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Biomedical subjects

A N Balwally

Publications and source records attributed to A N Balwally.

7 recordsLinked to original sources
PubMed1998

Isolated cervical tuberculosis in patients with HIV infection.

OBJECTIVE: Tuberculosis isolated to the head and neck region is common in patients with HIV infection. However, the management of isolated head and neck tuberculosis has not been reported in the literature. This study was done to describe the characteristics of tuberculosis isolated to the head and neck region in patients infected with HIV and to detect differences in presentation and diagnostic management based on the status of HIV infection at presentation. METHODS: A retrospective study was performed including 38 patients infected with HIV who were seen with tuberculosis isolated to the head and neck region at two tertiary care centers during a 10-year period. These patients were divided into two groups on the basis of the HIV status at presentation, which indirectly reflects the level of immunosuppression. Group 1 included 11 patients (29%) with AIDS at presentation. Group 2 included 27 patients (71%) with HIV infection but not AIDS. RESULTS: The cervical lymphatics were the most common site for isolated head and neck tuberculosis (89%), with the supraclavicular nodes most often involved (53%). Extralymphatic involvement was less common (11%), but involved a variety of anatomic locations (skin, spinal cord, larynx, parotid). The presenting history and physical examination had a low sensitivity for tuberculosis in patients with HIV infection, mainly because of the presence of multiple confounding factors. Purified protein derivative testing was highly sensitive for tuberculosis in patients with HIV infection alone (61 %); however, its usefulness was diminished in patients with AIDS (14%; p=0.03). Fine-needle aspiration biopsy was 94% sensitive for diagnosing tuberculosis and was not affected by the status of HIV infection. Surgical biopsy was the gold standard for diagnosing tuberculosis but was associated with chronically draining fistulas in a significant number of cases (14%). CONCLUSIONS: These data suggest that tuberculosis should be considered in the differential diagnosis of all head and neck lesions in patients infected with HIV, even in the absence of pulmonary involvement. Purified protein derivative testing should be done liberally in these patients, with realization that the sensitivity of purified protein derivative testing is reduced in patients with AIDS. Fine-needle aspiration biopsy should be the key diagnostic test in this patient population, with open surgical biopsy reserved for highly suspicious cases in which other measures were not diagnostic.

Adult↗
PubMed1998

Branchial cleft cyst carcinoma: myth or reality?

Skepticism has surrounded the existence of branchial cleft carcinoma since the entity was first described in 1882. However, a landmark work of 1950 established four criteria for the diagnosis of branchial cleft carcinoma, the most important criterion being histologic proof of carcinoma arising from a normal cyst epithelium. Of the 43 cases found in an extensive review of the literature, only 7 cases have satisfied all four of the criteria. To this we add 2 patients who had recurrent infections of a cervical cyst as children and later developed carcinoma within these structures. Additionally, we propose a minor modification to the 1950 criteria and a paradigm for diagnosis and management of these lesions.

Adult↗
PubMed1997

Sinus mucoceles: is marsupialization enough?

Traditional teaching in the United States has emphasized the need for complete removal of sinus mucoceles to achieve a cure. In Europe, however, many rhinologic surgeons have been treating sinus mucoceles by draining and marsupializing them. We present our experience with the treatment of 16 patients with sinus mucoceles. This series includes nine frontal, two ethmoid, two sphenoid, one sphenoethmoid, and two maxillary sinus mucoceles. All patients were treated transnasally under telescopic control. All mucoceles were marsupialized, and 11 were stented. Intraoperative transillumination as well as intraoperative lateral x rays (for sphenoethmoid lesions) and anteroposterior x rays (for frontal mucoceles) were used to ensure complete marsupialization of the lesion and to confirm proper placement of the stent. There were no complications associated with the procedure. Follow-up periods ranged from 8 to 62 months (median, 32 months). No evidence of recurrent mucocele has been seen in any of the patients.

Adult↗
PubMed1996

Upper aerodigestive tract squamous cell carcinoma. The human immunodeficiency virus connection.

OBJECTIVE: To evaluate the incidence, distribution, and course of squamous cell carcinoma (SCC) of the upper aerodigestive tract in patients infected with the human immunodeficiency virus (HIV) and compare it to SCC in non-HIV-infected patients. DESIGN: Case-control study of all patients with SCC during a 9.5-year period from January 1985 through June 1994. SETTING: Two academic tertiary care centers in a metropolitan location. PARTICIPANTS: Five hundred thirty-nine patients (18 to 95 years old) with SCC of the upper aerodigestive tract. RESULTS: Infection with HIV was present in 4.5% of the patients with SCC of the upper aerodigestive tract. Patients infected with HIV were significantly younger than noninfected patients (P < or = < .001), accounting for 21.3% of those patients younger than 45 years (P < .001). No significant difference in tumor location was present between HIV-infected and noninfected patients; however, HIV-infected patients had larger tumors (P = .004) and a more advanced tumor stage (TNM classification) at presentation (P = .05). Tumor-related survival was significantly poorer in patients with HIV infection (P = .01), with 57% at 1 year and 32% at 2 years, compared with 74% and 59%, for non-HIV-infected patients. The detrimental effect of HIV infection on survival remained significant after adjusting for the confounding effects of age, tumor stage, and location of the tumor. All study patients with HIV infection had cancer risk factors such as tobacco and/or alcohol abuse. CONCLUSIONS: Infection with HIV possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms. The decreased survival rates among these patients suggests that the SCC may be more aggressive or that other cofactors assume greater importance. A history of tobacco and/or alcohol abuse in patients with HIV infection warrants aggressive screening and early detection, to allow for early detection, which may help increase survival.

Adolescent↗
PubMed1996

Laryngeal tuberculosis in HIV-infected patients: a difficult diagnosis.

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB in patients with human immunodeficiency virus (HIV) infection can make its diagnosis difficult. In our population of 146 patients with TB involving the head and neck, HIV infection was present in 70 cases (48%). The prevalence of laryngeal TB in this population was 5.5% (8 patients). Concomitant HIV infection was present in 2 (25%) of 8 patients with laryngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% of patients with HIV infection, compared with 17% of non-HIV-infected patients (P = .055). The cause of the delayed diagnosis was multifactorial, mainly the presence of multiple confounding variables and the carcinoma-like appearance of the laryngeal TB lesions in HIV-infected patients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryngeal lesions, especially those with HIV infection.

Adult↗
PubMed1995

Transcutaneous cervical miniesophagostomy.

Nasogastric tubes have been shown to cause damage to the pharyngolaryngeal complex, producing laryngeal inflammation, granulation, muscle damage, and even vocal cord immobility. The coexistence of nasogastric and tracheotomy tubes after conservation laryngeal surgery is especially harmful. The friction between these two semirigid structures may result in damage to the remaining part of the larynx. This may result in a significant delay in healing, oral feeding, and decannulation. Percutaneous endoscopic gastrostomy is a possible solution. This procedure requires time, special expertise, and cooperation between services. We present our experience with 17 transcutaneous cervical miniesophagostomies using a small-caliber feeding tube, which were performed during conservation laryngeal and/or pharyngeal surgery. The rate of minor complications was 11.7%, or 0.40 complications per 100 tube days, and no major complications were related to the procedure. Transcutaneous cervical miniesophagostomy is a simple and quick procedure that may be performed during the primary cancer surgery. It is done by the head and neck surgeon and does not require special expertise. It takes about 5 minutes to perform and, if done correctly with funneling under skin flaps, is associated with minimal or no postoperative morbidity.

Adult↗