摘要:

AbstractSynovial sarcoma is a malignant tumor which usually arises from the extremities. Involvement of the cervical area has been quite rare and to date only 12 cases have been reported. Two additional cases are reported in this paper and their management discussed. Case 1 is a 32‐year‐old white female with a submucosal mass of the right retromolar area displacing the tonsillar fossa and soft palate anteriorly. Surgical exploration revealed a well encapsulated mass separate from the parotid gland. Surgical excision was carried out on August 30, 1972. Pathological report was a synovial sarcoma. There has been no recurrence to date. Case 2 is a 34‐year‐old male with a 4 to 5 centimeter submandibular mass. Sialography and carotid arteriography were non‐contributory. Biopsy showed synovial sarcoma. On May 12, 1973, surgical excision of the mass was carried out with the ipsilateral attached greater corneal of the hyoid bone and right hypoglossal nerve which ran into the tumor. Postoperative X‐ray therapy was given. There is no recurrence to date. Discussion: Synovial sarcoma represents a type of mesenchymal tumor whose differention can mimic non‐neoplastic synovial membrane. Histologically the tumor contains two neoplastic cell types. These are described as the fibrosarcomatous element and the synovial element. The tumor usually has no true capsule and grows by expansion with adherance to surrounding structures. The rate of growth is slow but the long term prognosis is poor. Metastasis usually occurs via blood stream most commonly to the lungs. Regional lymph node metastasis occurs in areas outside of the head and neck but has not been recorded in synovial sarcoma of the head and neck to date. Surgical excision is agreed to be the mode of treatment. The value of X‐ray therapy is uncertain but Pack and Ariel were able to show their best results with a combination of surgical resection followed by postoperative X‐ray therapy. It has been suggested that synovial sarcoma of the head and neck may behave in a more benign manner than synovial sarcoma elsewhere. Long term follow‐up is not available in enough of the cervical sarcoma cases to determine if this is true. Until a more benign behavior is proven the tumor should be treated as an aggressive malignancy. Wide surgical excision is the treatment of choice. Postoperative X‐ray therapy

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00001

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe incidence is about 0.7 percent of patients admitted for thyroid surgery.It is caused mainly by compression of the nerve against the cervical spine or the trachea by a thyroid mass.Other mechanisms may be stretching of the nerve, especially by retrosternal goiters, and inflammation and edema of the nerve trunk.Rapid enlargement of the thyroid gland, or of a pre‐existing goiter, hoarseness, and a sensation of pressure are cardinal signs of an advanced thyroid malignancy, usually carrying a poor prognosis.Five case histories were reported. All patients presented with all or most of these cardinal signs, yet their thyroid disease was proven benign at surgery. Two out of five patients regained motility of their previously paralyzed cords after surger

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00002

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractIn no surgical arena is the cooperation and mutual understanding of the anesthesiologist and surgeon more important than in endolaryngeal surgery; here in the narrowest part of the airway, they compete for a share of the limited space available! The anesthesiologist must understand the requirements for optimal operating conditions but more importantly, the surgeon must understand the requirements for safe general anesthesia if unnecessary complications are to be avoided.Cardiac infarction, myocardial ischemia and arrhythmias, may occur during or after microsurgery of the larynx; they are most likely to be precipitated by pressure stimulation of the deep receptors of the larynx during suspension of the laryngoscope. The reflex pathway that produces the arrhythmia includes the superior laryngeal nerve and the cardio‐in‐hibitory fibers of the vagus. It appears that the complications are most often induced by the surgical manipulation and potentiated by abnormal blood gases.A small bore cuffed endotracheal tube appears to be an eminently satisfactory way of providing control of the airway and good operating conditions.The incidence of cardiac complications was studied in 540 patients and found to be 6.8 percent in the high risk group and 1.9 percent in the group without a preoperative history of cardiac disease.These figures are somewhat higher than those reported by Tarhan, et al., in their study of the incidence of myocardial infarction following surgery of various types under general anesthesia.To keep these complications to a minimum, constant vigilance must be maintained by the surgeon and anesthesiologist, especially on the cardiac monitor and airway. If arrhythmias appear, steps must be taken immediately to remove the cause, otherwise myocardial ischemia and infarction are very likely to fol

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00003

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThree therapeutic modalities are available for the management of acute epiglottitis — medical, intubation, and tracheotomy. Helping the otolaryngologist discern the regimen of choice for a given situation is the format for this paper. The incidence of diagnosed epiglottitis is definitely increasing in our institution and in others; therefore, a rational individualized approach based on recent information is essential. Twelve cases formed the basis for the concepts presented.Our current management protocol for supraglottic infection is as follows: first, medical management for selected cases is given a two‐hour trial. Should this prove unsuccessful, intubation is effected. Tracheotomy will no longer be performed unless the internal lumen of the tube placed is so small that crusting becomes a problem; the patient cannot be extubated in 48‐72 hours; or in the very rare contingency that the patient could not be intubated.In this series, medical management alone sufficed in eight cases. Two cases received a tracheotomy. These were performed prior to the initiation of our current protocol. Two patients were intubated.The 12 cases were analyzed with regard to the parameters which might depict those cases that would not respond to medical management. The initial respiratory rate, pulse rate, and temperature elevation were not indicative. Rather, the potential and direction of change of the aforementioned recorded over a two‐hour period was very significant. A significant medical response as manifested by a decreased respiratory rate was seen in four cases in less than one hour and within two hours in the remaining four cases. It is of significance that in one of the eight cases steroids were withheld for the first two hours with a significant deterioration in the patient's condition. Steroids were then given, and within two hours there was a definite clinical improvement. It should be noted that the steroid response could not be correlated with the length of symptoms prior to admission; also, those patients whose initial difficulty was primarily dysphagia seemed to have a more benign general course. Medical management was therapeutic in all of these cases. Information from our later cases supports this contention as well.An analysis of the four initial cases requiring airway intervention revealed a syndrome of cyanosis, exhaustion, and severe sternal retraction to indicate an initially poor medical response. Patients with this triad should be intubated as soon as possible and given appropriate antibiotics and s

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00004

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThis paper is written so that I may discuss some of the experiences I have encountered in the operating room with succinylcholine. It is my hope that this paper might stimulate your reading the anesthesiology journals for further knowledge of succinylcholine.The chemical breakdown of succinylcholine by the body may be found in all of the anesthesiology journals. It has been established that succinylcholine can cause prolonged apnea. The usual figure given is one in 4,000 cases. My experience with prolonged apneas does not coincide with this figure. I personally feel that it occurs more often. The second complication of succinylcholine is cardiac arrest and the third malignant hyperthermia. I have never encountered either of these two conditions. The complications associated with the administration of succinylcholine can be avoided only if we have a basic understanding of the pharmacology of the drug, its side effects and the various conditions which will alter the normal response. This in turn will achieve the one thing we all strive for, a safe and sensible procedure for the patient.

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00005

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractRecent reports have suggested that carcinoma of the tonsil and adjacent structures (tonsillar pillars, adjacent soft palate and lateral pharyngeal wall) can be treated with improved survival rates by combining definitive surgery with planned preoperative radiotherapy. Experience to date does not clearly demonstrate the ideal dose of preoperative radiotherapy; however, in general it appears that survival rates improve in proportion to increasing dosage of preoperative radiation. The use of preoperative radiation in doses approaching or exceeding tumoricidal levels (6,000‐6,500 rads at approximately 1,000 rads/week) has been limited by the unacceptable complication rate to be expected. The rate of major complications reported has ranged from 18 percent to almost 47 percent.For the past three years, all patients seen by the Department of Otolaryngology of the Upstate Medical Center with malignancies involving the tonsil and its adjacent structures have been managed by a combined modality of 5,500 rads preoperative radiotherapy followed by definitive surgical resection, using distant, unirradiated flaps for repair where necessary. There were 33 patients in the group, including three T2, 20 T3and 10 T4lesions. Joint evaluation and planning of treatment between radio‐therapy and otolaryngology coupled with meticulous attention to various aspects of surgical management has yielded the results reported in the table. The major complication rate has been limited to 3.03 percent. These results indicate that it is possible to undertake extensive resections for carcinoma of the tonsil and adjacent structures after high‐dose preoperative radiotherapy without incurring any significant increase in morbidity over surgery

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00006

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe causes and relative incidence of stenosis in the trachea and subglottis are described. The special difficulties encountered in the subglottic region are discussed and references made to various treatments described in the past.An operation designed to produce a one‐stage cure with preservation of vocal cord function is described in detail. This consists of exposure of the laryngo‐tracheal complex and examination of the lesions directly. If suitable for excision, the upper line of resection is made at the lower border of the thyroid cartilage anteriorly and through the posterior cricoid lamina below the crico‐thyroid joints posteriorly. This is carried out only after identifying the recurrent laryngeal nerves on each side and tracing them up to the crico‐thyroid joints. Anastomosis of upper trachea to the remaining larynx is performed after mobilizing the two ends. At the upper end, this is achieved by the laryngeal drop procedure previously described by Bryce (1972). A stent may be inserted if the anastomosis requires support. A check suture preventing neck extension is not considered necessary.Postoperatively, a tracheostomy is maintained until the danger of aspiration has passed or until a stent is removed three weeks later. Naso‐gastric feeding is required for the first few days.Four case histories are presented.Pre‐operative radiographic assessment has been found to be misleading in most cases and the final decision on the procedure can be determined only at the time

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00007

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractAn unusual group of tumors originating from Schwann cells of the facial nerve has been studied. Twenty‐three neurilemmomas were found in 17 patients. Nine originated in the temporal bone, and the remaining 14 tumors arose from the peripheral portion of the facial nerve. All tumors were treated by excision, with partial or total resection of the facial nerve. The resultant facial nerve deficit was then reconstructed with a hypoglossal nerve crossover or a free autogenous nerve graf

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00008

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractMass lesions of the hypopharynx and pyriform sinus are usually malignant neoplasms. Benign tumors do occur but are uncommon. In a review of the literature, no case of impingement of a thyroid mass upon the hypopharynx and pyriform sinus was found. An unusual case of localized enlargement of the superior pole of the thyroid gland which impinges on the hypopharynx and pyriform sinus is presented.

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00009

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThis paper gives a brief description of the etiology, diagnosis and treatment of extracranial arteriovenous fistulas.These fistulas may be either acquired or congenital in origin. Their natural history is one of progression which can result in severe hemodynamic changes. Extracranial arteriovenous fistulas usually occur between the terminal branches of the external carotid artery and the lateral sinus or jugular venous systems. The most common symptom, pulsatile tinnitus, can often be decreased by common carotid artery compression unless there is a significant contribution from the vertebral arterial system.Selective arteriography utilizing subtraction technique is the most important diagnostic study.The recommended treatment is complete surgical excision of the fistula and ligation of all feeding vessels. The recurrence rate is higher with the other methods of control, such as simple ligation, irradiation, injection of sclerosing agents and embolization.Two patients with congenital arteriovenous fistulas are presented.

ISSN:0023-852X    

DOI:10.1288/00005537-197406000-00010

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY