摘要:

AbstractIntraosseous endolymphatic sacs obtained from patients with acoustic neuromas who had undergone total labyrinthectomy during tumor removal were examined for the presence of T helper/inducer and T suppressor/cytotoxic lymphocytes, B lymphocytes, plasma cells, and macrophages. Immunoperoxidase staining of cryostat sections revealed the presence of T helper/inducer lymphocytes, T suppressor/cytotoxic lymphocytes, and macrophages. The number of B lymphocytes and plasma cells was much smaller than the number of T lymphocytes. The number of T suppressor/cytotoxic lymphocytes was higher than the number of T helper/inducer lymphocytes. This study supports the notion of local immune responsiveness in the human inner ear. This is the first immunohistochemical study to analyze lymphocyte subpopulations; specifically, to provide insight into T‐cell function in the endolymphatic sa

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00001

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractCholesteatoma can develop as a late complication of fracture of the temporal bone. The otologist must be wary of it since the growth of the cholesteatoma resulting from a temporal bone fracture can be undetected for years allowing for invasive and extensive growth. Three illustrative cases are presented.

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00002

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractA study was conducted to better define the relationship between closing tension and the resulting tensile strength of scars in incisional wounds. Five groups consisting of ten hairless rats were studied. Transverse wounds were created and closed on the back of each rat, with closing tension varied by excising amounts of skin in widths of 0 (control), 15, 30, 45, and 60 mm. The tensile strengths were determined at 28 days. Higher mean tensile strengths were demonstrated in the two groups requiring the highest closing tensions (45 mm and 60 mm of skin excision) with P=0.0028 and P=0.00016, respectively. A logarithmic relationship between closing tension and tensile strength was demonstrated using linear regression analysis witht=6.18,p<.0001, and R2=.44.

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00003

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractWe examined the postoperative adjustment of 45 patients who underwent surgery for cancers of the head and neck: 23 who had laryngeal cancer, 18 who had oral cavity/oropharyngeal cancers, and 4 who had cancers of other sites. Patients were assessed preoperatively, and at 3 months and 9 to 12 months postsurgery. Interviews and questionnaires were used to assess depression, body image, limitations, pain, financial problems, need for help at home, and social interaction. Results revealed that pain, fatigue, weakness, and loss of speech were major concerns. Pain and financial concerns were worst at 3 months and then improved. Physical limitations increased steadily with time. Depression was a major factor in patients with oral cavity and oropharyngeal cancers. Of note, patients who underwent postoperative radiation therapy had the most difficulty adapting to their illness and treatment, with persistent limitations in function and social isolation. The implications of these findings are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00004

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe adaptation of implantable auditory prostheses for use in children has raised questions concerning both what effect growth may have on the implant and what effect the implant may have on growth. The purpose of this study is to describe temporal bone lateral surface dimensions in children of different ages to draw inferences about growth rates.Using a surface projected grid and point calipers, 158 intact temporal bones from 103 individuals of known ages between birth and 20 years were measured at six points from a fixed reference. These specimens were located in the skeletal collections of the Smithsonian Institute's Museum of Natural History, the Medical Museum of Walter Reed Hospital at the Armed Forces Institute of Pathology, and the Cleveland Museum of Natural History.Linear regression analysis helped clarify a bimodal pattern of growth in which marked increases in dimension occur from birth to 4 years of age and much less change is seen from age 4 to 20 years.These data suggest that implantation in children under 4 years of age is subject to maximal growth effects.

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00005

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractPostmeningitic hearing loss is often bilateral, profound, and rapid in onset. Children with postmeningitic hearing loss may be identified as potential candidates for cochlear implantation. The length of time required for a definitive trial with conventional amplification, which must precede a final decision regarding cochlear implant surgery, has been the subject of debate. Twenty‐five children with bilateral severe‐to‐profound postmeningitic sensorineural hearing loss were fitted with appropriate amplification and results of serial‐aided tests were analyzed to determine the degree of benefit and changes in aided thresholds over time. Twelve children gave aided responses that clearly indicated the presence of residual hearing and good aided benefit. Ten youngsters have responded consistently in the vibrotactile range when aided, thus receiving limited benefit from conventional amplification. Of particular interest are three children who initially exhibited limited or no auditory responses but who, after a period of 16 to 25 months, showed excellent benefit with binaural hearing aids. These children are all in total communication programs and have received good auditory training. Caution should be exercised when concluding that such a child does not benefit from amplif

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00006

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractInternal maxillary artery ligation is effective in treating epistaxis. Occasionally a patient may continue to hemorrhage after this procedure. Evaluation of postoperative angiograms reveals several factors accounting for the failure of internal maxillary artery ligation. These factors include incomplete ligation of vessels, alternative dominance of vessels, and reconstitution of flow through collaterals. Eleven such patients have been successfully treated with angiography and embolization. There was one complication of skin slough in the region of the columella. Embolization is a useful modality in the management of these difficult cases.

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00007

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe records of 25 patients who underwent excision of acoustic neuroma between 1980 and 1987 were reviewed. All patients originated from southern New England. Facial nerve function was preserved in 92% of all patients, and 42% of patients with tumors less than 2.0 cm retained residual hearing postoperatively. These rates compare favorably with those found in larger series.1‐3Our series demonstrated that 60% of patients complained of hearing loss for longer than 2 years prior to tumor diagnosis. The mean duration of hearing loss prior to diagnosis was 4.2 years. Although sophisticated diagnostic methods were generally available, early detection of tumors did not occur, despite the early onset of auditory symptoms. The emergence of sophisticated computer‐assisted diagnostic tests and the development of technologically advanced operative methods have reduced operative morbidity, but interestingly, have had little influence on early tumor diagnosis. Late detection of acoustic neuroma in an otherwise medically sophisticated community suggests the need for improved awareness among patients and their primary care providers. Failure of early detection may occur more commonly than generally appreciated, despite the availability of technologically advanced methods of diagno

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00008

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe authors reviewed 25 cases of pharyngoesophageal replacement. A tubed pectoralis major myocutaneous flap was employed in ten cases where an adequate distal resection margin could be obtained above the thoracic inlet. Total gastric transposition was used in 15 cases where resection extended into the mediastinum.The overall rates of complications (52%), postoperative mortality (20%), and satisfactory deglutition (80%) were similar for both operations and were superior to those achieved with reconstructive procedures previously used by the authors. The choice of method is influenced by the length of the pharyngoesophagus to be replaced and the general condition of the patient. Gastric transposition is a more versatile operation and is adaptable to replacement of the entire esophagus if necessary, while the tubed pectoralis major myocutaneous flap has proven particularly effective for the rehabilitation of elderly and severely debilitated patients.

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00009

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractA computer‐aided analysis of 5,109 patients with malignant melanoma was performed. Patient population characteristics according to body site (head and neck, extremity, and trunk) were determined for the following parameters: sex, histologic type of melanoma, Clark's level, Breslow thickness, age, clinical status of regional nodes, presence or absence of ulceration, and recurrence. Head and neck melanomas accounted for 17% of the total population (N=877). A detailed analysis of general population characteristics according to subsites within the head and neck region (ear, face, neck, nose, and scalp) was performed. Survival characteristics were determined for head and neck patients according to lymph node surgery, histologic type of tumor, and tumor thickness. The effect on survival of lymph node dissection (elective for stage I disease and therapeutic for stage II disease) was analyzed by univariate and multivariate methods. Elective lymph node dissection (ELND) was performed on 77 patients and 39 patients underwent therapeutic nodal dissection (TLND). Overall, survival was significantly improved following ELND as compared to TLND; however, multivariate analysis indicated the improved survival was related to variations of age within the population rather than the beneficial effect of lymph node surgery. Elective lymph node dissection did significantly reduce the incidence of recurrence for head and neck patients (p=0.002). Since recurrence was demonstrated to be directly related to survival, the trend toward improved survival following ELND after 5 years was felt to be important. There was no difference in survival according to the histologic type of melanom

ISSN:0023-852X    

DOI:10.1288/00005537-198908000-00010

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY