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Health Expenditures↗
Biomedical subjects
B F McCabe
Publications and source records attributed to B F McCabe.
Syndrome of inappropriate secretion of arginine vasopressin in patients with cancer of the head and neck.
The syndrome of inappropriate secretion of arginine vasopressin (AVP) known as the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is associated with a variety of malignant and nonmalignant diseases. Only 17 cases of SIADH have been reported in the literature in association with cancer isolated to the head and neck. A retrospective review of 1,436 patients with head and neck malignancy excluding skin cancer through The University of Iowa Tumor Registry revealed 60 patients with the diagnosis of either SIADH or hyposmolality. A chart review for each of these patients was then done to establish the diagnosis of SIADH through relevant laboratory values and by excluding other causes of hyposmolality and hyponatremia. In 43 of these patients (3%), SIADH was found to be associated only with the cancer of the head and neck. We conclude that the incidence of SIADH in patients with cancer of the head and neck is much higher than previously recognized. As elevated serum AVP levels may not be clinically apparent unless associated with excessive water ingestation, it is possible that an even higher percentage of patients may have increased serum AVP levels.
Aged↗
Tube-perilymph fistula. An experimental study.
Before exploratory tympanotomy, it is difficult to diagnose an idiopathic perilymph fistula (PLF) because of its variable presentations. An animal model tube-PLF on guinea pigs was established to evaluate the change of the sensitivity of the cochlea function and the value of the postural audiometry in PLF. A fine polyethylene tube (O.D. 0.6mm) was inserted into the scala tympani of the basal turn through the incised round window membrane in 10 experimental guinea pigs, and another 5 as controls. The hearing threshold (HT), action potential (AP) latency for stimulus of 105 dB SPL, difference of HT and AP latency from the test ear down to up were measured by electrocochleography (ECoG) immediately after operation and one week later. The HT, AP latency and postural audiometry showed no significant changes immediately but a significant difference one week later in HT (P less than 0.01) and postural audiometry, the AP latency also presented a significant delay (P less than 0.01). The results showed that the tube-PLF model may be a valuable method for studying chronic PLF.
Action Potentials↗
The effect of hyperbaric oxygen on growth of human squamous cell carcinoma xenografts.
Hyperbaric oxygen is an important adjunct to the treatment of patients with head and neck cancer with existing or recurrent wound healing problems. Anecdotal clinical observations and a recent study of chemically induced oral cancer in hamsters have raised concern that hyperbaric oxygen therapy may accelerate tumor growth in such patients. This study evaluated the effect of hyperbaric oxygen therapy on the growth of human squamous cell carcinoma xenografts in a proved animal model. Fresh tumor specimens from three patients with head and neck squamous cell carcinoma of varying degrees of differentiation were first subcutaneously transplanted into a nude mouse host. Growing xenografts were then transplanted into one of three mouse groups. Half of the mice in each group were given hyperbaric oxygen therapy. The transplant volume as an index of tumor growth was measured in controls and mice given hyperbaric oxygen therapy six times during the 3-week course. Xenograft growth was almost linear in all mice. No statistical difference in overall group mean growth rates was observed in mice given hyperbaric oxygen or control mice regardless of the degree of tumor differentiation. Xenograft tissue from all mice was microscopically examined for tumor mitotic indices and degree of differentiation. This study suggests that hyperbaric oxygen therapy has no effect on established tumor xenograft growth.
Animals↗
Autoimmune inner ear disease: results of therapy.
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Adolescent↗
Monothermal differential caloric testing in patients with Menière's disease.
The monothermal differential caloric test allows determination of vestibular recruitment and decruitment, variables which may help discriminate peripheral from central vestibular lesions. Previous reports indicated a strong association between vestibular recruitment and Menière's disease. This study examined patients having unilateral Menière's disease. Nystagmus beat frequency (NBF) and slow-component velocity (SCV) responses were recorded by electronystagmography (ENG). Electronystagmographic findings showing unilateral dysfunction were present in 54% of patients by slow-component velocity and in 31% by nystagmus beat frequency. Unilateral hypofunction was the most frequent lateralizing ENG finding. Absolute vestibular recruitment occurred in less than 10% of patients but relative recruitment was found in nearly 20% of patients. Slow-component velocity had higher sensitivity than nystagmus beat frequency, with excellent clinical concordance. Monothermal caloric testing as described in this study best detects peripheral vestibular disease in Meniere's patients using slow-component velocity to determine unilateral hypofunction and relative vestibular recruitment.
Adolescent↗
Temporal lobe tumor manifested by localized dysgeusia.
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Astrocytoma↗
Homograft tympanoplasty: the Iowa experience.
Homograft tympanic membranes have been used in tympanoplasty for nearly 30 years. Reported anatomical success rates vary from 50 to 100 percent. One hundred and one homograft tympanoplasty procedures were performed at the University of Iowa over the 10-year period of July 1978 through June 1988. The anatomical success rate was 76 percent. Hearing results were satisfactory in 86 percent of cases. The homograft tympanic membrane, with or without ossicles, has proven to be a highly satisfactory modality for the reconstruction of the severely ravaged middle ear.
Adolescent↗
Perilymph fistula: the Iowa experience to date.
This is a follow-up report to the Seltzer-McCabe paper, which appeared in Laryngoscope (1986; 96:37-49). The reader is referred to that article for details of operations, patient selection, and baseline data. This is merely an update.
Ear, Middle↗
Phonosurgery: indications and pitfalls.
Twenty-five patients underwent type 1 thyroplasty (external medialization of abducted true vocal cord) during a 2-year period 1986 to 1988) at the University of Iowa. The most common indication for thyroplasty was post-thyroidectomy vocal cord paralysis. Eighteen patients (72%) had either a good or an excellent initial result. Five patients were revised. Postrevision, 21 patients (84%) had achieved either a good or an excellent result. Complications were limited to one case of significant vocal cord edema and another instance of vocal cord hemorrhage. No patient required a tracheotomy. No prosthesis extruded. We feel that phonosurgery has the advantages over traditional Teflon injection of allowing the patient's head to be in a neutral position during the operation; of allowing local anesthesia; of permitting a predictable, graduated end point of the procedure; and of being infinitely adjustable, with preservation of the vocal cord mucosal wave.
Female↗
Audiologic results following reimplantation of cochlear implants.
Five patients using cochlear implants experienced internal device failure 6 weeks to 4 years following implantation. All devices were removed and new electrodes inserted. Single-channel implants were replaced with multichannel systems in three patients, while the others received identical multichannel implants. The performance on a uniform battery of audiologic tests was the same or better with the second implant in all patients. Replacement of intracochlear electrodes did not induce clinically apparent degeneration of auditory performance in this series.
Adolescent↗
The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience.
Chronic cerebrospinal fluid rhinorrhea (present for 2 months or longer) is a serious condition frequently encountered by the otolaryngologist-head and neck surgeon. The purpose of this report is that it can be successfully repaired transsinally, from below, with a high rate of success. Intracranial repair has been associated with reportedly high morbidity and failure rates. From 1967 to 1987, 16 patients underwent repair of chronic cerebrospinal fluid rhinorrhea in the cribriform plate or fovea ethmoidalis at the University of Iowa with an osteomucoperiosteal flap. Follow-up data from 1.6 to 22 years demonstrated no recurrent leaks in this group of patients. Minimal morbidity and no deaths were associated with the osteomucoperiosteal flap. On the basis of our experience, we recommend this technique, which can be performed by any experienced paranasal sinus surgeon, as superior to craniotomy for the repair of chronic cerebrospinal fluid rhinorrhea from cribriform plate and fovea ethmoidalis defects.
Adolescent↗
Facial nerve function following irradiated cable grafts.
Facial nerve cable grafting preceding postoperative radiation therapy in patients undergoing facial nerve resection for malignant disease remains controversial. Twelve cases of postoperatively irradiated facial nerve cable grafts are reviewed in detail. Of nine patients with long-term evaluations, all have shown some return of facial nerve function, with seven having moderate to excellent return of function, as documented on videotapes and shown in still photographs. We conclude that cable grafting is the treatment of choice, even though postoperative radiation therapy is planned. Cable grafting should almost always result in facial function that is clearly superior to the function provided by static or dynamic slings.
Adult↗
Synthetic two-formant vowel perception by some of the better cochlear-implant patients.
Synthetic two-formant vowel recognition was tested in some of the better cochlear-implant users to determine their ability to resolve sounds that differ essentially in their frequency content. The vowels /i, epsilon, alpha, u/ were synthesized with equal duration and similar sound pressure level. The formant values were chosen to approximate the values of these vowels in French, German and American English. Performance ranged from 29 to 71% for the 6 patients with the Chorimac implant, from 25 to 67% for the 9 patients with the 3M/Vienna implant, from 63 to 92% for the 10 patients with the Nucleus implant from Hannover, from 17 to 79% for the 10 patients with the Duren/Cologne implant, from 54 to 100% for the 9 patients with the Symbion implant, and from 79 to 100% for the 10 Nucleus patients from the USA. Patients with each of these devices can utilize some spectral information when recognizing steady-state vowels.
Cochlear Implants↗
Vascular loop as a cause of incapacitating dizziness.
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Adult↗
Autoimmune inner ear disease: therapy.
Sixty-six patients with this disease have been treated to date with cyclophosphamide and prednisolone resulting in significant improvement in hearing. In some patients the vestibular compartment may be involved as well, but the clinical pattern is significantly different enough from Meniere's disease to distinguish it by the careful historian. The cornerstone of treatment is cyclophosphamide, abetted by prednisolone. A test of treatment is to date the best method of determining who to treat for cure.
Autoimmune Diseases↗
Lipoid proteinosis of the larynx: a cause of voice change in the infant and young child.
Lipoid proteinosis is an autosomal recessive disorder that may display multiple systemic manifestations involving mucosal deposition of hyalin material. Skin and upper aerodigestive tract mucosal involvement predominate. In approximately two thirds of cases, voice change secondary to laryngeal involvement occurring at birth or early in infancy is the first manifestation of the disease.
Child, Preschool↗
Use of multichannel cochlear implants in obstructed and obliterated cochleas.
Obstruction that occurs within the scala tympani (after meningitis or otosclerosis) has been considered a contraindication for placement of a multichannel cochlear implant electrode. Two patients who exhibited radiographic evidence of intracochlear narrowing and obliteration were implanted with multichannel electrodes. Implantation involved creation of a channel for the electrode to wrap around the modiolus. The middle ear cavity and the external auditory canal also had to be removed to gain access. The response of one of the patients was similar to that of patients with normal cochlear anatomy who use multichannel devices. These early experiences, along with one case in which a single-channel electrode was placed, is presented.
Adult↗