bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical Esophagostomy in Dogs
Authors: Balkany Thomas J. , Bloustein Paul A. , Baker Bruce B. , Jafek Bruce W.
Published: October 2014

Prolonged tube feeding is frequently necessary in patients with head and neck cancer, facial trauma, or central nervous system disease. The advantages of cervical esophagostomy over nasogastric and gastrostomy tube feeding are established. One frequently overlooked complication of tube feeding is distal esophagitis and subsequent stricture formation. This complication has been widely reported in the medical literature although the pathophysiologic mechanism has in part been speculative. We have completed a prospective, randomized, controlled animal study in an attempt to delineate the mechanism of feeding tube esophagitis and to devise a method of avoiding it. Twelve dogs underwent cervical esophagostomy and were studied by endoscopy, contrast fluoroscopy, gross and microscopic pathology. The esophageal effects of placement of polyethylene and silicone rubber esophagostomy tubes in the customary position, through the cardioesophageal junction into the stomach, were compared with placement of tire distal end of the tube only as far as the midesophagus. Midesophageal placement of silicone rubber tubes greatly reduced esophageal injury inherent is esophagostomy tube feeding. A new esophagostomy feeding tube is presented with advantages over previously used tubes.
Intramural Pseudodiverticulosis of the Esophagus
Authors: Shapiro Myron J. , Sloan William C.
Published: October 2014

Intramural pseudodiverticulosis of the esophagus is a rare benign disease, developing most frequently in older males, but occurring in both sexes, at all ages. In some patients symptoms from early childhood suggest congenital origin. The characteristic appearance of “pinhead” outpouching from the lumen of the esophagus is seen with contrast esophagram. The major symptom is dysphagia with episodic exacerbations, often with foreign body lodgement. The pseudodiverticula are formed by abnormally dilated adnexal glands and ducts which lie in the submucosa of the esophagus. Secondary infection, most commonly momlial, is the rule, and surrounding inflammatory infiltration may progress to submucosal fibrosis and stenosis. Treatment with dilatation and appropriate antibiotics usually produces rapid relief. Prognosis is good.
Laryngotracheoesophageal Cleft: The Anterior Approach
Authors: Bell Douglas W. , Smith Thomas E. , Christiansen Thomas A. , Stucker Fred J.
Published: October 2014

Laryngotracheoesophageal cleft was reported by Richter in 1792 after he examined an infant at autopsy and found a common lumen of esophagus and laryngotrachea. The next case was not noted until 1949 by Finlay. A recent review shows 40 cases in the world literature to date. Successful surgical approaches to some of these problems have basically employed a lateral pharyngotomy technique. In the case presented herein, the exact pathology was obscured by a severe tetralogy of Fallot and recurrent pneumonitis from a suspected high H-type tracheoesophageal fistula. The length of this cleft prompted an anterior approach with laryngo-fissure, cricoidotomy, and division of four tracheal rings for a complete and successful repair. Thorough endoscopy of all infants suspected of any laryngeal anomaly would yield an earlier diagnosis and opportunity for reconstruction of the cleft.
Physiologic Differentiation of Upper and Lower Airway Obstruction
Authors: Davidson Frank F. , Burke George W.
Published: October 2014

Usual lower airway obstruction and fixed upper airway obstruction can be differentiated physiologically by means of the flow-volume curve. Normally, maximal flow decreases nearly linearly as lung volume decreases during expiration. In lower airway obstruction, this decrease is greatest at the beginning of expiration resulting in a curve that is concave upward. In fixed obstruction (stenosis) flow is constant throughout the initial part of forced maximal expiration and throughout virtually all of inspiration. This results in a plateau or flat curve which is characteristic and different from the curve in obstruction of lower airways. Cases in which this differentiation is clinically important are discussed.
Tracheal Granulation: A Complication of Pediatric Tracheotomy
Authors: Bromberg David , Turtz Myles G.
Published: October 2014

Tracheotomy has long been utilized as a rapid and safe method of providing unobstructed airway. In the pediatric population the tracheotomy itself is occasionally a problem, e.g., delayed decannulation. The problems creating delayed decannulation may result in death. In recent years our attention at St. Christopher's Hospital for Children, in Philadelphia, has been focused on several patients with partial tracheal obstruction due to posttracheotomy granulation tissue. These cases serve as the basis of this report. We were asked to treat two children who developed severe breathing difficulty weeks after decannulation due to tracheal granulation tissue. In both cases prompt evaluation and treatment would have averted emergency situations. Our principles in evaluating children following decannulation are discussed. Also presented is a patient who required a tracheotomy in the early months of life and who subsequently died. The postmortem examination of her trachea revealed a mass arising from the tracheal stoma. Anatomic lessons learned from this case were applied successfully in treating another child with a similar problem. Our treatment protocol is reviewed and emphasis placed on early diagnosis to determine the cause of difficulties encountered in decannulating children.
Idiopathic Subglottic Stenosis
Authors: Jazbi Basharat , Goodwin C. , Tackett D. , Faulkner S.
Published: October 2014

A 21/2-year-old child was found to have subglottic stenosis with no obvious etiology. He initially responded well to dilatation, injection of triamcinolone and intermittent stenting of the airway, but four months later developed a marked, unyielding subglottic stenosis requiring tracheostomy. He had a gradual good response to dilatations and injections with triamcinolone and acquired a good subglottic lumen. However, he developed a recurrence following an episode of croup. Systemic steroids were added to the regimen leading to gradual resolution of the stenosis and successful decannulation. The embryogenesis of subglottic stenosis and the correlation with the known anatomy and histology are discussed. Subglottic stenosis may be congenital, traumatic, inflammatory, neoplastic or neurogenic. An additional group of patients has no obvious etiology and are classified as idiopathic. Treatment consists of various combinations of stents, systemic and intralesional steroids, dilatations and various operative procedures in the more refractory cases.
Tracheobronchial Foreign Bodies: An Updated Approach
Authors: Strome Marshall
Published: October 2014

The foreign body spectrum was defined by Jackson and modernized since the turn of the century. In the past decade equipment advances have expanded the potential for successful endoscopic removal in centers other than metropolitan and university affiliates. Despite the aforementioned, morbidity statistics remain stable and early detection is declining. Reawakening diagnostic acumen and heightening public awareness are the keys to reversing this trend. Decreasing the 34% failure rate of plain films in the first 24 hours following inhalation of a foreign body will only be realized when fluoroscopy is universally accepted as an initial diagnostic technique in foreign body evaluation. A history compatible with foreign body aspiration dictates diagnostic endoscopy without radiologic confirmation. Lastly, a 24-hour interval is a safety zone which may be created in most instances. Only tracheal foreign bodies with associated intermittent dyspneic and/or cyanotic episodes need urgent removal. The safety zone assures adequate gastric emptying, the most qualified endoscopic team, and essential preparation regarding equipment. If the foreign body is not extracted, careful observation has been demonstrated in this study to be an attractive alternative. Vegetable foreign bodies including nuts have shown a potential for self extrusion. Physical therapy, corticosteroids and repeated endoscopy, when clinically indicated, can obviate the need for thoracotomy.
Glottic Squamous Cell Carcinoma (T2)
Authors: Doyle Patrick J. , Flores A. , Bell Desmond R.
Published: October 2014

Seventy-three patients with T2 glottic squamous cell carcinoma were treated primarily with a full course of cobalt radiotherapy. This series covered the time period between 1960 and 1972 and, therefore, all patients were eligible for five-year follow-up. Only seven patients, or 9.6%, have died of or with recurrent laryngeal carcinoma. Fourteen patients suffered recurrence of disease after radiotherapy and 12 of this group underwent salvage surgery. Surgery was successful in controlling recurrent disease in 7 of 12 patients, 3 of whom are still alive and free of disease. Forty-two patients, or 57.5%, are alive and free of disease five or more years after diagnosis. Twenty-four patients died without evidence of disease; 11 lived more than five years and 13 died in less than five years. On the basis of these findings, we feel that the best treatment for T2 glottic squamous cell carcinoma is a full course of cobalt radiotherapy followed, when necessary, by salvage surgery.
Lateral Rhinotomy: A Neglected Operation
Authors: Harrison D. F. N.
Published: October 2014

The operation of lateral rhinotomy does not perhaps receive as much attention as it might, despite the excellent exposure of the nasal passages and surrounding anatomy that can be obtained. A personal account of 100 consecutive operations for varying pathology is described in the hope that more surgeons may be aware of the value of this procedure.
Localization of Adductor and Abductor Motor Nerve Fibers to the Larynx
Authors: Gacek Richard R. , Malmgren Leslie T. , Lyon Michael J.
Published: October 2014

Knowledge of the location of motor nerve fibers to the adductor and abductor muscles of the larynx may be useful in the diagnosis and treatment of innervation disorders in this organ. Anterograde degeneration and retrograde tracer anatomical techniques have demonstrated the central and peripheral positions of these two groups of motor nerve fibers in the cat. Traditional nerve fiber degeneration methods applied following intracranial transection of the vagus nerve rootlets indicated that: 1) Most of the fibers in the recurrent laryngeal nerve (RLN) are motor; 2) Almost all of these motor fibers leave the brain stem in the most rostral rootlet(s) of the vagus nerve; and 3) Motor fibers to the larynx form a discrete bundle within the trunk of the vagus nerve before forming the RLN. A tracer (horseradish peroxidase) of retrograde axoplasmic flow in motor neurons has been employed to demonstrate: 1) Dorsoventral division of the adductor and abductor neurons in the nucleus ambiguus; and 2) Diffuse arrangement of both adductor and abductor nerve fibers in the vagus nerve but collection of these fibers into abductor and adductor halves of the RLN prior to entering the larynx. These findings dispel theories of differential cord paralysis (Semon's law) based on a vulnerable position of abductor fibers at the periphery of the RLN. Furthermore, the diffuse arrangement of these fiber groups explains the usually mixed functional results obtained following reimplantation of the RLN into a laryngeal muscle.
Preservation of the Laryngeal Nerves during Total Thyroid Lobectomy
Authors: Loré John M. , Kim Duck J. , Elias Samir
Published: October 2014

A technique of exposure and preservation of the recurrent laryngeal nerve at the very onset of thyroidectomy and preservation of the external branch of the superior laryngeal nerve at the close of the procedure is described, which is believed to afford maximum protection to these nerves during total thyroid lobectomy and isthmusectomy as well as total thyroidectomy. At the same time, preservation of the parathyroid glands is achieved. In 120 exposures and preservations of the recurrent laryngeal nerve there have been no instances of a single permanent paralysis of this nerve. In 111 total thyroid lobectomies in which the external branch of the superior laryngeal nerve was placed in jeopardy, only one patient had a slight bowing of the vocal cord with excellent voice function during a limited follow-up period.
Reinnervation of the Unilaterally Paralyzed Larynx
Authors: Tucker Harvey M.
Published: October 2014

Because of early success with reinnervation of the abductor musculature of bilaterally paralyzed larynges, experimental work and ultimately surgery in human patients has been undertaken to endeavor to apply the same basic concept to reinnervation of the unilaterally paralyzed larynx. A nerve-muscle pedicle is obtained from the omohyoid muscle in a manner identical to that previously reported. The lower 50% of the thyroid ala is carefully removed outside the perichondrial envelope and the lateral fibers of the thyroarytenoideus muscle (major laryngeal adductor) is exposed. The previously repaired nerve-muscle pedicle is inserted into this muscle to complete the procedure. The procedure has been undertaken in nine cases to date where the degree of posterior glottic chink, usually because of a concomitant superior nerve paralysis, was felt to be too great to be adequately managed by Teflon® injection. Some degree of spontaneous return of adduction was accomplished in all nine cases.
Recurrent Laryngeal Nerve Histopathology in Spastic Dysphonia
Authors: Dedo Herbert H. , Izdebski Krzysztof , Townsend Jeannette J.
Published: October 2014

Spastic dysphonia is a severe voice disorder ordinarily described as psychogenic. Organic-neurologic changes secondary to central or peripheral nervous system involvement have also been postulated and led recently to the surgical treatment of spastic dysphonia by unilateral section of the recurrent laryngeal nerve (RLN). This study reports the histologic findings from these resections of the RLN from patients with an average 9.5 years duration of spastic dysphonia. Thirty percent of the RLNs examined demonstrated significant abnormalities as compared to age-matched controls. Although no reactive changes were noted by light microscopy, groups of fibers which did not stain for myelin or axons were found in RLNs from patients with spastic dysphonia. A preliminary ultrastructural study of these areas in one RLN revealed sheets of unmyelinated axons. These findings suggest an organic basis for spastic dysphonia at least in some patients.
Bilateral First Branchial Cleft Cysts: Case Report and Literature Review
Authors: Schwartz Harmon E. , Calcaterra Thomas C.
Published: October 2014

Instances of first branchial cleft anomalies are quite uncommon. A patient with a first branchial cleft cyst was seen and surgically treated at UCLA Hospital in 1972. Three years later he developed a similar lesion on the opposite side of his neck and this also was surgically excised. A review of the literature has revealed only one prior report of bilateral first branchial cleft anomalies. The embryogenesis, diagnosis, and surgical management of these lesions are discussed in this paper.
Treatment of Infantile Subglottic Hemangioma with Radioactive Gold Grain
Authors: Benjamin Bruce
Published: October 2014

Congenital subglottic hemangioma causes life-threatening airway obstruction during the first few months of life. The mortality rate of recognized and untreated cases justifies active treatment, and although radiation therapy is currently most favored, it carries a risk of inducing malignant change in the thyroid gland later in life. A series of 11 patients with laryngeal hemangiomata is reported, conventional radiotherapy was utilized in the first seven patients, and placement of a radioactive gold grain directly into the lesion was used in the last four patients. This technique offers maximal tumor dose with minimal thyroid gland irradiation compared to treatment by conventional radiotherapy, and its successful use in these four patients is reported as worthy of further trial.
Studies on Cochlear Aqueduct Patency
Authors: Włodyka Janusz
Published: October 2014

Complex studies on the patency of the cochlear aqueduct were made on 250 human cadavers and the temporal bones isolated from these, using a chemical method (staining reaction) as well as filling the aqueduct with fluid plastics and exposing the whole of its course under an operating microscope. The disappearance of patency in the cochlear aqueduct is a progressive phenomenon reflecting the biological process of aging in the organism. Patency of the cochlear aqueduct renders possible a two-way spread of infection from the cerebrospinal fluid (CSF) to the inner ear and vice versa, CSF otorrhea, and sudden sensorineural hearing impairment through rises in CSF pressure, while in the absence of patency, the accumulation of harmful products of metabolism in the perilymph has a deleterious effect on the sensory elements of the inner ear.
Treatment of Sudden Deafness with Sodium Salts of Triiodobenzoic Acid Derivatives
Authors: Hirashima Naoko
Published: October 2014

Twenty-two patients with a complaint of sudden deafness were treated with one or the other of two of the radiopaque contrast media, 9 received daily doses of sodium iothalamate, and 13 were treated similarly with methlyglucamine and sodium iodamide. Four of the first group and eight of the second demonstrated either an effective partial or a complete recovery of hearing function. Those failing to respond were generally classified completely deaf at admission and reported nausea, vomiting, or vertigo at onset of sudden deafness. Treatment with sodium salts of triiodobenzoic acid derivatives, i.e., sodium iothalamate and methylglucamine and sodium iodamide, is judged to be effective in selected cases of sudden deafness.
Idiopathic Midface Lesions
Authors: Wetmore Stephen J. , Platz Charles E.
Published: October 2014

The term lethal midline granuloma has been used to describe a number of lesions which may present in the midface. A list of possible causes is presented and three entities, midline malignant reticulosis, Wegener's granulomatosis, and malignant lymphoma, are discussed in detail. The pathological descriptions, the clinical features, and the recommended forms of therapy are outlined. It is important to vigorously pursue the patient with a midline facial lesion until a definite tissue diagnosis is obtained. Multiple biopsies may be necessary because necrosis and nonspecific inflammatory changes may be present in various of these disease entities. The correct diagnosis is essential because the treatment of these diseases is different: Wegener's granulomatosis responds best to chemotherapy, whereas midline malignant reticulosis and lymphoma should be treated with radiation therapy if they are localized. Despite conceptual variations, most recent authors believe that these three diseases exist as separate entities, and furthermore, recommend that the term lethal midline granuloma be either dropped from the lexicon or relegated to a descriptive clinical term to be used only until a more definitive diagnosis can be made.
Intercellular Junctions in the Organ of Corti
Authors: Nadol Joseph B.
Published: October 2014

The intercellular junctions between adjacent supporting cells and between apposed hair and supporting cells in the organ of Corti of cat and human were studied. At the endolymphatic surface, the intercellular space was closed by a series of tight junctions (zonula occludens), whereas there were no tight junctions at the basilar membrane surface of the neuro-epithelium. Beneath the adlumenal zonula occludens between adjacent supporting cells, a zonula adherens (intermediate junction, “desmosome”) was found. Many gap junctions joined apposed supporting cells both within and below the endolymphatic junctional complex. Below the zonula occludens between apposed hair and supporting cells, membrane specialization sharing the morphological characteristics of both the macula adherens and zonula adherens was found. Between areas of tight junctional specialization in the junctional complex between hair and supporting cells, there were short areas of parallel limiting membranes separated by a 20A intercellular space. These areas were suggestive but not characteristic of gap junctional specialization. The functional significance of the junctional specialization between cells in the organ of Corti was discussed.
Primary Malignant Lymphoma of the Paranasal Sinuses
Authors: Lehrer Steven , Roswit Bernard
Published: October 2014

A case of primary malignant lymphoma of the paranasal sinuses is presented. The patient, a 56-year-old white man, had a good response to Cobalt 60 therapy. A review of the literature reveals that this rare tumor occurs predominantly in older individuals, and that the chance for survival is good when radiation has been administered.
Otosclerotic Inner Ear Syndrome
Authors: Ghorayeb Bechara Y. , Linthicum Fred H.
Published: October 2014

Twenty-seven patients with clinical otosclerosis and vertigo underwent stapedectomies. Vertigo improved or completely disappeared in 23 patients, indicating that stapedectomy is probably helpful. Three case reports are also presented as well as photomicrographs of temporal bones showing the focus in contact with the pars superior.
Nasopulmonary Reflex: Evaluation in the Nonparalyzed and Paralyzed Anesthetized Dog
Authors: Whicker James H. , Keen Eugene R. , Hyatt Robert E.
Published: October 2014

Changes in the pulmonary mechanics of various animal species have been observed after nasal stimulation. In reviewing the methods of these studies, we found that often the respiratory patterns were not controlled well enough to permit conclusions about changes in resistance and compliance. To further investigate the possibility of a nasopulmonary reflex, we first studied the effect of nasal stimulation on pulmonary mechanics in anesthetized, nonparalyzed dogs. In this group of 35 dogs, we found that nasal stimulation typically produced marked changes in breathing patterns, a large transient increase (150%) in pulmonary airflow resistance, but no change in compliance. This response to nasal stimulation could be abolished by interrupting either the trigeminal or the vagus nerves. In an additional group of 12 anesthetized, paralyzed dogs, we found no changes in resistance or compliance after nasal stimulation. From this observation, we concluded that nasal stimulation produced changes in breathing patterns that led to alterations in resistance without an actual change in the intrinsic behavior of the pulmonary airways.
Otitis Media with Effusion
Authors: Persico M. , Podoshin L. , Fradis M.
Published: October 2014

Eustachian tube dysfunction has been considered the main factor in the etiology of otitis media with effusion (OME). A short-term systemic steroid therapy, with combined chemotherapeutics, yielded 53.1% cure in 160 children in which OME had been diagnosed, whereas only 12.5% of similar 116 children were cured by chemotherapeutic treatment alone. It is postulated that steroids, acting by a mechanism much similar to the one in the newborn lung, increase the level of a tubal surface active agent, thus enhancing Eustachian tube refunctioning. This combined treatment, we believe, deserves its place as a routine conservative trial before surgery.
Air Calorics
Authors: Benitez Jaime T. , Bouchard Kenneth R. , Choe Yong K.
Published: October 2014

A major problem with air calories appears to be one of technique. A pilot study led to the design of irrigating tips which allow consistent air presentation and simultaneous measurements of irrigating temperature at the delivery orifice (adding a second sensor). Preset temperatures of 24 C and 50 C in our system yielded air equilibration mean temperatures of 27.4 C and 45 C at the delivery orifice during testing. A normal study was carried out at these temperatures with an air flow of six liters per minute for 60 seconds. The range of caloric responses, mean maximum speed, and standard deviation are comparable to values previously reported with water stimulations. Statistical testing indicated no difference between ears for either warm or cold. Also, there was no significant difference for warm versus cold responses. We have performed over 2000 clinical examinations that incorporate this technique with satisfactory results and remarkable acceptance by the patients. The normal or “standard” probe size has been found to be adequate for the majority of the clinic population.
Fine-Needle Biopsy of the Thyroid Gland
Authors: Schnürer Lars-Bertil , Widström Åke
Published: October 2014

At the ENT Clinic of the Regional Hospital in Örebro, cytological investigation of fine-needle biopsy specimens has been carried out to a steadily increasing extent for more than ten years as a complement to clinical methods of investigation and laboratory tests in cases of goiter. Evaluated here are the method's diagnostic accuracy and its value in investigatory work. The material consists of 303 patients with goiter who were operated from 1964 to 1971 following fine-needle biopsy. Cases where biopsy only was undertaken are not included. Assessable cytological material was obtained in 284 cases (94%). Although not less than 15 doctors carried out the fine-needle biopsies there was approximately a 93% agreement between the cytological and histological diagnoses. In 15 of 28 cases of thyroid carcinoma it was possible to make a definite diagnosis preoperatively, while in 12 of the remaining cases atypia suspected of malignancy was found. The possibility of being able to demonstrate or suspect a carcinoma preoperatively is of great importance for the surgeon, as a more extensive intervention can be planned in advance and the patient informed before the operation.
Safe Insertion of Tracheal T-Tubes
Authors: Eliachar I. , Joachims H. Z. , Simon K.
Published: October 2014

A modified technique for the insertion of silicone tracheal T-tubes is described and discussed. This modification reduces the danger of apneic intervals during the procedure.
Clinical Significance of Rebound Nystagmus in Neuro-Otological Diagnosis
Authors: Morales-Garcia C. , Arriagada C. , Cardenas J. L. , Otte J.
Published: October 2014

The present study is concerned with a clinical analysis of 17 patients with “rebound nystagmus” examined over a period of three years. All of them have shown a short duration second degree nystagmus evoked by changes in the direction of fixation, from the lateral to straight ahead gaze. This nystagmus was a fixation nystagmus, that is to say, it was enhanced in the presence of active optic fixation and inhibited in its absence. Almost all the patients (16 out of 17) had cerebellar signs on neurological examination (in one subject rebound nystagmus was the first sign suggesting cerebellar involvement and appeared several months before any other cerebellar sign was present). Rebound nystagmus was far more common than the other neuro-otological signs suggesting cerebellar dysfunction (vestibular hyperexcitability, dysrhythmia in postcaloric nystagmus and ocular dysmetria). In three out of four patients with unilateral lesions rebound nystagmus was ipsilateral with respect to the side of the lesion. Postmortem studies were carried out upon five cases and showed either pathological changes in the cerebellum or a lesion involving the cerebellar peduncles in the brain stem.
Use of Heart Rate Response for the Assessment of Hearing in Infants
Authors: Suzuki Tokuro
Published: October 2014

The clinical utility of the heart rate (HR) response as an index of hearing in infant children under 12 months of age was investigated. The most prominent component of the averaged HR response elicited with a short tone burst of 100 msec duration was a brief HR deceleration which mostly occurred between the first and second beats after stimulation. The mean response detectability for tones of 250 Hz and 1 kHz were 50, 82 and 100%, with stimulations of 40, 60 and 80 dB above subjective threshold of normal adults, respectively. The detectability decreased a little at 4 kHz stimulation. Though there was an individual variability in the appearance of the response, the method was considered to be useful as a supplementary tool for evaluating hearing in infant children.
Earmold Configuration: Relation to Speech Discrimination Scores
Authors: Epstein Aubrey , Shoenut Blanca , Sills John A.
Published: October 2014

Choice of the earmold for a particular individual is perhaps the most subjective of all decisions made by clinicians in hearing aid fitting. The four earmold designs used in this study were standard-long, standard-short, belled-vented, and cavernous. Conclusions were: 1) performance differences in earmolds of contrasting design can be assessed by discrimination scores with monosyllabic word lists of equal difficulty; 2) among the physical measures taken of the earmold-receiver systems, frequency-response overall range (HAIC) ranked the devices in agreement with group responses to a word identification task; and 3) these data offer a basis for endorsement of the standard-long and cavernous-short earmold types over the other two with their superiority evident in each of the discrimination categories of excellent, good, and poor.
Chevalier Jackson Lecture Analysis of New Optical Systems in Bronchoesophagology
Authors: Berci George
Published: October 2014

A new image transmitting system (Hopkins rod lens) made it possible to redesign the entire armamentarium of rigid broncho- and esophago- laryngology. The introduction of an optical biopsy forceps made tissue sampling more accurate. The increased light transmission produces a brighter image and easier perception. The larger viewing angle facilitates orientation. The new miniature pediatric bronchoscope, with a telescope, changed the pinpoint vision to a panoramic view. The optical foreign body forceps is of great help in fast and precise manipulations. The indirect laryngoscope proved to be a great investigative tool with the capability to obtain, with ease, a movie filmstrip for detailed analysis in the outpatient clinic. The introduction of the flexible fiber bronchoscope brought new dimensions in tissue sampling of peripheral lesions, treatment of pulmonary complications in the intensive care units, and became an important aid in intubating patients with difficult anatomy. The possibility to obtain movie films and to study our visual findings, at leisure, is an important diagnostic and teaching aid.
Effects of Various Drugs on Canine Tracheal Mucociliary Transport
Authors: Giordano Anthony , Holsclaw Douglas , Litt Mitchell
Published: October 2014

A study of the effects of dehydration, atropine, terbutaline and N-acetylcysteine on canine tracheobronchial mucus is presented. Mucociliary clearance rates, mucus secretion volumes and mucus rheologic properties were studied. Clearance rates were studied by a radioisotope technique, mucus collected by a canine “tracheal pouch” method and rheologic studies performed on a microrheometer. Clearance rate was unaffected by dehydration and terbutaline, increased by N-acetylcysteine and decreased by atropine. Secretion volume was increased by terbutaline while dehydration and atropine were without effect. Rheologic factors were increased by dehydration and atropine while terbutaline was without an effect. The effects of N-acetylcysteine on secretion volume and rheologic properties could not be studied because of the nature of the techniques employed.
Traumatically Acquired Conditioned Dysphagia in Children
Authors: Di Scipio William J. , Kaslon Karen , Ruben Robert J.
Published: October 2014

A new diagnosis identifying a nonorganic basis of dysphagia is proposed in relation to behavioral conditioning processes and thereby labeled “conditioned dysphagia” (CD). Literature review of both animal and human studies documents that rapidly acquired and persistent avoidance responses are learned when autonomic functions are contiguous with traumatic physical events. Three case studies with primary diagnoses of TE fistula, congenital heart disease and pseudobulbar palsy demonstrated an association between CD and early childhood incidence of trauma involving the esophagus. Successful treatment was achieved by operant deconditioning therapy. Results of a pilot epidemiological study of 28 postpharyngeal flap surgery children and 47 controls showed significantly higher incidence of mild to moderate CD in the surgery group.
Case for Pneumatic Dilatation in Achalasia
Authors: Heimlich Henby J. , O'Connor Terence W. , Flores Dionisio C.
Published: October 2014

A standardized method of performing pneumatic dilatation for the treatment of achalasia is described. Twenty-five patients were treated in this manner and 80% had excellent results. There was minimal morbidity and no mortality. Pneumatic dilatation is recommended as the primary procedure for achalasia as it is a simple and safe procedure which avoids unnecessary surgery. Local topical anesthesia, rather than general, is utilized and hospitalization time is two days, rather than the 14 days required following surgery. The Heller operation can be performed when pneumatic dilatation is unsuccessful.
Biomechanical Characteristics of the Canine Trachea
Authors: Meyers Arlen D. , Bishop Harry E.
Published: October 2014

The trachea is a dynamic organ that responds to the demands of deglutition, respiration, and gravity. Following tracheal resection, reconstruction should allow the trachea to assume its dynamic functions. Experiments in dogs revealed that mercury-in-silastic strain gage apparatus can successfully be used to measure the biomechanical dynamics of the trachea and subglottis. The upper tracheal segments assume a larger stress load than the lower tracheal segments following tracheal resection.
Mediastinoscopy: The Predictive Survival Value in Staging Carcinoma of the Lung
Authors: Welsh Louis W. , Welsh John J.
Published: October 2014

One hundred and thirty-seven cases of Stage III lung cancer established by mediastinoscopy have been followed to determine their survival. The tissue was classified according to World Health Organization schema and the degree of dedifferentiation graded from well to poorly differentiated. Two percent of the presented cases are well-differentiated tumors; the remaining 98% are moderately well-differentiated (11%), or poorly differentiated or small cell tumors (87%). The degree of anaplasia suggests an increasingly aggressive metastatic behavior pattern. The average life span is approximately 5 1/2 months in all groups and subgroups which were studied. Recommendations are presented for the utilization of mediastinoscopy in Stage I and II cases. Further considerations are suggested for priority of diagnostic procedures in establishing the diagnosis of lung cancer.
Insufflation Esophagoscopy
Authors: Edens E. Th.
Published: October 2014

A new electroscope has been designed from the conventional Haslinger tubes. The new rigid scope combines the advantage of air insufflation in the flexible system with the therapeutic possibilities of the rigid tubes and is trustworthy in the following esophageal procedures: a) finding entrance of severe strictures; b) introducing nasogastric feeding tubes; c) extraction of foreign bodies; d) tumor coagulation/spur in hypopharyngeal diverticuli; e) washing and suction in cases with severe food retention; f) making tumor smears in patients with clotting disorders; g) taking substantial biopsies with an optical forceps, and h) objective photodocumentation of esophageal pathology.
Flexible Fiberoptic Pediatric Bronchoscope
Authors: Tucker John A. , Silberman Harvey D.
Published: October 2014

A new instrument, the pediatric flexible fiberoptic bronchoscope, is described. It is meant to be an adjunct to the routine open tube fiberoptic lit bronchoscopes and Hopkins rod system telescopes.
Rigid Chest Support Holder
Authors: Andbews Albert H.
Published: October 2014

A rigid chest support holder used to keep the laryngoscope firmly in position during laryngeal surgery is described.
Lung Abscess Secondary to Esophageal Foreign Body
Authors: Okafor B. C.
Published: October 2014

The case reported here is one in which a foreign body in the esophagus resulted in a right lung abscess. Interest here centers on the unusual nature of the foreign body and the extraordinarily long period it was allowed to remain in the esophageal lumen even though it was producing symptoms throughout this period. The various factors involved are discussed, also the somewhat peculiar fact that the lung abscess was on the right, resulting from external pressure on the right main bronchus.
Immunobiology in Otolaryngology
Authors: Katz Arnold E. , Nysather John O.
Published: October 2014

Immunologic aspects of otolaryngologic diseases are appearing in our literature, and clinical applications of these concepts are becoming available. The significance of these advances is obscured by the confusing terminology usually employed; however, the terminology can be mastered without much difficulty. The humoral and cellular divisions of the immune system have long been recognized. The humoral division of the immune system appears to play a major role in the prevention of infection, autoimmune disease, and atopic disease. The cellular division is probably most important in the prevention of neoplastic disease. There is overlap and the systems do interact. Future manipulations of the immune system may assist in the diagnosis and treatment of diseases such as chronic secretory otitis media, allergic rhinitis, and cancer of the head and neck.
Subglottic Stenosis of the Larynx in the Infant and Child
Authors: Fearon Blair , Crysdale William S. , Bird Russell
Published: October 2014

This presentation is a ten-year retrospective study on all patients with proven subglottic stenosis admitted to the Department of Otolaryngology, Hospital for Sick Children, Toronto. Some of these patients have required no treatment, others one or two dilatations of the stenosis only; others tracheotomy only; some tracheotomy plus dilatations; some the Fearon-Cotton operation, and a few who had very extensive stenosis of the larynx and trachea, extensive reparative surgery. In this presentation, the authors describe the different types of management, and the results of treatment are assessed and compared.
Cyclic Pharyngeal Lymphoiditis: Immunological Considerations
Authors: Goldman Joseph L.
Published: October 2014

This communication presents the concept that recurrent infections of the lingual tonsils, lateral pharyngeal lymphoid bands and lymphoid follicles on the posterior pharyngeal wall, occurring with the same periodicity, is a cyclic clinical and immunological entity. These patients lacked resistance to the normal flora of the nasopharynx and pharynx. They were accordingly treated with a mixed respiratory bacterial vaccine, administered intradermally and according to a formulated program, to improve resistance or immunity of the lymphoid tissue. These patients showed definite improvement by this method of therapy. It is suggested that the effectiveness of therapy was accomplished through the immunological process of cell-mediated immunity. The immunobiologic development of cell-mediated immunity by T thymic-dependent cells and humoral immunity by B cells is briefly discussed.
Evaluation of Randomized Preoperative and Postoperative Radiation Therapy for Supraglottic Carcinoma
Authors: Snow James B. , Kramer Simon , Marcial Victor A. , Gelber Richard D. , Davis Lawrence W. , Lowry Louis D.
Published: October 2014

One hundred and ten patients with supraglottic squamous cell carcinoma have been randomized for preoperative radiation therapy and surgery versus surgery and postoperative radiation therapy. Data have been analyzed on 94 patients in this preliminary report. The differences between the two groups with respect to local control and survival are not statistically significant at this time. Additional accrual and continued follow-up are necessary in order to make a more definite treatment comparison.
Immune Monitoring Protocol for Patients with Carcinoma of the Head and Neck
Authors: Veltri R. W. , Sprinkle P. M. , Maxim P. E. , Theofilopoulos A. N. , Rodman S. M. , Kinney C. L.
Published: October 2014

Numerous investigators have observed a depression of cell-mediated immunity in patients with carcinoma of the head and neck using a variety of in vitro and in vivo assays. This report presents the data obtained when a group of head and neck cancer patients were evaluated for reactivity in an in vitro lymphocyte blastogenesis assay using polyclonal mitogens and specific antigens, numbers of peripheral blood T-lymphocytes, and levels of circulating immune complexes. Such an immunological monitoring protocol revealed a depressed reactivity of the cancer patients in the lymphocyte blastogenesis assay when compared to normal age-matched controls. We also observed that 75% of these patients had circulating soluble immune complexes in their sera before and after therapy. These preliminary data indicate that further research is needed to examine the potential role of soluble immune complexes in modulating the host's immune response.
Hypercholesterolemia and Auditory Dysfunction
Authors: Morizono Tetsuo , Paparella Michael M.
Published: October 2014

Rabbits were used for the long-term study of auditory function associated with experimental hypertension and hypercholesterolemia. Auditory dysfunction (threshold changes of sound evoked responses) was monitored with an electrode, chronically implanted into the contralateral inferior colliculus. Hypertension was created using the renal encapsulation technique. Auditory function in the hypertension trial demonstrated a dip at higher frequencies as well as improvement at lower frequencies. One gram of cholesterol fed daily for three months was capable of making rabbits atherosclerotic. Cholesterol-fed rabbits showed increasing auditory dysfunction over time at all frequencies. When experimental hypertension was combined with hypercholesterolemia, the auditory changes appeared additive. This work, although in preliminary stages, seems to provide experimental evidence that auditory dysfunction is associated with cholesterol diet.
Selected Hearing Impairment Associated with Pinealoma
Authors: Reger Scott N.
Published: October 2014

A 23-year-old Caucasian male entered the audiology clinic with a complaint of difficulty understanding speech, although speech sounds could be heard. Conventional clinical audiometry showed normal sensitivity bilaterally. The speech discrimination tests confirmed his inability to comprehend speech adequately. Békésy audiometer tests revealed dramatically rapid temporary threshold shifts bilaterally. Subsequent physical examinations revealed a massive pinealoma. Thirteen days after completion of Torkildsen's procedure, all the auditory tests indicated normal auditory function in each ear.
Cross-Power Spectral Density Analysis of Pursuit Tracking
Authors: Wolfe James W. , Olson James W. , Engelken Edward J. , Allen John P.
Published: October 2014

Twenty-one normal subjects were evaluated for pursuit tracking performance at frequencies of .2, .4, .8, 1.2 and 1.6 Hz. Measures of phase (lead or lag of target), gain (amplitude of response) and spectral purity (distortion of smooth tracking) were obtained by a cross-power spectrum analysis of the stimulus input and the eye movement output. It was determined that normal subjects could quite adequately track a target moving at .4 Hz. After establishing this parameter for normals, 43 patients with central and peripheral pathology related to the vestibulo-oculomotor system were tested at this frequency. Data revealed that not only central lesions but also peripheral labyrinthine impairment could cause a marked decrement in pursuit tracking ability. Also, marked changes in tracking were evident following both central and peripheral surgical procedures.
Clincal Use of Pseudorandom Binary Sequence White Noise in Assessment of the Human Vestibulo-Ocular System
Authors: Wall Conrad , Black F. Owen , O'leary Dennis P.
Published: October 2014

White noise rotational stimulation has been used to evaluate the human vestibulo-ocular response for 30 normal subjects over the frequency range from 0.02 to 1.6 Hz and is being extended to characterize response of patients having documented abnormalities. For clinical use, the white noise stimulus has the advantages of shortening the test time by presenting all stimulus frequencies simultaneously, and being well-tolerated by both normal subjects and patients alike. Cross spectral calculations which compare the computer reconstructed slow phase eye velocity response to the pseudorandom acceleration stimulus yield a set of linear and nonlinear estimates of the vestibulo-ocular response. Pilot data indicate that a classification of the disease state can be made using this set of estimates. This classification will be presented and discussed.
Computerized Screening of the Human Vestibulospinal System
Authors: Black F. Owen , Wall Conrad , O'leary Dennis P.
Published: October 2014

The vestibular nerve projects rostrally via the ascending medial longitudinal fasiculus (MLF) to eventually supply the ocular muscles and also projects caudally via the descending MLF to eventually supply the spinal and limb musculature. Electronystagmographic techniques are designed to evaluate only portions of the vestibulo-ocular and oculomotor systems. Vestibular lesions affecting only the caudal vestibular nerve distributions or lesions affecting both neural distributions, therefore, cannot be objectively assessed except for the vestibulo-ocular component. A promising recording technique for the evaluation of the vestibulospinal system has been developed and tested in the Raymond E. Jordan Human Vestibular Systems Laboratory. A comparison of two data analysis techniques in normal subjects, unilateral vestibular lesion patients and patients with unilateral lesions of the cerebellar hemispheres have provided pilot data which indicate that the vestibulospinal stability test technique holds considerable promise for both research and clinical evaluation of the human vestibulospinal system.
Surgical Anatomy of the Temporal Bone in the Chinchilla
Authors: Browning George G. , Granich Mark S.
Published: October 2014

The chinchilla is of value in otological research for many reasons, including the surgical accessibility of the majority of structures within its temporal bone. This paper describes the anatomy of the chinchilla's temporal bone, and four surgical approaches to the labyrinth and ossicular chain, three through the bulla and the other via the external canal. No one approach reveals all the temporal bone structures, and each route is therefore more suited to some surgical procedures than others. The cochlea is particularly accessible for microsurgical procedures because it projects into the labyrinthine part of the bulla and because its bony capsule is thin. Surgery in the posterior cranial fossae is both hazardous and difficult; the hazard is bleeding from the venous sinuses which run within the occipital and temporal bones, and the difficulty is the limited access due to the intervening cerebellum and the closeness of the brain stem.
Cricothyroid Distance and Vocal Pitch: Experimental Surgical Study to Elevate the Vocal Pitch
Authors: Kitajima Kazutomo , Tanabe Masahiro , Isshiki Nobuhiko
Published: October 2014

To establish an experimental basis for surgical approximation of the anterior cricothyroid distance which aims at raising the vocal pitch, the relationship between vocal pitch and the cricothyroid distance was analyzed in voices produced with excised human larynges (four male and two female larynges). Within the framework of the experimental conditions, the following conclusions were drawn: 1) The vocal pitch expressed in semitones was almost linearly related to the cricothyroid distance, with an increase of 0.15 to 0.90 semitones per millimeter of cricothyroid approximation. 2) The rise in vocal pitch reached a plateau when the force applied to shorten the cricothyroid distance reached 30 to 50 gm.