We report the case of a primary malignant melanoma arising from the mucosa of the hard palate on ... more We report the case of a primary malignant melanoma arising from the mucosa of the hard palate on a fibrovascular stalk. This is to our knowledge the first report of a pedunculated melanoma in this location. The possibility of a more favorable prognosis, because of the stalk, which shows no signs of invasion by the neoplasm, is considered.
International journal of pediatric otorhinolaryngology, 2008
Varying surgical techniques as well as a large selection of analgesics and other medications have... more Varying surgical techniques as well as a large selection of analgesics and other medications have been evaluated over the years in the hopes of reducing post-tonsillectomy pain. Several publications in recent years have demonstrated the efficacy of fibrin glue in reducing post-tonsillectomy bleeding and pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy. A prospective randomized double-blind study was performed on 168 consecutive patients undergoing tonsillectomy for obstructive sleep apnea and chronic tonsillitis. Patients were randomly assigned to the treatment protocol. In the study group, the tonsillar beds were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation. Patients in the controlled group underwent tonsillectomy without the use of fibrin glue. The patients were then monitored for postoperative bleeding, and a patient-based pain assessment instrument was used to evaluate...
CSF rhinorrhea constitutes a diagnostic challenge. If unrecognized or incompletely managed, it ca... more CSF rhinorrhea constitutes a diagnostic challenge. If unrecognized or incompletely managed, it can result in devastating complications. The physician must e aware to this entity and it's management. The conventional neurosurgical management of meningoencephaloceles and cerebrospinal rhinorrhea has been by the intracranial approach. Otolaryngologists have undertaken extracranial approaches for repair of these problems with fair results. In recent years, functional endoscopic sinus surgery has gained popularity and was advocated for the repair of nasal meningoencephaloceles and CSF fistulae. Between 1998 and 1999, five patients were operated by the senior author (M.P) by means of endoscopic sinus surgery. His success rate and lower morbidity make this approach the treatment of choice. The perioperative use of fluoroscein allows us to locate precisely the defect and to confirm complete sealing of the leak. We present our experience in managing 5 cases, 3 of which presented with men...
Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of ... more Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of a postgraduate educational program, results of a local survey were presented to the local medical staff in order to increase its awareness of this diagnostic possibility. The present study was carried out in order to evaluate the management of children with tracheobronchial FBs during two 2-year periods, before and after teaching sessions held in December 1976. In comparison with the previous two years during the 1977-1978 period, the percentage of cases in which a positive history of aspiration was obtained increased from 47.6% to 84.0%; the mean number of hospitalizations due to tracheobronchial FBs decreased from 1.9 to 1.04 per infant, and the mean number of hospital days required for final diagnosis decreased from 17.6 to 5.3. The postgraduate educational program had a positive effect on physician performance and patient care.
Chronic sinusitis with nasal polyps is an uncommon pathology in the pediatric population and may ... more Chronic sinusitis with nasal polyps is an uncommon pathology in the pediatric population and may be associated with systemic disease. In this study we aimed to characterize children who underwent nasal surgery at our medical center due to nasal polyps and review the current literature related to pediatric nasal polyps. We retrospectively reviewed all medical records of patients younger than 18 years who had sinus surgery from 2000 to 2010. We collected demographic and clinical data including age, sex, laterality, revision operations, and comorbidities including asthma, allergy, and cystic fibrosis (CF). Thirty-one patients age 8.8 to 18 years (mean 13.7) were treated surgically in our hospital. Thirteen had antrochoanal polyp, 16 had chronic sinusitis with nasal polyps, and 2 had mucocele. Among patients treated for nasal polyps, there were 6 boys and 10 girls, mean age was 14.2 years, and 14 (87.5%) had bilateral disease. Mean Lund McKay score was 15.8. Five (31.2%) had asthma, 15 ...
To describe the paranasal complications that may occur after dental implantation. A literature se... more To describe the paranasal complications that may occur after dental implantation. A literature search was performed in order to review currently available information about the complications of dental implantations and complementary procedures. The use of dental implants has gained great popularity due to their convenience, natural look, and better speech and chewing efficiency, as well as their potential to slow and even stop jawbone atrophy. Nevertheless, an increasing number of publications have drawn attention to the possible complications of the procedure for the paranasal sinuses. Both short-term and long-term complications have been described that should be familiar to otolaryngologists. Although the procedure is performed by dentists, dental implantations may also have a major impact on the paranasal sinuses. Complications may necessitate the knowledge and cooperation of both dentists and otolaryngologists.
Chronic frontal sinusitis is a relatively common condition, yet one with potential for complicati... more Chronic frontal sinusitis is a relatively common condition, yet one with potential for complications. The treatment of chronic frontal sinusitis has always been a challenge for the otolaryngologist, and it remains so even in the age of endoscopic sinus surgery. Successful treatment is evaluated by both subjective (patient history) and objective (radiologic and endoscopic) criteria. This article aims to present our experience in endoscopic surgery for chronic frontal sinusitis, with particular focus on the importance of the wide opening of the naso-frontal outflow tract, with maximal preservation of the mucosa in this area. During the period 1999 to 2001, 72 patients at the Soroka University Medical Center underwent endoscopic surgery for chronic frontal sinusitis. We reviewed the cases of fifty four patients of this group with a minimum six months follow-up. Patients who did not return for routine post-operative visits were excluded from this study. We evaluated and quantified subje...
The clinical picture of lateral sinus thrombosis (LST) has changed with the advent of antibiotics... more The clinical picture of lateral sinus thrombosis (LST) has changed with the advent of antibiotics, as have the utility of various diagnostic tests. LST may appear in children as a complication of acute otitis media, but nowadays it is more frequently encountered in adults with long-standing chronic ear disease. A retrospective study of all the pediatric patients with LST between 1982 and 1997. Thirteen cases of LST were diagnosed and treated by our department. In six cases, LST was due to acute otitis media and in the remaining cases it was due to chronic otitis media. Headache, fever, aural discharge and mastoid tenderness were the most frequent findings in these patients and four patients were initially diagnosed with meningitis. In the majority of the patients, LST was accompanied with other intracranial complications, such as perisinus abscess, brain abscess and meningitis. One patient with multiple brain abscesses, unresponsive to several drainage procedures, died. The other patients recovered and have since been followed-up as out-patients. LST may be difficult to diagnose due to previous antibiotic treatment and to the overlap of clinical findings with other entities such as meningitis. Despite the value of modern imaging techniques in the investigation of the disease, a high index of suspicion based on the clinical picture is warranted. Our results are consistent with those of other recent studies, who found that mortality of LST has dropped below 10%.
Objectives To study the relationship between peritonsillar abscess (PTA) and minor salivary gland... more Objectives To study the relationship between peritonsillar abscess (PTA) and minor salivary glands surrounding the palatine tonsils. Study Design Prospective population-based study. Settings Tertiary care university hospital. Subjects and Method Prospective study including 41 patients with PTA and 6 patients with a neck abscess. Amylase levels of the pus and serum were measured and compared between the 2 groups. Clinical data regarding hospitalization length and recurrence rate were also collected. Results Of the 41 patients with PTA, 7 suffered from recurrent PTA. Average level of amylase in the pus of the PTA group was 3841 U/L versus 7.7 U/L in the neck abscess group ( P < .001; median, 62 vs 9.5). Serum amylase was higher in the PTA group (49.3 U/L vs 37.3 U/L; P = .008). There were no recurrences in PTA patients with amylase greater than 65 U/dL in the pus in 0 of 20 (0%) versus 7 of 21 (33%) for amylase lower than 65 U/L ( P = .01). Conclusion High amylase in the pus lends ...
To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus... more To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus from patients with organic tinnitus. One hundred ninety-six patients with tinnitus were divided into 2 groups. Forty-three patients, group 1, were not exposed to noise and had sensorineural hearing loss. One hundred fifty-three patients, group 2, were exposed to noise and claimed disability. All the patients underwent 4 tinnitus evaluation tests: pitch matching, intensity matching, residual inhibition, and tinnitus masking. We compared the results of the tinnitus tests between the 2 groups. Group 1 patients had a high-frequency, low-intensity tinnitus that tended to be more inhibited by narrow-band noise, was usually consistent with type I Feldman masking curve, and could be effectively masked. Group 2 patients had tinnitus that could not be characterized. The results of the tinnitus tests were significantly different between the groups. Tinnitus tests may help us differentiate functional tinnitus that is not of cochlear origin from genuine tinnitus.
Objective. To investigate the relationship between tonsillar and peritonsillar infections. Study ... more Objective. To investigate the relationship between tonsillar and peritonsillar infections. Study Design. Retrospective population-based study and a retrospective case series review. Settings. Tertiary academic medical facility. Subjects and Methods. All individuals hospitalized with peritonsillar abscess (PTA) or peritonsillar cellulitis (PTC) during 2004-2008 were reviewed. Patient age, gender, diagnosis of PTA or PTC, recurrence, and date of presentation were recorded. In addition, a database of patients diagnosed in the community with acute tonsillitis (AT) was reviewed for the same time period. The weekly number of patients with AT was recorded, and a comparison between incidence of tonsillar infections and peritonsillar infection was performed. Results. A total of 685 patients were hospitalized with either PTA (467) or PTC (218). Incidence of both upper respiratory infections and AT peaked in January and February of every year with a nadir in August. In contrast, PTA and PTC sh...
Sjogren's syndrome is an autoimmune disease characterized by exocrine gland destruction and m... more Sjogren's syndrome is an autoimmune disease characterized by exocrine gland destruction and manifested by parotid, submandibular and lacrimal gland infection. We report a case with recurrent severe parotid gland infections. The sialographic and CT findings are presented.
... Sheba, Israel. t From the Department of Pathology, School of Medicine, Soroka Medical Center,... more ... Sheba, Israel. t From the Department of Pathology, School of Medicine, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel. 421 Page 2. 422 M. PUTERMAN, F. TOVI, J. SIDI AND II YANAY FIG. 1 ...
Presented here is a case of chronic persistent cough, in a patient in whom squamous papilloma of ... more Presented here is a case of chronic persistent cough, in a patient in whom squamous papilloma of the base of tongue was found. The cough disappeared completely after removal of the tumour.
We report the case of a primary malignant melanoma arising from the mucosa of the hard palate on ... more We report the case of a primary malignant melanoma arising from the mucosa of the hard palate on a fibrovascular stalk. This is to our knowledge the first report of a pedunculated melanoma in this location. The possibility of a more favorable prognosis, because of the stalk, which shows no signs of invasion by the neoplasm, is considered.
International journal of pediatric otorhinolaryngology, 2008
Varying surgical techniques as well as a large selection of analgesics and other medications have... more Varying surgical techniques as well as a large selection of analgesics and other medications have been evaluated over the years in the hopes of reducing post-tonsillectomy pain. Several publications in recent years have demonstrated the efficacy of fibrin glue in reducing post-tonsillectomy bleeding and pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy. A prospective randomized double-blind study was performed on 168 consecutive patients undergoing tonsillectomy for obstructive sleep apnea and chronic tonsillitis. Patients were randomly assigned to the treatment protocol. In the study group, the tonsillar beds were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation. Patients in the controlled group underwent tonsillectomy without the use of fibrin glue. The patients were then monitored for postoperative bleeding, and a patient-based pain assessment instrument was used to evaluate...
CSF rhinorrhea constitutes a diagnostic challenge. If unrecognized or incompletely managed, it ca... more CSF rhinorrhea constitutes a diagnostic challenge. If unrecognized or incompletely managed, it can result in devastating complications. The physician must e aware to this entity and it's management. The conventional neurosurgical management of meningoencephaloceles and cerebrospinal rhinorrhea has been by the intracranial approach. Otolaryngologists have undertaken extracranial approaches for repair of these problems with fair results. In recent years, functional endoscopic sinus surgery has gained popularity and was advocated for the repair of nasal meningoencephaloceles and CSF fistulae. Between 1998 and 1999, five patients were operated by the senior author (M.P) by means of endoscopic sinus surgery. His success rate and lower morbidity make this approach the treatment of choice. The perioperative use of fluoroscein allows us to locate precisely the defect and to confirm complete sealing of the leak. We present our experience in managing 5 cases, 3 of which presented with men...
Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of ... more Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of a postgraduate educational program, results of a local survey were presented to the local medical staff in order to increase its awareness of this diagnostic possibility. The present study was carried out in order to evaluate the management of children with tracheobronchial FBs during two 2-year periods, before and after teaching sessions held in December 1976. In comparison with the previous two years during the 1977-1978 period, the percentage of cases in which a positive history of aspiration was obtained increased from 47.6% to 84.0%; the mean number of hospitalizations due to tracheobronchial FBs decreased from 1.9 to 1.04 per infant, and the mean number of hospital days required for final diagnosis decreased from 17.6 to 5.3. The postgraduate educational program had a positive effect on physician performance and patient care.
Chronic sinusitis with nasal polyps is an uncommon pathology in the pediatric population and may ... more Chronic sinusitis with nasal polyps is an uncommon pathology in the pediatric population and may be associated with systemic disease. In this study we aimed to characterize children who underwent nasal surgery at our medical center due to nasal polyps and review the current literature related to pediatric nasal polyps. We retrospectively reviewed all medical records of patients younger than 18 years who had sinus surgery from 2000 to 2010. We collected demographic and clinical data including age, sex, laterality, revision operations, and comorbidities including asthma, allergy, and cystic fibrosis (CF). Thirty-one patients age 8.8 to 18 years (mean 13.7) were treated surgically in our hospital. Thirteen had antrochoanal polyp, 16 had chronic sinusitis with nasal polyps, and 2 had mucocele. Among patients treated for nasal polyps, there were 6 boys and 10 girls, mean age was 14.2 years, and 14 (87.5%) had bilateral disease. Mean Lund McKay score was 15.8. Five (31.2%) had asthma, 15 ...
To describe the paranasal complications that may occur after dental implantation. A literature se... more To describe the paranasal complications that may occur after dental implantation. A literature search was performed in order to review currently available information about the complications of dental implantations and complementary procedures. The use of dental implants has gained great popularity due to their convenience, natural look, and better speech and chewing efficiency, as well as their potential to slow and even stop jawbone atrophy. Nevertheless, an increasing number of publications have drawn attention to the possible complications of the procedure for the paranasal sinuses. Both short-term and long-term complications have been described that should be familiar to otolaryngologists. Although the procedure is performed by dentists, dental implantations may also have a major impact on the paranasal sinuses. Complications may necessitate the knowledge and cooperation of both dentists and otolaryngologists.
Chronic frontal sinusitis is a relatively common condition, yet one with potential for complicati... more Chronic frontal sinusitis is a relatively common condition, yet one with potential for complications. The treatment of chronic frontal sinusitis has always been a challenge for the otolaryngologist, and it remains so even in the age of endoscopic sinus surgery. Successful treatment is evaluated by both subjective (patient history) and objective (radiologic and endoscopic) criteria. This article aims to present our experience in endoscopic surgery for chronic frontal sinusitis, with particular focus on the importance of the wide opening of the naso-frontal outflow tract, with maximal preservation of the mucosa in this area. During the period 1999 to 2001, 72 patients at the Soroka University Medical Center underwent endoscopic surgery for chronic frontal sinusitis. We reviewed the cases of fifty four patients of this group with a minimum six months follow-up. Patients who did not return for routine post-operative visits were excluded from this study. We evaluated and quantified subje...
The clinical picture of lateral sinus thrombosis (LST) has changed with the advent of antibiotics... more The clinical picture of lateral sinus thrombosis (LST) has changed with the advent of antibiotics, as have the utility of various diagnostic tests. LST may appear in children as a complication of acute otitis media, but nowadays it is more frequently encountered in adults with long-standing chronic ear disease. A retrospective study of all the pediatric patients with LST between 1982 and 1997. Thirteen cases of LST were diagnosed and treated by our department. In six cases, LST was due to acute otitis media and in the remaining cases it was due to chronic otitis media. Headache, fever, aural discharge and mastoid tenderness were the most frequent findings in these patients and four patients were initially diagnosed with meningitis. In the majority of the patients, LST was accompanied with other intracranial complications, such as perisinus abscess, brain abscess and meningitis. One patient with multiple brain abscesses, unresponsive to several drainage procedures, died. The other patients recovered and have since been followed-up as out-patients. LST may be difficult to diagnose due to previous antibiotic treatment and to the overlap of clinical findings with other entities such as meningitis. Despite the value of modern imaging techniques in the investigation of the disease, a high index of suspicion based on the clinical picture is warranted. Our results are consistent with those of other recent studies, who found that mortality of LST has dropped below 10%.
Objectives To study the relationship between peritonsillar abscess (PTA) and minor salivary gland... more Objectives To study the relationship between peritonsillar abscess (PTA) and minor salivary glands surrounding the palatine tonsils. Study Design Prospective population-based study. Settings Tertiary care university hospital. Subjects and Method Prospective study including 41 patients with PTA and 6 patients with a neck abscess. Amylase levels of the pus and serum were measured and compared between the 2 groups. Clinical data regarding hospitalization length and recurrence rate were also collected. Results Of the 41 patients with PTA, 7 suffered from recurrent PTA. Average level of amylase in the pus of the PTA group was 3841 U/L versus 7.7 U/L in the neck abscess group ( P < .001; median, 62 vs 9.5). Serum amylase was higher in the PTA group (49.3 U/L vs 37.3 U/L; P = .008). There were no recurrences in PTA patients with amylase greater than 65 U/dL in the pus in 0 of 20 (0%) versus 7 of 21 (33%) for amylase lower than 65 U/L ( P = .01). Conclusion High amylase in the pus lends ...
To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus... more To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus from patients with organic tinnitus. One hundred ninety-six patients with tinnitus were divided into 2 groups. Forty-three patients, group 1, were not exposed to noise and had sensorineural hearing loss. One hundred fifty-three patients, group 2, were exposed to noise and claimed disability. All the patients underwent 4 tinnitus evaluation tests: pitch matching, intensity matching, residual inhibition, and tinnitus masking. We compared the results of the tinnitus tests between the 2 groups. Group 1 patients had a high-frequency, low-intensity tinnitus that tended to be more inhibited by narrow-band noise, was usually consistent with type I Feldman masking curve, and could be effectively masked. Group 2 patients had tinnitus that could not be characterized. The results of the tinnitus tests were significantly different between the groups. Tinnitus tests may help us differentiate functional tinnitus that is not of cochlear origin from genuine tinnitus.
Objective. To investigate the relationship between tonsillar and peritonsillar infections. Study ... more Objective. To investigate the relationship between tonsillar and peritonsillar infections. Study Design. Retrospective population-based study and a retrospective case series review. Settings. Tertiary academic medical facility. Subjects and Methods. All individuals hospitalized with peritonsillar abscess (PTA) or peritonsillar cellulitis (PTC) during 2004-2008 were reviewed. Patient age, gender, diagnosis of PTA or PTC, recurrence, and date of presentation were recorded. In addition, a database of patients diagnosed in the community with acute tonsillitis (AT) was reviewed for the same time period. The weekly number of patients with AT was recorded, and a comparison between incidence of tonsillar infections and peritonsillar infection was performed. Results. A total of 685 patients were hospitalized with either PTA (467) or PTC (218). Incidence of both upper respiratory infections and AT peaked in January and February of every year with a nadir in August. In contrast, PTA and PTC sh...
Sjogren's syndrome is an autoimmune disease characterized by exocrine gland destruction and m... more Sjogren's syndrome is an autoimmune disease characterized by exocrine gland destruction and manifested by parotid, submandibular and lacrimal gland infection. We report a case with recurrent severe parotid gland infections. The sialographic and CT findings are presented.
... Sheba, Israel. t From the Department of Pathology, School of Medicine, Soroka Medical Center,... more ... Sheba, Israel. t From the Department of Pathology, School of Medicine, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel. 421 Page 2. 422 M. PUTERMAN, F. TOVI, J. SIDI AND II YANAY FIG. 1 ...
Presented here is a case of chronic persistent cough, in a patient in whom squamous papilloma of ... more Presented here is a case of chronic persistent cough, in a patient in whom squamous papilloma of the base of tongue was found. The cough disappeared completely after removal of the tumour.
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