Acquired partial nasolacrimal obstruction due to a suture stent following esophagocolostomy.
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Colostomy↗
Biomedical subjects
T V McCaffrey
Publications and source records attributed to T V McCaffrey.
Glottographic analysis of phonation in the excised canine larynx.
An excised canine larynx model of phonation was developed to assess the effect of vocal fold length and tension on glottographic waveforms. The canine larynx in an experimentally produced phonatory model vibrated in a two-mass system comparable to human voice production. The recorded glottographic waveforms for the excised canine larynx were similar to signals recorded in humans in the chest register. Vocal fold length, longitudinal vocal fold tension, glottic width, and airflow rate were varied while simultaneous measurements were made of the subglottic pressure, electroglottographic signal, photoglottographic signal, and acoustic signal. The model used is illustrated and discussed, with emphasis on the method of simulating the actions of all of the intrinsic laryngeal muscles, including the thyroarytenoid muscles. The open quotient and speed quotient, calculated from the glottographic signals, were dependent on vocal fold length and tension and glottic width. These results suggest that glottographic analysis, particularly speed quotient and open quotient, provide valuable information on vocal fold vibration during phonation, and may be important in assessing laryngoplasty procedures.
Animals↗
Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis.
Klebsiella ozaenae is a gram-negative rod that has been isolated with relative frequency from patients with atrophic rhinitis. The relationship of this bacterium to the pathogenesis of atrophic rhinitis is not understood, and whether this bacterium is simply an opportunistic colonizer of the injured nose or the etiologic agent of the disease is unclear. This study was designed to investigate a potential role for bacterially produced cilioinhibition as a mechanism for the pathogenesis of atrophic rhinitis.
Cilia↗
Allergic fungal sinusitis secondary to dermatiaceous fungi--Curvularia lunata and Alternaria.
Allergic fungal sinusitis is a newly recognized entity consisting of a pansinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinosinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific fungal antigens. Here we present two cases of allergic fungal sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic fungal sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic fungal sinusitis have appeared in the literature. Diagnostic criteria for allergic fungal sinusitis include radiologic evidence of pansinusitis in an atopic individual; findings at surgery of allergic mucin; positive fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic fungal sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
Adolescent↗
Measurement of human nasal ciliary motility using computerized microphotometry.
A new computerized technique for the assessment of human nasal ciliary beat frequency is described. Thirty normal volunteers underwent nasal cytologic brushing to obtain ciliary samples. In each subject, 150 ciliary beats were analyzed from each of 50 separate ciliated cell clusters. The ciliary beat frequency for each area was determined with fast Fourier transformation. The results were plotted on a histogram to determine the ciliary beat distribution. The mean frequency for these samples was 11.29 Hz, with a standard deviation of 0.96 Hz. The median frequency for these samples was 11.25 Hz. These results show a marked improvement over hand-counting microphotometry techniques because of the much larger sampling size and elimination of much human error. We believe this method of ciliary analysis represents a significant advancement in the evaluation of ciliary function and should assist in the diagnosis of patients with congenital and acquired forms of ciliary dysmotility.
Body Temperature↗
Rhinolift operation in the treatment of the aging nose.
Disturbance of the normal relationship between the caudal border of the upper lateral cartilage and the cephalic margin of the lobular cartilage--the so-called "cul-de-sac" area--can result in alar collapse and nasal airway obstruction. This may be caused by either the aging process or trauma, both surgical and nonsurgical. Rhinolift is a surgical procedure that was developed for the treatment of the aging ptotic nasal tip. We have applied this technique to patients with nasal airway obstruction resulting from alar collapse. Elevation of the cephalic margin of the lobular cartilage to a position superficial to the upper lateral cartilage restores the normal relationship between these two structures. The upper lateral cartilage then assists in stenting the vestibule open, and thereby improves nasal breathing. Over the past 10 years, 20 patients have had rhinolifts at our institution for the relief of nasal airway obstruction. Concomitant surgery included nasal septal reconstruction in 12 patients, polypectomy in one patient, and placement of a silicone rubber septal prosthesis for closure of a large septal perforation in three patients. Rhinolift was the sole procedure used for the correction of valvular pathology in 10 patients. The other 10 patients had modifications made in their upper lateral cartilage along with the rhinolift. Five patients described restoration of normal nasal breathing, while 14 patients showed partial symptomatic improvement. One patient reported no improvement in nasal breathing. Rhinolift is a safe effective surgical technique for functional improvement of nasal breathing in patients with alar collapse resulting from inadequate cartilaginous support.
Adult↗
Third place--Resident Clinical Science Award 1990. The in vivo and in vitro effect of phenylephrine (Neo Synephrine) on nasal ciliary beat frequency and mucociliary transport.
Twenty volunteers with normal noses were studied to determine the effect of phenylephrine on nasal ciliary function. In vivo study of this drug was performed in 15 patients and revealed a significant increase in their ciliary beat frequency from a control of 11 Hz to 12.03 Hz (p = 0.001). Mucociliary transit times in these volunteers were also studied, revealing a mean of 9.9 minutes prestimulation and 10.2 minutes poststimulation, which was not statistically significant (p = 0.77). Five additional subjects donated ciliated mucosal samples for in vitro analysis of varying concentrations of this agent that showed a significant ciliostimulatory effect at lower concentrations (0.01%), with a progressive cilioinhibitory effect at higher concentrations (0.25%, 0.5%). The 0.05% concentration showed no significant change in ciliary activity compared to control measurements. These data demonstrate that phenylephrine has a ciliostimulatory effect in vivo, as well as in appropriate concentrations in vitro, and should be safe and relatively nontoxic to the mucociliary apparatus for short-term use.
Awards and Prizes↗
Phonatory vocal fold function in the excised canine larynx.
The development of valid objective measurements of vocal cord vibration during phonation is a goal of current research in laryngeal physiology. An excised canine larynx was used to study the effects of vocal cord tension, air flow rate, and glottic width on glottographic parameters. The electroglottographic and photoglottographic wave-forms were simultaneously recorded as the vocal cord tension, glottic width, and air flow rate were systematically varied. These glottographic waveforms were analyzed to determine the open quotient and speed quotient. Multiple regression analysis of the data obtained from 10 larynges showed the open quotient to be directly related to vocal fold tension (p less than 0.001), glottic width (p less than 0.01), and fundamental frequency (p less than 0.001). Speed quotient was inversely related to glottic width and and subglottic pressure (p less than 0.05). Regression analysis also showed frequency of vibration to be directly related to tension (p less than 0.001) and inversely related to glottic width (p less than 0.001), with different combinations of glottic tension and width capable of producing the same frequency. The open and speed quotients thus reflect the changes in the vibratory patterns of the vocal folds produced by alterations in tension and width. The clinical implications of these results will be discussed, with emphasis on glottography as an objective assessment of the various laryngeal framework procedures being performed.
Air↗
Thyroid carcinoma invading the upper aerodigestive system.
Well-differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs it is the source of significant morbidity and excess mortality. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus, which can produce symptoms of airway insufficiency, dysphagia, and hemoptysis. Locally invasive thyroid carcinoma can often be successfully treated while preserving function of the upper airway. If the tumor involves only the wall of the larynx or trachea without intraluminal extension, "shaving" the tumor from the trachea or larynx will produce local control rates comparable to more radical and destructive procedures. Intraluminal extension is a more serious problem that usually requires resection of a portion of the aerodigestive tract. Even in this situation, partial laryngeal or tracheal resection with preservation of function might be possible and should be used. Adjuvant therapy using radioiodine or external beam radiotherapy should be considered an integral part of any treatment plan for these tumors. These modalities will significantly reduce the rate of local recurrence and control symptomatic local disease.
Adenocarcinoma↗
Superior and transantral orbital decompression procedures. Effects on increased intraorbital pressure and orbital dynamics.
Eight superior and eight transantral decompressions were performed in 16 fresh cadaver orbits in which intraorbital pressure was experimentally increased by adding 12 mL of volume to an intraorbital balloon. Each decompression yielded a mean pressure decrease of 225 mm Hg (85% of the total) in experimentally induced intraorbital pressure. The maximal pressure decrease occurred after the removal of the first complete orbital wall. However, incision of the periorbita was most effective in achieving globe recession and a decrease in exophthalmos. Although the steps of the superior and transantral decompression techniques are not comparable, there was no statistically significant difference between the total net pressure decreases achieved.
Biomechanical Phenomena↗
Unsuspected foreign body in the frontal sinus and anterior cranial fossa.
We present the case of a 46-year-old man who was involved in a motor vehicle accident in which his forehead struck the dashboard of his semi-tractor trailer. A toggle switch penetrated the anterior and posterior tables of his frontal sinus and lodged in the frontal lobe. The foreign body was not found on physical examination at an emergency care facility. The wound was closed, and the patient was sent home. Severe headaches prompted his return the next day. Skull roentgenograms showed the toggle switch, and the patient was referred to our institution for definitive care. This unusual case serves to emphasize the potential for a foreign body to penetrate the frontal sinus with few physical findings.
Accidents, Traffic↗
Sectional anatomy of the larynx: implications for the transcutaneous approach to endolaryngeal structures.
A transcutaneous, transcricothyroid membrane approach to endolaryngeal structures is used for several techniques such as placement of electrodes for laryngeal electromyography and transcutaneous Teflon injection of the paralyzed vocal fold. The purpose of this study is to examine the sectional anatomy of the larynx with respect to the cricothyroid membrane and describe a suitable transcutaneous approach to endolaryngeal structures. Sixteen whole organ cadaveric larynges were frozen in clear gelatin to facilitate sectioning. Specimens were sectioned in the transaxial, sagittal, and coronal planes as well as 30 degrees, 45 degrees, and 60 degrees from the transaxial plane. For clinical orientation, the transaxial plane was defined as 90 degrees from the most anterior plane of the cricothyroid membrane. Sections were examined and angles and depths of penetration were measured with respect to the transcutaneous approach to endolaryngeal structures.
Female↗
Repair of motor nerve defects: comparison of suture and fibrin adhesive techniques.
Two groups of rats were used to evaluate the results of nerve repair using fibrin tissue adhesive. In one group of 10 rats, a simple neurotomy of the sciatic nerve was performed. In the second group of 10 rats, a 1-cm segment of sciatic nerve was excised bilaterally and used as an autogenous nerve graft. The neurotomy and the nerve graft were repaired on one side by microsurgical suture technique using 10-0 nylon suture. The opposite side was repaired using fibrin adhesive. The results of the repair were assessed at 12 weeks. Functional assessment of nerve regeneration was performed in those rats with intact repair sites. Nerve-muscle twitch strengths were not significantly different (p greater than 0.05) between nerves repaired using suture and fibrin adhesive; however, compound active potential parameters were significantly better in nerve grafts repaired using suture technique (p less than 0.05).
Animals↗
Rhinomanometry for preoperative and postoperative assessment of nasal obstruction.
In this retrospective study we used active, anterior mask rhinomanometric methods to measure nasal resistance before and after surgery for nasal obstruction. The study group comprised 60 patients with nasal obstruction who had 63 preoperative and postoperative rhinomanograms and the control group contained 14 asymptomatic patients who underwent rhinomanometric studies before transnasal, transsphenoidal pituitary surgery. Before surgery the study group had significantly higher total and combined unilateral nasal resistances than either the control group before surgery (p less than 0.05 and p less than 0.01, respectively) or the study group after surgery (p less than 0.0001 for both comparisons). Surgery normalized the nasal resistances of the study group in relation to the control group. A total nasal resistance greater than 1 cm H2O/L/sec or a unilateral resistance greater than 3.5 cm H2O/L/sec suggests clinically significant nasal obstruction. Airway narrowing and obstructive symptoms correlated with airway resistance in the preoperative patient, but symptoms did not correlate well with postoperative resistance.
Adolescent↗
Space-occupying orbital lesions: can critical increases in intraorbital pressure be predicted clinically?
Thirteen cadaver orbits were studied to determine whether noninvasive clinical measurements of globe excursion could be used to predict intraorbital pressure. Intraorbital pressure measurements, exophthalmometry, and orbitonometry (which measures resistance to globe retrodisplacement) were performed at 1-ml increments to 12 ml of added orbital volume. Orbitonometry, performed with forces of 100, 200, and 300 g, yielded both E (global position) and Y (retrodisplacement) values. Plots of orbital pressure against percentage of excursion, a function of orbital retrodisplacement (that is, orbital pressure versus [(E0 - E300)/E0] x 100), for 131 paired values over all orbits yielded a function with low percentage of excursion values associated with high intraorbital pressures. This relationship reflected both the proptosis and the increased orbital tension produced by added volumes. Comparison of clinical orbitonometry data with such experimental data may allow predictions about which patients are threatened by critical intraorbital pressure levels and may benefit from orbital decompression surgery to preserve vision.
Adult↗
Substance P and nasal secretion in dog, rat, and man.
The effect of substance P (SP) on nasal secretion was studied in dog, rat, and man. Substance P was administered topically by the use of filter papers that had been soaked with an aqueous solution of SP and dried. The SP-containing filter paper strips were applied to the nasal mucosa for five minutes. The secretion was absorbed onto the filter papers. The strips were weighed before and after the experiment. Substance P induced atropine-resistant nasal secretion in a dose-dependent manner in anaesthetized dogs and rats. In man, SP failed to evoke nasal secretion in the doses applied. Systemic effects limited the dose that could be given to man. When exposed to nasal secretions SP was rapidly degraded. This may explain the failure of SP to evoke nasal secretion in man.
Animals↗
Fungal mastoiditis in the immunocompromised host.
An immunocompromised patient is subject to unusual, severe opportunistic infections. We report a case of Aspergillus fumigatus mastoiditis in a patient with leukemia who also had cryptococcal meningitis. A fatal outcome ensued, despite extensive surgical and antimicrobial intervention.
Aged↗
The effects of sinus bacteria on human ciliated nasal epithelium in vitro.
The mechanisms by which bacteria colonize and damage ciliated epithelium are important in understanding the pathophysiology of rhinitis, sinusitis, and otitis. Bacteria that have the ability to impair mucociliary clearance would be at an advantage in establishing infection of ciliated surfaces. This study investigates the effect of Hemophilus Influenzae, Streptococcus pneumoniae, Branhamella catarrhalis, and Staphylococcus epidermidis on the ciliary activity of normal ciliated nasal epithelium in human beings. Ciliary activity of the nasal epithelium in the presence of each pathogen was assessed for more than 240 minutes with a photometric method of ciliary beat frequency (CBF) measurement. H. influenzae exerted significant effects on ciliary activity, with a 46% decrease in the CBF by 4 hours (with bacteria-containing broth) and a 32% decrease with bacteria-free filtrate. S. epidermidis decreased CBF by 44% with the bacterial broth. A sterile cell-free filtrate had no significant effect. S. pneumoniae and B. catarrhalis had no significant effect on CBF within a 240-minute period. H. influenzae and S. epidermidis disrupted normal synchronous ciliary motion, causing adjacent cilia to beat at different rates.
Bacterial Physiological Phenomena↗