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Biomedical subjects

J H Per-Lee

Publications and source records attributed to J H Per-Lee.

15 recordsLinked to original sources
PubMed1986

Transcatheter carotid occlusion: an alternative to the surgical treatment of cervical carotid aneurysms.

The treatment of choice for various aneurysms of the common and internal carotid arteries may involve carotid artery occlusion rather than a reconstructive approach. Carotid occlusion may be accomplished either surgically or via an endovascular method. We present two cases of patients with cervical carotid artery aneurysms in which the endovascular method was used for carotid occlusion, describe our rationale for using this approach rather than surgical intervention, and discuss the role of this method of treatment for this condition.

Adolescent↗
PubMed1983

Tissue response to Plasti-Pore and Proplast otologic implants in the middle ears of cats.

Plasti-Pore (high density polyethylene) and Proplast (polytetrafluoroethylene-carbon fiber composite) are porous materials that have been employed for the fabrication of ossicular replacement prostheses. Despite many years of clinical experience with these otologic implants, questions remain regarding the tissue response elicited by these materials in the middle ear. The objective of this study was to evaluate histologically the tissue response to Plasti-Pore and Proplast implants in the middle ears of cats through one year of implantation. Plasti-Pore and Proplast total ossicular replacement prostheses, trimmed to "T" shapes, were inserted in fourteen cats, replacing the superstructure of the stapes. One Plasti-Pore and one Proplast implant were implanted in each animal. Cats were killed after two weeks, one, three, and six months, and one year. The histologic response to the Plasti-Pore and Proplast implants was similar. A fibrous capsule contained within a flattened epithelial cell sheath enveloped both types of implants. The mucosa enveloping the devices was continuous with the lining of the tympanic cavity and served to stabilize the implants. Fibrous tissue from the capsule infiltrated larger surface pores. Multinucleated giant cells and macrophages were the predominant cell types in the porosity of both types of implants. The relatively small pores of the devices did not appear to be able to accommodate both the phagocytic cells, which were responding to the particulate features of the materials, and fibrous tissue.

Animals↗
PubMed1982

Lateral sinus thrombosis: a modern perspective.

At Emory, six cases of lateral sinus thrombosis (LST) were seen over the last ten years--two children and four adults. The picture and bacteriology of LST have changed with the advent of antibiotics as has the usefulness of various diagnostic tests. Less is it a disease of children in association with acute otitis media. More often it is seen in the adult patient after a long history of chronic ear disease. Fever and mastoid and neck tenderness are still universal signs of the affliction. However, rarely patients do present with progressive anemia, emaciation and evidence of septic emboli. Since antibiotics are commonly used during the prodromal ear infection, cultures are often negative. If they do identify an organism, it is usually a mixed flora rather than beta hemolytic streptococcus. Spinal fluid results are variable and seldom is there evidence of increased spinal fluid pressure. Arteriography, venography, and digital subtraction venography are the most reliable tests to prove and delimit the thrombus. Early management involves high dose broad spectrum, intravenous antibiotics including chloramphenicol. Surgical intervention involves a mastoidectomy, exposure of the sinus, incision and drainage, but not necessarily removal of the thrombus. Internal jugular vein ligation should be reserved for those cases in which septicemia and embolization do not respond to initial surgery and intravenous antibiotics.

Adult↗
PubMed1981

Long-term middle ear ventilation.

A 15 year experience using wide flange tube for long term ventilation is reported with emphasis on complications and is compared in some respects to a small series of Paparella tube implants. At one time or another 70% of the wide flange tube implants were complicated, as were 100% of the Paparella tubes. The incidence of infection over a long period is high, at times only manageable with removal of the tube. However, longevity when tubes are removed for uncontrolled complication is still almost 3 years and as long as 12 years. The average longevity for electively removed tubes exceeds 4 years. Peritubal drum atrophy is a significant side effect of long-term ventilation and predisposes to permanent perforation. It contributes to spontaneous extrusion which occurred in 5% of the implants. There were 49 permanent perforations in the wide flange series. Yet, a permanent perforation for permanent or severe chronic Eustachian tube dysfunction is not all bad. These permanent, mostly anterior perforations were not associated with much hearing loss; an average of 7.1 bd. Alternative methods to achieve permanent ventilation are discussed and do not seem more reliable or less complication prone.

Adolescent↗
PubMed1976

Acoustic neuroma in von Recklinghausen's disease.

Bilateral acoustic neuromas are common in von Recklinghausen's disease. Their surgical removal likely will produce total hearing loss unless the lesions are small and intracanalicular. Therefore, a posterior fossa myelogram is indicated in all patients when a diagnosis of neurofibromatosis is made. To preserve hearing in resection of small tumors, a middle fossa approach is appropriate. In lesions slightly larger than intracanalicular size, hearing may be preserved with a two-stage middle fossa and transsigmoid approach. The prospect of total hearing loss and even facial diplegia predisposes to surgical procrastination. However, the morbidity and mortality associated with removal of medium and large tumors may be greater for neurofibromatosis than for patients with singular acoustic neuromas. Therefore, we believe it is not advisable to postpone operation when tumors extend into the cerebral pontine angle, even though it means loss of hearing.

Adolescent↗
PubMed1975

Complications of acute frontal sinusitis.

The bone separating the frontal sinus from the anterior cranial fossa and the orbit is often quite thin. This, plus the interrelated venous drainage system of these areas, forms the anatomic basis for serious orbital and intracranial complications that must be recognized early. These include orbital cellulitis and abscess, cavernous sinus thrombosis, subdural and brain abscess and meningitis. Early hospitalization for intravenous antibiotic therapy and, occasionally, emergency surgical drainage are required.

Abscess↗