RESUMEN
Bone marrow transplantation (BMT) is used in the treatment of a wide range of malignancies. It involves immunosuppression and increased risk of infections such as sinusitis. However, the risk of infection is much higher in allogeneic transplants than those who are replaced with their own bone marrow (autologous). Immunodeficient patients may develop fungal sinusitis with a high mortality rate. An aggressive approach to evaluation and surgical intervention for fungal sinusitis in BMT patients at the Indiana University Medical Center was used for 2 years (from 1991 through 1992). This approach encouraged surgery on any BMT patient who was clinically septic or had any changes on a sinus CT scan. In 1993, a more medically oriented approach with radiologic and nasal endoscopic monitoring was adopted. During 1991 to 1992, 12 of the 21 allogeneic transplant patients (57%) who had sinus surgery died. The four autologous BMT patients operated on during this period all survived. Three allogeneic transplant recipients had surgery in 1993 and survived. No autologous cases had sinus procedures in 1993. No fungal sinus infection occurred in any BMT patient during the 3-year review. Careful patient selection, evaluation, and preventative measures can be successful in dealing with this rare but potentially fatal complication without performing unnecessary surgery on patients who have a poor prognosis unrelated to their sinuses.
Asunto(s)
Trasplante de Médula Ósea , Sinusitis/cirugía , Adolescente , Adulto , Trasplante de Médula Ósea/efectos adversos , Niño , Endoscopía , Senos Etmoidales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Terapia de Inmunosupresión/efectos adversos , Masculino , Seno Maxilar/microbiología , Persona de Mediana Edad , Micosis/diagnóstico , Micosis/prevención & control , Micosis/cirugía , Selección de Paciente , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Sinusitis/microbiología , Sinusitis/prevención & control , Tasa de Supervivencia , Irrigación Terapéutica , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Trasplante Homólogo , Resultado del TratamientoRESUMEN
We studied the effect of antileukotriene therapy for the relief of sinus symptoms in patients with aspirin triad disease (ATD). We reviewed the charts of 18 ATD patients who had received antileukotriene therapy. All patients had undergone previous sinus surgery. We then designed a questionnaire to determine the level of each patient's symptoms of chronic rhinosinusitis before and after antileukotriene therapy. Responses were converted to symptom scores. For each patient, the role of therapy in the relief of sinus symptoms was evaluated in three ways: by total symptom scores, by self-reports of overall benefit, and by findings on endoscopic nasal examination. Fifteen of the 18 patients completed the questionnaire. Symptom scores for both major and minor symptoms indicated that nine patients had improved following antileukotriene therapy; three other patients reported some overall benefit from therapy, despite no improvement in their symptom scores. Endoscopic nasal examination findings were consistent with the reports of overall benefit. We conclude that antileukotriene therapy is an effective treatment for most patients whose symptoms of chronic rhinosinusitis persist following sinus surgery.
Asunto(s)
Asma/tratamiento farmacológico , Antagonistas de Leucotrieno/uso terapéutico , Pólipos Nasales/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Compuestos de Tosilo/uso terapéutico , Adulto , Anciano , Aspirina/efectos adversos , Asma/complicaciones , Asma/diagnóstico , Hipersensibilidad a las Drogas/etiología , Femenino , Estudios de Seguimiento , Humanos , Indoles , Masculino , Persona de Mediana Edad , Pólipos Nasales/complicaciones , Pólipos Nasales/diagnóstico , Satisfacción del Paciente , Fenilcarbamatos , Estudios Retrospectivos , Sinusitis/complicaciones , Sinusitis/diagnóstico , Sulfonamidas , Encuestas y Cuestionarios , Síndrome , Resultado del TratamientoRESUMEN
Nineteen patients with primary ethmoid sinus malignancies were treated at the Cleveland (Ohio) Clinic Foundation between 1976 and 1989. Pathologic diagnoses included adenocarcinoma (eight), sarcoma (four), squamous cell carcinoma (three), mucoepidermoid carcinoma (two), adenoid cystic carcinoma (one), and undifferentiated carcinoma (one). All patients underwent surgical resection: 13 had craniofacial resection, four had craniofacial resection/orbital exenteration, one had radical ethmoidectomy/maxillectomy/orbital exenteration, and one had transantral ethmoidectomy. Twelve patients had combined treatment with radiation therapy. Ten patients were alive with no evidence of disease. A trend toward improved prognosis is associated with negative surgical margins. Preservation of the globe was not associated with local recurrence at this site. A poor prognosis was noted with involvement of the dura, brain, nasopharynx, or sphenoid sinus.
Asunto(s)
Carcinoma/mortalidad , Senos Etmoidales , Neoplasias de los Senos Paranasales/mortalidad , Sarcoma/mortalidad , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Carcinoma/terapia , Carcinoma Adenoide Quístico/mortalidad , Carcinoma Adenoide Quístico/patología , Carcinoma Adenoide Quístico/terapia , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/terapia , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Sarcoma/patología , Sarcoma/terapia , Tasa de SupervivenciaRESUMEN
The surgical management of carotid body tumors requires identification and preservation of neural and vascular structures without compromising resection of the neoplasm. Fifteen patients were examined and treated for carotid body tumors at the Cleveland (Ohio) Clinic Foundation from 1979 through 1987. The benchmark of diagnosis is bilateral carotid angiography. When neural structures are free of tumor, meticulous dissection facilitates their preservation. Large tumor size increases risk for arterial resection necessitating reconstruction. The use of a vascular shunt minimizes the risk of cerebral ischemia. Postoperative intravenous digital subtraction angiography allows for evaluation of arterial repair. A retrospective review of 15 carotid body tumor resections performed in 14 patients revealed no evidence of tumor recurrence, no mortality associated with surgical intervention, no postoperative cerebrovascular accident, and limited morbidity associated with unavoidable sacrifice of neural elements.
Asunto(s)
Tumor del Cuerpo Carotídeo/cirugía , Adulto , Anciano , Angiografía de Substracción Digital , Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Tumor del Cuerpo Carotídeo/radioterapia , Nervios Craneales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Primary squamous cell carcinoma of the parotid gland is an uncommon malignancy. It can be diagnosed only after squamous cell carcinoma metastatic to the parotid gland has been excluded. Histologic evaluation must differentiate primary squamous cell carcinoma from high-grade mucoepidermoid carcinoma or adenocarcinoma. Retrospective review of parotid gland neoplasms seen in the Department of Otolaryngology and Communicative Disorders between 1972 and 1987 identified eight cases for an incidence of 1.8%. The majority of these patients had advanced disease and were treated with both surgery and radiation therapy. Fifty percent of the cases demonstrated no evidence of disease at an average follow-up of 29 months.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de la Parótida/patología , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Parótida/diagnóstico , Neoplasias de la Parótida/terapia , Estudios RetrospectivosRESUMEN
Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a benign disorder predominantly of young women who present with cervical adenopathy. It has, on occasion, been misdiagnosed as a malignant neoplasm. Little mention of this condition has appeared in the otolaryngologic literature. A patient with Kikuchi's disease is reported and the pertinent literature is reviewed. Because both the clinical and pathological aspects of Kikuchi's disease are important in establishing the diagnosis, effective consultation between the head and neck surgeon and the pathologist is crucial.
Asunto(s)
Linfadenitis/diagnóstico , Adulto , Femenino , Humanos , Linfadenitis/patología , Cuello , NecrosisRESUMEN
The pharmacokinetics, tissue distribution and metabolism of caffeine were studied in male New Zealand White rabbits after an i.v. dose of 4 mg/kg. The mean (n = 4) distribution half-life was 0.2 hr and the mean elimination half-life was 3.8 hr. The mean clearance was 0.20 liters/kg/hr and the mean volume of distribution was 0.82 liters/kg. Concurrent samples of blood and semen from three rabbits, trained to ejaculate into an artificial vagina, were analyzed. The mean semen/blood concentration ratio of caffeine was 1.0. The concentrations of caffeine in the tissues of three rabbits were examined at 1 hr after an i.v. dose of 4 mg/kg. Most tissues exhibited a tissue/blood concentration ratio of approximately 1.0. Exceptions to this included fat, adrenals, liver and bile in which the ratios were 0.2, 0.6, 1.5 and 2.7, respectively. Urinary metabolites were investigated after an i.v. dose of 4 mg/kg of [14C]caffeine. The metabolites of caffeine were separated by high-pressure liquid chromatography and quantified by liquid scintillation counting. The major urinary metabolites of caffeine in the rabbit were 1-methylxanthine (22%), 1-methyluric acid (19%), 7-methylxanthine (16%) and 1,7-dimethylxanthine (14%).