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R Yahalom

Publications and source records attributed to R Yahalom.

14 recordsLinked to original sources
PubMed2006

Osteomylelitis and necrosis of the jaw in patients treated with bisphosphonates: a comparative study focused on multiple myeloma.

It was reported that multiple myeloma (MM)-patients suffer from a higher incidence of osteomyelitis and necrosis of the jaws than patients treated with bisphosphonates for other reasons. The aim of this study is to report about 57 cases of bisphosphonate-related osteomyelitis and necrosis of the jaws (BON) and to investigate the differences between BON in MM and non-MM patients. Clinical and laboratory data of 57 cases were assessed. The features of BON and clinical-outcome were compared between the two groups. Treatment approach was assessed as a contributing-factor to treatment-outcome. Clinical presentation included exposed bone, pain, swelling and suppuration with little variation between the two groups. Past dento-alveolar surgery was common in both study-groups. Treatment outcome was poor (33% and 25% responded to treatment in MM group and non-MM group, respectively). Treatment modality did not affect the treatment outcome. The clinical presentation described in this case series should alert the physician to the possibility of BON. Although the literature shows a higher incidence of BON in MM patients compared to non-MM patients, our study suggests that the severity of the clinical presentation and the response to treatment are not worse in MM patients compared with non-MM patients. The predisposition of MM patients to BON should be further investigated.

Aged↗
PubMed2006

[Bisphosphonate associated osteonecrosis of the jaws--the role of the dentist in prevention and early diagnosis].

During the past few years numerous cases of osteonecrosis of the jaws in patients receiving bisphosphonate therapy were published in the literature. In most cases, the osteonecrosis was diagnosed following dento-alveolar surgery, especially following extraction of teeth. To date, no efficient therapy is available and most efforts are geared towards prevention. The propose of the present review is to inform the Israeli dental community about osteonecrosis of the jaws in patients receiving bisphosphonate therapy and to suggest strategies for prevention.

Bone Density Conservation Agents↗
PubMed2005

PET/CT in the evaluation of patients with squamous cell cancer of the head and neck.

The purpose of this study was to compare the findings of positron emission tomography (PET) with fused PET and computed tomography (CT) in patients with suspected locoregional and distant head and neck cancer and to evaluate the impact of those findings on clinical management. Studies of 25 patients were retrospectively evaluated. PET findings were classified as malignant, benign or equivocal. PET/CT findings were then similarly classified and the PET-only results were amended accordingly. Comparison of findings was done on lesion and patient levels. A total of 45 foci of increased 18F-fluorodeoxyglucose (FDG) uptake were noted in 18 patients. PET/CT imaging defined anatomic localization of 41/45 lesions and clarified 6/10 equivocal PET findings. Additional information was provided by PET/CT regarding 9/45 (20%) of the lesions. PET/CT significantly affected patient management in 3/25 patients (12%) by limiting the extent of disease in one and excluding viable disease in two others. The accuracy of PET/CT was 88%, the sensitivity 100% and the specificity was 77%. The negative predictive value was 100% in this combined group of patients with locoregional and distant head and neck cancer. PET/CT is highly contributory for initial staging and in the evaluation of patients with suspected recurrent SCC of the head and neck, in whom anatomic imaging is inconclusive due to the locoregional distortions rendered by surgery and radiotherapy.

Adolescent↗
PubMed2005

The role of gamma-PET in the evaluation of patients with recurrent squamous cell cancer of the head and neck.

Squamous cell carcinoma (SCC) is the most common cancer of the head and neck (HNC). Advanced HNC warrants extensive ablative and reconstructive procedures, significantly altering locoregional anatomy, while radiation treatment further adds to the distortion. Anatomic imaging is therefore often inconclusive in suspected recurrent HNC. Functional imaging with fluorodeoxyglucose-positron emission tomography (FDG-PET) has been reported contributory in the evaluation of patients with SCC. While most reports are from dedicated PET systems, full ring PET is of limited availability and gamma-PET may offer a suitable compromise. The therapeutic impact of gamma-PET in patients with suspected recurrent HNC was retrospectively evaluated. Seventeen patients were evaluated. All had undergone surgery for HNC, 16 also received radiotherapy. gamma-PET scans were compared to anatomic imaging, histopathology and clinical follow-up. The impact of the FDG-PET scan on patient management was then evaluated. Eleven positive findings were confirmed. Two false positives were due to radiation changes, a recognized pitfall. There were no false negatives. Overall accuracy of the 18F-FDG gamma-PET scans was 88% with considerable effect on patient management. Gamma-PET with FDG appears valuable in the evaluation of suspected recurrent HNC, and may provide a suitable alternative when dedicated PET is unavailable.

Adolescent↗
PubMed2005

Midline versus paramidline mandibulotomy: a radiological study.

Mandibulotomy allows for wide exposure of deep oral cavity and oropharyngeal tumors and may be performed medial or lateral to the mental foramen. Medial mandibulotomy is divided into midline and paramidline. Midline mandibulotomy requires detachment of muscles which may lead to masticatory and swallowing problems and could potentially jeopardize the central incisors. Our study provides a basis for placement of bone cuts in mandibulotomy. The angles between the long axis of the two central incisors, the lateral incisor and canine bilaterally were measured in panoramic radiographs of 100 healthy patients. The distances between the roots were measured. The angle between the lateral incisor and the canine ranged from 1 degrees to 8 degrees compared to 1 degrees -4 degrees (P<0.001) between the central incisors. The distances between the lateral incisor and the canine were 1-6.2mm while the distances between the two central incisors ranged from 0.5 to 4.7mm (P<0.05). Although the measurements were taken from a younger group of patients compared to the usual age of presentation of oropharyngeal cancer, it shows that the paramidline mandibulotomy in which bony cuts are performed through a wider gap is the preferred approach.

Adolescent↗
PubMed2001

Upper jugular lymph nodes (submuscular recess) in non-squamous-cell cancer of the head and neck: surgical considerations.

Cervical lymphadenectomy of level II encompasses lymph nodes associated with the upper internal jugular vein and the spinal accessory nerve (SAN). Removal of tissue superior to the SAN (submuscular recess-(SMR)) was recently shown to be unwarranted in selected cases of squamous-cell cancer. Thirty-five patients with non-squamous-cell cancer (SCC) of the head and neck treated with cervical lymphadenectomy were prospectively evaluated. Thirty-seven neck dissection specimens were histologically analysed for the number of lymph nodes involved with cancer. At the time of surgery, level II was separated into the supraspinal accessory nerve component (IIa) and the component anterior to the SAN (IIb). Neck dissections were most commonly performed for cancer of the thyroid gland (19) followed in frequency by the parotid gland (seven), skin: melanoma (five), basal-cell cancer (two), and other sites (four). Twenty-five neck dissections were modified-selective procedures and 12 were either radical or modified radical neck dissection. Twenty-nine necks were clinically N+ and eight N0. Histological staging was pathologically N+ in 32 neck dissection specimens. Level IIb contained an average of 12 nodes and the IIa component contained a mean of 5.0 nodes. Level II contained metastatic disease in 28 of 32 histologically node-positive specimens (87 per cent). Level IIa was involved with cancer in six cases (16 per cent), five of which were pre-operatively staged as clinically N+. All cases (100 per cent) with level IIa involvement had level IIb positive nodes. Three of the level IIa positive cases were cancer of the parotid gland comprising 43 per cent of this sub-group of patients. Incidence of involvement of SMR in non-SCC cases is not uncommon. The additional time required and morbidity associated with dissection of the supraspinal accessory nerve component of level II are probably justified when performing neck dissection in cancer of the thyroid gland. The SMR should be excised in cancer of the parotid gland. Large-scale prospective controlled studies with long-term follow-up periods are necessary to support resection of level IIb only.

Adolescent↗
PubMed1998

Patterns of metastases to the upper jugular lymph nodes (the "submuscular recess").

BACKGROUND: Cervical lymphadenectomy to remove metastatic disease in level II encompasses lymph nodes associated with the upper third of the internal jugular vein and the adjacent spinal accessory nerve (SAN). Conservative neck dissection (ND) preserves these structures but requires manipulation of the SAN to remove tissue located in the posterosuperior aspect of level II. Limiting the dissection to the nodal group anterior to the SAN may reduce operating time and limit injury to it without compromising the removal of lymph nodes at risk for involvement with cancer. METHODS: Seventy-one patients with squamous cell carcinoma of the head and neck treated with cervical lymphadenectomy at two separate institutions were prospectively evaluated. One hundred two neck dissection specimens were histologically analyzed for number of lymph nodes present and number involved with cancer. At the time of surgery, level II was separated into the supraspinal accessory nerve component (IIa) and the component anterior to the SAN (IIb). Nodal involvement in level II was analyzed according to characteristics of the cancer at the primary site as well as nodal involvement of other levels. RESULTS: Neck dissections were most commonly done for cancer of the oral cavity (n = 33), followed in frequency by the larynx (n = 17), oropharynx (n = 7), skin of face (n = 4), unknown primary (n = 4), and other sites (n = 6). Eighty NDs were selective and 22 were either radical or modified radical NDs. Pathologic staging of the neck specimen was most commonly N0 (n = 61), followed in frequency by N1 (n= 17), N2 (n= 11), and N3 (n= 11). Data were unclear for two specimens. Level IIb contained an average of 6.9 nodes and the IIa component contained an average of 4.2 nodes. Level II contained metastatic disease in 31 of 39 node positive specimens (79%). Level IIa was involved with cancer in four cases, all of which were preoperatively staged N2 or greater. CONCLUSIONS: The additional time required and morbidity associated with dissection of the supraspinal accessory nerve component of level II may not be necessary when performing elective ND. More research with larger numbers of patients, long-term follow-up, and meticulous tissue analysis is needed to permit conclusions as to where to draw the line in determining extent of cervical lymphadenectomy.

Adult↗
PubMed1998

Incidence of secretory otitis media following maxillectomy.

OBJECTIVE: The purpose of this investigation was to determine the incidence and characteristics of secretory otitis media after maxillectomy procedures. STUDY DESIGN: Retrospective chart analysis was performed with the cases of 49 patients who underwent maxillectomy for tumor in the Departments of Otolaryngology-Head and Neck Surgery and Oral and Maxillofacial Surgery between the years 1990 and 1996. RESULTS: In 10 patients (20%), secretory otitis media manifested itself from 1 week to 6 months after surgery; 1 patient developed a central perforation with chronic otitis media. Nearly one third of patients who underwent total maxillectomy had secretory otitis media. Six patients (8 ears) required insertion of ventilation tubes. CONCLUSIONS: Patients undergoing total and partial maxillectomies are prone to occurrences of secretory otitis media. Insertion of ventilation tubes easily resolves the problem. Preoperative and routine postoperative patient follow-up should always include otoscopy and audiometry, and tympanometry should be performed when warranted.

Adolescent↗
PubMed1996

DentaCT for evaluating mandibular and maxillary invasion in cancer of the oral cavity.

We used a retrospective analysis of charts, imaging studies, and histologic findings when available in 17 patients with cancer of the oral cavity to define the value of DentaCT or multiplanar reformation software in assessing bony involvement by malignant tumors of the oral cavity. From two academic tertiary-referral medical centers, the 17 patients had a mean age of 63 years and suspected maxillary (2) or mandibular (15) invasion. All patients had conventional computed tomography scanning and multiplanar reformation scans with several additional imaging studies obtained. Two patients demonstrated no bony involvement by imaging and histologic studies. Twelve of the remaining 15 patients had surgically documented bony involvement also correctly detected by DentaCT. DentaCT was found to be a valuable tool in defining extent of bony invasion by tumor. Although not compared to other imaging modalities, our experience supports the use of DentaCT where available for this purpose.

Adult↗
PubMed1994

Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women.

A randomized study was conducted to assess the clinical and microbiological efficacies of a single 3-g dose of fosfomycin trometamol for the treatment of uncomplicated lower urinary tract infections in women compared with a 5-day regimen of cephalexin at 0.5 g four times daily. One hundred twelve women, all of whom had documented infections with bacteria sensitive to both antibiotics, were included. Fifty-eight women received fosfomycin trometamol, and 54 women received cephalexin. The two groups did not differ in age, severity, or duration of current urinary tract infection, menstrual status, sexual activity, or use of contraceptives. Ninety percent of pathogens in the fosfomycin trometamol group and 81% in the cephalexin group were Escherichia coli (the difference is not significant [NS]). A clinical evaluation at the 5-day follow-up showed that 91% of the women in each group were free of symptoms, while five women in each group were considered therapy failures and were treated by another antibiotic course. A microbiological evaluation at the 5-day follow-up showed a 91% eradication rate in the fosfomycin trometamol group and an 83% eradication rate in the cephalexin group (NS). At the 1-month follow-up, a clinical evaluation demonstrated prolonged resolution in 86 and 78%, respectively, of the participating women (NS). A microbiological evaluation at 1 month demonstrated prolonged eradication in 47 (81%) women treated with fosfomycin trometamol and in 37 (68%) women treated with cephalexin (NS). Three and six women, respectively, had relapsed. No adverse reactions were reported by the fosfomycin trometamol-treated women, while three women treated with cephalexin reported mild adverse reactions but completed the study period. Fosfomycin trometamol in a single 3-g dose is as effective as a 5-day regimen of cephalexin for the treatment of uncomplicated lower urinary tract infection in women.

Adolescent↗