Biomedical subjects

D Simmen

Publications and source records attributed to D Simmen.

25 records · Page 2Linked to original sources

PubMed1997

[Endonasal, microscopically controlled frontal sinus surgery].

BACKGROUND: The anatomic variation of the frontal sinus and frontal recess can create both a diagnostic and therapeutic challenge. Most cases of frontal sinus disease can now be treated by endoscopic approaches. For refractory cases or those with severe pathology, the microscopically controlled drainage (MCD) operation has at times been successful and spared the patient the morbidity of an external approach. The aim of this study was to evaluate microscopically controlled frontal sinus surgery in these difficult cases. MATERIAL AND METHODS: Prospective analysis was performed on the efficacy of MCD in patients for whom endoscopic sinus surgery had failed or in primary cases with severe pathology or unfavorable anatomy. The technique employs a self-retaining endonasal retractor and a diamond bur under microscopic visualization to remove solid bone (frontal spine) obstructing the sinus drainage and allow a wide opening of the frontal recess while causing minimal mucosal damage. Unilateral drainage (extended frontal sinus drainage operation), and in some cases bilateral drainage (median drainage procedure) is employed. RESULTS: With an average of 23 months of follow-up, over 90% of patients were either free of symptoms or substantially improved after the MCD procedure. Three patients required revision surgery (extend the opening into a median drainage procedure) for adequate relief of symptoms. CONCLUSIONS: The MCD procedure is highly successful in the treatment of frontal recess disease, particularly in those cases of severe pathology or difficult anatomy. It may be used in those cases refractory to standard endoscopic sinus surgery where an external approach and frontal sinus obliteration are contemplated. As with endoscopic sinus surgery, precise knowledge of the frontal recess and neighboring landmarks is critical, and adequate drainage with minimal mucosal disruption should be the goal.

Drainage↗

PubMed1997

[Experiences with assessment of frontobasal defects, a diagnostic concept].

BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea presents not only a therapeutic challenge, but a diagnostic challenge as well. This is especially true in the case of atraumatic spontaneous leakage, which is often only minimal in quantity and can occur intermittently. The purpose of this paper is to compare the current methods of evaluation of CSF Rhinorrhea (beta 2-Transferrin assay, high resolution computed tomography [HRCT], and computotomographic cisternography [CTC]) and develop a diagnostic protocol. METHOD: A retrospective analysis was performed of 61 patients who underwent operation for CSF rhinorrhea between 1988 and 1996 comparing the method of preoperative diagnosis and intraoperative findings. RESULTS: beta 2-transferrin-determination in the nasal discharge had a sensitivity of 79% (33/42), HRCT correctly identified the defect in 84% (48/57) of cases, and CTC correctly localized the pathology in 72% (18/25) of the patients. CONCLUSION: The sensitivity of each CSF rhinorrhea diagnosis method is less than 90%. It is our opinion that with the current level of technology a combined approach is optimal with two or more of the above studies. A diagnosis scheme is presented to manage step by step this challenging and potentially lethal problem.

Adolescent↗

PubMed1996

[Decongestant nasal spray. Results of a rhinomanometric double-blind study].

Between november 1993 and july 1995 60 patients with a common cold underwent randomized and double-blind testing of 3 commercial nasal sprays-benzydamine, xylometazoline combined with the secretolytic S-carboxymethylcysteine, and phenylephrine combined with the antihistaminic dimethindene maleate. After prior active rhinomanometric measurement of the untreated nose, the test substance was applied. The change of nasal patency was registered after 3 and 10 minutes and then after 2, 4, 6 and 8 hours. At the end the patient gave a subjective evaluation of the used spray. There was no change in nasal obstruction following application of NaCl or benzydamine. Xylometazoline/S-carboxymethylcysteine (+87%) or phenylephrine/ dimethindene maleate (+113%) augmented nasal patency within minutes. Using phenylephrine/dimethindene maleate the effect lasted less than 2 hours, while after xylometazoline/S-carboxymethylcysteine decongestion lasted more than 6 hours. The patients also subjectively reported an increase in nasal patency after the use of benzydamine and placebo. But only phenylephrine/ dimethindene maleate or xylometazoline/S-carboxymethylcysteine were judged good. Using benzydamine or phenylephrine + dimethindene maleate, more side-effects (mainly dryness and burning) were mentioned. Considering the subjective assessment of side-effects and duration of action, as well as objective parameters, derivatives of imidazole (oxymetazoline and xylometazoline) are first choice in treatment of the common cold.

Administration, Intranasal↗

PubMed1996

A probe holder for precise intranasal microcirculation measurements.

A probe holder for long-term measurements of intranasal microcirculation by laser Doppler flowmetry is described. It is adjustable to any physiognomy and allows precise intranasal probe insertion. It is based on a commercially-available shooting-spectacles frame and might also be useful for other measurements such as intranasal temperature, humidity and pO2.

Equipment Design↗

PubMed1995

[Sinusitis, current diagnostic and therapeutic possibilities].

Important progress in the management of sinusitis has been made during the past decade. Diagnosis has been refined by the general use of endoscopic examinations of the nose and the CT scan. Knowledge of the pathophysiology of sinusitis has been improved by the systematic use of the examinations. As a consequence, the treatment of sinusitis, particularly of chronic sinusitis, has been revolutionized by the introduction of functional, endoscopically controlled surgery of the paranasal sinus. This form of endonasal microsurgery permits the treatment of chronic sinusitis without the need of radical surgery or external skin incisions.

Endoscopy↗

PubMed1995

The mask: style and volume do not influence rhinomanometry.

We have tested the influence of face-mask style and volume on rhinomanometric measurements. Using an artificial head-and-piston pump to standardize the test conditions, four types of face masks (volumes varying from 120 to 200 ml) have been tested in a series of 20 measurements per mask. No statistical difference could be found between the series using a Chi-square test. We conclude that there is no influence of form and volume of the face mask on the accuracy of the rhinomanometric measurement.

Airway Resistance↗

PubMed1991

Staple closure of the hypopharynx after diverticulectomy and total laryngectomy.

The use of stapling devices to close hypopharyngeal defects was first published in 1969 but the technique does not seem to have gained much popularity among head and neck surgeons. Fifty-nine hypopharyngeal defects were closed using a linear stapler between January, 1984, and April, 1989, at the Department of Otolaryngology, Head and Neck Surgery of the University Hospital of Zurich. Twenty closures were performed following resection of hypopharyngeal diverticula, 39 following wide field laryngectomy. A total of 10 salivary fistulae was observed: 2 after diverticulectomy (10%), 3 after laryngectomy in nonirradiated patients (11%), and 5 after laryngectomy in irradiated patients (45%). These fistula rates are comparable with average rates quoted in the literature. Only after laryngectomy for radiation failure was the fistula rate unusually high. No other complications were seen that could have been attributed to this type of pharyngeal closure. Closure of a hypopharyngeal defect with a stapler is easier and faster than with traditional suture methods. Provided the patient has not been previously irradiated, staple closure of the hypopharynx appears to be as reliable as closure by standard techniques and can be safely recommended.

Diverticulum, Esophageal↗