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Biomedical subjects

R S Goodman

Publications and source records attributed to R S Goodman.

45 records · Page 3Linked to original sources

Heterotopic salivary tissue and branchial cleft sinus.

Bilateral lesions which appeared clinically to be branchial cleft sinuses were removed from a patient's neck. One was indeed a branchial cleft sinus, with elements of salivary tissue, but the other proved to be pure salivary tissue with a duct characteristic of a salivary gland. The embryology and clinical characteristics of heterotopic salivary glands are discussed. The occurrence of a heterotopic gland together with a branchial cleft sinus supports the contention that the heterotopic glands arise through errors of development in the branchial apparatus.

Branchioma↗

Tuberculoma of the nasopharynx.

When a patient of oriental extraction was seen with a mass in the nasopharynx, squamous cell carcinoma appeared to be the obvious diagnosis. Histologic examination, however, proved the mass to be a tuberculoma. This condition, which was not rare in the past, is almost always secondary to pulmonary tuberculosis. It responds to antituberculous medications.

Carcinoma, Squamous Cell↗

Cardiac and pulmonary failure secondary to adenotonsillar hypertrophy.

For over 15 years, upper respiratory tract obstruction due to adenotonsillar hypertrophy has been known to cause hypoxia, hypercapnia, increased pulmonary vascular resistance and thereby cor pulmonale and congestive heart failure. This is now an uncommon but not rare entity and three recent cases prompted this report. The typical patient is dyspneic with retractions, cyanosis, occasional periods of apnea and somnolence. Edema and hepatomegaly and at times splenomegaly are common. X-rays show cardiomegaly, which on electrocardiogram is found to involved mainly the right ventricle. The strict definition of cor pulmonale is right ventricular hypertrophy secondary to lung disease or abnormal pulmonary function, a definition that may logically be stretched to include abnormal respiratory function secondary to upper airway pathology. The mechanisms by which this occurs are generally agreed upon. Hypoxia has been demonstrated to cause pulmonary vasoconstriction. Acidosis and hypercapnia are thought by some to have the same effect. Pressure across the pulmonary vascular bed is also increased, as predicted by Poiseuille's law, by the high rate of blood flow required to maintain tissue oxygenation with poorly oxygenated blood. Conditions producing hypoxia of hypercapnia or both lead to hypertrophy and eventually to dilatation of the right ventricle. Three cases of children who underwent cardiac catheterization while suffering from cor pulmonale due to adenotonsillar hypertrophy are reported. Right ventricular pressure averaged 44/5, PAO2 72, pH 7.32, and PACO2 52. All were clinically improved following adenotonsillectomy. Cardiac catheterization was repeated in one case, with right ventricular pressure dropping from 44/5 to 21/2, pulmonary vascular resistance from eight units to three, and PACO2 from 62 to 44.

Adenoidectomy↗

Aberrant internal carotid artery in the middle ear.

Aberrant internal carotid artery in the middle ear is a rare anomaly. Myringotomy in a patient with this anomaly caused violent hemorrhage, requiring immediate packing and eventual ligation of the artery. The anomaly may represent the artery bulging through a dehiscent bony canal, or it may be due to traction on the developing carotid by a persistent stapedial artery. Various middle ear symptoms have been reported in earlier cases. Diagnosis is by angiography, and therapy is surgical.

Adult↗