PubMed Health⌕ Search

Biomedical subjects

D P Vrabec

Publications and source records attributed to D P Vrabec.

32 records · Page 2Linked to original sources
PubMed1975

The inverted Schneiderian papilloma: a clinical and pathological study.

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.

Adult↗
PubMedDate not supplied

Multiple primary malignancies of the upper aerodigestive system.

Multiple primary carcinomas were found in 11.5% of 1,518 patients presenting with an index tumor in the oral, pharyngeal or laryngeal areas. These additional malignancies were subdivided into two groups: 1) those occurring in distant or unrelated tissues and 2) those occurring in a multicentric zone defined as including the oral area, pharyngeal area, larynx, esophagus and tracheobronchial tree. Although some trends were noted, a primary lesion may be found anywhere in the zone of multicentricity. The dynamic nature of the progressive transition of the potentially malignant tissues in the multicentric zone is reemphasized. The physician, treating patients with head and neck cancer, should be prepared not only to cope with simultaneously occurring primary cancers but also to be constantly vigilant for the later development of subsequent primary carcinomas.

Esophageal Neoplasms↗
PubMedDate not supplied

Hypothyroidism following treatment for head and neck cancer.

One hundred ninety-six head and neck patients were studied to determine the effects of radiation therapy and surgery on thyroid function. Serum thyroid-stimulating hormone (TSH) levels were obtained as a screening test for primary hypothyroidism. Elevated TSH levels were found in 57 of the 196 patients (29.1%). The highest incidence of abnormal TSH values (66%) occurred in the group treated with combination radiation therapy and surgery, including partial thyroidectomy. TSH levels rose early in the posttreatment period with 60% of the abnormal values occurring within the first three posttreatment years. Posttreatment thyroid dysfunction was twice as common in women (48.6%) as in men (25.4%). When serum thyroxine levels by radioimmunoassay (T4RIA) were correlated with the elevated serum TSH levels, a similar pattern was seen with 65% of the patients in Group 3 having a decreased T4RIA level indicating overt hypothyroidism. Pretreatment levels of thyroid function including thyroid antibody studies should be established for all patients. Serial TSH levels should be done every three months during the first three posttreatment years and semiannually thereafter as long as the patient will return for follow-up care. All patients treated with combination radiation therapy and surgery who develop elevated TSH levels should be treated with thyroid replacement therapy. Patients receiving radiation therapy alone should receive replacement thyroid therapy if they develop a depressed T4RIA value or a pattern of gradually increasing TSH levels.

Autoantibodies↗
PubMedDate not supplied

Giant intraluminal polyps of the esophagus.

Giant intraluminal polyps of the esophagus are relatively rare. Their diagnosis often presents a confusing picture; radiographic studies are frequently misinterpreted as achalasia, and the endoscopic picture is often difficult to interpret. This report describes the case histories of three patients with giant intraluminal polyps of the esophagus. Each presents slightly different clinical features. The signs and symptoms are discussed in terms of the pathophysiology. Common pitfalls in diagnosis are reviewed. Suggestions to enable more accurate identification of these lesions are given. Finally, a systemic approach to treatment is outlined which offers the patient symptomatic relief while minimizing surgical complications and morbidity.

Adult↗