Biomedical subjects
Publications and source records attributed to R A Otto.
Adnexal carcinomas of the skin are a rare, highly malignant, and extremely diverse group of neoplasms. This article reviews skin adnexal tumors of nervous, vascular, and fibrous tissue of the head and neck. These tumors pose a significant diagnostic and therapeutic challenge, requiring close cooperation between the head and neck surgeon and the dermatopathologist.
RATIONALE AND OBJECTIVES: A study was designed to determine whether plain films, used as a screening modality for magnetic resonance imaging (MRI), could reliably detect intraorbital metallic foreign objects. METHODS: In the first experiment, 20 metal particles were placed in five human cadaver orbits. Routine orbital plain film series and computed tomography (CT) were obtained, randomized, and interpreted blinded by three experienced radiologists. RESULTS: The threshold size of particle detection for CT (0.07 mm3) was lower than for plain films (0.12 mm3). Placing metal particles in artificial and true vitreous demonstrated that all particles moved under a magnetic field at 1.5 T. When human globes were exposed to industrial tools (grinder, bandsaw, air hose, etc.), no metal objects penetrated the sclera. CONCLUSIONS: Plain films can be used as a low-cost, low-radiation screening procedure for high-risk patients with occupations involving metal work. CT should be used for patients with a history of eye trauma from other causes.
Otolaryngologists have long recognized the value of cocaine as a topical anesthetic and vasoconstricting agent. It is used in nasal surgery and as a vasoconstrictor before examination. As drug abuse has increased, screening for drugs of abuse has become common. This study was designed to determine how medicinal cocaine affects the urine test for the metabolite benzoylecgonine, the most common screening test for cocaine. Group I consisted of 12 patients scheduled for elective nasal surgery. Cocaine was given in our usual preoperative manner as 4 ml of 4% solution on cottonoids. Group II consisted of 30 volunteers in whom approximately 1 ml of 4% solution was sprayed intranasally. In both groups, a urine sample was collected before dosing and at regular intervals afterwards. All samples were negative before application of cocaine and all were positive 24 hours later. The duration of the positive result had some variability, but all were negative by 72 hours. The results show that medicinally used cocaine does make a drug screen positive. Patients should be informed that cocaine is being used and could cause a positive test for several days.
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Differential diagnosis of cervical masses varies with the age of the patient. In children, neck masses are most likely to be inflammatory or congenital, and evaluation may include routine laboratory evaluation, skin tests, chest films, computed tomography and/or magnetic resonance imaging of the neck, and, possibly, fine-needle aspiration of the mass. The workup in young adults is similar to that in children. In older patients (greater than 40 years), however, the likelihood of malignant disease increases significantly. These patients should have formal endoscopy with biopsy of any suspicious lesions before an open biopsy of the neck mass is performed.
We have presented three cases of metastatic tumor to the orbit. The first case illustrated metastatic tumor that originated from a cutaneous basosquamous cell carcinoma. This lesion, first reported by MacCormac as being morphologically intermediate between basal and squamous cell carcinoma, has become a topic of some controversy. Conley reported these tumors to represent 1% of basal cell carcinomas. Several authors have reported a higher incidence of recurrence with these lesions, as compared with the ordinary basal cell tumors. Recurrence of basal cell carcinomas are reported as approximately 10%, but are four times greater in the basosquamous cell tumors. The incidence of metastasis with the basosquamous cell tumors has been reported in between 37% and 51% of cases. The second case represented involvement of the orbit by direct extension of a facial squamous cell carcinoma. As illustrated by this case, these tumors can be very aggressive and should be treated with respect. The third case showed the metastatic potential of the nephroblastoma with metastatic tumor that involved the eye, orbit, and maxilla. Diagnostic techniques available in evaluation of these tumors include CT scan, magnetic resonance (MR) imaging, ultrasound, open biopsy, and fine-needle aspiration. Li et al., in an article that compared MR imaging, CT scan, and ultrasound concluded that MR imaging, with the use of the 0.15 T resistive magnet, offered no distinct advantage over the combination of CT and ultrasound in evaluation of patients with orbital tumors.(ABSTRACT TRUNCATED AT 250 WORDS)
We have previously presented the concept of electrophysiologic pacing of bilaterally paralyzed vocal cord abductors as a solution to the difficult problem incurred in this clinical situation. Initially, we demonstrated that it was indeed feasible to electrophysiologically pace abduction of the vocal cords synchronously with respiration, employing the EMG activity of the diaphragm as a trigger stimulus. Further research has led us to evaluate other possible physiologic trigger stimuli to ascertain which of these will prove most suitable in long-term pacing studies. In this article, we will report our preliminary results, employing negative intrathoracic pressure occurring with respiration--as detected by an implanted pressure transducer as a trigger stimulus. This device was interfaced with a muscle stimulator attached to electrodes placed in the cricoarytenoid muscles in five canines whose recurrent laryngeal nerves had been sectioned bilaterally. In all animals, obvious physiologic synchrony of vocal cord abduction and a reduction of negative inspiratory intratracheal pressure was achieved during electrical pacing. This reinforces our initial findings that it is indeed feasible to pace vocal cord abduction in bilateral recurrent laryngeal nerve paralysis with resultant return of physiologic normality to the glottis. Thus, functional electrical stimulation offers an alternative approach to the difficult problems incurred in the patient with bilateral recurrent laryngeal nerve paralysis. It also demonstrates that physiologic negative intrathoracic pressure activity occurring with inspiration can be a trigger source.
Several investigations have suggested that a sterile inflammatory reaction in a skin flap enhances flap survival. A chemical peel produces a mild chemical burn, which is one form of nonbacterial inflammatory response. Some authors advocate the concomitant use of face lift and chemical peel, while others caution that the peel might jeopardize the facial flaps. To determine whether the reaction caused by a chemical peel enhances or impairs skin flap survival, a study using miniature pigs was undertaken. Survival length of flaps treated with a chemical peel was compared to that of untreated flaps. A total of 36 dorsally based random flaps were used on three miniature pigs. Six identical 14 X 4 cm flaps were designed on each side of the pigs. A chemical peel was applied to the area of 18 of the proposed flaps 2 days prior to elevation. Alternate flaps on each side of the pigs were treated. As the flaps were elevated, the tips were examined to document the inflammatory response histologically. After 14 days, the surviving length of the flaps was measured. As determined by the Wilcoxon matched-pairs signed-ranks test, there was no significant difference between the treated and untreated groups. Our study shows that a nonbacterial inflammatory response produced by a chemical peel does not improve skin flap survival, at least not in pigs.
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We have reconfirmed our previous findings that controlled, reproducible, sustained, discrete vocal cord abduction can be achieved synchronously with respiration by electrophysiologic stimulation of the paralyzed posterior cricoarytenoid muscles. Moreover, we have demonstrated that this can be triggered synchronously by employing the normal physiologic chest wall movements that occur on respiration. To our knowledge, this represents the first report of functionally paced vocal fold abduction with respiration employing physiologic chest wall motions using an implantable device, and may represent an important step in the development of a physiologic approach to bilateral recurrent laryngeal nerve paralysis.
Electrodes were placed into the posterior cricoarytenoid and diaphragmatic muscles of five tracheostomized dogs. With the use of a sensor that would selectively detect diaphragmatic electromyographic activity, this activity served as a trigger and was amplified and interfaced with a muscle stimulator attached to electrodes placed in the posterior cricoarytenoid muscles. In all animals obvious physiologic synchrony of vocal fold abduction and a reduction of the negative inspiratory intratracheal pressure were observed during electrical pacing. This represents a preliminary step in the development of an alternative approach to the patient with bilateral recurrent laryngeal nerve paralysis.
Tracheostomy tube fracture with subsequent migration of the proximal fragment down the tracheobronchial tree is an almost unheard of cause of tracheal foreign bodies. Most such occurrences have been reported outside the United States, and only six previous reports have been filed. We report an additional case of fractured tracheostomy tube and review the literature.