Biomedical subjects

M L Lalakea

Publications and source records attributed to M L Lalakea.

7 recordsLinked to original sources

PubMed2000

Ankyloglossia: controversies in management.

PURPOSE: To determine current beliefs regarding ankyloglossia and its treatment. DESIGN: Anonymous written survey. PARTICIPANTS: Otolaryngologists (OTO, n=423), pediatricians (PD, n=425), speech pathologists (SP, n=400), and lactation consultants (LC, n=350) were randomly selected from professional membership lists, with a response rate of 209 (49%), 235 (55%), 150 (37.5%), and 203 (58%), respectively. CLINICAL FINDINGS: Sixty-nine percent of LCs, but a minority of physician respondents, believe tongue-tie is frequently associated with feeding problems. Sixty percent of OTOs, 50% of SPs, but only 23% of PDs believe tongue-tie is at least sometimes associated with speech difficulties. Sixty-seven percent of OTOs versus 21% of PDs believe tongue-tie is at least sometimes associated with social/mechanical issues. Surgery is recommended at least sometimes for feeding, speech, and social/mechanical issues by 53, 74, and 69% of OTOs, respectively, but by only 21%, 29%, and 19% of PDs. CONCLUSION: The significance of ankyloglossia in children remains controversial, both within, and between, specialty groups.

Adult↗

PubMed2000

Ankyloglossia: incidence and associated feeding difficulties.

OBJECTIVES: To determine the incidence of ankyloglossia (tongue-tie) in the well-baby population, and to determine whether patients with ankyloglossia experience breastfeeding difficulties. DESIGN: Prospective controlled study. SETTING: Tertiary care children's hospital. PATIENTS: A total of 1041 neonates in the well-baby nursery were screened for ankyloglossia. Those positively identified were invited to participate in the study. Mothers of newborns with ankyloglossia and mothers of a matched control group of unaffected newborns were contacted by telephone on a monthly basis for 6 months after their children were discharged from the hospital to determine the presence of breastfeeding difficulties. MAIN OUTCOME MEASURES: Incidence of ankyloglossia, percentage of infants successfully breastfed, and incidence of breastfeeding difficulties. RESULTS: Fifty newborns were identified with ankyloglossia, for an incidence of 4.8% The male-female ratio was 2.6:1.0. Of the 36 mothers of affected infants who were followed up and who intended to breastfeed, 30 (83%) successfully breastfed their infants for at least 2 months, compared with 33 (92%) of the 36 mothers of infants in the matched control group (P = .29). Breastfeeding difficulties were experienced by 9 (25%) of the mothers of infants with ankyloglossia compared with 1 (3%) of the control mothers (P<.01). CONCLUSION: Ankyloglossia, which is a relatively common finding in the newborn population, adversely affects breastfeeding in selected infants.

Breast Feeding↗

PubMed1999

Safety of pediatric short-stay tonsillectomy.

OBJECTIVE: To determine the safety of a relatively brief (<3-hour) period of postoperative observation prior to discharge in children undergoing outpatient tonsillectomy. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital and public teaching hospital. PATIENTS: The records of all patients (12 years of age who underwent tonsillectomy or adenotonsillectomy from November 1995 through July 1997 were reviewed. A total of 143 patients scheduled for ambulatory treatment were identified; 9 were excluded owing to insufficient follow-up. The remaining 134 patients made up the study group. MAIN OUTCOME MEASURES: (1) Duration of observation prior to discharge; (2) complication rates. RESULTS: The mean age of the study population was 6.1+/-2.6 (mean+/-SD) years. Obstructive sleep apnea was an indication for surgery in 86.5%. Eleven (8.2%) of 134 planned outpatients were electively admitted from the recovery room for inpatient observation, most often because of respiratory compromise. Patients admitted from the recovery room were significantly younger (mean age, 4.0 years) than those who were discharged as planned (6.3 years, P<.001). One hundred twenty-three patients were discharged from the recovery room as anticipated, following a mean+/-SD duration of postoperative observation of 144+/-48 minutes. Overall, 5 (4.1%) of these 123 outpatients suffered complications after discharge. Two patients (1.6%) experienced primary bleeding, both at 8 hours after surgery. Four patients (3.2%) were readmitted. The complication rate did not vary significantly with the duration of postoperative observation (P= .71). CONCLUSION: A short postoperative observation period is safe, with a low rate of complications, in appropriately selected children scheduled for ambulatory tonsillectomy.

Adenoidectomy↗

PubMed1994

Mandible fracture repair: specific indications for newer techniques.

Mandible fracture repair is commonly undertaken by otolaryngologists. Although the essential principles of reduction and immobilization are undisputed, the approach used to obtain these goals varies considerably. We performed a critical evaluation of all mandible fractures treated at the Santa Clara Valley Medical Center by the otolaryngology service between January 1988 and February 1992, with the purpose of better defining the indications for plate fixation and for the use of more traditional techniques. One hundred eighty-three fractures in 112 patients were evaluable. Thirty-six (32.1%) of these patients had at least one plate placed (group A); 39 (34.8%) underwent an open procedure, with interosseous wire fixation (group B); and 37 (33.0%) were treated with closed techniques (group C). The severity of fracture (indexed by comminution, presence of infection, teeth in the fracture line, interval to repair, and whether the fracture was open or closed) was similar in plated and nonplated mandibles. Mean (+/- standard deviation) operative times for the three groups were 3.2 +/- 1.6 hours for group A, 3.0 +/- 0.9 hours for group B, and 1.4 +/- 0.5 hours for group C. The number of follow-up visits required was not statistically different (group A, 5.6 +/- 3.8 visits; group B, 5.2 +/- 2.5 visits; and group C, 5.3 +/- 2.0 visits). The overall incidence of major complications was 14.3% (16 of 112), including 11 of 36 (30.6%) in group A, 4 of 39 (10.3%) in group B, and 1 of 37 (2.7%) in group C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Laryngeal brainstem evoked response: a developmental study.

A developmentally receding laryngeal chemoreflex (LCR) has been described in infant animals of several species characterized by vocal cord adduction in response to laryngeal stimulation as well as a potentially fatal cardio-respiratory response. Age-related differences in the brainstem respiratory centers may account for differences in the LCR and play a role in such disorders as Sudden Infant Death Syndrome (SIDS) and infant apnea. Study of the LCR at the brainstem level could provide insights into normal maturation of respiratory centers and eventually the pathophysiology of these disorders. The present study evaluated the laryngeal brainstem response (LBR) evoked by electrical stimulation of the superior laryngeal nerve in kittens using a far-field technique similar to auditory brainstem response testing. Recordings were obtained via posterior pharyngeal and posterior cervical recording sites and compared to results previously obtained in our laboratory for adult cats. The LBR in kittens demonstrated differences in threshold, latencies, and morphology which suggests that postnatal maturation of laryngeal function at the brainstem level does occur.

Aging↗

PubMed1989

Laryngeal brain stem evoked response.

Sensory stimuli to the larynx evoke a laryngeal adductor reflex mediated by the brain stem via superior and recurrent laryngeal nerves. Aberrant laryngeal reflexes have been proposed to explain a number of poorly understood disorders, including "reflex apnea," idiopathic laryngospasm, and sudden infant death syndrome. The purpose of the present study was to evaluate far field brain stem recordings following stimulation of the superior laryngeal nerve to determine whether laryngeal brain stem response is a valid measure of laryngeal activity at the brain stem level. The nerve was stimulated electrically in adult cats, and the resultant laryngeal adductor response as well as far field brain stem activity was recorded. For the latter, six reproducible positive and five reproducible negative waves were obtained via posterior pharyngeal (+) and posterior cervical (-) recording electrodes. Response threshold and latencies were measured and evaluated as a function of stimulus parameters. Wave latencies corresponded closely to those reported in prior near and far field evoked response recordings.

Animals↗

PubMed1983

Neurological and neuropsychological studies of patients with obsessive-compulsive disorder.

We studied 18 DSM-III diagnosed obsessive-compulsive disorder patients with the Halstead-Reitan Battery (HRB), EEGs, and CT scans. Results for the group as a whole were within the normal range; however two patients had abnormal EEGs and four showed average impairment ratings on the HRB high enough to suggest organic deficits. More than half of the subjects were impaired on the tactual performance test from the HRB suggesting a possible deficit in spatial perception. These data, however, do not define a single neuropsychological deficit nor do they replicate an earlier report of left frontal lobe dysfunction in obsessive-compulsive disorder. Cerebral CT scans in ten patients, including all those with EEG and average impairment rating abnormalities, showed VBR, asymmetry, and sulcal prominence measures indistinguishable from a matched group of nonpsychiatric control subjects.

Adult↗