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Biomedical subjects

C E Silver

Publications and source records attributed to C E Silver.

At least 37 records · Page 2Linked to original sources
PubMed1988

Schwannoma of the cervical sympathetic chain.

Two cases of schwannomas of the cervical sympathetic chain (CSC) are described. Eleven clearly documented cases have been described in the previous literature. These tumours are usually solitary, asymptomatic cervical masses that occur within the upper carotid sheath or parapharyngeal space. The lesions tend to be hypervascular, but not to the same extent as chemodectomas. Angiography may be employed for differential diagnosis. Schwannomas of the CSC are usually readily excised by a cervical approach. Horner's syndrome is a frequent post-operative sequel, despite anatomical preservation of the sympathetic chain. This neurological impairment is usually asymptomatic. Recurrences and malignant degeneration rarely occur.

Female↗
PubMed1987

Preoperative localization of lesions of the parathyroid gland using thallium-technetium scintiscanning.

Double tracer scanning of the neck after injection of thallium-210 and technetium pertechnetate was performed upon 33 patients with biochemically proved hyperparathyroidism operated upon during the past 14 months. Operative findings were correlated with the scans. Twenty-two of 29 single lesions of the parathyroid gland were successfully localized. There were ten unsuccessful studies, including three instances in which diffuse hyperplasia was incompletely identified. In one instance of diffuse hyperplasia, the bilateral pathologic finding was diagnosed correctly. Two of three substernal lesions were demonstrated in patients who had undergone previous unsuccessful explorations. An additional substernal lesion was localized in a patient prior to initial exploration. Nineteen of 21 lesions weighing more than 300 milligrams were identified, whereas only 50 per cent of the lesions weighing less than 300 milligrams could be seen. The scans demonstrated 12 of 14 lesions with C-terminal parathyroid hormone levels of more than 900 picograms per milliliter but only 60 per cent of the lesions that produced levels of less than 900 picograms per milliliter. Thallium-technetium scanning is a useful procedure for preoperative localization of parathyroid lesions and may preclude the need for more invasive testing in previously operated upon patients.

Aged↗
PubMed1985

The diagnostic value of flow cytometric DNA measurements in follicular tumors of the thyroid gland.

Flow cytometric analysis of DNA content was performed on single or multiple samples from 34 thyroidectomy specimens. There were 29 thyroids with diploid DNA content, comprising 15 nonneoplastic lesions, 5 follicular adenomas, 1 medullary carcinoma, and 8 papillary carcinomas. Aneuploid DNA pattern was observed in five cases, including one metastatic mammary carcinoma. The initial histologic diagnoses in the remaining four aneuploid thyroid lesions were follicular carcinoma in one and follicular adenoma in three. The abnormal DNA pattern in the three follicular "adenomas" prompted a review of their aspiration cytologic and histologic features. The fine-needle aspiration biopsy was performed in two of the three cases and showed evidence of a follicular neoplasm with significant nuclear atypia in both. Histologic review of the three lesions led to a modified diagnosis of noninvasive low grade follicular carcinoma in all three. Flow cytometric analysis of DNA content may prove to be a highly useful adjunct in the evaluation of follicular thyroid tumors. Long-term clinical follow-up is warranted to document the clinical significance of these observations.

Adenocarcinoma↗
PubMed1984

Needle aspiration biopsy of thyroid nodules.

Needle aspiration biopsies for cytology were performed on 224 patients with thyroid nodules. Diagnosis was confirmed by surgical exploration in 134 patients. Twenty-four biopsies were reported positive for malignancy; 23 were confirmed at operation and there was 1 false positive. Forty-one biopsies were reported benign. Three of these lesions were found to be malignant, representing false negatives. Sixty-nine biopsies were in the questionable category; 16 (23%) of these were malignant. None of the patients suffered complications from the biopsies. Routine employment of needle aspiration biopsy on our service has resulted in a marked increase in the incidence of carcinoma in thyroid nodules selected for surgery. This has resulted from detection of otherwise unsuspected malignancy, as well as avoidance of surgery in patients with benign lesions. Needle aspiration is not a substitute for surgery. It is a valuable diagnostic procedure, and should be performed in the evaluation of essentially all thyroid nodules. We continue to use radioiodine scanning to evaluate our patients, but have found the routine use of ultrasonography unnecessary when needle aspiration is employed. The ultimate decision regarding surgical exploration is based on a combination of factors including history, physical findings, radioiodine scan and needle aspiration biopsy.

Biopsy, Needle↗
PubMed1984

Prototype airway management system for use during laser surgery.

A Norton metal endotracheal tube with a Merav parachute cuff cemented to the distal end has solved many of the problems involved in administration of anesthesia for laser surgery of the upper aerodigestive tract. The tube is fireproof and provides an air-tight seal for positive pressure ventilation without the impediment of a cuff channel. It is ideal for laser surgery of the oral cavity and pharynx and may be used effectively for glottic lesions in many instances.

Anesthesia, Inhalation↗
PubMed1984

The initial evaluation of masses of the neck by needle aspiration biopsy.

Needle aspiration biopsy for cytologic study is a simple, safe and accurate procedure for evaluation of cervical masses. It is a valuable initial step for evaluation of undiagnosed neck masses and is most efficacious for follow-up evaluation of patients previously treated for cancer. The procedure does not interfere with subsequent treatment. Information obtained from aspiration cytologic findings is used to plan subsequent evaluation and treatment in the simplest and most cost effective manner.

Biopsy, Needle↗
PubMed1982

Cervical cysts: cancer until proven otherwise?

A cystic neck mass can be either malignant or benign; 22% of patients (4/18) admitted with the tentative diagnosis of branchial cyst in a recent 2-year period (1977-1979) had metastatic carcinoma: epidermoid, thyroid or salivary gland. Preoperative fine needle aspiration was diagnostic in 1 instance and unhelpful in 2. Frozen section analysis of the gross specimen invariably provided the correct diagnosis. All patients with malignancies had subclinical primary disease and in 1 instance random biopsies identified its origin. The prudent surgeon will avoid untoward results if he approaches a neck cyst in an adult as if it were malignant. Guidelines he can follow to prevent the inadvertent removal of a metastasis under the misapprehension that it is a benign neck cyst include: 1. Prior to operation, perform a thorough head and neck examination to identify a primary carcinoma; 2. Do a fine needle aspiration of the mass for cytology. A negative report must be considered inconclusive; 3. Make a gross examination in the operating room of the opened cyst and frozen section processing of suspicious areas; 4. Follow with a panendoscopy and random biopsies of appropriate areas and complete the neck dissection on the involved side, after a metastatic deposit has been recognized. The preoperative procurement of contingency consent for these procedures is understood.

Adult↗
PubMed1981

Needle aspiration biopsy of thyroid nodules.

Thin needle aspiration biopsies for cytology were performed upon 64 patients with hypofunctioning thyroid nodules. Surgical confirmation of the diagnoses was obtained in 41 of these patients. All 12 nodules with positive needle biopsies were found to be malignant at operation. Sixteen of 17 nodules with negative findings at biopsy were found to be benign; one was found to be malignant. Twelve nodules were in the questionable cytologic group, three were malignant and nine were benign. Twenty-three patients did not undergo operation after needle biopsy. Negative biopsy findings in these patients were instrumental in guiding decisions not to recommend operation. There was no morbidity after any of the 64 needle biopsies. An analysis of our results indicates that thin needle aspiration biopsy is a valuable diagnostic tool for the selection of thyroid nodules for surgical treatment. Its routine use on our service has increased the incidence of carcinoma in surgically explored cold thyroid nodules in the past year. The procedure was helpful not only in avoiding operation for some benign lesions but also in enabling the detection of a number of otherwise unsuspected malignant tumors. Objections which are usually raised to the large scale use of thin needle aspiration biopsies of thyroid nodules are not valid.

Biopsy, Needle↗
PubMed1981

The parasternal paddle: a modification of the pectoralis major myocutaneous flap.

A modification of the pectoralis major myocutaneous flap has been described for head and neck reconstruction. The flap uses the skin overlying the sternum and parasternal area and may extend across the midline to the contralateral internal mammary perforators. The flap has been uniformly reliable in our experience. It is thin and easy to elevate, and donor-site morbidity is minimal. This flap is rapidly becoming our first-choice for head and neck reconstruction.

Adult↗
PubMed1978

Oral and oropharyngeal carcinoma: surgical treatment in irradiated and nonirradiated patients.

Surgical treatment was used in 45 cases of oral cavity carcinoma and in 23 cases of oropharyngeal carcinoma. The three-year cure rate was 47% for oral cavity tumors and 9% for orophayngeal lesions. The cure rate was substantially higher in female patients than in males and in white patients than in nonwhites. Results of composite resections in 23 previously irradiated patients and 23 nonirradiated patients with T-2 and T-3 lesions are compared. The irradiated patients with oral cavity carcinoma had a lower cure rate and a much greater incidence of postoperative morbidity than the patients treated with operation alone. Surgical results for oropharyngeal carcinomas were poor in both radiated and nonirradiated patients, although the incidence of postoperative morbidity and mortality was higher in the irradiated group.

Female↗