Biomedical subjects

J B Kinsella

Publications and source records attributed to J B Kinsella.

9 recordsLinked to original sources

PubMed1997

Osteosarcoma of the head and neck: meta-analysis of nonrandomized studies.

To assess the role of adjuvant therapy in the treatment of osteogenic sarcoma of the head and neck, treatment and survival information from 173 patients with osteosarcoma of the head and neck was entered into a database. A meta-analysis of the data was attempted with primary emphasis on the effect of adjuvant therapy on disease outcome. The overall 5-year survival was 37%. Patients with mandibular and maxillary tumors had similar survival rates; both groups fared significantly better than patients with extragnathic tumors (P<0.001). Treatment with surgery alone was associated with significantly longer survival rates (P<0.03) than surgery with adjuvant therapy. In the majority of patients reported, information about surgical margins was not available. For this reason, the differences may not adequately represent the effect of adjuvant therapy. While there have been encouraging results with adjuvant treatment protocols for long bone osteosarcoma, the ultimate role of radiation and chemotherapy in the management of osteosarcoma of the head and neck remains unproven. Nevertheless, we recommend that adjuvant therapy be considered due to the poor prognosis in osteosarcoma of the head and neck.

Adolescent↗

PubMed1996

Rapid progression of head and neck squamous carcinoma after hyperbaric oxygenation.

We present four head and neck cancer patients who apparently had rapid progression of clinically occult disease during or soon after undergoing hyperbaric oxygenation. This led us to review existing knowledge about the interaction of HBO with tumors. The literature can be summarized as follows: 1. HBO is a useful tool in several situations commonly encountered by head and neck surgeons-infections, radionecrosis, and wound-healing problems. 2. The use of HBO as a hypoxic cell sensitizer during radiation therapy has been extensively studied, with evidence supporting only marginal advantage to this logistically difficult undertaking. 3. Most reports regarding the interaction of HBO with transplanted tumor cells suggest no effect on tumor growth or metastases. 4. Studies of chemically induced carcinogenesis are less conclusive. Some evidence supports a role for HBO in enhancing growth of preexisting tumors. Better understanding of the interaction of HBO with existing tumors is required to ensure that informed choices-weighing potential risks and benefits of HBO treatment--may be made by head and neck surgeons and their patients. Further research into the interaction between HBO and tumor cells is warranted.

Adult↗

PubMed1996

Allergic fungal sinusitis.

Allergic fungal sinusitis is a non-invasive disease, first described in the early 1980s. We review our experience with 25 patients treated at the University of Texas Medical Branch, Galveston. All patients were treated surgically, using endoscopic techniques in 17, and combined endoscopic and external procedures in eight. Histological evidence of tissue invasion was absent in all 25 patients, in spite of extensive destruction of the skull base in four. Dematiaceous fungi were the most common cultural isolate. Fifteen patients were available for more than 6 months post-operative follow-up. None of the eight patients who developed recurrent disease had been treated with post-operative systemic steroids. Four of the seven patients who remained disease-free had received steroids. Clinical trials to test the efficacy of systemic steroids in the prevention of disease recurrence are clearly warranted.

Administration, Topical↗

PubMed1995

The role of the middle ear and tonsil in the etiology of febrile convulsions.

The middle ear and tonsil are thought to be important sources of infection in children with febrile seizures. However, these patients are rarely examined by an otolaryngologist in the acute phase and we are unaware of any previous studies where otolaryngologists have documented the presence of acute suppurative otitis media (ASOM) and tonsillitis in a series of children with febrile convulsions. We carried out a prospective study on 47 children admitted to two Dublin hospitals with a diagnosis of simple febrile convulsion. All children were examined by an otolaryngology resident within 6 h of admission. Nine children were noted to have ASOM and 18 had acute tonsillitis. The otolaryngology resident's opinion of the condition of the ears and throat often differed from that of the admitting pediatric resident, as documented in the clinical records. We review the recent literature on febrile convulsions and discuss the possible role of the otolaryngologist in the prevention of seizure recurrence.

Child, Preschool↗

PubMed1995

Complications of endoscopic sinus surgery in a residency training program.

Endoscopic sinus surgery (ESS) is now taught in most otolaryngology residency programs in the United States. However, this is technically challenging surgery and concerns exist regarding patient safety early in the surgeon's learning curve. The authors reviewed 193 cases of ESS performed by residents, under faculty supervision at our program, between 1987 and 1992. Sixty-seven percent of patients underwent bilateral anterior ethmoidectomy, 40% had bilateral total ethmoidectomy, and 44% had bilateral middle turbinate reduction. The overall complication rate was 22% and included one major complication. Synechiae accounted for 50% of minor complications. There was no correlation between middle or inferior turbinate reduction and the formation of synechiae. Posterior ethmoidectomy was not associated with a significant increase in complications. We conclude that ESS can be safely performed by otolaryngology residents in carefully structured and supervised training programs.

Adolescent↗

PubMed1994

Tympanostomy tubes and early post-operative otorrhea.

Otorrhea is a recognized complication of tympanostomy tube insertion. This may be caused by external contamination or by the pre-existing conditions in the middle ear cleft. Some surgeons try to reduce the risk of surgical contamination by using a non-touch technique, never allowing the gloved hand to come into contact with the tympanostomy tube. A prospective study was carried out on 66 children to evaluate the efficacy of the non-touch technique. One tympanostomy tube was inserted by the non-touch method with the contralateral ear acting as a touched control in each patient. Postoperative otorrhea occurred within 10 days in 1.67% of the non-touch ears and in 1.67% of the controls. This study demonstrates a low incidence of otorrhea in the early post-operative period with either technique. Time-consuming and costly sterile precautions are unnecessary for this common procedure.

Child↗

PubMed1993

Familial stapes superstructure fixation.

Congenital stapes superstructure fixation was found in a mother in both ears and her daughter in one ear. The head of the stapes was fixed to the pyramid by a bony bar which lay immediately superior to a normal stapedius muscle. Removal of the bony bar resulted in normal hearing, which has been maintained. We believe that these are the first reported cases of this abnormality.

Adult↗

PubMedDate not supplied

Allergic fungal sinusitis with cranial base erosion.

BACKGROUND: Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses. METHODS: Our series of 28 cases of AFS was reviewed. We identified 6 cases of AFS with definite radiographic evidence of skull base erosion. RESULTS: Histologic diagnostic criteria for AFS were present in all 6 cases. All patients were managed with surgery, most recently conservative endoscopic surgery. An earlier patient underwent dural resection. Antibiotics were used in all patients, but no antifungal agents were administered. No patient has had a permanent neurologic complication, although one was seen with abducens palsy. There have been no cerebrospinal fluid (CSF) leaks. All 6 cases also had orbital bone erosion, but none has had permanent ophthalmologic sequelae. All patients were initially suspected to have a neoplastic disease. CONCLUSIONS: We propose a new diagnostic entity, "skull base allergic fungal sinusitis" (SBAFS), which incorporates the histologic diagnostic criteria of AFS with the computed tomographic (CT) criteria of bone erosion. Biopsy is necessary to rule out invasive fungus or tumor. Otolaryngologists, ophthalmologists, and neurosurgeons should be familiar with SBAFS so that systemic antifungal agents, craniotomy, and dural resection-which might initially appear necessary-can be avoided. Endoscopic surgical debridement and drainage combined with topical steroids can lead to resolution of disease, even in the presence of marked bone erosion and cranial neuropathy.

Adolescent↗

PubMedDate not supplied

Ventilation tubes and cholesteatoma.

Ventilation tubes (VTs) have been extensively used to treat chronic serous otitis media over the last 30 years. However, it is not known if this practice has affected the incidence of cholesteatoma. A retrospective study was carried out at two Regional ENT Centres in Northern Ireland, examining the clinical notes of all patients undergoing major ear surgery between 1965 and 1988. The incidence of cholesteatoma per operatively in this period varied from 0.01 to 0.16 per 1,000 of population per year. The total number of cholesteatomas in the first five years of the study was exactly equal to the number in the last five years, despite an eight-fold increase in VT insertion over this period. These results indicate that the incidence of cholesteatoma remained stable between 1965 and 1988 despite a huge increase in the use of VTs.

Cholesteatoma, Middle Ear↗