Biomedical subjects

C H Rassekh

Publications and source records attributed to C H Rassekh.

27 records · Page 2Linked to original sources

PubMed1995

Accuracy of intraoperative staging of the NO neck in squamous cell carcinoma.

Management of the neck in squamous cell carcinoma of the upper aerodigestive tract continues to be a topic of great debate. One major problem is that incorrect clinical staging is expected in approximately 20% of necks. This is true of both clinical stage NO and N+ necks, even when imaging studies are used. This prospective study of 108 necks in 79 patients examined the role of intraoperative palpation and inspection in improving the surgeon's ability to predict nodal stage. Of 62 patients with NO necks clinically on both sides, 26 were staged N+ by intraoperative node examination. Nineteen of the 26 were histologically negative (73% false-positive). Of the 36 patients staged intraoperatively as NO, 10 were histologically positive (28% false-negative). Of 108 necks judged clinically to be NO, 25 (23%) had occult metastases and 11 (10%) had extracapsular spread. Forty-one of 108 clinical NO necks were believed to have positive nodes at the time of neck dissection. Of these 41 necks, 30 (73%) were found to be histologically NO (false-positive). Of the 67 clinical NO necks that were also believed to be NO intraoperatively, occult metastases were found in 14 (21% false-negative). Therefore, intraoperative staging did not significantly improve the false-negative rate. Frozen-section biopsy obtained in the operating room was reliable in 24 (92.3%) of 26 patients. Although frozen-section biopsy was not performed in all patients, these data suggest that upstaging the neck without frozen-section biopsy is much less reliable. This study supports the use of frozen-section biopsy before converting the selective dissection to a radical or modified neck dissection in most instances.

Biopsy↗

PubMed1994

Circulating markers in squamous cell carcinoma of the head and neck: a review.

Biological markers of disease enhance the ability to diagnose, treat and evaluate results of therapy and are especially intriguing for their potential use in the management of malignant tumours. The serum levels of various biochemical substances have been shown to be abnormal for many cancers and are utilised in the management of affected patients. Several markers have been thoroughly investigated for potential clinical utility in head and neck carcinoma. Although no single marker has been found to be adequately sensitive and specific, combinations of markers may improve the utility for some aspects of patient management. This review highlights the literature to date in the realm of circulating markers for head and neck carcinoma. A discussion of the potential usefulness and limitations of such markers follows.

Antigens, Neoplasm↗

PubMed1992

The prevalence of migraine in Menière's disease.

This study attempted to determine the prevalence of migraine in unilateral classic Menière's disease and vestibular Menière's disease. Diagnostic criteria for these three entities were identified and charts of patients with episodic vertigo were reviewed. A questionnaire was designed to assess the prevalence of migraine using criteria established previously by other authors. Questionnaires were mailed to patients with classic Menière's disease, patients with vestibular Menière's disease, and a normal control group. The response rates from the questionnaires in the three groups were 75%, 70%, and 36%. The percentages of the respondents who met the predetermined criteria for migraine in the three groups were 22%, 81%, and 33%. The significant difference in migraine prevalence between classic and vestibular Menière's disease suggests the possibility of different etiologies for the two entities.

Humans↗

PubMed1987

Episodic vertigo in basilar artery migraine.

Vestibular symptoms commonly occur in migraine, and episodic vertigo is most frequently seen. Auditory symptoms also occur, but are less common. When Bickerstaff described basilar artery migraine in 1961, he postulated that the many different symptoms were caused by basilar artery ischemia. He documented that neuro-otologic and other symptoms could occur before or during a migraine headache; others later established that these symptoms could also occur during the headache-free period. Case histories of eleven patients with basilar artery migraine are presented in detail. All met the diagnostic criteria for migraine and experienced vertigo before or during episodic headaches--sometimes with other symptoms of transient brainstem dysfunction. Cases represented both typical and unusual manifestations of migraine with vestibular symptoms: four patients were adolescents, three were more than 45 years old and had previously diagnosed migraine headaches, and four were young adults not previously known to have migraine. Many of the patients were thought to have disorders of the vestibular end organ (sometimes in addition to migraine) and three had undergone previous endolymphatic sac decompressions or perilymph fistula repairs. Diagnostic criteria are reviewed, in order that patients with basilar artery migraine can be distinguished from those with peripheral labyrinthine disease, to allow initiation of appropriate antimigraine therapy and avoidance of unnecessary medical and surgical therapy for end-organ disorders.

Adolescent↗

PubMedDate not supplied

Allergic fungal sinusitis with cranial base erosion.

BACKGROUND: Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses. METHODS: Our series of 28 cases of AFS was reviewed. We identified 6 cases of AFS with definite radiographic evidence of skull base erosion. RESULTS: Histologic diagnostic criteria for AFS were present in all 6 cases. All patients were managed with surgery, most recently conservative endoscopic surgery. An earlier patient underwent dural resection. Antibiotics were used in all patients, but no antifungal agents were administered. No patient has had a permanent neurologic complication, although one was seen with abducens palsy. There have been no cerebrospinal fluid (CSF) leaks. All 6 cases also had orbital bone erosion, but none has had permanent ophthalmologic sequelae. All patients were initially suspected to have a neoplastic disease. CONCLUSIONS: We propose a new diagnostic entity, "skull base allergic fungal sinusitis" (SBAFS), which incorporates the histologic diagnostic criteria of AFS with the computed tomographic (CT) criteria of bone erosion. Biopsy is necessary to rule out invasive fungus or tumor. Otolaryngologists, ophthalmologists, and neurosurgeons should be familiar with SBAFS so that systemic antifungal agents, craniotomy, and dural resection-which might initially appear necessary-can be avoided. Endoscopic surgical debridement and drainage combined with topical steroids can lead to resolution of disease, even in the presence of marked bone erosion and cranial neuropathy.

Adolescent↗

PubMedDate not supplied

The QT interval following carotid artery resection.

BACKGROUND: Right radical neck dissection has been shown to prolong the QT interval, reportedly caused by surgical trauma to the cervical autonomic system, which may result in malignant ventricular arrhythmias. Carotid artery resection would be expected to be more likely to cause dangerous arrhythmias. METHODS: We prospectively studied eight patients with electrocardiograms before and after carotid resection. Four patients had left-sided procedures and four patients had right-sided procedures. In addition, 11 patients were studied retrospectively. QT intervals were normal in all patients preoperatively. RESULTS: Preoperative corrected QT intervals (QTc) were in the normal range used by our institution for all eight patients in the prospective group. There were no significant QTc changes after either left-sided or right-sided carotid resection. However, the retrospective group did show significant changes in QTc following right carotid resection (n = 5), but not left resection (n = 6). CONCLUSIONS: EKG changes associated with carotid resection may not be uniform and may depend on surgical technique or specific anatomic factors. Controlled prospective studies are needed to confirm the prevalence of QT interval changes in radical neck surgery.

Adult↗

PubMedDate not supplied

Allergic fungal sinusitis. A report of two cases with diagnosis by intraoperative aspiration cytology.

BACKGROUND: Allergic fungal sinusitis (AFS) is a newly recognized form of sinusitis characterized by opacification of the paranasal sinuses by "allergic mucin" (AM) admixed with scattered fungal organisms. AM consists of necrotic, or partially necrotic, eosinophils and Charcot-Leyden crystals suspended in lakes of laminated, mucinous material. AFS is characterized by the absence of bone or soft tissue invasion, purulent exudate or granulomatous inflammation. Clinically, it is important to differentiate AFS from both acute invasive fungal sinusitis and noninvasive mycetoma because the three diseases are treated with different modalities and have different prognoses. Although the radiologic features of AFS are often characteristic, occasionally it may be difficult to exclude neoplasia. CASES: Two cases of AFS, in which intraoperative diagnosis was made on the basis of the presence of both AM and fungal organisms, are reported. CONCLUSION: Cytologic diagnosis of AFS can be made from intraoperative sinus aspirates from the presence of AM and fungal elements. AM and fungi provide presumptive evidence for a noninvasive, allergic fungal disease and can help reassure clinicians intraoperatively and guide clinical management.

Adult↗

PubMedDate not supplied

Tobacco cancer of the oral cavity and pharynx.

Cancer of the oral cavity and pharynx affects a significant number of individuals worldwide. The most important risk factor for development of oral cavity cancer is cigarette smoking. Tobacco in other forms and other types of smoking are also thought to be major risk factors. Co-factors, particularly alcohol consumption, are also important factors in oral cancer. Management of oral cancer requires a multidisciplinary team and has major implications for patient quality of life and for public health. Efforts are underway in many countries to reduce the incidence of oral cancer. These efforts always emphasize cessation of tobacco use and cancer screening. Local smoking cessation programs should be supported to improve the future of health care in West Virginia.

Humans↗

PubMedDate not supplied

Gene expression of zinc-alpha 2-glycoprotein in normal human epidermal and buccal epithelia.

Zinc-alpha 2-glycoprotein (Zn alpha 2gp) is almost ubiquitous in body fluids. We have found it to be also present in stratified epithelia. We compare its mRNA expression in cells from human epidermis and buccal mucosa cultured in media of graded differentiation potential (attained by varying calcium ion concentration and adding serum). The Zn alpha 2gp gene is upregulated in both epithelia with differentiation and further with exposure to interferon gamma or transforming growth factor beta 1. The upregulation by these agents increases with differentiation in epidermal cells, but peaks in the low-differentiation medium in buccal epithelia. We compared gene expression levels of Zn alpha 2gp with those of characteristic cytokeratins of stratified epithelia (k5 for basal cells, K10 for epidermal suprabasal cells, and K13 for mucosal suprabasal cells). This pattern correlation associates Zn alpha 2gp cell-type dependently with late differentiation, i.e. with keratin K10 in epidermis and with K13 in buccal epithelium.

Cells, Cultured↗