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Biomedical subjects

J A Fornadley

Publications and source records attributed to J A Fornadley.

15 recordsLinked to original sources
PubMed2000

Operative times, postanesthesia recovery times, and complications during sinonasal surgery using general anesthesia and local anesthesia with sedation.

OBJECTIVE: The goal was to compare complication rates and recovery times in patients undergoing elective septoplasty or endoscopic sinus surgery using local anesthesia with sedation (LAS) versus general anesthesia (GA). METHODS AND PATIENTS: A retrospective chart review of a consecutive sample of 177 patients undergoing elective septoplasty or endoscopic sinus surgery between July 1, 1994, and June 30, 1996, was carried out at our university-based outpatient surgery unit. Outcome measures included total operative time, surgical time, recovery time, and perioperative complications. RESULTS: Total operative and recovery times were shorter in patients undergoing LAS. The frequency of emesis, epistaxis, and nausea were less in the LAS population than in the GA population. Three patients who underwent GA required unplanned admissions. CONCLUSION: This study suggests that in selected patients undergoing sinonasal surgery, LAS may result in shorter total operative times, shorter recovery times, and less frequent nausea, emesis, and epistaxis than GA.

Adolescent↗
PubMed1999

The stuffy nose and rhinitis.

The congested nose may represent a mild nuisance or be indicative of a serious health condition. Familiarity with appropriate methods of evaluation and testing can help avoid diagnostic pitfalls and make an accurate, timely assessment of the patient's condition.

Acute Disease↗
PubMed1999

Safety of home-based and office allergy immunotherapy: A multicenter prospective study.

During a 1-year period, 27 otolaryngic allergy practices recorded all systemic reactions to immunotherapy resulting from 635,600 patient visits and 1,144,000 injections. Sixty percent of injections were given at home. Major systemic reactions were observed after 0. 005% of injections. There were no hospitalizations or deaths. Eighty-seven percent of major reactions began within 20 minutes of injection. Frequently observed risk factors for major reactions were buildup phase of immunotherapy, active asthma, and first injection from a treatment vial. Home and office injections had similar rates of total systemic reactions, but home-based immunotherapy had far fewer major reactions. Home-based immunotherapy was found to be safe. The methods and precautions used to treat patients with this degree of safety are specified and discussed.

Adult↗
PubMed1998

Use of immunotherapy in a primary care office.

Immunotherapy has been used for over 80 years. It is a safe and effective therapeutic intervention for allergic rhinitis, but its use in the treatment of asthma is more controversial. Patients with unstable asthma are at increased risk of adverse effects from immunotherapy; therefore, if immunotherapy is used in such patients, it should be instituted cautiously. Indications for immunotherapy include evidence of IgE-mediated disease and positive results on skin tests or radioallergosorbent test (RAST). In addition, before immunotherapy is considered, measures to avoid exposure to offending agents and drug therapy should have failed to provide relief of symptoms. Before administering immunotherapy in the office, physicians should be knowledgeable about the use of immunotherapy and the treatment of anaphylaxis, and should have ready access to the equipment needed to avert anaphylaxis.

Asthma↗
PubMed1995

The role of MRI when relapsing polychondritis is suspected but not proven.

Relapsing polychondritis (RP), while relatively rare, presents a characteristic clinical picture. Based upon a symptom complex of auricular, nasal, and respiratory chondritis associated with ocular and otic complaints, diagnosis can frequently be made with confidence in the absence of histologic confirmation. We present a case where a therapeutic intervention was required without sufficient criteria for diagnosis. Magnetic resonance imaging (MRI) proved useful in initial evaluation and allowed follow-up imaging demonstrating a gratifying response to steroid treatment. We believe that MRI has an important role in the diagnosis and subsequent evaluation of patients with proven or suspected RP, particularly those with tracheal involvement.

Airway Obstruction↗
PubMed1995

Perioperative ketorolac tromethamine and postoperative hemorrhage in cases of tonsillectomy and adenoidectomy.

The charts of 258 patients undergoing tonsillectomy with or without adenoidectomy between June 1991 and June 1993 were reviewed. One hundred sixty-nine of these patients received ketorolac tromethamine during the perioperative period as a nonnarcotic alternative for postoperative pain management. The incidence of postoperative hemorrhage among patients who received ketorolac tromethamine was 10.1%, compared to 2.2% in those patients who received narcotic analgesia only. The average time to adequate oral intake and discharge was evaluated. Ketorolac appeared to moderately decrease the time to adequate oral intake. The use of ketorolac did not significantly alter the time to discharge. The increased incidence of postoperative hemorrhage in patients receiving ketorolac should be considered before this medication is used in the perioperative period. The risk/benefit ratio of ketorolac use as a postoperative analgesic may be better demonstrated in a prospective study.

Adenoidectomy↗
PubMed1994

The effect of surfactant on eustachian tube function in a gerbil model of otitis media with effusion.

The relationship of eustachian tube surfactant and otitis media with effusion on eustachian tube opening pressure was studied in a gerbil model. Injection of killed Streptococcus pneumoniae bacteria created a serous effusion that increased eustachian tube opening pressure. The introduction of exogenous surfactant to this system resulted in a dramatic decrease in eustachian tube opening pressure in both normal ears and those with effusion. Identifying means to increase surfactant in the eustachian tube could be beneficial in reducing persistent otitis media with effusion.

Animals↗
PubMed1994

Speaking trumpets.

Explore the source record for details and available documents.

Communication↗
PubMed1993

Malignant lesions presenting as symptoms of craniomandibular dysfunction.

Three cases of carcinoma, seen in a head/neck pain management practice during the past 2 years and presenting as craniomandibular dysfunction symptoms, are reported. Clinicians should always consider a differential diagnosis because of the variety of potential causes of the symptoms presented by the patient. These symptoms act as clues to help to differentiate between a routine or "evil" process. The need for imaging and remaining, when the clinical symptoms do not correlate with the clinical examination through established guidelines for craniomandibular dysfunction or head/neck pain, is of paramount importance.

Adult↗
PubMed1992

Management of recurrent otitis media.

Recurrent otitis media is defined as three or more episodes of acute otitis media in six months or four or more episodes in one year, with the bouts of acute infection separated by intervals of full resolution. The disorder is common in children and is different from otitis media with effusion, the other frequently encountered chronic ear disease. Daily low-dose antibiotic therapy is recommended as initial prophylaxis against recurrent otitis media. Pressure-equalizing tubes may be used in patients who have more than one episode of breakthrough otitis media while receiving antibiotics. Adenoidectomy should be reserved for use when pressure-equalizing tubes fail or when insertion of a second set of tubes is required.

Acute Disease↗
PubMedDate not supplied

Toxic shock syndrome following submandibular gland excision.

Acute toxic shock syndrome (TSS), initially described in association with the use of super absorbent tampons in menstruating women, has complicated a variety of surgical procedures. Recent attention in head and neck surgery has focused on absorbent packing materials, such as those used in postoperative nasal care. It is important to maintain a high index of suspicion in all postoperative patients to fever, hypotension, and erythroderma. We report TSS following submandibular gland excision.

Dermatitis, Exfoliative↗
PubMedDate not supplied

The feasibility of surgical site tagging with CT virtual reality of the paranasal sinuses.

PURPOSE: The purpose of this work was to evaluate the feasibility of tagging (highlighting) surgical sites using volumetric CT virtual reality of the paranasal sinuses in the planning for endoscopic sinus surgery. METHOD: Twenty-five patients with significant paranasal sinus disease had a planned surgical site marked on 2D coronal images. This planned surgical site was then tagged and included on CT volumetric virtual reality imaging. Each case was evaluated as to the ability of the CT virtual reality to demonstrate the planned surgical site and its orientation with respect to adjacent superficial anatomy. RESULTS: For all 25 planned surgeries, the virtual images showed the entire surgical site marked on the 2D coronal images. In all 25 cases, the orientation of the planned surgical site to adjacent normal anatomy was well demonstrated. For surgery into the maxillary sinuses, tagging and electronic removal of the middle turbinates and uncinate processes mimicked the actual surgery and allowed complete visualization of the infundibulum and the planned surgical site. CONCLUSION: Planned endoscopic paranasal sinus surgical sites can be easily and reliably highlighted using CT virtual reality techniques with respect to the patient's normal endoscopic anatomy.

Data Display↗