Biomedical subjects

Udi Cinamon

Publications and source records attributed to Udi Cinamon.

9 recordsLinked to original sources

PubMed2006

Modified endoscopic swallowing test for improved diagnosis and prevention of aspiration.

Laryngopharyngeal sensation is important in the normal process of swallowing, it is often impaired after neurological events and it has been common practice in such an occurrence to order non-oral tube feeding to prevent aspiration. This study assesses a novel approach to the evaluation of the laryngopharyngeal sensation that allows for improved triage of aspiration risk and more lenience towards oral feeding. This is a case series with follow-up period ranging from 6 to 24 months. Forty patients with neurological deficiencies were tested by a modified laryngopharyngeal sensation study that included evaluation of both supra and infra-glottis. All patients had impaired supra glottic sensation but had good infra glottic sensation that enabled cough protection. All had received oral feeding. Main outcome measure is incident aspiration pneumonia. Twenty-two patients maintained oral feeding without any evidence of aspiration. Eighteen patients had some aspirations associated with cough, and were maintained on modified oral feeding. Out of these 18 patients, four patients (10% of the entire group) developed aspiration pneumonia. The presented procedure identified patients with impaired supraglottic sensation but preserved good infra glottic sensation. This observation enables safe oral feeding in most patients and therefore offers a better quality of life for these individuals.

Adult↗

PubMed2006

Primary hyperparathyroidism and malignancy: "studies by nature".

The American Food and Drug Administration approval of parathyroid hormone (PTH) administration for osteoporosis as well as the possibility for its future therapeutic applications requires an examination of the suggested association between PTH and cancer, particularly osteosarcomas. The objective was to evaluate such a connection by collecting observational data from two groups of patients, designated as "studies by nature". Cohort 1: Medical records of all patients with primary hyperparathyroidism that were treated in a referral center during a 12-year period were retrospectively reviewed for malignancy before, at the time or after diagnosis. Cohort 2: Records of patients with osteosarcomas that were treated in referral centers during 15 years were retrospectively reviewed for hyperparathyroidism, as indicated by history or laboratory results. There were 582 patients with primary hyperparathyroidism. While 56 (9.6%) had malignancy, 47 (8%) developed cancer after diagnosis with hyperparathyroidism during 6.1 years of documentation. This rate did not exceed the incidence of developing cancer among the general population. Although thyroid cancer was about 4 times the incidence in the general population, this may be attributed to a high level of detection while work-up, treating and following the parathyroid disease. None had osteosarcoma. None of the 126 patients with osteosarcoma had documentation of primary hyperparathyroidism or had biochemical evidence of hyperparathyroidism. No obvious association was found between primary hyperparathyroidism and cancer. Similarly, there was no demonstrable relationship between osteosarcomas and hyperthyroidism biochemical stigmata. Since PTH may contribute to tumor invasiveness, screening for existing neoplasms, especially prostate and breast, before PTH treatment may be of importance.

Adult↗

PubMed2006

Age as a prognostic factor for head and neck squamous cell carcinoma: should older patients be treated differently?

OBJECTIVE: In an aging society, one may expect to encounter more seniors with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to question the appropriateness of feasible aggressive curative treatment for these older patients. DESIGN: A retrospective study. SETTING: A tertiary head and neck surgical oncology service. METHODS: A chart review of patients with HNSCC of the oral cavity, pharynx, and larynx, 75 years or older, who were primarily treated by our service from 1990 to 1999. MAIN OUTCOME MEASURES: Demographics, pretreatment comorbidities and treatment modalities, and their related morbidity and mortality were reviewed. Special attention was given to treatment decision making and long-term outcome. RESULTS: Twenty-six males and 14 females with an average age of 82.2 years were treated. Twenty-two had stage III and IV disease. All had at least one comorbidity. Four patients had palliative radiotherapy and were dead of disease within 6 months. Among the 36 patients who were treated for cure, there were 2 postoperative deaths, 11 recurrences, and 2 cases of distant metastasis. The average lifespan of the 34 survivors (until death or end of study) was 4.7 years. CONCLUSION: HNSCC is a serious disease that often necessitates aggressive treatment. All of the patients who were medically eligible received curative treatment, with age not serving as an exclusion criterion. The average survival almost approached the expected lifespan of a normal cohort (4.7 vs 6.3 years, respectively). Seniors with HNSCC may benefit from curative treatment, and exclusion should be based, as for younger subjects, on an individual basis.

Age Factors↗

PubMed2004

Gas flow into and within the middle ear.

HYPOTHESIS: Both a normal and a narrowed eustachian tube (ET) are capable of equilibrating pressures between the middle ear (ME) and the atmosphere almost instantaneously. OBJECTIVES: The objective of this study was to assess experimentally the effect of narrowing a simulated ET isthmus on air passage into the ME. METHODS: A Perspex ME model (0.5 mL) was constructed in which a 1.5-mm long ET of 0.07- to 1.0-mm diameter and a "mastoid" of 0- to 10-mL volume were changeable. The ET could be opened and closed with a valve. A -5 mm H2O pressure difference between the system and the atmosphere was created by withdrawing gas from the system. The time required to equalize these pressures after opening the valve to the atmosphere were measured with a pressure transducer. RESULTS: A pressure difference of -5 mm H2O was created in the system when 1.3 to 6.5 microL of ME gas was removed. On ET valve opening, the pressure was equalized within 0.1 and 0.15 to 0.3 seconds for ET diameters of 1.00 and 0.07 mm, respectively, depending also on the "mastoid" volume. Similar results were obtained when the pressure was measured through the "tympanic isthmus" and "aditus ad antrum." CONCLUSIONS: Our model shows that under ordinary physiological conditions, the amount of gas that can pass through the ET during swallowing time (0.4 sec) is potentially higher than required to equalize a negative pressure. This is also the case when the ET is very narrow and open for a very short time. It is unlikely that any narrowing of the tube will, by itself, hamper gas transfer into or within the ME, as long as the ET is not totally obstructed.

Cholesteatoma, Middle Ear↗

PubMed2004

Passive and dynamic properties of the eustachian tube: quantitative studies in a model.

OBJECTIVE: To question the conception of Eustachian tube (ET) dysfunction by investigating some of its passive and active properties. BACKGROUND: Middle ear (ME) fluid accumulation accompanied by a negative pressure is generally accepted to be induced by ET dysfunction, implying that the origin of pathology is within the tube. METHODS: Pressure changes were continuously and directly measured in a ME model having human dimensions, constructed with a patent ET, and employing different mastoid sizes. Various liquids were introduced into the ME chamber while maintaining atmospheric pressure. The model was tilted to a 45 degrees angle below the horizon, causing the liquid to block the tympanic inlet of the ET. Then either the ME was opened to the atmosphere (simulating an insertion of a ventilating tube) and the ET was inspected for liquid passage through it, or the cartilaginous ET was compressed and opened, imitating the "pumping" action of the ET at the process of deglutition. RESULTS: ET blockage produced a ME negative pressure in the range of -8 to -10 mm H2O. ET pumping caused a ME pressure change of 2 to 60 mm H2O, a greater change when a smaller mastoid was used. CONCLUSIONS: ET obstruction by intratympanic fluid may cause a negative pressure in an ME having a normal, patent ET. Clearance of such fluid would be facilitated according to its viscosity. The ET pumping mechanism may play a major role in fluid transport and pressure regulation of the ME.

Acoustic Impedance Tests↗

PubMed2004

Exceptionally elevated creatine kinase levels in a laryngectomized patient: hypothyroid myopathy.

We present a laryngectomized patient with unspecific complaints of fatigue whose laboratory findings were out of proportion with the clinical presentation. The enormously high blood levels of creatine kinase (CPK) (8000 IU/l, normal range 30-190 IU/l) and thyroid-stimulating hormone (100 mU/l, normal range 0.5-4.5 mU/l) led to diagnosis and treatment of and recovery from hypothyroid myopathy. Hypothyroidism reduces the ability of the muscle to maintain its adequate energetic economy, via several suggested mechanisms. This may lead to injury (myopathy) that allows enzymes such as CPK to leak out of cells and causes elevation of their serum levels. To our knowledge, this is the first reported case of a patient previously treated for head and neck cancer who developed hypothyroid myopathy, presenting with exceptionally elevated CPK levels. This is noteworthy, since hypothyroidism may be easily avoided by a comprehensive follow-up of patients treated for head and neck cancer.

Adult↗

PubMed2003

Mastoid and tympanic membrane as pressure buffers: a quantitative study in a middle ear cleft model.

HYPOTHESIS: The tympanic membrane (TM) and mastoid air cells are measurable pressure buffers of the middle ear (ME). BACKGROUND: Pressure homeostasis of the ME is maintained approximately atmospheric by mechanisms that neutralize (buffer) pressure fluctuations, two of which are the TM and mastoid. MATERIALS AND METHOD: Negative pressures were induced by volume changes in an artificial ME model. Those were recorded directly while using a rigid or a flexible TM with "mastoids" of various sizes. RESULTS: In the rigid TM model, the volume changes correlated linearly with the induced pressures and were confirmed to fit Boyle's law. In the flexible TM model, the pressure/volume correlation was nonlinear up to -50 mmH2O, where the TM was maximally displaced (approximately 25 mm3), became rigid, and constituted 75%, 41%, and 33% of the buffering gained in tandem with the "mastoid" in a model having a "mastoid" of 0, 5, and 10 mL, respectively. Altogether, a large "mastoid" required a greater volume change than a small one to induce the same pressure. CONCLUSIONS: The mastoid air volume "dilutes" pressure changes relatively to its size: the volume change required to alter a given pressure in an average (6 mL) mastoid is six-fold that which is needed in a small (1 mL) mastoid. ME volume reduction by TM retraction buffer negative ME pressures. This maximal ME volume change is constant for a "normal" TM. Therefore, it is the ME with the small mastoid that is most vulnerable to pressure changes and may develop compensatory buffering mechanisms, e.g., additional TM retraction (atelectasis) and/or ME volume reduction by fluid accumulation.

Acoustic Impedance Tests↗

PubMed2003

Tympanometry versus direct middle ear pressure measurement in an artificial model: is tympanometry an accurate method to measure middle ear pressure?

HYPOTHESIS: Indirect tympanometric pressure measurements of the middle ear (ME) do not correspond to direct pressure measurements. BACKGROUND: Tympanometry is an accepted method for estimating ME pressures. These pressure values are different, however, when measurements are made directly. MATERIALS AND METHODS: Negative pressures were induced by volume changes in an artificial ME model with various "mastoid" volumes. Both tympanometric and direct pressure measurements were obtained simultaneously. RESULTS: A substantial difference was demonstrated between tympanometric and direct pressure measurements. There was a linear correlation between tympanometry and direct pressures between -46.8 and -93.6 mmH2O, with a tympanometric overestimation of 40% to 20%, respectively. The smaller the "mastoid" volume, the greater the overestimation. The correlation was not linear for direct pressures between zero and -46.8 mmH2O. Tympanometric overestimation was greatest (i.e., 4-14-times the actual pressure) in the pressure range between zero and -12 mmH2O. CONCLUSIONS: Tympanometry does not yield precise ME pressure values. In a model with a larger "mastoid" and an actual pressure range of -46.8 to -93.6 mmH2O tympanometric readings are somewhat less unreliable (error of 40%-20%). However, tympanometry is in error of more than 400% in a model with a small mastoid in which the actual ME pressure is only slightly negative (i.e., range between -3.9 and -46.8 mmH2O). Therefore, this study implies that tympanometry has little use for measuring ME pressure especially in chronic ears or their sequelae that are usually characterized by having small negative pressures and small mastoids.

Acoustic Impedance Tests↗

PubMed2002

Neurofibromatosis type 1, hyperparathyroidism, and osteosarcoma: interplay?

Neurofibromatosis type 1 (NF 1) is a syndrome with a predisposition for benign and malignant tumor development. Of the malignant neoplasms, osteogenic sarcomas are rare but have been described. There are some reports of patients with neurofibromatosis type 1 with a parathyroid adenoma and hyperparathyroidism. Also, there are studies that imply that the parathyroid hormone plays a role in the regulation and modulation of oseogenic sarcomas in vitro. We report about a 50-year-old female suffering from neurofibromatosis type 1, with a 3-year documented history of untreated hyperparathyroidism and a parathyroid adenoma. The patient developed a mandibular osteogenic sarcoma. To our knowledge, this is the first reported case occurring in the mandible. The unusual tumor site for a patient with neurofibromatosis type 1, the conjugation with hyperparathyroidism and the rapid growth of an osteogenic sarcoma are intriguing.

Bone Neoplasms↗