bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined modalities in the prevention of venous thromboembolism: A review of the literature
Authors: Kakkos S K , Caprini J A , Nicolaides A N , Reddy D
Published: September 2006

Objective

Despite recent advances in the field of venous thromboembolism (VTE) prophylaxis and adherence to guideline recommendations, VTE remains a serious problem, especially in high-risk groups. The aim of the present review was to summarize the evidence supporting the use of combined modalities, both physical and pharmacological, in VTE prevention.

Methods

Using Medline, original studies on the value of combined modalities in VTE prevention were identified. Keywords used for physical methods included elastic stockings and intermittent pneumatic compression, and for pharmacological methods included unfractionated and low molecular weight heparin. Relevant articles from their bibliography were also retrieved.

Results

Combined pharmacological and physical modalities were more effective than each modality alone in a variety of specialties, including orthopaedic, general and cardiac surgery, as shown by 14 of the 18 randomized or case-control studies retrieved. Mean reduction in VTE incidence was 69% (range 16–100%).

Conclusion

Combined modalities are more effective than single modalities in VTE prophylaxis. These results endorse their use, especially in high-risk patients, and support this otherwise typical recommendation of the consensus documents on VTE prophylaxis.
Pharmacological methods of thromboprophylaxis
Authors: Thomas M , Hunt B J
Published: September 2006

The burden of venous thromboembolism (VTE) in hospitalized patients is significant and often underestimated. In this article the rationale for thromboprophylaxis is reviewed and rates of VTE in different patient populations considered. The options for pharmacological methods of prophylaxis are outlined and the evidence for their use in specific patient groups is reviewed. Thromboprophylaxis is effective but currently underused. Strategies are being developed to remedy this situation including the development of national guidelines and intervention by the Department of Health.
Introduction to venous thromboembolism and prophylaxis
Authors: Howard A , Howard D P J , Davies A H
Published: September 2006

The majority of fatal pulmonary emboli arise from deep vein thromboses in the lower limb. Pulmonary embolism continues to be a major cause of death in hospitalized patients. The classification, history, epidemiology, pathophysiology and prognosis are disclosed. An overview of the current recommendations for venous thromboembolism in surgical and medical patients and the failure of its application are discussed. The use of adequate thromboprophylaxis in approximately only one-third of patients is a familiar account. Prophylaxis guidelines use risk stratification systems, which lend to confusion by clinicians with the inevitable consequence of failed prophylaxis implementation. The National Institute of Health and Clinical Excellence are due to provide national prophylactic guidelines in May 2007. Simplified guidelines, a national consensus, and continued education of patients and health care professions to maintain compliance, is the solution to thromboprophylaxis.
Cost-effectiveness of prevention of venous thromboembolism
Authors: Sharp B , Davies A H
Published: September 2006

Venous thromboembolism (VTE) is a potentially fatal vascular disease that affects more than 170,000 patients in the USA every year. All hospitalized patients are at an increased risk of developing VTE and subsequent pulmonary embolus.

There is growing literature concentrating on the cost-effectiveness of preventing VTE occurring. So far recommendations have been conflicting and research has not explored the use of VTE prophylaxis in low-risk patient groups.

Comparisons between low-molecular-weight heparins (LMWH) and unfractionated heparins have revealed that LMWHs are superior not only in action but also in cost-effectiveness.

In elective surgery, patients who require long-term anticoagulation bridging therapy with LMWH at home have shown comparable safety and efficacy and the method is far less costly than inpatient bridging therapy with unfractionated heparin.
Inhibition as an important part of sensory perception.
Authors: Von Békésy Georg
Published: September 2006

INTRODUCTION.

Natural science made a big step forward when it was assumed that every phenomenon has a cause. The causality principle completely modified our daily thinking and started to interconnect different phenomena occurring in nature. To find the cause of every happening in nature was the aim of logical thinking. It was quite obvious from the beginning that every phenomenon probably had several causes; but it was further assumed that it was generally one cause which outdid all the others in producing the phenomenon.
Present concepts in cancer and immunologic responses.
Authors: Arena Sebastian
Published: September 2006

Many of us in clinical medicine, who deal with cancer, often become frustrated with the way malignancies behave in different individuals, and even the change of behavior of a specific malignancy in the same host. This reflects a lack of knowledge on our part of the basic abnormality in cancer. Herein are reviewed some of the present concepts which investigators are exploring, in order to unravel the mystery, or mysteries of cancer.
Audio‐visual aids in the teaching of otolaryngology.
Authors: Alberti Peter W. R. M.
Published: September 2006

New methods of teaching are in vogue. The vigorous growth of medical faculties in North America and Europe has left in its wake thousands of hours of new teaching time, brilliant concepts which can be translated into classroom and bedside instruction only by hard work. It has given rise to a search for new methods of presentation of facts and ideas.
Carcinoma of the supraglottis and tongue treated by supraglottic laryngectomy and mandibular swing.
Authors: Shumrick Donald A.
Published: September 2006

INTRODUCTION. In 1968, in the United States alone, 860 people died each day of cancer. This amounts to over 300,000 deaths a year. In 1969, it is estimated that over 915,000 persons will suffer from cancer and 600,000 new cases will be diagnosed.1 Except for cancer of the lung, pancreas and leukemia, cancer rates in general are leveling. Recent declines in the incidence of cancer of the stomach and uterus are apparently being partially replaced by increases in malignancies of the lip, tongue, floor of mouth, pharynx and larynx. The significance of cancers in these areas becomes apparent when one recalls that over 14,000 people will die of these lesions this year. Not only is there a steady increase in the overall number of cancers of the oral cavity and pharynx, but in the last 10 years, the incidence in females has increased by 8 percent and this alarming rise appears to be continuing. We, then, must increase not only our vigilance but also our armentarium to treat these devastating malignancies. The basic premise should be twofold: to cure the patient of his malignancy and to preserve as much physiologic function as possible but in so doing, not compromise the first premise.
Vertex response: Influence of lesions in the auditory system
Authors: Townsend Gary L. , Cody D. Thane R.
Published: September 2006

The principal value of specialized audiologic techniques lies in early diagnosis of retrocochlear lesions, which in turn minimizes technical difficulties in the surgical removal of acoustic neuromas; however, despite a wide battery of audiometric tests, the otolaryngologist too often has difficulty in distinguishing between cochlear and retrocochlear lesions. Johnson1 observed deviations in one or more respects from the classic audiometric findings in almost half of the cases of acoustic neuroma that he studied. Other audiologists2 have encountered similar problems.
Post diphtheria polyneuritis: Three case reports
Authors: Dietze William E. , Sudderth Jerry F.
Published: September 2006

The purpose of this paper is to present three patients; two with proven diphtheria and one with suspected diphtheria, who developed neuritis following their infections. The pathogenesis and the pathophysiology of post diphtheritic polyneuritis is discussed. The necessity for differentiating this condition from post infectious neuritis of other etiologies is stressed since early treatment with antitoxin will affect the course of the disease.
The effects of hypothyroidism on the ears of cats and squirrel monkeys: A pilot study
Authors: Withers Ben T. , Reuter S. Harold , Janeke Johan B.
Published: September 2006

Eleven animals (five cats and six squirrel monkeys) were studied before and after being rendered hypothyroid by, surgical excision or radioactive ablation of the thyroid gland. Blood chemistry studies, before ablation and after, proved the presence of hypothyroid state. Audiometric studies by the behaviorally trained avoidance technique and electronystagmograms indicated hypoactivity regarding hearing and labyrinthine function. In one cat given thyroid hormone to full compensation level, the high frequency hearing loss returned to normal.

Studies of temporal bone specimens of the five cats: hypothyroid, thyroid compensated, and control, microscopically showed no morphological alterations. Presumably functional changes were due to biochemical involvement which failed to show as a morphological one.
Maxillary sinus malignancy
Authors: Schechter Gary L. , Ogura Joseph H.
Published: September 2006

This report deals with the survival and failures of 50 patients with malignancies of the maxillary sinus. The clinical, surgical, pathology, and survival characteristics of this series are tabulated, using the TNM classification system. Forty‐one patients in the group had epidermoid cancers. The overall four‐year survival of the patients in this series is 34 percent. The following is a breakdown of survival according to the TNM classification.

1. T‐1 (eight patients) 85.7 percent

2. T‐2 (five patients) 100.0 percent

3. T‐3 (six patients) 50.0 percent

4. T‐4, including those with nodes and distant metastases (31 patients) 4.0 percent

Local recurrence was the major cause of treatment failure in this series. An analysis of the local recurrence failures, correlating the surgical pathology with the clinical classification, demonstrates that the advanced lesions (T‐3 and T‐4) and poorly differentiated tumors have the greatest chance of local recurrence. It is recommended that the latter group of cases receives an aggressive course of postoperative radiotherapy based on detailed pathology evaluation of the resected specimen. The liberal use of drainage procedures, radiotherapy, and cryotherapy for palliation is suggested.
The presence of melanocytes in the human larynx
Authors: Goldman Joseph L. , Lawson William , Zak Frederick G. , Roffman Jeffrey D.
Published: September 2006

During the study of serially sectioned cancerous and irradiated larynges, a unique case of extensive melanosis of the laryngeal mucosa was encountered. While pigmented neoplasms in the larynx had been reported repeatedly, to our knowledge the presence of melanocytes had not been demonstrated at that site; consequently, we initiated a study to ascertain whether melanocytes were present in the human larynx as an explanation for the histogenesis of these neoplasms.

We adopted the technique of Epstein for stripping the laryngeal mucosa, and of Nigogosyan and coworkers for embedding and sectioning the ribbons of tissue. In an ongoing study, using non‐selected adult larynges removed at autopsy, scattered foci of melanocytes were found in an appreciable number of Caucasian and Negro specimens. With the Masson‐Fontana silver procedure for melanin, they appear as dendritic cells containing black granular pigment, situated in the basal layer of the squamous epithelium and subjacent connective tissue.

While the origin of melanomas from pigment containing cells in the skin, eye and leptomeninges is well established, the histogenesis of those tumors arising in non‐integumentary and extra‐ocular sites remains obscure, because with few exceptions melanocytes have not been demonstrated in these organs.

Melanocytes have been observed in the esophagus, oral cavity, vagina, and now larynx. Theories attempting to explain their presence at nonectodermal sites include the migration of melanoblasts with mesoderm to visceral sites, the transformation of neural crest elements into melanocytes and nevus cells, as well as the metaplasia of both squamous and glandular epithelium into pigment producing cells.
Nasal and paranasal sinus polyps ‐ A suspected new etiological co‐factor
Authors: Neely John G. , Doggett Robert G. , Harrison G. M.
Published: September 2006

Seventeen adult patients with nasal or paranasal sinus polyposis were studied in an attempt to determine whether there was any relationship between them and children with cystic fibrosis.

The oyster gill cilia inhibition test, commonly used to detect the “C.F. factor” in the serum of cystic fibrosis patients (homozygous) and their parents (heterozygous), was applied to these 17 patients.

Fourteen of the 17 patients had the “C.F. factor” in their serum. There would appear to be some relationship between cystic fibrosis and adult nasal and paranasal sinus polyposis; however, it is too early to draw any strong conclusions to this affect.
Basal cell carcinoma: Treatment by the mohs technique
Authors: Robins Perry , Amonette Rex
Published: September 2006

A basal cell epithelioma presents a therapeutic problem when it recurs or when it is located in difficult to treat head and neck regions. Mohs' chemosurgery is a useful and highly effective technique for dealing with these cases. This is a staged procedure which utilizes application of a chemical fixative agent, scalpel excision, and microscopic study of the tissue. In addition to accuracy, the Mohs technique offers the advantage of conservation of valuable tissues. The chemosurgical technique is described and illustrated in detail with presentation of three typical cases.
Chondrosarcomas of the facial region
Authors: Gallagher T. M. , Strome Marshall
Published: September 2006

Less than 100 chondrosarcomas originating in the facial skeleton have been reported. Information regarding chondrosarcomas in the facial region is fragmentary. The largest series collected transcend a long period of time containing changes in surgical technique and philosophy. Precedence for therapy and prognostic information is not readily available. Three patients with facial chondrosarcomas are reported. All were diagnosed within a four‐year time span. The aforementioned adequately depict the protean manifestations of this tumor and the aggressive therapy required. Correlation is made with the existing body of information regarding this entity.
Meniere's disease and otosclerosis (without oval window involvement)
Authors: Cole James M. , Funkhouser George
Published: September 2006

It is our opinion that otosclerosis is a not infrequent cause of sensorineural hearing loss starting between the late teens and early 60's and, if suspected, that polytome X‐rays of the labyrinth can give valuable confirmatory evidence. We have approximately 250 polytome X‐ray examinations in our clinic which show evidence of otosclerosis with pure or predominant sensori‐neural hearing loss. We have been particularly interested in a group of 25 patients with signs and symptoms of Méniére's disease with polytome X‐ray evidence of otosclerosis of the labyrinthine capsule. They all have had typical acute rotary vertigo with nausea and vomiting, fluctuating sensori‐neural hearing loss of the end‐organ type,. and all have been studied extensively audiometrically. All have at least some degree of bilateral involvement. Seven have siblings either with Méniére's disease or adult onset sensori‐neural hearing loss of the end‐organ type.

We feel it is of considerable practical importance to identify Méniére's disease when it occurs in association with labyrinthine capsule otosclerosis, because we have a strong impression that sodium fluoride in 60 mg. per day doses for one to two years tends to arrest progression of the hearing loss and to reduce or eliminate recurring bouts of acute vertigo. Occasionally, when hydrops is a factor in the sensori‐neural hearing loss, we have seen distinct hearing improvement after starting sodium fluoride treatment. (Two case reports are presented in the complete paper with audiograms and medial and lateral oblique polytome views of the labyrinth showing otosclerosis.) When otosclerosis and Méniére's disease are associated there usually seems to be bilateral involvement. These constitute about 10 percent of our cases of Méniére's disease and most patients with unilateral involvement show no X‐ray evidence of otosclerosis. The majority of patients having signs and symptoms of bilateral Méniére's disease that we have studied, have had polytome X‐ray evidence of otosclerosis. We do not feel that we have conclusively proven an association between the observed bilateral Méniére's disease and the suspected labyrinthine otosclerosis. The final proof will depend on post mortem histo‐pathologic study of these temporal bones, and we hope that this material will be available in the future.
Stapedectomy with malleus homograft in the fenestration ear: A Method for Restoration of Hearing in the Fenestration Ear
Authors: Tabb Harold G.
Published: September 2006

A method for restoration of hearing in the fenestration ear is presented which consists of implanting a tailored malleus homograft between the manubrium in the drum and a vein grafted oval window following total stapedectomy.

Twelve out of 14 cases followed from six months to four years closed the bone‐air gap within 20 db. Two cases were failures, with one of these a dead ear. None of the cases extruded the homograft malleus. Hearing has been maintained at the serviceable level in 70 percent of the cases for a period up to four years.

Results have been promising enough to continue the use of this technique.
Symposium on prophylaxis and treatment of middle ear effusions.: Ii. Eustachian tube function and middle ear pressures as they influence susceptibility to disease
Authors: Proud G. O.
Published: September 2006

The bursting pressure necessary to rupture the tympanic membrane of cats and guinea pigs was determined by increasing and decreasing the intrabullar pressures and by increasing and decreasing the pressures in the external auditory canal after the bulla was vented to the outside. The average pressures in all experiments varied from 100 to 180 mm. Hg. Such pressures are far greater than the fall in intrabullar pressure which occurs following ligation of the eustachian tube in cats. It is suggested that drumhead perforations in humans with serous otitis may be due to smaller diminished tympanic pressures over a long period of time, leading to retraction pocket, entrapment of debris, and development of an expanding epithelial‐lined cyst.
Symposium on prophylaxis and treatment of middle ear effusions.: Iv. Physiology of the eustachian tube in the pathogenesis and management of middle ear effusions
Authors: Bluestone Charles D. , Paradise Jack L. , Beery Quinter C.
Published: September 2006

Eustachian tube function studies were carried out in patients with concurrent or recent middle ear effusions. Radiographic techniques were employed in assessing tubal response to liquid flow. Studies of air flow and air pressure were carried out using a Madsen bridge, and depended on the presence of either a perforation or a tympanostomy tube.

Most of the Eustachian tubes studied showed varying degrees of obstruction or abnormal distensibility or both, often depending on the direction of flow, or on whether pressures were increased or reduced.

Quite apart from other factors which may contribute to intrinsic oxextrinsic obstruction of the Eustachian tube, its compliance appears to play an important role in determining its function. In particular, compli. ance appears to be an important factor in the response of the Eustachian tube to increased positive or to negative pressures.

Elimination of the causes of both nasal obstruction and abnormal nasopharyngeal secretions may alleviate problems in the function of the Eustachian tube which seem attributable to increased tubal compliance.
Pedicled flaps: An experimental and clinical study.
Authors: Biller Hugh F.
Published: September 2006

This study was initiated in order to find a reliable, inexpensive, convenient and clinically applicable method to predict pedicle flap viability.

The method, if valid, would enable rapid patient rehabilitation. The method evaluated in this study is flap temperature.
High dose pre‐operative radiotherapy and surgery for cancer of the larynx.
Authors: Constable William C. , Marks Richard D. , Robbins Jeffrey P. , Fitz‐Hugh G. Slaughter
Published: September 2006

High dose pre‐operative radiotherapy has played an increasing role in the treatment of advanced cancer of the larynx at the University of Virginia Hospital since 1966. The results of treatment of 72 cases treated in this fashion are compared with 151 cases treated by surgery alone. Employing the actuarial method for calculating survival, there would appear to be a distinct improvement in the group receiving pre‐operative radiotherapy. Local recurrence was reduced to 15 percent following radiotherapy from a level of 30 percent with surgery alone; however, this is a retrospective study, and the two groups are not strictly comparable by age, sex and race. Comparison by stage demonstrates that the more advanced cases received pre‐operative radiotherapy. Morbidity from the combined approach was not increased with a dose of 5,000 rads delivered in five weeks.
Correction of saddle nose deformity
Authors: Sessions Donald G. , Stallings James O.
Published: September 2006

Selection of the procedure for correction of saddle nose deformity should be determined by the severity of the deformity. Cartilage inlay grafts are satisfactory in the repair of minor supratip depressions. Moderate deformity of the cartilaginous septum is readily reconstructed by transposition of the upper lateral cartilages. Marked saddle nose deformity with destruction of large portions of the cartilaginous and bony nasal septum requires bone grafting procedures.
Temporal bone fractures: Three identical cases of lateral middle ear fractures with facial nerve injury and conductive hearing loss
Authors: Leonard James R. , Belafsky Mark L.
Published: September 2006

During the past two years at Thomas Jefferson University Hospital the authors have encountered three identical cases of middle ear injuries and their treatment has been so alike that we believe they merit general discussion. These patients illustrate the basic pathology of middle ear fractures in association with skull trauma, and in addition, emphasize the transtympanic approach in the surgical repair. In the past there has been some hesitancy about operating on temporal bone fractures in the acute period. The authors wish to use the following three cases to illustrate the early surgical approach to temporal bone fractures with associated facial nerve injury.

It is our belief that the transcanal route is an excellent one for isolated middle ear fractures with concomitant facial nerve palsy when there is normal tearing on the involved side. We also believe that these middle ear fractures should be explored at the earliest possible time, as soon as general status of the patient will allow. We have some hesitancy about performing the standard incus body‐to‐head transposition for ossicular chain reconstruction because of the close proximity of the exposed facial nerve to the repositioned incus. We worry about pressure of this incus should it become displaced postoperatively onto this bare facial nerve. There is also difficulty experienced with this approach if re‐exploration is indicated. The tympano‐meatal flap must be elevated off the facial nerve, a procedure not without its own inherent dangers.
Surgical treatment of juvenile nasopharyngeal angiofibroma
Authors: Jafek Bruce W. , Nahum Alan M. , Butler R. Melvin , Ward Paul H.
Published: September 2006

Twenty‐five cases of juvenile nasopharyngeal angiofibroma are reviewed. Surgical removal via a transpalatal approach accompanied by a gingivobuccal incision and exploration of the pterygomaxillary space to remove lateral extension is advocated. This procedure is almost uniformly successful in eradicating tumors without intracranial extension. Pre‐operative estrogen therapy and temporary ligation of the ipsilateral carotid artery in selected cases appears to decrease blood loss at surgery. Pre‐operative angiography delineates the nasopharyngeal mass, shows any pterygomaxillary space extension, and demonstrates any middle cranial fossa extension. A fairly accurate estimate of the percentages of vascular contribution is also obtained, allowing the surgeon to plan possible vascular control by ligation. Intracranial fossa extension generally greatly increases the operative blood loss and risk, because of probable subtotal resection but is not an absolute contraindication to surgery.
Tympanic membrane grafting with fascia: Overlay vs. undersurface technique
Authors: Glasscock Michael E.
Published: September 2006

Early attempts to repair tympanic membrane perforations were not uniformly successful. At first, full thickness and later split thickness skin was used as an overlay graft. The many problems associated with this material soon led most surgeons to seek a substitute. Over the years canal skin and connective tissue (particularly fascia) became popular, and two grafting techniques developed. The use of connective tissue made it possible to place the graft under the drum remnant as well as over.

There are some difficulties associated with both procedures. When fascia is placed over the drum remnant several problems such as anterior sulcus blunting, graft lateralization, epithelial pearls and delayed healing may occur. The undersurface procedure is technically more difficult, and error in graft placement accounts for many of the failures that occur with this method.

This paper discusses both classic techniques in general terms, stressing the advantages and disadvantages of both. By combining some features of each technique and by employing the postauricular approach, a method of undersurface grafting in presented that has consistently produced good tympanic membranes. Results (take rate and quality of drum head) are described in 237 cases in which both techniques of grafting were used.
Long term results of perilymph fistula repair
Authors: Althaus Sean R. , House Howard P.
Published: September 2006

This paper presents the long term results of post‐stapedectomy perilymph fistula repair in a group of patients followed over several years. These results indicate that, in general, the outlook for preservation of hearing and relief of vertigo is promising in most cases. In 73 percent of cases hearing was maintained or improved, and in 75 percent of patients having vertigo significant improvement occurred.

Hearing loss following fistula repair occurs more often when the original stapes prosthesis was a wire loop. Patients with vertigo as a symptom have an increased possibility of further hearing loss after repair of a perilymph fistula.
Hypometabolism in allergy: A review for otolaryngologists
Authors: Withers Ben T.
Published: September 2006

Treatment failure in hyposensitization therapy for allergy is frequently associated with lack of utilizable thyroid hormone in the periphery at the cell level. Basic biochemical principles and endocrinological aspects of the problem relate to the enzymatic mechanism of allergy and atopy (Godlowski). Enzymatic protein synthesis and breakdown in the mitochondria within the cells requires energy supplied by the APT/ADP cycle. In turn, energy from metabolically active thyroid hormone (T3) is necessary as a driving force for the preceding. If T3 is lacking in the process, faulty, inefficient, toxic enzymes result, which cannot completely break down ragweed or other entering antigens to symptomless metabolites. Toxic allergy symptoms result in the patient.

Diagnosis and application of corrective measures in clinical allergy cases as well as treatment precautions will be detailed in representative case reports.
Overt responses of listeners to alaryngeal speech
Authors: Hartman David E. , Scott Davis A.
Published: September 2006

The investigators observed and analyzed the nonverbal and verbal reactions of 30 service station attendants who were exposed to alaryngeal speech produced with an electronic larynx and the reactions of another 30 attendants who heard normal speech. Although there was a significant difference between the patterns of response of the two groups of subjects, the difference was attributable primarily to responses on only three of the 16 behavior categories studied. Subjects who heard alaryngeal speech tended to stare more or speak louder or slower. The authors concluded that listener reactions should not be cited as an argument against the use of an artificial larynx; potential adverse reactions will be minimal, can be coped with easily, and will not interfere with effective communication.
Ceruminous gland tumors: Report of three cases
Authors: Anagnostou G. D. , Papademetriou D. G. , Segditsas TH. D.
Published: September 2006

Three patients with ceruminomata were treated by radiation therapy, surgery or a combination of both of them.

One patient was treated by surgery followed by radiation treatment and then, after recurrence of the tumor, by radical surgery, and another patient treated by surgery only, are free from disease six and five years respectively. One patient treated by incomplete radiation therapy only, has had recurrence of the tumor three months later, but after a full treatment by Cobalt teletherapy is free from recurrence four months later.

Surgery is considered the treatment of choice; however, radiation therapy may be indicated when the tumor, either primary or recurrent, has extended beyond limits of surgical resection, or because of distant metastases, due to the patient's general condition precluded surgery, or finally, when surgery is refused.
Pilomatrixoma masquerading as a parotid mass
Authors: Krausen Anthony S. , Ansel David G. , Mays Ben R.
Published: September 2006

A case report of pilomatrixoma masquerading as a parotid, tumor is presented. Although well known to dermatologists and knowledgeable pathologists, this is, to our knowledge, the first time this entity has been presented in the otolaryngologic literature. Radiographic, sialographic, and histopathologic features of this tumor are presented with differential diagnoses. Because this is strictly a benign lesion, treated by local excision, the importance of correct histopathologic diagnosis is emphasized. The ultimate intent of this report is to make otolaryngologists aware of this entity so that they might include it in the differential diagnosis of calcified masses presenting in the parotid region.
Submaxillary gland tumors
Authors: Lowe James T. , Farmer Joseph C.
Published: September 2006

Tumors arise much less frequently in the submaxillary gland than in the parotid gland; however, the incidence of malignancy is higher in submaxillary neoplasms. The records of 50 patients with submaxillary gland tumors were reviewed and the findings compared with those of other recent series. Malignant tumors of the submaxillary gland were found to behave aggressively, and poor results were obtained in treating these lesions, especially when recurrences were present. It is felt that a planned approach consisting of adequate initial resection would lead to improved results.
Vestibular pathology in otosclerosis temporal bone histopathological report
Authors: Sando Isamu , Hemenway William G. , Miller Daniel R. , Black Franklin O.
Published: September 2006

A histopathologic study of four temporal bones from two patients with vestibular pathology concurrent with otosclerosis is presented. The findings are as follows: 1. In each of the temporal bones, the otosclerotic focus was seen in apposition to the superior vestibular nerve with invasion of the cribriform area of the nerve in one of these ears; 2. there was vestibular nerve degeneration distal to these foci in all cases, worse in those nerve fibers close to the otosclerotic focus. In one case there was retrograde degeneration up to the area of Scarpa's ganglion; 3. three of the four temporal bones showed a marked degeneration of the sensory epithelium of the cristae of the lateral semicircular canals as well as loss of the subepithelial cells and neural elements; and 4. in all four temporal bones a basophilic deposit was found in the ampulated end of the posterior semicircular canal which may represent cupulolithiasis.

We feel that the findings in these temporal bones are important histological confirmations of vestibular pathology in otosclerosis which have not been previously reported. This pathology may be the explanation for various clinical vestibular disorders seen in patients with otosclerosis, but, heretofore, very poorly understood.
Quantitative determination of alkaline phosphatase and inorganic phosphate in fetal and neonatal otic capsules of rats
Authors: Marovitz William F. , Black Martin J.
Published: September 2006

A quantitative assay technique for alkaline phosphatase in pooled fetal ears has been developed. The data obtained by this microchemical assay agrees well with previous histochemical techniques. Starch gel electrophoresis was unable to differentiate different alkaline phosphatases in the extract. These data should prove useful for examination of experimental pathology of the embryonic capsule.
Epiglottitis — Individualized management with steroids
Authors: Strome Marshall , Jaffe Burton
Published: September 2006

Three therapeutic modalities are available for the management of acute epiglottitis — medical, intubation, and tracheotomy. Helping the otolaryngologist discern the regimen of choice for a given situation is the format for this paper. The incidence of diagnosed epiglottitis is definitely increasing in our institution and in others; therefore, a rational individualized approach based on recent information is essential. Twelve cases formed the basis for the concepts presented.

Our current management protocol for supraglottic infection is as follows: first, medical management for selected cases is given a two‐hour trial. Should this prove unsuccessful, intubation is effected. Tracheotomy will no longer be performed unless the internal lumen of the tube placed is so small that crusting becomes a problem; the patient cannot be extubated in 48‐72 hours; or in the very rare contingency that the patient could not be intubated.

In this series, medical management alone sufficed in eight cases. Two cases received a tracheotomy. These were performed prior to the initiation of our current protocol. Two patients were intubated.

The 12 cases were analyzed with regard to the parameters which might depict those cases that would not respond to medical management. The initial respiratory rate, pulse rate, and temperature elevation were not indicative. Rather, the potential and direction of change of the aforementioned recorded over a two‐hour period was very significant. A significant medical response as manifested by a decreased respiratory rate was seen in four cases in less than one hour and within two hours in the remaining four cases. It is of significance that in one of the eight cases steroids were withheld for the first two hours with a significant deterioration in the patient's condition. Steroids were then given, and within two hours there was a definite clinical improvement. It should be noted that the steroid response could not be correlated with the length of symptoms prior to admission; also, those patients whose initial difficulty was primarily dysphagia seemed to have a more benign general course. Medical management was therapeutic in all of these cases. Information from our later cases supports this contention as well.

An analysis of the four initial cases requiring airway intervention revealed a syndrome of cyanosis, exhaustion, and severe sternal retraction to indicate an initially poor medical response. Patients with this triad should be intubated as soon as possible and given appropriate antibiotics and steroids.
Prevention of complications of composite resection after high dose preoperative radiotherapy
Authors: Tucker Harvey M. , Rabuzzi Daniel D. , Sagerman Robert H. , Reed George F.
Published: September 2006

Recent reports have suggested that carcinoma of the tonsil and adjacent structures (tonsillar pillars, adjacent soft palate and lateral pharyngeal wall) can be treated with improved survival rates by combining definitive surgery with planned preoperative radiotherapy. Experience to date does not clearly demonstrate the ideal dose of preoperative radiotherapy; however, in general it appears that survival rates improve in proportion to increasing dosage of preoperative radiation. The use of preoperative radiation in doses approaching or exceeding tumoricidal levels (6,000‐6,500 rads at approximately 1,000 rads/week) has been limited by the unacceptable complication rate to be expected. The rate of major complications reported has ranged from 18 percent to almost 47 percent.

For the past three years, all patients seen by the Department of Otolaryngology of the Upstate Medical Center with malignancies involving the tonsil and its adjacent structures have been managed by a combined modality of 5,500 rads preoperative radiotherapy followed by definitive surgical resection, using distant, unirradiated flaps for repair where necessary. There were 33 patients in the group, including three T2, 20 T3 and 10 T4 lesions. Joint evaluation and planning of treatment between radio‐therapy and otolaryngology coupled with meticulous attention to various aspects of surgical management has yielded the results reported in the table. The major complication rate has been limited to 3.03 percent. These results indicate that it is possible to undertake extensive resections for carcinoma of the tonsil and adjacent structures after high‐dose preoperative radiotherapy without incurring any significant increase in morbidity over surgery alone.
Extracranial arteriovenus fistulas
Authors: Stucker Fred J.
Published: September 2006

This paper gives a brief description of the etiology, diagnosis and treatment of extracranial arteriovenous fistulas.

These fistulas may be either acquired or congenital in origin. Their natural history is one of progression which can result in severe hemodynamic changes. Extracranial arteriovenous fistulas usually occur between the terminal branches of the external carotid artery and the lateral sinus or jugular venous systems. The most common symptom, pulsatile tinnitus, can often be decreased by common carotid artery compression unless there is a significant contribution from the vertebral arterial system.

Selective arteriography utilizing subtraction technique is the most important diagnostic study.

The recommended treatment is complete surgical excision of the fistula and ligation of all feeding vessels. The recurrence rate is higher with the other methods of control, such as simple ligation, irradiation, injection of sclerosing agents and embolization.

Two patients with congenital arteriovenous fistulas are presented.
Complications of laryngotracheal disruption
Authors: Alonso William A. , Pratt Lindsay L. , Zollinger William K. , Ogura Joseph H.
Published: September 2006

Owing to the increased use of automobiles, minibikes, motorcycles and other devices for recreational activities, we are now seeing a growing number of severe head and neck injuries. In this paper we will discuss a rare and often fatal injury of the neck, namely, traumatic laryngotracheal separation. There are isolated reports in the literature of heroic efforts to save the lives of such patients, but little has been said regarding surgical repair of the injury and possible late complications.

Seven case reports of laryngotracheal avulsion injuries are presented with emphasis placed on the methods of repair of the acute injury and reconstruction of late complications. The etiology of the injury in all cases was a severe localized blow to the extended neck at the level of the cricoid cartilage. Most patients arrived in the emergency room near death, showing obvious signs of upper airway obstruction. A rapid tracheostomy was responsible for saving their lives. In most cases the avulsed trachea was repaired primarily over an internal stent. Associated laryngeal and cricoid fractures were reduced and immobilized. A thorough exploration of the neck was done in most of these patients, and injury to the recurrent laryngeal nerves was commonly noted. Late sequelae depended on the type and extent of associated injuries, the type of repair performed, and timing of the definitive reconstruction. The most satisfactory results were obtained in patients receiving early reconstruction with the use of an internal stent. Equally as important in determining a favorable result following reconstruction was an accurate preoperative and operative assessmet of the extent of injury. Despite optimal early treatment of the acute injury, some patients will remain disabled either from a compromised airway or a poor voice. Additional surgical intervention is possible in most cases, and the variety of problems encountered taxes the versatility of the surgeon.
Acoustic and vestibular defects in lightning survivors
Authors: Wright J. William , Silk Kenneth L.
Published: September 2006

An analysis of our series of seven patients who have survived lightning strokes and a review of such cases mentioned in the world literature since 1960 reveals that the most common audiovestibular lesion in lightning survivors is tympanic membrane rupture. Of the various injury‐producing properties of lightning, the one most likely implicated in the pathogenesis of these lesions is the cylindrical shock wave which expands from the axis of the lighting bolt. The tympanic membrane in close proximity to the lightning bolt is suddenly stressed with enough force to cause its rupture.

Lightning victims may also manifest various forms of neurosensory deafness and dizziness of central or vestibular origin. Possible explanations for these lesions are described but are primarily conjectural.

Otologic management of these cases varies with the lesion sustained. Cochlear, retrocochlear and vestibular lesions are usually treated expectantly and medically as symptoms indicate. Surgical treatment is reserved for incapacitating vestibular problems unresponsive to conservative treatment and to reconstructive approaches to the tympanic membrane and middle ear when indicated.
Osteitis fibrosa (brown tumor) of the maxilla
Authors: Beard Charles H. , Nichols Richard D.
Published: September 2006

Patients who present to the regional specialist with localized manifestations of systemic disease provide especially interesting diagnostic problems. We present a patient who was seen initially for facial swelling, thought to be caused by carcinoma of the antrum; however, tissue for biopsy was compatible with osteitis fibrosa, giant cell reparative granuloma, or giant cell tumor of bone, lesions which have identical histopathologic features.

There were no other radiographic abnormalities, but the diagnosis of hyperparathyroidism was suggested by persistent hypercalcemia without other clinical states to explain the abnormality and was confirmed by parathyroid exploration which revealed a large adenoma. Prior to operation, causes of hypercalcemia, such as malignant disease, the milk‐alkali syndrome, hypervitaminosis D, and others were ruled out by clinical evaluation.

When the Brown tumor of the maxilla failed to regress following treatment of the primary disease it was necessary to remove the mass surgically to relieve nasal obstruction and achieve a more acceptable facial appearance.

Brown tumors are seen occasionally in the skull and facial bones, but occurrence in the maxilla appears to be quite rare. Only six cases of isolated presentation of this abnormality in the maxilla have been cited. In each case this was an oral rather than a superior maxillary manifestation of the disease, the mass presenting from the superior alveolus or the hard palate.
Juvenile angiofibroma: A more rational therapeutic approach based upon clinical and experimental evidence
Authors: Ward Paul H. , Thompson Ronald , Calcaterra Thomas , Kadin Michael R.
Published: September 2006

A new and more rational therapeutic approach to the diagnosis and management of juvenile angiofibromas was formulated based upon the experiences in 35 cases.

Preoperative angiography is essential in delineating the mass, and demonstrating extension into surrounding areas, and for delineation of the sources of blood supply to the tumor. Arteriography has shown 20 percent of the cases to have middle fossa extension, and that the size of the tumor in the nasopharynx does not necessarily represent the size and extent of the tumor and may be only the “tip of the iceberg.”

The death of a patient with intracranial extension. The cessation of bleeding, and shrinkage of the tumor was demonstrated by pre and post therapy arteriography and scanning. Because of the success of the transpalatal surgical approach and the hesitancy of administering irradiation too, surgical excision is the treatment of choice in all cases that do not have intracranial extension.
Early diagnostic signs and symptoms of laryngeal disease
Authors: Brewer David W.
Published: September 2006

A compilation of late and early symptoms of patients who ultimately were found to have laryngeal disease was carried out. Notation of even minor changes in the indirect laryngoscopic appearance of the same patients was made routinely. Correlation of symptoms with signs has made possible a better understanding of the natural history of certain laryngeal lesions such as contact ulcer, polyps, nodes, dysphonia plica ventricularis as well as some of the pareses, paralyses and fixations. Identical early symptoms and numerous signs have apparently been ignored in subsequently proven cases of cancer of the larynx.

The expanded list of symptoms (33 in number) and the detailed list of signs (54 in number) may now assist the Otolaryngologist in earlier diagnosis. Although the reported findings are not specifically diagnostic of cancer of the larynx, they should draw earlier attention to the larynx as the etiological site of such symptoms. Earlier recognition of minor laryngeal changes, as detailed in the text, should lead to earlier biopsy and tissue diagnosis, earlier and more enlightened public awareness, and earlier and, therefore, more effective utilization of present day modalities in the management of carcinoma of the larynx.
Diagnosis of carcinoma of the larynx: A review of current methods
Authors: Strong M. Stuart
Published: September 2006

There is a need to establish the diagnosis of cancer of the larynx as early as possible. Delay in making the diagnosis should occur rarely if all of the available methods are fully utilized. Having established the presence of a carcinoma it should be possible to define the site and extent of the tumor; only with this additional information can the best treatment be selected.

The use of a fiber‐optic laryngoscope or a telescopic laryngoscope (Gould) has made examination of the “difficult larynx” more satisfactory.

X‐ray examination, with or without contrast material, has provided useful information regarding extent of the tumor, particularly with regard to its relation to the glottis.

Microscopic laryngoscopy has proven to be a most reliable way of identifying “the early lesion” and of establishing the extent of an established tumor, especially if supravital staining is applied and the microsurgical laryngeal mirror and laryngeal caliper are used.

The most difficult diagnosis to make at the present time is the presence of residual tumor after radiation, when the tumor does not present on the surface. The solution to this problem will not be found easily.