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Biomedical subjects

M Strome

Publications and source records attributed to M Strome.

108 records · Page 6Linked to original sources
PubMedDate not supplied

Postanginal sepsis.

Postanginal sepsis is a septicemia resulting from an antecedent pharyngitis that causes an internal jugular vein thrombophlebitis. Because of the severity of the disease and the difficulty in its diagnosis, familiarity with all aspects of the disease is essential. We present three cases and review the literature on postanginal sepsis. The clinical course of the disease is described and its evaluation and treatment are outlined.

Adult↗
PubMedDate not supplied

Circulating immune complexes and chemotherapy response in patients with head and neck cancer.

An assay which could prospectively predict a response to chemotherapy prior to instituting therapy would be beneficial, especially for nonresponders. We evaluated at random a total of 50 patients with previously untreated stage III and IV head and neck squamous cell carcinoma for T-cell subsets and levels of circulating immune complexes (CIC). Of this group 23 patients had induction chemotherapy as their first modality of treatment. These patients received standard protocols of therapy consisting of cisplatin, 5-fluorouracil, methotrexate, and bleomycin. Of the laboratory measures assessed, only CIC correlated with clinical response to chemotherapy [no response (NR), partial response (PR), complete response (CR)] at the completion of the induction period (two to four cycles). Levels of CIC were determined by a polyethylene glycol (PEG) precipitation assay, and measured by spectrophotometry at 280 nm. In our population of all head and neck cancer patients, CIC were elevated (mean +/- SD values: 0.475 +/- 3.8 compared with controls: 0.184 +/- 0.07). In the NR group, the mean +/- SD was 0.707 +/- 0.43 (P = 0.001). Complete responders had a mean value of 0.332 +/- 0.21; partial responders had a mean value of 0.255 +/- 0.13. On the basis of the values determined, patients with markedly elevated levels of CIC would be predicted to respond poorly, or not all, to current induction chemotherapy protocols.

Antigen-Antibody Complex↗
PubMedDate not supplied

Carcinoma of the tonsil.

Although the experts acknowledge that there is no conclusive evidence linking secondhand smoke to head and neck cancer, a recent report by the Environmental Protection Agency classifies secondhand smoke as a group A carcinogen. There is strong evidence linking it to carcinoma of the lung. Whereas you may not be able to tell your patient that the same cause and effect is present for head and neck cancer, it is the editor's belief that this will one day be proven. Three experts agreed to treat this patient with surgery followed by full-course radiotherapy, although the surgical approaches differed. They included a marginal mandibulectomy, radical neck dissection, and plating of the remaining mandible (Dr. Strome) and a composite resection (Drs. Ward and Johnson). For reconstruction, options included a modified FAMM flap or a split-thickness skin graft (Dr. Strome), tongue flap or pectoralis major myocutaneous flap (Dr. Ward), or a split-thickness skin graft (Dr. Johnson). One consultant suggested resecting the neck mass and treating the primary tumor and neck with radiotherapy. A dental consultation is in order prior to radiotherapy (Dr. Goepfert). With regard to this woman's mental status, all the experts called for counseling. The husband should be included in the discussions (Dr. Strome and Ward) and consideration should be given to the Women's Right Advocacy Group (Dr. Johnson).

Aged↗
PubMedDate not supplied

The importance of the pedicle for the survival of a vascularized free flap: an experimental study on rats.

It has been assumed, but never shown experimentally, that the survival of a free vascularized full-thickness island flap is based on the vascular pedicle. A study using the rat was designed to assess the three parameters of flap survival: the vascular pedicle, the recipient bed, and the perimeter of the recipient area. Isolation of the pedicle by ligation caused flap necrosis in 18 out of the 20 groin flaps. An intact pedicle, with the other two parameters excluded, led to flap survival in 75% (9 of 12 flaps). Our results indicate that the critical factor to island flap survival in the immediate postoperative period is the vasculature supplying the pedicle. The two other factors are of limited importance.

Animals↗
PubMedDate not supplied

An animal model for the assessment of microvascular patency.

A tubed superficial epigastric flap (TSEF), based on a single vascular pedicle, was designed in a rat. Forty TSEFs were created in three control groups: in 20 TSEFs both the femoral artery and vein were ligated proximal to the take-off of the superficial epigastric vessels, in 10 TSEFs the femoral artery and in the other 10 the femoral vein were ligated and transected at the same location. All TSEFs in the control groups sloughed, reflecting the dependence on the axial vasculature. A further 232 TSEFs were made with a survival rate of 84.5% (196/232). Delayed arterial or venous ligation was then performed up to 42 days after the initial surgery. The patency of the axial vein was crucial for survival for only the first postoperative week. The axial arterial patency was needed for survival of the TSEF for 6 weeks. The creation of this TSEF fulfills the need for a simple model that is as readily constructed as other models, is reproducible, has a high success rate and most importantly, reflects the patency of its nutrient vessels for a prolonged period of time.

Animals↗
PubMedDate not supplied

Clinical features as diagnostic guides in obstructive sleep apnea.

Obstructive sleep apnea (OSA) may induce psychiatric problems, but clinical risk factors do not reliably predict laboratory-verified OSA. Therefore, OSA diagnosis requires laboratory sleep monitoring. To find additional clinical features that would sharpen indications for sleep monitoring, we applied univariate analyses to clinical data for 137 OSA patients seen in a psychiatry sleep clinic. A symptomatology questionnaire was obtained from 101 of these patients: 71 had morning and 86 had afternoon vigilance tests, and all had upper-airway evaluation and polysomnography. Cigarette consumption but no other clinical features differed among OSA severity groups and total sleep period groups; upper-airway findings differed among vigilance groups. Multidiscriminant clinical predictor terms categorized several patients with severe OSA into less severe OSA categories. Clinical features did not accurately predict OSA. OSA will continue to be identified primarily by sleep laboratory testing. A two-phase laboratory routine, reserving full laboratory testing for patients with negative results on initial, less expensive screening tests, might conserve resources.

Adult↗
PubMedDate not supplied

Voice evaluation of myomucosal shunt after total laryngectomy: comparison with esophageal speech.

The vocal quality attained with a tracheoesophageal myomucosal shunt (MMS) as described by Strome was evaluated in four patients and compared with three esophageal speakers and two normal subjects. The patients with MMSs acquired speech sooner. Fundamental frequency, pitch, timbre, and melody were analyzed with computerized electroglottography and sonography. Intelligibility was deemed better after the MMS primarily because phonation time approximated that of normal speech, and this study suggests that, following total laryngectomy, the vocal quality achieved using the MMS is preferrable to that of esophageal speech.

Aged↗
PubMedDate not supplied

Adult epiglottitis.

Seventy-five patient-episodes of adult epiglottitis were analyzed retrospectively. Six tracheotomies were performed, and no deaths occurred. In a large subset of patients, viral pathogenesis was suggested by benign clinical courses that included normal or mildly elevated temperatures and minimally elevated leukocyte counts with relative lymphocytosis. Hospitalization may not be indicated for adults with epiglottitis of viral etiology as it is for patients with signs of bacterial infections.

Adolescent↗
PubMedDate not supplied

Injuries to the neonatal larynx from long-term endotracheal tube intubation and suggested tube modification for prevention.

Since the early 1960's nasotracheal tubes have been used for neonates with primary respiratory diseases which necessitated positive pressure ventilation. This therapy may be required for extended periods of weeks to months meaning prolonged trauma to the neonatal larynx. The initial injury and long-term effects of the endotracheal tube in this age group have not been adequately investigated. The acute findings can be arytenoid and posterior commissure ulcerations and, in some cases, cartilage erosion. Long-term follow-up in these children to age 3.5 years showed a persistent arytenoid defect with chronic hoarseness. The consideration of a change in the structure of the endotracheal tube is suggested as a possible means of avoiding these injuries.

Hoarseness↗
PubMedDate not supplied

Normal neonatal brainstem auditory evoked potentials.

Brainstem auditory evoked potentials present a unique opportunity to assess the neuronal and auditory status of the newborn. To date, sample data have been few in number, thereby limiting their interpretive value. The present study was undertaken in an effort to accrue data generated from a large sample size. One hundred fifty-five normal neonates were tested within the first 36 hours of life. No subjects qualified for inclusion in the High Risk Register for Hearing Loss established by the American Academy of Pediatrics. Each ear was tested independently, using click stimuli at a rate of 30.1 per second at 65 dB HTL. Test runs were replicated for purposes of reliability. A run consisted of 2,000 sweeps of data, each being 10 ms in length. Identification of wave forms were assessed by two or more observers. Total agreement was required from all observers for inclusion of wave peaks for analysis. Latencies of onset of stimulus to peak were obtained. Descriptive as well as inferential statistics were computed. Results provide standardized data for comparison.

Acoustic Stimulation↗
PubMedDate not supplied

Airway obstruction and sleep apnea in Hurler and Hunter syndromes.

The Hurler and Hunter syndromes are two forms of mucopolysaccharidosis. Although the diseases are rare, those afflicted commonly require otolaryngologic consultation. Upper airway obstruction is often severe, progressive, and not infrequently the suspected cause of death in these patients. Four patients with these problems are presented. In all of the children, obstructive sleep apnea was a major management problem. This and other upper airway difficulties are detailed with clinical and pathological correlates.

Airway Obstruction↗
PubMedDate not supplied

Bronchogenic cysts: a case report.

The otolaryngologist has a reference frame for congenital stridor that rarely includes diagnosis of a bronchogenic cyst. The life-threatening potential of this lesion makes consideration and recognition imperative. Representing less than 5% of the mediastinal childhood masses in the infant, respiratory distress most often initiates diagnostic studies leading to identification and extirpation. The case presentation highlights the clinical course. The diagnostic hallmark of this case was the delayed onset of stridor with subsequent progression. Thereafter, a chest film and barium swallow suggested the diagnosis. In newborns, however, such cysts may not be evident on routine chest films and, nonetheless, cause significant respiratory distress from airway compression. Surgical extirpation should be affected as soon as possible after the diagnosis is entertained in order to insure against a sudden respiratory death.

Bronchi↗