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Biomedical subjects

L A Hoover

Publications and source records attributed to L A Hoover.

30 records · Page 2Linked to original sources
PubMed1986

Magnetic resonance imaging of the larynx: a correlation with histologic sections.

To date, high-resolution computed tomographic (CT) scanning has proved to be the most valuable preoperative study for the evaluation of the anatomic extent of head and neck cancers. Now, with the development of magnetic resonance (MR) imaging, the prospect of having an equally reliable test without associated radiation exposure has emerged. This study is designed to compare MR images of the larynx with corresponding histologic sections obtained by step-serial sectioning of whole organ specimens. Images were generated by a 0.3 Tesla permanent magnet MR imager. Additional correlation with CT scans was obtained when possible. CT resolution proved to be slightly superior in the axial plane but markedly inferior to MR imaging in the coronal and sagittal planes. Overall, MR imaging appeared to have good resolution of the larynx.

Epiglottis↗
PubMed1984

Pilomatrixoma of the head and neck.

Pilomatrixoma is an uncommon neoplasm which occurs most frequently in the head and neck region. It usually presents as a slowly growing dermal or subcutaneous mass. Unfamiliarity with this lesion may lead the physician to mistake it for more common infectious or neoplastic processes. Most pilomatrixomas are benign and are adequately treated by local excision. Since a spectrum of clinical and histologic aggressiveness (pilomatrixoma carcinoma) has been noted in some lesions, a more aggressive surgical approach for such tumors is recommended. Two patients with pilomatrixoma are presented to emphasize the diagnostic confusion that can occur.

Aged↗
PubMed1984

Preoperative CT scan evaluation for laryngeal carcinoma: correlation with pathological findings.

The advent of newer generation high resolution computed tomography (CT) scanners has revolutionized diagnostic evaluation in head and neck cancer. Since the development of conservation surgical techniques for the larynx, a precise preoperative evaluation of the extent of laryngeal involvement by carcinoma has been of prime importance. No single diagnostic study now yields more information regarding the anatomic extent of tumor than high resolution CT scanning. This study was designed to evaluate the reliability of CT scanning in determining extent of disease at several laryngeal levels by comparing preoperative CT scans with corresponding postoperative pathology obtained by serially sectioning laryngeal specimens. We found very good correlation in the inferior larynx and good correlation in the superior larynx. Determination of cartilage invasion proved very difficult, and scanning was unreliable at all levels when severe postradiation reactions were present.

Cricoid Cartilage↗
PubMed1983

Differential diagnosis of nasopharyngeal tumors by computed tomography scanning.

While direct visual or even fiberoptic endoscopic examination of the nasopharynx may at times be diagnostic, some limitations are frequently encountered as follows: (1) determination of the extent of submucosal spread, (2) identification of intracranial extensions, (3) in some instances, the differentiation of benign from malignant processes, and (4) the delineation of aggressive inflammatory processes such as Wegener's granulomatosis or mucormycosis. Seventy patients were reviewed to determine what help could be anticipated from computed tomography scanning. Low-density fascial planes are readily identified in the paranasopharyngeal space that provide important clues to the spread and diagnosis of malignant disease or aggressive inflammatory processes. The use of intravenous contrast material for enhancement of intracranial spread of tumors or for identification of the margins of hypervascular lesions can be quite helpful.

Diagnosis, Differential↗
PubMedDate not supplied

Pharyngoesophageal intubation injuries: three case reports.

The hypopharynx and cervical esophagus are particularly vulnerable to intubation trauma. Contributing factors include hasty intubation by inexperienced personnel; the use of curved, beveled endotracheal tubes containing stylets; malpositioning of the head, and the application of cricoid pressure. Iatrogenic pharyngoesophageal perforations may go unsuspected until characteristic signs and symptoms are recognized. These include cervical pain, fever, dysphagia, leukocytosis, subcutaneous emphysema, and pneumomediastinum. We present three cases that illustrate important points in recognizing, evaluating, and treating pharyngoesophageal perforations. The third case presents a chronic cervical esophageal perforation with secondary pseudodiverticulum, requiring resection of the pseudodiverticulum and a primary sternocleidomastoid muscle flap repair of the cervical esophageal defect. To our knowledge, this technique has not previously been reported.

Adult↗
PubMedDate not supplied

Parathyroid carcinoma: clinical presentation and treatment.

Parathyroid tumors account for only a small percentage of all head and neck neoplasms. The overwhelming majority of these are parathyroid adenomas that result in primary hyperparathyroidism. From 0.5% to 4% of hyperparathyroid patients, however, will be found to have a parathyroid carcinoma. In this paper, the authors relate their recent experience with such a patient and with two other such cases. Parathyroid carcinoma patients usually present with striking hyperparathyroidism and hypercalcemia, with the resultant related symptoms being more severe than those associated with parathyroid adenomas. Parathyroid carcinomas also tend to be large and may be detectable by current imaging techniques. The surgical appearance of these lesions is also distinct; the tumors are frequently multilobulated, gray-tan in color, quite firm, and often invasive. These physical findings are important since frozen section diagnosis may be difficult. The final histologic diagnosis depends on the presence of mitotic figures and capsular and vascular invasions. Preoperative medical problems, surgical approach, and prognostic factors are also discussed.

Aged↗
PubMedDate not supplied

Efficacy of preoperative dual-phase sestamibi scanning in hyperparathyroidism.

PURPOSE: The objective of this article is to evaluate our experience with sestamibi scanning in patients with primary and secondary hyperparathyroidism. PATIENTS AND METHODS: A retrospective review of patients referred to the radiology department at the University of Kansas Medical Center for parathyroid studies between January 1, 1993, and August 1, 1998, was done. Patients included in the study were those who underwent both dual-phase technetium (Tc-99m) sestamibi scanning and subsequent parathyroidectomy at our institution (n = 34). Twenty-six patients had primary hyperparathyroidism and 8 patients had secondary hyperparathyroidism. Fifteen had previous history of neck exploration. RESULTS: Sensitivity of sestamibi scans in detection of all abnormal pathology in cases of primary hyperparathyroidism was 60% overall. Among the subset of adenoma cases, sensitivity was 82% (14/17). Among cases of primary parathyroid hyperplasia, no scan correctly localized all abnormal glands; however 60% (3/5) showed localization of at least one hyperplastic gland. Of the 2 patients with parathyroid carcinoma, in only one case was there evidence of sestamibi retention in the correct thyroid lobe. In patients with secondary hyperparathyroidism, sestamibi scanning was successful in identifying all hyperplastic tissue in only one case (sensitivity 13%). In 7 of the 8 cases of secondary hyperparathyroidism, the scan localized at least one hyperplastic gland. CONCLUSION: Sestamibi scanning is useful in the localization of abnormal pathology in cases of primary hyperparathyroidism, especially adenomas. In cases of hyperplasia, whether attributable to primary or secondary hyperparathyroidism, sestamibi imaging is less successful.

Adult↗
PubMedDate not supplied

Tumor recurrence within myocutaneous flaps.

Myocutaneous flaps have become increasingly popular in reconstructive head and neck surgery. As surgeons have gained familiarity with them, many of the advantages, limitations, and complications of these flaps have become apparent. A rare but serious complication of myocutaneous flaps is recurrent tumor within the pedicle. Three cases of squamous cell carcinoma involving three different myocutaneous flaps are presented and the literature is reviewed. Possible mechanisms of tumor metastasis to myocutaneous flap pedicles are discussed. Surgeons must be aware of the possibility of tumor involvement of reconstructive flaps to facilitate early diagnosis and aggressive treatment.

Adult↗
PubMedDate not supplied

Traumatic innominate pseudoaneurysm rupture during laryngeal dilatation.

Endotracheal hemorrhage from the innominate artery is, fortunately, a rare problem encountered by the otolaryngologist. We present a patient with a tracheal-innominate artery fistula secondary to delayed rupture of a traumatic innominate artery aneurysm. The differential diagnosis of innominate artery hemorrhage is discussed, as is the management of this potentially lethal event. We propose, as the treatment of choice, cessation of hemorrhage through the use of a cuffed endotracheal tube, followed by ligation of the innominate artery using cardiopulmonary bypass. These techniques were used in this patient with a successful outcome.

Adult↗
PubMedDate not supplied

Computed tomography of the submandibular salivary glands.

Computed tomography offers a convenient method for the evaluation of the submandibular salivary glands and their surroundings. Normal measurements were established based on 38 normal subjects. The visualization of the ductal system in the gland and the relationship of the gland to the platysma muscle were recorded. The CT scans of 12 patients with a tongue base carcinoma and 4 patients with a verified obstruction of the submandibular duct were also reviewed to establish how the glands are affected by extrinsic lesions. The normal glands measured 28 x 18 mm (+/- 5 mm) in the axial plane. Two patients with unilateral hypoplasia of the gland were found in the normal group. Visualization of the intraglandular duct is not a specific finding since it was observed in more than 25 per cent of the normal group. Displacement and bulging of the platysma muscle by the submandibular gland can be a sign of glandular enlargement. It was also seen in 9 out of 12 patients with carcinoma of the base of the tongue.

Female↗