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Biomedical subjects

G D Josephson

Publications and source records attributed to G D Josephson.

At least 19 recordsLinked to original sources
PubMed2000

Ludwig's angina in the pediatric population: report of a case and review of the literature.

Ludwig's angina is a rapidly progressing cellulitis involving the submandibular neck space. It is characterized by brawny induration of the submental region and floor of mouth, bearing the potential for rapid airway obstruction. Airway management, antibiotics, and judicious surgical intervention are the mainstays of successful therapy. We present a case of Ludwig's angina in a 5-year-old child and offer a meta-analysis of pediatric cases of Ludwig's angina described in the literature over the past 30 years. The presentation, etiology, management, and potential complications of this disorder in the pediatric population are discussed.

Anti-Bacterial Agents↗
PubMed2000

Cartilage tissue engineering using thyroid chondrocytes on a type I collagen matrix.

OBJECTIVE/HYPOTHESIS: Reconstructive procedures of the head and neck often require materials that offer long-term structural support. A problem that many surgeons have encountered is identifying a material that offers this support without rejection of the implanted material This has led many surgeons to prefer autologous cartilage However, autologous cartilage is of limited supply. Cartilage tissue engineering has become a new modality that allows investigators to harvest a small piece of cartilage and extract its chondrocytes for expansion in culture. These chondrocytes are applied to a matrix that will act as a scaffold and allow for cartilage growth. Finding a compatible matrix seems to be the limiting step in the progress of this research. We describe a new approach of tissue creation using bovine collagen matrices as templates onto which cells are seeded. STUDY DESIGN: Laboratory research. METHODS: Chondrocytes obtained from thyroid cartilage of dogs were seeded onto bovine collagen type I matrices and grown in vitro. Chondrocyte seeded matrices were evaluated histologically. RESULTS: Thyroid chondrocytes expressed themselves phenotypically by producing type II collagen in the presence of this type I collagen matrix. CONCLUSIONS: This study offers the preliminary findings on an exciting new type of matrix worth exploring in the ability to successfully engineer cartilage.

Animals↗
PubMed1998

Hemangiopericytoma presenting as a congenital midline nasal mass.

Hemangiopericytoma is a rare tumor that is thought to originate from the vascular pericytes of Zimmerman. Although they represent less than 1% of all vascular neoplasms, 15% to 30% of these tumors are found in the head and neck. The benign or malignant nature of a hemangiopericytoma is determined clinically, not histologically, indicating the need for close and careful follow-up. We describe a congenital midline nasal mass in a 2-year-old boy that proved to be a hemangiopericytoma. Clinical photographs, a magnetic resonance imaging scan, and histologic photographs depict the findings. The evaluation and differential diagnosis of midline nasal masses are discussed.

Child, Preschool↗
PubMed1998

Transnasal endoscopic repair of congenital choanal atresia: long-term results.

OBJECTIVE: To evaluate the short- and long-term success of the repair of congenital choanal atresia using the transnasal endoscopic approach with and without power instruments. DESIGN AND SETTING: Retrospective case series in a tertiary care center. PATIENTS: Fifteen patients with either unilateral or bilateral congenital choanal atresia were treated using the transnasal endoscopic approach. Postoperative stenting was used in all 15 patients. INTERVENTIONS: The senior surgeon (C.W.G.) currently uses the transnasal endoscopic drill-out technique. We describe our experience and long-term follow-up of 15 patients (9 with unilateral atresia, 5 with bilateral atresia, and 1 with unilateral stenosis) who were treated with the use of the transnasal endoscopic technique during a 7-year period. In 8 patients, the transnasal endoscopic technique was performed using conventional biting instruments, and in 7 patients, the transnasal endoscopic technique with power instruments was used. MAIN OUTCOME MEASURE: The patency of the surgical repair of congenital choanal atresia by the transnasal endoscopic approach. RESULTS: Of 14 patient procedures, 12 remained patent. One patient required minor debridement of granulation tissue 1 week following stent removal, and 1 patient required surgical transnasal revision 2 months after the primary procedure, with a patent result after the second procedure. Despite patent choanae being achieved, 1 patient died of cardiac anomalies 8 months after the atresia repair. CONCLUSIONS: The transnasal endoscopic route offers excellent visualization of the posterior choana and, hence, the ability to open the defect widely with a high surgical success rate. Newer powered instrumentation further enhances the ability to perform this technique cleanly.

Adolescent↗
PubMed1998

Thyroglossal duct cyst: the New York Eye and Ear Infirmary experience and a literature review.

Thyroglossal duct cysts often present in childhood but can also afflict the adult population. In 1920, Sistrunk described surgical management and advocated the removal of the central portion of the hyoid bone, following the cyst tract to the base of the tongue. This surgical technique has not changed since its description 60 years ago. In this paper, a retrospective review of 70 thyroglossal duct cyst excisions performed at the New York Eye and Ear Infirmary from 1988 through 1996 is presented. The patient population consisted of 43 females (61%) and 27 males (39%). The average age at presentation was 21.5 years, with a range of 18 months to 64 years. The most frequent presenting symptoms was a painless midline neck mass. Computed tomography (CT) was the most frequent imaging study performed. Sixty-four patients underwent a Sistrunk procedure while five patients had excision alone. One patient was diagnosed but lost to follow-up. All five patients who underwent simple cystectomy required a second procedure. One patient who underwent the Sistrunk operation required revision. Nine patients had postoperative complications, with recurrence being the most common. We present our experience over an eight-year period.

Adolescent↗
PubMed1996

Septoplasty for obstructive sleep apnea in infants after cleft lip repair.

A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea.

Cleft Lip↗
PubMed1993

Airway obstruction. New modalities in treatment.

The key to successful therapy of airway obstruction is always to first secure the airway. The primary care physician needs to understand the airway anatomy and the causes of airway obstruction. As a team, the primary care physician and the otolaryngologist can evaluate and treat these disorders.

Airway Obstruction↗
PubMed1993

Thrombosis of the descending thoracic aorta: a case report.

A 76-year-old woman with primary polycythemia vera had emboli to both superficial femoral arteries and to a branch of the superior mesenteric artery. Polycythemia vera is a neoplastic disease of bone marrow stem cells in which increased red cell production leads to hyperviscosity manifested by propensity to thromboembolic phenomena. These problems usually occur in smaller vessels, sparing large vessels that have high blood flow. The patient underwent an extensive investigation to determine the source of the emboli. Abdominal aortic angiograms and cardiac echogram failed to reveal the source. An esophageal echogram showed free-floating thrombus in the descending thoracic aorta, which was confirmed by magnetic resonance imaging. A thoracic aortic thrombectomy was performed. Embolic phenomena ceased and postoperative esophageal echogram confirmed a clear thoracic aorta. Although extremely rare in the descending thoracic aorta, thrombus formation may occur in association with polycythemia vera and should be sought when usual investigations fail to reveal the source.

Aged↗
PubMed1991

Practical management of epistaxis.

Epistaxis is a very common presenting symptom of patients seen in the emergency room or the physician's office. An understanding of the nasal anatomy and physiology is important for proper treatment of these patients. New methods of treatment are discussed briefly.

Catheterization↗