PubMed Health⌕ Search

Biomedical subjects

J T Zajtchuk

Publications and source records attributed to J T Zajtchuk.

15 recordsLinked to original sources
PubMed1992

Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea.

A study was conducted to assess oxygenation and respiratory changes on the first and second postoperative nights after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). Twelve patients were postoperatively evaluated with 8-hour nocturnal polysomnography on four occasions: (1) PREOP--night before UPPP, (2) POPN1--first postoperative night, (3) POPN2--second postoperative night, and (4) 3MOS--3-month follow-up study. Results demonstrate that apnea index (AI) and respiratory disturbance index (RDI) were significantly improved at 3MOS from PREOP levels: AI (p less than 0.01) and RDI (p less than 0.05). There were no statistical differences from PREOP to POPN1 or POPN2 for AI, RDI, lowest oxyhemoglobin saturation (LSAT), or number of desaturations (#DESAT). One of twelve patients dropped LSAT greater than 10% from PREOP to POPN1 or POPN2 (82% PREOP to 71% POPN2). Patients were grouped by PREOP LSAT greater than or equal to 80% or less than 80%, and the postoperative change in LSAT was evaluated by comparing PREOP to a value averaging POPN1 and POPN2. Patients with LSAT greater than or equal to 80% decreased by 2.6%; patients with LSAT less than 80% improved by 6.2%. This change in LSAT between groups was statistically different (p = 0.02). These data suggest that in the majority of patients, preoperative indices remain unchanged for at least 2 days after surgery, even for patients who demonstrated improvement at 3 months. However, worsening does occur in some patients. On the basis of the results of this study and clinical experience with the postoperative course, a selective management protocol is outlined.

Adult↗
PubMed1989

Blast injuries of the ear in military operations.

Exposure to blast waves from the explosion of ordnance is a common feature of combat operations. The ear is the organ most sensitive to such strong pressure waves. Blast damage to the ear may range from minor acoustic trauma to major disruption of middle and inner ear structures. Standard hearing protectors should offer a significant degree of shielding from these injuries. Aural injury alone seldom should cause a soldier to abandon a combat mission. However, the potential for a large temporary or permanent neurosensory hearing loss does raise issues about such a soldier's effectiveness on the modern, communication-intensive battlefield. Further research is necessary on mechanisms of injury, protective measures, and the effect of hearing loss on military performance.

Blast Injuries↗
PubMed1989

Otolaryngic health service support in the airland battle.

The Blast Injuries of the Ear Seminar was conducted to better define the state of knowledge about the medical care and consequences of blast injuries of the ear in battle. The immediate concern of this discussion was the relative importance of the finding of widespread eardrum ruptures in penetrating attacks by shaped charge munitions against the Bradley Fighting Vehicle and the M113 Armored Personnel Carrier. In order to focus on the care of the soldier with such injuries, a brief description of the current medical care and evacuation chain of the US Army, as well as the proposed future evacuation chain in the Airland Battle scenario, will be discussed. Detailed treatment of patients will be discussed in the descriptions from the Quad Service Clinical Data Base regarding wounds of the tympanic membrane. Most blast injuries of the ear would not be considered as incapacitating casualties by the Army Medical Department, except in severe circumstances.

Blast Injuries↗
PubMed1989

Blast injury of the ear: historical perspective.

Blast injury of the ear is rarely encountered by the practicing otolaryngologist. The recent world literature on this entity is reviewed. Symptoms, patterns of injury, and clinical course are highlighted and should form the basis of management under acute and chronic circumstances.

Blast Injuries↗
PubMed1989

Treatment of blast injury to the ear.

Blast injury to the ear has long been acknowledged as potentially incapacitating. This paper discusses the scope of these injuries in terms of the anatomic and physiologic consequences. Management of both acute and chronic injuries is discussed, with specific regard to the deficits in a patient's functional ability once blast injury has occurred.

Blast Injuries↗
PubMed1989

Mucosal leishmaniasis in Brazil.

The clinical diagnosis and laboratory identification of Leishmania braziliensis braziliensis, a parasitic disease affecting the upper aerodigestive tract, is difficult. A retrospective computer-assisted analysis of patient records was done after examination of 58 patients with mucosal leishmaniasis in an endemic area of L. braziliensis braziliensis in Bahia, Brazil during January 1987. Biopsies of clinically active and clinically inactive mucosal patients were examined for parasites using routine hematoxylin and eosin histopathology and a new technique for rapid detection of Leishmania amastigotes using a genus-specific indirect immunofluorescent assay. No amastigotes were found in specimens from seven patients with clinically inactive mucosal disease using immunofluorescent monoclonal assay techniques, whereas specimens from seven out of 14 patients with clinically active mucosal disease were positive. These results suggest that the immunofluorescent antibody technique is markedly superior in identifying the intracellular amastigote in tissue sections of mucosal biopsies when compared to histopathology techniques or with other standard tests done in rural areas of Brazil. Various clinical and laboratory test data of the entire group of patients were examined and the efficacy of treatment evaluated. The median interval of time noted between cutaneous and mucosal disease was 4.5 years. Relapse was noted in 31% of patients treated with a low dose of meglumine antimoniate (10 mg per kg of body weight). Patients treated with a high dose of meglumine antimoniate (20 mg per kg of body weight) had a relapse rate of 27.3%. A chi-square statistical analysis revealed no significant difference (chi 2 = 0.049) between the two groups. Patients were considered cured if mucosal granulations were clinically absent after 4.6 years.

Brazil↗
PubMed1989

Aggressive paranasal sinus ossifying fibroma.

Sixty-one cases of an aggressive OF involving the paranasal sinus area are reviewed from the literature. We describe another case of this unusual lesion in an 11-year-old girl. These tumors share a similar radiographic appearance, aggressive clinical behavior, and tendency for recurrence after incomplete treatment. Our experiences show that active OF accurately describes this entity and avoids the confusing histologic nomenclature usually encountered. The head and neck surgeon should be aware of this diagnosis so aggressive en bloc resection can be employed whenever possible.

Child↗
PubMed1985

Multimodality therapy for unresectable squamous cell carcinoma of the head and neck.

Eighteen patients with unresectable Stage III or IV squamous cell carcinoma of the head and neck were treated with induction therapy consisting of sequential methotrexate and 5-fluorouracil. This was followed by full course radiation therapy and radical neck dissection for those with residual neck disease. Those with local control were then treated with vinblastine, bleomycin, and cisplatin (VBP). Although 79% of patients achieved a partial or complete response to chemotherapy, only 50% of patients achieved local control. Marked mucositis limited the dose and schedule of radiation therapy. The methotrexate and 5-fluorouracil combination appears to be too toxic for multimodality therapy of advanced head and neck cancer.

Adult↗
PubMed1978

Ethmoidal mucoceles.

Twenty ethmoidal mucoceles were treated and observed for a minimum of two years after surgery. Unilateral exophthalmos was the initial complaint in all cases and nasal polyposis was a noteworthy finding in more than half of the patients. The lesions always extended into the orbit and usually eroded the floor of the frontal sinus. Exenteration through an ethmoidectomy approach was successful in 16 cases. Failure was due to recurrence of the mucocele in one case and in three cases to uncontrolled polypoid disease that produced recurrence of the exophthalmos. Long-term follow-up is mandatory since recurrences may take several years to occur.

Adolescent↗
PubMed1978

Melanotic neuroectodermal tumor of infancy.

The lack of knowledge regarding the histogenesis of the melanotic neuroectodermal tumor of infancy may account for the numerous names given to this neoplasm. The most appropriate nomenclature is melanotic neuroectodermal tumor of infancy as this term is both clinically descriptive and reflects its most likely histogenesis. The histological diagnosis of this neoplasm and its known benign biological behavior should be appreciated so that radical surgery or radiotherapy is not undertaken. Our case report includes an electron microscopic analysis which is in keeping with other reported cases. We have not confirmed high urinary VMA levels prior to resection of the lesion.

Female↗
PubMedDate not supplied

Osteogenesis imperfecta congenita and tarda: a temporal bone report.

The temporal bone report of an operated case of osteogenesis imperfecta tarda is presented. Histological examination confirmed the presence of bilateral fixation of the footplate by otosclerosis as the cause of the conductive hearing loss. Fragility of bony septae in the mastoid and of the stapedial crura were observed. Sensorineural impairment in later years with a reduction in neural elements in the cochlea appear related to the extent and activity of the otosclerotic foci. Additional temporal bone reports of three cases of osteogenesis imperfecta congenita show lack of deposition of the skein-like bone in the endochondral layer, sparse bony septae in marrow spaces and deficiency of the perosteal layer. The stapedial crura were thin and in two cases both were deformed and fractured.

Aged↗
PubMedDate not supplied

Hypercoagulability as a cause of sudden neurosensory hearing loss.

Fourteen patients with a documented sudden neurosensory hearing loss and four patients with other diseases causing neurosensory hearing loss were studied. The standardized coagulation workup included hematocrit, activated partial thromboplastin generation time, thrombin generation, prothrombin time, phase platelet count, platelet adhesivity, protamine sulfate, serum antithrombin III activity, fibrinogen, and Factor VIII values. Ony those patients having documented evidence of a neurosensory hearing loss occurring within hours or days were included in this study. Eight of the 14 paitents with a documented sudden neurosensory hearing loss satisfied our laboratory criteria for a diagnosis of in vitro hypercoagulability. Three of these patients had abnormal thrombin generation values, 4 had abnormal serum antithrombin III values, and 1 had an elevated platelet count. Four other patients with other diseases causing neurosensory hearing loss did not show evidence of in vitro hypercoagulability. It would appear from this data that coagulation abnormalities play a role in the pathogenesis of sudden neurosensory hearing loss.

Adult↗