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Biomedical subjects

J Zito

Publications and source records attributed to J Zito.

At least 19 recordsLinked to original sources
PubMed2001

Juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma is a rare yet potentially destructive vascular tumor that typically affects adolescent males. While the etiology of these tumors remains unknown, great advances have been made in their diagnosis and treatment. When juvenile nasopharyngeal angiofibroma is diagnosed at an early stage, the prognosis is generally very good, as patients can be treated with a combination of pre-operative embolization and surgical resection. Advanced juvenile nasopharyngeal angiofibroma is much more difficult to treat, since orbital and intracranial involvement are common in the natural progression of the disease. However, due to the rather innocuous presenting symptoms (commonly, nasal obstruction and epistaxis), diagnosis most often occurs in the later stages of the disease. For this reason, it is important for all physicians to have a high degree of suspicion for juvenile nasopharyngeal angiofibroma when evaluating a male adolescent with these symptoms.

Adolescent↗
PubMed1993

The disposition of criminal charges after involuntary medication to restore competency to stand trial.

The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination of the issue of involuntary treatment with anti-psychotic medication to the mentally disabled facing criminal trial. Although this was an extreme case where the defendant faced a possible death sentence, the involuntary administration of anti-psychotic medication to restore 'competency to stand trial' always raises unique medical and moral questions. This highly controversial issue has received little empirical investigation. We report here on the first study to follow-up on the disposition of the criminal charges of persons committed to a hospital for the restoration of 'competency to stand trial' who refused anti-psychotic medication and for whom involuntary treatment was sought. We have previously reported on the characteristics of these cases (N = 68) and aspects of their outcome in the hospital. This cohort of patients represents virtually all indicted felony offenders in New York state who were incompetent to stand trial and for whom involuntary treatment with anti-psychotic medication was requested between 1986 and 1990. The present retrospective report focuses on the disposition of the criminal charges for such cases, in a state that does not have a death penalty. Tentative inferences are considered based on the findings that persons who were involuntarily restored to 'competency to stand trial' had a variety of dispositions of their criminal charges, including plea negotiations that resulted in foreshortened incarceration and several cases of insanity acquittals. Suggestions for further and more conclusive studies are proposed.

Antipsychotic Agents↗
PubMed1993

Involuntary medication of patients who are incompetent to stand trial: a descriptive study of the New York experience with judicial review.

The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination of the issue of involuntary treatment with antipsychotic medication to the mentally disabled facing criminal trial. A criminal defendant who is "incompetent to stand trial" cannot be subjected to trial. Many such persons are committed to hospitals to be treated and rendered "competent to stand trial," and some of these patients refuse medication. The involuntary administration of antipsychotic medication to such patients raises important and unique medical and moral questions. This highly controversial issue has been understudied. We report here on the first study of persons committed to a state hospital in order to be rendered competent to stand trial who refuse antipsychotic medication and for whom judicial review is requested to allow involuntary treatment, and in which results are given specifically for these subjects. This is a retrospective study to determine the characteristics of such cases and aspects of their outcome in the hospital. We reviewed all cases (N = 68) of application for treatment over objection, filed since the inception in 1986 of the new laws and regulations requiring judicial review through 1990, among patients in the two facilities that receive over 95 percent of all indicted felony offenders in New York State who are incompetent to stand trial. Tentative conclusions are formulated based on the findings that, according to clinical reports, no patient gave only rational reasons for medication refusal, clinicians always indicated the clinical appropriateness of the proposed treatment, judges apparently never found that someone who is "incompetent to stand trial" is "competent" to refuse medication, 93 percent of patients treated involuntarily had a good clinical response, and 87 percent of patients treated involuntarily were restored to "competency to stand trial."

Adult↗
PubMed1991

The course of lymphocytic hypophysitis.

A 27-year-old woman presented to our institution in her seventh month of pregnancy with complaints of headache and visual field disturbance. Workup revealed bitemporal hemianopia, a markedly enlarged pituitary gland on computed tomography scan, and biochemical evidence of partial hypopituitarism. At surgery, a biopsy specimen of the pituitary gland was taken revealing lymphocytic hypophysitis. The patient was treated with steroids and replacement doses of thyroid hormone. Visual fields improved postoperatively. A repeat computed tomography scan obtained 2 months after an uneventful pregnancy showed that her pituitary had regained normal size and contour. Over the next 9 months she had gradual recovery of all pituitary function. This case allowed us to follow and document the course of lymphocytic hypophysitis from its presentation as a macroadenoma with partial hypopituitarism to full recovery of both size and hormonal function of the pituitary. Lymphocytic hypophysitis should be considered in the differential diagnosis of a pituitary mass or pituitary dysfunction presenting in pregnancy. In patients with suspected lymphocytic hypophysitis and a pituitary mass, a trial of steroids may be therapeutic.

Adult↗
PubMed1991

Sump catheter drainage of parotid abscess: an alternative to surgery.

It is a clinical challenge to distinguish patients with parotid abscesses from those with acute sialadenitis. A case of parotid abscess is presented in which a CT scan with intravenous contrast enhancement localized the abscess cavity and guided its aspiration and drainage with an indwelling catheter. By using this percutaneous technique, the need for early surgical intervention by incision and drainage was eliminated. The dense overlying parotid fascia and position of the deep parotid lobe make differentiating between these two clinical entities difficult. Parotid abscesses are readily apparent on computerized tomographic (CT) scanning evaluation with intravenous contrast enhancement, presenting as discrete fluid-filled areas unlike the amorphous appearance of acute sialadenitis. CT scanning with intravenous contrast enhancement has been the preferred radiographic study of choice for evaluating parotid masses or parapharyngeal masses. The treatment of a patient with acute sialadenitis differs from that of a patient with a parotid abscess. Patients with acute sialadenitis will usually respond to vigorous intravenous (IV) hydration, use of sialagogues and appropriate antibiotic coverage. Following a period of conservative treatment with antibiotics and warm soaks, patients with parotid abscesses will usually undergo an incision and drainage procedure, and later, parotidectomy. A case of parotid abscess is presented in which a CT scan with intravenous contrast enhancement localized the abscess cavity and guided its aspiration and drainage with an indwelling catheter. Percutaneous drainage of parapharyngeal abscesses guided by CT has been previously described by Cole. By using this percutaneous technique, the need for early surgical intervention by incision and drainage was eliminated.

Abscess↗
PubMed1988

Computed tomography of abdominal aortic aneurysm. An in vivo pathological report with a note on dynamic predictors.

A group of computed tomography (CT) descriptors were derived for abdominal aortic aneurysms. Terminology was defined and applied to the interpretation of the CT image in 55 prospective cases. Correlation of geometric parameters of aneurysm and analysis of the relationship of internal aneurysm components such as lumen and thrombus was performed. Predictive growth patterns for aneurysm demonstrated a synchronous increase in the volume of thrombus within the aneurysm in those aneurysms measuring 5 to 7 cm. Aneurysms greater than 7 cm were associated with an expansion of the patent pulsatile lumen, with no appreciable increase in thrombus volume. The thrombus-lumen ratio effectively described the changing internal architecture of aneurysm associated with increase in size. Proper utilization of CT descriptors develops a language that interprets aneurysm stability and potential for rupture and may provide an improved basis for timely surgical planning.

Aged↗
PubMed1987

Lower extremity swelling: computerized tomography following negative venography.

In 21 patients who had lower extremity swelling and negative venography, radiographic evaluation was extended to include computerized tomography (CT) of the lower extremity, which we have termed venography-CT, or VCT. All patients were referred with the diagnosis of deep vein thrombosis (DVT) and no patient had a history of trauma. CT was effective in demonstrating two occult mechanisms of lower extremity swelling: knee joint effusion (three patients) and intramuscular hemorrhage (five patients). Selective utilization of CT in the evaluation of lower extremity swelling is effective in directing the clinical management of these patients.

Adult↗
PubMed1985

Shunt placement and myelomeningocele repair: simultaneous vs sequential shunting. Review of 12 cases.

The optimal management of patients with myelomeningocele and hydrocephalus is facilitated by a constant review of the patients with the aid of the sonogram and CT scan. Six infants treated with simultaneous shunt placement and myelomeningocele repair were compared with six other neonates treated with conventional sequential myelomeningocele repairs requiring a second separate procedure for shunt placement. Infants operated upon simultaneously experienced no increase in morbidity or mortality and appeared to benefit substantially.

Cerebrospinal Fluid Shunts↗
PubMed1982

Acute cerebrospinal fluid hydrothorax: a delayed complication of subdural-pleural shunting.

A 31/2-year-old child with a bilateral chronic subdural hematoma due to battering suffered a recurrence on one side. She was treated successfully with a subdural-pleural shunt. Two months later, she returned with severe respiratory embarrassment due to what we think was a cerebrospinal fluid hydrothorax. The maintenance of her earlier neurological recovery was confirmed, and her hydrothorax was cured by removing the shunt. No hydrocephalus ensued.

Cerebrospinal Fluid↗
PubMed1977

Mechanism of inappropriate polyuria in septic patients.

Inappropriate polyuria leading to hypovolemia and hypotension occurs frequently in severely septic patients. It's etiology was studied in three patients with polyuria and systolic hypotension. Glomerular filtration rate and renal blood flow were measured by the standard renal clearance techniques. Renal blood flow distribution to the outer cortex, inner cortex-outer medulla, and the inner medulla were measured by radioactive xenon. The glomerular filtration rate, renal blood flow, and renal blood flow distribution were normal. Polyuria does not result from a maldistribution of renal blood flow. Antidiuretic hormone did not alter the polyuric syndrome. These data suggest that sepsis produces a blockade at either the distal tubule or the collecting duct, thereby preventing salt and water conservation. This blockade may be due to either a toxin or a toxic metabolic breakdown product of sepsis.

Adult↗
PubMedDate not supplied

Medical management of orbital subperiosteal abscess in children.

The traditional treatment of subperiosteal orbital abscess consists of surgical drainage and antibiotic therapy. We successfully treated with antibiotics alone nine children (age range 26 months to 12 years) with clinical signs and symptoms of orbital cellulitis and computerized tomographic (CT) evidence of subperiosteal abscess and contiguous ethmoid sinusitis. Two additional patients successfully treated with nonsurgical therapy were identified retrospectively. All patients were admitted to the pediatric service with normal vision. Their visual function was assessed twice daily during the early stages of their illness. All patients improved with intravenous antibiotic therapy. One additional patient required surgical drainage for persistent pain after 1 week of slow but steady clinical improvement. All other patients were clinically cured with medical therapy alone. Five of the medical "cures" had posttreatment CT, which documented the resolution. No patient had a recurrence. We conclude that orbital subperiosteal abscess, like some other abscesses located elsewhere, may be amenable to non-surgical treatment, or that these patients may have had a phlegmon rather than an abscess and the currently accepted CT criteria for diagnosis of a subperiosteal abscess may require modification. We recommend that children with a subperiosteal abscess from contiguous ethmoidal sinusitis who have no evidence of compromised optic nerve function be given a trial of intravenous antibiotic therapy prior to consideration of surgical drainage.

Abscess↗