Biomedical subjects
B Benjamin
Publications and source records attributed to B Benjamin.
Cycloidal tomography of the temporal bone.
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Assessment of medical care.
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High incidence of breast cancer in thyroid cancer patients.
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Coronary heart disease. 30-year experience of 1,160 men.
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Giant Teflon granuloma of the larynx.
Endolaryngeal injection of Teflon paste to augment and medialize the paralyzed hemilarynx aims to improve dysphonia and relieve aspiration. After an initial short-lived inflammatory reaction in the laryngeal tissues, a foreign body granuloma forms around the Teflon. In most cases the results are good but it may occasionally be necessary to consider removal of the granuloma if too large a volume has been injected, if it is inappropriately placed, or if the paralyzed vocal cord subsequently recovers. Surgical removal is difficult and the results are unpredictable. This case illustrates, for the first time, that evaluation using both a high-resolution computed tomographic (CT) scan and endoscopy with telescopes permits satisfactory assessment before removal of Teflon.
Demographic aspects of ageing.
The first part of this paper examines future changes in the age structure of the population of England and Wales which are likely to occur as a result of past and future changes in fertility and mortality. These changes in fertility and mortality are examined in some detail. Different methods of projecting future changes in mortality are discussed. On the basis of conservative estimates of these changes, estimates are made of the future economic strain of dependency and there is some discussion of the way in which this might be best handled to the advantage of both the active and the elderly populations. The second part of the paper looks at different ways of examining improvements in longevity and also discusses some of the biological and environmental factors involved. Reference is made to the limited morbidity data available and the tentative conclusion is reached that improvement in longevity, so far, owes less to the reduction of disease incidence than to medical maintenance. This review paper, which relates to England and Wales, is in two main parts: (1) a general discussion of the population factors and changes which have led to a focusing of attention upon the ageing of the population and associated economic problems; and (2) a consideration of the implications of current health advances for individual survival.
Osteoarticular complications of childhood brucellosis: a study of 57 cases in Saudi Arabia.
Fifty-seven (36%) of a cohort of 157 children with brucellosis from Saudi Arabia had arthritis. Most gave a history of contact with farm animals or drinking unpasteurized milk. Associated features included pyrexia, arthralgia, hepatosplenomegaly, and lymphadenopathy. A subacute presentation with peripheral oligoarthritis predominantly affecting hips or knees was common. Specific chemotherapy resulted in rapid defervescence followed by slower resolution of the arthritis. Children with osteoarticular brucellosis had a higher relapse rate and a longer hospital stay. Supervised combination chemotherapy for at least 6 weeks was effective in preventing relapse. A brucellar etiology should be considered in any child from an endemic area who has osteoarticular manifestations.
Acute epiglottitis in infants and children.
Sixty-one cases of acute epiglottitis at the Royal Alexandra Hospital for Children, Sydney, from July 1968 to December 1974 are reviewed. The average age of 2.7 years is lower than previously reported. The average time from the initial symptom to arrival at the hospital was 14 hours. The average time from arrival to performance of tracheotomy was two hours. The diagnosis was made when first seen and assessed in 50 of the 61 cases. There were eight respiratory arrests in the Casualty and five of these were successfully resuscitated. We believe that an artificial airway is necessary in most cases, and in this series, tracheotomy was performed, with minimal complications. Particular emphasis is given to diagnosis from the history, and a detailed description is given of physical examination of the oropharynx. Although x-ray examination is usually unnecessary when the diagnosis is in doubt, a plain lateral x-ray may be useful, with due precaution not to increase the respiratory obstruction. We consider that a patient with acute epiglottitis should be transferred immediately to a major pediatric hospital, and that in almost every case an artificial airway should be established.
Treatment of infantile subglottic hemangioma with radioactive gold grain.
Congenital subglottic hemangioma causes life-threatening airway obstruction during the first few months of life. The mortality rate of recognized and untreated cases justifies active treatment, and although radiation therapy is currently most favored, it carries a risk of inducing malignant change in the thyroid gland later in life. A series of 11 patients with laryngeal hemangiomata is reported, conventional radiotherapy was utilized in the first seven patients, and placement of a radioactive gold grain directly into the lesion was used in the last four patients. This technique offers maximal tumor dose with minimal thyroid gland irradiation compared to treatment by conventional radiotherapy, and its successful use in these four patients is reported as worthy of further trial.
Endoscopy and biopsy in gastroesophageal reflux in infants and children.
The clinical features of abnormal gastroesophageal reflux in infants and children extend beyond repeated vomiting and include dysphagia, pain, bleeding, failure to thrive, esophageal stricture, and recurrent respiratory symptoms including aspiration pneumonitis and cyanotic attacks. The unreliability of the traditional barium swallow examination as a diagnostic test is well known. This study reports the results of endoscopic assessment and esophageal biopsy in 100 infants and children and relates them to the clinical findings and the changes in the contrast esophagogram. The results show that further valuable diagnostic information can be gained from endoscopic examination of the esophageal mucosa, especially when there is esophagitis with ulceration, bleeding, or stricture. Endoscopic biopsies are useful to confirm the presence of esophagitis but biopsies alone do not give absolute diagnostic information.
Congenital tracheal stenosis.
Twenty-one cases of congenital tracheal stenosis seen at the Royal Alexandra Hospital for Children 1971 through 1980 were reviewed with regard to the clinical features, associated anomalies, endoscopic findings and radiological evaluation. Congenital tracheal stenosis was usually a serious problem often associated with other major anomalies of the respiratory tract, esophagus, or skeleton. There was no set pattern of presentation. The presenting features included: persistent wheeze or stridor, atypical "respiratory distress," and atypical "croup" or "bronchiolitis." Documentation of the nature and extent of the stenosis by endoscopy and, if necessary, tracheobronchogram was important for prognosis and to direct treatment. Congenital tracheal stenosis must be considered in infants who present with atypical respiratory tract obstruction, especially where there is an H-type tracheoesophageal fistula, pulmonary hypoplasia or skeletal abnormalities such as hemivertebrae or a thumb abnormality.
Endoscopy in esophageal atresia and tracheoesophageal fistula.
Between 1970 and 1979 152 infants born with the anomaly of esophageal atresia with or without tracheoesophageal fistula or of congenital tracheoesophageal fistula without atresia were treated at the Royal Alexandra Hospital for Children, Sydney. Recent developments in endoscopic equipment and new techniques of anesthesia allow detailed examination of the respiratory tract and esophagus with minimum trauma and maximum safety. Symptomatology relating to the airway and to the esophagus after surgical repair often occurs in patients who may have tracheomalacia, esophageal anastomotic stricture, esophageal reflux and sometimes recurrent or residual fistula. A definite diagnosis of tracheomalacia can be made by finding the typical triad of anteroposterior narrowing of the tracheal lumen, weakening of the semicircular-shaped cartilages and forward ballooning of the widened posterior membranous tracheal wall. Careful examination of the trachea and esophagus allows identification of an elusive recurrent fistula or an H-type fistula. As the primary results of surgery for esophageal atresia and tracheoesophageal fistula improve, long-term problems are becoming increasingly important. The role of the pediatric endoscopist is vital in the care of these patients.
Documentation in pediatric laryngology.
Endoscopy in pediatric laryngology continues to develop and broaden its horizons. The need for documentation of the various pathological conditions has become more apparent. The upper lateral airways radiological study together with endoscopic photography allows permanent objective documentation of the changes occurring in any part of the upper respiratory tract from the nose and nasopharynx to the bronchi and segmental openings. This combination of radiological study and single frame color photography is the most convenient means of studying the pathology, natural history, and results of treatment as well as for clinical research and teaching in training programs.
Chevalier Jackson Lecture. Congenital laryngeal webs.
Congenital laryngeal web is not as common as has been previously believed, and thorough clinical, radiographic, and endoscopic assessment is needed before any form of surgical treatment is undertaken. It is important to detect associated anomalies in the larynx, the respiratory tract, or in other organ systems. The results of treatment with regard to voice quality are good only in thin, membranous, uncomplicated webs. Treatment for thick webs with or without associated congenital subglottic stenosis remains unsatisfactory.
Ten-year review of pediatric tracheotomy.
One hundred sixty-four consecutive tracheotomies are reviewed over the 10-year period 1972-1981. Early in the series acute inflammatory airway obstruction was the major indication for tracheotomy, being 60% of cases in the first 3 years. In the last 3 years this fell to approximately 15%. After 1975 nasotracheal intubation replaced tracheotomy for acute epiglottis. More recently it has become the treatment of choice for acute laryngotracheobronchitis. Tracheotomy prior to reconstructive surgery for major craniofacial abnormalities is becoming more frequent. Acquired subglottic stenosis is not a problem in our hospital despite the use of long-term nasotracheal intubation in premature infants, and no tracheotomies were performed for this indication. There were few major complications. Decannulation difficulties were due to obstruction by stomal granulation tissue or displaced flap of anterior tracheal wall. There was no case of hemorrhage, no posttracheotomy stenosis, and no death was attributable to tracheotomy. These results demonstrate that in a major pediatric hospital tracheotomy is a relatively safe and effective procedure with minimal morbidity.
Congenital laryngeal hemangioma.
Congenital subglottic hemangioma consistently occurs in a site below the vocal cord. It is a distinct clinical entity with typical clinical features. However, congenital hemangioma in other sites can cause airway obstruction. An anatomical classification is proposed on the basis of review of 23 consecutive cases. It is important to accurately identify the site and distribution of the lesion before commencing treatment. Radiation has been an acknowledged form of treatment, and in our hospital we have confirmed that radiation therapy, either by external beam, or by insertion of a radioactive gold grain, gives good results. The theoretical possibility of radiation-induced malignancy in the thyroid gland is reduced to an absolute minimum by use of a radioactive grain for localized tumor-dose with minimum radiation of surrounding tissue.
Anesthesia for laryngoscopy.
The requirements of anesthesia for laryngoscopy and microlaryngeal surgery must be compatible with maximum safety and minimum patient discomfort. Some techniques require the use of an endotracheal tube while some do not. Others use a modified tube or a jetting system. In general, for pediatric endoscopy we prefer spontaneous respiration with inhalational anesthesia supplemented by topical lignocaine (lidocaine), and in adults, a relaxant technique with controlled jet ventilation supplemented by topical lignocaine. A new pediatric microlaryngoscope and a new tube for jet ventilation in older children and adults are described.