摘要:

AbstractAlthough computed tomography and magnetic resonance imaging have contributed to the ability to identify metastatic disease in head and neck Cancer, inadequacies in evaluating lymphadenopathy still exist. This study was undertaken to estimate the accuracy of radiological criteria used to detect cervical lymph node metastases. The morphological characteristics of 957 lymph nodes from 36 neck dissections from patients with squamous cell Cancer were examined microscopically. A large number of malignant nodes were found to have diameters of less than 10 mm. Extranodal spread also occurred in a substantial percentage of smaller nodes. Because the present radiological criteria for assessing cervical lymph node Status are based largely on size, findings indicate major limitations in the capabilities of detecting metastatic disease. New modalities to improve the Staging of head and neck Cancer are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00001

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractEvoked otoacoustic emissions (OAEs) are assumed to reflect healthy outer hair cell function. Over the past few years, evoked OAEs have been shown to be useful as indicators of cochlear hearing loss. Because basic studies have shown that OAEs are extremely sensitive to cochlear anoxia and hypoxia, as well as to the adverse effects of many inner ear diseases, it is possible that these objective tests can provide some insight into the fundamental basis of the hearing loss exhibited by patients with acoustic neuromas.The primary aim of the present study was to examine the effects of acoustic neuromas on the amplitudes of evoked OAEs and to compare these findings with tumor‐induced hearing levels. To this end, tests of behavioral audiometry, distortion‐product otoacoustic emissions and transiently evoked otoacoustic emissions were performed on 44 patients with verified acoustic neuromas. The results demonstrated that the majority of ears with acoustic neuromas displayed one of two distinct patterns of evoked OAEs: a cochlear pattern or a noncochlear pattern. Although behavioral hearing thresholds were higher with larger tumors, OAE levels exhibited no clear relationship to tumor size.The present findings support the notion that acoustic neuromas may cause hearing impairment according to two types of influence that act at different levels of the peripheral auditory system. The tumor's cochlear effect on evoked OAE activity is most likely caused by an indirectly mediated compromise of the organ of Corti's vascular supply. It is probable that the direct pressure of the tumor on the eighth cranial nerve is responsible for the observed noncochlear effe

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00002

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe value of diagnostic maxillary sinus aspiration in patients with abnormal findings on sinus radiographs and fever of unknown origin is unclear. To better define indications for this procedure, the results of 51 sinus aspirations in 34 patients with fevers of unknown origin and abnormal findings on sinus radiographs were analyzed retrospectively. Results of aerobic and anaerobic cultures were evaluated in the context of clinical signs and symptoms at the time of the maxillary sinus puncture. Typical symptoms of paranasal sinus disease were found to be the best predictor of a positive culture. Of patients with sinusitis complaints, 86.4% had culture‐positive aspirations, whereas only 8.3% of patients without clinical symptoms of sinusitis had culture‐positive aspirations. This study indicates that symptoms of sinus disease play an important role in determining the benefit of sinus aspiration in this group of patie

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00003

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThis study investigated the relative effects of vestibular rehabilitation (VR) and social reinforcement (SR) on recovery following ablative vestibular surgery. Twenty‐four subjects were randomly assigned to three treatment groups of either VR with SR, VR without SR, or general range of motion (ROM) exercises with SR. Outcome measures included equilibrium scores in dynamic posturography, asymmetry index in rotation testing, motion sensitivity quotient (MSQ), and dizziness handicap inventory (DHI). A multiple comparison of the overall outcome measures showed no significant differences in group performance over an 8‐week period. When individual outcome measures were compared, MSQ and DHI results at the end of the 8‐week treatment period revealed less motion sensitivity and dizziness handicap in groups who received VR, with or without SR, as compared with the group who received ROM exercises. These results suggest that after a vestibular injury most patients can effectively utilize central compensation mechanisms to recover from such an injury, regardless of the type of therapeutic intervention used. On the other hand, the reduction in motion sensitivity and dizziness handicap for patients who received VR could indicate a more rapid and complete recovery for these patients. This investigation is continuing as a long‐term follow‐up study to determine whether there are any long‐term benefits in participating in a

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00004

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractFor a long time, it has been speculated that pregnancy stimulates the growth of acoustic schwannomas. To test this hypothesis, immunohistochemical stains for estrogen receptor, progesterone receptor, and proliferating cell nuclear antigen (PCNA) were performed. Flow cytometric studies for DNA ploidy and S‐phase fraction determinations were also performed. The study subjects included 6 female patients with unilateral acoustic tumors; at the time of tumor removal, 1 woman was pregnant and the other 5 women were 2 to 10 months postpartum. The age‐sex‐matched control group consisted of 6 men and 12 nonpregnant women, all with acoustic schwannomas similar in size to those of the study group. The study found no statistically significant association between the presence or quantity of estrogen or progesterone receptors and pregnancy, DNA ploidy, proliferation indices, or clinical data. Based on PCNA indices, large tumors tended to be less “biologically active” than small lesions (P<.01). The authors concluded that pregnancy does not significantly stimulate the cellular growth of acoustic sc

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00005

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractDue to improved diagnostic techniques, acoustic neuromas more frequently are detected at an early stage. Subsequent treatment depends on such factors as expected tumor growth rate, tumor size, and patient age. The natural history of acoustic neuromas is still uncertain:This study was performed to examine possible correlations among tumor size, patient age, signs and symptoms, and duration of symptoms. The study included 164 patients with an acoustic neuroma who were treated at University Hospital Nijmegen, The Netherlands, over a period of 13 years. Comparisons were made between the findings of this study and the reports in the literature. No support was found for any of the correlations mentioned in other studies, and no relationships could be demonstrated between the parameters evaluated in this study. The authors therefore recommend that treatment policies be based only on well‐established correlation

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00006

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractHeat shock proteins (hsps) are essential for the survival of cells under an environmental insult. To elucidate the relationship between these intracellular proteins and acute otitis media (AOM), the authors studied hsp production in guinea pigs with AOM induced by inoculation ofStreptococcus pneumoniaeinto the middle ear. Animals were sacrificed 1,3, or 5 days after inoculation. Immunocytochemical study showed localization of hsp70 within the epithelium of infected ears, while the normal control epithelium showed very light staining. Western blot tests of the mucosal extraction confirmed the presence of hsp70 in otitis media. Enzyme‐linked immunosorbent assay (ELISA) showed that hsp levels were higher in the infected mucosa than in the normal control mucosa. In contrast, hsp60 was not stimulated in infected ears. This study showed that hsp70, and not hsp60, was produced in the AOM mode

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00007

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractIn 1978 a surgical procedure was developed to create a neoglottis from the upper tracheal rings to facilitate speech rehabilitation in patients who had undergone total laryngectomy for carcinoma of the larynx. To date, 45 such procedures have been performed and results indicate rapid postoperative speech rehabilitation in nearly all patients, good long‐term speech results, and low morbidity. This procedure has served as a very successful alternative to the more frequently used tracheoesophageal puncture (TEP) and prosthetic valve techniqu

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00008

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractAlthough much has been written on methods of dealing with pharyngocutaneous fistulas once they have formed, there are few reports of methods of preventing fistula formation from occurring. We examined the use of laser‐weld techniques with the neodymium:yttrium aluminum garnet (Nd:YAG) and diode lasers to seal pharyngotomy closures. Laser‐weld techniques have been used successfully in many other tissues, but reports documenting use in the upper aerodigestive tract are minimal. Indocyanine‐green dye‐enhanced collagen and fibrinogen were studied as laser solder materials for the diode laser. Twenty‐nine experimental animals were studied. Neither the Nd:YAG nor the diode laser was successful in preventing fistula formation. Tensiometric studies documented significant strength of the laser weldsex vivo, but this finding was not clinically si

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00009

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThirty‐eight patients with swallowing disorders underwent cricopharyngeal myotomy. The causes of the disorders were muscular in 12 cases, neurologic in 12, cricopharyngeal achalasia in 7, and unknown in 7. Surgery succeeded in 21 patients, gave a partial improvement in 4, and failed in 13. The quality of residual pharyngeal propulsion on clinical, manometric, and radiologic assessment appeared to be a more important predictor of surgical outcome than upper esophageal sphincter relaxation and the major factor in establishing the indications for cricopharyngeal myotomy. Achalasias in the elderly and oculopharyngeal muscular dystrophies had the most favorable outcom

ISSN:0023-852X    

DOI:10.1288/00005537-199507000-00010

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY