Squamous cell carcinoma of the anterior nasal cavity: a dual institution review.

Thirty-two patients with squamous cell carcinoma of the anterior nasal cavity were identified at two university hospitals. A retrospective review was conducted to identify clinical presentation, initial therapy, recurrence rates, and factors affecting survival. Treatment included surgery (n = 15), radiation therapy (n = 9), or combination therapy (n = 8). The primary lesions involved either the septum, vestibule, columella, anterior floor, or a combination of these subsites. The primary tumor involved a single nasal subsite in 22 patients and multiple nasal subsites in 10 patients. All patients had de novo squamous lesions, and all tumors were staged N0 at initial diagnosis. Six patients received prophylactic neck irradiation, and none underwent elective neck dissection. Overall, 18 (56%) patients had recurrent disease after primary therapy (5 local and 13 regional). The 5-year disease-free survival was 42%, and the 5-year overall survival was 50%. None of the patients receiving prophylactic neck irradiation had a regional recurrence. Involvement of 2 or more nasal subsites significantly decreased survival (P < 0.05). Squamous cell carcinoma of the anterior nasal cavity is an aggressive disease, and combined therapy initially with strong consideration for prophylactic radiation to the facial and cervical lymphatics is advocated.

Maxillofacial injuries caused by all-terrain vehicle accidents.

With the rise in popularity of all-terrain vehicles (ATVs), especially in rural America, injuries associated with their use are becoming more commonplace. A retrospective review was conducted of 153 patients with ATV-related injuries seen at West Virginia University Hospitals between January 1990 and June 1996. Of these patients, 33 had maxillofacial injuries. Only 2 of 21 (9.5%) patients noted to be wearing helmets had facial injuries, whereas 17 of 19 (89.5%) patients who had facial injuries were not wearing helmets. Most patients with maxillofacial injuries occurring at night had been drinking alcohol. Injury Severity Scores were worse for those patients with maxillofacial injuries, as well as for those patients who had been drinking alcohol. Patients with maxillofacial injuries were more likely to require a stay in the intensive care unit. Furthermore, children with facial injuries had higher Injury Severity Scores and longer hospital stays than the adults. To reduce these accidents and related injuries, the industry, local and federal governments, and ultimately individuals must change their attitudes regarding these potentially dangerous vehicles.

Correlation of allergy and severity of sinus disease.

Allergy is an important consideration in the evaluation of patients with rhinosinusitis. Several studies have addressed staging systems for rhinosinusitis based on the extent of disease present on computed tomography (CT) scanning. The severity and extent of sinus disease present on CT imaging helps guide decisions regarding medical and surgical treatment options. This study evaluates the severity of sinus disease in allergic and nonallergic patients. A total of 42 patients at our institution underwent both modified RAST and coronal sinus CT scan in the evaluation of their rhinosinusitis symptoms. A single, blinded staff neuroradiologist staged all 42 CT scans using the Lund-Mackay staging system. None of the patients had undergone sinus surgery. Age, sex, co-morbidities, asthma, smoking, RAST score, total IgE, and CT staging score were analyzed. Allergic patients were found to have a higher CT scan score (mean score = 12) when compared to nonallergic patients (mean score = 6), indicating more extensive sinus disease (p = 0.03). We conclude that allergy is a significant factor in the development of rhinosinusitis, and allergic patients are more likely to demonstrate advanced disease on CT scan when compared to nonallergic patients.

Internal jugular vein patency in patients undergoing microvascular reconstruction.

The objective of this study was to determine the incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction and simultaneous neck dissection. Patients underwent Doppler ultrasound examination of their internal jugular veins on postoperative days 1 and 7 after functional neck dissection and free flap transfer. Long-term follow up was obtained at a minimum of 3 months. The incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction with simultaneous neck dissection is similar to that of patients undergoing just neck dissection. A significant number of these veins recanalize and have excellent long term patency. There does not seem to be a correlation between venous thrombosis and free flap survival.

Internal jugular vein thrombosis after functional and selective neck dissection.

OBJECTIVE: To determine the incidence of internal jugular vein thrombosis after functional or selective neck dissection. DESIGN: Patients underwent serial Doppler ultrasonographic examinations of their internal jugular veins, on postoperative days 1 and 7, following functional neck dissection. Long-term follow-up was conducted at a minimum of 3 months. SETTING: Department of Otolaryngology, West Virginia University, Morgantown. PATIENTS: Sixty-five patients (51 men and 14 women) underwent 100 functional neck dissections between 1993 and 1995. Thirty-five patients had N0, 10 had N1, and 20 had N2 node involvement, respectively. Thirty-five patients underwent bilateral neck dissection, 17 underwent left neck dissection, and 13 underwent right neck dissection. MAIN OUTCOME MEASURES: Thrombosis of the internal jugular veins was determined using duplex Doppler scanning. Correlation with the length of the procedure, intraoperative blood loss, preoperative radiation therapy, stage of neck disease, presence of extracapsular spread, wound infection, and pedicled musculocutaneous flap closure was determined. RESULTS: Of the 100 internal jugular veins studied, 20 (24.7%) of 81 and 19 (26.4%) of 72 were found to have evidence of thrombosis on postoperative days 1 and 7, respectively. On long-term follow-up, the incidence of internal jugular vein thrombosis was significantly lower (5.8%; P < .001). None of the variables examined correlated significantly with the presence of thrombosis. Of the 20 veins that were thrombosed initially, on follow-up 13 had normal flow and 2 had persistent thrombosis. Five patients were unavailable for follow-up. No thrombosis developed as a late finding. CONCLUSIONS: Our results indicate that even though the incidence of internal jugular vein thrombosis is relatively high immediately following neck dissection, a significant number of these veins will undergo recanalization and have excellent long-term patency.

The effects of extended perioperative pentoxifylline on random skin flap survival.

PURPOSE: This study was designed to determine the effects of long-term perioperative pentoxifylline administration on random skin flap survival in an appropriate animal model. A secondary objective was to document bioavailability of pentoxifylline in the animal model by measuring blood levels of parent compound and metabolites at regular intervals and comparing these to levels measured in humans. MATERIALS AND METHODS: A randomized control study of the effects of oral pentoxifylline on the survival of "random" skin flaps was conducted at the animal care facility of an academic tertiary referral center on six randomly selected Yorkshire pigs. Oral pentoxifylline was administered daily to four pigs for 3 months, and two pigs received placebo. Pentoxifylline blood levels for each experimental animal were measured after 4, 8, and 12 weeks of daily dosing. Blood viscosity, fibrinogen, and hematocrit were measured for each of the six animals on day 1, day 30, day 60, and day 91. On day 91, 12 surgical random skin flaps were elevated on each of the six animals and immediately sewn back in the donor bed. Pentoxifylline dosing was continued for 2 weeks, and placebo was continued in control animals. On postoperative day 15, all animals were killed and all flaps were measured individually for area of viability. The outcome measure was the detection of statistically significant increase in survival area in skin flaps of those animals administered perioperative pentoxifylline. RESULTS: No significant augmentation of flap survival was noted in experimental animals when compared with those in the control group; no significant difference was noted between or within groups of experimental animals. Pentoxifylline and metabolite blood levels in all experimental animals at every interval were noted to be comparable to those documented in human studies; metabolite concentrations conformed to expected patterns as observed in humans. No significant alterations of blood viscosity, fibrinogen, or hematocrit were measured in the experimental animals when compared with those in the control group. The only animal showing mean flap survival outside the 95% confidence interval was one in the control group. CONCLUSION: No augmentation of random skin flap survival could be shown in the pig model after a 3 month regimen of daily oral pentoxifylline. Blood levels of pentoxifylline in experimental animals were compared with those documented in humans. No alteration of blood viscosity, fibrinogen, or hematocrit was noted in any of the experimental animals when compared with each other or with those in the control group.

Diagnostic efficacy of in vitro methods vs. skin testing in patients with inhalant allergies.

The purpose of our study was to investigate the diagnostic efficacy of two selected methods of in vitro allergy testing. Specifically, the PRIST/modified RAST I125 isotope systems and the Quantizyme/modified EAST alkaline phosphatase method were compared. The time, expense, convenience, and diagnostic efficacy of the two procedures are discussed. Special attention is given to the practicality of each method for the practicing physician.

Immune complexes, serum proteins, cell-mediated immunity, and immune regulation in patients with squamous cell carcinoma of the head and neck.

A collaborative study of the humoral and cellular immune status of patients with carcinoma of the Head and Neck (H&N) was conducted at the West Virginia University (WVU) hospital. In addition, blind-coded serum panels were supplied on H&N cancer patients being treated at the National Cancer Institute (NCI). Serum protein analysis of the WVU study groups revealed that at the pretreatment sampling, the alpha-1 acid glycoprotein (AGP), total complement, and IgA levels were significantly elevated. The AGP levels and total complement levels declined to normal levels in the post-treatment period, whereas the IgA levels remained elevated throughout the entire observation period. Levels of serum immune complexes (SIC) were measured in both the WVU and NCI H&N cancer populations using the polyethylene glycol (PEG) precipitation method. In both survey populations all cancer groups had significantly elevated levels of SIC when compared to any of the control populations. The SIC levels never returned to comparative normal values even in cases after successful treatment. A subpopulation of the WVU-H&N cancer study group underwent a short course of intravenous hyperalimentation prior to their treatment regimen. These patients demonstrated a transient decrease in their SIC levels as well as a concomitant increase in their in vitro cell-mediated immune (CMI) correlates. The analysis of in vitro CMI correlates of the WVU study group using both polyclonal mitogens and specific antigens demonstrated a significant depression in these parameters pretreatment and post-treatment. In addition, it was observed that the time course for elevation of selected serum proteins (i.e., IgA and SIC) correlated with concomitant drops in CMI activity. Investigations were also conducted into the effects of immune complex-rich serum fractions upon selected in vitro CMI correlates. Significant blockage of a normal donor leukocyte migration-inhibition assay was demonstrated. Also, a similar inhibition of the ability of normal human lymphocytes to form high affinity rosettes was accomplished with serum from H&N cancer patients.

The implication of viruses in idiopathic sudden hearing loss: primary infection or reactivation of latent viruses?

Seventy-seven paired serum samples from patients with known idiopathic sudden hearing loss (ISHL) were surveyed using viral serologic methods. Fifteen different viruses and Mycoplasma pneumonia were the agents tested. We determined an incidence of 65% (49/77) of documented significant seroconversions to one or more of the agents surveyed. Multiple agents were involved in 24 of the 49 positive cases we studied. Influenza virus Group B in 14 (18%) and rubeola in 12 (16%) were the most prevalent, followed by Herpes simplex type 1 in 6 (8%), mumps in 6 (8%), influenza Group A3 in 6 (8%), rubella in 5 (7%), and cytomegalovirus (CMV) in 5 (7%).

Immune monitoring protocol for patients with carcinoma of the head and neck. Preliminary report.

Numerous investigators have observed a depression of cell-mediated immunity in patients with carcinoma of the head and neck using a variety of in vitro and in vivo assays. This report presents the data obtained when a group of head and neck cancer patients were evaluated for reactivity in an in vitro lymphocyte blastogenesis assay using polyclonal mitogens and specific antigens, numbers of peripheral blood T-lymphocytes, and levels of circulating immune complexes. Such an immunological monitoring protocol revealed a depressed reactivity of the cancer patients in the lymphocyte blastogenesis assay when compared to normal age-matched controls. We also observed that 75% of these patients had circulating soluble immune complexes in their sera before and after therapy. These preliminary data indicate that further research is needed to examine the potential role of soluble immune complexes in modulating the host's immune response.

Soft-tissue concentration of 99mTc-phosphates associated with injections of iron dextran complex.

An unusual concentration of 99mTc-phosphates appeared in the gluteal area in bone scans of three patients who had recently had intramuscular injections of iron dextran complex. These cases indicate one more cause for extraosseous accumulation of these bone-seeking radiopharmaceuticals.