Biomedical subjects

Raphael Feinmesser

Publications and source records attributed to Raphael Feinmesser.

11 recordsLinked to original sources

PubMed2003

Report of a clinical trial in 12 patients with head and neck cancer treated intratumorally and peritumorally with multikine.

BACKGROUND: There is cumulative evidence suggesting that cells of the immune system recognize and may participate in eradicating neoplastic cells. As a result, immune modulation, first with interleukin 2 and later with other cytokines, has been tried in the clinical setting as part of antitumor therapy. OBJECTIVE: To examine the effectiveness and toxicity of a combination of natural interleukins in patients with squamous cell head and neck cancer. METHODS: Twelve previously untreated patients with various head and neck cancers were treated by peritumoral injection of a combination of cytokines (Multikine), in addition to zinc sulfate, indomethacin, and a single dose of cyclophosphamide, which were administered systemically. Response was evaluated clinically and histopathologically. T-lymphocyte determinants were studied by fluorescence-activated cell sorter analysis (against controls). RESULTS: Two patients showed complete regression and another 2 showed partial regression. There were no serious adverse effects of treatment. Pathological study results showed tumor fragmentation and the appearance of multinucleated macrophages. Fluorescence-activated cell sorter analysis showed lymphocyte activation, reflected by an unusually high number of cytotoxic T-lymphocyte activation 4 cells and natural killer cells. CONCLUSION: Multikine warrants further investigation for inclusion in the pharmacotherapeutic armamentarium of head and neck cancer.

Adult↗

PubMed2003

Transoral reconstruction of the mobile tongue, using radial forearm free flap.

Tongue resection has significant influence on the patient's quality of life, because it interferes with masticatory and speech functions and affects facial aesthetics. To avoid the disadvantages of the traditional lip-splitting used to approach partial tongue reconstruction for resection (40% of the tongue or more), we recommend a completely transoral approach, with the radial forearm free flap as a donor flap. Between 1999-2001, the suggested technique was applied in 11 patients with squamous-cell carcinoma of the mobile tongue. A follow-up of 6-30 months showed good to excellent oral function, with preservation of tongue volume, motion, and facial aesthetics. This approach seems to be preferable over the lip-split approach for the reconstruction of mobile tongue defects.

Adult↗

PubMed2003

Subtotal parathyroidectomy: a possible treatment for calciphylaxis.

Calciphylaxis is a rare disorder in patients with chronic renal failure that is characterized by ischemic necrotic skin lesions. The prognosis is grave and mortality is high (80%). The precise mechanism of calciphylaxis is still unknown, but in addition to chronic renal failure, elevated parathyroid hormone levels appear to play a role. The role of parathyroidectomy in treating affected patients is questionable. In this article, we describe the case of a patient with chronic renal failure who developed rapidly progressive subcutaneous calcifications and ulcerations in the lower extremities. These lesions regressed following subtotal parathyroidectomy. We also review the literature on calciphylaxis, with a focus on treatment options.

Biopsy, Needle↗

PubMed2003

Revision parathyroidectomy guided by intraoperative radionuclide imaging.

BACKGROUND: Technetium-99m sestamibi scintigraphy has become one of the most popular techniques for localization of the parathyroid gland after failure of primary neck exploration. OBJECTIVE: To examine the efficacy of sestamibi with the hand-held gamma ray detecting probe for the identification of parathyroid adenomas during revision parathyroidectomy. METHODS: We reviewed six cases of probe-assisted neck exploration for parathyroid lesions following unsuccessful primary exploration. RESULTS: In all cases the pathologic glands were successfully detected and removed. CONCLUSIONS: With careful planning, a gamma ray detecting probe can be used optimally 2-3 hours after technetium-99m sestamibi injection. The probe is efficient, easy and convenient to use.

Adenoma↗

PubMed2002

Preoperative evaluation of patients with parathyroid adenoma: role of high-resolution ultrasonography.

BACKGROUND: Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. METHODS: One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. RESULTS: The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p =.2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4-55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p =.01) and parathyroid hormone level (p =.0001). CONCLUSIONS: In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach.

Adenoma↗

PubMed2002

[CO2 laser surgery for the treatment of vocal cord carcinomas in early stages (T1 T2)].

BACKGROUND: The standard treatment for patients with early vocal cord carcinoma has been radiotherapy. In recent years, encouraging results with CO2 laser surgery has changed our treatment strategy in selective cases. During the past four years at the Rabin Medical Center we have treated patients with carcinoma of the vocal cord using CO2 laser surgery. PURPOSE: We conducted a retrospective study to investigate the results of the Head and Neck Surgery department with CO2 laser treatment for squamous cell carcinoma of the vocal cord during early stages (T1, T2) without radiotherapy. MATERIALS AND METHODS: Twenty one patients with carcinoma of the vocal cords in early stages were treated with CO2 laser. Nineteen patients suffered from stage T1 carcinoma located in one vocal cord, three of these patients suffered from involvement of the anterior commissure and one patient also had involvement with the anterior part of the second vocal cord. Two patients with carcinoma in stage T2, one with involvement of the ventricular band and one with limited movement of the vocal cord. The follow-up period for the patients ranged from one month to four years. RESULTS: Only one patient in stage T1 developed local recurrence after half a year, no patients died during the follow-up. CONCLUSION: Careful patient selection with endoscopic staging also during the biopsy, removal of the carcinoma in free border, strict follow-up and stroboscopic examination are essential to secure good results in the treatment of CO2 laser for early stages of vocal cord carcinoma.

Carcinoma↗

PubMed2000

Noise-induced vestibular dysfunction.

An association between noise exposure and vestibular function has long been suspected. Our wide experience in a major otologic outpatient clinic yielded six patients within the last seven years who presented with Meniere's disease and a history of long-term exposure to noise. Two of the cases are described in detail. Our evaluation in light of the data in the literature suggests that the relationship between vestibular dysfunction and exposure to hazardous noise may be more than coincidental.

Journal Article↗

PubMedDate not supplied

Basaloid squamous carcinoma of the larynx.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a distinct variant of squamous cell carcinoma that was first described by Wain et al in 1986. Since then, about 160 cases have been reported in the literature. Only 40 cases have been described in the larynx. METHODS: Four cases of BSCC of the larynx treated in our department between 1986 and 2000 are presented. The clinical features, biological behavior, and histopathological and immunohistochemical characteristics of this uncommon tumor are described, and the relevant literature is reviewed. RESULTS: The main clinical presentation did not differ from other histological types of laryngeal carcinoma. The clinical course, however, was much more aggressive. All the patients received aggressive therapy including radical surgery and radiation. Two patients received chemotherapy. Two of the 4 patients presented died of distant metastasis shortly after diagnosis and treatment. CONCLUSIONS: The finding of this study with a limited number of patients supports previous reports suggesting that BSCC is a highly aggressive tumor that presents in older population with male predominance. The frequency of associated regional as well as distant metastases suggests that aggressive treatment is indicated and that systemic chemotherapy should be contemplated.

Aged↗

PubMedDate not supplied

The cytological and clinical value of the thyroid "follicular lesion".

BACKGROUND: The main limitation of fine-needle aspiration (FNA) is its limited distinction between neoplastic and benign lesions. We summarize our experience with thyroid nodules that were defined as follicular lesions by comparing the clinical and cytological features of the thyroid follicular lesions that were examined histologically to define the most reliable criteria of malignancy. METHODS: The medical records of all patients who underwent thyroid aspiration at Rabin Medical Center from 1999 to 2000 were reviewed for a diagnosis of follicular lesion that warranted surgery (N = 58). The cytology and pathology reports of the patients who met these criteria were reviewed and compared with the original reports. RESULTS: The incidence of malignancy in follicular lesions of the thyroid is about 26%. There was a significant correlation between a histologic diagnosis of carcinoma and the cytologic findings of nuclear grooves (P =.041), solid arrangement (P =.019), hypercellularity (P =.01), and hypercellularity to colloid amount ratio (P =.016). Nodular size was predictive of malignancy. No correlation was found between patient age or gender and tendency toward malignancy. CONCLUSIONS: The combination of cytological characteristics and the size of the nodule aspirate are predictive values of malignancy. We believe that every follicular lesion should be excised to obtain a definitive histological diagnosis based on capsular or vascular invasion.

Adolescent↗

PubMedDate not supplied

Laser surgery for the treatment of glottic carcinomas.

PURPOSE: The standard treatment for patients with early glottic carcinoma in Israel has been radiotherapy. In recent years, encouraging results with laryngo-microscopic carbon dioxide laser surgery as a treatment for early glottic carcinoma has changed our treatment strategy. We conducted a retrospective study to investigate the results of carbon dioxide laser excisional technique for early glottic carcinoma (T1, T2). MATERIALS AND METHODS: Twenty-six had squamous cell carcinoma (SCC), (21 patients with T1 and 5 patients with T2 lesions), 3 had carcinoma in situ, (CIS) and 3 had verrucous carcinoma (VC). RESULTS: All patients were free of disease after salvage treatment at the most recent follow-up. CONCLUSIONS: Careful patient selection with endoscopic staging and strict follow-up are essential to secure good results in the treatment of carbon dioxide laser for early laryngeal carcinoma.

Adult↗

PubMedDate not supplied

Unusual primary and secondary facial blast injuries.

PURPOSE: To discuss unusual facial injuries resulting from a bomb blast. MATERIALS AND METHODS: In March 1997, a bomb consisting of a bag of nails was detonated in a coffee shop in Tel Aviv. Two of the wounded were brought to our level 1 Trauma Center with unique facial injuries. Computed tomography (CT) scan and CT angiogram were performed. RESULTS: The blast occurred to the immediate right of the victims who were sitting in an open cafe. Both had tympanic perforation. The first patient showed indirect damage to the facial nerve from a piece of shrapnel located anterior to the carotid artery and medial to the right mandibular angle. The second had a piece of shrapnel lodged in the parapharyngeal space that was initially missed and discovered only on reexamination 3 days later after the patient complained of pain in the temporomandibular joint; there was no facial nerve deficit. The port of entry was probably a small wound in the anterior wall of the external ear canal. CONCLUSIONS: The wounds are probably attributable to the spalling effect of the shrapnel passing through the parotid gland, which has mixed-density tissue. These cases show that nerves are susceptible to damage even in the absence of direct engagement and that the emergency room physician should be alert to even small skin imperfections in blast victims to avoid missing penetrating wounds.

Adult↗