摘要:

AbstractAerodigestive tract papillomatosis (ADTP) remains a distinct challenge for the otolaryngologist. None of the myriads of therapies utilized to date offers a distinctly improved prognosis with less frequent clinical recurrences or absolute cure rates. Significant complications are avoided by withholding tracheotomy whenever possible and avoiding overly aggressive papilloma removal. Laser technology seems to offer a distinct benefit as regards the latter. Despite much activity in this area, little new knowledge has actually influenced the outcome of patients afflicted with papillomatosis. The disorder remains one of long‐term morbidity in those acquiring it early in life and one with a significant rate of mortality for those with involvement of the lower airway.A review and selected discussion of our experience at The Milton S. Hershey Medical Center of The Pennsylvania State University with ADTP from 1974 to 1981 is presented. Nineteen patients ranging in age at the time of presentation from 1.5 to 68 years old have been diagnosed and treated. For the most part, therapy consisted of repeated microendoscopies with forceps removal of papillomas until recurrences ceased. However, in four adult patients with either rapidly recurring laryngeal and/or tracheobronchial papillomas, bacille Calmette‐Guérin (BCG) immunotherapy has been administered. Two of these patients are evaluable for greater than 12 months. The rationale and efficacy of the treatment of a high risk group in this fashion are discu

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00001

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractBronchopulmonary dysplasia has now become the most common chronic lung disease of early childhood, and is a sequel of neonatal intensive care. The condition is characterized by interstitial fibrosis, agenesis of pulmonary alveoli, and distension of the remaining lung tissue. The resultant stiffness of the lung leads to noisy, labored respiration with retraction of the soft tissues of the thorax during inspiration which may easily be mistaken for the signs of subglottic stenosis.Two cases which illustrate the problem are presented. The mechanism underlying the clinical picture is discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00002

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe anatomical limitations of CO2laser cordectomy in an experimental setting with maximal exposure are presented. The major limitation is the thyroid cartilage. This is reached in the area of anterior commissure tendon by removal of only 2 to 3 mm of soft tissue. Most posteriorly in the larynx, the distance to the thyroid cartilage becomes progressively greater, being 5.3 mm at mid‐cord and 9.0 mm at the anterior end of the vocal process of the arytenoid. The inferior limitation is the cricothyroid membrane. Anteriorly this is avoided by not extending laser excision more inferiorly than 5 mm's. Posterolaterally, the limitation is the para‐arytenoid musculature. Excisional biopsy or staging with the laser must be within the framework of these limitati

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00003

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractCarotid rupture following the treatment of head and neck malignancy is the most dreaded complication faced by the head and neck surgeon. Tissue coverage of the carotid artery has been advocated as the method of protection likely to prevent carotid rupture. A retrospective study was carried out to assess the benefit of carotid coverage and whether such protection plays a role in decreasing mortality and morbidity. A brief history of carotid protection is presented. A series of 194 head and neck cancer patients who underwent resection of their mucosal primary in continuity with radical neck dissection over a ten‐year period was reviewed. No coverage was used in 120 cases, while 72 cases received carotid coverage. There was a 13% fistula rate and a 15% rate of wound complication without fistula. Six patients without recurrence who had carotid rupture or ligation for imminent rupture were identified. This group was scrutinized with regard to several parameters. Three received tissue coverage of the carotid system, while the other three were left unprotected.There was a 50% mortality rate and 25% rate of neurologic sequelae amongst the survivors. This review tends not to support the premise that tissue coverage is a major factor in the prevention of carotid ruptur

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00004

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractFifty‐eight patients receiving planned high‐dose preoperative radiotherapy followed byen blocoro‐mandibular‐cervical resection for oropharyngeal cancer were reviewed. These patients received continued close observation and care from both the Otolaryngology and Radiotherapy services. In light of the ongoing controversy of preoperativevs. postoperative radiotherapy, we present our data demonstrating the value of preoperative radiation.An overall tumor control rate of 66% was achieved, with an adjusted survival rate of 62%. This was not only for early lesions, but also in patients having advanced (T3, T4) tumor and/or nodal disease (N1–4). These figures are somewhat higher than expected from the literature. A review and discussion of the surgical complications are also

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00005

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00006

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractAdvanced head and neck cancer patients can be managed by single modality or combined modalities, Between 1976 and 1979, three treatment groups were retrospectively identified. One group received induction chemotherapy, surgery, and postoperative radiation therapy. The second group received chemotherapy followed by radiotherapy. The third group was treated during the same time period with radiation alone. These groups were matched with respect to age, site of primary tumor, nodal status, absence of metastatic disease, and no prior cancer treatment.The combined modality groups were initially treated with two doses of cis‐platinum and a bleomycin infusion. Evaluation of tumor response was done 2 weeks following chemotherapy; 24 patients had surgery and postoperative radiation, 23 had radiotherapy without surgery and 24 patients were treated with radiotherapy alone.Median survival was 22 and 13 months respectively for the 2 combined modality groups and 4.7 months for the radiotherapy group. Disease‐free survival was a projected value of 40 and 35 months for the combined modality groups and an actual 3 months for the radiotherapy group.Combined modality treatment with chemotherapy and surgery and/or radiotherapy offers a higher response rate and prolonged survival than radiotherapy al

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00007

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractTumor metastasis to the esophagus is rare. While breast carcinoma metastasizing to the thoracic esophagus has been described, there are no reported cases of spread to the cervical esophagus. Two patients, having had mastectomy for breast carcinoma several years previously, presented with cervical esophageal obstruction secondary to metastatic disease.Tumor resection with cervical esophageal reconstruction is advocated for palliation. The details of the history, diagnosis and surgical technique are presented.

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00008

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractPosterior epistnxis from branches of the sphenopalatine artery can be rapidly and effectively controlled by a new ligation technique. The sphenopalatine artery or its branches arc directly ligated as they exit the sphenopalatine foramen to enter the nose, completely avoiding the pterygomaxillary fossa. The vessels are exposed via a transantral approach, through the posterior portion of the medial antral wall. The mucoperiosteum of the lateral wall of the nose (medial antral wall) is preserved, elevated medially and posteriorly and used to tense the sphenopalatine vessels, bringing them into view and accessible for ligation at the foramen. Advantages of this technique include direct, specific ligation of the end vessels; ease and speed of operation; and avoidance of complications associated with the pterygomaxillary space. The technique was defined in multiple dissections of anatomic specimens and has been successful to date in 14 cases of severe posterior epistaxis.

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00009

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractFrontal sinusitis with frontal osteomyelitis is a potentially life threatening disease. Diagnostic and therapeutic errors occur frequently because of antibiotic masking of already silent frontal lobe complications or lack of suspicion on the part of the otolaryngologist or the neurosurgeon. Frontal sinus infection and/or trauma frequently require otoneuro cooperation for care. Four cases of complications of frontal sinus infection with osteomyelitis are discussed. Three had epidural empyemas and one had a subdural emypema with an anterior 1/3, superior sagittal sinus thrombosis and multiple brain abscesses.Each patient was approached through a frontal craniotomy and the frontal sinus posterior plate examined from behind. Each had posterior dehiscences. Follow‐up of osteomyelitis requires multiple tests including computerized tomography, polytomography and possibly bone or gallium scans. Twenty year or more follow‐up is essent

ISSN:0023-852X    

DOI:10.1288/00005537-198209000-00010

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY