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Biomedical subjects

L M Flood

Publications and source records attributed to L M Flood.

50 records · Page 3Linked to original sources
PubMed1987

The management of a neck mass: presenting feature of an asymptomatic head and neck primary malignancy?

Malignancy of the upper aerodigestive tract is not always associated with obvious localizing symptoms. Presentation may then only be prompted by the appearance of a hard mass in the neck, a metastasis to a cervical lymph node. Neck exploration without a prior diligent search for an occult head and neck primary tumour is to be avoided as it compromises subsequent treatment. The diagnostic investigation of 112 patients complaining solely of a painless and enlarging neck swelling is reviewed. An otolaryngologic examination identified an asymptomatic malignancy of the head and neck in 72 patients (64%). Excision biopsy of the neck mass was required to achieve a diagnosis in only 29 (29%) of those patients who had not already undergone surgery. These results are presented to emphasize the need for a specialist examination of the head and neck prior to embarking on excision of any suspicious neck mass.

Carcinoma, Squamous Cell↗
PubMed1985

The investigation and management of petrous apex erosion.

Disease of the apex of the petrous temporal bone, while rarely encountered, can present a unique challenge to the otologist. Lesions tend to be advanced at presentation, as massive bony erosion can remain asymptomatic. When symptoms occur, they reflect involvement of the neurovascular contents of the temporal bone. The earliest clinical features, such as headache, facial numbness and middle-ear effusion, do not immediately suggest the site or gravity of the underlying pathology. Anterior extension of disease may produce ophthalmoplegia and diplopia whilst posterior spread involves the lower cranial nerves, within the internal auditory canal, jugular foramen and hypoglossal canal. Evaluation of apical disease relies on radiological evidence of bony erosion and should include polytomography, CT scanning and angiography. The clinical features and radiological findings in a series of patients with various apical lesions are presented. The surgical approaches reviewed aim to reconcile the need for adequate access to this remote site, with the desire to preserve residual facial nerve and cochlear function and to protect the brain-stem.

Adult↗
PubMed1985

Tracheal airway obstruction: a custom made tracheostomy tube.

Tracheal obstruction is encountered in primary malignancy of the trachea and invasion or compression from extrinsic lesions. No commercially available tracheostomy tube can be suitable for all cases. A flexible cannula of adjustable length can be produced from universally available anaesthetic equipment. Intubation is facilitated by the use of fibreoptic endoscopy.

Aged↗
PubMed1985

Cryptococcal meningitis: presentation as sudden deafness.

A patient presented with a bilateral profound hearing loss of sudden onset following a two-month neurologic illness. Microscopy and culture of cerebrospinal fluid revealed Cryptococcus neoformans. Treatment with amphotericin B and 5-fluorocytosine failed to restore hearing. Auditory brain stem response and electrical promontory stimulation suggest a profound deafness with poor neuronal survival. This is consistent with previous temporal bone histopathology reports in individuals dying of cryptococcal meningitis, suggesting a retrocochlear lesion. It is important to exclude this occult pathologic factor in a patient with the sudden onset of sensorineural deafness prior to embarking upon a course of steroid therapy.

Amphotericin B↗
PubMed1985

Pneumocephalus following treatment of a stapes gusher.

A case history is presented of a patient who underwent stapedectomy complicated by a cerebrospinal fluid (CSF) gusher. A persistent postoperative CSF leak was controlled by elevation of the head and spinal drainage. Retrograde passage of air through a labyrinthine fistula, however, resulted in pneumocephalus and transient neurologic deficit. This is a rare but serious complication of treatment of a stapes gusher which demonstrates the potential for entry of air intracranially in the presence of a perilymph fistula.

Adult↗
PubMed1984

Cochlear deafness in the presentation of a large acoustic neuroma.

It is exceptional for a large tumour, as presented, to present a cochlear pattern of hearing loss. Only a rigid adherence to a battery of audiological, vestibular and radiological tests can exclude neuroma. The possibility of hearing conservation in neuroma surgery (Clemis et al., 1981) demands further understanding of the mechanism of cochlear damage produced by CP angle tumours.

Adult↗
PubMed1984

Pitfalls in the diagnosis of acoustic neuroma.

The patient with an acoustic neuroma may present to the otologist with a variety of clinical features. Classically these include a retrocochlear pattern of sensorineural hearing loss, reduced vestibular response on caloric testing and radiological asymmetry of the internal auditory canals (IAC). The absence of any or all of these features, however, does not exclude the presence of tumour. Five cases are presented to illustrate the potential for diagnostic delay unless a routine battery of investigations is undertaken in patients with neuro-otological disorders. All patterns of subjective audiometry are encountered, auditory brain stem response testing may be unreliable where hearing loss is profound, vestibular testing is normal in half of small tumours and the intracanalicular tumour may be radiologically undetectable unless IAC meatography is employed.

Adult↗
PubMed1984

Surgery in lesions of the petrous apex.

It is fortunate that lesions of the petrous apex are rarely encountered. The occult nature of the local disease and the poorly localizing clinical features favor a delayed diagnosis. Its site deep to the labyrinth and facial nerve and its proximity to the internal carotid artery and brain stem potentially make surgery a risky prospect. The reconciling of preservation of neurologic function and adequate surgical exposure requires an extensive knowledge of temporal bone anatomy and surgical approaches.

Adolescent↗
PubMed1984

Clinical assessment of the irradiated larynx. Salvage laryngectomy in the absence of histological confirmation of residual or recurrent carcinoma.

Following radiotherapy for squamous carcinoma of the larynx, it may be impossible to differentiate occult persisting tumour from irradiation effects, possibly with chondroradionecrosis, even after repeated biopsy. In seven of the cases presented, post-treatment laryngoscopy failed to provide histological evidence of residual or recurrent carcinoma, which clinical examination had indicated. Nonetheless, total laryngectomy was performed, subsequently revealing tumour in five of the seven excised larynges. The two tumour-free larynges were associated with cervical metastases. The clinical indications of persisting tumour, the factors compromising post-irradiation evaluation and the role of diagnostic aids are discussed.

Carcinoma, Squamous Cell↗
PubMed1983

Sequential chemotherapy and radiotherapy in advanced head and neck cancer.

Eighty-six previously untreated patients with advanced squamous-cell carcinoma of the head and neck were entered into a prospective randomised controlled trial to evaluate whether the addition of a kinetically based chemotherapy regimen before and after radiotherapy would improve survival compared with radiotherapy alone. Survival at 30 months showed there was no evidence that the addition of chemotherapy to radiotherapy improved survival and that the chance of obtaining a significant result in favour of adjuvant chemotherapy was remote. We make a strong plea that all chemotherapy regimens for the treatment of squamous-cell carcinoma of the head and neck regions should be subjected to controlled prospective trials before they are widely adopted.

Adult↗
PubMed1982

Anaesthetic management of acute laryngeal trauma.

Three patients suffering acute laryngeal trauma illustrate problems of missed diagnosis and airway management confronting anaesthetists. A 55-year-old man suffered multiple injuries, including a supraglottic laryngeal fracture which was not diagnosed during administration of a subsequent general anaesthetic. The diagnostic delay compromised any reconstructive surgery. Two 26-year-old males suffered laryngeal fractures, but tracheal intubation for reconstruction and tracheostomy was successful. Guidelines for management are suggested.

Acute Disease↗