Evitable vs inevitable complications.
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Biomedical subjects
Publications and source records attributed to R S Goodman.
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A dermosubcutaneous nodule presenting with a superficial papular vascular component occurred in a man receiving long-term prednisone therapy. The histologic findings were characteristic of a phaeohyphomycotic cyst, and a black mold, Exophiala jeanselmei, was isolated. Despite treatment with ketoconazole and local heat, the lesion persisted and was excised. The fungus could be seen in the excised tissue, but cultures were sterile. Subcutaneous phaeohyphomycosis is a relatively uncommon, but recently more frequently recognized type of opportunistic fungus infection.
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The occult primary is a problem well known to head and neck surgeons. Less frequently discussed, but well documented, is cystic degeneration of metastatic nodes. When these conditions combine, they can suggest tumor arising in a pre-existing cervical cyst. This is a controversial condition, rare if it occurs at all, and is not to be invoked lightly.
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Cutaneous mucoepidermoid carcinoma is quite rare. We describe a case of extrasalivary cutaneous mucoepidermoid carcinoma in the head and neck region. The theories dealing with the origin of these tumors in the sweat and salivary glands are discussed, and the literature concerning these lesions reviewed. We believe this to be the first description of an extrasalivary mucoepidermoid carcinoma in the head and neck region or other sites that normally contain mucous glands.
Of more than 200 patients who underwent high-resolution computed tomography (CT) of the middle ear, the vast majority had tubotympanic disease in one of its forms: middle ear effusion, tympanosclerosis, granulation tissue, tympanic membrane retractions, or acquired cholesteatoma. The CT appearance of each of these conditions is discussed and illustrated. Emphasis is placed on the differential diagnosis of tubotympanic disease by determining dependent from nondependent soft-tissue opacity using two CT projections.
High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear and mastoid is recommended at approximately 3 months following the surgical procedure.
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