Gary D. Becker

Uvulopalatopharyngoplasty for snoring: Long‐term results

Uvulopalatopharyngoplasty (UPPP) has become a widely practiced procedure in the management of snoring. In a number of studies, all based on short‐term follow‐up, snoring was reduced or eliminated in 75% to 95% of patients. Because a declinein the initial success rate was casually observed, a formal analysis of the initial and long‐term results of UPPP for snoring was made in the present study. From 1985 to 1989, 69 patients with severe habitual snoring were retrospectively analyzed. A scoring system was devised for snoring, and each patient was interviewed regarding the effects of UPPP on his or her snoring 16 to 75 (mean 44) months after surgery. In 60 (87%) of 69 patients, snoring was initially significantly reduced or totally eliminated. After 13 months the success rate dropped to 46% (32 of 69 patients). Most failures occurred between 6 and 12 months of surgery, after which time the success rate remained relatively stable.

Swimming and tympanostomy tubes: a prospective study.

To prevent ear infection, many physicians advise their patients to avoid water after insertion of tympanostomy tubes. This advice is a logical extension of the supposition that contaminated water entering the middle ear through the tube may cause an infection.

Neurological Consequences of Scuba Diving With Chronic Sinusitis

Sinus barotrauma from scuba diving is relatively common, usually self‐limiting, and often the result of transient nasal pathology. We describe serious neurological sequelae occurring in two scuba divers who had chronic sinusitis. We suggest guidelines for evaluating and treating divers who have chronic sinusitis. Divers with nasal or sinus pathology should be aware of the potentially serious consequences associated with scuba diving even after endoscopic sinus surgery to correct this condition.

Late syphilitic hearing loss: a diagnostic and therapeutic dilemma.

Cochleovestibular dysfunction may occur as the only manifestation of late syphilis. It may occur singly, in combination, and be unilateral or bilateral. A presumptive diagnosis may be made on the basis of excluding other known etiologies of inner ear dysfunction and on a positive serological test for syphilis. The combined experience of the author and a literature review suggests that a combination of penicillin and prednisone is the treatment of choice. Since no controlled clinical trials have been reported, antibiotic and corticosteroid dosage, timing and route of administration are conjectural. All patients with a presumptive diagnosis of late otitic syphilis should be treated regardless of previous syphilitic treatment. Duration of symptoms and magnitude of functional loss are not contraindications. Penicillin is the antibiotic of choice and the minimal treatment should be the United States Public Health Service schedule for late syphilis, i.e., benzathine penicillin G, 2.4 million units by intramuscular injection weekly for three successive weeks. Since penicillin acts on dividing cells only and since treponemes probably divide very slowly in late syphilis, prolonged penicillinemia is desirable. This may be maintained with injectable depo‐penicillin (benzathine penicillin G) or penicillin by mouth, depending upon patient compliance. Duration of treatment of one year is suggested. Prednisone, 40 to 60 mgm/day by mouth is started and continued for at least two weeks. If symptomatic improvement occurs the dose is tapered to a level which will maintain this improvement.

Outcome analysis of Mohs surgery of the lip and chin: comparing secondary intention healing and surgery.

Wounds of the lip and chin resulting from microscopically controlled (Mohs) surgery are often repaired immediately. However, wounds allowed to heal by secondary intention have the advantage of optimal cancer surveillance, simplified wound care, and avoidance of the costs and potential complications associated with reconstructive procedures. Accurate prediction of the course of wound healing would allow a rational approach to selection of surgery or healing by secondary intention.

Quantitative bacteriology of closed-suction wound drainage in contaminated surgery

This study was designed to evaluate the predictive value of quantitative bacteriology of closed‐suction postoperative wound drainage in identifying the patient likely to develop wound infection as well as its subsequent flora. Forty‐one patients undergoing major cancer surgery of the head and neck were studied. Postoperatively, closed‐suction wound drainage was cultured, and anaerobic and aerobic bacterial isolates were quantitated. The wound infection rate was 20% (8/41). No trend toward increased rate of wound infection with increased numbers of bacteria colonizing the wound was observed. Additionally, there was no consistent correlation between species of bacteria isolated from closed‐suction wound drainage and recovery from subsequent wound infection.

Spontaneous Healing of Mohs Wounds of the Cheek: A Cosmetic Assessment

background. Facial defects after Mohs surgery may be closed at the time of surgery, shortly thereafter, or allowed to heal spontaneously. Selection of appropriate management options requires accurate prediction of the final cosmetic result. objective. To determine the relative merits of treatment options for facial defects resulting from Mohs surgery. methods. We prospectively and retrospectively analyzed outcomes for 132 wounds of the cheek resulting from Mohs surgery and allowed to heal spontaneously. The cheek was delineated into topographic areas and the wound location, size, and depth were recorded. Patients were observed intermittently, and a final evaluation of cosmesis was made after ≥6 months. results. Most wounds in the nasolabial fold and preauricular areas healed with excellent results and half the wounds in the medial area of the cheek healed with good or excellent results. Central and mandibular areas of the cheek healed unpredictably, and results were unsatisfactory for most of these wounds. conclusion. Final cosmetic results of Mohs surgery in the cheek area can be predicted on the basis of location, size, and depth of the wound, enabling physicians to knowledgeably select the most suitable treatment option.

Medical Examination of the Sport Scuba Diver

Prior to training, all scuba diving candidates must successfully complete a medical examination to determine their medical, physical, and psychological fitness for survival in a subaquatic environment. This article reviews the pecularities of the diving medical examination and the reasons for them, suggests absolute, relative, and temporary disqualifications from diving, and outlines a sport diving questionnaire and medical examination.

Double V-Y Subcutaneous Island Flap

More than 1 million new cases of skin cancer occur in the United States every year, and the incidence of these is increasing faster than that of any other human cancer. The majority of skin cancers occur on the face, since it receives the most exposure to ultraviolet radiation. Most basal cell and squamous cell carcinomas on the face can be removed and the wounds closed primarily with a simple rotational advancement flap. Excision of larger lesions creates defects which have traditionally been closed with local pedicled flaps or split-thickness or full-thickness skin grafts. These often leave less than optimal cosmetic results.