Biomedical subjects

A Shaha

Publications and source records attributed to A Shaha.

25 records · Page 2Linked to original sources

PubMed1988

Is parotid lymphadenopathy a new disease or part of AIDS?

This report describes a series of 15 patients who presented with masses in the tail of the parotid gland which proved at biopsy to be benign hyperplastic lymphadenopathy similar to lymphoepithelial hyperplasia. There were 11 male and 4 female patients. All had a history of intravenous drug use. Ten patients complained of pain. Six patients had smaller masses on the contralateral side of the gland, whereas seven patients had minor axillary adenopathy. Needle aspiration was performed in 12 patients; although not conclusively diagnostic, it ruled out primary salivary tumors. Thick purulent material was aspirated in five patients. All 15 patients underwent parotid exploration. It was apparent after raising the flap that the disease was related to intraparotid and periparotid lymph nodes. Lymphadenopathy in the jugular region, which was not appreciated preoperatively, was also noted in all patients. Each patient underwent exposure of the main trunk of the facial nerve and limited superficial parotidectomy. The postoperative course in each patient was uneventful and no patient had a facial nerve deficit. Cerebral toxoplasmosis developed in one patient who died 3 months after surgery; AIDS developed in one other patient. Human immunodeficiency virus (HIV) titers were not performed routinely because none of the patients came for regular follow-up. None of these patients demonstrated lymphoma at the time of this procedure. Parotid lymphadenopathy, which occurs primarily in intravenous drug users, appears to be an early manifestation of pre-AIDS or AIDS-related complex. If patients have no other sizable lymphadenopathy for biopsy, we advocate exploration of the parotid region and excision of periparotid and intraparotid lymph nodes.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Prosthetic reconstruction of the trachea.

Tracheal reconstruction has been a difficult and challenging problem over the years, mainly because of graft infection and extrusion. A small segment of the trachea can be resected and primary anastomosis can be performed easily with satisfactory results. The problem is always complex when a substantial portion of the trachea must be resected. A variety of prosthetic materials have been used, both in experimental animals and human subjects, with limited short-term success. This study describes an experiment using polytetrafluoroethylene (PTFE) grafts in dogs. PTFE patch and interposition grafts were used for tracheal reconstruction with very satisfactory results. Inflammatory reaction near the grafts and nonincorporation of long graft segments continue to be problems, but despite this, prosthetic reconstruction of the trachea using PTFE provided very satisfactory results in our experimental study.

Animals↗

PubMed1988

Exposure of the internal carotid artery near the skull base: the posterolateral anatomic approach.

Internal carotid injuries in zone III near the base of the skull are technically the most challenging of the carotid injuries. Diagnostic angiography is important to evaluate the exact site and extent of injury and the presence or absence of prograde flow in the injured segment. Vascular repair in this area is highly dependent on the adequacy of surgical exposure. Previous approaches have emphasized displacement of the mandible either by subluxation or mandibulotomy. Problems related to mandibulotomy, such as intraoral contamination, infection, and nonunion, are potential complications of this approach to the high carotid artery. In addition, it does not give adequate exposure of the internal carotid artery at the critical area, near the base of the skull. Experience gained from the extended radical neck dissection exposing the internal carotid artery up to the skull base has demonstrated that a posterolateral anatomic approach can provide superior exposure of the high carotid artery with lower morbidity and shortened operative time. This surgical approach involves cutting the sternomastoid muscle close to the mastoid and dissecting all the tissues away from the surface of the mastoid. Dividing the posterior belly of the digastric and styloid group of muscles assists in exposure of the internal carotid artery. Rarely, dissection of the facial nerve and removal of the tail of parotid add additional access to this area. This article describes the stepwise anatomic approach to the internal carotid artery near the base of the skull.

Adult↗

PubMed1988

Complications of thyroid surgery performed by residents.

The purpose of this report is to study the incidence of complications in thyroid surgery performed by the residents in a surgical training program. This is a report of complications in 200 consecutive thyroidectomies performed by residents with attending surgeons' assistance. There were 128 female and 72 male patients, ranging in age from 16 to 89 years. Ten patients had undergone previous thyroid surgery. There were 40 total thyroidectomies, 38 subtotal thyroidectomies, and 122 lobectomies with isthmusectomy. Preoperative and postoperative evaluation of the vocal cords was a standard routine. Identification of the recurrent laryngeal nerve was routine except in patients with large goiters, who underwent intracapsular subtotal thyroidectomy. An attempt was made to identify and preserve all four parathyroid glands. Even in lobectomy procedures, the ipsilateral parathyroids were identified and preserved. Parathyroid autotransplantation into the sternomastoid muscle was performed in thirteen instances, whenever any of the parathyroids was devascularized. Complications included superior laryngeal nerve palsy (one case) and temporary recurrent laryngeal nerve palsy (one case). There was only one patient in whom temporary hypoparathyroidism developed. In three patients hematomas developed in the recovery room and reexploration was required. Two diabetic patients had wound infections develop that required drainage. Seromas and minor wound collections were noted in 6% of the patients. The incidence of major postoperative complications of thyroidectomy is low, even when residents are the primary surgeons. Thyroidectomy appears to be a safe operation in the hands of residents with close supervision and assistance by the attending surgeons.

Adolescent↗

PubMed1987

Acute airway distress due to thyroid pathology.

Patients with multinodular goiter or related thyroid disorders rarely have acute airway distress due to tracheal deviation or compression. However, our institution cares for a large number of patients with untreated multinodular goiters, and in the progression of this disorder, tracheal deviation and airway problems are relatively common. During the past 4 years, we have cared for 24 patients who were admitted with acute, life-threatening airway distress that required emergency intervention. Nine patients had emergency intubation, the remaining 15 had stridor on admission and underwent emergency operations. The series consists of 19 females and five males whose ages ranged from 37 to 89 years. Only four patients had malignant thyroid lesions (two papillary-follicular, two anaplastic), and two of these had multiple pulmonary metastases. Fifteen of the patients with multinodular goiters had a mediastinal extension that led to marked tracheal deviation. Three patients had recurrent multinodular goiters decades after previous surgery. Twenty-one patients underwent surgery at our institution, and all did well. Only one patient required sternotomy for thyroidectomy. Two patients required tracheostomy procedures, one because of tracheomalacia and the other because of poor pulmonary reserve. Interestingly, two patients had acute symptoms when in their third trimester of pregnancy. We have routinely used the laryngoscope (fiberoptic rigid or flexible) for preoperative and postoperative evaluation of the vocal cords and for determination of the condition of the larynx. On the basis of our experience with acute airway distress, we strongly advocate elective surgery for patients with multinodular goiter at the first sign of tracheal compression, especially if they have mediastinal extension.

Acute Disease↗

PubMed1986

Fine-needle aspiration in the diagnosis of cervical lymphadenopathy.

The extent of workup in patients with cervical adenopathy has always been controversial. Extensive workup in the absence of a histologic diagnosis indicative of a malignant process is unwarranted. Although open biopsy may be necessary for certain benign conditions, its routine application for metastatic nodes is not advised. We have used fine-needle aspiration as a routine procedure in the initial evaluation of cervical adenopathy. Over the past 3 years, 140 needle aspirations have been performed. Adequate specimens were obtained in 97 percent of the patients and the diagnostic accuracy was 96 percent. Overall, 45 percent of the patients had the diagnosis of a malignant tumor established whereas others had benign tumors. Metastatic squamous cell carcinoma was diagnosed accurately in all of the patients. Other malignant tumors reported accurately included lymphoma, adenocarcinoma, and metastatic thyroid carcinoma. Among the benign conditions, accurate diagnoses could be established in patients with tuberculosis, chronic lymphadenitis, and hyperplastic lymph nodes. The findings of fine-needle aspiration are helpful in directing subsequent workup. If the findings do not correlate with the clinical suspicion, greater weight is given to the clinical picture and diagnostic workup appropriate for the suspected disease is performed. Proper use of fine-needle aspiration requires close communication between an experienced cytologist and the head and neck surgeon. This series demonstrates that fine-needle aspiration is a safe, accurate, and valuable tool for the evaluation of cervical adenopathy.

Adenocarcinoma↗

PubMedDate not supplied

Carcinoma of the uvula and midline soft palate: indication for neck treatment.

According to common classification and staging systems, tumors of the uvula and soft palate are included in the group of oropharyngeal cancers. As such, the same staging systems apply and therapeutic decisions are made accordingly. Our experience with small tumors of the uvula and midline soft palate has shown that these common rules may not apply in these anatomical sites. A multicenter retrospective study was performed to examine the aspects of presentation and clinical course of tumors of the uvula. Only patients with small tumors, less than 2.0 cm in diameter, were included. Twenty-three cases were reviewed. Eleven (47.8%) patients had clinical or radiologic evidence of neck disease on presentation. Five of 12 (41.7%) patients who presented with negative neck were found eventually to have neck disease. Eight patients had cervical recurrence. Only one patient had local recurrence. We suggest that attention may need to be directed to the treatment of the neck of all tumors of the uvula and midline soft palate, regardless of size.

Adult↗