Biomedical subjects
Publications and source records attributed to R K Newman.
Fermentation is known to modify nutritional value of foods positively. A new technique for supplementing traditional fermented foods with limiting amino acids is presented. Normal fermentative bacteria are induced to produce specific amino acids during the fermentation period. Acceptable food products have been prepared using fermented grain. The concept may be applicable to developing countries.
Broiler chicks were provided choices of synthetic diets (a) adequate or low in lysine, and (b) adequate in or devoid of lysine. In each case, chicks consumed some of each diet offered, but preference was shown for the adequate lysine diet. Growth rates of chicks given choices ranged from 80% of that of chicks fed an adequate lysine diet with no choice for two weeks, then growth rates fell to about 60% of those fed adequate lysine. In another study, chicks were fed a diet devoid of lysine but were offered pure L-lysine HCl in a separate feeder. These chicks selected some of the supplementary lysine, but their body weights were only 68% of the body weight of chicks fed an adequate lysine diet after 21 days. Chicks given a choice of diets prepared with an adequate quantity of either L- or D-lysine preferred with L-lysine diet but did not select sufficient quantity to reach normal growth. These observations indicate that chicks can discern the presence of L-lysine in diets or separately, but will not select sufficient quantity for maximum growth potential. A diet prepared with D-lysine was more acceptable than one completely devoid of lysine, suggesting some sensory recognition for lysine.
Computed tomography (CT) of the neck was used to identify deep-neck abscess formation. Twenty-two patients were screened by CT for deep-neck abscesses. Each patient suspected of having a deep-neck infection underwent CT, often with enhancement if the differential diagnosis included the possibility of a tumor or vascular lesion. Six cases were identified, and these patients were taken to surgery for incision and drainage. There were no false-positives or false-negatives in the series. In all six cases of abscesses, the CT scan accurately identified the anatomical location of the abscess, allowing a more accurate planning of the surgical approach. The selective use of CT when deep-neck infections are suspected seems to produce an accurate diagnosis of the presence of an abscess, its location, and the involvement of important surrounding structures.
Lesions on or about the auricle may be of congenital, traumatic, inflammatory, or neoplastic origin. For congenital lesions, appropriate treatment and correction of hearing loss are important concerns. The most common traumatic lesions, subperichondral hematomas and keloids, require accurate diagnosis and appropriate treatment to prevent development of further problems. Inflammatory lesions are usually easy to diagnose from the patient's complaints of recent onset of pain, erythema, and edema. Neoplasms, especially squamous cell carcinoma, should be considered in differential diagnosis of a sore that does not heal. When treatment of a periauricular abnormality involves surgery, biopsy, or incision and drainage, care should be taken not to jeopardize the facial nerve.
Aspergillosis is becoming an increasingly recognized pathogen in the sinonasal tract. The courses of two patients, one seemingly healthy and one with a terminal malignancy, are reviewed. These patients illustrate the clinical course, difficulties in diagnosis, and management of patients with aspergillosis of the sinonasal tract. Aspergillus is a common endogenous contaminant of the upper respiratory tract; however, bacterial sinusitis may trigger its growth and proliferation. Aspergillus fumigatus is the most common species implicated in paranasal sinus disease in the United States. The maxillary antrum is the most commonly involved site in the paranasal sinuses. Originally, aspergillosis was described in healthy patients, but it has become increasingly recognized in the immunocompromised and the chronically debilitated. Paranasal sinus Aspergillus infections are classified as non-invasive and fulminant. The treatment is primarily surgical. Antifungal chemotherapeutic agents are used in the treatment of central nervous system involvement and in the fulminant form of the disease.
Although we agree that postoperative irradiation does improve the local and regional control, our findings indicate that the rate of control, especially local control, is somewhat less than 90 percent. Our data reveal a recurrence rate of 32.7 percent in advanced, stage III and IV, squamous cell carcinomas in the head and neck treated by surgery and postoperative irradiation; this rate may be even greater with longer follow-up. We recommend that surgeons avoid "close" surgical margins (less than 5 mm) when resecting primary cancers and not rely too heavily on radiation therapy to control residual subclinical disease. It appears that continued study is needed to establish the true efficacy of irradiation in the control of subclinical disease, and that local recurrence must be differentiated from regional recurrence when reporting these results.
In adults with persistent (three to five weeks' duration) or recurrent serous otitis media, the possibility of an underlying malignancy in the nasopharynx should be considered. Alertness to this and other clues, such as atypical facial pain, will result in appropriate investigation and earlier diagnosis and treatment.
Persistent hoarseness in a patient should always alert the physician to the possibility of laryngeal carcinoma. Prompt visualization of the larynx is essential, particularly in high-risk patients over 40 years of age without a history of upper respiratory infection. Mirror examination (indirect laryngoscopy) is the usual initial diagnostic procedure, although Hopkins' rod telescope and the fiberoptic laryngoscope may provide more adequate visualization. Direct laryngoscopy and biopsy allow definitive diagnosis.
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Abscess of the lingual tonsil is an unusual entity that may cause diagnostic difficulty. The pathophysiologic mechanism of formation was correlated with normal posterior tongue histology in a case of lingual tonsillar abscess.
A case of an extrapulmonary oat cell carcinoma arising in the larynx of a 45-year-old male is described. Ultrastructural study demonstrated numerous neurosecretory granules in the tumor cells identical to those described in oat cell carcinomas of the lung. Primary oat cell carcinomas of the larynx are highly malignant neoplasms. Of six previously reported acceptable cases of this rare entity, with adequate followup, all but one has died of tumor within 14 months of diagnosis. The present patient is alive without evidence of tumor 15 months following diagnosis. Aggressive therapy consisting of a combination of surgery, radiation therapy and systemic chemotherapy was utilized in this case. The use of such aggressive combination therapy appears indicated in cases of primary oat cell carcinoma of the larynx if improved survival is to be achieved.
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Patients with carcinoma of the head and neck undergoing major ablative and reconstructive procedures following periods of prolonged debilitation, chemotherapy, and/or radiation therapy have been identified as having a high risk for postoperative wound complication, most often infection. Does postoperative wound infection arise de novo, does infection result from failure of prophylactic antibiotic coverage, or is it the result of anastomatic salivary leak? To investigate the incidence of unrecognized salivary leak into the neck, 24 patients underwent salivary radioisotope studies using technetium 99m sodium pertechnetate from three to six days postoperatively. The isotope was administered early in the morning with drainage bags empty. Patients and the collection system were scanned for activity between four and six hours later. Nine patients had postoperative evidence of salivary secretion radioactivity in their drainage system. All of these patients developed transient wound infections or fistulas. The remaining 15 had no uptake in their collection systems and no wound complications. We suggest that the preliminary results from this noninvasive, simply administered study indicate that the infected surgical neck wound may be secondary to unrecognized postoperative salivary contamination. This technique can be used to provide early identification of potential wound infection. Alternatively, information generated by this kind of study may be valuable in predicting patients with the highest risk for postoperative infection, thereby offering guidelines for the use of perioperative antibiotic prophylaxis.
It has been axiomatic among head and neck surgeons that open biopsy of cervical nodes will jeopardize patients having squamous cell carcinoma. The inappropriate biopsy of a squamous cell carcinoma metastatic to a cervical node will statistically double both the subsequent rates of local recurrence and distant metastasis. There is no reliable method to clearly distinguish a cervical node involved with squamous cell carcinoma from adenopathy of other sources. Because of this, all patients with cervical adenopathy are evaluated with the time honored approach of careful visualization and palpation of the upper aerodigestive tract prior to open biopsy. The extent of this evaluation is often judgmental. A review of patients with cervical adenopathy of unknown origin and who had a tissue diagnosis, shows that node location is the most helpful parameter for predicting eventual histopathology. Nodes in the jugulodigastric, digestive, and anterior cervical regions have a probability of 19% and 12%, respectively, of being a squamous cell carcinoma. Multiple adenopathies in the supraclavicular and posterior cervical areas are frequently malignant (84% and 61% respectively), however, these are usually either lymphoma or infraclavicular metastasis.
Laryngeal carcinoma usually occurs in men between the ages of 50 and 70. In general, epithelial malignancies other than those involving the skin are rare in the young adult. Those squamous carcinomas arising in the lip, tongue, and tonsil appear to have a poorer prognosis than in the older adult. This study is a review of the medical records of 33 patients under the age of 35 years with squamous cell carcinoma of the larynx. The follow-up of the entire series was at least 24 months with an overall survival rate of 81%. These results contrast to five-year survival rates of 79%, 45%, and 14% of the lip, tongue, and tonsil, respectively, in patients from a similar age group.