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Biomedical subjects

Joseph E Cillo

Publications and source records attributed to Joseph E Cillo.

14 recordsLinked to original sources
PubMed2007

Hemodynamic stability in medically treated hypothyroid patients undergoing intravenous sedation.

PURPOSE: To evaluate the hemodynamic stability of medically treated hypothyroid patients undergoing intravenous sedation for dentoalveolar surgery. PATIENTS AND METHODS: A retrospective chart analysis of 20 consecutive white male patients actively being treated for hypothyroidism undergoing intravenous sedation for dentoalveolar surgery. Twenty consecutive normothyroid white male patients undergoing intravenous sedation for dentoalveolar surgery were used as controls. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), pulse pressure (PP), peripheral oxygen saturation (S(p)O(2)) and pulse were recorded at 5-minute intervals during intravenous sedation. RESULTS: Statistically significant lower average hemodynamic values were seen in hypothyroid patients compared to normothyroid patients in SBP (P = .05) and PP (P = .003). There were highly significant baseline changes for hypothyroid patients in DBP (P < .001) and MAP (P < .001) and significant baseline changes for normothyroid patients in DBP (P = .03), PP (P = .02) and pulse (P = .03). All changes were maintained within +/- 10% of baseline (range, -8.9% to +9.6%). CONCLUSIONS: Intravenous sedation for dentoalveolar surgery in medically treated hypothyroid patients maintains hemodynamic stability.

Adult↗
PubMed2006

Excision of subcutaneous facial cysts and lipomas using cosmetic approaches.

PURPOSE: The excisional biopsy of subcutaneoous facial cysts and lipomas can be problematic due to the high esthetic nature of the affected area. Remote scar placement has advantages in allowing access to subcutaneous pathology while placing incision lines in cosmetic locations. This article will review excisional biopsies of subcutaneous facial cysts and lipomas using cosmetic approaches. PATIENTS AND METHODS: Patients with superficial facial cysts or lipomas undergoing excisional biopsies utilizing contemporary cosmetic surgery approaches (rhytidectomy, lower blepharoplasty, and submental) with tumescent anesthesia and either intravenous sedation or general anesthesia. RESULTS: All patients had successful removal of superficial facial pathology with good cosmetic results. CONCLUSION: The use of contemporary cosmetic surgical approaches for the excisional biopsy of superficial facial cysts and lipomas provides adequate surgical access, a cosmetically acceptable result, and is well-tolerated by patients.

Aged↗
PubMed2006

Correlation and comparison of body mass index on hemodynamics in hypertensive and normotensive patients undergoing intravenous sedation.

PURPOSE: The purpose of this project was to retrospectively compare and correlate body mass index (BMI) and hemodynamics in hypertensive and normotensive patients undergoing intravenous sedation for dentoalveolar surgery. PATIENTS AND METHODS: A retrospective chart analysis of 263 consecutive male patients undergoing intravenous (IV) sedation for dentoalveolar surgery was divided into 5 BMI groups: underweight, normal weight, overweight, obese, extremely obese. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and pulse (P). Statistical analysis of mean values between groups was carried out using multivariate linear regression analysis, Pearson's correlation coefficient, and Student's t test and found significant for P < .05. RESULTS: Average hemodynamic values for normotensive patients were significantly lower for all groups except for pulse in the normal group, pulse in the obese group, and DBP in the extremely obese group. For normotensive patients, there were statistically significant strong positive correlation for elevated BMI and increased baseline changes in SBP and PP. For the hypertensive group, there was a statistically significant moderate positive correlation for elevated BMI and increased baseline changes in PP and statistically significant strong positive correlation for baseline changes in MAP. Baseline changes were significant for greater increases in SBP and decreases in DBP and MAP in the underweight hypertensive group. Significant increases from baseline in the normotensive group were for PP in the normal BMI group and for pulse in the obese group. All baseline changes, with the exception of normotensive underweight SBP (+26.7%) and hypertensive PP (+23.9%), were within +/-20% of baseline (range, -12.2% to +17.4%). CONCLUSION: In general, normotensive patients in this study had lower average hemodynamic values than hypertensive patients in all BMI groups. Great variability was seen in baseline changes for all BMI groups, but a substantial majority of changes were within +/-20% of baseline. There were statistically significant moderate and positive correlations in BMI for changes from baseline for several hemodynamic measurements. Intravenous sedation for oral and maxillofacial surgery procedures maintains a stable hemodynamic state in hypertensive and normotensive patients regardless of BMI.

Adult↗
PubMed2006

Combined open rhinoplasty with spreader grafts and laser-assisted uvuloplasty for sleep-disordered breathing: long-term subjective outcomes.

PURPOSE: To subjectively assess the long-term outcomes of combined functional open rhinoplasty with spreader grafts and laser-assisted uvuloplasty (LAUP) for polysomnogram (PSG)-confirmed sleep-disordered breathing (SDB). METHODS: Postoperative Epworth Sleepiness Scale (ESS) questionnaires were given to 30 patients and compared with preoperative ESS. Patients were also asked questions concerning postoperative improvement in upper airway breathing, nasal appearance, and snoring. Statistical analysis used 2-tailed parametric and nonparametric tests. RESULTS: Thirty patients (average age 55 years) with an average (+/- standard deviation) preoperative apnea-hypopnea index (AHI) of 37 +/- 27 and mean follow-up times of 21 months were evaluated. A statistically significant 50% (P < .001) postoperative decrease in average ESS was observed. Patients with severe (AHI > 30) and very severe obstructive sleep apnea (OSA) (AHI > 60) also had statistically significant (61% and 66%, respectively, P < .001) postoperative decreases in average ESS. In all patients, subjective upper airway breathing was statistically improved (P < .008), graded as significantly in 47% and moderately in 33% of patients. According to the patient's bed partner, snoring was improved and/or decreased in 76% of patients (P = .008). All patients were satisfied with the postoperative cosmetic appearance of their nose (P < .0001). Finally, 90% of patients stated that they would have the procedure again (P = .009) and 90% stated that they would recommend the procedure to a friend or relative with the same condition (P = .009). CONCLUSION: Subjective assessment at long-term follow-up for combined open rhinoplasty with spreader grafts and LAUP for PSG-confirmed SDB produced a statistically significant decrease in excessive daytime sleepiness, even in patients with very high AHI, with high patient satisfaction.

Adult↗
PubMed2006

Hemodynamics in elderly coronary artery disease patients undergoing propofol sedation.

PURPOSE: The purpose of this study was to evaluate noninvasive intraoperative hemodynamics in an elderly population with coronary artery disease (CAD) undergoing midazolam/fentanyl intravenous sedation-analgesia, with or without propofol for dentoalveolar surgery. PATIENTS AND METHODS: A retrospective chart analysis of 24 consecutive male patients aged 60 years or greater, with coronary artery disease, undergoing midazolam/fentanyl intravenous sedation-analgesia with or without propofol for dentoalveolar surgery. Data recorded included noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and pulse (P). RESULTS: The addition of propofol to elderly CAD patients resulted in statistically significant lower averages for SBP (126.1 mm Hg vs 131.3 mm Hg, P < .01), DBP (64.1 mm Hg vs 74.3 mm Hg, P < .001), MAP (84.3 mm Hg vs 94.2 mm Hg, P < .001) and PP (57.7 mm Hg vs 61.8 mm Hg, P = .01) with statistically insignificant differences in pulse (74.2 beats per minute vs 75.8 beats per minute, P = .1). Baseline changes in elderly CAD patients who received propofol were within +/-20% (range: -13.8% to +6.9%). CONCLUSION: Midazolam/fentanyl intravenous sedation provided stable intraoperative hemodynamics in elderly CAD patients. The addition of propofol to elderly CAD patients also resulted in stable intraoperative hemodynamics and may be a safe adjunct to intravenous sedation in elderly CAD patients.

Age Factors↗
PubMed2006

Stereolithography for craniofacial surgery.

Advances in computer technology have aided in the diagnostic and clinical management of complex congenital craniofacial deformities. The use of stereolithographic models has begun to replace traditional milled models in the treatment of craniofacial deformities. Research has shown that stereolithography models are highly accurate and provide added information in treatment planning for the correction of craniofacial deformities. These include the added visualization of the complex craniofacial anatomy and preoperative surgical planning with a highly accurate three-dimensional model. While the stereolithographic process has had a beneficial impact on the field of craniofacial surgery, the added cost of the procedure continues to be a hindrance to its widespread acceptance in clinical practice. With improved technology and accessibility the utilization of stereolithography in craniofacial surgery is expected to increase. This review will highlight the development and current usage of stereolithography in craniofacial surgery and provide illustration of it use.

Child↗
PubMed2005

Hemodynamics and oxygen saturation during intravenous sedation for office-based laser-assisted uvuloplasty.

PURPOSE: Patients undergoing office-based laser-assisted uvuloplasty (LAUP) for snoring or mild obstructive sleep apnea are generally obese and have a high Mallampati score. Because avoidance of supplemental oxygen during laser procedures is generally mandated, the potential for intraoperative desaturation is high. This study was designed to look at intraoperative hemodynamic changes, respiration patterns, and oxygen saturations during intravenous sedation with midazolam and fentanyl during LAUP procedures. MATERIALS AND METHODS: This was a retrospective anesthesia chart review of 15 consecutive patients undergoing midazolam/fentanyl intravenous sedation for office-based LAUP treatment for snoring and/or mild obstructive sleep apnea. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse (P), and rate-pressure product (RPP). Data collected were reported as mean values with standard deviation. Statistical analysis using the Student's t test was performed and found significant for P<.05. RESULTS: All changes from baseline were statistically insignificant, SBP (P=.4), DBP (P=.2), MAP (P=.2), P (P=.1), PP (P=.9), RPP (P=.5), RR (P=.9), and SpO2 (P=.4), and all within +/-20% of baseline (range, -5.0% to +7.5%). CONCLUSION: Midazolam and fentanyl intravenous sedation with local anesthesia maintained intraoperative hemodynamic and oxygenation variables close to baseline for office-based LAUP procedures.

Ambulatory Surgical Procedures↗
PubMed2005

Moderate intravenous sedation for office-based full face laser resurfacing using a continuous infusion propofol pump.

PURPOSE: The purpose of this study was to compare the anesthetic requirements and hemodynamic and oxygenation variables involved between the bolus midazolam/fentanyl intravenous sedation-analgesia technique, and the same technique combined with continuous-infusion propofol. PATIENTS AND METHODS: This was a retrospective chart analysis of 41 consecutive patients undergoing full-face carbon dioxide laser resurfacing with either bolus midazolam/fentanyl (n = 15) or midazolam/fentanyl with continuous propofol infusion anesthesia (n = 26) techniques. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse (P), and rate-pressure product (RPP), respiratory rate (RR), and oxygen saturation (SpO2). Data collected were reported as mean values with standard deviation. Statistical analyses were performed with the Student's t test and found statistically significant for P < .05. RESULTS: Statistically significant decreases in averages were seen in SBP (P < .001), DBP (P = .02), MAP (P = .004), P (P < .00l), RPP (P < .00l), and RR (P < .001), but not PP (P = .4) and SpO2 (P = .08) in the midazolam/fentanyl/continuous propofol infusion group compared with the midazolam/fentanyl only group. Changes from baseline were statistically significant only for MAP (P = .04), but statistically insignificant for all other measurements, SBP (P = .7), DBP (P = .4), P (P = .95), PP (P = .97), RPP (P = .6), RR (P = .6), and SpO2 (P = .4). Statistically significant smaller amounts of midazolam (P = .01) and fentanyl (P < .001) were used in the midazolam/fentanyl/continuous propofol infusion pump group. Length of procedure was statistically insignificant between groups (P = .4). Conclusion The addition of a continuous propofol pump maintained hemodynamic and oxygenation values close to baseline, while decreasing the amount of respiratory depressing opiates administered and without affecting the length of the procedure.

Aged↗
PubMed2005

Management of middle meningeal and superficial temporal artery hemorrhage from total temporomandibular joint replacement surgery with a gelatin-based hemostatic agent.

Complications associated with temporomandibular joint (TMJ) replacement surgery may include injury to nerves, blood vessels, and otologic structures. Vascular injuries can be associated with trauma to the carotid artery and its terminal branches, the superficial temporal artery, and the internal maxillary artery. Suggested management to control hemorrhage has included uniand bipolar electrocautery, laser ablation, local anesthetics with vasoconstrictors, direct pressure, embolization, and ligation. In this case report, the iatrogenic injury to both the middle meningeal and superficial temporal arteries during total TMJ replacement surgery controlled by using a gelatin-based hemostatic agent is discussed.

Adult↗
PubMed2003

The effects of mechanical strain on synovial fibroblasts.

PURPOSE: Arthritic diseases of the temporomandibular joint, such as rheumatoid arthritis and osteoarthritis, suggest that inflammatory mediators and metalloproteinases may play a role in their pathogenesis. Recent clinical evidence from physical therapy and other modalities has shown a significant decrease in temporomandibular joint symptoms in patients with early disease. This project examines the effect of mechanical strain on synovial fibroblasts' production of inflammatory mediators including prostaglandin E(2) (PGE(2)) and proteinases. MATERIALS AND METHODS: An established synovial fibroblast cell line (HIG-82) was grown to confluency in modified Eagle's medium supplemented with 10% fetal calf serum. The monolayer of fibroblasts was then subjected to mechanical strain using the Flexercell Strain Unit (Flexcell International Corporation, McKeesport, PA) at 3 cycles per minute, with 10 seconds' elongation of up to 24% and 10 seconds of relaxation. Levels of PGE(2) were determined by radioimmunoassay using commercially available product and measured in nanograms per milliliter of supernatant. Proteinases collagenase, gelatinase, and stromelysin were measured by H(3) radioactive labeling of acidic anhydride to the specific substrate. Enzymatic proteolysis of the radiolabeled substrate was then measured in supernate as units per milliliter. Statistical analysis of all results was performed using Student's t test in triplicate. RESULTS: PGE(2) levels of mechanically activated cells was 18.1 +/- 13.4 ng/mL, with control levels being 58.0 +/- 9.2 ng/mL. This is a statistically significant decrease, between strained and unstrained cells with P <.05. In control cells, proteinase activity that degrades collagen, gelatin, or casein was 4.27 +/- 1.5, 4.62 +/- 0.11, or 0.11 +/- 0.01 U/mL, respectively. Levels for mechanically strained cells were 3.99 +/- 1.90, 4.02 +/- 0.90, and 0.12 +/- 0.01 U/mL, respectively. These results show that there is a significant decrease in PGE(2) levels of synovial fibroblasts undergoing mechanical strain. Proteinases examined show no difference in levels between mechanically activated fibroblasts and their controls. CONCLUSION: This decrease in PGE(2) production in synovial fibroblasts could help elucidate the mechanism by which physical therapy, and in particular continuous passive motion, may decrease inflammatory mediators of the temporomandibular joint.

Animals↗