the upper respiratory tract. Two case reports of inverted papillomas of the nasal septum are presented as well as a review of the literature on these neoplasms.
{"title":"Inverted papillomas of the nasal septum.","authors":"C K Bacon, R A Hendrix","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The inverted papilloma is a true neoplasm of the nose and paranasal sinuses with unusual biological and clinical characteristics. It is a benign process which exhibits certain malignant features such as recurrence, localized destruction of tissues and the possibility of malignant degeneration. Inverted papillomas occur most commonly on the lateral nasal wall, but a small percentage are discovered elsewhere including the ethmoid and sphenoid sinuses, the nasopharynx and the nasal septum. Controversy exists about whether septal papillomas are true inverted papillomas or whether they represent the more commonplace squamous papillomas found in the upper respiratory tract. Two case reports of inverted papillomas of the nasal septum are presented as well as a review of the literature on these neoplasms.</p>","PeriodicalId":76752,"journal":{"name":"Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology","volume":"42 ","pages":"1008-13"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13240681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}