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Biomedical subjects

D M Toriumi

Publications and source records attributed to D M Toriumi.

At least 73 records · Page 4Linked to original sources
PubMed1988

Lymph node infarction and malignant lymphoma: a case report.

An infarcted lymph node can precede, or occur simultaneously with, malignant lymphoma. Not infrequently a pathologic diagnosis of necrotic lymph node leaves the clinician puzzled as to its etiology after infectious and traumatic causes are excluded. The head and neck surgeon should be aware of this association and be prepared to follow these patients closely or rebiopsy to prevent delayed diagnosis of a malignant lymphoma. The literature is reviewed and a case of lymph node infarction with malignant lymphoma is presented to illustrate this clinicopathologic correlation.

Humans↗
PubMed1988

Otosclerosis masking coexistent acoustic neuroma.

The coexistence of an acoustic neuroma with otosclerosis can prove to be a great diagnostic dilemma. In such cases, the diagnosis of acoustic neuroma is usually delayed while more common causes of sensorineural hearing loss associated with otosclerosis or its surgery are considered. Any asymmetric progression of a sensorineural loss or shift in discrimination after stapes surgery, whether sudden or gradual, should provoke suspicion of a second pathologic process. These include perilymph fistula, labyrinthine otosclerosis or ischemia, and acoustic neuroma. The use of auditory brainstem response and acoustic reflex testing and various imaging techniques is essential for accurate diagnosis. This paper includes two cases that demonstrate this dual pathology, bringing the total to 15 such cases reported in the literature. The purposes of this paper are to alert the clinician to the diagnostic problem of acoustic neuroma coexisting with otosclerosis and to propose a means of evaluating these patients.

Adult↗
PubMed1987

The bilobed deltopectoral advancement flap.

The bilobed deltopectoral advancement flap is a versatile reconstructive option for selected cervical defects. This modified version of Bakamjian's classic deltopectoral flap utilizes thin anterolateral neck skin to cover complex anterior neck defects. It offers the safety of a minimally rotated pedicle to reduce the chance of flap necrosis from kinking, and the convenience of a single-stage procedure. We have used this flap six times in our clinical experience. Typically, the defects were located in the anterior cervical region, and many of them were reconstructed following total laryngectomy and radical neck dissection. There was no incidence of flap necrosis in the patients, including those who had had preoperative irradiation.

Humans↗
PubMed1987

Acquired subglottic cysts in premature infants.

Advances in the management of premature infants have resulted in improved survival. However, long-term intubation may produce associated laryngeal complications. We report 12 infants and children who developed subglottic cysts following long-term intubation as newborns. The majority of the cysts were in the posterior subglottic larynx. Laser excision of the cysts was undertaken in 8 patients and 3 underwent removal with cupped forceps. Recurrent cysts in 3 patients required more than one endoscopic procedure. The differential diagnosis of stridor in infants who have required long-term intubation includes subglottic cysts. The cysts are not always obvious at endoscopy and indeed may be buried below the mucosa within a soft tissue subglottic stenosis. Their presence may be suspected when tiny beads of mucus are released when laser surgery of a soft tissue stenosis is applied. Successful management of these cysts includes early precise diagnosis, with careful identification of these cysts to differentiate them from other types of subglottic stenosis. An initial attempt of conservative management with endoscopic excision is made. If this fails, an anterior cricoid split may be indicated in cases where the cysts are associated with soft tissue subglottic stenosis. Tracheostomy may be unavoidable in some cases.

Cysts↗
PubMed1987

Benign neoplasms of the oral cavity.

A wide variety of benign tumors present in the oral cavity. These tumors are for the most part rare and are classified by the tissue of origin. Although benign oral cavity tumors are not life-threatening, they can result in extensive loss of soft tissue and/or bone. Furthermore, many patients are subject to the threat of recurrence, multiple surgical procedures, and the possibility of malignant degeneration. Because many tumors vary little clinically, an adequate biopsy specimen must be obtained for diagnosis. Radiographs are, in general, nondiagnostic. Collaboration with an experienced pathologist is necessary to determine the tumor's probable clinical behavior. Therapy, which is dictated by tumor type, is almost always surgical.

Adolescent↗
PubMed1986

Parietal occipital nape of neck flap. A myocutaneous flap for selected head and neck reconstruction.

Reconstruction in head and neck surgery has been greatly advanced with the use of the pectoralis major and trapezius myocutaneous flaps. Most surgical defects can be repaired with one of these flaps alone, or in conjunction with cutaneous flaps. Specific problems, however, occur that cannot be successfully reconstructed by these standard flaps. The traditional scalp flaps are cutaneous flaps. Use of these flaps is limited because of their shortened arc of rotation and accompanying forehead deformity. Three patients underwent reconstruction with a parietal occipital nape of neck myocutaneous flap. Its advantages include the following: large segments of hairless skin from the contralateral side of the neck can be used, an extensive arc of rotation and distance can be achieved with excellent vascularity in the overlying skin, and cosmetic results are superior. Angiographic studies were used to demonstrate the vascular pattern and supply to this flap. Cadaver dissections were performed to determine the pattern of distribution of the perforating vessels to the skin from underlying muscle.

Carcinoma, Squamous Cell↗
PubMed1986

Nonrecurrent laryngeal nerves and their clinical significance.

The anomalous position of a nonrecurrent laryngeal nerve predisposes the nerve to injury during thyroidectomy and to compression by a thyroid mass. We present three cases in which a seemingly benign thyroid mass traumatized a nonrecurrent laryngeal nerve resulting in either vocal cord paralysis or a vague pressure sensation over the larynx. Some of these patients feel as if they need to clear a foreign body and present with a chronic cough. Normally the nerve is protected from thyroid masses as it passes through the tracheoesophageal groove. In all three patients, surgical excision of the thyroid mass and release of the nerve resulted in recovery of the nerve and resolution of the symptoms. We have found that small, benign, or otherwise asymptomatic lesions of the thyroid gland have a greater tendency to cause vocal cord paralysis in patients with nonrecurrent laryngeal nerves. The surgeon must always be aware of the possibility of the presence of a nonrecurrent laryngeal nerve.

Adenoma↗
PubMed1986

Extracranial neurogenic tumors of the head and neck.

The vast majority of head and neck nerve tumors are benign. Proper management involves accurate preoperative evaluation and a high degree of suspicion. Ideal treatment involves complete resection but debulking procedures have a definite role. Microneural dissection and reconstruction should be attempted in all cases. Malignant tumors of neural tissue are aggressive and are treated with radical surgical resection followed by radiation. Chemotherapy is reserved for unresectable or metastatic disease.

Adult↗
PubMed1986

Surgical treatment of hyperparathyroidism.

During the past decade, major advances have been made in many crucial areas of the surgical management of hyperparathyroidism. An up-to-date protocol is presented and stresses preoperative localization, operative technique, intraoperative diagnosis, cryopreservation, and autotransplantation designed for practical application.

Adenoma↗
PubMedDate not supplied

The effects of resorbable plates on rabbit ear cartilage.

BACKGROUND: When performing septorhinoplasty, deviated segments of septal cartilage can be straightened using cartilage or bone as splinting grafts. In some cases, autologous material is not available without an additional surgical procedure to harvest cartilage or bone. It is possible that resorbable plates can be used to splint and straighten deviated cartilage. Experience using bioresorbable rigid fixation devices on cartilage has been limited. OBJECTIVE: To examine early histopathologic changes of rabbit ear cartilage and adjacent soft tissue following implantation with bioresorbable plates. DESIGN: Nonrandomized, placebo-controlled trial. SUBJECTS: Twelve adult New Zealand white rabbits. MATERIALS AND METHODS: Ten adult New Zealand white rabbits (20 ears) underwent stenting of intact ear cartilage with LactoSorb plates (Lorenz, Jacksonville, Fla). Rabbits were killed 28 days after implantation, and the soft tissue, plates, and cartilage were harvested and prepared for histological examination. As controls, 2 rabbits (4 ears) underwent dissection and closure without stenting. RESULTS: Six rabbits experienced superficial skin breakdown on the ventral surface of the ear caused by excessive wound tension of the implant. The cartilage-plate interface and the surrounding soft tissues stenting the dorsal side of the ear remained free of inflammation or necrosis for all animals. Simple elevation of the perichondrium revealed no differences in the appearance of the cartilage between the control and test rabbits. CONCLUSIONS: Resorbable plates have no deleterious effects on cartilage during the first month of implantation. While short-term studies have documented the safety and efficacy of using bioresorbable plates, further studies are recommended.

Absorbable Implants↗
PubMedDate not supplied

Reconstruction of the subglottic larynx with a myoperiosteal flap: clinical and experimental study.

The literature describes numerous techniques for reconstruction of the subglottic larynx. The use of rigid bone grafts or flaps has been associated with problems because the rigid bone cannot conform to the defect and form an airtight seal. We have performed subglottic reconstruction using the sternocleidomastoid myoperiosteal flap with very optimistic results on long-term follow up. The sternocleidomastoid myoperiosteal flap is a relatively simple procedure that can be used for a large variety of defects. The pliable periosteal flap used for closing the defect can be molded over a stent to form an airtight seal. We have demonstrated bone formation in the periosteum which is crucial to the stability of the airway and long-term success of the procedure. The sternocleidomastoid myoperiosteal flap yields a pliable, durable tissue capable of airtight closure and a tension-free suture line. This technique will make the closure of subglottic defects a much more practical task.

Aged↗
PubMedDate not supplied

Peripheral nerve regeneration: comparison of laminin and acidic fibroblast growth factor.

PURPOSE: In an effort to show the differences between neurotrophic factors, laminin and acidic fibroblast growth factor (aFGF) were compared in terms of their abilities to regenerate axons in vivo over an extended distance. MATERIALS AND METHODS: The sciatic nerve was transected in 15 Sprague-Dawley rats. A 15-mm Silastic tube (Dow Corning, Midland, MI) was placed between the ends of the cut nerve and filled with either laminin, aFGF, or buffer applied to collagen sponges. RESULTS: Ten weeks postimplantation, mean axon counts showed that both laminin (2432) and aFGF (1612) produced significantly higher numbers of axons than controls (1009) (P < .05) and that laminin showed significantly more nerve regeneration than aFGF (P < .05). CONCLUSION: These results indicate that laminin and aFGF enhance peripheral nerve regeneration across a large gap, presumably through their neurotrophic effects and mitogenic properties on supporting cells. Furthermore, it is concluded that the transient nature of aFGF's effect on the regenerative environment limits its effectiveness at regenerating axons over a prolonged period of time.

Animals↗