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Biomedical subjects

D Poe

Publications and source records attributed to D Poe.

12 recordsLinked to original sources
PubMed2000

Laser-assisted myringoplasty--technical aspects.

At lower power, lasers fuse collagen fibres and weld tissues. Welded collagen fibres make a solid bond and allow tissue growth along the bonded edges. Our aim was to study applicability of lasers in myringoplasty. We used a KTP-532 laser in outpatient myringoplasty. The laser beam was delivered through a micromanipulator connected to a microscope or through a 200-400-micron silica fibre. The perichondrium was used for transplantant and harvested from the tragus. The margins of the perforation in the eardrum were evaporated, with the laser operating in a continuous mode at 2-4 W. The middle ear was filled with gelfilm to provide support for the transplant. The perichondrium was placed under the margins of the tympanic membrane and lazed at low power (0.2-1.5 W) in continuous mode. In pale tissues, venous blood, methylene blue or fluorescein was used to enhance the tissue admittance of laser energy. Surgical failures were linked to thermal tissue damage due to excessive energy during lazing. In two cases, visibility via microscope into the anterior edge was not complete and the transplantant did not adhere in the relatively limited area. One patient had epidermal growth under the tympanic membrane and developed local cholesteatoma. Laser-assisted myringoplasty provides several advantages over traditional myringoplasty: it is minimally invasive, no manipulation of the ossicles is needed and it is convenient in anterior perforations, where it can be done endoscopically. We prefer a fibre delivery system to a micromanipulator, as lazing with endoscopes is possible and thermal damage is easier to prevent.

Cholesteatoma, Middle Ear↗
PubMed1998

Peritoneal metastases in children with cancer.

BACKGROUND: This study attempted to evaluate the childhood malignancies associated with computed tomography (CT) detected peritoneal metastases as well as the diagnostic imaging characteristics of these metastases as shown on CT. METHODS: The authors reviewed all available pathology specimens and abdominopelvic CT scans of patients identified as having peritoneal metastases at three childhood cancer centers. Patient demographics, primary diagnosis, and CT characteristics of such metastases were evaluated. RESULTS: Peritoneal metastases were identified by CT in 32 children with cancer either at diagnosis (n = 20) or up to 6.2 years from diagnosis (n = 12). On CT, peritoneal disease appeared as a mass in 26 cases, as studding in 11 cases, as peritoneal enhancement in 15 cases, and as diffuse caking in 4 cases (15 patients had > 1 category of peritoneal metastasis). Thirteen patients had concurrent metastases in other sites. Fourteen patients died of progressive disease at a median of 10 months from the time peritoneal metastases were identified on CT. At last follow-up, the remaining 18 patients were alive, with follow-up ranging from 1 month to 9.7 years. As expected, peritoneal metastases were identified in patients with germ cell tumors and colon carcinoma. However, they also were observed in patients with epithelioid carcinoma, leiomyosarcoma, pineoblastoma, neuroblastoma, melanoma, and peripheral neuroectodermal tumor. CONCLUSIONS: Peritoneal metastases have variable appearance on CT, but most commonly appear mass-like. They are associated with a wider range of primary diagnoses than reported previously. The outcome varies with the type of the primary tumor and its responsiveness to existing therapies.

Adolescent↗
PubMed1997

Implementation of the RN first assistant role.

The RN first assistant (RNFA) program at Children's Hospital of The King's Daughters in Norfolk, Va, began as a dream in which RNs could expand their role within a cost-effective, hospital-based implementation of the RNFA role. Our dream included a career development path for perioperative nurses who had few other career options within the surgical arena. This article describes how the dream came true.

Goals↗
PubMed1996

In vitro and in vivo determination of the thermal effect of middle ear endoscopy.

During middle ear endoscopy, patients frequently experience vertigo. We theorized that this effect is secondary to heat produced by the scope. We evaluated two Hopkins rods and two fiberoptic scopes to assess the temperature elevation at the lateral semicircular canal (LSCC) of temporal bones and in a live canine model. These results were compared to the results of a standard 44 degrees C water caloric. We demonstrated in both models that the temperature rise at the LSCC increased relative to the scope diameter and that the Hopkins rods produced the same or greater heating effect than a warm caloric. Direct exposure of the thermocouple to the light produced a greater temperature elevation. We conclude that endoscopes produce sufficient heat to induce caloric stimulation of the LSCC. Care should be exercised to prevent the possibility of thermal injury.

Animals↗
PubMed1994

Phase II study of 5-fluorouracil/leucovorin for pediatric patients with malignant solid tumors.

BACKGROUND: 5-Fluorouracil (5-FU) activity for various carcinomas of adults has been enhanced through the synergistic effect of leucovorin. Few pediatric studies of 5-FU in pediatric patients have been previously reported. METHODS: Fifty-eight patients were treated with a 4-hour infusion of leucovorin, 400 mg/m2, administered daily for 5 days every 3-4 weeks. 5-Fluorouracil was administered by bolus injection 1 hour into each leucovorin infusion. Eleven adolescent patients with colorectal carcinoma, Stage 3 or 4, were treated with therapeutic intent, and other patients with a variety of drug-resistant pediatric solid neoplasms received similar treatment. RESULTS: Patients with measurable disease of colorectal carcinoma responded favorably to 5-FU/leucovorin. Stable disease activity was seen with other tumor types. Specifically, there were no objective responses in 12 patients with Ewing's Sarcoma or 11 with osteosarcoma. There were 4 deaths in this study from causes related to toxicity. Nonfatal grade 3/4 toxicities included mucositis, rash, myelosuppression, nausea, vomiting, diarrhea, and infection. CONCLUSION: The authors do not plan further evaluation of 5-FU/leucovorin in additional pediatric patients with colon cancer or other heavily pretreated malignant solid tumors and are presently treating their patients with colon carcinoma with 5-FU/leucovorin/interferon-alpha 2a.

Adolescent↗
PubMed1994

Operation Smile International: missions of mercy.

Operation Smile International (OSI) was formed in 1983 to provide underprivileged children in developing countries and the United States with common surgical procedures such as cleft lip, cleft palate, and burns, and to provide education to health care professionals in those countries. Over 11 years, OSI has aided over 20,000 children in 11 countries, and has grown into an organization of thousands of volunteers.

Burns↗
PubMed1988

Radiotherapy of the resected mandible following stainless steel plate fixation.

There is general concern among otolaryngologists that irradiation of a stainless steel prosthesis used in mandibular reconstruction may cause irradiation overdosage to adjacent tissues. A tissue-equivalent plastic/steel model, simulating the characteristics of a stainless steel, reconstructed mandible, was irradiated and measurements were made with a parallel plate ionization chamber. The results of our measurements show that irradiation of an implanted steel plate results in an overdosage (120%) "in front" and an underdosage (80%) "behind" the steel plate. The regions of overdosage and underdosage are 2 to 3 mm thick. The overall dose modification is greatly reduced when two opposing fields are used. We conclude that irradiation of a stainless steel, reconstructed mandible with a 6-mV photon beam through opposing fields does not significantly alter the amount of radiation delivered to surrounding tissues.

Bone Plates↗
PubMedDate not supplied

Tegmental defects and cerebrospinal fluid otorrhea.

Congenital tegmental defects that present as unsuspected cerebrospinal fluid (CSF) otorrhea are diagnostic and therapeutic challenges. We reviewed 5 such patients to determine an optimal strategy for evaluation. Five patients presented with watery otorrhea, 4 of them after ventilation tube placement, and only 1 with rhinorrhea. The preoperative analysis of middle ear effusion for beta(2)-transferrin was positive in 2/4, equivocal in 1/4 and false negative in 1/4. Computerized tomography (CT) revealed nonspecific tegmental defects in all 5 patients. Magnetic resonance imaging (MRI) demonstrated meningoencephalocele in 3/5 and dural irregularity in 1/5. Tegmental defects were confirmed at surgery in all cases, demonstrating meningocele or arachnoid granulations in 2/5 and encephalocele in 2/5 patients. We recommend a combination of beta(2)-transferrin analysis to verify CSF, high resolution CT (axial and coronal planes) to diagnose tegmental defects, and MRI (multiplanar) to evaluate the type of herniation. A combination mastoid and middle fossa approach for definitive repair is suggested.

Aged↗