摘要:

AbstractArteriographic studies are utilized to illustrate the presence and document the results of arterial ligation on three intracranial carotid aneurysms. All three aneurysms resulted from trauma, surgical and otherwise, and all presented as otolaryngologic dilemmas. All were successfully controlled by a combined Otolaryngological and Neurosurgical Team employing varying combinations of intra and extra cranial arterial ligations. None developed significant neurological impairments.The two major indications for common or internal carotid ligation are the resection of neoplasm and the control or prevention of hemorrhage. Sixty percent of patients undergoing elective carotid ligation survive these procedures without evidence of neurological sequelae. This uncompromised survival is based upon the presence or rapid development of collateral circulation to the cerebrovascular bed.Further arteriographic studies are employed to illustrate the development of intra and extra cranial collateralization to the internal carotid artery after surgical interruption of the ipsilateral common carotid. The major collateral circuits demonstrated via a case report are as follows:a. from the vertebral artery to the external carotid and hence to the internal carotid;b. from the posterior communicating artery to the internal carotid; andc. from the ophthalmic artery to the internal carotid.

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00001

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractTraumatic cerebrospinal fluid fistulas in children are not rare as described by Harwood‐Nash1and Caldicott, North, and Simpson.2Those involving the sphenoid bone apparently are rare, particularly in early childhoo

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00002

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractNonunion of the mandible was evaluated over a five‐year period (1968–1973). Fourteen cases were noted out of 577 mandibular fractures for an incidence of 2.4 percent.Causes of the complications were determined by a careful review of the poorly healing and successfully treated cases of mandibular fracture. The most important feature in nonunion cases was the large proportion of edentulous patients. In these cases immobilization appeared difficult, especially when only one form of fixation was used to stabilize the fracture, Other suspected causes of nonunion were postoperative trauma and osteomyelitis. These factors were most prevalent in the lower socio‐economic groups.Factors which did not appear important were sex, age and cause of the fracture. Analysis of the site of injury, combinations of sites, timing of treatment, periosteal stripping and general health of the patient failed to demonstrate any predisposition to the complication.Treatment of nonunion was confined to standard techniques of debridement, antibiotic therapy and further immobilization. Although most patients responded to this therapy, six patients required closure of the deficit by bone grafting.On the basis of accumulated data, it was possible to clarify the factors in the development of nonunion. It was also possible to recommend methods of prevention of the complication and to substantiate the success of several forms of th

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00003

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractThe most controversial therapeutic agent in the past decade has been dimethylsulphoxide (DMSO), an industrial solvent to which great healing‐powers have been attributed. After initial laboratory testing, DMSO was rapidly introduced into veterinarian medicine and clinical medicine as an experimental agent with the ability to relieve pain, reduce swelling and edema in trauma, to show anesthetic, antibacterial and anti‐inflammatory properties when applied topically to the skin. Ninety percent DMSO§was used alone and in conjunction with alkaloids and antibiotics to test the clinical properties attributed to this drug. Although DMSO was found not to be ototoxic, laboratory and clinical testing which included double blind studies on patients with otological infections demonstrated that DMSO had no antibacterial, anesthetic or anti‐inflammatory properties when applied within the external auditory canal. There was no indication that 90% DMSO, when combined with these various preparations, potentiated or acted synergistically to enhance their penetration through the dermal b

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00004

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractPalatal myoclonus with its concomittant objective tinnitus is often a missed diagnosis and poses a problem to the clinician in separating it from other middle ear anomalies. The etiology and symptomatology is outlined, but as suggested by our case presentations are not always diagnostic.The anatomical pathways of palatal myoclonus are traced, and its etiological complexities are realized when any locus or pathology along these tracks may create the characteristic chronic rhythmic contractions. We have experienced excellent results in determining a differential diagnosis of palatal myoclonus from other middle ear problems by the correlations of impedance audiometry with our clinical findings. Although the etiology is not defined the target structures can be separated from this test method and, therefore, enable more specific therapy.

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00005

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractConfusion surrounds the entity known as “lethal midline granuloma.” Partly responsible is the lack of specificity in this term. “Polymorphic reticulosis” has been used as a term to describe the morphology of the disease.Thirty‐two cases illustrate the protean features of this disease. Although it commonly presents in the head and neck, other sites such as the lungs, kidneys, skin, and gastrointentinal tract may be involved, either alone or in conjunction with lesions of the head and neck. Clinically, it is easily confused with Wegener's granulomatosis. Histopathologic differentiation, however, is both feasible and important. Wegener's granulomatosis is treatable with steroids with or without cyclophosphamide; polymorphic reticulosis confined to one site responds to irradiation.In polymorphic reticulosis, the best results of treatment are obtained in localized lesions of the upper airway treated early with irradiation; a poorer outcome is associated with multifocal involvement, which necessitates systemi

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00006

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractThe chemo‐therapy of vestibular disease has involved a wide spectrum of pharmacological agents insofar as their mode of action is concerned. In our experience, however, droperidol is one pharmaceutical agent which is remarkably effective in depressing vestibular disturbance regardless of etiology. This medication (also called Inapsine‡) belongs to a relatively new class of compounds known as butyrophenones and its pharmacological action can best be described as a dopa blocking agent.The activity of droperidol on the nervous system first became evident when it was used in combination with the potent analgesic fentanyl citrate in order to produce an anesthetic condition that has been termed neuroleptanalgesia. This mixture (also called Innovar‡) is rapid in action and results in complete suppression of vestibular activity of both normal subjects and those with Ménière's disease as described by Dowdy,et al., in a preliminary report. These impressive results have prompted us to evaluate the effectiveness of this medication in the treatment of different disorders of the labyrinth.The patients chosen for evaluation were referred for vestibular examination at the Toronto General and St. Michael's Hospitals. Electronystagmography was used to record objectively the effects of the drugs being tested while subjective symptoms including side effects were also noted. These studies involved 20 patients receiving Innovar while 12 patients were tested with Inapsine.Innovar administered in a single dose (droperidol 5 mg, fentanyl 0.1 mg) to patients undergoing acute episodes of vestibular disease (vestibular neuronitis and Ménière's disease) was found effective in the following symptoms and/or signs: nausea, vertigo, nystagmus, the positive past‐pointing test and the Romberg test. Innovar appeared to be effective in the amelioration of vomiting although the population was too small to demonstrate statistical significance in this regard.The drug mixture appeared to have no effect on improving auditory acuity and had no significant effects on tinnitus.Adverse reactions to the drug combination were unusual, and, occurring in three patients, were mild as manifested by drowsiness.Since the above findings confirmed the marked effectiveness of the fentanyl‐droperidol mixture in the management of vestibular disease, it was decided to determine the relative effectiveness of the droperidol component alone and this was determined by comparing the effectiveness of the drug with placebo in a double‐blind study.Review of our findings involving this double‐blind study indicates significant responses to Inapsine.This therapy clearly provided the statistically significant response (P<.01, Fisher's Exact Test). This was particularly apparent at the 60‐minute evaluation point. While some of the patients receiving Inapsine had recovered earlier, by 60 minutes none of the placebo patients but all of the Inapsine patients had recovered from the vestibular symptoms of Ménière's disease. Some adverse side effects consisting of drowsiness and slight drop in blood pressure occurred in some patients; these can be minimized by a de

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00007

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractPain in the ear is a common complaint for which patients consult their otolaryngologist. A rare cause is geniculate neuralgia, which has also been called tic douloureux of the nervus intermedius. In its most typical form, it is characterized by severe paroxysmal neuralgic pain centered directly in the ear. The pain may also be of gradual onset and of a dull, persistent nature, with occasional sharp, stabbing pain. The diagnostic features and two new surgical techniques for its treatment are described. Afferent sensory facial nerve fibers are shown to pass not only through the nervus intermedius, but also through the main motor trunk of the facial nerve.Excision of the nervus intermedius and/or of the geniculate ganglion by the middle cranial fossa approach without the production of facial paralysis, in any of 15 cases with geniculate neuralgia is reported. Use of these new techniques, sometimes in combination with selective section of the Vth cranial nerve, has been successful in relieving the pain of geniculate neuralgia.

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00008

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractThis paper focuses on vocal cord paralysis in children after operation for tracheoesophageal fistula and/or esophageal atresia. We reviewed the charts of 65 children who were operated upon for congenital esophageal atresia and/or tracheoesophageal fistula during a period from 1964 to 1974. Ten of these children manifested laryngeal symptoms. Five had laryngeal paralysis. Two were untreated. One was treated with cordectomy and stent. Two were treated successfully with the Thornell arytenoidectomy, one of these being done without a tracheotomy in place. Mention is made of a third case of bilateral vocal cord paralysis due to hydrocephalus treated successfully by the Thornell procedure.Follow‐up laryngoscopy was done on 21 children without laryngeal symptoms which revealed two previously unsuspected vocal cord paralyses and one vocal cord paresis which cleare

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00009

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY

摘要:

AbstractThe effects of the direction and intensity of the head blow and the effects of the lapse of time after a head blow on the development of hearing‐loss were studied in guinea pigs. The electrical responses from the right inferior colliculus (ER) and from the left round window (CP) to acoustic stimuli were measured. The elevation in threshold of the ER in the presence of normal CP in guinea pigs after a head blow suggests that the site of the lesion is central to the cochle

ISSN:0023-852X    

DOI:10.1288/00005537-197607000-00010

出版商:John Wiley&Sons, Inc.    

年代:1976

数据来源: WILEY