Biomedical subjects

J R Wanamaker

Publications and source records attributed to J R Wanamaker.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Undifferentiated nasopharyngeal carcinoma presenting as a parotid mass.

BACKGROUND: Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits. We present a case in which the initial manifestation of nasopharyngeal carcinoma of the lymphoepithelioma type was a parotid mass. METHODS: Case study. RESULTS: A patient who was initially seen with an isolated parotid mass was found to have an undifferentiated carcinoma of the lymphoepithelial type. Further evaluation identified an occult nasopharyngeal carcinoma, and the patient underwent radiotherapy. CONCLUSIONS: A diagnosis of a malignant lymphoepithelial lesion of the parotid gland or undifferentiated carcinoma of the lymphoepithelial type mandates a search for an occult primary nasopharyngeal tumor.

Aged↗

PubMedDate not supplied

Tension pneumocephalus following craniofacial resection.

BACKGROUND: The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are well-known complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus. METHODS: Case study. We reviewed the records of all patients who underwent anterior craniofacial resection at our institution, a tertiary care center, from 1976 to 1993. Among 45 patients identified, 2 had tension pneumocephalus. RESULTS: Neurologic deterioration after anterior craniofacial resection occurred in both patients in the immediate postoperative period. Both patients had extradural intracranial air under pressure and were diagnosed with tension pneumocephalus. In one patient, this was treated by needle aspiration followed by catheter drainage, and the second patient was treated with needle aspiration followed by airway diversion. The first patient recovered fully and was discharged on postoperative day 14; the second patient's mental status did not return to the preoperative level, and he was discharged on postoperative day 23 to a rehabilitative facility. Approximately 3 months later, his level of mentation returned to baseline. CONCLUSIONS: Tension pneumocephalus is a potentially devastating complication that may occur after craniofacial resection. It requires prompt recognition and treatment to minimize morbidity.

Adenocarcinoma↗

PubMedDate not supplied

The use of fibrin glue in the healing of skin flaps.

PURPOSE: To determine whether the use of fibrin glue has an impact on wound drainage created in an animal model. MATERIALS AND METHODS: Fibrin glue was prepared from single-donation autologous phlebotomy before surgery. Bilateral skin flaps were raised over the parotid gland in 10 rabbits. After exposure of the parotid, fibrin glue was applied on one side using an atomizer. The opposite side was treated with normal saline. Self-suction drains were placed under each flap and the wounds closed. Drainage was recorded daily for 7 days. RESULTS: Drainage differed significantly (P = .001) between the two sides on the first postoperative day and subsequent days. The average drainage on the fibrin-glue-treated side was 2.1 mL on the first day and 0.5 mL on subsequent days. On the nontreated side, the average output was 13.4 mL on the first day and 4.6 mL on subsequent days. CONCLUSIONS: This preliminary animal investigation showed that fibrin glue treatment decreased wound drainage. It is hoped that this concept may be applied to commonly performed head and neck procedures in which large flaps are elevated and large potential spaces are created. By decreasing the amount of drainage, fibrin glue has the potential to improve coaptation of flaps and minimize potential for seroma and hematoma formation. In some cases, the use of closed suction drains may be shortened and possibly eliminated, with shorter length of hospitalization.

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