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Biomedical subjects

D D Caldarelli

Publications and source records attributed to D D Caldarelli.

At least 55 records · Page 3Linked to original sources
PubMed1986

Retrospective DNA analysis of head and neck squamous cell carcinoma.

Abnormal cellular DNA content, a hallmark of malignancy, is known to occur in squamous cell carcinoma of the head and neck. The significance of this finding has yet to be elucidated. Paraffin-embedded blocks from 46 squamous cell carcinomas of the head and neck were sectioned, dewaxed, and made into a suspension of bare nuclei by mechanical mincing and enzymatic digestion. The nuclei were stained with propidium iodide, and quantitative DNA measurements were obtained with flow cytometry. The results were compared with existing prognostic factors: DNA aneuploidy was identified in 41% of the specimens and was significantly correlated with tumor size and surgical stage; the relationship between DNA aneuploidy and anatomic site approaches statistical significance. There was no correlation with histologic grade or presence or absence of cervical metastasis.

Aneuploidy↗
PubMed1986

Sensorineural hearing loss in lupus erythematosus.

A 51-year-old woman had sudden profound sensorineural hearing loss (SNHL) in her right ear, followed by profound SNHL in her left ear three weeks later. On subsequent work-up, a diagnosis of systemic lupus erythematosus (SLE) was made on the basis of an antinuclear antibody titer of 1:500 and immunofluorescence below the dermis on skin and muscle biopsy specimens. Treatment with prednisone and cyclophosphamide did not improve the hearing loss. To our knowledge, this is the second reported case of SLE occurring with SNHL and the first reported case of bilateral hearing loss.

Cyclophosphamide↗
PubMed1986

Severity of sleep apnea as a predictor of successful treatment by palatopharyngoplasty.

As awareness and understanding of obstructive sleep apnea has increased so has the number of treatments for this disorder. Options include surgical procedures: tracheostomy, palatopharyngoplasty (PPP), and mandibular advancement. Other treatments are medication, nasal CPAP, Tongue Retaining Device, and a position alarm. With these numerous choices available, it is important that reliable indicators be developed to guide treatment choice. And although PPP surgery is a one-time intervention with possibility of permanent correction, reports of percentages of successful treatment have varied widely from 85% to 0%. This has led us to investigate predictors of successful treatment. Twenty-two patients treated with PPP following their diagnosis by standard clinical polysomnography were restudied an average of 8 weeks later. When 11 successful cases were compared to 11 unsuccessful cases, successes were found to be initially more severely apneic (mean AI = 90.55 versus 49.45). Palatopharyngoplasty appears to be most appropriate for the sleep apnea patient whose apnea index is 70 or above and less effective for milder cases.

Adult↗
PubMed1985

A randomized trial of adjuvant chemotherapy in head and neck cancer.

Ninety-five patients with squamous cell carcinoma of the head and neck were entered into a randomized study testing a two-week course of induction chemotherapy with methotrexate and leucovorin given prior to regional therapy. In addition, following regional therapy, patients randomized to chemotherapy were to receive similar methotrexate courses every three months for one year. Poor tolerance to this regimen after radiation and surgery led to a change in the chemotherapy following regional therapy to a combination of Adriamycin (Adria Laboratories, Columbus, Ohio) and cisplatin every three weeks for four cycles after the first 35 patients had been entered. Nine cases were ineligible and four lacked any follow-up data, leaving 82 analyzable cases. Using Cox regression analysis, no differences in the percentage of patients achieving disease control, the relapse-free survival, or the overall survival were identified between any treatment group. As has been described in many pilot studies of induction chemotherapy of head and neck cancer, chemotherapy responders had a more favorable disease-free survival than chemotherapy nonresponders in the total group of patients receiving adjuvant chemotherapy. However, correcting for imbalances in the expected three year disease-free survival of these patients, based on their disease site and stage, erased this difference, indicating tumor response to this regimen of chemotherapy is not an independent factor affecting disease outcome. The division of patients into arbitrary prognostic categories based on the expected outcome for each specific tumor site and stage proved to be a useful method for balancing treatment groups, given the multiple site-stage combinations within the upper aerodigestive tract. The defined prognostic categories were the single most sensitive predictors of relapse-free and overall survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Improved control in advanced head and neck cancer with simultaneous radiation and cisplatin/5-FU chemotherapy.

Chemotherapy with cisplatin plus 5-FU infusion was given simultaneously with radiation therapy; both were administered every other week. Twenty-seven patients with stage IV disease and three with stage III disease were treated; 57% had T4, 33% had N3, and 10% had M1 disease. Of these patients, 17 (57%) achieved complete response and the rest achieved partial response. However, whether or not a clinically complete response occurred had no effect on subsequent risk for disease recurrence. With a median follow-up of 16 months (range, 6-35), only 11 patients (37%) have had disease recurrence and eight (27%) have died. Of those patients who recurred, six failed in distant sites only, one developed a second head and neck primary, and four (36% of all failures) failed regionally. Normally, greater than 50% of patients who are initially controlled (usually less than 60% of stage IV patients) would have failed within the first 12 months and greater than or equal to 75% of these would be expected to fail regionally. Nine patients who had received previous treatment or who had M1 disease accounted for six of the recurrences and four of the deaths. Because of the excellent local control, we have cautiously limited surgery to conserve laryngeal, tongue, and mandibular function in selected cases. Neither immediate nor long-term toxicity from radiation appeared increased. Although no patient with such advanced disease can be considered cured at this time, these results seem to represent a substantial improvement in the quality of life and degree of local control over other approaches. Controlled trials of the sequencing of radiation and chemotherapy in head and neck cancer appear indicated.

Aged↗
PubMed1985

Obstructive sleep apnea: variations in surgical management.

Forty patients with obstructive sleep apnea (OSA) were either treated by submucous resection, alone or by palatopharyngoplasty (PPP). Before surgery, each patient underwent a thorough sleep evaluation for the diagnosis of OSA. Of the 23 patients treated by submucous resection alone, eight had more than a 50% reduction in their apnea index and were considered successfully treated. Of the remaining 15, ten received a supplemental tongue retaining device (TRD). Five of the ten were markedly improved. The overall success rate in this group was 57%. Of the 17 patients treated by submucous resection and PPP, ten were treated successfully. Six of the remaining seven patients were subsequently treated with a TRD, which was successful in four. The overall success rate in this group was 82%.

Airway Obstruction↗
PubMed1982

Hearing and otopathology in Apert syndrome.

Otologic and audiologic records on patients wit phenotypic characteristics of Apert syndrome were reviewed. Eustachian tube function was evaluated in five patients. The otologic findings indicate that patients with Apert syndrome have serous otitis media and its sequelae develop during infancy, with persistence into adulthood. This situation is analogous to cleft palate and brings to light another form of probable congenital Eustachian tube dysfunction. Stapedial footplate fixation was noted in one patient, and a dehiscent jugular bulb was seen in two others. The middle ear disease contributes to auditory sensory deprivation in the form of a persistent conductive hearing loss.

Acoustic Impedance Tests↗
PubMed1981

Abnormal laryngeal vocal quality in ectodermal dysplasia.

Breathy vocal quality was verified in five of nine patients with the ectrodactyly--ectodermal dysplasia--cleft palate syndrome, nine of 15 patients with either suspected or confirmed anhidrotic ectodermal dysplasia (one case of partial expression), and one of two siblings with the Rapp-Hodgkin form of ectodermal dysplasia. Indirect laryngoscopy in eight of the breathy patients failed to show phonatory glottal chinks or any overt laryngeal pathologic conditions, but it did indicate absence of a normal mucosal covering of the folds. Limited spectrographic studies disclosed widely spaced voicing striations and also suggested prolonged voice onset times. Patients who exhibit breathy vocal quality in the presence of one of these ectodermal dysplasias should be counseled with regard to the advisability of longitudinal care and the avoidance of habitual use of increased vocal effort level.

Child↗
PubMed1980

Bacterial meningitis and sensorineural hearing loss: a prospective investigation.

The objectives of the present investigation are as follows: to prospectively assess the incidence of sensorineural hearing loss (SHL) associated with bacterial meningitis; to evaluate the onset and degree of SHL; and to describe the audiometric pattern. Forty-seven patients were studied otologically and audiologically. The incidence of SHL was 11%. Late onset of SHL was not observed, however, one patient demonstrated a probable progressive hearing loss. Both bilateral and unilateral hearing loss were noted. The degree of hearing loss varied from mild to profound, with no consistent audiometric pattern. Intensive follow-up on one hearing-impaired patient included temporal bone polytomograms. Obliterative labyrinthitis is detailed. Antibiotic treatment and laboratory data are evaluated. Suggestions are provided for the post-meningitic course.

Anti-Bacterial Agents↗
PubMed1980

A comparison of microtia and temporal bone anomalies in hemifacial microsomia and mandibulofacial dysostosis.

A number of entities can be categorized as otocraniofacial syndromes. New clinical and laboratory studies have demonstrated predictable patterns of occurrence, distinct anatomic interrelationships, separate genetic predispositions, and animal models of the varied embryogeneses. These investigations have allowed clinical separation of first and second branchial arch anomalies into syndromes of hemifacial microsomia and mandibulofacial dysostosis. The present study has established a relationship between the severity of the microtic auricle and middle ear malformation in those syndromes. Middle ear deformities, while present in both, are more severe when associated with mandibulofacial dysostosis.

Ear, External↗
PubMed1980

Hemifacial microsomia: priorities and sequence of comprehensive otologic management.

Hemifacial microsomia is evidenced by the clinical spectrum of microtia, mandibular deformities, and middle ear malformations. This constellation of defects suggests that the most efficacious treatment will be multidisciplinary management, which includes the otolaryngologist, audiologist, plastic surgeon, and temporal bone radiologist. In the past, microtia--the most clinically apparent malformation--usually has been studied and treated with respect to the area of special interest of the investigator, whether from an otologic, reconstructive, or radiologic perspective. Newer management, however, utilizes the combined skills of the clinical and behavioral disciplines in the treatment of the microtic auricle, associated middle ear pathology, and hearing loss. Such multidisciplined approach, commencing during the first year of life, is deemed advisable to cope with the severe unilateral or bilateral hearing loss which may lead to potentially serious sensory deprivation and impede adequate language development in these children.

Audiometry, Evoked Response↗
PubMed1978

Incidence and type of otopathology associated with congenital palatopharyngeal incompetence.

Based upon the known association of cleft palate and middle ear disease, a study was undertaken to determine the incidence and type of middle ear pathology associated with velar anomalies exclusive of cleft palate which may produce congenital palatal pharyngeal incompetence. The range of velar anomalies encountered was subdivided into congenital palatal incompetence Type 1 (clinically manifested by one or more of a triad of visible palatal anomalies including submucous deficiency of the hard palate, bifid uvula, and a diastasis of velar musculature) and congenital palatal incompetence Type 2 (no visible velar anomalies but radiographic anomalies of the velopharyngeal region such as short or thin velum and/or enlarged nasopharyngeal dimensions consequent to vertebral and skull base anomalies). Middle ear disease was assessed separately in CPI Types 1 and 2 in order to differentiate the effects upon middle ear function between overt and occult velar anomalies. Middle ear disease was more frequent in CPI Type 1 than in CPI Type 2. The predominant otopathologic finding was serous otitis media, paralleling the type associated with cleft palate. Tympanic membrane atrophy, tympanosclerosis and tympanic membrane perforation, often considered sequelae of chronic serous otitis media, were noted infrequently. This investigation supports the concept that middle ear disease frequently occurs with congenital palatal incompetence as it does with cleft palate.

Abnormalities, Multiple↗
PubMed1977

Alternative uses for the flexible fiberoptic bronchoscope in otolaryngology.

Currently there are many fiberoptic instruments available to the otolaryngologist. These include, in addition to the rigid endoscopes, the fiberoptic headlight, cable, indirect laryngoscope, nasopharyngoscope, flexible laryngoscope, flexible esophagoscope and flexible bronchoscope. Each possesses a certain unique characteristic to aid the otolaryngologist. For several of these, there are certain alternative uses. The purpose of this report is to discuss additional uses for the flexible fiberoptic bronchoscope in relation to the head and neck as it is the most versatile instrument.

Aged↗