Three previous papers have detailed my experience with various methods of surgical treatment of Meniere's disease: 1) surgery for all patients; 2) surgery for only those patients who demonstrated patency of the vestibular aqueduct as seen on tomographic examination; and 3) prognostic tests to determine which patients were most suitable for endolymphatic sac surgery. This paper details the results of endolymphatic shunt surgery performed on 43 patients over a 3-year period, restudying my prior conclusions. All patients were operated using a new method of capillary endolymph dispersement regardless of tomographic findings. The results are compared to the results of the prior studies to determine whether the findings of tomography are correlated with success or failure of shunt operations, a conclusion that others have questioned. This study clearly shows that the present technique affords better results than prior methods regardless of the x-ray findings. In addition, the tomographic findings correlate closely to the clinical pattern of the disease and to the success or failure of the operation.

Drainage↗

PubMedDate not supplied

Reconstructive techniques for tympanosclerosis.

Tympanosclerosis is found in more than 30% of patients with chronic ear disease. Clinically significant tympanosclerosis is defined as that affecting the surgical procedure by requiring removal to effect a hearing improvement. This type is seen in less than half of all patients with tympanosclerosis. The incidence and patterns of involvement are documented for 352 of the author's surgical patients subdivided into two groups: one operated on in the early 1960s and another observed more than 15 years later. The surgical techniques employed for hearing restoration are described, as are the hearing results obtained. The findings would indicate that tympanosclerosis is amenable to surgical correction, with a success rate approximately that of nontympanosclerotic ears. The special techniques needed to avoid complications when the disease invades the oval window are emphasized.

Chronic Disease↗

PubMedDate not supplied

Lung cancer in nonsmoking women: a multicenter case-control study.

The association between exposure to environmental tobacco smoke and lung cancer in female lifetime nonsmokers was evaluated using data collected during the first 3 years of an ongoing case-control study. This large, multicenter, population-based study was designed to minimize some of the methodological problems which have been of concern in previous studies of environmental tobacco smoke and lung cancer. Both a cancer control group and a population control group were selected in order to evaluate recall bias. A uniform histopathological review of diagnostic material was conducted for case confirmation and detailed classification. Biochemical determination of current exposure to tobacco and screening of multiple sources of information to determine lifetime nonuse were utilized to minimize misclassification of smokers as nonsmokers. A 30% increased risk of lung cancer was associated with exposure to environmental tobacco smoke from a spouse, and a 50% increase was observed for adenocarcinoma of the lung. A statistically significant positive trend in risk was observed as pack-years of exposure from a spouse increased, reaching a relative risk of 1.7 for pulmonary adenocarcinoma with exposures of 80 or more pack-years. The predominant cell type of the reviewed, eligible lung cancer cases was adenocarcinoma (78%). Results were very similar when cases were compared to each control group and when separate analyses were conducted for surrogate and personal respondents. Other adult-life exposures in household, occupational, and social settings were each associated with a 40-60% increased risk of adenocarcinoma of the lung. No association was found between risk of any type of lung cancer and childhood exposures from a father, mother, or other household members.

Adult↗

PubMedDate not supplied

The computer in otolaryngology: what ever happened?

Explore the source record for details and available documents.

Data Display↗

PubMedDate not supplied

Smoking and cervical cancer.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

Transcanal tympanoplasty: a 15-year report.

The data presented would seem to support the following conclusions: 1. Transcanal tympanoplasty employing connective tissue underlay grafts, ossicular bone prostheses, and avoidance of mastoid exposure, unless irreversible disease is present, seems to meet contemporary standards of efficacy, safety, and long-term stability when performed on patients with either chronic suppurative otitis or atelectatic otitis. 2. Although chronic suppurative otitis and atelectatic otitis have differing characteristics and are of seemingly different pathogenesis, no statistical differences were found in the pattern of ossicular destruction or in their response to surgical intervation. Hearing results, long-term stability of results, and pattern of complications had no significant differences. 3. Hearing results in those patients with destruction of the malleus handle in whom an L-shaped prosthesis was used were significantly different and poorer than when the malleus was present. A different approach, perhaps employing homograft tympanic membrane with incorporated malleus and staging, may be indicated for these patients. 4. The use of polymeric silicone film and homograft nasal cartilage was associated with a significant number of complications and has been abandoned, substituting instead absorbable gelatin film and ossicular bone transplants. 5. Since no significant changes were seen following one year's observation, this period would seem to be statistically suitable for analysis of results. This conclusion can only be applied to those patients with either chronic suppurative otitis or atelectatic otitis and in whom the surgical procedures herein described were applied.

Bone Transplantation↗

PubMedDate not supplied

The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group.

The relationship between social ties, stage of disease, and survival was analyzed in a population-based sample of 525 black and 486 white women with newly diagnosed breast cancer. There were significant differences between the two race groups in reported social ties. Using logistic regression to adjust for the effects of age, race, study area, education, and the presence of symptoms, there was little or no evidence for an association between individual network measures of social ties and stage of disease. However, a summary measure of social networks was found to be associated modestly with late stage disease, attributable in part to significantly more advanced disease among black, but not white, women reporting few friends and relatives [relative risk (RR) = 1.8; 95% confidence interval (CI) = 1.1-3.0]. With adjustments for differences in stage of disease and other covariates, and with the use of Cox proportional hazards modeling to estimate hazard ratios, the absence of close ties and perceived sources of emotional support were associated significantly with an increased breast cancer death rate. White women in the lowest quartile of reported close friends and relatives had twice the breast cancer death rate of white women in the highest quartile (RR = 2.1; 95% CI = 1.1-4.4). Notably, both black and white women reporting few sources of emotional support had a higher death rate from their disease during the 5-year period of follow-up (RR = 1.8; 95% CI = 1.3-2.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Race, socioeconomic status, and prostatic cancer.

Using mortality and incidence data from Alameda County, California, this study attempted to determine whether the higher occurrence rate of prostatic cancer among black men as compared with whites in the United States might be explained by racial differences in factors associated with socioeconomic status. Each death or case of prostatic cancer was assigned to a social class based on census tract of residence, and rates by race and socioeconomic status were computed. Comparison of age-specific mortality and incidence rates by socioeconomic status reveals no gradient in either whites or blacks. The higher risk for blacks holds up at almost every age and socioeconomic level. However, the racial differences are less pronounced for incidence than for mortality. Racial differences in the occurrrence of deaths appearing in Part II of the death certificate are also examined.

Age Factors↗