摘要:

AbstractEighteen patients underwent pharyngoesophageal reconstruction with a free jejunal autotransplant in a one‐stage procedure after circumferential resection for cancer of the pharynx and cervical esophagus. Of these, six had minor complications (fistulas) and six had major complications including abdominal bleeding, cervical bleeding, graft failure, and one surgical death. The mean survival was 427 days after resection and reconstruction (range, 120 to 866 days). Ten patients died of their disease, and four died of other causes. The site of failure was local in five and distant in five. In view of this high complication rate and unimpressive survival rate, the use of other lower‐morbidity reconstructive options or staged procedures may need to be considered in poor surgical candida

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00001

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractOur experience with the diagnosis and surgical management of 37 patients with congenital atresia or severe stenosis of both posterior nasal choanae is presented. Twenty‐five were repaired transnasally and 12 were repaired transpalatally. Soft stents were fashioned from Silastic® tubing and used for 6 to 12 weeks postoperatively. In 64% of the transnasal operations and 83% of the transpalatal operations, full patency of both choanae was achieved without the necessity of dilatations. In most of the remaining operations, one lumen remained pate

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00002

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe effect of controlled skin expansion in blood flow was investigated using the dermofluorometer. Twenty‐eight subcutaneous pockets in seven pigs were divided into three groups. Group 1: subcutaneous pockets with a gradually inflated 200‐cc tissue expander over 12 days, then deflated and observed for 6 days. Group 2: subcutaneous pockets with a noninflated 200‐cc tissue expander. Group 3: subcutaneous pockets elevated without placement of a tissue expander.Measurements taken 30 to 45 minutes after partial inflation of the tissue expander showed a decrease in blood flow while blood flow was increased 30 to 45 minutes after deflation of the tissue expander. The increase in blood flow, however, was not evident 6 days after the expander in group 1 was def

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00003

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe objective of this study was to determine the immediate patency rate for internal jugular veins preserved in functional neck dissections. Thirteen patients had contrast‐enhanced CT scans 2 to 4 weeks postoperatively. Ten veins were patent and had a diameter comparable to that seen on the preoperative scan; one vein was narrowed but patent; two were occluded. Probable factors associated with occlusion include trauma of the vessel and extrinsic compression of the vein by the skin or myocutaneous flap

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00004

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractMagnetic resonance studies frequently demonstrate increased T  2‐weighted signal in the nasal area. To further evaluate this phenomenon, several MRI examinations of the nasal cavity were performed within an 8‐ to 12‐hour period. The study demonstrated that changes alternated from side to side and were interrupted by the administration of topical vasoconstriction, confirming imaging of the normal nasal cycle. Changes were also observed within the ethmoid sinuses. Signal intensity on T  2‐weighted images during the congested phase was similar to inflammatory mucosa. Occasionally, these changes make interpretation of the extent of pathology difficult in patients with sinus disease, and raise the possibility of inflammatory pathology in asymptomatic patients. Awareness of MRI imaging of nasal cycle should reduce the likelihood of diagnostic errors and provides another method for study of this physiol

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00005

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractNecrotizing external otitis, or malignant external otitis, as initially described by Chandler, is a life‐threateningPseudomonasinfection of the external auditory canal and skull base, which occurs most commonly in elderly diabetic patients. Historically, radical surgical intervention was the primary method of treatment. The treatment of choice has shifted during the past 20 years to aggressive systemic antibiotic therapy, with surgery reserved for those patients whose disease is resistant to medical therapy. Using this approach, 19 patients with necrotizing external otitis were treated at the Cleveland Clinic Foundation during the past 8 years. A 90% rate of cure was obtained. The diagnostic approach to patients suspected of having necrotizing external otitis, a classification scheme defining the extent of disease, delivery of systemic antibiotic therapy, indications for surgical intervention, and overall effectiveness of treatment are reviewe

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00006

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractFollowing meningitis, 280 children (168 boys, 112 girls) had audiological assessment, and 87 (31%) were initially found to have a sensorineural hearing loss in one or both ears. Twenty‐three children were followed elsewhere. Of 64 children followed for an average of 3.46 years, 55 (86%) exhibited stable auditory thresholds over time, most commonly (24) bilateral, profound/anacusic losses. One moderate and four severe losses were identified, but no bilateral, mild losses. Nineteen children had asymmetric losses with varied audiometric configurations. Seven children presented with a unilateral hearing loss, again with a range of configurations. Auditory thresholds changed over time in nine children, either improving, declining, or fluctuating, over a variable interval ranging from 1 month to 12 year

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00007

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe clinical findings in 37 children with congenital cholesteatoma of the middle ear, 17 of which have not been previously reported, are presented. Clinical findings and surgical observations are correlated with recent developmental studies. It is hypothesized that congenital cholesteatoma may originate from an epidermoid formation, which has been identified in the anterior superior lateral tympanic cavity adjacent to the anterior annulus during fetal development, and which normally is present early in development, involuting by 33 weeks' gestation. It is proposed that the epidermoid formation may not always involute, and could serve as an embryologic anlage of congenital cholesteatomas.

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00008

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractA retrospective study was performed on 93 abscesses in children admitted for diagnosis and treatment at Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, during a 15‐year period from 1972 to 1987. Forty‐five percent were peritonsillar, 20.5% superficial neck, 21.5% submandibular‐submental, 9.6% retropharyngeal, and 3.4% parapharyngeal. All four complications resolved without sequelae. Early diagnosis and adequate treatment were of paramount importance to achieve a low complication rate and a short hospital stay. Bacteriology and antibiotic therapy, as well as surgical treatment, are disc

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00009

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractCurability of skull base tumors is related to the ability to achieve a complete resection. Resection of the internal carotid artery with the tumor puts the patient at risk for catastrophic cerebral injury. Autogenous vein grafting is not always technically or physiologically possible.We present eight patients with tumors eroding the cranial base who underwent safe resection or occlusion of the internal carotid artery as predicted by three tests:1.carotid arteriography,2.temporary balloon occlusion of the internal carotid artery, and3.xenon computerized tomography cerebral blood flow mapping. No patient suffered permanent central nervous system injury.

ISSN:0023-852X    

DOI:10.1288/00005537-198809000-00010

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY