15538 Background: Standard therapy for high risk SGC includes surgical resection with adjuvant RT, but a high risk of recurrence exists. The role of chemotherapy in this setting has not been fully defined. Methods: This limited... more
15538 Background: Standard therapy for high risk SGC includes surgical resection with adjuvant RT, but a high risk of recurrence exists. The role of chemotherapy in this setting has not been fully defined. Methods: This limited institution pilot study evaluated the use of P/C with concurrent RT as adjuvant treatment of high risk SGC. The primary objective was to assess toxicity of this treatment in anticipation of a larger cooperative group phase II study. Eligible patients (pts.) had a Southwest Oncology Group (SWOG) performance status (PS) of 0–2 who after surgical resection of their SGC had high risk features including positive surgical margins, perineural invasion, multiple lymph node (LN) metastases, or extracapsular extension. Treatment included P = 40 mg/m2 intravenously followed by C = AUC of 2 concurrently on days 1, 8, 15, 22, 29, 36 of RT. RT consisted of a total dose of 60 Gy in 30 fractions to the primary and regional LN sites of disease. Results: Five pts. were enrolle...
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OBJECTIVES: This study determined whether mobilization of immune inhibitory CD34+ cells by head and neck squamous cell carcinomas (HNSCC) is most prominent in patients who are node positive and whether these CD34+ cells could... more
OBJECTIVES: This study determined whether mobilization of immune inhibitory CD34+ cells by head and neck squamous cell carcinomas (HNSCC) is most prominent in patients who are node positive and whether these CD34+ cells could differentiate into immune stimulatory dendritic cells. STUDY DESIGN AND SETTING: Peripheral blood from patients with head and neck cancer was used to measure the frequency of CD34+ cells and their capacity to differentiate into immune stimulatory dendritic cells. RESULTS: This study demonstrated that increased CD34+ cell levels were most prominent in patients who were node positive and patients with recurrent disease. These CD34+ cells differentiated into dendritic cells that were able to present tetanus toxoid to autologous T-cells. CONCLUSIONS: Immune suppressive CD34+ cells that are prominent in patients with HNSCC who are node positive are able to develop into immune stimulatory dendritic cells. SIGNIFICANCE: Differentiation of tumor-mobilized CD34+ cells i...
Research Interests: Medicine, Dendritic Cells, Cell Differentiation, Humans, Head and Neck Cancer, and 15 moreHead and neck squamous cell carcinoma, Antigen Presentation, Dendritic cell, CD, Clinical Sciences, T lymphocytes, Oral Squamous Cell Carcinoma (OSCC), Immune system, Study design, Otolaryngology - Head and Neck Surgery, Tetanus Toxoid, Immune Suppression, Interferon gamma, Head and neck neoplasms, and Peripheral blood
Human head and neck squamous cell carcinoma (HNSCC) cell cultures were established to identify the angiogenic factors they produced and how these factors contribute to two steps of the angiogenic process: endothelial cell proliferation... more
Human head and neck squamous cell carcinoma (HNSCC) cell cultures were established to identify the angiogenic factors they produced and how these factors contribute to two steps of the angiogenic process: endothelial cell proliferation and migration. The HNSCC cells secreted vascular endothelial cell growth factor (VEGF), transforming growth factor-beta (TGF-beta) and prostaglandin E2 (PGE2), but only low levels of basic fibroblast growth factor. Both proliferation-stimulatory and -inhibitory cytokines were produced by the HNSCC cells, with VEGF promoting endothelial cell proliferation, prostaglandins having no effect and TGF-beta downregulating proliferation. Two methods were used to measure endothelial cell migration: migration into a wound in the endothelial cell monolayer and migration across a filter into lower compartments. HNSCC cell supernatants stimulated endothelial cell migration in both migration models. VEGF had no effect on the motility of endothelial cells. However, w...
Research Interests: Chemistry, Biology, Cell Migration, Cancer Research, Medicine, and 12 moreAngiogenesis, Cell Division, Humans, Pubmed, Head and neck squamous cell carcinoma, Vascular endothelium, Oral Squamous Cell Carcinoma (OSCC), Transforming Growth Factor Beta, Vascular Endothelial Growth Factor, Cell Growth, Head and neck neoplasms, and Vascular endothelial growth factors
Tumors of the anterior skull base most commonly originate from the nasal cavity and paranasal sinuses. Such early presenting signs and symptoms as nasal obstruction, epiphora, and epistaxis are frequently thought to have a benign... more
Tumors of the anterior skull base most commonly originate from the nasal cavity and paranasal sinuses. Such early presenting signs and symptoms as nasal obstruction, epiphora, and epistaxis are frequently thought to have a benign pathology. Proptosis, vision changes, skin fixation, and cervical adenopathy are associated with advanced disease. Treatment of paranasal sinus tumors is complex, involving combined therapy and multidisciplinary teams. The particular method of treatment is determined by multiple factors, including tumor histopathology, age, health of the patient, and extent of disease. In the past several years, numerous approaches to the skull base have evolved, allowing otolaryngologists and head and neck surgeons to extend earlier operative indications and treat cancers that were previously deemed unresectable. This article reviews some of the current surgical and nonsurgical approaches to skull base tumors originating from the paranasal sinuses.
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Research Interests: Fluorescence Microscopy, Biology, Cell Adhesion, Cell Biology, Medicine, and 15 moreExtracellular Matrix, Cytoskeleton, Motility, Humans, Collagen, Head and neck squamous cell carcinoma, Phosphorylation, Protein Phosphatase 2A, Oral Squamous Cell Carcinoma (OSCC), Fibronectin, Prostaglandins, Indomethacin, Okadaic acid, Down-Regulation, and Laminin
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A computerized relational database was programmed to provide an efficient yet powerful method of data storage presentation and extraction for a PC-based Head and Neck Tumor Registry. The database is organized into tables that contain... more
A computerized relational database was programmed to provide an efficient yet powerful method of data storage presentation and extraction for a PC-based Head and Neck Tumor Registry. The database is organized into tables that contain multiple categories of information, including identifying patient information, tumor-stage treatment plans, and pathology specimens. Dynamic links between the tables allows organization of multiple variables while at the same time providing the ability to perform sophisticated yet rapid searches for specific categories of information. The software package used is Paradox for Windows version 5.0, which is a PC-based application that takes advantage of the icon, mouse, and menu-driven environment of the Windows operating system, making this a user-friendly program not only for obtaining information but for entering data and programming. The capabilities of this program are further reflected in the ability to create links and transfer data to other programs, including software for statistical analysis. Furthermore, by taking advantage of the object linking and embedding capabilities of Paradox, an image processing and storage program has been integrated with the present database, allowing for collection of tumor diagrams and other graphical information to be linked with individual patient data. This program is presently being used in our department to manage the Head and Neck Tumor Registry and is integrated with our tumor biology program, allowing immediate correlation between molecular findings and clinical data. The program is also on a network system, allowing access to all members of the department. Diagrams of the graphical user interface and details of the program will be provided.
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A 48-year-old woman presented with a 5-month history of unilateral epiphora and progressive growth of a left-sided medial canthus mass. CT revealed a nonenhancing soft tissue mass of the left lacrimal sac with widening and erosion of the... more
A 48-year-old woman presented with a 5-month history of unilateral epiphora and progressive growth of a left-sided medial canthus mass. CT revealed a nonenhancing soft tissue mass of the left lacrimal sac with widening and erosion of the nasolacrimal canal. The tumor was resected and pathologically confirmed to be malignant melanoma. Despite wide resection and adjuvant radiotherapy, the patient developed metastases to the chest wall. The patient currently is receiving combined immunotherapy and chemotherapy. The clinical course and treatment strategies are reviewed for this highly aggressive and rare neoplasm.
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To compare CT and MRI target volumes for nasopharyngeal carcinoma (NPC) and evaluate the role of intensity-modulated radiotherapy (IMRT) in treating composite CT+MRI targets. CT and T(1)/T(2)-weighted MRI scans were obtained for 8... more
To compare CT and MRI target volumes for nasopharyngeal carcinoma (NPC) and evaluate the role of intensity-modulated radiotherapy (IMRT) in treating composite CT+MRI targets. CT and T(1)/T(2)-weighted MRI scans were obtained for 8 consecutive NPC patients. Using CT, MRI, and fused CT/MRI, various target volumes (gross target volume, clinical target volume, and planning target volume [PTV]) and critical structures were outlined. For each patient, three treatment plans were developed: (1) a three-dimensional conformal RT (3D-CRT) plan using CT-based targets; (2) a 3D-CRT plan using composite CT+MRI targets; and (3) a IMRT plan using CT+MRI targets. The prescription dose was 57.6 Gy and 70.2 Gy to the initial and boost PTV, respectively. Treatment plans were compared using the PTV dose to 95% volume (D(95)), critical structure dose to 5% organ volume (D(5)), and mean dose. Compared with CT, the MRI-based targets were 74% larger, more irregularly shaped, and did not always include the CT targets. For CT-based targets, 3D-CRT plans, in general, achieved adequate target coverage and sparing of critical structures. However, when these plans were evaluated using CT+MRI targets, the average PTV D(95) was approximately 60 Gy (14% underdosing), and critical structure doses were significantly worse. The use of IMRT for CT+MRI targets resulted in marked improvement in the PTV coverage and critical structure sparing: average PTV D(95) improved to 69.3 Gy, brainstem D(5) to <43 Gy (19% reduction), spinal cord D(5) to <37 Gy (19% reduction), and the mean dose to the parotids and cochlea reduced to below tolerance (23.7 Gy and 35.6 Gy, respectively). CT/MRI fusion improved the determination of target volumes in NPC. In contrast to 3D-CRT, IMRT planning resulted in significantly improved coverage of composite CT+MRI targets and sparing of critical structures.
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BackgroundIpsilateral salivary gland tumors of different histologic types are rare and make up less than 0.3% of all salivary gland neoplasms. Only nine cases of synchronous benign and malignant ipsilateral parotid gland tumors have been... more
BackgroundIpsilateral salivary gland tumors of different histologic types are rare and make up less than 0.3% of all salivary gland neoplasms. Only nine cases of synchronous benign and malignant ipsilateral parotid gland tumors have been described in the literature.MethodsTwo additional cases of synchronous benign and malignant neoplasms in the parotid gland are reported and discussed with a review of literature.ResultsOur first case describes a pleomorphic adenoma and a salivary duct carcinoma, an entity not previously reported in the literature. The second case documents the most common benign and malignant ipsilateral parotid gland neoplasm reported in this case series, a Warthin's tumor and a mucoepidermoid carcinoma.ConclusionsSynchronous salivary gland tumors exhibiting both benign and malignant components are uncommonly observed, with only nine cases published to date. We describe two additional cases of a synchronous benign and malignant ipsilateral parotid gland tumor. ...
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Squamous cell carcinoma of the head and neck induces neovascularization to support tumor growth and facilitate the metastatic spread. Others have suggested that the density of microvessels within the tumor correlates with the... more
Squamous cell carcinoma of the head and neck induces neovascularization to support tumor growth and facilitate the metastatic spread. Others have suggested that the density of microvessels within the tumor correlates with the neovascularization process and therefore with clinical behavior and outcome. To ascertain the value of the microvessel count as an independent prognostic indicator for squamous cel carcinoma of the head and neck, we studied the primary tumors of 44 patients. Histological slides were stained for factor VIII and the individual microvessels were counted on a 200 x field (0.49 mm). No statistically significant difference was found between the microvessel counts of tumors that metastasize or recur locally, as compared with tumors that did not. The possibility of a beta-error due to the small number of cases mandates a larger possibly multi-institutional, study to better ascertain the significance of a microvessel count as an independent prognostic indicator.
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Research Interests: Immunology, Biology, Cancer Research, Medicine, Hematopoietic Stem Cells, and 15 moreHead and Neck, Humans, Cord Blood, Immunosuppression, Head and neck squamous cell carcinoma, Chemotaxis, Fibroblast Growth Factor, CD, Human Immunology, In Vitro Studies, Lymphocytes, Growth Factor, Immune Suppression, Head and neck neoplasms, and Peripheral blood
Complications following total laryngectomy may include pharyngocutaneous fistula or pharyngeal stricture. Traditional techniques of repair of fistula and stricture with local or regional flaps lead to a high rate of failure. In this... more
Complications following total laryngectomy may include pharyngocutaneous fistula or pharyngeal stricture. Traditional techniques of repair of fistula and stricture with local or regional flaps lead to a high rate of failure. In this study, we report 18 patients treated by secondary jejunal interposition (JI) to rehabilitate swallowing following recalcitrant postlaryngectomy stricture or fistula. All patients had undergone total laryngectomy with or without partial pharyngectomy for treatment of squamous cell carcinoma of the larynx (8) or hypopharynx (10). Four were stage II; 5, stage III; and 9, stage IV. Thirteen patients (72%) regained swallowing function. Complications of secondary JI included perioperative death (2), flap loss (1), and persistent fistulas (3). Jejunal interposition may be the best modality in the rehabilitation of swallowing in patients with persistent fistula or stricture that fails to respond to traditional management.
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Neutropenic enterocolitis is a recognized complication of immunosuppression or chemotherapy for leukemia. It presents as severe abdominal pain and tenderness, fever, and diarrhea associated with granulocytopenia. Gastrointestinal symptoms... more
Neutropenic enterocolitis is a recognized complication of immunosuppression or chemotherapy for leukemia. It presents as severe abdominal pain and tenderness, fever, and diarrhea associated with granulocytopenia. Gastrointestinal symptoms associated with chemotherapy for head and neck neoplasms include nausea and emesis, but not acute abdominal distress. We present, to our knowledge, the first case of neutropenic enterocolitis in a patient receiving cisplatin and fluorouracil chemotherapy for metastatic head and neck cancer.
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Determine total plasminogen activator (PA) activity and urokinase-type plasminogen activator (u-PA) levels in cell-free supernatants derived from primary and metastatic squamous cell carcinoma of the head and neck. Plasminogen activator... more
Determine total plasminogen activator (PA) activity and urokinase-type plasminogen activator (u-PA) levels in cell-free supernatants derived from primary and metastatic squamous cell carcinoma of the head and neck. Plasminogen activator activity was measured by spectrophotometric assay with chromogenic substrate Val-Leu-Lys-para-nitroanilide. Urokinase-type plasminogen activator levels were measured with enzyme-linked immunosorbent assay technique. Fourteen established squamous cell carcinoma lines from patients with head and neck cancer were assayed for both total PA activity and u-PA levels at 24 to 48 hours of incubation. Compared with control and fibroblast-conditioned media, cell lines established from squamous cell carcinoma of the head and neck had significantly (P < .005) higher levels of both total PA activity and u-PA levels. Linear regression analysis showed a positive correlation (r = .65, P = .007) between total PA activity and u-PA levels. Squamous cell carcinomas of the head and neck are able to activate plasminogen and produce u-PA in vitro. The production of PA by squamous cell carcinomas of the head and neck may play an important role in the biology of invasion and metastasis.
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We seek to establish normative values for the volume of postoperative neck drainage from patients undergoing ablative oncologic procedures that include a neck dissection and to analyze neck drainage for lipid content to establish... more
We seek to establish normative values for the volume of postoperative neck drainage from patients undergoing ablative oncologic procedures that include a neck dissection and to analyze neck drainage for lipid content to establish guidelines that may be helpful in identifying chylous fistula when this diagnosis is not clinically straightforward. Neck drainage obtained through continuous suction percutaneous drainage catheters was evaluated following 23 neck dissections performed on 19 patients. In every case, either radicle or modified type I neck dissection was performed. The volume of drainage was quantitated on a day-to-day basis. In a separate group of 27 patients undergoing neck dissection, neck drainage was compared with serum levels of triglyceride, cholesterol, and chylomicron content. The mean duration of neck drainage was 5 days. Maximum drainage (160 mL) was noted on the first day and dropped daily to less than 10 mL by the fifth postoperative day. A statistically significant difference between serum and neck drainage triglyceride and cholesterol content was observed in nearly all cases. Neck drainage fat content was lower than that noted in serum in nearly all cases. Chylomicron content of 4% was encountered in neck drainage. This study provides normative data on lipid content of neck drainage. With only a rare exception, the triglyceride and cholesterol levels are higher in the serum than in the neck drainage. A triglyceride level of 100 mg/dL seems to be the upper limit of normal (mean plus 1 standard deviation). A low level of chylomicron (> 4%) is consistent with normal healing and may be due to breakdown of fatty tissue.
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Educational objectives: To appropriately select patients who would benefit from either a paratracheal or mediastinal lymph node dissection and to understand the surgical technique and methods of complication avoidance for each of these... more
Educational objectives: To appropriately select patients who would benefit from either a paratracheal or mediastinal lymph node dissection and to understand the surgical technique and methods of complication avoidance for each of these procedures.
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Background Hydroxyapatite cement (HAC) was first introduced in the 1980s as a new method for bone replacement. However, it has not been recommended for use in areas exposed to air. Despite this, surgeries have been performed using HAC to... more
Background Hydroxyapatite cement (HAC) was first introduced in the 1980s as a new method for bone replacement. However, it has not been recommended for use in areas exposed to air. Despite this, surgeries have been performed using HAC to close nasal/sinus cerebrospinal fluid (CSF) leaks or in the treatment of encephaloceles. Methods This study retrospectively documented four patients in whom HAC was used for closure of ethmoid and sphenoid sinus CSF leaks. Results This study showed that exposed hydroxyapatite could be extremely problematic resulting in scarring, chronic granulation, infection, and prolonged healing. Oftentimes, revision surgery was necessary to help control the reaction to hydroxyapatite. Conclusion Because of the frequent complications occurring with use of hydroxyapatite in the paranasal sinuses, its use should be limited to selected individuals in whom difficulty in achieving closure of the CFS leak could be anticipated and in whom adequate tissue coverage could ...
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ABSTRACT Objectives: (1) Analyze survival, complications, and impact of transnasal endoscopic cranial base surgery. (2) Describe time course and patterns of local, regional, and distant failure patients with olfactory neuroblastoma (ONB)... more
ABSTRACT Objectives: (1) Analyze survival, complications, and impact of transnasal endoscopic cranial base surgery. (2) Describe time course and patterns of local, regional, and distant failure patients with olfactory neuroblastoma (ONB) of the nasal cavity, ethmoid sinus, and/or anterior skull base.
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OBJECTIVE: The purpose of this article is to review the clinicoradiographic features of lower cranial nerve sheath tumors and to outline surgical approaches that allow the safe and complete resection of these lesions. METHODS: Thirteen... more
OBJECTIVE: The purpose of this article is to review the clinicoradiographic features of lower cranial nerve sheath tumors and to outline surgical approaches that allow the safe and complete resection of these lesions. METHODS: Thirteen patients with lower cranial nerve sheath tumors of the infratemporal fossa were surgically treated between 7/88 and 10/99. A retrospective chart analysis provided details pertaining to clinical manifestations, radiographic assessment, intraoperative findings, tumor histology, and postoperative results. RESULTS: The most common presenting symptoms were neck pressure and voice change while sub-mucosal palatal fullness and vocal cord paralysis were the most common presenting signs. All tumors were removed via lateral skull base approaches and the most common postoperative sequelae was dysphasia. CONCLUSION: Lower cranial nerve sheath tumors of the infratemporal fossa usually reach considerable size before diagnosis because of a naturally slow growth rate...
Research Interests: Aphasia, Magnetic Resonance Imaging, Biopsy, Humans, Female, and 15 moreMale, Clinical Sciences, Angiography, Middle Aged, Adult, Growth rate, Hematoma, Cranial Nerves, Hypoglossal Nerve, CAROTID ARTERY INJURIES, Internal Carotid Artery, Otolaryngology Head and Neck Surgery, Glossopharyngeal Nerve, Neurilemmoma, and Head and neck neoplasms
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Intratemporal skull base tumors may invade the facial nerve in the horizontal (tympanic) or descending (vertical) segments, while parotid malignancies typically infiltrate the facial nerve at the stylomastoid foramen. This article will... more
Intratemporal skull base tumors may invade the facial nerve in the horizontal (tympanic) or descending (vertical) segments, while parotid malignancies typically infiltrate the facial nerve at the stylomastoid foramen. This article will describe our results following intratemporal facial nerve grafting in 44 patients. This was a retrospective analysis of 44 patients requiring intratemporal facial nerve repair following lateral skull base tumor resection at our tertiary care, academic medical center. Tumor histology included 17 parotid cancers, 13 temporal bone malignancies, 9 glomus tumors, 3 facial neuromas, and 2 endolymphatic sac tumors. The greater auricular nerve was used in 25 patients and the sural nerve was used in 19 cases. Forty patients were available for facial function assessment at 2 years. Using the House-Brackmann (H-B) recovery scale, the breakdown of patients by facial function was as follows: Grade I, 0 patients; Grade II, 4 patients; Grade III, 29 patients; Grade ...
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To discuss surgical reconstructive options and complications in patients with extensive lateral skull base defects. Retrospective case review. Tertiary referral center. Eligibility criteria included patients seen between July 1999 and... more
To discuss surgical reconstructive options and complications in patients with extensive lateral skull base defects. Retrospective case review. Tertiary referral center. Eligibility criteria included patients seen between July 1999 and July 2003 with malignant neoplasms of the lateral skull base requiring surgical therapy, with resultant surgical defect not amenable to primary closure. Surgical extirpation of malignant skull base neoplasm requiring free tissue transfer or rotational flap closure. Closure and healing of surgical defect, intraoperative and postoperative complications, patient survival. There were 11 patients, 8 males and 3 females, with an average age of 65 years. Eight patients required trapezius flap reconstruction, whereas one patient required temporalis rotational flap closure, and two patients required rectus abdominus free tissue transfers. There was one perioperative death secondary to cardiac disease. There were no immediate wound complications. One patient developed a delayed partial trapezius flap failure successfully treated with a rectus abdominus flap. The trapezius rotational flap is a reliable means of closing complex lateral skull base defects with minimal morbidity.
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Objectives To report experience and oncologic outcomes of surgical resection and adjuvant therapy in the treatment of olfactory neuroblastoma. Methods A retrospective chart review of 31 patients with a histologic diagnosis of olfactory... more
Objectives To report experience and oncologic outcomes of surgical resection and adjuvant therapy in the treatment of olfactory neuroblastoma. Methods A retrospective chart review of 31 patients with a histologic diagnosis of olfactory neuroblastoma presenting to the senior author between February 1994 and August 2007. Results 3 of the 31 patients presenting with altered mental status were found to have tumors with either advanced or metastatic tumors and were excluded from analysis. One patient opted for treatment elsewhere and 1 patient received neoadjuvant chemo-radiation therapy and died prior to surgery, leaving 26 patients available for study. 3 patients received primary radiation and 23 had primary surgery. 2 patients had limited disease and were treated with solely with medial maxillectomy. 24 patients had surgical resection with an anterior craniofacial, either open (17) or endoscopic (5). Negative margins achieved in 8.2%. Adjuvant radiotherapy was performed in 19 patients...
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Objective To determine the role of native condyle preservation in local recurrence after segmental mandibulectomy in patients with head and neck squamous cell carcinoma. Methods Retrospective chart review with main outcome measuring local... more
Objective To determine the role of native condyle preservation in local recurrence after segmental mandibulectomy in patients with head and neck squamous cell carcinoma. Methods Retrospective chart review with main outcome measuring local control of cancer. Results Between 1994 and 2003, 72 patients (48 men, 24 women) with an average age of 73.5 years without previous treatment underwent segmental mandibulectomy. Fifty-four cases (n = 54) involved the mandible posterior to the mental foramen and are the subject of this review. In 36 patients, the condyle was preserved and mandibular continuity was restored. In 18 patients, condyle and ramus were resected without mandibular reconstruction. Reconstructive modalities included primary closure (3), split-thickness skin graft (3), pedicle flap (19), and free tissue reconstructions (29). Overall local-regional recurrence rate was 22 percent (12 of 54); no recurrences were identified in patients who underwent condylar resection. Recurrences...
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Object Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. Methods The authors performed a retrospective review of data obtained in 11... more
Object Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. Methods The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease. Conclusions Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade of the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.
Research Interests: Pain, Facial Paralysis, Medicine, Humans, Female, and 15 moreSkull, Male, Ear Nose and Throat, Differential Diagnosis, Clinical Sciences, Facial Nerve, Aged, Middle Aged, Neoplasm Invasiveness, Retrospective Studies, Neurosciences, Adenocarcinoma, Combined Modality Therapy, Fatal outcome, and Diagnostic errors
Objective: During the past decade, applications of anterior and anterolateral cranial approaches for both benign and malignant pathologies have expanded in frequency and application. Complications associated with these procedures impact... more
Objective: During the past decade, applications of anterior and anterolateral cranial approaches for both benign and malignant pathologies have expanded in frequency and application. Complications associated with these procedures impact significantly on patient outcome. The primary aim of this study is to detail the strategies for complication management and avoidance developed from experience with 120 patients who underwent anterior and anterolateral cranial base procedures during the past 14 years. Methods: Between July 1990 and February 2004, 62 male and 58 female patients underwent 120 combined (neurological surgery and otolaryngology joint participation) anterior and anterolateral cranial base procedures. Fifty-four percent had malignant pathology, and 46% had benign pathology. The approaches taken were transfacial (10%), extended subfrontal (33%), lateral craniofacial (23%), and anterior craniofacial (35%). Thirty-day morbidity and mortality were analyzed. Results: Twenty (17%...
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Mucormycosis is an infection caused by a group of fungi in the order Mucorales in the phylum Zygomycota. The most well-known form of this disease is rhinocerebral mucormycosis, which usually develops in diabetic or immunocompromised... more
Mucormycosis is an infection caused by a group of fungi in the order Mucorales in the phylum Zygomycota. The most well-known form of this disease is rhinocerebral mucormycosis, which usually develops in diabetic or immunocompromised patients. The fungal hyphal elements are easily detected in biopsy specimens by direct or histologic examination. However, the confirmatory identification of the genus or species requires culture of the specimen. This article presents a case of rhinocerebral mucormycosis in which presumptive identification of the genus was made without microbiologic cultures and was based on the extraordinarily rare appearance of fungal sporangia and sporangiospores in histologic tissue sections. Identification of these structures allowed an early and accurate diagnosis of rhinocerebral invasive mucormycosis.
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The acute response to stress consists of a series of physiological programs to promote survival by generating glucocorticoids and activating stress-response genes that increase the synthesis of many chaperone proteins specific to... more
The acute response to stress consists of a series of physiological programs to promote survival by generating glucocorticoids and activating stress-response genes that increase the synthesis of many chaperone proteins specific to individual organelles. In the endoplasmic reticulum (ER), short-term stress triggers activation of the unfolded protein response (UPR) module that either leads to neutralization of the initial stress or adaption to it; chronic stress favors cell death. UPR induces expression of the transcription factor, C/EBP homology protein (CHOP), and its deletion protects against the lethal consequences of prolonged UPR. Here, we show that stress-induced CHOP expression coincides with increased metabolic activity. During stress, the ER and mitochondria comes close to each other, resulting in the formation of a complex consisting of the mitochondrial translocase, translocase of outer mitochondrial membrane 22 (Tom22), steroidogenic acute regulatory protein (StAR) and 3β-...
Research Interests: Endocrinology, Biology, Cell Biology, Mitochondria, Endoplasmic Reticulum Stress, and 15 moreMedicine, Mammals, Biological Sciences, Molecular and cellular biology, Mice, Animals, Male, Endoplasmic Reticulum, Phosphates, Cytoplasm, Gonads, Mitochondrion, Adrenal glands, Stress Physiological, and Medical and Health Sciences
Epistaxis is a common emergency usually caused by local trauma to the nasal mucosa. Occasionally, it may result from systemic diseases such as atherosclerosis, hypertension, or coagulopathy. Anterior nosebleed often can be controlled with... more
Epistaxis is a common emergency usually caused by local trauma to the nasal mucosa. Occasionally, it may result from systemic diseases such as atherosclerosis, hypertension, or coagulopathy. Anterior nosebleed often can be controlled with topical vasoconstriction and cautery. Intranasal packing may be necessary to tamponade bleeding vessels. Occlusion of the sinus ostia by anterior nasal packing may necessitate prophylactic use of antibiotics to prevent sinusitis. Posterior nosebleed requires nasopharyngeal packing. Patients must be closely monitored and given supplemental high-humidity oxygen. Persistent or recurrent nosebleed or failure of posterior nasopharyngeal packing to control bleeding indicates the need for otolaryngologic consultation and perhaps surgical intervention.