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Biomedical subjects

S M Shapshay

Publications and source records attributed to S M Shapshay.

At least 37 records · Page 2Linked to original sources
PubMed1997

Autofluorescence characteristics of oral mucosa.

BACKGROUND: The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues. METHODS: Biopsy specimens from clinically suspicious lesions and normal-appearing oral mucosa were obtained from patients. Fluorescence spectroscopic measurements were obtained to study the differences between normal and dysplastic tissues and to determine the most appropriate excitation wavelength(s) for exploiting these differences. RESULTS: Fluorescence spectra from a total of 12 histologically normal (healthy mucosa or benign lesions) and ten abnormal (dysplastic or malignant) tissue samples were compared. Significant spectral differences were seen between the two groups. These differences were most marked at the excitation wavelength of 410 nm. Using this wavelength, fluorescence correctly diagnosed 20 of 22 samples studied. CONCLUSIONS: This technique accurately differentiates normal from abnormal tissues in vitro and has the potential applications for in vivo use as a noninvasive diagnostic tool.

Biopsy↗
PubMed1997

Kaposi's sarcoma of the larynx.

Kaposi's sarcoma (KS) is a neoplastic vascular disorder, classically arising in the skin of the lower extremities. As a consequence of the acquired immunodeficiency syndrome (AIDS) epidemic, an increasing number of patients have been found to have KS. In AIDS patients, KS appears to exhibit a more diffuse nature and frequently affects the head and neck. Mucosal lesions are most often seen, commonly involving the oral cavity. Only rare cases of laryngeal involvement have been recorded in the literature. We report 2 cases of KS of the supraglottic larynx. Our first patient, an elderly man of Mediterranean descent, complained of voice change and throat discomfort. Endoscopy with biopsy for diagnosis allowed conservative treatment with chemotherapy. Our second patient was a younger man with AIDS who presented with symptoms of airway obstruction. Management with carbon dioxide laser epiglottectomy was successful in relieving that patient's symptoms. Although rare, KS may present in both healthy and immunocompromised patients, and must be considered in the differential diagnosis of all violaceous lesions of the larynx.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Endoscopic laryngotracheoplasty and graft soldering with the carbon dioxide laser. An animal study.

Laryngotracheoplasty (LTP) has had considerable success for treatment of selected cases of subglottic stenosis in children. However, certain complications have been associated with an open approach. Our study explores the possibility of decreasing these complications by means of a minimally traumatic endoscopic laser cricoid split and graft transplantation technique. In an in vivo study of six dogs, LTP was performed with a carbon dioxide laser. The gap between the divided cricoid cartilage was either left with no coverage or filled by autogenous mucosa or cartilage grafts through a laser-assisted soldering technique. Compared to LTP without coverage, autogenous grafts, with either mucosa or cartilage, resulted in improved healing. The cartilage graft seems to offer the best result for expansion of the subglottic space. The results show that the new intraluminal approach, a combination of an endoscopic cartilage split and graft transplantation, may be an alternative to standard LTP. The advantage of this technique is that it is less traumatic than the open procedure, with the potential for less morbidity.

Animals↗
PubMed1996

Early diagnosis of upper aerodigestive tract cancer by autofluorescence.

OBJECTIVE: To explore the potential of autofluorescence spectroscopy as a tool for early detection of upper aerodigestive tract cancer. DESIGN: Autofluorescence spectral characteristics of 19 untreated oral and oropharyngeal lesions in 13 patients were studied with excitation wavelengths of 370 and 410 nm generated by a nitrogen pumped dye laser. Ten healthy volunteers were recruited to characterize the fluorescence spectra of normal mucosa at different oral sites and to study individual variations. Fluorescence intensity and line shape of the spectra from lesions were compared with the same parameters from the contralateral control site in the same individual. SETTING: Otolaryngology Research Center, Department of Otolaryngology-Head and Neck Surgery, New England Medical Center, Boston, Mass. RESULTS: The ratio of peak fluorescence intensities of the neoplastic lesions to contralateral normal control mucosa were consistently different compared with these ratios in benign lesions or normal mucosa. These differences were seen in 2 distinct regions of the fluorescence spectrum with both of the excitation wavelengths, but were more obvious with the excitation wavelength of 410 nm. Using these differences, we were able to correctly diagnose 17 of the 19 lesions studied, with 2 false-positive results. CONCLUSIONS: Neoplastic oral mucosa shows consistent differences in autofluorescence spectral intensity and line shape when compared with the normal mucosa in the same individual. These early results show that fluorescence spectroscopy may represent a useful technique for noninvasive early diagnosis of cancer of the upper aerodigestive tract.

Adult↗
PubMed1996

Mucosal intact laser tonsillar ablation.

BACKGROUND: A laser technique has been developed in the laboratory using a noncontact 810-nm diode laser. RESULTS: Mucosal intact laser tonsillar ablation (MILTA) coagulates tonsillar lymphoid tissue while preserving the overlying mucosa. A canine model was used to evaluate this new method. The canine tonsils were exposed to laser energy for 5 to 6 minutes each at 8 to 10 W of power. This technique was compared with standard "cold" knife tonsillectomy. The dogs were observed carefully during the postoperative period. When comparing parameters such as onset of eating solid food, amount of food ingested per day, onset of normal activity, and degree of weight loss, MILTA showed significant benefit over the standard technique. The operative sites were evaluated and compared at 1.5 hours and at 7, 21, and 45 days after treatment. CONCLUSIONS: None of the tonsils treated by MILTA showed mucosal ulceration. At the end of 45 days, histopathological examination showed complete absence of tonsillar tissue with normal mucosa in both the MILTA and standard groups. Traditional tonsillectomy techniques are associated with moderate morbidity and the potential for serious hemorrhage. With the preservation of the overlying mucosa, the possible clinical advantages of this approach to tonsillectomy are the absence of bleeding, avoidance of general anesthesia in older patients, less operating time, and decreased postoperative morbidity. The potential for office treatment exists. Additional laboratory studies, as well as careful clinical trials, are indicated based on these encouraging results.

Animals↗
PubMed1996

A combined endoscopic Co2 laser and external approach for treatment of glottic cancer involving the anterior commissure: an animal study.

Endoscopic laser resection usually has been discouraged for anterior commissure (AC) carcinoma because of inadequate exposure and close proximity to underlying cartilage. A new technique combining endoscopic CO2 laser incision and an external approach, creating a window in the thyroid cartilage, was tested in this in vivo study of six dogs. An en bloc specimen including adjacent cartilage was excised while preserving the thyroid framework. The glottic reconstruction was accomplished with external placement of a sternohyoid muscle flap, by either using a bipedicled muscle flap with overlying skin or a unipedicled muscle flap with a graft of free mucosa. The results showed a satisfactory anatomic reconstruction and acceptable functions. The bipedicled muscle flap was superior to the unipedicled muscle flap due to a better AC reconstruction. It is believed that this new combined technique may overcome limited access with endoscopic technique and excessive cartilage resection with the external partial laryngectomy.

Animals↗
PubMed1996

Erbium laser in middle ear surgery: in vitro and in vivo animal study.

Cadaveric human temporal bones, cadaveric rabbits, and live rats were used to demonstrate the utility and safety of the erbium:yttrium-scandium-gallium-garnet (Er:YSGG) laser for otologic applications. The shallow penetration in water of this wave-length and its ability to ablate bony tissue with minimal collateral thermal effects spare underlying and adjacent structures and make it appealing for stapedotomy. The authors were able to satisfactorily perform small fenestra stapedotomy, atticotomy facial nerve decompression, and mastoidectomy. Temperature measurements from the round window area during Er:YSGG stapedotomy recorded an elevation of less than 2 degrees C, which is well within acceptable limits. An acoustic shock produced at the impact site is the major disadvantage and requires further in vivo investigation of the transient and sustained deleterious effects away from the application site. This work supports further investigation into potential applications of the Er:YSGG laser in otology.

Animals↗
PubMed1996

Echo-planar magnetic resonance imaging of deglutitive vocal fold closure: normal and pathologic patterns of displacement.

Abnormalities of vocal fold closure during deglutition predispose to aspiration due to impairment of airway protection. Conventional assessment of deglutitive vocal fold motion with laryngoscopy does not permit visualization through a complete adduction-abduction cycle. We determined spatiotemporal patterns of deglutitive vocal fold adduction through echo-planar magnetic resonance imaging in 15 normal volunteers and 6 patients with vocal fold paralysis. In normal volunteers, deglutitive vocal fold adduction was synchronized with laryngeal elevation, with complete vocal fold closure at the apex. Patients with unilateral vocal fold paralysis demonstrated reduced elevation and medial movement of the involved vocal fold. At maximal laryngeal elevation the uninvolved vocal fold attained a position superior to the paralyzed fold, resulting in level differences and an interglottic gap. Patients with bilateral vocal fold paralysis demonstrated reduced elevation and medial movement of both vocal folds. These findings indicate that normal and abnormal patterns of vocal fold displacement can be distinguished noninvasively through the use of echo-planar imaging.

Adult↗
PubMed1996

Endoscopic laser-assisted reshaping of collapsed tracheal cartilage: a laboratory study.

Repair of anterior tracheal wall collapse is a common and troublesome problem encountered by the head and neck surgeon. The standard treatment calls for an open procedure with or without stenting, depending on the extent of the damage. To avoid the morbidity of the open procedure, a new concept of endoscopic cartilage reshaping was investigated in a laboratory animal study. It involved the application of 1.44-micron pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser at relatively low power to restructure without devitalizing cartilage. An in vivo study was done in six dogs to determine appropriate laser dosimetry in a model of tracheal wall collapse created by a tracheotomy. The deformed cartilage was treated endoscopically with a noncontact 1.44-micron Nd:YAG laser, at 2 to 4 W of power with a repetition rate of 20 Hz, in three animals. As a control, three animals had endoscopic cartilage incisions followed by stent placement. Six weeks postoperatively, both groups had an adequate airway lined by healthy mucosa. In the animals with stenting, however, there was stenosis formation due to scarring at both ends of the stent, with significant inflammatory response in the local area. This study shows that it is possible to use low-power laser energy to reshape cartilage without destroying its viability, and to restore the tracheal wall to a normal contour without ablation or vaporization. The reshaped cartilage will tend to retain its shape with functional elastic force, as seen in in vitro studies. These preliminary results are encouraging, and it seems reasonable to consider using the technique in selected clinical cases as an alternative to conventional open surgery.

Aluminum Compounds↗
PubMed1996

Laser use in the paranasal sinuses.

With the advancement of sinus endoscope and coronal computerized tomography, the ability to diagnose and relate paranasal sinus pathology to abnormal anatomy and function has increased rapidly. The continued development of surgical lasers and research into a better understanding of their advantages, limitations, and possible applications has paralleled this expansion in the diagnosis of paranasal sinuses. The result has been multiple studies now looking at laser use in the paranasal sinuses. These studies are reviewed and the utility of lasers in the sinuses is discussed.

Endoscopes↗
PubMed1995

New technique for laryngotracheal mucosa transplantation. 'Stamp' welding using indocyanine green dye and albumin interaction with diode laser.

OBJECTIVE: To investigate (1) the possibility of survival of free mucosa "stamp" grafts fixed in the airway with a new technique using indocyanine green-dyed albumin solder activated with a diode laser and (2) the degree of improvement of wound healing in the airway by applying modified microskin transplantation techniques from burn surgery to cover a relatively large wound with a few small pieces of mucosa anchored in place with the previously mentioned technique. DESIGN: Three (one control and two experimental) rectangular (10 x 8 mm) wounds in tracheal mucosa were produced in four experimental animals (dogs) using a carbon dioxide laser. The control wound was left uncovered. In the first experimental wound, a mucosal flap was raised and then fixed in place by a trapdoor flap method. In the second experimental wound, two small (each 2 x 3 mm) autogenous mucosa grafts were anchored onto the surface with indocyanine green-dyed albumin activated with an 810-nm diode laser. Histomorphologically, the postoperative results from three wounds were compared. RESULTS: The experimental wounds were completely covered by regenerated squamous cells in 1 week and by ciliated epithelium in 2 weeks after the operation despite the discrepancy in size of the graft to wound area (1:6.7) covered with the stamp mucosa. No thermal damage from the diode laser was noted in the second experimental wounds. In the control wounds, no coverage was observed at 1 week, and only squamous cells were noted 2 weeks postoperatively. All the wounds had normal ciliated epithelium coverage at 4 weeks. CONCLUSIONS: Transplanted stamp grafts provided similar or better healing than trapdoor flap transplants. This new technique made endoscopic mucosal grafting possible and offers a potential breakthrough in the management of laryngotracheal stenosis.

Albumins↗
PubMed1995

Idiopathic subglottic stenosis.

OBJECTIVE: To review our patients with subglottic stenosis and describe a rare subclass of patients in whom the cause of subglottic scarring and narrowing remains unknown. DESIGN: A retrospective chart review and clinical update were performed on all patients seen with the diagnosis of subglottic stenosis. SETTING: The patient pool represents a collection of primary care patients within a suburb of Boston, Mass, and tertiary referrals from community and out-of-state otolaryngologists. PATIENTS: The charts of 80 patients were reviewed, and 10 of the 80 patients fulfilled the criteria for idiopathic subglottic stenosis. INTERVENTION: Diagnostic and therapeutic intervention ranged from laboratory tests, topography, flexible bronchoscopy, rigid endoscopy and biopsy, laser-assisted dilation, and resection and repair of the lesion. MAIN OUTCOME MEASURES: Attention was directed toward the character of the lesion, treatment modality, and clinical outcome. RESULTS: From 1985 to 1992, 10 patients with idiopathic subglottic stenosis were treated at the Lahey Clinic, Burlington, Mass. Eight patients required therapy for exertional dyspnea. Endoscopic laser incision and dilation were performed in all eight patients, with good initial results. Four patients were treated successfully with endoscopy alone: three required only one dilation, and the fourth required a second dilation. The remaining four patients, who had longer and more complex stenoses, have had repeated restenosis at intervals ranging from 1.5 to 12 months. Two of these patients have undergone laryngotracheal resection and reconstruction and were without evidence of restenosis 10 and 20 months after surgery. CONCLUSIONS: There exists a subclass of patients with subglottic stenosis of unknown cause. Symptomatic idiopathic subglottic stenosis may be treated successfully with laser incision and dilation if the stenosis is simple and short. More complex, longer stenoses are prone to recurrence and are more definitively managed by resection and reconstruction of the narrowed area.

Adult↗
PubMed1995

The holmium:YAG laser-assisted otolaryngologic procedures.

OBJECTIVE: To determine the effectiveness of the holmium: YAG (Ho:YAG) laser in otolaryngologic procedures that necessitate the ablation of osseous and soft tissue. DESIGN: Case series. SETTING: Lahey Clinic, Burlington, Mass. PATIENTS: Consecutive series of 37 patients; 29 with chronic sinusitis, five with chronic dacryocystitis, one with recurrent choanal stenosis, one with tracheopathia osteoplastica, and one with a sphenoid sinus mucocele. INTERVENTION: The Ho:YAG laser was used to assist in 37 procedures, including endoscopic sinus surgery, dacryocystorhinostomy, treatment of choanal stenosis, ablation of obstructive tracheopathia osteoplastica, and removal of a sphenoid sinus mucocele. MAIN OUTCOME MEASURES: Postsurgical success and complications, satisfaction of the patients, and the ability of the laser to remove tissue. RESULTS: Complications occurred in eight patients: intranasal or ethmoid scarring (four), persistent polyps (one), bleeding (one), stent dislodgment (one), and tracheitis (one). Three patients required revision surgery. None of the complications were related to use of the laser, although the laser may produce increased scarring. The laser was effective for osseous and soft-tissue ablation, but its usefulness was limited for hemostasis. CONCLUSIONS: The Ho:YAG laser can be used in otolaryngologic procedures when surgical access is difficult or when controlled, precise ablation of osseous tissue is necessary.

Adult↗
PubMed1995

Autologous fibrin tissue adhesive in endoscopic sinus surgery.

Endoscopic sinus surgery may be complicated by bleeding, formation of synechia, and infection. This study investigated the application of autologous fibrin tissue adhesive during endoscopic sinus surgery in an attempt to avoid packing, to decrease complications, and to improve healing. Fibrin tissue adhesive from pooled human blood is a hemostatic and bacteriostatic agent. Autologous fibrin tissue adhesive avoids the potential infectious and immunologic risks of the pooled blood product. Twelve patients undergoing bilateral endoscopic sinus surgery participated in the study. Phlebotomy and preparation of the adhesive were performed during the procedure. Fibrin tissue adhesive was applied to only one side, with the contralateral side used as a control. Bacitracin ointment was applied to the adhesive-treated side, and packing coated with bacitracin was placed on the contralateral side. Patients were observed for a minimum of 3 months, and results were documented with photographic and video recordings. A uniformly high degree of patient satisfaction was achieved because of the elimination of packing and a sensation of increased nasal airway patency on the fibrin-treated side. Fibrin tissue adhesive provided hemostasis, decreased crusting, accelerated mucosal healing, and diminished synechia. Autologous fibrin tissue adhesive is beneficial in endoscopic sinus surgery, and its application should be considered, especially when the risk of hemorrhage or synechia is increased.

Adult↗
PubMed1995

Surgical management of life-threatening epistaxis in Osler-Weber-Rendu disease.

Hereditary hemorrhagic telangiectasia is a systemic disorder of blood vessels. It often leads to severe epistaxis that is refractory to conventional therapy. Three patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia unresponsive to laser coagulation and to septal dermoplasty and requiring multiple transfusions underwent extirpation of nasal mucosa through a rhinotomy approach, with a median forehead flap and split-thickness skin graft coverage of the mucosal defects over the floor and lateral walls of the nose. All patients had reduced frequency and severity of bleeding without any need for transfusions during follow-up periods of 6 months, 3 years, and 5 years, respectively. Forehead flaps resulted in minimal morbidity. Partial nasal obstruction and a forehead scar were the main complaints. Surgical technique, complications, and alternative therapy are discussed.

Epistaxis↗
PubMed1995

Resurfacing of a large laryngeal wound with mucosa grafting: a combined technique using endoscopic suture and laser soldering.

Resurfacing of a large laryngeal wound has traditionally been accomplished via an open approach--transplanting free mucosa either onto the wound directly or upon a stent. This study proposes a new approach for wound resurfacing that combines endoscopic suturing with a laser welding technique. By means of a carbon dioxide (CO2) laser, a large (20 x 25 mm) defect in laryngeal mucosa involving the glottic and subglottic area was created in five dogs. Two of the animals served as controls and received no further treatment. In the remaining three animals the wound was resurfaced with buccal mucosal grafts fixed in place by standard suture placement and a technique of CO2 laser-assisted tissue soldering. The accessible edges of the graft were soldered endoscopically with human albumin-based tissue adhesive "activated" by low power (0.8 to 1.0 W) of a CO2 laser. All animals were examined endoscopically 1 week after surgery and sacrificed painlessly 4 weeks after surgery. The treated animals showed a viable mucosal graft with improved wound healing and voice function compared to that of the control animals. This new approach combines suture fixation of the inferior aspect of the mucosal graft, an area not well exposed endoscopically, and endoscopic laser soldering techniques for the repair of large laryngeal wounds.

Animals↗
PubMed1995

Endoscopic diode laser welding of mucosal grafts on the larynx: a new technique.

Epithelial coverage of a laryngotracheal wound is an important factor in preventing stenosis, and endoscopic transplantation of a free mucosal graft without stents or sutures would be a significant therapeutic advance. In vitro and in vivo canine studies were performed to explore the feasibility of transplantation with a low-power diode laser (400 mW) enhanced by indocyanine green dye-doped albumin. The tensile strength of graft adherence in 10 cadaver larynges was strong (35.25 +/- 10.39 g). Survival studies in live canine models with a specially designed endoscopic instrument set showed excellent healing at 6, 14, and 28 days. Healing was documented with photography and by histologic examination. Successful endoscopic transplantation of a free mucosal graft should improve results of treatment for laryngotracheal stenosis and laryngeal reconstructive surgery.

Albumins↗