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Biomedical subjects

R J Toohill

Publications and source records attributed to R J Toohill.

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

Orbital complications of sinusitis in the aspirin triad syndrome.

Orbital complications are uncommon in adult sinusitis. In contrast, the sinusitis of the aspirin triad syndrome is often fulminate, expansive, and recurrent, and complications may be more frequent. Of 81 patients with aspirin triad who were treated surgically, 7 patients (8.6%) had orbital complications, including sinus mucoceles in 3 patients, lacrimal gland extension in 2 patients, inflammatory orbital mass in 1 patient, and proptosis from expansile sinonasal polyposis in 1 patient. All complications manifested within 2 years of prior surgery. Two patients suffered blindness. In a group of 120 consecutively treated sinus surgery patients without aspirin triad syndrome (51 of whom were followed for more than 2 years), no patient manifested nonoperative orbital complications. The results of this study suggest that aspirin triad patients are at significant risk for orbital complications and therefore should have long-term follow-up with aggressive treatment of persistent disease.

Adolescent↗
PubMed1994

Gastroesophageal reflux disease as a likely cause of "idiopathic" subglottic stenosis.

The cause of subglottic stenosis (SGS) is unknown for a subgroup of patients in which there is a female predominance. Seven women ranging in age from 39 to 66 years developed symptomatic and progressive SGS. Six of the 7 patients failed to respond to all measures of conservative and radical surgical intervention. After recent thorough evaluation for gastroesophageal reflux disease (GERD) followed by medical management for such, these 6 patients have stabilized and have responded to surgical management. The seventh patient recently presented with SGS, was evaluated and treated for GERD, and has not required any surgical management. This study suggests that GERD laryngitis may be pertinent in the development of SGS. Medical management of GERD thus appears vital to successful treatment of idiopathic SGS.

Adult↗
PubMed1993

Wound healing of KTP and argon laser lesions in the canine nasal cavity.

The potassium titanyl phosphate (KTP) and argon lasers are increasingly used in nasal and sinus surgery. Histologic effects of these lasers on living nasal tissue have not been investigated. Sixteen dogs underwent laser nasal surgery (eight for each laser). Flexible fiberoptic quartz fibers were used with both lasers to deliver the laser energy to the tissue. The dogs were allowed to heal and then underwent biopsy at 3, 7, 21, and 90 days postoperatively. The argon and KTP lasers had similar tissue effects. Histologically, a thin rim of coagulation necrosis and acute inflammation were seen at 3 days postoperatively. By 7 days, fibroblasts and granulation tissue were observed. At 21 days, fibroblast proliferation and re-epithelialization with respiratory epithelium were the predominant findings. Finally, at 90 days postoperatively, respiratory epithelium and submucosal structures were found overlying a plug of scar filling the defect in the septal cartilage. This healing was consistent through a wide range of energy densities. These lasers are easily used with sinus endoscopes and the operating microscope to allow access to difficult areas. These factors and the wound-healing characteristics noted in this study would seem to make them suited for use in rhinologic surgery.

Animals↗
PubMed1993

Transpalatal advancement pharyngoplasty for obstructive sleep apnea.

Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue-base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 +/- 12.2 to 12.3 +/- 2.8 events per hour. For the entire group, RDI decreased from 73.3 +/- 29.4 to 25.1 +/- 28.2 events per hour (P < .001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1). Transpalatal advancement pharyngoplasty potentially may offer an alternative to increasingly aggressive resection with UPPP in an effort to increase the upper oropharyngeal and retropalatal airway and may be appropriate in careful selected patients as part of the surgical treatment of OSA.

Adult↗
PubMed1993

Acute epiglottitis in the adult: experience with a seasonal presentation.

Acute epiglottitis in adults may follow an unpredictable clinical course, complicated by acute airway obstruction. Our experience with this disease was evaluated by looking at yearly incidence, seasonal occurrence, and clinical variables of both intubated and conservatively managed patients. In our series of 17 cases from 1987 through 1990, 16 occurred in 1988 and 1989. Ten of 17 cases occurred during the summer months. The two patients who developed stridor went on to require intubation and tracheotomy. Statistical analysis of our data revealed that, in adult acute epiglottitis, stridor is a strong predictor of airway obstruction. A significant summer seasonal predominance was seen, as well as a suggestion of an epidemic in 1988 and 1989.

Acute Disease↗
PubMed1991

Histopathologic changes in snoring and obstructive sleep apnea syndrome.

The pathophysiologic events that lead to the loss of airway compensation in obstructive sleep apnea (OSA) are poorly understood. The development of airway instability may be secondary to changes in neurologic control, airway morphology, or both. To identify potential histopathologic features of pharyngeal tissues that may contribute to OSA, transverse sections of the distal soft palate and uvula were qualitatively compared using light and electron microscopy from 4 severe apneics (greater than 50 apnea/hour), 4 severe snorers (less than 20 apnea/hour), and 4 nonsnorers. Light microscopy of both apneics and snorers revealed mucous gland hypertrophy with ductal dilation and focal squamous metaplasia, disruption of muscle bundles by infiltrating mucous glands, focal atrophy of muscle fibers, and extensive edema of the lamina propria with vascular dilation. Severe snorers did not differ qualitatively from apneics in the characteristic changes found; however, some snorers had less extensive changes. No distinctive histopathologic findings could be associated with the development of apnea. Electron microscopy of severe apneics identified frequent focal degeneration of myelinated nerve fibers and axons. The finding of similar histopathologic changes in apneics and severe snorers supports previous speculation of a common etiology not directly related to apnea, such as vibratory trauma to pharyngeal tissues. Degenerative changes in peripheral nerves, identified on electron microscopy, however, may contribute to airway instability and the development of obstructive apnea by impairing pharyngeal reflexes.

Atrophy↗
PubMed1991

Microtrapdoor flap repair of laryngeal and tracheal stenosis.

Twenty patients have undergone repair of laryngeal and tracheal stenosis by microtrapdoor accessing of scar or soft tissue and removal with the carbon dioxide laser. A total of 34 flap procedures were performed in the 20 patients. Follow-up ranged from 8 months to 4 years, and 30 of these flaps were considered successful on the basis of improvement of the airway. The only complications were postoperative granulation tissue in 2 patients that responded to endoscopic removal.

Adult↗
PubMed1991

The endo-extralaryngeal needle carrier.

A laryngeal needle holder has been devised. This instrument will allow endoscopic insertion of sutures for lateralization of a paralyzed vocal cord or for fixation of endoscopically inserted stents or keels in laryngotracheal stenosis. The suture material is delivered by a curved nontraumatic cutting needle. After the needle is inserted in the desired endoscopic area, the tip protrudes through the anterior neck skin. The needle and distal suture are then pulled through the skin and the needle holder is withdrawn. The proximal portion of the suture is then inserted in the same fashion. Both ends of the suture are then fixed over buttons on the neck. The technique avoids the blind and cumbersome method of placing suture material from the skin to airway and back out to skin again.

Humans↗
PubMed1990

Trigeminal nerve neurofibroma: case report.

A case of left trigeminal nerve neurofibroma is presented. The location of the lesion required a multidisciplinary surgical effort for total excision. A vertical ramus osteotomy allowed access to the infratemporal space and base of skull. The frequency and clinical features of trigeminal nerve tumors are discussed.

Bone Plates↗
PubMed1990

Treatment-related toxicities with Fluosol-DA 20% infusion during radiation in advanced head and neck malignancies.

Fluosol-DA 20%, a synthetic perfluorocarbon emulsion first developed as a blood substitute, is currently being investigated as a radiation sensitizer. Theoretically, an oxygen-carrying perfluorocarbon emulsion combined with oxygen inhalation might be able to increase tumor response by decreasing the relative proportion of hypoxic tumor cells. Twenty-one patients with advanced head and neck malignancies receiving primary radiation therapy were evaluated for treatment-related toxicity. Mucosal reactions and weight loss during treatment in the group of patients who received the perfluorocarbon emulsion and the group who did not were comparable. Late sequelae appeared comparable. No patient in either group who completed radiation therapy required an interruption of the treatment course. We conclude that Fluosol-DA 20% is a tolerated adjunct to primary radiation therapy. Further study is needed to determine whether the agent will improve local/regional tumor control.

Blood Substitutes↗
PubMed1990

Surgery for sinusitis and aspirin triad.

An 11-year retrospective study was conducted to evaluate the surgical treatment of sinusitis in aspirin-triad patients. Twenty-five patients were selected for surgery when their sinus disease and asthma progressed despite intense medical treatment. Sixteen patients had radiographic evidence of severe ethmoid disease, and their initial surgical procedures were limited (i.e., bilateral intranasal ethmoidectomies). Of these 16 patients, 6 required subsequent surgery for recurrent sinusitis. Nine of the 25 patients had radiographic evidence of severe antral, as well as ethmoid, disease. Their initial surgical procedures were radical, i.e., bilateral Caldwell-Luc operations with intranasal and transantral sphenoethmoidectomies. None of these 9 patients required further surgical treatment for control. This review indicates that if antral and sphenoid disease are detected in association with ethmoid involvement, a radical surgical approach is the operation of choice.

Adolescent↗
PubMed1989

Laryngotracheal reconstruction with composite nasal septal cartilage grafts.

The composite nasal septal graft has been used successfully by us to reconstruct patients with high tracheal and laryngotracheal stenosis. We have treated ten patients and have been able to decannulate seven of these patients. When these ten cases are added to the six original cases presented in an earlier report (1981), certain conclusions can be drawn. The success or failure of these procedures, which is judged by the ability to decannulate the patient, appears to be related to the extent of the initial injury. We discuss the indications for the composite nasal septal graft and the use of additional treatment, including stents, steroid injections, dilatations, and flaps. In conclusion, the addition of these ten cases to the original six cases of composite nasal septal grafts now provides the opportunity to review indications and contraindications for the use of this graft in the management of advanced laryngotracheal stenosis.

Adult↗
PubMed1988

Anterior pituitary involvement in Wegener's granulomatosis.

Wegener's granulomatosis rarely involves the pituitary, and is limited to the posterior gland. A young woman developed sinusitis, otitis media, asymptomatic pulmonary density, blindness, and anterior pituitary hormone deficiency over 7 years. Mucosal biopsies showed only chronic necrotizing inflammation without vasculitis. Since her clinical course suggested an atypical presentation of Wegener's granulomatosis, cyclophosphamide was finally added to corticosteroid therapy. All symptoms but monocular blindness and hypopituitarism remitted.

Adrenal Cortex Hormones↗
PubMed1987

Esthesioneuroblastoma masquerading as extramedullary plasmacytoma.

Nine years after biopsy and radiation therapy for an extramedullary plasmacytoma of the nasal cavity, a 64-year-old man developed locally recurrent tumor. Repeat biopsy revealed tumor identical in hematoxylin and eosin stain (H & E) appearance to that found originally, leading to the diagnosis of recurrent extramedullary plasmacytoma. Neither the original tumor or its recurrence demonstrated features characteristic of esthesioneuroblastoma (e.g., nests, rosettes, ganglion cells, or fibrillary background). However, Gremilus staining and neuron specific enolase tests (immunoperoxidase method), done strictly as a teaching exercise, were strongly positive and eventually resulted in an altered diagnosis to esthesioneuroblastoma. This case underscores the difficulty that may be encountered in distinguishing these two pathologic entities of the nasal cavity solely on the basis of H & E staining. In view of differences in staging, evaluation, prognosis, and management, accurate differentiation of these two relatively uncommon tumors of the nasal cavity is of immediate clinical importance. These observations suggest that care should be taken to exclude the possibility of esthesioneuroblastoma before making the histologic diagnosis of extramedullary plasmacytoma of the nasal cavity.

Diagnosis, Differential↗