Biomedical subjects
J A Stankiewicz
Publications and source records attributed to J A Stankiewicz.
Cerebrospinal fluid fistula and endoscopic sinus surgery.
Seven cases of cerebrospinal fluid fistulae occurring as a result of endoscopic sinus surgery in a total of 800 ethmoidectomies are discussed, along with 1 case referred for consultation. One cerebrospinal fluid fistula was intrasphenoid, 4 were posterior ethmoid/base of skull, 2 were anterior ethmoid, and 1 was ethmoid cribriform. Six of 8 fistulae were closed endoscopically. The sphenoid sinus cerebrospinal fluid fistula was closed successfully with fibrin glue and Gelfoam. Five cerebrospinal fluid fistulae were closed successfully using fascia, muscle, and Gel-foam. Two cerebrospinal fluid fistulae were treated conservatively, and only 1 stopped. Anatomic and technical aspects related to the occurrence of cerebrospinal fluid fistulae are discussed. Management and treatment of cerebrospinal fluid fistulae occurring during and after endoscopic sinus surgery is emphasized. When identified intraoperatively or delayed, cerebrospinal fluid fistulae can be managed successfully by endoscopic technique.
Cholesteatoma of the paranasal sinuses: case report & review of the literature.
Cholesteatoma of the paranasal sinuses is uncommon but makes interesting the differential diagnosis of unilateral sinus masses. When present, it is most often located in the frontal sinus; less commonly in the ethmoids and maxillary sinuses. Its presence elicits a spectrum of symptomatology differing among the varying locations of occurrence. Ultimately, complications of untreated sinus cholesteatoma can lead to severe disfigurement, carcinomatous degeneration or death. A review of this century's English literature revealed only twenty reported cases of cholesteatoma of any paranasal sinus. The distinguishing features of these cases are presented along with our personal experience with a cholesteatoma of the maxillary sinus. Treatment recommendations to avoid long-term complications are the total excision of the cholesteatoma with adequate drainage and sinusotomy for post-operative follow-up. CAT scanning plays an important role in diagnosis and follow-up.
Clinical accuracy of tuning fork tests.
A review of the literature reveals a surprisingly sparse amount of true documentation concerning the validity of using tuning forks as an adjunctive measure in the diagnosis of hearing impairment. Most reports are historical or anecdotal. With this in mind, a protocol was set up to identify the value of three standard tuning fork tests--the Rinne, the Weber, the Bing Occlusion--at frequencies of 256, 512 and 1024 Hz. The data were compared to otologic examination, audiometry and acoustic impedance. Results indicate the Rinne, Weber and Bing Occlusion tests do not accurately predict the type of hearing impairment as frequently as the literature suggests.
Cor pulmonale secondary to cleft palate repair. Case report.
A case of cor pulmonale occurred as a complication of a simultaneous palatoplasty and a superiorly-based pharyngeal flap. The patient, like two others found in the literature, had micrognathia. The cor pulmonale was not recognized in the immediate postoperative period but presented two years later with "failure to thrive." Therefore, surgeons must make other members of the health care team aware of this possible complication of combined palatoplasty and pharyngeal flap operations.