Biomedical subjects
Publications and source records attributed to D J Wittich.
Malignant fibrous histiocytoma of the head and neck is a rare tumor with less than 50 total cases reported in the literature. Its rarity and complex histopathology combine to make it a difficult diagnosis. Two cases are described. Pathology characteristics are discussed. The traditional treatment of choice is wide surgical excision. Radiation therapy is usually reserved for recurrent, unresectable, or extremely aggressive tumors.
Patients with head and neck cancer frequently suffer from chronic obstructive pulmonary disease and arteriosclerotic cardiovascular disease, making them poor risks for anesthesia. Arrhythmogenic inhalation anesthetics along with assisted ventilation used in general anesthesia further complicate the intraoperative, as well as the postoperative, course. Cervical epidural anesthesia has been employed in a number of cases of breast and upper thoracic surgery at Walter Reed Army Medical Center with remarkable success. It has also been used in chronic pain control. We described the use of cervical epidural anesthesia for a neck dissection. The technique of placing 0.5% Marcaine at the level of C7-T1 is described. Indications, limitations, complications, and the potential uses of cervical epidural anesthesia in head and neck cancer patients are discussed.
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Primary care physicians have become increasingly reluctant to refer children for tonsillectomy and adenoidectomy (T and A) during the past years while antimicrobial therapy for pharyngotonsillitis and otitis media has become more common. Consequently, more children retain tonsils and adenoids throughout the childhood years. Airway compromise from adenotonsillar hypertrophy is reported in 11 cases-8 with insidious onset, 3 with acute onset. Typical symptoms occurring during sleep include snoring, snorting, enuresis and obstructive apnea. Daytime symptoms included hyponasal speech, oral respiration and morning cephalgia. Methods of assessing children with adenotonsillar hypertrophy and airway compromise included polysomnography and acoustic analysis of respiratory sounds. It appears that airway compromise from adenotonsillar hypertrophy is more common now that fewer children are undergoing T and A, is being more commonly recognized because of improved methods of assessment, or both.