摘要:

AbstractDespite the recognized ototoxicity ofcis‐platinum, a clinical outline for the audiologic evaluation of patients receiving this drug has not been clearly defined. In a practical approach to this problem, the audiograms of 48 pediatric patients referred for monitoring during plannedcis‐platinum therapy were reviewed. Eleven patients tested with auditory brainstem response (ABR) audiometry demonstrated several limitations of this modality. Fourteen children underwent initial ABR testing followed by at least two pure‐tone audiograms. The remaining 23 patients had their hearing evaluated by pure‐tone audiometry only. Various factors such as patient age,cis‐platinum dosage, and cranial radiation exposure were analyzed for apparent effect. Younger patients tended to be more susceptible to audiologic changes with the administration ofcis‐platinum. The proportion of patients who demonstrated a hearing loss increased with successive dosing as did the severity of the hearing loss. Prior exposure to cranial radiation was strongly linked to the development of hearing loss followingcis‐platinum therapy. Guidelines are presented regarding the use of clinical audiometry in the screening of these pediatric onco

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00001

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractPrior to the advent of microneurosurgery, the operative mortality for acoustic tumor removal was high and management often consisted of observation until sufficient symptoms warranted removal. The treatment of these tumors has evolved, and recent introduction of gadolinium‐enhanced magnetic resonance imaging (MRI) allows the diagnosis of very small intracanalicular acoustic tumors before hearing has been significantly affected. For such tumors, some surgeons advocate the premicrosurgical philosophy of observation rather than removal.Our results of small acoustic tumor removal with attempt at hearing preservation were reviewed. From 1961 to June 1989, 39 acoustic tumors 0.5 cm or less were removed by the middle fossa approach. Measurable hearing was preserved in 67%, and facial function 1 year postoperatively was normal or nearly normal in 97%. There was no other permanent operative morbidity.Given our results, early surgical removal of small acoustic tumors is advocate

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00002

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intra‐operatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isth‐musectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngect

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00003

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractOver the past decade, the use of free flap transfers in head and neck surgery has led to remarkable advances in the reliability and the ultimate results of oromandibular reconstruction. Stable and retentive dental restorations have been achieved using enosseous implants placed directly into the vascularized bone flaps. However, the functional assessment of patients who underwent primary mandibular reconstruction with these techniques has not been previously reported. A group of 10 reconstructed and 10 nonreconstructed segmental hemimandibulectomy patients were compared using a battery of tests to assess their overall well‐being, cosmesis, deglutition, oral competence, speech, length of hospitalization, and dental rehabilitation. In addition, objective measures of the masticatory apparatus (interincisal opening, bite force, chewing performance, and chewing stroke) were used to compare these two groups as well as normal healthy subjects and edentulous patients restored with conventional and implant‐borne dentures. The results show a clear advantage for the reconstructed patients in almost all categories. Persistent problems and future directions in oromandibular reconstruction are discus

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00004

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe computed tomography scans and magnetic resonance imaging films of 57 patients who underwent anterior or anterolateral cranial base surgery from January 1987 to August 1989 were retrospectively reviewed to ascertain the significance of early and late postoperative intracranial imaging changes.Extra‐axial changes (air, blood, cerebrospinal fluid collection) were found in 96% of patients; axial changes (brain edema, contusion) were seen in 30% of patients in the first postoperative period (72 hours). Subsequently, extra‐axial changes began to resolve but axial changes became more prevalent. After 6 months, only axial changes persisted (enceph‐alomalacia).It was encouraging to find a low correlation of imaging abnormalities with clinically significant fin

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00005

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractBotulinum toxin was recently approved for treating several head and neck dystonias. Paralysis of neighboring muscles is the major complication of its use. Spread of toxin from the injected muscle has been suggested as an etiology. This study examines how botulinum toxin crosses muscle fascia by a novel method of quantifying muscular paralysis.Botulinum toxin (0.2 to 10 U) was placed onto the fascia of rat tibialis anterior (TA) muscles (n = 6). Toxin was also placed on dose‐matched muscles that had their fascia surgically removed (n = 6). Twenty‐four hours later, the nerve to the tibialis anterior was electrically stimulated to deplete the muscle fibers of glycogen. Toxin‐paralyzed fibers retained their glycogen and appeared purple on periodic acid‐Schiff (PAS) stain.Botulinum toxin easily passed through muscle fascia even at subclinical doses. The presence of fascia reduced the spread of botulinum toxin by 23%. These results suggest that spread of botulinum toxin can be prevented only by delivering small doses to the center of a target

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00006

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractAlthough distortion‐product otoacoustic emissions (DPOEs) have been studied in adults recently, there is little information regarding them in young children. DPOEs and click‐evoked otoacoustic emissions (CEOEs) were measured from a same group of normal and hearing‐impaired children (age 4 through 10 years) and normal adults (age 22 through 29 years). Measurements of DPOEs in 13 children's ears with normal hearing showed higher levels of emissions in the 700‐ to 1400‐Hz and 5.7‐kHz regions relative to the data obtained in 10 normal adult ears. The 22 ears of children with sensorineural hearing loss demonstrated agreement between pure‐tone audiograms and “DPOE audiograms.” Measurements of CEOEs revealed that the average level of emission in 15 normal‐hearing children's ears was slightly lower than that previously obtained in newborns, but slightly higher than that of adults. In children, the CEOE spectral components in the 4‐ to 6‐kHz region were lower than in newborns, but higher than in adults. These results support the view that the DPOEs and CEOEs comprise a valuable tool in assessment of cochlear function

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00007

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe purpose of this retrospective study is to document the natural history of epistaxis in patients with hereditary hemorrhagic telangiectasia. A telephone questionnaire was administered to 73 patients who had been previously screened for pulmonary arteriovenous malformations (PAVMs). The incidence of epistaxis in this population was 93%, with a mean onset age of epistaxis of 12 years, a mean frequency of bleeding of 18 episodes per month, and a mean duration of bleeding of 7.5 minutes. More than 90% of patients experienced the onset of epistaxis before the age of 21 and symptoms were progressive with age. There were no differences in the age of onset, frequency of epistaxis, or duration of epistaxis between patients with PAVMs versus those without PAVMs. Although the natural history of epistaxis does not predict the presence or absence of pulmonary arteriovenous malformations, epistaxis is an early marker of the disease, hereditary hemorrhagic telangiectasia, and might guide screening for pulmonary and cerebral arteriovenous malformations in children of affected parents.

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00008

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThis study determines the flammability of polyvinylchloride (PVC), red rubber (RR), and silicone (Si) endotracheal tubes in oxygen‐ and nitrous‐oxide‐enriched atmospheres. Flammability is measured by using the oxygen and nitrous oxide indices of flammability with laser ignition. The laser‐ignited oxygen (O2) index of flammability of the endotracheal tubes is: PVC, 0.25; RR, 0.19; Si, 0.20. The laser‐ignited nitrous oxide (N2O) index of flammability of the endotracheal tubes is: PVC, 0.45; RR, 0.37; and Si, 0.41. These results are similar to the previously reported O2and N2O indices of flammability with propane‐torch ignition. This study validates the concept that the indices of flammability are useful measures of endotracheal tube flammability and are independent of the igni

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00009

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractCis‐platinum is an ototoxic antineoplastic drug. Evaluation of auditory thresholds in 33 children receiving cis‐platinum shows that a threshold shift at 6 and 8 kHz is first measurable after a cumulative dose of 201 to 300 mg/m2. A 35‐ to 40‐dB high‐frequency threshold shift is evident after a cumulative cis‐platinum dose of 301 to 400 mg/m2. Increasing cumulative doses of cis‐platinum are associated with a greater degree of hearing loss. Receiver‐operator characteristic curves were used to find a criterion value that effectively identified threshold shifts that were due to cis‐platinum ototoxicity. A 15‐dB or greater shift in the 6‐ and 8‐kHz threshold average identifies a high true‐positive (50%) and low false‐positive (0%) rate of cis‐platinum‐induced hearing loss. Using this criterion, cis‐platinum ototoxicity affected 77% of children who received cis‐platinum

ISSN:0023-852X    

DOI:10.1288/00005537-199109000-00010

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY