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Biomedical subjects

S M Sobol

Publications and source records attributed to S M Sobol.

44 records · Page 3Linked to original sources
PubMedDate not supplied

Anterior neopharyngeal diverticulum following laryngectomy.

While less common than stricture, recurrent neoplasm, and neuromuscular dysfunction, neopharyngeal diverticulum must be considered in the differential diagnosis of postlaryngectomy dysphagia. Symptoms of difficulty clearing the neopharynx during and after a swallow, with regurgitation of undigested material, should alert the clinician to this possibility. Experience with 3 postlaryngectomy patients with anterior neopharyngeal divericulae serve as the springboard for discussion of the clinical spectrum, radiologic features, contributory pathophysiologic factors, and therapeutic options concerning this condition. Surgical indications, approaches, and potential hazards are reviewed.

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PubMedDate not supplied

Management of inadvertent injury to the carotid artery during head and neck surgery.

Rare, inadvertent injury to the carotid artery during head and neck surgery may result in disastrous neurologic sequelae or even death. Several cases are presented and used as the stimulus for an analytical discussion of the pathogenesis and management of cerebrovascular complications following head and neck surgery. The major pathogenetic mechanisms are identified as (1) microembolism from an ulcerated plaque; (2) intravascular thrombus with occlusion; (3) unintentional ligation, laceration, or transection; (4) ligation of a dominant external carotid; and (5) transient reduction in cerebrovascular perfusion pressure. Methods for identifying and evaluating the patient at risk for developing cerebrovascular complications are discussed and recommendations are made. The central question in the management of inadvertent arterial injury concerns whether to ligate the vessel or to restore blood flow. The controversies surrounding this issue are discussed in perspective through an analysis of current physiological concepts and of the collective clinical experiences of head and neck, vascular, and neurological surgeons handling extracranial cerebrovascular occlusive disease, penetrating injuries to the carotid artery, and tumor-related carotid catastrophes. Several factors are considered critical in determining appropriate management of any individual case; these include (1) whether recognition of the injury occurs intraoperatively or postoperatively; (2) the presence and severity of neurological deficits; (3) time from the injury to its recognition; (4) a quantitative assessment of collateral circulation; (5) a history of wound contamination or radiation therapy; (6) overall prognosis. These and other considerations are organized into a working framework through which the otolaryngologist and head and neck surgeon can better understand and manage the problem of inadvertent injury to the carotid artery.

Adult↗
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Streptococcal endocarditis temporally related to transesophageal echocardiography.

A case of streptococcal sanguis endocarditis temporally related to a transesophageal echocardiogram is reported; and the literature on the incidence of bacteremia occurring during transesophageal echocardiography is reviewed. On the basis of this case and review of the literature, a reevaluation of the current guidelines for endocarditis prophylaxis during this procedure is recommended.

Echocardiography↗
PubMedDate not supplied

Enteral and parenteral nutrition in patients with head and neck cancer.

Head and neck cancer patients present with special problems in nutritional homoeostasis because of local phayngeal discomfort and obstruction and difficulty with deglutition due to either the neoplasm or the surgical alterations in the upper aerodigestive tract. Pretreatment malnutrition and vitamin deficiency are only compounded by the nutritional stress imposed by radiation and surgery. Reduced wound complications occur if the patients are nutritionally replenished before treatment. While nasogastric feedings will suffice in many patients, rapid nutritional restoration by this method is limited, and positive nitrogen balance may be difficult to achieve in the severely malnourished patient. Intravenous hyperalimentation offers a rapid and efficacious alternative in selected cases. The case histories of two patients are presented to illustrate these concepts.

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Intramembranous and mesotympanic cholesteatomas associated with an intact tympanic membrane in children.

A series of 15 intramembranous (IMTC) and mesotympanic (MTC) cholesteatomas associated with intact tympanic membranes in children is presented. Clinical observations, audiometric and radiographic data, and surgical findings are correlated. A history of recurrent otitis media was obtained in 85% (13/15) of the cases, differentiating them from the usual congenital cholesteatomas. The possibility that many of these are indeed "acquired" lesions is emphasized. Hypothetical pathogenetic mechanisms are discussed. The basal cell papillary proliferation theory is considered the most attractive explanation of the development of both IMTCs and MTCs. The need for careful, prolonged, follow-up otoscopic examination of children with recurrent otitis media is stressed, if more of these lesions are to be recognized early.

Audiometry↗
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Epiglottic laryngoplasty for complicated laryngeal stenosis.

The technique of epiglottic laryngoplasty, previously described for reconstruction following near total laryngectomy for glottic carcinoma, has been used in selected patients with severe glottic and subglottic stenosis. Our experience in four patients suggests that it is useful for 1) laryngeal stenosis in which there is loss or collapse of the external cartilaginous framework, and 2) laryngeal stenosis which is refractory to the usual forms of therapy. The technique is a technically simple, one-stage procedure which provides its own endolaryngeal mucosal lining, as well as autogenous cartilaginous support. It has been successful in restoring adequate airway and preserving voice without interfering with deglutition or laryngeal competence in most patients.

Adult↗
PubMedDate not supplied

Anterolateral extrapharyngeal approach for cervical osteophyte-induced dysphagia. Literature review.

While it is estimated that hypertrophic cervical osteophytes occur in up to 20% to 30% of the population, they are only rarely associated with dysphagia. Pathophysiologically, dysphagia may occur secondary to 1) mechanical compression with partial obstruction, or 2) periesophageal inflammation caused by pharyngoesophageal motion over the osteophytes. A careful history, indirect laryngoscopy, cineesophagography, and lateral cervical spine films establish the diagnosis in most patients. While routine rigid endoscopy is potentially hazardous in view of the recognized risk of inadvertent pharyngoesophageal perforation, it may be necessary in selected patients to rule out the presence of other more common causes of dysphagia. Conservative management consisting of sedation, antiinflammatory medication, and reassurance is often sufficient in patients with only mild to moderate and often transient symptoms. The value of surgical therapy for this disorder has been debated, but most agree that surgical excision is appropriate in selected patients whose symptoms are severe and progressive. In this report, two patients illustrate the dichotomy between and value of both conservative and surgical approaches. While both transoropharyngeal and transcervical extrapharyngeal surgical approaches have been used, a comprehensive review of the results of such procedures has not been reported. In this report a detailed description of the anterolateral extrapharyngeal approach for the excision of these osteophytes is given, and its value compared to other surgical techniques discussed.

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