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Biomedical subjects

A G Pfleiderer

Publications and source records attributed to A G Pfleiderer.

31 records · Page 2Linked to original sources
PubMed1991

Persisting incidence and mortality of sinogenic cerebral abscess: a continuing reflection of late clinical diagnosis.

Seventy-four verified cases of cerebral abscess seen in the Regional Neurosurgical Centre at Addenbrookes Hospital, Cambridge between 1965 and 1987 were reviewed. During that time no decline in incidence or change in the associated mortality was found to occur. ENT disease, taken as a whole, represented the most common source (40%) while acute frontal sinusitis (23%) proved to be the most common single underlying cause. Cerebral abscesses of sinogenic origin in particular were diagnosed late, with a deteriorating conscious level being the precipitating event in 94% of cases. Over 80% of such patients had presented initially to a non-ENT department with acute frontal headache where neither the underlying frontal sinusitis nor the developing intracranial complication had been suspected. These findings might explain why the incidence and mortality associated with cerebral abscesses of sinogenic origin, have changed little in the last 25 years despite improvements in diagnostic imaging, surgical technique and antibiotic therapy. We recommend that the diagnosis of acute frontal sinusitis be considered in any patient who presents with acute frontal headache, particularly if symptoms are unilateral. Furthermore, we stress that early confirmation of intracerebral complications by computerized axial tomography (CT) scanning continues to depend entirely upon an early clinical diagnosis which should result from a high level of clinical suspicion in patients who develop intracranial symptoms in the presence of known acute frontal sinus infection.

Adolescent↗
PubMed1990

Dysequilibrium and otitis media with effusion: what is the association?

An association between non-suppurative otitis media (NSOM) and symptoms of dysequilibrium has been observed but not previously quantified in children (Gates, 1980; Busis, 1983; Blayney and Coleman, 1984). This study compared the incidence of balance related problems in 154 children with surgically proven glue ear and 51 children with normal ear function. Symptoms ranging from true vertigo to mild ataxia were discovered in 22 per cent of the children with NSOM but in none of those within the control group (p less than 0.001). Periods of dysequilibrium were associated with episodes of otalgia in 64 per cent of the children but were not increased in those with unilateral compared to those with bilateral effusions. Complete resolution of symptoms occurred in 85 per cent of children following the insertion of grommets. A history of balance disturbance should be actively sought in all children with otitis media with effusion, and when present, provides a strong indication for early operative intervention.

Child↗
PubMed1988

Cocaine and adrenaline: a safe or necessary combination in the nose? A study to determine the effect of adrenaline on the absorption and adverse side effects of cocaine.

The use of topical cocaine in nasal surgery is widely accepted. However, the value and safety of using adrenaline in addition is strongly disputed. Serial serum cocaine levels were estimated in 30 patients during routine nasal surgery with half the patients receiving preoperative nasal preparation with cocaine alone and the other half receiving a cocaine and adrenaline combination. The serum cocaine values and the incidence of toxic effects of cocaine were compared between the 2 groups. Results showed that the addition of adrenaline significantly reduced the systemic absorption of cocaine during surgery but caused no significant increase in toxic cardiovascular effects compared with the use of cocaine alone. No evidence of cocaine toxicity was seen in either group. Preparations including adrenaline were also observed to intensify local nasal vasoconstriction resulting in a better operative field. It is concluded that adrenaline can still be a valuable as well as safe addition to topical cocaine used in the nose.

Adolescent↗
PubMed1988

The fasciaform graft: a technique for the repair of large perforations of the tympanic membrane.

Our experience with the fasciaform graft, designed specifically for the repair of subtotal or total perforations of the tympanic membrane, is presented. The technique which utilizes a total tympanic graft of formalized autologous temporalis fascia is described in detail. We have employed this method in 29 patients with total closure of the defect being achieved in 93% of cases. The fasciaform graft is therefore recommended as a successful method of repair for subtotal and total perforations of the tympanic membrane for which the conventional grafting techniques currently available are much less effective.

Adolescent↗
PubMed1988

A screening protocol used for the detection of acoustic neuromas: a clinical evaluation.

Screening for acoustic neuromas in large numbers of patients in whom the possibility exists should effectively select out the small proportion who have a tumour, prior to more definitive but costly radiological scanning techniques. A suitable screening protocol has been suggested using a combination of caloric testing, tomography of the internal auditory meati and evoked response audiometry. The protocol was applied retrospectively from the records of 64 patients with proven acoustic neuromas and found to predict correctly the presence of a tumour in 97% of cases. It is concluded that this combination of investigations constitutes an effective method of screening patients in whom an acoustic neuroma confined to the 8th nerve is suspected. The great importance of early diagnosis is that the operative mortality and morbidity is much less when the tumour removed is small.

Audiometry, Evoked Response↗
PubMed1987

Antroscopy via the inferior meatal route under local anaesthetic: a practical guide to technique.

Antroscopy has been shown to have a significant role to play in the management of chronic sinus disease. A technique, performed via the inferior meatus, is described which has been used successfully in 103 patients under local anaesthetic. Particular attention has been paid to the practical problems and pitfalls which may be encountered and how they may be overcome. Vasovagal symptoms were the commonest adverse effect, occurring in 15 patients; otherwise the associated morbidity was encouragingly low. It is concluded that antroscopy performed with a good technique can be a rewarding procedure suitable for use in the outpatient department.

Anesthesia, Local↗
PubMed1986

Antroscopy: its place in clinical practice. A comparison of antroscopic findings with radiographic appearances of the maxillary sinus.

One hundred and fifteen patients with chronic nasal symptoms underwent both radiological and antroscopic investigation of their maxillary sinuses. A total of 193 antra were studied. The radiological diagnosis completely correlated with the antroscopic findings in only 44% of the cases. The reasons for this discrepancy are discussed as well as the additional limitations of radiology in the diagnosis of the opaque antrum and the accurate detection of sinus fluid. Antroscopy provides accurate information about the nature of mucosal changes, the presence of secretions and the state of the natural ostium. This technique therefore ensures a precise diagnosis on which appropriate primary treatment can be based as well as offering the most reliable means of selecting patients who require surgery. The potential for detecting early antral tumours is stressed. It is concluded that antroscopy is the most useful investigation in the management of chronic conditions of the maxillary sinus. However, radiology still has its place as a primary screening test, particularly when the radiographic findings are negative.

Adolescent↗
PubMed1984

Ultrasound of the sinuses: a worthwhile procedure? A comparison of ultrasound and radiography in predicting the findings of proof puncture on the maxillary sinuses.

Fifty-five consecutive patients had ultrasonic examination and routine radiology of the maxillary sinus prior to proof puncture. One hundred and eight antra were washed out and a positive aspiration was obtained in 20% (22). A clear return correlated with a normal radiograph and ultrasound in 91% and 85% of sides respectively. Radiographic results gave a 9% false negative result whereas 15% of normal ultrasounds had a return on proof puncture. Abnormal radiographic appearances and ultrasound traces were correlated with a positive return in 28% and 27% of punctures, respectively. It is concluded that ultrasound adds little further information and does not improve upon radiology in predicting the presence of fluid within the maxillary antrum.

Adolescent↗
PubMed1982

The consequences and effectiveness of intubation in the palliation of dysphagia due to benign and malignant strictures affecting the oesophagus.

In a study of 66 patients intubated to relieve dysphagia, 52 (79 per cent) survived the procedure and were discharged home. Of these, 23 (44 per cent) developed further dysphagia due to tube dysfunction, and 19 patients (37 per cent) were readmitted for further procedures to restore swallowing. With early intervention, the periods of dysphagia were short and the palliation so achieved was effective. Overall, intubation proved to be an effective method of relieving dysphagia in patients unsuitable for curative treatment.

Aged↗
PubMedDate not supplied

Lymphoma arising from Hashimoto's thyroiditis: an unusual cause of acute stridor.

We report an unusual presentation of non-Hodgkin's lymphoma of the thyroid which mimicked an acute infective thyroiditis and was associated with acute stridor and dysphagia. The mode of presentation and diagnosis of thyroid lymphoma are discussed and the value of early fine needle aspiration emphasised.

Biopsy, Needle↗