Biomedical subjects
Publications and source records attributed to W M Keane.
Chondrosarcoma of the larynx is a rare malignancy accounting for 0.5% of all laryngeal tumors. We report our approach to laryngeal chondrosarcoma and review the recent literature on the subject. Our review supports the previously held opinions about sites of origin, but draws new conclusions about symptoms. In addition, we examine the controversy of conservative surgery vs. total laryngectomy.
Twenty-nine patients were admitted to Pennsylvania Hospital between March 1984 and July 1990 with a diagnosis of epistaxis and hereditary hemorrhagic telangiectasia. Data were obtained through a retrospective review of the charts of these patients. Patients were treated for epistaxis with the CO2 laser, neodymium:aluminum garnet laser with a wavelength of 1064 nm (Nd-Yag), Nd-Yag laser with a wavelength of 532 nm (KTP), septodermoplasty, or any combination of these procedures. Patients underwent an average of 2.5 procedures each. Overall, 25 of 29 patients reported their symptoms had greatly improved with therapy. The average length of time without the need for further surgical intervention was 16.3 months for the Nd-Yag laser and 11.7 months for the KTP laser. Septodermoplasty using buccal mucosal grafts allowed, patients to avoid additional procedures for 24.4 months, which was twice as long as for standard septodermoplasty using split-thickness skin grafts. Although no therapy completely resolves the epistaxis, laser therapy combined with septodermoplasty enables the patients to gain excellent control of the epistaxis for several years.
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We treated twenty-three patients with blunt or penetrating wounds of the frontal sinus from 1978 through 1983. Nondisplaced anterior wall fractures were observed or explored. Posterior table fractures--with displacement confirmed by computed tomography or polycycloidal tomography--were explored. Either obliteration of the sinus or nasofrontal duct reconstruction with a Sewall-Boyden-McKnaught flap was selected, depending on the magnitude of duct injury. In all cases, the anterior wall was primarily reconstructed. All penetrating wounds with posterior table involvement were treated by cranialization of the frontal sinus and temporalis muscle obliteration of the nasofrontal ducts. Only one case of meningitis occurred, resulting in prolonged hospitalization.
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The hospital records for 100 cases of meningitis in which acute audiometric data has been obtained were reviewed. The incidence of sensorineural hearing loss was found to be 6%. The severity of hearing impairment varied from mild to profound and was frequently bilateral and irreversible. Two-cases showed asymmetrical involvement, and in one case, there was subsequent improvement in threshold sensitivity. Factors that influenced the incidence of neurologic sequela included severity of the initial disease process, age of the patient, and duration of symptoms before diagnosis and treatment. We discuss the pathophysiologic mechanisms that may account for such hearing loss, and we emphasize the importance of early diagnosis and intensive antimicrobial therapy. Careful neurologic evaluation is required after recovery and must include periodic sequential audiometric testing.
Flexible fiberoptic bronchoscopy with multiplanar fluoroscopic control is shown to be effective in the transbronchial drainage of pulmonary abscesses. A new technique which permits the intracavitary placement of brush forceps and fine arterial catheters is described. This has facilitated the rapid defervescence of fever and established immediate endobronchial drainage. Seventy percent of patients had complete radiographic closure of their abscess cavities at three months. Clinical findings are presented and the role of aspiration in pathogenesis of pulmonary abscess is stressed.
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Congenital vascular anomalies of the aortic arch are unusual etiologies of dysphagia in the adult. Swallowing abnormalities associated with compression of the esophagus primarily occur at birth or in the immediate neonatal period. However, as the result of arteriosclerotic vascular disease or aneurysm formation, anomalies which were asymptomatic postnatally may produce dysphagia in the adult. A retrospective analysis of 59 cases with aortic arch anomalies presenting initially in adulthood revealed characteristic clinical signs and symptoms. An aberrant right subclavian artery with left aortic arch was the most frequently encountered abnormality. The embryologic development of each vascular anomaly is described and the value of selective arteriography with contrast esophagography is stressed. Patients with minimal swallowing impairment are treated with dietary management alone. Surgical division of the anomalous artery is indicated only when severe dysphagia is associated with progressive life-threatening anorexia and weight loss.
A case of fatal disseminated aspergillosis in a renal transplant patient is presented. The initial manifestation of the disease was consistent with thyroiditis. Autopsy findings are shown and support this unique presentation. The diagnosis of aspergillosis is difficult to make and may require pulmonary biopsy. Early diagnosis and treatment with amphotericin B are the keys to successful management of the disease.
A method for measuring evoked cortical potentials to acoustic stimuli through the intact dura mater of the guinea pig without computer averaging studied. After exposure of the dura overlying the auditory cortex on the left side, thresholds to acoustic stimuli presented to the right ear were determined with a double tipped silver electrode by visual detection on an oscilloscope. The thresholds obtained are compared with other methods of determining audibility levels in the guinea pig. With relatively simple instrumentation, this method provides rapid and accurate determination of the audibility curve.
Cranial computed tomography (CT) is an effective radiologic method for the evaluation of extracranial and intracranial pathology. Representative cases of extracranial and intracranial pathology of otolaryngic interest are selected from 6,000 CT scans. Pathology of the nasal cavities, paranasal sinuses, orbits, and cerebellopontine angles is demonstrated.
The effect of carbon monoxide poisoning on the threshold sensitivity of the responses from the auditory cortex, inferior colliculus, and cochlea to acoustic stimuli in guinea pigs was studied. The toxicity of carbon monoxide is believed to be secondary to tissue hypoxia and is partially reversible. Loss of auditory threshold sensitivity in carbon monoxide poisoning is most prominent at the auditory cortex. The loss of sensitivity at the inferior colliculus is the next most severe. There is no loss of sensitivity at the cochlea. The relative vulnerability of the central auditory pathway to carbon monoxide poisoning as compared with the end organ is demonstrated.