Biomedical subjects
Publications and source records attributed to H B Neel.
The series involves 38 patients who had antral-choanal polyps removed at the Mayo Clinic during the 10 year period between 1965 and 1974. In contrast to common nasal polyps, antral-choanal polyps often are solitary and unilateral and usually are not associated with an allergic diathesis. These polyps recur frequently if they are simply avulsed; permanent ablation of the polyps requires thorough curettage of the antrum.
Thirty-five sera from American patients with nasopharyngeal carcinoma were examined for Epstein-Barr virus (EBV)-associated antigens and compared with 85 sera from patients with other head and neck cancers, 80 sera from patients with lymphoma, and 47 sera from healthy control subjects. There was a definite correlation between the presence of nasopharyngeal carcinoma and the level of antibody titers to EBV. In particular, two tests that detected antibody to early antigen and antibody to viral capsid antigen in the serum IgA fraction were highly specific for the presence of nasopharyngeal carcinoma. There was a significant decrease in these antibody titers with clinical remission of the disease in treated patients with nasopharyngeal carcinoma. Clinically, these tests should have important application in the management and follow-up of patients with nasopharyngeal carcinoma.
After extensive evaluation of patients with metastatic neck disease and clinically undetectable primary cancer of the head and neck, the clinician is often faced with the difficult question of subsequent management. In this study, sera from 11 patients with clinically occult carcinoma and metastatic lymphadenopathy were studied for Epstein-Barr virus-associated antigens. These were compared with 35 sera from patients with known nasopharyngeal carcinoma at all stages of disease and treatment and with 212 sera from control patients with other head and neck tumors, patients with lymphoma, and normal controls. There was a significant correlation between high antibody titers to Epstein-Barr virus, especially in the serum IgA fraction, and the presence of nasopharyngeal carcinoma. Thus, identification of occult nasopharyngeal carcinoma by immunologic means may have important application in the selective management of the patient with an unknown head and neck primary malignancy.
There is now extensive immunological, biological and biochemical evidence to support a possible etiological relationship between EBV and NPC in patients from different geographical locations. Besides providing information on the question of etiology, the results from immunological investigations suggest that antibodies to some of the EBV-associated antigens might also be of clinical importance in the diagnosis and prognosis of NPC. To determine the possible clinical application of EBV serology to American NPC, sera from patients seen at the Mayo Clinic and the National Institutes of Health were examined for antibodies to EBV-associated antigens in an effort to identify those parameters which most reliably distinguish NPC from other types of cancer. The results show that high antibody titres to EBV-induced EA and the presence of antibody to EBV antigens in the IgA immunoglobulin fraction were the two most specific discriminating parameters, although neither was infallible. These findings are discussed in relation to future studies that are needed in order to determine the potential clinical value of EBV serology to the diagnosis and prognosis of NPC.
Seroma formation was most apparent in the A-treated groups and was probably related to the continued leakage of methyl alcohol from the graft. Warping in the pinna, fibrosis around grafts, graft resorption, and cellular infiltration were least evident in the FZ and R groups. Both produced better results than storage in BSS or A, but because radiation is far more expensive and less convenient than FZ, the latter is the better preparation and preservation technique.
Plasmacytomas, indistinguishable histologically from plasma cell tumors arising in bone marrow, occur almost anywhere in the body-usually independently of multiple myeloma. Thus, they represent an isolated area of plasmacytic dyscrasia but occasionally can be the first evidence of multiple myeloma. From 1949 to 1974, six patients with solitary extramedullary plasmacytomas of the larynx were seen at the Mayo Clinic; during this period, approximately 3,100 patients with malignant laryngeal neoplasms were examined. For these six patients, the median age was 53 years (range, 32 to 63 years). The first symptom in five patients was hoarseness (mean duration, nine months). Excision, electrocoagulation, irradiation, or some combination of these constituted effective therapy. Follow-up ranged from 3 to 25 years. The choice of therapy depends on the size, shape, and location of the tumor. Extensive surgery is rarely necessary.
Conductive hearing loss due to secretory otitis media is the commonest form of hearing loss in children. Eustachian tube dysfunction is often implicated as the most important factor in the origin and course of the disease. It is well known that myringotomy, aspiration of fluid from within the middle ear, and ventilation with any one of several types of tubes will restore hearing and mobility of the tympanic membrane in the vast majority of patients. The effects of these procedures on Eustacian tube function and on middle ear and mastoid volumes, particularly on a long-term basis, have not been clearly delineated. Thirty-six children (72 ears) with secretory otitis media were studied. During the course of the disease, fluid was aspirated from the middle ear and Silastic ventilation tubes were inserted. Hearing levels, tympanogram type, middle ear volume, and Eustachian tube function were determined before and after operation. After myringotomy, aspiration of fluid, and ventilation, we found that (1) middle ear volume progressively increased during a period of three to eight months after operation; (2) Eustachian tube function remained abnormal while ventilation tubes were in place, and (3) hearing was restored to normal levels.
Experiments were designed to assess 1) relative immunity after adoptive transfer of spleen cells or serum from tumor-bearing mice to untreated syngeneic mice, and 2) the degree of tumor-specific transplantation immunity imparted by cells or serum relative to tumor size and the presence of metastases in the donor at the time of spleen cell or serum transfer or after in situ necrosis of the primary tumor by cryosurgery in a CDF1-sarcoma system. Viable lymphoid spleen cells or serum from normal mice had no effect on tumor growth. Serum from mice that had large tumors and gross metastases induced a protective effect similar to that found after cryosurgery of the primary tumor. Serum from mice with small tumors and spleen cells from animals bearing either small or large tumors failed to induce immunity consistently. In no instance did serum from tumor-bearing mice induce enhancement of tumor growth.
Improvement in tumor-free intervals and cure rates of patients with cancer of the head and neck will almost certainly come from utilization of more than one type of treatment in the same patient. For example, in treatment for formidable lesions this might take the form of a short course of preoperative chemotherapy followed by surgery. Postoperative chemotherapy might then be employed in preoperative responders, with the addition of radiation according to the usual postoperative indications. Specific or nonspecific immunotherapy might be used on a long-term basis, preoperatively and postoperatively. In selected patients, utilization of multiple modalities early in a careful long-term plan may bring improvement over current results from employment of adjuvant measures only after recurrence or metastatic spread is clinically obvious.
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Cryonecrosis of the upper lobe of the lung and bronchi was safely inudced in healthy dogs by application of the cryoprobe to serosal surfaces or, through a bronchotomy, to the mucosal surfaces under direct vision. Seven days after cryosurgery, hyperemia of the bronchus was seen. By 14 days the bronchus at the target site was covered with cuboidal epithelium. Reappearance of normal ciliated epithelium occurred by 180 days after cryosurgery. Cartilage remained intact, and there was no evidence of formation of a stricture or other gross alteration of bronchial architecture. In the lung there was coagulation necrosis; and by 14 days after cryosurgery, there was fibrosis in the target area. There were no complications of the pleural space. Cryosurgery of tissues at the margins of the bronchotomy does not impair healing. Cryosurgery may reduce the necessity for extensive surgery in selected patients with bronchopulmonary tumors, including those inaccessible to the rigid bronchoscope. Clinically, eight patients with recurrent bronchogenic tumors have received palliation by transbronchoscopic cryosurgery.
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Closure of the nasofrontal communication is the most common cause of failure of nonobliterative external of nonobliterative external frontal sinus operations for chronic sinus disease. To determine whether silicone rubber sheeting or tubing might prevent closure, we designed animal experiments and conducted a clinical study. We enlarged the nasofrontal duct in dogs, inserted silicone rubber tubing or sheeting and assessed ductal patency grossly and microscopically. The tubes prevented epithelization and failed to prevent local osteoblastic reaction, fibroplasia, and scar formation. In contrast, sheeting permitted rapid mucosal regeneration, less osteoblastic activity, and less fibrosis. Our 16 patients with chronic sinus disease underwent a modified Lynch operation, with enlargement of the nasofrontal duct and stenting with rubber tubes or sheeting. The sheeting provided the best long-term result. In our experience, it raised the success rate of the classic Lynch external operation.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.