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Biomedical subjects

R F Wetmore

Publications and source records attributed to R F Wetmore.

At least 55 records · Page 3Linked to original sources
PubMed1989

Approach to the pediatric neck mass.

Neck masses are frequent findings in the pediatric population and the physician caring for a child with a neck mass may be faced with a diagnostic dilemma. The etiology of pediatric cervical masses includes a variety of conditions. Unlike for the adult, there are few established guidelines for evaluation of these children. A recent review of 445 neck masses operated on at the Children's Hospital of Philadelphia noted the preoperative diagnosis to be correct in 270, or only 61%. Clinical characteristics which may aid in establishing a correct preoperative diagnosis, as well as guidelines for the evaluation of the child presenting with a neck mass will be discussed.

Biopsy↗
PubMed1988

Microbiology of the tonsils and adenoids in a pediatric population.

To investigate the microbial flora of the tonsils and adenoids, the core tissue from the tonsils and adenoids of 50 children undergoing tonsillectomy and adenoidectomy for either recurrent infection or airway obstruction was cultured aerobically and anaerobically, and the number of bacterial colonies was quantitated. The most common organisms isolated were alpha-hemolytic streptococci, nonpathogenic Neisseria species, Haemophilus species, Staphylococcus aureus, and Corynebacterium species. No anaerobes were identified. Bacterial isolates from the tonsils and adenoids were similar in number and frequency of occurrence. Potential pathogenic bacteria (Haemophilus species, S aureus, beta-hemolytic streptococci, and Streptococcus pneumoniae) were identified in 40 patients. Seventy-three percent of these patients shared a common pathogen in tonsil and adenoid tissue. Haemophilus species were recovered in 54% of patients and S aureus in 46%. No significant difference exists between the type and number of pathogens in patients undergoing adenotonsillectomy for recurrent infection or obstruction.

Adenoidectomy↗
PubMed1988

Cis-platinum ototoxicity after radiation treatment: an animal model.

The chemotherapeutic agent cis-platinum has been used effectively as a treatment for many tumors. One of the most common toxic effects caused by this treatment is ototoxicity. More severe hearing loss has been reported in patients who had received cranial radiation prior to chemotherapy with cis-platinum. The present laboratory study was undertaken with chinchillas to determine whether ototoxicity is potentiated by cis-platinum administration after cochlear irradiation. Results support the clinical observation that cranial radiation prior to administration of an ototoxic chemotherapeutic agent can have a synergistic effect of increased susceptibility to the ototoxic potential of the agent.

Acoustic Stimulation↗
PubMed1988

Pediatric neck masses: guidelines for evaluation.

Neck masses are frequent findings in the pediatric population. Unlike the adult, there are few established guidelines for evaluation of these children. The etiology of cervical masses includes many conditions. Knowledge of these conditions and their clinical presentations is essential. To elucidate the clinical characteristics which may help in establishing a correct diagnosis, the charts of 445 patients with biopsies of neck masses performed at the Children's Hospital of Philadelphia were analyzed. There were 244 (55%) congenital lesions, 118 (27%) inflammatory lesions, 23 (5%) non-inflammatory benign masses, 12 (3%) benign neoplasms, and 48 (11%) malignancies. The preoperative diagnosis was correct in 270 (61%) patients. Guidelines are established for the evaluation of the child presenting with a neck mass.

Adolescent↗
PubMed1988

The anterior cricoid split: the Children's Hospital of Philadelphia experience.

The anterior cricoid split procedure (ACS) is an alternative to tracheotomy in selected infants with subglottic stenosis. From February 1983 to October 1987, 26 children underwent ACS at the Children's Hospital of Philadelphia. All children had subglottic stenosis. Six children had previously undergone tracheotomy. A successful outcome, allowing extubation or decannulation, correlated only with decreased pre-operative intubation time and was achieved in 73% of these patients. A failed ACS had little adverse affect on the subsequent management of these children.

Cricoid Cartilage↗
PubMed1988

A prospective study of titanium ventilation tubes.

A prospective controlled study was undertaken in which in 100 children a titanium ventilation tube was inserted in one ear, and a Paparella silicone tube was inserted in the contralateral ear as a control. The tubes were evaluated with respect to length of time of intubation, episodes of otorrhea, and early occlusion. Sixty-five patients were followed for at least one year, or until both tubes had extruded. Long-term follow-up of these patients has revealed little difference in the incidence of tube occlusion, early extrusion, or infection with otorrhea. Since the titanium tube is more than twice as expensive and has no proven advantages over a silicone tube of similar design, we have no reason to recommend its use over the less costly, standard silicon ventilation tube.

Child, Preschool↗
PubMed1987

Fluorometric assay of O-linked glycoproteins by reaction with 2-cyanoacetamide.

A simple assay for O-glycosylated glycoproteins involving the liberation of oligosaccharides by beta-elimination with dilute alkali and the subsequent derivatization of the reducing end with 2-cyanoacetamide is reported. The method can be used to quantitate microgram amounts of mucin within 30 min. The assay is 30 times less sensitive to protein or N-linked glycoproteins and 100 times less sensitive to DNA than to the corresponding weight of canine tracheal mucin. Of the substances tested, only cesium chloride and potassium thiocyanate caused substantial interference, but in neither case was this sufficiently serious to prevent the method being used for monitoring mucin purification schemes utilizing these reagents. The coefficients of variation for replicate analyses of canine tracheal mucin (14.0, 5.0, and 2.0 micrograms) were 3.6, 6.5, and 12.3%, respectively.

Animals↗
PubMed1987

Cholesteatoma in the pediatric patient.

A review of patients with cholesteatoma at the Children's Hospital of Philadelphia from 1981 to 1986 yielded 161 children. Analysis of data from both outpatient and hospital charts revealed a higher incidence of males to females, and the peak incidence of cholesteatoma appeared to be in the 6-10 year age group. Otorrhea was the most common symptom; and on physical examination, the posterior-superior quadrant was most often affected. Both intact canal wall and open cavity procedures were employed depending upon the site and extent of disease. Seventy-six percent of patients underwent an intact canal wall or middle ear procedure initially, with the remainder requiring an open cavity procedure. Recurrent or residual cholesteatoma was found in 32% of 148 patients at the second procedure, and in 7% of 148 patients if a third procedure was necessary. Pre- and post-operative audiometric findings for 91 patients revealed 21% with decreased hearing post-surgically, 50% with no change in hearing and 29% with improved hearing. Post-operative complications were minimal.

Adolescent↗
PubMed1987

Postoperative complications following tonsillectomy and adenoidectomy--who is at risk?

Postoperative complications following a large series of adenotonsillectomies (784 patients) at the Children's Hospital of Philadelphia fell into two major categories: hemorrhage and airway problems. Bleeding requiring operative intervention occurred in one child in the immediate postoperative period and in 16 children (2.0%) within 7-10 days. Eight patients (1.0%) had minor bleeding requiring only observation, and 9 others (1.2%) reported mild bleeding at home. Airway obstruction requiring the reinsertion of an airway or intensive care observation occurred in 10 children (1.3%). In general, these children were younger and most had significant underlying medical problems. We conclude that many complications encountered after adenotonsillar surgery are intrinsic to the patient's disease and overall medical condition. Improved surgical and anesthetic techniques have minimized the complications noted in earlier studies.

Adenoidectomy↗
PubMed1987

The sternocleidomastoid tumor of infancy.

The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little attention in the otolaryngological literature. The diagnosis must be considered in any infant presenting with a lateral neck mass. Although its natural history favors spontaneous regression, the mass may initially grow in size. The purpose of treatment is the prevention of torticollis and craniofacial asymmetry. The initial treatment is non-surgical, passive and active exercises. Only when this treatment fails should surgery be performed. The disappearance of the lesion is not always a predictable sign. A small number of children will develop delayed torticollis or craniofacial asymmetry. It is important that parents be informed of this possibility and of the necessity for long term follow-up.

Birth Injuries↗
PubMed1987

Fibrous histiocytoma of the larynx in a child. Case report and review.

A 6-year-old child presented with a fibrous histiocytoma of the subglottic larynx. These tumors are rare in adults, and only one other case has been reported in a child. The current case is the youngest and best documented in the pediatric age group. The clinical presentation in this patient, along with controversies related to this class of neoplasms is discussed.

Child↗
PubMed1986

Glycogen-rich clear cell carcinoma in the tongue. A cytochemical and ultrastructural study.

An unusual epithelial neoplasm arising in the tongue of a 17 month-old-boy was studied by light and electron microscopy. By routine light microscopic examination, the tumor cells exhibited clear cytoplasm. Histochemical studies revealed the presence of large amounts of periodic acid-Schiff (PAS)-positive, diastase-labile material in the cytoplasm. Ultrastructurally, this material was identified as electron dense particles (20-35 nm diameter) of beta-glycogen. The epithelial nature of the tumor cells was suggested by the presence of intercellular junctions, segments of basal lamina, and well-developed Golgi complexes. Furthermore, the cells were often clustered and formed abnormal lumina with small microvillus projections. Several histologic features, such as lack of capsule, infiltration of muscle and invasion of blood vessel, indicated that this neoplasm was malignant. However, there was no recurrence or distant metastases more than 2.5 years after surgical excision, suggesting a low-grade malignancy. The glycogen-rich clear cell variant of adenocarcinoma is histogenetically derived from minor salivary glands like most of the glandular neoplasms in the oral cavity. Investigation of the literature on adult and childhood minor salivary gland neoplasms revealed that the glycogen-rich, clear-cell variant of adenocarcinoma has not previously been reported in the tongue.

Adenocarcinoma↗
PubMed1986

The effect of antibiotic therapy on recovery after tonsillectomy in children. A controlled study.

Tonsillectomy continues to be a commonly performed operation in the pediatric age group. The postoperative period is often protracted and characterized by throat and ear pain, intermittent fever, foul odor from the oral cavity, and poor oral intake. Consequently, antibiotics are frequently prescribed in an effort to minimize these symptoms and/or avoid complications such as dehydration or secondary infection of the operative site. However, to our knowledge, no study to date has been performed to demonstrate the efficacy of antibiotic therapy in this setting. At the Children's Hospital of Philadelphia, a prospective, randomized, double-blind study was undertaken in which ampicillin (or placebo) was administered intravenously at the time of surgery and for 12 to 24 hours postoperatively. The children then continued to receive oral amoxicillin therapy (or placebo) for an additional seven days. The patients were then evaluated for the incidence and severity of postoperative symptoms and complications. Intraoperative cultures of the oropharynx and tonsillar tissue, as well as cultures of the tonsillar fossa, were obtained following completion of one week of therapy. Our results indicate that ampicillin sodium/amoxicillin trihydrate therapy is well tolerated and safe in the nonallergic child and is effective in minimizing fever and other troublesome postoperative symptoms, such as pain, lassitude, mouth odor, and poor oral intake after tonsillectomy.

Adenoidectomy↗
PubMed1986

Computed tomography in the evaluation of choanal atresia.

Nine patients with choanal atresia or stenosis, ranging in age from two days to 6 years were evaluated by computer tomography (CT). The clinical, conventional radiographic and surgical findings were correlated with CT findings. In all patients, the complete anatomic abnormality and the thickness of the obstruction were better defined with CT than with a choanogram. Findings on CT included: thickening of the vomer, bowing of the lateral wall of the nasal cavity and fusion of bony elements in the choanal region. This information is essential in planning surgical correction.

Child↗
PubMed1986

A controlled study of a 'new' ventilating tube. The gold standard?

A prospective controlled study of a gold ventilation tube was undertaken in which a gold tube was inserted in one ear of 88 children and a Paparella silicone tube was inserted in the contralateral ear as a control. The tubes were evaluated with respect to length of time of intubation, episodes of otorrhea and early occlusion. Sixty-three patients were available for a follow-up of at least 6 months. The gold tube remained in place for a shorter period of time when compared to the control tube. Episodes of otorrhea were infrequent and there was not any significant difference between the two types of tubes. The gold tube became occluded more frequently than the control tube. Since the gold tube is approximately 3 times more expensive and has no proven advantages over our conventional silicone tube, we have no reason to recommend its use in preference to any other available tube.

Acute Disease↗
PubMed1985

Auditory and vestibular function in hyperbaric oxygen.

The therapeutic value of high partial pressures of oxygen is limited by the toxicity of oxygen. Pulmonary damage, visual impairment, and convulsions are known hazards during hyperoxic exposure, but dose-effect relationships have not been quantified for specific organs or functions. As part of an integrated study of organ oxygen tolerance in man (Predictive Study V of the Institute for Environmental Medicine), auditory and vestibular function was evaluated in man before, during, and after exposure to 100% oxygen at 3 atmospheres absolute pressure for 2 to 3.5 hours. No alterations in hearing or equilibrium were detected, suggesting that ototoxicity is not a factor that would limit exposure under these conditions.

Adult↗