Biomedical subjects
Y Zohar
Publications and source records attributed to Y Zohar.
Reduction of salivary flow in amyotrophic lateral sclerosis with Scopoderm TTS.
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Ethical dilemmas in head and neck cancer.
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Anatomic study of the otic ganglion in humans.
The presentation in the literature of the anatomy of the human otic ganglion (OG) has not varied much over the past three quarters of a century. Precise, similar descriptions of its size, color, shape, and relation with neighboring structures are portrayed in numerous textbooks and articles. We have carried out a study of the OG in 30 infratemporal fossae of 15 cadavers. Otic ganglia resembling the classic description were found in less than 60% of the cases. In 13%, some thickening could be seen adjacent to the mandibular nerve and in 27%, no definite structure could be observed. Except for a fleeting mention of this occurrence in a textbook from 1927, substantiated by personal communication with an authority in the field, we could find no record of the possible absence of this structure in the available literature. We describe our findings and stress the apparent anatomic variability of the OG. The pertinent literature is reviewed.
Nucleolar organizer regions in follicular tumors of the thyroid.
BACKGROUND: Nucleolar organizer regions (NORs) are loops of ribosomal DNA that occur in nucleoli and that transcribe to ribosomal RNA. NORs have been identified by means of the Ag-NOR technique in routinely processed tissues, and were found to be of discriminative value between some types of benign and malignant lesions. METHODS: Follicular lesions of the thyroid (17 adenomas and 25 carcinomas) were examined. Ten normal thyroids served as the control group. All slides were stained by the Ag-NOR technique and the number of Ag-NOR dots were counted in 50 randomly selected cells. The mean number of Ag-NORs was calculated for each case. Data were statistically analyzed by the Student's unpaired t test. RESULTS: The mean Ag-NOR counts were statistically higher in follicular carcinomas as compared to either follicular adenomas or the normal thyroid. Higher Ag-NOR counts were found in the more aggressively behaving tumors. CONCLUSIONS: It is suggested that the Ag-NOR technique could be of use as an adjunct to diagnostic histopathology and as an indicator of biologic behavior in follicular tumors of the thyroid.
Occult distant metastases of well-differentiated thyroid carcinoma.
BACKGROUND: The tendency of well-differentiated thyroid carcinoma to remain localized and its slow progression have supported the belief that this disease behaves as a low-grade malignancy. Consequently, a conservative approach in the management of the well-differentiated thyroid carcinoma has existed during the years. Occult distant metastases of thyroid cancer is an occasional finding considered of ominous significance. METHODS: In a retrospective study, we reviewed the records of 187 adult patients with well-differentiated thyroid carcinoma treated by total thyroidectomy. These cases were found among 1,240 thyroidectomies performed in our department between 1982 and 1993. Occult distant skeletal and lung metastases disclosed by total body 131I scans, after total thyroidectomy, were present at the time of initial treatment in 11 patients (11/187). This group included 9 women and 2 men ranging in age from 36 to 70 years, with a mean age of 47 years. Seven patients had papillary carcinoma, whereas follicular malignancy was found in four. Review of the surgical specimens showed total involvement of the gland in 5 cases, with extracapsular tumoral spread in 3 patients. Multicentric disease was present in 6 specimens. Patient follow-up revealed a mortality rate of 64% (7/11) during the first 3 post-operative years. CONCLUSIONS: Analysis of this population confirms that well-differentiated thyroid carcinoma with distant metastases is an aggressive disease with lethal consequence. Early detection and therapy of occult distant metastases present at the time of initial treatment is possible only after total thyroid ablation, because otherwise the radioactive iodine is trapped by the gland's remnants.
Thyroid function following radiation and surgical therapy in head and neck malignancy.
A retrospective 10-year review of thyroid function in 144 patients treated for cancer of the head and neck by radiation therapy, surgery, and combined surgery and radiation therapy was done. In five patients, hypothyroidism had been found in the posttreatment period. Two of them had developed a pharyngeal fistula resistant to intensive local care and surgical procedures, and a third patient had edema and necrosis of the skin flap. The five hypothyroid patients reported here have all been treated for laryngeal malignancy. In any other group of patients treated for head and neck malignancies studied within this article, we did not find clinical or chemical signs of thyroid hypofunction. Our report stresses the importance of periodic evaluation of thyroid function in patients who underwent irradiation of the neck or combined therapy for malignancy in the neck, even if they were clinically euthyroid. Hypofunction may be more frequent than generally recognized after multimodality treatment, and hormonal replacement therapy may be the keystone in curing rebellious pharyngeal fistula and shortening the disabled state of the patient.
Computed tomography evaluation of the nasal septal reconstructed larynx.
Computed tomography (CT) of the larynx was performed in 15 patients who had their larynx reconstructed by composite nasal septal autograft after frontal, or frontolateral laryngectomy. Five representative cases each with CT scan and additional laryngoscopic documentation are presented. The CT permitted a detailed appraisal of the nasal septal grafted larynx. Our attention was directed to the image of the graft in what concerned its patterns of distortion, fibrosis or chondrification, and width of the laryngeal airway. The scan from 10 patients brought radiographic evidence that the implanted cartilage retained vitality and structural integrity.
Metastatic carcinoma of oral soft tissue.
Metastatic carcinomas to the oral region are rare. Most of the lesions are located in the bones of the jaw. The medical literature contains quite a few examples of metastatic lesions located strictly in the oral soft tissue. We present two cases of oral soft tissue metastatic carcinoma of urogenital origin.
Antibacterial properties of human amniotic membranes.
Amniotic membranes are widely used in a multitude of surgical applications and have been shown to reduce bacterial counts and promote healing in infected wounds. Antibacterial properties of amniotic fluid are well documented and the presence of many potentially antibacterial factors has been demonstrated. No such factors have yet been found in amniotic membranes. We have applied a direct disc-diffusion susceptibility test to try to establish the possible existence of such a factor. Amniotic membranes did not inhibit five bacterial species when tested at 3 X 10(6) and 3 X 10(8) colony forming units/ml. However, complete growth inhibition of all organisms was seen immediately under the amniotic membrane discs. These results support the hypothesis that the antimicrobial effect of amniotic membranes in vitro is due to their close adherence to the wound surface.
Cutaneous malignant lymphoma of the nasal tip.
Cutaneous lymphomas are relatively rare malignant lesions. Lymphomas limited to the skin are uncommon and most patients have a generalized disease. The head and neck are the most common sites of presentation. This lesion is diagnostically problematic since histologic distinction from several benign cutaneous lymphocytic infiltrates is occasionally difficult and thus its clinical behavior is unpredictable. The most common histopathologic subtype is diffuse histiocytic lymphoma and therapy is analogous to that for lymphomas arising elsewhere. The prognosis of lymphoma presenting in the skin is dependent upon the initial extent of the disease and probably upon histology. A case of cutaneous malignant lymphoma arising at the nasal tip, surgically treated, is presented.
Eliminating the Toynbee phenomenon in patients with nasal packs.
Nasal packing is a common procedure in otolaryngology, but is not a completely innocuous procedure. Besides aggravating mouth breathing, complete nasal obstruction results in an annoying Toynbee phenomenon. In patients with bilateral anterior nasal packing, we recorded high pressure gradients in the nasopharynx and, in consequence, in the middle ear. Patients in whom rubber tubes were inserted between the gauze layers of the anterior nasal packs suffered no such inconvenience and showed no such gradients. Our work proves the value of using these tubes for pressure equalization when nasal packs are necessary.
Reduction of salivary flow with Scopoderm TTS.
Scopoderm transdermal therapeutic system (TTS) is a form of application permitting programmed release of scopolamine through the skin into the bloodstream. Scopoderm TTS is indicated for prevention of nausea and vomiting associated with motion sickness. The most common side effect associated with its use is dryness of the mouth. We have been using Scopoderm TTS for reducing salivary flow in patients with sialorrhea or with difficulties in swallowing normal amounts of salivary secretions. Good results were achieved with minimal discomfort from adverse effects. We recommend the use of Scopoderm TTS in selected cases of sialorrhea and drooling, preoperatively and postoperatively in patients undergoing surgery of oral, laryngeal, and pharyngeal lesions.
Study of Toynbee phenomenon by combined intranasopharyngeal and tympanometric measurements.
The Toynbee maneuver, swallowing when the nose is obstructed, leads in most cases to pressure changes in one or both middle ears, resulting in a sensation of fullness. Since first described, many varying and contradictory comments have been reported in the literature concerning the type and amount of pressure changes both in the nasopharynx and in the middle ear. In our study, the pressure changes were determined by catheters placed into the nasopharynx and repeated tympanometric measurements. New information concerning the rapid pressure variations in the nasopharynx and middle ear during deglutition with an obstructed nose was obtained. Typical individual nasopharyngeal pressure change patterns were recorded, ranging from a maximal positive pressure of +450 to a negative pressure as low as -320 mm H2O.
Can uvulopalatopharyngoplasty be harmful to eustachian tube function?
A study of the Eustachian tube, incorporating nasendoscopy, tympanometry and pressure swallow test was undertaken in patients undergoing uvulopalatopharyngoplasty. Marked negative middle ear pressure indicating impairment of tubal function was found during the first 7 postoperative days. In patients receiving antibiotic treatment the Eustachian tube dysfunction was significantly alleviated. This dysfunction is probably due to a postoperative infective inflammatory process in the tonsillar fossa. Antibiotic treatment is recommended for patients undergoing uvulopalatopharyngoplasty, to improve the postoperative course. Patients with middle ear abnormalities and following middle ear surgery could be high-risk candidates for this operation and should be carefully evaluated.
Salivary duct carcinoma of the parotid gland. Cytologic and histopathologic study.
Ductal carcinoma is an uncommon tumor of the salivary glands. Histopathologically, it is characterized by the presence of intraductal and infiltrative neoplastic components, morphologically resembling mammary carcinoma. A case of ductal carcinoma of the parotid gland, in which preoperative fine needle aspiration biopsy was performed, is presented. Cytologic examination of the aspirate revealed naked nuclei featuring anisokaryosis, chromatin clumps and clear vacuolar zones.