Biomedical subjects

Scott P Stringer

Publications and source records attributed to Scott P Stringer.

10 recordsLinked to original sources

PubMed2004

Utility of image guided surgery in the diagnosis of pterygopalatine fossa lesions.

OBJECTIVES: To describe the utility of image guided surgery in the diagnosis of pterygopalatine fossa lesions and to discuss the varied pathologic diagnoses from this area. STUDY DESIGN: Case series presentation. METHODS: Three cases of pterygopalatine fossa lesions were accessed and biopsied by way of a middle meatus antrostomy approach into the pterygopalatine fossa under image guidance for rapid localization. RESULTS: The diagnoses of melanoma, squamous cell carcinoma, and schwannoma were obtained with minimal morbidity with image guidance. More extensive external approaches were avoided, and appropriate treatment was started without delay. The utility of the image guided approach will be discussed along with the varied pathologies encountered in the pterygopalatine fossa. CONCLUSIONS: 1). One must recognize the diverse, yet related, symptoms of patients presenting with pterygopalatine fossa lesions. Early recognition as well as skull-base imaging is crucial. 2). Biopsy, in addition to imaging, is necessary for diagnosis and may be achieved with little morbidity and increased accuracy using the image guided surgery middle meatus antrostomy approach to the pterygopalatine fossa. 3). The origin of lesions that involve the pterygopalatine fossa may be difficult to identify. Involvement of the pterygopalatine fossa by malignancy may be by contiguous spread, by way of metastasis, or by perineural invasion.

Aged↗

PubMed2002

Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both.

BACKGROUND: The treatment of patients with squamous cell carcinoma (SCC) of the oropharynx remains controversial. No randomized trial has addressed adequately the question of whether surgery (S), radiation therapy (RT), or combined treatment is most effective. METHODS: Treatment results from North American academic institutions that used S with or without adjuvant RT (S +/- RT) or used RT alone or followed by neck dissection (RT +/- ND) for patients with SCC of the tonsillar region or the base of tongue were compiled through a MEDLINE search (from 1970 to August, 2000) and from the references cited in each report. Studies were eligible for inclusion if they contained direct, actuarial (life-table), or Kaplan-Meier calculations for the following end points: local control, local-regional control, 5-year absolute survival, 5-year cause specific survival, or severe or fatal treatment complications. Weighted average results, which took into account series size, were calculated for each end point for the purposes of treatment comparison. Results and conclusions were based on data from 51 reported series, representing the treatment of approximately 6400 patients from the United States and Canada. RESULTS: The results for patients with SCC of the base of tongue who underwent S +/- RT versus RT +/- ND, respectively, were as follows: local control, 79% versus 76% (P = 0.087); local-regional control, 60% versus 69% (P = 0.009); 5-year survival, 49% versus 52% (P = 0.2); 5-year cause specific survival, 62% versus 63% (P = 0.4); severe complications, 32% versus 3.8% (P < 0.001); and fatal complications, 3.5% versus 0.4% (P < 0.001). The results for patients with SCC in the tonsillar region who underwent S +/- RT versus RT +/- ND, respectively, were as follows: local control, 70% versus 68% (P = 0.2); local-regional control, 65% versus 69% (P = 0.1); 5-year survival, 47% versus 43% (P = 0.2); 5-year cause specific survival, 57% versus 59% (P = 0.3); severe complications, 23% versus 6% (P < 0.001); and fatal complications, 3.2% versus 0.8% (P < 0.001). CONCLUSIONS: The information in this article provides a useful benchmark for evidence-based counseling of patients with SCC of the oropharynx. The rates of local control, local-regional control, 5-year survival, and 5-year cause specific survival were similar for patients who underwent S +/- RT or RT +/- ND, whereas the rates of severe or fatal complications were significantly greater for the S +/- RT group. Furthermore, available data on the functional consequences of treatment suggest the superiority of RT +/- ND. The authors conclude that RT +/- ND is preferable for the majority of patients with SCC of the oropharynx.

Carcinoma, Squamous Cell↗

PubMed2002

Voice rehabilitation after total laryngectomy and postoperative radiation therapy.

PURPOSE: The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx. PATIENTS AND METHODS: Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment. All other living patients had follow-up for 2 years or longer. Twelve (7%) patients had incomplete data pertaining to voice rehabilitation. RESULTS: Data pertaining to voice rehabilitation were available at 2 to 3 years and longer and 5 years and longer after treatment for 118 and 69 patients, respectively. The methods of voice rehabilitation at 2 to 3 years and longer and 5 years and longer were as follows: tracheoesophageal, 27% and 19%; artificial larynx, 50% and 57%; esophageal, 1% and 3%; nonvocal, 17% and 14%; and no data, 5% and 7%, respectively. CONCLUSION: The most common form of voice rehabilitation after total laryngectomy and postoperative radiation therapy is the artificial larynx. Although the tracheoesophageal puncture is a technique frequently promoted by clinicians as a superior method, a relatively small subset of patients are successfully rehabilitated long-term. However, of those who undergo a tracheoesophageal puncture, approximately half will use this method of voice rehabilitation long term.

Adult↗

PubMed2002

Post-RT CT results as a predictive model for the necessity of planned post-RT neck dissection in patients with cervical metastatic disease from squamous cell carcinoma.

PURPOSE: To establish whether the extent of neck disease on postradiation therapy (RT) computed tomography (CT) can predict the likelihood of positive neck nodes and, thereby, the necessity of planned post-RT neck dissection. METHODS AND MATERIALS: Ninety-five patients who underwent post-RT neck dissection within 2 months for squamous cell carcinoma of the head and neck were eligible. Of the 95 patients, 37 (32.7%) of 113 hemineck specimens were pathologically positive. On post-RT CT imaging studies, the number and size of lymph nodes >1 cm were recorded. Internal focal defects and the likelihood of extracapsular spread were graded. RESULTS: If lymph nodes on post-RT CT were < or = 15 mm, free of significant internal focal low-attenuation or calcification, and without imaging evidence of extracapsular spread, the surgical hemineck specimen was positive in 1 (3.4%) of the 29 hemineck specimens. A focal low-attenuation defect (p = 0.0078) and evidence of extracapsular spread (p = 0.0721) seen in the residual nodal mass on CT were independent predictors of a positive surgical specimen by multivariate analysis. CONCLUSION: CT findings on post-RT neck studies can help predict the likelihood of residual disease and, thereby, the necessity of planned post-RT neck dissection.

Adult↗

PubMed2002

Carcinoma of the skin of the head and neck with perineural invasion.

BACKGROUND: Perineural invasion is observed in a small subset of patients with carcinomas of the skin of the head and neck. METHODS: Review of the patient literature highlighting the University of Florida experience. RESULTS: Patients with early perineural invasion are asymptomatic, and the phenomenon is discovered only on pathologic examination of the excised lesion. These patients are defined as having "incidental" perineural invasion, and treatment with surgery followed by postoperative irradiation results in a cure rate of approximately 80%. Undiagnosed, the perineural carcinoma slowly progresses and eventually results in symptoms, usually facial weakness or numbness. The disease eventually extends to the skull base and becomes incompletely resectable. Symptomatic patients are defined as having "clinical" perineural invasion, and aggressive treatment results in a cure rate of approximately 45%. CONCLUSIONS: Perineural invasion is an uncommon spread pattern observed in patients with skin cancer and is associated with a relatively poor prognosis. The likelihood of cure is inversely related to the proximal extent of the cancer and is lower for symptomatic compared with asymptomatic patients.

Carcinoma, Squamous Cell↗

PubMed2002

Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection.

PURPOSE: To present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx treated at the University of Florida and to compare these data with those obtained after conservation surgery. METHODS AND MATERIALS: Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 274 patients with squamous cell carcinoma of the supraglottic larynx between 1964 and 1998. All patients had follow-up for a minimum of 2 years, and 250 (91%) had follow-up for 5 years or more. RESULTS: At 5 years, the actuarial probability of local control after radiotherapy according to T stage was as follows: T1, 100%; T2, 86%; T3, 62%; and T4, 62%. The probability of cause-specific survival at 5 years by AJCC stage was as follows: stage I, 100%; II, 93%; III, 81% IVA, 50%; and IVB, 13%. The risk of severe late complications was 4%. Of 57 patients undergoing planned postradiotherapy neck dissection, 7% experienced a severe complication. CONCLUSIONS: On the basis of our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.

Carcinoma, Squamous Cell↗

PubMed2002

Economic analysis.

Explore the source record for details and available documents.

Cost-Benefit Analysis↗

PubMedDate not supplied

Lymph nodes of patients with regional metastases from head and neck squamous cell carcinoma as a predictor of pathologic outcome: size changes at CT before and after radiation therapy.

BACKGROUND AND PURPOSE: Viable tumor in a neck dissection specimen is important in predicting prognosis and directing treatment. Our purpose was to clarify the importance of size changes of regional metastases from head and neck squamous cell carcinoma on CT scans obtained before and after radiation therapy (RT) as a predictor of pathologic outcome. METHODS: Thirty-seven heminecks in 34 patients who underwent pre-RT CT, RT, post-RT CT, and post-RT neck dissection were reviewed. Thirteen hemineck specimens were pathologically positive. Decrease ratios of the largest axial dimension of the lymph nodes between the pre- and post-RT CT studies were calculated. RESULTS: Six of 37 heminecks had a decrease ratio greater than 50%. These yielded negative specimens after planned neck dissection. In two of 37 heminecks, the largest axial dimension of the largest node increased between studies, resulting in negative decrease ratio. One (decrease ratio, -20%) had a positive specimen, and the other (decrease ratio, -3%) had a negative specimen. No interval change in size in the largest node was noted in one of the 37 heminecks; its specimen was positive. Average decrease ratios were 41.2% (range, -3% to 62%) in the negative specimen group (n = 24) and 27.2% (range, -20% to 50%) in the positive specimen group (n = 13). Univariate analysis revealed that the decrease ratio was not a significant predictor of a positive surgical specimen (P =.154). CONCLUSION: Heminecks in which the decrease ratio was greater than 50% tended to have a negative surgical specimen. However, this trend was not statistically significant.

Adult↗

PubMedDate not supplied

Economic analysis of the use of limited coronal computed tomography scans in the management of sinusitis.

BACKGROUND: As medical costs increase, less expensive alternatives to standard diagnostic tests are sought to reduce the economic burden placed on society. One alternative is using limited, non-consecutive cut computed tomography (CT) scans for the evaluation of sinonasal disease. This study evaluates the cost-effectiveness of using limited CT scans instead of full sequence CT scans in the diagnosis and management of rhinosinusitis. METHODS: A Medline search was performed to obtain data for the sensitivity and specificity of limited CT scans, the prevalence of abnormal CT scans, and recommendations on using limited CT scans for operative management. A standard cost-effectiveness analysis, including a sensitivity analysis, was performed using a hypothetical population of patients with sinus complaints who failed prior appropriate medical therapy. RESULTS: At baseline, the limited CT scan was found to be less cost-effective than the full CT scan, costing $217.13 more per correct diagnosis. The sensitivity analysis demonstrated that changes in the prevalence of abnormal CT scans and the percentage of surgeons who would operate using a limited scan had the greatest impact on cost, whereas changes in the price of the full CT or limited CT scan had the least effect. CONCLUSIONS: This study finds the use of limited CT scans to be economically unsound as a method to reduce costs in the defined population. Published literature recommends obtaining a full CT scan before operative management. Basing intervention on limited CT scans increases the possibility of erroneous diagnoses leading to either excessive or inadequate treatment of patients.

Cost-Benefit Analysis↗

PubMedDate not supplied

Evidence-based recommendations for antimicrobial nasal washes in chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a difficult problem for patients and physicians. Topical antimicrobial nasal irrigations are commonly used for treatment with great variation in methodology and without clear scientific support for current treatment formulations. The purpose of this study was to develop a scientific rationale for creating standardized recommendations for clinical practice in the use of topical antimicrobial washes for CRS. METHODS: An extensive review of basic science and clinical literature on the treatment of CRS with topical antimicrobial washes was completed. Pharmacokinetics of and organism susceptibility to appropriate topically applied antimicrobial agents were reviewed. RESULTS: The most common organisms associated with CRS were identified. The relevant pharmacokinetics of drugs targeted at these organisms are presented. Susceptibility breakpoints set by the National Committee for Clinical Laboratory Standards are identified to help establish the most effective concentration of the identified drugs. Recommendations for agent selection, agent concentration, length of treatment, dosing schedule, and methods of irrigation are presented. CONCLUSION: Antimicrobial nasal washes provide a potentially effective treatment for the growing population of patients who remain symptomatic after appropriate medical and surgical intervention. This study establishes the basic principles supporting this treatment option and offers rational, evidence-based treatment guidelines. The study has identified additional areas that need to be investigated before prospective clinical trials can be effectively undertaken.

Administration, Intranasal↗