[Dyspnea or stridor?].
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Diagnosis, Differential↗
Biomedical subjects
P Illum
Publications and source records attributed to P Illum.
Septoplasty and compensatory inferior turbinate hypertrophy: long-term results after randomized turbinoplasty.
In patients with septal deviation, compensatory inferior turbinate hypertrophy in the side of the nose opposite the major septal deviation is often found. Although turbinectomy in connection with septoplasty is a relatively common clinical procedure, the effectiveness of the procedure is unknown, and the indications and technique applied vary considerably. Fifty patients with nasal obstruction and anterior septal deviations responded to a questionnaire 5 years after operation. Thirty-seven of these patients were available for objective examinations and acoustic rhinometry. In connection with their operations patients had been randomized into two groups. Septoplasty was performed in one group, while the other had a septoplasty supplemented with an anterior inferior turbinoplasty performed on the side opposite the major septal deviation. The subjective overall evaluation was not influenced by turbinoplasty, and no changes in the frequency of crusting were found. In all, 24% of the patients were dissatisfied with the results of surgery, and only 43% were completely satisfied with final results. No influence of turbinate reduction was detectable. Acoustic rhinometry also showed, that there was still a marked difference between the dimensions of the two sides of the nose, and that postoperative spatial conditions were still decreased on both sides when compared with normal controls.
Acoustics↗
Preincisional infiltration with bupivacaine in tonsillectomy.
OBJECTIVE: To investigate the value of preincisional peritonsillar infiltration of bupivacaine hydrochloride before tonsillectomy under general anesthesia. DESIGN: Double-blind trial with two groups comparing 0.25% bupivacaine with placebo (normal saline). The patients were followed up for 10 days after surgery. SETTING: Department of Otolaryngology, University Hospital of Aarhus (Denmark). PATIENTS: Men and women 18 to 40 years of age referred to our department for bilateral tonsillectomy, but with no sign of acute infection or suspected malignant neoplasm. Twenty-six patients entered the study; five were excluded for failure to complete the postoperative data; and two, one from each group, had postoperative bleeding. Data from 19 patients were analyzed, nine in the bupivacaine group and 10 in the placebo group. INTERVENTION: One group had 5 mL of 0.25% bupivacaine hydrochloride (Marcaine) infiltrated around each tonsil, the other an identical placebo (normal saline) infiltration. OUTCOME MEASURES: A visual analogue scale was used as the primary efficacy measure. The daily intake of analgesics and a possible weight loss were registered. RESULTS: A notably lower score on the visual analogue scale was found in the bupivacaine group. CONCLUSIONS: Preoperative blocking of nociceptive impulses reduces prolonged postoperative pain, but no reduction in the intake of analgesics was found. Medication was insufficient for the first postoperative days.
Adolescent↗
Bilateral inferior turbinoplasty in chronic nasal obstruction.
Bilateral inferior turbinoplasty was performed in cases of chronic nasal obstruction, in which conservative treatment had failed. Forty-five patients without significant septal deviation and with chronic nasal obstruction were objectively evaluated by acoustic rhinometry (AR) before and 3-6 months after turbinoplasty, in order to assess the changes of the dimensions of the nasal cavity obtained. Mucosal turbinate hypertrophy (defined objectively by AR) was present in 76% of the cases. Satisfactory subjective nasal patency was achieved in 93% of patients. Turbinoplasty resulted in an increase of 22% at the minimum cross-sectional area, 37% at the cross-sectional area 3.3 cm from the nostrils, and 47% at the cross-sectional area 4.0 cm from the nostrils. The increase was not related to the subjective result of the operation. Tendency to crusting and to vasomotor symptoms were related to unsatisfactory results. No crusting or bleeding were observed.
Adult↗
CO2-laser therapy for carcinoma of the larynx.
A retrospective study was undertaken to assess the outcome of 19 consecutive patients, who underwent endolaryngeal resection with a CO2-laser for laryngeal carcinomas. Sixteen of these patients had recurrences after primary curative radiotherapy. Seventeen of the patients had a curative operation carried out. So far, four CO2-laser treatment failures have been observed (median observation time 35 months). None of the patients needed tracheostomy in connection with the operation. Voice quality was in all cases acceptable. It is recommended, that small recurrences (after radiotherapy of laryngeal squamous cell carcinomas) should be considered for a partial laryngectomy with the aid of a laser.
Adult↗
Rhabdomyoma of the larynx: a review of the literature with a summary of previously described cases of rhabdomyoma of the larynx and a report of a new case.
A review of extracardial rhabdomyomas of the larynx reported in the literature is presented. A new case is added (the largest described yet). The diagnosis was based on routine histological and immunohistological staining, and electron microscopy. The extracardial rhabdomyomas were divided into three types according to histopathological findings: (i) adult; (ii) foetal cellular type; and (iii) foetal myxoid. There are 23 well-documented cases (including this case) of extracardial rhabdomyomas of the larynx; 15 of the adult type, four of the foetal myxoid type and four of the foetal cellular type. The differential diagnosis and the requisite diagnostic procedure is discussed. The tumour is benign. The treatment is surgical excision. Although rare, its existence should be kept in mind in the differential diagnosis of laryngeal tumours.
Diagnosis, Differential↗
[Long-term treatment with octreotide of patients with acromegaly].
We bring our experiences with and results of octreotide treatment for 0.5 to seven years in 26 highly selected acromegalic patients, i.e. they had almost all been operated upon before or were for other reasons not first-choice neurosurgical candidates. Sixteen patients responded immediately to octreotide and achieved good control of symptoms and average serum growth hormone levels below 5 micrograms/l. Five additional patients responded adequately to octreotide after a renewed neurosurgical attempt, and two other patients achieved satisfactory control after successful neurosurgery. Thus we had to resort to radiation therapy in three out of these 26 patients. We should like to emphasize the fact that acromegalic patients, who initially do not respond adequately to octreotide therapy, may often do so after a renewed partial adenomectomy. Octreotide therapy has in our hands been practically without side effects, apart from gastrointestinal symptoms during the initial days of treatment. All 26 patients had an ultrasound-scan of the gallbladder and biliary tracts before and during long-term octreotide administration, and with the exception of one patient with gallbladder sediment, in whom no pretreatment scanning had been performed, we had no development of biliary tract abnormalities in these up to 65 year old patients. This may be due to composition and timing of meal intake in relation to that of octreotide. Fecal fat excretion, D-vitamin metabolites in serum and prothrombin time were similar in octreotide-treated and untreated acromegalic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Acromegaly↗
Septoplasty and compensatory inferior turbinate hypertrophy: a randomized study evaluated by acoustic rhinometry.
The present study deals with the indication for inferior turbinate surgery in cases of concomitant anterior septal deviation. We define, by acoustic rhinometry, the characteristics of the obstructed nose and define mucosal turbinate hypertrophy. A random sample of 80 patients with nasal obstruction and anteriorly located septal deviation were objectively evaluated by acoustic rhinometry pre- and post-operatively. All had septoplasty and half were randomly selected to have anterior inferior turbinoplasty performed in the side opposite to the major septal deviation. Severe septal deviation, expressed by a minimal cross-sectional area less than 0.4 cm2 was present in 37 patients. In this group inferior turbinate reduction seems advisable. In the wide side, the minimal cross-sectional area and the cross-sectional areas at 3.3 and 4.0 cm from the nostrils increased in the turbinectomy group and decreased in the non-turbinectomy group after correction of the septal deviation. In the group with less pronounced septal deviation no influence of turbinate reduction could be detected.
Adolescent↗
The effect of budesonide (Rhinocort) in the treatment of small and medium-sized nasal polyps.
The objectives of this study were to determine if the size of nasal polyps could be assessed in a reproducible way and to study the effect of budesonide in patients suffering from eosinophilic nasal polyposis with small and medium sized polyps. Ninety-one patients entered the study. Budesonide 200 micrograms b.i.d. (aerosol or aqua) and placebo (aerosol or aqua) were compared in a 3-month double-blind, multi-centre, randomized study. Efficacy was measured by an assessment of polyp size, nasal peak-flow index and the patient's assessment of nasal symptoms. The conclusions were that the size of polyps could be assessed in a reproducible way, and that budesonide delivered either as a water-based suspension or as an aerosol is effective in the treatment of patients with small and medium sized polyps.
Administration, Topical↗
[Treatment of vocal cord paresis with Teflon injections].
Twenty-five patients suffering from unilateral paresis of the vocal cord of differing durations caused by benign diseases and 25 patients with unilateral paresis caused by malignant tumours in the thorax/mediastinum were treated with Teflon injection of the paretic vocal cord. The results of treatment were evaluated by a speech therapist by voice recording pre-operatively, three weeks post-operatively and at a later control. This evaluation together with self-assessment demonstrated a satisfactory result even the long term result. In 2/3 of the patients good voice function was found at later control. The results indicated that the injection of Teflon is effective and should also be offered to patients with malignant diseases in spite of the poor prognosis quo ad vitam. No serious complications were seen in the post-operative period.
Adult↗
Preliminary results with Sandostatin nasal powder in acromegalic patients.
This report details the first half of a double-blind, crossover sequence (Latin square) study of local and hormonal effects of nasally insufflated Sandostatin compared with those of subcutaneously injected Sandostatin. Nine of the planned 16 patients have been studied. They received a single application of 0.5, 1.0, and 2.0 mg Sandostatin as nasal powder and 0.1 mg by subcutaneous (SC) injection. The results indicate that absorption from the nasal epithelium occurs after approximately 10 minutes and comprises approximately 20% of the dose administered. This indicates that peak serum Sandostatin values occur very rapidly, ie, 10 minutes after application. After approximately 2 hours, the serum disappearance rates are similar to those obtained after SC injection. The suppressive effect on serum growth hormone (GH) levels is equal with the two forms of application and suggests that future clinical treatment with an intranasal application of 0.5 mg thrice daily is feasible. No side effects were noted apart from an immediate swelling of nasal mucosa, which receded gradually over the following 2 hours. This was either unnoticed or considered insignificant by the patients and will probably be deemed harmless by the rhinologist in eventual long-term clinical trials.
Absorption↗
Nasal packing after septoplasty.
A prospective study to compare 3 different types of nasal pack after septoplasty with or without a supplementary turbinectomy has been performed with respect to discomfort and complications caused by the packing and the short-term results evaluated 3 months after operation. Fingerstall packings gave less problems than either Merocel or hydrocortisone-terramycine gauze packs with ventilation tubes. They were easier to remove and were associated with less persistent secretion in the post-operative period. No definite advantage from the patient's point of view has been demonstrated by the use of tubes and nasal packing. An analysis of the nasal patency 3 months post-operatively by peak-flow index and acoustic rhinometry revealed no differences between groups.
Adolescent↗
A randomized comparison of intranasal and injectable octreotide administration in patients with acromegaly.
Fifteen acromegalic patients received four single doses of octreotide in random order (500 micrograms, 1000 micrograms, and 2000 micrograms applied intranasally and 100 micrograms given sc). Serum octreotide and GH data were subjected to pharmacokinetic analyses, and local nasal effects were evaluated by acoustic rhinometry. Average areas (+/- SEM) under the serum octreotide curves were: 2000 micrograms: 4597 +/- 536; 1000 micrograms: 1923 +/- 439; 500 micrograms: 957 +/- 168; and 100 micrograms sc: 896 +/- 81 micrograms.L-1.min (n = 13). The calculated relative availability was 27% +/- 0.03; 22% +/- 0.05; 22% +/- 0.03, respectively, for the three nasal doses. The rate of absorption after intranasally administered octreotide was greater than after sc application: t1/2 ka: 7.1 +/- 1.6; 7.9 +/- 1.6; 11.3 +/- 1.9, respectively, vs. 24.1 +/- 2.5 min, whereas the rates of disappearance were similar. GH suppression started immediately after application and reached minimum levels 1-2 h later. The average intervals during which serum GH was below 50% of preadministration values were: 2000 micrograms: 544 +/- 47; 1000 micrograms: 423 +/- 56; 500 micrograms: 289 +/- 52 vs. 351 +/- 34 min after sc injection of 100 micrograms. With 2000 micrograms intranasally all but one of the 15 patients attained constant suppression of serum GH below 5 micrograms/L for 273 to 680 min. Pharmacokinetic analysis demonstrated that 100 micrograms sc and 1000 micrograms intranasally induced the same GH suppressive effect and that 2000 micrograms intranasally approximately doubled the duration of action. Acoustic rhinometry was performed after nasal application of the largest dose of 2000 micrograms and after carrier (n = 9). A highly significant tumescence of the nasal mucosa was maximal after 10 min and gradually receded over the next 2 h. However, this was felt by the patients to be acceptable. The effect was caused by octreotide per se and was probably due to vasodilation.
Acromegaly↗
Legal aspects in nasal fractures.
A criminal act is involved in a high percentage of cases of nasal fracture, and exact medical information describing the damages found is mandatory for the criminal court. It is necessary, that the medical information are obtained from the ENT-department, where the patient is treated, as the information obtained from the casualty department has a too low degree of truth in the establishment of the diagnosis. The statement should include information on the treatment given, as linear fractures in good position requiring no treatment may be classified legally as an offence against the person rather than as a bodily harm. X-ray examination of the nose in cases of nasal fracture gives a much too high number of false positive and false negative results to have any legal value, and, having no medical value as well, they should not be taken unless for scientific purposes.
Denmark↗
[Zenker's diverticulum].
During a period of 25 years, 115 patients with Zenker's diverticulum were submitted to diverticulectomy in the Ear-Nose and Throat Department of Arhus Municipal Hospital. The condition recurred in 18 of the patients treated operatively. In 24 patients (21%), local complications most of which were infective occurred. Ten patients developed paresis of the recurrent nerve and this was permanent in half of these. Thirteen patients (11%) developed other complications which were most frequently infective and one death occurred. It was found that postoperative prophylactic antibiotic treatment could reduce the number of local infective complications significantly and that there was a correlation between the occurrence of local infective complications and subsequent recurrences. No connection was found between the occurrence of local or other complications and the age of the patient. The endoscopic operative technique with CO2-laser has proved a rapid and safe method of treatment which appears to result in fewer complications and briefer periods of hospitalization.
Adult↗
Surgical treatment of Zenker's diverticulum.
One-hundred-and-fifty patients with Zenker's diverticulum were reviewed; twelve patients received no treatment; 26 patients were treated endoscopically by dilatation, five of these had a diverticulectomy performed at a later stage. One-hundred-and-ten patients had a diverticulectomy performed (a total of 115 primary operations were performed). Eighteen of the patients operated upon had a recurrence and six underwent re-operation. Local complications occurred in 24 patients. Seven patients had a fistula and two had mediastinitis. Ten patients had recurrent nerve palsy, of which five were permanent. Thirteen patients had other complications, usually infection. One death occurred. Post-operative prophylactic treatment with antibiotics was found to significantly reduce the number of local infectious complications and a correlation was found between the occurrence of local, infectious complications and later recurrence of the pouch.
Adult↗
Resection with laser and high frequency cutting loop in tracheo-bronchial diseases.
A total of 23 patients have been treated endoscopically during the last three and a half years for a variety of diseases in the tracheo-bronchial tree; nine had a tracheal stenosis. Thirteen patients have been treated by resection with a high frequency cutting loop, eleven with a CO2-laser and one with an argon laser. A total of 44 treatments have been performed. Half of the treatments were given because of various malignant diseases. The results of the treatment of this very mixed group of patients were, as a whole, satisfactory with both CO2-laser and cutting loop. A more precise technique can be applied with the CO2-laser than the cutting loop, though the latter is the more efficient and easy to work with. Care must be taken with the loop because of its greater cutting depth. The argon laser has only limited use in the treatment of diseases in the trachea.
Bronchial Diseases↗
Hereditary hemorrhagic telangiectasia treated by laser surgery.
Hereditary hemorrhagic telangiectasia (Osler's disease) is a rare, inherited abnormality of the subepithelial vessels causing severe nose bleed as the most predominant symptom. The most efficient treatment has, until now, been dermoplasty of the nasal septum and cavity. There have been a few reports on treatment with CO2-, argon- or Nd-YAG-lasers, which have been encouraging. Ten patients with Osler's disease were treated for severe epistaxis. Three were treated with CO2-laser, two of these under general anaesthesia. Seven patients were treated with the argon laser under local anaesthesia. A variety of other sites were treated at the same time for functional or cosmetic reasons (mouth, face, fingers, rectum). Good results were obtained in eight cases. In three of the cases the observation period was more than two years. A second treatment has been necessary in three cases. Two other patients were treated recently, and it is too early to judge the results. The argon-laser is more convenient for this purpose than the CO2-laser. The method is quick and reliable and there is no need for hospitalization. The treatment can be repeated without permanent damage to the function of the nose.
Adult↗