Biomedical subjects
Publications and source records attributed to D R Maceri.
This article provides an overview of the various head and neck manifestations of endocrine disease. Presenting signs and symptoms may be indicators of more generalized systemic disease. The importance of a thorough history cannot be overemphasized.
Three hundred forty-two cases of laryngeal cancer were treated at the University of Michigan, Ann Arbor. One hundred ten supraglottic cancers and 150 glottic cancers were studied in depth. Conservation surgery was performed on 63 patients. Determinate two-year disease-free survival for glottic cancer was 90% in those irradiated primarily, 83% for those treated with vertical hemilaryngectomy, and 58% in the group that had total laryngectomy. Supraglottic cancers had a determinate survival rate at two years of 62% for those irradiated primarily, 80% for those treated with a supraglottic laryngectomy, and 62% when total laryngectomy was required. The cost of preserving the respiratory and sphincteric functions of the larynx in some cases amounted to the morbidity associated with a protracted hospital stay, altered deglutition, instances of a weak but functional voice, and the possibility of a permanent tracheostomy. Despite high recurrence rates of 30% to 40%, the overall determinate survival with salvage was an acceptable 80% for the conservation surgery group.
Intraoral ligation of the maxillary artery for intractable posterior epistaxis has been used effectively in 14 consecutive patients, all of whom had failed conventional anterior and posterior packing techniques. Fresh cadaver material was dissected in order to define the anatomic relationships of the infratemporal portion of the maxillary artery, as well as to develop the surgical technique prior to clinical application. The results indicate that this technique is rapid, safe, versatile, and effective in the majority of patients that require surgical interruption of the blood supply to the nose. The results of this study and the surgical technique are discussed.
Two cases of severe laryngeal injuries were evaluated by computed axial tomography (CT). Results of these studies correlated well with surgical findings and were helpful in planning structural repair. Axial views obtained by laryngeal CT were distinctly superior to the bidimensional picture obtained by polytomography. In addition, the method proved more advantageous than contrast laryngography, which is often impossible to perform in the presence of massive swelling.
Although most thyroid tumors first manifest clinically by a neck mass, several patients with thyroid tumor have been treated whose initial complaint was a disturbance of the respiratory and digestive tracts. Because this association is not well recognized, the diagnosis of a thyroid tumor can be delayed, or even missed until the tumor grows much larger causing other symptoms. A series of 269 patients with thyroid tumors seen at UCLA from 1979-1980 was reviewed. Approximately 16% of these patients sought treatment because of aerodigestive dysfunction such as dyspnea, dysphagia, hoarseness, throat discomfort and hemoptysis. Such symptoms often indicate malignancy of substernal extension of tumor. The management of these tumors is discussed.
This is the second report of a malignant peritoneal mesothelioma diagnosed by laparoscopy and guided needle biopsy and the first with photographic documentation of the lesion. The case illustrates the following points: (1) diagnosis of peritoneal mesothelioma should be considered in the evaluation of exudative ascites; (2) the only definitive diagnostic procedure is to obtain tissue for histology; and (3) laparoscopy with biopsies under direct vision is an accurate and safe technique which is underutilized and should be considered as the diagnostic procedure of choice when peritoneal disease is suspected.
Neurofibromatosis (von Recklinghausen's disease) is an autosomal dominant disease that affects one in 2,500-3,000 births. Because the head and neck is unique in its anatomical compartmentalization of the central and peripheral nervous systems, the potential for involvement of these areas with neurofibromas is substantial and accounts for a myriad of clinicopathologic presentations. In the present study, the incidence of involvement in the head and neck is 37%. We found 81% of the patients had café au lait spots, 63% had positive family histories, and 66% had multiple cutaneous nodules. An incidence of malignant transformation was documented in 3.5% of the cases. Management of benign neurofibromatosis must be individualized for each patient and ranges from incisional biopsy to wide local excision. In every case, the risk of severe neurologic deficit must be weighted against the benefits of surgical resection, which is usually incomplete. Genetic counseling is advised for all patients with this disease, since no cure is available.