Under most circumstances, thyroid lobectomy is appropriate for low-risk patients with papillary cancer of the thyroid.
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Biomedical subjects
Publications and source records attributed to F P Ogren.
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OBJECTIVES/HYPOTHESIS: The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid. STUDY DESIGN: A retrospective review of clinical charts was conducted to analyze results and complications in patients who underwent gold weight implantation within 30 days of onset of facial nerve paralysis and to compare these outcomes with those of patients who received gold weights after a traditional waiting period. METHODS: The charts of 67 patients who underwent gold weight implantation during the time period of this study were reviewed. Patients were categorized into "early" or "late" groups based on whether gold weights were implanted before or after 30 days following onset of facial nerve paralysis. Etiology of facial nerve paralysis, degree of paralysis, timing of surgery, and outcomes of the procedure, including degree of lid closure and complication rates, were compared between the two groups. RESULTS: Of the 67 patients, 49.3% underwent gold weight implantation within 30 days of onset of paralysis and 50.7% received gold weights after 30 days. A total of 89.2% of all patients who underwent implantation in this study achieved satisfactory lid closure after the initial procedure. Both early and late implantation groups had statistically similar lid closure and complication rates. CONCLUSIONS: Implantation of gold weights within 30 days of paralysis is as effective for the management of paralytic lagophthalmos as delayed implantation and is not associated with higher complication rates. Early implantation of gold weights should be considered in all patients with paralytic lagophthalmos.
Although lightning injuries are common, neuro-otologic sequelae are infrequently reported. The most common otologic injury encountered in the lightning strike victim is tympanic membrane rupture; the most common vestibular disturbance documented is transient vertigo. A variety of other clinical findings have been described in this population of patients. They include sensorineural hearing loss, conductive deafness, tinnitus, basilar skull fracture, avulsion of the mastoid bone, burns to the external auditory canal, and peripheral facial nerve palsy. The initial treatment of the lightning strike victim consists of basic life support measures. Once stabilized, the patient should undergo a complete otologic and vestibular evaluation. The majority of otolaryngologic problems encountered can be managed expectantly, with periodic re-evaluation. Tympanoplasty should be delayed for 6 to 12 months because of the frequent delay in spontaneous healing.
Transient mucositis occurs in almost all patients receiving bone marrow transplantation (BMT) but it is not known whether airway mucociliary transport is impaired during this period. We hypothesized that the preparative regimen associated with BMT impairs mucociliary clearance during the peri-transplant period. To test this hypothesis we determined nasal saccharine transit time (STT) and a mucositis score daily throughout the peri-transplant hospitalization in 13 patients receiving BMT. STT was prolonged in all patients at some time during the peri-transplant period and mucociliary clearance was ineffective in 12 of 13 patients for an average of 22% of the days. STT was most prolonged (about 155% of baseline) in the 2 week period following marrow infusion and correlated with the appearance of mucositis. STT returned to baseline values within 30 days after marrow infusion in all but one patient. These findings demonstrate that nasal mucociliary clearance is significantly impaired in most patients during BMT, if only temporarily. This decrease in local airway host defense may explain, in part, the increased risk of upper respiratory infections that these patients experience.
Perineural and endoneural tumor spread is a form of metastatic disease in which the primary tumors spread along neural pathways and gain access to noncontiguous regions. Although rare, this type of skip metastasis into the cranial cavity occurs from tumors of the parotid gland and facial skin. Recognition of this process, evaluation of the patient with proper diagnostic procedures, and its treatment are presented.
This paper presents a review of the extracranial evaluation and treatment of cerebrospinal fluid (CSF) rhinorrhea. Diagnosis with attention to a careful history and physical with maneuvers which exacerbate drainage and thorough physical exam along with imaging techniques are discussed. The common etiologies of CSF rhinorrhea including trauma, spontaneous leakage, tumor, and iatrogenic injury are included. Management consists of conservative measures including the avoidance of straining maneuvers which increases intracranial pressure. Periodic drainage of CSF via lumbar puncture or continuous drainage via flow-regulated systems may also be of benefit in attempts of conservative management. Failure of conservative management, constant leakage, pneumocephalus, and recurrent meningitis are indicators for surgical repairs. Ethmoid-cribiform plate region repairs are generally approached by external ethmoidectomy and the development of mucoperiosteal flaps from various donor sites which are then rotated to the leak area to seal the defect. Frontal sinus leaks are usually repaired via an osteoplastic flap technique with direct repair of the dural defect or the use of fascial graft tucked under the bony defect, then obliterated with abdominal fat. CSF rhinorrhea presents a diagnostic and surgical challenge to the otolaryngologist. After diagnosis and localization, operative repair using extracranial approaches is accepted as the initial method of intervention in these cases.
Patients struck by lightning can present with a wide variety of unusual otologic problems including burns to the external auditory canal, tympanic membrane rupture, middle ear injury, and sensorineural hearing loss. Four patients who incurred various otologic problems, including one patient with previously unreported bilateral oval window fistulas following lightning injury, are presented. Audiologic, otologic, and surgical findings are reviewed as well as patient follow-up and outcome.
A 67-year-old woman presented with an advanced esthesioneuroblastoma that recurred 2 years following external irradiation. She was successfully retreated with continuous low-dose rate interstitial irradiation from high-activity I-125 seeds implanted permanently into the tumor.
Tracheal invasion may occur by direct extension of thyroid carcinoma. Follicular, papillary, mixed follicular and papillary, and poorly differentiated cell types have all been found to cause tracheal invasion. Two cases of tracheal invasion by thyroid carcinomas prompted us to review the literature, although our review revealed little current data on tracheal invasion. We reviewed the records of all patients surgically treated for thyroid carcinoma at the University of Nebraska Medical Center from 1976 through 1987. The results of this review and our review of the literature on tracheal invasion are reported here. We conclude that thyroid carcinomas behave most aggressively in men and older patients. The more poorly differentiated follicular thyroid carcinomas have also been found to behave aggressively. Our findings show that en bloc resections are indicated in certain patients with tracheal invasion.
Bell's Palsy is not synonymous with facial nerve paralysis. While it is a common cause of facial nerve paralysis, it is a diagnosis of exclusion and other causes of facial nerve paralysis should be ruled out by appropriate evaluation and follow-up. A case report is presented of a patient with a facial nerve paralysis, which was initially diagnosed as Bell's Palsy, but which was found to be a poorly differentiated parotid malignancy causing facial nerve paralysis. A review and discussion of Bells Palsy, evaluation and treatment is presented.
Inoperable solid tumor recurrence within a surgical bed or within a previously irradiated field usually responds poorly to re-treatment with conventional external beam irradiation (EXRT) and/or chemotherapy. We present a new, alternative method of re-treatment used in two patients with recurrent head and neck cancer involving the parotid (adenocarcinoma) and neck nodes (squamous cell carcinoma). These patients were successfully re-treated with high-activity 125iodine (I-125) permanent implantation.
Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation-induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high-activity 125iodine (I-125) permanent implantation.
An uncontrolled retrospective analysis of 76 patients with locally advanced Stage III and Stage IV squamous cell carcinoma of the oral cavity, oropharynx, pyriform sinus, supraglottic larynx, glottic larynx, and hypopharynx, who were treated in a uniform manner by surgical resection and 6,600 rad postoperative external beam radiotherapy, revealed relatively high 2-year and 4-year adjusted survival rates of 76% and 68%, respectively. Complication rates were acceptable (8%). The advantages of this treatment approach for locally advanced head and neck cancers compared to treatment by surgery alone are discussed.
Transient salivary gland hypertrophy is a reported clinical finding in patients with bulimia. A retrospective chart review of 49 patients enrolled in the University of Nebraska Medical Center Eating Disorders Program with a diagnosis of bulimia showed 29% (14/49) had at some time either parotid and/or submandibular gland hypertrophy noted on physical exam. Resolution of the salivary gland enlargement occurred in all of our patients after treatment of their bulimia. Bulimia must, therefore, be considered in the differential diagnosis of salivary gland hypertrophy, and treatment should be directed at the underlying behavioral disorder.
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Total inferior turbinectomy has been proposed as a treatment for chronic nasal airway obstruction refractory to other, more conservative, methods of treatment. Traditionally, it has been criticized because of its adverse effects on nasophysiology. In this study, patients who had previously undergone total inferior turbinectomy were evaluated with the use of an extensive questionnaire. It confirms that total inferior turbinectomy carries significant morbidity and should be condemned.