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Biomedical subjects

D L Myers

Publications and source records attributed to D L Myers.

12 recordsLinked to original sources
PubMed1992

Complications of lumbar spinal fusion with transpedicular instrumentation.

Transpedicular screw fixation systems are coming into wide use as an adjunct to lumbar spinal fusion procedures. This 5-year series included 486 patients who underwent 533 variable screw placement procedures for discal, degenerative, and spondylolytic problems. The wound infection rate was 2.6%: 0.6% deep, 0.9% graft, and 1.1% superficial. The neural injury rate was 1.1% overall: 0.6% related to posterior lumbar interbody fusion and 0.6% related to instrumentation. Technical problems per procedure included 8.1% difficult screw placement, 5.6% nut loosening, and 4.3% screw breakage (1.1% per screw placed). Device modifications have reduced the incidence of screw breakage and nut loosening. No device-related neural injuries occurred in the last 333 procedures. With experience, the device can be applied safely without significantly increasing the risk of neural injury or morbidity.

Adult↗
PubMed1988

Giant cholesterol cysts of the petrous apex.

The giant cholesterol cyst is a clinical entity distinct from cholesterol granulomas and other destructive lesions of the petrous bone. Preoperative assessment by computed tomographic scan and magnetic resonance imaging is extremely helpful. Attempts at total resection of the lesion are not necessary. Adequate surgical drainage may be established through the mastoid or middle fossa.

Adolescent↗
PubMed1988

Total temporal bone resection. A radical but life-saving procedure.

Traditional therapeutic approaches for malignancies of the temporal bone have produced unacceptably low survival figures. The morbidity and mortality associated with temporal bone cancer justify extensive surgery. Total temporal bone resection can be performed successfully in the hands of an experienced skull-base surgical team. By circumscribing the tumor rather than transgressing it, this procedure follows generally accepted principles of oncologic surgery. This procedure also shows promise in resection of extensive, carefully selected, recurrent benign tumors. We believe this approach offers hope for improved survival in patients with malignancy of the temporal bone. Further refinements in technique are suggested by each new case. Additional experience and long-term follow-up are needed to assess the efficacy of this procedure. The interest, expertise, and active participation of the operating room nursing team are critical to the success of this surgery. Ideally, not only intraoperative participation but also preoperative assessment and postoperative support should be routine. Close cooperation and extensive communication among the surgeons and nurses are essential.

Adult↗
PubMed1987

Total temporal bone resection for squamous cell carcinoma.

Because of unsatisfactory results in treatment of malignant conditions of the temporal bone, a technique for total en bloc resection of the temporal bone and carotid artery was reported by Graham et al. in 1984. The procedure involves resection of the internal carotid artery, cranial nerves VI through XII, and structures adjacent to the temporal bone. Experience with two additional cases led to numerous modifications in the recommended procedure, as reported by Sataloff and Myers. Additional clinical experience with this technique and its complications has resulted in further modification. Additional pitfalls and specific changes in technique from previous reports are discussed in detail, including a new procedure to assure the adequacy of contralateral venous outflow.

Aged↗
PubMed1987

Transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma.

Transbronchial needle aspiration (TBNA) was performed as a diagnostic procedure in 91 consecutive patients ultimately proven to have bronchogenic carcinoma. Results of TBNA were compared, in the same patients, to the diagnostic yield of cytologic examination of sputum, endobronchial brushings and washings, and endobronchial/transbronchial biopsy. The diagnostic yield for sputum was 13 percent (10 of 75); brushings, 40 percent (34 of 84); washings, 29 percent (26 of 89); biopsy, 56 percent (42 of 75); and TBNA, 45 percent (41 of 91). Aspirates were positive in 35 percent of patients with adenocarcinoma, 41 percent with squamous cell carcinoma, 52 percent with large cell undifferentiated carcinoma, and 55 percent of patients with small cell carcinoma. Carinal aspirates were positive in 54 percent (6 of 11); paratracheal aspirates, 57 percent (13 of 23); parabronchial aspirates, 39 percent (11 of 28); endobronchial, 78 percent (7 of 9), and peripheral mass or solitary pulmonary nodule, 40 percent (17 of 42). The overall diagnostic yield for brushings, washings, and biopsy was 64 percent. The addition of TBNA increased the yield to 71 percent. Bronchogenic carcinoma was diagnosed solely by TBNA in six patients, all with extrabronchial or extratracheal lesions. We conclude that TBNA increases the diagnostic yield of bronchoscopy, particularly in patients with extratracheal and extrabronchial lesions. An equally important observation is that TBNA fails to contribute significantly to the diagnosis of cancer in patients with lesions readily accessible by conventional bronchoscopic techniques. Exceptions to this observation include occasional patients with necrotic endobronchial tumors, submucosal lesions, and rarely patients with peripheral lung nodules or masses.

Adenocarcinoma↗
PubMed1986

Transbronchial needle aspiration staging of bronchogenic carcinoma.

Transbronchial needle aspiration (TBNA) has been advocated as a reliable technique in the nonsurgical staging of patients with bronchogenic carcinoma. Some have questioned the reliability of TBNA, however. We used TBNA directed by computed tomography (CT) in 88 consecutive patients with bronchogenic carcinoma who had undergone chest CT. Chest CT was 94% sensitive, 79% specific, and 85% accurate in evaluating the mediastinum for malignant lymphadenopathy. There were 19 malignant aspirates in 44 patients with malignancy and apparent adenopathy evaluated by chest CT. No malignant carinal aspirates were obtained in any patient with a normal mediastinum evaluated by chest CT. There were 2 false positive needle aspirates. One patient with apparent right paratracheal adenopathy and malignant needle aspirate had no mediastinal neoplasm detected at surgery. The other false positive aspirate had been contaminated by tracheal debris. The overall sensitivity, specificity, and accuracy of TBNA mediastinal staging were 50, 96, and 78%, respectively. We conclude that CT scanning is a useful adjunct in the staging of patients with bronchogenic carcinoma, and that TBNA is a sensitive and highly specific staging technique that may negate the need for surgical staging in a large number of patients with bronchogenic carcinoma.

Adenocarcinoma↗
PubMed1985

Activity of rapidly-adapting receptors to histamine and antigen challenge before and after sodium cromoglycate.

Sodium cromoglycate (SCG) blocks histamine release from sensitized mast cells challenged by antigen in vitro. Yet, not all the observed effects of SCG in vivo can be explained by this mechanism alone. Rapidly-adapting or "irritant" receptors (RAR) are thought to mediate reflex bronchoconstriction. Others have proposed that SCG may desensitize these receptors to histamine. We administered aerosols of histamine (100 micrograms/ml given for 3 min) before and after SCG (20 mg/ml aerosol for 5 min) to adult, mongrel dogs. SCG did not reduce the increase in tracheal pressure or RAR activity in response to histamine challenge. We also administered aerosols of Ascaris suum antigen (7 min) to dogs which had shown a positive skin reaction to subepidermal injection of this antigen. SCG attenuated both the increase in tracheal pressure and RAR nerve activity in response to the antigen challenge. These findings suggest that SCG does not affect the activity of the RAR or decrease the tracheal pressure in response to histamine challenge in an anesthetized dog, whereas SCG is effective in decreasing the response of both these parameters to antigen challenge when given prophylactically presumably by stabilizing the mast cell membrane.

Adaptation, Biological↗
PubMed1985

Acoustic neuromas presenting as sudden deafness.

Caution is required in diagnosing even apparently "obvious" causes of hearing loss. A patient is described who came to medical attention through referral from a lawyer for sudden deafness allegedly caused by exposure to noise in an industrial setting. Thorough evaluation revealed an acoustic neuroma. Review of the literature suggests that presentation of acoustic neuromas as sudden deafness is more common than generally recognized. Clinicians must be alert to this possibility and diligent in their evaluation of any unilateral ear symptoms.

Diagnosis, Differential↗
PubMed1985

Petrous apicitis.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

Intracanalicular arachnoid cyst mimicking acoustic neuroma: CT and MRI.

A patient with a surgically proven intracanalicular arachnoid cyst was studied using computed tomography, magnetic resonance imaging, and air CT cisternography. The lesion had a similar radiographic appearance to acoustic neuroma and therefore, although rare, must be considered in the differential diagnosis of intracanalicular mass lesions. We report a case in which examination was performed, in evaluating the lesion, utilizing high-resolution air CT cisternography and magnetic resonance imaging (MRI).

Adult↗