History of ophthalmology in Hawaii.
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Biomedical subjects
Publications and source records attributed to R T Wong.
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A 36-year-old man had the Tolusa-Hunt syndrome, an unusual cause of painful ophthalmoplegia with a neurologic deficit that may not be distinguishable from the many other disease processes that involve the orbital apex. Diagnosis was made by excluding the other causes, and there was a prompt response to high-dose steroid therapy, which prevents or minimizes any permanent neurologic deficit. Because of this and the fact that the otolaryngologist is often involved in the diagnosis and treatment of the many causes of painful ophthalmoplegia, it is important to be aware of this syndrome.
The clinical, gross, and microscopic features of 40 cases of intranasal mixed tumor (pleomorphic adenoma) are reviewed and studied. The majority of these neoplasms originate from the mucosa of the bony or cartilaginous septum; they also occur on the lateral nasal wall. They may be found at any age, but the majority of our cases occurred in persons in the third through sixth decades of life. There was no significant sex predilection. All patients whose race was recorded (35) were Caucasian. The patients commonly had symptoms of nasal obstruction or the presence of a mass in the nasal cavity, or both. Clinically, the lesions were not unique, frequently being described only as polypoid, broad-based swellings. Microscopically, although similar to mixed tumors of major salivary glands, these tumors differed by being highly cellular (epithelial), with little or no stromal component, and thus simulated more aggressive epithelial neoplasms. Follow-up data (mean 7.5 years) in 34 of the 40 cases showed no evidence to suggest aggressive behavior. Thirty-one of the 34 cases followed showed no recurrence, regardless of the type of excisional procedure used. Those that did recur were either persistent from inadequate primary excisions (2 cases) or recurred locally (1) and were removed without sequelae. Local but adequate excision appears to be the treatment of choice.
Luetic hearing loss has been noted with increasing frequency in recent years. Four cases of luetic hearing loss seen at Walter Reed General Hospital from 1974 to 1975 are presented and discussed. Symptoms and pathology of luetic involvement of the inner ear are also presented. Serum FTA-ABS and TPI, in addition to VDRL, must be routinely obtained during the workup of hearing loss. CSF FTA-ABS should be obtained if serum FTA-ABS and TPI are positive. Reversibility may be dependent on early detection of luetic hearing loss and treatment with high doses of antibiotics and steroids.
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