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Biomedical subjects

E A Weymuller

Publications and source records attributed to E A Weymuller.

At least 37 records · Page 2Linked to original sources
PubMed1994

Surgical reporting instrument designed to improve outcome data in head and neck cancer trials.

Precise reporting of surgical staging and operative data in multi-institutional protocol studies could provide a number of benefits: 1) fewer cases would be discarded because of inadequate data, 2) staff review time would be reduced, 3) there would be assurance that participating surgeons were performing similar operations on similar tumors, 4) the resulting precision in stratification should improve the likelihood of achieving accurate comparison of the treatment options under study, and 5) by comparing the surgical parameters with local-regional control of disease, the specific factors that have a statistically significant correlation with outcome could be identified. This paper presents a computer-based, anatomically oriented reporting instrument that should improve the reliability of surgical data available to multi-institutional protocols.

Clinical Trials as Topic↗
PubMed1994

Tracheotomy and the role of postoperative chest radiography in adult patients.

A retrospective review of 100 adult tracheotomies performed by the University of Washington Department of Otolaryngology-Head and Neck Surgery was done to evaluate our complication rate and the role of postoperative chest radiography (CXR). In an attempt to identify specific risk factors for pneumothorax (PTX), the following items were reviewed: age, urgency (elective, urgent, and emergent), awake or general anesthesia, diagnosis (reason for tracheotomy), "difficulty" of tracheotomy, postoperative signs or symptoms of PTX, and findings on postoperative CXR. The series had a PTX rate of 2%. Both patients with complications reviewed here had definite risk factors, or signs and symptoms of PTX. The causes, risk factors, and treatments for PTX are reviewed. Postoperative CXR is indicated in cases at increased risk for PTX, and in patients with clinical signs or symptoms of PTX. Had we followed our proposed criteria, we would have performed postoperative CXR 13 times instead of 93. This would have resulted in a total savings of $10,020. We conclude that postoperative CXR after a routine, uncomplicated tracheotomy is of low yield and incurs unnecessary expense.

Adult↗
PubMed1994

Risk factors associated with prolonged intubation and laryngeal injury.

A prospective study evaluated potential risk factors associated with laryngeal injury after prolonged endotracheal tube intubation for longer than 3 days. Ninety-seven patients were evaluated after oral endotracheal tube intubation (mean, 9 days). This study updates a previously reported evaluation of 44 patients. The additional sample size has provided findings of unreported patient risk factors of laryngeal injury and confirmation of previous associations. The majority of the 97 patients had some type of laryngeal injury, ranging from mild mucosal erythema to ulceration, granuloma formation, or true vocal cord immobility. Patient examinations were continued until the larynx returned to normal or stabilized or the patient was lost to follow-up. Postextubation examinations in the survival group revealed the following. (1) Laryngeal erythema occurred in 94%, and ulceration occurred in 76% of the patients with resolution within 6 weeks. (2) Laryngeal granulomas occurred in 44% of the patients; the majority of the granulomas (57%) developed an average of 4 weeks after extubation. Associated risk factors included duration of endotracheal tube intubation (p < 0.05) and presence of nasogastric tube (p < 0.05). (3) Vocal cord immobility was observed in 16 patients (20%). Eight patients had true vocal cord immobility noted initially after extubation, and the remaining eight had true vocal cord immobility an average of 4 weeks after extubation. Initial and delayed true vocal cord immobility were associated with duration of intubation and size of endotracheal tube (p < 0.01). Delayed true vocal cord immobility developed only in patients with a size 8 endotracheal tube.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

MRI evaluation of the sphenoid sinus after transsphenoidal approach to the pituitary.

The transsphenoidal approach to the pituitary (TSA) is currently the most common approach used to treat pituitary tumors. The surgical technique necessitates an incomplete stripping of sphenoid sinus mucosa. Long-term postoperative magnetic resonance imaging (MRI) evaluation of the sphenoid sinus has not been reported. A retrospective review of patients undergoing a TSA at the University of Washington Hospitals was performed. Preoperative scans were compared with postoperative scans done during three time intervals. Group 1 had scans at 1 to 12 weeks postoperatively; 10 of 10 patients had sinus effusions. Group 2 had scans at 6 to 18 months post-operatively; 22 of 31 had mucosal abnormalities. Group 3 had scans at 2 to 3 years; 7 of 9 were abnormal. MRI evaluation indicates that a majority of patients have both acute and chronic sphenoid sinus abnormalities after TSA.

Female↗
PubMed1994

The effect of nifedipine on skin flap survival in rats.

Maintaining the viability of an extended skin flap remains one of the continuing challenges in reconstructive surgery. As flaps lengthen, viability becomes more unpredictable and necrosis of distal segments can occur. The specific mechanisms involved in determining flap survival remain unclear, but vasoconstriction within the flap microcirculation appears to play a significant role in regulating flap viability. Vasodilators have been used, with limited success, in an attempt to improve survival of ischemic skin flaps in rats. One such agent, nifedipine, a calcium channel blocker, demonstrated conflicting results when used to improve rat skin flap survival, despite its potent vasodilating properties. A standard rat flap model was used to help clarify the potential of nifedipine to salvage ischemic skin flaps. Alterations in flap perfusion were assessed using a laser Doppler flowmeter and dermofluorometry in an attempt to characterize nifedipine's mechanism of action on flap preservation. Increased flap survival was demonstrated in treatment animals when compared to controls. Despite significant improvement in flap viability, perfusion measurements failed to confirm increased flow within the flap microcirculation. Although the mechanisms of action remain speculative, nifedipine may have important therapeutic potential in improving skin flap survival in a clinical setting.

Animals↗
PubMed1993

Neutron radiotherapy for adenoid cystic carcinoma of the head and neck.

Achieving local control in patients with advanced adenoid cystic carcinoma continues to be a therapeutic challenge. From 1984 to 1990, we treated 34 patients with advanced adenoid cystic carcinoma of the head and neck with fast neutron radiation. Patients treated for minimal microscopic disease following surgery were not included in this study. Neutron radiotherapy achieved 5-year actuarial local control and locoregional control rates of 76% and 63%, respectively. Five-year actuarial overall survival and disease-specific survival rates were 65% and 93%, respectively. Eighty-one percent (17/21) of patients treated with neutron therapy alone and 100% (13/13) of the patients treated with neutron therapy and surgery achieved local control. All seven patients with paranasal sinus malignant neoplasms achieved local control. The success achieved in this prognostically unfavorable population affirms the important role of neutron radiotherapy in the treatment of adenoid cystic carcinoma.

Adolescent↗
PubMed1992

Rigid endoscopy for the control of epistaxis.

Six individuals were selected to undergo rigid nasal endoscopy and electrocautery for treatment of refractory epistaxis. This intervention was successful in five cases, with no major complications. The procedure was found to be both cost-effective and acceptable to the patient population.

Adult↗
PubMed1990

Endoscopic repair of failed dacryocystorhinostomy.

Primary dacryocystorhinostomy (DCR) failure is commonly due to scarring at the rhinostomy site. Nasolacrimal duct obstruction due to scarring may also occur in patients who have had their lacrimal bone removed during maxillary sinus surgery. Five patients following DCR and 3 patients after sinus surgery, all with constant epiphora, underwent endoscopic reconstruction of their lacrimal drainage system. Preoperatively, patency of the bony ostium was determined either by computed tomographic (CT) scan or dacryocystography. Endoscopically, the lacrimal drainage system was reopened then intubated with a silastic stent. Any scar tissue was visualized endoscopically and resected. Seven of the 8 patients have been followed from 3 to 24 months after stent removal, and all have had relief of their epiphora. Endoscopic repair is a useful adjunct in the management of patients with DCR failure or patients with epiphora after removal of the lacrimal bone during sinus surgery. This brief procedure can be performed under local anesthesia, does not require a skin incision, and allows the evaluation and correction of intranasal pathology.

Adolescent↗
PubMed1990

Problems associated with prolonged intubation in the geriatric patient.

The authors review problems associated with prolonged intubation. Laryngeal stenosis and injuries caused by the endotracheal tube itself are described. Postintubation laryngotracheal pathology, including signs and symptoms and the management of specific lesions, is described in detail. Other injuries associated with prolonged intubation, such as nasal ulceration, sinusitis, and oral ulcers, also are reviewed.

Aged↗
PubMed1989

Blood use in head and neck tumor surgery. Potential for autologous blood.

Recent increased concern regarding the risks of homologous blood transfusion led us to examine the use of blood products for head and neck tumor surgery. Major head and neck surgical procedures at three University of Washington (Seattle)-affiliated hospitals during 1987 were reviewed. Seventy-seven patients were identified. Parameters studied included the following: tumor site and stage, prior treatment, surgical procedure, preoperative and postoperative hematocrit values, estimated blood loss, operative and postoperative blood product use, and operative time. Data were grouped by procedure. Maxillectomy/midface procedures showed the highest average estimated blood loss (1037 mL) and the highest average blood use (1.5 units), followed by composite resections (883 mL and 0.8 units) and laryngectomies (724 mL and 0.9 units). When the data were subgrouped, larynogopharyngectomy (1450 mL and 4.0 units) and composite resection with mandibular swing (1300 mL and 1.0 units) showed the highest blood loss and blood product use. In the assessable groups, previous administration of radiation did not make a significant difference in blood loss or procedure time. However, blood loss correlated well with procedure time in all groups. The great majority of patients met all requirements to function as blood donors (84%). Sixty-five percent of patients met all criteria and used less than 2 units of blood, making autologous blood a reasonable option for the majority of patients with head and neck tumors.

Blood Transfusion, Autologous↗
PubMed1989

Prospective studies evaluating the standard endotracheal tube and a prototype endotracheal tube.

Two prospective studies were designed to evaluate laryngeal injury sustained with the standard endotracheal tube (ETT) and the relative safety of a new prototype ETT. The first study followed patients after prolonged intubation with the standard ETT. Potential patient host factors were recorded and correlated with subjective complaints and objective findings on fiberoptic laryngoscopy. Nearly all patients sustained laryngeal injury after prolonged intubation, although over two thirds experienced resolution. Nasogastric feeding tubes and larger-diameter ETTs were associated with true vocal cord (TVC) granuloma formation. Duration of intubation was associated with delayed TVC immobility. The mechanisms of TVC granulomas and immobility are probably different, as suggested by the different host factor associations and onset times. The second study compared the standard ETT with the prototype ETT in short-term intubations. The prototype ETT was associated with no complications in this setting and is considered relatively safe for further testing in the patient with prolonged intubation.

Adult↗
PubMed1988

Laryngeal injury from prolonged endotracheal intubation.

This project was undertaken to develop models of acute and chronic laryngeal intubation as a format for testing a newly designed endotracheal tube. The tube has a specially created laryngeal cuff designed to reduce pressure exerted against the laryngeal soft tissues. The laryngeal foam cuff was shown to prevent the injurious sequence of mucosal ischemia, ulceration, and cartilage damage. A laryngeal foam cuff has the potential to significantly reduce laryngeal injury from prolonged endotracheal intubation. A prospective randomized clinical trial has been initiated and will be reported subsequently.

Animals↗
PubMed1988

The sublabial transseptal transsphenoidal approach to sellar and parasellar lesions.

Multiple surgical approaches to the sella turcica have been described. The sublabial transseptal transsphenoidal approach provides a safe, cosmetically acceptable route to the sella with excellent exposure. Since 1976, we have employed this technique for the surgical treatment of pituitary neoplasms and parasellar tumors. The University of Washington experience with the sublabial transseptal transsphenoidal approach to the sella in a series of 253 patients is reported with respect to the otolaryngological aspects of the surgical technique, results, and complications of the procedure. In addition, a literature review of major studies that used this procedure is included, and the reported results and complications are compared to those of the present study.

Adolescent↗