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Biomedical subjects

M H Stevens

Publications and source records attributed to M H Stevens.

At least 19 recordsLinked to original sources
PubMed2001

Steroid-dependent anosmia.

OBJECTIVE: To document the response to steroids in patients remaining anosmic following endoscopic nasal and sinus polypectomy. STUDY DESIGN: A prospective study of 24 patients with nasal and sinus polyps who were anosmic prior to endoscopic nasal and sinus surgery. Those who remained anosmic after surgery were treated with steroids. Most patients had asthma, allergic rhinitis, or both. A few had aspirin sensitivity. METHODS: All 24 patients had testing of their sense of smell before and after surgery. Those who remained anosmic postoperatively were first treated with topical nasal and then oral steroids and then tested again. RESULTS: Twelve of the 24 remained anosmic after surgery and were found to be unresponsive to nasal steroids, but oral steroids were found to restore the sense of smell to normal in most patients. Few patients continued to take the medication for long periods of time mainly because of a fear of side effects. Recent studies have suggested the role of systemic steroids in olfactory secretion, which may explain the mechanism for this response. CONCLUSION: Patients who remain anosmic after the removal of nasal and sinus polyps can be treated with oral steroids resulting in improvement of their sense of smell. Further research is needed on a molecular level to determine the reason for this and also why oral but not nasal steroids are helpful in these patients.

Administration, Intranasal↗
PubMed1992

Biochemical parameters which may be useful in improving organ viability after storage.

Biochemical methods that accurately detect ischemic damage in livers stored by flush cooling would be useful in the efficient development of new storage solutions. This study compares UW and Collins' solutions to evaluate those biochemical parameters which may be useful in assessing the reversibility of ischemic damage and the efficiency of organ storage solutions. Livers stored in UW solution showed higher levels of adenine nucleotides at all storage times studied. This increase in adenine nucleotides averaged 29% and was statistically significant. There was also a significant increase in the NAD levels in organs stored in UW solutions; however, the ATP levels were not significantly different after storage in either solution. Storage of livers in UW solution also decreased the amount of DNA damage which occurs with storage as compared to storage in Collins' solution, becoming statistically significant after 48 hr of storage. This suggests that these biochemical parameters may be useful in designing improved storage solutions since they reflect the extent of ischemic damage to the organ and can be determined on a small section of liver taken by biopsy.

Adenine Nucleotides↗
PubMed1990

The resident selection process in otolaryngology-head and neck surgery.

This study was undertaken to characterize the objective information available about applicants to otolaryngology-head and neck surgery residency positions, and to determine the influence of these factors on obtaining a residency position. Applicants to the otolaryngology-head and neck surgery programs at University of Utah, Salt Lake City, University of Texas Medical Branch, Galveston, and University of Louisville (Ky) were studied. Thirty-one variables were examined, representing demographic and academic factors. Excellent academic performance in medical school (as represented by medical school grade-point average greater than 3.4, National Board part I score greater than 650, class percentile rank greater than 85th percentile, honors grades in both junior medicine and surgery clinical clerkships, or [5] election to Alpha Omega Alpha) was significantly correlated with success in obtaining an otolaryngology-head and neck surgery residency position.

Adult↗
PubMed1990

Selective management of early glottic cancer.

Seventy patients with stage I and II glottic cancer were treated at the University of Utah School of Medicine hospitals from 1980 through 1987. Forty-four patients had stage I cancer and 26 patients had stage II. The overall survival in the stage I group was 82%. Primary site control was 93% with only three deaths due to laryngeal cancer. Local control rates were 93% with CO2 laser excision, 80% with CO2 laser and irradiation, and 67% with radiation alone. Stage II glottic patients had an overall survival of 61.5% with a local control rate of 76%. Twenty-one of 24 patients were treated by full-course irradiation. Of the eight patients who recurred at the primary site, all were irradiation failures who had initial bulky disease and impaired vocal cord mobility. Selective CO2 laser excision was highly effective, whereas radiation therapy results were somewhat disappointing. Open partial laryngectomy should be considered in bulky stage II disease patients.

Adult↗
PubMed1990

Laser surgery of tonsils, adenoids, and pharynx.

The author reports his experience with the laser in the treatment of lingual and palatine tonsillitis as well as with other lesions of the region. The results of laser surgery for procedures in the tonsils, adenoids, and pharynx are compared with the results of conventional surgery and electrocautery.

Adenoidectomy↗
PubMed1989

Prognostic indicators in head and neck cancer patients receiving combined therapy.

In 1983 we initiated a prospective nonrandomized study of the value of preoperative chemotherapy in previously untreated patients with stages III and IV squamous cell carcinoma of the head and neck. In 1983 and 1984, 50 patients were entered in the study. Prior to therapy all patients were evaluated by a representative from the Medical Oncology, Radiation Therapy, and Head and Neck Surgery Divisions, University of Utah School of Medicine, Salt Lake City. In addition to the standard preoperative evaluation, pretreatment computed tomographic scans were performed on all patients. Follow-up computed tomographic scans were performed after the second cycle of chemotherapy and at the completion of treatment. Initial therapy in all patients consisted of induction chemotherapy with cisplatin (day 1, 100 mg/m2) and fluorouracil (days 1 through 5, 1000 mg/m2). Several factors were examined for their utility in predicting response to therapy and survival. Factors evaluated included: (1) extent and timing of chemotherapeutic response; (2) computed tomographic quantitated primary tumor size; (3) size of computed tomographic quantitated regional (neck) metastases; (4) performance status; (5) cancer stage; (6) total lymphocyte count; and (7) serum liver function tests. The factor found to be most useful in predicting improved survival was the extent of response to chemotherapy. The remaining factors, performance status, regional lymph node status, serum gamma-glutamyltransferase levels, and cancer stage, were also found to correlate with length of survival but were much less important than the response to chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Evaluation of single-dose cefazolin prophylaxis for toxic shock syndrome.

Otolaryngologists have increased their use of parenteral prophylactic antibiotics to prevent toxic shock syndrome following nasal surgery. This rare but potentially serious postoperative complication presumably requires nasal carriage of a toxigenic strain of Staphylococcus aureus by a susceptible patient. We investigated the effect of a single preoperative dose of intravenous cefazolin on nasal carriage of S aureus. Thirty patients were studied; 15 were S aureus carriers initially and 12 (80%) remained culture positive after prophylaxis and at the time surgery was completed. We conclude that this particular regimen is unlikely to have a major effect on the incidence of toxic shock syndrome following nasal surgery.

Cefazolin↗
PubMed1988

Effect of GABA on basal and vagally mediated gastric acid secretion and hormone release in dogs.

To stimulate peripheral gamma-aminobutyric acid (GABA) receptors, GABA, which does not cross the blood-brain barrier, was administered to dogs with vagally innervated gastric fistulas at intravenous doses of 0, 0.66, 2, 6, 18, and 54 micrograms.kg-1.min-1. Mean gastric acid output increased from zero basally to 3.0 +/- 1.4 mmol/h during infusion of 54 micrograms.kg-1.min-1 GABA. Plasma somatostatin-like immunoreactivity decreased significantly below basal levels during infusion of 54 micrograms.kg-1.min-1 GABA (P less than 0.05). To stimulate central nervous system GABA receptors as well as peripheral GABA receptors, progabide, a GABA-receptor agonist, which readily crosses the blood-brain barrier, was injected intravenously. Mean acid output was 3.5 +/- 1.3 mmol/h after 20 mg/kg progabide and 0.6 +/- 0.5 mmol/h after its vehicle (P less than 0.05). Basal serum gastrin concentration increased significantly after progabide injection. Acid output during insulin-induced hypoglycemia was inhibited 59% by 30 mg/kg intravenous progabide. Progabide infusion also diminished or abolished circulating gastrin, somatostatin, and pancreatic polypeptide responses during insulin-induced hypoglycemia (P less than 0.05). Further studies were performed in dogs with a gastric fistula and a vagally denervated Heidenhain pouch to confirm that GABA-receptor stimulation affects acid secretion via peripheral pathways. Intravenous injection of baclofen (0.5 mg/kg), a GABAB-receptor agonist, increased acid secretion significantly from the gastric fistula and the Heidenhain pouch. These studies suggest that GABA may play a role in regulating gastric acid secretion and gastrointestinal and pancreatic endocrine function by both central and peripheral mechanisms.

Animals↗
PubMed1987

Interferon gamma regulates HLA-D expression on solid tumors in vivo.

In vivo administration of recombinant human interferon-gamma, rIFN-gamma, to nude mice bearing human tumor xenografts resulted in a strong induction of HLA-DR expression on the tumor cells in 2 of 3 lines tested. The induction was dose-dependent and declined rapidly after cessation of therapy. IFN-gamma also switched on DQ and DP products when the xenograft cells were treated in vitro. The in vivo alteration of tumor surface properties by rIFN-gamma may have therapeutic implications.

Animals↗
PubMed1987

Ranulas and their mimics: CT evaluation.

The spectrum of computed tomographic (CT) findings in ten patients with pathologically proved simple and diving ranulas is reviewed. These retention cysts originate within the sublingual space from obstruction of the sublingual or minor salivary glands; when they enlarge, the cysts herniate to involve the submandibular and inferior parapharyngeal spaces (the so-called diving or plunging ranula). CT findings in 38 additional patients with a variety of cystic lesions in the floor of the mouth are contrasted with findings in cases of ranulas. The relevant anatomy is reviewed. This experience indicates that a unilocular, cystic mass emanating from the sublingual space and extending into the adjacent submandibular and/or inferior parapharyngeal spaces can be considered a diving ranula in virtually all cases. A unilocular, cystic mass entirely within the sublingual space can be considered a simple ranula in most instances, although absolute distinction between a simple ranula and an epidermoid cyst cannot be made radiographically.

Diagnosis, Differential↗
PubMed1987

Mechanism for high PCO2 in gastric juice: roles of bicarbonate secretion and CO2 diffusion.

The partial pressure of CO2 (PCO2) in gastric juice often exceeds the PCO2 of blood. CO2 in gastric juice may originate from blood and enter luminal fluid by diffusion, or CO2 may be produced in the lumen of the stomach from the reaction of HCO3- and H+. Because CO2 production from HCO3- is dependent on acid (low pH), we suppressed acid secretion with intravenous cimetidine to estimate to what extent appearance of CO2 in luminal fluid is due to production from HCO3-. When denervated fundic pouches of dogs were distended with saline, the PCO2 of the solution increased to the PCO2 of blood in approximately 20 min, with the initial rate of appearance of CO2 in the pouch solution only minimally affected by cimetidine. Thereafter, PCO2 of luminal fluid continued to increase to 50-60 mmHg in the absence of cimetidine, whereas PCO2 of luminal fluid remained approximately equal to that of blood when cimetidine was infused (P less than 0.001, cimetidine vs. control). The mean pH in the pouch solution remained between 6.3 and 6.9 during cimetidine infusion but decreased to 4.75 without cimetidine (P less than 0.001). In additional experiments, an acidic solution with high PCO2 (242 +/- 3 mmHg) was infused into the fundic pouches. PCO2 in luminal fluid decreased rather slowly toward plasma PCO2, requiring 240 min for luminal fluid PCO2 to decrease to 56 +/- 2 mmHg. Thus the permeability of the gastric mucosa to luminal CO2 was relatively low.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Absorbable gelatin film verses silicone rubber sheeting in orbital fracture treatment.

Orbital floor fractures can result in herniation of orbital tissues and impairment of ocular function. In this experimental study, orbital defects were created surgically in cats. The gross and histologic healing of these defects was compared among animals implanted with silicone rubber sheeting or absorbable gelatin film and animals that received no implants. Both implanted animal groups demonstrated enhancement of healing. The absorbable gelatin film showed less migration, less inflammatory response, and improved healing. This animal study supports the use of absorbable gelatin film in the surgical management of orbital fractures.

Absorption↗
PubMed1987

Non-Hodgkin's lymphoma of the head and neck: CT evaluation of nodal and extranodal sites.

Forty-five patients with non-Hodgkin's lymphoma (NHL) of the extracranial head and neck who had undergone CT as part of their evaluation were reviewed to assess the impact of CT on clinical management. The sites of tumor deposition were subdivided by location: I, nodal; II, extranodal, lymphatic (Waldeyer's ring); and III, extranodal, extralymphatic (orbit, sinonasal, deep facial spaces, mandible, salivary gland, skin, and larynx). The CT appearance of NHL in each of the three locations was analyzed for characteristic CT signatures. Nodal NHL was suspected when CT showed multiple, large, homogeneous lymph nodes, often in unusual nodal chains of the head and neck. Extranodal, lymphatic NHL of Waldeyer's ring was indistinguishable from squamous cell carcinoma of this area unless synchronous tumor deposit in an extranodal, extralymphatic location was also present. When NHL was in nodes and/or Waldeyer's ring, CT-derived information was of limited clinical value since treatment was unfocused (chemotherapy and/or large-field radiotherapy). The CT appearances of extranodal, extralymphatic NHL was generally not distinguishable from other malignancies of these areas. However, CT-derived information regarding deep-tissue tumor size and extent was critical to planning the radiotherapy ports.

Adult↗