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Biomedical subjects

D D Lydiatt

Publications and source records attributed to D D Lydiatt.

At least 19 recordsLinked to original sources

Synovial sarcoma of the head and neck: chromosomal translation (X;18) as a diagnostic aid.

BACKGROUND: Synovial sarcoma, a rare tumor in the head and neck, has been historically diagnosed by its characteristic biphasic histologic pattern. Monophasic variants exist which can be difficult to diagnose. METHODS: Two cases of synovial sarcoma of the head and neck are presented. Both cases, cytogenetic analysis was performed using standard protocols. RESULTS: Both tumors demonstrated a chromosomal translocation, t(X;18)(p11.2;q11.2), which either made or confirmed the diagnosis. CONCLUSIONS: Synovial sarcoma contains a characteristic chromosomal translocation which is a useful diagnostic tool, especially when histologic studies are equivocal.

Adult

Laparoscopic gastrostomy versus open gastrostomy in head and neck cancer patients.

Alimentation in the surgically treated head and neck cancer patient frequently requires bypassing the upper aerodigestive tract. The laparoscopic gastrostomy fulfills this criterion. The authors compared 25 laparoscopic gastrostomies (group 1) with 18 open gastrostomies (group 2) performed on head and neck cancer patients. The length of operation, morbidity, mortality, and cost were evaluated. Operative time was significantly shorter in group 1 (40 +/- 2 minutes) than in group 2 (56 +/- 4 minutes), with P=.003. The major complication rate was 9% for group 1 and 11% for group 2. There was no procedure-related mortality in group 1, but 1 patient died in the immediate postoperative period in group 2. The cost was not significantly different. It is concluded that the laparoscopic gastrostomy is a safe and cost-effective alternative to open gastrostomy in this patient group.

Anesthesia, General

Functional parathyroid cyst and hypocalciuric hypercalcemia.

Parathyroid cysts are uncommon. They can be divided into functional and nonfunctional cysts depending on whether or not they are associated with hypercalcemia. Functioning cysts are very rare, with fewer than twenty reported cases. We report a case of functioning parathyroid cyst associated with hypocalciuric hypercalcemia. We have been unable to find a similar case previously reported in the literature.

Adult

Serologic determinants of survival in patients with head and neck cancer: validating a clinical prediction model.

Quantitative measurements of serum C1q-binding macromolecules (C1qBM) and immunoglobulin A (IgA) were done on 162 patients using previously described methodology. The measurements were compared to a previously described head and neck cancer population. Using the Cox Proportional Hazards model, the prognostic implications regarding high C1qBM and subsequent death with disease (P = .02), and regional recurrence (P = .0094) were validated, but not our previous IgA-related prognostic implications. When both study populations were combined, C1qBM was predictive of survival in those patients treated with induction chemotherapy (P = .0001). C1qBM was not a significant predictor of survival in patients treated with surgery plus postoperative radiation therapy in either this second "test" population or in the original "training" population. The findings demonstrate the confounding influence of treatment modalities and the importance of model validation.

Age Factors

Microvascular reconstruction of the head and neck cancer patient.

Surgical resection of cancer of the head and neck often results in significant functional and cosmetic deformity. Reconstruction of these deficits have often been inadequate to reintegrate these patients into daily life. Recent advances in microsurgical techniques, however, have ushered in a new era for reconstruction following head and neck cancer ablative surgery. Microvascular free tissue transfers have made possible the reconstruction of major head and neck defects that previously were not possible as well as markedly improving function and cosmesis. Successful reconstruction requires close cooperation between the head and neck ablative surgeon as well as the reconstructive surgeon. We describe four different microvascular flap techniques which we have used for head and neck cancer reconstruction to illustrate some of the many applications of these microvascular flaps.

Head and Neck Neoplasms

Functional parathyroid cyst and hypocalciuric hypercalcemia.

Parathyroid cysts are uncommon. They can be divided into functional and nonfunctional cysts depending on whether or not they are associated with hypercalcemia. Functioning cysts are very rare with less than twenty reported cases. We report a case of functioning parathyroid cyst associated with hypocalciuric hypercalcemia. We have been unable to find a similar case previously reported in the literature.

Adult

Surgical treatment of obstructive sleep apnea syndrome (OSAS)

Obstructive sleep apnea syndrome patients usually present with multiple areas of anatomic disproportions. The site or sites of obstruction must be accurately diagnosed preoperatively by a systematic means of examining the patient. This includes nasopharyngoscopy with Muller maneuver and sometimes cephalometrics. The surgical treatment is individualized to the site or sites of obstruction and can include tracheostomy, septoplasty, UPPP, geniohyoid advancement and suspension of the hyoid. For extreme cases advancement of the maxilla, mandible and hyoid bone are sometimes necessary.

Combined Modality Therapy

Tracheal invasion by thyroid carcinoma.

Tracheal invasion may occur by direct extension of thyroid carcinoma. Follicular, papillary, mixed follicular and papillary, and poorly differentiated cell types have all been found to cause tracheal invasion. Two cases of tracheal invasion by thyroid carcinomas prompted us to review the literature, although our review revealed little current data on tracheal invasion. We reviewed the records of all patients surgically treated for thyroid carcinoma at the University of Nebraska Medical Center from 1976 through 1987. The results of this review and our review of the literature on tracheal invasion are reported here. We conclude that thyroid carcinomas behave most aggressively in men and older patients. The more poorly differentiated follicular thyroid carcinomas have also been found to behave aggressively. Our findings show that en bloc resections are indicated in certain patients with tracheal invasion.

Adenocarcinoma

Computed tomography and magnetic resonance imaging of cervical metastasis.

Thirteen patients with head and neck cancer underwent staging by clinical examination, computed tomography (CT), and magnetic resonance imaging (MRI) in a standardized blinded fashion. All patients subsequently underwent radical neck dissection with subsequent pathologic staging. CT and MRI each predicted 93% of staging results correctly, with clinical examination correct 67% of the time. Staging of primary tumors had an accuracy of 90% by clinical examination, 40% by CT, and 50% by MRI when compared to staging the pathologic specimen. Understaging was seen in 50% of CT scans and 30% of MRI scans. We believe either CT or MRI should be considered for routine staging of the neck in all head and neck malignancies.

Aged

The management of the cleft lip and palate patient.

We believe that early closure of the hard palate defect with a palatal appliance and surgical closure of the lip and soft palate according to the rule of tens are very important. Delaying the hard palate closure allows for maximal growth of the palatal shelves. We also feel that pressure equalizing tubes placed in the ears at the initial surgical procedure allows for more normal function of the middle ear, less middle ear infections, better hearing, and ultimately better speech. We feel that early closure of the soft palate may decrease velopharyngeal incompetence by normalizing the position of the pterygoid plates. It may also help to reduce serous otitis media by improving eustachian tube function.

Cleft Lip

Mesenchymal chondrosarcoma: a case report.

Mesenchymal chondrosarcoma is a rare tumor distinctly different from the more common chondrosarcoma. It shows a predilection for the head and neck in both osseous and extraosseous forms. The prognosis for cure is poor, with a high incidence of local recurrence as well as regional and distant metastasis. Treatment is based on radical surgical excision, although combination chemo-therapy has recently shown promise. Additional experience with this tumor is required to define the most efficacious form of treatment.

Adult