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Biomedical subjects

M I Singer

Publications and source records attributed to M I Singer.

At least 91 records · Page 5Linked to original sources
PubMed1983

Tracheoesophageal speech: vocal rehabilitation after total laryngectomy.

Treatment of laryngeal cancer has evolved over nearly 100 years and includes many methods to conserve the function of speech. It was understood from the inception of total laryngectomy that diversion of exhaled pulmonary air into the pharynx or esophagus would produce satisfactory speech. The effect on safe deglutition of the phonatory fistulae limited the wide applicability of these techniques. The introduction of a silicone bivalve device for use in a tracheoesophageal tunnel permits large numbers of laryngectomees to use tracheoesophageal speech. Acoustic, intelligibility, and aerodynamic studies are described for four laryngectomees and reveal that this method more nearly approximates normal laryngeal speech than conventional esophageal speech. The criteria for contemporary treatment of laryngeal carcinoma are not altered by this rehabilitative method, and expected survival rates are not likely to be affected. The findings and analysis of this method of alaryngeal speech rehabilitation may have important implications for future therapy of laryngeal carcinoma.

Aged↗
PubMed1983

Voice rehabilitation after total laryngectomy.

More than 100 years after the first laryngectomy, voice preservation remains a remarkable challenge. A number of surgical techniques have been proposed, yet complications related to aspiration, recurrent disease, or voice failure have been frequent. Representative historical examples are described and their results reviewed. The advent of tracheo-esophageal phonation with a silicone voice prosthesis simplified the approach to this perplexing problem. The principles learned from the secondary application of this method are applied to a primary technique for vocal rehabilitation immediately after laryngectomy. The results are promising without risking alteration of the basic laryngectomy technique and expected cure rates.

Aged↗
PubMed1981

Selective myotomy for voice restoration after total laryngectomy.

Reconstruction of the pharyngoesophagus after total laryngectomy avoids the development of salivary fistulae and restores satisfactory swallowing. Successful techniques for closure include multiple layers of tissue, selected suture materials, the application of postoperative radiation therapy, and modified neck dissection. In addition, vocal rehabilitation has been traditionally associated with the formation of a pharyngoesophageal segment capable of producing sound after air insufflation. A three-year experience with 129 patients after they underwent a total laryngectomy and tracheoesophageal shunt showed that 16 patients (12%) failed to achieve satisfactory speech after tracheoesophageal puncture because of pharyngoesophageal spasm. Response to percutaneous block of the pharyngeal plexus and subsequent myotomy of the cricopharyngeus and pharyngeal constrictor muscles was assessed in 14 patients. Increased pharyngoesophageal tone after total laryngectomy seems to be an important factor in the failure to acquire esophageal voice.

Esophagus↗
PubMed1980

Congenital fibrosarcoma in the oral cavity. First reported case.

Fibrosarcoma is uncommon in the head and neck and constitutes less than 1% of malignancies and approximately 6% of the soft tissue sarcomas. Congenital fibrosarcomas are characterized by rapid proliferation and frequent local recurrence following excision. Unlike other sarcomas, metastasis is a rare event. The literature contains less than 50 cases of congenital, solitary fibrosarcoma, with none occurring in the oral cavity. This paper describes a unique case of fibrosarcoma in the oral cavity of a neonate. A 12 month follow-up is provided with an analysis of the histopathology including electron microscopy. The spectrum of fibroproliferative lesions in the pediatric patient is reviewed, and the evaluation and treatment modalities applicable to this age group are outlined.

Fibrosarcoma↗
PubMed1979

Heterotopic salivary tissue in the neck.

Six cases of heterotopic salivary gland tissue in the anterolateral neck are presented with a review of their clinical and histopathologic characteristics. Neoplastic transformation, fistulization, and isolated rests represent a spectrum of these uncommon lesions. The embryologic derivation of salivary tissue and close association with the branchial apparatus are discussed. The significance of salivary carcinoma presenting in the neck is reinterpreted in light of the embryogenesis of these heterotopias.

Child↗
PubMed1978

Total laryngectomy and reconstruction of a pseudoglottis: problems and complications.

A modified procedure for the reconstruction of a pseudoglottis after total laryngectomy is examined. The history of this technique, including our experience, is reviewed with emphasis on problems and complications. Indications and justifications for surgery are discussed. Though we can only speculate on the basis of a few cases, we believe that a good voice can be obtained when a pseudoglottis is either primarily or secondarily constructed after laryngectomy. We acknowledge that perhaps the risk of liability tempers our approach and restricts our case selection which, no doubt, in part accounts for our modification of the procedure that was initially performed in Europe. We believe that continued careful application of this technique and its variations will improve the results of modern laryngeal surgery.

Glottis↗
PubMedDate not supplied

Grooming the victim: an analysis of a perpetrator's seduction letter.

The authors review the current literature on the sexual victimization of adolescent males with attention given to victim characteristics and victim selection factors and strategies. Following this review, a letter written by a middle-aged man to entice a teenage boy into sexual activity is presented and analyzed. The strategy used by the letter-writer is to refute the usual reservations a teenage boy might have about engaging in sexual activity with a man. The approach used in the letter and the ensuing analysis are generalizable to teenage boys experiencing similar encounters and highlight the sophisticated seduction and grooming strategies used to sexually victimize adolescent males.

Adolescent↗
PubMedDate not supplied

An endoscopic technique for restoration of voice after laryngectomy.

Reports of restoration of voice after total laryngectomy include diversion of exhaled pulmonary air though planned or spontaneous fistulae with a variety of modified tracheal cannulas and valves. Limitations of these techniques include aspiration, scar closure of the shunts, wound complications, and failure to achieve voice consistently. We report a two-year experience with an endoscopic method using a unique valved prosthesis eliminating complicated surgical reconstructions, aspiration, and stenosis. Fifty-four of 60 patients (90%) achieved fluent voices with one deglutition problem. Radiation therapy preceded voice restoration in 63% of the patients and radical neck dissection in 72%. The endoscopic procedure, hospitalization and period of speech therapy are short and constitute a cost-effective voice rehabilitation program. The results of this simple method and lack of complications are encouraging.

Adult↗
PubMedDate not supplied

Tracheostoma valve for postlaryngectomy voice rehabilitation.

Newer surgical techniques for postlaryngectomy voice rehabilitation provide a simple, effective method of communication but require manual occlusion of the tracheostoma during speech. We report the development of a unique tracheostoma valve that avoids the necessity for covering the stoma. This airflow-sensitive valve closes during speech and remains open with normal respiration. Results of a clinical trial with 50 patients over a ten-month period are encouraging. Our experience suggests that excessive vocal tract resistance to airflow is the principal limitation to effective valve use. Approaches to decreasing airflow resistance through the vocal tract to improve both voice production and tracheostoma valve use are discussed.

Clinical Trials as Topic↗
PubMedDate not supplied

Invasive mycotic infections in the immunocompromised child.

Oncologic therapy creates a highly vulnerable group of children with little or no natural immunity. In addition to the problems of coagulopathies, these children are prone to unusual infectious diseases. One group of saprophytic infections, the mycotic organisms, represents stubborn and often lethal diseases challenging present diagnostic and therapeutic skills. This is a case report of invasive Aspergillus organisms in the nose and premaxilla in a 9-year-old child suffering from acute monocytic leukemia.

Aspergillosis↗
PubMedDate not supplied

Symptomatic cervical thymic cyst in a neonate.

Thymic cysts are unusual neck masses in adults and children and are rarely differentiated from other neck masses by physical examination. This is a case report of a thymic cyst producing airway obstruction in a neonate. The embryogenesis and differential diagnosis of thymic cysts are reviewed.

Airway Obstruction↗