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Biomedical subjects

R H Mathog

Publications and source records attributed to R H Mathog.

At least 37 records · Page 2Linked to original sources
PubMed1997

Trace elements in head and neck cancer patients: zinc status and immunologic functions.

In this study we have assessed zinc status and zinc-dependent cell-mediated immune functions (interleukin-2 production by mononuclear cells, natural killer cell lytic activity, and interleukin-1 beta production by mononuclear cells) in adult patients with squamous cell carcinoma of the upper aerodigestive tract at diagnosis and before any therapy was instituted. Inasmuch as significant interactions between zinc, copper, and iron exist, we also assayed the plasma copper level, serum iron level, and total iron-binding capacity in our patients. We recruited 30 cancer subjects and 21 control subjects. On the basis of cellular zinc criteria, we diagnosed a mild deficiency of zinc in 53% of cancer subjects. The plasma zinc level was not decreased in our subjects. A univariate analysis was applied by use of one-way analysis of variance comparing study variables among the three study groups (controls and zinc-deficient and zinc-sufficient cancer patients) and Tukey's multiple comparison test, and we showed that interleukin-2 production and natural killer lytic activity were decreased in zinc-deficient cancer patients. Interleukin-1 beta production (ELISA assay) was increased in both zinc-deficient and zinc-sufficient groups. Plasma copper level was not different, but the iron utilization was decreased in both groups of cancer subjects. We conclude that zinc deficiency and zinc-dependent immunologic dysfunctions are present in more than half of the patients with head and neck cancer in the Detroit area.

Adult↗
PubMed1997

Early and delayed repair of orbitozygomatic complex fractures.

PURPOSE: The goal of this study was to review experience with early and delayed repair of orbitozygomatic complex fractures and develop guidelines for repair based on timing and extent of injury. PATIENTS AND METHODS: Records of patients with orbitozygomatic complex fractures over a 10-year period were reviewed for cause of injury, signs and symptoms, length of time from injury to repair, and method of repair. Results were evaluated by office examination and telephone interviews at least 6 months to 10 years after surgery. RESULTS: Seventy-eight patients who had undergone 81 surgical procedures were analyzed. The series consisted of 49 primary repairs (1 to 22 days postinjury), 10 delayed repairs using osteotomies at 21 days to 5 months postinjury, and 22 delayed repairs requiring onlay bone grafting from 4 months to 16 years postinjury. Forty patients (43 procedures) were available for follow-up. Early surgical intervention dramatically improved esthetic and functional outcomes, whereas late repair was less satisfactory. Hypoesthesia was not improved by surgery. Osteotomy and onlay grafting techniques were necessary for delayed treatment. CONCLUSION: Orbitozygomatic fractures can be repaired up to 21 days postinjury using primary reduction and fixation techniques. Osteotomies are required after 21 days and can be used successfully up to 4 months postinjury. After 4 months, successful repair requires onlay bone grafting.

Adolescent↗
PubMed1997

Zinc deficiency in head and neck cancer patients.

BACKGROUND: Although a great deal of attention has been given to protein and calorie malnutrition in patients with head and neck cancer, zinc status has not been assessed properly in such patients in the past. METHODS: In this study we characterized zinc status by cellular zinc criteria and assessed several measures of protein and calorie malnutrition in patients with head and neck cancer. We determined prognostic nutritional index (PNI) based on serum albumin, serum transferrin, triceps skin fold measures, and delayed hypersensitivity, as proposed by Buzby et al. In this study, the baseline zinc status and PNI of 60 head and neck cancer patients were correlated with the tumor size and overall stage of the disease. RESULTS: Our results showed that the tumor size and overall stage correlated significantly to zinc status whereas no correlation was seen with PNI, alcohol intake, or smoking in our study subjects. CONCLUSION: We conclude that zinc status is a better indicator of tumor burden and stage of the disease in head and neck cancer patients than the patients' overall nutritional status.

Aged↗
PubMed1997

Rehabilitation of patients with extended facial and craniofacial resection.

Surgery of benign and malignant disease of the nose and sinuses can result in disfigurement and disability. Many patients have speech, mastication, and swallowing problems, anosmia, and pain. If the orbit is retained, visual loss, dystopia, diplopia, and epiphora can occur. This study reviews the senior author's experience with 34 patients over the last 18 years. Group and case analyses demonstrate that in patients with cancer, the eye can be preserved if one anatomical boundary is retained beyond a negative frozen section margin. Dystopia can be prevented by reconstruction of the floor with skin and fascial grafts or flaps. Epiphora can be reduced by repair of the medial canthus and dacryocystorhinostomy. Evidence is presented for prosthetic management of speech and swallowing and restoration of cheek contour. Case examples are used to illustrate the surgical techniques.

Adolescent↗
PubMed1997

Zinc deficiency: changes in cytokine production and T-cell subpopulations in patients with head and neck cancer and in noncancer subjects.

Cell-mediated immune dysfunctions and susceptibility to infections have been observed in zinc-deficient human subjects. In this study, we investigated the production of cytokines and characterized the T-cell subpopulations in three groups of mildly zinc-deficient subjects. These included head and neck cancer patients, healthy volunteers who were found to have a dietary deficiency of zinc, and healthy volunteers in whom we induced zinc deficiency experimentally by dietary means. We used cellular zinc criteria for the diagnosis of zinc deficiency. We assayed enzyme-linked immunosorbent assay the production of cytokines from phytohemagglutinin-stimulated peripheral blood mononuclear cells and assessed by flow cytometry the differences in T-cell subpopulations. Our studies showed that the cytokines produced by TH1 cells were particularly sensitive to zinc status, inasmuch as the production of interleukin-2 (IL-2) and interferon-gamma were decreased even though the deficiency of zinc was mild in our subjects. TH2 cytokines (IL-4, IL-5, and IL-6) were not affected by zinc deficiency. Natural killer cell lytic activity also was decreased in zinc-deficient subjects. Recruitment of naive T cells (CD4+CD45 RA+) and CD8+ CD73+ CD11b-, precursors of cytolytic T cells, were decreased in mildly zinc-deficient subjects. An imbalance between the functions of TH1 and TH2 cells and changes in T-cell subpopulations are most probably responsible for cell-mediated immune dysfunctions in zinc deficiency.

Adult↗
PubMed1995

Medial orbital wall fractures: classification and clinical profile.

This article reports our experience and proposes a clinical classification regarding medial orbital wall fractures. After a retrospective analysis of 2741 patients with facial fractures, we were able to evaluate 273 patients with 304 medial orbital wall fractures. The male-to-female ratio was 5:1, and most injuries involved the left orbit. Most fractures were caused by personal altercations, but more complex injuries were noted with automobile accidents and falls. Fractures were divided into types based on location and severity of injury: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor), type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). Although visual loss (2%), diplopia (41%), and enophthalmos (12%) were seen, diplopia and enophthalmos were commonly observed with type II injuries. Imaging studies showed that about 52% of the fractures were associated with prolapse of orbital fat, but only 43% could be diagnosed with plain x rays. Type I fractures were generally explored through a frontoethmoid incision; other types were treated with subciliary or transconjunctival approaches. The usual treatment consisted of repositioning the fragments and repair of the wall with polyethylene mesh or cranial bone graft. Type I and type II fractures seemed best explained by the hydraulic mechanism of injury, whereas the type III and type IV fractures best fitted the buckling theory.

Accidents, Traffic↗
PubMed1994

Bone graft implantation for correction of the anophthalmic orbit.

Prosthetic rehabilitation of the anophthalmic orbit may result in a syndrome characterized by retrodisplacement and tilt of the prosthesis, deepening of the upper eyelid sulcus, retraction of the upper eyelid, and stretching of the lower eyelid. Patients requiring enucleation of the orbit following trauma can also have accentuation of the enophthalmos, with hypophthalmos and displacement of the malar eminence. These cosmetic defect are difficult to manage, and a number of corrective surgical techniques have been described. In this study we review the pathophysiology of the anophthalmic orbit and present our recent experience utilizing the strategic placement of iliac crest bone grafts to compensate for the bony and soft-tissue injuries associated with traumatic loss of the globe. All six patients experienced subjective and objective improvement postoperatively. Results are presented as case presentations with accompanying photographs and follow-up data.

Adult↗
PubMed1993

Mandible fractures--medical and economic considerations.

This article retrospectively evaluates 1278 mandibular fractures and compares intermaxillary fixation, plating, and interosseous wiring as to outcomes and cost-effectiveness of treatment. The predominance of young men with personal altercations reflects the urban patient setting. The infection from plating exceeds other methods and this difference is also reflected in increased patient days (in the hospital) and an increased length of time for postoperative care. No significant differences are observed between treatments for non-union, malunion, facial nerve injury, or temporal mandibular joint problems. Other factors, such as site and severity of injury and experience of the surgeons are considered. Cost implications are important, but should be just one factor in evaluation for the best treatment for each patient.

Adolescent↗
PubMed1991

The "plateau effect" of cis-platinum-induced hearing loss.

Cis-platinum-induced hearing loss has been reported to exhibit a "plateau effect" over the 2 to 8 kHz range. We examined serial audiometry data from 27 patients treated with cis-platinum. Although a plateau at 60 to 70 dB HL often occurred, this hearing loss was clearly exceeded in a number of patients. We identified 14 patients with sufficient cis-platinum-induced sensorineural hearing loss to evaluate a plateau limit to hearing loss over the 4 to 8 kHz range. Half of these 14 patients had hearing losses that exceeded the plateau level. More severe 4 to 8 kHz hearing losses did not correlate with number of treatments, cumulative dosages of cis-platinum, pre-existing hearing loss, radiation therapy, other chemotherapeutic agents, or even hearing losses below 4 kHz. Although cis-platinum therapy can induce a plateau of moderate hearing impairment for some patients over the 4 to 8 kHz range, a significant proportion of patients will experience more severe hearing impairment in this range, even after only one or two courses of cis-platinum.

Acoustics↗
PubMed1991

Management of orbital blow-out fractures.

The sequelae of the blow-out fracture can be predicted from a knowledge of the pathophysiology of the fracture as well as an accurate history and clinical and radiologic examination of the patient. The main indications for exploration and repair are acute changes in globe position and mechanical restriction of gaze. Surgery should be performed at 7 to 10 days posttrauma. For the surgeon who possesses the skills and expertise, reparative procedures should help the patient and infrequently cause complications.

Humans↗
PubMed1990

Mastication in patients treated for head and neck cancer: a pilot study.

Patients with head and neck cancer will experience alteration of oral anatomy and physiology caused by the disease and the treatment required. Despite the implied effects on the dynamics of mastication, objective studies have not been conducted to evaluate masticatory function of these patients. Masticatory performance and swallowing threshold performance were evaluated with Frito corn chips as the test substance. Edentulous patients treated for cancer demonstrated deficiencies in both tests. Masticatory performance and swallowing threshold performance improved with prosthodontic rehabilitation but this improvement was less than with comparable controls. Techniques to evaluate masticatory factors such as dentition, dentures, biting force, temporomandibular joint status, range of motion, and saliva are suggested.

Aged↗
PubMed1990

Flap reconstruction techniques in conjunctivorhinostomy.

Dacryocystorhinostomy is usually the standard approach to treat epiphora caused by lower lacrimal tract obstruction. When the pathologic condition lies in the upper lacrimal passage, however, alternate bypass or reconstructive options must be considered. Conjunctivodacryocystorhinostomy, using the Jones tube, can effectively bypass the upper tract, but the technique may be complicated by granulation tissue formation, infection from unapposed mucosal flaps, and inefficient passage of tears through scar as a result of healing by secondary intention. Canaliculodacryocystorhinostomy affords the advantages of a physiologic reconstruction, but is limited by availability of sufficient canaliculus, requires a lengthy and tedious dissection, and must be performed using a microsurgical approach. We describe an alternate technique of conjunctivorhinostomy that provides total lacrimal bypass and has the advantages of bipedicled mucosal flap apposition, temporary stenting, and symptomatic improvement of epiphora. Several case examples illustrate the indications, advantages, and disadvantages of this technique.

Adolescent↗
PubMed1990

Vestibular effects of chronic perilymph fistula in the cat.

Chronic, unilateral perilymph fistulae were created in cats by removal of the round window membrane and placement of a tympanostomy tube into the round window. Rotary chair, fistula, caloric, and vestibulospinal tests were performed before and after fistulization, and periodically for 2 weeks. At 2 weeks, patency of the fistula was documented by fluorescein injection into the spinal fluid and visualization of leakage into the middle ear bulla via the fistula. All the cats had a patent fistula at 2 weeks, but one of the three cats had a greater perilymph leak than the others. The cat with the more active leak had a spontaneous nystagmus toward the side of the fistula on the first postoperative day; this changed to nystagmus toward the opposite side by the third postoperative day. The other cats had a spontaneous nystagmus toward the opposite side from the first postoperative day. Most abnormal test results returned to normal in the first week after fistulization. Histologic study of the temporal bones revealed that the cat with the greater leak had a wider cochlear aqueduct than the other cats.

Animals↗
PubMed1989

Surgical correction of enophthalmos and diplopia. A report of 38 cases.

Enophthalmos, hypophthalmos, and diplopia are complications of orbital injury. This article reviews the causes of these sequelae, describes a method of strategic implantation of bone grafts to the orbit (and malar bone), and reports the long-term (six months to eight years) results in 38 cases. As a result of bone grafting, all but two patients had a correction of the enophthalmos to within 1 to 2 mm of the opposite eye. Of the 20 patients with diplopia, 15 had correction, and an additional four had an improvement of diplopia so it occurred in only one field of gaze. Of the 22 patients with grafts to the malar bone, 16 were thought to have good to excellent results; however, six developed some degree of reabsorption at the graft site. No patients had any decrease in vision. The advantages and disadvantages of the surgical procedure are described and compared with other methods.

Adolescent↗
PubMed1989

Repair of orbital floor fractures with Marlex mesh.

The best method for reconstructing the acutely fractured orbital floor is controversial. In this review, the outcome of 81 patients with an operatively confirmed pure orbital blow-out fracture is evaluated with respect to postoperative enophthalmos, diplopia, infection, and extrusion. A Marlex mesh implant was used to repair 58 of the fractures, with minimal resultant complications. We believe that Marlex mesh is an ideal implant for use in repairing the early blow-out fracture.

Adolescent↗
PubMed1988

Orbital wall and volume relationships.

Assuming that intraorbital volume is a space defined by the orbital walls, and that intraorbital contents represent a space occupied by soft tissues, changes between volume and contents will result in movement of the globe in usually a forward (exophthalmic) or backward (enophthalmic) direction. An understanding of the phenomenon is important if the clinician is to judge the effects of traumatic displacement of an orbital wall on globe positions and if the clinician is to design a reconstructive procedure to correct these changes. To study such relationships, we have designed physical models based on measurements of five dry human skulls. With these models, it has been possible to move a whole wall or part of a wall and, thereby, adjust the orbital volume. The experimental manipulations are useful in predicting the relationship of the orbital wall position and volume-information that can be ultimately used for diagnosis and reconstructive purposes.

Exophthalmos↗