摘要:

AbstractA number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph‐node metastasis. These parameters have been inconsistent and not readily reproducible.In an attempt to confirm these parameters, a retrospective analysis of 22 patients with Tl to T4 squamous cell carcinoma of the oral cavity and oropharynx was performed. Initially, these patients were managed with either wide local excision or surgical excision of the primary tumor combined with radical neck dissection. There was a minimum of 3 years of follow‐up.Chi‐square contingency tables and Fisher's Exact Test were used to correlate histopathologic parameters with lymph‐node metastasis. Statistically significant correlations were found for tumor thickness and inflammatory inf

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00001

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractSurgical endeavors in the field of laryngotracheal reconstruction in children have received much interest in the past 15 years. A unique experience with laryngotracheal reconstruction in 203 children is reviewed. The majority (194) of the cases were classified as acquired; only nine were classified as congenital. Excluded from the study were those cases of stenoses managed en‐doscopically, all resections and end‐to‐end anastomoses, all anterior cricoid split procedures, and all cases of anterior glottic stenosis repaired by a laryngeal keel. The degree of stenosis was graded into four categories. Five different methods of laryngotracheal reconstruction were used depending on the pathologic lesion in the larynx and trachea. Of the 203 children, 186 (92%) were decannulated. The results support the use of laryngotracheal reconstruction in children with grades 2, 3, and 4 laryngeal ste

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00002

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractA group of 87 patients with inverted papilloma, a locally aggressive benign sinonasol tumor, were treated over the past 15 years. Selection of therapy depends on an accurate radiographic assessment of the extent of tumor. The tumor's local aggressiveness, high rate of recurrence, associated malignancy, and multicentric tendency have led most workers to advocate radical surgical removal of the tumor by lateral rhinotomy anden blocresection of the ethmoid labyrinth. Radiographic evaluation by computed tomography scanning and magnetic resonance imaging permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor resection by intranasal or transantral sphenoethmoidectomy.Among our ten patients treated with conservative surgery, there was recurrence in one case (10%). Seventy‐five patients underwent rhinotomy and medial maxillectomy, with seven cases recurring (9%). The overall recurrence rate was 9% (8 of 87). Among the 87 cases, 5 patients had carcinoma (6%).The literature is reviewed and the principles of case selection and management are discusse

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00003

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractA retrospective review of 135 patients surgically treated for obstructive sleep apnea syndrome (OSAS) from 1982 to 1987 was performed to identify perioperative complications and potential risk factors. The incidence of complications was 13% (18/135). Airway problems comprised 77% (14/18) of these complications, resulting in one death. There were three postoperative hemorrhages and one postoperative arrhythmia. Comparison of the complication group versus the noncomplication group showed a statistically significant difference in the minimum oxygen saturation (66% vs. 79%) and apnea index (75 vs. 57) on the pro‐operative sleep study and in the amount of narcotic administered intraoperatively. Patients with intubation complications tended to be heavier, whereas patients with extubation complications received significantly more narcotic analgesia intraoperatively. Risk for a perioperative complication was not related to age, type of obstructive symptoms, medical problems, or concurrent septoplasty/tonsillectomy. A protocol for perioperative airway management is presente

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00004

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractFifty‐four of 103 malignancies of the paranasal sinuses treated at the Cleveland Clinic Foundation between 1977 and 1986 were squamous cell carcinomas. Six arose from the ethmoid sinus and 48 from the maxillary sinus. Of the maxillary sinus patients, 11 presented with Tl or T2 lesions, 20 with T3, 16 with T4, and 7 of these had nodal disease. Treatment was surgery and/or radiation therapy. There was local recurrence in 25 of 48 maxillary sinus patients and in 1 of 6 ethmoid patients. Overall 5‐year survival was 38.2% in the maxillary sinus group: Tl, 100.0%; T2, 85.7%; T3, 31.8%; and T4, 6.7%. Three of six patients with ethmoid tumors were cured. There was a statistical trend for better prognosis in those patients presenting with ethmoid primaries, with early lesions, treated with both radiation and surgery, and with history of inverting papilloma. There were complications of treatment in 10 patients, four of which resulted in death. Local control was the major problem for these patients; therefore, early detection and aggressive local treatment are desira

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00005

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractImmune‐mediated inner ear disease, by convention called autoimmune inner ear disease (AIED), has established clinical profile guidelines for diagnosis. Treatment consists of steroid and/or cytotoxic drug immunosuppression. The role of plasma‐pheresis (PMP) in the treatment of AIED has not been defined. Lack of a precise serological marker prevents accurate immuno‐logical understanding. Definition is, of course, difficult in a disease whose natural history is not well delineated.Successful use of PMP in one steroid and cytotoxic drug intolerant patient with AIED led to its use in a total of eight patients. The rationale for PMP was based on its known effectiveness in other autoimmune diseases and thus, its potential use in AIED. Improved auditory function occurred in 6 of the 8 patients, 3 of whom have been followed for over 3 years. Three of the six no longer require immunosuppressant medication. PMP can be used as an alternative or adjunctive therapy in AIED. These preliminary results suggest PMP can stabilize or improve auditory and vestibular symptoms in selected patients. Its use as a first line therapy followed by cytotoxic immunosuppres‐sants bears consid

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00006

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractLaryngeal tuberculosis continues to exist in spite of extensive tuberculosis eradication campaigns. We present 19 cases of laryngeal tuberculosis seen in our institution between 1982 and 1987. From the clinical findings it is clear that the localization of the lesions has changed since the preantibiotic era. Today the spread appears to be mainly via lymphatic and hematogenic routes, as opposed to the direct spread more common previously. The fibrosis caused by the lesions is incapacitating and frequently requires surgical correction.

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00007

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe hearing sensitivity of 9427 railroad train crew members, determined during the first year of a company‐wide hearing conservation program, was compared with hearing sensitivity in a control population not exposed to occupational noise. The hearing sensitivity of the trainmen did not differ significantly from that of the control population. Multiple regression analysis, which considered separately the effects of age and years of service, showed significant differences in hearing levels due to age, but no differences in hearing levels due to years of service. Evaluation of the data by risk categories developed by the National Institute for Occupational Safety and Health indicate that this group of trainmen had no risk of occupational noise‐induced hearing loss. These analyses, combined with studies of locomotive cab noise, show clearly that trainmen ore not typically exposed to hazardous occupational no

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00008

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe ability to identify surgical sinus disease using diagnostic nasal endoscopy and coronal CT scanning of the paranasal sinuses is studied prospectively. Fifty consecutive patients with symptoms of chronic sinusitis lacking surgical indications by traditional work‐up comprise the patient population. Sixty percent had endoscopic or CT indications for surgery. There was a 90% correlation between endoscopy and CT examination with the combined work‐up being more accurate than either modality alone. Functional endoscopic sinus surgery was performed in 18 cases. There were no major complications. Approximately 89% of the postoperative group report significant improvement, with 55.6% reporting total relief of symptoms.A complete endoscopic sinus work‐up can often identify surgically correctable sinusitis despite normal routine rhinoscopic and plain‐film examination. It is. therefore, warranted in those patients with a suggestive

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00009

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractA prospective double‐blind randomized pilot study was performed to test the benefits of steroids versus placebo in controlling edema and ecchymosis in rhinoplasty within the immediate postoperative period. Thirty consecutive patients who underwent rhinoplasty with osteotomies were entered into the study. Sixteen patients received 10 mg of intravenous dexnmethnsone before the procedure and 14 patients received placebo. All rhino‐plastics were performed by residents under the supervision of staff otolaryngologists. A 4‐point scale was used to assess the extent of periorbital edema and ecchymosis at 24 hours pustop‐eratively. A one‐time bolus of 10 mg of dexamethasone was beneficial in decreasing edema and ccchymosis in rhinoplasty. This benefit was demonstrated statistically (p&It .005). No complications were attributed to the administration of dexa

ISSN:0023-852X    

DOI:10.1288/00005537-198911000-00010

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY