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Biomedical subjects

C M Stiernberg

Publications and source records attributed to C M Stiernberg.

50 records · Page 3Linked to original sources

Nasal dermoid with intracranial involvement.

Nasal dermoids are unusual lesions resulting from embryopathology. They are diagnosed easily by physical examination. Treatment is complete surgical excision, aided by microsurgical techniques. Involvement of the skullbase is common with "deep-seated" ND, and intracranial involvement is not uncommon. The high-resolution CT scanner is believed to be valuable in diagnosing deep involvement, including intracranial extension. The finding of a bifid crista galli is suggestive of intracranial involvement. Neurosurgical consultation is mandatory for all cases of ND when deep extension is suspected.

Brain Neoplasms↗

Rhinoscleroma.

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Adult↗

Dissemination of computer skills among physicians: the infectious process model.

While the potential utility of computer technology to medicine is often acknowledged, little is known as to the best methods to actually teach physicians about computers. The current variability in physician computer fluency implies there is no accepted minimum required level of computer skills for physicians. Special techniques are needed to instill these skills in the physician and measure their effects within the medical profession. This hypothesis is suggested following the development of a specialized course for the new physician. In a population of physicians where medical computing usage was considered nonexistent, intense interest developed the following exposure to a role model having strong credentials in both medicine and computer science. This produced an atmosphere where there was a perceived benefit in being knowledgeable about the medical computer usage. The subsequent increase in computer systems use was the result of the availability of resources and development of computer skills that could be exchanged among the students and faculty. This growth in computer use is described using the parameters of an infectious process model. While other approaches may also be useful, the infectious process model permits the growth of medical computer usage to be quantitatively described, evaluates specific determinants of use patterns, and allows the future growth of computer utilization in medicine to be predicted.

Computers↗

Rhinoscleroma--a diagnostic challenge.

Rhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor-like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikuliz's cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long-term follow-up is important because these patients can have numerous relapses. Geographic distribution is also discussed.

Anti-Bacterial Agents↗

Esthesioneuroblastoma metastatic to the trachea.

Esthesioneuroblastoma is an uncommon nasal neoplasm of neural crest origin, which is recognized for its propensity for local recurrence and distant dissemination by both lymphatic and hematogenous routes. Hematogenous spread occurs most frequently to the lungs and bones, but metastases to the liver, spleen, scalp, face, breast, adrenal, aorta, and ovary have been reported. We present a patient who developed metastatic esthesioneuroblastoma of the trachea 1 year after successful craniofacial resection of his primary tumor. The patient was treated by YAG laser resection of the metastatic tumor followed by radiotherapy. He was free of tracheal disease 1 year after treatment of the metastases.

Adult↗

Teratomas of the head and neck.

Teratomas of the head and neck are uncommon. They are composed of tissues from all three germ layers with varying degrees of differentiation. They arise from pluripotent stem cells and ectopic embryonic nongerm cells. Head and neck teratomas most commonly emerge during the neonatal period and are associated with airway obstruction and high rates of mortality in untreated patients. The tumors are usually benign, but when found during adulthood, they have a high incidence of malignancy. The most common site of occurrence is the cervical region and the nasopharynx. We presented a rare case of teratoma originating from the base of the tongue. This case is an example of the development of teratoma by pinching off of remnants of the three germinal areas, which become marginated in the normal migratory pathway as the different structures of the head and neck develop. The remnants developed into the predetermined organ systems, giving rise to the heterotopic tissues encountered. The recommended treatment for head and neck teratomas is surgical excision. When a patient is experiencing respiratory difficulty, establishment of an airway is a priority.

Child, Preschool↗

Paraneoplastic syndromes in patients with head and neck cancer.

Paraneoplastic syndromes are distinct physiological disorders of malignancy that occur remote from a tumor site. A review of a number of paraneoplastic syndromes occurring in patients with head and neck cancer has been discussed. These syndromes can produce life-threatening sequelae in the patient with cancer. Understanding these syndromes may provide important clinical information to assist in the early detection of occult malignancy and in reducing the occurrence of tumor-associated morbidity.

Carcinoma, Squamous Cell↗

Superior mediastinal dissection in the treatment of Hürthle cell carcinoma of the thyroid.

BACKGROUND: Hürthle cell carcinoma of the thyroid frequently metastasizes to regional lymph nodes. Delayed lymph node dissection may become necessary, adding little risk to patient survivability; however, metastatic disease to the superior mediastinum that cannot be promptly detected, represents a survival threat that deserves special attention. The purpose of this study is to review our experience in managing Hürthle cell carcinoma of the thyroid and make recommendations for appropriate treatment. PATIENTS AND METHODS: A retrospective review of 371 thyroid neoplasms seen between 1987 and 1994 yielded six patients with Hürthle cell carcinoma of the thyroid gland. These include three cases treated with thyroidectomy and transcervical superior mediastinal dissection (SMD) as initial treatment and three cases treated with thyroidectomy alone. RESULTS: Of the three patients treated with SMD as part of their initial treatment, one had occult micrometastases to the superior mediastinum. All three patients remain alive and disease free at least 3 years later, whereas all three patients treated with thyroidectomy alone developed superior mediastinal metastases and died of their disease. CONCLUSION: We propose that at the time of initial surgery, a transcervical SMD may prevent spread to the superior mediastinum and therefore, improve survivability.

Adenocarcinoma↗

Risk factors associated with hearing loss in neonates.

PURPOSE: To identify the risk factors associated with hearing loss in our neonatal patient population and compare them to the ones listed by the Joint Committee on Infant Hearing. PATIENTS AND METHODS: The medical records of 50 consecutive infants with hearing impairment by auditory brainstem response (ABR) audiometry were reviewed retrospectively and were compared with the records of 50 randomly selected newborns that had normal hearing. RESULTS: In our review, only five of 18 variables were found to be associated with hearing impairment. These are: hyperbilirubinemia, craniofacial anomalies (CFA), length of stay in the intensive care unit, respiratory distress syndrome, and retrolental fibroplasia. The last three variables are not listed in the high-risk register published by the Joint Committee on Infant Hearing. CONCLUSION: The results of this study provide for additional risk factors that may be used in infant-hearing screening programs.

Audiometry, Evoked Response↗