摘要:

AbstractThe acquired immunodeficiency syndrome epidemic has introduced an increasing population of immune‐compromised patients susceptible to infections by unusual pathogens. To evaluate the role of traditional antibiotic therapy for deep neck infections in high‐risk patients, we reviewed the records of 73 patients with deep neck infections. Forty‐six had or were at risk for acquired immunodeficiency syndrome, and nine were diabetics. Staphylococcal infections were more common in the at‐risk group, and 24% of staphylococcal isolates in intravenous drug abusers were methicillin‐sodium resistant. In addition,Klebaiellawas isolated in two of nine diabetic patients. No other clinical differences were noted, and no unusual organisms were isolated from any other patients. Although traditional antibiotic therapy is appropriate for deep neck infections in patients at risk for acquired immunodeficiency syndrome, vancomycin hydrochloride should be considered when staphylococcal infections are suspected in intravenous drug abusers. Since diabetics appear to be susceptible to infections by gram‐negative rods, broader antibiotic coverage must be considered in this

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00001

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractNontuberculous mycobacteria (NTM) are an important cause of cervicofacial lymphadenitis in children. A dramatic increase has been seen in confirmed cases of NTM lymphadenitis in San Diego in the past few years. This report encompasses a span of 2 years 9 months, during which 22 children had confirmed NTM infection and another 14 had necrotizing granulomatous lymphadenitis in whom the specific diagnosis of NTM could not be made. This apparent increase in the prevalence of NTM as compared to previous reports in the literature suggests a possible endemic risk for NTM in the San Diego area. These cases are reviewed and our diagnostic and surgical approach to possible NTM infection is described. We also discuss possible explanations for the increasing occurrence of NTM in the San Diego area.

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00002

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractA transoropharyngeal/transpalatal approach to the clivus and anterior cervical spine in association with a midline labiomandibular glossotomy has proved successful in the treatment of craniovertebral instability. Nine cases at this institution between 1978 and 1986 were retrospectively reviewed. A head‐and‐neck surgeon, along with a neuro‐surgeon and/or orthopedic surgeon collaborated on these procedures. The indications, methods, operative techniques, results and postoperative complications are pres

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00003

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractSinusitis due to unusual fungal pathogens is thought to occur primarily in immunocompromised individuals. However, the fungiCurvularia, Drechslera, and others produce sinusitis in healthy young adults. The signs and symptoms produced by these organisms are usually considered to be complications of sinusitis. Of the three cases that we report, two manifested decreased visual acuity, and the third presented with acute onset of seizures. Computed tomography scans were helpful in delineating the extent of disease and in following the results of therapy. Aggressive surgical treatment is necessary; indeed, two of our cases required a second operation to eradicate all disease. If histopathology shows tissue invasion by the fungus, intravenous am‐photericin B is recommended. Fungal cultures and smears should be obtained when healthy patients present with complications of sinusiti

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00004

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractSubcutaneous cervical emphysema often appears as a result of surgery or trauma. However, when it occurs spontaneously, the patient may present with clinically impressive and dramatic features. The etiology is related to the rupture of terminal alveoli and dissection of air along the pulmonary vasculature. Exercise may contribute to the process by increases in intrathoracic pressure. Six cases of spontaneous cervical emphysema, all related to SCUBA diving training at a Naval facility, were recently seen at our institution. Proper management entails having a high index of suspicion for diagnosis, and then being able to identify potentially life‐threatening complication

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00005

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe presence of immune‐mediated hearing loss was investigated in an animal model. Eight guinea pigs and four mice underwent immunizations with a preparation of chick or guinea pig cochlear tissue and Freund's adjuvant. Hearing thresholds were monitored by auditory brainstem response (ABR) testing over a 5‐week period after immunization. The serum and temporal bones of test and control animals were then examined using an enzyme‐linked im‐munosorbent assay (ELISA), immunocytochemical, and his‐tological techniques.Hearing loss of 20 dB or greater occurred in eight animals. ELISA demonstrated antibodies to cochlear antigens in the sera of all test animals. Immunocytochemistry revealed immunostaining of hair cell stereocilia in the organ of Corti and saccule. Endolymphatic hydrops, and organ of Corti degeneration was observed in the temporal bones of three animals.This study provides evidence to suggest that cross‐species immunization with cochlear antigens might produce a humoral response that can be associeted with inner ear pathologic change and sensorineural h

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00006

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractUnilateral acoustic neuromas in only‐hearing ears and bilateral acoustic neuromas (NF‐2) are separate entities, but both pose a common problem because surgical removal has the potential to leave the patient totally deafened.A middle fossa decompression of the internal auditory canal (IAC) was performed in 8 patients (5 with NF‐2 tumors and 3 with neuromas in an only‐hearing ear). In 5 of the 8, the speech discrimination scores at the 6‐month follow‐up were better than preoperative scores. After 6 months, however, hearing regressed at variable rates. Although not a definitive therapeutic treatment, decompression of the IAC appears to improve and perhaps prolong useful hearing, which gains valuable time for rehabilitation. Rigid follow‐up by computed tomography scans or magnetic resonance imaging

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00007

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the “cold technique” with microlaryngeal instruments. Since the advent, in 1987, of a small‐spot (0.3 mm) CO2laser micromanipula‐tor and more precise microlaryngeal instruments, we have redefined our use of the CO2laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2laser was useful for mucosal micro‐flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2laser at low‐power settings (1 to 3 W), with 0.1‐second pulses, and with precise microlaryngeal instruments will give the

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00008

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractHead‐injured patients are frequently young, healthy individuals whose excellent medical condition is suddenly altered by trauma. The purpose of this study is to evaluate the early complications of airway management which occur in head‐injured patients and to determine if these are different from what has been reported in patients with chronic illnesses (i.e., diabetes, atherosclerosis, or immunosuppres‐sion).Chart review of 52 head‐injured patients reveals an early complication rate of 61% for endotracheal intubation and 20% for tracheotomy. Discriminant analysis shows that increasing duration of intubation is the most significant factor in predicting airway management complications (P<0.008). The incidence of complications seen in head‐injured patients is similar to that of the chronically ill. Complications of endotracheal intubation are judged to be more severe than those of tracheotomy. Data from this study supports the early tracheotomy of severely head‐injured patients who are likely to require prolonged airway

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00009

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe nasogastric tube can produce sudden, life‐threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cri‐coarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo‐documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pha‐ryngodynia, hoarseness, or evolving stridor present in the postoperative

ISSN:0023-852X    

DOI:10.1288/00005537-199009000-00010

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY