Frontal sinus obliteration.
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Frontal Sinus↗
Biomedical subjects
H B Neel
Publications and source records attributed to H B Neel.
Early glottic carcinoma treated with open laryngeal procedures.
OBJECTIVE: The purpose of this study was to determine the recurrence rate and long-term survival of patients treated with open cervical procedures. DESIGN: The study is a retrospective analysis of a cohort of patients who underwent an open laryngeal procedure between 1976 and 1986. The median follow-up was 6.6 years. PATIENTS/PARTICIPANTS: The sample was a consecutive series of 159 patients with early glottic carcinoma without impaired vocal cord mobility. Patients with a history of radiation therapy or surgical treatment elsewhere were excluded. INTERVENTION: Surgical treatment in this group of 159 patients included 82 frontolateral partial vertical laryngectomies, 61 laryngofissures with cordectomy, 12 hemilaryngectomies, and four anterior commissure procedures. OUTCOME MEASURE: Estimates of survival time beyond the day of surgery, time to first recurrence (local, regional, and distant), and time to first local recurrence were obtained with the Kaplan-Meier product-limit method. RESULTS: Eleven patients experienced recurrent laryngeal cancer. Ten patients underwent laryngectomy for recurrence. One patient underwent an anterior commissure procedure. Three of the 11 patients who underwent re-treatment of the larynx were ultimately salvaged. The probability of survival at 3 and 5 years was 91% and 84%, respectively. The probability of remaining free of local recurrence 3 and 5 years after surgery was 94% and 93%, respectively. CONCLUSION: In our experience, open laryngeal procedures continue to be excellent treatment for select cases of early glottic carcinoma. They are versatile and efficacious for managing the wide spectrum of larger T1 glottic carcinomas.
Adult↗
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↗
Recurrences after endoscopic management of early (T1) glottic carcinoma.
From 1976 to 1986, 106 patients with early glottic carcinoma were managed endoscopically at our institution. Twenty-four (23%) patients required retreatment of the larynx for local recurrences or new primary lesions after initial endoscopic management. The probability of remaining free of local recurrence 3 years after primary surgery was estimated to be 0.87 and, after 5 years, it was 0.81. Of the 24 patients who required re-treatment of their larynx, 10 did so beyond 3 years, indicating a new second primary. In 1 patient who required retreatment within 3 years, a new primary developed on the opposite cord. Therefore, true local recurrences developed in 13 patients (12.3%); 3 of these patients (2.8%) ultimately required laryngectomy and 3 are dead (2.8%) with disease.
Adult↗
Blastomycosis in otolaryngology: review of a large series.
Blastomycosis is a fungal disease whose signs, symptoms, and roentgenographic findings may suggest pneumonia, cancer, tuberculosis, or other fungal infections. Blastomycosis has a variable clinical course; it primarily affects the lower respiratory tract, although extrapulmonary manifestations are common. To determine the frequency of head and neck manifestations, we reviewed the records of patients with blastomycosis seen at the Mayo Clinic from 1960 to 1990 and found that involvement of the skin and mucosal surfaces, including the larynx, was common. Gross and histopathologic features of the lesions often resemble those of well-differentiated squamous cell carcinoma; thus, overly aggressive therapy may be mistakenly instituted. The clinical features, morphologic findings, and diagnosis of blastomycosis are discussed, and the importance of obtaining and handling specimens correctly is emphasized.
Blastomycosis↗
Nasopharyngeal carcinoma: diagnosis, staging, and management.
Nasopharyngeal carcinoma is a common tumor in several parts of the world, accounting for approximately 18% of cancers in Chinese populations, but is an uncommon tumor in whites. Genetic, environmental, and viral factors all seem to have a part in the genesis. Its various forms have been classified by the World Health Organization (WHO) into three histologic categories, all of which can be identified as squamous cell carcinomas by electron microscopy. The WHO types 2 and 3 tumors are associated with Epstein-Barr virus. Nasopharyngeal carcinoma most often arises in the fossa of Rosenmueller and the most common presenting signs are a lump in the neck and serous otitis media. External beam-supervoltage irradiation is the standard therapy, with surgery having a limited role. A new staging system has been proposed that predicts risk of death better than the TNM system. Evidence indicates two distinct types of nasopharyngeal carcinoma--WHO type 1 and the combined WHO types 2 and 3.
Carcinoma↗
Resident work hours and working environment in otolaryngology. Analysis of daily activity and resident perception.
OBJECTIVE: --To analyze the working environment and work hours of a cohort of otolaryngology--head and neck surgery residents. DESIGN: --Environmental analysis questionnaire and a log of daily activities. SETTING: --Residents were on a clinical rotation system. PARTICIPANTS: --Fifty-nine residents from six programs, including three public and three private institutions, from geographically diverse regions of the country were involved in the study. Residents were equally distributed from their second year through their fifth year of postgraduate work. All eligible residents participated in and completed the study. INTERVENTION: --The environmental analysis survey was designed to elicit resident perception of different aspects of their working environment. The daily activity log required the resident to report on activities for each half-hour period for 7 consecutive days. RESULTS: --Residents were on call an average of 52.8 hours (2.2 days) and worked 79.4 hours per week. Seventy-five percent believed that the level of faculty supervision and the degree of resident responsibility was about right. Two major inefficiencies were the time involved in completion of paperwork and the lack of nonmedical support services. Thirty-one percent of the residents responded that fatigue resulted in substandard patient care 10% of the time. Forty-seven percent responded that their educational experience was substandard 25% of the time secondary to fatigue. Two thirds responded that the demands of residency training had a negative impact on their family and personal life. CONCLUSIONS: --Seventy percent of the otolaryngology--head and neck surgery residents surveyed at six institutions believe that an 80-hour workweek, including being on call every third night with no more than 24 hours of continuous work without sleep, approximates a reasonable, maximum work schedule. Residents working the longest hours expressed concern about rendering substandard care and developing negative attitudes toward patients. Noneducational inefficiencies were identified and solutions were proposed. Demands of residency training, even within guidelines established as reasonable, can have detrimental effects on residents' educational activities and personal life.
Attitude↗
[Laryngeal dissection with chordectomy and vertical laryngeal resection].
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Carcinoma, Squamous Cell↗
Epstein-Barr virus-related antibody. Changes in titers after therapy for nasopharyngeal carcinoma.
Using long-term follow-up data from a prospective, collaborative study of 182 North American patients, we evaluated the significance of various serologic tests for antibody to Epstein-Barr virus in predicting outcome after treatment in patients with nasopharyngeal carcinoma. We restudied these patients by examining repeated measurements of each titer at various times after diagnosis and treatment. We looked for associations between trends of titers, measured as the slope of log(titer) against time, and titer level, measured as the mean of log(titer), with the outcome: alive and no evidence of disease; alive with recurrence; or dead of nasopharyngeal carcinoma. We found that posttreatment sequential measurements do not predict outcome.
Antibodies, Viral↗
Proliferation and differentiation characteristics of normal human squamous mucosal cells of the upper aerodigestive tract.
Normal human squamous mucosal cells of the soft palate, buccal surface, epiglottis, hypopharynx, floor of the mouth, and tongue were cultured in vitro in serum-free medium. In medium MCDB 153 containing epidermal growth factor, insulin, bovine pituitary extract, and 0.1 or 2.0 mmol/L Ca++, squamous mucosal cells double every 24 hours. These cells then can be induced to arrest their proliferation reversibly by treatment with transforming growth factor-beta or ethionine, and they can irreversibly growth-arrest during senescence or when cultured in growth factor-deficient medium containing 2 mmol/L Ca++. The latter medium also induces differentiation, as does culture of cells in serum-containing medium. Serum-containing medium furthermore promotes extensive cell stratification and the formation of multilayered squamous mucosal tissue specimens that can be removed intact by Dispase treatment. These specimens represent potential autogenous mucosal grafts that can be used in patients who require reconstructive surgery of the oral cavity and oropharynx. Normal human squamous mucosal cells therefore closely resemble keratinocytes derived from the epidermis in the mechanisms that regulate proliferation and differentiation. This model cell system should facilitate future studies on upper aerodigestive tract squamous mucosal cell physiology and pathophysiology.
Calcium↗
Effect of bleomycin on hematoporphyrin derivative phototherapy of solid tumors.
Hematoporphyrin derivative phototherapy (HpD-PT) has been successfully used to localize and treat superficial squamous cell cancers. Bleomycin sulfate is a glycopeptide antibiotic that has antineoplastic properties against squamous cell cancers. Because both HpD-PT and bleomycin chemotherapy are accepted forms of treatment for squamous cell cancer and their cytotoxicity is mediated by singlet oxygen and oxygen radicals, we studied the possibility of enhancing the response of solid tumors to HpD-PT by combining this modality with systemic bleomycin chemotherapy in a murine tumor model. Bleomycin did not enhance HpD-PT significantly. Also, we are not confident that HpD-PT alone or in combination with other agents can eradicate solid tumors; it certainly did not in this syngeneic murine tumor model.
Animals↗
New staging system for nasopharyngeal carcinoma. Long-term outcome.
We report prognostic determinants and survival found after a long follow-up of 182 patients in North America in a prospective collaborative study. All patients were under observation since enrollment, and all were treated with modern equipment and techniques at major medical centers. Use of Cox regression methods identified five disease-related characteristics significantly associated with survival. These form the basis of the new staging system. A second system including antibody-dependent cellular cytotoxicity was developed because a high antibody-dependent cellular cytotoxicity titer correlated with good prognosis. The two new systems are better predictors of outcome than are the traditional staging systems. The unique World Health Organization 2 and 3 morphologic forms of nasopharyngeal carcinoma appear to be chronic diseases, because the risk of death does not level off with time, as it does for most other cancers.
Adult↗
Choanal atresia: treatment trends in 47 patients over 33 years.
From 1977 through 1985, 11 patients underwent surgical correction of choanal atresia. This group brings the total number of patients corrected at our institution since 1951 to 47. This review compares treatment and outcome in the most recent group with the previous series of 36 patients. Eight patients were female and three were male; their ages at the time of surgical treatment ranged from 1 day to 19 years. The atresia was bilateral in five patients and unilateral in six. Six patients had other physical or mental developmental problems. Mean follow-up was 5.6 years (range, 2 to 10 years). All five patients who had transnasal puncture as primary treatment required reoperation; this is a higher incidence of failure than in the previous group. None of the three patients who had transpalatal procedures needed further operation. In two of the eight patients who had transseptal repair, restenosis developed.
Adolescent↗
Head and neck surgery and cancer in aging patients.
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Aged↗
Progesterone receptors in carcinomas of the upper aerodigestive tract.
This study had three major goals: (1) to vigorously verify the presence of progesterone receptors in squamous cell carcinoma of the upper aerodigestive tract (HN-SCC). Antiprogesterone receptor monoclonal antibodies revealed a distinct band at approximately 120 kilodaltons in samples taken from two of four patients with HN-SCC. These results illustrate that progesterone receptor in HN-SCC has the same molecular weight as progesterone receptor in normal human uterus and human breast cancer. Steroid specificity and saturability results support the evidence that it is true progesterone receptors that are measured and not other receptors or sex steroid-binding globulins; (2) to confirm the biochemical function of progesterone receptors in HN-SCC by assessing the binding of progesterone receptor to acceptor sites on chromosomes in the nucleus; and (3) to establish the clinical significance of progesterone receptor measurement. Patients with positive assays were more likely to be free of disease a mean of 6 months after resection. We used logistic regression to account for site of primary disease, grade of tumor, and stage of disease. This logistic regression was significant with a p = 0.014. Patients with a binding index greater than 2 (19 of 73 patients) were 4.34 times more likely to be free of disease than patients with negative assays.
Adult↗
Should video-endoscopic documentation be the new standard in office laryngeal examination?
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Ambulatory Care↗
Modified Lynch procedure for chronic frontal sinus diseases: rationale, technique, and long-term results.
The modified Lynch operation (Neel-Lake) differs in several ways from the operation described by Lynch. The operation begins with an intranasal anterior ethmoidectomy. The agger nasi cells are removed by curetting forward between the frontal process of the maxilla and the septum. The middle turbinate, normal-appearing mucosa of the frontal-ethmoid complex, and frontal process of the superior maxilla are preserved. Bone removal is limited in most cases to the anterior floor of the frontal sinus, a portion of the lacrimal bone, and the bone over the anterior ethmoid cells. Another important difference is the use of soft, nonreactive material (thin Silastic sheeting) to stent the nasal-frontal passageway. Removal of all the mucosa of the frontal-ethmoid-sphenoid complex is unnecessary for a good postoperative result, and the remaining normal mucosa hastens the process of reepithelialization of the nasal-frontal duct. The patients in our original study group have been observed for a period of 5 to 20 years (mean, 13.5 years) after the surgical procedure. This is the longest period of follow-up for any group of patients reported in the literature. The incidence of failures increased from 7% (one duct) to 20% (3 of 15 ducts) after an additional 7 years of follow-up.
Adolescent↗
A new assay to assess steroid-hormone responsiveness in head and neck cancer.
A new assay has been developed to predict the effectiveness of steroid-hormone therapy in various tumors. The Biopsy Nuclear Binding assay measures the amount of biologically active receptor that binds both steroid hormone and acceptor sites in the nucleus. This assay does not measure the entire receptor population, only those that are biologically active; therefore, it should more accurately predict the response to steroid-hormone therapy. We applied this assay effectively in breast and endometrial carcinoma. Preliminary studies have shown that 40% of patients with head and neck squamous-cell carcinomas have biologically active (nuclear bound) progesterone receptors. If nuclear binding predicts a remission with hormonal therapy, then the quality of life of appropriately selected patients could greatly improve.
Androgen Antagonists↗