Laryngoscope
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Comparison of Clinical Evaluation and Computed Tomographic Diagnostic Accuracy for Tumors of the Larynx and Hypopharynx Abstract Ninety‐five patients with laryngeal and hypopharyngeal cancer were examined and staged preoperatively by clinical evaluation (CE) and computed tomography(CT). The CE and CT staging were compared to each other and to the pathologic(PT) staging of the tumors. The CT staging showed high accuracy in staging transglottic (88%), supraglottic (68%), and oropharyngeal tumors invading the larynx (68%) when compared to the PT findings. The CT staging was less effective in evaluating glottic tumors (46%), both overstaging (12%) and understaging (20%) cases. Combined CE‐CT evaluation showed higher accuracy in staging all tumors (84%) compared to CE alone (52%) or CT alone (68%). The findings suggest that combined CE‐CT should be used to evaluate laryngeal and hypopharyngeal tumors. Laryngoscope, 106:589‐594, 1996
Laryngoscope - Tập 106 Số 5 - Trang 589-594 - 1996
Incidence of hypothyroidism following multimodality treatment for advanced squamous cell cancer of the head and neck Abstract The incidence of chemical hypothyroidism, as manifested by elevated thyroid stimulating hormone (TSH) levels, has been estimated to be as high as 25% after radiation therapy and 45% after radiation therapy and surgery to the neck for treatment of nodal metastases from squamous carcinoma of the head and neck. We prospectively evaluated 43 previously untreated patients seen in the Dana Farber Cancer Institute Interdisciplinary Head and Neck Service who were treated with aggressive combination chemotherapy in addition to standard surgery and/or radiotherapy. All patients were serially monitored for serum TSH, serum T4, and clincial evidence of hypothyroidism. Following cis‐platinum, bleomycin, and methotrexate chemotherapy and subsequent surgery and/or radiotherapy, decreased thyroid reserve appeared in 37% of patients at a median follow‐up of 9 months. Thirty percent of patients receiving radiotherapy alone and 43% of patients receiving surgery and radiotherapy developed elevated TSH levels. Only one patient developed clinical symptoms. Other patients were asymptomatic despite persistently elevated TSH levels. Abnormalities appeared within the first 4 months after completion of all therapy and were slowly progressive. The addition of combination chemotherapy does not appear to increase the incidence or severity of thyroid dysfunction following radiation therapy and surgery to the neck. In view of the extended survival seen in patients treated with interdisciplinary regimens, we recommend that all patients receiving irradiation to the neck – particularly those patients having neck dissections or total laryngectomies – have routine thyroid function studies performed following the cessation of treatment.
Laryngoscope - Tập 94 Số 4 - Trang 451-454 - 1984
The intraoperative management of the thyroid gland during laryngectomy Abstract The standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intra‐operatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isth‐musectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngectomy.
Laryngoscope - Tập 101 Số 9 - Trang 929-934 - 1991
Predictors of Thyroid Gland Invasion in Glottic Squamous Cell Carcinoma
Laryngoscope - Tập 115 Số 7 - Trang 1247-1250 - 2005
The effect of diuretics on cochlear potentials and inner ear fluids.
Laryngoscope - Tập 81 Số 6 - Trang 873-888 - 1971
DYSFUNCTIONS OF ENERGY RELEASING AND CONSUMING PROCESSES OF THE COCHLEA
Laryngoscope - Tập 83 Số 10 - Trang 1690-1712 - 1973
Early changes in the cochlear duct from ethacrynic ACID: An electronmicroscopic evaluation
Laryngoscope - Tập 80 Số 6 - Trang 954-965 - 1970
Bacteriology of tonsil surface and core in children Abstract The tonsils of 97 children undergoing tonsillectomy were studied to determine the correlation between surface culture swab and culture of tonsillar core. In many cases, pathogenic organisms were found in the tonsil core, despite the fact that surface cultures revealed only normal respiratory flora. The tonsil core cultures showed a high incidence of Hemophilus influenzae and Staphylococcus aureus , which was rarely reflected on surface culture. The study indicates that pharyngeal swab cultures do not reliably reflect the presence of pathogens in the tonsil core. The value of parameters such as history of recurrent bouts of tonsillitis and presence of erythema or cryptic debris on physical examination for predicting the differential bacteriology of the tonsil is studied. The implications for treatment of children with adenotonsillar hypertrophy are discussed.
Laryngoscope - Tập 99 Số 3 - Trang 261-266 - 1989
Experimental observations on the ototoxicity of nitrogen mustard
Laryngoscope - Tập 78 Số 4 - Trang 530-538 - 1968
Comparison of Antral Tap With Endoscopically Directed Nasal Culture Abstract Objectives/Hypothesis The diagnosis of acute bacterial rhinosinusitis continues to generate controversy in critically ill patients. The efficacy of endoscopically directed cultures in these patients is unknown. We compared antral tap (AT) with endoscopic tissue culture (ETC) of the osteomeatal complex in an intensive care unit (ICU) setting.Methods Twenty patients admitted to a surgical/trauma ICU were evaluated by AT and ENB for the presence of rhinosinusitis. All patients had 1) a fever of unknown origin without resolution on empiric antibiotic therapy for ≥48 hrs; 2) other sources of fever ruled out; 3) computed tomography scan evidence of mucoperiosteal thickening ± sinus air/fluid levels; and 4) attempt at conservative treatment with topical decongestants and removal of all nasal intubation. Microbiologic data were collected and analyzed for any statistical difference between groups.Results A total of 29 sides underwent simultaneous tap and endoscopically directed tissue culture. The mean age was 40 years (range, 23–77 y) with 85% being males. Fifteen of 20 (75%) patients in the AT group were culture‐positive. Of the 49 isolates from the AT, 55% yielded Gram‐negative bacilli (Acinetobacter sp. 37%) and 45% yielded Gram‐positive cocci. The ETC group was culture‐positive in 18 of 20 (90%) patients. Of the 52 isolates from the ETC, Gram‐negative bacilli were found in 58% (Acinetobacter sp. 33%) and 42% yielded Gram‐positive cocci. The ETCs were culture‐positive in all but 1 patient with positive taps. There appeared to be a concordance between AT and ETC in 60% of the patients. In five instances (25%), results of the AT or ETC changed ICU management. Two patients ultimately required sinus surgery.Conclusions Sinus taps and/or endoscopically directed tissue cultures led to a change in ICU care in 25% of ICU patients studied. In patients with fever of unknown origin and computed tomography evidence of sinusitis, an antral tap continues to provide important information concerning maxillary sinusitis. However, ETC may give as good a representation of the microbiology and secondary inflammatory changes responsible for bacterial ICU rhinosinusitis causing fever of unknown origin. Further study on a larger group of patients is needed.
Laryngoscope - Tập 111 Số 8 - Trang 1333-1337 - 2001
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