Fluorescein angiography is a recently developed method of studying the tympanic membrane's dynamic vasculature. Our preliminary studies using an ophthalmic fundus camera and aural speculum did not always permit visualization of the entire tympanic membrane, and the electronic flash unit used in our initial studies did not cycle fast enough to visualize effectively the rapid arterial phase of blood flow. In this report, we describe an endoscopic method of tympanic membrane fluorescein angiography that uses a continuous xenon light source. A representative angiogram from a normal subject is described. The mallear artery apparently is the major blood supply to the posterior half of the tympanic membrane, which is consistently better perfused than the anterior half. Branches from the annular ring of blood vessels supply the anterior half of the tympanic membrane. Preliminary studies of two temporalis fascia tympanoplasty patients indicate that the graft becomes revascularized 2 to 4 weeks after surgery and that posterior grafts may revascularize earlier than anterior grafts.
Otosclerosis (otospongiosis) occurs when the hard endochondral bone of the otic capsule is replaced by spongy vascular foci of haversian bone. Using computed tomography (CT), we studied the ears of 32 selected patients with mixed or sensorineural hearing loss (one patient had normal hearing); 24 were suspected of having otosclerosis. CT proved valuable in detecting cochlear otosclerosis, foci of demineralization, and changes in bony texture and enables the easy recognition of subtle radiographic findings. Our paper also reports the CT findings of temporal bones in osteogenesis imperfecta and Paget disease.
Three normal children with reported musical ability and three autistic children were tested for the ability to imitate individual tones and series of tones delivered by voice, piano, and synthesizer. Accuracy of imitation was judged by two independent observers on the basis of pitch, rhythm, and duration. The autistic children overall performed as well as or better than the age-matched normal children. These results are discussed and their implications for future neurological and clinical research are considered.
The human temporal bone is a 3-dimensionally complex anatomic region with many unique qualities that make anatomic teaching and learning difficult. Current teaching tools have proved only partially adequate for the needs of the aspiring otologic surgeon in learning this anatomy. We used a variety of computerized image processing and reconstruction techniques to reconstruct an anatomically accurate 3-dimensional computer model of the human temporal bone from serial histologic sections. The model is viewed with a specialized visualization system that allows it to be manipulated easily in a stereoscopic virtual environment. The model may then be interactively studied from any viewpoint, greatly simplifying the task of conceptualizing and learning this anatomy. The system also provides for simultaneous computer networking that can bring distant participants into a single shared virtual teaching environment. Future directions of the project are discussed.
Six cases of heterotopic salivary gland tissue in the anterolateral neck are presented with a review of their clinical and histopathologic characteristics. Neoplastic transformation, fistulization, and isolated rests represent a spectrum of these uncommon lesions. The embryologic derivation of salivary tissue and close association with the branchial apparatus are discussed. The significance of salivary carcinoma presenting in the neck is reinterpreted in light of the embryogenesis of these heterotopias.
A 15-year retrospective analysis was carried out at the University of Illinois College of Medicine, Chicago, reviewing the tumor staging and pathology data of 239 patients treated for carcinoma of the larynx and hypopharynx requiring laryngectomy alone, laryngectomy with neck dissection, or laryngopharyngectomy and neck dissection. Surgery was the primary treatment modality in 205 of the 239 cases, with the remaining 34 having surgery to treat radiation therapy failure. Primary tumors were located within the supraglottic region, the glottic region and, less commonly, the pyriform sinus. Ninety-five of the 239 patients either presented with or developed nodal metastases following initial treatment. Of these, only two had tumors within the lymph nodes of the submandibular triangle. This data corroborates impressions that tumors of the larynx and hypopharynx rarely metastasize to the submandibular triangle and that sparing this area during neck dissection for lesions of the larynx would seem justified.
Computed tomographic (CT) scans and tomograms of 60 patients with various soft-tissue masses of the middle ear, including 30 with cholesteatomas, were studied. CT produced excellent images of middle ear soft-tissue masses and appears to be the diagnostic method of choice for cholesteatomas, glomus tympanicum tumors, and other soft-tissue masses. In one patient CT demonstrated pneumolabyrinth resulting from postsurgical fracture of the footplate of the stapes. Pneumolabyrinth is a newly reported CT finding in stapes footplate fracture.
Ninety-five patients with squamous cell carcinoma of the head and neck were entered into a randomized study testing a two-week course of induction chemotherapy with methotrexate and leucovorin given prior to regional therapy. In addition, following regional therapy, patients randomized to chemotherapy were to receive similar methotrexate courses every three months for one year. Poor tolerance to this regimen after radiation and surgery led to a change in the chemotherapy following regional therapy to a combination of Adriamycin (Adria Laboratories, Columbus, Ohio) and cisplatin every three weeks for four cycles after the first 35 patients had been entered. Nine cases were ineligible and four lacked any follow-up data, leaving 82 analyzable cases. Using Cox regression analysis, no differences in the percentage of patients achieving disease control, the relapse-free survival, or the overall survival were identified between any treatment group. As has been described in many pilot studies of induction chemotherapy of head and neck cancer, chemotherapy responders had a more favorable disease-free survival than chemotherapy nonresponders in the total group of patients receiving adjuvant chemotherapy. However, correcting for imbalances in the expected three year disease-free survival of these patients, based on their disease site and stage, erased this difference, indicating tumor response to this regimen of chemotherapy is not an independent factor affecting disease outcome. The division of patients into arbitrary prognostic categories based on the expected outcome for each specific tumor site and stage proved to be a useful method for balancing treatment groups, given the multiple site-stage combinations within the upper aerodigestive tract. The defined prognostic categories were the single most sensitive predictors of relapse-free and overall survival.
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