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Biomedical subjects

L G Close

Publications and source records attributed to L G Close.

At least 55 records · Page 3Linked to original sources
PubMed1988

Orbital decompression for optic neuropathy secondary to thyroid eye disease.

To improve our management of optic neuropathy from thyroid eye disease, we have refined the external ethmoidectomy approach, which permits the removal of the medial orbital wall and adjacent floor. We now report our experience with six patients (11 eyes) selected for this surgical technique. These patients are part of a larger population of patients with thyroid eye disease who have been surgically managed by us over the last 6 years.

Adult↗
PubMed1987

Conservation of the hypopharyngeal mucous membrane in total laryngectomy.

Dysphagia secondary to partial pharyngeal stenosis after total laryngectomy is most likely attributable to the size of the reconstructed lumen. To reduce the incidence of this postoperative complication, we have utilized a modification of total laryngectomy that conserves the hypopharyngeal mucous membrane. The results of this surgical procedure are now reported in the context of two similar, contemporaneous groups of patients who underwent either standard wide-field laryngectomy or hypopharyngeal mucosa conservation laryngectomy. Statistical analysis showed no difference between groups in cancer control (P = .80) or survival (P = .65); whereas the group treated with hypopharyngeal conservation laryngectomy had significantly less pharyngeal stenosis as measured by dysphagia and need for dilatation (P = .011).

Adult↗
PubMed1987

Microvascular invasion in cancer of the oral cavity and oropharynx.

The presence of squamous cell carcinoma within capillaries and/or venules in the immediate vicinity of primary lesions of the oral cavity and oropharynx may be related to regional lymph node metastasis. To evaluate this possibility, we have reviewed the clinical and histopathologic features of 43 consecutive cases of previously untreated T2 or greater squamous cell carcinoma of these sites managed with simultaneous surgical treatment of the primary neoplasm and the neck. The incidence of histologically proved cervical metastasis for all lesions with vascular invasion compared with those without vascular involvement was highly significant. No statistical correlation was found for the clinical stage of neck disease or for the other pathologic features of the primary tumor, ie, size, appearance, differentiation, depth of invasion, periphery of lesion, inflammatory infiltrate, and perineural invasion, when compared with the histopathologic status of regional lymph nodes.

Aged↗
PubMed1987

The over-projecting nasal tip: precise reduction without rotation.

Excessive projection of the nasal tip is a relatively uncommon deformity, often referred to as the "Pinocchio" nose. When this unaesthetic appearance is secondary to abnormally long medial and lateral crura of the lower lateral cartilages, and when tip rotation is undesirable, surgical correction can represent a challenging problem. A simple and reproducible method via the open septorhinoplasty approach is described for correction of this deformity. In this technique, preoperative photographs are analyzed to calculate the exact length of cartilage to be excised from the medial and lateral crura. The results of this procedure are critically analyzed in six consecutive patients followed for 7 to 19 months. Based on this experience, the operation is recommended as a reliable method for correction of the over-projecting nasal tip when minimal or no rotation is desirable.

Adult↗
PubMed1986

Axial subcutaneous scalp flaps in the reconstruction of the anterior cranial fossa.

A major concern following combined craniofacial resection of neoplasms involving the floor of the anterior cranial fossa is the creation of a watertight separation between the contents of the anterior cranial fossa and the upper aerodigestive tract. The reconstructive technique should satisfy several goals, which we will outline. The axial subcutaneous scalp flap meets these goals and has proved to be useful in reconstruction of the anterior skull base. We used the axial subcutaneous scalp flap for this purpose in three patients. Herein, we report our experience and emphasize the importance of the vascular pattern of the anterior scalp.

Adenocarcinoma↗
PubMed1986

Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure.

Stenosis of the posterior laryngeal commissure with arytenoid fixation following intubation trauma or laryngeal fracture poses a treatment dilemma. Over the past 2 1/2 years we have managed four patients with this problem by mobilization of the fixated cricoarytenoid joint, arytenoid-pharyngeal mucosal advancement flap, brief splinting of the arytenoids in the fully abducted position, and early speech therapy. As of this time, three of the four patients have been both decannulated and have achieved adequate to near normal voices. Most significantly, the previously fixated arytenoids are now mobile, confirming the efficacy of the principles presented herein.

Adult↗
PubMed1985

Ototoxicity of low- and moderate-dose cisplatin.

Twenty-four patients with head and neck neoplasms were prospectively evaluated for cisplatin (DDP)-induced ototoxicity. Patients were selected from a larger population based on the uniformity of their chemotherapy regimen, renal status, lack of prior or concurrent exposure to ototoxic agents, and availability for repetitive audiometric testing in the same setting. Scanning electron microscopy of the inner ear was performed on four temporal bones. Hearing impairment was found to be dose-related, irreversible within the confines of the study period, and primarily in the higher frequencies. Vestibular toxicity was rare and well-documented by our testing methods in only one patient. Based on the results of this study, and a review of animal and human data on DDP ototoxicity, the authors concluded that ototoxic screening should be reserved for patients defined as "at risk" and those patients receiving more than 400 mg of DDP under the conditions stated in this report.

Aged↗
PubMed1985

Magnetic resonance imaging vs computed tomography. Comparison in imaging oral cavity and pharyngeal carcinomas.

Twenty-one patients with oral cavity and pharyngeal carcinomas were enrolled in a prospective protocol to study the diagnostic efficacy of magnetic resonance imaging vs computed tomography. Magnetic resonance imaging was found to be superior to computed tomography in the area of tumor contrast (conspicuity) and equal or inferior in edge definition, delineation of regional disease, and lymph node metastasis. These findings are consistent with the current applications and limitations of magnetic resonance imaging.

Adenocarcinoma↗
PubMed1985

Resection of upper aerodigestive tract tumors involving the middle cranial fossa.

Benign and malignant neoplasms of the upper aerodigestive tract that invade the middle cranial fossa are frequently considered unresectable due to the proximity of the cavernous sinus and internal artery, and to the inaccessibility of this region via conventional surgical approaches. We report our experience using a combined, lateral intracranial and infratemporal fossa procedure for the management of these tumors in four patients. Successful removal of neoplasm associated with minimal morbidity was accomplished in 3 patients, 2 with angiofibromas and 1 with an adenoid cystic carcinoma. The postoperative course of the fourth patient was complicated by meningitis which resulted in the patient's death five months following resection of an adenocarcinoma.

Adolescent↗
PubMed1985

Evaluation of NMR versus CT for parotid masses: a preliminary report.

Twelve patients with various parotid masses were prospectively studied by both nuclear magnetic resonance (NMR) imaging and intravenously enhanced computed tomography (CT). These imaging techniques were then correlated with the disease process and clinical relevance of both forms of imaging assessed. Our results suggest high resolution, spin-echo NMR offers several advantages over CT, and is likely to become the preferred method of evaluating a parotid mass.

Adenolymphoma↗
PubMed1984

Computed tomography of upper aerodigestive tract squamous cell carcinoma. Assessment following induction chemotherapy.

One hundred forty-seven previously untreated patients with stage III or IV upper aerodigestive tract squamous cell carcinomas were examined by computed tomography (CT) prior to treatment. Computed tomography was used to observe the tumor response in 72 patients receiving induction chemotherapy (100 mg/sq m of cisplatin on days 1 and 21 and 135 mg/sq m of bleomycin sulfate on days 3 through 10). The CT findings in ten patients were correlated with serial histologic examination of the operative specimens. Our study indicates that CT is useful in following tumor response to chemotherapy, provided the physician is aware of the limitations of scanning as outlined herein.

Carcinoma, Squamous Cell↗
PubMed1983

Sternohyoid myo-osseous flap for acquired subglottic stenosis in children.

Endotracheal intubation can occasionally result in acquired subglottic stenosis (ASGS) in infants and children. Twenty-one consecutive patients, ages 3 months to 13 years, with ASGS secondary to endotracheal intubation and severe enough to require tracheotomy, are reviewed. Of this population, eight cases of ASGS were refractory to endoscopic excision and dilatation. These eight patients, five of whom had complete stenosis, underwent subglottic reconstruction using a sternohyoid myo-osseus flap. Six of the eight patients had been successfully decannulated with no evidence of recurrent stenosis at the time of this report.

Adolescent↗
PubMed1983

Sphenoethmoidal mucoceles with intracranial extension.

Mucoceles of the paranasal sinuses are benign, expansile, locally destructive lesions that are thought to occur secondary to obstruction of the sinus ostia. Nasal and/or ocular signs and symptoms are the usual clinical manifestations of mucoceles arising in the ethmoid and sphenoid sinuses, and intracranial extension is rare. We describe three cases of widely destructive sphenoethmoidal mucoceles extending intracranially, with bone erosion and dural exposure in all cases and brain necrosis in one case.

Adult↗
PubMed1983

Acute symptoms of the aerodigestive tract caused by rapidly enlarging thyroid neoplasms.

Two cases of rapidly enlarging tumors of the thyroid presenting with the sudden onset of symptoms referable to the aerodigestive tract are discussed. Although tumors of the thyroid are known to produce dysfunction of these structures, these cases are highly unusual, since in the vast majority of cases the onset and progression of these symptoms are insidious and rarely recognized by the patient or physician. The diagnostic workup and management of enlarging masses in this area is reviewed.

Adenoma↗