摘要:

AbstractBecause of the controversy regarding the benefits of the lateral neck and chest radiographs in the evaluation of croup and epiglottitis, a two‐part retrospective study was initiated. Part I consisted of a retrospective chart review of 44 patients with a final diagnosis of croup and epiglottitis. Part II consisted of the 42 Interal neck and chest x‐rays from patients in part I presented to six radiologists who knew only the patients age and the history of respiratory distress. Two hundred forty‐six responses were obtained.The results of the part I study showed that 64% of patients with documented epiglottitis had a positive radiologic diagnosis. Only 33% of patients with croup had a positive radiologic diagnosis and importantly 27% had a diagnosis of possible epiglottitis.The results of part II showed 38% of the documented epiglottitis patients had a positive lateral neck radiograph. The croup patients had a lateral neck and/or chest x‐ray positive in 38%. Of interest, 24% had readings consistent with possible epiglottitis.Based on this two‐part study, it is our conclusion that the lateral neck and chest x‐ray may be unreliable and inaccurate in the diagnosis of croup and epiglottitis. Caution and good clinical judgement should be utilized when interpreting t

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00001

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractNeurotropic melanoma is a lesion which simulates a cutaneous fibrous tumor whose clinical course is characterized by local infiltration, multiple recurrences, and commonly by metastasis. Like adenoid‐cystic tumors of the head and neck, the neurotropic melanoma has a predilection for perineural invasion and extension along peripheral nerves. Its microscopic picture is characterized by atypical “neuroma‐like” patterns of Schwann cells and spindle cells, by poorly defined margins, and by neurotropism. Lentigo malignant melanoma (LMM) is a precursory lesion. The neurotropic melanoma is of particular interest to the head and neck surgeon because in the less than 50 reported cases of this rare tumor the preponderant sites were head, neck, and lip.We report two cases of neurotropic melanoma of the head and neck which demonstrate the characteristic perineural invasion of cranial nerves and extension along cranial nerves to the central nervous system. The clinical and pathologic features of the neurotropic melanoma are reviewed and the key diagnostic and therapeutic considerations in these patients are di

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00002

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe use of electrical stimulation to treat tinnitus was evaluated in a two‐experiment study. The stimulus was a low amperage, low frequency variable square wave applied to 13 sites on the auricle of the ear with tinnitus. The sites were selected for their increased electrical conductivity as measured by low electrical resistance readings. Experiment 1 results defined improvement as either a complete remission of the tinnitus or a decrease in the frequency of the tinnitus. Experiment 2 utilized a single blind protocol with 20 subjects comprising 33 ears with tinnitus. Eighty‐two percent of the 33 ears showed improvement by either of the two criteria. The permanence of the improvement ranged from 20 minutes to at least six months. The variables associated with this procedure were discussed. The adverse effects from the stimulation were mini

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00003

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractSnoring is a significant symptom of upper airway obstruction which has not been measured and quantified in a clinically useful manner. A technique to determine acoustic level, frequency, and duration of snoring is reported. Four case studies illustrate the utility of this method. It is recommended that acoustic monitoring be included in the polysomnographic assessment of selected sleep disorder patients.

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00004

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe diagnostic criteria and therapeutic regimens for upper airway necrotizing diseases such as Wegener's granulomatosis, polymorphic reticulosis, and the recently described idiopathic midlinc destructive disease have been better defined and clarified in the past decodes. Despite an improved understanding of the various disease processes, there continues to be difficulty in establishing an early diagnosis before proceeding with prompt treatment to minimize loss of function and cosmetic deformity. To achieve these goals, we have expanded the indications for the use of the cytotoxic drug, cyclophosphamide, in those patients whose clinical and histologic presentations are suggestive of Wegener's granulomalosis, but in whom a specific diagnosis has not been confirmed by biopsy specimen. We have seen ten patients with upper airway lesions of a chronic inflammatory nature over the past six years at the Medical College of Wisconsin affiliated hospitals. Only three of these have had a definitive histopathologic diagnosis of Wegener's granulomatosis made prior to the initiation of cytotoxic therapy. Six have undergone treatment under our expanded criteria without a prior definitive diagnosis. Five of these have had arrest of the disease process, and one has had no response to therapy. One patient was not treated. There have been no serious side‐effects from cyclophosphamide therapy in these patient

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00005

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractWe have used the gastric pull‐up technique for closure of large pharyngoesophageal defects after radical oncological surgery since 1979. The management of severe hypocalcemia and hypovitaminosis D seemed more difficult in patients undergoing pull‐up reconstruction than in patients undergoing the same extirpative surgery, but reconstructed with more traditional methods.To determine if hypocalcemia and hypovitaminosis D were more common in gastric pull‐up patients, and if postoperative management of these conditions is more problematic in this group, we retrospectively compared three groups of head and neck surgery patients. Group 1 consisted of 17 patients undergoing total laryngectomy with thyroid complex preservation. Group 2 consisted of 7 patients undergoing mediastinal dissection with total laryngectomy‐thyroidectomy previously or concurrently. Group 3 consisted of 30 patients undergoing total laryngopharyngoesophagectomy‐thyroidectomy and gastric pull‐up reconstruction. The incidences of hypocalcemia requiring therapy were 12%, 50%, and 73%, respectively, with an overall incidence of 51%. The average amounts of supplemental calcium and vitamin D in the three groups were compared. A significant difference between the three groups was noted. Finally, the dietary calcium and vitamin D requirements for one problematic patient were prospectively recorded and summarized graphically.We conclude that any patient should be carefully monitored for the signs and symptoms of hypocalcemia after major head and neck surgery. In the special instance of the gastric pull‐up patient, calcium requirements and the range of serum calcium fluctuation are greatly increased compared to patients undergoing more traditional methods of r

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00006

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractLesions of the cerebellopontine angle may cause a sudden hearing loss. To illustrate and reaffirm the importance of a thorough neurotologic evaluation we performed a retrospective review of the audiologic and clinical data available on 506 patients with proven lesions of the cerebellopontine angle. Seventy‐seven patients (15.2%) were found to have a history commensurate with sudden hearing loss. We reviewed the relevant audiologic data as well as the clinical circumstances of this select patient populatio

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00007

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractA fully reliable means of rehabilitating patients with bilateral vocal cord paralysis has not yet been developed. In order to improve upon existing solutions to this problem, the authors have recently described a laryngeal pacemaker, initially tested through stimulation of a cross‐over nerve‐muscle pedicle from one sternohyoid muscle to the other in the canine. Afferent stimuli, initiated through elongation of the airway during inspiration, were detected by a linear strain gauge sutured to the tracheal rings and appropriately amplified. The current report deals with the application of this concept to pace a nerve‐muscle pedicle reinnervating the posterior cricoarytenoid muscle. Videoscopie and cinematographic documentation of electrically paced abduction of the reinnervated vocal fold, synchronous with inspiration, was clearly demonstrated. Only miniaturization of an implantable electronic amplifier remains to permit an attempt at pacing of the paralyzed larynx in h

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00008

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractSixteen adult patients who ingested caustic substances were seen from 1977 through 1984. All patients underwent endoscopy to determine the site and severity of burns; mild hyperemia to severe, penetrating necrosis was detected in each patient. Ten ingestions were intentional, 4 accidental, and 2 questionably accidental. Morbidity and mortality were high, especially in patients who ingested caustic materials intentionally. A protocol for treatment with steroids and antibiotics was followed in half the patients studied. Those patients who completed this regime tended to have moderately severe burns. Caustic ingestion in adults must be viewed as a problem different from that of accidental ingestion in children. Since most adult caustic ingestions are intentional, the injuries are worse, more deaths result, and more severe scars causing permanent disability are a frequent outcome.

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00009

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

Abstract5‐Fluorouracil was introduced in the early 1960s as a topical chemotherapeutic agent and has become increasingly accepted because of its efficacy, economy, and relative absence of side effects in treating many pre‐cancerous conditions, certain benign and malignant tumors, and dermatoses. This paper addresses the use of topical 5‐fluorouracil in the management of cholesteatoma and unwanted mucus‐secreting cells. A retrospective study has suggested a very impressive efficacy of topical 5‐fluorouracil in the management of cholesteatoma and, to a lesser degree, control of hyper‐mucus‐secreting cells at locations in the middle ear and mastoid. The use of topical 5‐fluorouracil in the management of hyperkeratosis, cholesteatoma in the middle ear and mastoid, and in the external canal has been almost 100% effective with very few side effects. In the management of hyper‐mucous‐secreting cells, 5‐fluorouracil has a success rate

ISSN:0023-852X    

DOI:10.1288/00005537-198510000-00010

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY