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Biomedical subjects

A Komisar

Publications and source records attributed to A Komisar.

At least 37 records · Page 2Linked to original sources
PubMed1993

Ambulatory pH monitoring in the management of reflux.

Ambulatory pH monitoring is a useful tool in the diagnosis and treatment of different esophageal and pharyngeal complaints. We have studied its use in an office setting in 15 patients with suspected gastroesophageal reflux disease (GERD). The patients were monitored for at least 18 hours while wearing a two-channel probe at home. Data obtained confirmed severe GERD in 6 patients and chest pain without GERD in 2 patients. Two patients continued to have symptoms in spite of appropriate therapy, while 2 untreated patients had symptoms of GERD with normal pH studies. We feel this technique is relatively safe and cost-effective and causes minimal disruption of the patient's life-style, while enabling the physician to monitor therapy and help achieve a good therapeutic outcome.

Adult↗
PubMed1991

Head and neck trauma in taxicabs. A growing urban problem.

The passage of mandatory seat belt legislation has markedly decreased the incidence of head and neck trauma to passengers in private automobiles. However, taxicabs are exempt from seat belt laws in many states. Seat belts, which are included as standard equipment by automobile manufacturers, are often made inaccessible by taxicab operators. We present five cases of head and neck trauma sustained by passengers in taxicabs in which seat belts were not accessible. Injuries included laryngeal fractures, maxillofacial trauma, and severe trauma to the cervical spine. All injuries could have been avoided by the use of an accessible safety belt. The nationwide scope of this problem and strategies for modification of existing laws for better protection of passengers in cars for hire are presented.

Accidents, Traffic↗
PubMed1990

Experience with the Wilkie procedure for sialorrhea.

Sialorrhea (drooling) is most commonly seen in children with cerebral palsy or mental retardation. Surgical procedures for the control of sialorrhea include salivary gland excision, parasympathetic nerve section, and salivary duct ligation and/or rerouting. Eighteen children between the ages of 5 and 17 years underwent bilateral submandibular gland excision and rerouting of Stensen's duct (Wilkie procedure). All children had severe drooling associated with cerebral palsy or mental retardation. Follow-up at 7 years showed satisfactory control of sialorrhea in 16 of 18 patients (89%). There was one major complication: xerostomia. Our results indicate that submandibular gland excision together with parotid duct retropositioning provides effective control of sialorrhea in most cases. Unfavorable head and mandibular posturing seemed to cause persistent sialorrhea in one case.

Adolescent↗
PubMed1990

The functional result of mandibular reconstruction.

A study was performed to determine if patients who underwent mandibular reconstruction were functionally rehabilitated. Five parameters were evaluated: deglutition, mastication, cosmesis, diet, and the use of dentures. Deglutition was not improved in patients who had mandibular continuity restored. Problems with deglutition were related to soft tissue resection. Mastication was poorer in the reconstructed group due to scarring, loss of the muscles of mastication, and inhibition of compensatory mandibular motion. Cosmesis was improved in patients who had immediate restoration of mandibular continuity. Cosmesis was not improved in patients with delayed mandibular reconstruction due to previous scarring. Prosthetic rehabilitation was poor in both groups of patients. Reconstructed patients had a greater number of hospitalizations due to management of, or complications from reconstructive surgical procedures. The results of this study suggests that restoration of mandibular continuity does not enhance the functional rehabilitation of the majority of patients with oral-pharyngeal malignancy.

Adult↗
PubMed1989

A critical analysis of immediate and delayed mandibular reconstruction using A-O plates.

Eleven patients who underwent mandibular reconstruction with A-O plates were followed up for as long as 40 months. The patients underwent either immediate or delayed mandibular reconstruction. Nine patients had free cortical bone grafts included in the reconstruction. Complications in patients who underwent immediate reconstruction included loss of the bone graft due to infection, external and intraoral exposure of the reconstruction plate, pain, and infection. In the patients with immediate reconstruction, more than 50% of the bone grafts resorbed. There were less complications and minimal bone graft resorption in patients who underwent delayed reconstruction. The cosmetic results were initially good in both immediate and delayed reconstruction but deteriorated as more surgery was required for management of complications. At 40 months, 7 of 11 patients (5 of 9 with immediate reconstruction) had died of local recurrence, distant metastasis, or another primary tumor. No patients were rehabilitated prosthetically. We conclude that while A-O plating is technically easy and has a low perioperative morbidity rate, the long-term morbidity rate is high. This must be weighed against the benefits of the procedure and the probability that the patients will have a poor functional outcome.

Bone Plates↗
PubMed1989

The histopathologic diagnosis of head and neck tumors by special stains.

Various histochemical and immunocytochemical stains were useful in the diagnosis of six unusual head and neck neoplasms that included spindle-cell squamous carcinoma, synovial sarcoma, mucoepidermoid carcinoma, melanoma, T-cell lymphoma, and B-cell lymphoma. Close cooperation with a pathologist ensured rapid diagnosis and the initiation of appropriate therapy. Three cases required special histochemical stains to make a diagnosis or determined tumor differentiation. The three other cases would have been identified as poorly-differentiated tumors of unknown origin without the use of special immunocytochemical stains. These latter findings influenced our final therapeutic strategy, which emphasizes the uses of special stains and studies to accurately identify tumors of the head and neck.

Adolescent↗
PubMed1989

Nasal obstruction due to benign and malignant neoplasms.

Nasal obstruction can be the first symptom of an obstructing neoplasm originating in the paranasal sinuses, nasopharynx, nasal skin, or nasal chamber. Several standard approaches permit access to these lesions for surgical removal, and these are outlined here.

Airway Obstruction↗
PubMed1986

Sequential methotrexate and 5-fluorouracil with bleomycin and cisplatin in the chemotherapy of advanced squamous cancer of the head and neck.

A bolus intravenous dose of 5-fluorouracil of 600 mg/M2 was added exactly 1 hour after methotrexate administration in an established combination program including bleomycin and cisplatin for advanced squamous cell cancer of the head and neck. Results were no better than those observed previously with the three drugs, and hematologic and mucosal toxicities were slightly worse. The overall response rate was 41% in 34 patients with recurrent or metastatic disease, with only 6% complete remissions. Median time to disease progression for responding patients was 14 weeks, compared with 10 weeks for nonresponders. Partial response had little impact on survival. Among 12 patients with far-advanced disease confined above the clavicles without prior radiotherapy, 9 (75%) achieved partial remission, but the median survival, even with later surgery or irradiation, was only 34 weeks.

Adult↗
PubMed1986

Rhinorrhea and pneumocephalus after cerebrospinal fluid shunting. The role of lateral extensions of the sphenoid sinus.

Pneumocephalus is usually seen after trauma or neurologic surgery. A rare presentation is after cerebrospinal fluid (CSF) shunting for rhinorrhea. This may be a manifestation of shunt malfunction or of the failure to close a preexisting fistulous tract. A common site of failure is the sphenoid sinus, where CSF may leak from a dehiscence in the middle cranial fossa floor. These dehiscences often communicate with lateral extensions of the sphenoid. This complication is best managed by craniotomy with direct inspection of the floor of the middle cranial fossa and correction of deranged CSF dynamics.

Brain↗
PubMed1986

Primary reconstruction of palatal defects.

Removal of the soft palate can cause marked functional deficit in deglutition and phonation. Most commonly, treatment of this deformity with prosthetic obturation has been less than ideal. Numerous reconstructive techniques have met with only partial success, while deforming distant structures. We will present a technique of reconstruction of the soft palate by use of a superiorly based pharyngeal flap. It has been used successfully in five patients who underwent soft palatectomy for malignant disease. The flaps have been the full width of the pharynx and extended down to the esophageal inlet. Viability of the flap is excellent, and the donor site is allowed to heal by secondary intention. Excellent function has been achieved in all cases with no compromise of oncological principles.

Female↗
PubMed1985

Posttraumatic pseudoaneurysm of the extracranial middle meningeal artery.

Pseudoaneurysms of the extracranial arterial tree are uncommon. To our knowledge, four cases of pseudoaneurysm of the internal maxillary artery have been reported, but there have been no reports of pseudoaneurysm of the extracranial segment of the middle meningeal artery. A 15-year-old girl, who suffered a gunshot wound in the right maxillary region, suffered a pseudoaneurysm of the proximal portion of the middle meningeal artery, as shown by carotid angiography six days after injury. The lesion was successfully treated with absorbable gelatin sponge embolization. Treatment of pseudoaneurysms reduces the risk of hemorrhage from subsequent rupture. Although these lesions are amenable to surgery, transvascular embolization or mechanical interruption appears to be simpler and equally effective.

Adolescent↗
PubMed1985

Osteoradionecrosis of the maxilla and skull base.

Osteoradionecrosis of the maxilla and base of skull are rare phenomena, usually seen after combined therapy for malignancies of the maxillary sinus. While the mandible is most commonly affected by osteoradionecrosis, the maxilla and skull base may also be affected when preoperative or postoperative radiotherapy is combined with surgery. Contributing factors may be: high radiation dosage delivered to the treatment volume (greater than 6000 rads), loss of tissue protective effects due to surgery, decreased vascularity caused by surgery and radiation, and proximity of a contaminated field. Onset of symptoms may vary. One patient presented 25 years after postoperative radiotherapy. Major symptoms were pain, trismus, and purulent discharge. The best diagnostic modality remains the history and physical exam, as the area is readily accessible. CT scans may be helpful in diagnosis and treatment planning. Therapy should follow time honored principles of local wound care. Home irrigations and hyperbaric therapy have been helpful in encouraging early sequestration and rapid healing.

Bone Diseases↗