Pharyngeal Flap and Sphincterplasty for Velopharyngeal Insufficiency Have Equal Outcome at 1 Year Postoperatively: Results of a Randomized Trial

2005 ◽  
Vol 42 (5) ◽  
pp. 501-511 ◽  
Author(s):  
◽  
Frank Åbyholm ◽  
Linda D'Antonio ◽  
Sally L. Davidson Ward ◽  
Lillian Kjøll ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Randomized Trial ◽  
Surgical Procedures ◽  
Surgical Complications ◽  
Relative Effectiveness ◽  
The United States ◽  
Velopharyngeal Insufficiency ◽  
Significant Difference ◽  
Sphincter Pharyngoplasty ◽  
High Level

Objective The aim of this trial was to compare the relative effectiveness (efficacy and morbidity) of two surgical procedures for correcting velopharyngeal insufficiency (VPI). Design This was an international multicenter randomized trial to study the outcome of two surgical procedures (flap and sphincter pharyngoplasty) for speech, incidence of sleep apnea, and surgical complications. Method Ninety-seven patients 3 to 25 years old with repaired cleft palate and previously identified VPI were enrolled from five centers in the United States, Norway, and the U.K. Data were collected at presurgery, 3 months postsurgery, and 12 months postsurgery for subsequent analysis blind to the procedure. Main outcome measures included perceptual speech parameters, sleep apnea, nasalance measures, endoscopic features, and surgical complications. Results Groups for both surgical procedures achieved a high level of clinical improvement. At 3 months postsurgery, elimination of hypernasal resonance was achieved in twice as many patients after the flap procedure. This reached significance. However, at 12 months postsurgery, no statistically significant difference in outcomes remained between the two procedures for resonance, nasalance, endoscopic outcomes, or surgical complications. Flap and sphincter pharyngoplasty rarely resulted in clinically significant sleep apnea, and no difference was detected between the two procedures in the long-term incidence of sleep apnea. Conclusions Despite strongly held views in the literature concerning the relative effectiveness and safety of flap and sphincter pharyngoplasty, no significant differences were detected 1 year postoperatively.

scholarly journals Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
L. M. Paulson ◽  
C. J. MacArthur ◽  
K. B. Beaulieu ◽  
J. H. Brockman ◽  
H. A. Milczuk
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Speech Intelligibility ◽  
Velopharyngeal Insufficiency ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
History Of

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate.Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance.Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87%) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48%) and staged tonsillectomy prior to pharyngoplasty in 10 (43%). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population.Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

scholarly journals Characterization and Pathogenicity of Stem Blight Complex Isolates Associated with Stem Blight Disease on Vaccinium Species

HortScience ◽  
2019 ◽  
Vol 54 (7) ◽  
pp. 1199-1203
Author(s):  
Ebrahiem M. Babiker ◽  
Stephen J. Stringer ◽  
Hamidou F. Sakhanokho ◽  
Barbara J. Smith ◽  
James J. Polashock
Keyword(s):  
Management Practices ◽  
The United States ◽  
Lesion Length ◽  
Accurate Identification ◽  
Stem Blight ◽  
Significant Difference ◽  
Sequencing Strategy ◽  
Blight Disease ◽  
High Level

Species of Botryosphaeria and Neofusicoccum are major pathogens of blueberry worldwide. Accurate identification of these species is essential for developing effective management practices. A multigene sequencing strategy was used to distinguish between six isolates of stem blight pathogens collected from two different regions of the United States. The temperature growth study revealed that the optimal temperature for growth of five of the tested isolates ranged from 25 to 30 °C, although no significant difference was detected for the growth of Neofusicoccum spp. isolate SD16-86 at 20, 25, 30, and 35 °C. In vitro fungicide assays showed four fungicides, cyprodinil + fludioxonil, propiconazole, pyraclostrobin + boscalid, and azoxystrobin, were effective against the tested isolates with isolate SD16-86 being less sensitive compared with the other isolates. In a detached stem assay, none of 39 blueberry accessions displayed immunity or a high level of resistance to the two tested isolates, and no significant difference in lesion length was detected among the seven tested Vaccinium species inoculated with the two isolates.

Impact of Surgery for Velopharyngeal Insufficiency on Eustachian Tube Function in Children: Pharyngeal Flap Versus Sphincter Pharyngoplasty

2021 ◽  
pp. 105566562199174
Author(s):  
Colin Fuller ◽  
Kesley Brown ◽  
Olivia Speed ◽  
James Gardner ◽  
Ashlen Thomason ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nasal Obstruction ◽  
Eustachian Tube ◽  
Velopharyngeal Insufficiency ◽  
Deletion Syndrome ◽  
Younger Age ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty

Objective: Velopharyngeal insufficiency (VPI) is a common speech disorder in patients with a history of cleft palate (CP) or 22q11.2 deletion syndrome. Pharyngeal flap (PF) and sphincter pharyngoplasty (SP) are 2 common surgeries to treat this disorder by decreasing unwanted nasal air emission and hypernasal resonance. Because Eustachian tube dysfunction (ETD) in patients with CP may be more frequent after surgery for VPI, we examined whether ETD was associated with either type of surgery. Design: Retrospective cohort study. Setting: Children’s hospital-based tertiary referral center. Patients: A total of 225 children with VPI who underwent primary PF (201) or SP (24) between 2006 and 2017. Outcome measures: We examined differences in risk of ETD according to both surgical groups and proxies for postoperative nasal obstruction. These proxies included postoperative resonance measures and development of obstructive sleep apnea (OSA). Results: Both surgical groups had similar preoperative measures, except the PF group had higher hypernasality by PSA. Postoperatively, the PF group demonstrated lower hypernasal resonance by nasometry and PSA. There were no differences between PF and SP groups with regard to ETD. Proxies for postoperative nasal obstruction also were not predictive of postoperative ETD. Degree of CP and younger age were found to be risk factors for ETD. Conclusion: There was no significant difference in the effects of PF and SP on ETD in this study. Neither lower hypernasality nor incidence of OSA had any impact on ETD. Degree of CP and younger age were the only significant risk factors for ETD that this study identified.

Cross-Cultural Comparison of Adolescents' Online Self-Presentation Strategies

2016 ◽  
Vol 6 (3) ◽  
pp. 1-16 ◽  
Author(s):  
Nevfel Boz ◽  
Yalda T. Uhls ◽  
Patricia M. Greenfield
Keyword(s):  
The United States ◽  
Cross Cultural ◽  
Snowball Sampling ◽  
Promotion Strategy ◽  
Self Presentation ◽  
Cross Cultural Comparison ◽  
Significant Difference ◽  
Level Of Use ◽  
High Level ◽  
National Difference

Studying how social network site (SNS) users from different countries present themselves is crucial for inquiring into the dynamics of culture and youth. This study of 100 adolescents age 14-18 (Mage= 15.90, SD = .1.48) was designed to determine whether cultural differences between adolescents in the U.S. and Turkey would manifest themselves in their online self-presentation strategies on Facebook. Snowball sampling was used to reach U.S. and Turkish adolescents (50 participants from each country) who were using Facebook. The study provides novel insights into how adolescents from each country, in relation to its specific cultural framework, display certain kinds of self-presentation strategies. By coding Facebook profiles of adolescents, the authors found that the sharpest cross-cultural contrast was found in the frequency of the self-promotion strategy, which was more frequent in the United States. There was also a significant difference in use of exemplification strategy between the two countries; it was more widely used in Turkey. The high level of the ingratiation strategy in both countries may reflect the importance of “likes” in the Internet culture. There was also a significant cross-national difference in the ingratiation strategy, which U.S. teens used more. Finally, the authors also found a low level of use of the intimidation and supplication strategies in both countries. The study highlights the importance of self-exploration in constructing identities that conform to desirable cultural roles.

Shift Length and Shift Length Preference Among Acute Care Surgeons

2021 ◽  
pp. 000313482110257
Author(s):  
John Kepros ◽  
Susan Haag ◽  
Karen Lewandowski ◽  
Frank Bauer ◽  
Hirra Ali ◽  
...  
Keyword(s):  
Acute Care ◽  
Trauma Center ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Significant Difference ◽  
And Gender ◽  
High Level ◽  
Shift Length

Background Work hour restrictions have been imposed by the Accreditation Council for Graduate Medical Education since 2003 for medical trainees. Many acute care surgeons currently work longer shifts but their preferred shift length is not known. Methods The purpose of this study was to characterize the distribution of the current shift length among trauma and acute care surgeons and to identify the surgeons’ preference for shift length. Data collection included a questionnaire with a national administration. Frequencies and percentages are reported for categorical variables and medians and means with SDs are reported for continuous variables. A chi-square test of independence was performed to examine the relation between call shift choice and trauma center level (level 1 and level II), age, and gender. Results Data from 301 surgeons in 42 states included high-level trauma centers. Assuming the number of trauma surgeons in the United States is 4129, a sample of 301 gives the survey a 5% margin of error. The median age was 43 years (M = 46, SD = 9.44) and 33% were female. Currently, only 23.3% of acute care surgeons work a 12-hour shift, although 72% prefer the shorter shift. The preference for shorter shifts was statistically significant. There was no significant difference between call shift length preference and trauma center level, age, or gender. Conclusion Most surgeons currently work longer than 12-hour shifts. Yet, there was a preference for 12-hour shifts indicating there is a gap between current and preferred shift length. These findings have the potential to substantially impact staffing models.

Abstract 2: Comparative Effectiveness and Safety of Anticoagulant Therapy With Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients With Nonvalvular Atrial Fibrillation

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Gboyega Adeboyeje ◽  
Gosia Sylwestrzak ◽  
Jeff White ◽  
Alan Rosenberg ◽  
Jacob Abarca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Thromboembolic Event ◽  
Relative Effectiveness ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
The United States ◽  
Baseline Risk ◽  
Nonvalvular Atrial Fibrillation ◽  
Significant Difference

Background: The efficacy and safety of novel oral anticoagulants (NOACs) as alternatives to warfarin therapy in nonvalvular atrial fibrillation (NVAF) patients have been studied in randomized trials. Given the increasing use of NOACs, additional data is required to assess the relative effectiveness and safety of anticoagulation with warfarin, dabigatran, apixaban, or rivaroxaban therapy in real-world settings in the United States (U.S). Methods: A retrospective cohort study design was used to analyze data from a U.S. commercial claims database of > 38 million members. Study population included new users of warfarin, dabigatran, apixaban, or rivaroxaban aged ≥ 18 years with ≥ 2 diagnoses of NVAF from November 2010 to February 2015. The primary effectiveness outcome was a composite of thromboembolic event or stroke; the primary safety outcome was major bleeding event requiring hospitalization. Cox proportional hazards models with inverse probability of treatment weighting (IPTW) were used to compare event rates between NOAC and warfarin users, and among NOAC users. Results: In the final NVAF cohort studied, there were 23,431 warfarin, 8,539 dabigatran, 3,689 apixaban, and 8,398 rivaroxaban users. A total of 7,022 primary outcome events and 3,264 safety events were identified. Warfarin users were older than dabigatran, apixaban, or rivaroxaban users (mean: 73 vs 66 vs 69 vs 67 years). After IPTW, all treatment groups were balanced on all baseline risk factors including stroke and bleeding risk. Compared to warfarin, NOAC users had fewer thromboembolic events or strokes: dabigatran (hazard ratio HR, 0.77 [95% CI: 0.72 - 0.82]), apixaban (HR, 0.73 [CI: 0.65 - 0.82]), and rivaroxaban (HR, 0.80 [CI: 0.75 - 0.86]). Additionally, dabigatran ([HR], 0.67 [CI: 0.60 - 0.76]), and apixaban users (HR, 0.52 [CI: 0.41 - 0.67) experienced fewer major bleeding events compared to warfarin users. No significant difference was found in major bleeding risk between rivaroxaban (HR, 1.00 [CI: 0.89 - 1.12]) and warfarin users. All three NOAC groups had similar risks for thromboembolic event or stroke: dabigatran vs rivaroxaban (HR, 0.96 [CI: 0.88 - 1.05]); apixaban vs rivaroxaban (HR, 0.91 [CI: 0.80 - 1.04]); dabigatran vs apixaban (HR, 1.05 [CI: 0.93 - 1.19]). However, compared to rivaroxaban users, major bleeding risk was 33% and 48% lower in dabigatran and apixaban users respectively (HR, 0.67[CI: 0.58 - 0.78]) and HR, 0.52 [CI: 0.40 - 0.68]). Conclusions: Our results demonstrated a lower risk of a thromboembolic event or stroke among dabigatran, apixaban, or rivaroxaban users compared to warfarin users. Among NOACs, risks of a thromboembolic event or stroke were similar. Further studies are needed to clarify the finding of a higher major bleeding risk in warfarin and rivaroxaban users.

Sphincter Pharyngoplasty for Velopharyngeal Dysfunction

2019 ◽  
pp. 535-540
Author(s):  
Donald S. Mowlds ◽  
Raj M. Vyas
Keyword(s):  
Sleep Apnea ◽  
Upper Airway ◽  
Posterior Pharyngeal Wall ◽  
Upper Airway Obstruction ◽  
Velopharyngeal Insufficiency ◽  
Airway Compromise ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Velopharyngeal Closure ◽  
Sphincter Pharyngoplasty

The surgical correction of velopharyngeal insufficiency (VPI) seeks to augment the deficient aspect of the velopharyngeal apparatus. The objective of the sphincter pharyngoplasty is to narrow the velopharyngeal gap transversely by addressing lateral pharyngeal wall motion. Superiorly based lateral palatopharyngeus myomucosal flaps are transposed 90 degrees and inset into the posterior pharyngeal wall mucosa. Following sphincter pharyngoplasty, the patient is monitored overnight for impending airway compromise. If symptomatic VPI persists, repeat diagnostic evaluation is performed. Success is determined by acceptable perceptual oral resonance, adequate velopharyngeal closure on endoscopy, and the absence of upper airway obstruction or sleep apnea.

A randomized trial of one-day vs. three-day buprénorphine inpatient detoxification protocols for heroin dependence

2005 ◽  
Vol 1 (1) ◽  
pp. 31 ◽  
Author(s):  
John A. Hopper, MD ◽  
Joanna Wu, BS ◽  
Wesley Martus, BS ◽  
James D. Pierre, MD
Keyword(s):  
Randomized Trial ◽  
Treatment Program ◽  
The United States ◽  
Community Treatment ◽  
High Dose ◽  
Open Label ◽  
Opioid Agonist ◽  
Single High Dose ◽  
Significant Difference ◽  
Opioid Detoxification

Detoxification from opioids remains an important first step in the treatment of many patients with opioid dependence. Several pharmacologic regimens have been used for opioid detoxification. In the United States, the partial p-opioid agonist, buprenorphine (BUP) is the most recently approved pharmacotherapy for opioid detoxification and replacement. The literature in recent years has described detoxification protocols using a single high dose of BUP and a three-day BUP regimen. In many settings, such as drug-free programs, a single-dose detoxification protocol would be of significant benefit. There have been no prior studies comparing one-day and three-day BUP-assisted opioid withdrawal.In this pilot study, we conducted an open-label, randomized trial of one-day vs. three-day BUP/naloxone sublingual tablet-assisted opioid withdrawal. Twenty patients from a therapeutic community treatment program were randomly assigned to receive either 32 mg sublingual BUP over one hour (one-day group), or 32 mg sublingual BUP over three days (three-day group). Nine of 10 subjects (90percent) in each group completed seven days in the detoxification protocol. There was no statistically significant difference between the two groups in all other outcome variables, including retention in the treatment program, intensity of withdrawal signs and symptoms, amounts of adjunct medications used, and ability to produce opiate-free urine. This study further validates the feasibility of the single high dose of BUP as a rapid detoxification method.

Postoperative monitoring of children with obstructive sleep apnea syndrome

2014 ◽  
Vol 155 (18) ◽  
pp. 703-707 ◽  
Author(s):  
Pálma Benedek ◽  
Gabriella Kiss ◽  
Eszter Csábi ◽  
Gábor Katona
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Preoperative Evaluation ◽  
Sleep Apnea Syndrome ◽  
Study Patient ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Apnea Syndrome

Introduction: Treatment of pediatric obstructive sleep apnea syndrome is surgical. The incidence of postoperative respiratory complications in this population is 5–25%. Aim: The aim of the authors was to present the preoperative evaluation and monitoring procedure elaborated in Heim Pál Children Hospital, Budapest. Method: 142 patients were involved in the study. Patient history was obtained and physical examination was performed in all cases. Thereafter, polysomnography was carried out, the severity of the obstructive sleep apnea syndrome was determined, and the patients underwent tonsilloadenotomy. Results: 45 patients with mild, 50 patients with moderate and 47 patients with severe obstructive sleep apnea syndrome were diagnosed. There was no complication in patients with mild disease, while complications were observed in 6 patients in the moderate group and 24 patients in the severe group (desaturation, apnea, stridor, stop breathing) (p<0.000). In patients with severe obstructive sleep apnea syndrome, no significant difference was noted in preoperative apnoea-hypapnea index (p = 0.23) and in nadir oxygen saturation values (p = 0.73) between patients with and without complication. Conclusions: Patients with severe obstructive sleep apnea syndrome should be treated in hospital where pediatric intensive care unit is available. Orv. Hetil., 2014, 155(18), 703–707.

Effectiveness of Brushing Associated with Oral Irrigation in Maintenance of Peri-Implant Tissues and Overdentures: Clinical Parameters and Patient Satisfaction.

2020 ◽  
Author(s):  
Marcela Moreira Salles ◽  
Viviane de Cássia Oliveira ◽  
Ana Paula Macedo ◽  
Claudia Helena Silva-Lovato ◽  
Helena de Freitas Oliveira Paranhos
Keyword(s):  
Patient Satisfaction ◽  
Analogue Scale ◽  
Ring System ◽  
Complete Dentures ◽  
Gingival Index ◽  
Prosthetic Rehabilitation ◽  
Mean Values ◽  
Probing Depth ◽  
Significant Difference ◽  
High Level

Implant-supported prostheses hygiene and peri-implant tissues health are considered to be predictive factors for successful prosthetic rehabilitation. Therefore, the purpose of this study was to evaluate the effectiveness of brushing associated with oral irrigation measured as biofilm-removing capacity, maintenance of healthy oral tissues, and patient satisfaction. A randomized, crossover clinical trial was conducted with 38 patients who wore conventional maxillary complete dentures and mandibular overdentures retained by the O-ring system. The patients were instructed to use the following hygiene methods for 14 days: mechanical brushing [MB (brush and dentifrice - Control)]; and MB with oral irrigation [WP (Waterpik - Experimental)]. Biofilm-removing capacity and maintenance of healthy oral tissues were evaluated by the Modified Plaque Index (PI), Gingival Index (GI), Probing Depth (PD), and Bleeding on Probing Index (BP) recorded at baseline and after each method. In parallel, patients answered a specific questionnaire using a Visual Analogue Scale after each hygiene method. Data were analyzed by Friedman and Wilcoxon tests (α=0.05). The results showed significantly lower PI, GI, PD, and BP indices after application of the hygiene methods (P&lt;0.001) than those observed at baseline. However, no significant difference was found between MB and WP. The satisfaction questionnaire responses to both methods showed high mean values for all questions, with no statistically significant difference found between the answers given after the use of MB and WP (P&gt;0.05). The findings suggest that WP was effective in reducing PI, GI, PD, and BP indices and provided a high level of patient satisfaction.

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