bluuebunny/crossref_metadata_2025_split huggingface dataset:
Replacement of the arytenoid following vertical hemilaryngectomy
Authors: Blaugrund Stanley M. , Kurland Stephen R. 
Published: September 2006

AbstractA considerable body of literature advocates and defines treatment of vocal cord cancer with posterior extension by hemilaryngectomy. The present study was carried out to determine the feasibility of using a newly devised pedicle flap, composed of thyroid cartilage and inferior constrictor muscle, to replace the ablated arytenoid cartilage. Animal investigation revealed satisfactory viability of the pedicle flap in canines, and in humans, five patients with T2 glottic carcinoma demonstrated excellent postoperative deglutition and return of voice. The results of the study indicate that this surgical technique merits consideration for its use in minimizing protracted glottic incompetence following hemilaryngectomy. The thyroid cartilage‐inferior constrictor muscle pedicle flap may also prove useful as partial cricoid replacement in selected cases of subglottic extension and in cricoid reconstruction following trauma.
Reasons for irradiation failure in squamous cell carcinoma of the larynx
Authors: Fletcher Gilbert H. , Lindberg Robert D. , Hamberger Arthur , Horiot Jean‐Claude 
Published: September 2006

AbstractThe reasons for irradiation failure in squamous cell carcinoma of the larynx can be1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals.2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure.3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions.4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent.5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice.6. New cancer. Probably 25 percent of the so‐called recurrences on the vocal cords are actually new primary lesions.The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy.In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re‐irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.
Kinetics of tumor growth and of cell proliferation in U.R.D.T. cancers: Therapeutic implications
Authors: Tubiana M. , Richard J. M. , Malaise E. 
Published: September 2006

AbstractAfter a brief survey of the factors of clinical tumor radioresistance the available data on the growth rate and on the kinetics of cell proliferation of U.R.D.T. tumors are reviewed.The growth fraction and the cell turnover rate appear to be similar in U.R.D.T. tumors and in other squamous cell carcinomas. These two parameters are correlated with clinical tumor radiosensitivity and chemosensitivity. The possible value of tailoring fractionation and drug administration to the biological characteristics of the tumor is discussed.
Acalculous parotid sialadenopathy
Authors: Fried Marvin P. , Spector Gershon J. , Webber Bruce L. , Ogura Joseph H. 
Published: September 2006

AbstractAcalculous inflammation of the parotid gland has been regarded by some as a specific disorder that can be staged as to the severity of the disease process. A review of the literature, however, indicates a divergence of opinion. It is the purpose of this study to test this hypothesis by a retrospective double‐blind analysis of clinical, sialographic and histopathologic findings.Forty‐two patients who were seen by the Department of Otolaryngology, Washington University School of Medicine from 1961 to 1970 were evaluated by two separate teams. There were 20 sialograms and 30 pathologic specimens, and all were re‐examined. Eleven patients had both sialographic studies and histopathologic examination. The clinical presentations and sialographic findings were reviewed. These findings were then compared to each other. Our results indicate that we could not evaluate the severity of the clinical disease by sialography or histopathology. There was no consistent method of staging the sialographic and pathologic findings. In addition, there was no correlation between these two parameters. They reflect neither the patient's clinical syndrome pattern nor the extent of disease. It appears that the parotid gland responds variably to inflammation. These observations are exemplified by case histories.
Iv. multiple glomus tumors in the head and neck
Authors: Spector Gershon J. , Ciralsky Robert , Maisel Robert H. , Ogura Joseph H. 
Published: September 2006

AbstractEight of 76 glomus tumors in the head and neck region are multiple. The most common association is with carotid body tumors; the most common pattern is an ipsilateral glomus tympanicum and carotid body tumor. The approach to clinical evaluation is based on a complete otolaryngologic, neurologic, and neuroradiologic evaluation of all patients with glomus tumors. The rationale for priorities in management is the resection of the most dangerous lesion first. This study confirms the previous observations that glomus tumors have a definite proclivity for multicentricity (10 percent) and a high incidence for other associated malignancies (8 percent).
Pseudomonas aeruginosa meningitis following stapedectomy
Authors: Lairmont Albert A. , Nicholson William L. , Turner John S. 
Published: September 2006

AbstractMeningitis is a rare complication following stapedectomy. Most cases are preceded by a fistula in the oval window. Although fatalities have been reported, most cases respond to parenteral and intrathecal antibiotics if diagnosed and treated early. Gram‐positive organisms are the usual pathogens, but Gram‐negative organisms may be found, especially as a superinfection following antibiotics administered prophylacticly or for the treatment of otitis media or mastoiditis. A case of Pseudomonas aeruginosa meningitis five weeks after stapedectomy, successfully treated with gentamicin, is reported. The discussion includes the diagnosis of post‐stapedectomy fistula and meningitis and current trends in treatment.
Carcinoma of the subglottic area
Authors: Sessions Donald G. , Ogura Joseph H. , Fried Marvin P. 
Published: September 2006

AbstractThe subglottic area is defined as an anatomic region which is cylindrical in shape whose inferior margin is the inferior border of the cricoid cartilage and which is limited superiorly by an imaginary circle 5 mm below the free margin of the true vocal cords. Of 591 patients with glottic and subglottic cancers, only five (1 percent) had primary subglottic tumors and 132 (22 percent) had glottic tumors with subglottic extension. Sixty‐five percent of the patients with glottic primary with subglottic extension were Stage 2 and 35 percent were Stage 3. Most patients were treated surgically. Hemilaryngectomy is a very satisfactory primary modality in the treatment of Stage 2 and some Stage 3 glottic lesions with subglottic extension. Stage 2 and 3 glottic cancers which involve greater than 10 mm of the subglottis carry a significantly decreased prognosis. Patients with T3 lesions with cord fixation with subglottic extension show a decreased survival.
Panel discussion on glottic tumors. I. The evaluation of treatment of patients with extensive squamous cancer of the vocal cords
Authors: Jesse Richard H. 
Published: September 2006

AbstractFifty‐one patients with previously untreated squamous carcinoma originating on the true vocal cord, staged T4, were analyzed. Forty‐eight of the 51 patients were selected for treatment. Total laryngectomy was the minimal surgical procedure, and the pathologist confirmed the presence of cancer outside the confines of the larynx in 47 of 48 patients. Seventy‐three percent of the patients were thought clinically to have negative nodes, but examination by the pathologist showed a 20 percent false negative rate in this evaluation. Twenty‐one percent of the patients had received an emergency tracheostomy prior to being referred to our institution. An additional 8 percent required an emergency tracheostomy or laryngectomy. Radiation therapy was employed postoperatively for 16 patients.Twenty‐six (54 percent) of the 48 patients had no further evidence of cancer after treatment. In evaluating the failures, previous tracheostomy, extension of the disease to the pharyngeal wall, and positive cervical lymph nodes were found to effect adversely the survival of the patient; however, extension of the disease into the trachea, when it occurred alone, was not an adverse factor.In this patient group with a median age of 66 years, 27 percent died of causes other than the cancer within four years. Based on the data in this series, postoperative radiation therapy is now being routinely given to patients with disease extending to the pharyngeal wall, those with nodes in the neck, and those who have had an emergency tracheostomy previously.
Panel discussion on glottic tumors. V. Carcinoma of the laryngeal glottis therapy and end results
Authors: Skolnik Emanuel M. , Yee King F. , Wheatley Michael A. , Martin Lawrence O. 
Published: September 2006

AbstractThe end results of 264 patients with vocal cord carcinoma treated by either surgery or radiation therapy at the University of Illinois from 1955 to 1972 are analyzed. Stage I glottic carcinoma can be cured by either surgery or radiation alone (86 percent and 80 percent). Stage II glottic cancer treated by surgery has achieved survival rates of 70 percent. The five‐year end results of Stage III glottic cancer are 49 percent for surgery and 30 percent for radiation. The management of glottic carcinoma, according to anatomic site and indications for various modalities are discussed.
Panel discussion on glottic tumors. VIII. The treatment of glottic carcinoma: An analysis of 800 cases
Authors: Hawkins N. V. 
Published: September 2006

AbstractAll patients with cancer of the glottis seen at the Ontario Cancer Institute from 1955 to 1971 are reviewed. Changes in referral patterns and treatment policy are noted. Particular attention is given to those patients who received radiation for cure, and the place of laryngectomy in their subsequent management is examined. Of the estimated incidence of the disease in the geographic region served, 95 percent are now being seen and of these 97 percent receive treatment with curative intent. Two‐thirds or 67 percent are cured at five years with their larynges intact, while a further 18 percent are cured by subsequent laryngectomy.
Panel discussion on glottic tumors. IX. Radiotherapeutic management of cancer of the glottis, university of virginia, 1956–1971
Authors: Constable William C. , White Robert L. , El‐Mahdi Anas M. , Fitz‐Hugh G. Slaughter 
Published: September 2006

AbstractAll patients with cancer of the glottis treated by radiotherapy with curative intent at the University of Virginia from 1956 through 1971 have been reviewed. Follow‐up is complete through December, 1973. Results are presented by both stage and treatment policy and indicate that with our present methods of management a high degree of local control is achieved. The complications of treatment are examined, particularly those arising as a result of combined radiotherapy and surgery. A small number of cases have been salvaged following local recurrence and these are described in detail. Particularly striking has been the effectiveness of radiotherapy in the treatment of advanced (Stage III and IV) lesions. In this group 58 percent of the patients survive with their larynges intact. Considering the poor general condition and advanced nature of the lesions in these cases this result is important and may indicate the nature of future trends in treatment, namely radiotherapy, with surgery held in abeyance until there is overt recurrence.
Conservative neck dissection
Authors: Bocca E. 
Published: September 2006

AbstractThe areolar tissue which fills the laterovisceral spaces of the neck is thought to be in close contact with the limiting muscle and the large vessels and nerves of the neck. The site of lymph nodes and lymphatic vessels in such tissue is not clearly defined. A more profound anatomical study shows that the areolar tissue contains the whole lymphatic system of the neck, limited by a series of aponeuroses. These are derived from the embryonal mesenchyme, surrounding muscles and vessels, giving origin to a series of compartments which are in continuity with each other. These compartments, which contain the lymphatic structures, may be entirely removed en bloc including their limiting aponeurotical membranes, as long as the latter are carefully stripped from the muscular and vascular structures. This technique of neck dissection originating with O. Suarez in Argentina, is as radical as any traditional neck dissection, providing that some technical details are respected and that the nodes are still mobile. By preserving many useful or necessary structures of the neck, which themselves are unrelated to the lymphatic spread of cancer, conservative neck dissection presents important functional and cosmetic advantages as compared with traditional neck dissection.
Analysis of surgical therapy for epidermoid carcinoma of the laryngeal glottis
Authors: Ogura Joseph H. , Sessions Donald G. , Spector Gershon J. 
Published: September 2006

AbstractFour hundred sixty‐three patients with glottic carcinoma were treated by surgical techniques with or without preoperative irradiation. Two hundred eighty‐one had hemilaryngectomy and 182 total laryngectomy procedures. The overall cure rate for the hemilaryngectomy group was 91 percent and 80 percent for the total laryngectomy group, with an overall cure rate of 87 percent.Our observations support the fact that Stage I glottic carcinoma has slightly better prognosis when treated by hemilaryngectomy. Stage II and III lesions have a significant improvement in cure rate and survival when treated with combined preoperative irradiation and partial vertical laryngectomy or total laryngectomy than by irradiation alone.
Life‐threatening complications of infectious mononucleosis
Authors: Mccurdy John A. 
Published: September 2006

AbstractInfectious mononucleosis is a common febrile disorder of children and young adults which is generally benign and self‐limited. Patients with this disorder, however, may develop life‐threatening complications which require prompt recognition and treatment. The clinical features of three such cases are presented and pertinent features of other life‐threatening complications are reviewed.
The role of the middle ear in acoustic trauma from impulses
Authors: Eames B. L. , Hamernik R. P. , Henderson D. , Feldman A. 
Published: September 2006

AbstractExposure to high intensity impulse noise may produce a wide range of audiometric and histological effects in experimental animals. The objective of this study was to assess the changes in the middle ear mechanism after impulse noise exposure and to relate these changes to the audiometric and histological effects.Nine monaural chinchilla were exposed to either 161 or 166 db peak SPL impulses of 1 msec “A” duration, presented at a rate of 1 per minute for 50 minutes. The conductive mechanism of the chinchilla was assessed using standard clinical measures of static and dynamic impedance before and after the noise exposure. Auditory thresholds were measured before and after noise exposure using the average evoked response (AER) technique. At 30 days post‐exposure, the animals were sacrificed for histology.Pre‐exposure tympanometry showed that: 1. the total mean impedance of the chinchilla ear is considerably lower than that of man; 2. a method related hysterisis effect is present in both the susceptance and conductance tympanograms; and 3. sedation has a significant effect on the total impedance of the ear and on the shape of the tympanograms. After exposure to high level impulse noise: 1. tympanograms become irregular and double peaked, indicating tympanic membrane stress; 2. for the given exposure, 166 db is the impulse intensity needed to rupture consistently the tympanic membrane; and 3. audiometric and histological data correlate with the tympanometry findings and demonstrate a protective effect of a tympanic membrane rupture on the cochlea.
Specialties and the specialty boards
Authors: Holden William D. 
Published: September 2006

AbstractAs specialism has developed in the United States, multiple specialty societies and specialty boards have been created. Although they, in a very realistic fashion, have established the general standards for the delivery of specialty care and for graduate medical education, they, with other national medical organizations such as the American Medical Association, the Association of American Medical Colleges, and the American Hospital Association, function with a considerable degree of independence. There is lacking a cohesive and integrated effort to develop unified attitudes, postures, and policies that represent the medical profession and the health care industry in general. Recently the Coordinating Council on Medical Education and the Liaison Committee on Graduate Medical Education have been established. These two agencies represent a significant attempt to integrate policies for medical education and to identify a single accrediting agency that will apply uniform standards to the process of accrediting programs of graduate medical education.The federal government for the past several years has had an increasing interest in the health care industry and medical education. Many legislative bills have been passed which have imposed more and more regulations on medicine and have established more bureaucratic control over the professional activities of physicians. Insidiously the medical profession is being socialized.If accountability for the public welfare cannot be exercised by medicine, at least in the perspective of the federal government, more and more legislation and regulation are inevitable.The pluralistic structure of organized medicine will ultimately be self defeating. Cohesive policies on behalf of the medical profession must be developed if leadership in medicine is to remain in the private sector. The Coordinating Council on Medical Education is unquestionably a significant attempt to demonstrate public accountability. It is, however, only the first step in the long and difficult process of developing cohesive national policies on behalf of organized medicine.
Human laryngeal reinnervation
Authors: Tucker Harvey M. 
Published: September 2006

AbstractBilateral vocal cord paralysis is fortunately an uncommon occurrence although the incidence of this injury secondary to external neck trauma is increasing. In general, a patient with this lesion is faced with the choice between adequate airway at the expense of a breathy, weak voice or a fairly good voice with the need for a permanent tracheotomy. In an effort to provide a better solution to this dilemma, an attempt has been made to develop a means of reinnervation of at least one vocal cord without the problems inherent in the usual nerve anastomosis techniques. After extensive preliminary work in dogs the nerve‐muscle pedicle technique for reinnervation has been developed. In this procedure the branch of the ansa hypoglossi to the anterior belly of the omohyoid is mobilized and a small block of muscle containing the terminal branches is freed from the muscle proper.Using an approach similar to the Woodman arytenoidectomy, the posterior cricoarytenoid muscle is exposed, and its fibers are partially incised. The previously prepared nerve‐muscle pedicle is sutured to it.In the first five patients subjected to this procedure, return of spontaneous abduction of the reinnervated vocal cord was noted between six and eight weeks post surgery. In no case was the voice weakened nor was there any problem with aspiration. All five patients have achieved sufficient air‐way so that exercise tolerance for daily activities is adequate without a tracheotomy. The physiologic and histologic background of this technique is discussed in detail.
A radiologic advance in the diagnosis of disorders of the larynx
Authors: Travis Lawrence W. , Work Walter P. , Whitehouse Walter M. 
Published: September 2006

AbstractThe cervical spine greatly reduces the usefulness of anteroposterior soft tissue radiologic examination of the larynx. Fractures of the laryngeal and cricoid cartilages are difficult to diagnose by soft tissue technique, and time‐consuming laminagraphy is often required.A new technique for single exposure anteroposterior soft tissue radiography of the cartilages and airway is described. An esophageal cassette containing ultraspeed dental film placed in a retrolaryngeal position is shown to yield detailed radiographs of high contrast. The feasibility of this technique is illustrated by the presentation of radiographs from patients with laryngeal disorders. The new technique is compared with existing examinations available to the clinician and its application in other disorders of laryngeal cartilages and soft tissue is discussed.
Transposition of the lingual thyroid
Authors: Skolnik Emanuel M. , Yee King F. , Golden Theodore A. 
Published: September 2006

AbstractLingual thyroid represents the only functioning thyroid tissue in the body in 70–80 percent of the cases, surgical ablation of which will produce hypothyroidism. Transposition of the lingual ectopic thyroid with its vascular supply intact as a pedicle graft is presented. This seems to be the most logical approach in preserving the viability and function of these ectopic tissues.
Prognostic significance of lymph node histology in patients with squamous cell carcinoma of the larynx, pharynx, or oral cavity
Authors: Berlinger Norman T. , Tsakraklides Vasilis , Pollak Kurt , Adams George L. , Yang Monica , Good Robert A. 
Published: September 2006

AbstractIn a double‐blind retrospective analysis, sections of lymph nodes regional to head and neck squamous cell carcinomas were microscopically examined to assess morphologically the immunologic pattern of response. Patients whose nodes showed evidence of immunologic stimulation had five‐year survival rates significantly higher than those whose nodes showed no evidence of immunologic stimulation.None of the patients whose nodes showed the lymphocyte depletion pattern survived five years. The stage or histologic grade of the tumors did not influence these correlations. Metastases occurred much more frequently in patients whose nodes showed immunologic activity than in those whose did not. The data support the concept that immunologic capacities are important host defense mechanisms against malignancy. Histologic assessment of immunologic activity in regional nodes seems to be an important parameter for predicting survival.