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Biomedical subjects

I Eliachar

Publications and source records attributed to I Eliachar.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.

OBJECTIVE: To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. METHODS: We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. RESULTS: At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). CONCLUSION: Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Adult↗
PubMedDate not supplied

Histiocytic necrotizing lymphadenitis (Kikuchi's disease).

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a benign disorder predominantly of young women who present with cervical adenopathy. It has, on occasion, been misdiagnosed as a malignant neoplasm. Little mention of this condition has appeared in the otolaryngologic literature. A patient with Kikuchi's disease is reported and the pertinent literature is reviewed. Because both the clinical and pathological aspects of Kikuchi's disease are important in establishing the diagnosis, effective consultation between the head and neck surgeon and the pathologist is crucial.

Adult↗
PubMedDate not supplied

Manifestations of metastatic breast carcinoma to the head and neck.

Although metastatic neoplasms in the head and neck are rare compared to primary head and neck neoplasms, metastatic breast carcinoma has been described at numerous sites in the head and neck region. Two cases of breast carcinoma metastatic to sites in the head and neck are reported. In one case a laryngeal metastasis represented the first manifestation of recurrent breast cancer. The second case, a nasal metastasis, was unsuspected and was treated as cellulitis. The presentation of metastatic breast carcinoma to the head and neck may in fact be atypical, posing a diagnostic dilemma. These cases illustrate the importance of past medical history and the high index of suspicion in patients with a history of prior malignancy.

Adenocarcinoma↗
PubMedDate not supplied

Chondrosarcoma of the larynx: challenges in diagnosis and management.

Chondrosarcoma is a rare neoplasm of the larynx with approximately 200 cases reported in the literature. The infrequent occurrence of this neoplasm, and its indolent pattern of growth, can result in a delayed or missed diagnosis, thereby jeopardizing the preservation of laryngeal function. Four cases of chondrosarcoma of the larynx are presented demonstrating the challenges in the diagnosis and management of this neoplasm. Conservation surgery remains the mainstay of therapy aiming towards preservation of the framework and function of the larynx. Two innovative reconstructive techniques are presented which made conservation laryngeal surgery possible in two of the four patients. Indeed, surgical resection with sound oncologic principles must be applied and total laryngectomy may be necessary. On rare occasion radiotherapy may be used, although its value remains controversial.

Aged↗
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Undifferentiated nasopharyngeal carcinoma presenting as a parotid mass.

BACKGROUND: Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits. We present a case in which the initial manifestation of nasopharyngeal carcinoma of the lymphoepithelioma type was a parotid mass. METHODS: Case study. RESULTS: A patient who was initially seen with an isolated parotid mass was found to have an undifferentiated carcinoma of the lymphoepithelial type. Further evaluation identified an occult nasopharyngeal carcinoma, and the patient underwent radiotherapy. CONCLUSIONS: A diagnosis of a malignant lymphoepithelial lesion of the parotid gland or undifferentiated carcinoma of the lymphoepithelial type mandates a search for an occult primary nasopharyngeal tumor.

Aged↗
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Mediastinitis and bilateral pyopneumothorax complicating a parapharyngeal abscess.

A 38-year-old male suffered from mediastinitis, pericarditis, and bilateral sudden pyopneumothorax as a complication of the parapharyngeal abscess that ruptured into the hypopharynx. The full diagnosis remained obscure until the complete clinical picture evolved. Antibiotics and pleural and cervical drainage failed to alleviate the symptoms. Recovery commenced only after tamponade of the retropharyngeal space, which terminated the flow of air and saliva from the neck to the thorax. The anatomic relation of the spaces concerned are discussed, as well as the therapeutic and surgical approaches. the importance of the retropharyngeal space, which may serve as a conduit between the neck and the mediastinum, is pointed out.

Abscess↗
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Reconstruction of the laryngotracheal complex in children using the sternocleidomastoid myocutaneous flap.

Laryngotracheal stenosis in children should be treated effectively with minimal delay, and the tracheostomy should be closed within a reasonable period after surgery so that the child may develop normal speech and language. Successful reconstruction of the laryngotracheal complex was achieved by applying the superiorly based compound myocutaneous sternocleidomastoid muscle flap for wedge enhancement and resurfacing of the endolaryngeal and endotracheal lumen. A short stenting period, incorporating a custon-carved soft silicone laryngeal stent in direct continuity with an oversized silicone T-tube, helped in stabilizing the airway and ensuring good take of the flap. Postoperative recovery was relatively short, with good ventilation and vocal results. This single-step technique may be readily performed, and it interferes minimally with the child's development.

Child↗
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Continuous portable vacuum drainage of auricular hematomas.

A simple, fast, effective method of managing auricular hematoma is presented. It is based on continuous vacuum drainage after complete aseptic evacuation of the hematoma and blood clots. Pressure dressings are unnecessary.

Drainage↗
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Tinnitus as a prognostic factor in sudden deafness.

Recovery from idiopathic sudden hearing loss depends on many factors, some as yet unknown. This study found tinnitus to be a favorable prognostic sign, based on an analysis of symptoms and recovery rates in a series of 60 patients. Hearing improved in 80 per cent of the patients studied. Tinnitus was one of the complaints in 71 per cent of the patients who recovered, whereas it was present in only 39 per cent of those who did not recover. A possible explanation of the association between tinnitus and recovery from sudden hearing loss is suggested and discussed.

Adult↗
PubMedDate not supplied

The superiorly based flap long-term tracheostomy in pediatric patients.

PURPOSE: Tracheostomy is commonly used to provide control of the upper airway in pediatric patients. The traditional approach, which uses a midline vertical incision in the anterior tracheal wall, is associated with relatively high rates of complications when it is used on a long-term basis. Alternative approaches, such as removing tracheal window or creating tracheal flaps, have been avoided in the pediatric patient because of the risk of tracheal stenosis and the potential for the subsequent effect on tracheal growth. The superiorly based flap tracheostomy (SBFT) has greatly reduced these risks in adults and offers better stomal maintenance, safety, and patient acceptance, but it has not been widely evaluated in pediatric patients. METHODS: We reviewed 21 superiorly based flap tracheostomies performed in children at our institution between 1986 and 1993. Routine follow-up assessments included fixed and flexible laryngotracheoscopy. Average follow-up was 17 months. RESULTS: The most common indication for performing the SBFT was bilateral vocal cord paralysis. Short-term complications included wound infection and granuloma in 2 patients. Long-term complications were not observed. One patient died from lower respiratory tract causes. Five of the patients were eventually decannulated, and the stoma closed without laryngotracheal stenosis. Morbidity rates were less and mortality was comparable to those of traditional tracheostomy. CONCLUSION: We conclude that the SBFT is promising a technique for establishing long-term control of the airway in pediatric patients.

Child↗
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Cellular immunity in patients with laryngeal cancer developing additional primary malignant tumors.

Eleven patients with laryngeal cancer associated with additional primary tumors underwent cutaneous delayed hypersensitivity tests and lymphocyte stimulation studies with phytohemagglutinin for evaluation of their cellular immunity. Five of the 11 patients were anergic or hypoergic as shown by skin tests to recall antigens and seven of nine patients had impaired lymphocyte transformation. Depressed immunity was more often observed in patients with an active malignancy. The level of serum immunoglobulins was elevated in two of eight studied patients, and in the remaining patients was within the normal range. All patients had a history of excessive smoking. Most frequently, second tumors were found in the lung, urinary tract and skin. The prognosis seemed to be determined by the additional tumor rather than by the laryngeal cancer.

Aged↗