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Biomedical subjects

R A Sofferman

Publications and source records attributed to R A Sofferman.

15 recordsLinked to original sources
PubMed1991

Bilateral arteriovenous malformation of the mandible.

Spontaneous bleeding from the molar gingiva may reflect the presence of a life-threatening vascular malformation. Sporadic reports of exsanguinating hemorrhage in the dental literature warn of the dangers of extraction, although deaths from unrecognized lesions or secondary to mandibular fracture still occur. Arteriovenous malformation (AVM) may be either unilateral or, less commonly, bilateral, and should be suspected in individuals with large lower facial hemangiomata. Two cases of near-exsanguinating hemorrhage from bilateral AVMs are discussed with the long-term management over a 3- to 20-year follow-up. The report underscores the failure of therapeutic embolization and the need for computed tomographic scanning as a corollary to angiography. A newer treatment with direct removal of the AVM and obliteration methods solves the hemorrhagic complications, reduces the potential for steal syndromes, and reduces the potential for recurrence.

Arteriovenous Malformations↗
PubMed1990

The nasogastric tube syndrome.

The nasogastric tube can produce sudden, life-threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo-documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pharyngodynia, hoarseness, or evolving stridor present in the postoperative period.

Adult↗
PubMed1989

Cavernous hemangiomas of the internal auditory canal.

Cavernous hemangiomas are vascular malformations that are seldom found in the central nervous system. Four cavernous hemangiomas of the internal auditory canal and one of the cerebellopontine angle have been reported previously. We present a series of seven (six of which have never been reported) cavernous hemangiomas limited primarily to the internal auditory canal. Whereas all cases but one had marked unilateral sensorineural hearing loss, only two had preoperative facial nerve dysfunction. There are no specific symptoms or physical or audiometric findings to differentiate cavernous hemangiomas from acoustic neuromas. However, a hemangioma should be suspected when facial paralysis is present in conjunction with a small intracanalicular tumor as demonstrated by computed tomography or magnetic resonance imaging. The former reveals calcium stippling in the lesions, whereas magnetic resonance imaging reveals a high signal intensity on both T1- and T2-weighted images.

Adult↗
PubMed1988

The septal translocation procedure: an alternative to lateral rhinotomy.

Lesions deep in the nasal vault with contiguous sinus involvement often required a lateral rhinotomy for exposure. This procedure affords excellent surgical access, but requires a significant external incision. An alternative sublabial technique, with dislocation of the nasal septum into the opposite nasal passage, provides excellent surgical exposure for these same lesions, while external facial incisions are avoided. The text outlines the surgical technique and representative uses in optic nerve decompression, inverted papilloma, giant rhinolith, angiofibroma, and a variety of nasosinus and nasopharyngeal malignant lesions.

Adenocarcinoma↗
PubMed1988

Optic nerve decompression.

Post-traumatic deterioration of vision requires thorough ophthalmologic evaluation, as well as computed tomographic scanning of the orbits and central visual pathways if no obvious ocular origins of the visual decrement are detected. When optic nerve trauma is a suspected etiology, the patient should be treated with megadose intravenous steroids, as well as optic nerve decompression performed after 12 to 24 hours if improvement of vision fails to occur.

Craniocerebral Trauma↗
PubMed1986

Transoral unilateral facetectomy in the management of unilateral anterior rotatory atlantoaxial fracture/dislocation: a case report.

An unusual case of unilateral anterior rotatory atlantoaxial fracture/dislocation with neurological deficit is presented. The injury could not be reduced by skeletal traction, but was successfully reduced by partial facetectomy at C-1, C-2 accomplished through a transoral exposure of the atlantoaxial region combined with labiomandibularglossotomy. To the best of our knowledge, this is the first instance of an injury of this type to be so managed. The details of the operative procedure are described, and the subject of rotatory atlantoaxial dislocation is reviewed.

Adult↗
PubMed1985

Adenoid cystic carcinoma of the nasopharynx after previous adenoid irradiation.

In 1978, Pratt challenged the otolaryngology community to identify an incidence of malignancy in individuals who have previously received radium therapy to the nasopharyngeal lymphoid tissues. This case report is a direct response to that quest and presents a well documented adenoid cystic carcinoma evolving 23 years after radium applicator treatment to the fossa of Rosenmuller. Although a cause-and-effect relationship cannot be scientifically proven, the case history raises several important questions concerning the stimulating effects of radiation on the later onset of frank malignancy.

Carcinoma, Adenoid Cystic↗
PubMed1979

Unusual uses of the deltopectoral flap.

For the past decade the deltopectoral flap has become the premier reconstructive tool in oncologic head and neck surgery. It has achieved a level of reliability that has not been approached by any other single flap. Its most common application has been replacement of lost skin either from planned surgical resection or necrosis following ablative surgery. This paper illustrates a few unusual clinical settings in which the deltopectoral flap was used instead of other conventional methods: 1. Use of the same delopectoral flap in two different locations. 2. Employment of the base of the deltopectoral tube for skin coverage. 3. Successful application of bilateral simultaneous deltopectoral flaps. 4. Three-stage reconstruction of the cervical esophagus in a tenuous metabolic setting. 5. Two-stage technique for soft palate replacement. 6. An alteration of the design of the conventional deltopectoral flap because of an upper pectoral abscess.

Adolescent↗
PubMed1977

Side effects of minocycline: a double-blind study.

We studied the incidence and type of side effects of minocycline in a double-blind study. A total of 45 volunteers (18 men and 27 women) were given minocycline, and 44 volunteers (23 men and 21 women) were given placebo. The men in both the minocycline and placebo groups were significantly (P < 0.0001) larger than the women in the comparable groups. Minocycline dosage was 100 mg every 12 h for 5 days, and placebo was administered in an identical manner. Minocycline serum concentrations were determined in 12 volunteers at 1, 2, 4, and 6 h after the morning doses on days 1, 3, and 5 of the study. Side effects were recorded by volunteers in diaries and also through daily interviews and were evaluated by examination and electronystagmography. Peak minocycline serum concentrations were seen by day 3 and correlated with the peak onset of side effects. These concentrations were significantly higher in women than in men. Vestibular side effects occurred in 70.4% of the women on minocycline and significantly (P < 0.0001) exceeded the rate of the women on placebo (9.5%). Only loss of balance was significantly (P < 0.05) increased in the men taking minocycline as contrasted with men on placebo. Electronystagmography generally revealed no abnormalities. Side effects were usually not severe: four volunteers in the minocycline group and two in the placebo group discontinued their capsules because of side effects. It is concluded that women experience an unacceptably high incidence of side effects from minocycline, and this may be related to their higher serum concentrations, which in turn may relate to their smaller size.

Clinical Trials as Topic↗
PubMed1977

Traumatic carotid-cavernous sinus fistula.

Seventy-five percent of carotid-cavernous sinus fistulae result from high velocity head trauma. The most common symptom is a pulse synchronous bruit which usually becomes apparent when the patient regains his sensorium. The objective manifestations of such an arteriovenous fistula are characteristically localized to the ipsilateral orbit. A periorbital bruit and venous engorgement of the palpebral and bulbar conjunctivae are pathognomonic features. Bilateral carotid angiography confirms the diagnosis and determines which of several techniques might be used to obliterate the fistula. Occasionally the classic signs and symptoms may be delayed for days or weeks. Thus, the maxillofacial surgeon must be aware of this clinical entity to avoid untimely repair of facial fractures with potentially disastrous consequences.

Adult↗
PubMed1975

Malignant lymphoma of the paranasal sinuses.

Sinus lymphoma is a rare but potentially radiocurable malignant neoplasm. The disease is isolated to the sinus and adjacent local tissues on initial presentation, and concurrent generalized lymphoma is unusual. With rare exception, the histologic pattern is that of a diffuse histiocytic non-Hodgkin lymphoma (reticulum cell sarcoma). Radiotherapy to the involved sinuses without prophylactic neck irradiation is the treatment of choice, and a survival rate of 50 percent to 70 percent can be expected.

Aged↗
PubMedDate not supplied

Mondini dysplasia: spontaneous cerebrospinal fluid otorrhea. New perspectives in management.

The Mondini dysplasia represents a developmental arrest during the embryogenesis of the inner ear. The malformation, commonly associated with deafness, is frequently heralded by meningitis secondary to communication of the middle ear with the subarachnoid space. Early recognition and successful repair of the CSF leak is important to avoid the sequelae of repeated episodes of meningitis. We believe the addition of CSF diversion in the form of a lumbar drain during and after surgery will result in improved success.

Cerebrospinal Fluid Otorrhea↗
PubMedDate not supplied

Pyriform sinus fistula: an unusual cause of recurrent retropharyngeal abscess and cellulitis.

Recurrent retropharyngeal cellulitis and recurrent suppurative thyroiditis are rare entities that share a common cause. A congenital fistula from the pyriform sinus apex to the thyroid gland has been identified in approximately 23 cases of suppurative thyroiditis and now has been implicated in a case of retropharyngeal abscess and repeated episodes of cellulitis. Virtually all reported cases have been on the left side, and the fistula is usually identified with a barium swallow study. When the esophagogram fails to demonstrate a fistula, a careful endoscopic search in the area of the left pyriform sinus should be actively pursued. An external surgical approach, which includes resection of the entire tract and involved area of the left thyroid, has been curative in all reported cases subjected to definitive surgical exploration.

Abscess↗
PubMedDate not supplied

Decision analysis of treatment options in pyriform sinus carcinoma.

Decision analysis was used to evaluate the current treatment options for stage III squamous cell carcinoma of the pyriform sinus (surgery, radiation therapy, and combined surgery/radiation therapy). Using published data, a decision tree was constructed based on quality-adjusted weeks of survival. With this model the combination of surgery and postoperative radiation therapy is preferred over either primary surgery or the combination of preoperative irradiation and surgery; primary radiation therapy is least favored. The decision is quite sensitive to the augmentation in survival that postoperative radiation therapy seems to provide over primary surgery. The decision is somewhat sensitive to the operative mortality rate and to the probability of disease-free survival following surgery. Quality of life issues emerge as important variables which need to be considered when planning treatment for patients with stage III pyriform sinus carcinoma.

Carcinoma, Squamous Cell↗