Biomedical subjects

Raphael Feinmesser

Publications and source records attributed to Raphael Feinmesser.

30 records · Page 2Linked to original sources

PubMed2003

Subtotal parathyroidectomy: a possible treatment for calciphylaxis.

Calciphylaxis is a rare disorder in patients with chronic renal failure that is characterized by ischemic necrotic skin lesions. The prognosis is grave and mortality is high (80%). The precise mechanism of calciphylaxis is still unknown, but in addition to chronic renal failure, elevated parathyroid hormone levels appear to play a role. The role of parathyroidectomy in treating affected patients is questionable. In this article, we describe the case of a patient with chronic renal failure who developed rapidly progressive subcutaneous calcifications and ulcerations in the lower extremities. These lesions regressed following subtotal parathyroidectomy. We also review the literature on calciphylaxis, with a focus on treatment options.

Biopsy, Needle↗

PubMed2003

Revision parathyroidectomy guided by intraoperative radionuclide imaging.

BACKGROUND: Technetium-99m sestamibi scintigraphy has become one of the most popular techniques for localization of the parathyroid gland after failure of primary neck exploration. OBJECTIVE: To examine the efficacy of sestamibi with the hand-held gamma ray detecting probe for the identification of parathyroid adenomas during revision parathyroidectomy. METHODS: We reviewed six cases of probe-assisted neck exploration for parathyroid lesions following unsuccessful primary exploration. RESULTS: In all cases the pathologic glands were successfully detected and removed. CONCLUSIONS: With careful planning, a gamma ray detecting probe can be used optimally 2-3 hours after technetium-99m sestamibi injection. The probe is efficient, easy and convenient to use.

Adenoma↗

PubMed2002

Preoperative evaluation of patients with parathyroid adenoma: role of high-resolution ultrasonography.

BACKGROUND: Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. METHODS: One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. RESULTS: The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p =.2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4-55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p =.01) and parathyroid hormone level (p =.0001). CONCLUSIONS: In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach.

Adenoma↗

PubMed2002

[CO2 laser surgery for the treatment of vocal cord carcinomas in early stages (T1 T2)].

BACKGROUND: The standard treatment for patients with early vocal cord carcinoma has been radiotherapy. In recent years, encouraging results with CO2 laser surgery has changed our treatment strategy in selective cases. During the past four years at the Rabin Medical Center we have treated patients with carcinoma of the vocal cord using CO2 laser surgery. PURPOSE: We conducted a retrospective study to investigate the results of the Head and Neck Surgery department with CO2 laser treatment for squamous cell carcinoma of the vocal cord during early stages (T1, T2) without radiotherapy. MATERIALS AND METHODS: Twenty one patients with carcinoma of the vocal cords in early stages were treated with CO2 laser. Nineteen patients suffered from stage T1 carcinoma located in one vocal cord, three of these patients suffered from involvement of the anterior commissure and one patient also had involvement with the anterior part of the second vocal cord. Two patients with carcinoma in stage T2, one with involvement of the ventricular band and one with limited movement of the vocal cord. The follow-up period for the patients ranged from one month to four years. RESULTS: Only one patient in stage T1 developed local recurrence after half a year, no patients died during the follow-up. CONCLUSION: Careful patient selection with endoscopic staging also during the biopsy, removal of the carcinoma in free border, strict follow-up and stroboscopic examination are essential to secure good results in the treatment of CO2 laser for early stages of vocal cord carcinoma.

Carcinoma↗

PubMed2000

Noise-induced vestibular dysfunction.

An association between noise exposure and vestibular function has long been suspected. Our wide experience in a major otologic outpatient clinic yielded six patients within the last seven years who presented with Meniere's disease and a history of long-term exposure to noise. Two of the cases are described in detail. Our evaluation in light of the data in the literature suggests that the relationship between vestibular dysfunction and exposure to hazardous noise may be more than coincidental.

Journal Article↗

PubMedDate not supplied

Minimally invasive procedure for resection of a parathyroid adenoma: the role of preoperative high-resolution ultrasonography.

PURPOSE: Solitary adenoma of the parathyroid is the major cause of primary hyperparathyroidism. Many centers advocate a minimally invasive surgical approach, wherein the surgeon explores only a localized area of the neck according to the preoperative imaging evaluation, and the adenoma is resected without histological sampling from the other parathyroid glands. The aim of this study was to evaluate the ability of high-resolution ultrasonography (US) to localize adenomas preoperatively and thereby aid in patient selection for minimal procedures. METHODS: We reviewed the medical records of 77 consecutive patients who underwent resection of a parathyroid adenoma following ultrasonographic imaging between 2001 and 2002, and we assessed the accuracy of the preoperative localization of the adenomas as well as the efficacy of the minimally invasive procedure. RESULTS: US correctly localized the adenoma to a specific quadrant of the neck in 87% of the cases and to a specific side of the neck in 94%. Overall, US sensitivity was 89%, with a positive predictive value of 98%. Its sensitivity was not reduced by the presence of nodular disease of the thyroid gland. Success rate for the minimal procedure was 98% (50/51 patients). CONCLUSIONS: US performed by a skilled operator is a reliable tool for adenoma localization prior to minimally invasive parathyroidectomy. If the US findings are inconclusive, a Tc-sestamibi scan should be used. If there is a high clinical suspicion of adenoma in the presence of negative imaging studies, bilateral neck exploration should be performed.

Adenoma↗

PubMedDate not supplied

Value of minimal residual disease in patients with early cancer of the tongue.

PURPOSE: The clinical course of patients with squamous cell carcinoma (SCC) of the tongue is often unpredictable. Some patients have a fair course with good response to treatment, whereas others have aggressive locoregional disease despite diagnosis at an early stage. The purpose of the present study was to determine if histochemical staining for cytokeratins of the negative neck nodes obtained in prophylactic neck dissection could predict treatment failure in patients with SCC of the tongue. MATERIALS AND METHODS: Between 1990 and 2000, 18 patients with early squamous cell carcinoma of the tongue (T1,T2N0M0) underwent partial glossectomy with neck dissection at the Rabin Medical Center in Israel. All had clear resection margins and no evidence of neck metastasis and were expected to do well. Nevertheless, 6 patients had an aggressive course and died of disease shortly after presentation because of local or regional failure. In an attempt to predict failure of treatment and patients' outcome, paraffin-embedded blocks from the pathologically negative lymph nodes were subjected to immunohistochemical staining for cytokeratin using polyclonal antibodies. The antigen-antibody complex was identified by using the biotinylated secondary antibody and followed by the streptavidin-peroxidase detection method. RESULTS: None of the 142 sections from pathologically negative lymph nodes stained positive for keratin. On multivariate analysis, a statistically significant relationship was found between disease-free survival, early recurrence (P =.03), and metastasis to the neck (P =.008). CONCLUSIONS: Keratin staining failed to yield evidence of micrometastasis. Further studies with more samples are needed to confirm these findings.

Adult↗

PubMedDate not supplied

Basaloid squamous carcinoma of the larynx.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a distinct variant of squamous cell carcinoma that was first described by Wain et al in 1986. Since then, about 160 cases have been reported in the literature. Only 40 cases have been described in the larynx. METHODS: Four cases of BSCC of the larynx treated in our department between 1986 and 2000 are presented. The clinical features, biological behavior, and histopathological and immunohistochemical characteristics of this uncommon tumor are described, and the relevant literature is reviewed. RESULTS: The main clinical presentation did not differ from other histological types of laryngeal carcinoma. The clinical course, however, was much more aggressive. All the patients received aggressive therapy including radical surgery and radiation. Two patients received chemotherapy. Two of the 4 patients presented died of distant metastasis shortly after diagnosis and treatment. CONCLUSIONS: The finding of this study with a limited number of patients supports previous reports suggesting that BSCC is a highly aggressive tumor that presents in older population with male predominance. The frequency of associated regional as well as distant metastases suggests that aggressive treatment is indicated and that systemic chemotherapy should be contemplated.

Aged↗

PubMedDate not supplied

The cytological and clinical value of the thyroid "follicular lesion".

BACKGROUND: The main limitation of fine-needle aspiration (FNA) is its limited distinction between neoplastic and benign lesions. We summarize our experience with thyroid nodules that were defined as follicular lesions by comparing the clinical and cytological features of the thyroid follicular lesions that were examined histologically to define the most reliable criteria of malignancy. METHODS: The medical records of all patients who underwent thyroid aspiration at Rabin Medical Center from 1999 to 2000 were reviewed for a diagnosis of follicular lesion that warranted surgery (N = 58). The cytology and pathology reports of the patients who met these criteria were reviewed and compared with the original reports. RESULTS: The incidence of malignancy in follicular lesions of the thyroid is about 26%. There was a significant correlation between a histologic diagnosis of carcinoma and the cytologic findings of nuclear grooves (P =.041), solid arrangement (P =.019), hypercellularity (P =.01), and hypercellularity to colloid amount ratio (P =.016). Nodular size was predictive of malignancy. No correlation was found between patient age or gender and tendency toward malignancy. CONCLUSIONS: The combination of cytological characteristics and the size of the nodule aspirate are predictive values of malignancy. We believe that every follicular lesion should be excised to obtain a definitive histological diagnosis based on capsular or vascular invasion.

Adolescent↗

PubMedDate not supplied

Laser surgery for the treatment of glottic carcinomas.

PURPOSE: The standard treatment for patients with early glottic carcinoma in Israel has been radiotherapy. In recent years, encouraging results with laryngo-microscopic carbon dioxide laser surgery as a treatment for early glottic carcinoma has changed our treatment strategy. We conducted a retrospective study to investigate the results of carbon dioxide laser excisional technique for early glottic carcinoma (T1, T2). MATERIALS AND METHODS: Twenty-six had squamous cell carcinoma (SCC), (21 patients with T1 and 5 patients with T2 lesions), 3 had carcinoma in situ, (CIS) and 3 had verrucous carcinoma (VC). RESULTS: All patients were free of disease after salvage treatment at the most recent follow-up. CONCLUSIONS: Careful patient selection with endoscopic staging and strict follow-up are essential to secure good results in the treatment of carbon dioxide laser for early laryngeal carcinoma.

Adult↗

PubMedDate not supplied

Unusual primary and secondary facial blast injuries.

PURPOSE: To discuss unusual facial injuries resulting from a bomb blast. MATERIALS AND METHODS: In March 1997, a bomb consisting of a bag of nails was detonated in a coffee shop in Tel Aviv. Two of the wounded were brought to our level 1 Trauma Center with unique facial injuries. Computed tomography (CT) scan and CT angiogram were performed. RESULTS: The blast occurred to the immediate right of the victims who were sitting in an open cafe. Both had tympanic perforation. The first patient showed indirect damage to the facial nerve from a piece of shrapnel located anterior to the carotid artery and medial to the right mandibular angle. The second had a piece of shrapnel lodged in the parapharyngeal space that was initially missed and discovered only on reexamination 3 days later after the patient complained of pain in the temporomandibular joint; there was no facial nerve deficit. The port of entry was probably a small wound in the anterior wall of the external ear canal. CONCLUSIONS: The wounds are probably attributable to the spalling effect of the shrapnel passing through the parotid gland, which has mixed-density tissue. These cases show that nerves are susceptible to damage even in the absence of direct engagement and that the emergency room physician should be alert to even small skin imperfections in blast victims to avoid missing penetrating wounds.

Adult↗

PubMedDate not supplied

Immunohistochemical profile and treatment of uncommon types of thyroid carcinomas.

The distinction of uncommon types of thyroid carcinomas is important, because their treatment and prognosis differ. The aim of this study was to describe retrospectively the immunohistochemical profile of uncommon types of thyroid carcinomas and mode of treatment. Of the 1194 patients with thyroid carcinomas treated in Rabin Medical Center from 1954 to 2001, 153 were uncommon types (not papillary or follicular carcinomas). Specimens from archival tissue obtained from thyroidectomies in all these cases were revised and immunohistochemically examined. Anaplastic carcinomas (n=59) were positive for high molecular weight cytokeratin (CK HMW), low molecular molecular weight cytokeratin (CK LMW), cytokeratin (CK) 7, CK 8 and 18, thymoglobulin, EMA and vimentin; medullary carcinomas (n=39) were positive for CK LMW, CK 19, CK 8 and 18, CK 10, CK 7, carcinoembryonic antigen (CEA) and calcitonin; Hurthle cell carcinomas (n=30) for CK LMW, CK 19, CK 8 and 18, thyroglobulin, epithelial membrane antigen (EMA) and CEA; squamous cell carcinomas (SCC) (n=12) for CK HMW and cytokeratin total (CKs); lymphomas (n=7) for leukocyte common antigen (LCA) and B-cells (CD 20), and clear cell carcinomas (n=6) for CK LMW, CEA and thyroglobulin. Use of an immunohistochemical panel has diagnostic value in the differentiation of uncommon types of thyroid carcinoma, which help to plan the best mode of treatment.

Carcinoma↗