Biomedical subjects

Andrew C Urquhart

Publications and source records attributed to Andrew C Urquhart.

7 recordsLinked to original sources

PubMed2006

Diffuse idiopathic skeletal hyperostosis: a rare cause of Dysphagia, airway obstruction, and dysphonia.

BACKGROUND: We retrospectively query the clinical records of patients with cervical osteophytes to distinguish the clinical features of those presenting with symptomatic dysphagia and airway obstruction. STUDY DESIGN: Retrospective review of all patients presenting over a 20-year period (1985 to 2005) with the diagnosis of cervical osteophytes and dysphagia with or without airway compromise. Two hundred thirty-four patients were identified at Marshfield Clinic between 1985 and 2005; 9 (3.8%) met criteria for inclusion. RESULTS: Eight of nine patients presented with dysphagia. Three of nine patients presented with acute airway obstruction requiring intubation and tracheotomy. Osteophytes occurred at multiple levels, with C4, C5, and C6 being most commonly involved. Surgical decompression resulted in complete resolution of symptoms in four of five patients. CONCLUSIONS: Although commonly found and usually asymptomatic in the older population, anterior cervical osteophytes can be a source of considerable morbidity and potential life-threatening airway obstruction. Recognizing this clinical entity is imperative in establishing a diagnosis and initiating appropriate treatment. Surgical decompression appears to be beneficial in relieving symptoms.

Aged↗

PubMed2006

Primary laryngeal lymphoma: case report.

Extranodal laryngeal lymphoma is extremely rare. We report a case of primary laryngeal lymphoma in a 76-year-old man who had presented with a 7-week history of progressive hoarseness. Laryngoscopy revealed asymmetry of the right false vocal fold. Pathology of a deep biopsy specimen identified a malignant, diffuse, CD20-positive, B-cell lymphoma. The stage IE lymphoma completely resolved after treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and rituximab. Despite its relative rarity, the consequences of a missed diagnosis warrant vigilance for this type of laryngeal tumor.

Aged↗

PubMed2005

Management of mandibular invasion: when is a marginal mandibulectomy appropriate?

There has been a great deal of controversy regarding the appropriate method of management of oral cavity and oropharyngeal tumors that invade the mandible. The inability to acquire intraoperative bone margins can make the decision process complex. Preoperative imaging offers several advantages, however, there is no single modality that has proven accurate. Intraoperative assessment has been suggested as a method of evaluation, however, this approach does not allow for preoperative planning. The following is a review of the current literature regarding mandibular invasion and the indications for a marginal mandibulectomy.

Carcinoma, Squamous Cell↗

PubMed2005

Idiopathic vocal cord palsies and associated neurological conditions.

OBJECTIVE: To retrospectively review the clinical case records of patients with idiopathic vocal cord palsies (VCPs) for the presence of preexisting or subsequent development of neurological disease, including multiple sclerosis, motor neuron disease, myasthenia gravis, cerebrovascular disease, and Guillain-Barré syndrome. DESIGN: Retrospective case review of all patients with VCP presenting sequentially within a 45-month time span. SETTING: Tertiary referral center. PATIENTS: One hundred ninety-three patients with VCP. RESULTS: Thirty-five cases of VCP (18.1%) were idiopathic. Eight (22.8%) resolved after a mean time of 5 months. A preexisting central nervous system condition was noted in 9 (25.7%) of 35 patients with idiopathic VCP. A subsequent central nervous system condition developed in 7 patients (20.0%). These included 2 cases of cerebrovascular accidents, 1 case of postpolio syndrome with respiratory failure, and 1 case of polyneuropathy secondary to paraneoplastic syndrome. CONCLUSIONS: A high frequency of neurological conditions was observed in adult patients initially presenting with idiopathic VCP. Patients with VCP but without overt neurological disease may also subsequently develop a serious neurological condition. Careful neurological evaluation of all patients with idiopathic VCP is recommended.

Adult↗

PubMed2005

Arterial and venous parathyroid hormone levels in minimally invasive surgery.

OBJECTIVE: To establish if venous and arterial parathyroid hormone (PTH) levels are similar during minimal access parathyroid surgery. DESIGN: Prospective study. SETTING: Marshfield Clinic, a large multispecialty tertiary care referral center in central Wisconsin. PATIENTS: All patients who underwent minimally invasive parathyroid surgery over a 10-month period. RESULTS: Fifteen consecutive patients were evaluated. There were 11 women and 4 men, with an average age of 65 years. All patients underwent a preoperative technetium Tc 99m sestamibi scan, with 11 localizing to the site of a probable adenoma. Mean ionized calcium levels were 5.95 mg/dL (1.49 mmol/L) preoperatively and 4.84 mg/dL (1.21 mmol/L) postoperatively. Of 13 patients undergoing both arterial and venous sampling, mean baseline venous PTH level was 221 pg/mL and 37 pg/mL at 10 minutes after excision of suspected adenoma (83% decline). Mean baseline arterial PTH level was 247 pg/mL and 38 pg/mL at 10 minutes after excision (84% decline). Using the Wilcoxon signed rank test, there was no significant difference in the arterial vs venous levels at baseline (P = .70) or 10 minutes (P = .48). CONCLUSIONS: Intraoperative PTH levels during minimal access parathyroid surgery are similar for venous and arterial samples. Blood samples for PTH level monitoring can be obtained using a temporary indwelling arterial line.

Aged↗

PubMed2002

Distinguishing non-Hodgkin lymphoma from squamous cell carcinoma tumors of the head and neck by computed tomography parameters.

OBJECTIVE: Computed tomography (CT) remains the first-line imaging procedure for pre-therapeutic staging of head and neck tumors. Non-Hodgkin lymphoma (NHL) is not easily distinguished from squamous cell carcinoma (SCC), especially because NHL often appears in extranodal locations. We sought to explore whether specific CT characteristics could be used to distinguish these tumor types. METHOD: Cases of NHL and SCC involving the head and neckwere retrospectively identified. Of 165 subjects (110 NHL, 55 SCC) identified, 45 patients (19 NHL, 26 SCC) had complete CT scan records. The scans with no group identifiers were randomly presented to the radiologist for blinded review. Radiologic distribution, size, and tumor characteristics were recorded. Descriptive summaries of the data were analyzed by standard univariate statistical procedures. RESULTS: Significant differences between NHL and SCC tumors were observed: stage IV tumors (17% vs. 85%; P < .001), extranodal occurrence in the oral cavity (0% vs. 38%; P = .002), evidence of primary or extranodal tumor (11% vs. 73%; P < .001), tumor necrosis (5% vs. 54%; P <.001), non-isodensity nodes (16% vs. 50%; P = .03), and nodes in zones 5-7 (32% vs. 4%; P = .03). No significant difference was seen in the total number of nodes, the number of large nodes, or the maximum nodal diameter. CONCLUSION: While none of these features can be considered pathognomonic for either type of tumor, the distinctions may assist in distinguishing NHL from SCC of the head and neck until more sophisticated imaging techniques become widely available.

Adult↗

PubMed2002

Neck dissections: predicting postoperative drainage.

OBJECTIVES: Most head and neck dissections performed in conjunction with carcinomas of the upper aerodigestive tract require drain insertion. The time that the drains remain in place largely determines the duration of postoperative hospitalization. This study sought to retrospectively compare different neck dissections in terms of postoperative drainage and duration of hospitalization. We also sought to identify any correlation between total intraoperative blood loss and postoperative drainage. MATERIALS AND METHODS: Radical, modified radical, and selective neck dissections performed in conjunction with resection of a carcinoma of the upper aerodigestive tract over a 3-year period were evaluated. Total intraoperative blood loss at surgery, and amount and duration of postoperative drainage for each neck dissection were recorded. RESULTS: Seventy-nine neck dissections were performed on 52 patients, 27 (52%) of whom had bilateral neck dissections. Median drainage was 116.5 mL, 172 mL, and 319 mL for selective, modified radical, and radical neck dissections, respectively. Drainage differed significantly by type of neck dissection (P <.001). Drains remained in place a median of 4 days with no significant difference between different types of neck dissections. Drainage was clearly correlated with total intraoperative blood loss (Spearman correlation = 0.44, P <.001). CONCLUSION: The postoperative drainage per day was higher in radical neck dissections than modified radical neck dissections and lowest in selective neck dissections. This difference was not reflected in the duration that the drains would remain in place. Total intraoperative blood loss is a strong predictor of the amount and duration of postoperative drainage.

Adolescent↗