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Biomedical subjects

G J Parell

Publications and source records attributed to G J Parell.

18 recordsLinked to original sources
PubMed1993

Inner ear barotrauma in scuba divers. A long-term follow-up after continued diving.

Divers who suffer inner ear barotrauma are usually counseled to permanently avoid diving, reasoning that the injured inner ear is at increased risk of further damage. Twenty patients who suffered inner ear barotrauma while diving, but continued to dive against medical advice, were assessed on an interim basis for 1 to 12 years. As difficulty equalizing the ears during the barotraumatic event was a universal finding, prior to resuming diving, all patients were reinstructed on methods of maximizing eustachian tube function. No further deterioration of cochleovestibular function was noted. Based on these preliminary results, we conclude that recommending no further diving after inner ear barotrauma may be unnecessarily restrictive.

Adult↗
PubMed1993

Goode T tubes.

Explore the source record for details and available documents.

Child↗
PubMed1993

Temporal bone pathology in scuba diving deaths.

Scuba diving has long been associated with otologic injuries; however, little is known about temporal bone pathology in diving-related deaths. We examined 18 temporal bones from 11 divers who died, primarily from complications of rapid ascent. Bleeding into the middle ear and mastoid air cells was nearly universal. Inner ear damage included hemorrhage around Reissner's membrane and the round window membrane and rupture of the utricle and saccule. Most of the observed inner ear damage was not surgically treatable.

Adolescent↗
PubMed1986

Results of surgical repair of inapparent perilymph fistulas.

In patients who are thought to have a perilymph (PL) fistula, careful inspection of the round and oval windows during exploratory tympanotomy may be normal. The decision must then be made either to terminate the procedure--knowing that the patient's symptoms will probably continue or deteriorate--or to repair both windows as if PL fistulas were present, risking further damage to the inner ear. From a series of 14 patients explored for possible PL fistulas, we report on 6 patients with preoperative diagnoses of PL fistula, based on history, physical examination, and audiometry. Symptoms resulting from trauma were present from 10 days to 23 years before surgery. During exploratory tympanotomy, no fistulas were evident; however, both the oval and round windows were repaired with tissue grafts. Follow up--for 1 to 5 years--revealed that vertigo was relieved in all patients. Postoperatively, one patient had a mild conductive hearing loss; yet no patient sustained a sensory neural hearing loss. We conclude that patch grafting of both the oval and round windows is a safe and effective method of treating suspected, but inapparent fistulas. Patient selection, surgical technique, and results shall be detailed.

Fistula↗
PubMed1985

Conservative management of inner ear barotrauma resulting from scuba diving.

Fourteen patients who experienced inner ear barotrauma (IEBT) while scuba diving were examined shortly after the episode and were followed up until symptoms resolved or stabilized. On the basis of these observations and a review of the literature, three types of IEBT are hypothesized that usually result from forceful autoinflation of the middle ear: (1) hemorrhage within the inner ear, (2) labyrinthine membrane tear, and (3) perilymph fistula through the round or oval window. Presenting symptoms, treatment regimens, and final results are detailed.

Adolescent↗
PubMed1983

Medical examination of the sport scuba diver.

Prior to training, all scuba diving candidates must successfully complete a medical examination to determine their medical, physical, and psychological fitness for survival in a subaquatic environment. This article reviews the peculiarities of the diving medical examination and the reasons for them, suggests absolute, relative, and temporary disqualifications from diving, and outlines a sport diving questionnaire and medical examination.

Decompression Sickness↗
PubMed1980

The non-value of preoperative and intraoperative cultures in predicting the bacteriology of subsequent wound infection in patients undergoing major head and neck cancer surgery.

A prospective study of patients undergoing major head and neck cancer surgery was undertaken to define the value of preoperative and intraoperative cultures in identifying the patient at "high risk" of wound infection and in predicting the bacteriology of wound infection. One or two days before surgery, the skin of the operative site on the neck, the oropharynx and anterior nares were swabbed. an intraoperative wound culture was obtained after the pharyngeal defect was closed and the wound irrigated with water. All cultures were processed for aerobes in the Anaerobic Bacteriology Research Laboratory at Wadsworth Hospital Center. Wound infections developed in 10 of 31 patients who received cefazolin prophylactically and 21 of 25 patients who received no perioperative antibiotics. Fifty-five percent of infected patients and 68% of noninfected patients demonstrated potential pathogens preoperatively. A potential pathogen isolated preoperatively or intraoperatively was subsequently recovered from 35% of infected wounds. The majority of infected wound cultures grew one or more additional pathogens. A poor correlation was also noted between preoperative nasal Staphylococcus aureus isolation and subsequent recovery from wound infections. We conclude that preoperative and intraoperative aerobic wound cultures are not predictive of the "high risk" patient or of the bacteriology of subsequent wound infection in major head and neck cancer surgery.

Bacteriological Techniques↗
PubMed1979

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Prediction of lymph node metastases by lymphoscintigraphy of the neck after peri-cancer injection of a radiocolloid.

Radionuclide imaging is used to evaluate the status of neck nodes preoperatively in small group of patients with oral squamous cell carcinoma. An area adjacent to the carcinoma, and a similar area on the opposite side of the oral cavity, are injected with Technetium (Tc) 99m labeled sulfur minicolloid. Differences in imaging intensity between both sides of the neck is used to predict the presence of metastases. Neck dissection confirms the histologic status of the nodes. The scan correctly predicts the presence of metastases in 100% (2/2) of patients with palpable nodes, and the absence of metastases in 75% (3/4) of patients with clinically tested negative necks.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

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↗