RESUMEN
OBJECTIVES: To investigate the prognostic significance of positive margin and disease course in partial laryngectomy for advanced laryngeal carcinoma and radiation failure. DESIGN: Retrospective case control study. SETTING: A major tertiary referral centre. PARTICIPANTS: Patients who underwent partial laryngectomy for advanced laryngeal carcinoma or for radiation failure with at least 2 years of follow-up. MAIN OUTCOME MEASURES: Margin status versus primary treatment and salvage treatment versus disease-free survival and overall survival. RESULTS: Twenty nine patients with sufficient follow-up data were found. Twelve patients had histological positive margin. Five of the 12 patients with a histological positive margin failed surgery as did four patients with clear margins. A positive margin had no effect on disease-free survival (P = 0.287) but was associated with poorer overall survival (P = 0.051). Of 11 patients treated primarily with surgery, recurrence was documented in one of eight with a positive margin and none of three with clear margins. Of 18 patients who underwent surgery secondary to radiation failure, recurrence was documented in all four with a positive margin and 4 of 14 with negative margins. Extended frontolateral resection, performed only in radiation failures, was associated with worse disease-free survival. CONCLUSIONS: Non-irradiated patients with involvement of a single margin after partial laryngectomy may be spared total laryngectomy if adjuvant radiation is administered. Patients who fail radiation should undergo radical partial laryngectomy, with conversion to total laryngectomy in those with a positive margin.
Asunto(s)
Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Estudios de Casos y Controles , Terapia Combinada , Femenino , Humanos , Neoplasias Laríngeas/patología , Masculino , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Análisis de Supervivencia , Insuficiencia del TratamientoRESUMEN
Mixed-type tremors pose a clinical diagnostic challenge. The aim of the study was to better characterize patients with combined postural and rest tremor. Patients were categorized into four groups: essential tremor (ET) (n = 7), combined rest + postural tremor (n = 17), PD (n = 17), and control subjects (n = 9). All underwent the University of Pennsylvania Smell Identification Test (UPSIT). The mixed-tremor group was also evaluated with SPECT imaging using the dopamine transporter (DaT) ligand (123)I-labeled FP-CIT. There was no significant difference in olfaction scores between the mixed tremor and essential tremor groups (23.2 +/- 6.6 vs 21.7 +/- 4.9) or between these groups and controls (27.2 +/- 5.0). The patients with PD had significantly lower scores than all the other groups (13.7 +/- 5.4, p < 0.001). Of the 12 patients with mixed tremor evaluated by SPECT, 9 had normal findings. This study suggests that rest tremor is part of the spectrum of ET, even in patients with long-standing disease. However, in a minority of patients, there might be transformation of ET-PD.
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Temblor Esencial/diagnóstico , Enfermedad de Parkinson/diagnóstico , Olfato/fisiología , Tomografía Computarizada de Emisión de Fotón Único , Temblor/diagnóstico , Diagnóstico Diferencial , Pruebas Diagnósticas de Rutina , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/fisiopatología , Radiofármacos , TropanosRESUMEN
OBJECTIVE: To determine whether acoustic neuroma-induced sudden hearing loss is associated with hearing recovery and, if so, to characterize its clinical, audiometric and imaging manifestations. METHODS: The files of 72 patients with sudden hearing loss evaluated between 1989 to 2001 were reviewed. All patients underwent pure tone audiometry, acoustic reflex and auditory brain revoked response (ABR) test. Magnetic resonance imaging (MRI) was performed followed by a second hearing test after one month. The findings were compared between patients with and without evidence of tumors on imaging, and between patients with tumors with and without recovery. RESULTS: Twenty-five patients (35%) had a diagnosis of acoustic tumor. Of these, six (24%) recovered hearing after one month. Five of them had small intracanicular tumors and one had a small extracanicular tumor. There was variability in the hearing loss. Five had a pathological ABR and one had normal ABR. CONCLUSIONS: We conclude that recovery from hearing loss does not exclude acoustic tumors and these patients therefore require full evaluation including MRI.
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Pérdida Auditiva Súbita/fisiopatología , Neuroma Acústico/diagnóstico , Recuperación de la Función , Audiometría de Respuesta Evocada , Audiometría de Tonos Puros , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Sensorineural/fisiopatología , Pérdida Auditiva Súbita/etiología , Humanos , Imagen por Resonancia Magnética , Neuroma Acústico/complicaciones , Reflejo Acústico , Estudios Retrospectivos , Percepción del Habla , Tomografía Computarizada por Rayos XRESUMEN
HYPOTHESIS: In view of the proven effectiveness of vitamin A for the treatment of hyperkeratosis, it was hypothesized that vitamin A may also be a feasible therapeutic option for cholesteatoma, which has similar histologic features. BACKGROUND: Cholesteatoma is a major cause of chronic ear disease, often requiring surgery. The recurrence rate may exceed 20%. Hyperkeratosis is a major sequela of tympanomastoid surgery, causing chronic ear hygiene problems. METHODS: The external auditory canals of 40 Mongolian gerbils were ligated to induce cholesteatomas. The ears were divided into three groups by type of treatment: group I, vitamin A drops (n = 40); group II, Cortisporin drops (n = 20); group III, no treatment (control subjects) (n = 20). Examination for the development and grade of cholesteatomas was performed after 9 months. RESULTS: Cholesteatomas developed in 26 ears (65%) of group I, 12 ears (60%) of group II, and 20 ears (100%) of group III. The differences were significant between groups I and III and groups II and III for both rate of cholesteatomas and severity of grade. There were no significant differences between groups I and II. CONCLUSION: Local treatment reduces the risk of cholesteatomas in ligated gerbilline ears. Cortisporin and vitamin A are equally effective as local treatments.
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Colesteatoma del Oído Medio/prevención & control , Colesteatoma del Oído Medio/cirugía , Vitamina A/uso terapéutico , Animales , Combinación de Medicamentos , Gerbillinae , Hidrocortisona/uso terapéutico , Neomicina/uso terapéutico , Polimixina B/uso terapéutico , Periodo PosoperatorioRESUMEN
OBJECTIVE: This study evaluates the effectiveness and safety of fiberoptic carbon dioxide (CO2) laser welding for graft closure of tympanic membrane perforations in an animal model. STUDY DESIGN AND SETTING: Tympanic membrane perforation was surgically induced in 11 eardrums of 7 given pigs. A lumbar facial graft was placed over the wound, and albumin drops served as a biologic solder. CO2 laser energy, transmitted through silver halide infrared transmitting fibers, was used for "spot-welding" along the circumference of the graft. The welded sites were evaluated by using a surgical microscope as well as by evaluating the sites histologically. RESULTS: Healing started 3 to 4 days after surgery and was completed within 3 weeks with the formation of a neotympanum. Some inflammation with granulation tissue was noted in 5 eardrums. CONCLUSIONS AND SIGNIFICANCE: These preliminary results indicate that CO2 laser tympanoplasty with a fiberoptic delivery system may be a promising new technique for the clinical setting.
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Terapia por Láser , Modelos Animales , Miringoplastia/métodos , Perforación de la Membrana Timpánica/cirugía , Animales , Dióxido de Carbono , Estudios de Factibilidad , Tecnología de Fibra Óptica , Cobayas , Terapia por Láser/métodos , Cicatrización de HeridasRESUMEN
OBJECTIVE: To present our experience of endoscopic surgery for symptomatic mucus retention cyst of the maxillary sinus. DESIGN: Retrospective study. SETTING: Teaching hospital, Israel. PATIENTS: 60 patients with 65 symptomatic cysts of the maxillary sinus who were operated on endoscopically. Only patients with large cysts that filled at least 50% of the sinus space were included. INTERVENTION: A rigid nasal endoscope was used in all cases; most of the cysts were removed through the natural sinus ostium. RESULTS: Cysts recurred in only two patients during the first postoperative year. There were no complications from the procedure. CONCLUSION: The endoscopic approach to the treatment of maxillary sinus cyst is associated with a low rate of recurrence (3% in this study) and no complications, and we recommend it as the surgical procedure of choice.
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Endoscopía/métodos , Seno Maxilar/cirugía , Mucocele/cirugía , Enfermedades de los Senos Paranasales/cirugía , Adolescente , Adulto , Anciano , Niño , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVES: To describe the detailed auditory phenotype of DFNA15, genetic hearing loss associated with a mutation in the POU4F3 transcription factor, and to define genotype-phenotype correlations, namely, how specific mutations lead to particular clinical consequences. DESIGN: An analysis of clinical features of hearing-impaired members of an Israeli family, family H, with autosomal dominant-inherited hearing loss. SETTING: Department of Human Genetics and Molecular Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Audiology, Rabin Medical Center, Petah Tiqwa, Israel; and audiological centers. PARTICIPANTS: Clinical features of 11 affected and 5 unaffected individuals older than 40 years from family H were studied. Mutation analysis was performed in 6 presymptomatic individuals younger than 30 years; clinical features were analyzed in 4 of these family H members. INTERVENTIONS: Hearing was measured by pure-tone audiometry and speech audiometry on all participating relatives of family H. Immittance testing (tympanometry and acoustic reflexes), auditory brainstem response, and otoacoustic emissions were done in a selected patient population. RESULTS: The patients presented with progressive high-tone sensorineural hearing impairment, which became apparent between ages 18 and 30 years. The hearing impairment became more severe with time, eventually causing significant hearing loss across the spectrum at all frequencies. CONCLUSIONS: Our results indicate that POU4F3 mutation-associated deafness cannot be identified through clinical evaluation, but only through molecular analysis. Intrafamilial variability suggests that other genetic or environmental factors may modify the age at onset and rate of progression.
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Aberraciones Cromosómicas/genética , Genes Dominantes/genética , Pérdida Auditiva Sensorineural/genética , Proteínas de Homeodominio/genética , Mutación/genética , Factores de Transcripción/genética , Adulto , Audiometría de Tonos Puros , Deleción Cromosómica , Trastornos de los Cromosomas , Análisis Mutacional de ADN , Femenino , Tamización de Portadores Genéticos , Genotipo , Pérdida Auditiva Sensorineural/diagnóstico , Humanos , Israel , Masculino , Persona de Mediana Edad , Fenotipo , Factor de Transcripción Brn-3CRESUMEN
OBJECTIVE AND IMPORTANCE: A unique case of spontaneous pneumocephalus is described. It appeared a few years after the uneventful introduction of a cerebrospinal fluid shunt and was probably attributable to a defect of the posterior mastoid plate. CLINICAL PRESENTATION: A 65-year-old man presented with a subacute onset of vertigo, vomiting, and atactic gait instability. The patient had undergone a ventriculoperitoneal shunt implantation 2 years previously for communicating hydrocephalus. A computed tomographic scan revealed a posterior fossa pneumatocele without hydrocephalus. INTERVENTION: A simple mastoidectomy was performed. Detection of the area of the bone defect was followed by mastoid obliteration with abdominal fat. CONCLUSION: Clinicians should be aware that pneumocephalus can occur spontaneously, with or without obvious shunt problems. Treatment should be directed toward the area through which air penetrated the posterior fossa.
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Neumocéfalo/etiología , Derivación Ventriculoperitoneal , Anciano , Fosa Craneal Posterior , Humanos , Hidrocefalia/cirugía , Masculino , Apófisis Mastoides/diagnóstico por imagen , Apófisis Mastoides/cirugía , Neumocéfalo/diagnóstico por imagen , Neumocéfalo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Retrocochlear pathological findings may be suggested by findings on the brainstem response and acoustic sensorineural reflex (AR) tests. We describe the incidence of acoustic neuroma presenting as sudden hearing loss (SHL) and the effectiveness of the discrimination (DISC) test, the brainstem-evoked response, and AR test in predicting acoustic neuroma in patients with SHL. METHODS: We retrospectively reviewed the charts of all adult patients who presented to our center with sensorineural SHL between 1989 and 1995. Two groups were defined: those with cerebellopontine angle (CPA) tumor and those with negative imaging findings. Results of the brainstem-evoked response, AR, and DISC tests were compared. RESULTS: Forty patients were admitted with sensorineural SHL, of whom 19 (47.5%) had a CPA tumor. The latter group showed a significantly lower mean age and better results for the low frequencies on pure tone audiometry, as well as better brainstem-evoked response test results than the patients with negative imaging findings. There was also a significant difference between the groups for both the affected and unaffected ears on the discrimination test. CONCLUSION: Acoustic tumors may be a more common cause of sudden sensorineural hearing loss than previously suspected. The DISC test is a useful screening tool for acoustic tumor, whereas the brainstem-evoked response test shows poorer results in affected patients with sensorineural hearing loss than in other subgroups with different signs of acoustic neuroma. We recommend that young patients presenting with mild SHL who have normal results on the AR and brainstem-evoked response tests undergo magnetic resonance imaging to rule out CPA tumor.