Biomedical subjects

Jan L Kasperbauer

Publications and source records attributed to Jan L Kasperbauer.

36 records · Page 2Linked to original sources

PubMed2003

Characterization of antigen processing machinery and Survivin expression in tonsillar squamous cell carcinoma.

BACKGROUND: There is a statistically significant association between human leukocyte antigen (HLA) Class I antigen expression and improved prognosis for some patients. This association reflects the control of tumor growth by HLA Class I antigen-restricted, tumor-associated antigen-specific cytolytic T cells. However, progression of other malignant diseases is not associated with the loss of HLA expression. These observations show that the poor prognosis of a subset of tumors, despite high HLA Class I antigen expression, may reflect the development of alternative mechanisms utilized by tumor cells to escape from immune recognition and destruction. METHODS: The authors evaluated the possible correlation between the expression of the antiapoptosis gene, Survivin, HLA Class I, and progression of tonsillar squamous cell carcinomas (TSCC) lesions. Tissue microarrays were constructed from primary TSCC, metastatically involved lymph nodes, adjacent normal mucosa, and tonsillar parenchyma excised for nonmalignant conditions. RESULTS: Immunoperoxidase staining of tissue sections demonstrated that Survivin expression is significantly higher (P < 0.001) in malignant tumors than in normal tissue samples. In addition, Survivin expression is significantly higher (P = 0.05) in metastatic than in primary lesions. Survivin expression in primary lesions correlated positively with delta (P = 0.025), tapasin (P = 0.028), and HLA Class I antigen (P = 0.006) expression. The expression patterns of delta, tapasin, HLA Class I antigen, beta-2-microglobulin, and Survivin did not demonstrate any significant association with the clinical course of disease. CONCLUSIONS: For TSCC that maintain the expression of HLA Class I antigen, overexpression of Survivin may provide an alternative explanation for tumor progression.

Antigen Presentation↗

PubMed2003

Intraoperative radiotherapy for head and neck and skull base cancer.

BACKGROUND: The purpose of this study was to evaluate the use of intraoperative electron beam radiotherapy (IORT) as an adjuvant modality in the treatment of advanced head and neck and skull base cancer. METHODS: Between 1991 and 1996, 34 patients with squamous cell carcinoma (SCCA) and 10 patients with non-SCCA were enrolled in this prospective nonrandomized clinical trial. Most patients had been previously treated with combinations of surgery, external beam radiotherapy, and chemotherapy. The most frequent sites treated were the skull base (56%) and the neck (44%). IORT was delivered in a dedicated operating room suite with energies of 6 to 15 MeV (6 MeV most commonly used) at doses of 12.5 to 22.5 Gy. RESULTS: At 2 years overall and disease-free survival was 32% and 21%, respectively, for the SCCA patients and 50% and 40%, respectively, for the non-SCCA patients. Tumor control rates at 2 years in the IORT field were 46% for the SCCA patients and 52% for the non-SCCA patients. For squamous cell histology, survival in patients with microscopic residual tumor did not differ from those with no residual tumor, but they both had significantly longer disease-free survival than those patients with gross residual at the time of IORT (p =.03), with a trend toward longer overall survival (p =.09). The only complication directly attributable to IORT was a neuropathy in a patient who received an IORT dose of 22.5 Gy (cumulative dose 130.1 Gy). CONCLUSIONS: IORT at a dose of 12.5 Gy is safe and produces tumor control and survival for patients likely to have microscopic residual disease in sites difficult to resect such as the skull base.

Adolescent↗

PubMed2003

Congenital dacryocystocele associated with intranasal cysts: diagnosis and management.

OBJECTIVE: To improve the diagnostic and therapeutic database for congenital dacryocystoceles. STUDY DESIGN/METHODS: Retrospective case study of 10 patients with dacryocystoceles treated in an academic integrated tertiary care practice. Management and outcomes are compared to previous reports in the literature. RESULTS: Between the years 1990 and 2001, 10 patients were diagnosed with dacryocystoceles. Seven were females, and 3 were males. Age ranged from 1 to 75 days. Nine of 10 had a unilateral dacryocystocele, and 1 had bilateral dacryocystoceles. Epiphora was reported in 8 patients. Preoperatively, dacryocystitis, facial cellulitis, or both were present/developed in 2 patients. Symptoms of airway obstruction were present in 3 neonates. Surgery was performed in 9 of 10 patients and was a combined ophthalmology/otolaryngology surgery in 7 cases. Two patients were treated with probing only. Intranasal cysts were identified in all 7 patients who underwent a combined approach. Three of 7 patients had bilateral intranasal cysts. Follow-up ranged from 9 months to 10 years (mean, 5 years). Complete resolution was observed in 9 patients. One patient had postoperative nasolacrimal duct obstruction 2 months postoperatively, presenting with mucopurulent drainage and cellulitis. The existing literature often suggests conservative management as a treatment option. CONCLUSION: True dacryocystoceles are a relative rarity. The literature describes a variable natural course of these lesions with resultant controversy in their management. The current results demonstrate successful treatment in 6 of 7 patients with an early combined surgical approach and 2 of 2 patients treated by probing alone. The high failure rate with conservative management, reported in the literature, supports early surgical intervention.

Cysts↗

PubMed2003

Swallow function in patients before and after intra-arterial chemoradiation.

OBJECTIVES/HYPOTHESIS: To prospectively evaluate swallow function in patients with advanced head and neck cancer before and after completion of intra-arterial chemoradiation therapy and planned neck dissection. STUDY DESIGN: Prospective nonrandomized study. METHODS Swallow function was evaluated in 11 patients with resectable T4 and selected T3 head and neck cancer before and, on average, 19 weeks after completion of treatment. RESULTS: The Performance Status Scale demonstrated worse scores for both eating in public (P =.004) and normalcy of diet (P =.004) after treatment. Patients who underwent neck dissections had significantly worse scores (P =.02) in normalcy of diet. A significant decline was noted in swallowing functional measures at the time of the repeat evaluation (P =.02). Videofluoroscopic swallow studies revealed altered swallow function in 9 of 11 patients before treatment, with aspiration seen in 3 patients. Following treatment, the incidence of aspiration increased to seven patients. Tongue base retraction, reduced laryngeal elevation, and increased laryngeal vestibule penetration of thick liquid were all statistically significantly worse after treatment. The overall score on the quality of life instrument was not significantly changed from before to after treatment. CONCLUSIONS: The majority of patients demonstrated significantly worse swallow function on all three methods of analysis at 19 weeks after completion of treatment. Continued detailed monitoring of patients' swallow function is critical in determining long-term effects of intra-arterial chemoradiation therapy and neck dissection.

Adult↗

PubMed2003

Subglottic stenosis associated with Wegener's granulomatosis.

OBJECTIVE: To evaluate the outcomes of subglottic stenosis in patients with Wegener's granulomatosis. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review was undertaken to review all patients evaluated in an otolaryngology-head and neck surgery department between 1993 and 2001 for active symptoms attributed to subglottic stenosis who had undergone cytoplasmic staining antineutrophil cytoplasm antibody and perninuclear staining antineutrophil cytoplasm antibody testing and who had a clinical diagnosis of Wegener's granulomatosis. RESULTS: Twenty-seven patients were identified with Wegener's granulomatosis and subglottic stenosis. Among these, 11 of 27 (40.7%) underwent tracheotomy; 13 of 27 (48.1%) required multiple surgical procedures. A history of open laryngotracheal repair was present in 7 of 27 patients (25.9%). CO(2) laser resection and dilation was used in 12 of 27 patients (44.4%). Three of 27 patients (11.1%) had a tracheotomy at last follow-up. Patients were followed for an average duration of 76.8 months (6.4 y) from the onset of symptoms attributed to subglottic stenosis. All patients who underwent open laryngotracheal reconstruction had successful decannulation. CONCLUSIONS: Wegener's granulomatosis is a necrotizing vasculitis that can involve the subglottis. Our approach to airway management in these patients involves a tracheotomy if obstruction occurs during acute inflammatory activity. We recommend minimizing airway manipulation during episodes of systemic disease activity. Once control of the disease process is obtained, consideration is given to either an endoscopic or an open approach based on the extent of stenosis. Either laryngotracheal reconstruction or CO(2) laser resection and dilation may be undertaken with safety and should result in favorable outcomes.

Adolescent↗

PubMed2003

Vascularized radial forearm free tissue transfer for lining in nasal reconstruction.

OBJECTIVES/HYPOTHESIS: Total and near-total nasal reconstruction requires the surgeon to replace external nasal cover, skeletal support, and internal nasal lining. The successful result must re-create the form and function of the original nose. In large defects, traditional sources of internal lining may be unavailable. The study describes the recreation of nasal lining in three patients with extensive nasal defects with vascularized radial forearm tissue. STUDY DESIGN: Retrospective review of three patients who underwent nasal reconstruction with radial forearm for internal lining, costal cartilage grafts for skeletal support, and paramedian forehead flap for cover. METHODS: The charts of three patients who underwent total nasal reconstruction with radial forearm tissue transfer for lining were retrospectively reviewed. The technique was evaluated. The authors present a method for internal lining reconstruction in extensive nasal defects. They discuss the advantages and disadvantages of this method. RESULTS: Three patients underwent successful total nasal reconstruction with radial forearm tissue transfer for lining, costal cartilage for skeletal support, and paramedian forehead flap. None of the patients had adequate septal mucosa or nasal subunit skin to support mucosal rotation grafts or epithelial turn-in flaps. All patients have completed reconstruction and have satisfactory nasal form and function. Loss of the lining flap or graft loss did not occur. CONCLUSION: Vascularized radial forearm tissue supplies ample quantities of skin to recreate nasal lining. The tissue provides excellent support of graft material, and it prevents contracture of the covering flap. Because of its bulk and donor site morbidity, free forearm tissue transfer should not be considered for reconstruction of smaller defects when another lining flap will suffice.

Adult↗

PubMed2003

18F-FDG PET of patients with Hürthle cell carcinoma.

UNLABELLED: Hürthle cell carcinoma is an uncommon differentiated thyroid cancer characterized by an aggressive clinical course and low avidity for (131)I. Treatment usually involves an aggressive surgical approach often combined with (131)I. (18)F-FDG PET has been helpful in the staging and evaluation of many types of aggressive malignancy. No reports to date have described the utility of PET in a series of patients with Hürthle cell cancer. We reviewed our experience with (18)F-FDG PET in the care of patients with Hürthle cell carcinoma to determine the likelihood of uptake in these cancers and the effect of (18)F-FDG PET on patient care. METHODS: Patients with Hürthle cell cancer who were seen between June 2000 and April 2002 and were imaged with (18)F-FDG PET were included. Imaging and clinical data were reviewed. PET results were compared with the results of anatomic imaging (CT, sonography, or MRI) and (131)I imaging when performed. Patient charts were reviewed to identify any change in management that resulted from the (18)F-FDG PET findings. RESULTS: Fourteen (18)F-FDG PET scans of 12 patients were obtained in the time frame indicated. All patients had documented Hürthle cell carcinoma. PET showed intense (18)F-FDG uptake in all known Hürthle cell cancer lesions but one. PET showed disease not identified by other imaging methods in 7 of the 14 PET scans. PET identified distant metastatic disease (5) or local disease (2) that was more extensive than otherwise demonstrated. In 7 of the 14 scans, the information provided by PET was used to guide or change therapy. CONCLUSION: Hürthle cell carcinoma demonstrates intense uptake on (18)F-FDG PET images. PET improves disease detection and disease management in patients with Hürthle cell carcinoma relative to anatomic or iodine imaging. (18)F-FDG PET should be recommended for the evaluation and clinical management of patients with Hürthle cell carcinoma.

Adenoma, Oxyphilic↗

PubMed2002

Confirmation of existence of a new syndrome: LAPS syndrome.

In l998, Hopkin et al. described a new disorder characterized by progressive laryngotracheal stenosis, short stature, and arthropathy. We provide extensive clinical information on two additional unrelated patients with this distinctive disorder and propose the name LAPS syndrome, to reflect the most consistently recognized features, namely, Laryngotracheal stenosis, Arthropathy, Prognathism, and Short stature.

Abnormalities, Multiple↗

PubMed2002

Strategies for antigen loading of dendritic cells to enhance the antitumor immune response.

Dendritic cells (DCs) primed with tumor antigens can effectively mediate the regression of a variety of established solid malignancies in both murine and human models. Despite such clinical efficacy, the optimal means of DC priming is unknown. The goal of this study was to compare three methods of tumor preparation: irradiation, boiling, or freeze thaw lysis for DC priming. Mouse bone marrow-derived DCs were loaded with defined ratios of E.G7 tumor cells expressing a model tumor antigen, OVA. Sensitized DCs were used for stimulation of OVA-specific CTLs derived from OT-1 T-cell receptor transgenic mice. IFN-gamma release, determined by ELISA at 24 and 48 h, was used to assess the expression of antigens by DCs. DCs loaded with irradiated tumors were effective stimulators for OT-1 CTLs, whereas DCs stimulated with freeze-thawed or boiled tumors did not stimulate IFN-gamma production. Freeze-thaw lysis appeared to inhibit CTL activity in vitro and in two of three cases, this effect was not overcome by the addition of OVA. The ability to load irradiated tumor cells was reproduced in two analogous human melanoma models using melanoma cell lines expressing gp100 and CTL clones specific for a gp100 melanoma antigen. Consistent with the in vitro data, only DC/irradiated tumor vaccines were effective in preventing or delaying outgrowth of E.G7 and a poorly immunogenic murine squamous cell carcinoma (SCCVII), on local tumor challenge. These data demonstrate that the method of tumor cell preparation clearly influences the ability of DCs to present antigen to T cells. Correlation of in vitro data with the generation of protective immunity in vivo suggests the utility of irradiated tumor-primed DCs as a means to generate protective immunity in patients with solid malignancies.

Animals↗

PubMed2002

Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery.

BACKGROUND: We evaluated toxicity and long-term efficacy of stereotactic radiosurgery in patients with symptomatic or progressive glomus jugulare tumors. METHODS: Twenty-five consecutive patients (age, 30-88 years; 17 women, 8 men) who underwent stereotactic radiosurgery with the Leksell Gamma Knife (dose, 12-18 Gy) were prospectively followed. MRI and clinical examinations were performed at 6 months and 1, 2, and 3 years, and then every 2 years. RESULTS: None of the tumors increased in size, 17 were stable, and 8 decreased (median imaging follow-up, 35 months; range, 10-113 months). Symptoms subsided in 15 patients (60%); vertigo occurred in 1, but balance improved with vestibular training (median clinical follow-up, 37 months; range, 11-118 months). No other new or progressive neuropathy of cranial nerves V-XII developed. CONCLUSIONS: Stereotactic radiosurgery can achieve excellent tumor control with low risk of morbidity in the treatment of glomus jugulare tumors. The lower cranial nerves can safely tolerate a radiosurgical dose of 12 to 18 Gy.

Adult↗

PubMed2002

Merkel cell carcinoma of the head and neck: a retrospective case series.

BACKGROUND: Eighty-five percent of all Merkel cell carcinomas appear on sun-exposed areas, with 50% to 55% occurring on the head and neck. METHODS: A chart review was performed on 22 patients treated for Merkel cell carcinoma of the head and neck between 1981 and 1998. RESULTS: Fifteen patients were men (68%). The average age at operation was 69.9 years (range, 24-84 years). The average duration of follow-up was 3.6 years (range, 3 days-8.6 years). Overall survival at 1, 2, and 3 years postoperatively was 78%, 68%, and 68%, respectively. The only independent predictor of survival was the type of surgical therapy. All patients who underwent wide local excision (WLE) of the primary tumor with dissection of the lymphatic drainage basin were alive at 2 years as opposed to 68% who had WLE alone and 33% who had Mohs surgery. CONCLUSIONS: WLE and dissection of the lymphatic drainage basin provided the best overall survival.

Adult↗

PubMed2002

Use of a flap of extraocular muscle and fat during subtotal exenteration to repair bony orbital defects.

PURPOSE: To describe a technique for the primary repair of bony defects between the orbit and adjacent structures during subtotal exenteration. DESIGN: Interventional case reports. METHODS: A flap composed of orbital fat supported by an extraocular muscle pedicle was used to fill a defect between the orbit and the nasal cavity in one case, and to buttress a fascia lata graft covering exposed dura mater in one case. RESULTS: The exenterated socket healed satisfactorily without fistula formation in both cases. CONCLUSIONS: Primary repair of communications between the orbit and its surrounding cavities may prevent the development of postoperative fistulae or cerebrospinal fluid leakage.

Adipose Tissue↗

PubMed2002

Reassessment of CD62L as a marker of pre-effector T cells in the tumor draining lymph nodes of head and neck cancer patients.

OBJECTIVES: CD62L was evaluated as a determinant of human pre-effector T cells. STUDY DESIGN AND SETTING: Phenotype and cytokine secretion profiles of CD62L cells were determined based on activation status. RESULTS: CD62L(Low) T cells demonstrated significantly higher secretion of interleukin (IL)-10 and interferon (IFN)-gamma than did CD62L(High) T cells. After activation, the majority of cells expressed high levels of the CD62L surface marker. Postactivation levels of IL-10 production remained elevated or unchanged. In a murine B16 melanoma model, freshly isolated CD62L(Low) tumor draining lymph nodes (TDLN) T cells showed increased secretion of IL-2 and IL-4 but not of IL-10 or IFN-gamma. The surface expression of CD62L and cytokine secretion patterns were maintained after activation with concomitant increases in IL-10. CONCLUSION: Our results provide evidence that CD62L(Low) T cells in TDLNs of progressively growing squamous cell carcinoma of the head and neck differ phenotypically and functionally from those of mouse origin. SIGNIFICANCE: Characterization of this human CD62L(Low) T cell population provides initial insight regarding novel surface markers in TDLN T cells that might correlate with antitumor reactivity.

Animals↗

PubMed2002

Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis.

HYPOTHESIS: Pharyngeal inflammatory pain is reduced by a single dose of dexamethasone. STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled study. METHODS: From August 1998 to July 2000, a total of 118 patients were enrolled. We compared placebo (n = 37), a 10-mg single dose of intramuscular injection of dexamethasone (n = 39), and a 10-mg single dose of oral dexamethasone (n = 42). All patients were given oral antibiotics and had bacterial throat cultures. RESULTS: Complete telephone follow-up 12 hours after treatment was available in 111 patients, and 24-hour follow-up data were available in 116. The change in pain visual analogue scale scores (pretreatment score minus 12-h follow-up score) reported by patients who were given either intramuscular (median score, 4; mean score +/- SD, 4.2 +/- 2.3) or oral dexamethasone (median score, 3; mean score +/- SD, 3.8 +/- 2.3) was significantly greater than that of the patients who were given placebo (median score, 2; mean score +/- SD, 2.1 +/- 2.0) (P <.001 and P =.002, respectively). This difference in improvement was also evident when the percentage of change was compared in the three treatment arms at 12-hour and 24-hour follow-up. Patients who were given dexamethasone had the onset of pain relief a median of 4 hours earlier than those who were given oral and intramuscular placebo (P =.029). Statistically significant differences among the three treatment arms were confirmed when a bacterial pathogen was identified (n = 47) but not in a subset that did not have a pathogen identified. CONCLUSIONS: Single-dose dexamethasone appears to be a safe, effective, and inexpensive adjunctive treatment for acute pharyngitis in patients 15 years of age and older. Patients treated with intramuscular or oral dexamethasone had significant relief of pain (relative to baseline) compared with patients who were given placebo. Identification of a bacterial pathogen had a significant impact on the response to dexamethasone.

Acute Disease↗

PubMed2002

Rathke cleft cyst: diagnostic and therapeutic considerations.

OBJECTIVE: To highlight diagnostic and therapeutic issues about Rathke cleft cysts for otorhinolaryngologists. STUDY DESIGN: Retrospective. METHODS: We retrospectively reviewed data collected on Rathke cleft cysts between 1978 and 1998: presenting symptoms, visual acuity, surgical treatment, complications, recurrences, and effect on daily activity. RESULTS: Twenty-nine patients were diagnosed with a Rathke cleft cyst (11 male and 18 female patients; mean age, 46 y). The most common presenting symptom was head pain (55%). The majority (59%) of cases demonstrated suprasellar extension on preoperative imaging, with pituitary dysfunction identified in 66%. Recurrence occurred in eight patients (28%). Postoperative visual function improved or remained stable in all patients. Persistent pituitary dysfunction required hormonal supplementation in seven patients (24%). Only one patient with an astrocytoma in addition to a Rathke cleft cyst did not maintain the ability to perform normally on an assessment of activities of daily living, a striking contrast to patients with craniopharyngioma. CONCLUSIONS: Conclusions were as follows: 1) Rathke cleft cysts must be considered as sources of head pain and pituitary dysfunction. 2) Persistent or recurrent cyst formation occurs in approximately one-third of the patients. Recurrence may take many years, and follow-up imaging is recommended for at least a decade. 3) Maintenance of the ability to perform the activities of normal daily living can be expected after surgical management. 4) Most Rathke cleft cysts can be managed through transnasal exposure of the sella. 5) Packing the sella may result in predisposition to recurrent cyst formation.

Activities of Daily Living↗

PubMed2002

Interleukin 4 receptor-directed cytotoxin therapy for human head and neck squamous cell carcinoma in animal models.

Receptors for interleukin 4 (IL-4R) are overexpressed on the surface of various human solid tumors including renal cell carcinoma, glioblastoma, Kaposi's sarcoma, and head and neck squamous cell carcinoma (SCCHN). On the basis of this preferential receptor overexpression, a novel IL-4R-targeted cytotoxin, IL-4 (38-37)-PE38KDEL, was developed in which circularly permuted IL-4 [IL-4 (38-37)] was fused to mutated form of Pseudomonas exotoxin (PE38KDEL). Despite the recognized expression of the IL-4R on SSCHN, the utility of a receptor-specific fusion protein for the treatment of this disease remains unknown. The purpose of this study was to establish the utility of IL-4 (38-37)-PE38KDEL for the treatment of established SSCHN in animal models of human disease. Expression of IL-4R in SCCHN was confirmed by immunohistochemistry with eight of eight tissue sections expressing IL-4R. Protein synthesis inhibition assays demonstrated growth inhibition of two cell lines in IL-4 (38-37)-PE38KDEL in a dose-dependent fashion. In two SCCHN s.c. xenografted nude mouse models, i.p. and intratumoral injection of IL-4 (38-37)-PE38KDEL mediated tumor regression with no visual toxicity observed in any of the animals. Subcultured tumor cells after intratumoral treatment with IL-4 toxin did not develop resistance to the drug. These data demonstrate that IL-4 (38-37)-PE38KDEL is effective in mediating significant antitumor effects in SCCHN and may represent an attractive therapeutic option for patients with advanced cancers of the upper aerodigestive tract.

Adult↗

PubMed2002

Squamous cell carcinoma of the tonsils: a molecular analysis of HPV associations.

BACKGROUND: The role of human papilloma virus (HPV) in the pathogenesis and biological behavior of tonsillar squamous cell carcinoma (TSCC) are areas of intense investigation. METHODS: This study used PCR analysis to identify HPV in paraffin-embedded tonsillar and nodal tissue from 52 patients with TSCC and 48 age (+/-5 year)/gender-matched controls with benign tonsillar hyperplasia. Results were correlated with HLA-DRB1 haplotype and clinical outcome. RESULTS: HPV was identified in 46% of patients with TSCC and 6% of controls. DNA sequencing showed the presence of HPV type 16 in 21 patients (40%) with TSCC. There was no statistically significant association between HLA-DRB1 expression and TSCC or HPV infection. Fifteen of 16 patients with HPV-positive TSCC with regional metastases had evidence of HPV in pathologically involved lymph nodes. In eight HPV 16-positive TSCC patients with lymph node metastasis, PCR testing identified HPV 16 in 17 of 23 histologically negative lymph nodes. Patients with HPV-positive TSCC without metastatic disease had no evidence of HPV in their lymphatic tissue. Clinically, HPV-associated carcinoma was present in younger patients in comparison with HPV-negative TSCC patients (mean age, 56.6 versus 66 years; P = 0.001). The odds for patients with HPV infection to develop TSCC were 18.2 times greater than for patients without HPV infection (95% confidence interval 4.6, 73.1). There was no statistically significant association between presence of HPV and cause-specific survival (hazard ratio = 2.5 for HPV negative versus positive; P = 0.26), after adjusting for age in a Cox proportional hazards regression analysis. CONCLUSION: HPV is an independent risk factor for TSCC. Identification of HPV in the histologically positive and negative lymph nodes of patients with HPV-positive TSCC/metastatic disease supports the role of HPV in the oncogenesis of TSCC.

Adult↗

PubMedDate not supplied

Endoscopic orbital decompression for Graves' ophthalmopathy.

BACKGROUND: Graves' ophthalmopathy generates a volume excess for the orbital cavity, which may produce proptosis, pain, exposure keratitis, diplopia, and optic neuropathy. Endoscopic orbital decompression expands the orbital cavity into the ethmoid cavity and medial maxillary sinus. This retrospective study documents the outcomes after endoscopic orbital decompression for patients with Graves' ophthalmopathy. METHODS: Data collected included demographic information, symptom resolution, complications related to the surgery, reduction in proptosis, subsequent need for eye muscle surgery, and hospital length of stay. Between July 1989 and April 2003, 62 patients were referred for endoscopic orbital decompression (often unilateral). RESULTS: Three patients refused use of their medical records for research purposes. Seventy percent were women; the average age of the study group was 49 years. Preoperatively, 63% of the patients had diplopia and optic neuropathy was noted in 27%. Two patients had a cerebrospinal fluid leak identified and managed during the decompression. No postoperative leaks occurred. Twenty-five percent of patients did not require eye muscle surgery. Forty-eight percent of the patients underwent one procedure to manage diplopia. The average reduction in proptosis was 2.5 mm. Fifty-four percent were managed as an outpatient and 27% underwent a 23-hour observation period. CONCLUSION: This data supports the safety, efficiency, and efficacy of endoscopic orbital decompression for unilateral and bilateral Graves' ophthalmopathy. Eye muscle surgery frequently will be required to manage diplopia after decompression.

Adult↗