PubMed Health⌕ Search

Biomedical subjects

L Feenstra

Publications and source records attributed to L Feenstra.

At least 19 recordsLinked to original sources
PubMed1992

Temporal bone resections for carcinoma of the middle ear and the external ear canal.

Petrosectomy has been used in the management of carcinoma of the external ear canal and the middle ear for the last 45 years. In recent years, there have been conflicting reports; some authors advocate a conservative approach, whereas others support an ultraradical approach. Most retrospective studies report patients who have been treated with radiotherapy or surgery as having undergone the primary modality depending on where the patient first presented. No selection criteria seem to have been employed. Although radiotherapy was used postoperatively, the problems of wound healing were not addressed. This study presents our experience with temporal bone resection as described by Lewis and shows that, in combination with patient selection and proper choice of incision, reconstruction and timely postoperative radiotherapy can achieve better results, and the patient's quality of life can be preserved.

Combined Modality Therapy↗
PubMed1992

Results of full-thickness laryngotracheal wall reconstruction: a survey of the literature.

Full-thickness reconstruction of the laryngotracheal wall is needed after tumour removal, and also in patients where lumen augmentation is required to resolve laryngotracheal stenosis. For repairing such defects, several techniques are available. All techniques are more successful when small defects are reconstructed and less successful when there is a major deficit. The main problem with most methods of reconstruction is their unreliable blood supply which becomes most obvious in repairing larger areas.

Humans↗
PubMed1992

Comparison of intrinsic versus paced ventricular function.

UNLABELLED: There is increasing evidence supporting the benefits of providing optimum AV delay in cardiac pacing, though controversy exists regarding its value and the benefits of intrinsic versus paced ventricular activation. This study compared various AV delays at rest in patients whose native AV delays were > or = 200 msec. Only patients with DDD pacemakers who had intact AV conduction and normal ventricular activation were included in the study. Nine patients were studied. METHODS: Ten studies were performed. Evaluation was done in AAI and DDD modes at paced heart rates of 60/min or as close as possible to the intrinsic heart rate if this was > 60/min. Stroke volume (SV) and cardiac output (CO) were measured. RESULTS: When AV sequential pacing in the DDD mode with an optimum AV delay was compared to AAI pacing with a prolonged AV interval, the average optimum AV delay in the DDD mode was 157 msec and ranged from 125 to 175 msec. The average AV interval in the AAI mode was 245 msec and ranged from 212 to 300 msec. In the DDD mode, there was an overall significant improvement in CO of 11% and SV of 9%. Patients with intrinsic AV conduction times of > 220 msec showed an overall significant improvement in CO of 13% and SV of 11%. In patients with intrinsic AV conduction times of < 220 msec, an improvement in CO of 6% and SV of 4% was seen. CONCLUSIONS: (1) An optimum AV delay is an important component of hemodynamic performance; and (2) AV sequential pacing at rest with an optimum AV delay may provide better hemodynamic performance than atrial pacing with intrinsic ventricular conduction when native AV conduction is prolonged > 220 msec.

Aged↗
PubMed1992

Postoperative imaging of labyrinthine fistulae in cholesteatomas.

We evaluated the morphology of three operatively closed labyrinthine fistulae which were due to acquired middle ear cholesteatoma in three patients. In all three cases the fistula location was in the horizontal semicircular canal. The fistulae were closed by a mixture of bone powder and Tissucol. The layer closing the fistula was in all cases indistinguishable from the bony otic capsule on the postoperative CT.

Adult↗
PubMed1992

Dysthyroid orbitopathy and orbital decompression. A review.

In the treatment of severe manifestations of dysthyroid orbitopathy, such as optic neuropathy and exposure keratitis, orbital decompression occasionally may be performed if steroids fail. In general, medial and inferior orbital wall decompression gives satisfactory results. The route may be transantral, but the transconjunctival or endonasal approach may be more appropriate for extraocular muscle balance and optic neuropathy respectively.

Graves Disease↗
PubMed1992

Optic nerve decompression for indirect posterior optic nerve trauma.

Posterior indirect optic nerve trauma is a rare but possibly dramatic event. Since spontaneous recovery is unlikely, medical treatment by megadose steroid therapy is advocated. Optic nerve decompression may be usefull, but is still controversial. Medial optic canal wall decompression seems best and may be achieved by various approaches.

Adult↗
PubMed1990

Comparative evaluation of rate modulated dual chamber and VVIR pacing.

While dual chamber pacing is considered superior to VVI pacing at rest, there is a continuing debate as to the relative benefit of AV synchrony versus rate increase with exercise. To evaluate this question and to correlate different methods of evaluation, 14 patients with DDDR pacemakers were studied using serial treadmill exercise test with a CAEP protocol. Patients were exercised in DDD, DDDR, and VVIR modes. Echo-Doppler cardiac outputs were determined and pulmonary gas exchange was measured during exercise. There was a significant improvement in cardiac output with exercise in the DDDR versus VVIR modes, and in DDDR versus DDD modes in patients with chronotropic incompetence. There were small increases in exercise duration in DDDR versus VVIR modes, and small but consistent increases in VO2 at all levels of exercise, though not statistically significant. In this group of patients, DDDR pacing was superior to VVIR pacing, and superior to DDD pacing when chronotropic incompetence was present.

Aged↗
PubMed1989

[Premedication in ENT operations under local anesthesia].

Midazolam 15 mg orally, was compared with the combination of pentobarbital, promethazine, opial and scopolamine as premedication for ear surgery under local anaesthesia in the first of a series of three double blind clinical trials. Sedation, pain sensation and appreciation by patient and surgeon alike were in favour of the pentobarbital regime. Anxiolysis was the same for both regimes. The number of actions needed to administer the medication was basically lower for midazolam. Comparing in a similar, second study midazolam 15 mg with higher doses of 20 mg and 25 mg, the results were satisfactory with the highest dose. Pain during the administration of the local anaesthesia was felt in 16% of the patients. Adding 10 mg morphine intramuscularly in a third study did not prove to diminish the percentage of patients with pain complaints. It is concluded that 25 mg midazolam taken orally 45 minutes pre-operatively is a satisfactory premedication for ear surgery and less troublesome than the pentobarbital, promethazine, opial, scopolamine we used before. In day-care surgery this short acting premedication in our opinion is quite useful.

Adolescent↗
PubMed1989

[Causes and results of reoperations following stapedectomy].

The records of 145 patients who underwent revision stapedectomy were analysed to determine the causes of failure of the previous operation, the hearing results and the postoperative complaints. Displacement of the prosthesis was the most common cause of failure (49%). Other surgical findings, sometimes in combination, were a short prosthesis (35%), middle ear adhesions (23%), otosclerotic regrowth (14%) and eroded incus (10%). No specific cause of failure was identified in 6% of the revisions. Thirty-eight per cent of revision operations resulted in a hearing gain to a level less than 10 dB conduction loss and 61% to less than 20 dB. Slight sensorineural hearing loss after revision surgery occurred in 5%. 'Dead ears' were encountered in 2% as against 0.6% in the primary cases. Tinnitus was the most common complaint (21%) at the 3 week postoperative follow-up, declining to 7% four months postoperatively.

Adolescent↗
PubMed1989

The effect of stapedectomy on speech intelligibility in noise.

Speech intelligibility in noise was tested pre- and postoperatively after 27 stapedectomy cases and 10 cases of reexploration after previous stapes surgery. We did not find a postoperative threshold shift (signal-to-noise ratio) for the intelligibility of sentences presented in noise. This finding corresponds well with the absence of postoperative high-frequency sensorineural loss in these patients. Using two types of prostheses we found a significant amelioration of speech intelligibility in quiet for the Schuknecht minihole prosthesis as compared to the House wire loop.

Adult↗