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Biomedical subjects

G S Gussack

Publications and source records attributed to G S Gussack.

At least 19 recordsLinked to original sources
PubMed1997

Management of nasopharyngeal and oropharyngeal stenosis in children.

Nasopharyngeal stenosis and oropharyngeal stenosis are rare and challenging problems in the pediatric population. The most common etiology is currently the surgical trauma associated with adenotonsillectomy. Stenosis can vary from a thin band to a complete obstructing cicatrix. Presenting symptoms range from mild hyponasal speech to severe airway obstruction. We present a series of eight children with varying degrees of stenosis and associated symptoms. Choice of treatment varied with the severity of disease. In our series, successful interventions included triamcinolone acetonide injection, lysis of adhesions, rotational and advancement mucosal flaps, and jejunal free flap. Preoperative evaluation and individualized surgical repair are essential for successful treatment.

Adenoidectomy↗
PubMed1994

Neonatal laryngoceles. A cause for airway obstruction.

The neonatal laryngocele is a congenital pathologic entity originating in the saccule of the laryngeal ventricle. This entity may present as an uncommon cause of neonatal airway obstruction. We present two cases of this condition and the management undertaken. Both patients demonstrated significant airway distress. Evaluation of each patient included either plain x-ray films of the neck, ultrasound, or computed tomography of the neck. A cystic mass, containing air and fluid, was identified causing external compression of the airway in each case. Surgical intervention required airway endoscopy and an external approach to excise the mass. Tracheotomy was avoided in both cases; however, one infant required further surgery for laryngomalacia. Both children have done well in follow-up.

Airway Obstruction↗
PubMed1994

A treatment protocol for mandible fractures.

Mandibular fracture management has evolved over several decades, and controversies exist over ideal approaches for individual fractures. Treatment choices include closed versus open techniques, reduction methods and repair, and decision concerning intermaxillary fixation. Both the patient and the fracture characteristics have an impact on these choices. Patient factors include age, mandibular bone quality, dentition, patient reliability, and associated injuries. Fracture characteristics include favorability versus unfavorability, single versus multiple, location, and infection. This study was undertaken to develop and evaluate a management algorithm to determine the best treatment of mandible fractures. Sixty-seven patients were managed at the Grady Memorial Hospital otolaryngology service. Ages ranged from 3 to 68 years and included 55 male patients and 12 female patients. Forty-three patients had multiple fractures, while 24 had single fractures. Sixty-four patients were successfully managed and had normal function on follow-up examination. Eleven patients (16.4%) had complications. These included three infections, one malunion, two malocclusions, and five marginal nerve pareses. Multiple fractures did not have a higher incidence of complication. This protocol allows an orderly approach to the successful outcome of mandibular fractures.

Adolescent↗
PubMed1994

Three-dimensional magnetic resonance imaging evaluation of pediatric tracheobronchial tree.

Magnetic resonance imaging (MRI) of the airway has recently emerged as a diagnostic tool for evaluating tracheobronchial obstruction in pediatric patients. Computer-assisted reconstructions of transaxial images have enabled three-dimensional reconstructions of the airway to be manipulated in any plane and visualized in relation to adjacent anatomical structures. Eight patients in whom magnetic resonance imaging was used to diagnose a variety of airway obstructive lesions are presented. A protocol for the evaluation of pediatric tracheobronchial obstruction is presented, with the role of three dimensionally reconstructed MR imaging emphasized.

Airway Obstruction↗
PubMed1994

CT and MR appearance of recurrent malignant head and neck neoplasms after resection and flap reconstruction.

PURPOSE: To describe the appearance of recurrent malignant neoplasms in patients who have undergone resection of primary head and neck tumors with flap reconstruction. METHODS: Thirty-two examinations, 26 CT and 6 MR scans, were retrospectively reviewed in 25 patients with documented recurrent malignant neoplasms. Confirmation of disease was by biopsy or disease progression. The flaps included 15 myocutaneous, 6 free composite, 2 jejunal free grafts, and 2 combined jejunal and myocutaneous flaps. RESULTS: The most common location of recurrence was in the primary tumor bed involving the undersurface or suture line of the reconstruction flaps, 14 of 32 scans; both nodal and flap recurrence was seen in 12 of 32 scans. CONCLUSIONS: When examining patients who may have recurrent disease after flap reconstruction, the radiologist should be aware of the type of flap used and the expected appearance. Tumor recurrence in this patient population is manifest either as a focal recurrent mass at or near the suture line of the reconstruction flap, or nodal disease, usually in the contralateral neck.

Adult↗
PubMed1993

44-kd oncofetal transplantation antigen in rodent and human fetal cells. Implications of recrudescence in human and rodent cancers.

OBJECTIVE: This article summarizes the phase-specific nature of a cell surface, 44-kd tumor-associated transplantation antigen glycoprotein expressed during early and middle gestation in a portion of rodent and human fetal cells during normal fetal tissue development and illustrates how this glycoprotein is consistently recrudesced in primary and established human squamous cell carcinomas and other human and rodent tumors. The oncofetal antigen was not detectable in any human or rodent term fetal tissue or normal adult tissues tested. The tumor-associated transplantation antigen was tumor specific, yet not germ-line specific (expressed in lymphomas, sarcomas, and carcinomas) in human or rodent cancers. Rodent model tumor studies have shown 44-kd oncofetal antigen can act as a tumor-associated autoantigen of potential use in cancer detection and therapy. DESIGN: The oncofetal antigen was detected by immunogenicity, flow cytometry, and Western blotting in syngeneic rodent tumor recipients and by the last two methods in humans with progressive cancer. Syngeneically derived mouse monoclonal antibody (MoAb 115) was used to identify 44-kd oncofetal antigen. Early to middle gestation, oncofetal antigen-positive, mouse embryo/fetal cells used to stimulate the hybridoma were tested for immunogenicity as a tumor-associated transplantation antigen in syngeneic hosts. SETTING AND PATIENTS: Patients presenting with head and neck squamous cell carcinoma (N = 25) and other carcinomas at the University of South Alabama Medical Center, Mobile, underwent a biopsy, and the tumors were mechanically dispersed and were then tested for oncofetal antigen expression directly in flow cytometry. The tumors were also cultured and tested as squamous carcinoma cell lines. Growing squamous carcinoma cells and uncultured tumor cells were stained with MoAb 115 or control MoAb. Extracts of the cells were banded by electrophoresis in gels, Western blotted, and reacted with MoAbs and enzyme-linked immunosorbent assay second antibody. Time-mated mouse fetus and human fetal cells were also stained with MoAb 115 or control antibody and analyzed in the flow cytometer. RESULTS: Eight- to 13-day mouse fetal cells conferred protection against syngeneic tumor challenge. Term 18- to 21-day fetal or neonate or adult mouse cells were nonprotective. All head and neck squamous cell carcinomas tested expressed 44-kd oncofetal antigen by flow cytometric analysis and in Western blots as did ATCC cell lines of these tumors, whereas normal control tissues were negative. Second trimester human fetal cells were 44-kd oncofetal antigen positive. A large spectrum of rodent sarcomas and lymphomas express the OFA. CONCLUSIONS: Shared 44-kd oncofetal antigen OFA offers promise as a tumor detection marker in human squamous cell carcinoma and other human carcinoma development, and syngeneic mouse tumors are good model systems to explore oncofetal antigen antigenicity.

Animals↗
PubMed1992

Oncofetal antigen expression in head and neck carcinoma.

Oncofetal antigens (OFA) are proteins expressed during periods of embryonal/fetal development and on malignant cells. Previous investigations detected the presence of phase-specific 44- and 200-kd OFA, using a monoclonal antibody (MoAb 115). This study will determine if primary head and neck squamous cell carcinomas express the 44-kd OFA, and will assess the possible role of OFA in oncogenesis. Fifteen primary human head and neck squamous cell carcinomas (HNSCC) and six HNSCC cell lines were tested for OFA expression. Thirteen primary cancers and three cell lines demonstrated various degrees of OFA positivity. Oncofetal antigens are proposed to represent a proto-oncogene active during fetal development and malignant growth in head and neck squamous cell carcinomas.

Antigens, Neoplasm↗
PubMed1992

MR imaging in the management of extracranial malignant tumors of the head and neck.

Methods of treating malignant tumors of the extracranial portion of the head and neck have become more sophisticated. Cross-sectional imaging is extremely important in the evaluation of patients with a tumor in the head or neck. Although the complexities of head and neck radiology may be overwhelming, a uniform approach that first determines the location and extent of the primary tumor and then examines the nodal chains for metastatic adenopathy takes much of the mystery out of the process. MR imaging allows improved soft-tissue contrast and direct multiplanar acquisition of data, two advantages over CT. This review describes the current role of imaging in the clinical assessment of a patient with a malignant tumor in the head and neck, including the questions that must be answered before surgery and when MR imaging is the preferred technique.

Head↗
PubMed1991

Imaging modalities in recurrent head and neck tumors.

Patients with recurrent neoplasms of the head and neck present perplexing management problems, and accurate preoperative assessment of their disease is crucial. Thirty-eight patients with suspected recurrent neoplasms comprise this study: 30 had computed tomography scans, 4 had magnetic resonance images, and 4 patients underwent both computed tomography and magnetic resonance imaging to assess the anatomical extent of pathology in 34 malignant and 4 benign tumors. Contrast enhancement was essential for detecting disease on computed tomography scan. Differentiation of recurrent tumor was more difficult when the patient had undergone radiation. Magnetic resonance imaging demonstrated superior visibility in recurrent parotid and paranasal sinus neoplasm, but was less helpful in laryngeal and pharyngeal recurrences. Computed tomography demonstration of a mass with infiltration of normal fat or tissue planes or lymphadenopathy correlated highly with recurrent disease. Imaging techniques and fine points for determining recurrent neoplasms are presented.

Adult↗
PubMed1991

Prognostic factors in craniofacial surgery.

From 1979 to 1989, 21 patients underwent craniofacial resection for malignancies involving the anterior skull base. Histologic types included 8 squamous cell carcinomas, 3 chondrosarcomas, 2 melanomas, 2 basal cell carcinomas, 2 adenocarcinomas, 2 poorly differentiated carcinomas, 1 malignant schwannoma, and 1 malignant hemangiopericytoma. Survival was 57%, with follow-up of 41 months. A 50% complication rate included osteomyelitis, cerebrospinal fluid rhinorrhea, meningitis, brain abscess, epidural abscess, and syndrome of inappropriate antidiuretic hormone. Recurrent disease occurred in 9 patients (41%), the most reliable predictor being dural invasion indicated preoperatively by CT scan or at operation. Patients demonstrating dural involvement (N = 9) had a 22% survival rate, while patients without (N = 12) had a survival rate of 83%. The impact of dural invasion on long-term survival is emphasized. Though complications were frequent, long-term results were favorable.

Adult↗
PubMed1990

Pediatric penetrating head and neck trauma.

Penetrating head and neck trauma in children causes uncommon and potentially life-threatening injuries. We reviewed the charts of 21 patients who sustained penetrating injuries to the face or upper neck. Seventeen males and 4 females, aged 32 weeks' gestation to 19 years (mean = 10.2 years) comprised the study population. There were 15 gun-shot wounds, 1 shotgun injury, and 5 stab wounds. Significant problems included 7 vascular injuries, 6 central nervous system injuries, 5 ocular injuries, 3 airway compromises, 2 facial nerve injuries, 1 cervical esophageal penetration, and 2 cases of pneumothorax. Three deaths occurred, but the majority of the patients survived and sustained minimal permanent disability. Included in this review is a unique case of an intrauterine gunshot wound to the face at approximately 32 weeks' gestation. The treatment protocol, differences from adult patients, and management highlights are reviewed.

Adolescent↗
PubMed1989

Invasive basal cell carcinoma of the temporal bone.

Basal cell carcinomas involving the ear represent a spectrum of diseases, from a small superficial auricular lesion to an advanced destructive malignancy invading the temporal bone. The biologic activity of the morphea-form basal cell carcinoma variant of tumor and a postauricular location predispose to an aggressive biologic pattern. Management requires a thorough evaluation with determination of the degree of cranial and possible intracranial invasion. These lesions usually can be managed with partial temporal bone resections, although prognosis for patients with advanced lesions may be poor.

Aged↗
PubMed1988

Human squamous cell carcinoma lines express oncofetal 44-kD polypeptide defined by monoclonal antibody to mouse fetus.

Most primary human carcinomas uniformly express an oncofetal epitope which has not been demonstrated previously in established human carcinoma cell lines. We successfully derived several low-passage cell lines of human squamous cell carcinoma (SCC) from head and neck tumors using an in vitro adaptation procedure, characterized these lines, and examined them for expression of a 44-kilodalton (kD) polypeptide (PP) oncofetal antigen (OFA) at the cell surface. Newly established an in vitro-passaged SCC cells retained characteristic microvilli, numerous desmosomes and tonofilaments, abundant rough endoplasmic reticulum, osmophilic keratohyaline granules, and other features of the primary SCC cells. These new cell lines and two long-term, established SCC lines (FaDu and Detroit 562) displayed OFA at the cell surface, as determined by flow cytometry using monoclonal antibody (MoAb) 115. While the FaDu and Detroit 562 lines exhibited aneuploidy during flow cytometric analysis, the new, low-passage SCC lines that we developed remained diploid as were the primary SCC cells from which they were derived. We propose that the expression of a 44-kD OFA is a common feature of human SCC. This marker may prove useful in the detection and treatment of these tumors.

Antibodies, Monoclonal↗
PubMed1988

Craniofacial approach for the neonatal management of frontonasal encephalocoeles.

Three nasofrontal encephalocoeles managed at the University of South Alabama Medical Center are presented. Each consisted of abnormal brain originating from one frontal lobe, although the amount of cerebral tissue and the accompanying skin and meningeal layers varied. The encephalocoeles protruded through a defect in the anterior skull base near the cribiform plate. Repair in the neonatal period was required in two of the infants because of the size of the lesion and obstruction of the nasal airway. The operative approach utilized a bifrontal craniotomy with resection of the encephalocoele intradurally, repair of the anterior cranial fossa dura and osteoplastic repair of the foramen cecum defect. The closure of the facial defect depended upon the nature of the skin covering the herniation; either absence or excess of skin occurred. The preoperative evaluation disclosed associated congenital deformities in 2 of 3 patients in this series. Computerized tomographic scanning was of importance in preoperative planning. The operative technique can be modified to allow for each child's unique anatomy. Repair of nasofrontal encephalocoeles in the neonatal period may simplify the required operative procedures.

Abnormalities, Multiple↗
PubMed1988

Treatment dilemmas in laryngotracheal trauma.

The first step in trauma care is establishing an adequate airway. With laryngotracheal injuries the airway itself is injured, making this primary task more difficult. Several areas of management for patients with laryngotracheal trauma are controversial, and treatment dilemmas exist. These dilemmas include initial airway management, indications for computed tomography, operative approach, and utilization of stents. This institution has utilized a standard protocol which addresses each of these management dilemmas for the past 3 years. Twenty-one patients are reported. Voice results were good in 13, fair in six, and poor in two. Airway results were good in 16, fair in three, and poor in two. Complications included two wound infections and one death. The protocol and management dilemmas for these injuries are discussed in detail.

Adolescent↗
PubMed1988

Penetrating facial trauma: a management plan.

Penetrating wounds of the face present a spectrum of injuries and multiple management dilemmas. The surgeon's first concern remains the establishment of a proper airway and control of life-threatening injuries. Selected ancillary diagnostic procedures should be used to confirm vascular, aerodigestive, or central nervous system injuries. Diagnosis of injuries may require arteriography, endoscopic examination, barium studies, computerized tomography, and detailed ophthalmologic examination. We review 16 cases of penetrating facial trauma treated at the University of South Alabama Trauma Center over a one-year period. The injuries resulted from 13 gunshot wounds and three stab wounds. Injuries of the central nervous system occurred in three patients, mandibular fractures in four, optic nerve or globe injury in three, and maxillary sinus fracture in seven. Our experience with these patients demonstrates the spectrum of injuries and serves as a basis for a management algorithm.

Adult↗
PubMed1988

The role of radiation therapy in the management of catecholamine-secreting glomus tumors.

The major source of controversy that surrounds the use of radiation for glomus tumors is the finding of persistent chief cells years after completion of the treatment. Questions have been raised as to the viability of the irradiated chief cell and its capacity to proliferate. The radiotherapists consider a stable glomus tumor a radiation "cure," whereas skull base surgeons are fearful that these lesions will continue to slowly grow and cause problems 20 to 30 years later. We have recently managed a patient who was not a candidate for surgery, with a catecholamine-secreting glomus jugulare tumor. After 4750 rad of radiation therapy, no changes in tumor size or in catecholamine secretion have been observed (at 20 months of followup). The implications of the case are discussed.

Catecholamines↗