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Biomedical subjects

J A Koufman

Publications and source records attributed to J A Koufman.

At least 55 records · Page 3Linked to original sources
PubMed1995

Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus.

OBJECTIVE: The relationship of hiatal hernia to gastroesophageal reflux disease remains controversial. Previous endoscopic and radiologic studies of hiatal hernia and reflux esophagitis have shown that hiatal hernia is a poor predictor of the presence of endoscopic esophagitis, especially for smaller hernias. Similar correlations with 24-hr pH monitoring have not been done. The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hernias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux. MATERIALS AND METHODS: We reviewed the barium esophagograms and the results of pH monitoring of the esophagus in 319 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examination; size was categorized as "minimal" or "larger" (> or = 2 cm axial length). An abnormal result of pH monitoring was defined as a pH less than 4 for 6% or more of the 24-hr observation time. RESULTS: Abnormal results of pH monitoring were found in 61 (31%) of 199 patients with hiatal hernia compared with 21 (18%) of 120 patients without hiatal hernia (p < .05). Abnormal findings of pH monitoring were present in 33 (35%) of 95 patients with a larger hiatal hernia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > .05); a significant difference (p < .05) was observed when patients without hiatal hernia were compared with those with a larger hiatal hernia. CONCLUSION: Most patients in this study had normal results of pH monitoring of the esophagus regardless of the presence or absence of hiatal hernia. However, patients with larger hiatal hernias were more likely to have abnormal findings on pH monitoring; hiatal hernias of minimal size were a poorer predictor of the presence of abnormal gastroesophageal reflux.

Esophagus↗
PubMed1994

Comparative voice results after laser resection or irradiation of T1 vocal cord carcinoma.

OBJECTIVE: To compare voice results following laser resection or radiation therapy for T1a glottic carcinomas. DESIGN: Objective recordings of acoustical data that were analyzed and calculated by an acoustic analyzer and subjective scores by patients, speech therapists, surgeons, and radiation therapists are compared. SETTING: Academic medical center speech laboratory at an institution where patients had been treated. Archival files were searched and patients were solicited by letter to participate in this analysis. PATIENTS: Men treated at least 6 months previously and who were without active laryngeal disease. Criteria were unilateral vocal cord carcinomatous involvement with no subglottic, anterior commissure, or arytenoid extension and tumor invasion clinically judged to be less than half of the cordal depth. INTERVENTIONS: Thirteen patients had received approximately 63 Gy in 28 fractions, five fractions a week, with laterally opposed fields using a linear accelerator. Eleven patients had had resection of less than half of the cordal depth by using a carbon dioxide laser with a 300-microns spot size working at a 400-mm distance; 13- to 15-W power intensity with a one tenth of a second burn in a noncontinuous mode. RESULTS: No statistically significant differences between the two study groups were found. Patients and physicians subjectively rated (1 indicates normal; 5, aphonic) the quality of voices of patients in the irradiation group (1.5 and 2.0) as slightly better than the quality of voices of patients in the laser group (2.0 and 2.4). Speech pathologists rated the voices of patients in the laser and irradiation group as indistinguishable and mildly abnormal (2.75 and 2.73). CONCLUSION: Voice quality in highly selected patients with vocal cord carcinoma treated by laser resection can be as good as that in patients whose cancer was similarly staged after radiation therapy.

Carcinoma, Squamous Cell↗
PubMed1994

Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients.

PURPOSE: The authors correlated the radiographic evaluation and 24-hour pH monitoring of the pharynx and the esophagus in patients with globus pharyngeus. MATERIALS AND METHODS: Radiographic examination of the pharynx of 22 patients (13 women and nine men, aged 23-73 years [mean, 47 years]) included videofluoroscopy and static radiography. Twenty-four-hour double-probe pH monitoring of the pharynx (abnormal, pH < 4) and esophagus (abnormal, 6% or more total acid exposure) was performed in all patients. RESULTS: Radiographic results were normal in 17 patients; results were abnormal in five, with four having pharyngeal dysfunction and one showing a persistent cricopharyngeal impression. Zenker diverticulum was not seen. Results at pH monitoring of the pharynx and esophagus were normal in 20 and 18 of the 22 patients, respectively. In four of five patients with abnormal radiographic studies of the pharynx, results of pharyngeal pH monitoring were normal. CONCLUSION: Most patients with globus pharyngeus had normal results at pH monitoring and radiographic examination of the pharynx.

Adult↗
PubMed1994

Endoscopic treatment of supraglottic and hypopharynx cancer.

Transoral excision of supraglottic and hypopharynx cancer as a single modality is effective when lesions are selected for small size and endoscopic accessibility. Excisional biopsy with clear margins of larger supraglottic tumors in combination with postoperative radiotherapy provides an excellent treatment alternative for selected lesions in patients who are not candidates for open surgery. In this preliminary report, 45 cases using this minimally invasive approach are reviewed outlining oncologic rationale and functional advantages. A large bore tubed laryngoscope or the adjustable bivalve supraglottiscope was used along with a carbon dioxide laser in all cases. In 22 of the 45 patients (mostly T1), local en bloc excision of the primary cancer was performed as sole treatment on selected lesions of the supraglottis and hypopharynx. There were no local recurrences, however, 1 patient developed a neck recurrence and was salvaged by neck dissection. Twenty-three of the 45 patients had more extensive primaries (mostly T2, T3) and N0 necks. Transoral excisional biopsy was followed by full-course radiation therapy to the primary site and both necks. All 23 were followed a minimum of 2 years, and the median follow-up period was 58 months. Clear margins were obtained in 16 of 23, and there were no recurrences in the larynx. Two of 16 did fail in the neck and died despite neck dissection. Seven of 23 patients had positive margins and, despite full-course radiotherapy to the primary site and both necks, 5 of 7 failed locally or regionally. Two of the 7 died of their disease despite open salvage surgery. Therefore, 4 of 23 patients who underwent transoral excision of larger lesions followed by full-course radiotherapy died of recurrent cancer.

Combined Modality Therapy↗
PubMed1992

Voice analysis of patients with endoscopically treated early laryngeal carcinoma.

Endoscopic laser resection of early (T1) laryngeal carcinoma has been advocated as an alternative to radiotherapy. Heretofore, the voice characteristics following this procedure have been addressed in only one review, which included patients treated by irradiation and laser resection. We present the first review of voice findings in 22 patients treated only by endoscopic laser resection of their vocal cord carcinomas. Laser resection of selected vocal cord carcinomas produced voice function results acceptable to the patients and was rated by them to be normal to almost normal. Speech pathologists rated the voices to be near-normal to mildly abnormal. Voices after laser resection of vocal carcinoma exhibited a slightly higher fundamental frequency, a decrease in intensity and phonatory duration, and markedly higher laryngeal airway resistance. The percentage of voicing showed little deviation from normal, as did mean percentage of perturbations.

Airway Resistance↗
PubMed1991

The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury.

Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order ot test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double-probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx. Two hundred twenty-five consecutive patients with otolaryngologic disorders having suspected GERD evaluated from 1985 through 1988 are reported. Ambulatory 24-hour intraesophageal pH monitoring was performed in 197; of those, 81% underwent double-probe pH monitoring, with the second pH probe being placed in the hypopharynx at the laryngeal inlet. Seventy percent of the patients also underwent barium esophagography with videofluoroscopy. The patient population was divided into seven diagnostic subgroups: carcinoma of the larynx (n = 31), laryngeal and tracheal stenosis (n = 33), reflux laryngitis (n = 61), globus pharyngeus (n = 27), dysphagia (n = 25), chronic cough (n = 30), and a group with miscellaneous disorders (n = 18). The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation). Thus, by traditional symptomatology, GER was occult or silent in the majority of the study population. Twenty-eight patients (12%) refused or could not tolerate pH monitoring. Of the patients undergoing diagnostic pH monitoring, 62% had abnormal esophageal pH studies, and 30% demonstrated reflux into the pharynx. The results of diagnostic pH monitoring for each of the subgroups were as follows (percentage with abnormal studies): carcinoma (71%), stenosis (78%), reflux laryngitis (60%), globus (58%), dysphagia (45%), chronic cough (52%), and miscellaneous (13%). The highest yield of abnormal pharyngeal reflux was in the carcinoma group and the stenosis group (58% and 56%, respectively). By comparison, the diagnostic barium esophagogram with videofluoroscopy was frequently negative. The results were as follows: esophagitis (18%), reflux (9%), esophageal dysmotility (12%), and stricture (3%). All of the study patients were treated with antireflux therapy. Follow-up was available on 68% of the patients and the mean follow-up period was 11.6 +/- 12.7 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Unusual auricular complications in cutaneous oncology.

The anatomic complexity of the pinna predisposes that structure to a variety of unique, site specific postoperative complications following management of skin cancer. We describe four unusual auricular complications: 1) radiochondronecrosis; 2) autonecrosis of skin during second intention healing; 3) hearing loss secondary to tragal retraction over the external auditory canal; and 4) extension of tumor through fenestrated cartilage. Well-known postoperative auricular complications are reviewed and anticipation and recognition of these unusual complications are emphasized.

Adult↗
PubMed1991

Functional voice disorders.

Functional voice disorders (FVDs) are common. The diagnostic criteria for six types of FVD and the results of treatment in a large series of patients are reported. Voice therapy was effective in 69% of the patients. Failure of voice therapy usually correlated with continued tobacco use, noncompliance with therapy, or premature termination of therapy.

Adult↗
PubMed1991

Laryngoplastic phonosurgery.

Laryngoplastic phonosurgery is a new term used to describe all forms of laryngeal framework surgery to improve the voice. One of the most important new surgical techniques is medialization laryngoplasty (ML) for the correction of unilateral vocal cord paralysis. This article focuses on ML techniques, results, complications and indications; the artenoid adduction procedure (AA) is described as a complementary technique. In addition, some of the more experimental laryngoplastic procedures are reviewed.

Female↗
PubMed1991

The spectrum of vocal dysfunction.

Levels of vocal use, types of vocal complaints, and the spectrum of vocal dysfunction are discussed in this article. Functional voice disorders account for 40% and organic conditions for 60% of patients presenting with voice disorders. Twelve percent of the patients are children.

Humans↗
PubMed1991

Approach to the patient with a voice disorder.

The author's approach to patients with voice disorders emphasizes the value of a multidisciplinary voice team, including an otolaryngologist, a speech pathologist, and a neurologist.

Humans↗
PubMed1990

Sarcoidosis of the upper respiratory tract in patients with nasal rim lesions: a pilot study.

Lupus pernio has been associated with sarcoidosis of the upper respiratory tract. The semantic differences in the use of the designation "lupus pernio" are such that American dermatologists may not consider patients with nasal rim papules of sarcoidosis to have lupus pernio. During a 12-month period, we referred each new patient with sarcoidosis and nasal rim lesions for direct and indirect laryngoscopy. Three of our four patients had sarcoidosis of the upper respiratory tract. We recommend a large prospective study to assess the incidence of this disorder in patients with nasal rim lesions of sarcoidosis. Until such a study is undertaken, however, we believe that consideration should be given to otolaryngologic examination of these patients, regardless of their symptoms.

Adult↗
PubMed1990

Radiation-induced squamous sialometaplasia.

We describe a patient with recurrent acantholytic squamous cell carcinoma following radiation therapy. Mohs micrographic sections revealed extensive squamous sialometaplasia showing striking histologic similarity to the patient's squamous cell carcinoma. Criteria necessary to differentiate squamous sialometaplasia from neoplasm are presented. This differentiation is important to ensure adequate tumor resection without unnecessary sacrifice of tumor-free tissue.

Aged↗