Michael Nash

Acute Postobstructive Pulmonary Edema

Acute postobstructive pulmonary edema may occur after airway obstruction. A decrease in intrathoracic and intraalveolar pressures causes an increased blood flow into the pulmonary vasculature and favors the development of pulmonary edema. Two mechanisms for the development of acute postobstructive pulmonary edema are proposed: type 1 follows acute airway obstruction, and type 2 follows relief of chronic airway obstruction.

Low-velocity gunshot wounds to the paranasal sinuses

There are more than 200 million private firearms in the United States today. Firearm-associated deaths are the second leading cause of mortality for men 1 to 38 years of age. There are many studies in the literature concerning the management of high-velocity gunshot injuries to the head and neck. However, there are no studies in the English language literature concerning the management of isolated low-velocity gunshot wounds to the paranasal sinuses. We retrospectively reviewed 35 patients treated for low-velocity gunshot wounds of the paranasal sinuses between 1985 and 1994 at Kings County Hospital Center. The injuries sustained by these patients were less severe than previously reported for high-velocity missile or shotgun injuries. The management of these injuries is outlined with emphasis on (1) indications for angiographic studies, (2) airway management, and (3) indications for operative removal of bullet fragments.

Safety Awareness for the Otolaryngologist Caring for the HIV-Positive Patient†

The alarming increase in human immunodeficiency virus (HIV) infection, expected to reach 40 million cases worldwide by the year 2000, has enormous impact on the otolaryngologist, since up to 70% of HIV‐positive patients present with head and neck symptoms. Parenteral and nonparenteral acquisition of HIV has been documented with seroconversion from needle sticks estimated at 1 for every 200 exposures. The rate of compliance with universal precautions is found to be reported as low as 16%. In 1993, over 1400 patients with HIV were admitted to Kings County Hospital Center. There were 165 reported cases of sharp injuries of which 4 were scalpel related and 17 were suture needle related. We surveyed HIV safety experiences at five hospitals emphasizing operating room procedures, including instrument handling, gloving, elimination of excess equipment and personnel, utilization of nonsharp instruments, and team discipline. Preventive measures are recommended to help minimize inadvertent sharp injuries.

Condylomatous lesions of the upper aerodigestive tract.

Condyloma acuminatum is one of four types of common human verrucous lesions that are of viral etiology. Also known as “moist wart,” condyloma acuminatum is most often seen on the mucosal surfaces of the anogenital area. However, occurrences in the mucosal lined areas of the head and neck region are quite rare.

Dermal Grafting for the Repair of Nasal Septal Perforations

The closure of nasal septal perforations is a significant surgical challenge with a high failure rate. Dermis placed between mucoperichondrial advancement flaps may be an alternative. The usefulness of dermal grafting for the repair of nasal septal perforations was initially investigated in an animal model. Four pigs had 1.5 x 2.5 cm perforations surgically created and closed with either temporalis fascia or dermis placed under a local mucoperichondrial flap. The dermal graft group had an average closure of 80% with histologically normal mucosal surfaces. The temporalis fascia group had no closure. Fourteen patients with chronic nasal septal perforations from iatrogenic causes, trauma, and drug abuse were repaired with dermal grafting. Nine patients had complete closure, 3 patients had partial closures, and 1 patients graft dislodged on the first postoperative day. Dermal grafts placed between mucoperichondrial flaps are a viable alternative for the closure of nasal septal perforations.