Biomedical subjects

Welby Winstead

Publications and source records attributed to Welby Winstead.

6 recordsLinked to original sources

PubMed2006

Double-blind, placebo-controlled trial with single-dose pantoprazole for laryngopharyngeal reflux.

OBJECTIVES: Results of randomized treatment trials for laryngopharyngeal reflux (LPR) are mixed. The cause and effect between gastroesophageal reflux and laryngeal symptoms remain elusive. AIMS: To determine the efficacy of single-dose pantoprazole in newly diagnosed LPR and to correlate hypopharyngeal reflux with symptom improvement. METHODS: Randomized, double-blind, placebo-controlled trial was performed with a 2-wk run-in, 12-wk treatment period (pantoprazole 40 mg q.a.m. or placebo), and 4-wk follow-up. Study criteria were laryngeal complaints >3 days/wk and a positive triple-sensor pH test. Laryngeal exam was graded using a reflux finding score before and after treatment. Repeat pH test was performed on study drug at week 12. Weekly diaries were kept on symptom severity and global assessment. Total laryngeal symptom score was defined as the sum of six laryngeal symptoms. Mann-Whitney U, Wilcoxon, and Pearson tests were used. RESULTS: Thirty-nine subjects (13 M/26 F, median age 39 yr) were randomized; 35 completed the study. During the treatment period, total laryngeal symptom scores significantly improved compared with pretreatment scores in both study groups, but there were no significant differences between them. Forty percent of pantoprazole group reported adequate relief at week 12, compared with 42% of placebo group (p= 0.89). No significant improvement in hypopharyngeal reflux was found in either study group. There were no significant correlations between laryngeal reflux finding scores and hypopharyngeal reflux episodes with symptom improvement. CONCLUSIONS: Response was similar between single-dose pantoprazole and placebo in newly diagnosed LPR. Our results suggested that laryngeal exam was not useful in following treatment response. Hypopharyngeal reflux may represent acid reflux or artifacts, but is not likely the underlying cause.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2005

Design and implementation of an ambulatory pH monitoring protocol in patients with suspected laryngopharyngeal reflux.

OBJECTIVE/HYPOTHESIS: Adding a hypopharyngeal sensor to esophageal pH monitoring has been advocated for laryngopharyngeal reflux (LPR). However, selecting the proper pH catheter is problematic because esophageal lengths are variable among individuals. OBJECTIVE: To design and implement a new pH monitoring protocol for LPR. STUDY DESIGN/METHODS: Design parameters were defined prospectively: single-probe, triple-sensor pH catheter with sensors located in the hypopharynx (1-3 cm above upper esophageal sphincter) and in proximal and distal esophagus (20 cm and 5 cm above lower esophageal sphincter, respectively). Esophageal lengths were determined in a study population undergoing esophageal manometry. Optimal pH sensor spacings were determined using the least number of catheters to satisfy the design parameters. The protocol was implemented in consecutive subjects with suspected LPR. RESULTS: Distribution of esophageal lengths was determined in 1,043 subjects. In 92% of the study population, three pH catheters (3-15, 6-15, and 9-15 sensor-spacings) would satisfy the design criteria. Forty-one subjects with suspected LPR underwent the pH protocol. An abnormal pH test was found in 40 subjects (98%) with triple-sensor combination compared with 29 subjects (71%) if only dual esophageal sensors were used. CONCLUSIONS: Single-probe pH monitoring of the hypopharynx and esophagus was feasible. Adding a hypopharyngeal pH sensor increased the detection of abnormal acid reflux more often than traditional dual-sensor esophageal pH monitoring.

Catheterization↗

PubMed2003

Rhinosinusitis.

Rhinosinusitis is one of the most common health care complaints in this country. The burden on affected individuals in terms of decreased productivity, absenteeism from the workplace, and diminished quality of life, when added to the cost of care and the growing public health menace of antibiotic-resistant bacteria, makes rhinosinusitis a serious disease that warrants precise diagnosis and effective therapy. Technologic innovations in endoscopy and imaging have improved understanding of sinus pathophysiology, but diagnosis remains clinical and treatment empiric. Recognized pitfalls in acute rhinosinusitis management are injudicious use of antibiotics and antihistamines. Chronic rhinosinusitis is a complex, multifactorial disorder, not simply an infectious disease. In many patients, noninfectious inflammation and structural problems play an important role. Medical management should include an intranasal corticosteroid in addition to an appropriate antibiotic. Otolaryngology referral is indicated for complications of acute infection, immunocompromised patients, nasal polyps, and chronic rhinosinusitis having substantial effect on quality of life. Modern surgical principles that focus on obstructive pathology in the OMC region are efficacious but rarely curative. Developments in the fields of immunology, molecular biology, and genetics will lead to more effective treatment options.

Acute Disease↗

PubMed2002

Hypopharyngeal pH monitoring artifact in detection of laryngopharyngeal reflux.

Hypopharyngeal pH artifacts have been a concern in the detection of laryngopharyngeal reflux. Our purpose was to analyze and quantify artifacts from dual-sensor hypopharyngeal pH monitoring. In all, 42 hypopharyngeal and 58 esophageal pH studies were reviewed. Type 1 (out of range), type 2 (pH drift), and type 3 (isolated pH drop) artifacts were identified. The proportion of proximal-sensor pH drop to <4 that was artifactual was determined. The median number (range) of artifacts was 1 (0-17) and 2 (0-28) for hypopharyngeal and esophageal pH studies, respectively (P = NS). The median proportion of artifactual pH drop to <4 was 1% (0-84%) and 2% (0-74%) for hypopharyngeal and esophageal pH studies, respectively (P = NS). The diagnosis did not change in any patient after excluding pH artifacts. In all, 19% of the combined 2,432 hypopharyngeal pH drops of <4 were artifacts. In conclusion, hypopharyngeal pH artifacts per study were uncommon but can be prominent in a few patients. One can identify these artifacts and exclude them from analysis.

Artifacts↗

PubMedDate not supplied

The human vomeronasal organ: part IV. Incidence, topography, endoscopy, and ultrastructure of the nasopalatine recess, nasopalatine fossa, and vomeronasal organ.

BACKGROUND: Previous reports on the human vomeronasal organ (VNO) have been inconsistent. Observations of fossae on the nasal septum have been reported as the VNO. METHODS: Adult human subjects (210) and cadavers (31) were examined using rigid nasal endoscopy, serial histology, and biopsy ultrastructure (5). RESULTS: The nasopalatine fossa (NPF) and the nasopalatine recess (NPR) are discrete, but variable, structures located adjacent to the VNO region. The NPF is not a vomeronasal pit. A septal mucosal pit could hide the vomeronasal duct opening. The VNO is a submucosal structure located 2-8 mm superior to the NPR and cannot be positively identified either macroscopically or endoscopically. CONCLUSION: The VNO has long been mistaken for the NPF and septal mucosal pits. We show that serial histology is the correct method for identifying the VNO.

Chemoreceptor Cells↗

PubMedDate not supplied

Endoscopic biopsy of human olfactory epithelium as a source of progenitor cells.

BACKGROUND: The adult central nervous system contains progenitor cells; however, invasive surgery is required for their harvest. Olfactory neuroepithelium (ONe) has attracted attention because it is extracranial and contains progenitor cells that account for its regenerative capacity. Olfactory progenitor cells have been cultured from postmortem ONe. Our aim was to determine if olfactory progenitors could be obtained via biopsy from patients in a feasible, effective, and safe manner. METHODS: Endoscopic biopsy was performed on individuals undergoing sinus surgery (n = 42). Olfactory function was assessed pre- and postoperatively. Specimens were cultured under conditions for olfactory progenitor cell development. RESULTS: Progenitor cells emerged in cultures from 50% of our patients. The superior turbinate, biopsied with cutting punch forceps, gave the highest yield. No adverse impact on olfaction or complications with the biopsy were observed. CONCLUSION: Endoscopic biopsy of ONe for obtaining olfactory progenitor cells from living donors is feasible, effective, and safe.

Adolescent↗