Arnold M. Noyek

Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration.

BACKGROUNDnIn nasopharyngeal carcinoma the primary lesion is often difficult to find. Metastatic lesions occur frequently but are difficult to distinguish from other head and neck tumors. The viral genome of the Epstein-Barr virus (EBV) can be identified in the cells of this carcinoma.nnnMETHODSnWe used the polymerase chain reaction (PCR) to test for the presence of EBV genomes in 15 samples of metastatic squamous-cell carcinoma of the neck obtained by fine-needle aspiration and in 26 samples obtained by biopsy of lymph nodes. For controls we used disease-free lymph nodes from 10 patients with various head and neck tumors, tonsillar tissue from 46 subjects, blood from 59 EBV-seropositive blood donors, and mononuclear cells from 8 patients with fatal lymphoproliferative lesions.nnnRESULTSnOf the 41 malignant lesions examined, only the nine nasopharyngeal carcinomas (one primary lesion and eight metastases) contained EBV genomes. None of the 20 nodes with other types of cancer, the 10 disease-free nodes, or any of the 105 normal control samples contained detectable EBV. In two patients with suspected metastases from occult primary tumors, the presence of EBV was predictive of nasopharyngeal carcinoma; in both cases overt nasopharyngeal carcinoma developed within one year.nnnCONCLUSIONSnIn patients with suspected nasopharyngeal carcinoma, fine-needle aspiration can provide tissue for diagnosis by DNA amplification of EBV genomes. The presence of EBV in metastases from an occult primary tumor is predictive of the development of overt nasopharyngeal carcinoma.

The clinical significance of radionuclide bone and gallium scanning in osteomyelitis of the head and neck

Osteomyelitis of the head and neck remains a difficult clinical problem both in diagnosis and treatment evaluation. The purpose of this manuscript is to review our clinical experience with 25 cases of osteomyelitis distributed evenly among the temporal bone and skull base, the paranasal sinuses, and the mandible. Radionuclide bone and gallium scan images accurately depicted the biologic activity of the disease process and permitted accurate treatment evaluation and patient monitoring. This work demonstrates the potentials and limitations of radionuclide imaging with bone and gallium scan agents and attempts to define a role for their contemporary use in the management of osteomyelitis of the head and neck.

Laryngeal verrucous carcinoma: A clinicopathologic study and detection of human papillomavirus using polymerase chain reaction

Laryngeal verrucous carcinoma (LVC) is a rare, well‐differentiated variant of squamous carcinoma with a low malignant potential. Human papillomavirus (HPV)–16 DNA has been identified in a small number of LVC and an etiologic relationship has been suggested. A correlative clinical and molecular pathological study was performed in order to determine the prevalence and typing of HPV DNA in LVC. Possible associations between patient and tumor subsets, and the presence of HPV DNA were also investigated. Formalin‐fixed, paraffin‐embedded tissue samples from 29 patients with LVC were examined by polymerase chain reaction (PCR) using DNA primers specific for HPV types 6b/11, 16, and 18. Overall, HPVDNA was detected in 13 (45%) of the cases. Of these, HPV‐16 DNA, HPV‐18 DNA, and both HPV‐16 DNA and HPV‐18 DNA were detected in 4 (14% overall; 31% of positive cases), 4, and 5 (17% overall; 38% of positive cases), respectively. HPV‐6b/11 DNA was not detected in any LVCs. In 16 cases, no HPV DNA was detected. There was a trend toward HPV DNA detection in higher stage tumors. HPV DNA detection was unrelated to patient age, tumor site, or radiotherapeutic responsiveness. The detection of HPV DNA in 45% of LVCs suggests an association between the presence of HPV‐16 DNA and HPV‐18 DNA, and some LVCs.

Ultrasonography and ultrasound‐guided fine‐needle aspiration biopsy of head and neck lesions: A surgical perspective

A head and neck ultrasound‐guided fine‐needle aspiration clinic was set up to determine the role of ultrasound and ultrasound‐guided fine‐needle aspiration in the evaluation of patients with lesions in this region. One hundred ninety‐five lesions were biopsied by ultrasound‐guided fine‐needle aspiration in 203 patients. Ultrasound detected 2 or more lesions in 14 (48%) of 29 patients with a clinically solitary thyroid nodule. Three (8.8%) of 34 lesions thought to be within the parotid gland were determined to be external. A pronounced learning curve was evident in the technique of ultrasound‐guided fine‐needle aspiration, particularly for nonpalpable disease. Adequacy of sampling for each 3‐month period was 71%, 89%, and 94%, respectively. Seventy‐four percent of central aspirations were satisfactory compared to 54% of peripheral aspirations. Ultrasound‐guided fine‐needle aspiration did not alter the clinical staging of metastatic neck disease in 8 patients having 10 neck dissections but proved useful in detecting nodal recurrence in 3 irradiated necks that did not proceed to surgery. The smallest node to harbor malignancy had 4‐mm maximal axial diameter. We conclude that ultrasound and ultrasound‐guided fine‐needle aspiration are valuable adjuncts to the clinical examination.

Lipoma and liposarcoma of the parotid gland: high-resolution preoperative imaging diagnosis.

Over the past 7 years, nine fatty tumors within the parotid gland have been managed (eight lipomas, one liposar‐coma). High‐resolution computed tomography examination was carried out in all cases; with correct preoperative diagnosis recorded each time. The computed tomography imaging characteristics of lipoma, liposarcoma, and the differential diagnosis from other fat density lesions, such as a fatty infiltration, appear quite specific.

Promoting Arab and Israeli cooperation: peacebuilding through health initiatives

This article describes a positive experience in building Arab and Israeli cooperation through health initiatives. Over the past 10 years Israeli, Jordanian, and Palestinian health professionals have worked together through the Canada International Scientific Exchange Program (CISEPO). In the initial project, nearly 17,000 Arab and Israeli newborn babies were tested for early detection of hearing loss, an important health issue for the region. The network has grown to address additional needs, including mother-child health, nutrition, infectious diseases, and youth health. Our guiding model emphasises two goals: project-specific outcomes in health improvement, and broader effects on cross-border cooperation. Lessons learned from this experience and the model provide direction for ways that health professionals can contribute to peacebuilding.

The prevalence of congenital and early-onset hearing loss in Jordanian and Israeli infants

The objective of the study was to investigate the prevalence of congenital and early-onset hearing loss, and the influence of the known risk factors for hearing loss on infants in Jordan and Israel. Subjects were a total of nearly 17000 infants from both countries, including infants with and without risk factors for hearing loss. The hearing screening protocol included distortion product otoacoustic emission, followed in case of repeated OAE referral or high risk (HR) infant by diagnostic auditory brainstem responses. The results indicate that the prevalence and severity of hearing loss amongst Jordanian infants (1.37%) is remarkably higher as compared to the Israeli infants (0.48%). The overall prevalence of bilateral SNHL was seven times more in the Jordanian infants, 18 times in non-risk, and three times in the HR infants relative to the Israeli infants. Risk factors including family history, hyperbilirubinemia, bacterial meningitis, and associated syndromes were more prevalent amongst Jordanian infants. This unique study underscores the importance of sharing and exchanging information to create empirical data to guide health-care providers in adapting protocols to the local constraints in developing countries. Sumario Objetivo: Investigar la prevalencia de hipoacusias congénitas o de inicio temprano y la influencia de los factores de riesgo conocidos para sordera en niños de Jordania e Israel. Sujetos y materiales: Cerca de 17.000 infantes de ambos países participaron en el estudio, incluyendo niños con factores de riesgo y sin ellos. El protocolo de evaluación auditiva incluyó Emisiones Otoacústicas por Productos de Distorsión (DOPAE), seguido, en el caso de referencias repetidas de OAE, por Respuestas Auditivas del Tallo Cerebral (ABR). Resultados: La prevalencia y la severidad de los trastornos auditivos en niños de Jordania (1.37%) es marcadamente más alto en comparación con los niños israelitas (0.48%), especialmente en el caso de la SNHL bilateral, donde la prevalencia global en los niños jordanos era 7 veces mayor, 18 veces en los niños sin riesgo y 3 veces mayor en los infantes con HR, comparado con los israelitas. Los factores de riesgo, que incluían historia familiar, hiperbilirrubinemia, meningitis bacteriana y síndromes asociados, fueron más prevalentes entre los niños jordanos. Este estudio singular subraya la importancia de compartir e intercambiar información, para crear datos empíricos que guíen a los proveedores de salud en la adaptación de los protocolos a las limitaciones locales de cada país.

The art of diagnosis in head and neck tumors.

ALFIO FERLITO, PAOLO BOCCATO, ASHOK R. SHAHA, ANTONINO CARBONE, ARNOLD M. NOYEK, CLAUDIO DOGLIONI, PATRICK J. BRADLEY and ALESSANDRA RINALDO From the Department of Otolaryngology—Head and Neck Surgery, Uni×ersity of Udine, Udine, Italy, and Cytopathology Laboratory, Casa di Cura Villa Berica, Vicenza, Italy, and Head and Neck Ser×ice, Memorial Sloan–Kettering Cancer Center, New York, New York, USA, and Di×ision of Pathology, Centro di Riferimento Oncologico, National Cancer Institute, A×iano, Italy, and Department of Otolaryngology, Mount Sinai Hospital, Uni×ersity of Toronto, Toronto, Ontario, Canada , and Di×ision of Pathology, Belluno Hospital, Belluno, Italy, and Department of Otorhinolaryngolog y—Head and Neck Surgery, The Queen’s Medical Centre, Nottingham , UK

Detection of occult nasopharyngeal primary tumours by means of in situ hybridization

Detection of nasopharyngeal carcinoma primaries in patients presenting with neck node metastases may sometimes demand considerable efforts. By using the in situ hybridization technique, we manage to identify the Epstein-Barr virus in neck metastases secondary to nasopharyngeal carcinomas. We propose that such identification in neck node metastases where the primary lesion is unknown indicates a nasopharyngeal primary.

Flow cytometric analysis of DNA content in laryngeal cancer

DNA content was measured by flow-cytometric analysis in 30 paraffin embedded sections from patients with laryngeal squamous cell carcinoma. The morphological characteristics and N staging of the tumours as registered in their clinical charts were correlated with their DNA content. Eighty per cent of the tumours were found to have a predominantly aneuploid distribution of DNA values. There was no correlation between the N stage of the tumour or degree of cell differentiation and DNA content. A multiploid pattern correlates with non-metastatic laryngeal tumours and we suggest that this pattern may be a good indicator for biological activity.