摘要:

AbstractFew reports have described in detail the injuries that occur to the oral cavity, pharynx, and larynx following caustic ingestion.1The role of dynamic radiographic studies to delineate the extent of damage has been minimized.2In‐depth radiographic analysis of such cases has not, to our knowledge, been previously reported. In order to examine the injuries and functional abnormalities of these sites following caustic ingestion, the records of The Johns Hopkins Swallowing Center were reviewed. Five patients were identified as having significant upper aerodigestive tract caustic injuries. All patients had dysphagia, epiglottis injuries, and incomplete laryngeal protection with aspiration. Four of five had sustained some degree of esophageal stenosis. Also noted were pharyngeal muscle dysfunction, nasopharyngeal regurgitation, tongue fixation, and hypopharyngeal stenosis. Roentgenographic findings are described and illustrated. The multidisciplinary approach to the management and rehabilitation of these patients is discusse

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00001

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe clinical triad of a firstborn delivered vaginally to a young (teenage) mother has been previously noted among juvenile onset recurrent respiratory papillomatosis (JO‐RRP) patients. This study was based on a questionnaire survey of JO‐RRP patients, adult onset recurrent respiratory papillomatosis (AO‐RRP) patients, and juvenile and adult controls. The survey results revealed that the complete or partial triad was observed in 72% of JO‐RRP patients, 36% of AO‐RRP patients, 29% of juvenile controls, and 38% of adult controls. As compared with juvenile controls, JO‐RRP patients were more often firstborn (P<.05), delivered vaginally (P<.05), and born to a teenage mother (P<.01). Among adult participants, AO‐RRP patients reported more lifetime sex partners (P<.01) and a higher frequency of oral sex (P<.05) than reported by adult controls.AO‐RRP and JO‐RRP appear to have distinguishable epidemiologic features indicating that the mode of human papillomavirus (HPV) transmission is different in th

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00002

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThis study attempted to reestablish physiologic vocal cord motion, rather than synkinesis, to a rein‐nervated vocal cord. One mongrel dog underwent a division and reanastomosis of the anterior branch of the right recurrent laryngeal nerve and simultaneous separation and reimplantation of a posterior division nerve‐muscle pedicle into the posterior cricoarytenoid muscle. After 21 weeks, spontaneous physiologic vocal cord movement and electromyographic (EMG) activity were recorded during respiratory obstruction and laryngeal mechanical stimulation. Acoustic measures and histologic data are also presented from the reinnervated and normal vocalis muscle and from the recurrent laryngeal nerve. This study demonstrated that physiologic vocal cord motion can be achieved after laryngeal reinnervation using this techni

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00003

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractBipolar electrical stimulation of the brainstem cochlear nucleus (CN) following acoustic tumor removal in an only‐hearing ear can provide beneficial hearing. However, the benefits of multichannel stimulation have yet to be defined. Following removal of a second acoustic tumor in a patient with neurofibromatosis 2, a Nucleus mini‐22 channel implant device was inserted with the electrode array tip from the foramen of Luschka cephalad along the root entry zone of the eighth nerve, secured by a single suture superficially in the brain stem. Initial stimulation on the sixth postoperative day indicated that electrodes 18 to 22 were capable of CN stimulation without seventh nerve stimulation. Presumed electrode migration precluded further CN stimulation 1 month later. This report illustrates the feasibility of brainstem CN stimulation with an existing multichannel sys

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00004

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractInterstitial laser phototherapy (ILP) guided by magnetic resonance imaging (MRI) may become an attractive adjunctive modality for the treatment of deep and surgically inaccessible tumors of the head and neck when accurate methods of laser dosimetry and “real‐time” monitoring techniques with the MRI are introduced. We recently demonstrated in ex vivo and in vivo models, a linear relationship between levels of laser energies, thermal profiles, MR signal intensity changes, and histopathological tissue damage. Results of treatment in a patient with an unresectable large right jugulodigastric metastatic squamous carcinoma using new approach of MRI guided ILP are now reported. The patient complained of significant right‐sided neck pain and headaches secondary to a rapidly growing metastatic lymphadenopathy which recurred after previous surgery, radiation, and chemotherapy. Two treatment sessions were used at an interval of 2 weeks. Each treatment was performed in the MRI suite under heavy sedation. Using a 600‐μm bare fiber of the Nd:YAG laser implanted interstitially under MR guidance, the metastatic node was treated at three sites. T1‐ and T2‐weighted images were performed prior to, immediately after, 24 and 48 hours, and 4, 5, 7, 9, 16, and 25 days post‐treatment. Successful relief of pain and growth arrest of this node was observed after the second treatment and at the 3‐month follow‐up. These results demonstrate that this technique of ILP guided by MRI may be feasible in humans, and will become clinically practical when appropriate methods of dosimetry and instrumen

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00005

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractPatients having retrolabyrinthine vestibular neurectomy (RLVN) may have complications that compromise hearing. While most reviews have emphasized sensorineural loss, less attention has been given to conductive hearing loss, which may complicate RLVN. Hearing results of 25 consecutive cases of RLVN performed for Meniere's disease with incapacitating vertigo were tabulated according to 1985 American Academy of Otolaryngology (AAO) guidelines. Nine patients (36%) had improved hearing postoperatively, 5 (20%) had no change in hearing, and 11 (44%) had worse hearing postoperatively. The most commonly observed audiometric change was low‐frequency conductive hearing loss, presumably secondary to partial ossicular fixation by bone dust or fat fibrosis in the attic and antrum. Five patients (20%) had low‐frequency conductive hearing losses that increased by 10 dB or greater over preoperative levels. An additional 7 patients had lesser losses at low frequencies. One patient had a flat conductive hearing loss. Six (24%) of the patients had a decrease in bone levels of greater than 10 dB. Overall hearing results in this study are comparable to those of other series in the literature. Causes and prevention of conductive hearing loss in RLVN are discussed, and a format for presentation of hearing data that will highlight conductive hearing loss after surgery for Meniere's disease is presen

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00006

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractNucleolar organizer regions are collections of nucleolar proteins associated with ribosomal genes that can be visualized in histologic sections using a silver colloid stain, thus the term silver‐staining nucleolar organizer region (AgNOR). In some tissues, the number of AgNORs per nucleus correlates with cellular proliferation and, independently, with malignant change. AgNORs were studied in 66 paraffin‐embedded head and neck squamous cell carcinomas and in 12 samples of normal tonsillar squamous epithelium. Carcinomas had a significantly higher mean AgNOR count than the benign epithelium (P<.0001). Among carcinomas, mean AgNOR count increased with stage of the disease (P<.001), but there was no significant correlation with histologic grade or DNA ploidy as determined by flow cytometry. These data suggest that AgNOR count should be evaluated as a possible aid in differentiating benign from malignant squamous epithelial proliferations in the head and neck, and also possibly as a prognostic marker in these carcino

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00007

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractPreoperative pulmonary function tests (PFTs) are unproven in their predictive value for postoperative pulmonary complications. There is a lack of prospective outcome studies upon which to form an opinion, particularly regarding noncavitary surgery.1Seventy‐three head and neck surgery patients were prospectively evaluated with preoperative PFTs, arterial blood gas analysis (ABG), medical history, and physical examination. Age, anesthesia duration, forced expiratory volume in 1 second (FEV1), peak flow (PF), PaO2, Roizen class, and pack years of smoking were significantly correlated with postoperative pulmonary complications. As similar studies in head and neck surgery patients have not been previously taken, it is hoped that these results will serve as a basis for future endeavor

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00008

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractHyperbaric oxygen therapy (HBO) involves intermittent inhalation of 100% oxygen under a pressure greater than 1 atm. It is an important mode of adjuvant therapy for disease processes such as decompression sickness, osteomyelitis, carbon monoxide poisoning, and poorly healing wounds. Patients undergoing this therapy often complain of ear pain and/or fullness which can be transient or long standing. This prospective study objectively measured the changes in eustachian tube function before and after HBO treatment in 33 adult patients by the 9‐step inflation‐deflation test described by Bluestone. The results show 15 of the 33 patients (45%) had evidence of eustachian tube dysfunction after treatment was initiated. Of these, 15 (100%) developed the sensation of fullness, 13 (87%) developed serous otitis media, and 7 (47%) required tympanostomy tubes.The overall incidence of middle ear problems was 27 patients (82%) experiencing a sensation of fullness, 17 (52%) developing serous otitis media, and 8 (24%) requiring tympanostomy tubes. The middle ear complications reported in this study are much higher than those in previous reports in the literature. Twelve of 33 patients presented with a subjective history of eustachian tube dysfunction, and all 12 (100%) developed fullness in their ears and serous otitis media during the course of the treatment. The findings reveal that patients manifesting eustachian tube dysfunction after their first HBO treatment were at significantly greater risk toward developing symptoms of fullness and serous otitis media, often requiring tympanostomy tube placement. In addition, a history of eustachian tube dysfunction accurately predicted the development of fullness and serous otitis me

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00009

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe prognostic value of nuclear morphometry in nasopharyngeal carcinoma (NPC) was investigated in 28 patients. Seven morphometric nuclear variables were measured on 100 randomly selected tumor cells in nasopharyngeal biopsies from 18 patients with NPC confined to the nasopharynx. The same variables were measured in 6 patients with metastatic NPC, as well as in lymph node biopsies from 4 patients with metastatic NPC. Nuclear area, nuclear perimeter, long and short nuclear axes, nuclear form factor, nucleolar area, and the ratio of nucleolar area to nuclear area were all measured. Volume‐weighted mean nuclear volume was also obtained.Tumor cells from patients with NPC confined to the nasopharynx had significantly larger mean nuclear areas, perimeters, and volume‐weighted mean nuclear volumes but significantly smaller nucleolar to nuclear area ratios than tumor cells from patients with nodal metastases. Assessment of nuclear form factor and diameters did not differentiate the two gro

ISSN:0023-852X    

DOI:10.1288/00005537-199201000-00010

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY