Biomedical subjects
Publications and source records attributed to F E Lucente.
Basal cell carcinoma of the auricle presents a challenge in both excision and reconstruction to the clinician. The folloing case report discusses and illustrates the use of controlled excision with assessment of margins and reconstruction using chondrocutaneous advancement flaps and multiple Burow's triangles.
Numbers play a great role in our practice of laryngology, and when used appropriately can be extremely valuable. However, careless or uncritical use may cause them to be an impediment of detriment to clinical practice and teaching. Examples of problems which arise with numbers are readily found in the areas of tumor staging (TNM system), the scientific literature, resident training and communications with third-party agencies. Consideration of these examples reminds us of the need to evaluate our use of numbers frequently.
Explore the source record for details and available documents.
Among the more common manifestations of acquired immunodeficiency syndrome (AIDS) are tumors and infections that occur in regions treated by the bronchoesophagologist. In reviewing our institutional experience in the diagnosis and treatment of 396 patients with AIDS in 1987, we have noted that 226 (57%) had some form of pneumonia and 133 (34%) had candidiasis. In this communication we discuss the various types of bronchopulmonary, oropharyngeal, and esophageal infections that have been reported among AIDS patients. We also review the universal precautions and specific guidelines recommended for safeguarding the bronchoesophagologist and other health care workers who treat these patients.
Chyle fistula is a potentially devastating phenomenon that results from violation of the thoracic duct or right lymphatic duct in the neck, most commonly during radical neck dissection. It may impair nutrition, compromise and delay wound healing, and prolong hospitalization. In view of the morbidity produced by chyle leak discovered postoperatively and the lack of success of its management by aggressive surgical techniques, we have employed a different protocol for the past six years. It is based on careful intraoperative inspection of the neck for possibly chyle fistula, minimal but specific surgical handling of the damaged duct, and a postoperative nutritional program designed to reduce chyle formation and facilitate spontaneous closure. The nutritional element involves the use of medium chain triglycerides (MCT) that are easily ingested, rapidly absorbed, and readily metabolized directly into the portal venous system, bypassing the thoracic duct lymphatic system. During a four-year period, 1976 to 1980, 574 radical neck dissections were performed with only six chyle fistulas being detected postoperatively. All have been successfully treated by the protocol with no patients requiring reexploration. There have been no deaths owing to chyle fistula and no complications or side effects from the use of medium chain triglycerides.
Review of our experience in treating 16 patients with malignant external otitis, along with survey of the compromised defense mechanisms of diabetic patients, confirms the need for immediate, intense, and vigilant therapy. Radioisotope scans, high-resolution computed tomography scans, and multidirectional tomograms are used to delineate the extent of the disease. Therapy includes intravenous aminoglycoside and penicillin derivatives, limited surgery, and hyperbaric oxygenation. In view of the tendency for this infection to extend beyond the external auditory canal and to produce an invasive lethal osteomyelitis, we feel that the tendency to classify this disease as a variant of diffuse external otitis may foster undertreatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.