摘要:

AbstractJet ventilation for microsurgery of the larynx has been in common use at our institution since 1978. There were 942 cases performed, with ages ranging from 7 days to 90 years. A specially modified laryngoscope with multiple ports into which a 14‐ or 16‐gauge ventilation needle can be advanced just distal to the vocal cords simplifies this form of anesthesia and ventilation.Jet ventilation has been advocated in place of conventional ventilation methods during carbon dioxide laser surgery because it eliminates the potential fire hazard of the endotracheal tube and allows superior visibility of the vocal cords. Despite these advantages, it is still not in common use. We will review the airway mechanics and special anesthesia considerations that make jet ventilation a safe and time‐proven tech

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00001

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractWhen malignant lesions of the oral cavity, base of tongue, and oropharynx are treated with radical resection, adequate reconstruction is required. The free gastric mucosal flap with microvascular transfer is being used with increasing frequency at Washington University Medical Center. Because of the advanced nature of the primary lesions, most patients also require postoperative radiation therapy. In this paper the tolerance of the gastric mucosal flap to postoperative radiation therapy is reviewed. The changes resulting from radiation therapy in the mucosal flap were found to be acceptable, and no major complications were encountered.

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00002

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractInjection of Teflon® paste is a commonly accepted procedure to improve the caliber of voice in unilateral vocal cord paralysis. There are several drawbacks to Teflon injection, among them respiratory obstruction (from overinjected Teflon) and unsatisfactory voice quality (Teflon causes stiffness of the vocal folds).This paper is a preliminary report on lipoinjection instead of Teflon injection into a paralyzed vocal fold. Fat appears to impart a soft bulkiness to the injected cord, while allowing it to retain its vibratory qualities. It is autologous material and can be retrieved if excessively overinjected. The fate of autologous fat injected into a paralyzed vocal cord remains unknown. Most of the literature on lipoinjection concerns repairs of depressed scars or breast augmentation. Our longest follow‐up has been 12 months. Three patients have had this procedure, and the results appear to be very encouragi

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00003

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractFine‐needle aspiration biopsy cytology is widely used to screen masses in adults. The authors present a series of 89 fine‐needle aspiration biopsies performed between January 1973 and December 1988 on 86 pediatric patients with clinically significant head and neck masses. All fine‐needle aspiration diagnoses were confirmed by subsequent surgical biopsy, autopsy, or clinical follow‐up for a minimum of 18 months. Of 21 tumors identified, 19 were malignant.Of the 89 aspirations performed, 67 required no subsequent surgical biopsy. In 11 of these cases, meta‐static or recurrent tumor was diagnosed and appropriate therapy instituted. Fifteen of the 89 aspirates revealed previously undiagnosed tumors requiring surgical intervention.One false‐negative and two false‐positive results were obtained. No radical treatment resulted from the false‐positive diagnoses, and no patient delay in treatment occurred because of the false‐negative result. The sensitivity was 94.4%, and the specificity was 97.1%. The usefulness and cost‐effectiveness of fine‐needle a

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00004

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractIn tracheostomy patients with chronic bronchitis, scanning electron microscopy reveals detailed surface changes in the tracheobronchial mucosa. The principle of intermicroscopic correlation, i.e., the sequential examination of a specimen by different microscopic procedures, is illustrated with giant cilia. After re‐embedding the scanning electron microscopic specimens and precisely locating a ciliary convolution by light microscopy in semithin section, the giant cilia were studied in ultrathin sections by transmission electron microscopy. The cilia were shown to be at least 9 (μm long (normal ciliary length = 4 6 μm). Central and peripheral micro‐tubular axonemal structures with a 9 + 2 arrangement were clearly shown in both longitudinal and cross section. Giant cilia, thus, most closely resemble outgrowths of normal cilia. If they are motile at all, they seem unlikely to effect a transport function coordinated in direction and

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00005

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractObservation of the external aperture of the vestibular aqueduct was hitherto possible only in cadavers or dry temporal bones; however, by applying three‐dimensional surface reconstruction imaging, it is now possible to observe solid‐looking images of this structure in living humans. When the width of the external aperture of the vestibular aqueduct was measured in 58 people, it was found to be significantly narrower in the affected ears of patients with Meniere's disease than in normal e

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00006

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSudden infant death syndrome remains the leading cause of death in infants between the ages of 1 month and 1 year. Diagnosis at autopsy is usually reached by process of elimination, as no obvious cause of death is recognized. The larynges of 23 sudden infant death syndrome victims, as well as 6 infants and 3 fetuses who died of other known causes, were examined in this study. While thickening of the basement membrane of the vocal cords was apparent in all sudden infant death syndrome victims, no such finding was present in the larynges of infants and fetuses dying of other causes. Thus, it is suggested that basement‐membrane thickening may serve as a diagnostic tool for identification of sudden infant death syndrome at autops

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00007

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractForty‐five consecutive cases of nasopharyngeal carcinoma were morphologically and immunocyto‐chemically studied using monoclonal (anti‐B and anti‐T cell) and polyclonal (anti‐SlOO protein and antilysozyme) antibodies with the peroxidase‐anti‐peroxidase method to identify infiltrating lymphocytes (T and B cell) and histiocytes (monocytic/mac‐rophagic and dendritic cells) in nasopharyngeal carcinoma.A variable density of dendritic cells was found within the tumor nests in 22 (49%) of 45 nasopharyngeal carcinomas examined; infiltrating mac‐rophages were demonstrated in 15 (33%) specimens and around the tumor in almost all cases. Cases with moderate or marked density of dendritic cells (S100 + ) survived longer than those without such infiltration (mean 5‐year survival rates of 31%, 55%, or 64% in patients with absent, moderate, or marked densities, respectively; P<0.05).A significant relationship between monocytic/ macrophagic cells (lysozyme +) within the tumor and survival was also found (mean 5‐year survival rate of 27% or 61% in patients with absent, moderate, or marked densities, respectively).However, lymphocy tic infiltration was not statistically related to a better survival. Analyzing lympho‐cytic infiltration, we found a large prevalence of T cells in the neoplastic tissue without any prognostic significance.These data were correlated to different histo‐logical subtypes according to the principal histologi‐cal classifications of nasopharyngeal carcinomas (Micheau,et al.; World Health Organization; Cologne University) to individualize the scheme which correlates best with prognosis and biological features of nasopharyngeal carcinomas.Our data suggest that, considering dendritic cells and macrophages within cancer nests, nasopharyngeal carcinoma histiotypes can be corr

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00008

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractOne hundred two patients with recurrent and/or metastatic head and neck squamous cell cancer were entered into four consecutive phase II trials, all cis‐platinum (C‐DDP, 100 mg/m2/cycle)‐based. The two combinations tried were C‐DDP, bleomycin, and fluo‐rouracil (CFB) on 54 patients, and cisplatinum and vindesin in 36 patients (CV). The CFB combination was given with C‐DDP by continuous infusion over 96 hours (23 patients) or on day 1 (31 patients). The CV regimen was also given in two different schedules, with VDS at 3 mg/m2/g weekly (12 patients) or by a 96‐hour continuous infusion (0.6 to 1.0 mg/m2/d) in 24 patients. The following variables: sex, age, performance status, previous therapy, local recurrence, length of disease‐free interval (DFI), distant metasta‐ses, weight loss, primary site, histological differentiation, type of chemotherapy, previous chemotherapy, evaluable/measurable disease, erythrosedi‐mentation rate, and their relation with response to chemotherapy (WHO) and survival were submitted to both univariate and multivariate analysis (Cox). Overall response rate (RR:CR+PR) was 25 (28%) of 90. In the CFB protocols, RR was 12 (22%) of 54 us. 13 (38%) of 36 (P = 0.15, NS) in the CV combination group. For the four different combinations the RR was CFB C‐DDPci 7 (30%) of 23, CFB C‐DDP 1 hour 5 (16%) of 31, CV VDS weekly 2 (17%) of 12, CV VDSci 11 (45%) of 24. The patient populations were very different, with the latest combination consisting of metastatic patients exclusively. Univariate analysis of multiple variables showed age<60 years, PS:0 or 1, no previous therapy, absence of local relapse, metastatic disease, long DFI, and that measurable disease was significant for the probability of response. Median survival was 7 months for the 90 evaluated patients, 5 months for nonresponders, and 9 months for responders (P = 0.01). In the univariate analysis, significant factors for survival were PS:0 or 1, a weight loss below 10%, long DFI, response to chemotherapy, erythro‐sedimentation rate (ESR) of<30 mm/lst hr, presence of bone metastasis, and the number of metastases. Multivariate analysis shows PS, the absence of local relapse, and disease‐free interval as significant prognostic factors for response. Multivariate analysis factors of significance for survival were PS, weight loss, and response to chemotherapy. The analysis of the clinical pattern showed an evolution in RR from 3 (8%) of 36 on previously irradiated local recurrent disease to 8 (73%) of 11 in previously untreated patients with metastatic disease at presentation.Eligibility and stratification criteria of phase III studies should be based on evolutive patterns and major prognostic variables validated by multivariate analysis. The choice, dose, and schedule of drugs used is heavily

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00009

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractFifty‐two patients with laryngeal cancer who underwent radical neck dissections were studied to provide further information on the prognosis of various clinical and histopathological parameters.Extracapsular spread (ECS) was found in 31% of patients with Nl nodes, and in 60% of patients with histopathologically positive nodes.The 5‐year survival rate of histopathological findings was as follows: patients with no pathological evidence of neck metastasis (81%), patients with neck metastasis confined to the lymph node (no ECS) (76%), and patients with ECS (17%). The difference in survival rate between patients with no ECS and patients with ECS was statistically significant (P = .001).Staging classification, T‐stage classification, the number of malignant nodes, the diameter of malignant nodes, and combined therapy had no prognostic importance. The most significant factor was the presence of extracapsular s

ISSN:0023-852X    

DOI:10.1288/00005537-199105000-00010

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY