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D J Terris

Publications and source records attributed to D J Terris.

At least 55 records · Page 3Linked to original sources
PubMed1998

Balanced orbital decompression for Graves' ophthalmopathy.

OBJECTIVE/HYPOTHESIS: Surgical management of Graves' ophthalmopathy is an alternative to medical therapy with corticosteroids or external beam radiotherapy. Orbital decompression has commonly been performed via a transantral approach to the medial orbital wall and floor. Although an endoscopic approach to these walls has been described, a balanced approach (incorporating a lateral decompression by an ophthalmology team) is desirable. STUDY DESIGN: Retrospective review. METHODS: Endoscopic medial decompression and extended lateral decompression were accomplished in 18 orbits (11 patients); inferior decompression was performed in 11 of these. Five additional procedures were performed. RESULTS: Exophthalmos improved by a mean of 4.6 mm. All patients who underwent decompression for vision loss had improved vision after surgery. Exposure keratitis improved in six of six orbits. Two of five patients undergoing orbital decompression for vision loss developed postoperative diplopia, which was successfully treated with strabismus surgery or prism glasses. There were no other significant complications. CONCLUSIONS: The endoscopic approach to the medial orbital wall is an important component of balanced orbital decompression for patients with Graves' ophthalmopathy. Balancing the decompression and preserving the medial orbital strut between the ethmoid cavity and the orbital floor may minimize the risk of diplopia.

Adult↗
PubMed1998

Pretreatment and midtreatment measurement of oxygen tension levels in head and neck cancers.

OBJECTIVE: Considerable evidence exists to suggest that tumor hypoxia results in radioresistance. Historically, it has been difficult to assess tumor oxygen tension levels reliably. These levels can now be assessed in head and neck malignancies using the Eppendorf pO2 histograph, which uses a fine-needle electrode and a computerized micromanipulator. This technology was used to compare the pretreatment tumor oxygen tension level in lymph node metastases of patients with head and neck cancer to measurements taken during nonsurgical treatment after a partial response had been achieved. STUDY DESIGN: Prospective study. METHODS: Oxygen tension levels were measured in the cervical lymph nodes of 10 patients with biopsy-proven head and neck squamous cell carcinoma and cervical metastases who were being treated with nonsurgical management. These levels were obtained using the Eppendorf pO2 histograph system. Measurements were taken before the start of treatment and were repeated when the size of the cervical metastatic node had decreased by 50%. Normal subcutaneous tissue was measured during the same session. The mean and median pO2 levels, as well as the percentage of measurements with pO2 less than 5 mm Hg were determined. RESULTS: A mean of 72.6 measurements per session was taken from each lymph node. The median tumor pO2 measurement fell from a mean (+/-SD) of 13.9+/-8.0 mm Hg to 7.3+/-9.9 mm Hg. Even more dramatic, however, was the substantial increase in the percentage of values less than 5 mm Hg, a rise from 29% to 52%. CONCLUSIONS: While there is variability both in the pretreatment oxygenation of head and neck cervical metastases and in the change in tumor oxygen tension during treatment, there appears to be a decrease in the overall oxygenation of the tumors. The dramatic increase in very low oxygen measurements may reflect selective survival of radioresistant or chemoresistant hypoxic tumor cells. Cells at the very low level would be expected to be radiobiologically hypoxic (resistant to radiation-induced cell kill).

Aged↗
PubMed1998

Routine hospital admission for patients undergoing upper aerodigestive tract endoscopy is unwarranted.

Although upper aerodigestive tract endoscopy is commonly performed, the need for hospital admission remains controversial. A retrospective review of endoscopy performed between January 1, 1993, and June 30, 1995, identified 201 patients who underwent 371 procedures. Complications occurred in 34 of 371 (9.2%) procedures in 26 of 201 (12.9%) patients. Of these, 11 of 371 (3.0%) were major (requiring admission for management) and 23 of 371 (6.2%) were minor. For multiple concurrent procedures, the overall complication rate was 19.3% (22/114); 5.3% (6/114) were major and 14.0% (16/114) were minor. All 8 patients (100%) who went on to have major complications and 24 of the 26 (92.3%) who went on to have any complication were successfully identified prior to discharge; 2 required postdischarge outpatient management of urinary retention. Five statistically significant risk factors for complication were identified: preexisting cardiac conditions, American Society of Anesthesiologists rating, airway class rating, anesthesia type, and number of endoscopic procedures performed. A comparison of various approaches to hospital admission demonstrated that selective admission based on clinical judgment was superior to routine admission of all patients. In conclusion, we recommend that upper tract endoscopy be performed on an ambulatory basis because 1) the complication rate is low, 2) complications requiring inpatient management are identifiable in the immediate postoperative period, and 3) of the approaches to hospital admission examined, it was the most economical.

Adult↗
PubMed1997

Comparing uvulopalatopharyngoplasty and laser-assisted uvulopalatoplasty.

Finkelstein et al have attempted to provide objective data regarding laser-assisted uvulopalatoplasty (LAUP) and uvulopalatopharyngoplasty (UPPP). Their study represents an important and ambitious undertaking because there is a paucity of anatomical studies in the literature. There are several significant concerns in the design of the protocol, however, that require caution in the interpretation and application of the results.

Humans↗
PubMed1997

A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery.

This study compares the histologic effects of scalpel, CO2 laser, electrosurgery, and constant-voltage electrosurgery incisions on the mucosal tissue of swine. Tissue studies comparing the CO2 laser with the scalpel and electrosurgery have been done. However, a gross and histologic comparison of the effects of all three techniques on oral mucosal tissue has not been reported. A swine model of both tongue and buccal mucosa was used to compare the scalpel, CO2 laser, electrosurgery unit, and constant-voltage electrosurgery unit in an effort to assess their value in oral surgery. Tissue samples of tongue and buccal mucosal incisions and excisions were histologically examined at 0, 3, 7, 14, 28, and 42 days after surgery to evaluate tissue damage and wound healing properties induced by the four instruments. The instruments were also evaluated for performance and ease of use. On subjective evaluation of ease of use, constant-voltage electrosurgery scored highest (p < 0.05) on a scale of 0 to 4, followed by the CO2 laser. Speed of incisions and excisions, measured in seconds, was fastest with the scalpel (p < 0.001) and electrosurgery unit (p < 0.05). The amount of bleeding, as evaluated on a scale of 0 to 4, was least for electrosurgery (p < 0.001) and CO2 laser (p < 0.001). Histologic damage, as expected, was least with a scalpel. The extent of epithelial damage lateral to the wound edge and the extent of collagen denaturation were the lowest with the scalpel (p < 0.001), followed by constant-voltage electrosurgery. The wounds created by all four instruments displayed intact epithelium by 4 weeks, and granulation tissue peaked at 4 weeks with all methods except constant-voltage electrosurgery, where granulation tissue was still prevalent at week 6. Constant-voltage electrosurgery and the CO2 laser provided the best combination of ease of use, hemostasis, and lack of tissue injury among the instruments compared. Incisions and excisions made with constant-voltage electrosurgery required less time than those made with the laser, but constant-voltage electrosurgery wounds also had significantly more granulation tissue in later weeks of the study, suggesting that wound healing may be delayed.

Animals↗
PubMed1997

Percutaneous endoscopic gastrostomy by head and neck surgeons.

The endoscopic placement of percutaneous gastrostomy tubes has been an accepted technique for several years but has traditionally been performed by gastroenterologists and general surgeons. Fluoroscopically guided tube placement is now performed by radiologists. Head and neck surgeons have been slow to adopt the responsibility for placing percutaneous gastrostomy tubes despite the fact that most are proficient in both rigid and flexible esophagoscopy and trained in the Seldinger technique. We report on 41 percutaneous endoscopic gastrostomies performed in 39 patients by the Head and Neck Service at Stanford Medical Center between July 1, 1992, and August 30, 1995. There were 28 (71.8%) male and 11 (28.2%) female patients. Eleven (28.2%) procedures were performed in patients at the time of major head and neck resections. Another seven (17.9%) patients underwent percutaneous gastrostomy tube placement at the time of their initial staging panendoscopy before receiving chemotherapy and radiation. Fifteen (38.5%) procedures were performed for severe postsurgical dysphagia. Six (15.4%) patients had neurologic dysfunction, and this procedure was often performed in conjunction with tracheostomy. There were no major complications. Two patients had to undergo intraoperative tube replacement at 7 months and 18 months for chronic infection and tube damage, respectively. The only other complication was local irritation at the surgical site, which occurred in 2 (5.1%) patients. Our experience with percutaneous gastrostomy tube placement confirms that this is a procedure that can be safely performed by head and neck surgeons and should be part of otolaryngology-head and neck surgery training. The ability to provide comprehensive care of head and neck cancer patients as well as a means of supplemental feeding in conjunction with performing tracheostomy in neurologically impaired patients will no doubt improve the service that our specialty can provide.

Bacterial Infections↗
PubMed1997

Virtual endoscopy of the paranasal sinuses using perspective volume rendered helical sinus computed tomography.

Our goal was to use three-dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin-section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video "flight" model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data. VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.

Endoscopy↗
PubMed1997

A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome.

The past decade has seen several innovations in the surgical techniques available for treatment of patients with sleep-disordered breathing. Outpatient techniques such as laser-assisted uvulopalatoplasty (LAUP) and more aggressive procedures designed to address hypopharyngeal and base of tongue obstruction (genioglossus advancement and hyoid myotomy) have been developed and proven successful. We describe the efficacy of LAUP for snoring (72.7%), upper airway resistance syndrome (81.8%), and mild (mean [+/-SD] respiratory disturbance index [RDI] = 12 +/- 8.1) obstructive sleep apnea (41.7%) in 56 patients who underwent 132 LAUP procedures in a 26-month period. Thirty-two patients with more significant obstructive sleep apnea (mean RDI = 41.8 +/- 23.1) underwent multilevel pharyngeal surgery consisting of genioglossus advancement and hyoid myotomy combined with uvulopalatopharyngoplasty. The surgical success rate in this group of patients was 85.7% when commonly accepted criteria were applied. We recommend a stratified surgical approach to patients with sleep-disordered breathing. Progressively worse airway obstruction marked by multilevel pharyngeal collapse and more severe sleep-disordered breathing is treated with incrementally more aggressive surgery addressing multiple areas of the upper airway.

Adult↗
PubMed1997

Simultaneous treatment with BDNF and CNTF after peripheral nerve transection and repair enhances rate of functional recovery compared with BDNF treatment alone.

The objective was to investigate the effects of brain-derived neurotropic factor (BDNF) and ciliary neurotropic factor (CNTF) on peripheral nerve regeneration. Thirty Sprague-Dawley rats underwent left sciatic nerve transection and repair according to three experimental groups: epineurial coaptation (EC), EC with BDNF delivered by an osmotic pump (EC-BDNF), and EC with BDNF and CNTF delivered similarly (EC-BDNF/CNTF). Nerve regeneration was assessed using sciatic functional indices, quantitative histomorphology, and molecular analysis for proteins associated with nerve regeneration. Analysis of variance (ANOVA) comparing all groups at each time point demonstrated significant differences between groups on days 20, 30, 40, 50, 60, and 80. A paired, two-tailed Student's t-test with the Bonferroni correction for multiple comparisons demonstrated that at 40 days postoperatively, animals in the EC-BDNF/CNTF group (n = 7) manifested superior functional recovery compared with those in the EC group (n = 9) and those in the EC-BDNF group (n = 9) (P < 0.001 and P < 0.05, respectively). At 80 days, the animals in both the EC-BDNF (P < 0.01) and EC-BDNF/CNTF (P < 0.05) groups demonstrated greater functional recovery compared with those in the EC group, with no significant difference between the two factor groups at the endpoint. Morphometric analysis demonstrated that nerves from animals in the EC-BDNF/CNTF group had the largest mean axon diameters as compared with those from the EC (proximal: P < 0.001, distal: P < 0.05) and EC-BDNF (proximal: P < 0.01) groups. No significant differences were seen in nerve cross-sectional area. In distal nerve segments, Western blot analysis revealed that expression of myelin-associated glycoprotein was higher than control for the EC group and lower than control for both the EC-BDNF and EC-BDNF/CNTF groups. We conclude that BDNF/CNTF combined treatment increases the early rate of functional sciatic nerve regeneration over treatment with BDNF alone, although the degree of maximal recovery was similar at the conclusion of the experiment.

Analysis of Variance↗
PubMed1997

Surgical morbidity of neck dissection after chemoradiotherapy in advanced head and neck cancer.

The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.

Adult↗
PubMed1996

Ciliary neurotrophic factors enhances peripheral nerve regeneration.

BACKGROUND: Adjunctive measures to enhance nerve repair have focused on a variety of trophic factors that alter the physiologic response to nerve injury through Schwann cell-axonal interactions. OBJECTIVE: To evaluate the effects of two trophic factors, ciliary neurotrophic factor and nerve growth factor, on axonal response to injury. DESIGN: A prospective, randomized, blinded animal study with a placebo control using lactated Ringer's solution. INTERVENTION: Rat sciatic nerves were transected and repaired as a model of injury following which experimental factors were delivered in vivo through an implantable osmotic pump. OUTCOME MEASURES: Functional nerve recovery, muscle mass, and gene expression in the three experimental groups were evaluated. RESULTS: The ciliary neurotrophic factor group (n=6) showed a higher sciatic functional recovery (P=.003) and preservation of affected muscle mass (P=.03) compared with the nerve growth factor (n=8) and control (n=8) groups. Molecular analysis of injured nerves showed no difference in expression of ciliary neurotrophic factor, myelin basic protein, or low-affinity neurotrophin receptor messenger RNA among the three groups. CONCLUSION: These data suggest that ciliary neurotrophic factor may serve as an important neurocytokine for axonal regrowth during peripheral nerve regeneration.

Animals↗
PubMed1996

Brain-derived neurotrophic factor and collagen tubulization enhance functional recovery after peripheral nerve transection and repair.

OBJECTIVE: To investigate the effect of brain-derived neurotrophic factor (BDNF) and collagen tubulization (CT) on the regeneration of transected peripheral nerves. METHODS AND DESIGNS: The left sciatic nerve of 40 Sprague-Dawley rats was transected then repaired using one of four techniques; epineurial coaptation, CT, CT with BDNF delivered by an osmotic pump to the repair site, or CT with BDNF covalently cross-linked to the collagen matrix (CT/linked-BDNF). Sciatic functional indices were measured preoperatively at 10-day intervals for 90 days. Segments of the sciatic nerves proximal and distal to the repair site were harvested at 90 days for histologic and morphometric evaluation. RESULTS: Animals repaired by CT/linked-BDNF (n=10) demonstrated the most favorable functional recovery of all groups, with statistically significant differences seen compared with animals repaired by CT (n=10, P=.05) and epineural coaptation (n=9, P<.001). Animals repaired by CT with BDNF delivered by an osmotic pump (n=8) and CT also showed statistically superior functional recovery compared with those repaired by epineurial coaptation (P=.005 and P=.02, respectively). Nerves repaired by CT/linked-BDNF had the largest mean axon diameters proximal and distal to the repair site. CONCLUSION: Brain-derived neurotrophic factor and CT improve the rate and the degree to which recovery of sciatic function occurs after nerve transection and repair. Animals repaired by CT/BDNF-linked demonstrated the most favorable functional recovery of all groups. Animals whose repair technique included BDNF had the largest mean axon diameters of all groups.

Animals↗
PubMed1996

Characterization of postoperative edema following laser-assisted uvulopalatoplasty using MRI and polysomnography: implications for the outpatient treatment of obstructive sleep apnea syndrome.

Laser-assisted uvulopalatoplasty (LAUP) has been introduced as an alternative to uvuloplatopharyngoplasty for the treatment of snoring. Despite limited study, the use of this procedure has been expanded to include patients with obstructive sleep apnea syndrome. Although the potential cost-savings of performing sleep apnea surgery on an outpatient basis are self-evident, concern exists regarding the safety of this practice. In an effort to characterize the risk of performing LAUP on an outpatient basis, eight patients with mild or no sleep apnea were identified and intensively studied before and after the first stage of LAUP to cure snoring. Assessment included preoperative magnetic resonance imaging (MRI) scans, polysomnography, and videoendoscopy. Each of these diagnostic studies was then repeated between 48 and 72 hours after LAUP. Complete polysomnographic data were available for seven of the eight patients. The mean ( +/- SD) preoperative respiratory disturbance index (RDI) was 11.3 +/- 10.9, and the mean oxygen saturation nadir (LSAT) was 87.7 +/- 6.2% (n = 7). The mean airway cross-sectional area at the palate (by MRI) was 49.8 +/- 22.8 mm2 (n = 8). After LAUP, the mean RDI nearly doubled to 21.7 +/- 9.9 (P > .1). The apnea index increased fourfold from 3.3 +/- 3.5 to 14.8 +/- 10.9 (P < .03). The mean LSAT remained stable at 87.4 +/- 4.1% (P > .5). The cross-sectional area of the airway decreased to a mean of 47.9 +/- 22.4 mm2 (P > .5). These data suggest that LAUP may temporarily worsen obstructive sleep apnea. Although the clinical significance of this degree of worsening is uncertain, it would be prudent to consider perioperative use of nasal continuous positive airway pressure in patients with more than mild obstructive sleep apnea who undergo ambulatory LAUP.

Adult↗
PubMed1996

Recognition and surgical management of the upper airway resistance syndrome.

Patients with upper airway resistance syndrome (UARS) have clinical signs and symptoms of excessive daytime somnolence (EDS) in the absence of obstructive sleep apnea. These patients have increased upper airway resistance, reflected by an elevated intrathoracic pressure measurement, despite a normal respiratory disturbance index (RDI). Physical findings often include excessive palatal tissue and narrowing of the oropharynx and hypopharynx. Nine patients with UARS who received surgical treatment were prospectively evaluated. The four men and five women had signs of EDS, with or without snoring. The mean (+/- standard deviation) RDI was 2.1 (+/- 1.2), and the mean esophageal pressure recording during polysomnography was -36.7 (+/- 16.2) cm H2O. The Epworth sleepiness scale was used to quantify EDS. The preoperative score of 12.0 (+/- 6.6) decreased to 3.4 (+/- 1.9) (P = .001) after surgical treatment. A variety of procedures, all including some type of palatal surgery, were performed. No treatment complications occurred. The recognition of UARS and an understanding of the mechanisms responsible for the progressive development of obstructive sleep apnea syndrome may facilitate the prompt identification and treatment of such patients. The pathophysiology of UARS and a preliminary report of its surgical treatment are discussed.

Adult↗
PubMed1996

Potential success of near-total laryngectomy despite postoperative radiation therapy.

Advanced laryngeal cancers frequently require total laryngectomy (TL). Some of these cancers, however, are suitable for near-total laryngectomy (NTL). We review our experience with NTL over a 14-year period and compare the functional results with those obtained over the same period using TL followed by tracheoesophageal puncture (TEP). One particular interest was the results achieved when surgery was preceded or followed by radiation therapy. From January 1980 through December 1994, 22 patients underwent NTL. The mean age of the 19 men (86.4%) and 3 women (13.6%) was 61.1 +/- 9.9 years. Follow-up ranged from 4 to 109 months, with a mean of 26.5 months. The local control rate was 90.9% (i.e., 20 of the 22 patients). Over the same time period, 11 TEPs were performed in 7 men (63.6%) and 4 women (36.4%) who had a mean age of 60.4 +/- 7.2 years. Compared with the TEP group, the patients in the NTL group had higher mean scores for swallowing, aspiration, and voice quality evaluations, although the differences were not statistically significant. Notably, 21 of 22 patients (95.5%) received preoperative or postoperative radiotherapy. Complications in the NTL group included aspiration, dilated shunt appendix, and inadequate tracheopharyngeal shunt function. Slight modifications of the NTL technique, including routine entrance into the vallecula in uninvolved larynges, the use of contralateral pyriform mucosa flaps, and the performance of an H-flap tracheostomy are described. The NTL is a sound oncologic procedure for tumors causing vocal cord fixation, and it can be successful even when postoperative radiotherapy is administered. The quality of speech, the ease of swallowing, and the incidence of aspiration are similar to those in patients who have had a TEP following TL.

Aged↗
PubMed1996

Oxygen distributions partly explain the radiation response of human squamous cell carcinomas.

The oxygen tension of human tumours has often been thought to alter tumour response to radiation therapy. The purpose of this analysis is to determine to what extent the observed results of radiotherapy fit predictions based on in situ human tumour pO2 distributions. The radiation dose-response curve for patients treated with radiation alone for squamous cell cancers of the cervix and oropharynx were calculated based on published data. pO2 histograms were obtained from 30 women with cervical cancer and 11 patients with neck nodes from head and neck cancers. An average of 76 +/- 35 (range 28-174) measurements were made from each patient. Hypoxia was assumed to be a purely dose-modifying factor with a maximum OER of 2.5. Assuming patients are treated with daily radiation doses of 2 Gy, the squamous cell carcinoma alpha/beta ratio is 10 Gy, and that tumours have a mean of 10(8) clonogens, it was possible to estimate tumour control probability. Tumour oxygenation was an extremely important modifier of the slope of the dose-response curve and alone was sufficient to account for the slope of the clinically observed dose-response curve for neck nodes. The response curve for uterine cervical cancers is very shallow, and the oxygen distribution did not completely account for heterogeneity of response of these tumours. The results support the conclusion that oxygen tension distribution is an important modifier of human radiation treatment response.

Carcinoma, Squamous Cell↗
PubMed1995

Trends in the management of alcohol withdrawal syndrome.

Alcohol use among head and neck cancer patients is common. Alcohol withdrawal (especially delirium tremens) poses significant potential morbidity to postsurgical patients. Treatment with newer benzodiazepines (BZDs) such as lorazepam and midazolam has become more widespread, and mortality rates from severe alcohol withdrawal have decreased in recent years. The authors retrospectively studied 102 patients with a diagnosis of alcohol withdrawal, including 20 patients undergoing surgery for cancer of the head and neck. There were 81 men and 21 women, with a mean (+/- standard deviation [SD]) age of 52.3 (+/- 16.1) years. Many of these patients (46%) were treated with more than one BZD or other neuroleptic, while 49% received single agent therapy of either chlordiazepoxide (26%) or lorazepam (23%). Delirium tremens occurred in 12% of all patients undergoing withdrawal and in 10% of head and neck cancer patients, with a mortality rate of 9% and 0%, respectively. Single agent use was successful in greater than 95% when either lorazepam or chlordiazepoxide was used. Instances of combination treatment where older BZDs were used yielded a 69% success rate. The higher complication rate and lower treatment success with combination treatment was multifactorial. Optimal management of the alcohol withdrawal syndrome requires an understanding of its pathophysiology and the principles of its prevention along with a familiarity of BZD pharmacokinetic drug profiles. The authors present a treatment plan which is cost-effective, keeps morbidity low, and should allow a continued decreasing trend in mortality rates from delirium tremens.

Adult↗