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Biomedical subjects

M C Loury

Publications and source records attributed to M C Loury.

10 recordsLinked to original sources
PubMed1995

Immunologic defects in patients with chronic recurrent sinusitis: diagnosis and management.

Twenty patients with chronic refractory sinusitis or rhinitis were identified to have immune defects on the basis of total immunoglobulin level, immunoglobulin G subclass, and vaccine response. Eight patients were immunoglobulin A deficient, five had low immunoglobulin levels with vaccine hyporesponse, and four had low immunoglobulin levels with normal vaccine responses. Three subjects showed isolated immunoglobulin G1 deficiency. Demographic variables such as age, sex, infection pattern, and any other related disorders were studied retrospectively, which may have contributed to the diagnosis. An immunologic screen was essential for the diagnosis of immunodeficiency in these patients. Treatment options included prophylactic antibiotics, management of associated allergies, functional endoscopic sinus surgery, and replacement therapy with immunoglobulin in selected patients.

Adolescent↗
PubMed1993

Alveolar rhabdomyosarcoma that metastasized to the orbit.

A 22-year-old woman with a history of hyperthyroidism and a paravaginal alveolar rhabdomyosarcoma developed diplopia 3 months after successful autologous bone marrow transplantation. Results of computed tomographic scan showed apparent enlargement of the right inferior rectus muscle, and thyroid eye disease was suspected. However, results of further evaluation revealed an alveolar rhabdomyosarcoma that metastasized to the orbit.

Adult↗
PubMed1993

Endoscopic transnasal antrochoanal polypectomy: an alternative to the transantral approach.

The use of functional endoscopic sinus surgery has been limited typically to management of chronic sinusitis, nasal polyposis, and recurrent acute sinusitis. Antrochoanal polyps (ACPs) traditionally have been resected using a Caldwell-Luc sinusotomy. We used the endoscopic approach, however, in the treatment of five cases of ACP. There was recurrence in one case, but the polyp was successfully removed endoscopically. In the other four cases there has been no evidence of recurrence at a maximum follow-up of 24 months. We believe that transnasal endoscopic antrochoanal polypectomy is an excellent surgical option; there is significantly less postoperative morbidity than with the transantral approach, and rates of complete cure are similar.

Adult↗
PubMed1992

Complications and early outcome of anterior craniofacial resection.

OBJECTIVE: To evaluate the complications of anterior craniofacial resection and correlate their impact with tumor control status. DESIGN: We conducted a retrospective review of 32 consecutive, operable patients' records seen over a 6-year period, requiring 35 procedures. SETTING: Academic tertiary referral medical center. PARTICIPANTS: Twenty-six patients (81%) had malignant lesions (esthesioneuroblastoma, squamous cell carcinoma, and a group of miscellaneous malignant tumors). Six patients had various benign neoplasms. INTERVENTION: The surgical approach involved bifrontal craniotomy coupled with lateral rhinotomy in 19 cases (61%), facial degloving in 10 cases (32%), a total rhinectomy in one case, and endoscopic sinusectomy without facial incision in two cases. OUTCOME MEASURE: Clinically noted complications and oncologic outcome. RESULTS: There was one avoidable perioperative death indirectly associated with the patient's procedure. Nine patients suffered significant intracranial neurological complications such as tension pneumocephalus and delayed epidural abscess. All of these complications were managed successfully. Of patients with malignant tumors, 13 (52%) are alive with no evidence of disease and one is alive with recurrence after a mean follow-up period of 28.9 months. The 10 patients who succumbed to disease had a mean postoperative survival of 22.9 months. CONCLUSIONS: In contrast to the perspective of only a decade ago, we conclude that craniofacial resection is a relatively safe, versatile, and effective procedure for surgical management of tumors involving the anterior skull base.

Adult↗
PubMed1990

Current concepts in olfaction.

Because of the location of the olfactory epithelium and bulb, the processes involved in olfaction have been difficult to evaluate. However, the recent application of comprehensive nasal endoscopy, reproducible olfactory testing, and molecular biologic techniques to the study of the transduction of olfactory information has elucidated some of the events in odorant perception.

Chronic Disease↗
PubMed1989

Bilateral parotid enlargement in HIV-seropositive patients.

Bilateral enlargement of the parotid glands has been noted in five patients who are seropositive for antibody to the human immunodeficiency virus. A characteristic cystic appearance has been noted in these lesions on clinical and radiographic examination. A benign lymphoepithelial infiltrate with cystic degeneration is found in parotid specimens from these patients. The presence of human immunodeficiency virus ribonucleic acid in inflammatory cells infiltrating the parotid specimen was confirmed by an in situ hybridization technique. The clinical manifestations of sicca syndrome were not present nor were opportunistic infections diagnostic for the acquired immunodeficiency syndrome.

Adult↗
PubMed1988

Nasal and sinus pain: current diagnosis and treatment.

Intranasal and sinus disease may result in disabling head and facial pain and serious complications. Awareness of the symptoms of acute and chronic sinusitis and their various presentations will enhance diagnostic accuracy and improve patient outcome. It is important to remember that the nasal mucosa is under autonomic control. Sinus symptomatology, whether from anatomic abnormality or chronic inflammation, may occur with and will typically be exacerbated by increased parasympathetic outflow or reduced sympathetic tone. Thus, the possibility of underlying intranasal or sinus disease must be considered in patients with atypical migraine or vascular instability headaches. A new appreciation of the impact of sinusitis on facial and head pain syndromes is developing among otolaryngologists because of the improved diagnostic capabilities afforded by combined intranasal endoscopy and modified CT. In the past, patients with nasal complaints and facial pain who had normal plain radiographs were often passed off as "chronic nasal complainers" and given decongestants or the recommendation to see a psychiatrist. On the other hand, patients with symptoms and radiologic abnormalities often underwent radical surgery aimed at the maxillary or frontal sinus, sometimes with persistence or worsening of their complaints. Now, however, underlying causes for these problems can often be found in the ostiomeatal complex and corrected with minimally invasive surgery. In general, the major sinuses appear to be more sensitive to pain before the development of chronic mucosal changes. Minor disease in critical locations within the ostiomeatal complex may therefore give rise to greater symptomatology than diffuse disease in less critical sites. Although head CT may be a routine part of the neurologist's examination in patients with headache or facial pain, routine CT techniques are inadequate to evaluate fully the ostiomeatal complex and sinuses and must be modified to rule out adequately pain of sinus origin. Nasal endoscopic examination provides a noninvasive examination by which patients may be selected for sinus CT and is a necessary part of a complete evaluation. Close cooperation between the neurologist and otolaryngologist-head and neck surgeon is therefore essential for the accurate diagnosis of this often puzzling group of patients.

Facial Pain↗
PubMed1987

In vitro hyperdiploidy in head and neck cancer. A genetic predisposition?

The role of heredity in the cause of head and neck cancer has not been clarified. Contrary to the autosomal-dominant heritable cancer syndromes, there is no clear genetic pattern seen in oropharyngeal or laryngeal squamous cell carcinoma. Pedigree data demonstrating clusters of affected relatives suggest that some head and neck squamous cell cancers result from an interaction between environmental factors and germinal predisposition. Though no genetic marker has been described for head and neck epidermoid carcinomas, some heritable single tumor syndromes demonstrate increased amounts of hyperdiploidy (defined as a metaphase with more than 46 chromosomes exclusive of 92) in in vitro cultures of dermal fibroblasts. In the present study, dermal fibroblasts were cultured from 30 patients with biopsy-proved oropharyngeal and laryngeal squamous cell cancer. Compared with the percentage of cells with in vitro hyperdiploidy (IVH) of 0% to 1% in 155 clinically normal individuals without a family cancer history, 13 (43%) of these 30 patients had significantly elevated (7% to 12%) IVH. Six of the seven clinically affected women had IVH, a proportion significantly greater than that for the men. In vitro hyperdiploidy remained stable for each assayed cell line from the third through sixth passage. Each patient's IVH percentage of dermal and oropharyngeal fibroblasts remained nearly constant varying 0% to 1%. The stability of the hyperdiploid fraction independent of the biopsy site eliminates local factors as the sources of the elevated IVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗