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Biomedical subjects

B M Rasgon

Publications and source records attributed to B M Rasgon.

17 recordsLinked to original sources
PubMed2001

Use of low-dose technetium Tc 99m sulfur colloid to locate sentinel lymph nodes in melanoma of the head and neck: preliminary study.

OBJECTIVES/HYPOTHESIS: Because sentinel lymph nodes are the first lymph nodes that drain a primary cancer site, results of sentinel lymph node (SLN) biopsy indicate status of the regional lymph nodes. Preoperative lymphoscintigraphy and intraoperative combined application of the handheld gamma probe and blue-dye technique (i.e., the "combined technique") was used previously to accurately identify the SLN, mostly in melanoma of the extremities and trunk and, sometimes, in melanoma of the head or neck, which is anatomically complex. Because of this complexity, melanoma in the head or neck is inherently problematic to treat: Localization of the SLN can be difficult or impossible because the primary cancer site can be near or overlapping the nodal basin. The objective of the present study was to determine the technical modifications and other considerations that can make SLN localization feasible in cases of melanoma occurring near or overlapping the nodal basin in the head or neck. STUDY DESIGN/METHODS: In a retrospective study of clinical records containing our database of melanoma diagnoses made between January 1996 and December 1999, we identified 27 patients diagnosed with stage I or II primary melanoma of the head or neck with clinically negative neck nodes who also had had preoperative lymphoscintigraphy. Of the 27 patients (17 male and 10 female patients; mean age, 54 y), 24 had SLN biopsy by intraoperative localization using both the handheld gamma probe and the blue-dye technique. RESULTS: Among the 27 patients who had SLN mapping, a median Breslow thickness of 1.8 mm was noted. Sentinel lymph node was noted at preoperative lymphoscintigraphy in 26 (96%) of the 27 patients. Activity of technetium Tc 99m (Tc-99m) sulfur colloid injected ranged from 10 to 1000 microCi (0.37 to 37 megabecquerel [MBq]). Intraoperative use of the combined technique for sentinel lymphadenectomy was successful in 92% of patients. Sentinel lymph nodes were identified in all 14 patients who received Tc-99m sulfur colloid at an activity level less than 60 microCi (2.2 MBq); mean activity level of injected TC-99m sulfur colloid was 28 microCi (1.04 MBq). Sentinel lymph nodes were identified in 8 (80%) of 10 patients who received Tc-99m sulfur colloid at an activity level greater than 100 microCi (3.7 MBq); mean activity of injected Tc-99m sulfur colloid in these patients was 482 microCi (17.8 MBq). A mean number of 1.4 sentinel lymph nodes per patient was identified at preoperative lymphoscintigraphy, and a mean number of 3 sentinel lymph nodes per patient was identified intraoperatively using the combined technique. Tumor recurrence was seen in 2 (10%) of the 19 patients who had cancer-free SLN at mean follow-up of 18 months (range, 1 to 47 mo). Sentinel lymphadenectomy of the parotid region did not injure the facial nerve in any patients. CONCLUSIONS: For patients with primary melanoma that is near or overlaps the nodal basin in the head or neck, SLN biopsy can be accurately performed using Tc-99m sulfur colloid at low activity levels (10 microCi to 60 microCi [0.37 to 2.2 MBq]. However, background radiation from the primary injection site can incorporate the SLN, making localization at preoperative lymphoscintigraphy difficult if not impossible; therefore, the high doses commonly used for melanoma of the extremities and trunk (500 to 2000 microCi [18.5 to 74 MBq]) should not be used for melanoma of the head or neck if the primary site is near or overlaps the nodal basin. In addition, absorption of Tc-99m sulfur colloid by salivary glands increases background radiation in the nodal basin; therefore, use of the handheld gamma probe for intraoperative localization of SLN can be problematic in regions where lymph nodes are adjacent to or within the substance of the salivary gland (i.e., the submandibular and parotid glands).

Female↗
PubMed2000

Otolaryngological manifestations of velocardiofacial syndrome: a retrospective review of 35 patients.

OBJECTIVE: Because many patients with velocardiofacial syndrome (VCFS) are first examined by otolaryngologists for ear or speech problems before being diagnosed with VCFS, we describe a series of patients with this genetic disorder, which is associated with multiple anomalies, including velopharyngeal insufficiency, cardiac defects, characteristic facial features, and learning disabilities. STUDY DESIGN: We retrospectively analyzed the medical charts and available nasoendoscopic observations for 35 patients who were diagnosed with VCFS and who had a microscopic deletion in chromosome 22q11 as shown by DNA probe and fluorescence in situ hybridization. RESULTS: For most patients, the medical chart documented cardiac anomalies, velopharyngeal insufficiency with hypernasal speech, and characteristic facial features including nasal, auricular, craniofacial, and ocular abnormalities. Incidence of middle ear infection with associated conductive hearing loss was also high and necessitated early placement of pressure equalization tubes. Some patients were treated with adenoidectomy for chronic otitis media; consequently, velopharyngeal insufficiency and hypernasal speech worsened. Nasoendoscopic examination as documented in the medical chart showed occult cleft palate, a small adenoid pad, and pulsation in the muscular wall. CONCLUSION: Otolaryngologists have an important role in diagnosis and treatment of persons with VCFS and therefore should familiarize themselves with the typical history and most frequent head and neck manifestations of this syndrome.

Adolescent↗
PubMed1999

Efficacy of a eutectic mixture of local anesthetics as a topical anesthetic in minor otologic procedures.

A eutectic mixture of local anesthetics (EMLA), prepared as a cream, is an oil-in-water emulsion of 2 anesthetic agents lidocaine and prilocaine. Several clinical applications of EMLA cream, its effectiveness as a topical anesthetic, and its safety profile have been previously reported. We report our experience with EMLA cream in 17 adult and 24 pediatric patients. We find EMLA to be the preferred anesthetic for performing minor outpatient otologic procedures in adults. We also find EMLA to be a safe, well-tolerated alternative to general anesthesia in some pediatric patients. Potential cost savings of EMLA cream during pediatric myringotomies in the clinic are also discussed.

Adolescent↗
PubMed1999

Stapes surgery in a residency training program.

OBJECTIVES: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital. STUDY DESIGN: Retrospective analysis of techniques and results for 71 stapedectomy procedures. MATERIALS AND METHODS: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used. RESULTS: Overall, closure of the air-bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser-assisted, small-fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted. CONCLUSIONS: Residents can safely and successfully perform stapes surgery using a laser-assisted, small-fenestra technique.

Clinical Competence↗
PubMed1999

A preliminary study of cocaine absorption from the nasal mucosa.

OBJECTIVE/HYPOTHESIS: To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. STUDY DESIGN: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. METHODS: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group II received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group III received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5, 10, 15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. RESULTS: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group III, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. CONCLUSIONS: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 min is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.

Anesthetics, Local↗
PubMed1999

Relationship of the facial nerve to the tympanic annulus: a direct anatomic examination.

OBJECTIVE: To examine the relation of the facial nerve to the only identifiable surgical landmark in the external auditory canal. INSTITUTION: Community-based teaching hospital. STUDY DESIGN: Examination of formalin-fixed human temporal bones. BACKGROUND: The transcanal approach is often used in tympanoplasty, canaloplasty, hypotympanotomy, and removal of tumors of the external auditory canal (EAC), such as exostoses and osteomas. Surgery of the EAC places the facial nerve at risk for injury as the nerve courses vertically in the posterior canal wall. Few articles have described the relation of the facial nerve's course to the tympanic annulus, the only identifiable landmark in the EAC. This study is the first to document the relationship of the course of the facial nerve with respect to the tympanic annulus by direct anatomic measurement of the temporal bone. METHODS: Thirty-seven formalin-fixed cadaver temporal bones were studied after skeletonization of the facial nerve and tympanic annulus. RESULTS: The facial nerve coursed lateral to the plane of the annulus in 70% of specimens, always in the posteroinferior quadrant. The nerve also coursed anterior to a plane through the most posterior point of the annulus in 73.1% of specimens, also exclusively in the posteroinferior quadrant. The course of the nerve was quite variable with respect to the annulus. CONCLUSIONS: The facial nerve is most vulnerable to injury in the posteroinferior quadrant in transcanal surgery. The annulus is not a reliable landmark for the facial nerve. Anecdotal evidence is cited and recommendations are offered.

Culture Techniques↗
PubMed1998

Efficacy of tonsillectomy for recurrent throat infection in adults.

OBJECTIVE/HYPOTHESIS: Sore throats result in health care visits, use of oral antibiotics, and days off work or school for many patients who do not meet American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for tonsillectomy. We sought to determine whether tonsillectomy would benefit this group. STUDY DESIGN: Retrospective analysis of the medical records of all patients aged 16 years or older who had tonsillectomy at our institution between 1988 and 1993. METHODS: Number of clinic visits, number of throat cultures positive for streptococci, and number of prescriptions for oral antibiotics recorded for 147 patients during the 2-year periods before and after tonsillectomy were tabulated. Statistical comparisons were made using the Student's t test. Mean number of clinic visits and oral antibiotics prescribed for throat infection before tonsillectomy were significantly higher than after tonsillectomy. RESULTS: Patients who had throat cultures positive for streptococci had more preoperative clinic visits and use of oral antibiotics than patients whose throat cultures were not positive for streptococci. When surveyed by telephone, most (>87%) of the respondents reported that they had fewer and less severe sore throats, required fewer days off work or school, and would recommend the procedure. CONCLUSIONS: Our results suggest that early tonsillectomy in patients with recurrent throat infection may result in improved patient satisfaction, better health, and improved utilization of medical resources.

Adolescent↗
PubMed1997

Efficacy and cost-effectiveness of multihole fine-needle aspiration of head and neck masses.

To determine whether the specimen from fine-needle aspiration (FNA) biopsy of head and neck masses has greater diagnostic accuracy when using multihole needles than when using conventional, single-hole needles, we did a prospective, randomized, single-blinded study comparing diagnoses obtained using both types of needles in FNA biopsies of head and neck masses. Eighty-eight patients served as their own controls and had 91 FNA biopsies with both multihole and single-hole, 22-gauge needles. Order of biopsy was randomized and was unknown to the cytopathologist. No statistically significant differences were noted in quantity of specimen material obtained, quality of fixation, or diagnostic value between the multihole and conventional needle. We found no advantage in using the more costly multihole needle in FNA biopsy of head and neck masses.

Biopsy, Needle↗
PubMed1996

Laryngeal chondroma: a benign process with long-term clinical implications.

Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.

Adult↗
PubMed1995

Relation between age and head and neck cancer recurrence after surgery: a multivariate analysis.

Recent reports have described an increase in squamous cell carcinoma of the upper aerodigestive tract in young adults. As the preponderance of epidemiologic data exists for the population between 50 and 70 years of age, controversy has developed regarding the clinical course of head and neck cancer in youth. Some authors advocate more aggressive management, calling attention to the lack of "classic" predisposing factors and suggesting genetic disorders or immunodeficiency. Basic science researchers have reported greater DNA fragility, sensitivity to carcinogens, and altered immune responses in young patients with carcinoma. To further elucidate the clinical aspects of this controversy, we performed a retrospective review using multivariate analysis to determine factors that affect recurrence. After screening 820 charts, 155 patients were found who met strict entrance criteria to the study. The patients were separated into five age groups, and 16 clinical variables were collected on each patient. Cox proportional hazards modeling revealed no significantly higher likelihood of recurrence in the 15- to 39-year-old age group. The model did find that metastatic adenopathy was predictive of recurrence (p = 0.034). The overall model further suggested a trend toward higher relative risk of recurrence in the middle-aged groups (p = 0.0541). In our review of the English biomedical literature, this is the first study to directly compare the outcome of young head and neck cancer patients with that of old patients using multivariate analysis. Future research is indicated in developing precise outcome predictions according to TNM staging, aneuploidy status, and DNA fragility in young patients. Efforts at limiting carcinogen exposure should continue.

Age Factors↗
PubMed1994

Acute epiglottitis in adults. Analysis of 129 cases.

OBJECTIVE: To characterize the clinical features of acute epiglottitis in adults and to identify factors associated with airway intervention. DESIGN: Case series. SETTING: Northern California health maintenance organization. PARTICIPANTS: A total of 129 patients aged 18 years or older with laryngoscopically confirmed acute epiglottitis admitted from November 1986 through October 1991. RESULTS: The mean patient age was 47 years (range, 18 to 85 years) and the male-to-female ratio was 1.8 to 1.0 (P < .001). The most common symptoms were sore throat (95%) and odynophagia (94%); the most common signs were muffled voice and evidence of pharyngitis. Nineteen patients (15%) received airway intervention, including seven with tracheotomy and 12 with endotracheal intubation. The remaining 110 patients recovered fully without airway intervention. In multivariate analysis, factors associated with airway intervention were stridor (relative risk [RR], 6.2; 95% confidence interval [CI], 1.7 to 22.9) and sitting erect (RR, 4.8; 95% CI, 1.3 to 16.1). Six (12%) of 52 blood cultures yielded Haemophilus influenzae type b. Major complications occurred in six patients (5%), but no deaths occurred. CONCLUSION: Most adults who have acute epiglottitis can be managed conservatively and have low morbidity and mortality.

Acute Disease↗
PubMed1993

Acute epiglottitis: changing epidemiologic patterns.

We determined incidence of acute epiglottitis in the Northern California Region of the Kaiser Permanente Medical Care Program during an 11-year period, from 1980 through 1990. The health plan membership is representative of the ethnicity, age, sex, and occupation of the Northern California population. The study included 135 children and 258 adults. Annual incidence in adults was relatively stable, ranging from 1.16 to 2.12 cases per 100,000. Annual incidence in children, however, decreased from 3.47 cases per 100,000 in 1980 to 0.63 cases per 100,000 in 1990. The ratio of annual incidence in children to that in adults decreased from 2.6 in 1980 to 0.4 in 1990. This changing epidemiologic pattern may be the effect of the Hemophilus influenzae type b vaccine (Hib), which was first given to children in 1985. Acute epiglottitis, classically considered a disease of children, is now becoming a disease of adults.

Acute Disease↗
PubMed1991

Infiltration of epinephrine in tonsillectomy: a randomized, prospective, double-blind study.

A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperative blood loss and postoperative bleeding in tonsillectomy. The efficacy of most of these substances and techniques has been judged primarily on clinical impressions. Because of the paucity of prospective studies, a randomized, prospective, double-blind study, using the patients as their own controls, was conducted. Ninety-two patients were injected before tonsillectomy in a random, double-blind fashion with normal saline solution in one tonsil and 1:100,000 epinephrine in the other. The blood loss, time of dissection, and postoperative bleeding were recorded separately for each tonsil. Cardiac manifestations were also monitored. The tonsils injected with epinephrine had a statistically significant reduction in blood loss and dissection time when compared with those injected with normal saline. Subjectively, dissection was easier on the epinephrine-injected side. There was no difference in the incidence of postoperative hemorrhage. Cardiac manifestations of epinephrine were minimal and transient. This study demonstrates that epinephrine is useful in reducing hemorrhage during tonsillectomy and can be used safely with the appropriate inhalation anesthetics.

Adolescent↗
PubMed1989

Relation of lymph-node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review.

A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph-node metastasis. These parameters have been inconsistent and not readily reproducible. In an attempt to confirm these parameters, a retrospective analysis of 22 patients with T1 to T4 squamous cell carcinoma of the oral cavity and oropharynx was performed. Initially, these patients were managed with either wide local excision or surgical excision of the primary tumor combined with radical neck dissection. There was a minimum of 3 years of follow-up. Chi-square contingency tables and Fisher's Exact Test were used to correlate histopathologic parameters with lymph-node metastasis. Statistically significant correlations were found for tumor thickness and inflammatory infiltrate.

Adult↗