A peripatetic pancreatic pseudocyst in the neck.
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Adult↗
Biomedical subjects
A Lamothe
Publications and source records attributed to A Lamothe.
A logical approach to the thoracic inlet: the Dartevelle approach revisited.
BACKGROUND: Traditionally, Pancoast tumors have been associated with an extremely poor outlook. Recently, Dartevelle and colleagues have noted a significant survival advantage in patients treated by wide en bloc excision. METHODS: Utilizing an illustrative case example, step by step exposure of the lung apex and first rib is provided with the Dartevelle approach. RESULTS: Safe exposure was provided by this combined transcervical and transthoracic approach. CONCLUSIONS: The Dartevelle approach appears to be the favored approach to anterior lung apex or first rib lesions. The combined efforts of an Otolaryngolist-Head and Neck Surgeon and a Thoracic Surgeon may allow for safe, wide en bloc excision of these otherwise difficult to access lesions.
Adult↗
Recurrent thyroglossal duct cysts: a clinical and pathologic analysis.
OBJECTIVE: To analyze, in detail, the clinical and pathological findings in a patient population that had undergone previous Sistrunk procedures for the removal of thyroglossal duct cysts, in order to identify any possible factors that could be related to recurrence after 'definitive' surgery. SETTING: A large pediatric tertiary care center. METHODS: A retrospective chart review was performed to include all patients treated at a single center for thyroglossal duct cysts with a Sistrunk procedure, between 1978 and 1992 inclusive. RESULTS: A total of 108 consecutive patients were analyzed. We noted that the presence of recent preoperative infection of the cyst was the only statistically significant (P < 0.05) clinical difference noted between the successful and the unsuccessful surgical groups. However, pathological analysis revealed that there was a substantially greater number of multiple thyroglossal duct tracts (P < 0.05) noted in the group that failed a Sistrunk procedure. CONCLUSIONS: We feel that multiple thyroglossal tracts may play an etiologic role in some recurrent cysts. Thus, a wide conservative excision, including the middle two thirds of the hyoid bone, is necessary in order to include any multiple tracts in the resection.
Canada↗
Adult epiglottitis in a Canadian setting.
The objective of this study was to determine stable estimates of the incidence, case fatality, and epidemiologic features of adult epiglottitis, and risk factors for intubation. The authors designed a retrospective cohort combined with a nested case-control study, followed by detailed analysis of cases from two tertiary care institutions. Among 813 cases, the incidence was 2.02 cases/10(5) population per year. Ten recorded deaths constituted a case fatality rate of 1.2% (95% confidence interval [CI]: 0.5% to 1.9%). The eight fully documented deaths indicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (P < 0.001) predicted the need for intubation. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspnea suggest that prophylactic intubation and intensive care unit monitoring is not warranted in all patients. An early complaint of dyspnea may safely discriminate between patients requiring invasive airway management and close observation.
Adult↗
Tuberculosis of the retropharyngeal space.
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Adult↗
Description and evaluation of the vallecula sign: a new radiologic sign in the diagnosis of adult epiglottitis.
STUDY OBJECTIVE: To describe and prospectively evaluate a new radiologic sign with the potential to increase the diagnostic accuracy of soft-tissue radiography of the neck in the identification of adult epiglottitis. METHODS: We conducted a prospective, before-and-after blinded study at two tertiary care institutions. A convenience sample of four staff emergency physicians, three otolaryngology residents, four radiology residents, and four senior medical students volunteered to participate. We assembled 26 soft-tissue radiographs of the neck from consecutive patients ED with the diagnosis of epiglottitis made on the basic of direct visualization. Twenty-six control radiographs were identified from ED patients who were being evaluated for the presence of foreign bodies or minor cervical trauma. We then randomly mixed the two sets of radiographs. Participants were asked to identify epiglottis among the 52 randomly sequenced radiographs. A standardized 5-minute tutorial on the vallecula sign was presented to all participants after the first interpretation. We then asked the participants to make a second interpretation of the 52 radiographs without knowledge of correct answers from the initial evaluation. RESULTS: The participants accurately classified 80.5% of all radiographs reviewed before the tutorial and 98.8% after the tutorial (P < .0001). Similarly, sensitivity improved from 78.5% to 98.2% (P < .0001) and specificity improved from 82.8% to 99.5% (P < .0001). We found no significant differences in performance characteristics among the different types of participants. CONCLUSION: We have described a new radiographic sign that improves the diagnostic accuracy of soft-tissue radiography of the neck. If reproduced in prospective studies, the absence of the vallecula sign on radiography might obviate the need for routine use of direct visualization as an initial screen.
Acute Disease↗
A prospective comparison of octylcyanoacrylate tissue adhesive and suture for the closure of head and neck incisions.
OBJECTIVE: To compare the tissue adhesive octylcyanoacrylate with subcuticular suture for the closure of head and neck incisions. DESIGN: A prospective comparison with a blinded assessment of cosmetic outcome. SUBJECTS: Fifty consecutive patients undergoing head and neck procedures at two University of Ottawa teaching hospitals. METHODS: Twenty-six patients underwent skin closure with monofilament suture and 24 were closed with tissue adhesive. At 4 to 6 weeks the incisions were evaluated with a validated wound scale. Photographs of the incisions were rated using a visual analogue scale by two facial-plastic otolaryngologists who were blinded to the method of skin closure. RESULTS: The adhesive provided faster skin closure (29.7 seconds vs 289.0 seconds, p < .0001), and there were no differences in complications between the two groups. The primary outcome measure was the cosmetic appearance of the incision at 4 to 6 weeks. Although the adhesive group scored higher on both cosmesis scales, the visual analogue scale (octylcyanoacrylate 58.7 mm vs suture 53.2 mm) and the wound evaluation scale (57% vs 50% optimal wound scores), there were no statistical or clinically significant differences on either scale. The two facial-plastic otolaryngologists had good intraobserver and interobserver agreement when rating the cosmetic outcomes (0.87 and 0.71 respectively). CONCLUSIONS: Octylcyanoacrylate was found to be an effective method of skin closure in clean head and neck incisions. The practical advantages of tissue adhesives are reviewed.
Adult↗
[Physical activity and sports. How an activity can turn into nursing care].
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Adult↗
Comparison of laser-assisted uvulopalatopharyngoplasty to electrocautery-assisted uvulopalatopharyngoplasty: a clinical and pathologic correlation in an animal model.
OBJECTIVE: To determine if there are any pathologic or technical differences between laser-assisted uvulopalatopharyngoplasty (LAUP) and electrocautery-assisted uvulopalatopharyngoplasty (EAUP). DESIGN: A prospective randomized in vivo trial in an appropriate animal species. RESULTS: We found no gross difference in healing between the palates treated with laser and those treated with high-frequency electrocautery. However, there was consistently more thermal damage noted histologically in the hemipalates treated with LAUP. On the other hand, EAUP was faster to perform, more hemostatic, associated with less char formation, and had less histologic evidence of thermal damage. CONCLUSIONS: These results raise the possibility that the beneficial effects of LAUP over traditional uvulopalatopharyngoplasty (UPPP) may be as a consequence of staging rather than the particular treatment modality used.
Animals↗
Multiple endocrine neoplasia type 1: an interesting Canadian pedigree.
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Adenoma↗
Factors affecting platinum concentrations in human surgical tumour specimens after cisplatin.
We assessed factors which affect cisplatin concentrations in human surgical tumour specimens. Cisplatin 10 mg m-2 was given i.v. to 45 consenting patients undergoing surgical resection of neoplasms, and platinum was assayed in resected tumour and in deproteinated plasma by flameless atomic absorption spectrophotometry. By multiple stepwise regression analysis of normalised data, patient characteristics that emerged as being most closely associated (P < 0.05) with tumour platinum concentrations (after correcting for associations with other variables) were tumour 'source' [primary brain lymphomas, medulloblastomas and meningiomas ('type LMM') > 'others' > lung cancer > head/neck cancer > gliomas) or tumour 'type' (LMM > brain metastases > extracerebral tumours > gliomas), serum calcium and chloride (positive correlations) and bilirubin (negative). Tumour location (intracranial vs extracranial) did not correlate with platinum concentrations. If values for a single outlier were omitted, high-grade gliomas had significantly higher platinum concentrations (P < 0.003) than low-grade gliomas. For intracranial tumours, the computerised tomographic scan feature that correlated most closely with platinum concentrations in multivariate analysis was the darkness of peritumoral oedema. Tumour source or type is a much more important correlate of human tumour cisplatin concentrations than is intracranial vs extracranial location. Serum calcium, chloride and bilirubin levels may affect tumour cisplatin uptake or retention. CT scan characteristics may help predict cisplatin concentrations in intracranial tumours.
Blood-Brain Barrier↗
Doxorubicin plus metronidazole in the treatment of recurrent or metastatic squamous cell carcinoma of the head and neck.
Twenty-five patients were treated on a Phase II study of doxorubicin, 60-75 mg/m2 intravenously every 3 weeks, accompanied by metronidazole, 1500 mg/m2 orally 12 hours and immediately before the doxorubicin and 6 hours and 24 hours after the doxorubicin. Of 23 patients evaluable for response, 2 (9%) achieved complete remissions, 2 (9%) achieved partial remissions, and 4 (18%) were stable (one of whom achieved a minor response). One patient with an inoperable biopsy-proven 4 x 3 x 3 cm recurrence following radiation and surgery has had a complete remission that persists at 8 years. The second patient who achieved a complete remission subsequently underwent surgical resection of the involved area. No residual tumor was found, and he remains disease free after 8.5 years. Doxorubicin toxicity did not appear to be augmented significantly by metronidazole. Although the response rate seen in this study was low, the occurrence of two long-term complete remissions suggests that this combination should be studied further in other tumor types.
Adult↗
Cisplatin, cytosine arabinoside, and pentoxifylline in the treatment of squamous cell carcinoma of the head and neck.
Nine patients were entered on a Phase I-II study of cisplatin, cytosine arabinoside, and pentoxifylline in the treatment of advanced head and neck cancer. The treatment regimen consisted of cisplatin 100 mg/m2 intravenously on day 1 only, cytosine arabinoside 2,000 mg/m2 intravenously on days 1 and 2, and pentoxifylline 400 mg orally three times daily beginning 7 to 14 days before the chemotherapy. The pentoxifylline was continued between chemotherapy cycles. Chemotherapy courses were repeated at 3- to 4-week intervals. Partial remission were seen in two patients, two patients were stable, and five patients failed on treatment. Dose-limiting toxicity was granulocytopenia. Pentoxifylline itself caused some nausea and anorexia. Although the patient numbers were small, there was no indication that pentoxifylline increased the efficacy of this chemotherapy in head and neck cancer. It is possible that another dose schedule might have been more effective.
Adult↗
High resolution CT scan of the temporal bone.
With the new high resolution CT scanners with target reconstruction, detailed radiological anatomy can be assessed. Hence, very small structures within the petrous portion of the temporal bone are accessible owing to better density resolution. Not only bony structures but also soft tissue elements are directly visible, which represents an advantage over multidirectional conventional tomography. This technique is described and examples of the normal anatomy of the temporal bone are presented.
Cochlea↗
Serous otitis media: a six week prospective study.
The purpose of this project was to attempt to outline the natural history of serous otitis media. Sixty-eight children with uni or bilateral serous otitis media were placed under observation for a six week period. They were all left untreated. Otoscopy, impedance, and audiogram measurements were used to monitor the evolution of the disease. Results showed that spontaneous resolution occurred in 35 per cent of cases. Girls were cured more frequently than boys. Furthermore, the disease receded more satisfactorily in the right than in the left ear. Within our group of patients, age was not a factor in the evolution of the otitis. Finally, the impedancometry and audiometry were not useful in assessing the probable evolution of this disease.
Acoustic Impedance Tests↗
Multiple transcriptional activation of cellular oncogenes in human head and neck solid tumours.
Expression of six cellular oncogenes in fresh human tumours and normal tissue from head and neck regions of 20 patients were assessed: 7 samples of normal tissue (controls), 4 premalignant (pleomorphic salivary adenoma) and 14 malignant tumours (squamous cell carcinoma) were examined. Normal and malignant tissue was available from the same patient in four cases, whereas normal and premalignant tissue in one case. Significant elevation of Ha-ras, Ki-ras, and myc oncogene expression were found both in premalignant and malignant tumours as compared to the normal tissue. Oncogenes fes, abl, and sis were expressed at similar low levels in all tissues examined. The results suggest activation of multiple oncogenes in premalignant and malignant tumours from the human head and neck regions.
Adenoma↗
Clinical relevance of oncogene expression in head and neck tumours.
A study was undertaken to determine whether the variation in the increased expression of three oncogenes (Ha-ras, Ki-ras and myc) could be correlated with various clinicopathological parameters of squamous cell carcinoma (SCC) of the head and neck region. No correlation was found with sex, age, site of primary tumour, level of differentiation of the tumour, previous X-ray treatment, or fate. The one exception was myc expression with TNM staging of SCC. A significant increase was found for myc expression in TNM Stage III and IV as compared to the combined stages of I and II. Elevated expression of Ha-ras, Ki-ras and myc oncogenes was found in pleomorphic salivary adenoma (PSA), but at a lower level than SCC. It is proposed that in a percentage of cases the elevated expression of these oncogenes in PSA corresponds to a relatively early event in the multistep process of carcinogenesis.
Adenoma, Pleomorphic↗