PubMed Health⌕ Search

Biomedical subjects

J L Pulec

Publications and source records attributed to J L Pulec.

At least 73 records · Page 4Linked to original sources
PubMed1998

Cholesteatoma of the cerebellopontine angle.

Congenital cholesteatoma is the third most common tumor found in the cerebellopontine angle. It must be differentiated from acoustic neuromas, meningiomas, metastatic tumors, arachnoid cysts and lipomas. Symptoms include hemifacial spasm, progressive facial paralysis, hearing loss, tinnitus, vertigo, pain and otorrhea. Radiologic and magnetic resonance imaging frequently can be useful to establish a preoperative diagnosis. The treatment of choice is total removal of the lesion. Complete removal with preservation of normal structures is the most difficult and technically exacting procedure performed by the neurotologic surgeon. The clinical features and results from a series of 19 cases, nine of which extended into the cerebellopontine angle, are discussed.

Aged↗
PubMed1997

Ablation of posterior semicircular canal for benign paroxysmal positional vertigo.

Obstruction of the posterior semicircular canal to prevent fluid movement without injury to the neurosensory end organ has been shown to be effective treatment for benign paroxysmal positional vertigo. Risk of injury to the inner ear with loss of hearing has been reported with a variety of techniques. This paper will describe a modification of the procedure to ablate the posterior semicircular canal and to minimize the risk of inner ear injury. The procedure has been performed on 17 patients with prompt and lasting relief of vertigo and no hearing loss. The procedure seems to be a valuable and effective treatment for the disturbing condition of benign paroxysmal positional vertigo.

Adult↗
PubMed1997

Vestibular nerve pathology in cases of intractable vertigo: an electronmicroscopic study.

OBJECTIVE: This study aimed to determine the absence or presence and the nature of pathology of the vestibular nerve in case of intractable vertigo. STUDY DESIGN: This was a prospective study. SETTING: The study was performed at a private practice tertiary referral center. PATIENTS: There-were 42 patients with intractable vertigo in the study. INTERVENTIONS: All patients received thorough diagnostic examinations and surgical excision of the vestibular nerves. MAIN OUTCOME MEASURES: Segments of the superior and inferior vestibular nerves were surgically removed, preserved in glutaraldehyde, examined by electronmicroscopy, and the findings were correlated with the clinical diagnosis. RESULTS: A variety of different types of pathologic lesions were identified, including axon and supporting cell degeneration, herpes zoster virus, other viruses, results of bacterial infection, and regrowth of nerve after surgical resection. CONCLUSION: The vestibular nerves were found to be histologically normal in lesions primarily involving the end organ such as most early Meniere's disease cases, benign paroxysmal postural vertigo (BPPV), and mild labyrinthine concussion. Vestibular nerve degeneration was seen with advanced Meniere's disease, severe labyrinthine concussion, and with vascular loops in the internal auditory canal. Herpes zoster involves Scarpa ganglion in herpes zoster oticus. Viruses were found in the nuclei of vestibular nerve cells in a patient with delayed hydrops. Regrowth of the vestibular nerve after surgical resection was confirmed in three cases.

Adult↗
PubMed1997

Meniere's disease of syphilitic etiology.

Congenital or acquired syphilis is the cause of Meniere's disease in six percent of all cases. The pathogenesis is endolymphatic hydrops and osteitis of the otic capsule which produces the characteristic fluctuating hearing loss, tinnitus and ear pressure associated with episodic spells of vertigo. The ear symptoms are, at first, typical of Meniere's disease of other etiologies. Failure to establish the specific etiologic diagnosis can result in unnecessary surgical treatment or inappropriate medical therapy. In some cases, if a steroid, the specific treatment, is not given promptly, hearing can be quickly and permanently lost. The etiology is confirmed by obtaining a reactive fluorescent treponema antibody absorption (FTA-abs) test. The clinical features and natural history of Meniere's disease of syphilitic etiology are unique. Ear symptoms often begin in the fifth decade of life, first in one ear and, after a few years, involving the second ear. Reduced or absent caloric responses are characteristic. When hearing loss is severe and sudden, this condition represents a true medical emergency and should be treated with prompt administration of steroids. An endolymphatic subarachnoid shunt operation is occasionally necessary as adjunctive management. An analysis of 34 cases shows that long-term use of steroids can maintain effective hearing for more than 20 years.

Adult↗