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Biomedical subjects

W Lawson

Publications and source records attributed to W Lawson.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Sinonasal hemangiopericytomas: a clinicopathologic and immunohistochemical study of seven cases.

BACKGROUND: Sinonasal hemangiopericytoma (SNHPC) is a rare lesion usually of low-grade malignant potential. Aggressive and metastatic cases are uncommon, and experience using adjuvant therapy on these cases has been limited. Tumor-induced osteomalacia has a very rare association with SNHPC. Further, the diagnosis of SNHPC remains one of histologic-pattern recognition. Traditionally, immunohistochemistry has aided in excluding other diagnoses; only vimentin has been consistently expressed by the tumor spindle cells of HPC. Recent studies have shown that Factor XIIIa is also expressed by HPC, (as well as tumors of fibrohistiocytic differentiation) and hence may be yet another helpful positive marker in establishing an immunohistochemical profile. METHODS: We identified 7 patients at this institution with SNHPC from 1990 to 1994. Immunohistochemistry was performed on seven formalin-fixed paraffin-embedded tumors utilizing antibodies to factor XIIIa as well as antibodies to vimentin, factor VIII, muscle-specific antigen, cytokeratin, and S-100. RESULTS: All 7 patients were initially seen with nasal obstruction or epistaxis and underwent surgical resection. The period of follow-up was from 3 months to 14 years (mean 54 months) for 7 patients. Three patients had recurrent disease after 3, 5, and 10 years. The first 2 were known to have been originally treated by polypectomy. One patient required adjuvant radiotherapy for metastatic disease and local extension. One patient was initially seen with tumor-induced osteomalacia which dramatically improved following resection of the lesion. The immunohistochemical profile revealed strong expression of vimentin in 7/7 cases, and of factor XIIIa in 4/7 cases; tumor cells did not express the other markers studied. CONCLUSIONS: Adequate surgical resection with negative margins appears to be the appropriate therapy for SNHPC. Our 1 case associated with tumor-induced osteomalacia was reversible after surgical excision of the tumor. The immunohistochemical results suggest that the pattern of vimentin and factor XIIIa positivity, as well as lack of expression of other markers, is consistent with the diagnosis of HPC, which still remains in the domain of histopathology.

Adult↗
PubMedDate not supplied

Massive necrotizing infections of the neck.

Necrotizing fascitis of the head and neck is a rare condition with only 7 cases recorded in the literature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics, fasciotomy, radical debridement, and hyperbaric oxygenation (1 case). The clinical features, bacteriology, and treatment of necrotizing faciities are reviewed.

Adult↗
PubMedDate not supplied

Analysis of the methods of pharyngoesophageal reconstruction.

During the period 1972-1982, 84 pharyngoesophageal reconstructions were performed on 82 patients (10 benign lesions and 72 malignant lesions) by the Department of Otolaryngology, Mount Sinai Medical Center, New York. The overall mortality for the series was 10%, with postoperative complications developing in the majority of patients and swallowing accomplished in 61%. The most successful method of reconstruction was stomach transposition (92%), followed by cervical flap repair (68%). The least successful methods were the use of the tubed deltopectoral and pectoralis major myocutaneous flaps, colon interposition, and jejunal autografts (40%-50%). The pertinent literature is reviewed and the reported mortality, morbidity, indications, limitations, and success rates for each method of reconstruction are analyzed and compared with the present series.

Colon↗
PubMedDate not supplied

A compendium of intraoral flaps.

Intraoral flaps are an excellent source of tissue for reconstruction after resection of small malignant tumors of the oral cavity, pharynx, and hypopharynx. The principal donor sites used are the tongue, buccal mucosa, and palate. Intraoral flaps enable rapid rehabilitation of deglutition and speech with minimal morbidity. They provide easily transferred, well-vascularized tissue from sites adjacent to the operative defects. These flaps permit closure without tension and obviate the need for more distant tissue transfers. Their use does not compromise the oncologic resection.

Cheek↗
PubMedDate not supplied

Salvage surgery for recurrent neck carcinoma after multimodality therapy.

Recurrent carcinoma of the neck after treatment by radical neck dissection and radiotherapy leads to a progressive downhill course if no further therapy is instituted. Nine such patients having fixed, recurrent neck tumors with carotid artery involvement underwent 10 salvage procedures with carotid artery resection and replacement. One patient developed a transient hemiparesis that resolved in 3 days, and in another, a permanent hemiparesis occurred. Three patients have survived longer than 12 months. One patient is free of disease at 42 months following two salvage operations. We attribute the low operative morbidity to the frequent use of the subclavian artery for proximal anastomosis and myocutaneous flaps to resurface cutaneous and mucosal defects. We conclude that salvage surgery with carotid artery replacement can be performed on selected patients who have failed combined therapy as a palliative and possibly curative measure.

Aged↗
PubMedDate not supplied

Acrylic frontal cranioplasty.

The correction of contour defects of the frontal bone has been accomplished with a variety of autogenous and alloplastic materials. We report our experience in reconstructing 11 cases of congenital, traumatic, and postsurgical frontal defects with acrylic. The acrylic was cured intraoperatively within the defect in some patients, or prefabricated into a prosthesis and wired into position in others. The operative techniques for both methods of repair are detailed. The reconstruction was successful in all cases and there were no complications. The acrylic implant has been found to be well tolerated after 2-10 yr follow-up. The value of the construction of a facial moulage is stressed, especially when restoration of the orbital rim is required.

Adult↗
PubMedDate not supplied

Psychosocial effects of enhanced external counterpulsation in the angina patient.

Enhanced external counterpulsation (EECP) is a noninvasive pantaloon device designed to increase coronary artery flow in the treatment of angina. This pilot study, conducted in 1992-1993, which used psychosocial testing pre- and posttreatment, yielded data suggesting that EECP is well tolerated psychosocially and produces improvement in the anginal syndrome. More comprehensive research is under way to test these preliminary conclusions.

Activities of Daily Living↗
PubMedDate not supplied

The solitary thyroid nodule: diagnosis and management of malignant disease.

While few solitary thyroid nodules are carcinomatous, it is essential to identify and preferentially select those that are for surgery. Clinical, biochemical, serologic, radiographic, scintigraphic, sonographic, biopsy, and even therapeutic evaluation may be necessary to choose those patients with the greatest probability of malignancy. The benefits and limitations of each diagnostic modality are discussed, and the importance of fine-needle aspiration is stressed. After the operative confirmation of malignancy, the prognosis in any given case depends on 1) the histologic type of the neoplasm, 2) its size and extent, 3) the presence of angioinvasiveness, 4) the tendency toward multicentricity of the lesion, 5) the age and sex of the patient, and 6) whether distant metastases are present. These factors influence the extent of surgery required for well-differentiated carcinomas. Meticulous dissection and preservation of the recurrent laryngeal nerves and the parathyroid glands along with their blood supply are important if total thyroidectomy for papillary carcinoma is to be employed with an acceptable operative morbidity to optimize survival. The value of the adjunctive use of thyroid hormone and radioactive iodine is also discussed. Finally, the clinical behaviors and treatments of undifferentiated carcinomas, sarcomas, lymphomas, and neoplasms metastatic to the thyroid gland are reviewed.

Adenocarcinoma↗
PubMedDate not supplied

CT appearance distinguishing benign nasal polyps from malignancies.

In many cases the common nasal polyp is confused clinically, radiographically, and, on occasion, pathologically with a tumor of the nasal vault and paranasal sinuses. Similarly, this distinction often cannot be made by CT. However, we have identified in 12 patients a CT appearance of looping, minimally or nonenhancing soft tissue densities within a mucoid density background matrix, that is associated with cases of polyposis (nine patients) and fungal disease (three patients). We believe that when this CT appearance is present, malignant disease can be essentially eliminated from the differential diagnosis.

Aspergillosis↗
PubMedDate not supplied

Hemorrhaged cystic hygroma and facial nerve paralysis: CT and MR findings.

The association of peripheral facial nerve paralysis and cystic hygroma is rare, this being only the third reported case. In this patient paralysis was secondary to hemorrhage within the cyst and nerve compression. Although the magnetic resonance studies allowed the diagnosis to be made eventually, the complex signal intensities due to excessive bleeding within the cyst confused the issue. In this case, CT allowed an immediate diagnosis to be established.

Adult↗
PubMedDate not supplied

Psychosocial effects of enhanced external counterpulsation in the angina patient: a second study.

Enhanced external counterpulsation (EECP) is a noninvasive technique that has shown promise in the treatment of ischemic coronary artery disease. Patients undergoing EECP were tested for alterations in psychosocial state associated with treatment. Overall perception of health and quality of life improved with EECP. There was also significant improvement in levels of depression, anxiety, and somatization but no change in levels of anger or hostility. On most measures, change was more significant for subjects who showed objective evidence of resolution of ischemia. Given the known predictive relationship between depression and mortality from cardiac disease, the improvement in depression scores through EECP indicates a finding of potential importance that may warrant further study in future research.

Aged↗