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Biomedical subjects

Marc G Dubin

Publications and source records attributed to Marc G Dubin.

At least 19 recordsLinked to original sources
PubMed2007

Radiographic resolution of chronic rhinosinusitis without polyposis after 6 weeks vs 3 weeks of oral antibiotics.

BACKGROUND: Maximal medical therapy is poorly defined in chronic sinusitis treatment. OBJECTIVE: To objectively evaluate the radiographic response of chronic rhinosinusitis without polyposis after 3 and 6 weeks of oral antibiotics. METHODS: Thirty-five patients with confirmed chronic sinusitis without polyposis (disease apparent on initial computed tomography [CT] with appropriate symptom duration) were prescribed 6 weeks of antibiotics. When possible, culture-directed antibiotics were used; otherwise clindamycin was used empirically. A CT was performed after 3 and 6 weeks of therapy. CTs were then graded by the Lund-Mackay system. Demographic data were reviewed. RESULTS: Of the 35 patients, 16 underwent all 3 CT scans and completed all 6 weeks of antibiotics. Three patients completed only 3 weeks of antibiotics, and 16 did not undergo the interval 3-week CT. Six patients (38%) had statistically significant improvement in their CT scans between weeks 3 and 6. In this subset of patients who improved, 37% of their overall radiographic improvement occurred in the 3- to 6-week treatment interval. No prognostic variables predicted which patients would radiographically improve after 3 weeks of antibiotics. CONCLUSION: Some patients achieve radiographic improvement and disease resolution after the completion of a 3-week course of antibiotics. Therefore, maximal medical therapy for chronic sinusitis may consist of longer than 3 weeks of therapy to ensure maximal benefit.

Administration, Oral↗
PubMed2006

Preservation of natural frontal sinus outflow in the management of frontal sinus osteomas.

INTRODUCTION: Management of frontal sinus tumors has traditionally been through open approaches with obliteration of the sinus. Recently, increased comfort with endoscopic techniques has made endoscopic resection an alternative to more morbid approaches. However, many skilled endoscopists still champion obliteration of the frontal sinus after the open treatment of large osteomas. METHODS: A retrospective review of the senior author's experience with frontal sinus osteomas was performed. RESULTS: Twelve frontal sinus osteomas were treated surgically without obliteration. All patients with greater than 2 cm vertical extension of their tumor into the frontal sinus required an open approach (n = 4), whereas the remainder (n = 8) were treated endoscopically. Frontal ostia were stented if greater that 40% of the mucosa of the frontal recess was denuded. Eleven of 12 patients had patent, functional frontal sinuses. CONCLUSION: Successful resection of frontal sinus osteomas can be performed with preservation of the natural drainage of the frontal sinus in almost all cases. EBM RATING: C-4.

Adult↗
PubMed2005

Precursor B-cell lymphoblastic lymphoma presenting as an isolated external ear swelling in a two-year-old child.

The incidence of lymphoma in children is increasing in the United States and is the third most common childhood cancer. The head and neck is second only to the abdomen as the most common site of extranodal presentations of non-Hodgkin's lymphoma (NHL). We present and discuss the diagnosis and management of the first report of a child with an auricular mass as the sole manifestation of B-cell non-Hodgkin's lymphoma. In summary, the otolaryngologist and pediatrician should be cognizant of potential for NHL in atypical lesions of the head and neck in children.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Clear cell odontogenic carcinoma: a comprehensive analysis of treatment strategies.

BACKGROUND: Odontogenic neoplasms of predominately clear cells are unusual. They represent a diagnostic dilemma, and as a result, treatment strategies are diverse. Our goal is to present two new cases, summarize reported cases of clear cell odontogenic carcinoma (CCOC), assess potential risk factors for recurrence, and propose definitive surgical and therapeutic strategies. METHODS: A literature search and analysis was performed. Regression models were used to predict risk factors for recurrence. RESULTS: Forty-three cases of CCOC were reviewed, including two reported here. The overall rate of recurrent disease was 55%. Local recurrence rates were higher for curettage (80%) than for resection alone (43%). Age (p = .20), sex (p = .28), and tumor site (p = .50) did not predict risk for recurrence. CONCLUSIONS: CCOC is a potentially aggressive tumor with a tendency for recurrence. Treatment strategies should be directed toward wide surgical resection with confirmation of tumor-free margins. Lymph node dissection and adjuvant radiation therapy should be considered in selected cases.

Adenocarcinoma, Clear Cell↗
PubMed2005

Stereotactic computer assisted navigation: state of the art for sinus surgery, not standard of care.

There are circumstances in which image guidance is clearly useful to facilitate a more complete operation. By confirming the identity of known anatomic structures, a knowledgeable surgeon's understanding of the disease process can improve and only the necessary structures removed. CT guidance is a clear aid to understanding altered anatomy when combined with a thorough analysis of the preoperative CT scan and office nasal endoscopy. It is the combination of this preoperative planning with image guidance that allows a skilled surgeon to operate with confidence. This discussion intentionally did not refer to image guidance as the standard of care, because although this technology is clearly useful, valuable, and helpful in confirming anatomy and performing many procedures, it is not always necessary in achieving a complete operation. Therefore, it should not be considered the standard of care.

Decompression, Surgical↗
PubMed2002

Effect of intranasal histamine challenge on Eustachian tube function.

OBJECTIVE: To show a relationship between intranasal histamine challenge, the development of middle ear effusion and Eustachian tube (ET) dysfunction in a rat model. METHODS: Non-allergic Sprague-Dawley rats weighing between 450-600 g were randomly assigned to receive an intranasal infusion of 16 microl of 10% histamine or normal saline. ET function was assessed by using the forced-response test to measure passive and active opening and closing pressures at time intervals of 6, 10, 14, 18, 22, and 26 min and 24 h post-infusion. Mucociliary clearance times (MCCTs) of the tubotympanum at 18 min post-infusion were measured by timing the transit of dye from the middle ear to the nasopharynx. Outcome measures were ET dysfunction and evidence of clinical effusion. RESULTS: Intranasal histamine caused acute ET dysfunction when introduced into the nasopharynx demonstrated by significant elevations in passive and active opening and closing pressures (P < or = 0.001) compared to controls. The largest difference was seen at 26 min post-infusion. Furthermore, MCCTs were 2.4 times longer after infusing intranasal histamine than after saline infusion. No clinically significant effusions were evident in either group at any time interval. CONCLUSION: These data demonstrate a successful development of an intranasal histamine rat model, in addition to a relationship between intranasal histamine challenge and development of acute ET dysfunction.

Administration, Intranasal↗
PubMed2002

Eustachian tube dysfunction after tobacco smoke exposure.

OBJECTIVE: To examine the effects of tobacco smoke exposure on eustachian tube (ET) function. STUDY DESIGN: ET pressures of Sprague Dawley Rats (n = 16) were measured after 1, 7, and 15 exposures and in control animals. Passive opening pressure, passive closing pressure, active clearance of positive pressure, and active clearance of negative pressure were measured. Mucociliary clearance times were also quantified (n = 32). RESULTS: Passive opening and passive closing pressures of smoke-exposed animals were greater than controls (P < 0.05). Passive opening pressure in smoke-exposed animals increased with increasing exposure (P < 0.001). Animals with 1 exposure had an active clearance of positive pressure higher than controls (P = 0.005) and those with 7 and 15 exposures had more negative active clearance of negative pressure than controls (P = 0.002, 0.03) Mucociliary clearance time was significantly elevated in experimental animals with 7 exposures (P = 0.006). CONCLUSIONS: Alterations in ET function exist in animals exposed to tobacco smoke. SIGNIFICANCE: ET dysfunction after tobacco smoke exposure may predispose children to the development of otitis media.

Air↗
PubMed2002

The role of soluble interleukin-4 receptor and interleukin-5 antibody in preventing late-phase allergy-induced eustachian tube dysfunction.

OBJECTIVES: We investigated the role of soluble interleukin (IL)-4 receptors (sIL-4R) and IL-5 antibodies (IL-5Ab) in preventing allergic eustachian tube dysfunction (ETD) and middle ear effusion (MEE). STUDY DESIGN: Brown-Norway rats were sensitized to ovalbumin (OVA) and challenged transtympanically. Two groups of rats received either IL-4R or IL-5Ab transtympanically 1 hour before challenge. Three additional groups were used as controls. Following the second transtympanic challenge, the ventilatory and clearance functions of the eustachian tube (ET) were assessed at 0, 2, and 8 hours. Histology was prepared using cut paraffin sections stained with hematoxylin and eosin. RESULTS: sIL-4R-pretreated rats showed no significant changes in ventilatory or clearance functions of the ET or inflammatory changes in ET mucosa, whereas IL-5Ab pretreatment showed significant late ventilatory and clearance dysfunction as well as inflammatory mucosal changes. CONCLUSION: These data demonstrate that the late-phase allergic inflammatory response that leads to subsequent formation of ETD and MEE is prevented by pretreatment with sIL-4R and, more modestly, with IL-5Ab.

Animals↗
PubMed2002

Computed tomography's ability to predict sacrifice of hypoglossal nerve at resection.

OBJECTIVE: To assess whether preoperative computed tomography (CT) scan can determine if the hypoglossal nerve (cranial nerve XII) will be sacrificed in floor-of-mouth, oral tongue, and tongue base tumor resections. STUDY DESIGN: Retrospective review. METHODS: Patients who underwent resection of floor-of-mouth, oral tongue, and tongue base tumors from 1990 to 1999 were identified. Preoperative CT scans were reviewed by a neuroradiologist. The postoperative status of cranial nerve XII was predicted to be "saved" or "sacrificed." Hypoglossal nerve "sacrifice" was predicted if the fat planes surrounding the takeoff of the proximal lingual artery were obliterated by tumor. The nerve was determined to be sacrificed or spared during resection by review of the operative report. RESULTS: Of the 45 patients, 14 tumors were predicted radiographically to involve the hypoglossal nerve. Twenty-seven of 31 nerves that were predicted to be saved were saved at the time of surgery. Seven of 14 nerves that were predicted to be sacrificed were sacrificed at the time of surgery. The sensitivity was 0.64 (95% confidence interval [CI], 0.35-0.86) with a specificity of 0.79 (95% CI, 0.70-0.87). The positive predictive value was 0.50 (95% CI, 0.27-0.68) with a negative predictive value of 0.87 (95% CI, 0.77-0.95). CONCLUSIONS: The ability to predict preoperatively whether a tumor can be resected without sacrificing the hypoglossal nerve would be an important factor in determining management of these tumors. The results indicate that CT scan accurately predicts the ability of the surgeon to spare the hypoglossal nerve (negative predictive value, 87%) with a specificity of 0.79.

Female↗
PubMedDate not supplied

Endoscopic repair of cerebrospinal fluid leaks after neurosurgical procedures.

OBJECTIVES: Endoscopic repair of cerebrospinal fluid (CSF) leaks has proven to be effective and safe. CSF rhinorrhea is a well-known complication of neurosurgical procedures in the anterior cranial fossa. We present a series of endoscopic repairs of CSF rhinorrhea secondary to neurosurgical procedures. STUDY DESIGN: Retrospective review of 13 cases. METHODS: Thirteen patients are included in the study. Eleven had CSF leaks after hypophysectomy, one after clipping of an anterior circle of Willis aneurysm, and one after posttraumatic frontal lobe debridement. Leaks were identified intraoperatively during the neurosurgical procedure (n = 8) or with intrathecal fluorescein injection during a separate procedure (n = 5). Repair was performed by exposing the skull base defect, debriding the defect margins, and sealing the defect with a free mucosal graft or abdominal fat. RESULTS: Leaks were identified in the sphenoid (n = 12) and posterior ethmoid (n = 1) sinuses. Nine patients had lumbar drains placed. One patient had recurrence of CSF rhinorrhea 2 months after initial repair requiring a revision procedure. No other recurrences were noted. One patient developed postoperative meningitis requiring intravenous antibiotics and a prolonged hospital stay. No other postoperative complications were observed. CONCLUSIONS: Endoscopic repair is a safe and effective treatment for CSF rhinorrhea encountered as a neurosurgical complication.

Adolescent↗
PubMedDate not supplied

Multi-use Venturi nasal atomizer contamination in a clinical rhinologic practice.

INTRODUCTION: Cross-contamination of Venturi atomizers has been reported. METHODS: In phase I, 16 atomizers were sterilized and refilled with either 1% lidocaine or 0.1% Tyzine (day 0). During phase II, atomizers were wiped with isopropyl alcohol wipes between uses. In both phases, on days 7, 14, 21, and 28, the contents of the atomizer were sprayed onto two culture media. If a culture was found positive, cultures from the nozzle, lumen, and solution were taken and cultured in depth. RESULTS: Twelve lidocaine bottles and three Tyzine bottles were initially positive. There were more positive cultures from lidocaine bottles than Tyzine bottles at 2 weeks (p = 0.02). After wiping with isopropyl alcohol, contamination was significantly reduced in the lidocaine bottles at 2 weeks (p = 0.02). CONCLUSION: Microbial contamination of questionable clinical significance may occur with nasal atomizers. Regardless of this significance, wiping the devices with isopropyl alcohol can eliminate microbial growth for a 2-week interval.

2-Propanol↗
PubMedDate not supplied

Increased role of the otolaryngologist in endoscopic pituitary surgery: endoscopic hydroscopy of the sella.

BACKGROUND: The aim of this study was to discuss the use of nasal irrigation and suction systems in endoscopic pituitary surgery to examine the sella and facilitate tumor removal. We describe a new technique of sellar exploration. METHODS: Following the endoscopic approach to the pituitary by the otolaryngology team, pituitary masses are resected. Then, the ClearESS nasal irrigation and suction system is used by the otolaryngology team to visualize the sella ("hydroscopy"). The combination of this ClearESS technology and angled endoscopes is used to scrutinize previously inaccessible areas of the tumor bed. RESULTS: Over 50 patients have undergone minimally invasive pituitary surgery via the endoscopic approach with postresection hydroscopy of the sella. The use of angled endoscopes in combination with the ClearESS technology greatly increased visualization of the sella, thereby facilitating complete tumor removal. There have been no complications associated with the use of hydroscopy. CONCLUSION: The use of angled endoscopes in conjunction with hydroscopy increases visualization of the sella. The otolaryngologist plays a critical role in this examination with manipulation of the angled endoscopes. Therefore, the role of the otolaryngologist is extended beyond the approach to the pituitary.

Endoscopes↗
PubMedDate not supplied

Staged endoscopic and combined open/endoscopic approach in the management of inverted papilloma of the frontal sinus.

BACKGROUND: The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined. METHODS: We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004. RESULTS: A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. CONCLUSION: The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.

Endoscopy↗
PubMedDate not supplied

Concordance of middle meatal swab and maxillary sinus aspirate in acute and chronic sinusitis: a meta-analysis.

BACKGROUND: The medical management of acute and chronic sinusitis is a therapeutic challenge. The use of endoscopic middle meatal cultures as a noninvasive method to determine the bacteriology of the maxillary sinus has not accurately been established. The aim of this study was to review the literature that compares cultures obtained by endoscopic middle meatal swabs with those obtained from maxillary sinus aspirates (MSAs). METHODS: We reviewed studies published between January 1966 and October 2003 that were identified from searches of multiple databases, bibliographies, and original articles. Studies were included for analysis if they compared the results of endoscopic middle meatal cultures to aspirate cultures. All clinical variables and test performances were independently extracted by two reviewers. RESULTS: Middle meatal culture had a per isolate accuracy of 82% (95% confidence interval, 0.64, 0.92) compared with MSA (excluding coagulase negative staphylococcus and fungal cultures). CONCLUSION: Endoscopic middle meatal cultures have a high concordance with MSAs.

Acute Disease↗