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Biomedical subjects

H B Neel

Publications and source records attributed to H B Neel.

At least 37 records · Page 2Linked to original sources
PubMed1987

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↗
PubMed1987

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↗
PubMed1986

Juvenile angiofibromas. Behavior and treatment of extensive and residual tumors.

In a 15-year period, 40 juvenile angiofibromas were treated surgically (lateral or extended rhinotomy) at the Mayo Clinic, Rochester, Minn. Tumors were staged according to size and extension by using the Sessions classification. Stage III tumors involved the middle fossa or cavernous sinus or both structures, with or without extension into the orbit. Seven patients had stage I, ten had stage IIA, and six had stage IIB disease. Five tumors extended to the skull base (stage IIC). There were 12 cases that included intracranial extension (stage III), none of which involved the sella. There were eight cases with residual tumor: four (stages IIB [one], IIC [one], and III [two]) were not treated again, and four (stage III) were treated with various methods, including operation, embolization, and irradiation. No patient died. No complications or morbidity was experienced by the four patients who were not treated for residual tumor.

Follow-Up Studies↗
PubMed1986

Pain-inducing laryngeal paraganglioma: report of the ninth case and review of the literature.

There are two distinct forms of laryngeal paraganglioma. The patient with the rare Type II has exquisite throat pain that is often clinically confusing. The small size or submucosal location of the lesion often results in a delay in correct diagnosis and treatment. The lesion is very aggressive, even if tiny, generally with widespread metastasis. This tumor should be considered in the differential diagnosis of severe persistent throat pain, especially in the absence of abnormalities on physical or radiologic examination.

Humans↗
PubMed1986

Angiofibroma: treatment trends in 150 patients during 40 years.

A series of 150 patients with histologically confirmed angiofibroma examined from 1945 through 1983 was studied to contrast treatment methods and surgical approaches. From 1945 to 1955, treatment consisted primarily of radiation. From 1955 through 1971, the primary method of treatment was surgical removal; the lateral rhinotomy approach was used to expose the tumor and its extensions in most cases. From 1971 through 1983, all tumors were removed surgically. Trends in diagnosis, treatment, and adjunctive therapy at a single institution were evaluated. Specifically, the trends considered were operative approaches, blood replacement with and without hypotensive anesthesia, adjunctive measures such as hormonal therapy or tumor embolization, mortality, and morbidity. Lateral rhinotomy provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, elements of the skull base, temporal fossa, and infratemporal fossa. Surgical treatment, specifically the lateral rhinotomy approach and its extensions, is recommended as the best method of managing angiofibroma in most patients.

Adolescent↗
PubMed1986

A prospective evaluation of patients with nasopharyngeal carcinoma: an overview.

One hundred and eighty-two patients in North America with nasopharyngeal carcinoma underwent initial and interval estimations of serum viral capsid antigen (VCA) and early antigen (EA), and the sera were also titrated for antibody to the Epstein-Barr virus induced membrane antigen complex by using the antibody-dependent cellular cytotoxicity (ADCC) assay. The serologic findings differentiated the World Health Organization (WHO) type 1 tumors (keratinizing squamous cell carcinomas) from the WHO types 2 and 3 tumors (nonkeratinizing and undifferentiated carcinomas) which were often small, submucosal and hard to detect. Prospective evaluation of the predictive value of staging variables has shown that the extent of tumor within the nasopharynx, involvement of lower neck nodes, WHO tumor type, ADCC titer, the number of symptoms and the patient's age are the most important.

Antibodies, Viral↗
PubMed1985

Nasopharyngeal carcinoma. Clinical presentation, diagnosis, treatment, and prognosis.

Serologic testing is a useful diagnostic aid for patients with NPC, particularly those in whom the tumors are small and submucosal (difficult to see or occult). If a metastatic tumor is found in the neck but its primary source is occult, positive titers provide reason for a detailed investigation of the nasopharynx, including a thorough examination with the patient under anesthesia and a random biopsy procedure. This approach can spare the patient a biopsy of neck nodes. Dickson compared two groups of patients with NPC metastatic lesions in the neck--the only difference between the groups was that the patients in one group had undergone a neck biopsy before radiation treatment--and found a somewhat poorer survival rate in the biopsied group. A large body of clinical evidence, histopathologic data, and, more recently, immunologic studies support the concept that carcinomas of the nasopharynx constitute two distinct diseases. Today, these are classified as WHO type 1 tumors (according to previous terminology, the "keratinizing, squamous cell carcinomas") and combined WHO type 2 and 3 tumors (the "combined grade 4 undifferentiated carcinomas," which are mostly the lymphoepitheliomas and transitional cell carcinomas in previous terminology). Clearly, the anti-EBV serologic findings separate the WHO type 1 tumors from the WHO type 2 and 3 tumors. The serologic findings in the former group are essentially the same as those in control groups, and the WHO type 1 tumors can be considered the "common garden variety" of squamous cell carcinomas found in other areas of the head and neck region. Furthermore, the WHO type 2 and 3 tumors occur at an earlier age; disease-free periods after treatment are longer; survival after treatment is better; and early and advanced neck metastasis is more common. In addition, primary WHO type 2 and 3 tumors in the nasopharynx are more often small, submucosal, and sometimes difficult to detect; indeed, they may be clinically occult. The tumors seem to be more radiation-sensitive than the WHO type 1 carcinomas, which are more likely to recur or persist in the nasopharynx after treatment.

Antigens, Viral↗
PubMed1985

Lymphoepithelioma (undifferentiated carcinoma) of the laryngohypopharynx.

Lymphoepithelioma (World Health Organization type 3, undifferentiated carcinoma of the nasopharyngeal type) is an extremely rare cancer in the laryngohypopharyngeal regions. We found reports of only 6 such tumors in the English language medical literature; 1 of the 6 was from our institution. We report four additional cases seen at the Mayo Clinic. Radiotherapy controlled disease at the primary site in three of the four cases. The neoplasm has a propensity for early, widespread dissemination. Three of our four patients died of extensive visceral and nodal metastases. One patient has survived eight years without a recurrence.

Carcinoma, Squamous Cell↗
PubMed1984

Antibody-dependent cellular cytotoxicity and disease course in North American patients with nasopharyngeal carcinoma: a prospective study.

It has previously been reported that antibody-dependent cellular cytotoxicity (ADCC) levels determined at diagnosis against Epstein-Barr virus (EBV)-specific membrane antigens (MA) are predictive of disease course following therapy in patients with nasopharyngeal carcinoma (NPC). In general, survival was significantly shorter following therapy in patients with low ADCC titers at diagnosis versus those with high titers. To examine this further, a prospective study on North Americans with different histopathological types of this disease was initiated approximately 5 years ago. The results to date tend to support the conclusions drawn from the retrospective study for patients with the more poorly differentiated types (WHO 2 and WHO 3) of this disease. Over the first 3 years of this study, approximately 75% of the patients in the "high" category have remained clinically disease-free for 3 years or longer as opposed to approximately 35% of the patients in the "low" group. Disease progression rates were calculated to be approximately four times higher in the low group. Similar trends were noted in actual survival rates over a 3-year period. ADCC titers were in general found to be relatively stable in sequential serum samples from the same patient, with some exceptions. With the exceptions, however, changes in ADCC titers also reflected disease course. These results indicate, therefore, that anti-EBV ADCC titers are predictive of disease course in patients with the poorly differentiated types of NPC.

Actuarial Analysis↗
PubMed1984

Antibody-dependent cellular cytotoxicity. Relation to stage and disease course in North American patients with nasopharyngeal carcinoma.

A prospective study of North American patients, mostly white, with different histopathologic types of nasopharyngeal carcinoma was initiated approximately five years ago. Several anti-Epstein-Barr virus (EBV) serologic tests are being evaluated; one is the antibody-dependent cellular cytotoxicity (ADCC) assay, which measures antibodies to an EBV-induced membrane antigen component. A low ADCC titer at diagnosis reflects a poor prognosis, and the determination of antibody titers by this assay identifies patients in whom recurrent disease is likely to develop after conventional radiation therapy for World Health Organization types 2 and 3 carcinomas. Of the patients who had high ADCC titers at diagnosis, 80% survived three years or longer, whereas 50% of the patients with low titers survived three years, and only 35% survived five years. High and low ADCC titers were seen in all stages (except in Ho stage V), and the distribution of patients by high and low ADCC titers was similar in each of the stage groupings. We conclude that the ADCC titer at the time of diagnosis is generally predictive of the prognosis. Clinical staging is the traditional approach for predicting prognosis, but determination of the ADCC titer can be used to segregate patients within the stage groups into those with "good" and "poor" prognoses. Serologic testing may eventually become one of the methods for staging patients with WHO types 2 and 3 nasopharyngeal carcinoma.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1984

Fungal sinusitis in healthy and immunocompromised individuals.

Clinical and microbiologic aspects of fungal sinusitis occurring in six patients are presented. Three of the six patients were immunosuppressed. Fatal disseminated fungal disease developed in two of those immunosuppressed. The three patients with normal immune function had fungal infections confined to the nasal sinuses. Aspergillus fumigatus and Aspergillus flavus were recovered from the immunosuppressed patients and Sporothrix schenckii, Alternaria species, and Pseudallescheria boydii were recovered from the immunocompetent patients. Surgical debridement was performed on all patients; however, anti-fungal therapy only was prescribed in patients who were at risk of progressive fungal disease. The microbiology laboratory aids in the diagnosis of fungal sinusitis by examining surgical biopsy material for fungal organisms and by culturing the material for recovery of the fungal pathogen.

Adult↗
PubMed1984

The effect of cooling on the photodynamic action of hematoporphyrin derivative during interstitial phototherapy of solid tumors. 1983 Second-Place Resident Research Award: basic category.

Hematoporphyrin derivative (HpD), a mixture of compounds chemically prepared from naturally occurring crude hematoporphyrin, is preferentially concentrated in neoplastic cells and produces red fluorescence when irradiated with blue-violet light. In addition, HpD exhibits other photodynamic properties, which, in the presence of oxygen and visible light, result in cytotoxicity. Preliminary reports indicate that early, superficial carcinomas of the upper aerodigestive tract and tracheobronchial tree can be localized and treated successfully with HpD phototherapy (HpD-PT), in which a fiberoptic bundle transmits laser light to the tumors. To assess this modality's potential for treating solid tumors, the cytotoxic effect of HpD-PT was measured in a murine tumor model. We specifically assessed the effect of cooling on the pure photodynamic action of HpD-PT. Adult female mice with typical mammary tumors received interstitial phototherapy 24 hours after HpD was given intraperitoneally. Light from an argon-dye laser was delivered through an optical fiber, along with simultaneous cooling from a cryosurgical probe, for 15 minutes. After being cooled with a cryosurgical probe, tumors were excised 48 hours after treatment and the necrotic area was measured. The results indicate that cooling enhances the tumoricidal action of HpD-PT.

Adenocarcinoma↗
PubMed1983

Application of Epstein-Barr virus (EBV) serology to the diagnosis of North American nasopharyngeal carcinoma.

A cooperative study was established among a number of institutions in the USA to determine the clinical value of Epstein-Barr virus (EBV) serology for the diagnosis of different histopathological types of North American nasopharyngeal carcinoma (NPC) including occult primary tumors. One hundred-twenty-four patients with confirmed NPC have now been entered into the study. For each patient, anti-EBV antibody titers were determined at diagnosis and related to the histopathology as classified according to the World Health Organization (WHO). The results suggest that certain anti-EBV antibodies are of potential value for the diagnosis of undifferentiated types of NPC but not for the well-differentiated cancer. The IgA anti-VCA antibody response is the most specific for this disease and of the greatest diagnostic value when used alone or in combination with the anti-EA test. These tests have also been used successfully for the detection of occult NPC. These results indicate that these tests can be useful aids to the clinician for the diagnosis of certain histopathologic types of this disease.

Antigens, Viral↗
PubMed1983

Blastomycosis of the larynx.

Blastomycosis is a chronic fungal disease with a constellation of signs and symptoms and a variable course. It primarily affects the lower respiratory tract, although extrapulmonary manifestations are common. We describe 6 patients with blastomycosis of the larynx who represent 5.6% of 107 patients with blastomycosis seen at the Mayo Clinic from 1950 through 1981. When involvement of the larynx occurs, both gross and histopathologic findings of the lesion usually resemble the features of well-differentiated squamous cell carcinoma and often lead to misdiagnosis and inappropriate, overly aggressive, surgical or radiation therapy. So that this unnecessarily aggressive treatment of the diseased larynx can be avoided, we discuss the clinical features, histopathologic findings, diagnosis, and current forms of treatment of blastomycosis.

Adult↗
PubMed1983

Application of Epstein-Barr virus serology to the diagnosis and staging of North American patients with nasopharyngeal carcinoma.

From 1978 to 1981, 151 patients with nasopharyngeal carcinoma (NPC) were enrolled in a prospective, collaborative study of North American patients, most of them white. Thirty-seven had World Health Organization (WHO) type 1 tumors, and 114 had WHO types 2 and 3 tumors. The anti-Epstein-Barr virus (EBV) profile of elevated antibody titers directed against viral capsid antigen and early antigen was seen in 85% of the patients with WHO types 2 and 3 tumors but in only 16% of the patients with WHO type 1 tumors. Geometric mean titers tended to be higher in higher stages of the disease in several staging systems. Low antibody-dependent cellular cytotoxicity at diagnosis appears to reflect a poorer prognosis, and the determination of antibody titers by this assay may prove to be useful for identifying persons in whom recurrent disease is likely to develop after conventional therapy. Anti-EBV titers can aid in diagnosis and treatment planning in patients with NPC, particularly those with occult primary NPC.

Adolescent↗