Biomedical subjects
A D Noorily
Publications and source records attributed to A D Noorily.
Cocaine and phenylephrine.
Explore the source record for details and available documents.
Comparison of N-octyl-cyanoacrylate vs suture in the stabilization of cartilage grafts.
OBJECTIVE: To compare N-octyl-cyanoacrylate and suture control to determine the efficacy of this tissue glue preparation in securing grafted cartilage with an acceptable inflammatory reaction. DESIGN: Four 5-mm circular auricular cartilage grafts were harvested, and 2 of these grafts were either glued together with N-octyl-cyanoacrylate or sewn together with nylon suture. These sandwich grafts were then glued or sewn to the periosteum of the calvaria. Histologic analysis for inflammation, necrosis, fibrosis, and foreign-body giant cell reaction was performed 2 and 6 weeks after implantation. We also measured cartilage graft migration from the original site of surgical implantation. SUBJECTS: Sixteen New Zealand white rabbits. The 2-week study group consisted of 7 rabbits (1 died of dehydration), and the 6-week group totaled 8. INTERVENTION: Each rabbit underwent auricular cartilage harvest and cartilage graft implantation to the parietal skull periosteum. RESULTS: We found no histological differences between the glue specimens and the suture controls. Similarly, our examination of graft migration yielded no differences between groups. CONCLUSIONS: N-octyl-cyanoacrylate was superior to standard suture technique by virtue of its speed, ease, and accuracy of application. No adverse inflammation was observed. Further studies, including clinical trials, are needed to assess the safety of N-octyl-cyanoacrylate in humans.
Sharp dissection, electrosurgery, and argon-enhanced electrosurgery in porcine skin flaps.
Sharp scalpel dissection, electrosurgery, and argon-enhanced electrosurgery (argon beam coagulation) were used to elevate random pedicled skin flaps in a randomized blinded fashion with a porcine model. A total of 72 flaps on 9 pigs were examined. Flap survival was quantified, and histology was also reviewed 2 and 6 weeks after surgery. No significant difference among the three techniques was noted in terms of area or length of surviving flaps. There were also no histologic differences noted with regard to fibrosis, inflammatory infiltrate, or necrosis. We conclude that the use of electrosurgery during surgical dissection of random pedicled skin flaps is not detrimental to wound healing or tissue survival, and it provides benefits such as decreased blood loss, absence of the need for sharp instruments in the surgical field and faster operative times.
Pseudoaneurysm of the descending palatine artery presenting as epistaxis.
Explore the source record for details and available documents.
Intranasal anesthetic effects of lidocaine and tetracaine compared.
The quality of nasal anesthesia obtained with two local anesthetic solutions (2% lidocaine in oxymetazoline and 1% tetracaine in oxymetazoline) was evaluated in this double-blind, randomized study. Each local anesthetic mixture was applied to the nasal septum of healthy volunteers with medication-soaked pledgets. Measurements of anesthetic effect (sensation threshold and pain perception) were made with Semmes-Weinstein monofilaments (North Coast Medical, San Jose, Calif.). Measurements were performed before local anesthetic application and at 10 and 70 minutes after local anesthetic application. Subjects had greater increases in sensation threshold with tetracaine than with lidocaine at both 10 and 70 minutes (p = 0.0005 and p = 0.0001, respectively). Subjects had greater decreases in pain perception with tetracaine than with lidocaine at both time intervals (p = 0.0003 and p < 0.0001, respectively). Tetracaine mixed with oxymetazoline appears to be a superior topical anesthetic for nasal procedures.
Cocaine, lidocaine, tetracaine: which is best for topical nasal anesthesia?
The quality of nasal anesthesia obtained with three local anesthetic solutions (4% cocaine, 2% lidocaine in oxymetazoline, and 1% tetracaine in oxymetazoline) was evaluated in a randomized study. Each local anesthetic mixture was applied to the nasal septum of healthy volunteers using medication-soaked pledgets. Measurements of anesthetic effect (sensation threshold and pain perception) were made with Semmes-Weinstein monofilaments. Measurements were performed prior to local anesthetic application and 10 and 70 min after local anesthetic application. Subjects had greater increases in sensation threshold with tetracaine than with lidocaine or cocaine at both 10 and 70 min (P < 0.05). Subjects had greater decreases in pain perception with tetracaine than with lidocaine or cocaine at both time intervals (P < 0.05). Tetracaine mixed with oxymetazoline appears to be a superior topical anesthetic for nasal procedures.
Use of oxymetazoline in the management of epistaxis.
The purpose of this study was to determine if use of an intranasal vasoconstrictor (oxymetazoline) could be used to effectively treat epistaxis, avoiding nasal packing. The charts of 60 patients who presented to the emergency room with the diagnosis of epistaxis and who required medical management were reviewed. Sixty-five percent of these patients were successfully managed with oxymetazoline as their sole therapy. An additional 18% were managed successfully with silver nitrate cautery in combination with oxymetazoline. In only 17% of patients was it necessary to use nasal packing as treatment for epistaxis after an initial attempt with oxymetazoline alone or in combination with silver nitrate failed. These data suggest that pharmacologic management may be adequate in the majority of patients with epistaxis, thus avoiding the need for nasal packing with its associated complications.
A lateral rhinotomy closure technique to prevent alar blunting.
This paper describes a simple method of closing a lateral rhinotomy incision which prevents alar blunting. The problem with the standard methods of incision closure is that they will often result in noticeable blunting of the alar crease. The study was performed as a retrospective analysis of my closure results. In conclusion, this technique provides an easy method of lateral rhinotomy closure for optimal cosmetic results.
Cephalosporin antibiotics.
The last three decades have seen the emergence of a cornucopia of antimicrobials in the cephalosporin class. This becomes even more apparent when one realizes that over 60 pages of the 1993 AHFS drug information text is dedicated to the cephalosporin class. Due to similarities in nomenclature and the proliferation of available agents, the clinician is constantly challenged by this confusing array of antimicrobials. The intent of this manuscript will be to distill the volumes of information available on cephalosporins into a more manageable format and close with a summary of the most clinically important cephalosporin antimicrobials.
Metabolic activity of the central auditory structures following prolonged deafferentation.
The goal of this work was to evaluate, using autoradiographic techniques, the effects of variable periods of deafness on resting and evoked metabolic activity in central auditory structures elicited by direct electrical cochlear nucleus (CN) stimulation. Thirty-five pigmented guinea pigs, divided into five groups, underwent acute implantation of bipolar electrodes in the CN. One group was not deafened and served as hearing controls. The other four groups were deafened using an established protocol of sequential kanamycin/ethacrynic acid treatment and were tested at 4 weeks, 9 weeks, 16 weeks, and 15 months after deafening. Threshold currents for eliciting evoked middle latency responses (EMLRs) with direct CN stimulation were not significantly different between hearing and deafened groups. Autoradiographic data showed progressive reduction of the evoked metabolic response with incremental periods of deafferentation. Nevertheless, central auditory structures remained responsive to direct electrical stimulation of the CN. These data indicate that direct CN stimulation remains capable of activating the auditory tract despite prolonged periods of deafness.
A comparison of cocaine vs. lidocaine with oxymetazoline for use in nasal procedures.
This study compared the degree of vasoconstriction and anesthesia obtained with cocaine vs. that obtained with a mixture of lidocaine and oxymetazoline (lido/oxy) in healthy, male volunteers. Blood flow was evaluated by laser Doppler flowmetry. Anesthesia was measured with Semmes-Weinstein monofilaments, testing both sensation threshold and pain perception. A greater decrease in blood flow was seen after the administration of lido/oxy than after the administration of cocaine. Pain perception change was not significantly different between treatment groups at 10 minutes after removal of the medication-soaked pledget, but lido/oxy caused a greater decrease in pain perception than cocaine after 50 minutes. No significant difference in sensation threshold change was seen between treatment groups. Lidocaine with oxymetazoline is, therefore, believed to be an effective alternative to cocaine for nasal procedures.