Benign paroxysmal positional vertigo.
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Humans↗
Biomedical subjects
Malcolm Hilton
Publications and source records attributed to Malcolm Hilton.
Prognostic value of the blink reflex in acoustic neuroma surgery.
OBJECTIVE: The study goal was to demonstrate that blink reflex analysis can predict postoperative facial nerve outcome in cerebellopontine angle tumor surgery. STUDY DESIGN, SETTING, AND PATIENTS: In an open and prospective study conducted at a single tertiary care center over 3 years, 91 subjects with a vestibular schwannoma filling the internal auditory meatus were enrolled and operated on via a translabyrinthine approach. The difference in latency of the early response (DeltaR1) of the blink reflex between the pathologic side and the healthy side was calculated in every patient during a complete electrophysiologic examination of the facial nerve performed on the day before surgery. MIN OUTCOME MEASURES: DeltaR1 was compared with the other preoperative data (tumor volume, facial function), with the perioperative observations (difficulties with the dissection of the facial nerve), and especially with the postoperative status after 1 year. The statistical study was conducted using polynomial regression. RESULTS: Patients with a negative or zero DeltaR1 have normal facial function at 1 year. For those with a positive DeltaR1 the outcome is not favorable unless the tumor is small. For patients presenting with an immediate complete facial paralysis, the value of DeltaR1 is also indicative of facial function outcome. CONCLUSION: Statistical analysis shows that the blink reflex, through DeltaR1, has an excellent prognostic value in anticipating the difficulties with facial nerve dissection and postoperative facial function after 1 year.
Adult↗
Deoxyribonucleic acid fingerprinting in an outbreak of Staphylococcus aureus intracranial infection after neurotologic surgery.
BACKGROUND: Meningitis is the most common life-threatening infection occurring as an early postoperative complication of neurotologic surgery. From January to March 2001, Staphylococcus aureus intracranial infection developed in three patients; two cases were consecutive. METHODS: All staff members involved in surgery on any of the three patients had nasal swabs for S. aureus. The three patient isolates and all S. aureus isolates from staff members were typed by pulsed-field gel electrophoresis. Operating room procedures were reviewed. RESULTS: All three patient isolates were identical by pulsed-field gel electrophoresis. Six staff members (40%) were found to be S. aureus carriers. The isolate from one staff members was identical to the patient isolates. A procedure audit of the operating room revealed several breaks in recommended practice. The staff carrier was immediately removed from patient care duties, given decolonization therapy, and treated for chronic rhinosinusitis. Practice changes in the operating room were implemented. CONCLUSIONS: S. aureus remains a common cause of surgical site infections. S. aureus carriage is common, and carriers with intercurrent respiratory infections have increased shedding and are a higher risk to patients. Proper use of barrier devices and consistent hand hygiene reduce bacterial contamination of the wound. Current operating room technology involves technical personnel not traditionally trained in operating room procedures. Epidemiologic investigation may be delayed if operating room records are incomplete with respect to these personnel. Molecular typing of bacterial isolates can identify common source outbreaks and effectively focus investigations.
Adult↗
Outcome of neck dissection for node-positive melanoma.
OBJECTIVE: To determine the rates of regional recurrence for node-positive melanoma after neck dissection alone. DESIGN: Retrospective review from a single tertiary care institution. METHODS: Data were obtained for all patients receiving neck dissection from 1990 to 1997 at Sunnybrook and Women's Health Sciences Center. Analysis was performed using the Kaplan-Meier method. RESULTS: Thirty-one patients underwent neck dissection for node-positive melanoma in the study period. The rate of regional recurrence was 31% at 5 years. The mean time to recurrence was 78 months. CONCLUSION: Neck dissection alone may be appropriate for some patients, but those with more advanced neck disease are likely to benefit from adjuvant radiotherapy.
Head and Neck Neoplasms↗