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Biomedical subjects

N Bhattacharyya

Publications and source records attributed to N Bhattacharyya.

At least 37 records · Page 2Linked to original sources
PubMed1999

Alteration of hMSH2 and DNA polymerase beta genes in breast carcinomas and fibroadenomas.

Genomic stability is preserved by error-free DNA replication, post-replicative proofreading, DNA repair, and recombinational events. In essence, DNA repair genes are recognized to play key roles in such stability. We report evidence for expression of the wild-type and a truncated form of DNA polymerase beta (polbeta) proteins, a base-excision repair gene, in breast carcinomas and fibroadenomas, a benign breast disease. An 87-bp deleted variant of polbeta was identified to be prevalent in microsatellite unstable breast tumors and fibroadenomas. A large deletion of 1476 bp, as well as point mutations in human MutS homolog 2 (hMSH2) cDNA, was revealed in breast carcinomas. The protein truncation assay confirmed the 1476-bp deletion as a premature protein. This is the first evidence for variant forms of hMSH2 that are associated with breast cancer. Genomic instability in the hMSH2 and polbeta genes may facilitate the occurrence of mutator phenotype in breast cancer.

Breast Neoplasms↗
PubMed1999

The microbiology of recurrent rhinosinusitis after endoscopic sinus surgery.

OBJECTIVE: To determine the microbiology of recurrent sinus infections occurring in patients after endoscopic sinus surgery (ESS). DESIGN: Retrospective review of sinus cultures obtained over a 4-year period from a consecutive series of patients who underwent ESS. SETTING: An academic general otolaryngology practice. RESULTS: A total of 290 cultures were performed in 125 patients after ESS. The female-male ratio of cultures was 2.5:1 with an average patient age of 47.3 years. This group of patients represents 14.5% of 860 patients who underwent ESS during the same period. A total of 65 patients had 1 culture performed, and 60 patients had multiple cultures. Of the 290 culture specimens, 87 (30.0%) demonstrated no growth. Gram-positive cocci predominated, accounting for 37.9% of culture results. Gram-negative rods constituted 14.8% of the isolates. Of the cultures yielding gram-negative rods, 90.7% occurred in patients who had multiple cultures (P = .03). Fungal forms were cultured in 1.7% of the specimens. None of the Streptococcus pneumoniae isolates demonstrated penicillin-based resistance. The percentages of beta-lactamase-producing strains for Haemophilus influenzae and Branhamella (Moraxella) catarrhalis were 45.4% and 81.8%, respectively. Staphylococcal species also exhibited significant antibiotic resistance patterns, but no statistical association with multiple cultures was noted (P = .23). CONCLUSIONS: A wide range of bacteria may be present in the infected post-ESS sinus cavity, with a considerable population of gram-negative organisms, including Pseudomonas species. Beta-Lactamase-producing organisms continue to be prevalent in postoperative sinus infections. Culture and sensitivity analyses of pathologic secretions may identify drug-resistant organisms or organisms related to difficult-to-treat infections in exacerbations of chronic rhinosinusitis in the postoperative setting.

Chronic Disease↗
PubMed1999

Predictive factors for neoplasia and malignancy in a neck mass.

OBJECTIVE: To determine clinical factors that are able to predict the likelihood of neoplasia and malignancy of cervical masses. DESIGN: Retrospective review of case series. Data were collected for age, sex, a history of alcohol and tobacco use, mass location, number, bilaterality, size, and duration. Logistic regression was performed to determine which clinical variables were significant in a prediction model for neoplasia and malignancy in a cervical mass. SETTING: An academic general otolaryngology practice. RESULTS: Review of 160 open neck biopsies yielded 95 complete cases for regression analysis. Thirty cases of neoplasia (31.6%) and 12 cases of malignancy (12.6%) were noted. For the prediction of neoplasia, logistic regression analysis identified patient age, duration, and size of the mass to be statistically significant. The overall model for neoplasia had positive and negative predictive values of 63.6% and 78.1%, respectively, and an overall accuracy of 74.7%. For the prediction of malignancy, only age was found to be significant. The model for malignancy failed to show any classification utility beyond that of clinical judgment. CONCLUSIONS: On the basis of clinical factors, a logistic regression model can distinguish patients who have a low chance for neoplasia in a neck mass, and thereby help avoid unnecessary biopsy. It is not as useful in selecting patients for early biopsy. The strict prediction of malignancy on the basis of clinical variables alone is difficult.

Biopsy↗
PubMed1999

Computed tomographic staging and the fate of the dependent sinuses in revision endoscopic sinus surgery.

OBJECTIVES: To determine the patterns of disease recurrence in chronic sinusitis and to examine the influence of surgical intervention on the presence or absence of disease among sinuses at the time of revision. DESIGN: Retrospective review of case series in a 56-month period. Preoperative computed tomography (CT) scans at the initial surgery and at revision were staged using the Lund and Mackay system. Patterns of disease and CT stage were analyzed with respect to operative intervention, and statistical analysis was conducted to determine the influence of the initial surgical intervention on the patterns of disease at revision. SETTING: An academic general otolaryngology practice. RESULTS: A total of 42 paired cases of primary and revision endoscopic sinus surgery were identified with complete data. The average interval between procedures was 11.8 months, with a mean follow-up of 31.7 months. The average total Lund scores for the CT scan before the primary procedure and at revision were not significantly different at 10.5 and 9.7, respectively (P = .38). Analysis of 84 sides revealed that performance of a sinusotomy on an initially undiseased sinus resulted in a higher percentage of disease in that sinus at revision, although this was not significant (P = .15). A sinusotomy performed on an initially diseased sinus was associated with a higher likelihood of disease in that sinus at revision (P = .02). Similar data were found for the subset analysis of the sphenoid and frontal sinuses. CONCLUSIONS: The Lund and Mackay system can be applied in the setting of revision endoscopic sinus surgery. Sinusotomies should be performed only in sinuses with radiographic disease, and not prophylactically to prevent disease. The standard functional approach may allow disease initially present in the sphenoid or frontal sinuses to normalize without formal sphenoidotomy or frontal sinusotomy.

Adolescent↗
PubMed1999

Selection of antibiotics after incision and drainage of peritonsillar abscesses.

Despite the fact that peritonsillar abscess is the most common complication of acute tonsillitis, the treatment of peritonsillar abscess remains controversial. One element of controversy is the choice of antibiotics after drainage of the abscess. In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we conducted a retrospective review of records from patients with peritonsillar abscess treated with incision and drainage. Our review identified 103 patients, comprising two groups: 58 patients treated with broad-spectrum intravenous antibiotics and 45 patients treated with intravenous penicillin alone. These patients were hospitalized after incision and drainage, and therefore their clinical courses and responses to therapy could be rigorously assessed. Characterization of illness based on patient age, temperature, and white blood cell count revealed similar severity of illness between the two groups. Comparison of clinical outcomes with respect to hours hospitalized (mean 44.3 +/- 6.6 and 38.3 +/- 7.1 hours, 95% confidence interval, for broad-spectrum and penicillin groups, respectively) and mean hours febrile (16.9 +/- 5.0 and 13.3 +/- 4.2 hours, 95% confidence interval) were not statistically significantly different (p = 0.222 and 0.269, respectively) between groups, indicating that broad-spectrum antibiotics failed to show greater efficacy than penicillin in the treatment of these patients. The microbiologic characteristics of these infections, failures of therapy, and complication rates were similar to those reported in the literature. These results suggest that intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage.

Adolescent↗
PubMed1999

Variant forms of DNA polymerase beta in primary lung carcinomas.

DNA polymerase beta (pol beta) provides most of the gap-filling synthesis at apurinic/apyrimidine sites of damaged DNA in the base excision repair pathway. A truncated form of the pol beta protein is expressed in colon and breast cancers. However, the role of the pol beta gene in lung cancer is not known. Thus, we investigated a possible occurrence of pol beta variants in primary lung tumors. The entire cDNA of pol beta obtained by RT-PCR amplification was analyzed for nucleotide sequencing in lung tumor and matched normal lung tissue of the same patient. Three types of variants were detected in squamous, non-small, or large cell carcinomas. The most common variant was a deletion of 87 bp from pol beta cDNA at a site corresponding to exon 11. In addition, a variant exhibiting deletions of 87 and 140 bp together with an insertion of 105 bp was identified in three lung tumors. This is the first report of the occurrence of pol beta variants, possibly splicing variants, in lung cancer. A truncated pol beta protein resulting from variant forms of the gene may impact the function of the enzyme and increase susceptibility to carcinogenesis.

Aged↗
PubMed1999

Peer review: studying the major otolaryngology journals.

OBJECTIVE: To determine if the otolaryngology literature is comparable to other surgical specialty journals with respect to quality and types of articles published. METHODS: The four major otolaryngology journals--Annals of Otology, Rhinology and Laryngology, Archives of Otolaryngology--Head and Neck Surgery, Laryngoscope, and Otolaryngology--Head and Neck Surgery--were studied for 6-months and examined for the following variables: 1) proportion of clinical or basic science research, 2) proportion of prospective or retrospective studies, 3) types of statistics used, 4) sample sizes of the studies, and 5) proportion of single case reports. A composite group of surgical specialty journals consisting of Journal of Bone and Joint Surgery, Neurosurgery, and Ophthalmology was also studied for the same time period. The otolaryngology journals and other specialty journals were compared with respect to each of these variables, after which the comparison was conducted within the group of otolaryngology journals. RESULTS: Analysis of 905 articles, comprising 508 articles from the four major otolaryngology journals and 397 articles from the composite of the other specialty journals, was conducted. No significant difference in the proportion of single case reports between the otolaryngology journals (15.0%) and the other specialty journals (12.8%) was noted (P = .364). The otolaryngology journals had a significantly higher proportion of basic research than the other specialty journals (27.4% vs. 14.5%, P<.001) as well as a higher percentage of prospective studies (62.1% vs. 49.0%, P = .001). The studies in the otolaryngology journals had a much lower mean sample size than those in the other specialty journals (70.2 vs. 373.8, P = .010). No difference between the two groups was found in the use of statistics (P = .228). Among the otolaryngology journals, Laryngoscope was found to publish fewer single case reports than the other three journals, and Annals of Otology, Rhinology and Laryngology had the highest proportion of prospective studies (P = .031 and .012, respectively). No differences were found for sample sizes and use of statistical analysis (P = .266 and P = .710, respectively) among the otolaryngology journals. CONCLUSIONS: The otolaryngology literature compares quite favorably with the literature of other surgical specialties, excelling in prospective studies and basic science research. It only lags with respect to sample size. The study composition among the different major otolaryngology journals is largely similar with respect to basic study parameters, suggesting comparable quality among the journals.

Otolaryngology↗
PubMed1999

Test-retest reliability of computed tomography in the assessment of chronic rhinosinusitis.

OBJECTIVE: Computed tomography (CT) of the paranasal sinuses has emerged as the standard test for the assessment of chronic rhinosinusitis, as evidenced by the emergence of several CT-based staging systems. Despite its central role in the diagnosis and treatment planning for chronic rhinosinusitis, the sinus CT represents a "snapshot in time." This study was conducted to determine the reliability of the CT scan for chronic sinus disease: are the CT findings in chronic rhinosinusitis stable over time? METHODS: A prospective series of patients scheduled for endoscopic sinus surgery was evaluated. A total of 45 patients received two CT scans: an initial scan obtained during routine diagnostic evaluation, and a second scan performed for use as part of an image-guided sinus surgery protocol. No surgical intervention occurred between scans. The patients' scans were staged according to the Lund system by a blinded observer. The correlation between scans for each patient was determined using the matched pairs t test and the Pearson correlation coefficient. RESULTS: The mean time interval between scans was 122.6 days (range, 5364 d). The average Lund scores for the initial and second scans were 13.56 and 13.27, respectively. The Lund score for 5 patients remained the same, increased in 22 patients, and decreased in 18 patients. Overall, 75.6% of patients' second scans were within +/-2 points of the first scan Lund score. The mean change in score between scans of -0.29 was not significant (P = .606, paired samples t test). The Pearson correlation coefficient between scans was 0.796 (P < .0001). CONCLUSIONS: CT scan assessment of chronic rhinosinusitis is a reliable test. The CT findings in patients with chronic rhinosinusitis remain consistent over time.

Adolescent↗
PubMed1998

The effects of more conservative neck dissections and radiotherapy on nodal yields from the neck.

OBJECTIVE: To determine the effects of conservative neck dissections (NDs) and preoperative radiotherapy on the quantitative recovery of lymph nodes from the neck. DESIGN: Retrospective review of case series. Data were obtained for age, preoperative TNM staging, type of ND, preoperative radiotherapy, total nodal yield (tNY), and positive nodal yield (pNY). The tNY and pNY were analyzed with factorial analysis of variance (ANOVA) to determine differences among types of ND and the effect of radiotherapy. SETTING: Tertiary care center for head and neck cancer. PATIENTS: Consecutive sample of 135 NDs in 110 patients with cancer of the head and neck. RESULTS: A significant difference in tNY was found among dissections (P<.001, ANOVA). Supraomohyoid ND had a significantly lower mean tNY (9.9 nodes) than both radical ND and modified radical ND (21.8 and 26.3 nodes, respectively; P<.05). Functional ND also had a significantly lower tNY (16.1 nodes) than modified radical ND (P<.05); the differences between radical ND and both functional ND and modified radical ND were not statistically significant. Positive nodal yield was not different among the types of dissections (P=.62). Preoperative radiotherapy significantly decreased mean tNY from 22.0 to 17.1 nodes (P=.02) over all types of dissections. Differences in tNY among dissection types were independent of the effect of radiotherapy. The presence or absence of preoperative radiotherapy had no significant effect on pNY (P=.18). CONCLUSIONS: Conservative modifications of the classic radical ND differ with respect to the quantity of cervical lymph nodes excised, but survival may not be altered since the pNY is not significantly different. When compared with the radical ND, the modified radical ND and functional ND do not compromise the quantity of cervical nodes excised. Radiotherapy significantly reduces the quantity of cervical nodes, but a significant number of nodes will still remain.

Adult↗
PubMed1998

Aortobronchial fistula after expandable metal stent insertion for pediatric bronchomalacia.

Indications for using expandable metal stents (EMS) for airway disease have expanded considerably during the past decade. Complications have been infrequent but can be potentially life threatening. There are four reported instances of vascular bronchial fistula after Gianturco EMS insertion for managing airway disease in adults. The authors report a case of an aortobronchial fistula in a pediatric patient after Palmaz EMS insertion for treatment of bronchomalacia. A 14-year-old boy with severe scoliosis underwent left mainstem bronchus insertion of two Palmaz stents in tandem for correction of complete bronchial obstruction caused by vascular compression. Three weeks later fatal hemoptysis from an aortobronchial fistula developed. Elective EMS insertion for treatment of airway obstruction secondary to compression by vascular structures should be approached with caution. EMS placement should be reserved for situations in which there is no other reasonable surgical alternative.

Adolescent↗
PubMed1998

The childhood air gun: serious injuries and surgical interventions.

OBJECTIVE: Increasingly powerful nonpowder firearms or air guns are frequently given to children as toys. We undertook the present study to evaluate the injuries caused by these firearms, based on the concern that they are capable of inflicting serious trauma. DESIGN: Descriptive, retrospective chart review. SETTING: Urban level I pediatric trauma center. PARTICIPANTS: The study included all children with injuries secondary to air guns who were admitted between July 1988 and March 1995. MAIN OUTCOME MEASURES: Type of weapon, circumstances of injury, anatomic location of injury, injury severity, surgeries performed, morbidity. INTERVENTIONS: None. RESULTS: There were 42 admissions with a mean hospital stay of seven days (range 1 to 136 days). The average age was 10 years (range 1 to 23 years) with a median age of 11 years. There were 35 boys and 7 girls. Twenty-nine of the 42 injuries were caused by a family member or friend and five were self-inflicted. The mean injury severity score was 8.3. While there were no fatalities, 21 children (50%) underwent operative procedures for their injuries. Ten of the injuries were potentially lethal, of which seven were due to the "pump" action air gun. Sixteen patients had serious long-term disability as a result of their injuries. CONCLUSION: Air guns can cause a variety of serious injuries, often requiring operative intervention. The long-term morbidity from some of these injuries is significant. Both parents and physicians should be aware that nonpowder guns are not toys, but weapons capable of inflicting serious trauma. The evaluation and treatment of air gun injuries should be similar to that currently used for powder weapon injuries. Recommendations for evaluation and treatment are made.

Adolescent↗
PubMed1998

Examining the safety of nasogastric tube placement after endoscopic sinus surgery.

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.

Cadaver↗
PubMed1998

Clinical and pathologic characterization of mucosa-associated lymphoid tissue lymphoma of the head and neck.

Mucosa-associated lymphoid tissue (MALT) has recently been recognized as a possible site of origin for low-grade lymphomas of the B-cell type. Though relatively rare, these MALT lymphomas may arise within several sites in the head and neck, and often present diagnostic and therapeutic challenges. We review 4 cases of primary MALT lymphoma of the head and neck, treated with surgical excision (3 cases), irradiation (2 cases), and chemotherapy (1 case), to further characterize this new subtype of head and neck malignancy. The mean time from onset of symptoms to histologic diagnosis was 15 months. Fine needle aspiration identified an atypical lymphoid infiltrate in only 1 of 3 patients. Immunohistochemical analysis was essential in establishing the diagnosis of MALT lymphoma in all 4 of the cases, and demonstrated characteristic negative staining for CD3, CD5, and CD43, positive staining for CD20, and monotypic staining for either kappa or lambda light chain immunoglobulin markers. All patients achieved complete remission after primary therapy, and all remain free of disease with follow-up ranging from 6 to 54 months (mean 33 months). The diagnosis of MALT lymphoma should be considered in cases of atypical lymphoid infiltrates in the head and neck, and increased awareness coupled with detailed immunohistochemical analysis is essential to securing an accurate diagnosis. Clinical remission of MALT lymphoma may be achieved with several modalities, but further study will be required to determine the long-term response to treatment.

Adult↗