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Biomedical subjects

S D Schaefer

Publications and source records attributed to S D Schaefer.

At least 73 records · Page 4Linked to original sources
PubMed1984

A surgical alternative to internal maxillary artery ligation for posterior epistaxis.

Posterior epistaxis is a disease of varying magnitude and is associated with considerable morbidity. Surgical management often consists of transantral ligation of the internal maxillary artery and its branches, with or without ligation of the ethmoidal arteries. Ten patients underwent an alternative surgical procedure in which the nasopharynx and posterior nasal cavity were indirectly examined for bleeding sites with a large laryngeal mirror. Nasal septal reconstruction with mobilization of the anterior cartilaginous septum from the maxillary crest allowed lateral displacement of the septum with excellent visualization of the lateral nasal walls. Hemorrhage was controlled by electrocoagulation of bleeding sites with a disposable, malleable suction electrocautery. No complications occurred in this group of 10 patients and no further epistaxis has been reported during a follow-up of 17 to 35 months.

Adolescent↗
PubMed1983

Cis-platinum induction chemotherapy in the multi-modality initial treatment of advanced stage IV carcinoma of the head and neck.

Twenty-eight previously untreated patients with unresectable and radical radiotherapy incurable advanced stage IV squamous cell carcinoma of the head and neck underwent cis-diamminedichloroplatinum (DDP) induction chemotherapy followed by radiation with 6500 rad to the primary and 5000 rad to the supraclavicular area given over six weeks. Of the 26 patients completing this regimen, none had a complete remission after DDP alone. Following radiation therapy, 39% of the patients had a total regression of all disease. This modality converted 16 patients to operable candidates. After surgery, 68% of the patients were in complete remission. Survival was significantly correlated (P less than or equal to 0.001) with complete disappearance of disease, and surgical intervention was additive to chemotherapy and radiation. Histopathologic staging demonstrated that clinical assessment of residual disease in the neck determined after chemotherapy and radiation of the neck was unreliable. Therefore, radical neck dissection appears indicated in lesions initially staged as N2 and N3 irrespective of the postradiation clinical status of the neck region. Finally, a serious limitation of improved survival duration was the occurrence of disseminated disease in patients whose primary and regional lesions were well controlled.

Carcinoma, Squamous Cell↗
PubMed1983

Sternohyoid myo-osseous flap for acquired subglottic stenosis in children.

Endotracheal intubation can occasionally result in acquired subglottic stenosis (ASGS) in infants and children. Twenty-one consecutive patients, ages 3 months to 13 years, with ASGS secondary to endotracheal intubation and severe enough to require tracheotomy, are reviewed. Of this population, eight cases of ASGS were refractory to endoscopic excision and dilatation. These eight patients, five of whom had complete stenosis, underwent subglottic reconstruction using a sternohyoid myo-osseus flap. Six of the eight patients had been successfully decannulated with no evidence of recurrent stenosis at the time of this report.

Adolescent↗
PubMed1983

Head and neck manifestations of gastroesophageal reflux.

Gastroesophageal reflux (GER) is a common condition with many manifestations which are of interest to the otolaryngologist. Factors predisposing to GER include anatomic abnormalities of the esophagus and pharynx, neurogenic disease and diet induced decreased lower esophageal sphincter pressure. Three interesting cases are reported, including subglottic stenosis which has not previously been thought to be a complication of GER. A literature review of otolaryngologic symptoms, the problems of diagnosis, and a suggested treatment plan are presented.

Adolescent↗
PubMed1983

Neuropathology of spasmodic dysphonia.

Spasmodic dysphonia is a devastating voice disorder of unknown etiology, with a variable clinical presentation and response to treatment. Three independent evaluations of brain stem function were performed on spasmodic dysphonic patients, and age and sex-matched controls. Statistically significant (p less than 0.01 approximately 0.05) differences were noted between these groups, and the findings were consistent with impairment of somatic and visceral brain stem pathways. A significant correlation (p less than 0.05) was found between the severity of tested central nervous system impairment and vocal tremor, number of associated neurologic signs and duration of illness. Possible etiologies (viral or traumatic), age, and sex, did not correlate with the severity of brain stem impairment. Clinical signs and the brain stem findings appeared to stabilize 3 to 5 years after onset of dysphonia. The investigation of other spasmodic cranial nerve disorders afforded insight into the etiology and therapy for spasmodic dysphonia. Drawing upon previous observations and the results of the brain stem tests, two models are proposed for neuronal processing in spasmodic dysphonia, and future strategies are discussed. The evidence cited in this research project are consistent with spasmodic dysphonia being one of several spasmodic brain stem disorders with variable presentation which are known by the cranial nerve nuclei or pathways of major clinical involvement.

Adult↗
PubMed1983

Selective application of CT in the management of laryngeal trauma.

The clinical course of five patients with varying degrees of laryngeal trauma are presented to illustrate the predictive value of computed tomography (CT) in the management of laryngeal trauma. Computed tomography visualizes well the laryngeal skeleton, soft tissues and airway in the injured larynx. Cost effectiveness of CT scanning is an important consideration, and the authors have chosen their case examples to restrict this examination to selected patients.

Accidents, Traffic↗
PubMed1982

Attaining functional esophageal speech.

From the records of the Veterans Administration Hospital and the American Cancer Society, 357 patients who had undergone laryngectomy had their conditions evaluated retrospectively to see if they had acquired alaryngeal speech. Despite the efforts of highly qualified speech pathologists and the favorable implications of previous reports, only 24.4% of the entire patient population achieved functional esophageal speech. The addition of other treatment modalities did not substantially affect the results. It is concluded that if obtaining esophageal speech is the primary goal in successful rehabilitation of the alaryngeal patient, then there is a profound need to reassess the previous directions in restoration of postlaryngectomy communication.

Adult↗
PubMed1982

Computed tomographic assessment of squamous cell carcinoma of oral and pharyngeal cavities.

Computed tomographic (CT) scans were prospectively obtained on 68 patients with previously untreated stages III and IV squamous cell carcinoma of the oral and pharyngeal cavity. We report herein the results of CT evaluation of primary disease arising in these sites, improvements in contrast-enhancement techniques, and CT assessment of the patient's condition after radiation or chemotherapy treatment.

Biopsy↗
PubMed1982

Inner ear histopathology in patients treated with cis-platinum.

Temporal bone histopathology was studied in five patients (aged 51-67) who received cis-diamminedichloroplatinum (DDP) chemotherapy for head and neck squamous cell carcinoma. In each case, sensorineural hearing loss occurred during the course of treatment and temporal bones were acquired 3-5 hours postmortem for anatomical study. Scanning electron microscopy revealed acute degenerative changes in cochlear hair cells that appeared to be the result of drug treatment. However, the presence of age-related degeneration made it difficult to unequivocally identify hair cell loss due solely to ototoxicity. In one patient, a decrement in vestibular function was observed during DDP treatment. Postmortem examination showed severe degeneration of the maculae and cristae which could be correlated with the absence of caloric response seen after chemotherapy.

Aged↗
PubMed1981

Cis-platinum vestibular toxicity.

Cis-diamminedichloroplatinum has been proven to be an effective neoplastic agent. Nephrotoxicity and ototoxicity are two prominent side effects of this drug. Investigation of ototoxicity has been limited to auditory function. This report details the first known case of vestibular toxicity following platinum therapy. In addition, a prospective vestibular testing program is reported.

Aged↗
PubMed1981

The management of transpharyngeal gunshot wounds to the cervical spine.

Management to prevent cervical osteomyelitis in transpharyngeal gunshot wounds which involve the cervical spine consists of triple endoscopy to identify the pharyngeal injury, anteroposterior and lateral view roentgenograms to localize the injury to the cervical spine, administration of penicillin and gentamicin intravenously, exploration of the neck and repair of pharyngeal wounds, debridement of the cervical spine and external immobilization of the spine for six weeks. This management protocol has proved successful in five patients.

Cervical Vertebrae↗
PubMed1980

Forehead and scalp reconstruction after wide-field resection of skin carcinoma.

Full-thickness defects of the forehead and scalp after excision of extensive skin carcinomas are a reconstructive challenge. With loss of periosteum, bone can be covered by skin grafts after altering the outer table of the skull or by flaps. Axial subcutaneous fascial flaps and crane tissue methods are alternative techniques; clinical experience has elucidated their indications, benefits, and limitations.

Basal Cell Carcinoma↗
PubMed1980

Laryngeal paragangliomas: evaluation and treatment.

Paragangliomas are uncommon laryngeal tumors. A comprehensive review of the world literature disclosed the use of a variety of terms to designate the same disease as a result of the historical uncertainty of its origin. Important features of these neoplasms not previously reported include the high mortality rate in patients presenting with laryngeal pain and the need for longer follow-up periods to judge biological aggressiveness. An additional patient is presented to illustrate the diagnostic and therapeutic challenges inherent in the management of laryngeal paragangliomas. Radiotherapy has not been found to be beneficial, and surgery remains the treatment of choice for patients with laryngeal paragangliomas.

Female↗
PubMed1980

Malignant fibrous histiocytoma of the frontal sinus.

The first case of malignant fibrous histiocytoma of the frontal sinus is reported. The aggressive nature of the tumor despite its relatively benign histologic pattern and value of electron microscopy are emphasized. Ultrastructural examination reveals a progression of several principal cell types, lending support to the multi-potent mesenchymal cell origin of these malignancies. These cells may have arisen from the supporting stroma of the ectodermally derived respiratory epithelium of the paranasal sinuses. Wide local excision is currently the primary mode of therapy. The value of radiation therapy or chemotherapy in this tumor in unproven.

Adult↗