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1.
Orbit ; 42(3): 332-335, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34847834

RESUMO

Patients with COVID-19 have been reported to have elevated coagulation factors, which is a well-documented cause of venous thromboembolism events such as deep vein thrombosis and pulmonary embolism. Other venous thrombotic events, however, such as cavernous sinus thrombosis (CST) have been less commonly observed, specifically in combination with primary orbital cellulitis. Due to its unique anatomic location, the cavernous sinus is susceptible to thrombophlebitis processes including septic thrombosis and thrombosis most commonly from sinusitis. Many studies have shown that in the antibiotic era thromboembolic events of the cavernous sinus are less common due to infection spread from the orbit or facial region. This case report describes a 17-year-old COVID-19 positive male who presented with a left-sided primary orbital cellulitis with CST without radiographic evidence of ipsilateral sinus disease.


Assuntos
COVID-19 , Trombose do Corpo Cavernoso , Seio Cavernoso , Celulite Orbitária , Trombose , Humanos , Masculino , Adolescente , Celulite Orbitária/diagnóstico por imagem , Celulite Orbitária/tratamento farmacológico , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/etiologia , Seio Cavernoso/diagnóstico por imagem , Trombose/complicações , Celulite (Flegmão)/complicações
2.
Int J Radiat Oncol Biol Phys ; 99(4): 938-946, 2017 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-28847412

RESUMO

PURPOSE: To evaluate whether historic risk categories and indications for adjuvant therapy in the pre-human papillomavirus (HPV) and pre-transoral surgery (TOS) era were associated with clinically significant relapse rates in HPV+ oropharyngeal squamous cell cancer patients undergoing TOS. METHODS AND MATERIALS: A multi-institutional retrospective review of intermediate- and high-risk HPV+ oropharyngeal squamous cell cancer patients not receiving adjuvant therapy after TOS was performed. Perineural invasion, lymphovascular invasion, T3-T4, or ≥N2 disease were considered to be intermediate-risk factors, and extracapsular extension or positive margins were considered to be high-risk features, according to established risk categories. RESULTS: Median follow-up was 42.9 months. Among all 53 patients, the 3-year cumulative incidence of relapse was 26.0%. The 3-year cumulative incidence was 11.8% in the 37 intermediate-risk patients and 52.4% in the 16 high-risk patients. On univariate analysis only high-risk status was significantly associated with an increased risk of relapse (hazard ratio 3.9; P=.018). The salvage rate for relapse was 77%, with 10 of 13 patients undergoing salvage therapy. CONCLUSIONS: Risk category was associated with clinically significant relapse rates after TOS alone in HPV+ oropharyngeal cancer, comparable to historical data and traditional indications for adjuvant therapy for all oropharyngeal cancer.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/virologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Orofaríngeas/cirurgia , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Infecções por Papillomavirus , Idoso , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Seguimentos , Humanos , Incidência , Análise por Pareamento , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/virologia , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/patologia , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação/estatística & dados numéricos
3.
Head Neck ; 38 Suppl 1: E1674-9, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-26667985

RESUMO

BACKGROUND: Factors predicting locoregional relapse after surgery for oropharyngeal squamous cell carcinoma (SCC) were identified in the pre-human papillomavirus (HPV) era. We examined whether traditional indications for adjuvant radiotherapy (RT) or adjuvant chemoradiotherapy (CRT) still correlate with locoregional relapse in HPV-positive patients after transoral robotic surgery (TORS). METHODS: Retrospective review of oropharyngeal SCC cases identified patients with HPV-positive tumors who did not receive adjuvant therapy after TORS despite intermediate or high-risk features. RESULTS: Median follow-up was 26.7 months (range, 4.9-73.1 months). Five of 25 eligible patients (20%) relapsed at a median 4.8 months (range, 3.2-7.8 months). Two of 18 (11%) intermediate and 3 of 7 (43%) high-risk patients relapsed. Kaplan-Meier 2-year locoregional relapse-free survival estimates for intermediate and high-risk patients were 88% and 57% (p = .078), respectively. CONCLUSION: Traditional indications for adjuvant RT or CRT were associated with high risk of locoregional relapse in HPV-positive patients treated with TORS alone. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1674-E1679, 2016.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Orofaríngeas/cirurgia , Infecções por Papillomavirus/complicações , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/virologia , Humanos , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Estudos Retrospectivos , Fatores de Risco
4.
Am J Rhinol Allergy ; 29(5): 373-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26358350

RESUMO

BACKGROUND: Nasal congestion and/or obstruction represents a prevalent and extensively studied problem. No published research exists that describes the impact of nasal hair (vibrissae) on nasal obstruction. OBJECTIVE: To assess the impact of nasal vibrissae on subjective and objective measurements of nasal obstruction. METHODS: In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae density and were treated with a topical decongestant. The subjects were then asked to subjectively assess nasal breathing by using four questions from the Nasal Obstruction Symptom Evaluation instrument before undergoing rhinomanometry. Nasal vibrissae were then trimmed, and the participants repeated the subjective and objective assessments. Pre- and postintervention outcomes, including symptom scores, nasal airflow, and resistance, were compared by using statistical analysis. RESULTS: Statistically significant improvement was noted in subjects' nasal airway specific symptom scores and in objective measurements of their nasal airway. Patients with moderate or many vibrissae at baseline were noted to have greater likelihood of improvement in subjective and objective obstruction assessments than patients rated with few. CONCLUSION: In these 30 subjects, statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with greater density of vibrissae. These findings support further study of the potential benefit of the reduction of vibrissae density in some patients with nasal obstruction.


Assuntos
Resistência das Vias Respiratórias/fisiologia , Cabelo , Obstrução Nasal/etiologia , Nariz/fisiopatologia , Adulto , Idoso , Feminino , Seguimentos , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Obstrução Nasal/fisiopatologia , Estudos Prospectivos , Respiração , Rinomanometria
5.
Otolaryngol Head Neck Surg ; 152(4): 752-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25724573

RESUMO

OBJECTIVE: Assess human papilloma virus (HPV) transcriptional activity in inverted Schneiderian papillomas (IPs). STUDY DESIGN: Case series with chart review. SETTING: Academic tertiary care center. SUBJECTS AND METHODS: Retrospective clinicopathologic review of 19 cases of IP in patients undergoing surgical excision from 1995 to 2013 at Mayo Clinic in Rochester, Minnesota. Surgical pathology archival material was histopathologically reviewed using hematoxylin and eosin-stained slides. Formalin-fixed, paraffin-embedded material from each case was evaluated for p16 expression using immunohistochemistry as well as HPV DNA and E6/E7 messenger RNA (mRNA) transcription using polymerase chain reaction (PCR) and in situ hybridization (via RNAscope technology), respectively. RESULTS: Eight patients were female (42%), with an average age of 53 years (range, 23-82 years). Three demonstrated malignancy, and 5 subsequently recurred. Average follow-up was 49 months (range, 0-200 months), and 1 patient died from squamous cell carcinoma arising from the IP. RNAscope detected HPV mRNA transcripts exclusively within IP in 100% of cases; however, in 11 patients (58%), less than 1% of cells exhibited transcriptional activity. Only 2 of 19 cases (11%) demonstrated mRNA activity in 50% or more cells. HPV DNA was detected in only 2 specimens by PCR. CONCLUSIONS: This study reveals wide prevalence but limited transcriptional activity of HPV in IP. No correlation between HPV transcriptional activity and progression, recurrence, or malignant transformation was identified. These data suggest that transcription of HPV may contribute to the pathogenesis of IP, but prospective data are needed to definitively demonstrate this connection. These results also suggest that RNAscope may be more sensitive than PCR in detecting HPV activity in IP.


Assuntos
Neoplasias Nasais/virologia , Proteínas Oncogênicas Virais/genética , Papiloma Invertido/virologia , Papillomaviridae/genética , RNA Mensageiro/metabolismo , Ativação Transcricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidor p16 de Quinase Dependente de Ciclina , Sondas de DNA de HPV , DNA Viral/análise , DNA Viral/genética , Feminino , Humanos , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Mucosa Nasal/virologia , Proteínas de Neoplasias/metabolismo , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/genética , Estudos Retrospectivos , Adulto Jovem
6.
Prostate ; 70(6): 608-15, 2010 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-19998369

RESUMO

BACKGROUND: 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, otherwise known as statins, inhibit the enzyme that controls the conversion of HMG-CoA to mevalonate, a precursor for cholesterol. Statins may be important to prostate cancer biology by inhibiting cell growth, inflammation, and oxidative stress. The purpose of this study was to assess the influence of statin therapy on serum prostate-specific antigen (PSA) levels. METHODS: The computerized medical records at the University of Rochester Medical Center were used to identify men who filled statin prescriptions between May 31st, 2008 and September 30th, 2008. Men with at least one PSA assay performed within 2 years before and at least one PSA assay performed within 1 year after starting a statin medication were included. The primary endpoint was the change in PSA concentration computed as the difference between PSA levels before and after starting a statin medication. Paired t-tests were used to analyze the mean differences in PSA values. RESULTS: A total of 962 patients were identified. The mean difference in serum PSA level after statin administration was -0.29 ng/ml (-8.04%). Subgroup analyses for mean PSA concentration change before and after statin administration by age group revealed: 50-59 years old (-0.1609, 95% CI: -0.2444, -0.0775, P < 0.0002), 60-69 years old (-0.3393, 95% CI: -0.4641, -0.2145, P < 0.0001), and >70 years old (-0.351, 95% CI: -0.490, -0.212, P < 0.0001). CONCLUSIONS: These observations suggest a statistically significant reduction in serum PSA level that is associated with the onset of statin therapy.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Antígeno Prostático Específico/sangue , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Relação Dose-Resposta a Droga , Determinação de Ponto Final , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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