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Biomedical subjects

G Har-El

Publications and source records attributed to G Har-El.

108 records · Page 6Linked to original sources
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Clear cell carcinoma of the thyroid gland.

Clear cell carcinoma is a rare variant of thyroid cancer, histologically related to the well-differentiated thyroid malignancies. The purpose of this paper is to discuss data collected from the English literature and to present three additional cases. In two of the three cases presented, thyroglobulin levels were extremely high after thyroid ablation. Both cases presented metastasis to lung and bone with significant I131 uptake. It seems that, when compared to the well-differentiated carcinomas of the thyroid gland, clear cell carcinoma has a more aggressive clinical course. Initial radical surgery is the treatment of choice for this kind of neoplasm and I131 should always be considered for the treatment of its metastasis.

Adenocarcinoma↗
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Carcinoma of the prostate metastatic to the maxillary antrum.

Metastatic carcinoma of the maxillary antrum is an extreme rarity. Until 1980, less than 100 cases with distant primaries metastatic to the entire sinonasal tract had been reported. In a review of these cases, we found no mention of primary prostate cancer metastatic to the antrum. The purpose of this paper is to document the first case of this entity.

Aged↗
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Periosteum-wrapped alloplasts for reconstructive head and neck surgery.

Methylmethacrylate is widely used by orthopaedic and neurosurgeons for bone reconstruction. However, there is not much information about the interaction between methylmethacrylate and soft tissues. A prospective canine study was designed to examine the morphologic and histologic aspects of the use of methylmethacrylate with soft tissues. A previous study has shown that by wrapping the prosthesis with dense connective tissue, such as periosteum, better results can be achieved in tracheal reconstruction. Ten wrapped and 10 unwrapped pieces of methylmethacrylate were implanted in dogs, and were removed at intervals of 2, 4, 8, 11 and 16 weeks. Gross morphologic and histologic examination showed better incorporation of the wrapped implants into the surrounding soft tissues with less inflammation when compared to the unwrapped pieces. We suggest that connective tissue wrapped methylmethacrylate alloplasts are better tolerated by surrounding soft tissues and may lead to improved reconstructive results.

Animals↗
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Head and neck manifestations of non-Hodgkin's lymphoma in human immunodeficiency virus-infected patients.

PURPOSE: Non-Hodgkin's lymphoma is the 2nd most common malignancy in human immunodeficiency virus (HIV)-infected patients. However, limited information regarding head and neck manifestations of non-Hodgkin's lymphoma is present in the literature. The aim of this article is to describe the head and neck manifestations of non-Hodgkin's lymphoma in HIV-infected patients and compare it with that seen in noninfected patients. PATIENTS AND METHODS: A case-control study was performed including 124 patients with non-Hodgkin's lymphoma presenting over a 5.5-year period to tertiary care center in a metropolitan location. RESULTS: Overall, the anatomic distribution of non-Hodgkin's lymphoma is not altered in the presence of HIV infection with the head and neck region (63%) most often involved overall. However, within the head and neck region, extralymphatic disease is significantly more common in HIV-infected patients (59%) than noninfected patients (33%; P = .001). Central nervous system (CNS) involvement accounts for 41% of head and neck non-Hodgkin's lymphoma in HIV-infected patients, in contrast to only 12% of noninfected patients. High-grade lymphoma (68%) are more common than intermediate (30%) or low-grade disease (2%) in the HIV-infected population, whereas low (24%) and intermediate (60%) grades are more common than high-grade lymphoma (16%) in noninfected patients (P < .001). The large cell immunoblastic type (48%) is the most common subtype in HIV-infected patients, whereas diffuse large-cell type (32%) was most common in HIV-negative patients (P < .05). Survival is significantly poor for HIV-infected patients (P < .05). The impact of HIV infection on survival remain significant even after controlling for the effects of confounding factors. CONCLUSIONS: Head and neck involvement with non-Hodgkin's lymphoma occurs in a significant number of HIV-infected patients. Our data show that the distribution and course of non-Hodgkin's lymphoma is unique in HIV-infected patients. A high level of suspicion for non-Hodgkin's lymphoma is required in all cases of head and neck lesions in patients with HIV infection to facilitate management.

Adult↗
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Laryngeal granular cell tumor in children.

Laryngeal granular cell tumor in childhood is rare. This article describes its occurrence in a 14-year-old girl. A review of the literature revealed five other cases. Clinical, endoscopic, histopathologic, and therapeutic considerations are discussed and compared with those in the adult form of granular cell tumor. Although this lesion is rare, awareness of it is necessary to avoid overtreatment.

Adolescent↗
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Latissimus dorsi myocutaneous flap for secondary head and neck reconstruction.

PURPOSE: To review our experience and results with the use of pedicled latissimus dorsi myocutaneous flap (LDMF) for secondary reconstruction in head and neck surgery. METHODS: Twenty-two patients had LDMF, 17 of them for secondary reconstruction. Data were collected regarding the primary surgery, primary method of reconstruction, indication for secondary reconstruction, and outcome. RESULTS: Seventeen LDMF procedures were performed for secondary reconstruction. Flap success rate was 100%. Reconstructive goals were achieved immediately in 16 (94.1%) patients. CONCLUSION: LDMF is a thin flap with a large surface area and a long pedicle that allows it to reach any region in the head, neck, and scalp. Its main disadvantages are the need for lateral positioning of the patient and the fact that its pedicle is not protected with muscle. In our experience, LDMF provides an excellent reconstructive option especially in complicated cases of secondary reconstruction. It may be used in cases where a free flap is usually used, but with significantly reduced surgical time.

Adult↗
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A complete stylohyoid bone with a stylohyoid joint.

Different clinical entities are associated with elongation of the styloid process or ossification of the stylohyoid ligament. Although partial ossification of the stylohyoid ligament is not uncommon, complete ossification is rare. We present a rare case of complete ossification of the stylohyoid ligament. This case may represent the extreme end of the spectrum of entities known as cervicopharyngeal pain syndrome, which includes Eagle's syndrome, stylohyoid syndrome, and pseudostylohyoid syndrome.

Humans↗
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Respiratory distress due to diffuse cervical hyperostosis.

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are common findings. Although these hypertrophic changes can be completely asymptomatic, it is known that dysphagia may occur occasionally in the presence of massive cervical hyperostosis. Laryngotracheal symptoms due to cervical hyperostosis are less frequent and may be managed initially as tumors of the esophagus, trachea, or thyroid gland. The management of two severe cases of dyspnea due to cervical ankylosing hyperostosis are discussed.

Aged↗
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Thyroid cancer in patients 70 years of age or older. Retrospective study of 50 patients.

This report presents our experience with 50 thyroid cancer patients 70 years of age or older, out of 606 patients of all ages. Comparing this series to those describing thyroid cancer patients of all ages, we found that thyroid carcinoma in the 70+ age group presents at a more advanced clinical stage, behaves more aggressively, and has a higher death rate. These findings are attributed mainly to the higher incidence of undifferentiated carcinoma and the more aggressive course of the differentiated types of carcinoma in the older age group. If suspected thyroid nodules are managed by initial radical treatment, carcinoma can be diagnosed earlier and patients will survive longer.

Aged↗
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The superior turbinectomy approach to isolated sphenoid sinus disease and to the sella turcica.

Sphenoidotomy or sphenoidectomy are most commonly performed as part of a more extensive pansinus procedure. However, rhinologists may find themselves occasionally in a need to surgically treat an isolated sphenoid sinus disease. With the introduction of endoscopic sinus techniques and instrumentation, intranasal sphenoidotomy has become increasingly popular. The most common approach used is the intranasal, transethmoid sphenoidectomy. Alternatively, many surgeons perform middle turbinectomy to approach the sphenoid sinus transnasally. We describe our direct transnasal, nontransethmoid, nontransseptal approach to the sphenoid sinus. Superior tubinectomy is performed to enhance the exposure of the anterior sphenoid wall. Seventy patients underwent sphenoid sinus exploration for isolation sphenoid sinus disease or for pituitary lesions. Surgical goals were achieved in all patients and there were no complications related to the technique. The superior turbinectomy approach to isolated sphenoid sinus disease provides excellent exposure and avoids the sequelae of total ethmoidectomy or middle turbinectomy.

Adolescent↗
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Frontal sinus outflow anatomy.

Most of the studies of frontal sinus anatomy were completed 50 to 70 years ago. The information they provide is not necessarily relevant or helpful to the modern rhinologic surgeon who approaches the frontal sinus transnasally and endoscopically. We performed anatomical dissections of the outflow tract of 82 frontal sinuses in 41 cadaver heads to illustrate the various drainage patterns from the frontal sinus to the nose and to correlate these drainage sites with the distance and angle from the pyriform aperture. We found that the frontal sinus drained anterior to the uncinate process in 24 specimens (29.3%) with an average distance of 3.65 cm from the pyriform aperture and 58 degrees from the nasal floor. The frontal sinus drained posterior to the uncinate process in 56 specimens (68.3%) with an average distance of 4.10 cm and 65 degrees from the nasal floor. In this latter group, most of the sinuses (51 specimens) drained into the ethmoid infundibulum. Two of the specimens had a hypoplastic frontal sinus with no outflow tract at all. These findings are different from those described in the early 20th century.

Adult↗
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The role of endoscopic sinus surgery in chronic sinonasal sarcoidosis.

The aim of this study was to define a role for endoscopic sinus surgery (ESS) in the treatment of chronic sinonasal sarcoidosis. All patients seen for sinonasal sarcoidosis in an otolaryngology practice in a tertiary care center from 1991 to 2000 were reviewed. Of 86 patients, 6 were treated with ESS for an operative rate of 7%. Surgeries were performed on those patients with significant sinonasal anatomic blockage. This included nasal obstruction from nasal polyposis and chronic and recurrent acute sinusitis from granulomatous lesions of the ostiomeatal complex. Patients remained symptom free for years after surgery on a nasal steroid regimen. Endoscopic sinus surgery is a viable treatment for those few patients with nasal obstruction or chronic sinusitis due to anatomic blockage from sinonasal sarcoidosis. Although it does not eradicate the disease or prevent recurrence, it does markedly improve quality of life by relieving severe symptoms and reducing the need for systemic steroids. This is the first study to advocate a role for surgery in sinonasal sarcoidosis beyond biopsy and management of complications. Although it may not be the appropriate approach for every patient, ESS certainly should be considered in the treatment options.

Adult↗
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Diabetes insipidus after pituitary surgery: incidence after traditional versus endoscopic transsphenoidal approaches.

The endoscopic transnasal approach is gaining increasing popularity as the surgical method of choice for treatment of pituitary lesions. Previous studies have shown advantages such as quicker recovery and fewer cosmetic, dental, and nasal complications. However, no study has compared the rate of diabetes insipidus (DI) between the traditional and endoscopic approaches. This study will examine the incidence of short- and long-term postoperative DI after transnasal pituitary surgery and compare it with the incidence after traditional transseptal surgery. Eighty-one patients underwent transnasal surgery for the management of pituitary lesions. Fifty-five had the traditional sublabial, transseptal, transsphenoidal surgery and 26 patients had the direct transnasal, transsphenoidal endoscopic procedure. The incidence of immediate postoperative DI was 36% in the traditional group and 15% in the endoscopic group. Short-term (>2 weeks) DI that required treatment occurred in 11 patients (20%) in the traditional group and 2 patients (7.6%) in the endoscopic group. Long-term (>6 months) incidence of DI was 7.2% in the traditional group and 3.8% in the endoscopic group. We found a decreased incidence of immediate DI after transnasal endoscopic pituitary surgery as compared with the traditional sublabial transseptal approach. However, the incidence of long-term DI was not significantly different in the two groups.

Adenoma↗
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Hashimoto's thyroiditis and carcinoma of the thyroid gland.

Seven cases of Hashimoto's disease (HT) occurring in association with carcinoma of the thyroid gland are presented. The diagnosis of HT was not reached before surgery in any of the cases; it was an incidental histopathological finding. There was no case of pure papillary cancer: two specimens showed mixed papillary and follicular cancers, four revealed follicular carcinomas (one of them with anaplastic areas) and one medullary neoplasm. Other authors, however, have reported that pure papillary carcinoma occurred with significantly greater frequency in thyroids also displaying Hashimoto's disease. Total thyroidectomy was performed in all seven patients and one patient with anaplastic follicular cancer also received external irradiation. TSH suppressive therapy was given postoperatively. All these patients are alive with no evidence of further disease after seven to 17 years of follow-up study, whereas the mortality in our total series of thyroid cancers, even in patients with low-grade malignancy, was about 9%. Thus the prognosis of patients with carcinoma of the thyroid gland with coexisting Hashimoto's disease is better than that of patients with carcinoma of the thyroid gland alone. Hashimoto's thyroiditis does not seem to be a premalignant lesion. There was no evidence suggesting that thyroid carcinoma originated in the proliferating epithelium of Hashimoto's thyroiditis. It would appear that thyroid carcinoma stimulates the development of HT in some patients and that the presence of the autoimmune inflammatory reaction and the circulating antibodies retard growth and dissemination of carcinoma of the thyroid gland.

Adolescent↗