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Biomedical subjects

A D Cheesman

Publications and source records attributed to A D Cheesman.

At least 37 records · Page 2Linked to original sources
PubMed1991

Rhinocerebral mucormycosis: use of liposomal amphotericin B.

Rhinocerebral mucormycosis is a rare but often fatal condition characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit and hence to the central nervous system. A case is reported in which a diabetic male with advanced mucormycosis was successfully treated by a combination of surgery, supportive therapy and liposomal amphotericin B. Liposomal delivery allows the drug to be both less toxic and more effective, and this is the first reported case of its use in rhinocerebral mucormycosis.

Amphotericin B↗
PubMed1991

Cavernous angioma of the cerebello-pontine angle: a case report.

A case of cavernous angioma involving the facial nerve is described. The patient presented with decreased hearing on one side and after investigation a small mass was discovered enlarging the internal auditory meatus. The final diagnosis was made at operation. The pathology of this type of malformation is discussed.

Adult↗
PubMed1990

Imaging jugulotympanic glomus tumors.

Traditionally, jugulotympanic tumors, also called chemodectomas or paragangliomas, have been evaluated by conventional imaging to show bone erosion and angiography for the definitive diagnosis, location, and extent. More recently, computed tomography has been used to show these features as well as the intracranial extension. Magnetic resonance imaging has added a new dimension, particularly for assessment of intracranial spread and growth downward into the neck. We examined 20 jugulotympanic glomus tumors by computed tomography and magnetic resonance imaging with gadolinium enhancement and believe that these two imaging modalities, combined with clinical assessment, can provide all the necessary information regarding diagnosis, situation, and extent in the majority of jugulotympanic glomus tumors. Gadolinium-enhanced magnetic resonance imaging was particularly effective for the detection of small tumors confined to the middle ear and for confirmation that the jugular bulb was not involved. Consequently, angiography is no longer a first-line imaging investigation but rather a preoperative evaluation only in those tumors in which preoperative embolization is required or occasionally when the extent of the tumor, especially in the jugular bulb, cannot be confidently predicted by noninvasive imaging.

Aged↗
PubMed1990

Hypoglossal neuroma following excision of a huge recurrent acoustic neuroma and facio-hypoglossal anastomosis. A complex management problem.

A case of neuroma of the intracranial part of the hypoglossal nerve, not associated with neurofibromatosis, is presented. The patient had previously undergone surgery for the removal of a contralateral acoustic neuroma, and subsequent facio-hypoglossal anastomosis. The importance of early diagnosis, pre-operative clinical assessment and post-operative care is stressed.

Adult↗
PubMed1990

Jugular foramen neuromas: a review of 14 cases.

We present 14 patients with jugular foramen neuromas treated in the professorial unit at the National Hospital, Queen Square, in the 20-year period from 1969 to 1989. The growth characteristics and associated symptomatology of these tumors are variable, and often they do not give rise to a typical jugular foramen syndrome, making differentiation from other low cerebellopontine angle tumors difficult and occasionally impossible. One tumor presented mainly in the neck, but the remaining 13 were predominantly intracranial and their anatomical relationships as defined radiologically determined the surgical approach used. Nine tumors were resected using a posterior fossa approach, three required a combined posterior fossa and neck dissection, and one a combined supratentorial and infratentorial craniotomy. The aim of operation was total excision of the tumor, which was achieved in 10 patients; the remaining three all suffered recurrence. There was no operative mortality and little long-term disability.

Adolescent↗
PubMed1990

Radiological assessment of post laryngectomy speech.

Laryngectomy for carcinoma of the larynx has a five year survival rate of approximately 80% but the operation has a high morbidity as most patients do not develop effective alaryngeal speech. The published literature states that poor speech is occasionally due to anatomical or physiological problems in the reconstructed pharynx but is usually due to psychological, sociological or educational difficulties. We devised a radiological technique using a combination of video-fluoroscopy and static or spot films to assess the anatomy and function of the reconstructed pharynx of post-laryngectomy patients, and investigated 24 good and 134 poor or failed speakers. We examined the pharynx during the acts of swallowing, attempted phonation and attempted phonation with air insufflation. A single vibrating segment (P-E segment) in an otherwise dilated pharynx was present in all good speakers, but was absent in poor or failed speakers whom we classified as hypotonic (19), hypertonic (40), spastic (62) and strictured (13) according to the radiological appearances. This classification has been used to plan subsequent clinical management and 46 of the 55 patients treated to date (84%) have developed effective alaryngeal speech.

Deglutition↗
PubMed1989

Carcinoma of the ear: retrospective analysis of 61 patients.

Malignant tumours of the ear canal and middle ear retain a poor prognosis despite the development of increasingly radical procedures. We report the combined experience of 61 patients presenting to our hospital over the past 30 years with this condition. Radiotherapy was the preferred initial treatment in almost all patients. Early surgical treatment by local resection just before or just after radiotherapy and radical mastoidectomy produced disease free survival for two to 20 years in 59 per cent (16 of 27) patients. Long term survival was achieved in 50 per cent of patients with carcinoma of the external auditory meatus and only 24 per cent of those with middle ear carcinoma. Salvage surgery produced a variable degree and duration of palliation but few survivors. Little was gained in the quality of life by petrosectomy.

Adult↗
PubMed1989

The surgical management of glomus jugulare tumours--description of a single-staged posterolateral combined otoneurosurgical approach.

A series of 31 patients harbouring 33 glomus tumours of the skull base were treated by a posterolateral combined otoneurosurgical approach. Seventy-four percent of tumours were totally exercised. Only one case required a 2-staged procedure. Three patients were given postoperative radiotherapy. Twenty-eight patients had a satisfactory result. There were two deaths in the postoperative period, one from intracerebral haemorrhage and the other from left hemisphere infarction. The literature regarding the initial recognition and characterisation of these neoplasms is briefly summarised. Operative management of these challenging lesions is described and discussed in the context of other available techniques.

Adenoma↗
PubMed1989

Craniofacial resection for orbital tumours.

Craniofacial resection for nasal and paranasal sinus tumours is now well established and performed increasingly because it has several advantages over other surgical approaches. More recently a different craniofacial approach has been developed to allow better access to orbital tumours and permit their complete excision as a single block. The experience of nine patients is reported. Results so far suggest this operation, with its excellent exposure, gives a good oncological resection, low postoperative morbidity and satisfactory cosmesis. Large malignant tumours that previously would have been removed inadequately and in piecemeal fashion can now be excised surrounded by a margin of normal tissue.

Adult↗
PubMed1988

A British experience of surgical voice restoration as a primary procedure.

It has been the aim of surgeons since Billroth first described laryngectomy to restore speech to the patient. However, a substantial percentage of patients fail to develop esophageal speech. Many authors have confirmed the success of the tracheoesophageal fistula procedure as a means of surgical voice restoration as a secondary procedure. We have performed tracheoesophageal puncture as a primary procedure at the time of laryngectomy in 36 patients, with a success rate of 89%. We believe that primary puncture is the method of choice for surgical voice restoration following laryngectomy.

Adult↗
PubMed1988

Intraoperative monitoring of the electrocochleogram and the preservation of hearing during acoustic neuroma excision.

We have monitored the electrocochleogram (ECochG) of 24 patients, using a transtympanic electrode, during acoustic neuroma excision. All patients had unilateral tumours with good preoperative hearing and complete excision was achieved in each case. Of the 24 patients, seven retained some hearing, however, a further two patients had normal ECochG waveforms at the end of operation but were nevertheless deaf. Thus, there is not an invariable correlation between immediate preservation of the ECochG and hearing. As expected, tumour size was important in hearing preservation. Five of seven patients with tumours less than 1.5 cm in diameter retained some hearing after operation, whereas 15 of 17 patients with tumours greater than 1.5 cm in diameter were deaf.

Audiometry, Evoked Response↗
PubMed1988

Craniofacial resection for extensive paranasal sinus aspergilloma.

Craniofacial resection techniques were developed to allow complete monobloc removal of malignant tumours of the ethmoid region. Such a surgical approach may also occasionally be useful in certain non-malignant conditions. Extensive 'destructive' aspergillosis of the paranasal sinuses has a high mortality once the anterior cranial fossa dura is reached. Craniofacial surgery provides excellent access to excise such large infective 'tumours'.

Adolescent↗
PubMed1987

Intra-operative electrocochleography to monitor cochlear potentials during acoustic neuroma excision.

Intra-operative electrocochleography (ECochG) was used in an attempt to monitor the action potential of the cochlear nerve during acoustic neuroma surgery in 14 patients with useful pre-operative hearing. Five patients had ECochG potentials preserved and yet only three could hear when tested audiometrically later. Of those losing the potentials intra-operatively all were subsequently deaf and the pattern of waveform loss allowed determination of the probable cause of hearing loss. Complete excision of the tumour was achieved in each case regardless of the ultimate effect on the AP as it was not felt justified to risk subsequent recurrence. In common with other studies one of the best prognostic factors for these preservation of hearing was found to be the size of the tumour.

Adult↗
PubMed1987

A British experience of surgical voice restoration techniques as a secondary procedure following total laryngectomy.

An earlier paper (Cheesman et al., 1985) described assessment procedures for 'failed' oesophageal speakers who were referred to Charing Cross Hospital for possible Surgical Voice Restoration in 1983-4. This paper presents the results of surgical voice restoration in the first fifty laryngectomized patients referred and analyses the reasons for failure in those where surgical voice restoration was unsuccessful. 94 per cent of patients who underwent secondary voice restoration were successful at two weeks post-surgery, but this success rate dropped to 73 per cent at three months. Reasons for this are explained and the pre-requisites for a successful surgical voice restoration are indicated.

Adult↗