Maziar Sadri - Academia.edu (original) (raw)

Papers by Maziar Sadri

Journal of Stem Cell Research & Therapy, 2012

Despite remarkable progress in medical and surgical therapy for heart disease, congestive heart f... more Despite remarkable progress in medical and surgical therapy for heart disease, congestive heart failure (CHF) and coronary artery disease (CAD) are leading causes of morbidity and mortality in the United States. Although implantation of a left ventricular assist device has recently emerged as a promising therapy for CHF, no other therapy holds as much promise for the treatment of patients suffering from cardiovascular disease other than cardiac regeneration. In this regard, there are substantial pre-clinical and clinical studies that have elucidated the safety and efficacy of cardiac stem cell-based therapy using a variety of cell lines to promote regeneration of the heart. In spite of promising results in both animal and human studies, the exact fate of these administered stem cells within the human heart is poorly understood as is the mechanism by which they promote myocardial recovery and regeneration. These limitations of our current knowledge base can be considered a critical issue limiting widespread application of stem cell-based therapy.

Circulation, 2014

Introduction: LVADs are now used as a bridge to heart transplantation, or destination therapy in ... more Introduction: LVADs are now used as a bridge to heart transplantation, or destination therapy in patients with advanced heart failure. LVAD therapy reverses left ventricular (LV) remodeling and improves survival in 50% of patients. Hypothesis: We hypothesize that patients with poor prognosis after LVAD therapy will have a different genomic profile as compared to patients with higher survival rate. We propose to use genome-wide expression analysis to determine the mRNA and microRNA profiling of LV tissue and peripheral blood and identify probes that predicts outcome in patients receiving LVAD therapy. Methods: Genome-wide RNA expression profiling of the LV apex core tissue, and blood samples of patients receiving LVAD were performed using Illumina HumanHT-12 v4 Expression BeadChip, to study the expression of 47000 mRNA and micro-RNA transcripts. Follow up echocardiographic parameters were used to determine the patients’ clinical response to LVAD therapy. We proposed that ≥10% reducti...

J Stem Cell Res Ther …, 2011

Page 1. Open Access Review Article Stem Cell Research & Therapy Sadri et al., J Stem Cell Res... more Page 1. Open Access Review Article Stem Cell Research & Therapy Sadri et al., J Stem Cell Res Ther 2011, S1 http://dx.doi.org/10.4172/2157-7633.S1-003 J Stem Cell Res Ther ISSN:2157-7633 JSCRT, an open access journal Cardiovascular Cell Therapy ...

The Ocular Surface, 2012

Ocular surface disorders are frequently encountered in patients in Intensive Care Units (ICUs). B... more Ocular surface disorders are frequently encountered in patients in Intensive Care Units (ICUs). Because of significant impairment of major organs, treatment is focused on the management of organ failures. Therefore, ophthalmological complications are frequently overlooked in this setting. To identify the types and frequencies of ocular surface disorders reported in patients in ICUs, a literature review using the keywords: Intensive Care; Eye care; ICU; ITU; Ophthalmological disorders; Eye disorders was performed. The databases of CINAHL, PUBMED, EMBASE and COCHRANE library were searched. The higher quality papers are summarized in tables with statements of methodology to clarify the level of evidence. The most prevalent ocular disorders identified in ICU patients were exposure keratopathy (3.6% to 60%), chemosis (9% to 80%), and microbial keratitis. Of the various eye care measures that have been advocated to prevent exposure keratopathy, the most effective is the application of moisture chambers or polyethylene covers. Early diagnosis and effective treatment will help to prevent microbial keratitis and visual loss.

The Ocular Surface, 2013

Corneal abrasion is the most common ophthalmologic complication that occurs during general anesth... more Corneal abrasion is the most common ophthalmologic complication that occurs during general anesthesia for nonocular surgery. Such abrasions can be caused by a variety of mechanisms and can lead to sight-threatening microbial keratitis and permanent scarring. There is no standard mode of protecting the cornea during general anesthesia for nonocular surgery. Methods described in the literature are not entirely effective and may be associated with unwanted side effects. Taping alone provides protection that is equivalent or superior to other interventions and has fewer side effects. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia. Recently, the application of Geliperm and bio-occlusive dressings has been advocated. Geliperm may be particularly useful during endonasal surgery when continuous perioperative observation of the eye is required. In this article, the literature on the etiology of perioperative corneal abrasions is reviewed and various protection strategies are compared in order to identify the best methods to prevent corneal abrasions during general anesthesia.

The Journal of Laryngology & Otology, 2006

Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as ... more Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as the principal identifiable aetiological factor, the last two decades have seen publications investigating a potential role for gastroesophageal reflux, gastrectomy and human papilloma virus. Furthermore, there have been major advances in our understanding of the molecular biology of cancer and premalignancy. Accompanying this increased understanding, significant efforts have been made to correlate the expression of molecular markers with the clinical course of premalignant laryngeal lesions. This review summarizes current knowledge of the aetiological factors and molecular biology of laryngeal premalignancy. All aetiological factors, including molecular markers, are discussed separately and their possible role in the clinical course of these lesions is discussed.

Journal of Critical Care, 2012

Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Gr... more Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Grixti et al. Ocul Surf 2012;10(1):26-42). However, eye care is often overlooked in the critical care setting or just limited to the ocular surface because treatment is focussed on the management of organ failures. Lack of awareness about other less common intraocular sight-threatening conditions may have a devastating effect on the patient's vision. To identify specific, frequently missed uncommon ocular disorders in ICU, a literature review using the keywords "Intensive Care," "Eye care," "ITU," "ICU," "Ophthalmological disorders," "Eye disorders" was performed. The databases of CINAHL, PuBMed, EMBASE, and Cochrane library were searched. The higher quality studies are summarized in the table with statements of methodology to clarify the level of evidence. The most prevalent ophthalmologic disorders identified in critically ill subjects include exposure keratopathy, chemosis, and microbial keratitis. In addition, uncommon eye disorders reported in ICU include metastatic endogenous endophthalmitis, acute primary angle closure, ischemic optic neuropathy, pupil abnormalities, vascular occlusions, and rhino-orbital cerebral mucormycosis. Early diagnosis and effective treatment will help to prevent visual loss.

JACC: Cardiovascular Interventions, 2013

Background: Success of percutaneous coronary interventions (PCI) through Transradial access (TRA)... more Background: Success of percutaneous coronary interventions (PCI) through Transradial access (TRA) relies on capable guiding catheters (GC). The GC's performance is partly driven by its distal shape. Most of the actual shapes address the problem of the back up support through optimized contact with the aortic ascending wall. Aim: Through a shape modification in the shaft of existing GC, we tried to add a pendular effect, in order to make easier and safer the re-cannulation of coronary artery (CA) ostium. We tested the modification for GC used for left and right CA via right TRA, as for right CA via left TRA. The present communication reports the results of a modified GC aimed at RCA-PCI via right TRA. Methods: The new shape was added to the actual 6F Heartrail™ II GC from Terumo and the catheter was tested on 46 consecutive patients requiring RCA PCI through 6F TRA. The catheter's performance was scored on a scale of 5 for ease of RCA cannulation ("friendly"), degree of support and level of safety (well aligned in the centre of the lumen's artery, no induced wall damage). Presence of a pendular effect, fluoroscopy time, volume of contrast used and, crossover to another GC were recorded. Level of difficulty of the PCI was evaluated as "easy" or difficult using a scoring system based on patient, aorta, coronary anatomy and lesions characteristics. Results: PCI was successful for 45 patients (one patient left with partial revascularization). 6 GC crossovers happened (to 3 RRAD and 3 AL1 curves). Ease of RCA cannulation was graded Ն 3/5 for only 29 cases. For the 40 successful PCI with the new GC shape, degree of support and safety were respectively scored at 4,62 and 4,75/5. A pendulum-like effect was present for half of the cases. For the 22 PCIs classified as difficult, the crossover occurred for 3, support and safety remain at 4,2 and 4,5/5. The pendulum effect was detected for 14 (63%) of the 22 difficult cases but only for 8 of the 24 easy PCI (33%). There was no complication. Conclusion: A pendulum-like effect was visible in 63 % of the difficult PCI. The GC shape modification provided a good support, allowing successful PCI for 40 of the 46 cases, and for 19 of the 22 difficult RCA cases. Further modifications are required for enhancing the ease of RCA cannulation.

International Orthopaedics, 2008

The purpose of this study was to evaluate the changes in alignment during the course of treatment... more The purpose of this study was to evaluate the changes in alignment during the course of treatment for extra-articular distal radius fracture and the relationship of initial and intermediate radiographs, with the final radiograph taken at fracture union. A cohort of 96 consecutive patients who were conservatively managed for extra-articular distal radius fracture in an 18-month period was undertaken. The radiographs analysed were taken at prereduction, postreduction, a week later and at fracture union. The radiological parameters analysed were radial tilt, radial length, radial inclination, dorsal comminution and ulnar styloid fracture. There was a significant change in radiographic alignment between initial and immediate postreduction radiographs, and between postreduction 1 week later radiographs (p < 0.05), but the number of patients in the 1 week later and fracture union groups remained similar (p > 0.05). All patients with poor radiological outcome had ulnar styloid fractures. This was also associated with dorsal comminution in 86% of patients. Patients with satisfactory radiological outcome had ulnar styloid fracture and comminution in 34% and 43% of patients respectively. The final radiological outcome was not found to be influenced by initial unsatisfactory alignment of radial tilt, radial length and radial inclination individually or in combination. We suggest that two clinic visits after initial reduction of the fracture should be sufficient to manage such injuries; the first visit 1 week after manipulation to detect unacceptable displacement and if found satisfactory, the last visit at fracture union for final review, advice and referral to physiotherapy.

International Orthopaedics, 2008

The purpose of this study was to evaluate the relationship between radiological and functional re... more The purpose of this study was to evaluate the relationship between radiological and functional results in patients with extra-articular fractures of the distal radius. We conducted a prospective study of radiological and functional assessment in 95 consecutively selected extra-articular distal radius fractures. There were two patient groups: more than 60 and less than 60 years of age. The final fracture union radiographs were analysed for their functional outcome using the Michigan Hand Outcomes Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. In patients with acceptable radiological results, 62% (MHQ group) and 72% (DASH group) of patients had satisfactory functional outcome. Analysing patients with satisfactory functional results, 56% (MHQ group) and 59% (DASH group) had satisfactory radiological results. There was a higher proportion of patients with better functional results, despite poor radiological results, in both of the age groups. There was a statistically significant correlation between satisfactory radial tilt and functional outcome in the younger patients. In the older age group, patients with satisfactory radiological results had satisfactory functional outcome (p<0.05). However, in the older age group, satisfactory functional results were achieved, despite unsatisfactory radiological results.

Otolaryngology-head and Neck Surgery, 2005

evaluate the effect of topical anesthesia administered to the superior aspect of the vocal folds ... more evaluate the effect of topical anesthesia administered to the superior aspect of the vocal folds via a channeled flexible nasoendoscope on symptoms in patients with spasmodic dysphonia (SD).

European Archives of Oto-Rhino-Laryngology, 2006

Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a... more Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a significant number of patients with the condition progress to invasive carcinoma. In the recent years, new diagnostic techniques such as autofluorescence and contact endoscopy have been applied to increase the accuracy of the laryngeal biopsies. Moreover, significant efforts have been made to correlate the histopathological appearance of the dysplastic samples to their clinical course. So far, a wide range of therapeutic strategies for different grades of dysplasia has been suggested by authors; however, there is a lack of outcome reviews. In the current review, the outcome of different therapeutic strategies for severe dysplasia and carcinoma in situ has been compared with statistical analysis. The paper also summarises the current knowledge of the alternative management methods as well as current areas of research in the chemoprevention of the condition. (1) Significant efforts have been made to develop new techniques to improve the accuracy of microlaryngoscopic assessment of laryngeal premalignancy. Comparative studies are required using microlaryngoscopy against the new techniques to evaluate their clinical utility. (2) The meta-analysis suggests a better local control rate with radiotherapy compared to other standard methods of management of dysplasia; however, functional impairment and complications associated with each of the standard treatments should be further evaluated.

European Archives of Oto-Rhino-Laryngology, 2006

To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequen... more To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequential cases of intractable epistaxis that underwent embolisation in our centre were evaluated retrospectively and interviewed over the phone. All patients had several failed treatment modalities prior to embolisation. Patients' follow up ranged from 1 to 57 months with median of 26 months. All 14 cases underwent a single embolisation procedure with successful arrest of epistaxis. Four cases (29%) developed recurrent epistaxis at a later date. One (7%) required re-embolisation 19 months after his first procedure. One bled 17 days after embolisation, but this settled with hospital admission and Bismuth Iodoform Paraffin Paste packing. The other two developed minor episodes of epistaxis, which did not require hospital admission. Two patients developed local ischaemic complications following arterial embolisation. Of those, one developed necrosis of the left alar skin and cartilage that healed reasonably well after 5 months. The other case developed mucosal necrosis of the right side of the hard palate; this patient was the one who bled 17 days post-embolisation. The palatal necrosis healed in a satisfactory manner without causing any functional impairment of the oral cavity. Embolisation is a successful intervention in management of persistent epistaxis, when other interventions fail. The risks of major complications such as stroke are well known, and discussed with patients prior to the procedure. It is also important to discuss the risks of ischaemic damage to the face and oral cavity. In our experience, these complications have been minor and the benefits still outweigh the complications.

Diamond and Related Materials, 1997

Auris Nasus Larynx, 2006

We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequen... more We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequent large granuloma formation resulting in dysphonia and stridor. The patient underwent emergency excision of the obstructive granuloma and speech therapy was started post-operatively. A few weeks after surgery, the granuloma started to recur and laryngeal manipulation by a specialist osteopath was performed. A few weeks after the conservative management, the recurred granuloma resolved completely and patient's voice improved remarkably. Dislocation of the arytenoid cartilage due to blunt trauma is relatively rare and a consequent spontaneous granuloma formation has not been reported so far in the literature. This is also the first report about efficacy of speech therapy combined with laryngeal manipulation in the management of the arytenoid dislocation and the subsequent laryngeal granuloma.

Audiology and Neurotology, 2007

We aimed to investigate the incidence of false alarms that occurred with the pass/fail criteria u... more We aimed to investigate the incidence of false alarms that occurred with the pass/fail criteria used in a published series of neonatal hearing screening programmes, as a function of age. We analysed the database of 19137 normally hearing babies (38274 ears) tested in the Wessex Universal Neonatal Hearing Screening Project. Otoacoustic emissions were recorded prior to discharge from maternity units, using IL088 equipment. We assessed the pass/fail rate using the Wessex criteria and 10 other pass/fail criteria published in the literature. Using Pearson's correlation coefficient, a statistically significant correlation between signal-to-noise ratio at each of the frequency bands 1, 2, 3, 4 and 5 kHz and babies' age in hours at the 0.01 level was identified. The correlation was also significant (0.01 level) between age and frequency reproducibility in each of the bands at 1, 2, 3, 4 and 5 kHz as well as the whole reproducibility. The number of false alarms reduced significantly after the first 24 h of life with all the criteria examined. We conclude that in the first hours after birth due to insufficient maturation of the otoacoustic emission, there is a high rate of false alarms. This increase in the false alarm rate, whilst dependent on the criteria used, occurs with all criteria. This leads to the consideration of whether the establishment of age-dependent pass/fail criteria could reduce the false alarm rate and the subsequent strain on diagnostic centres.

Acta Oto-laryngologica, 2007

A significant reduction in post-tonsillectomy secondary haemorrhage rate was observed after cobla... more A significant reduction in post-tonsillectomy secondary haemorrhage rate was observed after coblation tonsillectomy was abandoned in our department. Comparison of the postoperative haemorrhage rate following coblation tonsillectomy and routine dissection tonsillectomy. This was a retrospective study. In the first audit period, 441 sequential tonsillectomies between January and September 2002 were reviewed. Coblation was compared with cold steel and diathermy dissection with either ties and/or diathermy used for haemostasis. Coblation tonsillectomy was subsequently abandoned in our unit and, in the second audit period, all tonsillectomies (n=416) between July 2003 and August 2004 were included. Statistical analysis was performed using the chi2 test. The overall primary haemorrhage rate in the first audit cycle was 1.8% (8/441). In the second cycle with no coblation procedures, 1.4% of patients (6/416) suffered from primary haemorrhage (c.f. 8/441 (1.8%) in the first cycle, p=0.666). Secondary haemorrhage, was seen among 15.4% of patients (68/441) in the first audit cycle. In the second cycle, after coblation was discontinued, the secondary haemorrhage rate fell significantly (p<0.001) to 5.8% (24/416). A breakdown of the results of cold steel/diathermy and coblation techniques in both adults and children is also presented.

Circulation, Nov 25, 2014

Journal of Stem Cell Research & Therapy, 2012

Despite remarkable progress in medical and surgical therapy for heart disease, congestive heart f... more Despite remarkable progress in medical and surgical therapy for heart disease, congestive heart failure (CHF) and coronary artery disease (CAD) are leading causes of morbidity and mortality in the United States. Although implantation of a left ventricular assist device has recently emerged as a promising therapy for CHF, no other therapy holds as much promise for the treatment of patients suffering from cardiovascular disease other than cardiac regeneration. In this regard, there are substantial pre-clinical and clinical studies that have elucidated the safety and efficacy of cardiac stem cell-based therapy using a variety of cell lines to promote regeneration of the heart. In spite of promising results in both animal and human studies, the exact fate of these administered stem cells within the human heart is poorly understood as is the mechanism by which they promote myocardial recovery and regeneration. These limitations of our current knowledge base can be considered a critical issue limiting widespread application of stem cell-based therapy.

Circulation, 2014

Introduction: LVADs are now used as a bridge to heart transplantation, or destination therapy in ... more Introduction: LVADs are now used as a bridge to heart transplantation, or destination therapy in patients with advanced heart failure. LVAD therapy reverses left ventricular (LV) remodeling and improves survival in 50% of patients. Hypothesis: We hypothesize that patients with poor prognosis after LVAD therapy will have a different genomic profile as compared to patients with higher survival rate. We propose to use genome-wide expression analysis to determine the mRNA and microRNA profiling of LV tissue and peripheral blood and identify probes that predicts outcome in patients receiving LVAD therapy. Methods: Genome-wide RNA expression profiling of the LV apex core tissue, and blood samples of patients receiving LVAD were performed using Illumina HumanHT-12 v4 Expression BeadChip, to study the expression of 47000 mRNA and micro-RNA transcripts. Follow up echocardiographic parameters were used to determine the patients’ clinical response to LVAD therapy. We proposed that ≥10% reducti...

J Stem Cell Res Ther …, 2011

Page 1. Open Access Review Article Stem Cell Research & Therapy Sadri et al., J Stem Cell Res... more Page 1. Open Access Review Article Stem Cell Research & Therapy Sadri et al., J Stem Cell Res Ther 2011, S1 http://dx.doi.org/10.4172/2157-7633.S1-003 J Stem Cell Res Ther ISSN:2157-7633 JSCRT, an open access journal Cardiovascular Cell Therapy ...

The Ocular Surface, 2012

Ocular surface disorders are frequently encountered in patients in Intensive Care Units (ICUs). B... more Ocular surface disorders are frequently encountered in patients in Intensive Care Units (ICUs). Because of significant impairment of major organs, treatment is focused on the management of organ failures. Therefore, ophthalmological complications are frequently overlooked in this setting. To identify the types and frequencies of ocular surface disorders reported in patients in ICUs, a literature review using the keywords: Intensive Care; Eye care; ICU; ITU; Ophthalmological disorders; Eye disorders was performed. The databases of CINAHL, PUBMED, EMBASE and COCHRANE library were searched. The higher quality papers are summarized in tables with statements of methodology to clarify the level of evidence. The most prevalent ocular disorders identified in ICU patients were exposure keratopathy (3.6% to 60%), chemosis (9% to 80%), and microbial keratitis. Of the various eye care measures that have been advocated to prevent exposure keratopathy, the most effective is the application of moisture chambers or polyethylene covers. Early diagnosis and effective treatment will help to prevent microbial keratitis and visual loss.

The Ocular Surface, 2013

Corneal abrasion is the most common ophthalmologic complication that occurs during general anesth... more Corneal abrasion is the most common ophthalmologic complication that occurs during general anesthesia for nonocular surgery. Such abrasions can be caused by a variety of mechanisms and can lead to sight-threatening microbial keratitis and permanent scarring. There is no standard mode of protecting the cornea during general anesthesia for nonocular surgery. Methods described in the literature are not entirely effective and may be associated with unwanted side effects. Taping alone provides protection that is equivalent or superior to other interventions and has fewer side effects. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia. Recently, the application of Geliperm and bio-occlusive dressings has been advocated. Geliperm may be particularly useful during endonasal surgery when continuous perioperative observation of the eye is required. In this article, the literature on the etiology of perioperative corneal abrasions is reviewed and various protection strategies are compared in order to identify the best methods to prevent corneal abrasions during general anesthesia.

The Journal of Laryngology & Otology, 2006

Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as ... more Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as the principal identifiable aetiological factor, the last two decades have seen publications investigating a potential role for gastroesophageal reflux, gastrectomy and human papilloma virus. Furthermore, there have been major advances in our understanding of the molecular biology of cancer and premalignancy. Accompanying this increased understanding, significant efforts have been made to correlate the expression of molecular markers with the clinical course of premalignant laryngeal lesions. This review summarizes current knowledge of the aetiological factors and molecular biology of laryngeal premalignancy. All aetiological factors, including molecular markers, are discussed separately and their possible role in the clinical course of these lesions is discussed.

Journal of Critical Care, 2012

Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Gr... more Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Grixti et al. Ocul Surf 2012;10(1):26-42). However, eye care is often overlooked in the critical care setting or just limited to the ocular surface because treatment is focussed on the management of organ failures. Lack of awareness about other less common intraocular sight-threatening conditions may have a devastating effect on the patient's vision. To identify specific, frequently missed uncommon ocular disorders in ICU, a literature review using the keywords "Intensive Care," "Eye care," "ITU," "ICU," "Ophthalmological disorders," "Eye disorders" was performed. The databases of CINAHL, PuBMed, EMBASE, and Cochrane library were searched. The higher quality studies are summarized in the table with statements of methodology to clarify the level of evidence. The most prevalent ophthalmologic disorders identified in critically ill subjects include exposure keratopathy, chemosis, and microbial keratitis. In addition, uncommon eye disorders reported in ICU include metastatic endogenous endophthalmitis, acute primary angle closure, ischemic optic neuropathy, pupil abnormalities, vascular occlusions, and rhino-orbital cerebral mucormycosis. Early diagnosis and effective treatment will help to prevent visual loss.

JACC: Cardiovascular Interventions, 2013

Background: Success of percutaneous coronary interventions (PCI) through Transradial access (TRA)... more Background: Success of percutaneous coronary interventions (PCI) through Transradial access (TRA) relies on capable guiding catheters (GC). The GC's performance is partly driven by its distal shape. Most of the actual shapes address the problem of the back up support through optimized contact with the aortic ascending wall. Aim: Through a shape modification in the shaft of existing GC, we tried to add a pendular effect, in order to make easier and safer the re-cannulation of coronary artery (CA) ostium. We tested the modification for GC used for left and right CA via right TRA, as for right CA via left TRA. The present communication reports the results of a modified GC aimed at RCA-PCI via right TRA. Methods: The new shape was added to the actual 6F Heartrail™ II GC from Terumo and the catheter was tested on 46 consecutive patients requiring RCA PCI through 6F TRA. The catheter's performance was scored on a scale of 5 for ease of RCA cannulation ("friendly"), degree of support and level of safety (well aligned in the centre of the lumen's artery, no induced wall damage). Presence of a pendular effect, fluoroscopy time, volume of contrast used and, crossover to another GC were recorded. Level of difficulty of the PCI was evaluated as "easy" or difficult using a scoring system based on patient, aorta, coronary anatomy and lesions characteristics. Results: PCI was successful for 45 patients (one patient left with partial revascularization). 6 GC crossovers happened (to 3 RRAD and 3 AL1 curves). Ease of RCA cannulation was graded Ն 3/5 for only 29 cases. For the 40 successful PCI with the new GC shape, degree of support and safety were respectively scored at 4,62 and 4,75/5. A pendulum-like effect was present for half of the cases. For the 22 PCIs classified as difficult, the crossover occurred for 3, support and safety remain at 4,2 and 4,5/5. The pendulum effect was detected for 14 (63%) of the 22 difficult cases but only for 8 of the 24 easy PCI (33%). There was no complication. Conclusion: A pendulum-like effect was visible in 63 % of the difficult PCI. The GC shape modification provided a good support, allowing successful PCI for 40 of the 46 cases, and for 19 of the 22 difficult RCA cases. Further modifications are required for enhancing the ease of RCA cannulation.

International Orthopaedics, 2008

The purpose of this study was to evaluate the changes in alignment during the course of treatment... more The purpose of this study was to evaluate the changes in alignment during the course of treatment for extra-articular distal radius fracture and the relationship of initial and intermediate radiographs, with the final radiograph taken at fracture union. A cohort of 96 consecutive patients who were conservatively managed for extra-articular distal radius fracture in an 18-month period was undertaken. The radiographs analysed were taken at prereduction, postreduction, a week later and at fracture union. The radiological parameters analysed were radial tilt, radial length, radial inclination, dorsal comminution and ulnar styloid fracture. There was a significant change in radiographic alignment between initial and immediate postreduction radiographs, and between postreduction 1 week later radiographs (p < 0.05), but the number of patients in the 1 week later and fracture union groups remained similar (p > 0.05). All patients with poor radiological outcome had ulnar styloid fractures. This was also associated with dorsal comminution in 86% of patients. Patients with satisfactory radiological outcome had ulnar styloid fracture and comminution in 34% and 43% of patients respectively. The final radiological outcome was not found to be influenced by initial unsatisfactory alignment of radial tilt, radial length and radial inclination individually or in combination. We suggest that two clinic visits after initial reduction of the fracture should be sufficient to manage such injuries; the first visit 1 week after manipulation to detect unacceptable displacement and if found satisfactory, the last visit at fracture union for final review, advice and referral to physiotherapy.

International Orthopaedics, 2008

The purpose of this study was to evaluate the relationship between radiological and functional re... more The purpose of this study was to evaluate the relationship between radiological and functional results in patients with extra-articular fractures of the distal radius. We conducted a prospective study of radiological and functional assessment in 95 consecutively selected extra-articular distal radius fractures. There were two patient groups: more than 60 and less than 60 years of age. The final fracture union radiographs were analysed for their functional outcome using the Michigan Hand Outcomes Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. In patients with acceptable radiological results, 62% (MHQ group) and 72% (DASH group) of patients had satisfactory functional outcome. Analysing patients with satisfactory functional results, 56% (MHQ group) and 59% (DASH group) had satisfactory radiological results. There was a higher proportion of patients with better functional results, despite poor radiological results, in both of the age groups. There was a statistically significant correlation between satisfactory radial tilt and functional outcome in the younger patients. In the older age group, patients with satisfactory radiological results had satisfactory functional outcome (p<0.05). However, in the older age group, satisfactory functional results were achieved, despite unsatisfactory radiological results.

Otolaryngology-head and Neck Surgery, 2005

evaluate the effect of topical anesthesia administered to the superior aspect of the vocal folds ... more evaluate the effect of topical anesthesia administered to the superior aspect of the vocal folds via a channeled flexible nasoendoscope on symptoms in patients with spasmodic dysphonia (SD).

European Archives of Oto-Rhino-Laryngology, 2006

Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a... more Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a significant number of patients with the condition progress to invasive carcinoma. In the recent years, new diagnostic techniques such as autofluorescence and contact endoscopy have been applied to increase the accuracy of the laryngeal biopsies. Moreover, significant efforts have been made to correlate the histopathological appearance of the dysplastic samples to their clinical course. So far, a wide range of therapeutic strategies for different grades of dysplasia has been suggested by authors; however, there is a lack of outcome reviews. In the current review, the outcome of different therapeutic strategies for severe dysplasia and carcinoma in situ has been compared with statistical analysis. The paper also summarises the current knowledge of the alternative management methods as well as current areas of research in the chemoprevention of the condition. (1) Significant efforts have been made to develop new techniques to improve the accuracy of microlaryngoscopic assessment of laryngeal premalignancy. Comparative studies are required using microlaryngoscopy against the new techniques to evaluate their clinical utility. (2) The meta-analysis suggests a better local control rate with radiotherapy compared to other standard methods of management of dysplasia; however, functional impairment and complications associated with each of the standard treatments should be further evaluated.

European Archives of Oto-Rhino-Laryngology, 2006

To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequen... more To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequential cases of intractable epistaxis that underwent embolisation in our centre were evaluated retrospectively and interviewed over the phone. All patients had several failed treatment modalities prior to embolisation. Patients' follow up ranged from 1 to 57 months with median of 26 months. All 14 cases underwent a single embolisation procedure with successful arrest of epistaxis. Four cases (29%) developed recurrent epistaxis at a later date. One (7%) required re-embolisation 19 months after his first procedure. One bled 17 days after embolisation, but this settled with hospital admission and Bismuth Iodoform Paraffin Paste packing. The other two developed minor episodes of epistaxis, which did not require hospital admission. Two patients developed local ischaemic complications following arterial embolisation. Of those, one developed necrosis of the left alar skin and cartilage that healed reasonably well after 5 months. The other case developed mucosal necrosis of the right side of the hard palate; this patient was the one who bled 17 days post-embolisation. The palatal necrosis healed in a satisfactory manner without causing any functional impairment of the oral cavity. Embolisation is a successful intervention in management of persistent epistaxis, when other interventions fail. The risks of major complications such as stroke are well known, and discussed with patients prior to the procedure. It is also important to discuss the risks of ischaemic damage to the face and oral cavity. In our experience, these complications have been minor and the benefits still outweigh the complications.

Diamond and Related Materials, 1997

Auris Nasus Larynx, 2006

We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequen... more We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequent large granuloma formation resulting in dysphonia and stridor. The patient underwent emergency excision of the obstructive granuloma and speech therapy was started post-operatively. A few weeks after surgery, the granuloma started to recur and laryngeal manipulation by a specialist osteopath was performed. A few weeks after the conservative management, the recurred granuloma resolved completely and patient's voice improved remarkably. Dislocation of the arytenoid cartilage due to blunt trauma is relatively rare and a consequent spontaneous granuloma formation has not been reported so far in the literature. This is also the first report about efficacy of speech therapy combined with laryngeal manipulation in the management of the arytenoid dislocation and the subsequent laryngeal granuloma.

Audiology and Neurotology, 2007

We aimed to investigate the incidence of false alarms that occurred with the pass/fail criteria u... more We aimed to investigate the incidence of false alarms that occurred with the pass/fail criteria used in a published series of neonatal hearing screening programmes, as a function of age. We analysed the database of 19137 normally hearing babies (38274 ears) tested in the Wessex Universal Neonatal Hearing Screening Project. Otoacoustic emissions were recorded prior to discharge from maternity units, using IL088 equipment. We assessed the pass/fail rate using the Wessex criteria and 10 other pass/fail criteria published in the literature. Using Pearson's correlation coefficient, a statistically significant correlation between signal-to-noise ratio at each of the frequency bands 1, 2, 3, 4 and 5 kHz and babies' age in hours at the 0.01 level was identified. The correlation was also significant (0.01 level) between age and frequency reproducibility in each of the bands at 1, 2, 3, 4 and 5 kHz as well as the whole reproducibility. The number of false alarms reduced significantly after the first 24 h of life with all the criteria examined. We conclude that in the first hours after birth due to insufficient maturation of the otoacoustic emission, there is a high rate of false alarms. This increase in the false alarm rate, whilst dependent on the criteria used, occurs with all criteria. This leads to the consideration of whether the establishment of age-dependent pass/fail criteria could reduce the false alarm rate and the subsequent strain on diagnostic centres.

Acta Oto-laryngologica, 2007

A significant reduction in post-tonsillectomy secondary haemorrhage rate was observed after cobla... more A significant reduction in post-tonsillectomy secondary haemorrhage rate was observed after coblation tonsillectomy was abandoned in our department. Comparison of the postoperative haemorrhage rate following coblation tonsillectomy and routine dissection tonsillectomy. This was a retrospective study. In the first audit period, 441 sequential tonsillectomies between January and September 2002 were reviewed. Coblation was compared with cold steel and diathermy dissection with either ties and/or diathermy used for haemostasis. Coblation tonsillectomy was subsequently abandoned in our unit and, in the second audit period, all tonsillectomies (n=416) between July 2003 and August 2004 were included. Statistical analysis was performed using the chi2 test. The overall primary haemorrhage rate in the first audit cycle was 1.8% (8/441). In the second cycle with no coblation procedures, 1.4% of patients (6/416) suffered from primary haemorrhage (c.f. 8/441 (1.8%) in the first cycle, p=0.666). Secondary haemorrhage, was seen among 15.4% of patients (68/441) in the first audit cycle. In the second cycle, after coblation was discontinued, the secondary haemorrhage rate fell significantly (p<0.001) to 5.8% (24/416). A breakdown of the results of cold steel/diathermy and coblation techniques in both adults and children is also presented.

Circulation, Nov 25, 2014