ABSTRACT
During the past 25 years, use of the carbon dioxide (CO2) laser has been accepted as the most appropriate surgical method for the treatment of recurrent laryngeal papillomatosis. Although CO2 laser technology and surgical techniques continue to improve, laser-related complications still occur. We describe a case of a very rare complication--to our knowledge, only the second such case reported in the literature--in which an endotracheal tube was almost completely obstructed by a piece of papillomatous tissue during CO2 laser microlaryngoscopy for the treatment of recurrent laryngeal papillomatosis.
Subject(s)
Airway Obstruction/etiology , Intraoperative Complications/etiology , Intubation, Intratracheal/adverse effects , Laryngeal Neoplasms/surgery , Laser Therapy/adverse effects , Neoplasm Recurrence, Local/surgery , Papilloma/surgery , Airway Obstruction/physiopathology , Child, Preschool , Female , Follow-Up Studies , Humans , Intraoperative Complications/physiopathology , Intubation, Intratracheal/instrumentation , Laryngeal Neoplasms/diagnosis , Laryngoscopy/methods , Laser Therapy/methods , Neoplasm Recurrence, Local/diagnosis , Papilloma/diagnosis , Reoperation , Risk AssessmentABSTRACT
OBJECTIVE: The purposes of this study were to evaluate the effectiveness of radiologic studies in diagnosing sinusitis in the intensive care unit (ICU) patient and to compare it with the effectiveness of endoscopic examination of the middle meatus. METHODS: We conducted a prospective collection of data in 141 ICU patients consulted for sinusitis over a 5-year period beginning in the 1994. RESULTS: Antral lavage was performed at least unilaterally in 112 patients, with a total of 195 lavages performed. Plain films and computer tomography scans predicted purulence in 41% (chi(2) = 2.9, P = 0.09) and 47% (chi(2) = 2.2, P = 0.14) of the cases, respectively, whereas the presence of purulence in the middle meatus as seen on endoscopy predicted purulence in the maxillary sinus in 78% of the lavages (chi(2) = 28.9, P = 8 x 10(-8)). When there was no evidence of purulence in the middle meatus on endoscopy, 73% of the lavages were negative. CONCLUSION: The most important predictor of a positive antral lavage in the ICU patient with suspected sinusitis is evidence of purulence on endoscopic examination of the middle meatus.
Subject(s)
Sinusitis/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Intensive Care Units , Intubation , Male , Middle Aged , Nose , Physical Examination , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: To identify potential risk factors for neonatal hearing loss that are not included in the current variables recognized by the Joint Committee on Infant Hearing (JCIH). METHODS: A series of consecutively born neonates with risk factors for hearing loss based on the 1994 JCIH registry were screened prospectively. There were 110 subjects with hearing loss and 636 subjects without hearing loss. Data collected as potential risk factors for infant hearing loss included not only those on the JCIH list but also others that we believed to be possibly significant. The infant hearing screening was performed on each subject using auditory brain stem testing. Statistical analysis of data was performed using the chi-square test. RESULTS: In addition to the variables listed by the JCIH, we identified 11 additional risk factors that were associated with hearing loss in our neonatal population. These are: length of stay in the intensive care unit, respiratory distress syndrome, retrolental fibroplasia, asphyxia, meconium aspiration, neurodegenerative disorders, chromosomal abnormalities, drug and alcohol abuse by the mother, maternal diabetes, multiple births, and lack of prenatal care. CONCLUSION: This study identifies 11 risk factors in addition to those currently on the high-risk registry published by the JCIH for neonatal hearing loss. The inclusion of these additional risk factors in neonatal screening programs may improve the detection rate of neonates with hearing loss. Further study will be needed to determine whether inclusion of these additional risk factors in a hearing screening program can provide an efficacious alternative to the use of universal infant screening.
Subject(s)
Deafness/diagnosis , Deafness/etiology , Age Factors , Female , Humans , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/etiology , Male , Neonatal Screening/standards , Pilot Projects , Prospective Studies , Random Allocation , Registries/standards , Risk FactorsABSTRACT
OBJECTIVE: The study goal was to compare endoscopically guided middle meatal cultures with cultures of antral lavage aspirate in intensive care unit (ICU) patients with sinusitis. METHODS: Prospective study of febrile ICU patients seen for sinusitis at a tertiary medical center. RESULTS: Of 31 antral lavages performed in 18 patients, 19 lavages yielded purulent or mucopurulent aspirate. Endoscopically guided middle meatal cultures yielded the same pathogen, as did cultures of the lavage aspirate in 4 (21%) of these 19 cases. The antral lavage was negative (absence of purulent/mucopurulent aspirate) in 12 cases, and of those, 5 (42%) of the 12 middle meatal cultures showed no growth (sensitivity = 21%, specificity = 58%, chi(2)-1.52, P = 0.218). CONCLUSION: Endoscopically guided middle meatal cultures did not correlate well with cultures from the antral lavage aspirate in febrile ICU patients evaluated for sinusitis.
Subject(s)
Ear, Middle/microbiology , Fever of Unknown Origin/etiology , Intensive Care Units , Sinusitis/microbiology , Female , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Sinusitis/diagnosis , Therapeutic IrrigationABSTRACT
To compare the effectiveness and predictive value of radiologic studies with fine-needle aspiration biopsy (FNAB) in correctly diagnosing thyroid lesions, we reviewed the medical records of 441 patients who had been treated surgically for thyroid disease from 1987 through 1999. We compared the results of thyroid scintigraphy, ultrasound, and FNAB with findings on final surgical pathology. The data were analyzed according to the chi-squared (chi 2) test. Of 189 thyroid scintigraphy scans that showed a hypofunctional (cold) nodule, 52 (27.5%) were found to be cancerous, and of 35 hyperfunctional (hot) nodules, two (5.7%) were malignant (sensitivity = 91%; specificity = 19%; accuracy = 38%; chi 2 = 7.67; p = 0.006). Of 66 ultrasounds that detected a solid or a mixed solid-cystic mass, 16(24.2%) were cancerous, while none of the eight sonograms that showed a purely cystic lesion was malignant (sensitivity = 100%; specificity = 14%; accuracy = 32%; chi 2 = 2.47; p = 0.116 [not statistically significant]). Of the 119 patients whose FNABs were diagnostic, 55 biopsies revealed follicular cells. Of the remaining 64 biopsies, cancer was correctly predicted in 35 of 44 patients (79.5%) and benign disease was correctly diagnosed in 18 of 20 patients (90.0%) (sensitivity = 95%; specificity = 67%; accuracy = 83%; chi 2 = 27.3; p = 0.00). We conclude that in the evaluation of thyroid lesions, FNAB is superior to imaging studies, which yield a relatively high rate of false-positive results.
