摘要:

AbstractA case of acute epiglottitis without prior treatment in a 64‐year‐old hypertensive alcoholic male is reported. A correct diagnosis was made in the emergency room and tracheostomy deferred as airway seemed adequate. A trial course of medical therapy under close observation was felt indicated. A detailed history up to the time of death, 8 hours after admission, will be presented as well as the findings at post mortem.Nine months later the executor of the estate filed a S2 million malpractice suit against the defendant doctor and the defendant hospital for wrongful death. A pretrial deposition was held followed by an offer to settle. This was refused and a trial date set in Superior Court. One week before trial another offer to settle was mode by the plaintiff for S12,500 from each of the two defendants. This offer was accep

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00001

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe phenomenon of central presbycusis has been investigated employing a central auditory battery in elderly individuals with essentially normul hearing. The studies indicate a progressive loss in central auditory competence measured by simultaneous binaural challenges and frequency and temporal distortion tests. The rate of failure is related to age, on the whole, but there is increasing variability from the normals with seniority. The hearing disability in noise or speech competitive environments is explained by these data. Auditory disabilities related to poor articulation and rapid speech presentation are identified by other tests in the battery. Central presbycusis, in addition to the peripheral form, does exist and further compounds the hearing disorder in many elderly.

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00002

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractAuditory evoked potential techniques have revitalized programs for early detection, quantification, and management of hearing loss. Some issues underlying the need for such programs, and their structure, are reviewed with reference to recently‐published guidelines. The prevalence of hearing loss in infancy is poorly understood; estimates depend on the type and degree of loss, the tests used, and their timing. Evidence that significant hearing loss can escape early detection continues to accumulate; delays are attributable to many factors, including insufficient awareness and deficiencies in conventional tests. High‐risk registers are valuable but imperfect tools, and should not be the sole avenue of early detection. Electrophysiologic tests, especially the auditory brain stem response, have a major role in early assessment. Attention to many technical and patient‐related factors is required, and frequencyspecific testing is feasible and inform

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00003

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe authors have utilized six pectoralis major myocutnneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull‐up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis.These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means.This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. We conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosi

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00004

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractUncontrolled cervical metastasis is the most common source of failure in the surgical treatment of supraglottic carcinoma. This study was designed to determine the value of suprnomohyoid neck dissection in patients undergoing supraglottic laryngectomy. The rationale for considering the role of supraomohyoid neck dissection is that such a dissection encompasses the subdigastric and midjugular nodes which arc the first echelon of lymphatic drainage of the supraglottic larynx.Thirty‐eight patients with a diagnosis of epidermoid carcinoma of the supraglottis were treated by subtotal supraglottic laryngectomy (SSL). Ten patients underwent SSL with no neck dissection, 16 patients underwent SSL with supraomohyoid neck dissection (SOHD) — 9 unilateral and 7 bilateral, and 12 patients underwent SSL with radical neck dissection (RND). The 3 groups had comparable T classifications. All of the SSL and SSL with SOHD patients were classified as No. Of the 12 patients treated with SSL and RND, 4 were classified as No, 4 as N1, 3 as N2, and 1 as N3. The patients were studied to determine the incidence and pattern of subsequent neck disease, survival, complications, and length of hospitalization.The data indicates that supraomohyoid neck dissection offers little benefit as an adjunct to supraglottic laryngect

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00005

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractAdvanced or recurrent carcinoma surrounding the tracheostoma in a previously laryngectomized patient is most effectively treated with transsternal radical dissection of the upper mediastinum and relocation of the trachea to the upper chest. The use of the pectoralis major myocutaneous flap, now enables the head and neck surgeon to perform immediate reconstruction and provide protection for the great vessels after mcdiastinal dissection for stomal recurrence. Formerly, patients with stomal recurrence also involving the cervical or upper thoracic esophagus were poor surgical candidates. Frequently, patients succumbed to their disease before the continuity of the digestive tract could be re‐established.Currently, at our institution, this vexing reconstructive problem is solved with immediate, one‐stage reconstruction. The esophagus is replaced by transposing the stomach through the posterior mediastinum and anastomosing to the tongue base, “gastric pull‐up.” The mediastinal defect is closed with the concomitant use of the pectoralis myocutaneous flap. The muscular portion of the myocutaneous flap provides excellent coverage for the great vessels of the upper mediastinum. Our experience with 39 patients who underwent this procedure between 1979 and 1983 is

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00006

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractIt was once believed that prognosis for many patients with neoplasms of the anterior skull base was hopeless. Now, however, craniofacial resection of these lesions has been curative for many patients.Massive resections of the anterior skull base pose many potentially life‐threatening complications. Cerebrospinal fluid leakage with meningitis is especially troublesome when previous radiation therapy compromises wound healing. In such circumstances local tissue flaps and skin grafting may not provide reliable separation of the brain from the nose.The pectoralis major flap was utilized in eight patients undergoing anterolateral resection of the skull base. Several major advantages of this technique include:1. reliable closure of the subarachnoid space;2. acceptable cosmesis;3. rapid wound rehabilitation, allowing early postoperative radiation therapy when necessar

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00007

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractAfter the auricular cartilage of 5‐week‐old rabbits was bent and fixed by suture, the cartilage increased in thickness in a short period of time. The thickness was maximal 6 weeks later and slightly greater than that of the control cartilage 12 weeks later. At this stage, the auricle was fixed in curved form. There was no difference in the morphology of cartilage cells between the bent group and the control.Tape attachment therapy is very simple. We propose that surgical treatment should be designed after a few months of tape attachment therapy.In the present work, the effect of taping was graded good in 4 cases of Stahl ear, 1 case of atypical cryptotia, and 2 other cases. In 2 cases of cup ear the result was fair, but this deformity with marked auricular aplasia was not curable by this conservative treatm

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00008

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThirty‐seven cases of adenoid cystic carcinoma treated at the Otolaryngologic Clinic of the University of Florence between 1962 and 1979 were studied. The patients were treated with radical surgical excision (20), non‐radical surgery associated with radiotherapy (13), or with palliative treatment (4).The aim of this study is to evaluate the course of the disease according to the site and type of operation. Our results show that nonradical surgical treatment associated with radiotherapy seems to give results comparable to those obtained with radical surgery al

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00009

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractPersons with diminished or absent vestibulo‐ocular reflexes (VORs) are thought to have difficulty with ocular stabilization during sufficiently rapid head movements. This suggests the hypothesis that labyrinthine defective individuals might have impaired visual abilities when in a moving motor vehicle. Ten licensed drivers likely to have abnormal VORs were recruited to assess this possibility. Their labyrinthine function was indexed by measurements of ocular counterroll responses to static head tilt and the nystagmus induced with caloric stimulations. Each person was evaluated on a visual task,i.e., answers to questions about alphanumeric information read from a stationary sign while sitting still and while riding in a car. Comparisons of vision scores tend to be lower in the moving than in the still condition. Furthermore, these decrements appear more closely related to the magnitudes of ocular counterroll than to the caloric reflexes. These results have implications concerning otolithic us. semicircular canal function, vehicle operations by vestibularimpaired individuals, and evaluations of clinical treatments which employ vestibulotoxic drug

ISSN:0023-852X    

DOI:10.1288/00005537-198502000-00010

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY