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Biomedical subjects

F E Lucente

Publications and source records attributed to F E Lucente.

At least 19 recordsLinked to original sources
PubMed2000

Retropharyngeal abscess secondary to penetrating foreign bodies.

A retrospective study was conducted on patients with upper aerodigestive tract foreign bodies requiring operative intervention over a 12-year period to aid in the recognition and management of foreign body associated complications. Oesophagoscopies were performed for the removal of foreign bodies in 37 patients, age one to 82 years with a male to female ratio of 1.2:1. Retropharyngeal abscesses accounted for eight of 11 foreign body-associated complications. Fish bones were the cause in six cases, chicken bone and a pen refill in one case each. An abscess was already present at the time of initial procedure in six cases and developed in two cases after successful removal of the foreign body. A high level of suspicion for a retropharyngeal abscess should be maintained in cases with perforation, and in patients with immunodeficiency.

Adolescent↗
PubMed1999

Alterations in head and neck cancer occurring in HIV-infected patients--results of a pilot, longitudinal, prospective study.

To assess the impact of human immunodeficiency virus (HIV) infection on the presentation and course of head and neck squamous cell carcinoma (HNSCC), we performed a pilot, prospective, longitudinal study of all patients with HNSCC presenting to our institutions over a 6-month period (n = 10). A 60% incidence of HIV infection was seen in this study population, with SCC presenting as the initial manifestation of HIV infection in 2 of the 6 patients. In addition. HIV-infected patients were significantly younger than non-infected patients at (p = 0.01). None of the HIV-infected patients had acquired immunodeficiency syndrome (AIDS) at the time of presentation, but 5 of 6 patients had an abnormal CD4 count, compared to none of the non-infected patients (p = 0.05). The absolute CD4 count in HIV-infected patients decreased to less than 100x10(9)/L in the majority of these patients within 3 months of presentation with HNSCC (p = 0.05). Treatment-associated complications were common in HIV-infected patients, occurring in 4 of the 6 cases in contrast to none of the patients without HIV infection (p = 0.046). Outcome was significantly poorer for HIV-Infected patients, with 5 patients succumbing to their disease within one year, in contrast to none of the non-infected patients (p = 0.046). These data, combined with our previous work, justify further investigation of the relationship between HNSCC and HIV infection and the possibility of its inclusion as an AIDS-defining process.

Adult↗
PubMed1999

The impact of comorbidity and age on survival with laryngeal cancer.

Previous studies have evaluated the effects of comorbidity on survival in patients with cancer. We applied the Charlson comorbidity index (CCI) to a cohort of patients with laryngeal cancer to validate its use and to assess the prognostic impact of age. Our study population consisted of 152 patients with laryngeal cancer who were seen over a 10-year period. Patients were assigned CCI scores and were categorized into low- and high-grade comorbidity groups for comparison. Age adjustments were performed by adding 1 point to the Charlson score for each decade over the median age. Low- vs. high-grade comorbidity was a valid predictor of survival independent of TNM (tumor, nodes, and metastases) stage. Low-grade comorbidity was present in 126 patients; their median survival was 41 months. High-grade comorbidity was present in 26 patients; their median survival was 8 months (p = 0.0002). The addition of the age factor to the CCI did not improve our prognostic ability. There was no difference in CCI groups with respect to tobacco and alcohol use, gender, treatment modality, or mean time to recurrence. The incidence and severity of complications were also similar in the two groups. We conclude that the CCI is a strong predictor of survival in patients with laryngeal cancer. The confounding effects of comorbidity should be considered in the TNM staging of laryngeal cancer to improve our prognostic ability. Further investigations are necessary to assess the validity of this index in patients with other head and neck cancers.

Adult↗
PubMed1998

Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma.

BACKGROUND: Comorbid conditions have a significant impact on the actuarial survival of patients with head and neck cancer. However, no studies have evaluated the impact of comorbidity on tumor- and treatment-specific outcomes. This study was performed to evaluate the impact of comorbidity, graded by the Kaplan-Feinstein comorbidity index (KFI) on the incidence and severity of complications, disease-free interval, and tumor-specific survival in patients undergoing curative treatment for head and neck cancer. METHODS: A multi-institutional, retrospective cohort of 70 patients 45 years of age and under with head and neck squamous cell carcinoma (SCC) presenting over an 11-year period was studied. RESULTS: Advanced comorbidity (KFI grade 2 or 3) was present in 21 patients (30%). Patients with advanced comorbidity did not differ from patients with low-level comorbidity (KFI grades 0 or 1) in sex distribution, race, presence of human immunodeficiency virus (HIV) infection, tobacco use, location of primary lesion, stage at presentation, pathologic differentiation of the tumor, or type of initial treatment. The overall incidence of treatment-associated complications was similar between the groups (57% versus 49%; p > 0.05), but a higher proportion of patients with advanced comorbidity developed high-grade complications (24% versus 6%; p = .04). The median disease-free interval (11.1 months versus 21.6 months; p = .045) and tumor-specific survival (13.7 months versus 57.6 months; p = .03) was poorer for patients with advanced comorbidity. The effects of comorbidity on survival remained significant even after adjusting for the confounding effects of HIV status and tumor stage (p = .05). CONCLUSIONS: The presence of comorbid conditions has a significant impact on tumor- and treatment-specific outcomes. Although the presence of advanced comorbid conditions is not associated with an increase in the rate of treatment-associated complications, complications tend to be more severe in this population. More importantly, advanced comorbidity has a detrimental effect on the disease-free interval and tumor-specific survival in patients with head and neck cancer, independent of other factors. This suggests that comorbidity may impact on tumor behavior, presumably by altering the host's response to cancer. Accordingly, to be more predictive and reliable, the current staging system for head and neck cancer should include a description of the patient's comorbidity.

Adult↗
PubMed1998

Isolated cervical tuberculosis in patients with HIV infection.

OBJECTIVE: Tuberculosis isolated to the head and neck region is common in patients with HIV infection. However, the management of isolated head and neck tuberculosis has not been reported in the literature. This study was done to describe the characteristics of tuberculosis isolated to the head and neck region in patients infected with HIV and to detect differences in presentation and diagnostic management based on the status of HIV infection at presentation. METHODS: A retrospective study was performed including 38 patients infected with HIV who were seen with tuberculosis isolated to the head and neck region at two tertiary care centers during a 10-year period. These patients were divided into two groups on the basis of the HIV status at presentation, which indirectly reflects the level of immunosuppression. Group 1 included 11 patients (29%) with AIDS at presentation. Group 2 included 27 patients (71%) with HIV infection but not AIDS. RESULTS: The cervical lymphatics were the most common site for isolated head and neck tuberculosis (89%), with the supraclavicular nodes most often involved (53%). Extralymphatic involvement was less common (11%), but involved a variety of anatomic locations (skin, spinal cord, larynx, parotid). The presenting history and physical examination had a low sensitivity for tuberculosis in patients with HIV infection, mainly because of the presence of multiple confounding factors. Purified protein derivative testing was highly sensitive for tuberculosis in patients with HIV infection alone (61 %); however, its usefulness was diminished in patients with AIDS (14%; p=0.03). Fine-needle aspiration biopsy was 94% sensitive for diagnosing tuberculosis and was not affected by the status of HIV infection. Surgical biopsy was the gold standard for diagnosing tuberculosis but was associated with chronically draining fistulas in a significant number of cases (14%). CONCLUSIONS: These data suggest that tuberculosis should be considered in the differential diagnosis of all head and neck lesions in patients infected with HIV, even in the absence of pulmonary involvement. Purified protein derivative testing should be done liberally in these patients, with realization that the sensitivity of purified protein derivative testing is reduced in patients with AIDS. Fine-needle aspiration biopsy should be the key diagnostic test in this patient population, with open surgical biopsy reserved for highly suspicious cases in which other measures were not diagnostic.

Adult↗
PubMed1998

Presentation, course, and outcome of head and neck skin cancer in African Americans: a case-control study.

BACKGROUND: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. METHODS: Retrospective case-control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin-American patients with skin cancer. RESULTS: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African-American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non-sun-exposed regions, the ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease-free interval was similar to the control group. Only the margin status was a significant predictor of disease-free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58-18.24) CONCLUSIONS: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non-sun-exposed regions.

Black or African American↗
PubMed1997

Sinus mucoceles: is marsupialization enough?

Traditional teaching in the United States has emphasized the need for complete removal of sinus mucoceles to achieve a cure. In Europe, however, many rhinologic surgeons have been treating sinus mucoceles by draining and marsupializing them. We present our experience with the treatment of 16 patients with sinus mucoceles. This series includes nine frontal, two ethmoid, two sphenoid, one sphenoethmoid, and two maxillary sinus mucoceles. All patients were treated transnasally under telescopic control. All mucoceles were marsupialized, and 11 were stented. Intraoperative transillumination as well as intraoperative lateral x rays (for sphenoethmoid lesions) and anteroposterior x rays (for frontal mucoceles) were used to ensure complete marsupialization of the lesion and to confirm proper placement of the stent. There were no complications associated with the procedure. Follow-up periods ranged from 8 to 62 months (median, 32 months). No evidence of recurrent mucocele has been seen in any of the patients.

Adult↗
PubMed1997

Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study.

Comorbid conditions are medical illnesses that accompany cancer. The impact of these conditions on the outcome of patients with head and neck cancer is well established. However, all of the comorbidity studies in patients with head and neck cancer reported in the literature have been performed using the Kaplan-Feinstein index (KFI), which may be too complicated for routine use. This study was performed to introduce and validate the use of the Charlson comorbidity index (CI) in patients with head and neck cancer and to compare it with the Kaplan-Feinstein comorbidity index for accuracy and ease of use. Study design was a retrospective cohort study. The study population was drawn for three academic tertiary care centers and included 88 patients 45 years of age and under who underwent curative treatment for head and neck cancer. All patients were staged by the KFI and the CI for comorbidity and divided into two groups based on the comorbidity severity staging. Group 1 included patients with advanced comorbidity (stages 2 or 3), and group 2 included those with low-level comorbidity (stages 0 or 1). Outcomes were compared based on these divisions. The KFI was successfully applied to 80% of this study population, and the CI was successfully applied in all cases (P < 0.0001). In addition, the KFI was found to be more difficult to use than the CI (P < 0.0001). However, both indices independently predicted the tumor-specific survival (P = 0.007), even after adjusting for the confounding effects of TNM stage by multivariate analysis. Overall, the CI was found to be a valid prognostic indicator in patients with head and neck cancer. In addition, because comorbidity staging by the CI independently predicted survival, was easier to use, and more readily applied, it may be better suited for use for retrospective comorbidity studies.

Adult↗
PubMed1997

Complications associated with 327 foreign bodies of the pharynx, larynx, and esophagus.

We intended to identify the types and incidence of complications associated with foreign bodies (FBs) impacted in the upper aerodigestive tract (UADT) and to ascertain factors predisposing to the development of these complications. The design was a retrospective cohort study of 327 patients with UADT foreign bodies admitted to a tertiary care center. The overall incidence (7.6%) and types of complications varied by age. Complications developed in 4.8% of 208 patients 10 years of age and under, with pulmonary complications being most common. In contrast, complications occurred in 12.6% of 119 older patients, with retropharyngeal abscess being the most common (p < .0001). Delayed presentation (> 24 hours after the onset of symptoms) was the only factor associated with an increase in the incidence of complications in the younger patients (p = .02). In contrast, pharyngeal location of the FB (p = .0004), the FB's being a fish bone (p = .006), and radiolucency (p = .02) were all associated with an increased incidence of complications in patients over 10 years of age. A significant risk for complications is present for patients admitted for the management of FBs in the UADT. Older patients with sharp FBs are at greatest risk. In this group of patients, close observation in the perioperative period is required, especially if there is evidence of mucosal injury.

Adolescent↗
PubMed1997

Swallowing and pharyngeal function in postoperative pharyngeal cancer patients.

This study examines the pharyngeal phase of swallowing after the resection of pharyngeal cancer, and focuses on the pharynx as a functional organ. The purpose of the study was to obtain information on both reconstruction and rehabilitation in cases of surgically treated pharyngeal cancer. The records of 21 consecutive patients who underwent surgical treatment of oropharyngeal and hypopharyngeal squamous cell carcinoma between 1990 and 1993 were reviewed. Functional results following surgery were graded on a numerical scale in three categories: pharyngeal swallow, laryngeal and lower airway protection, and oral alimentation. Three treatment groups were observed: group 1 = transoral excision with primary closure (six patients); group 2 = composite resection with primary closure (nine patients); and group 3 = composite resection with deltopectoral or pectoralis major flap closure (six patients). Comparison of pharyngeal swallow and laryngeal protection functions showed no significant difference between the three groups. However, oral alimentation performance in group 1 was significantly better than in group 3, and groups 1 and 2 achieved a similar level. In patients with T3 and T4 tumors postoperative function was poor and no difference in postoperative function was demonstrated between patients undergoing reconstruction with primary closure and patients undergoing reconstruction with deltopectoral or pectoralis major flaps. Patients with T3 and T4 tumors experienced impaired postoperative function regardless of the method of reconstruction used. This is not a condemnation of the surgical treatment of advanced pharyngeal tumors, but rather a suggestion that other reconstruction techniques be considered.

Aged↗
PubMed1996

Upper aerodigestive tract squamous cell carcinoma. The human immunodeficiency virus connection.

OBJECTIVE: To evaluate the incidence, distribution, and course of squamous cell carcinoma (SCC) of the upper aerodigestive tract in patients infected with the human immunodeficiency virus (HIV) and compare it to SCC in non-HIV-infected patients. DESIGN: Case-control study of all patients with SCC during a 9.5-year period from January 1985 through June 1994. SETTING: Two academic tertiary care centers in a metropolitan location. PARTICIPANTS: Five hundred thirty-nine patients (18 to 95 years old) with SCC of the upper aerodigestive tract. RESULTS: Infection with HIV was present in 4.5% of the patients with SCC of the upper aerodigestive tract. Patients infected with HIV were significantly younger than noninfected patients (P < or = < .001), accounting for 21.3% of those patients younger than 45 years (P < .001). No significant difference in tumor location was present between HIV-infected and noninfected patients; however, HIV-infected patients had larger tumors (P = .004) and a more advanced tumor stage (TNM classification) at presentation (P = .05). Tumor-related survival was significantly poorer in patients with HIV infection (P = .01), with 57% at 1 year and 32% at 2 years, compared with 74% and 59%, for non-HIV-infected patients. The detrimental effect of HIV infection on survival remained significant after adjusting for the confounding effects of age, tumor stage, and location of the tumor. All study patients with HIV infection had cancer risk factors such as tobacco and/or alcohol abuse. CONCLUSIONS: Infection with HIV possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms. The decreased survival rates among these patients suggests that the SCC may be more aggressive or that other cofactors assume greater importance. A history of tobacco and/or alcohol abuse in patients with HIV infection warrants aggressive screening and early detection, to allow for early detection, which may help increase survival.

Adolescent↗
PubMed1996

Rapid intraoperative facial nerve expansion.

The repair of nerve length defect presents a reconstructive challenge after trauma and oncologic resection. This study examined rapid intraoperative nerve expansion as a method of repairing nerve length defects with the cat facial nerve model. We compared expanded nerves with grafted nerves and intact nerves 1 year after repair using the criteria of gross function (symmetry and blink reflex according to a modified House scale), electromyography thresholds, nerve-conduction velocity, morphology, and axon count. Three of the five expanded nerves regenerated, and all of the grafted nerves regenerated. Functional results were similar for the regenerated expanded and the grafted facial nerves, and both methods achieved an equivalent level of function. The facial nerves of the regenerated expanded group, grafted group, and intact group had mean electromyography thresholds of 132 mV, 98 mV, and 134 mV, respectively, and mean conduction velocities of 48.3 mg/second, 47.9 m/second, and 44.7 m/second, respectively. Morphologic examination of all five expanded nerves immediately after the expansion process revealed an intact fascicular structure. However, 1 year after excision of the expanded segment and repair, only three of the five nerves regenerated. Axon count at 1 year was as follows: 404 for the regenerated expanded nerves, 449 for the grafted nerves, and 403 for the intact nerves. The potential advantages of rapid intraoperative nerve expansion over nerve grafting for the repair of nerve gap defects include a single suture line and absence of donor site morbidity. This pilot study demonstrates that rapid intraoperative nerve expansion and regeneration is possible and can be used to repair a nerve length deficit. The development of a rapid and reliable method of intraoperative nerve expansion deserves further study.

Animals↗