[Progressive gangrenous rhinitis--with special reference to clinical and vascular lesions of limited forms of Wegener's granuloma and similar nose diseases].
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There has been considerable controversy over the years regarding the distinctions between various disorders characterized by a necrotizing and granulomatous inflammation of the tissues of the upper respiratory tract and oral cavity. It now seems clear that if infections and other known agents can be excluded, three clinicopathologic entities remain: Wegener's granulomatosis (a systemic disease), idiopathic midline (nonhealing) granuloma, and premalignant or malignant lymphoreticular lesions. The antigenic stimulus for all three may be related but remains unidentified.
A retrospective study of the clinical and radiographic features of 51 nasopalatine duct cysts has been undertaken. Of these cysts 33 were in males (64.7%) and 18 in females (35.3%). The age range was 9--67 years (mean 32 years) with most cases being detected between the second and fourth decades. All of the subjects aged less than 20 years were South African Negroes and the lesions found in this group were invariably over 3.5 cm in diameter and rapidly growing. The average size for all of the cysts (after taking in 19% radiographic enlargment factor into account) was 3.5 cm in greatest diameter. The most common signs were: palatal swelling (88.2%), tooth displacement (78.4%) and sub-labial swelling (17.6%). Root resorption was found in only two of the 40 cysts which encroached upon lamina dura. No recurrences occurred following marsupialization or enucleation.
In this study, the frequency of occurrence of speech and voice symptoms in 200 Parkinson patients was defined by two expert listeners from high-fidelity tape recordings of conversational speech samples and readings of the sentence version of the Fisher-Logemann Test of Articulation Competence. Specific phonemes that were misarticulated were catalogued. Other vocal-tract dysfunctions, including laryngeal disorders, rate disorders, and hypernasality, were also recorded. Cooccurrence of symptoms in each patient was tabulated. Examination of the patterns of cooccurring dysfunctions permitted classifying the 200 patients into five groups: Group 1 (45% of the patients) with laryngeal dysfunction as their only vocal-tract symptom; Group 2 (13.5% of the patients) with laryngeal and back-tongue involvement; Group 3 (17% of the patients) with laryngeal, back-tongue, and tongue-blade dysfunction; Group 4 (5.5% of the patients) with laryngeal dysfunction, back-tongue involvement, tongue-blade dysfunction, and labial misarticulations; and Group 5 (9% of the patients) with laryngeal dysfunction and misarticulations of the back tongue, tongue blade, lips, and tongue tip. Disfluencies and hypernasality did not follow a systematic pattern of cooccurrence with other vocal-tract dysfunctions.
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Rhinosporidiosis is a fairly common problem for the Otolaryngologist in many parts of the world, because of its prompt recurrence after surgical excision. Though not a fatal disease, it inflicts various kinds of social and economic strain on the patients and their families. No medical treatment has been found to be effective in controlling rhinosporidiosis. Such drugs as griseofulvin and amphotericin have been tried without much benefit. In this clinical trial with dapsone on 32 patients (71.4%) did not have recurrence in a three year period and none of them needed surgery in that period. Thirty-two patients were used as controls, and 93% of them needed surgery for recurrent rhinosporidiosis in the same three year period. Dapsone (diaminodiphenylsulfone) is a relatively safe drug to use, and no major side effects were noticed in this trial.
Transoral microsurgery of the larynx has now made it possible to treat multiple lesions heretofore only treatable by external approach. The introduction of the surgical carbon dioxide laser has been the single greatest advance in transoral surgery of the airway in the past 15 years. This modality of therapy offers many features not found in any other known form of surgery. It is especially useful in the pediatric airway where the avoidance of edema and the need for minimal scarring is most critical. Its unique aspects make this form of treatment most desirable in the pediatric laryngotracheal region.
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