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Biomedical subjects

E S Deutsch

Publications and source records attributed to E S Deutsch.

13 recordsLinked to original sources
PubMed2001

Alternative indications for laser-assisted tympanic membrane fenestration.

BACKGROUND AND OBJECTIVE: To assess the utility of the CO(2) Flashscanner laser for treatment of selected middle ear diseases other than otitis media with effusion (OME) and acute otitis media (AOM). STUDY DESIGN/MATERIALS AND METHODS: A retrospective review of the records of 144 patients treated with the OtoLAM((R)) device, a Flashscanner laser, between July 1, 1998, and February 29, 2000. Patients treated for AOM or OME were excluded. RESULTS: Data are presented on 11 patients (17 ears). Four indications were identified: Elimination of middle ear fluid before auditory brainstem response with or without otoacoustic emission testing (ABR +/- OAE), barotrauma, eustachian tube obstruction, tympanocentesis when a culture of middle ear fluid was deemed necessary. All tympanic membranes (TM) healed. CONCLUSIONS: Fenestration of the TM can be accomplished for both diagnostic and therapeutic purposes. Laser assisted tympanic membrane fenestration seems to be effective in the management of middle ear fluid before ABR +/- OAE, barotrauma, eustachian tube dysfunction, and for tympanocentesis.

Adolescent↗
PubMed2000

Laser-assisted myringotomy for otitis media: a feasibility study with short-term followup.

Intermediate-duration middle ear ventilation appears to be a good treatment option for selected children with otitis media. Laser-assisted myringotomy is one way to provide such ventilation. It can provide prompt pain relief and resolution of middle ear effusion and effusion-related hearing loss, and it can provide an opportunity for surveillance of antibiotic-resistant organisms. We performed laser-assisted myringotomy on 97 ears of 54 children over a 5-month period. All children had acute or recurrent otitis media or persistent middle ear effusions. Our experience suggests that laser-assisted myringotomy is a feasible treatment option for selected patients. Practitioner experience and patient and family considerations will contribute to the decision whether to use general or topical anesthesia.

Anesthesia↗
PubMed1998

Early tracheostomy tube change in children.

OBJECTIVE: To review the safety of early tracheostomy tube change in children. DESIGN: Retrospective case series. SETTING: Pediatric tertiary care hospital. PATIENTS: Twenty-one consecutive pediatric patients undergoing routine tracheotomy. INTERVENTION: First tracheostomy tube change performed at patient's bedside at 3 (n = 15) or 4 (n = 5) days after surgery. OUTCOME MEASURE: The ability to safely change a tracheostomy tube at the patient's bedside 3 or 4 days after surgery. RESULTS: The first tracheostomy tube change was safely performed at 3 or 4 days after surgery in 20 patients. All changes were accomplished without complication or difficulty on the first attempt. The patients' ages ranged from 4 days to 16 years. The smallest child weighed 1.6 kg. Early tracheostomy tube change was not attempted in one obese 10-year-old girl whose pediatric tracheostomy tube became dislodged and formed a false tract 2 days after surgery. CONCLUSIONS: Most pediatric tracheostomy tubes can be safely changed at the patient's bedside approximately 3 days after surgery. Clinical applications of early tracheostomy tube change may include facilitating better hygiene, earlier completion of family caregiver tracheotomy education, and shorter hospital stays. It appears safe and advantageous for surgeons to consider early initial tracheostomy tube change for pediatric patients.

Child↗
PubMed1998

Sensorineural hearing loss in children after liver transplantation.

OBJECTIVE: To investigate risk factors for sensorineural hearing loss (SNHL) in children after liver transplantation. DESIGN: Retrospective medical record review. SETTING: Pediatric tertiary care hospital. PATIENTS: One hundred twenty-five consecutive children who received liver transplants between March 1, 1987, and June 30, 1996. MAIN OUTCOME MEASURES: The presence of SNHL (bone conduction threshold of >35 dB of hearing loss in at least 1 frequency) and the cause of the liver abnormality in all 125 patients. In addition, among the subset of children who had biliary atresia and underwent transplantation before 2 years of age, the total dose (milligrams per kilogram of body weight) of aminoglycoside antibiotic medications (tobramycin sulfate, gentamicin sulfate, and amikacin sulfate) and of intravenous loop diuretic agents (furosemide) was compared between children with and without SNHL. RESULTS: Audiologic evaluations were available for 66 of 125 patients, 15 (12%) of whom have SNHL. Of 5 survivors with the short-bowel syndrome, 4 have severe to profound SNHL. Of 46 children who have biliary atresia and who underwent transplantation before 2 years of age, 8 (17%) have SNHL. Among the 26 evaluable children with biliary atresia undergoing liver transplantation before 2 years of age, logistic regression analysis revealed that the most important risk factor for SNHL was the cumulative dose of amikacin (P = .05). CONCLUSIONS: Children receiving liver transplants are at an increased risk for SNHL. Those with the short-bowel syndrome have the greatest prevalence of SNHL. Among the subset of children with biliary atresia receiving liver transplants before 2 years of age, statistical analysis demonstrates a dose-response relationship between the receipt of amikacin and the occurrence of SNHL.

Audiometry↗
PubMed1998

Method for removing endobronchial beads.

The development of rigid bronchoscopes, Hopkins rod telescopes, and optical forceps has increased the efficacy and safety of removing endobronchial foreign bodies. These instruments have become the method of choice for managing the majority of foreign bodies. Spherical foreign bodies, such as beads, remain difficult to manage. Securing the foreign body by passing a Fogarty catheter through the lumen, inflating the balloon, and trapping the foreign body between the balloon and the bronchoscope allows controlled removal.

Bronchi↗
PubMed1996

Clonidine prophylaxis for narcotic and sedative withdrawal syndrome following laryngotracheal reconstruction.

OBJECTIVE: To determine the efficacy of transdermal clonidine hydrochloride for prophylaxis of withdrawal syndromes that are common following more than 7 days of deep sedation after single-stage laryngotracheal reconstruction (LTR) surgery. DESIGN: Consecutive case series. SETTING: Pediatric intensive care unit at tertiary care referral center, university-affiliated children's hospital. PATIENTS: Ten consecutive patients who had undergone single-stage LTR and received sedation with a combination of narcotics and benzodiazepines. INTERVENTIONS: A sustained release transdermal clonidine hydrochloride patch (50-100 micrograms/d; mean, 5.8 micrograms/kg per day; range, 4.2-8.5 micrograms/kg per day) was applied to 8 consecutive patients before discontinuation of sedative infusions and elective extubation. Physicians continued to treat patients for withdrawal symptoms, if seen, at their discretion. MAIN OUTCOME MEASURES: Seventeen characteristic narcotic and sedative withdrawal symptoms recorded at baseline and serially for at least 48 hours following discontinuation of deep sedation. RESULTS: No severe symptoms of narcotic or sedative withdrawal (seizure, choreoathetosis, tremors, or dehydration) were seen in any patient during treatment with clonidine. Not more than 2 minor withdrawal symptoms (lethargy and respiratory rate > 40 breaths/min) occurred simultaneously during treatment with clonidine in any patient. Two of 8 patients had clonidine patches removed prematurely. Both patients experienced withdrawal symptoms within hours, and these symptoms subsided in the 1 patient whose clonidine patch was reinstituted. No significant sustained side effects, bradycardia, or dysrhythmia necessitated discontinuation of clonidine therapy, and no rebound withdrawal was seen with routine discontinuation of clonidine after 7 days of therapy. CONCLUSIONS: Transdermal clonidine prophylaxis may be a safe and efficacious adjunct to prevent withdrawal symptoms in pediatric patients who have undergone single-stage LTR. Use of a validated withdrawal symptom scoring tool is indicated for patients undergoing single-stage LTR and requiring prolonged, deep sedation in the pediatric intensive care unit.

Administration, Cutaneous↗
PubMed1996

Tonsillectomy and adenoidectomy. Changing indications.

Obstructive sleep apnea and upper airway obstruction (even without complete apnea) from adenotonsillar hypertrophy is either occurring more frequently or is becoming better recognized. Tonsillectomy or adenoidectomy is indicated for these children. Most patients who would benefit from surgery can be identified by a thorough history and physical examination. Occasionally, additional methods of evaluation, such as lateral neck radiographs or polysomnograms, are helpful. The indications for tonsillectomy and adenoidectomy are varied. No review can cogently encompass all clinical scenarios. Tonsillectomy and adenoidectomy remain valuable procedures for carefully selected patients.

Adenoidectomy↗
PubMed1996

Tracheobronchography in children.

Tracheobronchography (TBG) can provide anatomic information supplementing endoscopy in evaluating complex congenital and acquired tracheal abnormalities. With the use of modern non-ionic contrast agents and flexible fiberoptic bronchoscopes, TBG can be performed safely and comfortably in children. As some tracheal lesions have a significant risk of mortality, obtaining maximum definition of the abnormality is imperative prior to attempting surgical management. Twenty-two patients underwent TBG at St. Christopher's Hospital for Children (Philadelphia) from July 1990 through June 1995. With the use of iohexol as a contrast agent, flexible bronchoscopes and adequate sedation and analgesia, without the need for intubation or general anesthesia, there were no significant complications or discomfort during or after the procedure. Techniques and illustrative radiographs are presented. TBG provides a useful adjunct to endoscopy.

Bronchi↗
PubMed1991

Quincke's edema, revisited.

Angioneurotic edema involving the uvula is sometimes referred to as Quincke's edema. The term angioneurotic edema describes several closely related diseases manifested by recurrent, acute edema of the skin or mucosa. We report a case of uvular edema secondary to food allergy, treated successfully with steroids. A short review of angioneurotic edema and its management is also presented.

Angioedema↗