Biomedical subjects
G A Gates
Publications and source records attributed to G A Gates.
Combined intracranial and extracranial excision of nasopharyngeal angiofibroma.
Of all angiofibromas, 10% to 20% may have intracranial extensions or receive vascular supply from the internal carotid artery. Until recently, the treatment of intracranial involvement has been radiation therapy. However, with improved anesthetic and neurosurgical techniques, transfusion capabilities and embolotherapy, the combined intracranial and extracranial excision of an angiofibroma has resulted in a low morbidity and mortality and a greater chance for complete excision of the tumor. The authors present the management of three patients with intracranial involvement of their tumors. Use of the midfacial degloving approach to the nasal cavity and paranasal sinuses has resulted in a significant improvement in the cosmetic appearance postoperatively.
Masked mastoiditis.
With the advent of broad-spectrum antibiotics, the clinical course of middle ear disease has been altered. One result has been the occasional suppression of the presenting signs and symptoms of mastoiditis secondary to acute middle ear disease, causing the clinician to have a false sense of security following apparent resolution of the middle ear infection. The course may be so insidious that the first awareness of the mastoiditis may be following presentation of an intracranial complication such as meningitis, lateral sinus thrombosis, or brain abscess. The authors report 9 patients seen in the past 5 years with masked mastoiditis, ranging in age from 4 months to 43 years. The presenting symptoms were all vague and non-classical; however, intracranial complications of meningitis, facial paralysis, brain abscess, and papilledema were present on admission in 7 patients, and another 2 patients had unsuspected epidural abscess upon surgical exploration. The mastoid radiographs were uniformly positive, while the CT scan was positive in 3/9 patients. All patients recovered following mastoidectomy and intracranial therapy except one patient who expired after brain herniation. The clinician is urged to maintain a high suspicion of masked mastoiditis in the high-risk patient, including newborn, diabetic, elderly, immunosuppressed or debilitated patients.
Workshop on effects of otitis media on the child.
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An IgD extramedullary plasmacytoma involving the sphenoid sinus at onset: an immunohistochemical study.
A 60-year-old man developed a left VIth-nerve paralysis and underwent biopsy of an extramedullary plasmacytoma in the sphenoid sinus. Immunohistochemistry demonstrated cytoplasmic IgD and lambda determinants. Subsequent specimens from left clavical and thoracic epidural lesions also showed a plasma cell neoplasm with IgD and lambda determinants. No abnormal plasma cells were found in bone marrow specimens. Lambda Bence-Jones protein and monoclonal IgD-lambda protein in the serum were detected several months after onset. The patient died with disseminated plasmacytoma 1 year after diagnosis. The mode of presentation, pattern of metastasis, and secretory features were typical of extramedullary plasmacytoma arising in the upper airway. Immunohistochemistry was more productive than serum electrophoresis and immunoelectrophoresis for following the course of this neoplasm.
Invasive Pseudomonas osteitis of the temporal bone.
Advances in the diagnosis and treatment of invasive Pseudomonas osteitis have improved the prognosis of this condition. The addition of hyperbaric oxygen therapy to the newer antibiotic regimens appears to enhance their efficacy. Radionuclide scanning can result in earlier diagnoses and also determine an end point for therapy. Surgical intervention should be reserved for those patients who do not respond to medical therapy and should be governed by knowledge of the temporal bone histopathology from available specimens.
Current concepts in otolaryngology: malignant neoplasms of the minor salivary glands.
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Eustachian tube function. Children with otitis media.
The relationship between middle ear disease and eustachian tube function was studied in 24 children with persistent otitis media with effusion and with pressure-equalization tubes in place using the pressure system of an impedance bridge. Five measurements of function were correlated with a child's age and six indexes of disease. The highest multiple correlation squared accounted for only 27% of the variability in results, indicating that knowledge of tubal function by this technique has little useful correlation with other indicators of disease.
Head and neck manifestations of uncommon infectious diseases.
Certain uncommon systemic infections may be present with head and neck manifestations either initially or during the course of the disease. A high index of suspicion is required on the part of the otolaryngologist with the subsequent procedures leading to the appropriate diagnosis. The manifestations of infectious diseases such as erysipelas, histoplasmosis, rabies, tetanus, botulism, and cysticercosis must be understood by the head and neck specialist. For successful management, many of the infections require prompt identification and initiation of therapy. Airway maintenance, ventilatory support, and medical chemotherapy may be required.
Technique modification for radioactive implants when plastic tubes are used in fibrosed head and neck areas.
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Research in otolaryngology--head and neck surgery.
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Simultaneous combination radiotherapy and multidrug chemotherapy for stage III and stage IV squamous cell carcinoma of the head and neck.
Combined simultaneous radiotherapy and multidrug chemotherapy have been utilized in an attempt to eradicate or shrink tumors of the head and neck area in advanced stages to allow subsequent surgical extirpation. Thirty-six patients (1 stage II; 11 stage III; 24 stage IV; 1 unknown primary) were treated with simultaneous radiotherapy and fractionalized doses of bleomycin, adriamycin, and 5-fluorouracil. Thirty of 36 patients completed the treatment schedule. Twenty-nine of 30 (97%) had a 75% or greater response to treatment; 20/30 (66%) had 100% response; 9/30 (30%) had 75% response; and 1/30 had 50% response. Of the 30 patients completing the regimen, 19/30 (63%) are alive three to 27 months later, and 12 (40%) of these have no evidence of disease. Six patients died within four months of initiation of therapy, mostly from complications of their disease. This treatment regimen appears effective in the control of locoregional disease or to produce enough shrinkage of tumor to allow subsequent surgical extirpation.
Upper esophageal sphincter: pre and post-laryngectomy--a normative study.
Correlation of anatomical, surgical, manometric, and radiographic observations leads to the conclusion that the normal high pressure zone of the pharyngoesophageal junction is composed of two parts: an annular muscular sphincter in the most proximal part of the upper esophagus and, above this, a complex pinchcock sphincter composed of the cricoid cartilage anteriorly and cricopharyngeus muscle laterally and posteriorly. The pinchcock part of the sphincter produces a high pressure zone in a predominantly anteroposterior direction. After laryngectomy, the sphincter becomes completely annular and behaves like a pure musculare constrictor; it is likely that both the cricopharyngeus and the upper esophageal circular muscles constitute the postlaryngectomy pharyngoesophageal high pressure zone. The relative contributions of the pinchcock segment (upper part) and annular constrictor segment (lower part) to the overall function of the upper esophageal sphincter have yet to be established in man.
Prosthetic support of laryngotracheoplasty for acquired subglottic stenosis in infants and children.
Using readily available materials and familiar techniques, prosthetic stents and T-tubes can be made to provide invaluable support in the treatment of subglottic stenosis in infants and children. A method of constructing these stents and tubes has been described along with an explanation of their surgical purpose and use.
Managing childhood ear infections.
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Vertigo in children.
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Hyperbaric oxygen. A new adjunct in the management of radiation necrosis.
Radiation necrosis is a significant complication of surgery for previously irradiated head and neck malignant neoplasms. We used hyperbaric oxygen therapy (HBO) as adjunctive therapy in 52 cases of radiation necrosis. Thirty-nine cases involved the head and neck. Nineteen of 23 cases of osteoradionecrosis of the mandible remain arrested after as much as two years of follow-up. Fifteen of the 16 cases of soft-tissue radionecrosis of the head and neck were successfully managed with HBO therapy as an adjunct to surgery and antibiotics. Fibroblastic proliferation, collagen formation, and capillary budding require at least 20 to 30 mm Hg of wound Po2. This effect can be achieved in wounds that are rendered hypoxic by radiation endarteritis and ischemia with high-dose or hyperbaric oxygenation.
Manometry of the normal upper esophageal sphincter and its alterations in laryngectomy.
Rapid pull-through pressure profiles of the normal human upper esophageal sphincter (UES) were simultaneously studied with a conventional three-orifice Honeywell solid-state probe, an eight lumen radially perfused (RP) probe, and a circumferentially sensitive (CS) probe designed to measure UES pressure (UESP) without regard to probe orientation. Pressure curves were digitized and analyzed by computer. The Honeywell probe recorded significantly lower peak pressures than the other two methods, and had wide intrasubject pressure variations (average coefficient of variation, 53%). In contrast, UESP measured with the CS probe was constant for each subject (mean peak UESP, 121 mm Hg; average coefficient of variation, 15%). Anteroposterior RP probe UESP were identical to CS probe pressures. Thus, peak perfused anteroposterior UESP correlates with circumferentially measured sphincter squeeze.Computer programs were written that allowed RP probe pressures to be mapped in three dimensions. Normal three-dimensional maps were characterized by anteroposterior accentuation of peak pressures and also by consistent axial asymmetry with anterior peak pressures occurring 0.8+/-0.2 cm closer to the pharynx. After defining the normal two- and three-dimensional UESP configuration, patients who had undergone laryngectomy were studied. Peak pressures measured with the RP probe decreased to congruent with50 mm Hg and radial pressure asymmetry vanished. Like normals, CS probe pressures corresponded to peak RP probe pressures. UES length did not change significantly. Three-dimensional mapping showed that axial asymmetry also vanished. It therefore appears that the anatomic alterations produced by laryngectomy abolishes UESP asymmetry.