PubMed Health⌕ Search

Biomedical subjects

James Chan

Publications and source records attributed to James Chan.

26 records · Page 2Linked to original sources
PubMed2003

Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children.

OBJECTIVE: We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery. STUDY DESIGN: We conducted a retrospective case series at a tertiary children's hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB. RESULTS: Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery. CONCLUSION: Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.

Child↗
PubMed2003

Malignant giant cell tumor of the sphenoid.

Malignant giant cell tumors (MGCTs) of the sphenoid sinus are extremely rare neoplasms. They are challenging to diagnose and difficult to treat because of their skull base location. To the best of our knowledge, we report the first case of a primary MGCT of the sphenoid arising in a patient with Paget's disease. A 77-year-old man presented with epistaxis and a history of Paget's disease. There was normal cranial nerve function although radiographic images disclosed a large mass centered in the sphenoid sinus and extending into the ethmoid and maxillary sinuses. Excisional biopsy revealed a MGCT composed of a cellular stroma with increased mitotic activity and necrosis with giant cells present throughout. Additional therapy was declined and the patient died with disease 7 months later. Because of their rarity, no treatment guidelines exist for the management of MGCTs of the sphenoid. We discuss both the diagnostic and therapeutic considerations based on a review of the pertinent literature.

Aged↗
PubMed2003

Treatment of subglottic stenosis, due to Wegener's granulomatosis, with intralesional corticosteroids and dilation.

OBJECTIVE: To determine the longterm efficacy of intralesional long-acting corticosteroid injection plus dilatation (ILCD) for subglottic stenosis (SGS) in Wegener's granulomatosis (WG). METHODS: Since November 1994, all patients with WG who presented with SGS of more than 50% or symptoms of airway compromise were treated with intralesional injection of methylprednisolone acetate, injected directly into the stenotic segment, followed by microsurgical lysis of the stenotic ring and serial dilatation with Maloney bougies or Fogarty catheter balloon. The procedure was repeated at a later date if re-stenosis occurred. Patient outcome was evaluated over a period of 7 years. RESULTS: Twenty-one patients underwent 64 procedures. Mean followup was 40.6 months. Patients who did not have scarring from prior procedures required a mean of 2.4 procedures at mean intervals of 11.6 months to maintain subglottic patency. Patients with established laryngotracheal scarring required a mean of 4.1 procedures at mean intervals of 6.8 months to maintain patency. None of the 21 patients required a new tracheostomy. Only 2 significant complications occurred, both pneumothoraces. There were no adverse longterm sequelae. CONCLUSION: ILCD is effective therapy for SGS due to WG. Best results are obtained when these endoscopic techniques are performed prior to other forms of surgery, which may produce extensive scar formation. Based on this experience, the authors recommend ILCD as the preferred therapy in WG-SGS.

Adult↗
PubMed2002

Power-assisted adenoidectomy: total and partial resection.

OBJECTIVE: To describe the surgical technique for power-assisted adenoidectomy and review the safety and effectiveness of the procedure. STUDY DESIGN: Retrospective review. METHODS: Power-assisted adenoidectomy uses a curved microdebrider shaver blade that conforms to the nasopharynx. The action of the shaver is controlled through visualization using a laryngeal mirror. Power-assisted adenoidectomy is started high in the nasopharynx, with resection beginning in the most superior aspect of the adenoid pad and moving inferiorly to the base of the pad. The cutting edge of the microdebrider remains in view continuously. RESULTS: Between 1998 and 2001, we performed power-assisted adenoidectomy in 677 children and conducted both retrospective and prospective reviews of our experience. No instances of excess intraoperative blood loss (>150 mL), postoperative hemorrhage, velopharyngeal insufficiency, or other complication associated with adenoidectomy have occurred. CONCLUSION: We have consistently demonstrated that power-assisted adenoidectomy is precise, rapid, and safe.

Adenoidectomy↗
PubMed2002

New approaches to the management of subglottic stenosis in Wegener's granulomatosis.

Further development of conservative endoscopic procedures at the CCF has provided patients with dependable surgical adjuncts to the systemic medications of WG. In most instances, a single surgical dilatation procedure stabilizes the patients at an airway diameter that exceeds 50% of the norm, thereby rendering the patient almost asymptomatic at rest and minimally restricted during exercise. The more chronic patients presenting with history of previous surgical procedures performed on their larynx and trachea, usually in other institutions, have been observed to require consecutive treatments after the original treatment, enjoying shorter symptom-free intervals. We have not encountered any local complications such as damage to the vocal cords, altered voice, or compromised structural integrity of the larynx and the trachea. The procedure has been found to be effective and well-tolerated as a means for treating, maintaining, and rehabilitating patients with chronic airway obstruction, particularly in those that have been initially treated by our service, and those that were managed from the very beginning of their disease. However, even the more difficult and complicated cases clearly demonstrate an improvement in their condition through the above treatment protocol, and the interval between treatments gradually increases in this group as well. The more aggressive long-term tube-free tracheostomy procedure, usually performed only on difficult and select patients with severe complications, has proven itself to be a highly gratifying procedure, achieving a permanent mode of management for these patients which safely allows for almost complete freedom from symptoms combined with good tolerance and functional rehabilitation. Video documentation will serve to further demonstrate the beneficial effects of both these modes of treatment.

Dilatation↗
PubMedDate not supplied

Lateral sinus thrombosis associated with zoster sine herpete.

Herpes zoster results from reactivation of the varicella zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. A 55-year-old woman presented with a 3-day history of left temporal and postauricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A computed tomography scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. Magnetic resonance imaging and magnetic resonance angiogram confirmed these findings. Laboratory studies revealed elevated neurotrophic immunoglobulin G levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anticoagulation. Her symptoms improved, and she was discharged 3 days later. LST is generally a complication of middle ear infection. Nonseptic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary in such cases so that a different treatment course can be identified and antiviral medication initiated promptly.

Clinical Laboratory Techniques↗
PubMedDate not supplied

A rare case of mucoepidermoid carcinoma of the thyroid.

OBJECTIVES: The aim of the study was to report a recent case of mucoepidermoid carcinoma (MEC) of the thyroid, review the pertinent literature, and highlight the importance of multimodal treatment in this potentially aggressive malignancy. STUDY DESIGN: The study comprise a case report and a review of literature. METHODS: A 42-year-old woman had initially presented to another hospital with a painful left neck mass. She subsequently underwent left hemithyroidectomy. Surgical pathology was significant for lymphocytic thyroiditis and MEC. One month later, she presented to us with a right neck mass. RESULTS: The patient underwent completion thyroidectomy and selective neck dissection, including level 6, for high-grade MEC. Operative findings included 3 lymph nodes positive for metastasis and tumor invasion of the transverse cervical vein. Postoperative chemoradiation therapy was administered in 2 cycles separated by 1 month. The patient remains disease-free 22 months after the last treatment. CONCLUSION: Mucoepidermoid carcinoma is a rare malignancy of the thyroid with less than 35 cases reported to date. The origins of this tumor are not completely understood, with debate regarding whether it arises from solid cell nests of the ultimobranchial apparatus or from follicular epithelium. Although MEC of the thyroid has frequently been reported as low grade, the aggressive presentation in our patient suggests the appropriateness of multimodal therapy.

Adult↗