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Biomedical subjects

E P Prokopakis

Publications and source records attributed to E P Prokopakis.

17 recordsLinked to original sources
PubMed2006

The risk of foreign body aspiration in children can be reduced with proper education of the general population.

OBJECTIVE: To evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children. METHODS: A retrospective analysis of 87 endoscopic foreign body removals in children was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Crete, during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted by the same Department during the period between 1991 and 1999. RESULTS: A foreign body was discovered in 44 cases, while in 43 cases there were no findings. Twenty-one foreign bodies (47.73%) were found in the right main bronchus, 20 foreign bodies (45.45%) were found in the left main bronchus and 3 (6.82%) in the trachea. Both crude and age-standardized bronchoscopy rates appear to be lower in the time period 2000-2004, as compared to the time period prior to the educational program. CONCLUSIONS: The decline in the total number of bronchoscopies during recent years has been a result of a campaign for proper education of the public and especially parents, caretakers and families. All aspects of the educational campaign are described in detail. The risk of high morbidity and mortality from foreign body aspiration makes it mandatory to increase even more the awareness of the general population.

Adolescent↗
PubMed2000

In vitro ear cartilage shaping with carbon dioxide laser: an experimental study.

Deformed cartilage remodeling appears to be a challenge, as cartilage tends to keep its initial shape because of internal stresses. Cartilage can be remodeled with heat, and this report describes the use of a CO2 laser beam for in vitro cartilaginous tissue remodeling. Straight cartilage samples were removed from the ears of 21 rabbits deprived of perichondrium and remodeled with the CO2 laser at an output power of 3 W, a spot diameter of 2 mm, and an exposure time of 0.5 second. The remodeled cartilages and control samples were implanted into the rabbits' backs and retrieved 6 to 12 months later. Histologic and morphological analysis showed that the irradiated cartilages retained both their shape and their viability. This may be a useful clinical technique for in situ remodeling of a deformed cartilage in operations such as septoplasty.

Animals↗
PubMed2000

Fibrous dysplasia of the temporal bone: report of a case and a review of its characteristics.

Fibrous dysplasia is an uncommon benign disorder of unknown etiology. It represents a disturbance of normal bone development--specifically a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone. Because fibrous dysplasia shows a predilection for the facial and cranial bones, where it causes deformity and dysfunction, the disease is of particular interest to the otolaryngologist. In this paper, we report a case of fibrous dysplasia of the temporal bone, the first symptom of which was a mixed hearing loss. We discuss the characteristic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of secondary sensorineural hearing loss.

Fibrous Dysplasia of Bone↗
PubMed1999

The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract.

BACKGROUND: Adenoid cystic carcinoma (ACC) of the sinonasal tract is an aggressive malignancy associated with a poor 5-year survival rate. The role of skull base surgery for the treatment of patients presenting with sinonasal ACC and its impact upon their survival has not previously been evaluated. METHODS: A retrospective review of 35 patients with ACC of the sinonasal tract who were treated with surgery and radiation therapy at the University of Pittsburgh Medical Center was performed to evaluate patient outcome. RESULTS: Local recurrence of tumor following surgery and radiation therapy was observed in 36% of the patients originally treated at the University of Pittsburgh Medical Center. Fourteen percent of these patients developed a regional tumor recurrence, and 21% developed distant metastases. We did not identify any tumor-related factors that predicted patient outcome. Local recurrences were treated with salvage surgical excision, and, despite aggressive management, only 1 of 17 patients with local recurrence was considered cured (NED) at 24 months (follow-up after salvage surgery). Overall, disease-free survival was 46.4%, at a median follow-up of 40 months. CONCLUSIONS: ACC of the sinonasal tract is an aggressive malignancy. Skull base surgery has facilitated the gross total excision of advanced lesions that were deemed inoperable in the past, but has not resulted in an overall improvement in disease-free survival. Local recurrence portends a very poor prognosis, despite aggressive salvage regimens. Alternative therapies for local recurrences warrant further investigation. Prospective, randomized studies are necessary to evaluate the outcome of patients treated with aggressive multimodal treatment regimens, including chemotherapeutic regimens.

Adult↗
PubMed1999

Assessment of nasal mucosa blood supply by quantitative endoscopic imaging of the back-scattered light.

In this article we present a method for the objective assessment and monitoring of tissue blood supply using a specially developed endoscopic imaging colorimeter that enables quantitative color modeling of the back-scattered light during endoscopic examination. Tissue blood volume changes in the nasal mucosa, induced by xylometazoline hydrochloride nasal spray, were evaluated with this method. It was found that quantitative imaging provides sensitive, reproducible, and reliable means for the monitoring and mapping of tissue blood supply and is easy to use routinely. The results showed that saturation decreases with time, being the most sensitive color parameter to the vasoconstriction procedure. It appears that objective indexes for optical tissue characterization and analysis may be promising in the understanding of the pathophysiology of tissue changes and in the objective evaluation of their response to different therapeutic schemes.

Colorimetry↗
PubMed1999

Negative pressure suction in nasal septum surgery.

Operations for the correction of septal deviations are among the most common in otorhinolaryngology. Several approaches and techniques have been proposed, for securing the mucoperichondrial flap back in place. A new method of stabilizing the septum by applying a negative pressure suction tube, without the insertion of any kind of packing, is described. The advantages of the negative pressure suction are that the patient can breathe through the nose immediately after the operation, there is no pressure sensation and the pain, if any, is reduced, there is no epiphora, no skin edema and the patient feels very comfortable. Risks for complications are minimal.

Equipment Design↗
PubMed1998

Primary malignant lymphoma of the parotid gland.

OBJECTIVES: To document the clinicopathologic features of primary malignant lymphoma of the parotid gland based on analysis of our cases and to compare the results with similar studies in the literature. DESIGN: Retrospective, nonrandomized case study. SETTING: Academic, tertiary medical center. PATIENTS: Forty-one consecutive cases of malignant lymphomas of the parotid gland were identified among 820 patients who had undergone parotid surgery during the course of 22 years. Thirty-three (80%) of these were primary lymphomas and were included in the study. Eight (20%) occurred in patients with a history of malignant lymphoma and were therefore excluded. INTERVENTION: Diagnosis was established by open parotid biopsy in 8 patients, superficial lobectomy in 23, and total parotidectomy in 2. After diagnosis, lymphomas were staged and treated with local irradiation and/or chemotherapy. RESULTS: Fifteen men and 18 women aged 26 to 100 years (mean, 66 years) had an enlarging painless mass on initial examination. Seven (21%) had an underlying autoimmune disease and 20 (61%) had Ann Arbor stage 1 disease at diagnosis. Of 25 patients available for a minimum 2-year follow-up, 16 (64%) were alive with or without disease. Histological grade was the only prognostic feature associated with outcome (P<.01). CONCLUSIONS: Our study, when viewed collectively with those in the literature, indicates that malignant lymphomas of the parotid gland are uncommon and often not suspected clinically. The disease affects both sexes equally and is unusual before the age of 50 years. Most are B-cell, non-Hodgkin lymphomas, and about 80% of patients have Ann Arbor stage I or II disease at diagnosis.

Adult↗
PubMed1997

Osteoblastoma of the nasal cavity arising from the perpendicular plate of the ethmoid bone.

The presence of a benign osteoblastoma in the ethmoid sinus is rare and only a few cases have been reported. This is a case of a benign osteoblastoma arising from the perpendicular plate of the ethmoid bone with extension to the nasal cavity. The diagnosis and management of this unusual lesion, as well as the histopathology and the imaging characteristics are reviewed. We also review the previously reported cases of benign osteoblastomas of different origin, with nasal cavity involvement.

Adult↗
PubMed1997

Nd:YAG laser treatment of recurrent epistaxis in heredity hemorrhagic telangiectasia.

OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is an inherited abnormality passed down as a dominant autosomal feature. Recurrent epistaxis usually constitutes the major clinical manifestation of this disease. The unsatisfactory results of conservative therapy have stimulated a research interest for the role of laser photocoagulation in telangiectatic vessels associated with this clinical entity. METHOD: The Nd:YAG laser was used to treat a group of 11 individuals suffering from HHT, all of whom had been previously treated using other modalities. RESULTS AND CONCLUSION: The excellent results of Nd:YAG laser irradiation are addressed in view of all treatment modalities proposed for the treatment of recurrent epistaxis in HHT.

Adult↗
PubMed1996

Applications of image-guided navigation in the middle cranial fossa: an anatomic study.

Determining the location of pertinent anatomic structures (ie, the internal auditory canal [IAC]) in middle cranial fossa surgery is commonly based on indirect inferences from bony landmarks. Several methods have been proposed for identification of the IAC, each using bony landmarks coupled with geometric formulation. Identification of the IAC based on bony architecture and geometry may be severely limited when a mass lesion is present. Image-guided surgery has the advantage of rapid localization and may be helpful in navigating a complex surgical field which has been distorted by tumor. This study evaluates the feasibility and accuracy of the ISG viewing wand in determining pertinent anatomic landmarks in the middle fossa of the human cadaver. High-resolution (1 mm) computed tomography was performed on a preserved human cadaver head in which fixed fiducial markers had been placed. Subsequently, the cadaver head was registered in a simulated operative field, and middle fossa craniotomy was performed. The foramen spinosum, foramen ovale, greater superficial petrosal nerve, internal carotid artery, arcuate eminence, and IAC were identified visually, and three independent localizations of each structure were performed with the viewing wand. Accurate localizations were consistently performed within 1 mm for each anatomic landmark. Image-guided navigation is both feasible and accurate in determining intraoperative landmarks in the middle fossa. Image-guidance may enhance surgical accuracy and efficiency. Further clinical studies evaluating image-guided techniques in the middle fossa are warranted.

Journal Article↗
PubMedDate not supplied

Risk factors for local recurrence of adenoid cystic carcinoma: the role of postoperative radiation therapy.

PURPOSE: Postoperative radiation therapy is often advocated in the treatment of patients with adenoid cystic carcinoma (ACC) of the head and neck. A retrospective analysis was performed to determine prognostic factors for local recurrence after surgery and to examine the role of postoperative radiation therapy. MATERIALS AND METHODS: A retrospective analysis of 58 patients undergoing surgery for ACC of the head and neck at the University of Pittsburgh Medical Center from 1974 to 1994 was performed. Patients were followed up for a minimum of 24 months for the development of recurrent disease. The association of recurrence was correlated with clinical factors (age, sex, site, and stage); postoperative treatment (radiation therapy v no radiation); and pathologic variables (grade, margins of resection, and perineural invasion), and appropriate statistical analysis was performed. RESULTS: Recurrent disease developed in 59% of patients, despite the addition of postoperative radiation therapy in 83% of patients. Tumor site was the single most important factor for the development of locally recurrent disease and was correlated with primary tumor stage and resection margins. Local recurrence rates were decreased (P = .07) in patients with negative surgical margins who were irradiated. CONCLUSIONS: Larger perspective randomized trials are necessary to evaluate the efficacy of postoperative radiation, and new treatments need to be investigated to improve local control rates for ACC of the head and neck.

Adult↗
PubMedDate not supplied

In vivo detection and staging of epithelial dysplasias and malignancies based on the quantitative assessment of acetic acid-tissue interaction kinetics.

A novel approach to the problem of non-destructive detection and staging of tissue lesions is presented. The method relies on the in vivo quantitative assessment of the spatial and temporal alterations of light-scattering properties, induced in epithelial dysplasias and malignancies of the cervix and larynx, after topical application of acetic acid solution. Initial clinical trials show that the method is capable of detecting incipient lesions and that differences in the dysplasia and malignancy grade are clearly manifested in the measured temporal characteristics of the phenomenon.

Acetic Acid↗
PubMedDate not supplied

Management of chylous fistula using the fibrin adhesive set.

Chylous fistula complicates 1.1% of all radical neck dissections, and 2.4% of left-sided dissections. The standard treatment of established chylous leak in the reported cases is a pressure dressing applied to the lower neck. Here we present a case of chylous fistula, where conservative methods failed to cope with this complication. The additional application of a fibrin adhesive set was a successful modality of treatment.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

A new stapedotomy prosthesis: preliminary report.

Our study describes a newly designed stapedotomy prosthesis which consists of two components: (1) a platinum ribbon, and (2) a Teflon shaft. The first innovation is a flattened 'tab' on the posterior aspect of the platinum ribbon. The second innovation concerns the dual diameter cylinder-like shaft. Our prosthesis was implanted into 25 individuals, who underwent stapedotomy for stapes fixation, and the results are shown and discussed. Our innovations offer a proper and safe insertion of the prosthesis into the oval window associated with excellent manipulation and handling. At the same time, maximum visualization of the surgical field is achieved, while the stepped-down design of the shaft prevents the prosthesis protruding into the vestibule.

Adult↗