Positive fistula test.
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Diagnosis, Differential↗
Biomedical subjects
G D Becker
Publications and source records attributed to G D Becker.
Late syphilitic hearing loss: a diagnostic and therapeutic dilemma.
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Adult↗
The screening value of monothermal caloric tests.
A valid screening caloric test should decrease examination time, increase patient comfort and maintain a high degree of sensitivity in predicting bithermal (BT) caloric results. This prospective study of 362 consecutive electronystagmograms (ENG) compared right/left (R/L) difference results obtained using monothermal (MT) warm and cold irrigations alone with that of the (combined) BT tests. Comparing MT warm and cold irrigations, false negative (normal MT but abnormal BT test) results were obtained in 14% and 25% of irrigations, while false positive (abnormal MT but normal BT test) information was obtained in 22% and 15% of irrigations, respectively. False negative MT tests preclude detection of the abnormal BT test, while false positive tests require unnecessary completion of the BT caloric irrigations. This lack of diagnostic sensitivity limits the usefulness of the MT irrigation as a screening test.
Air↗
Technique of preserving the spinal accessory nerve during radical neck dissection.
Preserving the spinal accessory nerve during radical neck dissection eliminates shoulder disability and does not compromise the incidence of neck recurrence in properly selected cases. The literature and standard textbooks only superficially refer to the method dissecting this nerve. We describe our technique of preserving the spinal accessory nerve during radical neck dissection.
Accessory Nerve↗
Monothermal upright-inverted caloric test.
This study evaluates the diagnostic sensitivity of a simple method of producing bidirectional cupular deviation using a monothermal stimulus. This stimulus has the advantage of conservation of time and increased patient comfort and acceptance (two caloric irrigations instead of four). Each patient was seated with his head extended 60 degrees during the caloric irrigation. Eighty seconds after the onset of irrigation, the patient placed his head forward, thereby causing both an ampullopetal and ampullofugal flow of endolymph. Right/left difference and directional preponderance were computed for both monothermal warm and monothermal cold irrigations and compared to the traditional bithermal caloric results. This study comprised a control group of 13 normal patients and 144 dizzy patients. False positive (abnormal monothermal but normal bithermal) and false negative (normal monothermal but abnormal bithermal) tests occurred in 45 percent and 50 percent of examinations, respectively. Inaccurate measurement of the weak slow phase velocity that usually accompanies the inverted position was a probable cause of the poor correlation between test results since a separate analysis of electronystagmograms with more intense nystagmus in the inverted position resulted in an improved correlation. Further evaluation of this technique should include methods that result in more accurate measurement of slow phase velocity.
Adolescent↗
The extended single transverse neck incision for composite resections.
An extended single transverse neck incision was used in an unselected group of 40 patients undergoing a composite resection for carcinoma of the head and neck. While 21 of the 40 patients had a fistula and wound infection develop, carotid artery exposure due to flap necrosis occurred in two patients while carotid artery rupture occurred in only two. The extended single transverse neck incision results in a viable flap because of its excellent blood supply. Despite being subjected to fistula formation and infection, it usually results in excellent carotid artery protection, adequate surgical exposure, minimal cosmetic deformity and does not interfere with primary or secondary reconstruction.
Aged↗
Pseudocaloric nystagmus.
Pseudocaloric nystagmus (PCN) is an appropriately beating nystagmus induced by cold caloric irrigation of an ear with abolished vestibular function. The nystagmus is not the result of endolymph flow but probably represents unmasking a latent nystagmus by altering the patient in this case, through tactile (caloric) stimulation. Pseudocaloric nystagmus has the following characteristics: (1) mild intensity (eyes closed-slow phase velocity usually less than 8 degrees/sec), it has not been observed with the eyes open, (2) always beats away from the diseased ear; therefore, any nystagmus induced by cold irrigation will be appropriately (contralateral) beating while that induced by warm irrigation will be inappropriately (contralateral beating; 3) the induced nystagmus will not reverse direction after inverting the ampulla. Establishing bidirectional sensitivity of the cupula by demonstrating appropriately beating nystagmus to ampullopetal and ampullofugal flow of endolymph not only assures that the lateral semicircular canal (SCC) is functionally intact to caloric stimulation but will avoid errors in electronystagmorgraphic (ENG) interpretation.
Caloric Tests↗
Anaerobic and aerobic bacteriology in head and neck cancer surgery.
A prospective study of wound infections following major head and neck cancer surgery was undertaken to define a rational approach to trials of antibiotic prophylaxis and initial therapy of these infections. Preoperative aerobic cultures were taken from the planned site of skin incision and from the oropharynx. Both aerobic and anaerobic cultures were obtained from all wound infections. Patients receiving prophylactic antibiotics were excluded from the study. The data indicate that preoperative cultures are not usually predictive of the bacteriology of subsequent wound infection. Mixed aerobic and anaerobic flora were cultured from most wound infections and usually reflected normal anaerobic oropharyngeal flora and/or exogenously acquired Staphylococcus aureus. Bacteroides fragilis was not cultured in this series. Antibiotics selected for trials of prophylaxis or initial treatment of these infections should cover both the resident oral aerobic and anaerobic flora and S aureus. Coverage for B fragilis does not appear necessary. Antibiotic choices might include (1) penicillin G agents plus a penicillinase-resistant penicillin or (2) a parenteral cephalosporin.
Head and Neck Neoplasms↗
Late syphilis. Otologic symptoms and results of the FTA-ABS test.
The clinician occasionally encounters a patient whose cochleovestibular symptoms are thought to be due to late syphilis mainly on the basis of a reactive FTA-ABS test. I describe 21 such patients, 11 of whom had either a spurious- or a false-positive reaction. The following suggestions may avoid an inaccurate diagnosis of late syphilis in such patients: (1) repeat all reactive serological tests for syphilis (STS); (2) rule out false-positive reactions; (3) request the degree of fluorescence (1+ to 4+) on all reactive FTA-ABS tests; (4) obtain a Treponema pallidum immobilization (TPI) test on all patients with repeatedly reactive (1+) FTA-ABS tests--a nonreactive TPI test rules out the diagnosis of syphilis; (5) if a TPI test cannot be performed, a repeatedly reactive (1+) FTA-ABS test in the absence of a reactive nontreponemal STS probably represents a false-positive reaction; (6) clinical judgment is the final determinant of whether a patient has or should be treated for late syphilis.
Adult↗
Cefazolin prophylaxis in head and neck cancer surgery.
This study evaluated the prophylactic use of cefazolin in reducing the incidence of infection in patients undetgoing cancer surgery where the upper aerodigestive tract was entered from the neck. A prospective, randomized, double-blind design was conducted in a single hospital. The patient was given placebo or cefazolin, 1 gm intramuscularly with the preoperative medications, then 0.5 gm every six hours for four doses. Of 55 determinate patients, 32 received antibiotics and 23 placebo. Infection rate was 38% (12/32) and 87% (20/23) respectively, representing a statistically significant reduction in infection (P less than 0.001/. There were 30 wound and two nonwound (sinusitis and pneumonia) infections. In conclusion, the perioperative use of cefazolin in patients undergoing cancer surgery where the oral cavity or pharynx has been entered from the neck is useful in reducing the incidence of wound infection.
Adult↗
Sources of error in interpretation of caloric tests.
Caloric testing plays a prominent role in evaluating the vestibular system. A unilateral reduced vestibular response (RVR) is a common abnormality and is consistent with peripheral vestibular pathology. An erroneous interpretation of RVR may be made due to the following circumstances: laboratory technique, the influence of directional preponderance (DP) on monothermal tests (MT), unilateral hyperactivity, or pseudocaloric (PC) nystagmus. These errors in interpretation may be avoided by (1) repeating any single irrigation that is significantly different from the other three, to rule out laboratory technical error; (2) performing bithermal (BT) testing exists, to eliminate the effects of directional preponderance; (3) observing that a right/left (R/L) difference is not due to unilateral hyperactivity, by noting absolute slow phase (SP) velocity; and (4) by demonstrating bidirectional sensitivity of the cupula before concluding that residual caloric function exists instead of no function.
Caloric Tests↗
Otolaryngologic aspects of scuba diving.
Among the most common injuries encountered by the 700,000 active sport scuba divers in the United States are sinus and otitic barotrauma. The management of these injuries and the identification of high-risk patients during their required pretraining physical examination are discussed.
Athletic Injuries↗
Anaerobic and aerobic bacteriology in head and neck cancer surgery.
A prospective study of wound infections following major head and neck cancer surgery was undertaken to define a rational approach to trials of antibiotic prophylaxis and initial therapy of these infections. Preoperative aerobic cultures were taken from the planned site of skin incision and from the oropharynx. Both aerobic and anaerobic cultures were obtained from all wound infections. Patients receiving prophylactic antibiotics were excluded from the study. The data indicate that preoperative cultures are not usually predictive of the bacteriology of subsequent wound infection. Mixed aerobic and anaerobic flora were cultured from most wound infections, and usually reflected normal anaerobic oropharyngeal flora, exogenously acquired Staphylococcus aureus, or both. Bacteroides fragilis was not cultured in this series. Antibiotics selected for trials of prophylaxis or initial treatment of these infections should cover both the resident oral aerobic and anaerobic flora and S aureus. Coverage for B fragilis does not appear necessary. Antibiotic choices might include penicillin G plus a penicillinase-resistant penicillin or a parenteral cephalosporin.
Anaerobiosis↗
The extended single transverse neck incision for composite resections.
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Carotid Arteries↗