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Biomedical subjects

G D Lyons

Publications and source records attributed to G D Lyons.

14 recordsLinked to original sources

Tracheomalacia repair using ceramic rings.

Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance parameters with a dramatic improvement in lifestyle, whereas the three with tracheostomy were successfully decannulated. The routine use of these rings has alleviated the need for rib/cartilage grafts, primary resections with anastomosis, prolonged periods of cannulation, and multiple surgeries. Our experience in the use of ceramic rings for tracheomalacia repair will be presented, highlighting selection criteria for their use, intraoperative placement, perioperative complications, and post-operative followup for a minimum of 6 months.

Adult

Local anesthesia in rhinoplasty: a new twist?

Twenty volunteers were asked to compare pain upon injection during septorhinoplasty using buffered versus unbuffered local anesthetics. The concentration of the buffer was one part sodium bicarbonate to five parts local. The surgeons performing the operation were asked to identify any difference in hemostasis or duration of anesthesia. Eighteen of twenty patients found the buffered anesthetic to be less painful and better tolerated. No difference in hemostasis or duration of action was noted between the buffered or unbuffered solution, however, faster onset of action was noted with the buffered solution. The addition of sodium bicarbonate as a buffering agent to the local anesthetics lidocaine and bupivacaine can significantly reduce pain upon injection. A solution of 5cc 2% lidocaine with 1:100,000 epinephrine, 5cc 0.25% bupivacaine with 1:200,000 epinephrine, and 2cc of 7.5% sodium bicarbonate mixed just prior to injection is a safe, effective, less painful local anesthetic with rapid onset of action and full efficacy.

Adult

Bone-conduction electrocochleography: clinical applications.

Cases are presented which show the clinical utility of recording an electrocochleographic response to bone-conducted stimuli. The procedure is fraught with problems of acoustic control and artifact generation, but has distinct although limited values in clarifying masking dilemmas in patients with bilateral hearing loss.

Adolescent

Round window rupture secondary to acoustic trauma.

Perilymph fistulas are a known cause of sudden hearing loss. The two cases presented illustrate round window ruptures secondary to acoustic trauma. The important considerations are early diagnosis and treatment, the possibility of associated congenital anomalies, and future protection against sound.

Adult

Laser surgery and immunotherapy in the management of laryngeal papilloma.

Twenty-three cases of laryngeal papilloma have been treated and followed for four years utilizing laser excision and laser excision/immunotherapy. Fourteen cases responded well to laser excision alone, nine did not and immunotherapy was instituted as adjunctive treatment. To date, immunotherapy has contributed little to the relief in this group of refractory cases.

Carbon Dioxide

Anatomical consequences of CO2 laser surgery of the guinea pig ear.

A modified American Optical (Model 100) CO2 laser was used to produce lesions in the tympanic membranes, ossicles, and cochlear capsules of guinea pigs. Even with the lowest available intensities and durations (0.4 watts, 50 msec), there was damage to the inner ear. Although laser surgery of the ear can avoid mechanical trauma and bleeding as well as increase accuracy, the use of commercial lasers in ear surgery should be avoided until a proven unit is available.

Animals

CO2 laser as a clinical tool in otolaryngology.

The CO2 laser has been used in a variety of lesions for two and one half years in areas other than the larynx. These lesions include viral papillomas, leukoplakias and erosive lichen planus in various otolaryngological sites. Laser therapy is compared with other modalities of treatment for similar lesions and the advantages and disadvantages of this type treatment is evaluated.

Adult

Morphologic analysis of tympanic membrane grafts.

Many materials are presently used for repair of tympanic membrane defects. Since the microscopic organization of these tissues may play a role with respect to the suitability of replacement of one with the other, a comparative electron microscopic study of temporalis fascia, fresh and preserved amniotic membrane was undertaken. An effort was made to determine the similarities and differences of these tissues and our clinical experience with their use is presented.

Amnion

The otological aspects of palatal myoclonus.

Palatal myoclonus with its concomittant objective tinnitus is often a missed diagnosis and poses a problem to the clinician in separating it from other middle ear anomalies. The etiology and symptomatology is outlined, but as suggested by our case presentations are not always diagnostic. The anatomical pathways of palatal myoclonus are traced, and its etiological complexities are realized when any locus or pathology along these tracks may create the characteristic chronic rhythmic contractions. We have experienced excellent results in determining a differential diagnosis of palatal myoclonus from other middle ear problems by the correlations of impedance audiometry with our clinical findings. Although the etiology is not defined the target structures can be separated from this test method and, therefore, enable more specific therapy.

Adolescent

CO2 laser laryngoscopy in a variety of lesions.

We have had the opportunity to employ the CO2 surgical laser with suspension laryngoscopy and microscopic adaptations to treat a variety of laryngeal conditions over two years. Each type of laryngeal condition is discussed, and the benefits of laser management is evaluated. This type of laryngeal management is compared with other forms of treatment such as the standard surgical approaches, electrocautery, and cryosurgery.

Aged

Complications of percutaneous transtracheal procedures.

The increasing use of transtracheal procedures by various specialties has caused a rash of new complications which have interested the endoscopist. These complications have resulted from the many diagnostic and therapeutic procedures involving the percutaneous puncture of the laryngeal or tracheal air space. The validity of these procedures is not questioned. However, they have spawned a host of diverse and bizarre complications which have led to serious and even fatal problems. The role of the endoscopist as a consultant in both the diagnosis and therapy of these developments must be understood and stressed.

Abscess