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2.
Laryngoscope ; 110(12): 2033-6, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11129015

ABSTRACT

OBJECTIVE: To examine whether screening chest radiographs lead to significantly longer life span in patients found to have pulmonary lesions than in those in whom lung cancer was detected after symptoms developed. STUDY DESIGN: A retrospective study. MATERIAL AND METHODS: Charts of 1,086 patients with squamous cell cancer of the head and neck treated for cure from January 1, 1974, to December 31, 1998, were analyzed. RESULTS: Pulmonary cancer developed in 62 patients. In 41 patients pulmonary malignancy was found because of patient symptoms. In 21 patients lung cancer was detected by routine annual chest radiography. Seventy-five percent of lung cancers were detected within 3 years of initial treatment of the head and neck cancer. CONCLUSION: Chest radiography is a poor screening tool, because it failed to find pulmonary lesions in more than 65% (41/62) of patients who were later found to have pulmonary cancer. Survival rate did not differ between patients in whom pulmonary cancer was found by screening chest radiography and those in whom symptoms prompted evaluation (P = .48). Using current treatment protocols, routine yearly chest radiography did not improve survival in patients with head and neck cancer. However, there maybe new therapeutic regimens under investigation that would benefit these patients if their lung cancers were found in early stages of disease. Future directives must include the establishment of an effective follow-up protocol for the early detection of lung malignancies in these patients.


Subject(s)
Carcinoma, Squamous Cell/mortality , Head and Neck Neoplasms/mortality , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/mortality , Neoplasms, Multiple Primary/mortality , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Prognosis , Radiography , Retrospective Studies , Survival Analysis
3.
Am J Otolaryngol ; 21(5): 337-9, 2000.
Article in English | MEDLINE | ID: mdl-11032301

ABSTRACT

The presence of air in the temporal regions is an uncommon presentation of spontaneous pneumomediastinum. As terminal alveoli rupture, air dissects along bronchovascular shafts. Usually, air travels either in a superior or inferior direction. Thus, extensive spontaneous subcutaneous emphysema accompanied by both cervical and retroperitoneal emphysema is rarely encountered. We present an unusual case of spontaneous pneumomediastinum, pneumoretroperitoneum, and cervical and facial emphysema presenting as bilateral painless temporal swelling. To our knowledge, this association has not been reported. Treatment involves observation for potentially life-threatening sequelae.


Subject(s)
Mediastinal Emphysema/diagnosis , Subcutaneous Emphysema/diagnosis , Adult , Humans , Male , Mediastinal Emphysema/complications , Subcutaneous Emphysema/complications , Temporal Bone , Tomography, X-Ray Computed
4.
Otolaryngol Head Neck Surg ; 122(2): 168-73, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10652385

ABSTRACT

The human temporal bone is a 3-dimensionally complex anatomic region with many unique qualities that make anatomic teaching and learning difficult. Current teaching tools have proved only partially adequate for the needs of the aspiring otologic surgeon in learning this anatomy. We used a variety of computerized image processing and reconstruction techniques to reconstruct an anatomically accurate 3-dimensional computer model of the human temporal bone from serial histologic sections. The model is viewed with a specialized visualization system that allows it to be manipulated easily in a stereoscopic virtual environment. The model may then be interactively studied from any viewpoint, greatly simplifying the task of conceptualizing and learning this anatomy. The system also provides for simultaneous computer networking that can bring distant participants into a single shared virtual teaching environment. Future directions of the project are discussed.


Subject(s)
Computer Simulation , Computer-Assisted Instruction , Internship and Residency , Otolaryngology/education , Temporal Bone/anatomy & histology , Humans , Image Processing, Computer-Assisted
7.
Am J Otol ; 19(5): 679-84; discussion 684-6, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9752980

ABSTRACT

OBJECTIVE: This study aimed to clarify the indications for elective surgical repair of unilateral aural atresia in children and to review the rates of successful repair in the literature. DATA SOURCES: A search of the published English language literature, 1966-1997, was conducted using the key words aural atresia. STUDY SELECTION: Articles were selected on the basis of their inclusion of the authors' indications for surgical repair of aural atresia or the inclusion of surgical series that showed outcomes. DATA EXTRACTION: Articles reviewed in the review had to either provide specific guidelines for surgical repair of unilateral aural atresia or provide postoperative pure-tone averages, air-bone gaps, or speech reception thresholds. DATA SYNTHESIS: The authors compiled the relevant data into summary tables and extracted conclusions from these data. CONCLUSIONS: Elective surgical repair of unilateral aural atresia should only be attempted in children who meet specific anatomic criteria that predict that they are the most likely to benefit from the results of surgery. Otherwise, repair should be delayed until the age at which the patient can make an informed decision, knowing the risks, benefits, and consequences of this difficult surgery. Parents and surgeons must have a realistic expectation of the surgical results and the practiced benefit to be expected with a normal, contralateral ear.


Subject(s)
Ear/abnormalities , Ear/surgery , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Treatment Outcome
8.
J Immunol ; 160(5): 2418-24, 1998 Mar 01.
Article in English | MEDLINE | ID: mdl-9498785

ABSTRACT

We examined the functional properties of CK beta-11/MIP-3 beta/ELC, a recently reported CC chemokine that specifically binds to a chemokine receptor, EBI1/BLR2/CCR7. CK beta-11/MIP-3 beta/ELC is distantly related to other CC and CXC chemokines in primary amino acid sequence structure. Recombinant human CK beta-11/MIP-3 beta/ELC expressed from a mammalian cell system showed potent chemotactic activity for T cells and B cells but not for granulocytes and monocytes. An optimal concentration of CK beta-11/MIP-3 beta/ELC attracted most input T cells within 3 h, a chemotactic activity comparable with that of stromal cell derived factor 1 (SDF-1), a highly efficacious CXC chemokine. CK beta-11/MIP-3 beta/ELC equally attracted naive CD45RA+ and memory type CD45RO+ T cells. CK beta-11/MIP-3 beta/ELC also strongly attracted both CD4+ and CD8+ T cells, but the attraction for CD4+ T cells was greater. CK beta-11/MIP-3 beta/ELC was also a more efficacious chemoattractant for B cells than MIP-1 alpha, a known B cell chemoattractant. CK beta-11/MIP-3 beta/ELC induced actin polymerization in lymphocytes, and chemotaxis was completely blocked by pertussis toxin showing its receptor, most likely EBI1/BLR2/CCR7, is coupled to a G(alpha i) protein. CK beta-11/MIP-3 beta/ELC induced calcium mobilization in lymphocytes, which could be desensitized by SDF-1, suggesting possible cross-regulation in their signaling. Human CK beta-11/MIP-3 beta/ELC attracted murine splenocytes suggesting functional conservation of CK beta-11/MIP-3 beta/ELC between human and mouse. The efficacy of chemoattraction by CK beta-11/MIP-3 beta/ELC and tissue expression of its mRNA suggest that CK beta-11/MIP-3 beta/ELC may be important in trafficking of T cells in thymus, and T cell and B cell migration to secondary lymphoid organs.


Subject(s)
B-Lymphocytes/physiology , Chemokines, CC , Chemotaxis, Leukocyte/immunology , Macrophage Inflammatory Proteins/physiology , Receptors, Cell Surface/physiology , Receptors, Chemokine , T-Lymphocytes/physiology , Actins/metabolism , Animals , B-Lymphocytes/metabolism , Calcium/metabolism , Chemokine CCL19 , Chemokines/physiology , Chemotaxis, Leukocyte/drug effects , Granulocytes/physiology , Humans , Ligands , Mice , Monocytes/physiology , Pertussis Toxin , Polymers/metabolism , Receptors, CCR7 , Spleen/cytology , T-Lymphocytes/metabolism , Virulence Factors, Bordetella/pharmacology
9.
Stud Health Technol Inform ; 50: 346-52, 1998.
Article in English | MEDLINE | ID: mdl-10180566

ABSTRACT

The human temporal bone is a 3-dimensionally complex portion of the skull that contains delicate and vital anatomic structures imbedded within dense bone. Current teaching tools have proven to be only marginally adequate for the needs of the aspiring otologic surgeon in learning this anatomy. A variety of image processing and reconstruction techniques were used to reconstruct an anatomically accurate 3-dimensional model of the human temporal bone from serial histologic sections. Using CAVE technology, the model can be manipulated in a stereoscopic virtual environment so that it can be studied from any viewpoint, greatly simplifying the task of learning this anatomy. Applications in surgical planning and Internet based teaching are discussed.


Subject(s)
Anatomy/education , Computer-Assisted Instruction , Temporal Bone/anatomy & histology , Computer Communication Networks , Education, Medical, Graduate , General Surgery/education , Humans , Image Processing, Computer-Assisted , Models, Anatomic , Temporal Bone/surgery
11.
J Cell Biochem ; 59(1): 57-68, 1995 Sep.
Article in English | MEDLINE | ID: mdl-8530537

ABSTRACT

Our goal is to examine the synthesis and deposition of corneal glycosaminoglycans (GAGs) in response to a wound created by the insertion of porous discs into stromal interlamellar pockets. The disc and the surrounding stromal tissue were assayed and compared to contralateral control stroma and to sham operated corneas at 14, 42, and 84 days. The tissue and/or discs were removed and labeled with 35S-sulfate for 18 h; GAGs were extracted with 4 M guanidine-HCl. Extracts were chromatographed on Q-Sepharose columns, bound proteoglycans were eluted with a linear salt gradient, and radioactive fractions were analyzed. Total GAG content was determined colorimetrically, using dimethylmethylene blue. Specific GAGs were determined using enzymatic digestion with selective polysaccharide lyases and protein cores were examined using SDS-PAGE. The nonbound fractions from the chromatography were assayed for TGF-beta using Western blot analysis and for hyaluronic acid using an 125I-radiometric assay. Specific GAGs were localized 42 days after the disc had been implanted in the stroma. The placement of the discs into the stroma resulted in a decrease in the total amount of GAG. However, the ratio of dermatan-chondroitin sulfate and heparan sulfate to keratan sulfate increased in the surrounding tissue and disc. Hyaluronic acid was elevated at day 14 in the surrounding tissue, and not until day 84 in the disc. Western blot analysis of surrounding tissue extracts revealed forms of TGF-beta that migrated with an apparent molecular mass of 63 and 43 kDa. The results indicate that the insertion of discs into interlamellar pockets causes changes in the sulfation and proportion of the glycosaminoglycans in the surrounding tissue and the disc. These changes are coincident with the appearance of TGF-beta. After 84 days, the population of glycosaminoglycans in the disc begins to resemble the surrounding stroma. This model will allow us to examine further the synthesis and deposition of proteins following an extensive wound in which cells must migrate to the wound site and then undergo extensive remodeling.


Subject(s)
Cornea/metabolism , Glucuronidase , Glycosaminoglycans/biosynthesis , Wounds and Injuries/metabolism , Animals , Chondroitinases and Chondroitin Lyases/metabolism , Chromatography, Ion Exchange , Corneal Injuries , Glycosaminoglycans/metabolism , Glycoside Hydrolases/metabolism , Hyaluronic Acid/metabolism , Immunohistochemistry , Proteins/metabolism , Rabbits , Transforming Growth Factor beta/metabolism , beta-Galactosidase/metabolism
12.
Laryngoscope ; 104(4): 409-14, 1994 Apr.
Article in English | MEDLINE | ID: mdl-8164478

ABSTRACT

The application of a rapidly vascularized epithelial equivalent that inhibits wound contraction would have great potential in the prevention and repair of tracheal stenosis. An animal model was developed to simulate the effects of circumferential tracheal injury and an autologous epithelial equivalent was created from a fibroblast-collagen matrix and subsequently implanted in the traumatized site in an attempt to prevent stenosis. Postinjury physiologic and histologic evaluation revealed near-normal mucosal flow analysis in the treated sites and an area of less than 20% stenosis versus 95+% in controls. This study's findings indicate that tracheal stenosis can be limited by the use of an epithelial equivalent.


Subject(s)
Skin Transplantation/methods , Trachea/surgery , Tracheal Stenosis/surgery , Animals , Collagen , Culture Techniques , Dogs , Endoscopy , Epithelium/blood supply , Epithelium/transplantation , Fibroblasts , Models, Biological , Mucous Membrane/physiopathology , Trachea/pathology , Trachea/physiopathology , Tracheal Stenosis/pathology , Tracheal Stenosis/physiopathology , Tracheal Stenosis/prevention & control
14.
Am J Otol ; 13(4): 369-71, 1992 Jul.
Article in English | MEDLINE | ID: mdl-1415503

ABSTRACT

Meningeal carcinomatosis is characterized by diffuse infiltration of the leptomeninges by metastatic cancer in patients usually with a previous history of malignancy. Primary tumors are usually adenocarcinomas of the breast or lung, or malignant melanoma. Meningeal carcinomatosis can present with headache and/or a variety of cranial neuropathies. We report a case of meningeal carcinomatosis presenting as a complete, bilateral, sudden hearing loss without other cranial nerve findings--a previously unreported presentation. Our patient also exhibited an unusual primary tumor site (esophagus) and histopathology for meningeal carcinomatosis. The case was impressive for the subsequent abrupt onset of a series of cranial neuropathies and the rapid deterioration in the patient's condition.


Subject(s)
Carcinoma/complications , Esophageal Neoplasms/pathology , Hearing Loss, Bilateral/etiology , Meningeal Neoplasms/complications , Acute Disease , Aged , Carcinoma/diagnosis , Carcinoma/secondary , Humans , Male , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/secondary
15.
Clin Chest Med ; 12(3): 545-53, 1991 Sep.
Article in English | MEDLINE | ID: mdl-1934954

ABSTRACT

Although the operation has been practiced for centuries, the modern technique of tracheotomy was introduced and popularized in the beginning of the 20th century. The initial indication for tracheotomy was limited to impending airway obstruction resulting from trauma, but current indications are broader. Tracheotomy is one of four methods available to intubate the trachea and is associated with physiologic changes that are dependent on the duration of tracheotomy. Although surgical in nature, it is employed to relieve or prevent airway obstruction and to offer ventilatory support. Tracheotomy may be performed as an elective or an emergency procedure. Ideally, it is done in a controlled situation. However, when performed in an emergency setting, variations of the procedure, such as minitracheotomy or cricothyroidotomy, may be temporarily substituted. Preferably, tracheotomy is performed in an operating room; however, it may be carried out successfully in an intensive care unit as well.


Subject(s)
Airway Obstruction/therapy , Tracheotomy/methods , Critical Care , Humans
16.
Laryngoscope ; 101(5): 516-8, 1991 May.
Article in English | MEDLINE | ID: mdl-2030631

ABSTRACT

A 15-year retrospective analysis was carried out at the University of Illinois College of Medicine, Chicago, reviewing the tumor staging and pathology data of 239 patients treated for carcinoma of the larynx and hypopharynx requiring laryngectomy alone, laryngectomy with neck dissection, or laryngopharyngectomy and neck dissection. Surgery was the primary treatment modality in 205 of the 239 cases, with the remaining 34 having surgery to treat radiation therapy failure. Primary tumors were located within the supraglottic region, the glottic region and, less commonly, the pyriform sinus. Ninety-five of the 239 patients either presented with or developed nodal metastases following initial treatment. Of these, only two had tumors within the lymph nodes of the submandibular triangle. This data corroborates impressions that tumors of the larynx and hypopharynx rarely metastasize to the submandibular triangle and that sparing this area during neck dissection for lesions of the larynx would seem justified.


Subject(s)
Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/surgery , Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/surgery , Lymphatic Metastasis , Neck/pathology , Carcinoma, Squamous Cell/pathology , Follow-Up Studies , Humans , Hypopharyngeal Neoplasms/pathology , Laryngeal Neoplasms/pathology , Laryngectomy , Lymph Node Excision , Lymphatic Metastasis/pathology , Neck Dissection , Neoplasm Staging , Pharyngectomy , Retrospective Studies , Survival Rate
18.
Ann Otol Rhinol Laryngol ; 99(10 Pt 1): 801-4, 1990 Oct.
Article in English | MEDLINE | ID: mdl-2221737

ABSTRACT

We investigated the effects of magnetic resonance imaging (MRI) fields on 21 stapedectomy prostheses and other middle ear implants and two different receiver-stimulator modules from 22-channel cochlear implants. None of the middle ear implants was displaced by the magnetic field, except for one platinum-stainless steel stapedectomy piston. Magnetism was not induced in any of the middle ear implants subjected to prolonged exposure in the MRI scanner. We conclude that MRI could pose a hazard to patients who have had stapedectomy using certain platinum-stainless steel piston prostheses and to patients with cochlear implants. Magnetic resonance imaging should pose no hazard to patients who have had the other middle ear implants reported on in this and our previous investigation.


Subject(s)
Cochlear Implants , Magnetic Resonance Imaging , Ossicular Prosthesis , Humans , Metals
19.
Am J Otolaryngol ; 11(5): 332-8, 1990.
Article in English | MEDLINE | ID: mdl-2264585

ABSTRACT

Proton nuclear magnetic resonance spectroscopy was used to evaluate changes in plasma lipoproteins in patients with squamous cell head and neck cancer. Plasma from 14 patients was analyzed by proton nuclear magnetic resonance spectroscopy, and line widths and fast and slow methyl and methylene transverse relaxation values were obtained. In addition, the lipid and lipoprotein concentrations in the sera of these patients were measured by standard biochemical techniques. Preliminary results suggested that squamous cell carcinomas of the head and neck with nodal metastases are associated with measureable changes in slow methylene transverse relaxation values, as compared with controls. These findings indicate the presence of a new lipoprotein complex in patients with squamous cell carcinomas of the head and neck with nodal metastases.


Subject(s)
Carcinoma, Squamous Cell/blood , Head and Neck Neoplasms/blood , Lipoproteins/blood , Magnetic Resonance Spectroscopy , Adult , Aged , Carcinoma, Squamous Cell/pathology , Female , Head and Neck Neoplasms/pathology , Humans , Lipids/blood , Male , Middle Aged , Neoplasm Metastasis
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