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Biomedical subjects

J P Atkins

Publications and source records attributed to J P Atkins.

At least 19 recordsLinked to original sources
PubMed2000

Endoscopic repair of cerebrospinal fluid rhinorrhea.

Endoscopic repair of cerebrospinal fluid rhinorrhea is a promising alternative to traditional repair techniques. This article reports our experience with 21 cases (10 spontaneous, 8 iatrogenic, and 3 traumatic). Various diagnostic radiographic modalities were used, including computer-aided techniques. Most repairs were accomplished with a free fascial graft positioned in the epidural space. Postoperative lumbar drainage was used in 15 cases. Initial repair was successful in 18 cases (85.7%). In all 3 failures, the surgeon had difficulty with proper graft placement. Additionally, 2 of these cases were confounded by early inadvertent removal of the lumbar drain. All patients in whom the procedure failed underwent a second successful endoscopic repair. There were no major complications. In our experience endoscopic repair of cerebrospinal fluid rhinorrhea is a safe and effective approach that can be improved with computer-aided localization devices. Proper graft placement is critical, and lumbar drainage is an important adjunct in selected cases.

Adult↗
PubMed2000

Vagal paraganglioma: the Jefferson experience.

Vagal paraganglioma is a rare tumor of neural crest origin. Although the literature is in agreement with regard to epidemiology, diagnosis, and tumor biology, there is some controversy over treatment modalities for these patients. We performed a nonrandomized retrospective study in a large single-institution series of patients (n = 19) in whom vagal paraganglioma was diagnosed. General statistics included age, male/female ratio, tumor size, and duration of follow-up. Other variables such as signs and symptoms at presentation, family history, multicentricity, metastatic disease, and secretion of catecholamines were included. CT scan, MRI, and angiography were used in combination for diagnostic purposes as well as for treatment planning. Preoperative embolization was performed in 5 of the more recently treated patients. Current issues regarding the use of preoperative embolization and choice of surgical approach were analyzed. In this article the possibility and sequela of vagus nerve-sparing procedures will be presented. Operative complications and postoperative morbidity related to cranial neuropathies will be discussed. The rationale for performing adjunct procedures, including cricopharyngeal myotomy and vocal fold medialization, to facilitate the rehabilitation of patients with postoperative cranial nerve deficits will be given. Our findings and recommendations will be compared with currently accepted treatment protocols in conjunction with a review of the literature.

Adult↗
PubMed1998

Revision endoscopic sinus surgery: the Thomas Jefferson University experience.

Since its introduction, functional endoscopic sinus surgery (FESS) has demonstrated success rates of 76% to 98%. A small group of the patients in whom initial FESS and optimal medical therapy fail require revision endoscopic sinus surgery (RESS). This group has recently been studied by several authors, and we have evaluated a group of 90 RESS patients selected from 753 consecutive primary FESS patients. Patients were followed for a mean of 22.8 months. Extent of disease, history of polyps, allergy, previous traditional endonasal sinus surgery, male gender, chronic steroid use, and the presence of a deviated septum all appeared to adversely affect RESS outcome. The surgeon's knowledge of the sinus anatomy is critical, especially in revision sinus cases in which landmarks are distorted or absent. In our review, RESS was associated with a 1% major complication rate and was successful in 67% of patients. Computer-assisted endoscopic sinus surgery integrates preoperative imaging with realtime endoscopic visualization, augments the surgeon's knowledge of anatomy, and helps to minimize patient risk.

Adult↗
PubMed1997

Expression of the RET/PTC fusion gene as a marker for papillary carcinoma in Hashimoto's thyroiditis.

Hashimoto's thyroiditis is an inflammatory disease of the thyroid gland with autoimmune etiology. Patients afflicted with Hashimoto's have a higher risk of thyroid malignancies such as papillary thyroid carcinoma. In the present study, we investigated the frequency of papillary thyroid carcinoma specific genes in patients diagnosed with Hashimoto's disease. The newly identified oncogenes RET/PTC1 and RET/PTC3 provide useful and specific markers of the early stages of papillary carcinoma as they are highly specific for malignant cells. Using a sensitive and specific reverse transcriptase-polymerase chain reaction (RT-PCR) assay, we found messenger RNA (mRNA) expression for the RET/PTC1 and RET/PTC3 oncogenes in 95% of the Hashimoto's patients studied. All Hashimoto's patients presenting without histopathologic evidence of papillary thyroid cancer showed molecular genetic evidence of cancer. These data suggest that multiple, independent occult tumors exist in these patients at high frequency.

Adult↗
PubMed1992

Laryngeal chondrosarcoma: diagnosis and management.

Chondrosarcoma of the larynx is a rare malignancy accounting for 0.5% of all laryngeal tumors. We report our approach to laryngeal chondrosarcoma and review the recent literature on the subject. Our review supports the previously held opinions about sites of origin, but draws new conclusions about symptoms. In addition, we examine the controversy of conservative surgery vs. total laryngectomy.

Aged↗
PubMed1991

Tracheo-gastric fistula following gastric pull-up.

Tissue damage from gastric acid may be more prevalent than currently believed following gastric pull-up. An intense anti-acid medical regimen should be instituted peri- and postoperatively. In cases where significant peptic ulcer disease exists preoperatively, an alternative means of reconstruction following laryngo-pharyngo-esophagectomy should be considered.

Fistula↗
PubMed1986

Evaluation and treatment of frontal sinus fractures.

We treated twenty-three patients with blunt or penetrating wounds of the frontal sinus from 1978 through 1983. Nondisplaced anterior wall fractures were observed or explored. Posterior table fractures--with displacement confirmed by computed tomography or polycycloidal tomography--were explored. Either obliteration of the sinus or nasofrontal duct reconstruction with a Sewall-Boyden-McKnaught flap was selected, depending on the magnitude of duct injury. In all cases, the anterior wall was primarily reconstructed. All penetrating wounds with posterior table involvement were treated by cranialization of the frontal sinus and temporalis muscle obliteration of the nasofrontal ducts. Only one case of meningitis occurred, resulting in prolonged hospitalization.

Facial Bones↗
PubMed1984

Value of panendoscopy in determination of second primary cancer. A study of 451 cases of head and neck cancer.

A series of 451 consecutive patient records were reviewed. Of these, 43 had diagnoses of epidermoid carcinoma of the head and neck. Triple endoscopy, by flexible fiberoptic methods, was performed on all these patients and was critical in the determination of second primary carcinoma in eight patients. As panendoscopy shows no mortality and a low morbidity rate, it should be used in diagnosis of second primary tumors, despite a probable low percentage of second primary discovery; long-term patient survival demands use of all available resources in such diagnoses.

Bronchoscopy↗
PubMed1984

CO2 laser surgery of the upper airway.

The use of CO2 laser surgery in otolaryngology has served as an effective tool to treat various lesions in the upper airway. This article discusses application of the CO2 laser to the upper airway, with specific reference to the larynx, nasal cavity, nasopharynx, and oropharynx.

Carbon Dioxide↗
PubMed1982

Reconstruction of the oral cavity using the platysma myocutaneous flap.

Reconstruction of intraoral defects after tumor ablation has been accomplished by a variety of different techniques. A platysma myocutaneous flap for intraoral reconstruction is outlined and the surgical technique described. Nineteen of 22 patients in whom this flap was used healed without major complication. In selected patients, the platysma myocutaneous flap is a highly useful one-stage procedure to close defects of the oral cavity. It provides 50 to 75 sq cm of flap coverage. The flap thickness closely matches the thickness of the mucosa of the oral cavity. The donor site is closed primarily with little or no cosmetic defect.

Carcinoma, Squamous Cell↗
PubMed1981

Epidemiology of head and neck cancer.

Epidemiologic considerations which are pertinent to cancer of the head and neck are broad and varied. Cigarette smoking continues to be the major cause of head and neck neoplasms. Occupational and environmental exposures to carcinogens have been well identified. Tumors may develop as a result of medical therapies. Susceptibility on a genetic basis has been shown, and the role of viruses in carcinogenesis has been further documented.

Animals↗
PubMed1979

Transbronchial drainage of pulmonary abscesses with the flexible fiberoptic bronchoscope.

Flexible fiberoptic bronchoscopy with multiplanar fluoroscopic control is shown to be effective in the transbronchial drainage of pulmonary abscesses. A new technique which permits the intracavitary placement of brush forceps and fine arterial catheters is described. This has facilitated the rapid defervescence of fever and established immediate endobronchial drainage. Seventy percent of patients had complete radiographic closure of their abscess cavities at three months. Clinical findings are presented and the role of aspiration in pathogenesis of pulmonary abscess is stressed.

Adult↗