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T Puls

Publications and source records attributed to T Puls.

10 recordsLinked to original sources
PubMed2003

Tympanoplasty using conchal cartilage graft.

Cartilage has been used successfully as a graft in middle ear surgery. It used to be reserved for advanced pathology because of its possible detrimental effect on postoperative hearing. Recent papers however failed to prove this effect. The present study describes the authors' experience in 161 cases of conchal cartilage tympanoplasty. In tympanoplasty type I postoperative pure tone average air-bone gap was within 20 dB in 88.4% of the cases. If combined with ossiculoplasty when the stapes was intact, 72% was within 20 dB and when the stapes was absent, 54.5% was within 20 dB. Taking rate of the graft was 95.6% (154/161) with 22% (36/161) representing revision surgery. At present the author uses cartilage graft as a first choice in tympanoplastic procedures.

Adolescent↗
PubMed1997

Stapes surgery: results when performing a moderate number of stapedectomies.

Stapes surgery: results when performing a moderate number of stapedectomies. The short term results of 40 small fenestra stapedectomies over a period of five years are presented. Closure of the air-bone gap is within 10 db in 62.5%, within 20 db in 90% of the cases, with a mean gain in air-bone gap of 27.2 db. Stapes surgery is difficult if not regularly performed. The concept of a learning curve is demonstrated in this study.

Adult↗
PubMed1997

Large vestibular aqueduct syndrome with mixed hearing loss: a case report.

A case report of a large vestibular aqueduct syndrome (LVAS) as the sole radiographically detectable inner ear anomaly with a mixed hearing loss is presented. Hearing loss in LVAS is sensorineural with a conductive component in 15-27% of the cases. The hearing loss fluctuates and is progressive, resulting in the deterioration of the hearing after minor head trauma. The pathophysiology of the sensorineural hearing loss and the conductive component remains unknown. Endolymphatic sac surgery has been abandoned because of possible adverse results. In our case a complex anomaly was found in the stapes region without noticeable hearing gain after correction. In case of a progressive mixed hearing loss in children with a normal tympanic membrane, a CT-scan is mandatory to rule out LVAS before attempting middle ear surgery that is to no avail.

Adolescent↗
PubMed1996

Cost-effectiveness of case management: experiences of a university managed health care organization.

Effective, multifaceted, and short-term case management services can result in significant, quantifiable cost savings for managed Medicaid, Medicare, and other health care programs. Such savings clearly offset the administrative costs of support for case managers, social services departments, and utilization management services. This report reviews various case management models, the costs for case management staff and resource support, and a number of quantified ways in which a social service and utilization management team model saved significant dollars in a number of different service areas. This cost-benefit analysis financially justifies administrative support for case management services in the budgets of managed Medicaid programs. Case management is a cost-effective and quality of care management tool.

Arizona↗
PubMed1996

Myringoplasty: is molded collagen xenograft a valid alternative for fresh temporalis fascia?

Seventy four simple myringoplasties, 53 with xenograft and 21 with fresh temporalis fascia were reviewed. Closure rate for all cases was 90.5%. There were 3 surgical failures in xenografts and none in the fascia graft. Fifty two myringoplasties, 37 using xenograft and 15 using fascia graft, had a mean follow-up of 20 months and late perforations were seen in 4 of these cases. Three of the late reperforations occurred in xenografts, one in the fascia graft. Postoperative air bone gap was within 15 dB in 83.3% of the xenografts and in 66.7% of the fascia grafts. Recurring bouts of granular myringitis after 6 months were seen in 4 xenografts and in one fascia graft. Based on these results xenograft can be considered as an alternative for fresh fascia in easy to reach perforations operated "in speculo" when there is no need for an external incision.

Adolescent↗
PubMed1993

The changing aspect of thyroid surgery: a review of 130 consecutive cases.

A retrospective analysis was performed on 130 thyroid gland operations from January 1986 to September 1992. In 69% a lobectomy and in 28% a subtotal thyroidectomy was performed for benign thyroid disorders. A total thyroidectomy for malignancy was required in only 3%. Recurrences, operated earlier elsewhere accounted for 6% of the cases. A dramatic fall in diagnostic lobectomies is seen through the years since the use of Fine Needle Aspiration (FNA) as a decisive tool in surgical strategy. The total load of thyroid surgery remains the same, but it has become more therapeutic: hyperthyroidism and relief of tracheo-oesophageal compression by large goiters have become the major indications for surgery. These procedures are more demanding on the surgeon, but early surgery and standard technique can keep complications to a minimum.

Adolescent↗
PubMed1988

New child abuse spectrum in an era of increased awareness.

Three hundred eight-two children were evaluated for abuse or neglect during a 30-month period in a pediatric clinic in a county hospital. Fifty-one percent presented for sexual abuse, 34% for physical abuse, and 15% for neglect. Thirteen children were hospitalized. Children examined for sexual abuse had a mean age of 5.8 years and a median age of 5 years; 71% had normal findings on examination, including 48% of those with a history of penetration. Fourteen children were brought for evaluation on the basis of caretakers' misinterpretation, overconcern, or malice. The current spectrum of patients seen for child abuse or neglect reflects increased public and professional awareness of the problem. Earlier recognition of abuse, especially greater readiness to consider sexual abuse, brings younger, less physically injured children to the clinic.

Age Factors↗
PubMed1981

Nystagmus alternans.

Nystagmus alternans is a seldom observed spontaneous nystagmus. Nevertheless, we would like to draw the attention to it and advice to be aware of its possibility when interpreting ENG recording for positional nystagmus. We draw the attention to some points eliciting suspicion. Continuous recording during several minutes, without changing any influencing factor, is required. Nystagmus alternans is certainly a central nystagmus and so it is important to differentiate it from a positional nystagmus type I. It may be congenital or a result of a lesion in brain stem or cerebellum. The exact localisation still remains an open question. Its interference with vestibular test results is discussed.

Electronystagmography↗