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Biomedical subjects

S A Reiner

Publications and source records attributed to S A Reiner.

8 recordsLinked to original sources
PubMed2000

Medical management of acute bacterial sinusitis. Recommendations of a clinical advisory committee on pediatric and adult sinusitis.

Acute sinusitis is commonly encountered in clinical practice and treated in the primary care setting. The clinician should recognize the subtle clinical presentation of acute bacterial sinusitis and initiate appropriate, aggressive treatment. Other upper respiratory tract disorders can confound the accurate diagnosis and appropriate treatment of sinusitis. Variable patterns of microbial resistance and antibiotic susceptibility and the dissociation between in vitro findings and clinical efficacy are a treatment challenge. This report is a comprehensive review of the pathophysiology and diagnosis of acute sinusitis, infectious agents, treatment methods, antibiotic resistance patterns, and costs associated with the management of sinusitis. Treatment algorithms are presented for adult and pediatric sinusitis.

Acute Disease↗
PubMed2000

Controversies in the medical management of persistent and recurrent acute otitis media. Recommendations of a clinical advisory committee.

Streptococcus pneumoniae is the predominant bacterial pathogen associated with acute otitis media (AOM), causing an estimated 7 million cases annually in the United States. Bacterial resistance should be considered when selecting an antimicrobial agent for otitis media. Significant increases in drug-resistant S pneumoniae are documented worldwide, and less than 50% of S pneumoniae strains are fully susceptible to penicillin in some regions of the United States. Although amoxicillin is recommended for uncomplicated AOM, treatment guidelines should be flexible and adaptable, taking into consideration local and regional susceptibility patterns, the age of the patient, the frequency of prior infections, and the response to prior therapy. Resistant organisms are more prevalent in children younger than 2 years of age and in those who have recurrent or persistent AOM. Overdiagnosing AOM, selecting inappropriate empiric therapy, or both, leads to overuse and misuse of antibiotics and causes increased drug resistance. This article reviews persistent and recurrent AOM and discusses the pitfalls of diagnosis and the practical limitations of current treatment recommendations.

Acute Disease↗
PubMed1990

Safety of outpatient tonsillectomy and adenoidectomy.

Recent changes in reimbursement for tonsillectomy and adenoidectomy have resulted in a large number of these procedures being done on an outpatient basis. There is still considerable controversy, however, as to the safety of this concept. We reviewed the charts of 1000 consecutive patients who underwent these procedures. Three hundred ninety-six procedures were performed as inpatient surgery and 604 were performed as outpatient surgery. Patients were considered as candidates for outpatient surgery if they met specific criteria, such as good overall medical health, no central apnea, normal bleeding history and profile, and had adequate social considerations. The inpatient group included those patients who did not meet the criteria to be outpatients. We compared the complication rates of these two groups with regard to age, type of procedure performed (tonsillectomy, adenoidectomy, adenotonsillectomy), and indication for surgery in order to determine if there was any increased risk of outpatient surgery, despite strict selection criteria. The two groups were similar in their distribution with regards to age, sex, type of procedure, and indication for surgery. The overall complication rate for the entire group was 7.9%, with an 11.8% complication rate for inpatients and 4.1% complications for outpatients. The higher complication rate among the inpatient group is probably a direct result of the selection process because this group included the higher-risk patients. On the basis of these findings, we believe that surgery of the tonsils and adenoids can be performed safely as an outpatient procedure, regardless of age, indication, or procedure, if the candidates for ambulatory surgery are carefully selected by the surgeon.

Adenoidectomy↗
PubMed1990

Hemangiopericytoma of the nasal cavity.

Hemangiopericytomas are unusual vascular tumours that rarely occur in the paranasal sinuses and nasal cavity. They are thought to arise from pericytes that surround capillaries, however, there is no proven etiology of these tumours. The diagnosis cannot be made based on gross morphologic characteristics nor on frozen section biopsy. Instead, the diagnosis is dependent on careful histologic examination and reticulum staining. The diagnosis can be confirmed by electron microscopy. The histologic picture is greatly varied from tumour to tumour and within a given tumour itself. The clinical course of hemangiopericytomas ranges from benign to malignant with possible distant metastases and cannot be reliably predicted by histologic criteria. Hemangiopericytomas of the nose and paranasal sinuses are thought to behave less aggressively than those occurring in other parts of the body. Lymph node metastasis is rare and elective neck dissection is not indicated. The accepted treatment of these tumours is wide surgical excision, however adequate surgical margins are usually difficult in the sinonasal region. As a result, hemangiopericytomas can exhibit a high recurrence rate. Therefore, it is mandatory that these patients be followed carefully for the remainder of their lives.

Adult↗
PubMed1989

Accurate radiographic evaluation of mandibular fractures.

Proper radiographic evaluation is essential to confirm the presence and location of a mandibular fracture. The panoramic view of the mandible is considered to be a very accurate technique and has been heavily relied on by many clinicians as the initial or sole means of diagnosing mandibular fractures. Three cases of mandibular fractures are presented in which a panoramic view failed to demonstrate fractures of the mandible that were obvious on plain film radiographs. Diagnosis and treatment planning should not be based on the information obtained from a single roentgenogram such as a panoramic view. The combination of the mandibular series with the panoramic view provides increased diagnostic information that should enable accurate diagnosis of fractures in all areas of the mandible.

Adult↗