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Biomedical subjects

D Ophir

Publications and source records attributed to D Ophir.

At least 19 recordsLinked to original sources
PubMed2001

Laser-assisted uvulopalatoplasty for snoring: medium- to long-term subjective and objective analysis.

OBJECTIVE: To assess the subjective and objective medium- to long-term results of laser-assisted uvulopalatoplasty for snoring. DESIGN: A nonrandomized, prospective, before-after trial. SUBJECTS AND INTERVENTIONS: Fourteen patients underwent laser-assisted uvulopalatoplasty surgery; 2 surgical techniques, which differ with respect to the mode of midline palatal vaporization, were used. MAIN OUTCOME MEASURES: Subjective analysis included a preoperative and 2 postoperative evaluations of the state of snoring: 4 weeks and 10.1 +/- 7.9 months (mean +/- SD) after completion of last laser treatment. In addition, a score on 5 other sleep-related symptoms was recorded before treatment and after 10.1 +/- 7.9 months; at that time, patients also estimated their overall satisfaction with the procedure. Objective analysis included preoperative nocturnal polysomnographic studies that were repeated postoperatively. RESULTS: A decline in snoring improvement from 79% (11/14) to 57% (8/14) was recorded; furthermore, state of snoring worsened from 7% (1/14) to 21% (3/14). Likewise, reevaluation of the 5 other sleep-related symptoms at the final follow-up visit uncovered a 57% improvement rate. Overall satisfaction with the procedure was 43%. The results of the postoperative objective studies corresponded to those of the subjective ones and demonstrated significant worsening of respiratory disturbance index in 3 (21%) of the 14 patients, who became mildly apneic. These findings were encountered with both laser techniques. CONCLUSIONS: The favorable subjective short-term results of laser-assisted uvulopalatoplasty deteriorated with time. In addition, postoperative nocturnal polysomnography showed that the procedure caused mild obstructive sleep apnea in a considerable number of patients who formerly were nonapneic snorers. These findings may be related to velopharyngeal narrowing and progressive palatal fibrosis, caused by the thermal damage inflicted by the laser beam.

Adult↗
PubMed2001

Acute mastoiditis--the antibiotic era: a multicenter study.

OBJECTIVES: To evaluate the clinical course and identify the causative organisms of acute mastoiditis in a community where most of the patients who develop acute otitis media are treated with antibiotics. METHODS: A multicenter retrospective review of a series of 223 consecutive cases of acute mastoiditis. SETTING: Nine secondary or tertiary academic or non-academic referral centers. RESULTS: Prior to the diagnosis of acute mastoiditis, 121 of the patients (54.3%) had been receiving oral antibiotic treatment for acute otitis media for periods ranging from 1 to 21 days (mean 5.3 days). Samples for bacterial culture were obtained from 152 patients. Cultures were negative in 60 patients. The organisms isolated in the 92 positive cultures were: Streptococcus pneumoniae (15 patients), Streptococcus pyogenes (14 patients), Staphylococcus aureus (13 patients), Staphylococcus coagulase negative (three patients), Pseudomonas aeruginosa (eight patients), Haemophilus influenzae (four patients), Proteus mirabilis (two patients), Escherichia coli (two patients), Klebsiella pneumoniae (one patient), Enterobacter (one patient), Acinetobacter (one patient), anaerobic gram-negative bacilli (one patient), and fungi (two patients). Ten patients had mixed flora. Sixteen patients presented with complications (cerebellar abscess, perisinus empyema, subdural abscess or empyema, extradural abscess, cavernous sinus thrombosis, lateral sinus thrombosis, bacterial meningitis, labyrinthitis, petrositis, or facial nerve palsy). CONCLUSIONS: Antibiotic treatment cannot be considered an absolute safeguard against the development of acute mastoiditis. Early myringotomy for acute otitis media seems to decrease the incidence of complications. The distribution of causative organisms in acute mastoiditis differs from that in acute otitis media. Intracranial complications in acute mastoiditis are not rare. Because of the diversity of causative organisms in acute mastoiditis and the growing resistance of bacteria to the various antibiotics, all means to obtain a sample for culture prior to antibiotic treatment, including general anesthesia.

Acute Disease↗
PubMed2001

Long-term histologic effects of inferior turbinate laser surgery.

OBJECTIVE: In this study we sought to define the histologic changes produced by laser treatment of inferior turbinates. STUDY DESIGN: Eight inferior turbinates with prior laser treatment (mean, 26.8 months) were analyzed by light microscopy after turbinectomy for relief of refractory nasal obstruction. Histologic findings were compared with those of a group of 8 hypertrophic inferior turbinates that had no previous laser surgery. RESULTS: Laser-treated areas of the inferior turbinates demonstrated a histologically bland appearance, with marked diminution of seromucinous glands and relative preponderance of connective tissue matrix. Prominence of venous sinusoids was also significantly reduced in the laser-treated areas. Surface epithelium including goblet cells was reconstituted over the areas of laser application. CONCLUSION: Clinical laser surgery of the inferior turbinate produces striking long-term histologic changes. SIGNIFICANCE: The data suggest a differential response of turbinate histologic components to application of laser energy, with the glandular component being particularly sensitive. Further correlative study is needed to clarify the clinical significance of laser-induced histologic changes in inferior turbinates.

Adolescent↗
PubMed2001

Frontal and lateral cephalometry in patients with sleep-disordered breathing.

OBJECTIVES/HYPOTHESIS: The traditional lateral-view cephalometric analysis is limited because it provides only two-dimensional analysis of the three-dimensional craniofacial structure. The objectives were to analyze lateral and frontal cephalometric radiographs in a series of normal patients and those with varying degrees of sleep-disordered breathing and to define the degrees of narrowing or other unfavorable anatomical changes that might differentiate the patients with sleep-disordered breathing from normal subjects. STUDY DESIGN: A prospective study of 100 adult patients with sleep-disordered breathing and 60 age-matched normal subjects. METHODS: An analysis of the lateral and frontal cephalometric measurements was performed to assess velopharyngeal anatomical features. A comparison was made between the patients' polysomnographic and cephalometric analyses. RESULTS: The compromised cephalometric parameters that may be found in patients with sleep-disordered breathing include acute skull-base and bony nasopharynx angles, inferior hyoid position, thickening of the velum, reduced retrovelar posterior air space along with thickening of the velum, thickening of the posterior pharyngeal wall, and narrowing of the velopharyngeal lumen. Worsening of sleep-disordered breathing was generally associated with increased numbers of compromised cephalometric parameters. As body mass index increases, there is reduced velopharyngeal width, the velum thickness is increased, and the posterior pharyngeal wall thickness is increased. CONCLUSIONS: Sleep-disordered breathing is associated with statistically significant changes in a number of cephalometric measurements. Frontal cephalometric analysis adds further information regarding the anatomical assessment of patients with upper airway obstruction, enhancing the traditional lateral cephalometric view.

Body Mass Index↗
PubMed2000

[Tracheoesophageal puncture after total laryngectomy: follow-up of healing procedure].

Total laryngectomy due to malignant laryngeal tumors is followed by loss of speaking ability. Voice restoration in laryngectomized patients is the main target in their rehabilitation. Until the late 70's, esophageal speech was considered the most effective rehabilitation method. In 1980 Singer and Blom introduced a prosthesis for tracheoesophageal speech which has been gaining popularity. Tracheoesophageal puncture (TEP) can be performed either at the time of total laryngectomy, or later. 30 of our patients underwent TEP between 1991 and 1999, 15 at the time of total laryngectomy and 15 as a delayed secondary procedure. Mean follow-up was 36 months (range 6 months to 8 years) during which all regained speaking ability. Over the long range, speech rehabilitation with the prosthesis was successful in 24 (80%). In only 1 in the primary TEP group did treatment fail, as the prosthesis had to be removed due to local recurrence of the tumor. Long range failure in 5/15 patients after secondary TEP stemmed from difficulties some patients had in handling the prosthesis and from psychological difficulties in adapting to the new speech device. Complications were mostly minor and occurred mainly in the secondary TEP group. TEP performed at the time of total laryngectomy, or later as a secondary procedure, is effective for speech rehabilitation after laryngectomy.

Aged↗
PubMed2000

Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction.

OBJECTIVE: To define, in a group of children with nasal obstruction, the anatomical differences that differentiate those with quiet, unobstructed nocturnal respiration from those with obstructive sleep-related breathing abnormalities (snoring and obstructive sleep apnea). DESIGN: Case series. PATIENTS: Fifty-nine children aged 3 to 13 years (35 boys and 24 girls) with nasal obstruction and without tonsillar hypertrophy, known craniofacial syndromes, or neuromuscular diseases were included in the study. MAIN OUTCOME MEASURES: Each patient was categorized as to severity of nocturnal obstructive breathing symptoms. Angular and linear cephalometric measurements were used for assessment of craniofacial features. Clinical symptom scores were correlated with the cephalometric measurements. RESULTS: Significant craniofacial abnormalities were identified in patients prone to obstructive breathing patterns: increased flexure of the cranial base and bony nasopharynx, opening of the gonial angle, shortened mandibular length, dorsocaudal location of the hyoid, reduced posterior airway space, and increased velar thickness. CONCLUSIONS: A number of anatomical abnormalities may contribute to sleep-related abnormal breathing in otherwise normal children with nasal obstruction. Our results suggest that symptomatic children show some of the same skeletal and soft-tissue configurations that are found in adults with obstructive sleep apnea. While adenoidectomy is generally an effective treatment in children with obstructive sleep-related breathing abnormalities, the underlying craniofacial variances that remain after adenoidectomy may predispose these patients to redevelopment of obstructive breathing abnormalities in adulthood.

Adolescent↗
PubMed2000

Speech-aid prostheses for neurogenic velopharyngeal incompetence.

STATEMENT OF PROBLEM: When surgical treatment is not considered an option, prosthetic management of velopharyngeal insufficiency is carried out by means of a speech-aid prosthesis, whereas velopharyngeal incompetence is traditionally managed by a palatal lift prosthesis. Varying degrees of treatment success have been attributed to palatal lift prostheses. PURPOSE: This study introduces the use of nasopharyngeal obturation instead of palatal elevation for the management of velopharyngeal incompetence. METHODS: Seven patients afflicted by neurogenic velopharyngeal incompetence were treated with wire-extension speech-aid prostheses constructed to circumvent the dysfunctional soft palate. The shape of the nasopharyngeal section was functionally molded in speech and swallowing and controlled by video-nasopharyngoscopic examinations. RESULTS: Effective nasopharyngeal obturation with notable improved speech was achieved in all patients. Even though all patients ultimately tolerated the prostheses well, 2 patients denied any improvement in speech with the finalized prostheses. CONCLUSION: Wire-extension speech-aid prostheses used by the patients were an effective treatment approach for velopharyngeal incompetence. Nasopharyngoscopic control is mandatory for maximizing the effect of velopharyngeal closure around the nasopharyngeal section of the prosthesis in function, yet it allows free nasal breathing. Velopharyngeally incompetent patients should be carefully tailored for prosthetic treatment because of contingent noncompliance.

Adult↗
PubMed2000

Tongue-base suspension with a soft tissue-to-bone anchor for obstructive sleep apnea: preliminary clinical results of a new minimally invasive technique.

The Repose system is a new minimally invasive technique for tongue-base suspension in the treatment of sleep-disordered breathing caused by tongue-base collapse. It involves the insertion of a titanium miniscrew with attached suture into the anterior intraoral mandible and passing the suture through the tongue base. The procedure was performed in 16 patients with sleep-disordered breathing. Fourteen patients reported an improvement in daytime sleepiness, and their bed partners reported an improvement in snoring. The mean respiratory distress index before surgery was 35. Two months after surgery, the mean respiratory distress index was 17, an improvement of 51.4% (P = 0.001, 2-tailed t test). These preliminary results show the initial efficacy and safety of this new surgical procedure.

Adult↗
PubMed2000

Acute sinusitis: a histopathological and immunohistochemical study.

OBJECTIVE: To provide data on the histopathological and immunohistochemical characteristics of acute sinusitis in humans. STUDY DESIGN: A nonrandomized, retrospective, controlled, qualitative and quantitative study. METHODS: Inflamed sinus mucosal tissues were removed during functional endoscopic sinus surgery from 11 patients with acute sinusitis, of whom 6 had complications with extension of inflammation to the orbit (4) or the meninges (2), 3 had recurrent sinusitis, and 2 had acute exacerbation of chronic sinusitis Normal sinus mucosal tissues were retrieved from four patients with various nasal tumors and served as controls All specimens underwent routine histological processing. Representative sections from each region were stained with hematoxylin and eosin, periodic acid-Schiff, and toluidine blue. Immunohistochemical staining for T and B lymphocytes was also applied. A two-phase examination was designed: low-magnification microscopic assessment (x40) to yield the typical pathological features and high-magnification assessment (x400) to count various inflammatory cells. RESULTS: The lamina propria displayed the most significant changes with edema, extensive infiltration of neutrophils and mononuclear cells, formation of microabscesses, thrombophlebitis, and necrotic foci, whereas the involvement of the epithelial layer in the inflammatory reaction was relatively modest. Immunohistochemistry revealed an increase in the population of T and B lymphocytes. The former were diffusely scattered, whereas the latter also formed distinct clusters: around small venules, adjacent to seromucous glands, and under the epithelium. CONCLUSIONS: The inflammatory reaction of the lamina propria exceeded that of the epithelial layer. It is assumed that the clusters of B lymphocytes around blood vessels may point to the fact that these cells were recruited from the blood during acute sinusitis.

Acute Disease↗
PubMed2000

Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septum.

OBJECTIVE: To measure the dimensions, composition, and possible structural and/or histopathological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum. STUDY DESIGN: A prospective, nonrandomized, and morphometric study. METHODS: Nineteen patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity underwent surgery for correction of nasal obstruction. Patients' specimens were compared with those of a control group consisting of 10 inferior turbinates removed at autopsy. Quantitative measurements of the inferior turbinate histological sections were carried out and included the width of the layers and morphometric calculations of the relative proportions of the soft tissue constituents. Also, qualitative study was performed to detect pathological changes. RESULTS: Of all layers, the inferior turbinate bone underwent a twofold increase in thickness and manifested the most significant expansion (P < or =.001), whereas the contribution of the mucosal layers to the inferior turbinate hypertrophy was modest. The morphometric analysis revealed a larger proportion of venous sinusoids in hypertrophic turbinates, but the difference was small and statistically insignificant. Qualitative assessment disclosed normal mucosal architecture in all inferior turbinates with compensatory hypertrophy. Eleven remained intact, while eight disclosed mild to moderate pathological changes. CONCLUSIONS: The data gathered in the present study are of importance to the decision-making process regarding turbinate surgery. The significant bone expansion and the relative minor role played by the mucosal hypertrophy would support the decision to excise the inferior turbinate bone at the time of septoplasty.

Adolescent↗
PubMed1999

Prognostic factors for local control of early glottic cancer: the Rabin Medical Center retrospective study on 207 patients.

PURPOSE: Different radiation therapy schedules and devices have been used over the last 20 years at Rabin Medical Center in patients with early glottic cancer. The aim of the present retrospective analysis was to identify the subgroup of patients at high risk of failure of radiation treatment. MATERIALS AND METHODS: Between 1974 and 1994, 207 patients with squamous cell carcinoma of the glottis, 182 Stage T1 and 25 Stage T2, underwent definitive radiation therapy. During this period, treatment was administered with different radiation devices (60Co or 6-MV X ray), using different dose/fraction protocols (1.8 or 2 Gy per day, 5 or 6 fractions per week), total doses (42-77.4 Gy), overall radiation times, and delays. These treatment variables, in addition to certain patient and tumor characteristics, were correlated with local control at a median follow-up of 57 months (range 18-265 months). RESULTS: The 5-year local control rates for T1 and T2 tumors were 88% and 73%, respectively. Univariate analysis showed that smoking, diabetes mellitus, anterior commissure involvement, T stage, and extension of tumor to one third or more of the vocal cord were highly significantly correlated with decreased local control. None of the treatment variables, including dosage at which complete tumor regression was noted, were found to be predictive. By multivariate analysis, only anterior commissure involvement was found to be highly significant (risk ratio 1.9, 95% CI 1.2-3.0, p = 0.027), and T stage was borderline significant (risk ratio 1.6, 95% CI 1.0-2.5, p = 0.054). CONCLUSION: This study suggests that only two tumor characteristics are predictive of local failure of early glottic cancer: anterior commissure involvement and T stage. Treatment variables apparently do not influence local control.

Adult↗
PubMed1999

Histopathologic changes of the soft palate after laser-assisted uvulopalatoplasty.

OBJECTIVE: To assess late histopathologic changes of the soft palate after laser-assisted uvulopalatoplasty in patients with snoring and mild obstructive sleep apnea. DESIGN: A nonrandomized, histopathologic controlled study. SUBJECTS AND INTERVENTIONS: Palatal surgical specimens were removed from 10 patients with snoring and obstructive sleep apnea in whom laser-assisted uvulopalatoplasty was not successful and who subsequently underwent uvulopalatopharyngoplasty. The mean interval between the last laser treatment and uvulopalatopharyngoplasty was 24 months. The patients' specimens were compared with those of a control group consisting of 12 palates and uvulae excised during uvulopalatopharyngoplasty. RESULTS: After laser-assisted uvulopalatoplasty, all soft palates displayed marked and progressive pathologic changes that increased with every additional treatment and extended far beyond the point of laser beam application. The loose connective tissue present in the lamina propria was replaced by diffuse fibrosis, which also extended to the central layer, on the expanse of seromucous glands and muscle fibers. Other changes included ulceration of the oral epithelium and a patchy inflammatory reaction. CONCLUSIONS: Extensive thermal-induced changes, involving the 3 layers of the organ, were found. They are compatible with clinical observations reported elsewhere and are probably responsible for the worsening of the obstructive sleep apnea status and the sensation of the pharyngeal dryness that developed months after the laser-assisted uvulopalatoplasty. Although it has immediate benefits, the procedure is still relatively new and all its implications are as yet unknown.

Adult↗
PubMed1998

Human lung cancer cell lines express cell membrane complement inhibitory proteins and are extremely resistant to complement-mediated lysis; a comparison with normal human respiratory epithelium in vitro, and an insight into mechanism(s) of resistance.

Human lung cancer expresses cell membrane complement inhibitory proteins (CIP). We investigated whether human lung cancer cell lines also express cell-membrane CIP molecules and whether the biology of CIP molecules in these cell lines differs from that of CIP in normal human respiratory epithelium in culture. The cell lines ChaGo K-1 and NCI-H596 were compared with normal human nasal epithelium in primary cultures in respect to the level of cell membrane CIP expression of membrane cofactor protein (MCP; CD46), decay-accelerating factor (DAF; CD55) and CD59, in respect to the level of cell resistance to complement-mediated lysis, and in respect to the contribution of cell membrane CIP to cell resistance against complement-mediated lysis. We found, using flow cytometry, that both human lung cancer cell lines expressed MCP, DAF and CD59, as did normal nasal epithelial cells. However, normal cells showed a large subpopulation of low DAF-expressing cells (60% of all cells) and a smaller subpopulation of high DAF-expressing cells (40%), while the lung cancer cell lines showed only one cell population, of high DAF expression. In addition, both lung cancer cell lines expressed higher MCP levels, and NCI-H596 cells showed higher levels of CD59. Cell resistance to complement-mediated lysis of both lung cancer cell lines was much higher than that of normal cells. Fifty percent normal human serum, under the same concentrations of complement activators, induced lysis of less than a mean of 10% of lung cancer cells, while lysing up to a mean of 50% of nasal epithelial cells. Lung cancer cell resistance to complement was due to its ability to prevent significant activation of complement upon its cell membrane, as manifested by a failure of complement activators to increase cell membrane deposition of C3-related fragments. The exact mechanism for this resistance remains obscure. Unexpectedly, neutralizing antibodies, anti-MCP and anti-DAF were entirely ineffective and anti-CD59 was only slightly effective (18% mean cell lysis) in increasing the susceptibility of the lung cancer cell lines to complement, while the same antibodies were very effective in facilitating complement-mediated lysis of the normal nasal epithelial cells (50% mean cell lysis with CD59 MoAb). On the other hand, detachment of DAF and CD59 by phosphatidylinositol-specific phospholipase C (PIPLC) from the lung cancer cell lines abrogated their resistance to lysis. We suggest that the biology of cell membrane CIP molecules in human lung cancer cell lines is different from that of CIP in normal respiratory epithelial cells. Human lung cancer cell lines are able to prevent significant complement activation upon its cell membrane and are therefore especially resistant to complement-mediated lysis. Complement resistance may serve this common and highly lethal human cancer as an escape mechanism from the body's immunosurveillance and prevent effective immunotherapy with tumour-specific MoAbs.

Antigens, CD↗
PubMed1997

[Toxic shock syndrome].

Toxic shock syndrome (TSS) is a rare, life-threatening, acute multisystem illness usually characterized by sudden onset of high fever, diffuse sunburn-like erythroderma and a variety of other signs and symptoms. It may progress rapidly to hypotension and shock with multiple organ failure. Its exact cause is unknown, but in almost all cases there has been an infection with exotoxin-producing strains of phage group I Staphylococcus aureus. Although initially described in association with the use of superabsorbent tampons in menstruation, TSS has complicated a variety of surgical procedures. Recently in head and neck surgery attention has focused on absorbent packing materials, such as those used in postoperative nasal care. TSS developed in a 12-year-old 28 hours after tonsillectomy, nasal septoplasty and inferior turbinectomy in which absorbent packing material was used. It is important to maintain a high index of suspicion for TSS in all postoperative patients with fever, hypotension and erythroderma.

Bandages↗