摘要:

AbstractWe have presented an overview of the Jackson service at St. Christopher's Hospital for Children as a reflection of current pediatric bronchoesophagology in a pediatric center. As a model for study we have given our statistics for a 12‐month period; July 1, 1970, to June 30, 1971. During this period of time there were 906 procedures: 626 for airway problems and 280 for esophageal problems. Airway distress acute, chronic or recurrent, accounted for much of our airway endoscopy, although in the year reviewed not one case of croup required bronchoscopy. Caustic ingestion remained our major indication for pediatric esophagoscope. Endoscopic foreign body removed accounted for less than 6 percent of all procedures. Complications were minimal.Although a considerable amount of the work was “traditional” pediatric bronchoesophagology, much of it was for diagnosis and treatment of problems encountered only rarely by our predecessors. Advances in pediatrics, neonatology, pediatric surgery and its subspecialties have created a large population of children formerly lost but now salvageable. A significant factor in this enhanced salvage rate is the assistance of the broncho‐esophag

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00001

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractAcquired lymphadenopathic toxoplasmosis is an insidious disease with protean manifestations. It usually follows a benign course. It is caused by a protozoan parasite, Isospora alias Toxoplasma. Infection is contracted by ingestion of raw encysted meat or ingestion of the oocyst found in cat litter. There is a large infected human population with a relatively high infection rate. The diagnosis is suggested by a nonspecific symptom complex, lymphadenopathy associated with a relative lymphocytosis, atypical lymphocytes, and a negative. heterophile antigen test. The microscopic findings of eosinophilic histiocytes further suggests toxoplasmosis. High serologic titers are considered most conclusive in diagnosing this usually self‐limited infection. Three cases in which biopsy was warranted are presente

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00002

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractA basal cell epithelioma presents a therapeutic problem when it recurs or when it is located in difficult to treat head and neck regions. Mohs' chemosurgery is a useful and highly effective technique for dealing with these cases. This is a staged procedure which utilizes application of a chemical fixative agent, scalpel excision, and microscopic study of the tissue. In addition to accuracy, the Mohs technique offers the advantage of conservation of valuable tissues. The chemosurgical technique is described and illustrated in detail with presentation of three typical cases.

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00003

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00004

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractLess than 100 chondrosarcomas originating in the facial skeleton have been reported. Information regarding chondrosarcomas in the facial region is fragmentary. The largest series collected transcend a long period of time containing changes in surgical technique and philosophy. Precedence for therapy and prognostic information is not readily available. Three patients with facial chondrosarcomas are reported. All were diagnosed within a four‐year time span. The aforementioned adequately depict the protean manifestations of this tumor and the aggressive therapy required. Correlation is made with the existing body of information regarding this entit

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00005

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThis paper contains a review of the gross pathology and histopathology of juvenile nasopharyngeal angiofibroma and a review of the theories of origin of this tumor. The relative merits of hormone therapy, carotid arteriography, external and interstitial radiation therapy, cryosurgery, and various surgical approaches are discussed.A plan for the management of these tumors has been developed:1. Estrogen therapy is begun one month pre‐operatively, if it is to be used.2. The patient sees a prosthodontist so that he may have a temporary plastic plate made which will fit onto the teeth in such a manner that it will hold a transpalatal flap in place following surgery, without disturbing the suture line.3. Arteriography is scheduled only if there is evidence of intracranial extension or an extensive recurrence.4. Radon seeds, usually 10 in number and 1 me in size, are ordered for the day of surgery.5. Liquid nitrogen is made ready for use with a closed cryo‐probe system.6. The expected blood loss and the possible use of planned hypotensive anesthesia are discussed with the anesthesiologist. An adequate supply of blood is to be available in the operating room at the start of the resection of tumor.7. A plan is made for a transpalatal or transantral approach, or both, or occasionally for a lateral rhinotomy approach. Rarely has a transmandibular pterygoid approach been found necessary.The combined transpalatal‐transantral approach is described in detail. Two. cases are pres

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00006

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00007

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe subject of premalignant changes in the vocal cords encompasses a very extensive scope; therefore, only two aspects are discussed in this presentation.The two most common clinically identifiable entities that progress to invasive carcinoma are examined, namely, keratosis and carcinomain situ.The treatment of keratosis and carcinomain situis probably the most provocative subject in laryngeal disease. There is a great difference of opinion as to the action or inaction to be taken when these conditions are identified in the larynx.Keratosis may appear in two forms: delineated keratosis and diffuse keratosis. They_have distinct‐Glinical appearances and have a different potential for malignant progression.The treatment of carcinomain situis a very controversial subject. The value and advisability of treating this disease with irradiation is questioned.The use of microlaryngeal surgery has been a valuable aid in the identification and delineation of both of these diseases of the vocal cords.The second part of this presentation discusses the role of the submucosa in intraepithelial and early invasive carcinoma of the vocal cord.Some interesting investigative studies have been performed in the study of the role of the stroma in epidermal carcinogenesis. These observations suggest the possibility of stromal elements being of pathogenic importance in the origin of epithelial tumors.The very rapid reappearance of carcinoma_in situin the regenerated epithelium of the vpcal cord after complete mucosal removal is suggestive of some extra‐epithelial stimulus. Both vocal cords being exposed to the same extrinsic irritants, carcinomain situwill frequently appear only in the regenerated epithelium of the vocal cord that first evidenced the disease. Multicentric foci of carcinoma is mentioned but not discussed in the presentat

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00008

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe in‐patient records at the Hospital for Sick Children were reviewed for the 10‐year period 1960 to 1970. All charts in which were coded a primary diagnosis of Bell's palsy, facial paralysis or paresis, or a secondary diagnosis of facial nerve functional disturbance were pulled and reviewed. As there was no out‐patient diagnostic index in that period, it proved impossible to identify the numbers or diagnosis of patients with the physical sign of those who were not admitted to the hospital.There were 150 patients in whom a facial nerve disorder was recorded. The distribution and a broad etiological classification is shown in Table I. It will be seen that there were significantly more lower motor neurone than upper motor neurone lesions, although it is likely that many upper motor neurone facial pareses were not recorded because they formed but a small part of a more serious generalized neurological disorder.The upper motor neurone pareses which were recorded had a variety of causes. The infections included meningitis and Guillain‐Barré syndrome. Three of the four infective cases made a complete recovery, as did all of the traumatic cases. In one of the hydrocephalic children the facial paresis diminished as the primary lesion responded to treatment. The presence of an upper motor neurone facial paresis is therefore not necessarily a sign of irreversible disease.Trauma due to birth injury, accident or motor vehicle injury was the most common cause of lower motor neurone paresis. The birth injuries usually cleared spontaneously. Bell's palsy was the next most common cause of facial palsy. The sexes were equally affected and the age distributions even throughout childhood. Bell's palsy in children, as in adults, may not clear spontaneously, and should be treated with respect.Facial palsy caused by acute inflammatory disease responds in most instances to antibiotic treatment, although simple mastoidectomy may be necessary. The outcome in this group is excellent. The remarkably few cases of facial palsy complicating chronic middle ear disease are a reflection of the changing pattern of disease.Operative causes were surprisingly mainly due to parotid surgery, and the indication for surgery was always excision of parotid hemangioma. In a 10‐year period there were only two facial palsies attributable to temporal bone surgery.There is a need for a detailed prospective study of all children with a facial paralysis and particularly the Bell's palsy group. Only in this way will accurate figures be obtained about the prognosis and thus allow appropriate regimens to be e

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00009

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe round window membrane presents the only non‐osseous wall of the labyrinth. Electron microscopic study of the round window membrane was undertaken in order to determine whether it could act as a route of transmission from the middle to the inner ear.In the cat round window membrane three layers can be identified. The tympanic surface is composed of a single layer of flat cells resting on the basal lamina. Multiple desmosomes and tight cell junctions are present. The intermediate layer contains supporting elements collagen and elastic tissues. The labyrinthine layer is composed of a single layer of long squamous cells which lie end to end on the basal lamina.The absence of intracellular organelles and microvilli, and the lack of basal lamina involutions into the epithelial cells preclude the presence of an active transport mechanism. The tight cell junctions also seem to present a barrier to free diffusion across the membrane.The chemical agents which have been observed to pass from the middle ear into the inner ear may have done so by diffusion through the round window membrane after altering the cell junctions; however, a readily accessible route of transmission through the round window membrane does not appear to be presen

ISSN:0023-852X    

DOI:10.1288/00005537-197206000-00010

出版商:John Wiley&Sons, Inc.    

年代:1972

数据来源: WILEY