Biomedical subjects
P Gullane
Publications and source records attributed to P Gullane.
MRI and neck metastases: a clinical, radiological, pathological correlative study.
In a previous report CT was shown to have no advantage over physical examination in the detection of metastatic neck disease. Therefore, a study was undertaken to evaluate whether MRI would show superiority to the CT in the diagnosis of neck nodes. A series of 35 patients with various head and neck tumors were evaluated clinically, radiographically and pathologically. Eight patients were excluded from the study because of various problems involving the MRI. Therefore, 27 patients with 30 neck dissections were analyzed. There was little advantage of MRI over clinical examination in the detection of metastatic neck disease. The present size criterion for the diagnosis of occult malignant nodes is not reliable. The soft tissue contrast resolution reported by MRI is inadequate to detect minimal morphological changes in lymph nodes involved by metastases, and MRI is difficult in patients who have airway or foodway obstruction.
Intracranial hypoglossal neurinoma.
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Glomus vagale tumors.
We present a case of a multicentric chemodectoma, with the unusual combination of a glomus vagale and a glomus tympanicum tumor. Multicentricity was suspected before selective carotid arteriography. Our patient, although asymptomatic, had elevated levels of urinary catecholamines preoperatively, which returned to normal postoperatively, suggesting biochemical activity of the tumor. Intraoperative hemostasis was assisted by the use of preoperative selective embolization of the tumor mass and the peripheral location of the injected Ivalon was confirmed histologically. The vagus nerve was anatomically spared and complete function was restored within 10 months. The asymptomatic small glomus tympanicum tumor was treated with embolization alone, as the patient chose to defer treatment at this time, but only time will reveal the effectiveness of this method of management.
Mandibulotomy and radical radiotherapy: compatible or not?
The mandibular swing, as an approach to upper aerodigestive tract malignancies, has been gaining popularity in recent years. Little has been reported in the literature as to the feasibility of this procedure in subjects having received radical preoperative radiotherapy. The preliminary results of a retrospective analysis of 23 subjects, 70% of whom received radical preoperative radiotherapy, is presented. There was no statistically significant difference between the complication rates in the irradiated and nonirradiated subject populations. All subjects, ultimately, were orally rehabilitated.
Functional assessment after laryngotracheoplasty.
Laryngotracheal stenosis is a difficult problem to manage. Functional assessment is measured primarily on the ability to successfully decannulate the patient. In an effort to identify reliable, objective parameters for postoperative functional assessment, we present a retrospective study of 10 postlaryngotracheoplasty patients. All subjects underwent analysis with computerized tomography, translaryngeal manometry, acoustic reflection, flow volume loops (FVL), and voice analysis. Our results led us to conclude that accurate functional assessment is best provided by use of a combination of CT and spectral voice analysis.
Alterations in nasal physiology after laryngectomy: the nasal cycle.
Several changes in nasal physiology have been reported following laryngectomy. This paper reviews these changes and investigates the cycle of alternating distribution of nasal airflow in 20 adults. Information about the cyclic activity was obtained from the areas of condensation formed by nasal expiration on the surface of a Gertner-Podoshin plate. Consecutive measurements of these areas were made at 15-minute intervals during a 6-8 hour period. Five control subjects demonstrated a nasal cyclic activity which was absent in five patients 1-3 years post-laryngectomy. Two patients with preoperative cycles showed none three weeks after laryngectomy. Three patients with a temporary surgical diversion of supraglottic airflow showed cessation of the cycle, which resumed after restoration of the natural airway; one of these patients had undergone hemilaryngectomy with section of both superior laryngeal nerves. Five patients showed no alteration after operation involving no diversion of supraglottic airflow (tonsillectomy). These results demonstrate cessation of the cycle following chronic absence of supraglottic airflow, temporary, cessation during acute absence, and independence of the cycle from superior laryngeal innervation.
Pharyngeal reconstruction: current controversies.
Total pharyngeal reconstruction following ablative surgery has made significant advances over the past 10 years with the development of new techniques and the refinement of older methods. The reconstructive methods utilized by the authors in 26 cases over the past three years are presented. The methods employed were classified into three groups. Group A (N = 3) were reconstructed using myocutaneous flaps, Group B (N = 17) were repaired by primary gastric transposition, and Group C (N = 6) were handled using a free vascularized jejunal graft. Twenty-two of the patients received preoperative irradiation. The selection of appropriate procedure and technique, and the complications and limitations of each method are discussed.
Adenoid cystic carcinoma involving the external auditory canal. A clinicopathologic study of 16 cases.
Sixteen patients with a rare tumor, adenoid cystic carcinoma (ACC) involving the external auditory canal, have been studied. Clinically, most patients complained of ear pain, often of several years duration. On physical examination, a mass or a nodule usually was identified in the ear canal. In most cases, treatment consisted of a wide surgical resection of the auditory canal and adjacent structures. Histologically, these neoplasms had the same appearance as ACC originating in salivary glands. In eight cases, the tumor was confined to the ear canal wall and unquestionably arose in this area, probably within the ceruminous glands. When incompletely excised, these lesions usually recurred locally. Nine patients had a total of 26 local recurrences. Most recurrences were found within two years of the preceding treatment, but the interval in some cases was long, ranging up to 14 years. Of the 16 patients, seven had no evidence of recurrence following surgical resection, two were living with recurrent, unresectable tumor, five had died of disease, one had died of other causes, and one was lost to follow-up. Some patients died of tumor after a prolonged clinical course with multiple recurrences. Death usually was caused by intracranial extension by the tumor, or by pulmonary metastases. Radiotherapy did not appear to cure the lesion, but probably resulted in palliation. An increased incidence of recurrent, unresectable tumor or of death from the neoplasm correlated with the following histologic features: demonstration of tumor on the lines of surgical excision, involvement of the parotid gland, extension into bone, perineural invasion and local recurrence of tumor.
Adenoid cystic carcinomas arising in salivary glands: a correlation of histologic features and clinical course.
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Noncutaneous cavernous hemangiomas of the head and neck.
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