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Biomedical subjects

T Lesser

Publications and source records attributed to T Lesser.

At least 19 recordsLinked to original sources
PubMed2005

Foreign bodies in the ear: a simple technique for removal analysed in vitro.

OBJECTIVE: Foreign bodies in the ear are mainly encountered in children. This can often pose a problem especially in an accident and emergency department where a microscope or expert help is not routinely available. This paper presents a simple, safe, and effective way of ear syringing. The ease and simplicity of the procedure along with the equipment are described. METHOD AND RESULT: The equipment consists of a "disposable" sterile kit, consisting of a 20 ml syringe, saline at body temperature and 14 or 16 gauge cannula (without the needle). An in vitro experiment was conducted to calculate the pressure generated by the water jet on the eardrum. The pressure was well below the pressure required to burst a tympanic membrane, and hence this technique is safe to use. CONCLUSIONS: Ear syringing is an effective and easy way of removing most foreign bodies. A detailed history and an otoscopic examination must precede the procedure. The novel method of syringing described in this paper with the usual safeguards could be a useful adjunct in the management of this common condition.

Disposable Equipment↗
PubMed2002

Does clinical assistant experience in ENT influence general practitioner referral rates to hospital?

Referral rates from individual partners within two demographically matched general practices to the local ENT service were gathered prospectively over a six-year period. The study was designed to determine if extra training in one practice altered these rates. A single partner from one practice attended otolaryngology clinics for regular training over a three-year period. This was funded by the local Family Practitioners' Committee. The funding enabled a locum to cover this partner's clinical commitment whilst he attended the specialist clinics for continued ENT training. The aim of this study was to identify whether the provision of continued ENT training and education to general practitioners (GPs) influenced referral patterns to specialist clinics.

Education, Medical, Continuing↗
PubMed2001

May pentoxifylline improve lung function after one-lung flooding?

One-lung flooding makes the intraoperative sonography of round pulmonary lesions possible. During the flooded phase, the flooded lung suffers a significant reduction in perfusion. After ischemia and reperfusion, neutrophil granulocytes lead to further tissue injuries. A study was made on four animals to determine whether administration of pentoxifylline--a potent inhibitor of granulocyte adhesion to the endothelium--improves lung function after one-lung flooding. Two animals were subjected to thoracotomy with extended hemodynamic monitoring. Thoracoscopy was performed on two other animals, which were extubated after the flooding liquid was drained and survived for 24 degrees h. A bolus of 1 mg/kg of pentoxifylline was administered at the time of thoracotomy/thoracoscopy. followed by continuous infusion of pentoxifylline at a rate of 1.5 mg/kg per hour until 30 degrees min after reventilation (thoracotomy), or until extubation, respectively. The control group consisted of animals employed in previous experiments. Except for pentoxifylline administration, they were subjected to identical experimental conditions. The control group for the thoracotomy experiment comprised 14 animals, that for the thoracoscopy experiment three animals. The experiments proved that 30 degrees min after the draining of the flooding liquid and reventilation, all four pentoxifylline-treated animals had a higher partial arterial oxygen pressure and a lower pulmonary shunt volume compared with the control animals. In the two animals that survived, a positive effect on lung function was no longer detectable 24 degrees h after extubation. The administration did not lead to a drop in the pulmonary arterial pressure and did not cause any hemodynamic changes other than a moderate tachycardia.

Animals↗
PubMed2001

Vestibular schwannomas in children.

OBJECTIVE: This article highlights the clinical presentation and management issues of unilateral vestibular schwannomas in children. We demonstrate how the presentation differs from neurofibromatosis type 2 (NF2) and from adult unilateral vestibular schwannomas. STUDY DESIGN: This article is composed of a series of three cases and a literature review. SETTING: The study was performed at a university hospital (tertiary referral center). PATIENTS: Three children, aged 9, 11, and 13 years, with histologically confirmed vestibular schwannomas were studied. All children under 16 years of age in the world literature with unilateral vestibular schwannomas were reviewed. INTERVENTION: Analysis of presentation and surgical management of these three children and those children reported in the literature. MAIN OUTCOME MEASURE: Pattern of presentation relative to children with NF2 and people with adult unilateral vestibular schwannomas. RESULTS: Two patients had multiple cranial nerve weakness and recurrence, and one patient had successful removal of the tumor with preservation of all functions of the cranial nerves, including the facial nerve. CONCLUSION: Vestibular schwannomas in children are very uncommon. It is likely that it is the first manifestation of NF2, but it may also be a variant of sporadic vestibular schwannomas. A presentation of three cases and a review of 36 other cases in the literature demonstrates how the presentation is different from adult sporadic vestibular schwannomas and NF2 because it lacks primary audiological symptoms. The study also provides evidence of non-NF2 vestibular schwannomas presenting in children and suggests that it is likely that these are a variant of unilateral sporadic vestibular schwannomas. The search for the features of NF2 in these cases remains mandatory.

Adolescent↗
PubMed2000

One-lung flooding for video-assisted thoracoscopic surgery in animal experiments on pigs--oxygenation and intrapulmonary shunt.

Unilateral flooding of the lung after intubation with a double-lumen tube makes intraoperative sonography of the lung during video-assisted thoracoscopic surgery possible. After flooding with 15 ml/kg, the arterial partial oxygen pressure (with FiO2=1.0) is higher than that in total atelectasis by about 100 mmHg, while it is only slightly less than that during bilateral lung ventilation. Compared to total atelectasis, lung flooding reduces the pulmonary right-to-left shunt volume. The pulmonary function normalizes within 8 h after the operation.

Air↗
PubMed2000

[Stage-adapted therapy of pleural empyema. Results during 1992-1998].

Despite the decreasing number of patients suffering tuberculosis and the use of modern broad spectrum antibiotics the pleural empyema did not lose its relevance. The main reasons are increasing numbers of patients with drug and alcohol abuse or immunodeficiency of different causes. We retrospectively analysed the data of 73 patients treated of pleural empyema between 1992 and 1998. Considering the known stages of pleural empyema we present the corresponding therapeutic results. All patients classified as stage I were treated with a chest drain and cure was achieved in all of them (100%). The treatment for patients classified as stage II was different: 5 out of 32 were treated with a continuous irrigation and suction chest drain system. 18 patients first underwent thoracoscopy and were afterwards treated with a continuous irrigation and suction system. Another 9 patients primarily underwent an early open decortication. In 40% the treatment with the suction and irrigation system was successful. Using video-assisted thoracoscopy (VATS) cure was achieved in 94.4%, with open decortication in 100%. The preferred treatment of patients classified as stage III is the open decortication. After the first operation 80% (30 patients) were cured. 6 patients needed thoracoplastic procedures after the first intervention. No patient was discharged neither with a permanent chest drain nor a permanent thoracic window. With the results a cause dependent analysis of morbidity and mortality was done. The overall morbidity rate was 27.9% and the overall mortality 5.4%. The treatment of pleural empyema still remains to be problematic. Corresponding to our results pleural empyema classified as stage I is best treated with a simple chest tube. The video-assisted thoracoscopy (VATS) lacks of complications and is a very efficient method in treating stage II. The method of choice in stage III is the open decortication which in the case of a chronic and recurrent or persistent infection should be followed by a thoracoplastic procedure.

Adolescent↗
PubMed2000

Wet-to-dry ratio of lung tissue and surfactant outwash after one-lung flooding.

Unilateral flooding of the lung after intubation with a double-lumen tube enables intraoperative sonography of the lung tissue. The flooding restricts the pulmonary blood stream of the flooded lung in a relevant degree and thus reduces the right-to-left shunt volume. The deficient perfusion of the lung tissue during the flooded phase might cause capillary permeability disorders and secondary oedema development. This can be determined by examination of extravascular lung water (EVLW) after draining and reventilation of the flooded lung. Although one-time unilateral lung flooding must be distinguished from bronchopulmonary lavage, it is interesting to study the effects of flooding on the surfactant system. The wet-to-dry ratio of the lung tissues of 13 female pigs was ascertained at different times following one-lung flooding (1 to 11 weeks). A trend towards an increased wet-to-dry ratio in the previously flooded lung was found only in the tissue samples taken 1 h after reventilation. After only 24 h, the two lungs no longer differed in their wet-to-dry ratio. In six pigs, the phospholipid content of the drained flooding liquid was determined. It was shown that the surfactant loss caused by flooding was maximally 47% of the calculated surfactant pool of the respective lung.

Animals↗
PubMed1999

Simulation of lung lesions for validating the sonography of the flooded lung.

The quality of sonography of a unilaterally flooded lung needs to be validated on lesions of different echogenicity, size and subpleural position. Lesions were simulated in 12 young pigs with three different methods. After transbronchial (method 1) or transpleural puncture (method 2), diverse substances were injected into the lung. After 4 weeks, the thorax was opened and the lung flooded for the sonographic location of the lesions. In method 3, pulmonary lesions were simulated in an acute experiment after thoracotomy by transpleural injection or by filling of a Fogarty catheter balloon and were located sonographically. Transbronchial injection of alcohol invariably led to subsegment atelectasis. Only 25% of thoracoscopically controlled transpleural injections produced focal lesions in experiments in which the animals survived. Representative lesions were found only after alcohol injections. Transpleural injection of blood or a blood/Echovist suspension (method 3) simulated isoechogenic or echo-rich lesions with indistinct boundaries. By filling a Fogarty catheter balloon with saline solution or Echovist suspension, we succeeded in simulating echo-free or echo-rich lesions with smooth contours, located in different subpleural depths. After unilateral lung flooding, sonography successfully detected the locations of all these lesions and revealed their correlation with functional structures. Sonography of the flooded lung might be helpful in the intraoperative location of lesions, especially in the context of video-assisted thoracoscopic surgery.

Animals↗
PubMed1999

Hemodynamics and gas exchange during experimental one-lung fluid flooding in pigs.

One-sided fluid flooding of the lung after intubation with a double-lumen tube facilitates pulmonary sonography during surgery. Arterial blood pressure, cardiac index, and heart rate remained unchanged during one-lung fluid flooding in healthy animals. The arterial PO(2) was greater by about 100 mmHg after flooding one lung with 15 ml/kg fluid and ventilation with a FiO(2) of 1.0 compared with total atelectasis. This seems to be identical to a continuos positive airway pressure level of 5 cm H(2)O with pure oxygen on the nonventilated lung. The one-sided fluid flooding induced a statistically significant increase in pulmonary artery pressures and pulmonary capillary wedge pressure. In comparison with total atelectasis, fluid flooding in tendency reduced the pulmonary right-left shunt and increased the arterial PO(2).

Animals↗
PubMed1999

Modification of subcutaneous adipose tissue by a methylxanthine formulation: a double-blind controlled study.

BACKGROUND: Excessive subcutaneous adipose tissue is typically treated by physically removing the fat through liposuction, but cost and accessibility have popularized alternative treatments for reducing adipose tissue thickness. OBJECTIVE: The purpose of this study was to test the absolute and relative effectiveness of a liposome-encapsulated caffeine-based cream in modifying subcutaneous adipose tissue. METHODS: Forty-one patients consented and completed the double-blind, single-center, placebo-controlled study. Caliper measurements, tape measurements, and photographs were taken over a 2-month period. RESULTS: Both concentrations of the cream were found to significantly reduce the thickness of the adipose tissue in all areas of the body. In addition, the more concentrated cream was significantly more effective than the less concentrated cream in the areas of the hips and the triceps. CONCLUSION: The caffeine-based liposome-encapsulated cream significantly reduced the thickness of the subcutaneous fat over a 2-month period.

Adipose Tissue↗
PubMed1999

The histologic evaluation of pulsed carbon dioxide laser resurfacing versus phenol chemical peels in vivo.

BACKGROUND: Carbon dioxide (CO2) lasers and phenol chemical peels have been used extensively for facial skin resurfacing. OBJECTIVE: The purpose of this study is to compare the histologic effects of phenol chemical peels and CO2 laser ablations. METHODS: Local preauricular areas were treated with lasers on one side of the face and a phenol peel on the other. One day after the procedures, the affected areas were biopsied for histologic evaluation. The areas were biopsied again after 3 months. RESULTS: The initial biopsies demonstrated that the CO2 lasers ablate more superficial skin than the peels, but the 3-month biopsy specimens showed that the zone of new collagen formation was thicker as a result of the phenol peels. CONCLUSION: With the parameters used in this study, phenol peels resulted in the formation of a thicker zone of collagen despite the deeper ablation depth of the laser.

Biopsy↗
PubMed1999

[The value of prognostic factors in patients who underwent a resection of pulmonary metastases].

155 patients were operated on pulmonary metastases in Jena during the period from 1.1.1984 to the 31.12.1994. The findings of 151 patients were analysed. 128 patients suffered from a carcinoma, 15 from a sarcoma, 6 from a malignant melanoma and 2 from a Wilms-tumor. The prognostic factors discussed in the international publications at present were investigated in those patients. Significant differences in the long-term survival were found for the following features: a possible radical resection, the tumor entity, the site, the histology and the grading of the primary tumor, the size and the site of the metastases and the resection of recurrent metastases. Tendencies are described for the type of dissemination and the staging of the primary tumor, the site of the pulmonary metastases in the lung lobes, solitary extrapulmonary metastases and more than 6 lung metastases. In addition patients who showed metastases of a renal cell carcinoma are considered separately.

Carcinoma, Renal Cell↗
PubMed1998

Lung flooding--a new method for complete lung sonography.

A sonographic examination of the lung has so far been impossible because of sound reflection. In conjunction with video-assisted thoracoscopic surgery, lung sonography would be helpful to make up for the lack of direct palpation. Animal experiments with pigs were performed to find out whether lung sonography becomes possible following bronchoalveolar flooding with a suitable liquid. The lung was filled with whole electrolyte solution through the left leg of a double-lumen endotracheal tube after resorption atelectasis (method 1) or compressive atelectasis (method 2). As an alternative, liquid perfluorocarbon was used (method 3). Under atelectasis, the lung thus flooded was investigated by ultrasound applied transpleurally and endobronchially. The first results proved that lung flooding is possible if certain prerequisites are fulfilled. Perfluorocarbon flooding led to total sound absorption which prevented sonography, whereas flooding with whole electrolyte solution made complete lung sonography possible, making visible the intrapulmonary vessels, bronchi and peribronchial lymphatic nodes. Measurements proved that the unilateral flooding caused no significant changes in the arterial and central venous pressure nor in transcutaneous oxygen saturation.

Animals↗
PubMed1997

[Recurrence after curative operation of non-small-cell bronchial carcinoma].

The poor prognosis of bronchial carcinoma is reflected among other things in a high recurrence rate. In general, recurrence is inoperable and only suitable for conservative/palliative management. The rate of curative surgical reintervention may be increased by early identification of recurrence. The value of tumour follow-up and the role of reoperation need to be assessed. 150 patients who underwent curative resection of non-small-cell lung cancer were followed-up for a mean of 4.5 years as part of a comprehensive after-care program. Fifty patients (33%) developed a recurrence at a mean of 13 months after operation. A second curative resection was possible in 9 patients (6%) with a mean survival of 22 months. Six of these patients had re-thoracotomy (completion pneumonectomy in 4 for local recurrence, mediastinal metastasectomy in 2), and in 3 patients a solitary cerebral metastasis was excised. Our results show that with focused, schematic tumour follow-up early recognition of recurrence is possible. Despite this, reoperation is only indicated in a selected group of patients because of multifocal recurrence, or local or functional inoperability. Further intensification of tumour follow-up is limited by personnel, logistical, and financial considerations. As an alternative, individualised, function-oriented tumour after-care could be considered.

Adult↗
PubMed1997

[Value of thoracoscopy in thoracic trauma--initial experiences].

The aim of this study was to assess the role of thoracoscopy in the evaluation of the cause of persistent intrathoracic bleeding, air leak, or nuclear basal opacification after blunt thoracic trauma. As a result, a decision to proceed to early thoracotomy could be made, or an attempt of thoracoscopic haemostasis, haematoma evacuation, or fistula closure was possible. Twelve patients (9 male, 3 female, mean age 33,7 years) with blunt thoracic trauma underwent video-assisted thoracoscopy under general anaesthesia with double-lumen endotracheal intubation and one-lung ventilation. The indication for operation was made after assessment of chest X-ray and CT findings, pleural ultrasound, and the volume and quality of pleural drainage. Persistent pneumothorax was shown to be due to traumatic rupture of a bulla in two cases and to parenchymal air-leak from a small lung laceration in two cases, all of which were treated endoscopically. In two cases a diaphragmatic rupture was confirmed as the cause of basal shadowing and in one case a major lower lobe laceration was identified as the cause of a persistent haemopneumothorax. In three cases, a fluid collection which could not be evacuated through a pleural drain was shown to be an organised haematoma and was removed endoscopically. Video-assisted thoracoscopy is helpful in the diagnosis and treatment of thoracic trauma, allowing early recognition of injuries that require thoracotomy. It is indicated for persistent (but not life-threatening) intrathoracic bleeding, unresolving pneumothorax, and unclear basal opacification. Therapeutic parenchymal tissue glue application and suturing as well as local resection and haematoma evacuation can be performed with this technique.

Adult↗