Biomedical subjects
C M Fernandes
Publications and source records attributed to C M Fernandes.
Eye irrigating lenses.
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Mycotic aneurysm of the petrous portion of the internal carotid artery.
A case of a mycotic aneurysm of the petrous portion of the internal carotid artery is presented. This entity is extremely rare and the problems associated with the diagnosis and clinical management are discussed.
Surgical experience with juvenile nasopharyngeal angiofibroma.
Our experience with 18 cases of juvenile nasopharyngeal angiofibroma (JNA) over a period of 9 years is discussed. All cases were managed surgically: 17 via a transpalatal approach and one case by a combined transpalatal, lateral rhinotomy, and transantral approach. In this series there were two recurrences following primary surgical procedures and these required a second procedure. There were no major complications and all 18 patients are alive. We believe that surgical excision should be the treatment of choice for JNA and that radiotherapy should be used adjunctively for cases wherein intracranial extension of the tumors prevents total excision.
The management of intractable vasomotor rhinorrhoea by transnasal vidian neurectomy.
The performance of transnasal vidian neurectomy in cases of intractable vasomotor rhinorrhoea is described. Of the 66 patients who underwent the procedure, 58 have been followed up and 96% of these reported total or marked improvement in nasal obstruction, 87% reported total or marked improvement in rhinorrhoea and sneezing and 90% reported improvement in post-nasal drip. The procedure is recommended for patients in whom medical treatment has failed.
Pharyngolaryngo-oesophagectomy with gastric 'pull-up' for cancer of the hypopharynx and cervical oesophagus.
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Bacteriology in acute mastoiditis.
During the period from July 1979 to December 1979, the bacteriology of 35 consecutive patients undergoing surgery for acute mastoiditis was studied. The patients' ages ranged from 3 to 13 years. All patients presented with a purulent otorrhea and a postauricular subperiosteal abscess and were subjected to a mastoidectomy within 12 hours of presentation. Specimens were obtained intraoperatively from the mastoid cavity and, using appropriate technology, were cultured for aerobic and anaerobic organisms. Bacteria were isolated from specimens of 32 patients (91.4%); specimens from three patients (8.6%) yielded no growth. Aerobes alone were cultured from four patients (11.4%); six patients' cultures (17.1%) yielded only anaerobes; and 22 patients' cultures (62.8%) had both aerobic and anaerobic organisms. Thus, anaerobes were cultured from a total of 28 patients (80.0%).
Nerve/muscle pedicle graft for bilateral vocal cord palsy.
The nerve-muscle pedicle graft was successfully used in six of the seven patients admitted with bilateral vocal cord palsy. The diagnostic evaluation included bilateral vocal cord palsy for more than six months; passive mobility test of the arytenoids under general anaesthesia; and exclusion of an organic lesion as a cause of the vocal cord paralysis. The post-operative assessment was done by indirect or direct laryngoscopy. An improvement in phonation and respiration was noted 4 to 10 weeks after the operation. An exertional test was performed. Identification of the origin of ansa cervicalis from the hypoglossal nerve facilitated the operation.
Laryngopyocele (a report of two cases).
A laryngocele is an air-filled dilatation of the saccule of the larynx. An infected laryngocele is called a laryngopyocele. Our experience with two cases of laryngopyoceles are presented. Only 29 cases of laryngopyoceles have so far been reported in the literature (Illum and Nehen, 1980). Case one had a right-sided combined laryngopyocele and case two had a right-sided combined laryngopyocele and a left-sided combined laryngocele. Both our cases had their lesions excised via an external approach, as described by Yarington and Frazer (1966), with case two having a bilateral excision.
Lateral sinus thrombosis (a review of 45 cases).
Forty-five cases of lateral sinus thrombosis were recorded in King Edward VIII Hospital from 1978 to 1984. Eighty-two per cent of the patients were under the age of 15 years. Associated complications recorded were: 9 patients with meningitis, 4 with posterior-fossa abscess, 1 patient suffering from posterior fossa empyema; 4 presented with facial palsy and 1 with tuberculous mastoiditis. Four deaths were recorded. Findings at mastoidectomy showed a prevalence of infective granulations (60 per cent) over cholesteatoma (40 per cent) as a cause of the extension of infection. The surgical protocol for the management of lateral sinus thrombosis was mastoidectomy, needling the sinus and removal of the thrombus, if necessary. Medical treatment consisted of Ampicillin and Metronidozol.
Anatomy of the recurrent laryngeal nerve: a redescription.
The recurrent laryngeal nerves on each side of the neck consist of numerous branches. The demonstration of the diverse relationships of the recurrent laryngeal nerve in the thyroid area explains the variation in vocal cord and cricopharyngeal muscle paralysis produced by surgical or other trauma to this area. The anastomosis of the middle cervical ganglion with the recurrent laryngeal nerve adds a new dimension to the already confused theories on vocal cord and laryngeal function. Both the motor and sensory supply of the larynx inferior to the cords, lower pharynx, cervical oesophagus and cervical trachea are supplied by the recurrent laryngeal nerve branches and their sympathetic anastomoses. The blood vessel-nerve relationship in these neck dissection specimens is quite different from that documented in the standard literature in that there are numerous blood vessels from the inferior thyroid artery that interdigitate with the branches of the recurrent laryngeal nerve.
Intracranial otogenic complications: a persisting problem.
Three hundred thirty-five cases of acute mastoiditis with complications due to extension of infection beyond the mastoid are reported. Two hundred twenty-four of those presented with intracranial sepsis. Meningitis occurred in 83 cases, brain abscess in 53, extradural abscess in 49 cases, and lateral sinus thrombosis in 39 cases. Intracranial complications are frequently seen in this group of patients with neglected otitis media. The complications occurred frequently in children and young adults (74%) with an overall mortality rate of 14%. Meningitis was the most common complication (37%); brain abscess had the highest mortality rate (36%). The overall mortality rate from intracranial complications was reduced in comparison with previous reported series. This is attributed to antibiotic treatment, the use of CT scan in excluding other intracranial complications, and close cooperation between the otologist and neurosurgeon.
The use of piracetam in vertigo.
A pilot study with piracetam (Nootropil; UCB) was performed in 5 selected dizzy patients who had a diagnosis of presbyvertigo or vertebrobasilar insufficiency. The study was monitored by assessing the effect of piracetam on the pursuit-tracking system. All patients showed a remarkable improvement in their pursuit tracking, in addition to marked subjective improvement in their vertigo.
Surgery for correction of bilateral choanal atresia.
A transnasal approach was employed in 28 neonates (26 blacks and 2 whites) with bilateral choanal atresia. In each patient the atresia was perforated microsurgically with the drill, followed by insertion of a Portex endotracheal tube for a period of three months. By this method a satisfactory nasal respiration was established immediately. Removal of the posterior part of the vomer is crucial to the successful result. During the follow-up, one death was recorded in a microcephalic neonate, unrelated to the operation and another four patients required repositioning of the tube under general anesthesia. We feel that the above technique is simple and definitive with negligible complications.
Otogenic complications with an intact tympanic membrane.
A review of 21 cases of complications of acute otitis media with a hyperemic, dull, bulging but intact tympanic membrane is presented. All cases had a retroauricular swelling. In 10 cases, a subperiosteal abscess was found, 1 of them complicated with a posterior fossa abscess, 2 had meningitis, 3 had Bezhold's abscess, 2 had thrombosis of the lateral sinus, 1 had a cerebellar abscess, 1 had cerebellitis, and 2 presented with facial nerve palsy. Ninety percent of the patients were below the age of 13. An incomplete course of antibiotic treatment was found to have been given in seven cases (30%) prior to admission. Surgical therapy consisted of a cortical mastoidectomy and a wide myringotomy. Ventilating tubes were inserted in three patients. The mastoid radiography demonstrated cloudiness, and CT scan was performed in six patients with suspected intracranial complications. The present study stresses that an intact tympanic membrane with minimal changes may be regarded by the medical profession with a low index of suspicion and can lead to severe otogenic complications. The disease can be masked by an improper antibiotic therapy.
Pyriform fossa carcinoma in South African Negro patients.
Seven patients with pyriform fossa carcinoma who presented at Baragwanath Hospital during the period 1973-1976 are discussed. The value of positive contrast studies with special reference to laryngography is emphasized and the results are reviewed.
Labyrinthine membrane rupture: a cause of post-traumatic vertigo.
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Tuberculous mastoiditis.
Twenty-three cases of tuberculous mastoiditis are presented, nine of which were complicated by facial palsy. Six presented with acute mastoiditis, and two had meningitis. Surgery was required in 16 patients; in four cases the diagnosis was made by culture and in another four by biopsy of the granulations or polyp of the external canal. The response to antituberculous treatment was satisfactory in 22 cases. One patient, whose case was complicated by meningitis, died.