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Biomedical subjects

Timothy J Martin

Publications and source records attributed to Timothy J Martin.

9 recordsLinked to original sources
PubMed2007

Autonomic nervous system evaluation in allergic rhinitis.

OBJECTIVES: To evaluate the relationship between allergic rhinitis (AR) and autonomic nervous system (ANS) dysfunction. METHODS: Quantitative ANS testing was completed in 10 patients with AR confirmed by clinical findings and allergy testing. This data was compared to 16 age-matched controls. RESULTS: ANS scores were significantly abnormal in AR patients when compared to normal controls. The composite autonomic scale score for the AR group was significantly impaired when compared to controls (1.6 vs 0.63, P < 0.0001). Additionally, subscore values quantifying the level of dysfunction within the sympathetic nervous system (1.0 for sudomotor and 0.5 adrenergic) were found to be significantly different (P < 0.0001 and 0.018). The mean subscore value quantifying the level of dysfunction within the parasympathetic system (cardiovagal) was not found to be significantly different from controls (P = 0.38). CONCLUSIONS: ANS dysfunction, specifically sympathetic hypofunction, was identified in all of the allergic rhinitis patients studied. Further characterization of the type of ANS abnormality may allow the development of novel pharmacologic therapies for these disorders.

Adult↗
PubMed2007

Endoscopic CSF leak repair.

PURPOSE OF REVIEW: The purpose of this review is to discuss endoscopic management of cerebrospinal fluid leaks and to highlight recent advances in both outcomes and technique. RECENT FINDINGS: Endoscopic techniques targeting the repair of skull-base defects have evolved as instrumentation for intranasal use has developed. The principles of endoscopic repair mirror those of open repair, with emphasis placed on site identification, site preparation, accurate graft placement and postoperative management. Several patient factors will affect the surgical and medical care of patients with cerebrospinal fluid rhinorrhea, including location, cause and overall medical condition. Numerous techniques have been described and large series attest to high success rates. The use of radiographic image-guidance systems promises to advance localization of the leak site. Endoscopic repair of cerebrospinal fluid leaks remains an accurate and complete method for the repair of cerebrospinal fluid leaks with decreased operative morbidity. SUMMARY: Endoscopic repair of anterior skull-base defects has a high success rate and markedly decreased morbidity as compared with traditional intracranial approaches. The endoscopic approach should be considered the technique of choice for repair of most cerebrospinal fluid fistulae and skull-base defects.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2006

Patients undergoing sinus surgery: constructing a demographic profile.

OBJECTIVES: The objective of this study is to construct an accurate and representative demographic profile of patients undergoing sinus surgery for chronic rhinosinusitis (CRS). This will enable future studies to enroll representative samples so that results can be more easily compared across studies and generalized to the U.S. population. METHODS: The investigators interrogated the databases of the National Survey of Ambulatory Surgery to gather demographic data. Whenever the NSAS provided incomplete characterization, deficiencies were corrected using state-level data provided by the Health care Cost and Utilization Project. The constructed profile was compared with available profiles of patients with CRS and demographic data provided by the U.S. Census Bureau. RESULTS: The demographic profile of patients undergoing sinus surgery is 52.7% female with a mean age of 38.5 years. A total of 93.5% of surgery is performed on an outpatient basis with 78.8% of patients having private insurance sources. No significant difference in occurrence of surgery was found between months of the year or between regions of the country. The constructed race profile is 85.7% white, 5% black, 1.2% Asian/Pacific Islander, 0.2% Native American, and 7.8% other. CONCLUSIONS: A novel integration of national and state databases can be used to create a demographic profile of patients undergoing surgery for CRS. The creation of this profile enables further study of representative populations of patients with CRS and enables thoughtful analysis of the existing literature. The difficulty in creating the profile highlights the need for complete and accurate healthcare information collection by national and state agencies.

Adolescent↗
PubMed2006

Arteriovenous fistula of the lower lip: case report of combined intravascular and surgical cure.

PURPOSE: We describe a patient presenting with a vascular mass of the lower lip with a history of traumatic lip-biting. The lesion was treated with preoperative intravascular embolic therapy and surgical excision. SUMMARY: Arteriovenous fistula (AVF) of the head and neck are vascular lesions with a single connection between the involved artery and vein. Trauma to the area, often in the distant past, is often seen as the inciting event. We describe a patient with a lower-lip AVF with repeated episodes of lip biting that caused expansion of the mass. The patient underwent preoperative embolic therapy and surgical excision with excellent functional and cosmetic outcome. CONCLUSION: Arteriovenous fistula of the lower lip can be successfully managed with preservation of lip function and cosmesis through combined intravascular and surgical therapy.

Adult↗
PubMed2005

Fungal causes of otitis externa and tympanostomy tube otorrhea.

OBJECTIVE: To describe the occurrence of fungal organisms in the setting of otitis externa and tympanostomy tube otorrhea, review the treatment course, timing of diagnosis, organism identified and time to resolution with fungal infections. DESIGN: Retrospective review. SETTING: Pediatric otolaryngology clinic within a tertiary care hospital. PATIENTS: One hundred and sixty-six patients (ages 16 days to 18 years) with fungal organisms on ear culture. OUTCOME MEASURES: Number of prior therapies, number of office visits, time to resolution and anti-fungal therapy. RESULTS: Ear cultures positive for fungal organisms were found in 166 patients seen between 1 January 1996 and 30 September 2003 from a total of 1242 patients undergoing ear culture. Comparing the 3-year period (1996-1998) prior to the availability of fluoroquinolone ototopical drops to the 3-year period after (1999-2001), there is a statistically significant increase in the incidence of positive fungal culture (p<0.001). Otitis media was diagnosed in 72% of these children, with otitis externa comprising 25%. Approximately 3% carried a diagnosis of both otitis externa and otitis media. Candida albicans was identified in 43% of fungal organism-positive cultures. Candida parapsilosis was found in 24% of and Aspergillus fumigatus in 13%. The remainder of the cultures yielded three other Candida and three other Aspergillus species, each at less than 5%. Time to resolution ranged from 1 week to 9 months, with a median of 3.8 weeks for symptom resolution. Patients were treated with an average of 1.7 oral antibiotics and 1.1 ototopical agent before a culture was taken. CONCLUSIONS: Otorrhea due to fungal organisms occurs in the setting of refractory infection and is often discovered after multiple oral and ototopical antibacterial medications. Due to the extended treatment period required to clear fungal organism, timely diagnosis with culture for bacteria and fungus is required in patients with persistent otorrhea. An increase in incidence of fungal infections of the ear was found in the period after widespread use of ofloxacin began.

Adolescent↗
PubMed2002

Mediators of adenosine- and ovalbumen-induced bronchoconstriction of sensitized guinea-pig isolated airways.

The mediators of bronchoconstriction of isolated lungs and trachea from ovalbumen sensitized guinea-pigs to adenosine and ovalbumen were examined using relevant antagonists. Changes in perfusion pressure and tension of paired lung halves and tracheal spiral strips, respectively, were recorded in response to adenosine (1 mM lung, 300 microM trachea), histamine (10 microM), methacholine (10 microM) and ovalbumen (10 microg). One half was perfused with antagonist while the other received vehicle. Tracheal strips were superfused throughout with the P(1) receptor antagonist 8-phenyltheophylline, to examine 8-phenyltheophylline-resistant responses. The histamine H(1) receptor antagonist, mepyramine (1.5 mM), the cyclooxygenase inhibitors, indomethacin (5 mM) and diclofenac (5 mM), the leukotriene receptor antagonist, zafirlukast (1 mM), and the lipoxygenase inhibitor, zileuton (20 mM), alone failed to inhibit bronchoconstriction by adenosine and ovalbumen of the lung and trachea. When two antagonists were combined, only mepyramine and zafirlukast significantly reduced the lung responses to adenosine and ovalbumen. The tracheal adenosine response was substantially reduced, although not significantly, while ovalbumen was significantly reduced. When mepyramine, indomethacin and zafirlukast were combined, the lung constriction by adenosine and ovalbumen were virtually abolished. Similarly, the combination of mepyramine, diclofenac and zafirlukast significantly attenuated the lung responses to adenosine and ovalbumen. Thus, histamine, cyclooxygenase products and leukotrienes alone are not responsible for the bronchoconstriction of isolated sensitized lung tissues to adenosine or ovalbumen, which appears to be due to the release of all three mediators.

Adenosine↗
PubMed2002

Evaluation and surgical management of isolated sphenoid sinus disease.

OBJECTIVES: To evaluate the pathologic conditions, preoperative evaluation, treatment, and clinical outcomes associated with sphenoid sinus disease. DESIGN: Retrospective study. SETTING: Tertiary university-based referral center. PATIENTS: All patients with isolated sphenoid sinus disease managed surgically or in which surgery was considered a primary treatment option. MAIN OUTCOME MEASURES: Demographic data, presenting signs and symptoms, endoscopic and imaging findings, surgical management, surgical pathology, and clinical outcomes were investigated in patients presenting with sphenoid sinus disease to the Medical College of Wisconsin, Milwaukee, between January 1, 1991, and December 31, 2001. RESULTS: The study population included 17 women and 12 men with a mean age of 52.3 years (range, 15-82 years). The most common presenting symptom was headache (20 patients [69%]). Imaging evaluation included computed tomography and/or magnetic resonance imaging studies in all cases. Sphenoid sinus abnormality was variable and included sinusitis (11 patients [38%]), tumor (7 [24%]), mucocele (5 [17%]), fungal process (3 [10%]), and cerebrospinal fluid fistula (3 [10%]). Twenty-one cases (72%) were managed endoscopically and 4 (14%) were managed with a transseptal approach. One patient (3%) underwent combined extracranial-endoscopic transnasal approach, while another (3%) underwent a midface degloving approach. The remaining 2 patients (7%) did not undergo surgical intervention. CONCLUSIONS: Given the high prevalence of noninflammatory lesions within the sphenoid sinus, thorough preoperative evaluation is imperative. Initially, this should include nasal endoscopy and computed tomography to help define the location, extent, and character of the lesion. In some cases, magnetic resonance imaging may help further define the nature and extent of a lesion. Angiography should be considered if a vascular lesion is suspected. The clinical and imaging findings should all be taken into consideration when the surgical approach is planned.

Adolescent↗
PubMed2002

Contractile responses to adenosine, R-PIA and ovalbumen in passively sensitized guinea-pig isolated airways.

1. Responses to adenosine, R-PIA and ovalbumen were examined in guinea-pig isolated superfused tracheal spirals to determine the effects of passive sensitization by overnight incubation in serum from ovalbumen (OA)-sensitized or non-sensitized guinea-pigs. 2. Tissues incubated with serum from non-sensitized and OA-sensitized guinea-pigs contracted (0.07+/-0.02 and 0.04+/-0.01 g, respectively) to adenosine (300 micro M) whereas non-incubated or Krebs-incubated tissues produced no contractions to adenosine or ovalbumen (10 micro g). Ovalbumen caused substantial contractions (0.40+/-0.09 g) after OA-sensitized serum incubation and significantly (P<0.05) smaller contractions (0.08+/-0.03 g) after non-sensitized serum incubation. Tracheae from guinea-pigs actively sensitized to ovalbumen 14-21 days beforehand also contracted to adenosine, R-PIA (3 micro M) and ovalbumen. 3. The A(1)/A(2) adenosine receptor antagonist, 8-phenyltheophylline (8-PT, 3 micro M), failed to antagonize these contractions, suggesting that A(1)/A(2) adenosine receptors were not involved. 4. Unlike adenosine, R-PIA (3 micro M) produced contractions in non-incubated (0.23+/-0.04 g) or Krebs-incubated (0.15+/-0.04 g) tracheae, as well as after passive and active sensitization. None of these responses were blocked by 8-PT. 5. The A(3) receptor agonist, IB-MECA, in the presence of 8-PT produced small contractions in passively sensitized tracheae (10 micro M, 0.02+/-0.003 g) and, in larger doses (100 micro M and 1 mM), contracted actively sensitized tracheae. 6. In actively sensitized trachea, the A(3) receptor antagonist, MRS-1220 (100 nM), significantly (P<0.05) attenuated adenosine contractions in the presence of 8-PT from 0.23+/-0.07 g to 0.07+/-0.03 g. 7. These results show that passive, like active sensitization, reveals bronchoconstrictions to adenosine of isolated tracheae. The insensitivity to 8-PT blockade, the antagonism by MRS-1220, and the fact that the A(3) receptor agonist, IB-MECA, mimics this response, suggest involvement of A(3) receptors. R-PIA, however, has a different profile of adenosine receptor activity.

Adenosine↗