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Biomedical subjects

G S Goding

Publications and source records attributed to G S Goding.

33 records · Page 2Linked to original sources
PubMed1994

Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated?

OBJECTIVE: The aim of this research was to describe the postoperative respiratory complications after tonsillectomy and/or adenoidectomy (T and/or A) in children with obstructive sleep apnea syndrome (OSAS), to define which children are at risk for these complications, and to determine whether continuous positive airway pressure (CPAP) is an effective strategy for dealing with these complications. METHODS: The data for this study were gathered through a retrospective chart review of all children 15 years of age or younger with polysomnographically (PSG) proven OSAS who had a T and/or A at Hennepin County Medical Center between January 1985 and September 1992. Particular attention was paid to factors that contributed to the OSAS, postoperative respiratory complications, and intervention strategies for dealing with these complications. RESULTS: The charts of 37 children with OSAS documented by preoperative PSG who later had a T and/or A were reviewed retrospectively. Ten of these children had significant postoperative respiratory compromise secondary to OSAS that prolonged their hospital stay from 1 to 30 days and caused symptoms ranging from O2 desaturation < 80% to respiratory failure. These children were younger and had significant associated medical problems that contributed to or resulted from their OSAS in addition to large tonsils and adenoids. The associated medical problems included craniofacial anomalies, hypotonia, morbid obesity, previous upper airway trauma, cor pulmonale, and failure to thrive. The children with postoperative respiratory complications also had more severe apnea on their preoperative PSG. One child had a uvulopalatopharyngoplasty (UPPP) in addition to the T & A. Taken together, the history, physical and neurological examination, and the PSG were able to identify successfully the children who subsequently developed respiratory compromise secondary to OSAS after a T and/or A. Nasal continuous positive airway pressure (CPAP) and bilevel CPAP was used successfully to manage the preoperative and/or postoperative upper airway obstruction in five of these children. CONCLUSIONS: Based on these findings, overnight observation is recommended with an apnea monitor and oximeter for patients undergoing a T and/or A who have OSAS and meet any of the following high-risk clinical criteria: (1) < 2 years of age, (2) craniofacial anomalies affecting the pharyngeal airway particularly midfacial hypoplasia or micro/retrognathia, (3) failure to thrive, (4) hypotonia, (5) cor pulmonale, (6) morbid obesity, and (7) previous upper airway trauma; or high-risk PSG criteria: (1) respiratory distress index (RDI) > 40 and (2) SaO2 nadir < 70%; or undergoing a UPPP in addition to the T and/or A. Nasal CPAP/bilevel CPAP can be used to manage the preoperative and/or postoperative upper airway obstruction in patients with OSAS undergoing a T and/or A.

Adenoidectomy↗
PubMed1993

Cholinergic agents in the laryngeal chemoreflex model of sudden infant death syndrome.

The laryngeal chemoreflex results in apnea, laryngospasm, and cardiovascular changes that can be fatal when a liquid stimulus is placed on the laryngeal mucosa of infant mammals. This study of 35 piglets assessed the effects of the cholinergic agents atropine and edrophonium on this laryngeal reflex response. Atropine, when placed intrathecally, resulted in a significant reduction of apnea as well as a decrease in the cardiovascular changes that occur during the reflex 60 minutes following its injection. Edrophonium, when placed intrathecally, resulted in a significant prolongation of apnea as well as death by asystole in 2 animals during laryngeal stimulation. Atropine placed intravenously also resulted in a significant reduction of apnea length, but required greater than 180 minutes to do so.

Animals↗
PubMed1993

Rehabilitation of the lower cranial nerves.

Brain stem lesions frequently cause dysfunction of the lower cranial nerves. Even with successful treatment, dysfunction may remain. Various methods for rehabilitating the patient with persistent lower cranial nerve dysfunction are presented.

Accessory Nerve↗
PubMed1992

The effects of inhalation anesthetic agents on survival in a pig random skin flap model.

In recent years a myriad of studies have been performed investigating the effects on flap survival of various pharmacologic agents. One class of agents, however, that has received relatively little attention is the inhalational anesthetics. Yet, they are widely used during reconstructive efforts using skin flaps and they possess several pharmacologic properties shown to affect flap survival. Using a dorsally based random skin flap model in 28 swine, the influence of nitrous oxide and isoflurane on skin flap survival was examined. The mean area of skin flap survival in the isoflurane, nitrous oxide, euoxemic control, and hyperoxygenated control groups was 79.4%, 29.7%, 42.0%, and 28.6%, respectively. A significant improvement in flap viability was seen only in the group using isoflurane as the anesthetic agent. Arterial blood gas content (PO2, PCO2, and HCO3), respiratory rate, acid-base balance, blood pressure, pulse, and temperature were monitored. Improved survival of the isoflurane group was independent of these parameters. These data suggest that the choice of anesthetic agent may effect random skin flap survival with isoflurane providing the greatest benefit of the agents tested in this model.

Anesthesia, Inhalation↗
PubMed1992

Fluorescein and acidosis. Implications for flap perfusion studies.

The visual fluorescein technique underpredicts survival of a skin flap during the first 24 hours after raising the flap. This problem limits its use as a research and clinical tool. There is no compelling explanation for this observation, but two facts are known: fluorescein is a derivative of phthalein, a pH indicator, and ischemic tissues become acidotic, with the pH falling below 7.0. These observations lead to the hypothesis that acidosis quenches fluorescence in distal skin flaps. No data could be found regarding this effect. Therefore, the effect of acidosis on sodium fluorescein was studied in vitro. A spectrophotometer was used to measure the intensity of the fluorescence of sodium fluorescein in buffered solutions of different hydrogen ion concentrations. Two studies were performed at different concentrations of fluorescein. At a concentration of 10(-5) g/mL, there is a drop of 26% in fluorescence intensity from pH 7.5 to 7.0, and 51% between pH 7.5 and 6.5. At 10(-7) g/mL, there is a 43% decrease in fluorescence between pH 7.5 and 6.5. This study supports our hypothesis that acidosis quenches the fluorescence of fluorescein. This effect must be considered when interpretating basic studies of skin flap microcirculation.

Acidosis↗
PubMed1991

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): diagnosis by fine-needle aspiration.

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare idiopathic proliferative disorder of histiocytes with characteristic morphologic features. We describe a case of SHML occurring in a 14-yr-old black male, in whom the diagnosis was made by fine-needle aspiration of a cervical lymph node. Cytologic features included increased numbers of large histiocytes associated with a polymorphous, cellular background composed of benign lymphocytes, plasma cells, and polymorphonuclear leukocytes. Lymphophagocytosis was a prominent feature. Extranodal involvement of the larynx was documented by surgical biopsy; there was no other extranodal disease. One year after diagnosis, the patient is clinically well, with no residual lymphadenopathy.

Adolescent↗
PubMed1991

Nerve-muscle pedicle reinnervation of the paralyzed vocal cord.

Reinnervation offers great potential for the rehabilitation of the paralyzed larynx, a potential that has yet to be realized. The nerve-muscle pedicle (NMP) technique is one method of reinnervation that attempts to transfer a nerve with a portion of its muscle intact to a denervated muscle. The selection of the nerve to incorporate into a NMP is examined in the first part of this article. Experimental data that argue for and against the use of a NMP, a description of the indications and the techniques for the procedure, and a review of the clinical results are detailed.

Animals↗
PubMed1990

Inhibition of endogenous superoxide dismutase with diethyldithiocarbamate in acute island skin flaps.

Oxygen free radicals have been implicated in postischemic tissue damage in a variety of experimental models including the island skin flap. Previous studies have demonstrated that supplementing animals with exogenous superoxide dismutase (SOD), a free radical scavenger, improves tissue survival in island flaps. No studies to our knowledge have attempted to inhibit endogenous SOD in a skin flap model. In this experiment 20 control rats demonstrated a 12.00% flap necrosis 7 days after a modified ventral island skin flap was raised. A second group of 20 rats were supplemented with exogenous SOD (50,000 U/kg 30 minutes preoperatively and 12 hours postoperatively) and demonstrated a statistically significant decreased flap necrosis of 5.28%. A third group of 20 rats received diethyldithiocarbamate (DDC, 0.5 gm/kg 12 hours preoperatively), an agent previously shown to inhibit SOD, and demonstrated a statistically significant increased flap necrosis of 19.77%. In a final group of 20 rats the effect of DDC was overcome by supplementation with exogenous SOD, obtaining a flap necrosis of 8.35%. Our results add further support to the importance of SOD and oxygen free radicals in postischemic tissue damage by demonstrating increased tissue necrosis with inhibition of endogenous SOD. This suggests that there is a baseline degree of SOD activity in ischemic areas working to preserve tissue. It appears that the copper-containing species of SOD found primarily in the cytoplasm plays a pivotal role in preservation of postischemic tissue.

Animals↗
PubMed1989

Acute blood flow changes in rapidly expanded and adjacent skin.

Random flaps raised in expanded skin demonstrate increased survival lengths when compared with flaps raised on an acute basis. Nutritive blood flow studies performed after skin expansion and elevation show augmented blood flows similar to those seen in conventionally delayed skin flaps. We utilized dermofluorometric analysis to study acute blood flow changes in sequentially, rapidly expanded porcine skin. Four subcutaneous pockets were developed in each of six pigs. The pockets were divided into the following three groups: (1) those with placement of a tissue expander inflated sequentially to 300 mL over four days and then totally deflated on day 6, (2) those with placement of a tissue expander that was not inflated, and (3) those with no tissue expander placed. Measurements were taken immediately before and after tissue expander manipulation in group 1 and daily in groups 2 and 3. Fluorescence was determined at points over and 4, 7, and 10 cm distal to the expander. Blood flow decreased immediately after skin expansion in areas over the tissue expander on days 0 and 1 and returned to baseline levels within 24 hours. Blood flow increased after tissue expander deflation on day 6 but returned to predeflation levels within 24 hours. Capillary blood flow increased over the duration of the study in all three groups. There was no significant difference in blood flow between and among the three groups on day 8, nor was there a significant difference in blood flow between and among sites over and distal to the tissue expander.

Animals↗
PubMed1989

Extension of neuromuscular pedicles and direct nerve implants in the rabbit.

Extension of neuromuscular pedicles and direct nerve implants was investigated in ten rabbits. All rabbits underwent facial nerve resection bilaterally. In five rabbits a neuromuscular pedicle, based on the ansa cervicalis nerve, was implanted into the denervated mentalis muscle unilaterally. On the opposite side, reinnervation was attempted using a neuromuscular pedicle with an interposed nerve graft. In the other five rabbits, reinnervation was attempted using a direct nerve implant on one side and a direct nerve implant extended with a nerve graft on the opposite side. Evoked electromyographic muscle tension and histologic studies were used to evaluate reinnervation. Functional neuromuscular units were consistently produced with neuromuscular pedicles, direct nerve implants, and extended direct nerve implants, while extended neuromuscular pedicles failed to produce detectable reinnervation.

Animals↗
PubMed1988

Tissue expansion and cutaneous blood flow.

The effect of controlled skin expansion in blood flow was investigated using the dermofluorometer. Twenty-eight subcutaneous pockets in seven pigs were divided into three groups. Group 1: subcutaneous pockets with a gradually inflated 200-cc tissue expander over 12 days, then deflated and observed for 6 days. Group 2: subcutaneous pockets with a noninflated 200-cc tissue expander. Group 3: subcutaneous pockets elevated without placement of a tissue expander. Measurements taken 30 to 45 minutes after partial inflation of the tissue expander showed a decrease in blood flow while blood flow was increased 30 to 45 minutes after deflation of the tissue expander. The increase in blood flow, however, was not evident 6 days after the expander in group 1 was deflated.

Animals↗
PubMed1987

Laryngeal chemoreflex: anatomic and physiologic study by use of the superior laryngeal nerve in the piglet.

The laryngeal chemoreflex (LCR) was investigated in 21 piglets (ages 6 to 80 days old) with the use of physiologic and histologic techniques. The central projection of the superior laryngeal nerve (SLN) was determined in 14 animals by use of horseradish peroxidase-wheat germ agglutinin. Ipsilateral labeling of the solitary tract nucleus was seen. The caudal extent of the labeling varied with age. Sensory labeling of the nucleus ambiguus was present bilaterally in three younger animals and unilaterally in older piglets. Bilateral labeling of the nucleus dorsomedialis was seen in all ages. Apneic and cardiovascular response to water stimulation of laryngeal mucosa and the laryngeal adductor reflex (LAR) were examined in 16 piglets. Blunting of the apneic and cardiovascular response was seen after sacrifice of a single SLN. Hypoxia did not significantly affect the LAR or apnea duration in animals with only one intact SLN. A contralateral LAR was found in younger animals. Relevance to the LCR is also discussed.

Aging↗
PubMed1986

Gaze nystagmus and blood alcohol.

Forty-six patients in an emergency room (ER) setting and 159 people suspected of driving while intoxicated (DWI) had their blood alcohol concentrations estimated by the angle of onset of horizontal gaze nystagmus and confirmed by blood alcohol analysis or breath-alcohol analysis (BAA) tests. In the ER group, 25/26 (96%) of legally intoxicated patients (blood alcohol concentration greater than or equal to .10% w/v) had an estimation consistent with intoxication. There were no cases in which the blood alcohol concentration (BAC) was incorrectly estimated to be greater than .10% w/v in the absence of other drugs. In DWI suspects there was a correlation of .878 between estimated BAC and BAA results. Three subjects were incorrectly classified as intoxicated. No subjects with estimated BAC less than .10% w/v were legally intoxicated by BAA testing. Alcohol gaze nystagmus is presented as an effective tool for estimating the BAC in pure alcoholic intoxication.

Adolescent↗