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Biomedical subjects

R L Carrau

Publications and source records attributed to R L Carrau.

At least 19 recordsLinked to original sources
PubMed1995

Cost analysis of antibiotic prophylaxis in clean head and neck surgery.

OBJECTIVE: This study was undertaken to assess the excess cost of hospitalization accrued to patients who develop postoperative wound infection following neck dissection in which the wound was not exposed to secretions from the upper aerodigestive tract. DESIGN: A retrospective cohort of patients who underwent "clean" neck dissection from 1976 to 1989 were evaluated. Antibiotic administration (yes or no), post-operative wound infection (yes or no), and duration and cost of hospitalization were assessed. SETTING: All surgeries were performed in a university medical center. PATIENTS: All patients underwent neck dissection in which the procedure was clean, ie, there was no exposure to secretions from the upper aerodigestive tract. MAIN OUTCOME MEASURES: Patients were assessed to determine administration of antibiotics (yes or no), development of postoperative wound infection (yes or no), and duration and cost of hospitalization. RESULTS: Wound infection developed in 10 (10%) of 99 patients who did not receive antibiotics. Of 93 patients who received perioperative antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant. The type II (beta) error was greater than 0.2, suggesting that a significant difference may have been missed (false-negative) as a result of the small number of patients studied. The excess cost accrued to each patient who developed a postoperative wound infection was in excess of $36,000 (1992 dollars). The cost of administration of antibiotic prophylaxis to 100 patients is less than this amount. CONCLUSION: The decision to withhold antibiotic prophylaxis should not be made in an effort to reduce hospital costs.

Adult↗
PubMed1995

Tumor angiogenesis as a predictor of tumor aggressiveness and metastatic potential in squamous cell carcinoma of the head and neck.

Squamous cell carcinoma of the head and neck induces neovascularization to support tumor growth and facilitate the metastatic spread. Others have suggested that the density of microvessels within the tumor correlates with the neovascularization process and therefore with clinical behavior and outcome. To ascertain the value of the microvessel count as an independent prognostic indicator for squamous cel carcinoma of the head and neck, we studied the primary tumors of 44 patients. Histological slides were stained for factor VIII and the individual microvessels were counted on a 200 x field (0.49 mm). No statistically significant difference was found between the microvessel counts of tumors that metastasize or recur locally, as compared with tumors that did not. The possibility of a beta-error due to the small number of cases mandates a larger possibly multi-institutional, study to better ascertain the significance of a microvessel count as an independent prognostic indicator.

Carcinoma, Squamous Cell↗
PubMed1994

Role of skull base surgery for local control of sarcoma of the nasal cavity and paranasal sinuses.

Sarcomas of the nose and paranasal sinuses are rare neoplasms and comprise less than 1% of the malignancies arising in the sinonasal tract. From 1977 to 1989, we had the opportunity to treat 15 patients presenting with these tumors at The Eye & Ear Institute of the University of Pittsburgh. The clinical charts of these patients were reviewed retrospectively for demographic data, characteristics of disease, treatment considerations and clinical outcome. Data were also analyzed with special attention to the role of skull base surgery for the local control of tumors. Seven patients underwent cranial base surgery as part of their original therapy. Two of these patients are alive with no evidence of disease, one patient died of other causes, and four are dead of disease. Two patients died with local disease. Although not statistically significant due to the small number of patients, these data suggest that cranial base surgery can improve the local control of sarcomas of the sinonasal tract that approach or invade the skull base.

Adolescent↗
PubMed1994

Mucoepidermoid carcinoma of the conjunctiva.

Mucoepidermoid carcinoma of the conjunctiva (MECa) is a rare neoplasm. It resembles squamous cell carcinoma (SCCa), clinically and histologically. Nevertheless, it is characterized by a high degree of local aggressiveness. We reviewed all cases of MECa reported in the English literature for epidemiological data, characteristics of the tumor, treatment, and outcome. We found that MECa, reported predominantly in aging males (median age 71 years), arises in the limbal and perilimbal areas. Simple excision is followed by rapid recurrence, and most tumors will require enucleation or exenteration for local control. Histological stains directed to the production of mucin are essential for the diagnosis. The recommended treatment is wide local excision. Enucleation or exenteration is recommended for tumors invading the globe or orbit.

Carcinoma, Mucoepidermoid↗
PubMed1994

Computer-assisted frontal sinusotomy.

An osteoplastic frontal sinus flap with flat obliteration is the "gold" standard for the management of chronic frontal sinus inflammatory disease caused by obstruction of the nasofrontal duct. Frontal sinusotomy, with an osteoplastic technique, call for osteotomies, guided by a template obtained from a Caldwell radiographic view taken at a distance of 6 feet. The reliability of the template depends on the position of the patient, distance at which the radiograph is taken, penetration of the x-rays, and other technical aspects. Therefore the template is a potential source of error. We present the use of a computer-assisted frontal sinusotomy as a method to corroborate the shape and margins of the frontal sinus in six patients undergoing obliterative frontal sinus surgery. In our hands, this technique has proved more reliable than the radiographic template to corroborate the positioning of the osteotomies.

Ethmoid Sinus↗
PubMed1992

Paranasal sinus carcinoma--diagnosis, treatment, and prognosis.

Sinonasal malignancies account for only 3% of all cancers of the head and neck and typically affect Caucasian males who are 50 to 70 years of age. This report identifies a number of risk and environmental factors that have been linked with the development of such malignancies, the clinical presentation of these tumors, clues to the diagnosis, and the pathology of the most commonly encountered types. Treatment of sinonasal malignancies is controversial and depends largely on the type of tumor encountered. The authors describe surgical and chemotherapeutic modalities, used alone and in combination. The controversy surrounding the utility of radiotherapy before or after surgery is also discussed.

Carcinoma↗
PubMed1991

Role of prophylactic antibiotics in uncontaminated neck dissections.

The use of perioperative prophylactic antibiotics in uncontaminated head and neck surgery remains controversial. We performed a retrospective analysis of 192 patients undergoing uncontaminated neck dissections from 1976 to 1989. Wound infection developed in 10% (10/99) of patients who did not receive antibiotics, while only three (3.3%) of 93 patients who received antibiotics developed infections. This difference was not statistically significant. We correlated the use of flaps, length of surgery, prior radiation treatment, and postoperative complications with rate of wound infection. The difference was not statistically significant for any of these variables. Our beta error was, however, greater than 0.2. Our data do not demonstrate efficacy of prophylactic antibiotics in uncontaminated neck dissections with statistical significance; however, a trend exists suggesting its possible value.

Adult↗
PubMed1991

Computerized tomography and magnetic resonance imaging following cranial base surgery.

The computed tomography scans and magnetic resonance imaging films of 57 patients who underwent anterior or anterolateral cranial base surgery from January 1987 to August 1989 were retrospectively reviewed to ascertain the significance of early and late postoperative intracranial imaging changes. Extra-axial changes (air, blood, cerebrospinal fluid collection) were found in 96% of patients; axial changes (brain edema, contusion) were seen in 30% of patients in the first postoperative period (72 hours). Subsequently, extra-axial changes began to resolve but axial changes became more prevalent. After 6 months, only axial changes persisted (encephalomalacia). It was encouraging to find a low correlation of imaging abnormalities with clinically significant findings.

Encephalomalacia↗
PubMed1991

Early complications of tracheotomy. Incidence and management.

Tracheotomy is associated with multiple and potentially life-threatening complications even under elective conditions. Minor bleeding, tube displacement or obstruction, subcutaneous emphysema, and pneumothorax are the most commonly encountered complications. Attention to details and the availability of adequate instrumentation, lighting, and trained personnel are essential to minimize morbidity.

Humans↗
PubMed1990

Transcervical approaches to the prevertebral space.

The anterolateral and posterolateral transcervical approaches were used to expose the prevertebral space in patients with diffuse idiopathic skeletal hyperostosis. In a series of six patients, both techniques produced equally effective palliation of dysphagia without associated morbidity. Theoretically, the anterolateral approach better preserves the carotid sheath neurovascular bundle, although the risk of injuring the recurrent laryngeal nerve is greater. The posterolateral technique offers a wider exposure of the prevertebral space but requires more retraction of the carotid sheath and increases the risk of injury to the sympathetic chain. Either exposure may be used depending on the preference of the attending surgeon.

Aged↗
PubMed1990

Management of tumors arising in the parapharyngeal space.

Tumors originating in the parapharyngeal space are rare. During the period of January 1977 to July 1989, 51 patients underwent surgery for parapharyngeal space tumors at the University of Pittsburgh's Eye and Ear Hospital. Eighty percent of the parapharyngeal space neoplasms were benign; 20% were malignant. Fifty-seven percent (31/54) were of neurogenic origin, 30% (16/54) were of salivary origin, and 13% (7/54) were of miscellaneous origin. The use of computed tomography scan and magnetic resonance imaging, and selective use of angiography, allowed us to ascertain the location, size, vascularity, and relation of parapharyngeal space tumors to surrounding anatomical structures. Imaging techniques established the site of origin of these tumors with 96% accuracy. This information was essential in planning surgical approaches and predicting prognoses. Details of the surgery, morbidity, and outcome of these patients are presented.

Adolescent↗
PubMedDate not supplied

Antibiotic prophylaxis in cranial base surgery.

The role of perioperative antibiotic prophylaxis was investigated in 95 patients undergoing 100 clean-contaminated cranial base surgeries. A variety of antibiotic regimens were employed. Potential risk factors for local infection were analyzed. Seven patients (7%) developed infections at the surgical site (meningitis, intracranial abscess, cellulitis/abscess, and osteomyelitis). Antibiotic prophylaxis for 24 hours or less was associated with a significantly increased risk of infection (p less than 0.04). Prolonged antibiotic prophylaxis (greater than 48 hours) was not more efficacious than prophylaxis for 48 hours. The surgical approach, type of reconstruction, duration of surgery, and use of drains were not significantly correlated with wound infection. The risk of intracranial infection following cranial base surgery is low despite the presence of bacterial contamination intraoperatively. Broad-spectrum coverage of gram-positive and gram-negative organisms for at least 48 hours is recommended. Attention to surgical technique is important in preventing infectious complications.

Adolescent↗