bluuebunny/crossref_metadata_2025 huggingface dataset:
Head and neck cancer developing in patients with pre‐existing reticuloendothelial malignancies
Authors: Boddie Arthur W. , Goepfert Helmuth , Fischer Edward P. , Ballantyne Alando J.
Published: September 2006

Second primary tumors develop in up to 20% of patients with reticuloendothelial malignancies (REM). At the M. D. Anderson Hospital between 1944 and 1975, there were 29 patients with pre‐existing reticuloendothelial malignancies who developed second primary tumors of the head and neck. The presence of pre‐existing REM complicated staging of the head and neck lesion in 14 of 29 cases (48%). In patients with clinically palpable nodes the status of involvement was correctly assessed in only 4 of 14 instances (28%).

Though only 3 of 29 patients (10%) survived for 5 or more years, the average survival from diagnosis of head and neck cancer to last follow‐up or death was 31 months. Patients with REM in conjunction with head and neck melanoma or with squamous carcinoma of the facial skin or lip had an average survival of 20.7, 40.3, and 51.3 months respectively. Patients with REM in conjunction with second primaries involving the oral cavity, nasal, or oral pharynx, hypopharynx, or larynx did poorly with an average survival of only 8.5 months.
Endolymphatic hydrops and otitis media
Authors: Paparella Michael M. , Goycoolea Marcos V. , Meyerhoff William L. , Shea Donald
Published: September 2006

Clinical observation of patients with fluctuant sensorineural hearing loss following or occurring with chronic otitis media led to the hypothesis that endolymphatic hydrops can result from chronic otitis media. Illustrative case reports are described. This hypothesis resulted in a temporal bone study of 560 cases in which 109 temporal bones demonstrated the presence of hydrops and 194 evidenced otitis media. Seventy‐five cases demonstrated both otitis media and hydrops, of which 20 cases were selected for more detailed histo‐pathological study. An interesting finding was the presence of apical hydrops in every case of the latter group. Statistical interpretation of this data helped rule out a coincidental or chance occurrence. A discussion of this clinical relationship included the significance of subclinical (silent) otitis media as a possible cause of endolymphatic hydrops.
Ménière's—An inner ear seizure
Authors: Dolowitz David A.
Published: September 2006

Data of 27 signs, symptoms or findings were collected on 125 confirmed cases of Meniere's disease. Statistical association, plus the percentage prevalence of these findings were studied to perform a cluster analysis. These findings were used to obtain a statistical picture of the disease in terms of the recorded variable (signs, symptoms and findings).

The major finding was the existence of a group of variables (a central core) of high percentage occurrence. They consisted of intermittent rotational vertigo, intermittent to constant nerve hearing impairment, tinnitus, pressure in the ears, positional vertigo, nausea, abnormal caloric nystagmus, headache and normal laterotorsion. The first four are the classic criteria of Meniere's disease, the remainder are additions. The average patient had 8 of the 9 conditions; 44% had all 9.

A graphic multi‐factor analysis of the signs, symptoms and findings suggests that these patients had a disease of a specific central origin. An alternative suggestion is that of several closely related diseases arising from adjacent central locations.

No indication was found that influenza, hypertension, arteriosclerosis or diabetes were consistent precursors of Meniere's disease.

Spontaneous, positional, gaze and optokinetic (tracking) nystagmus showed no demonstrable relationship to the Meniere's signs and symptoms. They showed the ordinary population prevalence except for spontaneous nystagmus which was slightly higher.

The possibility of using these associations as a guide for correlation of the disease manifestations with neuroatomic tracts and areas is suggested.
Arterial hypoxemia in patients with anterior and posterior nasal packings
Authors: Lin Yen T. , Orkin Louis R.
Published: September 2006

Previous clinical reports indicate that nasal packing is frequently associated with arterial hypoxemia. Anesthesia and surgery in hypoxemic patients can be hazardous, especially when it is associated with acute blood loss.

Nine patients with severe epistaxis, who failed to respond to anterior and posterior nasal packing, were anesthetized for emergency internal maxillary artery ligation. Arterial blood‐gas and pH changes during the procedure were evaluated. The results indicate some degree of arterial hypoxemia and high alveolar/arterial PO2 difference without significant change in PaCO2 and pH in most of the patients observed. Arterial PO2 was within normal range 24 hours after operation.

The anesthetic management is described and the various causes of such arterial hypoxemia are reviewed. It is important to recognize the presence of arterial hypoxemia and treat accordingly during surgery for such patients.
Wegener's granulomatosis: Unusual indication for orbital decompression
Authors: Thawley Stanley E.
Published: September 2006

Wegener's granulomatosis (WG) is characterized by granulomatous vasculitis of the upper and lower respiratory tract together with glomerulonephritis. The majority of cases have ocular, sinus and ear symptomatology. A case is presented with severe granulomatous disease of the sinuses with contiguous spread to the orbit producing exophthalmos and decreased vision. An orbital decompression relieved the pressure and preserved vision. The definitive medical therapy for WG is cyclophosphamide. Emergency orbital decompression may be necessary to preserve vision in WG in patients with rapidly decreasing vision secondary to high intraocular pressure produced by the granulomatous process.
A reaction‐time analysis of electrocochlear stimulation in cats
Authors: Walloch Richard A. , Fenwick James A. , Boberg Richard
Published: October 2006

The effects of pulse width and interstimulus interval of electrocochlear stimulation on behavioral reaction times were investigated in cats. It was determined that square wave, biphasic stimuli with pulse widths of 0.5 msec, elicited faster reaction times than did pulse widths of 0.2 msec. On the other hand, stimuli of 1.0 msec pulse widths showed no appreciable difference in reaction times when compared to 0.5 msec pulse widths. The effects of interstimulus interval (ISI) on reaction times are also discussed. An interstimulus interval of 2 msec demonstrated no marked difference in reaction time when compared to the same stimulus with an ISI of 4 msec.
Superiorly based tracheostomal flap to counteract tracheal stenosis: Experimental study.
Authors: Eliachar Isaac , Goldsher Moshe , Joachims H. Z. , Mordechovich Dan , Shohat S.
Published: October 2006

A superiorly based tracheal flap raised from the anterior tracheal wall was rotated anteriorly and superiorly to be sutured to the subcutaneous tissues. A series of 16 tracheostomies were performed on mongrel dogs. The stenosing effects of conventionally performed operations were compared to those of the new method. Autopsy sections of the post‐tracheostomy sites demonstrated a significant loss of anteroposterior diameter averaging 16.5% as compared to the original unoperated‐on luminae. No signs of tracheal stenosis were found whenever the proposed new technique was employed. This technique seems applicable to patients in whom assisted ventilation is contemplated.
Selective facial neurectomy for essential blepharospasm
Authors: Spector Gershon J. , Smith Peter G. , Burde Ronald M.
Published: October 2006

Selective distal facial nerve neurectomy was performed on seven orbicularis oculi muscles in four patients. Five operations were successful and two succeeded following a completion neurectomy.

Our operation combines the approach for an Aufricht rhytidectomy and the selective denervation of the orbicularis oculi muscle only, and bypasses the parotid gland completely. There have been no major complications.
Clinically‐directed ct in occult disease of the skull base involving foramen ovale
Authors: Noyek Arnold M. , Kassel Edward E. , Jazrawy Helen , Wortzman George , Holgate Richard C.
Published: October 2006

Occult disease of the skull base may present as an isolated neurogenic symptom in the absence of physical signs or radiologic findings. It therefore often remains undiagnosed until advanced. Computed tomography (CT) provides the potential for diagnostic imaging far beyond conventional radiology. Not only do current generation scanners provide exquisite bone detail, they also provide the capability of soft tissue imaging.

In the past year, we have matched the diagnostic problem of occult disease of the middle fossa skull base and its foramina with the potential diagnostic imaging solution of CT. Five patients were referred with possible occult middle fossa skull base disease — all had persistent unilateral facial paresthesia in the distribution of one of the lower two trigeminal nerve divisions (V2, V3) as their only complaint; all had previously been extensively investigated (including axial CT); all remained undiagnosed.

Utilizing clinically‐directed CT (based on acoustic neuroma diagnostic index of suspicion and imaging experience), 2 of the 5 patients were found to have small mass lesions involving foramen ovale. This presentation will demonstrate our experience based on image‐manipulated CT, actively monitored by both radiologist and otolaryngologist.
Adenotonsillectomies on a surgical day‐clinic basis
Authors: Segal Cornelia , Berger Gilad , Basker Morrie , Marshak Gabriel
Published: October 2006

Adenotonsillectomies are a common surgical procedure. A review is given of 892 cases of tonsillectomies and adenoidectomies performed on a basis of short hospitalization without added risk. Benefits, both financial and psychological, are described.
Clinical and experimental results with focused ultrasound
Authors: Peron Didiler L. , Kitamura Ken , Carniol Paul J. , Schuknecht Harold F.
Published: October 2006

Focused ultrasound was applied at the lateral semicircular canal in 19 patients and at the round window in 12 patients, all of whom had intractable vertigo caused by Meniere's disease. Postoperatively, the vertigo was relieved or diminished in 75% of the lateral canal cases and in 25% of the round window cases. The results indicate that the lateral canal approach may have some therapeutic value, but the treatment is arduous for the patient and the risk of facial palsy is always nettlesome. Utilizing similar techniques, ultrasound irradiation was given to the lateral canals of 6 squirrel monkeys and to the round windows of 15 cats. After survival times of up to 3 months, light microscopic studies of the temporal bones of these animals show no morphological changes which can be attributed to the ultrasound irradiation. In general, these findings are in concert with the reports of other investigators and show that selective ablation of the vestibular sense organs cannot be achieved by current techniques of ultrasound irradiation. It seems doubtful that prolonged relief of vertigo can be expected to occur without a more complete morphological ablation of the vestibular sense organs than is possible with the current methods of ultrasound treatment.
An assessment of neck node immunoreactivity in head and neck cancer
Authors: Schuller David E.
Published: October 2006

Current conventional forms of cancer treatment represent non‐specific modalities that destroy not only cancerous but also noncancerous tissue in an effort to totally eradicate the neoplasm. It was unknown in head and neck cancer whether a more specific form of treatment, as it relates to neck nodal disease, was advisable. The purpose of this investigation was to study the cervical node immunoreactivity in head and neck cancer patients as a means of determining their immunologic capabilities and thus provide information about the merits of specific vs. non‐specific cancer treatment. The results demonstrated that lymphocytes arising from cervical nodes caused alterations in the tumor growth. There appeared to be no particular difference in immunoreactivity of lymphocytes arising from nodes located in different areas of the neck. The regional immune system of neck nodes in the head and neck cancer patient appears to be capable of mounting an immune response irrespective of the patient's tumor status. Usual measures of systemic immunocompetence failed to identify any patients with advanced stage disease and showed little correlation with the regional immunoreactivity. The regional nodal immunoreactivity also did not correlate with the size or the numbers of metastatic neck nodes. The results demonstrate that cervidal neck nodes are capable of mounting an immune response to head and neck cancer and are not mere passive filters that are periodically involved with tumor emboli. These results support the need for the development of reliable treatments which are directed at tumor tissue only.
The role of supraomohyoid neck dissection at the time of supraglottic laryngectomy
Authors: Baredes Soly , Nussbaum Moses , Som Max L.
Published: October 2006

Uncontrolled cervical metastasis is the most common source of failure in the surgical treatment of supraglottic carcinoma. This study was designed to determine the value of suprnomohyoid neck dissection in patients undergoing supraglottic laryngectomy. The rationale for considering the role of supraomohyoid neck dissection is that such a dissection encompasses the subdigastric and midjugular nodes which arc the first echelon of lymphatic drainage of the supraglottic larynx.

Thirty‐eight patients with a diagnosis of epidermoid carcinoma of the supraglottis were treated by subtotal supraglottic laryngectomy (SSL). Ten patients underwent SSL with no neck dissection, 16 patients underwent SSL with supraomohyoid neck dissection (SOHD) — 9 unilateral and 7 bilateral, and 12 patients underwent SSL with radical neck dissection (RND). The 3 groups had comparable T classifications. All of the SSL and SSL with SOHD patients were classified as No. Of the 12 patients treated with SSL and RND, 4 were classified as No, 4 as N1, 3 as N2, and 1 as N3. The patients were studied to determine the incidence and pattern of subsequent neck disease, survival, complications, and length of hospitalization.

The data indicates that supraomohyoid neck dissection offers little benefit as an adjunct to supraglottic laryngectomy.
Pectoralis major myocutaneous reconstruction of the anterior skull base
Authors: Sasaki Clarence T. , Ariyan Stephen , Spencer Dennis , Buckwalter Jeffrey
Published: October 2006

It was once believed that prognosis for many patients with neoplasms of the anterior skull base was hopeless. Now, however, craniofacial resection of these lesions has been curative for many patients.

Massive resections of the anterior skull base pose many potentially life‐threatening complications. Cerebrospinal fluid leakage with meningitis is especially troublesome when previous radiation therapy compromises wound healing. In such circumstances local tissue flaps and skin grafting may not provide reliable separation of the brain from the nose.

The pectoralis major flap was utilized in eight patients undergoing anterolateral resection of the skull base. Several major advantages of this technique include: 1. reliable closure of the subarachnoid space; 2. acceptable cosmesis; 3. rapid wound rehabilitation, allowing early postoperative radiation therapy when necessary.
Ear‐Eye reflexes while riding in a car
Authors: Clack T. Dean , Milburn Wanda O. , Graham Malcolm D.
Published: October 2006

Persons with diminished or absent vestibulo‐ocular reflexes (VORs) are thought to have difficulty with ocular stabilization during sufficiently rapid head movements. This suggests the hypothesis that labyrinthine defective individuals might have impaired visual abilities when in a moving motor vehicle. Ten licensed drivers likely to have abnormal VORs were recruited to assess this possibility. Their labyrinthine function was indexed by measurements of ocular counterroll responses to static head tilt and the nystagmus induced with caloric stimulations. Each person was evaluated on a visual task, i.e., answers to questions about alphanumeric information read from a stationary sign while sitting still and while riding in a car. Comparisons of vision scores tend to be lower in the moving than in the still condition. Furthermore, these decrements appear more closely related to the magnitudes of ocular counterroll than to the caloric reflexes. These results have implications concerning otolithic us. semicircular canal function, vehicle operations by vestibularimpaired individuals, and evaluations of clinical treatments which employ vestibulotoxic drugs.
The efficacy of the CO2 laser in the sterilization of skin seeded with bacteria: Survival at the skin surface and in the plume emissions
Authors: Mullarky Michael B. , Norris Charley W. , Goldberg Ivan D.
Published: October 2006

A quantitative study on the survival of bacteria following exposure to the C02 laser was determined at the skin surface and in the plume. Known quantities of bacteria were inoculated onto the surface of fresh pig skin and exposed to timed bursts of the radiation. Results indicate that the bacterial population at the skin surface was reduced by several orders of magnitude while the potential for spread of bacteria by the plume of smoke was negligible.
Intratracheal thyroid: An unusual cause of upper airway obstruction in a newborn
Authors: Chanin Louis R. , Greenberg Lyon
Published: October 2006

The proper management of upper airway obstruction requires prompt recognition, correct diagnosis, and appropriate treatment. Of all the causes of upper airway compromise, intratracheal thyroid is one of the least common, especially in the newborn.

The majority of cases reported involve adults or adolescents, mostly in European countries. The English literature has fewer cases, none involving a newborn.

The authors report a case they believe to be the first example in the English language of obstructing intratracheal thyroid in a newborn. The authors' experience and literature review of this rare anomaly are presented in an effort to acquaint others with this often unthought of cause of airway compromise.
Nasopharyngeal carcinoma: An evaluation of 134 patients treated between 1971‐1980
Authors: Dickson Robert I. , Flores Albino D.
Published: September 2006

An analysis is made of 134 patients with nasopharyngeal carcinoma treated from 1971‐1980 at the Cancer Control Agency of British Columbia.

Incidence rate for Chinese born in the Orient was 20.5 per 100,000 per year compared to 1.32 per 100,000 for Canadian born Chinese. The Caucasian rate was .19 per 100,000 per year. These figures confirm a 15 times greater incidence of the disease in Chinese born in the Orient over those born in North America.

The 86 Chinese patients were noted to have a 10% poorer survival than the 48 Caucasian patients on long‐term follow‐up.

The main factor affecting survival was initial staging. Overall survival rates were 46.3% three year, no evidence of disease (NED) and 38.3% five year NED survival, but when disease was limited to the nasopharynx (T1, T2, N0) they were 73.9% three year NED and 66.6% five year NED survival.

One‐third of the patients ultimately developed distant metastases below the clavicle. Although lower T and N stage cases had fewer of these, the overall correlation with staging was poor.

Female patients showed statistically significant better survival which was not related to better initial staging. They did, however, have 11% fewer eventual distant metastases.
Auditory short, middle, and long latency responses in acutely comatose patients
Authors: Kaga Kimitaka , Nagai Taiji , Takamori Akiyu , Marsh Roger R.
Published: September 2006

For assessing comatose patients, the combination of auditory short, middle, and long latency evoked potentials (auditory brain stem response [ABR], middle latency component [MLC], and slow vertex response [SVR]) is more comprehensive than auditory brain stem response (ABR) only or ABR with slow vertex response (SVR). Fifty‐four acutely comatose patients were studied. Thirty‐four of the patients had severe head injury and others had coma of varied etiology. Within two months after admission, 25 patients survived, while 29 patients died.

Auditory evoked response measurements were conducted usually within 48 to 72 hours after admission. For patients with normal SVR, MLC, and ABR, there was 100% survival; with absent SVR but normal MLC and ABR, survival was 91%; with absent SVR and MLC and normal ABR, it was 60%; with abnormal ABR, it was 10%; no patient survived whose ABR was absent. It is emphasized that a normal MLC is clearly a predictor of survival of comatose patients, but a normal ABR is not always a reliable indicator of survival.
Anatomical investigation of the corticonuclear projections to the facial nerve nucleus in the cat
Authors: Schmitt John , Gacek Richard R.
Published: September 2006

The present study was performed to demonstrate a cortical projection to the facial nucleus of the cat. The right facial nucleus of 16 cats was injected with the retrograde tracer horseradish peroxidase (HRP). After allowing 36 hours for the retrograde transport of HRP, the animals were sacrificed by perfusion. The cortex, midbrain, and brain stem were removed, frozen sectioned, and reacted for HRP activity. Labeled pyramidal type cells were found bilaterally in layer V of the anterior sigmoid, presylvian, and coronal gyri of the frontal cerebral cortex. A significantly greater number of labeled cells were present in the contralateral motor cortex. Labeled cells were also found in the contralateral red nucleus, ipsilateral oculomotor nucleus, and periaqueductal gray substance of the midbrain.
The safety of frontal sinus fat obliteration when sinus walls are missing
Authors: Donald Paul J. , Ettin Malcolm
Published: September 2006

The dilemma of the management of a severely fractured frontal sinus when portions of the walls are missing presents a number of therapeutic options. The safety of placing a fat graft in such a sinus for obliteration when the graft will be required to obtain its nourishment from the scant vessels contained within the subcutaneous tissue or dura, or worse still, from a dural or bone graft is questioned. Clinical experience has suggested that such a procedure may not be safe. An experiment was performed in nine cats in which all of either the anterior or posterior frontal sinus wall was removed in eight sinuses, and 50% of either wall in the remaining ten. A standard asteoplastic flap and fat obliteration technique was then done.

On microscopic examination 3 months Inter, 50% of the sinuses showed either recpithelialization, mucocele formation, infection, or some combination. This gives some support to the contention that patients undergoing fat obliteration after fracture in which frontal sinus walls are missing are in jeopardy of subsequent mucocele formation and infection.
Vidian nerve surgery revisited
Authors: Bagatella Francesco
Published: September 2006

With microsurgical dissection of 30 nasosinusal blocks, the author has followed the steps of various techniques that have been proposed for vidian neurectomy. The anatomical information obtained leads to the conclusion that each of these techniques has shortcomings if the surgical steps are respected.
A technique for measuring the rate of cerumen production
Authors: Cipriani C. , Cardo P. P. , Rebora A. , Taborelli G.
Published: September 2006

A technique is described for quantitatively measuring the rate of cerumen production. Two different washing solutions were tried. A mixture of alcohol/ether (3:1 v/v) appeared to be the best extracting solution yielding 2.05±0.22 versus 0.73±0.14 mg/week per ear obtained with Triton X‐100 solution. In addition, reproducibility was definitely better. Triton X‐100 may be useful whenever microbiologic evaluations are requested. Total lipids accounted for 73.3% of cerumen extracted with the former solution, triglycerides being 19.5%, and cholesterol 7.2%. Our extracting technique appears to be a good estimate of the cerumen global output and may supply important information about cerumen in several biologic conditions.
Low frequency jet ventilation for tracheal resection
Authors: Scamman Franklin L. , Choi Won W.
Published: October 2006

Low frequency jet ventilation was used successfully for maintaining normal ventilation during tracheal resection for stenosis. Following resection of the stenosis around the endotrocheal tube, the tube was withdrawn and the proximal end of a sterile double lumen nasogastric tube with the distal end removed passed over the ether screen. The larger lumen was connected to a Saunders jet apparatus and the smaller to a CO2 analyzer. With the distal end held in the lumen of the distal tracheal stump, jet ventilation was initiated at a rate of 20/min at a pressure sufficient to obtain adequate chest rise and fall. Adequate CO2 removal was verified by monitoring the expired level and blood gases. We obtained normal arterial and end tidal gas tensions by this method which allowed the surgeon complete freedom to anastomose the posterior and lateral tracheal walls.
Microscopic fluorescence in photodynamic therapy
Authors: Berg Lawrence F. , Harris David M.
Published: October 2006

The use of hematoporphyrin derivative (HPD) as a photosensitizer has been studied in malignant tumor detection via fluorescence and in tumor destruction via a toxic photochemical reaction. Squamous cell carcinoma has been induced in hamster buccal mucosa utilizing the known carcinogen dimethyl‐benzanthracene. HPD was injected intraperitoneally, then at 24 and 48 hours following injection, unstained frozen section specimens were studied with fluorescent microscopy and photographed. The same specimens were then stained with hematoxylin and eosin and the microscopy correlated. HPD fluorescence was documented in the fibrous stroma of the tumor and the keratin layer. Essentially no fluorescence was noted in the malignant squamous cells themselves. No consistent differences between the two postinjection times were noted. These qualitative observations support the postulated mechanism of HPD accumulation in tumors.
Preoperative localization of parathyroid adenomas
Authors: Buchwach Kenneth A. , Mangum William B. , Hahn Frederick W.
Published: September 2006

Patients with primary hyperparathyroidism have a parathyroid adenoma approximately 80% of the time. Preoperative localization of parathyroid adenomas has been significantly improved by the utilization of high resolution (high frequency) real‐time ultrasound. This technique was accurate in 14 (78%) of the 18 cases in our series. There were four false negatives and no false positives. This imaging technique can routinely identify lesions less than 1 cm. High resolution real‐time ultrasound is fast, safe, and cost effective. It is an ideal screening test for the preoperative localization of parathyroid adenomas.
Anterior cricoid split: The chicago experience with an alternative to tracheotomy
Authors: Holinger Lauren D. , Stankiewicz James A. , Livingston Gary L.
Published: September 2006

Twenty‐six infants and children underwent anterior cricoid split (ACS) in an attempt to avoid tracheotomy. Twenty (77%) were extubated successfully without tracheotomy; six (23%) failed and required tracheotomy. Our experience corroborates that reported in the literature. To date, 106 (77%) of 138 patients who have undergone ACS have been extubated successfully without tracheotomy. These results substantiate the validity of the operation when done for the proper indications. Substantive glottic and tracheal pathology indicate a high likelihood of failure of ACS.

It is not clear precisely why the ACS is effective. Subglottic cysts are a factor in some cases. The histopathology of one such case is presented and the implications discussed.
Surgical considerations and hearing results with the ucsf/storz cochlear implant
Authors: Schindler Robert A. , Kessler Dorcas K. , Rebscher Stephen J. , Jackler Robert K. , Merzenich Michael M.
Published: September 2006

Sixteen patients have been implanted with the UCSF/Storz multichannel implant, 11 of whom have been fitted with their external speech processors and transmitters and administered postoperative audiological evaluations. Both the surgical procedures used and the hearing results for these patients are presented. The potential medical/surgical complications of implant surgery and the future direction of research and development within the UCSF/Storz implant program are discussed.
Reirradiation of recurrent head and neck cancers
Authors: Emami B. , Devineni V.R. , Hederman M.A. , Bignardi M. , Spector G. J.
Published: September 2006

Ninety‐nine patients with recurrent cancers of the head and neck region were treated with surgery, radiation therapy, or combination therapy. The follow‐up period ranged from 18 months to 18 years. An initial overall complete response rate of 67% and a partial response rate of 7% (overall response rate –‐ 74%) were achieved. The eventual tumor control rate was 15%. Although equal initial response rates were achieved in recurrences at the primary site and the cervical nodes, the eventual local control was better for the former (21% vs. 10%). Patients receiving less than 5,000 rad had radiotherapy had a 44% complete response and an 11% eventual tumor control. Patients receiving over 5,000 rad had an 80% complete response and a 25% eventual tumor control.
Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract carcinomas: Study of 1,713 cases during a 15‐year period
Authors: Richard J. M. , Saravane D. , Cachin Y. , Sancho‐Garnier H. , Micheau C.
Published: September 2006

A prospective study of 1,713 patients with squamous cell carcinoma of the head and neck submitted to neck dissection between 1957 and 1973 is presented.

We confirm the prognostic significance of the histological analysis of the nodal metastasis. Capsular rupture is the most important factor regardless of the primary site or tumor size. The presence of tumor emboli within lymphatics, the number of invaded nodes, and the number of nodes with capsular rupture are of significance though to a lesser extent. Classification of the clinical characteristics or the nodes provided, in 70% of the patients, a good prediction of histological involvement. In the clinical estimation of histological invasion, an important parameter is the size of the largest node detected, and we suggest this characteristic should be included in the TNM classification of UICC.
Benign and malignant neoplasms of the parotid gland: Incidence and histology in the danish county of funen
Authors: Poulsen Peter , Jøorgensen Karsten , Grøontved Aksel
Published: September 2006

The present series is comprised of 155 patients from the county of Funen who were operated on for tumors of the parotid gland during the 5‐year period, 1978 to 1982. Fifteen cases were malignant, 116 were benign, while no neoplasms were found in 24 cases. The incidence was calculated as 5.8 parotid neoplasms per year per 100,000 inhabitants. Computation of age standardized incidence rates adjusted to European and World Standard populations has been performed. It is stated that the county of Funen is a well‐defined area and the series can be regarded to be representative of a certain geographical area. The histological classification was carried out according to the rules of the World Health Organization (WHO) and revealed a remarkably high occurrence of Warthin's tumors, i.e., 27.5%.
Otolaryngologic cases of m¨︁nchausen's syndrome
Authors: Zohar Yuval , Avidan Gideon , Shvili Yitschak , Laurian Nelo
Published: September 2006

Münchausen syndrome (MS) is now a well recognized and demonstrated entity. This syndrome is characterized by patients who seek hospitalization and present factitious but usually well‐rehearsed histories and symptoms.

Five cases of MS, genuine by their ear‐nose‐throat‐maxillofacial factitious signs, are presented. Two of the cases are related to the uncommon MS by proxy. In this subentity the parents fabricate pathological signs for their children. The psycho‐dynamics and the clinical symptoms of our cases are described and the differential diagnoses of malingering, conversion disorders, and hypochondriasis are brought to attention.
Results in resident cholesteatoma surgery: A review of 85 cases
Authors: Moss Richard , Lucente Frank E.
Published: September 2006

A review of all patients with cholesteatoma operated on by the residents of the New York Eye and Ear Infirmary under the attending supervision of the Otology Service between 1980 and 1984 was done. Of 130 resident cases, 85 had documented follow‐up 1 year or longer and were included in the study. Recurrence rates were 18% with canal wall down (CWD) and 43% with canal wall up (CWU) techniques. Considering other forms of failure (such as precholesteatoma, tympanic membrane perforation, and chronic infection), overall failure rates were 33% (CWD) compared with 82% (CWU). Cholesteatoma recurrence failure rates were higher in patients under the age of 20 (33%) than over the age of 20 (19%). Overall failure rates were 61% and 37% for younger and older patients, respectively. Due to the high failure rate with canal wall up techniques in resident hands, it is recommended that resident service cases be treated with canal wall down technique, especially in the younger age group.
Parathyroid carcinoma: Two new cases — diagnosis, therapy, and treatment
Authors: Mashburn Mark A. , Chonkich George D. , Petti George H. , Chase Donald R.
Published: September 2006

Carcinoma of the parathyroid gland is a disease only rarely encountered in clinical practice. As most of these tumors retain the ability to manufacture active parathyroid hormone, most patients with the disease present with hypercalcemia, many times symptomatic. Since the tumor accounts for only 0.5% to 4.0% of cases of primary hyperparathyroidism, the diagnosis of parathyroid carcinoma may be unsuspected and delayed. The clinical index of suspicion should be elevated if there is a palpable neck mass, an exceptionally high serum calcium level, and/or recurrence of hypercalcemia following surgery.

We review two patients with parathyroid carcinoma who presented with hypercalcemia. In both, the diagnosis of malignancy was made only after microscopic examination of the operative specimen. Surgery consisted of wide local excision in both cases; radiation therapy was administered in one. Postoperative disease‐free status is now 23 and 37 months. One of the patients had a history of radiation therapy to the larynx 20 years prior to the development of parathyroid carcinoma. Also reviewed in this paper are the clinical and histopathologic criteria for making the diagnosis of parathyroid carcinoma and the therapeutic approaches and prognosis of this unusual tumor.
Morphological aspects of the vestibular nerve of the squirrel monkey
Authors: Honrubia Vicente , Kuruvilla Alexander , Mamikunian Dawn , Eichel James E.
Published: September 2006

A morphological study of the vestibular nerve of a primate, the squirrel monkey, revealed a systematic organization of neurons according to fiber diameter. At the center of the cristae, thick fibers align in two parallel rows along the long axis; in the periphery of the cristae, thin fibers predominate. Within the superior vestibular nerve the thick fibers of the anterior and horizontal semicircular canals and utricle are situated in the anterosuperior area, the thin fibers in the posterior part. A similar segregation occurs with fibers of the posterior ampullary nerve and the saccule within the inferior vestibular nerve. The fibers continue to segregate at the root entry zone where they lose their Schwann's cell ensheathing and begin to divide into secondary central branches. There is a correspondence between the volume of the ganglion cell and the fiber diameter; hence, a segregation of ganglion cells according to their size also takes place in the vestibular nerve. The organization of the primate's vestibular nerve is similar to that found earlier in an anuran. The relevance of the phylogenetic preservation of the vestibular nerve's anatomical organization is discussed in terms of current physiological findings, which support the differential role of fibers of different diameters in vestibular function.
Major complications following tracheoesophageal puncture for voice rehabilitation
Authors: Andrews James C. , Mickel Robert A. , Monahan Gail P. , Hanson David G. , Ward Paul H.
Published: September 2006

The successful use of the tracheoesophageal voice prosthesis for speech rehabilitation of the total laryngectomy patient has lead to common application of this device. Although the creation of a tracheoesophageal fistula is a simple procedure, it is not without complications. A review of 104 patients who underwent this procedure indicated a complication rate of 25%. Complications were related primarily to the fistula and included migration and progressive enlargement of the puncture, persistent or recurring infection of the fistula site, aspiration pneumonia, and death. Other problems included aspiration of the prosthesis, vertebral osteomyelitis, and tracheal stomal and esophageal stenosis. Many of these patients required hospitalization, intravenous antibiotics, and major surgical procedures to treat these complications. Guidelines for early identification and management of these problems as well as methods to prevent complications are discussed.
Vestibular reflex changes following aminoglycoside induced ototoxicity
Authors: Black F. Owen , Peterka Robert J. , Elardo Sandra M.
Published: September 2006

The effects of aminoglycoside‐induced changes on the vestibular system were evaluated in three subjects who suffered significant damage over the course of treatment. Measurements of vestibulo‐ocular reflex (VOR) function were made using sinusoidal and pseudorandom rotational stimuli between 0 to 5 days after initiation of drug therapy, during drug therapy, and up to 579 days following drug administration.

All subjects tested at baseline evaluations had normal VOR function. During aminoglycoside therapy there was a precipitous drop in both the VOR time and gain constants. The decline in VOR function was larger at lower stimulus frequencies compared to high frequencies, resulting in a relative preservation of function in the high frequencies. Over a period of about a year, VOR high frequency gains recovered to within normal limits. However, the VOR time constants showed only a modest recovery and remained well below the normal range.
Necrotizing external otitis in children: Report of two cases and review of the literature
Authors: Sobie Steven , Brodsky Linda , Stanievich John F.
Published: September 2006

Necrotizing external otitis is described almost exclusively in elderly diabetics. A review of the literature revealed 12 children, ages 2 months to 21 years, who have been described with this problem. Two additional patients are reported here.

In children the male:female ratio is 1:1, whereas in adults a 2:1 male preponderance is seen. Diabetes mellitus, present in 94.7% of adults, is seen in only 21% of children. Facial nerve paralysis occurs in 35% of the children as compared to 52% of the adults. Facial paralysis was permanent in 100% of the children, but only 36.3% of the surviving adults had permanent facial paralysis. Surgical intervention had no significant effect on either group. Other pediatric complications include external auditory canal stenosis (29%), auricular cartilage deformity (11%), and sensorineural hearing loss (18%). A 40% to 50% mortality rate is seen in adults whereas no deaths have been reported in children.

The clinical presentation of necrotizing external otitis in children shares some features with the disease as described in adults. However, notable differences do exist and form the basis of this report. The proposed pathophysiology of necrotizing external otitis in adults and its significance for disease in children are also discussed.
Transtracheal/transesophageal stimulation of the recurrent laryngeal nerve
Authors: Sanders Ira , Kraus Warren M. , Aviv Jonathan E. , Racenstein Michael , Biller Hugh F.
Published: September 2006

A new technique is described which allows stimulation of the recurrent laryngeal nerve (RLN) through intact tracheal and esophageal mucosa. In ten anesthetized dogs, the posterior‐lateral tracheal wall and the anterior‐lateral esophageal wall were stimulated by a 1 to 2 mA current with a probe placed just distal to the edge of the cricoid cartilage. The tracheal mucosa was approached through a tracheostomy stoma and the esophageal mucosa through the mouth. The resultant vocal cord motion was frequency dependent, with graded abduction occurring below 30 Hz and adduction above 40 Hz. By stimulating the posterior laryngeal mucosa proximal to the cricoid edge, the RLN branch to the posterior cricoarytenoid muscle was activated, causing ipsilateral vocal cord abduction independent of frequency. Monitoring of cardiopulmonary parameters demonstrated no alterations at these amperages. There were no mucosal abrasions noted. The transtracheal and transesophageal approaches to RLN stimulation appear promising as diagnostic techniques for evaluating vocal cord function during laryngoscopy and, possibly, as methods of glottic airway control.
Meningioma in the paeotid region
Authors: Nichols Richard D. , Knighton Robert S. , Chason Jacob L. , Strong Douglas D.
Published: September 2006

Meningiomas occurring ectopically in the neck are exceptional. We report two patients who presented as parotid and parapharyngeal masses and analyze them along with 27 previously reported cases.

Typical patients present with parotid or parapharyngeal masses and cranial nerve palsies. Meningioma is not considered in differential diagnosis. The tumor is an extension of an unsuspected intracranial mass, occasionally with associated multiple meningiomas or other neurogenic tumors.

Ectopic meningiomas should be considered inpatients with parotid and parapharyngeal masses, particularly those with cranial nerve deficits; jugular foramen syndrome is most characteristic. Associated occult intracranial and temporal bone tumors and the cranial form of neurofibromatosis should be suspected.

Treatment of cervical meningiomas is excision. The most important aspect of intracranial‐extracranial lesions is recognition and treatment of the intracranial portion.
Facial nerve monitoring during acoustic neuroma removal
Authors: Benecke James E. , Calder H. B. , Chadwick Geraldine
Published: September 2006

As the surgeon's ability to perform total acoustic tumor removal without major neurologic deficit has reached a pinnacle, preservation of facial nerve function has assumed a higher priority. Satisfactory postoperative facial function depends upon an anatomically and physiologically intact facial nerve. Precise localization of the facial nerve is the first step toward preservation of function. Intraoperative facial nerve (FN) stimulation allows the surgeon to safely locate the facial nerve. Monitoring evoked electromyographic activity with an audio speaker provides direct, ongoing information regarding trauma to the nerve during dissection.

Intraoperative FN monitoring was used in 18 consecutive translobyrinthine acoustic tumor removals. Seventeen patients had an excellent facial nerve result (Grade I or II using the House 6‐point scale). The authors conclude that intraoperative FN stimulation and monitoring during acoustic tumor removal is a safe and reliable method of locating and protecting the facial nerve during cerebellopontine angle surgery.
Speaking proficiency variations according to method of alaryngeal voicing
Authors: Williams Sarah E. , Watson Jennifer Barber
Published: September 2006

Twelve judges, with no previous exposure to laryngectomees, rated the speaking proficiencies of 33 laryngectomees divided into the following groups: 1. esophageal speakers (n=12); 2. electrolarynx speakers (n=11); and 3. tracheoesophageal puncture speakers (n=10). In addition, the speech of ten normal subjects was rated. Specific speaking parameters examined included voice quality, pitch, loudness, intelligibility, rate of speaking, visual presentation during speech, extraneous speaking noise, and overall communicative effectiveness. Multiple discriminant analyses performed on the ratings made by each judge revealed significant differences in ratings for various speaking parameters in the four subject groups. Results generally support the stance that tracheoesophageal speech is perceived as superior to communication with either an electrolarynx or with traditional esophageal speech, even though it is not viewed as comparable to normal voice.
Sublabial transseptal repair of choanal atresia or stenosis
Authors: Krespi Yosef P. , Husain Shaista , Levine Toni M. , Reede Deborah L.
Published: October 2006

Bilateral choanal atresia in newborns and infants carries significant morbidity and mortality, therefore, prompt correction is required. The transnasal route is usually preferred in the infant age group. This approach, however, carries significant incidence of restenosis. The transpalatal correction of choanal atresia has been the definitive approach in older children and adults. We are introducing a new procedure for correction of choanal atresia or stenosis that can be used at any age. The sublabial transseptal repair was performed in four infants without complications or restenosis. Two of our patients previously underwent different types of repair with persistent choanal stenosis. The sublabial transseptal approach provides wide exposure to the nasal cavity and the floor leading to the choanae. The operating microscope and various otologic micro‐instruments were used in the surgical dissection. Preservation of the anterior inferior cartilaginous septum and the maxillary crest and spine is mandatory in order not to disturb the nasal growth pattern of the nose and premaxilla. The infants were evaluated with a computed tomography (CT) scan, preoperatively. The posterior inferior portion of the vomer is uniformly wide, increasing the degree of stenosis or atresia. Removal of the vomer is an essential part of this procedure in order to open and enlarge the choanae. Both choanae were stented with polyvinyl tubes.

Every attempt was made to keep the stents in position for a minimum of 8 to 10 weeks. Follow‐up has been for 2 to 4 years, and no recurrent choanal stenosis has been experienced.
A computerized data management system for head and neck oncology
Authors: Fletcher Margaret M. , Mcmanus Christopher D.
Published: October 2006

Medical information, diagnostic technology, and modes of therapeutic intervention available for treatment of head and neck cancer have increased exponentially. The concurrent explosion of microcomputer technology has created an ideal instrument for organizing, storing, and reporting the expanded data the head and neck oncologist must now consider.

This paper presents the principles, design, and operation of a recently developed head and neck oncological database program (HNODB). Details of implementation on a microcomputer are also described. A historical review of currently used prominent cancer registration programs is presented. It defines the fundamental elements of cancer registration.

A review of cancer registration in the United States shows that current systems have serious deficiencies and have not kept pace with the evolution of diagnostics, treatments, and computer technologies. The HNODB database program, however, is a valuable model for cancer data management, for it can be applied to small or extensive data collection needs, and it provides an accurate system to identify risk factors, numbers of patients treated, and types of treatment given. The program allows for rapid analysis of treatment, results, follow‐up, and survival rates of patients with carcinoma of the head and neck.