Functional and oncologic results following transoral laser microsurgical excision of base of tongue carcinoma.

OBJECTIVE: The study objective was to determine survival and functional results in patients who underwent transoral laser excision of base of tongue squamous cell carcinoma. STUDY DESIGN: This was a case series with chart review. SUBJECTS AND METHODS: Patients with biopsy-proven base of tongue squamous cell carcinoma primarily treated with transoral laser excision and followed for at least 24 months were included. Disease-specific and overall survival data were determined. Quality-of-life data were obtained using the University of Washington Quality of Life instrument. RESULTS: Of the 71 patients treated, one (1.4%), nine (12.7%), seven (9.9%), and 54 (76.1%) were stage I, II, III, and IV, respectively, at diagnosis. At 24 months, overall survival was 90 percent; disease-specific survival was 94 percent. Locoregional recurrence occurred in 10 percent. Given the low number of deaths, no significance was detectable between survival and gender, overall stage, tumor size, nodal status, or adjuvant therapy. Quality-of-life data, obtained for 46 patients, revealed the majority of patients had mild or no pain, minimally impaired to normal swallowing, and normal speech. CONCLUSION: Transoral laser excision offers an acceptable treatment approach in terms of survival and quality of life for patients with base of tongue squamous cell carcinoma.

Endoscopic transnasal transethmoid ligation of the anterior ethmoid artery.

BACKGROUND: The current otolaryngologic literature is lacking in basic science investigation regarding endoscopic anterior ethmoid artery (AEA) ligation as part of the armamentarium for epistaxis control. This investigation provides the anatomic rationale for endoscopic ligation of the AEA in the surgical treatment of epistaxis. In addition, it provides tools for identification of this vessel during routine endoscopic sinus surgery. METHODS: This descriptive cadaver study investigates the feasibility of endoscopic transnasal transethmoid dissection; anatomic description; and clip ligation within the periorbital space of 16 AEA specimens. A careful assessment for skull base penetration and disruption was performed. RESULTS: All 16 anterior ethmoid arteries were readily identified and successfully clipped. The anatomy was carefully observed and described for each specimen, and no inadvertent skull base penetration occurred. CONCLUSION: This study confirms that endoscopic ligation of the AEA is a safe and feasible technique for the control of epistaxis. Additionally, this anatomic knowledge is beneficial during routine endoscopic sinus surgery if AEA injury should occur. Further evaluation is necessary for clinical application of this technique in the treatment of epistaxis.

Cellular immune response in HIV-infected patients with histoplasmosis.

The relationship of immunity to Histoplasma capsulatum and CD4 count in HIV-1-infected patients is unknown. Samples of blood from people with HIV infection and from HIV-negative volunteers were assessed for immune responsiveness to the histoplasmin antigen using proliferation and interferon-gamma production as indicators of immunity. Results of histoplasmin skin tests, lymphoproliferative responses (LPR), and interferon-gamma production were positive in 9 of 20 (45%) HIV-negative controls, and in vitro measurements agreed highly with skin test reactivity. Among HIV-1-infected patients with recent histoplasmosis, skin test results were positive in none, LPR results were positive in 14%, and interferon-gamma production in 18%. Among HIV-1-infected patients with CD4 counts between 200 and 500 cells/mm(3), LPR was positive in 8% and interferon-gamma production in 33%, and among those with CD4 counts >500 cells/mm(3), LPR was positive in 31% and interferon-gamma production in 46%. In conclusion, immune responsiveness to H. capsulatum was depressed in HIV-1-infected persons with CD4 counts between 200 and 500 cells/mm(3), but approached normal in those with CD4 counts >500 cells/mm(3).