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Biomedical subjects

W Pirsig

Publications and source records attributed to W Pirsig.

At least 19 recordsLinked to original sources
PubMed2003

[Hearing loss in a cultural-historical context. Part 1].

BACKGROUND: It is rare to find anything written about hearing loss or its treatment in either representative art or in a medical-historical context in ear, nose and throat journals. METHODS: Examples dating back over the past 4000 years found in medical-historical, philosophical, and literary documents are presented and commented on. RESULTS: The ancient Egyptians and Greeks attempted to explain deafness and sought remedies,making use not only of empiric rational means but also magic and religion. Later, in the Middle Ages, examples from Christian iconography are found demonstrating miracle healing of deafness. Education of the deaf was not considered possible from the time of Aristotle to the sixteenth century, but from then on was organized on a large scale utilizing speech with gestures.

Christianity↗
PubMed2001

Stuttering in history and culture.

The phenomenon of stuttering from Biblical times is covered from a historical and cultural point of view. Theories of its origin and the methods by which it was treated in former times including the surgical procedures of the 18th and 19th century are examined. Since the Renaissance, examples of stutterers in the performing arts have been found.

Attitude to Health↗
PubMed2001

[Current aspects on diagnosis of sleep-related breathing disorders].

Various diagnostic procedures are available to diagnose sleep-related breathing disorders. The present review examines the amount of diagnostics necessary for daily routine. Concerning taking patients' history, the medical examination and nasal parameters, no new recommendations derive from this review. On the other hand,the detection of the site of pharyngeal obstruction seems to have become less important than it was a couple of years ago.Today, the upper airway is considered to be a complex, functional unit. The classification of the obstruction site into retropalatal and retrolingual seems to be oversimplified. A fully attended, complete polysomnography in the sleep laboratory no longer seems to be necessary in every case of suspected sleep-related breathing disorders. Under certain conditions, ambulatory recording units provide cost-effective alternatives.

Humans↗
PubMed2001

[Postoperative management following rhinosurgery interventions in severe obstructive sleep apnea. A pilot study].

BACKGROUND: Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy. PATIENTS AND METHOD: Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively. RESULTS: None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed. CONCLUSION: The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.

Adult↗
PubMed2001

New developments in the therapy of obstructive sleep apnea.

This review of the literature summarizes new trends in the diagnosis and treatment of obstructive sleep apnea (OSA) over the last 3 years. A literature search in Medline on 5 March 2000 using the keywords "OSA" and "OSAS" identified 123 papers. Another 86 articles were added from the references of the first 123 papers. New trends were observed concerning measurements of quality of life. There are new developments regarding conservative treatment, for example, nasal continuous positive airway pressure (nCPAP) therapy and oral devices. With regard to surgical treatment of OSA new surgical procedures, the radiofrequency technique, and the concept of multilevel surgery are discussed. After more than 25 years of interdisciplinary sleep medicine there still are some new developments of interest for ears, nose, and throat surgeons, which indicate the need for the involvement of otorhinolaryngologists in modern sleep medicine.

Electric Stimulation Therapy↗
PubMed2001

Surgically repaired cleft lips depicted in paintings of the late Gothic period and the Renaissance.

Paintings and drawings by Lucas Moser, Leonardo da Vinci, Albrecht Dürer, and Jacob Cornelisz van Oostsanen suggest that they employed people who had had cleft lips operated on as models for their works of art. Created between 1431 and 1520, the portraits show diagnostic facial profiles with a curved nasal dorsum, short columella, maxillary retrusion, and pseudoprogenia. The first medical illustration of cleft lip surgery was published in 1564 by Ambroise Paré. It was therefore late Gothic and Renaissance artists who depicted the conspicuous signs of surgically treated patients with cleft lip more than 130 years before the surgeons.

Art↗
PubMed2000

[Obstructive sleep apnea in older patients after the closure of a tracheostoma].

BACKGROUND AND OBJECTIVE: The closure of tracheostomies may postoperatively induce an obstructive sleep apnea (OSA) even in patients who never complained about sleep related breathing disorders before they underwent tracheotomy. The present study was designed to evaluate, whether OSA appears after the tracheostomy has been airtightly blocked and if so, whether there are typically illnesses predictive for OSA after operative closure of tracheostomies. PATIENTS AND METHODS: Twelve consecutive patients (3 male; 9 female; mean age 66 years), who addressed our clinic for operative closure of their tracheostomies were enrolled in this study over a period of 18 months. On basis of patient's history and clinical findings the patients were divided into two groups. Group A included 7 patients with laryngeal pathologies and group B included 5 patients with normal larynges. All patients underwent a 12-channel polysomnography (PSG) with airtightly blocked tracheostomies preoperatively. RESULTS: In 5 patients a mild OSA and in one patient a severe OSA was diagnosed by PSG. The patients of group A with laryngeal pathologies were older, had a lower Body Mass Index (BMI) and a higher Apnea-Hypopnea Index than patients of group B (p < 0.05). CONCLUSION: Laryngeal pathologies in the elderly might facilitate the development of OSA after operative closure of tracheostomies. Based on the results postoperative reevaluation is recommended for all elderly patients with laryngeal abnormalities after operative closure of the tracheostomy.

Aged↗
PubMed2000

Long-term results in the treatment of obstructive sleep apnea.

No recent update is available on long-term results of the various types of treatment of obstructive sleep apnea (OSA) which can help the physician in evaluating the individually tailored treatment for patients with OSA in the long term. We arbitrarily defined "long-term" results as those after at least 3 years and reviewed the literature from the past 25 years for reports on conservative, apparative, and surgical therapy of OSA in children and adults. Another inclusion criterion was that the diagnosis was also confirmed by polysomnography before treatment and at follow-up. Only relatively few long-term studies meeting the criteria of 'evidence based medicine' were found, comparing the findings of these was difficult or impossible due to varying criteria for success. Long-term data were available about the effect of weight reduction, nasal ventilation therapy, oral devices, tonsillectomy, uvulopalatopharyngoplasty, maxillomandibular advancement osteotomies, and tracheotomy. After approx. 25 years many treatment modalities in sleep medicine are still experimental concerning the long-term use for the individual. In particular, randomized controlled trials in surgery are lacking. Late results show that at least 50% of patients with OSA can be treated effectively by one or a combination of treatments. Nasal continuous positive airway pressure, tracheotomy, maxillomandibular advancement osteotomy, and tonsillectomy are the most effective treatments of OSA.

Combined Modality Therapy↗
PubMed2000

Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy.

PURPOSE: To apply virtual-endoscopic mode to display the nasal cavity and to evaluate clinical application of virtual endoscopy in comparison with nasal fiberoptic endoscopy. MATERIALS AND METHODS: Eleven patients were examined by virtual endoscopy after axial spiral computed tomography (CT) scanning was performed. In addition, 9 out of these 11 patients underwent fiberoptic endoscopy. Spiral CT scanning was performed with 1-mm collimation, 0.5- to 1-mm increment, 25-250 mA s, and pitch 1-2. Virtual endoscopy was performed by Explorer software package. RESULTS: Virtual endoscopy could clearly demonstrate anatomic structures in the nasal cavity, septal deviation, stenosis and obstruction of the middle meatus, turbinate hyperplasia, and pathological masses larger than 3 mm in diameter. However, "false adhesions" may appear in virtual endoscopy. The main limitation of virtual endoscopy was the inability to evaluate mucosa and its surface. CONCLUSION: Virtual endoscopy of the nasal cavity is a new and noninvasive method. It can demonstrate normal and pathological structures in the nasal cavity. Its ability to visualize is comparable with fiberoptic endoscopy except for evaluating mucosal surface and secretions. In the future, this method will probably be a basic instrument of computer-assisted surgery in the midfacial region.

Adult↗
PubMed2000

[Effect of the long-acting beta-2 agonist inhalant formoterol on the quality of sleep of patients with bronchial asthma].

BACKGROUND: Patients with asthma bronchiale often complain of exacerbations during the night. Some anti-asthmatic drugs are known to impair the quality of sleep. HYPOTHESIS: The study was undertaken to prove the effect of the long-acting, inhaled beta-2-agonist formoterol on the quality of sleep in patients with mild or moderate asthma bronchiale. METHODS: 20 patients with asthma bronchiale (15 female, 21-75 years, O 33.3 years) without sleep disorder were evaluated by polysomnography during 3 nights. After one adaptation night, the patients were randomly assigned 24 micrograms of formoterol during one and placebo during the other night. The frequency of respiratory disturbances, arousals, sleep latency, sleep stages, sleep efficiency, motoric activity, and subjective impression of sleep quality were compared in both groups. RESULTS: Respiratory disturbances were less, and the subjective impression of sleep quality was better with formoterol in 50% of the patients. The objective quality of sleep was slightly better with formoterol, but not significant (Tab. 1). CONCLUSIONS: In patients with mild or moderate asthma bronchiale, formoterol does not impair, probably slightly improves the quality of sleep.

Administration, Inhalation↗
PubMed2000

[Meta-analysis of laser-assisted uvulopalatopharyngoplasty. What is clinically relevant up to now?].

BACKGROUND: Laser-assisted uvulopalatoplasty (LAUP) was not recommended by the American Sleep Disorders Association for the treatment of snoring and obstructive sleep apnea (OSA) because of data lacking in 1994. In the meantime numerous new papers concerning this subject have been published in peer reviewed journals. A new evaluation of the value of LAUP is presented. METHODS: In a world-wide literature search (Medline) from 1980 until March 1999, seventy articles were identified. The papers were analyzed concerning the subtopics "operative techniques", "LAUP and OSA", "LAUP and snoring", "pain", "side-effects", "indications" and "predictive criteria". RESULTS: On the basis of the collected data, it is possible to put definitive values on the subtopics "operative techniques", "LAUP and snoring" and "side-effects". In contrast, objective long-term results concerning "LAUP and OSA" are still missing. Short-term results are promising. CONCLUSION: Nevertheless, LAUP and its related procedures presently should not be recommended for the treatment of any severity of OSA.

Adult↗
PubMed2000

Tonsillectomy as a treatment of obstructive sleep apnea in adults with tonsillar hypertrophy.

OBJECTIVES: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. STUDY DESIGN: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). MATERIAL AND METHODS: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. RESULTS: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI > or = 50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. CONCLUSIONS: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.

Adult↗
PubMed2000

Uvulopalatopharyngoplasty changes fundamental frequency of the voice--a prospective study.

The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.

Adult↗