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Biomedical subjects

L W Welsh

Publications and source records attributed to L W Welsh.

35 records · Page 2Linked to original sources

Central auditory testing and dyslexia.

A group of dyslexic pupils with normal end organ function was studied by a central auditory battery to determine whether a hearing disability existed. The clinical features of dyslexia are presented with emphasis on the psychological developmental and functional disorders associated with this reading problem. The central battery of Willeford was selected as the test medium and the results of the 77 dyslexic students were compared to the normative data. The model proposed by Sparks, et al., is accepted as the mechanism for dichotic audition. Reference is made to the organic basis of reading disorders from lesion in the calcarine area to the angular gyrus. The competing sentence test, binaural fusion, rapidly alternating speech perception, and filtered speech are described in detail and are organic foundation for the study. The authors indentified a high rate of failure in this investigation. Over 50% of the dyslexic students failed two of the four tests, and each of the 77 failed at least one component. The most sensitive tests were binaural fusion and filtered speech with less variation from the norm in the remaining two components. The effect of maturation in central audition was measured in each of the four tests. The data suggest: 1. the scores are lower in the early ages in each test; 2. that rapidly alternating speech and competing sentences approach the normal range albeit somewhat delayed; and 3. that binaural fusion and filtered speech improve in score somewhat but rather moderately and never approach the normal range. Based upon the central auditory data and in conjunction with the anatomical pathways of vision, the authors suggest the site of lesion to be in the temporo-parietal cortex and the association fibers.

Adolescent↗

Endoscopic examination of corrosive injuries of the upper gastrointestinal tract.

The authors present the case histories of five patients who have sustained corrosive injuries of the upper gastrointestinal tract. Flexible endoscopic examination was successfully carried out in each patient to assess the extent of the injury and anticipate further therapeutic needs. Three patients sustained major gastric lesions, i.e., strictures or bleeding following the ingestion of alkali, acids, or phenol, and one instance of esophageal stricture was recognized. The endoscopic observation of antral gangrene was inexorably followed by antral stricture requiring surgical management. One fatality followed rigid esophagoscopic examination which resulted in esophageal perforation.

Adult↗

Problems of diagnosis in the evaluation of mediastinal sarcoidosis.

The diagnosis of sarcoidosis can be established when the case meets the criteria of clinical course, radiologic findings, and supportive histology. When there is variation from the established criteria and the clinical course of age, systemic evidence of disease or the radiologic findings of unilateral or solitary adenopathy are encountered, then ongoing evaluation is necessary to identify a possible second disease existence. Cases have been presented which indicate some problem requiring further investigative studies before acceptance of the diagnosis of sarcoidosis.

Adult↗

Glomus jugulare tumor. Disseminated form in the central nervous system.

We will describe a case of glomus jugulare tumor that illustrates the potential for multiple areas of metastasis throughout the central nervous system. Extension through the dura into the subarachnoid space allows seeding via the cerebrospinal fluid as far away as the cauda equina. We will review the usual clinical course of the tumor and will evaluate the symptoms relative to the location of extension. In this case, the symptoms related to increased intracranial pressure with brain stem compression, which progressed rapidly to cause the patient's death.

Autopsy↗

Fractures of the edentulous maxilla and mandible.

An evaluation and treatment of fracture of the edentulous maxilla and/or mandible is presented. The Le-Fort classification of maxillary fractures is the foundation for the program of care. Immobilization techniques are based upon the support of a fracture by suspension from the adjacent stable segments to the modified prosthesis. The mandibular fractures are repaired by interosseous wire fixation in the body and symphysis region, the other fracture sites are supported by circumferential wiring to the prosthesis for immobilization. General principles of time of repair, diet, types of healing factors are reviewed.

Aged↗

Cranial nerve injuries.

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Cranial Nerve Injuries↗

Clinical interpretations of transient otoacoustic emissions.

PURPOSE: The purpose of this study was to characterize the relation of different ordinal patterns of transient otoacoustic emissions (TEOAES) with respect to underlying otologic disorders and auditory status. PATIENTS AND METHODS: The results of TEOAEs in 225 patients with various auditory disorders were investigated and compared with normative data established from 90 subjects of various ages. TEOAEs were categorized according to four patterns: (1) normal (general response level within 90% of normative data, (2) reduced amplitude (general response level was > or =2 dB peak sound pressure level (pSPL), but less than the mean -1.64 SD of the normative data), (3) abnormal morphology of frequency spectrum (general response level was within normal limits, but reduced at > or =2 individual octave frequencies between 1,000 and 5,000 Hz), and (4) total absence (response level <2 dB pSPL). RESULTS: This study showed that the normal pattern of TEOAEs, in terms of response amplitude, varied with age. Our results further indicated that a reduced amplitude pattern of TEOAEs was noted in patients with a mild sensorineural hearing loss (SNHL), negative tympanometric pressure, a pressure-equalization tube, and Meniere's disease. TEOAEs provided good frequency-specific information for patients with a noise-induced hearing loss. All patients with ossicular chain abnormalities, more than moderate SNHL, and a middle ear mass or effusion had total absence of TEOAEs. Patients with acoustic neuroma and brainstem lesions presented a complex profile of TEOAEs. In the follow-up of auditory function in patients undergoing otologic surgery, different patterns of TEOAEs between the preoperative and postoperative recordings were evident, which correlated with the hearing thresholds and middle ear status. The abnormal findings of TEOAEs due to specific auditory diseases were discussed. CONCLUSION: The interpretation of TEOAEs can be facilitated through an analysis of specific patterns and in combination with other audiologic tests.

Acoustic Impedance Tests↗

Mediastinoscopy: the predictive survival value in staging carcinoma of the lung.

One hundred and thirty-seven cases of Stage III lung cancer established by mediastinoscopy have been followed to determine their survival. The tissue was classified according to World Health Organization schema and the degree of dedifferentiation graded from well to poorly differentiated. Two percent of the presented cases are well-differentiated tumors; the remaining 98% are moderately well-differentiated (11%), or poorly differentiated or small cell tumors (87%). The degree of anaplasia suggests an increasingly aggressive metastatic behavior pattern. The average life span is approximately 5 1/2 months in all groups and subgroups which were studied. Recommendations are presented for the utilization of mediastinoscopy in Stage I and II cases. Further considerations are suggested for priority of diagnostic procedures in establishing the diagnosis of lung cancer.

Adult↗

Effects of irradiation of cervical lymph nodes.

The effects of irradiation upon the functional integrity of lymph nodes were studied in the isolated cervical region of the dog. After 6000 rads were applied in one dose plan, the measure of lymph flow was determined by the migration of radiogold from the larynx to the associated primary lymphatic terminals at intervals of 2, 4, and 12 weeks, and six months post-irradiation. Interference with lymph flow was identified by radionuclide stasis in the injection depot; alteration in the direction of flow was identified by relative concentration of the tracer item in the associated nodal terminals. The lymph flow was minimally distorted by irradiation in the test period unless secondary damage to the associated lymphatic channels intervened. The relative migration was consistent with the normal data in 52%, depressed in 13% and increased in 35% of the cases studied. Major obstruction and rerouting of lymph flow contralaterally was evident in 19% of the subjects due to fibrosis secondary to local infection.

Animals↗

Cortical, subcortical, and brainstem dysfunction: a correlation in dyslexic children.

A group of dyslexic students was examined by a central auditory test (CAT) battery including competing sentences, binaural fusion, filtered speech, and compressed speech. Auditory evoked brainstem responses (BSER) were measured in conjunction with the CAT data. The auditory tests indicate a high degree of failure in those areas requiring sophisticated integration, coordination, and identification of the modified speech stimuli. The BSER did not identify a significant abnormality. The cortical and subcortical areas of integration are proposed as the multicentric sites of impairment in the hearing function found in dyslexic students.

Adolescent↗

Mediastinoscopy for extrathoracic malignancies.

Metastatic tumors from extrathoracic sources appear in the mediastinum infrequently and from a variety of locations. In this series of approximately 350 malignancies of the mediastinum, 20 (6%) originated from the breast, prostate, kidney, pelvis, and gastrointestinal tract. A radiologic review of these cases does not identify a unique pattern, although paratracheal masses present most often, while unilateral hilar adenopathy occurs somewhat less frequently. The history of previous surgery for malignancy suggests metastatic disease into the mediastinum. However, other entities of second primaries, lymphoma, Hodgkin's disease, and benign processes warrant consideration. Mediastinoscopy is reemphasized as a valuable diagnostic technique for the solution of these problems.

Adult↗

Laryngeal spaces and lymphatics: current anatomic concepts.

This investigation evaluates the anatomic concepts of individual spaces or compartments within the larynx by isotope and dye diffusion. The authors identified continuity of spaces particularly within the submucosal planes and a relative isolation within the fixed structures resulting from the longitudinal pattern of fibroelastic tissues, muscle bands, and perichondrium. The historical data of anatomic resistance are refuted by the radioisotope patterns of dispersion and the histologic evidence of tissue permeability to the carbon particles. There is little clinical application of the compartment concept to the perimeter of growth and the configuration of extensive endolaryngeal cancers. The internal and extralaryngeal lymphatic network is presented and the regional associations are identified. The normal ipsilateral relationship is distorted by dispersion within the endolarynx supervening the anatomic midline. The effects of lymphatic obstruction caused by regional lymphadenectomy, tumor fixation, and irradiation-infection sequelae are illustrated; these result in widespread bilateral lymphatic nodal terminals. Finally, the evidence suggests that the internal network is modified by external interruption to accommodate an outflow system in continuity with the residual patent lymphatic channels.

Dye Dilution Technique↗

Dysphagia due to cervical spine surgery.

Surgery upon the cervical vertebrae may produce prolonged dysphagia due to regional damage, hemorrhage, infection, and denervation. Cases illustrating these problems are presented with attention to the progression of the clinical course and the diagnostic modalities of radiology and endoscopy. Methods of prevention are emphasized and the therapeutic plan is outlined.

Adult↗