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Biomedical subjects

D E Eibling

Publications and source records attributed to D E Eibling.

34 records · Page 2Linked to original sources
PubMed1991

Flow cytometric evaluation of adenoid cystic carcinoma: correlation with histologic subtype and survival.

Adenoid cystic carcinoma is an unusual but capricious tumor of salivary gland origin. Characteristically, these tumors follow a relentless clinical course, although some patients experience prolonged disease-free survival. Tumor size, site, and grade have been shown to correlate with tumor behavior. Recent investigation by others has suggested that DNA ploidy as determined by flow cytometry may provide an additional biologic marker of tumor behavior. This study was undertaken to investigate the relationship of DNA ploidy to tumor grade, biologic behavior, and patient outcome. A retrospective comparison of flow cytometric evaluations of paraffin-embedded formalin-fixed tumor specimens with patient outcome and histopathologic grade was undertaken. Follow-up of 4 to 7 years in 26 patients confirmed that the presence of a solid histologic component in the tumor correlated with the presence of recurrent or persistent disease (p = 0.04). Twenty-two of 28 tumors (78%) were found to be aneuploid on at least one section. Comparison of DNA ploidy with either patient outcome or the presence of a solid component did not achieve statistical significance, although a trend was suggested. This study confirms previous studies demonstrating the validity of histopathologic evaluation of tumor grade in the prediction of the biologic behavior of adenoid cystic carcinoma. However, our findings suggest that DNA ploidy has only limited value as an additional marker of tumor behavior in this patient population.

Carcinoma, Adenoid Cystic↗
PubMed1990

A new method to predict safe resection of the internal carotid artery.

A patent internal carotid artery (ICA) is essential in most patients. Management of skull base lesions often requires translocation, balloon embolization, or resection of this vessel. Preoperative tests to assess the availability of collateral flow have not been uniformly accurate. A new test that significantly increases the safety of surgical removal of the ICA is described. One hundred thirty-six patients were studied with temporary balloon occlusion (TBO) of the ICA and determination of stable xenon-enhanced computed tomography cerebral blood flow (Xe/CT CBF) measurements. Eleven patients failed TBO and were determined to be at very high risk of stroke with loss of the ICA. Ninety-six of the patients were predicted to be at minimal risk with permanent loss of the ICA by Xe/CT CBF studies. Twenty-one patients in this group had either permanent balloon occlusion (PBO) or surgical resection of the ICA with no permanent neurologic sequelae. Our studies show that the combination of preoperative TBO and Xe/CT CBF studies significantly increases the safety of ICA resection.

Adolescent↗
PubMed1990

Anterior cranial base reconstruction: role of galeal and pericranial flaps.

Reconstruction of surgical defects in 30 patients undergoing surgery of the anterior cranial base was performed using pericranial, galeopericranial, and galeal scalp flaps. Twenty-seven patients had resection of neoplasms, the majority of which were malignant. Fifty-seven percent of patients received prior therapy consisting of surgery and/or radiotherapy. Adequate healing of the cranial base was noted in all cases without persistent cerebrospinal fluid leaks, meningitis, or brain herniation. Mucosalization of the intranasal surface was noted. No skin grafts were used. At a median follow-up of 13 months, 67% of patients were alive with no evidence of disease. The pericranial, galeopericranial, and galeal flaps are highly reliable, versatile, and well suited for reconstruction of the anterior cranial base.

Adolescent↗
PubMed1990

Tumor markers of head and neck carcinoma.

Evaluation of the various tumor markers that have been studied in patients with SCC of the head and neck reveals no single marker or battery of markers that is sufficiently specific or sensitive to provide useful clinical data in the treatment of patients with these cancers. This finding reinforces previous investigative and clinical impressions that would suggest that carcinoma of the head and neck is a heterogeneous entity. These tumor marker studies provide additional support for the hypothesis that although various carcinomas of the head and neck may appear identical microscopically, their behavior both clinically and biochemically is nevertheless heterogeneous. Due to the wide variability of the behavior of these tumors, the search for the perfect tumor marker continues. The development of additional multiple-marker batteries may provide the closest approximation to a perfect marker that is feasible. Additional studies into the nature and function of oncogenes may provide additional clues to the variability of these tumors and the resultant heterogenicity of their marker expression.

Antibodies, Viral↗
PubMed1989

SCC-RIA in the diagnosis of squamous cell carcinoma of the head and neck.

A reliable circulating tumor marker, appropriate for head and neck malignancy, is not yet available. This manuscript reports the efficacy of using circulating squamous cell carcinoma antigen in evaluating patients with squamous cell carcinoma of the head and neck. Serum samples from 89 patients with squamous cell carcinoma of the head and neck were obtained before treatment and at intervals following treatment. Squamous cell carcinoma antigen levels were determined by radioimmunoassay. Elevated pretreatment serum levels of squamous cell carcinoma antigen were identified in 39 of 89 patients (44%) who had head and neck squamous cell carcinoma. Of the 16 patients evaluated from this group with recurrent or persistent disease, 15 (93.5%) demonstrated elevated levels of squamous cell carcinoma antigen. However, of the 21 evaluable patients who remained disease free, only 10 (48%) had post-therapy levels within the normal range. The possible use of this marker in aiding the clinical follow-up of head and neck cancer patients is discussed.

Adult↗
PubMed1988

Gangrenous cellulitis associated with gram-negative bacilli in pancytopenic patients: dilemma with respect to effective therapy.

INTRODUCTION: Gangrenous (necrotizing) cellulitis is a progressive bacterial infection of skin and soft tissue; the infection can spread into subcutaneous tissue with involvement of superficial and deep fascia (necrotizing fasciitis). We describe two pancytopenic patients with polymicrobial gram-negative bacteremia and fulminating gangrenous cellulitis. CASE REPORTS: Pseudomonas aeruginosa was isolated from a localized hemorrhagic area of the face in one patient. The chronology of infection in these two patients is documented in a series of dramatic color photographs. Despite appropriate antibiotic therapy, the infections progressed relentlessly and both patients died. COMMENTS: We discuss the dilemma of establishing the correct diagnosis prior to the appearance of the characteristic cutaneous manifestations of hemorrhagic necrosis and gangrene. Once the diagnosis is established, surgical excision is universally recommended. Unfortunately, bleeding diatheses in pancytopenic patients with co-existing coagulation deficiencies pose logistic obstacles in urgent, real-life situations. The timing and conditions for surgery need to be elucidated in these patients. An approach to this infection is proposed. The utility of frozen-section biopsy of the involved tissue and computed tomographic scans of the involved area remains to be evaluated.

Adult↗
PubMed1988

Elective resection of the internal carotid artery without reconstruction.

Curability of skull base tumors is related to the ability to achieve a complete resection. Resection of the internal carotid artery with the tumor puts the patient at risk for catastrophic cerebral injury. Autogenous vein grafting is not always technically or physiologically possible. We present eight patients with tumors eroding the cranial base who underwent safe resection or occlusion of the internal carotid artery as predicted by three tests: 1. carotid arteriography, 2. temporary balloon occlusion of the internal carotid artery, and 3. xenon computerized tomography cerebral blood flow mapping. No patient suffered permanent central nervous system injury.

Adult↗
PubMedDate not supplied

Effect of the Passy-Muir Valve on aspiration in patients with tracheostomy.

OBJECTIVE: To assess potential benefit of a Passy-Muir Speaking Valve (PMV) in decreasing aspiration in patients with a tracheostomy. BACKGROUND: Many patients with tracheostomy exhibit clinically significant aspiration. It has been previously noted that aspiration can often be reduced or eliminated by plugging or removing the tracheostomy tube. Some patients, however, do not tolerate removal or plugging of their tracheostomy tube, which then leads to persistent aspiration. We postulated that a one-way speaking valve may restore more normal subglottic and glottic air flow and reduce aspiration. METHODS: Alert patients with a tracheostomy and clinical evidence of aspiration were eligible for study. Eleven patients with tracheostomy and known aspiration were studied with a modified barium swallow. Radiographic examination was used to evaluate the presence and amount of aspiration while patients swallowed both with and without a PMV in place on their tracheostomy tube. RESULTS: Aspiration was reduced (or eliminated) during swallowing in all 11 patients when they wore a PMV, when compared to swallowing with an open (unvalved) tube. This improvement was achieved with liquids, semisolids, and pureed consistencies. CONCLUSION: This study demonstrates that a Passy-Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration.

Adult↗
PubMedDate not supplied

Laryngeal framework surgery for the management of aspiration in high vagal lesions.

PURPOSE: The purpose of this study is to ascertain the effectiveness of laryngeal framework surgery, including medialization thyroplasty (MT), with or without arytenoid adduction (AA), on preventing aspiration, improving diet, and aiding in the subsequent decannulation of individuals with high vagal lesions. PATIENTS AND METHODS: A retrospective chart review was performed on each patient presenting with a high vagal lesion who was treated with laryngeal framework surgery from June 1992 to April 1996 at a university medical center. Thirty-five patients were identified; there were 20 women and 15 men, with a median age of 51. Information regarding etiology of the lesion, characteristics of the vocal cord deficits, degree of aspiration, the presence of other neurologic deficits and concurrent pulmonary disease, treatment, and outcome was obtained. The final outcome regarding voice, the presence and degree of aspiration, diet, and decannulation following MT, with or without AA, was assessed to determine the effectiveness of these procedures. RESULTS: Thirty-five patients underwent 40 MTs and 19 AAs. Ninety-four percent of patients who experienced aspiration improved, and 79% who had required tracheotomy were decannulated. Ninety percent of patients were noted to have subjective improvement in voice postoperatively. CONCLUSION: Laryngeal framework surgery improves airway, deglutition, and voice in individuals suffering from high vagal lesions, and facilitates the rehabilitation of these patients.

Adult↗
PubMedDate not supplied

A simple method of laryngeal photography through the operating microscope. "Macrolens technique".

A simple and inexpensive method of laryngeal photography through the eyepiece of the operating microscope is described. Provided that the operating room is equipped with the microscope, the laryngoscope and the laryngoscope holder, the only essential equipment required is an "aperture-preferred" automatic single lens reflex camera with a 50 mm macrolens. The macrolens of the camera is placed against an eyepiece of the microscope and the laryngeal image is centered and focused via the viewfinder of the camera. The respiration of the patient is temporarily halted. The camera is held still and pictures taken. Kodak high speed Ektachrome tungsten film ASA 160 is used and push-processed to ASA 320. With practice, one should be able to obtain satisfactory photographs of the larynx suitable for teaching and documentation.

Humans↗