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Biomedical subjects

M Strome

Publications and source records attributed to M Strome.

At least 19 recordsLinked to original sources
PubMed1992

Histopathologic correlates of acute laryngeal allograft rejection in a rat model.

This study used both clinical and histopathologic criteria to define the sequence and time parameters of rejection in histoincompatible vascularized rat laryngeal allografts. Clinical onset of rejection was characterized at 1 week by graft edema. Pathologic examination at this time revealed arterial wall thickening and a diffuse lymphocytic and macrophage mucosal infiltrate. At 14 days, the graft was encased in an inflammatory exudate with no visible cartilaginous structure. This correlated microscopically with a lymphocytic infiltrate of the lamina propria, loss of minor salivary glands, and squamous metaplasia of the surface respiratory epithelium. Arterial thrombosis was always correlated with tissue necrosis, but venous occlusion, occurring more than 2 days after transplantation, was not an independent determinant of graft viability. Definition of the time sequence and histopathology of rejection will allow future determination of the efficacy of various immunosuppressive regimens.

Acute Disease↗
PubMed1992

Rat model for a vascularized laryngeal allograft.

A new rat model was developed to reexamine the potential for laryngeal transplantation. The final anatomic derivation evolved from two earlier developmental phases. The first model had only a single arterial anastomosis; the second had an end-to-end arterial anastomosis with an end-to-end arteriovenous shunt. The final product employed an end-to-side arterial shunt and an end-to-side arteriovenous shunt for revascularization. The allografts were sited in tandem with the intact recipient larynges and were not innervated. A total of 16 animals were studied in phase 3; 2 died and the remaining 14 had a 64% arterial patency at intervals of 1 to 14 days. Our purpose is to detail the relevant technical considerations of this new model and compare it with historical controls.

Anastomosis, Surgical↗
PubMed1992

Down syndrome: an otolaryngologic perspective.

The otolaryngologic manifestations of Down syndrome often masquerade as common and seemingly trivial conditions. Behind this facade lies a broad spectrum of disease which can detract from an inherently diminished level of function and jeopardize survival. This paper examines the pertinent associations between Down syndrome and various pathological entities related to the head and neck. Evaluation of current therapeutic modalities reinforces the need for early diagnosis and treatment so that the potential of this patient group is fulfilled.

Down Syndrome↗
PubMed1991

Laryngeal transplantation. The future.

The ethics, justification, history, future, and rejection of laryngeal transplantation are examined in this article. The authors believe that laryngeal transplantation will be a viable alternative for a select group of patients before the end of this century.

Animals↗
PubMed1990

A long-term assessment of cryotherapy for treating vasomotor instability.

Cryotherapy was used to treat severe nasal vasomotor instability in 21 patients who had failed several varied medical regimens. Treatment was given via a closed nitrous oxide system for intervals of 60 to 75 seconds. Anatomic sites treated included the medial aspect of the pterygopalatine fossa, posterior inferior middle turbinate, and posterior superior inferior turbinate. The minimum follow-up interval was two years. The conditions of 18 of 21 patients were substantively improved with one surgical freeze, and an additional patient responded favorably to three procedures. Three of four patients with associated obstructive sleep apnea also had apnea relieved. The technique presented warrants further evaluation in a larger series of patients.

Adolescent↗
PubMed1989

Myomucosal shunt following total laryngectomy: a report of 31 cases.

An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.

Adult↗
PubMed1988

Relief of sleep apnea by revision of the adult upper airway. A review of clinical experience.

Surgical revision of the upper airway for obstructive sleep apnea has repeatedly improved subjective more than objective laboratory outcome measures. To examine this disparity, we obtained subjective sleepiness questionnaire scores, Continuous Performance test, and polysomnography (PSG) in 40 patients with mild to moderate obstructive sleep apnea (mean apnea index, 33.9; mean minimum oxygen saturation during sleep, 75.4%). Continuous Performance test confirmed abnormal daytime sleepiness and correlated with minimum oxygen saturation and number of transitions between stages. Postoperatively, questionnaire scores fell a mean of 62%, indicating a marked improvement in subjective sleepiness. Changes in questionnaire score correlated with changes in minimum oxygen saturation. Mean PSG indexes showed no change. Individual patients without PSG improvement reported long-term improvement in daytime functioning, as confirmed by family members. These results suggest that measures in addition to PSG, including patient subjective response, would more fully characterize the outcome of revision of the upper airway for sleep apnea.

Adult↗
PubMed1988

Further experience with the myomucosal tracheoesophageal shunt.

A follow-up study to the initial work of Strome and colleagues in advancing the concept of the myomucosal flap for voicing following total laryngectomy is described. Data are evaluated from 30 patients. Seven of the eight original patients have functioning shunts with excellent voicing and six remain tumor free at more than two years. In the Laennec Hospital (Paris) series of 22 patients, seven shunts are functioning independently. Eleven of 20 inferiorly based flaps stenosed, and all stenoses occurred at the posterior tracheal wall. Technique refinements improved the patency percentage with the seven successes occurring in the last 13 procedures. Four patients in the series had flap necrosis, two of whom had diabetes mellitus and two others extensive paratracheal resections. The technique continues to merit consideration, recognizing that there is a learning curve before success can be anticipated.

Esophagus↗
PubMed1988

Staging in the treatment of maxillary carcinoma revisited.

The site of origin of maxillary sinus carcinoma will not infrequently predetermine the varied neurological signs at presentation. Modifying Ohngren's division, the maxillary sinus can be divided into four quadrants based on anatomical nerve correlates, thus facilitating identification of the primary site. An inclusive classification of maxillary sinus carcinoma based on Broder's grading, site of origin, the TNM classification and the patient's general condition, serves as the basis for a correlative therapeutic regimen.

Carcinoma↗
PubMed1988

The effects of anesthesia on middle-ear effusions.

Surgeons occasionally note a discrepancy between preoperative assessment of middle-ear effusion and operative observation during the placement of ventilating tubes in children's ears. This study was designed to determine whether this variance is secondary to the effects of inhalation anesthesia or misinterpretation of the preoperative exam. Observations were recorded by three distinctly different methods of measurement: the surgeon, the MD-2 Impedance Analyzer, and the Acoustic Otoscope immediately before and after induction of anesthesia. These results were then analyzed and compared with the operative findings. Anesthetic induction was shown to cause alteration in the presence of middle-ear fluid in less than 10% of cases.

Acoustic Impedance Tests↗
PubMed1988

Hyperlipidemia in association with childhood sensorineural hearing loss.

In adults there has been an association noted between hyperlipidemia and sensorineural hearing loss. Etiologic considerations include hyperviscosity of the serum, vascular occlusion and an increased susceptibility to noise. Until now this correlation, to our knowledge, has not been made in the pediatric population. Several children with bilateral fluctuating sensorineural hearing losses have been identified with hyperlipidemia. The fluctuations in hearing varied with lipid levels. With dietary controls, the cholesterol levels returned to what would be near the norm for the pediatric population and hearing returned to near baseline. Unexplained fluctuating sensorineural hearing losses in children warrant the consideration of hyperlipidemia. Discovering a potentially reversible etiology for hearing loss is significant but more importantly, may lead to the early detection of hyperlipidemia in the young patient.

Auditory Threshold↗
PubMed1988

Vagaries of thyroglossal duct cysts.

The thyroglossal duct cyst is the most common congenital cyst found in the neck, classically presenting as a paramidline mass in a healthy young adult. Fifty-three cases managed at the Brigham and Women's Hospital and Boston's Beth Israel Hospital over the past 10 years were reviewed. The unique presentation of papillary adenocarcinoma in TGDCs and findings in the elderly population are discussed. These cases represent both diagnostic and therapeutic challenges. The existing literature is correlated with our data, providing a treatise on management.

Adenocarcinoma, Papillary↗
PubMed1988

[Vocal rehabilitation after total laryngectomy by musculomucous tracheo-esophageal fistula. Results apropos of 27 cases].

Twenty seven cases of Myomucosal Tracheoesophageal shunt following total laryngectomy performed at Laennec Hospital are presented. The surgical technique which was initially reported by M. Strome is summarized. The advantages of this procedure as compared to other tracheoesophageal fistulas are discussed. The first sixteen cases of this series failed: 12 stenoses occurred and 4 flaps necrosed. The eleven last Myomucosal shunts of this series are functioning. Aspiration was only problematic in one case. Six of the eleven functioning shunts have excellent voicing; three other patients are able to voice before completion of speech therapy and one patient has a too short follow-up for voice evaluation. The authors emphasize the contra-indications for the procedure. Medical conditions that can potentially lead to flap necrosis include: arteritis, diabetes mellitus, and gastrointestinal reflux.

Female↗
PubMed1987

T-cell subsets and natural killer cell function with squamous cell carcinoma of the head and neck.

Twenty-two patients with squamous cell carcinoma of the head and neck were studied to assess potential abnormalities in total T lymphocytes, T4/T8 ratios, and natural killer cell function. Total T-cell counts were reduced for the entire group with the greatest reduction occurring in individuals with hypopharyngeal tumors and/or stage IV disease. Helper to suppressor ratios were within the norm for the total group, but specific site variances were detected in patients with oral cavity and hypopharyngeal primary carcinomas. Similarly altered T4/T8 ratios were noted with stage III disease. Substantive differences in natural killer cell activity were not observed. These data suggest that perturbations in T-lymphocyte subsets can be associated with decreased survival.

Adult↗
PubMed1987

Fragmented care of facial fractures.

The treatment of facial trauma currently falls within the purview of several surgical subspecialties, including plastic surgery, oral and maxillofacial surgery, otolaryngology, ophthalmology, and neurosurgery. The complexity of facial anatomy and the newer techniques for skeletal and soft-tissue reconstruction demand interdisciplinary, rather than multidisciplinary, care for these injuries. Interdisciplinary cooperation benefits the patient with a complex facial fracture by: minimizing chances for inadequate primary therapy, promoting discussion of controversial therapy, and providing the optimal therapy. Examples are given of unfavorable results following treatment of facial fractures. Recommendations are made to foster communication between the concerned surgical subspecialties.

Adolescent↗
PubMed1986

Kartagener's syndrome. A blinded, controlled study of cilia ultrastructure.

We investigated respiratory mucosa cilia ultrastructure in patients homozygous for the gene for Kartagener's syndrome (KS) and patients apparently phenotypic for KS who had bronchiectasis and sinusitis but without situs inversus. Parents, as obligate carriers of the recessive KS gene, were also evaluated among other control groups. The four patients with KS had significantly fewer cilia outer dynein arms than normal subjects or parents of patients with KS. Two of five patients apparently phenotypic for KS demonstrated distinctive ultrastructural changes. No other subjects demonstrated explicit ultrastructural abnormalities. Internal control specimens showed that the number of outer dynein arms was consistent within a subject compared with variation between subjects. The outer dynein arm serves as a dependable ultrastructural marker. Carriers of KS do not demonstrate distinctive morphologic cilia abnormalities. Not every patient with chronic bronchiectasis and sinusitis demonstrates abnormal cilia ultrastructure.

Adolescent↗