摘要:

AbstractWe reviewed records of 116 consecutive acoustic tumor surgery patients aged 65 and older during the 10 years ending in 1984. One hundred six had total removal. Ninety‐four (81%) had no intraoperative complications and 66 (57%) had no post‐operative complications. Only one patient, who had previously undergone partial removal elsewhere, died.Because tumors grow at 2 mm per year, and because elderly patients can expect to live up to 18 more years, we recommend planned total removal of an acoustic tumor as the management of choice for senior citizens in good health. We feel that the advantages of immediate surgery outweigh the risks of delayed surgery when age is advanced, the tumor is enlarged, and general health may be declin

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00001

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractEctopic gastric mucosa is a known entity of the mid and lower esophagus which was initially described by Schmidt in 1805. The presence of ectopic gastric mucosa in the cervical esophagus, however, was not described. A review of the literature reveals that ectopic gastric mucosa of the cervical esophagus is not uncommon, but symptoms rarely have been attributed to its presence.This paper reports five patients with isolated inflamed ectopic gastric mucosa in the cervical esophagus who presented with odynophagia and/or dysphagia. Physical examination was unremarkable in each case, and an acid barium esophagram was negative in four of five patients. Factors that distinguish these patients from other cases of odynophagia and dysphagia, as well as detailed clinical findings and treatment, are described. Debate exists as to whether the origin of ectopic gastric mucosa is congenital or acquired. The embryology, gross and microscopic anatomy, and pathologic features are outlined.Patients with persistent dysphagia should have flexible fiberoptic esophagoscopy with an index of suspicion to the existence of ectopic gastric mucosa. Inflamed or ulcerated ectopic gastric mucosa in the cervical esophagus should be treated to relieve symptoms and because of the potential for complications.

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00002

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractFirst branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches and give rise to two distinct anomalies, termed type I and type II anomalies. Type I anomalies are purely ectodermal while type II anomalies exhibit ectodermal and mesodermal elements. The type II anomaly incorporates some portion of the first and second arch as well as the cleft.Type I lesions are extremely rare. They appear histologically as cysts lined by squamous epithelium. Clinically, they present as a cystic mass or fistula posterior to the pinna and concha. The cyst is usually superior to the main trunk of the facial nerve and ends in a cul‐de‐sac on or near a bony plate at the level of the mesotympanum.Type II lesions are more numerous and represent a duplication of both membranous and cartilaginous portions of the external auditory canal. They contain skin as well as adnexal structures and cartilage and may be associated with the parotid gland. Most frequently they are associated with fistulae in the concha or external auditory canal as well as fistulous openings in the n

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00003

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractMillions of people in the United States suffer from hearing impairment that is not benefited or poorly benefited by surgery or conventional hearing aids. Recently, we introduced an implantable Temporal Bone Stimulator (TBS) designed for those patients having a hearing loss due to external canal conditions; such as, external canal atresia or disease, inoperable ossicular problems, atelectasis or eustachian tube malfunction, and chronic open‐cavity mastoid disease. This device requires relatively good cochlear function. However, the electromagnetic application of this device has led to the development of a new device we call the Implantable Hearing Device (IHD). This device stimulates, by an electromagnetic field, an independent electromagnetic sensitive prosthesis attached to the ossicular chain. This direct energy transfer to the ossicular chain provides a high degree of sound amplification and fidelity, thus providing benefit for those with various degrees of sensorineural hearing impairment.Preliminary disclosure of the device design, the animal experimental results, and the data from human testing will be give

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00004

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThis study analyzes the complications encountered in the surgical treatment of 17 patients with large glomus jugulare tumors. All 17 patients sustained either new cranial nerve palsies or exacerbation of preexisting palsies. These involved, in descending order of frequency, the facial nerve, the vagus and glossopharyngeal nerves, and the hypoglossal nerve. Post‐operative palsies of the facial nerve involved 17 patients, as compared to 5 preoperatively. Fifteen patients had postoperative partial or complete paralysis of the vagus nerve as compared to eight preoperatively. Ten patients had postoperative palsies of the hypoglossal nerve as compared to six preoperatively. Other complications included CSF leak, meningitis, and wound infection. Aspiration and dysphagia were encountered postoperatively in 13 patients. Teflonr̀ injection of paretic vocal cords and cricopharyngeal myotomy effectively improved the ability to swallow and the quality of the voice. Prompt recognition and treatment of complications is essential for effective surgical management of large glomus jugulare tumo

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00005

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractA combined therapy approach to malignancies of the external auditory canal and middle ear has been developed. A technique of external canal resection and gross tumor removal from the middle ear, parotid gland, and superior cervical lymph nodes is followed by postoperative full‐therapy irradiation. This combined approach has been used in 30 patients with malignancies involving the external auditory canal and temporal bone. The preoperative evaluation and surgical technique, including the intraoperative decision‐making process, is described. Twenty‐four patients had squamous cell carcinoma of the external auditory canal, and two patients had basal cell carcinoma. There was one patient each with adenocystic carcinoma, acinic cell carcinoma, high grade mucoepidermoid carcinoma, and a giant cell tumor of bone.This group of patients was broken down into three groups based on the extent of disease as determined at surgery. Overall control of disease, both locally and distant, for the 30 patients was 66%. There were 12 patients with disease limited to the ear canal. These patients had a 91% survival of this disease process. Seven patients were determined to have limited extension beyond the ear canal. These were treated with combined therapy with an overall control of disease of 72%. Eleven patients had extensive disease outside of middle ear into the carotid jugular spine, stylomastoid foramen, and skull base, with a survival rate of 45%.It is concluded that a step‐wise removal of all gross tumor, as opposed to anen blocdissection of the temporal bone and skull base, followed by full‐therapy irradiation gives equally as good, or even better, long‐term survival for this malignancy of the external auditory canal and

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00006

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractA new procedure, the retrosigmoid internal auditory canal (IAC) vestibular neurectomy has been developed and presented. It involves a 3‐cm retrosigmoid craniotomy removing the posterior wall of the IAC to the singular canal, with transection of the superior vestibular nerve and posterior ampullary nerve. This produces a complete denervation of the vestibular labyrinth and preserves the patient's hearing. All ten patients with Meniere's disease had their vertigo cured. Hearing was preserved to within II dB of the preoperative pure tone average in 9 of 10 cases. There were no serious complications, no cases of facial paralysis, and no cases of total hearing loss. These results compare favorably with the MFVN and the RVN. The retrosigmoid IAC vestibular neurectomy is an important improvement in the evolution of vestibular neurectomy for the treatment of vertig

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00007

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractWhile traditional confirmatory clinical tests are helpful in establishing the diagnosis of choanal atresia, they give little useful information concerning the composition, position, and thickness of the atresia plate. Surgeons experienced in the repair of choanal atresia have recognized that detailed anatomic assessment is valuable in the preoperative selection of the method of repair and design of the repair once undertaken. The utilization of high‐resolution computerized tomography to provide such information in a group of infants and children with choanal atresia forms the basis for this report. The application of computed tomography in the evaluation of choanal atresia and preoperative surgical planning is discussed. Based on this experience, we feel that the introduction of high‐resolution computerized tomography is a significant advance in the diagnostic and therapeutic approach to choanal atresia and should be the single radiographic procedure of cho

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00008

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractProstaglandins (PGs) and leukotrienes (LTs) are known to play an important role in allergic inflammatory reactions. The triad of aspirin sensitivity, nasal polyposis, and asthma led us to suspect that PGs, LTs and other arachidonic acid metabolites may be involved in the pathogenesis of nasal polyps. The purpose of this study was to determine arachidonic acid metabolites and to measure concentrations of PGs and LTs in nasal polyps and nasal mucosa.Samples of nasal polyps and nasal mucosa were obtained at the time of polypectomies and nasal procedures. Metabolites of arachidonic acid in tissue were determined by incubation of tissue‐homogenates with14C‐arachidonic acid and analyses with thin‐layer chromatography and high performance liquid chromatography (HPLC). Levels of PGE2, 6‐keto‐PGF1α, throm‐boxane (Tx)B2, 15‐hydroxyeicosatetraenoic acid (HETE), LTC4, LTB4were measured by radioimmunoassay. The predominant arachidonic acid metabolite in both nasal polyps and mucosa was 15‐HETE. The HPLC analysis showed that the predominant metabolite in nasal polyp was 15‐HETE, especially in polyps from aspirin sensitive patients. Levels of 15‐HETE and PGE2were higher in polyps from patients with a history of allergy than from nonallergic patients. Levels of LTC4and LTB4in nasal polyps were determined.The findings of this study will help to explain biochemical basis of the pathogenesis of aspirin‐sensitive nasal polyps and to develop better medi

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00009

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractOver 300 instances of the association of laryngocele with laryngeal carcinoma have been reported in Europe, but only seven in North America. In the present study, 353 serially sectioned total laryngectomy specimens were examined and the saccule measured with a steel ruler. Saccules extending superior or posterior to the thyroid cartilage were considered as large. Larynges were classified as “cancer” or “normal,” the latter being uninvaded organs from patients with adjacent disease. Among the 242 cancer larynges, there were 43 specimens where the saccule exceeded thyroid cartilage dimensions, a laryngocele rate of 17.8%. Mean saccule height was significantly greater in cancer than in normal specimens in coronal sections (P=0.04), and mean saccule length was significantly greater in cancer than in normal specimens in horizontal sections (P=0.001). The incidence of large saccules showed a difference between cancer and normal larynges which was highly significant (P=

ISSN:0023-852X    

DOI:10.1288/00005537-198702000-00010

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY