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Biomedical subjects

G Isaacson

Publications and source records attributed to G Isaacson.

At least 37 records · Page 2Linked to original sources
PubMed1996

Patterns of sinusitis in cystic fibrosis.

It has been pediatric dogma that most children with cystic fibrosis (CF) have pansinusitis and few are symptomatic. To reassess this premise, we compared symptoms, clinical examinations, radiographic and surgical findings, and results of treatment in 19 children with cystic fibrosis who had undergone computed tomography at St. Christopher's Hospital (Philadelphia) from 1991 to 1994. We found two distinct patterns of sinus disease: chronic sinusitis (n = 3) and polyposis (n = 12). Two of the patients with polyposis had ethmoid mucoceles and 1 child had no sinus disease at all. Children with chronic sinusitis had headache as a major complaint, while those with polyposis suffered nasal obstruction alone unless a mucocele was present. Surgery provided marked and lasting improvement in the 14 patients who were operated on.

Child↗
PubMed1996

Acute airway obstruction in the hospitalized infant: four hard lessons in the distal trachea.

Acute obstructing lesions of the distal (lower) trachea present a unique challenge to the pediatric otolaryngologist. The small caliber of the airway and tenuous medical status of such patients test the ingenuity of the surgeon and the limits of instrumentation. This report presents the operative findings and management of four hospitalized infants with worsening respiratory distress. Difficulties encountered in maintaining airway control while diagnosing and correcting these lesions are described.

Airway Obstruction↗
PubMed1996

Meningitis after adenoidectomy: an anatomic explanation.

Meningitis is a rare complication of adenoidectomy. During a 5-month period, two children at St Christopher's Hospital for Children developed meningitis within days following this surgical procedure. The potential causes of this complication that we investigated include coincidence, systemic hematogenous spread of bacteria to the central nervous system, and direct or indirect contamination of the cerebrospinal fluid by bacteria introduced by retropharyngeal injection of lidocaine hydrochloride and epinephrine. Based on statistical analysis of the available literature and anatomic studies of the pediatric nasopharyngeal region, we conclude that a retrograde flow of bacteria via a newly described anastomotic network of veins was the most likely cause of this sequela.

Adenoidectomy↗
PubMed1995

Innominate artery compression of the trachea: diagnosis and treatment by anterior suspension. A 25-year experience.

Suspension of the innominate artery to the sternum has been a widely accepted therapy for the relief of tracheal compression. Recently, reimplantation of the innominate artery has been advocated as a superior operative procedure. While generally successful, arterial transfer carries the risk of early bleeding and stroke, and the potential for late stenosis at the anastomotic site. Between 1969 and 1994, 25 infants and children at our institution received diagnoses of innominate artery compression and were treated by anterior suspension. All presented with stridor and one third had a history of suspected or proven apnea. Twenty-four children had excellent results, while 1 required resuspension after stridor returned. There were no major complications. Our series strongly supports the belief that anterior suspension of the innominate artery is a successful and reliable operation with minimal morbidity and mortality. More complex procedures are rarely indicated.

Apnea↗
PubMed1991

Focal myositis. A new cause for the pediatric neck mass.

Focal myositis is an inflammatory pseudotumor of skeletal muscle that may involve the head and neck. It can closely mimic either a neoplastic or infectious process. We present the case of a 7-year-old boy with a 2-week history of a painful, unilateral neck swelling, fever, and torticollis. He failed to respond to antibiotic therapy and required an open neck exploration. An incisional biopsy of the indurated, inflammatory tissue adherent to his sternocleidomastoid muscle showed focal myositis. Focal myositis is an unusual, but important possibility in the differential diagnosis of any neck mass and especially one in a child. Although its cause is unknown, it is a self-limited disease and neither excisional biopsy nor radical resection is justified.

Abscess↗
PubMed1991

Concentration of cefuroxime in serum and middle ear effusion after single dose treatment with cefuroxime axetil.

Antimicrobial agents play an important role in the treatment of patients with acute otitis media and otitis media with effusion (OME). The study was undertaken to determine the concentrations of cefuroxime in the blood and middle ear effusions (MEE) of children between 6 and 12 years of age with acute otitis media and chronic OME after a single oral dose administration of cefuroxime axetil, the ester prodrug of cefuroxime. Cefuroxime axetil (250 mg) was administered 2 to 6 hours before either myringotomy for acute otitis media or myringotomy and tube insertion for chronic OME. Blood samples and middle ear aspirates were obtained from 31 children and the samples were analyzed by high performance liquid chromatography. Cefuroxime was recovered in measurable concentrations in all serum samples and in 15 (79%) of the 19 MEE specimens analyzed. No correlation was seen between cefuroxime MEE concentrations and effusion type, bacteriology or serum concentrations. This study shows that cefuroxime does penetrate into MEE when OME is present and that therapeutic concentrations can be achieved in some patients.

Acute Disease↗
PubMed1991

Human fetal upper respiratory tract function as revealed by ultrasonography.

The respiratory functions of the oropharynx, larynx, and trachea of normal human fetuses in utero were explored by means of real-time, two-dimensional ultrasonography combined with color-flow and spectral Doppler analysis. Coronal and transverse images revealed the maturation of coordinated respiratory activity of these structures in the late second and early third trimesters. Observation of the effects of these movements upon the flow of amniotic fluid in the fetal respiratory tract provides an appreciation of the early role of the upper airway in the modulation of fetal breathing.

Female↗
PubMed1991

Laryngoplastic phonosurgery.

Laryngoplastic phonosurgery is a new term used to describe all forms of laryngeal framework surgery to improve the voice. One of the most important new surgical techniques is medialization laryngoplasty (ML) for the correction of unilateral vocal cord paralysis. This article focuses on ML techniques, results, complications and indications; the artenoid adduction procedure (AA) is described as a complementary technique. In addition, some of the more experimental laryngoplastic procedures are reviewed.

Female↗
PubMed1991

The spectrum of vocal dysfunction.

Levels of vocal use, types of vocal complaints, and the spectrum of vocal dysfunction are discussed in this article. Functional voice disorders account for 40% and organic conditions for 60% of patients presenting with voice disorders. Twelve percent of the patients are children.

Humans↗
PubMed1990

Selective non-surgical management of subperiosteal abscess of the orbit: computerized tomography and clinical course as indication for surgical drainage.

Subperiosteal abscess of the orbit (SPA) in childhood is an uncommon but serious sequela of sinusitis, with partial or complete visual loss as the most common complication. Traditional management of SPA has combined systemic antibiotics with immediate surgical drainage. The records of 120 children admitted from 1982-1986 with the diagnosis of periorbital or orbital cellulitis were reviewed. Ten cases of SPA were documented by CT scan (8%). Antecedent ethmoid sinusitis was present in all cases. Five SPA patients were managed with intravenous antibiotics and nasal decongestants alone. All had complete clinical and radiographic resolution without complication. The remaining 5 patients underwent surgical drainage. Two patients required immediate drainage due to total ophthalmoplegia upon presentation. One case of postoperative epidural abscess occurred one week after external fronto-ethmoidectomy among these two patients. The remaining 3 patients did not respond adequately to medical therapy alone and underwent surgical drainage without complication. Length of hospital stay in both medical and surgical groups was similar. We conclude that SPA can be safely managed by medical therapy alone in selected cases. Criteria for surgical intervention of documented SPA while on optimal medical therapy should include: worsening of visual acuity or ocular motility, or failure to improve clinically within 48 h. The presence of SPA alone should no longer be considered an absolute indication for surgery.

Abscess↗
PubMed1990

Histology of Isshiki thyroplasty type I.

Isshiki thyroplasty type I, an open surgical procedure to medialize the true vocal cord, has been proposed as an alternative to Teflon injection in selected cases of recurrent nerve paralysis or vocalis muscle atrophy. This operation was performed in a man with a mediastinal tumor and a paralyzed vocal cord in an intermediate position. He died 1 month later, and his larynx and recurrent nerve were studied histologically. The gross and microscopic changes in the larynx caused by this operation are discussed, and the pathologic changes in the recurrent nerve leading to the paralysis are examined.

Aged↗
PubMed1990

Extraluminal arytenoid reconstruction: laryngeal framework surgery applied to a pediatric problem.

Laryngeal framework surgery has proved to be an important alternative in the treatment of vocal cord paralysis in adults. We have modified one of these operations in order to manage debilitating aspiration in a 14-year-old boy. His laryngeal incompetence resulted from a severe neurologic injury and laryngeal scarring from a unilateral arytenoidectomy and multiple Teflon injections. To help him, we studied a series of pediatric larynges and devised an operation that succeeded in rebuilding the bulk of his excised arytenoid cartilage and markedly reducing aspiration.

Adolescent↗