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Biomedical subjects

R J Toohill

Publications and source records attributed to R J Toohill.

At least 73 records · Page 4Linked to original sources
PubMed1983

Alloplastic implants of the larynx.

Biocompatible Teflon fluorocarbon polymer (Proplast) and porous polyethylene (Plasti-Pore) are porous alloplastic implant materials that are widely used in reconstructive head and neck surgery. These two materials were used in our study as replacement grafts for defects in three groups of 12 canines. For the first time, Plasti-Pore was found equal and perhaps superior to Proplast in deep implantation, this in the anterior cricoid cartilage when the internal and external perichondrium were preserved. Rejection of both substances occurred when the implant was exposed to air and aerodigestive tract contaminants after the removal of the perichondrium, subglottic, and upper tracheal mucosa. Airway exposure to the alloplasts, even when lined with buccal mucosa, resulted in infection and extrusion, but at a much slower rate.

Animals↗
PubMed1983

Diagnosis of malignant lymphomas of the nasal cavity, paranasal sinuses and nasopharynx.

The diagnosis of non-Hodgkin's malignant lymphoma of the nasal cavity, paranasal sinuses, and nasopharynx was made in 15 patients over a 7 year period (nasopharynx, 9; nasal cavity, 3; maxillary sinus, 2; frontal sinus, 1). A wide variety of head and neck symptoms, often characteristic of benign disease, was reported ranging from 2 weeks to 4 months prior to presentation. Of the 15 cases, the original diagnosis was inconclusive in 6; 4 of the 6 required rebiopsy, while the diagnosis in the other 2 was confirmed on further pathologic consultation. Tissue marker studies, which have recently become available, were performed in 7 cases and were crucial in the diagnosis of 2. B-cell lymphoma was diagnosed in the 7 patients who had tissue marker studies. Five patients had palpable cervical nodes, and none had distant adenopathy or masses. With further staging, 4 of the 15 patients were found to have disseminated disease. The paper emphasizes the need for early biopsy of suspicious lesions presenting in areas in which physical examination is limited. Recommendations are made for handling the biopsy specimen when malignant lymphoma is suspected, as well as for the evaluation of local and distant sites. The role of surgery is primarily diagnostic in patients with malignant lymphoma.

Adolescent↗
PubMed1982

Sudden sensorineural hearing loss: operative complication in non-otologic surgery.

Sudden sensorineural hearing loss is a well recognized phenomenon in otologic practice with both viral and vascular etiologies being supported. However, sudden hearing loss as a complication of non-otologic surgical procedure is a seldom reported and rare phenomenon. Five cases of unilateral sudden sensorineural hearing loss which are time related and probably causally related to non-otologic surgery are presented. Two cases underwent open heart surgery and support previous reports of hearing loss secondary to cardiopulmonary bypass procedures. Three noncardiac cases are also reviewed. None of these patients had prior otologic disease which would predispose to a sudden hearing loss, and no intraoperative or postoperative complication was specifically noted as a cause of the hearing loss. The literature is reviewed and attention is drawn to the problem. We wish to encourage further reports and to recommend early identification and treatment in those cases related to cardiopulmonary bypass.

Adult↗
PubMed1982

Adenoid cystic carcinoma of the submaxillary gland.

A review of submaxillary gland neoplasms over a 21 year period revealed 15 malignancies and 7 benign tumors. All of the malignancies occurred in females, and 11 of these were adenoid cystic carcinoma. Two of the 11 were found to have infiltrating ductal carcinoma of the breast (1 pre and 1 postdiagnosis of the submaxillary carcinoma) and 3 had benign breast disease. While previous reports have suggested an association of parotid gland neoplasia and breast cancer, this is the first known report of an association between adenoid cystic carcinoma of the submaxillary gland and cancer of the breast. The discussion of adenoid cystic carcinoma of the submaxillary gland emphasizes the increased frequency of this disease in females, its association with breast disease, and also experimental submaxillary gland neoplasia.

Adult↗
PubMed1981

Panel discussion: the management of advanced laryngotracheal stenosis. Composite nasal septal graft in the management of advanced laryngotracheal stenosis.

Reconstruction of the larynx and trachea is most often needed after conventional methods of repair have failed. The advanced stenotic lesion can be adequately corrected with a composite nasal septal graft in a one stage procedure. Severe glottic stenosis from crush injuries or following partial laryngectomy, subglottic stenosis, and high tracheal stenosis are most amenable to this type of reconstruction. The surgical technique is presented, and six cases of clinical utilization are reviewed.

Adult↗
PubMed1981

Rhinitis medicamentosa.

The diagnosis of rhinitis medicamentosa was made in 130 patients seen over a 10 year period from July 1967 to June 1977. There was an incidence of 1% in our otolaryngological practice. Patients had been taking the causal medication for an average of 21.4 months. There were 73 males and 57 females with the peak incidence in young and middle-age adults. The primary offending medications were decongestant nasal sprays in 85 patients, decongestant drops in 33, and a combination of these drugs in 12 patients. The major reasons for self-medication were 1. deviated nasal septum in 40 patients, 2. an acute upper respiratory infection in 33, 3. allergy in 18, 4. miscellaneous causes in 24 and 5. unknown in 15 patients. The initial management in addition to avoidance of the medication consisted of systemic antibiotics, decongestants, antihistamines, and sedatives depending on the severity of the rhinitis and the presence of secondary infection. Later treatment consisted of correction of the deviated septums, allergic management, and supportive care. Eight patients were considered to have complications of the disease by development of chronic ethmoiditis and nasal polyposis. The pharmacologic properties of the causal agents are thoroughly reviewed as they relate to the pathogenesis of this disease. It is felt that the ready commercial availability and limited clinical value of the topical nasal sprays and drops represents a certain risk to all patients using them.

Adolescent↗
PubMed1978

Nasal and paranasal sinus polyposis. Current concepts in radiologic diagnosis and surgical therapy.

We believe that hypocycloidal tomography is the method of choice in the pre and postoperative evaluation of chronic nasal and paranasal sinus polyposis, based on the radiographic examinations of 80 patients who have undergone intranasal ethmoidectomy. Although our overall study is incomplete at this time due the extended period necessary for follow-up, we hope that the basic information which is now available will be beneficial to others.

Ethmoid Sinus↗
PubMed1977

Ventilating tubes in tympanoplasty.

The successful surgical treatment of chronic otitis media or its sequela is frequently related to a ventilated tympanic cavity. Tubes at tympanoplasty have been recommended to assure ventilation until eustachian tube and middle ear mucosal functions have been restored and to prevent the complications of graft loss, atelectasis, cholesteatoma and ossicular destruction. This presentation reviews the literature on the subject and documents our results in 40 patients treated by tympanomastoid surgery with ventilating tubes. The types of tubes used, the surgical technique involved, and the selection of cases suitable for this method are described. Cholesteatoma was the primary disease in 32 patients, 6 had chronic otitis media, 1 cholesterol granuloma, and 1 eosinophilic granuloma. Complete healing of grafts following extrusion or removal of the tubes occurred in 34 patients, 2 tubes remain in place, 3 patients had persistent tube site perforations, and 1 was lost to follow-up. None of the patients had graft breakdown as a result of tube placement, and there has been no recurrence of cholesteatoma. In all cases, the follow-up period is a minimum of 18 months and extends to 92 months.

Adolescent↗
PubMed1976

Vocal cord fixation in laryngeal carcinoma.

The 1962 TNM classification (T, tumor and extent; N, regional lymph node metastasis, M, distant metastasis) did not emphasize vocal cord fixation in staging. In the revision of 1972, lesions with partial fixation were classified T2, stage II, and those causing fixation were T3, stage III. The therapeutic results in 39 patients with fixed cords revealed a determinante five-year survival of 41% and an absolute of 23%. These statistics support the validity of the 1972 classification. Careful evaluation of vocal cord mobility prior to selection of therapy is stressed.

Adult↗
PubMed1975

The psychosomatic aspects of children with vocal nodules.

Psychological and emotional aspects of voice disorders have long received attention from otolaryngologits and speech clinicians. The literature contains frequent reports of such problems, but there are few studies on the full importance of these aspects. The cause of vocal nodules in children has been attributed to vocal abuse, and therapy has consisted of the elimination of this abuse. Reports of long-term follow-up are few, lending suspicion to both the proposed causes and the therapeutic approaches. Seventy-seven prepuberal children with vocal nodules are studies from the social, medical, and physical aspects. The incidence of vocal nodules approaches 1% of all children. Boys predominate this amount by ratios greater than 3:1, with incidence peaks between ages 5 and 10. Conventional modes of therapy have been unsuccessful because of the lack of recognition of psychosomatic factors. New approaches for therapy are suggested including parental involvement, counseling, group therapy, and drug therapy. Though emotional problems may persist, the somatic aspect of this disease disappears at puberty.

Child↗
PubMedDate not supplied

DNA content in nasopharyngeal carcinoma.

DNA analysis by flow cytometry was performed on tissue blocks from 41 patients with nasopharyngeal carcinoma. The histologic slides were reviewed by a pathologist and blindly classified according to the World Health Organization classification. The paraffin-embedded blocks were processed to obtain individual nuclei, which were then stained with propidium iodide. The nuclei were analyzed on a flow cytometer. Excluding 10 uninterpretable histograms, the remainder were interpreted blindly and classified as diploid or aneuploid. The Cox proportional hazards survival model was used to analyze stage, histology, radiation dose, and ploidy. We observed more diploids (23 of 31; 74%) than aneuploids (eight of 31; 26%). The 2-year survival rate of diploids was 55%, compared with 25% of aneuploids (P less than .05). We conclude that ploidy status is an independent prognostic factor in nasopharyngeal carcinoma.

Carcinoma↗
PubMedDate not supplied

Recurrence patterns by treatment modality of carcinomas of the floor of the mouth and oral tongue.

Recurrence patterns were examined by stage of disease and treatment modality in 139 patients with 141 squamous cell carcinomas of the floor of the mouth and oral tongue, reflecting an 11-year experience at two hospitals. Treatment categories included surgery, irradiation, and combined treatment. Patients who were without evidence of disease at two years, or at the time of death, were considered cured. Cures were achieved in 87 per cent of patients with Stage I disease, 83 per cent with Stage II, 40 per cent with Stage III, and 34 per cent with Stage IV. Similar results were achieved by irradiation alone and by surgery alone in controlling early lesions. Combined treatment offered the best chance of cure for patients with advanced disease. Failure was most often associated with persistence at the primary site. No patient with advanced disease was salvaged after local treatment failure. One of 51 patients who received prophylactic treatment of the neck in the absence of clinical evidence of metastases had a regional treatment failure, while seven of 26 such patients who did not receive prophylactic treatment developed regional metastases. The ten-year adjusted survival rate, as calculated by the actuarial method, was 53 +/- 4.7 per cent. Forty-two multiple primary lesions were found in the 139 patients.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Carcinoma of the larynx in patients with gastroesophageal reflux.

PURPOSE: To study the relationship between gastroesophageal reflux disease (GERD) and the development of laryngeal cancer in patients who lack other accepted risk factors for the development of squamous cell carcinoma of the larynx. PATIENTS AND METHODS: A retrospective review of patients either treated surgically or with radiation therapy for stage 1 or stage 2 laryngeal carcinoma with specific reference to smoking history and the presence of GERD. RESULTS: We present 9 lifetime nonsmoking patients with stage 1 or 2 laryngeal carcinoma in whom GERD was clinically and/or radiographically shown. Also, 14 patients are identified who quit smoking more than 15 years before the development of laryngeal cancer and who also had evidence of GERD. CONCLUSION: We propose that the development of laryngeal carcinoma in this cohort of patients who lack typical risk factors supports the notion that GERD plays a role in the etiology of carcinoma of the larynx. Because the accepted risk factors for laryngeal carcinoma such as smoking and alcohol use increase the likelihood of reflux, GERD may act as a cocarcinogen in smokers and drinkers. Of interest, the treatment of GERD can reverse the signs of chronic laryngitis and should be instituted in patients with laryngeal pathology who have GERD.

Adult↗