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Biomedical subjects

G Har-El

Publications and source records attributed to G Har-El.

At least 55 records · Page 3Linked to original sources
PubMed1996

Upper aerodigestive tract squamous cell carcinoma. The human immunodeficiency virus connection.

OBJECTIVE: To evaluate the incidence, distribution, and course of squamous cell carcinoma (SCC) of the upper aerodigestive tract in patients infected with the human immunodeficiency virus (HIV) and compare it to SCC in non-HIV-infected patients. DESIGN: Case-control study of all patients with SCC during a 9.5-year period from January 1985 through June 1994. SETTING: Two academic tertiary care centers in a metropolitan location. PARTICIPANTS: Five hundred thirty-nine patients (18 to 95 years old) with SCC of the upper aerodigestive tract. RESULTS: Infection with HIV was present in 4.5% of the patients with SCC of the upper aerodigestive tract. Patients infected with HIV were significantly younger than noninfected patients (P < or = < .001), accounting for 21.3% of those patients younger than 45 years (P < .001). No significant difference in tumor location was present between HIV-infected and noninfected patients; however, HIV-infected patients had larger tumors (P = .004) and a more advanced tumor stage (TNM classification) at presentation (P = .05). Tumor-related survival was significantly poorer in patients with HIV infection (P = .01), with 57% at 1 year and 32% at 2 years, compared with 74% and 59%, for non-HIV-infected patients. The detrimental effect of HIV infection on survival remained significant after adjusting for the confounding effects of age, tumor stage, and location of the tumor. All study patients with HIV infection had cancer risk factors such as tobacco and/or alcohol abuse. CONCLUSIONS: Infection with HIV possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms. The decreased survival rates among these patients suggests that the SCC may be more aggressive or that other cofactors assume greater importance. A history of tobacco and/or alcohol abuse in patients with HIV infection warrants aggressive screening and early detection, to allow for early detection, which may help increase survival.

Adolescent↗
PubMed1996

Unusual presentation of a pituitary abscess.

We present a case of a pituitary abscess without an identifiable source. The patient presented with progressive visual field defects, unilateral visual loss, and proptosis. However, no symptoms or signs of local or systemic infectious process were present. Computerized tomography and magnetic resonance imaging studies suggested but did not confirm the diagnosis. Emergent transsphenoidal drainage resulted in a complete recovery.

Abscess↗
PubMed1996

Rapid intraoperative facial nerve expansion.

The repair of nerve length defect presents a reconstructive challenge after trauma and oncologic resection. This study examined rapid intraoperative nerve expansion as a method of repairing nerve length defects with the cat facial nerve model. We compared expanded nerves with grafted nerves and intact nerves 1 year after repair using the criteria of gross function (symmetry and blink reflex according to a modified House scale), electromyography thresholds, nerve-conduction velocity, morphology, and axon count. Three of the five expanded nerves regenerated, and all of the grafted nerves regenerated. Functional results were similar for the regenerated expanded and the grafted facial nerves, and both methods achieved an equivalent level of function. The facial nerves of the regenerated expanded group, grafted group, and intact group had mean electromyography thresholds of 132 mV, 98 mV, and 134 mV, respectively, and mean conduction velocities of 48.3 mg/second, 47.9 m/second, and 44.7 m/second, respectively. Morphologic examination of all five expanded nerves immediately after the expansion process revealed an intact fascicular structure. However, 1 year after excision of the expanded segment and repair, only three of the five nerves regenerated. Axon count at 1 year was as follows: 404 for the regenerated expanded nerves, 449 for the grafted nerves, and 403 for the intact nerves. The potential advantages of rapid intraoperative nerve expansion over nerve grafting for the repair of nerve gap defects include a single suture line and absence of donor site morbidity. This pilot study demonstrates that rapid intraoperative nerve expansion and regeneration is possible and can be used to repair a nerve length deficit. The development of a rapid and reliable method of intraoperative nerve expansion deserves further study.

Animals↗
PubMed1996

Laryngeal carcinoma in females.

Between 1950 and 1992, 96 women with squamous cell carcinoma of the larynx were diagnosed and treated in the Department of Otolaryngology and Oncology at Beilinson Medical Center, Israel, and Long Island College Hospital, Brooklyn, New York. Fifty-seven female patients (59%) had glottic carcinoma, 72% of them in stage I. Thirty-eight had supraglottic carcinoma, 68% of them in stages II and III. One patient had stage I subglottic carcinoma. Treatment varied between radiotherapy, surgery, or combined surgery with radiation and/or chemotherapy. The 5-year survival rate was 87%. Although most of the patients had glottic carcinoma in stage I, there was also a high percentage with supraglottic carcinoma, most in advanced stages and with metastases to other regions. The prognosis is not different from that in men. Smoking is an important factor in glottic carcinoma, but not as important as in males.

Carcinoma, Squamous Cell↗
PubMed1996

Regional spread of auricular and periauricular cutaneous malignancies.

Over 90% of all cutaneous malignancies occur in the head and neck. Malignancies involving the external auditory meatus, auricle, and periauricular region are notoriously difficult to control. The morbidity and mortality associated with extension of these malignancies underscore the importance of complete initial removal. We present 14 patients who underwent excision of periauricular lesions. All lesions were less than 2 cm in diameter and previously excised with negative margins. These patients were subsequently referred for regional disease. Twenty-nine percent of the patients failed definitive surgical therapy. We examine the indications for regional lymphadenectomy in the treatment of auricular and periauricular cutaneous malignancies.

Aged↗
PubMed1996

Laryngeal tuberculosis in HIV-infected patients: a difficult diagnosis.

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB in patients with human immunodeficiency virus (HIV) infection can make its diagnosis difficult. In our population of 146 patients with TB involving the head and neck, HIV infection was present in 70 cases (48%). The prevalence of laryngeal TB in this population was 5.5% (8 patients). Concomitant HIV infection was present in 2 (25%) of 8 patients with laryngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% of patients with HIV infection, compared with 17% of non-HIV-infected patients (P = .055). The cause of the delayed diagnosis was multifactorial, mainly the presence of multiple confounding variables and the carcinoma-like appearance of the laryngeal TB lesions in HIV-infected patients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryngeal lesions, especially those with HIV infection.

Adult↗
PubMed1995

Transcutaneous cervical miniesophagostomy.

Nasogastric tubes have been shown to cause damage to the pharyngolaryngeal complex, producing laryngeal inflammation, granulation, muscle damage, and even vocal cord immobility. The coexistence of nasogastric and tracheotomy tubes after conservation laryngeal surgery is especially harmful. The friction between these two semirigid structures may result in damage to the remaining part of the larynx. This may result in a significant delay in healing, oral feeding, and decannulation. Percutaneous endoscopic gastrostomy is a possible solution. This procedure requires time, special expertise, and cooperation between services. We present our experience with 17 transcutaneous cervical miniesophagostomies using a small-caliber feeding tube, which were performed during conservation laryngeal and/or pharyngeal surgery. The rate of minor complications was 11.7%, or 0.40 complications per 100 tube days, and no major complications were related to the procedure. Transcutaneous cervical miniesophagostomy is a simple and quick procedure that may be performed during the primary cancer surgery. It is done by the head and neck surgeon and does not require special expertise. It takes about 5 minutes to perform and, if done correctly with funneling under skin flaps, is associated with minimal or no postoperative morbidity.

Adult↗
PubMed1995

Nd:YAG laser turbinate surgery animal experimental study: preliminary report.

The chronically hypertrophic nasal turbinate is a challenging problem for otolaryngologists. Although some success has been achieved with a number of medical and surgical methods, other forms of treatment are still needed. In this study, encouraging results were achieved using the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser on canine turbinates. Clinical and histological results showed that with Nd:YAG laser surgery, coagulation occurs in the deep cavernous vessels and submucosal glands of the turbinate, while the overlying mucosa remains intact.

Animals↗
PubMed1995

Retropharyngeal abscess: clinical review.

Retropharyngeal abscess, once a relatively common entity in children, is uncommon today. From 1981 to 1991, we treated 20 cases. Abscesses secondary to upper respiratory infection in children were seen only in three (15%) cases. Trauma and foreign bodies were the most common etiologic factors in the adult subgroup. Streptococcus viridans and Klebsiella pneumoniae were the most common pathogens. The use of contrast-enhanced computed tomography has had a significant impact on the diagnostic work-up. The choice of initial antibiotic therapy is discussed. There were no deaths in this series.

Adolescent↗
PubMed1994

Changing trends in deep neck abscess. A retrospective study of 110 patients.

We have conducted a retrospective study of 110 patients with the diagnosis of deep neck abscess who had been seen between 1981 and 1990. Etiologic factors, common pathogens, and antimicrobial therapy were reviewed with reference to diagnostic methods of choice and management principles. The findings were compared with the literature. We have identified trends of change in the following aspects of deep neck abscess: cause, presentation, diagnostic methods, and bacteriology. Management principles of airway protection, intravenous antibiotics, and drainage have not changed.

Abscess↗
PubMed1994

Lymphatic drainage system after left radical neck dissection.

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.

Carcinoma, Squamous Cell↗
PubMed1993

The treatment of rhinophyma. 'Cold' vs laser techniques.

OBJECTIVE: To compare laser surgery and sharp blade excision of rhinophyma. DESIGN: Retrospective study of 23 patients treated surgically for rhinophyma. SETTING: Four academic tertiary referral medical centers. PARTICIPANTS: All 23 patients had moderate or major rhinophyma. INTERVENTION: Sixteen patients had laser surgery. Seven patients had sharp blade excision. OUTCOME MEASURES: Length of the procedure, preservation of normal tissue, the need for skin grafting, intraoperative pain and discomfort, intraoperative bleeding, postoperative pain and discomfort, postoperative bleeding, complications, and end results (all listed in the literature as advantages of laser surgery). RESULTS: No difference in length of surgery, preservation of normal tissue, complications, postoperative pain, and end results. No need for skin grafting in both procedures. Less intraoperative and postoperative bleeding, easier and smoother procedure, and more comfortable postoperative care with laser surgery. CONCLUSIONS: Our results do not agree with most of the list of advantages attributed to laser rhinophyma surgery in the literature.

Aged↗