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Transformation of mucosal secretory elements in chronic maxillary sinusitis after endoscopic sinus surgery
CURRENT LITERATURE
vascular decompression alone. The authors conclude that vascular decompression is an effective treatment for patients with trigeminal neuralgia caused by vertebrobasilar compression of the nerve.-R.E. ALEXANDER Reprint requests to Dr Jannetta: Department of Neurological Surgery, Room F948, Presbyterian University Hospital, 230 Lothrop St, Pittsburgh, PA 15213.
Percutaneous Cervical Cordotomy: A Review of 181 Operations on 146 Patients With a Study on the Location of “Pain Fibers” in the C-2 Spinal Cord Segment of 29 Cases. Lahuerta J, Bowsher D, Lipton S, et al: J Neurosurg 80:975. 1994 Nearly 1,000 cervical cordotomies for the relief of chronic pain have been performed by one of the authors of this review, using the percutaneous method. The authors present a review of 146 patients who underwent 181 percutaneous cervical cordotomies for intractable pain, and an anatomicalclinical correlation was done for 29 of those patients. The study was comprised of 83 men and 63 women, with a mean age of 58.7 (+ 11) years and an age range of 19 to 79 years. The mean duration of pain prior to cordotomy was 10.7 months. All of the patients were receiving analgesic medication (96% were on narcotics). Most of the patients had terminal cancers. Sixty-six percent of the patients obtained complete pain relief, 23% had partial relief, and only 11% had no relief from their pain. Patients with cancer had better success rates for full pain relief than patients with chronic benign pain (69% vs 17%). The best analgesic effects were obtained by creating lesions that extended 5.0 mm deep to the surface of the cord and destroyed 20% of the hemicord. The authors believe that the ascending fibers, which subserve the distinct sensations of pain induced by tissue damage and pinprick, are physiologically distinct from one another even though they are overlapping in the anterolateral funiculus of the spinal cord. Diagrams in the article show where the authors have found the primary pain pathways to be in the anterolateral funiculus at the C-2 spinal cord level.-R.E. ALEXANDER Reprint requests to Dr Bowsher: Pain Research Institute, Walton Hospital. Liverpool L9 IAE, England.
A Study of Pediatric House Staff’s Knowledge of Pulse Oximetry. Rodriguez LR, Kotin N, Lowenthal D, et al. Pediat 93:810. 1994 Knowledge of basic principles and clinical and technical considerations, as well as understanding of the oxyhemoglobin dissociation curve, are important to monitor patients properly and to render appropriate care. Most existing studies have focused on the comparison, accuracy, or efficacy of the different types of pulse oximeters. The issue of appropriate use and application of the data obtained from the units has not been addressed. This study sought to quantify the knowledge of the pediatric house staff from five different medical school-affiliated residency programs relative to pulse oximetry and their ability to interpret the information from it. A total of 134 doctors (about 40% of the total house staff) participated. Data were obtained by way of a 16-item multiple-choice questionnaire (in which six of the questions were demographic in nature). Participants had no advance notification of the questionnaire. Ninety-seven percent of the participants had used the pulse oximeter, but 43% believed they had not been adequately trained to use it. Forty-three percent
1345 did not know what a pulse oximeter measures, 66% did not know that a decline in oxygen saturation from 95% to 90% was a greater change in Paoz than a decrease in oxygen saturation from 80% to 75%. Twenty-one percent did not know that both nail polish and motion can affect the ability of the pulse oximeter to obtain a reliable reading. Thirtynine percent did not know that shock affects the accuracy but high blood pressure does not. Fifty-nine percent did not know that an oxygen saturation of 90% corresponds to a Pao, of only 60 mm Hg. Only 17% correctly answered all three questions relative to the oxyhemoglobin dissociation curve. Only 36% could correctly answer questions related to the accuracy of the pulse oximeter. Overall, the mean test score was approximately 64%, with a wide range from 10% to 100%. The authors conclude that there is a marked variability in pediatric house staffs knowledge that could contribute to increased morbidity in the patient population they serve. They emphasize that strategies for teaching pulse oximetery should be implemented at all levels of resident training.-R.E. ALEXANDER Reprint requests to Dr Kattan: Pediatric Pulmonary Division, Box 1202, Mount Sinai School of Medicine, One Gustave L. Levy PI. New York, NY 10029.
Reimplantation of Avulsed Maxillary Incisors: A Six Year Case Report. Davidson DF, Horbay VK, J Can Dent Assoc 60:500. 1994 Six days after avulsion, lateral and central incisors in a 17-year-old female were root canal-filled, immersed initially in local anesthetic solution and 2% epinephrine, subsequently in acetic acid for 20 seconds, then local anesthetic solution again prior to reimplantation into prepared sockets. The sockets were debrided of granulation tissue with a pearshaped acrylic trimmer and tapered bone drill. Durelon splinting (SB Preneir Co, Germany) and antibiotic therapy for 10 days followed reimplantation. A cast bar splint was then cemented to avulsed and adjacent teeth, and removed 10 months later. A 6-year follow-up showed satisfactory reattachment. The immersion of avulsed teeth in dilute acetic acid, etching radicular cementum, provided for reattachment without ankylosis.-G.H. SPERBER Reprint requests to Dr Davidson: Faculty of Dentistry, University of Manitoba, Bannatyn Ave, Winnipeg. MN, Canada R3E OWZ.
Transformation of Mucosal Secretory Elements in Chronic Maxillary Sinusitis After Endoscopic Sinus Surgery. Fang, S-Y. Ann Otol Rhino1 Laryngol 103:439, 1994 Twenty patients were evaluated for transformation of maxillary sinus secretory mucosa after endoscopic sinus surgery (ESS). Five normal antral mucosae were used as controls, and 15 post-ESS antral mucosae were evaluated at the 16th week when gross recovery occurred. Specimens from the rear wall of the antrum observed under scanning electron microscopy showed a significant decrease of goblet cells and an increase of polypoid and purulent glands in the post-ESS cases. Repair of an&al mucosa requires more time than gross recovery; post-ESS follow-up should be longer than 16 weeks to prevent recurrence.-G.H. SPERBER Reprint requests to Dr Fang: Department of Otolaryngology, National Cheng Kung University, 138 Sheng Li Rd. Tainan 70428 Taiwan, Republic of China.
vascular decompression alone. The authors conclude that vascular decompression is an effective treatment for patients with trigeminal neuralgia caused by vertebrobasilar compression of the nerve.-R.E. ALEXANDER Reprint requests to Dr Jannetta: Department of Neurological Surgery, Room F948, Presbyterian University Hospital, 230 Lothrop St, Pittsburgh, PA 15213.
Percutaneous Cervical Cordotomy: A Review of 181 Operations on 146 Patients With a Study on the Location of “Pain Fibers” in the C-2 Spinal Cord Segment of 29 Cases. Lahuerta J, Bowsher D, Lipton S, et al: J Neurosurg 80:975. 1994 Nearly 1,000 cervical cordotomies for the relief of chronic pain have been performed by one of the authors of this review, using the percutaneous method. The authors present a review of 146 patients who underwent 181 percutaneous cervical cordotomies for intractable pain, and an anatomicalclinical correlation was done for 29 of those patients. The study was comprised of 83 men and 63 women, with a mean age of 58.7 (+ 11) years and an age range of 19 to 79 years. The mean duration of pain prior to cordotomy was 10.7 months. All of the patients were receiving analgesic medication (96% were on narcotics). Most of the patients had terminal cancers. Sixty-six percent of the patients obtained complete pain relief, 23% had partial relief, and only 11% had no relief from their pain. Patients with cancer had better success rates for full pain relief than patients with chronic benign pain (69% vs 17%). The best analgesic effects were obtained by creating lesions that extended 5.0 mm deep to the surface of the cord and destroyed 20% of the hemicord. The authors believe that the ascending fibers, which subserve the distinct sensations of pain induced by tissue damage and pinprick, are physiologically distinct from one another even though they are overlapping in the anterolateral funiculus of the spinal cord. Diagrams in the article show where the authors have found the primary pain pathways to be in the anterolateral funiculus at the C-2 spinal cord level.-R.E. ALEXANDER Reprint requests to Dr Bowsher: Pain Research Institute, Walton Hospital. Liverpool L9 IAE, England.
A Study of Pediatric House Staff’s Knowledge of Pulse Oximetry. Rodriguez LR, Kotin N, Lowenthal D, et al. Pediat 93:810. 1994 Knowledge of basic principles and clinical and technical considerations, as well as understanding of the oxyhemoglobin dissociation curve, are important to monitor patients properly and to render appropriate care. Most existing studies have focused on the comparison, accuracy, or efficacy of the different types of pulse oximeters. The issue of appropriate use and application of the data obtained from the units has not been addressed. This study sought to quantify the knowledge of the pediatric house staff from five different medical school-affiliated residency programs relative to pulse oximetry and their ability to interpret the information from it. A total of 134 doctors (about 40% of the total house staff) participated. Data were obtained by way of a 16-item multiple-choice questionnaire (in which six of the questions were demographic in nature). Participants had no advance notification of the questionnaire. Ninety-seven percent of the participants had used the pulse oximeter, but 43% believed they had not been adequately trained to use it. Forty-three percent
1345 did not know what a pulse oximeter measures, 66% did not know that a decline in oxygen saturation from 95% to 90% was a greater change in Paoz than a decrease in oxygen saturation from 80% to 75%. Twenty-one percent did not know that both nail polish and motion can affect the ability of the pulse oximeter to obtain a reliable reading. Thirtynine percent did not know that shock affects the accuracy but high blood pressure does not. Fifty-nine percent did not know that an oxygen saturation of 90% corresponds to a Pao, of only 60 mm Hg. Only 17% correctly answered all three questions relative to the oxyhemoglobin dissociation curve. Only 36% could correctly answer questions related to the accuracy of the pulse oximeter. Overall, the mean test score was approximately 64%, with a wide range from 10% to 100%. The authors conclude that there is a marked variability in pediatric house staffs knowledge that could contribute to increased morbidity in the patient population they serve. They emphasize that strategies for teaching pulse oximetery should be implemented at all levels of resident training.-R.E. ALEXANDER Reprint requests to Dr Kattan: Pediatric Pulmonary Division, Box 1202, Mount Sinai School of Medicine, One Gustave L. Levy PI. New York, NY 10029.
Reimplantation of Avulsed Maxillary Incisors: A Six Year Case Report. Davidson DF, Horbay VK, J Can Dent Assoc 60:500. 1994 Six days after avulsion, lateral and central incisors in a 17-year-old female were root canal-filled, immersed initially in local anesthetic solution and 2% epinephrine, subsequently in acetic acid for 20 seconds, then local anesthetic solution again prior to reimplantation into prepared sockets. The sockets were debrided of granulation tissue with a pearshaped acrylic trimmer and tapered bone drill. Durelon splinting (SB Preneir Co, Germany) and antibiotic therapy for 10 days followed reimplantation. A cast bar splint was then cemented to avulsed and adjacent teeth, and removed 10 months later. A 6-year follow-up showed satisfactory reattachment. The immersion of avulsed teeth in dilute acetic acid, etching radicular cementum, provided for reattachment without ankylosis.-G.H. SPERBER Reprint requests to Dr Davidson: Faculty of Dentistry, University of Manitoba, Bannatyn Ave, Winnipeg. MN, Canada R3E OWZ.
Transformation of Mucosal Secretory Elements in Chronic Maxillary Sinusitis After Endoscopic Sinus Surgery. Fang, S-Y. Ann Otol Rhino1 Laryngol 103:439, 1994 Twenty patients were evaluated for transformation of maxillary sinus secretory mucosa after endoscopic sinus surgery (ESS). Five normal antral mucosae were used as controls, and 15 post-ESS antral mucosae were evaluated at the 16th week when gross recovery occurred. Specimens from the rear wall of the antrum observed under scanning electron microscopy showed a significant decrease of goblet cells and an increase of polypoid and purulent glands in the post-ESS cases. Repair of an&al mucosa requires more time than gross recovery; post-ESS follow-up should be longer than 16 weeks to prevent recurrence.-G.H. SPERBER Reprint requests to Dr Fang: Department of Otolaryngology, National Cheng Kung University, 138 Sheng Li Rd. Tainan 70428 Taiwan, Republic of China.