Search PubMed⌕ Search

Biomedical subjects

S R Cohen

Publications and source records attributed to S R Cohen.

At least 127 records · Page 7Linked to original sources
PubMed1991

Use of the Branemark implant in the cleft palate patient.

This paper describes the clinical and surgical management of a patient presenting with a unilateral alveolar cleft and associated oronasal fistula. After orthodontic expansion of the maxilla, a secondary osseous graft was placed. A single Branemark implant was subsequently utilized to allow for prosthetic restoration of the dental arch. Through case presentation, a detailed course of treatment is outlined that effectively restores the anatomy, integrity, and function of both the alveolar and dental arches.

Adolescent↗
PubMed1991

Eosinophilic fasciitis associated with tryptophan ingestion. A manifestation of eosinophilia-myalgia syndrome.

Recently, the ingestion of tryptophan has been associated with eosinophilia-myalgia syndrome, which is characterized by eosinophilia, myalgias, and several less consistently reported findings. We treated 13 patients who exhibited clinical features of eosinophilic fasciitis who were taking high-dose tryptophan before the onset of clinical symptoms. Twelve patients exhibited eosinophilia, with eosinophil counts ranging from 0.13 to 0.88. The remaining patient was taking oral corticosteroids when her eosinophil count was determined. Eight patients complained of myalgias. Other symptoms included arthralgias, pruritus, cutaneous burning, weakness, fever, rashes, malaise, edema, muscle spasms, and alopecia. 5-Hydroxyindoleacetic acid levels were elevated in four of the eight urine specimens that were tested. Our findings suggest that previously diagnosed cases of eosinophilic fasciitis may represent variants of tryptophan-associated eosinophilia-myalgia syndrome. Derangements in the metabolism of tryptophan may play a role in sclerotic diseases.

Adult↗
PubMed1991

Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management.

A retrospective, multivariate statistical analysis of 129 consecutive nonsyndromic patients undergoing cleft palate repair was performed to document the incidence of postoperative fistulas, to determine their cause, and to review methods of surgical management. Nasal-alveolar fistulas and/or anterior palatal fistulas that were intentionally not repaired were excluded from study. Cleft palate fistulas (CPFs) occurred in 30 of 129 patients (23 percent), although nearly a half were 1 to 2 mm in size. Extent of clefting, as estimated by the Veau classification, was significantly more severe in those patients who developed cleft palate fistula. Type of palate closure also influenced the frequency of cleft palate fistula. Forty-three percent of patients undergoing Wardill-type closures developed cleft palate fistula versus 10, 22, and 0 percent for Furlow, von Langenbeck, and Dorrance style closures, respectively. The fistula rate was similar in patients with (30 percent) and without (25 percent) intravelar veloplasty. Age at palate closure did not significantly affect the rate of fistulization; however, the surgeon performing the initial closure did not have an effect. Thirty-seven percent of patients developed recurrent cleft palate fistulas following initial fistula repair. Recurrence of cleft palate fistulas was not influenced by severity of cleft or type of original palate repair. Following end-stage management, a second cleft palate fistula recurrence occurred in 25 percent of patients. Continued open discussion of results of cleft palate repair is recommended.

Adolescent↗
PubMed1991

Chin disfigurement following removal of alloplastic chin implants.

Insertion and subsequent removal of alloplastic chin implants is not an innocuous procedure, as commonly believed. Ten women, aged 23 to 62 years of age (mean 45 years) are reported in whom severe soft-tissue deformities were observed 6 months to 6 years (mean 32 months) after removal of their implants. Resulting deformities consisted of chin ptosis and bizarre soft-tissue pogonial bunching and dimpling in repose or on animation in 9 of the 10 patients (90 percent). Asymmetrical motion of the lower lip was noted by 5 of the 10 patients. Two patients complained of pain and tenderness over the soft-tissue pogonion. The "bizarre" soft-tissue chin deformities, once established, are virtually uncorrectable. Presently, we recommend serious consideration be given to performing an immediate osseous genioplasty in patients requiring removal of alloplastic chin implants to prevent the evolution of such abnormalities.

Adult↗
PubMed1990

Occlusive hydrocolloid dressings decrease keratinocyte population growth fraction and clinical scale and skin thickness in active psoriatic plaques.

Clinical studies suggest a therapeutic role for occlusion in the treatment of psoriasis. Previous studies, using multiparameter RNA/DNA flow cytometric analysis of epidermal suspensions obtained from active plaques, demonstrated increased keratinocyte growth fraction which reversed with successful medical treatment. Because keratinocyte growth fraction reflected disease activity, it was used in this study in addition to clinical evaluations in order to determine the efficacy of occlusion in the treatment of psoriatic plaques. In each of 9 patients, scale, skin thickness and erythema were compared in one occluded and one control plaque using an analog scale. Both scale and skin thickness, but not erythema, were decreased after 2 weeks of occlusion. However after 10 weeks, no additional differences were seen when compared with assessments made after 2 weeks, suggesting that the benefits of occlusive therapy occurred early. After 10 weeks of occlusion, the keratinocyte growth fraction was significantly decreased in occluded plaques. This study demonstrates that occlusion plays a synergistic role with other therapeutic modalities in ameliorating psoriatic plaques.

Bandages, Hydrocolloid↗
PubMed1990

Reconstruction of late craniofacial deformities after irradiation of the head and face during childhood.

Little is known about the results of surgical management of late craniofacial abnormalities arising after irradiation of the head and face for treatment of childhood cancers. The clinical records of 10 children (4 males and 6 females) who received 4500 to 6500 rads (mean 5160 rads) of craniofacial radiation between birth and 8 years of age (mean 5 years) and who subsequently had reconstructive surgery were reviewed. Six of the 10 patients received orbital radiation, 3 received maxillary-midfacial radiation, and 1 patient underwent radiation to the frontal bone. Histologic tumor types included retinoblastoma (4), rhabdomyosarcoma (3), Ewing's sarcoma (2), and neurofibrosarcoma (1). In addition to radiation, 7 of the 10 patients underwent surgical resection or debulking of their tumors and 6 received adjuvant chemotherapy. All patients presented from 4 to 20 years after treatment (mean 10 years) with varying, but severe degrees of soft-tissue and bony hypoplasia of the irradiated territories. Onlay bone grafting with soft-tissue reconstruction by a combination of local pedicle flaps and dermal-fat grafts was initially performed in 9 patients, and an occipitoparietal bone-flap switch procedure was done in 1 patient. Late follow-up ranged from 11 months to 7.5 years (mean 34 months). A total of 8 secondary procedures were necessary in 4 of the 10 patients (40 percent). Of these 4 patients, major revisions were performed in 3 and minor adjustments in 1. In addition, 2 patients in whom secondary procedures had not been done would benefit from further reconstruction. Therapy for cancer of the head and face during childhood has profound and ongoing effects on the growth of soft tissue and bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

A trilaminar skin coverage technique for treatment of severe degloving injuries of the extremities and torso.

A 60 percent degloving injury involving the torso and lower extremities of an 8-year-old boy is described. Successful management employed the use of a new trilaminar skin coverage technique. With the avulsed flap still attached to its bed, a 0.14-inch split-thickness graft of epithelium and superficial dermis is raised with a power-driven dermatome. From the same harvest site, one level deeper, a second layer consisting of split-thickness dermis (0.14 inch) is taken. Both the first and second layers are meshed and expanded. The remaining degloved flap is excised and, on a sterile bench, defatted to produce a third layer of deep dermis. In our case, this third layer was ultimately lost, but it functioned well as a temporary biologic dressing. Depending on donor-site morbidity, other potential applications of this method (i.e., major burn injuries) may be feasible.

Body Surface Area↗
PubMed1990

Ventral cleft of the larynx: a rare congenital laryngeal defect.

An anterior cleft of the larynx is apparently extremely rare. Only two patients with this defect have been reported in the American literature. The purpose of this paper is to present a child who was aphonic at birth and who was later found to have a congenital anterior cleft of the larynx. The diagnosis is established by the clinical symptoms, direct laryngoscopic examination, and radiographic studies. While severe voice change is the most prominent symptom of this defect, chronic aspiration is also a disquieting symptom, albeit controllable. The literature is reviewed, and the patient's symptoms and radiographic findings are documented. The clinical course over a period of almost 4 years is discussed.

Child, Preschool↗
PubMed1990

Otitic candidiasis in children: an evaluation of the problem and effectiveness of ketoconazole in 10 patients.

The purpose of this paper is to report a group of children with recurring ear infections in whom persistent otorrhea was found to be due to monilial (Candida) infection of the middle ear. Some of the patients had associated mastoid disease. A review of the literature reveals few reports of otitis media and/or mastoiditis due to Candida infection. Ten patients who had persistent otorrhea were found to have monilial infection as a cause of the ear disease. None of the patients were immunosuppressed or immunocompromised. Nine of the 10 patients (one was lost to follow-up) were treated with antifungal medication, and the effectiveness of ketoconazole therapy is evaluated. None of the children in this series had systemic candidiasis. The probable causes of the problem of yeast infection of the ear are explored and appear to be related to the use of multiple broad-spectrum antibodies and local antibiotic-steroid ear drops.

Candidiasis↗
PubMed1990

Ligneous conjunctivitis: an ophthalmic disease with potentially fatal tracheobronchial obstruction. Laryngeal and tracheobronchial features.

Ligneous conjunctivitis is a rare disease of unknown cause characterized by pseudomembranous, fibrous, woody, plaquelike deposits on the conjunctiva. The disease appears to be hereditary and/or familial. Deposits similar to those found in the eye occur in the larynx, tracheobronchial tree, nose and nasopharynx, and vagina. When these lesions occur in the larynx and tracheobronchial tree, voice change and potentially life-threatening obstruction and pulmonary disease may occur. This paper reports the findings in a child with ligneous conjunctivitis who was followed for 1 1/2 years and who had laryngeal and tracheobronchial involvement with voice change and airway obstruction. The literature is reviewed and the histopathologic findings and endoscopic findings and management of the patient are documented. Because the patient had multiple papillomata of both hands, a possible association with human papillomavirus was suspected but never confirmed.

Airway Obstruction↗
PubMed1990

Humidity effects on corneal hydration.

Overall corneal hydration control expressed as the percent recovery per hour (PRPH) can be assessed with an exponential model that uses data derived from two kinds of corneal thickness measurements; one from monitoring recovery after inducing corneal swelling, and the other from measurements made after the eye has been open long enough to reach its open-eye steady-state (OESS) corneal thickness. Up to now these thickness measurements have been made without controlling the ambient humidity. It is possible that changes in relative humidity may effect tear film osmolarity sufficiently to change the state of corneal hydration. To evaluate the effects of humidity on hydration control, the OESS and PRPH were determined under several humidity levels. For both the OESS and the PRPH, two substudies were conducted. For the OESS, substudy 1 consisted of measuring corneal thickness when humidity was changed from 30% (ambient) to 52 or 97% controlled humidity. This resulted in mean +/- standard deviation (SD) changes in OESS thickness amounting to -0.33 +/- 3.5 microns and 2.6 +/- 3.4 microns, respectively, with a differential change of 2.94 +/- 3.04 microns (95% confidence interval [CI] from 0.77 to 5.11 microns). Corresponding results for substudy 2 connected with changes from 43% (ambient) to 12 or 97% controlled humidity were -2.4 +/- 2.7 microns and -0.3 +/- 1.9 microns, respectively, with a differential change of 2.1 +/- 1.8 microns (95% CI from 0.9 to 3.4 microns).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Hypoxic effects on corneal morphology and function.

Normal corneal metabolism depends on a critical level of oxygen, below which a series of acute corneal responses occur, including an increase in stromal lactate, a reduction in intercellular pH, and an increase in corneal hydration. These acute responses are reversible when normal oxygen is restored; however, it has been shown that chronic exposure to low oxygen levels can result in permanent morphologic changes in the corneal endothelium. Clinicians have expressed concern that these observed structural changes may also be accompanied by alterations in corneal physiology. Whether such effects occur is not known, since it has been difficult to assess human corneal function accurately. Recently, we have developed an in vivo test, able to measure overall corneal hydration control, that can be used to study the effects of hypoxia on corneal function. This test provides information on several characteristics of hydration control, one of which is the percent corneal thickness recovery per hour (PRPH) after inducing corneal swelling. In this study, we assumed that corneal hypoxia accompanies both extended and polymethylmethacrylate (PMMA) contact lens wear and that the dose received is related to the years of past lens wear. Using this paradigm, we explored the relationship of hypoxic dose to an endothelial polymegethism index (EPI), endothelial cell density (ECD), and PRPH in 36 subjects with varying contact lens wearing histories. Based on multiple regression analysis, the relative change (expressed as percent per year) associated with hypoxic dose (adjusted for age and gender) was found to be dose-dependent and corresponded to estimated changes of 1.70%/yr, -0.25%/yr, and -1.26%/yr, with 95% confidence limits of (-0.3, 3.7), (-1.4, 0.9), and (-2.6, 0.06) for EPI, ECD, and PRPH, respectively. These preliminary data suggest that hypoxic exposure alters endothelial morphology and reduces corneal function; however, it is important to indicate that this was a exploratory investigation with several limitations, and that therefore these results should be viewed as preliminary until more definitive studies are completed.

Adolescent↗
PubMed1989

Management of bilateral carotid body tumors and a glomus jugulare tumor in a child.

This paper reports on a 14-year-old female child with bilateral carotid tumors and a glomus jugulare tumor, a rare combination of tumors in any patient and previously unreported in a child. The literature is reviewed and the details of the history, physical findings, results of laboratory tests, and the surgical management of the patient are discussed. The need for an exhaustive preoperative evaluation is stressed so that the proper surgery can be planned. The difficulties of surgical management, the complications, morbidity and potential hazards of surgery in these vascular tumors are presented. The unusual complications that a patient in the pediatric age group encountered as compared to those seen in adults are discussed.

Adolescent↗
PubMed1989

Botulinum toxin for relief of bilateral abductor paralysis of the larynx: histologic study in an animal model.

We previously reported the effectiveness of botulinum toxin injections in the cricothyroid muscle under electromyographic guidance for lateralization of the true vocal cord in the mongrel dog. These additional experiments were performed to substantiate the effectiveness of botulinum toxin injections in laryngeal muscle to overcome airway obstruction produced by bilateral abductor vocal cord paralysis. A predetermined aliquot of the toxin was injected into the cricothyroid muscle of ten dogs, the duration of its effectiveness was noted, and repeated injections were given the animals. Biopsies of the injected muscles were obtained in three of the animals for routine histologic and electron microscopic studies. The effects of the toxin were recorded by cinelaryngoscopy and videotape documentation. In all the dogs, the true vocal cord was lateralized effectively and there was no morbidity, dysphagia, aspiration, or deaths. This study also confirms that the effects of the toxin in the canine larynx are spontaneously reversed and that multiple injections do not cause irreparable damage to the laryngeal muscles.

Airway Obstruction↗
PubMed1988

Anesthesia management of microlaryngeal laser surgery in children: apneic technique anesthesia.

The purpose of this paper is to describe apneic technique general anesthesia which has been used in children for suspension microlaryngoscopy in the nontracheotomized patient. Apneic anesthesia uses a paralyzing drug in combination with controlled ventilation using halothane or isoflurane, nitrous oxide and oxygen, delivered through an endotracheal tube. Patients are monitored throughout the procedure with end-tidal CO2 levels and a cutaneous oximeter. Surgery is performed without the impediment of an endotracheal tube. This method, used in 240 patients ranging in age from 3 months to 18 years, eliminates the danger of a laser fire, gives an unobstructed view of the larynx, is safe, and is free of complications. All outpatients were discharged from the hospital within a few hours after the surgical procedure.

Anesthesia, General↗