摘要:

AbstractThe pontobulbar body (PBB) is located in the cerebellopontine angle caudally to the cochlear nuclear complex (CN). We found the common boundary between these two structures on the surface of the brain stem as well as within it. We used the Kluver‐Barrerastaining technique tocharacterize different neuronal types adjacent to the boundary. Although the majority of them in the CN were globular, we also saw a substantial number of spherical neurons. Neurons in the PBB were substantially different in shape and were mainly angular. The boundary between the PBB and CN at their closest contact runs around the caudal side of the ventral cochlear nucleus and the most proximal part of the eighth nerve. In the more dorsal region, the PBB is completely separated from the CN by the brain stem tissue. In the ventral region, the PBB runs between the seventh and eighth nerves, and it is adjacent to both. These results might aid accurate placement of the central electroauditory prosthesis and further understanding of the general anatomy of the cerebellopontine angl

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00001

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractPoor eustachian tube function and prevalence of infectious ear disease are thought to be the reasons for less successful outcome associated with tympanoplasty in children. Since both of these factors are related to age, identification of those patients who may benefit by delaying the surgery has been a concern to otolaryngologists. In an effort to investigate the role of eustachian tube function on the outcome, we tested the tubal function in 63 ears (56 children) undergoing tympanoplasty for central perforations. In 49 ears (78%), the graft took; of these, 33 had good middle‐ear function, 8 developed persistent or recurrent otitis media, and 8 had severe retraction or atelectasis. There was a significant association (p<0.01) between outcome and preoperative tubal function as determined by combining the active and passive function parameters. However, the prognostic value of tubal function testing was low; predictive values for success and lack of success being 68% and 56%, respectively. Other factors, such as graft placement (medial or lateral) contralateral ear status, and child's age, were not associated with outcome. Consistent with other studies, good eustachian tube function was shown to predict good outcome, but poor tubal function was not helpful in predicting poor outcom

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00002

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractNecrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high‐frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long‐term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evaluation of the airway revealed a characteristic picture consisting of necrosis, neutrophil infiltration, epithelial erosion, and intraluminal obstruction.NTB is a newly recognized cause of sudden, potentially fatal airway obstruction. Treatment consists of emergency bronchoscopy and removal of intraluminal debris. All survivors had bronchopulmonary dyspla

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00003

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe data on 281 patients who underwent surgical therapy for laryngeal carcinoma from 1976 through 1984 were reviewed, revealing 16 patients who presented with an impending obstruction of the airway that was treated by an “emergency” laryngectomy. A review of the patients in our series did not reveal any serious complications from the procedure and it has allowed effective management of these advanced neoplasms.In addition, 10 patients who developed peristomal recurrences were reviewed. Preoperative factors such as location of lesion, antecedent surgery, and previous radiation therapy were assessed and compared to the patients who underwent “emergency” laryngectomy in an attempt to further define risk factors involved in peristomal recurrence. A strong association with subglottic extension was noted. Also associated in this review was antecedent full‐course radiatio

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00004

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractRecurrence of squamous cell cancer following total laryngectomy constitutes an extremely difficult therapeutic problem. Satisfactory management is elusive and frustrating to the head and neck oncologist. Various recommended therapeutic regimens include symptomatic treatment, palliation with chemotherapy and radiation, and aggressive surgical salvage. While surgery offers the only realistic chance at cure, this procedure is fraught with significant morbidity and a poor success rate.In an attempt to clarify the role of surgical salvage in these patients, experience with 57 patients with stomal recurrence presenting to three head and neck surgical groups will be presented. Forty‐one of these patients subsequently underwent definitive surgery. The overall 2‐year survival for operated patients was 16% with a 24% determinate survival. Further analysis revealed a 45% 5‐year survival with type 1 and 2 lesions and 9% survival with types 3 and 4. Recommendations regarding indications for surgery are made based on this exper

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00005

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractTwo hundred and fifty‐four patients with head and neck cancer were entered into a prospective study comparing the results of pharyngoesophagram to esophagoscopy. All patients had pharyngoesophagram deemed adequate to evaluate the esophagus and rigid esophagoscopy to at least 30 cm from the upper incisor teeth. In 239 (94.1%) patients both the pharyngoesophagram and esophagoscopy were negative. Four esophageal tumors were found. Only one of these tumors (25%) was detected on pharyngoesophagram. We believe that the pharyngoesophagram should be a part of the initial work‐up of every head and neck cancer patient and should precede esophagoscopy. However, the barium swallow cannot be relied upon exclusively to detect small simultaneous second primary esophageal malignanc

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00006

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe significance of metastatic cancer in the Delphian lymph node in patients with laryngeal carcinoma has not been thoroughly discussed. Between 1960 and 1985, we identified 20 cases of histologically proven metastasis to the Delphian node. In 12 of these patients with glottic cancer (T1‐T3), the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy; in 6 patients, ipsilateral neck metastasis developed. Eleven of the 20 patients have died from their laryngeal cancer. The frequency of neck metastasis or death, or both, from cancer is unusually high in patients with a positive Delphian nod

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00007

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractPrimary clinical presentation of malignant lymphoma in the middle ear is rare. One case of African Burkitt's lymphoma involving the mastoid has been reported, but the case herein presented would appear to be the first case of American Burkitt's lymphoma in the literature. American and African varieties have distinct clinical presentations but are histologically identical. Chemotherapy is effective against these aggressive tumors.A 6‐year‐old boy with the first known case of American Burkitt's lymphoma of the mastoid is presented. He is doing well 23 months from the onset of sympt

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00008

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe diagnosis of laryngeal trauma in an adult trauma patient is usually readily made. It is frequently overlooked in children, however, because of the severity of their concomitant injuries and the unfamiliarity of pediatricians with this type of injury. The child with laryngeal trauma may develop respiratory distress much more quickly than an adult because of the relatively small dimensions of the pediatric airway and the apparent propensity for children to develop edema of the soft tissues of the larynx.This report retrospectively reviews our experience during the past several years with ten children who experienced blunt laryngeal trauma. Emphasis is placed upon the diverse etiologies of laryngeal trauma in children and the importance of both flexible and rigid laryngoscopy in the diagnosis and management of these patients.

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00009

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractAlthough differentiation of Wegener's granulomatosis from other destructive midline lesions is now clearly recognized by clinicians and pathologists, confusion persists regarding the management of what has erroneously been called “lethal midline granuloma.” The experiences of 36 patients with destructive midline granuloma supports the view that probably all are manifestations of malignant lymphoma and should be treated as such. Although radical dosage radiotherapy will control most local lesions, dissemination of lymphoma may still occur despite absence of systemic disease at initial diagnostic work‐up. Subsequent control with cytotoxic drugs is frequently unsuccessful, and it is suggested that chemotherapy should be given routinely to every patient with primary nasal lymphoma and possibly to those with polymorphic reticulosis or necrosis with atypical cellular exudate (

ISSN:0023-852X    

DOI:10.1288/00005537-198709000-00010

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY