24 research outputs found
Review articles : Extracorporeal membrane oxygenation (ECMO): prolonged bedside cardiopulmonary bypass
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68988/2/10.1177_026765919000500402.pd
Extracorporeal life support in critical care medicine
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28857/1/0000692.pd
Analysis of histamine as a hair-cell transmitter in the lateral line of Xenopus laevis
The actions of histamine and histamine antagonists on afferent nerve activity were investigated in the lateral line of Xenopus laevis. Histamine (0.002-2.0 mM) had no effect on spontaneous activity or excitatory responses to water motion. In contrast, pyrilamine, an H1 receptor antagonist, suppressed spontaneous activity beginning at 0.01-0.05 mM. Below 0.3 mM the suppression was often preceded by a small excitatory response and responses to high (24-30 dB re threshold), but not low (0-18 dB) levels of water motion were selectively suppressed. Higher concentrations (0.3-2.0 mM) abolished spontaneous activity and suppressed responses at all levels of water motion. Cimetidine, an H2 receptor antagonist, had similar actions but was one-tenth as potent as pyrilamine. Tetrodotoxin (0.001-0.1 [mu]M), which blocks voltage-sensitive Na+ channels, mimicked the suppressive effects of the histamine antagonists. Histamine (2.0 mM) failed to block the actions of pyrilamine (0.1 mM) indicating its effects are mediated through a mechanism other than histamine receptors. In addition, pyrilamine (0.05-0.1 mM) non-selectively suppressed excitation to exogenously applied -glutamate (1.0-2.0 mM), -aspartate (1.0-2.0 mM), kainate (0.005-0.01 mM), and quisqualate (0.002-0.005 mM) and altered responses to (0.5-1.0 mM). The results are inconsistent with histamine being a transmitter in the Xenopus lateral line and reveal that the actions of histamine antagonists are nonspecific, possibly due, in part, to blockade of voltage-sensitive Na+ channels.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28027/1/0000465.pd
Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadImportance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research.
Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease.
Design, setting, and participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook.
Main outcomes and measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications.
Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk.
Conclusions and relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.Patient-Centered Outcomes Research Institute - PCOR
Expert System-Type Approach to Voice Disorders: Scheduling Botulinum Toxin Treatment for Adductor Spasmodic Dysphonia
One of the most debilitating disorders is adductor spasmodic dysphonia (ADSD), a voice disorder caused by involuntary movements of the muscles of the larynx (voice box). For treating ADSD, botulinum toxin (BT) injections turned out to be very useful. However, the effects of BT are highly variable, so at present, there is no objective criterion of when such a BT treatment is necessary. It is therefore desirable to develop such a criterion.
In this paper, we show that traditional statistical techniques are unable to generate such a criterion, while a natural expert system approach seems to be capable of generating reasonably simple rules that determine when a BT treatment is necessary
Expert System-Type Approach to Voice Disorders Paper: jc*-**-**-**** Expert System-Type Approach to Voice Disorders: Scheduling Botulinum Toxin Treatment for Adductor Spasmodic Dysphonia
One of the most debilitating disorders is adductor spasmodic dysphonia (ADSD), a voice disorder caused by involuntary movements of the muscles of the larynx (voice box). For treating ADSD, botulinum toxin (BT) injections turned out to be very useful. However, the effects of BT are highly variable, so at present, there is no objective criterion of when such a BT treatment is necessary. It is therefore desirable to develop such a criterion. In this paper, we show that traditional statistical techniques are unable to generate such a criterion, while a natural expert system approach seems to be capable of generating reasonably simple rules that determine when a BT treatment is necessary
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COMPLICATIONS OF ALLODERM AND DERMAMATRIX FOR PAROTIDECTOMY RECONSTRUCTION
Background. AlloDerm and DermaMatrix are 2 acellular dermal implants currently used by reconstructive surgeons at our institution for reconstruction of parotidectomy defects. We looked at the postoperative complication rates following subcutaneous implantation of these acellular dermal implants for parotid bed reconstruction.
Methods. A retrospective analysis was conducted following approval by the Institutional Review Board at Vanderbilt University Medical Center. All parotid and reconstructive operations were performed between 2001 and 2009 by 1 of 4 surgeons in the Department of Otolaryngology-Head and Neck Surgery. Data were collected to determine operative variables and postoperative course. Operative variables assessed were tumor type, type of implant used, type of parotidectomy (total or subtotal), and duration of Jackson Pratt (JP) drain placement.
Results. One hundred patients were analyzed. Sixty-nine AlloDerm implants were associated with 5 complications (7%), whereas 31 DermaMatrix implants were associated with 8 complications (26%) (p = .0107). When comparing total parotidectomies, the complication rate was 1 of 20 for AlloDerm (5%) and 1 of 12 for DermaMatrix (8%) (p = .7061). When looking at subtotal parotidectomies, the incidence of complications was found to be 4 of 49 for AlloDerm (8%) and 7 of 19 for DermaMatrix (37%) (p = .004).
Conclusions. Our study suggests that DermaMatrix was associated with increased postoperative complications compared to AlloDerm, especially in the subset of patients undergoing subtotal parotidectomy. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 88-93, 201