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Biomedical subjects

R G Amedee

Publications and source records attributed to R G Amedee.

At least 19 recordsLinked to original sources
PubMed2001

Individual monitoring of aspirin desensitization.

BACKGROUND: Patients with aspirin-sensitive rhinosinusitis, which is frequently associated with intrinsic bronchial asthma, can be desensitized by long-term treatment with oral aspirin. The exact mechanisms of this desensitization remain obscure, but modulations of the eicosanoid pathway occur and can be monitored with the help of a practicable in vitro assay on mixed leukocyte cultures. OBJECTIVE: To monitor the effect of low-dose aspirin desensitization therapy, 100 mg/d, objectively by an in vitro assay. DESIGN: In a prospective study, 30 patients with aspirin intolerance, who were treated following a desensitization protocol with a dose of oral aspirin of only 100 mg/d were followed up for 1 year and reassessed every 3 months clinically and in vitro. RESULTS: Twenty-five patients showed a normalization of in vitro eicosanoid levels during this period, 4 showed some improvement, and 1 showed no therapeutic effect on eicosanoid release. Clinical follow-up revealed a low recurrence rate of nasal polyposis, with recurrent disease only in 4 individuals who also showed no normalization of eicosanoid release levels. Furthermore, a reduction of the average incidence of purulent episodes of sinusitis was seen after 1 year. Of 12 patients with asthma, 9 experienced marked improvement in pulmonary function. Of 16 individuals with a marked impairment of nasal breathing, 14 felt an increase of nasal patency, and 7 of 11 patients with pretreatment hyposmia had an improved sense of smell after 1 year. CONCLUSIONS: Desensitization therapy in patients with aspirin-sensitive rhinosinusitis can be successfully performed with low oral doses of aspirin, and the individual course throughout the desensitization can be monitored with the help of an in vitro analysis of eicosanoid release from mixed leukocyte cultures.

Adult↗
PubMed2001

Fine-needle aspiration biopsy.

OBJECTIVES: Fine-needle aspiration biopsy (FNAB) is a technique in which a fine needle is introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered. It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors. FNAB lends itself to the diagnosis of palpable head and neck masses, in particular, those that persist following antibiotic treatment. STUDY DESIGN/METHODS: This clinical state-of-the-art review article is intended to provide an overview of the clinical use of FNAB in the management of head and neck masses. Relevant case histories are used to illustrate this point. RESULTS: Fine-needle aspiration biopsy has a high overall diagnostic accuracy of 95% for all head and neck masses, 95% for benign lesions, and 87% for malignant ones. CONCLUSIONS: There are virtually no contraindications, and complications are minimal. Advantages of FNAB are that it is safe and simple, it can be performed as an outpatient procedure, and it is well tolerated by patients. In the present managed care environment, it also proves cost-effective. The diagnosis is readily known to the clinician, and appropriate treatment modalities can be discussed with the patient. It is recommended as a first line of investigation in palpable head and neck masses.

Adult↗
PubMed2001

Base of tongue carcinoma.

Vigilance must remain high in order to detect the rare occurrence of base of tongue carcinoma. The combination of ubiquitous and nonspecific complaints coupled with difficult physical examination of this area contribute to delays in diagnosis, with patients often presenting at an advanced stage. This advanced presentation creates challenging treatment decisions in which adequate tumor control must be balanced with subsequent patient quality of life. The result is controversy over the primary treatment modality--external beam radiation, with or without brachytherapy, alone or in combination with surgical extirpation. Though the role of neck dissection in patients with neck disease is widely accepted, timing and implementation in patients whose neck disease completely responds to radiation are also contentious issues. Although evolving surgical reconstruction techniques and accelerated radiation protocols are improving treatment regimens, the prognosis for this disease remains poor.

Antimetabolites, Antineoplastic↗
PubMed2001

Pleomorphic adenoma.

Pleomorphic adenoma is the most common neoplasm of the salivary glands. Though a benign lesion, proper recognition and management of this process is needed to avoid increasing enlargement of the mass, facial nerve impairment, risk of malignant degeneration, and recurrence after surgical resection. The epidemiology, diagnosis, and treatment options for this neoplasm are discussed.

Adenoma, Pleomorphic↗
PubMed2001

Traumatic perforation of the tympanic membrane.

Traumatic perforations of the ear drum are often encountered in the emergency room and in the primary care setting. We review mechanisms of injury to the tympanic membrane and elucidate the appropriate evaluation and treatment of this injury.

Humans↗
PubMed2001

Angioedema of the head and neck.

Angioedema is an immunological disorder characterized by the acute onset of edema in a localized area of skin or mucosa. There are many different causes of angioedema, including hereditary, allergic, and idiopathic. Head and neck involvement is frequent and may cause potentially life-threatening airway compromise. Early diagnosis and appropriate management are thus critical. The pathophysiology, clinical presentation, and management of this disorder are discussed.

Acute Disease↗
PubMed2001

Merkel cell carcinoma: an overview and case report.

Merkel cell carcinoma is an extremely rare neoplasm with a high rate of recurrence and metastasis. The lesions predominantly arise on sun-exposed areas of skin in whites between the sixth and seventh decades of life. Within the head and neck region, the cheeks and eyelids are the most common sites. This article outlines the etiology, pathogenesis, and treatment of this rare but highly aggressive tumor.

Aged↗
PubMed2000

PH20: a novel tumor marker for laryngeal cancer.

OBJECTIVE: To determine whether levels of PH-20, a hyaluronidase similar to that found in human sperm, are elevated in laryngeal cancer tissue. DESIGN: In this case-control study. reverse transcription polymerase chain reaction was used to measure levels of PH-20 messenger RNA in tissue taken from laryngectomy specimens. SETTING: A university medical center. PATIENTS: We compared tissue samples taken from 11 patients with laryngeal cancer, and from 2 metastatic lymph nodes, with samples of normal, healthy laryngeal tissue and prostate cancer tissue (positive control). MAIN OUTCOME MEASURE: PH-20 complementary DNA expression as quantified by densitometric analysis. RESULTS: Expression of PH-20 was significantly higher in nonirradiated laryngeal cancer specimens than in normal laryngeal tissue (P<.01). Metastatic lymph nodes also had higher levels of PH-20 expression than did primary laryngeal cancer tissue (P = .11) and normal laryngeal tissue (P<.01). Irradiated laryngeal cancer specimens had PH-20 levels comparable to normal. CONCLUSIONS: We report the first data on PH-20 expression in laryngeal cancer tissue. PH-20 expression is significantly elevated in primary laryngeal cancer tissue and seems to be even higher in metastatic lesions compared with normal laryngeal tissue. PH-20 may be a useful tumor marker and prognostic tool for laryngeal cancer.

Biomarkers, Tumor↗
PubMed2000

Epidural abscess masquerading as lateral sinus thrombosis.

Controversy regarding the use of anticoagulants, the evacuation of the sinus, or the use of medical treatment alone surrounds the treatment of lateral sinus thrombosis. Treatment of an epidural abscess associated with coalescent mastoiditis is much less controversial-drainage is usually recommended. The differing treatments of these complications mandate accurate diagnosis. The advent of more sophisticated radiological studies has facilitated diagnosis of these complications; however, tests are not infallible. We present three cases in which preoperative imaging demonstrates an epidural abscess mimicking lateral sinus thrombosis by compression of the vessel. A false-positive computed tomography (CT) or magnetic resonance imaging (MRI) study may lead to the wrong diagnosis and, consequently, improper treatment. In light of this possibility, we recommend surgical exploration in all such cases.

Case Reports↗
PubMed2000

Recurrent aphthous stomatitis.

Recurrent aphthous stomatitis is the most common oral mucosal disease in North America but it is commonly misdiagnosed and poorly understood. Pediatricians, internists, otolaryngologists, oral surgeons, and dentists may all be expected to treat this illness but little formal training in oral medicine may be offered to many of these health care professionals. This article reviews current evidence regarding etiology, pathogenesis, natural history, and treatment of this disorder.

Humans↗
PubMed2000

The otologic manifestations of barotrauma.

Barotrauma is defined as an injury due to pressure differences between atmospheric and intratympanic pressures. Human beings are well suited to operate within an environment involving small alterations in atmospheric pressure. Man's persistence in operating outside this environment leads to exposure to large pressure differentials with resulting trauma. External, middle, and inner ear structures can all be injured due to alterations in pressure. The increase in popularity of sport diving and aviation travel has led to an increase in the number of otologic injuries caused by barotrauma. The physics, pathophysiology, symptoms, and treatment of barotrauma are presented.

Atmospheric Pressure↗
PubMed2000

Primary meningioma of the fallopian canal.

Meningiomas are slow-growing lesions that represent approximately 20% of all intracranial tumors and are the second most common tumor of the cerebellopontine angle. In contrast, primary extracranial meningiomas are found relatively infrequently, and most cases have inadequate radiologic studies to determine if they were actually an extension from a primary intracranial source. Meningiomas of the intratemporal segment of the facial nerve have also been reported, but they are exceedingly rare and their pathophysiology remains unclear. We report a case of a meningioma of the facial nerve in the fallopian canal of a 7-year-old girl and review pertinent literature.

Child↗
PubMed2000

Drug treatments for tinnitus: the Tulane experience.

It has recently been estimated that 12 million Americans have a severe form of tinnitus and that nearly 40 million Americans suffer from some form of tinnitus-related complaints [1]. The nature of patients' concerns at the time of the initial evaluation is very important in our overall patient management. Specific issues that we address in our practice include the following: (1) Why are patients here? (2) What do patients want and what do they expect of me? (3) Whom have they seen before and what if anything has been tried and proved ineffective in treating their condition? Each of these basic questions must be answered to ensure that we are addressing affected patients' concerns and are targeting our efforts according to individual patients' needs.

Academic Medical Centers↗
PubMed1999

ENT issues in pregnancy.

Pregnancy initiates a unique set of physiologic changes in a woman's body. These changes are commonly manifested as complaints concerning the head and neck. From common findings such as rhinitis, epistaxis, and cutaneous lesions to more rare disorders of the inner ear, physicians should be familiar with these conditions for optimal reassurance, expectant management, or treatment of the gravid female. It is especially important to be aware of the possible effects of any medication, including over-the-counter remedies, on the mother and fetus and to consult the treating obstetrician prior to writing any prescriptions. Many of these disorders will be discussed with an emphasis on rhinitis during pregnancy to illustrate the complexity and controversy surrounding many of the conditions. Finally, there will be a directed focus on commonly used pharmaceuticals in otolaryngology and their safety during pregnancy.

Estrogens↗
PubMed1999

The epidemiology of malignant melanoma in Louisiana and beyond.

The worldwide incidence of melanoma has reached epidemic proportions. One in 70 white Americans will develop melanoma in their lifetime. The global melanoma pandemic has particular relevance to the population of Louisiana. As habitants of the Sportsman's Paradise, much of our leisure time is spent outdoors hunting, fishing, and boating. The oil refining, ship-building, and agricultural industries demand outdoor work as well. Given that the incidence of melanoma in Louisiana has doubled over the past decade, a thorough knowledge of melanoma epidemiology, risk factors, and preventive strategies is necessary for physicians to reduce the mortality of this deadly disease.

Female↗
PubMed1999

HIV sinusitis: rationale for a treatment algorithm.

Over 12 million individuals worldwide are infected with the human immunodeficiency virus (HIV). Up to 60% of these persons may suffer from disease of the paranasal sinuses. Numerous differences exist between sinusitis in HIV and non-HIV infected patients. Some of the differences include HIV sinusitis pathogenesis, bacteriology, and management. This paper addresses these issues so that physicians may adequately prevent, diagnose, and treat persons suffering from HIV sinus infection.

AIDS-Related Opportunistic Infections↗
PubMed1998

Three-dimensional ultrasound evaluation in the head and neck.

We evaluated the use of a novel three-dimensional ultrasound imaging device in patients with various head and neck lesions. The investigated system was found to be a valuable adjunct to conventional ultrasound in head and neck evaluations. A disadvantage of the three-dimensional system was the need for expensive technical equipment.

Head and Neck Neoplasms↗