Yehuda Finkelstein

Antibacterial properties of human amniotic membranes.

Amniotic membranes are widely used in a multitude of surgical applications and have been shown to reduce bacterial counts and promote healing in infected wounds. Antibacterial properties of amniotic fluid are well documented and the presence of many potentially antibacterial factors has been demonstrated. No such factors have yet been found in amniotic membranes. We have applied a direct disc-diffusion susceptibility test to try to establish the possible existence of such a factor. Amniotic membranes did not inhibit five bacterial species when tested at 3 X 10(6) and 3 X 10(8) colony forming units/ml. However, complete growth inhibition of all organisms was seen immediately under the amniotic membrane discs. These results support the hypothesis that the antimicrobial effect of amniotic membranes in vitro is due to their close adherence to the wound surface.

Obsessive-compulsive disorder in patients with velocardiofacial (22q11 deletion) syndrome

The study of neurogenetic microdeletion syndromes provides an insight into the developmental psychopathology of psychiatric disorders. The aim of the study was to evaluate the prevalence of psychiatric disorders, especially obsessive‐compulsive disorder (OCD), in patients with velocardiofacial syndrome (VCFS), a 22q11 microdeletion syndrome. Forty‐three subjects with VCFS of mean age 18.3 ± 10.6 years were comprehensively assessed using semi‐structured psychiatric interview and the Yale–Brown obsessive compulsive scale (Y‐BOCS). Best estimate diagnoses were made on the basis of information gathered from subjects, parents, teachers, and social workers. Fourteen VCFS subjects (32.6%) met the DSM‐IV criteria for OCD. OCD had an early age of onset and generally responded to fluoxetine treatment. It was not related to mental retardation. The most common obsessive‐compulsive symptoms were contamination, aggression, somatic worries, hoarding, repetitive questions, and cleaning. Sixteen of the 43 patients (37.2%) had attention‐deficit/hyperactivity disorder (ADHD), and 7 (16.2%) had psychotic disorder. The results of our study suggest that there is a strong association between VCFS and early‐onset OCD. This finding may be significant in the understanding of the underlying genetic basis of OCD.

The Rising Incidence of Adult Acute Epiglottitis and Epiglottic Abscess

OBJECTIVE To examine preliminary observations that the incidence of adult acute epiglottitis has risen between 1986 and 2000. MATERIALS AND METHODS Demographics, annual and seasonal occurrences, clinical presentation, diagnostic procedures, treatment, airway management, and complications of 116 consecutive adult patients with laryngoscopically confirmed acute epiglottitis are presented. RESULTS The mean annual incidence of acute epiglottitis per 100,000 adults significantly increased from 0.88 (from 1986-1990) to 2.1 (from 1991-1995) and to 3.1 (from 1996-2000) (P <.001). This rise seems to be unrelated to Haemophilus influenzae type b infection but related to miscellaneous pathogenic bacteria. During these periods, the number of epiglottic abscesses increased concomitantly with the rise in the incidence of acute epiglottitis (from 4/14 episodes [29%], to 8/38 [21%], and to 16/66 [24%], respectively), showing a relatively constant ratio between both phenomena (P =.843). Twenty-five patients (21%) underwent airway intervention, 16 because of objective respiratory distress and 9 because of imminent respiratory obstruction. Stepwise logistic regression showed that drooling, diabetes mellitus, rapid onset of symptoms, and abscess formation were associated with airway obstruction. Diverse origins for the epiglottic abscess, either from coalescent epiglottic infection or from mucopyocele of the tongue base, are suggested. CONCLUSIONS A rise in the incidence of acute epiglottitis and a concomitant rise in the number of epiglottic abscesses were established. Although the course of acute epiglottitis is often benign and can be safely treated with a conservative management approach, delayed airway obstruction may develop from a few hours to days after admission.

Uvulopalatopharyngoplasty: Evaluation of postoperative complications, sequelae, and results

A study of 71 patients with obstructive sleep apnea syndrome was performed to evaluate the effectiveness, complications, and late sequelae of uvulo‐palatopharyngoplasty. Postoperative immediate complications were of minor importance. In 96% of the patients, the snoring was improved; it was completely resolved in 48%. The postoperative apnea index remained pathologic in all patients who underwent postoperative polysomnography, although mild improvement was noted. Seventy‐four percent of our patients felt a subjective postoperative improvement which was not always confirmed by the polysomno‐graphic examination. A record of improvement was obtained in 64% of the operated patients. Our results establish the beneficial effect of uvulopalatopharyn‐goplasty, which is the recommended surgical procedure for obstructive sleep apnea syndrome.

Frontal and lateral cephalometry in patients with sleep-disordered breathing

Objectives/Hypothesis The traditional lateral‐view cephalometric analysis is limited because it provides only two‐dimensional analysis of the three‐dimensional craniofacial structure. The objectives were to analyze lateral and frontal cephalometric radiographs in a series of normal patients and those with varying degrees of sleep‐disordered breathing and to define the degrees of narrowing or other unfavorable anatomical changes that might differentiate the patients with sleep‐disordered breathing from normal subjects.

Use of human amniotic membrane in otolaryngologic practice

Human amnion is a readily available allograft with low antigenicity, high antimicrobial potential, and the ability to foster cpithelialization. We have used human amniotic membrane in our department for replacing nasal mucosa in Rendu‐Osler‐Weber disease, as tympanic membrane grafts, and for covering head and neck sites after flap necrosis. Our experience shows moderate success for management of severe epistaxis and excellent results in covering surfaces after flap necrosis.

Levator veli palatini muscle and eustachian tube function.

Thirty previously unoperated patients with submucous cleft palate, occult submucous cleft palate, and unilateral congenital paralysis of the levator veli palatini muscle were examined. All patients were subjected to a comprehensive otoscopic, endoscopic, audiologic, and tympanometric evaluation. A correlation was made between levator veli palatini muscle anomalies, eustachian tube orifice anomalies, and middle ear ventilation and disorders. Normal middle ear ventilation was found in 23 patients. Negative middle ear pressure that consequently normalized following treatment of coexisting sinusitis was found in 3 patients. Only in 4 patients was chronic middle ear disease found. In one of them, middle ear effusion disappeared following successful treatment of sinusitis. Our conclusion is that the levator veli palatini muscle has no significant function in the opening mechanism of the eustachian tube and must be considered as a velopharyngeal valve muscle only.

Reduction of Salivary Flow with Transdermal Scopolamine: A Four-Year Experience

Scopoderm transdermal therapeutic system (TTS) is applied to prevent nausea and vomiting associated with motion sickness. Dry mouth is the most common side effect, appearing in up to two thirds of the patients treated. We have used this side effect to the benefit of patients with sialorrhea or with difficulties swallowing normally secreted amounts of saliva. More than 100 patients with tumors of the aerodigestive tract before and after surgery, and patients after parotidectomies, after tracheotomies, with peritonsillar abscesses, tonsillitis and pharyngitis, and neurologic disorders were thus treated. Reduced secretion of saliva was seen in 50% to 100% of the treatment groups. Other side effects were minimal and we recommend the use of scopoderm TTS for reduction of salivary flow.

Reduction of Salivary Flow with Scopoderm Tts

Scopoderm transdermal therapeutic system (TTS) is a form of application permitting programmed release of scopolamine through the skin into the bloodstream. Scopoderm TTS is indicated for prevention of nausea and vomiting associated with motion sickness. The most common side effect associated with its use is dryness of the mouth. We have been using Scopoderm TTS for reducing salivary flow in patients with sialorrhea or with difficulties in swallowing normal amounts of salivary secretions. Good results were achieved with minimal discomfort from adverse effects. We recommend the use of Scopoderm TTS in selected cases of sialorrhea and drooling, preoperatively and postoperatively in patients undergoing surgery of oral, laryngeal, and pharyngeal lesions.

Speech-aid prostheses for neurogenic velopharyngeal incompetence ☆ ☆☆

STATEMENT OF PROBLEM When surgical treatment is not considered an option, prosthetic management of velopharyngeal insufficiency is carried out by means of a speech-aid prosthesis, whereas velopharyngeal incompetence is traditionally managed by a palatal lift prosthesis. Varying degrees of treatment success have been attributed to palatal lift prostheses. PURPOSE This study introduces the use of nasopharyngeal obturation instead of palatal elevation for the management of velopharyngeal incompetence. METHODS Seven patients afflicted by neurogenic velopharyngeal incompetence were treated with wire-extension speech-aid prostheses constructed to circumvent the dysfunctional soft palate. The shape of the nasopharyngeal section was functionally molded in speech and swallowing and controlled by video-nasopharyngoscopic examinations. RESULTS Effective nasopharyngeal obturation with notable improved speech was achieved in all patients. Even though all patients ultimately tolerated the prostheses well, 2 patients denied any improvement in speech with the finalized prostheses. CONCLUSION Wire-extension speech-aid prostheses used by the patients were an effective treatment approach for velopharyngeal incompetence. Nasopharyngoscopic control is mandatory for maximizing the effect of velopharyngeal closure around the nasopharyngeal section of the prosthesis in function, yet it allows free nasal breathing. Velopharyngeally incompetent patients should be carefully tailored for prosthetic treatment because of contingent noncompliance.