Assuntos
Relações Médico-Paciente , Guerra , Ferimentos e Lesões/terapia , Cirurgia Geral , Humanos , Israel , SíriaRESUMO
Human epidermal growth factor receptor 2 (HER-2) is a well recognized prognostic and predictive factor in breast cancer. However, the role of HER-2 in thyroid cancer remains controversial. The aim of this study was to evaluate HER-2 expression in differentiated thyroid cancer (DTC) and determine whether there is an association with other clinical and pathological characteristics. A total of 69 patients with DTC were investigated, 58 of whom had papillary and 11 follicular carcinomas. HER-2 was detected by immunohistochemical examination on sections from formalin-fixed, paraffin-embedded tumor tissues. Tumors with HER-2 expression classed as +1 and +2 were retested with chromogenic in situ hybridization. Clinicopathological data were retrieved from the hospital records of the patients. HER-2 overexpression was found in 4 (6.9%) of the 58 patients with papillary carcinoma, whereas there was no HER-2 overexpression in any of the 11 cases of follicular carcinoma. There was no association of HER-2 expression with tumor size, pathological grade and cervical lymph node metastasis. In conclusion, there were no HER-2 positive cases of follicular carcinoma and the incidence of HER-2 overexpression in papillary carcinoma was very low. Thus, HER-2 cannot be used routinely as a prognostic or predictive factor in DTC. The expression of other epidermal growth factor receptors in DTC merits further investigation.
Assuntos
Perda Auditiva Condutiva/etiologia , Ventilação da Orelha Média/métodos , Assistência Terminal , Evolução Fatal , Perda Auditiva Condutiva/terapia , Humanos , Neoplasias Hipofaríngeas/complicações , Neoplasias Hipofaríngeas/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias Tonsilares/complicações , Neoplasias Tonsilares/mortalidadeRESUMO
OBJECTIVES: Fatal complications of percutaneous dilatational tracheostomy (PDT) are rare and intraoperative fatal complications of PDT even more so. We present the unique case of a fatal nonvascular intraoperative complication of PDT, previously unreported in the medical literature. We also present a review of all previously reported fatal complications of PDT. METHODS: A review of all previously reported fatal complications of PDT was conducted in order to examine the prevalent causes of death and to attempt to recommend measures designed to prevent similar fatal complications in the future. RESULTS: Cases of death during or following PDT in which the technique is related to the cause of death have only been reported in a small number of cases. Almost all fatal complications of PDT result from vascular injury. CONCLUSIONS: Any vascular pulsation palpated over the tracheostomy site mandates preoperative ultrasound or conversion to open surgical tracheostomy. Patients with previous neck surgery, radiotherapy or unclear surgical anatomy should be regarded with caution. If a difficult intubation or a difficult procedure is anticipated, it may be preferable not to attempt PDT with a plan to convert to surgical tracheostomy if necessary but instead to perform surgical tracheostomy without attempting PDT.
Assuntos
Estado Terminal/terapia , Dilatação/efeitos adversos , Traqueostomia/efeitos adversos , Evolução Fatal , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Traqueostomia/métodosRESUMO
PURPOSE: This is a unique case report of a self-inflicted orbital injury that presented as a simple upper vestibulum laceration. A 43-year-old man presented to the Oral and Maxillofacial Surgery Unit with a small laceration in his mouth and complaints of pain in his left eye due to a snooker cue penetration. Upon admission, clinical findings included a small laceration on the upper left vestibulum and a subdermal hematoma in the left eye lid with restricted movements of the left eye. Further examination revealed remote trauma to the orbit, penetrating through the oral cavity, passing the maxillary sinus, and the orbital floor causing traumatic optic neuropathy with partial visual loss. The patient was treated conservatively with antibiotics and corticosteroids and a 6-week follow up. CONCLUSION: In cases of remote penetrating injury, meticulous examination revealing precise injury mechanism is crucial. All cases of Dento-maxillofacial trauma should include a high degree of clinical suspicion for ocular injury, requiring early diagnosis and treatment to reduce risk of visual loss.
Assuntos
Corpos Estranhos/complicações , Boca/lesões , Fraturas Orbitárias/etiologia , Ferimentos Penetrantes/etiologia , Adulto , Pálpebras/lesões , Seguimentos , Hematoma/etiologia , Humanos , Lacerações/etiologia , Masculino , Seio Maxilar/lesões , Traumatismos do Nervo Óptico/etiologia , Fraturas Cranianas/etiologia , Transtornos da Visão/etiologia , Acuidade Visual/fisiologiaRESUMO
INTRODUCTION: The alternate binaural bithermal caloric test (ABBT) is the standard test for evaluation of the dizzy patient. Monothermal caloric testing (MT) has the potential benefits of reducing the administration time and patient discomfort. The goal of the present study was to investigate the role of MT screening in the prediction of ABBT results. METHODS: ABBT results of 218 patients having normal otoneurological examination, normal hearing, and normal electronystagmography (ENG) were retrospectively analyzed to generate norms for all subtests. These norms were then employed to calculate the sensitivity and specificity of MT for predicting normal ABBT in a group of 197 consecutive dizzy patients who were referred for vestibular testing. RESULTS: The best predictions of ABBT by MT results were achieved when ENG testing showed oculomotor integrity and no spontaneous, positional, or positioning nystagmus. Under these conditions, warm MT lateralization < 32% had 90% sensitivity and 92% specificity for the prediction of normal ABBT. DISCUSSION: When no pathology is detected in the other parts of the ENG, warm MT lateralization < 32% can indicate normal ABBT with a 10% probability for a false-negative result. This false negative rate precludes the routine use of warm MT in the clinical realm and its application as a screening tool for possible vestibular deficits in a generally healthy population like aviation or diving candidates. Higher sensitivity may be achieved by lowering the cut-off point of the response asymmetry required for the diagnosis of MT screening failure and the omission of directional preponderance diagnosis from the goals of the screening.
Assuntos
Aeronaves , Testes Calóricos , Confusão , Vertigem/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletronistagmografia , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Estatística como Assunto , Doenças Vestibulares/diagnóstico , Testes de Função Vestibular , Adulto JovemRESUMO
OBJECTIVES/HYPOTHESIS: The outcome of functional endoscopic sinus surgery (FESS) depends on a clean surgical field achieved by minimizing intraoperative bleeding. High frequency jet ventilation (HFJV), due to lower airway pressures, offers the benefit of improved venous return, less bleeding, and improved operating conditions. HFJV was compared to intermittent positive pressure ventilation (IPPV) by assessment of surgical conditions and measurement of intraoperative blood loss. STUDY DESIGN: Prospective, randomized, double-blind study. METHODS: A total of 22 patients undergoing FESS were randomly assigned to be ventilated during surgery under general anesthesia by either HFJV or IPPV. The quality of the surgical field was assessed and the total blood loss was measured. RESULTS: The mean airway pressure was significantly lower in the HFJV group than in the IPPV group (2.42 +/- 1.17 and 7.11 +/- 0.72, respectively, P < .0001). The total mean loss of blood in the HFJV group was 170 cc and in the IPPV group was 318.18 cc (P = .017). The quality of the surgical field as estimated by the surgeon was significantly better in the HFJV group. The mean point values on the Boezaart et al. scale for the IPPV and HFJV groups were 2.72 +/- 0.77 and 1.80 +/- 0.686, respectively (P = .012). CONCLUSIONS: HFJV significantly reduced the amount of intraoperative bleeding and thus significantly improved the quality of the surgical field. It is suggested that increased venous return due to lower intrathoracic pressures resulted in less bleeding and improved operating conditions. HFJV can be effectively used for FESS in order to improve endoscopic view with no adverse effects.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Endoscopia/normas , Ventilação em Jatos de Alta Frequência/métodos , Doenças dos Seios Paranasais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Seguimentos , Ventilação em Jatos de Alta Frequência/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Peritonsillar abscess is a suppurative infection of the tissues adjacent to the palatine tonsil and is regarded in otolarygologic practice as a complication of pharyngotonsillitis. The most common presentation is gradually increasing pain, fever, trismus, drooling and a muffled voice. Asymmetric tonsils are common in clinical practice. Differential diagnosis includes infectious, granulomatous, congenital and neoplastic lesions. This is a case study of two patients evaluated for unilateral tonsillar enlargement who were found to have a previously unexpected peritonsillar abscess at tonsillectomy. The patients had no other signs or symptoms of acute pharyngotonsillar or peritonsillar infection. To our knowledge, this is the first report of an occult peritonsillar infection causing unilateral tonsillar enlargement.
Assuntos
Abscesso/patologia , Tonsila Palatina/anormalidades , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Lateralidade Funcional , Humanos , Masculino , Tonsila Palatina/patologia , Tonsilectomia , Tonsilite/patologia , Tonsilite/cirurgiaAssuntos
Linfoma de Células B/diagnóstico , Neoplasias da Língua/diagnóstico , Terapia Combinada , Feminino , Isótopos de Gálio , Humanos , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/tratamento farmacológico , Linfoma de Células B/radioterapia , Pessoa de Meia-Idade , Cintilografia , Neoplasias da Língua/diagnóstico por imagem , Neoplasias da Língua/tratamento farmacológico , Neoplasias da Língua/radioterapiaRESUMO
BACKGROUND: Surgery for the closure of nasal septal perforations is challenging. Numerous techniques have been described. OBJECTIVES: To assess whether nasal septal perforations heal less consistently if a connective tissue scaffold is not placed between the repaired septal flaps. METHODS: We performed closure of a septal perforation via a closed approach using oral mucosal flaps without the interposition of a connective tissue graft in seven patients. RESULTS: Complete perforation closure was achieved in 5 cases (71.4%). There was no significant donor site morbidity. CONCLUSIONS: These initial results suggest that this is an effective technique for closing nasal septal perforations; it obviates the morbidity of the open approach and the added operating time and morbidity associated with the harvesting of a connective tissue graft.
Assuntos
Mucosa Bucal/transplante , Septo Nasal/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Seguimentos , Humanos , Pessoa de Meia-Idade , Septo Nasal/lesões , Estudos Retrospectivos , Técnicas de SuturaRESUMO
OBJECTIVE: To study morphometric and qualitative histopathologic changes of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea. STUDY DESIGN: A prospective, nonrandomized controlled study. METHODS: The distal soft palate and uvula were excised during uvulopalatopharyngoplasty from 34 male patients with obstructive sleep apnea. Control specimens were retrieved from 7 male cadavers with no related disorders. All specimens underwent routine processing and the mid-sagittal sections were studied. Morphometric analysis of the relative proportions of the tissue constituents was carried out. Also, a qualitative assessment was performed to detect possible pathologic changes. RESULTS: The body mass index of patients was significantly higher from that of control subjects. The area fraction occupied by the tissue constituents of the distal portion of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea and in control subjects was similar, with small and insignificant differences regarding the contents of glands, muscle, fat, blood vessels, and the epithelium. Only the connective tissue was significantly greater in patients with moderate obstructive sleep apnea than in those with severe obstructive sleep apnea and control subjects. The qualitative assessment of the specimens disclosed normal tissue architecture without evidence of destruction. Vascular engorgement, fibrosis, edema, inflammatory cell infiltration, and dilated glandular ducts were observed in a portion of patients and control subjects. CONCLUSIONS: The structure of the distal soft palate and uvula of patients with obstructive sleep apnea undergoes insignificant changes and is independent of the body mass index levels, indicating that the pathologic changes are probably the sequela of airway obstruction rather than its cause.