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Biomedical subjects

R L Hybels

Publications and source records attributed to R L Hybels.

At least 19 recordsLinked to original sources
PubMed1997

Otolaryngologic manifestations of sarcoidosis: presentation and diagnosis.

Neuro-otologic manifestations of sarcoidosis are rare. Dizziness in particular is a rare presenting complaint of the patient afflicted with this systemic granulomatous disorder. Head and neck and sinonasal presentations of this disease are more common. We reviewed our experience with six such patients who presented for management of their otolaryngologic (ORL) manifestations in order to delineate the involvement of the otolaryngologist in the treatment and diagnosis of these patients, with a focus upon the relevant tests and procedures in the otolaryngologist's de novo diagnosis of sarcoidosis. Studies ordered in the course of otolaryngologic evaluation and their utility in the diagnosis of sarcoidosis by the otolaryngologist are reviewed and classified into useful, supportive, and ancillary. The otolaryngologist played an important role in diagnosis, with four of six patients diagnosed to have sarcoidosis on the basis of their otolaryngologic presentations. Biopsy was performed by the otolaryngologist for diagnosis of sarcoidosis in all four of these cases. Steroids were central to treatment. Oral steroid therapy was the principal treatment: both patients with neuro-otologic sarcoid were successfully managed with oral steroids. Intralesional steroids were necessary to treat the skin lesion. One of six patients patients experienced complications related to steroid use.

Adrenal Cortex Hormones↗
PubMed1991

Holmium: yttrium aluminum garnet laser-assisted endoscopic sinus surgery: laboratory experience.

Endoscopic sinus surgery has gained wide acceptance since its introduction into the United States. Complex sinus anatomy and troublesome bleeding have been associated with complications, which vary in severity from synechia to blindness and leakage of cerebrospinal fluid. Endoscopic sinus surgery using a holmium: yttrium aluminum garnet pulsed solid-state laser oscillating at 2.1 microns with fiberoptic delivery was performed in the laboratory, and the results were compared with those of conventional endoscopic sinus surgery. Three beagle dogs, six human cadaver heads, and one calf head were used in the in vivo and in vitro studies to evaluate the bone ablation, tissue coagulation, and hemostatic properties of the holmium: yttrium aluminum garnet laser. Modified endoscopic telescopes for sinus surgery, a newly developed handpiece for fiberoptic delivery, and other surgical instruments were used. The results indicate that the holmium: yttrium aluminum garnet laser and new delivery instrumentation provide good hemostasis and controlled soft-tissue ablation and bone removal. The access to all sinuses in the human cadaver model was very good. The canine in vivo study showed delayed but complete healing on the laser-treated side. Clinical evaluation of the holmium: yttrium aluminum garnet laser is warranted to increase the precision and safety of endoscopic sinus surgery.

Animals↗
PubMed1990

Laser excision of early vocal cord carcinoma: indications, limitations, and precautions.

Forty-six patients referred for laser surgery of early vocal cord carcinoma were treated by laser excisional techniques with or without radiotherapy. Mean follow-up was 3.5 years. There was a 90% rate of carcinoma control (18 of 20 patients) in patients with untreated mid-vocal cord T1 carcinomas without involvement of the anterior commissure or vocal process or deep muscle invasion. Larger, more invasive T1 vocal cord tumors (13 patients) had laser excision followed by radiotherapy without recurrence. Careful patient selection and accurate histopathologic evaluation are key elements for successful treatment.

Follow-Up Studies↗
PubMed1990

Benign lesions of the larynx: should the laser be used?

The use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the "cold technique" with microlaryngeal instruments. Since the advent, in 1987, of a small-spot (0.3 mm) CO2 laser micromanipulator and more precise microlaryngeal instruments, we have redefined our use of the CO2 laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2 laser was useful for mucosal micro-flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2 laser at low-power settings (1 to 3 W), with 0.1-second pulses, and with precise microlaryngeal instruments will give the best results.

Adolescent↗
PubMed1988

New microspot micromanipulator for carbon dioxide laser surgery in otolaryngology. Early clinical results.

A new micromanipulator with microspot capability has been developed for carbon dioxide laser surgery in otolaryngology. The instrument features new infrared optics, which provide smaller laser spot sizes than those achievable with conventional micromanipulators (300 micron using a 400-mm operating microscope lens). The conventional red helium-neon aiming laser is replaced with a nonlaser fiberoptic image, and a power defocus control on the joystick manipulator eliminates external defocus controls. Less surrounding tissue trauma occurs with this new instrument by using a higher power density with average power settings of 1 to 2 W for cutting and ablation of tissue. Eight patients with benign laryngeal disease and one patient with dysplastic changes of the vocal cord were treated successfully without complications.

Animals↗
PubMed1988

Management of rhinophyma with carbon dioxide laser: Lahey Clinic experience.

The carbon dioxide (CO2) laser as a surgical tool for the difficult cosmetic problem of rhinophyma permits unprecedented refinement in treatment. Previously described conventional techniques have included the cold knife and the dermabrader. With these methods, hemostasis must be obtained with electrocautery, which if used extensively makes fine sculpting difficult. Seven patients with rhinophyma were treated with the CO2 laser at the Lahey Clinic from 1982 to 1987. We used a laser handpiece with a variable spot size. With this technique, we found the laser to be an excellent cutting tool while simultaneously providing superior hemostasis. In the followup period of up to 4.5 years, the cosmetic results have been excellent. Thus, the CO2 laser has become our treatment of choice for the management of patients with rhinophyma.

Hemostasis, Surgical↗
PubMed1987

The neck mass. 1. General concepts and congenital causes.

A carefully taken history and thorough physical examination are the first steps in establishing the cause of a neck mass. Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up. Further studies are ordered on the basis of the impressions gathered from this evaluation. Congenital neck masses can be found in patients of any age. Thyroglossal duct and branchial cleft cysts and fistulas are formed by incomplete obliteration of the thyroglossal duct and branchial clefts during embryonic development. Other congenital causes include lymphangiomas, cystic hygromas, dermoid cysts, and hemangiomas. Laryngoceles are acquired cysts that arise from an anatomic remnant, the laryngeal ventricle. Treatment for these neck masses is nearly always surgical removal.

Biopsy↗
PubMed1987

The neck mass. 2. Inflammatory and neoplastic causes.

Several inflammatory processes can cause nodules or swelling in the neck. A complete physical examination and, usually, laboratory testing are required to establish the diagnosis. Common infections include cervical lymphadenitis and tuberculous lymphadenitis, cat-scratch disease, infection in the neck spaces, infectious mononucleosis, and syphilis. Primary or metastatic cancer may also be the cause. Cervical metastasis often presents as a neck mass. Although a primary tumor may not be found immediately when a neck mass is being evaluated, one is often discovered later. Other types of malignancy that may be present are histiocytic lymphoma, Hodgkin's disease, rhabdomyosarcoma, thyroid cancer, and a salivary (most often parotid) gland tumor. Symptomatic treatment is sometimes adequate for infectious disease, but administration of antituberculous drugs or antibiotics may also be necessary. Incision and drainage are required for some nodes and abscesses. For neck masses caused by neoplasms, fine-needle aspiration cytology or biopsy is performed. Depending on the diagnosis, treatment consists of dissection, radiation therapy, and/or chemotherapy.

Abscess↗
PubMed1987

Carbon dioxide laser in removal of polytef paste.

Teflon injection is the most popular surgical technique for improvement of voice in patients with a unilaterally paralyzed larynx. The results with this method usually are good, but cases of overinjection with resultant poor voice, airway compromise, or both, do occur. The carbon dioxide laser has become a standard instrument for laryngeal surgery, and it might reasonably be used in attempts to correct the overinjected vocal cord. Realizing that Teflon could share flammable characteristics with other polymers, such as rubber and polyvinylchloride, we investigated the effect of the carbon dioxide laser on fresh polytef paste (Mentor O & O Inc, Hingham, Mass) before using it in a patient with an overinjected hemilarynx. Fresh paste was found to ignite after exposure to standard laser power at normal time settings, both in room air and in an oxygen-enriched atmosphere. To determine the effect of the laser on Teflon in situ, the paste was injected subcutaneously and intramuscularly into a rat. After a suitable interval of time, the Teflon was found to glow but not ignite when exposed to the laser under standard operating conditions. Only under high power in an oxygen-enriched environment did ignition occur. In our patient, the laser was used to incise the mucosa over the polytef granuloma, and standard microsurgical (nonlaser) techniques were used to complete the removal with good results. Laryngologists should be aware of the dangers of using the carbon dioxide laser on or near Teflon, especially in freshly injected vocal cords.

Carbon Dioxide↗
PubMed1987

Neodymium-YAG laser intranasal photocoagulation in hereditary hemorrhagic telangiectasia: an update report.

Hereditary hemorrhagic telangiectasia is a challenging problem for the otolaryngologist since frequent, often severe epistaxis is the major symptom. Options for therapy in the past have included nasal packing, electrocautery, systemic estrogens, septal dermatoplasty, arterial embolization, and arterial ligation. Although successful treatment has been achieved with some of these methods, particularly septal dermatoplasty, other forms of therapy are needed prompting the use of laser photocoagulation. The neodymium yttrium-aluminum-garnet (Nd-YAG) laser was used to treat a group of 19 patients with hereditary hemorrhagic telangiectasia over a 4-year period without complications. Endonasal laser photocoagulation was effective in decreasing epistaxis in patients not requiring frequent transfusions prior to laser therapy. Three patients with the most severe epistaxis received minimal or no benefit from Nd-YAG laser photocoagulation. In most patients Nd-YAG photocoagulation is successful in treating epistaxis associated with hereditary hemorrhagic telangiectasia and should be a therapeutic option for this chronic disease having no available cure.

Epistaxis↗
PubMed1985

Treatment of cancer of the larynx. Analysis of success and failure.

The treatment of patients with cancer of the larynx must consider the potential for multiple sites of origin and the possibility of regional metastasis. Treatment options must also address effects on the voice, deglutition, and the sphincteric function of the larynx which protects the lungs. Fortunately, our advanced techniques in surgery--reconstruction, radiotherapy, and endoscopic laser application--enable us to choose from and use these modalities in combination. Induction chemotherapy appears to be a promising, albeit unproved, adjuvant therapy. The oncologist dealing with cancer of the head and neck must select appropriate individualized therapy in a multidisciplinary environment.

Carcinoma in Situ↗
PubMed1984

History taking in dizziness. The most important diagnostic step.

When faced with a complaint of dizziness, the primary care physician may be tempted to assume that the cause is inner ear dysfunction and that the patient needs to be referred to an otologist. According to Dr Hybels, however, most dizzy patients do not have an ear problem and a carefully executed history is likely to pinpoint the correct diagnosis. The following article delineates the fine points of history taking and discusses some of the most common causes of dizziness.

Aging↗
PubMed1984

Primary intrasellar germinoma in a woman presenting with secondary amenorrhea and hyperprolactinemia.

A 32-year-old woman with secondary amenorrhea was found to have an elevated level of serum prolactin, partial diabetes insipidus, and a subtle visual field defect. A primary intrasellar tumor was noted on the computed tomographic scan. Although the tumor had some characteristics of a prolactinoma, transsphenoidal exploration revealed a primary germinoma. The tissue diagnosis led to appropriate treatment with radiotherapy. The tumor regressed, and the patient had a spontaneous pregnancy. Had dopamine agonists been used initially, amelioration of the hyperprolactinemia and delay in the proper diagnosis and treatment would have occurred.

Adult↗