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Biomedical subjects

Ninos J Joseph

Publications and source records attributed to Ninos J Joseph.

At least 19 recordsLinked to original sources
PubMed2006

Patient selection and efficacy of pillar implant technique for treatment of snoring and obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: Pillar implant (PIT) is a simple, office-based procedure with minimal morbidity that was introduced in 2003 to treat snoring and mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). We studied the: (1) success rate using subjective symptoms and objective polysomnographic improvement; (2) success rate based on BMI, OSAHS severity and Friedman tongue position (FTP); and (3) its value as an adjunctive or revision procedure. STUDY DESIGN AND SETTING: Retrospective review of 125 patients who underwent the PIT for snoring and OSAHS. Patients were grouped: Group I had PIT only (n = 29); Group II received adjunctive nasal procedures (n = 37), Group III received adjunctive oropharyngeal procedures (n = 55); and Group IV had failed previous UPPP (n = 4). RESULTS: Overall subjective and objective "cure" rates were 88.0% and 34.4%, respectively. Group IIb had the best objective cure rate of 46.7%. Neither AHI nor BMI correlated with outcome measures, whereas FTP did correlate. (FTP I and II had improved success vs FTP III and IV). Ten patients had partial extrusion of the PIT. These were removed and new PIT were carried out at a later date. CONCLUSIONS: Based on a short-term study, the Pillar implant is an effective treatment for snoring and OSAHS in selected patients and can be combined with adjunctive procedures to treat OSAHS.

Adolescent↗
PubMed2006

Reduction of C-reactive protein with surgical treatment of obstructive sleep apnea hypopnea syndrome.

OBJECTIVES: To determine whether surgical treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) has an impact on C-reactive protein (CRP) level. STUDY DESIGN: Prospective study of 34 consecutive subjects undergoing surgical treatment for OSAHS. CRP levels were evaluated preoperatively and 2 months postoperatively. The most commonly performed procedure was uvulopalatopharyngoplasty (UPPP) combined with radiofrequency tongue base reduction. RESULTS: Seven patients were treated for mild OSAHS and 23 were treated for moderated/severe OSAHS; 18 of 23 patients with moderate/severe disease had relative elevation of preoperative CRP levels. Mean CRP level decreased from 0.33 mg/dL preoperatively to 0.16 mg/dL postoperatively (P=0.003). Even patients who did not achieve complete "cure" by classical polysomnography (PSG) criteria may benefit from lowered CRP levels. All patients, however did achieve reduction in apnea hypopnea index and improvement in clinical symptoms. CONCLUSIONS: Levels of CRP were elevated preoperatively but decreased after surgical treatment. Therefore, OSAHS surgical treatment may be useful in reduction of CRP levels in patients who will not or cannot accept nasal-CPAP therapy.

Adult↗
PubMed2006

Comparison of the incidences of obstructive sleep apnea-hypopnea syndrome in African-Americans versus Caucasian-Americans.

OBJECTIVE: To determine the relative incidence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in African-Americans compared to a cohort of Caucasian-Americans. STUDY DESIGN AND SETTING: A prospective study of 2 groups of subjects (287 African-Americans and 236 Caucasian-Americans) to evaluate OSAHS severity based on subjective symptoms and anatomic findings. Subjects were from a public health and fitness fair attended by approximately 80,000 people where attendees were invited for an ENT screening. RESULTS: Using OSAHS scores based on subjective symptoms and anatomic findings, the African-American group had a significantly higher incidence of "probable" OSAHS. In addition to symptoms of OSAHS, the questionnaire ascertained that African-American bed partners are more likely to accept loud snoring as compared to Caucasian-American bed partners. CONCLUSIONS: OSAHS may be more common in African-Americans, but African-American bed partners are more likely to accept snoring. The medical community should strive to increase awareness and education about OSAHS in the African-American community. EBM RATING: B-3b.

Adolescent↗
PubMed2006

Percutaneous cement injection into a created cavity for the treatment of vertebral body fracture: preliminary results of a new vertebroplasty technique.

OBJECTIVES: Vertebral body fractures (VBFs) are the most common complication of osteoporosis. Minimally invasive placement of cement to stabilize VBFs results in significant pain reduction and improved performance of daily activities. The authors describe a modified percutaneous vertebroplasty (PV) procedure during which a cavity is created manually in the VBF, allowing the cement to be injected with less resistance. METHODS: Data were gathered from a retrospective chart review from 15 consecutive patients with acute compression VBFs who underwent 33 PV procedures with the Cavity Creation System. Mean follow-up was 30 weeks. Oral opiate intake, quality of life improvement, and visual analog pain scores (VAS) were measured before and 1 month after the procedure. RESULTS: All 15 patients exhibited a reduction in pain VAS (mean reduction 5.9 +/- 2.5). Improvement in quality of life was demonstrated by lower (improved) FACIT scores in the General Activity, Enjoyment of Life, Mood, Normal Work Routine, and Sleep subscales. In addition, opioid use decreased in 10 of the 12 (83%) patients who were taking opioids before surgery. In eight (67%) patients, opioid use decreased by over 50%. Complications included extrusion of cement in two patients (an incidence of 5.7% of the levels operated) and two patients with intraoperative rib fractures. No postoperative neurologic deficits were noted. CONCLUSIONS: The Cavity Creation System is a safe, cost-effective treatment of VBF resulting in good/excellent pain relief and an improved quality of life.

Activities of Daily Living↗
PubMed2006

Long-term results after endoscopic sinus surgery involving frontal recess dissection.

OBJECTIVE: To assess long-term follow-up on a cohort of patients who underwent endoscopic frontal sinus surgery with identification and preservation of the natural frontal outflow tract. STUDY DESIGN AND SETTINGS: Retrospective chart review, telephone interview, and endoscopic evaluation on a previously studied cohort of patients at a university affiliated medical center. RESULTS: Two hundred patients who underwent endoscopic frontal sinus surgery were previously studied and reported after short-term (mean = 12.2 mo) follow-up. One hundred fifty-two (76%) patients were available for long-term (mean 72.3 mo) follow-up and assessment of subjective symptoms. Fifty-seven of 152 (37.5%) patients also had nasal endoscopy for evaluation of objective findings. The percentage of patients responding to telephone interview reporting overall improvement after surgery was 92.4%. Endoscopic assessment revealed patency of the frontal sinus in 67.6% of the patients after initial surgery. Thirteen additional patients had patent sinuses after revision procedures, bringing overall patency rate to 71.1%. We found statistically significant correlation of asthma and smoking and poor subjective and objective outcome. CONCLUSION: Long-term assessment of subjective and objective findings in our previously reported cohort of patients who underwent frontal sinus surgery indicates that the frontal sinus, similar to any other sinus, can be successfully treated surgically by preserving the natural frontal sinus outflow tract.

Adolescent↗
PubMed2006

Palatal stiffening after failed uvulopalatopharyngoplasty with the Pillar Implant System.

OBJECTIVE/HYPOTHESIS: The objective of this study was to measure subjective and objective improvement after palatal stiffening in patients after uvulopalatopharyngoplasty (UPPP) who were experiencing persistence or recurrence of snoring with or without daytime sleepiness symptoms. STUDY DESIGN: The authors conducted a prospective, nonrandomized study of 26 patients after UPPP who underwent the Pillar Implant Technique (PIT) as a revision procedure. METHODS: Patients were selected to undergo revision PIT if they presented with recurrence or persistence of snoring after UPPP. Patients had mild or moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) (apnea-hypopnea index [AHI] >5 and < or =40), persistent retropalatal obstruction, and a residual palate > or =2 cm. Some patients experienced daytime somnolence as well. Patients with severe OSAHS (AHI > or =40), Friedman anatomic stage IV, and/or nasopharyngeal stenosis were excluded. Pre-/postoperative snoring levels, Epworth Sleepiness Scale (ESS), SF-36v2 Quality of Life (QOL) questionnaires, and polysomnograms were obtained. RESULTS: We completed data on 23 patients. Postoperative snoring levels (3.4 +/- 1.8) and ESS (8.7 +/- 1.8) significantly improved (P < .0001) compared with preoperative values (8.7 +/- 1.8 and 13.2 +/- 2.9). A total of 73.9% of patients improved subjectively. Seven of eight SF-36v2 QOL domains showed significant improvement (P < .05). Postoperative AHI and minimum oxygen saturation also improved significantly (P < .05). Objective cure was only achieved in 21.7% of patients. CONCLUSIONS: Revision PIT is effective in achieving subjective improvement of recurrent symptoms after UPPP. Objective cure was only obtained in 21.7% of patients. As a result of the safety and low morbidity of the procedure, it is an alternative to improve symptoms, especially snoring, in patients not willing to accept continuous positive airway pressure permanently or patients who refuse revision surgery.

Adult↗
PubMed2005

Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy.

OBJECTIVE: The goal of this study was to determine whether intraoperative intact parathyroid hormone (IOiPTH) levels can predict the functional status of remaining parathyroids at the end of total thyroidectomy and thereby be a guide for parathyroid autotransplantation when glands are deemed not functional. STUDY DESIGN: Prospective study involving 23 patients undergoing either total thyroidectomy or completion thyroidectomy METHODS: During surgery, an attempt was made to identify all four parathyroid glands. Normal size vascular glands were preserved, whereas avascular glands were microdissected and reimplanted. Serial IOiPTH was measured preoperatively after each parathyroid was identified, manipulated, or removed and serum iPTH measurements were done postoperatively up to 56 days. RESULTS: The sensitivity of low IOiPTH in identifying a devascularized gland was 88.9%, and specificity was 92.9%. A normal IOiPTH level indicates at least two functioning glands. IOiPTH levels between 1.5 and 10 pg/mL indicate only one functional gland. Undetectable IOiPTH levels indicate no residual functioning gland. CONCLUSIONS: For patients undergoing total or completion thyroidectomy, IOiPTH should be routinely measured at the end of the procedure, and a level less than 10 pg/mL requires reassessment of remaining parathyroid glands. Vascularized glands should be preserved regardless of IOiPTH levels. Devascularized glands or glands of questionable vascularity should be considered for autotransplantation.

Humans↗
PubMed2004

Z-palatoplasty (ZPP): a technique for patients without tonsils.

OBJECTIVE: Patients without tonsils and with Friedman tongue position (FTP) III and IV are poor candidates for uvulopalatopharyngoplasty (UP3). Even when combined with adjunctive hyopharyngeal techniques, results are poor. We assessed a modified uvulopalatoplasty based on a bilateral Z-plasty in treating patients without tonsils who have obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: 25 patients treated with a modified technique were matched with 25 patients previously treated with classic UP3. All patients in both groups also had radiofrequency tongue base reduction. Preoperative vs. postoperative measures of objective treatment success and subjective symptoms were compared for the 2 groups. Morbidity, including pain levels, narcotic use, and return to solid diet and normal activity, as well as complications were studied. RESULTS: Subjective improvement was good for both groups, but objective clinical improvement was significantly better for the experimental group. Morbidity and complications for the experimental group were comparable to the control group and to other published series on UP3. CONCLUSIONS: A modified technique for patients without tonsils who have OSAHS is presented. The new technique is more successful with acceptable morbidity for patients with OSAHS than classical techniques.

Adult↗
PubMed2004

A simplified technique for airway correction at the nasal valve area.

OBJECTIVE: To describe a simplified system to correct an obstructed nasal airway utilizing the Mitek bone anchor suspension technique (BAST). STUDY DESIGN: This is a retrospective/prospective study of patients with nasal airway obstruction treated with the BAST. The retrospective study is based on 188 patients who underwent the BAST over the past 5 years and were analyzed to assess complications and subjective results. The prospective group consisted of 52 patients with unilateral or bilateral valve obstruction who were assessed with preoperative and postoperative rhinomanometry and quality of life (QOL) questionnaires. METHODS: The surgical technique is based on introducing a bone anchor into the orbital rim through a 4-mm stab incision. The bone anchor system comes with attached sutures that are easily passed to the valve area and secured in position to support and open the valve area. Preoperative and postoperative QOL surveys and rhinometric studies were compared in 52 patients to assess the subjective and objective outcomes of the procedure. RESULTS: Based on subjective data, over 90% of the patients had significant improvement in their nasal airway. Objectively, cross-sectional areas at the nasal valve were found to have significantly improved postoperatively (P < 0.046). Complications were rare and limited to localized infection, reaction to sutures, and loss of support. CONCLUSION: Correction of nasal valve obstruction with this technique provides a simplified alternative in selected patients to improve airflow and decrease nasal resistance. The BAST allows for a simple, highly effective correction of an obstructed airway with minimal complications.

Airway Resistance↗
PubMed2004

Uvulopalatoplasty (UP2): a modified technique for selected patients.

OBJECTIVES: The goal of uvulopalatopharyngoplasty (UP3) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is to reduce obstruction by eliminating redundant tissue in three areas: the soft palate, tonsils, and pharynx. However, some OSAHS patients may present with tonsil hypertrophy and elongated soft palate without redundant pharyngeal folds. We treated this group of patients with tonsil reduction using radiofrequency coblation combined with uvulopalatoplasty (UP2) using a palatal flap technique without pharyngoplasty. Morbidity and outcome was then compared with a group of patients who underwent classic UP3. STUDY DESIGN: A retrospective, nonrandomized study comparing morbidity and outcomes of the modified technique (UP2) with patients who underwent standard UP3. METHODS: Patients were all staged according to the previously described Friedman staging system. Those with redundant pharyngeal folds were treated with UP3 (n = 33), and those without redundant pharyngeal folds were treated with tonsil coblation and UP2 (n = 30). Charts of patients undergoing UP2 and UP3 between July 1, 2001 and July 1, 2002 were reviewed. Thirty-three consecutive patients who underwent UP3 were selected for study as well as 30 consecutive patients who underwent UP2. Pre- and postoperative quality of life questionnaires and patient questionnaires focusing on diet, pain, and return to activity were reviewed to assess subjective morbidity and elimination of symptoms. Objective measurements include preoperative and postoperative (6-18 months) polysomnography (PSG). RESULTS: Symptom elimination and objective PSG results were compared. There was no statistical difference in results between the UP3 group and the UP2 group. Morbidity, however, was significantly more prominent, and recovery was more prolonged, in the UP3 group. Patients undergoing UP2 had fewer pain days, less narcotic use, quicker return to solid diet, and less long-term complaints of globus sensation. CONCLUSIONS: UP2 with tonsil coblation offers some reduction in postoperative morbidity without affecting outcome for selected patients with OSAHS. Pain levels, however, are still very significant.

Chi-Square Distribution↗
PubMed2004

Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment.

OBJECTIVE: Early studies by Friedman et al. have demonstrated the value of staging obstructive sleep apnea/hypopnea syndrome (OSAHS) patients for the prediction of success for uvulopalatopharyngoplasty (UPPP) on the basis of short-term follow up. The goal of this study is to test the value of this staging system in a prospective study. STUDY DESIGN: This is a prospective study of two cohorts of patients: one was treated with the benefit of a clinical staging system and the other without. METHODS: Patients with symptoms of OSAHS were assessed by polysomnography and were staged according to a previously described staging system. The staging system is based on palate position, tonsil size, and body mass index (BMI). The control group was treated without the benefit of staging. All patients in the control group were treated with UPPP only. Patients in the experimental group were treated based on their clinical stage. Patients with stage I disease, regardless of the severity of disease, were treated with UPPP only. Selected patients with stage II and stage III disease were treated with UPPP in addition to a staged tongue-base reduction using a radiofrequency technique (TBRF). RESULTS: Follow-up at 6 months showed significant improvement compared with a group of patients treated without the benefit of a staging system. Successful treatment of patients with stage II disease improved from 37.9% to 74.0%. The overall success rate improved from 40% to 59.1%. CONCLUSION: Clearly, patients with stage I disease had the best success rate, but a selective protocol based on clinical staging improves the overall success rate. In addition, it can eliminate as surgical candidates those patients with whom the procedure is likely to fail.

Adult↗
PubMed2004

The neuromuscular effects and tracheal intubation conditions after small doses of succinylcholine.

UNLABELLED: Succinylcholine 1.0 mg/kg usually produces excellent tracheal intubation conditions in 60 s. Recovery of respiratory muscle function after this dose, however, is not fast enough to forestall oxyhemoglobin desaturation when ventilation cannot be assisted. In this study, we investigated whether smaller doses of succinylcholine can produce satisfactory intubation conditions fast enough to allow rapid sequence induction with a shorter recovery time. Anesthesia was induced with fentanyl/propofol and maintained by propofol infusion and N(2)O in O(2). After the induction, 115 patients were randomly allocated to five groups according to the dose of succinylcholine (0.3 mg/kg, 0.4 mg/kg, 0.5 mg/kg, 0.6 mg/kg, or 1.0 mg/kg). Evoked adductor pollicis responses to continuous 1-Hz supramaximal ulnar nerve stimulation were recorded using acceleromyography. Tracheal intubation conditions were graded 60 s after succinylcholine administration. Onset time, maximal twitch depression, time to initial twitch detection after paralysis, and to 10%, 25%, 50%, and 90% twitch height recovery were recorded. Time to initial diaphragmatic movement as well as time to resumption of regular spontaneous respiratory movements were calculated. Onset times ranged between 82 s and 52 s, decreasing with increasing doses of succinylcholine but not differing between 0.6 and 1 mg/kg. Maximum twitch depression was similar after 0.5, 0.6, and 1 mg/kg (98.2%-100%). Recoveries of twitch height and apnea time were dose-dependent. Intubation conditions were often unacceptable after 0.3- and 0.4-mg/kg doses. Acceptable intubation conditions were achieved in all patients receiving a 0.5, 0.6, and 1 mg/kg dose of succinylcholine. Intubation conditions in patients receiving 0.6 and 1 mg/kg were identical, whereas times to T(1) = 50% and 90% and time to regular spontaneous reservoir bag movements were significantly shorter in the 0.6-mg/kg dose group (5.78, 7.25, and 4.0 min, respectively) versus patients receiving 1 mg/kg (8.55, 10.54, and 6.16 min, respectively). The use of 0.5 to 0.6 mg/kg of succinylcholine can produce acceptable intubation conditions 60 s after administration. The conditions achieved after 0.6 mg/kg are similar to those after 1.0 mg/kg. These smaller doses are associated with faster twitch recovery and shorter apnea time. IMPLICATIONS: In normal healthy patients, succinylcholine 0.6 mg/kg produces clinical intubation conditions identical to the traditional 1.0-mg/kg dose but is associated with a shorter recovery time.

Adult↗
PubMed2003

Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: In this study, we compare the objective results of uvulopalatopharyngoplasty (UPPP) combined with tongue base radiofrequency reduction (TBRF) with standard UPPP treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). STUDY DESIGN: We conducted a retrospective study of 277 patients who had stage I, II, or III OSAHS based on the Friedman staging system previously presented. METHODS: One hundred thirty-four patients who had treatment with UPPP only were used as a control group. This included 31 patients with stage I, 29 patients with stage II, and 74 patients with stage III OSAHS. An additional 143 patients with Stage II (n = 52) and III (n = 91) OSAHS were treated with combined UPPP and TBRF, initially and followed by additional TBRF treatments (up to 9000 J) as necessary. Subjective results were collected based on questionnaires and the Epworth Sleepiness Scale score for the experimental group, but these subjective measures were not available for the control group. Objective results were compared based on the polysomnographic findings before and after surgery. RESULTS: Subjectively, the study group did extremely well. Based on objective measures of successful treatment, UPPP plus TBRF resulted in a significantly higher percentage of patients who were "cured" of OSAHS compared with the control group. CONCLUSIONS: Stage I patients were usually successfully treated with UPPP only. However, patients allocated to stage II or III will benefit from the addition of TBRF to standard UPPP. Many UPPP-plus-TBRF patients in this study aborted further recommended TBRF treatments after subjective improvement and therefore objective results for this group, although improved in comparison to stage II and III patients treated with UPPP only, may not represent maximal potential improvement.

Adult↗
PubMed2003

Does the choice of intravenous induction drug affect intubation conditions after a fast-onset neuromuscular blocker?

STUDY OBJECTIVES: To compare intubation conditions and hemodynamic effects resulting from thiopental-rapacuronium, propofol-rapacuronium, and etomidate-rapacuronium intravenous (IV) induction. DESIGN: Randomized, blinded study. SETTING: Operating suites of a large university-affiliated medical center. PATIENTS: 60 ASA physical status I and II adult patients without airway abnormalities, who were scheduled for elective surgery requiring endotracheal intubation. Patients were randomly allocated to receive IV thiopental sodium 5 mg/kg (Group 1), propofol 2 mg/kg (Group 2), or etomidate 0.3 mg/kg (Group 3) followed by rapacuronium 1.5 mg/kg. Fifty seconds later, an anesthesiologist, who had no knowledge of the induction drug used, entered the operating room and attempted laryngoscopy and intubation. MEASUREMENTS: Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded. MAIN RESULTS: All patients were intubated within 55 to 70 seconds. Clinically acceptable intubation conditions were not statistically different among the three groups. Moderate tachycardia after induction was seen in all three groups, and blood pressure was significantly lower in Group 2 than in Groups 1 or 3. CONCLUSIONS: Clinically acceptable intubation conditions are similar after either thiopental, propofol, or etomidate when a fast-onset neuromuscular blocking drug (rapacuronium 1.5 mg/kg) is used to facilitate tracheal intubation.

Adult↗
PubMed2003

The relationship of posttetanic count and train-of-four responses during recovery from intense cisatracurium-induced neuromuscular blockade.

UNLABELLED: Posttetanic count (PTC) has been used to quantify intense degrees of nondepolarizing neuromuscular blockade. Our objective in the present investigation was to discern whether PTC correlates with recovery from intense cisatracurium-induced neuromuscular blockade under both inhaled and IV anesthesia. In 60 patients, anesthesia was induced with propofol 2 mg/kg and fentanyl 1.5 micro g/kg IV. Recovery from intense neuromuscular blockade induced by cisatracurium (0.15 mg/kg) was studied in 2 groups. Group 1 (n = 30) had anesthesia maintained with propofol 100-200 micro g x kg(-1) x min(-1) and 60% N(2)O in O(2), whereas Group 2 (n = 30) had anesthesia maintained with isoflurane (end-tidal concentration 0.8%) and 60% N(2)O in O(2). Neuromuscular functions were monitored using acceleromyography. Cycles of posttetanic stimulation were repeated every 6 min with train-of-four (TOF) stimulation in between. Measurement included times to posttetanic responses and to the first response to TOF stimulation (T(1)), as well as the correlation between PTC and T(1). In Group 1, the mean times to PTC(1) and T(1) were 35.6 +/- 7.5 and 46.9 +/- 6.5 min, respectively. Corresponding times in Group 2 were 39.5 +/- 6.8 and 56.7 +/- 5.4 min, respectively. There was a good time correlation, r = 0.919 for propofol (Group 1) and r = 0.779 for isoflurane (Group 2), between PTC and T(1) recovery in both groups. The PTC when T(1) appeared ranged between 8 and 9 in Group 1 and 8 and 14 in Group 2. Conforming to original observations with other neuromuscular blocking drugs, there is a correlation between PTC and TOF recovery from intense cisatracurium-induced neuromuscular blockade allowing better monitoring of this intense degree of blockade during both IV (propofol) and isoflurane anesthesia. IMPLICATIONS: Monitoring posttetanic count during intense neuromuscular blockade allows the clinician to estimate the intensity of the blockade and estimate recovery time. The relationship between posttetanic count and train-of-four recovery from intense cisatracurium-induced neuromuscular blockade was documented under both IV and inhaled anesthesia.

Adult↗