Biomedical subjects

Ravinder Dahiya

Publications and source records attributed to Ravinder Dahiya.

3 recordsLinked to original sources

PubMed2003

Microdissection needle tonsillectomy and postoperative pain: a pilot study.

OBJECTIVE: To determine whether microdissection needle cautery for tonsillectomy results in decreased postoperative pain when compared with standard electrocautery. DESIGN AND SETTING: A randomized prospective study of 2 groups of young children in an academic pediatric otolaryngology practice. SUBJECTS: Forty-two healthy children between the ages of 4 and 12 years. INTERVENTION: The 42 children were randomly assigned to 2 groups: in group A, the tonsillectomy was performed with standard monopolar electrocautery tip at 20 W; in group B, the microdissection needle was used at 8 W. The same surgeon performed each tonsillectomy. Other aspects of the procedure were constant, including patient positioning, intraoperative injection of 0.25% bupivacaine hydrochoride (Marcaine), a weight-appropriate dose of steroids, and the use of postoperative antibiotics. OUTCOME MEASURES: The subjective measure of postoperative pain was a questionnaire based on a standard visual analog scale ranging from 0 to 10. More objective measures included the doses of pain medications consumed and the tolerance of oral intake. RESULTS: There was no statistical significant difference in the amount of intraoperative hemorrhage between groups (P>. 01). Operative time was on average 3.2 minutes longer in group B (11 minutes vs 7.8 minutes). The postoperative pain as measured by the visual analog scale was significantly different on days 3, 4, and 5 in group B (P<.05). This difference in pain correlated to differences in the number of doses of pain medications used on the same days. There was no statistically significant difference between the 2 groups concerning the amount of fluids tolerated (P>.01). CONCLUSIONS: Without any increase in complications, subjective and objective measurement showed that the use of the microdissection needle resulted in significantly less postoperative pain by day 3.

Anesthetics, Local↗

PubMedDate not supplied

A systematic histologic analysis of nonablative laser therapy in a porcine model using the pulsed dye laser.

BACKGROUND: To our knowledge, no systematic analysis of nonablative laser therapy has been performed. OBJECTIVE: To alter the parameters (fluence, spot size, pulse duration, and use of cooling spray) for the pulsed dye laser to determine the precise settings that would yield the most favorable dermal remodeling in a porcine model. METHODS: Research was conducted in an animal laboratory at Albany Medical College. An anesthetized Yucatan miniature pig was subjected to a pulsed dye laser at various parameters. After 10 weeks, the laser-treated areas were harvested and processed for blinded, randomized, histologic evaluation. Negative (nontreated skin) and positive (ablative carbon dioxide laser-treated skin) controls were compared with the nonablative pulsed dye laser-treated areas. MAIN OUTCOME MEASURES: Quantitative assessment of collagen band width and cells per high-power field and qualitative assessment of epidermal and dermal changes. RESULTS: A significant difference (P<.001) in collagen band width was evident when nonablative laser-treated skin and carbon dioxide ablative laser-treated skin specimens were compared with untreated skin specimens, but no significant (P =.18) difference existed between the nonablative and ablative modalities. Similarly, cellular hypertrophy, as measured by high-power field, corroborated the previous findings. Furthermore, a higher fluence, a larger spot size, and a longer pulse duration proved statistically significant for increased collagen band width (P =.01, P<.001, and P<.001, respectively), and a larger spot size and a longer pulse duration exhibited significance for cells per high-power field (P =.02 and P =.009, respectively), with a trend toward significance for higher fluence (P =.09). Overall, the dermis was considerably thicker for nonablative and ablative laser-treated areas compared with untreated skin, but this could not be quantified because the depth exceeded the punch biopsy instrument. The epidermis remained unchanged. CONCLUSIONS: The nonablative pulsed dye laser has demonstrated favorable histologic evidence of dermal remodeling, and its effects were similar to histologic changes seen with the carbon dioxide ablative laser, both of which were statistically significant compared with untreated skin, as seen in this preliminary animal model.

Animals↗

PubMedDate not supplied

Midfacial rejuvenation via a minimal-incision brow-lift approach: critical evaluation of a 5-year experience.

OBJECTIVE: To evaluate the surgical technique, cosmetic results, and complications of patients who underwent a midface-lift via a minimal-incision brow-lift performed by the senior author (E.F.W.). SETTING: Private, ambulatory surgical center. DESIGN: A retrospective review of 325 midface-lifts performed over a 5-year period by a single surgeon. Patients A total of 325 consecutive patients who underwent a midface-lift, with or without concurrent rhytidectomy and other adjunctive procedures, and who completed 3 months of follow-up were reviewed for perioperative complications. One hundred patients who had complete photographic and chart records and who had a minimum of 6 months of follow-up were randomly selected for photographic rating and chart review. Of the patients who had a minimum of 1 year of follow-up, 50 were randomly selected to determine if midfacial elevation led to any evidence of lateral-canthal distortion. MAIN OUTCOME MEASURES: Midfacial elevation was assessed in 3 facial zones by 3 independent evaluators. Zone I represents the malar-infraorbital complex; zone II, the nasolabial sulcus; and zone III, the jawline. The zones were rated on a scale from 0 to 2 (0, no improvement; 1, mild improvement; and 2, marked improvement). Change in the lateral-canthal position was measured in the vertical and horizontal axis for each eye. All complications were recorded. RESULTS: The 3 independent evaluators correlated well in their scores (kappa = 0.643) and found that most patients showed the best improvements in zone I, with 70% of patients showing marked improvement (P<.001). Moderate improvement was noted in zone III (marked improvement, 30%; mild improvement, 50%; and no improvement, 20%). Little or no improvement was noted in zone II (marked improvement, 4%; mild improvement, 60%; and no improvement, 36%). Patients who underwent a rhytidectomy along with a midface-lift showed better elevation in zone III. However, patients who underwent a brow/midface-lift alone also showed favorable improvement along the jawline (zone III). Although the postoperative lateral-canthal position revealed statistically significant vertical elevation of the lateral canthus on the right side, this finding did not correlate with any perceived clinical significance by the reviewer or patient (P<.01). Temporary morbidity included 2 subperiosteal abscesses and 3 frontal and 1 buccal facial nerve neuropraxias that resolved by 6 months. Permanent complications included 1 case of unilateral cranial nerve V2 paresthesia. Five patients had alopecia requiring scar revision. Many of these complications, including subperiosteal abscess and alopecia, have subsequently been avoided by minor technique modifications. CONCLUSION: The technique of midface-lift via transbrow approach is a safe, reliable method of midfacial rejuvenation and avoids the unnatural lateral-canthal distortion previously described in the literature.

Adult↗