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Biomedical subjects

D T Cody

Publications and source records attributed to D T Cody.

At least 19 recordsLinked to original sources
PubMed2000

Allergic fungal sinusitis: an immunohistologic analysis.

BACKGROUND: Allergic fungal sinusitis is a noninvasive form of fungal sinusitis that has recently been delineated as a distinct clinicopathologic entity. It is increasingly recognized as a cause of chronic sinusitis, with the primary causative agents being members of the Dematiaceae fungus family. Although its immunopathogenesis has not been elucidated, the eosinophil is a prominent inflammatory cell on histologic examination. OBJECTIVE: We sought to characterize the involvement of eosinophils in sinus tissue and accompanying mucin from patients with allergic fungal sinusitis. As a comparison, neutrophil and mast cell involvement was also evaluated in the same group of patients. METHODS: Tissue specimens from 8 patients with allergic fungal sinusitis, along with 8 nasal polyp specimens from patients without allergic fungal sinusitis, were stained by using indirect immunofluorescence for eosinophil granule major basic protein (MBP). Neutrophil elastase and mast cell tryptase staining was also performed on the same allergic fungal sinusitis and nasal polyp tissues. RESULTS: MBP was diffusely localized within the mucin, showing intense staining at the periphery and variable staining of degenerated cell clusters throughout. Extracellular MBP in the mucin was strikingly greater than intact eosinophil staining. Diffuse extracellular neutrophil elastase was also present in the mucin. Mucinous areas showed no tryptase localization. Adjacent nonmucinous areas of respiratory mucosa showed predominantly cellular staining with eosinophil MBP, neutrophil elastase, and mast cell tryptase. MBP staining of nasal polyps showed a predominantly cellular pattern with focal areas of extracellular deposition. CONCLUSIONS: Given the known toxicities of eosinophil granule MBP and neutrophil elastase, their extracellular presence supports the contribution of these proteins in the pathogenesis of allergic fungal sinusitis and further indicates that eosinophil and neutrophil activation occurs in the disease.

Adult↗
PubMed1999

The use of granulocyte colony stimulating factor to promote wound healing in a neutropenic patient after head and neck surgery.

BACKGROUND: Neutropenia and neutrophil dysfunction, in association with a variety of diseases, has been shown to play a role in poor wound healing. Wound breakdown with fistula formation in patients undergoing total laryngectomy results in significant morbidity and increased hospital stay. Although malnutrition, prior radiation, diabetes, and other diseases are recognized as factors predisposing patients with head and neck cancer to developing fistulas, neutrophil dysfunction should also be considered. Granulocyte colony stimulating factor (G-CSF) has been used successfully to treat neutropenia and neutrophil dysfunction. METHODS: This study was conducted as a case report. RESULTS: We present the first report of a neutropenic head and neck cancer patient with a persistent wound of 6 months' duration who showed dramatic improvement after treatment with G-CSF. CONCLUSION: We conclude that G-CSF may represent a useful adjunct in patients with persistent wound healing problems and neutropenia despite adequate treatment by conventional means. Further clinical experience with G-CSF in patients with delayed healing is indicated.

Cutaneous Fistula↗
PubMed1999

Differential DNA methylation of the p16 INK4A/CDKN2A promoter in human oral cancer cells and normal human oral keratinocytes.

The p16 INK4A tumor suppressor gene participates in establishing and maintaining the malignant phenotype of a variety of cancer cell lines and primary tumors. Recently it has been observed that p16 expression is lost in oral cavity cancer cell lines in the presence of a normal intact gene. To examine the role of DNA methylation as an explanation for these findings, we analyzed the DNA methylation patterns of the p16 INK4A promoter in DNA isolated from primary cultures of normal human oral keratinocytes and squamous cell carcinoma (SCC-15) oral cancer cells using bisulfite genomic sequencing. Our results demonstrated striking differences in the methylation status of the 5' CpG island of the p16 gene between normal and cancer cells. Normal human oral keratinocytes showed practically no methylation of the p16 INK4A promoter, while SCC-15 oral cancer cells showed almost complete methylation in this region. These data implicate DNA methylation as a mechanism for transcriptional silencing of the p16 INK4A gene in oral cancer cells.

Cyclin-Dependent Kinase Inhibitor p16↗
PubMed1997

Paranasal sinus fungus balls.

BACKGROUND: Paranasal sinus fungus balls (mycetomas) are a form of fungal sinus infection distinct from allergic fungal sinusitis, fulminant invasive fungal disease, and paranasal aspergillus granulomas. METHODS: The Mayo Clinic surgical pathology files of inflammatory sinus specimens from 1984 to 1994 were examined. Twenty-nine paranasal sinus fungus balls were identified. Cases of allergic fungal sinus and invasive fungal disease were excluded. RESULTS: The fungus ball occurred in 11 men and 18 women, with an age range of 28 to 86 years, mean 64 years. Sinuses involved included maxillary (20 cases), sphenoid (10 cases), ethmoid (9 cases), and frontal (6 cases). In 12 patients, multiple sinuses were involved in a variety of combinations. By culture the most common pathogens were Aspergillus fumigatus and Aspergillus flavus. Treatment was by a variety of surgical procedures. Follow-up in 28 patients showed two recurrences and three deaths due to intracerebral bleed as a complication of surgery. These deaths occurred in patients with sphenoid sinus fungus balls. CONCLUSIONS: Paranasal sinus fungus balls occurs in an elderly population and have a female predominance. They have a low morbidity and recurrence rate. Death can occur in sphenoid sinus lesions as a complication of surgery.

Adult↗
PubMed1997

Effects of Aspergillus fumigatus and Alternaria alternata on human ciliated epithelium in vitro.

Fungi represent the etiologic agent in a large number of patients with chronic sinusitis. Despite this, no study has examined the effects of fungi on ciliated epithelium. This study evaluates the effects of cultures and filtrates of Aspergillus fumigatus and Alternaria alternata on ciliary beat frequency (CBF) in vitro. CBF was recorded after exposure to either a control or experimental solution. A statistical comparison of control and experimental values was performed to determine significance at P < 0.05. A statistically significant inhibition of CBF in cultures and filtrates of A fumigatus and A alternata was demonstrated. We conclude that a soluble metabolite produced by clinical isolates of both A fumigatus and A alternata causes inhibition of CBF and may represent one virulence factor involved in the development of fungal sinusitis.

Adult↗
PubMed1994

Allergic fungal sinusitis: the Mayo Clinic experience.

The diagnosis of allergic fungal sinusitis (AFS) is difficult to establish. The clinical presentation is not diagnostic. We define current criteria for diagnosis and the role of total and specific immunoglobulin E (IgE) and immunoglobulin G (IgG) levels in the disease process and review the clinical features of this disease. Fifty-one cases were identified in 44 patients who demonstrated characteristic allergic mucin. Thirty-one of these cases satisfied rigid criteria for the diagnosis of AFS. Twenty of these cases were classified as AFS-like syndrome. The prevalence of strictly defined AFS was 4.0%. Dematiaceous fungi were the predominant agents cultured. All our patients had polyps, 23 (54%) had asthma, 12 (27%) had aspirin sensitivity, 20 (65%) had eosinophilia, and 9 (69%) had increased total IgE levels.

Adolescent↗
PubMed1994

The sacculotomy procedure.

In patients who have unilateral idiopathic endolymphatic hydrops with intractable, severe episodic vertigo and established sensorineural deafness that cannot be helped by a hearing aid, the Cody tack procedure is the conservative procedure of choice. Local anesthesia is used, morbidity is unusual, vertigo is controlled in almost 80% of patients, and hearing can be maintained or improved.

Endolymphatic Hydrops↗
PubMed1984

Mastoidectomy for acquired cholesteatoma: follow-up to 20 years.

The results of 423 mastoidectomies for acquired cholesteatoma were reanalyzed 6 years after the first analysis. The mastoidectomies were placed into three groups: open-cavity, 135 modified radical and 37 radical; obliterated-cavity, 60 modified radical and 20 radical in which the mastoid cavities were obliterated with pedicle muscle grafts; and intact-canal-wall, 69 complete and 102 complete with opening of the facial recess. The following observations were made. The cholesteatoma failure rate increased: for the open-cavity group, from 6% to 7%; obliterated-cavity group, 16% to 18%; intact-canal-wall group, 35% to 45%. The precholesteatoma (retraction pocket) failure rate in the open-cavity and obliterated-cavity groups did not change. In the intact-canal-wall group, recurrent cholesteatomas developed in 8 cases initially classified as precholesteatoma failures. In 9 initially classified as successful, retraction pockets developed and 7 of these went on to recurrent cholesteatomas. Consequently, despite the progressive increase in formation of retraction pockets, the overall incidence dropped from 20% to 16%. Failure due to chronic or frequent recurrent infection did not change in the open-cavity and intact-canal-wall groups. However, in the obliterated-cavity group, it increased from 4% to 5%. The overall failure rate increased: open-cavity group, 18% to 19%; obliterated-cavity group, 29% to 30%; intact-canal-wall group, 60% to 66%.

Cholesteatoma↗
PubMed1983

Tack operation for idiopathic endolymphatic hydrops: an update.

This paper discusses an analysis of two groups of patients who underwent a tack operation for incapacitating recurrent attacks of vertigo due to idiopathic endolymphatic hydrops. Group I consisted of the first 140 patients operated on by one of the authors (D.T.R.C.). All were followed up for at least 5 years after the operation. However, between the 63rd and 166th postoperative months, 12 patients died of unrelated causes, and an additional 26 patients were lost to follow-up between the 70th and 119th postoperative months. The analysis was based on the condition of these patients up to the time of their death or the time that they were last contacted. The mean postoperative follow-up for the 140 patients was 12 years 9 months, and the range was 63 to 197 months. Group II consisted of 150 consecutive patients who had a tack operation performed by several consultants and residents in the Department of Otorhinolaryngology at the Mayo Clinic, and the opportunity for follow-up of at least 5 years existed for all patients. The patients who were lost to follow-up in the first 56 postoperative months were excluded from the analysis unless at the time they were last seen the operation had not controlled their vertigo, in which case the results were classified as failures. On this basis, 22 patients (15%) were excluded from the study, so that 128 patients remained in the analysis. The mean postoperative follow-up for this group was 9 years 4 months, with a range of 56 to 182 months. The following conclusions were reached. Vertigo was satisfactorily controlled in 79% of the patients in the two groups. Hearing was improved or maintained in 66% of the patients in Group I and 60% of the patients in Group II. A moderate-to-profound sensorineural hearing loss occurred in 34% of the patients in Group I and 40% of the patients in Group II. We consider the tack operation the conservative operation of choice in the management of idiopathic endolymphatic hydrops.

Follow-Up Studies↗
PubMed1983

Endolymphatic subarachnoid shunt operation for idiopathic endolymphatic hydrops.

In 1974 we reported on 92 patients who had endolymphatic subarachnoid shunt surgery for idiopathic endolymphatic hydrops. That group had a follow-up of at least 5 years, and only 41% had satisfactory control of vertigo. The purpose of this paper is to describe the results after a larger postoperative follow-up (12 1/2 years, with a range of 68 to 182 months), and to discuss some additional observations regarding endolymphatic sac operations. Two patients have died of unrelated causes, one in the 115th postoperative month and the other in the 124th postoperative month. Eight patients have been lost to follow-up. Our data show that 35% of the patients have had satisfactory control of their vertigo: 23% have had no vertigo, and 12% have had the vertigo improved by at least 75%. The remaining patients had improvement in vertigo, but not to a satisfactory degree, had pronounced improvement in vertigo, but with subsequent recurrence of severe attacks of dizziness, or had no improvement at all. In addition, there has been a steady deterioration in the success rate with increased time of observation. Nineteen percent of the patients showed significant improvement in hearing after surgery, 47% demonstrated no change in hearing, and 34% had a moderate to profound decline in hearing postoperatively. Of 17 patients who had socially adequate hearing in the afflicted ear preoperatively, 12 showed deterioration in hearing to the point that air-conduction thresholds were below the socially adequate level. Six patients with bilateral endolymphatic hydrops who had almost identical auditory acuity in each ear underwent a unilateral shunt operation. In each of these patients, the unoperated-on ear had better results from the hearing standpoint. The data show, therefore, that control of vertigo with the endolymphatic subarachnoid shunt operation was not only disappointing initially, but as the patients were followed over a longer time, the percentage of patients with satisfactory vertigo control declined. Additionally, one-third of the patients experienced further moderate to profound sensorineural deafness, either as a result of surgery or because the operation failed to control the disease process. Last, it is obvious that the endolymphatic subarachnoid shunt operation did not preserve hearing, even when the operation was performed early in the course of the disease.

Audiometry↗
PubMed1981

Neurologic perspectives of otosclerosis.

Of 500 patients with roentgenographically verified otosclerosis, 230 had vestibular manifestations. Because of its frequency in general practice, otosclerosis has a major impact on the differential diagnosis of vertigo and related symptoms. The vestibular syndrome encompasses the full symptomatic spectrum common to diseases of the vestibular system, from episodic violent rotational vertigo to a sense of almost continuous imbalance, and cannot usually be distinguished from idiopathic endolymphatic hydrops. Otosclerosis is easy to diagnose when vestibular symptoms occur in conjunction with conductive or mixed hearing loss and a normal tympanic membrane that excludes middle ear disease. However, in approximately one-third of patients with a hearing loss that is purely sensorineural, the diagnosis can be confirmed only by compound-motion tomography of the petrous bones.

Adolescent↗
PubMed1977

Facial palsy: unusual etiology.

This is a report of three patients who presented at the Mayo Clinic over a two-year period. All were initially diagnosed as having Bell's palsy but were later found to have a malignant neoplasm causing the paralysis. Two of the patients had breast carcinoma metastases involving the mastoid portion of the facial nerve. The third patient had an adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. The course of the facial paralysis in the two patients with the metastitic breast disease was almost identical. It consisted of episodes of pain in the mastoid area. generally in the late evening or during the night, often awakening the patient from sleep. This was then followed by peripheral facial-nerve paralysis, sometimes partial and at other times complete. These episodes lasted from 10 minutes to several hours and then resolved completely. They recurred over several months. The patients were completely asymptomatic and normal on examination in the intervals between episodes of paralysis until it became permanent. Metastatic lesions causing facial paralysis are extremely rare in the literature. In those cases that have been reported, the paralysis was progressive from the start and in the vast majority of cases was either painless or associated with other aural symptoms such as otorrhea, hearing loss, and periauricular swelling. There are two unusual features of these two cases: 1. the initial presentation of a breast metastasis as a facial paralysis; in the first case there were no other metastatic lesions present at diagnosis, whereas the second patient had other, asymptomatic, metastatic nodules; and 2. the multiple, brief, recurring episodes of facial paralysis, which have not previously been reported as a mode of presentation of metastitic disease. The third patient was diagnosed as having Bell's palsy. A facial nerve decompression was performed, and the nerve apparently looked normal. The paralysis failed to resolve. He was later found to have adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. A report of only one similar case could be found in the literature. The sequence of events in these three cases emphasizes the importance of submitting a patient suspected of having Bell's palsy to a thorough otoneurologic examination.

Adenocarcinoma↗