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Biomedical subjects

J S Reilly

Publications and source records attributed to J S Reilly.

At least 55 records · Page 3Linked to original sources
PubMed1988

Angiolipoma of the parotid: case report and review.

An angiolipoma is a benign adipose tissue tumor that can occur as either a circumscribed or an infiltrating lesion and represents up to 17% of all lipomas. Most angiolipomas occur in teenagers and young adults, and are rarely described in younger children. Angiolipoma generally arises on the extremities or trunk, and it is unusual when found in the head and neck. An angiolipoma of the parotid region was suspected in an infant girl after contrast-enhanced computerized tomographic scan, and was confirmed when the mass was surgically excised. The clinical characteristics, radiological appearance, and histopathology of angiolipoma are discussed.

Female↗
PubMed1987

Jet ventilation for laser laryngeal surgery in children. Modification of the Saunders jet ventilation technique.

In our clinical series, 40-50% O2 and 50-60% N2O (regulated by a blender and delivered by manual jet ventilation (MJV] and residual halothane from induction provided satisfactory supralaryngeal anesthesia. Fentanyl, N2O, atracurium, and lidocaine administered i.v. effectively blunted laryngeal stimulation, allowed control of respiration, and minimized vocal cord motion. Wide unobstructed surgical access to the entire endolarynx is provided. Atracurium (an intermediate-acting non-depolarizing muscle relaxant administered in a single bolus or by constant infusion) achieves the needed level of blockade and permits the anesthesiologist to focus on the pattern of respiration rather than the degree of neuromuscular blockade. Its duration of action seems to be well matched to the average duration of this surgical procedure. Because its reversal is prompt (35-45 min from i.v. injection to 25% recovery by neuromuscular transmission monitor) (Brandom et al., Clinical pharmacology of atracurium in paediatric patients, Br. J. Anaesth., 55 (1983) 117S-121S) children can be discharged safely from the recovery room to home after an appropriate period of observation in the short-stay unit. Our report confirms and extends another recent report supporting supraglottic jet ventilation (Scamman, F.L. and McCabe, B.F., Supraglottic jet ventilation for laser surgery of the larynx in children, Ann. Otol. Rhinol. Laryngol., 95 (1986) 142-145). We believe that the MJV technique is advantageous in children, particularly for outpatient surgery. Attention to detail and careful communication between a skilled anesthesiologist and surgeon are essential. Dangerous barotrauma can occur and skill and monitoring are essential.

Adolescent↗
PubMed1986

Duration of intubation in children with acute epiglottitis.

Nasotracheal intubation has been demonstrated to be effective in supporting the airways of children with acute epiglottitis. Length of intubation and criteria used for extubation are still controversial. A 6-year retrospective review at Children's Hospital of Pittsburgh identified 100 cases of acute epiglottitis, which were initially managed with nasotracheal intubation. Extubation was based on direct laryngeal inspection performed in the operating room (1979-1981) and, more recently, in the intensive care unit (1982-1984). Length of intubation decreased from 63.8 hours in 1979 to 42.1 hours in 1984. The percent of children intubated longer than 48 hours decreased from 69% to 22% in the same time period. These data indicate that a shorter period of intubation is aided by daily laryngeal inspection in the ICU. We propose a staging system for acute epiglottitis to aid in the decision to safely extubate these children.

Acute Disease↗
PubMed1986

Medical management of chronic suppurative otitis media without cholesteatoma in children.

Tympanomastoid surgery is considered standard management for chronic suppurative otitis media (CSOM) without cholesteatoma, which is unresponsive to ototopical/oral antimicrobial therapy. The following makes this sequence of management less attractive today: 1. potential ototoxicity of ototopical agents; 2. lack of oral antimicrobial agents effective against most common pathogens (e.g., Pseudomonas aeruginosa); 3. frequent occurrence in children who have tympanostomy tubes; and 4. failure of tympanomastoid surgery to eradicate the disease in all cases. We conducted a study in 36 pediatric patients with chronic suppurative otitis media, in which all received parenteral antimicrobial therapy and daily aural toilet (mean duration of treatment = 9.7 days). Thirty-two patients (89%) had resolution of their infection with medical therapy alone; four children required tympanomastoidectomy. Further investigation is needed to understand the etiology, pathogenesis, and most effective methods of management/prevention of CSOM in children.

Adolescent↗
PubMed1986

Effect of palatoplasty on the function of the Eustachian tube in children with cleft palate.

Eustachian tube function of 24 children with cleft palate (37 ears) was evaluated longitudinally utilizing the inflation-deflation and forced-response tests before and after palatoplasty. Our results for children in this longitudinal study showed that the passive function of the tube was improved following palatoplasty. Active tubal function, which measures the muscle-induced tubal dilations, was little affected by the procedure. The majority of ears tested both before and after palatoplasty demonstrated tubal dilations with swallowing. In contrast, cross-sectional data conducted on the children with a history of otitis media and repaired cleft palates, documented a severe defect in this active tubal function with 70 percent of the tests evidencing a tubal constriction. These data suggest that the results of Eustachian tube function tests may be prognostic of the future course of ear disease in these children.

Child, Preschool↗
PubMed1985

Airway obstruction in an immunosuppressed child.

Recipients of organ transplants who require continuous immunosuppression appear to have an increased incidence of lymphoproliferative disorders. A case of severe upper airway obstruction resulted from adenotonsillar hypertrophy in a 2-year-old girl following liver transplantation. Tonsillectomy and adenoidectomy dramatically reversed the airway problem and confirmed a transplant-associated lymphoproliferative disorder. A generalized lymphadenopathy also regressed with reduction of cyclosporine immunosuppression. We urge vigilance in monitoring transplant recipients, particularly children, for problems of upper airway obstruction and advocate prompt biopsy of persistently enlarged lymphoid tissue in all immunosuppressed individuals who fail to respond to conventional medical therapy.

Adenoidectomy↗
PubMed1985

Nasal surgery in children with cystic fibrosis: complications and risk management.

Children with cystic fibrosis (CF) are predisposed to pansinusitis and nasal polyposis and, therefore, require frequent surgery by otolaryngologists. These children are at risk to have complications following surgery, both locally, at the surgical site, as well as systemically from their underlying pulmonary disease. A 20-year retrospective study of children (average census 219 per year) revealed 39 children developed nasal polyps and these children required 85 nasal polypectomies. No major complications occurred and only three minor complications (fever, minor bleeding) were noted. Over 95% of our CF children were able to return home in less than 48 hours, and extensive hospital stays appeared not to be required.

Adolescent↗
PubMed1984

Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor.

Maxillary sinus aspiration and quantitative culture of the aspirate were performed in 50 patients, ranging in age from 1 to 16 years, with clinical and radiographic evidence of acute sinusitis. Of 79 sinuses aspirated, at least one was found to be infected in 35 (70%) children. Streptococcus pneumoniae, Branhamella catarrhalis, and Haemophilus influenzae were the most common organisms recovered. All H. influenzae were nontypeable. Twenty percent of the H. influenzae and 27% of the B. catarrhalis organisms were beta-lactamase positive and amoxicillin resistant. The subjects received either amoxicillin or cefaclor at a dose of 40 mg/kg/day in three doses for 10 days. The clinical cure rate with amoxicillin was 81%, compared to 78% with cefaclor. Radiographic improvement was similar in both treatment groups. Antibiotic therapy failed in four patients; three had been given amoxicillin, and one cefaclor. In three of these, a beta-lactamase-positive antibiotic-resistant bacterial species was recovered from the maxillary sinus aspirate; the fourth aspirate was sterile.

Acute Disease↗
PubMed1984

Isolated uvulitis due to Haemophilus influenzae type b.

Infections of the uvula are infrequently recognized and have been previously described only in association with group A streptococcal pharyngitis or Haemophilus influenzae type b epiglottitis. Three cases of H influenzae type b bacteremic uvulitis are described. In suspected cases of H influenzae type b uvulitis, a lateral neck radiograph should be performed and parenteral antibiotics initiated.

Arthritis, Infectious↗
PubMed1983

Treatment of ampicillin-resistant acute otitis media in the chinchilla.

The efficacy of sulbactam sodium (CP45,899-2) was investigated using the chinchilla animal model of acute otitis media with effusion (AOME). Both ears of 78 chinchillas were inoculated with beta-lactamase-producing nontypable Hemophilus influenzae. Half of the animals were treated with ampicillin sodium alone (group A) and the remaining animals received ampicillin plus sulbactam (group B). On day 14, all of the ears in group B were culture-negative whereas H influenzae was recoverable in over 70% of the effusions in group A. Similarly, the course of middle ear effusion was significantly abbreviated in group B during the two-week study period. These findings suggest that sulbactam in combination with ampicillin is effective in treating AOME secondary to infection with beta-lactamase-producing nontypable H influenzae in the chinchilla animal model.

Acute Disease↗
PubMed1983

Airway obstruction in aortic arch anomalies.

Tracheoesophageal compression by aortic arch anomalies is rare. Nevertheless, one must keep this entity in mind because it is associated with significant morbidity. Although it is generally agreed that the barium swallow shows when an abnormal vessel is compressing the esophagus, the literature disagrees on whether a bronchoscopy is needed in the evaluation of these patients. Not uncommonly the symptoms of airway obstruction persist after surgery resolves the anatomic defect. To provide a basis for postoperative comparison, we propose that all patients with suspected aortic arch anomalies undergo endoscopy just before their operation. A series of 26 cases of aortic arch anomalies affecting the airway, seen over a period of 29 years, is presented. A discussion of the clinical presentation, the diagnostic and bronchoscopic findings, and the results of surgical treatment are presented in addition to a brief embryologic and anatomic discussion. A case illustrating the value of preoperative and postoperative bronchoscopy is presented.

Airway Obstruction↗
PubMed1983

The effects of lignocaine spray on the laryngeal mucosa of the cat.

The laryngeal mucosa of cats which had been treated with a lignocaine aerosol spray prior to endotracheal intubation was examined histologically. A degree of oedema and cell damage was apparent. When one side of the larynx was sprayed before intubation and the other side protected in the same cat, cellular damage was greater on the side which received the lignocaine spray. In no cat were the changes considered severe enough to constitute a post-anaesthetic hazard.

Aerosols↗