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Biomedical subjects

E R Thaler

Publications and source records attributed to E R Thaler.

15 recordsLinked to original sources
PubMed2001

A comparison of monopolar electrosurgery to a new multipolar electrosurgical system in a rat model.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to compare collateral tissue damage and wound healing in incisions created by electro-dissociation and conventional electrosurgery. Conventional electrosurgery has been used as an alternative to the scalpel to improve hemostasis. However, the heat generated by this instrument can cause tissue damage surrounding the incision, limiting its use around nerves and large blood vessels. A new technology, Coblation (Arthrocare Corp., Sunnyvale, CA), uses "electro-dissociation" to achieve similar results by creating charged particles from a conductive medium to make an incision while simultaneously achieving hemostasis. This new approach to electrosurgery may reduce soft tissue damage. STUDY DESIGN METHODS: Two prospective, matched design experiments were performed. In experiment I, both devices were set at the same electrical power in watts and then used to create an incision on the tongue of rats. In experiment II, the electrical power settings of both devices were adjusted until they created incisions of the same size. Epithelial destruction and collateral tissue damage were measured in histologically prepared tissue in both experiments, and the wound healing process was observed in experiment II at 0, 3, 7, and 14 days after surgery. RESULTS: The results showed that the electro-dissociation method created significantly less epithelial destruction and collateral tissue damage in both experiments. Granulation tissue formation was also significantly less extensive in the electrodissociation-induced incision after 7 and 14 days of recovery. CONCLUSIONS: Wound healing may be faster than with conventional electrosurgery if the Coblation device is used.

Animals↗
PubMed2001

Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum.

OBJECTIVES/HYPOTHESIS: Endoscopic staple-assisted esophagodiverticulostomy (ESED) is a newly described method of surgically correcting Zenker's diverticulum. Initial reports on the ease and success of the surgery have been quite enthusiastic, making it seem the procedure of choice. We initiated the procedure in an algorithm of treatment of Zenker's diverticulum, to further explore the feasibility and outcome of this new technique. STUDY DESIGN: This is a case series of 23 patients with Zenker's diverticulum who have undergone surgical repair. For each patient, an attempt at ESED was made. If unsuccessful, an open approach was then taken. RESULTS: Seven of 23 patients (30%) were unable to be treated with ESED because of inability to expose the diverticulum or unfavorable anatomy of the diverticulum itself. Of the remaining 16 patients, ESED was successful in resolving the symptoms of diverticulum in 14 (87%). Two patients (13%) were somewhat improved but had persistent dysphagia. No significant complications occurred. All patients resumed oral diet within the first 24 hours after surgery. CONCLUSION: Esophagodiverticulostomy is an excellent method of surgically correcting Zenker's diverticulum in many patients, but anatomical considerations may prevent its use, making open approaches of continued importance in a surgeon's armamentarium.

Adult↗
PubMed2000

Use of an electronic nose to distinguish cerebrospinal fluid from serum.

BACKGROUND: Efforts to mimic the biologic olfactory system have resulted in the development of an electronic nose, whereby volatile gases may be identified by means of organic semiconductors. Such devices have been used in the food and beverage industry for quality-control purposes, but to date have not been used in the field of medicine. OBJECTIVE: To present the application of an electronic nose for clinical decision making by assessing the ability of an electronic nose to distinguish cerebrospinal fluid (CSF) from serum. DESIGN: Randomized, prospective, masked study. SUBJECTS: Nineteen matched sets of CSF and serum from inpatients at a university hospital. RESULTS: The electronic nose was able to distinguish CSF from serum in 18 of 19 patients. The data points for 18 of 19 CSF and 18 of 19 serum samples were within statistically distinct cluster groups, suggesting that the device is able to identify an unknown sample as CSF or serum. CONCLUSIONS: This new technology is able to distinguish CSF from serum with a high degree of accuracy and speed, and with small sample quantity, potentially allowing the physician to identify reliably CSF otorrhea or rhinorrhea. This revolutionary diagnostic approach may have further, widespread application in the field of otorhinolaryngology and in medicine as a whole.

Blood↗
PubMed2000

Preoperative imaging to predict orbital invasion by tumor.

BACKGROUND: Our purpose was to examine the accuracy of preoperative imaging in assessing tumor invasion of the orbit and nasolacrimal system. METHODS: Nineteen preoperative CT and 17 preoperative MR images from patients at risk for orbital invasion were retrospectively reviewed. Invasion was corroborated by pathologic and intraoperative assessment. RESULTS: Tumor adjacent to the periorbita was the most sensitive predictor of orbital invasion (90%) for both CT and MRI. Extraocular muscle involvement on MRI (100%) and orbital fat obliteration (80% MRI, 86% CT) had the highest positive predictive values of the criteria evaluated. Extraocular muscle displacement and enhancement were less accurate (<65%) predictors. No one criterion was >79% accurate in predicting orbital invasion. Six or more positive criteria predicted invasion with 67% sensitivity and 80% specificity (accuracy, 72%). CT was more accurate than MRI in seven of nine criteria. Invasion of the nasolacrimal system was predicted accurately (89%). CONCLUSIONS: Although preoperative imaging can aid in surgical planning, it should not replace intraoperative assessment in ambiguous cases of orbital invasion.

Adipose Tissue↗
PubMed1999

Clinical care pathways: decreasing resource utilization in head and neck surgical patients.

In this era of decreasing reimbursement, health systems have been forced to become more efficient and decrease resource utilization to remain financially viable. One of the methods of internal cost control has been the use of clinical pathways. Given the complexity of treatment of head and neck cancer patients, clinical pathways can help to standardize decision making and introduce uniformity in resource utilization. The objective of this study is to compare resource utilization and outcomes before and after implementation of a clinical pathway for head and neck surgical patients. We observed significant decreases in hospital costs as well as shorter lengths of stay after pathway implementation. It is our belief that a uniform management tool is beneficial in this complex disease.

Aged↗
PubMed1999

Superficial siderosis of the CNS associated with multiple cavernous malformations.

Superficial siderosis of the CNS due to chronic, recurrent subarachnoid hemorrhage is an uncommon and potentially debilitating disorder. The classic clinical manifestation is progressive bilateral sensorineural hearing loss (SNHL), although ataxia and pyramidal signs also are observed frequently. Cavernous malformations rarely present with subarachnoid hemorrhage. We describe an unusual case of a young patient who presented with progressive, bilateral SNHL who was found to have superficial CNS siderosis associated with multiple cavernous malformations.

Adult↗
PubMed1998

Neoplastic fixation to the prevertebral compartment by squamous cell carcinoma of the head and neck.

OBJECTIVE: The purpose of this study was to determine the accuracy of MR imaging in determining fixation of squamous cell carcinomas to the prevertebral space. MATERIALS AND METHODS: MR images of 15 patients with large pharyngeal carcinoma (n = 13) or laryngeal carcinomas with pharyngeal extension (n = 2) were retrospectively reviewed independently by two head and neck radiologists who were unaware of the surgical findings. MR images were evaluated for four criteria in the prevertebral longus muscle complex: muscle concavity, irregular tumor-muscle interface, T2 hyperintensity, and enhancement. All patients underwent panendoscopy where fixation or mobility of the tumor relative to the prevertebral fascia was assessed by manual manipulation. Tumors in six patients were fixed to the prevertebral space and inoperable. In nine patients whose tumors were not fixed, open neck explorations were performed and tumors were resected in seven patients. MR findings were compared with panendoscopy in all patients and with intraoperative assessment in nine patients. RESULTS: Eleven of 15 patients had at least two of the MR imaging criteria present. None of the MR findings were both sensitive and specific for tumor fixation. Although muscle concavity and enhancement each had a sensitivity of 88%, both criteria suffered from low specificity (14% and 29%, respectively). An irregular tumor-muscle interface and muscle T2 hyperintensity were criteria that suffered from both low sensitivity and specificity. Accuracy of the imaging criteria independently ranged from 53% to 60%. CONCLUSION: Although abnormal muscle contour, T2 hyperintensity, and enhancement are frequently present in neck carcinomas that are fixed to the prevertebral space, these findings may also be present in patients in whom the tumor is mobile and resectable. MR imaging may not be able to differentiate between neoplastic fixation and nonneoplastic changes in the prevertebral space.

Adipose Tissue↗
PubMed1997

Delphian lymph node in laryngeal carcinoma: a whole organ study.

The incidence of Delphian or cricothyroid lymph node involvement in laryngeal carcinoma was studied in whole organ sections of 92 laryngectomy specimens. Histologic examination revealed that of the 92 whole organ sections, 8 were noted to have cricothyroid node involvement (8.7%). All 8 patients had submucosal involvement of the conus elasticus, 7 had involvement of the subglottic mucosa, and 6 had invasion of the cricoid cartilage. Four of the 8 patients with cricothyroid node involvement died of the disease, 3 of whom had stomal recurrence. None of the patients who died of disease had surgical management of the paratracheal lymph nodes or postoperative radiation therapy. The benefit of surgical margins of the paratracheal lymph node bed as well as the role of radiation therapy are discussed.

Carcinoma↗
PubMedDate not supplied

Anesthesia in endoscopic sinus surgery.

Successful administration of anesthesia in endoscopic sinus surgery is of critical importance for patient comfort, to reduce bleeding, and for procedure safety. However, surgeons are often reluctant to perform the procedure under local anesthesia with sedation. Over the past four years, patients undergoing ESS have been asked to complete a questionnaire to evaluate their anesthetic experience. A total of 111 completed questionnaires were returned for evaluation. The questionnaire evaluated subjective level of pain, nausea, vomiting, and overall unpleasantness of surgery on a 100 mm visual analog scale. The results from this survey indicate a high level of patient satisfaction with our current anesthetic techniques, while identifying issues with postoperative nausea and vomiting. The results of the survey and a review of the anesthetic issues involved in successfully performing endoscopic sinus surgery are discussed.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Endoscopic management of sinonasal inverted papilloma.

Since 1992, 42 patients at the University of Pennsylvania have been treated for inverted papilloma (IP). Thirty-three patients were managed endoscopically with or without a Caldwell Luc approach (CLA) and retrospectively analyzed. The CLA, which involves a gingivobuccal incision for access to the maxillary sinus, is distinguished from a formal Caldwell Luc procedure. These 33 patients with histologically confirmed IP were without evidence of malignancy. They also did not have evidence of intracranial, orbital, or frontal sinus IP. Seventeen of 33 patients (17/33) were without prior treatment (primary). Sixteen of 33 (16/33) presented from an outside institution with recurrent IP (secondary). The recurrence rate using this method to treat primary IP was 6% (1/17), and for secondary IP was 25% (4/16). Scheduled postoperative endoscopic surveillance permitted early detection of recurrence and continued endoscopic control of IP. All 33 patients were endoscopically free of disease at the end of the study. These preliminary data are encouraging for the use of intranasal endoscopy with and without CLA as a means of managing and controlling IP in selected cases.

Adult↗
PubMedDate not supplied

Endoscopically assisted anterior cranial skull base resection of sinonasal tumors.

The traditional approach to sinonasal tumors involving the base of skull has been the anterior craniofacial resection. Endoscopic techniques have created the potential to approach the intranasal aspect of skull base lesions without external incisions and still develop an en bloc resection when removed. We report our initial experience with skull base neoplasms in which the otolaryngic portion of the standard resection was accomplished instead through an endoscopic approach. The nature of lesions favorable for this approach and associated technical issues are discussed. Although we do not consider this approach a replacement for the traditional anterior craniofacial resection, it is an important adjunct in the skull base surgeon's armamentarium.

Adenocarcinoma↗
PubMedDate not supplied

Medical applications of electronic nose technology: review of current status.

Electronic noses, or artificial sensors of odorants. have been developed over the last ten years to perform a variety of identification tasks in various industries. This powerful technology is only beginning to be introduced in the field of medicine, but is promising in its potential to assist in diagnosis. This article reviews electronic nose technology and some initial investigations of potential applicability of the technology in the field of medicine.

Acoustics↗