Radio-guided parathyroid surgery.
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Adenoma↗
Biomedical subjects
Yoav P Talmi
Publications and source records attributed to Yoav P Talmi.
Quality of life of nasopharyngeal carcinoma patients.
BACKGROUND: Quality of life (QOL) issues in patients with head and neck carcinoma are of importance beyond the incidence of these tumors because of the impact of the disease and its treatment on external appearance and function of the upper aerodigestive tract. Nasopharyngeal carcinoma (NPC) patients comprise a unique subgroup in whom, to our knowledge, QOL has not been studied directly. METHODS: Adult patients with NPC treated during the past 15 years at the Chaim Sheba Medical Center with a minimum follow-up of 6 months were included in the current study. Patients were mailed the revised University of Washington quality of life (UW-QOL) questionnaire and data pertaining to their disease were recorded. Patients with recurrent disease or another malignancy or those whose present status could not be ascertained were excluded from the study. QOL scores were analyzed based on treatment, disease stage, and patient age. RESULTS: Twenty-eight patients of 35 disease-free patients (80%) responded to the questionnaire sent to patients meeting the study criteria. The mean score for general health was 3.1 (range, 1-5). Pain was not a significant factor. Other domains without noteworthy problems were speech and shoulder disability. The majority of patients described their appearance as normal or with minor changes, and questions concerning activity, recreation/entertainment, employment, and swallowing all scored > 70 (range, 0-100). Dry mouth, chewing, and ear problems were of major concern with the majority of patients and affected the QOL indices. Nevertheless, the overall mean QOL score of these patients was rated as "good" (4.2 on a scale of 1-6). CONCLUSIONS: In the current study, patients with NPC reported ear problems, difficulties in chewing, and dry mouth but their overall QOL appeared to be good. Ear problems such as secretory otitis media should be recognized at the time of presentation and treated. Conformal radiotherapy techniques sparing the salivary glands and temporal bone most likely will be useful in reducing the morbidity associated with treatment.
Adult↗
Rhino-orbital and rhino-orbito-cerebral mucormycosis.
BACKGROUND: Rhino-orbito-cerebral mucormycosis (ROCM) is a devastating infection of immunocompromised hosts. We present our experience with 19 ROCM cases and attempt to define preferred diagnostic and treatment protocols. METHODS: All had tissue biopsies obtained studied by direct smear, histologic studies, and cultures. Imaging was obtained in 14 cases. RESULTS: Sixteen patients presented between August and November. Six had mixed fungal infections. Seven patients had end-stage underlying disease or infection and did not undergo surgery and 4 had an indolent form of disease. Patients were treated by surgery and by amphotericin B. The overall survival was 47%. CONCLUSIONS: ROCM may have seasonal incidence peaking in the fall and early winter. The therapeutic approach should be unchanged in cases of mixed fungal infections. Amphotericin B with aggressive debridement remains the mainstay of treatment. Early recognition and treatment are essential. A presentation and survival-dependent classification of ROCM are offered.
Adult↗
Pulmonary function after pectoralis major myocutaneous flap harvest.
OBJECTIVE: The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck. METHODS: Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack-years), anesthesia duration, percentage predicted pre- and postoperative FEV1, percentage-predicted pre- and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x-rays were reviewed. RESULTS: Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x-rays demonstrated atelectasis. CONCLUSIONS: PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders.
Aged↗
Syndrome of inappropriate antidiuretic hormone or arginine vasopressin secretion in patients following neck dissection.
OBJECTIVES/HYPOTHESIS: The syndrome of inappropriate antidiuretic hormone or arginine vasopressin secretion (SIADH) is a disorder in which release of antidiuretic hormone is independent of plasma osmolarity, resulting in fluid retention and development of dilutional hyponatremia. The incidence of SIADH following neck dissection was found to be 18% to 30% in two separate reports. The incidence of SIADH in a cohort of patients who underwent neck dissection was prospectively studied. METHODS: Eighty-six patients were included in the study, along with a control group of 19 patients who underwent other neck procedures. Patient gender, age, physical condition (American Society of Anesthesiologists score), type of neck dissection, prior treatment, and smoking history were noted. Blood and urine osmolarity and sodium levels were sampled before surgery and during the first 24 hours after the surgery. These were recorded daily in cases with SIADH until the syndrome resolved. RESULTS: The incidence of SIADH was only 1.15% in patients before surgery. The syndrome developed in seven patients following neck dissection (8.14%) and in none of the patients in the control group. SIADH resolved within 72 hours at the latest. No association was found with patient gender, age, physical condition, or type or laterality of neck dissection. A statistically significant connection between the syndrome and history of smoking was noted (P <.05), and it was more commonly seen in patients with node-positive necks (P =.1231). CONCLUSIONS: SIADH following neck dissection may be less common than formerly reported. Previous studies have presented contradicting data concerning the influence of tumor recurrence or prior radiation therapy on its incidence. Our results indicate no such association. A statistically significant connection between smoking and the syndrome was found. No clinical symptoms developed in the patients with SIADH, but it seems prudent to suggest limiting fluid intake in the first postoperative 24 hours for patients following neck dissection.
Adolescent↗
"Second look" at auricular reconstruction with a postauricular island flap: "flip-flop flap".
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Aged↗
Quality of life issues in cancer of the oral cavity.
Quality of life issues in head and neck cancer have been portrayed increasingly in the medical literature in recent decades. Reports vary in sample size and study design but the majority are cross-sectional and suffer from inherent bias. Many of the patients' complaints in cancer of the head and neck manifest close linkage to problems related to the oral cavity. Frequent specific problems are trismus, pain, xerostomia, and speech and swallowing disorders. Although quality of life is multifactorial and subjective, some improvement may be achieved by recognizing and addressing problems during the course of treatment. More longitudinal long-term studies are indicated in order to better define quality of life along the time axis.
Emotions↗
Smoking-induced squamous-cell cancer of the nose.
Squamous-cell cancer (SCC) isolated to the anterior nose is uncommon. Numerous industrial and environmental contaminants have been implicated as causative factors in nasal carcinoma. The association between nasal cancer and smoking was recognized in the 1980s, but results have not been consistent and no possible mechanisms have been suggested. The case histories of 11 patients with SCC limited to the anterior nasal cavity were reviewed. The authors found no relationship with exposures to chemicals previously implicated in nasal cancer. Nine patients with SCC were exposed to cigarette smoke (mean = 103 pack-years). Cigarette smoke may induce cancer directly, thus affecting the mucosa, or by inducing genetic alterations. The authors favor the former mechanism.
Aged↗